I

107TH CONGRESS

1ST SESSION H. R. 1662

To improve the implementation of the Federal responsibility for the care

and education of Indian people by improving the services and facilities

of Federal Indian health programs and encouraging maximum participation of Indians in such programs, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

MAY 1, 2001

Mr. GEORGE MILLER of California (for himself, Mr. PALLONE, Mr. RAHALL,

Mr. KILDEE, Mr. HAYWORTH, Mr. WAXMAN, Mr. OBERSTAR, Mr. FILNER, Mr. BONIOR, Mrs. MINK of Hawaii, Mr. CARSON of Oklahoma, Mr.

LARSEN of Washington, Mr. MCDERMOTT, Ms. LEE, Ms. MILLENDERMCDONALD, Mr. BACA, Mr. ABERCROMBIE, Mrs. BONO, Mr. KIND, Mr.

FRANK, Mr. STUPAK, Mr. FROST, Mr. KENNEDY of Rhode Island, Mr.

UDALL of New Mexico, Mr. INSLEE, Mr. NETHERCUTT, Mr. BALDACCI,

Mr. FALEOMAVAEGA, Mr. BLUMENAUER, Ms. LOFGREN, Mr. LANTOS,

Mr. JEFFERSON, Mr. CANNON, Mr. CONDIT, Mr. TOWNS, Mr.

BLAGOJEVICH, Mr. TAYLOR of North Carolina, Mr. WATKINS, Mr.

ALLEN, Mrs. NAPOLITANO, Mr. HINCHEY, Ms. MCCOLLUM, Mr. UDALL

of Colorado, Mr. LUCAS of Oklahoma, Mr. CAMP, Ms. KILPATRICK, and

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

Commerce, Ways and Means, and Government Reform, for a period to

be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee

concerned

A BILL

To improve the implementation of the Federal responsibility

for the care and education of Indian people by improving

the services and facilities of Federal Indian health pro-
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grams and encouraging maximum participation of Indians in such programs, and for other purposes.

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

3 SECTION 1. SHORT TITLE.

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

5 Improvement Act Amendments of 2001’’.

6 SEC. 2. INDIAN HEALTH CARE IMPROVEMENT ACT AMEND7 ED.

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

9 1601 note) is amended to read as follows:

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

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

12 ‘Indian Health Care Improvement Act’.

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

14 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.
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‘‘Sec. 114. Advanced training and research.

‘‘Sec. 115. Quentin B. Burdick American Indians into Nursing Program.

‘‘Sec. 116. Tribal cultural orientation.

‘‘Sec. 117. INMED program.

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

‘‘Sec. 119. Retention bonus.

‘‘Sec. 120. Nursing residency program.

‘‘Sec. 121. Community health aide program for Alaska.

‘‘Sec. 122. Tribal health program administration.

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

‘‘Sec. 124. Treatment of scholarships for certain purposes.

‘‘Sec. 125. National health service corps.

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

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

‘‘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.

‘‘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 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. Expenditure of nonservice funds for renovation.

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

ambulatory care facilities.

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

‘‘Sec. 307. Land transfer.

‘‘Sec. 308. Leases.
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‘‘Sec. 309. Loans, loan guarantees, and loan repayment.

‘‘Sec. 310. Tribal leasing.

‘‘Sec. 311. Indian health service/tribal facilities joint venture program.

‘‘Sec. 312. Location of facilities.

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

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

‘‘Sec. 315. Applicability of buy American requirement.

‘‘Sec. 316. Other funding for facilities.

‘‘Sec. 317. 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,

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 veterans affairs, and other Federal agency health facilities and services sharing.

‘‘Sec. 410. Payor of last resort.

‘‘Sec. 411. Payment or reimbursement for services.

‘‘Sec. 412. Tuba city demonstration project.

‘‘Sec. 413. Access to Federal insurance.

‘‘Sec. 414. Consultation and rulemaking.

‘‘Sec. 415. Limitation on secretary’s waiver authority.

‘‘Sec. 416. Children’s health insurance program funds.

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

‘‘Sec. 418. Safe harbor.

‘‘Sec. 419. Cost sharing.

‘‘Sec. 420. Managed care.

‘‘Sec. 421. Navajo nation medicaid agency.

‘‘Sec. 422. Indian advisory committees.

‘‘Sec. 423. Limitation on charges.

‘‘Sec. 424. 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.
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‘‘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. Memoranda of agreement with the department of the interior.

‘‘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.

‘‘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 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. Severability provisions.

‘‘Sec. 815. Establishment of national bipartisan commission on Indian health

care entitlement.
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‘‘Sec. 816. Appropriations; availability.

‘‘Sec. 817. Authorization of appropriations.

1 ‘‘SEC. 2. FINDINGS.

2 ‘‘The Congress finds the following:

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, as

8 reflected in the Constitution, treaties, Federal stat9 utes and the course of dealings of the United States

10 with Indian tribes and the United States resulting

11 Government to Government and trust responsibility

12 and obligations to the American Indian people.

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

14 and colonization through the 20th century policies

15 and practices of the United States caused and/or

16 contributed to the severe health conditions of Indi17 ans.

18 ‘‘(3) Indian tribes, have, through the cession of

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

20 in exchange for promises, often reflected in treaties,

21 of health care secured a de facto contract which en22 titles Indians to health care in perpetuity, based on

23 the moral legal and historic obligation of the United

24 States.
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1 ‘‘(4) The population growth of the Indian peo2 ple that began in the later part of the 20th century

3 increases the need for Federal health care services.

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

5 is to provide the quantity and quality of health serv6 ices which will permit the health status of Indians

7 regardless of where they live to be raised to the

8 highest possible level that is no less than that of the

9 general population and to provide for the maximum

10 participation of Indian tribes, tribal organizations,

11 and urban Indian organizations in the planning, de12 livery and management of those services.

13 ‘‘(6) Federal health services to Indians have re14 sulted in a reduction in the prevalence and incidence

15 of illnesses among, and unnecessary and premature

16 deaths of, Indians.

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

18 needs of the American Indian people remain alarm19 ingly severe, and even continue to decline, and the

20 health status of Indians is far below the health sta21 tus of the general population of the United States.

22 ‘‘(8) The disparity to be addressed is formi23 dable. In death rates, for example, Indian people

24 suffer a death rate for diabetes mellitus that is 249

25 percent higher than the all races rate for the United
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1 States, a pneumonia and influenza death rate 71

2 percent greater, a tuberculosis death rate that is

3 533 percent greater, and a death rate from alco4 holism that is 627 percent higher than that of the

5 all races United States rate.

6 ‘‘SEC. 3. DECLARATION OF HEALTH OBJECTIVES.

7 ‘‘(a) The Congress hereby declares that it is the pol8 icy of this Nation, in fulfillment of its special trust respon9 sibilities and legal obligations to the American Indian

10 people—

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

12 for Indians and to provide all resources necessary to

13 effect that policy;

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

15 year 2011 to at least the levels set forth in the goals

16 contained within the Healthy People 2000 or suc17 cessor standards;

18 ‘‘(3) to the greatest extent possible, to allow In19 dian people to set their own health care priorities

20 and establish goals that reflect their unmet needs;

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

22 the health professions and allied and associated

23 health professions awarded to Indians so that the

24 proportion of Indian health professionals in each ge-
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1 ographic service area is raised to at least the level

2 of that of the general population;

3 ‘‘(5) to require meaningful consultation with In4 dian tribes, Indian organizations, and urban Indian

5 organizations to implement this Act and the national

6 policy of Indian self-determination; and

7 ‘‘(6) to provide for health care programs and

8 facilities operated by Tribes and tribal organizations

9 in amounts that are not less funds than are provided

10 to programs and facilities operated directly by the

11 Service.

12 ‘‘SEC. 4. DEFINITIONS.

13 ‘‘For purposes of this Act:

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

15 a community college or other appropriate entity on

16 or near a Reservation and accredited by a national

17 or regional organization with accrediting authority.

18 ‘‘(2) The term ‘Area Office’ mean an adminis19 trative entity including a program office, within the

20 Indian Health Service through which services and

21 funds are provided to the service units within a de22 fined geographic area.

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

24 health services provided at the expense of the Serv25 ice, Indian tribe or tribal organization from public or
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1 private medical providers or hospitals, other than

2 those funded under the Indian Self-Determination

3 and Education Assistance Act.

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

6 Human Services.

7 ‘‘(5) The term ‘Director’ means the Director of

8 the Indian Health Service.

9 ‘‘(6) The term ‘disease prevention’ is the reduc10 tion, limitation, and prevention of disease and its

11 complications and reduction in the consequences of

12 such diseases including, but not limited to—

13 ‘‘(A) controlling—

14 ‘‘(i) development of diabetes;

15 ‘‘(ii) high blood pressure;

16 ‘‘(iii) infectious agents;

17 ‘‘(iv) injuries;

18 ‘‘(v) occupational hazards and disabil19 ities;

20 ‘‘(vi) sexually transmittable diseases;

21 and

22 ‘‘(vii) toxic agents; and

23 ‘‘(B) providing—

24 ‘‘(i) fluoridation of water; and

25 ‘‘(ii) immunizations.
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1 ‘‘(7) The term ‘fund’ or ‘funding’ means the

2 transfer of moneys from the Department to any eli3 gible entity or individual under this Act by any legal

4 means, including funding agreements, contracts,

5 memoranda of understanding, Buy Indian Act con6 tracts or otherwise.

7 ‘‘(8) The term ‘funding agreement’ means any

8 agreement to transfer funds for the planning, con9 duct, and administration of programs, functions,

10 services and activities to Tribes and tribal organiza11 tions from the Secretary under the Indian Self-De12 termination and Education Assistance Act.

13 ‘‘(9) The term ‘health profession’ means

14 allopathic medicine, family medicine, internal medi15 cine, pediatrics, geriatric medicine, obstetrics and

16 gynecology, podiatric medicine, nursing, public

17 health nursing, dentistry, psychiatry, osteopathy, op18 tometry, pharmacy, psychology, public health, social

19 work, marriage and family therapy, chiropractic

20 medicine, environmental health and engineering, and

21 allied health professions, or any other health profes22 sion.

23 ‘‘(10) The ‘health promotion’ means fostering

24 social, economic, environmental, and personal factors

25 conducive to health, including raising people’s
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1 awareness about health matters and enabling them

2 to cope with health problems by increasing their

3 knowledge and providing them with valid informa4 tion; encouraging adequate and appropriate diet, ex5 ercise, and enough sleep; promoting education and

6 work in conformity with physical and mental capac7 ity; making available suitable housing, safe water,

8 and sanitary facilities; improving the physical, eco9 nomic, cultural, psychological, and social environ10 ment; and promoting adequate opportunity for spir11 itual, religious, and traditional practices; and ade12 quate and appropriate programs including, but not

13 limited to—

14 ‘‘(A) abuse prevention (mental and phys15 ical);

16 ‘‘(B) community health;

17 ‘‘(C) community safety;

18 ‘‘(D) consumer health education;

19 ‘‘(E) diet and nutrition;

20 ‘‘(F) disease prevention (communicable,

21 immunizations, HIV/AIDS);

22 ‘‘(G) environmental health;

23 ‘‘(H) exercise and physical fitness;

24 ‘‘(I) fetal alcohol disorders;

25 ‘‘(J) first aid and CPR education;
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1 ‘‘(K) human growth and development;

2 ‘‘(L) injury prevention and personal safety;

3 ‘‘(M) mental health (emotional, self-worth);

4 ‘‘(N) personal health and wellness prac5 tices;

6 ‘‘(O) personal capacity building;

7 ‘‘(P) prenatal, pregnancy, and infant care;

8 ‘‘(Q) psychological well-being;

9 ‘‘(R) reproductive health (family planning);

10 ‘‘(S) safe and adequate water;

11 ‘‘(T) safe housing;

12 ‘‘(U) safe work environments;

13 ‘‘(V) stress control;

14 ‘‘(W) substance abuse;

15 ‘‘(X) sanitary facilities;

16 ‘‘(Y) tobacco use cessation and reduction;

17 ‘‘(Z) violence prevention; and

18 ‘‘(AA) such other activities identified by

19 the Indian Health Service, or an Indian tribe or

20 tribal organization, to promote achievement of

21 any of the objectives described in section 3(b).

22 ‘‘(11) The term ‘Indians’ or ‘Indian’ shall have

23 the same meaning as provided in the Indian Self-De24 termination and Education Assistance Act.
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1 ‘‘(12) The term ‘Indian health program’ means

2 any health program or facility funded, in whole or

3 part, by the Service for the benefit of Indians and

4 administered—

5 ‘‘(i) directly by the Service;

6 ‘‘(ii) by any Indian tribe or tribal organiza7 tion pursuant to a funding agreement under—

8 ‘‘(I) the Indian Self-Determination

9 and Educational Assistance Act; or

10 ‘‘(II) section 23 of the Act of April

11 30, 1908 (25 U.S.C. 47), popularly known

12 as the ‘Buy-Indian Act’’; or

13 ‘‘(iii) by an urban Indian organization pur14 suant to title V of this Act.

15 ‘‘(13) The term ‘Indian tribe’ shall have the

16 same meaning as provided in the Indian Self-Deter17 mination and Education Assistance Act.

18 ‘‘(14) The term ‘reservation’ means any feder19 ally recognized Indian tribe’s reservation, Pueblo or

20 colony, including former reservations in Oklahoma,

21 Alaska Native Regions established pursuant to the

22 Alaska Native Claims Settlement Act, and Indian al23 lotments.
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1 ‘‘(15) The term ‘Secretary’, unless otherwise

2 designated, means the Secretary of Health and

3 Human Services.

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

5 Health Service.

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

8 ‘‘(18) The term ‘Service Unit’ means—

9 ‘‘(A) an administrative entity within the

10 Indian Health Service, or

11 ‘‘(B) a Tribe or tribal organization oper12 ating health care programs or facilities with

13 funds from the Service under the Indian Self14 Determination and Education Assistance Act,

15 through which services are provided, directly or

16 by contract, to the eligible Indian population

17 within a defined geographic area.

18 ‘‘(19) The term ‘traditional health care prac19 tices’ means the application by Native healing prac20 titioners of the Native healing sciences (as opposed

21 or in contradistinction to Western Healing Sciences)

22 which embodies the influences or forces of innate

23 tribal discovery, history, description, explanation and

24 knowledge of the states of wellness and illness and

25 which calls upon these influences or forces, including
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1 physical, mental, and spiritual forces in the pro2 motion, restoration, preservation and maintenance of

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

4 ‘‘(20) The term ‘tribal organization’ shall have

5 the same meaning as provided in the Indian Self-De6 termination and Education Assistance Act.

7 ‘‘(21) The term ‘tribally controlled community

8 college’ has the meaning given such term in section

9 2(a)(4) of the Tribally Controlled Community Col10 lege Assistance Act of 1978 (25 U.S.C. 1801(a)(4))

11 and the definition contained in the Indian Land

12 Grant Status Act (7 U.S.C. 301 note).

13 ‘‘(22) The term ‘urban center’ means any com14 munity which has a sufficient urban Indian popu15 lation with unmet health needs to warrant assistance

16 under title V, as determined by the Secretary.

17 ‘‘(23) The term ‘urban Indian’ means any indi18 vidual who resides in an urban center and who

19 meets one or more of the following criteria:

20 ‘‘(A) Irrespective of whether the individual

21 lives on or near a reservation, the individual is

22 a member of a Tribe, band, or other organized

23 group of Indians, including those Tribes, bands,

24 or groups terminated since 1940.
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1 ‘‘(B) The individual is an Eskimo or Aleut

2 or other Alaskan Native.

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

4 Secretary of the Interior to be an Indian for

5 any purpose.

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

7 Indian under regulations promulgated by the

8 Secretary.

9 ‘‘(24) The term ‘urban Indian organization’

10 means a nonprofit corporate body situated in an

11 urban center, governed by an urban Indian con12 trolled board of directors, and providing for the par13 ticipation of all interested Indian groups and individ14 uals, which body is capable of legally cooperating

15 with other public and private entities for the purpose

16 of performing the activities described in section

17 503(a).

18 ‘‘TITLE I—INDIAN HEALTH,

19 HUMAN RESOURCES, AND DE20 VELOPMENT

21 ‘‘SEC. 101. PURPOSE.

22 ‘‘The purpose of this title is to increase to the max23 imum feasible extent the number of Indians entering the

24 health professions and providing health services, and to

25 assure an optimum supply of health professionals to the
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1 Service, Indian tribes, tribal organizations, and urban In2 dian organizations involved in the provision of health serv3 ices to Indian people.

4 ‘‘SEC. 102. GENERAL REQUIREMENTS.

5 ‘‘(a) SERVICE AREA PRIORITIES.—(1) Unless other6 wise specified, the funding for each program authorized

7 by this title shall be allocated by service area by formula

8 developed in consultation with Indian tribes, tribal organi9 zations, and urban Indian organizations. Such formula

10 shall consider the human resource and development needs

11 in each service area.

12 ‘‘(2) Each Area Office shall undertake active and

13 continuing consultation with representatives of Indian

14 tribes, tribal organizations, and urban Indian organiza15 tions to prioritize the use of funds authorized and provided

16 under this title within the service area.

17 ‘‘(3) Unless otherwise prohibited, the Area Office is

18 authorized to reallocate the funds available to it pursuant

19 to this title among the programs authorized by this title,

20 excepted that scholarship and loan repayment funds may

21 not be used for administrative functions.

22 ‘‘(b) All individual recipients of scholarships, loans,

23 or other funding authorized by this title that exist on Sep24 tember 30, 1976 shall be excluded from operation of this

25 subsection through to the completion of the individual’s
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1 course of study supported by funds appropriated to carry

2 out this title.

3 ‘‘SEC. 103. HEALTH PROFESSIONS RECRUITMENT PROGRAM

4 FOR INDIANS.

5 ‘‘(a) Subject to the requirements of section 102, the

6 Secretary shall make funds available to public or nonprofit

7 private health entities or Indian tribes or tribal organiza8 tions to assist such entities in meeting the costs of—

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

10 education or training in the health professions and

11 encouraging and assisting them—

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

13 health professions; or

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

15 any such courses of study, to undertake such

16 postsecondary education or training as may be

17 required to qualify them for enrollment;

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

19 available to Indians enrolled in any course of study

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

21 training necessary to qualify them to enroll in any

22 such course of study; or

23 ‘‘(3) establishing other programs which the

24 Area Office determines will enhance and facilitate

25 the enrollment of Indians in, and the subsequent
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1 pursuit and completion by them of, courses of study

2 referred to in paragraph (1).

3 ‘‘(b)(1) Funds under this section shall require that

4 an application has been submitted to, and approved by,

5 the Secretary through the Area Office. Such application

6 shall be in such form, submitted in such manner, and con7 tain such information, as the Secretary shall by regulation

8 prescribe pursuant to this Act. The Area Office shall give

9 a preference to applications submitted by Indian tribes,

10 tribal organizations, or urban Indian organizations.

11 ‘‘(2) The amount of funds provided to entities author12 ized under this section shall be determined by the Area

13 Office. Payments pursuant to this section may be made

14 in advance or by way of reimbursement, and at such inter15 vals and on such conditions as provided for in regulations

16 issued pursuant to this Act. To the extent not otherwise

17 prohibited by law, funding commitments shall be for 3

18 years, as provided for in regulations published pursuant

19 to this Act.

20 ‘‘(c) For purposes of this section and sections 104

21 and 105, the term ‘Indian’ or ‘Indians’ shall, in addition

22 to the meaning contained in section 4, also mean any per23 son who—

24 ‘‘(1) irrespective of whether he or she lives on

25 or near a reservation, is a member of a Tribe, band,
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1 or other organized group of Indians, including those

2 Tribes, bands, or groups terminated since 1940;

3 ‘‘(2) is an Eskimo or Aleut or other Alaska Na4 tive;

5 ‘‘(3) is considered by the Secretary of the Inte6 rior to be an Indian for any purpose; or

7 ‘‘(4) is determined to be an Indian under regu8 lations promulgated by the Secretary.

9 ‘‘SEC. 104. HEALTH PROFESSIONS PREPARATORY SCHOL10 ARSHIP PROGRAM FOR INDIANS.

11 ‘‘(a) Subject to the requirements of section 102, the

12 Secretary shall provide scholarships to Indians who—

13 ‘‘(1) have successfully completed their high

14 school education or high school equivalency; and

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

18 ‘‘(b) Scholarships provided pursuant to this section

19 shall be for the following purposes:

20 ‘‘(1) Compensatory preprofessional education of

21 any recipient, such scholarship not to exceed 2 years

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

23 thereof, as determined by the Area Office pursuant

24 to regulations issued under this Act).
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1 ‘‘(2) Pregraduate education of any recipient

2 leading to a baccalaureate degree in an approved

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

4 health profession, such scholarship not to exceed 4

5 years. An extension of up to 2-years (or the part6 time equivalent thereof, as determined by the Area

7 Office pursuant to regulations issued pursuant to

8 this Act) may be approved.

9 ‘‘(c) Scholarships under this section—

10 ‘‘(1) may cover costs of tuition, books, trans11 portation, board, and other necessary related ex12 penses of a recipient while attending school;

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

14 the applicant’s scholastic achievement if such appli15 cant has been admitted to, or maintained good

16 standing at, an accredited institution; and

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

18 applicant’s eligibility for assistance or benefits under

19 any other Federal program.

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

21 ‘‘(a) In order to meet the need for health profes22 sionals serving Indians, Indian tribes, tribal organizations,

23 and urban Indian organizations, subject to the require24 ments of section 102. The administration of this section

25 shall be a responsibility of the Director and shall not be
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1 delegated in a funding agreement pursuant to the Indian

2 Self-Determination and Education Assistance Act. The

3 Secretary shall make scholarships to Indians who are en4 rolled full or part time in accredited schools and pursuing

5 courses of study in the health professions. Such scholar6 ships shall be designated Indian Health Scholarships and

7 shall be made in accordance with section 338A of the Pub8 lic Health Service Act (42 U.S.C. 254l), except as pro9 vided in subsection (b) of this section.

10 ‘‘(b)(1) An Indian shall be eligible for a scholarship

11 under subsection (a) in any year in which such individual

12 is enrolled full or part time in a course of study referred

13 to in subsection (a).

14 ‘‘(2)(A) The active duty service obligation under a

15 written contract with the Secretary under section 338A

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

17 an Indian has entered into under that section shall, if that

18 individual is a recipient of an Indian Health Scholarship,

19 be met in full-time practice on an equivalent year for year

20 obligation, by service—

21 ‘‘(i) in the Indian Health Service;

22 ‘‘(ii) in a program conducted under a funding

23 agreement entered into under the Indian Self-Deter24 mination and Education Assistance Act;
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1 ‘‘(iii) in a program assisted under title V of this

2 Act; or

3 ‘‘(iv) in the private practice of the applicable

4 profession if, as determined by the Secretary, in ac5 cordance with guidelines promulgated by the Sec6 retary, such practice is situated in a physician or

7 other health professional shortage area and address8 es the health care needs of a substantial number of

9 Indians.

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

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

12 receives a degree in medicine (including osteopathic or

13 allopathic medicine), dentistry, optometry, podiatry, or

14 pharmacy, the Secretary shall defer the active duty service

15 obligation of that individual under that contract, in order

16 that such individual may complete any internship, resi17 dency, or other advanced clinical training that is required

18 for the practice of that health profession, for an appro19 priate period (in years, as determined by the Secretary),

20 subject to the following conditions:

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

22 advanced clinical training shall be counted as satis23 fying any period of obligated service that is required

24 under this section.
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•HR 1662 IH

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

2 individual shall commence not later than 90 days

3 after the completion of that advanced clinical train4 ing (or by a date specified by the Secretary).

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

6 served in the health profession of that individual, or

7 in a field or specialty where a need is determined to

8 exist by the appropriate service area, in a manner

9 consistent with clauses (i) through (iv) of subpara10 graph (A).

11 ‘‘(C) All new recipients of Indian Health Scholarships

12 awarded after 2002 shall meet the active duty service obli13 gation within the service area from which the scholarship

14 was awarded. Priority shall be given to a program that

15 funded the recipient. Under special circumstances, a re16 cipient may be placed in a different service area by agree17 ment between Areas or programs.

18 ‘‘(D) Subject to subparagraph (C), the Area Office,

19 in making assignments of Indian Health Scholarship re20 cipients required to meet the active duty service obligation

21 described in subparagraph (A), shall give priority to as22 signing individuals to service in those programs specified

23 in subparagraph (A) that have a need for health profes24 sionals to provide health care services as a result of indi-
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•HR 1662 IH

1 viduals having breached contracts entered into under this

2 section.

3 ‘‘(3) In the case of an individual receiving a scholar4 ship under this section who is enrolled part time in an

5 approved course of study—

6 ‘‘(A) such scholarship shall be for a period of

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

8 years, as determined by the Area Office;

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

10 paragraph (2)(A) shall be equal to the greater of—

11 ‘‘(i) the part-time equivalent of one year

12 for each year for which the individual was pro13 vided a scholarship (as determined by the Area

14 Office); or

15 ‘‘(ii) 2 years; and

16 ‘‘(C) the amount of the monthly stipend speci17 fied in section 338A(g)(1)(B) of the Public Health

18 Service Act (42 U.S.C. 254l(g)(1)(B)) shall be re19 duced pro rata (as determined by the Secretary)

20 based on the number of hours such student is en21 rolled.

22 ‘‘(4)(A) An individual who has, on or after the date

23 of the enactment of this paragraph, entered into a written

24 contract with the Secretary under this section and who—
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1 ‘‘(i) fails to maintain an acceptable level of aca2 demic standing in the educational institution in

3 which he is enrolled (such level determined by the

4 educational institution under regulations of the Sec5 retary),

6 ‘‘(ii) is dismissed from such educational institu7 tion for disciplinary reasons,

8 ‘‘(iii) voluntarily terminates the training in such

9 an educational institution for which he is provided a

10 scholarship under such contract before the comple11 tion of such training, or

12 ‘‘(iv) fails to accept payment, or instructs the

13 educational institution in which he is enrolled not to

14 accept payment, in whole or in part, of a scholarship

15 under such contract, in lieu of any service obligation

16 arising under such contract, shall be liable to the

17 United States for the amount which has been paid

18 to him, or on his behalf, under the contract.

19 ‘‘(B) If for any reason not specified in subparagraph

20 (A) an individual breaches a written contract by failing

21 either to begin such individual’s service obligation under

22 this section or to complete such service obligation, the

23 United States shall be entitled to recover from the indi24 vidual an amount determined in accordance with the for-
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•HR 1662 IH

1 mula specified in subsection (l) of section 108 in the man2 ner provided for in such subsection.

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

4 an Indian Health Scholarship, any obligation of that indi5 vidual for service or payment that relates to that scholar6 ship shall be canceled.

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

8 total waiver or suspension of any obligation of service or

9 payment of a recipient of an Indian Health Scholarship

10 if the Secretary, in consultation with the Area Office, In11 dian tribes, tribal organizations, and urban Indian organi12 zations, determines that—

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

14 that obligation or make that payment;

15 ‘‘(ii) requiring that recipient to meet that obli16 gation or make that payment would result in ex17 treme hardship to the recipient; or

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

19 meet the obligation or make the payment would be

20 unconscionable.

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

22 any case of extreme hardship or for other good cause

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

24 right of the United States to recover funds made available

25 under this section.
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•HR 1662 IH

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

2 with respect to a recipient of an Indian Health Scholar3 ship, no obligation for payment may be released by a dis4 charge in bankruptcy under title 11, United States Code,

5 unless that discharge is granted after the expiration of the

6 5-year period beginning on the initial date on which that

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

8 that the nondischarge of the obligation would be uncon9 scionable.

10 ‘‘(c) FUNDING FOR TRIBES FOR SCHOLARSHIP PRO11 GRAMS.—(1)(A) Subject to section 102, the Secretary

12 shall make funds available to Indian tribes and tribal or13 ganizations for the purpose of assisting such tribes and

14 tribal organizations in educating Indians to serve as health

15 professionals in Indian communities.

16 ‘‘(B) Amounts available under subparagraph (A) for

17 any fiscal year shall not exceed 5 percent of the amounts

18 available for each fiscal year for Indian Health Scholar19 ships under this section.

20 ‘‘(C) An application for funds under subparagraph

21 (A) shall be in such form and contain such agreements,

22 assurances, and information as consistent with this sec23 tion.

24 ‘‘(2)(A) An Indian tribe or tribal organization receiv25 ing funds under paragraph (1) shall provide scholarships
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•HR 1662 IH

1 to Indians in accordance with the requirements of this

2 subsection.

3 ‘‘(B) With respect to costs of providing any scholar4 ship pursuant to subparagraph (A)—

5 ‘‘(i) 80 percent of the costs of the scholarship

6 shall be paid from the funds pursuant to subsection

7 (c)(1) provided to the Indian tribe or tribal organi8 zation; and

9 ‘‘(ii) 20 percent of such costs may be paid from

10 any other source of funds.

11 ‘‘(3) An Indian tribe or tribal organization shall pro12 vide scholarships under subsection (c) only to Indians en13 rolled or accepted for enrollment in a course of study (ap14 proved by the Secretary) in one of the health professions

15 contemplated by this Act.

16 ‘‘(4) In providing scholarships under paragraph (2),

17 the Secretary and the Indian tribe or tribal organization

18 shall enter into a written contract with each recipient of

19 such scholarship. Such contract shall—

20 ‘‘(A) obligate such recipient to provide service

21 in an Indian health program (as defined in section

22 109(a)(2)(A)), in the same service area where the

23 Indian tribe or tribal organization providing the

24 scholarship is located, for—
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•HR 1662 IH

1 ‘‘(i) a number of years for which the schol2 arship is provided (or the part-time equivalent

3 thereof, as determined by the Secretary), or for

4 a period of 2 years, whichever period is greater;

5 or

6 ‘‘(ii) such greater period of time as the re7 cipient and the Indian tribe or tribal organiza8 tion may agree;

9 ‘‘(B) provide that the amount of the

10 scholarship—

11 ‘‘(i) may only be expended for—

12 ‘‘(I) tuition expenses, other reasonable

13 educational expenses, and reasonable living

14 expenses incurred in attendance at the

15 educational institution; and

16 ‘‘(II) payment to the recipient of a

17 monthly stipend of not more than the

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

19 of the Public Health Service Act (42

20 U.S.C. 254m(g)(1)(B), such amount to be

21 reduced pro rata (as determined by the

22 Secretary) based on the number of hours

23 such student is enrolled; and may not ex24 ceed, for any year of attendance for which

25 the scholarship is provided, the total
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•HR 1662 IH

1 amount required for the year for the pur2 poses authorized in this clause; and

3 ‘‘(ii) may not exceed, for any year of at4 tendance for which the scholarship is provided,

5 the total amount required for the year for the

6 purposes authorized in clause (i);

7 ‘‘(C) require the recipient of such scholarship to

8 maintain an acceptable level of academic standing as

9 determined by the educational institution in accord10 ance with regulations issued pursuant to this Act;

11 and

12 ‘‘(D) require the recipient of such scholarship

13 to meet the educational and licensure requirements

14 appropriate to each health profession.

15 ‘‘(5)(A) An individual who has entered into a written

16 contract with the Secretary and an Indian tribe or tribal

17 organization under this paragraph and who—

18 ‘‘(i) fails to maintain an acceptable level of aca19 demic standing in the educational institution in

20 which he is enrolled (such level determined by the

21 educational institution under regulations of the Sec22 retary);

23 ‘‘(ii) is dismissed from such educational institu24 tion for disciplinary reasons;
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•HR 1662 IH

1 ‘‘(iii) voluntarily terminates the training in such

2 an educational institution for which he or she is pro3 vided a scholarship under such contract before the

4 completion of such training; or

5 ‘‘(iv) fails to accept payment, or instructs the

6 educational institution in which he or she is enrolled

7 not to accept payment, in whole or in part, of a

8 scholarship under such contract, in lieu of any serv9 ice obligation arising under such contract,

10 shall be liable to the United States for the Federal share

11 of the amount which has been paid to him or her, or on

12 his or her behalf, under the contract.

13 ‘‘(B) If for any reason not specified in subparagraph

14 (A), an individual breaches his or her written contract by

15 failing to either begin such individual’s service obligation

16 required under such contract or to complete such service

17 obligation, the United States shall be entitled to recover

18 from the individual an amount determined in accordance

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

20 in the manner provided for in such subsection.

21 ‘‘(C) The Secretary may carry out this subsection on

22 the basis of information received from Indian tribes or

23 tribal organizations involved, or on the basis of informa24 tion collected through such other means as the Secretary

25 deems appropriate.
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1 ‘‘(6) The recipient of a scholarship under paragraph

2 (1) shall agree, in providing health care pursuant to the

3 requirements herein—

4 ‘‘(A) not to discriminate against an individual

5 seeking care on the basis of the ability of the indi6 vidual to pay for such care or on the basis that pay7 ment for such care will be made pursuant to the

8 program established in title XVIII of the Social Se9 curity Act or pursuant to the programs established

10 in title XIX of such Act; and

11 ‘‘(B) to accept assignment under section

12 1842(b)(3)(B)(ii) of the Social Security Act for all

13 services for which payment may be made under part

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

15 appropriate agreement with the State agency that

16 administers the State plan for medical assistance

17 under title XIX of such Act to provide service to in18 dividuals entitled to medical assistance under the

19 plan.

20 ‘‘(7) The Secretary shall make payments under this

21 paragraph to an Indian tribe or tribal organization for any

22 fiscal year subsequent to the first fiscal year of such pay23 ments unless the Secretary determines that, for the imme24 diately preceding fiscal year, the Indian tribe or tribal or-
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1 ganization has not complied with the requirements of this

2 subsection.

3 ‘‘SEC. 106. AMERICAN INDIANS INTO PSYCHOLOGY PRO4 GRAM.

5 ‘‘(a) Notwithstanding section 102, the Secretary shall

6 provide funding grants to at least 3 colleges and univer7 sities for the purpose of developing and maintaining Amer8 ican Indian psychology career recruitment programs as a

9 means of encouraging Indians to enter the mental health

10 field. These programs shall be located at various locations

11 throughout the country to maximize their availability to

12 Indian students and new programs shall be established in

13 different locations from time to time.

14 ‘‘(b) The Secretary shall provide one of the grants

15 authorized under subsection (a) to develop and maintain

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

17 as the ‘Quentin N. Burdick American Indians Into Psy18 chology Program’. Such program shall, to the maximum

19 extent feasible, coordinate with the Quentin N. Burdick

20 Indian Health Programs authorized under section 117(b),

21 the Quentin N. Burdick American Indians Into Nursing

22 Program authorized under section 115(e), and existing

23 university research and communications networks.
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1 ‘‘(c)(1) The Secretary shall issue regulations pursu2 ant to this Act for the competitive awarding of funds pro3 vided under this section.

4 ‘‘(2) Applicants under this section shall agree to pro5 vide a program which, at a minimum—

6 ‘‘(A) provides outreach and recruitment for

7 health professions to Indian communities including

8 elementary, secondary, and accredited and accessible

9 community colleges that will be served by the pro10 gram;

11 ‘‘(B) incorporates a program advisory board

12 comprised of representatives from the tribes and

13 communities that will be served by the program;

14 ‘‘(C) provides stipends to undergraduate and

15 graduate students to pursue a career in psychology;

16 ‘‘(D) develops affiliation agreements with tribal

17 community colleges, the Service, university affiliated

18 programs, and other appropriate accredited and ac19 cessible entities to enhance the education of Indian

20 students;

21 ‘‘(E) to the maximum extent feasible, uses ex22 isting university tutoring, counseling, and student

23 support services; and

24 ‘‘(F) to the maximum extent feasible, employs

25 qualified Indians in the program.
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1 ‘‘(d) The active duty service obligation prescribed

2 under section 338C of the Public Health Service Act (42

3 U.S.C. 254m) shall be met by each graduate who receives

4 a stipend described in subsection (c)(2)(D) that is funded

5 under this section. Such obligation shall be met by

6 service—

7 ‘‘(1) in the Indian Health Service;

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

9 agreement entered into under the Indian Self-Deter10 mination and Education Assistance Act;

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

12 Act; or

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

14 determined by the Secretary, in accordance with

15 guidelines promulgated by the Secretary, such prac16 tice is situated in a physician or other health profes17 sional shortage area and addresses the health care

18 needs of a substantial number of Indians.

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

20 ‘‘(a) Any individual who receives a scholarship pursu21 ant to section 105 shall be given preference for employ22 ment in the Service, or may be employed by a program

23 of an Indian tribe, tribal organization, or urban Indian

24 organization, or other agencies of the Department as

25 available, during any nonacademic period of the year. Pe-
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1 riods of employment pursuant to this subsection shall not

2 be counted in determining fulfillment of the service obliga3 tion incurred as a condition of the scholarship grant.

4 ‘‘(b) Any individual enrolled in a course of study in

5 the health professions may be employed by the Service or

6 by an Indian tribe, tribal organization, or urban Indian

7 organization during any nonacademic period of the year.

8 Any such employment shall not exceed 120 days during

9 any calendar year.

10 ‘‘(c) Any individual in a high school program author11 ized under section 103(a) may be employed by the Service

12 or by an Indian tribe, or tribal organization or urban In13 dian organization during any nonacademic period of the

14 year, not to exceed 120 days during a calendar year.

15 ‘‘(d) Any employment pursuant to this section shall

16 be made without regard to any competitive personnel sys17 tem or agency personnel limitation and to a position which

18 will enable the individual so employed to receive practical

19 experience in the health profession in which he or she is

20 engaged in study. Any individual so employed shall receive

21 payment for his or her services comparable to the salary

22 he or she would receive if he or she were employed in the

23 competitive system. Any individual so employed shall not

24 be counted against any employment ceiling affecting the

25 Service or the Department.
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1 ‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES.

2 ‘‘In order to encourage health professionals, including

3 for purposes of this section, community health representa4 tives and emergency medical technicians, to join or con5 tinue in the Service or program of an Indian tribe, tribal

6 organization, or urban Indian organization and to provide

7 their services in the rural and remote areas where a sig8 nificant portion of the Indian people reside, the Secretary,

9 subject to section 102, acting through the service area,

10 may provide allowances to health professionals employed

11 in the Service or program of an Indian tribe, tribal organi12 zation, or urban Indian organization to enable them for

13 a period of time each year prescribed by regulation of the

14 Secretary to take leave of their duty stations for profes15 sional consultation and refresher training courses.

16 ‘‘SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PRO17 GRAM.

18 ‘‘(a) Under the authority of the Act of November 2,

19 1921 (25 U.S.C. 13), popularly known as the Snyder Act,

20 the Secretary shall maintain a Community Health Rep21 resentative Program under which the Service, Indian

22 tribes, and tribal organizations—

23 ‘‘(1) provide for the training of Indians as com24 munity health representatives; and

25 ‘‘(2) use such community health representatives

26 in the provision of health care, health promotion,
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•HR 1662 IH

1 and disease prevention services to Indian commu2 nities.

3 ‘‘(b) The Secretary, acting through the Community

4 Health Representative Program of the Service, shall—

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

6 community health representatives to ensure that the

7 community health representatives provide quality

8 health care, health promotion, and disease preven9 tion services to the Indian communities served by

10 such Program;

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

12 and maintain a curriculum that—

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

14 health care with supervised practical experience

15 in the provision of health care; and

16 ‘‘(B) provides instruction and practical ex17 perience in health promotion and disease pre18 vention activities, with appropriate consider19 ation given to lifestyle factors that have an im20 pact on Indian health status, such as alco21 holism, family dysfunction, and poverty;

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

23 needs of community health representatives for con24 tinuing education in health care, health promotion,
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1 and disease prevention and develop programs that

2 meet the needs for continuing education;

3 ‘‘(4) maintain a system that provides close su4 pervision of Community Health Representatives;

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

6 of the Community Health Representatives is re7 viewed and evaluated; and

8 ‘‘(6) promote traditional health care practices

9 of the Indian tribes served consistent with the Serv10 ice standards for the provision of health care, health

11 promotion, and disease prevention.

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

13 PROGRAM.

14 ‘‘(a)(1) Subject to section 102, the Secretary shall es15 tablish a program to be known as the Indian Health Serv16 ice Loan Repayment Program (hereinafter referred to as

17 the ‘Loan Repayment Program’) in order to ensure an

18 adequate supply of trained health professionals necessary

19 to maintain accreditation of, and provide health care serv20 ices to Indians through, Indian health programs.

