IB 

Union Calendar No. 444 

110TH CONGRESS 

2D SESSION H. R. 1328 

[Report No. 110–564, Part I] 

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

that Act. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 6, 2007 

Mr. PALLONE (for himself, Mr. RAHALL, Mr. YOUNG of Alaska, Mr. KILDEE, 

Mr. GEORGE MILLER of California, Mr. FALEOMAVAEGA, Mrs. 

CHRISTENSEN, Mr. GRIJALVA, Mr. BOREN, Mr. HINCHEY, Mr. KENNEDY, Mr. KIND, Mr. INSLEE, Mr. BACA, Mr. UDALL of New Mexico, 

Mr. RENZI, Mr. WU, Mr. CONYERS, Mr. OBERSTAR, Mr. THOMPSON of 

California, Mr. WAXMAN, Mr. COLE of Oklahoma, Mr. BOSWELL, Ms. 

HERSETH, Mr. ENGEL, Mr. KAGEN, Ms. BORDALLO, Mrs. BONO, Mr. 

MORAN of Virginia, Mr. MCDERMOTT, Mr. HONDA, Mr. FILNER, Mr. 

MCKEON, and Ms. SOLIS) introduced the following bill; which was referred to the Committee on Natural Resources, and in addition to the 

Committees on Energy and Commerce and Ways and Means, for a period 

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

concerned 

APRIL 4, 2008 

Reported from the Committee on Natural Resources with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

APRIL 4, 2008 

Referral to the Committees on Energy and Commerce and Ways and Means 

extended for a period ending not later than June 6, 2008 

JUNE 6, 2008 

Additional sponsors: Mr. UDALL of Colorado, Mr. ALLEN, Mr. WALDEN of Oregon, Mr. BERMAN, Ms. ZOE LOFGREN of California, Ms. LINDA T. 

SA ́NCHEZ of California, Mr. LARSON of Connecticut, Mrs. CAPPS, Mrs. 

WILSON of New Mexico, Mr. MCCOTTER, Mr. MITCHELL, Mr. HINOJOSA, 


jbell on PROD1PC69 with BILLS
2 

•HR 1328 RH

Mr. MICHAUD, Mr. GORDON of Tennessee, Ms. DEGETTE, Ms. CARSON, 

Mr. CAPUANO, Mr. BLUMENAUER, Mr. MATHESON, Mr. PETERSON of 

Minnesota, Ms. BALDWIN, Mr. WALZ of Minnesota, Mr. PEARCE, Mr. 

MEEKS of New York, and Mr. SALAZAR

JUNE 6, 2008 

Committees on Energy and Commerce and Ways and Means discharged; committed to the Committee of the Whole House on the State of the Union 

and ordered to be printed 

[For text of introduced bill, see copy of bill as introduced on March 6, 2007] 

A BILL 

To amend the Indian Health Care Improvement Act to revise 

and extend that Act. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the ‘‘In5 dian Health Care Improvement Act Amendments of 2007’’. 

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

7 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. 


jbell on PROD1PC69 with BILLS
3 

•HR 1328 RH

Sec. 204. Premiums and cost sharing protections under Medicaid, eligibility determinations under Medicaid and SCHIP, and protection of certain Indian property from Medicaid estate recovery. 

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

Federal health care programs. 

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

funded under the Social Security Act involving Indian Health 

Programs and Urban Indian Organizations. 

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

safe harbor transactions under the Social Security Act. 

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

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

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

programs. 

1 SEC. 2. REPORT ON THIRD-PARTY PAYMENT COLLECTIONS. 

2 (a) STUDY.—The Secretary of Health and Human 

3 Services shall conduct a thorough study of the system of 

4 third-party payment collections for items and services fur5 nished through the Indian Health Service. 

6 (b) REPORT.—Not later than 6 months after the date 

7 of the enactment of this Act, the Secretary shall submit to 

8 each House of Congress a report on such study. Such report 

9 shall include such recommendations on how to improve such 

10 third-party payment collections as the Secretary determines 

11 appropriate. 

12 TITLE I—AMENDMENTS TO 

13 INDIAN LAWS 

14 SEC. 101. INDIAN HEALTH CARE IMPROVEMENT ACT 

15 AMENDED. 

16 (a) IN GENERAL.—The Indian Health Care Improve17 ment Act (25 U.S.C. 1601 et seq.) is amended to read as 

18 follows: 


jbell on PROD1PC69 with BILLS
4 

•HR 1328 RH

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

2 ‘‘(a) SHORT TITLE.—This Act may be cited as the ‘In3 dian Health Care Improvement Act’. 

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

5 this Act is as follows: 

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

‘‘Sec. 2. Findings. 

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

‘‘Sec. 4. Definitions. 

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

DEVELOPMENT 

‘‘Sec. 101. Purpose. 

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

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

‘‘Sec. 104. Indian health professions scholarships. 

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

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

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

‘‘Sec. 108. Continuing education allowances. 

‘‘Sec. 109. Community Health Representative Program. 

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

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

‘‘Sec. 112. Recruitment activities. 

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

‘‘Sec. 114. Advanced training and research. 

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

‘‘Sec. 116. Tribal cultural orientation. 

‘‘Sec. 117. INMED Program. 

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

‘‘Sec. 119. Retention bonus. 

‘‘Sec. 120. Nursing residency program. 

‘‘Sec. 121. Community Health Aide Program. 

‘‘Sec. 122. Tribal Health Program administration. 

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

‘‘Sec. 124. National Health Service Corps. 

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

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

‘‘Sec. 127. Authorization of appropriations. 

‘‘TITLE II—HEALTH SERVICES 

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

‘‘Sec. 202. Catastrophic Health Emergency Fund. 

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

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

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

‘‘Sec. 206. Health services research. 


jbell on PROD1PC69 with BILLS
5 

•HR 1328 RH

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

‘‘Sec. 208. Patient travel costs. 

‘‘Sec. 209. Epidemiology centers. 

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

‘‘Sec. 211. Indian youth program. 

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

diseases. 

‘‘Sec. 213. Authority for provision of other services. 

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

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

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

‘‘Sec. 217. North Dakota and South Dakota as contract health service delivery 

area. 

‘‘Sec. 218. California contract health services program. 

‘‘Sec. 219. California as a contract health service delivery area. 

‘‘Sec. 220. Contract health services for the Trenton Service Area. 

‘‘Sec. 221. Programs operated by Indian Tribes and Tribal Organizations. 

‘‘Sec. 222. Licensing. 

‘‘Sec. 223. Notification of provision of emergency contract health services. 

‘‘Sec. 224. Prompt action on payment of claims. 

‘‘Sec. 225. Liability for payment. 

‘‘Sec. 226. Office of Indian Men’s Health. 

‘‘Sec. 227. 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 project. 

‘‘Sec. 307. Land transfer. 

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

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

‘‘Sec. 310. Tribal leasing. 

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

‘‘Sec. 312. Location of facilities. 

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

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

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

‘‘Sec. 316. Other funding for facilities. 

‘‘Sec. 317. Authorization of appropriations. 

‘‘TITLE IV—ACCESS TO HEALTH SERVICES 

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

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

Act health benefit programs and other health benefits programs. 

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

‘‘Sec. 404. Crediting of reimbursements. 

‘‘Sec. 405. Purchasing health care coverage. 


jbell on PROD1PC69 with BILLS
6 

•HR 1328 RH

‘‘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. 

‘‘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. 


jbell on PROD1PC69 with BILLS
7 

•HR 1328 RH

‘‘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. Severability provisions. 

‘‘Sec. 813. Establishment of National Bipartisan Commission on Indian Health 

Care. 

‘‘Sec. 814. Confidentiality of medical quality assurance records; qualified immunity for participants. 

‘‘Sec. 815. Appropriations; availability. 

‘‘Sec. 816. Authorization of appropriations. 

1 ‘‘SEC. 2. FINDINGS. 

2 ‘‘Congress makes the following findings: 

3 ‘‘(1) Federal health services to maintain and im4 prove the health of the Indians are consonant with 

5 and required by the Federal Government’s historical 

6 and unique legal relationship with, and resulting re7 sponsibility to, the American Indian people. 

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

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

11 be raised to the highest possible level and to encourage 


jbell on PROD1PC69 with BILLS
8 

•HR 1328 RH

1 the maximum participation of Indians in the plan2 ning and management of those services. 

3 ‘‘(3) Federal health services to Indians have re4 sulted in a reduction in the prevalence and incidence 

5 of preventable illnesses among, and unnecessary and 

6 premature deaths of, Indians. 

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

8 needs of the American Indian people are severe and 

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

10 the general population of the United States. 

11 ‘‘SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POL12 ICY. 

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

14 in fulfillment of its special trust responsibilities and legal 

15 obligations to Indians— 

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

17 for Indians and Urban Indians and to provide all re18 sources necessary to effect that policy; 

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

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

21 goals contained within the Healthy People 2010 or 

22 successor objectives; 

23 ‘‘(3) to the greatest extent possible, to allow Indi24 ans to set their own health care priorities and estab25 lish goals that reflect their unmet needs; 


jbell on PROD1PC69 with BILLS
9 

•HR 1328 RH

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

2 the health professions and allied and associated health 

3 professions awarded to Indians so that the proportion 

4 of Indian health professionals in each Service Area is 

5 raised to at least the level of that of the general popu6 lation; 

7 ‘‘(5) to require meaningful consultation with In8 dian Tribes, Tribal Organizations, and Urban Indian 

9 Organizations to implement this Act and the national 

10 policy of Indian self-determination; and 

11 ‘‘(6) to provide funding for programs and facili12 ties operated by Indian Tribes and Tribal Organiza13 tions in amounts that are not less than the amounts 

14 provided to programs and facilities operated directly 

15 by the Service. 

16 ‘‘SEC. 4. DEFINITIONS. 

17 ‘‘For purposes of this Act: 

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

19 on or near a reservation and accredited by a national 

20 or regional organization with accrediting authority. 

21 ‘‘(2) The term ‘Area Office’ means an adminis22 trative entity, including a program office, within the 

23 Service through which services and funds are pro24 vided to the Service Units within a defined geo25 graphic area. 


jbell on PROD1PC69 with BILLS
10 

•HR 1328 RH

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

2 Assistant Secretary of Indian Health. 

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

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

5 tobacco) abuse and mental health prevention and 

6 treatment, for the purpose of providing comprehensive 

7 services. 

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

9 joint development of substance abuse and mental 

10 health treatment planning and coordinated case man11 agement using a multidisciplinary approach. 

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

13 Indians who are eligible for health services of the 

14 Service pursuant to section 806. 

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

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

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

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

19 health services provided at the expense of the Service 

20 or a Tribal Health Program by public or private 

21 medical providers or hospitals, other than the Service 

22 Unit or the Tribal Health Program at whose expense 

23 the services are provided. 


jbell on PROD1PC69 with BILLS
11 

•HR 1328 RH

1 ‘‘(8) The term ‘Department’ means, unless other2 wise designated, the Department of Health and 

3 Human Services. 

4 ‘‘(9) The term ‘disease prevention’ means the re5 duction, limitation, and prevention of disease and its 

6 complications and reduction in the consequences of 

7 disease, including— 

8 ‘‘(A) controlling— 

9 ‘‘(i) the development of diabetes; 

10 ‘‘(ii) high blood pressure; 

11 ‘‘(iii) infectious agents; 

12 ‘‘(iv) injuries; 

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

15 ‘‘(vi) sexually transmittable diseases; 

16 and 

17 ‘‘(vii) toxic agents; and 

18 ‘‘(B) providing— 

19 ‘‘(i) fluoridation of water; and 

20 ‘‘(ii) immunizations. 

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

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

24 gynecology, podiatric medicine, nursing, public health 

25 nursing, dentistry, psychiatry, osteopathy, optometry, 


jbell on PROD1PC69 with BILLS
12 

•HR 1328 RH

1 pharmacy, psychology, public health, social work, 

2 marriage and family therapy, chiropractic medicine, 

3 environmental health and engineering, allied health 

4 professions, naturopathic medicine, and any other 

5 health profession. 

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

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

9 including raising public awareness about health 

10 matters and enabling the people to cope with 

11 health problems by increasing their knowledge 

12 and providing them with valid information; 

13 ‘‘(B) encouraging adequate and appropriate 

14 diet, exercise, and sleep; 

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

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

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

21 ‘‘(F) promoting culturally competent care; 

22 and 

23 ‘‘(G) providing adequate and appropriate 

24 programs, which may include— 


jbell on PROD1PC69 with BILLS
13 

•HR 1328 RH

1 ‘‘(i) abuse prevention (mental and 

2 physical); 

3 ‘‘(ii) community health; 

4 ‘‘(iii) community safety; 

5 ‘‘(iv) consumer health education; 

6 ‘‘(v) diet and nutrition; 

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

9 HIV/AIDS; 

10 ‘‘(vii) environmental health; 

11 ‘‘(viii) exercise and physical fitness; 

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

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

15 ‘‘(xi) human growth and development; 

16 ‘‘(xii) injury prevention and personal 

17 safety; 

18 ‘‘(xiii) behavioral health; 

19 ‘‘(xiv) monitoring of disease indicators 

20 between health care provider visits, through 

21 appropriate means, including Internet22 based health care management systems; 

23 ‘‘(xv) personal health and wellness 

24 practices; 

25 ‘‘(xvi) personal capacity building; 


jbell on PROD1PC69 with BILLS
14 

•HR 1328 RH

1 ‘‘(xvii) prenatal, pregnancy, and in2 fant care; 

3 ‘‘(xviii) psychological well-being; 

4 ‘‘(xix) reproductive health and family 

5 planning; 

6 ‘‘(xx) safe and adequate water; 

7 ‘‘(xxi) healthy work environments; 

8 ‘‘(xxii) elimination, reduction, and 

9 prevention of contaminants that create 

10 unhealthy household conditions (including 

11 mold and other allergens); 

12 ‘‘(xxiii) stress control; 

13 ‘‘(xxiv) substance abuse; 

14 ‘‘(xxv) sanitary facilities; 

15 ‘‘(xxvi) sudden infant death syndrome 

16 prevention; 

17 ‘‘(xxvii) tobacco use cessation and re18 duction; 

19 ‘‘(xxviii) violence prevention; and 

20 ‘‘(xxix) such other activities identified 

21 by the Service, a Tribal Health Program, or 

22 an Urban Indian Organization, to promote 

23 achievement of any of the objectives de24 scribed in section 3(2). 


jbell on PROD1PC69 with BILLS
15 

•HR 1328 RH

1 ‘‘(12) The term ‘Indian’, unless otherwise des2 ignated, means any person who is a member of an In3 dian Tribe or is eligible for health services under sec4 tion 806, except that, for the purpose of sections 102 

5 and 103, the term also means any individual who— 

6 ‘‘(A)(i) irrespective of whether the indi7 vidual lives on or near a reservation, is a mem8 ber of a tribe, band, or other organized group of 

9 Indians, including those tribes, bands, or groups 

10 terminated since 1940 and those recognized now 

11 or in the future by the State in which they re12 side; or 

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

14 degree, of any such member; 

15 ‘‘(B) is an Eskimo or Aleut or other Alaska 

16 Native; 

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

18 Interior to be an Indian for any purpose; or 

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

20 regulations promulgated by the Secretary. 

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

22 means— 

23 ‘‘(A) any health program administered di24 rectly by the Service; 

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


jbell on PROD1PC69 with BILLS
16 

•HR 1328 RH

1 ‘‘(C) any Indian Tribe or Tribal Organiza2 tion to which the Secretary provides funding 

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

4 1910 (25 U.S.C. 47) (commonly known as the 

5 ‘Buy Indian Act’). 

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

7 given the term in the Indian Self-Determination and 

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

9 ‘‘(15) The term ‘junior or community college’ has 

10 the meaning given the term by section 312(e) of the 

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

12 ‘‘(16) The term ‘reservation’ means any federally 

13 recognized Indian Tribe’s reservation, Pueblo, or col14 ony, including former reservations in Oklahoma, In15 dian allotments, and Alaska Native Regions estab16 lished pursuant to the Alaska Native Claims Settle17 ment Act (43 U.S.C. 1601 et seq.). 

18 ‘‘(17) The term ‘Secretary’, unless otherwise des19 ignated, means the Secretary of Health and Human 

20 Services. 

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

22 Health Service. 

23 ‘‘(19) The term ‘Service Area’ means the geo24 graphical area served by each Area Office. 


jbell on PROD1PC69 with BILLS
17 

•HR 1328 RH

1 ‘‘(20) The term ‘Service Unit’ means an admin2 istrative entity of the Service, or a Tribal Health Pro3 gram through which services are provided, directly or 

4 by contract, to eligible Indians within a defined geo5 graphic area. 

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

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

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

9 ‘‘(22) The term ‘telemedicine’ means a tele10 communications link to an end user through the use 

11 of eligible equipment that electronically links health 

12 professionals or patients and health professionals at 

13 separate sites in order to exchange health care infor14 mation in audio, video, graphic, or other format for 

15 the purpose of providing improved health care serv16 ices. 

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

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

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

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

21 an Indian Tribe or Tribal Organization that operates 

22 any health program, service, function, activity, or fa23 cility funded, in whole or part, by the Service 

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


jbell on PROD1PC69 with BILLS
18 

•HR 1328 RH

1 with the Service under the Indian Self-Determination 

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

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

4 meaning given the term in the Indian Self-Deter5 mination and Education Assistance Act (25 U.S.C. 

6 450 et seq.). 

7 ‘‘(26) The term ‘Urban Center’ means any com8 munity which has a sufficient Urban Indian popu9 lation with unmet health needs to warrant assistance 

10 under title V of this Act, as determined by the Sec11 retary. 

12 ‘‘(27) The term ‘Urban Indian’ means any indi13 vidual who resides in an Urban Center and who 

14 meets 1 or more of the following criteria: 

15 ‘‘(A) Irrespective of whether the individual 

16 lives on or near a reservation, the individual is 

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

18 group of Indians, including those tribes, bands, 

19 or groups terminated since 1940 and those tribes, 

20 bands, or groups that are recognized by the 

21 States in which they reside, or who is a descend22 ant in the first or second degree of any such 

23 member. 

24 ‘‘(B) The individual is an Eskimo, Aleut, or 

25 other Alaska Native. 


jbell on PROD1PC69 with BILLS
19 

•HR 1328 RH

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

2 Secretary of the Interior to be an Indian for any 

3 purpose. 

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

5 Indian under regulations promulgated by the 

6 Secretary. 

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

8 means a nonprofit corporate body that (A) is situated 

9 in an Urban Center; (B) is governed by an Urban In10 dian-controlled board of directors; (C) provides for the 

11 participation of all interested Indian groups and in12 dividuals; and (D) is capable of legally cooperating 

13 with other public and private entities for the purpose 

14 of performing the activities described in section 

15 503(a). 

16 ‘‘TITLE I—INDIAN HEALTH, 

17 HUMAN RESOURCES, AND DE18 VELOPMENT 

19 ‘‘SEC. 101. PURPOSE. 

20 ‘‘The purpose of this title is to increase, to the max21 imum extent feasible, the number of Indians entering the 

22 health professions and providing health services, and to as23 sure an optimum supply of health professionals to the In24 dian Health Programs and Urban Indian Organizations 

25 involved in the provision of health services to Indians. 


jbell on PROD1PC69 with BILLS
20 

•HR 1328 RH

1 ‘‘SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM 

2 FOR INDIANS. 

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

4 Service, shall make grants to public or nonprofit private 

5 health or educational entities, Tribal Health Programs, or 

6 Urban Indian Organizations to assist such entities in meet7 ing the costs of— 

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

9 education or training in the health professions and 

10 encouraging and assisting them— 

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

12 health professions; or 

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

14 any such courses of study, to undertake such 

15 postsecondary education or training as may be 

16 required to qualify them for enrollment; 

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

18 available to Indians enrolled in any course of study 

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

20 training necessary to qualify them to enroll in any 

21 such course of study; or 

22 ‘‘(3) establishing other programs which the Sec23 retary determines will enhance and facilitate the en24 rollment of Indians in, and the subsequent pursuit 

25 and completion by them of, courses of study referred 

26 to in paragraph (1). 


jbell on PROD1PC69 with BILLS
21 

•HR 1328 RH

1 ‘‘(b) GRANTS.— 

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

3 make a grant under this section unless an application 

4 has been submitted to, and approved by, the Sec5 retary. Such application shall be in such form, sub6 mitted in such manner, and contain such informa7 tion, as the Secretary shall by regulation prescribe 

8 pursuant to this Act. The Secretary shall give a pref9 erence to applications submitted by Tribal Health 

10 Programs or Urban Indian Organizations. 

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

12 amount of a grant under this section shall be deter13 mined by the Secretary. Payments pursuant to this 

14 section may be made in advance or by way of reim15 bursement, and at such intervals and on such condi16 tions as provided for in regulations issued pursuant 

17 to this Act. To the extent not otherwise prohibited by 

18 law, grants shall be for 3 years, as provided in regu19 lations issued pursuant to this Act. 

20 ‘‘SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOLAR21 SHIP PROGRAM FOR INDIANS. 

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

23 acting through the Service, shall provide scholarship grants 

24 to Indians who— 


jbell on PROD1PC69 with BILLS
22 

•HR 1328 RH

1 ‘‘(1) have successfully completed their high school 

2 education or high school equivalency; and 

3 ‘‘(2) have demonstrated the potential to success4 fully complete courses of study in the health profes5 sions. 

6 ‘‘(b) PURPOSES.—Scholarship grants provided pursu7 ant to this section shall be for the following purposes: 

8 ‘‘(1) Compensatory preprofessional education of 

9 any recipient, such scholarship not to exceed 2 years 

10 on a full-time basis (or the part-time equivalent there11 of, as determined by the Secretary pursuant to regu12 lations issued under this Act). 

13 ‘‘(2) Pregraduate education of any recipient 

14 leading to a baccalaureate degree in an approved 

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

16 health profession, such scholarship not to exceed 4 

17 years. An extension of up to 2 years (or the part-time 

18 equivalent thereof, as determined by the Secretary 

19 pursuant to regulations issued pursuant to this Act) 

20 may be approved. 

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

22 section— 

23 ‘‘(1) may cover costs of tuition, books, transpor24 tation, board, and other necessary related expenses of 

25 a recipient while attending school; 


jbell on PROD1PC69 with BILLS
23 

•HR 1328 RH

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

2 applicant’s scholastic achievement if such applicant 

3 has been admitted to, or maintained good standing 

4 at, an accredited institution; and 

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

6 applicant’s eligibility for assistance or benefits under 

7 any other Federal program. 

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

9 ‘‘(a) IN GENERAL.— 

10 ‘‘(1) AUTHORITY.—The Secretary, acting through 

11 the Service, shall make scholarship grants to Indians 

12 who are enrolled full or part time in accredited 

13 schools pursuing courses of study in the health profes14 sions. Such scholarships shall be designated Indian 

15 Health Scholarships and shall be made in accordance 

16 with section 338A of the Public Health Services Act 

17 (42 U.S.C. 254l), except as provided in subsection (b) 

18 of this section. 

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

20 Secretary, acting through the Service, shall deter21 mine— 

22 ‘‘(A) who shall receive scholarship grants 

23 under subsection (a); and 

24 ‘‘(B) the distribution of the scholarships 

25 among health professions on the basis of the relVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00023 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
24 

•HR 1328 RH

1 ative needs of Indians for additional service in 

2 the health professions. 

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

4 administration of this section shall be a responsibility 

5 of the Assistant Secretary and shall not be delegated 

6 in a contract or compact under the Indian Self-Deter7 mination and Education Assistance Act (25 U.S.C. 

8 450 et seq.). 

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

10 ‘‘(1) OBLIGATION MET.—The active duty service 

11 obligation under a written contract with the Sec12 retary under this section that an Indian has entered 

13 into shall, if that individual is a recipient of an In14 dian Health Scholarship, be met in full-time practice 

15 equal to 1 year for each school year for which the par16 ticipant receives a scholarship award under this part, 

17 or 2 years, whichever is greater, by service in 1 or 

18 more of the following: 

19 ‘‘(A) In an Indian Health Program. 

20 ‘‘(B) In a program assisted under title V of 

21 this Act. 

22 ‘‘(C) In the private practice of the applica23 ble profession if, as determined by the Secretary, 

24 in accordance with guidelines promulgated by 

25 the Secretary, such practice is situated in a phyVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
25 

•HR 1328 RH

1 sician or other health professional shortage area 

2 and addresses the health care needs of a substan3 tial number of Indians. 

4 ‘‘(D) In a teaching capacity in a tribal col5 lege or university nursing program (or a related 

6 health profession program) if, as determined by 

7 the Secretary, the health service provided to In8 dians would not decrease. 

9 ‘‘(2) OBLIGATION DEFERRED.—At the request of 

10 any individual who has entered into a contract re11 ferred to in paragraph (1) and who receives a degree 

12 in medicine (including osteopathic or allopathic med13 icine), dentistry, optometry, podiatry, or pharmacy, 

14 the Secretary shall defer the active duty service obli15 gation of that individual under that contract, in 

16 order that such individual may complete any intern17 ship, residency, or other advanced clinical training 

18 that is required for the practice of that health profes19 sion, for an appropriate period (in years, as deter20 mined by the Secretary), subject to the following con21 ditions: 

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

23 other advanced clinical training shall be counted 

24 as satisfying any period of obligated service 

25 under this subsection. 


jbell on PROD1PC69 with BILLS
26 

•HR 1328 RH

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

2 that individual shall commence not later than 90 

3 days after the completion of that advanced clin4 ical training (or by a date specified by the Sec5 retary). 

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

7 be served in the health profession of that indi8 vidual in a manner consistent with paragraph 

9 (1). 

10 ‘‘(D) A recipient of a scholarship under this 

11 section may, at the election of the recipient, meet 

12 the active duty service obligation described in 

13 paragraph (1) by service in a program specified 

14 under that paragraph that— 

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

16 Indian Tribe in which the recipient is en17 rolled; or 

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

19 the recipient is enrolled. 

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

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

22 assignments of Indian Health Scholarship recipients 

23 required to meet the active duty service obligation de24 scribed in paragraph (1), shall give priority to as25 signing individuals to service in those programs specVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
27 

•HR 1328 RH

1 ified in paragraph (1) that have a need for health 

2 professionals to provide health care services as a re3 sult of individuals having breached contracts entered 

4 into under this section. 

5 ‘‘(c) PART-TIME STUDENTS.—In the case of an indi6 vidual receiving a scholarship under this section who is en7 rolled part time in an approved course of study— 

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

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

10 years, as determined by the Secretary; 

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

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

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

14 each year for which the individual was provided 

15 a scholarship (as determined by the Secretary); 

16 or 

17 ‘‘(B) 2 years; and 

18 ‘‘(3) the amount of the monthly stipend specified 

19 in section 338A(g)(1)(B) of the Public Health Service 

20 Act (42 U.S.C. 254l(g)(1)(B)) shall be reduced pro 

21 rata (as determined by the Secretary) based on the 

22 number of hours such student is enrolled. 

23 ‘‘(d) BREACH OF CONTRACT.— 

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

25 shall be liable to the United States for the amount 


jbell on PROD1PC69 with BILLS
28 

•HR 1328 RH

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

2 of the individual, under a contract entered into with 

3 the Secretary under this section on or after the date 

4 of enactment of the Indian Health Care Improvement 

5 Act Amendments of 2007 if that individual— 

6 ‘‘(A) fails to maintain an acceptable level of 

7 academic standing in the educational institution 

8 in which he or she is enrolled (such level deter9 mined by the educational institution under regu10 lations of the Secretary); 

11 ‘‘(B) is dismissed from such educational in12 stitution for disciplinary reasons; 

13 ‘‘(C) voluntarily terminates the training in 

14 such an educational institution for which he or 

15 she is provided a scholarship under such contract 

16 before the completion of such training; or 

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

18 the educational institution in which he or she is 

19 enrolled not to accept payment, in whole or in 

20 part, of a scholarship under such contract, in 

21 lieu of any service obligation arising under such 

22 contract. 

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

24 specified in paragraph (1) an individual breaches a 

25 written contract by failing either to begin such indiVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00028 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
29 

•HR 1328 RH

1 vidual’s service obligation required under such con2 tract or to complete such service obligation, the 

3 United States shall be entitled to recover from the in4 dividual an amount determined in accordance with 

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

6 in the manner provided for in such subsection. 

7 ‘‘(3) CANCELLATION UPON DEATH OF RECIPI8 ENT.—Upon the death of an individual who receives 

9 an Indian Health Scholarship, any outstanding obli10 gation of that individual for service or payment that 

11 relates to that scholarship shall be canceled. 

12 ‘‘(4) WAIVERS AND SUSPENSIONS.— 

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

14 provide for the partial or total waiver or suspen15 sion of any obligation of service or payment of 

16 a recipient of an Indian Health Scholarship if 

17 the Secretary determines that— 

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

19 to meet that obligation or make that pay20 ment; 

21 ‘‘(ii) requiring that recipient to meet 

22 that obligation or make that payment would 

23 result in extreme hardship to the recipient; 

24 or 


jbell on PROD1PC69 with BILLS
30 

•HR 1328 RH

1 ‘‘(iii) the enforcement of the require2 ment to meet the obligation or make the 

3 payment would be unconscionable. 

4 ‘‘(B) FACTORS FOR CONSIDERATION.—Be5 fore waiving or suspending an obligation of serv6 ice or payment under subparagraph (A), the Sec7 retary shall consult with the affected Area Office, 

8 Indian Tribes, Tribal Organizations, or Urban 

9 Indian Organizations, and may take into con10 sideration whether the obligation may be satis11 fied in a teaching capacity at a tribal college or 

12 university nursing program under subsection 

13 (b)(1)(D). 

14 ‘‘(5) EXTREME HARDSHIP.—Notwithstanding 

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

16 hardship or for other good cause shown, the Secretary 

17 may waive, in whole or in part, the right of the 

18 United States to recover funds made available under 

19 this section. 

20 ‘‘(6) BANKRUPTCY.—Notwithstanding any other 

21 provision of law, with respect to a recipient of an In22 dian Health Scholarship, no obligation for payment 

23 may be released by a discharge in bankruptcy under 

24 title 11, United States Code, unless that discharge is 

25 granted after the expiration of the 5-year period beVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
31 

•HR 1328 RH

1 ginning on the initial date on which that payment is 

2 due, and only if the bankruptcy court finds that the 

3 nondischarge of the obligation would be unconscion4 able. 

5 ‘‘SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PRO6 GRAM. 

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

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

9 $300,000 to each of 9 colleges and universities for the pur10 pose of developing and maintaining Indian psychology ca11 reer recruitment programs as a means of encouraging Indi12 ans to enter the behavioral health field. These programs 

13 shall be located at various locations throughout the country 

14 to maximize their availability to Indian students and new 

15 programs shall be established in different locations from 

16 time to time. 

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

18 Secretary shall provide a grant authorized under subsection 

19 (a) to develop and maintain a program at the University 

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

21 American Indians Into Psychology Program’. Such pro22 gram shall, to the maximum extent feasible, coordinate with 

23 the Quentin N. Burdick Indian Health Programs author24 ized under section 117(b), the Quentin N. Burdick Amer25 ican Indians Into Nursing Program authorized under secVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00031 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
32 

•HR 1328 RH

1 tion 115(e), and existing university research and commu2 nications networks. 

3 ‘‘(c) REGULATIONS.—The Secretary shall issue regula4 tions pursuant to this Act for the competitive awarding of 

5 grants provided under this section. 

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

7 section shall agree to provide a program which, at a min8 imum— 

9 ‘‘(1) provides outreach and recruitment for 

10 health professions to Indian communities including 

11 elementary, secondary, and accredited and accessible 

12 community colleges that will be served by the pro13 gram; 

14 ‘‘(2) incorporates a program advisory board 

15 comprised of representatives from the tribes and com16 munities that will be served by the program; 

17 ‘‘(3) provides summer enrichment programs to 

18 expose Indian students to the various fields of psy19 chology through research, clinical, and experimental 

20 activities; 

21 ‘‘(4) provides stipends to undergraduate and 

22 graduate students to pursue a career in psychology; 

23 ‘‘(5) develops affiliation agreements with tribal 

24 colleges and universities, the Service, university affili25 ated programs, and other appropriate accredited and 


jbell on PROD1PC69 with BILLS
33 

•HR 1328 RH

1 accessible entities to enhance the education of Indian 

2 students; 

3 ‘‘(6) to the maximum extent feasible, uses exist4 ing university tutoring, counseling, and student sup5 port services; and 

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

7 qualified Indians in the program. 

8 ‘‘(e) ACTIVE DUTY SERVICE REQUIREMENT.—The ac9 tive duty service obligation prescribed under section 338C 

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

11 be met by each graduate who receives a stipend described 

12 in subsection (d)(4) that is funded under this section. Such 

13 obligation shall be met by service— 

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

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

16 Act; or 

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

18 determined by the Secretary, in accordance with 

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

22 needs of a substantial number of Indians. 

23 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There is 

24 authorized to be appropriated to carry out this section 

25 $2,700,000 for each of fiscal years 2008 through 2017. 


jbell on PROD1PC69 with BILLS
34 

•HR 1328 RH

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

2 ‘‘(a) IN GENERAL.— 

3 ‘‘(1) GRANTS AUTHORIZED.—The Secretary, act4 ing through the Service, shall make grants to Tribal 

5 Health Programs for the purpose of providing schol6 arships for Indians to serve as health professionals in 

7 Indian communities. 

8 ‘‘(2) AMOUNT.—Amounts available under para9 graph (1) for any fiscal year shall not exceed 5 per10 cent of the amounts available for each fiscal year for 

11 Indian Health Scholarships under section 104. 

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

13 under paragraph (1) shall be in such form and con14 tain such agreements, assurances, and information as 

15 consistent with this section. 

16 ‘‘(b) REQUIREMENTS.— 

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

18 receiving a grant under subsection (a) shall provide 

19 scholarships to Indians in accordance with the re20 quirements of this section. 

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

22 any scholarship pursuant to subsection (a)— 

23 ‘‘(A) 80 percent of the costs of the scholar24 ship shall be paid from the funds made available 

25 pursuant to subsection (a)(1) provided to the 

26 Tribal Health Program; and 


jbell on PROD1PC69 with BILLS
35 

•HR 1328 RH

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

2 from any other source of funds. 

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

4 shall provide scholarships under this section only to Indians 

5 enrolled or accepted for enrollment in a course of study (ap6 proved by the Secretary) in 1 of the health professions con7 templated by this Act. 

8 ‘‘(d) CONTRACT.— 

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

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

11 Health Program shall enter into a written contract 

12 with each recipient of such scholarship. 

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

14 ‘‘(A) obligate such recipient to provide serv15 ice in an Indian Health Program or Urban In16 dian Organization, in the same Service Area 

17 where the Tribal Health Program providing the 

18 scholarship is located, for— 

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

20 scholarship is provided (or the part-time 

21 equivalent thereof, as determined by the Sec22 retary), or for a period of 2 years, which23 ever period is greater; or 


jbell on PROD1PC69 with BILLS
36 

•HR 1328 RH

1 ‘‘(ii) such greater period of time as the 

2 recipient and the Tribal Health Program 

3 may agree; 

4 ‘‘(B) provide that the amount of the scholar5 ship— 

6 ‘‘(i) may only be expended for— 

7 ‘‘(I) tuition expenses, other rea8 sonable educational expenses, and rea9 sonable living expenses incurred in at10 tendance at the educational institution; 

11 and 

12 ‘‘(II) payment to the recipient of 

13 a monthly stipend of not more than the 

14 amount authorized by section 

15 338(g)(1)(B) of the Public Health 

16 Service Act (42 U.S.C. 254m(g)(1)(B)), 

17 with such amount to be reduced pro 

18 rata (as determined by the Secretary) 

19 based on the number of hours such stu20 dent is enrolled, and not to exceed, for 

21 any year of attendance for which the 

22 scholarship is provided, the total 

23 amount required for the year for the 

24 purposes authorized in this clause; and 


jbell on PROD1PC69 with BILLS
37 

•HR 1328 RH

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

2 attendance for which the scholarship is pro3 vided, the total amount required for the 

4 year for the purposes authorized in clause 

5 (i); 

6 ‘‘(C) require the recipient of such scholar7 ship to maintain an acceptable level of academic 

8 standing as determined by the educational insti9 tution in accordance with regulations issued 

10 pursuant to this Act; and 

11 ‘‘(D) require the recipient of such scholar12 ship to meet the educational and licensure re13 quirements appropriate to each health profession. 

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

15 contract may allow the recipient to serve in another 

16 Service Area, provided the Tribal Health Program 

17 and Secretary approve and services are not dimin18 ished to Indians in the Service Area where the Tribal 

19 Health Program providing the scholarship is located. 

20 ‘‘(e) BREACH OF CONTRACT.— 

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

22 has entered into a written contract with the Secretary 

23 and a Tribal Health Program under subsection (d) 

24 shall be liable to the United States for the Federal 

25 share of the amount which has been paid to him or 


jbell on PROD1PC69 with BILLS
38 

•HR 1328 RH

1 her, or on his or her behalf, under the contract if that 

2 individual— 

3 ‘‘(A) fails to maintain an acceptable level of 

4 academic standing in the educational institution 

5 in which he or she is enrolled (such level as de6 termined by the educational institution under 

7 regulations of the Secretary); 

8 ‘‘(B) is dismissed from such educational in9 stitution for disciplinary reasons; 

10 ‘‘(C) voluntarily terminates the training in 

11 such an educational institution for which he or 

12 she is provided a scholarship under such contract 

13 before the completion of such training; or 

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

15 the educational institution in which he or she is 

16 enrolled not to accept payment, in whole or in 

17 part, of a scholarship under such contract, in 

18 lieu of any service obligation arising under such 

19 contract. 

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

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

22 written contract by failing to either begin such indi23 vidual’s service obligation required under such con24 tract or to complete such service obligation, the 

25 United States shall be entitled to recover from the inVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
39 

•HR 1328 RH

1 dividual an amount determined in accordance with 

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

3 in the manner provided for in such subsection. 

4 ‘‘(3) CANCELLATION UPON DEATH OF RECIPI5 ENT.—Upon the death of an individual who receives 

6 an Indian Health Scholarship, any outstanding obli7 gation of that individual for service or payment that 

8 relates to that scholarship shall be canceled. 

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

10 out this subsection on the basis of information re11 ceived from Tribal Health Programs involved or on 

12 the basis of information collected through such other 

13 means as the Secretary deems appropriate. 

14 ‘‘(f) RELATION TO SOCIAL SECURITY ACT.—The re15 cipient of a scholarship under this section shall agree, in 

16 providing health care pursuant to the requirements here17 in— 

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

19 seeking care on the basis of the ability of the indi20 vidual to pay for such care or on the basis that pay21 ment for such care will be made pursuant to a pro22 gram established in title XVIII of the Social Security 

23 Act or pursuant to the programs established in title 

24 XIX or title XXI of such Act; and 


jbell on PROD1PC69 with BILLS
40 

•HR 1328 RH

1 ‘‘(2) to accept assignment under section 

2 1842(b)(3)(B)(ii) of the Social Security Act for all 

3 services for which payment may be made under part 

4 B of title XVIII of such Act, and to enter into an ap5 propriate agreement with the State agency that ad6 ministers the State plan for medical assistance under 

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

8 XXI, of such Act to provide service to individuals en9 titled to medical assistance or child health assistance, 

10 respectively, under the plan. 

11 ‘‘(g) CONTINUANCE OF FUNDING.—The Secretary shall 

12 make payments under this section to a Tribal Health Pro13 gram for any fiscal year subsequent to the first fiscal year 

14 of such payments unless the Secretary determines that, for 

15 the immediately preceding fiscal year, the Tribal Health 

16 Program has not complied with the requirements of this sec17 tion. 

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

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

20 who receives a scholarship pursuant to section 104 or 106 

21 shall be given preference for employment in the Service, or 

22 may be employed by a Tribal Health Program or an Urban 

23 Indian Organization, or other agencies of the Department 

24 as available, during any nonacademic period of the year. 


jbell on PROD1PC69 with BILLS
41 

•HR 1328 RH

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

2 OBLIGATION.—Periods of employment pursuant to this sub3 section shall not be counted in determining fulfillment of 

4 the service obligation incurred as a condition of the scholar5 ship. 

6 ‘‘(c) TIMING; LENGTH OF EMPLOYMENT.—Any indi7 vidual enrolled in a program, including a high school pro8 gram, authorized under section 102(a) may be employed by 

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

10 Indian Organization during any nonacademic period of the 

11 year. Any such employment shall not exceed 120 days dur12 ing any calendar year. 

13 ‘‘(d) NONAPPLICABILITY OF COMPETITIVE PERSONNEL

14 SYSTEM.—Any employment pursuant to this section shall 

15 be made without regard to any competitive personnel sys16 tem or agency personnel limitation and to a position which 

17 will enable the individual so employed to receive practical 

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

19 engaged in study. Any individual so employed shall receive 

20 payment for his or her services comparable to the salary 

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

22 competitive system. Any individual so employed shall not 

23 be counted against any employment ceiling affecting the 

24 Service or the Department. 


jbell on PROD1PC69 with BILLS
42 

•HR 1328 RH

1 ‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES. 

2 ‘‘In order to encourage scholarship and stipend recipi3 ents under sections 104, 105, 106, and 115 and health pro4 fessionals, including community health representatives and 

5 emergency medical technicians, to join or continue in an 

6 Indian Health Program and to provide their services in the 

7 rural and remote areas where a significant portion of Indi8 ans reside, the Secretary, acting through the Service, may— 

9 ‘‘(1) provide programs or allowances to transi10 tion into an Indian Health Program, including li11 censing, board or certification examination assist12 ance, and technical assistance in fulfilling service ob13 ligations under sections 104, 105, 106, and 115; and 

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

15 professionals employed in an Indian Health Program 

16 to enable them for a period of time each year pre17 scribed by regulation of the Secretary to take leave of 

18 their duty stations for professional consultation, man19 agement, leadership, and refresher training courses. 

20 ‘‘SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PRO21 GRAM. 

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

23 November 2, 1921 (25 U.S.C. 13) (commonly known as the 

24 ‘Snyder Act’), the Secretary, acting through the Service, 

25 shall maintain a Community Health Representative Pro26 gram under which Indian Health Programs— 


jbell on PROD1PC69 with BILLS
43 

•HR 1328 RH

1 ‘‘(1) provide for the training of Indians as com2 munity health representatives; and 

3 ‘‘(2) use such community health representatives 

4 in the provision of health care, health promotion, and 

5 disease prevention services to Indian communities. 

6 ‘‘(b) DUTIES.—The Community Health Representative 

7 Program of the Service, shall— 

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

9 community health representatives to ensure that the 

10 community health representatives provide quality 

11 health care, health promotion, and disease prevention 

12 services to the Indian communities served by the Pro13 gram; 

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

15 and maintain a curriculum that— 

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

17 health care with supervised practical experience 

18 in the provision of health care; and 

19 ‘‘(B) provides instruction and practical ex20 perience in health promotion and disease preven21 tion activities, with appropriate consideration 

22 given to lifestyle factors that have an impact on 

23 Indian health status, such as alcoholism, family 

24 dysfunction, and poverty; 


jbell on PROD1PC69 with BILLS
44 

•HR 1328 RH

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

2 needs of community health representatives for con3 tinuing education in health care, health promotion, 

4 and disease prevention and develop programs that 

5 meet the needs for continuing education; 

6 ‘‘(4) maintain a system that provides close su7 pervision of Community Health Representatives; 

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

9 Community Health Representatives is reviewed and 

10 evaluated; and 

11 ‘‘(6) promote traditional health care practices of 

12 the Indian Tribes served consistent with the Service 

13 standards for the provision of health care, health pro14 motion, and disease prevention. 

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

16 PROGRAM. 

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

18 the Service, shall establish and administer a program to 

19 be known as the Service Loan Repayment Program (herein20 after referred to as the ‘Loan Repayment Program’) in 

21 order to ensure an adequate supply of trained health profes22 sionals necessary to maintain accreditation of, and provide 

23 health care services to Indians through, Indian Health Pro24 grams and Urban Indian Organizations. 


jbell on PROD1PC69 with BILLS
45 

•HR 1328 RH

1 ‘‘(b) ELIGIBLE INDIVIDUALS.—To be eligible to par2 ticipate in the Loan Repayment Program, an individual 

3 must— 

4 ‘‘(1)(A) be enrolled— 

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

6 accredited educational institution (as determined 

7 by the Secretary under section 338B(b)(1)(c)(i) 

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

9 254l–1(b)(1)(c)(i))) and be scheduled to complete 

10 such course of study in the same year such indi11 vidual applies to participate in such program; 

12 or 

13 ‘‘(ii) in an approved graduate training pro14 gram in a health profession; or 

15 ‘‘(B) have— 

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

17 ‘‘(ii) a license to practice a health profes18 sion; 

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

20 as a commissioned officer in the Regular or Reserve 

21 Corps of the Public Health Service; 

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

23 in the Regular or Reserve Corps of the Public Health 

24 Service; 


jbell on PROD1PC69 with BILLS
46 

•HR 1328 RH

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

2 service employment in the Service; or 

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

4 or Urban Indian Organization without a service obli5 gation; and 

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

7 a contract described in subsection (e). 

8 ‘‘(c) APPLICATION.— 

9 ‘‘(1) INFORMATION TO BE INCLUDED WITH

10 FORMS.—In disseminating application forms and 

11 contract forms to individuals desiring to participate 

12 in the Loan Repayment Program, the Secretary shall 

13 include with such forms a fair summary of the rights 

14 and liabilities of an individual whose application is 

15 approved (and whose contract is accepted) by the Sec16 retary, including in the summary a clear explanation 

17 of the damages to which the United States is entitled 

18 under subsection (l) in the case of the individual’s 

19 breach of contract. The Secretary shall provide such 

20 individuals with sufficient information regarding the 

21 advantages and disadvantages of service as a commis22 sioned officer in the Regular or Reserve Corps of the 

23 Public Health Service or a civilian employee of the 

24 Service to enable the individual to make a decision on 

25 an informed basis. 


jbell on PROD1PC69 with BILLS
47 

•HR 1328 RH

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

2 contract form, and all other information furnished by 

3 the Secretary under this section shall be written in a 

4 manner calculated to be understood by the average in5 dividual applying to participate in the Loan Repay6 ment Program. 

7 ‘‘(3) TIMELY AVAILABILITY OF FORMS.—The Sec8 retary shall make such application forms, contract 

9 forms, and other information available to individuals 

10 desiring to participate in the Loan Repayment Pro11 gram on a date sufficiently early to ensure that such 

12 individuals have adequate time to carefully review 

13 and evaluate such forms and information. 

14 ‘‘(d) PRIORITIES.— 

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

16 Secretary shall annually— 

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

18 Health Program or Urban Indian Organization 

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

20 ‘‘(B) rank those positions in order of pri21 ority. 

22 ‘‘(2) APPROVALS.—Notwithstanding the priority 

23 determined under paragraph (1), the Secretary, in de24 termining which applications under the Loan RepayVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00047 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
48 

•HR 1328 RH

1 ment Program to approve (and which contracts to ac2 cept), shall— 

3 ‘‘(A) give first priority to applications 

4 made by individual Indians; and 

5 ‘‘(B) after making determinations on all 

6 applications submitted by individual Indians as 

7 required under subparagraph (A), give priority 

8 to— 

9 ‘‘(i) individuals recruited through the 

10 efforts of an Indian Health Program or 

11 Urban Indian Organization; and 

12 ‘‘(ii) other individuals based on the 

13 priority rankings under paragraph (1). 

14 ‘‘(e) RECIPIENT CONTRACTS.— 

15 ‘‘(1) CONTRACT REQUIRED.—An individual be16 comes a participant in the Loan Repayment Program 

17 only upon the Secretary and the individual entering 

18 into a written contract described in paragraph (2). 

19 ‘‘(2) CONTENTS OF CONTRACT.—The written con20 tract referred to in this section between the Secretary 

21 and an individual shall contain— 

22 ‘‘(A) an agreement under which— 

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

24 Secretary agrees— 


jbell on PROD1PC69 with BILLS
49 

•HR 1328 RH

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

2 individual in accordance with the pro3 visions of this section; and 

4 ‘‘(II) to accept (subject to the 

5 availability of appropriated funds for 

6 carrying out this section) the indi7 vidual into the Service or place the in8 dividual with a Tribal Health Pro9 gram or Urban Indian Organization 

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

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

12 individual agrees— 

13 ‘‘(I) to accept loan payments on 

14 behalf of the individual; 

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

16 described in subsection (b)(1)— 

17 ‘‘(aa) to maintain enrollment 

18 in a course of study or training 

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

20 until the individual completes the 

21 course of study or training; and 

22 ‘‘(bb) while enrolled in such 

23 course of study or training, to 

24 maintain an acceptable level of 

25 academic standing (as determined 


jbell on PROD1PC69 with BILLS
50 

•HR 1328 RH

1 under regulations of the Secretary 

2 by the educational institution of3 fering such course of study or 

4 training); and 

5 ‘‘(III) to serve for a time period 

6 (hereinafter in this section referred to 

7 as the ‘period of obligated service’) 

8 equal to 2 years or such longer period 

9 as the individual may agree to serve in 

10 the full-time clinical practice of such 

11 individual’s profession in an Indian 

12 Health Program or Urban Indian Or13 ganization to which the individual 

14 may be assigned by the Secretary; 

15 ‘‘(B) a provision permitting the Secretary 

16 to extend for such longer additional periods, as 

17 the individual may agree to, the period of obli18 gated service agreed to by the individual under 

19 subparagraph (A)(ii)(III); 

20 ‘‘(C) a provision that any financial obliga21 tion of the United States arising out of a con22 tract entered into under this section and any ob23 ligation of the individual which is conditioned 

24 thereon is contingent upon funds being appro25 priated for loan repayments under this section; 


jbell on PROD1PC69 with BILLS
51 

•HR 1328 RH

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

2 the United States is entitled under subsection (l) 

3 for the individual’s breach of the contract; and 

4 ‘‘(E) such other statements of the rights and 

5 liabilities of the Secretary and of the individual, 

6 not inconsistent with this section. 

7 ‘‘(f) DEADLINE FOR DECISION ON APPLICATION.—The 

8 Secretary shall provide written notice to an individual 

9 within 21 days on— 

10 ‘‘(1) the Secretary’s approving, under subsection 

11 (e)(1), of the individual’s participation in the Loan 

12 Repayment Program, including extensions resulting 

13 in an aggregate period of obligated service in excess 

14 of 4 years; or 

15 ‘‘(2) the Secretary’s disapproving an individ16 ual’s participation in such Program. 

17 ‘‘(g) PAYMENTS.— 

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

19 for an individual under a written contract under the 

20 Loan Repayment Program shall consist of payment, 

21 in accordance with paragraph (2), on behalf of the in22 dividual of the principal, interest, and related ex23 penses on government and commercial loans received 

24 by the individual regarding the undergraduate or 


jbell on PROD1PC69 with BILLS
52 

•HR 1328 RH

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

2 loans were made for— 

3 ‘‘(A) tuition expenses; 

4 ‘‘(B) all other reasonable educational ex5 penses, including fees, books, and laboratory ex6 penses, incurred by the individual; and 

7 ‘‘(C) reasonable living expenses as deter8 mined by the Secretary. 

9 ‘‘(2) AMOUNT.—For each year of obligated serv10 ice that an individual contracts to serve under sub11 section (e), the Secretary may pay up to $35,000 or 

12 an amount equal to the amount specified in section 

13 338B(g)(2)(A) of the Public Health Service Act, 

14 whichever is more, on behalf of the individual for 

15 loans described in paragraph (1). In making a deter16 mination of the amount to pay for a year of such 

17 service by an individual, the Secretary shall consider 

18 the extent to which each such determination— 

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

20 maximize the number of contracts that can be 

21 provided under the Loan Repayment Program 

22 from the amounts appropriated for such con23 tracts; 

24 ‘‘(B) provides an incentive to serve in In25 dian Health Programs and Urban Indian OrgaVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
53 

•HR 1328 RH

1 nizations with the greatest shortages of health 

2 professionals; and 

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

4 the health professional involved remaining in an 

5 Indian Health Program or Urban Indian Orga6 nization with such a health professional short7 age, and continuing to provide primary health 

8 services, after the completion of the period of ob9 ligated service under the Loan Repayment Pro10 gram. 

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

12 Secretary for the making of loan repayments in ac13 cordance with this subsection shall provide that any 

14 repayments for a year of obligated service shall be 

15 made no later than the end of the fiscal year in which 

16 the individual completes such year of service. 

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

18 For the purpose of providing reimbursements for tax 

19 liability resulting from a payment under paragraph 

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

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

22 make payments to the individual in an amount 

23 equal to not less than 20 percent and not more 

24 than 39 percent of the total amount of loan reVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00053 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
54 

•HR 1328 RH

1 payments made for the taxable year involved; 

2 and 

3 ‘‘(B) may make such additional payments 

4 as the Secretary determines to be appropriate 

5 with respect to such purpose. 

6 ‘‘(5) PAYMENT SCHEDULE.—The Secretary may 

7 enter into an agreement with the holder of any loan 

8 for which payments are made under the Loan Repay9 ment Program to establish a schedule for the making 

10 of such payments. 

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

12 other provision of law, individuals who have entered into 

13 written contracts with the Secretary under this section shall 

14 not be counted against any employment ceiling affecting the 

15 Department while those individuals are undergoing aca16 demic training. 

17 ‘‘(i) RECRUITMENT.—The Secretary shall conduct re18 cruiting programs for the Loan Repayment Program and 

19 other manpower programs of the Service at educational in20 stitutions training health professionals or specialists identi21 fied in subsection (a). 

22 ‘‘(j) APPLICABILITY OF LAW.—Section 214 of the Pub23 lic Health Service Act (42 U.S.C. 215) shall not apply to 

24 individuals during their period of obligated service under 

25 the Loan Repayment Program. 


jbell on PROD1PC69 with BILLS
55 

•HR 1328 RH

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

2 in assigning individuals to serve in Indian Health Pro3 grams or Urban Indian Organizations pursuant to con4 tracts entered into under this section, shall— 

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

6 Health Programs and Urban Indian Organizations 

7 receive consideration on an equal basis with programs 

8 that are administered directly by the Service; and 

9 ‘‘(2) give priority to assigning individuals to In10 dian Health Programs and Urban Indian Organiza11 tions that have a need for health professionals to pro12 vide health care services as a result of individuals 

13 having breached contracts entered into under this sec14 tion. 

