II 

Calendar No. 421 

110TH CONGRESS 

1ST SESSION S. 1200 

[Report No. 110–197] 

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, Ms. MURKOWSKI, Mrs. MURRAY, Mr. COCHRAN, Mrs. CLINTON, Mr. BROWN, Mr. 

STEVENS, Ms. STABENOW, and Mr. LEVIN) introduced the following bill; 

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

OCTOBER 16, 2007 

Reported by Mr. DORGAN, without amendment 

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, 


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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘Indian Health Care Improvement Act Amendments of 

4 2007’’. 

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

6 this Act is as follows: 

Sec.1.Short title; table of contents. 

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. 


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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’. 

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

12 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. 


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‘‘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. 

‘‘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. 


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‘‘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). 

‘‘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. 


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‘‘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. 

‘‘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: 


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

2 improve the health of the Indians are consonant 

3 with and required by the Federal Government’s his4 torical and unique legal relationship with, and re5 sulting responsibility to, the American Indian people. 

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

7 is to provide the quantity and quality of health serv8 ices which will permit the health status of Indians 

9 to be raised to the highest possible level and to en10 courage the maximum participation of Indians in the 

11 planning and management of those services. 

12 ‘‘(3) Federal health services to Indians have re13 sulted in a reduction in the prevalence and incidence 

14 of preventable illnesses among, and unnecessary and 

15 premature deaths of, Indians. 

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

17 needs of the American Indian people are severe and 

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

19 the general population of the United States. 

20 ‘‘SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POL21 ICY. 

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

23 in fulfillment of its special trust responsibilities and legal 

24 obligations to Indians— 


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

2 for Indians and Urban Indians and to provide all re3 sources necessary to effect that policy; 

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

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

6 goals contained within the Healthy People 2010 or 

7 successor objectives; 

8 ‘‘(3) to the greatest extent possible, to allow In9 dians to set their own health care priorities and es10 tablish goals that reflect their unmet needs; 

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

12 the health professions and allied and associated 

13 health professions awarded to Indians so that the 

14 proportion of Indian health professionals in each 

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

16 the general population; 

17 ‘‘(5) to require meaningful consultation with In18 dian Tribes, Tribal Organizations, and Urban Indian 

19 Organizations to implement this Act and the na20 tional policy of Indian self-determination; and 

21 ‘‘(6) to provide funding for programs and facili22 ties operated by Indian Tribes and Tribal Organiza23 tions in amounts that are not less than the amounts 

24 provided to programs and facilities operated directly 

25 by the Service. 


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1 ‘‘SEC. 4. DEFINITIONS. 

2 ‘‘For purposes of this Act: 

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

4 on or near a reservation and accredited by a na5 tional or regional organization with accrediting au6 thority. 

7 ‘‘(2) The term ‘Area Office’ means an adminis8 trative entity, including a program office, within the 

9 Service through which services and funds are pro10 vided to the Service Units within a defined geo11 graphic area. 

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

13 Assistant Secretary for Indian Health. 

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

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

16 tobacco) abuse and mental health prevention and 

17 treatment, for the purpose of providing comprehen18 sive services. 

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

20 joint development of substance abuse and mental 

21 health treatment planning and coordinated case 

22 management using a multidisciplinary approach. 

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

24 Indians who are eligible for health services of the 

25 Service pursuant to section 806. 

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


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

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

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

4 health services provided at the expense of the Serv5 ice or a Tribal Health Program by public or private 

6 medical providers or hospitals, other than the Serv7 ice Unit or the Tribal Health Program at whose ex8 pense the services are provided. 

9 ‘‘(8) The term ‘Department’ means, unless oth10 erwise designated, the Department of Health and 

11 Human Services. 

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

13 reduction, limitation, and prevention of disease and 

14 its complications and reduction in the consequences 

15 of disease, including— 

16 ‘‘(A) controlling— 

17 ‘‘(i) the development of diabetes; 

18 ‘‘(ii) high blood pressure; 

19 ‘‘(iii) infectious agents; 

20 ‘‘(iv) injuries; 

21 ‘‘(v) occupational hazards and disabil22 ities; 

23 ‘‘(vi) sexually transmittable diseases; 

24 and 

25 ‘‘(vii) toxic agents; and 


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1 ‘‘(B) providing— 

2 ‘‘(i) fluoridation of water; and 

3 ‘‘(ii) immunizations. 

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

5 allopathic medicine, family medicine, internal medi6 cine, pediatrics, geriatric medicine, obstetrics and 

7 gynecology, podiatric medicine, nursing, public 

8 health nursing, dentistry, psychiatry, osteopathy, op9 tometry, pharmacy, psychology, public health, social 

10 work, marriage and family therapy, chiropractic 

11 medicine, environmental health and engineering, al12 lied health professions, and any other health profes13 sion. 

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

15 ‘‘(A) fostering social, economic, environ16 mental, and personal factors conducive to 

17 health, including raising public awareness about 

18 health matters and enabling the people to cope 

19 with health problems by increasing their knowl20 edge and providing them with valid information; 

21 ‘‘(B) encouraging adequate and appro22 priate diet, exercise, and sleep; 

23 ‘‘(C) promoting education and work in con24 formity with physical and mental capacity; 


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1 ‘‘(D) making available safe water and sani2 tary facilities; 

3 ‘‘(E) improving the physical, economic, cul4 tural, psychological, and social environment; 

5 ‘‘(F) promoting culturally competent care; 

6 and 

7 ‘‘(G) providing adequate and appropriate 

8 programs, which may include— 

9 ‘‘(i) abuse prevention (mental and 

10 physical); 

11 ‘‘(ii) community health; 

12 ‘‘(iii) community safety; 

13 ‘‘(iv) consumer health education; 

14 ‘‘(v) diet and nutrition; 

15 ‘‘(vi) immunization and other preven16 tion of communicable diseases, including 

17 HIV/AIDS; 

18 ‘‘(vii) environmental health; 

19 ‘‘(viii) exercise and physical fitness; 

20 ‘‘(ix) avoidance of fetal alcohol dis21 orders; 

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

23 ‘‘(xi) human growth and development; 

24 ‘‘(xii) injury prevention and personal 

25 safety; 


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1 ‘‘(xiii) behavioral health; 

2 ‘‘(xiv) monitoring of disease indicators 

3 between health care provider visits, 

4 through appropriate means, including 

5 Internet-based health care management 

6 systems; 

7 ‘‘(xv) personal health and wellness 

8 practices; 

9 ‘‘(xvi) personal capacity building; 

10 ‘‘(xvii) prenatal, pregnancy, and in11 fant care; 

12 ‘‘(xviii) psychological well-being; 

13 ‘‘(xix) reproductive health and family 

14 planning; 

15 ‘‘(xx) safe and adequate water; 

16 ‘‘(xxi) healthy work environments; 

17 ‘‘(xxii) elimination, reduction, and 

18 prevention of contaminants that create 

19 unhealthy household conditions (including 

20 mold and other allergens); 

21 ‘‘(xxiii) stress control; 

22 ‘‘(xxiv) substance abuse; 

23 ‘‘(xxv) sanitary facilities; 

24 ‘‘(xxvi) sudden infant death syndrome 

25 prevention; 


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1 ‘‘(xxvii) tobacco use cessation and re2 duction; 

3 ‘‘(xxviii) violence prevention; and 

4 ‘‘(xxix) such other activities identified 

5 by the Service, a Tribal Health Program, 

6 or an Urban Indian Organization, to pro7 mote achievement of any of the objectives 

8 described in section 3(2). 

9 ‘‘(12) The term ‘Indian’, unless otherwise des10 ignated, means any person who is a member of an 

11 Indian Tribe or is eligible for health services under 

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

13 102 and 103, the term also means any individual 

14 who— 

15 ‘‘(A)(i) irrespective of whether the indi16 vidual lives on or near a reservation, is a mem17 ber of a tribe, band, or other organized group 

18 of Indians, including those tribes, bands, or 

19 groups terminated since 1940 and those recog20 nized now or in the future by the State in 

21 which they reside; or 

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

23 degree, of any such member; 

24 ‘‘(B) is an Eskimo or Aleut or other Alas25 ka Native; 


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

2 Interior to be an Indian for any purpose; or 

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

4 regulations promulgated by the Secretary. 

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

6 means— 

7 ‘‘(A) any health program administered di8 rectly by the Service; 

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

10 ‘‘(C) any Indian Tribe or Tribal Organiza11 tion to which the Secretary provides funding 

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

13 1910 (25 U.S.C. 47) (commonly known as the 

14 ‘Buy Indian Act’). 

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

16 given the term in the Indian Self-Determination and 

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

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

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

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

21 1058(e)). 

22 ‘‘(16) The term ‘reservation’ means any feder23 ally recognized Indian Tribe’s reservation, Pueblo, or 

24 colony, including former reservations in Oklahoma, 

25 Indian allotments, and Alaska Native Regions estabVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 lished pursuant to the Alaska Native Claims Settle2 ment Act (43 U.S.C. 1601 et seq.). 

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

4 designated, means the Secretary of Health and 

5 Human Services. 

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

7 Health Service. 

8 ‘‘(19) The term ‘Service Area’ means the geo9 graphical area served by each Area Office. 

10 ‘‘(20) The term ‘Service Unit’ means an admin11 istrative entity of the Service, or a Tribal Health 

12 Program through which services are provided, di13 rectly or by contract, to eligible Indians within a de14 fined geographic area. 

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

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

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

18 ‘‘(22) The term ‘telemedicine’ means a tele19 communications link to an end user through the use 

20 of eligible equipment that electronically links health 

21 professionals or patients and health professionals at 

22 separate sites in order to exchange health care infor23 mation in audio, video, graphic, or other format for 

24 the purpose of providing improved health care serv25 ices. 


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

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

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

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

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

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

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

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

11 et seq.). 

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

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

15 450 et seq.). 

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

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

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

23 meets 1 or more of the following criteria: 

24 ‘‘(A) Irrespective of whether the individual 

25 lives on or near a reservation, the individual is 


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

2 group of Indians, including those tribes, bands, 

3 or groups terminated since 1940 and those 

4 tribes, bands, or groups that are recognized by 

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

7 such member. 

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

9 or other Alaska Native. 

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

11 Secretary of the Interior to be an Indian for 

12 any purpose. 

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

14 Indian under regulations promulgated by the 

15 Secretary. 

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

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

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

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

22 cooperating with other public and private entities for 

23 the purpose of performing the activities described in 

24 section 503(a). 


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1 ‘‘TITLE I—INDIAN HEALTH, 

2 HUMAN RESOURCES, AND DE3 VELOPMENT 

4 ‘‘SEC. 101. PURPOSE. 

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

7 health professions and providing health services, and to 

8 assure an optimum supply of health professionals to the 

9 Indian Health Programs and Urban Indian Organizations 

10 involved in the provision of health services to Indians. 

11 ‘‘SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM 

12 FOR INDIANS. 

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

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

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

19 education or training in the health professions and 

20 encouraging and assisting them— 

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

22 health professions; or 

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

24 any such courses of study, to undertake such 


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1 postsecondary education or training as may be 

2 required to qualify them for enrollment; 

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

4 available to Indians enrolled in any course of study 

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

6 training necessary to qualify them to enroll in any 

7 such course of study; or 

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

11 and completion by them of, courses of study referred 

12 to in paragraph (1). 

13 ‘‘(b) GRANTS.— 

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

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

17 Secretary. Such application shall be in such form, 

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

21 a preference to applications submitted by Tribal 

22 Health Programs or Urban Indian Organizations. 

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

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


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

4 to this Act. To the extent not otherwise prohibited 

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

6 regulations issued pursuant to this Act. 

7 ‘‘SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOL8 ARSHIP PROGRAM FOR INDIANS. 

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

10 acting through the Service, shall provide scholarship 

11 grants to Indians who— 

12 ‘‘(1) have successfully completed their high 

13 school education or high school equivalency; and 

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

17 ‘‘(b) PURPOSES.—Scholarship grants provided pursu18 ant to this section shall be for the following purposes: 

19 ‘‘(1) Compensatory preprofessional education of 

20 any recipient, such scholarship not to exceed 2 years 

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

22 thereof, as determined by the Secretary pursuant to 

23 regulations issued under this Act). 

24 ‘‘(2) Pregraduate education of any recipient 

25 leading to a baccalaureate degree in an approved 


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

2 health profession, such scholarship not to exceed 4 

3 years. An extension of up to 2 years (or the part4 time equivalent thereof, as determined by the Sec5 retary pursuant to regulations issued pursuant to 

6 this Act) may be approved. 

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

8 section— 

9 ‘‘(1) may cover costs of tuition, books, trans10 portation, board, and other necessary related ex11 penses of a recipient while attending school; 

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

13 the applicant’s scholastic achievement if such appli14 cant has been admitted to, or maintained good 

15 standing at, an accredited institution; and 

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

17 applicant’s eligibility for assistance or benefits under 

18 any other Federal program. 

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

20 ‘‘(a) IN GENERAL.— 

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

22 through the Service, shall make scholarship grants 

23 to Indians who are enrolled full or part time in ac24 credited schools pursuing courses of study in the 

25 health professions. Such scholarships shall be desVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 ignated Indian Health Scholarships and shall be 

2 made in accordance with section 338A of the Public 

3 Health Services Act (42 U.S.C. 254l), except as pro4 vided in subsection (b) of this section. 

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

6 Secretary, acting through the Service, shall deter7 mine— 

8 ‘‘(A) who shall receive scholarship grants 

9 under subsection (a); and 

10 ‘‘(B) the distribution of the scholarships 

11 among health professions on the basis of the 

12 relative needs of Indians for additional service 

13 in the health professions. 

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

15 The administration of this section shall be a respon16 sibility of the Assistant Secretary and shall not be 

17 delegated in a contract or compact under the Indian 

18 Self-Determination and Education Assistance Act 

19 (25 U.S.C. 450 et seq.). 

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

21 ‘‘(1) OBLIGATION MET.—The active duty serv22 ice obligation under a written contract with the Sec23 retary under this section that an Indian has entered 

24 into shall, if that individual is a recipient of an In25 dian Health Scholarship, be met in full-time practice 


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

2 participant receives a scholarship award under this 

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

4 1 or more of the following: 

5 ‘‘(A) In an Indian Health Program. 

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

7 of this Act. 

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

12 in a physician or other health professional 

13 shortage area and addresses the health care 

14 needs of a substantial number of Indians. 

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

17 health profession program) if, as determined by 

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

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

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

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

25 the Secretary shall defer the active duty service obliVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 gation of that individual under that contract, in 

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

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

7 conditions: 

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

9 other advanced clinical training shall be counted 

10 as satisfying any period of obligated service 

11 under this subsection. 

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

13 that individual shall commence not later than 

14 90 days after the completion of that advanced 

15 clinical training (or by a date specified by the 

16 Secretary). 

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

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

20 (1). 

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

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

23 meet the active duty service obligation described 

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


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

2 the Indian Tribe in which the recipient is 

3 enrolled; or 

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

5 the recipient is enrolled. 

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

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

8 assignments of Indian Health Scholarship recipients 

9 required to meet the active duty service obligation 

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

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

13 health professionals to provide health care services 

14 as a result of individuals having breached contracts 

15 entered into under this section. 

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

18 enrolled part time in an approved course of study— 

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

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

21 years, as determined by the Secretary; 

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

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

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

25 each year for which the individual was provided 


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1 a scholarship (as determined by the Secretary); 

2 or 

3 ‘‘(B) 2 years; and 

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

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

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

10 ‘‘(d) BREACH OF CONTRACT.— 

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

12 shall be liable to the United States for the amount 

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

14 of the individual, under a contract entered into with 

15 the Secretary under this section on or after the date 

16 of enactment of the Indian Health Care Improve17 ment Act Amendments of 2007 if that individual— 

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

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

21 determined by the educational institution under 

22 regulations of the Secretary); 

23 ‘‘(B) is dismissed from such educational 

24 institution for disciplinary reasons; 


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1 ‘‘(C) voluntarily terminates the training in 

2 such an educational institution for which he or 

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

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

6 the educational institution in which he or she is 

7 enrolled not to accept payment, in whole or in 

8 part, of a scholarship under such contract, in 

9 lieu of any service obligation arising under such 

10 contract. 

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

12 specified in paragraph (1) an individual breaches a 

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

16 United States shall be entitled to recover from the 

17 individual an amount determined in accordance with 

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

19 in the manner provided for in such subsection. 

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

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

24 relates to that scholarship shall be canceled. 

25 ‘‘(4) WAIVERS AND SUSPENSIONS.— 


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

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

4 of a recipient of an Indian Health Scholarship 

5 if the Secretary determines that— 

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

7 to meet that obligation or make that pay8 ment; 

9 ‘‘(ii) requiring that recipient to meet 

10 that obligation or make that payment 

11 would result in extreme hardship to the re12 cipient; or 

13 ‘‘(iii) the enforcement of the require14 ment to meet the obligation or make the 

15 payment would be unconscionable. 

16 ‘‘(B) FACTORS FOR CONSIDERATION.—Be17 fore waiving or suspending an obligation of 

18 service or payment under subparagraph (A), the 

19 Secretary shall consult with the affected Area 

20 Office, Indian Tribes, Tribal Organizations, or 

21 Urban Indian Organizations, and may take into 

22 consideration whether the obligation may be 

23 satisfied in a teaching capacity at a tribal col24 lege or university nursing program under sub25 section (b)(1)(D). 


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1 ‘‘(5) EXTREME HARDSHIP.—Notwithstanding 

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

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

5 the United States to recover funds made available 

6 under this section. 

7 ‘‘(6) BANKRUPTCY.—Notwithstanding any 

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

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

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

13 period beginning on the initial date on which that 

14 payment is due, and only if the bankruptcy court 

15 finds that the nondischarge of the obligation would 

16 be unconscionable. 

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

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

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

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

25 shall be located at various locations throughout the counVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 try to maximize their availability to Indian students and 

2 new programs shall be established in different locations 

3 from time to time. 

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

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

8 Burdick American Indians Into Psychology Program’. 

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

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

14 and communications networks. 

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

17 of grants provided under this section. 

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

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

21 ‘‘(1) provides outreach and recruitment for 

22 health professions to Indian communities including 

23 elementary, secondary, and accredited and accessible 

24 community colleges that will be served by the pro25 gram; 


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1 ‘‘(2) incorporates a program advisory board 

2 comprised of representatives from the tribes and 

3 communities that will be served by the program; 

4 ‘‘(3) provides summer enrichment programs to 

5 expose Indian students to the various fields of psy6 chology through research, clinical, and experimental 

7 activities; 

8 ‘‘(4) provides stipends to undergraduate and 

9 graduate students to pursue a career in psychology; 

10 ‘‘(5) develops affiliation agreements with tribal 

11 colleges and universities, the Service, university af12 filiated programs, and other appropriate accredited 

13 and accessible entities to enhance the education of 

14 Indian students; 

15 ‘‘(6) to the maximum extent feasible, uses exist16 ing university tutoring, counseling, and student sup17 port services; and 

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

19 qualified Indians in the program. 

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

21 active duty service obligation prescribed under section 

22 338C of the Public Health Service Act (42 U.S.C. 254m) 

23 shall be met by each graduate who receives a stipend de24 scribed in subsection (d)(4) that is funded under this sec25 tion. Such obligation shall be met by service— 


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1 ‘‘(1) in an Indian Health Program; 

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

3 Act; or 

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

5 determined by the Secretary, in accordance with 

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

9 needs of a substantial number of Indians. 

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

11 is authorized to be appropriated to carry out this section 

12 $2,700,000 for each of fiscal years 2008 through 2017. 

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

14 ‘‘(a) IN GENERAL.— 

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

16 acting through the Service, shall make grants to 

17 Tribal Health Programs for the purpose of providing 

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

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

23 Indian Health Scholarships under section 104. 

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

25 under paragraph (1) shall be in such form and conVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 tain such agreements, assurances, and information 

2 as consistent with this section. 

3 ‘‘(b) REQUIREMENTS.— 

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

5 receiving a grant under subsection (a) shall provide 

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

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

9 any scholarship pursuant to subsection (a)— 

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

13 the Tribal Health Program; and 

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

15 from any other source of funds. 

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

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

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

21 ‘‘(d) CONTRACT.— 

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

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

24 Health Program shall enter into a written contract 

25 with each recipient of such scholarship. 


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

2 ‘‘(A) obligate such recipient to provide 

3 service in an Indian Health Program or Urban 

4 Indian Organization, in the same Service Area 

5 where the Tribal Health Program providing the 

6 scholarship is located, for— 

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

8 scholarship is provided (or the part-time 

9 equivalent thereof, as determined by the 

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

11 whichever period is greater; or 

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

13 the recipient and the Tribal Health Pro14 gram may agree; 

15 ‘‘(B) provide that the amount of the schol16 arship— 

17 ‘‘(i) may only be expended for— 

18 ‘‘(I) tuition expenses, other rea19 sonable educational expenses, and rea20 sonable living expenses incurred in at21 tendance at the educational institu22 tion; and 

23 ‘‘(II) payment to the recipient of 

24 a monthly stipend of not more than 

25 the amount authorized by section 


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

2 Service Act (42 U.S.C. 

3 254m(g)(1)(B)), with such amount to 

4 be reduced pro rata (as determined by 

5 the Secretary) based on the number of 

6 hours such student is enrolled, and 

7 not to exceed, for any year of attend8 ance for which the scholarship is pro9 vided, the total amount required for 

10 the year for the purposes authorized 

11 in this clause; and 

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

13 attendance for which the scholarship is 

14 provided, the total amount required for the 

15 year for the purposes authorized in clause 

16 (i); 

17 ‘‘(C) require the recipient of such scholar18 ship to maintain an acceptable level of academic 

19 standing as determined by the educational insti20 tution in accordance with regulations issued 

21 pursuant to this Act; and 

22 ‘‘(D) require the recipient of such scholar23 ship to meet the educational and licensure re24 quirements appropriate to each health profes25 sion. 


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

2 contract may allow the recipient to serve in another 

3 Service Area, provided the Tribal Health Program 

4 and Secretary approve and services are not dimin5 ished to Indians in the Service Area where the Trib6 al Health Program providing the scholarship is lo7 cated. 

8 ‘‘(e) BREACH OF CONTRACT.— 

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

10 has entered into a written contract with the Sec11 retary and a Tribal Health Program under sub12 section (d) shall be liable to the United States for 

13 the Federal share of the amount which has been 

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

15 the contract if that individual— 

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

17 of academic standing in the educational institu18 tion in which he or she is enrolled (such level 

19 as determined by the educational institution 

20 under regulations of the Secretary); 

21 ‘‘(B) is dismissed from such educational 

22 institution for disciplinary reasons; 

23 ‘‘(C) voluntarily terminates the training in 

24 such an educational institution for which he or 


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1 she is provided a scholarship under such con2 tract before the completion of such training; or 

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

4 the educational institution in which he or she is 

5 enrolled not to accept payment, in whole or in 

6 part, of a scholarship under such contract, in 

7 lieu of any service obligation arising under such 

8 contract. 

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

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

11 written contract by failing to either begin such indi12 vidual’s service obligation required under such con13 tract or to complete such service obligation, the 

14 United States shall be entitled to recover from the 

15 individual an amount determined in accordance with 

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

17 in the manner provided for in such subsection. 

18 ‘‘(3) CANCELLATION UPON DEATH OF RECIPI19 ENT.—Upon the death of an individual who receives 

20 an Indian Health Scholarship, any outstanding obli21 gation of that individual for service or payment that 

22 relates to that scholarship shall be canceled. 

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

24 out this subsection on the basis of information re25 ceived from Tribal Health Programs involved or on 


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1 the basis of information collected through such other 

2 means as the Secretary deems appropriate. 

3 ‘‘(f) RELATION TO SOCIAL SECURITY ACT.—The re4 cipient of a scholarship under this section shall agree, in 

5 providing health care pursuant to the requirements here6 in— 

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

8 seeking care on the basis of the ability of the indi9 vidual to pay for such care or on the basis that pay10 ment for such care will be made pursuant to a pro11 gram established in title XVIII of the Social Secu12 rity Act or pursuant to the programs established in 

13 title XIX or title XXI of such Act; and 

14 ‘‘(2) to accept assignment under section 

15 1842(b)(3)(B)(ii) of the Social Security Act for all 

16 services for which payment may be made under part 

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

18 appropriate agreement with the State agency that 

19 administers the State plan for medical assistance 

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

21 title XXI, of such Act to provide service to individ22 uals entitled to medical assistance or child health as23 sistance, respectively, under the plan. 

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

25 shall make payments under this section to a Tribal Health 


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1 Program for any fiscal year subsequent to the first fiscal 

2 year of such payments unless the Secretary determines 

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

4 Health Program has not complied with the requirements 

5 of this section. 

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

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

8 who receives a scholarship pursuant to section 104 or 106 

9 shall be given preference for employment in the Service, 

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

11 Urban Indian Organization, or other agencies of the De12 partment as available, during any nonacademic period of 

13 the year. 

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

15 OBLIGATION.—Periods of employment pursuant to this 

16 subsection shall not be counted in determining fulfillment 

17 of the service obligation incurred as a condition of the 

18 scholarship. 

19 ‘‘(c) TIMING; LENGTH OF EMPLOYMENT.—Any indi20 vidual enrolled in a program, including a high school pro21 gram, authorized under section 102(a) may be employed 

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

23 Indian Organization during any nonacademic period of the 

24 year. Any such employment shall not exceed 120 days dur25 ing any calendar year. 


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1 ‘‘(d) NONAPPLICABILITY OF COMPETITIVE PER2 SONNEL SYSTEM.—Any employment pursuant to this sec3 tion shall be made without regard to any competitive per4 sonnel system or agency personnel limitation and to a po5 sition which will enable the individual so employed to re6 ceive practical experience in the health profession in which 

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

8 shall receive payment for his or her services comparable 

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

10 employed in the competitive system. Any individual so em11 ployed shall not be counted against any employment ceil12 ing affecting the Service or the Department. 

13 ‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES. 

14 ‘‘In order to encourage scholarship and stipend re15 cipients under sections 104, 105, 106, and 115 and health 

16 professionals, including community health representatives 

17 and emergency medical technicians, to join or continue in 

18 an Indian Health Program and to provide their services 

19 in the rural and remote areas where a significant portion 

20 of Indians reside, the Secretary, acting through the Serv21 ice, may— 

22 ‘‘(1) provide programs or allowances to transi23 tion into an Indian Health Program, including li24 censing, board or certification examination assistVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 ance, and technical assistance in fulfilling service ob2 ligations under sections 104, 105, 106, and 115; and 

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

4 professionals employed in an Indian Health Program 

5 to enable them for a period of time each year pre6 scribed by regulation of the Secretary to take leave 

7 of their duty stations for professional consultation, 

8 management, leadership, and refresher training 

9 courses. 

10 ‘‘SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PRO11 GRAM. 

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

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

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

15 Service, shall maintain a Community Health Representa16 tive Program under which Indian Health Programs— 

17 ‘‘(1) provide for the training of Indians as com18 munity health representatives; and 

19 ‘‘(2) use such community health representatives 

20 in the provision of health care, health promotion, 

21 and disease prevention services to Indian commu22 nities. 

23 ‘‘(b) DUTIES.—The Community Health Representa24 tive Program of the Service, shall— 


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

2 community health representatives to ensure that the 

3 community health representatives provide quality 

4 health care, health promotion, and disease preven5 tion services to the Indian communities served by 

6 the Program; 

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

8 and maintain a curriculum that— 

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

10 health care with supervised practical experience 

11 in the provision of health care; and 

12 ‘‘(B) provides instruction and practical ex13 perience in health promotion and disease pre14 vention activities, with appropriate consider15 ation given to lifestyle factors that have an im16 pact on Indian health status, such as alco17 holism, family dysfunction, and poverty; 

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

19 needs of community health representatives for con20 tinuing education in health care, health promotion, 

21 and disease prevention and develop programs that 

22 meet the needs for continuing education; 

23 ‘‘(4) maintain a system that provides close su24 pervision of Community Health Representatives; 


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

2 of Community Health Representatives is reviewed 

3 and evaluated; and 

4 ‘‘(6) promote traditional health care practices 

5 of the Indian Tribes served consistent with the Serv6 ice standards for the provision of health care, health 

7 promotion, and disease prevention. 

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

9 PROGRAM. 

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

11 through the Service, shall establish and administer a pro12 gram to be known as the Service Loan Repayment Pro13 gram (hereinafter referred to as the ‘Loan Repayment 

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

15 trained health professionals necessary to maintain accredi16 tation of, and provide health care services to Indians 

17 through, Indian Health Programs and Urban Indian Or18 ganizations. 

19 ‘‘(b) ELIGIBLE INDIVIDUALS.—To be eligible to par20 ticipate in the Loan Repayment Program, an individual 

21 must— 

22 ‘‘(1)(A) be enrolled— 

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

24 accredited educational institution (as deter25 mined by the Secretary under section 


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

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

3 scheduled to complete such course of study in 

4 the same year such individual applies to partici5 pate in such program; or 

6 ‘‘(ii) in an approved graduate training pro7 gram in a health profession; or 

8 ‘‘(B) have— 

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

10 ‘‘(ii) a license to practice a health profes11 sion; 

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

13 as a commissioned officer in the Regular or Reserve 

14 Corps of the Public Health Service; 

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

16 in the Regular or Reserve Corps of the Public 

17 Health Service; 

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

19 service employment in the Service; or 

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

21 or Urban Indian Organization without a service obli22 gation; and 

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

24 a contract described in subsection (e). 

25 ‘‘(c) APPLICATION.— 


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1 ‘‘(1) INFORMATION TO BE INCLUDED WITH

2 FORMS.—In disseminating application forms and 

3 contract forms to individuals desiring to participate 

4 in the Loan Repayment Program, the Secretary 

5 shall include with such forms a fair summary of the 

6 rights and liabilities of an individual whose applica7 tion is approved (and whose contract is accepted) by 

8 the Secretary, including in the summary a clear ex9 planation of the damages to which the United States 

10 is entitled under subsection (l) in the case of the in11 dividual’s breach of contract. The Secretary shall 

12 provide such individuals with sufficient information 

13 regarding the advantages and disadvantages of serv14 ice as a commissioned officer in the Regular or Re15 serve Corps of the Public Health Service or a civil16 ian employee of the Service to enable the individual 

17 to make a decision on an informed basis. 

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

19 contract form, and all other information furnished 

20 by the Secretary under this section shall be written 

21 in a manner calculated to be understood by the aver22 age individual applying to participate in the Loan 

23 Repayment Program. 

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

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1 tract forms, and other information available to indi2 viduals desiring to participate in the Loan Repay3 ment Program on a date sufficiently early to ensure 

4 that such individuals have adequate time to carefully 

5 review and evaluate such forms and information. 

6 ‘‘(d) PRIORITIES.— 

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

8 Secretary shall annually— 

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

10 Health Program or Urban Indian Organization 

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

12 ‘‘(B) rank those positions in order of pri13 ority. 

14 ‘‘(2) APPROVALS.—Notwithstanding the pri15 ority determined under paragraph (1), the Secretary, 

16 in determining which applications under the Loan 

17 Repayment Program to approve (and which con18 tracts to accept), shall— 

19 ‘‘(A) give first priority to applications 

20 made by individual Indians; and 

21 ‘‘(B) after making determinations on all 

22 applications submitted by individual Indians as 

23 required under subparagraph (A), give priority 

24 to— 


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1 ‘‘(i) individuals recruited through the 

2 efforts of an Indian Health Program or 

3 Urban Indian Organization; and 

4 ‘‘(ii) other individuals based on the 

5 priority rankings under paragraph (1). 

6 ‘‘(e) RECIPIENT CONTRACTS.— 

7 ‘‘(1) CONTRACT REQUIRED.—An individual be8 comes a participant in the Loan Repayment Pro9 gram only upon the Secretary and the individual en10 tering into a written contract described in paragraph 

11 (2). 

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

13 contract referred to in this section between the Sec14 retary and an individual shall contain— 

15 ‘‘(A) an agreement under which— 

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

17 Secretary agrees— 

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

19 individual in accordance with the pro20 visions of this section; and 

21 ‘‘(II) to accept (subject to the 

22 availability of appropriated funds for 

23 carrying out this section) the indi24 vidual into the Service or place the in25 dividual with a Tribal Health ProVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 gram or Urban Indian Organization 

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

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

4 individual agrees— 

5 ‘‘(I) to accept loan payments on 

6 behalf of the individual; 

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

8 described in subsection (b)(1)— 

9 ‘‘(aa) to maintain enrollment 

10 in a course of study or training 

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

12 until the individual completes the 

13 course of study or training; and 

14 ‘‘(bb) while enrolled in such 

15 course of study or training, to 

16 maintain an acceptable level of 

17 academic standing (as deter18 mined under regulations of the 

19 Secretary by the educational in20 stitution offering such course of 

21 study or training); and 

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

23 (hereinafter in this section referred to 

24 as the ‘period of obligated service’) 

25 equal to 2 years or such longer period 


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1 as the individual may agree to serve 

2 in the full-time clinical practice of 

3 such individual’s profession in an In4 dian Health Program or Urban In5 dian Organization to which the indi6 vidual may be assigned by the Sec7 retary; 

8 ‘‘(B) a provision permitting the Secretary 

9 to extend for such longer additional periods, as 

10 the individual may agree to, the period of obli11 gated service agreed to by the individual under 

12 subparagraph (A)(ii)(III); 

13 ‘‘(C) a provision that any financial obliga14 tion of the United States arising out of a con15 tract entered into under this section and any 

16 obligation of the individual which is conditioned 

17 thereon is contingent upon funds being appro18 priated for loan repayments under this section; 

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

20 the United States is entitled under subsection 

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

22 and 

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

24 and liabilities of the Secretary and of the indi25 vidual, not inconsistent with this section. 


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

2 The Secretary shall provide written notice to an individual 

3 within 21 days on— 

4 ‘‘(1) the Secretary’s approving, under sub5 section (e)(1), of the individual’s participation in the 

6 Loan Repayment Program, including extensions re7 sulting in an aggregate period of obligated service in 

8 excess of 4 years; or 

9 ‘‘(2) the Secretary’s disapproving an individ10 ual’s participation in such Program. 

11 ‘‘(g) PAYMENTS.— 

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

13 for an individual under a written contract under the 

14 Loan Repayment Program shall consist of payment, 

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

16 individual of the principal, interest, and related ex17 penses on government and commercial loans received 

18 by the individual regarding the undergraduate or 

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

20 loans were made for— 

21 ‘‘(A) tuition expenses; 

22 ‘‘(B) all other reasonable educational ex23 penses, including fees, books, and laboratory ex24 penses, incurred by the individual; and 


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1 ‘‘(C) reasonable living expenses as deter2 mined by the Secretary. 

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

4 service that an individual contracts to serve under 

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

6 or an amount equal to the amount specified in sec7 tion 338B(g)(2)(A) of the Public Health Service 

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

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

10 determination of the amount to pay for a year of 

11 such service by an individual, the Secretary shall 

12 consider the extent to which each such determina13 tion— 

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

15 maximize the number of contracts that can be 

16 provided under the Loan Repayment Program 

17 from the amounts appropriated for such con18 tracts; 

19 ‘‘(B) provides an incentive to serve in In20 dian Health Programs and Urban Indian Orga21 nizations with the greatest shortages of health 

22 professionals; and 

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

24 the health professional involved remaining in an 

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1 nization with such a health professional short2 age, and continuing to provide primary health 

3 services, after the completion of the period of 

4 obligated service under the Loan Repayment 

5 Program. 

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

7 Secretary for the making of loan repayments in ac8 cordance with this subsection shall provide that any 

9 repayments for a year of obligated service shall be 

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

11 which the individual completes such year of service. 

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

13 For the purpose of providing reimbursements for tax 

14 liability resulting from a payment under paragraph 

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

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

17 make payments to the individual in an amount 

18 equal to not less than 20 percent and not more 

19 than 39 percent of the total amount of loan re20 payments made for the taxable year involved; 

21 and 

22 ‘‘(B) may make such additional payments 

23 as the Secretary determines to be appropriate 

24 with respect to such purpose. 


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

2 may enter into an agreement with the holder of any 

3 loan for which payments are made under the Loan 

4 Repayment Program to establish a schedule for the 

5 making of such payments. 

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

7 other provision of law, individuals who have entered into 

8 written contracts with the Secretary under this section 

9 shall not be counted against any employment ceiling af10 fecting the Department while those individuals are under11 going academic training. 

12 ‘‘(i) RECRUITMENT.—The Secretary shall conduct re13 cruiting programs for the Loan Repayment Program and 

14 other manpower programs of the Service at educational 

15 institutions training health professionals or specialists 

16 identified in subsection (a). 

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

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

19 to individuals during their period of obligated service 

20 under the Loan Repayment Program. 

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

22 in assigning individuals to serve in Indian Health Pro23 grams or Urban Indian Organizations pursuant to con24 tracts entered into under this section, shall— 


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

2 Health Programs and Urban Indian Organizations 

3 receive consideration on an equal basis with pro4 grams that are administered directly by the Service; 

5 and 

6 ‘‘(2) give priority to assigning individuals to In7 dian Health Programs and Urban Indian Organiza8 tions that have a need for health professionals to 

9 provide health care services as a result of individuals 

10 having breached contracts entered into under this 

11 section. 

12 ‘‘(l) BREACH OF CONTRACT.— 

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

14 has entered into a written contract with the Sec15 retary under this section and has not received a 

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

17 of any service obligation arising under such contract, 

18 to the United States for the amount which has been 

19 paid on such individual’s behalf under the contract 

20 if that individual— 

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

22 course of study and— 

23 ‘‘(i) fails to maintain an acceptable 

24 level of academic standing in the edu25 cational institution in which he or she is 


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1 enrolled (such level determined by the edu2 cational institution under regulations of 

3 the Secretary); 

4 ‘‘(ii) voluntarily terminates such en5 rollment; or 

6 ‘‘(iii) is dismissed from such edu7 cational institution before completion of 

8 such course of study; or 

9 ‘‘(B) is enrolled in a graduate training pro10 gram and fails to complete such training pro11 gram. 

12 ‘‘(2) OTHER BREACHES; FORMULA FOR

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

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

15 written contract under this section by failing either 

16 to begin, or complete, such individual’s period of ob17 ligated service in accordance with subsection (e)(2), 

18 the United States shall be entitled to recover from 

19 such individual an amount to be determined in ac20 cordance with the following formula: A=3Z(t¥s/t) 

21 in which— 

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

23 is entitled to recover; 

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

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1 vidual and the interest on such amounts which 

2 would be payable if, at the time the amounts 

3 were paid, they were loans bearing interest at 

4 the maximum legal prevailing rate, as deter5 mined by the Secretary of the Treasury; 

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

7 the individual’s period of obligated service in 

8 accordance with subsection (f); and 

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

10 period served by such individual in accordance 

11 with this section. 

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

13 Amounts not paid within such period shall be sub14 ject to collection through deductions in Medicare 

15 payments pursuant to section 1892 of the Social Se16 curity Act. 

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

18 amount of damages which the United States is enti19 tled to recover under this subsection shall be paid to 

20 the United States within the 1-year period beginning 

21 on the date of the breach or such longer period be22 ginning on such date as shall be specified by the 

23 Secretary. 

24 ‘‘(5) RECOVERY OF DELINQUENCY.— 


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

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

3 the Secretary shall, for the purpose of recov4 ering such damages— 

5 ‘‘(i) use collection agencies contracted 

6 with by the Administrator of General Serv7 ices; or 

8 ‘‘(ii) enter into contracts for the re9 covery of such damages with collection 

10 agencies selected by the Secretary. 

11 ‘‘(B) REPORT.—Each contract for recov12 ering damages pursuant to this subsection shall 

13 provide that the contractor will, not less than 

14 once each 6 months, submit to the Secretary a 

15 status report on the success of the contractor in 

16 collecting such damages. Section 3718 of title 

17 31, United States Code, shall apply to any such 

18 contract to the extent not inconsistent with this 

19 subsection. 

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

21 ‘‘(1) IN GENERAL.—The Secretary shall by reg22 ulation provide for the partial or total waiver or sus23 pension of any obligation of service or payment by 

24 an individual under the Loan Repayment Program 

25 whenever compliance by the individual is impossible 


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1 or would involve extreme hardship to the individual 

2 and if enforcement of such obligation with respect to 

3 any individual would be unconscionable. 

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

5 of an individual under the Loan Repayment Pro6 gram for service or payment of damages shall be 

7 canceled upon the death of the individual. 

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

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

10 States to recover amounts under this section in any 

11 case of extreme hardship or other good cause shown, 

12 as determined by the Secretary. 

13 ‘‘(4) BANKRUPTCY.—Any obligation of an indi14 vidual under the Loan Repayment Program for pay15 ment of damages may be released by a discharge in 

16 bankruptcy under title 11 of the United States Code 

17 only if such discharge is granted after the expiration 

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

19 payment of such damages is required, and only if 

20 the bankruptcy court finds that nondischarge of the 

21 obligation would be unconscionable. 

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

23 President, for inclusion in the report required to be sub24 mitted to Congress under section 801, a report concerning 


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1 the previous fiscal year which sets forth by Service Area 

2 the following: 

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

4 maintained by Indian Health Programs and Urban 

5 Indian Organizations for which recruitment or reten6 tion is difficult. 

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

8 applications filed with respect to each type of health 

9 profession. 

10 ‘‘(3) The number of contracts described in sub11 section (e) that are entered into with respect to each 

12 health profession. 

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

14 this section, in total and by health profession. 

15 ‘‘(5) The number of scholarships that are pro16 vided under sections 104 and 106 with respect to 

17 each health profession. 

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

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

20 profession. 

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

22 that will be needed by Indian Health Programs and 

23 Urban Indian Organizations, by location and profes24 sion, during the 3 fiscal years beginning after the 

25 date the report is filed. 


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

2 to fill the health professional positions maintained 

3 by Indian Health Programs or Urban Indian Orga4 nizations for which recruitment or retention is dif5 ficult. 

6 ‘‘SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOV7 ERY FUND. 

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

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

10 Indian Health Scholarship and Loan Repayment Recovery 

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

12 The LRRF shall consist of such amounts as may be col13 lected from individuals under section 104(d), section 

14 106(e), and section 110(l) for breach of contract, such 

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

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

17 appropriated, or earned relative to the LRRF shall remain 

18 available until expended. 

19 ‘‘(b) USE OF FUNDS.— 

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

21 may be expended by the Secretary, acting through 

22 the Service, to make payments to an Indian Health 

23 Program— 

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

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1 gram participant under section 110 has been 

2 assigned to meet the obligated service require3 ments pursuant to such sections; and 

4 ‘‘(B) that has a need for a health profes5 sional to provide health care services as a result 

6 of such recipient or participant having breached 

7 the contract entered into under section 104, 

8 106, or section 110. 

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

10 Health Program receiving payments pursuant to 

11 paragraph (1) may expend the payments to provide 

12 scholarships or recruit and employ, directly or by 

13 contract, health professionals to provide health care 

14 services. 

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

16 Treasury shall invest such amounts of the LRRF as the 

17 Secretary of Health and Human Services determines are 

18 not required to meet current withdrawals from the LRRF. 

19 Such investments may be made only in interest bearing 

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

21 obligations may be acquired on original issue at the issue 

22 price, or by purchase of outstanding obligations at the 

23 market price. 


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1 ‘‘(d) SALE OF OBLIGATIONS.—Any obligation ac2 quired by the LRRF may be sold by the Secretary of the 

3 Treasury at the market price. 

4 ‘‘SEC. 112. RECRUITMENT ACTIVITIES. 

5 ‘‘(a) REIMBURSEMENT FOR TRAVEL.—The Sec6 retary, acting through the Service, may reimburse health 

7 professionals seeking positions with Indian Health Pro8 grams or Urban Indian Organizations, including individ9 uals considering entering into a contract under section 

10 110 and their spouses, for actual and reasonable expenses 

11 incurred in traveling to and from their places of residence 

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

13 of evaluating such area with respect to such assignment. 

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

15 acting through the Service, shall assign 1 individual in 

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

17 recruitment activities. 

18 ‘‘SEC. 113. INDIAN RECRUITMENT AND RETENTION PRO19 GRAM. 

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

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

22 demonstration projects for a period not to exceed 3 years 

23 to enable Tribal Health Programs and Urban Indian Or24 ganizations to recruit, place, and retain health profes25 sionals to meet their staffing needs. 


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1 ‘‘(b) ELIGIBLE ENTITIES; APPLICATION.—Any Trib2 al Health Program or Urban Indian Organization may 

3 submit an application for funding of a project pursuant 

4 to this section. 

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

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

7 acting through the Service, shall establish a demonstration 

8 project to enable health professionals who have worked in 

9 an Indian Health Program or Urban Indian Organization 

10 for a substantial period of time to pursue advanced train11 ing or research areas of study for which the Secretary de12 termines a need exists. 

13 ‘‘(b) SERVICE OBLIGATION.—An individual who par14 ticipates in a program under subsection (a), where the 

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

16 obligation to serve in an Indian Health Program or Urban 

17 Indian Organization for a period of obligated service equal 

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

19 participates in such program. In the event that the indi20 vidual fails to complete such obligated service, the indi21 vidual shall be liable to the United States for the period 

22 of service remaining. In such event, with respect to indi23 viduals entering the program after the date of enactment 

24 of the Indian Health Care Improvement Act Amendments 

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


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1 from such individual an amount to be determined in ac2 cordance with the formula specified in subsection (l) of 

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

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

5 Health professionals from Tribal Health Programs and 

6 Urban Indian Organizations shall be given an equal oppor7 tunity to participate in the program under subsection (a). 

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

9 NURSING PROGRAM. 

10 ‘‘(a) GRANTS AUTHORIZED.—For the purpose of in11 creasing the number of nurses, nurse midwives, and nurse 

12 practitioners who deliver health care services to Indians, 

13 the Secretary, acting through the Service, shall provide 

14 grants to the following: 

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

16 ‘‘(2) Tribal colleges or universities. 

17 ‘‘(3) Nurse midwife programs and advanced 

18 practice nurse programs that are provided by any 

19 tribal college or university accredited nursing pro20 gram, or in the absence of such, any other public or 

21 private institutions. 

22 ‘‘(b) USE OF GRANTS.—Grants provided under sub23 section (a) may be used for 1 or more of the following: 


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

2 train individuals to be nurses, nurse midwives, or 

3 advanced practice nurses. 

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

5 in such programs that may pay the tuition charged 

6 for such program and other expenses incurred in 

7 connection with such program, including books, fees, 

8 room and board, and stipends for living expenses. 

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

10 nurses, nurse midwives, and advanced practice 

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

12 services to Indians. 

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

14 skills of, and provides continuing education to, 

15 nurses, nurse midwives, and advanced practice 

16 nurses. 

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

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

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

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

21 Secretary may require to establish the connection between 

22 the program of the applicant and a health care facility 

23 that primarily serves Indians. 


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

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

3 extend a preference to the following: 

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

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

8 ‘‘(3) Programs that are interdisciplinary. 

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

11 students. 

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

13 universities. 

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

15 Secretary shall provide 1 of the grants authorized under 

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

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

18 N. Burdick American Indians Into Nursing Program’. 

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

22 N. Burdick American Indians Into Psychology Program 

23 established under section 105(b). 

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


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

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

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

5 Such obligation shall be met by service— 

6 ‘‘(1) in the Service; 

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

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

10 450 et seq.) (including programs under agreements 

11 with the Bureau of Indian Affairs); 

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

13 Act; 

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

17 situated in a physician or other health shortage area 

18 and addresses the health care needs of a substantial 

19 number of Indians; or 

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

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

23 health services provided to Indians would not de24 crease. 


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1 ‘‘SEC. 116. TRIBAL CULTURAL ORIENTATION. 

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

3 Secretary, acting through the Service, shall require that 

4 appropriate employees of the Service who serve Indian 

5 Tribes in each Service Area receive educational instruction 

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

7 relationship to the Service. 

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

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

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

13 Urban Indian Organizations; 

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

15 universities; 

16 ‘‘(3) include instruction in American Indian 

17 studies; and 

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

19 health care practices of the Indian Tribes in the 

20 Service Area. 

21 ‘‘SEC. 117. INMED PROGRAM. 

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

23 through the Service, is authorized to provide grants to col24 leges and universities for the purpose of maintaining and 

25 expanding the Indian health careers recruitment program 

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1 after in this section referred to as ‘INMED’) as a means 

2 of encouraging Indians to enter the health professions. 

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

4 shall provide 1 of the grants authorized under subsection 

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

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

7 Indian Health Programs’, unless the Secretary makes a 

8 determination, based upon program reviews, that the pro9 gram is not meeting the purposes of this section. Such 

10 program shall, to the maximum extent feasible, coordinate 

11 with the Quentin N. Burdick American Indians Into Psy12 chology Program established under section 105(b) and the 

13 Quentin N. Burdick American Indians Into Nursing Pro14 gram established under section 115. 

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

16 Act, shall develop regulations to govern grants pursuant 

17 to this section. 

18 ‘‘(d) REQUIREMENTS.—Applicants for grants pro19 vided under this section shall agree to provide a program 

20 which— 

21 ‘‘(1) provides outreach and recruitment for 

22 health professions to Indian communities including 

23 elementary and secondary schools and community 

24 colleges located on reservations which will be served 

25 by the program; 


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1 ‘‘(2) incorporates a program advisory board 

2 comprised of representatives from the Indian Tribes 

3 and Indian communities which will be served by the 

4 program; 

5 ‘‘(3) provides summer preparatory programs for 

6 Indian students who need enrichment in the subjects 

7 of math and science in order to pursue training in 

8 the health professions; 

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

10 to students who are enrolled in a health career pro11 gram of study at the respective college or university; 

12 and 

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

14 qualified Indians in the program. 

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

16 COLLEGES. 

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

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

19 through the Service, shall award grants to accredited 

20 and accessible community colleges for the purpose of 

21 assisting such community colleges in the establish22 ment of programs which provide education in a 

23 health profession leading to a degree or diploma in 

24 a health profession for individuals who desire to 


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1 practice such profession on or near a reservation or 

2 in an Indian Health Program. 

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

4 grant awarded to a community college under para5 graph (1) for the first year in which such a grant 

6 is provided to the community college shall not exceed 

7 $250,000. 

8 ‘‘(b) GRANTS FOR MAINTENANCE AND RECRUIT9 ING.— 

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

11 through the Service, shall award grants to accredited 

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

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

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

17 made under this section to a community college 

18 which— 

19 ‘‘(A) is accredited; 

20 ‘‘(B) has a relationship with a hospital fa21 cility, Service facility, or hospital that could 

22 provide training of nurses or health profes23 sionals; 


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

2 an accredited college or university medical 

3 school, the terms of which— 

4 ‘‘(i) provide a program that enhances 

5 the transition and recruitment of students 

6 into advanced baccalaureate or graduate 

7 programs that train health professionals; 

8 and 

9 ‘‘(ii) stipulate certifications necessary 

10 to approve internship and field placement 

11 opportunities at Indian Health Programs; 

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

13 appropriate certifications; 

14 ‘‘(E) is capable of obtaining State or re15 gional accreditation of the program described in 

16 subsection (a)(1); and 

17 ‘‘(F) agrees to provide for Indian pref18 erence for applicants for programs under this 

19 section. 

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

21 encourage community colleges described in subsection 

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

23 subsection (a)(1) by— 

24 ‘‘(1) entering into agreements with such col25 leges for the provision of qualified personnel of the 


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1 Service to teach courses of study in such programs; 

2 and 

3 ‘‘(2) providing technical assistance and support 

4 to such colleges. 