21 ‘‘(2) For the purposes of this section the term ‘State’

22 has the same meaning given such term in section 331(i)(4)

23 of the Public Health Service Act.

24 ‘‘(b) To be eligible to participate in the Loan Repay25 ment Program, an individual must—
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1 ‘‘(1)(A) be enrolled—

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

3 accredited institution, as determined by the

4 Secretary, within any State and be scheduled to

5 complete such course of study in the same year

6 such individual applies to participate in such

7 program; or

8 ‘‘(ii) in an approved graduate training pro9 gram in a health profession; or

10 ‘‘(B) have—

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

12 ‘‘(ii) a license to practice a health profes13 sion;

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

15 as a commissioned officer in the Regular or Reserve

16 Corps of the Public Health Service;

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

18 in the Regular or Reserve Corps of the Public

19 Health Service;

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

21 service employment in the Indian Health Service; or

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

23 without a service obligation; and

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

25 a contract described in subsection (f).
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1 ‘‘(c)(1) In disseminating application forms and con2 tract forms to individuals desiring to participate in the

3 Loan Repayment Program, the Secretary shall include

4 with such forms a fair summary of the rights and liabil5 ities of an individual whose application is approved (and

6 whose contract is accepted) by the Secretary, including in

7 the summary a clear explanation of the damages to which

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

9 case of the individual’s breach of contract. The Secretary

10 shall provide such individuals with sufficient information

11 regarding the advantages and disadvantages of service as

12 a commissioned officer in the Regular or Reserve Corps

13 of the Public Health Service or a civilian employee of the

14 Indian Health Service to enable the individual to make

15 a decision on an informed basis.

16 ‘‘(2) The application form, contract form, and all

17 other information furnished by the Secretary under this

18 section shall be written in a manner calculated to be un19 derstood by the average individual applying to participate

20 in the Loan Repayment Program.

21 ‘‘(3) The Secretary shall make such application

22 forms, contract forms, and other information available to

23 individuals desiring to participate in the Loan Repayment

24 Program on a date sufficiently early to ensure that such
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1 individuals have adequate time to carefully review and

2 evaluate such forms and information.

3 ‘‘(d)(1) Consistent with section 102 and subsection

4 (k), the Secretary shall annually—

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

6 health program for which there is a need or a va7 cancy; and

8 ‘‘(B) rank those positions in order of priority.

9 ‘‘(2) Consistent with the priority determined under

10 paragraph (1), the Secretary, in determining which appli11 cations under the Loan Repayment Program to approve

12 (and which contracts to accept), shall give priority to ap13 plications made by—

14 ‘‘(A) Indians; and

15 ‘‘(B) individuals recruited through the efforts of

16 an Indian tribe, tribal organization, or urban Indian

17 organization.

18 ‘‘(e)(1) An individual becomes a participant in the

19 Loan Repayment Program only upon the Secretary and

20 the individual entering into a written contract described

21 in subsection (f).

22 ‘‘(2) The Secretary shall provide written notice to an

23 individual within 21 days on—

24 ‘‘(A) the Secretary’s approving, under para25 graph (1), of the individual’s participation in the
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•HR 1662 IH

1 Loan Repayment Program, including extensions re2 sulting in an aggregate period of obligated service in

3 excess of 4 years; or

4 ‘‘(B) the Secretary’s disapproving an individ5 ual’s participation in such Program.

6 ‘‘(f) The written contract referred to in this section

7 between the Secretary and an individual shall contain—

8 ‘‘(1) an agreement under which—

9 ‘‘(A) subject to paragraph (3), the Sec10 retary agrees—

11 ‘‘(i) to pay loans on behalf of the indi12 vidual in accordance with the provisions of

13 this section; and

14 ‘‘(ii) to accept (subject to the avail15 ability of appropriated funds for carrying

16 out this section) the individual into the

17 Service or place the individual with a tribe,

18 tribal organization, or urban Indian orga19 nization as provided in subparagraph

20 (B)(iii); and

21 ‘‘(B) subject to paragraph (3), the indi22 vidual agrees—

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

24 of the individual;
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•HR 1662 IH

1 ‘‘(ii) in the case of an individual de2 scribed in subsection (b)(1)—

3 ‘‘(I) to maintain enrollment in a

4 course of study or training described

5 in subsection (b)(1)(A) until the indi6 vidual completes the course of study

7 or training, and

8 ‘‘(II) while enrolled in such

9 course of study or training, to main10 tain an acceptable level of academic

11 standing (as determined under regula12 tions of the Secretary by the edu13 cational institution offering such

14 course of study or training); and

15 ‘‘(iii) to serve for a time period (here16 inafter in this section referred to as the

17 ‘period of obligated service’) equal to 2

18 years or such longer period as the indi19 vidual may agree to serve in the full-time

20 clinical practice of such individual’s profes21 sion in an Indian health program to which

22 the individual may be assigned by the Sec23 retary;

24 ‘‘(2) a provision permitting the Secretary to ex25 tend for such longer additional periods, as the indi-
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1 vidual may agree to, the period of obligated service

2 agreed to by the individual under paragraph

3 (1)(B)(iii);

4 ‘‘(3) a provision that any financial obligation of

5 the United States arising out of a contract entered

6 into under this section and any obligation of the in7 dividual which is conditioned thereon is contingent

8 upon funds being appropriated for loan repayments

9 under this section;

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

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

12 individual’s breach of the contract; and

13 ‘‘(5) such other statements of the rights and li14 abilities of the Secretary and of the individual, not

15 inconsistent with this section.

16 ‘‘(g)(1) A loan repayment provided for an individual

17 under a written contract under the Loan Repayment Pro18 gram shall consist of payment, in accordance with para19 graph (2), on behalf of the individual of the principal, in20 terest, and related expenses on government and commer21 cial loans received by the individual regarding the under22 graduate or graduate education of the individual (or both),

23 which loans were made for—

24 ‘‘(A) tuition expenses;
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•HR 1662 IH

1 ‘‘(B) all other reasonable educational expenses,

2 including fees, books, and laboratory expenses, in3 curred by the individual; and

4 ‘‘(C) reasonable living expenses as determined

5 by the Secretary.

6 ‘‘(2)(A) For each year of obligated service that an

7 individual contracts to serve under subsection (f) the Sec8 retary may pay up to $35,000 or an amount equal to the

9 amount specified in section 338B(g)(2)(A) of the Public

10 Health Service Act, whichever is more, on behalf of the

11 individual for loans described in paragraph (1). In making

12 a determination of the amount to pay for a year of such

13 service by an individual, the Secretary shall consider the

14 extent to which each such determination—

15 ‘‘(i) affects the ability of the Secretary to maxi16 mize the number of contracts that can be provided

17 under the Loan Repayment Program from the

18 amounts appropriated for such contracts;

19 ‘‘(ii) provides an incentive to serve in Indian

20 health programs with the greatest shortages of

21 health professionals; and

22 ‘‘(iii) provides an incentive with respect to the

23 health professional involved remaining in an Indian

24 health program with such a health professional

25 shortage, and continuing to provide primary health
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•HR 1662 IH

1 services, after the completion of the period of obli2 gated service under the Loan Repayment Program.

3 ‘‘(B) Any arrangement made by the Secretary for the

4 making of loan repayments in accordance with this sub5 section shall provide that any repayments for a year of

6 obligated service shall be made no later than the end of

7 the fiscal year in which the individual completes such year

8 of service.

9 ‘‘(3) The Secretary may enter into an agreement with

10 the holder of any loan for which payments are made under

11 the Loan Repayment Program to establish a schedule for

12 the making of such payments.

13 ‘‘(h) Notwithstanding any other provision of law, in14 dividuals who have entered into written contracts with the

15 Secretary under this section, while undergoing academic

16 training, shall not be counted against any employment

17 ceiling affecting the Department.

18 ‘‘(i) The Secretary shall conduct recruiting programs

19 for the Loan Repayment Program and other Service man20 power programs of the Service at educational institutions

21 training health professionals or specialists identified in

22 subsection (a).

23 ‘‘(j) Section 214 of the Public Health Service Act (42

24 U.S.C. 215) shall not apply to individuals during their pe-
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1 riod of obligated service under the Loan Repayment Pro2 gram.

3 ‘‘(k) The Secretary, in assigning individuals to serve

4 in Indian health programs pursuant to contracts entered

5 into under this section, shall—

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

7 health programs administered by an Indian tribe or

8 tribal organization receive consideration on an equal

9 basis with programs that are administered directly

10 by the Service; and

11 ‘‘(2) give priority to assigning individuals to In12 dian health programs that have a need for health

13 professionals to provide health care services as a re14 sult of individuals having breached contracts entered

15 into under this section.

16 ‘‘(l)(1) An individual who has entered into a written

17 contract with the Secretary under this section and who—

18 (A) is enrolled in the final year of a course of

19 study and who—

20 ‘‘(i) fails to maintain an acceptable level of

21 academic standing in the educational institution

22 in which he is enrolled (such level determined

23 by the educational institution under regulations

24 of the Secretary);
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•HR 1662 IH

1 ‘‘(ii) voluntarily terminates such enroll2 ment; or

3 ‘‘(iii) is dismissed from such educational

4 institution before completion of such course of

5 study; or

6 ‘‘(B) is enrolled in a graduate training pro7 gram, fails to complete such training program, and

8 does not receive a waiver from the Secretary under

9 subsection (b)(1)(B)(ii),

10 shall be liable, in lieu of any service obligation arising

11 under such contract, to the United States for the amount

12 which has been paid on such individual’s behalf under the

13 contract.

14 ‘‘(2) If, for any reason not specified in paragraph (1),

15 an individual breaches his written contract under this sec16 tion by failing either to begin, or complete, such individ17 ual’s period of obligated service in accordance with sub18 section (f), the United States shall be entitled to recover

19 from such individual an amount to be determined in ac20 cordance with the following formula:

‘‘A=3Z(t-s/t)

21 in which—

22 ‘‘(A) ‘A’ is the amount the United States is en23 titled to recover;
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•HR 1662 IH

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

2 this section to, or on behalf of, the individual and

3 the interest on such amounts which would be pay4 able if, at the time the amounts were paid, they were

5 loans bearing interest at the maximum legal pre6 vailing rate, as determined by the Secretary of the

7 Treasury;

8 ‘‘(C) ‘t’ is the total number of months in the in9 dividual’s period of obligated service in accordance

10 with subsection (f); and

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

12 served by such individual in accordance with this

13 section.

14 Amounts not paid within such period shall be subject to

15 collection through deductions in medicare payments pur16 suant to section 1892 of the Social Security Act.

17 ‘‘(3)(A) Any amount of damages which the United

18 States is entitled to recover under this subsection shall be

19 paid to the United States within the 1-year period begin20 ning on the date of the breach or such longer period begin21 ning on such date as shall be specified by the Secretary.

22 ‘‘(B) If damages described in subparagraph (A) are

23 delinquent for 3 months, the Secretary shall, for the pur24 pose of recovering such damages—
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•HR 1662 IH

1 ‘‘(i) use collection agencies contracted with by

2 the Administrator of General Services; or

3 ‘‘(ii) enter into contracts for the recovery of

4 such damages with collection agencies selected by

5 the Secretary.

6 ‘‘(C) Each contract for recovering damages pursuant

7 to this subsection shall provide that the contractor will,

8 not less than once each 6 months, submit to the Secretary

9 a status report on the success of the contractor in col10 lecting such damages. Section 3718 of title 31, United

11 States Code, shall apply to any such contract to the extent

12 not inconsistent with this subsection.

13 ‘‘(m)(1) Any obligation of an individual under the

14 Loan Repayment Program for service or payment of dam15 ages shall be canceled upon the death of the individual.

16 ‘‘(2) The Secretary shall by regulation provide for the

17 partial or total waiver or suspension of any obligation of

18 service or payment by an individual under the Loan Re19 payment Program whenever compliance by the individual

20 is impossible or would involve extreme hardship to the in21 dividual and if enforcement of such obligation with respect

22 to any individual would be unconscionable.

23 ‘‘(3) The Secretary may waive, in whole or in part,

24 the rights of the United States to recover amounts under
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•HR 1662 IH

1 this section in any case of extreme hardship or other good

2 cause shown, as determined by the Secretary.

3 ‘‘(4) Any obligation of an individual under the Loan

4 Repayment Program for payment of damages may be re5 leased by a discharge in bankruptcy under title 11 of the

6 United States Code only if such discharge is granted after

7 the expiration of the 5-year period beginning on the first

8 date that payment of such damages is required, and only

9 if the bankruptcy court finds that nondischarge of the ob10 ligation would be unconscionable.

11 ‘‘(n) The Secretary shall submit to the President, for

12 inclusion in each report required to be submitted to the

13 Congress under section 801, a report concerning the pre14 vious fiscal year which sets forth by service area—

15 ‘‘(1) the health professional positions main16 tained by the Service or by tribal or Indian organi17 zations for which recruitment or retention is dif18 ficult;

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

20 applications filed with respect to each type of health

21 profession;

22 ‘‘(3) the number of contracts described in sub23 section (f) that are entered into with respect to each

24 health profession;
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•HR 1662 IH

1 ‘‘(4) the amount of loan payments made under

2 this section, in total and by health profession;

3 ‘‘(5) the number of scholarships that are pro4 vided under section 105 with respect to each health

5 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 or tribal organizations,

15 or urban Indian organization for which recruitment

16 or retention is difficult.

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

19 ‘‘(a) Notwithstanding section 102 of this title, there

20 is established in the Treasury of the United States a fund

21 to be known as the Indian Health Scholarship and Loan

22 Repayment Recovery Fund (hereafter in this section re23 ferred to as the ‘LRRF’). The LRRF shall consist of such

24 amounts as may be collected from individuals under sec25 tions 105(b)(4)(A) and (B) and 110(1) for breach of con-
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1 tract, such funds as may be appropriated to the LRRF,

2 and such interest earned on amounts in the LRRF, and

3 all amounts collected, appropriated, or earned relative to

4 the LRRF shall remain available until expended.

5 ‘‘(b)(1) Amounts in the LRRF may be expended by

6 the Secretary, subject to the provisions of section 102, to

7 make payments to the Service or to an Indian tribe or

8 tribal organization administering a health care program

9 pursuant to a funding agreement entered into under the

10 Indian Self-Determination and Education Assistance

11 Act—

12 ‘‘(A) to which a scholarship recipient under sec13 tion 105 or a loan repayment program participant

14 under section 110 has been assigned to meet the ob15 ligated service requirements pursuant to such sec16 tions; and

17 ‘‘(B) that has a need for a health professional

18 to provide health care services as a result of such re19 cipient or participant having breached the contract

20 entered into under section 105 or section 110.

21 ‘‘(2) An Indian tribe or tribal organization receiving

22 payments pursuant to paragraph (1) may expend the pay23 ments to provide scholarships or recruit and employ, di24 rectly or by contract, health professionals to provide health

25 care services.
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1 ‘‘(c)(1) The Secretary of the Treasury shall invest

2 such amounts of the LRRF as the Secretary determines

3 are not required to meet current withdrawals from the

4 LRRF. Such investments may be made only in interest5 bearing obligations of the United States. For such pur6 pose, such obligations may be acquired on original issue

7 at the issue price, or by purchase of outstanding obliga8 tions at the market price.

9 ‘‘(2) Any obligation acquired by the LRRF may be

10 sold by the Secretary of the Treasury at the market price.

11 ‘‘SEC. 112. RECRUITMENT ACTIVITIES.

12 ‘‘(a) The Secretary may reimburse health profes13 sionals seeking positions with the Service, Indian tribes,

14 tribal organizations, or urban Indian organizations, in15 cluding unpaid student volunteers and individuals consid16 ering entering into a contract under section 110, and their

17 spouses, for actual and reasonable expenses incurred in

18 traveling to and from their places of residence to an area

19 in which they may be assigned for the purpose of evalu20 ating such area with respect to such assignment.

21 ‘‘(b) The Secretary shall assign one individual in each

22 Area Office to be responsible on a full-time basis for re23 cruitment activities.
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1 ‘‘SEC. 113. TRIBAL RECRUITMENT AND RETENTION PRO2 GRAM.

3 ‘‘(a) Subject to section 102, the Secretary shall fund

4 innovative demonstration projects for a period not to ex5 ceed 3 years to enable Indian tribes, tribal organizations,

6 and urban Indian organizations to recruit, place, and re7 tain health professionals to meet the staffing needs of In8 dian health programs (as defined in section 110(a)(2)(A)).

9 ‘‘(b) Any Indian tribe, tribal organization, or urban

10 Indian organization may submit an application for funding

11 of a project pursuant to this section.

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

13 ‘‘(a) The Secretary shall establish a demonstration

14 project to enable health professionals who have worked in

15 an Indian health program (as defined in section 110 for

16 a substantial period of time to pursue advanced training

17 or research areas of study for which the Secretary deter18 mines a need exists.

19 ‘‘(b) An individual who participates in a program

20 under subsection (a), where the educational costs are

21 borne by the Service, shall incur an obligation to serve

22 in an Indian health program for a period of obligated serv23 ice equal to at least the period of time during which the

24 individual participates in such program. In the event that

25 the individual fails to complete such obligated service, the

26 individual shall be liable to the United States for the pe-
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1 riod of service remaining. In such event, with respect to

2 individuals entering the program after the date of the en3 actment of the Indian Health Care Improvement Act

4 Amendments of 2001, the United States shall be entitled

5 to recover from such individual an amount to be deter6 mined in accordance with the formula specified in sub7 section (l) of section 110 in the manner provided for in

8 such subsection.

9 ‘‘(c) Health professionals from Indian tribes and trib10 al organizations under the authority of the Indian Self11 Determination and Education Assistance Act, and urban

12 Indian organizations shall be given an equal opportunity

13 to participate in the program under subsection (a).

14 ‘‘SEC. 115. QUENTIN B. BURDICK AMERICAN INDIANS INTO

15 NURSING PROGRAM.

16 ‘‘(a) Notwithstanding section 102, the Secretary shall

17 provide grants to—

18 ‘‘(1) public or private schools of nursing,

19 ‘‘(2) tribally controlled community colleges and

20 tribally controlled postsecondary vocational institu21 tions (as defined in section 390(2) of the Tribally

22 Controlled Vocational Institutions Support Act of

23 1990 (20 U.S.C. 2397h(2)), and

24 ‘‘(3) nurse midwife programs, and advance

25 practice nurse programs, that are provided by any
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1 tribal college accredited nursing program, in the ab2 sence of such, any other public or private institu3 tions,

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

5 midwives, and nurse practitioners who deliver health care

6 services to Indians.

7 ‘‘(b) Grants provided under subsection (a) may be

8 used to—

9 ‘‘(1) recruit individuals for programs which

10 train individuals to be nurses, nurse midwives, or

11 advanced practice nurses,

12 ‘‘(2) provide scholarships to Indian individuals

13 enrolled in such programs that may pay the tuition

14 charged for such program and other expenses in15 curred in connection with such program, including

16 books, fees, room and board, and stipends for living

17 expenses,

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

19 nurse midwives, and advanced practice nurses to

20 provide, or continue to provide, health care services

21 to Indians,

22 ‘‘(4) provide a program that increases the skills

23 of, and provides continuing education to, nurses,

24 nurse midwives, and advanced practice nurses, or
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1 ‘‘(5) provide any program that is designed to

2 achieve the purpose described in subsection (a).

3 ‘‘(c) Each application for funding under subsection

4 (a) shall include such information as the Secretary may

5 require to establish the connection between the program

6 of the applicant and a health care facility that primarily

7 serves Indians.

8 ‘‘(d) In providing grants under subsection (a), the

9 Secretary shall extend a preference to—

10 ‘‘(1) programs that provide a preference to In11 dians,

12 ‘‘(2) programs that train nurse midwives or ad13 vanced practice nurses,

14 ‘‘(3) programs that are interdisciplinary, and

15 ‘‘(4) programs that are conducted in coopera16 tion with a center for gifted and talented Indian stu17 dents established under section 5324(a) of the In18 dian Education Act of 1988.

19 ‘‘(e) The Secretary shall provide one of the grants

20 authorized under subsection (a) to establish and maintain

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

22 as the ‘Quentin N. Burdick American Indians Into Nurs23 ing Program’. Such program shall, to the maximum extent

24 feasible, coordinate with the Quentin N. Burdick Indian

25 Health Programs established under section 117(b) and the
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1 Quentin N. Burdick American Indians Into Psychology

2 Program established under section 106(b).

3 ‘‘(f) The active duty service obligation prescribed

4 under section 338C of the Public Health Service Act (42

5 U.S.C. 254m) shall be met by each individual who receives

6 training or assistance described in paragraph (1) or (2)

7 of subsection (b) that is funded by a grant provided under

8 subsection (a). Such obligation shall be met by service—

9 ‘‘(A) in the Indian Health Service;

10 ‘‘(B) in a program conducted under a contract

11 entered into under the Indian Self-Determination

12 Act;

13 ‘‘(C) in a program assisted under title V of this

14 Act; or

15 ‘‘(D) in the private practice of nursing if, as de16 termined by the Secretary, in accordance with guide17 lines promulgated by the Secretary, such practice is

18 situated in a physician or other health professional

19 shortage area and addresses the health care needs of

20 a substantial number of Indians.

21 ‘‘SEC. 116. TRIBAL CULTURAL ORIENTATION.

22 ‘‘(a) The Secretary, pursuant to the requirements of

23 section 102, shall require that appropriate employees of

24 the Service who serve Indian tribes in each service area
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1 receive educational instruction in the history and culture

2 of such Tribes and their relationship to the Service.

3 ‘‘(b) To the extent feasible, the program established

4 under subsection (a) shall—

5 ‘‘(1) be developed in consultation with the af6 fected tribal governments, tribal organizations, and

7 urban Indian organizations,

8 ‘‘(2) be carried out through tribally controlled

9 community colleges (within the meaning of section

10 2(4) of the Tribally Controlled Community College

11 Assistance Act of 1978) and tribally controlled post12 secondary vocational institutions (as defined in sec13 tion 390(2) of the Tribally Controlled Vocational In14 stitutions Support Act of 1990 (20 U.S.C.

15 2397h(2)),

16 ‘‘(3) include instruction in American Indian

17 studies, and

18 ‘‘(4) the use and place of traditional health care

19 practices in the tribe.

20 ‘‘SEC. 117. INMED PROGRAM.

21 ‘‘(a) The Secretary is authorized to provide grants

22 to colleges and universities for the purpose of maintaining

23 and expanding the Native American health careers recruit24 ment program known as the ‘Indians into Medicine Pro25 gram’ (hereinafter in this section referred to as ‘INMED’)
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1 as a means of encouraging Indians to enter the health pro2 fessions.

3 ‘‘(b) The Secretary shall provide one of the grants

4 authorized under subsection (a) to maintain the INMED

5 program at the University of North Dakota, to be known

6 as the ‘Quentin N. Burdick Indian Health Programs’, un7 less the Secretary makes a determination, based upon pro8 gram reviews, that the program is not meeting the pur9 poses of this section. Such program shall, to the maximum

10 extent feasible, coordinate with the Quentin N. Burdick

11 American Indians Into Psychology Program established

12 under section 106(b) and the Quentin N. Burdick Amer13 ican Indians Into Nursing Program established under sec14 tion 115.

15 ‘‘(c)(1) The Secretary, pursuant to this Act, shall de16 velop regulations to govern grants pursuant to this sec17 tion.

18 ‘‘(2) Applicants for grants provided under this section

19 shall agree to provide a program which—

20 ‘‘(A) provides outreach and recruitment for

21 health professions to Indian communities including

22 elementary, secondary, and community colleges lo23 cated on Indian reservations which will be served by

24 the program,
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1 ‘‘(B) incorporates a program advisory board

2 comprised of representatives from the tribes and

3 communities which will be served by the program,

4 ‘‘(C) provides summer preparatory programs

5 for Indian students who need enrichment in the sub6 jects of math and science in order to pursue training

7 in the health professions,

8 ‘‘(D) provides tutoring, counseling, and support

9 to students who are enrolled in a health career pro10 gram of study at the respective college or university,

11 and

12 ‘‘(E) to the maximum extent feasible, employs

13 qualified Indians in the program.

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

15 COLLEGES.

16 ‘‘(a)(1) Subject to the requirements of section 102,

17 the Secretary shall award grants to accredited and acces18 sible community colleges for the purpose of assisting such

19 community colleges in the establishment of programs

20 which provide education in a health profession leading to

21 a degree or diploma in a health profession for individuals

22 who desire to practice such profession on an Indian res23 ervation, in the Service, or in a tribal health program.

24 ‘‘(2) The amount of any grant awarded to a commu25 nity college under paragraph (1) for the first year in which
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1 such a grant is provided to the community college shall

2 not exceed $100,000.

3 ‘‘(b)(1) The Secretary shall award grants to accred4 ited and accessible community colleges that have estab5 lished a program described in subsection (a)(1) for the

6 purpose of maintaining the program and recruiting stu7 dents for the program.

8 ‘‘(2) Grants may only be made under this section to

9 a community college which—

10 ‘‘(A) is accredited,

11 ‘‘(B) has a relationship with a hospital facility,

12 Service facility, or hospital that could provide train13 ing of nurses or health professionals,

14 ‘‘(C) has entered into an agreement with an ac15 credited college or university medical school, the

16 terms of which—

17 ‘‘(i) provide a program that enhances the

18 transition and recruitment of students into ad19 vanced baccalaureate or graduate programs

20 which train health professionals, and

21 ‘‘(ii) stipulate certifications necessary to

22 approve internship and field placement opportu23 nities at health programs of the Service or trib24 al health programs,
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1 ‘‘(D) has a qualified staff which has the appro2 priate certifications,

3 ‘‘(E) is capable of obtaining State or regional

4 accreditation of the program described in subsection

5 (a)(1), and

6 ‘‘(F) agrees to provide for Indian preference for

7 applicants for programs under this section.

8 ‘‘(c) The Secretary shall encourage community col9 leges described in subsection (b)(2) to establish and main10 tain programs described in subsection (a)(1) by—

11 ‘‘(1) entering into agreements with such col12 leges for the provision of qualified personnel of the

13 Service to teach courses of study in such programs,

14 and

15 ‘‘(2) providing technical assistance and support

16 to such colleges.

17 ‘‘(d) Any program receiving assistance under this sec18 tion that is conducted with respect to a health profession

19 shall also offer courses of study which provide advanced

20 training for any health professional who—

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

22 in such health profession, and

23 ‘‘(2) provides clinical services on an Indian res24 ervation, at a Service facility, or at a tribal clinic.
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1 Such courses of study may be offered in conjunction with

2 the college or university with which the community college

3 has entered into the agreement required under subsection

4 (b)(2)(C).

5 ‘‘(e) For purposes of this section:

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

7 ‘‘(A) a tribally controlled college, or

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

9 ‘‘(2) The term ‘tribally controlled college’ has

10 the meaning given to ‘tribally controlled community

11 college’ by section 2(4) of the Tribally Controlled

12 Community College Assistance Act of 1978.

13 ‘‘(3) The term ‘junior or community college’

14 has the meaning given to such term by section

15 312(e) of the Higher Education Act of 1965 (20

16 U.S.C. 1058(e)).

17 ‘‘(4) Where the requirements of subsection (b)

18 are met, funding priority shall be provided to tribally

19 controlled colleges in service areas where they exist.

20 ‘‘SEC. 119. RETENTION BONUS.

21 ‘‘(a) The Secretary may pay a retention bonus to any

22 health professional employed by, or assigned to, and serv23 ing in, the Service and Indian tribes, tribal organizations,

24 or urban Indian organizations either as a civilian employee
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1 or as a commissioned officer in the Regular or Reserve

2 Corps of the Public Health Service who—

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

4 for which recruitment or retention of personnel is

5 difficult,

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

7 Service, tribes, tribal organizations, and urban In8 dian organizations,

9 ‘‘(3) has—

10 ‘‘(A) completed 3 years of employment

11 with the Service, or Indian tribe, or tribal orga12 nization, or urban Indian organization, or

13 ‘‘(B) completed any service obligations in14 curred as a requirement of—

15 ‘‘(i) any Federal scholarship program,

16 or

17 ‘‘(ii) any Federal education loan re18 payment program, and

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

20 or Indian tribe, or tribal organization, or urban In21 dian organization for continued employment for a

22 period of not less than 1 year.

23 ‘‘(b) The Secretary may establish rates for the reten24 tion bonus which shall provide for a higher annual rate

25 for multiyear agreements than for single year agreements
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1 referred to in subsection (a)(4), but in no event shall the

2 annual rate be more than $25,000 per annum.

3 ‘‘(c) Any health professional failing to complete the

4 agreed upon term of service, except where such failure is

5 through no fault of the individual, shall be obligated to

6 refund to the Government the full amount of the retention

7 bonus for the period covered by the agreement, plus inter8 est as determined by the Secretary in accordance with sec9 tion 110(l)(2)(B).

10 ‘‘(d) The Secretary may pay a retention bonus to any

11 health professional employed by an organization providing

12 health care services to Indians pursuant to a funding

13 agreement under the Indian Self-Determination and Edu14 cation Assistance Act if such health professional is serving

15 in a position which the Secretary determines is—

16 ‘‘(1) a position for which recruitment or reten17 tion is difficult; and

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

19 to Indians.

20 ‘‘SEC. 120. NURSING RESIDENCY PROGRAM.

21 ‘‘(a) The Secretary shall establish a program to en22 able Indians who are licensed practical nurses, licensed vo23 cational nurses, and registered nurses who are working in

24 an Indian health program (as defined in section
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1 110(a)(2)(A)), and have done so for a period of not less

2 than one year, to pursue advanced training.

3 ‘‘(b) Such program shall include a combination of

4 education and work study in an Indian health program

5 (as defined in section 110(a)(2)(A)) leading to an asso6 ciate or bachelor’s degree (in the case of a licensed prac7 tical nurse or licensed vocational nurse) or a bachelor’s

8 degree (in the case of a registered nurse), or advanced

9 degrees in nursing and public health.

10 ‘‘(c) An individual who participates in a program

11 under subsection (a), where the educational costs are paid

12 by the Service, shall incur an obligation to serve in an

13 Indian health program for a period of obligated service

14 equal to the amount of time during which the individual

15 participates in such program. In the event that the indi16 vidual fails to complete such obligated service, the United

17 States shall be entitled to recover from such individual an

18 amount determined in accordance with the formula speci19 fied in subsection (l) of section 110 in the manner pro20 vided for in such subsection.

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

22 ALASKA.

23 ‘‘(a) Under the authority of the Act of November 2,

24 1921 (25 U.S.C. 13; popularly known as the Snyder Act),
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1 the Secretary shall maintain a Community Health Aide

2 Program in Alaska under which the Service—

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

4 as health aides or community health practitioners;

5 ‘‘(2) uses such aides or practitioners in the pro6 vision of health care, health promotion, and disease

7 prevention services to Alaska Natives living in vil8 lages in rural Alaska; and

9 ‘‘(3) provides for the establishment of tele10 conferencing capacity in health clinics located in or

11 near such villages for use by community health aides

12 or community health practitioners.

13 ‘‘(b) The Secretary, acting through the Community

14 Health Aide Program of the Service, shall—

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

16 provide a high standard of training to community

17 health aides and community health practitioners to

18 ensure that such aides and practitioners provide

19 quality health care, health promotion, and disease

20 prevention services to the villages served by the Pro21 gram;

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

23 a curriculum that—
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1 ‘‘(A) combines education in the theory of

2 health care with supervised practical experience

3 in the provision of health care;

4 ‘‘(B) provides instruction and practical ex5 perience in the provision of acute care, emer6 gency care, health promotion, disease preven7 tion, and the efficient and effective manage8 ment of clinic pharmacies, supplies, equipment,

9 and facilities; and

10 ‘‘(C) promotes the achievement of the

11 health status objectives specified in section

12 3(b);

13 ‘‘(3) establish and maintain a Community

14 Health Aide Certification Board to certify as com15 munity health aides or community health practi16 tioners individuals who have successfully completed

17 the training described in paragraph (1) or can dem18 onstrate equivalent experience;

19 ‘‘(4) develop and maintain a system which iden20 tifies the needs of community health aides and com21 munity health practitioners for continuing education

22 in the provision of health care, including the areas

23 described in paragraph (2)(B), and develop pro24 grams that meet the needs for such continuing edu25 cation;
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1 ‘‘(5) develop and maintain a system that pro2 vides close supervision of community health aides

3 and community health practitioners; and

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

5 community health aides and community health prac6 titioners is reviewed and evaluated to assure the pro7 vision of quality health care, health promotion, and

8 disease prevention services.

9 ‘‘(c) Subject to section 102, the Secretary shall de10 velop and operate a National Community Health Aide

11 Program based on the elements contained in this section.

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

13 ‘‘Subject to section 102, the Secretary shall, by fund14 ing agreement or otherwise, provide training for Indians

15 in the administration and planning of tribal health pro16 grams.

17 ‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE

18 DEMONSTRATION PROJECT.

19 ‘‘(a) Subject to section 102, the Secretary may fund

20 pilot programs for tribes and tribal organizations to ad21 dress the chronic shortages of health professionals.

22 ‘‘(b) The purposes of the health profession dem23 onstration program established herein are—
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1 ‘‘(1) to provide direct clinical and practical ex2 perience at a service unit to health profession stu3 dents and residents from medical schools;

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

5 Indians by assuring access to qualified health care

6 professionals; and

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

9 by identifying and using all academic and scholarly

10 resources of the region.

11 ‘‘(c) The demonstration programs established pursu12 ant to subsection (a) shall incorporate a program advisory

13 board composed of representatives from the tribes and

14 communities in the area which will be served by the pro15 gram.

16 ‘‘SEC. 124. TREATMENT OF SCHOLARSHIPS FOR CERTAIN

17 PURPOSES.

18 ‘‘Scholarships provided to individuals pursuant to

19 this title shall be deemed ‘qualified Scholarships’ for pur20 poses of section 117 of the Internal Revenue Code of

21 1986.

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

23 ‘‘(a) The Secretary shall not—

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

25 Service Corps from a health program operated by
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1 the Indian Health Service or by a tribe or tribal or2 ganization under funding agreement with the Service

3 under the Indian Self-Determination and Education

4 Assistance Act, or by urban Indian organizations, or

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

6 member,

7 unless the Secretary, acting through the Service, tribes,

8 or tribal organizations, has ensured that the Indians re9 ceiving services from such member will experience no re10 duction in services.

11 ‘‘(b) All service areas served by programs operated

12 by the Service or by tribes or tribal organizations under

13 the Indian Self-Determination and Education Assistance

14 Act or by urban Indian organizations shall be designated

15 under 42 U.S.C. 254c(a) as Health Professional Shortage

16 areas.

17 ‘‘(c) National Health Service Corps scholars quali18 fying for the Commissioned Corps in the United States

19 Public Health Service shall be exempt from the full-time

20 equivalent limitations of the National Health Service

21 Corps and the Service when serving as a commissioned

22 corps officer in a health program operated by an Indian

23 tribe or tribal organization under the Indian Self-Deter24 mination and Education Assistance Act or by urban In25 dian organizations.
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1 ‘‘SEC. 126. SUBSTANCE ABUSE COUNSELOR EDUCATION

2 DEMONSTRATION PROJECT.

3 ‘‘(a) The Secretary may enter into contracts with, or

4 make grants to, accredited tribally controlled community

5 colleges, tribally controlled postsecondary vocational insti6 tutions, and eligible accredited and accessible community

7 colleges to establish demonstration projects to develop

8 educational curricula for substance abuse counseling.

9 ‘‘(b) Funds provided under this section shall be used

10 only for developing and providing educational curriculum

11 for substance abuse counseling (including paying salaries

12 for instructors). Such curricula may be provided through

13 satellite campus programs.

14 ‘‘(c) A contract entered into or a grant provided

15 under this section shall be for a period of one year. Such

16 contract or grant may be renewed for an additional one17 year period upon the approval of the Secretary.

18 ‘‘(d) Not later than 180 days after the date of the

19 enactment of this section, the Secretary, after consultation

20 with Indian tribes and administrators of accredited trib21 ally controlled community colleges, tribally controlled post22 secondary vocational institutions, and eligible accredited

23 and accessible community colleges, shall develop and issue

24 criteria for the review and approval of applications for

25 funding (including applications for renewals of funding)

26 under this section. Such criteria shall ensure that dem-
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1 onstration projects established under this section promote

2 the development of the capacity of such entities to educate

3 substance abuse counselors.

4 ‘‘(e) The Secretary shall provide such technical and

5 other assistance as may be necessary to enable grant re6 cipients to comply with the provisions of this section.

7 ‘‘(f) The Secretary shall submit to the President, for

8 inclusion in the report which is required to be submitted

9 under section 801 for fiscal year 2000 a report on the

10 findings and conclusions derived from the demonstration

11 projects conducted under this section.

12 ‘‘(g) For the purposes of this section, the following

13 definitions apply:

14 ‘‘(1) The term ‘educational curriculum’ means

15 one or more of the following:

16 ‘‘(A) Classroom education.

17 ‘‘(B) Clinical work experience.

18 ‘‘(C) Continuing education workshops.

19 ‘‘(2) The term ‘tribally controlled postsecondary

20 vocational institution’ has the meaning given such

21 term in section 390(2) of the Tribally Controlled Vo22 cational Institutions Support Act of 1990 (20 U.S.C.

23 2397h(2)).
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1 ‘‘SEC. 127. MENTAL HEALTH TRAINING AND COMMUNITY

2 EDUCATION PROGRAMS.

3 ‘‘(a)(1) The Secretary and the Secretary of the Inte4 rior, in consultation with Indian tribes and tribal organi5 zations, shall conduct a study and compile a list of the

6 types of staff positions specified in subsection (b) whose

7 qualifications include, or should include, training in the

8 identification, prevention, education, referral, or treatment

9 of mental illness, or dysfunctional and self-destructive be10 havior.

11 ‘‘(2) The positions referred to in subsection (a) are—

12 ‘‘(A) staff positions within the Bureau of In13 dian Affairs, including existing positions, in the

14 fields of—

15 ‘‘(i) elementary and secondary education;

16 ‘‘(ii) social services and family and child

17 welfare;

18 ‘‘(iii) law enforcement and judicial services;

19 and

20 ‘‘(iv) alcohol and substance abuse;

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

22 ‘‘(C) staff positions similar to those identified

23 in subsection (b) established and maintained by In24 dian tribes, tribal organizations, and urban Indian

25 organizations, including positions established pursu26 ant to funding agreements pursuant to the Indian
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1 Self-Determination and Education Assistance Act,

2 and this Act.

3 ‘‘(3) The appropriate Secretary shall provide training

4 criteria appropriate to each type of position identified in

5 subsection (b)(1) and ensure that appropriate training has

6 been, or shall be provided to any individual in any such

7 position. With respect to any such individual in a position

8 identified pursuant to subsection (b)(3), the respective

9 Secretaries shall provide appropriate training to, or pro10 vide funds to an Indian tribe, tribal organization, or urban

11 Indian organization for training of appropriate individ12 uals. In the case of a funding agreement, the appropriate

13 Secretary shall ensure that such training costs are in14 cluded in the funding agreement, if necessary.

15 ‘‘(4) Position-specific training criteria shall be cul16 turally relevant to Indians and Indian tribes and shall en17 sure that appropriate information regarding traditional

18 health care practices is provided.

19 ‘‘(5) The Service shall develop and implement, or on

20 request of an Indian tribe or tribal organization, assist

21 an Indian tribe or tribal organization, to develop and im22 plement, a program of community education on mental ill23 ness. In carrying out this subsection, the Service shall,

24 upon request of an Indian tribe or tribal organization, pro25 vide technical assistance to an Indian tribe or tribal orga-
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1 nization to obtain and develop community educational ma2 terials on the identification, technical assistance to the In3 dian tribe or tribal organization to obtain or develop mate4 rials on the identification, prevention, referral, and treat5 ment of mental illness, dysfunctional, and self-destructive

6 behavior.

7 ‘‘(b)(1) Within 90 days after the date of the enact8 ment of the Indian Health Care Improvement Act Amend9 ments of 2001, the Secretary shall develop a plan under

10 which the Service will increase the health care staff pro11 viding mental health services by at least 500 positions

12 within 5 years after the date of enactment of this section,

13 with at least 200 of such positions devoted to child, adoles14 cent, and family services. The allocation of such positions

15 shall be subject to the provisions of section 102(a).