15 ‘‘(l) BREACH OF CONTRACT.— 

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

17 has entered into a written contract with the Secretary 

18 under this section and has not received a waiver 

19 under subsection (m) shall be liable, in lieu of any 

20 service obligation arising under such contract, to the 

21 United States for the amount which has been paid on 

22 such individual’s behalf under the contract if that in23 dividual— 

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

25 of study and— 


jbell on PROD1PC69 with BILLS
56 

•HR 1328 RH

1 ‘‘(i) fails to maintain an acceptable 

2 level of academic standing in the edu3 cational institution in which he or she is 

4 enrolled (such level determined by the edu5 cational institution under regulations of the 

6 Secretary); 

7 ‘‘(ii) voluntarily terminates such en8 rollment; or 

9 ‘‘(iii) is dismissed from such edu10 cational institution before completion of 

11 such course of study; or 

12 ‘‘(B) is enrolled in a graduate training pro13 gram and fails to complete such training pro14 gram. 

15 ‘‘(2) OTHER BREACHES; FORMULA FOR AMOUNT

16 OWED.—If, for any reason not specified in paragraph 

17 (1), an individual breaches his or her written con18 tract under this section by failing either to begin, or 

19 complete, such individual’s period of obligated service 

20 in accordance with subsection (e)(2), the United 

21 States shall be entitled to recover from such indi22 vidual an amount to be determined in accordance 

23 with the following formula: A=3Z(t¥s/t) in which— 

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

25 entitled to recover; 


jbell on PROD1PC69 with BILLS
57 

•HR 1328 RH

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

2 under this section to, or on behalf of, the indi3 vidual and the interest on such amounts which 

4 would be payable if, at the time the amounts 

5 were paid, they were loans bearing interest at 

6 the maximum legal prevailing rate, as deter7 mined by the Secretary of the Treasury; 

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

9 individual’s period of obligated service in accord10 ance with subsection (f); and 

11 ‘‘(D) ‘s’ is the number of months of such pe12 riod served by such individual in accordance 

13 with this section. 

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

15 Amounts not paid within such period shall be subject 

16 to collection through deductions in Medicare pay17 ments pursuant to section 1892 of the Social Security 

18 Act. 

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

20 amount of damages which the United States is enti21 tled to recover under this subsection shall be paid to 

22 the United States within the 1-year period beginning 

23 on the date of the breach or such longer period begin24 ning on such date as shall be specified by the Sec25 retary. 


jbell on PROD1PC69 with BILLS
58 

•HR 1328 RH

1 ‘‘(5) RECOVERY OF DELINQUENCY.— 

2 ‘‘(A) IN GENERAL.—If damages described in 

3 paragraph (4) are delinquent for 3 months, the 

4 Secretary shall, for the purpose of recovering 

5 such damages— 

6 ‘‘(i) use collection agencies contracted 

7 with by the Administrator of General Serv8 ices; or 

9 ‘‘(ii) enter into contracts for the recov10 ery of such damages with collection agencies 

11 selected by the Secretary. 

12 ‘‘(B) REPORT.—Each contract for recov13 ering damages pursuant to this subsection shall 

14 provide that the contractor will, not less than 

15 once each 6 months, submit to the Secretary a 

16 status report on the success of the contractor in 

17 collecting such damages. Section 3718 of title 31, 

18 United States Code, shall apply to any such con19 tract to the extent not inconsistent with this sub20 section. 

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

22 ‘‘(1) IN GENERAL.—The Secretary shall by regu23 lation provide for the partial or total waiver or sus24 pension of any obligation of service or payment by an 

25 individual under the Loan Repayment Program 


jbell on PROD1PC69 with BILLS
59 

•HR 1328 RH

1 whenever compliance by the individual is impossible 

2 or would involve extreme hardship to the individual 

3 and if enforcement of such obligation with respect to 

4 any individual would be unconscionable. 

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

6 of an individual under the Loan Repayment Program 

7 for service or payment of damages shall be canceled 

8 upon the death of the individual. 

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

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

11 States to recover amounts under this section in any 

12 case of extreme hardship or other good cause shown, 

13 as determined by the Secretary. 

14 ‘‘(4) BANKRUPTCY.—Any obligation of an indi15 vidual under the Loan Repayment Program for pay16 ment of damages may be released by a discharge in 

17 bankruptcy under title 11 of the United States Code 

18 only if such discharge is granted after the expiration 

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

20 payment of such damages is required, and only if the 

21 bankruptcy court finds that nondischarge of the obli22 gation would be unconscionable. 

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

24 President, for inclusion in the report required to be sub25 mitted to Congress under section 801, a report concerning 


jbell on PROD1PC69 with BILLS
60 

•HR 1328 RH

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 each 

17 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 that 

22 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. 


jbell on PROD1PC69 with BILLS
61 

•HR 1328 RH

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

2 fill the health professional positions maintained by 

3 Indian Health Programs or Urban Indian Organiza4 tions for which recruitment or retention is difficult. 

5 ‘‘SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOV6 ERY FUND. 

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

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

9 Indian Health Scholarship and Loan Repayment Recovery 

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

11 The LRRF shall consist of such amounts as may be collected 

12 from individuals under section 104(d), section 106(e), and 

13 section 110(l) for breach of contract, such funds as may be 

14 appropriated to the LRRF, and interest earned on amounts 

15 in the LRRF. All amounts collected, appropriated, or 

16 earned relative to the LRRF shall remain available until 

17 expended. 

18 ‘‘(b) USE OF FUNDS.— 

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

20 may be expended by the Secretary, acting through the 

21 Service, to make payments to an Indian Health Pro22 gram— 

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

24 section 104 and 106 or a loan repayment pro25 gram participant under section 110 has been asVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
62 

•HR 1328 RH

1 signed to meet the obligated service requirements 

2 pursuant to such sections; and 

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

5 of such recipient or participant having breached 

6 the contract entered into under section 104, 106, 

7 or section 110. 

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

9 Health Program receiving payments pursuant to 

10 paragraph (1) may expend the payments to provide 

11 scholarships or recruit and employ, directly or by 

12 contract, health professionals to provide health care 

13 services. 

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

15 Treasury shall invest such amounts of the LRRF as the Sec16 retary of Health and Human Services determines are not 

17 required to meet current withdrawals from the LRRF. Such 

18 investments may be made only in interest bearing obliga19 tions of the United States. For such purpose, such obliga20 tions may be acquired on original issue at the issue price, 

21 or by purchase of outstanding obligations at the market 

22 price. 

23 ‘‘(d) SALE OF OBLIGATIONS.—Any obligation acquired 

24 by the LRRF may be sold by the Secretary of the Treasury 

25 at the market price. 


jbell on PROD1PC69 with BILLS
63 

•HR 1328 RH

1 ‘‘SEC. 112. RECRUITMENT ACTIVITIES. 

2 ‘‘(a) REIMBURSEMENT FOR TRAVEL.—The Secretary, 

3 acting through the Service, may reimburse health profes4 sionals seeking positions with Indian Health Programs or 

5 Urban Indian Organizations, including individuals consid6 ering entering into a contract under section 110 and their 

7 spouses, for actual and reasonable expenses incurred in 

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

9 in which they may be assigned for the purpose of evaluating 

10 such area with respect to such assignment. 

11 ‘‘(b) RECRUITMENT PERSONNEL.—The Secretary, act12 ing through the Service, shall assign 1 individual in each 

13 Area Office to be responsible on a full-time basis for recruit14 ment activities. 

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

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

18 Service, shall fund, on a competitive basis, innovative dem19 onstration projects for a period not to exceed 3 years to 

20 enable Tribal Health Programs and Urban Indian Organi21 zations to recruit, place, and retain health professionals to 

22 meet their staffing needs. 

23 ‘‘(b) ELIGIBLE ENTITIES; APPLICATION.—Any Tribal 

24 Health Program or Urban Indian Organization may sub25 mit an application for funding of a project pursuant to 

26 this section. 


jbell on PROD1PC69 with BILLS
64 

•HR 1328 RH

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

2 ‘‘(a) DEMONSTRATION PROGRAM.—The Secretary, act3 ing through the Service, shall establish a demonstration 

4 project to enable health professionals who have worked in 

5 an Indian Health Program or Urban Indian Organization 

6 for a substantial period of time to pursue advanced train7 ing or research areas of study for which the Secretary deter8 mines a need exists. 

9 ‘‘(b) SERVICE OBLIGATION.—An individual who par10 ticipates in a program under subsection (a), where the edu11 cational costs are borne by the Service, shall incur an obli12 gation to serve in an Indian Health Program or Urban 

13 Indian Organization for a period of obligated service equal 

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

15 participates in such program. In the event that the indi16 vidual fails to complete such obligated service, the indi17 vidual shall be liable to the United States for the period 

18 of service remaining. In such event, with respect to individ19 uals entering the program after the date of enactment of 

20 the Indian Health Care Improvement Act Amendments of 

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

22 such individual an amount to be determined in accordance 

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

24 in the manner provided for in such subsection. 

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

26 Health professionals from Tribal Health Programs and 


jbell on PROD1PC69 with BILLS
65 

•HR 1328 RH

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

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

4 NURSING PROGRAM. 

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

7 practitioners who deliver health care services to Indians, 

8 the Secretary, acting through the Service, shall provide 

9 grants to the following: 

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

11 ‘‘(2) Tribal colleges or universities. 

12 ‘‘(3) Nurse midwife programs and advanced 

13 practice nurse programs that are provided by any 

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

16 private institutions. 

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

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

20 train individuals to be nurses, nurse midwives, or ad21 vanced practice nurses. 

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

23 in such programs that may pay the tuition charged 

24 for such program and other expenses incurred in conVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00065 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
66 

•HR 1328 RH

1 nection with such program, including books, fees, 

2 room and board, and stipends for living expenses. 

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

4 nurses, nurse midwives, and advanced practice nurses 

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

6 to Indians. 

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

8 skills of, and provides continuing education to, 

9 nurses, nurse midwives, and advanced practice 

10 nurses. 

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

12 achieve the purpose described in subsection (a). 

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

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

15 Secretary may require to establish the connection between 

16 the program of the applicant and a health care facility that 

17 primarily serves Indians. 

18 ‘‘(d) PREFERENCES FOR GRANT RECIPIENTS.—In pro19 viding grants under subsection (a), the Secretary shall ex20 tend a preference to the following: 

21 ‘‘(1) Programs that provide a preference to Indi22 ans. 

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

25 ‘‘(3) Programs that are interdisciplinary. 


jbell on PROD1PC69 with BILLS
67 

•HR 1328 RH

1 ‘‘(4) Programs that are conducted in cooperation 

2 with a program for gifted and talented Indian stu3 dents. 

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

5 universities. 

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

7 Secretary shall provide 1 of the grants authorized under 

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

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

10 N. Burdick American Indians Into Nursing Program’. 

11 Such program shall, to the maximum extent feasible, coordi12 nate with the Quentin N. Burdick Indian Health Programs 

13 established under section 117(b) and the Quentin N. Bur14 dick American Indians Into Psychology Program estab15 lished under section 105(b). 

16 ‘‘(f) ACTIVE DUTY SERVICE OBLIGATION.—The active 

17 duty service obligation prescribed under section 338C of the 

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

19 by each individual who receives training or assistance de20 scribed in paragraph (1) or (2) of subsection (b) that is 

21 funded by a grant provided under subsection (a). Such obli22 gation shall be met by service— 

23 ‘‘(1) in the Service; 

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

25 Organization conducted under the Indian Self-DeterVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00067 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
68 

•HR 1328 RH

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

2 450 et seq.) (including programs under agreements 

3 with the Bureau of Indian Affairs); 

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

5 Act; 

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

9 situated in a physician or other health shortage area 

10 and addresses the health care needs of a substantial 

11 number of Indians; or 

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

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

15 health services provided to Indians would not de16 crease. 

17 ‘‘SEC. 116. TRIBAL CULTURAL ORIENTATION. 

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

19 Secretary, acting through the Service, shall require that ap20 propriate employees of the Service who serve Indian Tribes 

21 in each Service Area receive educational instruction in the 

22 history and culture of such Indian Tribes and their rela23 tionship to the Service. 


jbell on PROD1PC69 with BILLS
69 

•HR 1328 RH

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

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

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

6 Urban Indian Organizations; 

7 ‘‘(2) be carried out through tribal colleges or uni8 versities; 

9 ‘‘(3) include instruction in American Indian 

10 studies; and 

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

12 health care practices of the Indian Tribes in the Serv13 ice Area. 

14 ‘‘SEC. 117. INMED PROGRAM. 

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

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

18 expanding the Indian health careers recruitment program 

19 known as the ‘Indians Into Medicine Program’ (hereinafter 

20 in this section referred to as ‘INMED’) as a means of en21 couraging Indians to enter the health professions. 

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

23 shall provide 1 of the grants authorized under subsection 

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

25 North Dakota, to be known as the ‘Quentin N. Burdick InVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
70 

•HR 1328 RH

1 dian Health Programs’, unless the Secretary makes a deter2 mination, based upon program reviews, that the program 

3 is not meeting the purposes of this section. Such program 

4 shall, to the maximum extent feasible, coordinate with the 

5 Quentin N. Burdick American Indians Into Psychology 

6 Program established under section 105(b) and the Quentin 

7 N. Burdick American Indians Into Nursing Program estab8 lished under section 115. 

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

10 Act, shall develop regulations to govern grants pursuant to 

11 this section. 

12 ‘‘(d) REQUIREMENTS.—Applicants for grants provided 

13 under this section shall agree to provide a program which— 

14 ‘‘(1) provides outreach and recruitment for 

15 health professions to Indian communities including 

16 elementary and secondary schools and community col17 leges located on reservations which will be served by 

18 the program; 

19 ‘‘(2) incorporates a program advisory board 

20 comprised of representatives from the Indian Tribes 

21 and Indian communities which will be served by the 

22 program; 

23 ‘‘(3) provides summer preparatory programs for 

24 Indian students who need enrichment in the subjects 


jbell on PROD1PC69 with BILLS
71 

•HR 1328 RH

1 of math and science in order to pursue training in 

2 the health professions; 

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

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

6 and 

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

8 qualified Indians in the program. 

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

10 COLLEGES. 

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

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

13 through the Service, shall award grants to accredited 

14 and accessible community colleges for the purpose of 

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

17 health profession leading to a degree or diploma in a 

18 health profession for individuals who desire to prac19 tice such profession on or near a reservation or in an 

20 Indian Health Program. 

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

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

24 provided to the community college shall not exceed 

25 $250,000. 


jbell on PROD1PC69 with BILLS
72 

•HR 1328 RH

1 ‘‘(b) GRANTS FOR MAINTENANCE AND RECRUITING.— 

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

3 through the Service, shall award grants to accredited 

4 and accessible community colleges that have estab5 lished a program described in subsection (a)(1) for the 

6 purpose of maintaining the program and recruiting 

7 students for the program. 

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

9 made under this section to a community college 

10 which— 

11 ‘‘(A) is accredited; 

12 ‘‘(B) has a relationship with a hospital fa13 cility, Service facility, or hospital that could 

14 provide training of nurses or health profes15 sionals; 

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

17 accredited college or university medical school, 

18 the terms of which— 

19 ‘‘(i) provide a program that enhances 

20 the transition and recruitment of students 

21 into advanced baccalaureate or graduate 

22 programs that train health professionals; 

23 and 


jbell on PROD1PC69 with BILLS
73 

•HR 1328 RH

1 ‘‘(ii) stipulate certifications necessary 

2 to approve internship and field placement 

3 opportunities at Indian Health Programs; 

4 ‘‘(D) has a qualified staff which has the ap5 propriate certifications; 

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

8 subsection (a)(1); and 

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

10 for applicants for programs under this section. 

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

12 encourage community colleges described in subsection (b)(2) 

13 to establish and maintain programs described in subsection 

14 (a)(1) by— 

15 ‘‘(1) entering into agreements with such colleges 

16 for the provision of qualified personnel of the Service 

17 to teach courses of study in such programs; and 

18 ‘‘(2) providing technical assistance and support 

19 to such colleges. 

20 ‘‘(d) ADVANCED TRAINING.— 

21 ‘‘(1) REQUIRED.—Any program receiving assist22 ance under this section that is conducted with respect 

23 to a health profession shall also offer courses of study 

24 which provide advanced training for any health pro25 fessional who— 


jbell on PROD1PC69 with BILLS
74 

•HR 1328 RH

1 ‘‘(A) has already received a degree or di2 ploma in such health profession; and 

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

4 reservation or for an Indian Health Program. 

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

6 Such courses of study may be offered in conjunction 

7 with the college or university with which the commu8 nity college has entered into the agreement required 

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

10 ‘‘(e) PRIORITY.—Where the requirements of subsection 

11 (b) are met, grant award priority shall be provided to tribal 

12 colleges and universities in Service Areas where they exist. 

13 ‘‘SEC. 119. RETENTION BONUS. 

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

15 a retention bonus to any health professional employed by, 

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

17 or Urban Indian Organization either as a civilian em18 ployee or as a commissioned officer in the Regular or Re19 serve Corps of the Public Health Service who— 

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

21 which recruitment or retention of personnel is dif22 ficult; 

23 ‘‘(2) the Secretary determines is needed by In24 dian Health Programs and Urban Indian Organiza25 tions; 


jbell on PROD1PC69 with BILLS
75 

•HR 1328 RH

1 ‘‘(3) has— 

2 ‘‘(A) completed 2 years of employment with 

3 an Indian Health Program or Urban Indian Or4 ganization; or 

5 ‘‘(B) completed any service obligations in6 curred as a requirement of— 

7 ‘‘(i) any Federal scholarship program; 

8 or 

9 ‘‘(ii) any Federal education loan re10 payment program; and 

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

12 Health Program or Urban Indian Organization for 

13 continued employment for a period of not less than 1 

14 year. 

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

16 the retention bonus which shall provide for a higher annual 

17 rate for multiyear agreements than for single year agree18 ments referred to in subsection (a)(4), but in no event shall 

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

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

21 health professional failing to complete the agreed upon term 

22 of service, except where such failure is through no fault of 

23 the individual, shall be obligated to refund to the Govern24 ment the full amount of the retention bonus for the period 


jbell on PROD1PC69 with BILLS
76 

•HR 1328 RH

1 covered by the agreement, plus interest as determined by 

2 the Secretary in accordance with section 110(l)(2)(B). 

3 ‘‘(d) OTHER RETENTION BONUS.—The Secretary may 

4 pay a retention bonus to any health professional employed 

5 by a Tribal Health Program if such health professional is 

6 serving in a position which the Secretary determines is— 

7 ‘‘(1) a position for which recruitment or reten8 tion is difficult; and 

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

10 to Indians. 

11 ‘‘SEC. 120. NURSING RESIDENCY PROGRAM. 

12 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Secretary, 

13 acting through the Service, shall establish a program to en14 able Indians who are licensed practical nurses, licensed vo15 cational nurses, and registered nurses who are working in 

16 an Indian Health Program or Urban Indian Organization, 

17 and have done so for a period of not less than 1 year, to 

18 pursue advanced training. Such program shall include a 

19 combination of education and work study in an Indian 

20 Health Program or Urban Indian Organization leading to 

21 an associate or bachelor’s degree (in the case of a licensed 

22 practical nurse or licensed vocational nurse), a bachelor’s 

23 degree (in the case of a registered nurse), or advanced de24 grees or certifications in nursing and public health. 


jbell on PROD1PC69 with BILLS
77 

•HR 1328 RH

1 ‘‘(b) SERVICE OBLIGATION.—An individual who par2 ticipates in a program under subsection (a), where the edu3 cational costs are paid by the Service, shall incur an obliga4 tion to serve in an Indian Health Program or Urban In5 dian Organization for a period of obligated service equal 

6 to 1 year for every year that nonprofessional employee (li7 censed practical nurses, licensed vocational nurses, nursing 

8 assistants, and various health care technicals), or 2 years 

9 for every year that professional nurse (associate degree and 

10 bachelor-prepared registered nurses), participates in such 

11 program. In the event that the individual fails to complete 

12 such obligated service, the United States shall be entitled 

13 to recover from such individual an amount determined in 

14 accordance with the formula specified in subsection (l) of 

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

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

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

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

19 (commonly known as the ‘Snyder Act’), the Secretary, act20 ing through the Service, shall develop and operate a Com21 munity Health Aide Program in Alaska under which the 

22 Service— 

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

24 as health aides or community health practitioners; 


jbell on PROD1PC69 with BILLS
78 

•HR 1328 RH

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

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

5 ‘‘(3) provides for the establishment of teleconfer6 encing capacity in health clinics located in or near 

7 such villages for use by community health aides or 

8 community health practitioners. 

9 ‘‘(b) SPECIFIC PROGRAM REQUIREMENTS.—The Sec10 retary, acting through the Community Health Aide Pro11 gram of the Service, shall— 

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

13 provide a high standard of training to community 

14 health aides and community health practitioners to 

15 ensure that such aides and practitioners provide qual16 ity health care, health promotion, and disease preven17 tion services to the villages served by the Program; 

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

19 a curriculum that— 

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

21 health care with supervised practical experience 

22 in the provision of health care; 

23 ‘‘(B) provides instruction and practical ex24 perience in the provision of acute care, emer25 gency care, health promotion, disease prevention, 


jbell on PROD1PC69 with BILLS
79 

•HR 1328 RH

1 and the efficient and effective management of 

2 clinic pharmacies, supplies, equipment, and fa3 cilities; and 

4 ‘‘(C) promotes the achievement of the health 

5 status objectives specified in section 3(2); 

6 ‘‘(3) establish and maintain a Community 

7 Health Aide Certification Board to certify as commu8 nity health aides or community health practitioners 

9 individuals who have successfully completed the train10 ing described in paragraph (1) or can demonstrate 

11 equivalent experience; 

12 ‘‘(4) develop and maintain a system which iden13 tifies the needs of community health aides and com14 munity health practitioners for continuing education 

15 in the provision of health care, including the areas 

16 described in paragraph (2)(B), and develop programs 

17 that meet the needs for such continuing education; 

18 ‘‘(5) develop and maintain a system that pro19 vides close supervision of community health aides and 

20 community health practitioners; 

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

22 community health aides and community health prac23 titioners is reviewed and evaluated to assure the pro24 vision of quality health care, health promotion, and 

25 disease prevention services; and 


jbell on PROD1PC69 with BILLS
80 

•HR 1328 RH

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

2 pulpotomies on deciduous teeth) or extraction of adult 

3 teeth can be performed by a dental health aide thera4 pist only after consultation with a licensed dentist 

5 who determines that the procedure is a medical emer6 gency that cannot be resolved with palliative treat7 ment, and further that dental health aide therapists 

8 are strictly prohibited from performing all other oral 

9 or jaw surgeries, provided that uncomplicated extrac10 tions shall not be considered oral surgery under this 

11 section. 

12 ‘‘(c) PROGRAM REVIEW.— 

13 ‘‘(1) NEUTRAL PANEL.— 

14 ‘‘(A) ESTABLISHMENT.—The Secretary, act15 ing through the Service, shall establish a neutral 

16 panel to carry out the study under paragraph 

17 (2). 

18 ‘‘(B) MEMBERSHIP.—Members of the neu19 tral panel shall be appointed by the Secretary 

20 from among clinicians, economists, community 

21 practitioners, oral epidemiologists, and Alaska 

22 Natives. 

23 ‘‘(2) STUDY.— 

24 ‘‘(A) IN GENERAL.—The neutral panel es25 tablished under paragraph (1) shall conduct a 


jbell on PROD1PC69 with BILLS
81 

•HR 1328 RH

1 study of the dental health aide therapist services 

2 provided by the Community Health Aide Pro3 gram under this section to ensure that the qual4 ity of care provided through those services is ade5 quate and appropriate. 

6 ‘‘(B) PARAMETERS OF STUDY.—The Sec7 retary, in consultation with interested parties, 

8 including professional dental organizations, shall 

9 develop the parameters of the study. 

10 ‘‘(C) INCLUSIONS.—The study shall include 

11 a determination by the neutral panel with re12 spect to— 

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

14 aide therapist services under this section to 

15 address the dental care needs of Alaska Na16 tives; 

17 ‘‘(ii) the quality of care provided 

18 through those services, including any train19 ing, improvement, or additional oversight 

20 required to improve the quality of care; and 

21 ‘‘(iii) whether safer and less costly al22 ternatives to the dental health aide therapist 

23 services exist. 

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

25 study under this paragraph, the neutral panel 


jbell on PROD1PC69 with BILLS
82 

•HR 1328 RH

1 shall consult with Alaska Tribal Organizations 

2 with respect to the adequacy and accuracy of the 

3 study. 

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

5 to the Secretary, the Committee on Indian Affairs of 

6 the Senate, and the Committee on Natural Resources 

7 of the House of Representatives a report describing 

8 the results of the study under paragraph (2), includ9 ing a description of— 

10 ‘‘(A) any determination of the neutral panel 

11 under paragraph (2)(C); and 

12 ‘‘(B) any comments received from an Alaska 

13 Tribal Organization under paragraph (2)(D). 

14 ‘‘(d) NATIONALIZATION OF PROGRAM.— 

15 ‘‘(1) IN GENERAL.—Except as provided in para16 graph (2), the Secretary, acting through the Service, 

17 may establish a national Community Health Aide 

18 Program in accordance with the program under this 

19 section, as the Secretary determines to be appropriate. 

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

21 Health Aide Program under paragraph (1) shall not 

22 include dental health aide therapist services. 

23 ‘‘(3) REQUIREMENT.—In establishing a national 

24 program under paragraph (1), the Secretary shall not 

25 reduce the amount of funds provided for the CommuVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
83 

•HR 1328 RH

1 nity Health Aide Program described in subsections 

2 (a) and (b). 

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

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

5 contract or otherwise, provide training for Indians in the 

6 administration and planning of Tribal Health Programs. 

7 ‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE 

8 DEMONSTRATION PROGRAMS. 

9 ‘‘(a) DEMONSTRATION PROGRAMS AUTHORIZED.—The 

10 Secretary, acting through the Service, may fund demonstra11 tion programs for Tribal Health Programs to address the 

12 chronic shortages of health professionals. 

13 ‘‘(b) PURPOSES OF PROGRAMS.—The purposes of dem14 onstration programs funded under subsection (a) shall be— 

15 ‘‘(1) to provide direct clinical and practical ex16 perience at a Service Unit to health profession stu17 dents and residents from medical schools; 

18 ‘‘(2) to improve the quality of health care for In19 dians by assuring access to qualified health care pro20 fessionals; and 

21 ‘‘(3) to provide academic and scholarly opportu22 nities for health professionals serving Indians by 

23 identifying all academic and scholarly resources of 

24 the region. 


jbell on PROD1PC69 with BILLS
84 

•HR 1328 RH

1 ‘‘(c) ADVISORY BOARD.—The demonstration programs 

2 established pursuant to subsection (a) shall incorporate a 

3 program advisory board composed of representatives from 

4 the Indian Tribes and Indian communities in the area 

5 which will be served by the program. 

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

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

8 shall not— 

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

10 Service Corps from an Indian Health Program or 

11 Urban Indian Organization; or 

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

13 member, unless the Secretary, acting through the 

14 Service, has ensured that the Indians receiving serv15 ices from such member will experience no reduction in 

16 services. 

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

18 Health Service Corps scholars qualifying for the Commis19 sioned Corps in the Public Health Service shall be exempt 

20 from the full-time equivalent limitations of the National 

21 Health Service Corps and the Service when serving as a 

22 commissioned corps officer in a Tribal Health Program or 

23 an Urban Indian Organization. 


jbell on PROD1PC69 with BILLS
85 

•HR 1328 RH

1 ‘‘SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL 

2 CURRICULA DEMONSTRATION PROGRAMS. 

3 ‘‘(a) CONTRACTS AND GRANTS.—The Secretary, acting 

4 through the Service, may enter into contracts with, or make 

5 grants to, accredited tribal colleges and universities and eli6 gible accredited and accessible community colleges to estab7 lish demonstration programs to develop educational cur8 ricula for substance abuse counseling. 

9 ‘‘(b) USE OF FUNDS.—Funds provided under this sec10 tion shall be used only for developing and providing edu11 cational curriculum for substance abuse counseling (includ12 ing paying salaries for instructors). Such curricula may 

13 be provided through satellite campus programs. 

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

15 contract entered into or a grant provided under this section 

16 shall be for a period of 3 years. Such contract or grant may 

17 be renewed for an additional 2-year period upon the ap18 proval of the Secretary. 

19 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF APPLI20 CATIONS.—Not later than 180 days after the date of enact21 ment of the Indian Health Care Improvement Act Amend22 ments of 2007, the Secretary, after consultation with Indian 

23 Tribes and administrators of tribal colleges and universities 

24 and eligible accredited and accessible community colleges, 

25 shall develop and issue criteria for the review and approval 

26 of applications for funding (including applications for reVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
86 

•HR 1328 RH

1 newals of funding) under this section. Such criteria shall 

2 ensure that demonstration programs established under this 

3 section promote the development of the capacity of such en4 tities to educate substance abuse counselors. 

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

6 technical and other assistance as may be necessary to enable 

7 grant recipients to comply with the provisions of this sec8 tion. 

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

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

11 is required to be submitted under section 801 for that fiscal 

12 year, a report on the findings and conclusions derived from 

13 the demonstration programs conducted under this section 

14 during that fiscal year. 

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

16 term ‘educational curriculum’ means 1 or more of the fol17 lowing: 

18 ‘‘(1) Classroom education. 

19 ‘‘(2) Clinical work experience. 

20 ‘‘(3) Continuing education workshops. 

21 ‘‘SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMU22 NITY EDUCATION PROGRAMS. 

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

24 Service, and the Secretary of the Interior, in consultation 

25 with Indian Tribes and Tribal Organizations, shall conduct 


jbell on PROD1PC69 with BILLS
87 

•HR 1328 RH

1 a study and compile a list of the types of staff positions 

2 specified in subsection (b) whose qualifications include, or 

3 should include, training in the identification, prevention, 

4 education, referral, or treatment of mental illness, or dys5 functional and self destructive behavior. 

6 ‘‘(b) POSITIONS.—The positions referred to in sub7 section (a) are— 

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

9 Affairs, including existing positions, in the fields of— 

10 ‘‘(A) elementary and secondary education; 

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

12 welfare; 

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

14 and 

15 ‘‘(D) alcohol and substance abuse; 

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

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

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

19 by Indian Tribes, Tribal Organizations (without re20 gard to the funding source), and Urban Indian Orga21 nizations. 

22 ‘‘(c) TRAINING CRITERIA.— 

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

24 shall provide training criteria appropriate to each 

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


jbell on PROD1PC69 with BILLS
88 

•HR 1328 RH

1 (b)(2) and ensure that appropriate training has been, 

2 or shall be provided to any individual in any such 

3 position. With respect to any such individual in a po4 sition identified pursuant to subsection (b)(3), the re5 spective Secretaries shall provide appropriate train6 ing to, or provide funds to, an Indian Tribe, Tribal 

7 Organization, or Urban Indian Organization for 

8 training of appropriate individuals. In the case of po9 sitions funded under a contract or compact under the 

10 Indian Self-Determination and Education Assistance 

11 Act (25 U.S.C. 450 et seq.), the appropriate Secretary 

12 shall ensure that such training costs are included in 

13 the contract or compact, as the Secretary determines 

14 necessary. 

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

16 Position specific training criteria shall be culturally 

17 relevant to Indians and Indian Tribes and shall en18 sure that appropriate information regarding tradi19 tional health care practices is provided. 

20 ‘‘(d) COMMUNITY EDUCATION ON MENTAL ILLNESS.— 

21 The Service shall develop and implement, on request of an 

22 Indian Tribe, Tribal Organization, or Urban Indian Orga23 nization, or assist the Indian Tribe, Tribal Organization, 

24 or Urban Indian Organization to develop and implement, 

25 a program of community education on mental illness. In 


jbell on PROD1PC69 with BILLS
89 

•HR 1328 RH

1 carrying out this subsection, the Service shall, upon request 

2 of an Indian Tribe, Tribal Organization, or Urban Indian 

3 Organization, provide technical assistance to the Indian 

4 Tribe, Tribal Organization, or Urban Indian Organization 

5 to obtain and develop community educational materials on 

6 the identification, prevention, referral, and treatment of 

7 mental illness and dysfunctional and self-destructive behav8 ior. 

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

10 enactment of the Indian Health Care Improvement Act 

11 Amendments of 2007, the Secretary shall develop a plan 

12 under which the Service will increase the health care staff 

13 providing behavioral health services by at least 500 posi14 tions within 5 years after the date of enactment of this sec15 tion, with at least 200 of such positions devoted to child, 

16 adolescent, and family services. The plan developed under 

17 this subsection shall be implemented under the Act of No18 vember 2, 1921 (25 U.S.C. 13) (commonly known as the 

19 ‘Snyder Act’). 

20 ‘‘SEC. 127. AUTHORIZATION OF APPROPRIATIONS. 

21 ‘‘There are authorized to be appropriated such sums 

22 as may be necessary for each fiscal year through fiscal year 

23 2017 to carry out this title. 


jbell on PROD1PC69 with BILLS
90 

•HR 1328 RH

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 under 

5 the authority of the Indian Self-Determination and Edu6 cation Assistance Act (25 U.S.C. 450 et seq.), which are 

7 appropriated under the authority of this section, for the 

8 purposes of— 

9 ‘‘(1) eliminating the deficiencies in health status 

10 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; and 

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

19 meet the following health service responsibilities with 

20 respect to those Indian Tribes with the highest levels 

21 of health status deficiencies and resource deficiencies: 

22 ‘‘(A) Clinical care, including inpatient 

23 care, outpatient care (including audiology, clin24 ical eye, and vision care), primary care, sec25 ondary and tertiary care, and long-term care. 


jbell on PROD1PC69 with BILLS
91 

•HR 1328 RH

1 ‘‘(B) Preventive health, including mammog2 raphy and other cancer screening in accordance 

3 with section 207. 

4 ‘‘(C) Dental care. 

5 ‘‘(D) Mental health, including community 

6 mental health services, inpatient mental health 

7 services, dormitory mental health services, thera8 peutic and residential treatment centers, and 

9 training of traditional health care practitioners. 

10 ‘‘(E) Emergency medical services. 

11 ‘‘(F) Treatment and control of, and reha12 bilitative care related to, alcoholism and drug 

13 abuse (including fetal alcohol syndrome) among 

14 Indians. 

15 ‘‘(G) Injury prevention programs, including 

16 data collection and evaluation, demonstration 

17 projects, training, and capacity building. 

18 ‘‘(H) Home health care. 

19 ‘‘(I) Community health representatives. 

20 ‘‘(J) Maintenance and improvement. 

21 ‘‘(b) NO OFFSET OR LIMITATION.—Any funds appro22 priated under the authority of this section shall not be used 

23 to offset or limit any other appropriations made to the 

24 Service under this Act or the Act of November 2, 1921 (25 


jbell on PROD1PC69 with BILLS
92 

•HR 1328 RH

1 U.S.C. 13) (commonly known as the ‘Snyder Act’), or any 

2 other provision of law. 

3 ‘‘(c) ALLOCATION; USE.— 

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

5 the authority of this section shall be allocated to Serv6 ice Units, Indian Tribes, or Tribal Organizations. 

7 The funds allocated to each Indian Tribe, Tribal Or8 ganization, or Service Unit under this paragraph 

9 shall be used by the Indian Tribe, Tribal Organiza10 tion, or Service Unit under this paragraph to im11 prove the health status and reduce the resource defi12 ciency of each Indian Tribe served by such Service 

13 Unit, Indian Tribe, or Tribal Organization. 

14 ‘‘(2) APPORTIONMENT OF ALLOCATED FUNDS.— 

15 The apportionment of funds allocated to a Service 

16 Unit, Indian Tribe, or Tribal Organization under 

17 paragraph (1) among the health service responsibil18 ities described in subsection (a)(5) shall be determined 

19 by the Service in consultation with, and with the ac20 tive participation of, the affected Indian Tribes and 

21 Tribal Organizations. 

22 ‘‘(d) PROVISIONS RELATING TO HEALTH STATUS AND

23 RESOURCE DEFICIENCIES.—For the purposes of this sec24 tion, the following definitions apply: 


jbell on PROD1PC69 with BILLS
93 

•HR 1328 RH

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

2 resource deficiency’ means the extent to which— 

3 ‘‘(A) the health status objectives set forth in 

4 section 3(2) are not being achieved; and 

5 ‘‘(B) the Indian Tribe or Tribal Organiza6 tion does not have available to it the health re7 sources it needs, taking into account the actual 

8 cost of providing health care services given local 

9 geographic, climatic, rural, or other cir10 cumstances. 

11 ‘‘(2) AVAILABLE RESOURCES.—The health re12 sources available to an Indian Tribe or Tribal Orga13 nization include health resources provided by the 

14 Service as well as health resources used by the Indian 

15 Tribe or Tribal Organization, including services and 

16 financing systems provided by any Federal programs, 

17 private insurance, and programs of State or local 

18 governments. 

19 ‘‘(3) PROCESS FOR REVIEW OF DETERMINA20 TIONS.—The Secretary shall establish procedures 

21 which allow any Indian Tribe or Tribal Organization 

22 to petition the Secretary for a review of any deter23 mination of the extent of the health status and re24 source deficiency of such Indian Tribe or Tribal Or25 ganization. 


jbell on PROD1PC69 with BILLS
94 

•HR 1328 RH

1 ‘‘(e) ELIGIBILITY FOR FUNDS.—Tribal Health Pro2 grams shall be eligible for funds appropriated under the au3 thority of this section on an equal basis with programs that 

4 are administered directly by the Service. 

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

6 years after the date of enactment of the Indian Health Care 

7 Improvement Act Amendments of 2007, the Secretary shall 

8 submit to Congress the current health status and resource 

9 deficiency report of the Service for each Service Unit, in10 cluding newly recognized or acknowledged Indian Tribes. 

11 Such report shall set out— 

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

13 for determining Tribal health status and resource de14 ficiencies, as well as the most recent application of 

15 that methodology; 

16 ‘‘(2) the extent of the health status and resource 

17 deficiency of each Indian Tribe served by the Service 

18 or a Tribal Health Program; 

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

20 the health status and resource deficiencies of all In21 dian Tribes served by the Service or a Tribal Health 

22 Program; and 

23 ‘‘(4) an estimate of— 

24 ‘‘(A) the amount of health service funds ap25 propriated under the authority of this Act, or 


jbell on PROD1PC69 with BILLS
95 

•HR 1328 RH

1 any other Act, including the amount of any 

2 funds transferred to the Service for the preceding 

3 fiscal year which is allocated to each Service 

4 Unit, Indian Tribe, or Tribal Organization; 

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

6 health services in each Service Unit or Indian 

7 Tribe or Tribal Organization; and 

8 ‘‘(C) the number of Indians using the Serv9 ice resources made available to each Service 

10 Unit, Indian Tribe or Tribal Organization, and, 

11 to the extent available, information on the wait12 ing lists and number of Indians turned away for 

13 services due to lack of resources. 

14 ‘‘(g) INCLUSION IN BASE BUDGET.—Funds appro15 priated under this section for any fiscal year shall be in16 cluded in the base budget of the Service for the purpose of 

17 determining appropriations under this section in subse18 quent fiscal years. 

19 ‘‘(h) CLARIFICATION.—Nothing in this section is in20 tended to diminish the primary responsibility of the Service 

21 to eliminate existing backlogs in unmet health care needs, 

22 nor are the provisions of this section intended to discourage 

23 the Service from undertaking additional efforts to achieve 

24 equity among Indian Tribes and Tribal Organizations. 


jbell on PROD1PC69 with BILLS
96 

•HR 1328 RH

1 ‘‘(i) FUNDING DESIGNATION.—Any funds appro2 priated under the authority of this section shall be des3 ignated as the ‘Indian Health Care Improvement Fund’. 

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

5 ‘‘(a) ESTABLISHMENT.—There is established an In6 dian Catastrophic Health Emergency Fund (hereafter in 

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

8 ‘‘(1) the amounts deposited under subsection (f); 

9 and 

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

11 this section. 

12 ‘‘(b) ADMINISTRATION.—CHEF shall be administered 

13 by the Secretary, acting through the headquarters of the 

14 Service, solely for the purpose of meeting the extraordinary 

15 medical costs associated with the treatment of victims of 

16 disasters or catastrophic illnesses who are within the re17 sponsibility of the Service. 

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

19 CHEF or its administration shall be subject to contract or 

20 grant under any law, including the Indian Self-Determina21 tion and Education Assistance Act (25 U.S.C. 450 et seq.), 

22 nor shall CHEF funds be allocated, apportioned, or dele23 gated on an Area Office, Service Unit, or other similar 

24 basis. 


jbell on PROD1PC69 with BILLS
97 

•HR 1328 RH

1 ‘‘(d) REGULATIONS.—The Secretary shall promulgate 

2 regulations consistent with the provisions of this section 

3 to— 

4 ‘‘(1) establish a definition of disasters and cata5 strophic illnesses for which the cost of the treatment 

6 provided under contract would qualify for payment 

7 from CHEF; 

8 ‘‘(2) provide that a Service Unit shall not be eli9 gible for reimbursement for the cost of treatment from 

10 CHEF until its cost of treating any victim of such 

11 catastrophic illness or disaster has reached a certain 

12 threshold cost which the Secretary shall establish at— 

13 ‘‘(A) the 2000 level of $19,000; and 

14 ‘‘(B) for any subsequent year, not less than 

15 the threshold cost of the previous year increased 

16 by the percentage increase in the medical care 

17 expenditure category of the consumer price index 

18 for all urban consumers (United States city av19 erage) for the 12-month period ending with De20 cember of the previous year; 

21 ‘‘(3) establish a procedure for the reimbursement 

22 of the portion of the costs that exceeds such threshold 

23 cost incurred by— 

24 ‘‘(A) Service Units; or 


jbell on PROD1PC69 with BILLS
98 

•HR 1328 RH

1 ‘‘(B) whenever otherwise authorized by the 

2 Service, non-Service facilities or providers; 

3 ‘‘(4) establish a procedure for payment from 

4 CHEF in cases in which the exigencies of the medical 

5 circumstances warrant treatment prior to the author6 ization of such treatment by the Service; and 

7 ‘‘(5) establish a procedure that will ensure that 

8 no payment shall be made from CHEF to any pro9 vider of treatment to the extent that such provider is 

10 eligible to receive payment for the treatment from any 

11 other Federal, State, local, or private source of reim12 bursement for which the patient is eligible. 

13 ‘‘(e) NO OFFSET OR LIMITATION.—Amounts appro14 priated to CHEF under this section shall not be used to 

15 offset or limit appropriations made to the Service under 

16 the authority of the Act of November 2, 1921 (25 U.S.C. 

17 13) (commonly known as the ‘Snyder Act’), or any other 

18 law. 

19 ‘‘(f) DEPOSIT OF REIMBURSEMENT FUNDS.—There 

20 shall be deposited into CHEF all reimbursements to which 

21 the Service is entitled from any Federal, State, local, or 

22 private source (including third party insurance) by reason 

23 of treatment rendered to any victim of a disaster or cata24 strophic illness the cost of which was paid from CHEF. 


jbell on PROD1PC69 with BILLS
99 

•HR 1328 RH

1 ‘‘SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION 

2 SERVICES. 

3 ‘‘(a) FINDINGS.—Congress finds that health promotion 

4 and disease prevention activities— 

5 ‘‘(1) improve the health and well-being of Indi6 ans; and 

7 ‘‘(2) reduce the expenses for health care of Indi8 ans. 

9 ‘‘(b) PROVISION OF SERVICES.—The Secretary, acting 

10 through the Service and Tribal Health Programs, shall pro11 vide health promotion and disease prevention services to In12 dians to achieve the health status objectives set forth in sec13 tion 3(2). 

14 ‘‘(c) EVALUATION.—The Secretary, after obtaining 

15 input from the affected Tribal Health Programs, shall sub16 mit to the President for inclusion in the report which is 

17 required to be submitted to Congress under section 801 an 

18 evaluation of— 

19 ‘‘(1) the health promotion and disease prevention 

20 needs of Indians; 

21 ‘‘(2) the health promotion and disease prevention 

22 activities which would best meet such needs; 

23 ‘‘(3) the internal capacity of the Service and 

24 Tribal Health Programs to meet such needs; and 

25 ‘‘(4) the resources which would be required to en26 able the Service and Tribal Health Programs to unVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
100 

•HR 1328 RH

1 dertake the health promotion and disease prevention 

2 activities necessary to meet such needs. 

3 ‘‘SEC. 204. DIABETES PREVENTION, TREATMENT, AND CON4 TROL. 

5 ‘‘(a) DETERMINATIONS REGARDING DIABETES.—The 

6 Secretary, acting through the Service, and in consultation 

7 with Indian Tribes and Tribal Organizations, shall deter8 mine— 

9 ‘‘(1) by Indian Tribe and by Service Unit, the 

10 incidence of, and the types of complications resulting 

11 from, diabetes among Indians; and 

12 ‘‘(2) based on the determinations made pursuant 

13 to paragraph (1), the measures (including patient 

14 education and effective ongoing monitoring of disease 

15 indicators) each Service Unit should take to reduce 

16 the incidence of, and prevent, treat, and control the 

17 complications resulting from, diabetes among Indian 

18 Tribes within that Service Unit. 

19 ‘‘(b) DIABETES SCREENING.—To the extent medically 

20 indicated and with informed consent, the Secretary shall 

21 screen each Indian who receives services from the Service 

22 for diabetes and for conditions which indicate a high risk 

23 that the individual will become diabetic and establish a 

24 cost-effective approach to ensure ongoing monitoring of dis25 ease indicators. Such screening and monitoring may be conVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00100 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
101 

•HR 1328 RH

1 ducted by a Tribal Health Program and may be conducted 

2 through appropriate Internet-based health care manage3 ment programs. 

4 ‘‘(c) DIABETES PROJECTS.—The Secretary shall con5 tinue to maintain each model diabetes project in existence 

6 on the date of enactment of the Indian Health Care Im7 provement Act Amendments of 2007, any such other diabe8 tes programs operated by the Service or Tribal Health Pro9 grams, and any additional diabetes projects, such as the 

10 Medical Vanguard program provided for in title IV of Pub11 lic Law 108–87, as implemented to serve Indian Tribes. 

12 Tribal Health Programs shall receive recurring funding for 

13 the diabetes projects that they operate pursuant to this sec14 tion, both at the date of enactment of the Indian Health 

15 Care Improvement Act Amendments of 2007 and for 

16 projects which are added and funded thereafter. 

17 ‘‘(d) DIALYSIS PROGRAMS.—The Secretary is author18 ized to provide, through the Service, Indian Tribes, and 

19 Tribal Organizations, dialysis programs, including the 

20 purchase of dialysis equipment and the provision of nec21 essary staffing. 

22 ‘‘(e) OTHER DUTIES OF THE SECRETARY.— 

23 ‘‘(1) IN GENERAL.—The Secretary shall, to the 

24 extent funding is available— 


jbell on PROD1PC69 with BILLS
102 

•HR 1328 RH

1 ‘‘(A) in each Area Office, consult with In2 dian Tribes and Tribal Organizations regarding 

3 programs for the prevention, treatment, and con4 trol of diabetes; 

5 ‘‘(B) establish in each Area Office a registry 

6 of patients with diabetes to track the incidence 

7 of diabetes and the complications from diabetes 

8 in that area; and 

9 ‘‘(C) ensure that data collected in each Area 

10 Office regarding diabetes and related complica11 tions among Indians are disseminated to all 

12 other Area Offices, subject to applicable patient 

13 privacy laws. 

14 ‘‘(2) DIABETES CONTROL OFFICERS.— 

15 ‘‘(A) IN GENERAL.—The Secretary may es16 tablish and maintain in each Area Office a posi17 tion of diabetes control officer to coordinate and 

18 manage any activity of that Area Office relating 

19 to the prevention, treatment, or control of diabe20 tes to assist the Secretary in carrying out a pro21 gram under this section or section 330C of the 

22 Public Health Service Act (42 U.S.C. 254c–3). 

23 ‘‘(B) CERTAIN ACTIVITIES.—Any activity 

24 carried out by a diabetes control officer under 

25 subparagraph (A) that is the subject of a conVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00102 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
103 

•HR 1328 RH

1 tract or compact under the Indian Self-Deter2 mination and Education Assistance Act (25 

3 U.S.C. 450 et seq.), and any funds made avail4 able to carry out such an activity, shall not be 

5 divisible for purposes of that Act. 

6 ‘‘SEC. 205. SHARED SERVICES FOR LONG-TERM CARE. 

7 ‘‘(a) LONG-TERM CARE.—Notwithstanding any other 

8 provision of law, the Secretary, acting through the Service, 

9 is authorized to provide directly, or enter into contracts or 

10 compacts under the Indian Self-Determination and Edu11 cation Assistance Act (25 U.S.C. 450 et seq.) with Indian 

12 Tribes or Tribal Organizations for, the delivery of long-term 

13 care (including health care services associated with long14 term care) provided in a facility to Indians. Such agree15 ments shall provide for the sharing of staff or other services 

16 between the Service or a Tribal Health Program and a long17 term care or related facility owned and operated (directly 

18 or through a contract or compact under the Indian Self19 Determination and Education Assistance Act (25 U.S.C. 

20 450 et seq.)) by such Indian Tribe or Tribal Organization. 

21 ‘‘(b) CONTENTS OF AGREEMENTS.—An agreement en22 tered into pursuant to subsection (a)— 

23 ‘‘(1) may, at the request of the Indian Tribe or 

24 Tribal Organization, delegate to such Indian Tribe or 

25 Tribal Organization such powers of supervision and 


jbell on PROD1PC69 with BILLS
104 

•HR 1328 RH

1 control over Service employees as the Secretary deems 

2 necessary to carry out the purposes of this section; 

3 ‘‘(2) shall provide that expenses (including sala4 ries) relating to services that are shared between the 

5 Service and the Tribal Health Program be allocated 

6 proportionately between the Service and the Indian 

7 Tribe or Tribal Organization; and 

8 ‘‘(3) may authorize such Indian Tribe or Tribal 

9 Organization to construct, renovate, or expand a 

10 long-term care or other similar facility (including the 

11 construction of a facility attached to a Service facil12 ity). 

13 ‘‘(c) MINIMUM REQUIREMENT.—Any nursing facility 

14 provided for under this section shall meet the requirements 

15 for nursing facilities under section 1919 of the Social Secu16 rity Act. 

17 ‘‘(d) OTHER ASSISTANCE.—The Secretary shall pro18 vide such technical and other assistance as may be nec19 essary to enable applicants to comply with the provisions 

20 of this section. 

21 ‘‘(e) USE OF EXISTING OR UNDERUSED FACILITIES.— 

22 The Secretary shall encourage the use of existing facilities 

23 that are underused or allow the use of swing beds for long24 term or similar care. 


jbell on PROD1PC69 with BILLS
105 

•HR 1328 RH

1 ‘‘SEC. 206. HEALTH SERVICES RESEARCH. 

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

3 Service, shall make funding available for research to further 

4 the performance of the health service responsibilities of In5 dian Health Programs. 

6 ‘‘(b) COORDINATION OF RESOURCES AND ACTIVI7 TIES.—The Secretary shall also, to the maximum extent 

8 practicable, coordinate departmental research resources and 

9 activities to address relevant Indian Health Program re10 search needs. 

11 ‘‘(c) AVAILABILITY.—Tribal Health Programs shall be 

12 given an equal opportunity to compete for, and receive, re13 search funds under this section. 

14 ‘‘(d) USE OF FUNDS.—This funding may be used for 

15 both clinical and nonclinical research. 

16 ‘‘(e) EVALUATION AND DISSEMINATION.—The Sec17 retary shall periodically— 

18 ‘‘(1) evaluate the impact of research conducted 

19 under this section; and 

20 ‘‘(2) disseminate to Tribal Health Programs in21 formation regarding that research as the Secretary 

22 determines to be appropriate. 

23 ‘‘SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREEN24 ING. 

25 ‘‘The Secretary, acting through the Service or Tribal 

26 Health Programs, shall provide for screening as follows: 


jbell on PROD1PC69 with BILLS
106 

•HR 1328 RH

1 ‘‘(1) Screening mammography (as defined in sec2 tion 1861(jj) of the Social Security Act) for Indian 

3 women at a frequency appropriate to such women 

4 under accepted and appropriate national standards, 

5 and under such terms and conditions as are con6 sistent with standards established by the Secretary to 

7 ensure the safety and accuracy of screening mammog8 raphy under part B of title XVIII of such Act. 

9 ‘‘(2) Other cancer screening that receives an A or 

10 B rating as recommended by the United States Pre11 ventive Services Task Force established under section 

12 915(a)(1) of the Public Health Service Act (42 U.S.C. 

13 299b–4(a)(1)). The Secretary shall ensure that screen14 ing provided for under this paragraph complies with 

15 the recommendations of the Task Force with respect 

16 to— 

17 ‘‘(A) frequency; 

18 ‘‘(B) the population to be served; 

19 ‘‘(C) the procedure or technology to be used; 

20 ‘‘(D) evidence of effectiveness; and 

21 ‘‘(E) other matters that the Secretary deter22 mines appropriate. 

23 ‘‘SEC. 208. PATIENT TRAVEL COSTS. 

24 ‘‘(a) DEFINITION OF QUALIFIED ESCORT.—In this sec25 tion, the term ‘qualified escort’ means— 


jbell on PROD1PC69 with BILLS
107 

•HR 1328 RH

1 ‘‘(1) an adult escort (including a parent, guard2 ian, or other family member) who is required because 

3 of the physical or mental condition, or age, of the ap4 plicable patient; 

5 ‘‘(2) a health professional for the purpose of pro6 viding necessary medical care during travel by the 

7 applicable patient; or 

8 ‘‘(3) other escorts, as the Secretary or applicable 

9 Indian Health Program determines to be appropriate. 

10 ‘‘(b) PROVISION OF FUNDS.—The Secretary, acting 

11 through the Service and Tribal Health Programs, is author12 ized to provide funds for the following patient travel costs, 

13 including qualified escorts, associated with receiving health 

14 care services provided (either through direct or contract care 

15 or through a contract or compact under the Indian Self16 Determination and Education Assistance Act (25 U.S.C. 

17 450 et seq.)) under this Act— 

18 ‘‘(1) emergency air transportation and non19 emergency air transportation where ground transpor20 tation is infeasible; 

21 ‘‘(2) transportation by private vehicle (where no 

22 other means of transportation is available), specially 

23 equipped vehicle, and ambulance; and 


jbell on PROD1PC69 with BILLS
108 

•HR 1328 RH

1 ‘‘(3) transportation by such other means as may 

2 be available and required when air or motor vehicle 

3 transportation is not available. 

4 ‘‘SEC. 209. EPIDEMIOLOGY CENTERS. 

5 ‘‘(a) ESTABLISHMENT OF CENTERS.—The Secretary 

6 shall establish an epidemiology center in each Service Area 

7 to carry out the functions described in subsection (b). Any 

8 new center established after the date of the enactment of 

9 the Indian Health Care Improvement Act Amendments of 

10 2007 may be operated under a grant authorized by sub11 section (d), but funding under such a grant shall not be 

12 divisible. 

