I 

110TH CONGRESS 

1ST SESSION H. R. 1328 

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 

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, 


ycherry on PROD1PC64 with BILLS
2 

•HR 1328 IH

1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

3 ‘‘Indian Health Care Improvement Act Amendments of 

4 2007’’. 

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

6 this Act is as follows: 

Sec.1.Short title; table of contents. 

TITLE I—AMENDMENTS TO INDIAN LAWS 

Sec.101.Indian Health Care Improvement Act amended. 

Sec.102.Soboba sanitation facilities. 

Sec.103.Native American Health and Wellness Foundation. 

TITLE II—IMPROVEMENT OF INDIAN HEALTH CARE PROVIDED 

UNDER THE SOCIAL SECURITY ACT 

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

covered services furnished by Indian Health Programs. 

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

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

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

certain Indian property from Medicaid estate recovery. 

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

Federal health care programs. 

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

funded under the Social Security Act involving Indian Health 

Programs and Urban Indian Organizations. 

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

safe harbor transactions under the Social Security Act. 

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

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

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

programs. 


ycherry on PROD1PC64 with BILLS
3 

•HR 1328 IH

1 TITLE I—AMENDMENTS TO 

2 INDIAN LAWS 

3 SEC. 101. INDIAN HEALTH CARE IMPROVEMENT ACT 

4 AMENDED. 

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

7 as follows: 

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

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

10 ‘Indian Health Care Improvement Act’. 

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

12 for this Act is as follows: 

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

‘‘Sec.2.Findings. 

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

‘‘Sec.4.Definitions. 

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

DEVELOPMENT 

‘‘Sec.101.Purpose. 

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

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

‘‘Sec.104.Indian health professions scholarships. 

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

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

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

‘‘Sec.108.Continuing education allowances. 

‘‘Sec.109.Community Health Representative Program. 

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

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

‘‘Sec.112.Recruitment activities. 

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

‘‘Sec.114.Advanced training and research. 

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

‘‘Sec.116.Tribal cultural orientation. 

‘‘Sec.117.INMED Program. 

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

‘‘Sec.119.Retention bonus. 

‘‘Sec.120.Nursing residency program. 

‘‘Sec.121.Community Health Aide Program. 


ycherry on PROD1PC64 with BILLS
4 

•HR 1328 IH

‘‘Sec.122.Tribal Health Program administration. 

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

‘‘Sec.124.National Health Service Corps. 

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

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

‘‘Sec.127.Authorization of appropriations. 

‘‘TITLE II–HEALTH SERVICES 

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

‘‘Sec.202.Catastrophic Health Emergency Fund. 

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

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

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

‘‘Sec.206.Health services research. 

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

‘‘Sec.208.Patient travel costs. 

‘‘Sec.209.Epidemiology centers. 

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

‘‘Sec.211.Indian youth program. 

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

diseases. 

‘‘Sec.213.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.216A.North Dakota and South Dakota as contract health service delivery area. 

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

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

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

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

‘‘Sec.221.Licensing. 

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

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

‘‘Sec.224.Liability for payment. 

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

‘‘Sec.226.Authorization of appropriations. 

‘‘TITLE III–FACILITIES 

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

‘‘Sec.302.Sanitation facilities. 

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

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

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

ambulatory care facilities. 

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


ycherry on PROD1PC64 with BILLS
5 

•HR 1328 IH

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

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

‘‘Sec.316.Other funding for facilities. 

‘‘Sec.317.Authorization of appropriations. 

‘‘TITLE IV–ACCESS TO HEALTH SERVICES 

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

programs. 

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

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

‘‘Sec.404.Crediting of reimbursements. 

‘‘Sec.405.Purchasing health care coverage. 

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

‘‘Sec.407.Payor of last resort. 

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

‘‘Sec.409.Consultation. 

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

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

safe harbor transactions under the Social Security Act. 

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

under Medicaid and SCHIP and protection of certain Indian 

property from Medicaid estate recovery. 

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

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

‘‘Sec.415.General exceptions. 

‘‘Sec.416.Authorization of appropriations. 

‘‘TITLE V–HEALTH SERVICES FOR URBAN INDIANS 

‘‘Sec.501.Purpose. 

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

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

services. 

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

needs. 

‘‘Sec.505.Evaluations; renewals. 

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

‘‘Sec.507.Reports and records. 

‘‘Sec.508.Limitation on contract authority. 

‘‘Sec.509.Facilities. 

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

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

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

‘‘Sec.513.Urban NIAAA transferred programs. 

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

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

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

‘‘Sec.517.Community Health Representatives. 

‘‘Sec.518.Effective date. 

‘‘Sec.519.Eligibility for services. 


ycherry on PROD1PC64 with BILLS
6 

•HR 1328 IH

‘‘Sec.520.Authorization of appropriations. 

‘‘TITLE VI–ORGANIZATIONAL IMPROVEMENTS 

‘‘Sec.601.Establishment of the Indian Health Service as an agency of the 

Public Health Service. 

‘‘Sec.602.Automated management information system. 

‘‘Sec.603.Authorization of appropriations. 

‘‘TITLE VII–BEHAVIORAL HEALTH PROGRAMS 

‘‘Sec.701.Behavioral health prevention and treatment services. 

‘‘Sec.702.Memoranda of agreement with the Department of the Interior. 

‘‘Sec.703.Comprehensive behavioral health prevention and treatment program. 

‘‘Sec.704.Mental health technician program. 

‘‘Sec.705.Licensing requirement for mental health care workers. 

‘‘Sec.706.Indian women treatment programs. 

‘‘Sec.707.Indian youth program. 

‘‘Sec.708.Indian youth telemental health demonstration project. 

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

‘‘Sec.710.Training and community education. 

‘‘Sec.711.Behavioral health program. 

‘‘Sec.712.Fetal alcohol disorder programs. 

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

‘‘Sec.714.Behavioral health research. 

‘‘Sec.715.Definitions. 

‘‘Sec.716.Authorization of appropriations. 

‘‘TITLE VIII–MISCELLANEOUS 

‘‘Sec.801.Reports. 

‘‘Sec.802.Regulations. 

‘‘Sec.803.Plan of implementation. 

‘‘Sec.804.Availability of funds. 

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

‘‘Sec.806.Eligibility of California Indians. 

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

‘‘Sec.808.Reallocation of base resources. 

‘‘Sec.809.Results of demonstration projects. 

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

‘‘Sec.811.Moratorium. 

‘‘Sec.812.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: 


ycherry on PROD1PC64 with BILLS
7 

•HR 1328 IH

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

2 improve the health of the Indians are consonant 

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

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

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

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

11 planning and management of those services. 

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

14 of preventable illnesses among, and unnecessary and 

15 premature deaths of, Indians. 

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

17 needs of the American Indian people are severe and 

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

19 the general population of the United States. 

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

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

23 in fulfillment of its special trust responsibilities and legal 

24 obligations to Indians— 


ycherry on PROD1PC64 with BILLS
8 

•HR 1328 IH

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

2 for Indians and to provide all resources necessary to 

3 effect that policy; 

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

5 least the levels set forth in the goals contained with6 in the Health People 2010 or successor objectives; 

7 ‘‘(3) to the greatest extent possible, to allow In8 dians to set their own health care priorities and es9 tablish goals that reflect their unmet needs; 

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

11 the health professions and allied and associated 

12 health professions awarded to Indians so that the 

13 proportion of Indian health professionals in each 

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

15 the general population; 

16 ‘‘(5) to require meaningful consultation with In17 dian Tribes, Tribal Organizations, and Urban Indian 

18 Organizations to implement this Act and the na19 tional policy of Indian self-determination; and 

20 ‘‘(6) to provide funding for programs and facili21 ties operated by Indian Tribes and Tribal Organiza22 tions in amounts that are not less than the amounts 

23 provided to programs and facilities operated directly 

24 by the Service. 


ycherry on PROD1PC64 with BILLS
9 

•HR 1328 IH

1 ‘‘SEC. 4. DEFINITIONS. 

2 ‘‘For purposes of this Act: 

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

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

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

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

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

13 Assistant Secretary of Indian Health. 

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

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

16 tobacco) abuse and mental health prevention and 

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

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

20 joint development of substance abuse and mental 

21 health treatment planning and coordinated case 

22 management using a multidisciplinary approach. 

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

24 Indians who are eligible for health services of the 

25 Service pursuant to section 806. 

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


ycherry on PROD1PC64 with BILLS
10 

•HR 1328 IH

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

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

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

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

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

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

11 Human Services. 

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

13 reduction, limitation, and prevention of disease and 

14 its complications and reduction in the consequences 

15 of disease, including— 

16 ‘‘(A) controlling— 

17 ‘‘(i) the development of diabetes; 

18 ‘‘(ii) high blood pressure; 

19 ‘‘(iii) infectious agents; 

20 ‘‘(iv) injuries; 

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

23 ‘‘(vi) sexually transmittable diseases; 

24 and 

25 ‘‘(vii) toxic agents; and 


ycherry on PROD1PC64 with BILLS
11 

•HR 1328 IH

1 ‘‘(B) providing— 

2 ‘‘(i) fluoridation of water; and 

3 ‘‘(ii) immunizations. 

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

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

7 gynecology, podiatric medicine, nursing, public 

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

10 work, marriage and family therapy, chiropractic 

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

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

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

17 health, including raising public awareness about 

18 health matters and enabling the people to cope 

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

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

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


ycherry on PROD1PC64 with BILLS
12 

•HR 1328 IH

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

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

5 ‘‘(F) promoting culturally competent care; 

6 and 

7 ‘‘(G) providing adequate and appropriate 

8 programs, which may include— 

9 ‘‘(i) abuse prevention (mental and 

10 physical); 

11 ‘‘(ii) community health; 

12 ‘‘(iii) community safety; 

13 ‘‘(iv) consumer health education; 

14 ‘‘(v) diet and nutrition; 

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

17 HIV/AIDS; 

18 ‘‘(vii) environmental health; 

19 ‘‘(viii) exercise and physical fitness; 

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

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

23 ‘‘(xi) human growth and development; 

24 ‘‘(xii) injury prevention and personal 

25 safety; 


ycherry on PROD1PC64 with BILLS
13 

•HR 1328 IH

1 ‘‘(xiii) behavioral health; 

2 ‘‘(xiv) monitoring of disease indicators 

3 between health care provider visits, 

4 through appropriate means, including 

5 Internet-based health care management 

6 systems; 

7 ‘‘(xv) personal health and wellness 

8 practices; 

9 ‘‘(xvi) personal capacity building; 

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

12 ‘‘(xviii) psychological well-being; 

13 ‘‘(xix) reproductive health and family 

14 planning; 

15 ‘‘(xx) safe and adequate water; 

16 ‘‘(xxi) healthy work environments; 

17 ‘‘(xxii) elimination, reduction, and 

18 prevention of contaminants that create 

19 unhealthy household conditions (including 

20 mold and other allergens); 

21 ‘‘(xxiii) stress control; 

22 ‘‘(xxiv) substance abuse; 

23 ‘‘(xxv) sanitary facilities; 

24 ‘‘(xxvi) sudden infant death syndrome 

25 prevention; 


ycherry on PROD1PC64 with BILLS
14 

•HR 1328 IH

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

3 ‘‘(xxviii) violence prevention; and 

4 ‘‘(xxix) such other activities identified 

5 by the Service, a Tribal Health Program, 

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

8 described in section 3(2). 

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

11 Indian Tribe or is eligible for health services under 

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

13 102 and 103, the term also means any individual 

14 who— 

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

18 of Indians, including those tribes, bands, or 

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

21 which they reside; or 

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

23 degree, of any such member; 

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


ycherry on PROD1PC64 with BILLS
15 

•HR 1328 IH

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

2 Interior to be an Indian for any purpose; or 

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

4 regulations promulgated by the Secretary. 

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

6 means— 

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

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

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

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

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

14 ‘Buy Indian Act’). 

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

16 given the term in the Indian Self-Determination and 

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

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

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

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

21 1058(e)). 

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

24 colony, including former reservations in Oklahoma, 

25 Indian allotments, and Alaska Native Regions estabVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
16 

•HR 1328 IH

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

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

4 designated, means the Secretary of Health and 

5 Human Services. 

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

7 Health Service. 

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

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

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

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

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

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

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

20 of eligible equipment that electronically links health 

21 professionals or patients and health professionals at 

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

24 the purpose of providing improved health care serv25 ices. 


ycherry on PROD1PC64 with BILLS
17 

•HR 1328 IH

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

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

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

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

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

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

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

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

11 et seq.). 

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

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

15 450 et seq.). 

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

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

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

23 meets 1 or more of the following criteria: 

24 ‘‘(A) Irrespective of whether the individual 

25 lives on or near a reservation, the individual is 


ycherry on PROD1PC64 with BILLS
18 

•HR 1328 IH

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

2 group of Indians, including those tribes, bands, 

3 or groups terminated since 1940 and those 

4 tribes, bands, or groups that are recognized by 

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

7 such member. 

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

9 or other Alaska Native. 

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

11 Secretary of the Interior to be an Indian for 

12 any purpose. 

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

14 Indian under regulations promulgated by the 

15 Secretary. 

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

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

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

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

22 cooperating with other public and private entities for 

23 the purpose of performing the activities described in 

24 section 503(a). 


ycherry on PROD1PC64 with BILLS
19 

•HR 1328 IH

1 ‘‘TITLE I—INDIAN HEALTH, 

2 HUMAN RESOURCES, AND DE3 VELOPMENT 

4 ‘‘SEC. 101. PURPOSE. 

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

7 health professions and providing health services, and to 

8 assure an optimum supply of health professionals to the 

9 Indian Health Programs and Urban Indian Organizations 

10 involved in the provision of health services to Indians. 

11 ‘‘SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM 

12 FOR INDIANS. 

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

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

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

19 education or training in the health professions and 

20 encouraging and assisting them— 

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

22 health professions; or 

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

24 any such courses of study, to undertake such 


ycherry on PROD1PC64 with BILLS
20 

•HR 1328 IH

1 postsecondary education or training as may be 

2 required to qualify them for enrollment; 

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

4 available to Indians enrolled in any course of study 

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

6 training necessary to qualify them to enroll in any 

7 such course of study; or 

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

11 and completion by them of, courses of study referred 

12 to in paragraph (1). 

13 ‘‘(b) GRANTS.— 

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

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

17 Secretary. Such application shall be in such form, 

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

21 a preference to applications submitted by Tribal 

22 Health Programs or Urban Indian Organizations. 

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

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


ycherry on PROD1PC64 with BILLS
21 

•HR 1328 IH

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

4 to this Act. To the extent not otherwise prohibited 

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

6 regulations issued pursuant to this Act. 

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

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

10 acting through the Service, shall provide scholarship 

11 grants to Indians who— 

12 ‘‘(1) have successfully completed their high 

13 school education or high school equivalency; and 

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

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

19 ‘‘(1) Compensatory preprofessional education of 

20 any recipient, such scholarship not to exceed 2 years 

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

22 thereof, as determined by the Secretary pursuant to 

23 regulations issued under this Act). 

24 ‘‘(2) Pregraduate education of any recipient 

25 leading to a baccalaureate degree in an approved 


ycherry on PROD1PC64 with BILLS
22 

•HR 1328 IH

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

2 health profession, such scholarship not to exceed 4 

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

6 this Act) may be approved. 

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

8 section— 

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

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

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

15 standing at, an accredited institution; and 

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

17 applicant’s eligibility for assistance or benefits under 

18 any other Federal program. 

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

20 ‘‘(a) IN GENERAL.— 

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

22 through the Service, shall make scholarship grants 

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

25 health professions. Such scholarships shall be desVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
23 

•HR 1328 IH

1 ignated Indian Health Scholarships and shall be 

2 made in accordance with section 338A of the Public 

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

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

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

8 ‘‘(A) who shall receive scholarship grants 

9 under subsection (a); and 

10 ‘‘(B) the distribution of the scholarships 

11 among health professions on the basis of the 

12 relative needs of Indians for additional service 

13 in the health professions. 

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

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

17 delegated in a contract or compact under the Indian 

18 Self-Determination and Education Assistance Act 

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

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

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

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


ycherry on PROD1PC64 with BILLS
24 

•HR 1328 IH

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

2 participant receives a scholarship award under this 

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

4 1 or more of the following: 

5 ‘‘(A) In an Indian Health Program. 

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

7 of this Act. 

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

12 in a physician or other health professional 

13 shortage area and addresses the health care 

14 needs of a substantial number of Indians. 

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

17 health profession program) if, as determined by 

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

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

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

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

25 the Secretary shall defer the active duty service obliVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
25 

•HR 1328 IH

1 gation of that individual under that contract, in 

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

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

7 conditions: 

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

9 other advanced clinical training shall be counted 

10 as satisfying any period of obligated service 

11 under this subsection. 

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

13 that individual shall commence not later than 

14 90 days after the completion of that advanced 

15 clinical training (or by a date specified by the 

16 Secretary). 

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

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

20 (1). 

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

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

23 meet the active duty service obligation described 

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


ycherry on PROD1PC64 with BILLS
26 

•HR 1328 IH

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

2 the Indian Tribe in which the recipient is 

3 enrolled; or 

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

5 the recipient is enrolled. 

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

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

8 assignments of Indian Health Scholarship recipients 

9 required to meet the active duty service obligation 

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

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

13 health professionals to provide health care services 

14 as a result of individuals having breached contracts 

15 entered into under this section. 

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

18 enrolled part time in an approved course of study— 

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

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

21 years, as determined by the Secretary; 

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

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

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

25 each year for which the individual was provided 


ycherry on PROD1PC64 with BILLS
27 

•HR 1328 IH

1 a scholarship (as determined by the Secretary); 

2 or 

3 ‘‘(B) 2 years; and 

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

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

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

10 ‘‘(d) BREACH OF CONTRACT.— 

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

12 shall be liable to the United States for the amount 

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

14 of the individual, under a contract entered into with 

15 the Secretary under this section on or after the date 

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

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

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

21 determined by the educational institution under 

22 regulations of the Secretary); 

23 ‘‘(B) is dismissed from such educational 

24 institution for disciplinary reasons; 


ycherry on PROD1PC64 with BILLS
28 

•HR 1328 IH

1 ‘‘(C) voluntarily terminates the training in 

2 such an educational institution for which he or 

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

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

6 the educational institution in which he or she is 

7 enrolled not to accept payment, in whole or in 

8 part, of a scholarship under such contract, in 

9 lieu of any service obligation arising under such 

10 contract. 

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

12 specified in paragraph (1) an individual breaches a 

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

16 United States shall be entitled to recover from the 

17 individual an amount determined in accordance with 

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

19 in the manner provided for in such subsection. 

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

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

24 relates to that scholarship shall be canceled. 

25 ‘‘(4) WAIVERS AND SUSPENSIONS.— 


ycherry on PROD1PC64 with BILLS
29 

•HR 1328 IH

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

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

4 of a recipient of an Indian Health Scholarship 

5 if the Secretary determines that— 

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

7 to meet that obligation or make that pay8 ment; 

9 ‘‘(ii) requiring that recipient to meet 

10 that obligation or make that payment 

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

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

15 payment would be unconscionable. 

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

18 service or payment under subparagraph (A), the 

19 Secretary shall consult with the affected Area 

20 Office, Indian Tribes, Tribal Organizations, or 

21 Urban Indian Organizations, and may take into 

22 consideration whether the obligation may be 

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


ycherry on PROD1PC64 with BILLS
30 

•HR 1328 IH

1 ‘‘(5) EXTREME HARDSHIP.—Notwithstanding 

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

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

5 the United States to recover funds made available 

6 under this section. 

7 ‘‘(6) BANKRUPTCY.—Notwithstanding any 

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

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

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

13 period beginning on the initial date on which that 

14 payment is due, and only if the bankruptcy court 

15 finds that the nondischarge of the obligation would 

16 be unconscionable. 

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

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

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

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

25 shall be located at various locations throughout the counVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
31 

•HR 1328 IH

1 try to maximize their availability to Indian students and 

2 new programs shall be established in different locations 

3 from time to time. 

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

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

8 Burdick American Indians Into Psychology Program’. 

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

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

14 and communications networks. 

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

17 of grants provided under this section. 

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

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

21 ‘‘(1) provides outreach and recruitment for 

22 health professions to Indian communities including 

23 elementary, secondary, and accredited and accessible 

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


ycherry on PROD1PC64 with BILLS
32 

•HR 1328 IH

1 ‘‘(2) incorporates a program advisory board 

2 comprised of representatives from the tribes and 

3 communities that will be served by the program; 

4 ‘‘(3) provides summer enrichment programs to 

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

7 activities; 

8 ‘‘(4) provides stipends to undergraduate and 

9 graduate students to pursue a career in psychology; 

10 ‘‘(5) develops affiliation agreements with tribal 

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

13 and accessible entities to enhance the education of 

14 Indian students; 

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

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

19 qualified Indians in the program. 

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

21 active duty service obligation prescribed under section 

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

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


ycherry on PROD1PC64 with BILLS
33 

•HR 1328 IH

1 ‘‘(1) in an Indian Health Program; 

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

3 Act; or 

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

5 determined by the Secretary, in accordance with 

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

9 needs of a substantial number of Indians. 

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

11 is authorized to be appropriated to carry out this section 

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

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

14 ‘‘(a) IN GENERAL.— 

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

16 acting through the Service, shall make grants to 

17 Tribal Health Programs for the purpose of providing 

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

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

23 Indian Health Scholarships under section 104. 

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

25 under paragraph (1) shall be in such form and conVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
34 

•HR 1328 IH

1 tain such agreements, assurances, and information 

2 as consistent with this section. 

3 ‘‘(b) REQUIREMENTS.— 

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

5 receiving a grant under subsection (a) shall provide 

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

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

9 any scholarship pursuant to subsection (a)— 

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

13 the Tribal Health Program; and 

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

15 from any other source of funds. 

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

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

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

21 ‘‘(d) CONTRACT.— 

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

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

24 Health Program shall enter into a written contract 

25 with each recipient of such scholarship. 


ycherry on PROD1PC64 with BILLS
35 

•HR 1328 IH

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

2 ‘‘(A) obligate such recipient to provide 

3 service in an Indian Health Program or Urban 

4 Indian Organization, in the same Service Area 

5 where the Tribal Health Program providing the 

6 scholarship is located, for— 

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

8 scholarship is provided (or the part-time 

9 equivalent thereof, as determined by the 

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

11 whichever period is greater; or 

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

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

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

17 ‘‘(i) may only be expended for— 

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

23 ‘‘(II) payment to the recipient of 

24 a monthly stipend of not more than 

25 the amount authorized by section 


ycherry on PROD1PC64 with BILLS
36 

•HR 1328 IH

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

2 Service Act (42 U.S.C. 

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

4 be reduced pro rata (as determined by 

5 the Secretary) based on the number of 

6 hours such student is enrolled, and 

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

10 the year for the purposes authorized 

11 in this clause; and 

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

13 attendance for which the scholarship is 

14 provided, the total amount required for the 

15 year for the purposes authorized in clause 

16 (i); 

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

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

21 pursuant to this Act; and 

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


ycherry on PROD1PC64 with BILLS
37 

•HR 1328 IH

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

2 contract may allow the recipient to serve in another 

3 Service Area, provided the Tribal Health Program 

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

8 ‘‘(e) BREACH OF CONTRACT.— 

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

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

13 the Federal share of the amount which has been 

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

15 the contract if that individual— 

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

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

19 as determined by the educational institution 

20 under regulations of the Secretary); 

21 ‘‘(B) is dismissed from such educational 

22 institution for disciplinary reasons; 

23 ‘‘(C) voluntarily terminates the training in 

24 such an educational institution for which he or 


ycherry on PROD1PC64 with BILLS
38 

•HR 1328 IH

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

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

4 the educational institution in which he or she is 

5 enrolled not to accept payment, in whole or in 

6 part, of a scholarship under such contract, in 

7 lieu of any service obligation arising under such 

8 contract. 

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

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

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

14 United States shall be entitled to recover from the 

15 individual an amount determined in accordance with 

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

17 in the manner provided for in such subsection. 

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

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

22 relates to that scholarship shall be canceled. 

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

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


ycherry on PROD1PC64 with BILLS
39 

•HR 1328 IH

1 the basis of information collected through such other 

2 means as the Secretary deems appropriate. 

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

5 providing health care pursuant to the requirements here6 in— 

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

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

13 title XIX or title XXI of such Act; and 

14 ‘‘(2) to accept assignment under section 

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

16 services for which payment may be made under part 

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

18 appropriate agreement with the State agency that 

19 administers the State plan for medical assistance 

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

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

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

25 shall make payments under this section to a Tribal Health 


ycherry on PROD1PC64 with BILLS
40 

•HR 1328 IH

1 Program for any fiscal year subsequent to the first fiscal 

2 year of such payments unless the Secretary determines 

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

4 Health Program has not complied with the requirements 

5 of this section. 

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

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

8 who receives a scholarship pursuant to section 104 or 106 

9 shall be given preference for employment in the Service, 

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

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

13 the year. 

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

15 OBLIGATION.—Periods of employment pursuant to this 

16 subsection shall not be counted in determining fulfillment 

17 of the service obligation incurred as a condition of the 

18 scholarship. 

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

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

23 Indian Organization during any nonacademic period of the 

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


ycherry on PROD1PC64 with BILLS
41 

•HR 1328 IH

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

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

8 shall receive payment for his or her services comparable 

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

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

13 ‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES. 

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

16 professionals, including community health representatives 

17 and emergency medical technicians, to join or continue in 

18 an Indian Health Program and to provide their services 

19 in the rural and remote areas where a significant portion 

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

22 ‘‘(1) provide programs or allowances to transi23 tion into an Indian Health Program, including li24 censing, board or certification examination assistVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
42 

•HR 1328 IH

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

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

4 professionals employed in an Indian Health Program 

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

7 of their duty stations for professional consultation, 

8 management, leadership, and refresher training 

9 courses. 

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

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

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

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

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

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

19 ‘‘(2) use such community health representatives 

20 in the provision of health care, health promotion, 

21 and disease prevention services to Indian commu22 nities. 

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


ycherry on PROD1PC64 with BILLS
43 

•HR 1328 IH

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

2 community health representatives to ensure that the 

3 community health representatives provide quality 

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

6 the Program; 

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

8 and maintain a curriculum that— 

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

10 health care with supervised practical experience 

11 in the provision of health care; and 

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

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

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

21 and disease prevention and develop programs that 

22 meet the needs for continuing education; 

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


ycherry on PROD1PC64 with BILLS
44 

•HR 1328 IH

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

2 of Community Health Representatives is reviewed 

3 and evaluated; and 

4 ‘‘(6) promote traditional health care practices 

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

7 promotion, and disease prevention. 

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

9 PROGRAM. 

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

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

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

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

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

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

21 must— 

22 ‘‘(1)(A) be enrolled— 

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

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


ycherry on PROD1PC64 with BILLS
45 

•HR 1328 IH

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

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

3 scheduled to complete such course of study in 

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

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

8 ‘‘(B) have— 

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

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

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

13 as a commissioned officer in the Regular or Reserve 

14 Corps of the Public Health Service; 

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

16 in the Regular or Reserve Corps of the Public 

17 Health Service; 

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

19 service employment in the Service; or 

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

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

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

24 a contract described in subsection (e). 

25 ‘‘(c) APPLICATION.— 


ycherry on PROD1PC64 with BILLS
46 

•HR 1328 IH

1 ‘‘(1) INFORMATION TO BE INCLUDED WITH

2 FORMS.—In disseminating application forms and 

3 contract forms to individuals desiring to participate 

4 in the Loan Repayment Program, the Secretary 

5 shall include with such forms a fair summary of the 

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

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

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

12 provide such individuals with sufficient information 

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

17 to make a decision on an informed basis. 

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

19 contract form, and all other information furnished 

20 by the Secretary under this section shall be written 

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

23 Repayment Program. 

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

25 Secretary shall make such application forms, conVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00046 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
47 

•HR 1328 IH

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

4 that such individuals have adequate time to carefully 

5 review and evaluate such forms and information. 

6 ‘‘(d) PRIORITIES.— 

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

8 Secretary shall annually— 

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

10 Health Program or Urban Indian Organization 

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

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

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

16 in determining which applications under the Loan 

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

19 ‘‘(A) give first priority to applications 

20 made by individual Indians; and 

21 ‘‘(B) after making determinations on all 

22 applications submitted by individual Indians as 

23 required under subparagraph (A), give priority 

24 to— 


ycherry on PROD1PC64 with BILLS
48 

•HR 1328 IH

1 ‘‘(i) individuals recruited through the 

2 efforts of an Indian Health Program or 

3 Urban Indian Organization; and 

4 ‘‘(ii) other individuals based on the 

5 priority rankings under paragraph (1). 

6 ‘‘(e) RECIPIENT CONTRACTS.— 

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

11 (2). 

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

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

15 ‘‘(A) an agreement under which— 

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

17 Secretary agrees— 

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

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

21 ‘‘(II) to accept (subject to the 

22 availability of appropriated funds for 

23 carrying out this section) the indi24 vidual into the Service or place the in25 dividual with a Tribal Health ProVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
49 

•HR 1328 IH

1 gram or Urban Indian Organization 

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

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

4 individual agrees— 

5 ‘‘(I) to accept loan payments on 

6 behalf of the individual; 

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

8 described in subsection (b)(1)— 

9 ‘‘(aa) to maintain enrollment 

10 in a course of study or training 

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

12 until the individual completes the 

13 course of study or training; and 

14 ‘‘(bb) while enrolled in such 

15 course of study or training, to 

16 maintain an acceptable level of 

17 academic standing (as deter18 mined under regulations of the 

19 Secretary by the educational in20 stitution offering such course of 

21 study or training); and 

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

23 (hereinafter in this section referred to 

24 as the ‘period of obligated service’) 

25 equal to 2 years or such longer period 


ycherry on PROD1PC64 with BILLS
50 

•HR 1328 IH

1 as the individual may agree to serve 

2 in the full-time clinical practice of 

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

8 ‘‘(B) a provision permitting the Secretary 

9 to extend for such longer additional periods, as 

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

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

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

16 obligation of the individual which is conditioned 

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

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

20 the United States is entitled under subsection 

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

22 and 

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

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


ycherry on PROD1PC64 with BILLS
51 

•HR 1328 IH

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

2 The Secretary shall provide written notice to an individual 

3 within 21 days on— 

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

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

8 excess of 4 years; or 

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

11 ‘‘(g) PAYMENTS.— 

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

13 for an individual under a written contract under the 

14 Loan Repayment Program shall consist of payment, 

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

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

18 by the individual regarding the undergraduate or 

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

20 loans were made for— 

21 ‘‘(A) tuition expenses; 

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


ycherry on PROD1PC64 with BILLS
52 

•HR 1328 IH

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

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

4 service that an individual contracts to serve under 

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

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

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

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

10 determination of the amount to pay for a year of 

11 such service by an individual, the Secretary shall 

12 consider the extent to which each such determina13 tion— 

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

15 maximize the number of contracts that can be 

16 provided under the Loan Repayment Program 

17 from the amounts appropriated for such con18 tracts; 

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

22 professionals; and 

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

24 the health professional involved remaining in an 

25 Indian Health Program or Urban Indian OrgaVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00052 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
53 

•HR 1328 IH

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

3 services, after the completion of the period of 

4 obligated service under the Loan Repayment 

5 Program. 

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

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

9 repayments for a year of obligated service shall be 

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

11 which the individual completes such year of service. 

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

13 For the purpose of providing reimbursements for tax 

14 liability resulting from a payment under paragraph 

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

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

17 make payments to the individual in an amount 

18 equal to not less than 20 percent and not more 

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

21 and 

22 ‘‘(B) may make such additional payments 

23 as the Secretary determines to be appropriate 

24 with respect to such purpose. 


ycherry on PROD1PC64 with BILLS
54 

•HR 1328 IH

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

2 may enter into an agreement with the holder of any 

3 loan for which payments are made under the Loan 

4 Repayment Program to establish a schedule for the 

5 making of such payments. 

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

7 other provision of law, individuals who have entered into 

8 written contracts with the Secretary under this section 

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

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

14 other manpower programs of the Service at educational 

15 institutions training health professionals or specialists 

16 identified in subsection (a). 

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

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

19 to individuals during their period of obligated service 

20 under the Loan Repayment Program. 

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

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


ycherry on PROD1PC64 with BILLS
55 

•HR 1328 IH

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

2 Health Programs and Urban Indian Organizations 

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

5 and 

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

9 provide health care services as a result of individuals 

10 having breached contracts entered into under this 

11 section. 

12 ‘‘(l) BREACH OF CONTRACT.— 

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

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

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

17 of any service obligation arising under such contract, 

18 to the United States for the amount which has been 

19 paid on such individual’s behalf under the contract 

20 if that individual— 

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

22 course of study and— 

23 ‘‘(i) fails to maintain an acceptable 

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


ycherry on PROD1PC64 with BILLS
56 

•HR 1328 IH

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

3 the Secretary); 

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

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

8 such course of study; or 

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

12 ‘‘(2) OTHER BREACHES; FORMULA FOR

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

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

15 written contract under this section by failing either 

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

18 the United States shall be entitled to recover from 

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

21 in which— 

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

23 is entitled to recover; 

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

25 under this section to, or on behalf of, the indiVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00056 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
57 

•HR 1328 IH

1 vidual and the interest on such amounts which 

2 would be payable if, at the time the amounts 

3 were paid, they were loans bearing interest at 

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

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

7 the individual’s period of obligated service in 

8 accordance with subsection (f); and 

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

10 period served by such individual in accordance 

11 with this section. 

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

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

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

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

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

20 the United States within the 1-year period beginning 

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

23 Secretary. 

24 ‘‘(5) RECOVERY OF DELINQUENCY.— 


ycherry on PROD1PC64 with BILLS
58 

•HR 1328 IH

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

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

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

5 ‘‘(i) use collection agencies contracted 

6 with by the Administrator of General Serv7 ices; or 

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

10 agencies selected by the Secretary. 

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

13 provide that the contractor will, not less than 

14 once each 6 months, submit to the Secretary a 

15 status report on the success of the contractor in 

16 collecting such damages. Section 3718 of title 

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

18 contract to the extent not inconsistent with this 

19 subsection. 

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

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

24 an individual under the Loan Repayment Program 

25 whenever compliance by the individual is impossible 


ycherry on PROD1PC64 with BILLS
59 

•HR 1328 IH

1 or would involve extreme hardship to the individual 

2 and if enforcement of such obligation with respect to 

3 any individual would be unconscionable. 

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

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

7 canceled upon the death of the individual. 

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

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

10 States to recover amounts under this section in any 

11 case of extreme hardship or other good cause shown, 

12 as determined by the Secretary. 

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

16 bankruptcy under title 11 of the United States Code 

17 only if such discharge is granted after the expiration 

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

19 payment of such damages is required, and only if 

20 the bankruptcy court finds that nondischarge of the 

21 obligation would be unconscionable. 

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

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


ycherry on PROD1PC64 with BILLS
60 

•HR 1328 IH

1 the previous fiscal year which sets forth by Service Area 

2 the following: 

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

4 maintained by Indian Health Programs and Urban 

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

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

8 applications filed with respect to each type of health 

9 profession. 

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

12 health profession. 

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

14 this section, in total and by health profession. 

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

17 each health profession. 

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

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

20 profession. 

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

22 that will be needed by Indian Health Programs and 

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

25 date the report is filed. 


ycherry on PROD1PC64 with BILLS
61 

•HR 1328 IH

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

2 to fill the health professional positions maintained 

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

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

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

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

10 Indian Health Scholarship and Loan Repayment Recovery 

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

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

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

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

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

17 appropriated, or earned relative to the LRRF shall remain 

18 available until expended. 

19 ‘‘(b) USE OF FUNDS.— 

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

21 may be expended by the Secretary, acting through 

22 the Service, to make payments to an Indian Health 

23 Program— 

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

25 section 104 and 106 or a loan repayment proVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00061 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
62 

•HR 1328 IH

1 gram participant under section 110 has been 

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

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

6 of such recipient or participant having breached 

7 the contract entered into under section 104, 

8 106, or section 110. 

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

10 Health Program receiving payments pursuant to 

11 paragraph (1) may expend the payments to provide 

12 scholarships or recruit and employ, directly or by 

13 contract, health professionals to provide health care 

14 services. 

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

16 Treasury shall invest such amounts of the LRRF as the 

17 Secretary of Health and Human Services determines are 

18 not required to meet current withdrawals from the LRRF. 

19 Such investments may be made only in interest bearing 

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

21 obligations may be acquired on original issue at the issue 

22 price, or by purchase of outstanding obligations at the 

23 market price. 


ycherry on PROD1PC64 with BILLS
63 

•HR 1328 IH

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

3 Treasury at the market price. 

4 ‘‘SEC. 112. RECRUITMENT ACTIVITIES. 

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

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

10 110 and their spouses, for actual and reasonable expenses 

11 incurred in traveling to and from their places of residence 

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

13 of evaluating such area with respect to such assignment. 

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

15 acting through the Service, shall assign 1 individual in 

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

17 recruitment activities. 

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

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

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

22 demonstration projects for a period not to exceed 3 years 

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


ycherry on PROD1PC64 with BILLS
64 

•HR 1328 IH

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

3 submit an application for funding of a project pursuant 

4 to this section. 

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

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

7 acting through the Service, shall establish a demonstration 

8 project to enable health professionals who have worked in 

9 an Indian Health Program or Urban Indian Organization 

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

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

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

16 obligation to serve in an Indian Health Program or Urban 

17 Indian Organization for a period of obligated service equal 

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

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

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

24 of the Indian Health Care Improvement Act Amendments 

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


ycherry on PROD1PC64 with BILLS
65 

•HR 1328 IH

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

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

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

5 Health professionals from Tribal Health Programs and 

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

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

9 NURSING PROGRAM. 

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

12 practitioners who deliver health care services to Indians, 

13 the Secretary, acting through the Service, shall provide 

14 grants to the following: 

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

16 ‘‘(2) Tribal colleges or universities. 

17 ‘‘(3) Nurse midwife programs and advanced 

18 practice nurse programs that are provided by any 

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

21 private institutions. 

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


ycherry on PROD1PC64 with BILLS
66 

•HR 1328 IH

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

2 train individuals to be nurses, nurse midwives, or 

3 advanced practice nurses. 

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

5 in such programs that may pay the tuition charged 

6 for such program and other expenses incurred in 

7 connection with such program, including books, fees, 

8 room and board, and stipends for living expenses. 

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

10 nurses, nurse midwives, and advanced practice 

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

12 services to Indians. 

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

14 skills of, and provides continuing education to, 

15 nurses, nurse midwives, and advanced practice 

16 nurses. 

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

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

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

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

21 Secretary may require to establish the connection between 

22 the program of the applicant and a health care facility 

23 that primarily serves Indians. 


ycherry on PROD1PC64 with BILLS
67 

•HR 1328 IH

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

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

3 extend a preference to the following: 

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

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

8 ‘‘(3) Programs that are interdisciplinary. 

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

11 students. 

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

13 universities. 

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

15 Secretary shall provide 1 of the grants authorized under 

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

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

18 N. Burdick American Indians Into Nursing Program’. 

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

22 N. Burdick American Indians Into Psychology Program 

23 established under section 105(b). 