5 ‘‘(d) ADVANCED TRAINING.— 

6 ‘‘(1) REQUIRED.—Any program receiving as7 sistance under this section that is conducted with re8 spect to a health profession shall also offer courses 

9 of study which provide advanced training for any 

10 health professional who— 

11 ‘‘(A) has already received a degree or di12 ploma in such health profession; and 

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

14 reservation or for an Indian Health Program. 

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

16 Such courses of study may be offered in conjunction 

17 with the college or university with which the commu18 nity college has entered into the agreement required 

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

20 ‘‘(e) PRIORITY.—Where the requirements of sub21 section (b) are met, grant award priority shall be provided 

22 to tribal colleges and universities in Service Areas where 

23 they exist. 


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1 ‘‘SEC. 119. RETENTION BONUS. 

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

3 a retention bonus to any health professional employed by, 

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

5 or Urban Indian Organization either as a civilian employee 

6 or as a commissioned officer in the Regular or Reserve 

7 Corps of the Public Health Service who— 

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

9 for which recruitment or retention of personnel is 

10 difficult; 

11 ‘‘(2) the Secretary determines is needed by In12 dian Health Programs and Urban Indian Organiza13 tions; 

14 ‘‘(3) has— 

15 ‘‘(A) completed 2 years of employment 

16 with an Indian Health Program or Urban In17 dian Organization; or 

18 ‘‘(B) completed any service obligations in19 curred as a requirement of— 

20 ‘‘(i) any Federal scholarship program; 

21 or 

22 ‘‘(ii) any Federal education loan re23 payment program; and 

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

25 Health Program or Urban Indian Organization for 


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1 continued employment for a period of not less than 

2 1 year. 

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

4 the retention bonus which shall provide for a higher an5 nual rate for multiyear agreements than for single year 

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

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

8 annum. 

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

10 health professional failing to complete the agreed upon 

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

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

13 Government the full amount of the retention bonus for the 

14 period covered by the agreement, plus interest as deter15 mined by the Secretary in accordance with section 

16 110(l)(2)(B). 

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

18 may pay a retention bonus to any health professional em19 ployed by a Tribal Health Program if such health profes20 sional is serving in a position which the Secretary deter21 mines is— 

22 ‘‘(1) a position for which recruitment or reten23 tion is difficult; and 

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

25 to Indians. 


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1 ‘‘SEC. 120. NURSING RESIDENCY PROGRAM. 

2 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Sec3 retary, acting through the Service, shall establish a pro4 gram to enable Indians who are licensed practical nurses, 

5 licensed vocational nurses, and registered nurses who are 

6 working in an Indian Health Program or Urban Indian 

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

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

9 shall include a combination of education and work study 

10 in an Indian Health Program or Urban Indian Organiza11 tion leading to an associate or bachelor’s degree (in the 

12 case of a licensed practical nurse or licensed vocational 

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

14 nurse), or advanced degrees or certifications in nursing 

15 and public health. 

16 ‘‘(b) SERVICE OBLIGATION.—An individual who par17 ticipates in a program under subsection (a), where the 

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

19 obligation to serve in an Indian Health Program or Urban 

20 Indian Organization for a period of obligated service equal 

21 to 1 year for every year that nonprofessional employee (li22 censed practical nurses, licensed vocational nurses, nurs23 ing assistants, and various health care technicals), or 2 

24 years for every year that professional nurse (associate de25 gree and bachelor-prepared registered nurses), partici26 pates in such program. In the event that the individual 


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1 fails to complete such obligated service, the United States 

2 shall be entitled to recover from such individual an amount 

3 determined in accordance with the formula specified in 

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

5 in such subsection. 

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

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

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

9 (commonly known as the ‘Snyder Act’), the Secretary, act10 ing through the Service, shall develop and operate a Com11 munity Health Aide Program in Alaska under which the 

12 Service— 

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

14 as health aides or community health practitioners; 

15 ‘‘(2) uses such aides or practitioners in the pro16 vision of health care, health promotion, and disease 

17 prevention services to Alaska Natives living in vil18 lages in rural Alaska; and 

19 ‘‘(3) provides for the establishment of tele20 conferencing capacity in health clinics located in or 

21 near such villages for use by community health aides 

22 or community health practitioners. 

23 ‘‘(b) SPECIFIC PROGRAM REQUIREMENTS.—The Sec24 retary, acting through the Community Health Aide Pro25 gram of the Service, shall— 


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

2 provide a high standard of training to community 

3 health aides and community health practitioners to 

4 ensure that such aides and practitioners provide 

5 quality health care, health promotion, and disease 

6 prevention services to the villages served by the Pro7 gram; 

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

9 a curriculum that— 

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

11 health care with supervised practical experience 

12 in the provision of health care; 

13 ‘‘(B) provides instruction and practical ex14 perience in the provision of acute care, emer15 gency care, health promotion, disease preven16 tion, and the efficient and effective manage17 ment of clinic pharmacies, supplies, equipment, 

18 and facilities; and 

19 ‘‘(C) promotes the achievement of the 

20 health status objectives specified in section 

21 3(2); 

22 ‘‘(3) establish and maintain a Community 

23 Health Aide Certification Board to certify as com24 munity health aides or community health practi25 tioners individuals who have successfully completed 


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1 the training described in paragraph (1) or can dem2 onstrate equivalent experience; 

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

6 in the provision of health care, including the areas 

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

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

12 and community health practitioners; 

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

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

17 disease prevention services; and 

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

19 pulpotomies on deciduous teeth) or extraction of 

20 adult teeth can be performed by a dental health aide 

21 therapist only after consultation with a licensed den22 tist who determines that the procedure is a medical 

23 emergency that cannot be resolved with palliative 

24 treatment, and further that dental health aide thera25 pists are strictly prohibited from performing all 


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1 other oral or jaw surgeries, provided that uncompli2 cated extractions shall not be considered oral sur3 gery under this section. 

4 ‘‘(c) PROGRAM REVIEW.— 

5 ‘‘(1) NEUTRAL PANEL.— 

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

7 acting through the Service, shall establish a 

8 neutral panel to carry out the study under 

9 paragraph (2). 

10 ‘‘(B) MEMBERSHIP.—Members of the neu11 tral panel shall be appointed by the Secretary 

12 from among clinicians, economists, community 

13 practitioners, oral epidemiologists, and Alaska 

14 Natives. 

15 ‘‘(2) STUDY.— 

16 ‘‘(A) IN GENERAL.—The neutral panel es17 tablished under paragraph (1) shall conduct a 

18 study of the dental health aide therapist serv19 ices provided by the Community Health Aide 

20 Program under this section to ensure that the 

21 quality of care provided through those services 

22 is adequate and appropriate. 

23 ‘‘(B) PARAMETERS OF STUDY.—The Sec24 retary, in consultation with interested parties, 


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1 including professional dental organizations, 

2 shall develop the parameters of the study. 

3 ‘‘(C) INCLUSIONS.—The study shall in4 clude a determination by the neutral panel with 

5 respect to— 

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

7 aide therapist services under this section to 

8 address the dental care needs of Alaska 

9 Natives; 

10 ‘‘(ii) the quality of care provided 

11 through those services, including any train12 ing, improvement, or additional oversight 

13 required to improve the quality of care; 

14 and 

15 ‘‘(iii) whether safer and less costly al16 ternatives to the dental health aide thera17 pist services exist. 

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

19 study under this paragraph, the neutral panel 

20 shall consult with Alaska Tribal Organizations 

21 with respect to the adequacy and accuracy of 

22 the study. 

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

24 to the Secretary, the Committee on Indian Affairs of 

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1 sources of the House of Representatives a report de2 scribing the results of the study under paragraph 

3 (2), including a description of— 

4 ‘‘(A) any determination of the neutral 

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

6 ‘‘(B) any comments received from an Alas7 ka Tribal Organization under paragraph 

8 (2)(D). 

9 ‘‘(d) NATIONALIZATION OF PROGRAM.— 

10 ‘‘(1) IN GENERAL.—Except as provided in para11 graph (2), the Secretary, acting through the Service, 

12 may establish a national Community Health Aide 

13 Program in accordance with the program under this 

14 section, as the Secretary determines to be appro15 priate. 

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

17 Health Aide Program under paragraph (1) shall not 

18 include dental health aide therapist services. 

19 ‘‘(3) REQUIREMENT.—In establishing a na20 tional program under paragraph (1), the Secretary 

21 shall not reduce the amount of funds provided for 

22 the Community Health Aide Program described in 

23 subsections (a) and (b). 


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

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

3 contract or otherwise, provide training for Indians in the 

4 administration and planning of Tribal Health Programs. 

5 ‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE 

6 DEMONSTRATION PROGRAMS. 

7 ‘‘(a) DEMONSTRATION PROGRAMS AUTHORIZED.— 

8 The Secretary, acting through the Service, may fund dem9 onstration programs for Tribal Health Programs to ad10 dress the chronic shortages of health professionals. 

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

12 demonstration programs funded under subsection (a) shall 

13 be— 

14 ‘‘(1) to provide direct clinical and practical ex15 perience at a Service Unit to health profession stu16 dents and residents from medical schools; 

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

18 Indians by assuring access to qualified health care 

19 professionals; and 

20 ‘‘(3) to provide academic and scholarly opportu21 nities for health professionals serving Indians by 

22 identifying all academic and scholarly resources of 

23 the region. 

24 ‘‘(c) ADVISORY BOARD.—The demonstration pro25 grams established pursuant to subsection (a) shall incor26 porate a program advisory board composed of representaVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00084 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 tives from the Indian Tribes and Indian communities in 

2 the area which will be served by the program. 

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

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

5 shall not— 

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

7 Service Corps from an Indian Health Program or 

8 Urban Indian Organization; or 

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

10 member, unless the Secretary, acting through the 

11 Service, has ensured that the Indians receiving serv12 ices from such member will experience no reduction 

13 in services. 

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

15 Health Service Corps scholars qualifying for the Commis16 sioned Corps in the Public Health Service shall be exempt 

17 from the full-time equivalent limitations of the National 

18 Health Service Corps and the Service when serving as a 

19 commissioned corps officer in a Tribal Health Program 

20 or an Urban Indian Organization. 

21 ‘‘SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL 

22 CURRICULA DEMONSTRATION PROGRAMS. 

23 ‘‘(a) CONTRACTS AND GRANTS.—The Secretary, act24 ing through the Service, may enter into contracts with, 

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1 sities and eligible accredited and accessible community col2 leges to establish demonstration programs to develop edu3 cational curricula for substance abuse counseling. 

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

5 section shall be used only for developing and providing 

6 educational curriculum for substance abuse counseling (in7 cluding paying salaries for instructors). Such curricula 

8 may be provided through satellite campus programs. 

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

10 contract entered into or a grant provided under this sec11 tion shall be for a period of 3 years. Such contract or 

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

13 upon the approval of the Secretary. 

14 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP15 PLICATIONS.—Not later than 180 days after the date of 

16 enactment of the Indian Health Care Improvement Act 

17 Amendments of 2007, the Secretary, after consultation 

18 with Indian Tribes and administrators of tribal colleges 

19 and universities and eligible accredited and accessible com20 munity colleges, shall develop and issue criteria for the 

21 review and approval of applications for funding (including 

22 applications for renewals of funding) under this section. 

23 Such criteria shall ensure that demonstration programs 

24 established under this section promote the development of 


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1 the capacity of such entities to educate substance abuse 

2 counselors. 

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

4 technical and other assistance as may be necessary to en5 able grant recipients to comply with the provisions of this 

6 section. 

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

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

9 is required to be submitted under section 801 for that fis10 cal year, a report on the findings and conclusions derived 

11 from the demonstration programs conducted under this 

12 section during that fiscal year. 

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

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

15 following: 

16 ‘‘(1) Classroom education. 

17 ‘‘(2) Clinical work experience. 

18 ‘‘(3) Continuing education workshops. 

19 ‘‘SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMU20 NITY EDUCATION PROGRAMS. 

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

22 the Service, and the Secretary of the Interior, in consulta23 tion with Indian Tribes and Tribal Organizations, shall 

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

25 positions specified in subsection (b) whose qualifications 


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

2 prevention, education, referral, or treatment of mental ill3 ness, or dysfunctional and self destructive behavior. 

4 ‘‘(b) POSITIONS.—The positions referred to in sub5 section (a) are— 

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

7 Affairs, including existing positions, in the fields 

8 of— 

9 ‘‘(A) elementary and secondary education; 

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

11 welfare; 

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

13 and 

14 ‘‘(D) alcohol and substance abuse; 

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

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

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

18 by Indian Tribes, Tribal Organizations (without re19 gard to the funding source), and Urban Indian Or20 ganizations. 

21 ‘‘(c) TRAINING CRITERIA.— 

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

23 shall provide training criteria appropriate to each 

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

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


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

2 such position. With respect to any such individual in 

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

4 the respective Secretaries shall provide appropriate 

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

6 Tribal Organization, or Urban Indian Organization 

7 for training of appropriate individuals. In the case of 

8 positions funded under a contract or compact under 

9 the Indian Self-Determination and Education Assist10 ance Act (25 U.S.C. 450 et seq.), the appropriate 

11 Secretary shall ensure that such training costs are 

12 included in the contract or compact, as the Sec13 retary determines necessary. 

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

15 Position specific training criteria shall be culturally 

16 relevant to Indians and Indian Tribes and shall en17 sure that appropriate information regarding tradi18 tional health care practices is provided. 

19 ‘‘(d) COMMUNITY EDUCATION ON MENTAL ILL20 NESS.—The Service shall develop and implement, on re21 quest of an Indian Tribe, Tribal Organization, or Urban 

22 Indian Organization, or assist the Indian Tribe, Tribal Or23 ganization, or Urban Indian Organization to develop and 

24 implement, a program of community education on mental 

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


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

2 Urban Indian Organization, provide technical assistance 

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

4 Organization to obtain and develop community edu5 cational materials on the identification, prevention, refer6 ral, and treatment of mental illness and dysfunctional and 

7 self-destructive behavior. 

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

9 of enactment of the Indian Health Care Improvement Act 

10 Amendments of 2007, the Secretary shall develop a plan 

11 under which the Service will increase the health care staff 

12 providing behavioral health services by at least 500 posi13 tions within 5 years after the date of enactment of this 

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

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

16 under this subsection shall be implemented under the Act 

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

18 as the ‘Snyder Act’). 

19 ‘‘SEC. 127. AUTHORIZATION OF APPROPRIATIONS. 

20 ‘‘There are authorized to be appropriated such sums 

21 as may be necessary for each fiscal year through fiscal 

22 year 2017 to carry out this title. 


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1 ‘‘TITLE II—HEALTH SERVICES 

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

3 ‘‘(a) USE OF FUNDS.—The Secretary, acting through 

4 the Service, is authorized to expend funds, directly or 

5 under the authority of the Indian Self-Determination and 

6 Education Assistance Act (25 U.S.C. 450 et seq.), which 

7 are appropriated under the authority of this section, for 

8 the purposes of— 

9 ‘‘(1) eliminating the deficiencies in health sta10 tus and health resources of all Indian Tribes; 

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

12 health care services to Indians; 

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

14 efficient and equitable manner, including the use of 

15 telehealth and telemedicine when appropriate; 

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

17 direct care and contract health service programs; 

18 and 

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

20 meet the following health service responsibilities with 

21 respect to those Indian Tribes with the highest levels 

22 of health status deficiencies and resource defi23 ciencies: 

24 ‘‘(A) Clinical care, including inpatient care, 

25 outpatient care (including audiology, clinical 


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1 eye, and vision care), primary care, secondary 

2 and tertiary care, and long-term care. 

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

6 ‘‘(C) Dental care. 

7 ‘‘(D) Mental health, including community 

8 mental health services, inpatient mental health 

9 services, dormitory mental health services, 

10 therapeutic and residential treatment centers, 

11 and training of traditional health care practi12 tioners. 

13 ‘‘(E) Emergency medical services. 

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

16 abuse (including fetal alcohol syndrome) among 

17 Indians. 

18 ‘‘(G) Injury prevention programs, includ19 ing data collection and evaluation, demonstra20 tion projects, training, and capacity building. 

21 ‘‘(H) Home health care. 

22 ‘‘(I) Community health representatives. 

23 ‘‘(J) Maintenance and improvement. 

24 ‘‘(b) NO OFFSET OR LIMITATION.—Any funds appro25 priated under the authority of this section shall not be 


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1 used to offset or limit any other appropriations made to 

2 the Service under this Act or the Act of November 2, 1921 

3 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

4 or any other provision of law. 

5 ‘‘(c) ALLOCATION; USE.— 

6 ‘‘(1) IN GENERAL.—Funds appropriated under 

7 the authority of this section shall be allocated to 

8 Service Units, Indian Tribes, or Tribal Organiza9 tions. The funds allocated to each Indian Tribe, 

10 Tribal Organization, or Service Unit under this 

11 paragraph shall be used by the Indian Tribe, Tribal 

12 Organization, or Service Unit under this paragraph 

13 to improve the health status and reduce the resource 

14 deficiency of each Indian Tribe served by such Serv15 ice Unit, Indian Tribe, or Tribal Organization. 

16 ‘‘(2) APPORTIONMENT OF ALLOCATED

17 FUNDS.—The apportionment of funds allocated to a 

18 Service Unit, Indian Tribe, or Tribal Organization 

19 under paragraph (1) among the health service re20 sponsibilities described in subsection (a)(5) shall be 

21 determined by the Service in consultation with, and 

22 with the active participation of, the affected Indian 

23 Tribes and Tribal Organizations. 


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1 ‘‘(d) PROVISIONS RELATING TO HEALTH STATUS

2 AND RESOURCE DEFICIENCIES.—For the purposes of this 

3 section, the following definitions apply: 

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

5 and resource deficiency’ means the extent to 

6 which— 

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

8 in section 3(2) are not being achieved; and 

9 ‘‘(B) the Indian Tribe or Tribal Organiza10 tion does not have available to it the health re11 sources it needs, taking into account the actual 

12 cost of providing health care services given local 

13 geographic, climatic, rural, or other cir14 cumstances. 

15 ‘‘(2) AVAILABLE RESOURCES.—The health re16 sources available to an Indian Tribe or Tribal Orga17 nization include health resources provided by the 

18 Service as well as health resources used by the In19 dian Tribe or Tribal Organization, including services 

20 and financing systems provided by any Federal pro21 grams, private insurance, and programs of State or 

22 local governments. 

23 ‘‘(3) PROCESS FOR REVIEW OF DETERMINA24 TIONS.—The Secretary shall establish procedures 

25 which allow any Indian Tribe or Tribal Organization 


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1 to petition the Secretary for a review of any deter2 mination of the extent of the health status and re3 source deficiency of such Indian Tribe or Tribal Or4 ganization. 

5 ‘‘(e) ELIGIBILITY FOR FUNDS.—Tribal Health Pro6 grams shall be eligible for funds appropriated under the 

7 authority of this section on an equal basis with programs 

8 that are administered directly by the Service. 

9 ‘‘(f) REPORT.—By no later than the date that is 3 

10 years after the date of enactment of the Indian Health 

11 Care Improvement Act Amendments of 2007, the Sec12 retary shall submit to Congress the current health status 

13 and resource deficiency report of the Service for each 

14 Service Unit, including newly recognized or acknowledged 

15 Indian Tribes. Such report shall set out— 

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

17 for determining Tribal health status and resource 

18 deficiencies, as well as the most recent application of 

19 that methodology; 

20 ‘‘(2) the extent of the health status and re21 source deficiency of each Indian Tribe served by the 

22 Service or a Tribal Health Program; 

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

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1 dian Tribes served by the Service or a Tribal Health 

2 Program; and 

3 ‘‘(4) an estimate of— 

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

5 appropriated under the authority of this Act, or 

6 any other Act, including the amount of any 

7 funds transferred to the Service for the pre8 ceding fiscal year which is allocated to each 

9 Service Unit, Indian Tribe, or Tribal Organiza10 tion; 

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

12 health services in each Service Unit or Indian 

13 Tribe or Tribal Organization; and 

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

15 Service resources made available to each Service 

16 Unit, Indian Tribe or Tribal Organization, and, 

17 to the extent available, information on the wait18 ing lists and number of Indians turned away for 

19 services due to lack of resources. 

20 ‘‘(g) INCLUSION IN BASE BUDGET.—Funds appro21 priated under this section for any fiscal year shall be in22 cluded in the base budget of the Service for the purpose 

23 of determining appropriations under this section in subse24 quent fiscal years. 


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1 ‘‘(h) CLARIFICATION.—Nothing in this section is in2 tended to diminish the primary responsibility of the Serv3 ice to eliminate existing backlogs in unmet health care 

4 needs, nor are the provisions of this section intended to 

5 discourage the Service from undertaking additional efforts 

6 to achieve equity among Indian Tribes and Tribal Organi7 zations. 

8 ‘‘(i) FUNDING DESIGNATION.—Any funds appro9 priated under the authority of this section shall be des10 ignated as the ‘Indian Health Care Improvement Fund’. 

11 ‘‘SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. 

12 ‘‘(a) ESTABLISHMENT.—There is established an In13 dian Catastrophic Health Emergency Fund (hereafter in 

14 this section referred to as the ‘CHEF’) consisting of— 

15 ‘‘(1) the amounts deposited under subsection 

16 (f); and 

17 ‘‘(2) the amounts appropriated to CHEF under 

18 this section. 

19 ‘‘(b) ADMINISTRATION.—CHEF shall be adminis20 tered by the Secretary, acting through the headquarters 

21 of the Service, solely for the purpose of meeting the ex22 traordinary medical costs associated with the treatment of 

23 victims of disasters or catastrophic illnesses who are with24 in the responsibility of the Service. 


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1 ‘‘(c) CONDITIONS ON USE OF FUND.—No part of 

2 CHEF or its administration shall be subject to contract 

3 or grant under any law, including the Indian Self-Deter4 mination and Education Assistance Act (25 U.S.C. 450 

5 et seq.), nor shall CHEF funds be allocated, apportioned, 

6 or delegated on an Area Office, Service Unit, or other 

7 similar basis. 

8 ‘‘(d) REGULATIONS.—The Secretary shall promul9 gate regulations consistent with the provisions of this sec10 tion to— 

11 ‘‘(1) establish a definition of disasters and cata12 strophic illnesses for which the cost of the treatment 

13 provided under contract would qualify for payment 

14 from CHEF; 

15 ‘‘(2) provide that a Service Unit shall not be el16 igible for reimbursement for the cost of treatment 

17 from CHEF until its cost of treating any victim of 

18 such catastrophic illness or disaster has reached a 

19 certain threshold cost which the Secretary shall es20 tablish at— 

21 ‘‘(A) the 2000 level of $19,000; and 

22 ‘‘(B) for any subsequent year, not less 

23 than the threshold cost of the previous year in24 creased by the percentage increase in the med25 ical care expenditure category of the consumer 


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1 price index for all urban consumers (United 

2 States city average) for the 12-month period 

3 ending with December of the previous year; 

4 ‘‘(3) establish a procedure for the reimburse5 ment of the portion of the costs that exceeds such 

6 threshold cost incurred by— 

7 ‘‘(A) Service Units; or 

8 ‘‘(B) whenever otherwise authorized by the 

9 Service, non-Service facilities or providers; 

10 ‘‘(4) establish a procedure for payment from 

11 CHEF in cases in which the exigencies of the med12 ical circumstances warrant treatment prior to the 

13 authorization of such treatment by the Service; and 

14 ‘‘(5) establish a procedure that will ensure that 

15 no payment shall be made from CHEF to any pro16 vider of treatment to the extent that such provider 

17 is eligible to receive payment for the treatment from 

18 any other Federal, State, local, or private source of 

19 reimbursement for which the patient is eligible. 

20 ‘‘(e) NO OFFSET OR LIMITATION.—Amounts appro21 priated to CHEF under this section shall not be used to 

22 offset or limit appropriations made to the Service under 

23 the authority of the Act of November 2, 1921 (25 U.S.C. 

24 13) (commonly known as the ‘Snyder Act’), or any other 

25 law. 


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1 ‘‘(f) DEPOSIT OF REIMBURSEMENT FUNDS.—There 

2 shall be deposited into CHEF all reimbursements to which 

3 the Service is entitled from any Federal, State, local, or 

4 private source (including third party insurance) by reason 

5 of treatment rendered to any victim of a disaster or cata6 strophic illness the cost of which was paid from CHEF. 

7 ‘‘SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION 

8 SERVICES. 

9 ‘‘(a) FINDINGS.—Congress finds that health pro10 motion and disease prevention activities— 

11 ‘‘(1) improve the health and well-being of Indi12 ans; and 

13 ‘‘(2) reduce the expenses for health care of In14 dians. 

15 ‘‘(b) PROVISION OF SERVICES.—The Secretary, act16 ing through the Service and Tribal Health Programs, shall 

17 provide health promotion and disease prevention services 

18 to Indians to achieve the health status objectives set forth 

19 in section 3(2). 

20 ‘‘(c) EVALUATION.—The Secretary, after obtaining 

21 input from the affected Tribal Health Programs, shall 

22 submit to the President for inclusion in the report which 

23 is required to be submitted to Congress under section 801 

24 an evaluation of— 


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1 ‘‘(1) the health promotion and disease preven2 tion needs of Indians; 

3 ‘‘(2) the health promotion and disease preven4 tion activities which would best meet such needs; 

5 ‘‘(3) the internal capacity of the Service and 

6 Tribal Health Programs to meet such needs; and 

7 ‘‘(4) the resources which would be required to 

8 enable the Service and Tribal Health Programs to 

9 undertake the health promotion and disease preven10 tion activities necessary to meet such needs. 

11 ‘‘SEC. 204. DIABETES PREVENTION, TREATMENT, AND CON12 TROL. 

13 ‘‘(a) DETERMINATIONS REGARDING DIABETES.— 

14 The Secretary, acting through the Service, and in con15 sultation with Indian Tribes and Tribal Organizations, 

16 shall determine— 

17 ‘‘(1) by Indian Tribe and by Service Unit, the 

18 incidence of, and the types of complications resulting 

19 from, diabetes among Indians; and 

20 ‘‘(2) based on the determinations made pursu21 ant to paragraph (1), the measures (including pa22 tient education and effective ongoing monitoring of 

23 disease indicators) each Service Unit should take to 

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1 trol the complications resulting from, diabetes 

2 among Indian Tribes within that Service Unit. 

3 ‘‘(b) DIABETES SCREENING.—To the extent medi4 cally indicated and with informed consent, the Secretary 

5 shall screen each Indian who receives services from the 

6 Service for diabetes and for conditions which indicate a 

7 high risk that the individual will become diabetic and es8 tablish a cost-effective approach to ensure ongoing moni9 toring of disease indicators. Such screening and moni10 toring may be conducted by a Tribal Health Program and 

11 may be conducted through appropriate Internet-based 

12 health care management programs. 

13 ‘‘(c) DIABETES PROJECTS.—The Secretary shall con14 tinue to maintain each model diabetes project in existence 

15 on the date of enactment of the Indian Health Care Im16 provement Act Amendments of 2007, any such other dia17 betes programs operated by the Service or Tribal Health 

18 Programs, and any additional diabetes projects, such as 

19 the Medical Vanguard program provided for in title IV 

20 of Public Law 108–87, as implemented to serve Indian 

21 Tribes. Tribal Health Programs shall receive recurring 

22 funding for the diabetes projects that they operate pursu23 ant to this section, both at the date of enactment of the 

24 Indian Health Care Improvement Act Amendments of 


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1 2007 and for projects which are added and funded there2 after. 

3 ‘‘(d) DIALYSIS PROGRAMS.—The Secretary is author4 ized to provide, through the Service, Indian Tribes, and 

5 Tribal Organizations, dialysis programs, including the 

6 purchase of dialysis equipment and the provision of nec7 essary staffing. 

8 ‘‘(e) OTHER DUTIES OF THE SECRETARY.— 

9 ‘‘(1) IN GENERAL.—The Secretary shall, to the 

10 extent funding is available— 

11 ‘‘(A) in each Area Office, consult with In12 dian Tribes and Tribal Organizations regarding 

13 programs for the prevention, treatment, and 

14 control of diabetes; 

15 ‘‘(B) establish in each Area Office a reg16 istry of patients with diabetes to track the inci17 dence of diabetes and the complications from 

18 diabetes in that area; and 

19 ‘‘(C) ensure that data collected in each 

20 Area Office regarding diabetes and related com21 plications among Indians are disseminated to 

22 all other Area Offices, subject to applicable pa23 tient privacy laws. 

24 ‘‘(2) DIABETES CONTROL OFFICERS.— 


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1 ‘‘(A) IN GENERAL.—The Secretary may es2 tablish and maintain in each Area Office a posi3 tion of diabetes control officer to coordinate and 

4 manage any activity of that Area Office relating 

5 to the prevention, treatment, or control of dia6 betes to assist the Secretary in carrying out a 

7 program under this section or section 330C of 

8 the Public Health Service Act (42 U.S.C. 254c– 

9 3). 

10 ‘‘(B) CERTAIN ACTIVITIES.—Any activity 

11 carried out by a diabetes control officer under 

12 subparagraph (A) that is the subject of a con13 tract or compact under the Indian Self-Deter14 mination and Education Assistance Act (25 

15 U.S.C. 450 et seq.), and any funds made avail16 able to carry out such an activity, shall not be 

17 divisible for purposes of that Act. 

18 ‘‘SEC. 205. SHARED SERVICES FOR LONG-TERM CARE. 

19 ‘‘(a) LONG-TERM CARE.—Notwithstanding any other 

20 provision of law, the Secretary, acting through the Service, 

21 is authorized to provide directly, or enter into contracts 

22 or compacts under the Indian Self-Determination and 

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

24 Indian Tribes or Tribal Organizations for, the delivery of 

25 long-term care (including health care services associated 


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1 with long-term care) provided in a facility to Indians. Such 

2 agreements shall provide for the sharing of staff or other 

3 services between the Service or a Tribal Health Program 

4 and a long-term care or related facility owned and oper5 ated (directly or through a contract or compact under the 

6 Indian Self-Determination and Education Assistance Act 

7 (25 U.S.C. 450 et seq.)) by such Indian Tribe or Tribal 

8 Organization. 

9 ‘‘(b) CONTENTS OF AGREEMENTS.—An agreement 

10 entered into pursuant to subsection (a)— 

11 ‘‘(1) may, at the request of the Indian Tribe or 

12 Tribal Organization, delegate to such Indian Tribe 

13 or Tribal Organization such powers of supervision 

14 and control over Service employees as the Secretary 

15 deems necessary to carry out the purposes of this 

16 section; 

17 ‘‘(2) shall provide that expenses (including sala18 ries) relating to services that are shared between the 

19 Service and the Tribal Health Program be allocated 

20 proportionately between the Service and the Indian 

21 Tribe or Tribal Organization; and 

22 ‘‘(3) may authorize such Indian Tribe or Tribal 

23 Organization to construct, renovate, or expand a 

24 long-term care or other similar facility (including the 


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1 construction of a facility attached to a Service facil2 ity). 

3 ‘‘(c) MINIMUM REQUIREMENT.—Any nursing facility 

4 provided for under this section shall meet the require5 ments for nursing facilities under section 1919 of the So6 cial Security Act. 

7 ‘‘(d) OTHER ASSISTANCE.—The Secretary shall pro8 vide such technical and other assistance as may be nec9 essary to enable applicants to comply with the provisions 

10 of this section. 

11 ‘‘(e) USE OF EXISTING OR UNDERUSED FACILI12 TIES.—The Secretary shall encourage the use of existing 

13 facilities that are underused or allow the use of swing beds 

14 for long-term or similar care. 

15 ‘‘SEC. 206. HEALTH SERVICES RESEARCH. 

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

17 the Service, shall make funding available for research to 

18 further the performance of the health service responsibil19 ities of Indian Health Programs. 

20 ‘‘(b) COORDINATION OF RESOURCES AND ACTIVI21 TIES.—The Secretary shall also, to the maximum extent 

22 practicable, coordinate departmental research resources 

23 and activities to address relevant Indian Health Program 

24 research needs. 


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1 ‘‘(c) AVAILABILITY.—Tribal Health Programs shall 

2 be given an equal opportunity to compete for, and receive, 

3 research funds under this section. 

4 ‘‘(d) USE OF FUNDS.—This funding may be used for 

5 both clinical and nonclinical research. 

6 ‘‘(e) EVALUATION AND DISSEMINATION.—The Sec7 retary shall periodically— 

8 ‘‘(1) evaluate the impact of research conducted 

9 under this section; and 

10 ‘‘(2) disseminate to Tribal Health Programs in11 formation regarding that research as the Secretary 

12 determines to be appropriate. 

13 ‘‘SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREEN14 ING. 

15 ‘‘The Secretary, acting through the Service or Tribal 

16 Health Programs, shall provide for screening as follows: 

17 ‘‘(1) Screening mammography (as defined in 

18 section 1861(jj) of the Social Security Act) for In19 dian women at a frequency appropriate to such 

20 women under accepted and appropriate national 

21 standards, and under such terms and conditions as 

22 are consistent with standards established by the Sec23 retary to ensure the safety and accuracy of screen24 ing mammography under part B of title XVIII of 

25 such Act. 


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1 ‘‘(2) Other cancer screening that receives an A 

2 or B rating as recommended by the United States 

3 Preventive Services Task Force established under 

4 section 915(a)(1) of the Public Health Service Act 

5 (42 U.S.C. 299b–4(a)(1)). The Secretary shall en6 sure that screening provided for under this para7 graph complies with the recommendations of the 

8 Task Force with respect to— 

9 ‘‘(A) frequency; 

10 ‘‘(B) the population to be served; 

11 ‘‘(C) the procedure or technology to be 

12 used; 

13 ‘‘(D) evidence of effectiveness; and 

14 ‘‘(E) other matters that the Secretary de15 termines appropriate. 

16 ‘‘SEC. 208. PATIENT TRAVEL COSTS. 

17 ‘‘(a) DEFINITION OF QUALIFIED ESCORT.—In this 

18 section, the term ‘qualified escort’ means— 

19 ‘‘(1) an adult escort (including a parent, guard20 ian, or other family member) who is required be21 cause of the physical or mental condition, or age, of 

22 the applicable patient; 

23 ‘‘(2) a health professional for the purpose of 

24 providing necessary medical care during travel by 

25 the applicable patient; or 


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1 ‘‘(3) other escorts, as the Secretary or applica2 ble Indian Health Program determines to be appro3 priate. 

4 ‘‘(b) PROVISION OF FUNDS.—The Secretary, acting 

5 through the Service and Tribal Health Programs, is au6 thorized to provide funds for the following patient travel 

7 costs, including qualified escorts, associated with receiving 

8 health care services provided (either through direct or con9 tract care or through a contract or compact under the In10 dian Self-Determination and Education Assistance Act 

11 (25 U.S.C. 450 et seq.)) under this Act— 

12 ‘‘(1) emergency air transportation and non13 emergency air transportation where ground trans14 portation is infeasible; 

15 ‘‘(2) transportation by private vehicle (where no 

16 other means of transportation is available), specially 

17 equipped vehicle, and ambulance; and 

18 ‘‘(3) transportation by such other means as 

19 may be available and required when air or motor ve20 hicle transportation is not available. 

21 ‘‘SEC. 209. EPIDEMIOLOGY CENTERS. 

22 ‘‘(a) ESTABLISHMENT OF CENTERS.—The Secretary 

23 shall establish an epidemiology center in each Service Area 

24 to carry out the functions described in subsection (b). Any 

25 new center established after the date of enactment of the 


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1 Indian Health Care Improvement Act Amendments of 

2 2007 may be operated under a grant authorized by sub3 section (d), but funding under such a grant shall not be 

4 divisible. 

5 ‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 

6 and upon the request of Indian Tribes, Tribal Organiza7 tions, and Urban Indian Organizations, each Service Area 

8 epidemiology center established under this section shall, 

9 with respect to such Service Area— 

10 ‘‘(1) collect data relating to, and monitor 

11 progress made toward meeting, each of the health 

12 status objectives of the Service, the Indian Tribes, 

13 Tribal Organizations, and Urban Indian Organiza14 tions in the Service Area; 

15 ‘‘(2) evaluate existing delivery systems, data 

16 systems, and other systems that impact the improve17 ment of Indian health; 

18 ‘‘(3) assist Indian Tribes, Tribal Organizations, 

19 and Urban Indian Organizations in identifying their 

20 highest priority health status objectives and the 

21 services needed to achieve such objectives, based on 

22 epidemiological data; 

23 ‘‘(4) make recommendations for the targeting 

24 of services needed by the populations served; 


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1 ‘‘(5) make recommendations to improve health 

2 care delivery systems for Indians and Urban Indi3 ans; 

4 ‘‘(6) provide requested technical assistance to 

5 Indian Tribes, Tribal Organizations, and Urban In6 dian Organizations in the development of local 

7 health service priorities and incidence and prevalence 

8 rates of disease and other illness in the community; 

9 and 

10 ‘‘(7) provide disease surveillance and assist In11 dian Tribes, Tribal Organizations, and Urban Indian 

12 Organizations to promote public health. 

13 ‘‘(c) TECHNICAL ASSISTANCE.—The Director of the 

14 Centers for Disease Control and Prevention shall provide 

15 technical assistance to the centers in carrying out the re16 quirements of this section. 

17 ‘‘(d) GRANTS FOR STUDIES.— 

18 ‘‘(1) IN GENERAL.—The Secretary may make 

19 grants to Indian Tribes, Tribal Organizations, 

20 Urban Indian Organizations, and eligible intertribal 

21 consortia to conduct epidemiological studies of In22 dian communities. 

23 ‘‘(2) ELIGIBLE INTERTRIBAL CONSORTIA.—An 

24 intertribal consortium is eligible to receive a grant 

25 under this subsection if— 


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1 ‘‘(A) the intertribal consortium is incor2 porated for the primary purpose of improving 

3 Indian health; and 

4 ‘‘(B) the intertribal consortium is rep5 resentative of the Indian Tribes or urban In6 dian communities in which the intertribal con7 sortium is located. 

8 ‘‘(3) APPLICATIONS.—An application for a 

9 grant under this subsection shall be submitted in 

10 such manner and at such time as the Secretary shall 

11 prescribe. 

12 ‘‘(4) REQUIREMENTS.—An applicant for a 

13 grant under this subsection shall— 

14 ‘‘(A) demonstrate the technical, adminis15 trative, and financial expertise necessary to 

16 carry out the functions described in paragraph 

17 (5); 

18 ‘‘(B) consult and cooperate with providers 

19 of related health and social services in order to 

20 avoid duplication of existing services; and 

21 ‘‘(C) demonstrate cooperation from Indian 

22 Tribes or Urban Indian Organizations in the 

23 area to be served. 

24 ‘‘(5) USE OF FUNDS.—A grant awarded under 

25 paragraph (1) may be used— 


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1 ‘‘(A) to carry out the functions described 

2 in subsection (b); 

3 ‘‘(B) to provide information to and consult 

4 with tribal leaders, urban Indian community 

5 leaders, and related health staff on health care 

6 and health service management issues; and 

7 ‘‘(C) in collaboration with Indian Tribes, 

8 Tribal Organizations, and urban Indian com9 munities, to provide the Service with informa10 tion regarding ways to improve the health sta11 tus of Indians. 

12 ‘‘(e) ACCESS TO INFORMATION.—An epidemiology 

13 center operated by a grantee pursuant to a grant awarded 

14 under subsection (d) shall be treated as a public health 

15 authority for purposes of the Health Insurance Portability 

16 and Accountability Act of 1996 (Public Law 104–191; 110 

17 Stat. 2033), as such entities are defined in part 164.501 

18 of title 45, Code of Federal Regulations (or a successor 

19 regulation). The Secretary shall grant such grantees ac20 cess to and use of data, data sets, monitoring systems, 

21 delivery systems, and other protected health information 

22 in the possession of the Secretary. 


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1 ‘‘SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION 

2 PROGRAMS. 

3 ‘‘(a) FUNDING FOR DEVELOPMENT OF PROGRAMS.— 

4 In addition to carrying out any other program for health 

5 promotion or disease prevention, the Secretary, acting 

6 through the Service, is authorized to award grants to In7 dian Tribes, Tribal Organizations, and Urban Indian Or8 ganizations to develop comprehensive school health edu9 cation programs for children from pre-school through 

10 grade 12 in schools for the benefit of Indian and Urban 

11 Indian children. 

12 ‘‘(b) USE OF GRANT FUNDS.—A grant awarded 

13 under this section may be used for purposes which may 

14 include, but are not limited to, the following: 

15 ‘‘(1) Developing health education materials both 

16 for regular school programs and afterschool pro17 grams. 

18 ‘‘(2) Training teachers in comprehensive school 

19 health education materials. 

20 ‘‘(3) Integrating school-based, community21 based, and other public and private health promotion 

22 efforts. 

23 ‘‘(4) Encouraging healthy, tobacco-free school 

24 environments. 


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1 ‘‘(5) Coordinating school-based health programs 

2 with existing services and programs available in the 

3 community. 

4 ‘‘(6) Developing school programs on nutrition 

5 education, personal health, oral health, and fitness. 

6 ‘‘(7) Developing behavioral health wellness pro7 grams. 

8 ‘‘(8) Developing chronic disease prevention pro9 grams. 

10 ‘‘(9) Developing substance abuse prevention 

11 programs. 

12 ‘‘(10) Developing injury prevention and safety 

13 education programs. 

14 ‘‘(11) Developing activities for the prevention 

15 and control of communicable diseases. 

16 ‘‘(12) Developing community and environmental 

17 health education programs that include traditional 

18 health care practitioners. 

19 ‘‘(13) Violence prevention. 

20 ‘‘(14) Such other health issues as are appro21 priate. 

22 ‘‘(c) TECHNICAL ASSISTANCE.—Upon request, the 

23 Secretary, acting through the Service, shall provide tech24 nical assistance to Indian Tribes, Tribal Organizations, 

25 and Urban Indian Organizations in the development of 


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1 comprehensive health education plans and the dissemina2 tion of comprehensive health education materials and in3 formation on existing health programs and resources. 

4 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP5 PLICATIONS.—The Secretary, acting through the Service, 

6 and in consultation with Indian Tribes, Tribal Organiza7 tions, and Urban Indian Organizations, shall establish cri8 teria for the review and approval of applications for grants 

9 awarded under this section. 

10 ‘‘(e) DEVELOPMENT OF PROGRAM FOR BIA-FUNDED

11 SCHOOLS.— 

12 ‘‘(1) IN GENERAL.—The Secretary of the Inte13 rior, acting through the Bureau of Indian Affairs 

14 and in cooperation with the Secretary, acting 

15 through the Service, and affected Indian Tribes and 

16 Tribal Organizations, shall develop a comprehensive 

17 school health education program for children from 

18 preschool through grade 12 in schools for which sup19 port is provided by the Bureau of Indian Affairs. 

20 ‘‘(2) REQUIREMENTS FOR PROGRAMS.—Such 

21 programs shall include— 

22 ‘‘(A) school programs on nutrition edu23 cation, personal health, oral health, and fitness; 

24 ‘‘(B) behavioral health wellness programs; 

25 ‘‘(C) chronic disease prevention programs; 


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1 ‘‘(D) substance abuse prevention pro2 grams; 

3 ‘‘(E) injury prevention and safety edu4 cation programs; and 

5 ‘‘(F) activities for the prevention and con6 trol of communicable diseases. 

7 ‘‘(3) DUTIES OF THE SECRETARY.—The Sec8 retary of the Interior shall— 

9 ‘‘(A) provide training to teachers in com10 prehensive school health education materials; 

11 ‘‘(B) ensure the integration and coordina12 tion of school-based programs with existing 

13 services and health programs available in the 

14 community; and 

15 ‘‘(C) encourage healthy, tobacco-free school 

16 environments. 

17 ‘‘SEC. 211. INDIAN YOUTH PROGRAM. 

18 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 

19 through the Service, is authorized to establish and admin20 ister a program to provide grants to Indian Tribes, Tribal 

21 Organizations, and Urban Indian Organizations for inno22 vative mental and physical disease prevention and health 

23 promotion and treatment programs for Indian and Urban 

24 Indian preadolescent and adolescent youths. 

25 ‘‘(b) USE OF FUNDS.— 


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1 ‘‘(1) ALLOWABLE USES.—Funds made available 

2 under this section may be used to— 

3 ‘‘(A) develop prevention and treatment 

4 programs for Indian youth which promote men5 tal and physical health and incorporate cultural 

6 values, community and family involvement, and 

7 traditional health care practitioners; and 

8 ‘‘(B) develop and provide community train9 ing and education. 

10 ‘‘(2) PROHIBITED USE.—Funds made available 

11 under this section may not be used to provide serv12 ices described in section 707(c). 

13 ‘‘(c) DUTIES OF THE SECRETARY.—The Secretary 

14 shall— 

15 ‘‘(1) disseminate to Indian Tribes, Tribal Orga16 nizations, and Urban Indian Organizations informa17 tion regarding models for the delivery of comprehen18 sive health care services to Indian and Urban Indian 

19 adolescents; 

20 ‘‘(2) encourage the implementation of such 

21 models; and 

22 ‘‘(3) at the request of an Indian Tribe, Tribal 

23 Organization, or Urban Indian Organization, provide 

24 technical assistance in the implementation of such 

25 models. 


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1 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP2 PLICATIONS.—The Secretary, in consultation with Indian 

3 Tribes, Tribal Organizations, and Urban Indian Organiza4 tions, shall establish criteria for the review and approval 

5 of applications or proposals under this section. 

6 ‘‘SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF 

7 COMMUNICABLE AND INFECTIOUS DISEASES. 

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

9 through the Service, and after consultation with the Cen10 ters for Disease Control and Prevention, may make grants 

11 available to Indian Tribes, Tribal Organizations, and 

12 Urban Indian Organizations for the following: 

13 ‘‘(1) Projects for the prevention, control, and 

14 elimination of communicable and infectious diseases, 

15 including tuberculosis, hepatitis, HIV, respiratory 

16 syncytial virus, hanta virus, sexually transmitted dis17 eases, and H. Pylori. 

18 ‘‘(2) Public information and education pro19 grams for the prevention, control, and elimination of 

20 communicable and infectious diseases. 

21 ‘‘(3) Education, training, and clinical skills im22 provement activities in the prevention, control, and 

23 elimination of communicable and infectious diseases 

24 for health professionals, including allied health pro25 fessionals. 


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1 ‘‘(4) Demonstration projects for the screening, 

2 treatment, and prevention of hepatitis C virus 

3 (HCV). 

4 ‘‘(b) APPLICATION REQUIRED.—The Secretary may 

5 provide funding under subsection (a) only if an application 

6 or proposal for funding is submitted to the Secretary. 

7 ‘‘(c) COORDINATION WITH HEALTH AGENCIES.—In8 dian Tribes, Tribal Organizations, and Urban Indian Or9 ganizations receiving funding under this section are en10 couraged to coordinate their activities with the Centers for 

11 Disease Control and Prevention and State and local health 

12 agencies. 

13 ‘‘(d) TECHNICAL ASSISTANCE; REPORT.—In carrying 

14 out this section, the Secretary— 

15 ‘‘(1) may, at the request of an Indian Tribe, 

16 Tribal Organization, or Urban Indian Organization, 

17 provide technical assistance; and 

18 ‘‘(2) shall prepare and submit a report to Con19 gress biennially on the use of funds under this sec20 tion and on the progress made toward the preven21 tion, control, and elimination of communicable and 

22 infectious diseases among Indians and Urban Indi23 ans. 


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1 ‘‘SEC. 213. OTHER AUTHORITY FOR PROVISION OF SERV2 ICES. 

3 ‘‘(a) FUNDING AUTHORIZED.—The Secretary, acting 

4 through the Service, Indian Tribes, and Tribal Organiza5 tions, may provide funding under this Act to meet the ob6 jectives set forth in section 3 of this Act through health 

7 care-related services and programs not otherwise described 

8 in this Act, including— 

9 ‘‘(1) hospice care; 

10 ‘‘(2) assisted living; 

11 ‘‘(3) long-term care; and 

12 ‘‘(4) home- and community-based services. 

13 ‘‘(b) TERMS AND CONDITIONS.— 

14 ‘‘(1) IN GENERAL.—Any service provided under 

15 this section shall be in accordance with such terms 

16 and conditions as are consistent with accepted and 

17 appropriate standards relating to the service, includ18 ing any licensing term or condition under this Act. 

19 ‘‘(2) STANDARDS.— 

20 ‘‘(A) IN GENERAL.—The Secretary may es21 tablish, by regulation, the standards for a serv22 ice provided under this section, provided that 

23 such standards shall not be more stringent than 

24 the standards required by the State in which 

25 the service is provided. 


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1 ‘‘(B) USE OF STATE STANDARDS.—If the 

2 Secretary does not, by regulation, establish 

3 standards for a service provided under this sec4 tion, the standards required by the State in 

5 which the service is or will be provided shall 

6 apply to such service. 

7 ‘‘(C) INDIAN TRIBES.—If a service under 

8 this section is provided by an Indian Tribe or 

9 Tribal Organization pursuant to the Indian 

10 Self-Determination and Education Assistance 

11 Act (25 U.S.C. 450 et seq.), the verification by 

12 the Secretary that the service meets any stand13 ards required by the State in which the service 

14 is or will be provided shall be considered to 

15 meet the terms and conditions required under 

16 this subsection. 

17 ‘‘(3) ELIGIBILITY.—The following individuals 

18 shall be eligible to receive long-term care under this 

19 section: 

20 ‘‘(A) Individuals who are unable to per21 form a certain number of activities of daily liv22 ing without assistance. 

23 ‘‘(B) Individuals with a mental impair24 ment, such as dementia, Alzheimer’s disease, or 

25 another disabling mental illness, who may be 


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1 able to perform activities of daily living under 

2 supervision. 

3 ‘‘(C) Such other individuals as an applica4 ble Indian Health Program determines to be 

5 appropriate. 

6 ‘‘(c) DEFINITIONS.—For the purposes of this section, 

7 the following definitions shall apply: 

8 ‘‘(1) The term ‘home- and community-based 

9 services’ means 1 or more of the services specified 

10 in paragraphs (1) through (9) of section 1929(a) of 

11 the Social Security Act (42 U.S.C. 1396t(a)) 

12 (whether provided by the Service or by an Indian 

13 Tribe or Tribal Organization pursuant to the Indian 

14 Self-Determination and Education Assistance Act 

15 (25 U.S.C. 450 et seq.)) that are or will be provided 

16 in accordance with the standards described in sub17 section (b). 

18 ‘‘(2) The term ‘hospice care’ means the items 

19 and services specified in subparagraphs (A) through 

20 (H) of section 1861(dd)(1) of the Social Security 

21 Act (42 U.S.C. 1395x(dd)(1)), and such other serv22 ices which an Indian Tribe or Tribal Organization 

23 determines are necessary and appropriate to provide 

24 in furtherance of this care. 


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1 ‘‘(d) AUTHORIZATION OF CONVENIENT CARE SERV2 ICES.—The Secretary, acting through the Service, Indian 

3 Tribes, and Tribal Organizations, may also provide fund4 ing under this Act to meet the objectives set forth in sec5 tion 3 of this Act for convenient care services programs 

6 pursuant to section 306(c)(2)(A). 

7 ‘‘SEC. 214. INDIAN WOMEN’S HEALTH CARE. 

8 ‘‘The Secretary, acting through the Service and In9 dian Tribes, Tribal Organizations, and Urban Indian Or10 ganizations, shall monitor and improve the quality of 

11 health care for Indian women of all ages through the plan12 ning and delivery of programs administered by the Service, 

13 in order to improve and enhance the treatment models of 

14 care for Indian women. 

15 ‘‘SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZ16 ARDS. 