16 ‘‘(2) The plan developed under paragraph (1) shall

17 be implemented under the Act of November 2, 1921 (25

18 U.S.C. 13), popularly known as the Snyder Act.

19 ‘‘SEC. 128. AUTHORIZATION OF APPROPRIATIONS.

20 ‘‘There are authorized to be appropriated such sums

21 as may be necessary for each fiscal year through fiscal

22 year 2013 to carry out this title.
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1 ‘‘TITLE II—HEALTH SERVICES

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

3 ‘‘(a) The Secretary is authorized to expend funds, di4 rectly or under the authority of the Indian Self-Deter5 mination and Education Assistance Act, which are appro6 priated under the authority of this section, for the purpose

7 of—

8 ‘‘(1) eliminating the deficiencies in health sta9 tus and resources of all Indian tribes,

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

11 health care services to Indians,

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

13 efficient and equitable manner,

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

15 direct care and contract health service programs,

16 and

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

18 meet the following health service responsibilities,

19 with respect to those Indian tribes with the highest

20 levels of health status deficiencies and resource defi21 ciencies:

22 ‘‘(A) Clinical care, including, but not lim23 ited to, inpatient care, outpatient care (includ24 ing audiology, clinical eye and vision care), pri-
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1 mary care, secondary and tertiary care, and

2 long-term care.

3 ‘‘(B) Preventive health, including mam4 mography and other cancer screening in accord5 ance with section 207.

6 ‘‘(C) Dental care.

7 ‘‘(D) Mental Health, including community

8 mental health services, inpatient mental health

9 services, dormitory mental health services,

10 therapeutic and residential treatment centers,

11 and training of traditional health care practi12 tioners.

13 ‘‘(E) Emergency medical services.

14 ‘‘(F) Treatment and control of, and reha15 bilitative care related to, alcoholism and drug

16 abuse (including fetal alcohol syndrome) among

17 Indians.

18 ‘‘(G) Accident prevention programs.

19 ‘‘(H) Home health care.

20 ‘‘(I) Community health representatives.

21 ‘‘(J) Maintenance and repair.

22 ‘‘(K) Traditional health care practices.

23 ‘‘(b)(1) Any funds appropriated under the authority

24 of this section shall not be used to offset or limit any other

25 appropriations made to the Service under this Act or the
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1 Act of November 2, 1921 (25 U.S.C. 13), popularly known

2 as the Snyder Act, or any other provision of law.

3 ‘‘(2)(A) Funds appropriated under the authority of

4 this section shall be allocated to service units or Indian

5 tribes or tribal organizations. The funds allocated to each

6 Tribe, tribal organization, or service unit under this sub7 paragraph shall be used by the Tribe, tribal organization,

8 or service unit under this subparagraph to improve the

9 health status and reduce the resource deficiency of each

10 Tribe served by such service unit, Tribe, or tribal organi11 zation.

12 ‘‘(B) The apportionment of funds allocated to a serv13 ice unit, Tribe, or tribal organization under subparagraph

14 (A) among the health service responsibilities described in

15 subsection (a)(4) shall be determined by the Service in

16 consultation with, and with the active participation of, the

17 affected Indian tribes in accordance with the provisions

18 of this section and such rulemaking as is permitted under

19 title VIII of this Act.

20 ‘‘(c) For purposes of this section:

21 ‘‘(1) The term ‘health status and resource defi22 ciency’ means the extent to which—

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

24 in section 3(b) are not being achieved; and
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1 ‘‘(B) the Indian tribe or tribal organization

2 does not have available to it the health re3 sources it needs, taking into account the actual

4 cost of providing health care services given local

5 geographic, climatic, rural, or other cir6 cumstances.

7 ‘‘(2) The health resources available to an In8 dian tribe or tribal organization include health re9 sources provided by the Service as well as health re10 sources used by the Indian tribe or tribal organiza11 tion, including services and financing systems pro12 vided by any Federal programs, private insurance,

13 and programs of State or local governments.

14 ‘‘(3) The Secretary shall establish procedures

15 which allow any Indian tribe or tribal organization

16 to petition the Secretary for a review of any deter17 mination of the extent of the health status and re18 source deficiency of such Tribe or tribal organiza19 tion.

20 ‘‘(d) Programs administered by any Indian tribe or

21 tribal organization under the authority of the Indian Self22 Determination and Education Assistance Act shall be eli23 gible for funds appropriated under the authority of this

24 section on an equal basis with programs that are adminis25 tered directly by the Service.
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1 ‘‘(e) By no later than the date that is 3 years after

2 the date of enactment of the Indian Health Care Improve3 ment Act of 2001, the Secretary shall submit to the Con4 gress the current health status and resource deficiency re5 port of the Service for each Indian tribe or service unit,

6 including newly recognized or acknowledged Indian tribes.

7 Such report shall set out—

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

9 for determining tribal health status and resource de10 ficiencies, as well as the most recent application of

11 that methodology;

12 ‘‘(2) the extent of the health status and re13 source deficiency of each Indian tribe served by the

14 Service;

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

16 the health status and resource deficiencies of all In17 dian tribes served by the Service; and

18 ‘‘(4) an estimate of—

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

20 appropriated under the authority of this Act, or

21 any other Act, including the amount of any

22 funds transferred to the Service, for the pre23 ceding fiscal year which is allocated to each

24 service unit, Indian tribe, or comparable entity;
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1 ‘‘(B) the number of Indians eligible for

2 health services in each service unit or Indian

3 tribe or tribal organization; and

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

5 Service resources made available to each service

6 unit or Indian tribe or tribal organization, and,

7 to the extent available, information on the wait8 ing lists and number of Indians turned away for

9 services due to lack of resources.

10 ‘‘(f) Funds appropriated under this section for any

11 fiscal year shall be included in the base budget of the Serv12 ice for the purpose of determining appropriations under

13 this section in subsequent fiscal years.

14 ‘‘(g) Nothing in this section is intended to diminish

15 the primary responsibility of the Service to eliminate exist16 ing backlogs in unmet health care needs, nor are the provi17 sions of this section intended to discourage the Service

18 from undertaking additional efforts to achieve equity

19 among Indian tribes and tribal organizations.

20 ‘‘(h) Any funds appropriated under the authority of

21 this section shall be designated as the ‘Indian Health Care

22 Improvement Fund’.
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1 ‘‘SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.

2 ‘‘(a)(1) There is hereby established an Indian Cata3 strophic Health Emergency Fund (hereafter in this sec4 tion referred to as the ‘CHEF’) consisting of—

5 ‘‘(A) the amounts deposited under subsection

6 (d), and

7 ‘‘(B) the amounts appropriated under sub8 section (e) to CHEF under this section.

9 ‘‘(2) CHEF shall be administered by the Secretary,

10 solely for the purpose of meeting the extraordinary med11 ical costs associated with the treatment of victims of disas12 ters or catastrophic illnesses who are within the responsi13 bility of the Service.

14 ‘‘(3) CHEF shall be equitably allocated, apportioned,

15 or delegated on a service unit or Area Office basis, based

16 upon a formula developed in consultation with the Indian

17 tribes and tribal organizations through negotiated rule18 making under title VIII of this Act, which formula shall

19 take into account the added needs of service areas which

20 are contract health-service dependent.

21 ‘‘(4) No part of CHEF or its administration shall be

22 subject to contract or grant under any law, including the

23 Indian Self-Determination Act, and shall be administered

24 by the Area Offices based upon priorities determined by

25 the Indian tribes and tribal organizations within each Area

26 including consideration of the needs of Indian tribes and
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1 tribal organizations which are contract health service-de2 pendent.

3 ‘‘(b) The Secretary shall, through the negotiated rule4 making process under title VIII of this Act, promulgate

5 regulations consistent with the provisions of this section—

6 ‘‘(1) establish a definition of disasters and cata7 strophic illnesses for which the cost of the treatment

8 provided under contract would qualify for payment

9 from the Fund;

10 ‘‘(2) provide that a service unit, Indian tribe, or

11 tribal organization shall not be eligible for reim12 bursement for the cost of treatment from CHEF

13 until its cost of treating any victim of such cata14 strophic illness or disaster has reached a certain

15 threshold cost which the Secretary shall establish

16 at—

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

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

19 than the threshold cost of the previous year in20 creased by the percentage increase in the med21 ical care expenditure category of the consumer

22 price index for all urban consumers (United

23 States city average) for the 12-month period

24 ending with December of the previous year; and
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1 ‘‘(3) establish a procedure for the reimburse2 ment of the portion of the costs incurred by—

3 ‘‘(A) service units, Indian tribes or tribal

4 organizations, or facilities of the Service, or

5 ‘‘(B) whenever otherwise authorized by the

6 Service, non-Service facilities or providers,

7 in rendering treatment that exceeds such threshold

8 cost;

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

10 CHEF in cases in which the exigencies of the med11 ical circumstances warrant treatment prior to the

12 authorization of such treatment by the Service; and

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

14 no payment shall be made from CHEF to any pro15 vider of treatment to the extent that such provider

16 is eligible to receive payment for the treatment from

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

18 reimbursement for which the patient is eligible.

19 ‘‘(c) Amounts appropriated to CHEF under this sec20 tion shall not be used to offset or limit appropriations

21 made to the Service under the authority of the Act of No22 vember 2, 1921 (25 U.S.C. 13), popularly known as the

23 Snyder Act, or any other law.

24 ‘‘(d) There shall be deposited into CHEF all reim25 bursements to which the Service is entitled from any Fed-
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1 eral, State, local, or private source (including third-party

2 insurance) by reason of treatment rendered to any victim

3 of a disaster or catastrophic illness the cost of which was

4 paid from CHEF.

5 ‘‘SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION

6 SERVICES.

7 ‘‘(a) The Congress finds that health promotion and

8 disease prevention activities will—

9 ‘‘(1) improve the health and well-being of Indi10 ans, and

11 ‘‘(2) reduce the expenses for health care of In12 dians.

13 ‘‘(b) The Secretary, acting through the Service, and

14 through willing Indian tribes and tribal organizations,

15 shall provide health promotion and disease prevention

16 services to Indians so as to achieve the health status objec17 tives set forth in section 3(b).

18 ‘‘(c) The Secretary, after obtaining input from the

19 affected Indian tribes and tribal organizations, shall sub20 mit to the President for inclusion in each statement which

21 is required to be submitted to the Congress under section

22 801 an evaluation of—

23 ‘‘(1) the health promotion and disease preven24 tion needs of Indians;
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1 ‘‘(2) the health promotion and disease preven2 tion activities which would best meet such needs;

3 ‘‘(3) the internal capacity of the Service to meet

4 such needs; and

5 ‘‘(4) the resources which would be required to

6 enable the Service to undertake the health promotion

7 and disease prevention activities necessary to meet

8 such needs.

9 ‘‘SEC. 204. DIABETES PREVENTION, TREATMENT, AND CON10 TROL.

11 ‘‘(a) The Secretary, in consultation with the Indian

12 tribes and tribal organizations, shall determine—

13 ‘‘(1) by tribe, tribal organization, and by Serv14 ice unit of the Service, the incidence of, and the

15 types of complications resulting from, diabetes

16 among Indians; and

17 ‘‘(2) based on paragraph (1), the measures (in18 cluding patient education) each Service unit should

19 take to reduce the incidence of, and prevent, treat,

20 and control the complications resulting from, diabe21 tes among Indian tribes within that Service unit.

22 ‘‘(b) The Secretary shall screen each Indian who re23 ceives services from the Service for diabetes and for condi24 tions which indicate a high risk that the individual will

25 become diabetic. Such screening may be done by a tribe
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1 or tribal organization operating health care programs or

2 facilities with funds from the Service under the Indian

3 Self-Determination and Education Assistance Act.

4 ‘‘(c) The Secretary shall continue to fund through fis5 cal year 2013 each model diabetes project in existence on

6 the date of the enactment of the Indian Health Amend7 ments of 2001 and any such other diabetes programs op8 erated by the Secretary or Indian tribes and tribal organi9 zations and any additional programs added to meet exist10 ing needs. Indian tribes and tribal organizations shall re11 ceive recurring funding for the diabetes programs which

12 they operate pursuant to this section.

13 ‘‘(d) The Secretary shall provide funding through the

14 Service, Indian tribes, and tribal organizations to establish

15 dialysis programs, including funding to purchase dialysis

16 equipment and provide necessary staffing.

17 ‘‘(e) The Secretary shall, to the extent funding is

18 available—

19 ‘‘(1) in each Area Office of the Service, consult

20 with Indian tribes and tribal organizations regarding

21 programs for the prevention, treatment, and control

22 of diabetes;

23 ‘‘(2) establish in each Area Office of the Service

24 a registry of patients with diabetes to track the inci-
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1 dence of diabetes and the complications from diabe2 tes in that area; and

3 ‘‘(3) ensure that data collected in each Area Of4 fice regarding diabetes and related complications

5 among Indians is disseminated to all other Area Of6 fices.

7 ‘‘SEC. 205. SHARED SERVICES.

8 ‘‘(a) The Secretary is authorized to enter into fund9 ing agreements or other arrangements with Indian tribes

10 or tribal organizations for the delivery of long-term care

11 and similar services to Indians. Such projects shall provide

12 for the sharing of staff or other services between a Service

13 or tribal facility and a long-term care or other similar fa14 cility owned and operated (directly or through funding

15 agreement) by such Indian tribe or tribal organization.

16 ‘‘(b) A funding agreement or other arrangement en17 tered into pursuant to subsection (a)—

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

19 tribal organization, delegate to such tribe or tribal

20 organization such powers of supervision and control

21 over Service employees as the Secretary deems nec22 essary to carry out the purposes of this section;

23 ‘‘(2) shall provide that expenses (including sala24 ries) relating to services that are shared between the

25 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) The Secretary shall provide such technical and

8 other assistance as may be necessary to enable applicants

9 to comply with the provisions of this section.

10 ‘‘(d) The Secretary shall encourage the use for long11 term or similar care of existing facilities that are

12 underused or allow the use of swing beds for such pur13 poses.

14 ‘‘SEC. 206. HEALTH SERVICES RESEARCH.

15 ‘‘The Secretary shall make funding available for re16 search to further the performance of the health service re17 sponsibilities of the Service, Indian tribes, and tribal orga18 nizations and shall coordinate the activities of other agen19 cies within the Department of Health and Human Services

20 to address these research needs. The funding shall be di21 vided equitably among the Area Offices and then each

22 Area Office shall award the funds competitively within

23 that Area. Indian tribes and tribal organizations receiving

24 funding from the Service under the authority of the Indian

25 Self-Determination and Education Assistance Act shall be
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1 given an equal opportunity to compete for, and receive,

2 research funds under this section. This funding may be

3 used for both clinical and nonclinical research by Indian

4 tribes and tribal organizations and shall be distributed to

5 the Area Offices which may make grants from these funds

6 within each Area.

7 ‘‘SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREEN8 ING.

9 ‘‘The Secretary, through the Service or through In10 dian tribes or tribal organizations, shall provide for screen11 ing, as follows:

12 ‘‘(1) Mammography (as defined in section

13 1861(jj) of the Social Security Act) for Indian

14 women at a frequency appropriate to such women

15 under national standards, and under such terms and

16 conditions as are consistent with standards estab17 lished by the Secretary to ensure the safety and ac18 curacy of screening mammography under part B of

19 title XVIII of the Social Security Act.

20 ‘‘(2) Other cancer screening meeting national

21 standards.

22 ‘‘SEC. 208. PATIENT TRAVEL COSTS.

23 ‘‘The Secretary, acting through the Service and will24 ing Indian tribes and tribal organizations, shall provide

25 funds for the following patient travel costs, including ap-
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1 propriate and necessary qualified escorts, associated with

2 receiving health care services provided (either through di3 rect or contract care or through funding agreements en4 tered into pursuant to the Indian Self-Determination and

5 Education Assistance Act) under this Act—

6 ‘‘(1) emergency air transportation non7 emergency air transportation where ground trans8 portation is infeasible;

9 ‘‘(2) transportation by private vehicle, specially

10 equipped vehicle and ambulance; and

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

12 may be available and required when air or motor ve13 hicle transportation is not available.

14 ‘‘SEC. 209. EPIDEMIOLOGY CENTERS.

15 ‘‘(a)(1) In addition to those centers already estab16 lished at the time of enactment of this Act (including those

17 for which funding is currently being provided in funding

18 agreements under the Indian Self-Determination and

19 Education Assistance Act), within 180 days of enactment

20 of the Indian Health Care Improvement Act Amendments

21 of 2001, the Secretary shall establish and fund an epide22 miology center in each service area which does not yet

23 have one to carry out the functions described in paragraph

24 (2). Any new centers so established may be operated by

25 Indian tribes or tribal organizations pursuant to funding
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1 agreements under the Indian Self-Determination and

2 Education Assistance Act, but such funding may not be

3 divisible.

4 ‘‘(2) In consultation with and upon the request of In5 dian tribes, tribal organizations, and urban Indian organi6 zations, each area epidemiology center established under

7 this subsection shall, with respect to such area carry out—

8 ‘‘(A) collect data relating to, and monitor

9 progress made toward meeting, each of the health

10 status objectives of the Indian Health Service, the

11 Indian tribes, tribal organizations, and urban Indian

12 organizations in the Area;

13 ‘‘(B) evaluate existing delivery systems, data

14 systems, and other systems that impact the improve15 ment of Indian health;

16 ‘‘(C) assist Indian tribes, tribal organizations,

17 and urban Indian organizations in identifying their

18 highest priority health status objectives and the

19 services needed to achieve such objectives, based on

20 epidemiological data;

21 ‘‘(D) make recommendations for the targeting

22 of services needed by tribal, urban, and other Indian

23 communities;

24 ‘‘(E) make recommendations to improve health

25 care delivery systems for Indians and urban Indians;
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1 ‘‘(F) provide requested technical assistance to

2 Indian tribes and urban Indian organizations in the

3 development of local health service priorities and in4 cidence and prevalence rates of disease and other ill5 ness in the community; and

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

8 organizations to promote public health.

9 ‘‘(3) The Director of the Centers for Disease Control

10 and Prevention shall provide technical assistance to the

11 centers in carrying out the requirements of this sub12 section.

13 ‘‘(b) The Secretary may make funding available to

14 Indian tribes, tribal organizations, and urban Indian orga15 nizations to conduct epidemiological studies of Indian

16 communities.

17 ‘‘SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION

18 PROGRAMS.

19 ‘‘(a) The Secretary shall provide funding to Indian

20 tribes, tribal organizations and urban Indian organizations

21 to develop comprehensive school health education pro22 grams for children from preschool through grade 12 in

23 schools for the benefit of Indian and urban Indian chil24 dren.
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1 ‘‘(b) Funding provided under this section may be

2 used for purposes which may include, but are not limited

3 to the following:

4 ‘‘(1) Developing and implementing health edu5 cation curricula both for regular school programs

6 and after-school programs.

7 ‘‘(2) Training teachers in comprehensive school

8 health education curricula.

9 ‘‘(3) Integrating school-based, community10 based, and other public and private health promotion

11 efforts.

12 ‘‘(4) Encouraging healthy, tobacco-free school

13 environments.

14 ‘‘(5) Coordinating school-based health programs

15 with existing services and programs available in the

16 community.

17 ‘‘(6) Developing school programs on nutrition

18 education, personal health, oral health, and fitness.

19 ‘‘(7) Developing mental health wellness pro20 grams.

21 ‘‘(8) Developing chronic disease prevention pro22 grams.

23 ‘‘(9) Developing substance abuse prevention

24 programs.
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1 ‘‘(10) Developing injury prevention and safety

2 education programs.

3 ‘‘(11) Developing activities for the prevention

4 and control of communicable diseases.

5 ‘‘(12) Developing community and environmental

6 health education programs that include traditional

7 health care practitioners.

8 ‘‘(13) Violence prevention.

9 ‘‘(14) Such other health issues as are appro10 priate.

11 ‘‘(c) Upon request, the Secretary shall provide tech12 nical assistance to Indian tribes, tribal organizations, and

13 urban Indian organizations in the development of com14 prehensive health education plans, and the dissemination

15 of comprehensive health education materials and informa16 tion on existing health programs and resources.

17 ‘‘(d) The Secretary, in consultation with Indian

18 tribes, tribal organizations, and urban Indian organiza19 tions, shall establish criteria for the review and approval

20 of applications for funding provided pursuant to this sec21 tion.

22 ‘‘(e)(1) The Secretary of the Interior, acting through

23 the Bureau of Indian Affairs and in cooperation with the

24 Secretary and the affected Indian tribes and tribal organi25 zations, shall develop a comprehensive school health edu-
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1 cation program for children from preschool through grade

2 12 in schools operated by the Bureau of Indian Affairs.

3 ‘‘(2) Such programs shall include—

4 ‘‘(A) school programs on nutrition education,

5 personal health, oral health, and fitness;

6 ‘‘(B) mental health wellness programs;

7 ‘‘(C) chronic disease prevention programs;

8 ‘‘(D) substance abuse prevention programs;

9 ‘‘(E) injury prevention and safety education

10 programs; and

11 ‘‘(F) activities for the prevention and control of

12 communicable diseases.

13 ‘‘(3) The Secretary of the Interior shall—

14 ‘‘(A) provide training to teachers in comprehen15 sive school health education curricula;

16 ‘‘(B) ensure the integration and coordination of

17 school-based programs with existing services and

18 health programs available in the community; and

19 ‘‘(C) encourage healthy, tobacco-free school en20 vironments.

21 ‘‘SEC. 211. INDIAN YOUTH PROGRAM.

22 ‘‘(a) The Secretary is authorized to provide funding

23 to Indian tribes, tribal organizations, and urban Indian

24 organizations for innovative mental and physical disease

25 prevention and health promotion and treatment programs
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1 for Indian and urban Indian preadolescent and adolescent

2 youths.

3 ‘‘(b)(1) Funds made available under this section may

4 be used to—

5 ‘‘(A) develop prevention and treatment pro6 grams for Indian youth which promote mental and

7 physical health and incorporate cultural values, com8 munity and family involvement, and traditional

9 health care practitioners; and

10 ‘‘(B) develop and provide community training

11 and education.

12 ‘‘(2) Funds made available under this section may

13 not be used to provide services described in section 707(c).

14 ‘‘(c) The Secretary shall—

15 ‘‘(1) disseminate to Indian tribes, tribal organi16 zations, and urban Indian organizations information

17 regarding models for the delivery of comprehensive

18 health care services to Indian and urban Indian ado19 lescents;

20 ‘‘(2) encourage the implementation of such

21 models; and

22 ‘‘(3) at the request of an Indian tribe, tribal or23 ganization, or urban Indian organization, provide

24 technical assistance in the implementation of such

25 models.
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1 ‘‘(d) The Secretary, in consultation with Indian

2 tribes, tribal organizations, and urban Indian organiza3 tions, shall establish criteria for the review and approval

4 of applications or proposals under this section.

5 ‘‘SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF

6 COMMUNICABLE AND INFECTIOUS DISEASES.

7 ‘‘(a) The Secretary, after consultation with Indian

8 tribes, tribal organizations, and urban Indian organiza9 tions, and the Centers for Disease Control and Prevention,

10 may make funding available to Indian tribes and tribal

11 organizations for—

12 ‘‘(1) projects for the prevention, control, and

13 elimination of communicable and infectious diseases

14 including, but not limited to, tuberculosis, hepatitis,

15 HIV, respiratory syncitial virus, hanta virus, sexu16 ally transmitted diseases, 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) The Secretary may provide funding under sub2 section (a) only if an application or proposal for funding

3 is submitted to the Secretary.

4 ‘‘(c) Indian tribes and tribal organizations receiving

5 funding under this section are encouraged to coordinate

6 their activities with the Centers for Disease Control and

7 Prevention and State and local health agencies.

8 ‘‘(d) In carrying out this section, the Secretary—

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

10 tribal organization, provide technical assistance; and

11 ‘‘(2) shall prepare and submit a report to the

12 Congress biennially on the use of funds under this

13 section and on the progress made toward the preven14 tion, control, and elimination of communicable and

15 infectious diseases among Indians and urban Indi16 ans.

17 ‘‘SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERV18 ICES.

19 ‘‘(a) The Secretary, acting through the Service and

20 willing tribes and tribal organizations, may provide fund21 ing under this Act to meet the objectives set forth in sec22 tion 3 of this Act through health care related services and

23 programs not otherwise described in this Act, which shall

24 include, but not be limited to—

25 ‘‘(1) hospice care and assisted living;
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1 ‘‘(2) long-term health care;

2 ‘‘(3) home- and community-based services;

3 ‘‘(4) public health functions; and

4 ‘‘(5) traditional health care practices.

5 ‘‘(b) At the discretion of the Service, Indian tribes,

6 or tribal organizations, services provided for hospice care,

7 home health care (under section 201 of this Act), home8 and community-based care, assisted living, and long-term

9 care may be provided (on a cost basis) to persons other10 wise ineligible for the health care benefits of the Service.

11 Any funds received under this subsection shall not be used

12 to offset or limit the funding allocated to a tribe or tribal

13 organization.

14 ‘‘(c) For the purposes of this section, the following

15 definitions shall apply:

16 ‘‘(1) The term ‘hospice care’ means the items

17 and services specified in subparagraphs (A) through

18 (H) of section 1861(dd)(1) of the Social Security

19 Act (42 U.S.C. 1395x(dd)(1)), and such other serv20 ices which a tribe or tribal organization determines

21 are necessary and appropriate to provide in further22 ance of this care.

23 ‘‘(2) The term ‘home- and community-based

24 services’ means 1 or more of the following:
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1 ‘‘(A) Homemaker/home health aide serv2 ices.

3 ‘‘(B) Chore services.

4 ‘‘(C) Personal care services.

5 ‘‘(D) Nursing care services provided out6 side of a nursing facility by, or under the super7 vision of, a registered nurse.

8 ‘‘(E) Training for family members.

9 ‘‘(F) Adult day care.

10 ‘‘(G) Such other home- and community11 based services as the Secretary or a tribe or

12 tribal organization may approve.

13 ‘‘(3) The term ‘public health functions’ means

14 the provision of public health related programs,

15 functions, and services including, but not limited to,

16 assessment, assurance, and policy development which

17 Indian tribes and tribal organizations are authorized

18 and encouraged, in those circumstances where it

19 meets their needs, to do by forming collaborative re20 lationships with all levels of local, State, and Federal

21 Government.

22 ‘‘SEC. 214. INDIAN WOMEN’S HEALTH CARE.

23 ‘‘The Secretary, acting through the Service and will24 ing Indian tribes, tribal organizations, and urban Indian

25 organizations, shall provide funding to monitor and im-
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1 prove the quality of health care for Indian women of all

2 ages through the planning and delivery of programs ad3 ministered by the Service, in order to improve and enhance

4 the treatment models of care for Indian women.

5 ‘‘SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZ6 ARDS.

7 ‘‘(a) The Secretary and the Service shall conduct, in

8 conjunction with other appropriate Federal agencies and

9 in consultation with concerned Indian tribes and tribal or10 ganizations, studies and ongoing monitoring programs to

11 determine trends in the health hazards to Indian miners

12 and to Indians on or near Indian reservations and in In13 dian communities as a result of environmental hazards

14 which may result in chronic or life-threatening health

15 problems, such as nuclear resource development, petro16 leum contamination, and contamination of water source

17 and of the food chain. Such study shall include—

18 ‘‘(1) an evaluation of the nature and extent of

19 health problems caused by environmental hazards

20 currently exhibited among Indians and the causes of

21 such health problems;

22 ‘‘(2) an analysis of the potential effect of ongo23 ing and future environmental resource development

24 on or near Indian reservations and communities in25 cluding the cumulative effect over time on health;
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1 ‘‘(3) an evaluation of the types and nature of

2 activities, practices, and conditions causing or affect3 ing such health problems including, but not limited

4 to, uranium mining and milling, uranium mine tail5 ing deposits, nuclear power plant operation and con6 struction, and nuclear waste disposal; oil and gas

7 production or transportation on or near Indian res8 ervations or communities; and other development

9 that could affect the health of Indians and their

10 water supply and food chain;

11 ‘‘(4) a summary of any findings and rec12 ommendations provided in Federal and State stud13 ies, reports, investigations, and inspections during

14 the 5 years prior to the date of the enactment of

15 this section that directly or indirectly relate to the

16 activities, practices, and conditions affecting the

17 health or safety of such Indians; and

18 ‘‘(5) the efforts that have been made by Federal

19 and State agencies and resource and economic devel20 opment companies to effectively carry out an edu21 cation program for such Indians regarding the

22 health and safety hazards of such development.

23 ‘‘(b) Upon completion of such study the Secretary

24 and the Service shall take into account the results of such

25 study and, in consultation with Indian tribes and tribal
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1 organizations, develop health care plans to address the

2 health problems studied under subsection (a). The plans

3 shall include—

4 ‘‘(1) methods for diagnosing and treating Indi5 ans currently exhibiting such health problems;

6 ‘‘(2) preventive care and testing for Indians

7 who may be exposed to such health hazards, includ8 ing the monitoring of the health of individuals who

9 have or may have been exposed to excessive amounts

10 of radiation, or affected by other activities that have

11 had or could have a serious impact upon the health

12 of such individuals; and

13 ‘‘(3) a program of education for Indians who,

14 by reason of their work or geographic proximity to

15 such nuclear or other development activities, may ex16 perience health problems.

17 ‘‘(c) The Secretary and the Service shall submit to

18 Congress the study prepared under subsection (a) no later

19 than the date 18 months after the date of enactment of

20 this section. The health care plan prepared under sub21 section (b) shall be submitted in a report no later than

22 the date 1 year after the date that the study prepared

23 under subsection (a) is submitted to Congress. Such re24 port shall include recommended activities for the imple25 mentation of the plan, as well as an evaluation of any ac-
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1 tivities previously undertaken by the Service to address

2 such health problems.

3 ‘‘(d)(1) There is established an Intergovernmental

4 Task Force to be composed of the following individuals

5 (or their designees): The Secretary of Energy, the Admin6 istrator of the Environmental Protection Agency, the Di7 rector of the Bureau of Mines, the Assistant Secretary for

8 Occupational Safety and Health, and the Secretary of the

9 Interior.

10 ‘‘(2) The Task Force shall identify existing and po11 tential operations related to nuclear resource development

12 or other environmental hazards that affect or may affect

13 the health of Indians on or near an Indian reservation or

14 in an Indian community and enter into activities to correct

15 existing health hazards and ensure that current and future

16 health problems resulting from nuclear resource or other

17 development activities are minimized or reduced.

18 ‘‘(3) The Secretary shall be Chairman of the Task

19 Force. The Task Force shall meet at least twice each year.

20 Each member of the Task Force shall furnish necessary

21 assistance to the Task Force.

22 ‘‘(e) In the case of any Indian who—

23 ‘‘(1) as a result of employment in or near a

24 uranium mine or mill or near any other environ-
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1 mental hazard, suffers from a work related illness or

2 condition;

3 ‘‘(2) is eligible to receive diagnosis and treat4 ment services from a Service facility; and

5 ‘‘(3) by reason of such Indian’s employment, is

6 entitled to medical care at the expense of such mine

7 or mill operator or entity responsible for the environ8 mental hazard,

9 the Service shall, at the request of such Indian, render

10 appropriate medical care to such Indian for such illness

11 or condition and may recover the costs of any medical care

12 so rendered to which such Indian is entitled at the expense

13 of such operator or entity from such operator or entity.

14 Nothing in this subsection shall affect the rights of such

15 Indian to recover damages other than such costs paid to

16 the Service from the employer for such illness or condition.

17 ‘‘SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DE18 LIVERY AREA.

19 ‘‘(a) For fiscal years beginning with the fiscal year

20 ending September 30, 1983, and ending with the fiscal

21 year ending September 30, 2013, the State of Arizona

22 shall be designated as a contract health service delivery

23 area by the Service for the purpose of providing contract

24 health care services to members of federally recognized In25 dian tribes of Arizona.
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1 ‘‘(b) The Service shall not curtail any health care

2 services provided to Indians residing on Federal reserva3 tions in the State of Arizona if such curtailment is due

4 to the provision of contract services in such State pursu5 ant to the designation of such State as a contract health

6 service delivery area pursuant to subsection (a).

7 ‘‘SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES PRO8 GRAM.

9 ‘‘(a) The Secretary is authorized to fund a program

10 using California Rural Indian Health Board as a contract

11 care intermediary to improve the accessibility of health

12 services to California Indians.

13 ‘‘(b)(1) The Secretary shall enter into an agreement

14 with the California Rural Indian Health Board to reim15 burse the Board for costs (including reasonable adminis16 trative costs) incurred pursuant to this section, in pro17 viding medical treatment under contract to California In18 dians described in section 809(b) throughout the Cali19 fornia contract health services delivery area described in

20 section 218 with respect to high-cost contract care cases.

21 ‘‘(2) Not more than 5 percent of the amounts pro22 vided to the Board under this section for any fiscal year

23 may be for reimbursement for administrative expenses in24 curred by the Board during such fiscal year.
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1 ‘‘(3) No payment may be made for treatment pro2 vided hereunder to the extent payment may be made for

3 such treatment under the Catastrophic Health Emergency

4 Fund described in section 202 or from amounts appro5 priated or otherwise made available to the California con6 tract health service delivery area for a fiscal year.

7 ‘‘(c) There is hereby established an advisory board

8 which shall advise the California Rural Indian Health

9 Board in carrying out the demonstration pursuant to this

10 section. The advisory board shall be composed of rep11 resentatives, selected by the California Rural Indian

12 Health Board, from not less than 8 tribal health programs

13 serving California Indians covered under such demonstra14 tion, at least one-half of whom are not affiliated with the

15 California Rural Indian Health Board.

16 ‘‘SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE

17 DELIVERY AREA.

18 ‘‘The State of California, excluding the Counties of

19 Alameda, Contra Costa, Los Angeles, Marin, Orange, Sac20 ramento, San Francisco, San Mateo, Santa Clara, Kern,

21 Merced, Monterey, Napa, San Benito, San Joaquin, San

22 Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ven23 tura, shall be designated as a contract health service deliv24 ery area by the Service for the purpose of providing con25 tract health services to Indians in such State. However,
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1 any of the counties herein may be included in the contract

2 health services delivery area if funding is specifically pro3 vided by the Service for such services in those counties.

4 ‘‘SEC. 219. CONTRACT HEALTH SERVICES FOR THE TREN5 TON SERVICE AREA.

6 ‘‘(a) The Secretary is directed to provide contract

7 health services to members of the Turtle Mountain Band

8 of Chippewa Indians that reside in the Trenton Service

9 Area of Divide, McKenzie, and Williams Counties in the

10 State of North Dakota and the adjoining Counties of

11 Richland, Roosevelt, and Sheridan in the State of Mon12 tana.

13 ‘‘(b) Nothing in this section may be construed as ex14 panding the eligibility of members of the Turtle Mountain

15 Band of Chippewa Indians for health services provided by

16 the Service beyond the scope of eligibility for such health

17 services that applied on May 1, 1986.

18 ‘‘SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND

19 TRIBAL ORGANIZATIONS.

20 ‘‘The Service shall provide funds for health care pro21 grams and facilities operated by Indian tribes and tribal

22 organizations under funding agreements with the Service

23 entered into under the Indian Self-Determination and

24 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 other State, be exempt from the

8 licensing requirements of the State in which the agreement

9 is performed.

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) The Service shall respond to a notification of a

20 claim by a provider of a contract care service with either

21 an individual purchase order or a denial of the claim with22 in 5 working days after the receipt of such notification.

23 ‘‘(b) If the Service fails to respond to a notification

24 of a claim in accordance with subsection (a), the Service
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1 shall accept as valid the claim submitted by the provider

2 of a contract care service.

3 ‘‘(c) The Service shall pay a valid contract care serv4 ice claim within 30 days after completion of the claim.

5 ‘‘SEC. 224. LIABILITY FOR PAYMENT.

6 ‘‘(a) A patient who receives contract health care serv7 ices that are authorized by the Service shall not be liable

8 for the payment of any charges or costs associated with

9 the provision of such services.

10 ‘‘(b) The Secretary shall notify a contract care pro11 vider and any patient who receives contract health care

12 services authorized by the Service that such patient is not

13 liable for the payment of any charges or costs associated

14 with the provision of such services.

15 ‘‘(c) Following receipt of the notice provided by sub16 section (a) of this section, or, if a claim has been deemed

17 accepted under section 223(b), the provider shall have no

18 further recourse against the patient who received the serv19 ices.

20 ‘‘SEC. 225. AUTHORIZATION OF APPROPRIATIONS.

21 ‘‘There are authorized to be appropriated such sums

22 as may be necessary for each fiscal year through fiscal

23 year 2013 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) Prior to the expenditure of, or the making of

5 any binding commitment to expend, any funds appro6 priated for the planning, design, construction, or renova7 tion of facilities pursuant to the Act of November 2, 1921

8 (25 U.S.C. 13), popularly known as the Snyder Act, the

9 Secretary 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)(1) Notwithstanding any provision of law other

22 than this subsection, no Service hospital or outpatient

23 health care facility or any inpatient service or special care

24 facility operated by the Service may be closed if the Sec25 retary has not submitted to the Congress at least 1 year
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1 prior to the date of such proposed closure an evaluation

2 of the impact of such proposed closure which specifies, in

3 addition to other considerations—

4 ‘‘(A) the accessibility of alternative health care

5 resources for the population served by such hospital

6 or facility;

7 ‘‘(B) the cost-effectiveness of such closure;

8 ‘‘(C) the quality of health care to be provided

9 to the population served by such hospital or facility

10 after such closure;

11 ‘‘(D) the availability of contract health care

12 funds to maintain existing levels of service;

13 ‘‘(E) the views of the Indian tribes served by

14 such hospital or facility concerning such closure;

15 ‘‘(F) the level of use of such hospital or facility

16 by all eligible Indians; and

17 ‘‘(G) the distance between such hospital or fa18 cility and the nearest operating Service hospital.

19 ‘‘(2) Paragraph (1) shall not apply to any temporary

20 closure of a facility or any portion of a facility if such

21 closure is necessary for medical, environmental, or con22 struction safety reasons.

23 ‘‘(c)(1)(A) The Secretary shall establish a health care

24 facility priority system, which shall—
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1 ‘‘(i) be developed with Indian tribes and tribal

2 organizations by negotiated rulemaking under sec3 tion 802;

4 ‘‘(ii) give Indian tribes’ needs the highest pri5 ority; and

6 ‘‘(iii) at a minimum, include the lists required

7 in paragraph (2)(B) and the methodology required

8 in paragraph (2)(E) of this subsection.

9 ‘‘(B) The priority of any project established under the

10 construction priority system in effect on the date of the

11 Indian Health Care Improvement Act Amendments of

12 2001 shall not be affected by any change in the construc13 tion priority system taking place thereafter if the project

14 was identified as one of the top ten priority inpatient

15 projects or one of the top ten outpatient projects in the

16 fiscal year 2001 Indian Health Service budget justifica17 tion, or if the project had completed both Phase I and

18 Phase II of the construction priority system in effect on

19 the date of the enactment of such Act.

20 ‘‘(2) The Secretary shall submit to the President, for

21 inclusion in each report required to be transmitted to the

22 Congress under section 801, a report which sets forth—

23 ‘‘(A) a description of the health care facility

24 priority system of the Service, established under

25 paragraph (1) of this subsection;
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1 ‘‘(B) health care facilities lists, including but

2 not limited to—

3 ‘‘(i) the total health care facilities plan4 ning, design, construction, and renovation needs

5 for Indians;

6 ‘‘(ii) the 10 top-priority inpatient care fa7 cilities;

8 ‘‘(iii) the 10 top-priority outpatient care

9 facilities;

10 ‘‘(iv) the 10 top-priority specialized care

11 facilities (such as long-term care and alcohol

12 and drug abuse treatment);

13 ‘‘(v) any staff quarters associated with

14 such prioritized facilities;

15 ‘‘(C) the justification for such order of priority;

16 ‘‘(D) the projected cost of such projects; and

17 ‘‘(E) the methodology adopted by the Service in

18 establishing priorities under its health care facility

19 priority system.

