II 

110TH CONGRESS 

1ST SESSION S. 1200 

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

that Act. 

IN THE SENATE OF THE UNITED STATES 

APRIL 24, 2007 

Mr. DORGAN (for himself, Mrs. BOXER, Mr. REID, Ms. CANTWELL, Mr. 

JOHNSON, Mr. TESTER, Mr. INOUYE, Mr. DOMENICI, Mr. BINGAMAN, 

Mr. BAUCUS, Ms. KLOBUCHAR, Mr. THOMAS, Mr. OBAMA, and Ms. MURKOWSKI) introduced the following bill; which was read twice and referred 

to the Committee on Indian Affairs 

A BILL 

To amend the Indian Health Care Improvement Act to revise 

and extend that Act. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Indian Health Care Improvement Act Amendments of 

6 2007’’. 

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

8 this Act is as follows: 

Sec.1.Short title; table of contents. 


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TITLE I—AMENDMENTS TO INDIAN LAWS 

Sec.101.Indian Health Care Improvement Act amended. 

Sec.102.Soboba sanitation facilities. 

Sec.103.Native American Health and Wellness Foundation. 

TITLE II—IMPROVEMENT OF INDIAN HEALTH CARE PROVIDED 

UNDER THE SOCIAL SECURITY ACT 

Sec.201.Expansion of payments under Medicare, Medicaid, and SCHIP for all 

covered services furnished by Indian Health Programs. 

Sec.202.Increased outreach to Indians under Medicaid and SCHIP and improved cooperation in the provision of items and services to Indians under Social Security Act health benefit programs. 

Sec.203.Additional provisions to increase outreach to, and enrollment of, Indians in SCHIP and Medicaid. 

Sec.204.Premiums and cost sharing protections under Medicaid, eligibility determinations under Medicaid and SCHIP, and protection of 

certain Indian property from Medicaid estate recovery. 

Sec.205.Nondiscrimination in qualifications for payment for services under 

Federal health care programs. 

Sec.206.Consultation on Medicaid, SCHIP, and other health care programs 

funded under the Social Security Act involving Indian Health 

Programs and Urban Indian Organizations. 

Sec.207.Exclusion waiver authority for affected Indian Health Programs and 

safe harbor transactions under the Social Security Act. 

Sec.208.Rules applicable under Medicaid and SCHIP to managed care entities 

with respect to Indian enrollees and Indian health care providers and Indian managed care entities. 

Sec.209.Annual report on Indians served by Social Security Act health benefit 

programs. 

1 TITLE I—AMENDMENTS TO 

2 INDIAN LAWS 

3 SEC. 101. INDIAN HEALTH CARE IMPROVEMENT ACT 

4 AMENDED. 

5 (a) IN GENERAL.—The Indian Health Care Improve6 ment Act (25 U.S.C. 1601 et seq.) is amended to read 

7 as follows: 

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

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

10 ‘Indian Health Care Improvement Act’. 


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

2 for this Act is as follows: 

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

‘‘Sec.2.Findings. 

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

‘‘Sec.4.Definitions. 

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

DEVELOPMENT 

‘‘Sec.101.Purpose. 

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

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

‘‘Sec.104.Indian health professions scholarships. 

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

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

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

‘‘Sec.108.Continuing education allowances. 

‘‘Sec.109.Community Health Representative Program. 

‘‘Sec.110.Indian Health Service Loan Repayment Program. 

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

‘‘Sec.112.Recruitment activities. 

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

‘‘Sec.114.Advanced training and research. 

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

‘‘Sec.116.Tribal cultural orientation. 

‘‘Sec.117.INMED Program. 

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

‘‘Sec.119.Retention bonus. 

‘‘Sec.120.Nursing residency program. 

‘‘Sec.121.Community Health Aide Program. 

‘‘Sec.122.Tribal Health Program administration. 

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

‘‘Sec.124.National Health Service Corps. 

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

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

‘‘Sec.127.Authorization of appropriations. 

‘‘TITLE II—HEALTH SERVICES 

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

‘‘Sec.202.Catastrophic Health Emergency Fund. 

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

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

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

‘‘Sec.206.Health services research. 

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

‘‘Sec.208.Patient travel costs. 

‘‘Sec.209.Epidemiology centers. 

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

‘‘Sec.211.Indian youth program. 

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

diseases. 


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‘‘Sec.213.Other authority for provision of services. 

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

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

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

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

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

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

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

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

‘‘Sec.221.Licensing. 

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

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

‘‘Sec.224.Liability for payment. 

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

‘‘Sec.226.Authorization of appropriations. 

‘‘TITLE III—FACILITIES 

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

‘‘Sec.302.Sanitation facilities. 

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

‘‘Sec.304.Expenditure of non-Service funds for renovation. 

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

ambulatory care facilities. 

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

‘‘Sec.307.Land transfer. 

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

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

‘‘Sec.310.Tribal leasing. 

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

‘‘Sec.312.Location of facilities. 

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

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

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

‘‘Sec.316.Other funding for facilities. 

‘‘Sec.317.Authorization of appropriations. 

‘‘TITLE IV—ACCESS TO HEALTH SERVICES 

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

programs. 

‘‘Sec.402.Grants to and contracts with the Service, Indian Tribes, Tribal Organizations, and Urban Indian Organizations to facilitate outreach, enrollment, and coverage of Indians under Social Security Act health benefit programs and other health benefits programs. 

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

‘‘Sec.404.Crediting of reimbursements. 

‘‘Sec.405.Purchasing health care coverage. 

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

‘‘Sec.407.Payor of last resort. 

‘‘Sec.408.Nondiscrimination under Federal health care programs in qualifications for reimbursement for services. 

‘‘Sec.409.Consultation. 

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


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‘‘Sec.411.Exclusion waiver authority for affected Indian Health Programs and 

safe harbor transactions under the Social Security Act. 

‘‘Sec.412.Premium and cost sharing protections and eligibility determinations 

under Medicaid and SCHIP and protection of certain Indian 

property from Medicaid estate recovery. 

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

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

‘‘Sec.415.General exceptions. 

‘‘Sec.416.Authorization of appropriations. 

‘‘TITLE V—HEALTH SERVICES FOR URBAN INDIANS 

‘‘Sec.501.Purpose. 

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

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

services. 

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

needs. 

‘‘Sec.505.Evaluations; renewals. 

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

‘‘Sec.507.Reports and records. 

‘‘Sec.508.Limitation on contract authority. 

‘‘Sec.509.Facilities. 

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

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

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

‘‘Sec.513.Urban NIAAA transferred programs. 

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

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

‘‘Sec.516.Grants for diabetes prevention, treatment, and control. 

‘‘Sec.517.Community Health Representatives. 

‘‘Sec.518.Effective date. 

‘‘Sec.519.Eligibility for services. 

‘‘Sec.520.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.Indian youth telemental health demonstration project. 

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

‘‘Sec.710.Training and community education. 

‘‘Sec.711.Behavioral health program. 


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‘‘Sec.712.Fetal alcohol disorder programs. 

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

‘‘Sec.714.Behavioral health research. 

‘‘Sec.715.Definitions. 

‘‘Sec.716.Authorization of appropriations. 

‘‘TITLE VIII—MISCELLANEOUS 

‘‘Sec.801.Reports. 

‘‘Sec.802.Regulations. 

‘‘Sec.803.Plan of implementation. 

‘‘Sec.804.Availability of funds. 

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

‘‘Sec.806.Eligibility of California Indians. 

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

‘‘Sec.808.Reallocation of base resources. 

‘‘Sec.809.Results of demonstration projects. 

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

‘‘Sec.811.Moratorium. 

‘‘Sec.812.Tribal employment. 

‘‘Sec.813.Severability provisions. 

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

Care. 

‘‘Sec.815.Confidentiality of medical quality assurance records; qualified immunity for participants. 

‘‘Sec.816.Appropriations; availability. 

‘‘Sec.817.Authorization of appropriations. 

1 ‘‘SEC. 2. FINDINGS. 

2 ‘‘Congress makes the following findings: 

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

4 improve the health of the Indians are consonant 

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

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

9 is to provide the quantity and quality of health serv10 ices which will permit the health status of Indians 

11 to be raised to the highest possible level and to en12 courage the maximum participation of Indians in the 

13 planning and management of those services. 


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1 ‘‘(3) Federal health services to Indians have re2 sulted in a reduction in the prevalence and incidence 

3 of preventable illnesses among, and unnecessary and 

4 premature deaths of, Indians. 

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

6 needs of the American Indian people are severe and 

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

8 the general population of the United States. 

9 ‘‘SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POL10 ICY. 

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

12 in fulfillment of its special trust responsibilities and legal 

13 obligations to Indians— 

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

15 for Indians and Urban Indians and to provide all re16 sources necessary to effect that policy; 

17 ‘‘(2) to raise the health status of Indians and 

18 Urban Indians to at least the levels set forth in the 

19 goals contained within the Healthy People 2010 or 

20 successor objectives; 

21 ‘‘(3) to the greatest extent possible, to allow In22 dians to set their own health care priorities and es23 tablish goals that reflect their unmet needs; 

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

25 the health professions and allied and associated 


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1 health professions awarded to Indians so that the 

2 proportion of Indian health professionals in each 

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

4 the general population; 

5 ‘‘(5) to require meaningful consultation with In6 dian Tribes, Tribal Organizations, and Urban Indian 

7 Organizations to implement this Act and the na8 tional policy of Indian self-determination; and 

9 ‘‘(6) to provide funding for programs and facili10 ties operated by Indian Tribes and Tribal Organiza11 tions in amounts that are not less than the amounts 

12 provided to programs and facilities operated directly 

13 by the Service. 

14 ‘‘SEC. 4. DEFINITIONS. 

15 ‘‘For purposes of this Act: 

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

17 on or near a reservation and accredited by a na18 tional or regional organization with accrediting au19 thority. 

20 ‘‘(2) The term ‘Area Office’ means an adminis21 trative entity, including a program office, within the 

22 Service through which services and funds are pro23 vided to the Service Units within a defined geo24 graphic area. 


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

2 Assistant Secretary for Indian Health. 

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

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

5 tobacco) abuse and mental health prevention and 

6 treatment, for the purpose of providing comprehen7 sive services. 

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

9 joint development of substance abuse and mental 

10 health treatment planning and coordinated case 

11 management using a multidisciplinary approach. 

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

13 Indians who are eligible for health services of the 

14 Service pursuant to section 806. 

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

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

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

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

19 health services provided at the expense of the Serv20 ice or a Tribal Health Program by public or private 

21 medical providers or hospitals, other than the Serv22 ice Unit or the Tribal Health Program at whose ex23 pense the services are provided. 


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1 ‘‘(8) The term ‘Department’ means, unless oth2 erwise designated, the Department of Health and 

3 Human Services. 

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

5 reduction, limitation, and prevention of disease and 

6 its complications and reduction in the consequences 

7 of disease, including— 

8 ‘‘(A) controlling— 

9 ‘‘(i) the development of diabetes; 

10 ‘‘(ii) high blood pressure; 

11 ‘‘(iii) infectious agents; 

12 ‘‘(iv) injuries; 

13 ‘‘(v) occupational hazards and disabil14 ities; 

15 ‘‘(vi) sexually transmittable diseases; 

16 and 

17 ‘‘(vii) toxic agents; and 

18 ‘‘(B) providing— 

19 ‘‘(i) fluoridation of water; and 

20 ‘‘(ii) immunizations. 

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

22 allopathic medicine, family medicine, internal medi23 cine, pediatrics, geriatric medicine, obstetrics and 

24 gynecology, podiatric medicine, nursing, public 

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1 tometry, pharmacy, psychology, public health, social 

2 work, marriage and family therapy, chiropractic 

3 medicine, environmental health and engineering, al4 lied health professions, and any other health profes5 sion. 

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

7 ‘‘(A) fostering social, economic, environ8 mental, and personal factors conducive to 

9 health, including raising public awareness about 

10 health matters and enabling the people to cope 

11 with health problems by increasing their knowl12 edge and providing them with valid information; 

13 ‘‘(B) encouraging adequate and appro14 priate diet, exercise, and sleep; 

15 ‘‘(C) promoting education and work in con16 formity with physical and mental capacity; 

17 ‘‘(D) making available safe water and sani18 tary facilities; 

19 ‘‘(E) improving the physical, economic, cul20 tural, psychological, and social environment; 

21 ‘‘(F) promoting culturally competent care; 

22 and 

23 ‘‘(G) providing adequate and appropriate 

24 programs, which may include— 


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1 ‘‘(i) abuse prevention (mental and 

2 physical); 

3 ‘‘(ii) community health; 

4 ‘‘(iii) community safety; 

5 ‘‘(iv) consumer health education; 

6 ‘‘(v) diet and nutrition; 

7 ‘‘(vi) immunization and other preven8 tion of communicable diseases, including 

9 HIV/AIDS; 

10 ‘‘(vii) environmental health; 

11 ‘‘(viii) exercise and physical fitness; 

12 ‘‘(ix) avoidance of fetal alcohol dis13 orders; 

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

15 ‘‘(xi) human growth and development; 

16 ‘‘(xii) injury prevention and personal 

17 safety; 

18 ‘‘(xiii) behavioral health; 

19 ‘‘(xiv) monitoring of disease indicators 

20 between health care provider visits, 

21 through appropriate means, including 

22 Internet-based health care management 

23 systems; 

24 ‘‘(xv) personal health and wellness 

25 practices; 


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1 ‘‘(xvi) personal capacity building; 

2 ‘‘(xvii) prenatal, pregnancy, and in3 fant care; 

4 ‘‘(xviii) psychological well-being; 

5 ‘‘(xix) reproductive health and family 

6 planning; 

7 ‘‘(xx) safe and adequate water; 

8 ‘‘(xxi) healthy work environments; 

9 ‘‘(xxii) elimination, reduction, and 

10 prevention of contaminants that create 

11 unhealthy household conditions (including 

12 mold and other allergens); 

13 ‘‘(xxiii) stress control; 

14 ‘‘(xxiv) substance abuse; 

15 ‘‘(xxv) sanitary facilities; 

16 ‘‘(xxvi) sudden infant death syndrome 

17 prevention; 

18 ‘‘(xxvii) tobacco use cessation and re19 duction; 

20 ‘‘(xxviii) violence prevention; and 

21 ‘‘(xxix) such other activities identified 

22 by the Service, a Tribal Health Program, 

23 or an Urban Indian Organization, to pro24 mote achievement of any of the objectives 

25 described in section 3(2). 


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1 ‘‘(12) The term ‘Indian’, unless otherwise des2 ignated, means any person who is a member of an 

3 Indian Tribe or is eligible for health services under 

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

5 102 and 103, the term also means any individual 

6 who— 

7 ‘‘(A)(i) irrespective of whether the indi8 vidual lives on or near a reservation, is a mem9 ber of a tribe, band, or other organized group 

10 of Indians, including those tribes, bands, or 

11 groups terminated since 1940 and those recog12 nized now or in the future by the State in 

13 which they reside; or 

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

15 degree, of any such member; 

16 ‘‘(B) is an Eskimo or Aleut or other Alas17 ka Native; 

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

19 Interior to be an Indian for any purpose; or 

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

21 regulations promulgated by the Secretary. 

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

23 means— 

24 ‘‘(A) any health program administered di25 rectly by the Service; 


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

2 ‘‘(C) any Indian Tribe or Tribal Organiza3 tion to which the Secretary provides funding 

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

5 1910 (25 U.S.C. 47) (commonly known as the 

6 ‘Buy Indian Act’). 

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

8 given the term in the Indian Self-Determination and 

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

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

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

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

13 1058(e)). 

14 ‘‘(16) The term ‘reservation’ means any feder15 ally recognized Indian Tribe’s reservation, Pueblo, or 

16 colony, including former reservations in Oklahoma, 

17 Indian allotments, and Alaska Native Regions estab18 lished pursuant to the Alaska Native Claims Settle19 ment Act (43 U.S.C. 1601 et seq.). 

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

21 designated, means the Secretary of Health and 

22 Human Services. 

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

24 Health Service. 


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1 ‘‘(19) The term ‘Service Area’ means the geo2 graphical area served by each Area Office. 

3 ‘‘(20) The term ‘Service Unit’ means an admin4 istrative entity of the Service, or a Tribal Health 

5 Program through which services are provided, di6 rectly or by contract, to eligible Indians within a de7 fined geographic area. 

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

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

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

11 ‘‘(22) The term ‘telemedicine’ means a tele12 communications link to an end user through the use 

13 of eligible equipment that electronically links health 

14 professionals or patients and health professionals at 

15 separate sites in order to exchange health care infor16 mation in audio, video, graphic, or other format for 

17 the purpose of providing improved health care serv18 ices. 

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

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

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

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

23 an Indian Tribe or Tribal Organization that oper24 ates any health program, service, function, activity, 

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


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

2 with the Service under the Indian Self-Determina3 tion and Education Assistance Act (25 U.S.C. 450 

4 et seq.). 

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

6 meaning given the term in the Indian Self-Deter7 mination and Education Assistance Act (25 U.S.C. 

8 450 et seq.). 

9 ‘‘(26) The term ‘Urban Center’ means any com10 munity which has a sufficient Urban Indian popu11 lation with unmet health needs to warrant assistance 

12 under title V of this Act, as determined by the Sec13 retary. 

14 ‘‘(27) The term ‘Urban Indian’ means any indi15 vidual who resides in an Urban Center and who 

16 meets 1 or more of the following criteria: 

17 ‘‘(A) Irrespective of whether the individual 

18 lives on or near a reservation, the individual is 

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

20 group of Indians, including those tribes, bands, 

21 or groups terminated since 1940 and those 

22 tribes, bands, or groups that are recognized by 

23 the States in which they reside, or who is a de24 scendant in the first or second degree of any 

25 such member. 


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

2 or other Alaska 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 ‘‘(28) The term ‘Urban Indian Organization’ 

10 means a nonprofit corporate body that (A) is situ11 ated in an Urban Center; (B) is governed by an 

12 Urban Indian-controlled board of directors; (C) pro13 vides for the participation of all interested Indian 

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

15 cooperating with other public and private entities for 

16 the purpose of performing the activities described in 

17 section 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 extent feasible, 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 Indian Health Programs and Urban Indian Organizations 

2 involved in the provision of health services to Indians. 

3 ‘‘SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM 

4 FOR INDIANS. 

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

6 the Service, shall make grants to public or nonprofit pri7 vate health or educational entities, Tribal Health Pro8 grams, or Urban Indian Organizations to assist such enti9 ties in meeting the costs of— 

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

11 education or training in the health professions and 

12 encouraging and assisting them— 

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

14 health professions; or 

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

16 any such courses of study, to undertake such 

17 postsecondary education or training as may be 

18 required to qualify them for enrollment; 

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

20 available to Indians enrolled in any course of study 

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

22 training necessary to qualify them to enroll in any 

23 such course of study; or 

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1 rollment of Indians in, and the subsequent pursuit 

2 and completion by them of, courses of study referred 

3 to in paragraph (1). 

4 ‘‘(b) GRANTS.— 

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

6 make a grant under this section unless an applica7 tion has been submitted to, and approved by, the 

8 Secretary. Such application shall be in such form, 

9 submitted in such manner, and contain such infor10 mation, as the Secretary shall by regulation pre11 scribe pursuant to this Act. The Secretary shall give 

12 a preference to applications submitted by Tribal 

13 Health Programs or Urban Indian Organizations. 

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

15 amount of a grant under this section shall be deter16 mined by the Secretary. Payments pursuant to this 

17 section may be made in advance or by way of reim18 bursement, and at such intervals and on such condi19 tions as provided for in regulations issued pursuant 

20 to this Act. To the extent not otherwise prohibited 

21 by law, grants shall be for 3 years, as provided in 

22 regulations issued pursuant to this Act. 


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1 ‘‘SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOL2 ARSHIP PROGRAM FOR INDIANS. 

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

4 acting through the Service, shall provide scholarship 

5 grants to Indians who— 

6 ‘‘(1) have successfully completed their high 

7 school education or high school equivalency; and 

8 ‘‘(2) have demonstrated the potential to suc9 cessfully complete courses of study in the health pro10 fessions. 

11 ‘‘(b) PURPOSES.—Scholarship grants provided pursu12 ant to this section shall be for the following purposes: 

13 ‘‘(1) Compensatory preprofessional education of 

14 any recipient, such scholarship not to exceed 2 years 

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

16 thereof, as determined by the Secretary pursuant to 

17 regulations issued under this Act). 

18 ‘‘(2) Pregraduate education of any recipient 

19 leading to a baccalaureate degree in an approved 

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

21 health profession, such scholarship not to exceed 4 

22 years. An extension of up to 2 years (or the part23 time equivalent thereof, as determined by the Sec24 retary pursuant to regulations issued pursuant to 

25 this Act) may be approved. 


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

2 section— 

3 ‘‘(1) may cover costs of tuition, books, trans4 portation, board, and other necessary related ex5 penses of a recipient while attending school; 

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

7 the applicant’s scholastic achievement if such appli8 cant has been admitted to, or maintained good 

9 standing at, an accredited institution; and 

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

11 applicant’s eligibility for assistance or benefits under 

12 any other Federal program. 

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

14 ‘‘(a) IN GENERAL.— 

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

16 through the Service, shall make scholarship grants 

17 to Indians who are enrolled full or part time in ac18 credited schools pursuing courses of study in the 

19 health professions. Such scholarships shall be des20 ignated Indian Health Scholarships and shall be 

21 made in accordance with section 338A of the Public 

22 Health Services Act (42 U.S.C. 254l), except as pro23 vided in subsection (b) of this section. 


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

2 Secretary, acting through the Service, shall deter3 mine— 

4 ‘‘(A) who shall receive scholarship grants 

5 under subsection (a); and 

6 ‘‘(B) the distribution of the scholarships 

7 among health professions on the basis of the 

8 relative needs of Indians for additional service 

9 in the health professions. 

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

11 The administration of this section shall be a respon12 sibility of the Assistant Secretary and shall not be 

13 delegated in a contract or compact under the Indian 

14 Self-Determination and Education Assistance Act 

15 (25 U.S.C. 450 et seq.). 

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

17 ‘‘(1) OBLIGATION MET.—The active duty serv18 ice obligation under a written contract with the Sec19 retary under this section that an Indian has entered 

20 into shall, if that individual is a recipient of an In21 dian Health Scholarship, be met in full-time practice 

22 equal to 1 year for each school year for which the 

23 participant receives a scholarship award under this 

24 part, or 2 years, whichever is greater, by service in 

25 1 or more of the following: 


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1 ‘‘(A) In an Indian Health Program. 

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

3 of this Act. 

4 ‘‘(C) In the private practice of the applica5 ble profession if, as determined by the Sec6 retary, in accordance with guidelines promul7 gated by the Secretary, such practice is situated 

8 in a physician or other health professional 

9 shortage area and addresses the health care 

10 needs of a substantial number of Indians. 

11 ‘‘(D) In a teaching capacity in a tribal col12 lege or university nursing program (or a related 

13 health profession program) if, as determined by 

14 the Secretary, the health service provided to In15 dians would not decrease. 

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

17 of any individual who has entered into a contract re18 ferred to in paragraph (1) and who receives a degree 

19 in medicine (including osteopathic or allopathic med20 icine), dentistry, optometry, podiatry, or pharmacy, 

21 the Secretary shall defer the active duty service obli22 gation of that individual under that contract, in 

23 order that such individual may complete any intern24 ship, residency, or other advanced clinical training 

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1 fession, for an appropriate period (in years, as deter2 mined by the Secretary), subject to the following 

3 conditions: 

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

5 other advanced clinical training shall be counted 

6 as satisfying any period of obligated service 

7 under this subsection. 

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

9 that individual shall commence not later than 

10 90 days after the completion of that advanced 

11 clinical training (or by a date specified by the 

12 Secretary). 

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

14 be served in the health profession of that indi15 vidual in a manner consistent with paragraph 

16 (1). 

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

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

19 meet the active duty service obligation described 

20 in paragraph (1) by service in a program speci21 fied under that paragraph that— 

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

23 the Indian Tribe in which the recipient is 

24 enrolled; or 


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

2 the recipient is enrolled. 

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

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

5 assignments of Indian Health Scholarship recipients 

6 required to meet the active duty service obligation 

7 described in paragraph (1), shall give priority to as8 signing individuals to service in those programs 

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

10 health professionals to provide health care services 

11 as a result of individuals having breached contracts 

12 entered into under this section. 

13 ‘‘(c) PART-TIME STUDENTS.—In the case of an indi14 vidual receiving a scholarship under this section who is 

15 enrolled part time in an approved course of study— 

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

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

18 years, as determined by the Secretary; 

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

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

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

22 each year for which the individual was provided 

23 a scholarship (as determined by the Secretary); 

24 or 

25 ‘‘(B) 2 years; and 


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1 ‘‘(3) the amount of the monthly stipend speci2 fied in section 338A(g)(1)(B) of the Public Health 

3 Service Act (42 U.S.C. 254l(g)(1)(B)) shall be re4 duced pro rata (as determined by the Secretary) 

5 based on the number of hours such student is en6 rolled. 

7 ‘‘(d) BREACH OF CONTRACT.— 

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

9 shall be liable to the United States for the amount 

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

11 of the individual, under a contract entered into with 

12 the Secretary under this section on or after the date 

13 of enactment of the Indian Health Care Improve14 ment Act Amendments of 2007 if that individual— 

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

16 of academic standing in the educational institu17 tion in which he or she is enrolled (such level 

18 determined by the educational institution under 

19 regulations of the Secretary); 

20 ‘‘(B) is dismissed from such educational 

21 institution for disciplinary reasons; 

22 ‘‘(C) voluntarily terminates the training in 

23 such an educational institution for which he or 

24 she is provided a scholarship under such con25 tract before the completion of such training; or 


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

2 the educational institution in which he or she is 

3 enrolled not to accept payment, in whole or in 

4 part, of a scholarship under such contract, in 

5 lieu of any service obligation arising under such 

6 contract. 

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

8 specified in paragraph (1) an individual breaches a 

9 written contract by failing either to begin such indi10 vidual’s service obligation required under such con11 tract or to complete such service obligation, the 

12 United States shall be entitled to recover from the 

13 individual an amount determined in accordance with 

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

15 in the manner provided for in such subsection. 

16 ‘‘(3) CANCELLATION UPON DEATH OF RECIPI17 ENT.—Upon the death of an individual who receives 

18 an Indian Health Scholarship, any outstanding obli19 gation of that individual for service or payment that 

20 relates to that scholarship shall be canceled. 

21 ‘‘(4) WAIVERS AND SUSPENSIONS.— 

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

23 provide for the partial or total waiver or sus24 pension of any obligation of service or payment 


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1 of a recipient of an Indian Health Scholarship 

2 if the Secretary determines that— 

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

4 to meet that obligation or make that pay5 ment; 

6 ‘‘(ii) requiring that recipient to meet 

7 that obligation or make that payment 

8 would result in extreme hardship to the re9 cipient; or 

10 ‘‘(iii) the enforcement of the require11 ment to meet the obligation or make the 

12 payment would be unconscionable. 

13 ‘‘(B) FACTORS FOR CONSIDERATION.—Be14 fore waiving or suspending an obligation of 

15 service or payment under subparagraph (A), the 

16 Secretary shall consult with the affected Area 

17 Office, Indian Tribes, Tribal Organizations, or 

18 Urban Indian Organizations, and may take into 

19 consideration whether the obligation may be 

20 satisfied in a teaching capacity at a tribal col21 lege or university nursing program under sub22 section (b)(1)(D). 

23 ‘‘(5) EXTREME HARDSHIP.—Notwithstanding 

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

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1 retary may waive, in whole or in part, the right of 

2 the United States to recover funds made available 

3 under this section. 

4 ‘‘(6) BANKRUPTCY.—Notwithstanding any 

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

6 an Indian Health Scholarship, no obligation for pay7 ment may be released by a discharge in bankruptcy 

8 under title 11, United States Code, unless that dis9 charge is granted after the expiration of the 5-year 

10 period beginning on the initial date on which that 

11 payment is due, and only if the bankruptcy court 

12 finds that the nondischarge of the obligation would 

13 be unconscionable. 

14 ‘‘SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PRO15 GRAM. 

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

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

18 $300,000 to each of 9 colleges and universities for the pur19 pose of developing and maintaining Indian psychology ca20 reer recruitment programs as a means of encouraging In21 dians to enter the behavioral health field. These programs 

22 shall be located at various locations throughout the coun23 try to maximize their availability to Indian students and 

24 new programs shall be established in different locations 

25 from time to time. 


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

2 Secretary shall provide a grant authorized under sub3 section (a) to develop and maintain a program at the Uni4 versity of North Dakota to be known as the ‘Quentin N. 

5 Burdick American Indians Into Psychology Program’. 

6 Such program shall, to the maximum extent feasible, co7 ordinate with the Quentin N. Burdick Indian Health Pro8 grams authorized under section 117(b), the Quentin N. 

9 Burdick American Indians Into Nursing Program author10 ized under section 115(e), and existing university research 

11 and communications networks. 

12 ‘‘(c) REGULATIONS.—The Secretary shall issue regu13 lations pursuant to this Act for the competitive awarding 

14 of grants provided under this section. 

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

16 section shall agree to provide a program which, at a min17 imum— 

18 ‘‘(1) provides outreach and recruitment for 

19 health professions to Indian communities including 

20 elementary, secondary, and accredited and accessible 

21 community colleges that will be served by the pro22 gram; 

23 ‘‘(2) incorporates a program advisory board 

24 comprised of representatives from the tribes and 

25 communities that will be served by the program; 


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1 ‘‘(3) provides summer enrichment programs to 

2 expose Indian students to the various fields of psy3 chology through research, clinical, and experimental 

4 activities; 

5 ‘‘(4) provides stipends to undergraduate and 

6 graduate students to pursue a career in psychology; 

7 ‘‘(5) develops affiliation agreements with tribal 

8 colleges and universities, the Service, university af9 filiated programs, and other appropriate accredited 

10 and accessible entities to enhance the education of 

11 Indian students; 

12 ‘‘(6) to the maximum extent feasible, uses exist13 ing university tutoring, counseling, and student sup14 port services; and 

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

16 qualified Indians in the program. 

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

18 active duty service obligation prescribed under section 

19 338C of the Public Health Service Act (42 U.S.C. 254m) 

20 shall be met by each graduate who receives a stipend de21 scribed in subsection (d)(4) that is funded under this sec22 tion. Such obligation shall be met by service— 

23 ‘‘(1) in an Indian Health Program; 

24 ‘‘(2) in a program assisted under title V of this 

25 Act; or 


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

2 determined by the Secretary, in accordance with 

3 guidelines promulgated by the Secretary, such prac4 tice is situated in a physician or other health profes5 sional shortage area and addresses the health care 

6 needs of a substantial number of Indians. 

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

8 is authorized to be appropriated to carry out this section 

9 $2,700,000 for each of fiscal years 2008 through 2017. 

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

11 ‘‘(a) IN GENERAL.— 

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

13 acting through the Service, shall make grants to 

14 Tribal Health Programs for the purpose of providing 

15 scholarships for Indians to serve as health profes16 sionals in Indian communities. 

17 ‘‘(2) AMOUNT.—Amounts available under para18 graph (1) for any fiscal year shall not exceed 5 per19 cent of the amounts available for each fiscal year for 

20 Indian Health Scholarships under section 104. 

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

22 under paragraph (1) shall be in such form and con23 tain such agreements, assurances, and information 

24 as consistent with this section. 

25 ‘‘(b) REQUIREMENTS.— 


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

2 receiving a grant under subsection (a) shall provide 

3 scholarships to Indians in accordance with the re4 quirements of this section. 

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

6 any scholarship pursuant to subsection (a)— 

7 ‘‘(A) 80 percent of the costs of the scholar8 ship shall be paid from the funds made avail9 able pursuant to subsection (a)(1) provided to 

10 the Tribal Health Program; and 

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

12 from any other source of funds. 

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

14 shall provide scholarships under this section only to Indi15 ans enrolled or accepted for enrollment in a course of 

16 study (approved by the Secretary) in 1 of the health pro17 fessions contemplated by this Act. 

18 ‘‘(d) CONTRACT.— 

19 ‘‘(1) IN GENERAL.—In providing scholarships 

20 under subsection (b), the Secretary and the Tribal 

21 Health Program shall enter into a written contract 

22 with each recipient of such scholarship. 

23 ‘‘(2) REQUIREMENTS.—Such contract shall— 

24 ‘‘(A) obligate such recipient to provide 

25 service in an Indian Health Program or Urban 


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1 Indian Organization, in the same Service Area 

2 where the Tribal Health Program providing the 

3 scholarship is located, for— 

4 ‘‘(i) a number of years for which the 

5 scholarship is provided (or the part-time 

6 equivalent thereof, as determined by the 

7 Secretary), or for a period of 2 years, 

8 whichever period is greater; or 

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

10 the recipient and the Tribal Health Pro11 gram may agree; 

12 ‘‘(B) provide that the amount of the schol13 arship— 

14 ‘‘(i) may only be expended for— 

15 ‘‘(I) tuition expenses, other rea16 sonable educational expenses, and rea17 sonable living expenses incurred in at18 tendance at the educational institu19 tion; and 

20 ‘‘(II) payment to the recipient of 

21 a monthly stipend of not more than 

22 the amount authorized by section 

23 338(g)(1)(B) of the Public Health 

24 Service Act (42 U.S.C. 

25 254m(g)(1)(B)), with such amount to 


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1 be reduced pro rata (as determined by 

2 the Secretary) based on the number of 

3 hours such student is enrolled, and 

4 not to exceed, for any year of attend5 ance for which the scholarship is pro6 vided, the total amount required for 

7 the year for the purposes authorized 

8 in this clause; and 

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

10 attendance for which the scholarship is 

11 provided, the total amount required for the 

12 year for the purposes authorized in clause 

13 (i); 

14 ‘‘(C) require the recipient of such scholar15 ship to maintain an acceptable level of academic 

16 standing as determined by the educational insti17 tution in accordance with regulations issued 

18 pursuant to this Act; and 

19 ‘‘(D) require the recipient of such scholar20 ship to meet the educational and licensure re21 quirements appropriate to each health profes22 sion. 

23 ‘‘(3) SERVICE IN OTHER SERVICE AREAS.—The 

24 contract may allow the recipient to serve in another 

25 Service Area, provided the Tribal Health Program 


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1 and Secretary approve and services are not dimin2 ished to Indians in the Service Area where the Trib3 al Health Program providing the scholarship is lo4 cated. 

5 ‘‘(e) BREACH OF CONTRACT.— 

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

7 has entered into a written contract with the Sec8 retary and a Tribal Health Program under sub9 section (d) shall be liable to the United States for 

10 the Federal share of the amount which has been 

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

12 the contract if that individual— 

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

14 of academic standing in the educational institu15 tion in which he or she is enrolled (such level 

16 as determined by the educational institution 

17 under regulations of the Secretary); 

18 ‘‘(B) is dismissed from such educational 

19 institution for disciplinary reasons; 

20 ‘‘(C) voluntarily terminates the training in 

21 such an educational institution for which he or 

22 she is provided a scholarship under such con23 tract before the completion of such training; or 

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

25 the educational institution in which he or she is 


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1 enrolled not to accept payment, in whole or in 

2 part, of a scholarship under such contract, in 

3 lieu of any service obligation arising under such 

4 contract. 

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

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

7 written contract by failing to either begin such indi8 vidual’s service obligation required under such con9 tract or to complete such service obligation, the 

10 United States shall be entitled to recover from the 

11 individual an amount determined in accordance with 

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

13 in the manner provided for in such subsection. 

14 ‘‘(3) CANCELLATION UPON DEATH OF RECIPI15 ENT.—Upon the death of an individual who receives 

16 an Indian Health Scholarship, any outstanding obli17 gation of that individual for service or payment that 

18 relates to that scholarship shall be canceled. 

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

20 out this subsection on the basis of information re21 ceived from Tribal Health Programs involved or on 

22 the basis of information collected through such other 

23 means as the Secretary deems appropriate. 

24 ‘‘(f) RELATION TO SOCIAL SECURITY ACT.—The re25 cipient of a scholarship under this section shall agree, in 


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1 providing health care pursuant to the requirements here2 in— 

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

4 seeking care on the basis of the ability of the indi5 vidual to pay for such care or on the basis that pay6 ment for such care will be made pursuant to a pro7 gram established in title XVIII of the Social Secu8 rity Act or pursuant to the programs established in 

9 title XIX or title XXI of such Act; and 

10 ‘‘(2) to accept assignment under section 

11 1842(b)(3)(B)(ii) of the Social Security Act for all 

12 services for which payment may be made under part 

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

14 appropriate agreement with the State agency that 

15 administers the State plan for medical assistance 

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

17 title XXI, of such Act to provide service to individ18 uals entitled to medical assistance or child health as19 sistance, respectively, under the plan. 

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

21 shall make payments under this section to a Tribal Health 

22 Program for any fiscal year subsequent to the first fiscal 

23 year of such payments unless the Secretary determines 

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


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1 Health Program has not complied with the requirements 

2 of this section. 

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

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

5 who receives a scholarship pursuant to section 104 or 106 

6 shall be given preference for employment in the Service, 

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

8 Urban Indian Organization, or other agencies of the De9 partment as available, during any nonacademic period of 

10 the year. 

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

12 OBLIGATION.—Periods of employment pursuant to this 

13 subsection shall not be counted in determining fulfillment 

14 of the service obligation incurred as a condition of the 

15 scholarship. 

16 ‘‘(c) TIMING; LENGTH OF EMPLOYMENT.—Any indi17 vidual enrolled in a program, including a high school pro18 gram, authorized under section 102(a) may be employed 

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

20 Indian Organization during any nonacademic period of the 

21 year. Any such employment shall not exceed 120 days dur22 ing any calendar year. 

23 ‘‘(d) NONAPPLICABILITY OF COMPETITIVE PER24 SONNEL SYSTEM.—Any employment pursuant to this sec25 tion shall be made without regard to any competitive perVerDate Aug 31 2005 21:58 Apr 25, 2007 Jkt 059200 PO 00000 Frm 00040 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.IS S1200

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1 sonnel system or agency personnel limitation and to a po2 sition which will enable the individual so employed to re3 ceive practical experience in the health profession in which 

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

5 shall receive payment for his or her services comparable 

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

7 employed in the competitive system. Any individual so em8 ployed shall not be counted against any employment ceil9 ing affecting the Service or the Department. 

10 ‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES. 

11 ‘‘In order to encourage scholarship and stipend re12 cipients under sections 104, 105, 106, and 115 and health 

13 professionals, including community health representatives 

14 and emergency medical technicians, to join or continue in 

15 an Indian Health Program and to provide their services 

16 in the rural and remote areas where a significant portion 

17 of Indians reside, the Secretary, acting through the Serv18 ice, may— 

19 ‘‘(1) provide programs or allowances to transi20 tion into an Indian Health Program, including li21 censing, board or certification examination assist22 ance, and technical assistance in fulfilling service ob23 ligations under sections 104, 105, 106, and 115; and 

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

25 professionals employed in an Indian Health Program 


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1 to enable them for a period of time each year pre2 scribed by regulation of the Secretary to take leave 

3 of their duty stations for professional consultation, 

4 management, leadership, and refresher training 

5 courses. 

6 ‘‘SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PRO7 GRAM. 

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

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

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

11 Service, shall maintain a Community Health Representa12 tive Program under which Indian Health Programs— 

13 ‘‘(1) provide for the training of Indians as com14 munity health representatives; and 

15 ‘‘(2) use such community health representatives 

16 in the provision of health care, health promotion, 

17 and disease prevention services to Indian commu18 nities. 

19 ‘‘(b) DUTIES.—The Community Health Representa20 tive Program of the Service, shall— 

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

22 community health representatives to ensure that the 

23 community health representatives provide quality 

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1 tion services to the Indian communities served by 

2 the Program; 

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

4 and maintain a curriculum that— 

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

6 health care with supervised practical experience 

7 in the provision of health care; and 

8 ‘‘(B) provides instruction and practical ex9 perience in health promotion and disease pre10 vention activities, with appropriate consider11 ation given to lifestyle factors that have an im12 pact on Indian health status, such as alco13 holism, family dysfunction, and poverty; 

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

15 needs of community health representatives for con16 tinuing education in health care, health promotion, 

17 and disease prevention and develop programs that 

18 meet the needs for continuing education; 

19 ‘‘(4) maintain a system that provides close su20 pervision of Community Health Representatives; 

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

22 of Community Health Representatives is reviewed 

23 and evaluated; and 

24 ‘‘(6) promote traditional health care practices 

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1 ice standards for the provision of health care, health 

2 promotion, and disease prevention. 

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

4 PROGRAM. 

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

6 through the Service, shall establish and administer a pro7 gram to be known as the Service Loan Repayment Pro8 gram (hereinafter referred to as the ‘Loan Repayment 

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

10 trained health professionals necessary to maintain accredi11 tation of, and provide health care services to Indians 

12 through, Indian Health Programs and Urban Indian Or13 ganizations. 

14 ‘‘(b) ELIGIBLE INDIVIDUALS.—To be eligible to par15 ticipate in the Loan Repayment Program, an individual 

16 must— 

17 ‘‘(1)(A) be enrolled— 

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

19 accredited educational institution (as deter20 mined by the Secretary under section 

21 338B(b)(1)(c)(i) of the Public Health Service 

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

23 scheduled to complete such course of study in 

24 the same year such individual applies to partici25 pate in such program; or 


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1 ‘‘(ii) in an approved graduate training pro2 gram in a health profession; or 

3 ‘‘(B) have— 

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

5 ‘‘(ii) a license to practice a health profes6 sion; 

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

8 as a commissioned officer in the Regular or Reserve 

9 Corps of the Public Health Service; 

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

11 in the Regular or Reserve Corps of the Public 

12 Health Service; 

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

14 service employment in the Service; or 

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

16 or Urban Indian Organization without a service obli17 gation; and 

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

19 a contract described in subsection (e). 

20 ‘‘(c) APPLICATION.— 

21 ‘‘(1) INFORMATION TO BE INCLUDED WITH

22 FORMS.—In disseminating application forms and 

23 contract forms to individuals desiring to participate 

24 in the Loan Repayment Program, the Secretary 

25 shall include with such forms a fair summary of the 


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1 rights and liabilities of an individual whose applica2 tion is approved (and whose contract is accepted) by 

3 the Secretary, including in the summary a clear ex4 planation of the damages to which the United States 

5 is entitled under subsection (l) in the case of the in6 dividual’s breach of contract. The Secretary shall 

7 provide such individuals with sufficient information 

8 regarding the advantages and disadvantages of serv9 ice as a commissioned officer in the Regular or Re10 serve Corps of the Public Health Service or a civil11 ian employee of the Service to enable the individual 

12 to make a decision on an informed basis. 

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

14 contract form, and all other information furnished 

15 by the Secretary under this section shall be written 

16 in a manner calculated to be understood by the aver17 age individual applying to participate in the Loan 

18 Repayment Program. 

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

20 Secretary shall make such application forms, con21 tract forms, and other information available to indi22 viduals desiring to participate in the Loan Repay23 ment Program on a date sufficiently early to ensure 

24 that such individuals have adequate time to carefully 

25 review and evaluate such forms and information. 


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1 ‘‘(d) PRIORITIES.— 

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

3 Secretary shall annually— 

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

5 Health Program or Urban Indian Organization 

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

7 ‘‘(B) rank those positions in order of pri8 ority. 

9 ‘‘(2) APPROVALS.—Notwithstanding the pri10 ority determined under paragraph (1), the Secretary, 

11 in determining which applications under the Loan 

12 Repayment Program to approve (and which con13 tracts to accept), shall— 

14 ‘‘(A) give first priority to applications 

15 made by individual Indians; and 

16 ‘‘(B) after making determinations on all 

17 applications submitted by individual Indians as 

18 required under subparagraph (A), give priority 

19 to— 

20 ‘‘(i) individuals recruited through the 

21 efforts of an Indian Health Program or 

22 Urban Indian Organization; and 

23 ‘‘(ii) other individuals based on the 

24 priority rankings under paragraph (1). 

25 ‘‘(e) RECIPIENT CONTRACTS.— 


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1 ‘‘(1) CONTRACT REQUIRED.—An individual be2 comes a participant in the Loan Repayment Pro3 gram only upon the Secretary and the individual en4 tering into a written contract described in paragraph 

5 (2). 

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

7 contract referred to in this section between the Sec8 retary and an individual shall contain— 

9 ‘‘(A) an agreement under which— 

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

11 Secretary agrees— 

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

13 individual in accordance with the pro14 visions of this section; and 

15 ‘‘(II) to accept (subject to the 

16 availability of appropriated funds for 

17 carrying out this section) the indi18 vidual into the Service or place the in19 dividual with a Tribal Health Pro20 gram or Urban Indian Organization 

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

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

23 individual agrees— 

24 ‘‘(I) to accept loan payments on 

25 behalf of the individual; 


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

2 described in subsection (b)(1)— 

3 ‘‘(aa) to maintain enrollment 

4 in a course of study or training 

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

6 until the individual completes the 

7 course of study or training; and 

8 ‘‘(bb) while enrolled in such 

9 course of study or training, to 

10 maintain an acceptable level of 

11 academic standing (as deter12 mined under regulations of the 

13 Secretary by the educational in14 stitution offering such course of 

15 study or training); and 

16 ‘‘(III) to serve for a time period 

17 (hereinafter in this section referred to 

18 as the ‘period of obligated service’) 

19 equal to 2 years or such longer period 

20 as the individual may agree to serve 

21 in the full-time clinical practice of 

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1 vidual may be assigned by the Sec2 retary; 

3 ‘‘(B) a provision permitting the Secretary 

4 to extend for such longer additional periods, as 

5 the individual may agree to, the period of obli6 gated service agreed to by the individual under 

7 subparagraph (A)(ii)(III); 

8 ‘‘(C) a provision that any financial obliga9 tion of the United States arising out of a con10 tract entered into under this section and any 

11 obligation of the individual which is conditioned 

12 thereon is contingent upon funds being appro13 priated for loan repayments under this section; 

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

15 the United States is entitled under subsection 

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

17 and 

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

19 and liabilities of the Secretary and of the indi20 vidual, not inconsistent with this section. 

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

22 The Secretary shall provide written notice to an individual 

23 within 21 days on— 

24 ‘‘(1) the Secretary’s approving, under sub25 section (e)(1), of the individual’s participation in the 


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

3 excess of 4 years; or 

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

6 ‘‘(g) PAYMENTS.— 

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

8 for an individual under a written contract under the 

9 Loan Repayment Program shall consist of payment, 

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

11 individual of the principal, interest, and related ex12 penses on government and commercial loans received 

13 by the individual regarding the undergraduate or 

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

15 loans were made for— 

16 ‘‘(A) tuition expenses; 

17 ‘‘(B) all other reasonable educational ex18 penses, including fees, books, and laboratory ex19 penses, incurred by the individual; and 

20 ‘‘(C) reasonable living expenses as deter21 mined by the Secretary. 

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

23 service that an individual contracts to serve under 

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

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1 tion 338B(g)(2)(A) of the Public Health Service 

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

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

4 determination of the amount to pay for a year of 

5 such service by an individual, the Secretary shall 

6 consider the extent to which each such determina7 tion— 

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

9 maximize the number of contracts that can be 

10 provided under the Loan Repayment Program 

11 from the amounts appropriated for such con12 tracts; 

13 ‘‘(B) provides an incentive to serve in In14 dian Health Programs and Urban Indian Orga15 nizations with the greatest shortages of health 

16 professionals; and 

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

18 the health professional involved remaining in an 

19 Indian Health Program or Urban Indian Orga20 nization with such a health professional short21 age, and continuing to provide primary health 

22 services, after the completion of the period of 

23 obligated service under the Loan Repayment 

24 Program. 


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

2 Secretary for the making of loan repayments in ac3 cordance with this subsection shall provide that any 

4 repayments for a year of obligated service shall be 

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

6 which the individual completes such year of service. 

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

8 For the purpose of providing reimbursements for tax 

9 liability resulting from a payment under paragraph 

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

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

12 make payments to the individual in an amount 

13 equal to not less than 20 percent and not more 

14 than 39 percent of the total amount of loan re15 payments made for the taxable year involved; 

16 and 

17 ‘‘(B) may make such additional payments 

18 as the Secretary determines to be appropriate 

19 with respect to such purpose. 

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

21 may enter into an agreement with the holder of any 

22 loan for which payments are made under the Loan 

23 Repayment Program to establish a schedule for the 

24 making of such payments. 


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

2 other provision of law, individuals who have entered into 

3 written contracts with the Secretary under this section 

4 shall not be counted against any employment ceiling af5 fecting the Department while those individuals are under6 going academic training. 

7 ‘‘(i) RECRUITMENT.—The Secretary shall conduct re8 cruiting programs for the Loan Repayment Program and 

9 other manpower programs of the Service at educational 

10 institutions training health professionals or specialists 

11 identified in subsection (a). 

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

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

14 to individuals during their period of obligated service 

15 under the Loan Repayment Program. 

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

17 in assigning individuals to serve in Indian Health Pro18 grams or Urban Indian Organizations pursuant to con19 tracts entered into under this section, shall— 

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

21 Health Programs and Urban Indian Organizations 

22 receive consideration on an equal basis with pro23 grams that are administered directly by the Service; 

24 and 


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1 ‘‘(2) give priority to assigning individuals to In2 dian Health Programs and Urban Indian Organiza3 tions that have a need for health professionals to 

4 provide health care services as a result of individuals 

5 having breached contracts entered into under this 

6 section. 

7 ‘‘(l) BREACH OF CONTRACT.— 

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

9 has entered into a written contract with the Sec10 retary under this section and has not received a 

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

12 of any service obligation arising under such contract, 

13 to the United States for the amount which has been 

14 paid on such individual’s behalf under the contract 

15 if that individual— 

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

17 course of study and— 

18 ‘‘(i) fails to maintain an acceptable 

19 level of academic standing in the edu20 cational institution in which he or she is 

21 enrolled (such level determined by the edu22 cational institution under regulations of 

23 the Secretary); 

24 ‘‘(ii) voluntarily terminates such en25 rollment; or 


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1 ‘‘(iii) is dismissed from such edu2 cational institution before completion of 

3 such course of study; or 

4 ‘‘(B) is enrolled in a graduate training pro5 gram and fails to complete such training pro6 gram. 

7 ‘‘(2) OTHER BREACHES; FORMULA FOR

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

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

10 written contract under this section by failing either 

11 to begin, or complete, such individual’s period of ob12 ligated service in accordance with subsection (e)(2), 

13 the United States shall be entitled to recover from 

14 such individual an amount to be determined in ac15 cordance with the following formula: A=3Z(t¥s/t) 

16 in which— 

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

18 is entitled to recover; 

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

20 under this section to, or on behalf of, the indi21 vidual and the interest on such amounts which 

22 would be payable if, at the time the amounts 

23 were paid, they were loans bearing interest at 

24 the maximum legal prevailing rate, as deter25 mined by the Secretary of the Treasury; 


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

2 the individual’s period of obligated service in 

3 accordance with subsection (f); and 

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

5 period served by such individual in accordance 

6 with this section. 

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

8 Amounts not paid within such period shall be sub9 ject to collection through deductions in Medicare 

10 payments pursuant to section 1892 of the Social Se11 curity Act. 

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

13 amount of damages which the United States is enti14 tled to recover under this subsection shall be paid to 

15 the United States within the 1-year period beginning 

16 on the date of the breach or such longer period be17 ginning on such date as shall be specified by the 

18 Secretary. 

19 ‘‘(5) RECOVERY OF DELINQUENCY.— 

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

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

22 the Secretary shall, for the purpose of recov23 ering such damages— 


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1 ‘‘(i) use collection agencies contracted 

2 with by the Administrator of General Serv3 ices; or 

4 ‘‘(ii) enter into contracts for the re5 covery of such damages with collection 

6 agencies selected by the Secretary. 