13 ‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 

14 and upon the request of Indian Tribes, Tribal Organiza15 tions, and Urban Indian Organizations, each Service Area 

16 epidemiology center established under this subsection shall, 

17 with respect to such Service Area— 

18 ‘‘(1) collect data relating to, and monitor 

19 progress made toward meeting, each of the health sta20 tus objectives of the Service, the Indian Tribes, Tribal 

21 Organizations, and Urban Indian Organizations in 

22 the Service Area; 

23 ‘‘(2) evaluate existing delivery systems, data sys24 tems, and other systems that impact the improvement 

25 of Indian health; 


jbell on PROD1PC69 with BILLS
109 

•HR 1328 RH

1 ‘‘(3) assist Indian Tribes, Tribal Organizations, 

2 and Urban Indian Organizations in identifying their 

3 highest priority health status objectives and the serv4 ices needed to achieve such objectives, based on epide5 miological data; 

6 ‘‘(4) make recommendations for the targeting of 

7 services needed by the populations served; 

8 ‘‘(5) make recommendations to improve health 

9 care delivery systems for Indians and Urban Indians; 

10 ‘‘(6) provide requested technical assistance to In11 dian Tribes, Tribal Organizations, and Urban Indian 

12 Organizations in the development of local health serv13 ice priorities and incidence and prevalence rates of 

14 disease and other illness in the community; and 

15 ‘‘(7) provide disease surveillance and assist In16 dian Tribes, Tribal Organizations, and Urban Indian 

17 Organizations to promote public health. 

18 ‘‘(c) TECHNICAL ASSISTANCE.—The Director of the 

19 Centers for Disease Control and Prevention shall provide 

20 technical assistance to the centers in carrying out the re21 quirements of this subsection. 

22 ‘‘(d) GRANTS FOR STUDIES.— 

23 ‘‘(1) IN GENERAL.—The Secretary may make 

24 grants to Indian Tribes, Tribal Organizations, Urban 

25 Indian Organizations, and eligible intertribal conVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
110 

•HR 1328 RH

1 sortia to conduct epidemiological studies of Indian 

2 communities. 

3 ‘‘(2) ELIGIBLE INTERTRIBAL CONSORTIA.—An 

4 intertribal consortium is eligible to receive a grant 

5 under this subsection if— 

6 ‘‘(A) the intertribal consortium is incor7 porated for the primary purpose of improving 

8 Indian health; and 

9 ‘‘(B) the intertribal consortium is represent10 ative of the Indian Tribes or urban Indian com11 munities in which the intertribal consortium is 

12 located. 

13 ‘‘(3) APPLICATIONS.—An application for a grant 

14 under this subsection shall be submitted in such man15 ner and at such time as the Secretary shall prescribe. 

16 ‘‘(4) REQUIREMENTS.—An applicant for a grant 

17 under this subsection shall— 

18 ‘‘(A) demonstrate the technical, administra19 tive, and financial expertise necessary to carry 

20 out the functions described in paragraph (5); 

21 ‘‘(B) consult and cooperate with providers 

22 of related health and social services in order to 

23 avoid duplication of existing services; and 


jbell on PROD1PC69 with BILLS
111 

•HR 1328 RH

1 ‘‘(C) demonstrate cooperation from Indian 

2 tribes or Urban Indian Organizations in the 

3 area to be served. 

4 ‘‘(5) USE OF FUNDS.—A grant awarded under 

5 paragraph (1) may be used— 

6 ‘‘(A) to carry out the functions described in 

7 subsection (b); 

8 ‘‘(B) to provide information to and consult 

9 with tribal leaders, urban Indian community 

10 leaders, and related health staff on health care 

11 and health service management issues; and 

12 ‘‘(C) in collaboration with Indian Tribes, 

13 Tribal Organizations, and urban Indian com14 munities, to provide the Service with informa15 tion regarding ways to improve the health status 

16 of Indians. 

17 ‘‘(e) ACCESS TO INFORMATION.—An epidemiology cen18 ter operated by a grantee pursuant to a grant awarded 

19 under subsection (d) shall be treated as a public health au20 thority for purposes of the Health Insurance Portability 

21 and Accountability Act of 1996 (Public Law 104–191; 110 

22 Stat. 2033), as such entities are defined in part 164.501 

23 of title 45, Code of Federal Regulations (or a successor regu24 lation). The Secretary shall grant such grantees access to 

25 and use of data, data sets, monitoring systems, delivery sysVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00111 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
112 

•HR 1328 RH

1 tems, and other protected health information in the posses2 sion of the Secretary. 

3 ‘‘SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION 

4 PROGRAMS. 

5 ‘‘(a) FUNDING FOR DEVELOPMENT OF PROGRAMS.— 

6 In addition to carrying out any other program for health 

7 promotion or disease prevention, the Secretary, acting 

8 through the Service, is authorized to award grants to In9 dian Tribes, Tribal Organizations, and Urban Indian Or10 ganizations to develop comprehensive school health edu11 cation programs for children from pre-school through grade 

12 12 in schools for the benefit of Indian and Urban Indian 

13 children. 

14 ‘‘(b) USE OF GRANT FUNDS.—A grant awarded under 

15 this section may be used for purposes which may include, 

16 but are not limited to, the following: 

17 ‘‘(1) Developing health education materials both 

18 for regular school programs and afterschool programs. 

19 ‘‘(2) Training teachers in comprehensive school 

20 health education materials. 

21 ‘‘(3) Integrating school-based, community-based, 

22 and other public and private health promotion efforts. 

23 ‘‘(4) Encouraging healthy, tobacco-free school en24 vironments. 


jbell on PROD1PC69 with BILLS
113 

•HR 1328 RH

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 pro11 grams. 

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 Sec23 retary, acting through the Service, shall provide technical 

24 assistance to Indian Tribes, Tribal Organizations, and 

25 Urban Indian Organizations in the development of comVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00113 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
114 

•HR 1328 RH

1 prehensive health education plans and the dissemination of 

2 comprehensive health education materials and information 

3 on existing health programs and resources. 

4 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF APPLI5 CATIONS.—The Secretary, acting through the Service, and 

6 in consultation with Indian Tribes, Tribal Organizations, 

7 and Urban Indian Organizations, shall establish criteria 

8 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 and 

14 in cooperation with the Secretary, acting through the 

15 Service, and affected Indian Tribes and Tribal Orga16 nizations, shall develop a comprehensive school health 

17 education program for children from preschool 

18 through grade 12 in schools for which support is pro19 vided 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; 


jbell on PROD1PC69 with BILLS
115 

•HR 1328 RH

1 ‘‘(D) substance abuse prevention programs; 

2 ‘‘(E) injury prevention and safety education 

3 programs; and 

4 ‘‘(F) activities for the prevention and con5 trol of communicable diseases. 

6 ‘‘(3) DUTIES OF THE SECRETARY.—The Sec7 retary of the Interior shall— 

8 ‘‘(A) provide training to teachers in com9 prehensive school health education materials; 

10 ‘‘(B) ensure the integration and coordina11 tion of school-based programs with existing serv12 ices and health programs available in the com13 munity; and 

14 ‘‘(C) encourage healthy, tobacco-free school 

15 environments. 

16 ‘‘SEC. 211. INDIAN YOUTH PROGRAM. 

17 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 

18 through the Service, is authorized to establish and admin19 ister a program to provide grants to Indian Tribes, Tribal 

20 Organizations, and Urban Indian Organizations for inno21 vative mental and physical disease prevention and health 

22 promotion and treatment programs for Indian and Urban 

23 Indian preadolescent and adolescent youths. 

24 ‘‘(b) USE OF FUNDS.— 


jbell on PROD1PC69 with BILLS
116 

•HR 1328 RH

1 ‘‘(1) ALLOWABLE USES.—Funds made available 

2 under this section may be used to— 

3 ‘‘(A) develop prevention and treatment pro4 grams for Indian youth which promote mental 

5 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 services 

12 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 mod21 els; 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. 


jbell on PROD1PC69 with BILLS
117 

•HR 1328 RH

1 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF APPLI2 CATIONS.—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 Centers 

10 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 programs 

19 for the prevention, control, and elimination of com20 municable 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 profes25 sionals. 


jbell on PROD1PC69 with BILLS
118 

•HR 1328 RH

1 ‘‘(4) Demonstration projects for the screening, 

2 treatment, and prevention of hepatitis C virus (HCV). 

3 ‘‘(b) APPLICATION REQUIRED.—The Secretary may 

4 provide funding under subsection (a) only if an application 

5 or proposal for funding is submitted to the Secretary. 

6 ‘‘(c) COORDINATION WITH HEALTH AGENCIES.—In7 dian Tribes, Tribal Organizations, and Urban Indian Or8 ganizations receiving funding under this section are encour9 aged to coordinate their activities with the Centers for Dis10 ease Control and Prevention and State and local health 

11 agencies. 

12 ‘‘(d) TECHNICAL ASSISTANCE; REPORT.—In carrying 

13 out this section, the Secretary— 

14 ‘‘(1) may, at the request of an Indian Tribe, 

15 Tribal Organization, or Urban Indian Organization, 

16 provide technical assistance; and 

17 ‘‘(2) shall prepare and submit a report to Con18 gress biennially on the use of funds under this section 

19 and on the progress made toward the prevention, con20 trol, and elimination of communicable and infectious 

21 diseases among Indians and Urban Indians. 

22 ‘‘SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERV23 ICES. 

24 ‘‘(a) FUNDING AUTHORIZED.—The Secretary, acting 

25 through the Service, Indian Tribes, and Tribal OrganizaVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00118 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
119 

•HR 1328 RH

1 tions, may provide funding under this Act to meet the objec2 tives set forth in section 3 through health care-related serv3 ices and programs not otherwise described in this Act, in4 cluding— 

5 ‘‘(1) hospice care; 

6 ‘‘(2) assisted living; 

7 ‘‘(3) long-term care; and 

8 ‘‘(4) home- and community-based services. 

9 ‘‘(b) TERMS AND CONDITIONS.— 

10 ‘‘(1) IN GENERAL.—Any service provided under 

11 this section shall be in accordance with such terms 

12 and conditions as are consistent with accepted and 

13 appropriate standards relating to the service, includ14 ing any licensing term or condition under this Act. 

15 ‘‘(2) STANDARDS.— 

16 ‘‘(A) IN GENERAL.—The Secretary may es17 tablish, by regulation, the standards for a service 

18 provided under this section, provided that such 

19 standards shall not be more stringent than the 

20 standards required by the State in which the 

21 service is provided. 

22 ‘‘(B) USE OF STATE STANDARDS.—If the 

23 Secretary does not, by regulation, establish 

24 standards for a service provided under this sec25 tion, the standards required by the State in 


jbell on PROD1PC69 with BILLS
120 

•HR 1328 RH

1 which the service is or will be provided shall 

2 apply to such service. 

3 ‘‘(C) INDIAN TRIBES.—If a service under 

4 this section is provided by an Indian Tribe or 

5 Tribal Organization pursuant to the Indian 

6 Self-Determination and Education Assistance 

7 Act (25 U.S.C. 450 et seq.), the verification by 

8 the Secretary that the service meets any stand9 ards required by the State in which the service 

10 is or will be provided shall be considered to meet 

11 the terms and conditions required under this 

12 subsection. 

13 ‘‘(3) ELIGIBILITY.—The following individuals 

14 shall be eligible to receive long-term care under this 

15 section: 

16 ‘‘(A) Individuals who are unable to perform 

17 a certain number of activities of daily living 

18 without assistance. 

19 ‘‘(B) Individuals with a mental impair20 ment, such as dementia, Alzheimer’s disease, or 

21 another disabling mental illness, who may be 

22 able to perform activities of daily living under 

23 supervision. 


jbell on PROD1PC69 with BILLS
121 

•HR 1328 RH

1 ‘‘(C) Such other individuals as an applica2 ble Indian Health Program determines to be ap3 propriate. 

4 ‘‘(c) DEFINITIONS.—For the purposes of this section, 

5 the following definitions shall apply: 

6 ‘‘(1) The term ‘home- and community-based serv7 ices’ means 1 or more of the services specified in 

8 paragraphs (1) through (9) of section 1929(a) of the 

9 Social Security Act (42 U.S.C. 1396t(a)) (whether 

10 provided by the Service or by an Indian Tribe or 

11 Tribal Organization pursuant to the Indian Self-De12 termination and Education Assistance Act (25 U.S.C. 

13 450 et seq.)) that are or will be provided in accord14 ance with the standards described in subsection (b). 

15 ‘‘(2) The term ‘hospice care’ means the items and 

16 services specified in subparagraphs (A) through (H) 

17 of section 1861(dd)(1) of the Social Security Act (42 

18 U.S.C. 1395x(dd)(1)), and such other services which 

19 an Indian Tribe or Tribal Organization determines 

20 are necessary and appropriate to provide in further21 ance of this care. 

22 ‘‘SEC. 214. INDIAN WOMEN’S HEALTH CARE. 

23 ‘‘The Secretary, acting through the Service and Indian 

24 Tribes, Tribal Organizations, and Urban Indian Organiza25 tions, shall monitor and improve the quality of health care 


jbell on PROD1PC69 with BILLS
122 

•HR 1328 RH

1 for Indian women of all ages through the planning and de2 livery of programs administered by the Service, in order 

3 to improve and enhance the treatment models of care for 

4 Indian women. 

5 ‘‘SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZ6 ARDS. 

7 ‘‘(a) STUDIES AND MONITORING.—The Secretary and 

8 the Service shall conduct, in conjunction with other appro9 priate Federal agencies and in consultation with concerned 

10 Indian Tribes and Tribal Organizations, studies and ongo11 ing monitoring programs to determine trends in the health 

12 hazards to Indian miners and to Indians on or near res13 ervations and Indian communities as a result of environ14 mental hazards which may result in chronic or life threat15 ening health problems, such as nuclear resource develop16 ment, petroleum contamination, and contamination of 

17 water source and of the food chain. Such studies shall in18 clude— 

19 ‘‘(1) an evaluation of the nature and extent of 

20 health problems caused by environmental hazards cur21 rently exhibited among Indians and the causes of such 

22 health problems; 

23 ‘‘(2) an analysis of the potential effect of ongoing 

24 and future environmental resource development on or 


jbell on PROD1PC69 with BILLS
123 

•HR 1328 RH

1 near reservations and Indian communities, including 

2 the cumulative effect over time on health; 

3 ‘‘(3) an evaluation of the types and nature of ac4 tivities, practices, and conditions causing or affecting 

5 such health problems, including uranium mining and 

6 milling, uranium mine tailing deposits, nuclear 

7 power plant operation and construction, and nuclear 

8 waste disposal; oil and gas production or transpor9 tation on or near reservations or Indian commu10 nities; and other development that could affect the 

11 health of Indians and their water supply and food 

12 chain; 

13 ‘‘(4) a summary of any findings and rec14 ommendations provided in Federal and State studies, 

15 reports, investigations, and inspections during the 5 

16 years prior to the date of enactment of the Indian 

17 Health Care Improvement Act Amendments of 2007 

18 that directly or indirectly relate to the activities, 

19 practices, and conditions affecting the health or safety 

20 of such Indians; and 

21 ‘‘(5) the efforts that have been made by Federal 

22 and State agencies and resource and economic devel23 opment companies to effectively carry out an edu24 cation program for such Indians regarding the health 

25 and safety hazards of such development. 


jbell on PROD1PC69 with BILLS
124 

•HR 1328 RH

1 ‘‘(b) HEALTH CARE PLANS.—Upon completion of such 

2 studies, the Secretary and the Service shall take into ac3 count the results of such studies and develop health care 

4 plans to address the health problems studied under sub5 section (a). The plans shall include— 

6 ‘‘(1) methods for diagnosing and treating Indi7 ans currently exhibiting such health problems; 

8 ‘‘(2) preventive care and testing for Indians who 

9 may be exposed to such health hazards, including the 

10 monitoring of the health of individuals who have or 

11 may have been exposed to excessive amounts of radi12 ation or affected by other activities that have had or 

13 could have a serious impact upon the health of such 

14 individuals; and 

15 ‘‘(3) a program of education for Indians who, by 

16 reason of their work or geographic proximity to such 

17 nuclear or other development activities, may experi18 ence health problems. 

19 ‘‘(c) SUBMISSION OF REPORT AND PLAN TO CON20 GRESS.—The Secretary and the Service shall submit to 

21 Congress the study prepared under subsection (a) no later 

22 than 18 months after the date of enactment of the Indian 

23 Health Care Improvement Act Amendments of 2007. The 

24 health care plan prepared under subsection (b) shall be sub25 mitted in a report no later than 1 year after the study preVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00124 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
125 

•HR 1328 RH

1 pared under subsection (a) is submitted to Congress. Such 

2 report shall include recommended activities for the imple3 mentation of the plan, as well as an evaluation of any ac4 tivities previously undertaken by the Service to address such 

5 health problems. 

6 ‘‘(d) INTERGOVERNMENTAL TASK FORCE.— 

7 ‘‘(1) ESTABLISHMENT; MEMBERS.—There is es8 tablished an Intergovernmental Task Force to be com9 posed of the following individuals (or their designees): 

10 ‘‘(A) The Secretary of Energy. 

11 ‘‘(B) The Secretary of the Environmental 

12 Protection Agency. 

13 ‘‘(C) The Director of the Bureau of Mines. 

14 ‘‘(D) The Assistant Secretary for Occupa15 tional Safety and Health. 

16 ‘‘(E) The Secretary of the Interior. 

17 ‘‘(F) The Secretary of Health and Human 

18 Services. 

19 ‘‘(G) The Director of the Indian Health 

20 Service. 

21 ‘‘(2) DUTIES.—The Task Force shall— 

22 ‘‘(A) identify existing and potential oper23 ations related to nuclear resource development or 

24 other environmental hazards that affect or may 


jbell on PROD1PC69 with BILLS
126 

•HR 1328 RH

1 affect the health of Indians on or near a reserva2 tion or in an Indian community; and 

3 ‘‘(B) enter into activities to correct existing 

4 health hazards and ensure that current and fu5 ture health problems resulting from nuclear re6 source or other development activities are mini7 mized or reduced. 

8 ‘‘(3) CHAIRMAN; MEETINGS.—The Secretary of 

9 Health and Human Services shall be the Chairman 

10 of the Task Force. The Task Force shall meet at least 

11 twice each year. 

12 ‘‘(e) HEALTH SERVICES TO CERTAIN EMPLOYEES.— 

13 In the case of any Indian who— 

14 ‘‘(1) as a result of employment in or near a ura15 nium mine or mill or near any other environmental 

16 hazard, suffers from a work-related illness or condi17 tion; 

18 ‘‘(2) is eligible to receive diagnosis and treatment 

19 services from an Indian Health Program; and 

20 ‘‘(3) by reason of such Indian’s employment, is 

21 entitled to medical care at the expense of such mine 

22 or mill operator or entity responsible for the environ23 mental hazard, the Indian Health Program shall, at 

24 the request of such Indian, render appropriate med25 ical care to such Indian for such illness or condition 


jbell on PROD1PC69 with BILLS
127 

•HR 1328 RH

1 and may be reimbursed for any medical care so ren2 dered to which such Indian is entitled at the expense 

3 of such operator or entity from such operator or enti4 ty. Nothing in this subsection shall affect the rights 

5 of such Indian to recover damages other than such 

6 amounts paid to the Indian Health Program from the 

7 employer for providing medical care for such illness 

8 or condition. 

9 ‘‘SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DE10 LIVERY AREA. 

11 ‘‘(a) IN GENERAL.—For fiscal years beginning with 

12 the fiscal year ending September 30, 1983, and ending with 

13 the fiscal year ending September 30, 2016, the State of Ari14 zona shall be designated as a contract health service delivery 

15 area by the Service for the purpose of providing contract 

16 health care services to members of federally recognized In17 dian Tribes of Arizona. 

18 ‘‘(b) MAINTENANCE OF SERVICES.—The Service shall 

19 not curtail any health care services provided to Indians re20 siding on reservations in the State of Arizona if such cur21 tailment is due to the provision of contract services in such 

22 State pursuant to the designation of such State as a con23 tract health service delivery area pursuant to subsection (a). 


jbell on PROD1PC69 with BILLS
128 

•HR 1328 RH

1 ‘‘SEC. 217. NORTH DAKOTA AND SOUTH DAKOTA AS CON2 TRACT HEALTH SERVICE DELIVERY AREA. 

3 ‘‘(a) IN GENERAL.—Beginning in fiscal year 2003, the 

4 States of North Dakota and South Dakota shall be des5 ignated as a contract health service delivery area by the 

6 Service for the purpose of providing contract health care 

7 services to members of federally recognized Indian Tribes 

8 of North Dakota and South Dakota. 

9 ‘‘(b) LIMITATION.—The Service shall not curtail any 

10 health care services provided to Indians residing on any 

11 reservation, or in any county that has a common boundary 

12 with any reservation, in the State of North Dakota or South 

13 Dakota if such curtailment is due to the provision of con14 tract services in such States pursuant to the designation 

15 of such States as a contract health service delivery area pur16 suant to subsection (a). 

17 ‘‘SEC. 218. CALIFORNIA CONTRACT HEALTH SERVICES PRO18 GRAM. 

19 ‘‘(a) FUNDING AUTHORIZED.—The Secretary is au20 thorized to fund a program using the California Rural In21 dian Health Board (hereafter in this section referred to as 

22 the ‘CRIHB’) as a contract care intermediary to improve 

23 the accessibility of health services to California Indians. 

24 ‘‘(b) REIMBURSEMENT CONTRACT.—The Secretary 

25 shall enter into an agreement with the CRIHB to reimburse 

26 the CRIHB for costs (including reasonable administrative 


jbell on PROD1PC69 with BILLS
129 

•HR 1328 RH

1 costs) incurred pursuant to this section, in providing med2 ical treatment under contract to California Indians de3 scribed in section 806(a) throughout the California contract 

4 health services delivery area described in section 218 with 

5 respect to high cost contract care cases. 

6 ‘‘(c) ADMINISTRATIVE EXPENSES.—Not more than 5 

7 percent of the amounts provided to the CRIHB under this 

8 section for any fiscal year may be for reimbursement for 

9 administrative expenses incurred by the CRIHB during 

10 such fiscal year. 

11 ‘‘(d) LIMITATION ON PAYMENT.—No payment may be 

12 made for treatment provided hereunder to the extent pay13 ment may be made for such treatment under the Indian 

14 Catastrophic Health Emergency Fund described in section 

15 202 or from amounts appropriated or otherwise made 

16 available to the California contract health service delivery 

17 area for a fiscal year. 

18 ‘‘(e) ADVISORY BOARD.—There is established an advi19 sory board which shall advise the CRIHB in carrying out 

20 this section. The advisory board shall be composed of rep21 resentatives, selected by the CRIHB, from not less than 8 

22 Tribal Health Programs serving California Indians covered 

under this section at least 1 23 ⁄2 of whom of whom are not 

24 affiliated with the CRIHB. 


jbell on PROD1PC69 with BILLS
130 

•HR 1328 RH

1 ‘‘SEC. 219. CALIFORNIA AS A CONTRACT HEALTH SERVICE 

2 DELIVERY AREA. 

3 ‘‘The State of California, excluding the counties of Ala4 meda, Contra Costa, Los Angeles, Marin, Orange, Sac5 ramento, San Francisco, San Mateo, Santa Clara, Kern, 

6 Merced, Monterey, Napa, San Benito, San Joaquin, San 

7 Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ventura, 

8 shall be designated as a contract health service delivery area 

9 by the Service for the purpose of providing contract health 

10 services to California Indians. However, any of the counties 

11 listed herein may only be included in the contract health 

12 services delivery area if funding is specifically provided by 

13 the Service for such services in those counties. 

14 ‘‘SEC. 220. CONTRACT HEALTH SERVICES FOR THE TREN15 TON SERVICE AREA. 

16 ‘‘(a) AUTHORIZATION FOR SERVICES.—The Secretary, 

17 acting through the Service, is directed to provide contract 

18 health services to members of the Turtle Mountain Band 

19 of Chippewa Indians that reside in the Trenton Service 

20 Area of Divide, McKenzie, and Williams counties in the 

21 State of North Dakota and the adjoining counties of Rich22 land, Roosevelt, and Sheridan in the State of Montana. 

23 ‘‘(b) NO EXPANSION OF ELIGIBILITY.—Nothing in this 

24 section may be construed as expanding the eligibility of 

25 members of the Turtle Mountain Band of Chippewa Indians 

26 for health services provided by the Service beyond the scope 


jbell on PROD1PC69 with BILLS
131 

•HR 1328 RH

1 of eligibility for such health services that applied on May 

2 1, 1986. 

3 ‘‘SEC. 221. PROGRAMS OPERATED BY INDIAN TRIBES AND 

4 TRIBAL ORGANIZATIONS. 

5 ‘‘The Service shall provide funds for health care pro6 grams and facilities operated by Tribal Health Programs 

7 on the same basis as such funds are provided to programs 

8 and facilities operated directly by the Service. 

9 ‘‘SEC. 222. LICENSING. 

10 ‘‘Health care professionals employed by a Tribal 

11 Health Program shall, if licensed in any State, be exempt 

12 from the licensing requirements of the State in which the 

13 Tribal Health Program performs the services described in 

14 its contract or compact under the Indian Self-Determina15 tion and Education Assistance Act (25 U.S.C. 450 et seq.). 

16 ‘‘SEC. 223. NOTIFICATION OF PROVISION OF EMERGENCY 

17 CONTRACT HEALTH SERVICES. 

18 ‘‘With respect to an elderly Indian or an Indian with 

19 a disability receiving emergency medical care or services 

20 from a non-Service provider or in a non-Service facility 

21 under the authority of this Act, the time limitation (as a 

22 condition of payment) for notifying the Service of such 

23 treatment or admission shall be 30 days. 


jbell on PROD1PC69 with BILLS
132 

•HR 1328 RH

1 ‘‘SEC. 224. PROMPT ACTION ON PAYMENT OF CLAIMS. 

2 ‘‘(a) DEADLINE FOR RESPONSE.—The Service shall re3 spond to a notification of a claim by a provider of a con4 tract care service with either an individual purchase order 

5 or a denial of the claim within 5 working days after the 

6 receipt of such notification. 

7 ‘‘(b) EFFECT OF UNTIMELY RESPONSE.—If the Service 

8 fails to respond to a notification of a claim in accordance 

9 with subsection (a), the Service shall accept as valid the 

10 claim submitted by the provider of a contract care service. 

11 ‘‘(c) DEADLINE FOR PAYMENT OF VALID CLAIM.—The 

12 Service shall pay a valid contract care service claim within 

13 30 days after the completion of the claim. 

14 ‘‘SEC. 225. LIABILITY FOR PAYMENT. 

15 ‘‘(a) NO PATIENT LIABILITY.—A patient who receives 

16 contract health care services that are authorized by the 

17 Service shall not be liable for the payment of any charges 

18 or costs associated with the provision of such services. 

19 ‘‘(b) NOTIFICATION.—The Secretary shall notify a con20 tract care provider and any patient who receives contract 

21 health care services authorized by the Service that such pa22 tient is not liable for the payment of any charges or costs 

23 associated with the provision of such services not later than 

24 5 business days after receipt of a notification of a claim 

25 by a provider of contract care services. 


jbell on PROD1PC69 with BILLS
133 

•HR 1328 RH

1 ‘‘(c) NO RECOURSE.—Following receipt of the notice 

2 provided under subsection (b), or, if a claim has been 

3 deemed accepted under section 223(b), the provider shall 

4 have no further recourse against the patient who received 

5 the services. 

6 ‘‘SEC. 226. OFFICE OF INDIAN MEN’S HEALTH. 

7 ‘‘(a) ESTABLISHMENT.—The Secretary may establish 

8 within the Service an office to be known as the ‘Office of 

9 Indian Men’s Health’ (referred to in this section as the ‘Of10 fice’). 

11 ‘‘(b) DIRECTOR.— 

12 ‘‘(1) IN GENERAL.—The Office shall be headed by 

13 a director, to be appointed by the Secretary. 

14 ‘‘(2) DUTIES.—The director shall coordinate and 

15 promote the status of the health of Indian men in the 

16 United States. 

17 ‘‘(c) REPORT.—Not later than 2 years after the date 

18 of enactment of the Indian Health Care Improvement Act 

19 Amendments of 2007, the Secretary, acting through the di20 rector of the Office, shall submit to Congress a report de21 scribing— 

22 ‘‘(1) any activity carried out by the director as 

23 of the date on which the report is prepared; and 

24 ‘‘(2) any finding of the director with respect to 

25 the health of Indian men. 


jbell on PROD1PC69 with BILLS
134 

•HR 1328 RH

1 ‘‘SEC. 227. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘There are authorized to be appropriated such sums 

3 as may be necessary for each fiscal year through fiscal year 

4 2017 to carry out this title. 

5 ‘‘TITLE III—FACILITIES 

6 ‘‘SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVA7 TION OF FACILITIES; REPORTS. 

8 ‘‘(a) PREREQUISITES FOR EXPENDITURE OF

9 FUNDS.—Prior to the expenditure of, or the making of any 

10 binding commitment to expend, any funds appropriated for 

11 the planning, design, construction, or renovation of facili12 ties pursuant to the Act of November 2, 1921 (25 U.S.C. 

13 13) (commonly known as the ‘Snyder Act’), the Secretary, 

14 acting through the Service, shall— 

15 ‘‘(1) consult with any Indian Tribe that would 

16 be significantly affected by such expenditure for the 

17 purpose of determining and, whenever practicable, 

18 honoring tribal preferences concerning size, location, 

19 type, and other characteristics of any facility on 

20 which such expenditure is to be made; and 

21 ‘‘(2) ensure, whenever practicable and applicable, 

22 that such facility meets the construction standards of 

23 any accrediting body recognized by the Secretary for 

24 the purposes of the Medicare, Medicaid, and SCHIP 

25 programs under titles XVIII, XIX, and XXI of the 

26 Social Security Act by not later than 1 year after the 


jbell on PROD1PC69 with BILLS
135 

•HR 1328 RH

1 date on which the construction or renovation of such 

2 facility is completed. 

3 ‘‘(b) CLOSURES.— 

4 ‘‘(1) EVALUATION REQUIRED.—Notwithstanding 

5 any other provision of law, no facility operated by the 

6 Service, or any portion of such facility, may be closed 

7 if the Secretary has not submitted to Congress, not 

8 less than 1 year and not more than 2 years before the 

9 date of the proposed closure, an evaluation, completed 

10 not more than 2 years before such submission, of the 

11 impact of the proposed closure that specifies, in addi12 tion to other considerations— 

13 ‘‘(A) the accessibility of alternative health 

14 care resources for the population served by such 

15 facility; 

16 ‘‘(B) the cost-effectiveness of such closure; 

17 ‘‘(C) the quality of health care to be pro18 vided to the population served by such facility 

19 after such closure; 

20 ‘‘(D) the availability of contract health care 

21 funds to maintain existing levels of service; 

22 ‘‘(E) the views of the Indian Tribes served 

23 by such facility concerning such closure; 

24 ‘‘(F) the level of use of such facility by all 

25 eligible Indians; and 


jbell on PROD1PC69 with BILLS
136 

•HR 1328 RH

1 ‘‘(G) the distance between such facility and 

2 the nearest operating Service hospital. 

3 ‘‘(2) EXCEPTION FOR CERTAIN TEMPORARY CLO4 SURES.—Paragraph (1) shall not apply to any tem5 porary closure of a facility or any portion of a facil6 ity if such closure is necessary for medical, environ7 mental, or construction safety reasons. 

8 ‘‘(c) HEALTH CARE FACILITY PRIORITY SYSTEM.— 

9 ‘‘(1) IN GENERAL.— 

10 ‘‘(A) PRIORITY SYSTEM.—The Secretary, 

11 acting through the Service, shall maintain a 

12 health care facility priority system, which— 

13 ‘‘(i) shall be developed in consultation 

14 with Indian Tribes and Tribal Organiza15 tions; 

16 ‘‘(ii) shall give Indian Tribes’ needs 

17 the highest priority; 

18 ‘‘(iii)(I) may include the lists required 

19 in paragraph (2)(B)(ii); and 

20 ‘‘(II) shall include the methodology re21 quired in paragraph (2)(B)(v); and 

22 ‘‘(III) may include such other facili23 ties, and such renovation or expansion 

24 needs of any health care facility, as the 


jbell on PROD1PC69 with BILLS
137 

•HR 1328 RH

1 Service, Indian Tribes, and Tribal Organi2 zations may identify; and 

3 ‘‘(iv) shall provide an opportunity for 

4 the nomination of planning, design, and 

5 construction projects by the Service, Indian 

6 Tribes, and Tribal Organizations for con7 sideration under the priority system at least 

8 once every 3 years, or more frequently as 

9 the Secretary determines to be appropriate. 

10 ‘‘(B) NEEDS OF FACILITIES UNDER ISDEAA

11 AGREEMENTS.—The Secretary shall ensure that 

12 the planning, design, construction, renovation, 

13 and expansion needs of Service and non-Service 

14 facilities operated under contracts or compacts 

15 in accordance with the Indian Self-Determina16 tion and Education Assistance Act (25 U.S.C. 

17 450 et seq.) are fully and equitably integrated 

18 into the health care facility priority system. 

19 ‘‘(C) CRITERIA FOR EVALUATING NEEDS.— 

20 For purposes of this subsection, the Secretary, in 

21 evaluating the needs of facilities operated under 

22 a contract or compact under the Indian Self-De23 termination and Education Assistance Act (25 

24 U.S.C. 450 et seq.), shall use the criteria used by 


jbell on PROD1PC69 with BILLS
138 

•HR 1328 RH

1 the Secretary in evaluating the needs of facilities 

2 operated directly by the Service. 

3 ‘‘(D) PRIORITY OF CERTAIN PROJECTS PRO4 TECTED.—The priority of any project established 

5 under the construction priority system in effect 

6 on the date of enactment of the Indian Health 

7 Care Improvement Act Amendments of 2007 

8 shall not be affected by any change in the con9 struction priority system taking place after that 

10 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 system 

23 in effect on the date of enactment of such 

24 Act; or 


jbell on PROD1PC69 with BILLS
139 

•HR 1328 RH

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 of 

16 12 members representing Indian tribes 

17 and 2 members representing the Serv18 ice, established at the discretion of the 

19 Assistant Secretary— 

20 ‘‘(aa) to provide advice and 

21 recommendations for policies and 

22 procedures of the programs funded 

23 pursuant to facilities appropria24 tions; and 


jbell on PROD1PC69 with BILLS
140 

•HR 1328 RH

1 ‘‘(bb) to address other facili2 ties issues. 

3 ‘‘(II) FACILITIES NEEDS ASSESS4 MENT WORKGROUP.—The term ‘Facili5 ties Needs Assessment Workgroup’ 

6 means the workgroup established at the 

7 discretion of the Assistant Secretary— 

8 ‘‘(aa) to review the health 

9 care facilities construction pri10 ority system; and 

11 ‘‘(bb) to make recommenda12 tions to the Facilities Appropria13 tion Advisory Board for revising 

14 the priority system. 

15 ‘‘(ii) INITIAL REPORT.— 

16 ‘‘(I) IN GENERAL.—Not later than 

17 1 year after the date of enactment of 

18 the Indian Health Care Improvement 

19 Act Amendments of 2007, the Secretary 

20 shall submit to the Committee on In21 dian Affairs of the Senate and the 

22 Committee on Natural Resources of the 

23 House of Representatives a report that 

24 describes the comprehensive, national, 

25 ranked list of all health care facilities 


jbell on PROD1PC69 with BILLS
141 

•HR 1328 RH

1 needs for the Service, Indian Tribes, 

2 and Tribal Organizations (including 

3 inpatient health care facilities, out4 patient health care facilities, special5 ized health care facilities (such as for 

6 long-term care and alcohol and drug 

7 abuse treatment), wellness centers, staff 

8 quarters and hostels associated with 

9 health care facilities, and the renova10 tion and expansion needs, if any, of 

11 such facilities) developed by the Serv12 ice, Indian Tribes, and Tribal Organi13 zations for the Facilities Needs Assess14 ment Workgroup and the Facilities Ap15 propriation Advisory Board. 

16 ‘‘(II) INCLUSIONS.—The initial 

17 report shall include— 

18 ‘‘(aa) the methodology and 

19 criteria used by the Service in de20 termining the needs and estab21 lishing the ranking of the facili22 ties needs; and 

23 ‘‘(bb) such other information 

24 as the Secretary determines to be 

25 appropriate. 


jbell on PROD1PC69 with BILLS
142 

•HR 1328 RH

1 ‘‘(iii) UPDATES OF REPORT.—Begin2 ning in calendar year 2011, the Secretary 

3 shall— 

4 ‘‘(I) update the report under 

5 clause (ii) not less frequently that once 

6 every 5 years; and 

7 ‘‘(II) include the updated report 

8 in the appropriate annual report 

9 under subparagraph (B) for submis10 sion to Congress under section 801. 

11 ‘‘(B) ANNUAL REPORTS.—The Secretary 

12 shall submit to the President, for inclusion in the 

13 report required to be transmitted to Congress 

14 under section 801, a report which sets forth the 

15 following: 

16 ‘‘(i) A description of the health care fa17 cility priority system of the Service estab18 lished under paragraph (1). 

19 ‘‘(ii) Health care facilities lists, which 

20 may include— 

21 ‘‘(I) the 10 top-priority inpatient 

22 health care facilities; 

23 ‘‘(II) the 10 top-priority out24 patient health care facilities; 


jbell on PROD1PC69 with BILLS
143 

•HR 1328 RH

1 ‘‘(III) the 10 top-priority special2 ized health care facilities (such as long3 term care and alcohol and drug abuse 

4 treatment); 

5 ‘‘(IV) the 10 top-priority staff 

6 quarters developments associated with 

7 health care facilities; and 

8 ‘‘(V) the 10 top-priority hostels 

9 associated with health care facilities. 

10 ‘‘(iii) The justification for such order 

11 of priority. 

12 ‘‘(iv) The projected cost of such 

13 projects. 

14 ‘‘(v) The methodology adopted by the 

15 Service in establishing priorities under its 

16 health care facility priority system. 

17 ‘‘(3) REQUIREMENTS FOR PREPARATION OF RE18 PORTS.—In preparing the report required under 

19 paragraph (2), the Secretary shall— 

20 ‘‘(A) consult with and obtain information 

21 on all health care facilities needs from Indian 

22 Tribes, Tribal Organizations, and Urban Indian 

23 Organizations; and 

24 ‘‘(B) review the total unmet needs of all In25 dian Tribes, Tribal Organizations, and Urban 


jbell on PROD1PC69 with BILLS
144 

•HR 1328 RH

1 Indian Organizations for health care facilities 

2 (including hostels and staff quarters), including 

3 needs for renovation and expansion of existing 

4 facilities. 

5 ‘‘(d) REVIEW OF METHODOLOGY USED FOR HEALTH

6 FACILITIES CONSTRUCTION PRIORITY SYSTEM.— 

7 ‘‘(1) IN GENERAL.—Not later than 1 year after 

8 the establishment of the priority system under sub9 section (c)(1)(A), the Comptroller General of the 

10 United States shall prepare and finalize a report re11 viewing the methodologies applied, and the processes 

12 followed, by the Service in making each assessment of 

13 needs for the list under subsection (c)(2)(A)(ii) and 

14 developing the priority system under subsection 

15 (c)(1), including a review of— 

16 ‘‘(A) the recommendations of the Facilities 

17 Appropriation Advisory Board and the Facili18 ties Needs Assessment Workgroup (as those terms 

19 are defined in subsection (c)(2)(A)(i)); and 

20 ‘‘(B) the relevant criteria used in ranking 

21 or prioritizing facilities other than hospitals or 

22 clinics. 

23 ‘‘(2) SUBMISSION TO CONGRESS.—The Comp24 troller General of the United States shall submit the 

25 report under paragraph (1) to— 


jbell on PROD1PC69 with BILLS
145 

•HR 1328 RH

1 ‘‘(A) the Committees on Indian Affairs and 

2 Appropriations of the Senate; 

3 ‘‘(B) the Committees on Natural Resources 

4 and Appropriations of the House of Representa5 tives; and 

6 ‘‘(C) the Secretary. 

7 ‘‘(e) FUNDING CONDITION.—All funds appropriated 

8 under the Act of November 2, 1921 (25 U.S.C. 13) (com9 monly known as the ‘Snyder Act’), for the planning, design, 

10 construction, or renovation of health facilities for the benefit 

11 of 1 or more Indian Tribes shall be subject to the provisions 

12 of the Indian Self-Determination and Education Assistance 

13 Act (25 U.S.C. 450 et seq.). 

14 ‘‘(f) DEVELOPMENT OF INNOVATIVE APPROACHES.— 

15 The Secretary shall consult and cooperate with Indian 

16 Tribes, Tribal Organizations, and Urban Indian Organiza17 tions in developing innovative approaches to address all or 

18 part of the total unmet need for construction of health facili19 ties, including those provided for in other sections of this 

20 title and other approaches. 

21 ‘‘SEC. 302. SANITATION FACILITIES. 

22 ‘‘(a) FINDINGS.—Congress finds the following: 

23 ‘‘(1) The provision of sanitation facilities is pri24 marily a health consideration and function. 


jbell on PROD1PC69 with BILLS
146 

•HR 1328 RH

1 ‘‘(2) Indian people suffer an inordinately high 

2 incidence of disease, injury, and illness directly at3 tributable to the absence or inadequacy of sanitation 

4 facilities. 

5 ‘‘(3) The long-term cost to the United States of 

6 treating and curing such disease, injury, and illness 

7 is substantially greater than the short-term cost of 

8 providing sanitation facilities and other preventive 

9 health measures. 

10 ‘‘(4) Many Indian homes and Indian commu11 nities still lack sanitation facilities. 

12 ‘‘(5) It is in the interest of the United States, 

13 and it is the policy of the United States, that all In14 dian communities and Indian homes, new and exist15 ing, be provided with sanitation facilities. 

16 ‘‘(b) FACILITIES AND SERVICES.—In furtherance of the 

17 findings made in subsection (a), Congress reaffirms the pri18 mary responsibility and authority of the Service to provide 

19 the necessary sanitation facilities and services as provided 

20 in section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a). 

21 Under such authority, the Secretary, acting through the 

22 Service, is authorized to provide the following: 

23 ‘‘(1) Financial and technical assistance to In24 dian Tribes, Tribal Organizations, and Indian com25 munities in the establishment, training, and equipVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00146 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
147 

•HR 1328 RH

1 ping of utility organizations to operate and maintain 

2 sanitation facilities, including the provision of exist3 ing plans, standard details, and specifications avail4 able in the Department, to be used at the option of 

5 the Indian Tribe, Tribal Organization, or Indian 

6 community. 

7 ‘‘(2) Ongoing technical assistance and training 

8 to Indian Tribes, Tribal Organizations, and Indian 

9 communities in the management of utility organiza10 tions which operate and maintain sanitation facili11 ties. 

12 ‘‘(3) Priority funding for operation and mainte13 nance assistance for, and emergency repairs to, sani14 tation facilities operated by an Indian Tribe, Tribal 

15 Organization or Indian community when necessary 

16 to avoid an imminent health threat or to protect the 

17 investment in sanitation facilities and the investment 

18 in the health benefits gained through the provision of 

19 sanitation facilities. 

20 ‘‘(c) FUNDING.—Notwithstanding any other provision 

21 of law— 

22 ‘‘(1) the Secretary of Housing and Urban Devel23 opment is authorized to transfer funds appropriated 

24 under the Native American Housing Assistance and 


jbell on PROD1PC69 with BILLS
148 

•HR 1328 RH

1 Self-Determination Act of 1996 (25 U.S.C. 4101 et 

2 seq.) to the Secretary of Health and Human Services; 

3 ‘‘(2) the Secretary of Health and Human Serv4 ices is authorized to accept and use such funds for the 

5 purpose of providing sanitation facilities and services 

6 for Indians under section 7 of the Act of August 5, 

7 1954 (42 U.S.C. 2004a); 

8 ‘‘(3) unless specifically authorized when funds 

9 are appropriated, the Secretary shall not use funds 

10 appropriated under section 7 of the Act of August 5, 

11 1954 (42 U.S.C. 2004a), to provide sanitation facili12 ties to new homes constructed using funds provided by 

13 the Department of Housing and Urban Development; 

14 ‘‘(4) the Secretary of Health and Human Serv15 ices is authorized to accept from any source, includ16 ing Federal and State agencies, funds for the purpose 

17 of providing sanitation facilities and services and 

18 place these funds into contracts or compacts under the 

19 Indian Self-Determination and Education Assistance 

20 Act (25 U.S.C. 450 et seq.); 

21 ‘‘(5) except as otherwise prohibited by this sec22 tion, the Secretary may use funds appropriated under 

23 the authority of section 7 of the Act of August 5, 1954 

24 (42 U.S.C. 2004a), to fund up to 100 percent of the 

25 amount of an Indian Tribe’s loan obtained under any 


jbell on PROD1PC69 with BILLS
149 

•HR 1328 RH

1 Federal program for new projects to construct eligible 

2 sanitation facilities to serve Indian homes; 

3 ‘‘(6) except as otherwise prohibited by this sec4 tion, the Secretary may use funds appropriated under 

5 the authority of section 7 of the Act of August 5, 1954 

6 (42 U.S.C. 2004a) to meet matching or cost partici7 pation requirements under other Federal and non8 Federal programs for new projects to construct eligible 

9 sanitation facilities; 

10 ‘‘(7) all Federal agencies are authorized to trans11 fer to the Secretary funds identified, granted, loaned, 

12 or appropriated whereby the Department’s applicable 

13 policies, rules, and regulations shall apply in the im14 plementation of such projects; 

15 ‘‘(8) the Secretary of Health and Human Serv16 ices shall enter into interagency agreements with Fed17 eral and State agencies for the purpose of providing 

18 financial assistance for sanitation facilities and serv19 ices under this Act; 

20 ‘‘(9) the Secretary of Health and Human Serv21 ices shall, by regulation, establish standards applica22 ble to the planning, design, and construction of sani23 tation facilities funded under this Act; and 

24 ‘‘(10) the Secretary of Health and Human Serv25 ices is authorized to accept payments for goods and 


jbell on PROD1PC69 with BILLS
150 

•HR 1328 RH

1 services furnished by the Service from appropriate 

2 public authorities, nonprofit organizations or agen3 cies, or Indian Tribes, as contributions by that au4 thority, organization, agency, or tribe to agreements 

5 made under section 7 of the Act of August 5, 1954 (42 

6 U.S.C. 2004a), and such payments shall be credited 

7 to the same or subsequent appropriation account as 

8 funds appropriated under the authority of section 7 

9 of the Act of August 5, 1954 (42 U.S.C. 2004a). 

10 ‘‘(d) CERTAIN CAPABILITIES NOT PREREQUISITE.— 

11 The financial and technical capability of an Indian Tribe, 

12 Tribal Organization, or Indian community to safely oper13 ate, manage, and maintain a sanitation facility shall not 

14 be a prerequisite to the provision or construction of sanita15 tion facilities by the Secretary. 

16 ‘‘(e) FINANCIAL ASSISTANCE.—The Secretary is au17 thorized to provide financial assistance to Indian Tribes, 

18 Tribal Organizations, and Indian communities for oper19 ation, management, and maintenance of their sanitation 

20 facilities. 

21 ‘‘(f) OPERATION, MANAGEMENT, AND MAINTENANCE OF

22 FACILITIES.—The Indian Tribe has the primary responsi23 bility to establish, collect, and use reasonable user fees, or 

24 otherwise set aside funding, for the purpose of operating, 

25 managing, and maintaining sanitation facilities. If a saniVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00150 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
151 

•HR 1328 RH

1 tation facility serving a community that is operated by an 

2 Indian Tribe or Tribal Organization is threatened with im3 minent failure and such operator lacks capacity to main4 tain the integrity or the health benefits of the sanitation 

5 facility, then the Secretary is authorized to assist the In6 dian Tribe, Tribal Organization, or Indian community in 

7 the resolution of the problem on a short-term basis through 

8 cooperation with the emergency coordinator or by providing 

9 operation, management, and maintenance service. 

10 ‘‘(g) ISDEAA PROGRAM FUNDED ON EQUAL BASIS.— 

11 Tribal Health Programs shall be eligible (on an equal basis 

12 with programs that are administered directly by the Serv13 ice) for— 

14 ‘‘(1) any funds appropriated pursuant to this 

15 section; and 

16 ‘‘(2) any funds appropriated for the purpose of 

17 providing sanitation facilities. 

18 ‘‘(h) REPORT.— 

19 ‘‘(1) REQUIRED; CONTENTS.—The Secretary, in 

20 consultation with the Secretary of Housing and 

21 Urban Development, Indian Tribes, Tribal Organiza22 tions, and tribally designated housing entities (as de23 fined in section 4 of the Native American Housing 

24 Assistance and Self-Determination Act of 1996 (25 

25 U.S.C. 4103)) shall submit to the President, for incluVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00151 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
152 

•HR 1328 RH

1 sion in the report required to be transmitted to Con2 gress under section 801, a report which sets forth— 

3 ‘‘(A) the current Indian sanitation facility 

4 priority system of the Service; 

5 ‘‘(B) the methodology for determining sani6 tation deficiencies and needs; 

7 ‘‘(C) the criteria on which the deficiencies 

8 and needs will be evaluated; 

9 ‘‘(D) the level of initial and final sanitation 

10 deficiency for each type of sanitation facility for 

11 each project of each Indian Tribe or Indian com12 munity; 

13 ‘‘(E) the amount and most effective use of 

14 funds, derived from whatever source, necessary to 

15 accommodate the sanitation facilities needs of 

16 new homes assisted with funds under the Native 

17 American Housing Assistance and Self-Deter18 mination Act (25 U.S.C. 4101 et seq.), and to re19 duce the identified sanitation deficiency levels of 

20 all Indian Tribes and Indian communities to 

21 level I sanitation deficiency as defined in para22 graph (3)(A); and 

23 ‘‘(F) a 10-year plan to provide sanitation 

24 facilities to serve existing Indian homes and InVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00152 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
153 

•HR 1328 RH

1 dian communities and new and renovated In2 dian homes. 

3 ‘‘(2) UNIFORM METHODOLOGY.—The method4 ology used by the Secretary in determining, pre5 paring cost estimates for, and reporting sanitation 

6 deficiencies for purposes of paragraph (1) shall be ap7 plied uniformly to all Indian Tribes and Indian com8 munities. 

9 ‘‘(3) SANITATION DEFICIENCY LEVELS.—For 

10 purposes of this subsection, the sanitation deficiency 

11 levels for an individual, Indian Tribe, or Indian com12 munity sanitation facility to serve Indian homes are 

13 determined as follows: 

14 ‘‘(A) A level I deficiency exists if a sanita15 tion facility serving an individual, Indian 

16 Tribe, or Indian community— 

17 ‘‘(i) complies with all applicable water 

18 supply, pollution control, and solid waste 

19 disposal laws; and 

20 ‘‘(ii) deficiencies relate to routine re21 placement, repair, or maintenance needs. 

22 ‘‘(B) A level II deficiency exists if a sanita23 tion facility serving an individual, Indian 

24 Tribe, or Indian community substantially or re25 cently complied with all applicable water supVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00153 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
154 

•HR 1328 RH

1 ply, pollution control, and solid waste laws and 

2 any deficiencies relate to— 

3 ‘‘(i) small or minor capital improve4 ments needed to bring the facility back into 

5 compliance; 

6 ‘‘(ii) capital improvements that are 

7 necessary to enlarge or improve the facili8 ties in order to meet the current needs for 

9 domestic sanitation facilities; or 

10 ‘‘(iii) the lack of equipment or training 

11 by an Indian Tribe, Tribal Organization, 

12 or an Indian community to properly oper13 ate and maintain the sanitation facilities. 

14 ‘‘(C) A level III deficiency exists if a sani15 tation facility serving an individual, Indian 

16 Tribe or Indian community meets 1 or more of 

17 the following conditions— 

18 ‘‘(i) water or sewer service in the home 

19 is provided by a haul system with holding 

20 tanks and interior plumbing; 

21 ‘‘(ii) major significant interruptions to 

22 water supply or sewage disposal occur fre23 quently, requiring major capital improve24 ments to correct the deficiencies; or 


jbell on PROD1PC69 with BILLS
155 

•HR 1328 RH

1 ‘‘(iii) there is no access to or no ap2 proved or permitted solid waste facility 

3 available. 

4 ‘‘(D) A level IV deficiency exists— 

5 ‘‘(i) if a sanitation facility for an in6 dividual home, an Indian Tribe, or an In7 dian community exists but— 

8 ‘‘(I) lacks— 

9 ‘‘(aa) a safe water supply 

10 system; or 

11 ‘‘(bb) a waste disposal sys12 tem; 

13 ‘‘(II) contains no piped water or 

14 sewer facilities; or 

15 ‘‘(III) has become inoperable due 

16 to a major component failure; or 

17 ‘‘(ii) if only a washeteria or central fa18 cility exists in the community. 

19 ‘‘(E) A level V deficiency exists in the ab20 sence of a sanitation facility, where individual 

21 homes do not have access to safe drinking water 

22 or adequate wastewater (including sewage) dis23 posal. 

24 ‘‘(i) DEFINITIONS.—For purposes of this section, the 

25 following terms apply: 


jbell on PROD1PC69 with BILLS
156 

•HR 1328 RH

1 ‘‘(1) INDIAN COMMUNITY.—The term ‘Indian 

2 community’ means a geographic area, a significant 

3 proportion of whose inhabitants are Indians and 

4 which is served by or capable of being served by a fa5 cility described in this section. 

6 ‘‘(2) SANITATION FACILITIES.—The terms ‘sani7 tation facility’ and ‘sanitation facilities’ mean safe 

8 and adequate water supply systems, sanitary sewage 

9 disposal systems, and sanitary solid waste systems 

10 (and all related equipment and support infrastruc11 ture). 

12 ‘‘SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS. 

13 ‘‘(a) BUY INDIAN ACT.—The Secretary, acting through 

14 the Service, may use the negotiating authority of section 

15 23 of the Act of June 25, 1910 (25 U.S.C. 47, commonly 

16 known as the ‘Buy Indian Act’), to give preference to any 

17 Indian or any enterprise, partnership, corporation, or other 

18 type of business organization owned and controlled by an 

19 Indian or Indians including former or currently federally 

20 recognized Indian Tribes in the State of New York (herein21 after referred to as an ‘Indian firm’) in the construction 

22 and renovation of Service facilities pursuant to section 301 

23 and in the construction of sanitation facilities pursuant to 

24 section 302. Such preference may be accorded by the Sec25 retary unless the Secretary finds, pursuant to regulations, 


jbell on PROD1PC69 with BILLS
157 

•HR 1328 RH

1 that the project or function to be contracted for will not 

2 be satisfactory or such project or function cannot be prop3 erly completed or maintained under the proposed contract. 