20 ‘‘(3) In preparing each report required under para21 graph (2) (other than the initial report), the Secretary

22 shall annually—

23 ‘‘(A) consult with and obtain information on all

24 health care facilities needs from Indian tribes and

25 tribal organizations, including those tribes or tribal
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1 organizations operating health programs or facilities

2 under any funding agreement entered into with the

3 Service under the Indian Self-Determination and

4 Education Assistance Act; and

5 ‘‘(B) review the total unmet needs of all tribes

6 and tribal organizations for health care facilities (in7 cluding staff quarters), including needs for renova8 tion and expansion of existing facilities.

9 ‘‘(4) For purposes of this subsection, the Secretary

10 shall, in evaluating the needs of facilities operated under

11 any funding agreement entered into with the Service

12 under the Indian Self-Determination and Education As13 sistance Act, use the same criteria that the Secretary uses

14 in evaluating the needs of facilities operated directly by

15 the Service.

16 ‘‘(5) The Secretary shall ensure that the planning,

17 design, construction, and renovation needs of Service and

18 non-Service facilities, operated under funding agreements

19 in accordance with the Indian Self-Determination and

20 Education Assistance Act, are fully and equitably inte21 grated into the health care facility priority system.

22 ‘‘(d) REVIEW OF NEED FOR FACILITIES.—

23 ‘‘(1) Beginning in the year 2001, the Secretary

24 shall annually submit to the President, for inclusion

25 in the report required to be transmitted to the Con-
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1 gress under section 801 of this Act, a report which

2 sets forth the needs of the Indian Health Service

3 and all Indian tribes and tribal organizations, in4 cluding urban Indian organizations, for inpatient,

5 outpatient, and specialized care facilities, including

6 the needs for renovation and expansion of existing

7 facilities .

8 ‘‘(2) In preparing each report required under

9 paragraph (1) (other than the initial report), the

10 Secretary shall consult with Indian tribes and tribal

11 organizations including those Tribes or tribal organi12 zations operating health programs or facilities under

13 any funding agreement entered into with the Service

14 under the Indian Self-Determination and Education

15 Assistance Act (25 U.S.C. 450f et seq.), and with

16 urban Indian organizations.

17 ‘‘(3) For purposes of this subsection, the Sec18 retary shall, in evaluating the needs of facilities op19 erated under any funding agreement entered into

20 with the Service under the Indian Self-Determina21 tion and Education Assistance Act, use the same cri22 teria that the Secretary uses in evaluating the needs

23 of facilities operated directly by the Service.

24 ‘‘(4) The Secretary shall ensure that the plan25 ning, design, construction, and renovation needs of
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1 facilities operated under funding agreements, in ac2 cordance with the Indian Self-Determination and

3 Education Assistance Act, are fully and equitably in4 tegrated into the development of the health facility

5 priority system.

6 ‘‘(5) Each fiscal year, the Secretary shall pro7 vide an opportunity for nomination of planning, de8 sign, and construction projects by the Indian Health

9 Service and all tribes and tribal organizations for

10 consideration under the health care facility priority

11 system.

12 ‘‘(e) All funds appropriated under the Act of Novem13 ber 2, 1921 (25 U.S.C. 13), for the planning, design, con14 struction, or renovation of health facilities for the benefit

15 of an Indian tribe or Tribes shall be subject to the provi16 sions of section 102 of the Indian Self-Determination and

17 Education Assistance Act.

18 ‘‘(f) The Secretary shall consult and cooperate with

19 Indian tribes, tribal organizations, and urban Indian orga20 nizations in developing innovative approaches to address

21 all or part of the total unmet need for construction of

22 health facilities, including those provided for in other sec23 tions of this title and other approaches.
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1 ‘‘SEC. 302. SAFE WATER AND SANITARY WASTE DISPOSAL

2 FACILITIES.

3 ‘‘(a) The Congress hereby finds and declares that—

4 ‘‘(1) the provision of safe water supply facilities

5 and sanitary sewage and solid waste disposal facili6 ties is primarily a health consideration and function;

7 ‘‘(2) Indian people suffer an inordinately high

8 incidence of disease, injury, and illness directly at9 tributable to the absence or inadequacy of such fa10 cilities;

11 ‘‘(3) the long-term cost to the United States of

12 treating and curing such disease, injury, and illness

13 is substantially greater than the short-term cost of

14 providing such facilities and other preventive health

15 measures;

16 ‘‘(4) many Indian homes and communities still

17 lack safe water supply facilities and sanitary sewage

18 and solid waste disposal facilities; and

19 ‘‘(5) it is in the interest of the United States,

20 and it is the policy of the United States, that all In21 dian communities and Indian homes, new and exist22 ing, be provided with safe and adequate water sup23 ply facilities and sanitary sewage waste disposal fa24 cilities.

25 ‘‘(b)(1) In furtherance of the findings and declara26 tions made in subsection (a), Congress reaffirms the pri-
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1 mary responsibility and authority of the Service to provide

2 the necessary sanitation facilities and services as provided

3 in section 7 of the Act of August 5, 1954 (42 U.S.C.

4 2004a).

5 ‘‘(2) The Secretary is authorized to provide under

6 section 7 of the Act of August 5, 1954 (42 U.S.C.

7 2004a)—

8 ‘‘(A) financial and technical assistance to In9 dian tribes, tribal organizations, and Indian commu10 nities in the establishment, training, and equipping

11 of utility organizations to operate and maintain In12 dian sanitation facilities, including the provision of

13 existing plans, standard details, and specifications

14 available in the department, to be used at the option

15 of the tribe or tribal organization;

16 ‘‘(B) ongoing technical assistance and training

17 in the management of utility organizations which op18 erate and maintain sanitation facilities; and

19 ‘‘(C) priority funding for operation and mainte20 nance assistance for, and emergency repairs to, trib21 al sanitation facilities when necessary to avoid an

22 imminent health threat or to protect the investment

23 in sanitation facilities and the investment in the

24 health benefits gained through the provision of sani25 tation facilities.
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1 ‘‘(3) Notwithstanding any other provision of law—

2 ‘‘(A) the Secretary of Housing and Urban De3 velopment is authorized to transfer funds appro4 priated under the Native American Housing Assist5 ance and Self-Determination Act of 1996 to the Sec6 retary of Health and Human Services,

7 ‘‘(B) the Secretary of Health and Human Serv8 ices is authorized to accept and use such funds for

9 the purpose of providing sanitation facilities and

10 services for Indians under section 7 of the Act of

11 August 5, 1954 (42 U.S.C. 2004a),

12 ‘‘(C) unless specifically authorized when funds

13 are appropriated, the Secretary of Health and

14 Human Services shall not use funds appropriated

15 under section 7 of the Act of August 5, 1954 (42

16 U.S.C. 2004a) to provide sanitation facilities to new

17 homes constructed using funds provided by the De18 partment of Housing and Urban Development,

19 ‘‘(D) the Secretary of Health and Human Serv20 ices is authorized to accept all Federal funds that

21 are for the purpose of providing sanitation facilities

22 and related services and place those funds into fund23 ing agreements, authorized under the Indian Self24 Determination and Education Assistance Act (25
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1 U.S.C. 450f et seq.), between the Secretary and In2 dian tribes and tribal organizations,

3 ‘‘(E) the Secretary may allow funds appro4 priated under the authority of section 7 of the Act

5 of August 5, 1954 (42 U.S.C. 2004a), to be used to

6 fund up to 100 percent of the amount of a tribe’s

7 loan obtained under any Federal program for new

8 projects to construct eligible sanitation facilities to

9 serve Indian homes,

10 ‘‘(F) the Secretary may allow funds appro11 priated under the authority of section 7 of the Act

12 of August 5, 1954 (42 U.S.C. 2004a), to be used to

13 meet matching or cost participation requirements

14 under other Federal and non-Federal programs for

15 new projects to construct eligible sanitation facilities,

16 ‘‘(G) all Federal agencies are authorized to

17 transfer to the Secretary funds identified, granted,

18 loaned, or appropriated whereby the Department’s

19 applicable policies, rules, and regulations shall apply

20 in the implementation of such projects,

21 ‘‘(H) The Secretary of Health and Human

22 Services shall enter into interagency agreements

23 with the Bureau of Indian Affairs, the Department

24 of Housing and Urban Development, the Depart25 ment of Agriculture, the Environmental Protection
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1 Agency, and other appropriate Federal agencies, for

2 the purpose of providing financial assistance for safe

3 water supply and sanitary sewage disposal facilities

4 under this Act, and

5 ‘‘(I) the Secretary of Health and Human Serv6 ices shall, by regulation developed through rule7 making under section 802, establish standards appli8 cable to the planning, design, and construction of

9 water supply and sanitary sewage and solid waste

10 disposal facilities funded under this Act.

11 ‘‘(c) The Secretary, in consultation with Indian tribes

12 and tribal organizations, shall develop and begin imple13 mentation of a 10-year funding plan to provide safe water

14 supply and sanitary sewage and solid waste disposal facili15 ties serving existing Indian homes and communities and

16 new and renovated Indian homes.

17 ‘‘(d) The financial and technical capability of an In18 dian tribe or community to safely operate and maintain

19 a sanitation facility shall not be a prerequisite to the provi20 sion or construction of sanitation facilities by the Sec21 retary.

22 ‘‘(e) The Secretary is authorized to provide financial

23 assistance to Indian tribes, tribal organizations, and com24 munities for operation, management, and maintenance of

25 their sanitation facilities.
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1 ‘‘(f) The Indian family, community, or Tribe has the

2 primary responsibility to establish, collect, and use reason3 able user fees, or otherwise set aside funding, for the pur4 pose of operating and maintaining sanitation facilities. If

5 a community facility is threatened with imminent failure

6 and there is a lack of tribal capacity to maintain the integ7 rity or the health benefits of the facility, then the Sec8 retary is authorized to assist the Tribe in the resolution

9 of the problem on a short-term basis through cooperation

10 with the emergency coordinator or by providing operation

11 and maintenance service.

12 ‘‘(g) Programs administered by Indian tribes or tribal

13 organizations under the authority of the Indian Self-De14 termination and Education Assistance Act shall be eligible

15 for—

16 ‘‘(1) any funds appropriated pursuant to this

17 section, and

18 ‘‘(2) any funds appropriated for the purpose of

19 providing water supply, sewage disposal, or solid

20 waste facilities,

21 on an equal basis with programs that are administered

22 directly by the Service.

23 ‘‘(h)(1) The Secretary shall submit to the President,

24 for inclusion in each report required to be transmitted to
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1 the Congress under section 801, a report which sets

2 forth—

3 ‘‘(A) the current Indian sanitation facility pri4 ority system of the Service;

5 ‘‘(B) the methodology for determining sanita6 tion deficiencies;

7 ‘‘(C) the level of initial and final sanitation defi8 ciency for each type of sanitation facility for each

9 project of each Indian tribe or community; and

10 ‘‘(D) the amount of funds necessary to reduce

11 the identified sanitation deficiency levels of all In12 dian tribes and communities to level I sanitation de13 ficiency as defined in subsection (h)(4)(A) of this

14 section.

15 ‘‘(2) In preparing each report required under para16 graph (1), the Secretary shall consult with Indian tribes

17 and tribal organizations (including those tribes or tribal

18 organizations operating health care programs or facilities

19 under any funding agreement entered into with the Serv20 ice under the Indian Self-Determination and Education

21 Assistance Act) to determine the sanitation needs of each

22 tribe and in developing the criteria on which the needs

23 will be evaluated through a process of negotiated rule24 making.
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1 ‘‘(3) The methodology used by the Secretary in deter2 mining, preparing cost estimates for and reporting sanita3 tion deficiencies for purposes of paragraph (1) shall be ap4 plied uniformly to all Indian tribes and communities.

5 ‘‘(4) For purposes of this subsection, the sanitation

6 deficiency levels for an individual or community sanitation

7 facility serving Indian homes are as follows:

8 ‘‘(A) A level I deficiency is a sanitation facility

9 serving an individual or community—

10 ‘‘(i) which complies with all applicable

11 water supply, pollution control, and solid waste

12 disposal laws, and

13 ‘‘(ii) in which the deficiencies relate to rou14 tine replacement, repair, or maintenance needs.

15 ‘‘(B) A level II deficiency is a sanitation facility

16 serving an individual or community—

17 ‘‘(i) which substantially or recently com18 plied with all applicable water supply, pollution

19 control, and solid waste laws, in which the defi20 ciencies relate to small or minor capital im21 provements needed to bring the facility back

22 into compliance;

23 ‘‘(ii) in which the deficiencies relate to cap24 ital improvements that are necessary to enlarge

25 or improve the facilities in order to meet the
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1 current needs for domestic sanitation facilities;

2 or

3 ‘‘(iii) in which the deficiencies relate to the

4 lack of equipment or training by an Indian tribe

5 or community to properly operate and maintain

6 the sanitation facilities.

7 ‘‘(C) A level III deficiency is an individual or

8 community facility with water or sewer service in the

9 home, piped services, or a haul system with holding

10 tanks and interior plumbing, or where major signifi11 cant interruptions to water supply or sewage dis12 posal occur frequently, requiring major capital im13 provements to correct the deficiencies. There is no

14 access to or no approved or permitted solid waste fa15 cility available.

16 ‘‘(D) A level IV deficiency is an individual or

17 community facility where there is no piped water or

18 sewer facilities in the home or the facility has be19 come inoperable due to major component failure or

20 where only a washeteria or central facility exists.

21 ‘‘(E) A level V deficiency is the absence of a

22 sanitation facility, where individual homes do not

23 have access to safe drinking water or adequate

24 wastewater disposal.

25 ‘‘(i) For purposes of this section—
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1 ‘‘(1) the terms ‘facility’ and ‘facilities’ have the

2 same meanings as the terms ‘system’ and ‘systems’

3 unless the context requires otherwise; and

4 ‘‘(2) the term ‘Indian community’ means a geo5 graphic area, a significant proportion of whose in6 habitants are Indians and which is served by or ca7 pable of being served by a facility described in this

8 section.

9 ‘‘SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS.

10 ‘‘(a) The Secretary may use the negotiating authority

11 of the Act of June 25, 1910 (25 U.S.C. 47), to give pref12 erence to any Indian or any enterprise, partnership, cor13 poration, or other type of business organization owned and

14 controlled by an Indian or Indians including former or

15 currently federally recognized Indian tribes in the State

16 of New York (hereinafter referred to as an ‘Indian firm’)

17 in the construction and renovation of Service facilities pur18 suant to section 301 and in the construction of safe water

19 and sanitary waste disposal facilities pursuant to section

20 302. Such preference may be accorded by the Secretary

21 unless he finds, pursuant to rules and regulations promul22 gated by him, that the project or function to be contracted

23 for will not be satisfactory or such project or function can24 not be properly completed or maintained under the pro25 posed contract. The Secretary, in arriving at his finding,
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1 shall consider whether the Indian or Indian firm will be

2 deficient with respect to (1) ownership and control by In3 dians, (2) equipment, (3) bookkeeping and accounting pro4 cedures, (4) substantive knowledge of the project or func5 tion to be contracted for, (5) adequately trained personnel,

6 or (6) other necessary components of contract perform7 ance.

8 ‘‘(b) For the purpose of implementing the provisions

9 of this title, construction or renovation of facilities con10 structed or renovated in whole or in part by funds made

11 available pursuant to this title are exempt from the Act

12 of March 3, 1931 (40 U.S.C. 276a–276a–5, known as the

13 Davis-Bacon Act.) For all health facilities, staff quarters,

14 and sanitation facilities, construction and renovation sub15 contractors shall be paid wage rates not less than the pre16 vailing wages on similar construction in the locality, as

17 determined by the Indian tribe, Tribes, or tribal organiza18 tions served by such facilities.

19 ‘‘SEC. 304. EXPENDITURE OF NONSERVICE FUNDS FOR REN20 OVATION.

21 ‘‘(a)(1) Notwithstanding any other provision of law,

22 the Secretary is authorized to accept any major expansion,

23 renovation, or modernization by any Indian tribe of any

24 Service facility, or of any other Indian health facility oper25 ated pursuant to a funding agreement entered into under
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1 the Indian Self-Determination and Education Assistance

2 Act, including—

3 ‘‘(A) any plans or designs for such expansion,

4 renovation, or modernization; and

5 ‘‘(B) any expansion, renovation, or moderniza6 tion for which funds appropriated under any Federal

7 law were lawfully expended,

8 but only if the requirements of subsection (b) are met.

9 ‘‘(2) The Secretary shall maintain a separate priority

10 list to address the needs for increased operating expenses,

11 personnel, or equipment for such facilities. The method12 ology for establishing priorities shall be developed by nego13 tiated rulemaking under section 802. The list of priority

14 facilities will be revised annually in consultation with In15 dian tribes and tribal organizations.

16 ‘‘(3) The Secretary shall submit to the President, for

17 inclusion in each report required to be transmitted to the

18 Congress under section 801, the priority list maintained

19 pursuant to paragraph (2).

20 ‘‘(b) The requirements of this subsection are met with

21 respect to any expansion, renovation, or modernization

22 if—

23 ‘‘(1) the tribe or tribal organization—

24 ‘‘(A) provides notice to the Secretary of its

25 intent to expand, renovate, or modernize; and
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1 ‘‘(B) applies to the Secretary to be placed

2 on a separate priority list to address the needs

3 of such new facilities for increased operating ex4 penses, personnel, or equipment; and

5 ‘‘(2) the expansion, renovation, or

6 modernization—

7 ‘‘(A) is approved by the appropriate area

8 director of the Service for Federal facilities; and

9 ‘‘(B) is administered by the Indian tribe or

10 tribal organization in accordance with any ap11 plicable regulations prescribed by the Secretary

12 with respect to construction or renovation of

13 Service facilities.

14 ‘‘(c) If any Service facility which has been expanded,

15 renovated, or modernized by an Indian tribe under this

16 section ceases to be used as a Service facility during the

17 20-year period beginning on the date such expansion, ren18 ovation, or modernization is completed, such Indian tribe

19 shall be entitled to recover from the United States an

20 amount which bears the same ratio to the value of such

21 facility at the time of such cessation as the value of such

22 expansion, renovation, or modernization (less the total

23 amount of any funds provided specifically for such facility

24 under any Federal program that were expended for such

25 expansion, renovation, or modernization) bore to the value
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1 of such facility at the time of the completion of such ex2 pansion, renovation, or modernization.

3 ‘‘SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION,

4 AND MODERNIZATION OF SMALL AMBULA5 TORY CARE FACILITIES.

6 ‘‘(a)(1) The Secretary, in consultation with Indian

7 tribes and tribal organizations, shall make funding avail8 able to Tribes and tribal organizations for the construc9 tion, expansion, or modernization of facilities for the provi10 sion of ambulatory care services to eligible Indians (and

11 noneligible persons as provided in subsections (c)(1)(C)

12 and (b)(2) of this section). Funding made under this sec13 tion may cover up to 100 percent of the costs of such con14 struction, expansion, or modernization. For the purposes

15 of this section, the term ‘construction’ includes the re16 placement of an existing facility.

17 ‘‘(2) Funding under paragraph (1) may only be made

18 available to an Indian tribe or tribal organization oper19 ating an Indian health facility (other than a facility owned

20 or constructed by the Service, including a facility origi21 nally owned or constructed by the Service and transferred

22 to an Indian tribe or tribal organization) pursuant to a

23 funding agreement entered into under the Indian Self-De24 termination and Education Assistance Act.
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1 ‘‘(b)(1) Funding provided under this section may be

2 used only for the construction, expansion, or moderniza3 tion (including the planning and design of such construc4 tion, expansion, or modernization) of an ambulatory care

5 facility—

6 ‘‘(A) located apart from a hospital;

7 ‘‘(B) not funded under section 301 or section

8 307; and

9 ‘‘(C) which, upon completion of such construc10 tion or modernization will—

11 ‘‘(i) have a total capacity appropriate to its

12 projected service population;

13 ‘‘(ii) provide annually no less than 500 pa14 tient visits by eligible Indians and other users

15 who are eligible for services in such facility in

16 accordance with section 807(b)(1)(B); and

17 ‘‘(iii) provide ambulatory care in a service

18 area (specified in the funding agreement en19 tered into under the Indian Self-Determination

20 and Education Assistance Act) with a popu21 lation of no fewer than 1,500 eligible Indians

22 and other users who are eligible for services in

23 such facility in accordance with section

24 807(b)(1)(B).
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1 ‘‘(2) Funding provided under this section may be

2 used only for the cost of that portion of a construction,

3 expansion, or modernization project that benefits the serv4 ice population identified above in subsection (b)(1)(C)(ii)

5 and (iii). The requirements of clauses (ii) and (iii) of para6 graph (1)(C) shall not apply to a Tribe or tribal organiza7 tion applying for funding under this section whose prin8 cipal office for health care administration is located on an

9 island or when such office is not located on a road system

10 providing direct access to an inpatient hospital where care

11 is available to the service population.

12 ‘‘(c)(1) No funding may be made available under this

13 section unless an application or proposal for such funding

14 has been submitted to and approved by the Secretary. An

15 application or proposal for funding under this section shall

16 be submitted in accordance with applicable regulations

17 and shall set forth reasonable assurance by the applicant

18 that, at all times after the construction, expansion, or

19 modernization of a facility carried out pursuant to funding

20 received under this section—

21 ‘‘(A) adequate financial support will be avail22 able for the provision of services at such facility;

23 ‘‘(B) such facility will be available to eligible In24 dians without regard to ability to pay or source of

25 payment; and
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1 ‘‘(C) such facility will, as feasible without di2 minishing the quality or quantity of services pro3 vided to eligible Indians, serve noneligible persons on

4 a cost basis.

5 ‘‘(2) In awarding funding under this section, the Sec6 retary shall give priority to tribes and tribal organizations

7 that demonstrate—

8 ‘‘(A) a need for increased ambulatory care serv9 ices; and

10 ‘‘(B) insufficient capacity to deliver such serv11 ices.

12 ‘‘(3) The Secretary may provide for the establishment

13 of peer review panels, as necessary, to review and evaluate

14 applications and proposals and to advise the Secretary re15 garding such applications using the criteria developed pur16 suant to paragraph (1).

17 ‘‘(d) If any facility (or portion thereof) with respect

18 to which funds have been paid under this section, ceases,

19 within 5 years after completion of the construction, expan20 sion, or modernization carried out with such funds, to be

21 used for the purposes of providing health care services to

22 eligible Indians, all of the right, title, and interest in and

23 to such facility (or portion thereof) shall transfer to the

24 United States unless otherwise negotiated by the Service

25 and the Indian tribe or tribal organization.
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1 ‘‘(e) Funding provided to Indian tribes and tribal or2 ganizations under this section shall be nonrecurring and

3 shall not be available for inclusion in any individual

4 Tribe’s tribal share for an award under the Indian Self5 Determination and Education Assistance Act or for re6 allocation or redesign thereunder.

7 ‘‘SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRA8 TION PROJECT.

9 ‘‘(a) HEALTH CARE DEMONSTRATION PROJECTS.—

10 The Secretary, in consultation with Indian tribes and trib11 al organizations, is authorized to enter into funding agree12 ments with, or make grants or loan guarantees to, Indian

13 tribes or tribal organizations for the purpose of carrying

14 out a health care delivery demonstration project to test

15 alternative means of delivering health care and services

16 through facilities, including but not limited to hospice, tra17 ditional Indian health, and child care facilities to Indians.

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

19 projects pursuant to this section, may authorize funding

20 for the construction and renovation of hospitals, health

21 centers, health stations, and other facilities to deliver

22 health care services and is authorized to—

23 ‘‘(1) waive any leasing prohibition;

24 ‘‘(2) permit carryover of funds appropriated for

25 the provision of health care services;
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1 ‘‘(3) permit the use of other available funds;

2 ‘‘(4) permit the use of funds or property do3 nated from any source for project purposes;

4 ‘‘(5) provide for the reversion of donated real or

5 personal property to the donor; and

6 ‘‘(6) permit the use of Service funds to match

7 other funds, including Federal funds.

8 ‘‘(c) CRITERIA.—(1) The Secretary shall develop and

9 publish regulations, through rulemaking under section

10 802, for the review and approval of applications submitted

11 under this section. The Secretary may enter into a con12 tract or funding agreement or award a grant under this

13 section for projects which meet the following criteria:

14 ‘‘(A) There is a need for a new facility or pro15 gram or the reorientation of an existing facility or

16 program.

17 ‘‘(B) A significant number of Indians, including

18 those with low health status, will be served by the

19 project.

20 ‘‘(C) The project has the potential to deliver

21 services in an efficient and effective manner.

22 ‘‘(D) The project is economically viable.

23 ‘‘(E) The Indian tribe or tribal organization has

24 the administrative and financial capability to admin25 ister the project.
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1 ‘‘(F) The project is integrated with providers of

2 related health and social services and is coordinated

3 with, and avoids duplication of, existing services.

4 ‘‘(2) The Secretary may provide for the establishment

5 of peer review panels, as necessary, to review and evaluate

6 applications and using the criteria developed pursuant to

7 paragraph (1).

8 ‘‘(3) The Secretary shall give priority to applications

9 for demonstration projects in each of the following service

10 units to the extent that such applications are timely filed

11 and meet the criteria specified in paragraph (1):

12 ‘‘(i) Cass Lake, Minnesota.

13 ‘‘(ii) Clinton, Oklahoma.

14 ‘‘(iii) Harlem, Montana.

15 ‘‘(iv) Mescalero, New Mexico.

16 ‘‘(v) Owyhee, Nevada.

17 ‘‘(vi) Parker, Arizona.

18 ‘‘(vii) Schurz, Nevada.

19 ‘‘(viii) Winnebago, Nebraska.

20 ‘‘(ix) Ft. Yuma, California.

21 ‘‘(d) TECHNICAL ASSISTANCE.—The Secretary shall

22 provide such technical and other assistance as may be nec23 essary to enable applicants to comply with the provisions

24 of this section.
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1 ‘‘(e) SERVICE TO INELIGIBLE PERSONS.—The au2 thority to provide services to persons otherwise ineligible

3 for the health care benefits of the Service and the author4 ity to extend hospital privileges in Service facilities to non5 Service health practitioners as provided in section 807

6 may be included, subject to the terms of such section, in

7 any demonstration project approved pursuant to this sec8 tion.

9 ‘‘(f) EQUITABLE TREATMENT.—For purposes of sub10 section (c)(1)(A), the Secretary shall, in evaluating facili11 ties operated under any funding agreement entered into

12 with the Service under the Indian Self-Determination and

13 Education Assistance Act, use the same criteria that the

14 Secretary uses in evaluating facilities operated directly by

15 the Service.

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

17 The Secretary shall ensure that the planning, design, con18 struction, renovation, and expansion needs of Service and

19 non-Service facilities which are the subject of a funding

20 agreement for health services entered into with the Service

21 under the Indian Self-Determination and Education As22 sistance Act, are fully and equitably integrated into the

23 implementation of the health care delivery demonstration

24 projects under this section.
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1 ‘‘SEC. 307. LAND TRANSFER.

2 ‘‘(a) The Bureau of Indian Affairs is authorized to

3 transfer, at no cost, up to 5 acres of land at the Chemawa

4 Indian School, Salem, Oregon, to the Service for the provi5 sion of health care services. The land authorized to be

6 transferred by this section is that land adjacent to land

7 under the jurisdiction of the Service and occupied by the

8 Chemawa Indian Health Center.

9 ‘‘(b) Notwithstanding any other provision of law, the

10 Bureau of Indian Affairs and all other agencies and de11 partments of the United States are authorized to transfer,

12 at no cost, land and improvements to the Service for the

13 provision of health care services. The Secretary is author14 ized to accept such land and improvements for such pur15 poses.

16 ‘‘SEC. 308. LEASES.

17 ‘‘(a) Notwithstanding any other provision of law, the

18 Secretary is authorized, in carrying out the purposes of

19 this Act, to enter into leases with Indian tribes and tribal

20 organizations for periods not in excess of 20 years. Prop21 erty leased by the Secretary from an Indian tribe or tribal

22 organization may be reconstructed or renovated by the

23 Secretary pursuant to an agreement with such Indian

24 tribe or tribal organization.
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1 ‘‘(b) The Secretary may enter into leases, contracts,

2 and other legal agreements with Indian tribes or tribal or3 ganizations which hold title to—

4 ‘‘(1) a leasehold interest in; or

5 ‘‘(2) a beneficial interest in (where title is held

6 by the United States in trust for the benefit of a

7 Tribe); facilities used for the administration and de8 livery of health services by the Service or by pro9 grams operated by Indian tribes or tribal organiza10 tions to compensate such Indian tribes or tribal or11 ganizations for costs associated with the use of such

12 facilities for such purposes, and such leases shall be

13 considered as operating leases for the purposes of

14 scoring under the Budget Enforcement Act of 1990,

15 notwithstanding any other provision of law. Such

16 costs include rent, depreciation based on the useful

17 life of the building, principal and interest paid or ac18 crued, operation and maintenance expenses, and

19 other expenses determined by regulation to be allow20 able pursuant to regulations under section 105(l) of

21 the Indian Self-Determination and Education Assist22 ance Act.
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1 ‘‘SEC. 309. LOANS, LOAN GUARANTEES, AND LOAN REPAY2 MENT.

3 ‘‘(a) There is established in the Treasury of the

4 United States a fund to be known as the Health Care Fa5 cilities Loan Fund (hereinafter referred to as the

6 ‘HCFLF’) to provide to Indian tribes and tribal organiza7 tions direct loans, or guarantees for loans, for construction

8 of health care facilities (including but not limited to inpa9 tient facilities, outpatient facilities, associated staff quar10 ters and specialized care facilities such as behavioral

11 health and elder care facilities).

12 ‘‘(b) The Secretary is authorized to issue regulations,

13 developed through rulemaking as set out in section 802,

14 to provide standards and procedures for governing such

15 loans and loan guarantees, subject to the following condi16 tions:

17 ‘‘(1) The principal amount of a loan or loan

18 guarantee may cover 100 percent of eligible costs,

19 including but not limited to planning, design, financ20 ing, site land development, construction, rehabilita21 tion, renovation, conversion, improvements, medical

22 equipment and furnishings, other facility-related

23 costs and capital purchase (but excluding staffing).

24 ‘‘(2) The cumulative total of the principal of di25 rect loans and loan guarantees, respectively, out-
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1 standing at any one time shall not exceed such limi2 tations as may be specified in appropriation Acts.

3 ‘‘(3) In the discretion of the Secretary, the pro4 gram may be administered by the Service or the

5 Health Resources and Services Administration

6 (which shall be specified by regulation).

7 ‘‘(4) The Secretary may make or guarantee a

8 loan with a term of the useful estimated life of the

9 facility, or 25 years, whichever is shorter.

10 ‘‘(5) The Secretary may allocate up to 100 per11 cent of the funds available for loans or loan guaran12 tees in any year for the purpose of planning and ap13 plying for a loan or loan guarantee.

14 ‘‘(6) The Secretary may accept an assignment

15 of the revenue of an Indian tribe or tribal organiza16 tion as security for any direct loan or loan guarantee

17 under this section.

18 ‘‘(7) In the planning and design of health facili19 ties under this section, users eligible under section

20 807(b) may be included in any projection of patient

21 population.

22 ‘‘(8) The Secretary shall not collect loan appli23 cation, processing, or other similar fees from Indian

24 tribes or tribal organizations applying for direct

25 loans or loan guarantees under this section.
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1 ‘‘(9) Service funds authorized under loans or

2 loan guarantees in this section shall be eligible for

3 use in matching other Federal funds.

4 ‘‘(c)(1) The HCFLF shall consist of—

5 ‘‘(A) such sums as may be initially appropriated

6 to the HCFLF and as may be subsequently appro7 priated to the fund under paragraph (2);

8 ‘‘(B) such amounts as may be collected from

9 borrowers; and

10 ‘‘(C) all interest earned on amounts in the

11 HCFLF.

12 ‘‘(2) There are authorized to be appropriated such

13 sums as may be necessary to initiate the HCFLF. For

14 each fiscal year after the initial year in which funds are

15 appropriated to the HCFLF, there is authorized to be ap16 propriated an amount equal to the sum of the amount col17 lected by the HCFLF during the preceding fiscal year,

18 and all accrued interest.

19 ‘‘(3) All amounts appropriated, collected, or earned

20 relative to the HCFLF shall remain available until ex21 pended.

22 ‘‘(d) Amounts in the HCFLF and available pursuant

23 to appropriation Acts may be expended by the Secretary

24 to make loans under this section to an Indian tribe or trib25 al organization pursuant to a funding agreement entered
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1 into under the Indian Self-Determination and Education

2 Assistance Act.

3 ‘‘(e) The Secretary of the Treasury shall invest such

4 amounts of the HCFLF as such Secretary determines are

5 not required to meet current withdrawals from the

6 HCFLF. Such investments may be made only in interest7 bearing obligations of the United States. For such pur8 pose, such obligations may be acquired on original issue

9 at the issue price, or by purchase of outstanding obliga10 tions at the market price. Any obligation acquired by the

11 fund may be sold by the Secretary of the Treasury at the

12 market price.

13 ‘‘(f) The Secretary is authorized to establish a pro14 gram to provide grants to Indian tribes and tribal organi15 zations for the purpose of repaying all or part of any loan

16 obtained by an Indian tribe or tribal organization for con17 struction and renovation of health care facilities (including

18 inpatient facilities, outpatient facilities, associated staff

19 quarters and specialized care facilities). Loans eligible for

20 such repayment grants shall include loans that have been

21 obtained under this section or otherwise.

22 ‘‘SEC. 310. TRIBAL LEASING.

23 ‘‘Indian tribes and tribal organizations providing

24 health care services pursuant to a funding agreement en25 tered into under the Indian Self-Determination and Edu-
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1 cation Assistance Act may lease permanent structures for

2 the purpose of providing such health care services without

3 obtaining advance approval in appropriation Acts.

4 ‘‘SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES

5 JOINT VENTURE PROGRAM.

6 ‘‘(a) The Secretary shall make arrangements with In7 dian tribes and tribal organizations to establish joint ven8 ture demonstration projects under which an Indian tribe

9 or tribal organization shall expend tribal, private, or other

10 available funds, for the acquisition or construction of a

11 health facility for a minimum of 10 years, under a no12 cost lease, in exchange for agreement by the Service to

13 provide the equipment, supplies, and staffing for the oper14 ation and maintenance of such a health facility. A Tribe

15 or tribal organization may use tribal funds, private sector,

16 or other available resources, including loan guarantees, to

17 fulfill its commitment under this subsection. A Tribe that

18 has begun and substantially completed the process of ac19 quisition or construction of a health facility shall be eligi20 ble to establish a joint venture project with the Service

21 using such health facility.

22 ‘‘(b)(1) The Secretary shall make such an arrange23 ment with an Indian tribe or tribal organization only if—

24 ‘‘(A) the Secretary first determines that the In25 dian tribe or tribal organization has the administra-
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1 tive and financial capabilities necessary to complete

2 the timely acquisition or construction of the health

3 facility described in paragraph (1), and

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

5 meets the need criteria which shall be developed

6 through the negotiated rulemaking process provided

7 for under section 802.

8 ‘‘(2) The Secretary shall negotiate an agreement with

9 the Indian tribe or tribal organization regarding the con10 tinued operation of the facility at the end of the initial

11 10 year no-cost lease period.

12 ‘‘(c) An Indian tribe or tribal organization that has

13 entered into a written agreement with the Secretary under

14 this subsection, and that breaches or terminates without

15 cause such agreement, shall be liable to the United States

16 for the amount that has been paid to the Tribe or tribal

17 organization, or paid to a third party on the Tribe’s or

18 tribal organization’s behalf, under the agreement. The

19 Secretary has the right to recover tangible property (in20 cluding supplies), and equipment, less depreciation, and

21 any funds expended for operations and maintenance under

22 this section. The preceding sentence does not apply to any

23 funds expended for the delivery of health care services, or

24 for personnel or staffing.
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1 ‘‘(d) RECOVERY FOR NONUSE.—An Indian tribe or

2 tribal organization that has entered into a written agree3 ment with the Secretary under this subsection shall be en4 titled to recover from the United States an amount that

5 is proportional to the value of such facility should at any

6 time within 10 years the Service ceases to use the facility

7 or otherwise breaches the agreement.

8 ‘‘(e) Wherever ‘health facility’ or ‘health facilities’ is

9 used in this section, they may include quarters needed to

10 provide housing for staff of the tribal health program.

11 ‘‘SEC. 312. LOCATION OF FACILITIES.

12 ‘‘(a) The Bureau of Indian Affairs and the Service

13 shall, in all matters involving the reorganization or devel14 opment of Service facilities, or in the establishment of re15 lated employment projects to address unemployment con16 ditions in economically depressed areas, give priority to

17 locating such facilities and projects on Indian lands if re18 quested by the Indian owner and the Indian tribe with

19 jurisdiction over such lands or other lands owned or leased

20 by the Indian tribe or tribal organization, provided that

21 priority shall be given to Indian land owned by an Indian

22 tribe or Tribes.

23 ‘‘(b) For purposes of this section, the term ‘Indian

24 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 village or regional corporation

11 under the Alaska Native Claims Settlement Act, or

12 any land allotted to any Alaska Native.

13 ‘‘SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH

14 CARE FACILITIES.

15 ‘‘(a) The Secretary shall submit to the President, for

16 inclusion in the report required to be transmitted to the

17 Congress under section 801, a report which identifies the

18 backlog of maintenance and repair work required at both

19 Service and tribal facilities, including new facilities ex20 pected to be in operation in the next fiscal year. The re21 port shall also identify the need for renovation and expan22 sion of existing facilities to support the growth of health

23 care programs.

24 ‘‘(b) The Secretary is authorized to expend mainte25 nance and improvement funds to support maintenance of
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1 newly constructed space only if such space falls within the

2 approved supportable space allocation for the Tribe or

3 tribal organization. ‘Supportable space allocation’ shall be

4 defined through the negotiated rulemaking process pro5 vided for under section 802.

6 ‘‘(c) In addition to using maintenance and improve7 ment funds for renovation, modernization, and expansion

8 of facilities, an Indian tribe or tribal organization may use

9 maintenance and improvement funds for construction of

10 a replacement facility if the costs of renovation of such

11 facility would exceed a maximum renovation cost thresh12 old. The ‘maximum renovation cost threshold’ shall be de13 termined through the negotiated rulemaking process pro14 vided for under section 802.

15 ‘‘SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY OWNED

16 QUARTERS.

17 ‘‘(a)(1) Notwithstanding any other provision of law,

18 an Indian tribe or tribal organization which operates a

19 hospital or other health facility and the federally owned

20 quarters associated therewith pursuant to a funding

21 agreement under the Indian Self-Determination and Edu22 cation Assistance Act shall have the authority to establish

23 the rental rates charged to the occupants of such quarters

24 by providing notice to the Secretary of its election to exer25 cise such authority.
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1 ‘‘(2) In establishing rental rates pursuant to author2 ity of this subsection, an Indian tribe or tribal organiza3 tion shall endeavor to achieve the following objectives:

4 ‘‘(A) To base such rental rates on the reason5 able value of the quarters to the occupants thereof.

6 ‘‘(B) To generate sufficient funds to prudently

7 provide for the operation and maintenance of the

8 quarters, and, subject to the discretion of the Indian

9 tribe or tribal organization, to supply reserve funds

10 for capital repairs and replacement of the quarters.

11 ‘‘(3) Any quarters whose rental rates are established

12 by an Indian tribe or tribal organization pursuant to au13 thority of this subsection shall remain eligible for quarters

14 improvement and repair funds to the same extent as all

15 federally owned quarters used to house personnel in In16 dian Health Services-supported programs;

17 ‘‘(4) An Indian tribe or tribal organization which ex18 ercises the authority provided under this subsection shall

19 provide occupants with no less than 60 days notice of any

20 change in rental rates.

21 ‘‘(b)(1) Notwithstanding any other provision of law,

22 and subject to paragraph (2) hereof, an Indian tribe or

23 a tribal organization which operates federally owned quar24 ters pursuant to a funding agreement under the Indian

25 Self-Determination and Education Assistance Act shall
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1 have the authority to collect rents directly from Federal

2 employees who occupy such quarters in accordance with

3 the following:

4 ‘‘(A) The Indian tribe or tribal organization

5 shall notify the Secretary and the subject Federal

6 employees of its election to exercise its authority to

7 collect rents directly from such Federal employees.

8 ‘‘(B) Upon receipt of a notice described in sub9 paragraph (A), the Federal employees shall pay

10 rents for occupancy of such quarters directly to the

11 Indian tribe or tribal organization and the Secretary

12 shall have no further authority to collect rents from

13 such employees through payroll deduction or other14 wise.