7 ‘‘(B) REPORT.—Each contract for recov8 ering damages pursuant to this subsection shall 

9 provide that the contractor will, not less than 

10 once each 6 months, submit to the Secretary a 

11 status report on the success of the contractor in 

12 collecting such damages. Section 3718 of title 

13 31, United States Code, shall apply to any such 

14 contract to the extent not inconsistent with this 

15 subsection. 

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

17 ‘‘(1) IN GENERAL.—The Secretary shall by reg18 ulation provide for the partial or total waiver or sus19 pension of any obligation of service or payment by 

20 an individual under the Loan Repayment Program 

21 whenever compliance by the individual is impossible 

22 or would involve extreme hardship to the individual 

23 and if enforcement of such obligation with respect to 

24 any individual would be unconscionable. 


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

2 of an individual under the Loan Repayment Pro3 gram for service or payment of damages shall be 

4 canceled upon the death of the individual. 

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

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

7 States to recover amounts under this section in any 

8 case of extreme hardship or other good cause shown, 

9 as determined by the Secretary. 

10 ‘‘(4) BANKRUPTCY.—Any obligation of an indi11 vidual under the Loan Repayment Program for pay12 ment of damages may be released by a discharge in 

13 bankruptcy under title 11 of the United States Code 

14 only if such discharge is granted after the expiration 

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

16 payment of such damages is required, and only if 

17 the bankruptcy court finds that nondischarge of the 

18 obligation would be unconscionable. 

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

20 President, for inclusion in the report required to be sub21 mitted to Congress under section 801, a report concerning 

22 the previous fiscal year which sets forth by Service Area 

23 the following: 

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

25 maintained by Indian Health Programs and Urban 


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1 Indian Organizations for which recruitment or reten2 tion is difficult. 

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

4 applications filed with respect to each type of health 

5 profession. 

6 ‘‘(3) The number of contracts described in sub7 section (e) that are entered into with respect to each 

8 health profession. 

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

10 this section, in total and by health profession. 

11 ‘‘(5) The number of scholarships that are pro12 vided under sections 104 and 106 with respect to 

13 each health profession. 

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

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

16 profession. 

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

18 that will be needed by Indian Health Programs and 

19 Urban Indian Organizations, by location and profes20 sion, during the 3 fiscal years beginning after the 

21 date the report is filed. 

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

23 to fill the health professional positions maintained 

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1 nizations for which recruitment or retention is dif2 ficult. 

3 ‘‘SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOV4 ERY FUND. 

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

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

7 Indian Health Scholarship and Loan Repayment Recovery 

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

9 The LRRF shall consist of such amounts as may be col10 lected from individuals under section 104(d), section 

11 106(e), and section 110(l) for breach of contract, such 

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

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

14 appropriated, or earned relative to the LRRF shall remain 

15 available until expended. 

16 ‘‘(b) USE OF FUNDS.— 

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

18 may be expended by the Secretary, acting through 

19 the Service, to make payments to an Indian Health 

20 Program— 

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

22 section 104 and 106 or a loan repayment pro23 gram participant under section 110 has been 

24 assigned to meet the obligated service require25 ments pursuant to such sections; and 


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1 ‘‘(B) that has a need for a health profes2 sional to provide health care services as a result 

3 of such recipient or participant having breached 

4 the contract entered into under section 104, 

5 106, or section 110. 

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

7 Health Program receiving payments pursuant to 

8 paragraph (1) may expend the payments to provide 

9 scholarships or recruit and employ, directly or by 

10 contract, health professionals to provide health care 

11 services. 

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

13 Treasury shall invest such amounts of the LRRF as the 

14 Secretary of Health and Human Services determines are 

15 not required to meet current withdrawals from the LRRF. 

16 Such investments may be made only in interest bearing 

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

18 obligations may be acquired on original issue at the issue 

19 price, or by purchase of outstanding obligations at the 

20 market price. 

21 ‘‘(d) SALE OF OBLIGATIONS.—Any obligation ac22 quired by the LRRF may be sold by the Secretary of the 

23 Treasury at the market price. 


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1 ‘‘SEC. 112. RECRUITMENT ACTIVITIES. 

2 ‘‘(a) REIMBURSEMENT FOR TRAVEL.—The Sec3 retary, acting through the Service, may reimburse health 

4 professionals seeking positions with Indian Health Pro5 grams or Urban Indian Organizations, including individ6 uals considering entering into a contract under section 

7 110 and their spouses, for actual and reasonable expenses 

8 incurred in traveling to and from their places of residence 

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

10 of evaluating such area with respect to such assignment. 

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

12 acting through the Service, shall assign 1 individual in 

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

14 recruitment activities. 

15 ‘‘SEC. 113. INDIAN RECRUITMENT AND RETENTION PRO16 GRAM. 

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

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

19 demonstration projects for a period not to exceed 3 years 

20 to enable Tribal Health Programs and Urban Indian Or21 ganizations to recruit, place, and retain health profes22 sionals to meet their staffing needs. 

23 ‘‘(b) ELIGIBLE ENTITIES; APPLICATION.—Any Trib24 al Health Program or Urban Indian Organization may 

25 submit an application for funding of a project pursuant 

26 to this section. 


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

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

3 acting through the Service, shall establish a demonstration 

4 project to enable health professionals who have worked in 

5 an Indian Health Program or Urban Indian Organization 

6 for a substantial period of time to pursue advanced train7 ing or research areas of study for which the Secretary de8 termines a need exists. 

9 ‘‘(b) SERVICE OBLIGATION.—An individual who par10 ticipates in a program under subsection (a), where the 

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

12 obligation to serve in an Indian Health Program or Urban 

13 Indian Organization for a period of obligated service equal 

14 to at least the period 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 indi17 vidual shall be liable to the United States for the period 

18 of service remaining. In such event, with respect to indi19 viduals entering the program after the date of enactment 

20 of the Indian Health Care Improvement Act Amendments 

21 of 2007, the United States shall be entitled to recover 

22 from such individual an amount to be determined in ac23 cordance with the formula specified in subsection (l) of 

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

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

26 Health professionals from Tribal Health Programs and 


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1 Urban Indian Organizations shall be given an equal oppor2 tunity to participate in the program under subsection (a). 

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

4 NURSING PROGRAM. 

5 ‘‘(a) GRANTS AUTHORIZED.—For the purpose of in6 creasing the number of nurses, nurse midwives, and nurse 

7 practitioners who deliver health care services to Indians, 

8 the Secretary, acting through the Service, shall provide 

9 grants to the following: 

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

11 ‘‘(2) Tribal colleges or universities. 

12 ‘‘(3) Nurse midwife programs and advanced 

13 practice nurse programs that are provided by any 

14 tribal college or university accredited nursing pro15 gram, or in the absence of such, any other public or 

16 private institutions. 

17 ‘‘(b) USE OF GRANTS.—Grants provided under sub18 section (a) may be used for 1 or more of the following: 

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

20 train individuals to be nurses, nurse midwives, or 

21 advanced practice nurses. 

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

23 in such programs that may pay the tuition charged 

24 for such program and other expenses incurred in 


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1 connection with such program, including books, fees, 

2 room and board, and stipends for living expenses. 

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

4 nurses, nurse midwives, and advanced practice 

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

6 services to Indians. 

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

8 skills of, and provides continuing education to, 

9 nurses, nurse midwives, and advanced practice 

10 nurses. 

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

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

13 ‘‘(c) APPLICATIONS.—Each application for a grant 

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

15 Secretary may require to establish the connection between 

16 the program of the applicant and a health care facility 

17 that primarily serves Indians. 

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

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

20 extend a preference to the following: 

21 ‘‘(1) Programs that provide a preference to In22 dians. 

23 ‘‘(2) Programs that train nurse midwives or ad24 vanced practice nurses. 

25 ‘‘(3) Programs that are interdisciplinary. 


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1 ‘‘(4) Programs that are conducted in coopera2 tion with a program for gifted and talented Indian 

3 students. 

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

5 universities. 

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

7 Secretary shall provide 1 of the grants authorized under 

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

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

10 N. Burdick American Indians Into Nursing Program’. 

11 Such program shall, to the maximum extent feasible, co12 ordinate with the Quentin N. Burdick Indian Health Pro13 grams established under section 117(b) and the Quentin 

14 N. Burdick American Indians Into Psychology Program 

15 established under section 105(b). 

16 ‘‘(f) ACTIVE DUTY SERVICE OBLIGATION.—The ac17 tive duty service obligation prescribed under section 338C 

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

19 be met by each individual who receives training or assist20 ance described in paragraph (1) or (2) of subsection (b) 

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

22 Such obligation shall be met by service— 

23 ‘‘(1) in the Service; 

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

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1 mination and Education Assistance Act (25 U.S.C. 

2 450 et seq.) (including programs under agreements 

3 with the Bureau of Indian Affairs); 

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

5 Act; 

6 ‘‘(4) in the private practice of nursing if, as de7 termined by the Secretary, in accordance with guide8 lines promulgated by the Secretary, such practice is 

9 situated in a physician or other health shortage area 

10 and addresses the health care needs of a substantial 

11 number of Indians; or 

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

13 university nursing program (or a related health pro14 fession program) if, as determined by the Secretary, 

15 health services provided to Indians would not de16 crease. 

17 ‘‘SEC. 116. TRIBAL CULTURAL ORIENTATION. 

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

19 Secretary, acting through the Service, shall require that 

20 appropriate employees of the Service who serve Indian 

21 Tribes in each Service Area receive educational instruction 

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

23 relationship to the Service. 


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

2 Secretary shall establish a program which shall, to the ex3 tent feasible— 

4 ‘‘(1) be developed in consultation with the af5 fected Indian Tribes, Tribal Organizations, and 

6 Urban Indian Organizations; 

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

8 universities; 

9 ‘‘(3) include instruction in American Indian 

10 studies; and 

11 ‘‘(4) describe the use and place of traditional 

12 health care practices of the Indian Tribes in the 

13 Service Area. 

14 ‘‘SEC. 117. INMED PROGRAM. 

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

16 through the Service, is authorized to provide grants to col17 leges and universities for the purpose of maintaining and 

18 expanding the Indian health careers recruitment program 

19 known as the ‘Indians Into Medicine Program’ (herein20 after in this section referred to as ‘INMED’) as a means 

21 of encouraging Indians to enter the health professions. 

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

23 shall provide 1 of the grants authorized under subsection 

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

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


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1 Indian Health Programs’, unless the Secretary makes a 

2 determination, based upon program reviews, that the pro3 gram is not meeting the purposes of this section. Such 

4 program shall, to the maximum extent feasible, coordinate 

5 with the Quentin N. Burdick American Indians Into Psy6 chology Program established under section 105(b) and the 

7 Quentin N. Burdick American Indians Into Nursing Pro8 gram established under section 115. 

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

10 Act, shall develop regulations to govern grants pursuant 

11 to this section. 

12 ‘‘(d) REQUIREMENTS.—Applicants for grants pro13 vided under this section shall agree to provide a program 

14 which— 

15 ‘‘(1) provides outreach and recruitment for 

16 health professions to Indian communities including 

17 elementary and secondary schools and community 

18 colleges located on reservations which will be served 

19 by the program; 

20 ‘‘(2) incorporates a program advisory board 

21 comprised of representatives from the Indian Tribes 

22 and Indian communities which will be served by the 

23 program; 

24 ‘‘(3) provides summer preparatory programs for 

25 Indian students who need enrichment in the subjects 


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1 of math and science in order to pursue training in 

2 the health professions; 

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

4 to students who are enrolled in a health career pro5 gram of study at the respective college or university; 

6 and 

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

8 qualified Indians in the program. 

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

10 COLLEGES. 

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

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

13 through the Service, shall award grants to accredited 

14 and accessible community colleges for the purpose of 

15 assisting such community colleges in the establish16 ment of programs which provide education in a 

17 health profession leading to a degree or diploma in 

18 a health profession for individuals who desire to 

19 practice such profession on or near a reservation or 

20 in an Indian Health Program. 

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

22 grant awarded to a community college under para23 graph (1) for the first year in which such a grant 

24 is provided to the community college shall not exceed 

25 $250,000. 


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1 ‘‘(b) GRANTS FOR MAINTENANCE AND RECRUIT2 ING.— 

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

4 through the Service, shall award grants to accredited 

5 and accessible community colleges that have estab6 lished a program described in subsection (a)(1) for 

7 the purpose of maintaining the program and recruit8 ing students for the program. 

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

10 made under this section to a community college 

11 which— 

12 ‘‘(A) is accredited; 

13 ‘‘(B) has a relationship with a hospital fa14 cility, Service facility, or hospital that could 

15 provide training of nurses or health profes16 sionals; 

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

18 an accredited college or university medical 

19 school, the terms of which— 

20 ‘‘(i) provide a program that enhances 

21 the transition and recruitment of students 

22 into advanced baccalaureate or graduate 

23 programs that train health professionals; 

24 and 


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1 ‘‘(ii) stipulate certifications necessary 

2 to approve internship and field placement 

3 opportunities at Indian Health Programs; 

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

5 appropriate certifications; 

6 ‘‘(E) is capable of obtaining State or re7 gional accreditation of the program described in 

8 subsection (a)(1); and 

9 ‘‘(F) agrees to provide for Indian pref10 erence for applicants for programs under this 

11 section. 

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

13 encourage community colleges described in subsection 

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

15 subsection (a)(1) by— 

16 ‘‘(1) entering into agreements with such col17 leges for the provision of qualified personnel of the 

18 Service to teach courses of study in such programs; 

19 and 

20 ‘‘(2) providing technical assistance and support 

21 to such colleges. 

22 ‘‘(d) ADVANCED TRAINING.— 

23 ‘‘(1) REQUIRED.—Any program receiving as24 sistance under this section that is conducted with re25 spect to a health profession shall also offer courses 


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1 of study which provide advanced training for any 

2 health professional who— 

3 ‘‘(A) has already received a degree or di4 ploma in such health profession; and 

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

6 reservation or for an Indian Health Program. 

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

8 Such courses of study may be offered in conjunction 

9 with the college or university with which the commu10 nity college has entered into the agreement required 

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

12 ‘‘(e) PRIORITY.—Where the requirements of sub13 section (b) are met, grant award priority shall be provided 

14 to tribal colleges and universities in Service Areas where 

15 they exist. 

16 ‘‘SEC. 119. RETENTION BONUS. 

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

18 a retention bonus to any health professional employed by, 

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

20 or Urban Indian Organization either as a civilian employee 

21 or as a commissioned officer in the Regular or Reserve 

22 Corps of the Public Health Service who— 

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

24 for which recruitment or retention of personnel is 

25 difficult; 


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1 ‘‘(2) the Secretary determines is needed by In2 dian Health Programs and Urban Indian Organiza3 tions; 

4 ‘‘(3) has— 

5 ‘‘(A) completed 2 years of employment 

6 with an Indian Health Program or Urban In7 dian Organization; or 

8 ‘‘(B) completed any service obligations in9 curred as a requirement of— 

10 ‘‘(i) any Federal scholarship program; 

11 or 

12 ‘‘(ii) any Federal education loan re13 payment program; and 

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

15 Health Program or Urban Indian Organization for 

16 continued employment for a period of not less than 

17 1 year. 

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

19 the retention bonus which shall provide for a higher an20 nual rate for multiyear agreements than for single year 

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

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

23 annum. 

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

25 health professional failing to complete the agreed upon 


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

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

3 Government the full amount of the retention bonus for the 

4 period covered by the agreement, plus interest as deter5 mined by the Secretary in accordance with section 

6 110(l)(2)(B). 

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

8 may pay a retention bonus to any health professional em9 ployed by a Tribal Health Program if such health profes10 sional is serving in a position which the Secretary deter11 mines is— 

12 ‘‘(1) a position for which recruitment or reten13 tion is difficult; and 

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

15 to Indians. 

16 ‘‘SEC. 120. NURSING RESIDENCY PROGRAM. 

17 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Sec18 retary, acting through the Service, shall establish a pro19 gram to enable Indians who are licensed practical nurses, 

20 licensed vocational nurses, and registered nurses who are 

21 working in an Indian Health Program or Urban Indian 

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

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

24 shall include a combination of education and work study 

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1 tion leading to an associate or bachelor’s degree (in the 

2 case of a licensed practical nurse or licensed vocational 

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

4 nurse), or advanced degrees or certifications in nursing 

5 and public health. 

6 ‘‘(b) SERVICE OBLIGATION.—An individual who par7 ticipates in a program under subsection (a), where the 

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

9 obligation to serve in an Indian Health Program or Urban 

10 Indian Organization for a period of obligated service equal 

11 to 1 year for every year that nonprofessional employee (li12 censed practical nurses, licensed vocational nurses, nurs13 ing assistants, and various health care technicals), or 2 

14 years for every year that professional nurse (associate de15 gree and bachelor-prepared registered nurses), partici16 pates in such program. In the event that the individual 

17 fails to complete such obligated service, the United States 

18 shall be entitled to recover from such individual an amount 

19 determined in accordance with the formula specified in 

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

21 in such subsection. 

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

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

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

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1 ing through the Service, shall develop and operate a Com2 munity Health Aide Program in Alaska under which the 

3 Service— 

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

5 as health aides or community health practitioners; 

6 ‘‘(2) uses such aides or practitioners in the pro7 vision of health care, health promotion, and disease 

8 prevention services to Alaska Natives living in vil9 lages in rural Alaska; and 

10 ‘‘(3) provides for the establishment of tele11 conferencing capacity in health clinics located in or 

12 near such villages for use by community health aides 

13 or community health practitioners. 

14 ‘‘(b) SPECIFIC PROGRAM REQUIREMENTS.—The Sec15 retary, acting through the Community Health Aide Pro16 gram of the Service, shall— 

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

18 provide a high standard of training to community 

19 health aides and community health practitioners to 

20 ensure that such aides and practitioners provide 

21 quality health care, health promotion, and disease 

22 prevention services to the villages served by the Pro23 gram; 

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

25 a curriculum that— 


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1 ‘‘(A) combines education 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(2); 

13 ‘‘(3) establish and maintain a Community 

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

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

19 ‘‘(4) develop and maintain a system 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; 

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; and 

9 ‘‘(7) ensure that pulpal therapy (not including 

10 pulpotomies on deciduous teeth) or extraction of 

11 adult teeth can be performed by a dental health aide 

12 therapist only after consultation with a licensed den13 tist who determines that the procedure is a medical 

14 emergency that cannot be resolved with palliative 

15 treatment, and further that dental health aide thera16 pists are strictly prohibited from performing all 

17 other oral or jaw surgeries, provided that uncompli18 cated extractions shall not be considered oral sur19 gery under this section. 

20 ‘‘(c) PROGRAM REVIEW.— 

21 ‘‘(1) NEUTRAL PANEL.— 

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

23 acting through the Service, shall establish a 

24 neutral panel to carry out the study under 

25 paragraph (2). 


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1 ‘‘(B) MEMBERSHIP.—Members of the neu2 tral panel shall be appointed by the Secretary 

3 from among clinicians, economists, community 

4 practitioners, oral epidemiologists, and Alaska 

5 Natives. 

6 ‘‘(2) STUDY.— 

7 ‘‘(A) IN GENERAL.—The neutral panel es8 tablished under paragraph (1) shall conduct a 

9 study of the dental health aide therapist serv10 ices provided by the Community Health Aide 

11 Program under this section to ensure that the 

12 quality of care provided through those services 

13 is adequate and appropriate. 

14 ‘‘(B) PARAMETERS OF STUDY.—The Sec15 retary, in consultation with interested parties, 

16 including professional dental organizations, 

17 shall develop the parameters of the study. 

18 ‘‘(C) INCLUSIONS.—The study shall in19 clude a determination by the neutral panel with 

20 respect to— 

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

22 aide therapist services under this section to 

23 address the dental care needs of Alaska 

24 Natives; 


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1 ‘‘(ii) the quality of care provided 

2 through those services, including any train3 ing, improvement, or additional oversight 

4 required to improve the quality of care; 

5 and 

6 ‘‘(iii) whether safer and less costly al7 ternatives to the dental health aide thera8 pist services exist. 

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

10 study under this paragraph, the neutral panel 

11 shall consult with Alaska Tribal Organizations 

12 with respect to the adequacy and accuracy of 

13 the study. 

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

15 to the Secretary, the Committee on Indian Affairs of 

16 the Senate, and the Committee on Natural Re17 sources of the House of Representatives a report de18 scribing the results of the study under paragraph 

19 (2), including a description of— 

20 ‘‘(A) any determination of the neutral 

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

22 ‘‘(B) any comments received from an Alas23 ka Tribal Organization under paragraph 

24 (2)(D). 

25 ‘‘(d) NATIONALIZATION OF PROGRAM.— 


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1 ‘‘(1) IN GENERAL.—Except as provided in para2 graph (2), the Secretary, acting through the Service, 

3 may establish a national Community Health Aide 

4 Program in accordance with the program under this 

5 section, as the Secretary determines to be appro6 priate. 

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

8 Health Aide Program under paragraph (1) shall not 

9 include dental health aide therapist services. 

10 ‘‘(3) REQUIREMENT.—In establishing a na11 tional program under paragraph (1), the Secretary 

12 shall not reduce the amount of funds provided for 

13 the Community Health Aide Program described in 

14 subsections (a) and (b). 

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

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

17 contract or otherwise, provide training for Indians in the 

18 administration and planning of Tribal Health Programs. 

19 ‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE 

20 DEMONSTRATION PROGRAMS. 

21 ‘‘(a) DEMONSTRATION PROGRAMS AUTHORIZED.— 

22 The Secretary, acting through the Service, may fund dem23 onstration programs for Tribal Health Programs to ad24 dress the chronic shortages of health professionals. 


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

2 demonstration programs funded under subsection (a) shall 

3 be— 

4 ‘‘(1) to provide direct clinical and practical ex5 perience at a Service Unit to health profession stu6 dents and residents from medical schools; 

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

8 Indians by assuring access to qualified health care 

9 professionals; and 

10 ‘‘(3) to provide academic and scholarly opportu11 nities for health professionals serving Indians by 

12 identifying all academic and scholarly resources of 

13 the region. 

14 ‘‘(c) ADVISORY BOARD.—The demonstration pro15 grams established pursuant to subsection (a) shall incor16 porate a program advisory board composed of representa17 tives from the Indian Tribes and Indian communities in 

18 the area which will be served by the program. 

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

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

21 shall not— 

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

23 Service Corps from an Indian Health Program or 

24 Urban Indian Organization; or 


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

2 member, unless the Secretary, acting through the 

3 Service, has ensured that the Indians receiving serv4 ices from such member will experience no reduction 

5 in services. 

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

7 Health Service Corps scholars qualifying for the Commis8 sioned Corps in the Public Health Service shall be exempt 

9 from the full-time equivalent limitations of the National 

10 Health Service Corps and the Service when serving as a 

11 commissioned corps officer in a Tribal Health Program 

12 or an Urban Indian Organization. 

13 ‘‘SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL 

14 CURRICULA DEMONSTRATION PROGRAMS. 

15 ‘‘(a) CONTRACTS AND GRANTS.—The Secretary, act16 ing through the Service, may enter into contracts with, 

17 or make grants to, accredited tribal colleges and univer18 sities and eligible accredited and accessible community col19 leges to establish demonstration programs to develop edu20 cational curricula for substance abuse counseling. 

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

22 section shall be used only for developing and providing 

23 educational curriculum for substance abuse counseling (in24 cluding paying salaries for instructors). Such curricula 

25 may be provided through satellite campus programs. 


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

2 contract entered into or a grant provided under this sec3 tion shall be for a period of 3 years. Such contract or 

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

5 upon the approval of the Secretary. 

6 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP7 PLICATIONS.—Not later than 180 days after the date of 

8 enactment of the Indian Health Care Improvement Act 

9 Amendments of 2007, the Secretary, after consultation 

10 with Indian Tribes and administrators of tribal colleges 

11 and universities and eligible accredited and accessible com12 munity colleges, shall develop and issue criteria for the 

13 review and approval of applications for funding (including 

14 applications for renewals of funding) under this section. 

15 Such criteria shall ensure that demonstration programs 

16 established under this section promote the development of 

17 the capacity of such entities to educate substance abuse 

18 counselors. 

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

20 technical and other assistance as may be necessary to en21 able grant recipients to comply with the provisions of this 

22 section. 

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

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

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1 cal year, a report on the findings and conclusions derived 

2 from the demonstration programs conducted under this 

3 section during that fiscal year. 

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

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

6 following: 

7 ‘‘(1) Classroom education. 

8 ‘‘(2) Clinical work experience. 

9 ‘‘(3) Continuing education workshops. 

10 ‘‘SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMU11 NITY EDUCATION PROGRAMS. 

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

13 the Service, and the Secretary of the Interior, in consulta14 tion with Indian Tribes and Tribal Organizations, shall 

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

16 positions specified in subsection (b) whose qualifications 

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

18 prevention, education, referral, or treatment of mental ill19 ness, or dysfunctional and self destructive behavior. 

20 ‘‘(b) POSITIONS.—The positions referred to in sub21 section (a) are— 

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

23 Affairs, including existing positions, in the fields 

24 of— 

25 ‘‘(A) elementary and secondary education; 


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

2 welfare; 

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

4 and 

5 ‘‘(D) alcohol and substance abuse; 

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

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

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

9 by Indian Tribes, Tribal Organizations (without re10 gard to the funding source), and Urban Indian Or11 ganizations. 

12 ‘‘(c) TRAINING CRITERIA.— 

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

14 shall provide training criteria appropriate to each 

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

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

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

18 such position. With respect to any such individual in 

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

20 the respective Secretaries shall provide appropriate 

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

22 Tribal Organization, or Urban Indian Organization 

23 for training of appropriate individuals. In the case of 

24 positions funded under a contract or compact under 

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1 ance Act (25 U.S.C. 450 et seq.), the appropriate 

2 Secretary shall ensure that such training costs are 

3 included in the contract or compact, as the Sec4 retary determines necessary. 

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

6 Position specific training criteria shall be culturally 

7 relevant to Indians and Indian Tribes and shall en8 sure that appropriate information regarding tradi9 tional health care practices is provided. 

10 ‘‘(d) COMMUNITY EDUCATION ON MENTAL ILL11 NESS.—The Service shall develop and implement, on re12 quest of an Indian Tribe, Tribal Organization, or Urban 

13 Indian Organization, or assist the Indian Tribe, Tribal Or14 ganization, or Urban Indian Organization to develop and 

15 implement, a program of community education on mental 

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

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

18 Urban Indian Organization, provide technical assistance 

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

20 Organization to obtain and develop community edu21 cational materials on the identification, prevention, refer22 ral, and treatment of mental illness and dysfunctional and 

23 self-destructive behavior. 

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

25 of enactment of the Indian Health Care Improvement Act 


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1 Amendments of 2007, the Secretary shall develop a plan 

2 under which the Service will increase the health care staff 

3 providing behavioral health services by at least 500 posi4 tions within 5 years after the date of enactment of this 

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

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

7 under this subsection shall be implemented under the Act 

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

9 as the ‘Snyder Act’). 

10 ‘‘SEC. 127. AUTHORIZATION OF APPROPRIATIONS. 

11 ‘‘There are authorized to be appropriated such sums 

12 as may be necessary for each fiscal year through fiscal 

13 year 2017 to carry out this title. 

14 ‘‘TITLE II—HEALTH SERVICES 

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

16 ‘‘(a) USE OF FUNDS.—The Secretary, acting through 

17 the Service, is authorized to expend funds, directly or 

18 under the authority of the Indian Self-Determination and 

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

20 are appropriated under the authority of this section, for 

21 the purposes of— 

22 ‘‘(1) eliminating the deficiencies in health sta23 tus and health resources of all Indian Tribes; 

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

25 health care services to Indians; 


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

2 efficient and equitable manner, including the use of 

3 telehealth and telemedicine when appropriate; 

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

5 direct care and contract health service programs; 

6 and 

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

8 meet the following health service responsibilities with 

9 respect to those Indian Tribes with the highest levels 

10 of health status deficiencies and resource defi11 ciencies: 

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

13 outpatient care (including audiology, clinical 

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

15 and tertiary care, and long-term care. 

16 ‘‘(B) Preventive health, including mam17 mography and other cancer screening in accord18 ance with section 207. 

19 ‘‘(C) Dental care. 

20 ‘‘(D) Mental health, including community 

21 mental health services, inpatient mental health 

22 services, dormitory mental health services, 

23 therapeutic and residential treatment centers, 

24 and training of traditional health care practi25 tioners. 


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1 ‘‘(E) Emergency medical services. 

2 ‘‘(F) Treatment and control of, and reha3 bilitative care related to, alcoholism and drug 

4 abuse (including fetal alcohol syndrome) among 

5 Indians. 

6 ‘‘(G) Injury prevention programs, includ7 ing data collection and evaluation, demonstra8 tion projects, training, and capacity building. 

9 ‘‘(H) Home health care. 

10 ‘‘(I) Community health representatives. 

11 ‘‘(J) Maintenance and improvement. 

12 ‘‘(b) NO OFFSET OR LIMITATION.—Any funds appro13 priated under the authority of this section shall not be 

14 used to offset or limit any other appropriations made to 

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

16 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

17 or any other provision of law. 

18 ‘‘(c) ALLOCATION; USE.— 

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

20 the authority of this section shall be allocated to 

21 Service Units, Indian Tribes, or Tribal Organiza22 tions. The funds allocated to each Indian Tribe, 

23 Tribal Organization, or Service Unit under this 

24 paragraph shall be used by the Indian Tribe, Tribal 

25 Organization, or Service Unit under this paragraph 


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1 to improve the health status and reduce the resource 

2 deficiency of each Indian Tribe served by such Serv3 ice Unit, Indian Tribe, or Tribal Organization. 

4 ‘‘(2) APPORTIONMENT OF ALLOCATED

5 FUNDS.—The apportionment of funds allocated to a 

6 Service Unit, Indian Tribe, or Tribal Organization 

7 under paragraph (1) among the health service re8 sponsibilities described in subsection (a)(5) shall be 

9 determined by the Service in consultation with, and 

10 with the active participation of, the affected Indian 

11 Tribes and Tribal Organizations. 

12 ‘‘(d) PROVISIONS RELATING TO HEALTH STATUS

13 AND RESOURCE DEFICIENCIES.—For the purposes of this 

14 section, the following definitions apply: 

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

16 and resource deficiency’ means the extent to 

17 which— 

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

19 in section 3(2) are not being achieved; and 

20 ‘‘(B) the Indian Tribe or Tribal Organiza21 tion does not have available to it the health re22 sources it needs, taking into account the actual 

23 cost of providing health care services given local 

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


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1 ‘‘(2) AVAILABLE RESOURCES.—The health re2 sources available to an Indian Tribe or Tribal Orga3 nization include health resources provided by the 

4 Service as well as health resources used by the In5 dian Tribe or Tribal Organization, including services 

6 and financing systems provided by any Federal pro7 grams, private insurance, and programs of State or 

8 local governments. 

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

11 which allow any Indian Tribe or Tribal Organization 

12 to petition the Secretary for a review of any deter13 mination of the extent of the health status and re14 source deficiency of such Indian Tribe or Tribal Or15 ganization. 

16 ‘‘(e) ELIGIBILITY FOR FUNDS.—Tribal Health Pro17 grams shall be eligible for funds appropriated under the 

18 authority of this section on an equal basis with programs 

19 that are administered directly by the Service. 

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

21 years after the date of enactment of the Indian Health 

22 Care Improvement Act Amendments of 2007, the Sec23 retary shall submit to Congress the current health status 

24 and resource deficiency report of the Service for each 


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1 Service Unit, including newly recognized or acknowledged 

2 Indian Tribes. Such report shall set out— 

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

4 for determining Tribal health status and resource 

5 deficiencies, as well as the most recent application of 

6 that methodology; 

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

9 Service or a Tribal Health Program; 

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

11 the health status and resource deficiencies of all In12 dian Tribes served by the Service or a Tribal Health 

13 Program; and 

14 ‘‘(4) an estimate of— 

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

16 appropriated under the authority of this Act, or 

17 any other Act, including the amount of any 

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

20 Service Unit, Indian Tribe, or Tribal Organiza21 tion; 

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

23 health services in each Service Unit or Indian 

24 Tribe or Tribal Organization; and 


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

2 Service resources made available to each Service 

3 Unit, Indian Tribe or Tribal Organization, and, 

4 to the extent available, information on the wait5 ing lists and number of Indians turned away for 

6 services due to lack of resources. 

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

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

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

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

16 discourage the Service from undertaking additional efforts 

17 to achieve equity among Indian Tribes and Tribal Organi18 zations. 

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

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

23 ‘‘(a) ESTABLISHMENT.—There is established an In24 dian Catastrophic Health Emergency Fund (hereafter in 

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


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1 ‘‘(1) the amounts deposited under subsection 

2 (f); and 

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

4 this section. 

5 ‘‘(b) ADMINISTRATION.—CHEF shall be adminis6 tered by the Secretary, acting through the headquarters 

7 of the Service, solely for the purpose of meeting the ex8 traordinary medical costs associated with the treatment of 

9 victims of disasters or catastrophic illnesses who are with10 in the responsibility of the Service. 

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

12 CHEF or its administration shall be subject to contract 

13 or grant under any law, including the Indian Self-Deter14 mination and Education Assistance Act (25 U.S.C. 450 

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

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

17 similar basis. 

18 ‘‘(d) REGULATIONS.—The Secretary shall promul19 gate regulations consistent with the provisions of this sec20 tion to— 

21 ‘‘(1) establish a definition of disasters and cata22 strophic illnesses for which the cost of the treatment 

23 provided under contract would qualify for payment 

24 from CHEF; 


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1 ‘‘(2) provide that a Service Unit shall not be el2 igible for reimbursement for the cost of treatment 

3 from CHEF until its cost of treating any victim of 

4 such catastrophic illness or disaster has reached a 

5 certain threshold cost which the Secretary shall es6 tablish at— 

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

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

9 than the threshold cost of the previous year in10 creased by the percentage increase in the med11 ical care expenditure category of the consumer 

12 price index for all urban consumers (United 

13 States city average) for the 12-month period 

14 ending with December of the previous year; 

15 ‘‘(3) establish a procedure for the reimburse16 ment of the portion of the costs that exceeds such 

17 threshold cost incurred by— 

18 ‘‘(A) Service Units; or 

19 ‘‘(B) whenever otherwise authorized by the 

20 Service, non-Service facilities or providers; 

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

22 CHEF in cases in which the exigencies of the med23 ical circumstances warrant treatment prior to the 

24 authorization of such treatment by the Service; and 


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

2 no payment shall be made from CHEF to any pro3 vider of treatment to the extent that such provider 

4 is eligible to receive payment for the treatment from 

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

6 reimbursement for which the patient is eligible. 

7 ‘‘(e) NO OFFSET OR LIMITATION.—Amounts appro8 priated to CHEF under this section shall not be used to 

9 offset or limit appropriations made to the Service under 

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

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

12 law. 

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

14 shall be deposited into CHEF all reimbursements to which 

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

16 private source (including third party insurance) by reason 

17 of treatment rendered to any victim of a disaster or cata18 strophic illness the cost of which was paid from CHEF. 

19 ‘‘SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION 

20 SERVICES. 

21 ‘‘(a) FINDINGS.—Congress finds that health pro22 motion and disease prevention activities— 

23 ‘‘(1) improve the health and well-being of Indi24 ans; and 


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1 ‘‘(2) reduce the expenses for health care of In2 dians. 

3 ‘‘(b) PROVISION OF SERVICES.—The Secretary, act4 ing through the Service and Tribal Health Programs, shall 

5 provide health promotion and disease prevention services 

6 to Indians to achieve the health status objectives set forth 

7 in section 3(2). 

8 ‘‘(c) EVALUATION.—The Secretary, after obtaining 

9 input from the affected Tribal Health Programs, shall 

10 submit to the President for inclusion in the report which 

11 is required to be submitted to Congress under section 801 

12 an evaluation of— 

13 ‘‘(1) the health promotion and disease preven14 tion needs of Indians; 

15 ‘‘(2) the health promotion and disease preven16 tion activities which would best meet such needs; 

17 ‘‘(3) the internal capacity of the Service and 

18 Tribal Health Programs to meet such needs; and 

19 ‘‘(4) the resources which would be required to 

20 enable the Service and Tribal Health Programs to 

21 undertake the health promotion and disease preven22 tion activities necessary to meet such needs. 


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

3 ‘‘(a) DETERMINATIONS REGARDING DIABETES.— 

4 The Secretary, acting through the Service, and in con5 sultation with Indian Tribes and Tribal Organizations, 

6 shall determine— 

7 ‘‘(1) by Indian Tribe and by Service Unit, the 

8 incidence of, and the types of complications resulting 

9 from, diabetes among Indians; and 

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

13 disease indicators) each Service Unit should take to 

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

16 among Indian Tribes within that Service Unit. 

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

19 shall screen each Indian who receives services from the 

20 Service for diabetes and for conditions which indicate a 

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

25 may be conducted through appropriate Internet-based 

26 health care management programs. 


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

3 on the date of enactment of the Indian Health Care Im4 provement Act Amendments of 2007, any such other dia5 betes programs operated by the Service or Tribal Health 

6 Programs, and any additional diabetes projects, such as 

7 the Medical Vanguard program provided for in title IV 

8 of Public Law 108–87, as implemented to serve Indian 

9 Tribes. Tribal Health Programs shall receive recurring 

10 funding for the diabetes projects that they operate pursu11 ant to this section, both at the date of enactment of the 

12 Indian Health Care Improvement Act Amendments of 

13 2007 and for projects which are added and funded there14 after. 

15 ‘‘(d) DIALYSIS PROGRAMS.—The Secretary is author16 ized to provide, through the Service, Indian Tribes, and 

17 Tribal Organizations, dialysis programs, including the 

18 purchase of dialysis equipment and the provision of nec19 essary staffing. 

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

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

22 extent funding is available— 

23 ‘‘(A) in each Area Office, consult with In24 dian Tribes and Tribal Organizations regarding 


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1 programs for the prevention, treatment, and 

2 control of diabetes; 

3 ‘‘(B) establish in each Area Office a reg4 istry of patients with diabetes to track the inci5 dence of diabetes and the complications from 

6 diabetes in that area; and 

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

8 Area Office regarding diabetes and related com9 plications among Indians are disseminated to 

10 all other Area Offices, subject to applicable pa11 tient privacy laws. 

12 ‘‘(2) DIABETES CONTROL OFFICERS.— 

13 ‘‘(A) IN GENERAL.—The Secretary may es14 tablish and maintain in each Area Office a posi15 tion of diabetes control officer to coordinate and 

16 manage any activity of that Area Office relating 

17 to the prevention, treatment, or control of dia18 betes to assist the Secretary in carrying out a 

19 program under this section or section 330C of 

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

21 3). 

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

23 carried out by a diabetes control officer under 

24 subparagraph (A) that is the subject of a con25 tract or compact under the Indian Self-DeterVerDate Aug 31 2005 21:58 Apr 25, 2007 Jkt 059200 PO 00000 Frm 00103 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.IS S1200

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1 mination and Education Assistance Act (25 

2 U.S.C. 450 et seq.), and any funds made avail3 able to carry out such an activity, shall not be 

4 divisible for purposes of that Act. 

5 ‘‘SEC. 205. SHARED SERVICES FOR LONG-TERM CARE. 

6 ‘‘(a) LONG-TERM CARE.—Notwithstanding any other 

7 provision of law, the Secretary, acting through the Service, 

8 is authorized to provide directly, or enter into contracts 

9 or compacts under the Indian Self-Determination and 

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

11 Indian Tribes or Tribal Organizations for, the delivery of 

12 long-term care (including health care services associated 

13 with long-term care) provided in a facility to Indians. Such 

14 agreements shall provide for the sharing of staff or other 

15 services between the Service or a Tribal Health Program 

16 and a long-term care or related facility owned and oper17 ated (directly or through a contract or compact under the 

18 Indian Self-Determination and Education Assistance Act 

19 (25 U.S.C. 450 et seq.)) by such Indian Tribe or Tribal 

20 Organization. 

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

22 entered into pursuant to subsection (a)— 

23 ‘‘(1) may, at the request of the Indian Tribe or 

24 Tribal Organization, delegate to such Indian Tribe 

25 or Tribal Organization such powers of supervision 


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1 and control over Service employees as the Secretary 

2 deems necessary to carry out the purposes of this 

3 section; 

4 ‘‘(2) shall provide that expenses (including sala5 ries) relating to services that are shared between the 

6 Service and the Tribal Health Program be allocated 

7 proportionately between the Service and the Indian 

8 Tribe or Tribal Organization; and 

9 ‘‘(3) may authorize such Indian Tribe or Tribal 

10 Organization to construct, renovate, or expand a 

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

12 construction of a facility attached to a Service facil13 ity). 

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

15 provided for under this section shall meet the require16 ments for nursing facilities under section 1919 of the So17 cial Security Act. 

18 ‘‘(d) OTHER ASSISTANCE.—The Secretary shall pro19 vide such technical and other assistance as may be nec20 essary to enable applicants to comply with the provisions 

21 of this section. 

22 ‘‘(e) USE OF EXISTING OR UNDERUSED FACILI23 TIES.—The Secretary shall encourage the use of existing 

24 facilities that are underused or allow the use of swing beds 

25 for long-term or similar care. 


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1 ‘‘SEC. 206. HEALTH SERVICES RESEARCH. 

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

3 the Service, shall make funding available for research to 

4 further the performance of the health service responsibil5 ities of Indian Health Programs. 

6 ‘‘(b) COORDINATION OF RESOURCES AND ACTIVI7 TIES.—The Secretary shall also, to the maximum extent 

8 practicable, coordinate departmental research resources 

9 and activities to address relevant Indian Health Program 

10 research needs. 

11 ‘‘(c) AVAILABILITY.—Tribal Health Programs shall 

12 be given an equal opportunity to compete for, and receive, 

13 research funds under this section. 

14 ‘‘(d) USE OF FUNDS.—This funding may be used for 

15 both clinical and nonclinical research. 

16 ‘‘(e) EVALUATION AND DISSEMINATION.—The Sec17 retary shall periodically— 

18 ‘‘(1) evaluate the impact of research conducted 

19 under this section; and 

20 ‘‘(2) disseminate to Tribal Health Programs in21 formation regarding that research as the Secretary 

22 determines to be appropriate. 

23 ‘‘SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREEN24 ING. 

25 ‘‘The Secretary, acting through the Service or Tribal 

26 Health Programs, shall provide for screening as follows: 


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1 ‘‘(1) Screening mammography (as defined in 

2 section 1861(jj) of the Social Security Act) for In3 dian women at a frequency appropriate to such 

4 women under accepted and appropriate national 

5 standards, and under such terms and conditions as 

6 are consistent with standards established by the Sec7 retary to ensure the safety and accuracy of screen8 ing mammography under part B of title XVIII of 

9 such Act. 

10 ‘‘(2) Other cancer screening that receives an A 

11 or B rating as recommended by the United States 

12 Preventive Services Task Force established under 

13 section 915(a)(1) of the Public Health Service Act 

14 (42 U.S.C. 299b–4(a)(1)). The Secretary shall en15 sure that screening provided for under this para16 graph complies with the recommendations of the 

17 Task Force with respect to— 

18 ‘‘(A) frequency; 

19 ‘‘(B) the population to be served; 

20 ‘‘(C) the procedure or technology to be 

21 used; 

22 ‘‘(D) evidence of effectiveness; and 

23 ‘‘(E) other matters that the Secretary de24 termines appropriate. 


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1 ‘‘SEC. 208. PATIENT TRAVEL COSTS. 

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

3 section, the term ‘qualified escort’ means— 

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

7 the applicable patient; 

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

9 providing necessary medical care during travel by 

10 the applicable patient; or 

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

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

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

17 costs, including qualified escorts, associated with receiving 

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

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

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


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

2 other means of transportation is available), specially 

3 equipped vehicle, and ambulance; and 

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

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

7 ‘‘SEC. 209. EPIDEMIOLOGY CENTERS. 

8 ‘‘(a) ESTABLISHMENT OF CENTERS.—The Secretary 

9 shall establish an epidemiology center in each Service Area 

10 to carry out the functions described in subsection (b). Any 

11 new center established after the date of enactment of the 

12 Indian Health Care Improvement Act Amendments of 

13 2007 may be operated under a grant authorized by sub14 section (d), but funding under such a grant shall not be 

15 divisible. 

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

17 and upon the request of Indian Tribes, Tribal Organiza18 tions, and Urban Indian Organizations, each Service Area 

19 epidemiology center established under this section shall, 

20 with respect to such Service Area— 

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

22 progress made toward meeting, each of the health 

23 status objectives of the Service, the Indian Tribes, 

24 Tribal Organizations, and Urban Indian Organiza25 tions in the Service Area; 


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

2 systems, and other systems that impact the improve3 ment of Indian health; 

4 ‘‘(3) assist Indian Tribes, Tribal Organizations, 

5 and Urban Indian Organizations in identifying their 

6 highest priority health status objectives and the 

7 services needed to achieve such objectives, based on 

8 epidemiological data; 

9 ‘‘(4) make recommendations for the targeting 

10 of services needed by the populations served; 

11 ‘‘(5) make recommendations to improve health 

12 care delivery systems for Indians and Urban Indi13 ans; 

14 ‘‘(6) provide requested technical assistance to 

15 Indian Tribes, Tribal Organizations, and Urban In16 dian Organizations in the development of local 

17 health service priorities and incidence and prevalence 

18 rates of disease and other illness in the community; 

19 and 

20 ‘‘(7) provide disease surveillance and assist In21 dian Tribes, Tribal Organizations, and Urban Indian 

22 Organizations to promote public health. 

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

24 Centers for Disease Control and Prevention shall provide 


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1 technical assistance to the centers in carrying out the re2 quirements of this section. 

3 ‘‘(d) GRANTS FOR STUDIES.— 

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

5 grants to Indian Tribes, Tribal Organizations, 

6 Urban Indian Organizations, and eligible intertribal 

7 consortia to conduct epidemiological studies of In8 dian communities. 

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

10 intertribal consortium is eligible to receive a grant 

11 under this subsection if— 

12 ‘‘(A) the intertribal consortium is incor13 porated for the primary purpose of improving 

14 Indian health; and 

15 ‘‘(B) the intertribal consortium is rep16 resentative of the Indian Tribes or urban In17 dian communities in which the intertribal con18 sortium is located. 

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

20 grant under this subsection shall be submitted in 

21 such manner and at such time as the Secretary shall 

22 prescribe. 

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

24 grant under this subsection shall— 


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1 ‘‘(A) demonstrate the technical, adminis2 trative, and financial expertise necessary to 

3 carry out the functions described in paragraph 

4 (5); 

5 ‘‘(B) consult and cooperate with providers 

6 of related health and social services in order to 

7 avoid duplication of existing services; and 

8 ‘‘(C) demonstrate cooperation from Indian 

9 Tribes or Urban Indian Organizations in the 

10 area to be served. 

11 ‘‘(5) USE OF FUNDS.—A grant awarded under 

12 paragraph (1) may be used— 

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

14 in subsection (b); 

15 ‘‘(B) to provide information to and consult 

16 with tribal leaders, urban Indian community 

17 leaders, and related health staff on health care 

18 and health service management issues; and 

19 ‘‘(C) in collaboration with Indian Tribes, 

20 Tribal Organizations, and urban Indian com21 munities, to provide the Service with informa22 tion regarding ways to improve the health sta23 tus of Indians. 

24 ‘‘(e) ACCESS TO INFORMATION.—An epidemiology 

25 center operated by a grantee pursuant to a grant awarded 


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1 under subsection (d) shall be treated as a public health 

2 authority for purposes of the Health Insurance Portability 

3 and Accountability Act of 1996 (Public Law 104–191; 110 

4 Stat. 2033), as such entities are defined in part 164.501 

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

6 regulation). The Secretary shall grant such grantees ac7 cess to and use of data, data sets, monitoring systems, 

8 delivery systems, and other protected health information 

9 in the possession of the Secretary. 

10 ‘‘SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION 

11 PROGRAMS. 

12 ‘‘(a) FUNDING FOR DEVELOPMENT OF PROGRAMS.— 

13 In addition to carrying out any other program for health 

14 promotion or disease prevention, the Secretary, acting 

15 through the Service, is authorized to award grants to In16 dian Tribes, Tribal Organizations, and Urban Indian Or17 ganizations to develop comprehensive school health edu18 cation programs for children from pre-school through 

19 grade 12 in schools for the benefit of Indian and Urban 

20 Indian children. 

21 ‘‘(b) USE OF GRANT FUNDS.—A grant awarded 

22 under this section may be used for purposes which may 

23 include, but are not limited to, the following: 


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1 ‘‘(1) Developing health education materials both 

2 for regular school programs and afterschool pro3 grams. 

4 ‘‘(2) Training teachers in comprehensive school 

5 health education materials. 

6 ‘‘(3) Integrating school-based, community7 based, and other public and private health promotion 

8 efforts. 

9 ‘‘(4) Encouraging healthy, tobacco-free school 

10 environments. 

11 ‘‘(5) Coordinating school-based health programs 

12 with existing services and programs available in the 

13 community. 

14 ‘‘(6) Developing school programs on nutrition 

15 education, personal health, oral health, and fitness. 

16 ‘‘(7) Developing behavioral health wellness pro17 grams. 

18 ‘‘(8) Developing chronic disease prevention pro19 grams. 

20 ‘‘(9) Developing substance abuse prevention 

21 programs. 

22 ‘‘(10) Developing injury prevention and safety 

23 education programs. 

24 ‘‘(11) Developing activities for the prevention 

25 and control of communicable diseases. 


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1 ‘‘(12) Developing community and environmental 

2 health education programs that include traditional 

3 health care practitioners. 

4 ‘‘(13) Violence prevention. 

5 ‘‘(14) Such other health issues as are appro6 priate. 

7 ‘‘(c) TECHNICAL ASSISTANCE.—Upon request, the 

8 Secretary, acting through the Service, shall provide tech9 nical assistance to Indian Tribes, Tribal Organizations, 

10 and Urban Indian Organizations in the development of 

11 comprehensive health education plans and the dissemina12 tion of comprehensive health education materials and in13 formation on existing health programs and resources. 

14 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP15 PLICATIONS.—The Secretary, acting through the Service, 

16 and in consultation with Indian Tribes, Tribal Organiza17 tions, and Urban Indian Organizations, shall establish cri18 teria for the review and approval of applications for grants 

19 awarded under this section. 

20 ‘‘(e) DEVELOPMENT OF PROGRAM FOR BIA-FUNDED

21 SCHOOLS.— 

22 ‘‘(1) IN GENERAL.—The Secretary of the Inte23 rior, acting through the Bureau of Indian Affairs 

24 and in cooperation with the Secretary, acting 

25 through the Service, and affected Indian Tribes and 


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1 Tribal Organizations, shall develop a comprehensive 

2 school health education program for children from 

3 preschool through grade 12 in schools for which sup4 port is provided by the Bureau of Indian Affairs. 

5 ‘‘(2) REQUIREMENTS FOR PROGRAMS.—Such 

6 programs shall include— 

7 ‘‘(A) school programs on nutrition edu8 cation, personal health, oral health, and fitness; 

9 ‘‘(B) behavioral health wellness programs; 

10 ‘‘(C) chronic disease prevention programs; 

11 ‘‘(D) substance abuse prevention pro12 grams; 

13 ‘‘(E) injury prevention and safety edu14 cation programs; and 

15 ‘‘(F) activities for the prevention and con16 trol of communicable diseases. 

17 ‘‘(3) DUTIES OF THE SECRETARY.—The Sec18 retary of the Interior shall— 

19 ‘‘(A) provide training to teachers in com20 prehensive school health education materials; 

21 ‘‘(B) ensure the integration and coordina22 tion of school-based programs with existing 

23 services and health programs available in the 

24 community; and 


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1 ‘‘(C) encourage healthy, tobacco-free school 

2 environments. 