17 ‘‘(a) STUDIES AND MONITORING.—The Secretary 

18 and the Service shall conduct, in conjunction with other 

19 appropriate Federal agencies and in consultation with con20 cerned Indian Tribes and Tribal Organizations, studies 

21 and ongoing monitoring programs to determine trends in 

22 the health hazards to Indian miners and to Indians on 

23 or near reservations and Indian communities as a result 

24 of environmental hazards which may result in chronic or 

25 life threatening health problems, such as nuclear resource 


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1 development, petroleum contamination, and contamination 

2 of water source and of the food chain. Such studies shall 

3 include— 

4 ‘‘(1) an evaluation of the nature and extent of 

5 health problems caused by environmental hazards 

6 currently exhibited among Indians and the causes of 

7 such health problems; 

8 ‘‘(2) an analysis of the potential effect of ongo9 ing and future environmental resource development 

10 on or near reservations and Indian communities, in11 cluding the cumulative effect over time on health; 

12 ‘‘(3) an evaluation of the types and nature of 

13 activities, practices, and conditions causing or affect14 ing such health problems, including uranium mining 

15 and milling, uranium mine tailing deposits, nuclear 

16 power plant operation and construction, and nuclear 

17 waste disposal; oil and gas production or transpor18 tation on or near reservations or Indian commu19 nities; and other development that could affect the 

20 health of Indians and their water supply and food 

21 chain; 

22 ‘‘(4) a summary of any findings and rec23 ommendations provided in Federal and State stud24 ies, reports, investigations, and inspections during 

25 the 5 years prior to the date of enactment of the InVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00125 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 dian Health Care Improvement Act Amendments of 

2 2007 that directly or indirectly relate to the activi3 ties, practices, and conditions affecting the health or 

4 safety of such Indians; and 

5 ‘‘(5) the efforts that have been made by Federal 

6 and State agencies and resource and economic devel7 opment companies to effectively carry out an edu8 cation program for such Indians regarding the 

9 health and safety hazards of such development. 

10 ‘‘(b) HEALTH CARE PLANS.—Upon completion of 

11 such studies, the Secretary and the Service shall take into 

12 account the results of such studies and develop health care 

13 plans to address the health problems studied under sub14 section (a). The plans shall include— 

15 ‘‘(1) methods for diagnosing and treating Indi16 ans currently exhibiting such health problems; 

17 ‘‘(2) preventive care and testing for Indians 

18 who may be exposed to such health hazards, includ19 ing the monitoring of the health of individuals who 

20 have or may have been exposed to excessive amounts 

21 of radiation or affected by other activities that have 

22 had or could have a serious impact upon the health 

23 of such individuals; and 

24 ‘‘(3) a program of education for Indians who, 

25 by reason of their work or geographic proximity to 


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1 such nuclear or other development activities, may ex2 perience health problems. 

3 ‘‘(c) SUBMISSION OF REPORT AND PLAN TO CON4 GRESS.—The Secretary and the Service shall submit to 

5 Congress the study prepared under subsection (a) no later 

6 than 18 months after the date of enactment of the Indian 

7 Health Care Improvement Act Amendments of 2007. The 

8 health care plan prepared under subsection (b) shall be 

9 submitted in a report no later than 1 year after the study 

10 prepared under subsection (a) is submitted to Congress. 

11 Such report shall include recommended activities for the 

12 implementation of the plan, as well as an evaluation of 

13 any activities previously undertaken by the Service to ad14 dress such health problems. 

15 ‘‘(d) INTERGOVERNMENTAL TASK FORCE.— 

16 ‘‘(1) ESTABLISHMENT; MEMBERS.—There is es17 tablished an Intergovernmental Task Force to be 

18 composed of the following individuals (or their des19 ignees): 

20 ‘‘(A) The Secretary of Energy. 

21 ‘‘(B) The Secretary of the Environmental 

22 Protection Agency. 

23 ‘‘(C) The Director of the Bureau of Mines. 

24 ‘‘(D) The Assistant Secretary for Occupa25 tional Safety and Health. 


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1 ‘‘(E) The Secretary of the Interior. 

2 ‘‘(F) The Secretary of Health and Human 

3 Services. 

4 ‘‘(G) The Assistant Secretary. 

5 ‘‘(2) DUTIES.—The Task Force shall— 

6 ‘‘(A) identify existing and potential oper7 ations related to nuclear resource development 

8 or other environmental hazards that affect or 

9 may affect the health of Indians on or near a 

10 reservation or in an Indian community; and 

11 ‘‘(B) enter into activities to correct exist12 ing health hazards and ensure that current and 

13 future health problems resulting from nuclear 

14 resource or other development activities are 

15 minimized or reduced. 

16 ‘‘(3) CHAIRMAN; MEETINGS.—The Secretary of 

17 Health and Human Services shall be the Chairman 

18 of the Task Force. The Task Force shall meet at 

19 least twice each year. 

20 ‘‘(e) HEALTH SERVICES TO CERTAIN EMPLOYEES.— 

21 In the case of any Indian who— 

22 ‘‘(1) as a result of employment in or near a 

23 uranium mine or mill or near any other environ24 mental hazard, suffers from a work-related illness or 

25 condition; 


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1 ‘‘(2) is eligible to receive diagnosis and treat2 ment services from an Indian Health Program; and 

3 ‘‘(3) by reason of such Indian’s employment, is 

4 entitled to medical care at the expense of such mine 

5 or mill operator or entity responsible for the environ6 mental hazard, the Indian Health Program shall, at 

7 the request of such Indian, render appropriate med8 ical care to such Indian for such illness or condition 

9 and may be reimbursed for any medical care so ren10 dered to which such Indian is entitled at the expense 

11 of such operator or entity from such operator or en12 tity. Nothing in this subsection shall affect the 

13 rights of such Indian to recover damages other than 

14 such amounts paid to the Indian Health Program 

15 from the employer for providing medical care for 

16 such illness or condition. 

17 ‘‘SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DE18 LIVERY AREA. 

19 ‘‘(a) IN GENERAL.—For fiscal years beginning with 

20 the fiscal year ending September 30, 1983, and ending 

21 with the fiscal year ending September 30, 2016, the State 

22 of Arizona shall be designated as a contract health service 

23 delivery area by the Service for the purpose of providing 

24 contract health care services to members of federally rec25 ognized Indian Tribes of Arizona. 


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1 ‘‘(b) MAINTENANCE OF SERVICES.—The Service 

2 shall not curtail any health care services provided to Indi3 ans residing on reservations in the State of Arizona if such 

4 curtailment is due to the provision of contract services in 

5 such State pursuant to the designation of such State as 

6 a contract health service delivery area pursuant to sub7 section (a). 

8 ‘‘SEC. 216A. NORTH DAKOTA AND SOUTH DAKOTA AS CON9 TRACT HEALTH SERVICE DELIVERY AREA. 

10 ‘‘(a) IN GENERAL.—Beginning in fiscal year 2003, 

11 the States of North Dakota and South Dakota shall be 

12 designated as a contract health service delivery area by 

13 the Service for the purpose of providing contract health 

14 care services to members of federally recognized Indian 

15 Tribes of North Dakota and South Dakota. 

16 ‘‘(b) LIMITATION.—The Service shall not curtail any 

17 health care services provided to Indians residing on any 

18 reservation, or in any county that has a common boundary 

19 with any reservation, in the State of North Dakota or 

20 South Dakota if such curtailment is due to the provision 

21 of contract services in such States pursuant to the des22 ignation of such States as a contract health service deliv23 ery area pursuant to subsection (a). 


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1 ‘‘SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES PRO2 GRAM. 

3 ‘‘(a) FUNDING AUTHORIZED.—The Secretary is au4 thorized to fund a program using the California Rural In5 dian Health Board (hereafter in this section referred to 

6 as the ‘CRIHB’) as a contract care intermediary to im7 prove the accessibility of health services to California Indi8 ans. 

9 ‘‘(b) REIMBURSEMENT CONTRACT.—The Secretary 

10 shall enter into an agreement with the CRIHB to reim11 burse the CRIHB for costs (including reasonable adminis12 trative costs) incurred pursuant to this section, in pro13 viding medical treatment under contract to California In14 dians described in section 806(a) throughout the Cali15 fornia contract health services delivery area described in 

16 section 218 with respect to high cost contract care cases. 

17 ‘‘(c) ADMINISTRATIVE EXPENSES.—Not more than 5 

18 percent of the amounts provided to the CRIHB under this 

19 section for any fiscal year may be for reimbursement for 

20 administrative expenses incurred by the CRIHB during 

21 such fiscal year. 

22 ‘‘(d) LIMITATION ON PAYMENT.—No payment may 

23 be made for treatment provided hereunder to the extent 

24 payment may be made for such treatment under the In25 dian Catastrophic Health Emergency Fund described in 

26 section 202 or from amounts appropriated or otherwise 


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1 made available to the California contract health service de2 livery area for a fiscal year. 

3 ‘‘(e) ADVISORY BOARD.—There is established an ad4 visory board which shall advise the CRIHB in carrying 

5 out this section. The advisory board shall be composed of 

6 representatives, selected by the CRIHB, from not less 

7 than 8 Tribal Health Programs serving California Indians 

covered under this section at least 1 8 ⁄2 of whom of whom 

9 are not affiliated with the CRIHB. 

10 ‘‘SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE 

11 DELIVERY AREA. 

12 ‘‘The State of California, excluding the counties of 

13 Alameda, Contra Costa, Los Angeles, Marin, Orange, Sac14 ramento, San Francisco, San Mateo, Santa Clara, Kern, 

15 Merced, Monterey, Napa, San Benito, San Joaquin, San 

16 Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ven17 tura, shall be designated as a contract health service deliv18 ery area by the Service for the purpose of providing con19 tract health services to California Indians. However, any 

20 of the counties listed herein may only be included in the 

21 contract health services delivery area if funding is specifi22 cally provided by the Service for such services in those 

23 counties. 


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1 ‘‘SEC. 219. CONTRACT HEALTH SERVICES FOR THE TREN2 TON SERVICE AREA. 

3 ‘‘(a) AUTHORIZATION FOR SERVICES.—The Sec4 retary, acting through the Service, is directed to provide 

5 contract health services to members of the Turtle Moun6 tain Band of Chippewa Indians that reside in the Trenton 

7 Service Area of Divide, McKenzie, and Williams counties 

8 in the State of North Dakota and the adjoining counties 

9 of Richland, Roosevelt, and Sheridan in the State of Mon10 tana. 

11 ‘‘(b) NO EXPANSION OF ELIGIBILITY.—Nothing in 

12 this section may be construed as expanding the eligibility 

13 of members of the Turtle Mountain Band of Chippewa In14 dians for health services provided by the Service beyond 

15 the scope of eligibility for such health services that applied 

16 on May 1, 1986. 

17 ‘‘SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND 

18 TRIBAL ORGANIZATIONS. 

19 ‘‘The Service shall provide funds for health care pro20 grams and facilities operated by Tribal Health Programs 

21 on the same basis as such funds are provided to programs 

22 and facilities operated directly by the Service. 

23 ‘‘SEC. 221. LICENSING. 

24 ‘‘Health care professionals employed by a Tribal 

25 Health Program shall, if licensed in any State, be exempt 

26 from the licensing requirements of the State in which the 


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1 Tribal Health Program performs the services described in 

2 its contract or compact under the Indian Self-Determina3 tion and Education Assistance Act (25 U.S.C. 450 et 

4 seq.). 

5 ‘‘SEC. 222. NOTIFICATION OF PROVISION OF EMERGENCY 

6 CONTRACT HEALTH SERVICES. 

7 ‘‘With respect to an elderly Indian or an Indian with 

8 a disability receiving emergency medical care or services 

9 from a non-Service provider or in a non-Service facility 

10 under the authority of this Act, the time limitation (as 

11 a condition of payment) for notifying the Service of such 

12 treatment or admission shall be 30 days. 

13 ‘‘SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS. 

14 ‘‘(a) DEADLINE FOR RESPONSE.—The Service shall 

15 respond to a notification of a claim by a provider of a 

16 contract care service with either an individual purchase 

17 order or a denial of the claim within 5 working days after 

18 the receipt of such notification. 

19 ‘‘(b) EFFECT OF UNTIMELY RESPONSE.—If the 

20 Service fails to respond to a notification of a claim in ac21 cordance with subsection (a), the Service shall accept as 

22 valid the claim submitted by the provider of a contract 

23 care service. 


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1 ‘‘(c) DEADLINE FOR PAYMENT OF VALID CLAIM.— 

2 The Service shall pay a valid contract care service claim 

3 within 30 days after the completion of the claim. 

4 ‘‘SEC. 224. LIABILITY FOR PAYMENT. 

5 ‘‘(a) NO PATIENT LIABILITY.—A patient who re6 ceives contract health care services that are authorized by 

7 the Service shall not be liable for the payment of any 

8 charges or costs associated with the provision of such serv9 ices. 

10 ‘‘(b) NOTIFICATION.—The Secretary shall notify a 

11 contract care provider and any patient who receives con12 tract health care services authorized by the Service that 

13 such patient is not liable for the payment of any charges 

14 or costs associated with the provision of such services not 

15 later than 5 business days after receipt of a notification 

16 of a claim by a provider of contract care services. 

17 ‘‘(c) NO RECOURSE.—Following receipt of the notice 

18 provided under subsection (b), or, if a claim has been 

19 deemed accepted under section 223(b), the provider shall 

20 have no further recourse against the patient who received 

21 the services. 

22 ‘‘SEC. 225. OFFICE OF INDIAN MEN’S HEALTH. 

23 ‘‘(a) ESTABLISHMENT.—The Secretary may establish 

24 within the Service an office to be known as the ‘Office 


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1 of Indian Men’s Health’ (referred to in this section as the 

2 ‘Office’). 

3 ‘‘(b) DIRECTOR.— 

4 ‘‘(1) IN GENERAL.—The Office shall be headed 

5 by a director, to be appointed by the Secretary. 

6 ‘‘(2) DUTIES.—The director shall coordinate 

7 and promote the status of the health of Indian men 

8 in the United States. 

9 ‘‘(c) REPORT.—Not later than 2 years after the date 

10 of enactment of the Indian Health Care Improvement Act 

11 Amendments of 2007, the Secretary, acting through the 

12 director of the Office, shall submit to Congress a report 

13 describing— 

14 ‘‘(1) any activity carried out by the director as 

15 of the date on which the report is prepared; and 

16 ‘‘(2) any finding of the director with respect to 

17 the health of Indian men. 

18 ‘‘SEC. 226. AUTHORIZATION OF APPROPRIATIONS. 

19 ‘‘There are 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 III—FACILITIES 

2 ‘‘SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVA3 TION OF FACILITIES; REPORTS. 

4 ‘‘(a) PREREQUISITES FOR EXPENDITURE OF

5 FUNDS.—Prior to the expenditure of, or the making of 

6 any binding commitment to expend, any funds appro7 priated for the planning, design, construction, or renova8 tion of facilities pursuant to the Act of November 2, 1921 

9 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

10 the Secretary, acting through the Service, shall— 

11 ‘‘(1) consult with any Indian Tribe that would 

12 be significantly affected by such expenditure for the 

13 purpose of determining and, whenever practicable, 

14 honoring tribal preferences concerning size, location, 

15 type, and other characteristics of any facility on 

16 which such expenditure is to be made; and 

17 ‘‘(2) ensure, whenever practicable and applica18 ble, that such facility meets the construction stand19 ards of any accrediting body recognized by the Sec20 retary for the purposes of the Medicare, Medicaid, 

21 and SCHIP programs under titles XVIII, XIX, and 

22 XXI of the Social Security Act by not later than 1 

23 year after the date on which the construction or ren24 ovation of such facility is completed. 

25 ‘‘(b) CLOSURES.— 


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1 ‘‘(1) EVALUATION REQUIRED.—Notwith2 standing any other provision of law, no facility oper3 ated by the Service, or any portion of such facility, 

4 may be closed if the Secretary has not submitted to 

5 Congress not less than 1 year, and not more than 

6 2 years, before the date of the proposed closure an 

7 evaluation, completed not more than 2 years before 

8 the submission, of the impact of the proposed clo9 sure that specifies, in addition to other consider10 ations— 

11 ‘‘(A) the accessibility of alternative health 

12 care resources for the population served by such 

13 facility; 

14 ‘‘(B) the cost-effectiveness of such closure; 

15 ‘‘(C) the quality of health care to be pro16 vided to the population served by such facility 

17 after such closure; 

18 ‘‘(D) the availability of contract health 

19 care funds to maintain existing levels of service; 

20 ‘‘(E) the views of the Indian Tribes served 

21 by such facility concerning such closure; 

22 ‘‘(F) the level of use of such facility by all 

23 eligible Indians; and 

24 ‘‘(G) the distance between such facility and 

25 the nearest operating Service hospital. 


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1 ‘‘(2) EXCEPTION FOR CERTAIN TEMPORARY

2 CLOSURES.—Paragraph (1) shall not apply to any 

3 temporary closure of a facility or any portion of a 

4 facility if such closure is necessary for medical, envi5 ronmental, or construction safety reasons. 

6 ‘‘(c) HEALTH CARE FACILITY PRIORITY SYSTEM.— 

7 ‘‘(1) IN GENERAL.— 

8 ‘‘(A) PRIORITY SYSTEM.—The Secretary, 

9 acting through the Service, shall maintain a 

10 health care facility priority system, which— 

11 ‘‘(i) shall be developed in consultation 

12 with Indian Tribes and Tribal Organiza13 tions; 

14 ‘‘(ii) shall give Indian Tribes’ needs 

15 the highest priority; 

16 ‘‘(iii)(I) may include the lists required 

17 in paragraph (2)(B)(ii); and 

18 ‘‘(II) shall include the methodology re19 quired in paragraph (2)(B)(v); and 

20 ‘‘(III) may include such other facili21 ties, and such renovation or expansion 

22 needs of any health care facility, as the 

23 Service, Indian Tribes, and Tribal Organi24 zations may identify; and 


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1 ‘‘(iv) shall provide an opportunity for 

2 the nomination of planning, design, and 

3 construction projects by the Service, In4 dian Tribes, and Tribal Organizations for 

5 consideration under the priority system at 

6 least once every 3 years, or more fre7 quently as the Secretary determines to be 

8 appropriate. 

9 ‘‘(B) NEEDS OF FACILITIES UNDER

10 ISDEAA AGREEMENTS.—The Secretary shall en11 sure that the planning, design, construction, 

12 renovation, and expansion needs of Service and 

13 non-Service facilities operated under contracts 

14 or compacts in accordance with the Indian Self15 Determination and Education Assistance Act 

16 (25 U.S.C. 450 et seq.) are fully and equitably 

17 integrated into the health care facility priority 

18 system. 

19 ‘‘(C) CRITERIA FOR EVALUATING

20 NEEDS.—For purposes of this subsection, the 

21 Secretary, in evaluating the needs of facilities 

22 operated under a contract or compact under the 

23 Indian Self-Determination and Education As24 sistance Act (25 U.S.C. 450 et seq.), shall use 

25 the criteria used by the Secretary in evaluating 


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1 the needs of facilities operated directly by the 

2 Service. 

3 ‘‘(D) PRIORITY OF CERTAIN PROJECTS

4 PROTECTED.—The priority of any project estab5 lished under the construction priority system in 

6 effect on the date of enactment of the Indian 

7 Health Care Improvement Act Amendments of 

8 2007 shall not be affected by any change in the 

9 construction priority system taking place after 

10 that date if the project— 

11 ‘‘(i) was identified in the fiscal year 

12 2008 Service budget justification as— 

13 ‘‘(I) 1 of the 10 top-priority inpa14 tient projects; 

15 ‘‘(II) 1 of the 10 top-priority out16 patient projects; 

17 ‘‘(III) 1 of the 10 top-priority 

18 staff quarters developments; or 

19 ‘‘(IV) 1 of the 10 top-priority 

20 Youth Regional Treatment Centers; 

21 ‘‘(ii) had completed both Phase I and 

22 Phase II of the construction priority sys23 tem in effect on the date of enactment of 

24 such Act; or 


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1 ‘‘(iii) is not included in clause (i) or 

2 (ii) and is selected, as determined by the 

3 Secretary— 

4 ‘‘(I) on the initiative of the Sec5 retary; or 

6 ‘‘(II) pursuant to a request of an 

7 Indian Tribe or Tribal Organization. 

8 ‘‘(2) REPORT; CONTENTS.— 

9 ‘‘(A) INITIAL COMPREHENSIVE REPORT.— 

10 ‘‘(i) DEFINITIONS.—In this subpara11 graph: 

12 ‘‘(I) FACILITIES APPROPRIATION

13 ADVISORY BOARD.—The term ‘Facili14 ties Appropriation Advisory Board’ 

15 means the advisory board, comprised 

16 of 12 members representing Indian 

17 tribes and 2 members representing 

18 the Service, established at the discre19 tion of the Assistant Secretary— 

20 ‘‘(aa) to provide advice and 

21 recommendations for policies and 

22 procedures of the programs fund23 ed pursuant to facilities appro24 priations; and 


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1 ‘‘(bb) to address other facili2 ties issues. 

3 ‘‘(II) FACILITIES NEEDS ASSESS4 MENT WORKGROUP.—The term ‘Fa5 cilities Needs Assessment Workgroup’ 

6 means the workgroup established at 

7 the discretion of the Assistant Sec8 retary— 

9 ‘‘(aa) to review the health 

10 care facilities construction pri11 ority system; and 

12 ‘‘(bb) to make recommenda13 tions to the Facilities Appropria14 tion Advisory Board for revising 

15 the priority system. 

16 ‘‘(ii) INITIAL REPORT.— 

17 ‘‘(I) IN GENERAL.—Not later 

18 than 1 year after the date of enact19 ment of the Indian Health Care Im20 provement Act Amendments of 2007, 

21 the Secretary shall submit to the 

22 Committee on Indian Affairs of the 

23 Senate and the Committee on Natural 

24 Resources of the House of Represent25 atives a report that describes the comVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00143 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 prehensive, national, ranked list of all 

2 health care facilities needs for the 

3 Service, Indian Tribes, and Tribal Or4 ganizations (including inpatient health 

5 care facilities, outpatient health care 

6 facilities, specialized health care facili7 ties (such as for long-term care and 

8 alcohol and drug abuse treatment), 

9 wellness centers, staff quarters and 

10 hostels associated with health care fa11 cilities, and the renovation and expan12 sion needs, if any, of such facilities) 

13 developed by the Service, Indian 

14 Tribes, and Tribal Organizations for 

15 the Facilities Needs Assessment 

16 Workgroup and the Facilities Appro17 priation Advisory Board. 

18 ‘‘(II) INCLUSIONS.—The initial 

19 report shall include— 

20 ‘‘(aa) the methodology and 

21 criteria used by the Service in de22 termining the needs and estab23 lishing the ranking of the facili24 ties needs; and 


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1 ‘‘(bb) such other information 

2 as the Secretary determines to be 

3 appropriate. 

4 ‘‘(iii) UPDATES OF REPORT.—Begin5 ning in calendar year 2011, the Secretary 

6 shall— 

7 ‘‘(I) update the report under 

8 clause (ii) not less frequently that 

9 once every 5 years; and 

10 ‘‘(II) include the updated report 

11 in the appropriate annual report 

12 under subparagraph (B) for submis13 sion to Congress under section 801. 

14 ‘‘(B) ANNUAL REPORTS.—The Secretary 

15 shall submit to the President, for inclusion in 

16 the report required to be transmitted to Con17 gress under section 801, a report which sets 

18 forth the following: 

19 ‘‘(i) A description of the health care 

20 facility priority system of the Service es21 tablished under paragraph (1). 

22 ‘‘(ii) Health care facilities lists, which 

23 may include— 

24 ‘‘(I) the 10 top-priority inpatient 

25 health care facilities; 


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1 ‘‘(II) the 10 top-priority out2 patient health care facilities; 

3 ‘‘(III) the 10 top-priority special4 ized health care facilities (such as 

5 long-term care and alcohol and drug 

6 abuse treatment); 

7 ‘‘(IV) the 10 top-priority staff 

8 quarters developments associated with 

9 health care facilities; and 

10 ‘‘(V) the 10 top-priority hostels 

11 associated with health care facilities. 

12 ‘‘(iii) The justification for such order 

13 of priority. 

14 ‘‘(iv) The projected cost of such 

15 projects. 

16 ‘‘(v) The methodology adopted by the 

17 Service in establishing priorities under its 

18 health care facility priority system. 

19 ‘‘(3) REQUIREMENTS FOR PREPARATION OF RE20 PORTS.—In preparing the report required under 

21 paragraph (2), the Secretary shall— 

22 ‘‘(A) consult with and obtain information 

23 on all health care facilities needs from Indian 

24 Tribes, Tribal Organizations, and Urban Indian 

25 Organizations; and 


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1 ‘‘(B) review the total unmet needs of all 

2 Indian Tribes, Tribal Organizations, and Urban 

3 Indian Organizations for health care facilities 

4 (including hostels and staff quarters), including 

5 needs for renovation and expansion of existing 

6 facilities. 

7 ‘‘(d) REVIEW OF METHODOLOGY USED FOR HEALTH

8 FACILITIES CONSTRUCTION PRIORITY SYSTEM.— 

9 ‘‘(1) IN GENERAL.—Not later than 1 year after 

10 the establishment of the priority system under sub11 section (c)(1)(A), the Comptroller General of the 

12 United States shall prepare and finalize a report re13 viewing the methodologies applied, and the processes 

14 followed, by the Service in making each assessment 

15 of needs for the list under subsection (c)(2)(A)(ii) 

16 and developing the priority system under subsection 

17 (c)(1), including a review of— 

18 ‘‘(A) the recommendations of the Facilities 

19 Appropriation Advisory Board and the Facili20 ties Needs Assessment Workgroup (as those 

21 terms are defined in subsection (c)(2)(A)(i)); 

22 and 

23 ‘‘(B) the relevant criteria used in ranking 

24 or prioritizing facilities other than hospitals or 

25 clinics. 


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1 ‘‘(2) SUBMISSION TO CONGRESS.—The Comp2 troller General of the United States shall submit the 

3 report under paragraph (1) to— 

4 ‘‘(A) the Committees on Indian Affairs and 

5 Appropriations of the Senate; 

6 ‘‘(B) the Committees on Natural Re7 sources and Appropriations of the House of 

8 Representatives; and 

9 ‘‘(C) the Secretary. 

10 ‘‘(e) FUNDING CONDITION.—All funds appropriated 

11 under the Act of November 2, 1921 (25 U.S.C. 13) (com12 monly known as the ‘Snyder Act’), for the planning, de13 sign, construction, or renovation of health facilities for the 

14 benefit of 1 or more Indian Tribes shall be subject to the 

15 provisions of the Indian Self-Determination and Edu16 cation Assistance Act (25 U.S.C. 450 et seq.). 

17 ‘‘(f) DEVELOPMENT OF INNOVATIVE APPROACHES.— 

18 The Secretary shall consult and cooperate with Indian 

19 Tribes, Tribal Organizations, and Urban Indian Organiza20 tions in developing innovative approaches to address all 

21 or part of the total unmet need for construction of health 

22 facilities, including those provided for in other sections of 

23 this title and other approaches. 

24 ‘‘SEC. 302. SANITATION FACILITIES. 

25 ‘‘(a) FINDINGS.—Congress finds the following: 


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1 ‘‘(1) The provision of sanitation facilities is pri2 marily a health consideration and function. 

3 ‘‘(2) Indian people suffer an inordinately high 

4 incidence of disease, injury, and illness directly at5 tributable to the absence or inadequacy of sanitation 

6 facilities. 

7 ‘‘(3) The long-term cost to the United States of 

8 treating and curing such disease, injury, and illness 

9 is substantially greater than the short-term cost of 

10 providing sanitation facilities and other preventive 

11 health measures. 

12 ‘‘(4) Many Indian homes and Indian commu13 nities still lack sanitation facilities. 

14 ‘‘(5) It is in the interest of the United States, 

15 and it is the policy of the United States, that all In16 dian communities and Indian homes, new and exist17 ing, be provided with sanitation facilities. 

18 ‘‘(b) FACILITIES AND SERVICES.—In furtherance of 

19 the findings made in subsection (a), Congress reaffirms 

20 the primary responsibility and authority of the Service to 

21 provide the necessary sanitation facilities and services as 

22 provided in section 7 of the Act of August 5, 1954 (42 

23 U.S.C. 2004a). Under such authority, the Secretary, act24 ing through the Service, is authorized to provide the fol25 lowing: 


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1 ‘‘(1) Financial and technical assistance to In2 dian Tribes, Tribal Organizations, and Indian com3 munities in the establishment, training, and equip4 ping of utility organizations to operate and maintain 

5 sanitation facilities, including the provision of exist6 ing plans, standard details, and specifications avail7 able in the Department, to be used at the option of 

8 the Indian Tribe, Tribal Organization, or Indian 

9 community. 

10 ‘‘(2) Ongoing technical assistance and training 

11 to Indian Tribes, Tribal Organizations, and Indian 

12 communities in the management of utility organiza13 tions which operate and maintain sanitation facili14 ties. 

15 ‘‘(3) Priority funding for operation and mainte16 nance assistance for, and emergency repairs to, sani17 tation facilities operated by an Indian Tribe, Tribal 

18 Organization or Indian community when necessary 

19 to avoid an imminent health threat or to protect the 

20 investment in sanitation facilities and the investment 

21 in the health benefits gained through the provision 

22 of sanitation facilities. 

23 ‘‘(c) FUNDING.—Notwithstanding any other provi24 sion of law— 


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1 ‘‘(1) the Secretary of Housing and Urban De2 velopment is authorized to transfer funds appro3 priated under the Native American Housing Assist4 ance and Self-Determination Act of 1996 (25 U.S.C. 

5 4101 et seq.) to the Secretary of Health and Human 

6 Services; 

7 ‘‘(2) the Secretary of Health and Human Serv8 ices is authorized to accept and use such funds for 

9 the purpose of providing sanitation facilities and 

10 services for Indians under section 7 of the Act of 

11 August 5, 1954 (42 U.S.C. 2004a); 

12 ‘‘(3) unless specifically authorized when funds 

13 are appropriated, the Secretary shall not use funds 

14 appropriated under section 7 of the Act of August 

15 5, 1954 (42 U.S.C. 2004a), to provide sanitation fa16 cilities to new homes constructed using funds pro17 vided by the Department of Housing and Urban De18 velopment; 

19 ‘‘(4) the Secretary of Health and Human Serv20 ices is authorized to accept from any source, includ21 ing Federal and State agencies, funds for the pur22 pose of providing sanitation facilities and services 

23 and place these funds into contracts or compacts 

24 under the Indian Self-Determination and Education 

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


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1 ‘‘(5) except as otherwise prohibited by this sec2 tion, the Secretary may use funds appropriated 

3 under the authority of section 7 of the Act of Au4 gust 5, 1954 (42 U.S.C. 2004a), to fund up to 100 

5 percent of the amount of an Indian Tribe’s loan ob6 tained under any Federal program for new projects 

7 to construct eligible sanitation facilities to serve In8 dian homes; 

9 ‘‘(6) except as otherwise prohibited by this sec10 tion, the Secretary may use funds appropriated 

11 under the authority of section 7 of the Act of Au12 gust 5, 1954 (42 U.S.C. 2004a) to meet matching 

13 or cost participation requirements under other Fed14 eral and non-Federal programs for new projects to 

15 construct eligible sanitation facilities; 

16 ‘‘(7) all Federal agencies are authorized to 

17 transfer to the Secretary funds identified, granted, 

18 loaned, or appropriated whereby the Department’s 

19 applicable policies, rules, and regulations shall apply 

20 in the implementation of such projects; 

21 ‘‘(8) the Secretary of Health and Human Serv22 ices shall enter into interagency agreements with 

23 Federal and State agencies for the purpose of pro24 viding financial assistance for sanitation facilities 

25 and services under this Act; 


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1 ‘‘(9) the Secretary of Health and Human Serv2 ices shall, by regulation, establish standards applica3 ble to the planning, design, and construction of sani4 tation facilities funded under this Act; and 

5 ‘‘(10) the Secretary of Health and Human 

6 Services is authorized to accept payments for goods 

7 and services furnished by the Service from appro8 priate public authorities, nonprofit organizations or 

9 agencies, or Indian Tribes, as contributions by that 

10 authority, organization, agency, or tribe to agree11 ments made under section 7 of the Act of August 5, 

12 1954 (42 U.S.C. 2004a), and such payments shall 

13 be credited to the same or subsequent appropriation 

14 account as funds appropriated under the authority 

15 of section 7 of the Act of August 5, 1954 (42 U.S.C. 

16 2004a). 

17 ‘‘(d) CERTAIN CAPABILITIES NOT PREREQUISITE.— 

18 The financial and technical capability of an Indian Tribe, 

19 Tribal Organization, or Indian community to safely oper20 ate, manage, and maintain a sanitation facility shall not 

21 be a prerequisite to the provision or construction of sanita22 tion facilities by the Secretary. 

23 ‘‘(e) FINANCIAL ASSISTANCE.—The Secretary is au24 thorized to provide financial assistance to Indian Tribes, 

25 Tribal Organizations, and Indian communities for operVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00153 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 ation, management, and maintenance of their sanitation 

2 facilities. 

3 ‘‘(f) OPERATION, MANAGEMENT, AND MAINTENANCE

4 OF FACILITIES.—The Indian Tribe has the primary re5 sponsibility to establish, collect, and use reasonable user 

6 fees, or otherwise set aside funding, for the purpose of 

7 operating, managing, and maintaining sanitation facilities. 

8 If a sanitation facility serving a community that is oper9 ated by an Indian Tribe or Tribal Organization is threat10 ened with imminent failure and such operator lacks capac11 ity to maintain the integrity or the health benefits of the 

12 sanitation facility, then the Secretary is authorized to as13 sist the Indian Tribe, Tribal Organization, or Indian com14 munity in the resolution of the problem on a short-term 

15 basis through cooperation with the emergency coordinator 

16 or by providing operation, management, and maintenance 

17 service. 

18 ‘‘(g) ISDEAA PROGRAM FUNDED ON EQUAL

19 BASIS.—Tribal Health Programs shall be eligible (on an 

20 equal basis with programs that are administered directly 

21 by the Service) for— 

22 ‘‘(1) any funds appropriated pursuant to this 

23 section; and 

24 ‘‘(2) any funds appropriated for the purpose of 

25 providing sanitation facilities. 


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1 ‘‘(h) REPORT.— 

2 ‘‘(1) REQUIRED; CONTENTS.—The Secretary, in 

3 consultation with the Secretary of Housing and 

4 Urban Development, Indian Tribes, Tribal Organiza5 tions, and tribally designated housing entities (as de6 fined in section 4 of the Native American Housing 

7 Assistance and Self-Determination Act of 1996 (25 

8 U.S.C. 4103)) shall submit to the President, for in9 clusion in the report required to be transmitted to 

10 Congress under section 801, a report which sets 

11 forth— 

12 ‘‘(A) the current Indian sanitation facility 

13 priority system of the Service; 

14 ‘‘(B) the methodology for determining 

15 sanitation deficiencies and needs; 

16 ‘‘(C) the criteria on which the deficiencies 

17 and needs will be evaluated; 

18 ‘‘(D) the level of initial and final sanitation 

19 deficiency for each type of sanitation facility for 

20 each project of each Indian Tribe or Indian 

21 community; 

22 ‘‘(E) the amount and most effective use of 

23 funds, derived from whatever source, necessary 

24 to accommodate the sanitation facilities needs 

25 of new homes assisted with funds under the 


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1 Native American Housing Assistance and Self2 Determination Act (25 U.S.C. 4101 et seq.), 

3 and to reduce the identified sanitation defi4 ciency levels of all Indian Tribes and Indian 

5 communities to level I sanitation deficiency as 

6 defined in paragraph (3)(A); and 

7 ‘‘(F) a 10-year plan to provide sanitation 

8 facilities to serve existing Indian homes and In9 dian communities and new and renovated In10 dian homes. 

11 ‘‘(2) UNIFORM METHODOLOGY.—The method12 ology used by the Secretary in determining, pre13 paring cost estimates for, and reporting sanitation 

14 deficiencies for purposes of paragraph (1) shall be 

15 applied uniformly to all Indian Tribes and Indian 

16 communities. 

17 ‘‘(3) SANITATION DEFICIENCY LEVELS.—For 

18 purposes of this subsection, the sanitation deficiency 

19 levels for an individual, Indian Tribe, or Indian com20 munity sanitation facility to serve Indian homes are 

21 determined as follows: 

22 ‘‘(A) A level I deficiency exists if a sanita23 tion facility serving an individual, Indian Tribe, 

24 or Indian community— 


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1 ‘‘(i) complies with all applicable water 

2 supply, pollution control, and solid waste 

3 disposal laws; and 

4 ‘‘(ii) deficiencies relate to routine re5 placement, repair, or maintenance needs. 

6 ‘‘(B) A level II deficiency exists if a sanita7 tion facility serving an individual, Indian Tribe, 

8 or Indian community substantially or recently 

9 complied with all applicable water supply, pollu10 tion control, and solid waste laws and any defi11 ciencies relate to— 

12 ‘‘(i) small or minor capital improve13 ments needed to bring the facility back 

14 into compliance; 

15 ‘‘(ii) capital improvements that are 

16 necessary to enlarge or improve the facili17 ties in order to meet the current needs for 

18 domestic sanitation facilities; or 

19 ‘‘(iii) the lack of equipment or train20 ing by an Indian Tribe, Tribal Organiza21 tion, or an Indian community to properly 

22 operate and maintain the sanitation facili23 ties. 

24 ‘‘(C) A level III deficiency exists if a sani25 tation facility serving an individual, Indian 


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1 Tribe or Indian community meets 1 or more of 

2 the following conditions— 

3 ‘‘(i) water or sewer service in the 

4 home is provided by a haul system with 

5 holding tanks and interior plumbing; 

6 ‘‘(ii) major significant interruptions to 

7 water supply or sewage disposal occur fre8 quently, requiring major capital improve9 ments to correct the deficiencies; or 

10 ‘‘(iii) there is no access to or no ap11 proved or permitted solid waste facility 

12 available. 

13 ‘‘(D) A level IV deficiency exists— 

14 ‘‘(i) if a sanitation facility for an indi15 vidual home, an Indian Tribe, or an Indian 

16 community exists but— 

17 ‘‘(I) lacks— 

18 ‘‘(aa) a safe water supply 

19 system; or 

20 ‘‘(bb) a waste disposal sys21 tem; 

22 ‘‘(II) contains no piped water or 

23 sewer facilities; or 

24 ‘‘(III) has become inoperable due 

25 to a major component failure; or 


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1 ‘‘(ii) if only a washeteria or central fa2 cility exists in the community. 

3 ‘‘(E) A level V deficiency exists in the ab4 sence of a sanitation facility, where individual 

5 homes do not have access to safe drinking 

6 water or adequate wastewater (including sew7 age) disposal. 

8 ‘‘(i) DEFINITIONS.—For purposes of this section, the 

9 following terms apply: 

10 ‘‘(1) INDIAN COMMUNITY.—The term ‘Indian 

11 community’ means a geographic area, a significant 

12 proportion of whose inhabitants are Indians and 

13 which is served by or capable of being served by a 

14 facility described in this section. 

15 ‘‘(2) SANITATION FACILITIES.—The terms 

16 ‘sanitation facility’ and ‘sanitation facilities’ mean 

17 safe and adequate water supply systems, sanitary 

18 sewage disposal systems, and sanitary solid waste 

19 systems (and all related equipment and support in20 frastructure). 

21 ‘‘SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS. 

22 ‘‘(a) BUY INDIAN ACT.—The Secretary, acting 

23 through the Service, may use the negotiating authority of 

24 section 23 of the Act of June 25, 1910 (25 U.S.C. 47, 

25 commonly known as the ‘Buy Indian Act’), to give prefVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00159 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 erence to any Indian or any enterprise, partnership, cor2 poration, or other type of business organization owned and 

3 controlled by an Indian or Indians including former or 

4 currently federally recognized Indian Tribes in the State 

5 of New York (hereinafter referred to as an ‘Indian firm’) 

6 in the construction and renovation of Service facilities pur7 suant to section 301 and in the construction of sanitation 

8 facilities pursuant to section 302. Such preference may be 

9 accorded by the Secretary unless the Secretary finds, pur10 suant to regulations, that the project or function to be 

11 contracted for will not be satisfactory or such project or 

12 function cannot be properly completed or maintained 

13 under the proposed contract. The Secretary, in arriving 

14 at such a finding, shall consider whether the Indian or 

15 Indian firm will be deficient with respect to— 

16 ‘‘(1) ownership and control by Indians; 

17 ‘‘(2) equipment; 

18 ‘‘(3) bookkeeping and accounting procedures; 

19 ‘‘(4) substantive knowledge of the project or 

20 function to be contracted for; 

21 ‘‘(5) adequately trained personnel; or 

22 ‘‘(6) other necessary components of contract 

23 performance. 

24 ‘‘(b) LABOR STANDARDS.— 


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1 ‘‘(1) IN GENERAL.—For the purposes of imple2 menting the provisions of this title, contracts for the 

3 construction or renovation of health care facilities, 

4 staff quarters, and sanitation facilities, and related 

5 support infrastructure, funded in whole or in part 

6 with funds made available pursuant to this title, 

7 shall contain a provision requiring compliance with 

8 subchapter IV of chapter 31 of title 40, United 

9 States Code (commonly known as the ‘Davis-Bacon 

10 Act’), unless such construction or renovation— 

11 ‘‘(A) is performed by a contractor pursu12 ant to a contract with an Indian Tribe or Trib13 al Organization with funds supplied through a 

14 contract or compact authorized by the Indian 

15 Self-Determination and Education Assistance 

16 Act (25 U.S.C. 450 et seq.), or other statutory 

17 authority; and 

18 ‘‘(B) is subject to prevailing wage rates for 

19 similar construction or renovation in the locality 

20 as determined by the Indian Tribes or Tribal 

21 Organizations to be served by the construction 

22 or renovation. 

23 ‘‘(2) EXCEPTION.—This subsection shall not 

24 apply to construction or renovation carried out by an 


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1 Indian Tribe or Tribal Organization with its own 

2 employees. 

3 ‘‘SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR 

4 RENOVATION. 

5 ‘‘(a) IN GENERAL.—Notwithstanding any other pro6 vision of law, if the requirements of subsection (c) are met, 

7 the Secretary, acting through the Service, is authorized 

8 to accept any major expansion, renovation, or moderniza9 tion by any Indian Tribe or Tribal Organization of any 

10 Service facility or of any other Indian health facility oper11 ated pursuant to a contract or compact under the Indian 

12 Self-Determination and Education Assistance Act (25 

13 U.S.C. 450 et seq.), including— 

14 ‘‘(1) any plans or designs for such expansion, 

15 renovation, or modernization; and 

16 ‘‘(2) any expansion, renovation, or moderniza17 tion for which funds appropriated under any Federal 

18 law were lawfully expended. 

19 ‘‘(b) PRIORITY LIST.— 

20 ‘‘(1) IN GENERAL.—The Secretary shall main21 tain a separate priority list to address the needs for 

22 increased operating expenses, personnel, or equip23 ment for such facilities. The methodology for estab24 lishing priorities shall be developed through regula25 tions. The list of priority facilities will be revised anVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00162 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 nually in consultation with Indian Tribes and Tribal 

2 Organizations. 

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

4 the President, for inclusion in the report required to 

5 be transmitted to Congress under section 801, the 

6 priority list maintained pursuant to paragraph (1). 

7 ‘‘(c) REQUIREMENTS.—The requirements of this sub8 section are met with respect to any expansion, renovation, 

9 or modernization if— 

10 ‘‘(1) the Indian Tribe or Tribal Organization— 

11 ‘‘(A) provides notice to the Secretary of its 

12 intent to expand, renovate, or modernize; and 

13 ‘‘(B) applies to the Secretary to be placed 

14 on a separate priority list to address the needs 

15 of such new facilities for increased operating ex16 penses, personnel, or equipment; and 

17 ‘‘(2) the expansion, renovation, or moderniza18 tion— 

19 ‘‘(A) is approved by the appropriate area 

20 director of the Service for Federal facilities; and 

21 ‘‘(B) is administered by the Indian Tribe 

22 or Tribal Organization in accordance with any 

23 applicable regulations prescribed by the Sec24 retary with respect to construction or renova25 tion of Service facilities. 


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1 ‘‘(d) ADDITIONAL REQUIREMENT FOR EXPANSION.— 

2 In addition to the requirements under subsection (c), for 

3 any expansion, the Indian Tribe or Tribal Organization 

4 shall provide to the Secretary additional information pur5 suant to regulations, including additional staffing, equip6 ment, and other costs associated with the expansion. 

7 ‘‘(e) CLOSURE OR CONVERSION OF FACILITIES.—If 

8 any Service facility which has been expanded, renovated, 

9 or modernized by an Indian Tribe or Tribal Organization 

10 under this section ceases to be used as a Service facility 

11 during the 20-year period beginning on the date such ex12 pansion, renovation, or modernization is completed, such 

13 Indian Tribe or Tribal Organization shall be entitled to 

14 recover from the United States an amount which bears 

15 the same ratio to the value of such facility at the time 

16 of such cessation as the value of such expansion, renova17 tion, or modernization (less the total amount of any funds 

18 provided specifically for such facility under any Federal 

19 program that were expended for such expansion, renova20 tion, or modernization) bore to the value of such facility 

21 at the time of the completion of such expansion, renova22 tion, or modernization. 


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1 ‘‘SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, 

2 AND MODERNIZATION OF SMALL AMBULA3 TORY CARE FACILITIES. 

4 ‘‘(a) GRANTS.— 

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

6 through the Service, shall make grants to Indian 

7 Tribes and Tribal Organizations for the construc8 tion, expansion, or modernization of facilities for the 

9 provision of ambulatory care services to eligible Indi10 ans (and noneligible persons pursuant to subsections 

11 (b)(2) and (c)(1)(C)). A grant made under this sec12 tion may cover up to 100 percent of the costs of 

13 such construction, expansion, or modernization. For 

14 the purposes of this section, the term ‘construction’ 

15 includes the replacement of an existing facility. 

16 ‘‘(2) GRANT AGREEMENT REQUIRED.—A grant 

17 under paragraph (1) may only be made available to 

18 a Tribal Health Program operating an Indian health 

19 facility (other than a facility owned or constructed 

20 by the Service, including a facility originally owned 

21 or constructed by the Service and transferred to an 

22 Indian Tribe or Tribal Organization). 

23 ‘‘(b) USE OF GRANT FUNDS.— 

24 ‘‘(1) ALLOWABLE USES.—A grant awarded 

25 under this section may be used for the construction, 

26 expansion, or modernization (including the planning 


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1 and design of such construction, expansion, or mod2 ernization) of an ambulatory care facility— 

3 ‘‘(A) located apart from a hospital; 

4 ‘‘(B) not funded under section 301 or sec5 tion 306; and 

6 ‘‘(C) which, upon completion of such con7 struction or modernization will— 

8 ‘‘(i) have a total capacity appropriate 

9 to its projected service population; 

10 ‘‘(ii) provide annually no fewer than 

11 150 patient visits by eligible Indians and 

12 other users who are eligible for services in 

13 such facility in accordance with section 

14 807(c)(2); and 

15 ‘‘(iii) provide ambulatory care in a 

16 Service Area (specified in the contract or 

17 compact under the Indian Self-Determina18 tion and Education Assistance Act (25 

19 U.S.C. 450 et seq.)) with a population of 

20 no fewer than 1,500 eligible Indians and 

21 other users who are eligible for services in 

22 such facility in accordance with section 

23 807(c)(2). 

24 ‘‘(2) ADDITIONAL ALLOWABLE USE.—The Sec25 retary may also reserve a portion of the funding proVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00166 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 vided under this section and use those reserved 

2 funds to reduce an outstanding debt incurred by In3 dian Tribes or Tribal Organizations for the con4 struction, expansion, or modernization of an ambula5 tory care facility that meets the requirements under 

6 paragraph (1). The provisions of this section shall 

7 apply, except that such applications for funding 

8 under this paragraph shall be considered separately 

9 from applications for funding under paragraph (1). 

10 ‘‘(3) USE ONLY FOR CERTAIN PORTION OF

11 COSTS.—A grant provided under this section may be 

12 used only for the cost of that portion of a construc13 tion, expansion, or modernization project that bene14 fits the Service population identified above in sub15 section (b)(1)(C) (ii) and (iii). The requirements of 

16 clauses (ii) and (iii) of paragraph (1)(C) shall not 

17 apply to an Indian Tribe or Tribal Organization ap18 plying for a grant under this section for a health 

19 care facility located or to be constructed on an is20 land or when such facility is not located on a road 

21 system providing direct access to an inpatient hos22 pital where care is available to the Service popu23 lation. 

24 ‘‘(c) GRANTS.— 


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1 ‘‘(1) APPLICATION.—No grant may be made 

2 under this section unless an application or proposal 

3 for the grant has been approved by the Secretary in 

4 accordance with applicable regulations and has set 

5 forth reasonable assurance by the applicant that, at 

6 all times after the construction, expansion, or mod7 ernization of a facility carried out using a grant re8 ceived under this section— 

9 ‘‘(A) adequate financial support will be 

10 available for the provision of services at such 

11 facility; 

12 ‘‘(B) such facility will be available to eligi13 ble Indians without regard to ability to pay or 

14 source of payment; and 

15 ‘‘(C) such facility will, as feasible without 

16 diminishing the quality or quantity of services 

17 provided to eligible Indians, serve noneligible 

18 persons on a cost basis. 

19 ‘‘(2) PRIORITY.—In awarding grants under this 

20 section, the Secretary shall give priority to Indian 

21 Tribes and Tribal Organizations that demonstrate— 

22 ‘‘(A) a need for increased ambulatory care 

23 services; and 

24 ‘‘(B) insufficient capacity to deliver such 

25 services. 


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1 ‘‘(3) PEER REVIEW PANELS.—The Secretary 

2 may provide for the establishment of peer review 

3 panels, as necessary, to review and evaluate applica4 tions and proposals and to advise the Secretary re5 garding such applications using the criteria devel6 oped pursuant to subsection (a)(1). 

7 ‘‘(d) REVERSION OF FACILITIES.—If any facility (or 

8 portion thereof) with respect to which funds have been 

9 paid under this section, ceases, at any time after comple10 tion of the construction, expansion, or modernization car11 ried out with such funds, to be used for the purposes of 

12 providing health care services to eligible Indians, all of the 

13 right, title, and interest in and to such facility (or portion 

14 thereof) shall transfer to the United States unless other15 wise negotiated by the Service and the Indian Tribe or 

16 Tribal Organization. 

17 ‘‘(e) FUNDING NONRECURRING.—Funding provided 

18 under this section shall be nonrecurring and shall not be 

19 available for inclusion in any individual Indian Tribe’s 

20 tribal share for an award under the Indian Self-Deter21 mination and Education Assistance Act (25 U.S.C. 450 

22 et seq.) or for reallocation or redesign thereunder. 


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1 ‘‘SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRA2 TION PROJECTS. 

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

4 the Service, is authorized to carry out, or to enter into 

5 contracts under the Indian Self-Determination and Edu6 cation Assistance Act (25 U.S.C. 450 et seq.) with Indian 

7 Tribes or Tribal Organizations to carry out, a health care 

8 delivery demonstration project to test alternative means 

9 of delivering health care and services to Indians through 

10 facilities. 