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


ycherry on PROD1PC64 with BILLS
68 

•HR 1328 IH

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

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

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

5 Such obligation shall be met by service— 

6 ‘‘(1) in the Service; 

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

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

10 450 et seq.) (including programs under agreements 

11 with the Bureau of Indian Affairs); 

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

13 Act; 

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

17 situated in a physician or other health shortage area 

18 and addresses the health care needs of a substantial 

19 number of Indians; or 

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

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

23 health services provided to Indians would not de24 crease. 


ycherry on PROD1PC64 with BILLS
69 

•HR 1328 IH

1 ‘‘SEC. 116. TRIBAL CULTURAL ORIENTATION. 

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

3 Secretary, acting through the Service, shall require that 

4 appropriate employees of the Service who serve Indian 

5 Tribes in each Service Area receive educational instruction 

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

7 relationship to the Service. 

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

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

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

13 Urban Indian Organizations; 

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

15 universities; 

16 ‘‘(3) include instruction in American Indian 

17 studies; and 

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

19 health care practices of the Indian Tribes in the 

20 Service Area. 

21 ‘‘SEC. 117. INMED PROGRAM. 

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

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

25 expanding the Indian health careers recruitment program 

26 known as the ‘Indians Into Medicine Program’ (hereinVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00069 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
70 

•HR 1328 IH

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

2 of encouraging Indians to enter the health professions. 

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

4 shall provide 1 of the grants authorized under subsection 

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

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

7 Indian Health Programs’, unless the Secretary makes a 

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

10 program shall, to the maximum extent feasible, coordinate 

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

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

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

16 Act, shall develop regulations to govern grants pursuant 

17 to this section. 

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

20 which— 

21 ‘‘(1) provides outreach and recruitment for 

22 health professions to Indian communities including 

23 elementary and secondary schools and community 

24 colleges located on reservations which will be served 

25 by the program; 


ycherry on PROD1PC64 with BILLS
71 

•HR 1328 IH

1 ‘‘(2) incorporates a program advisory board 

2 comprised of representatives from the Indian Tribes 

3 and Indian communities which will be served by the 

4 program; 

5 ‘‘(3) provides summer preparatory programs for 

6 Indian students who need enrichment in the subjects 

7 of math and science in order to pursue training in 

8 the health professions; 

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

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

12 and 

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

14 qualified Indians in the program. 

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

16 COLLEGES. 

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

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

19 through the Service, shall award grants to accredited 

20 and accessible community colleges for the purpose of 

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

23 health profession leading to a degree or diploma in 

24 a health profession for individuals who desire to 


ycherry on PROD1PC64 with BILLS
72 

•HR 1328 IH

1 practice such profession on or near a reservation or 

2 in an Indian Health Program. 

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

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

6 is provided to the community college shall not exceed 

7 $250,000. 

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

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

11 through the Service, shall award grants to accredited 

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

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

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

17 made under this section to a community college 

18 which— 

19 ‘‘(A) is accredited; 

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

22 provide training of nurses or health profes23 sionals; 


ycherry on PROD1PC64 with BILLS
73 

•HR 1328 IH

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

2 an accredited college or university medical 

3 school, the terms of which— 

4 ‘‘(i) provide a program that enhances 

5 the transition and recruitment of students 

6 into advanced baccalaureate or graduate 

7 programs that train health professionals; 

8 and 

9 ‘‘(ii) stipulate certifications necessary 

10 to approve internship and field placement 

11 opportunities at Indian Health Programs; 

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

13 appropriate certifications; 

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

16 subsection (a)(1); and 

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

19 section. 

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

21 encourage community colleges described in subsection 

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

23 subsection (a)(1) by— 

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


ycherry on PROD1PC64 with BILLS
74 

•HR 1328 IH

1 Service to teach courses of study in such programs; 

2 and 

3 ‘‘(2) providing technical assistance and support 

4 to such colleges. 

5 ‘‘(d) ADVANCED TRAINING.— 

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

9 of study which provide advanced training for any 

10 health professional who— 

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

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

14 reservation or for an Indian Health Program. 

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

16 Such courses of study may be offered in conjunction 

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

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

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

22 to tribal colleges and universities in Service Areas where 

23 they exist. 


ycherry on PROD1PC64 with BILLS
75 

•HR 1328 IH

1 ‘‘SEC. 119. RETENTION BONUS. 

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

3 a retention bonus to any health professional employed by, 

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

5 or Urban Indian Organization either as a civilian employee 

6 or as a commissioned officer in the Regular or Reserve 

7 Corps of the Public Health Service who— 

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

9 for which recruitment or retention of personnel is 

10 difficult; 

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

14 ‘‘(3) has— 

15 ‘‘(A) completed 2 years of employment 

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

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

20 ‘‘(i) any Federal scholarship program; 

21 or 

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

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

25 Health Program or Urban Indian Organization for 


ycherry on PROD1PC64 with BILLS
76 

•HR 1328 IH

1 continued employment for a period of not less than 

2 1 year. 

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

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

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

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

8 annum. 

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

10 health professional failing to complete the agreed upon 

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

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

13 Government the full amount of the retention bonus for the 

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

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

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

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

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

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

25 to Indians. 


ycherry on PROD1PC64 with BILLS
77 

•HR 1328 IH

1 ‘‘SEC. 120. NURSING RESIDENCY PROGRAM. 

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

5 licensed vocational nurses, and registered nurses who are 

6 working in an Indian Health Program or Urban Indian 

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

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

9 shall include a combination of education and work study 

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

12 case of a licensed practical nurse or licensed vocational 

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

14 nurse), or advanced degrees or certifications in nursing 

15 and public health. 

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

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

19 obligation to serve in an Indian Health Program or Urban 

20 Indian Organization for a period of obligated service equal 

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

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


ycherry on PROD1PC64 with BILLS
78 

•HR 1328 IH

1 fails to complete such obligated service, the United States 

2 shall be entitled to recover from such individual an amount 

3 determined in accordance with the formula specified in 

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

5 in such subsection. 

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

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

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

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

12 Service— 

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

14 as health aides or community health practitioners; 

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

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

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

21 near such villages for use by community health aides 

22 or community health practitioners. 

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


ycherry on PROD1PC64 with BILLS
79 

•HR 1328 IH

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

2 provide a high standard of training to community 

3 health aides and community health practitioners to 

4 ensure that such aides and practitioners provide 

5 quality health care, health promotion, and disease 

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

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

9 a curriculum that— 

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

11 health care with supervised practical experience 

12 in the provision of health care; 

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

18 and facilities; and 

19 ‘‘(C) promotes the achievement of the 

20 health status objectives specified in section 

21 3(2); 

22 ‘‘(3) establish and maintain a Community 

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


ycherry on PROD1PC64 with BILLS
80 

•HR 1328 IH

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

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

6 in the provision of health care, including the areas 

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

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

12 and community health practitioners; 

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

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

17 disease prevention services; and 

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

19 pulpotomies on deciduous teeth) or extraction of 

20 adult teeth can be performed by a dental health aide 

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

23 emergency that cannot be resolved with palliative 

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


ycherry on PROD1PC64 with BILLS
81 

•HR 1328 IH

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

4 ‘‘(c) PROGRAM REVIEW.— 

5 ‘‘(1) NEUTRAL PANEL.— 

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

7 acting through the Service, shall establish a 

8 neutral panel to carry out the study under 

9 paragraph (2). 

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

12 from among clinicians, economists, community 

13 practitioners, oral epidemiologists, and Alaska 

14 Natives. 

15 ‘‘(2) STUDY.— 

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

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

20 Program under this section to ensure that the 

21 quality of care provided through those services 

22 is adequate and appropriate. 

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


ycherry on PROD1PC64 with BILLS
82 

•HR 1328 IH

1 including professional dental organizations, 

2 shall develop the parameters of the study. 

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

5 respect to— 

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

7 aide therapist services under this section to 

8 address the dental care needs of Alaska 

9 Natives; 

10 ‘‘(ii) the quality of care provided 

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

13 required to improve the quality of care; 

14 and 

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

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

19 study under this paragraph, the neutral panel 

20 shall consult with Alaska Tribal Organizations 

21 with respect to the adequacy and accuracy of 

22 the study. 

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

24 to the Secretary, the Committee on Indian Affairs of 

25 the Senate, and the Committee on Natural ReVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00082 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
83 

•HR 1328 IH

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

3 (2), including a description of— 

4 ‘‘(A) any determination of the neutral 

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

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

8 (2)(D). 

9 ‘‘(d) NATIONALIZATION OF PROGRAM.— 

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

12 may establish a national Community Health Aide 

13 Program in accordance with the program under this 

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

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

17 Health Aide Program under paragraph (1) shall not 

18 include dental health aide therapist services. 

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

21 shall not reduce the amount of funds provided for 

22 the Community Health Aide Program described in 

23 subsections (a) and (b). 


ycherry on PROD1PC64 with BILLS
84 

•HR 1328 IH

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

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

3 contract or otherwise, provide training for Indians in the 

4 administration and planning of Tribal Health Programs. 

5 ‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE 

6 DEMONSTRATION PROGRAMS. 

7 ‘‘(a) DEMONSTRATION PROGRAMS AUTHORIZED.— 

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

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

12 demonstration programs funded under subsection (a) shall 

13 be— 

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

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

18 Indians by assuring access to qualified health care 

19 professionals; and 

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

22 identifying all academic and scholarly resources of 

23 the region. 

24 ‘‘(c) ADVISORY BOARD.—The demonstration pro25 grams established pursuant to subsection (a) shall incor26 porate a program advisory board composed of representaVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00084 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
85 

•HR 1328 IH

1 tives from the Indian Tribes and Indian communities in 

2 the area which will be served by the program. 

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

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

5 shall not— 

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

7 Service Corps from an Indian Health Program or 

8 Urban Indian Organization; or 

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

10 member, unless the Secretary, acting through the 

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

13 in services. 

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

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

17 from the full-time equivalent limitations of the National 

18 Health Service Corps and the Service when serving as a 

19 commissioned corps officer in a Tribal Health Program 

20 or an Urban Indian Organization. 

21 ‘‘SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL 

22 CURRICULA DEMONSTRATION PROGRAMS. 

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

25 or make grants to, accredited tribal colleges and univerVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00085 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
86 

•HR 1328 IH

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

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

5 section shall be used only for developing and providing 

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

8 may be provided through satellite campus programs. 

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

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

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

13 upon the approval of the Secretary. 

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

16 enactment of the Indian Health Care Improvement Act 

17 Amendments of 2007, the Secretary, after consultation 

18 with Indian Tribes and administrators of tribal colleges 

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

21 review and approval of applications for funding (including 

22 applications for renewals of funding) under this section. 

23 Such criteria shall ensure that demonstration programs 

24 established under this section promote the development of 


ycherry on PROD1PC64 with BILLS
87 

•HR 1328 IH

1 the capacity of such entities to educate substance abuse 

2 counselors. 

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

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

6 section. 

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

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

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

11 from the demonstration programs conducted under this 

12 section during that fiscal year. 

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

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

15 following: 

16 ‘‘(1) Classroom education. 

17 ‘‘(2) Clinical work experience. 

18 ‘‘(3) Continuing education workshops. 

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

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

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

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

25 positions specified in subsection (b) whose qualifications 


ycherry on PROD1PC64 with BILLS
88 

•HR 1328 IH

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

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

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

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

7 Affairs, including existing positions, in the fields 

8 of— 

9 ‘‘(A) elementary and secondary education; 

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

11 welfare; 

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

13 and 

14 ‘‘(D) alcohol and substance abuse; 

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

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

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

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

21 ‘‘(c) TRAINING CRITERIA.— 

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

23 shall provide training criteria appropriate to each 

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

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


ycherry on PROD1PC64 with BILLS
89 

•HR 1328 IH

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

2 such position. With respect to any such individual in 

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

4 the respective Secretaries shall provide appropriate 

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

6 Tribal Organization, or Urban Indian Organization 

7 for training of appropriate individuals. In the case of 

8 positions funded under a contract or compact under 

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

11 Secretary shall ensure that such training costs are 

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

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

15 Position specific training criteria shall be culturally 

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

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

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

24 implement, a program of community education on mental 

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


ycherry on PROD1PC64 with BILLS
90 

•HR 1328 IH

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

2 Urban Indian Organization, provide technical assistance 

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

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

7 self-destructive behavior. 

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

9 of enactment of the Indian Health Care Improvement Act 

10 Amendments of 2007, the Secretary shall develop a plan 

11 under which the Service will increase the health care staff 

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

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

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

16 under this subsection shall be implemented under the Act 

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

18 as the ‘Snyder Act’). 

19 ‘‘SEC. 127. AUTHORIZATION OF APPROPRIATIONS. 

20 ‘‘There are authorized to be appropriated such sums 

21 as may be necessary for each fiscal year through fiscal 

22 year 2017 to carry out this title. 


ycherry on PROD1PC64 with BILLS
91 

•HR 1328 IH

1 ‘‘TITLE II—HEALTH SERVICES 

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

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

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

5 under the authority of the Indian Self-Determination and 

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

7 are appropriated under the authority of this section, for 

8 the purposes of— 

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

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

12 health care services to Indians; 

13 ‘‘(3) meeting the health needs of Indians in an 

14 efficient and equitable manner, including the use of 

15 telehealth and telemedicine when appropriate; 

16 ‘‘(4) eliminating inequities in funding for both 

17 direct care and contract health service programs; 

18 and 

19 ‘‘(5) augmenting the ability of the Service to 

20 meet the following health service responsibilities with 

21 respect to those Indian Tribes with the highest levels 

22 of health status deficiencies and resource defi23 ciencies: 

24 ‘‘(A) Clinical care, including inpatient care, 

25 outpatient care (including audiology, clinical 


ycherry on PROD1PC64 with BILLS
92 

•HR 1328 IH

1 eye, and vision care), primary care, secondary 

2 and tertiary care, and long-term care. 

3 ‘‘(B) Preventive health, including mam4 mography and other cancer screening in accord5 ance with section 207. 

6 ‘‘(C) Dental care. 

7 ‘‘(D) Mental health, including community 

8 mental health services, inpatient mental health 

9 services, dormitory mental health services, 

10 therapeutic and residential treatment centers, 

11 and training of traditional health care practi12 tioners. 

13 ‘‘(E) Emergency medical services. 

14 ‘‘(F) Treatment and control of, and reha15 bilitative care related to, alcoholism and drug 

16 abuse (including fetal alcohol syndrome) among 

17 Indians. 

18 ‘‘(G) Injury prevention programs, includ19 ing data collection and evaluation, demonstra20 tion projects, training, and capacity building. 

21 ‘‘(H) Home health care. 

22 ‘‘(I) Community health representatives. 

23 ‘‘(J) Maintenance and improvement. 

24 ‘‘(b) NO OFFSET OR LIMITATION.—Any funds appro25 priated under the authority of this section shall not be 


ycherry on PROD1PC64 with BILLS
93 

•HR 1328 IH

1 used to offset or limit any other appropriations made to 

2 the Service under this Act or the Act of November 2, 1921 

3 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

4 or any other provision of law. 

5 ‘‘(c) ALLOCATION; USE.— 

6 ‘‘(1) IN GENERAL.—Funds appropriated under 

7 the authority of this section shall be allocated to 

8 Service Units, Indian Tribes, or Tribal Organiza9 tions. The funds allocated to each Indian Tribe, 

10 Tribal Organization, or Service Unit under this 

11 paragraph shall be used by the Indian Tribe, Tribal 

12 Organization, or Service Unit under this paragraph 

13 to improve the health status and reduce the resource 

14 deficiency of each Indian Tribe served by such Serv15 ice Unit, Indian Tribe, or Tribal Organization. 

16 ‘‘(2) APPORTIONMENT OF ALLOCATED

17 FUNDS.—The apportionment of funds allocated to a 

18 Service Unit, Indian Tribe, or Tribal Organization 

19 under paragraph (1) among the health service re20 sponsibilities described in subsection (a)(5) shall be 

21 determined by the Service in consultation with, and 

22 with the active participation of, the affected Indian 

23 Tribes and Tribal Organizations. 


ycherry on PROD1PC64 with BILLS
94 

•HR 1328 IH

1 ‘‘(d) PROVISIONS RELATING TO HEALTH STATUS

2 AND RESOURCE DEFICIENCIES.—For the purposes of this 

3 section, the following definitions apply: 

4 ‘‘(1) DEFINITION.—The term ‘health status 

5 and resource deficiency’ means the extent to 

6 which— 

7 ‘‘(A) the health status objectives set forth 

8 in section 3(2) are not being achieved; and 

9 ‘‘(B) the Indian Tribe or Tribal Organiza10 tion does not have available to it the health re11 sources it needs, taking into account the actual 

12 cost of providing health care services given local 

13 geographic, climatic, rural, or other cir14 cumstances. 

15 ‘‘(2) AVAILABLE RESOURCES.—The health re16 sources available to an Indian Tribe or Tribal Orga17 nization include health resources provided by the 

18 Service as well as health resources used by the In19 dian Tribe or Tribal Organization, including services 

20 and financing systems provided by any Federal pro21 grams, private insurance, and programs of State or 

22 local governments. 

23 ‘‘(3) PROCESS FOR REVIEW OF DETERMINA24 TIONS.—The Secretary shall establish procedures 

25 which allow any Indian Tribe or Tribal Organization 


ycherry on PROD1PC64 with BILLS
95 

•HR 1328 IH

1 to petition the Secretary for a review of any deter2 mination of the extent of the health status and re3 source deficiency of such Indian Tribe or Tribal Or4 ganization. 

5 ‘‘(e) ELIGIBILITY FOR FUNDS.—Tribal Health Pro6 grams shall be eligible for funds appropriated under the 

7 authority of this section on an equal basis with programs 

8 that are administered directly by the Service. 

9 ‘‘(f) REPORT.—By no later than the date that is 3 

10 years after the date of enactment of the Indian Health 

11 Care Improvement Act Amendments of 2007, the Sec12 retary shall submit to Congress the current health status 

13 and resource deficiency report of the Service for each 

14 Service Unit, including newly recognized or acknowledged 

15 Indian Tribes. Such report shall set out— 

16 ‘‘(1) the methodology then in use by the Service 

17 for determining Tribal health status and resource 

18 deficiencies, as well as the most recent application of 

19 that methodology; 

20 ‘‘(2) the extent of the health status and re21 source deficiency of each Indian Tribe served by the 

22 Service or a Tribal Health Program; 

23 ‘‘(3) the amount of funds necessary to eliminate 

24 the health status and resource deficiencies of all InVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
96 

•HR 1328 IH

1 dian Tribes served by the Service or a Tribal Health 

2 Program; and 

3 ‘‘(4) an estimate of— 

4 ‘‘(A) the amount of health service funds 

5 appropriated under the authority of this Act, or 

6 any other Act, including the amount of any 

7 funds transferred to the Service for the pre8 ceding fiscal year which is allocated to each 

9 Service Unit, Indian Tribe, or Tribal Organiza10 tion; 

11 ‘‘(B) the number of Indians eligible for 

12 health services in each Service Unit or Indian 

13 Tribe or Tribal Organization; and 

14 ‘‘(C) the number of Indians using the 

15 Service resources made available to each Service 

16 Unit, Indian Tribe or Tribal Organization, and, 

17 to the extent available, information on the wait18 ing lists and number of Indians turned away for 

19 services due to lack of resources. 

20 ‘‘(g) INCLUSION IN BASE BUDGET.—Funds appro21 priated under this section for any fiscal year shall be in22 cluded in the base budget of the Service for the purpose 

23 of determining appropriations under this section in subse24 quent fiscal years. 


ycherry on PROD1PC64 with BILLS
97 

•HR 1328 IH

1 ‘‘(h) CLARIFICATION.—Nothing in this section is in2 tended to diminish the primary responsibility of the Serv3 ice to eliminate existing backlogs in unmet health care 

4 needs, nor are the provisions of this section intended to 

5 discourage the Service from undertaking additional efforts 

6 to achieve equity among Indian Tribes and Tribal Organi7 zations. 

8 ‘‘(i) FUNDING DESIGNATION.—Any funds appro9 priated under the authority of this section shall be des10 ignated as the ‘Indian Health Care Improvement Fund’. 

11 ‘‘SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. 

12 ‘‘(a) ESTABLISHMENT.—There is established an In13 dian Catastrophic Health Emergency Fund (hereafter in 

14 this section referred to as the ‘CHEF’) consisting of— 

15 ‘‘(1) the amounts deposited under subsection 

16 (f); and 

17 ‘‘(2) the amounts appropriated to CHEF under 

18 this section. 

19 ‘‘(b) ADMINISTRATION.—CHEF shall be adminis20 tered by the Secretary, acting through the headquarters 

21 of the Service, solely for the purpose of meeting the ex22 traordinary medical costs associated with the treatment of 

23 victims of disasters or catastrophic illnesses who are with24 in the responsibility of the Service. 


ycherry on PROD1PC64 with BILLS
98 

•HR 1328 IH

1 ‘‘(c) CONDITIONS ON USE OF FUND.—No part of 

2 CHEF or its administration shall be subject to contract 

3 or grant under any law, including the Indian Self-Deter4 mination and Education Assistance Act (25 U.S.C. 450 

5 et seq.), nor shall CHEF funds be allocated, apportioned, 

6 or delegated on an Area Office, Service Unit, or other 

7 similar basis. 

8 ‘‘(d) REGULATIONS.—The Secretary shall promul9 gate regulations consistent with the provisions of this sec10 tion to— 

11 ‘‘(1) establish a definition of disasters and cata12 strophic illnesses for which the cost of the treatment 

13 provided under contract would qualify for payment 

14 from CHEF; 

15 ‘‘(2) provide that a Service Unit shall not be el16 igible for reimbursement for the cost of treatment 

17 from CHEF until its cost of treating any victim of 

18 such catastrophic illness or disaster has reached a 

19 certain threshold cost which the Secretary shall es20 tablish at— 

21 ‘‘(A) the 2000 level of $19,000; and 

22 ‘‘(B) for any subsequent year, not less 

23 than the threshold cost of the previous year in24 creased by the percentage increase in the med25 ical care expenditure category of the consumer 


ycherry on PROD1PC64 with BILLS
99 

•HR 1328 IH

1 price index for all urban consumers (United 

2 States city average) for the 12-month period 

3 ending with December of the previous year; 

4 ‘‘(3) establish a procedure for the reimburse5 ment of the portion of the costs that exceeds such 

6 threshold cost incurred by— 

7 ‘‘(A) Service Units; or 

8 ‘‘(B) whenever otherwise authorized by the 

9 Service, non-Service facilities or providers; 

10 ‘‘(4) establish a procedure for payment from 

11 CHEF in cases in which the exigencies of the med12 ical circumstances warrant treatment prior to the 

13 authorization of such treatment by the Service; and 

14 ‘‘(5) establish a procedure that will ensure that 

15 no payment shall be made from CHEF to any pro16 vider of treatment to the extent that such provider 

17 is eligible to receive payment for the treatment from 

18 any other Federal, State, local, or private source of 

19 reimbursement for which the patient is eligible. 

20 ‘‘(e) NO OFFSET OR LIMITATION.—Amounts appro21 priated to CHEF under this section shall not be used to 

22 offset or limit appropriations made to the Service under 

23 the authority of the Act of November 2, 1921 (25 U.S.C. 

24 13) (commonly known as the ‘Snyder Act’), or any other 

25 law. 


ycherry on PROD1PC64 with BILLS
100 

•HR 1328 IH

1 ‘‘(f) DEPOSIT OF REIMBURSEMENT FUNDS.—There 

2 shall be deposited into CHEF all reimbursements to which 

3 the Service is entitled from any Federal, State, local, or 

4 private source (including third party insurance) by reason 

5 of treatment rendered to any victim of a disaster or cata6 strophic illness the cost of which was paid from CHEF. 

7 ‘‘SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION 

8 SERVICES. 

9 ‘‘(a) FINDINGS.—Congress finds that health pro10 motion and disease prevention activities— 

11 ‘‘(1) improve the health and well-being of Indi12 ans; and 

13 ‘‘(2) reduce the expenses for health care of In14 dians. 

15 ‘‘(b) PROVISION OF SERVICES.—The Secretary, act16 ing through the Service and Tribal Health Programs, shall 

17 provide health promotion and disease prevention services 

18 to Indians to achieve the health status objectives set forth 

19 in section 3(2). 

20 ‘‘(c) EVALUATION.—The Secretary, after obtaining 

21 input from the affected Tribal Health Programs, shall 

22 submit to the President for inclusion in the report which 

23 is required to be submitted to Congress under section 801 

24 an evaluation of— 


ycherry on PROD1PC64 with BILLS
101 

•HR 1328 IH

1 ‘‘(1) the health promotion and disease preven2 tion needs of Indians; 

3 ‘‘(2) the health promotion and disease preven4 tion activities which would best meet such needs; 

5 ‘‘(3) the internal capacity of the Service and 

6 Tribal Health Programs to meet such needs; and 

7 ‘‘(4) the resources which would be required to 

8 enable the Service and Tribal Health Programs to 

9 undertake the health promotion and disease preven10 tion activities necessary to meet such needs. 

11 ‘‘SEC. 204. DIABETES PREVENTION, TREATMENT, AND CON12 TROL. 

13 ‘‘(a) DETERMINATIONS REGARDING DIABETES.— 

14 The Secretary, acting through the Service, and in con15 sultation with Indian Tribes and Tribal Organizations, 

16 shall determine— 

17 ‘‘(1) by Indian Tribe and by Service Unit, the 

18 incidence of, and the types of complications resulting 

19 from, diabetes among Indians; and 

20 ‘‘(2) based on the determinations made pursu21 ant to paragraph (1), the measures (including pa22 tient education and effective ongoing monitoring of 

23 disease indicators) each Service Unit should take to 

24 reduce the incidence of, and prevent, treat, and conVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00101 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
102 

•HR 1328 IH

1 trol the complications resulting from, diabetes 

2 among Indian Tribes within that Service Unit. 

3 ‘‘(b) DIABETES SCREENING.—To the extent medi4 cally indicated and with informed consent, the Secretary 

5 shall screen each Indian who receives services from the 

6 Service for diabetes and for conditions which indicate a 

7 high risk that the individual will become diabetic and es8 tablish a cost-effective approach to ensure ongoing moni9 toring of disease indicators. Such screening and moni10 toring may be conducted by a Tribal Health Program and 

11 may be conducted through appropriate Internet-based 

12 health care management programs. 

13 ‘‘(c) DIABETES PROJECTS.—The Secretary shall con14 tinue to maintain each model diabetes project in existence 

15 on the date of enactment of the Indian Health Care Im16 provement Act Amendments of 2007, any such other dia17 betes programs operated by the Service or Tribal Health 

18 Programs, and any additional diabetes projects, such as 

19 the Medical Vanguard program provided for in title IV 

20 of Public Law 108–87, as implemented to serve Indian 

21 Tribes. Tribal Health Programs shall receive recurring 

22 funding for the diabetes projects that they operate pursu23 ant to this section, both at the date of enactment of the 

24 Indian Health Care Improvement Act Amendments of 


ycherry on PROD1PC64 with BILLS
103 

•HR 1328 IH

1 2007 and for projects which are added and funded there2 after. 

3 ‘‘(d) DIALYSIS PROGRAMS.—The Secretary is author4 ized to provide, through the Service, Indian Tribes, and 

5 Tribal Organizations, dialysis programs, including the 

6 purchase of dialysis equipment and the provision of nec7 essary staffing. 

8 ‘‘(e) OTHER DUTIES OF THE SECRETARY.— 

9 ‘‘(1) IN GENERAL.—The Secretary shall, to the 

10 extent funding is available— 

11 ‘‘(A) in each Area Office, consult with In12 dian Tribes and Tribal Organizations regarding 

13 programs for the prevention, treatment, and 

14 control of diabetes; 

15 ‘‘(B) establish in each Area Office a reg16 istry of patients with diabetes to track the inci17 dence of diabetes and the complications from 

18 diabetes in that area; and 

19 ‘‘(C) ensure that data collected in each 

20 Area Office regarding diabetes and related com21 plications among Indians are disseminated to 

22 all other Area Offices, subject to applicable pa23 tient privacy laws. 

24 ‘‘(2) DIABETES CONTROL OFFICERS.— 


ycherry on PROD1PC64 with BILLS
104 

•HR 1328 IH

1 ‘‘(A) IN GENERAL.—The Secretary may es2 tablish and maintain in each Area Office a posi3 tion of diabetes control officer to coordinate and 

4 manage any activity of that Area Office relating 

5 to the prevention, treatment, or control of dia6 betes to assist the Secretary in carrying out a 

7 program under this section or section 330C of 

8 the Public Health Service Act (42 U.S.C. 254c– 

9 3). 

10 ‘‘(B) CERTAIN ACTIVITIES.—Any activity 

11 carried out by a diabetes control officer under 

12 subparagraph (A) that is the subject of a con13 tract or compact under the Indian Self-Deter14 mination and Education Assistance Act (25 

15 U.S.C. 450 et seq.), and any funds made avail16 able to carry out such an activity, shall not be 

17 divisible for purposes of that Act. 

18 ‘‘SEC. 205. SHARED SERVICES FOR LONG-TERM CARE. 

19 ‘‘(a) LONG-TERM CARE.—Notwithstanding any other 

20 provision of law, the Secretary, acting through the Service, 

21 is authorized to provide directly, or enter into contracts 

22 or compacts under the Indian Self-Determination and 

23 Education Assistance Act (25 U.S.C. 450 et seq.) with 

24 Indian Tribes or Tribal Organizations for, the delivery of 

25 long-term care (including health care services associated 


ycherry on PROD1PC64 with BILLS
105 

•HR 1328 IH

1 with long-term care) provided in a facility to Indians. Such 

2 agreements shall provide for the sharing of staff or other 

3 services between the Service or a Tribal Health Program 

4 and a long-term care or related facility owned and oper5 ated (directly or through a contract or compact under the 

6 Indian Self-Determination and Education Assistance Act 

7 (25 U.S.C. 450 et seq.)) by such Indian Tribe or Tribal 

8 Organization. 

9 ‘‘(b) CONTENTS OF AGREEMENTS.—An agreement 

10 entered into pursuant to subsection (a)— 

11 ‘‘(1) may, at the request of the Indian Tribe or 

12 Tribal Organization, delegate to such Indian Tribe 

13 or Tribal Organization such powers of supervision 

14 and control over Service employees as the Secretary 

15 deems necessary to carry out the purposes of this 

16 section; 

17 ‘‘(2) shall provide that expenses (including sala18 ries) relating to services that are shared between the 

19 Service and the Tribal Health Program be allocated 

20 proportionately between the Service and the Indian 

21 Tribe or Tribal Organization; and 

22 ‘‘(3) may authorize such Indian Tribe or Tribal 

23 Organization to construct, renovate, or expand a 

24 long-term care or other similar facility (including the 


ycherry on PROD1PC64 with BILLS
106 

•HR 1328 IH

1 construction of a facility attached to a Service facil2 ity). 

3 ‘‘(c) MINIMUM REQUIREMENT.—Any nursing facility 

4 provided for under this section shall meet the require5 ments for nursing facilities under section 1919 of the So6 cial Security Act. 

7 ‘‘(d) OTHER ASSISTANCE.—The Secretary shall pro8 vide such technical and other assistance as may be nec9 essary to enable applicants to comply with the provisions 

10 of this section. 

11 ‘‘(e) USE OF EXISTING OR UNDERUSED FACILI12 TIES.—The Secretary shall encourage the use of existing 

13 facilities that are underused or allow the use of swing beds 

14 for long-term or similar care. 

15 ‘‘SEC. 206. HEALTH SERVICES RESEARCH. 

16 ‘‘(a) IN GENERAL.—The Secretary, acting through 

17 the Service, shall make funding available for research to 

18 further the performance of the health service responsibil19 ities of Indian Health Programs. 

20 ‘‘(b) COORDINATION OF RESOURCES AND ACTIVI21 TIES.—The Secretary shall also, to the maximum extent 

22 practicable, coordinate departmental research resources 

23 and activities to address relevant Indian Health Program 

24 research needs. 


ycherry on PROD1PC64 with BILLS
107 

•HR 1328 IH

1 ‘‘(c) AVAILABILITY.—Tribal Health Programs shall 

2 be given an equal opportunity to compete for, and receive, 

3 research funds under this section. 

4 ‘‘(d) USE OF FUNDS.—This funding may be used for 

5 both clinical and nonclinical research. 

6 ‘‘(e) EVALUATION AND DISSEMINATION.—The Sec7 retary shall periodically— 

8 ‘‘(1) evaluate the impact of research conducted 

9 under this section; and 

10 ‘‘(2) disseminate to Tribal Health Programs in11 formation regarding that research as the Secretary 

12 determines to be appropriate. 

13 ‘‘SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREEN14 ING. 

15 ‘‘The Secretary, acting through the Service or Tribal 

16 Health Programs, shall provide for screening as follows: 

17 ‘‘(1) Screening mammography (as defined in 

18 section 1861(jj) of the Social Security Act) for In19 dian women at a frequency appropriate to such 

20 women under accepted and appropriate national 

21 standards, and under such terms and conditions as 

22 are consistent with standards established by the Sec23 retary to ensure the safety and accuracy of screen24 ing mammography under part B of title XVIII of 

25 such Act. 


ycherry on PROD1PC64 with BILLS
108 

•HR 1328 IH

1 ‘‘(2) Other cancer screening that receives an A 

2 or B rating as recommended by the United States 

3 Preventive Services Task Force established under 

4 section 915(a)(1) of the Public Health Service Act 

5 (42 U.S.C. 299b–4(a)(1)). The Secretary shall en6 sure that screening provided for under this para7 graph complies with the recommendations of the 

8 Task Force with respect to— 

9 ‘‘(A) frequency; 

10 ‘‘(B) the population to be served; 

11 ‘‘(C) the procedure or technology to be 

12 used; 

13 ‘‘(D) evidence of effectiveness; and 

14 ‘‘(E) other matters that the Secretary de15 termines appropriate. 

16 ‘‘SEC. 208. PATIENT TRAVEL COSTS. 

17 ‘‘(a) DEFINITION OF QUALIFIED ESCORT.—In this 

18 section, the term ‘qualified escort’ means— 

19 ‘‘(1) an adult escort (including a parent, guard20 ian, or other family member) who is required be21 cause of the physical or mental condition, or age, of 

22 the applicable patient; 

23 ‘‘(2) a health professional for the purpose of 

24 providing necessary medical care during travel by 

25 the applicable patient; or 


ycherry on PROD1PC64 with BILLS
109 

•HR 1328 IH

1 ‘‘(3) other escorts, as the Secretary or applica2 ble Indian Health Program determines to be appro3 priate. 

4 ‘‘(b) PROVISION OF FUNDS.—The Secretary, acting 

5 through the Service and Tribal Health Programs, is au6 thorized to provide funds for the following patient travel 

7 costs, including qualified escorts, associated with receiving 

8 health care services provided (either through direct or con9 tract care or through a contract or compact under the In10 dian Self-Determination and Education Assistance Act 

11 (25 U.S.C. 450 et seq.)) under this Act— 

12 ‘‘(1) emergency air transportation and non13 emergency air transportation where ground trans14 portation is infeasible; 

15 ‘‘(2) transportation by private vehicle (where no 

16 other means of transportation is available), specially 

17 equipped vehicle, and ambulance; and 

18 ‘‘(3) transportation by such other means as 

19 may be available and required when air or motor ve20 hicle transportation is not available. 

21 ‘‘SEC. 209. EPIDEMIOLOGY CENTERS. 

22 ‘‘(a) ADDITIONAL CENTERS.—In addition to those 

23 epidemiology centers already established as of the date of 

24 enactment of the Indian Health Care Improvement Act 

25 Amendments of 2007, and without reducing the funding 


ycherry on PROD1PC64 with BILLS
110 

•HR 1328 IH

1 levels for such centers, not later than 180 days after the 

2 date of enactment of the Indian Health Care Improvement 

3 Act Amendments of 2007, the Secretary, acting through 

4 the Service, shall establish an epidemiology center in each 

5 Service Area which does not yet have one to carry out the 

6 functions described in subsection (b). Any new centers so 

7 established may be operated by Tribal Health Programs, 

8 but such funding shall not be divisible. 

9 ‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 

10 and upon the request of Indian Tribes, Tribal Organiza11 tions, and Urban Indian Organizations, each Service Area 

12 epidemiology center established under this subsection 

13 shall, with respect to such Service Area— 

14 ‘‘(1) collect data relating to, and monitor 

15 progress made toward meeting, each of the health 

16 status objectives of the Service, the Indian Tribes, 

17 Tribal Organizations, and Urban Indian Organiza18 tions in the Service Area; 

19 ‘‘(2) evaluate existing delivery systems, data 

20 systems, and other systems that impact the improve21 ment of Indian health; 

22 ‘‘(3) assist Indian Tribes, Tribal Organizations, 

23 and Urban Indian Organizations in identifying their 

24 highest priority health status objectives and the 


ycherry on PROD1PC64 with BILLS
111 

•HR 1328 IH

1 services needed to achieve such objectives, based on 

2 epidemiological data; 

3 ‘‘(4) make recommendations for the targeting 

4 of services needed by the populations served; 

5 ‘‘(5) make recommendations to improve health 

6 care delivery systems for Indians and Urban Indi7 ans; 

8 ‘‘(6) provide requested technical assistance to 

9 Indian Tribes, Tribal Organizations, and Urban In10 dian Organizations in the development of local 

11 health service priorities and incidence and prevalence 

12 rates of disease and other illness in the community; 

13 and 

14 ‘‘(7) provide disease surveillance and assist In15 dian Tribes, Tribal Organizations, and Urban Indian 

16 Organizations to promote public health. 

17 ‘‘(c) TECHNICAL ASSISTANCE.—The Director of the 

18 Centers for Disease Control and Prevention shall provide 

19 technical assistance to the centers in carrying out the re20 quirements of this subsection. 

21 ‘‘(d) GRANTS FOR STUDIES.—The Secretary may 

22 make grants to Indian Tribes, Tribal Organizations, and 

23 Urban Indian Organizations to conduct epidemiological 

24 studies of Indian communities. 


ycherry on PROD1PC64 with BILLS
112 

•HR 1328 IH

1 ‘‘(e) ACCESS TO INFORMATION.—Epidemiology cen2 ters operated by Indian tribes, tribal organizations, and 

3 inter-tribal consortia pursuant to grants awarded under 

4 section (d) shall be treated as public health authorities for 

5 purposes of the Health Insurance Portability and Account6 ability Act of 1996, as such entities are defined in part 

7 164.501 of title 45, Code of Federal Regulations. The Sec8 retary shall grant such epidemiology centers access to and 

9 use of data, data sets, monitoring systems, delivery sys10 tems, and other protected health information in the pos11 session of the Secretary. 

12 ‘‘SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION 

13 PROGRAMS. 

14 ‘‘(a) FUNDING FOR DEVELOPMENT OF PROGRAMS.— 

15 In addition to carrying out any other program for health 

16 promotion or disease prevention, the Secretary, acting 

17 through the Service, is authorized to award grants to In18 dian Tribes, Tribal Organizations, and Urban Indian Or19 ganizations to develop comprehensive school health edu20 cation programs for children from pre-school through 

21 grade 12 in schools for the benefit of Indian and Urban 

22 Indian children. 

23 ‘‘(b) USE OF GRANT FUNDS.—A grant awarded 

24 under this section may be used for purposes which may 

25 include, but are not limited to, the following: 


ycherry on PROD1PC64 with BILLS
113 

•HR 1328 IH

1 ‘‘(1) Developing health education materials both 

2 for regular school programs and afterschool pro3 grams. 