3 ‘‘SEC. 211. INDIAN YOUTH PROGRAM. 

4 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 

5 through the Service, is authorized to establish and admin6 ister a program to provide grants to Indian Tribes, Tribal 

7 Organizations, and Urban Indian Organizations for inno8 vative mental and physical disease prevention and health 

9 promotion and treatment programs for Indian and Urban 

10 Indian preadolescent and adolescent youths. 

11 ‘‘(b) USE OF FUNDS.— 

12 ‘‘(1) ALLOWABLE USES.—Funds made available 

13 under this section may be used to— 

14 ‘‘(A) develop prevention and treatment 

15 programs for Indian youth which promote men16 tal and physical health and incorporate cultural 

17 values, community and family involvement, and 

18 traditional health care practitioners; and 

19 ‘‘(B) develop and provide community train20 ing and education. 

21 ‘‘(2) PROHIBITED USE.—Funds made available 

22 under this section may not be used to provide serv23 ices described in section 707(c). 

24 ‘‘(c) DUTIES OF THE SECRETARY.—The Secretary 

25 shall— 


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1 ‘‘(1) disseminate to Indian Tribes, Tribal Orga2 nizations, and Urban Indian Organizations informa3 tion regarding models for the delivery of comprehen4 sive health care services to Indian and Urban Indian 

5 adolescents; 

6 ‘‘(2) encourage the implementation of such 

7 models; and 

8 ‘‘(3) at the request of an Indian Tribe, Tribal 

9 Organization, or Urban Indian Organization, provide 

10 technical assistance in the implementation of such 

11 models. 

12 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP13 PLICATIONS.—The Secretary, in consultation with Indian 

14 Tribes, Tribal Organizations, and Urban Indian Organiza15 tions, shall establish criteria for the review and approval 

16 of applications or proposals under this section. 

17 ‘‘SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF 

18 COMMUNICABLE AND INFECTIOUS DISEASES. 

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

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

22 available to Indian Tribes, Tribal Organizations, and 

23 Urban Indian Organizations for the following: 

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

25 elimination of communicable and infectious diseases, 


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1 including tuberculosis, hepatitis, HIV, respiratory 

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

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

6 communicable and infectious diseases. 

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

9 elimination of communicable and infectious diseases 

10 for health professionals, including allied health pro11 fessionals. 

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

13 treatment, and prevention of hepatitis C virus 

14 (HCV). 

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

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

17 or proposal for funding is submitted to the Secretary. 

18 ‘‘(c) COORDINATION WITH HEALTH AGENCIES.—In19 dian Tribes, Tribal Organizations, and Urban Indian Or20 ganizations receiving funding under this section are en21 couraged to coordinate their activities with the Centers for 

22 Disease Control and Prevention and State and local health 

23 agencies. 

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

25 out this section, the Secretary— 


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

2 Tribal Organization, or Urban Indian Organization, 

3 provide technical assistance; and 

4 ‘‘(2) shall prepare and submit a report to Con5 gress biennially on the use of funds under this sec6 tion and on the progress made toward the preven7 tion, control, and elimination of communicable and 

8 infectious diseases among Indians and Urban Indi9 ans. 

10 ‘‘SEC. 213. OTHER AUTHORITY FOR PROVISION OF SERV11 ICES. 

12 ‘‘(a) FUNDING AUTHORIZED.—The Secretary, acting 

13 through the Service, Indian Tribes, and Tribal Organiza14 tions, may provide funding under this Act to meet the ob15 jectives set forth in section 3 of this Act through health 

16 care-related services and programs not otherwise described 

17 in this Act, including— 

18 ‘‘(1) hospice care; 

19 ‘‘(2) assisted living; 

20 ‘‘(3) long-term care; and 

21 ‘‘(4) home- and community-based services. 

22 ‘‘(b) TERMS AND CONDITIONS.— 

23 ‘‘(1) IN GENERAL.—Any service provided under 

24 this section shall be in accordance with such terms 

25 and conditions as are consistent with accepted and 


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1 appropriate standards relating to the service, includ2 ing any licensing term or condition under this Act. 

3 ‘‘(2) STANDARDS.— 

4 ‘‘(A) IN GENERAL.—The Secretary may es5 tablish, by regulation, the standards for a serv6 ice provided under this section, provided that 

7 such standards shall not be more stringent than 

8 the standards required by the State in which 

9 the service is provided. 

10 ‘‘(B) USE OF STATE STANDARDS.—If the 

11 Secretary does not, by regulation, establish 

12 standards for a service provided under this sec13 tion, the standards required by the State in 

14 which the service is or will be provided shall 

15 apply to such service. 

16 ‘‘(C) INDIAN TRIBES.—If a service under 

17 this section is provided by an Indian Tribe or 

18 Tribal Organization pursuant to the Indian 

19 Self-Determination and Education Assistance 

20 Act (25 U.S.C. 450 et seq.), the verification by 

21 the Secretary that the service meets any stand22 ards required by the State in which the service 

23 is or will be provided shall be considered to 

24 meet the terms and conditions required under 

25 this subsection. 


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1 ‘‘(3) ELIGIBILITY.—The following individuals 

2 shall be eligible to receive long-term care under this 

3 section: 

4 ‘‘(A) Individuals who are unable to per5 form a certain number of activities of daily liv6 ing without assistance. 

7 ‘‘(B) Individuals with a mental impair8 ment, such as dementia, Alzheimer’s disease, or 

9 another disabling mental illness, who may be 

10 able to perform activities of daily living under 

11 supervision. 

12 ‘‘(C) Such other individuals as an applica13 ble Indian Health Program determines to be 

14 appropriate. 

15 ‘‘(c) DEFINITIONS.—For the purposes of this section, 

16 the following definitions shall apply: 

17 ‘‘(1) The term ‘home- and community-based 

18 services’ means 1 or more of the services specified 

19 in paragraphs (1) through (9) of section 1929(a) of 

20 the Social Security Act (42 U.S.C. 1396t(a)) 

21 (whether provided by the Service or by an Indian 

22 Tribe or Tribal Organization pursuant to the Indian 

23 Self-Determination and Education Assistance Act 

24 (25 U.S.C. 450 et seq.)) that are or will be provided 


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1 in accordance with the standards described in sub2 section (b). 

3 ‘‘(2) The term ‘hospice care’ means the items 

4 and services specified in subparagraphs (A) through 

5 (H) of section 1861(dd)(1) of the Social Security 

6 Act (42 U.S.C. 1395x(dd)(1)), and such other serv7 ices which an Indian Tribe or Tribal Organization 

8 determines are necessary and appropriate to provide 

9 in furtherance of this care. 

10 ‘‘(d) AUTHORIZATION OF CONVENIENT CARE SERV11 ICES.—The Secretary, acting through the Service, Indian 

12 Tribes, and Tribal Organizations, may also provide fund13 ing under this Act to meet the objectives set forth in sec14 tion 3 of this Act for convenient care services programs 

15 pursuant to section 306(c)(2)(A). 

16 ‘‘SEC. 214. INDIAN WOMEN’S HEALTH CARE. 

17 ‘‘The Secretary, acting through the Service and In18 dian Tribes, Tribal Organizations, and Urban Indian Or19 ganizations, shall monitor and improve the quality of 

20 health care for Indian women of all ages through the plan21 ning and delivery of programs administered by the Service, 

22 in order to improve and enhance the treatment models of 

23 care for Indian women. 


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1 ‘‘SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZ2 ARDS. 

3 ‘‘(a) STUDIES AND MONITORING.—The Secretary 

4 and the Service shall conduct, in conjunction with other 

5 appropriate Federal agencies and in consultation with con6 cerned Indian Tribes and Tribal Organizations, studies 

7 and ongoing monitoring programs to determine trends in 

8 the health hazards to Indian miners and to Indians on 

9 or near reservations and Indian communities as a result 

10 of environmental hazards which may result in chronic or 

11 life threatening health problems, such as nuclear resource 

12 development, petroleum contamination, and contamination 

13 of water source and of the food chain. Such studies shall 

14 include— 

15 ‘‘(1) an evaluation of the nature and extent of 

16 health problems caused by environmental hazards 

17 currently exhibited among Indians and the causes of 

18 such health problems; 

19 ‘‘(2) an analysis of the potential effect of ongo20 ing and future environmental resource development 

21 on or near reservations and Indian communities, in22 cluding the cumulative effect over time on health; 

23 ‘‘(3) an evaluation of the types and nature of 

24 activities, practices, and conditions causing or affect25 ing such health problems, including uranium mining 

26 and milling, uranium mine tailing deposits, nuclear 


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1 power plant operation and construction, and nuclear 

2 waste disposal; oil and gas production or transpor3 tation on or near reservations or Indian commu4 nities; and other development that could affect the 

5 health of Indians and their water supply and food 

6 chain; 

7 ‘‘(4) a summary of any findings and rec8 ommendations provided in Federal and State stud9 ies, reports, investigations, and inspections during 

10 the 5 years prior to the date of enactment of the In11 dian Health Care Improvement Act Amendments of 

12 2007 that directly or indirectly relate to the activi13 ties, practices, and conditions affecting the health or 

14 safety of such Indians; and 

15 ‘‘(5) the efforts that have been made by Federal 

16 and State agencies and resource and economic devel17 opment companies to effectively carry out an edu18 cation program for such Indians regarding the 

19 health and safety hazards of such development. 

20 ‘‘(b) HEALTH CARE PLANS.—Upon completion of 

21 such studies, the Secretary and the Service shall take into 

22 account the results of such studies and develop health care 

23 plans to address the health problems studied under sub24 section (a). The plans shall include— 


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1 ‘‘(1) methods for diagnosing and treating Indi2 ans currently exhibiting such health problems; 

3 ‘‘(2) preventive care and testing for Indians 

4 who may be exposed to such health hazards, includ5 ing the monitoring of the health of individuals who 

6 have or may have been exposed to excessive amounts 

7 of radiation or affected by other activities that have 

8 had or could have a serious impact upon the health 

9 of such individuals; and 

10 ‘‘(3) a program of education for Indians who, 

11 by reason of their work or geographic proximity to 

12 such nuclear or other development activities, may ex13 perience health problems. 

14 ‘‘(c) SUBMISSION OF REPORT AND PLAN TO CON15 GRESS.—The Secretary and the Service shall submit to 

16 Congress the study prepared under subsection (a) no later 

17 than 18 months after the date of enactment of the Indian 

18 Health Care Improvement Act Amendments of 2007. The 

19 health care plan prepared under subsection (b) shall be 

20 submitted in a report no later than 1 year after the study 

21 prepared under subsection (a) is submitted to Congress. 

22 Such report shall include recommended activities for the 

23 implementation of the plan, as well as an evaluation of 

24 any activities previously undertaken by the Service to ad25 dress such health problems. 


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1 ‘‘(d) INTERGOVERNMENTAL TASK FORCE.— 

2 ‘‘(1) ESTABLISHMENT; MEMBERS.—There is es3 tablished an Intergovernmental Task Force to be 

4 composed of the following individuals (or their des5 ignees): 

6 ‘‘(A) The Secretary of Energy. 

7 ‘‘(B) The Secretary of the Environmental 

8 Protection Agency. 

9 ‘‘(C) The Director of the Bureau of Mines. 

10 ‘‘(D) The Assistant Secretary for Occupa11 tional Safety and Health. 

12 ‘‘(E) The Secretary of the Interior. 

13 ‘‘(F) The Secretary of Health and Human 

14 Services. 

15 ‘‘(G) The Assistant Secretary. 

16 ‘‘(2) DUTIES.—The Task Force shall— 

17 ‘‘(A) identify existing and potential oper18 ations related to nuclear resource development 

19 or other environmental hazards that affect or 

20 may affect the health of Indians on or near a 

21 reservation or in an Indian community; and 

22 ‘‘(B) enter into activities to correct exist23 ing health hazards and ensure that current and 

24 future health problems resulting from nuclear 


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1 resource or other development activities are 

2 minimized or reduced. 

3 ‘‘(3) CHAIRMAN; MEETINGS.—The Secretary of 

4 Health and Human Services shall be the Chairman 

5 of the Task Force. The Task Force shall meet at 

6 least twice each year. 

7 ‘‘(e) HEALTH SERVICES TO CERTAIN EMPLOYEES.— 

8 In the case of any Indian who— 

9 ‘‘(1) as a result of employment in or near a 

10 uranium mine or mill or near any other environ11 mental hazard, suffers from a work-related illness or 

12 condition; 

13 ‘‘(2) is eligible to receive diagnosis and treat14 ment services from an Indian Health Program; and 

15 ‘‘(3) by reason of such Indian’s employment, is 

16 entitled to medical care at the expense of such mine 

17 or mill operator or entity responsible for the environ18 mental hazard, the Indian Health Program shall, at 

19 the request of such Indian, render appropriate med20 ical care to such Indian for such illness or condition 

21 and may be reimbursed for any medical care so ren22 dered to which such Indian is entitled at the expense 

23 of such operator or entity from such operator or en24 tity. Nothing in this subsection shall affect the 

25 rights of such Indian to recover damages other than 


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1 such amounts paid to the Indian Health Program 

2 from the employer for providing medical care for 

3 such illness or condition. 

4 ‘‘SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DE5 LIVERY AREA. 

6 ‘‘(a) IN GENERAL.—For fiscal years beginning with 

7 the fiscal year ending September 30, 1983, and ending 

8 with the fiscal year ending September 30, 2016, the State 

9 of Arizona shall be designated as a contract health service 

10 delivery area by the Service for the purpose of providing 

11 contract health care services to members of federally rec12 ognized Indian Tribes of Arizona. 

13 ‘‘(b) MAINTENANCE OF SERVICES.—The Service 

14 shall not curtail any health care services provided to Indi15 ans residing on reservations in the State of Arizona if such 

16 curtailment is due to the provision of contract services in 

17 such State pursuant to the designation of such State as 

18 a contract health service delivery area pursuant to sub19 section (a). 

20 ‘‘SEC. 216A. NORTH DAKOTA AND SOUTH DAKOTA AS CON21 TRACT HEALTH SERVICE DELIVERY AREA. 

22 ‘‘(a) IN GENERAL.—Beginning in fiscal year 2003, 

23 the States of North Dakota and South Dakota shall be 

24 designated as a contract health service delivery area by 

25 the Service for the purpose of providing contract health 


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1 care services to members of federally recognized Indian 

2 Tribes of North Dakota and South Dakota. 

3 ‘‘(b) LIMITATION.—The Service shall not curtail any 

4 health care services provided to Indians residing on any 

5 reservation, or in any county that has a common boundary 

6 with any reservation, in the State of North Dakota or 

7 South Dakota if such curtailment is due to the provision 

8 of contract services in such States pursuant to the des9 ignation of such States as a contract health service deliv10 ery area pursuant to subsection (a). 

11 ‘‘SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES PRO12 GRAM. 

13 ‘‘(a) FUNDING AUTHORIZED.—The Secretary is au14 thorized to fund a program using the California Rural In15 dian Health Board (hereafter in this section referred to 

16 as the ‘CRIHB’) as a contract care intermediary to im17 prove the accessibility of health services to California Indi18 ans. 

19 ‘‘(b) REIMBURSEMENT CONTRACT.—The Secretary 

20 shall enter into an agreement with the CRIHB to reim21 burse the CRIHB for costs (including reasonable adminis22 trative costs) incurred pursuant to this section, in pro23 viding medical treatment under contract to California In24 dians described in section 806(a) throughout the CaliVerDate Aug 31 2005 21:58 Apr 25, 2007 Jkt 059200 PO 00000 Frm 00130 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.IS S1200

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1 fornia contract health services delivery area described in 

2 section 218 with respect to high cost contract care cases. 

3 ‘‘(c) ADMINISTRATIVE EXPENSES.—Not more than 5 

4 percent of the amounts provided to the CRIHB under this 

5 section for any fiscal year may be for reimbursement for 

6 administrative expenses incurred by the CRIHB during 

7 such fiscal year. 

8 ‘‘(d) LIMITATION ON PAYMENT.—No payment may 

9 be made for treatment provided hereunder to the extent 

10 payment may be made for such treatment under the In11 dian Catastrophic Health Emergency Fund described in 

12 section 202 or from amounts appropriated or otherwise 

13 made available to the California contract health service de14 livery area for a fiscal year. 

15 ‘‘(e) ADVISORY BOARD.—There is established an ad16 visory board which shall advise the CRIHB in carrying 

17 out this section. The advisory board shall be composed of 

18 representatives, selected by the CRIHB, from not less 

19 than 8 Tribal Health Programs serving California Indians 

covered under this section at least 1 20 ⁄2 of whom of whom 

21 are not affiliated with the CRIHB. 

22 ‘‘SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE 

23 DELIVERY AREA. 

24 ‘‘The State of California, excluding the counties of 

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1 ramento, San Francisco, San Mateo, Santa Clara, Kern, 

2 Merced, Monterey, Napa, San Benito, San Joaquin, San 

3 Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ven4 tura, shall be designated as a contract health service deliv5 ery area by the Service for the purpose of providing con6 tract health services to California Indians. However, any 

7 of the counties listed herein may only be included in the 

8 contract health services delivery area if funding is specifi9 cally provided by the Service for such services in those 

10 counties. 

11 ‘‘SEC. 219. CONTRACT HEALTH SERVICES FOR THE TREN12 TON SERVICE AREA. 

13 ‘‘(a) AUTHORIZATION FOR SERVICES.—The Sec14 retary, acting through the Service, is directed to provide 

15 contract health services to members of the Turtle Moun16 tain Band of Chippewa Indians that reside in the Trenton 

17 Service Area of Divide, McKenzie, and Williams counties 

18 in the State of North Dakota and the adjoining counties 

19 of Richland, Roosevelt, and Sheridan in the State of Mon20 tana. 

21 ‘‘(b) NO EXPANSION OF ELIGIBILITY.—Nothing in 

22 this section may be construed as expanding the eligibility 

23 of members of the Turtle Mountain Band of Chippewa In24 dians for health services provided by the Service beyond 


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1 the scope of eligibility for such health services that applied 

2 on May 1, 1986. 

3 ‘‘SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND 

4 TRIBAL ORGANIZATIONS. 

5 ‘‘The Service shall provide funds for health care pro6 grams and facilities operated by Tribal Health Programs 

7 on the same basis as such funds are provided to programs 

8 and facilities operated directly by the Service. 

9 ‘‘SEC. 221. LICENSING. 

10 ‘‘Health care professionals employed by a Tribal 

11 Health Program shall, if licensed in any State, be exempt 

12 from the licensing requirements of the State in which the 

13 Tribal Health Program performs the services described in 

14 its contract or compact under the Indian Self-Determina15 tion and Education Assistance Act (25 U.S.C. 450 et 

16 seq.). 

17 ‘‘SEC. 222. NOTIFICATION OF PROVISION OF EMERGENCY 

18 CONTRACT HEALTH SERVICES. 

19 ‘‘With respect to an elderly Indian or an Indian with 

20 a disability receiving emergency medical care or services 

21 from a non-Service provider or in a non-Service facility 

22 under the authority of this Act, the time limitation (as 

23 a condition of payment) for notifying the Service of such 

24 treatment or admission shall be 30 days. 


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1 ‘‘SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS. 

2 ‘‘(a) DEADLINE FOR RESPONSE.—The Service shall 

3 respond to a notification of a claim by a provider of a 

4 contract care service with either an individual purchase 

5 order or a denial of the claim within 5 working days after 

6 the receipt of such notification. 

7 ‘‘(b) EFFECT OF UNTIMELY RESPONSE.—If the 

8 Service fails to respond to a notification of a claim in ac9 cordance with subsection (a), the Service shall accept as 

10 valid the claim submitted by the provider of a contract 

11 care service. 

12 ‘‘(c) DEADLINE FOR PAYMENT OF VALID CLAIM.— 

13 The Service shall pay a valid contract care service claim 

14 within 30 days after the completion of the claim. 

15 ‘‘SEC. 224. LIABILITY FOR PAYMENT. 

16 ‘‘(a) NO PATIENT LIABILITY.—A patient who re17 ceives contract health care services that are authorized by 

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

19 charges or costs associated with the provision of such serv20 ices. 

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

22 contract care provider and any patient who receives con23 tract health care services authorized by the Service that 

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

25 or costs associated with the provision of such services not 


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1 later than 5 business days after receipt of a notification 

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

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

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

5 deemed accepted under section 223(b), the provider shall 

6 have no further recourse against the patient who received 

7 the services. 

8 ‘‘SEC. 225. OFFICE OF INDIAN MEN’S HEALTH. 

9 ‘‘(a) ESTABLISHMENT.—The Secretary may establish 

10 within the Service an office to be known as the ‘Office 

11 of Indian Men’s Health’ (referred to in this section as the 

12 ‘Office’). 

13 ‘‘(b) DIRECTOR.— 

14 ‘‘(1) IN GENERAL.—The Office shall be headed 

15 by a director, to be appointed by the Secretary. 

16 ‘‘(2) DUTIES.—The director shall coordinate 

17 and promote the status of the health of Indian men 

18 in the United States. 

19 ‘‘(c) REPORT.—Not later than 2 years after the date 

20 of enactment of the Indian Health Care Improvement Act 

21 Amendments of 2007, the Secretary, acting through the 

22 director of the Office, shall submit to Congress a report 

23 describing— 

24 ‘‘(1) any activity carried out by the director as 

25 of the date on which the report is prepared; and 


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1 ‘‘(2) any finding of the director with respect to 

2 the health of Indian men. 

3 ‘‘SEC. 226. AUTHORIZATION OF APPROPRIATIONS. 

4 ‘‘There are authorized to be appropriated such sums 

5 as may be necessary for each fiscal year through fiscal 

6 year 2017 to carry out this title. 

7 ‘‘TITLE III—FACILITIES 

8 ‘‘SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVA9 TION OF FACILITIES; REPORTS. 

10 ‘‘(a) PREREQUISITES FOR EXPENDITURE OF

11 FUNDS.—Prior to the expenditure of, or the making of 

12 any binding commitment to expend, any funds appro13 priated for the planning, design, construction, or renova14 tion of facilities pursuant to the Act of November 2, 1921 

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

16 the Secretary, acting through the Service, shall— 

17 ‘‘(1) consult with any Indian Tribe that would 

18 be significantly affected by such expenditure for the 

19 purpose of determining and, whenever practicable, 

20 honoring tribal preferences concerning size, location, 

21 type, and other characteristics of any facility on 

22 which such expenditure is to be made; and 

23 ‘‘(2) ensure, whenever practicable and applica24 ble, that such facility meets the construction stand25 ards of any accrediting body recognized by the SecVerDate Aug 31 2005 21:58 Apr 25, 2007 Jkt 059200 PO 00000 Frm 00136 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.IS S1200

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1 retary for the purposes of the Medicare, Medicaid, 

2 and SCHIP programs under titles XVIII, XIX, and 

3 XXI of the Social Security Act by not later than 1 

4 year after the date on which the construction or ren5 ovation of such facility is completed. 

6 ‘‘(b) CLOSURES.— 

7 ‘‘(1) EVALUATION REQUIRED.—Notwith8 standing any other provision of law, no facility oper9 ated by the Service, or any portion of such facility, 

10 may be closed if the Secretary has not submitted to 

11 Congress not less than 1 year, and not more than 

12 2 years, before the date of the proposed closure an 

13 evaluation, completed not more than 2 years before 

14 the submission, of the impact of the proposed clo15 sure that specifies, in addition to other consider16 ations— 

17 ‘‘(A) the accessibility of alternative health 

18 care resources for the population served by such 

19 facility; 

20 ‘‘(B) the cost-effectiveness of such closure; 

21 ‘‘(C) the quality of health care to be pro22 vided to the population served by such facility 

23 after such closure; 

24 ‘‘(D) the availability of contract health 

25 care funds to maintain existing levels of service; 


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1 ‘‘(E) the views of the Indian Tribes served 

2 by such facility concerning such closure; 

3 ‘‘(F) the level of use of such facility by all 

4 eligible Indians; and 

5 ‘‘(G) the distance between such facility and 

6 the nearest operating Service hospital. 

7 ‘‘(2) EXCEPTION FOR CERTAIN TEMPORARY

8 CLOSURES.—Paragraph (1) shall not apply to any 

9 temporary closure of a facility or any portion of a 

10 facility if such closure is necessary for medical, envi11 ronmental, or construction safety reasons. 

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

13 ‘‘(1) IN GENERAL.— 

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

15 acting through the Service, shall maintain a 

16 health care facility priority system, which— 

17 ‘‘(i) shall be developed in consultation 

18 with Indian Tribes and Tribal Organiza19 tions; 

20 ‘‘(ii) shall give Indian Tribes’ needs 

21 the highest priority; 

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

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

24 ‘‘(II) shall include the methodology re25 quired in paragraph (2)(B)(v); and 


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1 ‘‘(III) may include such other facili2 ties, and such renovation or expansion 

3 needs of any health care facility, as the 

4 Service, Indian Tribes, and Tribal Organi5 zations may identify; and 

6 ‘‘(iv) shall provide an opportunity for 

7 the nomination of planning, design, and 

8 construction projects by the Service, In9 dian Tribes, and Tribal Organizations for 

10 consideration under the priority system at 

11 least once every 3 years, or more fre12 quently as the Secretary determines to be 

13 appropriate. 

14 ‘‘(B) NEEDS OF FACILITIES UNDER

15 ISDEAA AGREEMENTS.—The Secretary shall en16 sure that the planning, design, construction, 

17 renovation, and expansion needs of Service and 

18 non-Service facilities operated under contracts 

19 or compacts in accordance with the Indian Self20 Determination and Education Assistance Act 

21 (25 U.S.C. 450 et seq.) are fully and equitably 

22 integrated into the health care facility priority 

23 system. 

24 ‘‘(C) CRITERIA FOR EVALUATING

25 NEEDS.—For purposes of this subsection, the 


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1 Secretary, in evaluating the needs of facilities 

2 operated under a contract or compact under the 

3 Indian Self-Determination and Education As4 sistance Act (25 U.S.C. 450 et seq.), shall use 

5 the criteria used by the Secretary in evaluating 

6 the needs of facilities operated directly by the 

7 Service. 

8 ‘‘(D) PRIORITY OF CERTAIN PROJECTS

9 PROTECTED.—The priority of any project estab10 lished under the construction priority system in 

11 effect on the date of enactment of the Indian 

12 Health Care Improvement Act Amendments of 

13 2007 shall not be affected by any change in the 

14 construction priority system taking place after 

15 that date if the project— 

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

17 2008 Service budget justification as— 

18 ‘‘(I) 1 of the 10 top-priority inpa19 tient projects; 

20 ‘‘(II) 1 of the 10 top-priority out21 patient projects; 

22 ‘‘(III) 1 of the 10 top-priority 

23 staff quarters developments; or 

24 ‘‘(IV) 1 of the 10 top-priority 

25 Youth Regional Treatment Centers; 


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

2 Phase II of the construction priority sys3 tem in effect on the date of enactment of 

4 such Act; or 

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

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

7 Secretary— 

8 ‘‘(I) on the initiative of the Sec9 retary; or 

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

11 Indian Tribe or Tribal Organization. 

12 ‘‘(2) REPORT; CONTENTS.— 

13 ‘‘(A) INITIAL COMPREHENSIVE REPORT.— 

14 ‘‘(i) DEFINITIONS.—In this subpara15 graph: 

16 ‘‘(I) FACILITIES APPROPRIATION

17 ADVISORY BOARD.—The term ‘Facili18 ties Appropriation Advisory Board’ 

19 means the advisory board, comprised 

20 of 12 members representing Indian 

21 tribes and 2 members representing 

22 the Service, established at the discre23 tion of the Assistant Secretary— 

24 ‘‘(aa) to provide advice and 

25 recommendations for policies and 


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1 procedures of the programs fund2 ed pursuant to facilities appro3 priations; and 

4 ‘‘(bb) to address other facili5 ties issues. 

6 ‘‘(II) FACILITIES NEEDS ASSESS7 MENT WORKGROUP.—The term ‘Fa8 cilities Needs Assessment Workgroup’ 

9 means the workgroup established at 

10 the discretion of the Assistant Sec11 retary— 

12 ‘‘(aa) to review the health 

13 care facilities construction pri14 ority system; and 

15 ‘‘(bb) to make recommenda16 tions to the Facilities Appropria17 tion Advisory Board for revising 

18 the priority system. 

19 ‘‘(ii) INITIAL REPORT.— 

20 ‘‘(I) IN GENERAL.—Not later 

21 than 1 year after the date of enact22 ment of the Indian Health Care Im23 provement Act Amendments of 2007, 

24 the Secretary shall submit to the 

25 Committee on Indian Affairs of the 


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1 Senate and the Committee on Natural 

2 Resources of the House of Represent3 atives a report that describes the com4 prehensive, national, ranked list of all 

5 health care facilities needs for the 

6 Service, Indian Tribes, and Tribal Or7 ganizations (including inpatient health 

8 care facilities, outpatient health care 

9 facilities, specialized health care facili10 ties (such as for long-term care and 

11 alcohol and drug abuse treatment), 

12 wellness centers, staff quarters and 

13 hostels associated with health care fa14 cilities, and the renovation and expan15 sion needs, if any, of such facilities) 

16 developed by the Service, Indian 

17 Tribes, and Tribal Organizations for 

18 the Facilities Needs Assessment 

19 Workgroup and the Facilities Appro20 priation Advisory Board. 

21 ‘‘(II) INCLUSIONS.—The initial 

22 report shall include— 

23 ‘‘(aa) the methodology and 

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1 lishing the ranking of the facili2 ties needs; and 

3 ‘‘(bb) such other information 

4 as the Secretary determines to be 

5 appropriate. 

6 ‘‘(iii) UPDATES OF REPORT.—Begin7 ning in calendar year 2011, the Secretary 

8 shall— 

9 ‘‘(I) update the report under 

10 clause (ii) not less frequently that 

11 once every 5 years; and 

12 ‘‘(II) include the updated report 

13 in the appropriate annual report 

14 under subparagraph (B) for submis15 sion to Congress under section 801. 

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

17 shall submit to the President, for inclusion in 

18 the report required to be transmitted to Con19 gress under section 801, a report which sets 

20 forth the following: 

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

22 facility priority system of the Service es23 tablished under paragraph (1). 

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

25 may include— 


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

2 health care facilities; 

3 ‘‘(II) the 10 top-priority out4 patient health care facilities; 

5 ‘‘(III) the 10 top-priority special6 ized health care facilities (such as 

7 long-term care and alcohol and drug 

8 abuse treatment); 

9 ‘‘(IV) the 10 top-priority staff 

10 quarters developments associated with 

11 health care facilities; and 

12 ‘‘(V) the 10 top-priority hostels 

13 associated with health care facilities. 

14 ‘‘(iii) The justification for such order 

15 of priority. 

16 ‘‘(iv) The projected cost of such 

17 projects. 

18 ‘‘(v) The methodology adopted by the 

19 Service in establishing priorities under its 

20 health care facility priority system. 

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

23 paragraph (2), the Secretary shall— 

24 ‘‘(A) consult with and obtain information 

25 on all health care facilities needs from Indian 


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1 Tribes, Tribal Organizations, and Urban Indian 

2 Organizations; and 

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

4 Indian Tribes, Tribal Organizations, and Urban 

5 Indian Organizations for health care facilities 

6 (including hostels and staff quarters), including 

7 needs for renovation and expansion of existing 

8 facilities. 

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

10 FACILITIES CONSTRUCTION PRIORITY SYSTEM.— 

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

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

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

16 followed, by the Service in making each assessment 

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

18 and developing the priority system under subsection 

19 (c)(1), including a review of— 

20 ‘‘(A) the recommendations of the Facilities 

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

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

24 and 


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

2 or prioritizing facilities other than hospitals or 

3 clinics. 

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

6 report under paragraph (1) to— 

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

8 Appropriations of the Senate; 

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

11 Representatives; and 

12 ‘‘(C) the Secretary. 

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

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

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

18 provisions of the Indian Self-Determination and Edu19 cation Assistance Act (25 U.S.C. 450 et seq.). 

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

21 The Secretary shall consult and cooperate with Indian 

22 Tribes, Tribal Organizations, and Urban Indian Organiza23 tions in developing innovative approaches to address all 

24 or part of the total unmet need for construction of health 


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1 facilities, including those provided for in other sections of 

2 this title and other approaches. 

3 ‘‘SEC. 302. SANITATION FACILITIES. 

4 ‘‘(a) FINDINGS.—Congress finds the following: 

5 ‘‘(1) The provision of sanitation facilities is pri6 marily 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 sanitation 

10 facilities. 

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 sanitation facilities and other preventive 

15 health measures. 

16 ‘‘(4) Many Indian homes and Indian commu17 nities still lack sanitation facilities. 

18 ‘‘(5) It is in the interest of the United States, 

19 and it is the policy of the United States, that all In20 dian communities and Indian homes, new and exist21 ing, be provided with sanitation facilities. 

22 ‘‘(b) FACILITIES AND SERVICES.—In furtherance of 

23 the findings made in subsection (a), Congress reaffirms 

24 the primary responsibility and authority of the Service to 

25 provide the necessary sanitation facilities and services as 


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1 provided in section 7 of the Act of August 5, 1954 (42 

2 U.S.C. 2004a). Under such authority, the Secretary, act3 ing through the Service, is authorized to provide the fol4 lowing: 

5 ‘‘(1) Financial and technical assistance to In6 dian Tribes, Tribal Organizations, and Indian com7 munities in the establishment, training, and equip8 ping of utility organizations to operate and maintain 

9 sanitation facilities, including the provision of exist10 ing plans, standard details, and specifications avail11 able in the Department, to be used at the option of 

12 the Indian Tribe, Tribal Organization, or Indian 

13 community. 

14 ‘‘(2) Ongoing technical assistance and training 

15 to Indian Tribes, Tribal Organizations, and Indian 

16 communities in the management of utility organiza17 tions which operate and maintain sanitation facili18 ties. 

19 ‘‘(3) Priority funding for operation and mainte20 nance assistance for, and emergency repairs to, sani21 tation facilities operated by an Indian Tribe, Tribal 

22 Organization or Indian community when necessary 

23 to avoid an imminent health threat or to protect the 

24 investment in sanitation facilities and the investment 


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1 in the health benefits gained through the provision 

2 of sanitation facilities. 

3 ‘‘(c) FUNDING.—Notwithstanding any other provi4 sion of law— 

5 ‘‘(1) the Secretary of Housing and Urban De6 velopment is authorized to transfer funds appro7 priated under the Native American Housing Assist8 ance and Self-Determination Act of 1996 (25 U.S.C. 

9 4101 et seq.) to the Secretary of Health and Human 

10 Services; 

11 ‘‘(2) the Secretary of Health and Human Serv12 ices is authorized to accept and use such funds for 

13 the purpose of providing sanitation facilities and 

14 services for Indians under section 7 of the Act of 

15 August 5, 1954 (42 U.S.C. 2004a); 

16 ‘‘(3) unless specifically authorized when funds 

17 are appropriated, the Secretary shall not use funds 

18 appropriated under section 7 of the Act of August 

19 5, 1954 (42 U.S.C. 2004a), to provide sanitation fa20 cilities to new homes constructed using funds pro21 vided by the Department of Housing and Urban De22 velopment; 

23 ‘‘(4) the Secretary of Health and Human Serv24 ices is authorized to accept from any source, includ25 ing Federal and State agencies, funds for the purVerDate Aug 31 2005 21:58 Apr 25, 2007 Jkt 059200 PO 00000 Frm 00150 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.IS S1200

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1 pose of providing sanitation facilities and services 

2 and place these funds into contracts or compacts 

3 under the Indian Self-Determination and Education 

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

5 ‘‘(5) except as otherwise prohibited by this sec6 tion, the Secretary may use funds appropriated 

7 under the authority of section 7 of the Act of Au8 gust 5, 1954 (42 U.S.C. 2004a), to fund up to 100 

9 percent of the amount of an Indian Tribe’s loan ob10 tained under any Federal program for new projects 

11 to construct eligible sanitation facilities to serve In12 dian homes; 

13 ‘‘(6) except as otherwise prohibited by this sec14 tion, the Secretary may use funds appropriated 

15 under the authority of section 7 of the Act of Au16 gust 5, 1954 (42 U.S.C. 2004a) to meet matching 

17 or cost participation requirements under other Fed18 eral and non-Federal programs for new projects to 

19 construct eligible sanitation facilities; 

20 ‘‘(7) all Federal agencies are authorized to 

21 transfer to the Secretary funds identified, granted, 

22 loaned, or appropriated whereby the Department’s 

23 applicable policies, rules, and regulations shall apply 

24 in the implementation of such projects; 


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1 ‘‘(8) the Secretary of Health and Human Serv2 ices shall enter into interagency agreements with 

3 Federal and State agencies for the purpose of pro4 viding financial assistance for sanitation facilities 

5 and services under this Act; 

6 ‘‘(9) the Secretary of Health and Human Serv7 ices shall, by regulation, establish standards applica8 ble to the planning, design, and construction of sani9 tation facilities funded under this Act; and 

10 ‘‘(10) the Secretary of Health and Human 

11 Services is authorized to accept payments for goods 

12 and services furnished by the Service from appro13 priate public authorities, nonprofit organizations or 

14 agencies, or Indian Tribes, as contributions by that 

15 authority, organization, agency, or tribe to agree16 ments made under section 7 of the Act of August 5, 

17 1954 (42 U.S.C. 2004a), and such payments shall 

18 be credited to the same or subsequent appropriation 

19 account as funds appropriated under the authority 

20 of section 7 of the Act of August 5, 1954 (42 U.S.C. 

21 2004a). 

22 ‘‘(d) CERTAIN CAPABILITIES NOT PREREQUISITE.— 

23 The financial and technical capability of an Indian Tribe, 

24 Tribal Organization, or Indian community to safely oper25 ate, manage, and maintain a sanitation facility shall not 


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1 be a prerequisite to the provision or construction of sanita2 tion facilities by the Secretary. 

3 ‘‘(e) FINANCIAL ASSISTANCE.—The Secretary is au4 thorized to provide financial assistance to Indian Tribes, 

5 Tribal Organizations, and Indian communities for oper6 ation, management, and maintenance of their sanitation 

7 facilities. 

8 ‘‘(f) OPERATION, MANAGEMENT, AND MAINTENANCE

9 OF FACILITIES.—The Indian Tribe has the primary re10 sponsibility to establish, collect, and use reasonable user 

11 fees, or otherwise set aside funding, for the purpose of 

12 operating, managing, and maintaining sanitation facilities. 

13 If a sanitation facility serving a community that is oper14 ated by an Indian Tribe or Tribal Organization is threat15 ened with imminent failure and such operator lacks capac16 ity to maintain the integrity or the health benefits of the 

17 sanitation facility, then the Secretary is authorized to as18 sist the Indian Tribe, Tribal Organization, or Indian com19 munity in the resolution of the problem on a short-term 

20 basis through cooperation with the emergency coordinator 

21 or by providing operation, management, and maintenance 

22 service. 

23 ‘‘(g) ISDEAA PROGRAM FUNDED ON EQUAL

24 BASIS.—Tribal Health Programs shall be eligible (on an 


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1 equal basis with programs that are administered directly 

2 by the Service) for— 

3 ‘‘(1) any funds appropriated pursuant to this 

4 section; and 

5 ‘‘(2) any funds appropriated for the purpose of 

6 providing sanitation facilities. 

7 ‘‘(h) REPORT.— 

8 ‘‘(1) REQUIRED; CONTENTS.—The Secretary, in 

9 consultation with the Secretary of Housing and 

10 Urban Development, Indian Tribes, Tribal Organiza11 tions, and tribally designated housing entities (as de12 fined in section 4 of the Native American Housing 

13 Assistance and Self-Determination Act of 1996 (25 

14 U.S.C. 4103)) shall submit to the President, for in15 clusion in the report required to be transmitted to 

16 Congress under section 801, a report which sets 

17 forth— 

18 ‘‘(A) the current Indian sanitation facility 

19 priority system of the Service; 

20 ‘‘(B) the methodology for determining 

21 sanitation deficiencies and needs; 

22 ‘‘(C) the criteria on which the deficiencies 

23 and needs will be evaluated; 

24 ‘‘(D) the level of initial and final sanitation 

25 deficiency for each type of sanitation facility for 


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1 each project of each Indian Tribe or Indian 

2 community; 

3 ‘‘(E) the amount and most effective use of 

4 funds, derived from whatever source, necessary 

5 to accommodate the sanitation facilities needs 

6 of new homes assisted with funds under the 

7 Native American Housing Assistance and Self8 Determination Act (25 U.S.C. 4101 et seq.), 

9 and to reduce the identified sanitation defi10 ciency levels of all Indian Tribes and Indian 

11 communities to level I sanitation deficiency as 

12 defined in paragraph (3)(A); and 

13 ‘‘(F) a 10-year plan to provide sanitation 

14 facilities to serve existing Indian homes and In15 dian communities and new and renovated In16 dian homes. 

17 ‘‘(2) UNIFORM METHODOLOGY.—The method18 ology used by the Secretary in determining, pre19 paring cost estimates for, and reporting sanitation 

20 deficiencies for purposes of paragraph (1) shall be 

21 applied uniformly to all Indian Tribes and Indian 

22 communities. 

23 ‘‘(3) SANITATION DEFICIENCY LEVELS.—For 

24 purposes of this subsection, the sanitation deficiency 

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1 munity sanitation facility to serve Indian homes are 

2 determined as follows: 

3 ‘‘(A) A level I deficiency exists if a sanita4 tion facility serving an individual, Indian Tribe, 

5 or Indian community— 

6 ‘‘(i) complies with all applicable water 

7 supply, pollution control, and solid waste 

8 disposal laws; and 

9 ‘‘(ii) deficiencies relate to routine re10 placement, repair, or maintenance needs. 

11 ‘‘(B) A level II deficiency exists if a sanita12 tion facility serving an individual, Indian Tribe, 

13 or Indian community substantially or recently 

14 complied with all applicable water supply, pollu15 tion control, and solid waste laws and any defi16 ciencies relate to— 

17 ‘‘(i) small or minor capital improve18 ments needed to bring the facility back 

19 into compliance; 

20 ‘‘(ii) capital improvements that are 

21 necessary to enlarge or improve the facili22 ties in order to meet the current needs for 

23 domestic sanitation facilities; or 

24 ‘‘(iii) the lack of equipment or train25 ing by an Indian Tribe, Tribal OrganizaVerDate Aug 31 2005 21:58 Apr 25, 2007 Jkt 059200 PO 00000 Frm 00156 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.IS S1200

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1 tion, or an Indian community to properly 

2 operate and maintain the sanitation facili3 ties. 

4 ‘‘(C) A level III deficiency exists if a sani5 tation facility serving an individual, Indian 

6 Tribe or Indian community meets 1 or more of 

7 the following conditions— 

8 ‘‘(i) water or sewer service in the 

9 home is provided by a haul system with 

10 holding tanks and interior plumbing; 

11 ‘‘(ii) major significant interruptions to 

12 water supply or sewage disposal occur fre13 quently, requiring major capital improve14 ments to correct the deficiencies; or 

15 ‘‘(iii) there is no access to or no ap16 proved or permitted solid waste facility 

17 available. 

18 ‘‘(D) A level IV deficiency exists— 

19 ‘‘(i) if a sanitation facility for an indi20 vidual home, an Indian Tribe, or an Indian 

21 community exists but— 

22 ‘‘(I) lacks— 

23 ‘‘(aa) a safe water supply 

24 system; or 


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1 ‘‘(bb) a waste disposal sys2 tem; 

3 ‘‘(II) contains no piped water or 

4 sewer facilities; or 

5 ‘‘(III) has become inoperable due 

6 to a major component failure; or 

7 ‘‘(ii) if only a washeteria or central fa8 cility exists in the community. 

9 ‘‘(E) A level V deficiency exists in the ab10 sence of a sanitation facility, where individual 

11 homes do not have access to safe drinking 

12 water or adequate wastewater (including sew13 age) disposal. 

14 ‘‘(i) DEFINITIONS.—For purposes of this section, the 

15 following terms apply: 

16 ‘‘(1) INDIAN COMMUNITY.—The term ‘Indian 

17 community’ means a geographic area, a significant 

18 proportion of whose inhabitants are Indians and 

19 which is served by or capable of being served by a 

20 facility described in this section. 

21 ‘‘(2) SANITATION FACILITIES.—The terms 

22 ‘sanitation facility’ and ‘sanitation facilities’ mean 

23 safe and adequate water supply systems, sanitary 

24 sewage disposal systems, and sanitary solid waste 


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1 systems (and all related equipment and support in2 frastructure). 

3 ‘‘SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS. 

4 ‘‘(a) BUY INDIAN ACT.—The Secretary, acting 

5 through the Service, may use the negotiating authority of 

6 section 23 of the Act of June 25, 1910 (25 U.S.C. 47, 

7 commonly known as the ‘Buy Indian Act’), to give pref8 erence to any Indian or any enterprise, partnership, cor9 poration, or other type of business organization owned and 

10 controlled by an Indian or Indians including former or 

11 currently federally recognized Indian Tribes in the State 

12 of New York (hereinafter referred to as an ‘Indian firm’) 

13 in the construction and renovation of Service facilities pur14 suant to section 301 and in the construction of sanitation 

15 facilities pursuant to section 302. Such preference may be 

16 accorded by the Secretary unless the Secretary finds, pur17 suant to regulations, that the project or function to be 

18 contracted for will not be satisfactory or such project or 

19 function cannot be properly completed or maintained 

20 under the proposed contract. The Secretary, in arriving 

21 at such a finding, shall consider whether the Indian or 

22 Indian firm will be deficient with respect to— 

23 ‘‘(1) ownership and control by Indians; 

24 ‘‘(2) equipment; 

25 ‘‘(3) bookkeeping and accounting procedures; 


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1 ‘‘(4) substantive knowledge of the project or 

2 function to be contracted for; 

3 ‘‘(5) adequately trained personnel; or 

4 ‘‘(6) other necessary components of contract 

5 performance. 

6 ‘‘(b) LABOR STANDARDS.— 

7 ‘‘(1) IN GENERAL.—For the purposes of imple8 menting the provisions of this title, contracts for the 

9 construction or renovation of health care facilities, 

10 staff quarters, and sanitation facilities, and related 

11 support infrastructure, funded in whole or in part 

12 with funds made available pursuant to this title, 

13 shall contain a provision requiring compliance with 

14 subchapter IV of chapter 31 of title 40, United 

15 States Code (commonly known as the ‘Davis-Bacon 

16 Act’), unless such construction or renovation— 

17 ‘‘(A) is performed by a contractor pursu18 ant to a contract with an Indian Tribe or Trib19 al Organization with funds supplied through a 

20 contract or compact authorized by the Indian 

21 Self-Determination and Education Assistance 

22 Act (25 U.S.C. 450 et seq.), or other statutory 

23 authority; and 

24 ‘‘(B) is subject to prevailing wage rates for 

25 similar construction or renovation in the locality 


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1 as determined by the Indian Tribes or Tribal 

2 Organizations to be served by the construction 

3 or renovation. 

4 ‘‘(2) EXCEPTION.—This subsection shall not 

5 apply to construction or renovation carried out by an 

6 Indian Tribe or Tribal Organization with its own 

7 employees. 

8 ‘‘SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR 

9 RENOVATION. 

10 ‘‘(a) IN GENERAL.—Notwithstanding any other pro11 vision of law, if the requirements of subsection (c) are met, 

12 the Secretary, acting through the Service, is authorized 

13 to accept any major expansion, renovation, or moderniza14 tion by any Indian Tribe or Tribal Organization of any 

15 Service facility or of any other Indian health facility oper16 ated pursuant to a contract or compact under the Indian 

17 Self-Determination and Education Assistance Act (25 

18 U.S.C. 450 et seq.), including— 

19 ‘‘(1) any plans or designs for such expansion, 

20 renovation, or modernization; and 

21 ‘‘(2) any expansion, renovation, or moderniza22 tion for which funds appropriated under any Federal 

23 law were lawfully expended. 

24 ‘‘(b) PRIORITY LIST.— 


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1 ‘‘(1) IN GENERAL.—The Secretary shall main2 tain a separate priority list to address the needs for 

3 increased operating expenses, personnel, or equip4 ment for such facilities. The methodology for estab5 lishing priorities shall be developed through regula6 tions. The list of priority facilities will be revised an7 nually in consultation with Indian Tribes and Tribal 

8 Organizations. 

9 ‘‘(2) REPORT.—The Secretary shall submit to 

10 the President, for inclusion in the report required to 

11 be transmitted to Congress under section 801, the 

12 priority list maintained pursuant to paragraph (1). 

13 ‘‘(c) REQUIREMENTS.—The requirements of this sub14 section are met with respect to any expansion, renovation, 

15 or modernization if— 

16 ‘‘(1) the Indian Tribe or Tribal Organization— 

17 ‘‘(A) provides notice to the Secretary of its 

18 intent to expand, renovate, or modernize; and 

19 ‘‘(B) applies to the Secretary to be placed 

20 on a separate priority list to address the needs 

21 of such new facilities for increased operating ex22 penses, personnel, or equipment; and 

23 ‘‘(2) the expansion, renovation, or moderniza24 tion— 


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1 ‘‘(A) is approved by the appropriate area 

2 director of the Service for Federal facilities; and 

3 ‘‘(B) is administered by the Indian Tribe 

4 or Tribal Organization in accordance with any 

5 applicable regulations prescribed by the Sec6 retary with respect to construction or renova7 tion of Service facilities. 

8 ‘‘(d) ADDITIONAL REQUIREMENT FOR EXPANSION.— 

9 In addition to the requirements under subsection (c), for 

10 any expansion, the Indian Tribe or Tribal Organization 

11 shall provide to the Secretary additional information pur12 suant to regulations, including additional staffing, equip13 ment, and other costs associated with the expansion. 

14 ‘‘(e) CLOSURE OR CONVERSION OF FACILITIES.—If 

15 any Service facility which has been expanded, renovated, 

16 or modernized by an Indian Tribe or Tribal Organization 

17 under this section ceases to be used as a Service facility 

18 during the 20-year period beginning on the date such ex19 pansion, renovation, or modernization is completed, such 

20 Indian Tribe or Tribal Organization shall be entitled to 

21 recover from the United States an amount which bears 

22 the same ratio to the value of such facility at the time 

23 of such cessation as the value of such expansion, renova24 tion, or modernization (less the total amount of any funds 

25 provided specifically for such facility under any Federal 


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1 program that were expended for such expansion, renova2 tion, or modernization) bore to the value of such facility 

3 at the time of the completion of such expansion, renova4 tion, or modernization. 

5 ‘‘SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, 

6 AND MODERNIZATION OF SMALL AMBULA7 TORY CARE FACILITIES. 

8 ‘‘(a) GRANTS.— 

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

10 through the Service, shall make grants to Indian 

11 Tribes and Tribal Organizations for the construc12 tion, expansion, or modernization of facilities for the 

13 provision of ambulatory care services to eligible Indi14 ans (and noneligible persons pursuant to subsections 

15 (b)(2) and (c)(1)(C)). A grant made under this sec16 tion may cover up to 100 percent of the costs of 

17 such construction, expansion, or modernization. For 

18 the purposes of this section, the term ‘construction’ 

19 includes the replacement of an existing facility. 