15 ‘‘(C) Such rent payments shall be retained by

16 the Indian tribe or tribal organization and shall not

17 be made payable to or otherwise be deposited with

18 the United States.

19 ‘‘(D) Such rent payments shall be deposited

20 into a separate account which shall be used by the

21 Indian tribe or tribal organization for the mainte22 nance (including capital repairs and replacement)

23 and operation of the quarters and facilities as the

24 Indian tribe or tribal organization shall determine.
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1 ‘‘(2) If an Indian tribe or tribal organization which

2 has made an election under paragraph (1) hereof requests

3 retrocession of its authority to directly collect rents from

4 Federal employees occupying federally owned quarters,

5 such retrocession shall become effective on the earlier of—

6 ‘‘(A) the first day of the month that begins no

7 less than 180 days after the Indian tribe or tribal

8 organization notifies the Secretary of its desire to

9 retrocede; or

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

11 agreed by the Secretary and the Indian tribe or trib12 al organization.

13 ‘‘(c) To the extent that an Indian tribe or tribal orga14 nization, pursuant to authority granted in subsection (a)

15 hereof, establishes rental rates for federally owned quar16 ters provided to a Federal employee in Alaska, such rents

17 may be based on the cost of comparable private rental

18 housing in the nearest established community with a year19 round population of 1,500 or more individuals.

20 ‘‘SEC. 315. APPLICABILITY OF BUY AMERICAN REQUIRE21 MENT.

22 ‘‘(a) The Secretary shall ensure that the require23 ments of the Buy American Act apply to all procurements

24 made with funds provided pursuant to the authorization

25 contained in section 318, provided that Indian tribes and
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1 tribal organizations shall be exempt from these require2 ments.

3 ‘‘(b) If it has been finally determined by a court or

4 Federal agency that any person intentionally affixed a

5 label bearing a ‘Made in America’ inscription, or any in6 scription with the same meaning, to any product sold in

7 or shipped to the United States that is not made in the

8 United States, such person shall be ineligible to receive

9 any contract or subcontract made with funds provided

10 pursuant to the authorization contained in section 309,

11 pursuant to the debarment, suspension, and ineligibility

12 procedures described in sections 9.400 through 9.409 of

13 title 48, Code of Federal Regulations.

14 ‘‘(c) For purposes of this section, the term ‘Buy

15 American Act’ means title III of the Act entitled ‘An Act

16 making appropriations for the Treasury and Post Office

17 Departments for the fiscal year ending June 30, 1934,

18 and for other purposes’, approved March 3, 1933 (41

19 U.S.C. 10a et seq.).

20 ‘‘SEC. 316. OTHER FUNDING FOR FACILITIES.

21 ‘‘Notwithstanding any other provision of law—

22 ‘‘(1) the Secretary is authorized to accept from

23 any source, including Federal and State agencies,

24 funds that are available for the construction of

25 health care facilities and use such funds to plan, de-
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1 sign, and construct health care facilities for Indians

2 and to place such funds into funding agreements au3 thorized under the Indian Self-Determination and

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

5 between the Secretary and an Indian tribe or tribal

6 organization, provided that receipt of such funds

7 shall have not an effect on the priorities established

8 pursuant to section 301;

9 ‘‘(2) the Secretary is authorized to enter into

10 interagency agreements with other Federal agencies

11 or State agencies and other entities and to accept

12 funds from such Federal or State agencies or other

13 sources to provide for the planning, design, and con14 struction of health care facilities to be administered

15 by the Service or by Indian tribes or tribal organiza16 tions under the Indian Self-Determination and Edu17 cation Assistance Act in order to carry out the pur18 poses of this Act, together with the purposes for

19 which such funds are appropriated to such other

20 Federal department or State agency or for which the

21 funds were otherwise provided;

22 ‘‘(3) any Federal agency to which funds for the

23 construction of health care facilities are appropriated

24 is authorized to transfer such funds to the Secretary

25 for the construction of health care facilities to carry
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1 out the purposes of this Act as well as the purposes

2 for which such funds are appropriated to such other

3 Federal agency; and

4 ‘‘(4) the Secretary, through the Service, shall

5 establish standards by regulation, developed by rule6 making under section 802, for the planning, design,

7 and construction of health care facilities serving In8 dians under this Act.

9 ‘‘SEC. 317. AUTHORIZATION OF APPROPRIATIONS.

10 ‘‘There are authorized to be appropriated such sums

11 as may be necessary for each fiscal year through fiscal

12 year 2013 to carry out this title.

13 ‘‘TITLE IV—ACCESS TO HEALTH

14 SERVICES

15 ‘‘SEC. 401. TREATMENT OF PAYMENTS UNDER MEDICARE

16 PROGRAM.

17 ‘‘(a) Any payments received by the Service or by an

18 Indian tribe or tribal organization pursuant to a funding

19 agreement under the Indian Self-Determination and Edu20 cation Assistance Act or by an urban Indian organization

21 pursuant to title V of this Act for services provided to

22 Indians eligible for benefits under title XVIII of the Social

23 Security Act shall not be considered in determining appro24 priations for health care and services to Indians.
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1 ‘‘(b) Nothing in this Act authorizes the Secretary to

2 provide services to an Indian beneficiary with coverage

3 under title XVIII of the Social Security Act, as amended,

4 in preference to an Indian beneficiary without such cov5 erage.

6 ‘‘(c) Notwithstanding any other provision of this title

7 or of title XVIII of the Social Security Act, payments to

8 which facility of the Service is entitled by reason of this

9 section shall be placed in a special fund to be held by the

10 Secretary and first used (to such extent or in such

11 amounts as are provided in appropriation Acts) for the

12 purpose of making any improvements in the programs of

13 the Service which may be necessary to achieve or maintain

14 compliance with the applicable conditions and require15 ments of this title and of title XVIII of the Social Security

16 Act. Any funds to be reimbursed which are in excess of

17 the amount necessary to achieve or maintain such condi18 tions and requirements shall, subject to the consultation

19 with Tribes being served by the service unit, be used for

20 reducing the health resource deficiencies of the Indian

21 tribes. This paragraph shall not apply upon the election

22 of an Indian tribe or tribal organization under section 405

23 of the Indian Health Care Improvement Act to receive

24 payments directly.
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1 ‘‘SEC. 402. TREATMENT OF PAYMENTS UNDER MEDICAID

2 PROGRAM.

3 ‘‘(a) Notwithstanding any other provision of law, pay4 ments to which any facility of the Service (including a hos5 pital, nursing facility, intermediate care facility for the

6 mentally retarded, or any other type of facility which pro7 vides services for which payment is available under title

8 XIX of the Social Security Act) is entitled under a State

9 plan by reason of section 1911 of such Act shall be placed

10 in a special fund to be held by the Secretary and first

11 used (to such extent or in such amounts as are provided

12 in appropriation Acts) for the purpose of making any im13 provements in the facilities of such Service which may be

14 necessary to achieve or maintain compliance with the ap15 plicable conditions and requirements of such title. Any

16 payments which are in excess of the amount necessary to

17 achieve or maintain such conditions and requirements

18 shall, subject to the consultation with Tribes being served

19 by the service unit, be used for reducing the health re20 source deficiencies of the Indian tribes. In making pay21 ments from such fund, the Secretary shall ensure that

22 each service unit of the Service receives 100 percent of

23 the amounts to which the facilities of the Service, for

24 which such service unit makes collections, are entitled by

25 reason of section 1911 of the Social Security Act. This

26 subsection shall not apply to Indian tribes and tribal orga-
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1 nizations that elect under section 405 to receive payments

2 directly.

3 ‘‘(b) Any payments received under section 1911 of

4 the Social Security Act for services provided to Indians

5 eligible for benefits under title XIX of the Social Security

6 Act shall not be considered in determining appropriations

7 for the provision of health care and services to Indians.

8 ‘‘(c) For provisions relating to the authority of cer9 tain Indian tribes and tribal organizations to elect to di10 rectly bill for, and receive payment for, health care services

11 provided by a hospital or clinic of such Tribes or tribal

12 organizations and for which payment may be made under

13 this title, see section 405 of the Indian Health Care Im14 provement Act.

15 ‘‘SEC. 403. REPORT.

16 ‘‘(a) The Secretary shall submit to the President, for

17 inclusion in the report required to be transmitted to the

18 Congress under section 801, an accounting on the amount

19 and use of funds made available to the Service pursuant

20 to this title as a result of reimbursements through titles

21 XVIII and XIX of the Social Security Act, as amended.

22 ‘‘(b) If an Indian tribe or tribal organization receives

23 funding from the Service under the Indian Self-Deter24 mination and Education Assistance Act or an urban In25 dian organization receives funding from the Indian Health
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1 Service under title V of the Indian Health Care Improve2 ment Act receives reimbursements or payments under title

3 XVIII (medicare), title XIX (medicaid), or title XXI (chil4 dren’s health insurance program) of the Social Security

5 Act, such Indian tribe, tribal organization, or urban In6 dian organization shall provide to the Service a list of each

7 provider enrollment number (or other identifier) under

8 which it receives payments.

9 ‘‘SEC. 404. GRANTS TO AND FUNDING AGREEMENTS WITH

10 THE SERVICE, INDIAN TRIBES, TRIBAL ORGA11 NIZATIONS, AND URBAN INDIAN ORGANIZA12 TIONS.

13 ‘‘(a) The Secretary shall make grants to or enter into

14 funding agreements with Indian tribes and tribal organi15 zations to assist such organizations in establishing and ad16 ministering programs on or near Federal Indian reserva17 tions and trust areas and in or near Alaska Native villages

18 to assist individual Indians to—

19 ‘‘(1) enroll under section 1818 of part A and

20 sections 1836 and 1837 of part B of title XVIII of

21 the Social Security Act;

22 ‘‘(2) pay premiums for coverage; and

23 ‘‘(3) apply for medical assistance provided pur24 suant to title XIX (medicaid) and XXI (children’s
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1 health insurance program) of the Social Security

2 Act.

3 ‘‘(b) The Secretary shall place conditions as deemed

4 necessary to effect the purpose of this section in any fund5 ing agreement or grant which the Secretary makes with

6 any Indian tribe or tribal organization pursuant to this

7 section. Such conditions shall include, but are not limited

8 to, requirements that the organization successfully under9 take to—

10 ‘‘(1) determine the population of Indians to be

11 served that are or could be recipients of benefits

12 under titles XVIII, XIX, and XXI of the Social Se13 curity Act;

14 ‘‘(2) assist individual Indians in becoming fa15 miliar with and using such benefits;

16 ‘‘(3) provide transportation to such individual

17 Indians to the appropriate offices for enrollment or

18 applications for medical assistance; and

19 ‘‘(4) develop and implement—

20 ‘‘(A) a schedule of income levels to deter21 mine the extent of payments of premiums by

22 such organizations for coverage of needy indi23 viduals; and

24 ‘‘(B) methods of improving the participa25 tion of Indians in receiving the benefits pro-
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1 vided under titles XVIII, XIX, and XXI of the

2 Social Security Act.

3 ‘‘(c) The Secretary may enter into an agreement with

4 an Indian tribe, tribal organization, or urban Indian orga5 nization which provides for the receipt and processing of

6 applications for medical assistance under title XIX of the

7 Social Security Act and benefits under titles XVIII and

8 XXI of the Social Security Act by a Service facility or

9 a health care program administered by such Indian tribe,

10 tribal organization, or urban Indian organization pursuant

11 to a funding agreement under the Indian Self-Determina12 tion and Education Assistance Act or a grant or contract

13 entered into with an urban Indian organization under title

14 V of this Act. Notwithstanding any other provision of law,

15 such agreements shall provide for reimbursement of the

16 cost of outreach, education regarding eligibility and bene17 fits, and translation when such services are provided. The

18 reimbursement may be included in an encounter rate or

19 be made on a fee for service basis as appropriate for the

20 provider. When necessary to carry out the terms of this

21 section, the Secretary, acting through the Health Care Fi22 nancing Administration or the Service, may enter into

23 agreements with a State (or political subdivision thereof)

24 to facilitate cooperation between the State and the Service,

25 Indian tribe, or tribal organization.
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1 ‘‘(d)(1) The Secretary shall make grants or enter into

2 contracts with urban Indian organizations to assist such

3 organizations in establishing and administering programs

4 to assist individual urban Indians to—

5 ‘‘(A) enroll under section 1818 of part A and

6 sections 1836 and 1837 of part B of title XVIII

7 (medicare) of the Social Security Act;

8 ‘‘(B) pay premiums on behalf of such individ9 uals for coverage under title XVIII of the Social Se10 curity Act; and

11 ‘‘(C) apply for medical assistance provided

12 under title XIX (medicaid) of the Social Security

13 Act and for child health assistance under title XXI

14 (child health insurance program) of the Social Secu15 rity Act.

16 ‘‘(2) The Secretary shall include in the grants or con17 tracts made or entered into under paragraph (1) require18 ments that are—

19 ‘‘(A) consistent with the requirements imposed

20 by the Secretary under subsection (b);

21 ‘‘(B) appropriate to urban Indian organizations

22 and urban Indians; and

23 ‘‘(C) necessary to effect the purposes of this

24 section.
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1 ‘‘SEC. 405. DIRECT BILLING AND REIMBURSEMENT OF

2 MEDICARE, MEDICAID, AND OTHER THIRD3 PARTY PAYORS.

4 ‘‘(a)(1) An Indian tribe or tribal organization may

5 directly bill for, and receive payment for, health care serv6 ices provided by such health program for which payment

7 is made under title XVIII of the Social Security Act (42

8 U.S.C. 1395 et seq.) (medicare), under a State plan for

9 medical assistance approved under title XIX of the Social

10 Security Act (42 U.S.C. 1396 et seq.) (medicaid), under

11 a State’s children’s health insurance plan approved under

12 title XXI of the Social Security Act (42 U.S.C. 1397aa

13 et seq.) or from any other third-party payor.

14 ‘‘(2) The third sentence of section 1905(b) of the So15 cial Security Act (42 U.S.C. 1396d(b)) and the second

16 sentence of section 2101(c) of the Social Security Act (42

17 U.S.C. 1397aa(c)) shall apply for purposes of reimburse18 ment under the medicaid or children’s health insurance

19 program for health care services directly billed under the

20 program established under this section.

21 ‘‘(b)(1) Each Indian tribe or tribal organization exer22 cising the option described in subsection (a) of this section

23 shall be reimbursed directly under the medicare, medicaid,

24 and children’s health insurance programs for services fur25 nished, without regard to the provisions of section 1880(c)

26 of the Social Security Act (42 U.S.C. 1395qq(c)) and sec-
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1 tion 402(a) of this title, but all funds so reimbursed shall

2 first be used by the health program for the purpose of

3 making any improvements in the facility or health pro4 grams that may be necessary to achieve or maintain com5 pliance with the conditions and requirements applicable

6 generally to such health services under the medicare, med7 icaid, or children’s health insurance program. Any funds

8 so reimbursed which are in excess of the amount necessary

9 to achieve or maintain such conditions or requirements

10 shall be used to provide additional health services, im11 provements in its health care facilities, or otherwise to

12 achieve the health objectives provided for under section 3

13 of this Act.

14 ‘‘(2) The amounts paid to the health programs exer15 cising the option described in subsection (a) of this section

16 shall be subject to all auditing requirements applicable to

17 programs administered directly by the Service and to fa18 cilities participating in the medicare, medicaid, and chil19 dren’s health insurance programs.

20 ‘‘(3) Notwithstanding section 1880(c) of the Social

21 Security Act (42 U.S.C. 1395qq(c)) or section 402(a) of

22 this title, no payment may be made out of the special fund

23 described in section 1880(c) of the Social Security Act (42

24 U.S.C. 1395qq(c)), or section 402(a) of this title, for the

25 benefit of any health program exercising the option de-
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1 scribed in subsection (a) of this section during the period

2 of such participation.

3 ‘‘(c) The Secretary, and with the assistance of the

4 Administrator of the Health Care Financing Administra5 tion, shall examine on an ongoing basis and implement

6 any administrative changes that may be necessary to fa7 cilitate direct billing and reimbursement under the pro8 gram established under this section, including any agree9 ments with States that may be necessary to provide for

10 direct billing under the medicaid or children’s health in11 surance program.

12 ‘‘(d) A participant in the program established under

13 this section may withdraw from participation in the same

14 manner and under the same conditions that an Indian

15 tribe or tribal organization may retrocede a contracted

16 program to the Secretary under authority of the Indian

17 Self-Determination and Education Assistance Act (25

18 U.S.C. 450 et seq.). All cost accounting and billing author19 ity under the program established under this section shall

20 be returned to the Secretary upon the Secretary’s accept21 ance of the withdrawal of participation in this program.

22 ‘‘SEC. 406. REIMBURSEMENT FROM CERTAIN THIRD PAR23 TIES OF COSTS OF HEALTH SERVICES.

24 ‘‘(a) Except as provided in subsection (g), the United

25 States, an Indian tribe, or tribal organization shall have
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1 the right to recover the reasonable charges billed or ex2 penses incurred by the Secretary, an Indian tribe, or tribal

3 organization in providing health services, through the

4 Service, an Indian tribe, or tribal organization to any indi5 vidual to the same extent that such individual, or any non6 governmental provider of such services, would be eligible

7 to receive reimbursement or indemnification for such

8 charges or expenses if—

9 ‘‘(1) such services had been provided by a non10 governmental provider, and

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

12 such charges or expenses and did pay such expenses.

13 ‘‘(b) Except as provided in subsection (g), an urban

14 Indian organization shall have the right to recover the rea15 sonable charges billed or expenses incurred by the organi16 zation in providing health services to any individual to the

17 same extent that such individual, or any other nongovern18 mental provider of such services, would be eligible to re19 ceive reimbursement or indemnification for such charges

20 or expenses if such individual had been required to pay

21 such charges or expenses and did pay such charges or ex22 penses.

23 ‘‘(c) Subsections (a) and (b) shall provide a right of

24 recovery against any State, only if the injury, illness, or
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1 disability for which health services were provided is cov2 ered under—

3 ‘‘(1) workers’ compensation laws, or

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

5 plan or program.

6 ‘‘(d) No law of any State, or of any political subdivi7 sion of a State and no provision of any contract entered

8 into or renewed after the date of enactment of the Indian

9 Health Care Amendments of 1988, shall prevent or hinder

10 the right of recovery of the United States, an Indian tribe,

11 or tribal organization under subsection (a) or an urban

12 Indian organization under subsection (b).

13 ‘‘(e) No action taken by the United States, an Indian

14 tribe, or tribal organization to enforce the right of recovery

15 provided under subsection (a), or by an urban Indian or16 ganization to enforce the right of recovery provided under

17 subsection (b), shall affect the right of any person to any

18 damages (other than damages for the cost of health serv19 ices provided by the Secretary through the Service).

20 ‘‘(f) The United States, an Indian tribe, or tribal or21 ganization may enforce the right of recovery provided

22 under subsection (a), and an urban Indian organization

23 may enforce the right of recovery provided under sub24 section (b), by—
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1 ‘‘(1) intervening or joining in any civil action or

2 proceeding brought—

3 ‘‘(A) by the individual for whom health

4 services were provided by the Secretary, an In5 dian tribe, tribal organization, or urban Indian

6 organization; or

7 ‘‘(B) by any representative or heirs of such

8 individual, or

9 ‘‘(2) instituting a civil action.

10 All reasonable efforts shall be made to provide notice of

11 such action to the individual to whom health services were

12 provided, either before or during the pendency of such ac13 tion.

14 ‘‘(g) Absent specific written authorization by the gov15 erning body of an Indian tribe for the period of such au16 thorization which may not be for a period of more than

17 one year, and which may be revoked at any time upon

18 written notice by the governing body to the Service, the

19 United States shall not have a right of recovery under this

20 section if the injury, illness, or disability for which health

21 services were provided is covered under a self-insurance

22 plan funded by an Indian tribe, tribal organization, or

23 urban Indian organization. However, where such tribal au24 thorization is provided, the Service may receive and ex-
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1 pend such funds for the provision of additional health

2 services.

3 ‘‘(h) In any action brought to enforce the provisions

4 of this section, a prevailing plaintiff shall be awarded its

5 reasonable attorneys fees and costs of litigation.

6 ‘‘(i) Where an insurance company or employee benefit

7 plan fails or refuses to pay the amount due under sub8 section (a) of this section for services provided to an indi9 vidual who is a beneficiary, participant, or insured of such

10 company or plan, the United States, Indian tribe, or tribal

11 organization shall have a right to assert and pursue all

12 the claims and remedies against such company or plan,

13 and against the fiduciaries of such company or plan, that

14 the individual could assert or pursue under applicable

15 Federal, State, or tribal law.

16 ‘‘(j) Where an insurance company or employee benefit

17 plan fails or refuses to pay the amounts due under sub18 section (b) for health services provided to an individual

19 who is a beneficiary, participant, or insured of such com20 pany or plan, the urban Indian organization shall have a

21 right to assert and pursue all the claims and remedies

22 against such company or plan, and against the fiduciaries

23 of such company or plan, that the individual could assert

24 or pursue under applicable Federal or State law.
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1 ‘‘(k) Notwithstanding any other provision in law, the

2 Service, an Indian tribe, tribal organization, or an urban

3 Indian organization shall have a right of recovery for any

4 otherwise reimbursable claim filed on a current HCFA–

5 1500 or UB–92 form, or the current electronic format,

6 or their successors. No health plan shall deny payment

7 because a claim has not been submitted in a unique format

8 that differs from such forms.

9 ‘‘SEC. 407. CREDITING OF REIMBURSEMENTS.

10 ‘‘(a) Except as provided in section 202(d), this title,

11 and section 807, all reimbursements received or recovered,

12 under authority of this Act, Public Law 87–693 (42

13 U.S.C. 2651 et seq.), or any other provision of law, by

14 reason of the provision of health services by the Service

15 or by an Indian tribe or tribal organization under a fund16 ing agreement pursuant to the Indian Self-Determination

17 and Education Assistance Act or by an urban Indian orga18 nization funded under title V shall be retained by the Serv19 ice or that Tribe or tribal organization and shall be avail20 able for the facilities, and to carry out the programs, of

21 the Service or that Tribe or tribal organization to provide

22 health care services to Indians.

23 ‘‘(b) The Service may not offset or limit the amount

24 of funds obligated to any service unit or entity receiving
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1 funding from the Service because of the receipt of reim2 bursements under subsection (a).

3 ‘‘SEC. 408. PURCHASING HEALTH CARE COVERAGE.

4 ‘‘Tribes, tribal organizations, and urban Indian orga5 nizations are authorized to use funding from the Secretary

6 under this Act to purchase managed care coverage for In7 dian Health Services beneficiaries (including authority to

8 purchase insurance to limit the financial risks of such enti9 ties) from—

10 ‘‘(1) a tribally owned and operated managed

11 care plan;

12 ‘‘(2) a State or locally authorized or licensed

13 managed care plan; or

14 ‘‘(3) a health insurance provider.

15 ‘‘SEC. 409. INDIAN HEALTH SERVICE, DEPARTMENT OF VET16 ERANS AFFAIRS, AND OTHER FEDERAL AGEN17 CY HEALTH FACILITIES AND SERVICES SHAR18 ING.

19 ‘‘(a) The Secretary shall examine the feasibility of en20 tering into arrangements or expanding existing arrange21 ments for the sharing of medical facilities and services be22 tween the Indian Health Service and the Veterans Admin23 istration, and other appropriate Federal agencies, includ24 ing those within the Department, and shall, in accordance

25 with subsection (b), prepare a report on the feasibility of
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1 such an arrangement and submit such report to the Con2 gress by no later than September 30, 2001, provided that

3 the Secretary may not finalize any such agreement with4 out first consulting with the affected Indian tribes.

5 ‘‘(b) The Secretary shall not take any action under

6 this section or under subchapter IV of chapter 81 of title

7 38, United States Code, which would impair—

8 ‘‘(1) the priority access of any Indian to health

9 care services provided through the Indian Health

10 Service;

11 ‘‘(2) the quality of health care services provided

12 to any Indian through the Indian Health Service;

13 ‘‘(3) the priority access of any veteran to health

14 care services provided by the Veterans Administra15 tion;

16 ‘‘(4) the quality of health care services provided

17 to any veteran by the Veterans Administration;

18 ‘‘(5) the eligibility of any Indian to receive

19 health services through the Indian Health Service;

20 or

21 ‘‘(6) the eligibility of any Indian who is a vet22 eran to receive health services through the Veterans

23 Administration (provided that the Service, the In24 dian tribe or tribal organization shall be reimbursed

25 by the Veterans Administration where services are
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1 provided through the Service, Indian tribes or tribal

2 organizations to beneficiaries eligible for services

3 from the Veterans Administration, notwithstanding

4 any other provision of law).

5 ‘‘(c) The Director is authorized to enter into agree6 ments with other Federal agencies to assist in achieving

7 parity in services for Indians. Nothing in this section may

8 be construed as creating any right of a veteran to obtain

9 health services from the Indian Health Service.

10 ‘‘SEC. 410. PAYOR OF LAST RESORT.

11 ‘‘The Indian Health Service, and programs operated

12 by Tribes, tribal organizations, or urban Indian organiza13 tions shall be the payor of last resort for services provided

14 to persons eligible for services from these programs, not15 withstanding any Federal, State, or local law to the con16 trary, unless such law explicitly provides otherwise.

17 ‘‘SEC. 411. PAYMENT OR REIMBURSEMENT FOR SERVICES.

18 ‘‘Notwithstanding any other provision of law, the In19 dian Health Service, Indian tribes, tribal organizations,

20 and urban Indian organizations (notwithstanding limita21 tions on who is eligible to receive services from such enti22 ty) shall be eligible to receive payment or reimbursement

23 for services provided by such entities from any federally

24 funded health care program, unless there is an explicit
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1 prohibition on such payments in the applicable authorizing

2 statute.

3 ‘‘SEC. 412. TUBA CITY DEMONSTRATION PROJECT.

4 ‘‘Notwithstanding any other provision of law, includ5 ing the Anti-Deficiency Act, provided the Indian tribes to

6 be served approve, the Service in the Tuba City Service

7 Unit is authorized to enter into a demonstration project

8 with the State of Arizona under which the Service would

9 provide certain specified medicaid services to Indian

10 Health Services/medicaid eligibles in return for payment

11 on a capitated basis from the State of Arizona and is au12 thorized to purchase insurance to limit its financial risks

13 under this project. This project may be extended to other

14 service units in Arizona, subject to the approval of the In15 dian tribes to be served in such service units, the Service,

16 and the State of Arizona.

17 ‘‘SEC. 413. ACCESS TO FEDERAL INSURANCE.

18 ‘‘Notwithstanding the provisions of title 5, United

19 States Code, executive order, or administrative regulation,

20 an Indian tribe or tribal organization carrying out pro21 grams under the Indian Self-Determination and Edu22 cation Assistance Act or an urban Indian organization car23 rying out programs under title V of this Act shall be enti24 tled to purchase coverage, rights, and benefits for the em25 ployees of such Indian tribe, tribal organization, or urban
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1 Indian organization under chapter 89 of title 5, United

2 States Code, (relating to health insurance) and chapter

3 87 of title 5, United States Code, (relating to life insur4 ance) if necessary employee deductions and agency con5 tributions in payment for the coverage, rights, and bene6 fits for the period of employment with such Indian tribe,

7 tribal organization, or urban Indian organization are cur8 rently deposited in the applicable Employee’s Fund under

9 title 5, United States Code.

10 ‘‘SEC. 414. CONSULTATION AND RULEMAKING.

11 ‘‘(a) CONSULTATION.—Prior to the adoption of any

12 policy or regulation by the Health Care Financing Admin13 istration, the Secretary shall—

14 ‘‘(1) identify the impact such policy or regula15 tion may have on the Service, Indian tribes, tribal

16 organizations, and urban Indian organizations;

17 ‘‘(2) provide to the Service, Indian tribes, tribal

18 organizations, and urban Indian organizations the

19 information described in paragraph (1); and

20 ‘‘(3) engage in consultation with the Service,

21 Indian tribes, tribal organizations, and urban Indian

22 organizations prior to enacting any such policy or

23 regulation. Such consultation shall be consistent

24 with the requirements of Executive Order 13084 of

25 May 14, 1998.
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1 ‘‘(b) RULEMAKING.—The Health Care Financing Ad2 ministration shall participate in the negotiated rulemaking

3 provided for under title VIII of this Act with regard to

4 any regulations necessary to implement the provisions of

5 this title that relate to the Social Security Act.’’.

6 ‘‘SEC. 415. LIMITATION ON SECRETARY’S WAIVER AUTHOR7 ITY.

8 ‘‘Notwithstanding any other provision of law, the Sec9 retary may not waive the application of section

10 1902(a)(13)(D) to any State Plan under title XIX of the

11 Social Security Act.

12 ‘‘SEC. 416. CHILDREN’S HEALTH INSURANCE PROGRAM

13 FUNDS.

14 ‘‘(a) DIRECT FUNDING.—The Secretary is authorized

15 to enter into agreements directly with the Indian Health

16 Service and Indian tribes and tribal organizations under

17 which such entities will provide children’s health insurance

18 program-like services to Indians who reside in a service

19 area on or near an Indian reservation. Such agreements

20 may provide for funding under a block grant or such other

21 mechanism as is agreed upon by the Secretary and the

22 Indian Health Service, Indian tribe, or tribal organization.

23 Such agreements may not be made contingent on the ap24 proval of the State in which the Indians to be served re25 side.
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1 ‘‘(b) TRANSFER.—Notwithstanding any other provi2 sion of law, a State may transfer funds to which it is,

3 or would otherwise be, entitled under title XXI of the So4 cial Security Act to the Indian Health Service, Indian

5 tribes, and tribal organizations to be administered to

6 achieve the purposes and objectives of such title under

7 agreements between the State and recipient entity or

8 under an agreement directly between the recipient entity

9 and the Health Care Financing Administration.

10 ‘‘SEC. 417. WAIVER OF MEDICARE AND MEDICAID SANC11 TIONS.

12 ‘‘Notwithstanding any other provision of law, the In13 dian Health Service or an Indian tribe or tribal organiza14 tion operating a health program under the Indian Self15 Determination and Education Assistance Act shall be enti16 tled to seek a waiver of sanctions imposed under title

17 XVIII, XIX, or XXI of the Social Security Act as if it

18 were directly responsible for administering the State

19 health care program.

20 ‘‘SEC. 418. SAFE HARBOR.

21 ‘‘(a) The term ‘remuneration’ as used in sections

22 1128A and 1128B of the Social Security Act (42 U.S.C.

23 1320a–7a and 1320a–7b) shall not include any exchange

24 of anything of value between or among—
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1 ‘‘(1) any Indian tribe or tribal organization that

2 administers health programs under the authority of

3 the Indian Self-Determination and Education Assist4 ance Act (25 U.S.C. 450 et seq.);

5 ‘‘(2) any such Indian tribe or tribal organiza6 tion and the Indian Health Service;

7 ‘‘(3) any such Indian tribe or tribal organiza8 tion and any patient served or eligible for service

9 under such programs, including patients served or

10 eligible for service pursuant to section 813 of Public

11 Law 94–437 (25 U.S.C. 1680c); or

12 ‘‘(4) any such Indian tribe or tribal organiza13 tion and any third party required by contract, sec14 tion 206 or 207 of Public Law 94–437 (42 U.S.C.

15 1621e or 1621f), or other applicable law, to pay or

16 reimburse the reasonable health care costs incurred

17 by the United States or any such Indian tribe or

18 tribal organization;

19 if the exchange arises from or relates to such health pro20 grams.

21 ‘‘(b) An Indian tribe, tribal organization, or urban

22 Indian organization that administers health programs

23 under the authority of the Indian Self-Determination and

24 Education Assistance Act (25 U.S.C. 450 et seq.) or title

25 V of the Indian Health Care Improvement Act shall be
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1 deemed to be an agency of the United States and immune

2 from liability under the Sherman Act (15 U.S.C. 1 et

3 seq.), the Clayton Act (15 U.S.C. 12 et seq.), the Robin4 son-Patman Act, the Federal Trade Commission Act (15

5 U.S.C. 41 et seq.), and any other Federal, State, or local

6 antitrust laws, with regard to any transaction, agreement,

7 or conduct that relates to such programs.

8 ‘‘SEC. 419. COST SHARING.

9 ‘‘(a) COINSURANCE, COPAYMENTS, AND

10 DEDUCTIBLES.—Notwithstanding any other provision of

11 Federal or State law, no Indian who is eligible for services

12 under title XVIII, XIX, or XXI of the Social Security Act,

13 or any other federally funded health programs may be

14 charged a deductible, copayment, or coinsurance for any

15 service provided by or through the Indian Health Service,

16 an Indian tribe, tribal organization, or urban Indian orga17 nization, nor may the payment or reimbursement due to

18 the Indian Health Service or an Indian tribe, tribal organi19 zation, or urban Indian organization be reduced by the

20 amount of the deductible, copayment, or coinsurance that

21 would be due from the Indian but for the operation of

22 this section. For the purposes of this section, ‘through’

23 shall include services provided directly, by referral, or

24 under contracts or other arrangements between the Indian
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1 Health Service, Indian tribe, tribal organization, or urban

2 Indian organization and another health provider.

3 ‘‘(b) PREMIUMS.—

4 ‘‘(1) MEDICAID AND CHILD HEALTH INSUR5 ANCE PROGRAM.—Notwithstanding any other provi6 sion of Federal or State law, no Indian who is other7 wise eligible for services under title XIX (medicaid)

8 or title XXI (children’s health insurance program) of

9 the Social Security Act may be charged a premium

10 as a condition of receiving benefits from the pro11 gram.

12 ‘‘(2) MEDICARE ENROLLMENT PREMIUM PEN13 ALTIES.—Notwithstanding any other provision of

14 Federal or State law, no Indian (as that term is de15 fined in section 4 of the Indian Health Care Im16 provement Act) who is eligible for Medicare, but for

17 the payment of premiums, shall be charged a penalty

18 for enrolling in Medicare at a time later than the

19 person might otherwise have been eligible. This pro20 hibition applies whether the Indian pays for the pre21 miums directly or the premiums are paid by another

22 person or entity, including a State, the Indian

23 Health Service, an Indian tribe, tribal organization,

24 or an urban Indian organization.
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1 ‘‘(c) MEDICALLY NEEDY PROGRAM SPEND-DOWN.—

2 For the purposes of any medically needy option under a

3 State’s Medicaid plan under title XIX of the Social Secu4 rity Act, the cost of providing services to an Indian in a

5 health program of the Indian Health Service, an Indian

6 tribe, tribal organization, or urban Indian organization

7 shall be deemed to have been an expenditure for health

8 care by the person applying for Medicaid.

9 ‘‘(d) ESTATE RECOVERY.—Notwithstanding any

10 other provision of Federal or State law, the following prop11 erty may not be included when determining eligibility for

12 services or implementing estate recovery rights under title

13 XVIII, XIX, or XXI of the Social Security Act, or other

14 health care programs funded in whole or part with Federal

15 moneys—

16 ‘‘(1) income derived from rents, leases, or royal17 ties of property held in trust for individuals by the

18 Federal Government;

19 ‘‘(2) income derived from rents, leases, royal20 ties, or natural resources (including timber and fish21 ing activities) resulting from the exercise of federally

22 protected rights, whether collected by an individual

23 or tribal group, and distributed to individuals;

24 ‘‘(3) property, including interests in real prop25 erty currently or formerly held in trust by the Fed-
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1 eral Government which is protected under applicable

2 Federal, State or tribal law or custom from recourse

3 and including public domain allotments; and

4 ‘‘(4) property that has unique religious or cul5 tural significance or that supports subsistence or

6 traditional lifestyle according to applicable tribal law

7 or custom.

8 ‘‘(e) MEDICAL CHILD SUPPORT RECOVERY.—Not9 withstanding any other provision of law, a parent shall not

10 be responsible for reimbursing a State or the Federal Gov11 ernment for the cost of medical services provided to a child

12 by or through the Indian Health Service, an Indian tribe,

13 tribal organization, or urban Indian organization. For the

14 purposes of this subsection, ‘through’ shall include services

15 provided directly, by referral, or under contracts or other

16 arrangements between the Indian Health Service, Indian

17 tribe, tribal organization or urban Indian organization and

18 another health provider.

19 ‘‘SEC. 420. MANAGED CARE.

20 ‘‘(a) RECOVERY FROM MANAGED CARE PLANS.—(1)

21 Notwithstanding any other provision in law, the Indian

22 Health Service, an Indian tribe, tribal organization, or

23 urban Indian organization shall have a right of recovery

24 under section 408 of this title from all private and public

25 health plans, including medicare, medicaid, children’s
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1 health insurance, and privately managed care plans for the

2 reasonable costs of delivering health services to Indians

3 entitled to receive services from the Service, an Indian

4 tribe, tribal organization, or urban Indian organization.

5 ‘‘(2) No provision of a contract, regulation or statute

6 may be relied upon or interpreted to deny or reduce pay7 ments otherwise due under this section, except to the ex8 tent the Service, Indian tribe, tribal organization, or urban

9 Indian organization has entered into an agreement with

10 the managed care plan regarding services to be provided

11 or rates to be paid, provided that such an agreement may

12 not be made a prerequisite for such payments to be made.

13 ‘‘(3) Payments due under this section may not be less

14 than those paid to a ‘preferred provider’ under the man15 aged care plan or, in the event there is no such rate, the

16 usual and customary fee for equivalent services.

17 ‘‘(4) A managed care plan may not deny payment

18 under this section because the insured or covered bene19 ficiary of the plan has not submitted a claim.

20 ‘‘(5) Notwithstanding paragraphs (1) through (4) of

21 this section, the Indian Health Service, an Indian tribe,

22 tribal organization, or urban Indian organization that pro23 vides a health service to an Indian entitled under title XIX

24 (medicaid) or enrolled under title XXI (children’s health

25 insurance program) of the Social Security Act to receive
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1 such services shall have the right to be paid directly by

2 the State’s Medicaid or children’s health insurance pro3 gram notwithstanding any agreements the State may have

4 entered into with managed care organizations or pro5 viders.

6 ‘‘(6) A managed care organization that is enrolled in

7 a State Medicaid program must as a condition of such

8 enrollment offer a contract to health programs adminis9 tered by the Indian Health Service, an Indian tribe, tribal

10 organization, or urban Indian organization that provides

11 health services in the geographic area served by the man12 aged care organization and such contract (or other pro13 vider participation agreement) shall contain terms and

14 conditions of participation and payment no more restric15 tive or onerous than those provided for in this section.

16 ‘‘(b) PROHIBIT AUTO- AND DEFAULT ASSIGN17 MENT.—Notwithstanding any other provision of law or

18 any waiver granted by the Secretary, no Indian may be

19 assigned automatically or by default under any managed

20 care plan paid under title XIX (medicaid) or title XXI

21 (children’s health insurance program) of the Social Secu22 rity Act unless the person had the option of enrolling in

23 a managed care plan or health program administered by

24 the Service, an Indian tribe, tribal organization, or urban

25 Indian organization in which case an Indian may be as-
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1 signed only to such a managed care plan or health pro2 gram.

3 ‘‘(c) INDIAN MANAGED CARE PLANS.—Notwith4 standing any other provision of law, any State entering

5 into agreements with one or more managed care organiza6 tions to provide services under title XIX or title XXI of

7 the Social Security Act must enter into such an agreement

8 with the Service, an Indian tribe, tribal organization, or

9 urban Indian organization that can provide services to In10 dians who may be eligible or required to enroll in such

11 a managed care plan similar to those to be offered by

12 other managed care organizations. The Secretary and the

13 State are hereby authorized to waive requirements regard14 ing discrimination, capitalization, and other matters that

15 might otherwise prevent the Indian managed care organi16 zation or health program from meeting Federal or State

17 standards applicable to such organizations, provided such

18 Indian managed care organization or health program must

19 be able to offer its Indian enrollees services of an equiva20 lent quality to that required of other managed care organi21 zations.

22 ‘‘(d) ADVERTISING.—A managed care organization

23 entering into contracts to provide services to Indians on

24 or near an Indian reservation shall provide a certificate

25 of coverage or similar type of document that is written
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1 in the Indian language of the majority of the Indian popu2 lation residing on such reservation.