4 ‘‘(2) Training teachers in comprehensive school 

5 health education materials. 

6 ‘‘(3) Integrating school-based, community7 based, and other public and private health promotion 

8 efforts. 

9 ‘‘(4) Encouraging healthy, tobacco-free school 

10 environments. 

11 ‘‘(5) Coordinating school-based health programs 

12 with existing services and programs available in the 

13 community. 

14 ‘‘(6) Developing school programs on nutrition 

15 education, personal health, oral health, and fitness. 

16 ‘‘(7) Developing behavioral health wellness pro17 grams. 

18 ‘‘(8) Developing chronic disease prevention pro19 grams. 

20 ‘‘(9) Developing substance abuse prevention 

21 programs. 

22 ‘‘(10) Developing injury prevention and safety 

23 education programs. 

24 ‘‘(11) Developing activities for the prevention 

25 and control of communicable diseases. 


ycherry on PROD1PC64 with BILLS
114 

•HR 1328 IH

1 ‘‘(12) Developing community and environmental 

2 health education programs that include traditional 

3 health care practitioners. 

4 ‘‘(13) Violence prevention. 

5 ‘‘(14) Such other health issues as are appro6 priate. 

7 ‘‘(c) TECHNICAL ASSISTANCE.—Upon request, the 

8 Secretary, acting through the Service, shall provide tech9 nical assistance to Indian Tribes, Tribal Organizations, 

10 and Urban Indian Organizations in the development of 

11 comprehensive health education plans and the dissemina12 tion of comprehensive health education materials and in13 formation on existing health programs and resources. 

14 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP15 PLICATIONS.—The Secretary, acting through the Service, 

16 and in consultation with Indian Tribes, Tribal Organiza17 tions, and Urban Indian Organizations, shall establish cri18 teria for the review and approval of applications for grants 

19 awarded under this section. 

20 ‘‘(e) DEVELOPMENT OF PROGRAM FOR BIA-FUNDED

21 SCHOOLS.— 

22 ‘‘(1) IN GENERAL.—The Secretary of the Inte23 rior, acting through the Bureau of Indian Affairs 

24 and in cooperation with the Secretary, acting 

25 through the Service, and affected Indian Tribes and 


ycherry on PROD1PC64 with BILLS
115 

•HR 1328 IH

1 Tribal Organizations, shall develop a comprehensive 

2 school health education program for children from 

3 preschool through grade 12 in schools for which sup4 port is provided by the Bureau of Indian Affairs. 

5 ‘‘(2) REQUIREMENTS FOR PROGRAMS.—Such 

6 programs shall include— 

7 ‘‘(A) school programs on nutrition edu8 cation, personal health, oral health, and fitness; 

9 ‘‘(B) behavioral health wellness programs; 

10 ‘‘(C) chronic disease prevention programs; 

11 ‘‘(D) substance abuse prevention pro12 grams; 

13 ‘‘(E) injury prevention and safety edu14 cation programs; and 

15 ‘‘(F) activities for the prevention and con16 trol of communicable diseases. 

17 ‘‘(3) DUTIES OF THE SECRETARY.—The Sec18 retary of the Interior shall— 

19 ‘‘(A) provide training to teachers in com20 prehensive school health education materials; 

21 ‘‘(B) ensure the integration and coordina22 tion of school-based programs with existing 

23 services and health programs available in the 

24 community; and 


ycherry on PROD1PC64 with BILLS
116 

•HR 1328 IH

1 ‘‘(C) encourage healthy, tobacco-free school 

2 environments. 

3 ‘‘SEC. 211. INDIAN YOUTH PROGRAM. 

4 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 

5 through the Service, is authorized to establish and admin6 ister a program to provide grants to Indian Tribes, Tribal 

7 Organizations, and Urban Indian Organizations for inno8 vative mental and physical disease prevention and health 

9 promotion and treatment programs for Indian and Urban 

10 Indian preadolescent and adolescent youths. 

11 ‘‘(b) USE OF FUNDS.— 

12 ‘‘(1) ALLOWABLE USES.—Funds made available 

13 under this section may be used to— 

14 ‘‘(A) develop prevention and treatment 

15 programs for Indian youth which promote men16 tal and physical health and incorporate cultural 

17 values, community and family involvement, and 

18 traditional health care practitioners; and 

19 ‘‘(B) develop and provide community train20 ing and education. 

21 ‘‘(2) PROHIBITED USE.—Funds made available 

22 under this section may not be used to provide serv23 ices described in section 707(c). 

24 ‘‘(c) DUTIES OF THE SECRETARY.—The Secretary 

25 shall— 


ycherry on PROD1PC64 with BILLS
117 

•HR 1328 IH

1 ‘‘(1) disseminate to Indian Tribes, Tribal Orga2 nizations, and Urban Indian Organizations informa3 tion regarding models for the delivery of comprehen4 sive health care services to Indian and Urban Indian 

5 adolescents; 

6 ‘‘(2) encourage the implementation of such 

7 models; and 

8 ‘‘(3) at the request of an Indian Tribe, Tribal 

9 Organization, or Urban Indian Organization, provide 

10 technical assistance in the implementation of such 

11 models. 

12 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP13 PLICATIONS.—The Secretary, in consultation with Indian 

14 Tribes, Tribal Organizations, and Urban Indian Organiza15 tions, shall establish criteria for the review and approval 

16 of applications or proposals under this section. 

17 ‘‘SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF 

18 COMMUNICABLE AND INFECTIOUS DISEASES. 

19 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 

20 through the Service, and after consultation with the Cen21 ters for Disease Control and Prevention, may make grants 

22 available to Indian Tribes, Tribal Organizations, and 

23 Urban Indian Organizations for the following: 

24 ‘‘(1) Projects for the prevention, control, and 

25 elimination of communicable and infectious diseases, 


ycherry on PROD1PC64 with BILLS
118 

•HR 1328 IH

1 including tuberculosis, hepatitis, HIV, respiratory 

2 syncytial virus, hanta virus, sexually transmitted dis3 eases, and H. Pylori. 

4 ‘‘(2) Public information and education pro5 grams for the prevention, control, and elimination of 

6 communicable and infectious diseases. 

7 ‘‘(3) Education, training, and clinical skills im8 provement activities in the prevention, control, and 

9 elimination of communicable and infectious diseases 

10 for health professionals, including allied health pro11 fessionals. 

12 ‘‘(4) Demonstration projects for the screening, 

13 treatment, and prevention of hepatitis C virus 

14 (HCV). 

15 ‘‘(b) APPLICATION REQUIRED.—The Secretary may 

16 provide funding under subsection (a) only if an application 

17 or proposal for funding is submitted to the Secretary. 

18 ‘‘(c) COORDINATION WITH HEALTH AGENCIES.—In19 dian Tribes, Tribal Organizations, and Urban Indian Or20 ganizations receiving funding under this section are en21 couraged to coordinate their activities with the Centers for 

22 Disease Control and Prevention and State and local health 

23 agencies. 

24 ‘‘(d) TECHNICAL ASSISTANCE; REPORT.—In carrying 

25 out this section, the Secretary— 


ycherry on PROD1PC64 with BILLS
119 

•HR 1328 IH

1 ‘‘(1) may, at the request of an Indian Tribe, 

2 Tribal Organization, or Urban Indian Organization, 

3 provide technical assistance; and 

4 ‘‘(2) shall prepare and submit a report to Con5 gress biennially on the use of funds under this sec6 tion and on the progress made toward the preven7 tion, control, and elimination of communicable and 

8 infectious diseases among Indians and Urban Indi9 ans. 

10 ‘‘SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERV11 ICES. 

12 ‘‘(a) FUNDING AUTHORIZED.—The Secretary, acting 

13 through the Service, Indian Tribes, and Tribal Organiza14 tions, may provide funding under this Act to meet the ob15 jectives set forth in section 3 through health care-related 

16 services and programs not otherwise described in this Act, 

17 including— 

18 ‘‘(1) hospice care; 

19 ‘‘(2) assisted living; 

20 ‘‘(3) long-term care; and 

21 ‘‘(4) home- and community-based services. 

22 ‘‘(b) TERMS AND CONDITIONS.— 

23 ‘‘(1) IN GENERAL.—Any service provided under 

24 this section shall be in accordance with such terms 

25 and conditions as are consistent with accepted and 


ycherry on PROD1PC64 with BILLS
120 

•HR 1328 IH

1 appropriate standards relating to the service, includ2 ing any licensing term or condition under this Act. 

3 ‘‘(2) STANDARDS.— 

4 ‘‘(A) IN GENERAL.—The Secretary may es5 tablish, by regulation, the standards for a serv6 ice provided under this section, provided that 

7 such standards shall not be more stringent than 

8 the standards required by the State in which 

9 the service is provided. 

10 ‘‘(B) USE OF STATE STANDARDS.—If the 

11 Secretary does not, by regulation, establish 

12 standards for a service provided under this sec13 tion, the standards required by the State in 

14 which the service is or will be provided shall 

15 apply to such service. 

16 ‘‘(C) INDIAN TRIBES.—If a service under 

17 this section is provided by an Indian Tribe or 

18 Tribal Organization pursuant to the Indian 

19 Self-Determination and Education Assistance 

20 Act (25 U.S.C. 450 et seq.), the verification by 

21 the Secretary that the service meets any stand22 ards required by the State in which the service 

23 is or will be provided shall be considered to 

24 meet the terms and conditions required under 

25 this subsection. 


ycherry on PROD1PC64 with BILLS
121 

•HR 1328 IH

1 ‘‘(3) ELIGIBILITY.—The following individuals 

2 shall be eligible to receive long-term care under this 

3 section: 

4 ‘‘(A) Individuals who are unable to per5 form a certain number of activities of daily liv6 ing without assistance. 

7 ‘‘(B) Individuals with a mental impair8 ment, such as dementia, Alzheimer’s disease, or 

9 another disabling mental illness, who may be 

10 able to perform activities of daily living under 

11 supervision. 

12 ‘‘(C) Such other individuals as an applica13 ble Indian Health Program determines to be 

14 appropriate. 

15 ‘‘(c) DEFINITIONS.—For the purposes of this section, 

16 the following definitions shall apply: 

17 ‘‘(1) The term ‘home- and community-based 

18 services’ means 1 or more of the services specified 

19 in paragraphs (1) through (9) of section 1929(a) of 

20 the Social Security Act (42 U.S.C. 1396t(a)) 

21 (whether provided by the Service or by an Indian 

22 Tribe or Tribal Organization pursuant to the Indian 

23 Self-Determination and Education Assistance Act 

24 (25 U.S.C. 450 et seq.)) that are or will be provided 


ycherry on PROD1PC64 with BILLS
122 

•HR 1328 IH

1 in accordance with the standards described in sub2 section (b). 

3 ‘‘(2) The term ‘hospice care’ means the items 

4 and services specified in subparagraphs (A) through 

5 (H) of section 1861(dd)(1) of the Social Security 

6 Act (42 U.S.C. 1395x(dd)(1)), and such other serv7 ices which an Indian Tribe or Tribal Organization 

8 determines are necessary and appropriate to provide 

9 in furtherance of this care. 

10 ‘‘SEC. 214. INDIAN WOMEN’S HEALTH CARE. 

11 ‘‘The Secretary, acting through the Service and In12 dian Tribes, Tribal Organizations, and Urban Indian Or13 ganizations, shall monitor and improve the quality of 

14 health care for Indian women of all ages through the plan15 ning and delivery of programs administered by the Service, 

16 in order to improve and enhance the treatment models of 

17 care for Indian women. 

18 ‘‘SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZ19 ARDS. 

20 ‘‘(a) STUDIES AND MONITORING.—The Secretary 

21 and the Service shall conduct, in conjunction with other 

22 appropriate Federal agencies and in consultation with con23 cerned Indian Tribes and Tribal Organizations, studies 

24 and ongoing monitoring programs to determine trends in 

25 the health hazards to Indian miners and to Indians on 


ycherry on PROD1PC64 with BILLS
123 

•HR 1328 IH

1 or near reservations and Indian communities as a result 

2 of environmental hazards which may result in chronic or 

3 life threatening health problems, such as nuclear resource 

4 development, petroleum contamination, and contamination 

5 of water source and of the food chain. Such studies shall 

6 include— 

7 ‘‘(1) an evaluation of the nature and extent of 

8 health problems caused by environmental hazards 

9 currently exhibited among Indians and the causes of 

10 such health problems; 

11 ‘‘(2) an analysis of the potential effect of ongo12 ing and future environmental resource development 

13 on or near reservations and Indian communities, in14 cluding the cumulative effect over time on health; 

15 ‘‘(3) an evaluation of the types and nature of 

16 activities, practices, and conditions causing or affect17 ing such health problems, including uranium mining 

18 and milling, uranium mine tailing deposits, nuclear 

19 power plant operation and construction, and nuclear 

20 waste disposal; oil and gas production or transpor21 tation on or near reservations or Indian commu22 nities; and other development that could affect the 

23 health of Indians and their water supply and food 

24 chain; 


ycherry on PROD1PC64 with BILLS
124 

•HR 1328 IH

1 ‘‘(4) a summary of any findings and rec2 ommendations provided in Federal and State stud3 ies, reports, investigations, and inspections during 

4 the 5 years prior to the date of enactment of the In5 dian Health Care Improvement Act Amendments of 

6 2007 that directly or indirectly relate to the activi7 ties, practices, and conditions affecting the health or 

8 safety of such Indians; and 

9 ‘‘(5) the efforts that have been made by Federal 

10 and State agencies and resource and economic devel11 opment companies to effectively carry out an edu12 cation program for such Indians regarding the 

13 health and safety hazards of such development. 

14 ‘‘(b) HEALTH CARE PLANS.—Upon completion of 

15 such studies, the Secretary and the Service shall take into 

16 account the results of such studies and develop health care 

17 plans to address the health problems studied under sub18 section (a). The plans shall include— 

19 ‘‘(1) methods for diagnosing and treating Indi20 ans currently exhibiting such health problems; 

21 ‘‘(2) preventive care and testing for Indians 

22 who may be exposed to such health hazards, includ23 ing the monitoring of the health of individuals who 

24 have or may have been exposed to excessive amounts 

25 of radiation or affected by other activities that have 


ycherry on PROD1PC64 with BILLS
125 

•HR 1328 IH

1 had or could have a serious impact upon the health 

2 of such individuals; and 

3 ‘‘(3) a program of education for Indians who, 

4 by reason of their work or geographic proximity to 

5 such nuclear or other development activities, may ex6 perience health problems. 

7 ‘‘(c) SUBMISSION OF REPORT AND PLAN TO CON8 GRESS.—The Secretary and the Service shall submit to 

9 Congress the study prepared under subsection (a) no later 

10 than 18 months after the date of enactment of the Indian 

11 Health Care Improvement Act Amendments of 2007. The 

12 health care plan prepared under subsection (b) shall be 

13 submitted in a report no later than 1 year after the study 

14 prepared under subsection (a) is submitted to Congress. 

15 Such report shall include recommended activities for the 

16 implementation of the plan, as well as an evaluation of 

17 any activities previously undertaken by the Service to ad18 dress such health problems. 

19 ‘‘(d) INTERGOVERNMENTAL TASK FORCE.— 

20 ‘‘(1) ESTABLISHMENT; MEMBERS.—There is es21 tablished an Intergovernmental Task Force to be 

22 composed of the following individuals (or their des23 ignees): 

24 ‘‘(A) The Secretary of Energy. 


ycherry on PROD1PC64 with BILLS
126 

•HR 1328 IH

1 ‘‘(B) The Secretary of the Environmental 

2 Protection Agency. 

3 ‘‘(C) The Director of the Bureau of Mines. 

4 ‘‘(D) The Assistant Secretary for Occupa5 tional Safety and Health. 

6 ‘‘(E) The Secretary of the Interior. 

7 ‘‘(F) The Secretary of Health and Human 

8 Services. 

9 ‘‘(G) The Director of the Indian Health 

10 Service. 

11 ‘‘(2) DUTIES.—The Task Force shall— 

12 ‘‘(A) identify existing and potential oper13 ations related to nuclear resource development 

14 or other environmental hazards that affect or 

15 may affect the health of Indians on or near a 

16 reservation or in an Indian community; and 

17 ‘‘(B) enter into activities to correct exist18 ing health hazards and ensure that current and 

19 future health problems resulting from nuclear 

20 resource or other development activities are 

21 minimized or reduced. 

22 ‘‘(3) CHAIRMAN; MEETINGS.—The Secretary of 

23 Health and Human Services shall be the Chairman 

24 of the Task Force. The Task Force shall meet at 

25 least twice each year. 


ycherry on PROD1PC64 with BILLS
127 

•HR 1328 IH

1 ‘‘(e) HEALTH SERVICES TO CERTAIN EMPLOYEES.— 

2 In the case of any Indian who— 

3 ‘‘(1) as a result of employment in or near a 

4 uranium mine or mill or near any other environ5 mental hazard, suffers from a work-related illness or 

6 condition; 

7 ‘‘(2) is eligible to receive diagnosis and treat8 ment services from an Indian Health Program; and 

9 ‘‘(3) by reason of such Indian’s employment, is 

10 entitled to medical care at the expense of such mine 

11 or mill operator or entity responsible for the environ12 mental hazard, the Indian Health Program shall, at 

13 the request of such Indian, render appropriate med14 ical care to such Indian for such illness or condition 

15 and may be reimbursed for any medical care so ren16 dered to which such Indian is entitled at the expense 

17 of such operator or entity from such operator or en18 tity. Nothing in this subsection shall affect the 

19 rights of such Indian to recover damages other than 

20 such amounts paid to the Indian Health Program 

21 from the employer for providing medical care for 

22 such illness or condition. 


ycherry on PROD1PC64 with BILLS
128 

•HR 1328 IH

1 ‘‘SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DE2 LIVERY AREA. 

3 ‘‘(a) IN GENERAL.—For fiscal years beginning with 

4 the fiscal year ending September 30, 1983, and ending 

5 with the fiscal year ending September 30, 2016, the State 

6 of Arizona shall be designated as a contract health service 

7 delivery area by the Service for the purpose of providing 

8 contract health care services to members of federally rec9 ognized Indian Tribes of Arizona. 

10 ‘‘(b) MAINTENANCE OF SERVICES.—The Service 

11 shall not curtail any health care services provided to Indi12 ans residing on reservations in the State of Arizona if such 

13 curtailment is due to the provision of contract services in 

14 such State pursuant to the designation of such State as 

15 a contract health service delivery area pursuant to sub16 section (a). 

17 ‘‘SEC. 216A. NORTH DAKOTA AND SOUTH DAKOTA AS CON18 TRACT HEALTH SERVICE DELIVERY AREA. 

19 ‘‘(a) IN GENERAL.—Beginning in fiscal year 2003, 

20 the States of North Dakota and South Dakota shall be 

21 designated as a contract health service delivery area by 

22 the Service for the purpose of providing contract health 

23 care services to members of federally recognized Indian 

24 Tribes of North Dakota and South Dakota. 

25 ‘‘(b) LIMITATION.—The Service shall not curtail any 

26 health care services provided to Indians residing on any 


ycherry on PROD1PC64 with BILLS
129 

•HR 1328 IH

1 reservation, or in any county that has a common boundary 

2 with any reservation, in the State of North Dakota or 

3 South Dakota if such curtailment is due to the provision 

4 of contract services in such States pursuant to the des5 ignation of such States as a contract health service deliv6 ery area pursuant to subsection (a). 

7 ‘‘SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES PRO8 GRAM. 

9 ‘‘(a) FUNDING AUTHORIZED.—The Secretary is au10 thorized to fund a program using the California Rural In11 dian Health Board (hereafter in this section referred to 

12 as the ‘CRIHB’) as a contract care intermediary to im13 prove the accessibility of health services to California Indi14 ans. 

15 ‘‘(b) REIMBURSEMENT CONTRACT.—The Secretary 

16 shall enter into an agreement with the CRIHB to reim17 burse the CRIHB for costs (including reasonable adminis18 trative costs) incurred pursuant to this section, in pro19 viding medical treatment under contract to California In20 dians described in section 806(a) throughout the Cali21 fornia contract health services delivery area described in 

22 section 218 with respect to high cost contract care cases. 

23 ‘‘(c) ADMINISTRATIVE EXPENSES.—Not more than 5 

24 percent of the amounts provided to the CRIHB under this 

25 section for any fiscal year may be for reimbursement for 


ycherry on PROD1PC64 with BILLS
130 

•HR 1328 IH

1 administrative expenses incurred by the CRIHB during 

2 such fiscal year. 

3 ‘‘(d) LIMITATION ON PAYMENT.—No payment may 

4 be made for treatment provided hereunder to the extent 

5 payment may be made for such treatment under the In6 dian Catastrophic Health Emergency Fund described in 

7 section 202 or from amounts appropriated or otherwise 

8 made available to the California contract health service de9 livery area for a fiscal year. 

10 ‘‘(e) ADVISORY BOARD.—There is established an ad11 visory board which shall advise the CRIHB in carrying 

12 out this section. The advisory board shall be composed of 

13 representatives, selected by the CRIHB, from not less 

14 than 8 Tribal Health Programs serving California Indians 

covered under this section at least 1 15 ⁄2 of whom of whom 

16 are not affiliated with the CRIHB. 

17 ‘‘SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE 

18 DELIVERY AREA. 

19 ‘‘The State of California, excluding the counties of 

20 Alameda, Contra Costa, Los Angeles, Marin, Orange, Sac21 ramento, San Francisco, San Mateo, Santa Clara, Kern, 

22 Merced, Monterey, Napa, San Benito, San Joaquin, San 

23 Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ven24 tura, shall be designated as a contract health service deliv25 ery area by the Service for the purpose of providing conVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00130 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
131 

•HR 1328 IH

1 tract health services to California Indians. However, any 

2 of the counties listed herein may only be included in the 

3 contract health services delivery area if funding is specifi4 cally provided by the Service for such services in those 

5 counties. 

6 ‘‘SEC. 219. CONTRACT HEALTH SERVICES FOR THE TREN7 TON SERVICE AREA. 

8 ‘‘(a) AUTHORIZATION FOR SERVICES.—The Sec9 retary, acting through the Service, is directed to provide 

10 contract health services to members of the Turtle Moun11 tain Band of Chippewa Indians that reside in the Trenton 

12 Service Area of Divide, McKenzie, and Williams counties 

13 in the State of North Dakota and the adjoining counties 

14 of Richland, Roosevelt, and Sheridan in the State of Mon15 tana. 

16 ‘‘(b) NO EXPANSION OF ELIGIBILITY.—Nothing in 

17 this section may be construed as expanding the eligibility 

18 of members of the Turtle Mountain Band of Chippewa In19 dians for health services provided by the Service beyond 

20 the scope of eligibility for such health services that applied 

21 on May 1, 1986. 

22 ‘‘SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND 

23 TRIBAL ORGANIZATIONS. 

24 ‘‘The Service shall provide funds for health care pro25 grams and facilities operated by Tribal Health Programs 


ycherry on PROD1PC64 with BILLS
132 

•HR 1328 IH

1 on the same basis as such funds are provided to programs 

2 and facilities operated directly by the Service. 

3 ‘‘SEC. 221. LICENSING. 

4 ‘‘Health care professionals employed by a Tribal 

5 Health Program shall, if licensed in any State, be exempt 

6 from the licensing requirements of the State in which the 

7 Tribal Health Program performs the services described in 

8 its contract or compact under the Indian Self-Determina9 tion and Education Assistance Act (25 U.S.C. 450 et 

10 seq.). 

11 ‘‘SEC. 222. NOTIFICATION OF PROVISION OF EMERGENCY 

12 CONTRACT HEALTH SERVICES. 

13 ‘‘With respect to an elderly Indian or an Indian with 

14 a disability receiving emergency medical care or services 

15 from a non-Service provider or in a non-Service facility 

16 under the authority of this Act, the time limitation (as 

17 a condition of payment) for notifying the Service of such 

18 treatment or admission shall be 30 days. 

19 ‘‘SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS. 

20 ‘‘(a) DEADLINE FOR RESPONSE.—The Service shall 

21 respond to a notification of a claim by a provider of a 

22 contract care service with either an individual purchase 

23 order or a denial of the claim within 5 working days after 

24 the receipt of such notification. 


ycherry on PROD1PC64 with BILLS
133 

•HR 1328 IH

1 ‘‘(b) EFFECT OF UNTIMELY RESPONSE.—If the 

2 Service fails to respond to a notification of a claim in ac3 cordance with subsection (a), the Service shall accept as 

4 valid the claim submitted by the provider of a contract 

5 care service. 

6 ‘‘(c) DEADLINE FOR PAYMENT OF VALID CLAIM.— 

7 The Service shall pay a valid contract care service claim 

8 within 30 days after the completion of the claim. 

9 ‘‘SEC. 224. LIABILITY FOR PAYMENT. 

10 ‘‘(a) NO PATIENT LIABILITY.—A patient who re11 ceives contract health care services that are authorized by 

12 the Service shall not be liable for the payment of any 

13 charges or costs associated with the provision of such serv14 ices. 

15 ‘‘(b) NOTIFICATION.—The Secretary shall notify a 

16 contract care provider and any patient who receives con17 tract health care services authorized by the Service that 

18 such patient is not liable for the payment of any charges 

19 or costs associated with the provision of such services not 

20 later than 5 business days after receipt of a notification 

21 of a claim by a provider of contract care services. 

22 ‘‘(c) NO RECOURSE.—Following receipt of the notice 

23 provided under subsection (b), or, if a claim has been 

24 deemed accepted under section 223(b), the provider shall 


ycherry on PROD1PC64 with BILLS
134 

•HR 1328 IH

1 have no further recourse against the patient who received 

2 the services. 

3 ‘‘SEC. 225. OFFICE OF INDIAN MEN’S HEALTH. 

4 ‘‘(a) ESTABLISHMENT.—The Secretary may establish 

5 within the Service an office to be known as the ‘Office 

6 of Indian Men’s Health’ (referred to in this section as the 

7 ‘Office’). 

8 ‘‘(b) DIRECTOR.— 

9 ‘‘(1) IN GENERAL.—The Office shall be headed 

10 by a director, to be appointed by the Secretary. 

11 ‘‘(2) DUTIES.—The director shall coordinate 

12 and promote the status of the health of Indian men 

13 in the United States. 

14 ‘‘(c) REPORT.—Not later than 2 years after the date 

15 of enactment of the Indian Health Care Improvement Act 

16 Amendments of 2007, the Secretary, acting through the 

17 director of the Office, shall submit to Congress a report 

18 describing— 

19 ‘‘(1) any activity carried out by the director as 

20 of the date on which the report is prepared; and 

21 ‘‘(2) any finding of the director with respect to 

22 the health of Indian men. 


ycherry on PROD1PC64 with BILLS
135 

•HR 1328 IH

1 ‘‘SEC. 226. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘There are authorized to be appropriated such sums 

3 as may be necessary for each fiscal year through fiscal 

4 year 2017 to carry out this title. 

5 ‘‘TITLE 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 

10 any binding commitment to expend, any funds appro11 priated for the planning, design, construction, or renova12 tion of facilities pursuant to the Act of November 2, 1921 

13 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

14 the Secretary, 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 applica22 ble, that such facility meets the construction stand23 ards of any accrediting body recognized by the Sec24 retary for the purposes of the Medicare, Medicaid, 

25 and SCHIP programs under titles XVIII, XIX, and 

26 XXI of the Social Security Act by not later than 1 


ycherry on PROD1PC64 with BILLS
136 

•HR 1328 IH

1 year after the date on which the construction or ren2 ovation of such facility is completed. 

3 ‘‘(b) CLOSURES.— 

4 ‘‘(1) EVALUATION REQUIRED.—Notwith5 standing any other provision of law, no facility oper6 ated by the Service may be closed if the Secretary 

7 has not submitted to Congress, not less than 1 year 

8 and not more than 2 years before the date of the 

9 proposed closure, an evaluation, completed not more 

10 than 2 years before such submission, of the impact 

11 of the proposed closure that specifies, in addition to 

12 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 

21 care 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 


ycherry on PROD1PC64 with BILLS
137 

•HR 1328 IH

1 ‘‘(G) the distance between such facility and 

2 the nearest operating Service hospital. 

3 ‘‘(2) EXCEPTION FOR CERTAIN TEMPORARY

4 CLOSURES.—Paragraph (1) shall not apply to any 

5 temporary closure of a facility or any portion of a 

6 facility if such closure is necessary for medical, envi7 ronmental, 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 


ycherry on PROD1PC64 with BILLS
138 

•HR 1328 IH

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, In6 dian Tribes, and Tribal Organizations for 

7 consideration under the priority system at 

8 least once every 3 years, or more fre9 quently as the Secretary determines to be 

10 appropriate. 

11 ‘‘(B) NEEDS OF FACILITIES UNDER

12 ISDEAA AGREEMENTS.—The Secretary shall en13 sure that the planning, design, construction, 

14 renovation, and expansion needs of Service and 

15 non-Service facilities operated under contracts 

16 or compacts in accordance with the Indian Self17 Determination and Education Assistance Act 

18 (25 U.S.C. 450 et seq.) are fully and equitably 

19 integrated into the health care facility priority 

20 system. 

21 ‘‘(C) CRITERIA FOR EVALUATING

22 NEEDS.—For purposes of this subsection, the 

23 Secretary, in evaluating the needs of facilities 

24 operated under a contract or compact under the 

25 Indian Self-Determination and Education AsVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00138 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
139 

•HR 1328 IH

1 sistance Act (25 U.S.C. 450 et seq.), shall use 

2 the criteria used by the Secretary in evaluating 

3 the needs of facilities operated directly by the 

4 Service. 

5 ‘‘(D) PRIORITY OF CERTAIN PROJECTS

6 PROTECTED.—The priority of any project estab7 lished under the construction priority system in 

8 effect on the date of enactment of the Indian 

9 Health Care Improvement Act Amendments of 

10 2007 shall not be affected by any change in the 

11 construction priority system taking place after 

12 that date if the project— 

13 ‘‘(i) was identified in the fiscal year 

14 2008 Service budget justification as— 

15 ‘‘(I) 1 of the 10 top-priority inpa16 tient projects; 

17 ‘‘(II) 1 of the 10 top-priority out18 patient projects; 

19 ‘‘(III) 1 of the 10 top-priority 

20 staff quarters developments; or 

21 ‘‘(IV) 1 of the 10 top-priority 

22 Youth Regional Treatment Centers; 

23 ‘‘(ii) had completed both Phase I and 

24 Phase II of the construction priority sysVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00139 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
140 

•HR 1328 IH

1 tem in effect on the date of enactment of 

2 such Act; or 

3 ‘‘(iii) is not included in clause (i) or 

4 (ii) and is selected, as determined by the 

5 Secretary— 

6 ‘‘(I) on the initiative of the Sec7 retary; or 

8 ‘‘(II) pursuant to a request of an 

9 Indian Tribe or Tribal Organization. 

10 ‘‘(2) REPORT; CONTENTS.— 

11 ‘‘(A) INITIAL COMPREHENSIVE REPORT.— 

12 ‘‘(i) DEFINITIONS.—In this subpara13 graph: 

14 ‘‘(I) FACILITIES APPROPRIATION

15 ADVISORY BOARD.—The term ‘Facili16 ties Appropriation Advisory Board’ 

17 means the advisory board, comprised 

18 of 12 members representing Indian 

19 tribes and 2 members representing 

20 the Service, established at the discre21 tion of the Assistant Secretary— 

22 ‘‘(aa) to provide advice and 

23 recommendations for policies and 

24 procedures of the programs fundVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00140 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
141 

•HR 1328 IH

1 ed pursuant to facilities appro2 priations; and 

3 ‘‘(bb) to address other facili4 ties issues. 

5 ‘‘(II) FACILITIES NEEDS ASSESS6 MENT WORKGROUP.—The term ‘Fa7 cilities Needs Assessment Workgroup’ 

8 means the workgroup established at 

9 the discretion of the Assistant Sec10 retary— 

11 ‘‘(aa) to review the health 

12 care facilities construction pri13 ority system; and 

14 ‘‘(bb) to make recommenda15 tions to the Facilities Appropria16 tion Advisory Board for revising 

17 the priority system. 

18 ‘‘(ii) INITIAL REPORT.— 

19 ‘‘(I) IN GENERAL.—Not later 

20 than 1 year after the date of enact21 ment of the Indian Health Care Im22 provement Act Amendments of 2007, 

23 the Secretary shall submit to the 

24 Committee on Indian Affairs of the 

25 Senate and the Committee on Natural 


ycherry on PROD1PC64 with BILLS
142 

•HR 1328 IH

1 Resources of the House of Represent2 atives a report that describes the com3 prehensive, national, ranked list of all 

4 health care facilities needs for the 

5 Service, Indian Tribes, and Tribal Or6 ganizations (including inpatient health 

7 care facilities, outpatient health care 

8 facilities, specialized health care facili9 ties (such as for long-term care and 

10 alcohol and drug abuse treatment), 

11 wellness centers, staff quarters and 

12 hostels associated with health care fa13 cilities, and the renovation and expan14 sion needs, if any, of such facilities) 

15 developed by the Service, Indian 

16 Tribes, and Tribal Organizations for 

17 the Facilities Needs Assessment 

18 Workgroup and the Facilities Appro19 priation Advisory Board. 

20 ‘‘(II) INCLUSIONS.—The initial 

21 report shall include— 

22 ‘‘(aa) the methodology and 

23 criteria used by the Service in de24 termining the needs and estabVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00142 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
143 

•HR 1328 IH

1 lishing the ranking of the facili2 ties needs; and 

3 ‘‘(bb) such other information 

4 as the Secretary determines to be 

5 appropriate. 

6 ‘‘(iii) UPDATES OF REPORT.—Begin7 ning in calendar year 2011, the Secretary 

8 shall— 

9 ‘‘(I) update the report under 

10 clause (ii) not less frequently that 

11 once every 5 years; and 

12 ‘‘(II) include the updated report 

13 in the appropriate annual report 

14 under subparagraph (B) for submis15 sion to Congress under section 801. 

16 ‘‘(B) ANNUAL REPORTS.—The Secretary 

17 shall submit to the President, for inclusion in 

18 the report required to be transmitted to Con19 gress under section 801, a report which sets 

20 forth the following: 

21 ‘‘(i) A description of the health care 

22 facility priority system of the Service es23 tablished under paragraph (1). 

24 ‘‘(ii) Health care facilities lists, which 

25 may include— 


ycherry on PROD1PC64 with BILLS
144 

•HR 1328 IH

1 ‘‘(I) the 10 top-priority inpatient 

2 health care facilities; 

3 ‘‘(II) the 10 top-priority out4 patient health care facilities; 

5 ‘‘(III) the 10 top-priority special6 ized health care facilities (such as 

7 long-term care and alcohol and drug 

8 abuse treatment); 

9 ‘‘(IV) the 10 top-priority staff 

10 quarters developments associated with 

11 health care facilities; and 

12 ‘‘(V) the 10 top-priority hostels 

13 associated with health care facilities. 

14 ‘‘(iii) The justification for such order 

15 of priority. 

16 ‘‘(iv) The projected cost of such 

17 projects. 

18 ‘‘(v) The methodology adopted by the 

19 Service in establishing priorities under its 

20 health care facility priority system. 

21 ‘‘(3) REQUIREMENTS FOR PREPARATION OF RE22 PORTS.—In preparing the report required under 

23 paragraph (2), the Secretary shall— 

24 ‘‘(A) consult with and obtain information 

25 on all health care facilities needs from Indian 


ycherry on PROD1PC64 with BILLS
145 

•HR 1328 IH

1 Tribes, Tribal Organizations, and Urban Indian 

2 Organizations; and 

3 ‘‘(B) review the total unmet needs of all 

4 Indian Tribes, Tribal Organizations, and Urban 

5 Indian Organizations for health care facilities 

6 (including hostels and staff quarters), including 

7 needs for renovation and expansion of existing 

8 facilities. 

9 ‘‘(d) REVIEW OF METHODOLOGY USED FOR HEALTH

10 FACILITIES CONSTRUCTION PRIORITY SYSTEM.— 

11 ‘‘(1) IN GENERAL.—Not later than 1 year after 

12 the establishment of the priority system under sub13 section (c)(1)(A), the Comptroller General of the 

14 United States shall prepare and finalize a report re15 viewing the methodologies applied, and the processes 

16 followed, by the Service in making each assessment 

17 of needs for the list under subsection (c)(2)(A)(ii) 

18 and developing the priority system under subsection 

19 (c)(1), including a review of— 

20 ‘‘(A) the recommendations of the Facilities 

21 Appropriation Advisory Board and the Facili22 ties Needs Assessment Workgroup (as those 

23 terms are defined in subsection (c)(2)(A)(i)); 

24 and 


ycherry on PROD1PC64 with BILLS
146 

•HR 1328 IH

1 ‘‘(B) the relevant criteria used in ranking 

2 or prioritizing facilities other than hospitals or 

3 clinics. 

4 ‘‘(2) SUBMISSION TO CONGRESS.—The Comp5 troller General of the United States shall submit the 

6 report under paragraph (1) to— 

7 ‘‘(A) the Committees on Indian Affairs and 

8 Appropriations of the Senate; 

9 ‘‘(B) the Committees on Natural Re10 sources and Appropriations of the House of 

11 Representatives; and 

12 ‘‘(C) the Secretary. 

13 ‘‘(e) FUNDING CONDITION.—All funds appropriated 

14 under the Act of November 2, 1921 (25 U.S.C. 13) (com15 monly known as the ‘Snyder Act’), for the planning, de16 sign, construction, or renovation of health facilities for the 

17 benefit of 1 or more Indian Tribes shall be subject to the 

18 provisions of the Indian Self-Determination and Edu19 cation Assistance Act (25 U.S.C. 450 et seq.). 

20 ‘‘(f) DEVELOPMENT OF INNOVATIVE APPROACHES.— 

21 The Secretary shall consult and cooperate with Indian 

22 Tribes, Tribal Organizations, and Urban Indian Organiza23 tions in developing innovative approaches to address all 

24 or part of the total unmet need for construction of health 


ycherry on PROD1PC64 with BILLS
147 

•HR 1328 IH

1 facilities, including those provided for in other sections of 

2 this title and other approaches. 

3 ‘‘SEC. 302. SANITATION FACILITIES. 

4 ‘‘(a) FINDINGS.—Congress finds the following: 

5 ‘‘(1) The provision of sanitation facilities is pri6 marily a health consideration and function. 

7 ‘‘(2) Indian people suffer an inordinately high 

8 incidence of disease, injury, and illness directly at9 tributable to the absence or inadequacy of sanitation 

10 facilities. 

11 ‘‘(3) The long-term cost to the United States of 

12 treating and curing such disease, injury, and illness 

13 is substantially greater than the short-term cost of 

14 providing sanitation facilities and other preventive 

15 health measures. 

16 ‘‘(4) Many Indian homes and Indian commu17 nities still lack sanitation facilities. 

18 ‘‘(5) It is in the interest of the United States, 

19 and it is the policy of the United States, that all In20 dian communities and Indian homes, new and exist21 ing, be provided with sanitation facilities. 