20 ‘‘(2) GRANT AGREEMENT REQUIRED.—A grant 

21 under paragraph (1) may only be made available to 

22 a Tribal Health Program operating an Indian health 

23 facility (other than a facility owned or constructed 

24 by the Service, including a facility originally owned 


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1 or constructed by the Service and transferred to an 

2 Indian Tribe or Tribal Organization). 

3 ‘‘(b) USE OF GRANT FUNDS.— 

4 ‘‘(1) ALLOWABLE USES.—A grant awarded 

5 under this section may be used for the construction, 

6 expansion, or modernization (including the planning 

7 and design of such construction, expansion, or mod8 ernization) of an ambulatory care facility— 

9 ‘‘(A) located apart from a hospital; 

10 ‘‘(B) not funded under section 301 or sec11 tion 306; and 

12 ‘‘(C) which, upon completion of such con13 struction or modernization will— 

14 ‘‘(i) have a total capacity appropriate 

15 to its projected service population; 

16 ‘‘(ii) provide annually no fewer than 

17 150 patient visits by eligible Indians and 

18 other users who are eligible for services in 

19 such facility in accordance with section 

20 807(c)(2); and 

21 ‘‘(iii) provide ambulatory care in a 

22 Service Area (specified in the contract or 

23 compact under the Indian Self-Determina24 tion and Education Assistance Act (25 

25 U.S.C. 450 et seq.)) with a population of 


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1 no fewer than 1,500 eligible Indians and 

2 other users who are eligible for services in 

3 such facility in accordance with section 

4 807(c)(2). 

5 ‘‘(2) ADDITIONAL ALLOWABLE USE.—The Sec6 retary may also reserve a portion of the funding pro7 vided under this section and use those reserved 

8 funds to reduce an outstanding debt incurred by In9 dian Tribes or Tribal Organizations for the con10 struction, expansion, or modernization of an ambula11 tory care facility that meets the requirements under 

12 paragraph (1). The provisions of this section shall 

13 apply, except that such applications for funding 

14 under this paragraph shall be considered separately 

15 from applications for funding under paragraph (1). 

16 ‘‘(3) USE ONLY FOR CERTAIN PORTION OF

17 COSTS.—A grant provided under this section may be 

18 used only for the cost of that portion of a construc19 tion, expansion, or modernization project that bene20 fits the Service population identified above in sub21 section (b)(1)(C) (ii) and (iii). The requirements of 

22 clauses (ii) and (iii) of paragraph (1)(C) shall not 

23 apply to an Indian Tribe or Tribal Organization ap24 plying for a grant under this section for a health 

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1 land or when such facility is not located on a road 

2 system providing direct access to an inpatient hos3 pital where care is available to the Service popu4 lation. 

5 ‘‘(c) GRANTS.— 

6 ‘‘(1) APPLICATION.—No grant may be made 

7 under this section unless an application or proposal 

8 for the grant has been approved by the Secretary in 

9 accordance with applicable regulations and has set 

10 forth reasonable assurance by the applicant that, at 

11 all times after the construction, expansion, or mod12 ernization of a facility carried out using a grant re13 ceived under this section— 

14 ‘‘(A) adequate financial support will be 

15 available for the provision of services at such 

16 facility; 

17 ‘‘(B) such facility will be available to eligi18 ble Indians without regard to ability to pay or 

19 source of payment; and 

20 ‘‘(C) such facility will, as feasible without 

21 diminishing the quality or quantity of services 

22 provided to eligible Indians, serve noneligible 

23 persons on a cost basis. 


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1 ‘‘(2) PRIORITY.—In awarding grants under this 

2 section, the Secretary shall give priority to Indian 

3 Tribes and Tribal Organizations that demonstrate— 

4 ‘‘(A) a need for increased ambulatory care 

5 services; and 

6 ‘‘(B) insufficient capacity to deliver such 

7 services. 

8 ‘‘(3) PEER REVIEW PANELS.—The Secretary 

9 may provide for the establishment of peer review 

10 panels, as necessary, to review and evaluate applica11 tions and proposals and to advise the Secretary re12 garding such applications using the criteria devel13 oped pursuant to subsection (a)(1). 

14 ‘‘(d) REVERSION OF FACILITIES.—If any facility (or 

15 portion thereof) with respect to which funds have been 

16 paid under this section, ceases, at any time after comple17 tion of the construction, expansion, or modernization car18 ried out with such funds, to be used for the purposes of 

19 providing health care services to eligible Indians, all of the 

20 right, title, and interest in and to such facility (or portion 

21 thereof) shall transfer to the United States unless other22 wise negotiated by the Service and the Indian Tribe or 

23 Tribal Organization. 

24 ‘‘(e) FUNDING NONRECURRING.—Funding provided 

25 under this section shall be nonrecurring and shall not be 


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1 available for inclusion in any individual Indian Tribe’s 

2 tribal share for an award under the Indian Self-Deter3 mination and Education Assistance Act (25 U.S.C. 450 

4 et seq.) or for reallocation or redesign thereunder. 

5 ‘‘SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRA6 TION PROJECTS. 

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

8 the Service, is authorized to carry out, or to enter into 

9 contracts under the Indian Self-Determination and Edu10 cation Assistance Act (25 U.S.C. 450 et seq.) with Indian 

11 Tribes or Tribal Organizations to carry out, a health care 

12 delivery demonstration project to test alternative means 

13 of delivering health care and services to Indians through 

14 facilities. 

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

16 projects pursuant to this section, may authorize such con17 tracts for the construction and renovation of hospitals, 

18 health centers, health stations, and other facilities to de19 liver health care services and is authorized to— 

20 ‘‘(1) waive any leasing prohibition; 

21 ‘‘(2) permit carryover of funds appropriated for 

22 the provision of health care services; 

23 ‘‘(3) permit the use of other available funds; 

24 ‘‘(4) permit the use of funds or property do25 nated from any source for project purposes; 


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1 ‘‘(5) provide for the reversion of donated real or 

2 personal property to the donor; and 

3 ‘‘(6) permit the use of Service funds to match 

4 other funds, including Federal funds. 

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

6 ‘‘(1) GENERAL PROJECTS.— 

7 ‘‘(A) CRITERIA.—The Secretary may ap8 prove under this section demonstration projects 

9 that meet the following criteria: 

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

11 or program, such as a program for conven12 ient care services, or the reorientation of 

13 an existing facility or program. 

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

15 including Indians with low health status, 

16 will be served by the project. 

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

18 deliver services in an efficient and effective 

19 manner. 

20 ‘‘(iv) The project is economically via21 ble. 

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

23 Indian Tribe or Tribal Organization, the 

24 Indian Tribe or Tribal Organization has 


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1 the administrative and financial capability 

2 to administer the project. 

3 ‘‘(vi) The project is integrated with 

4 providers of related health and social serv5 ices and is coordinated with, and avoids 

6 duplication of, existing services in order to 

7 expand the availability of services. 

8 ‘‘(B) PRIORITY.—In approving demonstra9 tion projects under this paragraph, the Sec10 retary shall give priority to demonstration 

11 projects, to the extent the projects meet the cri12 teria described in subparagraph (A), located in 

13 any of the following Service Units: 

14 ‘‘(i) Cass Lake, Minnesota. 

15 ‘‘(ii) Mescalero, New Mexico. 

16 ‘‘(iii) Owyhee, Nevada. 

17 ‘‘(iv) Schurz, Nevada. 

18 ‘‘(v) Ft. Yuma, California. 

19 ‘‘(2) CONVENIENT CARE SERVICE PROJECTS.— 

20 ‘‘(A) DEFINITION OF CONVENIENT CARE

21 SERVICE.—In this paragraph, the term ‘conven22 ient care service’ means any primary health 

23 care service, such as urgent care services, non24 emergent care services, prevention services and 


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1 screenings, and any service authorized by sec2 tions 203 or 213(d), that is— 

3 ‘‘(i) provided outside the regular 

4 hours of operation of a health care facility; 

5 or 

6 ‘‘(ii) offered at an alternative setting. 

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

8 described in paragraph (1), in any fiscal year, 

9 the Secretary is authorized to approve not more 

10 than 10 applications for health care delivery 

11 demonstration projects that— 

12 ‘‘(i) include a convenient care services 

13 program as an alternative means of deliv14 ering health care services to Indians; and 

15 ‘‘(ii) meet the criteria described in 

16 subparagraph (C). 

17 ‘‘(C) CRITERIA.—The Secretary shall ap18 prove under subparagraph (B) demonstration 

19 projects that meet all of the following criteria: 

20 ‘‘(i) The criteria set forth in para21 graph (1)(A). 

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

23 health care services at existing health care 

24 facilities, which may be due to limited 


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1 hours of operation at those facilities or 

2 other factors. 

3 ‘‘(iii) The project— 

4 ‘‘(I) expands the availability of 

5 services; or 

6 ‘‘(II) reduces— 

7 ‘‘(aa) the burden on Con8 tract Health Services; or 

9 ‘‘(bb) the need for emer10 gency room visits. 

11 ‘‘(d) PEER REVIEW PANELS.—The Secretary may 

12 provide for the establishment of peer review panels, as nec13 essary, to review and evaluate applications using the cri14 teria described in paragraphs (1)(A) and (2)(C) of sub15 section (c). 

16 ‘‘(e) TECHNICAL ASSISTANCE.—The Secretary shall 

17 provide such technical and other assistance as may be nec18 essary to enable applicants to comply with this section. 

19 ‘‘(f) SERVICE TO INELIGIBLE PERSONS.—Subject to 

20 section 807, the authority to provide services to persons 

21 otherwise ineligible for the health care benefits of the 

22 Service, and the authority to extend hospital privileges in 

23 Service facilities to non-Service health practitioners as 

24 provided in section 807, may be included, subject to the 


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1 terms of that section, in any demonstration project ap2 proved pursuant to this section. 

3 ‘‘(g) EQUITABLE TREATMENT.—For purposes of 

4 subsection (c), the Secretary, in evaluating facilities oper5 ated under any contract or compact under the Indian Self6 Determination and Education Assistance Act (25 U.S.C. 

7 450 et seq.), shall use the same criteria that the Secretary 

8 uses in evaluating facilities operated directly by the Serv9 ice. 

10 ‘‘(h) EQUITABLE INTEGRATION OF FACILITIES.— 

11 The Secretary shall ensure that the planning, design, con12 struction, renovation, and expansion needs of Service and 

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

14 compact under the Indian Self-Determination and Edu15 cation Assistance Act (25 U.S.C. 450 et seq.) for health 

16 services are fully and equitably integrated into the imple17 mentation of the health care delivery demonstration 

18 projects under this section. 

19 ‘‘SEC. 307. LAND TRANSFER. 

20 ‘‘Notwithstanding any other provision of law, the Bu21 reau of Indian Affairs and all other agencies and depart22 ments of the United States are authorized to transfer, at 

23 no cost, land and improvements to the Service for the pro24 vision of health care services. The Secretary is authorized 

25 to accept such land and improvements for such purposes. 


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1 ‘‘SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS. 

2 ‘‘The Secretary, acting through the Service, may 

3 enter into leases, contracts, and other agreements with In4 dian Tribes and Tribal Organizations which hold (1) title 

5 to, (2) a leasehold interest in, or (3) a beneficial interest 

6 in (when title is held by the United States in trust for 

7 the benefit of an Indian Tribe) facilities used or to be used 

8 for the administration and delivery of health services by 

9 an Indian Health Program. Such leases, contracts, or 

10 agreements may include provisions for construction or ren11 ovation and provide for compensation to the Indian Tribe 

12 or Tribal Organization of rental and other costs consistent 

13 with section 105(l) of the Indian Self-Determination and 

14 Education Assistance Act (25 U.S.C. 450j(l)) and regula15 tions thereunder. 

16 ‘‘SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND 

17 LOAN REPAYMENT. 

18 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

19 with the Secretary of the Treasury, Indian Tribes, and 

20 Tribal Organizations, shall carry out a study to determine 

21 the feasibility of establishing a loan fund to provide to In22 dian Tribes and Tribal Organizations direct loans or guar23 antees for loans for the construction of health care facili24 ties, including— 

25 ‘‘(1) inpatient facilities; 

26 ‘‘(2) outpatient facilities; 


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1 ‘‘(3) staff quarters; 

2 ‘‘(4) hostels; and 

3 ‘‘(5) specialized care facilities, such as behav4 ioral health and elder care facilities. 

5 ‘‘(b) DETERMINATIONS.—In carrying out the study 

6 under subsection (a), the Secretary shall determine— 

7 ‘‘(1) the maximum principal amount of a loan 

8 or loan guarantee that should be offered to a recipi9 ent from the loan fund; 

10 ‘‘(2) the percentage of eligible costs, not to ex11 ceed 100 percent, that may be covered by a loan or 

12 loan guarantee from the loan fund (including costs 

13 relating to planning, design, financing, site land de14 velopment, construction, rehabilitation, renovation, 

15 conversion, improvements, medical equipment and 

16 furnishings, and other facility-related costs and cap17 ital purchase (but excluding staffing)); 

18 ‘‘(3) the cumulative total of the principal of di19 rect loans and loan guarantees, respectively, that 

20 may be outstanding at any 1 time; 

21 ‘‘(4) the maximum term of a loan or loan guar22 antee that may be made for a facility from the loan 

23 fund; 

24 ‘‘(5) the maximum percentage of funds from 

25 the loan fund that should be allocated for payment 


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1 of costs associated with planning and applying for a 

2 loan or loan guarantee; 

3 ‘‘(6) whether acceptance by the Secretary of an 

4 assignment of the revenue of an Indian Tribe or 

5 Tribal Organization as security for any direct loan 

6 or loan guarantee from the loan fund would be ap7 propriate; 

8 ‘‘(7) whether, in the planning and design of 

9 health facilities under this section, users eligible 

10 under section 807(c) may be included in any projec11 tion of patient population; 

12 ‘‘(8) whether funds of the Service provided 

13 through loans or loan guarantees from the loan fund 

14 should be eligible for use in matching other Federal 

15 funds under other programs; 

16 ‘‘(9) the appropriateness of, and best methods 

17 for, coordinating the loan fund with the health care 

18 priority system of the Service under section 301; and 

19 ‘‘(10) any legislative or regulatory changes re20 quired to implement recommendations of the Sec21 retary based on results of the study. 

22 ‘‘(c) REPORT.—Not later than September 30, 2009, 

23 the Secretary shall submit to the Committee on Indian Af24 fairs of the Senate and the Committee on Natural ReVerDate Aug 31 2005 21:58 Apr 25, 2007 Jkt 059200 PO 00000 Frm 00177 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.IS S1200

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1 sources and the Committee on Energy and Commerce of 

2 the House of Representatives a report that describes— 

3 ‘‘(1) the manner of consultation made as re4 quired by subsection (a); and 

5 ‘‘(2) the results of the study, including any rec6 ommendations of the Secretary based on results of 

7 the study. 

8 ‘‘SEC. 310. TRIBAL LEASING. 

9 ‘‘A Tribal Health Program may lease permanent 

10 structures for the purpose of providing health care services 

11 without obtaining advance approval in appropriation Acts. 

12 ‘‘SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES 

13 JOINT VENTURE PROGRAM. 

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

15 the Service, shall make arrangements with Indian Tribes 

16 and Tribal Organizations to establish joint venture dem17 onstration projects under which an Indian Tribe or Tribal 

18 Organization shall expend tribal, private, or other avail19 able funds, for the acquisition or construction of a health 

20 facility for a minimum of 10 years, under a no-cost lease, 

21 in exchange for agreement by the Service to provide the 

22 equipment, supplies, and staffing for the operation and 

23 maintenance of such a health facility. An Indian Tribe or 

24 Tribal Organization may use tribal funds, private sector, 

25 or other available resources, including loan guarantees, to 


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1 fulfill its commitment under a joint venture entered into 

2 under this subsection. An Indian Tribe or Tribal Organi3 zation shall be eligible to establish a joint venture project 

4 if, when it submits a letter of intent, it— 

5 ‘‘(1) has begun but not completed the process 

6 of acquisition or construction of a health facility to 

7 be used in the joint venture project; or 

8 ‘‘(2) has not begun the process of acquisition or 

9 construction of a health facility for use in the joint 

10 venture project. 

11 ‘‘(b) REQUIREMENTS.—The Secretary shall make 

12 such an arrangement with an Indian Tribe or Tribal Orga13 nization only if— 

14 ‘‘(1) the Secretary first determines that the In15 dian Tribe or Tribal Organization has the adminis16 trative and financial capabilities necessary to com17 plete the timely acquisition or construction of the 

18 relevant health facility; and 

19 ‘‘(2) the Indian Tribe or Tribal Organization 

20 meets the need criteria determined using the criteria 

21 developed under the health care facility priority sys22 tem under section 301, unless the Secretary deter23 mines, pursuant to regulations, that other criteria 

24 will result in a more cost-effective and efficient 


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1 method of facilitating and completing construction of 

2 health care facilities. 

3 ‘‘(c) CONTINUED OPERATION.—The Secretary shall 

4 negotiate an agreement with the Indian Tribe or Tribal 

5 Organization regarding the continued operation of the fa6 cility at the end of the initial 10 year no-cost lease period. 

7 ‘‘(d) BREACH OF AGREEMENT.—An Indian Tribe or 

8 Tribal Organization that has entered into a written agree9 ment with the Secretary under this section, and that 

10 breaches or terminates without cause such agreement, 

11 shall be liable to the United States for the amount that 

12 has been paid to the Indian Tribe or Tribal Organization, 

13 or paid to a third party on the Indian Tribe’s or Tribal 

14 Organization’s behalf, under the agreement. The Sec15 retary has the right to recover tangible property (including 

16 supplies) and equipment, less depreciation, and any funds 

17 expended for operations and maintenance under this sec18 tion. The preceding sentence does not apply to any funds 

19 expended for the delivery of health care services, per20 sonnel, or staffing. 

21 ‘‘(e) RECOVERY FOR NONUSE.—An Indian Tribe or 

22 Tribal Organization that has entered into a written agree23 ment with the Secretary under this subsection shall be en24 titled to recover from the United States an amount that 

25 is proportional to the value of such facility if, at any time 


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1 within the 10-year term of the agreement, the Service 

2 ceases to use the facility or otherwise breaches the agree3 ment. 

4 ‘‘(f) DEFINITION.—For the purposes of this section, 

5 the term ‘health facility’ or ‘health facilities’ includes 

6 quarters needed to provide housing for staff of the rel7 evant Tribal Health Program. 

8 ‘‘SEC. 312. LOCATION OF FACILITIES. 

9 ‘‘(a) IN GENERAL.—In all matters involving the reor10 ganization or development of Service facilities or in the 

11 establishment of related employment projects to address 

12 unemployment conditions in economically depressed areas, 

13 the Bureau of Indian Affairs and the Service shall give 

14 priority to locating such facilities and projects on Indian 

15 lands, or lands in Alaska owned by any Alaska Native vil16 lage, or village or regional corporation under the Alaska 

17 Native Claims Settlement Act (43 U.S.C. 1601 et seq.), 

18 or any land allotted to any Alaska Native, if requested 

19 by the Indian owner and the Indian Tribe with jurisdiction 

20 over such lands or other lands owned or leased by the In21 dian Tribe or Tribal Organization. Top priority shall be 

22 given to Indian land owned by 1 or more Indian Tribes. 

23 ‘‘(b) DEFINITION.—For purposes of this section, the 

24 term ‘Indian lands’ means— 


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1 ‘‘(1) all lands within the exterior boundaries of 

2 any reservation; and 

3 ‘‘(2) any lands title to which is held in trust by 

4 the United States for the benefit of any Indian 

5 Tribe or individual Indian or held by any Indian 

6 Tribe or individual Indian subject to restriction by 

7 the United States against alienation. 

8 ‘‘SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH 

9 CARE FACILITIES. 

10 ‘‘(a) REPORT.—The Secretary shall submit to the 

11 President, for inclusion in the report required to be trans12 mitted to Congress under section 801, a report which iden13 tifies the backlog of maintenance and repair work required 

14 at both Service and tribal health care facilities, including 

15 new health care facilities expected to be in operation in 

16 the next fiscal year. The report shall also identify the need 

17 for renovation and expansion of existing facilities to sup18 port the growth of health care programs. 

19 ‘‘(b) MAINTENANCE OF NEWLY CONSTRUCTED

20 SPACE.—The Secretary, acting through the Service, is au21 thorized to expend maintenance and improvement funds 

22 to support maintenance of newly constructed space only 

23 if such space falls within the approved supportable space 

24 allocation for the Indian Tribe or Tribal Organization. 


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1 Supportable space allocation shall be defined through the 

2 health care facility priority system under section 301(c). 

3 ‘‘(c) REPLACEMENT FACILITIES.—In addition to 

4 using maintenance and improvement funds for renovation, 

5 modernization, and expansion of facilities, an Indian Tribe 

6 or Tribal Organization may use maintenance and improve7 ment funds for construction of a replacement facility if 

8 the costs of renovation of such facility would exceed a 

9 maximum renovation cost threshold. The maximum ren10 ovation cost threshold shall be determined through the ne11 gotiated rulemaking process provided for under section 

12 802. 

13 ‘‘SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY-OWNED 

14 QUARTERS. 

15 ‘‘(a) RENTAL RATES.— 

16 ‘‘(1) ESTABLISHMENT.—Notwithstanding any 

17 other provision of law, a Tribal Health Program 

18 which operates a hospital or other health facility and 

19 the federally-owned quarters associated therewith 

20 pursuant to a contract or compact under the Indian 

21 Self-Determination and Education Assistance Act 

22 (25 U.S.C. 450 et seq.) shall have the authority to 

23 establish the rental rates charged to the occupants 

24 of such quarters by providing notice to the Secretary 

25 of its election to exercise such authority. 


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

2 pursuant to authority of this subsection, a Tribal 

3 Health Program shall endeavor to achieve the fol4 lowing objectives: 

5 ‘‘(A) To base such rental rates on the rea6 sonable value of the quarters to the occupants 

7 thereof. 

8 ‘‘(B) To generate sufficient funds to pru9 dently provide for the operation and mainte10 nance of the quarters, and subject to the discre11 tion of the Tribal Health Program, to supply 

12 reserve funds for capital repairs and replace13 ment of the quarters. 

14 ‘‘(3) EQUITABLE FUNDING.—Any quarters 

15 whose rental rates are established by a Tribal 

16 Health Program pursuant to this subsection shall 

17 remain eligible for quarters improvement and repair 

18 funds to the same extent as all federally-owned quar19 ters used to house personnel in Services-supported 

20 programs. 

21 ‘‘(4) NOTICE OF RATE CHANGE.—A Tribal 

22 Health Program which exercises the authority pro23 vided under this subsection shall provide occupants 

24 with no less than 60 days notice of any change in 

25 rental rates. 


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1 ‘‘(b) DIRECT COLLECTION OF RENT.— 

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

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

4 Tribal Health Program shall have the authority to 

5 collect rents directly from Federal employees who oc6 cupy such quarters in accordance with the following: 

7 ‘‘(A) The Tribal Health Program shall no8 tify the Secretary and the subject Federal em9 ployees of its election to exercise its authority 

10 to collect rents directly from such Federal em11 ployees. 

12 ‘‘(B) Upon receipt of a notice described in 

13 subparagraph (A), the Federal employees shall 

14 pay rents for occupancy of such quarters di15 rectly to the Tribal Health Program and the 

16 Secretary shall have no further authority to col17 lect rents from such employees through payroll 

18 deduction or otherwise. 

19 ‘‘(C) Such rent payments shall be retained 

20 by the Tribal Health Program and shall not be 

21 made payable to or otherwise be deposited with 

22 the United States. 

23 ‘‘(D) Such rent payments shall be depos24 ited into a separate account which shall be used 

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1 nance (including capital repairs and replace2 ment) and operation of the quarters and facili3 ties as the Tribal Health Program shall deter4 mine. 

5 ‘‘(2) RETROCESSION OF AUTHORITY.—If a 

6 Tribal Health Program which has made an election 

7 under paragraph (1) requests retrocession of its au8 thority to directly collect rents from Federal employ9 ees occupying federally-owned quarters, such ret10 rocession shall become effective on the earlier of— 

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

12 no less than 180 days after the Tribal Health 

13 Program notifies the Secretary of its desire to 

14 retrocede; or 

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

16 agreed by the Secretary and the Tribal Health 

17 Program. 

18 ‘‘(c) RATES IN ALASKA.—To the extent that a Tribal 

19 Health Program, pursuant to authority granted in sub20 section (a), establishes rental rates for federally-owned 

21 quarters provided to a Federal employee in Alaska, such 

22 rents may be based on the cost of comparable private rent23 al housing in the nearest established community with a 

24 year-round population of 1,500 or more individuals. 


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1 ‘‘SEC. 315. APPLICABILITY OF BUY AMERICAN ACT RE2 QUIREMENT. 

3 ‘‘(a) APPLICABILITY.—The Secretary shall ensure 

4 that the requirements of the Buy American Act apply to 

5 all procurements made with funds provided pursuant to 

6 section 317. Indian Tribes and Tribal Organizations shall 

7 be exempt from these requirements. 

8 ‘‘(b) EFFECT OF VIOLATION.—If it has been finally 

9 determined by a court or Federal agency that any person 

10 intentionally affixed a label bearing a ‘Made in America’ 

11 inscription or any inscription with the same meaning, to 

12 any product sold in or shipped to the United States that 

13 is not made in the United States, such person shall be 

14 ineligible to receive any contract or subcontract made with 

15 funds provided pursuant to section 317, pursuant to the 

16 debarment, suspension, and ineligibility procedures de17 scribed in sections 9.400 through 9.409 of title 48, Code 

18 of Federal Regulations. 

19 ‘‘(c) DEFINITIONS.—For purposes of this section, the 

20 term ‘Buy American Act’ means title III of the Act enti21 tled ‘An Act making appropriations for the Treasury and 

22 Post Office Departments for the fiscal year ending June 

23 30, 1934, and for other purposes’, approved March 3, 

24 1933 (41 U.S.C. 10a et seq.). 


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1 ‘‘SEC. 316. OTHER FUNDING FOR FACILITIES. 

2 ‘‘(a) AUTHORITY TO ACCEPT FUNDS.—The Sec3 retary is authorized to accept from any source, including 

4 Federal and State agencies, funds that are available for 

5 the construction of health care facilities and use such 

6 funds to plan, design, and construct health care facilities 

7 for Indians and to place such funds into a contract or com8 pact under the Indian Self-Determination and Education 

9 Assistance Act (25 U.S.C. 450 et seq.). Receipt of such 

10 funds shall have no effect on the priorities established pur11 suant to section 301. 

12 ‘‘(b) INTERAGENCY AGREEMENTS.—The Secretary is 

13 authorized to enter into interagency agreements with 

14 other Federal agencies or State agencies and other entities 

15 and to accept funds from such Federal or State agencies 

16 or other sources to provide for the planning, design, and 

17 construction of health care facilities to be administered by 

18 Indian Health Programs in order to carry out the pur19 poses of this Act and the purposes for which the funds 

20 were appropriated or for which the funds were otherwise 

21 provided. 

22 ‘‘(c) ESTABLISHMENT OF STANDARDS.—The Sec23 retary, through the Service, shall establish standards by 

24 regulation for the planning, design, and construction of 

25 health care facilities serving Indians under this Act. 


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1 ‘‘SEC. 317. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘There are authorized to be appropriated such sums 

3 as may be necessary for each fiscal year through fiscal 

4 year 2017 to carry out this title. 

5 ‘‘TITLE IV—ACCESS TO HEALTH 

6 SERVICES 

7 ‘‘SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SE8 CURITY ACT HEALTH BENEFITS PROGRAMS. 

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

10 SCHIP PAYMENTS IN DETERMINING APPROPRIATIONS.— 

11 Any payments received by an Indian Health Program or 

12 by an Urban Indian Organization under title XVIII, XIX, 

13 or XXI of the Social Security Act for services provided 

14 to Indians eligible for benefits under such respective titles 

15 shall not be considered in determining appropriations for 

16 the provision of health care and services to Indians. 

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

18 this Act authorizes the Secretary to provide services to an 

19 Indian with coverage under title XVIII, XIX, or XXI of 

20 the Social Security Act in preference to an Indian without 

21 such coverage. 

22 ‘‘(c) USE OF FUNDS.— 

23 ‘‘(1) SPECIAL FUND.— 

24 ‘‘(A) 100 PERCENT PASS-THROUGH OF

25 PAYMENTS DUE TO FACILITIES.—Notwith26 standing any other provision of law, but subject 


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

2 of the Service is entitled by reason of a provi3 sion of the Social Security Act shall be placed 

4 in a special fund to be held by the Secretary. 

5 In making payments from such fund, the Sec6 retary shall ensure that each Service Unit of 

7 the Service receives 100 percent of the amount 

8 to which the facilities of the Service, for which 

9 such Service Unit makes collections, are enti10 tled by reason of a provision of the Social Secu11 rity Act. 

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

13 by a facility of the Service under subparagraph 

14 (A) shall first be used (to such extent or in 

15 such amounts as are provided in appropriation 

16 Acts) for the purpose of making any improve17 ments in the programs of the Service operated 

18 by or through such facility which may be nec19 essary to achieve or maintain compliance with 

20 the applicable conditions and requirements of 

21 titles XVIII and XIX of the Social Security 

22 Act. Any amounts so received that are in excess 

23 of the amount necessary to achieve or maintain 

24 such conditions and requirements shall, subject 

25 to consultation with the Indian Tribes being 


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1 served by the Service Unit, be used for reducing 

2 the health resource deficiencies (as determined 

3 under section 201(d)) of such Indian Tribes. 

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

5 (1) shall not apply to a Tribal Health Program upon 

6 the election of such Program under subsection (d) to 

7 receive payments directly. No payment may be made 

8 out of the special fund described in such paragraph 

9 with respect to reimbursement made for services 

10 provided by such Program during the period of such 

11 election. 

12 ‘‘(d) DIRECT BILLING.— 

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

14 the requirements of paragraph (2), a Tribal Health 

15 Program may elect to directly bill for, and receive 

16 payment for, health care items and services provided 

17 by such Program for which payment is made under 

18 title XVIII or XIX of the Social Security Act or 

19 from any other third party payor. 

20 ‘‘(2) DIRECT REIMBURSEMENT.— 

21 ‘‘(A) USE OF FUNDS.—Each Tribal Health 

22 Program making the election described in para23 graph (1) with respect to a program under a 

24 title of the Social Security Act shall be reim25 bursed directly by that program for items and 


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1 services furnished without regard to subsection 

2 (c)(1), but all amounts so reimbursed shall be 

3 used by the Tribal Health Program for the pur4 pose of making any improvements in facilities 

5 of the Tribal Health Program that may be nec6 essary to achieve or maintain compliance with 

7 the conditions and requirements applicable gen8 erally to such items and services under the pro9 gram under such title and to provide additional 

10 health care services, improvements in health 

11 care facilities and Tribal Health Programs, any 

12 health care related purpose, or otherwise to 

13 achieve the objectives provided in section 3 of 

14 this Act. 

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

16 Tribal Health Program making the election de17 scribed in paragraph (1) with respect to a pro18 gram under a title of the Social Security Act 

19 shall be subject to all auditing requirements ap20 plicable to the program under such title, as well 

21 as all auditing requirements applicable to pro22 grams administered by an Indian Health Pro23 gram. Nothing in the preceding sentence shall 

24 be construed as limiting the application of au25 diting requirements applicable to amounts paid 


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1 under title XVIII, XIX, or XXI of the Social 

2 Security Act. 

3 ‘‘(C) IDENTIFICATION OF SOURCE OF PAY4 MENTS.—Any Tribal Health Program that re5 ceives reimbursements or payments under title 

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

7 shall provide to the Service a list of each pro8 vider enrollment number (or other identifier) 

9 under which such Program receives such reim10 bursements or payments. 

11 ‘‘(3) EXAMINATION AND IMPLEMENTATION OF

12 CHANGES.— 

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

14 through the Service and with the assistance of 

15 the Administrator of the Centers for Medicare 

16 & Medicaid Services, shall examine on an ongo17 ing basis and implement any administrative 

18 changes that may be necessary to facilitate di19 rect billing and reimbursement under the pro20 gram established under this subsection, includ21 ing any agreements with States that may be 

22 necessary to provide for direct billing under a 

23 program under a title of the Social Security 

24 Act. 


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1 ‘‘(B) COORDINATION OF INFORMATION.— 

2 The Service shall provide the Administrator of 

3 the Centers for Medicare & Medicaid Services 

4 with copies of the lists submitted to the Service 

5 under paragraph (2)(C), enrollment data re6 garding patients served by the Service (and by 

7 Tribal Health Programs, to the extent such 

8 data is available to the Service), and such other 

9 information as the Administrator may require 

10 for purposes of administering title XVIII, XIX, 

11 or XXI of the Social Security Act. 

12 ‘‘(4) WITHDRAWAL FROM PROGRAM.—A Tribal 

13 Health Program that bills directly under the pro14 gram established under this subsection may with15 draw from participation in the same manner and 

16 under the same conditions that an Indian Tribe or 

17 Tribal Organization may retrocede a contracted pro18 gram to the Secretary under the authority of the In19 dian Self-Determination and Education Assistance 

20 Act (25 U.S.C. 450 et seq.). All cost accounting and 

21 billing authority under the program established 

22 under this subsection shall be returned to the Sec23 retary upon the Secretary’s acceptance of the with24 drawal of participation in this program. 


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1 ‘‘(5) TERMINATION FOR FAILURE TO COMPLY

2 WITH REQUIREMENTS.—The Secretary may termi3 nate the participation of a Tribal Health Program or 

4 in the direct billing program established under this 

5 subsection if the Secretary determines that the Pro6 gram has failed to comply with the requirements of 

7 paragraph (2). The Secretary shall provide a Tribal 

8 Health Program with notice of a determination that 

9 the Program has failed to comply with any such re10 quirement and a reasonable opportunity to correct 

11 such noncompliance prior to terminating the Pro12 gram’s participation in the direct billing program es13 tablished under this subsection. 

14 ‘‘(e) RELATED PROVISIONS UNDER THE SOCIAL SE15 CURITY ACT.—For provisions related to subsections (c) 

16 and (d), see sections 1880, 1911, and 2107(e)(1)(D) of 

17 the Social Security Act. 


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1 ‘‘SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERV2 ICE, INDIAN TRIBES, TRIBAL ORGANIZA3 TIONS, AND URBAN INDIAN ORGANIZATIONS 

4 TO FACILITATE OUTREACH, ENROLLMENT, 

5 AND COVERAGE OF INDIANS UNDER SOCIAL 

6 SECURITY ACT HEALTH BENEFIT PROGRAMS 

7 AND OTHER HEALTH BENEFITS PROGRAMS. 

8 ‘‘(a) INDIAN TRIBES AND TRIBAL ORGANIZA9 TIONS.—From funds appropriated to carry out this title 

10 in accordance with section 416, the Secretary, acting 

11 through the Service, shall make grants to or enter into 

12 contracts with Indian Tribes and Tribal Organizations to 

13 assist such Tribes and Tribal Organizations in estab14 lishing and administering programs on or near reserva15 tions and trust lands to assist individual Indians— 

16 ‘‘(1) to enroll for benefits under a program es17 tablished under title XVIII, XIX, or XXI of the So18 cial Security Act and other health benefits pro19 grams; and 

20 ‘‘(2) with respect to such programs for which 

21 the charging of premiums and cost sharing is not 

22 prohibited under such programs, to pay premiums or 

23 cost sharing for coverage for such benefits, which 

24 may be based on financial need (as determined by 

25 the Indian Tribe or Tribes or Tribal Organizations 

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1 veloped or implemented by such Tribe, Tribes, or 

2 Tribal Organizations). 

3 ‘‘(b) CONDITIONS.—The Secretary, acting through 

4 the Service, shall place conditions as deemed necessary to 

5 effect the purpose of this section in any grant or contract 

6 which the Secretary makes with any Indian Tribe or Trib7 al Organization pursuant to this section. Such conditions 

8 shall include requirements that the Indian Tribe or Tribal 

9 Organization successfully undertake— 

10 ‘‘(1) to determine the population of Indians eli11 gible for the benefits described in subsection (a); 

12 ‘‘(2) to educate Indians with respect to the ben13 efits available under the respective programs; 

14 ‘‘(3) to provide transportation for such indi15 vidual Indians to the appropriate offices for enroll16 ment or applications for such benefits; and 

17 ‘‘(4) to develop and implement methods of im18 proving the participation of Indians in receiving ben19 efits under such programs. 

20 ‘‘(c) APPLICATION TO URBAN INDIAN ORGANIZA21 TIONS.— 

22 ‘‘(1) IN GENERAL.—The provisions of sub23 section (a) shall apply with respect to grants and 

24 other funding to Urban Indian Organizations with 

25 respect to populations served by such organizations 


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1 in the same manner they apply to grants and con2 tracts with Indian Tribes and Tribal Organizations 

3 with respect to programs on or near reservations. 

4 ‘‘(2) REQUIREMENTS.—The Secretary shall in5 clude in the grants or contracts made or provided 

6 under paragraph (1) requirements that are— 

7 ‘‘(A) consistent with the requirements im8 posed by the Secretary under subsection (b); 

9 ‘‘(B) appropriate to Urban Indian Organi10 zations and Urban Indians; and 

11 ‘‘(C) necessary to effect the purposes of 

12 this section. 

13 ‘‘(d) FACILITATING COOPERATION.—The Secretary, 

14 acting through the Centers for Medicare & Medicaid Serv15 ices, shall take such steps as are necessary to facilitate 

16 cooperation with, and agreements between, States and the 

17 Service, Indian Tribes, Tribal Organizations, or Urban In18 dian Organizations with respect to the provision of health 

19 care items and services to Indians under the programs es20 tablished under title XVIII, XIX, or XXI of the Social 

21 Security Act. 

22 ‘‘(e) AGREEMENTS RELATING TO IMPROVING EN23 ROLLMENT OF INDIANS UNDER SOCIAL SECURITY ACT

24 HEALTH BENEFITS PROGRAMS.—For provisions relating 

25 to agreements between the Secretary, acting through the 


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1 Service, and Indian Tribes, Tribal Organizations, and 

2 Urban Indian Organizations for the collection, prepara3 tion, and submission of applications by Indians for assist4 ance under the Medicaid and State children’s health insur5 ance programs established under titles XIX and XXI of 

6 the Social Security Act, and benefits under the Medicare 

7 program established under title XVIII of such Act, see 

8 subsections (a) and (b) of section 1139 of the Social Secu9 rity Act. 

10 ‘‘(f) DEFINITION OF PREMIUMS AND COST SHAR11 ING.—In this section: 

12 ‘‘(1) PREMIUM.—The term ‘premium’ includes 

13 any enrollment fee or similar charge. 

14 ‘‘(2) COST SHARING.—The term ‘cost sharing’ 

15 includes any deduction, deductible, copayment, coin16 surance, or similar charge. 

17 ‘‘SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PAR18 TIES OF COSTS OF HEALTH SERVICES. 

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

20 subsection (f), the United States, an Indian Tribe, or 

21 Tribal Organization shall have the right to recover from 

22 an insurance company, health maintenance organization, 

23 employee benefit plan, third-party tortfeasor, or any other 

24 responsible or liable third party (including a political sub25 division or local governmental entity of a State) the reaVerDate Aug 31 2005 21:58 Apr 25, 2007 Jkt 059200 PO 00000 Frm 00199 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.IS S1200

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1 sonable charges billed by the Secretary, an Indian Tribe, 

2 or Tribal Organization in providing health services 

3 through the Service, an Indian Tribe, or Tribal Organiza4 tion to any individual to the same extent that such indi5 vidual, or any nongovernmental provider of such services, 

6 would be eligible to receive damages, reimbursement, or 

7 indemnification for such charges or expenses if— 

8 ‘‘(1) such services had been provided by a non9 governmental provider; and 

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

11 such charges or expenses and did pay such charges 

12 or expenses. 

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

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

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

16 health services were provided is covered under— 

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

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

19 plan or program. 

20 ‘‘(c) NONAPPLICATION OF OTHER LAWS.—No law of 

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

22 no provision of any contract, insurance or health mainte23 nance organization policy, employee benefit plan, self-in24 surance plan, managed care plan, or other health care plan 

25 or program entered into or renewed after the date of the 


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1 enactment of the Indian Health Care Amendments of 

2 1988, shall prevent or hinder the right of recovery of the 

3 United States, an Indian Tribe, or Tribal Organization 

4 under subsection (a). 

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

6 No action taken by the United States, an Indian Tribe, 

7 or Tribal Organization to enforce the right of recovery 

8 provided under this section shall operate to deny to the 

9 injured person the recovery for that portion of the person’s 

10 damage not covered hereunder. 

11 ‘‘(e) ENFORCEMENT.— 

12 ‘‘(1) IN GENERAL.—The United States, an In13 dian Tribe, or Tribal Organization may enforce the 

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

15 ‘‘(A) intervening or joining in any civil ac16 tion or proceeding brought— 

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

18 services were provided by the Secretary, an 

19 Indian Tribe, or Tribal Organization; or 

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

21 such individual, or 

22 ‘‘(B) instituting a civil action, including a 

23 civil action for injunctive relief and other relief 

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1 division or local governmental entity of a State, 

2 such an action against an official thereof. 

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

4 made to provide notice of action instituted under 

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

6 services were provided, either before or during the 

7 pendency of such action. 

8 ‘‘(3) RECOVERY FROM TORTFEASORS.— 

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

10 an Indian Tribe or Tribal Organization that is 

11 authorized or required under a compact or con12 tract issued pursuant to the Indian Self-Deter13 mination and Education Assistance Act (25 

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

15 services to a person who is injured or suffers a 

16 disease on or after the date of enactment of the 

17 Indian Health Care Improvement Act Amend18 ments of 2007 under circumstances that estab19 lish grounds for a claim of liability against the 

20 tortfeasor with respect to the injury or disease, 

21 the Indian Tribe or Tribal Organization shall 

22 have a right to recover from the tortfeasor (or 

23 an insurer of the tortfeasor) the reasonable 

24 value of the health services so furnished, paid 

25 for, or to be paid for, in accordance with the 


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1 Federal Medical Care Recovery Act (42 U.S.C. 

2 2651 et seq.), to the same extent and under the 

3 same circumstances as the United States may 

4 recover under that Act. 

5 ‘‘(B) TREATMENT.—The right of an In6 dian Tribe or Tribal Organization to recover 

7 under subparagraph (A) shall be independent of 

8 the rights of the injured or diseased person 

9 served by the Indian Tribe or Tribal Organiza10 tion. 

11 ‘‘(f) LIMITATION.—Absent specific written authoriza12 tion by the governing body of an Indian Tribe for the pe13 riod of such authorization (which may not be for a period 

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

15 time upon written notice by the governing body to the 

16 Service), the United States shall not have a right of recov17 ery under this section if the injury, illness, or disability 

18 for which health services were provided is covered under 

19 a self-insurance plan funded by an Indian Tribe, Tribal 

20 Organization, or Urban Indian Organization. Where such 

21 authorization is provided, the Service may receive and ex22 pend such amounts for the provision of additional health 

23 services consistent with such authorization. 

24 ‘‘(g) COSTS AND ATTORNEYS’ FEES.—In any action 

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1 vailing plaintiff shall be awarded its reasonable attorneys’ 

2 fees and costs of litigation. 

3 ‘‘(h) NONAPPLICATION OF CLAIMS FILING REQUIRE4 MENTS.—An insurance company, health maintenance or5 ganization, self-insurance plan, managed care plan, or 

6 other health care plan or program (under the Social Secu7 rity Act or otherwise) may not deny a claim for benefits 

8 submitted by the Service or by an Indian Tribe or Tribal 

9 Organization based on the format in which the claim is 

10 submitted if such format complies with the format re11 quired for submission of claims under title XVIII of the 

12 Social Security Act or recognized under section 1175 of 

13 such Act. 

14 ‘‘(i) APPLICATION TO URBAN INDIAN ORGANIZA15 TIONS.—The previous provisions of this section shall apply 

16 to Urban Indian Organizations with respect to populations 

17 served by such Organizations in the same manner they 

18 apply to Indian Tribes and Tribal Organizations with re19 spect to populations served by such Indian Tribes and 

20 Tribal Organizations. 

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

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

23 to all actions commenced under this section, and the ref24 erences therein to the United States are deemed to include 


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1 Indian Tribes, Tribal Organizations, and Urban Indian 

2 Organizations. 

3 ‘‘(k) SAVINGS.—Nothing in this section shall be con4 strued to limit any right of recovery available to the 

5 United States, an Indian Tribe, or Tribal Organization 

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

7 Tribal law, including medical lien laws. 

8 ‘‘SEC. 404. CREDITING OF REIMBURSEMENTS. 

9 ‘‘(a) USE OF AMOUNTS.— 

10 ‘‘(1) RETENTION BY PROGRAM.—Except as pro11 vided in section 202(f) (relating to the Catastrophic 

12 Health Emergency Fund) and section 807 (relating 

13 to health services for ineligible persons), all reim14 bursements received or recovered under any of the 

15 programs described in paragraph (2), including 

16 under section 807, by reason of the provision of 

17 health services by the Service, by an Indian Tribe or 

18 Tribal Organization, or by an Urban Indian Organi19 zation, shall be credited to the Service, such Indian 

20 Tribe or Tribal Organization, or such Urban Indian 

21 Organization, respectively, and may be used as pro22 vided in section 401. In the case of such a service 

23 provided by or through a Service Unit, such 

24 amounts shall be credited to such unit and used for 

25 such purposes. 


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1 ‘‘(2) PROGRAMS COVERED.—The programs re2 ferred to in paragraph (1) are the following: 

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

4 Social Security Act. 

5 ‘‘(B) This Act, including section 807. 

6 ‘‘(C) Public Law 87–693. 

7 ‘‘(D) Any other provision of law. 

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

9 not offset or limit any amount obligated to any Service 

10 Unit or entity receiving funding from the Service because 

11 of the receipt of reimbursements under subsection (a). 

12 ‘‘SEC. 405. PURCHASING HEALTH CARE COVERAGE. 

13 ‘‘(a) IN GENERAL.—Insofar as amounts are made 

14 available under law (including a provision of the Social 

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

17 law, other than under section 402) to Indian Tribes, Trib18 al Organizations, and Urban Indian Organizations for 

19 health benefits for Service beneficiaries, Indian Tribes, 

20 Tribal Organizations, and Urban Indian Organizations 

21 may use such amounts to purchase health benefits cov22 erage for such beneficiaries in any manner, including 

23 through— 

24 ‘‘(1) a tribally owned and operated health care 

25 plan; 


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1 ‘‘(2) a State or locally authorized or licensed 

2 health care plan; 

3 ‘‘(3) a health insurance provider or managed 

4 care organization; or 

5 ‘‘(4) a self-insured plan. 

6 The purchase of such coverage by an Indian Tribe, Tribal 

7 Organization, or Urban Indian Organization may be based 

8 on the financial needs of such beneficiaries (as determined 

9 by the Indian Tribe or Tribes being served based on a 

10 schedule of income levels developed or implemented by 

11 such Indian Tribe or Tribes). 

12 ‘‘(b) EXPENSES FOR SELF-INSURED PLAN.—In the 

13 case of a self-insured plan under subsection (a)(4), the 

14 amounts may be used for expenses of operating the plan, 

15 including administration and insurance to limit the finan16 cial risks to the entity offering the plan. 

17 ‘‘(c) CONSTRUCTION.—Nothing in this section shall 

18 be construed as affecting the use of any amounts not re19 ferred to in subsection (a). 

20 ‘‘SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGEN21 CIES. 

22 ‘‘(a) AUTHORITY.— 

23 ‘‘(1) IN GENERAL.—The Secretary may enter 

24 into (or expand) arrangements for the sharing of 

25 medical facilities and services between the Service, 


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1 Indian Tribes, and Tribal Organizations and the De2 partment of Veterans Affairs and the Department of 

3 Defense. 

4 ‘‘(2) CONSULTATION BY SECRETARY RE5 QUIRED.—The Secretary may not finalize any ar6 rangement between the Service and a Department 

7 described in paragraph (1) without first consulting 

8 with the Indian Tribes which will be significantly af9 fected by the arrangement. 

10 ‘‘(b) LIMITATIONS.—The Secretary shall not take 

11 any action under this section or under subchapter IV of 

12 chapter 81 of title 38, United States Code, which would 

13 impair— 

14 ‘‘(1) the priority access of any Indian to health 

15 care services provided through the Service and the 

16 eligibility of any Indian to receive health services 

17 through the Service; 

18 ‘‘(2) the quality of health care services provided 

19 to any Indian through the Service; 

20 ‘‘(3) the priority access of any veteran to health 

21 care services provided by the Department of Vet22 erans Affairs; 

23 ‘‘(4) the quality of health care services provided 

24 by the Department of Veterans Affairs or the De25 partment of Defense; or 


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1 ‘‘(5) the eligibility of any Indian who is a vet2 eran to receive health services through the Depart3 ment of Veterans Affairs. 

4 ‘‘(c) REIMBURSEMENT.—The Service, Indian Tribe, 

5 or Tribal Organization shall be reimbursed by the Depart6 ment of Veterans Affairs or the Department of Defense 

7 (as the case may be) where services are provided through 

8 the Service, an Indian Tribe, or a Tribal Organization to 

9 beneficiaries eligible for services from either such Depart10 ment, notwithstanding any other provision of law. 

11 ‘‘(d) CONSTRUCTION.—Nothing in this section may 

12 be construed as creating any right of a non-Indian veteran 

13 to obtain health services from the Service. 

14 ‘‘SEC. 407. PAYOR OF LAST RESORT. 

15 ‘‘Indian Health Programs and health care programs 

16 operated by Urban Indian Organizations shall be the 

17 payor of last resort for services provided to persons eligible 

18 for services from Indian Health Programs and Urban In19 dian Organizations, notwithstanding any Federal, State, 

20 or local law to the contrary. 

21 ‘‘SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH 

22 CARE PROGRAMS IN QUALIFICATIONS FOR 

23 REIMBURSEMENT FOR SERVICES. 

24 ‘‘(a) REQUIREMENT TO SATISFY GENERALLY APPLI25 CABLE PARTICIPATION REQUIREMENTS.— 


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1 ‘‘(1) IN GENERAL.—A Federal health care pro2 gram must accept an entity that is operated by the 

3 Service, an Indian Tribe, Tribal Organization, or 

4 Urban Indian Organization as a provider eligible to 

5 receive payment under the program for health care 

6 services furnished to an Indian on the same basis as 

7 any other provider qualified to participate as a pro8 vider of health care services under the program if 

9 the entity meets generally applicable State or other 

10 requirements for participation as a provider of 

11 health care services under the program. 

12 ‘‘(2) SATISFACTION OF STATE OR LOCAL LICEN13 SURE OR RECOGNITION REQUIREMENTS.—Any re14 quirement for participation as a provider of health 

15 care services under a Federal health care program 

16 that an entity be licensed or recognized under the 

17 State or local law where the entity is located to fur18 nish health care services shall be deemed to have 

19 been met in the case of an entity operated by the 

20 Service, an Indian Tribe, Tribal Organization, or 

21 Urban Indian Organization if the entity meets all 

22 the applicable standards for such licensure or rec23 ognition, regardless of whether the entity obtains a 

24 license or other documentation under such State or 

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1 sence of the licensure of a health care professional 

2 employed by such an entity under the State or local 

3 law where the entity is located shall not be taken 

4 into account for purposes of determining whether 

5 the entity meets such standards, if the professional 

6 is licensed in another State. 

7 ‘‘(b) APPLICATION OF EXCLUSION FROM PARTICIPA8 TION IN FEDERAL HEALTH CARE PROGRAMS.— 

9 ‘‘(1) EXCLUDED ENTITIES.—No entity operated 

10 by the Service, an Indian Tribe, Tribal Organiza11 tion, or Urban Indian Organization that has been 

12 excluded from participation in any Federal health 

13 care program or for which a license is under suspen14 sion or has been revoked by the State where the en15 tity is located shall be eligible to receive payment or 

16 reimbursement under any such program for health 

17 care services furnished to an Indian. 