4 The Secretary, in arriving at such a finding, shall consider 

5 whether the Indian or Indian firm will be deficient with 

6 respect to— 

7 ‘‘(1) ownership and control by Indians; 

8 ‘‘(2) equipment; 

9 ‘‘(3) bookkeeping and accounting procedures; 

10 ‘‘(4) substantive knowledge of the project or func11 tion to be contracted for; 

12 ‘‘(5) adequately trained personnel; or 

13 ‘‘(6) other necessary components of contract per14 formance. 

15 ‘‘(b) LABOR STANDARDS.—For the purposes of imple16 menting the provisions of this title, contracts for the con17 struction or renovation of health care facilities, staff quar18 ters, and sanitation facilities, and related support infra19 structure, funded in whole or in part with funds made 

20 available pursuant to this title, shall contain a provision 

21 requiring compliance with subchapter IV of chapter 31 of 

22 title 40, United States Code (commonly known as the 

23 ‘Davis-Bacon Act’). 


jbell on PROD1PC69 with BILLS
158 

•HR 1328 RH

1 ‘‘SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR 

2 RENOVATION. 

3 ‘‘(a) IN GENERAL.—Notwithstanding any other provi4 sion of law, if the requirements of subsection (c) are met, 

5 the Secretary, acting through the Service, is authorized to 

6 accept any major expansion, renovation, or modernization 

7 by any Indian Tribe or Tribal Organization of any Service 

8 facility or of any other Indian health facility operated pur9 suant to a contract or compact under the Indian Self-Deter10 mination and Education Assistance Act (25 U.S.C. 450 et 

11 seq.), including— 

12 ‘‘(1) any plans or designs for such expansion, 

13 renovation, or modernization; and 

14 ‘‘(2) any expansion, renovation, or moderniza15 tion for which funds appropriated under any Federal 

16 law were lawfully expended. 

17 ‘‘(b) PRIORITY LIST.— 

18 ‘‘(1) IN GENERAL.—The Secretary shall main19 tain a separate priority list to address the needs for 

20 increased operating expenses, personnel, or equipment 

21 for such facilities. The methodology for establishing 

22 priorities shall be developed through regulations. The 

23 list of priority facilities will be revised annually in 

24 consultation with Indian Tribes and Tribal Organi25 zations. 


jbell on PROD1PC69 with BILLS
159 

•HR 1328 RH

1 ‘‘(2) REPORT.—The Secretary shall submit to the 

2 President, for inclusion in the report required to be 

3 transmitted to Congress under section 801, the pri4 ority list maintained pursuant to paragraph (1). 

5 ‘‘(c) REQUIREMENTS.—The requirements of this sub6 section are met with respect to any expansion, renovation, 

7 or modernization if— 

8 ‘‘(1) the Indian Tribe or Tribal Organization— 

9 ‘‘(A) provides notice to the Secretary of its 

10 intent to expand, renovate, or modernize; and 

11 ‘‘(B) applies to the Secretary to be placed 

12 on a separate priority list to address the needs 

13 of such new facilities for increased operating ex14 penses, personnel, or equipment; and 

15 ‘‘(2) the expansion, renovation, or moderniza16 tion— 

17 ‘‘(A) is approved by the appropriate area 

18 director of the Service for Federal facilities; and 

19 ‘‘(B) is administered by the Indian Tribe or 

20 Tribal Organization in accordance with any ap21 plicable regulations prescribed by the Secretary 

22 with respect to construction or renovation of 

23 Service facilities. 

24 ‘‘(d) ADDITIONAL REQUIREMENT FOR EXPANSION.— 

25 In addition to the requirements under subsection (c), for 


jbell on PROD1PC69 with BILLS
160 

•HR 1328 RH

1 any expansion, the Indian Tribe or Tribal Organization 

2 shall provide to the Secretary additional information pur3 suant to regulations, including additional staffing, equip4 ment, and other costs associated with the expansion. 

5 ‘‘(e) CLOSURE OR CONVERSION OF FACILITIES.—If 

6 any Service facility which has been expanded, renovated, 

7 or modernized by an Indian Tribe or Tribal Organization 

8 under this section ceases to be used as a Service facility 

9 during the 20-year period beginning on the date such ex10 pansion, renovation, or modernization is completed, such 

11 Indian Tribe or Tribal Organization shall be entitled to 

12 recover from the United States an amount which bears the 

13 same ratio to the value of such facility at the time of such 

14 cessation as the value of such expansion, renovation, or 

15 modernization (less the total amount of any funds provided 

16 specifically for such facility under any Federal program 

17 that were expended for such expansion, renovation, or mod18 ernization) bore to the value of such facility at the time 

19 of the completion of such expansion, renovation, or mod20 ernization. 

21 ‘‘SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, 

22 AND MODERNIZATION OF SMALL AMBULA23 TORY CARE FACILITIES. 

24 ‘‘(a) GRANTS.— 


jbell on PROD1PC69 with BILLS
161 

•HR 1328 RH

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

2 through the Service, shall make grants to Indian 

3 Tribes and Tribal Organizations for the construction, 

4 expansion, or modernization of facilities for the provi5 sion of ambulatory care services to eligible Indians 

6 (and noneligible persons pursuant to subsections 

7 (b)(2) and (c)(1)(C)). A grant made under this sec8 tion may cover up to 100 percent of the costs of such 

9 construction, expansion, or modernization. For the 

10 purposes of this section, the term ‘construction’ in11 cludes the replacement of an existing facility. 

12 ‘‘(2) GRANT AGREEMENT REQUIRED.—A grant 

13 under paragraph (1) may only be made available to 

14 a Tribal Health Program operating an Indian health 

15 facility (other than a facility owned or constructed by 

16 the Service, including a facility originally owned or 

17 constructed by the Service and transferred to an In18 dian Tribe or Tribal Organization). 

19 ‘‘(b) USE OF GRANT FUNDS.— 

20 ‘‘(1) ALLOWABLE USES.—A grant awarded 

21 under this section may be used for the construction, 

22 expansion, or modernization (including the planning 

23 and design of such construction, expansion, or mod24 ernization) of an ambulatory care facility— 

25 ‘‘(A) located apart from a hospital; 


jbell on PROD1PC69 with BILLS
162 

•HR 1328 RH

1 ‘‘(B) not funded under section 301 or sec2 tion 306; and 

3 ‘‘(C) which, upon completion of such con4 struction or modernization will— 

5 ‘‘(i) have a total capacity appropriate 

6 to its projected service population; 

7 ‘‘(ii) provide annually no fewer than 

8 150 patient visits by eligible Indians and 

9 other users who are eligible for services in 

10 such facility in accordance with section 

11 807(c)(2); and 

12 ‘‘(iii) provide ambulatory care in a 

13 Service Area (specified in the contract or 

14 compact under the Indian Self-Determina15 tion and Education Assistance Act (25 

16 U.S.C. 450 et seq.)) with a population of no 

17 fewer than 1,500 eligible Indians and other 

18 users who are eligible for services in such 

19 facility in accordance with section 

20 807(c)(2). 

21 ‘‘(2) ADDITIONAL ALLOWABLE USE.—The Sec22 retary may also reserve a portion of the funding pro23 vided under this section and use those reserved funds 

24 to reduce an outstanding debt incurred by Indian 

25 Tribes or Tribal Organizations for the construction, 


jbell on PROD1PC69 with BILLS
163 

•HR 1328 RH

1 expansion, or modernization of an ambulatory care 

2 facility that meets the requirements under paragraph 

3 (1). The provisions of this section shall apply, except 

4 that such applications for funding under this para5 graph shall be considered separately from applica6 tions for funding under paragraph (1). 

7 ‘‘(3) USE ONLY FOR CERTAIN PORTION OF

8 COSTS.—A grant provided under this section may be 

9 used only for the cost of that portion of a construc10 tion, expansion, or modernization project that benefits 

11 the Service population identified above in subsection 

12 (b)(1)(C) (ii) and (iii). The requirements of clauses 

13 (ii) and (iii) of paragraph (1)(C) shall not apply to 

14 an Indian Tribe or Tribal Organization applying for 

15 a grant under this section for a health care facility 

16 located or to be constructed on an island or when such 

17 facility is not located on a road system providing di18 rect access to an inpatient hospital where care is 

19 available to the Service population. 

20 ‘‘(c) GRANTS.— 

21 ‘‘(1) APPLICATION.—No grant may be made 

22 under this section unless an application or proposal 

23 for the grant has been approved by the Secretary in 

24 accordance with applicable regulations and has set 

25 forth reasonable assurance by the applicant that, at 


jbell on PROD1PC69 with BILLS
164 

•HR 1328 RH

1 all times after the construction, expansion, or mod2 ernization of a facility carried out using a grant re3 ceived under this section— 

4 ‘‘(A) adequate financial support will be 

5 available for the provision of services at such fa6 cility; 

7 ‘‘(B) such facility will be available to eligi8 ble Indians without regard to ability to pay or 

9 source of payment; and 

10 ‘‘(C) such facility will, as feasible without 

11 diminishing the quality or quantity of services 

12 provided to eligible Indians, serve noneligible 

13 persons on a cost basis. 

14 ‘‘(2) PRIORITY.—In awarding grants under this 

15 section, the Secretary shall give priority to Indian 

16 Tribes and Tribal Organizations that demonstrate— 

17 ‘‘(A) a need for increased ambulatory care 

18 services; and 

19 ‘‘(B) insufficient capacity to deliver such 

20 services. 

21 ‘‘(3) PEER REVIEW PANELS.—The Secretary may 

22 provide for the establishment of peer review panels, as 

23 necessary, to review and evaluate applications and 

24 proposals and to advise the Secretary regarding such 


jbell on PROD1PC69 with BILLS
165 

•HR 1328 RH

1 applications using the criteria developed pursuant to 

2 subsection (a)(1). 

3 ‘‘(d) REVERSION OF FACILITIES.—If any facility (or 

4 portion thereof) with respect to which funds have been paid 

5 under this section, ceases, at any time after completion of 

6 the construction, expansion, or modernization carried out 

7 with such funds, to be used for the purposes of providing 

8 health care services to eligible Indians, all of the right, title, 

9 and interest in and to such facility (or portion thereof) shall 

10 transfer to the United States unless otherwise negotiated by 

11 the Service and the Indian Tribe or Tribal Organization. 

12 ‘‘(e) FUNDING NONRECURRING.—Funding provided 

13 under this section shall be nonrecurring and shall not be 

14 available for inclusion in any individual Indian Tribe’s 

15 tribal share for an award under the Indian Self-Determina16 tion and Education Assistance Act (25 U.S.C. 450 et seq.) 

17 or for reallocation or redesign thereunder. 

18 ‘‘SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRA19 TION PROJECT. 

20 ‘‘(a) HEALTH CARE DEMONSTRATION PROJECTS.— 

21 The Secretary, acting through the Service, is authorized to 

22 enter into contracts under the Indian Self-Determination 

23 and Education Assistance Act (25 U.S.C. 450 et seq.) with 

24 Indian Tribes or Tribal Organizations for the purpose of 

25 carrying out a health care delivery demonstration project 


jbell on PROD1PC69 with BILLS
166 

•HR 1328 RH

1 to test alternative means of delivering health care and serv2 ices to Indians through facilities. 

3 ‘‘(b) USE OF FUNDS.—The Secretary, in approving 

4 projects pursuant to this section, may authorize such con5 tracts for the construction and renovation of hospitals, 

6 health centers, health stations, and other facilities to deliver 

7 health care services and is authorized to— 

8 ‘‘(1) waive any leasing prohibition; 

9 ‘‘(2) permit carryover of funds appropriated for 

10 the provision of health care services; 

11 ‘‘(3) permit the use of other available funds; 

12 ‘‘(4) permit the use of funds or property donated 

13 from any source for project purposes; 

14 ‘‘(5) provide for the reversion of donated real or 

15 personal property to the donor; and 

16 ‘‘(6) permit the use of Service funds to match 

17 other funds, including Federal funds. 

18 ‘‘(c) REGULATIONS.—The Secretary shall develop and 

19 promulgate regulations, not later than 1 year after the date 

20 of enactment of the Indian Health Care Improvement Act 

21 Amendments of 2007, for the review and approval of appli22 cations submitted under this section. 

23 ‘‘(d) CRITERIA.—The Secretary may approve projects 

24 that meet the following criteria: 


jbell on PROD1PC69 with BILLS
167 

•HR 1328 RH

1 ‘‘(1) There is a need for a new facility or pro2 gram or the reorientation of an existing facility or 

3 program. 

4 ‘‘(2) A significant number of Indians, including 

5 those with low health status, will be served by the 

6 project. 

7 ‘‘(3) The project has the potential to deliver serv8 ices in an efficient and effective manner. 

9 ‘‘(4) The project is economically viable. 

10 ‘‘(5) The Indian Tribe or Tribal Organization 

11 has the administrative and financial capability to 

12 administer the project. 

13 ‘‘(6) The project is integrated with providers of 

14 related health and social services and is coordinated 

15 with, and avoids duplication of, existing services. 

16 ‘‘(e) PEER REVIEW PANELS.—The Secretary may pro17 vide for the establishment of peer review panels, as nec18 essary, to review and evaluate applications using the cri19 teria developed pursuant to subsection (d). 

20 ‘‘(f) PRIORITY.—The Secretary shall give priority to 

21 applications for demonstration projects in each of the fol22 lowing Service Units to the extent that such applications 

23 are timely filed and meet the criteria specified in subsection 

24 (d): 

25 ‘‘(1) Cass Lake, Minnesota. 


jbell on PROD1PC69 with BILLS
168 

•HR 1328 RH

1 ‘‘(2) Mescalero, New Mexico. 

2 ‘‘(3) Owyhee, Nevada. 

3 ‘‘(4) Schurz, Nevada. 

4 ‘‘(5) Ft. Yuma, California. 

5 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 

6 provide such technical and other assistance as may be nec7 essary to enable applicants to comply with the provisions 

8 of this section. 

9 ‘‘(h) SERVICE TO INELIGIBLE PERSONS.—Subject to 

10 section 807, the authority to provide services to persons oth11 erwise ineligible for the health care benefits of the Service 

12 and the authority to extend hospital privileges in Service 

13 facilities to non-Service health practitioners as provided in 

14 section 807 may be included, subject to the terms of such 

15 section, in any demonstration project approved pursuant 

16 to this section. 

17 ‘‘(i) EQUITABLE TREATMENT.—For purposes of sub18 section (d)(1), the Secretary shall, in evaluating facilities 

19 operated under any contract or compact under the Indian 

20 Self-Determination and Education Assistance Act (25 

21 U.S.C. 450 et seq.), use the same criteria that the Secretary 

22 uses in evaluating facilities operated directly by the Service. 

23 ‘‘(j) EQUITABLE INTEGRATION OF FACILITIES.—The 

24 Secretary shall ensure that the planning, design, construc25 tion, renovation, and expansion needs of Service and nonVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00168 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
169 

•HR 1328 RH

1 Service facilities which are the subject of a contract or com2 pact under the Indian Self-Determination and Education 

3 Assistance Act (25 U.S.C. 450 et seq.) for health services 

4 are fully and equitably integrated into the implementation 

5 of the health care delivery demonstration projects under this 

6 section. 

7 ‘‘SEC. 307. LAND TRANSFER. 

8 ‘‘Notwithstanding any other provision of law, the Bu9 reau of Indian Affairs and all other agencies and depart10 ments of the United States are authorized to transfer, at 

11 no cost, land and improvements to the Service for the provi12 sion of health care services. The Secretary is authorized to 

13 accept such land and improvements for such purposes. 

14 ‘‘SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS. 

15 ‘‘The Secretary, acting through the Service, may enter 

16 into leases, contracts, and other agreements with Indian 

17 Tribes and Tribal Organizations which hold (1) title to, (2) 

18 a leasehold interest in, or (3) a beneficial interest in (when 

19 title is held by the United States in trust for the benefit 

20 of an Indian Tribe) facilities used or to be used for the ad21 ministration and delivery of health services by an Indian 

22 Health Program. Such leases, contracts, or agreements may 

23 include provisions for construction or renovation and pro24 vide for compensation to the Indian Tribe or Tribal Orga25 nization of rental and other costs consistent with section 


jbell on PROD1PC69 with BILLS
170 

•HR 1328 RH

1 105(l) of the Indian Self-Determination and Education As2 sistance Act (25 U.S.C. 450j(l)) and regulations thereunder. 

3 ‘‘SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND 

4 LOAN REPAYMENT. 

5 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

6 with the Secretary of the Treasury, Indian Tribes, and 

7 Tribal Organizations, shall carry out a study to determine 

8 the feasibility of establishing a loan fund to provide to In9 dian Tribes and Tribal Organizations direct loans or guar10 antees for loans for the construction of health care facilities, 

11 including— 

12 ‘‘(1) inpatient facilities; 

13 ‘‘(2) outpatient facilities; 

14 ‘‘(3) staff quarters; 

15 ‘‘(4) hostels; and 

16 ‘‘(5) specialized care facilities, such as behavioral 

17 health and elder care facilities. 

18 ‘‘(b) DETERMINATIONS.—In carrying out the study 

19 under subsection (a), the Secretary shall determine— 

20 ‘‘(1) the maximum principal amount of a loan 

21 or loan guarantee that should be offered to a recipient 

22 from the loan fund; 

23 ‘‘(2) the percentage of eligible costs, not to exceed 

24 100 percent, that may be covered by a loan or loan 

25 guarantee from the loan fund (including costs relating 


jbell on PROD1PC69 with BILLS
171 

•HR 1328 RH

1 to planning, design, financing, site land development, 

2 construction, rehabilitation, renovation, conversion, 

3 improvements, medical equipment and furnishings, 

4 and other facility-related costs and capital purchase 

5 (but excluding staffing)); 

6 ‘‘(3) the cumulative total of the principal of di7 rect loans and loan guarantees, respectively, that may 

8 be outstanding at any 1 time; 

9 ‘‘(4) the maximum term of a loan or loan guar10 antee that may be made for a facility from the loan 

11 fund; 

12 ‘‘(5) the maximum percentage of funds from the 

13 loan fund that should be allocated for payment of 

14 costs associated with planning and applying for a 

15 loan or loan guarantee; 

16 ‘‘(6) whether acceptance by the Secretary of an 

17 assignment of the revenue of an Indian Tribe or Trib18 al Organization as security for any direct loan or 

19 loan guarantee from the loan fund would be appro20 priate; 

21 ‘‘(7) whether, in the planning and design of 

22 health facilities under this section, users eligible 

23 under section 807(c) may be included in any projec24 tion of patient population; 


jbell on PROD1PC69 with BILLS
172 

•HR 1328 RH

1 ‘‘(8) whether funds of the Service provided 

2 through loans or loan guarantees from the loan fund 

3 should be eligible for use in matching other Federal 

4 funds under other programs; 

5 ‘‘(9) the appropriateness of, and best methods 

6 for, coordinating the loan fund with the health care 

7 priority system of the Service under section 301; and 

8 ‘‘(10) any legislative or regulatory changes re9 quired to implement recommendations of the Sec10 retary based on results of the study. 

11 ‘‘(c) REPORT.—Not later than September 30, 2009, the 

12 Secretary shall submit to the Committee on Indian Affairs 

13 of the Senate and the Committee on Natural Resources and 

14 the Committee on Energy and Commerce of the House of 

15 Representatives a report that describes— 

16 ‘‘(1) the manner of consultation made as re17 quired by subsection (a); and 

18 ‘‘(2) the results of the study, including any rec19 ommendations of the Secretary based on results of the 

20 study. 

21 ‘‘SEC. 310. TRIBAL LEASING. 

22 ‘‘A Tribal Health Program may lease permanent 

23 structures for the purpose of providing health care services 

24 without obtaining advance approval in appropriation Acts. 


jbell on PROD1PC69 with BILLS
173 

•HR 1328 RH

1 ‘‘SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES 

2 JOINT VENTURE PROGRAM. 

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

4 Service, shall make arrangements with Indian Tribes and 

5 Tribal Organizations to establish joint venture demonstra6 tion projects under which an Indian Tribe or Tribal Orga7 nization shall expend tribal, private, or other available 

8 funds, for the acquisition or construction of a health facility 

9 for a minimum of 10 years, under a no-cost lease, in ex10 change for agreement by the Service to provide the equip11 ment, supplies, and staffing for the operation and mainte12 nance of such a health facility. An Indian Tribe or Tribal 

13 Organization may use tribal funds, private sector, or other 

14 available resources, including loan guarantees, to fulfill its 

15 commitment under a joint venture entered into under this 

16 subsection. An Indian Tribe or Tribal Organization shall 

17 be eligible to establish a joint venture project if, when it 

18 submits a letter of intent, it— 

19 ‘‘(1) has begun but not completed the process of 

20 acquisition or construction of a health facility to be 

21 used in the joint venture project; or 

22 ‘‘(2) has not begun the process of acquisition or 

23 construction of a health facility for use in the joint 

24 venture project. 


jbell on PROD1PC69 with BILLS
174 

•HR 1328 RH

1 ‘‘(b) REQUIREMENTS.—The Secretary shall make such 

2 an arrangement with an Indian Tribe or Tribal Organiza3 tion only if— 

4 ‘‘(1) the Secretary first determines that the In5 dian Tribe or Tribal Organization has the adminis6 trative and financial capabilities necessary to com7 plete the timely acquisition or construction of the rel8 evant health facility; and 

9 ‘‘(2) the Indian Tribe or Tribal Organization 

10 meets the need criteria determined using the criteria 

11 developed under the health care facility priority sys12 tem under section 301, unless the Secretary deter13 mines, pursuant to regulations, that other criteria 

14 will result in a more cost-effective and efficient meth15 od of facilitating and completing construction of 

16 health care facilities. 

17 ‘‘(c) CONTINUED OPERATION.—The Secretary shall ne18 gotiate an agreement with the Indian Tribe or Tribal Orga19 nization regarding the continued operation of the facility 

20 at the end of the initial 10 year no-cost lease period. 

21 ‘‘(d) BREACH OF AGREEMENT.—An Indian Tribe or 

22 Tribal Organization that has entered into a written agree23 ment with the Secretary under this section, and that 

24 breaches or terminates without cause such agreement, shall 

25 be liable to the United States for the amount that has been 


jbell on PROD1PC69 with BILLS
175 

•HR 1328 RH

1 paid to the Indian Tribe or Tribal Organization, or paid 

2 to a third party on the Indian Tribe’s or Tribal Organiza3 tion’s behalf, under the agreement. The Secretary has the 

4 right to recover tangible property (including supplies) and 

5 equipment, less depreciation, and any funds expended for 

6 operations and maintenance under this section. The pre7 ceding sentence does not apply to any funds expended for 

8 the delivery of health care services, personnel, or staffing. 

9 ‘‘(e) RECOVERY FOR NONUSE.—An Indian Tribe or 

10 Tribal Organization that has entered into a written agree11 ment with the Secretary under this subsection shall be enti12 tled to recover from the United States an amount that is 

13 proportional to the value of such facility if, at any time 

14 within the 10-year term of the agreement, the Service ceases 

15 to use the facility or otherwise breaches the agreement. 

16 ‘‘(f) DEFINITION.—For the purposes of this section, the 

17 term ‘health facility’ or ‘health facilities’ includes quarters 

18 needed to provide housing for staff of the relevant Tribal 

19 Health Program. 

20 ‘‘SEC. 312. LOCATION OF FACILITIES. 

21 ‘‘(a) IN GENERAL.—In all matters involving the reor22 ganization or development of Service facilities or in the es23 tablishment of related employment projects to address un24 employment conditions in economically depressed areas, the 

25 Bureau of Indian Affairs and the Service shall give priority 


jbell on PROD1PC69 with BILLS
176 

•HR 1328 RH

1 to locating such facilities and projects on Indian lands, or 

2 lands in Alaska owned by any Alaska Native village, or 

3 village or regional corporation under the Alaska Native 

4 Claims Settlement Act (43 U.S.C. 1601 et seq.), or any land 

5 allotted to any Alaska Native, if requested by the Indian 

6 owner and the Indian Tribe with jurisdiction over such 

7 lands or other lands owned or leased by the Indian Tribe 

8 or Tribal Organization. Top priority shall be given to In9 dian land owned by 1 or more Indian Tribes. 

10 ‘‘(b) DEFINITION.—For purposes of this section, the 

11 term ‘Indian lands’ means— 

12 ‘‘(1) all lands within the exterior boundaries of 

13 any reservation; and 

14 ‘‘(2) any lands title to which is held in trust by 

15 the United States for the benefit of any Indian Tribe 

16 or individual Indian or held by any Indian Tribe or 

17 individual Indian subject to restriction by the United 

18 States against alienation. 

19 ‘‘SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH 

20 CARE FACILITIES. 

21 ‘‘(a) REPORT.—The Secretary shall submit to the 

22 President, for inclusion in the report required to be trans23 mitted to Congress under section 801, a report which identi24 fies the backlog of maintenance and repair work required 

25 at both Service and tribal health care facilities, including 


jbell on PROD1PC69 with BILLS
177 

•HR 1328 RH

1 new health care facilities expected to be in operation in the 

2 next fiscal year. The report shall also identify the need for 

3 renovation and expansion of existing facilities to support 

4 the growth of health care programs. 

5 ‘‘(b) MAINTENANCE OF NEWLY CONSTRUCTED

6 SPACE.—The Secretary, acting through the Service, is au7 thorized to expend maintenance and improvement funds to 

8 support maintenance of newly constructed space only if 

9 such space falls within the approved supportable space allo10 cation for the Indian Tribe or Tribal Organization. Sup11 portable space allocation shall be defined through the health 

12 care facility priority system under section 301(c). 

13 ‘‘(c) REPLACEMENT FACILITIES.—In addition to using 

14 maintenance and improvement funds for renovation, mod15 ernization, and expansion of facilities, an Indian Tribe or 

16 Tribal Organization may use maintenance and improve17 ment funds for construction of a replacement facility if the 

18 costs of renovation of such facility would exceed a maximum 

19 renovation cost threshold. The maximum renovation cost 

20 threshold shall be determined through the negotiated rule21 making process provided for under section 802. 

22 ‘‘SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY-OWNED 

23 QUARTERS. 

24 ‘‘(a) RENTAL RATES.— 


jbell on PROD1PC69 with BILLS
178 

•HR 1328 RH

1 ‘‘(1) ESTABLISHMENT.—Notwithstanding any 

2 other provision of law, a Tribal Health Program 

3 which operates a hospital or other health facility and 

4 the federally-owned quarters associated therewith pur5 suant to a contract or compact under the Indian Self6 Determination and Education Assistance Act (25 

7 U.S.C. 450 et seq.) shall have the authority to estab8 lish the rental rates charged to the occupants of such 

9 quarters by providing notice to the Secretary of its 

10 election to exercise such authority. 

11 ‘‘(2) OBJECTIVES.—In establishing rental rates 

12 pursuant to authority of this subsection, a Tribal 

13 Health Program shall endeavor to achieve the fol14 lowing objectives: 

15 ‘‘(A) To base such rental rates on the rea16 sonable value of the quarters to the occupants 

17 thereof. 

18 ‘‘(B) To generate sufficient funds to pru19 dently provide for the operation and mainte20 nance of the quarters, and subject to the discre21 tion of the Tribal Health Program, to supply re22 serve funds for capital repairs and replacement 

23 of the quarters. 

24 ‘‘(3) EQUITABLE FUNDING.—Any quarters whose 

25 rental rates are established by a Tribal Health ProVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00178 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
179 

•HR 1328 RH

1 gram pursuant to this subsection shall remain eligible 

2 for quarters improvement and repair funds to the 

3 same extent as all federally-owned quarters used to 

4 house personnel in Services-supported programs. 

5 ‘‘(4) NOTICE OF RATE CHANGE.—A Tribal 

6 Health Program which exercises the authority pro7 vided under this subsection shall provide occupants 

8 with no less than 60 days notice of any change in 

9 rental rates. 

10 ‘‘(b) DIRECT COLLECTION OF RENT.— 

11 ‘‘(1) IN GENERAL.—Notwithstanding any other 

12 provision of law, and subject to paragraph (2), a 

13 Tribal Health Program shall have the authority to 

14 collect rents directly from Federal employees who oc15 cupy such quarters in accordance with the following: 

16 ‘‘(A) The Tribal Health Program shall no17 tify the Secretary and the subject Federal em18 ployees of its election to exercise its authority to 

19 collect rents directly from such Federal employ20 ees. 

21 ‘‘(B) Upon receipt of a notice described in 

22 subparagraph (A), the Federal employees shall 

23 pay rents for occupancy of such quarters directly 

24 to the Tribal Health Program and the Secretary 

25 shall have no further authority to collect rents 


jbell on PROD1PC69 with BILLS
180 

•HR 1328 RH

1 from such employees through payroll deduction 

2 or otherwise. 

3 ‘‘(C) Such rent payments shall be retained 

4 by the Tribal Health Program and shall not be 

5 made payable to or otherwise be deposited with 

6 the United States. 

7 ‘‘(D) Such rent payments shall be deposited 

8 into a separate account which shall be used by 

9 the Tribal Health Program for the maintenance 

10 (including capital repairs and replacement) and 

11 operation of the quarters and facilities as the 

12 Tribal Health Program shall determine. 

13 ‘‘(2) RETROCESSION OF AUTHORITY.—If a Trib14 al Health Program which has made an election under 

15 paragraph (1) requests retrocession of its authority to 

16 directly collect rents from Federal employees occu17 pying federally-owned quarters, such retrocession 

18 shall become effective on the earlier of— 

19 ‘‘(A) the first day of the month that begins 

20 no less than 180 days after the Tribal Health 

21 Program notifies the Secretary of its desire to 

22 retrocede; or 

23 ‘‘(B) such other date as may be mutually 

24 agreed by the Secretary and the Tribal Health 

25 Program. 


jbell on PROD1PC69 with BILLS
181 

•HR 1328 RH

1 ‘‘(c) RATES IN ALASKA.—To the extent that a Tribal 

2 Health Program, pursuant to authority granted in sub3 section (a), establishes rental rates for federally-owned quar4 ters provided to a Federal employee in Alaska, such rents 

5 may be based on the cost of comparable private rental hous6 ing in the nearest established community with a year-round 

7 population of 1,500 or more individuals. 

8 ‘‘SEC. 315. APPLICABILITY OF BUY AMERICAN ACT REQUIRE9 MENT. 

10 ‘‘(a) APPLICABILITY.—The Secretary shall ensure that 

11 the requirements of the Buy American Act apply to all pro12 curements made with funds provided pursuant to section 

13 317. Indian Tribes and Tribal Organizations shall be ex14 empt from these requirements. 

15 ‘‘(b) EFFECT OF VIOLATION.—If it has been finally de16 termined by a court or Federal agency that any person in17 tentionally affixed a label bearing a ‘Made in America’ in18 scription or any inscription with the same meaning, to any 

19 product sold in or shipped to the United States that is not 

20 made in the United States, such person shall be ineligible 

21 to receive any contract or subcontract made with funds pro22 vided pursuant to section 317, pursuant to the debarment, 

23 suspension, and ineligibility procedures described in sec24 tions 9.400 through 9.409 of title 48, Code of Federal Regu25 lations. 


jbell on PROD1PC69 with BILLS
182 

•HR 1328 RH

1 ‘‘(c) DEFINITIONS.—For purposes of this section, the 

2 term ‘Buy American Act’ means title III of the Act entitled 

3 ‘An Act making appropriations for the Treasury and Post 

4 Office Departments for the fiscal year ending June 30, 

5 1934, and for other purposes’, approved March 3, 1933 (41 

6 U.S.C. 10a et seq.). 

7 ‘‘SEC. 316. OTHER FUNDING FOR FACILITIES. 

8 ‘‘(a) AUTHORITY TO ACCEPT FUNDS.—The Secretary 

9 is authorized to accept from any source, including Federal 

10 and State agencies, funds that are available for the con11 struction of health care facilities and use such funds to 

12 plan, design, and construct health care facilities for Indians 

13 and to place such funds into a contract or compact under 

14 the Indian Self-Determination and Education Assistance 

15 Act (25 U.S.C. 450 et seq.). Receipt of such funds shall have 

16 no effect on the priorities established pursuant to section 

17 301. 

18 ‘‘(b) INTERAGENCY AGREEMENTS.—The Secretary is 

19 authorized to enter into interagency agreements with other 

20 Federal agencies or State agencies and other entities and 

21 to accept funds from such Federal or State agencies or other 

22 sources to provide for the planning, design, and construc23 tion of health care facilities to be administered by Indian 

24 Health Programs in order to carry out the purposes of this 


jbell on PROD1PC69 with BILLS
183 

•HR 1328 RH

1 Act and the purposes for which the funds were appropriated 

2 or for which the funds were otherwise provided. 

3 ‘‘(c) ESTABLISHMENT OF STANDARDS.—The Sec4 retary, through the Service, shall establish standards by reg5 ulation for the planning, design, and construction of health 

6 care facilities serving Indians under this Act. 

7 ‘‘SEC. 317. AUTHORIZATION OF APPROPRIATIONS. 

8 ‘‘There are authorized to be appropriated such sums 

9 as may be necessary for each fiscal year through fiscal year 

10 2017 to carry out this title. 

11 ‘‘TITLE IV—ACCESS TO HEALTH 

12 SERVICES 

13 ‘‘SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECU14 RITY ACT HEALTH BENEFITS PROGRAMS. 

15 ‘‘(a) DISREGARD OF MEDICARE, MEDICAID, AND

16 SCHIP PAYMENTS IN DETERMINING APPROPRIATIONS.— 

17 Any payments received by an Indian Health Program or 

18 by an Urban Indian Organization under title XVIII, XIX, 

19 or XXI of the Social Security Act for services provided to 

20 Indians eligible for benefits under such respective titles shall 

21 not be considered in determining appropriations for the 

22 provision of health care and services to Indians. 

23 ‘‘(b) NONPREFERENTIAL TREATMENT.—Nothing in 

24 this Act authorizes the Secretary to provide services to an 

25 Indian with coverage under title XVIII, XIX, or XXI of 


jbell on PROD1PC69 with BILLS
184 

•HR 1328 RH

1 the Social Security Act in preference to an Indian without 

2 such coverage. 

3 ‘‘(c) USE OF FUNDS.— 

4 ‘‘(1) SPECIAL FUND.— 

5 ‘‘(A) 100 PERCENT PASS-THROUGH OF PAY6 MENTS DUE TO FACILITIES.—Notwithstanding 

7 any other provision of law, but subject to para8 graph (2), payments to which a facility of the 

9 Service is entitled by reason of a provision of the 

10 Social Security Act shall be placed in a special 

11 fund to be held by the Secretary. In making pay12 ments from such fund, the Secretary shall ensure 

13 that each Service Unit of the Service receives 100 

14 percent of the amount to which the facilities of 

15 the Service, for which such Service Unit makes 

16 collections, are entitled by reason of a provision 

17 of the Social Security Act. 

18 ‘‘(B) USE OF FUNDS.—Amounts received by 

19 a facility of the Service under subparagraph (A) 

20 shall first be used (to such extent or in such 

21 amounts as are provided in appropriation Acts) 

22 for the purpose of making any improvements in 

23 the programs of the Service operated by or 

24 through such facility which may be necessary to 

25 achieve or maintain compliance with the appliVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00184 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
185 

•HR 1328 RH

1 cable conditions and requirements of titles XVIII 

2 and XIX of the Social Security Act. Any 

3 amounts so received that are in excess of the 

4 amount necessary to achieve or maintain such 

5 conditions and requirements shall, subject to con6 sultation with the Indian Tribes being served by 

7 the Service Unit, be used for reducing the health 

8 resource deficiencies (as determined under sec9 tion 201(d)) of such Indian Tribes. 

10 ‘‘(2) DIRECT PAYMENT OPTION.—Paragraph (1) 

11 shall not apply to a Tribal Health Program upon the 

12 election of such Program under subsection (d) to re13 ceive payments directly. No payment may be made 

14 out of the special fund described in such paragraph 

15 with respect to reimbursement made for services pro16 vided by such Program during the period of such elec17 tion. 

18 ‘‘(d) DIRECT BILLING.— 

19 ‘‘(1) IN GENERAL.—Subject to complying with 

20 the requirements of paragraph (2), a Tribal Health 

21 Program may elect to directly bill for, and receive 

22 payment for, health care items and services provided 

23 by such Program for which payment is made under 

24 title XVIII or XIX of the Social Security Act or from 

25 any other third party payor. 


jbell on PROD1PC69 with BILLS
186 

•HR 1328 RH

1 ‘‘(2) DIRECT REIMBURSEMENT.— 

2 ‘‘(A) USE OF FUNDS.—Each Tribal Health 

3 Program making the election described in para4 graph (1) with respect to a program under a 

5 title of the Social Security Act shall be reim6 bursed directly by that program for items and 

7 services furnished without regard to subsection 

8 (c)(1), but all amounts so reimbursed shall be 

9 used by the Tribal Health Program for the pur10 pose of making any improvements in facilities of 

11 the Tribal Health Program that may be nec12 essary to achieve or maintain compliance with 

13 the conditions and requirements applicable gen14 erally to such items and services under the pro15 gram under such title and to provide additional 

16 health care services, improvements in health care 

17 facilities and Tribal Health Programs, any 

18 health care related purpose, or otherwise to 

19 achieve the objectives provided in section 3 of 

20 this Act. 

21 ‘‘(B) AUDITS.—The amounts paid to a 

22 Tribal Health Program making the election de23 scribed in paragraph (1) with respect to a pro24 gram under a title of the Social Security Act 

25 shall be subject to all auditing requirements apVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00186 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
187 

•HR 1328 RH

1 plicable to the program under such title, as well 

2 as all auditing requirements applicable to pro3 grams administered by an Indian Health Pro4 gram. Nothing in the preceding sentence shall be 

5 construed as limiting the application of auditing 

6 requirements applicable to amounts paid under 

7 title XVIII, XIX, or XXI of the Social Security 

8 Act. 

9 ‘‘(C) IDENTIFICATION OF SOURCE OF PAY10 MENTS.—Any Tribal Health Program that re11 ceives reimbursements or payments under title 

12 XVIII, XIX, or XXI of the Social Security Act, 

13 shall provide to the Service a list of each pro14 vider enrollment number (or other identifier) 

15 under which such Program receives such reim16 bursements or payments. 

17 ‘‘(3) EXAMINATION AND IMPLEMENTATION OF

18 CHANGES.— 

19 ‘‘(A) IN GENERAL.—The Secretary, acting 

20 through the Service and with the assistance of 

21 the Administrator of the Centers for Medicare & 

22 Medicaid Services, shall examine on an ongoing 

23 basis and implement any administrative changes 

24 that may be necessary to facilitate direct billing 

25 and reimbursement under the program estabVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00187 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
188 

•HR 1328 RH

1 lished under this subsection, including any 

2 agreements with States that may be necessary to 

3 provide for direct billing under a program under 

4 a title of the Social Security Act. 

5 ‘‘(B) COORDINATION OF INFORMATION.— 

6 The Service shall provide the Administrator of 

7 the Centers for Medicare & Medicaid Services 

8 with copies of the lists submitted to the Service 

9 under paragraph (2)(C), enrollment data regard10 ing patients served by the Service (and by Tribal 

11 Health Programs, to the extent such data is 

12 available to the Service), and such other infor13 mation as the Administrator may require for 

14 purposes of administering title XVIII, XIX, or 

15 XXI of the Social Security Act. 

16 ‘‘(4) WITHDRAWAL FROM PROGRAM.—A Tribal 

17 Health Program that bills directly under the program 

18 established under this subsection may withdraw from 

19 participation in the same manner and under the 

20 same conditions that an Indian Tribe or Tribal Orga21 nization may retrocede a contracted program to the 

22 Secretary under the authority of the Indian Self-De23 termination and Education Assistance Act (25 U.S.C. 

24 450 et seq.). All cost accounting and billing authority 

25 under the program established under this subsection 


jbell on PROD1PC69 with BILLS
189 

•HR 1328 RH

1 shall be returned to the Secretary upon the Sec2 retary’s acceptance of the withdrawal of participation 

3 in this program. 

4 ‘‘(5) TERMINATION FOR FAILURE TO COMPLY

5 WITH REQUIREMENTS.—The Secretary may terminate 

6 the participation of a Tribal Health Program or in 

7 the direct billing program established under this sub8 section if the Secretary determines that the Program 

9 has failed to comply with the requirements of para10 graph (2). The Secretary shall provide a Tribal 

11 Health Program with notice of a determination that 

12 the Program has failed to comply with any such re13 quirement and a reasonable opportunity to correct 

14 such noncompliance prior to terminating the Pro15 gram’s participation in the direct billing program es16 tablished under this subsection. 

17 ‘‘(e) RELATED PROVISIONS UNDER THE SOCIAL SECU18 RITY ACT.—For provisions related to subsections (c) and 

19 (d), see sections 1880, 1911, and 2107(e)(1)(D) of the Social 

20 Security Act. 


jbell on PROD1PC69 with BILLS
190 

•HR 1328 RH

1 ‘‘SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERV2 ICE, INDIAN TRIBES, TRIBAL ORGANIZA3 TIONS, AND URBAN INDIAN ORGANIZATIONS 

4 TO FACILITATE OUTREACH, ENROLLMENT, 

5 AND COVERAGE OF INDIANS UNDER SOCIAL 

6 SECURITY ACT HEALTH BENEFIT PROGRAMS 

7 AND OTHER HEALTH BENEFITS PROGRAMS. 

8 ‘‘(a) INDIAN TRIBES AND TRIBAL ORGANIZATIONS.— 

9 From funds appropriated to carry out this title in accord10 ance with section 416, the Secretary, acting through the 

11 Service, shall make grants to or enter into contracts with 

12 Indian Tribes and Tribal Organizations to assist such 

13 Tribes and Tribal Organizations in establishing and ad14 ministering programs on or near reservations and trust 

15 lands to assist individual Indians— 

16 ‘‘(1) to enroll for benefits under a program estab17 lished under title XVIII, XIX, or XXI of the Social 

18 Security Act and other health benefits programs; and 

19 ‘‘(2) with respect to such programs for which the 

20 charging of premiums and cost sharing is not prohib21 ited under such programs, to pay premiums or cost 

22 sharing for coverage for such benefits, which may be 

23 based on financial need (as determined by the Indian 

24 Tribe or Tribes or Tribal Organizations being served 

25 based on a schedule of income levels developed or imVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00190 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
191 

•HR 1328 RH

1 plemented by such Tribe, Tribes, or Tribal Organiza2 tions). 

3 ‘‘(b) CONDITIONS.—The Secretary, acting through the 

4 Service, shall place conditions as deemed necessary to effect 

5 the purpose of this section in any grant or contract which 

6 the Secretary makes with any Indian Tribe or Tribal Orga7 nization pursuant to this section. Such conditions shall in8 clude requirements that the Indian Tribe or Tribal Organi9 zation successfully undertake— 

10 ‘‘(1) to determine the population of Indians eli11 gible for the benefits described in subsection (a); 

12 ‘‘(2) to educate Indians with respect to the bene13 fits available under the respective programs; 

14 ‘‘(3) to provide transportation for such indi15 vidual Indians to the appropriate offices for enroll16 ment or applications for such benefits; and 

17 ‘‘(4) to develop and implement methods of im18 proving the participation of Indians in receiving ben19 efits under such programs. 

20 ‘‘(c) APPLICATION TO URBAN INDIAN ORGANIZA21 TIONS.— 

22 ‘‘(1) IN GENERAL.—The provisions of subsection 

23 (a) shall apply with respect to grants and other fund24 ing to Urban Indian Organizations with respect to 

25 populations served by such organizations in the same 


jbell on PROD1PC69 with BILLS
192 

•HR 1328 RH

1 manner they apply to grants and contracts with In2 dian Tribes and Tribal Organizations with respect to 

3 programs on or near reservations. 

4 ‘‘(2) REQUIREMENTS.—The Secretary shall in5 clude in the grants or contracts made or provided 

6 under paragraph (1) requirements that are— 

7 ‘‘(A) consistent with the requirements im8 posed by the Secretary under subsection (b); 

9 ‘‘(B) appropriate to Urban Indian Organi10 zations and Urban Indians; and 

11 ‘‘(C) necessary to effect the purposes of this 

12 section. 

13 ‘‘(d) FACILITATING COOPERATION.—The Secretary, 

14 acting through the Centers for Medicare & Medicaid Serv15 ices, shall take such steps as are necessary to facilitate co16 operation with, and agreements between, States and the 

17 Service, Indian Tribes, Tribal Organizations, or Urban In18 dian Organizations with respect to the provision of health 

19 care items and services to Indians under the programs es20 tablished under title XVIII, XIX, or XXI of the Social Secu21 rity Act. 

22 ‘‘(e) AGREEMENTS RELATING TO IMPROVING ENROLL23 MENT OF INDIANS UNDER SOCIAL SECURITY ACT HEALTH

24 BENEFITS PROGRAMS.—For provisions relating to agree25 ments between the Secretary, acting through the Service, 


jbell on PROD1PC69 with BILLS
193 

•HR 1328 RH

1 and Indian Tribes, Tribal Organizations, and Urban In2 dian Organizations for the collection, preparation, and sub3 mission of applications by Indians for assistance under the 

4 Medicaid and State children’s health insurance programs 

5 established under titles XIX and XXI of the Social Security 

6 Act, and benefits under the Medicare program established 

7 under title XVIII of such Act, see subsections (a) and (b) 

8 of section 1139 of the Social Security Act. 

9 ‘‘(f) DEFINITION OF PREMIUMS AND COST SHARING.— 

10 In this section: 

11 ‘‘(1) PREMIUM.—The term ‘premium’ includes 

12 any enrollment fee or similar charge. 

13 ‘‘(2) COST SHARING.—The term ‘cost sharing’ 

14 includes any deduction, deductible, copayment, coin15 surance, or similar charge. 

16 ‘‘SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PAR17 TIES OF COSTS OF HEALTH SERVICES. 

18 ‘‘(a) RIGHT OF RECOVERY.—Except as provided in 

19 subsection (f), the United States, an Indian Tribe, or Tribal 

20 Organization shall have the right to recover from an insur21 ance company, health maintenance organization, employee 

22 benefit plan, third-party tortfeasor, or any other responsible 

23 or liable third party (including a political subdivision or 

24 local governmental entity of a State) the reasonable charges 

25 billed by the Secretary, an Indian Tribe, or Tribal OrganiVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00193 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
194 

•HR 1328 RH

1 zation in providing health services through the Service, an 

2 Indian Tribe, or Tribal Organization to any individual to 

3 the same extent that such individual, or any nongovern4 mental provider of such services, would be eligible to receive 

5 damages, reimbursement, or indemnification for such 

6 charges or expenses if— 

7 ‘‘(1) such services had been provided by a non8 governmental provider; and 

9 ‘‘(2) such individual had been required to pay 

10 such charges or expenses and did pay such charges or 

11 expenses. 

12 ‘‘(b) LIMITATIONS ON RECOVERIES FROM STATES.— 

13 Subsection (a) shall provide a right of recovery against any 

14 State, only if the injury, illness, or disability for which 

15 health services were provided is covered under— 

16 ‘‘(1) workers’ compensation laws; or 

17 ‘‘(2) a no-fault automobile accident insurance 

18 plan or program. 

19 ‘‘(c) NONAPPLICATION OF OTHER LAWS.—No law of 

20 any State, or of any political subdivision of a State and 

21 no provision of any contract, insurance or health mainte22 nance organization policy, employee benefit plan, self-in23 surance plan, managed care plan, or other health care plan 

24 or program entered into or renewed after the date of the 

25 enactment of the Indian Health Care Amendments of 1988, 


jbell on PROD1PC69 with BILLS
195 

•HR 1328 RH

1 shall prevent or hinder the right of recovery of the United 

2 States, an Indian Tribe, or Tribal Organization under sub3 section (a). 

4 ‘‘(d) NO EFFECT ON PRIVATE RIGHTS OF ACTION.— 

5 No action taken by the United States, an Indian Tribe, or 

6 Tribal Organization to enforce the right of recovery pro7 vided under this section shall operate to deny to the injured 

8 person the recovery for that portion of the person’s damage 

9 not covered hereunder. 

10 ‘‘(e) ENFORCEMENT.— 

11 ‘‘(1) IN GENERAL.—The United States, an In12 dian Tribe, or Tribal Organization may enforce the 

13 right of recovery provided under subsection (a) by— 

14 ‘‘(A) intervening or joining in any civil ac15 tion or proceeding brought— 

16 ‘‘(i) by the individual for whom health 

17 services were provided by the Secretary, an 

18 Indian Tribe, or Tribal Organization; or 

19 ‘‘(ii) by any representative or heirs of 

20 such individual, or 

21 ‘‘(B) instituting a civil action, including a 

22 civil action for injunctive relief and other relief 

23 and including, with respect to a political sub24 division or local governmental entity of a State, 

25 such an action against an official thereof. 


jbell on PROD1PC69 with BILLS
196 

•HR 1328 RH

1 ‘‘(2) NOTICE.—All reasonable efforts shall be 

2 made to provide notice of action instituted under 

3 paragraph (1)(B) to the individual to whom health 

4 services were provided, either before or during the 

5 pendency of such action. 

6 ‘‘(3) RECOVERY FROM TORTFEASORS.— 

7 ‘‘(A) IN GENERAL.—In any case in which 

8 an Indian Tribe or Tribal Organization that is 

9 authorized or required under a compact or con10 tract issued pursuant to the Indian Self-Deter11 mination and Education Assistance Act (25 

12 U.S.C. 450 et seq.) to furnish or pay for health 

13 services to a person who is injured or suffers a 

14 disease on or after the date of enactment of the 

15 Indian Health Care Improvement Act Amend16 ments of 2007 under circumstances that establish 

17 grounds for a claim of liability against the 

18 tortfeasor with respect to the injury or disease, 

19 the Indian Tribe or Tribal Organization shall 

20 have a right to recover from the tortfeasor (or an 

21 insurer of the tortfeasor) the reasonable value of 

22 the health services so furnished, paid for, or to 

23 be paid for, in accordance with the Federal Med24 ical Care Recovery Act (42 U.S.C. 2651 et seq.), 

25 to the same extent and under the same cirVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00196 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
197 

•HR 1328 RH

1 cumstances as the United States may recover 

2 under that Act. 

3 ‘‘(B) TREATMENT.—The right of an Indian 

4 Tribe or Tribal Organization to recover under 

5 subparagraph (A) shall be independent of the 

6 rights of the injured or diseased person served by 

7 the Indian Tribe or Tribal Organization. 

8 ‘‘(f) LIMITATION.—Absent specific written authoriza9 tion by the governing body of an Indian Tribe for the period 

10 of such authorization (which may not be for a period of 

11 more than 1 year and which may be revoked at any time 

12 upon written notice by the governing body to the Service), 

13 the United States shall not have a right of recovery under 

14 this section if the injury, illness, or disability for which 

15 health services were provided is covered under a self-insur16 ance plan funded by an Indian Tribe, Tribal Organization, 

17 or Urban Indian Organization. Where such authorization 

18 is provided, the Service may receive and expend such 

19 amounts for the provision of additional health services con20 sistent with such authorization. 

21 ‘‘(g) COSTS AND ATTORNEYS’ FEES.—In any action 

22 brought to enforce the provisions of this section, a prevailing 

23 plaintiff shall be awarded its reasonable attorneys’ fees and 

24 costs of litigation. 


jbell on PROD1PC69 with BILLS
198 

•HR 1328 RH

1 ‘‘(h) NONAPPLICATION OF CLAIMS FILING REQUIRE2 MENTS.—An insurance company, health maintenance orga3 nization, self-insurance plan, managed care plan, or other 

4 health care plan or program (under the Social Security Act 

5 or otherwise) may not deny a claim for benefits submitted 

6 by the Service or by an Indian Tribe or Tribal Organiza7 tion based on the format in which the claim is submitted 

8 if such format complies with the format required for sub9 mission of claims under title XVIII of the Social Security 

10 Act or recognized under section 1175 of such Act. 

11 ‘‘(i) APPLICATION TO URBAN INDIAN ORGANIZA12 TIONS.—The previous provisions of this section shall apply 

13 to Urban Indian Organizations with respect to populations 

14 served by such Organizations in the same manner they 

15 apply to Indian Tribes and Tribal Organizations with re16 spect to populations served by such Indian Tribes and Trib17 al Organizations. 

18 ‘‘(j) STATUTE OF LIMITATIONS.—The provisions of sec19 tion 2415 of title 28, United States Code, shall apply to 

20 all actions commenced under this section, and the references 

21 therein to the United States are deemed to include Indian 

22 Tribes, Tribal Organizations, and Urban Indian Organiza23 tions. 

24 ‘‘(k) SAVINGS.—Nothing in this section shall be con25 strued to limit any right of recovery available to the United 


jbell on PROD1PC69 with BILLS
199 

•HR 1328 RH

1 States, an Indian Tribe, or Tribal Organization under the 

2 provisions of any applicable, Federal, State, or Tribal law, 

3 including medical lien laws. 

4 ‘‘SEC. 404. CREDITING OF REIMBURSEMENTS. 

5 ‘‘(a) USE OF AMOUNTS.— 

6 ‘‘(1) RETENTION BY PROGRAM.—Except as pro7 vided in section 202(f) (relating to the Catastrophic 

8 Health Emergency Fund) and section 807 (relating to 

9 health services for ineligible persons), all reimburse10 ments received or recovered under any of the pro11 grams described in paragraph (2), including under 

12 section 807, by reason of the provision of health serv13 ices by the Service, by an Indian Tribe or Tribal Or14 ganization, or by an Urban Indian Organization, 

15 shall be credited to the Service, such Indian Tribe or 

16 Tribal Organization, or such Urban Indian Organi17 zation, respectively, and may be used as provided in 

18 section 401. In the case of such a service provided by 

19 or through a Service Unit, such amounts shall be 

20 credited to such unit and used for such purposes. 

21 ‘‘(2) PROGRAMS COVERED.—The programs re22 ferred to in paragraph (1) are the following: 

23 ‘‘(A) Titles XVIII, XIX, and XXI of the So24 cial Security Act. 

25 ‘‘(B) This Act, including section 807. 


jbell on PROD1PC69 with BILLS
200 

•HR 1328 RH

1 ‘‘(C) Public Law 87–693. 

2 ‘‘(D) Any other provision of law. 

3 ‘‘(b) NO OFFSET OF AMOUNTS.—The Service may not 

4 offset or limit any amount obligated to any Service Unit 

5 or entity receiving funding from the Service because of the 

6 receipt of reimbursements under subsection (a). 

7 ‘‘SEC. 405. PURCHASING HEALTH CARE COVERAGE. 