22 ‘‘(b) FACILITIES AND SERVICES.—In furtherance of 

23 the findings made in subsection (a), Congress reaffirms 

24 the primary responsibility and authority of the Service to 

25 provide the necessary sanitation facilities and services as 


ycherry on PROD1PC64 with BILLS
148 

•HR 1328 IH

1 provided in section 7 of the Act of August 5, 1954 (42 

2 U.S.C. 2004a). Under such authority, the Secretary, act3 ing through the Service, is authorized to provide the fol4 lowing: 

5 ‘‘(1) Financial and technical assistance to In6 dian Tribes, Tribal Organizations, and Indian com7 munities in the establishment, training, and equip8 ping of utility organizations to operate and maintain 

9 sanitation facilities, including the provision of exist10 ing plans, standard details, and specifications avail11 able in the Department, to be used at the option of 

12 the Indian Tribe, Tribal Organization, or Indian 

13 community. 

14 ‘‘(2) Ongoing technical assistance and training 

15 to Indian Tribes, Tribal Organizations, and Indian 

16 communities in the management of utility organiza17 tions which operate and maintain sanitation facili18 ties. 

19 ‘‘(3) Priority funding for operation and mainte20 nance assistance for, and emergency repairs to, sani21 tation facilities operated by an Indian Tribe, Tribal 

22 Organization or Indian community when necessary 

23 to avoid an imminent health threat or to protect the 

24 investment in sanitation facilities and the investment 


ycherry on PROD1PC64 with BILLS
149 

•HR 1328 IH

1 in the health benefits gained through the provision 

2 of sanitation facilities. 

3 ‘‘(c) FUNDING.—Notwithstanding any other provi4 sion of law— 

5 ‘‘(1) the Secretary of Housing and Urban De6 velopment is authorized to transfer funds appro7 priated under the Native American Housing Assist8 ance and Self-Determination Act of 1996 (25 U.S.C. 

9 4101 et seq.) to the Secretary of Health and Human 

10 Services; 

11 ‘‘(2) the Secretary of Health and Human Serv12 ices is authorized to accept and use such funds for 

13 the purpose of providing sanitation facilities and 

14 services for Indians under section 7 of the Act of 

15 August 5, 1954 (42 U.S.C. 2004a); 

16 ‘‘(3) unless specifically authorized when funds 

17 are appropriated, the Secretary shall not use funds 

18 appropriated under section 7 of the Act of August 

19 5, 1954 (42 U.S.C. 2004a), to provide sanitation fa20 cilities to new homes constructed using funds pro21 vided by the Department of Housing and Urban De22 velopment; 

23 ‘‘(4) the Secretary of Health and Human Serv24 ices is authorized to accept from any source, includ25 ing Federal and State agencies, funds for the purVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00149 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
150 

•HR 1328 IH

1 pose of providing sanitation facilities and services 

2 and place these funds into contracts or compacts 

3 under the Indian Self-Determination and Education 

4 Assistance Act (25 U.S.C. 450 et seq.); 

5 ‘‘(5) except as otherwise prohibited by this sec6 tion, the Secretary may use funds appropriated 

7 under the authority of section 7 of the Act of Au8 gust 5, 1954 (42 U.S.C. 2004a), to fund up to 100 

9 percent of the amount of an Indian Tribe’s loan ob10 tained under any Federal program for new projects 

11 to construct eligible sanitation facilities to serve In12 dian homes; 

13 ‘‘(6) except as otherwise prohibited by this sec14 tion, the Secretary may use funds appropriated 

15 under the authority of section 7 of the Act of Au16 gust 5, 1954 (42 U.S.C. 2004a) to meet matching 

17 or cost participation requirements under other Fed18 eral and non-Federal programs for new projects to 

19 construct eligible sanitation facilities; 

20 ‘‘(7) all Federal agencies are authorized to 

21 transfer to the Secretary funds identified, granted, 

22 loaned, or appropriated whereby the Department’s 

23 applicable policies, rules, and regulations shall apply 

24 in the implementation of such projects; 


ycherry on PROD1PC64 with BILLS
151 

•HR 1328 IH

1 ‘‘(8) the Secretary of Health and Human Serv2 ices shall enter into interagency agreements with 

3 Federal and State agencies for the purpose of pro4 viding financial assistance for sanitation facilities 

5 and services under this Act; 

6 ‘‘(9) the Secretary of Health and Human Serv7 ices shall, by regulation, establish standards applica8 ble to the planning, design, and construction of sani9 tation facilities funded under this Act; and 

10 ‘‘(10) the Secretary of Health and Human 

11 Services is authorized to accept payments for goods 

12 and services furnished by the Service from appro13 priate public authorities, nonprofit organizations or 

14 agencies, or Indian Tribes, as contributions by that 

15 authority, organization, agency, or tribe to agree16 ments made under section 7 of the Act of August 5, 

17 1954 (42 U.S.C. 2004a), and such payments shall 

18 be credited to the same or subsequent appropriation 

19 account as funds appropriated under the authority 

20 of section 7 of the Act of August 5, 1954 (42 U.S.C. 

21 2004a). 

22 ‘‘(d) CERTAIN CAPABILITIES NOT PREREQUISITE.— 

23 The financial and technical capability of an Indian Tribe, 

24 Tribal Organization, or Indian community to safely oper25 ate, manage, and maintain a sanitation facility shall not 


ycherry on PROD1PC64 with BILLS
152 

•HR 1328 IH

1 be a prerequisite to the provision or construction of sanita2 tion facilities by the Secretary. 

3 ‘‘(e) FINANCIAL ASSISTANCE.—The Secretary is au4 thorized to provide financial assistance to Indian Tribes, 

5 Tribal Organizations, and Indian communities for oper6 ation, management, and maintenance of their sanitation 

7 facilities. 

8 ‘‘(f) OPERATION, MANAGEMENT, AND MAINTENANCE

9 OF FACILITIES.—The Indian Tribe has the primary re10 sponsibility to establish, collect, and use reasonable user 

11 fees, or otherwise set aside funding, for the purpose of 

12 operating, managing, and maintaining sanitation facilities. 

13 If a sanitation facility serving a community that is oper14 ated by an Indian Tribe or Tribal Organization is threat15 ened with imminent failure and such operator lacks capac16 ity to maintain the integrity or the health benefits of the 

17 sanitation facility, then the Secretary is authorized to as18 sist the Indian Tribe, Tribal Organization, or Indian com19 munity in the resolution of the problem on a short-term 

20 basis through cooperation with the emergency coordinator 

21 or by providing operation, management, and maintenance 

22 service. 

23 ‘‘(g) ISDEAA PROGRAM FUNDED ON EQUAL

24 BASIS.—Tribal Health Programs shall be eligible (on an 


ycherry on PROD1PC64 with BILLS
153 

•HR 1328 IH

1 equal basis with programs that are administered directly 

2 by the Service) for— 

3 ‘‘(1) any funds appropriated pursuant to this 

4 section; and 

5 ‘‘(2) any funds appropriated for the purpose of 

6 providing sanitation facilities. 

7 ‘‘(h) REPORT.— 

8 ‘‘(1) REQUIRED; CONTENTS.—The Secretary, in 

9 consultation with the Secretary of Housing and 

10 Urban Development, Indian Tribes, Tribal Organiza11 tions, and tribally designated housing entities (as de12 fined in section 4 of the Native American Housing 

13 Assistance and Self-Determination Act of 1996 (25 

14 U.S.C. 4103)) shall submit to the President, for in15 clusion in the report required to be transmitted to 

16 Congress under section 801, a report which sets 

17 forth— 

18 ‘‘(A) the current Indian sanitation facility 

19 priority system of the Service; 

20 ‘‘(B) the methodology for determining 

21 sanitation deficiencies and needs; 

22 ‘‘(C) the criteria on which the deficiencies 

23 and needs will be evaluated; 

24 ‘‘(D) the level of initial and final sanitation 

25 deficiency for each type of sanitation facility for 


ycherry on PROD1PC64 with BILLS
154 

•HR 1328 IH

1 each project of each Indian Tribe or Indian 

2 community; 

3 ‘‘(E) the amount and most effective use of 

4 funds, derived from whatever source, necessary 

5 to accommodate the sanitation facilities needs 

6 of new homes assisted with funds under the 

7 Native American Housing Assistance and Self8 Determination Act (25 U.S.C. 4101 et seq.), 

9 and to reduce the identified sanitation defi10 ciency levels of all Indian Tribes and Indian 

11 communities to level I sanitation deficiency as 

12 defined in paragraph (3)(A); and 

13 ‘‘(F) a 10-year plan to provide sanitation 

14 facilities to serve existing Indian homes and In15 dian communities and new and renovated In16 dian homes. 

17 ‘‘(2) UNIFORM METHODOLOGY.—The method18 ology used by the Secretary in determining, pre19 paring cost estimates for, and reporting sanitation 

20 deficiencies for purposes of paragraph (1) shall be 

21 applied uniformly to all Indian Tribes and Indian 

22 communities. 

23 ‘‘(3) SANITATION DEFICIENCY LEVELS.—For 

24 purposes of this subsection, the sanitation deficiency 

25 levels for an individual, Indian Tribe, or Indian comVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00154 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
155 

•HR 1328 IH

1 munity sanitation facility to serve Indian homes are 

2 determined as follows: 

3 ‘‘(A) A level I deficiency exists if a sanita4 tion facility serving an individual, Indian Tribe, 

5 or Indian community— 

6 ‘‘(i) complies with all applicable water 

7 supply, pollution control, and solid waste 

8 disposal laws; and 

9 ‘‘(ii) deficiencies relate to routine re10 placement, repair, or maintenance needs. 

11 ‘‘(B) A level II deficiency exists if a sanita12 tion facility serving an individual, Indian Tribe, 

13 or Indian community substantially or recently 

14 complied with all applicable water supply, pollu15 tion control, and solid waste laws and any defi16 ciencies relate to— 

17 ‘‘(i) small or minor capital improve18 ments needed to bring the facility back 

19 into compliance; 

20 ‘‘(ii) capital improvements that are 

21 necessary to enlarge or improve the facili22 ties in order to meet the current needs for 

23 domestic sanitation facilities; or 

24 ‘‘(iii) the lack of equipment or train25 ing by an Indian Tribe, Tribal OrganizaVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00155 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
156 

•HR 1328 IH

1 tion, or an Indian community to properly 

2 operate and maintain the sanitation facili3 ties. 

4 ‘‘(C) A level III deficiency exists if a sani5 tation facility serving an individual, Indian 

6 Tribe or Indian community meets 1 or more of 

7 the following conditions— 

8 ‘‘(i) water or sewer service in the 

9 home is provided by a haul system with 

10 holding tanks and interior plumbing; 

11 ‘‘(ii) major significant interruptions to 

12 water supply or sewage disposal occur fre13 quently, requiring major capital improve14 ments to correct the deficiencies; or 

15 ‘‘(iii) there is no access to or no ap16 proved or permitted solid waste facility 

17 available. 

18 ‘‘(D) A level IV deficiency exists— 

19 ‘‘(i) if a sanitation facility for an indi20 vidual home, an Indian Tribe, or an Indian 

21 community exists but— 

22 ‘‘(I) lacks— 

23 ‘‘(aa) a safe water supply 

24 system; or 


ycherry on PROD1PC64 with BILLS
157 

•HR 1328 IH

1 ‘‘(bb) a waste disposal sys2 tem; 

3 ‘‘(II) contains no piped water or 

4 sewer facilities; or 

5 ‘‘(III) has become inoperable due 

6 to a major component failure; or 

7 ‘‘(ii) if only a washeteria or central fa8 cility exists in the community. 

9 ‘‘(E) A level V deficiency exists in the ab10 sence of a sanitation facility, where individual 

11 homes do not have access to safe drinking 

12 water or adequate wastewater (including sew13 age) disposal. 

14 ‘‘(i) DEFINITIONS.—For purposes of this section, the 

15 following terms apply: 

16 ‘‘(1) INDIAN COMMUNITY.—The term ‘Indian 

17 community’ means a geographic area, a significant 

18 proportion of whose inhabitants are Indians and 

19 which is served by or capable of being served by a 

20 facility described in this section. 

21 ‘‘(2) SANITATION FACILITIES.—The terms 

22 ‘sanitation facility’ and ‘sanitation facilities’ mean 

23 safe and adequate water supply systems, sanitary 

24 sewage disposal systems, and sanitary solid waste 


ycherry on PROD1PC64 with BILLS
158 

•HR 1328 IH

1 systems (and all related equipment and support in2 frastructure). 

3 ‘‘SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS. 

4 ‘‘(a) BUY INDIAN ACT.—The Secretary, acting 

5 through the Service, may use the negotiating authority of 

6 section 23 of the Act of June 25, 1910 (25 U.S.C. 47, 

7 commonly known as the ‘Buy Indian Act’), to give pref8 erence to any Indian or any enterprise, partnership, cor9 poration, or other type of business organization owned and 

10 controlled by an Indian or Indians including former or 

11 currently federally recognized Indian Tribes in the State 

12 of New York (hereinafter referred to as an ‘Indian firm’) 

13 in the construction and renovation of Service facilities pur14 suant to section 301 and in the construction of sanitation 

15 facilities pursuant to section 302. Such preference may be 

16 accorded by the Secretary unless the Secretary finds, pur17 suant to regulations, that the project or function to be 

18 contracted for will not be satisfactory or such project or 

19 function cannot be properly completed or maintained 

20 under the proposed contract. The Secretary, in arriving 

21 at such a finding, shall consider whether the Indian or 

22 Indian firm will be deficient with respect to— 

23 ‘‘(1) ownership and control by Indians; 

24 ‘‘(2) equipment; 

25 ‘‘(3) bookkeeping and accounting procedures; 


ycherry on PROD1PC64 with BILLS
159 

•HR 1328 IH

1 ‘‘(4) substantive knowledge of the project or 

2 function to be contracted for; 

3 ‘‘(5) adequately trained personnel; or 

4 ‘‘(6) other necessary components of contract 

5 performance. 

6 ‘‘(b) LABOR STANDARDS.—For the purposes of im7 plementing the provisions of this title, contracts for the 

8 construction or renovation of health care facilities, staff 

9 quarters, and sanitation facilities, and related support in10 frastructure, funded in whole or in part with funds made 

11 available pursuant to this title, shall contain a provision 

12 requiring compliance with subchapter IV of chapter 31 of 

13 title 40, United States Code (commonly known as the 

14 ‘Davis-Bacon Act’). 

15 ‘‘SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR 

16 RENOVATION. 

17 ‘‘(a) IN GENERAL.—Notwithstanding any other pro18 vision of law, if the requirements of subsection (c) are met, 

19 the Secretary, acting through the Service, is authorized 

20 to accept any major expansion, renovation, or moderniza21 tion by any Indian Tribe or Tribal Organization of any 

22 Service facility or of any other Indian health facility oper23 ated pursuant to a contract or compact under the Indian 

24 Self-Determination and Education Assistance Act (25 

25 U.S.C. 450 et seq.), including— 


ycherry on PROD1PC64 with BILLS
160 

•HR 1328 IH

1 ‘‘(1) any plans or designs for such expansion, 

2 renovation, or modernization; and 

3 ‘‘(2) any expansion, renovation, or moderniza4 tion for which funds appropriated under any Federal 

5 law were lawfully expended. 

6 ‘‘(b) PRIORITY LIST.— 

7 ‘‘(1) IN GENERAL.—The Secretary shall main8 tain a separate priority list to address the needs for 

9 increased operating expenses, personnel, or equip10 ment for such facilities. The methodology for estab11 lishing priorities shall be developed through regula12 tions. The list of priority facilities will be revised an13 nually in consultation with Indian Tribes and Tribal 

14 Organizations. 

15 ‘‘(2) REPORT.—The Secretary shall submit to 

16 the President, for inclusion in the report required to 

17 be transmitted to Congress under section 801, the 

18 priority list maintained pursuant to paragraph (1). 

19 ‘‘(c) REQUIREMENTS.—The requirements of this sub20 section are met with respect to any expansion, renovation, 

21 or modernization if— 

22 ‘‘(1) the Indian Tribe or Tribal Organization— 

23 ‘‘(A) provides notice to the Secretary of its 

24 intent to expand, renovate, or modernize; and 


ycherry on PROD1PC64 with BILLS
161 

•HR 1328 IH

1 ‘‘(B) applies to the Secretary to be placed 

2 on a separate priority list to address the needs 

3 of such new facilities for increased operating ex4 penses, personnel, or equipment; and 

5 ‘‘(2) the expansion, renovation, or moderniza6 tion— 

7 ‘‘(A) is approved by the appropriate area 

8 director of the Service for Federal facilities; and 

9 ‘‘(B) is administered by the Indian Tribe 

10 or Tribal Organization in accordance with any 

11 applicable regulations prescribed by the Sec12 retary with respect to construction or renova13 tion of Service facilities. 

14 ‘‘(d) ADDITIONAL REQUIREMENT FOR EXPANSION.— 

15 In addition to the requirements under subsection (c), for 

16 any expansion, the Indian Tribe or Tribal Organization 

17 shall provide to the Secretary additional information pur18 suant to regulations, including additional staffing, equip19 ment, and other costs associated with the expansion. 

20 ‘‘(e) CLOSURE OR CONVERSION OF FACILITIES.—If 

21 any Service facility which has been expanded, renovated, 

22 or modernized by an Indian Tribe or Tribal Organization 

23 under this section ceases to be used as a Service facility 

24 during the 20-year period beginning on the date such ex25 pansion, renovation, or modernization is completed, such 


ycherry on PROD1PC64 with BILLS
162 

•HR 1328 IH

1 Indian Tribe or Tribal Organization shall be entitled to 

2 recover from the United States an amount which bears 

3 the same ratio to the value of such facility at the time 

4 of such cessation as the value of such expansion, renova5 tion, or modernization (less the total amount of any funds 

6 provided specifically for such facility under any Federal 

7 program that were expended for such expansion, renova8 tion, or modernization) bore to the value of such facility 

9 at the time of the completion of such expansion, renova10 tion, or modernization. 

11 ‘‘SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, 

12 AND MODERNIZATION OF SMALL AMBULA13 TORY CARE FACILITIES. 

14 ‘‘(a) GRANTS.— 

15 ‘‘(1) IN GENERAL.—The Secretary, acting 

16 through the Service, shall make grants to Indian 

17 Tribes and Tribal Organizations for the construc18 tion, expansion, or modernization of facilities for the 

19 provision of ambulatory care services to eligible Indi20 ans (and noneligible persons pursuant to subsections 

21 (b)(2) and (c)(1)(C)). A grant made under this sec22 tion may cover up to 100 percent of the costs of 

23 such construction, expansion, or modernization. For 

24 the purposes of this section, the term ‘construction’ 

25 includes the replacement of an existing facility. 


ycherry on PROD1PC64 with BILLS
163 

•HR 1328 IH

1 ‘‘(2) GRANT AGREEMENT REQUIRED.—A grant 

2 under paragraph (1) may only be made available to 

3 a Tribal Health Program operating an Indian health 

4 facility (other than a facility owned or constructed 

5 by the Service, including a facility originally owned 

6 or constructed by the Service and transferred to an 

7 Indian Tribe or Tribal Organization). 

8 ‘‘(b) USE OF GRANT FUNDS.— 

9 ‘‘(1) ALLOWABLE USES.—A grant awarded 

10 under this section may be used for the construction, 

11 expansion, or modernization (including the planning 

12 and design of such construction, expansion, or mod13 ernization) of an ambulatory care facility— 

14 ‘‘(A) located apart from a hospital; 

15 ‘‘(B) not funded under section 301 or sec16 tion 306; and 

17 ‘‘(C) which, upon completion of such con18 struction or modernization will— 

19 ‘‘(i) have a total capacity appropriate 

20 to its projected service population; 

21 ‘‘(ii) provide annually no fewer than 

22 150 patient visits by eligible Indians and 

23 other users who are eligible for services in 

24 such facility in accordance with section 

25 807(c)(2); and 


ycherry on PROD1PC64 with BILLS
164 

•HR 1328 IH

1 ‘‘(iii) provide ambulatory care in a 

2 Service Area (specified in the contract or 

3 compact under the Indian Self-Determina4 tion and Education Assistance Act (25 

5 U.S.C. 450 et seq.)) with a population of 

6 no fewer than 1,500 eligible Indians and 

7 other users who are eligible for services in 

8 such facility in accordance with section 

9 807(c)(2). 

10 ‘‘(2) ADDITIONAL ALLOWABLE USE.—The Sec11 retary may also reserve a portion of the funding pro12 vided under this section and use those reserved 

13 funds to reduce an outstanding debt incurred by In14 dian Tribes or Tribal Organizations for the con15 struction, expansion, or modernization of an ambula16 tory care facility that meets the requirements under 

17 paragraph (1). The provisions of this section shall 

18 apply, except that such applications for funding 

19 under this paragraph shall be considered separately 

20 from applications for funding under paragraph (1). 

21 ‘‘(3) USE ONLY FOR CERTAIN PORTION OF

22 COSTS.—A grant provided under this section may be 

23 used only for the cost of that portion of a construc24 tion, expansion, or modernization project that bene25 fits the Service population identified above in subVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00164 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
165 

•HR 1328 IH

1 section (b)(1)(C) (ii) and (iii). The requirements of 

2 clauses (ii) and (iii) of paragraph (1)(C) shall not 

3 apply to an Indian Tribe or Tribal Organization ap4 plying for a grant under this section for a health 

5 care facility located or to be constructed on an is6 land or when such facility is not located on a road 

7 system providing direct access to an inpatient hos8 pital where care is available to the Service popu9 lation. 

10 ‘‘(c) GRANTS.— 

11 ‘‘(1) APPLICATION.—No grant may be made 

12 under this section unless an application or proposal 

13 for the grant has been approved by the Secretary in 

14 accordance with applicable regulations and has set 

15 forth reasonable assurance by the applicant that, at 

16 all times after the construction, expansion, or mod17 ernization of a facility carried out using a grant re18 ceived under this section— 

19 ‘‘(A) adequate financial support will be 

20 available for the provision of services at such 

21 facility; 

22 ‘‘(B) such facility will be available to eligi23 ble Indians without regard to ability to pay or 

24 source of payment; and 


ycherry on PROD1PC64 with BILLS
166 

•HR 1328 IH

1 ‘‘(C) such facility will, as feasible without 

2 diminishing the quality or quantity of services 

3 provided to eligible Indians, serve noneligible 

4 persons on a cost basis. 

5 ‘‘(2) PRIORITY.—In awarding grants under this 

6 section, the Secretary shall give priority to Indian 

7 Tribes and Tribal Organizations that demonstrate— 

8 ‘‘(A) a need for increased ambulatory care 

9 services; and 

10 ‘‘(B) insufficient capacity to deliver such 

11 services. 

12 ‘‘(3) PEER REVIEW PANELS.—The Secretary 

13 may provide for the establishment of peer review 

14 panels, as necessary, to review and evaluate applica15 tions and proposals and to advise the Secretary re16 garding such applications using the criteria devel17 oped pursuant to subsection (a)(1). 

18 ‘‘(d) REVERSION OF FACILITIES.—If any facility (or 

19 portion thereof) with respect to which funds have been 

20 paid under this section, ceases, at any time after comple21 tion of the construction, expansion, or modernization car22 ried out with such funds, to be used for the purposes of 

23 providing health care services to eligible Indians, all of the 

24 right, title, and interest in and to such facility (or portion 

25 thereof) shall transfer to the United States unless otherVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00166 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
167 

•HR 1328 IH

1 wise negotiated by the Service and the Indian Tribe or 

2 Tribal Organization. 

3 ‘‘(e) FUNDING NONRECURRING.—Funding provided 

4 under this section shall be nonrecurring and shall not be 

5 available for inclusion in any individual Indian Tribe’s 

6 tribal share for an award under the Indian Self-Deter7 mination and Education Assistance Act (25 U.S.C. 450 

8 et seq.) or for reallocation or redesign thereunder. 

9 ‘‘SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRA10 TION PROJECT. 

11 ‘‘(a) HEALTH CARE DEMONSTRATION PROJECTS.— 

12 The Secretary, acting through the Service, is authorized 

13 to enter into contracts under the Indian Self-Determina14 tion and Education Assistance Act (25 U.S.C. 450 et seq.) 

15 with Indian Tribes or Tribal Organizations for the pur16 pose of carrying out a health care delivery demonstration 

17 project to test alternative means of delivering health care 

18 and services to Indians through facilities. 

19 ‘‘(b) USE OF FUNDS.—The Secretary, in approving 

20 projects pursuant to this section, may authorize such con21 tracts for the construction and renovation of hospitals, 

22 health centers, health stations, and other facilities to de23 liver health care services and is authorized to— 

24 ‘‘(1) waive any leasing prohibition; 


ycherry on PROD1PC64 with BILLS
168 

•HR 1328 IH

1 ‘‘(2) permit carryover of funds appropriated for 

2 the provision of health care services; 

3 ‘‘(3) permit the use of other available funds; 

4 ‘‘(4) permit the use of funds or property do5 nated from any source for project purposes; 

6 ‘‘(5) provide for the reversion of donated real or 

7 personal property to the donor; and 

8 ‘‘(6) permit the use of Service funds to match 

9 other funds, including Federal funds. 

10 ‘‘(c) REGULATIONS.—The Secretary shall develop 

11 and promulgate regulations, not later than 1 year after 

12 the date of enactment of the Indian Health Care Improve13 ment Act Amendments of 2007, for the review and ap14 proval of applications submitted under this section. 

15 ‘‘(d) CRITERIA.—The Secretary may approve projects 

16 that meet the following criteria: 

17 ‘‘(1) There is a need for a new facility or pro18 gram or the reorientation of an existing facility or 

19 program. 

20 ‘‘(2) A significant number of Indians, including 

21 those with low health status, will be served by the 

22 project. 

23 ‘‘(3) The project has the potential to deliver 

24 services in an efficient and effective manner. 

25 ‘‘(4) The project is economically viable. 


ycherry on PROD1PC64 with BILLS
169 

•HR 1328 IH

1 ‘‘(5) The Indian Tribe or Tribal Organization 

2 has the administrative and financial capability to ad3 minister the project. 

4 ‘‘(6) The project is integrated with providers of 

5 related health and social services and is coordinated 

6 with, and avoids duplication of, existing services. 

7 ‘‘(e) PEER REVIEW PANELS.—The Secretary may 

8 provide for the establishment of peer review panels, as nec9 essary, to review and evaluate applications using the cri10 teria developed pursuant to subsection (d). 

11 ‘‘(f) PRIORITY.—The Secretary shall give priority to 

12 applications for demonstration projects in each of the fol13 lowing Service Units to the extent that such applications 

14 are timely filed and meet the criteria specified in sub15 section (d): 

16 ‘‘(1) Cass Lake, Minnesota. 

17 ‘‘(2) Mescalero, New Mexico. 

18 ‘‘(3) Owyhee, Nevada. 

19 ‘‘(4) Schurz, Nevada. 

20 ‘‘(5) Ft. Yuma, California. 

21 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 

22 provide such technical and other assistance as may be nec23 essary to enable applicants to comply with the provisions 

24 of this section. 


ycherry on PROD1PC64 with BILLS
170 

•HR 1328 IH

1 ‘‘(h) SERVICE TO INELIGIBLE PERSONS.—Subject to 

2 section 807, the authority to provide services to persons 

3 otherwise ineligible for the health care benefits of the 

4 Service and the authority to extend hospital privileges in 

5 Service facilities to non-Service health practitioners as 

6 provided in section 807 may be included, subject to the 

7 terms of such section, in any demonstration project ap8 proved pursuant to this section. 

9 ‘‘(i) EQUITABLE TREATMENT.—For purposes of sub10 section (d)(1), the Secretary shall, in evaluating facilities 

11 operated under any contract or compact under the Indian 

12 Self-Determination and Education Assistance Act (25 

13 U.S.C. 450 et seq.), use the same criteria that the Sec14 retary uses in evaluating facilities operated directly by the 

15 Service. 

16 ‘‘(j) EQUITABLE INTEGRATION OF FACILITIES.—The 

17 Secretary shall ensure that the planning, design, construc18 tion, renovation, and expansion needs of Service and non19 Service facilities which are the subject of a contract or 

20 compact under the Indian Self-Determination and Edu21 cation Assistance Act (25 U.S.C. 450 et seq.) for health 

22 services are fully and equitably integrated into the imple23 mentation of the health care delivery demonstration 

24 projects under this section. 


ycherry on PROD1PC64 with BILLS
171 

•HR 1328 IH

1 ‘‘SEC. 307. LAND TRANSFER. 

2 ‘‘Notwithstanding any other provision of law, the Bu3 reau of Indian Affairs and all other agencies and depart4 ments of the United States are authorized to transfer, at 

5 no cost, land and improvements to the Service for the pro6 vision of health care services. The Secretary is authorized 

7 to accept such land and improvements for such purposes. 

8 ‘‘SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS. 

9 ‘‘The Secretary, acting through the Service, may 

10 enter into leases, contracts, and other agreements with In11 dian Tribes and Tribal Organizations which hold (1) title 

12 to, (2) a leasehold interest in, or (3) a beneficial interest 

13 in (when title is held by the United States in trust for 

14 the benefit of an Indian Tribe) facilities used or to be used 

15 for the administration and delivery of health services by 

16 an Indian Health Program. Such leases, contracts, or 

17 agreements may include provisions for construction or ren18 ovation and provide for compensation to the Indian Tribe 

19 or Tribal Organization of rental and other costs consistent 

20 with section 105(l) of the Indian Self-Determination and 

21 Education Assistance Act (25 U.S.C. 450j(l)) and regula22 tions thereunder. 

23 ‘‘SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND 

24 LOAN REPAYMENT. 

25 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

26 with the Secretary of the Treasury, Indian Tribes, and 


ycherry on PROD1PC64 with BILLS
172 

•HR 1328 IH

1 Tribal Organizations, shall carry out a study to determine 

2 the feasibility of establishing a loan fund to provide to In3 dian Tribes and Tribal Organizations direct loans or guar4 antees for loans for the construction of health care facili5 ties, including— 

6 ‘‘(1) inpatient facilities; 

7 ‘‘(2) outpatient facilities; 

8 ‘‘(3) staff quarters; 

9 ‘‘(4) hostels; and 

10 ‘‘(5) specialized care facilities, such as behav11 ioral health and elder care facilities. 

12 ‘‘(b) DETERMINATIONS.—In carrying out the study 

13 under subsection (a), the Secretary shall determine— 

14 ‘‘(1) the maximum principal amount of a loan 

15 or loan guarantee that should be offered to a recipi16 ent from the loan fund; 

17 ‘‘(2) the percentage of eligible costs, not to ex18 ceed 100 percent, that may be covered by a loan or 

19 loan guarantee from the loan fund (including costs 

20 relating to planning, design, financing, site land de21 velopment, construction, rehabilitation, renovation, 

22 conversion, improvements, medical equipment and 

23 furnishings, and other facility-related costs and cap24 ital purchase (but excluding staffing)); 


ycherry on PROD1PC64 with BILLS
173 

•HR 1328 IH

1 ‘‘(3) the cumulative total of the principal of di2 rect loans and loan guarantees, respectively, that 

3 may be outstanding at any 1 time; 

4 ‘‘(4) the maximum term of a loan or loan guar5 antee that may be made for a facility from the loan 

6 fund; 

7 ‘‘(5) the maximum percentage of funds from 

8 the loan fund that should be allocated for payment 

9 of costs associated with planning and applying for a 

10 loan or loan guarantee; 

11 ‘‘(6) whether acceptance by the Secretary of an 

12 assignment of the revenue of an Indian Tribe or 

13 Tribal Organization as security for any direct loan 

14 or loan guarantee from the loan fund would be ap15 propriate; 

16 ‘‘(7) whether, in the planning and design of 

17 health facilities under this section, users eligible 

18 under section 807(c) may be included in any projec19 tion of patient population; 

20 ‘‘(8) whether funds of the Service provided 

21 through loans or loan guarantees from the loan fund 

22 should be eligible for use in matching other Federal 

23 funds under other programs; 


ycherry on PROD1PC64 with BILLS
174 

•HR 1328 IH

1 ‘‘(9) the appropriateness of, and best methods 

2 for, coordinating the loan fund with the health care 

3 priority system of the Service under section 301; and 

4 ‘‘(10) any legislative or regulatory changes re5 quired to implement recommendations of the Sec6 retary based on results of the study. 

7 ‘‘(c) REPORT.—Not later than September 30, 2009, 

8 the Secretary shall submit to the Committee on Indian Af9 fairs of the Senate and the Committee on Natural Re10 sources and the Committee on Energy and Commerce of 

11 the House of Representatives a report that describes— 

12 ‘‘(1) the manner of consultation made as re13 quired by subsection (a); and 

14 ‘‘(2) the results of the study, including any rec15 ommendations of the Secretary based on results of 

16 the study. 

17 ‘‘SEC. 310. TRIBAL LEASING. 

18 ‘‘A Tribal Health Program may lease permanent 

19 structures for the purpose of providing health care services 

20 without obtaining advance approval in appropriation Acts. 

21 ‘‘SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES 

22 JOINT VENTURE PROGRAM. 

23 ‘‘(a) IN GENERAL.—The Secretary, acting through 

24 the Service, shall make arrangements with Indian Tribes 

25 and Tribal Organizations to establish joint venture demVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00174 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
175 

•HR 1328 IH

1 onstration projects under which an Indian Tribe or Tribal 

2 Organization shall expend tribal, private, or other avail3 able funds, for the acquisition or construction of a health 

4 facility for a minimum of 10 years, under a no-cost lease, 

5 in exchange for agreement by the Service to provide the 

6 equipment, supplies, and staffing for the operation and 

7 maintenance of such a health facility. An Indian Tribe or 

8 Tribal Organization may use tribal funds, private sector, 

9 or other available resources, including loan guarantees, to 

10 fulfill its commitment under a joint venture entered into 

11 under this subsection. An Indian Tribe or Tribal Organi12 zation shall be eligible to establish a joint venture project 

13 if, when it submits a letter of intent, it— 

14 ‘‘(1) has begun but not completed the process 

15 of acquisition or construction of a health facility to 

16 be used in the joint venture project; or 

17 ‘‘(2) has not begun the process of acquisition or 

18 construction of a health facility for use in the joint 

19 venture project. 

20 ‘‘(b) REQUIREMENTS.—The Secretary shall make 

21 such an arrangement with an Indian Tribe or Tribal Orga22 nization only if— 

23 ‘‘(1) the Secretary first determines that the In24 dian Tribe or Tribal Organization has the adminis25 trative and financial capabilities necessary to comVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00175 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
176 

•HR 1328 IH

1 plete the timely acquisition or construction of the 

2 relevant health facility; and 

3 ‘‘(2) the Indian Tribe or Tribal Organization 

4 meets the need criteria determined using the criteria 

5 developed under the health care facility priority sys6 tem under section 301, unless the Secretary deter7 mines, pursuant to regulations, that other criteria 

8 will result in a more cost-effective and efficient 

9 method of facilitating and completing construction of 

10 health care facilities. 

11 ‘‘(c) CONTINUED OPERATION.—The Secretary shall 

12 negotiate an agreement with the Indian Tribe or Tribal 

13 Organization regarding the continued operation of the fa14 cility at the end of the initial 10 year no-cost lease period. 

15 ‘‘(d) BREACH OF AGREEMENT.—An Indian Tribe or 

16 Tribal Organization that has entered into a written agree17 ment with the Secretary under this section, and that 

18 breaches or terminates without cause such agreement, 

19 shall be liable to the United States for the amount that 

20 has been paid to the Indian Tribe or Tribal Organization, 

21 or paid to a third party on the Indian Tribe’s or Tribal 

22 Organization’s behalf, under the agreement. The Sec23 retary has the right to recover tangible property (including 

24 supplies) and equipment, less depreciation, and any funds 

25 expended for operations and maintenance under this secVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00176 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
177 

•HR 1328 IH

1 tion. The preceding sentence does not apply to any funds 

2 expended for the delivery of health care services, per3 sonnel, or staffing. 

4 ‘‘(e) RECOVERY FOR NONUSE.—An Indian Tribe or 

5 Tribal Organization that has entered into a written agree6 ment with the Secretary under this subsection shall be en7 titled to recover from the United States an amount that 

8 is proportional to the value of such facility if, at any time 

9 within the 10-year term of the agreement, the Service 

10 ceases to use the facility or otherwise breaches the agree11 ment. 

12 ‘‘(f) DEFINITION.—For the purposes of this section, 

13 the term ‘health facility’ or ‘health facilities’ includes 

14 quarters needed to provide housing for staff of the rel15 evant Tribal Health Program. 

16 ‘‘SEC. 312. LOCATION OF FACILITIES. 

17 ‘‘(a) IN GENERAL.—In all matters involving the reor18 ganization or development of Service facilities or in the 

19 establishment of related employment projects to address 

20 unemployment conditions in economically depressed areas, 

21 the Bureau of Indian Affairs and the Service shall give 

22 priority to locating such facilities and projects on Indian 

23 lands, or lands in Alaska owned by any Alaska Native vil24 lage, or village or regional corporation under the Alaska 

25 Native Claims Settlement Act (43 U.S.C. 1601 et seq.), 


ycherry on PROD1PC64 with BILLS
178 

•HR 1328 IH

1 or any land allotted to any Alaska Native, if requested 

2 by the Indian owner and the Indian Tribe with jurisdiction 

3 over such lands or other lands owned or leased by the In4 dian Tribe or Tribal Organization. Top priority shall be 

5 given to Indian land owned by 1 or more Indian Tribes. 

6 ‘‘(b) DEFINITION.—For purposes of this section, the 

7 term ‘Indian lands’ means— 

8 ‘‘(1) all lands within the exterior boundaries of 

9 any reservation; and 

10 ‘‘(2) any lands title to which is held in trust by 

11 the United States for the benefit of any Indian 

12 Tribe or individual Indian or held by any Indian 

13 Tribe or individual Indian subject to restriction by 

14 the United States against alienation. 

15 ‘‘SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH 

16 CARE FACILITIES. 

17 ‘‘(a) REPORT.—The Secretary shall submit to the 

18 President, for inclusion in the report required to be trans19 mitted to Congress under section 801, a report which iden20 tifies the backlog of maintenance and repair work required 

21 at both Service and tribal health care facilities, including 

22 new health care facilities expected to be in operation in 

23 the next fiscal year. The report shall also identify the need 

24 for renovation and expansion of existing facilities to sup25 port the growth of health care programs. 


ycherry on PROD1PC64 with BILLS
179 

•HR 1328 IH

1 ‘‘(b) MAINTENANCE OF NEWLY CONSTRUCTED

2 SPACE.—The Secretary, acting through the Service, is au3 thorized to expend maintenance and improvement funds 

4 to support maintenance of newly constructed space only 

5 if such space falls within the approved supportable space 

6 allocation for the Indian Tribe or Tribal Organization. 

7 Supportable space allocation shall be defined through the 

8 health care facility priority system under section 301(c). 

9 ‘‘(c) REPLACEMENT FACILITIES.—In addition to 

10 using maintenance and improvement funds for renovation, 

11 modernization, and expansion of facilities, an Indian Tribe 

12 or Tribal Organization may use maintenance and improve13 ment funds for construction of a replacement facility if 

14 the costs of renovation of such facility would exceed a 

15 maximum renovation cost threshold. The maximum ren16 ovation cost threshold shall be determined through the ne17 gotiated rulemaking process provided for under section 

18 802. 