11 ‘‘(b) USE OF FUNDS.—The Secretary, in approving 

12 projects pursuant to this section, may authorize such con13 tracts for the construction and renovation of hospitals, 

14 health centers, health stations, and other facilities to de15 liver health care services and is authorized to— 

16 ‘‘(1) waive any leasing prohibition; 

17 ‘‘(2) permit carryover of funds appropriated for 

18 the provision of health care services; 

19 ‘‘(3) permit the use of other available funds; 

20 ‘‘(4) permit the use of funds or property do21 nated from any source for project purposes; 

22 ‘‘(5) provide for the reversion of donated real or 

23 personal property to the donor; and 

24 ‘‘(6) permit the use of Service funds to match 

25 other funds, including Federal funds. 

26 ‘‘(c) HEALTH CARE DEMONSTRATION PROJECTS.— 


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1 ‘‘(1) GENERAL PROJECTS.— 

2 ‘‘(A) CRITERIA.—The Secretary may ap3 prove under this section demonstration projects 

4 that meet the following criteria: 

5 ‘‘(i) There is a need for a new facility 

6 or program, such as a program for conven7 ient care services, or the reorientation of 

8 an existing facility or program. 

9 ‘‘(ii) A significant number of Indians, 

10 including Indians with low health status, 

11 will be served by the project. 

12 ‘‘(iii) The project has the potential to 

13 deliver services in an efficient and effective 

14 manner. 

15 ‘‘(iv) The project is economically via16 ble. 

17 ‘‘(v) For projects carried out by an 

18 Indian Tribe or Tribal Organization, the 

19 Indian Tribe or Tribal Organization has 

20 the administrative and financial capability 

21 to administer the project. 

22 ‘‘(vi) The project is integrated with 

23 providers of related health and social serv24 ices and is coordinated with, and avoids 


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1 duplication of, existing services in order to 

2 expand the availability of services. 

3 ‘‘(B) PRIORITY.—In approving demonstra4 tion projects under this paragraph, the Sec5 retary shall give priority to demonstration 

6 projects, to the extent the projects meet the cri7 teria described in subparagraph (A), located in 

8 any of the following Service Units: 

9 ‘‘(i) Cass Lake, Minnesota. 

10 ‘‘(ii) Mescalero, New Mexico. 

11 ‘‘(iii) Owyhee, Nevada. 

12 ‘‘(iv) Schurz, Nevada. 

13 ‘‘(v) Ft. Yuma, California. 

14 ‘‘(2) CONVENIENT CARE SERVICE PROJECTS.— 

15 ‘‘(A) DEFINITION OF CONVENIENT CARE

16 SERVICE.—In this paragraph, the term ‘conven17 ient care service’ means any primary health 

18 care service, such as urgent care services, non19 emergent care services, prevention services and 

20 screenings, and any service authorized by sec21 tions 203 or 213(d), that is— 

22 ‘‘(i) provided outside the regular 

23 hours of operation of a health care facility; 

24 or 

25 ‘‘(ii) offered at an alternative setting. 


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1 ‘‘(B) APPROVAL.—In addition to projects 

2 described in paragraph (1), in any fiscal year, 

3 the Secretary is authorized to approve not more 

4 than 10 applications for health care delivery 

5 demonstration projects that— 

6 ‘‘(i) include a convenient care services 

7 program as an alternative means of deliv8 ering health care services to Indians; and 

9 ‘‘(ii) meet the criteria described in 

10 subparagraph (C). 

11 ‘‘(C) CRITERIA.—The Secretary shall ap12 prove under subparagraph (B) demonstration 

13 projects that meet all of the following criteria: 

14 ‘‘(i) The criteria set forth in para15 graph (1)(A). 

16 ‘‘(ii) There is a lack of access to 

17 health care services at existing health care 

18 facilities, which may be due to limited 

19 hours of operation at those facilities or 

20 other factors. 

21 ‘‘(iii) The project— 

22 ‘‘(I) expands the availability of 

23 services; or 

24 ‘‘(II) reduces— 


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1 ‘‘(aa) the burden on Con2 tract Health Services; or 

3 ‘‘(bb) the need for emer4 gency room visits. 

5 ‘‘(d) PEER REVIEW PANELS.—The Secretary may 

6 provide for the establishment of peer review panels, as nec7 essary, to review and evaluate applications using the cri8 teria described in paragraphs (1)(A) and (2)(C) of sub9 section (c). 

10 ‘‘(e) TECHNICAL ASSISTANCE.—The Secretary shall 

11 provide such technical and other assistance as may be nec12 essary to enable applicants to comply with this section. 

13 ‘‘(f) SERVICE TO INELIGIBLE PERSONS.—Subject to 

14 section 807, the authority to provide services to persons 

15 otherwise ineligible for the health care benefits of the 

16 Service, and the authority to extend hospital privileges in 

17 Service facilities to non-Service health practitioners as 

18 provided in section 807, may be included, subject to the 

19 terms of that section, in any demonstration project ap20 proved pursuant to this section. 

21 ‘‘(g) EQUITABLE TREATMENT.—For purposes of 

22 subsection (c), the Secretary, in evaluating facilities oper23 ated under any contract or compact under the Indian Self24 Determination and Education Assistance Act (25 U.S.C. 

25 450 et seq.), shall use the same criteria that the Secretary 


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1 uses in evaluating facilities operated directly by the Serv2 ice. 

3 ‘‘(h) EQUITABLE INTEGRATION OF FACILITIES.— 

4 The Secretary shall ensure that the planning, design, con5 struction, renovation, and expansion needs of Service and 

6 non-Service facilities that are the subject of a contract or 

7 compact under the Indian Self-Determination and Edu8 cation Assistance Act (25 U.S.C. 450 et seq.) for health 

9 services are fully and equitably integrated into the imple10 mentation of the health care delivery demonstration 

11 projects under this section. 

12 ‘‘SEC. 307. LAND TRANSFER. 

13 ‘‘Notwithstanding any other provision of law, the Bu14 reau of Indian Affairs and all other agencies and depart15 ments of the United States are authorized to transfer, at 

16 no cost, land and improvements to the Service for the pro17 vision of health care services. The Secretary is authorized 

18 to accept such land and improvements for such purposes. 

19 ‘‘SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS. 

20 ‘‘The Secretary, acting through the Service, may 

21 enter into leases, contracts, and other agreements with In22 dian Tribes and Tribal Organizations which hold (1) title 

23 to, (2) a leasehold interest in, or (3) a beneficial interest 

24 in (when title is held by the United States in trust for 

25 the benefit of an Indian Tribe) facilities used or to be used 


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1 for the administration and delivery of health services by 

2 an Indian Health Program. Such leases, contracts, or 

3 agreements may include provisions for construction or ren4 ovation and provide for compensation to the Indian Tribe 

5 or Tribal Organization of rental and other costs consistent 

6 with section 105(l) of the Indian Self-Determination and 

7 Education Assistance Act (25 U.S.C. 450j(l)) and regula8 tions thereunder. 

9 ‘‘SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND 

10 LOAN REPAYMENT. 

11 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

12 with the Secretary of the Treasury, Indian Tribes, and 

13 Tribal Organizations, shall carry out a study to determine 

14 the feasibility of establishing a loan fund to provide to In15 dian Tribes and Tribal Organizations direct loans or guar16 antees for loans for the construction of health care facili17 ties, including— 

18 ‘‘(1) inpatient facilities; 

19 ‘‘(2) outpatient facilities; 

20 ‘‘(3) staff quarters; 

21 ‘‘(4) hostels; and 

22 ‘‘(5) specialized care facilities, such as behav23 ioral health and elder care facilities. 

24 ‘‘(b) DETERMINATIONS.—In carrying out the study 

25 under subsection (a), the Secretary shall determine— 


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1 ‘‘(1) the maximum principal amount of a loan 

2 or loan guarantee that should be offered to a recipi3 ent from the loan fund; 

4 ‘‘(2) the percentage of eligible costs, not to ex5 ceed 100 percent, that may be covered by a loan or 

6 loan guarantee from the loan fund (including costs 

7 relating to planning, design, financing, site land de8 velopment, construction, rehabilitation, renovation, 

9 conversion, improvements, medical equipment and 

10 furnishings, and other facility-related costs and cap11 ital purchase (but excluding staffing)); 

12 ‘‘(3) the cumulative total of the principal of di13 rect loans and loan guarantees, respectively, that 

14 may be outstanding at any 1 time; 

15 ‘‘(4) the maximum term of a loan or loan guar16 antee that may be made for a facility from the loan 

17 fund; 

18 ‘‘(5) the maximum percentage of funds from 

19 the loan fund that should be allocated for payment 

20 of costs associated with planning and applying for a 

21 loan or loan guarantee; 

22 ‘‘(6) whether acceptance by the Secretary of an 

23 assignment of the revenue of an Indian Tribe or 

24 Tribal Organization as security for any direct loan 


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1 or loan guarantee from the loan fund would be ap2 propriate; 

3 ‘‘(7) whether, in the planning and design of 

4 health facilities under this section, users eligible 

5 under section 807(c) may be included in any projec6 tion of patient population; 

7 ‘‘(8) whether funds of the Service provided 

8 through loans or loan guarantees from the loan fund 

9 should be eligible for use in matching other Federal 

10 funds under other programs; 

11 ‘‘(9) the appropriateness of, and best methods 

12 for, coordinating the loan fund with the health care 

13 priority system of the Service under section 301; and 

14 ‘‘(10) any legislative or regulatory changes re15 quired to implement recommendations of the Sec16 retary based on results of the study. 

17 ‘‘(c) REPORT.—Not later than September 30, 2009, 

18 the Secretary shall submit to the Committee on Indian Af19 fairs of the Senate and the Committee on Natural Re20 sources and the Committee on Energy and Commerce of 

21 the House of Representatives a report that describes— 

22 ‘‘(1) the manner of consultation made as re23 quired by subsection (a); and 


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1 ‘‘(2) the results of the study, including any rec2 ommendations of the Secretary based on results of 

3 the study. 

4 ‘‘SEC. 310. TRIBAL LEASING. 

5 ‘‘A Tribal Health Program may lease permanent 

6 structures for the purpose of providing health care services 

7 without obtaining advance approval in appropriation Acts. 

8 ‘‘SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES 

9 JOINT VENTURE PROGRAM. 

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

11 the Service, shall make arrangements with Indian Tribes 

12 and Tribal Organizations to establish joint venture dem13 onstration projects under which an Indian Tribe or Tribal 

14 Organization shall expend tribal, private, or other avail15 able funds, for the acquisition or construction of a health 

16 facility for a minimum of 10 years, under a no-cost lease, 

17 in exchange for agreement by the Service to provide the 

18 equipment, supplies, and staffing for the operation and 

19 maintenance of such a health facility. An Indian Tribe or 

20 Tribal Organization may use tribal funds, private sector, 

21 or other available resources, including loan guarantees, to 

22 fulfill its commitment under a joint venture entered into 

23 under this subsection. An Indian Tribe or Tribal Organi24 zation shall be eligible to establish a joint venture project 

25 if, when it submits a letter of intent, it— 


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1 ‘‘(1) has begun but not completed the process 

2 of acquisition or construction of a health facility to 

3 be used in the joint venture project; or 

4 ‘‘(2) has not begun the process of acquisition or 

5 construction of a health facility for use in the joint 

6 venture project. 

7 ‘‘(b) REQUIREMENTS.—The Secretary shall make 

8 such an arrangement with an Indian Tribe or Tribal Orga9 nization only if— 

10 ‘‘(1) the Secretary first determines that the In11 dian Tribe or Tribal Organization has the adminis12 trative and financial capabilities necessary to com13 plete the timely acquisition or construction of the 

14 relevant health facility; and 

15 ‘‘(2) the Indian Tribe or Tribal Organization 

16 meets the need criteria determined using the criteria 

17 developed under the health care facility priority sys18 tem under section 301, unless the Secretary deter19 mines, pursuant to regulations, that other criteria 

20 will result in a more cost-effective and efficient 

21 method of facilitating and completing construction of 

22 health care facilities. 

23 ‘‘(c) CONTINUED OPERATION.—The Secretary shall 

24 negotiate an agreement with the Indian Tribe or Tribal 


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1 Organization regarding the continued operation of the fa2 cility at the end of the initial 10 year no-cost lease period. 

3 ‘‘(d) BREACH OF AGREEMENT.—An Indian Tribe or 

4 Tribal Organization that has entered into a written agree5 ment with the Secretary under this section, and that 

6 breaches or terminates without cause such agreement, 

7 shall be liable to the United States for the amount that 

8 has been paid to the Indian Tribe or Tribal Organization, 

9 or paid to a third party on the Indian Tribe’s or Tribal 

10 Organization’s behalf, under the agreement. The Sec11 retary has the right to recover tangible property (including 

12 supplies) and equipment, less depreciation, and any funds 

13 expended for operations and maintenance under this sec14 tion. The preceding sentence does not apply to any funds 

15 expended for the delivery of health care services, per16 sonnel, or staffing. 

17 ‘‘(e) RECOVERY FOR NONUSE.—An Indian Tribe or 

18 Tribal Organization that has entered into a written agree19 ment with the Secretary under this subsection shall be en20 titled to recover from the United States an amount that 

21 is proportional to the value of such facility if, at any time 

22 within the 10-year term of the agreement, the Service 

23 ceases to use the facility or otherwise breaches the agree24 ment. 


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

2 the term ‘health facility’ or ‘health facilities’ includes 

3 quarters needed to provide housing for staff of the rel4 evant Tribal Health Program. 

5 ‘‘SEC. 312. LOCATION OF FACILITIES. 

6 ‘‘(a) IN GENERAL.—In all matters involving the reor7 ganization or development of Service facilities or in the 

8 establishment of related employment projects to address 

9 unemployment conditions in economically depressed areas, 

10 the Bureau of Indian Affairs and the Service shall give 

11 priority to locating such facilities and projects on Indian 

12 lands, or lands in Alaska owned by any Alaska Native vil13 lage, or village or regional corporation under the Alaska 

14 Native Claims Settlement Act (43 U.S.C. 1601 et seq.), 

15 or any land allotted to any Alaska Native, if requested 

16 by the Indian owner and the Indian Tribe with jurisdiction 

17 over such lands or other lands owned or leased by the In18 dian Tribe or Tribal Organization. Top priority shall be 

19 given to Indian land owned by 1 or more Indian Tribes. 

20 ‘‘(b) DEFINITION.—For purposes of this section, the 

21 term ‘Indian lands’ means— 

22 ‘‘(1) all lands within the exterior boundaries of 

23 any reservation; and 

24 ‘‘(2) any lands title to which is held in trust by 

25 the United States for the benefit of any Indian 


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1 Tribe or individual Indian or held by any Indian 

2 Tribe or individual Indian subject to restriction by 

3 the United States against alienation. 

4 ‘‘SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH 

5 CARE FACILITIES. 

6 ‘‘(a) REPORT.—The Secretary shall submit to the 

7 President, for inclusion in the report required to be trans8 mitted to Congress under section 801, a report which iden9 tifies the backlog of maintenance and repair work required 

10 at both Service and tribal health care facilities, including 

11 new health care facilities expected to be in operation in 

12 the next fiscal year. The report shall also identify the need 

13 for renovation and expansion of existing facilities to sup14 port the growth of health care programs. 

15 ‘‘(b) MAINTENANCE OF NEWLY CONSTRUCTED

16 SPACE.—The Secretary, acting through the Service, is au17 thorized to expend maintenance and improvement funds 

18 to support maintenance of newly constructed space only 

19 if such space falls within the approved supportable space 

20 allocation for the Indian Tribe or Tribal Organization. 

21 Supportable space allocation shall be defined through the 

22 health care facility priority system under section 301(c). 

23 ‘‘(c) REPLACEMENT FACILITIES.—In addition to 

24 using maintenance and improvement funds for renovation, 

25 modernization, and expansion of facilities, an Indian Tribe 


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1 or Tribal Organization may use maintenance and improve2 ment funds for construction of a replacement facility if 

3 the costs of renovation of such facility would exceed a 

4 maximum renovation cost threshold. The maximum ren5 ovation cost threshold shall be determined through the ne6 gotiated rulemaking process provided for under section 

7 802. 

8 ‘‘SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY-OWNED 

9 QUARTERS. 

10 ‘‘(a) RENTAL RATES.— 

11 ‘‘(1) ESTABLISHMENT.—Notwithstanding any 

12 other provision of law, a Tribal Health Program 

13 which operates a hospital or other health facility and 

14 the federally-owned quarters associated therewith 

15 pursuant to a contract or compact under the Indian 

16 Self-Determination and Education Assistance Act 

17 (25 U.S.C. 450 et seq.) shall have the authority to 

18 establish the rental rates charged to the occupants 

19 of such quarters by providing notice to the Secretary 

20 of its election to exercise such authority. 

21 ‘‘(2) OBJECTIVES.—In establishing rental rates 

22 pursuant to authority of this subsection, a Tribal 

23 Health Program shall endeavor to achieve the fol24 lowing objectives: 


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1 ‘‘(A) To base such rental rates on the rea2 sonable value of the quarters to the occupants 

3 thereof. 

4 ‘‘(B) To generate sufficient funds to pru5 dently provide for the operation and mainte6 nance of the quarters, and subject to the discre7 tion of the Tribal Health Program, to supply 

8 reserve funds for capital repairs and replace9 ment of the quarters. 

10 ‘‘(3) EQUITABLE FUNDING.—Any quarters 

11 whose rental rates are established by a Tribal 

12 Health Program pursuant to this subsection shall 

13 remain eligible for quarters improvement and repair 

14 funds to the same extent as all federally-owned quar15 ters used to house personnel in Services-supported 

16 programs. 

17 ‘‘(4) NOTICE OF RATE CHANGE.—A Tribal 

18 Health Program which exercises the authority pro19 vided under this subsection shall provide occupants 

20 with no less than 60 days notice of any change in 

21 rental rates. 

22 ‘‘(b) DIRECT COLLECTION OF RENT.— 

23 ‘‘(1) IN GENERAL.—Notwithstanding any other 

24 provision of law, and subject to paragraph (2), a 

25 Tribal Health Program shall have the authority to 


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1 collect rents directly from Federal employees who oc2 cupy such quarters in accordance with the following: 

3 ‘‘(A) The Tribal Health Program shall no4 tify the Secretary and the subject Federal em5 ployees of its election to exercise its authority 

6 to collect rents directly from such Federal em7 ployees. 

8 ‘‘(B) Upon receipt of a notice described in 

9 subparagraph (A), the Federal employees shall 

10 pay rents for occupancy of such quarters di11 rectly to the Tribal Health Program and the 

12 Secretary shall have no further authority to col13 lect rents from such employees through payroll 

14 deduction or otherwise. 

15 ‘‘(C) Such rent payments shall be retained 

16 by the Tribal Health Program and shall not be 

17 made payable to or otherwise be deposited with 

18 the United States. 

19 ‘‘(D) Such rent payments shall be depos20 ited into a separate account which shall be used 

21 by the Tribal Health Program for the mainte22 nance (including capital repairs and replace23 ment) and operation of the quarters and facili24 ties as the Tribal Health Program shall deter25 mine. 


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1 ‘‘(2) RETROCESSION OF AUTHORITY.—If a 

2 Tribal Health Program which has made an election 

3 under paragraph (1) requests retrocession of its au4 thority to directly collect rents from Federal employ5 ees occupying federally-owned quarters, such ret6 rocession shall become effective on the earlier of— 

7 ‘‘(A) the first day of the month that begins 

8 no less than 180 days after the Tribal Health 

9 Program notifies the Secretary of its desire to 

10 retrocede; or 

11 ‘‘(B) such other date as may be mutually 

12 agreed by the Secretary and the Tribal Health 

13 Program. 

14 ‘‘(c) RATES IN ALASKA.—To the extent that a Tribal 

15 Health Program, pursuant to authority granted in sub16 section (a), establishes rental rates for federally-owned 

17 quarters provided to a Federal employee in Alaska, such 

18 rents may be based on the cost of comparable private rent19 al housing in the nearest established community with a 

20 year-round population of 1,500 or more individuals. 

21 ‘‘SEC. 315. APPLICABILITY OF BUY AMERICAN ACT RE22 QUIREMENT. 

23 ‘‘(a) APPLICABILITY.—The Secretary shall ensure 

24 that the requirements of the Buy American Act apply to 

25 all procurements made with funds provided pursuant to 


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1 section 317. Indian Tribes and Tribal Organizations shall 

2 be exempt from these requirements. 

3 ‘‘(b) EFFECT OF VIOLATION.—If it has been finally 

4 determined by a court or Federal agency that any person 

5 intentionally affixed a label bearing a ‘Made in America’ 

6 inscription or any inscription with the same meaning, to 

7 any product sold in or shipped to the United States that 

8 is not made in the United States, such person shall be 

9 ineligible to receive any contract or subcontract made with 

10 funds provided pursuant to section 317, pursuant to the 

11 debarment, suspension, and ineligibility procedures de12 scribed in sections 9.400 through 9.409 of title 48, Code 

13 of Federal Regulations. 

14 ‘‘(c) DEFINITIONS.—For purposes of this section, the 

15 term ‘Buy American Act’ means title III of the Act enti16 tled ‘An Act making appropriations for the Treasury and 

17 Post Office Departments for the fiscal year ending June 

18 30, 1934, and for other purposes’, approved March 3, 

19 1933 (41 U.S.C. 10a et seq.). 

20 ‘‘SEC. 316. OTHER FUNDING FOR FACILITIES. 

21 ‘‘(a) AUTHORITY TO ACCEPT FUNDS.—The Sec22 retary is authorized to accept from any source, including 

23 Federal and State agencies, funds that are available for 

24 the construction of health care facilities and use such 

25 funds to plan, design, and construct health care facilities 


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1 for Indians and to place such funds into a contract or com2 pact under the Indian Self-Determination and Education 

3 Assistance Act (25 U.S.C. 450 et seq.). Receipt of such 

4 funds shall have no effect on the priorities established pur5 suant to section 301. 

6 ‘‘(b) INTERAGENCY AGREEMENTS.—The Secretary is 

7 authorized to enter into interagency agreements with 

8 other Federal agencies or State agencies and other entities 

9 and to accept funds from such Federal or State agencies 

10 or other sources to provide for the planning, design, and 

11 construction of health care facilities to be administered by 

12 Indian Health Programs in order to carry out the pur13 poses of this Act and the purposes for which the funds 

14 were appropriated or for which the funds were otherwise 

15 provided. 

16 ‘‘(c) ESTABLISHMENT OF STANDARDS.—The Sec17 retary, through the Service, shall establish standards by 

18 regulation for the planning, design, and construction of 

19 health care facilities serving Indians under this Act. 

20 ‘‘SEC. 317. AUTHORIZATION OF APPROPRIATIONS. 

21 ‘‘There are authorized to be appropriated such sums 

22 as may be necessary for each fiscal year through fiscal 

23 year 2017 to carry out this title. 


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1 ‘‘TITLE IV—ACCESS TO HEALTH 

2 SERVICES 

3 ‘‘SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SE4 CURITY ACT HEALTH BENEFITS PROGRAMS. 

5 ‘‘(a) DISREGARD OF MEDICARE, MEDICAID, AND

6 SCHIP PAYMENTS IN DETERMINING APPROPRIATIONS.— 

7 Any payments received by an Indian Health Program or 

8 by an Urban Indian Organization under title XVIII, XIX, 

9 or XXI of the Social Security Act for services provided 

10 to Indians eligible for benefits under such respective titles 

11 shall not be considered in determining appropriations for 

12 the provision of health care and services to Indians. 

13 ‘‘(b) NONPREFERENTIAL TREATMENT.—Nothing in 

14 this Act authorizes the Secretary to provide services to an 

15 Indian with coverage under title XVIII, XIX, or XXI of 

16 the Social Security Act in preference to an Indian without 

17 such coverage. 

18 ‘‘(c) USE OF FUNDS.— 

19 ‘‘(1) SPECIAL FUND.— 

20 ‘‘(A) 100 PERCENT PASS-THROUGH OF

21 PAYMENTS DUE TO FACILITIES.—Notwith22 standing any other provision of law, but subject 

23 to paragraph (2), payments to which a facility 

24 of the Service is entitled by reason of a provi25 sion of the Social Security Act shall be placed 


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1 in a special fund to be held by the Secretary. 

2 In making payments from such fund, the Sec3 retary shall ensure that each Service Unit of 

4 the Service receives 100 percent of the amount 

5 to which the facilities of the Service, for which 

6 such Service Unit makes collections, are enti7 tled by reason of a provision of the Social Secu8 rity Act. 

9 ‘‘(B) USE OF FUNDS.—Amounts received 

10 by a facility of the Service under subparagraph 

11 (A) shall first be used (to such extent or in 

12 such amounts as are provided in appropriation 

13 Acts) for the purpose of making any improve14 ments in the programs of the Service operated 

15 by or through such facility which may be nec16 essary to achieve or maintain compliance with 

17 the applicable conditions and requirements of 

18 titles XVIII and XIX of the Social Security 

19 Act. Any amounts so received that are in excess 

20 of the amount necessary to achieve or maintain 

21 such conditions and requirements shall, subject 

22 to consultation with the Indian Tribes being 

23 served by the Service Unit, be used for reducing 

24 the health resource deficiencies (as determined 

25 under section 201(d)) of such Indian Tribes. 


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1 ‘‘(2) DIRECT PAYMENT OPTION.—Paragraph 

2 (1) shall not apply to a Tribal Health Program upon 

3 the election of such Program under subsection (d) to 

4 receive payments directly. No payment may be made 

5 out of the special fund described in such paragraph 

6 with respect to reimbursement made for services 

7 provided by such Program during the period of such 

8 election. 

9 ‘‘(d) DIRECT BILLING.— 

10 ‘‘(1) IN GENERAL.—Subject to complying with 

11 the requirements of paragraph (2), a Tribal Health 

12 Program may elect to directly bill for, and receive 

13 payment for, health care items and services provided 

14 by such Program for which payment is made under 

15 title XVIII or XIX of the Social Security Act or 

16 from any other third party payor. 

17 ‘‘(2) DIRECT REIMBURSEMENT.— 

18 ‘‘(A) USE OF FUNDS.—Each Tribal Health 

19 Program making the election described in para20 graph (1) with respect to a program under a 

21 title of the Social Security Act shall be reim22 bursed directly by that program for items and 

23 services furnished without regard to subsection 

24 (c)(1), but all amounts so reimbursed shall be 

25 used by the Tribal Health Program for the purVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00192 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 pose of making any improvements in facilities 

2 of the Tribal Health Program that may be nec3 essary to achieve or maintain compliance with 

4 the conditions and requirements applicable gen5 erally to such items and services under the pro6 gram under such title and to provide additional 

7 health care services, improvements in health 

8 care facilities and Tribal Health Programs, any 

9 health care related purpose, or otherwise to 

10 achieve the objectives provided in section 3 of 

11 this Act. 

12 ‘‘(B) AUDITS.—The amounts paid to a 

13 Tribal Health Program making the election de14 scribed in paragraph (1) with respect to a pro15 gram under a title of the Social Security Act 

16 shall be subject to all auditing requirements ap17 plicable to the program under such title, as well 

18 as all auditing requirements applicable to pro19 grams administered by an Indian Health Pro20 gram. Nothing in the preceding sentence shall 

21 be construed as limiting the application of au22 diting requirements applicable to amounts paid 

23 under title XVIII, XIX, or XXI of the Social 

24 Security Act. 


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1 ‘‘(C) IDENTIFICATION OF SOURCE OF PAY2 MENTS.—Any Tribal Health Program that re3 ceives reimbursements or payments under title 

4 XVIII, XIX, or XXI of the Social Security Act, 

5 shall provide to the Service a list of each pro6 vider enrollment number (or other identifier) 

7 under which such Program receives such reim8 bursements or payments. 

9 ‘‘(3) EXAMINATION AND IMPLEMENTATION OF

10 CHANGES.— 

11 ‘‘(A) IN GENERAL.—The Secretary, acting 

12 through the Service and with the assistance of 

13 the Administrator of the Centers for Medicare 

14 & Medicaid Services, shall examine on an ongo15 ing basis and implement any administrative 

16 changes that may be necessary to facilitate di17 rect billing and reimbursement under the pro18 gram established under this subsection, includ19 ing any agreements with States that may be 

20 necessary to provide for direct billing under a 

21 program under a title of the Social Security 

22 Act. 

23 ‘‘(B) COORDINATION OF INFORMATION.— 

24 The Service shall provide the Administrator of 

25 the Centers for Medicare & Medicaid Services 


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1 with copies of the lists submitted to the Service 

2 under paragraph (2)(C), enrollment data re3 garding patients served by the Service (and by 

4 Tribal Health Programs, to the extent such 

5 data is available to the Service), and such other 

6 information as the Administrator may require 

7 for purposes of administering title XVIII, XIX, 

8 or XXI of the Social Security Act. 

9 ‘‘(4) WITHDRAWAL FROM PROGRAM.—A Tribal 

10 Health Program that bills directly under the pro11 gram established under this subsection may with12 draw from participation in the same manner and 

13 under the same conditions that an Indian Tribe or 

14 Tribal Organization may retrocede a contracted pro15 gram to the Secretary under the authority of the In16 dian Self-Determination and Education Assistance 

17 Act (25 U.S.C. 450 et seq.). All cost accounting and 

18 billing authority under the program established 

19 under this subsection shall be returned to the Sec20 retary upon the Secretary’s acceptance of the with21 drawal of participation in this program. 

22 ‘‘(5) TERMINATION FOR FAILURE TO COMPLY

23 WITH REQUIREMENTS.—The Secretary may termi24 nate the participation of a Tribal Health Program or 

25 in the direct billing program established under this 


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1 subsection if the Secretary determines that the Pro2 gram has failed to comply with the requirements of 

3 paragraph (2). The Secretary shall provide a Tribal 

4 Health Program with notice of a determination that 

5 the Program has failed to comply with any such re6 quirement and a reasonable opportunity to correct 

7 such noncompliance prior to terminating the Pro8 gram’s participation in the direct billing program es9 tablished under this subsection. 

10 ‘‘(e) RELATED PROVISIONS UNDER THE SOCIAL SE11 CURITY ACT.—For provisions related to subsections (c) 

12 and (d), see sections 1880, 1911, and 2107(e)(1)(D) of 

13 the Social Security Act. 

14 ‘‘SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERV15 ICE, INDIAN TRIBES, TRIBAL ORGANIZA16 TIONS, AND URBAN INDIAN ORGANIZATIONS 

17 TO FACILITATE OUTREACH, ENROLLMENT, 

18 AND COVERAGE OF INDIANS UNDER SOCIAL 

19 SECURITY ACT HEALTH BENEFIT PROGRAMS 

20 AND OTHER HEALTH BENEFITS PROGRAMS. 

21 ‘‘(a) INDIAN TRIBES AND TRIBAL ORGANIZA22 TIONS.—From funds appropriated to carry out this title 

23 in accordance with section 416, the Secretary, acting 

24 through the Service, shall make grants to or enter into 

25 contracts with Indian Tribes and Tribal Organizations to 


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1 assist such Tribes and Tribal Organizations in estab2 lishing and administering programs on or near reserva3 tions and trust lands to assist individual Indians— 

4 ‘‘(1) to enroll for benefits under a program es5 tablished under title XVIII, XIX, or XXI of the So6 cial Security Act and other health benefits pro7 grams; and 

8 ‘‘(2) with respect to such programs for which 

9 the charging of premiums and cost sharing is not 

10 prohibited under such programs, to pay premiums or 

11 cost sharing for coverage for such benefits, which 

12 may be based on financial need (as determined by 

13 the Indian Tribe or Tribes or Tribal Organizations 

14 being served based on a schedule of income levels de15 veloped or implemented by such Tribe, Tribes, or 

16 Tribal Organizations). 

17 ‘‘(b) CONDITIONS.—The Secretary, acting through 

18 the Service, shall place conditions as deemed necessary to 

19 effect the purpose of this section in any grant or contract 

20 which the Secretary makes with any Indian Tribe or Trib21 al Organization pursuant to this section. Such conditions 

22 shall include requirements that the Indian Tribe or Tribal 

23 Organization successfully undertake— 

24 ‘‘(1) to determine the population of Indians eli25 gible for the benefits described in subsection (a); 


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1 ‘‘(2) to educate Indians with respect to the ben2 efits available under the respective programs; 

3 ‘‘(3) to provide transportation for such indi4 vidual Indians to the appropriate offices for enroll5 ment or applications for such benefits; and 

6 ‘‘(4) to develop and implement methods of im7 proving the participation of Indians in receiving ben8 efits under such programs. 

9 ‘‘(c) APPLICATION TO URBAN INDIAN ORGANIZA10 TIONS.— 

11 ‘‘(1) IN GENERAL.—The provisions of sub12 section (a) shall apply with respect to grants and 

13 other funding to Urban Indian Organizations with 

14 respect to populations served by such organizations 

15 in the same manner they apply to grants and con16 tracts with Indian Tribes and Tribal Organizations 

17 with respect to programs on or near reservations. 

18 ‘‘(2) REQUIREMENTS.—The Secretary shall in19 clude in the grants or contracts made or provided 

20 under paragraph (1) requirements that are— 

21 ‘‘(A) consistent with the requirements im22 posed by the Secretary under subsection (b); 

23 ‘‘(B) appropriate to Urban Indian Organi24 zations and Urban Indians; and 


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1 ‘‘(C) necessary to effect the purposes of 

2 this section. 

3 ‘‘(d) FACILITATING COOPERATION.—The Secretary, 

4 acting through the Centers for Medicare & Medicaid Serv5 ices, shall take such steps as are necessary to facilitate 

6 cooperation with, and agreements between, States and the 

7 Service, Indian Tribes, Tribal Organizations, or Urban In8 dian Organizations with respect to the provision of health 

9 care items and services to Indians under the programs es10 tablished under title XVIII, XIX, or XXI of the Social 

11 Security Act. 

12 ‘‘(e) AGREEMENTS RELATING TO IMPROVING EN13 ROLLMENT OF INDIANS UNDER SOCIAL SECURITY ACT

14 HEALTH BENEFITS PROGRAMS.—For provisions relating 

15 to agreements between the Secretary, acting through the 

16 Service, and Indian Tribes, Tribal Organizations, and 

17 Urban Indian Organizations for the collection, prepara18 tion, and submission of applications by Indians for assist19 ance under the Medicaid and State children’s health insur20 ance programs established under titles XIX and XXI of 

21 the Social Security Act, and benefits under the Medicare 

22 program established under title XVIII of such Act, see 

23 subsections (a) and (b) of section 1139 of the Social Secu24 rity Act. 


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1 ‘‘(f) DEFINITION OF PREMIUMS AND COST SHAR2 ING.—In this section: 

3 ‘‘(1) PREMIUM.—The term ‘premium’ includes 

4 any enrollment fee or similar charge. 

5 ‘‘(2) COST SHARING.—The term ‘cost sharing’ 

6 includes any deduction, deductible, copayment, coin7 surance, or similar charge. 

8 ‘‘SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PAR9 TIES OF COSTS OF HEALTH SERVICES. 

10 ‘‘(a) RIGHT OF RECOVERY.—Except as provided in 

11 subsection (f), the United States, an Indian Tribe, or 

12 Tribal Organization shall have the right to recover from 

13 an insurance company, health maintenance organization, 

14 employee benefit plan, third-party tortfeasor, or any other 

15 responsible or liable third party (including a political sub16 division or local governmental entity of a State) the rea17 sonable charges billed by the Secretary, an Indian Tribe, 

18 or Tribal Organization in providing health services 

19 through the Service, an Indian Tribe, or Tribal Organiza20 tion to any individual to the same extent that such indi21 vidual, or any nongovernmental provider of such services, 

22 would be eligible to receive damages, reimbursement, or 

23 indemnification for such charges or expenses if— 

24 ‘‘(1) such services had been provided by a non25 governmental provider; and 


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1 ‘‘(2) such individual had been required to pay 

2 such charges or expenses and did pay such charges 

3 or expenses. 

4 ‘‘(b) LIMITATIONS ON RECOVERIES FROM STATES.— 

5 Subsection (a) shall provide a right of recovery against 

6 any State, only if the injury, illness, or disability for which 

7 health services were provided is covered under— 

8 ‘‘(1) workers’ compensation laws; or 

9 ‘‘(2) a no-fault automobile accident insurance 

10 plan or program. 

11 ‘‘(c) NONAPPLICATION OF OTHER LAWS.—No law of 

12 any State, or of any political subdivision of a State and 

13 no provision of any contract, insurance or health mainte14 nance organization policy, employee benefit plan, self-in15 surance plan, managed care plan, or other health care plan 

16 or program entered into or renewed after the date of the 

17 enactment of the Indian Health Care Amendments of 

18 1988, shall prevent or hinder the right of recovery of the 

19 United States, an Indian Tribe, or Tribal Organization 

20 under subsection (a). 

21 ‘‘(d) NO EFFECT ON PRIVATE RIGHTS OF ACTION.— 

22 No action taken by the United States, an Indian Tribe, 

23 or Tribal Organization to enforce the right of recovery 

24 provided under this section shall operate to deny to the 


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1 injured person the recovery for that portion of the person’s 

2 damage not covered hereunder. 

3 ‘‘(e) ENFORCEMENT.— 

4 ‘‘(1) IN GENERAL.—The United States, an In5 dian Tribe, or Tribal Organization may enforce the 

6 right of recovery provided under subsection (a) by— 

7 ‘‘(A) intervening or joining in any civil ac8 tion or proceeding brought— 

9 ‘‘(i) by the individual for whom health 

10 services were provided by the Secretary, an 

11 Indian Tribe, or Tribal Organization; or 

12 ‘‘(ii) by any representative or heirs of 

13 such individual, or 

14 ‘‘(B) instituting a civil action, including a 

15 civil action for injunctive relief and other relief 

16 and including, with respect to a political sub17 division or local governmental entity of a State, 

18 such an action against an official thereof. 

19 ‘‘(2) NOTICE.—All reasonable efforts shall be 

20 made to provide notice of action instituted under 

21 paragraph (1)(B) to the individual to whom health 

22 services were provided, either before or during the 

23 pendency of such action. 

24 ‘‘(3) RECOVERY FROM TORTFEASORS.— 


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1 ‘‘(A) IN GENERAL.—In any case in which 

2 an Indian Tribe or Tribal Organization that is 

3 authorized or required under a compact or con4 tract issued pursuant to the Indian Self-Deter5 mination and Education Assistance Act (25 

6 U.S.C. 450 et seq.) to furnish or pay for health 

7 services to a person who is injured or suffers a 

8 disease on or after the date of enactment of the 

9 Indian Health Care Improvement Act Amend10 ments of 2007 under circumstances that estab11 lish grounds for a claim of liability against the 

12 tortfeasor with respect to the injury or disease, 

13 the Indian Tribe or Tribal Organization shall 

14 have a right to recover from the tortfeasor (or 

15 an insurer of the tortfeasor) the reasonable 

16 value of the health services so furnished, paid 

17 for, or to be paid for, in accordance with the 

18 Federal Medical Care Recovery Act (42 U.S.C. 

19 2651 et seq.), to the same extent and under the 

20 same circumstances as the United States may 

21 recover under that Act. 

22 ‘‘(B) TREATMENT.—The right of an In23 dian Tribe or Tribal Organization to recover 

24 under subparagraph (A) shall be independent of 

25 the rights of the injured or diseased person 


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1 served by the Indian Tribe or Tribal Organiza2 tion. 

3 ‘‘(f) LIMITATION.—Absent specific written authoriza4 tion by the governing body of an Indian Tribe for the pe5 riod of such authorization (which may not be for a period 

6 of more than 1 year and which may be revoked at any 

7 time upon written notice by the governing body to the 

8 Service), the United States shall not have a right of recov9 ery under this section if the injury, illness, or disability 

10 for which health services were provided is covered under 

11 a self-insurance plan funded by an Indian Tribe, Tribal 

12 Organization, or Urban Indian Organization. Where such 

13 authorization is provided, the Service may receive and ex14 pend such amounts for the provision of additional health 

15 services consistent with such authorization. 

16 ‘‘(g) COSTS AND ATTORNEYS’ FEES.—In any action 

17 brought to enforce the provisions of this section, a pre18 vailing plaintiff shall be awarded its reasonable attorneys’ 

19 fees and costs of litigation. 

20 ‘‘(h) NONAPPLICATION OF CLAIMS FILING REQUIRE21 MENTS.—An insurance company, health maintenance or22 ganization, self-insurance plan, managed care plan, or 

23 other health care plan or program (under the Social Secu24 rity Act or otherwise) may not deny a claim for benefits 

25 submitted by the Service or by an Indian Tribe or Tribal 


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1 Organization based on the format in which the claim is 

2 submitted if such format complies with the format re3 quired for submission of claims under title XVIII of the 

4 Social Security Act or recognized under section 1175 of 

5 such Act. 

6 ‘‘(i) APPLICATION TO URBAN INDIAN ORGANIZA7 TIONS.—The previous provisions of this section shall apply 

8 to Urban Indian Organizations with respect to populations 

9 served by such Organizations in the same manner they 

10 apply to Indian Tribes and Tribal Organizations with re11 spect to populations served by such Indian Tribes and 

12 Tribal Organizations. 

13 ‘‘(j) STATUTE OF LIMITATIONS.—The provisions of 

14 section 2415 of title 28, United States Code, shall apply 

15 to all actions commenced under this section, and the ref16 erences therein to the United States are deemed to include 

17 Indian Tribes, Tribal Organizations, and Urban Indian 

18 Organizations. 

19 ‘‘(k) SAVINGS.—Nothing in this section shall be con20 strued to limit any right of recovery available to the 

21 United States, an Indian Tribe, or Tribal Organization 

22 under the provisions of any applicable, Federal, State, or 

23 Tribal law, including medical lien laws. 

24 ‘‘SEC. 404. CREDITING OF REIMBURSEMENTS. 

25 ‘‘(a) USE OF AMOUNTS.— 


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1 ‘‘(1) RETENTION BY PROGRAM.—Except as pro2 vided in section 202(f) (relating to the Catastrophic 

3 Health Emergency Fund) and section 807 (relating 

4 to health services for ineligible persons), all reim5 bursements received or recovered under any of the 

6 programs described in paragraph (2), including 

7 under section 807, by reason of the provision of 

8 health services by the Service, by an Indian Tribe or 

9 Tribal Organization, or by an Urban Indian Organi10 zation, shall be credited to the Service, such Indian 

11 Tribe or Tribal Organization, or such Urban Indian 

12 Organization, respectively, and may be used as pro13 vided in section 401. In the case of such a service 

14 provided by or through a Service Unit, such 

15 amounts shall be credited to such unit and used for 

16 such purposes. 

17 ‘‘(2) PROGRAMS COVERED.—The programs re18 ferred to in paragraph (1) are the following: 

19 ‘‘(A) Titles XVIII, XIX, and XXI of the 

20 Social Security Act. 

21 ‘‘(B) This Act, including section 807. 

22 ‘‘(C) Public Law 87–693. 

23 ‘‘(D) Any other provision of law. 

24 ‘‘(b) NO OFFSET OF AMOUNTS.—The Service may 

25 not offset or limit any amount obligated to any Service 


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1 Unit or entity receiving funding from the Service because 

2 of the receipt of reimbursements under subsection (a). 

3 ‘‘SEC. 405. PURCHASING HEALTH CARE COVERAGE. 

4 ‘‘(a) IN GENERAL.—Insofar as amounts are made 

5 available under law (including a provision of the Social 

6 Security Act, the Indian Self-Determination and Edu7 cation Assistance Act (25 U.S.C. 450 et seq.), or other 

8 law, other than under section 402) to Indian Tribes, Trib9 al Organizations, and Urban Indian Organizations for 

10 health benefits for Service beneficiaries, Indian Tribes, 

11 Tribal Organizations, and Urban Indian Organizations 

12 may use such amounts to purchase health benefits cov13 erage for such beneficiaries in any manner, including 

14 through— 

15 ‘‘(1) a tribally owned and operated health care 

16 plan; 

17 ‘‘(2) a State or locally authorized or licensed 

18 health care plan; 

19 ‘‘(3) a health insurance provider or managed 

20 care organization; or 

21 ‘‘(4) a self-insured plan. 

22 The purchase of such coverage by an Indian Tribe, Tribal 

23 Organization, or Urban Indian Organization may be based 

24 on the financial needs of such beneficiaries (as determined 

25 by the Indian Tribe or Tribes being served based on a 


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1 schedule of income levels developed or implemented by 

2 such Indian Tribe or Tribes). 

3 ‘‘(b) EXPENSES FOR SELF-INSURED PLAN.—In the 

4 case of a self-insured plan under subsection (a)(4), the 

5 amounts may be used for expenses of operating the plan, 

6 including administration and insurance to limit the finan7 cial risks to the entity offering the plan. 

8 ‘‘(c) CONSTRUCTION.—Nothing in this section shall 

9 be construed as affecting the use of any amounts not re10 ferred to in subsection (a). 

11 ‘‘SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGEN12 CIES. 

13 ‘‘(a) AUTHORITY.— 

14 ‘‘(1) IN GENERAL.—The Secretary may enter 

15 into (or expand) arrangements for the sharing of 

16 medical facilities and services between the Service, 

17 Indian Tribes, and Tribal Organizations and the De18 partment of Veterans Affairs and the Department of 

19 Defense. 

20 ‘‘(2) CONSULTATION BY SECRETARY RE21 QUIRED.—The Secretary may not finalize any ar22 rangement between the Service and a Department 

23 described in paragraph (1) without first consulting 

24 with the Indian Tribes which will be significantly af25 fected by the arrangement. 


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1 ‘‘(b) LIMITATIONS.—The Secretary shall not take 

2 any action under this section or under subchapter IV of 

3 chapter 81 of title 38, United States Code, which would 

4 impair— 

5 ‘‘(1) the priority access of any Indian to health 

6 care services provided through the Service and the 

7 eligibility of any Indian to receive health services 

8 through the Service; 

9 ‘‘(2) the quality of health care services provided 

10 to any Indian through the Service; 

11 ‘‘(3) the priority access of any veteran to health 

12 care services provided by the Department of Vet13 erans Affairs; 

14 ‘‘(4) the quality of health care services provided 

15 by the Department of Veterans Affairs or the De16 partment of Defense; or 

17 ‘‘(5) the eligibility of any Indian who is a vet18 eran to receive health services through the Depart19 ment of Veterans Affairs. 

20 ‘‘(c) REIMBURSEMENT.—The Service, Indian Tribe, 

21 or Tribal Organization shall be reimbursed by the Depart22 ment of Veterans Affairs or the Department of Defense 

23 (as the case may be) where services are provided through 

24 the Service, an Indian Tribe, or a Tribal Organization to 


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1 beneficiaries eligible for services from either such Depart2 ment, notwithstanding any other provision of law. 

3 ‘‘(d) CONSTRUCTION.—Nothing in this section may 

4 be construed as creating any right of a non-Indian veteran 

5 to obtain health services from the Service. 

6 ‘‘SEC. 407. PAYOR OF LAST RESORT. 

7 ‘‘Indian Health Programs and health care programs 

8 operated by Urban Indian Organizations shall be the 

9 payor of last resort for services provided to persons eligible 

10 for services from Indian Health Programs and Urban In11 dian Organizations, notwithstanding any Federal, State, 

12 or local law to the contrary. 

13 ‘‘SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH 

14 CARE PROGRAMS IN QUALIFICATIONS FOR 

15 REIMBURSEMENT FOR SERVICES. 

16 ‘‘(a) REQUIREMENT TO SATISFY GENERALLY APPLI17 CABLE PARTICIPATION REQUIREMENTS.— 

18 ‘‘(1) IN GENERAL.—A Federal health care pro19 gram must accept an entity that is operated by the 

20 Service, an Indian Tribe, Tribal Organization, or 

21 Urban Indian Organization as a provider eligible to 

22 receive payment under the program for health care 

23 services furnished to an Indian on the same basis as 

24 any other provider qualified to participate as a pro25 vider of health care services under the program if 


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1 the entity meets generally applicable State or other 

2 requirements for participation as a provider of 

3 health care services under the program. 

4 ‘‘(2) SATISFACTION OF STATE OR LOCAL LICEN5 SURE OR RECOGNITION REQUIREMENTS.—Any re6 quirement for participation as a provider of health 

7 care services under a Federal health care program 

8 that an entity be licensed or recognized under the 

9 State or local law where the entity is located to fur10 nish health care services shall be deemed to have 

11 been met in the case of an entity operated by the 

12 Service, an Indian Tribe, Tribal Organization, or 

13 Urban Indian Organization if the entity meets all 

14 the applicable standards for such licensure or rec15 ognition, regardless of whether the entity obtains a 

16 license or other documentation under such State or 

17 local law. In accordance with section 221, the ab18 sence of the licensure of a health care professional 

19 employed by such an entity under the State or local 

20 law where the entity is located shall not be taken 

21 into account for purposes of determining whether 

22 the entity meets such standards, if the professional 

23 is licensed in another State. 

24 ‘‘(b) APPLICATION OF EXCLUSION FROM PARTICIPA25 TION IN FEDERAL HEALTH CARE PROGRAMS.— 


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1 ‘‘(1) EXCLUDED ENTITIES.—No entity operated 

2 by the Service, an Indian Tribe, Tribal Organiza3 tion, or Urban Indian Organization that has been 

4 excluded from participation in any Federal health 

5 care program or for which a license is under suspen6 sion or has been revoked by the State where the en7 tity is located shall be eligible to receive payment or 

8 reimbursement under any such program for health 

9 care services furnished to an Indian. 

10 ‘‘(2) EXCLUDED INDIVIDUALS.—No individual 

11 who has been excluded from participation in any 

12 Federal health care program or whose State license 

13 is under suspension shall be eligible to receive pay14 ment or reimbursement under any such program for 

15 health care services furnished by that individual, di16 rectly or through an entity that is otherwise eligible 

17 to receive payment for health care services, to an In18 dian. 

19 ‘‘(3) FEDERAL HEALTH CARE PROGRAM DE20 FINED.—In this subsection, the term, ‘Federal 

21 health care program’ has the meaning given that 

22 term in section 1128B(f) of the Social Security Act 

23 (42 U.S.C. 1320a–7b(f)), except that, for purposes 

24 of this subsection, such term shall include the health 


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1 insurance program under chapter 89 of title 5, 

2 United States Code. 

3 ‘‘(c) RELATED PROVISIONS.—For provisions related 

4 to nondiscrimination against providers operated by the 

5 Service, an Indian Tribe, Tribal Organization, or Urban 

6 Indian Organization, see section 1139(c) of the Social Se7 curity Act (42 U.S.C. 1320b–9(c)). 

8 ‘‘SEC. 409. CONSULTATION. 

9 ‘‘For provisions related to consultation with rep10 resentatives of Indian Health Programs and Urban Indian 

11 Organizations with respect to the health care programs 

12 established under titles XVIII, XIX, and XXI of the Social 

13 Security Act, see section 1139(d) of the Social Security 

14 Act (42 U.S.C. 1320b–9(d)). 

15 ‘‘SEC. 410. STATE CHILDREN’S HEALTH INSURANCE PRO16 GRAM (SCHIP). 