8 ‘‘(a) IN GENERAL.—Insofar as amounts are made 

9 available under law (including a provision of the Social 

10 Security Act, the Indian Self-Determination and Education 

11 Assistance Act (25 U.S.C. 450 et seq.), or other law, other 

12 than under section 402) to Indian Tribes, Tribal Organiza13 tions, and Urban Indian Organizations for health benefits 

14 for Service beneficiaries, Indian Tribes, Tribal Organiza15 tions, and Urban Indian Organizations may use such 

16 amounts to purchase health benefits coverage for such bene17 ficiaries in any manner, including through— 

18 ‘‘(1) a tribally owned and operated health care 

19 plan; 

20 ‘‘(2) a State or locally authorized or licensed 

21 health care plan; 

22 ‘‘(3) a health insurance provider or managed 

23 care organization; or 

24 ‘‘(4) a self-insured plan. 


jbell on PROD1PC69 with BILLS
201 

•HR 1328 RH

1 The purchase of such coverage by an Indian Tribe, Tribal 

2 Organization, or Urban Indian Organization may be based 

3 on the financial needs of such beneficiaries (as determined 

4 by the Indian Tribe or Tribes being served based on a sched5 ule of income levels developed or implemented by such In6 dian Tribe or Tribes). 

7 ‘‘(b) EXPENSES FOR SELF-INSURED PLAN.—In the 

8 case of a self-insured plan under subsection (a)(4), the 

9 amounts may be used for expenses of operating the plan, 

10 including administration and insurance to limit the finan11 cial risks to the entity offering the plan. 

12 ‘‘(c) CONSTRUCTION.—Nothing in this section shall be 

13 construed as affecting the use of any amounts not referred 

14 to in subsection (a). 

15 ‘‘SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGEN16 CIES. 

17 ‘‘(a) AUTHORITY.— 

18 ‘‘(1) IN GENERAL.—The Secretary may enter 

19 into (or expand) arrangements for the sharing of 

20 medical facilities and services between the Service, In21 dian Tribes, and Tribal Organizations and the De22 partment of Veterans Affairs and the Department of 

23 Defense. 

24 ‘‘(2) CONSULTATION BY SECRETARY RE25 QUIRED.—The Secretary may not finalize any arVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00201 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
202 

•HR 1328 RH

1 rangement between the Service and a Department de2 scribed in paragraph (1) without first consulting with 

3 the Indian Tribes which will be significantly affected 

4 by the arrangement. 

5 ‘‘(b) LIMITATIONS.—The Secretary shall not take any 

6 action under this section or under subchapter IV of chapter 

7 81 of title 38, United States Code, which would impair— 

8 ‘‘(1) the priority access of any Indian to health 

9 care services provided through the Service and the eli10 gibility of any Indian to receive health services 

11 through the Service; 

12 ‘‘(2) the quality of health care services provided 

13 to any Indian through the Service; 

14 ‘‘(3) the priority access of any veteran to health 

15 care services provided by the Department of Veterans 

16 Affairs; 

17 ‘‘(4) the quality of health care services provided 

18 by the Department of Veterans Affairs or the Depart19 ment of Defense; or 

20 ‘‘(5) the eligibility of any Indian who is a vet21 eran to receive health services through the Department 

22 of Veterans Affairs. 

23 ‘‘(c) REIMBURSEMENT.—The Service, Indian Tribe, or 

24 Tribal Organization shall be reimbursed by the Department 

25 of Veterans Affairs or the Department of Defense (as the 


jbell on PROD1PC69 with BILLS
203 

•HR 1328 RH

1 case may be) where services are provided through the Serv2 ice, an Indian Tribe, or a Tribal Organization to bene3 ficiaries eligible for services from either such Department, 

4 notwithstanding any other provision of law. 

5 ‘‘(d) CONSTRUCTION.—Nothing in this section may be 

6 construed as creating any right of a non-Indian veteran 

7 to obtain health services from the Service. 

8 ‘‘SEC. 407. PAYOR OF LAST RESORT. 

9 ‘‘Indian Health Programs and health care programs 

10 operated by Urban Indian Organizations shall be the payor 

11 of last resort for services provided to persons eligible for 

12 services from Indian Health Programs and Urban Indian 

13 Organizations, notwithstanding any Federal, State, or local 

14 law to the contrary. 

15 ‘‘SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH 

16 CARE PROGRAMS IN QUALIFICATIONS FOR 

17 REIMBURSEMENT FOR SERVICES. 

18 ‘‘(a) REQUIREMENT TO SATISFY GENERALLY APPLI19 CABLE PARTICIPATION REQUIREMENTS.— 

20 ‘‘(1) IN GENERAL.—A Federal health care pro21 gram must accept an entity that is operated by the 

22 Service, an Indian Tribe, Tribal Organization, or 

23 Urban Indian Organization as a provider eligible to 

24 receive payment under the program for health care 

25 services furnished to an Indian on the same basis as 


jbell on PROD1PC69 with BILLS
204 

•HR 1328 RH

1 any other provider qualified to participate as a pro2 vider of health care services under the program if the 

3 entity meets generally applicable State or other re4 quirements for participation as a provider of health 

5 care services under the program. 

6 ‘‘(2) SATISFACTION OF STATE OR LOCAL LICEN7 SURE OR RECOGNITION REQUIREMENTS.—Any re8 quirement for participation as a provider of health 

9 care services under a Federal health care program 

10 that an entity be licensed or recognized under the 

11 State or local law where the entity is located to fur12 nish health care services shall be deemed to have been 

13 met in the case of an entity operated by the Service, 

14 an Indian Tribe, Tribal Organization, or Urban In15 dian Organization if the entity meets all the applica16 ble standards for such licensure or recognition, re17 gardless of whether the entity obtains a license or 

18 other documentation under such State or local law. In 

19 accordance with section 221, the absence of the licen20 sure of a health care professional employed by such 

21 an entity under the State or local law where the enti22 ty is located shall not be taken into account for pur23 poses of determining whether the entity meets such 

24 standards, if the professional is licensed in another 

25 State. 


jbell on PROD1PC69 with BILLS
205 

•HR 1328 RH

1 ‘‘(b) APPLICATION OF EXCLUSION FROM PARTICIPA2 TION IN FEDERAL HEALTH CARE PROGRAMS.— 

3 ‘‘(1) EXCLUDED ENTITIES.—No entity operated 

4 by the Service, an Indian Tribe, Tribal Organization, 

5 or Urban Indian Organization that has been excluded 

6 from participation in any Federal health care pro7 gram or for which a license is under suspension or 

8 has been revoked by the State where the entity is lo9 cated shall be eligible to receive payment or reim10 bursement under any such program for health care 

11 services furnished to an Indian. 

12 ‘‘(2) EXCLUDED INDIVIDUALS.—No individual 

13 who has been excluded from participation in any 

14 Federal health care program or whose State license is 

15 under suspension shall be eligible to receive payment 

16 or reimbursement under any such program for health 

17 care services furnished by that individual, directly or 

18 through an entity that is otherwise eligible to receive 

19 payment for health care services, to an Indian. 

20 ‘‘(3) FEDERAL HEALTH CARE PROGRAM DE21 FINED.—In this subsection, the term, ‘Federal health 

22 care program’ has the meaning given that term in 

23 section 1128B(f) of the Social Security Act (42 U.S.C. 

24 1320a–7b(f)), except that, for purposes of this sub25 section, such term shall include the health insurance 


jbell on PROD1PC69 with BILLS
206 

•HR 1328 RH

1 program under chapter 89 of title 5, United States 

2 Code. 

3 ‘‘(c) RELATED PROVISIONS.—For provisions related to 

4 nondiscrimination against providers operated by the Serv5 ice, an Indian Tribe, Tribal Organization, or Urban In6 dian Organization, see section 1139(c) of the Social Secu7 rity Act (42 U.S.C. 1320b–9(c)). 

8 ‘‘SEC. 409. CONSULTATION. 

9 ‘‘For provisions related to consultation with represent10 atives of Indian Health Programs and Urban Indian Orga11 nizations with respect to the health care programs estab12 lished under titles XVIII, XIX, and XXI of the Social Secu13 rity Act, see section 1139(d) of the Social Security Act (42 

14 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 like19 ly to be eligible for child health assistance under the 

20 State children’s health insurance program established 

21 under title XXI of the Social Security Act, see sec22 tions 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 pro25 vided under such program to targeted low-income 


jbell on PROD1PC69 with BILLS
207 

•HR 1328 RH

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 Act, 

14 see section 1128(k) of the Social Security Act (42 

15 U.S.C. 1320a–7(k)); and 

16 ‘‘(2) certain transactions involving Indian 

17 Health Programs deemed to be in safe harbors under 

18 that Act, see section 1128B(b)(4) of the Social Secu19 rity 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— 


jbell on PROD1PC69 with BILLS
208 

•HR 1328 RH

1 ‘‘(1) premiums or cost sharing protections for 

2 Indians furnished items or services directly by Indian 

3 Health Programs or through referral under the con4 tract health service under the Medicaid program es5 tablished under title XIX of the Social Security Act, 

6 see sections 1916(j) and 1916A(a)(1) of the Social Se7 curity Act (42 U.S.C. 1396o(j), 1396o–1(a)(1)); 

8 ‘‘(2) rules regarding the treatment of certain 

9 property for purposes of determining eligibility under 

10 such programs, see sections 1902(e)(13) and 

11 2107(e)(1)(B) of such Act (42 U.S.C. 1396a(e)(13), 

12 1397gg(e)(1)(B)); and 

13 ‘‘(3) the protection of certain property from es14 tate recovery provisions under the Medicaid program, 

15 see section 1917(b)(3)(B) of such Act (42 U.S.C. 

16 1396p(b)(3)(B)). 

17 ‘‘SEC. 413. TREATMENT UNDER MEDICAID AND SCHIP MAN18 AGED CARE. 

19 ‘‘For provisions relating to the treatment of Indians 

20 enrolled in a managed care entity under the Medicaid pro21 gram under title XIX of the Social Security Act and Indian 

22 Health Programs and Urban Indian Organizations that 

23 are providers of items or services to such Indian enrollees, 

24 see sections 1932(h) and 2107(e)(1)(H) of the Social Secu25 rity Act (42 U.S.C. 1396u–2(h), 1397gg(e)(1)(H)). 


jbell on PROD1PC69 with BILLS
209 

•HR 1328 RH

1 ‘‘SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASIBILITY 

2 STUDY. 

3 ‘‘(a) STUDY.—The Secretary shall conduct a study to 

4 determine the feasibility of treating the Navajo Nation as 

5 a State for the purposes of title XIX of the Social Security 

6 Act, to provide services to Indians living within the bound7 aries of the Navajo Nation through an entity established 

8 having the same authority and performing the same func9 tions as single-State medicaid agencies responsible for the 

10 administration of the State plan under title XIX of the So11 cial Security Act. 

12 ‘‘(b) CONSIDERATIONS.—In conducting the study, the 

13 Secretary shall consider the feasibility of— 

14 ‘‘(1) assigning and paying all expenditures for 

15 the provision of services and related administration 

16 funds, under title XIX of the Social Security Act, to 

17 Indians living within the boundaries of the Navajo 

18 Nation that are currently paid to or would otherwise 

19 be paid to the State of Arizona, New Mexico, or Utah; 

20 ‘‘(2) providing assistance to the Navajo Nation 

21 in the development and implementation of such entity 

22 for the administration, eligibility, payment, and de23 livery of medical assistance under title XIX of the So24 cial Security Act; 

25 ‘‘(3) providing an appropriate level of matching 

26 funds for Federal medical assistance with respect to 


jbell on PROD1PC69 with BILLS
210 

•HR 1328 RH

1 amounts such entity expends for medical assistance 

2 for services and related administrative costs; and 

3 ‘‘(4) authorizing the Secretary, at the option of 

4 the Navajo Nation, to treat the Navajo Nation as a 

5 State for the purposes of title XIX of the Social Secu6 rity Act (relating to the State children’s health insur7 ance program) under terms equivalent to those de8 scribed in paragraphs (2) through (4). 

9 ‘‘(c) REPORT.—Not later then 3 years after the date 

10 of enactment of the Indian Health Care Improvement Act 

11 Amendments of 2007, the Secretary shall submit to the 

12 Committee on Indian Affairs and Committee on Finance 

13 of the Senate and the Committee on Natural Resources and 

14 Committee on Energy and Commerce of the House of Rep15 resentatives a report that includes— 

16 ‘‘(1) the results of the study under this section; 

17 ‘‘(2) a summary of any consultation that oc18 curred between the Secretary and the Navajo Nation, 

19 other Indian Tribes, the States of Arizona, New Mex20 ico, and Utah, counties which include Navajo Lands, 

21 and other interested parties, in conducting this study; 

22 ‘‘(3) projected costs or savings associated with es23 tablishment of such entity, and any estimated impact 

24 on services provided as described in this section in re25 lation to probable costs or savings; and 


jbell on PROD1PC69 with BILLS
211 

•HR 1328 RH

1 ‘‘(4) legislative actions that would be required to 

2 authorize the establishment of such entity if such enti3 ty is determined by the Secretary to be feasible. 

4 ‘‘SEC. 415. GENERAL EXCEPTIONS. 

5 ‘‘The requirements of this title shall not apply to any 

6 excepted benefits described in paragraph (1)(A) or (3) of 

7 section 2791(c) of the Public Health Service Act (42 U.S.C. 

8 300gg–91). 

9 ‘‘SEC. 416. AUTHORIZATION OF APPROPRIATIONS. 

10 ‘‘There are authorized to be appropriated such sums 

11 as may be necessary for each fiscal year through fiscal year 

12 2017 to carry out this title. 

13 ‘‘TITLE V—HEALTH SERVICES 

14 FOR URBAN INDIANS 

15 ‘‘SEC. 501. PURPOSE. 

16 ‘‘The purpose of this title is to establish and maintain 

17 programs in Urban Centers to make health services more 

18 accessible and available to Urban Indians. 

19 ‘‘SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN IN20 DIAN ORGANIZATIONS. 

21 ‘‘Under authority of the Act of November 2, 1921 (25 

22 U.S.C. 13) (commonly known as the ‘Snyder Act’), the Sec23 retary, acting through the Service, shall enter into contracts 

24 with, or make grants to, Urban Indian Organizations to 

25 assist such organizations in the establishment and adminisVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00211 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
212 

•HR 1328 RH

1 tration, within Urban Centers, of programs which meet the 

2 requirements set forth in this title. Subject to section 506, 

3 the Secretary, acting through the Service, shall include such 

4 conditions as the Secretary considers necessary to effect the 

5 purpose of this title in any contract into which the Sec6 retary enters with, or in any grant the Secretary makes 

7 to, any Urban Indian Organization pursuant to this title. 

8 ‘‘SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION 

9 OF HEALTH CARE AND REFERRAL SERVICES. 

10 ‘‘(a) REQUIREMENTS FOR GRANTS AND CONTRACTS.— 

11 Under authority of the Act of November 2, 1921 (25 U.S.C. 

12 13) (commonly known as the ‘Snyder Act’), the Secretary, 

13 acting through the Service, shall enter into contracts with, 

14 and make grants to, Urban Indian Organizations for the 

15 provision of health care and referral services for Urban In16 dians. Any such contract or grant shall include require17 ments that the Urban Indian Organization successfully un18 dertake to— 

19 ‘‘(1) estimate the population of Urban Indians 

20 residing in the Urban Center or centers that the orga21 nization proposes to serve who are or could be recipi22 ents of health care or referral services; 

23 ‘‘(2) estimate the current health status of Urban 

24 Indians residing in such Urban Center or centers; 


jbell on PROD1PC69 with BILLS
213 

•HR 1328 RH

1 ‘‘(3) estimate the current health care needs of 

2 Urban Indians residing in such Urban Center or cen3 ters; 

4 ‘‘(4) provide basic health education, including 

5 health promotion and disease prevention education, to 

6 Urban Indians; 

7 ‘‘(5) make recommendations to the Secretary and 

8 Federal, State, local, and other resource agencies on 

9 methods of improving health service programs to meet 

10 the needs of Urban Indians; and 

11 ‘‘(6) where necessary, provide, or enter into con12 tracts for the provision of, health care services for 

13 Urban Indians. 

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

15 Service, shall, by regulation, prescribe the criteria for select16 ing Urban Indian Organizations to enter into contracts or 

17 receive grants under this section. Such criteria shall, among 

18 other factors, include— 

19 ‘‘(1) the extent of unmet health care needs of 

20 Urban Indians in the Urban Center or centers in21 volved; 

22 ‘‘(2) the size of the Urban Indian population in 

23 the Urban Center or centers involved; 

24 ‘‘(3) the extent, if any, to which the activities set 

25 forth in subsection (a) would duplicate any project 


jbell on PROD1PC69 with BILLS
214 

•HR 1328 RH

1 funded under this title, or under any current public 

2 health service project funded in a manner other than 

3 pursuant to this title; 

4 ‘‘(4) the capability of an Urban Indian Organi5 zation to perform the activities set forth in subsection 

6 (a) and to enter into a contract with the Secretary 

7 or to meet the requirements for receiving a grant 

8 under this section; 

9 ‘‘(5) the satisfactory performance and successful 

10 completion by an Urban Indian Organization of 

11 other contracts with the Secretary under this title; 

12 ‘‘(6) the appropriateness and likely effectiveness 

13 of conducting the activities set forth in subsection (a) 

14 in an Urban Center or centers; and 

15 ‘‘(7) the extent of existing or likely future par16 ticipation in the activities set forth in subsection (a) 

17 by appropriate health and health-related Federal, 

18 State, local, and other agencies. 

19 ‘‘(c) ACCESS TO HEALTH PROMOTION AND DISEASE

20 PREVENTION PROGRAMS.—The Secretary, acting through 

21 the Service, shall facilitate access to or provide health pro22 motion and disease prevention services for Urban Indians 

23 through grants made to Urban Indian Organizations ad24 ministering contracts entered into or receiving grants under 

25 subsection (a). 


jbell on PROD1PC69 with BILLS
215 

•HR 1328 RH

1 ‘‘(d) IMMUNIZATION SERVICES.— 

2 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The Sec3 retary, acting through the Service, shall facilitate ac4 cess to, or provide, immunization services for Urban 

5 Indians through grants made to Urban Indian Orga6 nizations administering contracts entered into or re7 ceiving grants under this section. 

8 ‘‘(2) DEFINITION.—For purposes of this sub9 section, the term ‘immunization services’ means serv10 ices to provide without charge immunizations against 

11 vaccine-preventable diseases. 

12 ‘‘(e) BEHAVIORAL HEALTH SERVICES.— 

13 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The Sec14 retary, acting through the Service, shall facilitate ac15 cess to, or provide, behavioral health services for 

16 Urban Indians through grants made to Urban Indian 

17 Organizations administering contracts entered into or 

18 receiving grants under subsection (a). 

19 ‘‘(2) ASSESSMENT REQUIRED.—Except as pro20 vided by paragraph (3)(A), a grant may not be made 

21 under this subsection to an Urban Indian Organiza22 tion until that organization has prepared, and the 

23 Service has approved, an assessment of the following: 

24 ‘‘(A) The behavioral health needs of the 

25 Urban Indian population concerned. 


jbell on PROD1PC69 with BILLS
216 

•HR 1328 RH

1 ‘‘(B) The behavioral health services and 

2 other related resources available to that popu3 lation. 

4 ‘‘(C) The barriers to obtaining those services 

5 and resources. 

6 ‘‘(D) The needs that are unmet by such 

7 services and resources. 

8 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

9 made under this subsection for the following: 

10 ‘‘(A) To prepare assessments required under 

11 paragraph (2). 

12 ‘‘(B) To provide outreach, educational, and 

13 referral services to Urban Indians regarding the 

14 availability of direct behavioral health services, 

15 to educate Urban Indians about behavioral 

16 health issues and services, and effect coordina17 tion with existing behavioral health providers in 

18 order to improve services to Urban Indians. 

19 ‘‘(C) To provide outpatient behavioral 

20 health services to Urban Indians, including the 

21 identification and assessment of illness, thera22 peutic treatments, case management, support 

23 groups, family treatment, and other treatment. 


jbell on PROD1PC69 with BILLS
217 

•HR 1328 RH

1 ‘‘(D) To develop innovative behavioral 

2 health service delivery models which incorporate 

3 Indian cultural support systems and resources. 

4 ‘‘(f) PREVENTION OF CHILD ABUSE.— 

5 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The Sec6 retary, acting through the Service, shall facilitate ac7 cess to or provide services for Urban Indians through 

8 grants to Urban Indian Organizations administering 

9 contracts entered into or receiving grants under sub10 section (a) to prevent and treat child abuse (including 

11 sexual abuse) among Urban Indians. 

12 ‘‘(2) EVALUATION REQUIRED.—Except as pro13 vided by paragraph (3)(A), a grant may not be made 

14 under this subsection to an Urban Indian Organiza15 tion until that organization has prepared, and the 

16 Service has approved, an assessment that documents 

17 the prevalence of child abuse in the Urban Indian 

18 population concerned and specifies the services and 

19 programs (which may not duplicate existing services 

20 and programs) for which the grant is requested. 

21 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

22 made under this subsection for the following: 

23 ‘‘(A) To prepare assessments required under 

24 paragraph (2). 


jbell on PROD1PC69 with BILLS
218 

•HR 1328 RH

1 ‘‘(B) For the development of prevention, 

2 training, and education programs for Urban In3 dians, including child education, parent edu4 cation, provider training on identification and 

5 intervention, education on reporting require6 ments, prevention campaigns, and establishing 

7 service networks of all those involved in Indian 

8 child protection. 

9 ‘‘(C) To provide direct outpatient treatment 

10 services (including individual treatment, family 

11 treatment, group therapy, and support groups) 

12 to Urban Indians who are child victims of abuse 

13 (including sexual abuse) or adult survivors of 

14 child sexual abuse, to the families of such child 

15 victims, and to Urban Indian perpetrators of 

16 child abuse (including sexual abuse). 

17 ‘‘(4) CONSIDERATIONS WHEN MAKING GRANTS.— 

18 In making grants to carry out this subsection, the 

19 Secretary shall take into consideration— 

20 ‘‘(A) the support for the Urban Indian Or21 ganization demonstrated by the child protection 

22 authorities in the area, including committees or 

23 other services funded under the Indian Child 

24 Welfare Act of 1978 (25 U.S.C. 1901 et seq.), if 

25 any; 


jbell on PROD1PC69 with BILLS
219 

•HR 1328 RH

1 ‘‘(B) the capability and expertise dem2 onstrated by the Urban Indian Organization to 

3 address the complex problem of child sexual 

4 abuse in the community; and 

5 ‘‘(C) the assessment required under para6 graph (2). 

7 ‘‘(g) OTHER GRANTS.—The Secretary, acting through 

8 the Service, may enter into a contract with or make grants 

9 to an Urban Indian Organization that provides or arranges 

10 for the provision of health care services (through satellite 

11 facilities, provider networks, or otherwise) to Urban Indi12 ans in more than 1 Urban Center. 

13 ‘‘SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINA14 TION OF UNMET HEALTH CARE NEEDS. 

15 ‘‘(a) GRANTS AND CONTRACTS AUTHORIZED.—Under 

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

17 (commonly known as the ‘Snyder Act’), the Secretary, act18 ing through the Service, may enter into contracts with or 

19 make grants to Urban Indian Organizations situated in 

20 Urban Centers for which contracts have not been entered 

21 into or grants have not been made under section 503. 

22 ‘‘(b) PURPOSE.—The purpose of a contract or grant 

23 made under this section shall be the determination of the 

24 matters described in subsection (c)(1) in order to assist the 

25 Secretary in assessing the health status and health care 


jbell on PROD1PC69 with BILLS
220 

•HR 1328 RH

1 needs of Urban Indians in the Urban Center involved and 

2 determining whether the Secretary should enter into a con3 tract or make a grant under section 503 with respect to 

4 the Urban Indian Organization which the Secretary has en5 tered into a contract with, or made a grant to, under this 

6 section. 

7 ‘‘(c) GRANT AND CONTRACT REQUIREMENTS.—Any 

8 contract entered into, or grant made, by the Secretary 

9 under this section shall include requirements that— 

10 ‘‘(1) the Urban Indian Organization successfully 

11 undertakes to— 

12 ‘‘(A) document the health care status and 

13 unmet health care needs of Urban Indians in the 

14 Urban Center involved; and 

15 ‘‘(B) with respect to Urban Indians in the 

16 Urban Center involved, determine the matters 

17 described in paragraphs (2), (3), (4), and (7) of 

18 section 503(b); and 

19 ‘‘(2) the Urban Indian Organization complete 

20 performance of the contract, or carry out the require21 ments of the grant, within 1 year after the date on 

22 which the Secretary and such organization enter into 

23 such contract, or within 1 year after such organiza24 tion receives such grant, whichever is applicable. 


jbell on PROD1PC69 with BILLS
221 

•HR 1328 RH

1 ‘‘(d) NO RENEWALS.—The Secretary may not renew 

2 any contract entered into or grant made under this section. 

3 ‘‘SEC. 505. EVALUATIONS; RENEWALS. 

4 ‘‘(a) PROCEDURES FOR EVALUATIONS.—The Sec5 retary, acting through the Service, shall develop procedures 

6 to evaluate compliance with grant requirements and com7 pliance with and performance of contracts entered into by 

8 Urban Indian Organizations under this title. Such proce9 dures shall include provisions for carrying out the require10 ments of this section. 

11 ‘‘(b) EVALUATIONS.—The Secretary, acting through 

12 the Service, shall evaluate the compliance of each Urban 

13 Indian Organization which has entered into a contract or 

14 received a grant under section 503 with the terms of such 

15 contract or grant. For purposes of this evaluation, the Sec16 retary shall— 

17 ‘‘(1) acting through the Service, conduct an an18 nual onsite evaluation of the organization; or 

19 ‘‘(2) accept in lieu of such onsite evaluation evi20 dence of the organization’s provisional or full accredi21 tation by a private independent entity recognized by 

22 the Secretary for purposes of conducting quality re23 views of providers participating in the Medicare pro24 gram under title XVIII of the Social Security Act. 


jbell on PROD1PC69 with BILLS
222 

•HR 1328 RH

1 ‘‘(c) NONCOMPLIANCE; UNSATISFACTORY PERFORM2 ANCE.—If, as a result of the evaluations conducted under 

3 this section, the Secretary determines that an Urban Indian 

4 Organization has not complied with the requirements of a 

5 grant or complied with or satisfactorily performed a con6 tract under section 503, the Secretary shall, prior to renew7 ing such contract or grant, attempt to resolve with the orga8 nization the areas of noncompliance or unsatisfactory per9 formance and modify the contract or grant to prevent future 

10 occurrences of noncompliance or unsatisfactory perform11 ance. If the Secretary determines that the noncompliance 

12 or unsatisfactory performance cannot be resolved and pre13 vented in the future, the Secretary shall not renew the con14 tract or grant with the organization and is authorized to 

15 enter into a contract or make a grant under section 503 

16 with another Urban Indian Organization which is situated 

17 in the same Urban Center as the Urban Indian Organiza18 tion whose contract or grant is not renewed under this sec19 tion. 

20 ‘‘(d) CONSIDERATIONS FOR RENEWALS.—In deter21 mining whether to renew a contract or grant with an Urban 

22 Indian Organization under section 503 which has com23 pleted performance of a contract or grant under section 504, 

24 the Secretary shall review the records of the Urban Indian 

25 Organization, the reports submitted under section 507, and 


jbell on PROD1PC69 with BILLS
223 

•HR 1328 RH

1 shall consider the results of the onsite evaluations or accred2 itations under subsection (b). 

3 ‘‘SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS. 

4 ‘‘(a) PROCUREMENT.—Contracts with Urban Indian 

5 Organizations entered into pursuant to this title shall be 

6 in accordance with all Federal contracting laws and regula7 tions relating to procurement except that in the discretion 

8 of the Secretary, such contracts may be negotiated without 

9 advertising and need not conform to the provisions of sec10 tions 1304 and 3131 through 3133 of title 40, United States 

11 Code. 

12 ‘‘(b) PAYMENTS UNDER CONTRACTS OR GRANTS.— 

13 ‘‘(1) IN GENERAL.—Payments under any con14 tracts or grants pursuant to this title, notwith15 standing any term or condition of such contract or 

16 grant— 

17 ‘‘(A) may be made in a single advance pay18 ment by the Secretary to the Urban Indian Or19 ganization by no later than the end of the first 

20 30 days of the funding period with respect to 

21 which the payments apply, unless the Secretary 

22 determines through an evaluation under section 

23 505 that the organization is not capable of ad24 ministering such a single advance payment; and 


jbell on PROD1PC69 with BILLS
224 

•HR 1328 RH

1 ‘‘(B) if any portion thereof is unexpended 

2 by the Urban Indian Organization during the 

3 funding period with respect to which the pay4 ments initially apply, shall be carried forward 

5 for expenditure with respect to allowable or re6 imbursable costs incurred by the organization 

7 during 1 or more subsequent funding periods 

8 without additional justification or documenta9 tion by the organization as a condition of car10 rying forward the availability for expenditure of 

11 such funds. 

12 ‘‘(2) SEMIANNUAL AND QUARTERLY PAYMENTS

13 AND REIMBURSEMENTS.—If the Secretary determines 

14 under paragraph (1)(A) that an Urban Indian Orga15 nization is not capable of administering an entire 

16 single advance payment, on request of the Urban In17 dian Organization, the payments may be made— 

18 ‘‘(A) in semiannual or quarterly payments 

19 by not later than 30 days after the date on which 

20 the funding period with respect to which the 

21 payments apply begins; or 

22 ‘‘(B) by way of reimbursement. 

23 ‘‘(c) REVISION OR AMENDMENT OF CONTRACTS.—Not24 withstanding any provision of law to the contrary, the Sec25 retary may, at the request and consent of an Urban Indian 


jbell on PROD1PC69 with BILLS
225 

•HR 1328 RH

1 Organization, revise or amend any contract entered into 

2 by the Secretary with such organization under this title as 

3 necessary to carry out the purposes of this title. 

4 ‘‘(d) FAIR AND UNIFORM SERVICES AND ASSIST5 ANCE.—Contracts with or grants to Urban Indian Organi6 zations and regulations adopted pursuant to this title shall 

7 include provisions to assure the fair and uniform provision 

8 to Urban Indians of services and assistance under such con9 tracts or grants by such organizations. 

10 ‘‘SEC. 507. REPORTS AND RECORDS. 

11 ‘‘(a) REPORTS.— 

12 ‘‘(1) IN GENERAL.—For each fiscal year during 

13 which an Urban Indian Organization receives or ex14 pends funds pursuant to a contract entered into or a 

15 grant received pursuant to this title, such Urban In16 dian Organization shall submit to the Secretary not 

17 more frequently than every 6 months, a report that 

18 includes the following: 

19 ‘‘(A) In the case of a contract or grant 

20 under section 503, recommendations pursuant to 

21 section 503(a)(5). 

22 ‘‘(B) Information on activities conducted by 

23 the organization pursuant to the contract or 

24 grant. 


jbell on PROD1PC69 with BILLS
226 

•HR 1328 RH

1 ‘‘(C) An accounting of the amounts and 

2 purpose for which Federal funds were expended. 

3 ‘‘(D) A minimum set of data, using uni4 formly defined elements, as specified by the Sec5 retary after consultation with Urban Indian Or6 ganizations. 

7 ‘‘(2) HEALTH STATUS AND SERVICES.— 

8 ‘‘(A) IN GENERAL.—Not later than 18 

9 months after the date of enactment of the Indian 

10 Health Care Improvement Act Amendments of 

11 2007, the Secretary, acting through the Service, 

12 shall submit to Congress a report evaluating— 

13 ‘‘(i) the health status of Urban Indi14 ans; 

15 ‘‘(ii) the services provided to Indians 

16 pursuant to this title; and 

17 ‘‘(iii) areas of unmet needs in the de18 livery of health services to Urban Indians. 

19 ‘‘(B) CONSULTATION AND CONTRACTS.—In 

20 preparing the report under paragraph (1), the 

21 Secretary— 

22 ‘‘(i) shall consult with Urban Indian 

23 Organizations; and 

24 ‘‘(ii) may enter into a contract with a 

25 national organization representing Urban 


jbell on PROD1PC69 with BILLS
227 

•HR 1328 RH

1 Indian Organizations to conduct any aspect 

2 of the report. 

3 ‘‘(b) AUDIT.—The reports and records of the Urban In4 dian Organization with respect to a contract or grant under 

5 this title shall be subject to audit by the Secretary and the 

6 Comptroller General of the United States. 

7 ‘‘(c) COSTS OF AUDITS.—The Secretary shall allow as 

8 a cost of any contract or grant entered into or awarded 

9 under section 502 or 503 the cost of an annual independent 

10 financial audit conducted by— 

11 ‘‘(1) a certified public accountant; or 

12 ‘‘(2) a certified public accounting firm qualified 

13 to conduct Federal compliance audits. 

14 ‘‘SEC. 508. LIMITATION ON CONTRACT AUTHORITY. 

15 ‘‘The authority of the Secretary to enter into contracts 

16 or to award grants under this title shall be to the extent, 

17 and in an amount, provided for in appropriation Acts. 

18 ‘‘SEC. 509. FACILITIES. 

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

20 Service, may make grants to contractors or grant recipients 

21 under this title for the lease, purchase, renovation, construc22 tion, or expansion of facilities, including leased facilities, 

23 in order to assist such contractors or grant recipients in 

24 complying with applicable licensure or certification re25 quirements. 


jbell on PROD1PC69 with BILLS
228 

•HR 1328 RH

1 ‘‘(b) LOAN FUND STUDY.—The Secretary, acting 

2 through the Service, may carry out a study to determine 

3 the feasibility of establishing a loan fund to provide to 

4 Urban Indian Organizations direct loans or guarantees for 

5 loans for the construction of health care facilities in a man6 ner consistent with section 309, including by submitting a 

7 report in accordance with subsection (c) of that section. 

8 ‘‘SEC. 510. DIVISION OF URBAN INDIAN HEALTH. 

9 ‘‘There is established within the Service a Division of 

10 Urban Indian Health, which shall be responsible for— 

11 ‘‘(1) carrying out the provisions of this title; 

12 ‘‘(2) providing central oversight of the programs 

13 and services authorized under this title; and 

14 ‘‘(3) providing technical assistance to Urban In15 dian Organizations. 

16 ‘‘SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE17 RELATED SERVICES. 

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

19 through the Service, may make grants for the provision of 

20 health-related services in prevention of, treatment of, reha21 bilitation of, or school- and community-based education re22 garding, alcohol and substance abuse in Urban Centers to 

23 those Urban Indian Organizations with which the Sec24 retary has entered into a contract under this title or under 

25 section 201. 


jbell on PROD1PC69 with BILLS
229 

•HR 1328 RH

1 ‘‘(b) GOALS.—Each grant made pursuant to subsection 

2 (a) shall set forth the goals to be accomplished pursuant 

3 to the grant. The goals shall be specific to each grant as 

4 agreed to between the Secretary and the grantee. 

5 ‘‘(c) CRITERIA.—The Secretary shall establish criteria 

6 for the grants made under subsection (a), including criteria 

7 relating to the following: 

8 ‘‘(1) The size of the Urban Indian population. 

9 ‘‘(2) Capability of the organization to adequately 

10 perform the activities required under the grant. 

11 ‘‘(3) Satisfactory performance standards for the 

12 organization in meeting the goals set forth in such 

13 grant. The standards shall be negotiated and agreed 

14 to between the Secretary and the grantee on a grant15 by-grant basis. 

16 ‘‘(4) Identification of the need for services. 

17 ‘‘(d) ALLOCATION OF GRANTS.—The Secretary shall 

18 develop a methodology for allocating grants made pursuant 

19 to this section based on the criteria established pursuant 

20 to subsection (c). 

21 ‘‘(e) GRANTS SUBJECT TO CRITERIA.—Any grant re22 ceived by an Urban Indian Organization under this Act 

23 for substance abuse prevention, treatment, and rehabilita24 tion shall be subject to the criteria set forth in subsection 

25 (c). 


jbell on PROD1PC69 with BILLS
230 

•HR 1328 RH

1 ‘‘SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION 

2 PROJECTS. 

3 ‘‘Notwithstanding any other provision of law, the 

4 Tulsa Clinic and Oklahoma City Clinic demonstration 

5 projects shall— 

6 ‘‘(1) be permanent programs within the Service’s 

7 direct care program; 

8 ‘‘(2) continue to be treated as Service Units and 

9 Operating Units in the allocation of resources and co10 ordination of care; and 

11 ‘‘(3) continue to meet the requirements and defi12 nitions of an Urban Indian Organization in this Act, 

13 and shall not be subject to the provisions of the In14 dian Self-Determination and Education Assistance 

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

16 ‘‘SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS. 

17 ‘‘(a) GRANTS AND CONTRACTS.—The Secretary, 

18 through the Division of Urban Indian Health, shall make 

19 grants or enter into contracts with Urban Indian Organiza20 tions, to take effect not later than September 30, 2010, for 

21 the administration of Urban Indian alcohol programs that 

22 were originally established under the National Institute on 

23 Alcoholism and Alcohol Abuse (hereafter in this section re24 ferred to as ‘NIAAA’) and transferred to the Service. 

25 ‘‘(b) USE OF FUNDS.—Grants provided or contracts 

26 entered into under this section shall be used to provide supVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00230 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
231 

•HR 1328 RH

1 port for the continuation of alcohol prevention and treat2 ment services for Urban Indian populations and such other 

3 objectives as are agreed upon between the Service and a re4 cipient of a grant or contract under this section. 

5 ‘‘(c) ELIGIBILITY.—Urban Indian Organizations that 

6 operate Indian alcohol programs originally funded under 

7 the NIAAA and subsequently transferred to the Service are 

8 eligible for grants or contracts under this section. 

9 ‘‘(d) REPORT.—The Secretary shall evaluate and re10 port to Congress on the activities of programs funded under 

11 this section not less than every 5 years. 

12 ‘‘SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZA13 TIONS. 

14 ‘‘(a) IN GENERAL.—The Secretary shall ensure that 

15 the Service consults, to the greatest extent practicable, with 

16 Urban Indian Organizations. 

17 ‘‘(b) DEFINITION OF CONSULTATION.—For purposes of 

18 subsection (a), consultation is the open and free exchange 

19 of information and opinions which leads to mutual under20 standing and comprehension and which emphasizes trust, 

21 respect, and shared responsibility. 

22 ‘‘SEC. 515. URBAN YOUTH TREATMENT CENTER DEM23 ONSTRATION. 

24 ‘‘(a) CONSTRUCTION AND OPERATION.—The Secretary, 

25 acting through the Service, through grant or contract, is 


jbell on PROD1PC69 with BILLS
232 

•HR 1328 RH

1 authorized to fund the construction and operation of at least 

2 2 residential treatment centers in each State described in 

3 subsection (b) to demonstrate the provision of alcohol and 

4 substance abuse treatment services to Urban Indian youth 

5 in a culturally competent residential setting. 

6 ‘‘(b) DEFINITION OF STATE.—A State described in this 

7 subsection is a State in which— 

8 ‘‘(1) there resides Urban Indian youth with need 

9 for alcohol and substance abuse treatment services in 

10 a residential setting; and 

11 ‘‘(2) there is a significant shortage of culturally 

12 competent residential treatment services for Urban 

13 Indian youth. 

14 ‘‘SEC. 516. GRANTS FOR DIABETES PREVENTION, TREAT15 MENT, AND CONTROL. 

16 ‘‘(a) GRANTS AUTHORIZED.—The Secretary may 

17 make grants to those Urban Indian Organizations that have 

18 entered into a contract or have received a grant under this 

19 title for the provision of services for the prevention and 

20 treatment of, and control of the complications resulting 

21 from, diabetes among Urban Indians. 

22 ‘‘(b) GOALS.—Each grant made pursuant to subsection 

23 (a) shall set forth the goals to be accomplished under the 

24 grant. The goals shall be specific to each grant as agreed 

25 to between the Secretary and the grantee. 


jbell on PROD1PC69 with BILLS
233 

•HR 1328 RH

1 ‘‘(c) ESTABLISHMENT OF CRITERIA.—The Secretary 

2 shall establish criteria for the grants made under subsection 

3 (a) relating to— 

4 ‘‘(1) the size and location of the Urban Indian 

5 population to be served; 

6 ‘‘(2) the need for prevention of and treatment of, 

7 and control of the complications resulting from, dia8 betes among the Urban Indian population to be 

9 served; 

10 ‘‘(3) performance standards for the organization 

11 in meeting the goals set forth in such grant that are 

12 negotiated and agreed to by the Secretary and the 

13 grantee; 

14 ‘‘(4) the capability of the organization to ade15 quately perform the activities required under the 

16 grant; and 

17 ‘‘(5) the willingness of the organization to col18 laborate with the registry, if any, established by the 

19 Secretary under section 204(e) in the Area Office of 

20 the Service in which the organization is located. 

21 ‘‘(d) FUNDS SUBJECT TO CRITERIA.—Any funds re22 ceived by an Urban Indian Organization under this Act 

23 for the prevention, treatment, and control of diabetes among 

24 Urban Indians shall be subject to the criteria developed by 

25 the Secretary under subsection (c). 


jbell on PROD1PC69 with BILLS
234 

•HR 1328 RH

1 ‘‘SEC. 517. COMMUNITY HEALTH REPRESENTATIVES. 

2 ‘‘The Secretary, acting through the Service, may enter 

3 into contracts with, and make grants to, Urban Indian Or4 ganizations for the employment of Indians trained as health 

5 service providers through the Community Health Represent6 atives Program under section 109 in the provision of health 

7 care, health promotion, and disease prevention services to 

8 Urban Indians. 

9 ‘‘SEC. 518. EFFECTIVE DATE. 

10 ‘‘The amendments made by the Indian Health Care 

11 Improvement Act Amendments of 2007 to this title shall 

12 take effect beginning on the date of enactment of that Act, 

13 regardless of whether the Secretary has promulgated regula14 tions implementing such amendments. 

15 ‘‘SEC. 519. ELIGIBILITY FOR SERVICES. 

16 ‘‘Urban Indians shall be eligible for, and the ultimate 

17 beneficiaries of, health care or referral services provided 

18 pursuant to this title. 

19 ‘‘SEC. 520. AUTHORIZATION OF APPROPRIATIONS. 

20 ‘‘There are authorized to be appropriated such sums 

21 as may be necessary for each fiscal year through fiscal year 

22 2017 to carry out this title. 


jbell on PROD1PC69 with BILLS
235 

•HR 1328 RH

1 ‘‘TITLE VI—ORGANIZATIONAL 

2 IMPROVEMENTS 

3 ‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV4 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

5 SERVICE. 

6 ‘‘(a) ESTABLISHMENT.— 

7 ‘‘(1) IN GENERAL.—In order to more effectively 

8 and efficiently carry out the responsibilities, authori9 ties, and functions of the United States to provide 

10 health care services to Indians and Indian Tribes, as 

11 are or may be hereafter provided by Federal statute 

12 or treaties, there is established within the Public 

13 Health Service of the Department the Indian Health 

14 Service. 

15 ‘‘(2) ASSISTANT SECRETARY OF INDIAN

16 HEALTH.—The Service shall be administered by an 

17 Assistant Secretary of Indian Health, who shall be 

18 appointed by the President, by and with the advice 

19 and consent of the Senate. The Assistant Secretary 

20 shall report to the Secretary. Effective with respect to 

21 an individual appointed by the President, by and 

22 with the advice and consent of the Senate, after Janu23 ary 1, 2007, the term of service of the Assistant Sec24 retary shall be 4 years. An Assistant Secretary may 

25 serve more than 1 term. 


jbell on PROD1PC69 with BILLS
236 

•HR 1328 RH

1 ‘‘(3) INCUMBENT.—The individual serving in the 

2 position of Director of the Service on the day before 

3 the date of enactment of the Indian Health Care Im4 provement Act Amendments of 2007 shall serve as As5 sistant Secretary. 

6 ‘‘(4) ADVOCACY AND CONSULTATION.—The posi7 tion of Assistant Secretary is established to, in a 

8 manner consistent with the government-to-government 

9 relationship between the United States and Indian 

10 Tribes— 

11 ‘‘(A) facilitate advocacy for the development 

12 of appropriate Indian health policy; and 

13 ‘‘(B) promote consultation on matters relat14 ing to Indian health. 

15 ‘‘(b) AGENCY.—The Service shall be an agency within 

16 the Public Health Service of the Department, and shall not 

17 be an office, component, or unit of any other agency of the 

18 Department. 

19 ‘‘(c) DUTIES.—The Assistant Secretary shall— 

20 ‘‘(1) perform all functions that were, on the day 

21 before the date of enactment of the Indian Health 

22 Care Improvement Act Amendments of 2007, carried 

23 out by or under the direction of the individual serv24 ing as Director of the Service on that day; 


jbell on PROD1PC69 with BILLS
237 

•HR 1328 RH

1 ‘‘(2) perform all functions of the Secretary relat2 ing to the maintenance and operation of hospital and 

3 health facilities for Indians and the planning for, and 

4 provision and utilization of, health services for Indi5 ans; 

6 ‘‘(3) administer all health programs under which 

7 health care is provided to Indians based upon their 

8 status as Indians which are administered by the Sec9 retary, including programs under— 

10 ‘‘(A) this Act; 

11 ‘‘(B) the Act of November 2, 1921 (25 

12 U.S.C. 13); 

13 ‘‘(C) the Act of August 5, 1954 (42 U.S.C. 

14 2001 et seq.); 

15 ‘‘(D) the Act of August 16, 1957 (42 U.S.C. 

16 2005 et seq.); and 

17 ‘‘(E) the Indian Self-Determination and 

18 Education Assistance Act (25 U.S.C. 450 et 

19 seq.); 

20 ‘‘(4) administer all scholarship and loan func21 tions carried out under title I; 

22 ‘‘(5) report directly to the Secretary concerning 

23 all policy- and budget-related matters affecting In24 dian health; 


jbell on PROD1PC69 with BILLS
238 

•HR 1328 RH

1 ‘‘(6) collaborate with the Assistant Secretary for 

2 Health concerning appropriate matters of Indian 

3 health that affect the agencies of the Public Health 

4 Service; 

5 ‘‘(7) advise each Assistant Secretary of the De6 partment concerning matters of Indian health with 

7 respect to which that Assistant Secretary has author8 ity and responsibility; 

9 ‘‘(8) advise the heads of other agencies and pro10 grams of the Department concerning matters of In11 dian health with respect to which those heads have 

12 authority and responsibility; 

13 ‘‘(9) coordinate the activities of the Department 

14 concerning matters of Indian health; and 

15 ‘‘(10) perform such other functions as the Sec16 retary may designate. 

17 ‘‘(d) AUTHORITY.— 

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

19 through the Assistant Secretary, shall have the au20 thority— 

21 ‘‘(A) except to the extent provided for in 

22 paragraph (2), to appoint and compensate em23 ployees for the Service in accordance with title 

24 5, United States Code; 


jbell on PROD1PC69 with BILLS
239 

•HR 1328 RH

1 ‘‘(B) to enter into contracts for the procure2 ment of goods and services to carry out the func3 tions of the Service; and 

4 ‘‘(C) to manage, expend, and obligate all 

5 funds appropriated for the Service. 

6 ‘‘(2) PERSONNEL ACTIONS.—Notwithstanding 

7 any other provision of law, the provisions of section 

8 12 of the Act of June 18, 1934 (48 Stat. 986; 25 

9 U.S.C. 472), shall apply to all personnel actions 

10 taken with respect to new positions created within the 

11 Service as a result of its establishment under sub12 section (a). 

13 ‘‘(e) REFERENCES.—Any reference to the Director of 

14 the Indian Health Service in any other Federal law, Execu15 tive order, rule, regulation, or delegation of authority, or 

16 in any document of or relating to the Director of the Indian 

17 Health Service, shall be deemed to refer to the Assistant Sec18 retary. 

19 ‘‘SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYS20 TEM. 

21 ‘‘(a) ESTABLISHMENT.— 

22 ‘‘(1) IN GENERAL.—The Secretary shall establish 

23 an automated management information system for 

24 the Service. 


jbell on PROD1PC69 with BILLS
240 

•HR 1328 RH

1 ‘‘(2) REQUIREMENTS OF SYSTEM.—The informa2 tion system established under paragraph (1) shall in3 clude— 

4 ‘‘(A) a financial management system; 

5 ‘‘(B) a patient care information system for 

6 each area served by the Service; 

7 ‘‘(C) a privacy component that protects the 

8 privacy of patient information held by, or on be9 half of, the Service; 

10 ‘‘(D) a services-based cost accounting com11 ponent that provides estimates of the costs associ12 ated with the provision of specific medical treat13 ments or services in each Area office of the Serv14 ice; 

15 ‘‘(E) an interface mechanism for patient 

16 billing and accounts receivable system; and 

17 ‘‘(F) a training component. 

18 ‘‘(b) PROVISION OF SYSTEMS TO TRIBES AND ORGANI19 ZATIONS.—The Secretary shall provide each Tribal Health 

20 Program automated management information systems 

21 which— 

22 ‘‘(1) meet the management information needs of 

23 such Tribal Health Program with respect to the treat24 ment by the Tribal Health Program of patients of the 

25 Service; and 


jbell on PROD1PC69 with BILLS
241 

•HR 1328 RH

1 ‘‘(2) meet the management information needs of 

2 the Service. 

3 ‘‘(c) ACCESS TO RECORDS.—Notwithstanding any 

4 other provision of law, each patient shall have reasonable 

5 access to the medical or health records of such patient which 

6 are held by, or on behalf of, the Service. 

7 ‘‘(d) AUTHORITY TO ENHANCE INFORMATION TECH8 NOLOGY.—The Secretary, acting through the Assistant Sec9 retary, shall have the authority to enter into contracts, 

10 agreements, or joint ventures with other Federal agencies, 

11 States, private and nonprofit organizations, for the purpose 

12 of enhancing information technology in Indian Health Pro13 grams and facilities. 

14 ‘‘SEC. 603. AUTHORIZATION OF APPROPRIATIONS. 

15 ‘‘There is authorized to be appropriated such sums as 

16 may be necessary for each fiscal year through fiscal year 

17 2017 to carry out this title. 

18 ‘‘TITLE VII—BEHAVIORAL 

19 HEALTH PROGRAMS 

20 ‘‘SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREAT21 MENT SERVICES. 

22 ‘‘(a) PURPOSES.—The purposes of this section are as 

23 follows: 

24 ‘‘(1) To authorize and direct the Secretary, act25 ing through the Service, Indian Tribes, Tribal OrgaVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00241 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
242 

•HR 1328 RH

1 nizations, and Urban Indian Organizations, to de2 velop a comprehensive behavioral health prevention 

3 and treatment program which emphasizes collabora4 tion among alcohol and substance abuse, social serv5 ices, and mental health programs. 

6 ‘‘(2) To provide information, direction, and 

7 guidance relating to mental illness and dysfunction 

8 and self-destructive behavior, including child abuse 

9 and family violence, to those Federal, tribal, State, 

10 and local agencies responsible for programs in Indian 

11 communities in areas of health care, education, social 

12 services, child and family welfare, alcohol and sub13 stance abuse, law enforcement, and judicial services. 

14 ‘‘(3) To assist Indian Tribes to identify services 

15 and resources available to address mental illness and 

16 dysfunctional and self-destructive behavior. 

17 ‘‘(4) To provide authority and opportunities for 

18 Indian Tribes and Tribal Organizations to develop, 

19 implement, and coordinate with community-based 

20 programs which include identification, prevention, 

21 education, referral, and treatment services, including 

22 through multidisciplinary resource teams. 

23 ‘‘(5) To ensure that Indians, as citizens of the 

24 United States and of the States in which they reside, 


jbell on PROD1PC69 with BILLS
243 

•HR 1328 RH

1 have the same access to behavioral health services to 

2 which all citizens have access. 

3 ‘‘(6) To modify or supplement existing programs 

4 and authorities in the areas identified in paragraph 

5 (2). 

6 ‘‘(b) PLANS.— 

7 ‘‘(1) DEVELOPMENT.—The Secretary, acting 

8 through the Service, Indian Tribes, Tribal Organiza9 tions, and Urban Indian Organizations, shall encour10 age Indian Tribes and Tribal Organizations to de11 velop tribal plans, and Urban Indian Organizations 

12 to develop local plans, and for all such groups to par13 ticipate in developing areawide plans for Indian Be14 havioral Health Services. The plans shall include, to 

15 the extent feasible, the following components: 

16 ‘‘(A) An assessment of the scope of alcohol 

17 or other substance abuse, mental illness, and dys18 functional and self-destructive behavior, includ19 ing suicide, child abuse, and family violence, 

20 among Indians, including— 

21 ‘‘(i) the number of Indians served who 

22 are directly or indirectly affected by such 

23 illness or behavior; or 


jbell on PROD1PC69 with BILLS
244 

•HR 1328 RH

1 ‘‘(ii) an estimate of the financial and 

2 human cost attributable to such illness or 

3 behavior. 

4 ‘‘(B) An assessment of the existing and ad5 ditional resources necessary for the prevention 

6 and treatment of such illness and behavior, in7 cluding an assessment of the progress toward 

8 achieving the availability of the full continuum 

9 of care described in subsection (c). 

10 ‘‘(C) An estimate of the additional funding 

11 needed by the Service, Indian Tribes, Tribal Or12 ganizations, and Urban Indian Organizations to 

13 meet their responsibilities under the plans. 

14 ‘‘(2) NATIONAL CLEARINGHOUSE.—The Sec15 retary, acting through the Service, shall coordinate 

16 with existing national clearinghouses and informa17 tion centers to include at the clearinghouses and cen18 ters plans and reports on the outcomes of such plans 

19 developed by Indian Tribes, Tribal Organizations, 

20 Urban Indian Organizations, and Service Areas re21 lating to behavioral health. The Secretary shall ensure 

22 access to these plans and outcomes by any Indian 

23 Tribe, Tribal Organization, Urban Indian Organiza24 tion, or the Service. 


jbell on PROD1PC69 with BILLS
245 

•HR 1328 RH

1 ‘‘(3) TECHNICAL ASSISTANCE.—The Secretary 

2 shall provide technical assistance to Indian Tribes, 

3 Tribal Organizations, and Urban Indian Organiza4 tions in preparation of plans under this section and 

5 in developing standards of care that may be used and 

6 adopted locally. 

7 ‘‘(c) PROGRAMS.—The Secretary, acting through the 

8 Service, Indian Tribes, and Tribal Organizations, shall 

9 provide, to the extent feasible and if funding is available, 

10 programs including the following: 

11 ‘‘(1) COMPREHENSIVE CARE.—A comprehensive 

12 continuum of behavioral health care which provides— 

13 ‘‘(A) community-based prevention, interven14 tion, outpatient, and behavioral health aftercare; 

15 ‘‘(B) detoxification (social and medical); 

16 ‘‘(C) acute hospitalization; 

17 ‘‘(D) intensive outpatient/day treatment; 

18 ‘‘(E) residential treatment; 

19 ‘‘(F) transitional living for those needing a 

20 temporary, stable living environment that is 

21 supportive of treatment and recovery goals; 

22 ‘‘(G) emergency shelter; 

23 ‘‘(H) intensive case management; and 

24 ‘‘(I) diagnostic services. 


jbell on PROD1PC69 with BILLS
246 

•HR 1328 RH

1 ‘‘(2) CHILD CARE.—Behavioral health services 

2 for Indians from birth through age 17, including— 

3 ‘‘(A) preschool and school age fetal alcohol 

4 disorder services, including assessment and be5 havioral intervention; 

6 ‘‘(B) mental health and substance abuse 

7 services (emotional, organic, alcohol, drug, inhal8 ant, and tobacco); 

9 ‘‘(C) identification and treatment of co-oc10 curring disorders and comorbidity; 

11 ‘‘(D) prevention of alcohol, drug, inhalant, 

12 and tobacco use; 

13 ‘‘(E) early intervention, treatment, and 

14 aftercare; 

15 ‘‘(F) promotion of healthy approaches to 

16 risk and safety issues; and 

17 ‘‘(G) identification and treatment of neglect 

18 and physical, mental, and sexual abuse. 