18 ‘‘(2) EXCLUDED INDIVIDUALS.—No individual 

19 who has been excluded from participation in any 

20 Federal health care program or whose State license 

21 is under suspension shall be eligible to receive pay22 ment or reimbursement under any such program for 

23 health care services furnished by that individual, di24 rectly or through an entity that is otherwise eligible 


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1 to receive payment for health care services, to an In2 dian. 

3 ‘‘(3) FEDERAL HEALTH CARE PROGRAM DE4 FINED.—In this subsection, the term, ‘Federal 

5 health care program’ has the meaning given that 

6 term in section 1128B(f) of the Social Security Act 

7 (42 U.S.C. 1320a–7b(f)), except that, for purposes 

8 of this subsection, such term shall include the health 

9 insurance program under chapter 89 of title 5, 

10 United States Code. 

11 ‘‘(c) RELATED PROVISIONS.—For provisions related 

12 to nondiscrimination against providers operated by the 

13 Service, an Indian Tribe, Tribal Organization, or Urban 

14 Indian Organization, see section 1139(c) of the Social Se15 curity Act (42 U.S.C. 1320b–9(c)). 

16 ‘‘SEC. 409. CONSULTATION. 

17 ‘‘For provisions related to consultation with rep18 resentatives of Indian Health Programs and Urban Indian 

19 Organizations with respect to the health care programs 

20 established under titles XVIII, XIX, and XXI of the Social 

21 Security Act, see section 1139(d) of the Social Security 

22 Act (42 U.S.C. 1320b–9(d)). 

23 ‘‘SEC. 410. STATE CHILDREN’S HEALTH INSURANCE PRO24 GRAM (SCHIP). 

25 ‘‘For provisions relating to— 


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1 ‘‘(1) outreach to families of Indian children 

2 likely to be eligible for child health assistance under 

3 the State children’s health insurance program estab4 lished under title XXI of the Social Security Act, see 

5 sections 2105(c)(2)(C) and 1139(a) of such Act (42 

6 U.S.C. 1397ee(c)(2), 1320b–9); and 

7 ‘‘(2) ensuring that child health assistance is 

8 provided under such program to targeted low-income 

9 children who are Indians and that payments are 

10 made under such program to Indian Health Pro11 grams and Urban Indian Organizations operating in 

12 the State that provide such assistance, see sections 

13 2102(b)(3)(D) and 2105(c)(6)(B) of such Act (42 

14 U.S.C. 1397bb(b)(3)(D), 1397ee(c)(6)(B)). 

15 ‘‘SEC. 411. EXCLUSION WAIVER AUTHORITY FOR AFFECTED 

16 INDIAN HEALTH PROGRAMS AND SAFE HAR17 BOR TRANSACTIONS UNDER THE SOCIAL SE18 CURITY ACT. 

19 ‘‘For provisions relating to— 

20 ‘‘(1) exclusion waiver authority for affected In21 dian Health Programs under the Social Security 

22 Act, see section 1128(k) of the Social Security Act 

23 (42 U.S.C. 1320a–7(k)); and 

24 ‘‘(2) certain transactions involving Indian 

25 Health Programs deemed to be in safe harbors 


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1 under that Act, see section 1128B(b)(4) of the So2 cial Security Act (42 U.S.C. 1320a–7b(b)(4)). 

3 ‘‘SEC. 412. PREMIUM AND COST SHARING PROTECTIONS 

4 AND ELIGIBILITY DETERMINATIONS UNDER 

5 MEDICAID AND SCHIP AND PROTECTION OF 

6 CERTAIN INDIAN PROPERTY FROM MEDICAID 

7 ESTATE RECOVERY. 

8 ‘‘For provisions relating to— 

9 ‘‘(1) premiums or cost sharing protections for 

10 Indians furnished items or services directly by In11 dian Health Programs or through referral under the 

12 contract health service under the Medicaid program 

13 established under title XIX of the Social Security 

14 Act, see sections 1916(j) and 1916A(a)(1) of the So15 cial Security Act (42 U.S.C. 1396o(j), 1396o– 

16 1(a)(1)); 

17 ‘‘(2) rules regarding the treatment of certain 

18 property for purposes of determining eligibility 

19 under such programs, see sections 1902(e)(13) and 

20 2107(e)(1)(B) of such Act (42 U.S.C. 1396a(e)(13), 

21 1397gg(e)(1)(B)); and 

22 ‘‘(3) the protection of certain property from es23 tate recovery provisions under the Medicaid pro24 gram, see section 1917(b)(3)(B) of such Act (42 

25 U.S.C. 1396p(b)(3)(B)). 


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1 ‘‘SEC. 413. TREATMENT UNDER MEDICAID AND SCHIP MAN2 AGED CARE. 

3 ‘‘For provisions relating to the treatment of Indians 

4 enrolled in a managed care entity under the Medicaid pro5 gram under title XIX of the Social Security Act and In6 dian Health Programs and Urban Indian Organizations 

7 that are providers of items or services to such Indian en8 rollees, see sections 1932(h) and 2107(e)(1)(H) of the So9 cial Security Act (42 U.S.C. 1396u–2(h), 

10 1397gg(e)(1)(H)). 

11 ‘‘SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASI12 BILITY STUDY. 

13 ‘‘(a) STUDY.—The Secretary shall conduct a study 

14 to determine the feasibility of treating the Navajo Nation 

15 as a State for the purposes of title XIX of the Social Secu16 rity Act, to provide services to Indians living within the 

17 boundaries of the Navajo Nation through an entity estab18 lished having the same authority and performing the same 

19 functions as single-State medicaid agencies responsible for 

20 the administration of the State plan under title XIX of 

21 the Social Security Act. 

22 ‘‘(b) CONSIDERATIONS.—In conducting the study, 

23 the Secretary shall consider the feasibility of— 

24 ‘‘(1) assigning and paying all expenditures for 

25 the provision of services and related administration 

26 funds, under title XIX of the Social Security Act, to 


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1 Indians living within the boundaries of the Navajo 

2 Nation that are currently paid to or would otherwise 

3 be paid to the State of Arizona, New Mexico, or 

4 Utah; 

5 ‘‘(2) providing assistance to the Navajo Nation 

6 in the development and implementation of such enti7 ty for the administration, eligibility, payment, and 

8 delivery of medical assistance under title XIX of the 

9 Social Security Act; 

10 ‘‘(3) providing an appropriate level of matching 

11 funds for Federal medical assistance with respect to 

12 amounts such entity expends for medical assistance 

13 for services and related administrative costs; and 

14 ‘‘(4) authorizing the Secretary, at the option of 

15 the Navajo Nation, to treat the Navajo Nation as a 

16 State for the purposes of title XIX of the Social Se17 curity Act (relating to the State children’s health in18 surance program) under terms equivalent to those 

19 described in paragraphs (2) through (4). 

20 ‘‘(c) REPORT.—Not later then 3 years after the date 

21 of enactment of the Indian Health Care Improvement Act 

22 Amendments of 2007, the Secretary shall submit to the 

23 Committee on Indian Affairs and Committee on Finance 

24 of the Senate and the Committee on Natural Resources 


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1 and Committee on Energy and Commerce of the House 

2 of Representatives a report that includes— 

3 ‘‘(1) the results of the study under this section; 

4 ‘‘(2) a summary of any consultation that oc5 curred between the Secretary and the Navajo Na6 tion, other Indian Tribes, the States of Arizona, 

7 New Mexico, and Utah, counties which include Nav8 ajo Lands, and other interested parties, in con9 ducting this study; 

10 ‘‘(3) projected costs or savings associated with 

11 establishment of such entity, and any estimated im12 pact on services provided as described in this section 

13 in relation to probable costs or savings; and 

14 ‘‘(4) legislative actions that would be required 

15 to authorize the establishment of such entity if such 

16 entity is determined by the Secretary to be feasible. 

17 ‘‘SEC. 415. GENERAL EXCEPTIONS. 

18 ‘‘The requirements of this title shall not apply to any 

19 excepted benefits described in paragraph (1)(A) or (3) of 

20 section 2791(c) of the Public Health Service Act (42 

21 U.S.C. 300gg–91). 

22 ‘‘SEC. 416. AUTHORIZATION OF APPROPRIATIONS. 

23 ‘‘There are authorized to be appropriated such sums 

24 as may be necessary for each fiscal year through fiscal 

25 year 2017 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 and maintain 

5 programs in Urban Centers to make health services more 

6 accessible 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) (commonly known as the ‘Snyder Act’), 

11 the Secretary, acting through the Service, shall enter into 

12 contracts with, or make grants to, Urban Indian Organi13 zations to assist such organizations in the establishment 

14 and administration, within Urban Centers, of programs 

15 which meet the requirements set forth in this title. Subject 

16 to section 506, the Secretary, acting through the Service, 

17 shall include such conditions as the Secretary considers 

18 necessary to effect the purpose of this title in any contract 

19 into which the Secretary enters with, or in any grant the 

20 Secretary makes to, any Urban Indian Organization pur21 suant to this title. 

22 ‘‘SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION 

23 OF HEALTH CARE AND REFERRAL SERVICES. 

24 ‘‘(a) REQUIREMENTS FOR GRANTS AND CON25 TRACTS.—Under authority of the Act of November 2, 


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1 1921 (25 U.S.C. 13) (commonly known as the ‘Snyder 

2 Act’), the Secretary, acting through the Service, shall 

3 enter into contracts with, and make grants to, Urban In4 dian Organizations for the provision of health care and 

5 referral services for Urban Indians. Any such contract or 

6 grant shall include requirements that the Urban Indian 

7 Organization successfully undertake to— 

8 ‘‘(1) estimate the population of Urban Indians 

9 residing in the Urban Center or centers that the or10 ganization proposes to serve who are or could be re11 cipients of health care or referral services; 

12 ‘‘(2) estimate the current health status of 

13 Urban Indians residing in such Urban Center or 

14 centers; 

15 ‘‘(3) estimate the current health care needs of 

16 Urban Indians residing in such Urban Center or 

17 centers; 

18 ‘‘(4) provide basic health education, including 

19 health promotion and disease prevention education, 

20 to Urban Indians; 

21 ‘‘(5) make recommendations to the Secretary 

22 and Federal, State, local, and other resource agen23 cies on methods of improving health service pro24 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) CRITERIA.—The Secretary, acting through the 

5 Service, shall, by regulation, prescribe the criteria for se6 lecting Urban Indian Organizations to enter into contracts 

7 or receive grants under this section. Such criteria shall, 

8 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, or under any current 

17 public health service project funded in a manner 

18 other than pursuant to this title; 

19 ‘‘(4) the capability of an Urban Indian Organi20 zation to perform the activities set forth in sub21 section (a) and to enter into a contract with the Sec22 retary or to meet the requirements for receiving a 

23 grant under this section; 


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1 ‘‘(5) the satisfactory performance and success2 ful completion by an Urban Indian Organization of 

3 other contracts with the Secretary under this title; 

4 ‘‘(6) the appropriateness and likely effectiveness 

5 of conducting the activities set forth in subsection 

6 (a) in an Urban Center or centers; and 

7 ‘‘(7) the extent of existing or likely future par8 ticipation in the activities set forth in subsection (a) 

9 by appropriate health and health-related Federal, 

10 State, local, and other agencies. 

11 ‘‘(c) ACCESS TO HEALTH PROMOTION AND DISEASE

12 PREVENTION PROGRAMS.—The Secretary, acting through 

13 the Service, shall facilitate access to or provide health pro14 motion and disease prevention services for Urban Indians 

15 through grants made to Urban Indian Organizations ad16 ministering contracts entered into or receiving grants 

17 under subsection (a). 

18 ‘‘(d) IMMUNIZATION SERVICES.— 

19 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

20 Secretary, acting through the Service, shall facilitate 

21 access to, or provide, immunization services for 

22 Urban Indians through grants made to Urban In23 dian Organizations administering contracts entered 

24 into or receiving grants under this section. 


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1 ‘‘(2) DEFINITION.—For purposes of this sub2 section, the term ‘immunization services’ means 

3 services to provide without charge immunizations 

4 against vaccine-preventable diseases. 

5 ‘‘(e) BEHAVIORAL HEALTH SERVICES.— 

6 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

7 Secretary, acting through the Service, shall facilitate 

8 access to, or provide, behavioral health services for 

9 Urban Indians through grants made to Urban In10 dian Organizations administering contracts entered 

11 into or receiving grants under subsection (a). 

12 ‘‘(2) ASSESSMENT REQUIRED.—Except as pro13 vided by paragraph (3)(A), a grant may not be made 

14 under this subsection to an Urban Indian Organiza15 tion until that organization has prepared, and the 

16 Service has approved, an assessment of the fol17 lowing: 

18 ‘‘(A) The behavioral health needs of the 

19 Urban Indian population concerned. 

20 ‘‘(B) The behavioral health services and 

21 other related resources available to that popu22 lation. 

23 ‘‘(C) The barriers to obtaining those serv24 ices and resources. 


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1 ‘‘(D) The needs that are unmet by such 

2 services and resources. 

3 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

4 made under this subsection for the following: 

5 ‘‘(A) To prepare assessments required 

6 under paragraph (2). 

7 ‘‘(B) To provide outreach, educational, and 

8 referral services to Urban Indians regarding the 

9 availability of direct behavioral health services, 

10 to educate Urban Indians about behavioral 

11 health issues and services, and effect coordina12 tion with existing behavioral health providers in 

13 order to improve services to Urban Indians. 

14 ‘‘(C) To provide outpatient behavioral 

15 health services to Urban Indians, including the 

16 identification and assessment of illness, thera17 peutic treatments, case management, support 

18 groups, family treatment, and other treatment. 

19 ‘‘(D) To develop innovative behavioral 

20 health service delivery models which incorporate 

21 Indian cultural support systems and resources. 

22 ‘‘(f) PREVENTION OF CHILD ABUSE.— 

23 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

24 Secretary, acting through the Service, shall facilitate 

25 access to or provide services for Urban Indians 


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1 through grants to Urban Indian Organizations ad2 ministering contracts entered into or receiving 

3 grants under subsection (a) to prevent and treat 

4 child abuse (including sexual abuse) among Urban 

5 Indians. 

6 ‘‘(2) EVALUATION REQUIRED.—Except as pro7 vided by paragraph (3)(A), a grant may not be made 

8 under this subsection to an Urban Indian Organiza9 tion until that organization has prepared, and the 

10 Service has approved, an assessment that documents 

11 the prevalence of child abuse in the Urban Indian 

12 population concerned and specifies the services and 

13 programs (which may not duplicate existing services 

14 and programs) for which the grant is requested. 

15 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

16 made under this subsection for the following: 

17 ‘‘(A) To prepare assessments required 

18 under paragraph (2). 

19 ‘‘(B) For the development of prevention, 

20 training, and education programs for Urban In21 dians, including child education, parent edu22 cation, provider training on identification and 

23 intervention, education on reporting require24 ments, prevention campaigns, and establishing 


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1 service networks of all those involved in Indian 

2 child protection. 

3 ‘‘(C) To provide direct outpatient treat4 ment services (including individual treatment, 

5 family treatment, group therapy, and support 

6 groups) to Urban Indians who are child victims 

7 of abuse (including sexual abuse) or adult sur8 vivors of child sexual abuse, to the families of 

9 such child victims, and to Urban Indian per10 petrators of child abuse (including sexual 

11 abuse). 

12 ‘‘(4) CONSIDERATIONS WHEN MAKING

13 GRANTS.—In making grants to carry out this sub14 section, the Secretary shall take into consideration— 

15 ‘‘(A) the support for the Urban Indian Or16 ganization demonstrated by the child protection 

17 authorities in the area, including committees or 

18 other services funded under the Indian Child 

19 Welfare Act of 1978 (25 U.S.C. 1901 et seq.), 

20 if any; 

21 ‘‘(B) the capability and expertise dem22 onstrated by the Urban Indian Organization to 

23 address the complex problem of child sexual 

24 abuse in the community; and 


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1 ‘‘(C) the assessment required under para2 graph (2). 

3 ‘‘(g) OTHER GRANTS.—The Secretary, acting 

4 through the Service, may enter into a contract with or 

5 make grants to an Urban Indian Organization that pro6 vides or arranges for the provision of health care services 

7 (through satellite facilities, provider networks, or other8 wise) to Urban Indians in more than 1 Urban Center. 

9 ‘‘SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINA10 TION OF UNMET HEALTH CARE NEEDS. 

11 ‘‘(a) GRANTS AND CONTRACTS AUTHORIZED.— 

12 Under authority of the Act of November 2, 1921 (25 

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

14 Secretary, acting through the Service, may enter into con15 tracts with or make grants to Urban Indian Organizations 

16 situated in Urban Centers for which contracts have not 

17 been entered into or grants have not been made under sec18 tion 503. 

19 ‘‘(b) PURPOSE.—The purpose of a contract or grant 

20 made under this section shall be the determination of the 

21 matters described in subsection (c)(1) in order to assist 

22 the Secretary in assessing the health status and health 

23 care needs of Urban Indians in the Urban Center involved 

24 and determining whether the Secretary should enter into 

25 a contract or make a grant under section 503 with respect 


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1 to the Urban Indian Organization which the Secretary has 

2 entered into a contract with, or made a grant to, under 

3 this section. 

4 ‘‘(c) GRANT AND CONTRACT REQUIREMENTS.—Any 

5 contract entered into, or grant made, by the Secretary 

6 under this section shall include requirements that— 

7 ‘‘(1) the Urban Indian Organization success8 fully undertakes to— 

9 ‘‘(A) document the health care status and 

10 unmet health care needs of Urban Indians in 

11 the Urban Center involved; and 

12 ‘‘(B) with respect to Urban Indians in the 

13 Urban Center involved, determine the matters 

14 described in paragraphs (2), (3), (4), and (7) of 

15 section 503(b); and 

16 ‘‘(2) the Urban Indian Organization complete 

17 performance of the contract, or carry out the re18 quirements of the grant, within 1 year after the date 

19 on which the Secretary and such organization enter 

20 into such contract, or within 1 year after such orga21 nization receives such grant, whichever is applicable. 

22 ‘‘(d) NO RENEWALS.—The Secretary may not renew 

23 any contract entered into or grant made under this sec24 tion. 


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1 ‘‘SEC. 505. EVALUATIONS; RENEWALS. 

2 ‘‘(a) PROCEDURES FOR EVALUATIONS.—The Sec3 retary, acting through the Service, shall develop proce4 dures to evaluate compliance with grant requirements and 

5 compliance with and performance of contracts entered into 

6 by Urban Indian Organizations under this title. Such pro7 cedures shall include provisions for carrying out the re8 quirements of this section. 

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

10 the Service, shall evaluate the compliance of each Urban 

11 Indian Organization which has entered into a contract or 

12 received a grant under section 503 with the terms of such 

13 contract or grant. For purposes of this evaluation, the 

14 Secretary shall— 

15 ‘‘(1) acting through the Service, conduct an an16 nual onsite evaluation of the organization; or 

17 ‘‘(2) accept in lieu of such onsite evaluation evi18 dence of the organization’s provisional or full accred19 itation by a private independent entity recognized by 

20 the Secretary for purposes of conducting quality re21 views of providers participating in the Medicare pro22 gram under title XVIII of the Social Security Act. 

23 ‘‘(c) NONCOMPLIANCE; UNSATISFACTORY PERFORM24 ANCE.—If, as a result of the evaluations conducted under 

25 this section, the Secretary determines that an Urban In26 dian Organization has not complied with the requirements 


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1 of a grant or complied with or satisfactorily performed a 

2 contract under section 503, the Secretary shall, prior to 

3 renewing such contract or grant, attempt to resolve with 

4 the organization the areas of noncompliance or unsatisfac5 tory performance and modify the contract or grant to pre6 vent future occurrences of noncompliance or unsatisfac7 tory performance. If the Secretary determines that the 

8 noncompliance or unsatisfactory performance cannot be 

9 resolved and prevented in the future, the Secretary shall 

10 not renew the contract or grant with the organization and 

11 is authorized to enter into a contract or make a grant 

12 under section 503 with another Urban Indian Organiza13 tion which is situated in the same Urban Center as the 

14 Urban Indian Organization whose contract or grant is not 

15 renewed under this section. 

16 ‘‘(d) CONSIDERATIONS FOR RENEWALS.—In deter17 mining whether to renew a contract or grant with an 

18 Urban Indian Organization under section 503 which has 

19 completed performance of a contract or grant under sec20 tion 504, the Secretary shall review the records of the 

21 Urban Indian Organization, the reports submitted under 

22 section 507, and shall consider the results of the onsite 

23 evaluations or accreditations under subsection (b). 


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1 ‘‘SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS. 

2 ‘‘(a) PROCUREMENT.—Contracts with Urban Indian 

3 Organizations entered into pursuant to this title shall be 

4 in accordance with all Federal contracting laws and regu5 lations relating to procurement except that in the discre6 tion of the Secretary, such contracts may be negotiated 

7 without advertising and need not conform to the provisions 

8 of sections 1304 and 3131 through 3133 of title 40, 

9 United States Code. 

10 ‘‘(b) PAYMENTS UNDER CONTRACTS OR GRANTS.— 

11 ‘‘(1) IN GENERAL.—Payments under any con12 tracts or grants pursuant to this title, notwith13 standing any term or condition of such contract or 

14 grant— 

15 ‘‘(A) may be made in a single advance pay16 ment by the Secretary to the Urban Indian Or17 ganization by no later than the end of the first 

18 30 days of the funding period with respect to 

19 which the payments apply, unless the Secretary 

20 determines through an evaluation under section 

21 505 that the organization is not capable of ad22 ministering such a single advance payment; and 

23 ‘‘(B) if any portion thereof is unexpended 

24 by the Urban Indian Organization during the 

25 funding period with respect to which the pay26 ments initially apply, shall be carried forward 


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1 for expenditure with respect to allowable or re2 imbursable costs incurred by the organization 

3 during 1 or more subsequent funding periods 

4 without additional justification or documenta5 tion by the organization as a condition of car6 rying forward the availability for expenditure of 

7 such funds. 

8 ‘‘(2) SEMIANNUAL AND QUARTERLY PAYMENTS

9 AND REIMBURSEMENTS.—If the Secretary deter10 mines under paragraph (1)(A) that an Urban Indian 

11 Organization is not capable of administering an en12 tire single advance payment, on request of the 

13 Urban Indian Organization, the payments may be 

14 made— 

15 ‘‘(A) in semiannual or quarterly payments 

16 by not later than 30 days after the date on 

17 which the funding period with respect to which 

18 the payments apply begins; or 

19 ‘‘(B) by way of reimbursement. 

20 ‘‘(c) REVISION OR AMENDMENT OF CONTRACTS.— 

21 Notwithstanding any provision of law to the contrary, the 

22 Secretary may, at the request and consent of an Urban 

23 Indian Organization, revise or amend any contract entered 

24 into by the Secretary with such organization under this 

25 title as necessary to carry out the purposes of this title. 


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1 ‘‘(d) FAIR AND UNIFORM SERVICES AND ASSIST2 ANCE.—Contracts with or grants to Urban Indian Organi3 zations and regulations adopted pursuant to this title shall 

4 include provisions to assure the fair and uniform provision 

5 to Urban Indians of services and assistance under such 

6 contracts or grants by such organizations. 

7 ‘‘SEC. 507. REPORTS AND RECORDS. 

8 ‘‘(a) REPORTS.— 

9 ‘‘(1) IN GENERAL.—For each fiscal year during 

10 which an Urban Indian Organization receives or ex11 pends funds pursuant to a contract entered into or 

12 a grant received pursuant to this title, such Urban 

13 Indian Organization shall submit to the Secretary 

14 not more frequently than every 6 months, a report 

15 that includes the following: 

16 ‘‘(A) In the case of a contract or grant 

17 under section 503, recommendations pursuant 

18 to section 503(a)(5). 

19 ‘‘(B) Information on activities conducted 

20 by the organization pursuant to the contract or 

21 grant. 

22 ‘‘(C) An accounting of the amounts and 

23 purpose for which Federal funds were ex24 pended. 


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1 ‘‘(D) A minimum set of data, using uni2 formly defined elements, as specified by the 

3 Secretary after consultation with Urban Indian 

4 Organizations. 

5 ‘‘(2) HEALTH STATUS AND SERVICES.— 

6 ‘‘(A) IN GENERAL.—Not later than 18 

7 months after the date of enactment of the In8 dian Health Care Improvement Act Amend9 ments of 2007, the Secretary, acting through 

10 the Service, shall submit to Congress a report 

11 evaluating— 

12 ‘‘(i) the health status of Urban Indi13 ans; 

14 ‘‘(ii) the services provided to Indians 

15 pursuant to this title; and 

16 ‘‘(iii) areas of unmet needs in the de17 livery of health services to Urban Indians. 

18 ‘‘(B) CONSULTATION AND CONTRACTS.— 

19 In preparing the report under paragraph (1), 

20 the Secretary— 

21 ‘‘(i) shall consult with Urban Indian 

22 Organizations; and 

23 ‘‘(ii) may enter into a contract with a 

24 national organization representing Urban 


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1 Indian Organizations to conduct any as2 pect of the report. 

3 ‘‘(b) AUDIT.—The reports and records of the Urban 

4 Indian Organization with respect to a contract or grant 

5 under this title shall be subject to audit by the Secretary 

6 and the Comptroller General of the United States. 

7 ‘‘(c) COSTS OF AUDITS.—The Secretary shall allow 

8 as a cost of any contract or grant entered into or awarded 

9 under section 502 or 503 the cost of an annual inde10 pendent financial audit 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) GRANTS.—The Secretary, acting through the 

21 Service, may make grants to contractors or grant recipi22 ents under this title for the lease, purchase, renovation, 

23 construction, or expansion of facilities, including leased fa24 cilities, in order to assist such contractors or grant recipiVerDate Aug 31 2005 21:58 Apr 25, 2007 Jkt 059200 PO 00000 Frm 00234 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.IS S1200

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1 ents in complying with applicable licensure or certification 

2 requirements. 

3 ‘‘(b) LOAN FUND STUDY.—The Secretary, acting 

4 through the Service, may carry out a study to determine 

5 the feasibility of establishing a loan fund to provide to 

6 Urban Indian Organizations direct loans or guarantees for 

7 loans for the construction of health care facilities in a 

8 manner consistent with section 309, including by submit9 ting a report in accordance with subsection (c) of that sec10 tion. 

11 ‘‘SEC. 510. DIVISION OF URBAN INDIAN HEALTH. 

12 ‘‘There is established within the Service a Division 

13 of Urban Indian Health, which shall be responsible for— 

14 ‘‘(1) carrying out the provisions of this title; 

15 ‘‘(2) providing central oversight of the pro16 grams and services authorized under this title; and 

17 ‘‘(3) providing technical assistance to Urban In18 dian Organizations. 

19 ‘‘SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE20 RELATED SERVICES. 

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

22 through the Service, may make grants for the provision 

23 of health-related services in prevention of, treatment of, 

24 rehabilitation of, or school- and community-based edu25 cation regarding, alcohol and substance abuse in Urban 


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1 Centers to those Urban Indian Organizations with which 

2 the Secretary has entered into a contract under this title 

3 or under section 201. 

4 ‘‘(b) GOALS.—Each grant made pursuant to sub5 section (a) shall set forth the goals to be accomplished 

6 pursuant to the grant. The goals shall be specific to each 

7 grant as agreed to between the Secretary and the grantee. 

8 ‘‘(c) CRITERIA.—The Secretary shall establish cri9 teria for the grants made under subsection (a), including 

10 criteria relating to the following: 

11 ‘‘(1) The size of the Urban Indian population. 

12 ‘‘(2) Capability of the organization to ade13 quately perform the activities required under the 

14 grant. 

15 ‘‘(3) Satisfactory performance standards for the 

16 organization in meeting the goals set forth in such 

17 grant. The standards shall be negotiated and agreed 

18 to between the Secretary and the grantee on a 

19 grant-by-grant basis. 

20 ‘‘(4) Identification of the need for services. 

21 ‘‘(d) ALLOCATION OF GRANTS.—The Secretary shall 

22 develop a methodology for allocating grants made pursu23 ant to this section based on the criteria established pursu24 ant to subsection (c). 


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1 ‘‘(e) GRANTS SUBJECT TO CRITERIA.—Any grant re2 ceived by an Urban Indian Organization under this Act 

3 for substance abuse prevention, treatment, and rehabilita4 tion shall be subject to the criteria set forth in subsection 

5 (c). 

6 ‘‘SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION 

7 PROJECTS. 

8 ‘‘Notwithstanding any other provision of law, the 

9 Tulsa Clinic and Oklahoma City Clinic demonstration 

10 projects shall— 

11 ‘‘(1) be permanent programs within the Serv12 ice’s direct care program; 

13 ‘‘(2) continue to be treated as Service Units 

14 and Operating Units in the allocation of resources 

15 and coordination of care; and 

16 ‘‘(3) continue to meet the requirements and 

17 definitions of an Urban Indian Organization in this 

18 Act, and shall not be subject to the provisions of the 

19 Indian Self-Determination and Education Assistance 

20 Act (25 U.S.C. 450 et seq.). 

21 ‘‘SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS. 

22 ‘‘(a) GRANTS AND CONTRACTS.—The Secretary, 

23 through the Division of Urban Indian Health, shall make 

24 grants or enter into contracts with Urban Indian Organi25 zations, to take effect not later than September 30, 2010, 


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1 for the administration of Urban Indian alcohol programs 

2 that were originally established under the National Insti3 tute on Alcoholism and Alcohol Abuse (hereafter in this 

4 section referred to as ‘NIAAA’) and transferred to the 

5 Service. 

6 ‘‘(b) USE OF FUNDS.—Grants provided or contracts 

7 entered into under this section shall be used to provide 

8 support for the continuation of alcohol prevention and 

9 treatment services for Urban Indian populations and such 

10 other objectives as are agreed upon between the Service 

11 and a recipient of a grant or contract under this section. 

12 ‘‘(c) ELIGIBILITY.—Urban Indian Organizations that 

13 operate Indian alcohol programs originally funded under 

14 the NIAAA and subsequently transferred to the Service 

15 are eligible for grants or contracts under this section. 

16 ‘‘(d) REPORT.—The Secretary shall evaluate and re17 port to Congress on the activities of programs funded 

18 under this section not less than every 5 years. 

19 ‘‘SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZA20 TIONS. 

21 ‘‘(a) IN GENERAL.—The Secretary shall ensure that 

22 the Service consults, to the greatest extent practicable, 

23 with Urban Indian Organizations. 

24 ‘‘(b) DEFINITION OF CONSULTATION.—For purposes 

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1 change of information and opinions which leads to mutual 

2 understanding and comprehension and which emphasizes 

3 trust, respect, and shared responsibility. 

4 ‘‘SEC. 515. URBAN YOUTH TREATMENT CENTER DEM5 ONSTRATION. 

6 ‘‘(a) CONSTRUCTION AND OPERATION.—The Sec7 retary, acting through the Service, through grant or con8 tract, is authorized to fund the construction and operation 

9 of at least 2 residential treatment centers in each State 

10 described in subsection (b) to demonstrate the provision 

11 of alcohol and substance abuse treatment services to 

12 Urban Indian youth in a culturally competent residential 

13 setting. 

14 ‘‘(b) DEFINITION OF STATE.—A State described in 

15 this subsection is a State in which— 

16 ‘‘(1) there resides Urban Indian youth with 

17 need for alcohol and substance abuse treatment serv18 ices in a residential setting; and 

19 ‘‘(2) there is a significant shortage of culturally 

20 competent residential treatment services for Urban 

21 Indian youth. 

22 ‘‘SEC. 516. GRANTS FOR DIABETES PREVENTION, TREAT23 MENT, AND CONTROL. 

24 ‘‘(a) GRANTS AUTHORIZED.—The Secretary may 

25 make grants to those Urban Indian Organizations that 


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1 have entered into a contract or have received a grant 

2 under this title for the provision of services for the preven3 tion and treatment of, and control of the complications 

4 resulting from, diabetes among Urban Indians. 

5 ‘‘(b) GOALS.—Each grant made pursuant to sub6 section (a) shall set forth the goals to be accomplished 

7 under the grant. The goals shall be specific to each grant 

8 as agreed to between the Secretary and the grantee. 

9 ‘‘(c) ESTABLISHMENT OF CRITERIA.—The Secretary 

10 shall establish criteria for the grants made under sub11 section (a) relating to— 

12 ‘‘(1) the size and location of the Urban Indian 

13 population to be served; 

14 ‘‘(2) the need for prevention of and treatment 

15 of, and control of the complications resulting from, 

16 diabetes among the Urban Indian population to be 

17 served; 

18 ‘‘(3) performance standards for the organiza19 tion in meeting the goals set forth in such grant 

20 that are negotiated and agreed to by the Secretary 

21 and the grantee; 

22 ‘‘(4) the capability of the organization to ade23 quately perform the activities required under the 

24 grant; and 


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1 ‘‘(5) the willingness of the organization to col2 laborate with the registry, if any, established by the 

3 Secretary under section 204(e) in the Area Office of 

4 the Service in which the organization is located. 

5 ‘‘(d) FUNDS SUBJECT TO CRITERIA.—Any funds re6 ceived by an Urban Indian Organization under this Act 

7 for the prevention, treatment, and control of diabetes 

8 among Urban Indians shall be subject to the criteria devel9 oped by the Secretary under subsection (c). 

10 ‘‘SEC. 517. COMMUNITY HEALTH REPRESENTATIVES. 

11 ‘‘The Secretary, acting through the Service, may 

12 enter into contracts with, and make grants to, Urban In13 dian Organizations for the employment of Indians trained 

14 as health service providers through the Community Health 

15 Representatives Program under section 109 in the provi16 sion of health care, health promotion, and disease preven17 tion services to Urban Indians. 

18 ‘‘SEC. 518. EFFECTIVE DATE. 

19 ‘‘The amendments made by the Indian Health Care 

20 Improvement Act Amendments of 2007 to this title shall 

21 take effect beginning on the date of enactment of that Act, 

22 regardless of whether the Secretary has promulgated regu23 lations implementing such amendments. 


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1 ‘‘SEC. 519. ELIGIBILITY FOR SERVICES. 

2 ‘‘Urban Indians shall be eligible for, and the ultimate 

3 beneficiaries of, health care or referral services provided 

4 pursuant to this title. 

5 ‘‘SEC. 520. AUTHORIZATION OF APPROPRIATIONS. 

6 ‘‘There are authorized to be appropriated such sums 

7 as may be necessary for each fiscal year through fiscal 

8 year 2017 to carry out this title. 

9 ‘‘TITLE VI—ORGANIZATIONAL 

10 IMPROVEMENTS 

11 ‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV12 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

13 SERVICE. 

14 ‘‘(a) ESTABLISHMENT.— 

15 ‘‘(1) IN GENERAL.—In order to more effectively 

16 and efficiently carry out the responsibilities, authori17 ties, and functions of the United States to provide 

18 health care services to Indians and Indian Tribes, as 

19 are or may be hereafter provided by Federal statute 

20 or treaties, there is established within the Public 

21 Health Service of the Department the Indian Health 

22 Service. 

23 ‘‘(2) ASSISTANT SECRETARY FOR INDIAN

24 HEALTH.—The Service shall be administered by an 

25 Assistant Secretary for Indian Health, who shall be 

26 appointed by the President, by and with the advice 


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1 and consent of the Senate. The Assistant Secretary 

2 shall report to the Secretary. Effective with respect 

3 to an individual appointed by the President, by and 

4 with the advice and consent of the Senate, after 

5 January 1, 2007, the term of service of the Assist6 ant Secretary shall be 4 years. An Assistant Sec7 retary may serve more than 1 term. 

8 ‘‘(3) INCUMBENT.—The individual serving in 

9 the position of Director of the Service on the day be10 fore the date of enactment of the Indian Health 

11 Care Improvement Act Amendments of 2007 shall 

12 serve as Assistant Secretary. 

13 ‘‘(4) ADVOCACY AND CONSULTATION.—The po14 sition of Assistant Secretary is established to, in a 

15 manner consistent with the government-to-govern16 ment relationship between the United States and In17 dian Tribes— 

18 ‘‘(A) facilitate advocacy for the develop19 ment of appropriate Indian health policy; and 

20 ‘‘(B) promote consultation on matters re21 lating to Indian health. 

22 ‘‘(b) AGENCY.—The Service shall be an agency within 

23 the Public Health Service of the Department, and shall 

24 not be an office, component, or unit of any other agency 

25 of the Department. 


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1 ‘‘(c) DUTIES.—The Assistant Secretary shall— 

2 ‘‘(1) perform all functions that were, on the day 

3 before the date of enactment of the Indian Health 

4 Care Improvement Act Amendments of 2007, car5 ried out by or under the direction of the individual 

6 serving as Director of the Service on that day; 

7 ‘‘(2) perform all functions of the Secretary re8 lating to the maintenance and operation of hospital 

9 and health facilities for Indians and the planning 

10 for, and provision and utilization of, health services 

11 for Indians; 

12 ‘‘(3) administer all health programs under 

13 which health care is provided to Indians based upon 

14 their status as Indians which are administered by 

15 the Secretary, including programs under— 

16 ‘‘(A) this Act; 

17 ‘‘(B) the Act of November 2, 1921 (25 

18 U.S.C. 13); 

19 ‘‘(C) the Act of August 5, 1954 (42 U.S.C. 

20 2001 et seq.); 

21 ‘‘(D) the Act of August 16, 1957 (42 

22 U.S.C. 2005 et seq.); and 

23 ‘‘(E) the Indian Self-Determination and 

24 Education Assistance Act (25 U.S.C. 450 et 

25 seq.); 


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1 ‘‘(4) administer all scholarship and loan func2 tions carried out under title I; 

3 ‘‘(5) report directly to the Secretary concerning 

4 all policy- and budget-related matters affecting In5 dian health; 

6 ‘‘(6) collaborate with the Assistant Secretary 

7 for Health concerning appropriate matters of Indian 

8 health that affect the agencies of the Public Health 

9 Service; 

10 ‘‘(7) advise each Assistant Secretary of the De11 partment concerning matters of Indian health with 

12 respect to which that Assistant Secretary has au13 thority and responsibility; 

14 ‘‘(8) advise the heads of other agencies and pro15 grams of the Department concerning matters of In16 dian health with respect to which those heads have 

17 authority and responsibility; 

18 ‘‘(9) coordinate the activities of the Department 

19 concerning matters of Indian health; and 

20 ‘‘(10) perform such other functions as the Sec21 retary may designate. 

22 ‘‘(d) AUTHORITY.— 

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

24 through the Assistant Secretary, shall have the au25 thority— 


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1 ‘‘(A) except to the extent provided for in 

2 paragraph (2), to appoint and compensate em3 ployees for the Service in accordance with title 

4 5, United States Code; 

5 ‘‘(B) to enter into contracts for the pro6 curement of goods and services to carry out the 

7 functions of the Service; and 

8 ‘‘(C) to manage, expend, and obligate all 

9 funds appropriated for the Service. 

10 ‘‘(2) PERSONNEL ACTIONS.—Notwithstanding 

11 any other provision of law, the provisions of section 

12 12 of the Act of June 18, 1934 (48 Stat. 986; 25 

13 U.S.C. 472), shall apply to all personnel actions 

14 taken with respect to new positions created within 

15 the Service as a result of its establishment under 

16 subsection (a). 

17 ‘‘(e) REFERENCES.—Any reference to the Director of 

18 the Indian Health Service in any other Federal law, Exec19 utive order, rule, regulation, or delegation of authority, or 

20 in any document of or relating to the Director of the In21 dian Health Service, shall be deemed to refer to the Assist22 ant Secretary. 

23 ‘‘SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYS24 TEM. 

25 ‘‘(a) ESTABLISHMENT.— 


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1 ‘‘(1) IN GENERAL.—The Secretary shall estab2 lish an automated management information system 

3 for the Service. 

4 ‘‘(2) REQUIREMENTS OF SYSTEM.—The infor5 mation system established under paragraph (1) shall 

6 include— 

7 ‘‘(A) a financial management system; 

8 ‘‘(B) a patient care information system for 

9 each area served by the Service; 

10 ‘‘(C) a privacy component that protects the 

11 privacy of patient information held by, or on be12 half of, the Service; 

13 ‘‘(D) a services-based cost accounting com14 ponent that provides estimates of the costs as15 sociated with the provision of specific medical 

16 treatments or services in each Area office of the 

17 Service; 

18 ‘‘(E) an interface mechanism for patient 

19 billing and accounts receivable system; and 

20 ‘‘(F) a training component. 

21 ‘‘(b) PROVISION OF SYSTEMS TO TRIBES AND ORGA22 NIZATIONS.—The Secretary shall provide each Tribal 

23 Health Program automated management information sys24 tems which— 


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1 ‘‘(1) meet the management information needs 

2 of such Tribal Health Program with respect to the 

3 treatment by the Tribal Health Program of patients 

4 of the Service; and 

5 ‘‘(2) meet the management information needs 

6 of the Service. 

7 ‘‘(c) ACCESS TO RECORDS.—Notwithstanding any 

8 other provision of law, each patient shall have reasonable 

9 access to the medical or health records of such patient 

10 which are held by, or on behalf of, the Service. 

11 ‘‘(d) AUTHORITY TO ENHANCE INFORMATION TECH12 NOLOGY.—The Secretary, acting through the Assistant 

13 Secretary, shall have the authority to enter into contracts, 

14 agreements, or joint ventures with other Federal agencies, 

15 States, private and nonprofit organizations, for the pur16 pose of enhancing information technology in Indian 

17 Health Programs and facilities. 

18 ‘‘SEC. 603. AUTHORIZATION OF APPROPRIATIONS. 

19 ‘‘There is authorized to be appropriated such sums 

20 as may be necessary for each fiscal year through fiscal 

21 year 2017 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) PURPOSES.—The purposes of this section are as 

6 follows: 

7 ‘‘(1) To authorize and direct the Secretary, act8 ing through the Service, Indian Tribes, Tribal Orga9 nizations, and Urban Indian Organizations, to de10 velop a comprehensive behavioral health prevention 

11 and treatment program which emphasizes collabora12 tion among alcohol and substance abuse, social serv13 ices, and mental health programs. 

14 ‘‘(2) To provide information, direction, and 

15 guidance relating to mental illness and dysfunction 

16 and self-destructive behavior, including child abuse 

17 and family violence, to those Federal, tribal, State, 

18 and local agencies responsible for programs in In19 dian communities in areas of health care, education, 

20 social services, child and family welfare, alcohol and 

21 substance abuse, law enforcement, and judicial serv22 ices. 

23 ‘‘(3) To assist Indian Tribes to identify services 

24 and resources available to address mental illness and 

25 dysfunctional and self-destructive behavior. 


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1 ‘‘(4) To provide authority and opportunities for 

2 Indian Tribes and Tribal Organizations to develop, 

3 implement, and coordinate with community-based 

4 programs which include identification, prevention, 

5 education, referral, and treatment services, including 

6 through multidisciplinary resource teams. 

7 ‘‘(5) To 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. 

11 ‘‘(6) To modify or supplement existing pro12 grams and authorities in the areas identified in 

13 paragraph (2). 

14 ‘‘(b) PLANS.— 

15 ‘‘(1) DEVELOPMENT.—The Secretary, acting 

16 through the Service, Indian Tribes, Tribal Organiza17 tions, and Urban Indian Organizations, shall encour18 age Indian Tribes and Tribal Organizations to de19 velop tribal plans, and Urban Indian Organizations 

20 to develop local plans, and for all such groups to 

21 participate in developing areawide plans for Indian 

22 Behavioral Health Services. The plans shall include, 

23 to the extent feasible, the following components: 

24 ‘‘(A) An assessment of the scope of alcohol 

25 or other substance abuse, mental illness, and 


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1 dysfunctional and self-destructive behavior, in2 cluding suicide, child abuse, and family vio3 lence, among Indians, including— 

4 ‘‘(i) the number of Indians served who 

5 are directly or indirectly affected by such 

6 illness or behavior; or 

7 ‘‘(ii) an estimate of the financial and 

8 human cost attributable to such illness or 

9 behavior. 

10 ‘‘(B) An assessment of the existing and 

11 additional resources necessary for the preven12 tion and treatment of such illness and behavior, 

13 including an assessment of the progress toward 

14 achieving the availability of the full continuum 

15 of care described in subsection (c). 

16 ‘‘(C) An estimate of the additional funding 

17 needed by the Service, Indian Tribes, Tribal 

18 Organizations, and Urban Indian Organizations 

19 to meet their responsibilities under the plans. 

20 ‘‘(2) NATIONAL CLEARINGHOUSE.—The Sec21 retary, acting through the Service, shall coordinate 

22 with existing national clearinghouses and informa23 tion centers to include at the clearinghouses and 

24 centers plans and reports on the outcomes of such 

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1 tions, Urban Indian Organizations, and Service 

2 Areas relating to behavioral health. The Secretary 

3 shall ensure access to these plans and outcomes by 

4 any Indian Tribe, Tribal Organization, Urban In5 dian Organization, or the Service. 

6 ‘‘(3) TECHNICAL ASSISTANCE.—The Secretary 

7 shall provide technical assistance to Indian Tribes, 

8 Tribal Organizations, and Urban Indian Organiza9 tions in preparation of plans under this section and 

10 in developing standards of care that may be used 

11 and adopted locally. 

12 ‘‘(c) PROGRAMS.—The Secretary, acting through the 

13 Service, Indian Tribes, and Tribal Organizations, shall 

14 provide, to the extent feasible and if funding is available, 

15 programs including the following: 

16 ‘‘(1) COMPREHENSIVE CARE.—A comprehensive 

17 continuum of behavioral health care which pro18 vides— 

19 ‘‘(A) community-based prevention, inter20 vention, outpatient, and behavioral health 

21 aftercare; 

22 ‘‘(B) detoxification (social and medical); 

23 ‘‘(C) acute hospitalization; 

24 ‘‘(D) intensive outpatient/day treatment; 

25 ‘‘(E) residential treatment; 


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1 ‘‘(F) transitional living for those needing a 

2 temporary, stable living environment that is 

3 supportive of treatment and recovery goals; 

4 ‘‘(G) emergency shelter; 

5 ‘‘(H) intensive case management; and 

6 ‘‘(I) diagnostic services. 

7 ‘‘(2) CHILD CARE.—Behavioral health services 

8 for Indians from birth through age 17, including— 

9 ‘‘(A) preschool and school age fetal alcohol 

10 disorder services, including assessment and be11 havioral intervention; 

12 ‘‘(B) mental health and substance abuse 

13 services (emotional, organic, alcohol, drug, in14 halant, and tobacco); 

15 ‘‘(C) identification and treatment of co-oc16 curring disorders and comorbidity; 

17 ‘‘(D) prevention of alcohol, drug, inhalant, 

18 and tobacco use; 

19 ‘‘(E) early intervention, treatment, and 

20 aftercare; 

21 ‘‘(F) promotion of healthy approaches to 

22 risk and safety issues; and 

23 ‘‘(G) identification and treatment of ne24 glect and physical, mental, and sexual abuse. 


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1 ‘‘(3) ADULT CARE.—Behavioral health services 

2 for Indians from age 18 through 55, including— 

3 ‘‘(A) early intervention, treatment, and 

4 aftercare; 

5 ‘‘(B) mental health and substance abuse 

6 services (emotional, alcohol, drug, inhalant, and 

7 tobacco), including sex specific services; 

8 ‘‘(C) identification and treatment of co-oc9 curring disorders (dual diagnosis) and comor10 bidity; 

11 ‘‘(D) promotion of healthy approaches for 

12 risk-related behavior; 

13 ‘‘(E) treatment services for women at risk 

14 of giving birth to a child with a fetal alcohol 

15 disorder; and 

16 ‘‘(F) sex specific treatment for sexual as17 sault and domestic violence. 

18 ‘‘(4) FAMILY CARE.—Behavioral health services 

19 for families, including— 

20 ‘‘(A) early intervention, treatment, and 

21 aftercare for affected families; 

22 ‘‘(B) treatment for sexual assault and do23 mestic violence; and 


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1 ‘‘(C) promotion of healthy approaches re2 lating to parenting, domestic violence, and other 

3 abuse issues. 

4 ‘‘(5) ELDER CARE.—Behavioral health services 

5 for Indians 56 years of age and older, including— 

6 ‘‘(A) early intervention, treatment, and 

7 aftercare; 

8 ‘‘(B) mental health and substance abuse 

9 services (emotional, alcohol, drug, inhalant, and 

10 tobacco), including sex specific services; 

11 ‘‘(C) identification and treatment of co-oc12 curring disorders (dual diagnosis) and comor13 bidity; 

14 ‘‘(D) promotion of healthy approaches to 

15 managing conditions related to aging; 

16 ‘‘(E) sex specific treatment for sexual as17 sault, domestic violence, neglect, physical and 

18 mental abuse and exploitation; and 

19 ‘‘(F) identification and treatment of de20 mentias regardless of cause. 

21 ‘‘(d) COMMUNITY BEHAVIORAL HEALTH PLAN.— 

22 ‘‘(1) ESTABLISHMENT.—The governing body of 

23 any Indian Tribe, Tribal Organization, or Urban In24 dian Organization may adopt a resolution for the es25 tablishment of a community behavioral health plan 


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1 providing for the identification and coordination of 

2 available resources and programs to identify, pre3 vent, or treat substance abuse, mental illness, or 

4 dysfunctional and self-destructive behavior, including 

5 child abuse and family violence, among its members 

6 or its service population. This plan should include 

7 behavioral health services, social services, intensive 

8 outpatient services, and continuing aftercare. 

9 ‘‘(2) TECHNICAL ASSISTANCE.—At the request 

10 of an Indian Tribe, Tribal Organization, or Urban 

11 Indian Organization, the Bureau of Indian Affairs 

12 and the Service shall cooperate with and provide 

13 technical assistance to the Indian Tribe, Tribal Or14 ganization, or Urban Indian Organization in the de15 velopment and implementation of such plan. 

16 ‘‘(3) FUNDING.—The Secretary, acting through 

17 the Service, may make funding available to Indian 

18 Tribes and Tribal Organizations which adopt a reso19 lution pursuant to paragraph (1) to obtain technical 

20 assistance for the development of a community be21 havioral health plan and to provide administrative 

22 support in the implementation of such plan. 

23 ‘‘(e) COORDINATION FOR AVAILABILITY OF SERV24 ICES.—The Secretary, acting through the Service, Indian 

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1 tions, shall coordinate behavioral health planning, to the 

2 extent feasible, with other Federal agencies and with State 

3 agencies, to encourage comprehensive behavioral health 

4 services for Indians regardless of their place of residence. 

5 ‘‘(f) MENTAL HEALTH CARE NEED ASSESSMENT.— 

6 Not later than 1 year after the date of enactment of the 

7 Indian Health Care Improvement Act Amendments of 

8 2007, the Secretary, acting through the Service, shall 

9 make an assessment of the need for inpatient mental 

10 health care among Indians and the availability and cost 

11 of inpatient mental health facilities which can meet such 

12 need. In making such assessment, the Secretary shall con13 sider the possible conversion of existing, underused Service 

14 hospital beds into psychiatric units to meet such need. 

15 ‘‘SEC. 702. MEMORANDA OF AGREEMENT WITH THE DE16 PARTMENT OF THE INTERIOR. 

17 ‘‘(a) CONTENTS.—Not later than 12 months after the 

18 date of enactment of the Indian Health Care Improvement 

19 Act Amendments of 2007, the Secretary, acting through 

20 the Service, and the Secretary of the Interior shall develop 

21 and enter into a memoranda of agreement, or review and 

22 update any existing memoranda of agreement, as required 

23 by section 4205 of the Indian Alcohol and Substance 

24 Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 

25 2411) under which the Secretaries address the following: 


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1 ‘‘(1) The scope and nature of mental illness and 

2 dysfunctional and self-destructive behavior, including 

3 child abuse and family violence, among Indians. 

4 ‘‘(2) The existing Federal, tribal, State, local, 

5 and private services, resources, and programs avail6 able to provide behavioral health services for Indi7 ans. 