3 ‘‘SEC. 421. NAVAJO NATION MEDICAID AGENCY.

4 ‘‘(a) Notwithstanding any other provision of law, the

5 Secretary is authorized to treat the Navajo Nation as a

6 State for the purposes of title XIX of the Social Security

7 Act, to provide services to Indians living within the bound8 aries of the Navajo Nation.

9 ‘‘(b) Notwithstanding any other provision of law, the

10 Secretary shall have the authority to assign and pay all

11 funds for the provision of services to Indians living within

12 the boundaries of the Navajo Nation under title XIX of

13 the Social Security Act and related administrative funds

14 under title XIX (medicaid) of the Social Security Act,

15 which are currently paid to or would otherwise be paid

16 to the States of Arizona, New Mexico, and Utah, to an

17 entity established by the Navajo Nation and approved by

18 the Secretary, which shall be denominated the Navajo Na19 tion Medicaid Agency.

20 ‘‘(c) The Navajo Nation Medicaid Agency shall serve

21 Indians living within the boundaries of the Navajo Nation

22 and shall have the same authority and perform the same

23 functions as other single State medicaid agencies.

24 ‘‘(d) The Secretary is authorized to directly assist the

25 Navajo Nation in the development and implementation of
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1 a Navajo Nation Medicaid Agency for the administration,

2 eligibility, payment, and delivery of Medicaid eligible serv3 ices, including western and traditional Navajo healing

4 services, within the Navajo Nation.

5 ‘‘(e) Notwithstanding section 1905(b) of the Social

6 Security Act, the Federal medical assistance percentage

7 shall be 100 per centum with respect to amounts the Nav8 ajo Nation Medicaid Agency expends for medical assist9 ance for services and for related administrative costs.

10 ‘‘(f) The Secretary is further authorized to assist the

11 Navajo Nation by providing funding including demonstra12 tion grant funding for this project.

13 ‘‘(g) The Secretary shall have the authority to waive

14 applicable provisions of title XIX of the Social Security

15 Act to establish, develop, and implement the Navajo Na16 tion Medicaid Agency.

17 ‘‘(h) In the option of the Navajo Nation, the Sec18 retary is authorized to treat the Navajo Nation as a State

19 for the purposes of title XXI (children’s health insurance

20 program) under terms equivalent to those described in

21 subsections (a) through (g) of this section.

22 ‘‘SEC. 422. INDIAN ADVISORY COMMITTEES.

23 ‘‘(a) NATIONAL INDIAN TECHNICAL ADVISORY

24 GROUP.—The Health Care Financing Administration

25 shall establish and fund the expenses of a National Indian
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1 Technical Advisory Group which shall have no fewer than

2 14 members including at least 1 member designated by

3 the Indian tribes and tribal organizations in each service

4 area, 1 urban Indian organization representative, and 1

5 member representing the Indian Health Service. The

6 scope of the activities of such group shall be established

7 under section 802. Such scope shall include providing com8 ment on and advice regarding the programs funded under

9 titles XVIII, XIX, and XXI of the Social Security Act or

10 any other health care program funded (in whole or part)

11 by the Health Care Financing Administration.

12 ‘‘(b) INDIAN MEDICAID ADVISORY COMMITTEES.—

13 The Health Care Financing Administration shall establish

14 and provide funding for an Indian Medicaid Advisory

15 Committee made up of designees of the Indian Health

16 Service, Indian tribes, tribal organizations, and urban In17 dian organizations in each State in which the Indian

18 Health Service directly operates a health program or in

19 which there is 1 or more Indian tribe, tribal organization,

20 or urban Indian organization.

21 ‘‘SEC. 423. LIMITATIONS ON CHARGES.

22 ‘‘No provider of health services that is eligible to re23 ceive payments or reimbursements from under title XVIII,

24 XIX, or XXI of the Social Security Act or from any feder-
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1 ally funded (whether in whole or part) health care pro2 gram may seek to recover payment for services—

3 ‘‘(1) that are covered under and furnished to an

4 individual eligible for the contract health services

5 program operated by the Indian Health Service, by

6 an Indian tribe or tribal organization or furnished to

7 an urban Indian eligible for health services pur8 chased by an urban Indian organization (as those

9 terms are defined in section 4 of the Indian Health

10 Care Improvement Act), an amount in excess of the

11 lowest amount paid by any other payor for com12 parable services; or

13 ‘‘(2) for examinations or other diagnostic proce14 dures that are not medically necessary if such proce15 dures have already been performed by the referring

16 Indian health program and reported to the provider.

17 ‘‘SEC. 424. AUTHORIZATION OF APPROPRIATIONS.

18 ‘‘There are authorized to be appropriated such sums

19 as may be necessary for each fiscal year through fiscal

20 year 2013 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 authority of the Act of November 2, 1921

10 (25 U.S.C. 13), popularly 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 subsection 506, shall in17 clude such conditions as the Secretary considers necessary

18 to effect the purpose of this title in any contract which

19 the Secretary enters into with, or in any grant the Sec20 retary makes to, any urban Indian organization pursuant

21 to this title.

22 ‘‘SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION

23 OF HEALTH CARE AND REFERRAL SERVICES.

24 ‘‘(a) Under authority of the Act of November 2, 1921

25 (25 U.S.C. 13), popularly known as the Snyder Act, the
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1 Secretary, through the Service, shall enter into contracts

2 with, and make grants to, urban Indian organizations for

3 the provision of health care and referral services for urban

4 Indians. Any such contract or grant shall include require5 ments that the urban Indian organization successfully un6 dertake 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
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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) The Secretary, through the Service, shall by reg5 ulation adopted pursuant to section 520 prescribe the cri6 teria for selecting urban Indian organizations to enter into

7 contracts or receive grants under this section. Such cri8 teria shall, among other factors, include—

9 ‘‘(1) the extent of unmet health care needs of

10 urban Indians in the urban center or centers in11 volved;

12 ‘‘(2) the size of the urban Indian population in

13 the urban center or centers involved;

14 ‘‘(3) the extent, if any, to which the activities

15 set forth in subsection (a) would duplicate any

16 project funded under this title;

17 ‘‘(4) the capability of an urban Indian organiza18 tion to perform the activities set forth in subsection

19 (a) and to enter into a contract with the Secretary

20 or to meet the requirements for receiving a grant

21 under this section;

22 ‘‘(5) the satisfactory performance and success23 ful completion by an urban Indian organization of

24 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) The Secretary shall facilitate access to, or pro9 vide, health promotion and disease prevention services for

10 urban Indians through grants made to urban Indian orga11 nizations administering contracts entered into pursuant to

12 this section or receiving grants under subsection (a).

13 ‘‘(d)(1) The Secretary shall facilitate access to, or

14 provide, immunization services for urban Indians through

15 grants made to urban Indian organizations administering

16 contracts entered into or receiving grants under this sec17 tion.

18 ‘‘(2) For purposes of this subsection, the term ‘immu19 nization services’ means services to provide without charge

20 immunizations against vaccine-preventable diseases.

21 ‘‘(e)(1) The Secretary shall facilitate access to, or

22 provide, mental health services for urban Indians through

23 grants made to urban Indian organizations administering

24 contracts entered into pursuant to this section or receiving

25 grants under subsection (a).
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1 ‘‘(2) A grant may not be made under this subsection

2 to an urban Indian organization until that organization

3 has prepared, and the Service has approved, an assess4 ment of the mental health needs of the urban Indian popu5 lation concerned, the mental health services, and other re6 lated resources available to that population, the barriers

7 to obtaining those services and resources, and the needs

8 that are unmet by such services and resources.

9 ‘‘(3) Grants may be made under this subsection—

10 ‘‘(A) to prepare assessments required under

11 paragraph (2);

12 ‘‘(B) to provide outreach, educational, and re13 ferral services to urban Indians regarding the avail14 ability of direct behavioral health services, to educate

15 urban Indians about behavioral health issues and

16 services, and effect coordination with existing behav17 ioral health providers in order to improve services to

18 urban Indians;

19 ‘‘(C) to provide outpatient behavioral health

20 services to urban Indians, including the identifica21 tion and assessment of illness, therapeutic treat22 ments, case management, support groups, family

23 treatment, and other treatment; and
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1 ‘‘(D) to develop innovative behavioral health

2 service delivery models which incorporate Indian cul3 tural support systems and resources.

4 ‘‘(f)(1) The Secretary shall facilitate access to, or

5 provide, services for urban Indians through grants to

6 urban Indian organizations administering contracts en7 tered into pursuant to this section or receiving grants

8 under subsection (a) to prevent and treat child abuse (in9 cluding sexual abuse) among urban Indians.

10 ‘‘(2) A grant may not be made under this subsection

11 to an urban Indian organization until that organization

12 has prepared, and the Service has approved, an assess13 ment that documents the prevalence of child abuse in the

14 urban Indian population concerned and specifies the serv15 ices and programs (which may not duplicate existing serv16 ices and programs) for which the grant is requested.

17 ‘‘(3) Grants may be made under this subsection—

18 ‘‘(A) to prepare assessments required under

19 paragraph (2);

20 ‘‘(B) for the development of prevention, train21 ing, and education programs for urban Indian popu22 lations, including child education, parent education,

23 provider training on identification and intervention,

24 education on reporting requirements, prevention
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1 campaigns, and establishing service networks of all

2 those involved in Indian child protection; and

3 ‘‘(C) to provide direct outpatient treatment

4 services (including individual treatment, family

5 treatment, group therapy, and support groups) to

6 urban Indians who are child victims of abuse (in7 cluding sexual abuse) or adult survivors of child sex8 ual abuse, to the families of such child victims, and

9 to urban Indian perpetrators of child abuse (includ10 ing sexual abuse).

11 ‘‘(4) In making grants to carry out this subsection,

12 the Secretary shall take into consideration—

13 ‘‘(A) the support for the urban Indian organiza14 tion demonstrated by the child protection authorities

15 in the area, including committees or other services

16 funded under the Indian Child Welfare Act of 1978

17 (25 U.S.C. 1901 et seq.), if any;

18 ‘‘(B) the capability and expertise demonstrated

19 by the urban Indian organization to address the

20 complex problem of child sexual abuse in the com21 munity; and

22 ‘‘(C) the assessment required under paragraph

23 (2).

24 ‘‘(g) The Secretary, through the Service, may enter

25 into a contract with, or make grants to, an urban Indian
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1 organization that provides or arranges for the provision

2 of health care services (through satellite facilities, provider

3 networks, or otherwise) to urban Indians in more than 1

4 urban center.

5 ‘‘SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINA6 TION OF UNMET HEALTH CARE NEEDS.

7 ‘‘(a) Under authority of the Act of November 2, 1921

8 (25 U.S.C. 13), popularly known as the Snyder Act, the

9 Secretary, through the Service, may enter into contracts

10 with, or make grants to, urban Indian organizations situ11 ated in urban centers for which contracts have not been

12 entered into, or grants have not been made, under section

13 503. The purpose of a contract or grant made under this

14 section shall be the determination of the matters described

15 in subsection (b)(1) in order to assist the Secretary in as16 sessing the health status and health care needs of urban

17 Indians in the urban center involved and determining

18 whether the Secretary should enter into a contract or

19 make a grant under section 503 with respect to the urban

20 Indian organization which the Secretary has entered into

21 a contract with, or made a grant to, under this section.

22 ‘‘(b) Any contract entered into, or grant made, by

23 the Secretary under this section shall include requirements

24 that—
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1 ‘‘(1) the urban Indian organization successfully

2 undertakes to—

3 ‘‘(A) document the health care status and

4 unmet health care needs of urban Indians in

5 the urban center involved; and

6 ‘‘(B) with respect to urban Indians in the

7 urban center involved, determine the matters

8 described in paragraphs (2), (3), (4), and (7) of

9 section 503(b); and

10 ‘‘(2) the urban Indian organization complete

11 performance of the contract, or carry out the re12 quirements of the grant, within 1 year after the date

13 on which the Secretary and such organization enter

14 into such contract, or within 1 year after such orga15 nization receives such grant, whichever is applicable.

16 ‘‘(c) The Secretary may not renew any contract en17 tered into, or grant made, under this section.

18 ‘‘SEC. 505. EVALUATIONS; RENEWALS.

19 ‘‘(a) The Secretary shall develop procedures to evalu20 ate compliance with grant requirements under this title

21 and compliance with, and performance of contracts en22 tered into by urban Indian organizations under this title.

23 Such procedures shall include provisions for carrying out

24 the requirements of this section.
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1 ‘‘(b) The Secretary shall evaluate the compliance of

2 each urban Indian organization which has entered into a

3 contract or received a grant under section 503 with the

4 terms of such contract or grant. For purposes of this eval5 uation, the Secretary, in determining the capacity of an

6 urban Indian organization to deliver quality patient care

7 shall, at the option of the organization—

8 ‘‘(1) through the Service conduct an annual on9 site evaluation of the organization; or

10 ‘‘(2) accept in lieu of such onsite evaluation evi11 dence of the organization’s provisional or full accred12 itation by a private independent entity recognized by

13 the Secretary for purposes of conducting quality re14 views or providers participating in the Medicare pro15 gram under title XVIII of the Social Security Act.

16 ‘‘(c) If, as a result of the evaluations conducted under

17 this section, the Secretary determines that an urban In18 dian organization has not complied with the requirements

19 of a grant or complied with or satisfactorily performed a

20 contract under section 503, the Secretary shall, prior to

21 renewing such contract or grant, attempt to resolve with

22 such organization the areas of noncompliance or unsatis23 factory performance and modify such contract or grant to

24 prevent future occurrences of such noncompliance or un25 satisfactory performance. If the Secretary determines that
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1 such noncompliance or unsatisfactory performance cannot

2 be resolved and prevented in the future, the Secretary

3 shall not renew such contract or grant with such organiza4 tion and is authorized to enter into a contract or make

5 a grant under section 503 with another urban Indian or6 ganization which is situated in the same urban center as

7 the urban Indian organization whose contract or grant is

8 not renewed under this section.

9 ‘‘(d) In determining whether to renew a contract or

10 grant with an urban Indian organization under section

11 503 which has completed performance of a contract or

12 grant under section 504, the Secretary shall review the

13 records of the urban Indian organization, the reports sub14 mitted under section 507, and, in the case of a renewal

15 of a contract or grant under section 503, shall consider

16 the results of the onsite evaluations or accreditations

17 under subsection (b).

18 ‘‘SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS.

19 ‘‘(a) Contracts with urban Indian organizations en20 tered into pursuant to this title shall be in accordance with

21 all Federal contracting laws and regulations relating to

22 procurement except that in the discretion of the Secretary,

23 such contracts may be negotiated without advertising and

24 need not conform to the provisions of the Act of August

25 24, 1935 (40 U.S.C. 270a et seq.).
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1 ‘‘(b) Payments under any contracts or grants pursu2 ant to this title shall, notwithstanding any term or condi3 tion of such contract or grant—

4 ‘‘(1) be made in their entirety by the Secretary

5 to the urban Indian organization by no later than

6 the end of the first 30 days of the funding period

7 with respect to which the payments apply, unless the

8 Secretary determines through an evaluation under

9 section 505 that the organization is not capable of

10 administering such payments in their entirety; and

11 ‘‘(2) if unexpended by the urban Indian organi12 zation during the funding period with respect to

13 which the payments initially apply, shall be carried

14 forward for expenditure with respect to allowable or

15 reimbursable costs incurred by the organization dur16 ing one or more subsequent funding periods without

17 additional justification or documentation by the or18 ganization as a condition of carrying forward the ex19 penditure of such funds.

20 ‘‘(c) Notwithstanding any provision of law to the con21 trary, the Secretary may, at the request or consent of an

22 urban Indian organization, revise or amend any contract

23 entered into by the Secretary with such organization under

24 this title as necessary to carry out the purposes of this

25 title.
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1 ‘‘(d) Contracts with or grants to urban Indian organi2 zations and regulations adopted pursuant to this title shall

3 include provisions to assure the fair and uniform provision

4 to urban Indians of services and assistance under such

5 contracts or grants by such organizations.

6 ‘‘(e) Urban Indians, as defined under section 4(t) of

7 this Act, shall be eligible for health care or referral serv8 ices provided pursuant to this title.

9 ‘‘SEC. 507. REPORTS AND RECORDS.

10 ‘‘(a) For each fiscal year during which an urban In11 dian organization receives or expends funds pursuant to

12 a contract entered into, or a grant received, pursuant to

13 this title, such organization shall submit to the Secretary

14 on a basis no more frequent than every 6 months,

15 including—

16 ‘‘(1) in the case of a contract or grant under

17 section 503, information gathered pursuant to para18 graph (5) of subsection (a) of such section;

19 ‘‘(2) information on activities conducted by the

20 organization pursuant to the contract or grant;

21 ‘‘(3) an accounting of the amounts and purpose

22 for which Federal funds were expended; and

23 ‘‘(4) a minimum set of data, using uniformly

24 defined elements, that is specified by the Secretary
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1 in consultation consistent with section 514, with

2 urban Indian organizations.

3 ‘‘(b) The reports and records of the urban Indian or4 ganization with respect to a contract or grant under this

5 title shall be subject to audit by the Secretary and the

6 Comptroller General of the United States.

7 ‘‘(c) The Secretary shall allow as a cost of any con8 tract or grant entered into or awarded under section 502

9 or 503 the cost of an annual independent financial audit

10 conducted by—

11 ‘‘(1) a certified public accountant; or

12 ‘‘(2) a certified public accounting firm qualified

13 to conduct Federal compliance audits.

14 ‘‘SEC. 508. LIMITATION ON CONTRACT AUTHORITY.

15 ‘‘The authority of the Secretary to enter into con16 tracts or to award grants under this title shall be to the

17 extent, and in an amount, provided for in appropriation

18 Acts.

19 ‘‘SEC. 509. FACILITIES.

20 ‘‘(a) The Secretary may make grants to contractors

21 or grant recipients under this title for the lease, purchase,

22 renovation, construction, or expansion of facilities, includ23 ing leased facilities, in order to assist such contractors or

24 grant recipients in complying with applicable licensure or

25 certification requirements.
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1 ‘‘(b) The Secretary, acting through the Service or

2 through the Health Resources and Services Administra3 tion, may provide to contractors or grant recipients under

4 this title loans from the Urban Indian Health Care Facili5 ties Revolving Loan Fund (hereinafter in this section re6 ferred to as the ‘URLF’) described in subsection (c), or

7 guarantees for loans, for the construction, renovation, ex8 pansion, or purchase of health care facilities, subject to

9 the following requirements:

10 ‘‘(1) The principal amount of a loan or loan

11 guarantee may cover 100 percent of the costs (other

12 than staffing) relating to the facility, including plan13 ning, design, financing, site land development, con14 struction, rehabilitation, renovation, conversion,

15 medical equipment, furnishings, and capital pur16 chase.

17 ‘‘(2) The total of the principal of loans and loan

18 guarantees, respectively, outstanding at any one

19 time shall not exceed such limitations as may be

20 specified in appropriation Acts.

21 ‘‘(3) The loan or loan guarantee may have a

22 term of the shorter of the estimated useful life of the

23 facility, or 25 years.

24 ‘‘(4) An urban Indian organization may assign,

25 and the Secretary may accept assignment of, the
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1 revenue of the organization as security for a loan or

2 loan guarantee under this subsection.

3 ‘‘(5) The Secretary shall not collect application,

4 processing, or similar fees from urban Indian organi5 zations applying for loans or loan guarantees under

6 this subsection.

7 ‘‘(c)(1) There is established in the Treasury of the

8 United States a fund to be known as the Urban Indian

9 Health Care Facilities Revolving Loan Fund. The URLF

10 shall consist of—

11 ‘‘(A) such amounts as may be appropriated to

12 the URLF;

13 ‘‘(B) amounts received from urban Indian orga14 nizations in repayment of loans made to such orga15 nizations under paragraph (2); and

16 ‘‘(C) interest earned on amounts in the URLF

17 under paragraph (3).

18 ‘‘(2) Amounts in the URLF may be expended by the

19 Secretary, acting through the Service or the Health Re20 sources and Services Administration, to make loans avail21 able to urban Indian organizations receiving grants or con22 tracts under this title for the purposes, and subject to the

23 requirements, described in subsection (b). Amounts appro24 priated to the URLF, amounts received from urban In25 dian organizations in repayment of loans, and interest on
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1 amounts in the URLF shall remain available until ex2 pended.

3 ‘‘(3) The Secretary of the Treasury shall invest such

4 amounts of the URLF as such Secretary determines are

5 not required to meet current withdrawals from the URLF.

6 Such investments may be made only in interest-bearing

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

8 obligations may be acquired on original issue at the issue

9 price, or by purchase of outstanding obligations at the

10 market price. Any obligation acquired by the URLF may

11 be sold by the Secretary of the Treasury at the market

12 price.

13 ‘‘SEC. 510. OFFICE OF URBAN INDIAN HEALTH.

14 ‘‘There is hereby established within the Service an

15 Office of Urban Indian Health, which shall be responsible

16 for—

17 ‘‘(1) carrying out the provisions of this title;

18 ‘‘(2) providing central oversight of the pro19 grams and services authorized under this title; and

20 ‘‘(3) providing technical assistance to urban In21 dian organizations.

22 ‘‘SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE

23 RELATED SERVICES.

24 ‘‘(a) The Secretary may make grants for the provi25 sion of health-related services in prevention of, treatment
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1 of, rehabilitation of, or school and community-based edu2 cation in, alcohol and substance abuse in urban centers

3 to those urban Indian organizations with which the Sec4 retary has entered into a contract under this title or under

5 section 201.

6 ‘‘(b) Each grant made pursuant to subsection (a)

7 shall set forth the goals to be accomplished pursuant to

8 the grant. The goals shall be specific to each grant as

9 agreed to between the Secretary and the grantee.

10 ‘‘(c) The Secretary shall establish criteria for the

11 grants made under subsection (a), including criteria relat12 ing to the—

13 ‘‘(1) size of the urban Indian population;

14 ‘‘(2) capability of the organization to adequately

15 perform the activities required under the grant;

16 ‘‘(3) satisfactory performance standards for the

17 organization in meeting the goals set forth in such

18 grant, which standards shall be negotiated and

19 agreed to between the Secretary and the grantee on

20 a grant-by-grant basis; and

21 ‘‘(4) identification of need for services.

22 The Secretary shall develop a methodology for allocating

23 grants made pursuant to this section based on such cri24 teria.
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1 ‘‘(d) Any funds received by an urban Indian organiza2 tion under this Act for substance abuse prevention, treat3 ment, and rehabilitation shall be subject to the criteria set

4 forth in subsection (c).

5 ‘‘SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION

6 PROJECTS.

7 ‘‘(a)(1) Notwithstanding any other provision of law,

8 the Oklahoma City Clinic demonstration project shall be

9 treated as a service unit in the allocation of resources and

10 coordination of care and shall not be subject to the provi11 sions of the Indian Self-Determination and Education As12 sistance Act for the term of such project. The Secretary

13 shall provide assistance to such project in the development

14 of resources and equipment and facility needs.

15 ‘‘(2) The Secretary shall submit to the President, for

16 inclusion in the report required to be submitted to the

17 Congress under section 801 for fiscal year 2000, a report

18 on the findings and conclusions derived from the dem19 onstration project specified in paragraph (1).

20 ‘‘(b) Notwithstanding any other provision of law, the

21 Tulsa Clinic demonstration project shall become perma22 nent programs within the Service’s direct care program

23 and continue to be treated as service units in the allocation

24 of resources and coordination of care, and shall continue

25 to meet the requirements and definitions of an urban In-
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1 dian organization in this title, and as such will not be sub2 ject to the provisions of the Indian Self-Determination and

3 Education Assistance Act.

4 ‘‘SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.

5 ‘‘(a) The Secretary shall, through the Office of Urban

6 Indian Health of the Service, make grants or enter into

7 contracts effective no later than September 30, 2002, with

8 urban Indian organizations for the administration of

9 urban Indian alcohol programs that were originally estab10 lished under the National Institute on Alcoholism and Al11 cohol Abuse (hereafter in this section referred to as

12 ‘NIAAA’) and transferred to the Service.

13 ‘‘(b) Grants provided or contracts entered into under

14 this section shall be used to provide support for the con15 tinuation of alcohol prevention and treatment services for

16 urban Indian populations and such other objectives as are

17 agreed upon between the Service and a recipient of a grant

18 or contract under this section.

19 ‘‘(c) Urban Indian organizations that operate Indian

20 alcohol programs originally funded under the NIAAA and

21 subsequently transferred to the Service are eligible for

22 grants or contracts under this section.

23 ‘‘(d) The Secretary shall evaluate and report to the

24 Congress on the activities of programs funded under this

25 section at least every 5 years.
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1 ‘‘SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZA2 TIONS.

3 ‘‘(a) The Secretary shall ensure that the Service, the

4 Health Care Financing Administration, and other oper5 ating divisions and staff divisions of the Department con6 sult, to the greatest extent practicable, with urban Indian

7 organizations (as defined in section 4(w)) prior to taking

8 any action, or approving Federal financial assistance for

9 any action of a State, that may affect urban Indians or

10 urban Indian organizations.

11 ‘‘(b) For purposes of subsection (a), consultation is

12 the open and free exchange of information and opinion

13 among urban Indian organizations and the operating and

14 staff divisions of the Department which leads to mutual

15 understanding and comprehension and which emphasizes

16 trust, respect, and shared responsibility.

17 ‘‘SEC. 515. FEDERAL TORT CLAIMS ACT COVERAGE.

18 ‘‘For purposes of section 224 of the Public Health

19 Service Act of July 1, 1944 (42 U.S.C. 233(a)) with re20 spect to claims by any person, initially filed on or after

21 October 1, 2000, whether or not such person is an Indian

22 or Alaska Native or is served on a fee basis or under other

23 circumstances as permitted by Federal law or regulations,

24 for personal injury, including death, resulting from the

25 performance prior to, including, or after October 1, 2000,

26 of medical, surgical, dental, or related functions, including
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1 the conduct of clinical studies or investigations, or for pur2 poses of section 2679 of title 28, United States Code, with

3 respect to claims by any such person, on or after October

4 1, 2000, for personal injury, including death, resulting

5 from the operation of an emergency motor vehicle, an

6 urban Indian organization that has entered into a contract

7 or received a grant pursuant to this title is deemed to be

8 part of the Public Health Service in the Department of

9 Health and Human Services while carrying out any such

10 contract or grant and its employees (including those act11 ing on behalf of the organization as provided in section

12 2671 of title 28, United States Code, and including an

13 individual who provides health care services pursuant to

14 a personal services contract with an urban Indian organi15 zation 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. Such employees shall be

20 deemed to be acting within the scope of their employment

21 in carrying out the contract or grant when they are re22 quired, by reason of their employment, to perform medical,

23 surgical, dental, or related functions at a facility other

24 than a facility operated by the urban Indian organization

25 pursuant to such contract or grant, but only if such em-
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1 ployees are not compensated for the performance of such

2 functions by a person or entity other than the urban In3 dian organization.

4 ‘‘SEC. 516. URBAN YOUTH TREATMENT CENTER DEM5 ONSTRATION.

6 ‘‘(a) The Secretary shall, through grant or contract,

7 make payment for the construction and operation of at

8 least 2 residential treatment centers in each State de9 scribed in subsection (b) to demonstrate the provision of

10 alcohol and substance abuse treatment services to urban

11 Indian youth in a culturally competent residential setting.

12 ‘‘(b) A State described in this subsection is a State

13 in which—

14 ‘‘(1) there reside urban Indian youth with need

15 for alcohol and substance abuse treatment services

16 in a residential setting; and

17 ‘‘(2) there is a significant shortage of culturally

18 competent residential treatment services for urban

19 Indian youth.

20 ‘‘SEC. 517. USE OF FEDERAL GOVERNMENT FACILITIES AND

21 SOURCES OF SUPPLY.

22 ‘‘(a) The Secretary shall permit an urban Indian or23 ganization that has entered into a contract or received a

24 grant pursuant to this title, in carrying out such contract

25 or grant, to use existing facilities and all equipment there-
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1 in or pertaining thereto and other personal property

2 owned by the Federal Government within the Secretary’s

3 jurisdiction under such terms and conditions as may be

4 agreed upon for their use and maintenance.

5 ‘‘(b) Subject to subsection (d), the Secretary may do6 nate to an urban Indian organization that has entered into

7 a contract or received a grant pursuant to this title any

8 personal or real property determined to be excess to the

9 needs of the Indian Health Service or the General Services

10 Administration for purposes of carrying out the contract

11 or grant.

12 ‘‘(c) The Secretary may acquire excess or surplus

13 government personal or real property for donation, subject

14 to subsection (d), to an urban Indian organization that

15 has entered into a contract or received a grant pursuant

16 to this title if the Secretary determines that the property

17 is appropriate for use by the urban Indian organization

18 for a purpose for which a contract or grant is authorized

19 under this title.

20 ‘‘(d) In the event that the Secretary receives a re21 quest for a specific item of personal or real property de22 scribed in subsection (b) or (c) from an urban Indian orga23 nization and from an Indian tribe or tribal organization,

24 the Secretary shall give priority to the request for dona25 tion of the Indian tribe or tribal organization if the Sec-
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1 retary receives the request from the Indian tribe or tribal

2 organization before the date the Secretary transfers title

3 to the property or, if earlier, the date the Secretary trans4 fers the property physically, to the urban Indian organiza5 tion.

6 ‘‘(e) For purposes of section 201(a) of the Federal

7 Property and Administrative Services Act of 1949 (40

8 U.S.C. 481(a)) (relating to Federal sources of supply, in9 cluding lodging providers, airlines, and other transpor10 tation providers), an urban Indian organization that has

11 entered into a contract or received a grant pursuant to

12 this title shall be deemed an executive agency when car13 rying out such contract or grant, and the employees of

14 the urban Indian organization shall be eligible to have ac15 cess to such sources of supply on the same basis as em16 ployees of an executive agency have such access.

17 ‘‘SEC. 518. GRANTS FOR DIABETES PREVENTION, TREAT18 MENT, AND CONTROL.

19 ‘‘(a) The Secretary may make grants to those urban

20 Indian organizations that have entered into a contract or

21 have received a grant under this title for the provision of

22 services for the prevention, treatment, and control of the

23 complications resulting from, diabetes among urban Indi24 ans.
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1 ‘‘(b) Each grant made pursuant to subsection (a)

2 shall set forth the goals to be accomplished under the

3 grant. The goals shall be specific to each grant as agreed

4 to between the Secretary and the grantee.

5 ‘‘(c) The Secretary shall establish criteria for the

6 grants made under subsection (a) relating to—

7 ‘‘(1) the size and location of the urban Indian

8 population to be served;

9 ‘‘(2) the need for prevention of, treatment of,

10 and control of the complications resulting from dia11 betes among the urban Indian population to be

12 served;

13 ‘‘(3) performance standards for the organiza14 tion in meeting the goals set forth in such grant

15 that are negotiated and agreed to by the Secretary

16 and the grantee;

17 ‘‘(4) the capability of the organization to ade18 quately perform the activities required under the

19 grant; and

20 ‘‘(5) the willingness of the organization to col21 laborate with the registry, if any, established by the

22 Secretary under section 204(e) in the Area Office of

23 the Service in which the organization is located.

24 ‘‘(d) Any funds received by an urban Indian organiza25 tion under this Act for the prevention, treatment, and con-
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1 trol of diabetes among urban Indians shall be subject to

2 the criteria developed by the Secretary under subsection

3 (c).

4 ‘‘SEC. 519. COMMUNITY HEALTH REPRESENTATIVES.

5 ‘‘The Secretary, through the Service, may enter into

6 contracts with, and make grants to, urban Indian organi7 zations for the use of Indians trained as health service

8 providers through the Community Health Representatives

9 Program under section 107(b) in the provision of health

10 care, health promotion, and disease prevention services to

11 urban Indians.

12 ‘‘SEC. 520. REGULATIONS.

13 ‘‘(a) The amendments to this title made by the Indian

14 Health Care Improvement Act Amendments of 2001 shall

15 be effective on the date of enactment of such amendments,

16 regardless of whether the Secretary has promulgated regu17 lations implementing such amendments have been promul18 gated.

19 ‘‘(b) The Secretary may promulgate regulations to

20 implement the provisions of this title.

21 ‘‘(1) Proposed regulations to implement this

22 Act shall be published in the Federal Register by the

23 Secretary no later than 270 days after the date of

24 enactment of this Act and shall have no less than a

25 120-day comment period.
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1 ‘‘(2) The authority to promulgate regulations

2 under this Act shall expire 18 months from the date

3 of enactment of this Act.

4 ‘‘(c) The negotiated rulemaking committee described

5 in this section shall be established pursuant to section 565

6 of title 5, United States Code, and shall have as the major7 ity of its members representatives of urban Indian organi8 zations from each service area in addition to Federal rep9 resentatives.

10 ‘‘(d) The Secretary shall adapt the negotiated rule11 making procedures to the unique context of this Act.

12 ‘‘SEC. 521. AUTHORIZATION OF APPROPRIATIONS.

13 ‘‘There are authorized to be appropriated such sums

14 as may be necessary for each fiscal year through fiscal

15 year 2013 to carry out this title.

16 ‘‘TITLE VI—ORGANIZATIONAL

17 IMPROVEMENTS

18 ‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV19 ICE AS AN AGENCY OF THE PUBLIC HEALTH

20 SERVICE.

21 ‘‘(a) In order to more effectively and efficiently carry

22 out the responsibilities, authorities, and functions of the

23 United States to provide health care services to Indians

24 and Indian tribes, as are or may be hereafter provided

25 by Federal statute or treaties, there is established within
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1 the Public Health Service of the Department of Health

2 and Human Services the Indian Health Service. The In3 dian Health Service shall be administered by a Director,

4 who shall be appointed by the President, by and with the

5 advice and consent of the Senate. The Director of the In6 dian Health Service shall report to the Secretary through

7 the Assistant Secretary for Health of the Department of

8 Health and Human Services. Effective with respect to an

9 individual appointed by the President, by and with the ad10 vice and consent of the Senate, after January 1, 1993,

11 the term of service of the Director shall be 4 years. A

12 Director may serve more than 1 term.

13 ‘‘(b) The Indian Health Service shall be an agency

14 within the Public Health Service of the Department of

15 Health and Human Services, and shall not be an office,

16 component, or unit of any other agency of the Depart17 ment.

18 ‘‘(c) The Secretary shall carry out through the Direc19 tor of the Indian Health Service—

20 ‘‘(1) all functions which were, on the day before

21 the date of enactment of the Indian Health Care

22 Amendments of 1988, carried out by or under the

23 direction of the individual serving as Director of the

24 Indian Health Service on such day;
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1 ‘‘(2) all functions of the Secretary relating to

2 the maintenance and operation of hospital and

3 health facilities for Indians and the planning for,

4 and provision and use of, health services for Indians;

5 ‘‘(3) all health programs under which health

6 care is provided to Indians based upon their status

7 as Indians which are administered by the Secretary,

8 including but not limited to programs under—

9 ‘‘(A) this Act;

10 ‘‘(B) the Act of November 2, 1921 (25

11 U.S.C. 13);

12 ‘‘(C) the Act of August 5, 1954 (42 U.S.C.

13 2001 et seq.);

14 ‘‘(D) the Act of August 16, 1957 (42

15 U.S.C. 2005 et seq.); and

16 ‘‘(E) the Indian Self-Determination and

17 Education Assistance Act (25 U.S.C. 450f et

18 seq.); and

19 ‘‘(4) all scholarship and loan functions carried

20 out under title I.

21 ‘‘(d)(1) The Director shall have the authority—

22 ‘‘(A) except to the extent provided in paragraph

23 (2), to appoint and compensate employees for the

24 Service in accordance with title 5, United States

25 Code;
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1 ‘‘(B) to enter into contracts for the procure2 ment of goods and services to carry out the func3 tions of the Service; and

4 ‘‘(C) to manage, expend, and obligate all funds

5 appropriated for the Service.

6 ‘‘(2) Notwithstanding any other law, the provisions

7 of section 12 of the Act of June 18, 1934 (48 Stat. 986;

8 25 U.S.C. 472), shall apply to all personnel actions taken

9 with respect to new positions created within the Service

10 as a result of its establishment under subsection (a).

11 ‘‘(e) All personnel, records, equipment, facilities, and

12 interests in property that are administered by the Indian

13 Health Service shall be transferred to the Indian Health

14 Service established by the amendment made by subsection

15 (a) of this section. All transfers must be accomplished

16 within 9 months of the date of enactment of this section.

17 The Secretary is authorize to waive the Indian preference

18 laws on a case-by-case basis for temporary transfers in19 volved in implementing this section during such 9-month

20 period.

21 ‘‘(f)(1) Except as provided in paragraph (2), section

22 601 of the Indian Health Care Improvement Act shall take

23 effect 9 months from the date of the enactment of this

24 section.
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1 ‘‘(2) Notwithstanding subsections (e) and (f)(1), any

2 action which carries out such section 601 that is taken

3 by the Secretary before the effective date of such section

4 601 shall be effective beginning on the date such action

5 was taken.

6 ‘‘SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYS7 TEM.

8 ‘‘(a)(1) The Secretary shall establish an automated

9 management information system for the Service.

10 ‘‘(2) The information system established under para11 graph (1) shall include—

12 ‘‘(A) a financial management system;

13 ‘‘(B) a patient care information system for each

14 area served by the Service;

15 ‘‘(C) a privacy component that protects the pri16 vacy of patient information held by, or on behalf of,

17 the Service;

18 ‘‘(D) a services-based cost accounting compo19 nent that provides estimates of the costs associated

20 with the provision of specific medical treatments or

21 services in each Area Office of the Service;

22 ‘‘(E) an interface mechanism for patient billing

23 and accounts receivable system; and

24 ‘‘(F) a training component.
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1 ‘‘(b) The Secretary shall provide each Indian tribe

2 and tribal organization that provides health services under

3 a contract entered into with the Service under the Indian

4 Self-Determination and Education Assistance Act auto5 mated management information systems which—

6 ‘‘(1) meet the management information needs

7 of such Indian tribe or tribal organization with re8 spect to the treatment by the Indian tribe or tribal

9 organization of patients of the Service; and

10 ‘‘(2) meet the management information needs

11 of the Service.

12 ‘‘(c) Notwithstanding any other provision of law, each

13 patient shall have reasonable access to the medical or

14 health records of such patient which are held by, or on

15 behalf of, the Service.

16 ‘‘(d) The Director shall have the authority to enter

17 into contracts, agreements, or joint ventures with other

18 Federal agencies, States, private and nonprofit organiza19 tions, for the purpose of enhancing information technology

20 in Indian health programs and facilities.

21 ‘‘SEC. 603. 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 2013 to carry out this title.
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1 ‘‘TITLE VII—BEHAVIORAL

2 HEALTH PROGRAMS

3 ‘‘SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREAT4 MENT SERVICES.

5 ‘‘(a) The purposes of this section are to—

6 ‘‘(1) authorize and direct the Secretary, acting

7 through the Indian Health Service, and willing In8 dian tribes, tribal organizations, and urban Indian

9 organizations, to develop a comprehensive behavioral

10 health prevention and treatment program which em11 phasizes collaboration among alcohol and substance

12 abuse, social services, and mental health programs;

13 ‘‘(2) provide information, direction, and guid14 ance relating to mental illness and dysfunction and

15 self-destructive behavior, including child abuse and

16 family violence, to those Federal, tribal, State, and

17 local agencies responsible for programs in Indian

18 communities in areas of health care, education, so19 cial services, child and family welfare, alcohol and

20 substance abuse, law enforcement, and judicial serv21 ices;

22 ‘‘(3) assist Indian tribes to identify services and

23 resources available to address mental illness and

24 dysfunctional and self-destructive behavior;
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1 ‘‘(4) provide authority and opportunities for In2 dian tribes to develop and implement, and coordinate

3 with, community-based programs which include iden4 tification, prevention, education, referral, and treat5 ment services, including through multidisciplinary

6 resource teams;

7 ‘‘(5) ensure that Indians, as citizens of the

8 United States and of the States in which they re9 side, have the same access to behavioral health serv10 ices to which all citizens have access; and

11 ‘‘(6) modify or supplement existing programs

12 and authorities in the areas identified in paragraph

13 (2).