19 ‘‘(3) ADULT CARE.—Behavioral health services 

20 for Indians from age 18 through 55, including— 

21 ‘‘(A) early intervention, treatment, and 

22 aftercare; 

23 ‘‘(B) mental health and substance abuse 

24 services (emotional, alcohol, drug, inhalant, and 

25 tobacco), including sex specific services; 


jbell on PROD1PC69 with BILLS
247 

•HR 1328 RH

1 ‘‘(C) identification and treatment of co-oc2 curring disorders (dual diagnosis) and comor3 bidity; 

4 ‘‘(D) promotion of healthy approaches for 

5 risk-related behavior; 

6 ‘‘(E) treatment services for women at risk of 

7 giving birth to a child with a fetal alcohol dis8 order; and 

9 ‘‘(F) sex specific treatment for sexual as10 sault and domestic violence. 

11 ‘‘(4) FAMILY CARE.—Behavioral health services 

12 for families, including— 

13 ‘‘(A) early intervention, treatment, and 

14 aftercare for affected families; 

15 ‘‘(B) treatment for sexual assault and do16 mestic violence; and 

17 ‘‘(C) promotion of healthy approaches relat18 ing to parenting, domestic violence, and other 

19 abuse issues. 

20 ‘‘(5) ELDER CARE.—Behavioral health services 

21 for Indians 56 years of age and older, including— 

22 ‘‘(A) early intervention, treatment, and 

23 aftercare; 


jbell on PROD1PC69 with BILLS
248 

•HR 1328 RH

1 ‘‘(B) mental health and substance abuse 

2 services (emotional, alcohol, drug, inhalant, and 

3 tobacco), including sex specific services; 

4 ‘‘(C) identification and treatment of co-oc5 curring disorders (dual diagnosis) and comor6 bidity; 

7 ‘‘(D) promotion of healthy approaches to 

8 managing conditions related to aging; 

9 ‘‘(E) sex specific treatment for sexual as10 sault, domestic violence, neglect, physical and 

11 mental abuse and exploitation; and 

12 ‘‘(F) identification and treatment of demen13 tias regardless of cause. 

14 ‘‘(d) COMMUNITY BEHAVIORAL HEALTH PLAN.— 

15 ‘‘(1) ESTABLISHMENT.—The governing body of 

16 any Indian Tribe, Tribal Organization, or Urban In17 dian Organization may adopt a resolution for the es18 tablishment of a community behavioral health plan 

19 providing for the identification and coordination of 

20 available resources and programs to identify, prevent, 

21 or treat substance abuse, mental illness, or dysfunc22 tional and self-destructive behavior, including child 

23 abuse and family violence, among its members or its 

24 service population. This plan should include behavVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00248 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
249 

•HR 1328 RH

1 ioral health services, social services, intensive out2 patient services, and continuing aftercare. 

3 ‘‘(2) TECHNICAL ASSISTANCE.—At the request of 

4 an Indian Tribe, Tribal Organization, or Urban In5 dian Organization, the Bureau of Indian Affairs and 

6 the Service shall cooperate with and provide technical 

7 assistance to the Indian Tribe, Tribal Organization, 

8 or Urban Indian Organization in the development 

9 and implementation of such plan. 

10 ‘‘(3) FUNDING.—The Secretary, acting through 

11 the Service, may make funding available to Indian 

12 Tribes and Tribal Organizations which adopt a reso13 lution pursuant to paragraph (1) to obtain technical 

14 assistance for the development of a community behav15 ioral health plan and to provide administrative sup16 port in the implementation of such plan. 

17 ‘‘(e) COORDINATION FOR AVAILABILITY OF SERV18 ICES.—The Secretary, acting through the Service, Indian 

19 Tribes, Tribal Organizations, and Urban Indian Organiza20 tions, shall coordinate behavioral health planning, to the 

21 extent feasible, with other Federal agencies and with State 

22 agencies, to encourage comprehensive behavioral health serv23 ices for Indians regardless of their place of residence. 

24 ‘‘(f) MENTAL HEALTH CARE NEED ASSESSMENT.— 

25 Not later than 1 year after the date of enactment of the 


jbell on PROD1PC69 with BILLS
250 

•HR 1328 RH

1 Indian Health Care Improvement Act Amendments of 2007, 

2 the Secretary, acting through the Service, shall make an as3 sessment of the need for inpatient mental health care among 

4 Indians and the availability and cost of inpatient mental 

5 health facilities which can meet such need. In making such 

6 assessment, the Secretary shall consider the possible conver7 sion of existing, underused Service hospital beds into psy8 chiatric units to meet such need. 

9 ‘‘SEC. 702. MEMORANDA OF AGREEMENT WITH THE DEPART10 MENT OF THE INTERIOR. 

11 ‘‘(a) CONTENTS.—Not later than 12 months after the 

12 date of enactment of the Indian Health Care Improvement 

13 Act Amendments of 2007, the Secretary, acting through the 

14 Service, and the Secretary of the Interior shall develop and 

15 enter into a memoranda of agreement, or review and update 

16 any existing memoranda of agreement, as required by sec17 tion 4205 of the Indian Alcohol and Substance Abuse Pre18 vention and Treatment Act of 1986 (25 U.S.C. 2411) under 

19 which the Secretaries address the following: 

20 ‘‘(1) The scope and nature of mental illness and 

21 dysfunctional and self-destructive behavior, including 

22 child abuse and family violence, among Indians. 

23 ‘‘(2) The existing Federal, tribal, State, local, 

24 and private services, resources, and programs avail25 able to provide behavioral health services for Indians. 


jbell on PROD1PC69 with BILLS
251 

•HR 1328 RH

1 ‘‘(3) The unmet need for additional services, re2 sources, and programs necessary to meet the needs 

3 identified pursuant to paragraph (1). 

4 ‘‘(4)(A) The right of Indians, as citizens of the 

5 United States and of the States in which they reside, 

6 to have access to behavioral health services to which 

7 all citizens have access. 

8 ‘‘(B) The right of Indians to participate in, and 

9 receive the benefit of, such services. 

10 ‘‘(C) The actions necessary to protect the exercise 

11 of such right. 

12 ‘‘(5) The responsibilities of the Bureau of Indian 

13 Affairs and the Service, including mental illness iden14 tification, prevention, education, referral, and treat15 ment services (including services through multidisci16 plinary resource teams), at the central, area, and 

17 agency and Service Unit, Service Area, and head18 quarters levels to address the problems identified in 

19 paragraph (1). 

20 ‘‘(6) A strategy for the comprehensive coordina21 tion of the behavioral health services provided by the 

22 Bureau of Indian Affairs and the Service to meet the 

23 problems identified pursuant to paragraph (1), in24 cluding— 


jbell on PROD1PC69 with BILLS
252 

•HR 1328 RH

1 ‘‘(A) the coordination of alcohol and sub2 stance abuse programs of the Service, the Bureau 

3 of Indian Affairs, and Indian Tribes and Tribal 

4 Organizations (developed under the Indian Alco5 hol and Substance Abuse Prevention and Treat6 ment Act of 1986 (25 U.S.C. 2401 et seq.)) with 

7 behavioral health initiatives pursuant to this 

8 Act, particularly with respect to the referral and 

9 treatment of dually diagnosed individuals re10 quiring behavioral health and substance abuse 

11 treatment; and 

12 ‘‘(B) ensuring that the Bureau of Indian 

13 Affairs and Service programs and services (in14 cluding multidisciplinary resource teams) ad15 dressing child abuse and family violence are co16 ordinated with such non-Federal programs and 

17 services. 

18 ‘‘(7) Directing appropriate officials of the Bu19 reau of Indian Affairs and the Service, particularly 

20 at the agency and Service Unit levels, to cooperate 

21 fully with tribal requests made pursuant to commu22 nity behavioral health plans adopted under section 

23 701(c) and section 4206 of the Indian Alcohol and 

24 Substance Abuse Prevention and Treatment Act of 

25 1986 (25 U.S.C. 2412). 


jbell on PROD1PC69 with BILLS
253 

•HR 1328 RH

1 ‘‘(8) Providing for an annual review of such 

2 agreement by the Secretaries which shall be provided 

3 to Congress and Indian Tribes and Tribal Organiza4 tions. 

5 ‘‘(b) SPECIFIC PROVISIONS REQUIRED.—The memo6 randa of agreement updated or entered into pursuant to 

7 subsection (a) shall include specific provisions pursuant to 

8 which the Service shall assume responsibility for— 

9 ‘‘(1) the determination of the scope of the prob10 lem of alcohol and substance abuse among Indians, 

11 including the number of Indians within the jurisdic12 tion of the Service who are directly or indirectly af13 fected by alcohol and substance abuse and the finan14 cial and human cost; 

15 ‘‘(2) an assessment of the existing and needed re16 sources necessary for the prevention of alcohol and 

17 substance abuse and the treatment of Indians affected 

18 by alcohol and substance abuse; and 

19 ‘‘(3) an estimate of the funding necessary to ade20 quately support a program of prevention of alcohol 

21 and substance abuse and treatment of Indians affected 

22 by alcohol and substance abuse. 

23 ‘‘(c) PUBLICATION.—Each memorandum of agreement 

24 entered into or renewed (and amendments or modifications 

25 thereto) under subsection (a) shall be published in the FedVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00253 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
254 

•HR 1328 RH

1 eral Register. At the same time as publication in the Fed2 eral Register, the Secretary shall provide a copy of such 

3 memoranda, amendment, or modification to each Indian 

4 Tribe, Tribal Organization, and Urban Indian Organiza5 tion. 

6 ‘‘SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVEN7 TION AND TREATMENT PROGRAM. 

8 ‘‘(a) ESTABLISHMENT.— 

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

10 through the Service, Indian Tribes, and Tribal Orga11 nizations, shall provide a program of comprehensive 

12 behavioral health, prevention, treatment, and 

13 aftercare, which shall include— 

14 ‘‘(A) prevention, through educational inter15 vention, in Indian communities; 

16 ‘‘(B) acute detoxification, psychiatric hos17 pitalization, residential, and intensive out18 patient treatment; 

19 ‘‘(C) community-based rehabilitation and 

20 aftercare; 

21 ‘‘(D) community education and involve22 ment, including extensive training of health care, 

23 educational, and community-based personnel; 

24 ‘‘(E) specialized residential treatment pro25 grams for high-risk populations, including pregVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00254 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
255 

•HR 1328 RH

1 nant and postpartum women and their children; 

2 and 

3 ‘‘(F) diagnostic services. 

4 ‘‘(2) TARGET POPULATIONS.—The target popu5 lation of such programs shall be members of Indian 

6 Tribes. Efforts to train and educate key members of 

7 the Indian community shall also target employees of 

8 health, education, judicial, law enforcement, legal, 

9 and social service programs. 

10 ‘‘(b) CONTRACT HEALTH SERVICES.— 

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

12 through the Service, Indian Tribes, and Tribal Orga13 nizations, may enter into contracts with public or 

14 private providers of behavioral health treatment serv15 ices for the purpose of carrying out the program re16 quired under subsection (a). 

17 ‘‘(2) PROVISION OF ASSISTANCE.—In carrying 

18 out this subsection, the Secretary shall provide assist19 ance to Indian Tribes and Tribal Organizations to 

20 develop criteria for the certification of behavioral 

21 health service providers and accreditation of service 

22 facilities which meet minimum standards for such 

23 services and facilities. 


jbell on PROD1PC69 with BILLS
256 

•HR 1328 RH

1 ‘‘SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM. 

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

3 November 2, 1921 (25 U.S.C. 13) (commonly known as the 

4 ‘Snyder Act’), the Secretary shall establish and maintain 

5 a mental health technician program within the Service 

6 which— 

7 ‘‘(1) provides for the training of Indians as men8 tal health technicians; and 

9 ‘‘(2) employs such technicians in the provision of 

10 community-based mental health care that includes 

11 identification, prevention, education, referral, and 

12 treatment services. 

13 ‘‘(b) PARAPROFESSIONAL TRAINING.—In carrying out 

14 subsection (a), the Secretary, acting through the Service, In15 dian Tribes, and Tribal Organizations, shall provide high16 standard paraprofessional training in mental health care 

17 necessary to provide quality care to the Indian communities 

18 to be served. Such training shall be based upon a cur19 riculum developed or approved by the Secretary which com20 bines education in the theory of mental health care with 

21 supervised practical experience in the provision of such 

22 care. 

23 ‘‘(c) SUPERVISION AND EVALUATION OF TECHNI24 CIANS.—The Secretary, acting through the Service, Indian 

25 Tribes, and Tribal Organizations, shall supervise and 


jbell on PROD1PC69 with BILLS
257 

•HR 1328 RH

1 evaluate the mental health technicians in the training pro2 gram. 

3 ‘‘(d) TRADITIONAL HEALTH CARE PRACTICES.—The 

4 Secretary, acting through the Service, shall ensure that the 

5 program established pursuant to this subsection involves the 

6 use and promotion of the traditional health care practices 

7 of the Indian Tribes to be served. 

8 ‘‘SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH 

9 CARE WORKERS. 

10 ‘‘(a) IN GENERAL.—Subject to the provisions of section 

11 221, and except as provided in subsection (b), any indi12 vidual employed as a psychologist, social worker, or mar13 riage and family therapist for the purpose of providing 

14 mental health care services to Indians in a clinical setting 

15 under this Act is required to be licensed as a psychologist, 

16 social worker, or marriage and family therapist, respec17 tively. 

18 ‘‘(b) TRAINEES.—An individual may be employed as 

19 a trainee in psychology, social work, or marriage and fam20 ily therapy to provide mental health care services described 

21 in subsection (a) if such individual— 

22 ‘‘(1) works under the direct supervision of a li23 censed psychologist, social worker, or marriage and 

24 family therapist, respectively; 


jbell on PROD1PC69 with BILLS
258 

•HR 1328 RH

1 ‘‘(2) is enrolled in or has completed at least 2 

2 years of course work at a post-secondary, accredited 

3 education program for psychology, social work, mar4 riage and family therapy, or counseling; and 

5 ‘‘(3) meets such other training, supervision, and 

6 quality review requirements as the Secretary may es7 tablish. 

8 ‘‘SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS. 

9 ‘‘(a) GRANTS.—The Secretary, consistent with section 

10 701, may make grants to Indian Tribes, Tribal Organiza11 tions, and Urban Indian Organizations to develop and im12 plement a comprehensive behavioral health program of pre13 vention, intervention, treatment, and relapse prevention 

14 services that specifically addresses the cultural, historical, 

15 social, and child care needs of Indian women, regardless 

16 of age. 

17 ‘‘(b) USE OF GRANT FUNDS.—A grant made pursuant 

18 to this section may be used to— 

19 ‘‘(1) develop and provide community training, 

20 education, and prevention programs for Indian 

21 women relating to behavioral health issues, including 

22 fetal alcohol disorders; 

23 ‘‘(2) identify and provide psychological services, 

24 counseling, advocacy, support, and relapse prevention 

25 to Indian women and their families; and 


jbell on PROD1PC69 with BILLS
259 

•HR 1328 RH

1 ‘‘(3) develop prevention and intervention models 

2 for Indian women which incorporate traditional 

3 health care practices, cultural values, and community 

4 and family involvement. 

5 ‘‘(c) CRITERIA.—The Secretary, in consultation with 

6 Indian Tribes and Tribal Organizations, shall establish cri7 teria for the review and approval of applications and pro8 posals for funding under this section. 

9 ‘‘(d) EARMARK OF CERTAIN FUNDS.—Twenty percent 

10 of the funds appropriated pursuant to this section shall be 

11 used to make grants to Urban Indian Organizations. 

12 ‘‘SEC. 707. INDIAN YOUTH PROGRAM. 

13 ‘‘(a) DETOXIFICATION AND REHABILITATION.—The 

14 Secretary, acting through the Service, consistent with sec15 tion 701, shall develop and implement a program for acute 

16 detoxification and treatment for Indian youths, including 

17 behavioral health services. The program shall include re18 gional treatment centers designed to include detoxification 

19 and rehabilitation for both sexes on a referral basis and 

20 programs developed and implemented by Indian Tribes or 

21 Tribal Organizations at the local level under the Indian 

22 Self-Determination and Education Assistance Act (25 

23 U.S.C. 450 et seq.). Regional centers shall be integrated 

24 with the intake and rehabilitation programs based in the 

25 referring Indian community. 


jbell on PROD1PC69 with BILLS
260 

•HR 1328 RH

1 ‘‘(b) ALCOHOL AND SUBSTANCE ABUSE TREATMENT

2 CENTERS OR FACILITIES.— 

3 ‘‘(1) ESTABLISHMENT.— 

4 ‘‘(A) IN GENERAL.—The Secretary, acting 

5 through the Service, Indian Tribes, and Tribal 

6 Organizations, shall construct, renovate, or, as 

7 necessary, purchase, and appropriately staff and 

8 operate, at least 1 youth regional treatment cen9 ter or treatment network in each area under the 

10 jurisdiction of an Area Office. 

11 ‘‘(B) AREA OFFICE IN CALIFORNIA.—For 

12 the purposes of this subsection, the Area Office in 

13 California shall be considered to be 2 Area Of14 fices, 1 office whose jurisdiction shall be consid15 ered to encompass the northern area of the State 

16 of California, and 1 office whose jurisdiction 

17 shall be considered to encompass the remainder 

18 of the State of California for the purpose of im19 plementing California treatment networks. 

20 ‘‘(2) FUNDING.—For the purpose of staffing and 

21 operating such centers or facilities, funding shall be 

22 pursuant to the Act of November 2, 1921 (25 U.S.C. 

23 13). 

24 ‘‘(3) LOCATION.—A youth treatment center con25 structed or purchased under this subsection shall be 


jbell on PROD1PC69 with BILLS
261 

•HR 1328 RH

1 constructed or purchased at a location within the 

2 area described in paragraph (1) agreed upon (by ap3 propriate tribal resolution) by a majority of the In4 dian Tribes to be served by such center. 

5 ‘‘(4) SPECIFIC PROVISION OF FUNDS.— 

6 ‘‘(A) IN GENERAL.—Notwithstanding any 

7 other provision of this title, the Secretary may, 

8 from amounts authorized to be appropriated for 

9 the purposes of carrying out this section, make 

10 funds available to— 

11 ‘‘(i) the Tanana Chiefs Conference, In12 corporated, for the purpose of leasing, con13 structing, renovating, operating, and main14 taining a residential youth treatment facil15 ity in Fairbanks, Alaska; and 

16 ‘‘(ii) the Southeast Alaska Regional 

17 Health Corporation to staff and operate a 

18 residential youth treatment facility without 

19 regard to the proviso set forth in section 4(l) 

20 of the Indian Self-Determination and Edu21 cation Assistance Act (25 U.S.C. 450b(l)). 

22 ‘‘(B) PROVISION OF SERVICES TO ELIGIBLE

23 YOUTHS.—Until additional residential youth 

24 treatment facilities are established in Alaska 

25 pursuant to this section, the facilities specified 


jbell on PROD1PC69 with BILLS
262 

•HR 1328 RH

1 in subparagraph (A) shall make every effort to 

2 provide services to all eligible Indian youths re3 siding in Alaska. 

4 ‘‘(c) INTERMEDIATE ADOLESCENT BEHAVIORAL

5 HEALTH SERVICES.— 

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

7 through the Service, Indian Tribes, and Tribal Orga8 nizations, may provide intermediate behavioral health 

9 services to Indian children and adolescents, includ10 ing— 

11 ‘‘(A) pretreatment assistance; 

12 ‘‘(B) inpatient, outpatient, and aftercare 

13 services; 

14 ‘‘(C) emergency care; 

15 ‘‘(D) suicide prevention and crisis interven16 tion; and 

17 ‘‘(E) prevention and treatment of mental 

18 illness and dysfunctional and self-destructive be19 havior, including child abuse and family vio20 lence. 

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

22 this subsection may be used— 

23 ‘‘(A) to construct or renovate an existing 

24 health facility to provide intermediate behavioral 

25 health services; 


jbell on PROD1PC69 with BILLS
263 

•HR 1328 RH

1 ‘‘(B) to hire behavioral health professionals; 

2 ‘‘(C) to staff, operate, and maintain an in3 termediate mental health facility, group home, 

4 sober housing, transitional housing or similar fa5 cilities, or youth shelter where intermediate be6 havioral health services are being provided; 

7 ‘‘(D) to make renovations and hire appro8 priate staff to convert existing hospital beds into 

9 adolescent psychiatric units; and 

10 ‘‘(E) for intensive home- and community11 based services. 

12 ‘‘(3) CRITERIA.—The Secretary, acting through 

13 the Service, shall, in consultation with Indian Tribes 

14 and Tribal Organizations, establish criteria for the 

15 review and approval of applications or proposals for 

16 funding made available pursuant to this subsection. 

17 ‘‘(d) FEDERALLY-OWNED STRUCTURES.— 

18 ‘‘(1) IN GENERAL.—The Secretary, in consulta19 tion with Indian Tribes and Tribal Organizations, 

20 shall— 

21 ‘‘(A) identify and use, where appropriate, 

22 federally-owned structures suitable for local resi23 dential or regional behavioral health treatment 

24 for Indian youths; and 


jbell on PROD1PC69 with BILLS
264 

•HR 1328 RH

1 ‘‘(B) establish guidelines for determining 

2 the suitability of any such federally-owned struc3 ture to be used for local residential or regional 

4 behavioral health treatment for Indian youths. 

5 ‘‘(2) TERMS AND CONDITIONS FOR USE OF

6 STRUCTURE.—Any structure described in paragraph 

7 (1) may be used under such terms and conditions as 

8 may be agreed upon by the Secretary and the agency 

9 having responsibility for the structure and any In10 dian Tribe or Tribal Organization operating the pro11 gram. 

12 ‘‘(e) REHABILITATION AND AFTERCARE SERVICES.— 

13 ‘‘(1) IN GENERAL.—The Secretary, Indian 

14 Tribes, or Tribal Organizations, in cooperation with 

15 the Secretary of the Interior, shall develop and imple16 ment within each Service Unit, community-based re17 habilitation and follow-up services for Indian youths 

18 who are having significant behavioral health prob19 lems, and require long-term treatment, community re20 integration, and monitoring to support the Indian 

21 youths after their return to their home community. 

22 ‘‘(2) ADMINISTRATION.—Services under para23 graph (1) shall be provided by trained staff within 

24 the community who can assist the Indian youths in 

25 their continuing development of self-image, positive 


jbell on PROD1PC69 with BILLS
265 

•HR 1328 RH

1 problem-solving skills, and nonalcohol or substance 

2 abusing behaviors. Such staff may include alcohol 

3 and substance abuse counselors, mental health profes4 sionals, and other health professionals and para5 professionals, including community health representa6 tives. 

7 ‘‘(f) INCLUSION OF FAMILY IN YOUTH TREATMENT

8 PROGRAM.—In providing the treatment and other services 

9 to Indian youths authorized by this section, the Secretary, 

10 acting through the Service, Indian Tribes, and Tribal Orga11 nizations, shall provide for the inclusion of family members 

12 of such youths in the treatment programs or other services 

13 as may be appropriate. Not less than 10 percent of the funds 

14 appropriated for the purposes of carrying out subsection (e) 

15 shall be used for outpatient care of adult family members 

16 related to the treatment of an Indian youth under that sub17 section. 

18 ‘‘(g) MULTIDRUG ABUSE PROGRAM.—The Secretary, 

19 acting through the Service, Indian Tribes, Tribal Organiza20 tions, and Urban Indian Organizations, shall provide, con21 sistent with section 701, programs and services to prevent 

22 and treat the abuse of multiple forms of substances, includ23 ing alcohol, drugs, inhalants, and tobacco, among Indian 

24 youths residing in Indian communities, on or near reserva25 tions, and in urban areas and provide appropriate mental 


jbell on PROD1PC69 with BILLS
266 

•HR 1328 RH

1 health services to address the incidence of mental illness 

2 among such youths. 

3 ‘‘(h) INDIAN YOUTH MENTAL HEALTH.—The Sec4 retary, acting through the Service, shall collect data for the 

5 report under section 801 with respect to— 

6 ‘‘(1) the number of Indian youth who are being 

7 provided mental health services through the Service 

8 and Tribal Health Programs; 

9 ‘‘(2) a description of, and costs associated with, 

10 the mental health services provided for Indian youth 

11 through the Service and Tribal Health Programs; 

12 ‘‘(3) the number of youth referred to the Service 

13 or Tribal Health Programs for mental health services; 

14 ‘‘(4) the number of Indian youth provided resi15 dential treatment for mental health and behavioral 

16 problems through the Service and Tribal Health Pro17 grams, reported separately for on- and off-reservation 

18 facilities; and 

19 ‘‘(5) the costs of the services described in para20 graph (4). 

21 ‘‘SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEM22 ONSTRATION PROJECT. 

23 ‘‘(a) PURPOSE.—The purpose of this section is to au24 thorize the Secretary to carry out a demonstration project 

25 to test the use of telemental health services in suicide preVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00266 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
267 

•HR 1328 RH

1 vention, intervention and treatment of Indian youth, in2 cluding through— 

3 ‘‘(1) the use of psychotherapy, psychiatric assess4 ments, diagnostic interviews, therapies for mental 

5 health conditions predisposing to suicide, and alcohol 

6 and substance abuse treatment; 

7 ‘‘(2) the provision of clinical expertise to, con8 sultation services with, and medical advice and train9 ing for frontline health care providers working with 

10 Indian youth; 

11 ‘‘(3) training and related support for community 

12 leaders, family members and health and education 

13 workers who work with Indian youth; 

14 ‘‘(4) the development of culturally-relevant edu15 cational materials on suicide; and 

16 ‘‘(5) data collection and reporting. 

17 ‘‘(b) DEFINITIONS.—For the purpose of this section, 

18 the following definitions shall apply: 

19 ‘‘(1) DEMONSTRATION PROJECT.—The term 

20 ‘demonstration project’ means the Indian youth tele21 mental health demonstration project authorized under 

22 subsection (c). 

23 ‘‘(2) TELEMENTAL HEALTH.—The term ‘tele24 mental health’ means the use of electronic information 

25 and telecommunications technologies to support long 


jbell on PROD1PC69 with BILLS
268 

•HR 1328 RH

1 distance mental health care, patient and professional2 related education, public health, and health adminis3 tration. 

4 ‘‘(c) AUTHORIZATION.— 

5 ‘‘(1) IN GENERAL.—The Secretary is authorized 

6 to award grants under the demonstration project for 

7 the provision of telemental health services to Indian 

8 youth who— 

9 ‘‘(A) have expressed suicidal ideas; 

10 ‘‘(B) have attempted suicide; or 

11 ‘‘(C) have mental health conditions that in12 crease or could increase the risk of suicide. 

13 ‘‘(2) ELIGIBILITY FOR GRANTS.—Such grants 

14 shall be awarded to Indian Tribes and Tribal Organi15 zations that operate 1 or more facilities— 

16 ‘‘(A) located in Alaska and part of the Alas17 ka Federal Health Care Access Network; 

18 ‘‘(B) reporting active clinical telehealth ca19 pabilities; or 

20 ‘‘(C) offering school-based telemental health 

21 services relating to psychiatry to Indian youth. 

22 ‘‘(3) GRANT PERIOD.—The Secretary shall 

23 award grants under this section for a period of up to 

24 4 years. 


jbell on PROD1PC69 with BILLS
269 

•HR 1328 RH

1 ‘‘(4) AWARDING OF GRANTS.—Not more than 5 

2 grants shall be provided under paragraph (1), with 

3 priority consideration given to Indian Tribes and 

4 Tribal Organizations that— 

5 ‘‘(A) serve a particular community or geo6 graphic area where there is a demonstrated need 

7 to address Indian youth suicide; 

8 ‘‘(B) enter in to collaborative partnerships 

9 with Indian Health Service or Tribal Health 

10 Programs or facilities to provide services under 

11 this demonstration project; 

12 ‘‘(C) serve an isolated community or geo13 graphic area which has limited or no access to 

14 behavioral health services; or 

15 ‘‘(D) operate a detention facility at which 

16 Indian youth are detained. 

17 ‘‘(d) USE OF FUNDS.— 

18 ‘‘(1) IN GENERAL.—An Indian Tribe or Tribal 

19 Organization shall use a grant received under sub20 section (c) for the following purposes: 

21 ‘‘(A) To provide telemental health services 

22 to Indian youth, including the provision of— 

23 ‘‘(i) psychotherapy; 

24 ‘‘(ii) psychiatric assessments and diag25 nostic interviews, therapies for mental 


jbell on PROD1PC69 with BILLS
270 

•HR 1328 RH

1 health conditions predisposing to suicide, 

2 and treatment; and 

3 ‘‘(iii) alcohol and substance abuse 

4 treatment. 

5 ‘‘(B) To provide clinician-interactive med6 ical advice, guidance and training, assistance in 

7 diagnosis and interpretation, crisis counseling 

8 and intervention, and related assistance to Serv9 ice, tribal, or urban clinicians and health serv10 ices providers working with youth being served 

11 under this demonstration project. 

12 ‘‘(C) To assist, educate and train commu13 nity leaders, health education professionals and 

14 paraprofessionals, tribal outreach workers, and 

15 family members who work with the youth receiv16 ing telemental health services under this dem17 onstration project, including with identification 

18 of suicidal tendencies, crisis intervention and 

19 suicide prevention, emergency skill development, 

20 and building and expanding networks among 

21 these individuals and with State and local health 

22 services providers. 

23 ‘‘(D) To develop and distribute culturally 

24 appropriate community educational materials 

25 on— 


jbell on PROD1PC69 with BILLS
271 

•HR 1328 RH

1 ‘‘(i) suicide prevention; 

2 ‘‘(ii) suicide education; 

3 ‘‘(iii) suicide screening; 

4 ‘‘(iv) suicide intervention; and 

5 ‘‘(v) ways to mobilize communities 

6 with respect to the identification of risk fac7 tors for suicide. 

8 ‘‘(E) For data collection and reporting re9 lated to Indian youth suicide prevention efforts. 

10 ‘‘(2) TRADITIONAL HEALTH CARE PRACTICES.— 

11 In carrying out the purposes described in paragraph 

12 (1), an Indian Tribe or Tribal Organization may use 

13 and promote the traditional health care practices of 

14 the Indian Tribes of the youth to be served. 

15 ‘‘(e) APPLICATIONS.—To be eligible to receive a grant 

16 under subsection (c), an Indian Tribe or Tribal Organiza17 tion shall prepare and submit to the Secretary an applica18 tion, at such time, in such manner, and containing such 

19 information as the Secretary may require, including— 

20 ‘‘(1) a description of the project that the Indian 

21 Tribe or Tribal Organization will carry out using the 

22 funds provided under the grant; 

23 ‘‘(2) a description of the manner in which the 

24 project funded under the grant would— 


jbell on PROD1PC69 with BILLS
272 

•HR 1328 RH

1 ‘‘(A) meet the telemental health care needs 

2 of the Indian youth population to be served by 

3 the project; or 

4 ‘‘(B) improve the access of the Indian youth 

5 population to be served to suicide prevention and 

6 treatment services; 

7 ‘‘(3) evidence of support for the project from the 

8 local community to be served by the project; 

9 ‘‘(4) a description of how the families and lead10 ership of the communities or populations to be served 

11 by the project would be involved in the development 

12 and ongoing operations of the project; 

13 ‘‘(5) a plan to involve the tribal community of 

14 the youth who are provided services by the project in 

15 planning and evaluating the mental health care and 

16 suicide prevention efforts provided, in order to ensure 

17 the integration of community, clinical, environ18 mental, and cultural components of the treatment; 

19 and 

20 ‘‘(6) a plan for sustaining the project after Fed21 eral assistance for the demonstration project has ter22 minated. 

23 ‘‘(f) COLLABORATION; REPORTING TO NATIONAL

24 CLEARINGHOUSE.— 


jbell on PROD1PC69 with BILLS
273 

•HR 1328 RH

1 ‘‘(1) COLLABORATION.—The Secretary, acting 

2 through the Service, shall encourage Indian Tribes 

3 and Tribal Organizations receiving grants under this 

4 section to collaborate to enable comparisons about best 

5 practices across projects. 

6 ‘‘(2) REPORTING TO NATIONAL CLEARING7 HOUSE.—The Secretary, acting through the Service, 

8 shall also encourage Indian Tribes and Tribal Orga9 nizations receiving grants under this section to sub10 mit relevant, declassified project information to the 

11 national clearinghouse authorized under section 

12 701(b)(2) in order to better facilitate program per13 formance and improve suicide prevention, interven14 tion, and treatment services. 

15 ‘‘(g) ANNUAL REPORT.—Each grant recipient shall 

16 submit to the Secretary an annual report that— 

17 ‘‘(1) describes the number of telemental health 

18 services provided; and 

19 ‘‘(2) includes any other information that the Sec20 retary may require. 

21 ‘‘(h) REPORT TO CONGRESS.—Not later than 270 days 

22 after the termination of the demonstration project, the Sec23 retary shall submit to the Committee on Indian Affairs of 

24 the Senate and the Committee on Natural Resources and 

25 Committee on Energy and Commerce of the House of RepVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00273 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
274 

•HR 1328 RH

1 resentatives a final report, based on the annual reports pro2 vided by grant recipients under subsection (h), that— 

3 ‘‘(1) describes the results of the projects funded 

4 by grants awarded under this section, including any 

5 data available which indicates the number of at6 tempted suicides; 

7 ‘‘(2) evaluates the impact of the telemental health 

8 services funded by the grants in reducing the number 

9 of completed suicides among Indian youth; 

10 ‘‘(3) evaluates whether the demonstration project 

11 should be— 

12 ‘‘(A) expanded to provide more than 5 

13 grants; and 

14 ‘‘(B) designated a permanent program; and 

15 ‘‘(4) evaluates the benefits of expanding the dem16 onstration project to include Urban Indian Organiza17 tions. 

18 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

19 authorized to be appropriated to carry out this section 

20 $1,500,000 for each of fiscal years 2008 through 2011. 

21 ‘‘SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL 

22 HEALTH FACILITIES DESIGN, CONSTRUC23 TION, AND STAFFING. 

24 ‘‘Not later than 1 year after the date of enactment of 

25 the Indian Health Care Improvement Act Amendments of 


jbell on PROD1PC69 with BILLS
275 

•HR 1328 RH

1 2007, the Secretary, acting through the Service, Indian 

2 Tribes, and Tribal Organizations, may provide, in each 

3 area of the Service, not less than 1 inpatient mental health 

4 care facility, or the equivalent, for Indians with behavioral 

5 health problems. For the purposes of this subsection, Cali6 fornia shall be considered to be 2 Area Offices, 1 office whose 

7 location shall be considered to encompass the northern area 

8 of the State of California and 1 office whose jurisdiction 

9 shall be considered to encompass the remainder of the State 

10 of California. The Secretary shall consider the possible con11 version of existing, underused Service hospital beds into 

12 psychiatric units to meet such need. 

13 ‘‘SEC. 710. TRAINING AND COMMUNITY EDUCATION. 

14 ‘‘(a) PROGRAM.—The Secretary, in cooperation with 

15 the Secretary of the Interior, shall develop and implement 

16 or assist Indian Tribes and Tribal Organizations to develop 

17 and implement, within each Service Unit or tribal pro18 gram, a program of community education and involvement 

19 which shall be designed to provide concise and timely infor20 mation to the community leadership of each tribal commu21 nity. Such program shall include education about behav22 ioral health issues to political leaders, Tribal judges, law 

23 enforcement personnel, members of tribal health and edu24 cation boards, health care providers including traditional 

25 practitioners, and other critical members of each tribal 


jbell on PROD1PC69 with BILLS
276 

•HR 1328 RH

1 community. Such program may also include community2 based training to develop local capacity and tribal commu3 nity provider training for prevention, intervention, treat4 ment, and aftercare. 

5 ‘‘(b) INSTRUCTION.—The Secretary, acting through the 

6 Service, shall, either directly or through Indian Tribes and 

7 Tribal Organizations, provide instruction in the area of be8 havioral health issues, including instruction in crisis inter9 vention and family relations in the context of alcohol and 

10 substance abuse, child sexual abuse, youth alcohol and sub11 stance abuse, and the causes and effects of fetal alcohol dis12 orders to appropriate employees of the Bureau of Indian 

13 Affairs and the Service, and to personnel in schools or pro14 grams operated under any contract with the Bureau of In15 dian Affairs or the Service, including supervisors of emer16 gency shelters and halfway houses described in section 4213 

17 of the Indian Alcohol and Substance Abuse Prevention and 

18 Treatment Act of 1986 (25 U.S.C. 2433). 

19 ‘‘(c) TRAINING MODELS.—In carrying out the edu20 cation and training programs required by this section, the 

21 Secretary, in consultation with Indian Tribes, Tribal Orga22 nizations, Indian behavioral health experts, and Indian al23 cohol and substance abuse prevention experts, shall develop 

24 and provide community-based training models. Such mod25 els shall address— 


jbell on PROD1PC69 with BILLS
277 

•HR 1328 RH

1 ‘‘(1) the elevated risk of alcohol and behavioral 

2 health problems faced by children of alcoholics; 

3 ‘‘(2) the cultural, spiritual, and multigenera4 tional aspects of behavioral health problem prevention 

5 and recovery; and 

6 ‘‘(3) community-based and multidisciplinary 

7 strategies for preventing and treating behavioral 

8 health problems. 

9 ‘‘SEC. 711. BEHAVIORAL HEALTH PROGRAM. 

10 ‘‘(a) INNOVATIVE PROGRAMS.—The Secretary, acting 

11 through the Service, Indian Tribes, and Tribal Organiza12 tions, consistent with section 701, may plan, develop, im13 plement, and carry out programs to deliver innovative com14 munity-based behavioral health services to Indians. 

15 ‘‘(b) AWARDS; CRITERIA.—The Secretary may award 

16 a grant for a project under subsection (a) to an Indian 

17 Tribe or Tribal Organization and may consider the fol18 lowing criteria: 

19 ‘‘(1) The project will address significant unmet 

20 behavioral health needs among Indians. 

21 ‘‘(2) The project will serve a significant number 

22 of Indians. 

23 ‘‘(3) The project has the potential to deliver serv24 ices in an efficient and effective manner. 


jbell on PROD1PC69 with BILLS
278 

•HR 1328 RH

1 ‘‘(4) The Indian Tribe or Tribal Organization 

2 has the administrative and financial capability to 

3 administer the project. 

4 ‘‘(5) The project may deliver services in a man5 ner consistent with traditional health care practices. 

6 ‘‘(6) The project is coordinated with, and avoids 

7 duplication of, existing services. 

8 ‘‘(c) EQUITABLE TREATMENT.—For purposes of this 

9 subsection, the Secretary shall, in evaluating project appli10 cations or proposals, use the same criteria that the Sec11 retary uses in evaluating any other application or proposal 

12 for such funding. 

13 ‘‘SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS. 

14 ‘‘(a) PROGRAMS.— 

15 ‘‘(1) ESTABLISHMENT.—The Secretary, con16 sistent with section 701, acting through the Service, 

17 Indian Tribes, and Tribal Organizations, is author18 ized to establish and operate fetal alcohol disorder 

19 programs as provided in this section for the purposes 

20 of meeting the health status objectives specified in sec21 tion 3. 

22 ‘‘(2) USE OF FUNDS.— 

23 ‘‘(A) IN GENERAL.—Funding provided pur24 suant to this section shall be used for the fol25 lowing: 


jbell on PROD1PC69 with BILLS
279 

•HR 1328 RH

1 ‘‘(i) To develop and provide for Indi2 ans community and in-school training, edu3 cation, and prevention programs relating to 

4 fetal alcohol disorders. 

5 ‘‘(ii) To identify and provide behav6 ioral health treatment to high-risk Indian 

7 women and high-risk women pregnant with 

8 an Indian’s child. 

9 ‘‘(iii) To identify and provide appro10 priate psychological services, educational 

11 and vocational support, counseling, advo12 cacy, and information to fetal alcohol dis13 order affected Indians and their families or 

14 caretakers. 

15 ‘‘(iv) To develop and implement coun16 seling and support programs in schools for 

17 fetal alcohol disorder affected Indian chil18 dren. 

19 ‘‘(v) To develop prevention and inter20 vention models which incorporate practi21 tioners of traditional health care practices, 

22 cultural values, and community involve23 ment. 


jbell on PROD1PC69 with BILLS
280 

•HR 1328 RH

1 ‘‘(vi) To develop, print, and dissemi2 nate education and prevention materials on 

3 fetal alcohol disorder. 

4 ‘‘(vii) To develop and implement, in 

5 consultation with Indian Tribes, Tribal Or6 ganizations, and Urban Indian Organiza7 tions, culturally sensitive assessment and 

8 diagnostic tools including dysmorphology 

9 clinics and multidisciplinary fetal alcohol 

10 disorder clinics for use in Indian commu11 nities and Urban Centers. 

12 ‘‘(B) ADDITIONAL USES.—In addition to 

13 any purpose under subparagraph (A), funding 

14 provided pursuant to this section may be used 

15 for 1 or more of the following: 

16 ‘‘(i) Early childhood intervention 

17 projects from birth on to mitigate the effects 

18 of fetal alcohol disorder among Indians. 

19 ‘‘(ii) Community-based support serv20 ices for Indians and women pregnant with 

21 Indian children. 

22 ‘‘(iii) Community-based housing for 

23 adult Indians with fetal alcohol disorder. 


jbell on PROD1PC69 with BILLS
281 

•HR 1328 RH

1 ‘‘(3) CRITERIA FOR APPLICATIONS.—The Sec2 retary shall establish criteria for the review and ap3 proval of applications for funding under this section. 

4 ‘‘(b) SERVICES.—The Secretary, acting through the 

5 Service and Indian Tribes, Tribal Organizations, and 

6 Urban Indian Organizations, shall— 

7 ‘‘(1) develop and provide services for the preven8 tion, intervention, treatment, and aftercare for those 

9 affected by fetal alcohol disorder in Indian commu10 nities; and 

11 ‘‘(2) provide supportive services, including serv12 ices to meet the special educational, vocational, 

13 school-to-work transition, and independent living 

14 needs of adolescent and adult Indians with fetal alco15 hol disorder. 

16 ‘‘(c) TASK FORCE.—The Secretary shall establish a 

17 task force to be known as the Fetal Alcohol Disorder Task 

18 Force to advise the Secretary in carrying out subsection (b). 

19 Such task force shall be composed of representatives from 

20 the following: 

21 ‘‘(1) The National Institute on Drug Abuse. 

22 ‘‘(2) The National Institute on Alcohol and Alco23 holism. 

24 ‘‘(3) The Office of Substance Abuse Prevention. 

25 ‘‘(4) The National Institute of Mental Health. 


jbell on PROD1PC69 with BILLS
282 

•HR 1328 RH

1 ‘‘(5) The Service. 

2 ‘‘(6) The Office of Minority Health of the De3 partment of Health and Human Services. 

4 ‘‘(7) The Administration for Native Americans. 

5 ‘‘(8) The National Institute of Child Health and 

6 Human Development (NICHD). 

7 ‘‘(9) The Centers for Disease Control and Pre8 vention. 

9 ‘‘(10) The Bureau of Indian Affairs. 

10 ‘‘(11) Indian Tribes. 

11 ‘‘(12) Tribal Organizations. 

12 ‘‘(13) Urban Indian Organizations. 

13 ‘‘(14) Indian fetal alcohol disorder experts. 

14 ‘‘(d) APPLIED RESEARCH PROJECTS.—The Secretary, 

15 acting through the Substance Abuse and Mental Health 

16 Services Administration, shall make grants to Indian 

17 Tribes, Tribal Organizations, and Urban Indian Organiza18 tions for applied research projects which propose to elevate 

19 the understanding of methods to prevent, intervene, treat, 

20 or provide rehabilitation and behavioral health aftercare for 

21 Indians and Urban Indians affected by fetal alcohol dis22 order. 

23 ‘‘(e) FUNDING FOR URBAN INDIAN ORGANIZATIONS.— 

24 Ten percent of the funds appropriated pursuant to this secVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00282 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
283 

•HR 1328 RH

1 tion shall be used to make grants to Urban Indian Organi2 zations funded under title V. 

3 ‘‘SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREAT4 MENT PROGRAMS. 

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

6 the Service, and the Secretary of the Interior, Indian 

7 Tribes, and Tribal Organizations, shall establish, consistent 

8 with section 701, in every Service Area, programs involving 

9 treatment for— 

10 ‘‘(1) victims of sexual abuse who are Indian chil11 dren or children in an Indian household; and 

12 ‘‘(2) perpetrators of child sexual abuse who are 

13 Indian or members of an Indian household. 

14 ‘‘(b) USE OF FUNDS.—Funding provided pursuant to 

15 this section shall be used for the following: 

16 ‘‘(1) To develop and provide community edu17 cation and prevention programs related to sexual 

18 abuse of Indian children or children in an Indian 

19 household. 

20 ‘‘(2) To identify and provide behavioral health 

21 treatment to victims of sexual abuse who are Indian 

22 children or children in an Indian household, and to 

23 their family members who are affected by sexual 

24 abuse. 


jbell on PROD1PC69 with BILLS
284 

•HR 1328 RH

1 ‘‘(3) To develop prevention and intervention 

2 models which incorporate traditional health care 

3 practices, cultural values, and community involve4 ment. 

5 ‘‘(4) To develop and implement culturally sen6 sitive assessment and diagnostic tools for use in In7 dian communities and Urban Centers. 

8 ‘‘(5) To identify and provide behavioral health 

9 treatment to Indian perpetrators and perpetrators 

10 who are members of an Indian household— 

11 ‘‘(A) making efforts to begin offender and 

12 behavioral health treatment while the perpetrator 

13 is incarcerated or at the earliest possible date if 

14 the perpetrator is not incarcerated; and 

15 ‘‘(B) providing treatment after the perpe16 trator is released, until it is determined that the 

17 perpetrator is not a threat to children. 

18 ‘‘(c) COORDINATION.—The programs established under 

19 subsection (a) shall be carried out in coordination with pro20 grams and services authorized under the Indian Child Pro21 tection and Family Violence Prevention Act (25 U.S.C. 

22 3201 et seq.). 

23 ‘‘SEC. 714. BEHAVIORAL HEALTH RESEARCH. 

24 ‘‘The Secretary, in consultation with appropriate Fed25 eral agencies, shall make grants to, or enter into contracts 


jbell on PROD1PC69 with BILLS
285 

•HR 1328 RH

1 with, Indian Tribes, Tribal Organizations, and Urban In2 dian Organizations or enter into contracts with, or make 

3 grants to appropriate institutions for, the conduct of re4 search on the incidence and prevalence of behavioral health 

5 problems among Indians served by the Service, Indian 

6 Tribes, or Tribal Organizations and among Indians in 

7 urban areas. Research priorities under this section shall in8 clude— 

9 ‘‘(1) the multifactorial causes of Indian youth 

10 suicide, including— 

11 ‘‘(A) protective and risk factors and sci12 entific data that identifies those factors; and 

13 ‘‘(B) the effects of loss of cultural identity 

14 and the development of scientific data on those 

15 effects; 

16 ‘‘(2) the interrelationship and interdependence of 

17 behavioral health problems with alcoholism and other 

18 substance abuse, suicide, homicides, other injuries, 

19 and the incidence of family violence; and 

20 ‘‘(3) the development of models of prevention 

21 techniques. 

22 The effect of the interrelationships and interdependencies 

23 referred to in paragraph (2) on children, and the develop24 ment of prevention techniques under paragraph (3) appli25 cable to children, shall be emphasized. 


jbell on PROD1PC69 with BILLS
286 

•HR 1328 RH

1 ‘‘SEC. 715. DEFINITIONS. 

2 ‘‘For the purpose of this title, the following definitions 

3 shall apply: 

4 ‘‘(1) ASSESSMENT.—The term ‘assessment’ 

5 means the systematic collection, analysis, and dis6 semination of information on health status, health 

7 needs, and health problems. 

8 ‘‘(2) ALCOHOL-RELATED NEURODEVELOPMENTAL

9 DISORDERS OR ARND.—The term ‘alcohol-related 

10 neurodevelopmental disorders’ or ‘ARND’ means, with 

11 a history of maternal alcohol consumption during 

12 pregnancy, central nervous system involvement such 

13 as developmental delay, intellectual deficit, or 

14 neurologic abnormalities. Behaviorally, there can be 

15 problems with irritability, and failure to thrive as in16 fants. As children become older there will likely be hy17 peractivity, attention deficit, language dysfunction, 

18 and perceptual and judgment problems. 

19 ‘‘(3) BEHAVIORAL HEALTH AFTERCARE.—The 

20 term ‘behavioral health aftercare’ includes those ac21 tivities and resources used to support recovery fol22 lowing inpatient, residential, intensive substance 

23 abuse, or mental health outpatient or outpatient 

24 treatment. The purpose is to help prevent or deal with 

25 relapse by ensuring that by the time a client or pa26 tient is discharged from a level of care, such as outVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00286 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
287 

•HR 1328 RH

1 patient treatment, an aftercare plan has been devel2 oped with the client. An aftercare plan may use such 

3 resources as a community-based therapeutic group, 

4 transitional living facilities, a 12-step sponsor, a 

5 local 12-step or other related support group, and other 

6 community-based providers. 

7 ‘‘(4) DUAL DIAGNOSIS.—The term ‘dual diag8 nosis’ means coexisting substance abuse and mental 

9 illness conditions or diagnosis. Such clients are some10 times referred to as mentally ill chemical abusers 

11 (MICAs). 

12 ‘‘(5) FETAL ALCOHOL DISORDERS.—The term 

13 ‘fetal alcohol disorders’ means fetal alcohol syndrome, 

14 partial fetal alcohol syndrome and alcohol related 

15 neurodevelopmental disorder (ARND). 

16 ‘‘(6) FETAL ALCOHOL SYNDROME OR FAS.—The 

17 term ‘fetal alcohol syndrome’ or ‘FAS’ means a syn18 drome in which, with a history of maternal alcohol 

19 consumption during pregnancy, the following criteria 

20 are met: 

21 ‘‘(A) Central nervous system involvement 

22 such as developmental delay, intellectual deficit, 

23 microencephaly, or neurologic abnormalities. 

24 ‘‘(B) Craniofacial abnormalities with at 

25 least 2 of the following: microophthalmia, short 


jbell on PROD1PC69 with BILLS
288 

•HR 1328 RH

1 palpebral fissures, poorly developed philtrum, 

2 thin upper lip, flat nasal bridge, and short 

3 upturned nose. 

4 ‘‘(C) Prenatal or postnatal growth delay. 

5 ‘‘(7) PARTIAL FAS.—The term ‘partial FAS’ 

6 means, with a history of maternal alcohol consump7 tion during pregnancy, having most of the criteria of 

8 FAS, though not meeting a minimum of at least 2 of 

9 the following: microophthalmia, short palpebral fis10 sures, poorly developed philtrum, thin upper lip, flat 

11 nasal bridge, and short upturned nose. 

12 ‘‘(8) REHABILITATION.—The term ‘rehabilita13 tion’ means to restore the ability or capacity to en14 gage in usual and customary life activities through 

15 education and therapy. 

16 ‘‘(9) SUBSTANCE ABUSE.—The term ‘substance 

17 abuse’ includes inhalant abuse. 

18 ‘‘SEC. 716. AUTHORIZATION OF APPROPRIATIONS. 

19 ‘‘There is authorized to be appropriated such sums as 

20 may be necessary for each fiscal year through fiscal year 

21 2017 to carry out the provisions of this title. 

22 ‘‘TITLE VIII—MISCELLANEOUS 

23 ‘‘SEC. 801. REPORTS. 

24 ‘‘For each fiscal year following the date of enactment 

25 of the Indian Health Care Improvement Act Amendments 


jbell on PROD1PC69 with BILLS
289 

•HR 1328 RH

1 of 2007, the Secretary shall transmit to Congress a report 

2 containing the following: 

3 ‘‘(1) A report on the progress made in meeting 

4 the objectives of this Act, including a review of pro5 grams established or assisted pursuant to this Act and 

6 assessments and recommendations of additional pro7 grams or additional assistance necessary to, at a 

8 minimum, provide health services to Indians and en9 sure a health status for Indians, which are at a par10 ity with the health services available to and the health 

11 status of the general population. 

12 ‘‘(2) A report on whether, and to what extent, 

13 new national health care programs, benefits, initia14 tives, or financing systems have had an impact on the 

15 purposes of this Act and any steps that the Secretary 

16 may have taken to consult with Indian Tribes, Tribal 

17 Organizations, and Urban Indian Organizations to 

18 address such impact, including a report on proposed 

19 changes in allocation of funding pursuant to section 

20 808. 

21 ‘‘(3) A report on the use of health services by In22 dians— 

23 ‘‘(A) on a national and area or other rel24 evant geographical basis; 

25 ‘‘(B) by gender and age; 


jbell on PROD1PC69 with BILLS
290 

•HR 1328 RH

1 ‘‘(C) by source of payment and type of serv2 ice; 

3 ‘‘(D) comparing such rates of use with rates 

4 of use among comparable non-Indian popu5 lations; and 

6 ‘‘(E) provided under contracts. 

7 ‘‘(4) A report of contractors to the Secretary on 

8 Health Care Educational Loan Repayments every 6 

9 months required by section 110. 

10 ‘‘(5) A general audit report of the Secretary on 

11 the Health Care Educational Loan Repayment Pro12 gram as required by section 110(n). 

13 ‘‘(6) A report of the findings and conclusions of 

14 demonstration programs on development of edu15 cational curricula for substance abuse counseling as 

16 required in section 125(f). 

17 ‘‘(7) A separate statement which specifies the 

18 amount of funds requested to carry out the provisions 

19 of section 201. 

20 ‘‘(8) A report of the evaluations of health pro21 motion and disease prevention as required in section 

22 203(c). 

23 ‘‘(9) A biennial report to Congress on infectious 

24 diseases as required by section 212. 


jbell on PROD1PC69 with BILLS
291 

•HR 1328 RH

1 ‘‘(10) A report on environmental and nuclear 

2 health hazards as required by section 215. 

3 ‘‘(11) An annual report on the status of all 

4 health care facilities needs as required by section 

5 301(c)(2)(B) and 301(d). 