19 ‘‘SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY-OWNED 

20 QUARTERS. 

21 ‘‘(a) RENTAL RATES.— 

22 ‘‘(1) ESTABLISHMENT.—Notwithstanding any 

23 other provision of law, a Tribal Health Program 

24 which operates a hospital or other health facility and 

25 the federally-owned quarters associated therewith 


ycherry on PROD1PC64 with BILLS
180 

•HR 1328 IH

1 pursuant to a contract or compact under the Indian 

2 Self-Determination and Education Assistance Act 

3 (25 U.S.C. 450 et seq.) shall have the authority to 

4 establish the rental rates charged to the occupants 

5 of such quarters by providing notice to the Secretary 

6 of its election to exercise such authority. 

7 ‘‘(2) OBJECTIVES.—In establishing rental rates 

8 pursuant to authority of this subsection, a Tribal 

9 Health Program shall endeavor to achieve the fol10 lowing objectives: 

11 ‘‘(A) To base such rental rates on the rea12 sonable value of the quarters to the occupants 

13 thereof. 

14 ‘‘(B) To generate sufficient funds to pru15 dently provide for the operation and mainte16 nance of the quarters, and subject to the discre17 tion of the Tribal Health Program, to supply 

18 reserve funds for capital repairs and replace19 ment of the quarters. 

20 ‘‘(3) EQUITABLE FUNDING.—Any quarters 

21 whose rental rates are established by a Tribal 

22 Health Program pursuant to this subsection shall 

23 remain eligible for quarters improvement and repair 

24 funds to the same extent as all federally-owned quarVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00180 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
181 

•HR 1328 IH

1 ters used to house personnel in Services-supported 

2 programs. 

3 ‘‘(4) NOTICE OF RATE CHANGE.—A Tribal 

4 Health Program which exercises the authority pro5 vided under this subsection shall provide occupants 

6 with no less than 60 days notice of any change in 

7 rental rates. 

8 ‘‘(b) DIRECT COLLECTION OF RENT.— 

9 ‘‘(1) IN GENERAL.—Notwithstanding any other 

10 provision of law, and subject to paragraph (2), a 

11 Tribal Health Program shall have the authority to 

12 collect rents directly from Federal employees who oc13 cupy such quarters in accordance with the following: 

14 ‘‘(A) The Tribal Health Program shall no15 tify the Secretary and the subject Federal em16 ployees of its election to exercise its authority 

17 to collect rents directly from such Federal em18 ployees. 

19 ‘‘(B) Upon receipt of a notice described in 

20 subparagraph (A), the Federal employees shall 

21 pay rents for occupancy of such quarters di22 rectly to the Tribal Health Program and the 

23 Secretary shall have no further authority to col24 lect rents from such employees through payroll 

25 deduction or otherwise. 


ycherry on PROD1PC64 with BILLS
182 

•HR 1328 IH

1 ‘‘(C) Such rent payments shall be retained 

2 by the Tribal Health Program and shall not be 

3 made payable to or otherwise be deposited with 

4 the United States. 

5 ‘‘(D) Such rent payments shall be depos6 ited into a separate account which shall be used 

7 by the Tribal Health Program for the mainte8 nance (including capital repairs and replace9 ment) and operation of the quarters and facili10 ties as the Tribal Health Program shall deter11 mine. 

12 ‘‘(2) RETROCESSION OF AUTHORITY.—If a 

13 Tribal Health Program which has made an election 

14 under paragraph (1) requests retrocession of its au15 thority to directly collect rents from Federal employ16 ees occupying federally-owned quarters, such ret17 rocession shall become effective on the earlier of— 

18 ‘‘(A) the first day of the month that begins 

19 no less than 180 days after the Tribal Health 

20 Program notifies the Secretary of its desire to 

21 retrocede; or 

22 ‘‘(B) such other date as may be mutually 

23 agreed by the Secretary and the Tribal Health 

24 Program. 


ycherry on PROD1PC64 with BILLS
183 

•HR 1328 IH

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 

4 quarters provided to a Federal employee in Alaska, such 

5 rents may be based on the cost of comparable private rent6 al housing in the nearest established community with a 

7 year-round population of 1,500 or more individuals. 

8 ‘‘SEC. 315. APPLICABILITY OF BUY AMERICAN ACT RE9 QUIREMENT. 

10 ‘‘(a) APPLICABILITY.—The Secretary shall ensure 

11 that the requirements of the Buy American Act apply to 

12 all procurements made with funds provided pursuant to 

13 section 317. Indian Tribes and Tribal Organizations shall 

14 be exempt from these requirements. 

15 ‘‘(b) EFFECT OF VIOLATION.—If it has been finally 

16 determined by a court or Federal agency that any person 

17 intentionally affixed a label bearing a ‘Made in America’ 

18 inscription or any inscription with the same meaning, to 

19 any product sold in or shipped to the United States that 

20 is not made in the United States, such person shall be 

21 ineligible to receive any contract or subcontract made with 

22 funds provided pursuant to section 317, pursuant to the 

23 debarment, suspension, and ineligibility procedures de24 scribed in sections 9.400 through 9.409 of title 48, Code 

25 of Federal Regulations. 


ycherry on PROD1PC64 with BILLS
184 

•HR 1328 IH

1 ‘‘(c) DEFINITIONS.—For purposes of this section, the 

2 term ‘Buy American Act’ means title III of the Act enti3 tled ‘An Act making appropriations for the Treasury and 

4 Post Office Departments for the fiscal year ending June 

5 30, 1934, and for other purposes’, approved March 3, 

6 1933 (41 U.S.C. 10a et seq.). 

7 ‘‘SEC. 316. OTHER FUNDING FOR FACILITIES. 

8 ‘‘(a) AUTHORITY TO ACCEPT FUNDS.—The Sec9 retary is authorized to accept from any source, including 

10 Federal and State agencies, funds that are available for 

11 the construction of health care facilities and use such 

12 funds to plan, design, and construct health care facilities 

13 for Indians and to place such funds into a contract or com14 pact under the Indian Self-Determination and Education 

15 Assistance Act (25 U.S.C. 450 et seq.). Receipt of such 

16 funds shall have no effect on the priorities established pur17 suant to section 301. 

18 ‘‘(b) INTERAGENCY AGREEMENTS.—The Secretary is 

19 authorized to enter into interagency agreements with 

20 other Federal agencies or State agencies and other entities 

21 and to accept funds from such Federal or State agencies 

22 or other sources to provide for the planning, design, and 

23 construction of health care facilities to be administered by 

24 Indian Health Programs in order to carry out the pur25 poses of this Act and the purposes for which the funds 


ycherry on PROD1PC64 with BILLS
185 

•HR 1328 IH

1 were appropriated or for which the funds were otherwise 

2 provided. 

3 ‘‘(c) ESTABLISHMENT OF STANDARDS.—The Sec4 retary, through the Service, shall establish standards by 

5 regulation for the planning, design, and construction of 

6 health 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 

10 year 2017 to carry out this title. 

11 ‘‘TITLE IV—ACCESS TO HEALTH 

12 SERVICES 

13 ‘‘SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SE14 CURITY 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 

20 to Indians eligible for benefits under such respective titles 

21 shall not be considered in determining appropriations for 

22 the 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 


ycherry on PROD1PC64 with BILLS
186 

•HR 1328 IH

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

6 PAYMENTS DUE TO FACILITIES.—Notwith7 standing any other provision of law, but subject 

8 to paragraph (2), payments to which a facility 

9 of the Service is entitled by reason of a provi10 sion of the Social Security Act shall be placed 

11 in a special fund to be held by the Secretary. 

12 In making payments from such fund, the Sec13 retary shall ensure that each Service Unit of 

14 the Service receives 100 percent of the amount 

15 to which the facilities of the Service, for which 

16 such Service Unit makes collections, are enti17 tled by reason of a provision of the Social Secu18 rity Act. 

19 ‘‘(B) USE OF FUNDS.—Amounts received 

20 by a facility of the Service under subparagraph 

21 (A) shall first be used (to such extent or in 

22 such amounts as are provided in appropriation 

23 Acts) for the purpose of making any improve24 ments in the programs of the Service operated 

25 by or through such facility which may be necVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00186 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
187 

•HR 1328 IH

1 essary to achieve or maintain compliance with 

2 the applicable conditions and requirements of 

3 titles XVIII and XIX of the Social Security 

4 Act. Any amounts so received that are in excess 

5 of the amount necessary to achieve or maintain 

6 such conditions and requirements shall, subject 

7 to consultation with the Indian Tribes being 

8 served by the Service Unit, be used for reducing 

9 the health resource deficiencies (as determined 

10 under section 201(d)) of such Indian Tribes. 

11 ‘‘(2) DIRECT PAYMENT OPTION.—Paragraph 

12 (1) shall not apply to a Tribal Health Program upon 

13 the election of such Program under subsection (d) to 

14 receive payments directly. No payment may be made 

15 out of the special fund described in such paragraph 

16 with respect to reimbursement made for services 

17 provided by such Program during the period of such 

18 election. 

19 ‘‘(d) DIRECT BILLING.— 

20 ‘‘(1) IN GENERAL.—Subject to complying with 

21 the requirements of paragraph (2), a Tribal Health 

22 Program may elect to directly bill for, and receive 

23 payment for, health care items and services provided 

24 by such Program for which payment is made under 


ycherry on PROD1PC64 with BILLS
188 

•HR 1328 IH

1 title XVIII or XIX of the Social Security Act or 

2 from any other third party payor. 

3 ‘‘(2) DIRECT REIMBURSEMENT.— 

4 ‘‘(A) USE OF FUNDS.—Each Tribal Health 

5 Program making the election described in para6 graph (1) with respect to a program under a 

7 title of the Social Security Act shall be reim8 bursed directly by that program for items and 

9 services furnished without regard to subsection 

10 (c)(1), but all amounts so reimbursed shall be 

11 used by the Tribal Health Program for the pur12 pose of making any improvements in facilities 

13 of the Tribal Health Program that may be nec14 essary to achieve or maintain compliance with 

15 the conditions and requirements applicable gen16 erally to such items and services under the pro17 gram under such title and to provide additional 

18 health care services, improvements in health 

19 care facilities and Tribal Health Programs, any 

20 health care related purpose, or otherwise to 

21 achieve the objectives provided in section 3 of 

22 this Act. 

23 ‘‘(B) AUDITS.—The amounts paid to a 

24 Tribal Health Program making the election de25 scribed in paragraph (1) with respect to a proVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00188 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
189 

•HR 1328 IH

1 gram under a title of the Social Security Act 

2 shall be subject to all auditing requirements ap3 plicable to the program under such title, as well 

4 as all auditing requirements applicable to pro5 grams administered by an Indian Health Pro6 gram. Nothing in the preceding sentence shall 

7 be construed as limiting the application of au8 diting requirements applicable to amounts paid 

9 under title XVIII, XIX, or XXI of the Social 

10 Security Act. 

11 ‘‘(C) IDENTIFICATION OF SOURCE OF PAY12 MENTS.—Any Tribal Health Program that re13 ceives reimbursements or payments under title 

14 XVIII, XIX, or XXI of the Social Security Act, 

15 shall provide to the Service a list of each pro16 vider enrollment number (or other identifier) 

17 under which such Program receives such reim18 bursements or payments. 

19 ‘‘(3) EXAMINATION AND IMPLEMENTATION OF

20 CHANGES.— 

21 ‘‘(A) IN GENERAL.—The Secretary, acting 

22 through the Service and with the assistance of 

23 the Administrator of the Centers for Medicare 

24 & Medicaid Services, shall examine on an ongo25 ing basis and implement any administrative 


ycherry on PROD1PC64 with BILLS
190 

•HR 1328 IH

1 changes that may be necessary to facilitate di2 rect billing and reimbursement under the pro3 gram established under this subsection, includ4 ing any agreements with States that may be 

5 necessary to provide for direct billing under a 

6 program under a title of the Social Security 

7 Act. 

8 ‘‘(B) COORDINATION OF INFORMATION.— 

9 The Service shall provide the Administrator of 

10 the Centers for Medicare & Medicaid Services 

11 with copies of the lists submitted to the Service 

12 under paragraph (2)(C), enrollment data re13 garding patients served by the Service (and by 

14 Tribal Health Programs, to the extent such 

15 data is available to the Service), and such other 

16 information as the Administrator may require 

17 for purposes of administering title XVIII, XIX, 

18 or XXI of the Social Security Act. 

19 ‘‘(4) WITHDRAWAL FROM PROGRAM.—A Tribal 

20 Health Program that bills directly under the pro21 gram established under this subsection may with22 draw from participation in the same manner and 

23 under the same conditions that an Indian Tribe or 

24 Tribal Organization may retrocede a contracted pro25 gram to the Secretary under the authority of the InVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00190 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
191 

•HR 1328 IH

1 dian Self-Determination and Education Assistance 

2 Act (25 U.S.C. 450 et seq.). All cost accounting and 

3 billing authority under the program established 

4 under this subsection shall be returned to the Sec5 retary upon the Secretary’s acceptance of the with6 drawal of participation in this program. 

7 ‘‘(5) TERMINATION FOR FAILURE TO COMPLY

8 WITH REQUIREMENTS.—The Secretary may termi9 nate the participation of a Tribal Health Program or 

10 in the direct billing program established under this 

11 subsection if the Secretary determines that the Pro12 gram has failed to comply with the requirements of 

13 paragraph (2). The Secretary shall provide a Tribal 

14 Health Program with notice of a determination that 

15 the Program has failed to comply with any such re16 quirement and a reasonable opportunity to correct 

17 such noncompliance prior to terminating the Pro18 gram’s participation in the direct billing program es19 tablished under this subsection. 

20 ‘‘(e) RELATED PROVISIONS UNDER THE SOCIAL SE21 CURITY ACT.—For provisions related to subsections (c) 

22 and (d), see sections 1880, 1911, and 2107(e)(1)(D) of 

23 the Social Security Act. 


ycherry on PROD1PC64 with BILLS
192 

•HR 1328 IH

1 ‘‘SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERV2 ICE, INDIAN TRIBES, TRIBAL ORGANIZA3 TIONS, AND URBAN INDIAN ORGANIZATIONS 

4 TO FACILITATE OUTREACH, ENROLLMENT, 

5 AND COVERAGE OF INDIANS UNDER SOCIAL 

6 SECURITY ACT HEALTH BENEFIT PROGRAMS 

7 AND OTHER HEALTH BENEFITS PROGRAMS. 

8 ‘‘(a) INDIAN TRIBES AND TRIBAL ORGANIZA9 TIONS.—From funds appropriated to carry out this title 

10 in accordance with section 416, the Secretary, acting 

11 through the Service, shall make grants to or enter into 

12 contracts with Indian Tribes and Tribal Organizations to 

13 assist such Tribes and Tribal Organizations in estab14 lishing and administering programs on or near reserva15 tions and trust lands to assist individual Indians— 

16 ‘‘(1) to enroll for benefits under a program es17 tablished under title XVIII, XIX, or XXI of the So18 cial Security Act and other health benefits pro19 grams; and 

20 ‘‘(2) with respect to such programs for which 

21 the charging of premiums and cost sharing is not 

22 prohibited under such programs, to pay premiums or 

23 cost sharing for coverage for such benefits, which 

24 may be based on financial need (as determined by 

25 the Indian Tribe or Tribes or Tribal Organizations 

26 being served based on a schedule of income levels deVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00192 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
193 

•HR 1328 IH

1 veloped or implemented by such Tribe, Tribes, or 

2 Tribal Organizations). 

3 ‘‘(b) CONDITIONS.—The Secretary, acting through 

4 the Service, shall place conditions as deemed necessary to 

5 effect the purpose of this section in any grant or contract 

6 which the Secretary makes with any Indian Tribe or Trib7 al Organization pursuant to this section. Such conditions 

8 shall include requirements that the Indian Tribe or Tribal 

9 Organization successfully undertake— 

10 ‘‘(1) to determine the population of Indians eli11 gible for the benefits described in subsection (a); 

12 ‘‘(2) to educate Indians with respect to the ben13 efits available under the respective programs; 

14 ‘‘(3) to provide transportation for such indi15 vidual Indians to the appropriate offices for enroll16 ment or applications for such benefits; and 

17 ‘‘(4) to develop and implement methods of im18 proving the participation of Indians in receiving ben19 efits under such programs. 

20 ‘‘(c) APPLICATION TO URBAN INDIAN ORGANIZA21 TIONS.— 

22 ‘‘(1) IN GENERAL.—The provisions of sub23 section (a) shall apply with respect to grants and 

24 other funding to Urban Indian Organizations with 

25 respect to populations served by such organizations 


ycherry on PROD1PC64 with BILLS
194 

•HR 1328 IH

1 in the same manner they apply to grants and con2 tracts with Indian Tribes and Tribal Organizations 

3 with respect to programs on or near reservations. 

4 ‘‘(2) REQUIREMENTS.—The Secretary shall in5 clude in the grants or contracts made or provided 

6 under paragraph (1) requirements that are— 

7 ‘‘(A) consistent with the requirements im8 posed by the Secretary under subsection (b); 

9 ‘‘(B) appropriate to Urban Indian Organi10 zations and Urban Indians; and 

11 ‘‘(C) necessary to effect the purposes of 

12 this section. 

13 ‘‘(d) FACILITATING COOPERATION.—The Secretary, 

14 acting through the Centers for Medicare & Medicaid Serv15 ices, shall take such steps as are necessary to facilitate 

16 cooperation with, and agreements between, States and the 

17 Service, Indian Tribes, Tribal Organizations, or Urban In18 dian Organizations with respect to the provision of health 

19 care items and services to Indians under the programs es20 tablished under title XVIII, XIX, or XXI of the Social 

21 Security Act. 

22 ‘‘(e) AGREEMENTS RELATING TO IMPROVING EN23 ROLLMENT OF INDIANS UNDER SOCIAL SECURITY ACT

24 HEALTH BENEFITS PROGRAMS.—For provisions relating 

25 to agreements between the Secretary, acting through the 


ycherry on PROD1PC64 with BILLS
195 

•HR 1328 IH

1 Service, and Indian Tribes, Tribal Organizations, and 

2 Urban Indian Organizations for the collection, prepara3 tion, and submission of applications by Indians for assist4 ance under the Medicaid and State children’s health insur5 ance programs established under titles XIX and XXI of 

6 the Social Security Act, and benefits under the Medicare 

7 program established under title XVIII of such Act, see 

8 subsections (a) and (b) of section 1139 of the Social Secu9 rity Act. 

10 ‘‘(f) DEFINITION OF PREMIUMS AND COST SHAR11 ING.—In this section: 

12 ‘‘(1) PREMIUM.—The term ‘premium’ includes 

13 any enrollment fee or similar charge. 

14 ‘‘(2) COST SHARING.—The term ‘cost sharing’ 

15 includes any deduction, deductible, copayment, coin16 surance, or similar charge. 

17 ‘‘SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PAR18 TIES OF COSTS OF HEALTH SERVICES. 

19 ‘‘(a) RIGHT OF RECOVERY.—Except as provided in 

20 subsection (f), the United States, an Indian Tribe, or 

21 Tribal Organization shall have the right to recover from 

22 an insurance company, health maintenance organization, 

23 employee benefit plan, third-party tortfeasor, or any other 

24 responsible or liable third party (including a political sub25 division or local governmental entity of a State) the reaVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00195 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
196 

•HR 1328 IH

1 sonable charges billed by the Secretary, an Indian Tribe, 

2 or Tribal Organization in providing health services 

3 through the Service, an Indian Tribe, or Tribal Organiza4 tion to any individual to the same extent that such indi5 vidual, or any nongovernmental provider of such services, 

6 would be eligible to receive damages, reimbursement, or 

7 indemnification for such charges or expenses if— 

8 ‘‘(1) such services had been provided by a non9 governmental provider; and 

10 ‘‘(2) such individual had been required to pay 

11 such charges or expenses and did pay such charges 

12 or expenses. 

13 ‘‘(b) LIMITATIONS ON RECOVERIES FROM STATES.— 

14 Subsection (a) shall provide a right of recovery against 

15 any State, only if the injury, illness, or disability for which 

16 health services were provided is covered under— 

17 ‘‘(1) workers’ compensation laws; or 

18 ‘‘(2) a no-fault automobile accident insurance 

19 plan or program. 

20 ‘‘(c) NONAPPLICATION OF OTHER LAWS.—No law of 

21 any State, or of any political subdivision of a State and 

22 no provision of any contract, insurance or health mainte23 nance organization policy, employee benefit plan, self-in24 surance plan, managed care plan, or other health care plan 

25 or program entered into or renewed after the date of the 


ycherry on PROD1PC64 with BILLS
197 

•HR 1328 IH

1 enactment of the Indian Health Care Amendments of 

2 1988, shall prevent or hinder the right of recovery of the 

3 United States, an Indian Tribe, or Tribal Organization 

4 under subsection (a). 

5 ‘‘(d) NO EFFECT ON PRIVATE RIGHTS OF ACTION.— 

6 No action taken by the United States, an Indian Tribe, 

7 or Tribal Organization to enforce the right of recovery 

8 provided under this section shall operate to deny to the 

9 injured person the recovery for that portion of the person’s 

10 damage not covered hereunder. 

11 ‘‘(e) ENFORCEMENT.— 

12 ‘‘(1) IN GENERAL.—The United States, an In13 dian Tribe, or Tribal Organization may enforce the 

14 right of recovery provided under subsection (a) by— 

15 ‘‘(A) intervening or joining in any civil ac16 tion or proceeding brought— 

17 ‘‘(i) by the individual for whom health 

18 services were provided by the Secretary, an 

19 Indian Tribe, or Tribal Organization; or 

20 ‘‘(ii) by any representative or heirs of 

21 such individual, or 

22 ‘‘(B) instituting a civil action, including a 

23 civil action for injunctive relief and other relief 

24 and including, with respect to a political subVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00197 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
198 

•HR 1328 IH

1 division or local governmental entity of a State, 

2 such an action against an official thereof. 

3 ‘‘(2) NOTICE.—All reasonable efforts shall be 

4 made to provide notice of action instituted under 

5 paragraph (1)(B) to the individual to whom health 

6 services were provided, either before or during the 

7 pendency of such action. 

8 ‘‘(3) RECOVERY FROM TORTFEASORS.— 

9 ‘‘(A) IN GENERAL.—In any case in which 

10 an Indian Tribe or Tribal Organization that is 

11 authorized or required under a compact or con12 tract issued pursuant to the Indian Self-Deter13 mination and Education Assistance Act (25 

14 U.S.C. 450 et seq.) to furnish or pay for health 

15 services to a person who is injured or suffers a 

16 disease on or after the date of enactment of the 

17 Indian Health Care Improvement Act Amend18 ments of 2007 under circumstances that estab19 lish grounds for a claim of liability against the 

20 tortfeasor with respect to the injury or disease, 

21 the Indian Tribe or Tribal Organization shall 

22 have a right to recover from the tortfeasor (or 

23 an insurer of the tortfeasor) the reasonable 

24 value of the health services so furnished, paid 

25 for, or to be paid for, in accordance with the 


ycherry on PROD1PC64 with BILLS
199 

•HR 1328 IH

1 Federal Medical Care Recovery Act (42 U.S.C. 

2 2651 et seq.), to the same extent and under the 

3 same circumstances as the United States may 

4 recover under that Act. 

5 ‘‘(B) TREATMENT.—The right of an In6 dian Tribe or Tribal Organization to recover 

7 under subparagraph (A) shall be independent of 

8 the rights of the injured or diseased person 

9 served by the Indian Tribe or Tribal Organiza10 tion. 

11 ‘‘(f) LIMITATION.—Absent specific written authoriza12 tion by the governing body of an Indian Tribe for the pe13 riod of such authorization (which may not be for a period 

14 of more than 1 year and which may be revoked at any 

15 time upon written notice by the governing body to the 

16 Service), the United States shall not have a right of recov17 ery under this section if the injury, illness, or disability 

18 for which health services were provided is covered under 

19 a self-insurance plan funded by an Indian Tribe, Tribal 

20 Organization, or Urban Indian Organization. Where such 

21 authorization is provided, the Service may receive and ex22 pend such amounts for the provision of additional health 

23 services consistent with such authorization. 

24 ‘‘(g) COSTS AND ATTORNEYS’ FEES.—In any action 

25 brought to enforce the provisions of this section, a preVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00199 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
200 

•HR 1328 IH

1 vailing plaintiff shall be awarded its reasonable attorneys’ 

2 fees and costs of litigation. 

3 ‘‘(h) NONAPPLICATION OF CLAIMS FILING REQUIRE4 MENTS.—An insurance company, health maintenance or5 ganization, self-insurance plan, managed care plan, or 

6 other health care plan or program (under the Social Secu7 rity Act or otherwise) may not deny a claim for benefits 

8 submitted by the Service or by an Indian Tribe or Tribal 

9 Organization based on the format in which the claim is 

10 submitted if such format complies with the format re11 quired for submission of claims under title XVIII of the 

12 Social Security Act or recognized under section 1175 of 

13 such Act. 

14 ‘‘(i) APPLICATION TO URBAN INDIAN ORGANIZA15 TIONS.—The previous provisions of this section shall apply 

16 to Urban Indian Organizations with respect to populations 

17 served by such Organizations in the same manner they 

18 apply to Indian Tribes and Tribal Organizations with re19 spect to populations served by such Indian Tribes and 

20 Tribal Organizations. 

21 ‘‘(j) STATUTE OF LIMITATIONS.—The provisions of 

22 section 2415 of title 28, United States Code, shall apply 

23 to all actions commenced under this section, and the ref24 erences therein to the United States are deemed to include 


ycherry on PROD1PC64 with BILLS
201 

•HR 1328 IH

1 Indian Tribes, Tribal Organizations, and Urban Indian 

2 Organizations. 

3 ‘‘(k) SAVINGS.—Nothing in this section shall be con4 strued to limit any right of recovery available to the 

5 United States, an Indian Tribe, or Tribal Organization 

6 under the provisions of any applicable, Federal, State, or 

7 Tribal law, including medical lien laws. 

8 ‘‘SEC. 404. CREDITING OF REIMBURSEMENTS. 

9 ‘‘(a) USE OF AMOUNTS.— 

10 ‘‘(1) RETENTION BY PROGRAM.—Except as pro11 vided in section 202(f) (relating to the Catastrophic 

12 Health Emergency Fund) and section 807 (relating 

13 to health services for ineligible persons), all reim14 bursements received or recovered under any of the 

15 programs described in paragraph (2), including 

16 under section 807, by reason of the provision of 

17 health services by the Service, by an Indian Tribe or 

18 Tribal Organization, or by an Urban Indian Organi19 zation, shall be credited to the Service, such Indian 

20 Tribe or Tribal Organization, or such Urban Indian 

21 Organization, respectively, and may be used as pro22 vided in section 401. In the case of such a service 

23 provided by or through a Service Unit, such 

24 amounts shall be credited to such unit and used for 

25 such purposes. 


ycherry on PROD1PC64 with BILLS
202 

•HR 1328 IH

1 ‘‘(2) PROGRAMS COVERED.—The programs re2 ferred to in paragraph (1) are the following: 

3 ‘‘(A) Titles XVIII, XIX, and XXI of the 

4 Social Security Act. 

5 ‘‘(B) This Act, including section 807. 

6 ‘‘(C) Public Law 87–693. 

7 ‘‘(D) Any other provision of law. 

8 ‘‘(b) NO OFFSET OF AMOUNTS.—The Service may 

9 not offset or limit any amount obligated to any Service 

10 Unit or entity receiving funding from the Service because 

11 of the receipt of reimbursements under subsection (a). 

12 ‘‘SEC. 405. PURCHASING HEALTH CARE COVERAGE. 

13 ‘‘(a) IN GENERAL.—Insofar as amounts are made 

14 available under law (including a provision of the Social 

15 Security Act, the Indian Self-Determination and Edu16 cation Assistance Act (25 U.S.C. 450 et seq.), or other 

17 law, other than under section 402) to Indian Tribes, Trib18 al Organizations, and Urban Indian Organizations for 

19 health benefits for Service beneficiaries, Indian Tribes, 

20 Tribal Organizations, and Urban Indian Organizations 

21 may use such amounts to purchase health benefits cov22 erage for such beneficiaries in any manner, including 

23 through— 

24 ‘‘(1) a tribally owned and operated health care 

25 plan; 


ycherry on PROD1PC64 with BILLS
203 

•HR 1328 IH

1 ‘‘(2) a State or locally authorized or licensed 

2 health care plan; 

3 ‘‘(3) a health insurance provider or managed 

4 care organization; or 

5 ‘‘(4) a self-insured plan. 

6 The purchase of such coverage by an Indian Tribe, Tribal 

7 Organization, or Urban Indian Organization may be based 

8 on the financial needs of such beneficiaries (as determined 

9 by the Indian Tribe or Tribes being served based on a 

10 schedule of income levels developed or implemented by 

11 such Indian Tribe or Tribes). 

12 ‘‘(b) EXPENSES FOR SELF-INSURED PLAN.—In the 

13 case of a self-insured plan under subsection (a)(4), the 

14 amounts may be used for expenses of operating the plan, 

15 including administration and insurance to limit the finan16 cial risks to the entity offering the plan. 

17 ‘‘(c) CONSTRUCTION.—Nothing in this section shall 

18 be construed as affecting the use of any amounts not re19 ferred to in subsection (a). 

20 ‘‘SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGEN21 CIES. 

22 ‘‘(a) AUTHORITY.— 

23 ‘‘(1) IN GENERAL.—The Secretary may enter 

24 into (or expand) arrangements for the sharing of 

25 medical facilities and services between the Service, 


ycherry on PROD1PC64 with BILLS
204 

•HR 1328 IH

1 Indian Tribes, and Tribal Organizations and the De2 partment of Veterans Affairs and the Department of 

3 Defense. 

4 ‘‘(2) CONSULTATION BY SECRETARY RE5 QUIRED.—The Secretary may not finalize any ar6 rangement between the Service and a Department 

7 described in paragraph (1) without first consulting 

8 with the Indian Tribes which will be significantly af9 fected by the arrangement. 

10 ‘‘(b) LIMITATIONS.—The Secretary shall not take 

11 any action under this section or under subchapter IV of 

12 chapter 81 of title 38, United States Code, which would 

13 impair— 

14 ‘‘(1) the priority access of any Indian to health 

15 care services provided through the Service and the 

16 eligibility of any Indian to receive health services 

17 through the Service; 

18 ‘‘(2) the quality of health care services provided 

19 to any Indian through the Service; 

20 ‘‘(3) the priority access of any veteran to health 

21 care services provided by the Department of Vet22 erans Affairs; 

23 ‘‘(4) the quality of health care services provided 

24 by the Department of Veterans Affairs or the De25 partment of Defense; or 


ycherry on PROD1PC64 with BILLS
205 

•HR 1328 IH

1 ‘‘(5) the eligibility of any Indian who is a vet2 eran to receive health services through the Depart3 ment of Veterans Affairs. 

4 ‘‘(c) REIMBURSEMENT.—The Service, Indian Tribe, 

5 or Tribal Organization shall be reimbursed by the Depart6 ment of Veterans Affairs or the Department of Defense 

7 (as the case may be) where services are provided through 

8 the Service, an Indian Tribe, or a Tribal Organization to 

9 beneficiaries eligible for services from either such Depart10 ment, notwithstanding any other provision of law. 

11 ‘‘(d) CONSTRUCTION.—Nothing in this section may 

12 be construed as creating any right of a non-Indian veteran 

13 to obtain health services from the Service. 

14 ‘‘SEC. 407. PAYOR OF LAST RESORT. 

15 ‘‘Indian Health Programs and health care programs 

16 operated by Urban Indian Organizations shall be the 

17 payor of last resort for services provided to persons eligible 

18 for services from Indian Health Programs and Urban In19 dian Organizations, notwithstanding any Federal, State, 

20 or local law to the contrary. 

21 ‘‘SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH 

22 CARE PROGRAMS IN QUALIFICATIONS FOR 

23 REIMBURSEMENT FOR SERVICES. 

24 ‘‘(a) REQUIREMENT TO SATISFY GENERALLY APPLI25 CABLE PARTICIPATION REQUIREMENTS.— 


ycherry on PROD1PC64 with BILLS
206 

•HR 1328 IH

1 ‘‘(1) IN GENERAL.—A Federal health care pro2 gram must accept an entity that is operated by the 

3 Service, an Indian Tribe, Tribal Organization, or 

4 Urban Indian Organization as a provider eligible to 

5 receive payment under the program for health care 

6 services furnished to an Indian on the same basis as 

7 any other provider qualified to participate as a pro8 vider of health care services under the program if 

9 the entity meets generally applicable State or other 

10 requirements for participation as a provider of 

11 health care services under the program. 

12 ‘‘(2) SATISFACTION OF STATE OR LOCAL LICEN13 SURE OR RECOGNITION REQUIREMENTS.—Any re14 quirement for participation as a provider of health 

15 care services under a Federal health care program 

16 that an entity be licensed or recognized under the 

17 State or local law where the entity is located to fur18 nish health care services shall be deemed to have 

19 been met in the case of an entity operated by the 

20 Service, an Indian Tribe, Tribal Organization, or 

21 Urban Indian Organization if the entity meets all 

22 the applicable standards for such licensure or rec23 ognition, regardless of whether the entity obtains a 

24 license or other documentation under such State or 

25 local law. In accordance with section 221, the abVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00206 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
207 

•HR 1328 IH

1 sence of the licensure of a health care professional 

2 employed by such an entity under the State or local 

3 law where the entity is located shall not be taken 

4 into account for purposes of determining whether 

5 the entity meets such standards, if the professional 

6 is licensed in another State. 

7 ‘‘(b) APPLICATION OF EXCLUSION FROM PARTICIPA8 TION IN FEDERAL HEALTH CARE PROGRAMS.— 

9 ‘‘(1) EXCLUDED ENTITIES.—No entity operated 

10 by the Service, an Indian Tribe, Tribal Organiza11 tion, or Urban Indian Organization that has been 

12 excluded from participation in any Federal health 

13 care program or for which a license is under suspen14 sion or has been revoked by the State where the en15 tity is located shall be eligible to receive payment or 

16 reimbursement under any such program for health 

17 care services furnished to an Indian. 

18 ‘‘(2) EXCLUDED INDIVIDUALS.—No individual 

19 who has been excluded from participation in any 

20 Federal health care program or whose State license 

21 is under suspension shall be eligible to receive pay22 ment or reimbursement under any such program for 

23 health care services furnished by that individual, di24 rectly or through an entity that is otherwise eligible 


ycherry on PROD1PC64 with BILLS
208 

•HR 1328 IH

1 to receive payment for health care services, to an In2 dian. 

3 ‘‘(3) FEDERAL HEALTH CARE PROGRAM DE4 FINED.—In this subsection, the term, ‘Federal 

5 health care program’ has the meaning given that 

6 term in section 1128B(f) of the Social Security Act 

7 (42 U.S.C. 1320a–7b(f)), except that, for purposes 

8 of this subsection, such term shall include the health 

9 insurance program under chapter 89 of title 5, 

10 United States Code. 

11 ‘‘(c) RELATED PROVISIONS.—For provisions related 

12 to nondiscrimination against providers operated by the 

13 Service, an Indian Tribe, Tribal Organization, or Urban 

14 Indian Organization, see section 1139(c) of the Social Se15 curity Act (42 U.S.C. 1320b–9(c)). 

16 ‘‘SEC. 409. CONSULTATION. 

17 ‘‘For provisions related to consultation with rep18 resentatives of Indian Health Programs and Urban Indian 

19 Organizations with respect to the health care programs 

20 established under titles XVIII, XIX, and XXI of the Social 

21 Security Act, see section 1139(d) of the Social Security 

22 Act (42 U.S.C. 1320b–9(d)). 

23 ‘‘SEC. 410. STATE CHILDREN’S HEALTH INSURANCE PRO24 GRAM (SCHIP). 

25 ‘‘For provisions relating to— 


ycherry on PROD1PC64 with BILLS
209 

•HR 1328 IH

1 ‘‘(1) outreach to families of Indian children 

2 likely to be eligible for child health assistance under 

3 the State children’s health insurance program estab4 lished under title XXI of the Social Security Act, see 

5 sections 2105(c)(2)(C) and 1139(a) of such Act (42 

6 U.S.C. 1397ee(c)(2), 1320b–9); and 

7 ‘‘(2) ensuring that child health assistance is 

8 provided under such program to targeted low-income 

9 children who are Indians and that payments are 

10 made under such program to Indian Health Pro11 grams and Urban Indian Organizations operating in 

12 the State that provide such assistance, see sections 

13 2102(b)(3)(D) and 2105(c)(6)(B) of such Act (42 

14 U.S.C. 1397bb(b)(3)(D), 1397ee(c)(6)(B)). 

15 ‘‘SEC. 411. EXCLUSION WAIVER AUTHORITY FOR AFFECTED 

16 INDIAN HEALTH PROGRAMS AND SAFE HAR17 BOR TRANSACTIONS UNDER THE SOCIAL SE18 CURITY ACT. 

19 ‘‘For provisions relating to— 

20 ‘‘(1) exclusion waiver authority for affected In21 dian Health Programs under the Social Security 

22 Act, see section 1128(k) of the Social Security Act 

23 (42 U.S.C. 1320a–7(k)); and 

24 ‘‘(2) certain transactions involving Indian 

25 Health Programs deemed to be in safe harbors 


ycherry on PROD1PC64 with BILLS
210 

•HR 1328 IH

1 under that Act, see section 1128B(b)(4) of the So2 cial Security Act (42 U.S.C. 1320a–7b(b)(4)). 

3 ‘‘SEC. 412. PREMIUM AND COST SHARING PROTECTIONS 

4 AND ELIGIBILITY DETERMINATIONS UNDER 

5 MEDICAID AND SCHIP AND PROTECTION OF 

6 CERTAIN INDIAN PROPERTY FROM MEDICAID 

7 ESTATE RECOVERY. 

8 ‘‘For provisions relating to— 

9 ‘‘(1) premiums or cost sharing protections for 

10 Indians furnished items or services directly by In11 dian Health Programs or through referral under the 

12 contract health service under the Medicaid program 

13 established under title XIX of the Social Security 

14 Act, see sections 1916(j) and 1916A(a)(1) of the So15 cial Security Act (42 U.S.C. 1396o(j), 1396o– 

16 1(a)(1)); 

17 ‘‘(2) rules regarding the treatment of certain 

18 property for purposes of determining eligibility 

19 under such programs, see sections 1902(e)(13) and 

20 2107(e)(1)(B) of such Act (42 U.S.C. 1396a(e)(13), 

21 1397gg(e)(1)(B)); and 

22 ‘‘(3) the protection of certain property from es23 tate recovery provisions under the Medicaid pro24 gram, see section 1917(b)(3)(B) of such Act (42 

25 U.S.C. 1396p(b)(3)(B)). 


ycherry on PROD1PC64 with BILLS
211 

•HR 1328 IH

1 ‘‘SEC. 413. TREATMENT UNDER MEDICAID AND SCHIP MAN2 AGED CARE. 

3 ‘‘For provisions relating to the treatment of Indians 

4 enrolled in a managed care entity under the Medicaid pro5 gram under title XIX of the Social Security Act and In6 dian Health Programs and Urban Indian Organizations 

7 that are providers of items or services to such Indian en8 rollees, see sections 1932(h) and 2107(e)(1)(H) of the So9 cial Security Act (42 U.S.C. 1396u–2(h), 

10 1397gg(e)(1)(H)). 