17 ‘‘For provisions relating to— 

18 ‘‘(1) outreach to families of Indian children 

19 likely to be eligible for child health assistance under 

20 the State children’s health insurance program estab21 lished under title XXI of the Social Security Act, see 

22 sections 2105(c)(2)(C) and 1139(a) of such Act (42 

23 U.S.C. 1397ee(c)(2), 1320b–9); and 

24 ‘‘(2) ensuring that child health assistance is 

25 provided under such program to targeted low-income 


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1 children who are Indians and that payments are 

2 made under such program to Indian Health Pro3 grams and Urban Indian Organizations operating in 

4 the State that provide such assistance, see sections 

5 2102(b)(3)(D) and 2105(c)(6)(B) of such Act (42 

6 U.S.C. 1397bb(b)(3)(D), 1397ee(c)(6)(B)). 

7 ‘‘SEC. 411. EXCLUSION WAIVER AUTHORITY FOR AFFECTED 

8 INDIAN HEALTH PROGRAMS AND SAFE HAR9 BOR TRANSACTIONS UNDER THE SOCIAL SE10 CURITY ACT. 

11 ‘‘For provisions relating to— 

12 ‘‘(1) exclusion waiver authority for affected In13 dian Health Programs under the Social Security 

14 Act, see section 1128(k) of the Social Security Act 

15 (42 U.S.C. 1320a–7(k)); and 

16 ‘‘(2) certain transactions involving Indian 

17 Health Programs deemed to be in safe harbors 

18 under that Act, see section 1128B(b)(4) of the So19 cial Security Act (42 U.S.C. 1320a–7b(b)(4)). 

20 ‘‘SEC. 412. PREMIUM AND COST SHARING PROTECTIONS 

21 AND ELIGIBILITY DETERMINATIONS UNDER 

22 MEDICAID AND SCHIP AND PROTECTION OF 

23 CERTAIN INDIAN PROPERTY FROM MEDICAID 

24 ESTATE RECOVERY. 

25 ‘‘For provisions relating to— 


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1 ‘‘(1) premiums or cost sharing protections for 

2 Indians furnished items or services directly by In3 dian Health Programs or through referral under the 

4 contract health service under the Medicaid program 

5 established under title XIX of the Social Security 

6 Act, see sections 1916(j) and 1916A(a)(1) of the So7 cial Security Act (42 U.S.C. 1396o(j), 1396o– 

8 1(a)(1)); 

9 ‘‘(2) rules regarding the treatment of certain 

10 property for purposes of determining eligibility 

11 under such programs, see sections 1902(e)(13) and 

12 2107(e)(1)(B) of such Act (42 U.S.C. 1396a(e)(13), 

13 1397gg(e)(1)(B)); and 

14 ‘‘(3) the protection of certain property from es15 tate recovery provisions under the Medicaid pro16 gram, see section 1917(b)(3)(B) of such Act (42 

17 U.S.C. 1396p(b)(3)(B)). 

18 ‘‘SEC. 413. TREATMENT UNDER MEDICAID AND SCHIP MAN19 AGED CARE. 

20 ‘‘For provisions relating to the treatment of Indians 

21 enrolled in a managed care entity under the Medicaid pro22 gram under title XIX of the Social Security Act and In23 dian Health Programs and Urban Indian Organizations 

24 that are providers of items or services to such Indian en25 rollees, see sections 1932(h) and 2107(e)(1)(H) of the SoVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00215 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 cial Security Act (42 U.S.C. 1396u–2(h), 

2 1397gg(e)(1)(H)). 

3 ‘‘SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASI4 BILITY STUDY. 

5 ‘‘(a) STUDY.—The Secretary shall conduct a study 

6 to determine the feasibility of treating the Navajo Nation 

7 as a State for the purposes of title XIX of the Social Secu8 rity Act, to provide services to Indians living within the 

9 boundaries of the Navajo Nation through an entity estab10 lished having the same authority and performing the same 

11 functions as single-State medicaid agencies responsible for 

12 the administration of the State plan under title XIX of 

13 the Social Security Act. 

14 ‘‘(b) CONSIDERATIONS.—In conducting the study, 

15 the Secretary shall consider the feasibility of— 

16 ‘‘(1) assigning and paying all expenditures for 

17 the provision of services and related administration 

18 funds, under title XIX of the Social Security Act, to 

19 Indians living within the boundaries of the Navajo 

20 Nation that are currently paid to or would otherwise 

21 be paid to the State of Arizona, New Mexico, or 

22 Utah; 

23 ‘‘(2) providing assistance to the Navajo Nation 

24 in the development and implementation of such enti25 ty for the administration, eligibility, payment, and 


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1 delivery of medical assistance under title XIX of the 

2 Social Security Act; 

3 ‘‘(3) providing an appropriate level of matching 

4 funds for Federal medical assistance with respect to 

5 amounts such entity expends for medical assistance 

6 for services and related administrative costs; and 

7 ‘‘(4) authorizing the Secretary, at the option of 

8 the Navajo Nation, to treat the Navajo Nation as a 

9 State for the purposes of title XIX of the Social Se10 curity Act (relating to the State children’s health in11 surance program) under terms equivalent to those 

12 described in paragraphs (2) through (4). 

13 ‘‘(c) REPORT.—Not later then 3 years after the date 

14 of enactment of the Indian Health Care Improvement Act 

15 Amendments of 2007, the Secretary shall submit to the 

16 Committee on Indian Affairs and Committee on Finance 

17 of the Senate and the Committee on Natural Resources 

18 and Committee on Energy and Commerce of the House 

19 of Representatives a report that includes— 

20 ‘‘(1) the results of the study under this section; 

21 ‘‘(2) a summary of any consultation that oc22 curred between the Secretary and the Navajo Na23 tion, other Indian Tribes, the States of Arizona, 

24 New Mexico, and Utah, counties which include NavVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00217 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 ajo Lands, and other interested parties, in con2 ducting this study; 

3 ‘‘(3) projected costs or savings associated with 

4 establishment of such entity, and any estimated im5 pact on services provided as described in this section 

6 in relation to probable costs or savings; and 

7 ‘‘(4) legislative actions that would be required 

8 to authorize the establishment of such entity if such 

9 entity is determined by the Secretary to be feasible. 

10 ‘‘SEC. 415. GENERAL EXCEPTIONS. 

11 ‘‘The requirements of this title shall not apply to any 

12 excepted benefits described in paragraph (1)(A) or (3) of 

13 section 2791(c) of the Public Health Service Act (42 

14 U.S.C. 300gg–91). 

15 ‘‘SEC. 416. AUTHORIZATION OF APPROPRIATIONS. 

16 ‘‘There are authorized to be appropriated such sums 

17 as may be necessary for each fiscal year through fiscal 

18 year 2017 to carry out this title. 

19 ‘‘TITLE V—HEALTH SERVICES 

20 FOR URBAN INDIANS 

21 ‘‘SEC. 501. PURPOSE. 

22 ‘‘The purpose of this title is to establish and maintain 

23 programs in Urban Centers to make health services more 

24 accessible and available to Urban Indians. 


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1 ‘‘SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN IN2 DIAN ORGANIZATIONS. 

3 ‘‘Under authority of the Act of November 2, 1921 

4 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

5 the Secretary, acting through the Service, shall enter into 

6 contracts with, or make grants to, Urban Indian Organi7 zations to assist such organizations in the establishment 

8 and administration, within Urban Centers, of programs 

9 which meet the requirements set forth in this title. Subject 

10 to section 506, the Secretary, acting through the Service, 

11 shall include such conditions as the Secretary considers 

12 necessary to effect the purpose of this title in any contract 

13 into which the Secretary enters with, or in any grant the 

14 Secretary makes to, any Urban Indian Organization pur15 suant to this title. 

16 ‘‘SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION 

17 OF HEALTH CARE AND REFERRAL SERVICES. 

18 ‘‘(a) REQUIREMENTS FOR GRANTS AND CON19 TRACTS.—Under authority of the Act of November 2, 

20 1921 (25 U.S.C. 13) (commonly known as the ‘Snyder 

21 Act’), the Secretary, acting through the Service, shall 

22 enter into contracts with, and make grants to, Urban In23 dian Organizations for the provision of health care and 

24 referral services for Urban Indians. Any such contract or 

25 grant shall include requirements that the Urban Indian 

26 Organization successfully undertake to— 


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1 ‘‘(1) estimate the population of Urban Indians 

2 residing in the Urban Center or centers that the or3 ganization proposes to serve who are or could be re4 cipients of health care or referral services; 

5 ‘‘(2) estimate the current health status of 

6 Urban Indians residing in such Urban Center or 

7 centers; 

8 ‘‘(3) estimate the current health care needs of 

9 Urban Indians residing in such Urban Center or 

10 centers; 

11 ‘‘(4) provide basic health education, including 

12 health promotion and disease prevention education, 

13 to Urban Indians; 

14 ‘‘(5) make recommendations to the Secretary 

15 and Federal, State, local, and other resource agen16 cies on methods of improving health service pro17 grams to meet the needs of Urban Indians; and 

18 ‘‘(6) where necessary, provide, or enter into 

19 contracts for the provision of, health care services 

20 for Urban Indians. 

21 ‘‘(b) CRITERIA.—The Secretary, acting through the 

22 Service, shall, by regulation, prescribe the criteria for se23 lecting Urban Indian Organizations to enter into contracts 

24 or receive grants under this section. Such criteria shall, 

25 among other factors, include— 


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1 ‘‘(1) the extent of unmet health care needs of 

2 Urban Indians in the Urban Center or centers in3 volved; 

4 ‘‘(2) the size of the Urban Indian population in 

5 the Urban Center or centers involved; 

6 ‘‘(3) the extent, if any, to which the activities 

7 set forth in subsection (a) would duplicate any 

8 project funded under this title, or under any current 

9 public health service project funded in a manner 

10 other than pursuant to this title; 

11 ‘‘(4) the capability of an Urban Indian Organi12 zation to perform the activities set forth in sub13 section (a) and to enter into a contract with the Sec14 retary or to meet the requirements for receiving a 

15 grant under this section; 

16 ‘‘(5) the satisfactory performance and success17 ful completion by an Urban Indian Organization of 

18 other contracts with the Secretary under this title; 

19 ‘‘(6) the appropriateness and likely effectiveness 

20 of conducting the activities set forth in subsection 

21 (a) in an Urban Center or centers; and 

22 ‘‘(7) the extent of existing or likely future par23 ticipation in the activities set forth in subsection (a) 

24 by appropriate health and health-related Federal, 

25 State, local, and other agencies. 


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1 ‘‘(c) ACCESS TO HEALTH PROMOTION AND DISEASE

2 PREVENTION PROGRAMS.—The Secretary, acting through 

3 the Service, shall facilitate access to or provide health pro4 motion and disease prevention services for Urban Indians 

5 through grants made to Urban Indian Organizations ad6 ministering contracts entered into or receiving grants 

7 under subsection (a). 

8 ‘‘(d) IMMUNIZATION SERVICES.— 

9 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

10 Secretary, acting through the Service, shall facilitate 

11 access to, or provide, immunization services for 

12 Urban Indians through grants made to Urban In13 dian Organizations administering contracts entered 

14 into or receiving grants under this section. 

15 ‘‘(2) DEFINITION.—For purposes of this sub16 section, the term ‘immunization services’ means 

17 services to provide without charge immunizations 

18 against vaccine-preventable diseases. 

19 ‘‘(e) BEHAVIORAL HEALTH SERVICES.— 

20 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

21 Secretary, acting through the Service, shall facilitate 

22 access to, or provide, behavioral health services for 

23 Urban Indians through grants made to Urban In24 dian Organizations administering contracts entered 

25 into or receiving grants under subsection (a). 


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1 ‘‘(2) ASSESSMENT REQUIRED.—Except as pro2 vided by paragraph (3)(A), a grant may not be made 

3 under this subsection to an Urban Indian Organiza4 tion until that organization has prepared, and the 

5 Service has approved, an assessment of the fol6 lowing: 

7 ‘‘(A) The behavioral health needs of the 

8 Urban Indian population concerned. 

9 ‘‘(B) The behavioral health services and 

10 other related resources available to that popu11 lation. 

12 ‘‘(C) The barriers to obtaining those serv13 ices and resources. 

14 ‘‘(D) The needs that are unmet by such 

15 services and resources. 

16 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

17 made under this subsection for the following: 

18 ‘‘(A) To prepare assessments required 

19 under paragraph (2). 

20 ‘‘(B) To provide outreach, educational, and 

21 referral services to Urban Indians regarding the 

22 availability of direct behavioral health services, 

23 to educate Urban Indians about behavioral 

24 health issues and services, and effect coordinaVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00223 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 tion with existing behavioral health providers in 

2 order to improve services to Urban Indians. 

3 ‘‘(C) To provide outpatient behavioral 

4 health services to Urban Indians, including the 

5 identification and assessment of illness, thera6 peutic treatments, case management, support 

7 groups, family treatment, and other treatment. 

8 ‘‘(D) To develop innovative behavioral 

9 health service delivery models which incorporate 

10 Indian cultural support systems and resources. 

11 ‘‘(f) PREVENTION OF CHILD ABUSE.— 

12 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

13 Secretary, acting through the Service, shall facilitate 

14 access to or provide services for Urban Indians 

15 through grants to Urban Indian Organizations ad16 ministering contracts entered into or receiving 

17 grants under subsection (a) to prevent and treat 

18 child abuse (including sexual abuse) among Urban 

19 Indians. 

20 ‘‘(2) EVALUATION REQUIRED.—Except as pro21 vided by paragraph (3)(A), a grant may not be made 

22 under this subsection to an Urban Indian Organiza23 tion until that organization has prepared, and the 

24 Service has approved, an assessment that documents 

25 the prevalence of child abuse in the Urban Indian 


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1 population concerned and specifies the services and 

2 programs (which may not duplicate existing services 

3 and programs) for which the grant is requested. 

4 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

5 made under this subsection for the following: 

6 ‘‘(A) To prepare assessments required 

7 under paragraph (2). 

8 ‘‘(B) For the development of prevention, 

9 training, and education programs for Urban In10 dians, including child education, parent edu11 cation, provider training on identification and 

12 intervention, education on reporting require13 ments, prevention campaigns, and establishing 

14 service networks of all those involved in Indian 

15 child protection. 

16 ‘‘(C) To provide direct outpatient treat17 ment services (including individual treatment, 

18 family treatment, group therapy, and support 

19 groups) to Urban Indians who are child victims 

20 of abuse (including sexual abuse) or adult sur21 vivors of child sexual abuse, to the families of 

22 such child victims, and to Urban Indian per23 petrators of child abuse (including sexual 

24 abuse). 


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1 ‘‘(4) CONSIDERATIONS WHEN MAKING

2 GRANTS.—In making grants to carry out this sub3 section, the Secretary shall take into consideration— 

4 ‘‘(A) the support for the Urban Indian Or5 ganization demonstrated by the child protection 

6 authorities in the area, including committees or 

7 other services funded under the Indian Child 

8 Welfare Act of 1978 (25 U.S.C. 1901 et seq.), 

9 if any; 

10 ‘‘(B) the capability and expertise dem11 onstrated by the Urban Indian Organization to 

12 address the complex problem of child sexual 

13 abuse in the community; and 

14 ‘‘(C) the assessment required under para15 graph (2). 

16 ‘‘(g) OTHER GRANTS.—The Secretary, acting 

17 through the Service, may enter into a contract with or 

18 make grants to an Urban Indian Organization that pro19 vides or arranges for the provision of health care services 

20 (through satellite facilities, provider networks, or other21 wise) to Urban Indians in more than 1 Urban Center. 

22 ‘‘SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINA23 TION OF UNMET HEALTH CARE NEEDS. 

24 ‘‘(a) GRANTS AND CONTRACTS AUTHORIZED.— 

25 Under authority of the Act of November 2, 1921 (25 


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1 U.S.C. 13) (commonly known as the ‘Snyder Act’), the 

2 Secretary, acting through the Service, may enter into con3 tracts with or make grants to Urban Indian Organizations 

4 situated in Urban Centers for which contracts have not 

5 been entered into or grants have not been made under sec6 tion 503. 

7 ‘‘(b) PURPOSE.—The purpose of a contract or grant 

8 made under this section shall be the determination of the 

9 matters described in subsection (c)(1) in order to assist 

10 the Secretary in assessing the health status and health 

11 care needs of Urban Indians in the Urban Center involved 

12 and determining whether the Secretary should enter into 

13 a contract or make a grant under section 503 with respect 

14 to the Urban Indian Organization which the Secretary has 

15 entered into a contract with, or made a grant to, under 

16 this section. 

17 ‘‘(c) GRANT AND CONTRACT REQUIREMENTS.—Any 

18 contract entered into, or grant made, by the Secretary 

19 under this section shall include requirements that— 

20 ‘‘(1) the Urban Indian Organization success21 fully undertakes to— 

22 ‘‘(A) document the health care status and 

23 unmet health care needs of Urban Indians in 

24 the Urban Center involved; and 


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1 ‘‘(B) with respect to Urban Indians in the 

2 Urban Center involved, determine the matters 

3 described in paragraphs (2), (3), (4), and (7) of 

4 section 503(b); and 

5 ‘‘(2) the Urban Indian Organization complete 

6 performance of the contract, or carry out the re7 quirements of the grant, within 1 year after the date 

8 on which the Secretary and such organization enter 

9 into such contract, or within 1 year after such orga10 nization receives such grant, whichever is applicable. 

11 ‘‘(d) NO RENEWALS.—The Secretary may not renew 

12 any contract entered into or grant made under this sec13 tion. 

14 ‘‘SEC. 505. EVALUATIONS; RENEWALS. 

15 ‘‘(a) PROCEDURES FOR EVALUATIONS.—The Sec16 retary, acting through the Service, shall develop proce17 dures to evaluate compliance with grant requirements and 

18 compliance with and performance of contracts entered into 

19 by Urban Indian Organizations under this title. Such pro20 cedures shall include provisions for carrying out the re21 quirements of this section. 

22 ‘‘(b) EVALUATIONS.—The Secretary, acting through 

23 the Service, shall evaluate the compliance of each Urban 

24 Indian Organization which has entered into a contract or 

25 received a grant under section 503 with the terms of such 


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1 contract or grant. For purposes of this evaluation, the 

2 Secretary shall— 

3 ‘‘(1) acting through the Service, conduct an an4 nual onsite evaluation of the organization; or 

5 ‘‘(2) accept in lieu of such onsite evaluation evi6 dence of the organization’s provisional or full accred7 itation by a private independent entity recognized by 

8 the Secretary for purposes of conducting quality re9 views of providers participating in the Medicare pro10 gram under title XVIII of the Social Security Act. 

11 ‘‘(c) NONCOMPLIANCE; UNSATISFACTORY PERFORM12 ANCE.—If, as a result of the evaluations conducted under 

13 this section, the Secretary determines that an Urban In14 dian Organization has not complied with the requirements 

15 of a grant or complied with or satisfactorily performed a 

16 contract under section 503, the Secretary shall, prior to 

17 renewing such contract or grant, attempt to resolve with 

18 the organization the areas of noncompliance or unsatisfac19 tory performance and modify the contract or grant to pre20 vent future occurrences of noncompliance or unsatisfac21 tory performance. If the Secretary determines that the 

22 noncompliance or unsatisfactory performance cannot be 

23 resolved and prevented in the future, the Secretary shall 

24 not renew the contract or grant with the organization and 

25 is authorized to enter into a contract or make a grant 


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1 under section 503 with another Urban Indian Organiza2 tion which is situated in the same Urban Center as the 

3 Urban Indian Organization whose contract or grant is not 

4 renewed under this section. 

5 ‘‘(d) CONSIDERATIONS FOR RENEWALS.—In deter6 mining whether to renew a contract or grant with an 

7 Urban Indian Organization under section 503 which has 

8 completed performance of a contract or grant under sec9 tion 504, the Secretary shall review the records of the 

10 Urban Indian Organization, the reports submitted under 

11 section 507, and shall consider the results of the onsite 

12 evaluations or accreditations under subsection (b). 

13 ‘‘SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS. 

14 ‘‘(a) PROCUREMENT.—Contracts with Urban Indian 

15 Organizations entered into pursuant to this title shall be 

16 in accordance with all Federal contracting laws and regu17 lations relating to procurement except that in the discre18 tion of the Secretary, such contracts may be negotiated 

19 without advertising and need not conform to the provisions 

20 of sections 1304 and 3131 through 3133 of title 40, 

21 United States Code. 

22 ‘‘(b) PAYMENTS UNDER CONTRACTS OR GRANTS.— 

23 ‘‘(1) IN GENERAL.—Payments under any con24 tracts or grants pursuant to this title, notwithVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00230 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 standing any term or condition of such contract or 

2 grant— 

3 ‘‘(A) may be made in a single advance pay4 ment by the Secretary to the Urban Indian Or5 ganization by no later than the end of the first 

6 30 days of the funding period with respect to 

7 which the payments apply, unless the Secretary 

8 determines through an evaluation under section 

9 505 that the organization is not capable of ad10 ministering such a single advance payment; and 

11 ‘‘(B) if any portion thereof is unexpended 

12 by the Urban Indian Organization during the 

13 funding period with respect to which the pay14 ments initially apply, shall be carried forward 

15 for expenditure with respect to allowable or re16 imbursable costs incurred by the organization 

17 during 1 or more subsequent funding periods 

18 without additional justification or documenta19 tion by the organization as a condition of car20 rying forward the availability for expenditure of 

21 such funds. 

22 ‘‘(2) SEMIANNUAL AND QUARTERLY PAYMENTS

23 AND REIMBURSEMENTS.—If the Secretary deter24 mines under paragraph (1)(A) that an Urban Indian 

25 Organization is not capable of administering an enVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00231 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 tire single advance payment, on request of the 

2 Urban Indian Organization, the payments may be 

3 made— 

4 ‘‘(A) in semiannual or quarterly payments 

5 by not later than 30 days after the date on 

6 which the funding period with respect to which 

7 the payments apply begins; or 

8 ‘‘(B) by way of reimbursement. 

9 ‘‘(c) REVISION OR AMENDMENT OF CONTRACTS.— 

10 Notwithstanding any provision of law to the contrary, the 

11 Secretary may, at the request and consent of an Urban 

12 Indian Organization, revise or amend any contract entered 

13 into by the Secretary with such organization under this 

14 title as necessary to carry out the purposes of this title. 

15 ‘‘(d) FAIR AND UNIFORM SERVICES AND ASSIST16 ANCE.—Contracts with or grants to Urban Indian Organi17 zations and regulations adopted pursuant to this title shall 

18 include provisions to assure the fair and uniform provision 

19 to Urban Indians of services and assistance under such 

20 contracts or grants by such organizations. 

21 ‘‘SEC. 507. REPORTS AND RECORDS. 

22 ‘‘(a) REPORTS.— 

23 ‘‘(1) IN GENERAL.—For each fiscal year during 

24 which an Urban Indian Organization receives or ex25 pends funds pursuant to a contract entered into or 


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1 a grant received pursuant to this title, such Urban 

2 Indian Organization shall submit to the Secretary 

3 not more frequently than every 6 months, a report 

4 that includes the following: 

5 ‘‘(A) In the case of a contract or grant 

6 under section 503, recommendations pursuant 

7 to section 503(a)(5). 

8 ‘‘(B) Information on activities conducted 

9 by the organization pursuant to the contract or 

10 grant. 

11 ‘‘(C) An accounting of the amounts and 

12 purpose for which Federal funds were ex13 pended. 

14 ‘‘(D) A minimum set of data, using uni15 formly defined elements, as specified by the 

16 Secretary after consultation with Urban Indian 

17 Organizations. 

18 ‘‘(2) HEALTH STATUS AND SERVICES.— 

19 ‘‘(A) IN GENERAL.—Not later than 18 

20 months after the date of enactment of the In21 dian Health Care Improvement Act Amend22 ments of 2007, the Secretary, acting through 

23 the Service, shall submit to Congress a report 

24 evaluating— 


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1 ‘‘(i) the health status of Urban Indi2 ans; 

3 ‘‘(ii) the services provided to Indians 

4 pursuant to this title; and 

5 ‘‘(iii) areas of unmet needs in the de6 livery of health services to Urban Indians. 

7 ‘‘(B) CONSULTATION AND CONTRACTS.— 

8 In preparing the report under paragraph (1), 

9 the Secretary— 

10 ‘‘(i) shall consult with Urban Indian 

11 Organizations; and 

12 ‘‘(ii) may enter into a contract with a 

13 national organization representing Urban 

14 Indian Organizations to conduct any as15 pect of the report. 

16 ‘‘(b) AUDIT.—The reports and records of the Urban 

17 Indian Organization with respect to a contract or grant 

18 under this title shall be subject to audit by the Secretary 

19 and the Comptroller General of the United States. 

20 ‘‘(c) COSTS OF AUDITS.—The Secretary shall allow 

21 as a cost of any contract or grant entered into or awarded 

22 under section 502 or 503 the cost of an annual inde23 pendent financial audit conducted by— 

24 ‘‘(1) a certified public accountant; or 


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1 ‘‘(2) a certified public accounting firm qualified 

2 to conduct Federal compliance audits. 

3 ‘‘SEC. 508. LIMITATION ON CONTRACT AUTHORITY. 

4 ‘‘The authority of the Secretary to enter into con5 tracts or to award grants under this title shall be to the 

6 extent, and in an amount, provided for in appropriation 

7 Acts. 

8 ‘‘SEC. 509. FACILITIES. 

9 ‘‘(a) GRANTS.—The Secretary, acting through the 

10 Service, may make grants to contractors or grant recipi11 ents under this title for the lease, purchase, renovation, 

12 construction, or expansion of facilities, including leased fa13 cilities, in order to assist such contractors or grant recipi14 ents in complying with applicable licensure or certification 

15 requirements. 

16 ‘‘(b) LOAN FUND STUDY.—The Secretary, acting 

17 through the Service, may carry out a study to determine 

18 the feasibility of establishing a loan fund to provide to 

19 Urban Indian Organizations direct loans or guarantees for 

20 loans for the construction of health care facilities in a 

21 manner consistent with section 309, including by submit22 ting a report in accordance with subsection (c) of that sec23 tion. 


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1 ‘‘SEC. 510. DIVISION OF URBAN INDIAN HEALTH. 

2 ‘‘There is established within the Service a Division 

3 of Urban Indian Health, which shall be responsible for— 

4 ‘‘(1) carrying out the provisions of this title; 

5 ‘‘(2) providing central oversight of the pro6 grams and services authorized under this title; and 

7 ‘‘(3) providing technical assistance to Urban In8 dian Organizations. 

9 ‘‘SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE10 RELATED SERVICES. 

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

12 through the Service, may make grants for the provision 

13 of health-related services in prevention of, treatment of, 

14 rehabilitation of, or school- and community-based edu15 cation regarding, alcohol and substance abuse in Urban 

16 Centers to those Urban Indian Organizations with which 

17 the Secretary has entered into a contract under this title 

18 or under section 201. 

19 ‘‘(b) GOALS.—Each grant made pursuant to sub20 section (a) shall set forth the goals to be accomplished 

21 pursuant to the grant. The goals shall be specific to each 

22 grant as agreed to between the Secretary and the grantee. 

23 ‘‘(c) CRITERIA.—The Secretary shall establish cri24 teria for the grants made under subsection (a), including 

25 criteria relating to the following: 

26 ‘‘(1) The size of the Urban Indian population. 


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1 ‘‘(2) Capability of the organization to ade2 quately perform the activities required under the 

3 grant. 

4 ‘‘(3) Satisfactory performance standards for the 

5 organization in meeting the goals set forth in such 

6 grant. The standards shall be negotiated and agreed 

7 to between the Secretary and the grantee on a 

8 grant-by-grant basis. 

9 ‘‘(4) Identification of the need for services. 

10 ‘‘(d) ALLOCATION OF GRANTS.—The Secretary shall 

11 develop a methodology for allocating grants made pursu12 ant to this section based on the criteria established pursu13 ant to subsection (c). 

14 ‘‘(e) GRANTS SUBJECT TO CRITERIA.—Any grant re15 ceived by an Urban Indian Organization under this Act 

16 for substance abuse prevention, treatment, and rehabilita17 tion shall be subject to the criteria set forth in subsection 

18 (c). 

19 ‘‘SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION 

20 PROJECTS. 

21 ‘‘Notwithstanding any other provision of law, the 

22 Tulsa Clinic and Oklahoma City Clinic demonstration 

23 projects shall— 

24 ‘‘(1) be permanent programs within the Serv25 ice’s direct care program; 


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1 ‘‘(2) continue to be treated as Service Units 

2 and Operating Units in the allocation of resources 

3 and coordination of care; and 

4 ‘‘(3) continue to meet the requirements and 

5 definitions of an Urban Indian Organization in this 

6 Act, and shall not be subject to the provisions of the 

7 Indian Self-Determination and Education Assistance 

8 Act (25 U.S.C. 450 et seq.). 

9 ‘‘SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS. 

10 ‘‘(a) GRANTS AND CONTRACTS.—The Secretary, 

11 through the Division of Urban Indian Health, shall make 

12 grants or enter into contracts with Urban Indian Organi13 zations, to take effect not later than September 30, 2010, 

14 for the administration of Urban Indian alcohol programs 

15 that were originally established under the National Insti16 tute on Alcoholism and Alcohol Abuse (hereafter in this 

17 section referred to as ‘NIAAA’) and transferred to the 

18 Service. 

19 ‘‘(b) USE OF FUNDS.—Grants provided or contracts 

20 entered into under this section shall be used to provide 

21 support for the continuation of alcohol prevention and 

22 treatment services for Urban Indian populations and such 

23 other objectives as are agreed upon between the Service 

24 and a recipient of a grant or contract under this section. 


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1 ‘‘(c) ELIGIBILITY.—Urban Indian Organizations that 

2 operate Indian alcohol programs originally funded under 

3 the NIAAA and subsequently transferred to the Service 

4 are eligible for grants or contracts under this section. 

5 ‘‘(d) REPORT.—The Secretary shall evaluate and re6 port to Congress on the activities of programs funded 

7 under this section not less than every 5 years. 

8 ‘‘SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZA9 TIONS. 

10 ‘‘(a) IN GENERAL.—The Secretary shall ensure that 

11 the Service consults, to the greatest extent practicable, 

12 with Urban Indian Organizations. 

13 ‘‘(b) DEFINITION OF CONSULTATION.—For purposes 

14 of subsection (a), consultation is the open and free ex15 change of information and opinions which leads to mutual 

16 understanding and comprehension and which emphasizes 

17 trust, respect, and shared responsibility. 

18 ‘‘SEC. 515. URBAN YOUTH TREATMENT CENTER DEM19 ONSTRATION. 

20 ‘‘(a) CONSTRUCTION AND OPERATION.—The Sec21 retary, acting through the Service, through grant or con22 tract, is authorized to fund the construction and operation 

23 of at least 2 residential treatment centers in each State 

24 described in subsection (b) to demonstrate the provision 

25 of alcohol and substance abuse treatment services to 


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1 Urban Indian youth in a culturally competent residential 

2 setting. 

3 ‘‘(b) DEFINITION OF STATE.—A State described in 

4 this subsection is a State in which— 

5 ‘‘(1) there resides Urban Indian youth with 

6 need for alcohol and substance abuse treatment serv7 ices in a residential setting; and 

8 ‘‘(2) there is a significant shortage of culturally 

9 competent residential treatment services for Urban 

10 Indian youth. 

11 ‘‘SEC. 516. GRANTS FOR DIABETES PREVENTION, TREAT12 MENT, AND CONTROL. 

13 ‘‘(a) GRANTS AUTHORIZED.—The Secretary may 

14 make grants to those Urban Indian Organizations that 

15 have entered into a contract or have received a grant 

16 under this title for the provision of services for the preven17 tion and treatment of, and control of the complications 

18 resulting from, diabetes among Urban Indians. 

19 ‘‘(b) GOALS.—Each grant made pursuant to sub20 section (a) shall set forth the goals to be accomplished 

21 under the grant. The goals shall be specific to each grant 

22 as agreed to between the Secretary and the grantee. 

23 ‘‘(c) ESTABLISHMENT OF CRITERIA.—The Secretary 

24 shall establish criteria for the grants made under sub25 section (a) relating to— 


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1 ‘‘(1) the size and location of the Urban Indian 

2 population to be served; 

3 ‘‘(2) the need for prevention of and treatment 

4 of, and control of the complications resulting from, 

5 diabetes among the Urban Indian population to be 

6 served; 

7 ‘‘(3) performance standards for the organiza8 tion in meeting the goals set forth in such grant 

9 that are negotiated and agreed to by the Secretary 

10 and the grantee; 

11 ‘‘(4) the capability of the organization to ade12 quately perform the activities required under the 

13 grant; and 

14 ‘‘(5) the willingness of the organization to col15 laborate with the registry, if any, established by the 

16 Secretary under section 204(e) in the Area Office of 

17 the Service in which the organization is located. 

18 ‘‘(d) FUNDS SUBJECT TO CRITERIA.—Any funds re19 ceived by an Urban Indian Organization under this Act 

20 for the prevention, treatment, and control of diabetes 

21 among Urban Indians shall be subject to the criteria devel22 oped by the Secretary under subsection (c). 

23 ‘‘SEC. 517. COMMUNITY HEALTH REPRESENTATIVES. 

24 ‘‘The Secretary, acting through the Service, may 

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1 dian Organizations for the employment of Indians trained 

2 as health service providers through the Community Health 

3 Representatives Program under section 109 in the provi4 sion of health care, health promotion, and disease preven5 tion services to Urban Indians. 

6 ‘‘SEC. 518. EFFECTIVE DATE. 

7 ‘‘The amendments made by the Indian Health Care 

8 Improvement Act Amendments of 2007 to this title shall 

9 take effect beginning on the date of enactment of that Act, 

10 regardless of whether the Secretary has promulgated regu11 lations implementing such amendments. 

12 ‘‘SEC. 519. ELIGIBILITY FOR SERVICES. 

13 ‘‘Urban Indians shall be eligible for, and the ultimate 

14 beneficiaries of, health care or referral services provided 

15 pursuant to this title. 

16 ‘‘SEC. 520. AUTHORIZATION OF APPROPRIATIONS. 

17 ‘‘There are authorized to be appropriated such sums 

18 as may be necessary for each fiscal year through fiscal 

19 year 2017 to carry out this title. 

20 ‘‘TITLE VI—ORGANIZATIONAL 

21 IMPROVEMENTS 

22 ‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV23 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

24 SERVICE. 

25 ‘‘(a) ESTABLISHMENT.— 


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1 ‘‘(1) IN GENERAL.—In order to more effectively 

2 and efficiently carry out the responsibilities, authori3 ties, and functions of the United States to provide 

4 health care services to Indians and Indian Tribes, as 

5 are or may be hereafter provided by Federal statute 

6 or treaties, there is established within the Public 

7 Health Service of the Department the Indian Health 

8 Service. 

9 ‘‘(2) ASSISTANT SECRETARY FOR INDIAN

10 HEALTH.—The Service shall be administered by an 

11 Assistant Secretary for Indian Health, who shall be 

12 appointed by the President, by and with the advice 

13 and consent of the Senate. The Assistant Secretary 

14 shall report to the Secretary. Effective with respect 

15 to an individual appointed by the President, by and 

16 with the advice and consent of the Senate, after 

17 January 1, 2007, the term of service of the Assist18 ant Secretary shall be 4 years. An Assistant Sec19 retary may serve more than 1 term. 

20 ‘‘(3) INCUMBENT.—The individual serving in 

21 the position of Director of the Service on the day be22 fore the date of enactment of the Indian Health 

23 Care Improvement Act Amendments of 2007 shall 

24 serve as Assistant Secretary. 


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1 ‘‘(4) ADVOCACY AND CONSULTATION.—The po2 sition of Assistant Secretary is established to, in a 

3 manner consistent with the government-to-govern4 ment relationship between the United States and In5 dian Tribes— 

6 ‘‘(A) facilitate advocacy for the develop7 ment of appropriate Indian health policy; and 

8 ‘‘(B) promote consultation on matters re9 lating to Indian health. 

10 ‘‘(b) AGENCY.—The Service shall be an agency within 

11 the Public Health Service of the Department, and shall 

12 not be an office, component, or unit of any other agency 

13 of the Department. 

14 ‘‘(c) DUTIES.—The Assistant Secretary shall— 

15 ‘‘(1) perform all functions that were, on the day 

16 before the date of enactment of the Indian Health 

17 Care Improvement Act Amendments of 2007, car18 ried out by or under the direction of the individual 

19 serving as Director of the Service on that day; 

20 ‘‘(2) perform all functions of the Secretary re21 lating to the maintenance and operation of hospital 

22 and health facilities for Indians and the planning 

23 for, and provision and utilization of, health services 

24 for Indians; 


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1 ‘‘(3) administer all health programs under 

2 which health care is provided to Indians based upon 

3 their status as Indians which are administered by 

4 the Secretary, including programs under— 

5 ‘‘(A) this Act; 

6 ‘‘(B) the Act of November 2, 1921 (25 

7 U.S.C. 13); 

8 ‘‘(C) the Act of August 5, 1954 (42 U.S.C. 

9 2001 et seq.); 

10 ‘‘(D) the Act of August 16, 1957 (42 

11 U.S.C. 2005 et seq.); and 

12 ‘‘(E) the Indian Self-Determination and 

13 Education Assistance Act (25 U.S.C. 450 et 

14 seq.); 

15 ‘‘(4) administer all scholarship and loan func16 tions carried out under title I; 

17 ‘‘(5) report directly to the Secretary concerning 

18 all policy- and budget-related matters affecting In19 dian health; 

20 ‘‘(6) collaborate with the Assistant Secretary 

21 for Health concerning appropriate matters of Indian 

22 health that affect the agencies of the Public Health 

23 Service; 

24 ‘‘(7) advise each Assistant Secretary of the De25 partment concerning matters of Indian health with 


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1 respect to which that Assistant Secretary has au2 thority and responsibility; 

3 ‘‘(8) advise the heads of other agencies and pro4 grams of the Department concerning matters of In5 dian health with respect to which those heads have 

6 authority and responsibility; 

7 ‘‘(9) coordinate the activities of the Department 

8 concerning matters of Indian health; and 

9 ‘‘(10) perform such other functions as the Sec10 retary may designate. 

11 ‘‘(d) AUTHORITY.— 

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

13 through the Assistant Secretary, shall have the au14 thority— 

15 ‘‘(A) except to the extent provided for in 

16 paragraph (2), to appoint and compensate em17 ployees for the Service in accordance with title 

18 5, United States Code; 

19 ‘‘(B) to enter into contracts for the pro20 curement of goods and services to carry out the 

21 functions of the Service; and 

22 ‘‘(C) to manage, expend, and obligate all 

23 funds appropriated for the Service. 

24 ‘‘(2) PERSONNEL ACTIONS.—Notwithstanding 

25 any other provision of law, the provisions of section 


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1 12 of the Act of June 18, 1934 (48 Stat. 986; 25 

2 U.S.C. 472), shall apply to all personnel actions 

3 taken with respect to new positions created within 

4 the Service as a result of its establishment under 

5 subsection (a). 

6 ‘‘(e) REFERENCES.—Any reference to the Director of 

7 the Indian Health Service in any other Federal law, Exec8 utive order, rule, regulation, or delegation of authority, or 

9 in any document of or relating to the Director of the In10 dian Health Service, shall be deemed to refer to the Assist11 ant Secretary. 

12 ‘‘SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYS13 TEM. 

14 ‘‘(a) ESTABLISHMENT.— 

15 ‘‘(1) IN GENERAL.—The Secretary shall estab16 lish an automated management information system 

17 for the Service. 

18 ‘‘(2) REQUIREMENTS OF SYSTEM.—The infor19 mation system established under paragraph (1) shall 

20 include— 

21 ‘‘(A) a financial management system; 

22 ‘‘(B) a patient care information system for 

23 each area served by the Service; 


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1 ‘‘(C) a privacy component that protects the 

2 privacy of patient information held by, or on be3 half of, the Service; 

4 ‘‘(D) a services-based cost accounting com5 ponent that provides estimates of the costs as6 sociated with the provision of specific medical 

7 treatments or services in each Area office of the 

8 Service; 

9 ‘‘(E) an interface mechanism for patient 

10 billing and accounts receivable system; and 

11 ‘‘(F) a training component. 

12 ‘‘(b) PROVISION OF SYSTEMS TO TRIBES AND ORGA13 NIZATIONS.—The Secretary shall provide each Tribal 

14 Health Program automated management information sys15 tems which— 

16 ‘‘(1) meet the management information needs 

17 of such Tribal Health Program with respect to the 

18 treatment by the Tribal Health Program of patients 

19 of the Service; and 

20 ‘‘(2) meet the management information needs 

21 of the Service. 

22 ‘‘(c) ACCESS TO RECORDS.—Notwithstanding any 

23 other provision of law, each patient shall have reasonable 

24 access to the medical or health records of such patient 

25 which are held by, or on behalf of, the Service. 


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1 ‘‘(d) AUTHORITY TO ENHANCE INFORMATION TECH2 NOLOGY.—The Secretary, acting through the Assistant 

3 Secretary, shall have the authority to enter into contracts, 

4 agreements, or joint ventures with other Federal agencies, 

5 States, private and nonprofit organizations, for the pur6 pose of enhancing information technology in Indian 

7 Health Programs and facilities. 

8 ‘‘SEC. 603. AUTHORIZATION OF APPROPRIATIONS. 

9 ‘‘There is authorized to be appropriated such sums 

10 as may be necessary for each fiscal year through fiscal 

11 year 2017 to carry out this title. 

12 ‘‘TITLE VII—BEHAVIORAL 

13 HEALTH PROGRAMS 

14 ‘‘SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREAT15 MENT SERVICES. 

16 ‘‘(a) PURPOSES.—The purposes of this section are as 

17 follows: 

18 ‘‘(1) To authorize and direct the Secretary, act19 ing through the Service, Indian Tribes, Tribal Orga20 nizations, and Urban Indian Organizations, to de21 velop a comprehensive behavioral health prevention 

22 and treatment program which emphasizes collabora23 tion among alcohol and substance abuse, social serv24 ices, and mental health programs. 


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1 ‘‘(2) To provide information, direction, and 

2 guidance relating to mental illness and dysfunction 

3 and self-destructive behavior, including child abuse 

4 and family violence, to those Federal, tribal, State, 

5 and local agencies responsible for programs in In6 dian communities in areas of health care, education, 

7 social services, child and family welfare, alcohol and 

8 substance abuse, law enforcement, and judicial serv9 ices. 

10 ‘‘(3) To assist Indian Tribes to identify services 

11 and resources available to address mental illness and 

12 dysfunctional and self-destructive behavior. 

13 ‘‘(4) To provide authority and opportunities for 

14 Indian Tribes and Tribal Organizations to develop, 

15 implement, and coordinate with community-based 

16 programs which include identification, prevention, 

17 education, referral, and treatment services, including 

18 through multidisciplinary resource teams. 

19 ‘‘(5) To ensure that Indians, as citizens of the 

20 United States and of the States in which they re21 side, have the same access to behavioral health serv22 ices to which all citizens have access. 

23 ‘‘(6) To modify or supplement existing pro24 grams and authorities in the areas identified in 

25 paragraph (2). 


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1 ‘‘(b) PLANS.— 

2 ‘‘(1) DEVELOPMENT.—The Secretary, acting 

3 through the Service, Indian Tribes, Tribal Organiza4 tions, and Urban Indian Organizations, shall encour5 age Indian Tribes and Tribal Organizations to de6 velop tribal plans, and Urban Indian Organizations 

7 to develop local plans, and for all such groups to 

8 participate in developing areawide plans for Indian 

9 Behavioral Health Services. The plans shall include, 

10 to the extent feasible, the following components: 

11 ‘‘(A) An assessment of the scope of alcohol 

12 or other substance abuse, mental illness, and 

13 dysfunctional and self-destructive behavior, in14 cluding suicide, child abuse, and family vio15 lence, among Indians, including— 

16 ‘‘(i) the number of Indians served who 

17 are directly or indirectly affected by such 

18 illness or behavior; or 

19 ‘‘(ii) an estimate of the financial and 

20 human cost attributable to such illness or 

21 behavior. 

22 ‘‘(B) An assessment of the existing and 

23 additional resources necessary for the preven24 tion and treatment of such illness and behavior, 

25 including an assessment of the progress toward 


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1 achieving the availability of the full continuum 

2 of care described in subsection (c). 

3 ‘‘(C) An estimate of the additional funding 

4 needed by the Service, Indian Tribes, Tribal 

5 Organizations, and Urban Indian Organizations 

6 to meet their responsibilities under the plans. 

7 ‘‘(2) NATIONAL CLEARINGHOUSE.—The Sec8 retary, acting through the Service, shall coordinate 

9 with existing national clearinghouses and informa10 tion centers to include at the clearinghouses and 

11 centers plans and reports on the outcomes of such 

12 plans developed by Indian Tribes, Tribal Organiza13 tions, Urban Indian Organizations, and Service 

14 Areas relating to behavioral health. The Secretary 

15 shall ensure access to these plans and outcomes by 

16 any Indian Tribe, Tribal Organization, Urban In17 dian Organization, or the Service. 

18 ‘‘(3) TECHNICAL ASSISTANCE.—The Secretary 

19 shall provide technical assistance to Indian Tribes, 

20 Tribal Organizations, and Urban Indian Organiza21 tions in preparation of plans under this section and 

22 in developing standards of care that may be used 

23 and adopted locally. 

24 ‘‘(c) PROGRAMS.—The Secretary, acting through the 

25 Service, Indian Tribes, and Tribal Organizations, shall 


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1 provide, to the extent feasible and if funding is available, 

2 programs including the following: 

3 ‘‘(1) COMPREHENSIVE CARE.—A comprehensive 

4 continuum of behavioral health care which pro5 vides— 

6 ‘‘(A) community-based prevention, inter7 vention, outpatient, and behavioral health 

8 aftercare; 

9 ‘‘(B) detoxification (social and medical); 

10 ‘‘(C) acute hospitalization; 

11 ‘‘(D) intensive outpatient/day treatment; 

12 ‘‘(E) residential treatment; 

13 ‘‘(F) transitional living for those needing a 

14 temporary, stable living environment that is 

15 supportive of treatment and recovery goals; 

16 ‘‘(G) emergency shelter; 

17 ‘‘(H) intensive case management; and 

18 ‘‘(I) diagnostic services. 

19 ‘‘(2) CHILD CARE.—Behavioral health services 

20 for Indians from birth through age 17, including— 

21 ‘‘(A) preschool and school age fetal alcohol 

22 disorder services, including assessment and be23 havioral intervention; 


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1 ‘‘(B) mental health and substance abuse 

2 services (emotional, organic, alcohol, drug, in3 halant, and tobacco); 

4 ‘‘(C) identification and treatment of co-oc5 curring disorders and comorbidity; 

6 ‘‘(D) prevention of alcohol, drug, inhalant, 

7 and tobacco use; 

8 ‘‘(E) early intervention, treatment, and 

9 aftercare; 

10 ‘‘(F) promotion of healthy approaches to 

11 risk and safety issues; and 

12 ‘‘(G) identification and treatment of ne13 glect and physical, mental, and sexual abuse. 

14 ‘‘(3) ADULT CARE.—Behavioral health services 

15 for Indians from age 18 through 55, including— 

16 ‘‘(A) early intervention, treatment, and 

17 aftercare; 

18 ‘‘(B) mental health and substance abuse 

19 services (emotional, alcohol, drug, inhalant, and 

20 tobacco), including sex specific services; 

21 ‘‘(C) identification and treatment of co-oc22 curring disorders (dual diagnosis) and comor23 bidity; 

24 ‘‘(D) promotion of healthy approaches for 

25 risk-related behavior; 


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1 ‘‘(E) treatment services for women at risk 

2 of giving birth to a child with a fetal alcohol 

3 disorder; and 

4 ‘‘(F) sex specific treatment for sexual as5 sault and domestic violence. 

6 ‘‘(4) FAMILY CARE.—Behavioral health services 

7 for families, including— 

8 ‘‘(A) early intervention, treatment, and 

9 aftercare for affected families; 

10 ‘‘(B) treatment for sexual assault and do11 mestic violence; and 

12 ‘‘(C) promotion of healthy approaches re13 lating to parenting, domestic violence, and other 

14 abuse issues. 

15 ‘‘(5) ELDER CARE.—Behavioral health services 

16 for Indians 56 years of age and older, including— 

17 ‘‘(A) early intervention, treatment, and 

18 aftercare; 

19 ‘‘(B) mental health and substance abuse 

20 services (emotional, alcohol, drug, inhalant, and 

21 tobacco), including sex specific services; 

22 ‘‘(C) identification and treatment of co-oc23 curring disorders (dual diagnosis) and comor24 bidity; 


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1 ‘‘(D) promotion of healthy approaches to 

2 managing conditions related to aging; 

3 ‘‘(E) sex specific treatment for sexual as4 sault, domestic violence, neglect, physical and 

5 mental abuse and exploitation; and 

6 ‘‘(F) identification and treatment of de7 mentias regardless of cause. 

8 ‘‘(d) COMMUNITY BEHAVIORAL HEALTH PLAN.— 

9 ‘‘(1) ESTABLISHMENT.—The governing body of 

10 any Indian Tribe, Tribal Organization, or Urban In11 dian Organization may adopt a resolution for the es12 tablishment of a community behavioral health plan 

13 providing for the identification and coordination of 

14 available resources and programs to identify, pre15 vent, or treat substance abuse, mental illness, or 

16 dysfunctional and self-destructive behavior, including 

17 child abuse and family violence, among its members 

18 or its service population. This plan should include 

19 behavioral health services, social services, intensive 

20 outpatient services, and continuing aftercare. 

21 ‘‘(2) TECHNICAL ASSISTANCE.—At the request 

22 of an Indian Tribe, Tribal Organization, or Urban 

23 Indian Organization, the Bureau of Indian Affairs 

24 and the Service shall cooperate with and provide 

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1 ganization, or Urban Indian Organization in the de2 velopment and implementation of such plan. 

3 ‘‘(3) FUNDING.—The Secretary, acting through 

4 the Service, may make funding available to Indian 

5 Tribes and Tribal Organizations which adopt a reso6 lution pursuant to paragraph (1) to obtain technical 

7 assistance for the development of a community be8 havioral health plan and to provide administrative 

9 support in the implementation of such plan. 

10 ‘‘(e) COORDINATION FOR AVAILABILITY OF SERV11 ICES.—The Secretary, acting through the Service, Indian 

12 Tribes, Tribal Organizations, and Urban Indian Organiza13 tions, shall coordinate behavioral health planning, to the 

14 extent feasible, with other Federal agencies and with State 

15 agencies, to encourage comprehensive behavioral health 

16 services for Indians regardless of their place of residence. 

17 ‘‘(f) MENTAL HEALTH CARE NEED ASSESSMENT.— 

18 Not later than 1 year after the date of enactment of the 

19 Indian Health Care Improvement Act Amendments of 

20 2007, the Secretary, acting through the Service, shall 

21 make an assessment of the need for inpatient mental 

22 health care among Indians and the availability and cost 

23 of inpatient mental health facilities which can meet such 

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1 sider the possible conversion of existing, underused Service 

2 hospital beds into psychiatric units to meet such need. 

3 ‘‘SEC. 702. MEMORANDA OF AGREEMENT WITH THE DE4 PARTMENT OF THE INTERIOR. 

5 ‘‘(a) CONTENTS.—Not later than 12 months after the 

6 date of enactment of the Indian Health Care Improvement 

7 Act Amendments of 2007, the Secretary, acting through 

8 the Service, and the Secretary of the Interior shall develop 

9 and enter into a memoranda of agreement, or review and 

10 update any existing memoranda of agreement, as required 

11 by section 4205 of the Indian Alcohol and Substance 

12 Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 

13 2411) under which the Secretaries address the following: 

14 ‘‘(1) The scope and nature of mental illness and 

15 dysfunctional and self-destructive behavior, including 

16 child abuse and family violence, among Indians. 

17 ‘‘(2) The existing Federal, tribal, State, local, 

18 and private services, resources, and programs avail19 able to provide behavioral health services for Indi20 ans. 

21 ‘‘(3) The unmet need for additional services, re22 sources, and programs necessary to meet the needs 

23 identified pursuant to paragraph (1). 