6 ‘‘(12) Reports on safe water and sanitary waste 

7 disposal facilities as required by section 302(h). 

8 ‘‘(13) An annual report on the expenditure of 

9 non-Service funds for renovation as required by sec10 tions 304(b)(2). 

11 ‘‘(14) A report identifying the backlog of mainte12 nance and repair required at Service and tribal fa13 cilities required by section 313(a). 

14 ‘‘(15) A report providing an accounting of reim15 bursement funds made available to the Secretary 

16 under titles XVIII, XIX, and XXI of the Social Secu17 rity Act. 

18 ‘‘(16) A report on any arrangements for the 

19 sharing of medical facilities or services, as authorized 

20 by section 406. 

21 ‘‘(17) A report on evaluation and renewal of 

22 Urban Indian programs under section 505. 

23 ‘‘(18) A report on the evaluation of programs as 

24 required by section 513(d). 


jbell on PROD1PC69 with BILLS
292 

•HR 1328 RH

1 ‘‘(19) A report on alcohol and substance abuse as 

2 required by section 701(f). 

3 ‘‘(20) A report on Indian youth mental health 

4 services as required by section 707(h). 

5 ‘‘(21) A report on the reallocation of base re6 sources if required by section 808. 

7 ‘‘(22) REPORT REGARDING PATIENT MOVE8 MENT.—A report on the movement of patients between 

9 Service Units, including— 

10 ‘‘(A) a list of those Service Units that have 

11 a net increase and those that have a net decrease 

12 of patients due to patients assigned to one Serv13 ice Unit voluntarily choosing to receive service at 

14 another Service Unit; 

15 ‘‘(B) an analysis of the effect of patient 

16 movement on the quality of services for those 

17 Service Units experiencing an increase in the 

18 number of patients served; and 

19 ‘‘(C) what funding changes are necessary to 

20 maintain a consistent quality of service at Serv21 ice Units that have an increase in the number of 

22 patients served. 

23 ‘‘SEC. 802. REGULATIONS. 

24 ‘‘(a) DEADLINES.— 


jbell on PROD1PC69 with BILLS
293 

•HR 1328 RH

1 ‘‘(1) PROCEDURES.—Not later than 90 days 

2 after the date of enactment of the Indian Health Care 

3 Improvement Act Amendments of 2007, the Secretary 

4 shall initiate procedures under subchapter III of 

5 chapter 5 of title 5, United States Code, to negotiate 

6 and promulgate such regulations or amendments 

7 thereto that are necessary to carry out titles II (except 

8 section 202) and VII, the sections of title III for 

9 which negotiated rulemaking is specifically required, 

10 and section 807. Unless otherwise required, the Sec11 retary may promulgate regulations to carry out titles 

12 I, III, IV, and V, and section 202, using the proce13 dures required by chapter V of title 5, United States 

14 Code (commonly known as the ‘Administrative Proce15 dure Act’). 

16 ‘‘(2) PROPOSED REGULATIONS.—Proposed regu17 lations to implement this Act shall be published in the 

18 Federal Register by the Secretary no later than 2 

19 years after the date of enactment of the Indian Health 

20 Care Improvement Act Amendments of 2007 and shall 

21 have no less than a 120-day comment period. 

22 ‘‘(3) FINAL REGULATIONS.—The Secretary shall 

23 publish in the Federal Register final regulations to 

24 implement this Act by not later than 3 years after the 


jbell on PROD1PC69 with BILLS
294 

•HR 1328 RH

1 date of enactment of the Indian Health Care Improve2 ment Act Amendments of 2007. 

3 ‘‘(b) COMMITTEE.—A negotiated rulemaking com4 mittee established pursuant to section 565 of title 5, United 

5 States Code, to carry out this section shall have as its mem6 bers only representatives of the Federal Government and 

7 representatives of Indian Tribes, and Tribal Organizations, 

8 a majority of whom shall be nominated by and be represent9 atives of Indian Tribes and Tribal Organizations from each 

10 Service Area. 

11 ‘‘(c) ADAPTATION OF PROCEDURES.—The Secretary 

12 shall adapt the negotiated rulemaking procedures to the 

13 unique context of self-governance and the government-to14 government relationship between the United States and In15 dian Tribes. 

16 ‘‘(d) LACK OF REGULATIONS.—The lack of promul17 gated regulations shall not limit the effect of this Act. 

18 ‘‘(e) INCONSISTENT REGULATIONS.—The provisions of 

19 this Act shall supersede any conflicting provisions of law 

20 in effect on the day before the date of enactment of the In21 dian Health Care Improvement Act Amendments of 2007, 

22 and the Secretary is authorized to repeal any regulation 

23 inconsistent with the provisions of this Act. 


jbell on PROD1PC69 with BILLS
295 

•HR 1328 RH

1 ‘‘SEC. 803. PLAN OF IMPLEMENTATION. 

2 ‘‘Not later than 9 months after the date of enactment 

3 of the Indian Health Care Improvement Act Amendments 

4 of 2007, the Secretary, in consultation with Indian Tribes, 

5 Tribal Organizations, and Urban Indian Organizations, 

6 shall submit to Congress a plan explaining the manner and 

7 schedule, by title and section, by which the Secretary will 

8 implement the provisions of this Act. This consultation may 

9 be conducted jointly with the annual budget consultation 

10 pursuant to the Indian Self-Determination and Education 

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

12 ‘‘SEC. 804. AVAILABILITY OF FUNDS. 

13 ‘‘The funds appropriated pursuant to this Act shall re14 main available until expended. 

15 ‘‘SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED 

16 TO INDIAN HEALTH SERVICE. 

17 ‘‘Any limitation on the use of funds contained in an 

18 Act providing appropriations for the Department for a pe19 riod with respect to the performance of abortions shall 

20 apply for that period with respect to the performance of 

21 abortions using funds contained in an Act providing appro22 priations for the Service. 

23 ‘‘SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS. 

24 ‘‘(a) IN GENERAL.—The following California Indians 

25 shall be eligible for health services provided by the Service: 


jbell on PROD1PC69 with BILLS
296 

•HR 1328 RH

1 ‘‘(1) Any member of a federally recognized In2 dian Tribe. 

3 ‘‘(2) Any descendant of an Indian who was re4 siding in California on June 1, 1852, if such descend5 ant— 

6 ‘‘(A) is a member of the Indian community 

7 served by a local program of the Service; and 

8 ‘‘(B) is regarded as an Indian by the com9 munity in which such descendant lives. 

10 ‘‘(3) Any Indian who holds trust interests in 

11 public domain, national forest, or reservation allot12 ments in California. 

13 ‘‘(4) Any Indian in California who is listed on 

14 the plans for distribution of the assets of rancherias 

15 and reservations located within the State of Cali16 fornia under the Act of August 18, 1958 (72 Stat. 

17 619), and any descendant of such an Indian. 

18 ‘‘(b) CLARIFICATION.—Nothing in this section may be 

19 construed as expanding the eligibility of California Indians 

20 for health services provided by the Service beyond the scope 

21 of eligibility for such health services that applied on May 

22 1, 1986. 

23 ‘‘SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS. 

24 ‘‘(a) CHILDREN.—Any individual who— 

25 ‘‘(1) has not attained 19 years of age; 


jbell on PROD1PC69 with BILLS
297 

•HR 1328 RH

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 Serv7 ice on the same basis and subject to the same rules that 

8 apply to eligible Indians until such individual attains 19 

9 years of age. The existing and potential health needs of all 

10 such individuals shall be taken into consideration by the 

11 Service in determining the need for, or the allocation of, 

12 the health resources of the Service. If such an individual 

13 has been determined to be legally incompetent prior to at14 taining 19 years of age, such individual shall remain eligi15 ble for such services until 1 year after the date of a deter16 mination 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 In22 dian Tribe being served are made eligible, as a class, by 

23 an appropriate resolution of the governing body of the In24 dian Tribe or Tribal Organization providing such services. 

25 The health needs of persons made eligible under this paraVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00297 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
298 

•HR 1328 RH

1 graph shall not be taken into consideration by the Service 

2 in determining the need for, or allocation of, its health re3 sources. 

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 Serv13 ice Unit request such provision of health services 

14 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. 


jbell on PROD1PC69 with BILLS
299 

•HR 1328 RH

1 ‘‘(2) ISDEAA PROGRAMS.—In the case of health 

2 programs and facilities operated under a contract or 

3 compact entered into under the Indian Self-Deter4 mination and Education Assistance Act (25 U.S.C. 

5 450 et seq.), the governing body of the Indian Tribe 

6 or Tribal Organization providing health services 

7 under such contract or compact is authorized to deter8 mine whether health services should be provided under 

9 such contract to individuals who are not eligible for 

10 such health services under any other subsection of this 

11 section or under any other provision of law. In mak12 ing such determinations, the governing body of the In13 dian Tribe or Tribal Organization shall take into ac14 count the considerations described in paragraph 

15 (1)(B). 

16 ‘‘(3) PAYMENT FOR SERVICES.— 

17 ‘‘(A) IN GENERAL.—Persons receiving 

18 health services provided by the Service under this 

19 subsection shall be liable for payment of such 

20 health services under a schedule of charges pre21 scribed by the Secretary which, in the judgment 

22 of the Secretary, results in reimbursement in an 

23 amount not less than the actual cost of providing 

24 the health services. Notwithstanding section 404 

25 of this Act or any other provision of law, 


jbell on PROD1PC69 with BILLS
300 

•HR 1328 RH

1 amounts collected under this subsection, includ2 ing Medicare, Medicaid, or SCHIP reimburse3 ments under titles XVIII, XIX, and XXI of the 

4 Social Security Act, shall be credited to the ac5 count of the program providing the service and 

6 shall be used for the purposes listed in section 

7 401(d)(2) and amounts collected under this sub8 section shall be available for expenditure within 

9 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 en16 tered into with a State or local government 

17 under which the State or local government agrees 

18 to reimburse the Service for the expenses in19 curred by the Service in providing such health 

20 services to such indigent individual. 

21 ‘‘(4) REVOCATION OF CONSENT FOR SERVICES.— 

22 ‘‘(A) SINGLE TRIBE SERVICE AREA.—In the 

23 case of a Service Area which serves only 1 In24 dian Tribe, the authority of the Secretary to pro25 vide health services under paragraph (1) shall 


jbell on PROD1PC69 with BILLS
301 

•HR 1328 RH

1 terminate at the end of the fiscal year succeeding 

2 the fiscal year in which the governing body of the 

3 Indian Tribe revokes its concurrence to the pro4 vision of such health services. 

5 ‘‘(B) MULTITRIBAL SERVICE AREA.—In the 

6 case of a multitribal Service Area, the authority 

7 of the Secretary to provide health services under 

8 paragraph (1) shall terminate at the end of the 

9 fiscal year succeeding the fiscal year in which at 

10 least 51 percent of the number of Indian Tribes 

11 in the Service Area revoke their concurrence to 

12 the provisions of such health services. 

13 ‘‘(d) OTHER SERVICES.—The Service may provide 

14 health services under this subsection to individuals who are 

15 not eligible for health services provided by the Service under 

16 any other provision of law in order to— 

17 ‘‘(1) achieve stability in a medical emergency; 

18 ‘‘(2) prevent the spread of a communicable dis19 ease or otherwise deal with a public health hazard; 

20 ‘‘(3) provide care to non-Indian women pregnant 

21 with an eligible Indian’s child for the duration of the 

22 pregnancy through postpartum; or 

23 ‘‘(4) provide care to immediate family members 

24 of an eligible individual if such care is directly re25 lated to the treatment of the eligible individual. 


jbell on PROD1PC69 with BILLS
302 

•HR 1328 RH

1 ‘‘(e) HOSPITAL PRIVILEGES FOR PRACTITIONERS.— 

2 Hospital privileges in health facilities operated and main3 tained by the Service or operated under a contract or com4 pact pursuant to the Indian Self-Determination and Edu5 cation Assistance Act (25 U.S.C. 450 et seq.) may be ex6 tended to non-Service health care practitioners who provide 

7 services to individuals described in subsection (a), (b), (c), 

8 or (d). Such non-Service health care practitioners may, as 

9 part of the privileging process, be designated as employees 

10 of the Federal Government for purposes of section 1346(b) 

11 and chapter 171 of title 28, United States Code (relating 

12 to Federal tort claims) only with respect to acts or omis13 sions which occur in the course of providing services to eli14 gible individuals as a part of the conditions under which 

15 such hospital privileges are extended. 

16 ‘‘(f) ELIGIBLE INDIAN.—For purposes of this section, 

17 the term ‘eligible Indian’ means any Indian who is eligible 

18 for health services provided by the Service without regard 

19 to the provisions of this section. 

20 ‘‘SEC. 808. REALLOCATION OF BASE RESOURCES. 

21 ‘‘(a) REPORT REQUIRED.—Notwithstanding any other 

22 provision of law, any allocation of Service funds for a fiscal 

23 year that reduces by 5 percent or more from the previous 

24 fiscal year the funding for any recurring program, project, 

25 or activity of a Service Unit may be implemented only after 


jbell on PROD1PC69 with BILLS
303 

•HR 1328 RH

1 the Secretary has submitted to Congress, under section 801, 

2 a report on the proposed change in allocation of funding, 

3 including the reasons for the change and its likely effects. 

4 ‘‘(b) EXCEPTION.—Subsection (a) shall not apply if 

5 the total amount appropriated to the Service for a fiscal 

6 year is at least 5 percent less than the amount appropriated 

7 to the Service for the previous fiscal year. 

8 ‘‘SEC. 809. RESULTS OF DEMONSTRATION PROJECTS. 

9 ‘‘The Secretary shall provide for the dissemination to 

10 Indian Tribes, Tribal Organizations, and Urban Indian 

11 Organizations of the findings and results of demonstration 

12 projects conducted under this Act. 

13 ‘‘SEC. 810. PROVISION OF SERVICES IN MONTANA. 

14 ‘‘(a) CONSISTENT WITH COURT DECISION.—The Sec15 retary, acting through the Service, shall provide services 

16 and benefits for Indians in Montana in a manner con17 sistent with the decision of the United States Court of Ap18 peals for the Ninth Circuit in McNabb for McNabb v. 

19 Bowen, 829 F.2d 787 (9th Cir. 1987). 

20 ‘‘(b) CLARIFICATION.—The provisions of subsection (a) 

21 shall not be construed to be an expression of the sense of 

22 Congress on the application of the decision described in sub23 section (a) with respect to the provision of services or bene24 fits for Indians living in any State other than Montana. 


jbell on PROD1PC69 with BILLS
304 

•HR 1328 RH

1 ‘‘SEC. 811. MORATORIUM. 

2 ‘‘During the period of the moratorium imposed on im3 plementation of the final rule published in the Federal Reg4 ister on September 16, 1987, by the Department of Health 

5 and Human Services, relating to eligibility for the health 

6 care services of the Indian Health Service, the Indian 

7 Health Service shall provide services pursuant to the cri8 teria for eligibility for such services that were in effect on 

9 September 15, 1987, subject to the provisions of sections 806 

10 and 807, until the Service has submitted to the Committees 

11 on Appropriations of the Senate and the House of Rep12 resentatives a budget request reflecting the increased costs 

13 associated with the proposed final rule, and the request has 

14 been included in an appropriations Act and enacted into 

15 law. 

16 ‘‘SEC. 812. SEVERABILITY PROVISIONS. 

17 ‘‘If any provision of this Act, any amendment made 

18 by the Act, or the application of such provision or amend19 ment to any person or circumstances is held to be invalid, 

20 the remainder of this Act, the remaining amendments made 

21 by this Act, and the application of such provisions to per22 sons or circumstances other than those to which it is held 

23 invalid, shall not be affected thereby. 


jbell on PROD1PC69 with BILLS
305 

•HR 1328 RH

1 ‘‘SEC. 813. ESTABLISHMENT OF NATIONAL BIPARTISAN 

2 COMMISSION ON INDIAN HEALTH CARE. 

3 ‘‘(a) ESTABLISHMENT.—There is established the Na4 tional Bipartisan Indian Health Care Commission (the 

5 ‘Commission’). 

6 ‘‘(b) DUTIES OF COMMISSION.—The duties of the Com7 mission are the following: 

8 ‘‘(1) To establish a study committee composed of 

9 those members of the Commission appointed by the 

10 Director of the Service and at least 4 members of 

11 Congress from among the members of the Commission, 

12 the duties of which shall be the following: 

13 ‘‘(A) To the extent necessary to carry out its 

14 duties, collect and compile data necessary to un15 derstand the extent of Indian needs with regard 

16 to the provision of health services, regardless of 

17 the location of Indians, including holding hear18 ings and soliciting the views of Indians, Indian 

19 Tribes, Tribal Organizations, and Urban Indian 

20 Organizations, which may include authorizing 

21 and making funds available for feasibility stud22 ies of various models for providing and funding 

23 health services for all Indian beneficiaries, in24 cluding those who live outside of a reservation, 

25 temporarily or permanently. 


jbell on PROD1PC69 with BILLS
306 

•HR 1328 RH

1 ‘‘(B) To make legislative recommendations 

2 to the Commission regarding the delivery of Fed3 eral health care services to Indians. Such rec4 ommendations shall include those related to 

5 issues of eligibility, benefits, the range of service 

6 providers, the cost of such services, financing 

7 such services, and the optimal manner in which 

8 to provide such services. 

9 ‘‘(C) To determine the effect of the enact10 ment of such recommendations on (i) the existing 

11 system of delivery of health services for Indians, 

12 and (ii) the sovereign status of Indian Tribes. 

13 ‘‘(D) Not later than 12 months after the ap14 pointment of all members of the Commission, to 

15 submit a written report of its findings and rec16 ommendations to the full Commission. The re17 port shall include a statement of the minority 

18 and majority position of the Committee and 

19 shall be disseminated, at a minimum, to every 

20 Indian Tribe, Tribal Organization, and Urban 

21 Indian Organization for comment to the Com22 mission. 

23 ‘‘(E) To report regularly to the full Com24 mission regarding the findings and recommenda25 tions developed by the study committee in the 


jbell on PROD1PC69 with BILLS
307 

•HR 1328 RH

1 course of carrying out its duties under this sec2 tion. 

3 ‘‘(2) To review and analyze the recommendations 

4 of the report of the study committee. 

5 ‘‘(3) To make legislative recommendations to 

6 Congress regarding the delivery of Federal health care 

7 services to Indians. Such recommendations shall in8 clude those related to issues of eligibility, benefits, the 

9 range of service providers, the cost of such services, fi10 nancing such services, and the optimal manner in 

11 which to provide such services. 

12 ‘‘(4) Not later than 18 months following the date 

13 of appointment of all members of the Commission, 

14 submit a written report to Congress regarding the de15 livery of Federal health care services to Indians. Such 

16 recommendations shall include those related to issues 

17 of eligibility, benefits, the range of service providers, 

18 the cost of such services, financing such services, and 

19 the optimal manner in which to provide such services. 

20 ‘‘(c) MEMBERS.— 

21 ‘‘(1) APPOINTMENT.—The Commission shall be 

22 composed of 25 members, appointed as follows: 

23 ‘‘(A) Ten members of Congress, including 3 

24 from the House of Representatives and 2 from 

25 the Senate, appointed by their respective majorVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00307 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
308 

•HR 1328 RH

1 ity leaders, and 3 from the House of Representa2 tives and 2 from the Senate, appointed by their 

3 respective minority leaders, and who shall be 

4 members of the standing committees of Congress 

5 that consider legislation affecting health care to 

6 Indians. 

7 ‘‘(B) Twelve persons chosen by the congres8 sional members of the Commission, 1 from each 

9 Service Area as currently designated by the Di10 rector of the Service to be chosen from among 3 

11 nominees from each Service Area put forward by 

12 the Indian Tribes within the area, with due re13 gard being given to the experience and expertise 

14 of the nominees in the provision of health care 

15 to Indians and to a reasonable representation on 

16 the commission of members who are familiar 

17 with various health care delivery modes and who 

18 represent Indian Tribes of various size popu19 lations. 

20 ‘‘(C) Three persons appointed by the Direc21 tor who are knowledgeable about the provision of 

22 health care to Indians, at least 1 of whom shall 

23 be appointed from among 3 nominees put for24 ward by those programs whose funds are pro25 vided in whole or in part by the Service priVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00308 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
309 

•HR 1328 RH

1 marily or exclusively for the benefit of Urban In2 dians. 

3 ‘‘(D) All those persons chosen by the con4 gressional members of the Commission and by 

5 the Director shall be members of federally recog6 nized Indian Tribes. 

7 ‘‘(2) CHAIR; VICE CHAIR.—The Chair and Vice 

8 Chair of the Commission shall be selected by the con9 gressional members of the Commission. 

10 ‘‘(3) TERMS.—The terms of members of the Com11 mission shall be for the life of the Commission. 

12 ‘‘(4) DEADLINE FOR APPOINTMENTS.—Congres13 sional members of the Commission shall be appointed 

14 not later than 180 days after the date of enactment 

15 of the Indian Health Care Improvement Act Amend16 ments of 2007, and the remaining members of the 

17 Commission shall be appointed not later than 60 days 

18 following the appointment of the congressional mem19 bers. 

20 ‘‘(5) VACANCY.—A vacancy in the Commission 

21 shall be filled in the manner in which the original 

22 appointment was made. 

23 ‘‘(d) COMPENSATION.— 

24 ‘‘(1) CONGRESSIONAL MEMBERS.—Each congres25 sional member of the Commission shall receive no adVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00309 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
310 

•HR 1328 RH

1 ditional pay, allowances, or benefits by reason of their 

2 service on the Commission and shall receive travel ex3 penses and per diem in lieu of subsistence in accord4 ance with sections 5702 and 5703 of title 5, United 

5 States Code. 

6 ‘‘(2) OTHER MEMBERS.—Remaining members of 

7 the Commission, while serving on the business of the 

8 Commission (including travel time), shall be entitled 

9 to receive compensation at the per diem equivalent of 

10 the rate provided for level IV of the Executive Sched11 ule under section 5315 of title 5, United States Code, 

12 and while so serving away from home and the mem13 ber’s regular place of business, a member may be al14 lowed travel expenses, as authorized by the Chairman 

15 of the Commission. For purpose of pay (other than 

16 pay of members of the Commission) and employment 

17 benefits, rights, and privileges, all personnel of the 

18 Commission shall be treated as if they were employees 

19 of the United States Senate. 

20 ‘‘(e) MEETINGS.—The Commission shall meet at the 

21 call of the Chair. 

22 ‘‘(f) QUORUM.—A quorum of the Commission shall 

23 consist of not less than 15 members, provided that no less 

24 than 6 of the members of Congress who are Commission 


jbell on PROD1PC69 with BILLS
311 

•HR 1328 RH

1 members are present and no less than 9 of the members who 

2 are Indians are present. 

3 ‘‘(g) EXECUTIVE DIRECTOR; STAFF; FACILITIES.— 

4 ‘‘(1) APPOINTMENT; PAY.—The Commission shall 

5 appoint an executive director of the Commission. The 

6 executive director shall be paid the rate of basic pay 

7 for level V of the Executive Schedule. 

8 ‘‘(2) STAFF APPOINTMENT.—With the approval 

9 of the Commission, the executive director may ap10 point such personnel as the executive director deems 

11 appropriate. 

12 ‘‘(3) STAFF PAY.—The staff of the Commission 

13 shall be appointed without regard to the provisions of 

14 title 5, United States Code, governing appointments 

15 in the competitive service, and shall be paid without 

16 regard to the provisions of chapter 51 and subchapter 

17 III of chapter 53 of such title (relating to classifica18 tion and General Schedule pay rates). 

19 ‘‘(4) TEMPORARY SERVICES.—With the approval 

20 of the Commission, the executive director may procure 

21 temporary and intermittent services under section 

22 3109(b) of title 5, United States Code. 

23 ‘‘(5) FACILITIES.—The Administrator of General 

24 Services shall locate suitable office space for the oper25 ation of the Commission. The facilities shall serve as 


jbell on PROD1PC69 with BILLS
312 

•HR 1328 RH

1 the headquarters of the Commission and shall include 

2 all necessary equipment and incidentals required for 

3 the proper functioning of the Commission. 

4 ‘‘(h) HEARINGS.—(1) For the purpose of carrying out 

5 its duties, the Commission may hold such hearings and un6 dertake such other activities as the Commission determines 

7 to be necessary to carry out its duties, provided that at least 

8 6 regional hearings are held in different areas of the United 

9 States in which large numbers of Indians are present. Such 

10 hearings are to be held to solicit the views of Indians re11 garding the delivery of health care services to them. To con12 stitute a hearing under this subsection, at least 5 members 

13 of the Commission, including at least 1 member of Congress, 

14 must be present. Hearings held by the study committee es15 tablished in this section may count toward the number of 

16 regional hearings required by this subsection. 

17 ‘‘(2) Upon request of the Commission, the Comptroller 

18 General shall conduct such studies or investigations as the 

19 Commission determines to be necessary to carry out its du20 ties. 

21 ‘‘(3)(A) The Director of the Congressional Budget Of22 fice or the Chief Actuary of the Centers for Medicare & Med23 icaid Services, or both, shall provide to the Commission, 

24 upon the request of the Commission, such cost estimates as 


jbell on PROD1PC69 with BILLS
313 

•HR 1328 RH

1 the Commission determines to be necessary to carry out its 

2 duties. 

3 ‘‘(B) The Commission shall reimburse the Director of 

4 the Congressional Budget Office for expenses relating to the 

5 employment in the office of that Director of such additional 

6 staff as may be necessary for the Director to comply with 

7 requests by the Commission under subparagraph (A). 

8 ‘‘(4) Upon the request of the Commission, the head of 

9 any Federal agency is authorized to detail, without reim10 bursement, any of the personnel of such agency to the Com11 mission to assist the Commission in carrying out its duties. 

12 Any such detail shall not interrupt or otherwise affect the 

13 civil service status or privileges of the Federal employee. 

14 ‘‘(5) Upon the request of the Commission, the head of 

15 a Federal agency shall provide such technical assistance to 

16 the Commission as the Commission determines to be nec17 essary to carry out its duties. 

18 ‘‘(6) The Commission may use the United States mails 

19 in the same manner and under the same conditions as Fed20 eral agencies and shall, for purposes of the frank, be consid21 ered a commission of Congress as described in section 3215 

22 of title 39, United States Code. 

23 ‘‘(7) The Commission may secure directly from any 

24 Federal agency information necessary to enable it to carry 

25 out its duties, if the information may be disclosed under 


jbell on PROD1PC69 with BILLS
314 

•HR 1328 RH

1 section 552 of title 4, United States Code. Upon request of 

2 the Chairman of the Commission, the head of such agency 

3 shall furnish such information to the Commission. 

4 ‘‘(8) Upon the request of the Commission, the Adminis5 trator of General Services shall provide to the Commission 

6 on a reimbursable basis such administrative support serv7 ices as the Commission may request. 

8 ‘‘(9) For purposes of costs relating to printing and 

9 binding, including the cost of personnel detailed from the 

10 Government Printing Office, the Commission shall be 

11 deemed to be a committee of Congress. 

12 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

13 authorized to be appropriated $4,000,000 to carry out the 

14 provisions of this section, which sum shall not be deducted 

15 from or affect any other appropriation for health care for 

16 Indian persons. 

17 ‘‘(j) NONAPPLICABILITY OF FACA.—The Federal Advi18 sory Committee Act (5 U.S.C. App.) shall not apply to the 

19 Commission. 

20 ‘‘SEC. 814. CONFIDENTIALITY OF MEDICAL QUALITY ASSUR21 ANCE RECORDS; QUALIFIED IMMUNITY FOR 

22 PARTICIPANTS. 

23 ‘‘(a) CONFIDENTIALITY OF RECORDS.—Medical qual24 ity assurance records created by or for any Indian Health 

25 Program or a health program of an Urban Indian OrganiVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00314 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
315 

•HR 1328 RH

1 zation as part of a medical quality assurance program are 

2 confidential and privileged. Such records may not be dis3 closed to any person or entity, except as provided in sub4 section (c). 

5 ‘‘(b) PROHIBITION ON DISCLOSURE AND TESTI6 MONY.— 

7 ‘‘(1) IN GENERAL.—No part of any medical 

8 quality assurance record described in subsection (a) 

9 may be subject to discovery or admitted into evidence 

10 in any judicial or administrative proceeding, except 

11 as provided in subsection (c). 

12 ‘‘(2) TESTIMONY.—A person who reviews or cre13 ates medical quality assurance records for any Indian 

14 Health Program or Urban Indian Organization who 

15 participates in any proceeding that reviews or creates 

16 such records may not be permitted or required to tes17 tify in any judicial or administrative proceeding 

18 with respect to such records or with respect to any 

19 finding, recommendation, evaluation, opinion, or ac20 tion taken by such person or body in connection with 

21 such records except as provided in this section. 

22 ‘‘(c) AUTHORIZED DISCLOSURE AND TESTIMONY.— 

23 ‘‘(1) IN GENERAL.—Subject to paragraph (2), a 

24 medical quality assurance record described in sub25 section (a) may be disclosed, and a person referred to 


jbell on PROD1PC69 with BILLS
316 

•HR 1328 RH

1 in subsection (b) may give testimony in connection 

2 with such a record, only as follows: 

3 ‘‘(A) To a Federal executive agency or pri4 vate organization, if such medical quality assur5 ance record or testimony is needed by such agen6 cy or organization to perform licensing or ac7 creditation functions related to any Indian 

8 Health Program or to a health program of an 

9 Urban Indian Organization to perform moni10 toring, required by law, of such program or or11 ganization. 

12 ‘‘(B) To an administrative or judicial pro13 ceeding commenced by a present or former In14 dian Health Program or Urban Indian Organi15 zation provider concerning the termination, sus16 pension, or limitation of clinical privileges of 

17 such health care provider. 

18 ‘‘(C) To a governmental board or agency or 

19 to a professional health care society or organiza20 tion, if such medical quality assurance record or 

21 testimony is needed by such board, agency, soci22 ety, or organization to perform licensing, 

23 credentialing, or the monitoring of professional 

24 standards with respect to any health care proVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00316 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
317 

•HR 1328 RH

1 vider who is or was an employee of any Indian 

2 Health Program or Urban Indian Organization. 

3 ‘‘(D) To a hospital, medical center, or other 

4 institution that provides health care services, if 

5 such medical quality assurance record or testi6 mony is needed by such institution to assess the 

7 professional qualifications of any health care 

8 provider who is or was an employee of any In9 dian Health Program or Urban Indian Organi10 zation and who has applied for or been granted 

11 authority or employment to provide health care 

12 services in or on behalf of such program or orga13 nization. 

14 ‘‘(E) To an officer, employee, or contractor 

15 of the Indian Health Program or Urban Indian 

16 Organization that created the records or for 

17 which the records were created. If that officer, 

18 employee, or contractor has a need for such 

19 record or testimony to perform official duties. 

20 ‘‘(F) To a criminal or civil law enforcement 

21 agency or instrumentality charged under appli22 cable law with the protection of the public health 

23 or safety, if a qualified representative of such 

24 agency or instrumentality makes a written reVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00317 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
318 

•HR 1328 RH

1 quest that such record or testimony be provided 

2 for a purpose authorized by law. 

3 ‘‘(G) In an administrative or judicial pro4 ceeding commenced by a criminal or civil law 

5 enforcement agency or instrumentality referred 

6 to in subparagraph (F), but only with respect to 

7 the subject of such proceeding. 

8 ‘‘(2) IDENTITY OF PARTICIPANTS.—With the ex9 ception of the subject of a quality assurance action, 

10 the identity of any person receiving health care serv11 ices from any Indian Health Program or Urban In12 dian Organization or the identity of any other person 

13 associated with such program or organization for 

14 purposes of a medical quality assurance program that 

15 is disclosed in a medical quality assurance record de16 scribed in subsection (a) shall be deleted from that 

17 record or document before any disclosure of such 

18 record is made outside such program or organization. 

19 Such requirement does not apply to the release of in20 formation pursuant to section 552a of title 5. 

21 ‘‘(d) DISCLOSURE FOR CERTAIN PURPOSES.— 

22 ‘‘(1) IN GENERAL.—Nothing in this section shall 

23 be construed as authorizing or requiring the with24 holding from any person or entity aggregate statis25 tical information regarding the results of any Indian 


jbell on PROD1PC69 with BILLS
319 

•HR 1328 RH

1 Health Program or Urban Indian Organizations’s 

2 medical quality assurance programs. 

3 ‘‘(2) WITHHOLDING FROM CONGRESS.—Nothing 

4 in this section shall be construed as authority to with5 hold any medical quality assurance record from a 

6 committee of either House of Congress, any joint com7 mittee of Congress, or the Government Accountability 

8 Office if such record pertains to any matter within 

9 their respective jurisdictions. 

10 ‘‘(e) PROHIBITION ON DISCLOSURE OF RECORD OR

11 TESTIMONY.—A person or entity having possession of or ac12 cess to a record or testimony described by this section may 

13 not disclose the contents of such record or testimony in any 

14 manner or for any purpose except as provided in this sec15 tion. 

16 ‘‘(f) EXEMPTION FROM FREEDOM OF INFORMATION

17 ACT.—Medical quality assurance records described in sub18 section (a) may not be made available to any person under 

19 section 552 of title 5. 

20 ‘‘(g) LIMITATION ON CIVIL LIABILITY.—A person who 

21 participates in or provides information to a person or body 

22 that reviews or creates medical quality assurance records 

23 described in subsection (a) shall not be civilly liable for such 

24 participation or for providing such information if the par25 ticipation or provision of information was in good faith 


jbell on PROD1PC69 with BILLS
320 

•HR 1328 RH

1 based on prevailing professional standards at the time the 

2 medical quality assurance program activity took place. 

3 ‘‘(h) APPLICATION TO INFORMATION IN CERTAIN

4 OTHER RECORDS.—Nothing in this section shall be con5 strued as limiting access to the information in a record cre6 ated and maintained outside a medical quality assurance 

7 program, including a patient’s medical records, on the 

8 grounds that the information was presented during meet9 ings of a review body that are part of a medical quality 

10 assurance program. 

11 ‘‘(i) REGULATIONS.—The Secretary, acting through 

12 the Service, shall promulgate regulations pursuant to sec13 tion 802. 

14 ‘‘(j) DEFINITIONS.—In this section: 

15 ‘‘(1) The term ‘health care provider’ means any 

16 health care professional, including community health 

17 aides and practitioners certified under section 121, 

18 who are granted clinical practice privileges or em19 ployed to provide health care services in an Indian 

20 Health Program or health program of an Urban In21 dian Organization, who is licensed or certified to per22 form health care services by a governmental board or 

23 agency or professional health care society or organiza24 tion. 


jbell on PROD1PC69 with BILLS
321 

•HR 1328 RH

1 ‘‘(2) The term ‘medical quality assurance pro2 gram’ means any activity carried out before, on, or 

3 after the date of enactment of this Act by or for any 

4 Indian Health Program or Urban Indian Organiza5 tion to assess the quality of medical care, including 

6 activities conducted by or on behalf of individuals, 

7 Indian Health Program or Urban Indian Organiza8 tion medical or dental treatment review committees, 

9 or other review bodies responsible for quality assur10 ance, credentials, infection control, patient safety, pa11 tient care assessment (including treatment procedures, 

12 blood, drugs, and therapeutics), medical records, 

13 health resources management review and identifica14 tion and prevention of medical or dental incidents 

15 and risks. 

16 ‘‘(3) The term ‘medical quality assurance record’ 

17 means the proceedings, records, minutes, and reports 

18 that emanate from quality assurance program activi19 ties described in paragraph (2) and are produced or 

20 compiled by or for an Indian Health Program or 

21 Urban Indian Organization as part of a medical 

22 quality assurance program. 

23 ‘‘SEC. 815. APPROPRIATIONS; AVAILABILITY. 

24 ‘‘Any new spending authority (described in subpara25 graph (A) or (B) of section 401(c)(2) of the Congressional 


jbell on PROD1PC69 with BILLS
322 

•HR 1328 RH

1 Budget Act of 1974 (Public Law 93–344; 88 Stat. 317)) 

2 which is provided under this Act shall be effective for any 

3 fiscal year only to such extent or in such amounts as are 

4 provided in appropriation Acts. 

5 ‘‘SEC. 816. AUTHORIZATION OF APPROPRIATIONS. 

6 ‘‘There are authorized to be appropriated such sums 

7 as may be necessary for each fiscal year through fiscal year 

8 2017 to carry out this title.’’. 

9 (b) RATE OF PAY.— 

10 (1) POSITIONS AT LEVEL IV.—Section 5315 of 

11 title 5, United States Code, is amended by striking 

12 ‘‘Assistant Secretaries of Health and Human Services 

13 (6)’’ and inserting ‘‘Assistant Secretaries of Health 

14 and Human Services (7)’’. 

15 (2) POSITIONS AT LEVEL V.—Section 5316 of 

16 title 5, United States Code, is amended by striking 

17 ‘‘Director, Indian Health Service, Department of 

18 Health and Human Services’’. 

19 (c) AMENDMENTS TO OTHER PROVISIONS OF LAW.— 

20 (1) Section 3307(b)(1)(C) of the Children’s 

21 Health Act of 2000 (25 U.S.C. 1671 note; Public Law 

22 106–310) is amended by striking ‘‘Director of the In23 dian Health Service’’ and inserting ‘‘Assistant Sec24 retary for Indian Health’’. 


jbell on PROD1PC69 with BILLS
323 

•HR 1328 RH

1 (2) The Indian Lands Open Dump Cleanup Act 

2 of 1994 is amended— 

3 (A) in section 3 (25 U.S.C. 3902)— 

4 (i) by striking paragraph (2); 

5 (ii) by redesignating paragraphs (1), 

6 (3), (4), (5), and (6) as paragraphs (4), (5), 

7 (2), (6), and (1), respectively, and moving 

8 those paragraphs so as to appear in numer9 ical order; and 

10 (iii) by inserting before paragraph (4) 

11 (as redesignated by clause (ii)) the fol12 lowing: 

13 ‘‘(3) ASSISTANT SECRETARY.—The term ‘Assist14 ant Secretary’ means the Assistant Secretary for In15 dian Health.’’; 

16 (B) in section 5 (25 U.S.C. 3904), by strik17 ing the section designation and heading and in18 serting the following: 

19 ‘‘SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR IN20 DIAN HEALTH.’’; 

21 (C) in section 6(a) (25 U.S.C. 3905(a)), in 

22 the subsection heading, by striking ‘‘DIRECTOR’’ 

23 and inserting ‘‘ASSISTANT SECRETARY’’; 


jbell on PROD1PC69 with BILLS
324 

•HR 1328 RH

1 (D) in section 9(a) (25 U.S.C. 3908(a)), in 

2 the subsection heading, by striking ‘‘DIRECTOR’’ 

3 and inserting ‘‘ASSISTANT SECRETARY’’; and 

4 (E) by striking ‘‘Director’’ each place it ap5 pears and inserting ‘‘Assistant Secretary’’. 

6 (3) Section 5504(d)(2) of the Augustus F. Haw7 kins-Robert T. Stafford Elementary and Secondary 

8 School Improvement Amendments of 1988 (25 U.S.C. 

9 2001 note; Public Law 100–297) is amended by strik10 ing ‘‘Director of the Indian Health Service’’ and in11 serting ‘‘Assistant Secretary for Indian Health’’. 

12 (4) Section 203(a)(1) of the Rehabilitation Act of 

13 1973 (29 U.S.C. 763(a)(1)) is amended by striking 

14 ‘‘Director of the Indian Health Service’’ and inserting 

15 ‘‘Assistant Secretary for Indian Health’’. 

16 (5) Subsections (b) and (e) of section 518 of the 

17 Federal Water Pollution Control Act (33 U.S.C. 1377) 

18 are amended by striking ‘‘Director of the Indian 

19 Health Service’’ each place it appears and inserting 

20 ‘‘Assistant Secretary for Indian Health’’. 

21 (6) Section 317M(b) of the Public Health Service 

22 Act (42 U.S.C. 247b–14(b)) is amended— 

23 (A) by striking ‘‘Director of the Indian 

24 Health Service’’ each place it appears and inVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00324 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
325 

•HR 1328 RH

1 serting ‘‘Assistant Secretary for Indian Health’’; 

2 and 

3 (B) in paragraph (2)(A), by striking ‘‘the 

4 Directors referred to in such paragraph’’ and in5 serting ‘‘the Director of the Centers for Disease 

6 Control and Prevention and the Assistant Sec7 retary for Indian Health’’. 

8 (7) Section 417C(b) of the Public Health Service 

9 Act (42 U.S.C. 285–9(b)) is amended by striking ‘‘Di10 rector of the Indian Health Service’’ and inserting 

11 ‘‘Assistant Secretary for Indian Health’’. 

12 (8) Section 1452(i) of the Safe Drinking Water 

13 Act (42 U.S.C. 300j–12(i)) is amended by striking 

14 ‘‘Director of the Indian Health Service’’ each place it 

15 appears and inserting ‘‘Assistant Secretary for In16 dian Health’’. 

17 (9) Section 803B(d)(1) of the Native American 

18 Programs Act of 1974 (42 U.S.C. 2991b–2(d)(1)) is 

19 amended in the last sentence by striking ‘‘Director of 

20 the Indian Health Service’’ and inserting ‘‘Assistant 

21 Secretary for Indian Health’’. 

22 (10) Section 203(b) of the Michigan Indian 

23 Land Claims Settlement Act (Public Law 105–143; 

24 111 Stat. 2666) is amended by striking ‘‘Director of 


jbell on PROD1PC69 with BILLS
326 

•HR 1328 RH

1 the Indian Health Service’’ and inserting ‘‘Assistant 

2 Secretary for Indian Health’’. 

3 SEC. 102. SOBOBA SANITATION FACILITIES. 

4 The Act of December 17, 1970 (84 Stat. 1465), is 

5 amended by adding at the end the following: 

6 ‘‘SEC. 9. Nothing in this Act shall preclude the Soboba 

7 Band of Mission Indians and the Soboba Indian Reserva8 tion from being provided with sanitation facilities and serv9 ices under the authority of section 7 of the Act of August 

10 5, 1954 (68 Stat. 674), as amended by the Act of July 31, 

11 1959 (73 Stat. 267).’’. 

12 SEC. 103. NATIVE AMERICAN HEALTH AND WELLNESS 

13 FOUNDATION. 

14 (a) IN GENERAL.—The Indian Self-Determination 

15 and Education Assistance Act (25 U.S.C. 450 et seq.) is 

16 amended by adding at the end the following: 

17 ‘‘TITLE VIII—NATIVE AMERICAN 

18 HEALTH AND WELLNESS 

19 FOUNDATION 

20 ‘‘SEC. 801. DEFINITIONS. 

21 ‘‘In this title: 

22 ‘‘(1) BOARD.—The term ‘Board’ means the 

23 Board of Directors of the Foundation. 

24 ‘‘(2) COMMITTEE.—The term ‘Committee’ means 

25 the Committee for the Establishment of Native AmerVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00326 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
327 

•HR 1328 RH

1 ican Health and Wellness Foundation established 

2 under section 802(f). 

3 ‘‘(3) FOUNDATION.—The term ‘Foundation’ 

4 means the Native American Health and Wellness 

5 Foundation established under section 802. 

6 ‘‘(4) SECRETARY.—The term ‘Secretary’ means 

7 the Secretary of Health and Human Services. 

8 ‘‘(5) SERVICE.—The term ‘Service’ means the In9 dian Health Service of the Department of Health and 

10 Human Services. 

11 ‘‘SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS 

12 FOUNDATION. 

13 ‘‘(a) ESTABLISHMENT.— 

14 ‘‘(1) IN GENERAL.—As soon as practicable after 

15 the date of enactment of this title, the Secretary shall 

16 establish, under the laws of the District of Columbia 

17 and in accordance with this title, the Native Amer18 ican Health and Wellness Foundation. 

19 ‘‘(2) FUNDING DETERMINATIONS.—No funds, 

20 gift, property, or other item of value (including any 

21 interest accrued on such an item) acquired by the 

22 Foundation shall— 

23 ‘‘(A) be taken into consideration for pur24 poses of determining Federal appropriations reVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00327 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
328 

•HR 1328 RH

1 lating to the provision of health care and services 

2 to Indians; or 

3 ‘‘(B) otherwise limit, diminish, or affect the 

4 Federal responsibility for the provision of health 

5 care and services to Indians. 

6 ‘‘(b) PERPETUAL EXISTENCE.—The Foundation shall 

7 have perpetual existence. 

8 ‘‘(c) NATURE OF CORPORATION.—The Foundation— 

9 ‘‘(1) shall be a charitable and nonprofit federally 

10 chartered corporation; and 

11 ‘‘(2) shall not be an agency or instrumentality of 

12 the United States. 

13 ‘‘(d) PLACE OF INCORPORATION AND DOMICILE.—The 

14 Foundation shall be incorporated and domiciled in the Dis15 trict of Columbia. 

16 ‘‘(e) DUTIES.—The Foundation shall— 

17 ‘‘(1) encourage, accept, and administer private 

18 gifts of real and personal property, and any income 

19 from or interest in such gifts, for the benefit of, or in 

20 support of, the mission of the Service; 

21 ‘‘(2) undertake and conduct such other activities 

22 as will further the health and wellness activities and 

23 opportunities of Native Americans; and 

24 ‘‘(3) participate with and assist Federal, State, 

25 and tribal governments, agencies, entities, and indiVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00328 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
329 

•HR 1328 RH

1 viduals in undertaking and conducting activities that 

2 will further the health and wellness activities and op3 portunities of Native Americans. 

4 ‘‘(f) COMMITTEE FOR THE ESTABLISHMENT OF NATIVE

5 AMERICAN HEALTH AND WELLNESS FOUNDATION.— 

6 ‘‘(1) IN GENERAL.—The Secretary shall establish 

7 the Committee for the Establishment of Native Amer8 ican Health and Wellness Foundation to assist the 

9 Secretary in establishing the Foundation. 

10 ‘‘(2) DUTIES.—Not later than 180 days after the 

11 date of enactment of this section, the Committee 

12 shall— 

13 ‘‘(A) carry out such activities as are nec14 essary to incorporate the Foundation under the 

15 laws of the District of Columbia, including act16 ing as incorporators of the Foundation; 

17 ‘‘(B) ensure that the Foundation qualifies 

18 for and maintains the status required to carry 

19 out this section, until the Board is established; 

20 ‘‘(C) establish the constitution and initial 

21 bylaws of the Foundation; 

22 ‘‘(D) provide for the initial operation of the 

23 Foundation, including providing for temporary 

24 or interim quarters, equipment, and staff; and 


jbell on PROD1PC69 with BILLS
330 

•HR 1328 RH

1 ‘‘(E) appoint the initial members of the 

2 Board in accordance with the constitution and 

3 initial bylaws of the Foundation. 

4 ‘‘(g) BOARD OF DIRECTORS.— 

5 ‘‘(1) IN GENERAL.—The Board of Directors shall 

6 be the governing body of the Foundation. 

7 ‘‘(2) POWERS.—The Board may exercise, or pro8 vide for the exercise of, the powers of the Foundation. 

9 ‘‘(3) SELECTION.— 

10 ‘‘(A) IN GENERAL.—Subject to subpara11 graph (B), the number of members of the Board, 

12 the manner of selection of the members (includ13 ing the filling of vacancies), and the terms of of14 fice of the members shall be as provided in the 

15 constitution and bylaws of the Foundation. 

16 ‘‘(B) REQUIREMENTS.— 

17 ‘‘(i) NUMBER OF MEMBERS.—The 

18 Board shall have at least 11 members, who 

19 shall have staggered terms. 

20 ‘‘(ii) INITIAL VOTING MEMBERS.—The 

21 initial voting members of the Board— 

22 ‘‘(I) shall be appointed by the 

23 Committee not later than 180 days 

24 after the date on which the Foundation 

25 is established; and 


jbell on PROD1PC69 with BILLS
331 

•HR 1328 RH

1 ‘‘(II) shall have staggered terms. 

2 ‘‘(iii) QUALIFICATION.—The members 

3 of the Board shall be United States citizens 

4 who are knowledgeable or experienced in 

5 Native American health care and related 

6 matters. 

7 ‘‘(C) COMPENSATION.—A member of the 

8 Board shall not receive compensation for service 

9 as a member, but shall be reimbursed for actual 

10 and necessary travel and subsistence expenses in11 curred in the performance of the duties of the 

12 Foundation. 

13 ‘‘(h) OFFICERS.— 

14 ‘‘(1) IN GENERAL.—The officers of the Founda15 tion shall be— 

16 ‘‘(A) a secretary, elected from among the 

17 members of the Board; and 

18 ‘‘(B) any other officers provided for in the 

19 constitution and bylaws of the Foundation. 

20 ‘‘(2) CHIEF OPERATING OFFICER.—The secretary 

21 of the Foundation may serve, at the direction of the 

22 Board, as the chief operating officer of the Founda23 tion, or the Board may appoint a chief operating offi24 cer, who shall serve at the direction of the Board. 


jbell on PROD1PC69 with BILLS
332 

•HR 1328 RH

1 ‘‘(3) ELECTION.—The manner of election, term 

2 of office, and duties of the officers of the Foundation 

3 shall be as provided in the constitution and bylaws 

4 of the Foundation. 

5 ‘‘(i) POWERS.—The Foundation— 

6 ‘‘(1) shall adopt a constitution and bylaws for 

7 the management of the property of the Foundation 

8 and the regulation of the affairs of the Foundation; 

9 ‘‘(2) may adopt and alter a corporate seal; 

10 ‘‘(3) may enter into contracts; 

11 ‘‘(4) may acquire (through a gift or otherwise), 

12 own, lease, encumber, and transfer real or personal 

13 property as necessary or convenient to carry out the 

14 purposes of the Foundation; 

15 ‘‘(5) may sue and be sued; and 

16 ‘‘(6) may perform any other act necessary and 

17 proper to carry out the purposes of the Foundation. 

18 ‘‘(j) PRINCIPAL OFFICE.— 

19 ‘‘(1) IN GENERAL.—The principal office of the 

20 Foundation shall be in the District of Columbia. 

21 ‘‘(2) ACTIVITIES; OFFICES.—The activities of the 

22 Foundation may be conducted, and offices may be 

23 maintained, throughout the United States in accord24 ance with the constitution and bylaws of the Founda25 tion. 


jbell on PROD1PC69 with BILLS
333 

•HR 1328 RH

1 ‘‘(k) SERVICE OF PROCESS.—The Foundation shall 

2 comply with the law on service of process of each State in 

3 which the Foundation is incorporated and of each State in 

4 which the Foundation carries on activities. 

5 ‘‘(l) LIABILITY OF OFFICERS, EMPLOYEES, AND

6 AGENTS.— 

7 ‘‘(1) IN GENERAL.—The Foundation shall be lia8 ble for the acts of the officers, employees, and agents 

9 of the Foundation acting within the scope of their au10 thority. 

11 ‘‘(2) PERSONAL LIABILITY.—A member of the 

12 Board shall be personally liable only for gross neg13 ligence in the performance of the duties of the mem14 ber. 

15 ‘‘(m) RESTRICTIONS.— 

16 ‘‘(1) LIMITATION ON SPENDING.—Beginning 

17 with the fiscal year following the first full fiscal year 

18 during which the Foundation is in operation, the ad19 ministrative costs of the Foundation shall not exceed 

20 the percentage described in paragraph (2) of the sum 

21 of— 

22 ‘‘(A) the amounts transferred to the Foun23 dation under subsection (o) during the preceding 

24 fiscal year; and 


jbell on PROD1PC69 with BILLS
334 

•HR 1328 RH

1 ‘‘(B) donations received from private 

2 sources during the preceding fiscal year. 

3 ‘‘(2) PERCENTAGES.—The percentages referred to 

4 in paragraph (1) are— 

5 ‘‘(A) for the first fiscal year described in 

6 that paragraph, 20 percent; 

7 ‘‘(B) for the following fiscal year, 15 per8 cent; and 

9 ‘‘(C) for each fiscal year thereafter, 10 per10 cent. 

11 ‘‘(3) APPOINTMENT AND HIRING.—The appoint12 ment of officers and employees of the Foundation 

13 shall be subject to the availability of funds. 

14 ‘‘(4) STATUS.—A member of the Board or officer, 

15 employee, or agent of the Foundation shall not by 

16 reason of association with the Foundation be consid17 ered to be an officer, employee, or agent of the United 

18 States. 

19 ‘‘(n) AUDITS.—The Foundation shall comply with sec20 tion 10101 of title 36, United States Code, as if the Founda21 tion were a corporation under part B of subtitle II of that 

22 title. 

23 ‘‘(o) FUNDING.— 

24 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

25 There is authorized to be appropriated to carry out 


jbell on PROD1PC69 with BILLS
335 

•HR 1328 RH

1 subsection (e)(1) $500,000 for each fiscal year, as ad2 justed to reflect changes in the Consumer Price Index 

3 for all-urban consumers published by the Department 

4 of Labor. 

5 ‘‘(2) TRANSFER OF DONATED FUNDS.—The Sec6 retary shall transfer to the Foundation funds held by 

7 the Department of Health and Human Services under 

8 the Act of August 5, 1954 (42 U.S.C. 2001 et seq.), 

9 if the transfer or use of the funds is not prohibited 

10 by any term under which the funds were donated. 

11 ‘‘SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT. 

12 ‘‘(a) PROVISION OF SUPPORT BY SECRETARY.—Sub13 ject to subsection (b), during the 5-year period beginning 

14 on the date on which the Foundation is established, the Sec15 retary— 

16 ‘‘(1) may provide personnel, facilities, and other 

17 administrative support services to the Foundation; 

18 ‘‘(2) may provide funds for initial operating 

19 costs and to reimburse the travel expenses of the mem20 bers of the Board; and 

21 ‘‘(3) shall require and accept reimbursements 

22 from the Foundation for— 

23 ‘‘(A) services provided under paragraph (1); 

24 and 

25 ‘‘(B) funds provided under paragraph (2). 


jbell on PROD1PC69 with BILLS
336 

•HR 1328 RH

1 ‘‘(b) REIMBURSEMENT.—Reimbursements accepted 

2 under subsection (a)(3)— 

3 ‘‘(1) shall be deposited in the Treasury of the 

4 United States to the credit of the applicable appro5 priations account; and 

6 ‘‘(2) shall be chargeable for the cost of providing 

7 services described in subsection (a)(1) and travel ex8 penses described in subsection (a)(2). 

9 ‘‘(c) CONTINUATION OF CERTAIN SERVICES.—The Sec10 retary may continue to provide facilities and necessary sup11 port services to the Foundation after the termination of the 

12 5-year period specified in subsection (a) if the facilities and 

13 services— 

14 ‘‘(1) are available; and 

15 ‘‘(2) are provided on reimbursable cost basis.’’. 

16 (b) TECHNICAL AMENDMENTS.—The Indian Self-De17 termination and Education Assistance Act is amended— 

18 (1) by redesignating the second title V (25 U.S.C. 