8 ‘‘(3) The unmet need for additional services, re9 sources, and programs necessary to meet the needs 

10 identified pursuant to paragraph (1). 

11 ‘‘(4)(A) The right of Indians, as citizens of the 

12 United States and of the States in which they re13 side, to have access to behavioral health services to 

14 which all citizens have access. 

15 ‘‘(B) The right of Indians to participate in, and 

16 receive the benefit of, such services. 

17 ‘‘(C) The actions necessary to protect the exer18 cise of such right. 

19 ‘‘(5) The responsibilities of the Bureau of In20 dian Affairs and the Service, including mental illness 

21 identification, prevention, education, referral, and 

22 treatment services (including services through multi23 disciplinary resource teams), at the central, area, 

24 and agency and Service Unit, Service Area, and 


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1 headquarters levels to address the problems identi2 fied in paragraph (1). 

3 ‘‘(6) A strategy for the comprehensive coordina4 tion of the behavioral health services provided by the 

5 Bureau of Indian Affairs and the Service to meet 

6 the problems identified pursuant to paragraph (1), 

7 including— 

8 ‘‘(A) the coordination of alcohol and sub9 stance abuse programs of the Service, the Bu10 reau of Indian Affairs, and Indian Tribes and 

11 Tribal Organizations (developed under the In12 dian Alcohol and Substance Abuse Prevention 

13 and Treatment Act of 1986 (25 U.S.C. 2401 et 

14 seq.)) with behavioral health initiatives pursu15 ant to this Act, particularly with respect to the 

16 referral and treatment of dually diagnosed indi17 viduals requiring behavioral health and sub18 stance abuse treatment; and 

19 ‘‘(B) ensuring that the Bureau of Indian 

20 Affairs and Service programs and services (in21 cluding multidisciplinary resource teams) ad22 dressing child abuse and family violence are co23 ordinated with such non-Federal programs and 

24 services. 


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1 ‘‘(7) Directing appropriate officials of the Bu2 reau of Indian Affairs and the Service, particularly 

3 at the agency and Service Unit levels, to cooperate 

4 fully with tribal requests made pursuant to commu5 nity behavioral health plans adopted under section 

6 701(c) and section 4206 of the Indian Alcohol and 

7 Substance Abuse Prevention and Treatment Act of 

8 1986 (25 U.S.C. 2412). 

9 ‘‘(8) Providing for an annual review of such 

10 agreement by the Secretaries which shall be provided 

11 to Congress and Indian Tribes and Tribal Organiza12 tions. 

13 ‘‘(b) SPECIFIC PROVISIONS REQUIRED.—The memo14 randa of agreement updated or entered into pursuant to 

15 subsection (a) shall include specific provisions pursuant to 

16 which the Service shall assume responsibility for— 

17 ‘‘(1) the determination of the scope of the prob18 lem of alcohol and substance abuse among Indians, 

19 including the number of Indians within the jurisdic20 tion of the Service who are directly or indirectly af21 fected by alcohol and substance abuse and the finan22 cial and human cost; 

23 ‘‘(2) an assessment of the existing and needed 

24 resources necessary for the prevention of alcohol and 


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1 substance abuse and the treatment of Indians af2 fected by alcohol and substance abuse; and 

3 ‘‘(3) an estimate of the funding necessary to 

4 adequately support a program of prevention of alco5 hol and substance abuse and treatment of Indians 

6 affected by alcohol and substance abuse. 

7 ‘‘(c) PUBLICATION.—Each memorandum of agree8 ment entered into or renewed (and amendments or modi9 fications thereto) under subsection (a) shall be published 

10 in the Federal Register. At the same time as publication 

11 in the Federal Register, the Secretary shall provide a copy 

12 of such memoranda, amendment, or modification to each 

13 Indian Tribe, Tribal Organization, and Urban Indian Or14 ganization. 

15 ‘‘SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PRE16 VENTION AND TREATMENT PROGRAM. 

17 ‘‘(a) ESTABLISHMENT.— 

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

19 through the Service, Indian Tribes, and Tribal Orga20 nizations, shall provide a program of comprehensive 

21 behavioral health, prevention, treatment, and 

22 aftercare, which shall include— 

23 ‘‘(A) prevention, through educational inter24 vention, in Indian communities; 


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1 ‘‘(B) acute detoxification, psychiatric hos2 pitalization, residential, and intensive outpatient 

3 treatment; 

4 ‘‘(C) community-based rehabilitation and 

5 aftercare; 

6 ‘‘(D) community education and involve7 ment, including extensive training of health 

8 care, educational, and community-based per9 sonnel; 

10 ‘‘(E) specialized residential treatment pro11 grams for high-risk populations, including preg12 nant and postpartum women and their children; 

13 and 

14 ‘‘(F) diagnostic services. 

15 ‘‘(2) TARGET POPULATIONS.—The target popu16 lation of such programs shall be members of Indian 

17 Tribes. Efforts to train and educate key members of 

18 the Indian community shall also target employees of 

19 health, education, judicial, law enforcement, legal, 

20 and social service programs. 

21 ‘‘(b) CONTRACT HEALTH SERVICES.— 

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

23 through the Service, Indian Tribes, and Tribal Orga24 nizations, may enter into contracts with public or 

25 private providers of behavioral health treatment 


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1 services for the purpose of carrying out the program 

2 required under subsection (a). 

3 ‘‘(2) PROVISION OF ASSISTANCE.—In carrying 

4 out this subsection, the Secretary shall provide as5 sistance to Indian Tribes and Tribal Organizations 

6 to develop criteria for the certification of behavioral 

7 health service providers and accreditation of service 

8 facilities which meet minimum standards for such 

9 services and facilities. 

10 ‘‘SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM. 

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

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

13 as the ‘Snyder Act’), the Secretary shall establish and 

14 maintain a mental health technician program within the 

15 Service which— 

16 ‘‘(1) provides for the training of Indians as 

17 mental health technicians; and 

18 ‘‘(2) employs such technicians in the provision 

19 of community-based mental health care that includes 

20 identification, prevention, education, referral, and 

21 treatment services. 

22 ‘‘(b) PARAPROFESSIONAL TRAINING.—In carrying 

23 out subsection (a), the Secretary, acting through the Serv24 ice, Indian Tribes, and Tribal Organizations, shall provide 

25 high-standard paraprofessional training in mental health 


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1 care necessary to provide quality care to the Indian com2 munities to be served. Such training shall be based upon 

3 a curriculum developed or approved by the Secretary 

4 which combines education in the theory of mental health 

5 care with supervised practical experience in the provision 

6 of such care. 

7 ‘‘(c) SUPERVISION AND EVALUATION OF TECHNI8 CIANS.—The Secretary, acting through the Service, Indian 

9 Tribes, and Tribal Organizations, shall supervise and 

10 evaluate the mental health technicians in the training pro11 gram. 

12 ‘‘(d) TRADITIONAL HEALTH CARE PRACTICES.—The 

13 Secretary, acting through the Service, shall ensure that 

14 the program established pursuant to this subsection in15 volves the use and promotion of the traditional health care 

16 practices of the Indian Tribes to be served. 

17 ‘‘SEC. 705. LICENSING REQUIREMENT FOR MENTAL 

18 HEALTH CARE WORKERS. 

19 ‘‘(a) IN GENERAL.—Subject to the provisions of sec20 tion 221, and except as provided in subsection (b), any 

21 individual employed as a psychologist, social worker, or 

22 marriage and family therapist for the purpose of providing 

23 mental health care services to Indians in a clinical setting 

24 under this Act is required to be licensed as a psychologist, 


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1 social worker, or marriage and family therapist, respec2 tively. 

3 ‘‘(b) TRAINEES.—An individual may be employed as 

4 a trainee in psychology, social work, or marriage and fam5 ily therapy to provide mental health care services de6 scribed in subsection (a) if such individual— 

7 ‘‘(1) works under the direct supervision of a li8 censed psychologist, social worker, or marriage and 

9 family therapist, respectively; 

10 ‘‘(2) is enrolled in or has completed at least 2 

11 years of course work at a post-secondary, accredited 

12 education program for psychology, social work, mar13 riage and family therapy, or counseling; and 

14 ‘‘(3) meets such other training, supervision, and 

15 quality review requirements as the Secretary may es16 tablish. 

17 ‘‘SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS. 

18 ‘‘(a) GRANTS.—The Secretary, consistent with sec19 tion 701, may make grants to Indian Tribes, Tribal Orga20 nizations, and Urban Indian Organizations to develop and 

21 implement a comprehensive behavioral health program of 

22 prevention, intervention, treatment, and relapse preven23 tion services that specifically addresses the cultural, his24 torical, social, and child care needs of Indian women, re25 gardless of age. 


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1 ‘‘(b) USE OF GRANT FUNDS.—A grant made pursu2 ant to this section may be used to— 

3 ‘‘(1) develop and provide community training, 

4 education, and prevention programs for Indian 

5 women relating to behavioral health issues, including 

6 fetal alcohol disorders; 

7 ‘‘(2) identify and provide psychological services, 

8 counseling, advocacy, support, and relapse preven9 tion to Indian women and their families; and 

10 ‘‘(3) develop prevention and intervention models 

11 for Indian women which incorporate traditional 

12 health care practices, cultural values, and commu13 nity and family involvement. 

14 ‘‘(c) CRITERIA.—The Secretary, in consultation with 

15 Indian Tribes and Tribal Organizations, shall establish 

16 criteria for the review and approval of applications and 

17 proposals for funding under this section. 

18 ‘‘(d) EARMARK OF CERTAIN FUNDS.—Twenty per19 cent of the funds appropriated pursuant to this section 

20 shall be used to make grants to Urban Indian Organiza21 tions. 

22 ‘‘SEC. 707. INDIAN YOUTH PROGRAM. 

23 ‘‘(a) DETOXIFICATION AND REHABILITATION.—The 

24 Secretary, acting through the Service, consistent with sec25 tion 701, shall develop and implement a program for acute 


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1 detoxification and treatment for Indian youths, including 

2 behavioral health services. The program shall include re3 gional treatment centers designed to include detoxification 

4 and rehabilitation for both sexes on a referral basis and 

5 programs developed and implemented by Indian Tribes or 

6 Tribal Organizations at the local level under the Indian 

7 Self-Determination and Education Assistance Act (25 

8 U.S.C. 450 et seq.). Regional centers shall be integrated 

9 with the intake and rehabilitation programs based in the 

10 referring Indian community. 

11 ‘‘(b) ALCOHOL AND SUBSTANCE ABUSE TREATMENT

12 CENTERS OR FACILITIES.— 

13 ‘‘(1) ESTABLISHMENT.— 

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

15 through the Service, Indian Tribes, and Tribal 

16 Organizations, shall construct, renovate, or, as 

17 necessary, purchase, and appropriately staff 

18 and operate, at least 1 youth regional treatment 

19 center or treatment network in each area under 

20 the jurisdiction of an Area Office. 

21 ‘‘(B) AREA OFFICE IN CALIFORNIA.—For 

22 the purposes of this subsection, the Area Office 

23 in California shall be considered to be 2 Area 

24 Offices, 1 office whose jurisdiction shall be con25 sidered to encompass the northern area of the 


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1 State of California, and 1 office whose jurisdic2 tion shall be considered to encompass the re3 mainder of the State of California for the pur4 pose of implementing California treatment net5 works. 

6 ‘‘(2) FUNDING.—For the purpose of staffing 

7 and operating such centers or facilities, funding 

8 shall be pursuant to the Act of November 2, 1921 

9 (25 U.S.C. 13). 

10 ‘‘(3) LOCATION.—A youth treatment center 

11 constructed or purchased under this subsection shall 

12 be constructed or purchased at a location within the 

13 area described in paragraph (1) agreed upon (by ap14 propriate tribal resolution) by a majority of the In15 dian Tribes to be served by such center. 

16 ‘‘(4) SPECIFIC PROVISION OF FUNDS.— 

17 ‘‘(A) IN GENERAL.—Notwithstanding any 

18 other provision of this title, the Secretary may, 

19 from amounts authorized to be appropriated for 

20 the purposes of carrying out this section, make 

21 funds available to— 

22 ‘‘(i) the Tanana Chiefs Conference, 

23 Incorporated, for the purpose of leasing, 

24 constructing, renovating, operating, and 


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1 maintaining a residential youth treatment 

2 facility in Fairbanks, Alaska; and 

3 ‘‘(ii) the Southeast Alaska Regional 

4 Health Corporation to staff and operate a 

5 residential youth treatment facility without 

6 regard to the proviso set forth in section 

7 4(l) of the Indian Self-Determination and 

8 Education Assistance Act (25 U.S.C. 

9 450b(l)). 

10 ‘‘(B) PROVISION OF SERVICES TO ELIGI11 BLE YOUTHS.—Until additional residential 

12 youth treatment facilities are established in 

13 Alaska pursuant to this section, the facilities 

14 specified in subparagraph (A) shall make every 

15 effort to provide services to all eligible Indian 

16 youths residing in Alaska. 

17 ‘‘(c) INTERMEDIATE ADOLESCENT BEHAVIORAL

18 HEALTH SERVICES.— 

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

20 through the Service, Indian Tribes, and Tribal Orga21 nizations, may provide intermediate behavioral 

22 health services to Indian children and adolescents, 

23 including— 

24 ‘‘(A) pretreatment assistance; 


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1 ‘‘(B) inpatient, outpatient, and aftercare 

2 services; 

3 ‘‘(C) emergency care; 

4 ‘‘(D) suicide prevention and crisis interven5 tion; and 

6 ‘‘(E) prevention and treatment of mental 

7 illness and dysfunctional and self-destructive 

8 behavior, including child abuse and family vio9 lence. 

10 ‘‘(2) USE OF FUNDS.—Funds provided under 

11 this subsection may be used— 

12 ‘‘(A) to construct or renovate an existing 

13 health facility to provide intermediate behav14 ioral health services; 

15 ‘‘(B) to hire behavioral health profes16 sionals; 

17 ‘‘(C) to staff, operate, and maintain an in18 termediate mental health facility, group home, 

19 sober housing, transitional housing or similar 

20 facilities, or youth shelter where intermediate 

21 behavioral health services are being provided; 

22 ‘‘(D) to make renovations and hire appro23 priate staff to convert existing hospital beds 

24 into adolescent psychiatric units; and 


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1 ‘‘(E) for intensive home- and community2 based services. 

3 ‘‘(3) CRITERIA.—The Secretary, acting through 

4 the Service, shall, in consultation with Indian Tribes 

5 and Tribal Organizations, establish criteria for the 

6 review and approval of applications or proposals for 

7 funding made available pursuant to this subsection. 

8 ‘‘(d) FEDERALLY-OWNED STRUCTURES.— 

9 ‘‘(1) IN GENERAL.—The Secretary, in consulta10 tion with Indian Tribes and Tribal Organizations, 

11 shall— 

12 ‘‘(A) identify and use, where appropriate, 

13 federally-owned structures suitable for local res14 idential or regional behavioral health treatment 

15 for Indian youths; and 

16 ‘‘(B) establish guidelines for determining 

17 the suitability of any such federally-owned 

18 structure to be used for local residential or re19 gional behavioral health treatment for Indian 

20 youths. 

21 ‘‘(2) TERMS AND CONDITIONS FOR USE OF

22 STRUCTURE.—Any structure described in paragraph 

23 (1) may be used under such terms and conditions as 

24 may be agreed upon by the Secretary and the agency 

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1 dian Tribe or Tribal Organization operating the pro2 gram. 

3 ‘‘(e) REHABILITATION AND AFTERCARE SERVICES.— 

4 ‘‘(1) IN GENERAL.—The Secretary, Indian 

5 Tribes, or Tribal Organizations, in cooperation with 

6 the Secretary of the Interior, shall develop and im7 plement within each Service Unit, community-based 

8 rehabilitation and follow-up services for Indian 

9 youths who are having significant behavioral health 

10 problems, and require long-term treatment, commu11 nity reintegration, and monitoring to support the In12 dian youths after their return to their home commu13 nity. 

14 ‘‘(2) ADMINISTRATION.—Services under para15 graph (1) shall be provided by trained staff within 

16 the community who can assist the Indian youths in 

17 their continuing development of self-image, positive 

18 problem-solving skills, and nonalcohol or substance 

19 abusing behaviors. Such staff may include alcohol 

20 and substance abuse counselors, mental health pro21 fessionals, and other health professionals and para22 professionals, including community health represent23 atives. 

24 ‘‘(f) INCLUSION OF FAMILY IN YOUTH TREATMENT

25 PROGRAM.—In providing the treatment and other services 


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1 to Indian youths authorized by this section, the Secretary, 

2 acting through the Service, Indian Tribes, and Tribal Or3 ganizations, shall provide for the inclusion of family mem4 bers of such youths in the treatment programs or other 

5 services as may be appropriate. Not less than 10 percent 

6 of the funds appropriated for the purposes of carrying out 

7 subsection (e) shall be used for outpatient care of adult 

8 family members related to the treatment of an Indian 

9 youth under that subsection. 

10 ‘‘(g) MULTIDRUG ABUSE PROGRAM.—The Secretary, 

11 acting through the Service, Indian Tribes, Tribal Organi12 zations, and Urban Indian Organizations, shall provide, 

13 consistent with section 701, programs and services to pre14 vent and treat the abuse of multiple forms of substances, 

15 including alcohol, drugs, inhalants, and tobacco, among 

16 Indian youths residing in Indian communities, on or near 

17 reservations, and in urban areas and provide appropriate 

18 mental health services to address the incidence of mental 

19 illness among such youths. 

20 ‘‘(h) INDIAN YOUTH MENTAL HEALTH.—The Sec21 retary, acting through the Service, shall collect data for 

22 the report under section 801 with respect to— 

23 ‘‘(1) the number of Indian youth who are being 

24 provided mental health services through the Service 

25 and Tribal Health Programs; 


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1 ‘‘(2) a description of, and costs associated with, 

2 the mental health services provided for Indian youth 

3 through the Service and Tribal Health Programs; 

4 ‘‘(3) the number of youth referred to the Serv5 ice or Tribal Health Programs for mental health 

6 services; 

7 ‘‘(4) the number of Indian youth provided resi8 dential treatment for mental health and behavioral 

9 problems through the Service and Tribal Health 

10 Programs, reported separately for on- and off-res11 ervation facilities; and 

12 ‘‘(5) the costs of the services described in para13 graph (4). 

14 ‘‘SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEM15 ONSTRATION PROJECT. 

16 ‘‘(a) PURPOSE.—The purpose of this section is to au17 thorize the Secretary to carry out a demonstration project 

18 to test the use of telemental health services in suicide pre19 vention, intervention and treatment of Indian youth, in20 cluding through— 

21 ‘‘(1) the use of psychotherapy, psychiatric as22 sessments, diagnostic interviews, therapies for men23 tal health conditions predisposing to suicide, and al24 cohol and substance abuse treatment; 


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1 ‘‘(2) the provision of clinical expertise to, con2 sultation services with, and medical advice and train3 ing for frontline health care providers working with 

4 Indian youth; 

5 ‘‘(3) training and related support for commu6 nity leaders, family members and health and edu7 cation workers who work with Indian youth; 

8 ‘‘(4) the development of culturally-relevant edu9 cational materials on suicide; and 

10 ‘‘(5) data collection and reporting. 

11 ‘‘(b) DEFINITIONS.—For the purpose of this section, 

12 the following definitions shall apply: 

13 ‘‘(1) DEMONSTRATION PROJECT.—The term 

14 ‘demonstration project’ means the Indian youth tele15 mental health demonstration project authorized 

16 under subsection (c). 

17 ‘‘(2) TELEMENTAL HEALTH.—The term ‘tele18 mental health’ means the use of electronic informa19 tion and telecommunications technologies to support 

20 long distance mental health care, patient and profes21 sional-related education, public health, and health 

22 administration. 

23 ‘‘(c) AUTHORIZATION.— 

24 ‘‘(1) IN GENERAL.—The Secretary is authorized 

25 to award grants under the demonstration project for 


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1 the provision of telemental health services to Indian 

2 youth who— 

3 ‘‘(A) have expressed suicidal ideas; 

4 ‘‘(B) have attempted suicide; or 

5 ‘‘(C) have mental health conditions that in6 crease or could increase the risk of suicide. 

7 ‘‘(2) ELIGIBILITY FOR GRANTS.—Such grants 

8 shall be awarded to Indian Tribes and Tribal Orga9 nizations that operate 1 or more facilities— 

10 ‘‘(A) located in Alaska and part of the 

11 Alaska Federal Health Care Access Network; 

12 ‘‘(B) reporting active clinical telehealth ca13 pabilities; or 

14 ‘‘(C) offering school-based telemental 

15 health services relating to psychiatry to Indian 

16 youth. 

17 ‘‘(3) GRANT PERIOD.—The Secretary shall 

18 award grants under this section for a period of up 

19 to 4 years. 

20 ‘‘(4) AWARDING OF GRANTS.—Not more than 5 

21 grants shall be provided under paragraph (1), with 

22 priority consideration given to Indian Tribes and 

23 Tribal Organizations that— 


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1 ‘‘(A) serve a particular community or geo2 graphic area where there is a demonstrated 

3 need to address Indian youth suicide; 

4 ‘‘(B) enter in to collaborative partnerships 

5 with Indian Health Service or Tribal Health 

6 Programs or facilities to provide services under 

7 this demonstration project; 

8 ‘‘(C) serve an isolated community or geo9 graphic area which has limited or no access to 

10 behavioral health services; or 

11 ‘‘(D) operate a detention facility at which 

12 Indian youth are detained. 

13 ‘‘(d) USE OF FUNDS.— 

14 ‘‘(1) IN GENERAL.—An Indian Tribe or Tribal 

15 Organization shall use a grant received under sub16 section (c) for the following purposes: 

17 ‘‘(A) To provide telemental health services 

18 to Indian youth, including the provision of— 

19 ‘‘(i) psychotherapy; 

20 ‘‘(ii) psychiatric assessments and di21 agnostic interviews, therapies for mental 

22 health conditions predisposing to suicide, 

23 and treatment; and 

24 ‘‘(iii) alcohol and substance abuse 

25 treatment. 


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1 ‘‘(B) To provide clinician-interactive med2 ical advice, guidance and training, assistance in 

3 diagnosis and interpretation, crisis counseling 

4 and intervention, and related assistance to 

5 Service, tribal, or urban clinicians and health 

6 services providers working with youth being 

7 served under this demonstration project. 

8 ‘‘(C) To assist, educate and train commu9 nity leaders, health education professionals and 

10 paraprofessionals, tribal outreach workers, and 

11 family members who work with the youth re12 ceiving telemental health services under this 

13 demonstration project, including with identifica14 tion of suicidal tendencies, crisis intervention 

15 and suicide prevention, emergency skill develop16 ment, and building and expanding networks 

17 among these individuals and with State and 

18 local health services providers. 

19 ‘‘(D) To develop and distribute culturally 

20 appropriate community educational materials 

21 on— 

22 ‘‘(i) suicide prevention; 

23 ‘‘(ii) suicide education; 

24 ‘‘(iii) suicide screening; 

25 ‘‘(iv) suicide intervention; and 


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1 ‘‘(v) ways to mobilize communities 

2 with respect to the identification of risk 

3 factors for suicide. 

4 ‘‘(E) For data collection and reporting re5 lated to Indian youth suicide prevention efforts. 

6 ‘‘(2) TRADITIONAL HEALTH CARE PRAC7 TICES.—In carrying out the purposes described in 

8 paragraph (1), an Indian Tribe or Tribal Organiza9 tion may use and promote the traditional health care 

10 practices of the Indian Tribes of the youth to be 

11 served. 

12 ‘‘(e) APPLICATIONS.—To be eligible to receive a grant 

13 under subsection (c), an Indian Tribe or Tribal Organiza14 tion shall prepare and submit to the Secretary an applica15 tion, at such time, in such manner, and containing such 

16 information as the Secretary may require, including— 

17 ‘‘(1) a description of the project that the Indian 

18 Tribe or Tribal Organization will carry out using the 

19 funds provided under the grant; 

20 ‘‘(2) a description of the manner in which the 

21 project funded under the grant would— 

22 ‘‘(A) meet the telemental health care needs 

23 of the Indian youth population to be served by 

24 the project; or 


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1 ‘‘(B) improve the access of the Indian 

2 youth population to be served to suicide preven3 tion and treatment services; 

4 ‘‘(3) evidence of support for the project from 

5 the local community to be served by the project; 

6 ‘‘(4) a description of how the families and lead7 ership of the communities or populations to be 

8 served by the project would be involved in the devel9 opment and ongoing operations of the project; 

10 ‘‘(5) a plan to involve the tribal community of 

11 the youth who are provided services by the project 

12 in planning and evaluating the mental health care 

13 and suicide prevention efforts provided, in order to 

14 ensure the integration of community, clinical, envi15 ronmental, and cultural components of the treat16 ment; and 

17 ‘‘(6) a plan for sustaining the project after Fed18 eral assistance for the demonstration project has ter19 minated. 

20 ‘‘(f) COLLABORATION; REPORTING TO NATIONAL

21 CLEARINGHOUSE.— 

22 ‘‘(1) COLLABORATION.—The Secretary, acting 

23 through the Service, shall encourage Indian Tribes 

24 and Tribal Organizations receiving grants under this 


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1 section to collaborate to enable comparisons about 

2 best practices across projects. 

3 ‘‘(2) REPORTING TO NATIONAL CLEARING4 HOUSE.—The Secretary, acting through the Service, 

5 shall also encourage Indian Tribes and Tribal Orga6 nizations receiving grants under this section to sub7 mit relevant, declassified project information to the 

8 national clearinghouse authorized under section 

9 701(b)(2) in order to better facilitate program per10 formance and improve suicide prevention, interven11 tion, and treatment services. 

12 ‘‘(g) ANNUAL REPORT.—Each grant recipient shall 

13 submit to the Secretary an annual report that— 

14 ‘‘(1) describes the number of telemental health 

15 services provided; and 

16 ‘‘(2) includes any other information that the 

17 Secretary may require. 

18 ‘‘(h) REPORT TO CONGRESS.—Not later than 270 

19 days after the termination of the demonstration project, 

20 the Secretary shall submit to the Committee on Indian Af21 fairs of the Senate and the Committee on Natural Re22 sources and Committee on Energy and Commerce of the 

23 House of Representatives a final report, based on the an24 nual reports provided by grant recipients under subsection 

25 (h), that— 


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1 ‘‘(1) describes the results of the projects funded 

2 by grants awarded under this section, including any 

3 data available which indicates the number of at4 tempted suicides; 

5 ‘‘(2) evaluates the impact of the telemental 

6 health services funded by the grants in reducing the 

7 number of completed suicides among Indian youth; 

8 ‘‘(3) evaluates whether the demonstration 

9 project should be— 

10 ‘‘(A) expanded to provide more than 5 

11 grants; and 

12 ‘‘(B) designated a permanent program; 

13 and 

14 ‘‘(4) evaluates the benefits of expanding the 

15 demonstration project to include Urban Indian Or16 ganizations. 

17 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

18 authorized to be appropriated to carry out this section 

19 $1,500,000 for each of fiscal years 2008 through 2011. 

20 ‘‘SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL 

21 HEALTH FACILITIES DESIGN, CONSTRUC22 TION, AND STAFFING. 

23 ‘‘Not later than 1 year after the date of enactment 

24 of the Indian Health Care Improvement Act Amendments 

25 of 2007, the Secretary, acting through the Service, Indian 


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1 Tribes, and Tribal Organizations, may provide, in each 

2 area of the Service, not less than 1 inpatient mental health 

3 care facility, or the equivalent, for Indians with behavioral 

4 health problems. For the purposes of this subsection, Cali5 fornia shall be considered to be 2 Area Offices, 1 office 

6 whose location shall be considered to encompass the north7 ern area of the State of California and 1 office whose ju8 risdiction shall be considered to encompass the remainder 

9 of the State of California. The Secretary shall consider 

10 the possible conversion of existing, underused Service hos11 pital beds into psychiatric units to meet such need. 

12 ‘‘SEC. 710. TRAINING AND COMMUNITY EDUCATION. 

13 ‘‘(a) PROGRAM.—The Secretary, in cooperation with 

14 the Secretary of the Interior, shall develop and implement 

15 or assist Indian Tribes and Tribal Organizations to de16 velop and implement, within each Service Unit or tribal 

17 program, a program of community education and involve18 ment which shall be designed to provide concise and timely 

19 information to the community leadership of each tribal 

20 community. Such program shall include education about 

21 behavioral health issues to political leaders, Tribal judges, 

22 law enforcement personnel, members of tribal health and 

23 education boards, health care providers including tradi24 tional practitioners, and other critical members of each 

25 tribal community. Such program may also include commuVerDate Aug 31 2005 21:58 Apr 25, 2007 Jkt 059200 PO 00000 Frm 00283 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.IS S1200

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1 nity-based training to develop local capacity and tribal 

2 community provider training for prevention, intervention, 

3 treatment, and aftercare. 

4 ‘‘(b) INSTRUCTION.—The Secretary, acting through 

5 the Service, shall, either directly or through Indian Tribes 

6 and Tribal Organizations, provide instruction in the area 

7 of behavioral health issues, including instruction in crisis 

8 intervention and family relations in the context of alcohol 

9 and substance abuse, child sexual abuse, youth alcohol and 

10 substance abuse, and the causes and effects of fetal alco11 hol disorders to appropriate employees of the Bureau of 

12 Indian Affairs and the Service, and to personnel in schools 

13 or programs operated under any contract with the Bureau 

14 of Indian Affairs or the Service, including supervisors of 

15 emergency shelters and halfway houses described in sec16 tion 4213 of the Indian Alcohol and Substance Abuse Pre17 vention and Treatment Act of 1986 (25 U.S.C. 2433). 

18 ‘‘(c) TRAINING MODELS.—In carrying out the edu19 cation and training programs required by this section, the 

20 Secretary, in consultation with Indian Tribes, Tribal Or21 ganizations, Indian behavioral health experts, and Indian 

22 alcohol and substance abuse prevention experts, shall de23 velop and provide community-based training models. Such 

24 models shall address— 


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1 ‘‘(1) the elevated risk of alcohol and behavioral 

2 health problems faced by children of alcoholics; 

3 ‘‘(2) the cultural, spiritual, and 

4 multigenerational aspects of behavioral health prob5 lem prevention and recovery; and 

6 ‘‘(3) community-based and multidisciplinary 

7 strategies for preventing and treating behavioral 

8 health problems. 

9 ‘‘SEC. 711. BEHAVIORAL HEALTH PROGRAM. 

10 ‘‘(a) INNOVATIVE PROGRAMS.—The Secretary, acting 

11 through the Service, Indian Tribes, and Tribal Organiza12 tions, consistent with section 701, may plan, develop, im13 plement, and carry out programs to deliver innovative 

14 community-based behavioral health services to Indians. 

15 ‘‘(b) AWARDS; CRITERIA.—The Secretary may award 

16 a grant for a project under subsection (a) to an Indian 

17 Tribe or Tribal Organization and may consider the fol18 lowing criteria: 

19 ‘‘(1) The project will address significant unmet 

20 behavioral health needs among Indians. 

21 ‘‘(2) The project will serve a significant number 

22 of Indians. 

23 ‘‘(3) The project has the potential to deliver 

24 services in an efficient and effective manner. 


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1 ‘‘(4) The Indian Tribe or Tribal Organization 

2 has the administrative and financial capability to ad3 minister the project. 

4 ‘‘(5) The project may deliver services in a man5 ner consistent with traditional health care practices. 

6 ‘‘(6) The project is coordinated with, and avoids 

7 duplication of, existing services. 

8 ‘‘(c) EQUITABLE TREATMENT.—For purposes of this 

9 subsection, the Secretary shall, in evaluating project appli10 cations or proposals, use the same criteria that the Sec11 retary uses in evaluating any other application or proposal 

12 for such funding. 

13 ‘‘SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS. 

14 ‘‘(a) PROGRAMS.— 

15 ‘‘(1) ESTABLISHMENT.—The Secretary, con16 sistent with section 701, acting through the Service, 

17 Indian Tribes, and Tribal Organizations, is author18 ized to establish and operate fetal alcohol disorder 

19 programs as provided in this section for the pur20 poses of meeting the health status objectives speci21 fied in section 3. 

22 ‘‘(2) USE OF FUNDS.— 

23 ‘‘(A) IN GENERAL.—Funding provided 

24 pursuant to this section shall be used for the 

25 following: 


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1 ‘‘(i) To develop and provide for Indi2 ans community and in-school training, edu3 cation, and prevention programs relating 

4 to fetal alcohol disorders. 

5 ‘‘(ii) To identify and provide behav6 ioral health treatment to high-risk Indian 

7 women and high-risk women pregnant with 

8 an Indian’s child. 

9 ‘‘(iii) To identify and provide appro10 priate psychological services, educational 

11 and vocational support, counseling, advo12 cacy, and information to fetal alcohol dis13 order affected Indians and their families or 

14 caretakers. 

15 ‘‘(iv) To develop and implement coun16 seling and support programs in schools for 

17 fetal alcohol disorder affected Indian chil18 dren. 

19 ‘‘(v) To develop prevention and inter20 vention models which incorporate practi21 tioners of traditional health care practices, 

22 cultural values, and community involve23 ment. 


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1 ‘‘(vi) To develop, print, and dissemi2 nate education and prevention materials on 

3 fetal alcohol disorder. 

4 ‘‘(vii) To develop and implement, in 

5 consultation with Indian Tribes, Tribal Or6 ganizations, and Urban Indian Organiza7 tions, culturally sensitive assessment and 

8 diagnostic tools including dysmorphology 

9 clinics and multidisciplinary fetal alcohol 

10 disorder clinics for use in Indian commu11 nities and Urban Centers. 

12 ‘‘(B) ADDITIONAL USES.—In addition to 

13 any purpose under subparagraph (A), funding 

14 provided pursuant to this section may be used 

15 for 1 or more of the following: 

16 ‘‘(i) Early childhood intervention 

17 projects from birth on to mitigate the ef18 fects of fetal alcohol disorder among Indi19 ans. 

20 ‘‘(ii) Community-based support serv21 ices for Indians and women pregnant with 

22 Indian children. 

23 ‘‘(iii) Community-based housing for 

24 adult Indians with fetal alcohol disorder. 


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1 ‘‘(3) CRITERIA FOR APPLICATIONS.—The Sec2 retary shall establish criteria for the review and ap3 proval of applications for funding under this section. 

4 ‘‘(b) SERVICES.—The Secretary, acting through the 

5 Service and Indian Tribes, Tribal Organizations, and 

6 Urban Indian Organizations, shall— 

7 ‘‘(1) develop and provide services for the pre8 vention, intervention, treatment, and aftercare for 

9 those affected by fetal alcohol disorder in Indian 

10 communities; and 

11 ‘‘(2) provide supportive services, including serv12 ices to meet the special educational, vocational, 

13 school-to-work transition, and independent living 

14 needs of adolescent and adult Indians with fetal al15 cohol disorder. 

16 ‘‘(c) TASK FORCE.—The Secretary shall establish a 

17 task force to be known as the Fetal Alcohol Disorder Task 

18 Force to advise the Secretary in carrying out subsection 

19 (b). Such task force shall be composed of representatives 

20 from the following: 

21 ‘‘(1) The National Institute on Drug Abuse. 

22 ‘‘(2) The National Institute on Alcohol and Al23 coholism. 

24 ‘‘(3) The Office of Substance Abuse Prevention. 

25 ‘‘(4) The National Institute of Mental Health. 


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1 ‘‘(5) The Service. 

2 ‘‘(6) The Office of Minority Health of the De3 partment of Health and Human Services. 

4 ‘‘(7) The Administration for Native Americans. 

5 ‘‘(8) The National Institute of Child Health 

6 and Human Development (NICHD). 

7 ‘‘(9) The Centers for Disease Control and Pre8 vention. 

9 ‘‘(10) The Bureau of Indian Affairs. 

10 ‘‘(11) Indian Tribes. 

11 ‘‘(12) Tribal Organizations. 

12 ‘‘(13) Urban Indian Organizations. 

13 ‘‘(14) Indian fetal alcohol disorder experts. 

14 ‘‘(d) APPLIED RESEARCH PROJECTS.—The Sec15 retary, acting through the Substance Abuse and Mental 

16 Health Services Administration, shall make grants to In17 dian Tribes, Tribal Organizations, and Urban Indian Or18 ganizations for applied research projects which propose to 

19 elevate the understanding of methods to prevent, inter20 vene, treat, or provide rehabilitation and behavioral health 

21 aftercare for Indians and Urban Indians affected by fetal 

22 alcohol disorder. 

23 ‘‘(e) FUNDING FOR URBAN INDIAN ORGANIZA24 TIONS.—Ten percent of the funds appropriated pursuant 


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1 to this section shall be used to make grants to Urban In2 dian Organizations funded under title V. 

3 ‘‘SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREAT4 MENT PROGRAMS. 

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

6 through the Service, and the Secretary of the Interior, In7 dian Tribes, and Tribal Organizations, shall establish, 

8 consistent with section 701, in every Service Area, pro9 grams involving treatment for— 

10 ‘‘(1) victims of sexual abuse who are Indian 

11 children or children in an Indian household; and 

12 ‘‘(2) perpetrators of child sexual abuse who are 

13 Indian or members of an Indian household. 

14 ‘‘(b) USE OF FUNDS.—Funding provided pursuant to 

15 this section shall be used for the following: 

16 ‘‘(1) To develop and provide community edu17 cation and prevention programs related to sexual 

18 abuse of Indian children or children in an Indian 

19 household. 

20 ‘‘(2) To identify and provide behavioral health 

21 treatment to victims of sexual abuse who are Indian 

22 children or children in an Indian household, and to 

23 their family members who are affected by sexual 

24 abuse. 


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1 ‘‘(3) To develop prevention and intervention 

2 models which incorporate traditional health care 

3 practices, cultural values, and community involve4 ment. 

5 ‘‘(4) To develop and implement culturally sen6 sitive assessment and diagnostic tools for use in In7 dian communities and Urban Centers. 

8 ‘‘(5) To identify and provide behavioral health 

9 treatment to Indian perpetrators and perpetrators 

10 who are members of an Indian household— 

11 ‘‘(A) making efforts to begin offender and 

12 behavioral health treatment while the perpe13 trator is incarcerated or at the earliest possible 

14 date if the perpetrator is not incarcerated; and 

15 ‘‘(B) providing treatment after the perpe16 trator is released, until it is determined that the 

17 perpetrator is not a threat to children. 

18 ‘‘(c) COORDINATION.—The programs established 

19 under subsection (a) shall be carried out in coordination 

20 with programs and services authorized under the Indian 

21 Child Protection and Family Violence Prevention Act (25 

22 U.S.C. 3201 et seq.). 

23 ‘‘SEC. 714. BEHAVIORAL HEALTH RESEARCH. 

24 ‘‘The Secretary, in consultation with appropriate 

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1 tracts with, Indian Tribes, Tribal Organizations, and 

2 Urban Indian Organizations or enter into contracts with, 

3 or make grants to appropriate institutions for, the conduct 

4 of research on the incidence and prevalence of behavioral 

5 health problems among Indians served by the Service, In6 dian Tribes, or Tribal Organizations and among Indians 

7 in urban areas. Research priorities under this section shall 

8 include— 

9 ‘‘(1) the multifactorial causes of Indian youth 

10 suicide, including— 

11 ‘‘(A) protective and risk factors and sci12 entific data that identifies those factors; and 

13 ‘‘(B) the effects of loss of cultural identity 

14 and the development of scientific data on those 

15 effects; 

16 ‘‘(2) the interrelationship and interdependence 

17 of behavioral health problems with alcoholism and 

18 other substance abuse, suicide, homicides, other in19 juries, and the incidence of family violence; and 

20 ‘‘(3) the development of models of prevention 

21 techniques. 

22 The effect of the interrelationships and interdependencies 

23 referred to in paragraph (2) on children, and the develop24 ment of prevention techniques under paragraph (3) appli25 cable to children, shall be emphasized. 


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1 ‘‘SEC. 715. DEFINITIONS. 

2 ‘‘For the purpose of this title, the following defini3 tions shall apply: 

4 ‘‘(1) ASSESSMENT.—The term ‘assessment’ 

5 means the systematic collection, analysis, and dis6 semination of information on health status, health 

7 needs, and health problems. 

8 ‘‘(2) ALCOHOL-RELATED

9 NEURODEVELOPMENTAL DISORDERS OR ARND.—The 

10 term ‘alcohol-related neurodevelopmental disorders’ 

11 or ‘ARND’ means, with a history of maternal alco12 hol consumption during pregnancy, central nervous 

13 system involvement such as developmental delay, in14 tellectual deficit, or neurologic abnormalities. Behav15 iorally, there can be problems with irritability, and 

16 failure to thrive as infants. As children become older 

17 there will likely be hyperactivity, attention deficit, 

18 language dysfunction, and perceptual and judgment 

19 problems. 

20 ‘‘(3) BEHAVIORAL HEALTH AFTERCARE.—The 

21 term ‘behavioral health aftercare’ includes those ac22 tivities and resources used to support recovery fol23 lowing inpatient, residential, intensive substance 

24 abuse, or mental health outpatient or outpatient 

25 treatment. The purpose is to help prevent or deal 

26 with relapse by ensuring that by the time a client or 


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1 patient is discharged from a level of care, such as 

2 outpatient treatment, an aftercare plan has been de3 veloped with the client. An aftercare plan may use 

4 such resources as a community-based therapeutic 

5 group, transitional living facilities, a 12-step spon6 sor, a local 12-step or other related support group, 

7 and other community-based providers. 

8 ‘‘(4) DUAL DIAGNOSIS.—The term ‘dual diag9 nosis’ means coexisting substance abuse and mental 

10 illness conditions or diagnosis. Such clients are 

11 sometimes referred to as mentally ill chemical abus12 ers (MICAs). 

13 ‘‘(5) FETAL ALCOHOL DISORDERS.—The term 

14 ‘fetal alcohol disorders’ means fetal alcohol syn15 drome, partial fetal alcohol syndrome and alcohol re16 lated neurodevelopmental disorder (ARND). 

17 ‘‘(6) FETAL ALCOHOL SYNDROME OR FAS.— 

18 The term ‘fetal alcohol syndrome’ or ‘FAS’ means a 

19 syndrome in which, with a history of maternal alco20 hol consumption during pregnancy, the following cri21 teria are met: 

22 ‘‘(A) Central nervous system involvement 

23 such as developmental delay, intellectual deficit, 

24 microencephaly, or neurologic abnormalities. 


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1 ‘‘(B) Craniofacial abnormalities with at 

2 least 2 of the following: microophthalmia, short 

3 palpebral fissures, poorly developed philtrum, 

4 thin upper lip, flat nasal bridge, and short 

5 upturned nose. 

6 ‘‘(C) Prenatal or postnatal growth delay. 

7 ‘‘(7) PARTIAL FAS.—The term ‘partial FAS’ 

8 means, with a history of maternal alcohol consump9 tion during pregnancy, having most of the criteria of 

10 FAS, though not meeting a minimum of at least 2 

11 of the following: microophthalmia, short palpebral 

12 fissures, poorly developed philtrum, thin upper lip, 

13 flat nasal bridge, and short upturned nose. 

14 ‘‘(8) REHABILITATION.—The term ‘rehabilita15 tion’ means to restore the ability or capacity to en16 gage in usual and customary life activities through 

17 education and therapy. 

18 ‘‘(9) SUBSTANCE ABUSE.—The term ‘substance 

19 abuse’ includes inhalant abuse. 

20 ‘‘SEC. 716. AUTHORIZATION OF APPROPRIATIONS. 

21 ‘‘There is authorized to be appropriated such sums 

22 as may be necessary for each fiscal year through fiscal 

23 year 2017 to carry out the provisions of this title. 


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1 ‘‘TITLE VIII—MISCELLANEOUS 

2 ‘‘SEC. 801. REPORTS. 

3 ‘‘For each fiscal year following the date of enactment 

4 of the Indian Health Care Improvement Act Amendments 

5 of 2007, the Secretary shall transmit to Congress a report 

6 containing the following: 

7 ‘‘(1) A report on the progress made in meeting 

8 the objectives of this Act, including a review of pro9 grams established or assisted pursuant to this Act 

10 and assessments and recommendations of additional 

11 programs or additional assistance necessary to, at a 

12 minimum, provide health services to Indians and en13 sure a health status for Indians, which are at a par14 ity with the health services available to and the 

15 health status of the general population. 

16 ‘‘(2) A report on whether, and to what extent, 

17 new national health care programs, benefits, initia18 tives, or financing systems have had an impact on 

19 the purposes of this Act and any steps that the Sec20 retary may have taken to consult with Indian Tribes, 

21 Tribal Organizations, and Urban Indian Organiza22 tions to address such impact, including a report on 

23 proposed changes in allocation of funding pursuant 

24 to section 808. 


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1 ‘‘(3) A report on the use of health services by 

2 Indians— 

3 ‘‘(A) on a national and area or other rel4 evant geographical basis; 

5 ‘‘(B) by gender and age; 

6 ‘‘(C) by source of payment and type of 

7 service; 

8 ‘‘(D) comparing such rates of use with 

9 rates of use among comparable non-Indian pop10 ulations; and 

11 ‘‘(E) provided under contracts. 

12 ‘‘(4) A report of contractors to the Secretary on 

13 Health Care Educational Loan Repayments every 6 

14 months required by section 110. 

15 ‘‘(5) A general audit report of the Secretary on 

16 the Health Care Educational Loan Repayment Pro17 gram as required by section 110(n). 

18 ‘‘(6) A report of the findings and conclusions of 

19 demonstration programs on development of edu20 cational curricula for substance abuse counseling as 

21 required in section 125(f). 

22 ‘‘(7) A separate statement which specifies the 

23 amount of funds requested to carry out the provi24 sions of section 201. 


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1 ‘‘(8) A report of the evaluations of health pro2 motion and disease prevention as required in section 

3 203(c). 

4 ‘‘(9) A biennial report to Congress on infectious 

5 diseases as required by section 212. 

6 ‘‘(10) A report on environmental and nuclear 

7 health hazards as required by section 215. 

8 ‘‘(11) An annual report on the status of all 

9 health care facilities needs as required by section 

10 301(c)(2)(B) and 301(d). 

11 ‘‘(12) Reports on safe water and sanitary waste 

12 disposal facilities as required by section 302(h). 

13 ‘‘(13) An annual report on the expenditure of 

14 non-Service funds for renovation as required by sec15 tions 304(b)(2). 

16 ‘‘(14) A report identifying the backlog of main17 tenance and repair required at Service and tribal fa18 cilities required by section 313(a). 

19 ‘‘(15) A report providing an accounting of reim20 bursement funds made available to the Secretary 

21 under titles XVIII, XIX, and XXI of the Social Se22 curity Act. 

23 ‘‘(16) A report on any arrangements for the 

24 sharing of medical facilities or services, as author25 ized by section 406. 


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1 ‘‘(17) A report on evaluation and renewal of 

2 Urban Indian programs under section 505. 

3 ‘‘(18) A report on the evaluation of programs 

4 as required by section 513(d). 

5 ‘‘(19) A report on alcohol and substance abuse 

6 as required by section 701(f). 

7 ‘‘(20) A report on Indian youth mental health 

8 services as required by section 707(h). 

9 ‘‘(21) A report on the reallocation of base re10 sources if required by section 808. 

11 ‘‘SEC. 802. REGULATIONS. 

12 ‘‘(a) DEADLINES.— 

13 ‘‘(1) PROCEDURES.—Not later than 90 days 

14 after the date of enactment of the Indian Health 

15 Care Improvement Act Amendments of 2007, the 

16 Secretary shall initiate procedures under subchapter 

17 III of chapter 5 of title 5, United States Code, to 

18 negotiate and promulgate such regulations or 

19 amendments thereto that are necessary to carry out 

20 titles II (except section 202) and VII, the sections 

21 of title III for which negotiated rulemaking is spe22 cifically required, and section 807. Unless otherwise 

23 required, the Secretary may promulgate regulations 

24 to carry out titles I, III, IV, and V, and section 202, 

25 using the procedures required by chapter V of title 


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1 5, United States Code (commonly known as the ‘Ad2 ministrative Procedure Act’). 

3 ‘‘(2) PROPOSED REGULATIONS.—Proposed reg4 ulations to implement this Act shall be published in 

5 the Federal Register by the Secretary no later than 

6 2 years after the date of enactment of the Indian 

7 Health Care Improvement Act Amendments of 2007 

8 and shall have no less than a 120-day comment pe9 riod. 

10 ‘‘(3) FINAL REGULATIONS.—The Secretary 

11 shall publish in the Federal Register final regula12 tions to implement this Act by not later than 3 years 

13 after the date of enactment of the Indian Health 

14 Care Improvement Act Amendments of 2007. 

15 ‘‘(b) COMMITTEE.—A negotiated rulemaking com16 mittee established pursuant to section 565 of title 5, 

17 United States Code, to carry out this section shall have 

18 as its members only representatives of the Federal Gov19 ernment and representatives of Indian Tribes, and Tribal 

20 Organizations, a majority of whom shall be nominated by 

21 and be representatives of Indian Tribes and Tribal Orga22 nizations from each Service Area. 

23 ‘‘(c) ADAPTATION OF PROCEDURES.—The Secretary 

24 shall adapt the negotiated rulemaking procedures to the 

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1 government relationship between the United States and 

2 Indian Tribes. 

3 ‘‘(d) LACK OF REGULATIONS.—The lack of promul4 gated regulations shall not limit the effect of this Act. 

5 ‘‘(e) INCONSISTENT REGULATIONS.—The provisions 

6 of this Act shall supersede any conflicting provisions of 

7 law in effect on the day before the date of enactment of 

8 the Indian Health Care Improvement Act Amendments of 

9 2007, and the Secretary is authorized to repeal any regu10 lation inconsistent with the provisions of this Act. 

11 ‘‘SEC. 803. PLAN OF IMPLEMENTATION. 

12 ‘‘Not later than 9 months after the date of enactment 

13 of the Indian Health Care Improvement Act Amendments 

14 of 2007, the Secretary, in consultation with Indian Tribes, 

15 Tribal Organizations, and Urban Indian Organizations, 

16 shall submit to Congress a plan explaining the manner and 

17 schedule, by title and section, by which the Secretary will 

18 implement the provisions of this Act. This consultation 

19 may be conducted jointly with the annual budget consulta20 tion pursuant to the Indian Self-Determination and Edu21 cation Assistance Act (25 U.S.C. 450 et seq). 

22 ‘‘SEC. 804. AVAILABILITY OF FUNDS. 

23 ‘‘The funds appropriated pursuant to this Act shall 

24 remain available until expended. 


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1 ‘‘SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED 

2 TO INDIAN HEALTH SERVICE. 

3 ‘‘Any limitation on the use of funds contained in an 

4 Act providing appropriations for the Department for a pe5 riod with respect to the performance of abortions shall 

6 apply for that period with respect to the performance of 

7 abortions using funds contained in an Act providing ap8 propriations for the Service. 

9 ‘‘SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS. 

10 ‘‘(a) IN GENERAL.—The following California Indians 

11 shall be eligible for health services provided by the Service: 

12 ‘‘(1) Any member of a federally recognized In13 dian Tribe. 

14 ‘‘(2) Any descendant of an Indian who was re15 siding in California on June 1, 1852, if such de16 scendant— 

17 ‘‘(A) is a member of the Indian community 

18 served by a local program of the Service; and 

19 ‘‘(B) is regarded as an Indian by the com20 munity in which such descendant lives. 

21 ‘‘(3) Any Indian who holds trust interests in 

22 public domain, national forest, or reservation allot23 ments in California. 

24 ‘‘(4) Any Indian in California who is listed on 

25 the plans for distribution of the assets of rancherias 

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1 fornia under the Act of August 18, 1958 (72 Stat. 

2 619), and any descendant of such an Indian. 