24 ‘‘(4)(A) The right of Indians, as citizens of the 

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1 side, to have access to behavioral health services to 

2 which all citizens have access. 

3 ‘‘(B) The right of Indians to participate in, and 

4 receive the benefit of, such services. 

5 ‘‘(C) The actions necessary to protect the exer6 cise of such right. 

7 ‘‘(5) The responsibilities of the Bureau of In8 dian Affairs and the Service, including mental illness 

9 identification, prevention, education, referral, and 

10 treatment services (including services through multi11 disciplinary resource teams), at the central, area, 

12 and agency and Service Unit, Service Area, and 

13 headquarters levels to address the problems identi14 fied in paragraph (1). 

15 ‘‘(6) A strategy for the comprehensive coordina16 tion of the behavioral health services provided by the 

17 Bureau of Indian Affairs and the Service to meet 

18 the problems identified pursuant to paragraph (1), 

19 including— 

20 ‘‘(A) the coordination of alcohol and sub21 stance abuse programs of the Service, the Bu22 reau of Indian Affairs, and Indian Tribes and 

23 Tribal Organizations (developed under the In24 dian Alcohol and Substance Abuse Prevention 

25 and Treatment Act of 1986 (25 U.S.C. 2401 et 


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1 seq.)) with behavioral health initiatives pursu2 ant to this Act, particularly with respect to the 

3 referral and treatment of dually diagnosed indi4 viduals requiring behavioral health and sub5 stance abuse treatment; and 

6 ‘‘(B) ensuring that the Bureau of Indian 

7 Affairs and Service programs and services (in8 cluding multidisciplinary resource teams) ad9 dressing child abuse and family violence are co10 ordinated with such non-Federal programs and 

11 services. 

12 ‘‘(7) Directing appropriate officials of the Bu13 reau of Indian Affairs and the Service, particularly 

14 at the agency and Service Unit levels, to cooperate 

15 fully with tribal requests made pursuant to commu16 nity behavioral health plans adopted under section 

17 701(c) and section 4206 of the Indian Alcohol and 

18 Substance Abuse Prevention and Treatment Act of 

19 1986 (25 U.S.C. 2412). 

20 ‘‘(8) Providing for an annual review of such 

21 agreement by the Secretaries which shall be provided 

22 to Congress and Indian Tribes and Tribal Organiza23 tions. 

24 ‘‘(b) SPECIFIC PROVISIONS REQUIRED.—The memo25 randa of agreement updated or entered into pursuant to 


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1 subsection (a) shall include specific provisions pursuant to 

2 which the Service shall assume responsibility for— 

3 ‘‘(1) the determination of the scope of the prob4 lem of alcohol and substance abuse among Indians, 

5 including the number of Indians within the jurisdic6 tion of the Service who are directly or indirectly af7 fected by alcohol and substance abuse and the finan8 cial and human cost; 

9 ‘‘(2) an assessment of the existing and needed 

10 resources necessary for the prevention of alcohol and 

11 substance abuse and the treatment of Indians af12 fected by alcohol and substance abuse; and 

13 ‘‘(3) an estimate of the funding necessary to 

14 adequately support a program of prevention of alco15 hol and substance abuse and treatment of Indians 

16 affected by alcohol and substance abuse. 

17 ‘‘(c) PUBLICATION.—Each memorandum of agree18 ment entered into or renewed (and amendments or modi19 fications thereto) under subsection (a) shall be published 

20 in the Federal Register. At the same time as publication 

21 in the Federal Register, the Secretary shall provide a copy 

22 of such memoranda, amendment, or modification to each 

23 Indian Tribe, Tribal Organization, and Urban Indian Or24 ganization. 


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1 ‘‘SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PRE2 VENTION AND TREATMENT PROGRAM. 

3 ‘‘(a) ESTABLISHMENT.— 

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

5 through the Service, Indian Tribes, and Tribal Orga6 nizations, shall provide a program of comprehensive 

7 behavioral health, prevention, treatment, and 

8 aftercare, which shall include— 

9 ‘‘(A) prevention, through educational inter10 vention, in Indian communities; 

11 ‘‘(B) acute detoxification, psychiatric hos12 pitalization, residential, and intensive outpatient 

13 treatment; 

14 ‘‘(C) community-based rehabilitation and 

15 aftercare; 

16 ‘‘(D) community education and involve17 ment, including extensive training of health 

18 care, educational, and community-based per19 sonnel; 

20 ‘‘(E) specialized residential treatment pro21 grams for high-risk populations, including preg22 nant and postpartum women and their children; 

23 and 

24 ‘‘(F) diagnostic services. 

25 ‘‘(2) TARGET POPULATIONS.—The target popu26 lation of such programs shall be members of Indian 


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1 Tribes. Efforts to train and educate key members of 

2 the Indian community shall also target employees of 

3 health, education, judicial, law enforcement, legal, 

4 and social service programs. 

5 ‘‘(b) CONTRACT HEALTH SERVICES.— 

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

7 through the Service, Indian Tribes, and Tribal Orga8 nizations, may enter into contracts with public or 

9 private providers of behavioral health treatment 

10 services for the purpose of carrying out the program 

11 required under subsection (a). 

12 ‘‘(2) PROVISION OF ASSISTANCE.—In carrying 

13 out this subsection, the Secretary shall provide as14 sistance to Indian Tribes and Tribal Organizations 

15 to develop criteria for the certification of behavioral 

16 health service providers and accreditation of service 

17 facilities which meet minimum standards for such 

18 services and facilities. 

19 ‘‘SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM. 

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

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

22 as the ‘Snyder Act’), the Secretary shall establish and 

23 maintain a mental health technician program within the 

24 Service which— 


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1 ‘‘(1) provides for the training of Indians as 

2 mental health technicians; and 

3 ‘‘(2) employs such technicians in the provision 

4 of community-based mental health care that includes 

5 identification, prevention, education, referral, and 

6 treatment services. 

7 ‘‘(b) PARAPROFESSIONAL TRAINING.—In carrying 

8 out subsection (a), the Secretary, acting through the Serv9 ice, Indian Tribes, and Tribal Organizations, shall provide 

10 high-standard paraprofessional training in mental health 

11 care necessary to provide quality care to the Indian com12 munities to be served. Such training shall be based upon 

13 a curriculum developed or approved by the Secretary 

14 which combines education in the theory of mental health 

15 care with supervised practical experience in the provision 

16 of such care. 

17 ‘‘(c) SUPERVISION AND EVALUATION OF TECHNI18 CIANS.—The Secretary, acting through the Service, Indian 

19 Tribes, and Tribal Organizations, shall supervise and 

20 evaluate the mental health technicians in the training pro21 gram. 

22 ‘‘(d) TRADITIONAL HEALTH CARE PRACTICES.—The 

23 Secretary, acting through the Service, shall ensure that 

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1 volves the use and promotion of the traditional health care 

2 practices of the Indian Tribes to be served. 

3 ‘‘SEC. 705. LICENSING REQUIREMENT FOR MENTAL 

4 HEALTH CARE WORKERS. 

5 ‘‘(a) IN GENERAL.—Subject to the provisions of sec6 tion 221, and except as provided in subsection (b), any 

7 individual employed as a psychologist, social worker, or 

8 marriage and family therapist for the purpose of providing 

9 mental health care services to Indians in a clinical setting 

10 under this Act is required to be licensed as a psychologist, 

11 social worker, or marriage and family therapist, respec12 tively. 

13 ‘‘(b) TRAINEES.—An individual may be employed as 

14 a trainee in psychology, social work, or marriage and fam15 ily therapy to provide mental health care services de16 scribed in subsection (a) if such individual— 

17 ‘‘(1) works under the direct supervision of a li18 censed psychologist, social worker, or marriage and 

19 family therapist, respectively; 

20 ‘‘(2) is enrolled in or has completed at least 2 

21 years of course work at a post-secondary, accredited 

22 education program for psychology, social work, mar23 riage and family therapy, or counseling; and 


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1 ‘‘(3) meets such other training, supervision, and 

2 quality review requirements as the Secretary may es3 tablish. 

4 ‘‘SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS. 

5 ‘‘(a) GRANTS.—The Secretary, consistent with sec6 tion 701, may make grants to Indian Tribes, Tribal Orga7 nizations, and Urban Indian Organizations to develop and 

8 implement a comprehensive behavioral health program of 

9 prevention, intervention, treatment, and relapse preven10 tion services that specifically addresses the cultural, his11 torical, social, and child care needs of Indian women, re12 gardless of age. 

13 ‘‘(b) USE OF GRANT FUNDS.—A grant made pursu14 ant to this section may be used to— 

15 ‘‘(1) develop and provide community training, 

16 education, and prevention programs for Indian 

17 women relating to behavioral health issues, including 

18 fetal alcohol disorders; 

19 ‘‘(2) identify and provide psychological services, 

20 counseling, advocacy, support, and relapse preven21 tion to Indian women and their families; and 

22 ‘‘(3) develop prevention and intervention models 

23 for Indian women which incorporate traditional 

24 health care practices, cultural values, and commu25 nity and family involvement. 


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1 ‘‘(c) CRITERIA.—The Secretary, in consultation with 

2 Indian Tribes and Tribal Organizations, shall establish 

3 criteria for the review and approval of applications and 

4 proposals for funding under this section. 

5 ‘‘(d) EARMARK OF CERTAIN FUNDS.—Twenty per6 cent of the funds appropriated pursuant to this section 

7 shall be used to make grants to Urban Indian Organiza8 tions. 

9 ‘‘SEC. 707. INDIAN YOUTH PROGRAM. 

10 ‘‘(a) DETOXIFICATION AND REHABILITATION.—The 

11 Secretary, acting through the Service, consistent with sec12 tion 701, shall develop and implement a program for acute 

13 detoxification and treatment for Indian youths, including 

14 behavioral health services. The program shall include re15 gional treatment centers designed to include detoxification 

16 and rehabilitation for both sexes on a referral basis and 

17 programs developed and implemented by Indian Tribes or 

18 Tribal Organizations at the local level under the Indian 

19 Self-Determination and Education Assistance Act (25 

20 U.S.C. 450 et seq.). Regional centers shall be integrated 

21 with the intake and rehabilitation programs based in the 

22 referring Indian community. 

23 ‘‘(b) ALCOHOL AND SUBSTANCE ABUSE TREATMENT

24 CENTERS OR FACILITIES.— 

25 ‘‘(1) ESTABLISHMENT.— 


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

2 through the Service, Indian Tribes, and Tribal 

3 Organizations, shall construct, renovate, or, as 

4 necessary, purchase, and appropriately staff 

5 and operate, at least 1 youth regional treatment 

6 center or treatment network in each area under 

7 the jurisdiction of an Area Office. 

8 ‘‘(B) AREA OFFICE IN CALIFORNIA.—For 

9 the purposes of this subsection, the Area Office 

10 in California shall be considered to be 2 Area 

11 Offices, 1 office whose jurisdiction shall be con12 sidered to encompass the northern area of the 

13 State of California, and 1 office whose jurisdic14 tion shall be considered to encompass the re15 mainder of the State of California for the pur16 pose of implementing California treatment net17 works. 

18 ‘‘(2) FUNDING.—For the purpose of staffing 

19 and operating such centers or facilities, funding 

20 shall be pursuant to the Act of November 2, 1921 

21 (25 U.S.C. 13). 

22 ‘‘(3) LOCATION.—A youth treatment center 

23 constructed or purchased under this subsection shall 

24 be constructed or purchased at a location within the 

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1 propriate tribal resolution) by a majority of the In2 dian Tribes to be served by such center. 

3 ‘‘(4) SPECIFIC PROVISION OF FUNDS.— 

4 ‘‘(A) IN GENERAL.—Notwithstanding any 

5 other provision of this title, the Secretary may, 

6 from amounts authorized to be appropriated for 

7 the purposes of carrying out this section, make 

8 funds available to— 

9 ‘‘(i) the Tanana Chiefs Conference, 

10 Incorporated, for the purpose of leasing, 

11 constructing, renovating, operating, and 

12 maintaining a residential youth treatment 

13 facility in Fairbanks, Alaska; and 

14 ‘‘(ii) the Southeast Alaska Regional 

15 Health Corporation to staff and operate a 

16 residential youth treatment facility without 

17 regard to the proviso set forth in section 

18 4(l) of the Indian Self-Determination and 

19 Education Assistance Act (25 U.S.C. 

20 450b(l)). 

21 ‘‘(B) PROVISION OF SERVICES TO ELIGI22 BLE YOUTHS.—Until additional residential 

23 youth treatment facilities are established in 

24 Alaska pursuant to this section, the facilities 

25 specified in subparagraph (A) shall make every 


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1 effort to provide services to all eligible Indian 

2 youths residing in Alaska. 

3 ‘‘(c) INTERMEDIATE ADOLESCENT BEHAVIORAL

4 HEALTH SERVICES.— 

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

6 through the Service, Indian Tribes, and Tribal Orga7 nizations, may provide intermediate behavioral 

8 health services to Indian children and adolescents, 

9 including— 

10 ‘‘(A) pretreatment assistance; 

11 ‘‘(B) inpatient, outpatient, and aftercare 

12 services; 

13 ‘‘(C) emergency care; 

14 ‘‘(D) suicide prevention and crisis interven15 tion; and 

16 ‘‘(E) prevention and treatment of mental 

17 illness and dysfunctional and self-destructive 

18 behavior, including child abuse and family vio19 lence. 

20 ‘‘(2) USE OF FUNDS.—Funds provided under 

21 this subsection may be used— 

22 ‘‘(A) to construct or renovate an existing 

23 health facility to provide intermediate behav24 ioral health services; 


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1 ‘‘(B) to hire behavioral health profes2 sionals; 

3 ‘‘(C) to staff, operate, and maintain an in4 termediate mental health facility, group home, 

5 sober housing, transitional housing or similar 

6 facilities, or youth shelter where intermediate 

7 behavioral health services are being provided; 

8 ‘‘(D) to make renovations and hire appro9 priate staff to convert existing hospital beds 

10 into adolescent psychiatric units; and 

11 ‘‘(E) for intensive home- and community12 based services. 

13 ‘‘(3) CRITERIA.—The Secretary, acting through 

14 the Service, shall, in consultation with Indian Tribes 

15 and Tribal Organizations, establish criteria for the 

16 review and approval of applications or proposals for 

17 funding made available pursuant to this subsection. 

18 ‘‘(d) FEDERALLY-OWNED STRUCTURES.— 

19 ‘‘(1) IN GENERAL.—The Secretary, in consulta20 tion with Indian Tribes and Tribal Organizations, 

21 shall— 

22 ‘‘(A) identify and use, where appropriate, 

23 federally-owned structures suitable for local res24 idential or regional behavioral health treatment 

25 for Indian youths; and 


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1 ‘‘(B) establish guidelines for determining 

2 the suitability of any such federally-owned 

3 structure to be used for local residential or re4 gional behavioral health treatment for Indian 

5 youths. 

6 ‘‘(2) TERMS AND CONDITIONS FOR USE OF

7 STRUCTURE.—Any structure described in paragraph 

8 (1) may be used under such terms and conditions as 

9 may be agreed upon by the Secretary and the agency 

10 having responsibility for the structure and any In11 dian Tribe or Tribal Organization operating the pro12 gram. 

13 ‘‘(e) REHABILITATION AND AFTERCARE SERVICES.— 

14 ‘‘(1) IN GENERAL.—The Secretary, Indian 

15 Tribes, or Tribal Organizations, in cooperation with 

16 the Secretary of the Interior, shall develop and im17 plement within each Service Unit, community-based 

18 rehabilitation and follow-up services for Indian 

19 youths who are having significant behavioral health 

20 problems, and require long-term treatment, commu21 nity reintegration, and monitoring to support the In22 dian youths after their return to their home commu23 nity. 

24 ‘‘(2) ADMINISTRATION.—Services under para25 graph (1) shall be provided by trained staff within 


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1 the community who can assist the Indian youths in 

2 their continuing development of self-image, positive 

3 problem-solving skills, and nonalcohol or substance 

4 abusing behaviors. Such staff may include alcohol 

5 and substance abuse counselors, mental health pro6 fessionals, and other health professionals and para7 professionals, including community health represent8 atives. 

9 ‘‘(f) INCLUSION OF FAMILY IN YOUTH TREATMENT

10 PROGRAM.—In providing the treatment and other services 

11 to Indian youths authorized by this section, the Secretary, 

12 acting through the Service, Indian Tribes, and Tribal Or13 ganizations, shall provide for the inclusion of family mem14 bers of such youths in the treatment programs or other 

15 services as may be appropriate. Not less than 10 percent 

16 of the funds appropriated for the purposes of carrying out 

17 subsection (e) shall be used for outpatient care of adult 

18 family members related to the treatment of an Indian 

19 youth under that subsection. 

20 ‘‘(g) MULTIDRUG ABUSE PROGRAM.—The Secretary, 

21 acting through the Service, Indian Tribes, Tribal Organi22 zations, and Urban Indian Organizations, shall provide, 

23 consistent with section 701, programs and services to pre24 vent and treat the abuse of multiple forms of substances, 

25 including alcohol, drugs, inhalants, and tobacco, among 


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1 Indian youths residing in Indian communities, on or near 

2 reservations, and in urban areas and provide appropriate 

3 mental health services to address the incidence of mental 

4 illness among such youths. 

5 ‘‘(h) INDIAN YOUTH MENTAL HEALTH.—The Sec6 retary, acting through the Service, shall collect data for 

7 the report under section 801 with respect to— 

8 ‘‘(1) the number of Indian youth who are being 

9 provided mental health services through the Service 

10 and Tribal Health Programs; 

11 ‘‘(2) a description of, and costs associated with, 

12 the mental health services provided for Indian youth 

13 through the Service and Tribal Health Programs; 

14 ‘‘(3) the number of youth referred to the Serv15 ice or Tribal Health Programs for mental health 

16 services; 

17 ‘‘(4) the number of Indian youth provided resi18 dential treatment for mental health and behavioral 

19 problems through the Service and Tribal Health 

20 Programs, reported separately for on- and off-res21 ervation facilities; and 

22 ‘‘(5) the costs of the services described in para23 graph (4). 


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1 ‘‘SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEM2 ONSTRATION PROJECT. 

3 ‘‘(a) PURPOSE.—The purpose of this section is to au4 thorize the Secretary to carry out a demonstration project 

5 to test the use of telemental health services in suicide pre6 vention, intervention and treatment of Indian youth, in7 cluding through— 

8 ‘‘(1) the use of psychotherapy, psychiatric as9 sessments, diagnostic interviews, therapies for men10 tal health conditions predisposing to suicide, and al11 cohol and substance abuse treatment; 

12 ‘‘(2) the provision of clinical expertise to, con13 sultation services with, and medical advice and train14 ing for frontline health care providers working with 

15 Indian youth; 

16 ‘‘(3) training and related support for commu17 nity leaders, family members and health and edu18 cation workers who work with Indian youth; 

19 ‘‘(4) the development of culturally-relevant edu20 cational materials on suicide; and 

21 ‘‘(5) data collection and reporting. 

22 ‘‘(b) DEFINITIONS.—For the purpose of this section, 

23 the following definitions shall apply: 

24 ‘‘(1) DEMONSTRATION PROJECT.—The term 

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1 mental health demonstration project authorized 

2 under subsection (c). 

3 ‘‘(2) TELEMENTAL HEALTH.—The term ‘tele4 mental health’ means the use of electronic informa5 tion and telecommunications technologies to support 

6 long distance mental health care, patient and profes7 sional-related education, public health, and health 

8 administration. 

9 ‘‘(c) AUTHORIZATION.— 

10 ‘‘(1) IN GENERAL.—The Secretary is authorized 

11 to award grants under the demonstration project for 

12 the provision of telemental health services to Indian 

13 youth who— 

14 ‘‘(A) have expressed suicidal ideas; 

15 ‘‘(B) have attempted suicide; or 

16 ‘‘(C) have mental health conditions that in17 crease or could increase the risk of suicide. 

18 ‘‘(2) ELIGIBILITY FOR GRANTS.—Such grants 

19 shall be awarded to Indian Tribes and Tribal Orga20 nizations that operate 1 or more facilities— 

21 ‘‘(A) located in Alaska and part of the 

22 Alaska Federal Health Care Access Network; 

23 ‘‘(B) reporting active clinical telehealth ca24 pabilities; or 


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1 ‘‘(C) offering school-based telemental 

2 health services relating to psychiatry to Indian 

3 youth. 

4 ‘‘(3) GRANT PERIOD.—The Secretary shall 

5 award grants under this section for a period of up 

6 to 4 years. 

7 ‘‘(4) AWARDING OF GRANTS.—Not more than 5 

8 grants shall be provided under paragraph (1), with 

9 priority consideration given to Indian Tribes and 

10 Tribal Organizations that— 

11 ‘‘(A) serve a particular community or geo12 graphic area where there is a demonstrated 

13 need to address Indian youth suicide; 

14 ‘‘(B) enter in to collaborative partnerships 

15 with Indian Health Service or Tribal Health 

16 Programs or facilities to provide services under 

17 this demonstration project; 

18 ‘‘(C) serve an isolated community or geo19 graphic area which has limited or no access to 

20 behavioral health services; or 

21 ‘‘(D) operate a detention facility at which 

22 Indian youth are detained. 

23 ‘‘(d) USE OF FUNDS.— 


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1 ‘‘(1) IN GENERAL.—An Indian Tribe or Tribal 

2 Organization shall use a grant received under sub3 section (c) for the following purposes: 

4 ‘‘(A) To provide telemental health services 

5 to Indian youth, including the provision of— 

6 ‘‘(i) psychotherapy; 

7 ‘‘(ii) psychiatric assessments and di8 agnostic interviews, therapies for mental 

9 health conditions predisposing to suicide, 

10 and treatment; and 

11 ‘‘(iii) alcohol and substance abuse 

12 treatment. 

13 ‘‘(B) To provide clinician-interactive med14 ical advice, guidance and training, assistance in 

15 diagnosis and interpretation, crisis counseling 

16 and intervention, and related assistance to 

17 Service, tribal, or urban clinicians and health 

18 services providers working with youth being 

19 served under this demonstration project. 

20 ‘‘(C) To assist, educate and train commu21 nity leaders, health education professionals and 

22 paraprofessionals, tribal outreach workers, and 

23 family members who work with the youth re24 ceiving telemental health services under this 

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1 tion of suicidal tendencies, crisis intervention 

2 and suicide prevention, emergency skill develop3 ment, and building and expanding networks 

4 among these individuals and with State and 

5 local health services providers. 

6 ‘‘(D) To develop and distribute culturally 

7 appropriate community educational materials 

8 on— 

9 ‘‘(i) suicide prevention; 

10 ‘‘(ii) suicide education; 

11 ‘‘(iii) suicide screening; 

12 ‘‘(iv) suicide intervention; and 

13 ‘‘(v) ways to mobilize communities 

14 with respect to the identification of risk 

15 factors for suicide. 

16 ‘‘(E) For data collection and reporting re17 lated to Indian youth suicide prevention efforts. 

18 ‘‘(2) TRADITIONAL HEALTH CARE PRAC19 TICES.—In carrying out the purposes described in 

20 paragraph (1), an Indian Tribe or Tribal Organiza21 tion may use and promote the traditional health care 

22 practices of the Indian Tribes of the youth to be 

23 served. 

24 ‘‘(e) APPLICATIONS.—To be eligible to receive a grant 

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1 tion shall prepare and submit to the Secretary an applica2 tion, at such time, in such manner, and containing such 

3 information as the Secretary may require, including— 

4 ‘‘(1) a description of the project that the Indian 

5 Tribe or Tribal Organization will carry out using the 

6 funds provided under the grant; 

7 ‘‘(2) a description of the manner in which the 

8 project funded under the grant would— 

9 ‘‘(A) meet the telemental health care needs 

10 of the Indian youth population to be served by 

11 the project; or 

12 ‘‘(B) improve the access of the Indian 

13 youth population to be served to suicide preven14 tion and treatment services; 

15 ‘‘(3) evidence of support for the project from 

16 the local community to be served by the project; 

17 ‘‘(4) a description of how the families and lead18 ership of the communities or populations to be 

19 served by the project would be involved in the devel20 opment and ongoing operations of the project; 

21 ‘‘(5) a plan to involve the tribal community of 

22 the youth who are provided services by the project 

23 in planning and evaluating the mental health care 

24 and suicide prevention efforts provided, in order to 

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1 ronmental, and cultural components of the treat2 ment; and 

3 ‘‘(6) a plan for sustaining the project after Fed4 eral assistance for the demonstration project has ter5 minated. 

6 ‘‘(f) COLLABORATION; REPORTING TO NATIONAL

7 CLEARINGHOUSE.— 

8 ‘‘(1) COLLABORATION.—The Secretary, acting 

9 through the Service, shall encourage Indian Tribes 

10 and Tribal Organizations receiving grants under this 

11 section to collaborate to enable comparisons about 

12 best practices across projects. 

13 ‘‘(2) REPORTING TO NATIONAL CLEARING14 HOUSE.—The Secretary, acting through the Service, 

15 shall also encourage Indian Tribes and Tribal Orga16 nizations receiving grants under this section to sub17 mit relevant, declassified project information to the 

18 national clearinghouse authorized under section 

19 701(b)(2) in order to better facilitate program per20 formance and improve suicide prevention, interven21 tion, and treatment services. 

22 ‘‘(g) ANNUAL REPORT.—Each grant recipient shall 

23 submit to the Secretary an annual report that— 

24 ‘‘(1) describes the number of telemental health 

25 services provided; and 


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1 ‘‘(2) includes any other information that the 

2 Secretary may require. 

3 ‘‘(h) REPORT TO CONGRESS.—Not later than 270 

4 days after the termination of the demonstration project, 

5 the Secretary shall submit to the Committee on Indian Af6 fairs of the Senate and the Committee on Natural Re7 sources and Committee on Energy and Commerce of the 

8 House of Representatives a final report, based on the an9 nual reports provided by grant recipients under subsection 

10 (h), that— 

11 ‘‘(1) describes the results of the projects funded 

12 by grants awarded under this section, including any 

13 data available which indicates the number of at14 tempted suicides; 

15 ‘‘(2) evaluates the impact of the telemental 

16 health services funded by the grants in reducing the 

17 number of completed suicides among Indian youth; 

18 ‘‘(3) evaluates whether the demonstration 

19 project should be— 

20 ‘‘(A) expanded to provide more than 5 

21 grants; and 

22 ‘‘(B) designated a permanent program; 

23 and 


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1 ‘‘(4) evaluates the benefits of expanding the 

2 demonstration project to include Urban Indian Or3 ganizations. 

4 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

5 authorized to be appropriated to carry out this section 

6 $1,500,000 for each of fiscal years 2008 through 2011. 

7 ‘‘SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL 

8 HEALTH FACILITIES DESIGN, CONSTRUC9 TION, AND STAFFING. 

10 ‘‘Not later than 1 year after the date of enactment 

11 of the Indian Health Care Improvement Act Amendments 

12 of 2007, the Secretary, acting through the Service, Indian 

13 Tribes, and Tribal Organizations, may provide, in each 

14 area of the Service, not less than 1 inpatient mental health 

15 care facility, or the equivalent, for Indians with behavioral 

16 health problems. For the purposes of this subsection, Cali17 fornia shall be considered to be 2 Area Offices, 1 office 

18 whose location shall be considered to encompass the north19 ern area of the State of California and 1 office whose ju20 risdiction shall be considered to encompass the remainder 

21 of the State of California. The Secretary shall consider 

22 the possible conversion of existing, underused Service hos23 pital beds into psychiatric units to meet such need. 


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1 ‘‘SEC. 710. TRAINING AND COMMUNITY EDUCATION. 

2 ‘‘(a) PROGRAM.—The Secretary, in cooperation with 

3 the Secretary of the Interior, shall develop and implement 

4 or assist Indian Tribes and Tribal Organizations to de5 velop and implement, within each Service Unit or tribal 

6 program, a program of community education and involve7 ment which shall be designed to provide concise and timely 

8 information to the community leadership of each tribal 

9 community. Such program shall include education about 

10 behavioral health issues to political leaders, Tribal judges, 

11 law enforcement personnel, members of tribal health and 

12 education boards, health care providers including tradi13 tional practitioners, and other critical members of each 

14 tribal community. Such program may also include commu15 nity-based training to develop local capacity and tribal 

16 community provider training for prevention, intervention, 

17 treatment, and aftercare. 

18 ‘‘(b) INSTRUCTION.—The Secretary, acting through 

19 the Service, shall, either directly or through Indian Tribes 

20 and Tribal Organizations, provide instruction in the area 

21 of behavioral health issues, including instruction in crisis 

22 intervention and family relations in the context of alcohol 

23 and substance abuse, child sexual abuse, youth alcohol and 

24 substance abuse, and the causes and effects of fetal alco25 hol disorders to appropriate employees of the Bureau of 

26 Indian Affairs and the Service, and to personnel in schools 


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1 or programs operated under any contract with the Bureau 

2 of Indian Affairs or the Service, including supervisors of 

3 emergency shelters and halfway houses described in sec4 tion 4213 of the Indian Alcohol and Substance Abuse Pre5 vention and Treatment Act of 1986 (25 U.S.C. 2433). 

6 ‘‘(c) TRAINING MODELS.—In carrying out the edu7 cation and training programs required by this section, the 

8 Secretary, in consultation with Indian Tribes, Tribal Or9 ganizations, Indian behavioral health experts, and Indian 

10 alcohol and substance abuse prevention experts, shall de11 velop and provide community-based training models. Such 

12 models shall address— 

13 ‘‘(1) the elevated risk of alcohol and behavioral 

14 health problems faced by children of alcoholics; 

15 ‘‘(2) the cultural, spiritual, and 

16 multigenerational aspects of behavioral health prob17 lem prevention and recovery; and 

18 ‘‘(3) community-based and multidisciplinary 

19 strategies for preventing and treating behavioral 

20 health problems. 

21 ‘‘SEC. 711. BEHAVIORAL HEALTH PROGRAM. 

22 ‘‘(a) INNOVATIVE PROGRAMS.—The Secretary, acting 

23 through the Service, Indian Tribes, and Tribal Organiza24 tions, consistent with section 701, may plan, develop, imVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00285 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 plement, and carry out programs to deliver innovative 

2 community-based behavioral health services to Indians. 

3 ‘‘(b) AWARDS; CRITERIA.—The Secretary may award 

4 a grant for a project under subsection (a) to an Indian 

5 Tribe or Tribal Organization and may consider the fol6 lowing criteria: 

7 ‘‘(1) The project will address significant unmet 

8 behavioral health needs among Indians. 

9 ‘‘(2) The project will serve a significant number 

10 of Indians. 

11 ‘‘(3) The project has the potential to deliver 

12 services in an efficient and effective manner. 

13 ‘‘(4) The Indian Tribe or Tribal Organization 

14 has the administrative and financial capability to ad15 minister the project. 

16 ‘‘(5) The project may deliver services in a man17 ner consistent with traditional health care practices. 

18 ‘‘(6) The project is coordinated with, and avoids 

19 duplication of, existing services. 

20 ‘‘(c) EQUITABLE TREATMENT.—For purposes of this 

21 subsection, the Secretary shall, in evaluating project appli22 cations or proposals, use the same criteria that the Sec23 retary uses in evaluating any other application or proposal 

24 for such funding. 


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1 ‘‘SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS. 

2 ‘‘(a) PROGRAMS.— 

3 ‘‘(1) ESTABLISHMENT.—The Secretary, con4 sistent with section 701, acting through the Service, 

5 Indian Tribes, and Tribal Organizations, is author6 ized to establish and operate fetal alcohol disorder 

7 programs as provided in this section for the pur8 poses of meeting the health status objectives speci9 fied in section 3. 

10 ‘‘(2) USE OF FUNDS.— 

11 ‘‘(A) IN GENERAL.—Funding provided 

12 pursuant to this section shall be used for the 

13 following: 

14 ‘‘(i) To develop and provide for Indi15 ans community and in-school training, edu16 cation, and prevention programs relating 

17 to fetal alcohol disorders. 

18 ‘‘(ii) To identify and provide behav19 ioral health treatment to high-risk Indian 

20 women and high-risk women pregnant with 

21 an Indian’s child. 

22 ‘‘(iii) To identify and provide appro23 priate psychological services, educational 

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1 order affected Indians and their families or 

2 caretakers. 

3 ‘‘(iv) To develop and implement coun4 seling and support programs in schools for 

5 fetal alcohol disorder affected Indian chil6 dren. 

7 ‘‘(v) To develop prevention and inter8 vention models which incorporate practi9 tioners of traditional health care practices, 

10 cultural values, and community involve11 ment. 

12 ‘‘(vi) To develop, print, and dissemi13 nate education and prevention materials on 

14 fetal alcohol disorder. 

15 ‘‘(vii) To develop and implement, in 

16 consultation with Indian Tribes, Tribal Or17 ganizations, and Urban Indian Organiza18 tions, culturally sensitive assessment and 

19 diagnostic tools including dysmorphology 

20 clinics and multidisciplinary fetal alcohol 

21 disorder clinics for use in Indian commu22 nities and Urban Centers. 

23 ‘‘(B) ADDITIONAL USES.—In addition to 

24 any purpose under subparagraph (A), funding 


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1 provided pursuant to this section may be used 

2 for 1 or more of the following: 

3 ‘‘(i) Early childhood intervention 

4 projects from birth on to mitigate the ef5 fects of fetal alcohol disorder among Indi6 ans. 

7 ‘‘(ii) Community-based support serv8 ices for Indians and women pregnant with 

9 Indian children. 

10 ‘‘(iii) Community-based housing for 

11 adult Indians with fetal alcohol disorder. 

12 ‘‘(3) CRITERIA FOR APPLICATIONS.—The Sec13 retary shall establish criteria for the review and ap14 proval of applications for funding under this section. 

15 ‘‘(b) SERVICES.—The Secretary, acting through the 

16 Service and Indian Tribes, Tribal Organizations, and 

17 Urban Indian Organizations, shall— 

18 ‘‘(1) develop and provide services for the pre19 vention, intervention, treatment, and aftercare for 

20 those affected by fetal alcohol disorder in Indian 

21 communities; and 

22 ‘‘(2) provide supportive services, including serv23 ices to meet the special educational, vocational, 

24 school-to-work transition, and independent living 


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1 needs of adolescent and adult Indians with fetal al2 cohol disorder. 

3 ‘‘(c) TASK FORCE.—The Secretary shall establish a 

4 task force to be known as the Fetal Alcohol Disorder Task 

5 Force to advise the Secretary in carrying out subsection 

6 (b). Such task force shall be composed of representatives 

7 from the following: 

8 ‘‘(1) The National Institute on Drug Abuse. 

9 ‘‘(2) The National Institute on Alcohol and Al10 coholism. 

11 ‘‘(3) The Office of Substance Abuse Prevention. 

12 ‘‘(4) The National Institute of Mental Health. 

13 ‘‘(5) The Service. 

14 ‘‘(6) The Office of Minority Health of the De15 partment of Health and Human Services. 

16 ‘‘(7) The Administration for Native Americans. 

17 ‘‘(8) The National Institute of Child Health 

18 and Human Development (NICHD). 

19 ‘‘(9) The Centers for Disease Control and Pre20 vention. 

21 ‘‘(10) The Bureau of Indian Affairs. 

22 ‘‘(11) Indian Tribes. 

23 ‘‘(12) Tribal Organizations. 

24 ‘‘(13) Urban Indian Organizations. 

25 ‘‘(14) Indian fetal alcohol disorder experts. 


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1 ‘‘(d) APPLIED RESEARCH PROJECTS.—The Sec2 retary, acting through the Substance Abuse and Mental 

3 Health Services Administration, shall make grants to In4 dian Tribes, Tribal Organizations, and Urban Indian Or5 ganizations for applied research projects which propose to 

6 elevate the understanding of methods to prevent, inter7 vene, treat, or provide rehabilitation and behavioral health 

8 aftercare for Indians and Urban Indians affected by fetal 

9 alcohol disorder. 

10 ‘‘(e) FUNDING FOR URBAN INDIAN ORGANIZA11 TIONS.—Ten percent of the funds appropriated pursuant 

12 to this section shall be used to make grants to Urban In13 dian Organizations funded under title V. 

14 ‘‘SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREAT15 MENT PROGRAMS. 

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

17 through the Service, and the Secretary of the Interior, In18 dian Tribes, and Tribal Organizations, shall establish, 

19 consistent with section 701, in every Service Area, pro20 grams involving treatment for— 

21 ‘‘(1) victims of sexual abuse who are Indian 

22 children or children in an Indian household; and 

23 ‘‘(2) perpetrators of child sexual abuse who are 

24 Indian or members of an Indian household. 


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1 ‘‘(b) USE OF FUNDS.—Funding provided pursuant to 

2 this section shall be used for the following: 

3 ‘‘(1) To develop and provide community edu4 cation and prevention programs related to sexual 

5 abuse of Indian children or children in an Indian 

6 household. 

7 ‘‘(2) To identify and provide behavioral health 

8 treatment to victims of sexual abuse who are Indian 

9 children or children in an Indian household, and to 

10 their family members who are affected by sexual 

11 abuse. 

12 ‘‘(3) To develop prevention and intervention 

13 models which incorporate traditional health care 

14 practices, cultural values, and community involve15 ment. 

16 ‘‘(4) To develop and implement culturally sen17 sitive assessment and diagnostic tools for use in In18 dian communities and Urban Centers. 

19 ‘‘(5) To identify and provide behavioral health 

20 treatment to Indian perpetrators and perpetrators 

21 who are members of an Indian household— 

22 ‘‘(A) making efforts to begin offender and 

23 behavioral health treatment while the perpe24 trator is incarcerated or at the earliest possible 

25 date if the perpetrator is not incarcerated; and 


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1 ‘‘(B) providing treatment after the perpe2 trator is released, until it is determined that the 

3 perpetrator is not a threat to children. 

4 ‘‘(c) COORDINATION.—The programs established 

5 under subsection (a) shall be carried out in coordination 

6 with programs and services authorized under the Indian 

7 Child Protection and Family Violence Prevention Act (25 

8 U.S.C. 3201 et seq.). 

9 ‘‘SEC. 714. BEHAVIORAL HEALTH RESEARCH. 

10 ‘‘The Secretary, in consultation with appropriate 

11 Federal agencies, shall make grants to, or enter into con12 tracts with, Indian Tribes, Tribal Organizations, and 

13 Urban Indian Organizations or enter into contracts with, 

14 or make grants to appropriate institutions for, the conduct 

15 of research on the incidence and prevalence of behavioral 

16 health problems among Indians served by the Service, In17 dian Tribes, or Tribal Organizations and among Indians 

18 in urban areas. Research priorities under this section shall 

19 include— 

20 ‘‘(1) the multifactorial causes of Indian youth 

21 suicide, including— 

22 ‘‘(A) protective and risk factors and sci23 entific data that identifies those factors; and 


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1 ‘‘(B) the effects of loss of cultural identity 

2 and the development of scientific data on those 

3 effects; 

4 ‘‘(2) the interrelationship and interdependence 

5 of behavioral health problems with alcoholism and 

6 other substance abuse, suicide, homicides, other in7 juries, and the incidence of family violence; and 

8 ‘‘(3) the development of models of prevention 

9 techniques. 

10 The effect of the interrelationships and interdependencies 

11 referred to in paragraph (2) on children, and the develop12 ment of prevention techniques under paragraph (3) appli13 cable to children, shall be emphasized. 

14 ‘‘SEC. 715. DEFINITIONS. 

15 ‘‘For the purpose of this title, the following defini16 tions shall apply: 

17 ‘‘(1) ASSESSMENT.—The term ‘assessment’ 

18 means the systematic collection, analysis, and dis19 semination of information on health status, health 

20 needs, and health problems. 

21 ‘‘(2) ALCOHOL-RELATED

22 NEURODEVELOPMENTAL DISORDERS OR ARND.—The 

23 term ‘alcohol-related neurodevelopmental disorders’ 

24 or ‘ARND’ means, with a history of maternal alco25 hol consumption during pregnancy, central nervous 


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1 system involvement such as developmental delay, in2 tellectual deficit, or neurologic abnormalities. Behav3 iorally, there can be problems with irritability, and 

4 failure to thrive as infants. As children become older 

5 there will likely be hyperactivity, attention deficit, 

6 language dysfunction, and perceptual and judgment 

7 problems. 

8 ‘‘(3) BEHAVIORAL HEALTH AFTERCARE.—The 

9 term ‘behavioral health aftercare’ includes those ac10 tivities and resources used to support recovery fol11 lowing inpatient, residential, intensive substance 

12 abuse, or mental health outpatient or outpatient 

13 treatment. The purpose is to help prevent or deal 

14 with relapse by ensuring that by the time a client or 

15 patient is discharged from a level of care, such as 

16 outpatient treatment, an aftercare plan has been de17 veloped with the client. An aftercare plan may use 

18 such resources as a community-based therapeutic 

19 group, transitional living facilities, a 12-step spon20 sor, a local 12-step or other related support group, 

21 and other community-based providers. 

22 ‘‘(4) DUAL DIAGNOSIS.—The term ‘dual diag23 nosis’ means coexisting substance abuse and mental 

24 illness conditions or diagnosis. Such clients are 


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1 sometimes referred to as mentally ill chemical abus2 ers (MICAs). 

3 ‘‘(5) FETAL ALCOHOL DISORDERS.—The term 

4 ‘fetal alcohol disorders’ means fetal alcohol syn5 drome, partial fetal alcohol syndrome and alcohol re6 lated neurodevelopmental disorder (ARND). 

7 ‘‘(6) FETAL ALCOHOL SYNDROME OR FAS.— 

8 The term ‘fetal alcohol syndrome’ or ‘FAS’ means a 

9 syndrome in which, with a history of maternal alco10 hol consumption during pregnancy, the following cri11 teria are met: 

12 ‘‘(A) Central nervous system involvement 

13 such as developmental delay, intellectual deficit, 

14 microencephaly, or neurologic abnormalities. 

15 ‘‘(B) Craniofacial abnormalities with at 

16 least 2 of the following: microophthalmia, short 

17 palpebral fissures, poorly developed philtrum, 

18 thin upper lip, flat nasal bridge, and short 

19 upturned nose. 

20 ‘‘(C) Prenatal or postnatal growth delay. 

21 ‘‘(7) PARTIAL FAS.—The term ‘partial FAS’ 

22 means, with a history of maternal alcohol consump23 tion during pregnancy, having most of the criteria of 

24 FAS, though not meeting a minimum of at least 2 

25 of the following: microophthalmia, short palpebral 


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1 fissures, poorly developed philtrum, thin upper lip, 

2 flat nasal bridge, and short upturned nose. 

3 ‘‘(8) REHABILITATION.—The term ‘rehabilita4 tion’ means to restore the ability or capacity to en5 gage in usual and customary life activities through 

6 education and therapy. 

7 ‘‘(9) SUBSTANCE ABUSE.—The term ‘substance 

8 abuse’ includes inhalant abuse. 

9 ‘‘SEC. 716. AUTHORIZATION OF APPROPRIATIONS. 

10 ‘‘There is authorized to be appropriated such sums 

11 as may be necessary for each fiscal year through fiscal 

12 year 2017 to carry out the provisions of this title. 

13 ‘‘TITLE VIII—MISCELLANEOUS 

14 ‘‘SEC. 801. REPORTS. 

15 ‘‘For each fiscal year following the date of enactment 

16 of the Indian Health Care Improvement Act Amendments 

17 of 2007, the Secretary shall transmit to Congress a report 

18 containing the following: 

19 ‘‘(1) A report on the progress made in meeting 

20 the objectives of this Act, including a review of pro21 grams established or assisted pursuant to this Act 

22 and assessments and recommendations of additional 

23 programs or additional assistance necessary to, at a 

24 minimum, provide health services to Indians and en25 sure a health status for Indians, which are at a parVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00297 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 ity with the health services available to and the 

2 health status of the general population. 

3 ‘‘(2) A report on whether, and to what extent, 

4 new national health care programs, benefits, initia5 tives, or financing systems have had an impact on 

6 the purposes of this Act and any steps that the Sec7 retary may have taken to consult with Indian Tribes, 

8 Tribal Organizations, and Urban Indian Organiza9 tions to address such impact, including a report on 

10 proposed changes in allocation of funding pursuant 

11 to section 808. 

12 ‘‘(3) A report on the use of health services by 

13 Indians— 

14 ‘‘(A) on a national and area or other rel15 evant geographical basis; 

16 ‘‘(B) by gender and age; 

17 ‘‘(C) by source of payment and type of 

18 service; 

19 ‘‘(D) comparing such rates of use with 

20 rates of use among comparable non-Indian pop21 ulations; and 

22 ‘‘(E) provided under contracts. 

23 ‘‘(4) A report of contractors to the Secretary on 

24 Health Care Educational Loan Repayments every 6 

25 months required by section 110. 


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1 ‘‘(5) A general audit report of the Secretary on 

2 the Health Care Educational Loan Repayment Pro3 gram as required by section 110(n). 

4 ‘‘(6) A report of the findings and conclusions of 

5 demonstration programs on development of edu6 cational curricula for substance abuse counseling as 

7 required in section 125(f). 

8 ‘‘(7) A separate statement which specifies the 

9 amount of funds requested to carry out the provi10 sions of section 201. 

11 ‘‘(8) A report of the evaluations of health pro12 motion and disease prevention as required in section 

13 203(c). 

14 ‘‘(9) A biennial report to Congress on infectious 

15 diseases as required by section 212. 

16 ‘‘(10) A report on environmental and nuclear 

17 health hazards as required by section 215. 

18 ‘‘(11) An annual report on the status of all 

19 health care facilities needs as required by section 

20 301(c)(2)(B) and 301(d). 

21 ‘‘(12) Reports on safe water and sanitary waste 

22 disposal facilities as required by section 302(h). 

23 ‘‘(13) An annual report on the expenditure of 

24 non-Service funds for renovation as required by sec25 tions 304(b)(2). 


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1 ‘‘(14) A report identifying the backlog of main2 tenance and repair required at Service and tribal fa3 cilities required by section 313(a). 

4 ‘‘(15) A report providing an accounting of reim5 bursement funds made available to the Secretary 

6 under titles XVIII, XIX, and XXI of the Social Se7 curity Act. 

8 ‘‘(16) A report on any arrangements for the 

9 sharing of medical facilities or services, as author10 ized by section 406. 

11 ‘‘(17) A report on evaluation and renewal of 

12 Urban Indian programs under section 505. 

13 ‘‘(18) A report on the evaluation of programs 

14 as required by section 513(d). 

15 ‘‘(19) A report on alcohol and substance abuse 

16 as required by section 701(f). 

17 ‘‘(20) A report on Indian youth mental health 

18 services as required by section 707(h). 

19 ‘‘(21) A report on the reallocation of base re20 sources if required by section 808. 

21 ‘‘SEC. 802. REGULATIONS. 

22 ‘‘(a) DEADLINES.— 

23 ‘‘(1) PROCEDURES.—Not later than 90 days 

24 after the date of enactment of the Indian Health 

25 Care Improvement Act Amendments of 2007, the 


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1 Secretary shall initiate procedures under subchapter 

2 III of chapter 5 of title 5, United States Code, to 

3 negotiate and promulgate such regulations or 

4 amendments thereto that are necessary to carry out 

5 titles II (except section 202) and VII, the sections 

6 of title III for which negotiated rulemaking is spe7 cifically required, and section 807. Unless otherwise 

8 required, the Secretary may promulgate regulations 

9 to carry out titles I, III, IV, and V, and section 202, 

10 using the procedures required by chapter V of title 

11 5, United States Code (commonly known as the ‘Ad12 ministrative Procedure Act’). 

13 ‘‘(2) PROPOSED REGULATIONS.—Proposed reg14 ulations to implement this Act shall be published in 

15 the Federal Register by the Secretary no later than 

16 2 years after the date of enactment of the Indian 

17 Health Care Improvement Act Amendments of 2007 

18 and shall have no less than a 120-day comment pe19 riod. 

20 ‘‘(3) FINAL REGULATIONS.—The Secretary 

21 shall publish in the Federal Register final regula22 tions to implement this Act by not later than 3 years 

23 after the date of enactment of the Indian Health 

24 Care Improvement Act Amendments of 2007. 


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1 ‘‘(b) COMMITTEE.—A negotiated rulemaking com2 mittee established pursuant to section 565 of title 5, 

3 United States Code, to carry out this section shall have 

4 as its members only representatives of the Federal Gov5 ernment and representatives of Indian Tribes, and Tribal 

6 Organizations, a majority of whom shall be nominated by 

7 and be representatives of Indian Tribes and Tribal Orga8 nizations from each Service Area. 

9 ‘‘(c) ADAPTATION OF PROCEDURES.—The Secretary 

10 shall adapt the negotiated rulemaking procedures to the 

11 unique context of self-governance and the government-to12 government relationship between the United States and 

13 Indian Tribes. 

14 ‘‘(d) LACK OF REGULATIONS.—The lack of promul15 gated regulations shall not limit the effect of this Act. 

16 ‘‘(e) INCONSISTENT REGULATIONS.—The provisions 

17 of this Act shall supersede any conflicting provisions of 

18 law in effect on the day before the date of enactment of 

19 the Indian Health Care Improvement Act Amendments of 

20 2007, and the Secretary is authorized to repeal any regu21 lation inconsistent with the provisions of this Act. 

22 ‘‘SEC. 803. PLAN OF IMPLEMENTATION. 

23 ‘‘Not later than 9 months after the date of enactment 

24 of the Indian Health Care Improvement Act Amendments 

25 of 2007, the Secretary, in consultation with Indian Tribes, 


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1 Tribal Organizations, and Urban Indian Organizations, 

2 shall submit to Congress a plan explaining the manner and 

3 schedule, by title and section, by which the Secretary will 

4 implement the provisions of this Act. This consultation 

5 may be conducted jointly with the annual budget consulta6 tion pursuant to the Indian Self-Determination and Edu7 cation Assistance Act (25 U.S.C. 450 et seq). 

8 ‘‘SEC. 804. AVAILABILITY OF FUNDS. 

9 ‘‘The funds appropriated pursuant to this Act shall 

10 remain available until expended. 

11 ‘‘SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED 

12 TO INDIAN HEALTH SERVICE. 

13 ‘‘Any limitation on the use of funds contained in an 

14 Act providing appropriations for the Department for a pe15 riod with respect to the performance of abortions shall 

16 apply for that period with respect to the performance of 

17 abortions using funds contained in an Act providing ap18 propriations for the Service. 

19 ‘‘SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS. 

20 ‘‘(a) IN GENERAL.—The following California Indians 

21 shall be eligible for health services provided by the Service: 

22 ‘‘(1) Any member of a federally recognized In23 dian Tribe. 


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1 ‘‘(2) Any descendant of an Indian who was re2 siding in California on June 1, 1852, if such de3 scendant— 

4 ‘‘(A) is a member of the Indian community 

5 served by a local program of the Service; and 

6 ‘‘(B) is regarded as an Indian by the com7 munity in which such descendant lives. 

8 ‘‘(3) Any Indian who holds trust interests in 

9 public domain, national forest, or reservation allot10 ments in California. 

11 ‘‘(4) Any Indian in California who is listed on 

12 the plans for distribution of the assets of rancherias 

13 and reservations located within the State of Cali14 fornia under the Act of August 18, 1958 (72 Stat. 

15 619), and any descendant of such an Indian. 

16 ‘‘(b) CLARIFICATION.—Nothing in this section may 

17 be construed as expanding the eligibility of California Indi18 ans for health services provided by the Service beyond the 

19 scope of eligibility for such health services that applied on 

20 May 1, 1986. 

21 ‘‘SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS. 