14 ‘‘(b)(1) The Secretary, acting through the Service,

15 and willing Indian tribes, tribal organizations, and urban

16 Indian organizations, shall encourage Indian tribes and

17 tribal organizations to develop tribal plans, and urban In18 dian organizations to develop local plans, and for all such

19 groups to participate in developing area-wide plans for In20 dian Behavioral Health Services. The plans shall include,

21 to the extent feasible, the following components:

22 ‘‘(A) An assessment of the scope of the problem

23 of alcohol or other substance abuse, mental illness,

24 and dysfunctional and self-destructive behavior, in-
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1 cluding suicide, child abuse, and family violence,

2 among Indians, including—

3 ‘‘(i) the number of Indians served who are

4 directly or indirectly affected by such illness or

5 behavior, and

6 ‘‘(ii) an estimate of the financial and

7 human cost attributable to such illness or be8 havior.

9 ‘‘(B) An assessment of the existing and addi10 tional resources necessary for the prevention and

11 treatment of such illness and behavior, including an

12 assessment of the progress toward achieving the

13 availability of the full continuum of care described in

14 subsection (c).

15 ‘‘(C) An estimate of the additional funding

16 needed by the Service, Indian tribes, tribal organiza17 tions, and urban Indian organizations to meet their

18 responsibilities under the plans.

19 ‘‘(2) The Secretary shall establish a national clearing20 house of plans and reports on the outcomes of such plans

21 developed by Indian tribes, tribal organizations, and by

22 Areas relating to Behavioral Health. The Secretary shall

23 ensure access to these plans and outcomes by any Indian

24 tribe, tribal organization, urban organization, or the Serv25 ice.
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1 ‘‘(3) The Secretary shall provide technical assistance

2 to Indian tribes, tribal organizations, and urban Indian

3 organizations in preparation of their plans and in devel4 oping standards of care that may be used and adopted

5 locally.

6 ‘‘(c) The Secretary, acting through the Service and

7 willing Indian tribes and tribal organizations, shall pro8 vide, to the extent feasible and funding is available, pro9 grams including, but not limited to, the following:

10 ‘‘(1) A comprehensive continuum of behavioral

11 health care which provides—

12 ‘‘(A) community-based prevention, inter13 vention, outpatient, and behavioral health

14 aftercare;

15 ‘‘(B) detoxification (social and medical);

16 ‘‘(C) acute hospitalization;

17 ‘‘(D) intensive outpatient/day treatment;

18 ‘‘(E) residential treatment;

19 ‘‘(F) transitional living for those needing a

20 temporary stable living environment that is sup21 portive of treatment/recovery goals;

22 ‘‘(G) emergency shelter;

23 ‘‘(H) intensive case management; and

24 ‘‘(I) traditional health care practices.
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1 ‘‘(2) Behavioral health services by the following

2 services and populations:

3 ‘‘(A) Child Behavioral Health Services for

4 persons from birth through age 17, including—

5 ‘‘(i) preschool and school age fetal al6 cohol disorder services, including assess7 ment and behavioral intervention;

8 ‘‘(ii) mental health/substance abuse

9 services (emotional, organic, alcohol, drug,

10 inhalant and, tobacco);

11 ‘‘(iii) co-occurring disorders (multiple

12 diagnosis);

13 ‘‘(iv) prevention focused on ages 5

14 through 10 (alcohol, drug, inhalant, and

15 tobacco);

16 ‘‘(v) early intervention, treatment and

17 aftercare focused on ages 11–17;

18 ‘‘(vi) healthy choices/lifestyle (related

19 to sexually transmitted diseases, domestic

20 violence, sexual abuse; suicide, teen preg21 nancy, obesity, and other risk/safety

22 issues); and

23 ‘‘(vii) co-morbidity.

24 ‘‘(B) Adult Behavioral Health Services

25 (ages 18 through 55):
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1 ‘‘(i) Early intervention, treatment,

2 and aftercare.

3 ‘‘(ii) Mental health/substance abuse

4 services (emotional, alcohol, drug, inhalant

5 and tobacco).

6 ‘‘(iii) Co-occurring disorders (dual di7 agnosis) and co-morbidity.

8 ‘‘(iv) Healthy choices/lifestyle (related

9 to parenting, partners, domestic violence,

10 sexual abuse, suicide, obesity, and other

11 risk-related behavior).

12 ‘‘(v)(I) Treatment services for women

13 at risk of giving birth to a child with a

14 fetal alcohol disorder.

15 ‘‘(II) Treatment for substance abuse

16 requiring gender-specific services.

17 ‘‘(III) Treatment for sexual assault

18 and domestic violence.

19 ‘‘(IV) Healthy choices/lifestyle (par20 enting, partners, obesity, suicide, and other

21 related behavioral risk).

22 ‘‘(vi) Men-specific:

23 ‘‘(I) Treatment for substance

24 abuse requiring gender-specific serv25 ices.
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1 ‘‘(II) Treatment for sexual as2 sault and domestic violence.

3 ‘‘(III) Healthy choices/lifestyle

4 (parenting, partners, obesity, suicide,

5 and other risk-related behavior).

6 ‘‘(C) Family Behavioral Health Services:

7 ‘‘(i) Early intervention, treatment,

8 and aftercare for affected families.

9 ‘‘(ii) Treatment for sexual as10 sault and domestic violence.

11 ‘‘(iii) Healthy choices/lifestyle

12 (related to parenting, partners, do13 mestic violence, and other abuse

14 issues).

15 ‘‘(D) Elder Behavioral Health Services

16 (age 56 and above):

17 ‘‘(i) Early intervention, treatment,

18 and aftercare.

19 ‘‘(I) Mental health/substance

20 abuse services (emotional, alcohol,

21 drug, inhalant, and tobacco).

22 ‘‘(II) Co-occurring disorders

23 (dual diagnosis) and co-morbidity.
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1 ‘‘(III) Healthy choices/lifestyle

2 (managing conditions related to

3 aging).

4 ‘‘(ii) Elder women-specific:

5 ‘‘(I) Treatment for substance

6 abuse requiring gender-specific serv7 ices.

8 ‘‘(II) Treatment for sexual as9 sault, domestic violence, and neglect.

10 ‘‘(iii) Elder men-specific:

11 ‘‘(I) Treatment for substance

12 abuse requiring gender-specific serv13 ices.

14 ‘‘(II) Treatment for sexual as15 sault, domestic violence, and neglect.

16 ‘‘(iv) Dementias regardless of cause.

17 ‘‘(d)(1) The governing body of any Indian tribe, or

18 tribal organization, or urban Indian organization may, at

19 its discretion, adopt a resolution for the establishment of

20 a community behavioral health plan providing for the iden21 tification and coordination of available resources and pro22 grams to identify, prevent, or treat alcohol and other sub23 stance abuse, mental illness, or dysfunctional and self-de24 structive behavior, including child abuse and family vio25 lence, among its members or its service population. This
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1 plan should include, but not be limited to, behavioral

2 health services, social services, intensive outpatient serv3 ices, and continuing after care.

4 ‘‘(2) In furtherance of a plan established pursuant

5 to paragraph (1) and at the request of a Tribe, the appro6 priate agency, service unit, or other officials of the Bureau

7 of Indian Affairs and the Service shall cooperate with, and

8 provide technical assistance to, the Indian tribe or tribal

9 organization in the development of such plan. Upon the

10 establishment of such a plan and at the request of the

11 Indian tribe or tribal organization, such officials shall co12 operate with the Indian tribe or tribal organization in the

13 implementation of such plan.

14 ‘‘(3) The Secretary may make funding available to

15 Indian tribes and tribal organizations adopting a resolu16 tion pursuant to paragraph (1) to obtain technical assist17 ance for the development of a community mental health

18 plan and to provide administrative support in the imple19 mentation of such plan.

20 ‘‘(e) The Secretary, acting through the Service and

21 willing Indian tribes, tribal organizations, and urban In22 dian organizations, shall coordinate behavioral health

23 planning, to the extent feasible, with other Federal agen24 cies and with State agencies, to encourage comprehensive
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1 behavioral health services are available to Indians without

2 regard to their place of residence.

3 ‘‘(f) Within 1 year after the date of the enactment

4 of the Indian Health Care Improvement Act Amendments

5 of 2001, the Secretary shall make an assessment of the

6 need for inpatient mental health care among Indians and

7 the availability and cost of inpatient mental health facili8 ties which can meet such need. In making such assess9 ment, the Secretary shall consider the possible conversion

10 of existing, underused service hospital beds into psy11 chiatric units to meet such need.

12 ‘‘SEC. 702. MEMORANDA OF AGREEMENT WITH THE DE13 PARTMENT OF THE INTERIOR.

14 ‘‘(a) Not later than 12 months after the date of the

15 enactment of the Indian Health Care Improvement Act

16 Amendments of 2001, the Secretary and the Secretary of

17 the Interior shall develop and enter into memoranda of

18 agreement, or review and update any existing memoranda

19 of agreement, as required by section 4205 of the Indian

20 Alcohol and Substance Abuse Prevention and Treatment

21 Act of 1986 (25 U.S.C. 2411) and under which the Secre22 taries 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) take 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 the Bureau of Indian

14 Affairs and Service programs and services (in15 cluding multi-disciplinary resource teams) ad16 dressing child abuse and family violence are co17 ordinated 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 which shall be pro5 vided to Congress and the Indian tribes.

6 ‘‘(b) The memoranda of agreement updated or en7 tered into pursuant to subsection (a) shall include specific

8 provisions pursuant to which the Service shall assume re9 sponsibility for—

10 ‘‘(1) the determination of the scope of the prob11 lem of alcohol and substance abuse among Indian

12 people, including the number of Indians within the

13 jurisdiction of the Service who are directly or indi14 rectly affected by alcohol and substance abuse and

15 the financial and human cost;

16 ‘‘(2) an assessment of the existing and needed

17 resources necessary for the prevention of alcohol and

18 substance abuse and the treatment of Indians af19 fected by alcohol and substance abuse; and

20 ‘‘(3) an estimate of the funding necessary to

21 adequately support a program of prevention of alco22 hol and substance abuse and treatment of Indians

23 affected by alcohol and substance abuse.

24 ‘‘(c) The Secretary and the Secretary of the Interior

25 shall, in developing the memoranda of agreement under
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1 subsection (a) of this section, consult with and solicit the

2 comments of—

3 ‘‘(1) Indian tribes and tribal organizations;

4 ‘‘(2) Indian individuals;

5 ‘‘(3) urban Indian organizations and other In6 dian organizations; and

7 ‘‘(4) behavioral health service providers.

8 ‘‘(d) The memoranda of agreement under subsection

9 (a) of this section shall be published in the Federal Reg10 ister. At the same time as publication in the Federal Reg11 ister, the Secretary shall provide a copy of such memo12 randa to each Indian tribe, tribal organization, and urban

13 Indian organization.

14 ‘‘SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PRE15 VENTION AND TREATMENT PROGRAM.

16 ‘‘(a)(1) The Secretary, acting through the Service

17 and willing Indian tribes, and tribal organizations, con18 sistent with section 701, shall provide a program of com19 prehensive behavioral health, prevention, treatment, and

20 aftercare, including traditional health care practices,

21 which shall include—

22 ‘‘(A) prevention, through educational interven23 tion, in Indian communities;
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1 ‘‘(B) acute detoxification and psychiatric hos2 pitalization and treatment (residential and intensive

3 outpatient);

4 ‘‘(C) community-based rehabilitation and

5 aftercare;

6 ‘‘(D) community education and involvement, in7 cluding extensive training of health care, edu8 cational, and community-based personnel; and

9 ‘‘(E) specialized residential treatment programs

10 for high-risk populations, including but not limited

11 to pregnant and post partum women and their chil12 dren.

13 ‘‘(2) The target population of such program shall be

14 members of Indian tribes. Efforts to train and educate key

15 members of the Indian community shall target employees

16 of health, education, judicial, law enforcement, legal, and

17 social service programs.

18 ‘‘(b)(1) The Secretary, acting through the Service

19 and willing Indian tribes and tribal organizations, may,

20 enter into contracts with public or private providers of be21 havioral health treatment services for the purpose of car22 rying out the program required under subsection (a).

23 ‘‘(2) In carrying out this subsection, the Secretary

24 shall provide assistance to Indian tribes and tribal organi25 zations to develop criteria for the certification of behav-
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1 ioral health service providers and accreditation of service

2 facilities which meet minimum standards for such services

3 and facilities.

4 ‘‘SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.

5 ‘‘(a) Under the authority of the Snyder Act of No6 vember 2, 1921 (25 U.S.C. 13), the Secretary shall estab7 lish and maintain a mental health technician program

8 within the Service which—

9 ‘‘(1) provides for the training of Indians as

10 mental health technicians; and

11 ‘‘(2) employs such technicians in the provision

12 of community-based mental health care that includes

13 identification, prevention, education, referral, and

14 treatment services.

15 ‘‘(b) In carrying out subsection (a), the Secretary

16 shall provide high-standard paraprofessional training in

17 mental health care necessary to provide quality care to the

18 Indian communities to be served. Such training shall be

19 based upon a curriculum developed or approved by the

20 Secretary which combines education in the theory of men21 tal health care with supervised practical experience in the

22 provision of such care.

23 ‘‘(c) The Secretary shall supervise and evaluate the

24 mental health technicians in the training program.
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1 ‘‘(d) The Secretary shall ensure that the program es2 tablished pursuant to this subsection involves the use and

3 promotion of the traditional health care practices of the

4 Indian tribes to be served.

5 ‘‘SEC. 705. LICENSING REQUIREMENT FOR MENTAL

6 HEALTH CARE WORKERS.

7 ‘‘Subject to the provisions of section 220, any person

8 employed as a psychologist, social worker, or marriage and

9 family therapist for the purpose of providing mental health

10 care services to Indians in a clinical setting under the au11 thority of this Act or through a funding agreement pursu12 ant to the Indian Self-Determination and Education As13 sistance Act shall—

14 ‘‘(1) in the case of a person employed as a psy15 chologist, be licensed as a clinical psychologist or

16 working under the direct supervision of a licensed

17 clinical psychologist;

18 ‘‘(2) in the case of a person employed as a so19 cial worker, be licensed as a social worker or work20 ing under the direct supervision of a licensed social

21 worker; or

22 ‘‘(3) in the case of a person employed as a mar23 riage and family therapist, be licensed as a marriage

24 and family therapist or working under the direct su-
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1 pervision of a licensed marriage and family thera2 pist.

3 ‘‘SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

4 ‘‘(a) The Secretary, consistent with section 701, shall

5 make funding available to Indian tribes, tribal organiza6 tions, and urban Indian organizations to develop and im7 plement a comprehensive behavioral health program of

8 prevention, intervention, treatment, and relapse preven9 tion services that specifically addresses the spiritual, cul10 tural, historical, social, and child care needs of Indian

11 women, regardless of age.

12 ‘‘(b) Funding made available pursuant to this section

13 may be used to—

14 ‘‘(1) develop and provide community training,

15 education, and prevention programs for Indian

16 women relating to behavioral health issues, including

17 fetal alcohol disorders;

18 ‘‘(2) identify and provide psychological services,

19 counseling, advocacy, support, and relapse preven20 tion to Indian women and their families; and

21 ‘‘(3) develop prevention and intervention models

22 for Indian women which incorporate traditional

23 health care practices, cultural values, and commu24 nity and family involvement.
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1 ‘‘(c) The Secretary, in consultation with Indian tribes

2 and tribal organizations, shall establish criteria for the re3 view and approval of applications and proposals for fund4 ing under this section.

5 ‘‘(d) Twenty percent of the funds appropriated pursu6 ant to this section shall be used to make grants to urban

7 Indian organizations funded under title V.

8 ‘‘SEC. 707. INDIAN YOUTH PROGRAM.

9 ‘‘(a) The Secretary, consistent with section 701, shall

10 develop and implement a program for acute detoxification

11 and treatment for Indian youth, including behavioral

12 health services. The program shall include regional treat13 ment centers designed to include detoxification and reha14 bilitation for both sexes on a referral basis and programs

15 developed and implemented by Indian tribes or tribal orga16 nizations at the local level under the Indian Self-Deter17 mination and Education Assistance Act. Regional centers

18 shall be integrated with the intake and rehabilitation pro19 grams based in the referring Indian community.

20 ‘‘(b)(1) The Secretary, acting through the Service or

21 willing Indian tribes, or tribal organizations, shall con22 struct, renovate, or, as necessary, purchase, and appro23 priately staff and operate, at least 1 youth regional treat24 ment center or treatment network in each area under the

25 jurisdiction of an Area Office. For the purposes of this
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•HR 1662 IH

1 subsection, the Area Office in California shall be consid2 ered to be 2 Area Offices, 1 office whose jurisdiction shall

3 be considered to encompass the northern area of the State

4 of California, and 1 office whose jurisdiction shall be con5 sidered to encompass the remainder of the State of Cali6 fornia for the purpose of implementing California treat7 ment networks.

8 ‘‘(2) For the purpose of staffing and operating such

9 centers or facilities, funding shall be pursuant to the Act

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

11 ‘‘(3) A youth treatment center constructed or pur12 chased under this subsection shall be constructed or pur13 chased at a location within the area described in para14 graph (1) agreed upon (by appropriate tribal resolution)

15 by a majority of the Indian tribes to be served by such

16 center.

17 ‘‘(4)(A) Notwithstanding any other provision of this

18 title, the Secretary may, from amounts authorized to be

19 appropriated for the purposes of carrying out this section,

20 make funds available to—

21 ‘‘(i) the Tanana Chiefs Conference, Incor22 porated, for the purpose of leasing, constructing,

23 renovating, operating, and maintaining a residential

24 youth treatment facility in Fairbanks, Alaska; and
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•HR 1662 IH

1 ‘‘(ii) the Southeast Alaska Regional Health

2 Corporation to staff and operate a residential youth

3 treatment facility without regard to the proviso set

4 forth in section 4(l) of the Indian Self-Determina5 tion and Education Assistance Act (25 U.S.C.

6 450b(l)).

7 ‘‘(B) Until additional residential youth treatment fa8 cilities are established in Alaska pursuant to this section,

9 the facilities specified in subparagraph (A) shall make

10 every effort to provide services to all eligible Indian youth

11 residing in such State.

12 ‘‘(c)(1) The Secretary, acting through the Service

13 and willing Indian tribes and tribal organizations, may

14 provide intermediate behavioral health services, which may

15 incorporate traditional health care practices, to Indian

16 children and adolescents, including—

17 ‘‘(A) pretreatment assistance;

18 ‘‘(B) inpatient, outpatient, and after-care serv19 ices;

20 ‘‘(C) emergency care;

21 ‘‘(D) suicide prevention and crisis intervention;

22 and

23 ‘‘(E) prevention and treatment of mental illness

24 and dysfunctional and self-destructive behavior, in25 cluding child abuse and family violence.
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1 ‘‘(2) Funds provided under this subsection may be

2 used—

3 ‘‘(A) to construct or renovate an existing health

4 facility to provide intermediate behavioral health

5 services;

6 ‘‘(B) to hire behavioral health professionals;

7 ‘‘(C) to staff, operate, and maintain an inter8 mediate mental health facility, group home, sober

9 housing, transitional housing or similar facilities, or

10 youth shelter where intermediate behavioral health

11 services are being provided;

12 ‘‘(D) to make renovations and hire appropriate

13 staff to convert existing hospital beds into adolescent

14 psychiatric units; and

15 ‘‘(E) for intensive home- and community-based

16 services.

17 ‘‘(3) The Secretary shall, in consultation with Indian

18 tribes and tribal organizations, establish criteria for the

19 review and approval of applications or proposals for fund20 ing made available pursuant to this subsection.

21 ‘‘(d)(1) The Secretary, in consultation with Indian

22 tribes and tribal organizations, shall—

23 ‘‘(A) identify and use, where appropriate, feder24 ally owned structures suitable for local residential or
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1 regional behavioral health treatment for Indian

2 youth; and

3 ‘‘(B) establish guidelines, in consultation with

4 Indian tribes and tribal organizations, for deter5 mining the suitability of any such federally owned

6 structure to be used for local residential or regional

7 behavioral health treatment for Indian youth.

8 ‘‘(2) Any structure described in paragraph (1) may

9 be used under such terms and conditions as may be agreed

10 upon by the Secretary and the agency having responsi11 bility for the structure and any Tribe or tribal organiza12 tion operating the program.

13 ‘‘(e)(1) The Secretary, Indian tribes or tribal organi14 zations, in cooperation with the Secretary of the Interior,

15 shall develop and implement within each service unit, com16 munity-based rehabilitation and follow-up services for In17 dian youth who are having significant behavioral health

18 problems, and require long-term treatment, community re19 integration, and monitoring to support the Indian youth

20 after their return to their home community.

21 ‘‘(2) Services under paragraph (1) shall be ad22 ministered within each service unit or tribal program

23 by trained staff within the community who can as24 sist the Indian youth in continuing development of

25 self-image, positive problem-solving skills, and non-
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1 alcohol or substance abusing behaviors. Such staff

2 may include alcohol and substance abuse counselors,

3 mental health professionals, and other health profes4 sionals and paraprofessionals, including community

5 health representatives.

6 ‘‘(f) In providing the treatment and other services to

7 Indian youth authorized by this section, the Secretary, In8 dian tribes, and tribal organizations 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) The Secretary, acting through the Service and

16 willing Indian tribes, tribal organizations, and urban In17 dian organizations, shall provide, consistent with section

18 701, programs and services to prevent and treat the abuse

19 of multiple forms of substances, including, but not limited

20 to, alcohol, drugs, inhalants, and tobacco, among Indian

21 youth residing in Indian communities, on Indian reserva22 tions, and in urban areas and provide appropriate mental

23 health services to address the incidence of mental illness

24 among such youth.
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1 ‘‘SEC. 708. INPATIENT AND COMMUNITY-BASED MENTAL

2 HEALTH FACILITIES DESIGN, CONSTRUC3 TION, AND STAFFING.

4 ‘‘Within 1 year after the date of enactment of the

5 Indian Health Care Improvement Act Amendments of

6 2001, the Secretary, acting through the Service and will7 ing Indian tribes and tribal organizations, shall provide,

8 in each area of the Service, not less than 1 inpatient men9 tal health care facility, or the equivalent, for Indians with

10 behavioral health problems. For the purposes of this sub11 section, California shall be considered to be 2 Area Offices,

12 1 office whose location shall be considered to encompass

13 the northern area of the State of California and 1 office

14 whose jurisdiction shall be considered to encompass the

15 remainder of the State of California. The Secretary shall

16 consider the possible conversion of existing, underused

17 service hospital beds into psychiatric units to meet such

18 need.

19 ‘‘SEC. 709. TRAINING AND COMMUNITY EDUCATION.

20 ‘‘(a) The Secretary, in cooperation with the Secretary

21 of the Interior, shall develop and implement or provide

22 funding for Indian tribes and tribal organizations to de23 velop and implement within each service unit or tribal pro24 gram a program of community education and involvement

25 which shall be designed to provide concise and timely in26 formation to the community leadership of each tribal com-
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1 munity. Such program shall include education about be2 havioral health issues to political leaders, tribal judges,

3 law enforcement personnel, members of tribal health and

4 education boards, health care providers including tradi5 tional practitioners, and other critical members of each

6 tribal community. Community-based training (oriented to7 ward local capacity development) shall also include tribal

8 community provider training (designed for adult learners

9 from the communities receiving services for prevention,

10 intervention, treatment and aftercare).

11 ‘‘(b) The Secretary shall, either directly or through

12 Indian tribes and tribal organizations, provide instruction

13 in the area of behavioral health issues, including instruc14 tion in crisis intervention and family relations in the con15 text of alcohol and substance abuse, child sexual abuse,

16 youth alcohol and substance abuse, and the causes and

17 effects of fetal alcohol disorders to appropriate employees

18 of the Bureau of Indian Affairs and the Service, and to

19 personnel in schools or programs operated under any con20 tract with the Bureau of Indian Affairs or the Service,

21 including supervisors of emergency shelters and halfway

22 houses described in section 4213 of the Indian Alcohol and

23 Substance Abuse Prevention and Treatment Act of 1986

24 (25 U.S.C. 2433).
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1 ‘‘(c) In carrying out the education and training pro2 grams required by this section, the Secretary, in consulta3 tion with Indian tribes, tribal organizations, Indian behav4 ioral health experts, and Indian alcohol and substance

5 abuse prevention experts, shall develop and provide com6 munity-based training models. Such models shall

7 address—

8 ‘‘(1) the elevated risk of alcohol and behavioral

9 health problems faced by children of alcoholics;

10 ‘‘(2) the cultural, spiritual and

11 multigenerational aspects of behavioral health prob12 lem prevention and recovery; and

13 ‘‘(3) community-based and multidisciplinary

14 strategies for preventing and treating behavioral

15 health problems.

16 ‘‘SEC. 710. BEHAVIORAL HEALTH PROGRAM.

17 ‘‘(a) The Secretary, acting through the Service or

18 willing Indian tribes or tribal organizations, consistent

19 with section 701, may plan, develop, implement, and carry

20 out programs to deliver innovative community-based be21 havioral health services to Indians.

22 ‘‘(b) The Secretary may award such funding for a

23 project under subsection (a) to an Indian tribe or tribal

24 organization and may consider the following criteria:
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1 ‘‘(1) The project will address significant unmet

2 behavioral health needs among Indians.

3 ‘‘(2) The project will serve a significant number

4 of Indians.

5 ‘‘(3) The project has the potential to deliver

6 services in an efficient and effective manner.

7 ‘‘(4) The Tribe or tribal organization has the

8 administrative and financial capability to administer

9 the project.

10 ‘‘(5) The project may deliver services in a man11 ner consistent with traditional health care practices.

12 ‘‘(6) The project is coordinated with, and avoids

13 duplication of, existing services.

14 ‘‘(c) For purposes of this subsection, the Secretary

15 shall, in evaluating applications or proposals for funding

16 for projects to be operated under any funding agreement

17 entered into with the Service under the Indian Self-Deter18 mination and Education Assistance Act, use the same cri19 teria that the Secretary uses in evaluating any other appli20 cation or proposal for such funding.

21 ‘‘SEC. 711. FETAL ALCOHOL DISORDER FUNDING.

22 ‘‘(a)(1) The Secretary, consistent with section 701,

23 acting through willing Indian tribes, tribal organizations,

24 and urban Indian organizations, shall establish and oper25 ate fetal alcohol disorders programs as provided in this
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1 section for the purposes of meeting the health status ob2 jectives specified in section 3(b).

3 ‘‘(2) Funding provided pursuant to this section shall

4 be used to—

5 ‘‘(A) develop and provide community and in6 school training, education, and prevention programs

7 relating to fetal alcohol disorders;

8 ‘‘(B) identify and provide behavioral health

9 treatment to high-risk women;

10 ‘‘(C) identify and provide appropriate psycho11 logical services, educational and vocational support,

12 counseling, advocacy, and information to fetal alco13 hol disorder affected persons and their families or

14 caretakers;

15 ‘‘(D) develop and implement counseling and

16 support programs in schools for fetal alcohol dis17 order affected children;

18 ‘‘(E) develop prevention and intervention mod19 els which incorporate traditional practitioners, cul20 tural and spiritual values, and community involve21 ment;

22 ‘‘(F) develop, print, and disseminate education

23 and prevention materials on fetal alcohol disorders;

24 ‘‘(G) develop and implement, through the tribal

25 consultation process, culturally sensitive assessment
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1 and diagnostic tools including dysmorphology clinics

2 and multidisciplinary fetal alcohol disorder clinics

3 for use in tribal and urban Indian communities;

4 ‘‘(H) develop early childhood intervention

5 projects from birth on to mitigate the effects of fetal

6 alcohol disorders; and

7 ‘‘(I) develop and fund community-based adult

8 fetal alcohol disorder housing and support services.

9 ‘‘(3) The Secretary shall establish criteria for the re10 view and approval of applications for funding under this

11 section.

12 ‘‘(b) The Secretary, acting through the Service and

13 willing Indian tribes, tribal organizations, and urban In14 dian organizations, shall—

15 ‘‘(1) develop and provide services for the pre16 vention, intervention, treatment, and aftercare for

17 those affected by fetal alcohol disorders in Indian

18 communities; and

19 ‘‘(2) provide supportive services, directly or

20 through an Indian tribe, tribal organization, or

21 urban Indian organization, including, which services

22 shall include but not be limited to, meeting the spe23 cial educational, vocational, school-to-work transi24 tion, and independent living needs of adolescent and

25 adult Indians with fetal alcohol disorders.
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1 ‘‘(c) The Secretary shall establish a task force to be

2 known as the Fetal Alcohol Disorders Task Force to ad3 vise the Secretary in carrying out subsection (b). Such

4 task force shall be composed of representatives from the

5 National Institute on Drug Abuse, the National Institute

6 on Alcohol and Alcoholism, the Office of Substance Abuse

7 Prevention, the National Institute of Mental Health, the

8 Service, the Office of Minority Health of the Department

9 of Health and Human Services, the Administration for

10 Native Americans, the National Institute of Child Health

11 and Human Development (NICHD), the Centers for Dis12 ease Control and Prevention, the Bureau of Indian Af13 fairs, Indian tribes, tribal organizations, urban Indian

14 communities, and Indian fetal alcohol disorders experts.

15 ‘‘(d) The Secretary, acting through the Substance

16 Abuse and Mental Health Services Administration, shall

17 make funding available to Indian tribes, tribal organiza18 tions, and urban Indian organizations for applied research

19 projects which propose to elevate the understanding of

20 methods to prevent, intervene, treat, or provide rehabilita21 tion and behavioral health aftercare for Indians and urban

22 Indians affected by fetal alcohol disorders.

23 ‘‘(e) Ten percent of the funds appropriated pursuant

24 to this section shall be used to make grants to urban In25 dian organizations funded under title V.
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1 ‘‘SEC. 712. CHILD SEXUAL ABUSE AND PREVENTION TREAT2 MENT PROGRAMS.

3 ‘‘(a) The Secretary and the Secretary of the Interior,

4 acting through the Service and willing Indian tribes and

5 tribal organizations, shall establish, consistent with section

6 701, in every service area, programs involving treatment

7 for—

8 ‘‘(1) victims of child sexual abuse; and

9 ‘‘(2) perpetrators of child sexual abuse.

10 ‘‘(b) Funding provided pursuant to this section shall

11 be used to—

12 ‘‘(1) develop and provide community education

13 and prevention programs related to child sexual

14 abuse;

15 ‘‘(2) identify and provide behavioral health

16 treatment to children who are victims of sexual

17 abuse and to their families who are affected by sex18 ual abuse;

19 ‘‘(3) develop prevention and intervention models

20 which incorporate traditional health care practi21 tioners, cultural and spiritual values, and community

22 involvement;

23 ‘‘(4) develop and implement, through the tribal

24 consultation process, culturally sensitive assessment

25 and diagnostic tools for use in tribal and urban In26 dian communities; and
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1 ‘‘(5) identify and provide behavioral health

2 treatment to perpetrators—

3 ‘‘(A) efforts will be made to begin offender

4 and behavioral health treatment while the per5 petrator is incarcerated or at the earliest pos6 sible date if the perpetrator is not incarcerated;

7 and

8 ‘‘(B) treatment should be provided after

9 release to the community, until it is determined

10 that the perpetrator is not a threat to children.

11 ‘‘SEC. 713. BEHAVIORAL HEALTH RESEARCH.

12 ‘‘The Secretary, in consultation with appropriate

13 Federal agencies, shall provide funding to Indian tribes,

14 tribal organizations, and urban Indian organizations or,

15 enter into contracts with, or make grants to appropriate

16 institutions for the conduct of research on the incidence

17 and prevalence of behavioral health problems among Indi18 ans served by the Service, Indian tribes, or tribal organiza19 tions and among Indians in urban areas. Research prior20 ities under this section shall include—

21 ‘‘(1) the interrelationship and interdependence

22 of behavioral health problems with alcoholism and

23 other substance abuse, suicide, homicides, other in24 juries, and the incidence of family violence; and
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1 ‘‘(2) the development of models of prevention

2 techniques.

3 The effect of the interrelationships and interdependencies

4 referred to in paragraph (1) on children, and the develop5 ment of prevention techniques under paragraph (2) appli6 cable to children, shall be emphasized.

7 ‘‘SEC. 714. DEFINITIONS.

8 ‘‘For the purpose of this title, the following defini9 tions shall apply:

10 ‘‘(1) ‘Assessment’ means the systematic collec11 tion, analysis, and dissemination of information on

12 health status, health needs, and health problems.

13 ‘‘(2) ‘Alcohol related neurodevelopmental dis14 orders’ or ‘ARND’ means with a history of maternal

15 alcohol consumption during pregnancy, central nerv16 ous system involvement such as developmental delay,

17 intellectual deficit, or neurologic abnormalities. Be18 haviorally, there can be problems with irritability,

19 and failure to thrive as infants. As children become

20 older there will likely be hyperactivity, attention def21 icit, language dysfunction, and perceptual and judg22 ment problems.

23 ‘‘(3) ‘Behavioral health’ means the blending of

24 substances (alcohol, drugs, inhalants, and tobacco)

25 abuse and mental health prevention and treatment,
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1 for the purpose of providing comprehensive services.

2 This can include the joint development of substance

3 abuse and mental health treatment planning and co4 ordinated case management using a multidisci5 plinary approach.

6 ‘‘(4) ‘Behavioral health aftercare’ includes those

7 activities and resources used to support recovery fol8 lowing inpatient, residential, intensive substance

9 abuse, or mental health outpatient or outpatient

10 treatment. The purpose is to help prevent or deal

11 with relapse by ensuring that by the time a client or

12 patient is discharged from a level of care, such as

13 outpatient treatment, an aftercare plan has been de14 veloped with the client. An aftercare plan may use

15 such resources as community-based therapeutic

16 group, transitional living, a 12-step sponsor, a local

17 12-step or other related support group, and other

18 community-based providers (mental health profes19 sionals, traditional health care practitioners, commu20 nity health aides, community health representatives,

21 mental health technicians, ministers, etc.)

22 ‘‘(5) ‘Dual diagnosis’ means coexisting sub23 stance abuse and mental illness conditions or diag24 nosis. Patients/clients are sometimes referred to as

25 mentally ill chemical abusers (MICAs).
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1 ‘‘(6) ‘Fetal alcohol disorders’ means fetal alco2 hol syndrome, partial fetal alcohol syndrome and al3 cohol related neural developmental disorder

4 (ARNDD).

5 ‘‘(7) ‘Fetal alcohol syndrome’ or ‘FAS’ means

6 a syndrome in which with a history of maternal alco7 hol consumption during pregnancy, the following cri8 teria should be met:

9 ‘‘(A) Central nervous system involvement

10 such as developmental delay, intellectual deficit,

11 microcephaly, or neurologic abnormalities.

12 ‘‘(B) Craniofacial abnormalities with at

13 least 2 of the following: microphthalmia, short

14 palpebral fissures, poorly developed philtrum,

15 thin upper lip, flat nasal bridge, and short

16 upturned nose.

17 ‘‘(C) Prenatal or postnatal growth delay.

18 ‘‘(8) ‘Partial FAS’ means with a history of ma19 ternal alcohol consumption during pregnancy having

20 most of the criteria of FAS, though not meeting a

21 minimum of at least 2 of the following: microoph22 thalmia, short palpebral fissures, poorly developed

23 philtrum, thin upper lip, flat nasal bridge, short

24 upturned nose.
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1 ‘‘(9) ‘Rehabilitation’ means to restore the abil2 ity or capacity to engage in usual and customary life

3 activities through education and therapy.

4 ‘‘(10) ‘Substance abuse’ includes inhalant

5 abuse.

6 ‘‘SEC. 715. AUTHORIZATION OF APPROPRIATIONS.

7 ‘‘There are authorized to be appropriated such sums

8 as may be necessary for each fiscal year through fiscal

9 year 2013 to carry out the provisions of this title.

10 ‘‘TITLE VIII—MISCELLANEOUS

11 ‘‘SEC. 801. REPORTS.

12 ‘‘The President shall, at the time the budget is sub13 mitted under section 1105 of title 31, United States Code,

14 for each fiscal year transmit to the Congress a report

15 containing—

16 ‘‘(1) a report on the progress made in meeting

17 the objectives of this Act, including a review of pro18 grams established or assisted pursuant to this Act

19 and an assessment and recommendations of addi20 tional programs or additional assistance necessary

21 to, at a minimum, provide health services to Indians,

22 and ensure a health status for Indians, which are at

23 a parity with the health services available to and the

24 health status of, the general population including
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1 specific comparisons of appropriations provided and

2 those required for such parity;

3 ‘‘(2) a report on whether, and to what extent,

4 new national health care programs, benefits, initia5 tives, or financing systems have had an impact on

6 the purposes of this Act and any steps that the Sec7 retary may have taken to consult with Indian tribes,

8 tribal organizations, and urban Indian organizations

9 to address such impact, including a report on pro10 posed changes in allocation of funding pursuant to

11 section 808;

12 ‘‘(3) a report on the use of health services by

13 Indians—

14 ‘‘(A) on a national and area or other rel15 evant geographical basis;

16 ‘‘(B) by gender and age;

17 ‘‘(C) by source of payment and type of

18 service;

19 ‘‘(D) comparing such rates of use with

20 rates of use among comparable non-Indian pop21 ulations; and

22 ‘‘(E) on the services provided under fund23 ing agreements pursuant to the Indian Self-De24 termination and Education Assistance Act;
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1 ‘‘(4) a report of contractors to the Secretary on

2 Health Care Educational Loan Repayments every 6

3 months required by section 110;

4 ‘‘(5) a General Audit Report of the Secretary

5 on the Health Care Educational Loan Repayment

6 Program as required by section 110(n);

7 ‘‘(6) a separate statement which specifies the

8 amount of funds requested to carry out the provi9 sions of section 201;

10 ‘‘(7) a biennial report to Congress on infectious

11 diseases as required by section 212;

12 ‘‘(8) a report on environmental and nuclear

13 health hazards as required by section 214;

14 ‘‘(9) an annual report on the status of all

15 health care facilities needs as required by section

16 301(c)(2) and 301(d);

17 ‘‘(10) reports on safe water and sanitary waste

18 disposal facilities as required by section 302(h)(1);

19 ‘‘(11) an annual report on the expenditure of

20 nonservice funds for renovation as required by sec21 tions 305(a)(2) and 305(a)(3);

22 ‘‘(12) a report identifying the backlog of main23 tenance and repair required at Service and tribal fa24 cilities required by section 314(a);
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1 ‘‘(13) a report providing an accounting of reim2 bursement funds made available to the Secretary

3 under titles XVIII and XIX of the Social Security

4 Act required by section 403(a);

5 ‘‘(14) a report on services sharing of Indian

6 Health Service, Veterans Affairs, and other Federal

7 agency health programs as required by section

8 412(c)(2);

9 ‘‘(15) a report on evaluation and renewal of

10 urban Indian programs as required by section 505;

11 ‘‘(16) a report on the findings and conclusions

12 derived from the demonstration project as required

13 by section 512(a)(2);

14 ‘‘(17) a report on the evaluation of programs as

15 required by section 513; and

16 ‘‘(18) a report on alcohol and substance abuse

17 as required by section 701(f).

18 ‘‘SEC. 802. REGULATIONS.

19 ‘‘(a)(1) Not later than 90 days after the date of en20 actment of this Act, the Secretary shall initiate procedures

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

22 Code, to negotiate and promulgate such regulations or

23 amendments thereto that are necessary to carry out the

24 Indian Health Care Improvement Act, as amended.
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1 ‘‘(2) Proposed regulations to implement this Act shall

2 be published in the Federal Register by the Secretary no

3 later than 270 days after the date of enactment of this

4 Act and shall have no less than a 120-day comment pe5 riod.

6 ‘‘(3) The authority to promulgate regulations under

7 this Act shall expire 18 months from the date of enact8 ment of this Act.

9 ‘‘(b) COMMITTEE.—A negotiated rulemaking com10 mittee established pursuant to section 565 of title 5,

11 United States Code, to carry out this section shall have

12 as its members only representatives of the Federal Gov13 ernment and representatives of Indian tribes, and tribal

14 organizations, a majority of whom shall be nominated by

15 and be representatives of Indian tribes, tribal organiza16 tions, and urban Indian organizations from each service

17 area.