11 ‘‘SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASI12 BILITY STUDY. 

13 ‘‘(a) STUDY.—The Secretary shall conduct a study 

14 to determine the feasibility of treating the Navajo Nation 

15 as a State for the purposes of title XIX of the Social Secu16 rity Act, to provide services to Indians living within the 

17 boundaries of the Navajo Nation through an entity estab18 lished having the same authority and performing the same 

19 functions as single-State medicaid agencies responsible for 

20 the administration of the State plan under title XIX of 

21 the Social Security Act. 

22 ‘‘(b) CONSIDERATIONS.—In conducting the study, 

23 the Secretary shall consider the feasibility of— 

24 ‘‘(1) assigning and paying all expenditures for 

25 the provision of services and related administration 

26 funds, under title XIX of the Social Security Act, to 


ycherry on PROD1PC64 with BILLS
212 

•HR 1328 IH

1 Indians living within the boundaries of the Navajo 

2 Nation that are currently paid to or would otherwise 

3 be paid to the State of Arizona, New Mexico, or 

4 Utah; 

5 ‘‘(2) providing assistance to the Navajo Nation 

6 in the development and implementation of such enti7 ty for the administration, eligibility, payment, and 

8 delivery of medical assistance under title XIX of the 

9 Social Security Act; 

10 ‘‘(3) providing an appropriate level of matching 

11 funds for Federal medical assistance with respect to 

12 amounts such entity expends for medical assistance 

13 for services and related administrative costs; and 

14 ‘‘(4) authorizing the Secretary, at the option of 

15 the Navajo Nation, to treat the Navajo Nation as a 

16 State for the purposes of title XIX of the Social Se17 curity Act (relating to the State children’s health in18 surance program) under terms equivalent to those 

19 described in paragraphs (2) through (4). 

20 ‘‘(c) REPORT.—Not later then 3 years after the date 

21 of enactment of the Indian Health Care Improvement Act 

22 Amendments of 2007, the Secretary shall submit to the 

23 Committee on Indian Affairs and Committee on Finance 

24 of the Senate and the Committee on Natural Resources 


ycherry on PROD1PC64 with BILLS
213 

•HR 1328 IH

1 and Committee on Energy and Commerce of the House 

2 of Representatives a report that includes— 

3 ‘‘(1) the results of the study under this section; 

4 ‘‘(2) a summary of any consultation that oc5 curred between the Secretary and the Navajo Na6 tion, other Indian Tribes, the States of Arizona, 

7 New Mexico, and Utah, counties which include Nav8 ajo Lands, and other interested parties, in con9 ducting this study; 

10 ‘‘(3) projected costs or savings associated with 

11 establishment of such entity, and any estimated im12 pact on services provided as described in this section 

13 in relation to probable costs or savings; and 

14 ‘‘(4) legislative actions that would be required 

15 to authorize the establishment of such entity if such 

16 entity is determined by the Secretary to be feasible. 

17 ‘‘SEC. 415. GENERAL EXCEPTIONS. 

18 ‘‘The requirements of this title shall not apply to any 

19 excepted benefits described in paragraph (1)(A) or (3) of 

20 section 2791(c) of the Public Health Service Act (42 

21 U.S.C. 300gg–91). 

22 ‘‘SEC. 416. AUTHORIZATION OF APPROPRIATIONS. 

23 ‘‘There are authorized to be appropriated such sums 

24 as may be necessary for each fiscal year through fiscal 

25 year 2017 to carry out this title. 


ycherry on PROD1PC64 with BILLS
214 

•HR 1328 IH

1 ‘‘TITLE V—HEALTH SERVICES 

2 FOR URBAN INDIANS 

3 ‘‘SEC. 501. PURPOSE. 

4 ‘‘The purpose of this title is to establish and maintain 

5 programs in Urban Centers to make health services more 

6 accessible and available to Urban Indians. 

7 ‘‘SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN IN8 DIAN ORGANIZATIONS. 

9 ‘‘Under authority of the Act of November 2, 1921 

10 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

11 the Secretary, acting through the Service, shall enter into 

12 contracts with, or make grants to, Urban Indian Organi13 zations to assist such organizations in the establishment 

14 and administration, within Urban Centers, of programs 

15 which meet the requirements set forth in this title. Subject 

16 to section 506, the Secretary, acting through the Service, 

17 shall include such conditions as the Secretary considers 

18 necessary to effect the purpose of this title in any contract 

19 into which the Secretary enters with, or in any grant the 

20 Secretary makes to, any Urban Indian Organization pur21 suant to this title. 

22 ‘‘SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION 

23 OF HEALTH CARE AND REFERRAL SERVICES. 

24 ‘‘(a) REQUIREMENTS FOR GRANTS AND CON25 TRACTS.—Under authority of the Act of November 2, 


ycherry on PROD1PC64 with BILLS
215 

•HR 1328 IH

1 1921 (25 U.S.C. 13) (commonly known as the ‘Snyder 

2 Act’), the Secretary, acting through the Service, shall 

3 enter into contracts with, and make grants to, Urban In4 dian Organizations for the provision of health care and 

5 referral services for Urban Indians. Any such contract or 

6 grant shall include requirements that the Urban Indian 

7 Organization successfully undertake to— 

8 ‘‘(1) estimate the population of Urban Indians 

9 residing in the Urban Center or centers that the or10 ganization proposes to serve who are or could be re11 cipients of health care or referral services; 

12 ‘‘(2) estimate the current health status of 

13 Urban Indians residing in such Urban Center or 

14 centers; 

15 ‘‘(3) estimate the current health care needs of 

16 Urban Indians residing in such Urban Center or 

17 centers; 

18 ‘‘(4) provide basic health education, including 

19 health promotion and disease prevention education, 

20 to Urban Indians; 

21 ‘‘(5) make recommendations to the Secretary 

22 and Federal, State, local, and other resource agen23 cies on methods of improving health service pro24 grams to meet the needs of Urban Indians; and 


ycherry on PROD1PC64 with BILLS
216 

•HR 1328 IH

1 ‘‘(6) where necessary, provide, or enter into 

2 contracts for the provision of, health care services 

3 for Urban Indians. 

4 ‘‘(b) CRITERIA.—The Secretary, acting through the 

5 Service, shall, by regulation, prescribe the criteria for se6 lecting Urban Indian Organizations to enter into contracts 

7 or receive grants under this section. Such criteria shall, 

8 among other factors, include— 

9 ‘‘(1) the extent of unmet health care needs of 

10 Urban Indians in the Urban Center or centers in11 volved; 

12 ‘‘(2) the size of the Urban Indian population in 

13 the Urban Center or centers involved; 

14 ‘‘(3) the extent, if any, to which the activities 

15 set forth in subsection (a) would duplicate any 

16 project funded under this title, or under any current 

17 public health service project funded in a manner 

18 other than pursuant to this title; 

19 ‘‘(4) the capability of an Urban Indian Organi20 zation to perform the activities set forth in sub21 section (a) and to enter into a contract with the Sec22 retary or to meet the requirements for receiving a 

23 grant under this section; 


ycherry on PROD1PC64 with BILLS
217 

•HR 1328 IH

1 ‘‘(5) the satisfactory performance and success2 ful completion by an Urban Indian Organization of 

3 other contracts with the Secretary under this title; 

4 ‘‘(6) the appropriateness and likely effectiveness 

5 of conducting the activities set forth in subsection 

6 (a) in an Urban Center or centers; and 

7 ‘‘(7) the extent of existing or likely future par8 ticipation in the activities set forth in subsection (a) 

9 by appropriate health and health-related Federal, 

10 State, local, and other agencies. 

11 ‘‘(c) ACCESS TO HEALTH PROMOTION AND DISEASE

12 PREVENTION PROGRAMS.—The Secretary, acting through 

13 the Service, shall facilitate access to or provide health pro14 motion and disease prevention services for Urban Indians 

15 through grants made to Urban Indian Organizations ad16 ministering contracts entered into or receiving grants 

17 under subsection (a). 

18 ‘‘(d) IMMUNIZATION SERVICES.— 

19 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

20 Secretary, acting through the Service, shall facilitate 

21 access to, or provide, immunization services for 

22 Urban Indians through grants made to Urban In23 dian Organizations administering contracts entered 

24 into or receiving grants under this section. 


ycherry on PROD1PC64 with BILLS
218 

•HR 1328 IH

1 ‘‘(2) DEFINITION.—For purposes of this sub2 section, the term ‘immunization services’ means 

3 services to provide without charge immunizations 

4 against vaccine-preventable diseases. 

5 ‘‘(e) BEHAVIORAL HEALTH SERVICES.— 

6 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

7 Secretary, acting through the Service, shall facilitate 

8 access to, or provide, behavioral health services for 

9 Urban Indians through grants made to Urban In10 dian Organizations administering contracts entered 

11 into or receiving grants under subsection (a). 

12 ‘‘(2) ASSESSMENT REQUIRED.—Except as pro13 vided by paragraph (3)(A), a grant may not be made 

14 under this subsection to an Urban Indian Organiza15 tion until that organization has prepared, and the 

16 Service has approved, an assessment of the fol17 lowing: 

18 ‘‘(A) The behavioral health needs of the 

19 Urban Indian population concerned. 

20 ‘‘(B) The behavioral health services and 

21 other related resources available to that popu22 lation. 

23 ‘‘(C) The barriers to obtaining those serv24 ices and resources. 


ycherry on PROD1PC64 with BILLS
219 

•HR 1328 IH

1 ‘‘(D) The needs that are unmet by such 

2 services and resources. 

3 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

4 made under this subsection for the following: 

5 ‘‘(A) To prepare assessments required 

6 under paragraph (2). 

7 ‘‘(B) To provide outreach, educational, and 

8 referral services to Urban Indians regarding the 

9 availability of direct behavioral health services, 

10 to educate Urban Indians about behavioral 

11 health issues and services, and effect coordina12 tion with existing behavioral health providers in 

13 order to improve services to Urban Indians. 

14 ‘‘(C) To provide outpatient behavioral 

15 health services to Urban Indians, including the 

16 identification and assessment of illness, thera17 peutic treatments, case management, support 

18 groups, family treatment, and other treatment. 

19 ‘‘(D) To develop innovative behavioral 

20 health service delivery models which incorporate 

21 Indian cultural support systems and resources. 

22 ‘‘(f) PREVENTION OF CHILD ABUSE.— 

23 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

24 Secretary, acting through the Service, shall facilitate 

25 access to or provide services for Urban Indians 


ycherry on PROD1PC64 with BILLS
220 

•HR 1328 IH

1 through grants to Urban Indian Organizations ad2 ministering contracts entered into or receiving 

3 grants under subsection (a) to prevent and treat 

4 child abuse (including sexual abuse) among Urban 

5 Indians. 

6 ‘‘(2) EVALUATION REQUIRED.—Except as pro7 vided by paragraph (3)(A), a grant may not be made 

8 under this subsection to an Urban Indian Organiza9 tion until that organization has prepared, and the 

10 Service has approved, an assessment that documents 

11 the prevalence of child abuse in the Urban Indian 

12 population concerned and specifies the services and 

13 programs (which may not duplicate existing services 

14 and programs) for which the grant is requested. 

15 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

16 made under this subsection for the following: 

17 ‘‘(A) To prepare assessments required 

18 under paragraph (2). 

19 ‘‘(B) For the development of prevention, 

20 training, and education programs for Urban In21 dians, including child education, parent edu22 cation, provider training on identification and 

23 intervention, education on reporting require24 ments, prevention campaigns, and establishing 


ycherry on PROD1PC64 with BILLS
221 

•HR 1328 IH

1 service networks of all those involved in Indian 

2 child protection. 

3 ‘‘(C) To provide direct outpatient treat4 ment services (including individual treatment, 

5 family treatment, group therapy, and support 

6 groups) to Urban Indians who are child victims 

7 of abuse (including sexual abuse) or adult sur8 vivors of child sexual abuse, to the families of 

9 such child victims, and to Urban Indian per10 petrators of child abuse (including sexual 

11 abuse). 

12 ‘‘(4) CONSIDERATIONS WHEN MAKING

13 GRANTS.—In making grants to carry out this sub14 section, the Secretary shall take into consideration— 

15 ‘‘(A) the support for the Urban Indian Or16 ganization demonstrated by the child protection 

17 authorities in the area, including committees or 

18 other services funded under the Indian Child 

19 Welfare Act of 1978 (25 U.S.C. 1901 et seq.), 

20 if any; 

21 ‘‘(B) the capability and expertise dem22 onstrated by the Urban Indian Organization to 

23 address the complex problem of child sexual 

24 abuse in the community; and 


ycherry on PROD1PC64 with BILLS
222 

•HR 1328 IH

1 ‘‘(C) the assessment required under para2 graph (2). 

3 ‘‘(g) OTHER GRANTS.—The Secretary, acting 

4 through the Service, may enter into a contract with or 

5 make grants to an Urban Indian Organization that pro6 vides or arranges for the provision of health care services 

7 (through satellite facilities, provider networks, or other8 wise) to Urban Indians in more than 1 Urban Center. 

9 ‘‘SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINA10 TION OF UNMET HEALTH CARE NEEDS. 

11 ‘‘(a) GRANTS AND CONTRACTS AUTHORIZED.— 

12 Under authority of the Act of November 2, 1921 (25 

13 U.S.C. 13) (commonly known as the ‘Snyder Act’), the 

14 Secretary, acting through the Service, may enter into con15 tracts with or make grants to Urban Indian Organizations 

16 situated in Urban Centers for which contracts have not 

17 been entered into or grants have not been made under sec18 tion 503. 

19 ‘‘(b) PURPOSE.—The purpose of a contract or grant 

20 made under this section shall be the determination of the 

21 matters described in subsection (c)(1) in order to assist 

22 the Secretary in assessing the health status and health 

23 care needs of Urban Indians in the Urban Center involved 

24 and determining whether the Secretary should enter into 

25 a contract or make a grant under section 503 with respect 


ycherry on PROD1PC64 with BILLS
223 

•HR 1328 IH

1 to the Urban Indian Organization which the Secretary has 

2 entered into a contract with, or made a grant to, under 

3 this section. 

4 ‘‘(c) GRANT AND CONTRACT REQUIREMENTS.—Any 

5 contract entered into, or grant made, by the Secretary 

6 under this section shall include requirements that— 

7 ‘‘(1) the Urban Indian Organization success8 fully undertakes to— 

9 ‘‘(A) document the health care status and 

10 unmet health care needs of Urban Indians in 

11 the Urban Center involved; and 

12 ‘‘(B) with respect to Urban Indians in the 

13 Urban Center involved, determine the matters 

14 described in paragraphs (2), (3), (4), and (7) of 

15 section 503(b); and 

16 ‘‘(2) the Urban Indian Organization complete 

17 performance of the contract, or carry out the re18 quirements of the grant, within 1 year after the date 

19 on which the Secretary and such organization enter 

20 into such contract, or within 1 year after such orga21 nization receives such grant, whichever is applicable. 

22 ‘‘(d) NO RENEWALS.—The Secretary may not renew 

23 any contract entered into or grant made under this sec24 tion. 


ycherry on PROD1PC64 with BILLS
224 

•HR 1328 IH

1 ‘‘SEC. 505. EVALUATIONS; RENEWALS. 

2 ‘‘(a) PROCEDURES FOR EVALUATIONS.—The Sec3 retary, acting through the Service, shall develop proce4 dures to evaluate compliance with grant requirements and 

5 compliance with and performance of contracts entered into 

6 by Urban Indian Organizations under this title. Such pro7 cedures shall include provisions for carrying out the re8 quirements of this section. 

9 ‘‘(b) EVALUATIONS.—The Secretary, acting through 

10 the Service, shall evaluate the compliance of each Urban 

11 Indian Organization which has entered into a contract or 

12 received a grant under section 503 with the terms of such 

13 contract or grant. For purposes of this evaluation, the 

14 Secretary shall— 

15 ‘‘(1) acting through the Service, conduct an an16 nual onsite evaluation of the organization; or 

17 ‘‘(2) accept in lieu of such onsite evaluation evi18 dence of the organization’s provisional or full accred19 itation by a private independent entity recognized by 

20 the Secretary for purposes of conducting quality re21 views of providers participating in the Medicare pro22 gram under title XVIII of the Social Security Act. 

23 ‘‘(c) NONCOMPLIANCE; UNSATISFACTORY PERFORM24 ANCE.—If, as a result of the evaluations conducted under 

25 this section, the Secretary determines that an Urban In26 dian Organization has not complied with the requirements 


ycherry on PROD1PC64 with BILLS
225 

•HR 1328 IH

1 of a grant or complied with or satisfactorily performed a 

2 contract under section 503, the Secretary shall, prior to 

3 renewing such contract or grant, attempt to resolve with 

4 the organization the areas of noncompliance or unsatisfac5 tory performance and modify the contract or grant to pre6 vent future occurrences of noncompliance or unsatisfac7 tory performance. If the Secretary determines that the 

8 noncompliance or unsatisfactory performance cannot be 

9 resolved and prevented in the future, the Secretary shall 

10 not renew the contract or grant with the organization and 

11 is authorized to enter into a contract or make a grant 

12 under section 503 with another Urban Indian Organiza13 tion which is situated in the same Urban Center as the 

14 Urban Indian Organization whose contract or grant is not 

15 renewed under this section. 

16 ‘‘(d) CONSIDERATIONS FOR RENEWALS.—In deter17 mining whether to renew a contract or grant with an 

18 Urban Indian Organization under section 503 which has 

19 completed performance of a contract or grant under sec20 tion 504, the Secretary shall review the records of the 

21 Urban Indian Organization, the reports submitted under 

22 section 507, and shall consider the results of the onsite 

23 evaluations or accreditations under subsection (b). 


ycherry on PROD1PC64 with BILLS
226 

•HR 1328 IH

1 ‘‘SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS. 

2 ‘‘(a) PROCUREMENT.—Contracts with Urban Indian 

3 Organizations entered into pursuant to this title shall be 

4 in accordance with all Federal contracting laws and regu5 lations relating to procurement except that in the discre6 tion of the Secretary, such contracts may be negotiated 

7 without advertising and need not conform to the provisions 

8 of sections 1304 and 3131 through 3133 of title 40, 

9 United States Code. 

10 ‘‘(b) PAYMENTS UNDER CONTRACTS OR GRANTS.— 

11 ‘‘(1) IN GENERAL.—Payments under any con12 tracts or grants pursuant to this title, notwith13 standing any term or condition of such contract or 

14 grant— 

15 ‘‘(A) may be made in a single advance pay16 ment by the Secretary to the Urban Indian Or17 ganization by no later than the end of the first 

18 30 days of the funding period with respect to 

19 which the payments apply, unless the Secretary 

20 determines through an evaluation under section 

21 505 that the organization is not capable of ad22 ministering such a single advance payment; and 

23 ‘‘(B) if any portion thereof is unexpended 

24 by the Urban Indian Organization during the 

25 funding period with respect to which the pay26 ments initially apply, shall be carried forward 


ycherry on PROD1PC64 with BILLS
227 

•HR 1328 IH

1 for expenditure with respect to allowable or re2 imbursable costs incurred by the organization 

3 during 1 or more subsequent funding periods 

4 without additional justification or documenta5 tion by the organization as a condition of car6 rying forward the availability for expenditure of 

7 such funds. 

8 ‘‘(2) SEMIANNUAL AND QUARTERLY PAYMENTS

9 AND REIMBURSEMENTS.—If the Secretary deter10 mines under paragraph (1)(A) that an Urban Indian 

11 Organization is not capable of administering an en12 tire single advance payment, on request of the 

13 Urban Indian Organization, the payments may be 

14 made— 

15 ‘‘(A) in semiannual or quarterly payments 

16 by not later than 30 days after the date on 

17 which the funding period with respect to which 

18 the payments apply begins; or 

19 ‘‘(B) by way of reimbursement. 

20 ‘‘(c) REVISION OR AMENDMENT OF CONTRACTS.— 

21 Notwithstanding any provision of law to the contrary, the 

22 Secretary may, at the request and consent of an Urban 

23 Indian Organization, revise or amend any contract entered 

24 into by the Secretary with such organization under this 

25 title as necessary to carry out the purposes of this title. 


ycherry on PROD1PC64 with BILLS
228 

•HR 1328 IH

1 ‘‘(d) FAIR AND UNIFORM SERVICES AND ASSIST2 ANCE.—Contracts with or grants to Urban Indian Organi3 zations and regulations adopted pursuant to this title shall 

4 include provisions to assure the fair and uniform provision 

5 to Urban Indians of services and assistance under such 

6 contracts or grants by such organizations. 

7 ‘‘SEC. 507. REPORTS AND RECORDS. 

8 ‘‘(a) REPORTS.— 

9 ‘‘(1) IN GENERAL.—For each fiscal year during 

10 which an Urban Indian Organization receives or ex11 pends funds pursuant to a contract entered into or 

12 a grant received pursuant to this title, such Urban 

13 Indian Organization shall submit to the Secretary 

14 not more frequently than every 6 months, a report 

15 that includes the following: 

16 ‘‘(A) In the case of a contract or grant 

17 under section 503, recommendations pursuant 

18 to section 503(a)(5). 

19 ‘‘(B) Information on activities conducted 

20 by the organization pursuant to the contract or 

21 grant. 

22 ‘‘(C) An accounting of the amounts and 

23 purpose for which Federal funds were ex24 pended. 


ycherry on PROD1PC64 with BILLS
229 

•HR 1328 IH

1 ‘‘(D) A minimum set of data, using uni2 formly defined elements, as specified by the 

3 Secretary after consultation with Urban Indian 

4 Organizations. 

5 ‘‘(2) HEALTH STATUS AND SERVICES.— 

6 ‘‘(A) IN GENERAL.—Not later than 18 

7 months after the date of enactment of the In8 dian Health Care Improvement Act Amend9 ments of 2007, the Secretary, acting through 

10 the Service, shall submit to Congress a report 

11 evaluating— 

12 ‘‘(i) the health status of Urban Indi13 ans; 

14 ‘‘(ii) the services provided to Indians 

15 pursuant to this title; and 

16 ‘‘(iii) areas of unmet needs in the de17 livery of health services to Urban Indians. 

18 ‘‘(B) CONSULTATION AND CONTRACTS.— 

19 In preparing the report under paragraph (1), 

20 the Secretary— 

21 ‘‘(i) shall consult with Urban Indian 

22 Organizations; and 

23 ‘‘(ii) may enter into a contract with a 

24 national organization representing Urban 


ycherry on PROD1PC64 with BILLS
230 

•HR 1328 IH

1 Indian Organizations to conduct any as2 pect of the report. 

3 ‘‘(b) AUDIT.—The reports and records of the Urban 

4 Indian Organization with respect to a contract or grant 

5 under this title shall be subject to audit by the Secretary 

6 and the Comptroller General of the United States. 

7 ‘‘(c) COSTS OF AUDITS.—The Secretary shall allow 

8 as a cost of any contract or grant entered into or awarded 

9 under section 502 or 503 the cost of an annual inde10 pendent financial audit conducted by— 

11 ‘‘(1) a certified public accountant; or 

12 ‘‘(2) a certified public accounting firm qualified 

13 to conduct Federal compliance audits. 

14 ‘‘SEC. 508. LIMITATION ON CONTRACT AUTHORITY. 

15 ‘‘The authority of the Secretary to enter into con16 tracts or to award grants under this title shall be to the 

17 extent, and in an amount, provided for in appropriation 

18 Acts. 

19 ‘‘SEC. 509. FACILITIES. 

20 ‘‘(a) GRANTS.—The Secretary, acting through the 

21 Service, may make grants to contractors or grant recipi22 ents under this title for the lease, purchase, renovation, 

23 construction, or expansion of facilities, including leased fa24 cilities, in order to assist such contractors or grant recipiVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00230 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
231 

•HR 1328 IH

1 ents in complying with applicable licensure or certification 

2 requirements. 

3 ‘‘(b) LOAN FUND STUDY.—The Secretary, acting 

4 through the Service, may carry out a study to determine 

5 the feasibility of establishing a loan fund to provide to 

6 Urban Indian Organizations direct loans or guarantees for 

7 loans for the construction of health care facilities in a 

8 manner consistent with section 309, including by submit9 ting a report in accordance with subsection (c) of that sec10 tion. 

11 ‘‘SEC. 510. DIVISION OF URBAN INDIAN HEALTH. 

12 ‘‘There is established within the Service a Division 

13 of Urban Indian Health, which shall be responsible for— 

14 ‘‘(1) carrying out the provisions of this title; 

15 ‘‘(2) providing central oversight of the pro16 grams and services authorized under this title; and 

17 ‘‘(3) providing technical assistance to Urban In18 dian Organizations. 

19 ‘‘SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE20 RELATED SERVICES. 

21 ‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 

22 through the Service, may make grants for the provision 

23 of health-related services in prevention of, treatment of, 

24 rehabilitation of, or school- and community-based edu25 cation regarding, alcohol and substance abuse in Urban 


ycherry on PROD1PC64 with BILLS
232 

•HR 1328 IH

1 Centers to those Urban Indian Organizations with which 

2 the Secretary has entered into a contract under this title 

3 or under section 201. 

4 ‘‘(b) GOALS.—Each grant made pursuant to sub5 section (a) shall set forth the goals to be accomplished 

6 pursuant to the grant. The goals shall be specific to each 

7 grant as agreed to between the Secretary and the grantee. 

8 ‘‘(c) CRITERIA.—The Secretary shall establish cri9 teria for the grants made under subsection (a), including 

10 criteria relating to the following: 

11 ‘‘(1) The size of the Urban Indian population. 

12 ‘‘(2) Capability of the organization to ade13 quately perform the activities required under the 

14 grant. 

15 ‘‘(3) Satisfactory performance standards for the 

16 organization in meeting the goals set forth in such 

17 grant. The standards shall be negotiated and agreed 

18 to between the Secretary and the grantee on a 

19 grant-by-grant basis. 

20 ‘‘(4) Identification of the need for services. 

21 ‘‘(d) ALLOCATION OF GRANTS.—The Secretary shall 

22 develop a methodology for allocating grants made pursu23 ant to this section based on the criteria established pursu24 ant to subsection (c). 


ycherry on PROD1PC64 with BILLS
233 

•HR 1328 IH

1 ‘‘(e) GRANTS SUBJECT TO CRITERIA.—Any grant re2 ceived by an Urban Indian Organization under this Act 

3 for substance abuse prevention, treatment, and rehabilita4 tion shall be subject to the criteria set forth in subsection 

5 (c). 

6 ‘‘SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION 

7 PROJECTS. 

8 ‘‘Notwithstanding any other provision of law, the 

9 Tulsa Clinic and Oklahoma City Clinic demonstration 

10 projects shall— 

11 ‘‘(1) be permanent programs within the Serv12 ice’s direct care program; 

13 ‘‘(2) continue to be treated as Service Units 

14 and Operating Units in the allocation of resources 

15 and coordination of care; and 

16 ‘‘(3) continue to meet the requirements and 

17 definitions of an Urban Indian Organization in this 

18 Act, and shall not be subject to the provisions of the 

19 Indian Self-Determination and Education Assistance 

20 Act (25 U.S.C. 450 et seq.). 

21 ‘‘SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS. 

22 ‘‘(a) GRANTS AND CONTRACTS.—The Secretary, 

23 through the Division of Urban Indian Health, shall make 

24 grants or enter into contracts with Urban Indian Organi25 zations, to take effect not later than September 30, 2010, 


ycherry on PROD1PC64 with BILLS
234 

•HR 1328 IH

1 for the administration of Urban Indian alcohol programs 

2 that were originally established under the National Insti3 tute on Alcoholism and Alcohol Abuse (hereafter in this 

4 section referred to as ‘NIAAA’) and transferred to the 

5 Service. 

6 ‘‘(b) USE OF FUNDS.—Grants provided or contracts 

7 entered into under this section shall be used to provide 

8 support for the continuation of alcohol prevention and 

9 treatment services for Urban Indian populations and such 

10 other objectives as are agreed upon between the Service 

11 and a recipient of a grant or contract under this section. 

12 ‘‘(c) ELIGIBILITY.—Urban Indian Organizations that 

13 operate Indian alcohol programs originally funded under 

14 the NIAAA and subsequently transferred to the Service 

15 are eligible for grants or contracts under this section. 

16 ‘‘(d) REPORT.—The Secretary shall evaluate and re17 port to Congress on the activities of programs funded 

18 under this section not less than every 5 years. 

19 ‘‘SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZA20 TIONS. 

21 ‘‘(a) IN GENERAL.—The Secretary shall ensure that 

22 the Service consults, to the greatest extent practicable, 

23 with Urban Indian Organizations. 

24 ‘‘(b) DEFINITION OF CONSULTATION.—For purposes 

25 of subsection (a), consultation is the open and free exVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00234 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
235 

•HR 1328 IH

1 change of information and opinions which leads to mutual 

2 understanding and comprehension and which emphasizes 

3 trust, respect, and shared responsibility. 

4 ‘‘SEC. 515. URBAN YOUTH TREATMENT CENTER DEM5 ONSTRATION. 

6 ‘‘(a) CONSTRUCTION AND OPERATION.—The Sec7 retary, acting through the Service, through grant or con8 tract, is authorized to fund the construction and operation 

9 of at least 2 residential treatment centers in each State 

10 described in subsection (b) to demonstrate the provision 

11 of alcohol and substance abuse treatment services to 

12 Urban Indian youth in a culturally competent residential 

13 setting. 

14 ‘‘(b) DEFINITION OF STATE.—A State described in 

15 this subsection is a State in which— 

16 ‘‘(1) there resides Urban Indian youth with 

17 need for alcohol and substance abuse treatment serv18 ices in a residential setting; and 

19 ‘‘(2) there is a significant shortage of culturally 

20 competent residential treatment services for Urban 

21 Indian youth. 

22 ‘‘SEC. 516. GRANTS FOR DIABETES PREVENTION, TREAT23 MENT, AND CONTROL. 

24 ‘‘(a) GRANTS AUTHORIZED.—The Secretary may 

25 make grants to those Urban Indian Organizations that 


ycherry on PROD1PC64 with BILLS
236 

•HR 1328 IH

1 have entered into a contract or have received a grant 

2 under this title for the provision of services for the preven3 tion and treatment of, and control of the complications 

4 resulting from, diabetes among Urban Indians. 

5 ‘‘(b) GOALS.—Each grant made pursuant to sub6 section (a) shall set forth the goals to be accomplished 

7 under the grant. The goals shall be specific to each grant 

8 as agreed to between the Secretary and the grantee. 

9 ‘‘(c) ESTABLISHMENT OF CRITERIA.—The Secretary 

10 shall establish criteria for the grants made under sub11 section (a) relating to— 

12 ‘‘(1) the size and location of the Urban Indian 

13 population to be served; 

14 ‘‘(2) the need for prevention of and treatment 

15 of, and control of the complications resulting from, 

16 diabetes among the Urban Indian population to be 

17 served; 

18 ‘‘(3) performance standards for the organiza19 tion in meeting the goals set forth in such grant 

20 that are negotiated and agreed to by the Secretary 

21 and the grantee; 

22 ‘‘(4) the capability of the organization to ade23 quately perform the activities required under the 

24 grant; and 


ycherry on PROD1PC64 with BILLS
237 

•HR 1328 IH

1 ‘‘(5) the willingness of the organization to col2 laborate with the registry, if any, established by the 

3 Secretary under section 204(e) in the Area Office of 

4 the Service in which the organization is located. 

5 ‘‘(d) FUNDS SUBJECT TO CRITERIA.—Any funds re6 ceived by an Urban Indian Organization under this Act 

7 for the prevention, treatment, and control of diabetes 

8 among Urban Indians shall be subject to the criteria devel9 oped by the Secretary under subsection (c). 

10 ‘‘SEC. 517. COMMUNITY HEALTH REPRESENTATIVES. 

11 ‘‘The Secretary, acting through the Service, may 

12 enter into contracts with, and make grants to, Urban In13 dian Organizations for the employment of Indians trained 

14 as health service providers through the Community Health 

15 Representatives Program under section 109 in the provi16 sion of health care, health promotion, and disease preven17 tion services to Urban Indians. 

18 ‘‘SEC. 518. EFFECTIVE DATE. 

19 ‘‘The amendments made by the Indian Health Care 

20 Improvement Act Amendments of 2007 to this title shall 

21 take effect beginning on the date of enactment of that Act, 

22 regardless of whether the Secretary has promulgated regu23 lations implementing such amendments. 


ycherry on PROD1PC64 with BILLS
238 

•HR 1328 IH

1 ‘‘SEC. 519. ELIGIBILITY FOR SERVICES. 

2 ‘‘Urban Indians shall be eligible for, and the ultimate 

3 beneficiaries of, health care or referral services provided 

4 pursuant to this title. 

5 ‘‘SEC. 520. AUTHORIZATION OF APPROPRIATIONS. 

6 ‘‘There are authorized to be appropriated such sums 

7 as may be necessary for each fiscal year through fiscal 

8 year 2017 to carry out this title. 

9 ‘‘TITLE VI—ORGANIZATIONAL 

10 IMPROVEMENTS 

11 ‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV12 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

13 SERVICE. 

14 ‘‘(a) ESTABLISHMENT.— 

15 ‘‘(1) IN GENERAL.—In order to more effectively 

16 and efficiently carry out the responsibilities, authori17 ties, and functions of the United States to provide 

18 health care services to Indians and Indian Tribes, as 

19 are or may be hereafter provided by Federal statute 

20 or treaties, there is established within the Public 

21 Health Service of the Department the Indian Health 

22 Service. 

23 ‘‘(2) ASSISTANT SECRETARY OF INDIAN

24 HEALTH.—The Service shall be administered by an 

25 Assistant Secretary of Indian Health, who shall be 

26 appointed by the President, by and with the advice 


ycherry on PROD1PC64 with BILLS
239 

•HR 1328 IH

1 and consent of the Senate. The Assistant Secretary 

2 shall report to the Secretary. Effective with respect 

3 to an individual appointed by the President, by and 

4 with the advice and consent of the Senate, after 

5 January 1, 2007, the term of service of the Assist6 ant Secretary shall be 4 years. An Assistant Sec7 retary may serve more than 1 term. 

8 ‘‘(3) INCUMBENT.—The individual serving in 

9 the position of Director of the Service on the day be10 fore the date of enactment of the Indian Health 

11 Care Improvement Act Amendments of 2007 shall 

12 serve as Assistant Secretary. 

13 ‘‘(4) ADVOCACY AND CONSULTATION.—The po14 sition of Assistant Secretary is established to, in a 

15 manner consistent with the government-to-govern16 ment relationship between the United States and In17 dian Tribes— 

18 ‘‘(A) facilitate advocacy for the develop19 ment of appropriate Indian health policy; and 

20 ‘‘(B) promote consultation on matters re21 lating to Indian health. 

22 ‘‘(b) AGENCY.—The Service shall be an agency within 

23 the Public Health Service of the Department, and shall 

24 not be an office, component, or unit of any other agency 

25 of the Department. 


ycherry on PROD1PC64 with BILLS
240 

•HR 1328 IH

1 ‘‘(c) DUTIES.—The Assistant Secretary shall— 

2 ‘‘(1) perform all functions that were, on the day 

3 before the date of enactment of the Indian Health 

4 Care Improvement Act Amendments of 2007, car5 ried out by or under the direction of the individual 

6 serving as Director of the Service on that day; 

7 ‘‘(2) perform all functions of the Secretary re8 lating to the maintenance and operation of hospital 

9 and health facilities for Indians and the planning 

10 for, and provision and utilization of, health services 

11 for Indians; 

12 ‘‘(3) administer all health programs under 

13 which health care is provided to Indians based upon 

14 their status as Indians which are administered by 

15 the Secretary, including programs under— 

16 ‘‘(A) this Act; 

17 ‘‘(B) the Act of November 2, 1921 (25 

18 U.S.C. 13); 

19 ‘‘(C) the Act of August 5, 1954 (42 U.S.C. 

20 2001 et seq.); 

21 ‘‘(D) the Act of August 16, 1957 (42 

22 U.S.C. 2005 et seq.); and 

23 ‘‘(E) the Indian Self-Determination and 

24 Education Assistance Act (25 U.S.C. 450 et 

25 seq.); 


ycherry on PROD1PC64 with BILLS
241 

•HR 1328 IH

1 ‘‘(4) administer all scholarship and loan func2 tions carried out under title I; 

3 ‘‘(5) report directly to the Secretary concerning 

4 all policy- and budget-related matters affecting In5 dian health; 

6 ‘‘(6) collaborate with the Assistant Secretary 

7 for Health concerning appropriate matters of Indian 

8 health that affect the agencies of the Public Health 

9 Service; 

10 ‘‘(7) advise each Assistant Secretary of the De11 partment concerning matters of Indian health with 

12 respect to which that Assistant Secretary has au13 thority and responsibility; 

14 ‘‘(8) advise the heads of other agencies and pro15 grams of the Department concerning matters of In16 dian health with respect to which those heads have 

17 authority and responsibility; 

18 ‘‘(9) coordinate the activities of the Department 

19 concerning matters of Indian health; and 

20 ‘‘(10) perform such other functions as the Sec21 retary may designate. 

22 ‘‘(d) AUTHORITY.— 

23 ‘‘(1) IN GENERAL.—The Secretary, acting 

24 through the Assistant Secretary, shall have the au25 thority— 


ycherry on PROD1PC64 with BILLS
242 

•HR 1328 IH

1 ‘‘(A) except to the extent provided for in 

2 paragraph (2), to appoint and compensate em3 ployees for the Service in accordance with title 

4 5, United States Code; 

5 ‘‘(B) to enter into contracts for the pro6 curement of goods and services to carry out the 

7 functions of the Service; and 

8 ‘‘(C) to manage, expend, and obligate all 

9 funds appropriated for the Service. 

10 ‘‘(2) PERSONNEL ACTIONS.—Notwithstanding 

11 any other provision of law, the provisions of section 

12 12 of the Act of June 18, 1934 (48 Stat. 986; 25 

13 U.S.C. 472), shall apply to all personnel actions 

14 taken with respect to new positions created within 

15 the Service as a result of its establishment under 

16 subsection (a). 

17 ‘‘(e) REFERENCES.—Any reference to the Director of 

18 the Indian Health Service in any other Federal law, Exec19 utive order, rule, regulation, or delegation of authority, or 

20 in any document of or relating to the Director of the In21 dian Health Service, shall be deemed to refer to the Assist22 ant Secretary. 

23 ‘‘SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYS24 TEM. 

25 ‘‘(a) ESTABLISHMENT.— 


ycherry on PROD1PC64 with BILLS
243 

•HR 1328 IH

1 ‘‘(1) IN GENERAL.—The Secretary shall estab2 lish an automated management information system 

3 for the Service. 

4 ‘‘(2) REQUIREMENTS OF SYSTEM.—The infor5 mation system established under paragraph (1) shall 

6 include— 

7 ‘‘(A) a financial management system; 

8 ‘‘(B) a patient care information system for 

9 each area served by the Service; 

10 ‘‘(C) a privacy component that protects the 

11 privacy of patient information held by, or on be12 half of, the Service; 

13 ‘‘(D) a services-based cost accounting com14 ponent that provides estimates of the costs as15 sociated with the provision of specific medical 

16 treatments or services in each Area office of the 

17 Service; 

18 ‘‘(E) an interface mechanism for patient 

19 billing and accounts receivable system; and 

20 ‘‘(F) a training component. 