3 ‘‘(b) CLARIFICATION.—Nothing in this section may 

4 be construed as expanding the eligibility of California Indi5 ans for health services provided by the Service beyond the 

6 scope of eligibility for such health services that applied on 

7 May 1, 1986. 

8 ‘‘SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS. 

9 ‘‘(a) CHILDREN.—Any individual who— 

10 ‘‘(1) has not attained 19 years of age; 

11 ‘‘(2) is the natural or adopted child, stepchild, 

12 foster child, legal ward, or orphan of an eligible In13 dian; and 

14 ‘‘(3) is not otherwise eligible for health services 

15 provided by the Service, 

16 shall be eligible for all health services provided by the 

17 Service on the same basis and subject to the same rules 

18 that apply to eligible Indians until such individual attains 

19 19 years of age. The existing and potential health needs 

20 of all such individuals shall be taken into consideration 

21 by the Service in determining the need for, or the alloca22 tion of, the health resources of the Service. If such an indi23 vidual has been determined to be legally incompetent prior 

24 to attaining 19 years of age, such individual shall remain 


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1 eligible for such services until 1 year after the date of a 

2 determination of competency. 

3 ‘‘(b) SPOUSES.—Any spouse of an eligible Indian who 

4 is not an Indian, or who is of Indian descent but is not 

5 otherwise eligible for the health services provided by the 

6 Service, shall be eligible for such health services if all such 

7 spouses or spouses who are married to members of each 

8 Indian Tribe being served are made eligible, as a class, 

9 by an appropriate resolution of the governing body of the 

10 Indian Tribe or Tribal Organization providing such serv11 ices. The health needs of persons made eligible under this 

12 paragraph shall not be taken into consideration by the 

13 Service in determining the need for, or allocation of, its 

14 health resources. 

15 ‘‘(c) PROVISION OF SERVICES TO OTHER INDIVID16 UALS.— 

17 ‘‘(1) IN GENERAL.—The Secretary is authorized 

18 to provide health services under this subsection 

19 through health programs operated directly by the 

20 Service to individuals who reside within the Service 

21 Unit and who are not otherwise eligible for such 

22 health services if— 

23 ‘‘(A) the Indian Tribes served by such 

24 Service Unit request such provision of health 

25 services to such individuals; and 


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1 ‘‘(B) the Secretary and the served Indian 

2 Tribes have jointly determined that— 

3 ‘‘(i) the provision of such health serv4 ices will not result in a denial or diminu5 tion of health services to eligible Indians; 

6 and 

7 ‘‘(ii) there is no reasonable alternative 

8 health facilities or services, within or with9 out the Service Unit, available to meet the 

10 health needs of such individuals. 

11 ‘‘(2) ISDEAA PROGRAMS.—In the case of 

12 health programs and facilities operated under a con13 tract or compact entered into under the Indian Self14 Determination and Education Assistance Act (25 

15 U.S.C. 450 et seq.), the governing body of the In16 dian Tribe or Tribal Organization providing health 

17 services under such contract or compact is author18 ized to determine whether health services should be 

19 provided under such contract to individuals who are 

20 not eligible for such health services under any other 

21 subsection of this section or under any other provi22 sion of law. In making such determinations, the gov23 erning body of the Indian Tribe or Tribal Organiza24 tion shall take into account the considerations de25 scribed in paragraph (1)(B). 


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1 ‘‘(3) PAYMENT FOR SERVICES.— 

2 ‘‘(A) IN GENERAL.—Persons receiving 

3 health services provided by the Service under 

4 this subsection shall be liable for payment of 

5 such health services under a schedule of charges 

6 prescribed by the Secretary which, in the judg7 ment of the Secretary, results in reimbursement 

8 in an amount not less than the actual cost of 

9 providing the health services. Notwithstanding 

10 section 404 of this Act or any other provision 

11 of law, amounts collected under this subsection, 

12 including Medicare, Medicaid, or SCHIP reim13 bursements under titles XVIII, XIX, and XXI 

14 of the Social Security Act, shall be credited to 

15 the account of the program providing the serv16 ice and shall be used for the purposes listed in 

17 section 401(d)(2) and amounts collected under 

18 this subsection shall be available for expendi19 ture within such program. 

20 ‘‘(B) INDIGENT PEOPLE.—Health services 

21 may be provided by the Secretary through the 

22 Service under this subsection to an indigent in23 dividual who would not be otherwise eligible for 

24 such health services but for the provisions of 

25 paragraph (1) only if an agreement has been 


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1 entered into with a State or local government 

2 under which the State or local government 

3 agrees to reimburse the Service for the expenses 

4 incurred by the Service in providing such health 

5 services to such indigent individual. 

6 ‘‘(4) REVOCATION OF CONSENT FOR SERV7 ICES.— 

8 ‘‘(A) SINGLE TRIBE SERVICE AREA.—In 

9 the case of a Service Area which serves only 1 

10 Indian Tribe, the authority of the Secretary to 

11 provide health services under paragraph (1) 

12 shall terminate at the end of the fiscal year suc13 ceeding the fiscal year in which the governing 

14 body of the Indian Tribe revokes its concur15 rence to the provision of such health services. 

16 ‘‘(B) MULTITRIBAL SERVICE AREA.—In 

17 the case of a multitribal Service Area, the au18 thority of the Secretary to provide health serv19 ices under paragraph (1) shall terminate at the 

20 end of the fiscal year succeeding the fiscal year 

21 in which at least 51 percent of the number of 

22 Indian Tribes in the Service Area revoke their 

23 concurrence to the provisions of such health 

24 services. 


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1 ‘‘(d) OTHER SERVICES.—The Service may provide 

2 health services under this subsection to individuals who 

3 are not eligible for health services provided by the Service 

4 under any other provision of law in order to— 

5 ‘‘(1) achieve stability in a medical emergency; 

6 ‘‘(2) prevent the spread of a communicable dis7 ease or otherwise deal with a public health hazard; 

8 ‘‘(3) provide care to non-Indian women preg9 nant with an eligible Indian’s child for the duration 

10 of the pregnancy through postpartum; or 

11 ‘‘(4) provide care to immediate family members 

12 of an eligible individual if such care is directly re13 lated to the treatment of the eligible individual. 

14 ‘‘(e) HOSPITAL PRIVILEGES FOR PRACTITIONERS.— 

15 Hospital privileges in health facilities operated and main16 tained by the Service or operated under a contract or com17 pact pursuant to the Indian Self-Determination and Edu18 cation Assistance Act (25 U.S.C. 450 et seq.) may be ex19 tended to non-Service health care practitioners who pro20 vide services to individuals described in subsection (a), (b), 

21 (c), or (d). Such non-Service health care practitioners 

22 may, as part of the privileging process, be designated as 

23 employees of the Federal Government for purposes of sec24 tion 1346(b) and chapter 171 of title 28, United States 

25 Code (relating to Federal tort claims) only with respect 


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1 to acts or omissions which occur in the course of providing 

2 services to eligible individuals as a part of the conditions 

3 under which such hospital privileges are extended. 

4 ‘‘(f) ELIGIBLE INDIAN.—For purposes of this sec5 tion, the term ‘eligible Indian’ means any Indian who is 

6 eligible for health services provided by the Service without 

7 regard to the provisions of this section. 

8 ‘‘SEC. 808. REALLOCATION OF BASE RESOURCES. 

9 ‘‘(a) REPORT REQUIRED.—Notwithstanding any 

10 other provision of law, any allocation of Service funds for 

11 a fiscal year that reduces by 5 percent or more from the 

12 previous fiscal year the funding for any recurring pro13 gram, project, or activity of a Service Unit may be imple14 mented only after the Secretary has submitted to Con15 gress, under section 801, a report on the proposed change 

16 in allocation of funding, including the reasons for the 

17 change and its likely effects. 

18 ‘‘(b) EXCEPTION.—Subsection (a) shall not apply if 

19 the total amount appropriated to the Service for a fiscal 

20 year is at least 5 percent less than the amount appro21 priated to the Service for the previous fiscal year. 

22 ‘‘SEC. 809. RESULTS OF DEMONSTRATION PROJECTS. 

23 ‘‘The Secretary shall provide for the dissemination to 

24 Indian Tribes, Tribal Organizations, and Urban Indian 


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1 Organizations of the findings and results of demonstration 

2 projects conducted under this Act. 

3 ‘‘SEC. 810. PROVISION OF SERVICES IN MONTANA. 

4 ‘‘(a) CONSISTENT WITH COURT DECISION.—The 

5 Secretary, acting through the Service, shall provide serv6 ices and benefits for Indians in Montana in a manner con7 sistent with the decision of the United States Court of Ap8 peals for the Ninth Circuit in McNabb for McNabb v. 

9 Bowen, 829 F.2d 787 (9th Cir. 1987). 

10 ‘‘(b) CLARIFICATION.—The provisions of subsection 

11 (a) shall not be construed to be an expression of the sense 

12 of Congress on the application of the decision described 

13 in subsection (a) with respect to the provision of services 

14 or benefits for Indians living in any State other than Mon15 tana. 

16 ‘‘SEC. 811. MORATORIUM. 

17 ‘‘During the period of the moratorium imposed on 

18 implementation of the final rule published in the Federal 

19 Register on September 16, 1987, by the Department of 

20 Health and Human Services, relating to eligibility for the 

21 health care services of the Indian Health Service, the In22 dian Health Service shall provide services pursuant to the 

23 criteria for eligibility for such services that were in effect 

24 on September 15, 1987, subject to the provisions of sec25 tions 806 and 807, until the Service has submitted to the 


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1 Committees on Appropriations of the Senate and the 

2 House of Representatives a budget request reflecting the 

3 increased costs associated with the proposed final rule, 

4 and the request has been included in an appropriations 

5 Act and enacted into law. 

6 ‘‘SEC. 812. TRIBAL EMPLOYMENT. 

7 ‘‘For purposes of section 2(2) of the Act of July 5, 

8 1935 (49 Stat. 450, chapter 372), an Indian Tribe or 

9 Tribal Organization carrying out a contract or compact 

10 pursuant to the Indian Self-Determination and Education 

11 Assistance Act (25 U.S.C. 450 et seq.) shall not be consid12 ered an ‘employer’. 

13 ‘‘SEC. 813. SEVERABILITY PROVISIONS. 

14 ‘‘If any provision of this Act, any amendment made 

15 by the Act, or the application of such provision or amend16 ment to any person or circumstances is held to be invalid, 

17 the remainder of this Act, the remaining amendments 

18 made by this Act, and the application of such provisions 

19 to persons or circumstances other than those to which it 

20 is held invalid, shall not be affected thereby. 

21 ‘‘SEC. 814. ESTABLISHMENT OF NATIONAL BIPARTISAN 

22 COMMISSION ON INDIAN HEALTH CARE. 

23 ‘‘(a) ESTABLISHMENT.—There is established the Na24 tional Bipartisan Indian Health Care Commission (the 

25 ‘Commission’). 


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1 ‘‘(b) DUTIES OF COMMISSION.—The duties of the 

2 Commission are the following: 

3 ‘‘(1) To establish a study committee composed 

4 of those members of the Commission appointed by 

5 the Director of the Service and at least 4 members 

6 of Congress from among the members of the Com7 mission, the duties of which shall be the following: 

8 ‘‘(A) To the extent necessary to carry out 

9 its duties, collect and compile data necessary to 

10 understand the extent of Indian needs with re11 gard to the provision of health services, regard12 less of the location of Indians, including holding 

13 hearings and soliciting the views of Indians, In14 dian Tribes, Tribal Organizations, and Urban 

15 Indian Organizations, which may include au16 thorizing and making funds available for feasi17 bility studies of various models for providing 

18 and funding health services for all Indian bene19 ficiaries, including those who live outside of a 

20 reservation, temporarily or permanently. 

21 ‘‘(B) To make legislative recommendations 

22 to the Commission regarding the delivery of 

23 Federal health care services to Indians. Such 

24 recommendations shall include those related to 

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1 ice providers, the cost of such services, financ2 ing such services, and the optimal manner in 

3 which to provide such services. 

4 ‘‘(C) To determine the effect of the enact5 ment of such recommendations on (i) the exist6 ing system of delivery of health services for In7 dians, and (ii) the sovereign status of Indian 

8 Tribes. 

9 ‘‘(D) Not later than 12 months after the 

10 appointment of all members of the Commission, 

11 to submit a written report of its findings and 

12 recommendations to the full Commission. The 

13 report shall include a statement of the minority 

14 and majority position of the Committee and 

15 shall be disseminated, at a minimum, to every 

16 Indian Tribe, Tribal Organization, and Urban 

17 Indian Organization for comment to the Com18 mission. 

19 ‘‘(E) To report regularly to the full Com20 mission regarding the findings and rec21 ommendations developed by the study com22 mittee in the course of carrying out its duties 

23 under this section. 

24 ‘‘(2) To review and analyze the recommenda25 tions of the report of the study committee. 


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1 ‘‘(3) To make legislative recommendations to 

2 Congress regarding the delivery of Federal health 

3 care services to Indians. Such recommendations 

4 shall include those related to issues of eligibility, 

5 benefits, the range of service providers, the cost of 

6 such services, financing such services, and the opti7 mal manner in which to provide such services. 

8 ‘‘(4) Not later than 18 months following the 

9 date of appointment of all members of the Commis10 sion, submit a written report to Congress regarding 

11 the delivery of Federal health care services to Indi12 ans. Such recommendations shall include those re13 lated to issues of eligibility, benefits, the range of 

14 service providers, the cost of such services, financing 

15 such services, and the optimal manner in which to 

16 provide such services. 

17 ‘‘(c) MEMBERS.— 

18 ‘‘(1) APPOINTMENT.—The Commission shall be 

19 composed of 25 members, appointed as follows: 

20 ‘‘(A) Ten members of Congress, including 

21 3 from the House of Representatives and 2 

22 from the Senate, appointed by their respective 

23 majority leaders, and 3 from the House of Rep24 resentatives and 2 from the Senate, appointed 

25 by their respective minority leaders, and who 


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1 shall be members of the standing committees of 

2 Congress that consider legislation affecting 

3 health care to Indians. 

4 ‘‘(B) Twelve persons chosen by the con5 gressional members of the Commission, 1 from 

6 each Service Area as currently designated by 

7 the Director of the Service to be chosen from 

8 among 3 nominees from each Service Area put 

9 forward by the Indian Tribes within the area, 

10 with due regard being given to the experience 

11 and expertise of the nominees in the provision 

12 of health care to Indians and to a reasonable 

13 representation on the commission of members 

14 who are familiar with various health care deliv15 ery modes and who represent Indian Tribes of 

16 various size populations. 

17 ‘‘(C) Three persons appointed by the Di18 rector who are knowledgeable about the provi19 sion of health care to Indians, at least 1 of 

20 whom shall be appointed from among 3 nomi21 nees put forward by those programs whose 

22 funds are provided in whole or in part by the 

23 Service primarily or exclusively for the benefit 

24 of Urban Indians. 


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1 ‘‘(D) All those persons chosen by the con2 gressional members of the Commission and by 

3 the Director shall be members of federally rec4 ognized Indian Tribes. 

5 ‘‘(2) CHAIR; VICE CHAIR.—The Chair and Vice 

6 Chair of the Commission shall be selected by the 

7 congressional members of the Commission. 

8 ‘‘(3) TERMS.—The terms of members of the 

9 Commission shall be for the life of the Commission. 

10 ‘‘(4) DEADLINE FOR APPOINTMENTS.—Con11 gressional members of the Commission shall be ap12 pointed not later than 180 days after the date of en13 actment of the Indian Health Care Improvement Act 

14 Amendments of 2007, and the remaining members 

15 of the Commission shall be appointed not later than 

16 60 days following the appointment of the congres17 sional members. 

18 ‘‘(5) VACANCY.—A vacancy in the Commission 

19 shall be filled in the manner in which the original 

20 appointment was made. 

21 ‘‘(d) COMPENSATION.— 

22 ‘‘(1) CONGRESSIONAL MEMBERS.—Each con23 gressional member of the Commission shall receive 

24 no additional pay, allowances, or benefits by reason 

25 of their service on the Commission and shall receive 


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1 travel expenses and per diem in lieu of subsistence 

2 in accordance with sections 5702 and 5703 of title 

3 5, United States Code. 

4 ‘‘(2) OTHER MEMBERS.—Remaining members 

5 of the Commission, while serving on the business of 

6 the Commission (including travel time), shall be en7 titled to receive compensation at the per diem equiv8 alent of the rate provided for level IV of the Execu9 tive Schedule under section 5315 of title 5, United 

10 States Code, and while so serving away from home 

11 and the member’s regular place of business, a mem12 ber may be allowed travel expenses, as authorized by 

13 the Chairman of the Commission. For purpose of 

14 pay (other than pay of members of the Commission) 

15 and employment benefits, rights, and privileges, all 

16 personnel of the Commission shall be treated as if 

17 they were employees of the United States Senate. 

18 ‘‘(e) MEETINGS.—The Commission shall meet at the 

19 call of the Chair. 

20 ‘‘(f) QUORUM.—A quorum of the Commission shall 

21 consist of not less than 15 members, provided that no less 

22 than 6 of the members of Congress who are Commission 

23 members are present and no less than 9 of the members 

24 who are Indians are present. 

25 ‘‘(g) EXECUTIVE DIRECTOR; STAFF; FACILITIES.— 


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1 ‘‘(1) APPOINTMENT; PAY.—The Commission 

2 shall appoint an executive director of the Commis3 sion. The executive director shall be paid the rate of 

4 basic pay for level V of the Executive Schedule. 

5 ‘‘(2) STAFF APPOINTMENT.—With the approval 

6 of the Commission, the executive director may ap7 point such personnel as the executive director deems 

8 appropriate. 

9 ‘‘(3) STAFF PAY.—The staff of the Commission 

10 shall be appointed without regard to the provisions 

11 of title 5, United States Code, governing appoint12 ments in the competitive service, and shall be paid 

13 without regard to the provisions of chapter 51 and 

14 subchapter III of chapter 53 of such title (relating 

15 to classification and General Schedule pay rates). 

16 ‘‘(4) TEMPORARY SERVICES.—With the ap17 proval of the Commission, the executive director may 

18 procure temporary and intermittent services under 

19 section 3109(b) of title 5, United States Code. 

20 ‘‘(5) FACILITIES.—The Administrator of Gen21 eral Services shall locate suitable office space for the 

22 operation of the Commission. The facilities shall 

23 serve as the headquarters of the Commission and 

24 shall include all necessary equipment and incidentals 


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1 required for the proper functioning of the Commis2 sion. 

3 ‘‘(h) HEARINGS.—(1) For the purpose of carrying 

4 out its duties, the Commission may hold such hearings 

5 and undertake such other activities as the Commission de6 termines to be necessary to carry out its duties, provided 

7 that at least 6 regional hearings are held in different areas 

8 of the United States in which large numbers of Indians 

9 are present. Such hearings are to be held to solicit the 

10 views of Indians regarding the delivery of health care serv11 ices to them. To constitute a hearing under this sub12 section, at least 5 members of the Commission, including 

13 at least 1 member of Congress, must be present. Hearings 

14 held by the study committee established in this section 

15 may count toward the number of regional hearings re16 quired by this subsection. 

17 ‘‘(2) Upon request of the Commission, the Comp18 troller General shall conduct such studies or investigations 

19 as the Commission determines to be necessary to carry 

20 out its duties. 

21 ‘‘(3)(A) The Director of the Congressional Budget 

22 Office or the Chief Actuary of the Centers for Medicare 

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1 mates as the Commission determines to be necessary to 

2 carry out its duties. 

3 ‘‘(B) The Commission shall reimburse the Director 

4 of the Congressional Budget Office for expenses relating 

5 to the employment in the office of that Director of such 

6 additional staff as may be necessary for the Director to 

7 comply with requests by the Commission under subpara8 graph (A). 

9 ‘‘(4) Upon the request of the Commission, the head 

10 of any Federal agency is authorized to detail, without re11 imbursement, any of the personnel of such agency to the 

12 Commission to assist the Commission in carrying out its 

13 duties. Any such detail shall not interrupt or otherwise 

14 affect the civil service status or privileges of the Federal 

15 employee. 

16 ‘‘(5) Upon the request of the Commission, the head 

17 of a Federal agency shall provide such technical assistance 

18 to the Commission as the Commission determines to be 

19 necessary to carry out its duties. 

20 ‘‘(6) The Commission may use the United States 

21 mails in the same manner and under the same conditions 

22 as Federal agencies and shall, for purposes of the frank, 

23 be considered a commission of Congress as described in 

24 section 3215 of title 39, United States Code. 


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1 ‘‘(7) The Commission may secure directly from any 

2 Federal agency information necessary to enable it to carry 

3 out its duties, if the information may be disclosed under 

4 section 552 of title 4, United States Code. Upon request 

5 of the Chairman of the Commission, the head of such 

6 agency shall furnish such information to the Commission. 

7 ‘‘(8) Upon the request of the Commission, the Ad8 ministrator of General Services shall provide to the Com9 mission on a reimbursable basis such administrative sup10 port services as the Commission may request. 

11 ‘‘(9) For purposes of costs relating to printing and 

12 binding, including the cost of personnel detailed from the 

13 Government Printing Office, the Commission shall be 

14 deemed to be a committee of Congress. 

15 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

16 authorized to be appropriated $4,000,000 to carry out the 

17 provisions of this section, which sum shall not be deducted 

18 from or affect any other appropriation for health care for 

19 Indian persons. 

20 ‘‘(j) NONAPPLICABILITY OF FACA.—The Federal 

21 Advisory Committee Act (5 U.S.C. App.) shall not apply 

22 to the Commission. 


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1 ‘‘SEC. 815. CONFIDENTIALITY OF MEDICAL QUALITY ASSUR2 ANCE RECORDS; QUALIFIED IMMUNITY FOR 

3 PARTICIPANTS. 

4 ‘‘(a) CONFIDENTIALITY OF RECORDS.—Medical qual5 ity assurance records created by or for any Indian Health 

6 Program or a health program of an Urban Indian Organi7 zation as part of a medical quality assurance program are 

8 confidential and privileged. Such records may not be dis9 closed to any person or entity, except as provided in sub10 section (c). 

11 ‘‘(b) PROHIBITION ON DISCLOSURE AND TESTI12 MONY.— 

13 ‘‘(1) IN GENERAL.—No part of any medical 

14 quality assurance record described in subsection (a) 

15 may be subject to discovery or admitted into evi16 dence in any judicial or administrative proceeding, 

17 except as provided in subsection (c). 

18 ‘‘(2) TESTIMONY.—A person who reviews or 

19 creates medical quality assurance records for any In20 dian Health Program or Urban Indian Organization 

21 who participates in any proceeding that reviews or 

22 creates such records may not be permitted or re23 quired to testify in any judicial or administrative 

24 proceeding with respect to such records or with re25 spect to any finding, recommendation, evaluation, 

26 opinion, or action taken by such person or body in 


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1 connection with such records except as provided in 

2 this section. 

3 ‘‘(c) AUTHORIZED DISCLOSURE AND TESTIMONY.— 

4 ‘‘(1) IN GENERAL.—Subject to paragraph (2), a 

5 medical quality assurance record described in sub6 section (a) may be disclosed, and a person referred 

7 to in subsection (b) may give testimony in connec8 tion with such a record, only as follows: 

9 ‘‘(A) To a Federal executive agency or pri10 vate organization, if such medical quality assur11 ance record or testimony is needed by such 

12 agency or organization to perform licensing or 

13 accreditation functions related to any Indian 

14 Health Program or to a health program of an 

15 Urban Indian Organization to perform moni16 toring, required by law, of such program or or17 ganization. 

18 ‘‘(B) To an administrative or judicial pro19 ceeding commenced by a present or former In20 dian Health Program or Urban Indian Organi21 zation provider concerning the termination, sus22 pension, or limitation of clinical privileges of 

23 such health care provider. 

24 ‘‘(C) To a governmental board or agency 

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1 nization, if such medical quality assurance 

2 record or testimony is needed by such board, 

3 agency, society, or organization to perform li4 censing, credentialing, or the monitoring of pro5 fessional standards with respect to any health 

6 care provider who is or was an employee of any 

7 Indian Health Program or Urban Indian Orga8 nization. 

9 ‘‘(D) To a hospital, medical center, or 

10 other institution that provides health care serv11 ices, if such medical quality assurance record or 

12 testimony is needed by such institution to as13 sess the professional qualifications of any health 

14 care provider who is or was an employee of any 

15 Indian Health Program or Urban Indian Orga16 nization and who has applied for or been grant17 ed authority or employment to provide health 

18 care services in or on behalf of such program or 

19 organization. 

20 ‘‘(E) To an officer, employee, or contractor 

21 of the Indian Health Program or Urban Indian 

22 Organization that created the records or for 

23 which the records were created. If that officer, 

24 employee, or contractor has a need for such 

25 record or testimony to perform official duties. 


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1 ‘‘(F) To a criminal or civil law enforce2 ment agency or instrumentality charged under 

3 applicable law with the protection of the public 

4 health or safety, if a qualified representative of 

5 such agency or instrumentality makes a written 

6 request that such record or testimony be pro7 vided for a purpose authorized by law. 

8 ‘‘(G) In an administrative or judicial pro9 ceeding commenced by a criminal or civil law 

10 enforcement agency or instrumentality referred 

11 to in subparagraph (F), but only with respect 

12 to the subject of such proceeding. 

13 ‘‘(2) IDENTITY OF PARTICIPANTS.—With the 

14 exception of the subject of a quality assurance ac15 tion, the identity of any person receiving health care 

16 services from any Indian Health Program or Urban 

17 Indian Organization or the identity of any other per18 son associated with such program or organization 

19 for purposes of a medical quality assurance program 

20 that is disclosed in a medical quality assurance 

21 record described in subsection (a) shall be deleted 

22 from that record or document before any disclosure 

23 of such record is made outside such program or or24 ganization. Such requirement does not apply to the 


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1 release of information pursuant to section 552a of 

2 title 5. 

3 ‘‘(d) DISCLOSURE FOR CERTAIN PURPOSES.— 

4 ‘‘(1) IN GENERAL.—Nothing in this section 

5 shall be construed as authorizing or requiring the 

6 withholding from any person or entity aggregate sta7 tistical information regarding the results of any In8 dian Health Program or Urban Indian 

9 Organizations’s medical quality assurance programs. 

10 ‘‘(2) WITHHOLDING FROM CONGRESS.—Noth11 ing in this section shall be construed as authority to 

12 withhold any medical quality assurance record from 

13 a committee of either House of Congress, any joint 

14 committee of Congress, or the Government Account15 ability Office if such record pertains to any matter 

16 within their respective jurisdictions. 

17 ‘‘(e) PROHIBITION ON DISCLOSURE OF RECORD OR

18 TESTIMONY.—A person or entity having possession of or 

19 access to a record or testimony described by this section 

20 may not disclose the contents of such record or testimony 

21 in any manner or for any purpose except as provided in 

22 this section. 

23 ‘‘(f) EXEMPTION FROM FREEDOM OF INFORMATION

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1 section (a) may not be made available to any person under 

2 section 552 of title 5. 

3 ‘‘(g) LIMITATION ON CIVIL LIABILITY.—A person 

4 who participates in or provides information to a person 

5 or body that reviews or creates medical quality assurance 

6 records described in subsection (a) shall not be civilly lia7 ble for such participation or for providing such informa8 tion if the participation or provision of information was 

9 in good faith based on prevailing professional standards 

10 at the time the medical quality assurance program activity 

11 took place. 

12 ‘‘(h) APPLICATION TO INFORMATION IN CERTAIN

13 OTHER RECORDS.—Nothing in this section shall be con14 strued as limiting access to the information in a record 

15 created and maintained outside a medical quality assur16 ance program, including a patient’s medical records, on 

17 the grounds that the information was presented during 

18 meetings of a review body that are part of a medical qual19 ity assurance program. 

20 ‘‘(i) REGULATIONS.—The Secretary, acting through 

21 the Service, shall promulgate regulations pursuant to sec22 tion 802. 

23 ‘‘(j) DEFINITIONS.—In this section: 

24 ‘‘(1) The term ‘health care provider’ means any 

25 health care professional, including community health 


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1 aides and practitioners certified under section 121, 

2 who are granted clinical practice privileges or em3 ployed to provide health care services in an Indian 

4 Health Program or health program of an Urban In5 dian Organization, who is licensed or certified to 

6 perform health care services by a governmental 

7 board or agency or professional health care society 

8 or organization. 

9 ‘‘(2) The term ‘medical quality assurance pro10 gram’ means any activity carried out before, on, or 

11 after the date of enactment of this Act by or for any 

12 Indian Health Program or Urban Indian Organiza13 tion to assess the quality of medical care, including 

14 activities conducted by or on behalf of individuals, 

15 Indian Health Program or Urban Indian Organiza16 tion medical or dental treatment review committees, 

17 or other review bodies responsible for quality assur18 ance, credentials, infection control, patient safety, 

19 patient care assessment (including treatment proce20 dures, blood, drugs, and therapeutics), medical 

21 records, health resources management review and 

22 identification and prevention of medical or dental in23 cidents and risks. 

24 ‘‘(3) The term ‘medical quality assurance 

25 record’ means the proceedings, records, minutes, and 


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1 reports that emanate from quality assurance pro2 gram activities described in paragraph (2) and are 

3 produced or compiled by or for an Indian Health 

4 Program or Urban Indian Organization as part of a 

5 medical quality assurance program. 

6 ‘‘SEC. 816. APPROPRIATIONS; AVAILABILITY. 

7 ‘‘Any new spending authority (described in subpara8 graph (A) or (B) of section 401(c)(2) of the Congressional 

9 Budget Act of 1974 (Public Law 93–344; 88 Stat. 317)) 

10 which is provided under this Act shall be effective for any 

11 fiscal year only to such extent or in such amounts as are 

12 provided in appropriation Acts. 

13 ‘‘SEC. 817. AUTHORIZATION OF APPROPRIATIONS. 

14 ‘‘There are authorized to be appropriated such sums 

15 as may be necessary for each fiscal year through fiscal 

16 year 2017 to carry out this title.’’. 

17 (b) RATE OF PAY.— 

18 (1) POSITIONS AT LEVEL IV.—Section 5315 of 

19 title 5, United States Code, is amended by striking 

20 ‘‘Assistant Secretaries of Health and Human Serv21 ices (6).’’ and inserting ‘‘Assistant Secretaries of 

22 Health and Human Services (7)’’. 

23 (2) POSITIONS AT LEVEL V.—Section 5316 of 

24 title 5, United States Code, is amended by striking 


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1 ‘‘Director, Indian Health Service, Department of 

2 Health and Human Services’’. 

3 (c) AMENDMENTS TO OTHER PROVISIONS OF LAW.— 

4 (1) Section 3307(b)(1)(C) of the Children’s 

5 Health Act of 2000 (25 U.S.C. 1671 note; Public 

6 Law 106–310) is amended by striking ‘‘Director of 

7 the Indian Health Service’’ and inserting ‘‘Assistant 

8 Secretary for Indian Health’’. 

9 (2) The Indian Lands Open Dump Cleanup Act 

10 of 1994 is amended— 

11 (A) in section 3 (25 U.S.C. 3902)— 

12 (i) by striking paragraph (2); 

13 (ii) by redesignating paragraphs (1), 

14 (3), (4), (5), and (6) as paragraphs (4), 

15 (5), (2), (6), and (1), respectively, and 

16 moving those paragraphs so as to appear 

17 in numerical order; and 

18 (iii) by inserting before paragraph (4) 

19 (as redesignated by subclause (II)) the fol20 lowing: 

21 ‘‘(3) ASSISTANT SECRETARY.—The term ‘As22 sistant Secretary’ means the Assistant Secretary for 

23 Indian Health.’’; 


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1 (B) in section 5 (25 U.S.C. 3904), by 

2 striking the section designation and heading 

3 and inserting the following: 

4 ‘‘SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR IN5 DIAN HEALTH.’’; 

6 (C) in section 6(a) (25 U.S.C. 3905(a)), in 

7 the subsection heading, by striking ‘‘DIREC8 TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 

9 (D) in section 9(a) (25 U.S.C. 3908(a)), in 

10 the subsection heading, by striking ‘‘DIREC11 TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 

12 and 

13 (E) by striking ‘‘Director’’ each place it 

14 appears and inserting ‘‘Assistant Secretary’’. 

15 (3) Section 5504(d)(2) of the Augustus F. 

16 Hawkins-Robert T. Stafford Elementary and Sec17 ondary School Improvement Amendments of 1988 

18 (25 U.S.C. 2001 note; Public Law 100–297) is 

19 amended by striking ‘‘Director of the Indian Health 

20 Service’’ and inserting ‘‘Assistant Secretary for In21 dian Health’’. 

22 (4) Section 203(a)(1) of the Rehabilitation Act 

23 of 1973 (29 U.S.C. 763(a)(1)) is amended by strik24 ing ‘‘Director of the Indian Health Service’’ and in25 serting ‘‘Assistant Secretary for Indian Health’’. 


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1 (5) Subsections (b) and (e) of section 518 of 

2 the Federal Water Pollution Control Act (33 U.S.C. 

3 1377) are amended by striking ‘‘Director of the In4 dian Health Service’’ each place it appears and in5 serting ‘‘Assistant Secretary for Indian Health’’. 

6 (6) Section 317M(b) of the Public Health Serv7 ice Act (42 U.S.C. 247b–14(b)) is amended— 

8 (A) by striking ‘‘Director of the Indian 

9 Health Service’’ each place it appears and in10 serting ‘‘Assistant Secretary for Indian 

11 Health’’; and 

12 (B) in paragraph (2)(A), by striking ‘‘the 

13 Directors referred to in such paragraph’’ and 

14 inserting ‘‘the Director of the Centers for Dis15 ease Control and Prevention and the Assistant 

16 Secretary for Indian Health’’. 

17 (7) Section 417C(b) of the Public Health Serv18 ice Act (42 U.S.C. 285–9(b)) is amended by striking 

19 ‘‘Director of the Indian Health Service’’ and insert20 ing ‘‘Assistant Secretary for Indian Health’’. 

21 (8) Section 1452(i) of the Safe Drinking Water 

22 Act (42 U.S.C. 300j–12(i)) is amended by striking 

23 ‘‘Director of the Indian Health Service’’ each place 

24 it appears and inserting ‘‘Assistant Secretary for In25 dian Health’’. 


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1 (9) Section 803B(d)(1) of the Native American 

2 Programs Act of 1974 (42 U.S.C. 2991b–2(d)(1)) is 

3 amended in the last sentence by striking ‘‘Director 

4 of the Indian Health Service’’ and inserting ‘‘Assist5 ant Secretary for Indian Health’’. 

6 (10) Section 203(b) of the Michigan Indian 

7 Land Claims Settlement Act (Public Law 105–143; 

8 111 Stat. 2666) is amended by striking ‘‘Director of 

9 the Indian Health Service’’ and inserting ‘‘Assistant 

10 Secretary for Indian Health’’. 

11 SEC. 102. SOBOBA SANITATION FACILITIES. 

12 The Act of December 17, 1970 (84 Stat. 1465), is 

13 amended by adding at the end the following: 

14 ‘‘SEC. 9. Nothing in this Act shall preclude the 

15 Soboba Band of Mission Indians and the Soboba Indian 

16 Reservation from being provided with sanitation facilities 

17 and services under the authority of section 7 of the Act 

18 of August 5, 1954 (68 Stat. 674), as amended by the Act 

19 of July 31, 1959 (73 Stat. 267).’’. 

20 SEC. 103. NATIVE AMERICAN HEALTH AND WELLNESS 

21 FOUNDATION. 

22 (a) IN GENERAL.—The Indian Self-Determination 

23 and Education Assistance Act (25 U.S.C. 450 et seq.) is 

24 amended by adding at the end the following: 


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1 ‘‘TITLE VIII—NATIVE AMERICAN 

2 HEALTH AND WELLNESS 

3 FOUNDATION 

4 ‘‘SEC. 801. DEFINITIONS. 

5 ‘‘In this title: 

6 ‘‘(1) BOARD.—The term ‘Board’ means the 

7 Board of Directors of the Foundation. 

8 ‘‘(2) COMMITTEE.—The term ‘Committee’ 

9 means the Committee for the Establishment of Na10 tive American Health and Wellness Foundation es11 tablished under section 802(f). 

12 ‘‘(3) FOUNDATION.—The term ‘Foundation’ 

13 means the Native American Health and Wellness 

14 Foundation established under section 802. 

15 ‘‘(4) SECRETARY.—The term ‘Secretary’ means 

16 the Secretary of Health and Human Services. 

17 ‘‘(5) SERVICE.—The term ‘Service’ means the 

18 Indian Health Service of the Department of Health 

19 and Human Services. 

20 ‘‘SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS 

21 FOUNDATION. 

22 ‘‘(a) ESTABLISHMENT.— 

23 ‘‘(1) IN GENERAL.—As soon as practicable 

24 after the date of enactment of this title, the Sec25 retary shall establish, under the laws of the District 


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1 of Columbia and in accordance with this title, the 

2 Native American Health and Wellness Foundation. 

3 ‘‘(2) FUNDING DETERMINATIONS.—No funds, 

4 gift, property, or other item of value (including any 

5 interest accrued on such an item) acquired by the 

6 Foundation shall— 

7 ‘‘(A) be taken into consideration for pur8 poses of determining Federal appropriations re9 lating to the provision of health care and serv10 ices to Indians; or 

11 ‘‘(B) otherwise limit, diminish, or affect 

12 the Federal responsibility for the provision of 

13 health care and services to Indians. 

14 ‘‘(b) PERPETUAL EXISTENCE.—The Foundation 

15 shall have perpetual existence. 

16 ‘‘(c) NATURE OF CORPORATION.—The Foundation— 

17 ‘‘(1) shall be a charitable and nonprofit feder18 ally chartered corporation; and 

19 ‘‘(2) shall not be an agency or instrumentality 

20 of the United States. 

21 ‘‘(d) PLACE OF INCORPORATION AND DOMICILE.— 

22 The Foundation shall be incorporated and domiciled in the 

23 District of Columbia. 

24 ‘‘(e) DUTIES.—The Foundation shall— 


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1 ‘‘(1) encourage, accept, and administer private 

2 gifts of real and personal property, and any income 

3 from or interest in such gifts, for the benefit of, or 

4 in support of, the mission of the Service; 

5 ‘‘(2) undertake and conduct such other activi6 ties as will further the health and wellness activities 

7 and opportunities of Native Americans; and 

8 ‘‘(3) participate with and assist Federal, State, 

9 and tribal governments, agencies, entities, and indi10 viduals in undertaking and conducting activities that 

11 will further the health and wellness activities and op12 portunities of Native Americans. 

13 ‘‘(f) COMMITTEE FOR THE ESTABLISHMENT OF NA14 TIVE AMERICAN HEALTH AND WELLNESS FOUNDA15 TION.— 

16 ‘‘(1) IN GENERAL.—The Secretary shall estab17 lish the Committee for the Establishment of Native 

18 American Health and Wellness Foundation to assist 

19 the Secretary in establishing the Foundation. 

20 ‘‘(2) DUTIES.—Not later than 180 days after 

21 the date of enactment of this section, the Committee 

22 shall— 

23 ‘‘(A) carry out such activities as are nec24 essary to incorporate the Foundation under the 


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1 laws of the District of Columbia, including act2 ing as incorporators of the Foundation; 

3 ‘‘(B) ensure that the Foundation qualifies 

4 for and maintains the status required to carry 

5 out this section, until the Board is established; 

6 ‘‘(C) establish the constitution and initial 

7 bylaws of the Foundation; 

8 ‘‘(D) provide for the initial operation of 

9 the Foundation, including providing for tem10 porary or interim quarters, equipment, and 

11 staff; and 

12 ‘‘(E) appoint the initial members of the 

13 Board in accordance with the constitution and 

14 initial bylaws of the Foundation. 

15 ‘‘(g) BOARD OF DIRECTORS.— 

16 ‘‘(1) IN GENERAL.—The Board of Directors 

17 shall be the governing body of the Foundation. 

18 ‘‘(2) POWERS.—The Board may exercise, or 

19 provide for the exercise of, the powers of the Foun20 dation. 

21 ‘‘(3) SELECTION.— 

22 ‘‘(A) IN GENERAL.—Subject to subpara23 graph (B), the number of members of the 

24 Board, the manner of selection of the members 

25 (including the filling of vacancies), and the 


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1 terms of office of the members shall be as pro2 vided in the constitution and bylaws of the 

3 Foundation. 

4 ‘‘(B) REQUIREMENTS.— 

5 ‘‘(i) NUMBER OF MEMBERS.—The 

6 Board shall have at least 11 members, who 

7 shall have staggered terms. 

8 ‘‘(ii) INITIAL VOTING MEMBERS.—The 

9 initial voting members of the Board— 

10 ‘‘(I) shall be appointed by the 

11 Committee not later than 180 days 

12 after the date on which the Founda13 tion is established; and 

14 ‘‘(II) shall have staggered terms. 

15 ‘‘(iii) QUALIFICATION.—The members 

16 of the Board shall be United States citi17 zens who are knowledgeable or experienced 

18 in Native American health care and related 

19 matters. 

20 ‘‘(C) COMPENSATION.—A member of the 

21 Board shall not receive compensation for service 

22 as a member, but shall be reimbursed for actual 

23 and necessary travel and subsistence expenses 

24 incurred in the performance of the duties of the 

25 Foundation. 


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1 ‘‘(h) OFFICERS.— 

2 ‘‘(1) IN GENERAL.—The officers of the Founda3 tion shall be— 

4 ‘‘(A) a secretary, elected from among the 

5 members of the Board; and 

6 ‘‘(B) any other officers provided for in the 

7 constitution and bylaws of the Foundation. 

8 ‘‘(2) CHIEF OPERATING OFFICER.—The sec9 retary of the Foundation may serve, at the direction 

10 of the Board, as the chief operating officer of the 

11 Foundation, or the Board may appoint a chief oper12 ating officer, who shall serve at the direction of the 

13 Board. 

14 ‘‘(3) ELECTION.—The manner of election, term 

15 of office, and duties of the officers of the Founda16 tion shall be as provided in the constitution and by17 laws of the Foundation. 

18 ‘‘(i) POWERS.—The Foundation— 

19 ‘‘(1) shall adopt a constitution and bylaws for 

20 the management of the property of the Foundation 

21 and the regulation of the affairs of the Foundation; 

22 ‘‘(2) may adopt and alter a corporate seal; 

23 ‘‘(3) may enter into contracts; 

24 ‘‘(4) may acquire (through a gift or otherwise), 

25 own, lease, encumber, and transfer real or personal 


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1 property as necessary or convenient to carry out the 

2 purposes of the Foundation; 

3 ‘‘(5) may sue and be sued; and 

4 ‘‘(6) may perform any other act necessary and 

5 proper to carry out the purposes of the Foundation. 

6 ‘‘(j) PRINCIPAL OFFICE.— 

7 ‘‘(1) IN GENERAL.—The principal office of the 

8 Foundation shall be in the District of Columbia. 

9 ‘‘(2) ACTIVITIES; OFFICES.—The activities of 

10 the Foundation may be conducted, and offices may 

11 be maintained, throughout the United States in ac12 cordance with the constitution and bylaws of the 

13 Foundation. 

14 ‘‘(k) SERVICE OF PROCESS.—The Foundation shall 

15 comply with the law on service of process of each State 

16 in which the Foundation is incorporated and of each State 

17 in which the Foundation carries on activities. 

18 ‘‘(l) LIABILITY OF OFFICERS, EMPLOYEES, AND

19 AGENTS.— 

20 ‘‘(1) IN GENERAL.—The Foundation shall be 

21 liable for the acts of the officers, employees, and 

22 agents of the Foundation acting within the scope of 

23 their authority. 

24 ‘‘(2) PERSONAL LIABILITY.—A member of the 

25 Board shall be personally liable only for gross negVerDate Aug 31 2005 21:58 Apr 25, 2007 Jkt 059200 PO 00000 Frm 00341 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.IS S1200

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1 ligence in the performance of the duties of the mem2 ber. 

3 ‘‘(m) RESTRICTIONS.— 

4 ‘‘(1) LIMITATION ON SPENDING.—Beginning 

5 with the fiscal year following the first full fiscal year 

6 during which the Foundation is in operation, the ad7 ministrative costs of the Foundation shall not exceed 

8 the percentage described in paragraph (2) of the 

9 sum of— 

10 ‘‘(A) the amounts transferred to the Foun11 dation under subsection (o) during the pre12 ceding fiscal year; and 

13 ‘‘(B) donations received from private 

14 sources during the preceding fiscal year. 

15 ‘‘(2) PERCENTAGES.—The percentages referred 

16 to in paragraph (1) are— 

17 ‘‘(A) for the first fiscal year described in 

18 that paragraph, 20 percent; 

19 ‘‘(B) for the following fiscal year, 15 per20 cent; and 

21 ‘‘(C) for each fiscal year thereafter, 10 

22 percent. 

23 ‘‘(3) APPOINTMENT AND HIRING.—The ap24 pointment of officers and employees of the Founda25 tion shall be subject to the availability of funds. 


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1 ‘‘(4) STATUS.—A member of the Board or offi2 cer, employee, or agent of the Foundation shall not 

3 by reason of association with the Foundation be con4 sidered to be an officer, employee, or agent of the 

5 United States. 

6 ‘‘(n) AUDITS.—The Foundation shall comply with 

7 section 10101 of title 36, United States Code, as if the 

8 Foundation were a corporation under part B of subtitle 

9 II of that title. 

10 ‘‘(o) FUNDING.— 

11 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

12 There is authorized to be appropriated to carry out 

13 subsection (e)(1) $500,000 for each fiscal year, as 

14 adjusted to reflect changes in the Consumer Price 

15 Index for all-urban consumers published by the De16 partment of Labor. 

17 ‘‘(2) TRANSFER OF DONATED FUNDS.—The 

18 Secretary shall transfer to the Foundation funds 

19 held by the Department of Health and Human Serv20 ices under the Act of August 5, 1954 (42 U.S.C. 

21 2001 et seq.), if the transfer or use of the funds is 

22 not prohibited by any term under which the funds 

23 were donated. 


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1 ‘‘SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT. 

2 ‘‘(a) PROVISION OF SUPPORT BY SECRETARY.—Sub3 ject to subsection (b), during the 5-year period beginning 

4 on the date on which the Foundation is established, the 

5 Secretary— 

6 ‘‘(1) may provide personnel, facilities, and other 

7 administrative support services to the Foundation; 

8 ‘‘(2) may provide funds for initial operating 

9 costs and to reimburse the travel expenses of the 

10 members of the Board; and 

11 ‘‘(3) shall require and accept reimbursements 

12 from the Foundation for— 

13 ‘‘(A) services provided under paragraph 

14 (1); and 

15 ‘‘(B) funds provided under paragraph (2). 

16 ‘‘(b) REIMBURSEMENT.—Reimbursements accepted 

17 under subsection (a)(3)— 

18 ‘‘(1) shall be deposited in the Treasury of the 

19 United States to the credit of the applicable appro20 priations account; and 

21 ‘‘(2) shall be chargeable for the cost of pro22 viding services described in subsection (a)(1) and 

23 travel expenses described in subsection (a)(2). 

24 ‘‘(c) CONTINUATION OF CERTAIN SERVICES.—The 

25 Secretary may continue to provide facilities and necessary 

26 support services to the Foundation after the termination 


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1 of the 5-year period specified in subsection (a) if the facili2 ties and services— 

3 ‘‘(1) are available; and 

4 ‘‘(2) are provided on reimbursable cost basis.’’. 

5 (b) TECHNICAL AMENDMENTS.—The Indian Self-De6 termination and Education Assistance Act is amended— 

7 (1) by redesignating title V (25 U.S.C. 458bbb 

8 et seq.) as title VII; 

9 (2) by redesignating sections 501, 502, and 503 

10 (25 U.S.C. 458bbb, 458bbb–1, 458bbb–2) as sec11 tions 701, 702, and 703, respectively; and 

12 (3) in subsection (a)(2) of section 702 and 

13 paragraph (2) of section 703 (as redesignated by 

14 paragraph (2)), by striking ‘‘section 501’’ and in15 serting ‘‘section 701’’. 

16 TITLE II—IMPROVEMENT OF IN17 DIAN HEALTH CARE PRO18 VIDED UNDER THE SOCIAL 

19 SECURITY ACT 

20 SEC. 201. EXPANSION OF PAYMENTS UNDER MEDICARE, 

21 MEDICAID, AND SCHIP FOR ALL COVERED 

22 SERVICES FURNISHED BY INDIAN HEALTH 

23 PROGRAMS. 

24 (a) MEDICAID.— 


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1 (1) EXPANSION TO ALL COVERED SERVICES.— 

2 Section 1911 of the Social Security Act (42 U.S.C. 

3 1396j) is amended— 

4 (A) by amending the heading to read as 

5 follows: 

6 ‘‘SEC. 1911. INDIAN HEALTH PROGRAMS.’’; 

7 and 

8 (B) by amending subsection (a) to read as 

9 follows: 

10 ‘‘(a) ELIGIBILITY FOR PAYMENT FOR MEDICAL AS11 SISTANCE.—The Indian Health Service and an Indian 

12 Tribe, Tribal Organization, or an Urban Indian Organiza13 tion shall be eligible for payment for medical assistance 

14 provided under a State plan or under waiver authority 

15 with respect to items and services furnished by the Indian 

16 Health Service, Indian Tribe, Tribal Organization, or 

17 Urban Indian Organization if the furnishing of such serv18 ices meets all the conditions and requirements which are 

19 applicable generally to the furnishing of items and services 

20 under this title and under such plan or waiver authority.’’. 

21 (2) COMPLIANCE WITH CONDITIONS AND RE22 QUIREMENTS.—Subsection (b) of such section is 

23 amended to read as follows: 

24 ‘‘(b) COMPLIANCE WITH CONDITIONS AND REQUIRE25 MENTS.—A facility of the Indian Health Service or an InVerDate Aug 31 2005 21:58 Apr 25, 2007 Jkt 059200 PO 00000 Frm 00346 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.IS S1200

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1 dian Tribe, Tribal Organization, or an Urban Indian Or2 ganization which is eligible for payment under subsection 

3 (a) with respect to the furnishing of items and services, 

4 but which does not meet all of the conditions and require5 ments of this title and under a State plan or waiver au6 thority which are applicable generally to such facility, shall 

7 make such improvements as are necessary to achieve or 

8 maintain compliance with such conditions and require9 ments in accordance with a plan submitted to and accept10 ed by the Secretary for achieving or maintaining compli11 ance with such conditions and requirements, and shall be 

12 deemed to meet such conditions and requirements (and to 

13 be eligible for payment under this title), without regard 

14 to the extent of its actual compliance with such conditions 

15 and requirements, during the first 12 months after the 

16 month in which such plan is submitted.’’. 

17 (3) REVISION OF AUTHORITY TO ENTER INTO

18 AGREEMENTS.—Subsection (c) of such section is 

19 amended to read as follows: 

20 ‘‘(c) AUTHORITY TO ENTER INTO AGREEMENTS.— 

21 The Secretary may enter into an agreement with a State 

22 for the purpose of reimbursing the State for medical as23 sistance provided by the Indian Health Service, an Indian 

24 Tribe, Tribal Organization, or an Urban Indian Organiza25 tion (as so defined), directly, through referral, or under 


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1 contracts or other arrangements between the Indian 

2 Health Service, an Indian Tribe, Tribal Organization, or 

3 an Urban Indian Organization and another health care 

4 provider to Indians who are eligible for medical assistance 

5 under the State plan or under waiver authority.’’. 