19 458bbb et seq.) as title VII; 

20 (2) by redesignating sections 501, 502, and 503 

21 (25 U.S.C. 458bbb, 458bbb–1, 458bbb–2) as sections 

22 701, 702, and 703, respectively; and 

23 (3) in subsection (a)(2) of section 702 and para24 graph (2) of section 703 (as redesignated by paraVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00336 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
337 

•HR 1328 RH

1 graph (2)), by striking ‘‘section 501’’ and inserting 

2 ‘‘section 701’’. 

3 TITLE II—IMPROVEMENT OF IN4 DIAN HEALTH CARE PRO5 VIDED UNDER THE SOCIAL 

6 SECURITY ACT 

7 SEC. 201. EXPANSION OF PAYMENTS UNDER MEDICARE, 

8 MEDICAID, AND SCHIP FOR ALL COVERED 

9 SERVICES FURNISHED BY INDIAN HEALTH 

10 PROGRAMS. 

11 (a) MEDICAID.— 

12 (1) EXPANSION TO ALL COVERED SERVICES.— 

13 Section 1911 of the Social Security Act (42 U.S.C. 

14 1396j) is amended— 

15 (A) by amending the section designation 

16 and heading to read as follows: 

17 ‘‘SEC. 1911. INDIAN HEALTH PROGRAMS.’’; 

18 and 

19 (B) by amending subsection (a) to read as 

20 follows: 

21 ‘‘(a) ELIGIBILITY FOR PAYMENT FOR MEDICAL AS22 SISTANCE.—The Indian Health Service and an Indian 

23 Tribe, Tribal Organization, or an Urban Indian Organiza24 tion shall be eligible for payment for medical assistance pro25 vided under a State plan or under waiver authority with 


jbell on PROD1PC69 with BILLS
338 

•HR 1328 RH

1 respect to items and services furnished by the Indian Health 

2 Service, Indian Tribe, Tribal Organization, or Urban In3 dian Organization if the furnishing of such services meets 

4 all the conditions and requirements which are applicable 

5 generally to the furnishing of items and services under this 

6 title and under such plan or waiver authority.’’. 

7 (2) COMPLIANCE WITH CONDITIONS AND RE8 QUIREMENTS.—Subsection (b) of such section is 

9 amended to read as follows: 

10 ‘‘(b) COMPLIANCE WITH CONDITIONS AND REQUIRE11 MENTS.—A facility of the Indian Health Service or an In12 dian Tribe, Tribal Organization, or an Urban Indian Or13 ganization which is eligible for payment under subsection 

14 (a) with respect to the furnishing of items and services, but 

15 which does not meet all of the conditions and requirements 

16 of this title and under a State plan or waiver authority 

17 which are applicable generally to such facility, shall make 

18 such improvements as are necessary to achieve or maintain 

19 compliance with such conditions and requirements in ac20 cordance with a plan submitted to and accepted by the Sec21 retary for achieving or maintaining compliance with such 

22 conditions and requirements, and shall be deemed to meet 

23 such conditions and requirements (and to be eligible for 

24 payment under this title), without regard to the extent of 

25 its actual compliance with such conditions and requireVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00338 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
339 

•HR 1328 RH

1 ments, during the first 12 months after the month in which 

2 such plan is submitted.’’. 

3 (3) REVISION OF AUTHORITY TO ENTER INTO

4 AGREEMENTS.—Subsection (c) of such section is 

5 amended to read as follows: 

6 ‘‘(c) AUTHORITY TO ENTER INTO AGREEMENTS.—The 

7 Secretary may enter into an agreement with a State for 

8 the purpose of reimbursing the State for medical assistance 

9 provided by the Indian Health Service, an Indian Tribe, 

10 Tribal Organization, or an Urban Indian Organization (as 

11 so defined), directly, through referral, or under contracts or 

12 other arrangements between the Indian Health Service, an 

13 Indian Tribe, Tribal Organization, or an Urban Indian 

14 Organization and another health care provider to Indians 

15 who are eligible for medical assistance under the State plan 

16 or under waiver authority.’’. 

17 (4) CROSS-REFERENCES TO SPECIAL FUND FOR

18 IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING

19 OPTION; DEFINITIONS.—Such section is further 

20 amended by striking subsection (d) and adding at the 

21 end the following new subsections: 

22 ‘‘(d) SPECIAL FUND FOR IMPROVEMENT OF IHS FA23 CILITIES.—For provisions relating to the authority of the 

24 Secretary to place payments to which a facility of the In25 dian Health Service is eligible for payment under this title 


jbell on PROD1PC69 with BILLS
340 

•HR 1328 RH

1 into a special fund established under section 401(c)(1) of 

2 the Indian Health Care Improvement Act, and the require3 ment to use amounts paid from such fund for making im4 provements in accordance with subsection (b), see subpara5 graphs (A) and (B) of section 401(c)(1) of such Act. 

6 ‘‘(e) DIRECT BILLING.—For provisions relating to the 

7 authority of a Tribal Health Program or an Urban Indian 

8 Organization to elect to directly bill for, and receive pay9 ment for, health care items and services provided by such 

10 Program or Organization for which payment is made under 

11 this title, see section 401(d) of the Indian Health Care Im12 provement Act. 

13 ‘‘(f) DEFINITIONS.—In this section, the terms ‘Indian 

14 Health Program’, ‘Indian Tribe’, ‘Tribal Health Program’, 

15 ‘Tribal Organization’, and ‘Urban Indian Organization’ 

16 have the meanings given those terms in section 4 of the In17 dian Health Care Improvement Act.’’. 

18 (b) MEDICARE.— 

19 (1) EXPANSION TO ALL COVERED SERVICES.— 

20 Section 1880 of such Act (42 U.S.C. 1395qq) is 

21 amended— 

22 (A) by amending the section designation 

23 and heading to read as follows: 

24 ‘‘SEC. 1880. INDIAN HEALTH PROGRAMS.’’; 

25 and 


jbell on PROD1PC69 with BILLS
341 

•HR 1328 RH

1 (B) by amending subsection (a) to read as 

2 follows: 

3 ‘‘(a) ELIGIBILITY FOR PAYMENTS.—Subject to sub4 section (e), the Indian Health Service and an Indian Tribe, 

5 Tribal Organization, or an Urban Indian Organization 

6 shall be eligible for payments under this title with respect 

7 to items and services furnished by the Indian Health Serv8 ice, Indian Tribe, Tribal Organization, or Urban Indian 

9 Organization if the furnishing of such services meets all the 

10 conditions and requirements which are applicable generally 

11 to the furnishing of items and services under this title.’’. 

12 (2) COMPLIANCE WITH CONDITIONS AND RE13 QUIREMENTS.—Subsection (b) of such section is 

14 amended to read as follows: 

15 ‘‘(b) COMPLIANCE WITH CONDITIONS AND REQUIRE16 MENTS.—Subject to subsection (e), a facility of the Indian 

17 Health Service or an Indian Tribe, Tribal Organization, 

18 or an Urban Indian Organization which is eligible for pay19 ment under subsection (a) with respect to the furnishing 

20 of items and services, but which does not meet all of the 

21 conditions and requirements of this title which are applica22 ble generally to such facility, shall make such improvements 

23 as are necessary to achieve or maintain compliance with 

24 such conditions and requirements in accordance with a 

25 plan submitted to and accepted by the Secretary for achievVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00341 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
342 

•HR 1328 RH

1 ing or maintaining compliance with such conditions and 

2 requirements, and shall be deemed to meet such conditions 

3 and requirements (and to be eligible for payment under this 

4 title), without regard to the extent of its actual compliance 

5 with such conditions and requirements, during the first 12 

6 months after the month in which such plan 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) and 

12 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 subpara21 graphs (A) and (B) of section 401(c)(1) of such Act. 

22 ‘‘(d) DIRECT BILLING.—For provisions relating to the 

23 authority of a Tribal Health Program or an Urban Indian 

24 Organization to elect to directly bill for, and receive pay25 ment for, health care items and services provided by such 


jbell on PROD1PC69 with BILLS
343 

•HR 1328 RH

1 Program or Organization for which payment is made under 

2 this title, see section 401(d) of the Indian Health Care Im3 provement Act.’’. 

4 (B) CONFORMING AMENDMENT.—Paragraph 

5 (3) of section 1880(e) of such Act (42 U.S.C. 

6 1395qq(e)) is amended by inserting ‘‘and section 

7 401(c)(1) of the Indian Health Care Improve8 ment 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 ‘Indian 

13 Health Program’, ‘Indian Tribe’, ‘Service Unit’, ‘Tribal 

14 Health Program’, ‘Tribal Organization’, and ‘Urban In15 dian Organization’ have the meanings given those terms in 

16 section 4 of the Indian Health Care Improvement Act.’’. 

17 (c) APPLICATION TO SCHIP.—Section 2107(e)(1) of 

18 the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amend19 ed— 

20 (1) by redesignating subparagraph (D) as sub21 paragraph (E); and 

22 (2) by inserting after subparagraph (C), the fol23 lowing new subparagraph: 


jbell on PROD1PC69 with BILLS
344 

•HR 1328 RH

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 SERV7 ICES TO INDIANS UNDER SOCIAL SECURITY 

8 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 AND

15 SCHIP OUTREACH ON OR NEAR RESERVATIONS TO IN16 CREASE THE ENROLLMENT OF INDIANS IN THOSE PRO17 GRAMS.— 

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 the 

23 State to take steps to provide for enrollment on or 

24 near the reservation. Such steps may include outreach 

25 efforts such as the outstationing of eligibility workers, 


jbell on PROD1PC69 with BILLS
345 

•HR 1328 RH

1 entering into agreements with the Indian Health 

2 Service, Indian Tribes, Tribal Organizations, and 

3 Urban Indian Organizations to provide outreach, 

4 education regarding eligibility and benefits, enroll5 ment, and translation services when such services are 

6 appropriate. 

7 ‘‘(2) CONSTRUCTION.—Nothing in subparagraph 

8 (A) shall be construed as affecting arrangements en9 tered into between States and the Indian Health 

10 Service, Indian Tribes, Tribal Organizations, or 

11 Urban Indian Organizations for such Service, Tribes, 

12 or Organizations to conduct administrative activities 

13 under such titles. 

14 ‘‘(b) REQUIREMENT TO FACILITATE COOPERATION.— 

15 The Secretary, acting through the Centers for Medicare & 

16 Medicaid Services, shall take such steps as are necessary 

17 to facilitate cooperation with, and agreements between, 

18 States and the Indian Health Service, Indian Tribes, Trib19 al Organizations, or Urban Indian Organizations with re20 spect to the provision of health care items and services to 

21 Indians under the programs established under title XVIII, 

22 XIX, or XXI. 

23 ‘‘(c) DEFINITION OF INDIAN; INDIAN TRIBE; INDIAN

24 HEALTH PROGRAM; TRIBAL ORGANIZATION; URBAN INDIAN

25 ORGANIZATION.—In this section, the terms ‘Indian’, ‘InVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00345 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
346 

•HR 1328 RH

1 dian Tribe’, ‘Indian Health Program’, ‘Tribal Organiza2 tion’, and ‘Urban Indian Organization’ have the meanings 

3 given those terms in section 4 of the Indian Health Care 

4 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 OUT9 REACH AND CERTAIN OTHER EXPENDITURES.—Section 

10 2105(c)(2) of the Social Security Act (42 U.S.C. 

11 1397ee(c)(2)) is amended by adding at the end the following 

12 new subparagraph: 

13 ‘‘(C) NONAPPLICATION TO EXPENDITURES

14 FOR OUTREACH TO INCREASE THE ENROLLMENT

15 OF INDIAN CHILDREN UNDER THIS TITLE AND

16 TITLE XIX.—The limitation under subparagraph 

17 (A) on expenditures for items described in sub18 section (a)(1)(D) shall not apply in the case of 

19 expenditures for outreach activities to families of 

20 Indian children likely to be eligible for child 

21 health assistance under the plan or medical as22 sistance under the State plan under title XIX (or 

23 under a waiver of such plan), to inform such 

24 families of the availability of, and to assist them 

25 in enrolling their children in, such plans, includVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00346 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
347 

•HR 1328 RH

1 ing such activities conducted under grants, con2 tracts, or agreements entered into under section 

3 1139(a).’’. 

4 (b) ASSURANCE OF PAYMENTS TO INDIAN HEALTH

5 CARE PROVIDERS FOR CHILD HEALTH ASSISTANCE.—Sec6 tion 2102(b)(3)(D) of such Act (42 U.S.C. 1397bb(b)(3)(D)) 

7 is amended by striking ‘‘(as defined in section 4(c) of the 

8 Indian Health Care Improvement Act, 25 U.S.C. 1603(c))’’ 

9 and inserting ‘‘, including how the State will ensure that 

10 payments are made to Indian Health Programs and Urban 

11 Indian Organizations operating in the State for the provi12 sion of such assistance’’. 

13 (c) INCLUSION OF OTHER INDIAN FINANCED HEALTH

14 CARE PROGRAMS IN EXEMPTION FROM PROHIBITION ON

15 CERTAIN PAYMENTS.—Section 2105(c)(6)(B) of such Act 

16 (42 U.S.C. 1397ee(c)(6)(B)) is amended by striking ‘‘insur17 ance program, other than an insurance program operated 

18 or financed by the Indian Health Service’’ and inserting 

19 ‘‘program, other than a health care program operated or 

20 financed by the Indian Health Service or by an Indian 

21 Tribe, Tribal Organization, or Urban Indian Organiza22 tion’’. 

23 (d) SATISFACTION OF MEDICAID DOCUMENTATION RE24 QUIREMENTS.— 


jbell on PROD1PC69 with BILLS
348 

•HR 1328 RH

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 such 

18 other forms of documentation (including tribal docu19 mentation, if appropriate) that the Secretary deter20 mines to be satisfactory documentary evidence of citi21 zenship or nationality for purposes of satisfying the 

22 requirement of this subsection.’’. 

23 (2) TRANSITION RULE.—During the period that 

24 begins on July 1, 2006, and ends on the effective date 

25 of final regulations issued under subclause (II) of secVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00348 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
349 

•HR 1328 RH

1 tion 1903(x)(3)(B)(v) of the Social Security Act (42 

2 U.S.C. 1396b(x)(3)(B)(v)) (as added by paragraph 

3 (1)), an individual who is a member of a federally4 recognized Indian tribe described in subclause (II) of 

5 that section who presents a document described in 

6 subclause (I) of such section that is issued by such In7 dian tribe, shall be deemed to have presented satisfac8 tory evidence of citizenship or nationality for pur9 poses of satisfying the requirement of subsection (x) of 

10 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 fol13 lowing new paragraph: 

14 ‘‘(9) INDIAN; INDIAN HEALTH PROGRAM; INDIAN

15 TRIBE; ETC.—The terms ‘Indian’, ‘Indian Health 

16 Program’, ‘Indian Tribe’, ‘Tribal Organization’, and 

17 ‘Urban Indian Organization’ have the meanings 

18 given those terms in section 4 of the Indian Health 

19 Care Improvement Act.’’. 


jbell on PROD1PC69 with BILLS
350 

•HR 1328 RH

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 Se9 curity 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 THE

18 CONTRACT HEALTH SERVICE.— 

19 ‘‘(1) NO COST SHARING FOR ITEMS OR SERVICES

20 FURNISHED TO INDIANS THROUGH INDIAN HEALTH

21 PROGRAMS.— 

22 ‘‘(A) IN GENERAL.—No enrollment fee, pre23 mium, or similar charge, and no deduction, co24 payment, cost sharing, or similar charge shall be 

25 imposed against an Indian who is furnished an 

26 item or service directly by the Indian Health 


jbell on PROD1PC69 with BILLS
351 

•HR 1328 RH

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.—Payment 

7 due under this title to the Indian Health Service, 

8 an Indian Tribe, Tribal Organization, or Urban 

9 Indian Organization, or a health care provider 

10 through referral under the contract health service 

11 for the furnishing of an item or service to an In12 dian who is eligible for assistance under such 

13 title, may not be reduced by the amount of any 

14 enrollment fee, premium, or similar charge, or 

15 any deduction, copayment, cost sharing, or simi16 lar charge that would be due from the Indian but 

17 for the operation of subparagraph (A). 

18 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in this 

19 subsection shall be construed as restricting the appli20 cation of any other limitations on the imposition of 

21 premiums or cost sharing that may apply to an indi22 vidual receiving medical assistance under this title 

23 who is an Indian. 

24 ‘‘(3) DEFINITIONS.—In this subsection, the terms 

25 ‘contract health service’, ‘Indian’, ‘Indian Tribe’, 


jbell on PROD1PC69 with BILLS
352 

•HR 1328 RH

1 ‘Tribal Organization’, and ‘Urban Indian Organiza2 tion’ have the meanings given those terms in section 

3 4 of the Indian Health Care Improvement Act.’’. 

4 (2) CONFORMING AMENDMENT.—Section 1916A 

5 (a)(1) of such Act (42 U.S.C. 1396o–1(a)(1)) is 

6 amended by striking ‘‘section 1916(g)’’ and inserting 

7 ‘‘subsections (g), (i), or (j) of section 1916’’. 

8 (b) TREATMENT OF CERTAIN PROPERTY FOR MED9 ICAID AND SCHIP ELIGIBILITY.— 

10 (1) MEDICAID.—Section 1902(e) of the Social 

11 Security Act (42 U.S.C. 1396a) is amended by add12 ing at the end the following new paragraph: 

13 ‘‘(13) Notwithstanding any other requirement of this 

14 title or any other provision of Federal or State law, a State 

15 shall disregard the following property for purposes of deter16 mining the eligibility of an individual who is an Indian 

17 (as defined in section 4 of the Indian Health Care Improve18 ment Act) for medical assistance under this title: 

19 ‘‘(A) Property, including real property and im20 provements, that is held in trust, subject to Federal 

21 restrictions, or otherwise under the supervision of the 

22 Secretary of the Interior, located on a reservation, in23 cluding any federally recognized Indian Tribe’s res24 ervation, pueblo, or colony, including former reserva25 tions in Oklahoma, Alaska Native regions established 


jbell on PROD1PC69 with BILLS
353 

•HR 1328 RH

1 by the Alaska Native Claims Settlement Act, and In2 dian allotments on or near a reservation as des3 ignated and approved by the Bureau of Indian Af4 fairs of the Department of the Interior. 

5 ‘‘(B) For any federally recognized Tribe not de6 scribed in subparagraph (A), property located within 

7 the most recent boundaries of a prior Federal reserva8 tion. 

9 ‘‘(C) Ownership interests in rents, leases, royal10 ties, or usage rights related to natural resources (in11 cluding extraction of natural resources or harvesting 

12 of timber, other plants and plant products, animals, 

13 fish, and shellfish) resulting from the exercise of feder14 ally protected rights. 

15 ‘‘(D) Ownership interests in or usage rights to 

16 items not covered by subparagraphs (A) through (C) 

17 that have unique religious, spiritual, traditional, or 

18 cultural significance or rights that support subsist19 ence or a traditional lifestyle according to applicable 

20 tribal law or custom.’’. 

21 (2) APPLICATION TO SCHIP.—Section 2107(e)(1) 

22 of such Act (42 U.S.C. 1397gg(e)(1)), as amended by 

23 section 201(c), is amended— 


jbell on PROD1PC69 with BILLS
354 

•HR 1328 RH

1 (A) by redesignating subparagraphs (B) 

2 through (E), as subparagraphs (C) through (F), 

3 respectively; and 

4 (B) by inserting after subparagraph (A), 

5 the following new subparagraph: 

6 ‘‘(B) Section 1902(e)(13) (relating to dis7 regard of certain property for purposes of mak8 ing eligibility determinations).’’. 

9 (c) CONTINUATION OF CURRENT LAW PROTECTIONS OF

10 CERTAIN INDIAN PROPERTY FROM MEDICAID ESTATE RE11 COVERY.—Section 1917(b)(3) of the Social Security Act (42 

12 U.S.C. 1396p(b)(3)) is amended— 

13 (1) by inserting ‘‘(A)’’ after ‘‘(3)’’; and 

14 (2) by adding at the end the following new sub15 paragraph: 

16 ‘‘(B) The standards specified by the Secretary under 

17 subparagraph (A) shall require that the procedures estab18 lished by the State agency under subparagraph (A) exempt 

19 income, resources, and property that are exempt from the 

20 application of this subsection as of April 1, 2003, under 

21 manual instructions issued to carry out this subsection (as 

22 in effect on such date) because of the Federal responsibility 

23 for Indian Tribes and Alaska Native Villages. Nothing in 

24 this subparagraph shall be construed as preventing the SecVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00354 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
355 

•HR 1328 RH

1 retary from providing additional estate recovery exemp2 tions under this title for Indians.’’. 

3 SEC. 205. NONDISCRIMINATION IN QUALIFICATIONS FOR 

4 PAYMENT FOR SERVICES UNDER FEDERAL 

5 HEALTH CARE PROGRAMS. 

6 Section 1139 of the Social Security Act (42 U.S.C. 

7 1320b–9), as amended by section 202, is amended by redes8 ignating subsection (c) as subsection (d), and inserting after 

9 subsection (b) the following new subsection: 

10 ‘‘(c) NONDISCRIMINATION IN QUALIFICATIONS FOR

11 PAYMENT FOR SERVICES UNDER FEDERAL HEALTH CARE

12 PROGRAMS.— 

13 ‘‘(1) REQUIREMENT TO SATISFY GENERALLY AP14 PLICABLE PARTICIPATION REQUIREMENTS.— 

15 ‘‘(A) IN GENERAL.—A Federal health care 

16 program must accept an entity that is operated 

17 by the Indian Health Service, an Indian Tribe, 

18 Tribal Organization, or Urban Indian Organi19 zation as a provider eligible to receive payment 

20 under the program for health care services fur21 nished to an Indian on the same basis as any 

22 other provider qualified to participate as a pro23 vider of health care services under the program 

24 if the entity meets generally applicable State or 


jbell on PROD1PC69 with BILLS
356 

•HR 1328 RH

1 other requirements for participation as a pro2 vider of health care services under the program. 

3 ‘‘(B) SATISFACTION OF STATE OR LOCAL LI4 CENSURE OR RECOGNITION REQUIREMENTS.— 

5 Any requirement for participation as a provider 

6 of health care services under a Federal health 

7 care program that an entity be licensed or recog8 nized under the State or local law where the en9 tity is located to furnish health care services 

10 shall be deemed to have been met in the case of 

11 an entity operated by the Indian Health Service, 

12 an Indian Tribe, Tribal Organization, or Urban 

13 Indian Organization if the entity meets all the 

14 applicable standards for such licensure or rec15 ognition, regardless of whether the entity obtains 

16 a license or other documentation under such 

17 State or local law. In accordance with section 

18 221 of the Indian Health Care Improvement Act, 

19 the absence of the licensure of a health care pro20 fessional employed by such an entity under the 

21 State or local law where the entity is located 

22 shall not be taken into account for purposes of 

23 determining whether the entity meets such stand24 ards, if the professional is licensed in another 

25 State. 


jbell on PROD1PC69 with BILLS
357 

•HR 1328 RH

1 ‘‘(2) PROHIBITION ON FEDERAL PAYMENTS TO

2 ENTITIES OR INDIVIDUALS EXCLUDED FROM PARTICI3 PATION IN FEDERAL HEALTH CARE PROGRAMS OR

4 WHOSE STATE LICENSES ARE UNDER SUSPENSION OR

5 HAVE BEEN REVOKED.— 

6 ‘‘(A) EXCLUDED ENTITIES.—No entity op7 erated by the Indian Health Service, an Indian 

8 Tribe, Tribal Organization, or Urban Indian 

9 Organization that has been excluded from par10 ticipation in any Federal health care program 

11 or for which a license is under suspension or has 

12 been revoked by the State where the entity is lo13 cated shall be eligible to receive payment under 

14 any such program for health care services fur15 nished to an Indian. 

16 ‘‘(B) EXCLUDED INDIVIDUALS.—No indi17 vidual who has been excluded from participation 

18 in any Federal health care program or whose 

19 State license is under suspension or has been re20 voked shall be eligible to receive payment under 

21 any such program for health care services fur22 nished by that individual, directly or through an 

23 entity that is otherwise eligible to receive pay24 ment for health care services, to an Indian. 


jbell on PROD1PC69 with BILLS
358 

•HR 1328 RH

1 ‘‘(C) FEDERAL HEALTH CARE PROGRAM DE2 FINED.—In this subsection, the term, ‘Federal 

3 health care program’ has the meaning given that 

4 term in section 1128B(f), except that, for pur5 poses of this subsection, such term shall include 

6 the health insurance program under chapter 89 

7 of title 5, United States Code.’’. 

8 SEC. 206. CONSULTATION ON MEDICAID, SCHIP, AND 

9 OTHER HEALTH CARE PROGRAMS FUNDED 

10 UNDER THE SOCIAL SECURITY ACT INVOLV11 ING INDIAN HEALTH PROGRAMS AND URBAN 

12 INDIAN ORGANIZATIONS. 

13 (a) IN GENERAL.—Section 1139 of the Social Security 

14 Act (42 U.S.C. 1320b–9), as amended by sections 202 and 

15 205, is amended by redesignating subsection (d) as sub16 section (e), and inserting after subsection (c) the following 

17 new subsection: 

18 ‘‘(d) CONSULTATION WITH TRIBAL TECHNICAL ADVI19 SORY GROUP (TTAG).—The Secretary shall maintain 

20 within the Centers for Medicaid & Medicare Services (CMS) 

21 a Tribal Technical Advisory Group, established in accord22 ance with requirements of the charter dated September 30, 

23 2003, and in such group shall include a representative of 

24 the Urban Indian Organizations and the Service. The rep25 resentative of the Urban Indian Organization shall be 


jbell on PROD1PC69 with BILLS
359 

•HR 1328 RH

1 deemed to be an elected officer of a tribal government for 

2 purposes of applying section 204(b) of the Unfunded Man3 dates Reform Act of 1995 (2 U.S.C. 1534(b)).’’. 

4 (b) SOLICITATION OF ADVICE UNDER MEDICAID AND

5 SCHIP.— 

6 (1) MEDICAID STATE PLAN AMENDMENT.—Sec7 tion 1902(a) of the Social Security Act (42 U.S.C. 

8 1396a(a)) is amended— 

9 (A) in paragraph (69), by striking ‘‘and’’ 

10 at the end; 

11 (B) in paragraph (70)(B)(iv), by striking 

12 the period at the end and inserting ‘‘; and’’; and 

13 (C) by inserting after paragraph 

14 (70)(B)(iv), the following new paragraph: 

15 ‘‘(71) in the case of any State in which the In16 dian Health Service operates or funds health care 

17 programs, or in which 1 or more Indian Health Pro18 grams or Urban Indian Organizations (as such terms 

19 are defined in section 4 of the Indian Health Care 

20 Improvement Act) provide health care in the State for 

21 which medical assistance is available under such title, 

22 provide for a process under which the State seeks ad23 vice on a regular, ongoing basis from designees of 

24 such Indian Health Programs and Urban Indian Or25 ganizations on matters relating to the application of 


jbell on PROD1PC69 with BILLS
360 

•HR 1328 RH

1 this title that are likely to have a direct effect on such 

2 Indian Health Programs and Urban Indian Organi3 zations and that— 

4 ‘‘(A) shall include solicitation of advice 

5 prior to submission of any plan amendments, 

6 waiver requests, and proposals for demonstration 

7 projects likely to have a direct effect on Indians, 

8 Indian Health Programs, or Urban Indian Or9 ganizations; and 

10 ‘‘(B) may include appointment of an advi11 sory committee and of a designee of such Indian 

12 Health Programs and Urban Indian Organiza13 tions to the medical care advisory committee ad14 vising the State on its State plan under this 

15 title.’’. 

16 (2) APPLICATION TO SCHIP.—Section 2107(e)(1) 

17 of such Act (42 U.S.C. 1397gg(e)(1)), as amended by 

18 section 204(b)(2), is amended— 

19 (A) by redesignating subparagraphs (B) 

20 through (F) as subparagraphs (C) through (G), 

21 respectively; and 

22 (B) by inserting after subparagraph (A), 

23 the following new subparagraph: 

24 ‘‘(B) Section 1902(a)(71) (relating to the 

25 option of certain States to seek advice from desVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00360 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
361 

•HR 1328 RH

1 ignees of Indian Health Programs and Urban 

2 Indian Organizations).’’. 

3 (c) RULE OF CONSTRUCTION.—Nothing in the amend4 ments made by this section shall be construed as super5 seding existing advisory committees, working groups, guid6 ance, or other advisory procedures established by the Sec7 retary of Health and Human Services or by any State with 

8 respect to the provision of health care to Indians. 

9 SEC. 207. EXCLUSION WAIVER AUTHORITY FOR AFFECTED 

10 INDIAN HEALTH PROGRAMS AND SAFE HAR11 BOR TRANSACTIONS UNDER THE SOCIAL SE12 CURITY ACT. 

13 (a) EXCLUSION WAIVER AUTHORITY.—Section 1128 of 

14 the Social Security Act (42 U.S.C. 1320a–7) is amended 

15 by adding at the end the following new subsection: 

16 ‘‘(k) ADDITIONAL EXCLUSION WAIVER AUTHORITY

17 FOR AFFECTED INDIAN HEALTH PROGRAMS.—In addition 

18 to the authority granted the Secretary under subsections 

19 (c)(3)(B) and (d)(3)(B) to waive an exclusion under sub20 section (a)(1), (a)(3), (a)(4), or (b), the Secretary may, in 

21 the case of an Indian Health Program, waive such an exclu22 sion upon the request of the administrator of an affected 

23 Indian Health Program (as defined in section 4 of the In24 dian Health Care Improvement Act) who determines that 

25 the exclusion would impose a hardship on individuals entiVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00361 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
362 

•HR 1328 RH

1 tled to benefits under or enrolled in a Federal health care 

2 program.’’. 

3 (b) CERTAIN TRANSACTIONS INVOLVING INDIAN

4 HEALTH CARE PROGRAMS DEEMED TO BE IN SAFE HAR5 BORS.—Section 1128B(b) of the Social Security Act (42 

6 U.S.C. 1320a–7b(b)) is amended by adding at the end the 

7 following new paragraph: 

8 ‘‘(4) Subject to such conditions as the Secretary may 

9 promulgate from time to time as necessary to prevent fraud 

10 and abuse, for purposes of paragraphs (1) and (2) and sec11 tion 1128A(a), the following transfers shall not be treated 

12 as remuneration: 

13 ‘‘(A) TRANSFERS BETWEEN INDIAN HEALTH

14 PROGRAMS, INDIAN TRIBES, TRIBAL ORGANIZATIONS, 

15 AND URBAN INDIAN ORGANIZATIONS.—Transfers of 

16 anything of value between or among an Indian 

17 Health Program, Indian Tribe, Tribal Organization, 

18 or Urban Indian Organization, that are made for the 

19 purpose of providing necessary health care items and 

20 services to any patient served by such Program, 

21 Tribe, or Organization and that consist of— 

22 ‘‘(i) services in connection with the collec23 tion, transport, analysis, or interpretation of di24 agnostic specimens or test data; 

25 ‘‘(ii) inventory or supplies; 


jbell on PROD1PC69 with BILLS
363 

•HR 1328 RH

1 ‘‘(iii) staff; or 

2 ‘‘(iv) a waiver of all or part of premiums 

3 or cost sharing. 

4 ‘‘(B) TRANSFERS BETWEEN INDIAN HEALTH

5 PROGRAMS, INDIAN TRIBES, TRIBAL ORGANIZATIONS, 

6 OR URBAN INDIAN ORGANIZATIONS AND PATIENTS.— 

7 Transfers of anything of value between an Indian 

8 Health Program, Indian Tribe, Tribal Organization, 

9 or Urban Indian Organization and any patient 

10 served or eligible for service from an Indian Health 

11 Program, Indian Tribe, Tribal Organization, or 

12 Urban Indian Organization, including any patient 

13 served or eligible for service pursuant to section 807 

14 of the Indian Health Care Improvement Act, but only 

15 if such transfers— 

16 ‘‘(i) consist of expenditures related to pro17 viding transportation for the patient for the pro18 vision of necessary health care items or services, 

19 provided that the provision of such transpor20 tation is not advertised, nor an incentive of 

21 which the value is disproportionately large in re22 lationship to the value of the health care item or 

23 service (with respect to the value of the item or 

24 service itself or, for preventative items or servVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00363 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
364 

•HR 1328 RH

1 ices, the future health care costs reasonably ex2 pected to be avoided); 

3 ‘‘(ii) consist of expenditures related to pro4 viding housing to the patient (including a preg5 nant patient) and immediate family members or 

6 an escort necessary to assuring the timely provi7 sion of health care items and services to the pa8 tient, provided that the provision of such housing 

9 is not advertised nor an incentive of which the 

10 value is disproportionately large in relationship 

11 to the value of the health care item or service 

12 (with respect to the value of the item or service 

13 itself or, for preventative items or services, the 

14 future health care costs reasonably expected to be 

15 avoided); or 

16 ‘‘(iii) are for the purpose of paying pre17 miums or cost sharing on behalf of such a pa18 tient, provided that the making of such payment 

19 is not subject to conditions other than conditions 

20 agreed to under a contract for the delivery of 

21 contract health services. 

22 ‘‘(C) CONTRACT HEALTH SERVICES.—A transfer 

23 of anything of value negotiated as part of a contract 

24 entered into between an Indian Health Program, In25 dian Tribe, Tribal Organization, Urban Indian OrVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00364 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
365 

•HR 1328 RH

1 ganization, or the Indian Health Service and a con2 tract care provider for the delivery of contract health 

3 services authorized by the Indian Health Service, pro4 vided that— 

5 ‘‘(i) such a transfer is not tied to volume or 

6 value of referrals or other business generated by 

7 the parties; and 

8 ‘‘(ii) any such transfer is limited to the fair 

9 market value of the health care items or services 

10 provided or, in the case of a transfer of items or 

11 services related to preventative care, the value of 

12 the future health care costs reasonably expected 

13 to be avoided. 

14 ‘‘(D) OTHER TRANSFERS.—Any other transfer of 

15 anything of value involving an Indian Health Pro16 gram, Indian Tribe, Tribal Organization, or Urban 

17 Indian Organization, or a patient served or eligible 

18 for service from an Indian Health Program, Indian 

19 Tribe, Tribal Organization, or Urban Indian Organi20 zation, that the Secretary, in consultation with the 

21 Attorney General, determines is appropriate, taking 

22 into account the special circumstances of such Indian 

23 Health Programs, Indian Tribes, Tribal Organiza24 tions, and Urban Indian Organizations, and of paVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00365 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
366 

•HR 1328 RH

1 tients served by such Programs, Tribes, and Organi2 zations.’’. 

3 SEC. 208. RULES APPLICABLE UNDER MEDICAID AND SCHIP 

4 TO MANAGED CARE ENTITIES WITH RESPECT 

5 TO INDIAN ENROLLEES AND INDIAN HEALTH 

6 CARE PROVIDERS AND INDIAN MANAGED 

7 CARE ENTITIES. 

8 (a) IN GENERAL.—Section 1932 of the Social Security 

9 Act (42 U.S.C. 1396u–2) is amended by adding at the end 

10 the following new subsection: 

11 ‘‘(h) SPECIAL RULES WITH RESPECT TO INDIAN EN12 ROLLEES, INDIAN HEALTH CARE PROVIDERS, AND INDIAN

13 MANAGED CARE ENTITIES.— 

14 ‘‘(1) ENROLLEE OPTION TO SELECT AN INDIAN

15 HEALTH CARE PROVIDER AS PRIMARY CARE PRO16 VIDER.—In the case of a non-Indian Medicaid man17 aged care entity that— 

18 ‘‘(A) has an Indian enrolled with the entity; 

19 and 

20 ‘‘(B) has an Indian health care provider 

21 that is participating as a primary care provider 

22 within the network of the entity, 

23 insofar as the Indian is otherwise eligible to receive 

24 services from such Indian health care provider and 

25 the Indian health care provider has the capacity to 


jbell on PROD1PC69 with BILLS
367 

•HR 1328 RH

1 provide primary care services to such Indian, the con2 tract with the entity under section 1903(m) or under 

3 section 1905(t)(3) shall require, as a condition of re4 ceiving payment under such contract, that the Indian 

5 shall be allowed to choose such Indian health care 

6 provider as the Indian’s primary care provider under 

7 the entity. 

8 ‘‘(2) ASSURANCE OF PAYMENT TO INDIAN

9 HEALTH CARE PROVIDERS FOR PROVISION OF COV10 ERED SERVICES.—Each contract with a managed 

11 care entity under section 1903(m) or under section 

12 1905(t)(3) shall require any such entity that has a 

13 significant percentage of Indian enrollees (as deter14 mined by the Secretary), as a condition of receiving 

15 payment under such contract to satisfy the following 

16 requirements: 

17 ‘‘(A) DEMONSTRATION OF PARTICIPATING

18 INDIAN HEALTH CARE PROVIDERS OR APPLICA19 TION OF ALTERNATIVE PAYMENT ARRANGE20 MENTS.—Subject to subparagraph (E), to— 

21 ‘‘(i) demonstrate that the number of 

22 Indian health care providers that are par23 ticipating providers with respect to such en24 tity are sufficient to ensure timely access to 

25 covered Medicaid managed care services for 


jbell on PROD1PC69 with BILLS
368 

•HR 1328 RH

1 those enrollees who are eligible to receive 

2 services from such providers; or 

3 ‘‘(ii) agree to pay Indian health care 

4 providers who are not participating pro5 viders with the entity for covered Medicaid 

6 managed care services provided to those en7 rollees who are eligible to receive services 

8 from such providers at a rate equal to the 

9 rate negotiated between such entity and the 

10 provider involved or, if such a rate has not 

11 been negotiated, at a rate that is not less 

12 than the level and amount of payment 

13 which the entity would make for the services 

14 if the services were furnished by a partici15 pating provider which is not an Indian 

16 health care provider. 

17 ‘‘(B) PROMPT PAYMENT.—To agree to make 

18 prompt payment (in accordance with rules ap19 plicable to managed care entities) to Indian 

20 health care providers that are participating pro21 viders with respect to such entity or, in the case 

22 of an entity to which subparagraph (A)(ii) or 

23 (E) applies, that the entity is required to pay in 

24 accordance with that subparagraph. 


jbell on PROD1PC69 with BILLS
369 

•HR 1328 RH

1 ‘‘(C) SATISFACTION OF CLAIM REQUIRE2 MENT.—To deem any requirement for the sub3 mission of a claim or other documentation for 

4 services covered under subparagraph (A) by the 

5 enrollee to be satisfied through the submission of 

6 a claim or other documentation by an Indian 

7 health care provider that is consistent with sec8 tion 403(h) of the Indian Health Care Improve9 ment Act. 

10 ‘‘(D) COMPLIANCE WITH GENERALLY APPLI11 CABLE REQUIREMENTS.— 

12 ‘‘(i) IN GENERAL.—Subject to clause 

13 (ii), as a condition of payment under sub14 paragraph (A), an Indian health care pro15 vider shall comply with the generally appli16 cable requirements of this title, the State 

17 plan, and such entity with respect to cov18 ered Medicaid managed care services pro19 vided by the Indian health care provider to 

20 the same extent that non-Indian providers 

21 participating with the entity must comply 

22 with such requirements. 

23 ‘‘(ii) LIMITATIONS ON COMPLIANCE

24 WITH MANAGED CARE ENTITY GENERALLY


jbell on PROD1PC69 with BILLS
370 

•HR 1328 RH

1 APPLICABLE REQUIREMENTS.—An Indian 

2 health care provider— 

3 ‘‘(I) shall not be required to com4 ply with a generally applicable re5 quirement of a managed care entity 

6 described in clause (i) as a condition of 

7 payment under subparagraph (A) if 

8 such compliance would conflict with 

9 any other statutory or regulatory re10 quirements applicable to the Indian 

11 health care provider; and 

12 ‘‘(II) shall only need to comply 

13 with those generally applicable require14 ments of a managed care entity de15 scribed in clause (i) as a condition of 

16 payment under subparagraph (A) that 

17 are necessary for the entity’s compli18 ance with the State plan, such as those 

19 related to care management, quality 

20 assurance, and utilization manage21 ment. 

22 ‘‘(E) APPLICATION OF SPECIAL PAYMENT

23 REQUIREMENTS FOR FEDERALLY-QUALIFIED

24 HEALTH CENTERS AND ENCOUNTER RATE FOR


jbell on PROD1PC69 with BILLS
371 

•HR 1328 RH

1 SERVICES PROVIDED BY CERTAIN INDIAN

2 HEALTH CARE PROVIDERS.— 

3 ‘‘(i) FEDERALLY-QUALIFIED HEALTH

4 CENTERS.— 

5 ‘‘(I) MANAGED CARE ENTITY PAY6 MENT REQUIREMENT.—To agree to pay 

7 any Indian health care provider that 

8 is a federally-qualified health center 

9 but not a participating provider with 

10 respect to the entity, for the provision 

11 of covered Medicaid managed care 

12 services by such provider to an Indian 

13 enrollee of the entity at a rate equal to 

14 the amount of payment that the entity 

15 would pay a federally-qualified health 

16 center that is a participating provider 

17 with respect to the entity but is not an 

18 Indian health care provider for such 

19 services. 

20 ‘‘(II) CONTINUED APPLICATION OF

21 STATE REQUIREMENT TO MAKE SUP22 PLEMENTAL PAYMENT.—Nothing in 

23 subclause (I) or subparagraph (A) or 

24 (B) shall be construed as waiving the 

25 application of section 1902(bb)(5) reVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00371 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
372 

•HR 1328 RH

1 garding the State plan requirement to 

2 make any supplemental payment due 

3 under such section to a federally-quali4 fied health center for services furnished 

5 by such center to an enrollee of a man6 aged care entity (regardless of whether 

7 the federally-qualified health center is 

8 or is not a participating provider with 

9 the entity). 

10 ‘‘(ii) CONTINUED APPLICATION OF EN11 COUNTER RATE FOR SERVICES PROVIDED BY

12 CERTAIN INDIAN HEALTH CARE PRO13 VIDERS.—If the amount paid by a managed 

14 care entity to an Indian health care pro15 vider that is not a federally-qualified health 

16 center and that has elected to receive pay17 ment under this title as an Indian Health 

18 Service provider under the July 11, 1996, 

19 Memorandum of Agreement between the 

20 Health Care Financing Administration 

21 (now the Centers for Medicare & Medicaid 

22 Services) and the Indian Health Service for 

23 services provided by such provider to an In24 dian enrollee with the managed care entity 

25 is less than the encounter rate that applies 


jbell on PROD1PC69 with BILLS
373 

•HR 1328 RH

1 to the provision of such services under such 

2 memorandum, the State plan shall provide 

3 for payment to the Indian health care pro4 vider of the difference between the applicable 

5 encounter rate under such memorandum 

6 and the amount paid by the managed care 

7 entity to the provider for such services. 

8 ‘‘(F) CONSTRUCTION.—Nothing in this 

9 paragraph shall be construed as waiving the ap10 plication of section 1902(a)(30)(A) (relating to 

11 application of standards to assure that payments 

12 are consistent with efficiency, economy, and 

13 quality of care). 

14 ‘‘(3) OFFERING OF MANAGED CARE THROUGH IN15 DIAN MEDICAID MANAGED CARE ENTITIES.—If— 

16 ‘‘(A) a State elects to provide services 

17 through Medicaid managed care entities under 

18 its Medicaid managed care program; and 

19 ‘‘(B) an Indian health care provider that is 

20 funded in whole or in part by the Indian Health 

21 Service, or a consortium composed of 1 or more 

22 Tribes, Tribal Organizations, or Urban Indian 

23 Organizations, and which also may include the 

24 Indian Health Service, has established an In25 dian Medicaid managed care entity in the State 


jbell on PROD1PC69 with BILLS
374 

•HR 1328 RH

1 that meets generally applicable standards re2 quired of such an entity under such Medicaid 

3 managed care program, 

4 the State shall offer to enter into an agreement with 

5 the entity to serve as a Medicaid managed care entity 

6 with respect to eligible Indians served by such entity 

7 under such program. 

8 ‘‘(4) SPECIAL RULES FOR INDIAN MANAGED CARE

9 ENTITIES.—The following are special rules regarding 

10 the application of a Medicaid managed care program 

11 to Indian Medicaid managed care entities: 

12 ‘‘(A) ENROLLMENT.— 

13 ‘‘(i) LIMITATION TO INDIANS.—An In14 dian Medicaid managed care entity may re15 strict enrollment under such program to In16 dians and to members of specific Tribes in 

17 the same manner as Indian Health Pro18 grams may restrict the delivery of services 

19 to such Indians and tribal members. 

20 ‘‘(ii) NO LESS CHOICE OF PLANS.— 

21 Under such program the State may not 

22 limit the choice of an Indian among Med23 icaid managed care entities only to Indian 

24 Medicaid managed care entities or to be 

25 more restrictive than the choice of managed 


jbell on PROD1PC69 with BILLS
375 

•HR 1328 RH

1 care entities offered to individuals who are 

2 not Indians. 

3 ‘‘(iii) DEFAULT ENROLLMENT.— 

4 ‘‘(I) IN GENERAL.—If such pro5 gram of a State requires the enrollment 

6 of Indians in a Medicaid managed 

7 care entity in order to receive benefits, 

8 the State, taking into consideration the 

9 criteria specified in subsection 

10 (a)(4)(D)(ii)(I), shall provide for the 

11 enrollment of Indians described in sub12 clause (II) who are not otherwise en13 rolled with such an entity in an In14 dian Medicaid managed care entity de15 scribed in such clause. 

16 ‘‘(II) INDIAN DESCRIBED.—An 

17 Indian described in this subclause, 

18 with respect to an Indian Medicaid 

19 managed care entity, is an Indian 

20 who, based upon the service area and 

21 capacity of the entity, is eligible to be 

22 enrolled with the entity consistent with 

23 subparagraph (A). 

24 ‘‘(iv) EXCEPTION TO STATE LOCK-IN.— 

25 A request by an Indian who is enrolled 


jbell on PROD1PC69 with BILLS
376 

•HR 1328 RH

1 under such program with a non-Indian 

2 Medicaid managed care entity to change en3 rollment with that entity to enrollment with 

4 an Indian Medicaid managed care entity 

5 shall be considered cause for granting such 

6 request under procedures specified by the 

7 Secretary. 

8 ‘‘(B) FLEXIBILITY IN APPLICATION OF SOL9 VENCY.—In applying section 1903(m)(1) to an 

10 Indian Medicaid managed care entity— 

11 ‘‘(i) any reference to a ‘State’ in sub12 paragraph (A)(ii) of that section shall be 

13 deemed to be a reference to the ‘Secretary’; 

14 and 

15 ‘‘(ii) the entity shall be deemed to be a 

16 public entity described in subparagraph 

17 (C)(ii) of that section. 

18 ‘‘(C) EXCEPTIONS TO ADVANCE DIREC19 TIVES.—The Secretary may modify or waive the 

20 requirements of section 1902(w) (relating to pro21 vision of written materials on advance direc22 tives) insofar as the Secretary finds that the re23 quirements otherwise imposed are not an appro24 priate or effective way of communicating the in25 formation to Indians. 


jbell on PROD1PC69 with BILLS
377 

•HR 1328 RH

1 ‘‘(D) FLEXIBILITY IN INFORMATION AND

2 MARKETING.— 

3 ‘‘(i) MATERIALS.—The Secretary may 

4 modify requirements under subsection (a)(5) 

5 to ensure that information described in that 

6 subsection is provided to enrollees and po7 tential enrollees of Indian Medicaid man8 aged care entities in a culturally appro9 priate and understandable manner that 

10 clearly communicates to such enrollees and 

11 potential enrollees their rights, protections, 

12 and benefits. 

13 ‘‘(ii) DISTRIBUTION OF MARKETING

14 MATERIALS.—The provisions of subsection 

15 (d)(2)(B) requiring the distribution of mar16 keting materials to an entire service area 

17 shall be deemed satisfied in the case of an 

18 Indian Medicaid managed care entity that 

19 distributes appropriate materials only to 

20 those Indians who are potentially eligible to 

21 enroll with the entity in the service area. 

22 ‘‘(5) MALPRACTICE INSURANCE.—Insofar as, 

23 under a Medicaid managed care program, a health 

24 care provider is required to have medical malpractice 

25 insurance coverage as a condition of contracting as a 


jbell on PROD1PC69 with BILLS
378 

•HR 1328 RH

1 provider with a Medicaid managed care entity, an 

2 Indian health care provider that is— 

3 ‘‘(A) a federally-qualified health center that 

4 is covered under the Federal Tort Claims Act (28 

5 U.S.C. 1346(b), 2671 et seq.); 

6 ‘‘(B) providing health care services pursu7 ant to a contract or compact under the Indian 

8 Self-Determination and Education Assistance 

9 Act (25 U.S.C. 450 et seq.) that are covered 

10 under the Federal Tort Claims Act (28 U.S.C. 

11 1346(b), 2671 et seq.); or 

12 ‘‘(C) the Indian Health Service providing 

13 health care services that are covered under the 

14 Federal Tort Claims Act (28 U.S.C. 1346(b), 

15 2671 et seq.); 

16 are deemed to satisfy such requirement. 

17 ‘‘(6) DEFINITIONS.—For purposes of this sub18 section: 

19 ‘‘(A) INDIAN HEALTH CARE PROVIDER.— 

20 The term ‘Indian health care provider’ means an 

21 Indian Health Program or an Urban Indian Or22 ganization. 

23 ‘‘(B) INDIAN; INDIAN HEALTH PROGRAM; 

24 SERVICE; TRIBE; TRIBAL ORGANIZATION; URBAN

25 INDIAN ORGANIZATION.—The terms ‘Indian’, ‘InVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00378 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
379 

•HR 1328 RH

1 dian Health Program’, ‘Service’, ‘Tribe’, ‘tribal 

2 organization’, ‘Urban Indian Organization’ have 

3 the meanings given such terms in section 4 of the 

4 Indian Health Care Improvement Act. 

5 ‘‘(C) INDIAN MEDICAID MANAGED CARE EN6 TITY.—The term ‘Indian Medicaid managed care 

7 entity’ means a managed care entity that is con8 trolled (within the meaning of the last sentence 

9 of section 1903(m)(1)(C)) by the Indian Health 

10 Service, a Tribe, Tribal Organization, or Urban 

11 Indian Organization, or a consortium, which 

12 may be composed of 1 or more Tribes, Tribal Or13 ganizations, or Urban Indian Organizations, 

14 and which also may include the Service. 

15 ‘‘(D) NON-INDIAN MEDICAID MANAGED CARE

16 ENTITY.—The term ‘non-Indian Medicaid man17 aged care entity’ means a managed care entity 

18 that is not an Indian Medicaid managed care 

19 entity. 

20 ‘‘(E) COVERED MEDICAID MANAGED CARE

21 SERVICES.—The term ‘covered Medicaid man22 aged care services’ means, with respect to an in23 dividual enrolled with a managed care entity, 

24 items and services that are within the scope of 

25 items and services for which benefits are availVerDate Aug 31 2005 00:07 Jun 07, 2008 Jkt 069200 PO 00000 Frm 00379 Fmt 6652 Sfmt 6203 E:\BILLS\H1328.RH H1328

jbell on PROD1PC69 with BILLS
380 

•HR 1328 RH

1 able with respect to the individual under the con2 tract between the entity and the State involved. 

3 ‘‘(F) MEDICAID MANAGED CARE PRO4 GRAM.—The term ‘Medicaid managed care pro5 gram’ means a program under sections 1903(m) 

6 and 1932 and includes a managed care program 

7 operating under a waiver under section 1915(b) 

8 or 1115 or otherwise.’’. 

9 (b) APPLICATION TO SCHIP.—Section 2107(e)(1) of 

10 such Act (42 U.S.C. 1397gg(1)), as amended by section 

11 206(b)(2), is amended by adding at the end the following 

12 new subparagraph: 

13 ‘‘(H) Subsections (a)(2)(C) and (h) of sec14 tion 1932.’’. 

15 SEC. 209. ANNUAL REPORT ON INDIANS SERVED BY SOCIAL 

16 SECURITY ACT HEALTH BENEFIT PROGRAMS. 

17 Section 1139 of the Social Security Act (42 U.S.C. 

18 1320b–9), as amended by the sections 202, 205, and 206, 

19 is amended by redesignating subsection (e) as subsection (f), 

20 and inserting after subsection (d) the following new sub21 section: 

22 ‘‘(e) ANNUAL REPORT ON INDIANS SERVED BY

23 HEALTH BENEFIT PROGRAMS FUNDED UNDER THIS

24 ACT.—Beginning January 1, 2007, and annually there25 after, the Secretary, acting through the Administrator of the 


jbell on PROD1PC69 with BILLS
381 

•HR 1328 RH

1 Centers for Medicare & Medicaid Services and the Director 

2 of the Indian Health Service, shall submit a report to Con3 gress regarding the enrollment and health status of Indians 

4 receiving items or services under health benefit programs 

5 funded under this Act during the preceding year. Each such 

6 report shall include the following: 

7 ‘‘(1) The total number of Indians enrolled in, or 

8 receiving items or services under, such programs, 

9 disaggregated with respect to each such program. 

10 ‘‘(2) The number of Indians described in para11 graph (1) that also received health benefits under pro12 grams funded by the Indian Health Service. 

13 ‘‘(3) General information regarding the health 

14 status of the Indians described in paragraph (1), 

15 disaggregated with respect to specific diseases or con16 ditions and presented in a manner that is consistent 

17 with protections for privacy of individually identifi18 able health information under section 264(c) of the 

19 Health Insurance Portability and Accountability Act 

20 of 1996. 

21 ‘‘(4) A detailed statement of the status of facili22 ties of the Indian Health Service or an Indian Tribe, 

23 Tribal Organization, or an Urban Indian Organiza24 tion with respect to such facilities’ compliance with 

25 the applicable conditions and requirements of titles 


jbell on PROD1PC69 with BILLS
382 

•HR 1328 RH

1 XVIII, XIX, and XXI, and, in the case of title XIX 

2 or XXI, under a State plan under such title or under 

3 waiver authority, and of the progress being made by 

4 such facilities (under plans submitted under section 

5 1880(b), 1911(b) or otherwise) toward the achieve6 ment and maintenance of such compliance. 

7 ‘‘(5) Such other information as the Secretary de8 termines is appropriate.’’. 


jbell on PROD1PC69 with BILLS

jbell on PROD1PC69 with BILLS
Union Calendar No. 444 

110TH CONGRESS 

2D SESSION H. R. 1328 

[Report No. 110

–564, Part I] 

A BILL 

To amend the Indian Health Care Improvement 

Act to revise and extend that Act. 

JUNE 6, 2008 

Committees on Energy and Commerce and Ways and 

to be printed Whole House on the State of the Union and ordered Means discharged; committed to the Committee of the 


jbell on PROD1PC69 with BILLS