21 ‘‘(b) PROVISION OF SYSTEMS TO TRIBES AND ORGA22 NIZATIONS.—The Secretary shall provide each Tribal 

23 Health Program automated management information sys24 tems which— 


ycherry on PROD1PC64 with BILLS
244 

•HR 1328 IH

1 ‘‘(1) meet the management information needs 

2 of such Tribal Health Program with respect to the 

3 treatment by the Tribal Health Program of patients 

4 of the Service; and 

5 ‘‘(2) meet the management information needs 

6 of the Service. 

7 ‘‘(c) ACCESS TO RECORDS.—Notwithstanding any 

8 other provision of law, each patient shall have reasonable 

9 access to the medical or health records of such patient 

10 which are held by, or on behalf of, the Service. 

11 ‘‘(d) AUTHORITY TO ENHANCE INFORMATION TECH12 NOLOGY.—The Secretary, acting through the Assistant 

13 Secretary, shall have the authority to enter into contracts, 

14 agreements, or joint ventures with other Federal agencies, 

15 States, private and nonprofit organizations, for the pur16 pose of enhancing information technology in Indian 

17 Health Programs and facilities. 

18 ‘‘SEC. 603. AUTHORIZATION OF APPROPRIATIONS. 

19 ‘‘There is authorized to be appropriated such sums 

20 as may be necessary for each fiscal year through fiscal 

21 year 2017 to carry out this title. 


ycherry on PROD1PC64 with BILLS
245 

•HR 1328 IH

1 ‘‘TITLE VII—BEHAVIORAL 

2 HEALTH PROGRAMS 

3 ‘‘SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREAT4 MENT SERVICES. 

5 ‘‘(a) PURPOSES.—The purposes of this section are as 

6 follows: 

7 ‘‘(1) To authorize and direct the Secretary, act8 ing through the Service, Indian Tribes, Tribal Orga9 nizations, and Urban Indian Organizations, to de10 velop a comprehensive behavioral health prevention 

11 and treatment program which emphasizes collabora12 tion among alcohol and substance abuse, social serv13 ices, and mental health programs. 

14 ‘‘(2) To provide information, direction, and 

15 guidance relating to mental illness and dysfunction 

16 and self-destructive behavior, including child abuse 

17 and family violence, to those Federal, tribal, State, 

18 and local agencies responsible for programs in In19 dian communities in areas of health care, education, 

20 social services, child and family welfare, alcohol and 

21 substance abuse, law enforcement, and judicial serv22 ices. 

23 ‘‘(3) To assist Indian Tribes to identify services 

24 and resources available to address mental illness and 

25 dysfunctional and self-destructive behavior. 


ycherry on PROD1PC64 with BILLS
246 

•HR 1328 IH

1 ‘‘(4) To provide authority and opportunities for 

2 Indian Tribes and Tribal Organizations to develop, 

3 implement, and coordinate with community-based 

4 programs which include identification, prevention, 

5 education, referral, and treatment services, including 

6 through multidisciplinary resource teams. 

7 ‘‘(5) To ensure that Indians, as citizens of the 

8 United States and of the States in which they re9 side, have the same access to behavioral health serv10 ices to which all citizens have access. 

11 ‘‘(6) To modify or supplement existing pro12 grams and authorities in the areas identified in 

13 paragraph (2). 

14 ‘‘(b) PLANS.— 

15 ‘‘(1) DEVELOPMENT.—The Secretary, acting 

16 through the Service, Indian Tribes, Tribal Organiza17 tions, and Urban Indian Organizations, shall encour18 age Indian Tribes and Tribal Organizations to de19 velop tribal plans, and Urban Indian Organizations 

20 to develop local plans, and for all such groups to 

21 participate in developing areawide plans for Indian 

22 Behavioral Health Services. The plans shall include, 

23 to the extent feasible, the following components: 

24 ‘‘(A) An assessment of the scope of alcohol 

25 or other substance abuse, mental illness, and 


ycherry on PROD1PC64 with BILLS
247 

•HR 1328 IH

1 dysfunctional and self-destructive behavior, in2 cluding suicide, child abuse, and family vio3 lence, among Indians, including— 

4 ‘‘(i) the number of Indians served who 

5 are directly or indirectly affected by such 

6 illness or behavior; or 

7 ‘‘(ii) an estimate of the financial and 

8 human cost attributable to such illness or 

9 behavior. 

10 ‘‘(B) An assessment of the existing and 

11 additional resources necessary for the preven12 tion and treatment of such illness and behavior, 

13 including an assessment of the progress toward 

14 achieving the availability of the full continuum 

15 of care described in subsection (c). 

16 ‘‘(C) An estimate of the additional funding 

17 needed by the Service, Indian Tribes, Tribal 

18 Organizations, and Urban Indian Organizations 

19 to meet their responsibilities under the plans. 

20 ‘‘(2) NATIONAL CLEARINGHOUSE.—The Sec21 retary, acting through the Service, shall coordinate 

22 with existing national clearinghouses and informa23 tion centers to include at the clearinghouses and 

24 centers plans and reports on the outcomes of such 

25 plans developed by Indian Tribes, Tribal OrganizaVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00247 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
248 

•HR 1328 IH

1 tions, Urban Indian Organizations, and Service 

2 Areas relating to behavioral health. The Secretary 

3 shall ensure access to these plans and outcomes by 

4 any Indian Tribe, Tribal Organization, Urban In5 dian Organization, or the Service. 

6 ‘‘(3) TECHNICAL ASSISTANCE.—The Secretary 

7 shall provide technical assistance to Indian Tribes, 

8 Tribal Organizations, and Urban Indian Organiza9 tions in preparation of plans under this section and 

10 in developing standards of care that may be used 

11 and adopted locally. 

12 ‘‘(c) PROGRAMS.—The Secretary, acting through the 

13 Service, Indian Tribes, and Tribal Organizations, shall 

14 provide, to the extent feasible and if funding is available, 

15 programs including the following: 

16 ‘‘(1) COMPREHENSIVE CARE.—A comprehensive 

17 continuum of behavioral health care which pro18 vides— 

19 ‘‘(A) community-based prevention, inter20 vention, outpatient, and behavioral health 

21 aftercare; 

22 ‘‘(B) detoxification (social and medical); 

23 ‘‘(C) acute hospitalization; 

24 ‘‘(D) intensive outpatient/day treatment; 

25 ‘‘(E) residential treatment; 


ycherry on PROD1PC64 with BILLS
249 

•HR 1328 IH

1 ‘‘(F) transitional living for those needing a 

2 temporary, stable living environment that is 

3 supportive of treatment and recovery goals; 

4 ‘‘(G) emergency shelter; 

5 ‘‘(H) intensive case management; and 

6 ‘‘(I) diagnostic services. 

7 ‘‘(2) CHILD CARE.—Behavioral health services 

8 for Indians from birth through age 17, including— 

9 ‘‘(A) preschool and school age fetal alcohol 

10 disorder services, including assessment and be11 havioral intervention; 

12 ‘‘(B) mental health and substance abuse 

13 services (emotional, organic, alcohol, drug, in14 halant, and tobacco); 

15 ‘‘(C) identification and treatment of co-oc16 curring disorders and comorbidity; 

17 ‘‘(D) prevention of alcohol, drug, inhalant, 

18 and tobacco use; 

19 ‘‘(E) early intervention, treatment, and 

20 aftercare; 

21 ‘‘(F) promotion of healthy approaches to 

22 risk and safety issues; and 

23 ‘‘(G) identification and treatment of ne24 glect and physical, mental, and sexual abuse. 


ycherry on PROD1PC64 with BILLS
250 

•HR 1328 IH

1 ‘‘(3) ADULT CARE.—Behavioral health services 

2 for Indians from age 18 through 55, including— 

3 ‘‘(A) early intervention, treatment, and 

4 aftercare; 

5 ‘‘(B) mental health and substance abuse 

6 services (emotional, alcohol, drug, inhalant, and 

7 tobacco), including sex specific services; 

8 ‘‘(C) identification and treatment of co-oc9 curring disorders (dual diagnosis) and comor10 bidity; 

11 ‘‘(D) promotion of healthy approaches for 

12 risk-related behavior; 

13 ‘‘(E) treatment services for women at risk 

14 of giving birth to a child with a fetal alcohol 

15 disorder; and 

16 ‘‘(F) sex specific treatment for sexual as17 sault and domestic violence. 

18 ‘‘(4) FAMILY CARE.—Behavioral health services 

19 for families, including— 

20 ‘‘(A) early intervention, treatment, and 

21 aftercare for affected families; 

22 ‘‘(B) treatment for sexual assault and do23 mestic violence; and 


ycherry on PROD1PC64 with BILLS
251 

•HR 1328 IH

1 ‘‘(C) promotion of healthy approaches re2 lating to parenting, domestic violence, and other 

3 abuse issues. 

4 ‘‘(5) ELDER CARE.—Behavioral health services 

5 for Indians 56 years of age and older, including— 

6 ‘‘(A) early intervention, treatment, and 

7 aftercare; 

8 ‘‘(B) mental health and substance abuse 

9 services (emotional, alcohol, drug, inhalant, and 

10 tobacco), including sex specific services; 

11 ‘‘(C) identification and treatment of co-oc12 curring disorders (dual diagnosis) and comor13 bidity; 

14 ‘‘(D) promotion of healthy approaches to 

15 managing conditions related to aging; 

16 ‘‘(E) sex specific treatment for sexual as17 sault, domestic violence, neglect, physical and 

18 mental abuse and exploitation; and 

19 ‘‘(F) identification and treatment of de20 mentias regardless of cause. 

21 ‘‘(d) COMMUNITY BEHAVIORAL HEALTH PLAN.— 

22 ‘‘(1) ESTABLISHMENT.—The governing body of 

23 any Indian Tribe, Tribal Organization, or Urban In24 dian Organization may adopt a resolution for the es25 tablishment of a community behavioral health plan 


ycherry on PROD1PC64 with BILLS
252 

•HR 1328 IH

1 providing for the identification and coordination of 

2 available resources and programs to identify, pre3 vent, or treat substance abuse, mental illness, or 

4 dysfunctional and self-destructive behavior, including 

5 child abuse and family violence, among its members 

6 or its service population. This plan should include 

7 behavioral health services, social services, intensive 

8 outpatient services, and continuing aftercare. 

9 ‘‘(2) TECHNICAL ASSISTANCE.—At the request 

10 of an Indian Tribe, Tribal Organization, or Urban 

11 Indian Organization, the Bureau of Indian Affairs 

12 and the Service shall cooperate with and provide 

13 technical assistance to the Indian Tribe, Tribal Or14 ganization, or Urban Indian Organization in the de15 velopment and implementation of such plan. 

16 ‘‘(3) FUNDING.—The Secretary, acting through 

17 the Service, may make funding available to Indian 

18 Tribes and Tribal Organizations which adopt a reso19 lution pursuant to paragraph (1) to obtain technical 

20 assistance for the development of a community be21 havioral health plan and to provide administrative 

22 support in the implementation of such plan. 

23 ‘‘(e) COORDINATION FOR AVAILABILITY OF SERV24 ICES.—The Secretary, acting through the Service, Indian 

25 Tribes, Tribal Organizations, and Urban Indian OrganizaVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00252 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
253 

•HR 1328 IH

1 tions, shall coordinate behavioral health planning, to the 

2 extent feasible, with other Federal agencies and with State 

3 agencies, to encourage comprehensive behavioral health 

4 services for Indians regardless of their place of residence. 

5 ‘‘(f) MENTAL HEALTH CARE NEED ASSESSMENT.— 

6 Not later than 1 year after the date of enactment of the 

7 Indian Health Care Improvement Act Amendments of 

8 2007, the Secretary, acting through the Service, shall 

9 make an assessment of the need for inpatient mental 

10 health care among Indians and the availability and cost 

11 of inpatient mental health facilities which can meet such 

12 need. In making such assessment, the Secretary shall con13 sider the possible conversion of existing, underused Service 

14 hospital beds into psychiatric units to meet such need. 

15 ‘‘SEC. 702. MEMORANDA OF AGREEMENT WITH THE DE16 PARTMENT OF THE INTERIOR. 

17 ‘‘(a) CONTENTS.—Not later than 12 months after the 

18 date of enactment of the Indian Health Care Improvement 

19 Act Amendments of 2007, the Secretary, acting through 

20 the Service, and the Secretary of the Interior shall develop 

21 and enter into a memoranda of agreement, or review and 

22 update any existing memoranda of agreement, as required 

23 by section 4205 of the Indian Alcohol and Substance 

24 Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 

25 2411) under which the Secretaries address the following: 


ycherry on PROD1PC64 with BILLS
254 

•HR 1328 IH

1 ‘‘(1) The scope and nature of mental illness and 

2 dysfunctional and self-destructive behavior, including 

3 child abuse and family violence, among Indians. 

4 ‘‘(2) The existing Federal, tribal, State, local, 

5 and private services, resources, and programs avail6 able to provide behavioral health services for Indi7 ans. 

8 ‘‘(3) The unmet need for additional services, re9 sources, and programs necessary to meet the needs 

10 identified pursuant to paragraph (1). 

11 ‘‘(4)(A) The right of Indians, as citizens of the 

12 United States and of the States in which they re13 side, to have access to behavioral health services to 

14 which all citizens have access. 

15 ‘‘(B) The right of Indians to participate in, and 

16 receive the benefit of, such services. 

17 ‘‘(C) The actions necessary to protect the exer18 cise of such right. 

19 ‘‘(5) The responsibilities of the Bureau of In20 dian Affairs and the Service, including mental illness 

21 identification, prevention, education, referral, and 

22 treatment services (including services through multi23 disciplinary resource teams), at the central, area, 

24 and agency and Service Unit, Service Area, and 


ycherry on PROD1PC64 with BILLS
255 

•HR 1328 IH

1 headquarters levels to address the problems identi2 fied in paragraph (1). 

3 ‘‘(6) A strategy for the comprehensive coordina4 tion of the behavioral health services provided by the 

5 Bureau of Indian Affairs and the Service to meet 

6 the problems identified pursuant to paragraph (1), 

7 including— 

8 ‘‘(A) the coordination of alcohol and sub9 stance abuse programs of the Service, the Bu10 reau of Indian Affairs, and Indian Tribes and 

11 Tribal Organizations (developed under the In12 dian Alcohol and Substance Abuse Prevention 

13 and Treatment Act of 1986 (25 U.S.C. 2401 et 

14 seq.)) with behavioral health initiatives pursu15 ant to this Act, particularly with respect to the 

16 referral and treatment of dually diagnosed indi17 viduals requiring behavioral health and sub18 stance abuse treatment; and 

19 ‘‘(B) ensuring that the Bureau of Indian 

20 Affairs and Service programs and services (in21 cluding multidisciplinary resource teams) ad22 dressing child abuse and family violence are co23 ordinated with such non-Federal programs and 

24 services. 


ycherry on PROD1PC64 with BILLS
256 

•HR 1328 IH

1 ‘‘(7) Directing appropriate officials of the Bu2 reau of Indian Affairs and the Service, particularly 

3 at the agency and Service Unit levels, to cooperate 

4 fully with tribal requests made pursuant to commu5 nity behavioral health plans adopted under section 

6 701(c) and section 4206 of the Indian Alcohol and 

7 Substance Abuse Prevention and Treatment Act of 

8 1986 (25 U.S.C. 2412). 

9 ‘‘(8) Providing for an annual review of such 

10 agreement by the Secretaries which shall be provided 

11 to Congress and Indian Tribes and Tribal Organiza12 tions. 

13 ‘‘(b) SPECIFIC PROVISIONS REQUIRED.—The memo14 randa of agreement updated or entered into pursuant to 

15 subsection (a) shall include specific provisions pursuant to 

16 which the Service shall assume responsibility for— 

17 ‘‘(1) the determination of the scope of the prob18 lem of alcohol and substance abuse among Indians, 

19 including the number of Indians within the jurisdic20 tion of the Service who are directly or indirectly af21 fected by alcohol and substance abuse and the finan22 cial and human cost; 

23 ‘‘(2) an assessment of the existing and needed 

24 resources necessary for the prevention of alcohol and 


ycherry on PROD1PC64 with BILLS
257 

•HR 1328 IH

1 substance abuse and the treatment of Indians af2 fected by alcohol and substance abuse; and 

3 ‘‘(3) an estimate of the funding necessary to 

4 adequately support a program of prevention of alco5 hol and substance abuse and treatment of Indians 

6 affected by alcohol and substance abuse. 

7 ‘‘(c) PUBLICATION.—Each memorandum of agree8 ment entered into or renewed (and amendments or modi9 fications thereto) under subsection (a) shall be published 

10 in the Federal Register. At the same time as publication 

11 in the Federal Register, the Secretary shall provide a copy 

12 of such memoranda, amendment, or modification to each 

13 Indian Tribe, Tribal Organization, and Urban Indian Or14 ganization. 

15 ‘‘SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PRE16 VENTION AND TREATMENT PROGRAM. 

17 ‘‘(a) ESTABLISHMENT.— 

18 ‘‘(1) IN GENERAL.—The Secretary, acting 

19 through the Service, Indian Tribes, and Tribal Orga20 nizations, shall provide a program of comprehensive 

21 behavioral health, prevention, treatment, and 

22 aftercare, which shall include— 

23 ‘‘(A) prevention, through educational inter24 vention, in Indian communities; 


ycherry on PROD1PC64 with BILLS
258 

•HR 1328 IH

1 ‘‘(B) acute detoxification, psychiatric hos2 pitalization, residential, and intensive outpatient 

3 treatment; 

4 ‘‘(C) community-based rehabilitation and 

5 aftercare; 

6 ‘‘(D) community education and involve7 ment, including extensive training of health 

8 care, educational, and community-based per9 sonnel; 

10 ‘‘(E) specialized residential treatment pro11 grams for high-risk populations, including preg12 nant and postpartum women and their children; 

13 and 

14 ‘‘(F) diagnostic services. 

15 ‘‘(2) TARGET POPULATIONS.—The target popu16 lation of such programs shall be members of Indian 

17 Tribes. Efforts to train and educate key members of 

18 the Indian community shall also target employees of 

19 health, education, judicial, law enforcement, legal, 

20 and social service programs. 

21 ‘‘(b) CONTRACT HEALTH SERVICES.— 

22 ‘‘(1) IN GENERAL.—The Secretary, acting 

23 through the Service, Indian Tribes, and Tribal Orga24 nizations, may enter into contracts with public or 

25 private providers of behavioral health treatment 


ycherry on PROD1PC64 with BILLS
259 

•HR 1328 IH

1 services for the purpose of carrying out the program 

2 required under subsection (a). 

3 ‘‘(2) PROVISION OF ASSISTANCE.—In carrying 

4 out this subsection, the Secretary shall provide as5 sistance to Indian Tribes and Tribal Organizations 

6 to develop criteria for the certification of behavioral 

7 health service providers and accreditation of service 

8 facilities which meet minimum standards for such 

9 services and facilities. 

10 ‘‘SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM. 

11 ‘‘(a) IN GENERAL.—Under the authority of the Act 

12 of November 2, 1921 (25 U.S.C. 13) (commonly known 

13 as the ‘Snyder Act’), the Secretary shall establish and 

14 maintain a mental health technician program within the 

15 Service which— 

16 ‘‘(1) provides for the training of Indians as 

17 mental health technicians; and 

18 ‘‘(2) employs such technicians in the provision 

19 of community-based mental health care that includes 

20 identification, prevention, education, referral, and 

21 treatment services. 

22 ‘‘(b) PARAPROFESSIONAL TRAINING.—In carrying 

23 out subsection (a), the Secretary, acting through the Serv24 ice, Indian Tribes, and Tribal Organizations, shall provide 

25 high-standard paraprofessional training in mental health 


ycherry on PROD1PC64 with BILLS
260 

•HR 1328 IH

1 care necessary to provide quality care to the Indian com2 munities to be served. Such training shall be based upon 

3 a curriculum developed or approved by the Secretary 

4 which combines education in the theory of mental health 

5 care with supervised practical experience in the provision 

6 of such care. 

7 ‘‘(c) SUPERVISION AND EVALUATION OF TECHNI8 CIANS.—The Secretary, acting through the Service, Indian 

9 Tribes, and Tribal Organizations, shall supervise and 

10 evaluate the mental health technicians in the training pro11 gram. 

12 ‘‘(d) TRADITIONAL HEALTH CARE PRACTICES.—The 

13 Secretary, acting through the Service, shall ensure that 

14 the program established pursuant to this subsection in15 volves the use and promotion of the traditional health care 

16 practices of the Indian Tribes to be served. 

17 ‘‘SEC. 705. LICENSING REQUIREMENT FOR MENTAL 

18 HEALTH CARE WORKERS. 

19 ‘‘(a) IN GENERAL.—Subject to the provisions of sec20 tion 221, and except as provided in subsection (b), any 

21 individual employed as a psychologist, social worker, or 

22 marriage and family therapist for the purpose of providing 

23 mental health care services to Indians in a clinical setting 

24 under this Act is required to be licensed as a psychologist, 


ycherry on PROD1PC64 with BILLS
261 

•HR 1328 IH

1 social worker, or marriage and family therapist, respec2 tively. 

3 ‘‘(b) TRAINEES.—An individual may be employed as 

4 a trainee in psychology, social work, or marriage and fam5 ily therapy to provide mental health care services de6 scribed in subsection (a) if such individual— 

7 ‘‘(1) works under the direct supervision of a li8 censed psychologist, social worker, or marriage and 

9 family therapist, respectively; 

10 ‘‘(2) is enrolled in or has completed at least 2 

11 years of course work at a post-secondary, accredited 

12 education program for psychology, social work, mar13 riage and family therapy, or counseling; and 

14 ‘‘(3) meets such other training, supervision, and 

15 quality review requirements as the Secretary may es16 tablish. 

17 ‘‘SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS. 

18 ‘‘(a) GRANTS.—The Secretary, consistent with sec19 tion 701, may make grants to Indian Tribes, Tribal Orga20 nizations, and Urban Indian Organizations to develop and 

21 implement a comprehensive behavioral health program of 

22 prevention, intervention, treatment, and relapse preven23 tion services that specifically addresses the cultural, his24 torical, social, and child care needs of Indian women, re25 gardless of age. 


ycherry on PROD1PC64 with BILLS
262 

•HR 1328 IH

1 ‘‘(b) USE OF GRANT FUNDS.—A grant made pursu2 ant to this section may be used to— 

3 ‘‘(1) develop and provide community training, 

4 education, and prevention programs for Indian 

5 women relating to behavioral health issues, including 

6 fetal alcohol disorders; 

7 ‘‘(2) identify and provide psychological services, 

8 counseling, advocacy, support, and relapse preven9 tion to Indian women and their families; and 

10 ‘‘(3) develop prevention and intervention models 

11 for Indian women which incorporate traditional 

12 health care practices, cultural values, and commu13 nity and family involvement. 

14 ‘‘(c) CRITERIA.—The Secretary, in consultation with 

15 Indian Tribes and Tribal Organizations, shall establish 

16 criteria for the review and approval of applications and 

17 proposals for funding under this section. 

18 ‘‘(d) EARMARK OF CERTAIN FUNDS.—Twenty per19 cent of the funds appropriated pursuant to this section 

20 shall be used to make grants to Urban Indian Organiza21 tions. 

22 ‘‘SEC. 707. INDIAN YOUTH PROGRAM. 

23 ‘‘(a) DETOXIFICATION AND REHABILITATION.—The 

24 Secretary, acting through the Service, consistent with sec25 tion 701, shall develop and implement a program for acute 


ycherry on PROD1PC64 with BILLS
263 

•HR 1328 IH

1 detoxification and treatment for Indian youths, including 

2 behavioral health services. The program shall include re3 gional treatment centers designed to include detoxification 

4 and rehabilitation for both sexes on a referral basis and 

5 programs developed and implemented by Indian Tribes or 

6 Tribal Organizations at the local level under the Indian 

7 Self-Determination and Education Assistance Act (25 

8 U.S.C. 450 et seq.). Regional centers shall be integrated 

9 with the intake and rehabilitation programs based in the 

10 referring Indian community. 

11 ‘‘(b) ALCOHOL AND SUBSTANCE ABUSE TREATMENT

12 CENTERS OR FACILITIES.— 

13 ‘‘(1) ESTABLISHMENT.— 

14 ‘‘(A) IN GENERAL.—The Secretary, acting 

15 through the Service, Indian Tribes, and Tribal 

16 Organizations, shall construct, renovate, or, as 

17 necessary, purchase, and appropriately staff 

18 and operate, at least 1 youth regional treatment 

19 center or treatment network in each area under 

20 the jurisdiction of an Area Office. 

21 ‘‘(B) AREA OFFICE IN CALIFORNIA.—For 

22 the purposes of this subsection, the Area Office 

23 in California shall be considered to be 2 Area 

24 Offices, 1 office whose jurisdiction shall be con25 sidered to encompass the northern area of the 


ycherry on PROD1PC64 with BILLS
264 

•HR 1328 IH

1 State of California, and 1 office whose jurisdic2 tion shall be considered to encompass the re3 mainder of the State of California for the pur4 pose of implementing California treatment net5 works. 

6 ‘‘(2) FUNDING.—For the purpose of staffing 

7 and operating such centers or facilities, funding 

8 shall be pursuant to the Act of November 2, 1921 

9 (25 U.S.C. 13). 

10 ‘‘(3) LOCATION.—A youth treatment center 

11 constructed or purchased under this subsection shall 

12 be constructed or purchased at a location within the 

13 area described in paragraph (1) agreed upon (by ap14 propriate tribal resolution) by a majority of the In15 dian Tribes to be served by such center. 

16 ‘‘(4) SPECIFIC PROVISION OF FUNDS.— 

17 ‘‘(A) IN GENERAL.—Notwithstanding any 

18 other provision of this title, the Secretary may, 

19 from amounts authorized to be appropriated for 

20 the purposes of carrying out this section, make 

21 funds available to— 

22 ‘‘(i) the Tanana Chiefs Conference, 

23 Incorporated, for the purpose of leasing, 

24 constructing, renovating, operating, and 


ycherry on PROD1PC64 with BILLS
265 

•HR 1328 IH

1 maintaining a residential youth treatment 

2 facility in Fairbanks, Alaska; and 

3 ‘‘(ii) the Southeast Alaska Regional 

4 Health Corporation to staff and operate a 

5 residential youth treatment facility without 

6 regard to the proviso set forth in section 

7 4(l) of the Indian Self-Determination and 

8 Education Assistance Act (25 U.S.C. 

9 450b(l)). 

10 ‘‘(B) PROVISION OF SERVICES TO ELIGI11 BLE YOUTHS.—Until additional residential 

12 youth treatment facilities are established in 

13 Alaska pursuant to this section, the facilities 

14 specified in subparagraph (A) shall make every 

15 effort to provide services to all eligible Indian 

16 youths residing in Alaska. 

17 ‘‘(c) INTERMEDIATE ADOLESCENT BEHAVIORAL

18 HEALTH SERVICES.— 

19 ‘‘(1) IN GENERAL.—The Secretary, acting 

20 through the Service, Indian Tribes, and Tribal Orga21 nizations, may provide intermediate behavioral 

22 health services to Indian children and adolescents, 

23 including— 

24 ‘‘(A) pretreatment assistance; 


ycherry on PROD1PC64 with BILLS
266 

•HR 1328 IH

1 ‘‘(B) inpatient, outpatient, and aftercare 

2 services; 

3 ‘‘(C) emergency care; 

4 ‘‘(D) suicide prevention and crisis interven5 tion; and 

6 ‘‘(E) prevention and treatment of mental 

7 illness and dysfunctional and self-destructive 

8 behavior, including child abuse and family vio9 lence. 

10 ‘‘(2) USE OF FUNDS.—Funds provided under 

11 this subsection may be used— 

12 ‘‘(A) to construct or renovate an existing 

13 health facility to provide intermediate behav14 ioral health services; 

15 ‘‘(B) to hire behavioral health profes16 sionals; 

17 ‘‘(C) to staff, operate, and maintain an in18 termediate mental health facility, group home, 

19 sober housing, transitional housing or similar 

20 facilities, or youth shelter where intermediate 

21 behavioral health services are being provided; 

22 ‘‘(D) to make renovations and hire appro23 priate staff to convert existing hospital beds 

24 into adolescent psychiatric units; and 


ycherry on PROD1PC64 with BILLS
267 

•HR 1328 IH

1 ‘‘(E) for intensive home- and community2 based services. 

3 ‘‘(3) CRITERIA.—The Secretary, acting through 

4 the Service, shall, in consultation with Indian Tribes 

5 and Tribal Organizations, establish criteria for the 

6 review and approval of applications or proposals for 

7 funding made available pursuant to this subsection. 

8 ‘‘(d) FEDERALLY-OWNED STRUCTURES.— 

9 ‘‘(1) IN GENERAL.—The Secretary, in consulta10 tion with Indian Tribes and Tribal Organizations, 

11 shall— 

12 ‘‘(A) identify and use, where appropriate, 

13 federally-owned structures suitable for local res14 idential or regional behavioral health treatment 

15 for Indian youths; and 

16 ‘‘(B) establish guidelines for determining 

17 the suitability of any such federally-owned 

18 structure to be used for local residential or re19 gional behavioral health treatment for Indian 

20 youths. 

21 ‘‘(2) TERMS AND CONDITIONS FOR USE OF

22 STRUCTURE.—Any structure described in paragraph 

23 (1) may be used under such terms and conditions as 

24 may be agreed upon by the Secretary and the agency 

25 having responsibility for the structure and any InVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00267 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
268 

•HR 1328 IH

1 dian Tribe or Tribal Organization operating the pro2 gram. 

3 ‘‘(e) REHABILITATION AND AFTERCARE SERVICES.— 

4 ‘‘(1) IN GENERAL.—The Secretary, Indian 

5 Tribes, or Tribal Organizations, in cooperation with 

6 the Secretary of the Interior, shall develop and im7 plement within each Service Unit, community-based 

8 rehabilitation and follow-up services for Indian 

9 youths who are having significant behavioral health 

10 problems, and require long-term treatment, commu11 nity reintegration, and monitoring to support the In12 dian youths after their return to their home commu13 nity. 

14 ‘‘(2) ADMINISTRATION.—Services under para15 graph (1) shall be provided by trained staff within 

16 the community who can assist the Indian youths in 

17 their continuing development of self-image, positive 

18 problem-solving skills, and nonalcohol or substance 

19 abusing behaviors. Such staff may include alcohol 

20 and substance abuse counselors, mental health pro21 fessionals, and other health professionals and para22 professionals, including community health represent23 atives. 

24 ‘‘(f) INCLUSION OF FAMILY IN YOUTH TREATMENT

25 PROGRAM.—In providing the treatment and other services 


ycherry on PROD1PC64 with BILLS
269 

•HR 1328 IH

1 to Indian youths authorized by this section, the Secretary, 

2 acting through the Service, Indian Tribes, and Tribal Or3 ganizations, shall provide for the inclusion of family mem4 bers of such youths in the treatment programs or other 

5 services as may be appropriate. Not less than 10 percent 

6 of the funds appropriated for the purposes of carrying out 

7 subsection (e) shall be used for outpatient care of adult 

8 family members related to the treatment of an Indian 

9 youth under that subsection. 

10 ‘‘(g) MULTIDRUG ABUSE PROGRAM.—The Secretary, 

11 acting through the Service, Indian Tribes, Tribal Organi12 zations, and Urban Indian Organizations, shall provide, 

13 consistent with section 701, programs and services to pre14 vent and treat the abuse of multiple forms of substances, 

15 including alcohol, drugs, inhalants, and tobacco, among 

16 Indian youths residing in Indian communities, on or near 

17 reservations, and in urban areas and provide appropriate 

18 mental health services to address the incidence of mental 

19 illness among such youths. 

20 ‘‘(h) INDIAN YOUTH MENTAL HEALTH.—The Sec21 retary, acting through the Service, shall collect data for 

22 the report under section 801 with respect to— 

23 ‘‘(1) the number of Indian youth who are being 

24 provided mental health services through the Service 

25 and Tribal Health Programs; 


ycherry on PROD1PC64 with BILLS
270 

•HR 1328 IH

1 ‘‘(2) a description of, and costs associated with, 

2 the mental health services provided for Indian youth 

3 through the Service and Tribal Health Programs; 

4 ‘‘(3) the number of youth referred to the Serv5 ice or Tribal Health Programs for mental health 

6 services; 

7 ‘‘(4) the number of Indian youth provided resi8 dential treatment for mental health and behavioral 

9 problems through the Service and Tribal Health 

10 Programs, reported separately for on- and off-res11 ervation facilities; and 

12 ‘‘(5) the costs of the services described in para13 graph (4). 

14 ‘‘SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEM15 ONSTRATION PROJECT. 

16 ‘‘(a) PURPOSE.—The purpose of this section is to au17 thorize the Secretary to carry out a demonstration project 

18 to test the use of telemental health services in suicide pre19 vention, intervention and treatment of Indian youth, in20 cluding through— 

21 ‘‘(1) the use of psychotherapy, psychiatric as22 sessments, diagnostic interviews, therapies for men23 tal health conditions predisposing to suicide, and al24 cohol and substance abuse treatment; 


ycherry on PROD1PC64 with BILLS
271 

•HR 1328 IH

1 ‘‘(2) the provision of clinical expertise to, con2 sultation services with, and medical advice and train3 ing for frontline health care providers working with 

4 Indian youth; 

5 ‘‘(3) training and related support for commu6 nity leaders, family members and health and edu7 cation workers who work with Indian youth; 

8 ‘‘(4) the development of culturally-relevant edu9 cational materials on suicide; and 

10 ‘‘(5) data collection and reporting. 

11 ‘‘(b) DEFINITIONS.—For the purpose of this section, 

12 the following definitions shall apply: 

13 ‘‘(1) DEMONSTRATION PROJECT.—The term 

14 ‘demonstration project’ means the Indian youth tele15 mental health demonstration project authorized 

16 under subsection (c). 

17 ‘‘(2) TELEMENTAL HEALTH.—The term ‘tele18 mental health’ means the use of electronic informa19 tion and telecommunications technologies to support 

20 long distance mental health care, patient and profes21 sional-related education, public health, and health 

22 administration. 

23 ‘‘(c) AUTHORIZATION.— 

24 ‘‘(1) IN GENERAL.—The Secretary is authorized 

25 to award grants under the demonstration project for 


ycherry on PROD1PC64 with BILLS
272 

•HR 1328 IH

1 the provision of telemental health services to Indian 

2 youth who— 

3 ‘‘(A) have expressed suicidal ideas; 

4 ‘‘(B) have attempted suicide; or 

5 ‘‘(C) have mental health conditions that in6 crease or could increase the risk of suicide. 

7 ‘‘(2) ELIGIBILITY FOR GRANTS.—Such grants 

8 shall be awarded to Indian Tribes and Tribal Orga9 nizations that operate 1 or more facilities— 

10 ‘‘(A) located in Alaska and part of the 

11 Alaska Federal Health Care Access Network; 

12 ‘‘(B) reporting active clinical telehealth ca13 pabilities; or 

14 ‘‘(C) offering school-based telemental 

15 health services relating to psychiatry to Indian 

16 youth. 

17 ‘‘(3) GRANT PERIOD.—The Secretary shall 

18 award grants under this section for a period of up 

19 to 4 years. 

20 ‘‘(4) AWARDING OF GRANTS.—Not more than 5 

21 grants shall be provided under paragraph (1), with 

22 priority consideration given to Indian Tribes and 

23 Tribal Organizations that— 


ycherry on PROD1PC64 with BILLS
273 

•HR 1328 IH

1 ‘‘(A) serve a particular community or geo2 graphic area where there is a demonstrated 

3 need to address Indian youth suicide; 

4 ‘‘(B) enter in to collaborative partnerships 

5 with Indian Health Service or Tribal Health 

6 Programs or facilities to provide services under 

7 this demonstration project; 

8 ‘‘(C) serve an isolated community or geo9 graphic area which has limited or no access to 

10 behavioral health services; or 

11 ‘‘(D) operate a detention facility at which 

12 Indian youth are detained. 

13 ‘‘(d) USE OF FUNDS.— 

14 ‘‘(1) IN GENERAL.—An Indian Tribe or Tribal 

15 Organization shall use a grant received under sub16 section (c) for the following purposes: 

17 ‘‘(A) To provide telemental health services 

18 to Indian youth, including the provision of— 

19 ‘‘(i) psychotherapy; 

20 ‘‘(ii) psychiatric assessments and di21 agnostic interviews, therapies for mental 

22 health conditions predisposing to suicide, 

23 and treatment; and 

24 ‘‘(iii) alcohol and substance abuse 

25 treatment. 


ycherry on PROD1PC64 with BILLS
274 

•HR 1328 IH

1 ‘‘(B) To provide clinician-interactive med2 ical advice, guidance and training, assistance in 

3 diagnosis and interpretation, crisis counseling 

4 and intervention, and related assistance to 

5 Service, tribal, or urban clinicians and health 

6 services providers working with youth being 

7 served under this demonstration project. 

8 ‘‘(C) To assist, educate and train commu9 nity leaders, health education professionals and 

10 paraprofessionals, tribal outreach workers, and 

11 family members who work with the youth re12 ceiving telemental health services under this 

13 demonstration project, including with identifica14 tion of suicidal tendencies, crisis intervention 

15 and suicide prevention, emergency skill develop16 ment, and building and expanding networks 

17 among these individuals and with State and 

18 local health services providers. 

19 ‘‘(D) To develop and distribute culturally 

20 appropriate community educational materials 

21 on— 

22 ‘‘(i) suicide prevention; 

23 ‘‘(ii) suicide education; 

24 ‘‘(iii) suicide screening; 

25 ‘‘(iv) suicide intervention; and 


ycherry on PROD1PC64 with BILLS
275 

•HR 1328 IH

1 ‘‘(v) ways to mobilize communities 

2 with respect to the identification of risk 

3 factors for suicide. 

4 ‘‘(E) For data collection and reporting re5 lated to Indian youth suicide prevention efforts. 

6 ‘‘(2) TRADITIONAL HEALTH CARE PRAC7 TICES.—In carrying out the purposes described in 

8 paragraph (1), an Indian Tribe or Tribal Organiza9 tion may use and promote the traditional health care 

10 practices of the Indian Tribes of the youth to be 

11 served. 

12 ‘‘(e) APPLICATIONS.—To be eligible to receive a grant 

13 under subsection (c), an Indian Tribe or Tribal Organiza14 tion shall prepare and submit to the Secretary an applica15 tion, at such time, in such manner, and containing such 

16 information as the Secretary may require, including— 

17 ‘‘(1) a description of the project that the Indian 

18 Tribe or Tribal Organization will carry out using the 

19 funds provided under the grant; 

20 ‘‘(2) a description of the manner in which the 

21 project funded under the grant would— 

22 ‘‘(A) meet the telemental health care needs 

23 of the Indian youth population to be served by 

24 the project; or 


ycherry on PROD1PC64 with BILLS
276 

•HR 1328 IH

1 ‘‘(B) improve the access of the Indian 

2 youth population to be served to suicide preven3 tion and treatment services; 

4 ‘‘(3) evidence of support for the project from 

5 the local community to be served by the project; 

6 ‘‘(4) a description of how the families and lead7 ership of the communities or populations to be 

8 served by the project would be involved in the devel9 opment and ongoing operations of the project; 

10 ‘‘(5) a plan to involve the tribal community of 

11 the youth who are provided services by the project 

12 in planning and evaluating the mental health care 

13 and suicide prevention efforts provided, in order to 

14 ensure the integration of community, clinical, envi15 ronmental, and cultural components of the treat16 ment; and 

17 ‘‘(6) a plan for sustaining the project after Fed18 eral assistance for the demonstration project has ter19 minated. 