18 ‘‘(c) ADAPTATION OF PROCEDURES.—The Secretary

19 shall adapt the negotiated rulemaking procedures to the

20 unique context of self-governance and the government-to21 government relationship between the United States and

22 Indian tribes.

23 ‘‘(d) The lack of promulgated regulations shall not

24 limit the effect of this Act.
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1 ‘‘(e) The provisions of this Act shall supersede any

2 conflicting provisions of law (including any conflicting reg3 ulations) in effect on the day before the date of enactment

4 of the Indian Self-Determination Contract Reform Act of

5 1994, and the Secretary is authorized to repeal any regu6 lation inconsistent with the provisions of this Act.

7 ‘‘SEC. 803. PLAN OF IMPLEMENTATION.

8 ‘‘Within 240 days after the date of the enactment of

9 the Indian Health Care Improvement Act Amendments of

10 2001, a plan will be prepared by the Secretary in consulta11 tion with Indian tribes, tribal organizations, and urban In12 dian organizations, and will be submitted to the Congress.

13 The plan will explain the manner and schedule (including

14 a schedule of appropriation requests), by title and section,

15 by which the Secretary will implement the provisions of

16 this Act.

17 ‘‘SEC. 804. AVAILABILITY OF FUNDS.

18 ‘‘The funds appropriated pursuant to this Act shall

19 remain available until expended.

20 ‘‘SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED

21 TO THE INDIAN HEALTH SERVICE.

22 ‘‘Any limitation on the use of funds contained in an

23 Act providing appropriations for the Department for a pe24 riod with respect to the performance of abortions shall

25 apply for that period with respect to the performance of
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1 abortions using funds contained in an Act providing ap2 propriations for the Indian Health Service.

3 ‘‘SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.

4 ‘‘(a) Until such time as any subsequent law may oth5 erwise provide, the following California Indians shall be

6 eligible for health services provided by the Service:

7 ‘‘(1) Any member of a federally recognized In8 dian tribe.

9 ‘‘(2) Any descendant of an Indian who was re10 siding in California on June 1, 1852, but only if

11 such descendant—

12 ‘‘(A) is a member of the Indian community

13 served by a local program of the Service; and

14 ‘‘(B) is regarded as an Indian by the com15 munity in which such descendant lives.

16 ‘‘(3) Any Indian who holds trust interests in

17 public domain, national forest, or Indian reservation

18 allotments in California.

19 ‘‘(4) Any Indian in California who is listed on

20 the plans for distribution of the assets of California

21 rancherias and reservations under the Act of August

22 18, 1958 (72 Stat. 619), and any descendant of

23 such an Indian.

24 ‘‘(b) Nothing in this section may be construed as ex25 panding the eligibility of California Indians for health
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1 services provided by the Service beyond the scope of eligi2 bility for such health services that applied on May 1, 1986.

3 ‘‘SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS.

4 ‘‘(a)(1) Any individual who—

5 ‘‘(A) has not attained 19 years of age;

6 ‘‘(B) is the natural or adopted child, step-child,

7 foster-child, legal ward, or orphan of an eligible In8 dian; and

9 ‘‘(C) is not otherwise eligible for health services

10 provided by the Service,

11 shall be eligible for all health services provided by the

12 Service on the same basis and subject to the same rules

13 that apply to eligible Indians until such individual attains

14 19 years of age. The existing and potential health needs

15 of all such individuals shall be taken into consideration

16 by the Service in determining the need for, or the alloca17 tion of, the health resources of the service. If such an indi18 vidual has been determined to be legally incompetent prior

19 to attaining 19 years of age, such individual shall remain

20 eligible for such services until 1 year after the date of a

21 determination of competency.

22 ‘‘(2) Any spouse of an eligible Indian who is not an

23 Indian, or who is of Indian descent but not otherwise eligi24 ble for the health services provided by the Service, shall

25 be eligible for such health services if all such spouses or
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1 spouses who are married to members of the Indian tribe(s)

2 being served are made eligible, as a class, by an appro3 priate resolution of the governing body of the Indian tribe

4 or tribal organization providing such services. The health

5 needs of persons made eligible under this paragraph shall

6 not be taken into consideration by the Service in deter7 mining the need for, or allocation of, its health resources.

8 ‘‘(b)(1)(A) The Secretary is authorized to provide

9 health services under this subsection through health pro10 grams operated directly by the Service to individuals who

11 reside within the service area of a service unit and who

12 are not eligible for such health services under any other

13 subsection of this section or under any other provision of

14 law if—

15 ‘‘(i) the Indian tribe (or, in the case of a multi16 tribal service area, all the Indian tribes) served by

17 such service unit requests such provision of health

18 services to such individuals; and

19 ‘‘(ii) the Secretary and the Indian tribe or

20 tribes have jointly determined that—

21 ‘‘(I) the provision of such health services

22 will not result in a denial or diminution of

23 health services to eligible Indians; and

24 ‘‘(II) there is no reasonable alternative

25 health program, within or without the service
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1 area of such service unit, available to meet the

2 health needs of such individuals.

3 ‘‘(B) In the case of health programs operated under

4 a contract entered into under the Indian Self-Determina5 tion and Education Assistance Act, the governing body of

6 the Indian tribe or tribal organization providing health

7 services under such contract is authorized to determine

8 whether health services should be provided under such

9 funding agreement to individuals who are not eligible for

10 such health services under any other subsection in this

11 section or under any other provision of law. In making

12 such determinations, the governing body of the Indian

13 tribe or tribal organization shall take into account the con14 siderations described in subparagraph (A)(ii).

15 ‘‘(2)(A) Persons receiving health services provided by

16 the Service by reason of this subsection shall be liable for

17 payment of such health services under a schedule of

18 charges prescribed by the Secretary which, in the judg19 ment of the Secretary, results in reimbursement in an

20 amount not less than the actual cost of providing the

21 health services. Notwithstanding section 1880(c) of the

22 Social Security Act, section 402(a) of this Act, or any

23 other provision of law, amounts collected under this sub24 section, including medicare or medicaid reimbursements

25 under titles XVIII and XIX of the Social Security Act,
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1 shall be credited to the account of the program providing

2 the service and shall be used solely for the provision of

3 health services within that program. Amounts collected

4 under this subsection shall be available for expenditure

5 within such program.

6 ‘‘(B) Health services may be provided by the Sec7 retary through the Service under this subsection to an in8 digent person who would not be eligible for such health

9 services but for the provisions of paragraph (1) only if

10 an agreement has been entered into with a State or local

11 government under which the State or local government

12 agrees to reimburse the Service for the expenses incurred

13 by the Service in providing such health services to such

14 indigent person.

15 ‘‘(3)(A) In the case of a service area which serves

16 only one Indian tribe, the authority of the Secretary to

17 provide health services under paragraph (1)(A) shall ter18 minate at the end of the fiscal year succeeding the fiscal

19 year in which the governing body of the Indian tribe re20 vokes its concurrence to the provision of such health serv21 ices.

22 ‘‘(B) In the case of a multi-tribal service area, the

23 authority of the Secretary to provide health services under

24 paragraph (1)(A) shall terminate at the end of the fiscal

25 year succeeding the fiscal year in which at least 51 percent
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1 of the number of Indian tribes in the service area revoke

2 their concurrence to the provisions of such health services.

3 ‘‘(c) The Service may provide health services under

4 this subsection to individuals who are not eligible for

5 health services provided by the Service under any other

6 subsection of this section or under any other provision of

7 law in order to—

8 ‘‘(1) achieve stability in a medical emergency;

9 ‘‘(2) prevent the spread of a communicable dis10 ease or otherwise deal with a public health hazard;

11 ‘‘(3) provide care to non-Indian women preg12 nant with an eligible Indian’s child for the duration

13 of the pregnancy through post partum; or

14 ‘‘(4) provide care to immediate family members

15 of an eligible person if such care is directly related

16 to the treatment of the eligible person.

17 ‘‘(d) Hospital privileges in health facilities operated

18 and maintained by the Service or operated under a con19 tract entered into under the Indian Self-Determination

20 and Education Assistance Act may be extended to non21 Service health care practitioners who provide services to

22 persons described in subsection (a) or (b). Such non-Serv23 ice health care practitioners may be regarded as employees

24 of the Federal Government for purposes of section

25 1346(b) and chapter 171 of title 28, United States Code
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1 (relating to Federal tort claims) only with respect to acts

2 or omissions which occur in the course of providing serv3 ices to eligible persons as a part of the conditions under

4 which such hospital privileges are extended.

5 ‘‘(e) For purposes of this section, the term ‘eligible

6 Indian’ means any Indian who is eligible for health serv7 ices provided by the Service without regard to the provi8 sions of this section.

9 ‘‘SEC. 808. REALLOCATION OF BASE RESOURCES.

10 ‘‘(a) Notwithstanding any other provision of law, any

11 allocation of Service funds for a fiscal year that reduces

12 by 5 percent or more from the previous fiscal year the

13 funding for any recurring program, project, or activity of

14 a service unit may be implemented only after the Secretary

15 has submitted to the President, for inclusion in the report

16 required to be transmitted to the Congress under section

17 801, a report on the proposed change in allocation of fund18 ing, including the reasons for the change and its likely

19 effects.

20 ‘‘(b) Subsection (a) shall not apply if the total

21 amount appropriated to the Service for a fiscal year is less

22 than the amount appropriated to the Service for the pre23 vious fiscal year.
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1 ‘‘SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.

2 ‘‘The Secretary shall provide for the dissemination to

3 Indian tribes of the findings and results of demonstration

4 projects conducted under this Act.

5 ‘‘SEC. 810. PROVISION OF SERVICES IN MONTANA.

6 ‘‘(a) The Secretary shall provide services and benefits

7 for Indians in Montana in a manner consistent with the

8 decision of the United States Court of Appeals for the

9 Ninth Circuit in McNabb for McNabb v. Bowen, 829 F.2d

10 787 (9th Cir. 1987).

11 ‘‘(b) The provisions of subsection (a) shall not be con12 strued to be an expression of the sense of the Congress

13 on the application of the decision described in subsection

14 (a) with respect to the provision of services or benefits

15 for Indians living in any State other than Montana.

16 ‘‘SEC. 811. MORATORIUM.

17 ‘‘During the period of the moratorium imposed by

18 Public Law 100–446 on implementation of the final rule

19 published in the Federal Register on September 16, 1987,

20 by the Health Resources and Services Administration of

21 the Public Health Service, relating to eligibility for the

22 health care services of the Indian Health Service, the In23 dian Health Service shall provide services pursuant to the

24 criteria for eligibility for such services that were in effect

25 on September 15, 1987, subject to the provisions of sec26 tions 806 and 807 of the Indian Health Care Improvement
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•HR 1662 IH

1 Act, as amended by this Act until such time as new cri2 teria governing eligibility for services are developed in ac3 cordance with section 802 of this Act.

4 ‘‘SEC. 812. TRIBAL EMPLOYMENT.

5 ‘‘For purposes of section 2(2) of the Act of July 5,

6 1935, as amended (49 Stat. 450, chapter 372), an Indian

7 tribe or tribal organization carrying out a funding agree8 ment under the Indian Self-Determination and Education

9 Assistance Act shall not be considered an ‘employer’.

10 ‘‘SEC. 813. PRIME VENDOR.

11 ‘‘For purposes of section 4 of Public Law 102–585

12 (38 U.S.C. 812) tribes and tribal organizations carrying

13 out a grant, cooperative agreement of funding agreement

14 under the Indian Self-Determination and Education As15 sistance Act (25 U.S.C. 450 et seq.) shall be deemed to

16 be an executive agency and part of the Indian Health

17 Service in the Department of Health and Human Services

18 and, as such, may act as an ordering agent of the Indian

19 Health Service and the employees of the tribe or tribal

20 organization may order supplies on behalf thereof on the

21 same basis as employees of the Indian Health Service.

22 ‘‘SEC. 814. SEVERABILITY PROVISIONS.

23 ‘‘If any provision of this Act, any amendment made

24 by the Act, or the application of such provision or amend25 ment to any person or circumstances is held to be invalid,
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1 the remainder of this Act, the remaining amendments

2 made by this Act, and the application of such provisions

3 to persons or circumstances other than those to which it

4 is held invalid, shall not be affected thereby.

5 ‘‘SEC. 815. ESTABLISHMENT OF NATIONAL BIPARTISAN

6 COMMISSION ON INDIAN HEALTH CARE ENTI7 TLEMENT.

8 ‘‘(a) There is hereby established the National Bipar9 tisan Indian Health Care Entitlement Commission (the

10 ‘Commission’).

11 ‘‘(b) DUTIES OF COMMISSION.—The Commission

12 shall—

13 ‘‘(1) review and analyze the recommendations

14 of the report of the Study Committee, as established

15 below, to the Commission;

16 ‘‘(2) make recommendations to the Congress

17 for providing health services for Indian persons as

18 an entitlement, giving due regard to the effects of

19 such a program on existing health care delivery sys20 tems for Indian persons and the effect of such a pro21 gram on the sovereign status of Indian tribes;

22 ‘‘(3) establish a Study Committee composed of

23 those members of the Commission appointed by the

24 Director of the Indian Health Service and at least
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1 4 members of Congress from among the members of

2 the Commission which shall—

3 ‘‘(A) to the extent necessary to carry out

4 its duties, collect and compile data necessary to

5 understand the extent of Indian needs with re6 gard to the provision of health services, regard7 less of the location of Indians, including holding

8 hearings and soliciting the views of Indians, In9 dian tribes, tribal organizations, and urban In10 dian organizations, and which may include au11 thorizing and funding feasibility studies of var12 ious models for providing and funding health

13 services for all Indian beneficiaries including

14 those who live outside of a reservation, tempo15 rarily or permanently;

16 ‘‘(B) make recommendations to the Com17 mission for legislation that will provide for the

18 delivery of health services for Indians as an en19 titlement, which will address, among other

20 things, issues of eligibility, benefits to be pro21 vided, including recommendations regarding

22 from whom such health services are to be pro23 vided and the cost, including mechanisms for

24 funding of the health services to be provided;
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•HR 1662 IH

1 ‘‘(C) determine the effect of the enactment

2 of such recommendations on the existing system

3 of delivery of health services for Indians;

4 ‘‘(D) determine the effect of a health serv5 ices entitlement program for Indian persons on

6 the sovereign status of Indian tribes;

7 ‘‘(E) not later than 12 months after the

8 appointment of all members of the Commission,

9 shall make a written report of its findings and

10 recommendations to the full Commission, which

11 report shall include a statement of the minority

12 and majority position of the Committee and

13 which shall be disseminated, at a minimum, to

14 every federally recognized Indian tribe, tribal

15 organization, and urban Indian organization for

16 comment to the Commission; and

17 ‘‘(F) report regularly to the full Commis18 sion regarding the findings and recommenda19 tions developed by the Study Committee in the

20 course of carrying out its duties under this sec21 tion.

22 ‘‘(4) By not later than 18 months following the

23 date of appointment of all members of the Commis24 sion, submit a written report to Congress containing

25 a recommendation of policies and legislation to im-
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•HR 1662 IH

1 plement a policy that would establish a health care

2 system for Indians based on delivery of health serv3 ices as an entitlement, together with a determination

4 of the implications of such an entitlement system on

5 existing health care delivery systems for Indians and

6 on the sovereign status of Indian tribes.

7 ‘‘(c)(1) The Commission shall be composed of 25

8 members, selected by as follows:

9 ‘‘(A) 10 members of Congress, including 3 from

10 the United States House of Representatives and 2

11 from the United States Senate, appointed by their

12 respective majority leaders, and 3 from the United

13 States House of Representatives and 2 from the

14 United States Senate, appointed by their respective

15 minority leaders, and who shall be members of the

16 standing committees of Congress that consider legis17 lation affecting health care to Indians.

18 ‘‘(B) 12 persons chosen by the Congressional

19 members of the Commission, 1 from each Indian

20 health care service area as currently designated by

21 the Director of the Indian Health Service, to be cho22 sen from among 3 nominees from each area put for23 ward by the Tribes within the area, with due regard

24 being given to the experience and expertise of the

25 nominees in the provision of health care to Indians
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1 and with due regard being given to a reasonable rep2 resentation on the commission of members who are

3 familiar with various health care delivery modes and

4 who represent Tribes of various size populations.

5 ‘‘(C) 3 persons appointed by the Director of the

6 Indian Health Service who are knowledgeable about

7 the provision of health care to Indians, at least one

8 of whom shall be appointed from among 3 nominees

9 put forward by those programs whose funding is

10 provided in whole or in part by the Indian Health

11 Service primarily or exclusively for the benefit of

12 urban Indians.

13 ‘‘(D) All those persons chosen by the Congres14 sional members of the Commission and by the Presi15 dent shall be members of federally recognized Indian

16 tribes.

17 ‘‘(E) The Chairman and Vice Chairman of the

18 Commission shall be selected by the Congressional

19 members of the Commission.

20 ‘‘(c)(1) The terms of members of the Commission

21 shall be for the life of the Commission.

22 ‘‘(2) Congressional members of the Commission shall

23 be appointed not later than 90 days after the approval

24 of this Act, and the remaining members of the Commis-
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1 sion shall be appointed not later than 60 days following

2 the appointment of the Congressional members.

3 ‘‘(3) A vacancy in the Commission shall be filled in

4 the manner in which the original appointment was made.

5 ‘‘(d)(1) Each Congressional member of the Commis6 sion shall receive no additional pay, allowances, or benefits

7 by reason of their service on the Commission and shall

8 receive travel expenses and per diem in lieu of subsistence

9 in accordance with sections 5702 and 5703 of title 5,

10 United States Code.

11 ‘‘(2) Remaining members of the Commission,

12 while serving on the business of the Commission (in13 cluding travel time) shall be entitled to receive com14 pensation at the per diem equivalent of the rate pro15 vided for level IV of the Executive Schedule under

16 section 5315 of title 5, United States Code, and

17 while so serving away from home and the member’s

18 regular place of business, a member may be allowed

19 travel expenses, as authorized by the Chairman of

20 the Commission. For purpose of pay (other than pay

21 of members of the Commission) and employment

22 benefits, rights, and privileges, all personnel of the

23 Commission shall be treated as if they were employ24 ees of the United States Senate.
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1 ‘‘(e)(1) The Commission shall meet at the call of the

2 Chairman.

3 ‘‘(2) A quorum of the Commission shall consist of not

4 less than 15 members, provided that no less than 6 of

5 the members of Congress who are Commission members

6 are present and no less than 9 of the members who are

7 Indians are present.

8 ‘‘(f)(1)(A) The Commission shall appoint an execu9 tive director of the Commission.

10 ‘‘(B) The executive director shall be paid the rate of

11 basic pay for level V of the Executive Schedule.

12 ‘‘(2) With the approval of the Commission, the execu13 tive director may appoint such personnel as the executive

14 director deems appropriate.

15 ‘‘(3) The staff of the Commission shall be appointed

16 without regard to the provisions of title 5, United States

17 Code, governing appointments in the competitive service,

18 and shall be paid without regard to the provisions of chap19 ter 51 and subchapter III of chapter 53 of such title (re20 lating to classification and General Schedule pay rates).

21 ‘‘(4) With the approval of the Commission, the execu22 tive director may procure temporary and intermittent

23 services under section 3109(b) of title 5, United States

24 Code.
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1 ‘‘(5) The Administrator of General Services shall lo2 cate suitable office space for the operation of the Commis3 sion. The facilities shall serve as the headquarters of the

4 Commission and shall include all necessary equipment and

5 incidentals required for the proper functioning of the Com6 mission.

7 ‘‘(g)(1) For the purpose of carrying out its duties,

8 the Commission may hold such hearings and undertake

9 such other activities as the Commission determines to be

10 necessary to carry out its duties, provided that at least

11 6 regional hearings are held in different areas of the

12 United States in which large numbers of Indians are

13 present. Such hearings are to be held to solicit the views

14 of Indians regarding the delivery of health care services

15 to them. To constitute a hearing under this subsection,

16 at least 5 members of the Commission, including at least

17 1 member of Congress, must be present. Hearings held

18 by the Study Committee established in this section may

19 count towards the number of regional hearings required

20 by this subsection.

21 ‘‘(2) Upon request of the Commission, the Comp22 troller General shall conduct such studies or investigations

23 as the Commission determines to be necessary to carry

24 out its duties.
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1 ‘‘(3)(A) The Director of the Congressional Budget

2 Office or the Chief Actuary of the Health Care Financing

3 Administration, or both, shall provide to the Commission,

4 upon the request of the Commission, such cost estimates

5 as the Commission determines to be necessary to carry

6 out its duties.

7 ‘‘(B) The Commission shall reimburse the Director

8 of the Congressional Budget Office for expenses relating

9 to the employment in the office of the Director of such

10 additional staff as may be necessary for the Director to

11 comply with requests by the Commission under subpara12 graph (A).

13 ‘‘(4) Upon the request of the Commission, the head

14 of any Federal agency is authorized to detail, without re15 imbursement, any of the personnel of such agency to the

16 Commission to assist the Commission in carrying out its

17 duties. Any such detail shall not interrupt or otherwise

18 affect the civil service status or privileges of the Federal

19 employee.

20 ‘‘(5) Upon the request of the Commission, the head

21 of a Federal agency shall provide such technical assistance

22 to the Commission as the Commission determines to be

23 necessary to carry out its duties.

24 ‘‘(6) The Commission may use the United States

25 mails in the same manner and under the same conditions
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1 as Federal agencies and shall, for purposes of the frank,

2 be considered a commission of Congress as described in

3 section 3215 of title 39, United States Code.

4 ‘‘(7) The Commission may secure directly from any

5 Federal agency information necessary to enable it to carry

6 out its duties, if the information may be disclosed under

7 section 552 of title 4, United States Code. Upon request

8 of the Chairman of the Commission, the head of such

9 agency shall furnish such information to the Commission.

10 ‘‘(8) Upon the request of the Commission, the Ad11 ministrator of General Services shall provide to the Com12 mission on a reimbursable basis such administrative sup13 port services as the Commission may request.

14 ‘‘(9) For purposes of costs relating to printing and

15 binding, including the cost of personnel detailed from the

16 Government Printing Office, the Commission shall be

17 deemed to be a committee of the Congress.

18 ‘‘(h) There are authorized to be appropriated

19 $4,000,000 to carry out the provisions of this section,

20 which sum shall not be deducted from or affect any other

21 appropriation for health care for Indian persons.

22 ‘‘SEC. 816. APPROPRIATIONS; AVAILABILITY.

23 ‘‘Any new spending authority (described in subsection

24 (c)(2)(A) or (B) of section 401 of the Congressional Budg25 et Act of 1974) which is provided under this Act shall
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1 be effective for any fiscal year only to such extent or in

2 such amounts as are provided in appropriation Acts.

3 ‘‘SEC. 817. AUTHORIZATION OF APPROPRIATIONS.

4 ‘‘There are authorized to be appropriated such sums

5 as may be necessary for each fiscal year through fiscal

6 year 2013 to carry out this title.’’.

7 SEC. 3. SOBOBA SANITATION FACILITIES.

8 The Act of December 17, 1970 (84 Stat. 1465), is

9 amended by adding at the end the following new section:

10 ‘‘SEC. 9. Nothing in this Act shall preclude the

11 Soboba Band of Mission Indians and the Soboba Indian

12 Reservation from being provided with sanitation facilities

13 and services under the authority of section 7 of the Act

14 of August 5, 1954 (68 Stat 674), as amended by the Act

15 of July 31, 1959 (73 Stat. 267).’’.

16 SEC. 4. SOCIAL SECURITY ACT AMENDMENTS.

17 (a) Section 1866(a)(1) of the Social Security Act (42

18 U.S.C. 1395cc(a)(1)) is amended by adding at the end the

19 following new subparagraph:

20 ‘‘(T) in the case of hospitals and critical

21 access hospitals which provide inpatient hospital

22 services for which payment may be made under

23 this title, to accept as payment in full for serv24 ices that are covered under and furnished to an

25 individual eligible for the contract health serv-
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1 ices program operated by the Indian Health

2 Service, by an Indian tribe or tribal organiza3 tion or furnished to an urban Indian eligible for

4 health services purchased by an urban Indian

5 organization (as those terms are defined in sec6 tion 4 of the Indian Health Care Improvement

7 Act), in accordance with such admission prac8 tices, and such payment methodology and

9 amounts, as are prescribed under regulations

10 issued by the Secretary in implementation of

11 such section.’’.

12 (b) Section 1880 of the Social Security Act is amend13 ed to read as follows:

14 ‘‘SEC. 1880. INDIAN HEALTH PROGRAMS.

15 ‘‘(a) The Indian Health Service and an Indian tribe

16 or tribal organization (as those terms are defined in sec17 tion 4 of the Indian Health Care Improvement Act), shall

18 be eligible for payments under this title, notwithstanding

19 sections 1814(c) and 1835(d), if and for so long as it

20 meets the conditions and requirements for such payments

21 which are applicable generally to the service or provider

22 type for which it seeks payment under this title and for

23 services and provider types provided by a qualified Indian

24 health program under section 1880A.
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1 ‘‘(b) Notwithstanding subsection (a), if the Indian

2 Health Service or an Indian tribe, tribal organization, or

3 urban Indian organization, does not meet all of the condi4 tions and requirements of this title which are applicable

5 generally to such service or provider type submits to the

6 Secretary within 6 months after the date on which it first

7 sought reimbursement for the service or provider type an

8 acceptable plan for achieving compliance with such condi9 tions and requirements, it shall be deemed to meet such

10 conditions and requirements (and to be eligible for reim11 bursement under this title), without regard to the extent

12 of its actual compliance with such conditions and require13 ments, during the first 12 months after the month in

14 which such plan is submitted.

15 ‘‘(c) For provisions relating to the authority of cer16 tain Indian tribes and tribal organizations to elect to di17 rectly bill for, and receive payment for, health care services

18 provided by a hospital or clinic of such Tribes or tribal

19 organizations and for which payment may be made under

20 this title, see section 405 of the Indian Health Care Im21 provement Act.

22 ‘‘(d) The Indian Health Service, an Indian tribe, or

23 tribal organization providing a service otherwise eligible

24 for payment under this section through the use of a com25 munity health aide or practitioner certified under the pro-
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1 visions of section 121 of the Indian Health Care Improve2 ment Act (25 U.S.C. 1616l) shall be paid for such services

3 on the same basis that such services are reimbursed under

4 State Plans approved under title XIX of the Social Secu5 rity Act.

6 ‘‘(e) Notwithstanding any other provision of law, a

7 health program operated by the Indian Health Service, an

8 Indian tribe, or tribal organization, which collaborates

9 with a hospital operated by the Indian Health Service or

10 an Indian tribe or tribal organization, shall, at the option

11 of the Indian tribe or tribal organization, be paid for serv12 ices for which it would otherwise be eligible under this sec13 tion as if it were an outpatient department of the hospital.

14 In situations where the health program is on a separate

15 campus from the hospital, billing as an outpatient depart16 ment of the hospital shall not subject such a health pro17 gram to the requirements of section 1867 (42 U.S.C.

18 1395dd) (the Emergency Medical Treatment and Active

19 Labor Act).

20 ‘‘(f) The Indian Health Service, an Indian tribe, or

21 tribal organization providing visiting nurse services in a

22 Home Health Agency Shortage Area shall be paid for such

23 services on the same basis that such services are reim24 bursed for other primary care providers.
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1 ‘‘(g) Notwithstanding any other provision of law, the

2 Secretary shall have broad authority to identify and imple3 ment alternative methods of reimbursing Indian health

4 programs for Medicare services provided to Indians. The

5 Indian tribe, tribal organization, or urban Indian organi6 zation may opt to receive reimbursement under reimburse7 ment methodologies applicable to other providers of simi8 lar services, provided that the amount of reimbursement

9 resulting under such alternative methodology shall not be

10 less than 100 percent of the reasonable cost of the service

11 to which the methodology applies under section 1861(v).’’.

12 (c) Title XVIII of the Social Security Act is amended

13 by adding after section 1880A the following new section:

14 ‘‘SEC. 1880B. QUALIFIED INDIAN HEALTH PROGRAM.

15 ‘‘(a) A qualified Indian health program shall be eligi16 ble for payments under this title, notwithstanding sections

17 1814(c) and 1835(d), if and for so long as it meets all

18 the conditions and requirements set forth in this section.

19 ‘‘(b)(1) The term ‘qualified Indian health program’

20 means a health program operated by—

21 ‘‘(A) the Indian Health Service;

22 ‘‘(B) an Indian tribe, tribal organization, or

23 urban Indian organization (as those terms are de24 fined in section 4 of the Indian Health Care Im25 provement Act) and which is funded in whole or part
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1 by the Indian Health Service under the Indian Self2 Determination and Education Assistance Act; and

3 ‘‘(C) an urban Indian organization (as that

4 term is defined in section 4 of the Indian Health

5 Care Improvement Act) and which is funded in

6 whole or part under title V of the Indian Health

7 Care Improvement Act.

8 ‘‘(2) A qualified Indian health program may include

9 one or more hospitals, nursing homes, home health pro10 grams, clinics, ambulance services, or other health pro11 grams providing a service for which payments may be

12 made under this title and which is covered in the Medicare

13 or Medicaid cost report for such qualified Indian health

14 program.

15 ‘‘(c)(1) Notwithstanding any other provision in the

16 law, a qualified Indian health program shall be entitled

17 to receive payment based on an all-inclusive rate which

18 shall be calculated to provide full cost recovery for the cost

19 of furnishing services provided under this section.

20 ‘‘(2) The term ‘full cost recovery’ shall mean—

21 ‘‘(A) the direct costs, which are reasonable,

22 adequate, and related to the cost of furnishing such

23 services, taking into account the unique nature, loca24 tion, and service population of the qualified Indian

25 health program, and which shall include direct pro-
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1 gram, administrative, and overhead costs, without

2 regard to the customary or other charge or any fee

3 schedule that would otherwise be applicable, plus

4 ‘‘(B) indirect costs which for a qualified Indian

5 health program operated by—

6 ‘‘(i) an Indian tribe or tribal organization

7 for which an indirect cost rate (as that term is

8 defined in section 4(g) of the Indian Self-Deter9 mination and Education Assistance Act) has

10 been established or an urban Indian organiza11 tion for which an indirect cost rate has other12 wise been established shall be not less than an

13 amount determined on the basis of the indirect

14 cost rate; or

15 ‘‘(ii) the Indian Health Service, an Indian

16 tribe, tribal organization, or urban Indian orga17 nization for which no such rate has been estab18 lished shall be not less than the administrative

19 costs specifically associated with the delivery of

20 the services being provided.

21 ‘‘(C) Notwithstanding any other provision of

22 law, the amount determined to be payable as full

23 cost recovery may not be reduced for coinsurance,

24 copayments or deductibles when the service was pro25 vided to an Indian entitled under Federal law to re-
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1 ceive service from the Indian Health Service, an In2 dian tribe, or tribal organization, or an urban Indian

3 organization or because of any limitations on pay4 ment provided for in any managed care plan.

5 ‘‘(3) In addition to full cost recovery, a qualified In6 dian health program shall be entitled to reasonable

7 outstationing costs, which shall include all administrative

8 costs associated with outreach and acceptance of eligibility

9 applications for any Federal or State health program in10 cluding, but not limited to medicare, medicaid, and the

11 Children’s Health Insurance Program.

12 ‘‘(4) Costs identified for services addressed in a cost

13 report submitted by the qualified Indian health program

14 shall be used to determine an all-inclusive encounter or

15 per diem payment amount for such services. Not all health

16 programs provided or administered by the Indian Health

17 Service, an Indian tribe or tribal organization, or an urban

18 Indian organization must be combined into a single cost

19 report. A full cost recovery payment for services not cov20 ered by such cost report shall be made on a fee-for-service,

21 encounter, or per diem basis.

22 ‘‘(5) The full cost recovery rate provided for in para23 graphs (1) through (3) of this subsection may be deter24 mined, at the election of the qualified Indian health pro25 gram, by the Health Care Financing Administration or by
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1 a State Medicaid agency and shall be valid for reimburse2 ment made under title XVIII (medicare), title XIX (med3 icaid), and title XXI (children’s health insurance program)

4 purposes. The costs described in subparagraph (A) of

5 paragraph (2) shall be calculated under whatever method6 ology yields the greatest aggregate payment for the cost

7 reporting period, provided that such methodology shall be

8 adjusted to include adjustments to such payment to take

9 into account for those qualified Indian health programs

10 that include hospitals—

11 ‘‘(A) a significant decrease in discharges;

12 ‘‘(B) costs for graduate medical education pro13 grams;

14 ‘‘(C) additional payment as a disproportionate

15 share hospital with a payment adjustment factor of

16 10; and

17 ‘‘(D) payment for outlier cases.

18 ‘‘(6) A qualified Indian health program may elect to

19 receive payment for services provided under this section—

20 ‘‘(A) on the full cost recovery basis provided in

21 subsection (c)(1)–(5)

22 ‘‘(B) on the basis of the inpatient or outpatient

23 encounter rates established for Indian Health Serv24 ice facilities and published annually in the Federal

25 Register;
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1 ‘‘(C) on the same basis as other providers are

2 reimbursed under this title, provided that to this

3 amount shall be added the amounts determined

4 under subparagraph (B) of subsection (c)(2);

5 ‘‘(D) on the basis of any other rate or method6 ology applicable to the Service, an Indian tribe, or

7 tribal organization; or

8 ‘‘(E) on the basis of any rate or methodology

9 negotiated with the agency responsible for making

10 payment.

11 ‘‘(d) A qualified Indian health program may under

12 this section provide and be reimbursed for any service the

13 Indian Health Service, an Indian tribe, or tribal organiza14 tion or an urban Indian organization may be reimbursed

15 under section 1880 for the medicare program and section

16 1911 for the Medicaid program, provided that in either

17 event such services may also include, at the election of

18 the qualified Indian health program—

19 ‘‘(1) any service when furnished by an employee

20 of the qualified Indian health program who is li21 censed or certified to perform such a service to the

22 same extent that such service would be reimbursable

23 if performed by a physician and any service or sup24 plies furnished as incident to a physician’s service as
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1 would otherwise be covered if furnished by a physi2 cian or as an incident to a physician’s service;

3 ‘‘(2) screening, diagnostic, and therapeutic out4 patient services including, but not limited to, part5 time or intermittent screening, diagnostic and thera6 peutic skilled nursing care and related medical sup7 plies (other than drugs and biologicals), furnished by

8 an employee of the qualified Indian health program

9 who is licensed or certified to perform such a service

10 for an individual in the individual’s home or in a

11 community health setting under a written plan of

12 treatment established and periodically reviewed by a

13 physician, when furnished to an individual as an

14 outpatient of a qualified Indian health program;

15 ‘‘(3) preventive primary health services as de16 scribed under sections 329, 330, and 340 of the

17 Public Health Service Act, when provided by an em18 ployee of the qualified Indian health program who is

19 licensed or certified to perform such a service, re20 gardless of the location in which the service is pro21 vided;

22 ‘‘(4) for children, all services specified as part

23 of the State medicaid plan, Children’s Health Insur24 ance Program, and EPSDT;
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1 ‘‘(5) influenza and pneumococcal immuniza2 tions;

3 ‘‘(6) other immunizations for prevention of

4 communicable diseases when targeted; and

5 ‘‘(7) the cost of transportation for providers or

6 patients necessary to facilitate access for patients.’’.

7 (d) Section 1902(a)(13) of the Social Security Act

8 is amended by adding at the end the following:

9 ‘‘(D)(i) for payment for services described

10 in subparagraph (C) of section 1905(a)(2)

11 under the plan furnished by an Indian tribe,

12 tribal organization, or urban Indian organiza13 tion (as defined in section 4 of the Indian

14 Health Care Improvement Act) of 100 percent

15 of costs which are reasonable and related to the

16 cost of furnishing such services or based on

17 other tests of reasonableness as the Secretary

18 prescribes in regulations under section

19 1833(a)(3), or, in the case of services to which

20 those regulations do not apply, the same meth21 odology used under section 1833(a)(3).

22 ‘‘(ii) in carrying out clause (i) in the case

23 of services furnished by a federally qualified

24 health center that is operated by an Indian

25 tribe, tribal organization or urban Indian orga-
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1 nization (as defined in section 4 of the Indian

2 Health Care Improvement Act) pursuant to a

3 contract between the center and an organization

4 under section 1903(m), for payment to the cen5 ter at least quarterly by the State of a supple6 mental payment equal to the amount (if any) by

7 which the amount determined under clause (i)

8 exceeds the amount of the payments provided

9 under such contract.’’.

10 (e) Section 1902(a) of the Social Security Act is

11 amended by adding at the end the following:

12 ‘‘(66) if the Indian Health Service operates or

13 funds health programs in the State or if there are

14 Indian tribes, tribal organizations or urban Indian

15 organizations (as those terms are defined in section

16 4 of the Indian Health Care Improvement Act)

17 present in the State, provide for meaningful con18 sultation with such entities prior to the submission

19 of, and as a precondition of approval of, any pro20 posed amendment, waiver, demonstration project, or

21 other request that would have the effect of changing

22 any aspect of the State’s administration of the Med23 icaid program, provided that ‘meaningful consulta24 tion’ shall be defined through the negotiated rule25 making provided for under section 802 of the Indian
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1 Health Care Improvement Act, provided that such

2 consultation must be carried out in collaboration

3 with the Indian Medicaid Advisory Committee estab4 lished under section 415(a)(3) of the Indian Health

5 Care Improvement Act.’’.

6 (f) The last sentence of section 1905(b) of the Social

7 Security Act is amended to read as follows: ‘‘Notwith8 standing the first sentence of this section, the Federal

9 medical assistance percentage shall be 100 percent with

10 respect to amounts expended as medical assistance for

11 services which are received through the Indian Health

12 Service or an Indian tribe, tribal organization, or urban

13 Indian organization (as defined in section 4 of the Indian

14 Health Care Improvement Act) under section 1911 of the

15 Social Security Act. ‘Through’ in this subsection shall in16 clude services provided directly, by referral, or under con17 tracts or other arrangements between the Indian Health

18 Service, Indian tribe, tribal organization, or urban Indian

19 organization and another health provider.’’.

20 (g) Section 1911 of the Social Security Act is amend21 ed to read as follows:

22 ‘‘SEC. 1911. INDIAN HEALTH SERVICE PROGRAMS.

23 ‘‘(a) The Indian Health Service and an Indian tribe,

24 tribal organization, or urban Indian organization (as those

25 terms are defined in section 4 of the Indian Health Care
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1 Improvement Act) shall be eligible for reimbursement for

2 medical assistance provided under a State plan if and for

3 so long as it provides services or provider types of a type

4 otherwise covered under the State plan and meets the con5 ditions and requirements which are applicable generally to

6 the service for which it seeks reimbursement under this

7 title and for services provided by a qualified Indian health

8 program under section 1880A.

9 ‘‘(b) Notwithstanding subsection (a), if the Indian

10 Health Service, an Indian tribe, or tribal organization,

11 which provides services of a type otherwise covered under

12 the State plan, does not meet all of the conditions and

13 requirements of this title which are applicable generally

14 to such services submits to the Secretary within 6 months

15 after the date on which it first sought reimbursement for

16 the service an acceptable plan for achieving compliance

17 with such conditions and requirements, it shall be deemed

18 to meet such conditions and requirements (and to be eligi19 ble for reimbursement under this title), without regard to

20 the extent of its actual compliance with such conditions

21 and requirements, during the first 12 months after the

22 month in which such plan is submitted.

23 ‘‘(c) The Secretary is authorized to enter into agree24 ments with the State agency for the purpose of reimburs25 ing such agency for health care and services provided by
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1 the Indian Health Service, Indian tribes, tribal organiza2 tions, and urban Indian organizations, directly, through

3 referral, or under contracts or other arrangements be4 tween the Indian Health Service, Indian tribe, tribal orga5 nization, or urban Indian organization and another health

6 provider to Indians who are eligible for medical assistance

7 under the State plan.’’.

8 (h) Section 2101(c) of the Social Security Act is

9 amended by adding at the end the following: ‘‘Without re10 gard to which option a State chooses under section

11 2101(a), the Federal medical assistance percentage shall

12 be 100 per centum with respect to amounts expended as

13 medical assistance for services which are provided through

14 a health program operated by the Indian Health Service,

15 an Indian tribe, or tribal organization (as those terms are

16 defined in section 4 of the Indian Health Care Improve17 ment Act).’’.

18 SEC. 5. REPEAL OF FACILITIES SURVEY AND REPORTING

19 REQUIREMENT.

20 Subsections (a) and (b) of section 506 of P.L. 101–

21 630 are repealed.

Æ