6 (4) CROSS-REFERENCES TO SPECIAL FUND FOR

7 IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING

8 OPTION; DEFINITIONS.—Such section is further 

9 amended by striking subsection (d) and adding at 

10 the end the following new subsections: 

11 ‘‘(d) SPECIAL FUND FOR IMPROVEMENT OF IHS FA12 CILITIES.—For provisions relating to the authority of the 

13 Secretary to place payments to which a facility of the In14 dian Health Service is eligible for payment under this title 

15 into a special fund established under section 401(c)(1) of 

16 the Indian Health Care Improvement Act, and the require17 ment to use amounts paid from such fund for making im18 provements in accordance with subsection (b), see sub19 paragraphs (A) and (B) of section 401(c)(1) of such Act. 

20 ‘‘(e) DIRECT BILLING.—For provisions relating to 

21 the authority of a Tribal Health Program or an Urban 

22 Indian Organization to elect to directly bill for, and receive 

23 payment for, health care items and services provided by 

24 such Program or Organization for which payment is made 


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1 under this title, see section 401(d) of the Indian Health 

2 Care Improvement Act. 

3 ‘‘(f) DEFINITIONS.—In this section, the terms ‘In4 dian Health Program’, ‘Indian Tribe’,‘Tribal Health Pro5 gram’, ‘Tribal Organization’, and ‘Urban Indian Organi6 zation’ have the meanings given those terms in section 4 

7 of the Indian Health Care Improvement Act.’’. 

8 (b) MEDICARE.— 

9 (1) EXPANSION TO ALL COVERED SERVICES.— 

10 Section 1880 of such Act (42 U.S.C. 1395qq) is 

11 amended— 

12 (A) by amending the heading to read as 

13 follows: 

14 ‘‘SEC. 1880. INDIAN HEALTH PROGRAMS.’’; 

15 and 

16 (B) by amending subsection (a) to read as 

17 follows: 

18 ‘‘(a) ELIGIBILITY FOR PAYMENTS.—Subject to sub19 section (e), the Indian Health Service and an Indian 

20 Tribe, Tribal Organization, or an Urban Indian Organiza21 tion shall be eligible for payments under this title with 

22 respect to items and services furnished by the Indian 

23 Health Service, Indian Tribe, Tribal Organization, or 

24 Urban Indian Organization if the furnishing of such serv25 ices meets all the conditions and requirements which are 


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1 applicable generally to the furnishing of items and services 

2 under this title.’’. 

3 (2) COMPLIANCE WITH CONDITIONS AND RE4 QUIREMENTS.—Subsection (b) of such section is 

5 amended to read as follows: 

6 ‘‘(b) COMPLIANCE WITH CONDITIONS AND REQUIRE7 MENTS.—Subject to subsection (e), a facility of the Indian 

8 Health Service or an Indian Tribe, Tribal Organization, 

9 or an Urban Indian Organization which is eligible for pay10 ment under subsection (a) with respect to the furnishing 

11 of items and services, but which does not meet all of the 

12 conditions and requirements of this title which are applica13 ble generally to such facility, shall make such improve14 ments as are necessary to achieve or maintain compliance 

15 with such conditions and requirements in accordance with 

16 a plan submitted to and accepted by the Secretary for 

17 achieving or maintaining compliance with such conditions 

18 and requirements, and shall be deemed to meet such con19 ditions and requirements (and to be eligible for payment 

20 under this title), without regard to the extent of its actual 

21 compliance with such conditions and requirements, during 

22 the first 12 months after the month in which such plan 

23 is submitted.’’. 


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1 (3) CROSS-REFERENCES TO SPECIAL FUND FOR

2 IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING

3 OPTION; DEFINITIONS.— 

4 (A) IN GENERAL.—Such section is further 

5 amended by striking subsections (c) and (d) 

6 and inserting the following new subsections: 

7 ‘‘(c) SPECIAL FUND FOR IMPROVEMENT OF IHS FA8 CILITIES.—For provisions relating to the authority of the 

9 Secretary to place payments to which a facility of the In10 dian Health Service is eligible for payment under this title 

11 into a special fund established under section 401(c)(1) of 

12 the Indian Health Care Improvement Act, and the require13 ment to use amounts paid from such fund for making im14 provements in accordance with subsection (b), see sub15 paragraphs (A) and (B) of section 401(c)(1) of such Act. 

16 ‘‘(d) DIRECT BILLING.—For provisions relating to 

17 the authority of a Tribal Health Program or an Urban 

18 Indian Organization to elect to directly bill for, and receive 

19 payment for, health care items and services provided by 

20 such Program or Organization for which payment is made 

21 under this title, see section 401(d) of the Indian Health 

22 Care Improvement Act.’’. 

23 (B) CONFORMING AMENDMENT.—Para24 graph (3) of section 1880(e) of such Act (42 

25 U.S.C. 1395qq(e)) is amended by inserting 


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1 ‘‘and section 401(c)(1) of the Indian Health 

2 Care Improvement Act’’ after ‘‘Subsection (c)’’. 

3 (4) DEFINITIONS.—Such section is further 

4 amended by amending subsection (f) to read as fol5 lows: 

6 ‘‘(f) DEFINITIONS.—In this section, the terms ‘In7 dian Health Program’, ‘Indian Tribe’, ‘Service Unit’, 

8 ‘Tribal Health Program’, ‘Tribal Organization’, and 

9 ‘Urban Indian Organization’ have the meanings given 

10 those terms in section 4 of the Indian Health Care Im11 provement Act.’’. 

12 (c) APPLICATION TO SCHIP.—Section 2107(e)(1) of 

13 the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 

14 amended— 

15 (1) by redesignating subparagraph (D) as sub16 paragraph (E); and 

17 (2) by inserting after subparagraph (C), the fol18 lowing new subparagraph: 

19 ‘‘(D) Section 1911 (relating to Indian 

20 Health Programs, other than subsection (d) of 

21 such section).’’. 


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1 SEC. 202. INCREASED OUTREACH TO INDIANS UNDER MED2 ICAID AND SCHIP AND IMPROVED COOPERA3 TION IN THE PROVISION OF ITEMS AND 

4 SERVICES TO INDIANS UNDER SOCIAL SECU5 RITY ACT HEALTH BENEFIT PROGRAMS. 

6 Section 1139 of the Social Security Act (42 U.S.C. 

7 1320b–9) is amended to read as follows: 

8 ‘‘SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, 

9 HEALTH CARE FOR INDIANS UNDER TITLES 

10 XVIII, XIX, AND XXI. 

11 ‘‘(a) AGREEMENTS WITH STATES FOR MEDICAID

12 AND SCHIP OUTREACH ON OR NEAR RESERVATIONS TO

13 INCREASE THE ENROLLMENT OF INDIANS IN THOSE

14 PROGRAMS.— 

15 ‘‘(1) IN GENERAL.—In order to improve the ac16 cess of Indians residing on or near a reservation to 

17 obtain benefits under the Medicaid and State chil18 dren’s health insurance programs established under 

19 titles XIX and XXI, the Secretary shall encourage 

20 the State to take steps to provide for enrollment on 

21 or near the reservation. Such steps may include out22 reach efforts such as the outstationing of eligibility 

23 workers, entering into agreements with the Indian 

24 Health Service, Indian Tribes, Tribal Organizations, 

25 and Urban Indian Organizations to provide out26 reach, education regarding eligibility and benefits, 


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1 enrollment, and translation services when such serv2 ices are appropriate. 

3 ‘‘(2) CONSTRUCTION.—Nothing in subpara4 graph (A) shall be construed as affecting arrange5 ments entered into between States and the Indian 

6 Health Service, Indian Tribes, Tribal Organizations, 

7 or Urban Indian Organizations for such Service, 

8 Tribes, or Organizations to conduct administrative 

9 activities under such titles. 

10 ‘‘(b) REQUIREMENT TO FACILITATE COOPERA11 TION.—The Secretary, acting through the Centers for 

12 Medicare & Medicaid Services, shall take such steps as are 

13 necessary to facilitate cooperation with, and agreements 

14 between, States and the Indian Health Service, Indian 

15 Tribes, Tribal Organizations, or Urban Indian Organiza16 tions with respect to the provision of health care items 

17 and services to Indians under the programs established 

18 under title XVIII, XIX, or XXI. 

19 ‘‘(c) DEFINITION OF INDIAN; INDIAN TRIBE; INDIAN

20 HEALTH PROGRAM; TRIBAL ORGANIZATION; URBAN IN21 DIAN ORGANIZATION.—In this section, the terms ‘Indian’, 

22 ‘Indian Tribe’, ‘Indian Health Program’, ‘Tribal Organi23 zation’, and ‘Urban Indian Organization’ have the mean24 ings given those terms in section 4 of the Indian Health 

25 Care Improvement Act.’’. 


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1 SEC. 203. ADDITIONAL PROVISIONS TO INCREASE OUT2 REACH TO, AND ENROLLMENT OF, INDIANS 

3 IN SCHIP AND MEDICAID. 

4 (a) NONAPPLICATION OF 10 PERCENT LIMIT ON

5 OUTREACH AND CERTAIN OTHER EXPENDITURES.—Sec6 tion 2105(c)(2) of the Social Security Act (42 U.S.C. 

7 1397ee(c)(2)) is amended by adding at the end the fol8 lowing new subparagraph: 

9 ‘‘(C) NONAPPLICATION TO EXPENDITURES

10 FOR OUTREACH TO INCREASE THE ENROLL11 MENT OF INDIAN CHILDREN UNDER THIS TITLE

12 AND TITLE XIX.—The limitation under sub13 paragraph (A) on expenditures for items de14 scribed in subsection (a)(1)(D) shall not apply 

15 in the case of expenditures for outreach activi16 ties to families of Indian children likely to be el17 igible for child health assistance under the plan 

18 or medical assistance under the State plan 

19 under title XIX (or under a waiver of such 

20 plan), to inform such families of the availability 

21 of, and to assist them in enrolling their children 

22 in, such plans, including such activities con23 ducted under grants, contracts, or agreements 

24 entered into under section 1139(a).’’. 

25 (b) ASSURANCE OF PAYMENTS TO INDIAN HEALTH

26 CARE PROVIDERS FOR CHILD HEALTH ASSISTANCE.— 


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1 Section 2102(b)(3)(D) of such Act (42 U.S.C. 

2 1397bb(b)(3)(D)) is amended by striking ‘‘(as defined in 

3 section 4(c) of the Indian Health Care Improvement Act, 

4 25 U.S.C. 1603(c))’’ and inserting ‘‘, including how the 

5 State will ensure that payments are made to Indian 

6 Health Programs and Urban Indian Organizations oper7 ating in the State for the provision of such assistance’’. 

8 (c) INCLUSION OF OTHER INDIAN FINANCED

9 HEALTH CARE PROGRAMS IN EXEMPTION FROM PROHI10 BITION ON CERTAIN PAYMENTS.—Section 2105(c)(6)(B) 

11 of such Act (42 U.S.C. 1397ee(c)(6)(B)) is amended by 

12 striking ‘‘insurance program, other than an insurance pro13 gram operated or financed by the Indian Health Service’’ 

14 and inserting ‘‘program, other than a health care program 

15 operated or financed by the Indian Health Service or by 

16 an Indian Tribe, Tribal Organization, or Urban Indian 

17 Organization’’. 

18 (d) SATISFACTION OF MEDICAID DOCUMENTATION

19 REQUIREMENTS.— 

20 (1) IN GENERAL.—Section 1903(x)(3)(B) of the 

21 Social Security Act (42 U.S.C. 1396b(x)(3)(B)) is 

22 amended— 

23 (A) by redesignating clause (v) as clause 

24 (vi); and 


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1 (B) by inserting after clause (iv), the fol2 lowing new clause: 

3 ‘‘(v)(I) Except as provided in subclause (II), a 

4 document issued by a federally-recognized Indian 

5 tribe evidencing membership or enrollment in, or af6 filiation with, such tribe. 

7 ‘‘(II) With respect to those federally-recognized 

8 Indian tribes located within States having an inter9 national border whose membership includes individ10 uals who are not citizens of the United States, the 

11 Secretary shall, after consulting with such tribes, 

12 issue regulations authorizing the presentation of 

13 such other forms of documentation (including tribal 

14 documentation, if appropriate) that the Secretary 

15 determines to be satisfactory documentary evidence 

16 of citizenship or nationality for purposes of satis17 fying the requirement of this subsection.’’. 

18 (2) TRANSITION RULE.—During the period that 

19 begins on July 1, 2006, and ends on the effective 

20 date of final regulations issued under subclause (II) 

21 of section 1903(x)(3)(B)(v) of the Social Security 

22 Act (42 U.S.C. 1396b(x)(3)(B)(v)) (as added by 

23 paragraph (1)), an individual who is a member of a 

24 federally-recognized Indian tribe described in sub25 clause (II) of that section who presents a document 


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1 described in subclause (I) of such section that is 

2 issued by such Indian tribe, shall be deemed to have 

3 presented satisfactory evidence of citizenship or na4 tionality for purposes of satisfying the requirement 

5 of subsection (x) of section 1903 of such Act. 

6 (e) DEFINITIONS.—Section 2110(c) of such Act (42 

7 U.S.C. 1397jj(c)) is amended by adding at the end the 

8 following new paragraph: 

9 ‘‘(9) INDIAN; INDIAN HEALTH PROGRAM; IN10 DIAN TRIBE; ETC.—The terms ‘Indian’, ‘Indian 

11 Health Program’, ‘Indian Tribe’, ‘Tribal Organiza12 tion’, and ‘Urban Indian Organization’ have the 

13 meanings given those terms in section 4 of the In14 dian Health Care Improvement Act.’’. 

15 SEC. 204. PREMIUMS AND COST SHARING PROTECTIONS 

16 UNDER MEDICAID, ELIGIBILITY DETERMINA17 TIONS UNDER MEDICAID AND SCHIP, AND 

18 PROTECTION OF CERTAIN INDIAN PROPERTY 

19 FROM MEDICAID ESTATE RECOVERY. 

20 (a) PREMIUMS AND COST SHARING PROTECTION

21 UNDER MEDICAID.— 

22 (1) IN GENERAL.—Section 1916 of the Social 

23 Security Act (42 U.S.C. 1396o) is amended— 


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1 (A) in subsection (a), in the matter pre2 ceding paragraph (1), by striking ‘‘and (i)’’ and 

3 inserting ‘‘, (i), and (j)’’; and 

4 (B) by adding at the end the following new 

5 subsection: 

6 ‘‘(j) NO PREMIUMS OR COST SHARING FOR INDIANS

7 FURNISHED ITEMS OR SERVICES DIRECTLY BY INDIAN

8 HEALTH PROGRAMS OR THROUGH REFERRAL UNDER

9 THE CONTRACT HEALTH SERVICE.— 

10 ‘‘(1) NO COST SHARING FOR ITEMS OR SERV11 ICES FURNISHED TO INDIANS THROUGH INDIAN

12 HEALTH PROGRAMS.— 

13 ‘‘(A) IN GENERAL.—No enrollment fee, 

14 premium, or similar charge, and no deduction, 

15 copayment, cost sharing, or similar charge shall 

16 be imposed against an Indian who is furnished 

17 an item or service directly by the Indian Health 

18 Service, an Indian Tribe, Tribal Organization, 

19 or Urban Indian Organization or through refer20 ral under the contract health service for which 

21 payment may be made under this title. 

22 ‘‘(B) NO REDUCTION IN AMOUNT OF PAY23 MENT TO INDIAN HEALTH PROVIDERS.—Pay24 ment due under this title to the Indian Health 

25 Service, an Indian Tribe, Tribal Organization, 


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1 or Urban Indian Organization, or a health care 

2 provider through referral under the contract 

3 health service for the furnishing of an item or 

4 service to an Indian who is eligible for assist5 ance under such title, may not be reduced by 

6 the amount of any enrollment fee, premium, or 

7 similar charge, or any deduction, copayment, 

8 cost sharing, or similar charge that would be 

9 due from the Indian but for the operation of 

10 subparagraph (A). 

11 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

12 this subsection shall be construed as restricting the 

13 application of any other limitations on the imposi14 tion of premiums or cost sharing that may apply to 

15 an individual receiving medical assistance under this 

16 title who is an Indian. 

17 ‘‘(3) DEFINITIONS.—In this subsection, the 

18 terms ‘contract health service’, ‘Indian’, ‘Indian 

19 Tribe’, ‘Tribal Organization’, and ‘Urban Indian Or20 ganization’ have the meanings given those terms in 

21 section 4 of the Indian Health Care Improvement 

22 Act.’’. 

23 (2) CONFORMING AMENDMENT.—Section 

24 1916A (a)(1) of such Act (42 U.S.C. 1396o–1(a)(1)) 


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1 is amended by striking ‘‘section 1916(g)’’ and in2 serting ‘‘subsections (g), (i), or (j) of section 1916’’. 

3 (b) TREATMENT OF CERTAIN PROPERTY FOR MED4 ICAID AND SCHIP ELIGIBILITY.— 

5 (1) MEDICAID.—Section 1902(e) of the Social 

6 Security Act (42 U.S.C. 1396a) is amended by add7 ing at the end the following new paragraph: 

8 ‘‘(13) Notwithstanding any other requirement 

9 of this title or any other provision of Federal or 

10 State law, a State shall disregard the following prop11 erty for purposes of determining the eligibility of an 

12 individual who is an Indian (as defined in section 4 

13 of the Indian Health Care Improvement Act) for 

14 medical assistance under this title: 

15 ‘‘(A) Property, including real property and 

16 improvements, that is held in trust, subject to 

17 Federal restrictions, or otherwise under the su18 pervision of the Secretary of the Interior, lo19 cated on a reservation, including any federally 

20 recognized Indian Tribe’s reservation, pueblo, 

21 or colony, including former reservations in 

22 Oklahoma, Alaska Native regions established by 

23 the Alaska Native Claims Settlement Act, and 

24 Indian allotments on or near a reservation as 


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1 designated and approved by the Bureau of In2 dian Affairs of the Department of the Interior. 

3 ‘‘(B) For any federally recognized Tribe 

4 not described in subparagraph (A), property lo5 cated within the most recent boundaries of a 

6 prior Federal reservation. 

7 ‘‘(C) Ownership interests in rents, leases, 

8 royalties, or usage rights related to natural re9 sources (including extraction of natural re10 sources or harvesting of timber, other plants 

11 and plant products, animals, fish, and shellfish) 

12 resulting from the exercise of federally pro13 tected rights. 

14 ‘‘(D) Ownership interests in or usage 

15 rights to items not covered by subparagraphs 

16 (A) through (C) that have unique religious, 

17 spiritual, traditional, or cultural significance or 

18 rights that support subsistence or a traditional 

19 lifestyle according to applicable tribal law or 

20 custom.’’. 

21 (2) APPLICATION TO SCHIP.—Section 

22 2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)) is 

23 amended— 


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1 (A) by redesignating subparagraphs (B) 

2 through (E), as subparagraphs (C) through 

3 (F), respectively; and 

4 (B) by inserting after subparagraph (A), 

5 the following new subparagraph: 

6 ‘‘(B) Section 1902(e)(13) (relating to dis7 regard of certain property for purposes of mak8 ing eligibility determinations).’’. 

9 (c) CONTINUATION OF CURRENT LAW PROTECTIONS

10 OF CERTAIN INDIAN PROPERTY FROM MEDICAID ESTATE

11 RECOVERY.—Section 1917(b)(3) of the Social Security 

12 Act (42 U.S.C. 1396p(b)(3)) is amended— 

13 (1) by inserting ‘‘(A)’’ after ‘‘(3)’’; and 

14 (2) by adding at the end the following new sub15 paragraph: 

16 ‘‘(B) The standards specified by the Sec17 retary under subparagraph (A) shall require 

18 that the procedures established by the State 

19 agency under subparagraph (A) exempt income, 

20 resources, and property that are exempt from 

21 the application of this subsection as of April 1, 

22 2003, under manual instructions issued to carry 

23 out this subsection (as in effect on such date) 

24 because of the Federal responsibility for Indian 

25 Tribes and Alaska Native Villages. Nothing in 


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1 this subparagraph shall be construed as pre2 venting the Secretary from providing additional 

3 estate recovery exemptions under this title for 

4 Indians.’’. 

5 SEC. 205. NONDISCRIMINATION IN QUALIFICATIONS FOR 

6 PAYMENT FOR SERVICES UNDER FEDERAL 

7 HEALTH CARE PROGRAMS. 

8 Section 1139 of the Social Security Act (42 U.S.C. 

9 1320b–9), as amended by section 202, is amended by re10 designating subsection (c) as subsection (d), and inserting 

11 after subsection (b) the following new subsection: 

12 ‘‘(c) NONDISCRIMINATION IN QUALIFICATIONS FOR

13 PAYMENT FOR SERVICES UNDER FEDERAL HEALTH

14 CARE PROGRAMS.— 

15 ‘‘(1) REQUIREMENT TO SATISFY GENERALLY

16 APPLICABLE PARTICIPATION REQUIREMENTS.— 

17 ‘‘(A) IN GENERAL.—A Federal health care 

18 program must accept an entity that is operated 

19 by the Indian Health Service, an Indian Tribe, 

20 Tribal Organization, or Urban Indian Organiza21 tion as a provider eligible to receive payment 

22 under the program for health care services fur23 nished to an Indian on the same basis as any 

24 other provider qualified to participate as a pro25 vider of health care services under the program 


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1 if the entity meets generally applicable State or 

2 other requirements for participation as a pro3 vider of health care services under the program. 

4 ‘‘(B) SATISFACTION OF STATE OR LOCAL

5 LICENSURE OR RECOGNITION REQUIRE6 MENTS.—Any requirement for participation as 

7 a provider of health care services under a Fed8 eral health care program that an entity be li9 censed or recognized under the State or local 

10 law where the entity is located to furnish health 

11 care services shall be deemed to have been met 

12 in the case of an entity operated by the Indian 

13 Health Service, an Indian Tribe, Tribal Organi14 zation, or Urban Indian Organization if the en15 tity meets all the applicable standards for such 

16 licensure or recognition, regardless of whether 

17 the entity obtains a license or other documenta18 tion under such State or local law. In accord19 ance with section 221 of the Indian Health 

20 Care Improvement Act, the absence of the licen21 sure of a health care professional employed by 

22 such an entity under the State or local law 

23 where the entity is located shall not be taken 

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1 er the entity meets such standards, if the pro2 fessional is licensed in another State. 

3 ‘‘(2) PROHIBITION ON FEDERAL PAYMENTS TO

4 ENTITIES OR INDIVIDUALS EXCLUDED FROM PAR5 TICIPATION IN FEDERAL HEALTH CARE PROGRAMS

6 OR WHOSE STATE LICENSES ARE UNDER SUSPEN7 SION OR HAVE BEEN REVOKED.— 

8 ‘‘(A) EXCLUDED ENTITIES.—No entity op9 erated by the Indian Health Service, an Indian 

10 Tribe, Tribal Organization, or Urban Indian 

11 Organization that has been excluded from par12 ticipation in any Federal health care program 

13 or for which a license is under suspension or 

14 has been revoked by the State where the entity 

15 is located shall be eligible to receive payment 

16 under any such program for health care serv17 ices furnished to an Indian. 

18 ‘‘(B) EXCLUDED INDIVIDUALS.—No indi19 vidual who has been excluded from participation 

20 in any Federal health care program or whose 

21 State license is under suspension or has been 

22 revoked shall be eligible to receive payment 

23 under any such program for health care serv24 ices furnished by that individual, directly or 

25 through an entity that is otherwise eligible to 


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1 receive payment for health care services, to an 

2 Indian. 

3 ‘‘(C) FEDERAL HEALTH CARE PROGRAM

4 DEFINED.—In this subsection, the term, ‘Fed5 eral health care program’ has the meaning 

6 given that term in section 1128B(f), except 

7 that, for purposes of this subsection, such term 

8 shall include the health insurance program 

9 under chapter 89 of title 5, United States 

10 Code.’’. 

11 SEC. 206. CONSULTATION ON MEDICAID, SCHIP, AND 

12 OTHER HEALTH CARE PROGRAMS FUNDED 

13 UNDER THE SOCIAL SECURITY ACT INVOLV14 ING INDIAN HEALTH PROGRAMS AND URBAN 

15 INDIAN ORGANIZATIONS. 

16 (a) IN GENERAL.—Section 1139 of the Social Secu17 rity Act (42 U.S.C. 1320b–9), as amended by sections 202 

18 and 205, is amended by redesignating subsection (d) as 

19 subsection (e), and inserting after subsection (c) the fol20 lowing new subsection: 

21 ‘‘(d) CONSULTATION WITH TRIBAL TECHNICAL AD22 VISORY GROUP (TTAG).—The Secretary shall maintain 

23 within the Centers for Medicaid & Medicare Services 

24 (CMS) a Tribal Technical Advisory Group, established in 

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1 tember 30, 2003, and in such group shall include a rep2 resentative of the Urban Indian Organizations and the 

3 Service. The representative of the Urban Indian Organiza4 tion shall be deemed to be an elected officer of a tribal 

5 government for purposes of applying section 204(b) of the 

6 Unfunded Mandates Reform Act of 1995 (2 U.S.C. 

7 1534(b)).’’. 

8 (b) SOLICITATION OF ADVICE UNDER MEDICAID AND

9 SCHIP.— 

10 (1) MEDICAID STATE PLAN AMENDMENT.—Sec11 tion 1902(a) of the Social Security Act (42 U.S.C. 

12 1396a(a)) is amended— 

13 (A) in paragraph (69), by striking ‘‘and’’ 

14 at the end; 

15 (B) in paragraph (70)(B)(iv), by striking 

16 the period at the end and inserting ‘‘; and’’; 

17 and 

18 (C) by inserting after paragraph 

19 (70)(B)(iv), the following new paragraph: 

20 ‘‘(71) in the case of any State in which the In21 dian Health Service operates or funds health care 

22 programs, or in which 1 or more Indian Health Pro23 grams or Urban Indian Organizations (as such 

24 terms are defined in section 4 of the Indian Health 

25 Care Improvement Act) provide health care in the 


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1 State for which medical assistance is available under 

2 such title, provide for a process under which the 

3 State seeks advice on a regular, ongoing basis from 

4 designees of such Indian Health Programs and 

5 Urban Indian Organizations on matters relating to 

6 the application of this title that are likely to have a 

7 direct effect on such Indian Health Programs and 

8 Urban Indian Organizations and that— 

9 ‘‘(A) shall include solicitation of advice 

10 prior to submission of any plan amendments, 

11 waiver requests, and proposals for demonstra12 tion projects likely to have a direct effect on In13 dians, Indian Health Programs, or Urban In14 dian Organizations; and 

15 ‘‘(B) may include appointment of an advi16 sory committee and of a designee of such In17 dian Health Programs and Urban Indian Orga18 nizations to the medical care advisory com19 mittee advising the State on its State plan 

20 under this title.’’. 

21 (2) APPLICATION TO SCHIP.—Section 

22 2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)), as 

23 amended by section 204(b)(2), is amended— 


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1 (A) by redesignating subparagraphs (B) 

2 through (F) as subparagraphs (C) through (G), 

3 respectively; and 

4 (B) by inserting after subparagraph (A), 

5 the following new subparagraph: 

6 ‘‘(B) Section 1902(a)(71) (relating to the 

7 option of certain States to seek advice from 

8 designees of Indian Health Programs and 

9 Urban Indian Organizations).’’. 

10 (c) RULE OF CONSTRUCTION.—Nothing in the 

11 amendments made by this section shall be construed as 

12 superseding existing advisory committees, working groups, 

13 guidance, or other advisory procedures established by the 

14 Secretary of Health and Human Services or by any State 

15 with respect to the provision of health care to Indians. 

16 SEC. 207. EXCLUSION WAIVER AUTHORITY FOR AFFECTED 

17 INDIAN HEALTH PROGRAMS AND SAFE HAR18 BOR TRANSACTIONS UNDER THE SOCIAL SE19 CURITY ACT. 

20 (a) EXCLUSION WAIVER AUTHORITY.—Section 1128 

21 of the Social Security Act (42 U.S.C. 1320a–7) is amend22 ed by adding at the end the following new subsection: 

23 ‘‘(k) ADDITIONAL EXCLUSION WAIVER AUTHORITY

24 FOR AFFECTED INDIAN HEALTH PROGRAMS.—In addi25 tion to the authority granted the Secretary under subVerDate Aug 31 2005 21:58 Apr 25, 2007 Jkt 059200 PO 00000 Frm 00370 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.IS S1200

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1 sections (c)(3)(B) and (d)(3)(B) to waive an exclusion 

2 under subsection (a)(1), (a)(3), (a)(4), or (b), the Sec3 retary may, in the case of an Indian Health Program, 

4 waive such an exclusion upon the request of the adminis5 trator of an affected Indian Health Program (as defined 

6 in section 4 of the Indian Health Care Improvement Act) 

7 who determines that the exclusion would impose a hard8 ship on individuals entitled to benefits under or enrolled 

9 in a Federal health care program.’’. 

10 (b) CERTAIN TRANSACTIONS INVOLVING INDIAN

11 HEALTH CARE PROGRAMS DEEMED TO BE IN SAFE HAR12 BORS.—Section 1128B(b) of the Social Security Act (42 

13 U.S.C. 1320a–7b(b)) is amended by adding at the end the 

14 following new paragraph: 

15 ‘‘(4) Subject to such conditions as the Secretary may 

16 promulgate from time to time as necessary to prevent 

17 fraud and abuse, for purposes of paragraphs (1) and (2) 

18 and section 1128A(a), the following transfers shall not be 

19 treated as remuneration: 

20 ‘‘(A) TRANSFERS BETWEEN INDIAN HEALTH

21 PROGRAMS, INDIAN TRIBES, TRIBAL ORGANIZATIONS, 

22 AND URBAN INDIAN ORGANIZATIONS.—Transfers of 

23 anything of value between or among an Indian 

24 Health Program, Indian Tribe, Tribal Organization, 

25 or Urban Indian Organization, that are made for the 


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1 purpose of providing necessary health care items and 

2 services to any patient served by such Program, 

3 Tribe, or Organization and that consist of— 

4 ‘‘(i) services in connection with the collec5 tion, transport, analysis, or interpretation of di6 agnostic specimens or test data; 

7 ‘‘(ii) inventory or supplies; 

8 ‘‘(iii) staff; or 

9 ‘‘(iv) a waiver of all or part of premiums 

10 or cost sharing. 

11 ‘‘(B) TRANSFERS BETWEEN INDIAN HEALTH

12 PROGRAMS, INDIAN TRIBES, TRIBAL ORGANIZATIONS, 

13 OR URBAN INDIAN ORGANIZATIONS AND PA14 TIENTS.—Transfers of anything of value between an 

15 Indian Health Program, Indian Tribe, Tribal Orga16 nization, or Urban Indian Organization and any pa17 tient served or eligible for service from an Indian 

18 Health Program, Indian Tribe, Tribal Organization, 

19 or Urban Indian Organization, including any patient 

20 served or eligible for service pursuant to section 807 

21 of the Indian Health Care Improvement Act, but 

22 only if such transfers— 

23 ‘‘(i) consist of expenditures related to pro24 viding transportation for the patient for the 

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1 ices, provided that the provision of such trans2 portation is not advertised, nor an incentive of 

3 which the value is disproportionately large in 

4 relationship to the value of the health care item 

5 or service (with respect to the value of the item 

6 or service itself or, for preventative items or 

7 services, the future health care costs reasonably 

8 expected to be avoided); 

9 ‘‘(ii) consist of expenditures related to pro10 viding housing to the patient (including a preg11 nant patient) and immediate family members or 

12 an escort necessary to assuring the timely pro13 vision of health care items and services to the 

14 patient, provided that the provision of such 

15 housing is not advertised nor an incentive of 

16 which the value is disproportionately large in 

17 relationship to the value of the health care item 

18 or service (with respect to the value of the item 

19 or service itself or, for preventative items or 

20 services, the future health care costs reasonably 

21 expected to be avoided); or 

22 ‘‘(iii) are for the purpose of paying pre23 miums or cost sharing on behalf of such a pa24 tient, provided that the making of such pay25 ment is not subject to conditions other than 


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1 conditions agreed to under a contract for the 

2 delivery of contract health services. 

3 ‘‘(C) CONTRACT HEALTH SERVICES.—A trans4 fer of anything of value negotiated as part of a con5 tract entered into between an Indian Health Pro6 gram, Indian Tribe, Tribal Organization, Urban In7 dian Organization, or the Indian Health Service and 

8 a contract care provider for the delivery of contract 

9 health services authorized by the Indian Health 

10 Service, provided that— 

11 ‘‘(i) such a transfer is not tied to volume 

12 or value of referrals or other business generated 

13 by the parties; and 

14 ‘‘(ii) any such transfer is limited to the fair 

15 market value of the health care items or serv16 ices provided or, in the case of a transfer of 

17 items or services related to preventative care, 

18 the value of the future health care costs reason19 ably expected to be avoided. 

20 ‘‘(D) OTHER TRANSFERS.—Any other transfer 

21 of anything of value involving an Indian Health Pro22 gram, Indian Tribe, Tribal Organization, or Urban 

23 Indian Organization, or a patient served or eligible 

24 for service from an Indian Health Program, Indian 

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1 zation, that the Secretary, in consultation with the 

2 Attorney General, determines is appropriate, taking 

3 into account the special circumstances of such In4 dian Health Programs, Indian Tribes, Tribal Orga5 nizations, and Urban Indian Organizations, and of 

6 patients served by such Programs, Tribes, and Orga7 nizations.’’. 

8 SEC. 208. RULES APPLICABLE UNDER MEDICAID AND 

9 SCHIP TO MANAGED CARE ENTITIES WITH 

10 RESPECT TO INDIAN ENROLLEES AND IN11 DIAN HEALTH CARE PROVIDERS AND INDIAN 

12 MANAGED CARE ENTITIES. 

13 (a) IN GENERAL.—Section 1932 of the Social Secu14 rity Act (42 U.S.C. 1396u–2) is amended by adding at 

15 the end the following new subsection: 

16 ‘‘(h) SPECIAL RULES WITH RESPECT TO INDIAN EN17 ROLLEES, INDIAN HEALTH CARE PROVIDERS, AND IN18 DIAN MANAGED CARE ENTITIES.— 

19 ‘‘(1) ENROLLEE OPTION TO SELECT AN INDIAN

20 HEALTH CARE PROVIDER AS PRIMARY CARE PRO21 VIDER.—In the case of a non-Indian Medicaid man22 aged care entity that— 

23 ‘‘(A) has an Indian enrolled with the enti24 ty; and 


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1 ‘‘(B) has an Indian health care provider 

2 that is participating as a primary care provider 

3 within the network of the entity, 

4 insofar as the Indian is otherwise eligible to receive 

5 services from such Indian health care provider and 

6 the Indian health care provider has the capacity to 

7 provide primary care services to such Indian, the 

8 contract with the entity under section 1903(m) or 

9 under section 1905(t)(3) shall require, as a condi10 tion of receiving payment under such contract, that 

11 the Indian shall be allowed to choose such Indian 

12 health care provider as the Indian’s primary care 

13 provider under the entity. 

14 ‘‘(2) ASSURANCE OF PAYMENT TO INDIAN

15 HEALTH CARE PROVIDERS FOR PROVISION OF COV16 ERED SERVICES.—Each contract with a managed 

17 care entity under section 1903(m) or under section 

18 1905(t)(3) shall require any such entity that has a 

19 significant percentage of Indian enrollees (as deter20 mined by the Secretary), as a condition of receiving 

21 payment under such contract to satisfy the following 

22 requirements: 

23 ‘‘(A) DEMONSTRATION OF PARTICIPATING

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1 TION OF ALTERNATIVE PAYMENT ARRANGE2 MENTS.—Subject to subparagraph (E), to— 

3 ‘‘(i) demonstrate that the number of 

4 Indian health care providers that are par5 ticipating providers with respect to such 

6 entity are sufficient to ensure timely access 

7 to covered Medicaid managed care services 

8 for those enrollees who are eligible to re9 ceive services from such providers; or 

10 ‘‘(ii) agree to pay Indian health care 

11 providers who are not participating pro12 viders with the entity for covered Medicaid 

13 managed care services provided to those 

14 enrollees who are eligible to receive services 

15 from such providers at a rate equal to the 

16 rate negotiated between such entity and 

17 the provider involved or, if such a rate has 

18 not been negotiated, at a rate that is not 

19 less than the level and amount of payment 

20 which the entity would make for the serv21 ices if the services were furnished by a par22 ticipating provider which is not an Indian 

23 health care provider. 

24 ‘‘(B) PROMPT PAYMENT.—To agree to 

25 make prompt payment (in accordance with 


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1 rules applicable to managed care entities) to In2 dian health care providers that are participating 

3 providers with respect to such entity or, in the 

4 case of an entity to which subparagraph (A)(ii) 

5 or (E) applies, that the entity is required to pay 

6 in accordance with that subparagraph. 

7 ‘‘(C) SATISFACTION OF CLAIM REQUIRE8 MENT.—To deem any requirement for the sub9 mission of a claim or other documentation for 

10 services covered under subparagraph (A) by the 

11 enrollee to be satisfied through the submission 

12 of a claim or other documentation by an Indian 

13 health care provider that is consistent with sec14 tion 403(h) of the Indian Health Care Improve15 ment Act. 

16 ‘‘(D) COMPLIANCE WITH GENERALLY AP17 PLICABLE REQUIREMENTS.— 

18 ‘‘(i) IN GENERAL.—Subject to clause 

19 (ii), as a condition of payment under sub20 paragraph (A), an Indian health care pro21 vider shall comply with the generally appli22 cable requirements of this title, the State 

23 plan, and such entity with respect to cov24 ered Medicaid managed care services pro25 vided by the Indian health care provider to 


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1 the same extent that non-Indian providers 

2 participating with the entity must comply 

3 with such requirements. 

4 ‘‘(ii) LIMITATIONS ON COMPLIANCE

5 WITH MANAGED CARE ENTITY GENERALLY

6 APPLICABLE REQUIREMENTS.—An Indian 

7 health care provider— 

8 ‘‘(I) shall not be required to com9 ply with a generally applicable re10 quirement of a managed care entity 

11 described in clause (i) as a condition 

12 of payment under subparagraph (A) if 

13 such compliance would conflict with 

14 any other statutory or regulatory re15 quirements applicable to the Indian 

16 health care provider; and 

17 ‘‘(II) shall only need to comply 

18 with those generally applicable re19 quirements of a managed care entity 

20 described in clause (i) as a condition 

21 of payment under subparagraph (A) 

22 that are necessary for the entity’s 

23 compliance with the State plan, such 

24 as those related to care management, 


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1 quality assurance, and utilization 

2 management. 

3 ‘‘(E) APPLICATION OF SPECIAL PAYMENT

4 REQUIREMENTS FOR FEDERALLY-QUALIFIED

5 HEALTH CENTERS AND ENCOUNTER RATE FOR

6 SERVICES PROVIDED BY CERTAIN INDIAN

7 HEALTH CARE PROVIDERS.— 

8 ‘‘(i) FEDERALLY-QUALIFIED HEALTH

9 CENTERS.— 

10 ‘‘(I) MANAGED CARE ENTITY

11 PAYMENT REQUIREMENT.—To agree 

12 to pay any Indian health care provider 

13 that is a Federally-qualified health 

14 center but not a participating provider 

15 with respect to the entity, for the pro16 vision of covered Medicaid managed 

17 care services by such provider to an 

18 Indian enrollee of the entity at a rate 

19 equal to the amount of payment that 

20 the entity would pay a Federally21 qualified health center that is a par22 ticipating provider with respect to the 

23 entity but is not an Indian health care 

24 provider for such services. 


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1 ‘‘(II) CONTINUED APPLICATION

2 OF STATE REQUIREMENT TO MAKE

3 SUPPLEMENTAL PAYMENT.—Nothing 

4 in subclause (I) or subparagraph (A) 

5 or (B) shall be construed as waiving 

6 the application of section 1902(bb)(5) 

7 regarding the State plan requirement 

8 to make any supplemental payment 

9 due under such section to a Federally10 qualified health center for services 

11 furnished by such center to an en12 rollee of a managed care entity (re13 gardless of whether the Federally14 qualified health center is or is not a 

15 participating provider with the entity). 

16 ‘‘(ii) CONTINUED APPLICATION OF

17 ENCOUNTER RATE FOR SERVICES PRO18 VIDED BY CERTAIN INDIAN HEALTH CARE

19 PROVIDERS.—If the amount paid by a 

20 managed care entity to an Indian health 

21 care provider that is not a Federally-quali22 fied health center and that has elected to 

23 receive payment under this title as an In24 dian Health Service provider under the 

25 July 11, 1996, Memorandum of Agreement 


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1 between the Health Care Financing Ad2 ministration (now the Centers for Medicare 

3 & Medicaid Services) and the Indian 

4 Health Service for services provided by 

5 such provider to an Indian enrollee with 

6 the managed care entity is less than the 

7 encounter rate that applies to the provision 

8 of such services under such memorandum, 

9 the State plan shall provide for payment to 

10 the Indian health care provider of the dif11 ference between the applicable encounter 

12 rate under such memorandum and the 

13 amount paid by the managed care entity to 

14 the provider for such services. 

15 ‘‘(F) CONSTRUCTION.—Nothing in this 

16 paragraph shall be construed as waiving the ap17 plication of section 1902(a)(30)(A) (relating to 

18 application of standards to assure that pay19 ments are consistent with efficiency, economy, 

20 and quality of care). 

21 ‘‘(3) OFFERING OF MANAGED CARE THROUGH

22 INDIAN MEDICAID MANAGED CARE ENTITIES.—If— 

23 ‘‘(A) a State elects to provide services 

24 through Medicaid managed care entities under 

25 its Medicaid managed care program; and 


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1 ‘‘(B) an Indian health care provider that is 

2 funded in whole or in part by the Indian Health 

3 Service, or a consortium composed of 1 or more 

4 Tribes, Tribal Organizations, or Urban Indian 

5 Organizations, and which also may include the 

6 Indian Health Service, has established an In7 dian Medicaid managed care entity in the State 

8 that meets generally applicable standards re9 quired of such an entity under such Medicaid 

10 managed care program, 

11 the State shall offer to enter into an agreement with 

12 the entity to serve as a Medicaid managed care enti13 ty with respect to eligible Indians served by such en14 tity under such program. 

15 ‘‘(4) SPECIAL RULES FOR INDIAN MANAGED

16 CARE ENTITIES.—The following are special rules re17 garding the application of a Medicaid managed care 

18 program to Indian Medicaid managed care entities: 

19 ‘‘(A) ENROLLMENT.— 

20 ‘‘(i) LIMITATION TO INDIANS.—An In21 dian Medicaid managed care entity may re22 strict enrollment under such program to 

23 Indians and to members of specific Tribes 

24 in the same manner as Indian Health ProVerDate Aug 31 2005 21:58 Apr 25, 2007 Jkt 059200 PO 00000 Frm 00383 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.IS S1200

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1 grams may restrict the delivery of services 

2 to such Indians and tribal members. 

3 ‘‘(ii) NO LESS CHOICE OF PLANS.— 

4 Under such program the State may not 

5 limit the choice of an Indian among Med6 icaid managed care entities only to Indian 

7 Medicaid managed care entities or to be 

8 more restrictive than the choice of man9 aged care entities offered to individuals 

10 who are not Indians. 

11 ‘‘(iii) DEFAULT ENROLLMENT.— 

12 ‘‘(I) IN GENERAL.—If such pro13 gram of a State requires the enroll14 ment of Indians in a Medicaid man15 aged care entity in order to receive 

16 benefits, the State, taking into consid17 eration the criteria specified in sub18 section (a)(4)(D)(ii)(I), shall provide 

19 for the enrollment of Indians de20 scribed in subclause (II) who are not 

21 otherwise enrolled with such an entity 

22 in an Indian Medicaid managed care 

23 entity described in such clause. 

24 ‘‘(II) INDIAN DESCRIBED.—An 

25 Indian described in this subclause, 


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1 with respect to an Indian Medicaid 

2 managed care entity, is an Indian 

3 who, based upon the service area and 

4 capacity of the entity, is eligible to be 

5 enrolled with the entity consistent 

6 with subparagraph (A). 

7 ‘‘(iv) EXCEPTION TO STATE LOCK8 IN.—A request by an Indian who is en9 rolled under such program with a non-In10 dian Medicaid managed care entity to 

11 change enrollment with that entity to en12 rollment with an Indian Medicaid managed 

13 care entity shall be considered cause for 

14 granting such request under procedures 

15 specified by the Secretary. 

16 ‘‘(B) FLEXIBILITY IN APPLICATION OF

17 SOLVENCY.—In applying section 1903(m)(1) to 

18 an Indian Medicaid managed care entity— 

19 ‘‘(i) any reference to a ‘State’ in sub20 paragraph (A)(ii) of that section shall be 

21 deemed to be a reference to the ‘Sec22 retary’; and 

23 ‘‘(ii) the entity shall be deemed to be 

24 a public entity described in subparagraph 

25 (C)(ii) of that section. 


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1 ‘‘(C) EXCEPTIONS TO ADVANCE DIREC2 TIVES.—The Secretary may modify or waive the 

3 requirements of section 1902(w) (relating to 

4 provision of written materials on advance direc5 tives) insofar as the Secretary finds that the re6 quirements otherwise imposed are not an appro7 priate or effective way of communicating the in8 formation to Indians. 

9 ‘‘(D) FLEXIBILITY IN INFORMATION AND

10 MARKETING.— 

11 ‘‘(i) MATERIALS.—The Secretary may 

12 modify requirements under subsection 

13 (a)(5) to ensure that information described 

14 in that subsection is provided to enrollees 

15 and potential enrollees of Indian Medicaid 

16 managed care entities in a culturally ap17 propriate and understandable manner that 

18 clearly communicates to such enrollees and 

19 potential enrollees their rights, protections, 

20 and benefits. 

21 ‘‘(ii) DISTRIBUTION OF MARKETING

22 MATERIALS.—The provisions of subsection 

23 (d)(2)(B) requiring the distribution of 

24 marketing materials to an entire service 

25 area shall be deemed satisfied in the case 


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1 of an Indian Medicaid managed care entity 

2 that distributes appropriate materials only 

3 to those Indians who are potentially eligi4 ble to enroll with the entity in the service 

5 area. 

6 ‘‘(5) MALPRACTICE INSURANCE.—Insofar as, 

7 under a Medicaid managed care program, a health 

8 care provider is required to have medical malpractice 

9 insurance coverage as a condition of contracting as 

10 a provider with a Medicaid managed care entity, an 

11 Indian health care provider that is— 

12 ‘‘(A) a Federally-qualified health center 

13 that is covered under the Federal Tort Claims 

14 Act (28 U.S.C. 1346(b), 2671 et seq.); 

15 ‘‘(B) providing health care services pursu16 ant to a contract or compact under the Indian 

17 Self-Determination and Education Assistance 

18 Act (25 U.S.C. 450 et seq.) that are covered 

19 under the Federal Tort Claims Act (28 U.S.C. 

20 1346(b), 2671 et seq.); or 

21 ‘‘(C) the Indian Health Service providing 

22 health care services that are covered under the 

23 Federal Tort Claims Act (28 U.S.C. 1346(b), 

24 2671 et seq.); 

25 are deemed to satisfy such requirement. 


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1 ‘‘(6) DEFINITIONS.—For purposes of this sub2 section: 

3 ‘‘(A) INDIAN HEALTH CARE PROVIDER.— 

4 The term ‘Indian health care provider’ means 

5 an Indian Health Program or an Urban Indian 

6 Organization. 

7 ‘‘(B) INDIAN; INDIAN HEALTH PROGRAM; 

8 SERVICE; TRIBE; TRIBAL ORGANIZATION; URBAN

9 INDIAN ORGANIZATION.—The terms ‘Indian’, 

10 ‘Indian Health Program’, ‘Service’, ‘Tribe’, 

11 ‘tribal organization’, ‘Urban Indian Organiza12 tion’ have the meanings given such terms in 

13 section 4 of the Indian Health Care Improve14 ment Act. 

15 ‘‘(C) INDIAN MEDICAID MANAGED CARE

16 ENTITY.—The term ‘Indian Medicaid managed 

17 care entity’ means a managed care entity that 

18 is controlled (within the meaning of the last 

19 sentence of section 1903(m)(1)(C)) by the In20 dian Health Service, a Tribe, Tribal Organiza21 tion, or Urban Indian Organization, or a con22 sortium, which may be composed of 1 or more 

23 Tribes, Tribal Organizations, or Urban Indian 

24 Organizations, and which also may include the 

25 Service. 


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1 ‘‘(D) NON-INDIAN MEDICAID MANAGED

2 CARE ENTITY.—The term ‘non-Indian Medicaid 

3 managed care entity’ means a managed care en4 tity that is not an Indian Medicaid managed 

5 care entity. 

6 ‘‘(E) COVERED MEDICAID MANAGED CARE

7 SERVICES.—The term ‘covered Medicaid man8 aged care services’ means, with respect to an 

9 individual enrolled with a managed care entity, 

10 items and services that are within the scope of 

11 items and services for which benefits are avail12 able with respect to the individual under the 

13 contract between the entity and the State in14 volved. 

15 ‘‘(F) MEDICAID MANAGED CARE PRO16 GRAM.—The term ‘Medicaid managed care pro17 gram’ means a program under sections 

18 1903(m) and 1932 and includes a managed 

19 care program operating under a waiver under 

20 section 1915(b) or 1115 or otherwise.’’. 

21 (b) APPLICATION TO SCHIP.—Section 2107(e)(1) of 

22 such Act (42 U.S.C. 1397gg(1)), as amended by section 

23 206(b)(2), is amended by adding at the end the following 

24 new subparagraph: 


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1 ‘‘(H) Subsections (a)(2)(C) and (h) of sec2 tion 1932.’’. 

3 SEC. 209. ANNUAL REPORT ON INDIANS SERVED BY SOCIAL 

4 SECURITY ACT HEALTH BENEFIT PROGRAMS. 

5 Section 1139 of the Social Security Act (42 U.S.C. 

6 1320b–9), as amended by the sections 202, 205, and 206, 

7 is amended by redesignating subsection (e) as subsection 

8 (f), and inserting after subsection (d) the following new 

9 subsection: 

10 ‘‘(e) ANNUAL REPORT ON INDIANS SERVED BY

11 HEALTH BENEFIT PROGRAMS FUNDED UNDER THIS

12 ACT.—Beginning January 1, 2007, and annually there13 after, the Secretary, acting through the Administrator of 

14 the Centers for Medicare & Medicaid Services and the Di15 rector of the Indian Health Service, shall submit a report 

16 to Congress regarding the enrollment and health status 

17 of Indians receiving items or services under health benefit 

18 programs funded under this Act during the preceding 

19 year. Each such report shall include the following: 

20 ‘‘(1) The total number of Indians enrolled in, or 

21 receiving items or services under, such programs, 

22 disaggregated with respect to each such program. 

23 ‘‘(2) The number of Indians described in para24 graph (1) that also received health benefits under 

25 programs funded by the Indian Health Service. 


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1 ‘‘(3) General information regarding the health 

2 status of the Indians described in paragraph (1), 

3 disaggregated with respect to specific diseases or 

4 conditions and presented in a manner that is con5 sistent with protections for privacy of individually 

6 identifiable health information under section 264(c) 

7 of the Health Insurance Portability and Account8 ability Act of 1996. 

9 ‘‘(4) A detailed statement of the status of facili10 ties of the Indian Health Service or an Indian Tribe, 

11 Tribal Organization, or an Urban Indian Organiza12 tion with respect to such facilities’ compliance with 

13 the applicable conditions and requirements of titles 

14 XVIII, XIX, and XXI, and, in the case of title XIX 

15 or XXI, under a State plan under such title or 

16 under waiver authority, and of the progress being 

17 made by such facilities (under plans submitted 

18 under section 1880(b), 1911(b) or otherwise) toward 

19 the achievement and maintenance of such compli20 ance. 

21 ‘‘(5) Such other information as the Secretary 

22 determines is appropriate.’’. 

Æ 


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