22 ‘‘(a) CHILDREN.—Any individual who— 

23 ‘‘(1) has not attained 19 years of age; 


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1 ‘‘(2) is the natural or adopted child, stepchild, 

2 foster child, legal ward, or orphan of an eligible In3 dian; and 

4 ‘‘(3) is not otherwise eligible for health services 

5 provided by the Service, 

6 shall be eligible for all health services provided by the 

7 Service on the same basis and subject to the same rules 

8 that apply to eligible Indians until such individual attains 

9 19 years of age. The existing and potential health needs 

10 of all such individuals shall be taken into consideration 

11 by the Service in determining the need for, or the alloca12 tion of, the health resources of the Service. If such an indi13 vidual has been determined to be legally incompetent prior 

14 to attaining 19 years of age, such individual shall remain 

15 eligible for such services until 1 year after the date of a 

16 determination of competency. 

17 ‘‘(b) SPOUSES.—Any spouse of an eligible Indian who 

18 is not an Indian, or who is of Indian descent but is not 

19 otherwise eligible for the health services provided by the 

20 Service, shall be eligible for such health services if all such 

21 spouses or spouses who are married to members of each 

22 Indian Tribe being served are made eligible, as a class, 

23 by an appropriate resolution of the governing body of the 

24 Indian Tribe or Tribal Organization providing such serv25 ices. The health needs of persons made eligible under this 


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1 paragraph shall not be taken into consideration by the 

2 Service in determining the need for, or allocation of, its 

3 health resources. 

4 ‘‘(c) PROVISION OF SERVICES TO OTHER INDIVID5 UALS.— 

6 ‘‘(1) IN GENERAL.—The Secretary is authorized 

7 to provide health services under this subsection 

8 through health programs operated directly by the 

9 Service to individuals who reside within the Service 

10 Unit and who are not otherwise eligible for such 

11 health services if— 

12 ‘‘(A) the Indian Tribes served by such 

13 Service Unit request such provision of health 

14 services to such individuals; and 

15 ‘‘(B) the Secretary and the served Indian 

16 Tribes have jointly determined that— 

17 ‘‘(i) the provision of such health serv18 ices will not result in a denial or diminu19 tion of health services to eligible Indians; 

20 and 

21 ‘‘(ii) there is no reasonable alternative 

22 health facilities or services, within or with23 out the Service Unit, available to meet the 

24 health needs of such individuals. 


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1 ‘‘(2) ISDEAA PROGRAMS.—In the case of 

2 health programs and facilities operated under a con3 tract or compact entered into under the Indian Self4 Determination and Education Assistance Act (25 

5 U.S.C. 450 et seq.), the governing body of the In6 dian Tribe or Tribal Organization providing health 

7 services under such contract or compact is author8 ized to determine whether health services should be 

9 provided under such contract to individuals who are 

10 not eligible for such health services under any other 

11 subsection of this section or under any other provi12 sion of law. In making such determinations, the gov13 erning body of the Indian Tribe or Tribal Organiza14 tion shall take into account the considerations de15 scribed in paragraph (1)(B). 

16 ‘‘(3) PAYMENT FOR SERVICES.— 

17 ‘‘(A) IN GENERAL.—Persons receiving 

18 health services provided by the Service under 

19 this subsection shall be liable for payment of 

20 such health services under a schedule of charges 

21 prescribed by the Secretary which, in the judg22 ment of the Secretary, results in reimbursement 

23 in an amount not less than the actual cost of 

24 providing the health services. Notwithstanding 

25 section 404 of this Act or any other provision 


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1 of law, amounts collected under this subsection, 

2 including Medicare, Medicaid, or SCHIP reim3 bursements under titles XVIII, XIX, and XXI 

4 of the Social Security Act, shall be credited to 

5 the account of the program providing the serv6 ice and shall be used for the purposes listed in 

7 section 401(d)(2) and amounts collected under 

8 this subsection shall be available for expendi9 ture within such program. 

10 ‘‘(B) INDIGENT PEOPLE.—Health services 

11 may be provided by the Secretary through the 

12 Service under this subsection to an indigent in13 dividual who would not be otherwise eligible for 

14 such health services but for the provisions of 

15 paragraph (1) only if an agreement has been 

16 entered into with a State or local government 

17 under which the State or local government 

18 agrees to reimburse the Service for the expenses 

19 incurred by the Service in providing such health 

20 services to such indigent individual. 

21 ‘‘(4) REVOCATION OF CONSENT FOR SERV22 ICES.— 

23 ‘‘(A) SINGLE TRIBE SERVICE AREA.—In 

24 the case of a Service Area which serves only 1 

25 Indian Tribe, the authority of the Secretary to 


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1 provide health services under paragraph (1) 

2 shall terminate at the end of the fiscal year suc3 ceeding the fiscal year in which the governing 

4 body of the Indian Tribe revokes its concur5 rence to the provision of such health services. 

6 ‘‘(B) MULTITRIBAL SERVICE AREA.—In 

7 the case of a multitribal Service Area, the au8 thority of the Secretary to provide health serv9 ices under paragraph (1) shall terminate at the 

10 end of the fiscal year succeeding the fiscal year 

11 in which at least 51 percent of the number of 

12 Indian Tribes in the Service Area revoke their 

13 concurrence to the provisions of such health 

14 services. 

15 ‘‘(d) OTHER SERVICES.—The Service may provide 

16 health services under this subsection to individuals who 

17 are not eligible for health services provided by the Service 

18 under any other provision of law in order to— 

19 ‘‘(1) achieve stability in a medical emergency; 

20 ‘‘(2) prevent the spread of a communicable dis21 ease or otherwise deal with a public health hazard; 

22 ‘‘(3) provide care to non-Indian women preg23 nant with an eligible Indian’s child for the duration 

24 of the pregnancy through postpartum; or 


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1 ‘‘(4) provide care to immediate family members 

2 of an eligible individual if such care is directly re3 lated to the treatment of the eligible individual. 

4 ‘‘(e) HOSPITAL PRIVILEGES FOR PRACTITIONERS.— 

5 Hospital privileges in health facilities operated and main6 tained by the Service or operated under a contract or com7 pact pursuant to the Indian Self-Determination and Edu8 cation Assistance Act (25 U.S.C. 450 et seq.) may be ex9 tended to non-Service health care practitioners who pro10 vide services to individuals described in subsection (a), (b), 

11 (c), or (d). Such non-Service health care practitioners 

12 may, as part of the privileging process, be designated as 

13 employees of the Federal Government for purposes of sec14 tion 1346(b) and chapter 171 of title 28, United States 

15 Code (relating to Federal tort claims) only with respect 

16 to acts or omissions which occur in the course of providing 

17 services to eligible individuals as a part of the conditions 

18 under which such hospital privileges are extended. 

19 ‘‘(f) ELIGIBLE INDIAN.—For purposes of this sec20 tion, the term ‘eligible Indian’ means any Indian who is 

21 eligible for health services provided by the Service without 

22 regard to the provisions of this section. 

23 ‘‘SEC. 808. REALLOCATION OF BASE RESOURCES. 

24 ‘‘(a) REPORT REQUIRED.—Notwithstanding any 

25 other provision of law, any allocation of Service funds for 


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1 a fiscal year that reduces by 5 percent or more from the 

2 previous fiscal year the funding for any recurring pro3 gram, project, or activity of a Service Unit may be imple4 mented only after the Secretary has submitted to Con5 gress, under section 801, a report on the proposed change 

6 in allocation of funding, including the reasons for the 

7 change and its likely effects. 

8 ‘‘(b) EXCEPTION.—Subsection (a) shall not apply if 

9 the total amount appropriated to the Service for a fiscal 

10 year is at least 5 percent less than the amount appro11 priated to the Service for the previous fiscal year. 

12 ‘‘SEC. 809. RESULTS OF DEMONSTRATION PROJECTS. 

13 ‘‘The Secretary shall provide for the dissemination to 

14 Indian Tribes, Tribal Organizations, and Urban Indian 

15 Organizations of the findings and results of demonstration 

16 projects conducted under this Act. 

17 ‘‘SEC. 810. PROVISION OF SERVICES IN MONTANA. 

18 ‘‘(a) CONSISTENT WITH COURT DECISION.—The 

19 Secretary, acting through the Service, shall provide serv20 ices and benefits for Indians in Montana in a manner con21 sistent with the decision of the United States Court of Ap22 peals for the Ninth Circuit in McNabb for McNabb v. 

23 Bowen, 829 F.2d 787 (9th Cir. 1987). 

24 ‘‘(b) CLARIFICATION.—The provisions of subsection 

25 (a) shall not be construed to be an expression of the sense 


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1 of Congress on the application of the decision described 

2 in subsection (a) with respect to the provision of services 

3 or benefits for Indians living in any State other than Mon4 tana. 

5 ‘‘SEC. 811. MORATORIUM. 

6 ‘‘During the period of the moratorium imposed on 

7 implementation of the final rule published in the Federal 

8 Register on September 16, 1987, by the Department of 

9 Health and Human Services, relating to eligibility for the 

10 health care services of the Indian Health Service, the In11 dian Health Service shall provide services pursuant to the 

12 criteria for eligibility for such services that were in effect 

13 on September 15, 1987, subject to the provisions of sec14 tions 806 and 807, until the Service has submitted to the 

15 Committees on Appropriations of the Senate and the 

16 House of Representatives a budget request reflecting the 

17 increased costs associated with the proposed final rule, 

18 and the request has been included in an appropriations 

19 Act and enacted into law. 

20 ‘‘SEC. 812. TRIBAL EMPLOYMENT. 

21 ‘‘For purposes of section 2(2) of the Act of July 5, 

22 1935 (49 Stat. 450, chapter 372), an Indian Tribe or 

23 Tribal Organization carrying out a contract or compact 

24 pursuant to the Indian Self-Determination and Education 


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1 Assistance Act (25 U.S.C. 450 et seq.) shall not be consid2 ered an ‘employer’. 

3 ‘‘SEC. 813. SEVERABILITY PROVISIONS. 

4 ‘‘If any provision of this Act, any amendment made 

5 by the Act, or the application of such provision or amend6 ment to any person or circumstances is held to be invalid, 

7 the remainder of this Act, the remaining amendments 

8 made by this Act, and the application of such provisions 

9 to persons or circumstances other than those to which it 

10 is held invalid, shall not be affected thereby. 

11 ‘‘SEC. 814. ESTABLISHMENT OF NATIONAL BIPARTISAN 

12 COMMISSION ON INDIAN HEALTH CARE. 

13 ‘‘(a) ESTABLISHMENT.—There is established the Na14 tional Bipartisan Indian Health Care Commission (the 

15 ‘Commission’). 

16 ‘‘(b) DUTIES OF COMMISSION.—The duties of the 

17 Commission are the following: 

18 ‘‘(1) To establish a study committee composed 

19 of those members of the Commission appointed by 

20 the Director of the Service and at least 4 members 

21 of Congress from among the members of the Com22 mission, the duties of which shall be the following: 

23 ‘‘(A) To the extent necessary to carry out 

24 its duties, collect and compile data necessary to 

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1 gard to the provision of health services, regard2 less of the location of Indians, including holding 

3 hearings and soliciting the views of Indians, In4 dian Tribes, Tribal Organizations, and Urban 

5 Indian Organizations, which may include au6 thorizing and making funds available for feasi7 bility studies of various models for providing 

8 and funding health services for all Indian bene9 ficiaries, including those who live outside of a 

10 reservation, temporarily or permanently. 

11 ‘‘(B) To make legislative recommendations 

12 to the Commission regarding the delivery of 

13 Federal health care services to Indians. Such 

14 recommendations shall include those related to 

15 issues of eligibility, benefits, the range of serv16 ice providers, the cost of such services, financ17 ing such services, and the optimal manner in 

18 which to provide such services. 

19 ‘‘(C) To determine the effect of the enact20 ment of such recommendations on (i) the exist21 ing system of delivery of health services for In22 dians, and (ii) the sovereign status of Indian 

23 Tribes. 

24 ‘‘(D) Not later than 12 months after the 

25 appointment of all members of the Commission, 


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1 to submit a written report of its findings and 

2 recommendations to the full Commission. The 

3 report shall include a statement of the minority 

4 and majority position of the Committee and 

5 shall be disseminated, at a minimum, to every 

6 Indian Tribe, Tribal Organization, and Urban 

7 Indian Organization for comment to the Com8 mission. 

9 ‘‘(E) To report regularly to the full Com10 mission regarding the findings and rec11 ommendations developed by the study com12 mittee in the course of carrying out its duties 

13 under this section. 

14 ‘‘(2) To review and analyze the recommenda15 tions of the report of the study committee. 

16 ‘‘(3) To make legislative recommendations to 

17 Congress regarding the delivery of Federal health 

18 care services to Indians. Such recommendations 

19 shall include those related to issues of eligibility, 

20 benefits, the range of service providers, the cost of 

21 such services, financing such services, and the opti22 mal manner in which to provide such services. 

23 ‘‘(4) Not later than 18 months following the 

24 date of appointment of all members of the Commis25 sion, submit a written report to Congress regarding 


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1 the delivery of Federal health care services to Indi2 ans. Such recommendations shall include those re3 lated to issues of eligibility, benefits, the range of 

4 service providers, the cost of such services, financing 

5 such services, and the optimal manner in which to 

6 provide such services. 

7 ‘‘(c) MEMBERS.— 

8 ‘‘(1) APPOINTMENT.—The Commission shall be 

9 composed of 25 members, appointed as follows: 

10 ‘‘(A) Ten members of Congress, including 

11 3 from the House of Representatives and 2 

12 from the Senate, appointed by their respective 

13 majority leaders, and 3 from the House of Rep14 resentatives and 2 from the Senate, appointed 

15 by their respective minority leaders, and who 

16 shall be members of the standing committees of 

17 Congress that consider legislation affecting 

18 health care to Indians. 

19 ‘‘(B) Twelve persons chosen by the con20 gressional members of the Commission, 1 from 

21 each Service Area as currently designated by 

22 the Director of the Service to be chosen from 

23 among 3 nominees from each Service Area put 

24 forward by the Indian Tribes within the area, 

25 with due regard being given to the experience 


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1 and expertise of the nominees in the provision 

2 of health care to Indians and to a reasonable 

3 representation on the commission of members 

4 who are familiar with various health care deliv5 ery modes and who represent Indian Tribes of 

6 various size populations. 

7 ‘‘(C) Three persons appointed by the Di8 rector who are knowledgeable about the provi9 sion of health care to Indians, at least 1 of 

10 whom shall be appointed from among 3 nomi11 nees put forward by those programs whose 

12 funds are provided in whole or in part by the 

13 Service primarily or exclusively for the benefit 

14 of Urban Indians. 

15 ‘‘(D) All those persons chosen by the con16 gressional members of the Commission and by 

17 the Director shall be members of federally rec18 ognized Indian Tribes. 

19 ‘‘(2) CHAIR; VICE CHAIR.—The Chair and Vice 

20 Chair of the Commission shall be selected by the 

21 congressional members of the Commission. 

22 ‘‘(3) TERMS.—The terms of members of the 

23 Commission shall be for the life of the Commission. 

24 ‘‘(4) DEADLINE FOR APPOINTMENTS.—Con25 gressional members of the Commission shall be apVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00317 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 pointed not later than 180 days after the date of en2 actment of the Indian Health Care Improvement Act 

3 Amendments of 2007, and the remaining members 

4 of the Commission shall be appointed not later than 

5 60 days following the appointment of the congres6 sional members. 

7 ‘‘(5) VACANCY.—A vacancy in the Commission 

8 shall be filled in the manner in which the original 

9 appointment was made. 

10 ‘‘(d) COMPENSATION.— 

11 ‘‘(1) CONGRESSIONAL MEMBERS.—Each con12 gressional member of the Commission shall receive 

13 no additional pay, allowances, or benefits by reason 

14 of their service on the Commission and shall receive 

15 travel expenses and per diem in lieu of subsistence 

16 in accordance with sections 5702 and 5703 of title 

17 5, United States Code. 

18 ‘‘(2) OTHER MEMBERS.—Remaining members 

19 of the Commission, while serving on the business of 

20 the Commission (including travel time), shall be en21 titled to receive compensation at the per diem equiv22 alent of the rate provided for level IV of the Execu23 tive Schedule under section 5315 of title 5, United 

24 States Code, and while so serving away from home 

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1 ber may be allowed travel expenses, as authorized by 

2 the Chairman of the Commission. For purpose of 

3 pay (other than pay of members of the Commission) 

4 and employment benefits, rights, and privileges, all 

5 personnel of the Commission shall be treated as if 

6 they were employees of the United States Senate. 

7 ‘‘(e) MEETINGS.—The Commission shall meet at the 

8 call of the Chair. 

9 ‘‘(f) QUORUM.—A quorum of the Commission shall 

10 consist of not less than 15 members, provided that no less 

11 than 6 of the members of Congress who are Commission 

12 members are present and no less than 9 of the members 

13 who are Indians are present. 

14 ‘‘(g) EXECUTIVE DIRECTOR; STAFF; FACILITIES.— 

15 ‘‘(1) APPOINTMENT; PAY.—The Commission 

16 shall appoint an executive director of the Commis17 sion. The executive director shall be paid the rate of 

18 basic pay for level V of the Executive Schedule. 

19 ‘‘(2) STAFF APPOINTMENT.—With the approval 

20 of the Commission, the executive director may ap21 point such personnel as the executive director deems 

22 appropriate. 

23 ‘‘(3) STAFF PAY.—The staff of the Commission 

24 shall be appointed without regard to the provisions 

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1 ments in the competitive service, and shall be paid 

2 without regard to the provisions of chapter 51 and 

3 subchapter III of chapter 53 of such title (relating 

4 to classification and General Schedule pay rates). 

5 ‘‘(4) TEMPORARY SERVICES.—With the ap6 proval of the Commission, the executive director may 

7 procure temporary and intermittent services under 

8 section 3109(b) of title 5, United States Code. 

9 ‘‘(5) FACILITIES.—The Administrator of Gen10 eral Services shall locate suitable office space for the 

11 operation of the Commission. The facilities shall 

12 serve as the headquarters of the Commission and 

13 shall include all necessary equipment and incidentals 

14 required for the proper functioning of the Commis15 sion. 

16 ‘‘(h) HEARINGS.—(1) For the purpose of carrying 

17 out its duties, the Commission may hold such hearings 

18 and undertake such other activities as the Commission de19 termines to be necessary to carry out its duties, provided 

20 that at least 6 regional hearings are held in different areas 

21 of the United States in which large numbers of Indians 

22 are present. Such hearings are to be held to solicit the 

23 views of Indians regarding the delivery of health care serv24 ices to them. To constitute a hearing under this sub25 section, at least 5 members of the Commission, including 


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1 at least 1 member of Congress, must be present. Hearings 

2 held by the study committee established in this section 

3 may count toward the number of regional hearings re4 quired by this subsection. 

5 ‘‘(2) Upon request of the Commission, the Comp6 troller General shall conduct such studies or investigations 

7 as the Commission determines to be necessary to carry 

8 out its duties. 

9 ‘‘(3)(A) The Director of the Congressional Budget 

10 Office or the Chief Actuary of the Centers for Medicare 

11 & Medicaid Services, or both, shall provide to the Commis12 sion, upon the request of the Commission, such cost esti13 mates as the Commission determines to be necessary to 

14 carry out its duties. 

15 ‘‘(B) The Commission shall reimburse the Director 

16 of the Congressional Budget Office for expenses relating 

17 to the employment in the office of that Director of such 

18 additional staff as may be necessary for the Director to 

19 comply with requests by the Commission under subpara20 graph (A). 

21 ‘‘(4) Upon the request of the Commission, the head 

22 of any Federal agency is authorized to detail, without re23 imbursement, any of the personnel of such agency to the 

24 Commission to assist the Commission in carrying out its 

25 duties. Any such detail shall not interrupt or otherwise 


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1 affect the civil service status or privileges of the Federal 

2 employee. 

3 ‘‘(5) Upon the request of the Commission, the head 

4 of a Federal agency shall provide such technical assistance 

5 to the Commission as the Commission determines to be 

6 necessary to carry out its duties. 

7 ‘‘(6) The Commission may use the United States 

8 mails in the same manner and under the same conditions 

9 as Federal agencies and shall, for purposes of the frank, 

10 be considered a commission of Congress as described in 

11 section 3215 of title 39, United States Code. 

12 ‘‘(7) The Commission may secure directly from any 

13 Federal agency information necessary to enable it to carry 

14 out its duties, if the information may be disclosed under 

15 section 552 of title 4, United States Code. Upon request 

16 of the Chairman of the Commission, the head of such 

17 agency shall furnish such information to the Commission. 

18 ‘‘(8) Upon the request of the Commission, the Ad19 ministrator of General Services shall provide to the Com20 mission on a reimbursable basis such administrative sup21 port services as the Commission may request. 

22 ‘‘(9) For purposes of costs relating to printing and 

23 binding, including the cost of personnel detailed from the 

24 Government Printing Office, the Commission shall be 

25 deemed to be a committee of Congress. 


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1 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

2 authorized to be appropriated $4,000,000 to carry out the 

3 provisions of this section, which sum shall not be deducted 

4 from or affect any other appropriation for health care for 

5 Indian persons. 

6 ‘‘(j) NONAPPLICABILITY OF FACA.—The Federal 

7 Advisory Committee Act (5 U.S.C. App.) shall not apply 

8 to the Commission. 

9 ‘‘SEC. 815. CONFIDENTIALITY OF MEDICAL QUALITY ASSUR10 ANCE RECORDS; QUALIFIED IMMUNITY FOR 

11 PARTICIPANTS. 

12 ‘‘(a) CONFIDENTIALITY OF RECORDS.—Medical qual13 ity assurance records created by or for any Indian Health 

14 Program or a health program of an Urban Indian Organi15 zation as part of a medical quality assurance program are 

16 confidential and privileged. Such records may not be dis17 closed to any person or entity, except as provided in sub18 section (c). 

19 ‘‘(b) PROHIBITION ON DISCLOSURE AND TESTI20 MONY.— 

21 ‘‘(1) IN GENERAL.—No part of any medical 

22 quality assurance record described in subsection (a) 

23 may be subject to discovery or admitted into evi24 dence in any judicial or administrative proceeding, 

25 except as provided in subsection (c). 


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1 ‘‘(2) TESTIMONY.—A person who reviews or 

2 creates medical quality assurance records for any In3 dian Health Program or Urban Indian Organization 

4 who participates in any proceeding that reviews or 

5 creates such records may not be permitted or re6 quired to testify in any judicial or administrative 

7 proceeding with respect to such records or with re8 spect to any finding, recommendation, evaluation, 

9 opinion, or action taken by such person or body in 

10 connection with such records except as provided in 

11 this section. 

12 ‘‘(c) AUTHORIZED DISCLOSURE AND TESTIMONY.— 

13 ‘‘(1) IN GENERAL.—Subject to paragraph (2), a 

14 medical quality assurance record described in sub15 section (a) may be disclosed, and a person referred 

16 to in subsection (b) may give testimony in connec17 tion with such a record, only as follows: 

18 ‘‘(A) To a Federal executive agency or pri19 vate organization, if such medical quality assur20 ance record or testimony is needed by such 

21 agency or organization to perform licensing or 

22 accreditation functions related to any Indian 

23 Health Program or to a health program of an 

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1 toring, required by law, of such program or or2 ganization. 

3 ‘‘(B) To an administrative or judicial pro4 ceeding commenced by a present or former In5 dian Health Program or Urban Indian Organi6 zation provider concerning the termination, sus7 pension, or limitation of clinical privileges of 

8 such health care provider. 

9 ‘‘(C) To a governmental board or agency 

10 or to a professional health care society or orga11 nization, if such medical quality assurance 

12 record or testimony is needed by such board, 

13 agency, society, or organization to perform li14 censing, credentialing, or the monitoring of pro15 fessional standards with respect to any health 

16 care provider who is or was an employee of any 

17 Indian Health Program or Urban Indian Orga18 nization. 

19 ‘‘(D) To a hospital, medical center, or 

20 other institution that provides health care serv21 ices, if such medical quality assurance record or 

22 testimony is needed by such institution to as23 sess the professional qualifications of any health 

24 care provider who is or was an employee of any 

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1 nization and who has applied for or been grant2 ed authority or employment to provide health 

3 care services in or on behalf of such program or 

4 organization. 

5 ‘‘(E) To an officer, employee, or contractor 

6 of the Indian Health Program or Urban Indian 

7 Organization that created the records or for 

8 which the records were created. If that officer, 

9 employee, or contractor has a need for such 

10 record or testimony to perform official duties. 

11 ‘‘(F) To a criminal or civil law enforce12 ment agency or instrumentality charged under 

13 applicable law with the protection of the public 

14 health or safety, if a qualified representative of 

15 such agency or instrumentality makes a written 

16 request that such record or testimony be pro17 vided for a purpose authorized by law. 

18 ‘‘(G) In an administrative or judicial pro19 ceeding commenced by a criminal or civil law 

20 enforcement agency or instrumentality referred 

21 to in subparagraph (F), but only with respect 

22 to the subject of such proceeding. 

23 ‘‘(2) IDENTITY OF PARTICIPANTS.—With the 

24 exception of the subject of a quality assurance ac25 tion, the identity of any person receiving health care 


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1 services from any Indian Health Program or Urban 

2 Indian Organization or the identity of any other per3 son associated with such program or organization 

4 for purposes of a medical quality assurance program 

5 that is disclosed in a medical quality assurance 

6 record described in subsection (a) shall be deleted 

7 from that record or document before any disclosure 

8 of such record is made outside such program or or9 ganization. Such requirement does not apply to the 

10 release of information pursuant to section 552a of 

11 title 5. 

12 ‘‘(d) DISCLOSURE FOR CERTAIN PURPOSES.— 

13 ‘‘(1) IN GENERAL.—Nothing in this section 

14 shall be construed as authorizing or requiring the 

15 withholding from any person or entity aggregate sta16 tistical information regarding the results of any In17 dian Health Program or Urban Indian 

18 Organizations’s medical quality assurance programs. 

19 ‘‘(2) WITHHOLDING FROM CONGRESS.—Noth20 ing in this section shall be construed as authority to 

21 withhold any medical quality assurance record from 

22 a committee of either House of Congress, any joint 

23 committee of Congress, or the Government Account24 ability Office if such record pertains to any matter 

25 within their respective jurisdictions. 


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1 ‘‘(e) PROHIBITION ON DISCLOSURE OF RECORD OR

2 TESTIMONY.—A person or entity having possession of or 

3 access to a record or testimony described by this section 

4 may not disclose the contents of such record or testimony 

5 in any manner or for any purpose except as provided in 

6 this section. 

7 ‘‘(f) EXEMPTION FROM FREEDOM OF INFORMATION

8 ACT.—Medical quality assurance records described in sub9 section (a) may not be made available to any person under 

10 section 552 of title 5. 

11 ‘‘(g) LIMITATION ON CIVIL LIABILITY.—A person 

12 who participates in or provides information to a person 

13 or body that reviews or creates medical quality assurance 

14 records described in subsection (a) shall not be civilly lia15 ble for such participation or for providing such informa16 tion if the participation or provision of information was 

17 in good faith based on prevailing professional standards 

18 at the time the medical quality assurance program activity 

19 took place. 

20 ‘‘(h) APPLICATION TO INFORMATION IN CERTAIN

21 OTHER RECORDS.—Nothing in this section shall be con22 strued as limiting access to the information in a record 

23 created and maintained outside a medical quality assur24 ance program, including a patient’s medical records, on 

25 the grounds that the information was presented during 


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1 meetings of a review body that are part of a medical qual2 ity assurance program. 

3 ‘‘(i) REGULATIONS.—The Secretary, acting through 

4 the Service, shall promulgate regulations pursuant to sec5 tion 802. 

6 ‘‘(j) DEFINITIONS.—In this section: 

7 ‘‘(1) The term ‘health care provider’ means any 

8 health care professional, including community health 

9 aides and practitioners certified under section 121, 

10 who are granted clinical practice privileges or em11 ployed to provide health care services in an Indian 

12 Health Program or health program of an Urban In13 dian Organization, who is licensed or certified to 

14 perform health care services by a governmental 

15 board or agency or professional health care society 

16 or organization. 

17 ‘‘(2) The term ‘medical quality assurance pro18 gram’ means any activity carried out before, on, or 

19 after the date of enactment of this Act by or for any 

20 Indian Health Program or Urban Indian Organiza21 tion to assess the quality of medical care, including 

22 activities conducted by or on behalf of individuals, 

23 Indian Health Program or Urban Indian Organiza24 tion medical or dental treatment review committees, 

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1 ance, credentials, infection control, patient safety, 

2 patient care assessment (including treatment proce3 dures, blood, drugs, and therapeutics), medical 

4 records, health resources management review and 

5 identification and prevention of medical or dental in6 cidents and risks. 

7 ‘‘(3) The term ‘medical quality assurance 

8 record’ means the proceedings, records, minutes, and 

9 reports that emanate from quality assurance pro10 gram activities described in paragraph (2) and are 

11 produced or compiled by or for an Indian Health 

12 Program or Urban Indian Organization as part of a 

13 medical quality assurance program. 

14 ‘‘SEC. 816. APPROPRIATIONS; AVAILABILITY. 

15 ‘‘Any new spending authority (described in subpara16 graph (A) or (B) of section 401(c)(2) of the Congressional 

17 Budget Act of 1974 (Public Law 93–344; 88 Stat. 317)) 

18 which is provided under this Act shall be effective for any 

19 fiscal year only to such extent or in such amounts as are 

20 provided in appropriation Acts. 

21 ‘‘SEC. 817. AUTHORIZATION OF APPROPRIATIONS. 

22 ‘‘There are authorized to be appropriated such sums 

23 as may be necessary for each fiscal year through fiscal 

24 year 2017 to carry out this title.’’. 

25 (b) RATE OF PAY.— 


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1 (1) POSITIONS AT LEVEL IV.—Section 5315 of 

2 title 5, United States Code, is amended by striking 

3 ‘‘Assistant Secretaries of Health and Human Serv4 ices (6).’’ and inserting ‘‘Assistant Secretaries of 

5 Health and Human Services (7)’’. 

6 (2) POSITIONS AT LEVEL V.—Section 5316 of 

7 title 5, United States Code, is amended by striking 

8 ‘‘Director, Indian Health Service, Department of 

9 Health and Human Services’’. 

10 (c) AMENDMENTS TO OTHER PROVISIONS OF LAW.— 

11 (1) Section 3307(b)(1)(C) of the Children’s 

12 Health Act of 2000 (25 U.S.C. 1671 note; Public 

13 Law 106–310) is amended by striking ‘‘Director of 

14 the Indian Health Service’’ and inserting ‘‘Assistant 

15 Secretary for Indian Health’’. 

16 (2) The Indian Lands Open Dump Cleanup Act 

17 of 1994 is amended— 

18 (A) in section 3 (25 U.S.C. 3902)— 

19 (i) by striking paragraph (2); 

20 (ii) by redesignating paragraphs (1), 

21 (3), (4), (5), and (6) as paragraphs (4), 

22 (5), (2), (6), and (1), respectively, and 

23 moving those paragraphs so as to appear 

24 in numerical order; and 


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1 (iii) by inserting before paragraph (4) 

2 (as redesignated by subclause (II)) the fol3 lowing: 

4 ‘‘(3) ASSISTANT SECRETARY.—The term ‘As5 sistant Secretary’ means the Assistant Secretary for 

6 Indian Health.’’; 

7 (B) in section 5 (25 U.S.C. 3904), by 

8 striking the section designation and heading 

9 and inserting the following: 

10 ‘‘SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR IN11 DIAN HEALTH.’’; 

12 (C) in section 6(a) (25 U.S.C. 3905(a)), in 

13 the subsection heading, by striking ‘‘DIREC14 TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 

15 (D) in section 9(a) (25 U.S.C. 3908(a)), in 

16 the subsection heading, by striking ‘‘DIREC17 TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 

18 and 

19 (E) by striking ‘‘Director’’ each place it 

20 appears and inserting ‘‘Assistant Secretary’’. 

21 (3) Section 5504(d)(2) of the Augustus F. 

22 Hawkins-Robert T. Stafford Elementary and Sec23 ondary School Improvement Amendments of 1988 

24 (25 U.S.C. 2001 note; Public Law 100–297) is 

25 amended by striking ‘‘Director of the Indian Health 


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1 Service’’ and inserting ‘‘Assistant Secretary for In2 dian Health’’. 

3 (4) Section 203(a)(1) of the Rehabilitation Act 

4 of 1973 (29 U.S.C. 763(a)(1)) is amended by strik5 ing ‘‘Director of the Indian Health Service’’ and in6 serting ‘‘Assistant Secretary for Indian Health’’. 

7 (5) Subsections (b) and (e) of section 518 of 

8 the Federal Water Pollution Control Act (33 U.S.C. 

9 1377) are amended by striking ‘‘Director of the In10 dian Health Service’’ each place it appears and in11 serting ‘‘Assistant Secretary for Indian Health’’. 

12 (6) Section 317M(b) of the Public Health Serv13 ice Act (42 U.S.C. 247b–14(b)) is amended— 

14 (A) by striking ‘‘Director of the Indian 

15 Health Service’’ each place it appears and in16 serting ‘‘Assistant Secretary for Indian 

17 Health’’; and 

18 (B) in paragraph (2)(A), by striking ‘‘the 

19 Directors referred to in such paragraph’’ and 

20 inserting ‘‘the Director of the Centers for Dis21 ease Control and Prevention and the Assistant 

22 Secretary for Indian Health’’. 

23 (7) Section 417C(b) of the Public Health Serv24 ice Act (42 U.S.C. 285–9(b)) is amended by striking 


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1 ‘‘Director of the Indian Health Service’’ and insert2 ing ‘‘Assistant Secretary for Indian Health’’. 

3 (8) Section 1452(i) of the Safe Drinking Water 

4 Act (42 U.S.C. 300j–12(i)) is amended by striking 

5 ‘‘Director of the Indian Health Service’’ each place 

6 it appears and inserting ‘‘Assistant Secretary for In7 dian Health’’. 

8 (9) Section 803B(d)(1) of the Native American 

9 Programs Act of 1974 (42 U.S.C. 2991b–2(d)(1)) is 

10 amended in the last sentence by striking ‘‘Director 

11 of the Indian Health Service’’ and inserting ‘‘Assist12 ant Secretary for Indian Health’’. 

13 (10) Section 203(b) of the Michigan Indian 

14 Land Claims Settlement Act (Public Law 105–143; 

15 111 Stat. 2666) is amended by striking ‘‘Director of 

16 the Indian Health Service’’ and inserting ‘‘Assistant 

17 Secretary for Indian Health’’. 

18 SEC. 102. SOBOBA SANITATION FACILITIES. 

19 The Act of December 17, 1970 (84 Stat. 1465), is 

20 amended by adding at the end the following: 

21 ‘‘SEC. 9. Nothing in this Act shall preclude the 

22 Soboba Band of Mission Indians and the Soboba Indian 

23 Reservation from being provided with sanitation facilities 

24 and services under the authority of section 7 of the Act 


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1 of August 5, 1954 (68 Stat. 674), as amended by the Act 

2 of July 31, 1959 (73 Stat. 267).’’. 

3 SEC. 103. NATIVE AMERICAN HEALTH AND WELLNESS 

4 FOUNDATION. 

5 (a) IN GENERAL.—The Indian Self-Determination 

6 and Education Assistance Act (25 U.S.C. 450 et seq.) is 

7 amended by adding at the end the following: 

8 ‘‘TITLE VIII—NATIVE AMERICAN 

9 HEALTH AND WELLNESS 

10 FOUNDATION 

11 ‘‘SEC. 801. DEFINITIONS. 

12 ‘‘In this title: 

13 ‘‘(1) BOARD.—The term ‘Board’ means the 

14 Board of Directors of the Foundation. 

15 ‘‘(2) COMMITTEE.—The term ‘Committee’ 

16 means the Committee for the Establishment of Na17 tive American Health and Wellness Foundation es18 tablished under section 802(f). 

19 ‘‘(3) FOUNDATION.—The term ‘Foundation’ 

20 means the Native American Health and Wellness 

21 Foundation established under section 802. 

22 ‘‘(4) SECRETARY.—The term ‘Secretary’ means 

23 the Secretary of Health and Human Services. 


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1 ‘‘(5) SERVICE.—The term ‘Service’ means the 

2 Indian Health Service of the Department of Health 

3 and Human Services. 

4 ‘‘SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS 

5 FOUNDATION. 

6 ‘‘(a) ESTABLISHMENT.— 

7 ‘‘(1) IN GENERAL.—As soon as practicable 

8 after the date of enactment of this title, the Sec9 retary shall establish, under the laws of the District 

10 of Columbia and in accordance with this title, the 

11 Native American Health and Wellness Foundation. 

12 ‘‘(2) FUNDING DETERMINATIONS.—No funds, 

13 gift, property, or other item of value (including any 

14 interest accrued on such an item) acquired by the 

15 Foundation shall— 

16 ‘‘(A) be taken into consideration for pur17 poses of determining Federal appropriations re18 lating to the provision of health care and serv19 ices to Indians; or 

20 ‘‘(B) otherwise limit, diminish, or affect 

21 the Federal responsibility for the provision of 

22 health care and services to Indians. 

23 ‘‘(b) PERPETUAL EXISTENCE.—The Foundation 

24 shall have perpetual existence. 

25 ‘‘(c) NATURE OF CORPORATION.—The Foundation— 


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1 ‘‘(1) shall be a charitable and nonprofit feder2 ally chartered corporation; and 

3 ‘‘(2) shall not be an agency or instrumentality 

4 of the United States. 

5 ‘‘(d) PLACE OF INCORPORATION AND DOMICILE.— 

6 The Foundation shall be incorporated and domiciled in the 

7 District of Columbia. 

8 ‘‘(e) DUTIES.—The Foundation shall— 

9 ‘‘(1) encourage, accept, and administer private 

10 gifts of real and personal property, and any income 

11 from or interest in such gifts, for the benefit of, or 

12 in support of, the mission of the Service; 

13 ‘‘(2) undertake and conduct such other activi14 ties as will further the health and wellness activities 

15 and opportunities of Native Americans; and 

16 ‘‘(3) participate with and assist Federal, State, 

17 and tribal governments, agencies, entities, and indi18 viduals in undertaking and conducting activities that 

19 will further the health and wellness activities and op20 portunities of Native Americans. 

21 ‘‘(f) COMMITTEE FOR THE ESTABLISHMENT OF NA22 TIVE AMERICAN HEALTH AND WELLNESS FOUNDA23 TION.— 

24 ‘‘(1) IN GENERAL.—The Secretary shall estab25 lish the Committee for the Establishment of Native 


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1 American Health and Wellness Foundation to assist 

2 the Secretary in establishing the Foundation. 

3 ‘‘(2) DUTIES.—Not later than 180 days after 

4 the date of enactment of this section, the Committee 

5 shall— 

6 ‘‘(A) carry out such activities as are nec7 essary to incorporate the Foundation under the 

8 laws of the District of Columbia, including act9 ing as incorporators of the Foundation; 

10 ‘‘(B) ensure that the Foundation qualifies 

11 for and maintains the status required to carry 

12 out this section, until the Board is established; 

13 ‘‘(C) establish the constitution and initial 

14 bylaws of the Foundation; 

15 ‘‘(D) provide for the initial operation of 

16 the Foundation, including providing for tem17 porary or interim quarters, equipment, and 

18 staff; and 

19 ‘‘(E) appoint the initial members of the 

20 Board in accordance with the constitution and 

21 initial bylaws of the Foundation. 

22 ‘‘(g) BOARD OF DIRECTORS.— 

23 ‘‘(1) IN GENERAL.—The Board of Directors 

24 shall be the governing body of the Foundation. 


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1 ‘‘(2) POWERS.—The Board may exercise, or 

2 provide for the exercise of, the powers of the Foun3 dation. 

4 ‘‘(3) SELECTION.— 

5 ‘‘(A) IN GENERAL.—Subject to subpara6 graph (B), the number of members of the 

7 Board, the manner of selection of the members 

8 (including the filling of vacancies), and the 

9 terms of office of the members shall be as pro10 vided in the constitution and bylaws of the 

11 Foundation. 

12 ‘‘(B) REQUIREMENTS.— 

13 ‘‘(i) NUMBER OF MEMBERS.—The 

14 Board shall have at least 11 members, who 

15 shall have staggered terms. 

16 ‘‘(ii) INITIAL VOTING MEMBERS.—The 

17 initial voting members of the Board— 

18 ‘‘(I) shall be appointed by the 

19 Committee not later than 180 days 

20 after the date on which the Founda21 tion is established; and 

22 ‘‘(II) shall have staggered terms. 

23 ‘‘(iii) QUALIFICATION.—The members 

24 of the Board shall be United States citi25 zens who are knowledgeable or experienced 


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1 in Native American health care and related 

2 matters. 

3 ‘‘(C) COMPENSATION.—A member of the 

4 Board shall not receive compensation for service 

5 as a member, but shall be reimbursed for actual 

6 and necessary travel and subsistence expenses 

7 incurred in the performance of the duties of the 

8 Foundation. 

9 ‘‘(h) OFFICERS.— 

10 ‘‘(1) IN GENERAL.—The officers of the Founda11 tion shall be— 

12 ‘‘(A) a secretary, elected from among the 

13 members of the Board; and 

14 ‘‘(B) any other officers provided for in the 

15 constitution and bylaws of the Foundation. 

16 ‘‘(2) CHIEF OPERATING OFFICER.—The sec17 retary of the Foundation may serve, at the direction 

18 of the Board, as the chief operating officer of the 

19 Foundation, or the Board may appoint a chief oper20 ating officer, who shall serve at the direction of the 

21 Board. 

22 ‘‘(3) ELECTION.—The manner of election, term 

23 of office, and duties of the officers of the Founda24 tion shall be as provided in the constitution and by25 laws of the Foundation. 


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1 ‘‘(i) POWERS.—The Foundation— 

2 ‘‘(1) shall adopt a constitution and bylaws for 

3 the management of the property of the Foundation 

4 and the regulation of the affairs of the Foundation; 

5 ‘‘(2) may adopt and alter a corporate seal; 

6 ‘‘(3) may enter into contracts; 

7 ‘‘(4) may acquire (through a gift or otherwise), 

8 own, lease, encumber, and transfer real or personal 

9 property as necessary or convenient to carry out the 

10 purposes of the Foundation; 

11 ‘‘(5) may sue and be sued; and 

12 ‘‘(6) may perform any other act necessary and 

13 proper to carry out the purposes of the Foundation. 

14 ‘‘(j) PRINCIPAL OFFICE.— 

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

16 Foundation shall be in the District of Columbia. 

17 ‘‘(2) ACTIVITIES; OFFICES.—The activities of 

18 the Foundation may be conducted, and offices may 

19 be maintained, throughout the United States in ac20 cordance with the constitution and bylaws of the 

21 Foundation. 

22 ‘‘(k) SERVICE OF PROCESS.—The Foundation shall 

23 comply with the law on service of process of each State 

24 in which the Foundation is incorporated and of each State 

25 in which the Foundation carries on activities. 


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1 ‘‘(l) LIABILITY OF OFFICERS, EMPLOYEES, AND

2 AGENTS.— 

3 ‘‘(1) IN GENERAL.—The Foundation shall be 

4 liable for the acts of the officers, employees, and 

5 agents of the Foundation acting within the scope of 

6 their authority. 

7 ‘‘(2) PERSONAL LIABILITY.—A member of the 

8 Board shall be personally liable only for gross neg9 ligence in the performance of the duties of the mem10 ber. 

11 ‘‘(m) RESTRICTIONS.— 

12 ‘‘(1) LIMITATION ON SPENDING.—Beginning 

13 with the fiscal year following the first full fiscal year 

14 during which the Foundation is in operation, the ad15 ministrative costs of the Foundation shall not exceed 

16 the percentage described in paragraph (2) of the 

17 sum of— 

18 ‘‘(A) the amounts transferred to the Foun19 dation under subsection (o) during the pre20 ceding fiscal year; and 

21 ‘‘(B) donations received from private 

22 sources during the preceding fiscal year. 

23 ‘‘(2) PERCENTAGES.—The percentages referred 

24 to in paragraph (1) are— 


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1 ‘‘(A) for the first fiscal year described in 

2 that paragraph, 20 percent; 

3 ‘‘(B) for the following fiscal year, 15 per4 cent; and 

5 ‘‘(C) for each fiscal year thereafter, 10 

6 percent. 

7 ‘‘(3) APPOINTMENT AND HIRING.—The ap8 pointment of officers and employees of the Founda9 tion shall be subject to the availability of funds. 

10 ‘‘(4) STATUS.—A member of the Board or offi11 cer, employee, or agent of the Foundation shall not 

12 by reason of association with the Foundation be con13 sidered to be an officer, employee, or agent of the 

14 United States. 

15 ‘‘(n) AUDITS.—The Foundation shall comply with 

16 section 10101 of title 36, United States Code, as if the 

17 Foundation were a corporation under part B of subtitle 

18 II of that title. 

19 ‘‘(o) FUNDING.— 

20 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

21 There is authorized to be appropriated to carry out 

22 subsection (e)(1) $500,000 for each fiscal year, as 

23 adjusted to reflect changes in the Consumer Price 

24 Index for all-urban consumers published by the De25 partment of Labor. 


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1 ‘‘(2) TRANSFER OF DONATED FUNDS.—The 

2 Secretary shall transfer to the Foundation funds 

3 held by the Department of Health and Human Serv4 ices under the Act of August 5, 1954 (42 U.S.C. 

5 2001 et seq.), if the transfer or use of the funds is 

6 not prohibited by any term under which the funds 

7 were donated. 

8 ‘‘SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT. 

9 ‘‘(a) PROVISION OF SUPPORT BY SECRETARY.—Sub10 ject to subsection (b), during the 5-year period beginning 

11 on the date on which the Foundation is established, the 

12 Secretary— 

13 ‘‘(1) may provide personnel, facilities, and other 

14 administrative support services to the Foundation; 

15 ‘‘(2) may provide funds for initial operating 

16 costs and to reimburse the travel expenses of the 

17 members of the Board; and 

18 ‘‘(3) shall require and accept reimbursements 

19 from the Foundation for— 

20 ‘‘(A) services provided under paragraph 

21 (1); and 

22 ‘‘(B) funds provided under paragraph (2). 

23 ‘‘(b) REIMBURSEMENT.—Reimbursements accepted 

24 under subsection (a)(3)— 


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1 ‘‘(1) shall be deposited in the Treasury of the 

2 United States to the credit of the applicable appro3 priations account; and 

4 ‘‘(2) shall be chargeable for the cost of pro5 viding services described in subsection (a)(1) and 

6 travel expenses described in subsection (a)(2). 

7 ‘‘(c) CONTINUATION OF CERTAIN SERVICES.—The 

8 Secretary may continue to provide facilities and necessary 

9 support services to the Foundation after the termination 

10 of the 5-year period specified in subsection (a) if the facili11 ties and services— 

12 ‘‘(1) are available; and 

13 ‘‘(2) are provided on reimbursable cost basis.’’. 

14 (b) TECHNICAL AMENDMENTS.—The Indian Self-De15 termination and Education Assistance Act is amended— 

16 (1) by redesignating title V (25 U.S.C. 458bbb 

17 et seq.) as title VII; 

18 (2) by redesignating sections 501, 502, and 503 

19 (25 U.S.C. 458bbb, 458bbb–1, 458bbb–2) as sec20 tions 701, 702, and 703, respectively; and 

21 (3) in subsection (a)(2) of section 702 and 

22 paragraph (2) of section 703 (as redesignated by 

23 paragraph (2)), by striking ‘‘section 501’’ and in24 serting ‘‘section 701’’. 


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1 TITLE II—IMPROVEMENT OF IN2 DIAN HEALTH CARE PRO3 VIDED UNDER THE SOCIAL 

4 SECURITY ACT 

5 SEC. 201. EXPANSION OF PAYMENTS UNDER MEDICARE, 

6 MEDICAID, AND SCHIP FOR ALL COVERED 

7 SERVICES FURNISHED BY INDIAN HEALTH 

8 PROGRAMS. 

9 (a) MEDICAID.— 

10 (1) EXPANSION TO ALL COVERED SERVICES.— 

11 Section 1911 of the Social Security Act (42 U.S.C. 

12 1396j) is amended— 

13 (A) by amending the heading to read as 

14 follows: 

15 ‘‘SEC. 1911. INDIAN HEALTH PROGRAMS.’’; 

16 and 

17 (B) by amending subsection (a) to read as 

18 follows: 

19 ‘‘(a) ELIGIBILITY FOR PAYMENT FOR MEDICAL AS20 SISTANCE.—The Indian Health Service and an Indian 

21 Tribe, Tribal Organization, or an Urban Indian Organiza22 tion shall be eligible for payment for medical assistance 

23 provided under a State plan or under waiver authority 

24 with respect to items and services furnished by the Indian 

25 Health Service, Indian Tribe, Tribal Organization, or 


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1 Urban Indian Organization if the furnishing of such serv2 ices meets all the conditions and requirements which are 

3 applicable generally to the furnishing of items and services 

4 under this title and under such plan or waiver authority.’’. 

5 (2) COMPLIANCE WITH CONDITIONS AND RE6 QUIREMENTS.—Subsection (b) of such section is 

7 amended to read as follows: 

8 ‘‘(b) COMPLIANCE WITH CONDITIONS AND REQUIRE9 MENTS.—A facility of the Indian Health Service or an In10 dian Tribe, Tribal Organization, or an Urban Indian Or11 ganization which is eligible for payment under subsection 

12 (a) with respect to the furnishing of items and services, 

13 but which does not meet all of the conditions and require14 ments of this title and under a State plan or waiver au15 thority which are applicable generally to such facility, shall 

16 make such improvements as are necessary to achieve or 

17 maintain compliance with such conditions and require18 ments in accordance with a plan submitted to and accept19 ed by the Secretary for achieving or maintaining compli20 ance with such conditions and requirements, and shall be 

21 deemed to meet such conditions and requirements (and to 

22 be eligible for payment under this title), without regard 

23 to the extent of its actual compliance with such conditions 

24 and requirements, during the first 12 months after the 

25 month in which such plan is submitted.’’. 


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1 (3) REVISION OF AUTHORITY TO ENTER INTO

2 AGREEMENTS.—Subsection (c) of such section is 

3 amended to read as follows: 

4 ‘‘(c) AUTHORITY TO ENTER INTO AGREEMENTS.— 

5 The Secretary may enter into an agreement with a State 

6 for the purpose of reimbursing the State for medical as7 sistance provided by the Indian Health Service, an Indian 

8 Tribe, Tribal Organization, or an Urban Indian Organiza9 tion (as so defined), directly, through referral, or under 

10 contracts or other arrangements between the Indian 

11 Health Service, an Indian Tribe, Tribal Organization, or 

12 an Urban Indian Organization and another health care 

13 provider to Indians who are eligible for medical assistance 

14 under the State plan or under waiver authority.’’. 

15 (4) CROSS-REFERENCES TO SPECIAL FUND FOR

16 IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING

17 OPTION; DEFINITIONS.—Such section is further 

18 amended by striking subsection (d) and adding at 

19 the end the following new subsections: 

20 ‘‘(d) SPECIAL FUND FOR IMPROVEMENT OF IHS FA21 CILITIES.—For provisions relating to the authority of the 

22 Secretary to place payments to which a facility of the In23 dian Health Service is eligible for payment under this title 

24 into a special fund established under section 401(c)(1) of 

25 the Indian Health Care Improvement Act, and the requireVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00348 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 ment to use amounts paid from such fund for making im2 provements in accordance with subsection (b), see sub3 paragraphs (A) and (B) of section 401(c)(1) of such Act. 

4 ‘‘(e) DIRECT BILLING.—For provisions relating to 

5 the authority of a Tribal Health Program or an Urban 

6 Indian Organization to elect to directly bill for, and receive 

7 payment for, health care items and services provided by 

8 such Program or Organization for which payment is made 

9 under this title, see section 401(d) of the Indian Health 

10 Care Improvement Act. 

11 ‘‘(f) DEFINITIONS.—In this section, the terms ‘In12 dian Health Program’, ‘Indian Tribe’,‘Tribal Health Pro13 gram’, ‘Tribal Organization’, and ‘Urban Indian Organi14 zation’ have the meanings given those terms in section 4 

15 of the Indian Health Care Improvement Act.’’. 

16 (b) MEDICARE.— 

17 (1) EXPANSION TO ALL COVERED SERVICES.— 

18 Section 1880 of such Act (42 U.S.C. 1395qq) is 

19 amended— 

20 (A) by amending the heading to read as 

21 follows: 

22 ‘‘SEC. 1880. INDIAN HEALTH PROGRAMS.’’; 

23 and 

24 (B) by amending subsection (a) to read as 

25 follows: 


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1 ‘‘(a) ELIGIBILITY FOR PAYMENTS.—Subject to sub2 section (e), the Indian Health Service and an Indian 

3 Tribe, Tribal Organization, or an Urban Indian Organiza4 tion shall be eligible for payments under this title with 

5 respect to items and services furnished by the Indian 

6 Health Service, Indian Tribe, Tribal Organization, or 

7 Urban Indian Organization if the furnishing of such serv8 ices meets all the conditions and requirements which are 

9 applicable generally to the furnishing of items and services 

10 under this title.’’. 

11 (2) COMPLIANCE WITH CONDITIONS AND RE12 QUIREMENTS.—Subsection (b) of such section is 

13 amended to read as follows: 

14 ‘‘(b) COMPLIANCE WITH CONDITIONS AND REQUIRE15 MENTS.—Subject to subsection (e), a facility of the Indian 

16 Health Service or an Indian Tribe, Tribal Organization, 

17 or an Urban Indian Organization which is eligible for pay18 ment under subsection (a) with respect to the furnishing 

19 of items and services, but which does not meet all of the 

20 conditions and requirements of this title which are applica21 ble generally to such facility, shall make such improve22 ments as are necessary to achieve or maintain compliance 

23 with such conditions and requirements in accordance with 

24 a plan submitted to and accepted by the Secretary for 

25 achieving or maintaining compliance with such conditions 


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1 and requirements, and shall be deemed to meet such con2 ditions and requirements (and to be eligible for payment 

3 under this title), without regard to the extent of its actual 

4 compliance with such conditions and requirements, during 

5 the first 12 months after the month in which such plan 

6 is submitted.’’. 

7 (3) CROSS-REFERENCES TO SPECIAL FUND FOR

8 IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING

9 OPTION; DEFINITIONS.— 

10 (A) IN GENERAL.—Such section is further 

11 amended by striking subsections (c) and (d) 

12 and inserting the following new subsections: 

13 ‘‘(c) SPECIAL FUND FOR IMPROVEMENT OF IHS FA14 CILITIES.—For provisions relating to the authority of the 

15 Secretary to place payments to which a facility of the In16 dian Health Service is eligible for payment under this title 

17 into a special fund established under section 401(c)(1) of 

18 the Indian Health Care Improvement Act, and the require19 ment to use amounts paid from such fund for making im20 provements in accordance with subsection (b), see sub21 paragraphs (A) and (B) of section 401(c)(1) of such Act. 

22 ‘‘(d) DIRECT BILLING.—For provisions relating to 

23 the authority of a Tribal Health Program or an Urban 

24 Indian Organization to elect to directly bill for, and receive 

25 payment for, health care items and services provided by 


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1 such Program or Organization for which payment is made 

2 under this title, see section 401(d) of the Indian Health 

3 Care Improvement Act.’’. 

4 (B) CONFORMING AMENDMENT.—Para5 graph (3) of section 1880(e) of such Act (42 

6 U.S.C. 1395qq(e)) is amended by inserting 

7 ‘‘and section 401(c)(1) of the Indian Health 

8 Care Improvement Act’’ after ‘‘Subsection (c)’’. 

9 (4) DEFINITIONS.—Such section is further 

10 amended by amending subsection (f) to read as fol11 lows: 

12 ‘‘(f) DEFINITIONS.—In this section, the terms ‘In13 dian Health Program’, ‘Indian Tribe’, ‘Service Unit’, 

14 ‘Tribal Health Program’, ‘Tribal Organization’, and 

15 ‘Urban Indian Organization’ have the meanings given 

16 those terms in section 4 of the Indian Health Care Im17 provement Act.’’. 

18 (c) APPLICATION TO SCHIP.—Section 2107(e)(1) of 

19 the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 

20 amended— 

21 (1) by redesignating subparagraph (D) as sub22 paragraph (E); and 

23 (2) by inserting after subparagraph (C), the fol24 lowing new subparagraph: 


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1 ‘‘(D) Section 1911 (relating to Indian 

2 Health Programs, other than subsection (d) of 

3 such section).’’. 

4 SEC. 202. INCREASED OUTREACH TO INDIANS UNDER MED5 ICAID AND SCHIP AND IMPROVED COOPERA6 TION IN THE PROVISION OF ITEMS AND 

7 SERVICES TO INDIANS UNDER SOCIAL SECU8 RITY ACT HEALTH BENEFIT PROGRAMS. 

9 Section 1139 of the Social Security Act (42 U.S.C. 

10 1320b–9) is amended to read as follows: 

11 ‘‘SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, 

12 HEALTH CARE FOR INDIANS UNDER TITLES 

13 XVIII, XIX, AND XXI. 

14 ‘‘(a) AGREEMENTS WITH STATES FOR MEDICAID

15 AND SCHIP OUTREACH ON OR NEAR RESERVATIONS TO

16 INCREASE THE ENROLLMENT OF INDIANS IN THOSE

17 PROGRAMS.— 

18 ‘‘(1) IN GENERAL.—In order to improve the ac19 cess of Indians residing on or near a reservation to 

20 obtain benefits under the Medicaid and State chil21 dren’s health insurance programs established under 

22 titles XIX and XXI, the Secretary shall encourage 

23 the State to take steps to provide for enrollment on 

24 or near the reservation. Such steps may include out25 reach efforts such as the outstationing of eligibility 


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1 workers, entering into agreements with the Indian 

2 Health Service, Indian Tribes, Tribal Organizations, 

3 and Urban Indian Organizations to provide out4 reach, education regarding eligibility and benefits, 

5 enrollment, and translation services when such serv6 ices are appropriate. 

7 ‘‘(2) CONSTRUCTION.—Nothing in subpara8 graph (A) shall be construed as affecting arrange9 ments entered into between States and the Indian 

10 Health Service, Indian Tribes, Tribal Organizations, 

11 or Urban Indian Organizations for such Service, 

12 Tribes, or Organizations to conduct administrative 

13 activities under such titles. 

14 ‘‘(b) REQUIREMENT TO FACILITATE COOPERA15 TION.—The Secretary, acting through the Centers for 

16 Medicare & Medicaid Services, shall take such steps as are 

17 necessary to facilitate cooperation with, and agreements 

18 between, States and the Indian Health Service, Indian 

19 Tribes, Tribal Organizations, or Urban Indian Organiza20 tions with respect to the provision of health care items 

21 and services to Indians under the programs established 

22 under title XVIII, XIX, or XXI. 

23 ‘‘(c) DEFINITION OF INDIAN; INDIAN TRIBE; INDIAN

24 HEALTH PROGRAM; TRIBAL ORGANIZATION; URBAN IN25 DIAN ORGANIZATION.—In this section, the terms ‘Indian’, 


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1 ‘Indian Tribe’, ‘Indian Health Program’, ‘Tribal Organi2 zation’, and ‘Urban Indian Organization’ have the mean3 ings given those terms in section 4 of the Indian Health 

4 Care Improvement Act.’’. 

5 SEC. 203. ADDITIONAL PROVISIONS TO INCREASE OUT6 REACH TO, AND ENROLLMENT OF, INDIANS 

7 IN SCHIP AND MEDICAID. 

8 (a) NONAPPLICATION OF 10 PERCENT LIMIT ON

9 OUTREACH AND CERTAIN OTHER EXPENDITURES.—Sec10 tion 2105(c)(2) of the Social Security Act (42 U.S.C. 

11 1397ee(c)(2)) is amended by adding at the end the fol12 lowing new subparagraph: 

13 ‘‘(C) NONAPPLICATION TO EXPENDITURES

14 FOR OUTREACH TO INCREASE THE ENROLL15 MENT OF INDIAN CHILDREN UNDER THIS TITLE

16 AND TITLE XIX.—The limitation under sub17 paragraph (A) on expenditures for items de18 scribed in subsection (a)(1)(D) shall not apply 

19 in the case of expenditures for outreach activi20 ties to families of Indian children likely to be el21 igible for child health assistance under the plan 

22 or medical assistance under the State plan 

23 under title XIX (or under a waiver of such 

24 plan), to inform such families of the availability 

25 of, and to assist them in enrolling their children 


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1 in, such plans, including such activities con2 ducted under grants, contracts, or agreements 

3 entered into under section 1139(a).’’. 

4 (b) ASSURANCE OF PAYMENTS TO INDIAN HEALTH

5 CARE PROVIDERS FOR CHILD HEALTH ASSISTANCE.— 

6 Section 2102(b)(3)(D) of such Act (42 U.S.C. 

7 1397bb(b)(3)(D)) is amended by striking ‘‘(as defined in 

8 section 4(c) of the Indian Health Care Improvement Act, 

9 25 U.S.C. 1603(c))’’ and inserting ‘‘, including how the 

10 State will ensure that payments are made to Indian 

11 Health Programs and Urban Indian Organizations oper12 ating in the State for the provision of such assistance’’. 

13 (c) INCLUSION OF OTHER INDIAN FINANCED

14 HEALTH CARE PROGRAMS IN EXEMPTION FROM PROHI15 BITION ON CERTAIN PAYMENTS.—Section 2105(c)(6)(B) 

16 of such Act (42 U.S.C. 1397ee(c)(6)(B)) is amended by 

17 striking ‘‘insurance program, other than an insurance pro18 gram operated or financed by the Indian Health Service’’ 

19 and inserting ‘‘program, other than a health care program 

20 operated or financed by the Indian Health Service or by 

21 an Indian Tribe, Tribal Organization, or Urban Indian 

22 Organization’’. 

23 (d) SATISFACTION OF MEDICAID DOCUMENTATION

24 REQUIREMENTS.— 


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1 (1) IN GENERAL.—Section 1903(x)(3)(B) of the 

2 Social Security Act (42 U.S.C. 1396b(x)(3)(B)) is 

3 amended— 

4 (A) by redesignating clause (v) as clause 

5 (vi); and 

6 (B) by inserting after clause (iv), the fol7 lowing new clause: 

8 ‘‘(v)(I) Except as provided in subclause (II), a 

9 document issued by a federally-recognized Indian 

10 tribe evidencing membership or enrollment in, or af11 filiation with, such tribe. 

12 ‘‘(II) With respect to those federally-recognized 

13 Indian tribes located within States having an inter14 national border whose membership includes individ15 uals who are not citizens of the United States, the 

16 Secretary shall, after consulting with such tribes, 

17 issue regulations authorizing the presentation of 

18 such other forms of documentation (including tribal 

19 documentation, if appropriate) that the Secretary 

20 determines to be satisfactory documentary evidence 

21 of citizenship or nationality for purposes of satis22 fying the requirement of this subsection.’’. 

23 (2) TRANSITION RULE.—During the period that 

24 begins on July 1, 2006, and ends on the effective 

25 date of final regulations issued under subclause (II) 


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1 of section 1903(x)(3)(B)(v) of the Social Security 

2 Act (42 U.S.C. 1396b(x)(3)(B)(v)) (as added by 

3 paragraph (1)), an individual who is a member of a 

4 federally-recognized Indian tribe described in sub5 clause (II) of that section who presents a document 

6 described in subclause (I) of such section that is 

7 issued by such Indian tribe, shall be deemed to have 

8 presented satisfactory evidence of citizenship or na9 tionality for purposes of satisfying the requirement 

10 of subsection (x) of section 1903 of such Act. 

11 (e) DEFINITIONS.—Section 2110(c) of such Act (42 

12 U.S.C. 1397jj(c)) is amended by adding at the end the 

13 following new paragraph: 

14 ‘‘(9) INDIAN; INDIAN HEALTH PROGRAM; IN15 DIAN TRIBE; ETC.—The terms ‘Indian’, ‘Indian 

16 Health Program’, ‘Indian Tribe’, ‘Tribal Organiza17 tion’, and ‘Urban Indian Organization’ have the 

18 meanings given those terms in section 4 of the In19 dian Health Care Improvement Act.’’. 


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1 SEC. 204. PREMIUMS AND COST SHARING PROTECTIONS 

2 UNDER MEDICAID, ELIGIBILITY DETERMINA3 TIONS UNDER MEDICAID AND SCHIP, AND 

4 PROTECTION OF CERTAIN INDIAN PROPERTY 

5 FROM MEDICAID ESTATE RECOVERY. 

6 (a) PREMIUMS AND COST SHARING PROTECTION

7 UNDER MEDICAID.— 

8 (1) IN GENERAL.—Section 1916 of the Social 

9 Security Act (42 U.S.C. 1396o) is amended— 

10 (A) in subsection (a), in the matter pre11 ceding paragraph (1), by striking ‘‘and (i)’’ and 

12 inserting ‘‘, (i), and (j)’’; and 

13 (B) by adding at the end the following new 

14 subsection: 

15 ‘‘(j) NO PREMIUMS OR COST SHARING FOR INDIANS

16 FURNISHED ITEMS OR SERVICES DIRECTLY BY INDIAN

17 HEALTH PROGRAMS OR THROUGH REFERRAL UNDER

18 THE CONTRACT HEALTH SERVICE.— 

19 ‘‘(1) NO COST SHARING FOR ITEMS OR SERV20 ICES FURNISHED TO INDIANS THROUGH INDIAN

21 HEALTH PROGRAMS.— 

22 ‘‘(A) IN GENERAL.—No enrollment fee, 

23 premium, or similar charge, and no deduction, 

24 copayment, cost sharing, or similar charge shall 

25 be imposed against an Indian who is furnished 

26 an item or service directly by the Indian Health 


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1 Service, an Indian Tribe, Tribal Organization, 

2 or Urban Indian Organization or through refer3 ral under the contract health service for which 

4 payment may be made under this title. 

5 ‘‘(B) NO REDUCTION IN AMOUNT OF PAY6 MENT TO INDIAN HEALTH PROVIDERS.—Pay7 ment due under this title to the Indian Health 

8 Service, an Indian Tribe, Tribal Organization, 

9 or Urban Indian Organization, or a health care 

10 provider through referral under the contract 

11 health service for the furnishing of an item or 

12 service to an Indian who is eligible for assist13 ance under such title, may not be reduced by 

14 the amount of any enrollment fee, premium, or 

15 similar charge, or any deduction, copayment, 

16 cost sharing, or similar charge that would be 

17 due from the Indian but for the operation of 

18 subparagraph (A). 

19 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

20 this subsection shall be construed as restricting the 

21 application of any other limitations on the imposi22 tion of premiums or cost sharing that may apply to 

23 an individual receiving medical assistance under this 

24 title who is an Indian. 


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1 ‘‘(3) DEFINITIONS.—In this subsection, the 

2 terms ‘contract health service’, ‘Indian’, ‘Indian 

3 Tribe’, ‘Tribal Organization’, and ‘Urban Indian Or4 ganization’ have the meanings given those terms in 

5 section 4 of the Indian Health Care Improvement 

6 Act.’’. 

7 (2) CONFORMING AMENDMENT.—Section 

8 1916A (a)(1) of such Act (42 U.S.C. 1396o–1(a)(1)) 

9 is amended by striking ‘‘section 1916(g)’’ and in10 serting ‘‘subsections (g), (i), or (j) of section 1916’’. 

11 (b) TREATMENT OF CERTAIN PROPERTY FOR MED12 ICAID AND SCHIP ELIGIBILITY.— 

13 (1) MEDICAID.—Section 1902(e) of the Social 

14 Security Act (42 U.S.C. 1396a) is amended by add15 ing at the end the following new paragraph: 

16 ‘‘(13) Notwithstanding any other requirement 

17 of this title or any other provision of Federal or 

18 State law, a State shall disregard the following prop19 erty for purposes of determining the eligibility of an 

20 individual who is an Indian (as defined in section 4 

21 of the Indian Health Care Improvement Act) for 

22 medical assistance under this title: 

23 ‘‘(A) Property, including real property and 

24 improvements, that is held in trust, subject to 

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1 pervision of the Secretary of the Interior, lo2 cated on a reservation, including any federally 

3 recognized Indian Tribe’s reservation, pueblo, 

4 or colony, including former reservations in 

5 Oklahoma, Alaska Native regions established by 

6 the Alaska Native Claims Settlement Act, and 

7 Indian allotments on or near a reservation as 

8 designated and approved by the Bureau of In9 dian Affairs of the Department of the Interior. 

10 ‘‘(B) For any federally recognized Tribe 

11 not described in subparagraph (A), property lo12 cated within the most recent boundaries of a 

13 prior Federal reservation. 

14 ‘‘(C) Ownership interests in rents, leases, 

15 royalties, or usage rights related to natural re16 sources (including extraction of natural re17 sources or harvesting of timber, other plants 

18 and plant products, animals, fish, and shellfish) 

19 resulting from the exercise of federally pro20 tected rights. 

21 ‘‘(D) Ownership interests in or usage 

22 rights to items not covered by subparagraphs 

23 (A) through (C) that have unique religious, 

24 spiritual, traditional, or cultural significance or 

25 rights that support subsistence or a traditional 


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1 lifestyle according to applicable tribal law or 

2 custom.’’. 

3 (2) APPLICATION TO SCHIP.—Section 

4 2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)) is 

5 amended— 

6 (A) by redesignating subparagraphs (B) 

7 through (E), as subparagraphs (C) through 

8 (F), respectively; and 

9 (B) by inserting after subparagraph (A), 

10 the following new subparagraph: 

11 ‘‘(B) Section 1902(e)(13) (relating to dis12 regard of certain property for purposes of mak13 ing eligibility determinations).’’. 

14 (c) CONTINUATION OF CURRENT LAW PROTECTIONS

15 OF CERTAIN INDIAN PROPERTY FROM MEDICAID ESTATE

16 RECOVERY.—Section 1917(b)(3) of the Social Security 

17 Act (42 U.S.C. 1396p(b)(3)) is amended— 

18 (1) by inserting ‘‘(A)’’ after ‘‘(3)’’; and 

19 (2) by adding at the end the following new sub20 paragraph: 

21 ‘‘(B) The standards specified by the Sec22 retary under subparagraph (A) shall require 

23 that the procedures established by the State 

24 agency under subparagraph (A) exempt income, 

25 resources, and property that are exempt from 


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1 the application of this subsection as of April 1, 

2 2003, under manual instructions issued to carry 

3 out this subsection (as in effect on such date) 

4 because of the Federal responsibility for Indian 

5 Tribes and Alaska Native Villages. Nothing in 

6 this subparagraph shall be construed as pre7 venting the Secretary from providing additional 

8 estate recovery exemptions under this title for 

9 Indians.’’. 

10 SEC. 205. NONDISCRIMINATION IN QUALIFICATIONS FOR 

11 PAYMENT FOR SERVICES UNDER FEDERAL 

12 HEALTH CARE PROGRAMS. 

13 Section 1139 of the Social Security Act (42 U.S.C. 

14 1320b–9), as amended by section 202, is amended by re15 designating subsection (c) as subsection (d), and inserting 

16 after subsection (b) the following new subsection: 

17 ‘‘(c) NONDISCRIMINATION IN QUALIFICATIONS FOR

18 PAYMENT FOR SERVICES UNDER FEDERAL HEALTH

19 CARE PROGRAMS.— 

20 ‘‘(1) REQUIREMENT TO SATISFY GENERALLY

21 APPLICABLE PARTICIPATION REQUIREMENTS.— 

22 ‘‘(A) IN GENERAL.—A Federal health care 

23 program must accept an entity that is operated 

24 by the Indian Health Service, an Indian Tribe, 

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1 tion as a provider eligible to receive payment 

2 under the program for health care services fur3 nished to an Indian on the same basis as any 

4 other provider qualified to participate as a pro5 vider of health care services under the program 

6 if the entity meets generally applicable State or 

7 other requirements for participation as a pro8 vider of health care services under the program. 

9 ‘‘(B) SATISFACTION OF STATE OR LOCAL

10 LICENSURE OR RECOGNITION REQUIRE11 MENTS.—Any requirement for participation as 

12 a provider of health care services under a Fed13 eral health care program that an entity be li14 censed or recognized under the State or local 

15 law where the entity is located to furnish health 

16 care services shall be deemed to have been met 

17 in the case of an entity operated by the Indian 

18 Health Service, an Indian Tribe, Tribal Organi19 zation, or Urban Indian Organization if the en20 tity meets all the applicable standards for such 

21 licensure or recognition, regardless of whether 

22 the entity obtains a license or other documenta23 tion under such State or local law. In accord24 ance with section 221 of the Indian Health 

25 Care Improvement Act, the absence of the licenVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00365 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 sure of a health care professional employed by 

2 such an entity under the State or local law 

3 where the entity is located shall not be taken 

4 into account for purposes of determining wheth5 er the entity meets such standards, if the pro6 fessional is licensed in another State. 

7 ‘‘(2) PROHIBITION ON FEDERAL PAYMENTS TO

8 ENTITIES OR INDIVIDUALS EXCLUDED FROM PAR9 TICIPATION IN FEDERAL HEALTH CARE PROGRAMS

10 OR WHOSE STATE LICENSES ARE UNDER SUSPEN11 SION OR HAVE BEEN REVOKED.— 

12 ‘‘(A) EXCLUDED ENTITIES.—No entity op13 erated by the Indian Health Service, an Indian 

14 Tribe, Tribal Organization, or Urban Indian 

15 Organization that has been excluded from par16 ticipation in any Federal health care program 

17 or for which a license is under suspension or 

18 has been revoked by the State where the entity 

19 is located shall be eligible to receive payment 

20 under any such program for health care serv21 ices furnished to an Indian. 

22 ‘‘(B) EXCLUDED INDIVIDUALS.—No indi23 vidual who has been excluded from participation 

24 in any Federal health care program or whose 

25 State license is under suspension or has been 


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1 revoked shall be eligible to receive payment 

2 under any such program for health care serv3 ices furnished by that individual, directly or 

4 through an entity that is otherwise eligible to 

5 receive payment for health care services, to an 

6 Indian. 

7 ‘‘(C) FEDERAL HEALTH CARE PROGRAM

8 DEFINED.—In this subsection, the term, ‘Fed9 eral health care program’ has the meaning 

10 given that term in section 1128B(f), except 

11 that, for purposes of this subsection, such term 

12 shall include the health insurance program 

13 under chapter 89 of title 5, United States 

14 Code.’’. 

15 SEC. 206. CONSULTATION ON MEDICAID, SCHIP, AND 

16 OTHER HEALTH CARE PROGRAMS FUNDED 

17 UNDER THE SOCIAL SECURITY ACT INVOLV18 ING INDIAN HEALTH PROGRAMS AND URBAN 

19 INDIAN ORGANIZATIONS. 

20 (a) IN GENERAL.—Section 1139 of the Social Secu21 rity Act (42 U.S.C. 1320b–9), as amended by sections 202 

22 and 205, is amended by redesignating subsection (d) as 

23 subsection (e), and inserting after subsection (c) the fol24 lowing new subsection: 


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1 ‘‘(d) CONSULTATION WITH TRIBAL TECHNICAL AD2 VISORY GROUP (TTAG).—The Secretary shall maintain 

3 within the Centers for Medicaid & Medicare Services 

4 (CMS) a Tribal Technical Advisory Group, established in 

5 accordance with requirements of the charter dated Sep6 tember 30, 2003, and in such group shall include a rep7 resentative of the Urban Indian Organizations and the 

8 Service. The representative of the Urban Indian Organiza9 tion shall be deemed to be an elected officer of a tribal 

10 government for purposes of applying section 204(b) of the 

11 Unfunded Mandates Reform Act of 1995 (2 U.S.C. 

12 1534(b)).’’. 

13 (b) SOLICITATION OF ADVICE UNDER MEDICAID AND

14 SCHIP.— 

15 (1) MEDICAID STATE PLAN AMENDMENT.—Sec16 tion 1902(a) of the Social Security Act (42 U.S.C. 

17 1396a(a)) is amended— 

18 (A) in paragraph (69), by striking ‘‘and’’ 

19 at the end; 

20 (B) in paragraph (70)(B)(iv), by striking 

21 the period at the end and inserting ‘‘; and’’; 

22 and 

23 (C) by inserting after paragraph 

24 (70)(B)(iv), the following new paragraph: 


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1 ‘‘(71) in the case of any State in which the In2 dian Health Service operates or funds health care 

3 programs, or in which 1 or more Indian Health Pro4 grams or Urban Indian Organizations (as such 

5 terms are defined in section 4 of the Indian Health 

6 Care Improvement Act) provide health care in the 

7 State for which medical assistance is available under 

8 such title, provide for a process under which the 

9 State seeks advice on a regular, ongoing basis from 

10 designees of such Indian Health Programs and 

11 Urban Indian Organizations on matters relating to 

12 the application of this title that are likely to have a 

13 direct effect on such Indian Health Programs and 

14 Urban Indian Organizations and that— 

15 ‘‘(A) shall include solicitation of advice 

16 prior to submission of any plan amendments, 

17 waiver requests, and proposals for demonstra18 tion projects likely to have a direct effect on In19 dians, Indian Health Programs, or Urban In20 dian Organizations; and 

21 ‘‘(B) may include appointment of an advi22 sory committee and of a designee of such In23 dian Health Programs and Urban Indian Orga24 nizations to the medical care advisory comVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00369 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 mittee advising the State on its State plan 

2 under this title.’’. 

3 (2) APPLICATION TO SCHIP.—Section 

4 2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)), as 

5 amended by section 204(b)(2), is amended— 

6 (A) by redesignating subparagraphs (B) 

7 through (F) as subparagraphs (C) through (G), 

8 respectively; and 

9 (B) by inserting after subparagraph (A), 

10 the following new subparagraph: 

11 ‘‘(B) Section 1902(a)(71) (relating to the 

12 option of certain States to seek advice from 

13 designees of Indian Health Programs and 

14 Urban Indian Organizations).’’. 

15 (c) RULE OF CONSTRUCTION.—Nothing in the 

16 amendments made by this section shall be construed as 

17 superseding existing advisory committees, working groups, 

18 guidance, or other advisory procedures established by the 

19 Secretary of Health and Human Services or by any State 

20 with respect to the provision of health care to Indians. 


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1 SEC. 207. EXCLUSION WAIVER AUTHORITY FOR AFFECTED 

2 INDIAN HEALTH PROGRAMS AND SAFE HAR3 BOR TRANSACTIONS UNDER THE SOCIAL SE4 CURITY ACT. 

5 (a) EXCLUSION WAIVER AUTHORITY.—Section 1128 

6 of the Social Security Act (42 U.S.C. 1320a–7) is amend7 ed by adding at the end the following new subsection: 

8 ‘‘(k) ADDITIONAL EXCLUSION WAIVER AUTHORITY

9 FOR AFFECTED INDIAN HEALTH PROGRAMS.—In addi10 tion to the authority granted the Secretary under sub11 sections (c)(3)(B) and (d)(3)(B) to waive an exclusion 

12 under subsection (a)(1), (a)(3), (a)(4), or (b), the Sec13 retary may, in the case of an Indian Health Program, 

14 waive such an exclusion upon the request of the adminis15 trator of an affected Indian Health Program (as defined 

16 in section 4 of the Indian Health Care Improvement Act) 

17 who determines that the exclusion would impose a hard18 ship on individuals entitled to benefits under or enrolled 

19 in a Federal health care program.’’. 

20 (b) CERTAIN TRANSACTIONS INVOLVING INDIAN

21 HEALTH CARE PROGRAMS DEEMED TO BE IN SAFE HAR22 BORS.—Section 1128B(b) of the Social Security Act (42 

23 U.S.C. 1320a–7b(b)) is amended by adding at the end the 

24 following new paragraph: 

25 ‘‘(4) Subject to such conditions as the Secretary may 

26 promulgate from time to time as necessary to prevent 


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1 fraud and abuse, for purposes of paragraphs (1) and (2) 

2 and section 1128A(a), the following transfers shall not be 

3 treated as remuneration: 

4 ‘‘(A) TRANSFERS BETWEEN INDIAN HEALTH

5 PROGRAMS, INDIAN TRIBES, TRIBAL ORGANIZATIONS, 

6 AND URBAN INDIAN ORGANIZATIONS.—Transfers of 

7 anything of value between or among an Indian 

8 Health Program, Indian Tribe, Tribal Organization, 

9 or Urban Indian Organization, that are made for the 

10 purpose of providing necessary health care items and 

11 services to any patient served by such Program, 

12 Tribe, or Organization and that consist of— 

13 ‘‘(i) services in connection with the collec14 tion, transport, analysis, or interpretation of di15 agnostic specimens or test data; 

16 ‘‘(ii) inventory or supplies; 

17 ‘‘(iii) staff; or 

18 ‘‘(iv) a waiver of all or part of premiums 

19 or cost sharing. 

20 ‘‘(B) TRANSFERS BETWEEN INDIAN HEALTH

21 PROGRAMS, INDIAN TRIBES, TRIBAL ORGANIZATIONS, 

22 OR URBAN INDIAN ORGANIZATIONS AND PA23 TIENTS.—Transfers of anything of value between an 

24 Indian Health Program, Indian Tribe, Tribal Orga25 nization, or Urban Indian Organization and any paVerDate Aug 31 2005 00:38 Oct 17, 2007 Jkt 069200 PO 00000 Frm 00372 Fmt 6652 Sfmt 6201 E:\BILLS\S1200.RS S1200

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1 tient served or eligible for service from an Indian 

2 Health Program, Indian Tribe, Tribal Organization, 

3 or Urban Indian Organization, including any patient 

4 served or eligible for service pursuant to section 807 

5 of the Indian Health Care Improvement Act, but 

6 only if such transfers— 

7 ‘‘(i) consist of expenditures related to pro8 viding transportation for the patient for the 

9 provision of necessary health care items or serv10 ices, provided that the provision of such trans11 portation is not advertised, nor an incentive of 

12 which the value is disproportionately large in 

13 relationship to the value of the health care item 

14 or service (with respect to the value of the item 

15 or service itself or, for preventative items or 

16 services, the future health care costs reasonably 

17 expected to be avoided); 

18 ‘‘(ii) consist of expenditures related to pro19 viding housing to the patient (including a preg20 nant patient) and immediate family members or 

21 an escort necessary to assuring the timely pro22 vision of health care items and services to the 

23 patient, provided that the provision of such 

24 housing is not advertised nor an incentive of 

25 which the value is disproportionately large in 


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1 relationship to the value of the health care item 

2 or service (with respect to the value of the item 

3 or service itself or, for preventative items or 

4 services, the future health care costs reasonably 

5 expected to be avoided); or 

6 ‘‘(iii) are for the purpose of paying pre7 miums or cost sharing on behalf of such a pa8 tient, provided that the making of such pay9 ment is not subject to conditions other than 

10 conditions agreed to under a contract for the 

11 delivery of contract health services. 

12 ‘‘(C) CONTRACT HEALTH SERVICES.—A trans13 fer of anything of value negotiated as part of a con14 tract entered into between an Indian Health Pro15 gram, Indian Tribe, Tribal Organization, Urban In16 dian Organization, or the Indian Health Service and 

17 a contract care provider for the delivery of contract 

18 health services authorized by the Indian Health 

19 Service, provided that— 

20 ‘‘(i) such a transfer is not tied to volume 

21 or value of referrals or other business generated 

22 by the parties; and 

23 ‘‘(ii) any such transfer is limited to the fair 

24 market value of the health care items or serv25 ices provided or, in the case of a transfer of 


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1 items or services related to preventative care, 

2 the value of the future health care costs reason3 ably expected to be avoided. 

4 ‘‘(D) OTHER TRANSFERS.—Any other transfer 

5 of anything of value involving an Indian Health Pro6 gram, Indian Tribe, Tribal Organization, or Urban 

7 Indian Organization, or a patient served or eligible 

8 for service from an Indian Health Program, Indian 

9 Tribe, Tribal Organization, or Urban Indian Organi10 zation, that the Secretary, in consultation with the 

11 Attorney General, determines is appropriate, taking 

12 into account the special circumstances of such In13 dian Health Programs, Indian Tribes, Tribal Orga14 nizations, and Urban Indian Organizations, and of 

15 patients served by such Programs, Tribes, and Orga16 nizations.’’. 

17 SEC. 208. RULES APPLICABLE UNDER MEDICAID AND 

18 SCHIP TO MANAGED CARE ENTITIES WITH 

19 RESPECT TO INDIAN ENROLLEES AND IN20 DIAN HEALTH CARE PROVIDERS AND INDIAN 

21 MANAGED CARE ENTITIES. 

22 (a) IN GENERAL.—Section 1932 of the Social Secu23 rity Act (42 U.S.C. 1396u–2) is amended by adding at 

24 the end the following new subsection: 


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1 ‘‘(h) SPECIAL RULES WITH RESPECT TO INDIAN EN2 ROLLEES, INDIAN HEALTH CARE PROVIDERS, AND IN3 DIAN MANAGED CARE ENTITIES.— 

4 ‘‘(1) ENROLLEE OPTION TO SELECT AN INDIAN

5 HEALTH CARE PROVIDER AS PRIMARY CARE PRO6 VIDER.—In the case of a non-Indian Medicaid man7 aged care entity that— 

8 ‘‘(A) has an Indian enrolled with the enti9 ty; and 

10 ‘‘(B) has an Indian health care provider 

11 that is participating as a primary care provider 

12 within the network of the entity, 

13 insofar as the Indian is otherwise eligible to receive 

14 services from such Indian health care provider and 

15 the Indian health care provider has the capacity to 

16 provide primary care services to such Indian, the 

17 contract with the entity under section 1903(m) or 

18 under section 1905(t)(3) shall require, as a condi19 tion of receiving payment under such contract, that 

20 the Indian shall be allowed to choose such Indian 

21 health care provider as the Indian’s primary care 

22 provider under the entity. 

23 ‘‘(2) ASSURANCE OF PAYMENT TO INDIAN

24 HEALTH CARE PROVIDERS FOR PROVISION OF COV25 ERED SERVICES.—Each contract with a managed 


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1 care entity under section 1903(m) or under section 

2 1905(t)(3) shall require any such entity that has a 

3 significant percentage of Indian enrollees (as deter4 mined by the Secretary), as a condition of receiving 

5 payment under such contract to satisfy the following 

6 requirements: 

7 ‘‘(A) DEMONSTRATION OF PARTICIPATING

8 INDIAN HEALTH CARE PROVIDERS OR APPLICA9 TION OF ALTERNATIVE PAYMENT ARRANGE10 MENTS.—Subject to subparagraph (E), to— 

11 ‘‘(i) demonstrate that the number of 

12 Indian health care providers that are par13 ticipating providers with respect to such 

14 entity are sufficient to ensure timely access 

15 to covered Medicaid managed care services 

16 for those enrollees who are eligible to re17 ceive services from such providers; or 

18 ‘‘(ii) agree to pay Indian health care 

19 providers who are not participating pro20 viders with the entity for covered Medicaid 

21 managed care services provided to those 

22 enrollees who are eligible to receive services 

23 from such providers at a rate equal to the 

24 rate negotiated between such entity and 

25 the provider involved or, if such a rate has 


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1 not been negotiated, at a rate that is not 

2 less than the level and amount of payment 

3 which the entity would make for the serv4 ices if the services were furnished by a par5 ticipating provider which is not an Indian 

6 health care provider. 

7 ‘‘(B) PROMPT PAYMENT.—To agree to 

8 make prompt payment (in accordance with 

9 rules applicable to managed care entities) to In10 dian health care providers that are participating 

11 providers with respect to such entity or, in the 

12 case of an entity to which subparagraph (A)(ii) 

13 or (E) applies, that the entity is required to pay 

14 in accordance with that subparagraph. 

15 ‘‘(C) SATISFACTION OF CLAIM REQUIRE16 MENT.—To deem any requirement for the sub17 mission of a claim or other documentation for 

18 services covered under subparagraph (A) by the 

19 enrollee to be satisfied through the submission 

20 of a claim or other documentation by an Indian 

21 health care provider that is consistent with sec22 tion 403(h) of the Indian Health Care Improve23 ment Act. 

24 ‘‘(D) COMPLIANCE WITH GENERALLY AP25 PLICABLE REQUIREMENTS.— 


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1 ‘‘(i) IN GENERAL.—Subject to clause 

2 (ii), as a condition of payment under sub3 paragraph (A), an Indian health care pro4 vider shall comply with the generally appli5 cable requirements of this title, the State 

6 plan, and such entity with respect to cov7 ered Medicaid managed care services pro8 vided by the Indian health care provider to 

9 the same extent that non-Indian providers 

10 participating with the entity must comply 

11 with such requirements. 

12 ‘‘(ii) LIMITATIONS ON COMPLIANCE

13 WITH MANAGED CARE ENTITY GENERALLY

14 APPLICABLE REQUIREMENTS.—An Indian 

15 health care provider— 

16 ‘‘(I) shall not be required to com17 ply with a generally applicable re18 quirement of a managed care entity 

19 described in clause (i) as a condition 

20 of payment under subparagraph (A) if 

21 such compliance would conflict with 

22 any other statutory or regulatory re23 quirements applicable to the Indian 

24 health care provider; and 


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1 ‘‘(II) shall only need to comply 

2 with those generally applicable re3 quirements of a managed care entity 

4 described in clause (i) as a condition 

5 of payment under subparagraph (A) 

6 that are necessary for the entity’s 

7 compliance with the State plan, such 

8 as those related to care management, 

9 quality assurance, and utilization 

10 management. 

11 ‘‘(E) APPLICATION OF SPECIAL PAYMENT

12 REQUIREMENTS FOR FEDERALLY-QUALIFIED

13 HEALTH CENTERS AND ENCOUNTER RATE FOR

14 SERVICES PROVIDED BY CERTAIN INDIAN

15 HEALTH CARE PROVIDERS.— 

16 ‘‘(i) FEDERALLY-QUALIFIED HEALTH

17 CENTERS.— 

18 ‘‘(I) MANAGED CARE ENTITY

19 PAYMENT REQUIREMENT.—To agree 

20 to pay any Indian health care provider 

21 that is a Federally-qualified health 

22 center but not a participating provider 

23 with respect to the entity, for the pro24 vision of covered Medicaid managed 

25 care services by such provider to an 


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1 Indian enrollee of the entity at a rate 

2 equal to the amount of payment that 

3 the entity would pay a Federally4 qualified health center that is a par5 ticipating provider with respect to the 

6 entity but is not an Indian health care 

7 provider for such services. 

8 ‘‘(II) CONTINUED APPLICATION

9 OF STATE REQUIREMENT TO MAKE

10 SUPPLEMENTAL PAYMENT.—Nothing 

11 in subclause (I) or subparagraph (A) 

12 or (B) shall be construed as waiving 

13 the application of section 1902(bb)(5) 

14 regarding the State plan requirement 

15 to make any supplemental payment 

16 due under such section to a Federally17 qualified health center for services 

18 furnished by such center to an en19 rollee of a managed care entity (re20 gardless of whether the Federally21 qualified health center is or is not a 

22 participating provider with the entity). 

23 ‘‘(ii) CONTINUED APPLICATION OF

24 ENCOUNTER RATE FOR SERVICES PRO25 VIDED BY CERTAIN INDIAN HEALTH CARE


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1 PROVIDERS.—If the amount paid by a 

2 managed care entity to an Indian health 

3 care provider that is not a Federally-quali4 fied health center and that has elected to 

5 receive payment under this title as an In6 dian Health Service provider under the 

7 July 11, 1996, Memorandum of Agreement 

8 between the Health Care Financing Ad9 ministration (now the Centers for Medicare 

10 & Medicaid Services) and the Indian 

11 Health Service for services provided by 

12 such provider to an Indian enrollee with 

13 the managed care entity is less than the 

14 encounter rate that applies to the provision 

15 of such services under such memorandum, 

16 the State plan shall provide for payment to 

17 the Indian health care provider of the dif18 ference between the applicable encounter 

19 rate under such memorandum and the 

20 amount paid by the managed care entity to 

21 the provider for such services. 

22 ‘‘(F) CONSTRUCTION.—Nothing in this 

23 paragraph shall be construed as waiving the ap24 plication of section 1902(a)(30)(A) (relating to 

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1 ments are consistent with efficiency, economy, 

2 and quality of care). 

3 ‘‘(3) OFFERING OF MANAGED CARE THROUGH

4 INDIAN MEDICAID MANAGED CARE ENTITIES.—If— 

5 ‘‘(A) a State elects to provide services 

6 through Medicaid managed care entities under 

7 its Medicaid managed care program; and 

8 ‘‘(B) an Indian health care provider that is 

9 funded in whole or in part by the Indian Health 

10 Service, or a consortium composed of 1 or more 

11 Tribes, Tribal Organizations, or Urban Indian 

12 Organizations, and which also may include the 

13 Indian Health Service, has established an In14 dian Medicaid managed care entity in the State 

15 that meets generally applicable standards re16 quired of such an entity under such Medicaid 

17 managed care program, 

18 the State shall offer to enter into an agreement with 

19 the entity to serve as a Medicaid managed care enti20 ty with respect to eligible Indians served by such en21 tity under such program. 

22 ‘‘(4) SPECIAL RULES FOR INDIAN MANAGED

23 CARE ENTITIES.—The following are special rules re24 garding the application of a Medicaid managed care 

25 program to Indian Medicaid managed care entities: 


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1 ‘‘(A) ENROLLMENT.— 

2 ‘‘(i) LIMITATION TO INDIANS.—An In3 dian Medicaid managed care entity may re4 strict enrollment under such program to 

5 Indians and to members of specific Tribes 

6 in the same manner as Indian Health Pro7 grams may restrict the delivery of services 

8 to such Indians and tribal members. 

9 ‘‘(ii) NO LESS CHOICE OF PLANS.— 

10 Under such program the State may not 

11 limit the choice of an Indian among Med12 icaid managed care entities only to Indian 

13 Medicaid managed care entities or to be 

14 more restrictive than the choice of man15 aged care entities offered to individuals 

16 who are not Indians. 

17 ‘‘(iii) DEFAULT ENROLLMENT.— 

18 ‘‘(I) IN GENERAL.—If such pro19 gram of a State requires the enroll20 ment of Indians in a Medicaid man21 aged care entity in order to receive 

22 benefits, the State, taking into consid23 eration the criteria specified in sub24 section (a)(4)(D)(ii)(I), shall provide 

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1 scribed in subclause (II) who are not 

2 otherwise enrolled with such an entity 

3 in an Indian Medicaid managed care 

4 entity described in such clause. 

5 ‘‘(II) INDIAN DESCRIBED.—An 

6 Indian described in this subclause, 

7 with respect to an Indian Medicaid 

8 managed care entity, is an Indian 

9 who, based upon the service area and 

10 capacity of the entity, is eligible to be 

11 enrolled with the entity consistent 

12 with subparagraph (A). 

13 ‘‘(iv) EXCEPTION TO STATE LOCK14 IN.—A request by an Indian who is en15 rolled under such program with a non-In16 dian Medicaid managed care entity to 

17 change enrollment with that entity to en18 rollment with an Indian Medicaid managed 

19 care entity shall be considered cause for 

20 granting such request under procedures 

21 specified by the Secretary. 

22 ‘‘(B) FLEXIBILITY IN APPLICATION OF

23 SOLVENCY.—In applying section 1903(m)(1) to 

24 an Indian Medicaid managed care entity— 


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1 ‘‘(i) any reference to a ‘State’ in sub2 paragraph (A)(ii) of that section shall be 

3 deemed to be a reference to the ‘Sec4 retary’; and 

5 ‘‘(ii) the entity shall be deemed to be 

6 a public entity described in subparagraph 

7 (C)(ii) of that section. 

8 ‘‘(C) EXCEPTIONS TO ADVANCE DIREC9 TIVES.—The Secretary may modify or waive the 

10 requirements of section 1902(w) (relating to 

11 provision of written materials on advance direc12 tives) insofar as the Secretary finds that the re13 quirements otherwise imposed are not an appro14 priate or effective way of communicating the in15 formation to Indians. 

16 ‘‘(D) FLEXIBILITY IN INFORMATION AND

17 MARKETING.— 

18 ‘‘(i) MATERIALS.—The Secretary may 

19 modify requirements under subsection 

20 (a)(5) to ensure that information described 

21 in that subsection is provided to enrollees 

22 and potential enrollees of Indian Medicaid 

23 managed care entities in a culturally ap24 propriate and understandable manner that 

25 clearly communicates to such enrollees and 


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1 potential enrollees their rights, protections, 

2 and benefits. 

3 ‘‘(ii) DISTRIBUTION OF MARKETING

4 MATERIALS.—The provisions of subsection 

5 (d)(2)(B) requiring the distribution of 

6 marketing materials to an entire service 

7 area shall be deemed satisfied in the case 

8 of an Indian Medicaid managed care entity 

9 that distributes appropriate materials only 

10 to those Indians who are potentially eligi11 ble to enroll with the entity in the service 

12 area. 

13 ‘‘(5) MALPRACTICE INSURANCE.—Insofar as, 

14 under a Medicaid managed care program, a health 

15 care provider is required to have medical malpractice 

16 insurance coverage as a condition of contracting as 

17 a provider with a Medicaid managed care entity, an 

18 Indian health care provider that is— 

19 ‘‘(A) a Federally-qualified health center 

20 that is covered under the Federal Tort Claims 

21 Act (28 U.S.C. 1346(b), 2671 et seq.); 

22 ‘‘(B) providing health care services pursu23 ant to a contract or compact under the Indian 

24 Self-Determination and Education Assistance 

25 Act (25 U.S.C. 450 et seq.) that are covered 


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1 under the Federal Tort Claims Act (28 U.S.C. 

2 1346(b), 2671 et seq.); or 

3 ‘‘(C) the Indian Health Service providing 

4 health care services that are covered under the 

5 Federal Tort Claims Act (28 U.S.C. 1346(b), 

6 2671 et seq.); 

7 are deemed to satisfy such requirement. 

8 ‘‘(6) DEFINITIONS.—For purposes of this sub9 section: 

10 ‘‘(A) INDIAN HEALTH CARE PROVIDER.— 

11 The term ‘Indian health care provider’ means 

12 an Indian Health Program or an Urban Indian 

13 Organization. 

14 ‘‘(B) INDIAN; INDIAN HEALTH PROGRAM; 

15 SERVICE; TRIBE; TRIBAL ORGANIZATION; URBAN

16 INDIAN ORGANIZATION.—The terms ‘Indian’, 

17 ‘Indian Health Program’, ‘Service’, ‘Tribe’, 

18 ‘tribal organization’, ‘Urban Indian Organiza19 tion’ have the meanings given such terms in 

20 section 4 of the Indian Health Care Improve21 ment Act. 

22 ‘‘(C) INDIAN MEDICAID MANAGED CARE

23 ENTITY.—The term ‘Indian Medicaid managed 

24 care entity’ means a managed care entity that 

25 is controlled (within the meaning of the last 


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1 sentence of section 1903(m)(1)(C)) by the In2 dian Health Service, a Tribe, Tribal Organiza3 tion, or Urban Indian Organization, or a con4 sortium, which may be composed of 1 or more 

5 Tribes, Tribal Organizations, or Urban Indian 

6 Organizations, and which also may include the 

7 Service. 

8 ‘‘(D) NON-INDIAN MEDICAID MANAGED

9 CARE ENTITY.—The term ‘non-Indian Medicaid 

10 managed care entity’ means a managed care en11 tity that is not an Indian Medicaid managed 

12 care entity. 

13 ‘‘(E) COVERED MEDICAID MANAGED CARE

14 SERVICES.—The term ‘covered Medicaid man15 aged care services’ means, with respect to an 

16 individual enrolled with a managed care entity, 

17 items and services that are within the scope of 

18 items and services for which benefits are avail19 able with respect to the individual under the 

20 contract between the entity and the State in21 volved. 

22 ‘‘(F) MEDICAID MANAGED CARE PRO23 GRAM.—The term ‘Medicaid managed care pro24 gram’ means a program under sections 

25 1903(m) and 1932 and includes a managed 


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1 care program operating under a waiver under 

2 section 1915(b) or 1115 or otherwise.’’. 

3 (b) APPLICATION TO SCHIP.—Section 2107(e)(1) of 

4 such Act (42 U.S.C. 1397gg(1)), as amended by section 

5 206(b)(2), is amended by adding at the end the following 

6 new subparagraph: 

7 ‘‘(H) Subsections (a)(2)(C) and (h) of sec8 tion 1932.’’. 

9 SEC. 209. ANNUAL REPORT ON INDIANS SERVED BY SOCIAL 

10 SECURITY ACT HEALTH BENEFIT PROGRAMS. 

11 Section 1139 of the Social Security Act (42 U.S.C. 

12 1320b–9), as amended by the sections 202, 205, and 206, 

13 is amended by redesignating subsection (e) as subsection 

14 (f), and inserting after subsection (d) the following new 

15 subsection: 

16 ‘‘(e) ANNUAL REPORT ON INDIANS SERVED BY

17 HEALTH BENEFIT PROGRAMS FUNDED UNDER THIS

18 ACT.—Beginning January 1, 2007, and annually there19 after, the Secretary, acting through the Administrator of 

20 the Centers for Medicare & Medicaid Services and the Di21 rector of the Indian Health Service, shall submit a report 

22 to Congress regarding the enrollment and health status 

23 of Indians receiving items or services under health benefit 

24 programs funded under this Act during the preceding 

25 year. Each such report shall include the following: 


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1 ‘‘(1) The total number of Indians enrolled in, or 

2 receiving items or services under, such programs, 

3 disaggregated with respect to each such program. 

4 ‘‘(2) The number of Indians described in para5 graph (1) that also received health benefits under 

6 programs funded by the Indian Health Service. 

7 ‘‘(3) General information regarding the health 

8 status of the Indians described in paragraph (1), 

9 disaggregated with respect to specific diseases or 

10 conditions and presented in a manner that is con11 sistent with protections for privacy of individually 

12 identifiable health information under section 264(c) 

13 of the Health Insurance Portability and Account14 ability Act of 1996. 

15 ‘‘(4) A detailed statement of the status of facili16 ties of the Indian Health Service or an Indian Tribe, 

17 Tribal Organization, or an Urban Indian Organiza18 tion with respect to such facilities’ compliance with 

19 the applicable conditions and requirements of titles 

20 XVIII, XIX, and XXI, and, in the case of title XIX 

21 or XXI, under a State plan under such title or 

22 under waiver authority, and of the progress being 

23 made by such facilities (under plans submitted 

24 under section 1880(b), 1911(b) or otherwise) toward 


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1 the achievement and maintenance of such compli2 ance. 

3 ‘‘(5) Such other information as the Secretary 

4 determines is appropriate.’’. 


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Calendar No. 421 

110TH CONGRESS 

1ST SESSION S. 1200 

[Report No. 110

–197] 

A BILL 

To amend the Indian Health Care Improvement 

Act to revise and extend that Act. 

OCTOBER 16, 2007 

Reported without amendment 


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