20 ‘‘(f) COLLABORATION; REPORTING TO NATIONAL

21 CLEARINGHOUSE.— 

22 ‘‘(1) COLLABORATION.—The Secretary, acting 

23 through the Service, shall encourage Indian Tribes 

24 and Tribal Organizations receiving grants under this 


ycherry on PROD1PC64 with BILLS
277 

•HR 1328 IH

1 section to collaborate to enable comparisons about 

2 best practices across projects. 

3 ‘‘(2) REPORTING TO NATIONAL CLEARING4 HOUSE.—The Secretary, acting through the Service, 

5 shall also encourage Indian Tribes and Tribal Orga6 nizations receiving grants under this section to sub7 mit relevant, declassified project information to the 

8 national clearinghouse authorized under section 

9 701(b)(2) in order to better facilitate program per10 formance and improve suicide prevention, interven11 tion, and treatment services. 

12 ‘‘(g) ANNUAL REPORT.—Each grant recipient shall 

13 submit to the Secretary an annual report that— 

14 ‘‘(1) describes the number of telemental health 

15 services provided; and 

16 ‘‘(2) includes any other information that the 

17 Secretary may require. 

18 ‘‘(h) REPORT TO CONGRESS.—Not later than 270 

19 days after the termination of the demonstration project, 

20 the Secretary shall submit to the Committee on Indian Af21 fairs of the Senate and the Committee on Natural Re22 sources and Committee on Energy and Commerce of the 

23 House of Representatives a final report, based on the an24 nual reports provided by grant recipients under subsection 

25 (h), that— 


ycherry on PROD1PC64 with BILLS
278 

•HR 1328 IH

1 ‘‘(1) describes the results of the projects funded 

2 by grants awarded under this section, including any 

3 data available which indicates the number of at4 tempted suicides; 

5 ‘‘(2) evaluates the impact of the telemental 

6 health services funded by the grants in reducing the 

7 number of completed suicides among Indian youth; 

8 ‘‘(3) evaluates whether the demonstration 

9 project should be— 

10 ‘‘(A) expanded to provide more than 5 

11 grants; and 

12 ‘‘(B) designated a permanent program; 

13 and 

14 ‘‘(4) evaluates the benefits of expanding the 

15 demonstration project to include Urban Indian Or16 ganizations. 

17 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

18 authorized to be appropriated to carry out this section 

19 $1,500,000 for each of fiscal years 2008 through 2011. 

20 ‘‘SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL 

21 HEALTH FACILITIES DESIGN, CONSTRUC22 TION, AND STAFFING. 

23 ‘‘Not later than 1 year after the date of enactment 

24 of the Indian Health Care Improvement Act Amendments 

25 of 2007, the Secretary, acting through the Service, Indian 


ycherry on PROD1PC64 with BILLS
279 

•HR 1328 IH

1 Tribes, and Tribal Organizations, may provide, in each 

2 area of the Service, not less than 1 inpatient mental health 

3 care facility, or the equivalent, for Indians with behavioral 

4 health problems. For the purposes of this subsection, Cali5 fornia shall be considered to be 2 Area Offices, 1 office 

6 whose location shall be considered to encompass the north7 ern area of the State of California and 1 office whose ju8 risdiction shall be considered to encompass the remainder 

9 of the State of California. The Secretary shall consider 

10 the possible conversion of existing, underused Service hos11 pital beds into psychiatric units to meet such need. 

12 ‘‘SEC. 710. TRAINING AND COMMUNITY EDUCATION. 

13 ‘‘(a) PROGRAM.—The Secretary, in cooperation with 

14 the Secretary of the Interior, shall develop and implement 

15 or assist Indian Tribes and Tribal Organizations to de16 velop and implement, within each Service Unit or tribal 

17 program, a program of community education and involve18 ment which shall be designed to provide concise and timely 

19 information to the community leadership of each tribal 

20 community. Such program shall include education about 

21 behavioral health issues to political leaders, Tribal judges, 

22 law enforcement personnel, members of tribal health and 

23 education boards, health care providers including tradi24 tional practitioners, and other critical members of each 

25 tribal community. Such program may also include commuVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00279 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
280 

•HR 1328 IH

1 nity-based training to develop local capacity and tribal 

2 community provider training for prevention, intervention, 

3 treatment, and aftercare. 

4 ‘‘(b) INSTRUCTION.—The Secretary, acting through 

5 the Service, shall, either directly or through Indian Tribes 

6 and Tribal Organizations, provide instruction in the area 

7 of behavioral health issues, including instruction in crisis 

8 intervention and family relations in the context of alcohol 

9 and substance abuse, child sexual abuse, youth alcohol and 

10 substance abuse, and the causes and effects of fetal alco11 hol disorders to appropriate employees of the Bureau of 

12 Indian Affairs and the Service, and to personnel in schools 

13 or programs operated under any contract with the Bureau 

14 of Indian Affairs or the Service, including supervisors of 

15 emergency shelters and halfway houses described in sec16 tion 4213 of the Indian Alcohol and Substance Abuse Pre17 vention and Treatment Act of 1986 (25 U.S.C. 2433). 

18 ‘‘(c) TRAINING MODELS.—In carrying out the edu19 cation and training programs required by this section, the 

20 Secretary, in consultation with Indian Tribes, Tribal Or21 ganizations, Indian behavioral health experts, and Indian 

22 alcohol and substance abuse prevention experts, shall de23 velop and provide community-based training models. Such 

24 models shall address— 


ycherry on PROD1PC64 with BILLS
281 

•HR 1328 IH

1 ‘‘(1) the elevated risk of alcohol and behavioral 

2 health problems faced by children of alcoholics; 

3 ‘‘(2) the cultural, spiritual, and 

4 multigenerational aspects of behavioral health prob5 lem prevention and recovery; and 

6 ‘‘(3) community-based and multidisciplinary 

7 strategies for preventing and treating behavioral 

8 health problems. 

9 ‘‘SEC. 711. BEHAVIORAL HEALTH PROGRAM. 

10 ‘‘(a) INNOVATIVE PROGRAMS.—The Secretary, acting 

11 through the Service, Indian Tribes, and Tribal Organiza12 tions, consistent with section 701, may plan, develop, im13 plement, and carry out programs to deliver innovative 

14 community-based behavioral health services to Indians. 

15 ‘‘(b) AWARDS; CRITERIA.—The Secretary may award 

16 a grant for a project under subsection (a) to an Indian 

17 Tribe or Tribal Organization and may consider the fol18 lowing criteria: 

19 ‘‘(1) The project will address significant unmet 

20 behavioral health needs among Indians. 

21 ‘‘(2) The project will serve a significant number 

22 of Indians. 

23 ‘‘(3) The project has the potential to deliver 

24 services in an efficient and effective manner. 


ycherry on PROD1PC64 with BILLS
282 

•HR 1328 IH

1 ‘‘(4) The Indian Tribe or Tribal Organization 

2 has the administrative and financial capability to ad3 minister the project. 

4 ‘‘(5) The project may deliver services in a man5 ner consistent with traditional health care practices. 

6 ‘‘(6) The project is coordinated with, and avoids 

7 duplication of, existing services. 

8 ‘‘(c) EQUITABLE TREATMENT.—For purposes of this 

9 subsection, the Secretary shall, in evaluating project appli10 cations or proposals, use the same criteria that the Sec11 retary uses in evaluating any other application or proposal 

12 for such funding. 

13 ‘‘SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS. 

14 ‘‘(a) PROGRAMS.— 

15 ‘‘(1) ESTABLISHMENT.—The Secretary, con16 sistent with section 701, acting through the Service, 

17 Indian Tribes, and Tribal Organizations, is author18 ized to establish and operate fetal alcohol disorder 

19 programs as provided in this section for the pur20 poses of meeting the health status objectives speci21 fied in section 3. 

22 ‘‘(2) USE OF FUNDS.— 

23 ‘‘(A) IN GENERAL.—Funding provided 

24 pursuant to this section shall be used for the 

25 following: 


ycherry on PROD1PC64 with BILLS
283 

•HR 1328 IH

1 ‘‘(i) To develop and provide for Indi2 ans community and in-school training, edu3 cation, and prevention programs relating 

4 to fetal alcohol disorders. 

5 ‘‘(ii) To identify and provide behav6 ioral health treatment to high-risk Indian 

7 women and high-risk women pregnant with 

8 an Indian’s child. 

9 ‘‘(iii) To identify and provide appro10 priate psychological services, educational 

11 and vocational support, counseling, advo12 cacy, and information to fetal alcohol dis13 order affected Indians and their families or 

14 caretakers. 

15 ‘‘(iv) To develop and implement coun16 seling and support programs in schools for 

17 fetal alcohol disorder affected Indian chil18 dren. 

19 ‘‘(v) To develop prevention and inter20 vention models which incorporate practi21 tioners of traditional health care practices, 

22 cultural values, and community involve23 ment. 


ycherry on PROD1PC64 with BILLS
284 

•HR 1328 IH

1 ‘‘(vi) To develop, print, and dissemi2 nate education and prevention materials on 

3 fetal alcohol disorder. 

4 ‘‘(vii) To develop and implement, in 

5 consultation with Indian Tribes, Tribal Or6 ganizations, and Urban Indian Organiza7 tions, culturally sensitive assessment and 

8 diagnostic tools including dysmorphology 

9 clinics and multidisciplinary fetal alcohol 

10 disorder clinics for use in Indian commu11 nities and Urban Centers. 

12 ‘‘(B) ADDITIONAL USES.—In addition to 

13 any purpose under subparagraph (A), funding 

14 provided pursuant to this section may be used 

15 for 1 or more of the following: 

16 ‘‘(i) Early childhood intervention 

17 projects from birth on to mitigate the ef18 fects of fetal alcohol disorder among Indi19 ans. 

20 ‘‘(ii) Community-based support serv21 ices for Indians and women pregnant with 

22 Indian children. 

23 ‘‘(iii) Community-based housing for 

24 adult Indians with fetal alcohol disorder. 


ycherry on PROD1PC64 with BILLS
285 

•HR 1328 IH

1 ‘‘(3) CRITERIA FOR APPLICATIONS.—The Sec2 retary shall establish criteria for the review and ap3 proval of applications for funding under this section. 

4 ‘‘(b) SERVICES.—The Secretary, acting through the 

5 Service and Indian Tribes, Tribal Organizations, and 

6 Urban Indian Organizations, shall— 

7 ‘‘(1) develop and provide services for the pre8 vention, intervention, treatment, and aftercare for 

9 those affected by fetal alcohol disorder in Indian 

10 communities; and 

11 ‘‘(2) provide supportive services, including serv12 ices to meet the special educational, vocational, 

13 school-to-work transition, and independent living 

14 needs of adolescent and adult Indians with fetal al15 cohol disorder. 

16 ‘‘(c) TASK FORCE.—The Secretary shall establish a 

17 task force to be known as the Fetal Alcohol Disorder Task 

18 Force to advise the Secretary in carrying out subsection 

19 (b). Such task force shall be composed of representatives 

20 from the following: 

21 ‘‘(1) The National Institute on Drug Abuse. 

22 ‘‘(2) The National Institute on Alcohol and Al23 coholism. 

24 ‘‘(3) The Office of Substance Abuse Prevention. 

25 ‘‘(4) The National Institute of Mental Health. 


ycherry on PROD1PC64 with BILLS
286 

•HR 1328 IH

1 ‘‘(5) The Service. 

2 ‘‘(6) The Office of Minority Health of the De3 partment of Health and Human Services. 

4 ‘‘(7) The Administration for Native Americans. 

5 ‘‘(8) The National Institute of Child Health 

6 and Human Development (NICHD). 

7 ‘‘(9) The Centers for Disease Control and Pre8 vention. 

9 ‘‘(10) The Bureau of Indian Affairs. 

10 ‘‘(11) Indian Tribes. 

11 ‘‘(12) Tribal Organizations. 

12 ‘‘(13) Urban Indian Organizations. 

13 ‘‘(14) Indian fetal alcohol disorder experts. 

14 ‘‘(d) APPLIED RESEARCH PROJECTS.—The Sec15 retary, acting through the Substance Abuse and Mental 

16 Health Services Administration, shall make grants to In17 dian Tribes, Tribal Organizations, and Urban Indian Or18 ganizations for applied research projects which propose to 

19 elevate the understanding of methods to prevent, inter20 vene, treat, or provide rehabilitation and behavioral health 

21 aftercare for Indians and Urban Indians affected by fetal 

22 alcohol disorder. 

23 ‘‘(e) FUNDING FOR URBAN INDIAN ORGANIZA24 TIONS.—Ten percent of the funds appropriated pursuant 


ycherry on PROD1PC64 with BILLS
287 

•HR 1328 IH

1 to this section shall be used to make grants to Urban In2 dian Organizations funded under title V. 

3 ‘‘SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREAT4 MENT PROGRAMS. 

5 ‘‘(a) ESTABLISHMENT.—The Secretary, acting 

6 through the Service, and the Secretary of the Interior, In7 dian Tribes, and Tribal Organizations, shall establish, 

8 consistent with section 701, in every Service Area, pro9 grams involving treatment for— 

10 ‘‘(1) victims of sexual abuse who are Indian 

11 children or children in an Indian household; and 

12 ‘‘(2) perpetrators of child sexual abuse who are 

13 Indian or members of an Indian household. 

14 ‘‘(b) USE OF FUNDS.—Funding provided pursuant to 

15 this section shall be used for the following: 

16 ‘‘(1) To develop and provide community edu17 cation and prevention programs related to sexual 

18 abuse of Indian children or children in an Indian 

19 household. 

20 ‘‘(2) To identify and provide behavioral health 

21 treatment to victims of sexual abuse who are Indian 

22 children or children in an Indian household, and to 

23 their family members who are affected by sexual 

24 abuse. 


ycherry on PROD1PC64 with BILLS
288 

•HR 1328 IH

1 ‘‘(3) To develop prevention and intervention 

2 models which incorporate traditional health care 

3 practices, cultural values, and community involve4 ment. 

5 ‘‘(4) To develop and implement culturally sen6 sitive assessment and diagnostic tools for use in In7 dian communities and Urban Centers. 

8 ‘‘(5) To identify and provide behavioral health 

9 treatment to Indian perpetrators and perpetrators 

10 who are members of an Indian household— 

11 ‘‘(A) making efforts to begin offender and 

12 behavioral health treatment while the perpe13 trator is incarcerated or at the earliest possible 

14 date if the perpetrator is not incarcerated; and 

15 ‘‘(B) providing treatment after the perpe16 trator is released, until it is determined that the 

17 perpetrator is not a threat to children. 

18 ‘‘(c) COORDINATION.—The programs established 

19 under subsection (a) shall be carried out in coordination 

20 with programs and services authorized under the Indian 

21 Child Protection and Family Violence Prevention Act (25 

22 U.S.C. 3201 et seq.). 

23 ‘‘SEC. 714. BEHAVIORAL HEALTH RESEARCH. 

24 ‘‘The Secretary, in consultation with appropriate 

25 Federal agencies, shall make grants to, or enter into conVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00288 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
289 

•HR 1328 IH

1 tracts with, Indian Tribes, Tribal Organizations, and 

2 Urban Indian Organizations or enter into contracts with, 

3 or make grants to appropriate institutions for, the conduct 

4 of research on the incidence and prevalence of behavioral 

5 health problems among Indians served by the Service, In6 dian Tribes, or Tribal Organizations and among Indians 

7 in urban areas. Research priorities under this section shall 

8 include— 

9 ‘‘(1) the multifactorial causes of Indian youth 

10 suicide, including— 

11 ‘‘(A) protective and risk factors and sci12 entific data that identifies those factors; and 

13 ‘‘(B) the effects of loss of cultural identity 

14 and the development of scientific data on those 

15 effects; 

16 ‘‘(2) the interrelationship and interdependence 

17 of behavioral health problems with alcoholism and 

18 other substance abuse, suicide, homicides, other in19 juries, and the incidence of family violence; and 

20 ‘‘(3) the development of models of prevention 

21 techniques. 

22 The effect of the interrelationships and interdependencies 

23 referred to in paragraph (2) on children, and the develop24 ment of prevention techniques under paragraph (3) appli25 cable to children, shall be emphasized. 


ycherry on PROD1PC64 with BILLS
290 

•HR 1328 IH

1 ‘‘SEC. 715. DEFINITIONS. 

2 ‘‘For the purpose of this title, the following defini3 tions shall apply: 

4 ‘‘(1) ASSESSMENT.—The term ‘assessment’ 

5 means the systematic collection, analysis, and dis6 semination of information on health status, health 

7 needs, and health problems. 

8 ‘‘(2) ALCOHOL-RELATED

9 NEURODEVELOPMENTAL DISORDERS OR ARND.—The 

10 term ‘alcohol-related neurodevelopmental disorders’ 

11 or ‘ARND’ means, with a history of maternal alco12 hol consumption during pregnancy, central nervous 

13 system involvement such as developmental delay, in14 tellectual deficit, or neurologic abnormalities. Behav15 iorally, there can be problems with irritability, and 

16 failure to thrive as infants. As children become older 

17 there will likely be hyperactivity, attention deficit, 

18 language dysfunction, and perceptual and judgment 

19 problems. 

20 ‘‘(3) BEHAVIORAL HEALTH AFTERCARE.—The 

21 term ‘behavioral health aftercare’ includes those ac22 tivities and resources used to support recovery fol23 lowing inpatient, residential, intensive substance 

24 abuse, or mental health outpatient or outpatient 

25 treatment. The purpose is to help prevent or deal 

26 with relapse by ensuring that by the time a client or 


ycherry on PROD1PC64 with BILLS
291 

•HR 1328 IH

1 patient is discharged from a level of care, such as 

2 outpatient treatment, an aftercare plan has been de3 veloped with the client. An aftercare plan may use 

4 such resources as a community-based therapeutic 

5 group, transitional living facilities, a 12-step spon6 sor, a local 12-step or other related support group, 

7 and other community-based providers. 

8 ‘‘(4) DUAL DIAGNOSIS.—The term ‘dual diag9 nosis’ means coexisting substance abuse and mental 

10 illness conditions or diagnosis. Such clients are 

11 sometimes referred to as mentally ill chemical abus12 ers (MICAs). 

13 ‘‘(5) FETAL ALCOHOL DISORDERS.—The term 

14 ‘fetal alcohol disorders’ means fetal alcohol syn15 drome, partial fetal alcohol syndrome and alcohol re16 lated neurodevelopmental disorder (ARND). 

17 ‘‘(6) FETAL ALCOHOL SYNDROME OR FAS.— 

18 The term ‘fetal alcohol syndrome’ or ‘FAS’ means a 

19 syndrome in which, with a history of maternal alco20 hol consumption during pregnancy, the following cri21 teria are met: 

22 ‘‘(A) Central nervous system involvement 

23 such as developmental delay, intellectual deficit, 

24 microencephaly, or neurologic abnormalities. 


ycherry on PROD1PC64 with BILLS
292 

•HR 1328 IH

1 ‘‘(B) Craniofacial abnormalities with at 

2 least 2 of the following: microophthalmia, short 

3 palpebral fissures, poorly developed philtrum, 

4 thin upper lip, flat nasal bridge, and short 

5 upturned nose. 

6 ‘‘(C) Prenatal or postnatal growth delay. 

7 ‘‘(7) PARTIAL FAS.—The term ‘partial FAS’ 

8 means, with a history of maternal alcohol consump9 tion during pregnancy, having most of the criteria of 

10 FAS, though not meeting a minimum of at least 2 

11 of the following: microophthalmia, short palpebral 

12 fissures, poorly developed philtrum, thin upper lip, 

13 flat nasal bridge, and short upturned nose. 

14 ‘‘(8) REHABILITATION.—The term ‘rehabilita15 tion’ means to restore the ability or capacity to en16 gage in usual and customary life activities through 

17 education and therapy. 

18 ‘‘(9) SUBSTANCE ABUSE.—The term ‘substance 

19 abuse’ includes inhalant abuse. 

20 ‘‘SEC. 716. AUTHORIZATION OF APPROPRIATIONS. 

21 ‘‘There is authorized to be appropriated such sums 

22 as may be necessary for each fiscal year through fiscal 

23 year 2017 to carry out the provisions of this title. 


ycherry on PROD1PC64 with BILLS
293 

•HR 1328 IH

1 ‘‘TITLE VIII—MISCELLANEOUS 

2 ‘‘SEC. 801. REPORTS. 

3 ‘‘For each fiscal year following the date of enactment 

4 of the Indian Health Care Improvement Act Amendments 

5 of 2007, the Secretary shall transmit to Congress a report 

6 containing the following: 

7 ‘‘(1) A report on the progress made in meeting 

8 the objectives of this Act, including a review of pro9 grams established or assisted pursuant to this Act 

10 and assessments and recommendations of additional 

11 programs or additional assistance necessary to, at a 

12 minimum, provide health services to Indians and en13 sure a health status for Indians, which are at a par14 ity with the health services available to and the 

15 health status of the general population. 

16 ‘‘(2) A report on whether, and to what extent, 

17 new national health care programs, benefits, initia18 tives, or financing systems have had an impact on 

19 the purposes of this Act and any steps that the Sec20 retary may have taken to consult with Indian Tribes, 

21 Tribal Organizations, and Urban Indian Organiza22 tions to address such impact, including a report on 

23 proposed changes in allocation of funding pursuant 

24 to section 808. 


ycherry on PROD1PC64 with BILLS
294 

•HR 1328 IH

1 ‘‘(3) A report on the use of health services by 

2 Indians— 

3 ‘‘(A) on a national and area or other rel4 evant geographical basis; 

5 ‘‘(B) by gender and age; 

6 ‘‘(C) by source of payment and type of 

7 service; 

8 ‘‘(D) comparing such rates of use with 

9 rates of use among comparable non-Indian pop10 ulations; and 

11 ‘‘(E) provided under contracts. 

12 ‘‘(4) A report of contractors to the Secretary on 

13 Health Care Educational Loan Repayments every 6 

14 months required by section 110. 

15 ‘‘(5) A general audit report of the Secretary on 

16 the Health Care Educational Loan Repayment Pro17 gram as required by section 110(n). 

18 ‘‘(6) A report of the findings and conclusions of 

19 demonstration programs on development of edu20 cational curricula for substance abuse counseling as 

21 required in section 125(f). 

22 ‘‘(7) A separate statement which specifies the 

23 amount of funds requested to carry out the provi24 sions of section 201. 


ycherry on PROD1PC64 with BILLS
295 

•HR 1328 IH

1 ‘‘(8) A report of the evaluations of health pro2 motion and disease prevention as required in section 

3 203(c). 

4 ‘‘(9) A biennial report to Congress on infectious 

5 diseases as required by section 212. 

6 ‘‘(10) A report on environmental and nuclear 

7 health hazards as required by section 215. 

8 ‘‘(11) An annual report on the status of all 

9 health care facilities needs as required by section 

10 301(c)(2)(B) and 301(d). 

11 ‘‘(12) Reports on safe water and sanitary waste 

12 disposal facilities as required by section 302(h). 

13 ‘‘(13) An annual report on the expenditure of 

14 non-Service funds for renovation as required by sec15 tions 304(b)(2). 

16 ‘‘(14) A report identifying the backlog of main17 tenance and repair required at Service and tribal fa18 cilities required by section 313(a). 

19 ‘‘(15) A report providing an accounting of reim20 bursement funds made available to the Secretary 

21 under titles XVIII, XIX, and XXI of the Social Se22 curity Act. 

23 ‘‘(16) A report on any arrangements for the 

24 sharing of medical facilities or services, as author25 ized by section 406. 


ycherry on PROD1PC64 with BILLS
296 

•HR 1328 IH

1 ‘‘(17) A report on evaluation and renewal of 

2 Urban Indian programs under section 505. 

3 ‘‘(18) A report on the evaluation of programs 

4 as required by section 513(d). 

5 ‘‘(19) A report on alcohol and substance abuse 

6 as required by section 701(f). 

7 ‘‘(20) A report on Indian youth mental health 

8 services as required by section 707(h). 

9 ‘‘(21) A report on the reallocation of base re10 sources if required by section 808. 

11 ‘‘SEC. 802. REGULATIONS. 

12 ‘‘(a) DEADLINES.— 

13 ‘‘(1) PROCEDURES.—Not later than 90 days 

14 after the date of enactment of the Indian Health 

15 Care Improvement Act Amendments of 2007, the 

16 Secretary shall initiate procedures under subchapter 

17 III of chapter 5 of title 5, United States Code, to 

18 negotiate and promulgate such regulations or 

19 amendments thereto that are necessary to carry out 

20 titles II (except section 202) and VII, the sections 

21 of title III for which negotiated rulemaking is spe22 cifically required, and section 807. Unless otherwise 

23 required, the Secretary may promulgate regulations 

24 to carry out titles I, III, IV, and V, and section 202, 

25 using the procedures required by chapter V of title 


ycherry on PROD1PC64 with BILLS
297 

•HR 1328 IH

1 5, United States Code (commonly known as the ‘Ad2 ministrative Procedure Act’). 

3 ‘‘(2) PROPOSED REGULATIONS.—Proposed reg4 ulations to implement this Act shall be published in 

5 the Federal Register by the Secretary no later than 

6 2 years after the date of enactment of the Indian 

7 Health Care Improvement Act Amendments of 2007 

8 and shall have no less than a 120-day comment pe9 riod. 

10 ‘‘(3) FINAL REGULATIONS.—The Secretary 

11 shall publish in the Federal Register final regula12 tions to implement this Act by not later than 3 years 

13 after the date of enactment of the Indian Health 

14 Care Improvement Act Amendments of 2007. 

15 ‘‘(b) COMMITTEE.—A negotiated rulemaking com16 mittee established pursuant to section 565 of title 5, 

17 United States Code, to carry out this section shall have 

18 as its members only representatives of the Federal Gov19 ernment and representatives of Indian Tribes, and Tribal 

20 Organizations, a majority of whom shall be nominated by 

21 and be representatives of Indian Tribes and Tribal Orga22 nizations from each Service Area. 

23 ‘‘(c) ADAPTATION OF PROCEDURES.—The Secretary 

24 shall adapt the negotiated rulemaking procedures to the 

25 unique context of self-governance and the government-toVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00297 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
298 

•HR 1328 IH

1 government relationship between the United States and 

2 Indian Tribes. 

3 ‘‘(d) LACK OF REGULATIONS.—The lack of promul4 gated regulations shall not limit the effect of this Act. 

5 ‘‘(e) INCONSISTENT REGULATIONS.—The provisions 

6 of this Act shall supersede any conflicting provisions of 

7 law in effect on the day before the date of enactment of 

8 the Indian Health Care Improvement Act Amendments of 

9 2007, and the Secretary is authorized to repeal any regu10 lation inconsistent with the provisions of this Act. 

11 ‘‘SEC. 803. PLAN OF IMPLEMENTATION. 

12 ‘‘Not later than 9 months after the date of enactment 

13 of the Indian Health Care Improvement Act Amendments 

14 of 2007, the Secretary, in consultation with Indian Tribes, 

15 Tribal Organizations, and Urban Indian Organizations, 

16 shall submit to Congress a plan explaining the manner and 

17 schedule, by title and section, by which the Secretary will 

18 implement the provisions of this Act. This consultation 

19 may be conducted jointly with the annual budget consulta20 tion pursuant to the Indian Self-Determination and Edu21 cation Assistance Act (25 U.S.C. 450 et seq). 

22 ‘‘SEC. 804. AVAILABILITY OF FUNDS. 

23 ‘‘The funds appropriated pursuant to this Act shall 

24 remain available until expended. 


ycherry on PROD1PC64 with BILLS
299 

•HR 1328 IH

1 ‘‘SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED 

2 TO INDIAN HEALTH SERVICE. 

3 ‘‘Any limitation on the use of funds contained in an 

4 Act providing appropriations for the Department for a pe5 riod with respect to the performance of abortions shall 

6 apply for that period with respect to the performance of 

7 abortions using funds contained in an Act providing ap8 propriations for the Service. 

9 ‘‘SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS. 

10 ‘‘(a) IN GENERAL.—The following California Indians 

11 shall be eligible for health services provided by the Service: 

12 ‘‘(1) Any member of a federally recognized In13 dian Tribe. 

14 ‘‘(2) Any descendant of an Indian who was re15 siding in California on June 1, 1852, if such de16 scendant— 

17 ‘‘(A) is a member of the Indian community 

18 served by a local program of the Service; and 

19 ‘‘(B) is regarded as an Indian by the com20 munity in which such descendant lives. 

21 ‘‘(3) Any Indian who holds trust interests in 

22 public domain, national forest, or reservation allot23 ments in California. 

24 ‘‘(4) Any Indian in California who is listed on 

25 the plans for distribution of the assets of rancherias 

26 and reservations located within the State of CaliVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00299 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
300 

•HR 1328 IH

1 fornia under the Act of August 18, 1958 (72 Stat. 

2 619), and any descendant of such an Indian. 

3 ‘‘(b) CLARIFICATION.—Nothing in this section may 

4 be construed as expanding the eligibility of California Indi5 ans for health services provided by the Service beyond the 

6 scope of eligibility for such health services that applied on 

7 May 1, 1986. 

8 ‘‘SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS. 

9 ‘‘(a) CHILDREN.—Any individual who— 

10 ‘‘(1) has not attained 19 years of age; 

11 ‘‘(2) is the natural or adopted child, stepchild, 

12 foster child, legal ward, or orphan of an eligible In13 dian; and 

14 ‘‘(3) is not otherwise eligible for health services 

15 provided by the Service, 

16 shall be eligible for all health services provided by the 

17 Service on the same basis and subject to the same rules 

18 that apply to eligible Indians until such individual attains 

19 19 years of age. The existing and potential health needs 

20 of all such individuals shall be taken into consideration 

21 by the Service in determining the need for, or the alloca22 tion of, the health resources of the Service. If such an indi23 vidual has been determined to be legally incompetent prior 

24 to attaining 19 years of age, such individual shall remain 


ycherry on PROD1PC64 with BILLS
301 

•HR 1328 IH

1 eligible for such services until 1 year after the date of a 

2 determination of competency. 

3 ‘‘(b) SPOUSES.—Any spouse of an eligible Indian who 

4 is not an Indian, or who is of Indian descent but is not 

5 otherwise eligible for the health services provided by the 

6 Service, shall be eligible for such health services if all such 

7 spouses or spouses who are married to members of each 

8 Indian Tribe being served are made eligible, as a class, 

9 by an appropriate resolution of the governing body of the 

10 Indian Tribe or Tribal Organization providing such serv11 ices. The health needs of persons made eligible under this 

12 paragraph shall not be taken into consideration by the 

13 Service in determining the need for, or allocation of, its 

14 health resources. 

15 ‘‘(c) PROVISION OF SERVICES TO OTHER INDIVID16 UALS.— 

17 ‘‘(1) IN GENERAL.—The Secretary is authorized 

18 to provide health services under this subsection 

19 through health programs operated directly by the 

20 Service to individuals who reside within the Service 

21 Unit and who are not otherwise eligible for such 

22 health services if— 

23 ‘‘(A) the Indian Tribes served by such 

24 Service Unit request such provision of health 

25 services to such individuals; and 


ycherry on PROD1PC64 with BILLS
302 

•HR 1328 IH

1 ‘‘(B) the Secretary and the served Indian 

2 Tribes have jointly determined that— 

3 ‘‘(i) the provision of such health serv4 ices will not result in a denial or diminu5 tion of health services to eligible Indians; 

6 and 

7 ‘‘(ii) there is no reasonable alternative 

8 health facilities or services, within or with9 out the Service Unit, available to meet the 

10 health needs of such individuals. 

11 ‘‘(2) ISDEAA PROGRAMS.—In the case of 

12 health programs and facilities operated under a con13 tract or compact entered into under the Indian Self14 Determination and Education Assistance Act (25 

15 U.S.C. 450 et seq.), the governing body of the In16 dian Tribe or Tribal Organization providing health 

17 services under such contract or compact is author18 ized to determine whether health services should be 

19 provided under such contract to individuals who are 

20 not eligible for such health services under any other 

21 subsection of this section or under any other provi22 sion of law. In making such determinations, the gov23 erning body of the Indian Tribe or Tribal Organiza24 tion shall take into account the considerations de25 scribed in paragraph (1)(B). 


ycherry on PROD1PC64 with BILLS
303 

•HR 1328 IH

1 ‘‘(3) PAYMENT FOR SERVICES.— 

2 ‘‘(A) IN GENERAL.—Persons receiving 

3 health services provided by the Service under 

4 this subsection shall be liable for payment of 

5 such health services under a schedule of charges 

6 prescribed by the Secretary which, in the judg7 ment of the Secretary, results in reimbursement 

8 in an amount not less than the actual cost of 

9 providing the health services. Notwithstanding 

10 section 404 of this Act or any other provision 

11 of law, amounts collected under this subsection, 

12 including Medicare, Medicaid, or SCHIP reim13 bursements under titles XVIII, XIX, and XXI 

14 of the Social Security Act, shall be credited to 

15 the account of the program providing the serv16 ice and shall be used for the purposes listed in 

17 section 401(d)(2) and amounts collected under 

18 this subsection shall be available for expendi19 ture within such program. 

20 ‘‘(B) INDIGENT PEOPLE.—Health services 

21 may be provided by the Secretary through the 

22 Service under this subsection to an indigent in23 dividual who would not be otherwise eligible for 

24 such health services but for the provisions of 

25 paragraph (1) only if an agreement has been 


ycherry on PROD1PC64 with BILLS
304 

•HR 1328 IH

1 entered into with a State or local government 

2 under which the State or local government 

3 agrees to reimburse the Service for the expenses 

4 incurred by the Service in providing such health 

5 services to such indigent individual. 

6 ‘‘(4) REVOCATION OF CONSENT FOR SERV7 ICES.— 

8 ‘‘(A) SINGLE TRIBE SERVICE AREA.—In 

9 the case of a Service Area which serves only 1 

10 Indian Tribe, the authority of the Secretary to 

11 provide health services under paragraph (1) 

12 shall terminate at the end of the fiscal year suc13 ceeding the fiscal year in which the governing 

14 body of the Indian Tribe revokes its concur15 rence to the provision of such health services. 

16 ‘‘(B) MULTITRIBAL SERVICE AREA.—In 

17 the case of a multitribal Service Area, the au18 thority of the Secretary to provide health serv19 ices under paragraph (1) shall terminate at the 

20 end of the fiscal year succeeding the fiscal year 

21 in which at least 51 percent of the number of 

22 Indian Tribes in the Service Area revoke their 

23 concurrence to the provisions of such health 

24 services. 


ycherry on PROD1PC64 with BILLS
305 

•HR 1328 IH

1 ‘‘(d) OTHER SERVICES.—The Service may provide 

2 health services under this subsection to individuals who 

3 are not eligible for health services provided by the Service 

4 under any other provision of law in order to— 

5 ‘‘(1) achieve stability in a medical emergency; 

6 ‘‘(2) prevent the spread of a communicable dis7 ease or otherwise deal with a public health hazard; 

8 ‘‘(3) provide care to non-Indian women preg9 nant with an eligible Indian’s child for the duration 

10 of the pregnancy through postpartum; or 

11 ‘‘(4) provide care to immediate family members 

12 of an eligible individual if such care is directly re13 lated to the treatment of the eligible individual. 

14 ‘‘(e) HOSPITAL PRIVILEGES FOR PRACTITIONERS.— 

15 Hospital privileges in health facilities operated and main16 tained by the Service or operated under a contract or com17 pact pursuant to the Indian Self-Determination and Edu18 cation Assistance Act (25 U.S.C. 450 et seq.) may be ex19 tended to non-Service health care practitioners who pro20 vide services to individuals described in subsection (a), (b), 

21 (c), or (d). Such non-Service health care practitioners 

22 may, as part of the privileging process, be designated as 

23 employees of the Federal Government for purposes of sec24 tion 1346(b) and chapter 171 of title 28, United States 

25 Code (relating to Federal tort claims) only with respect 


ycherry on PROD1PC64 with BILLS
306 

•HR 1328 IH

1 to acts or omissions which occur in the course of providing 

2 services to eligible individuals as a part of the conditions 

3 under which such hospital privileges are extended. 

4 ‘‘(f) ELIGIBLE INDIAN.—For purposes of this sec5 tion, the term ‘eligible Indian’ means any Indian who is 

6 eligible for health services provided by the Service without 

7 regard to the provisions of this section. 

8 ‘‘SEC. 808. REALLOCATION OF BASE RESOURCES. 

9 ‘‘(a) REPORT REQUIRED.—Notwithstanding any 

10 other provision of law, any allocation of Service funds for 

11 a fiscal year that reduces by 5 percent or more from the 

12 previous fiscal year the funding for any recurring pro13 gram, project, or activity of a Service Unit may be imple14 mented only after the Secretary has submitted to Con15 gress, under section 801, a report on the proposed change 

16 in allocation of funding, including the reasons for the 

17 change and its likely effects. 

18 ‘‘(b) EXCEPTION.—Subsection (a) shall not apply if 

19 the total amount appropriated to the Service for a fiscal 

20 year is at least 5 percent less than the amount appro21 priated to the Service for the previous fiscal year. 

22 ‘‘SEC. 809. RESULTS OF DEMONSTRATION PROJECTS. 

23 ‘‘The Secretary shall provide for the dissemination to 

24 Indian Tribes, Tribal Organizations, and Urban Indian 


ycherry on PROD1PC64 with BILLS
307 

•HR 1328 IH

1 Organizations of the findings and results of demonstration 

2 projects conducted under this Act. 

3 ‘‘SEC. 810. PROVISION OF SERVICES IN MONTANA. 

4 ‘‘(a) CONSISTENT WITH COURT DECISION.—The 

5 Secretary, acting through the Service, shall provide serv6 ices and benefits for Indians in Montana in a manner con7 sistent with the decision of the United States Court of Ap8 peals for the Ninth Circuit in McNabb for McNabb v. 

9 Bowen, 829 F.2d 787 (9th Cir. 1987). 

10 ‘‘(b) CLARIFICATION.—The provisions of subsection 

11 (a) shall not be construed to be an expression of the sense 

12 of Congress on the application of the decision described 

13 in subsection (a) with respect to the provision of services 

14 or benefits for Indians living in any State other than Mon15 tana. 

16 ‘‘SEC. 811. MORATORIUM. 

17 ‘‘During the period of the moratorium imposed on 

18 implementation of the final rule published in the Federal 

19 Register on September 16, 1987, by the Department of 

20 Health and Human Services, relating to eligibility for the 

21 health care services of the Indian Health Service, the In22 dian Health Service shall provide services pursuant to the 

23 criteria for eligibility for such services that were in effect 

24 on September 15, 1987, subject to the provisions of sec25 tions 806 and 807, until the Service has submitted to the 


ycherry on PROD1PC64 with BILLS
308 

•HR 1328 IH

1 Committees on Appropriations of the Senate and the 

2 House of Representatives a budget request reflecting the 

3 increased costs associated with the proposed final rule, 

4 and the request has been included in an appropriations 

5 Act and enacted into law. 

6 ‘‘SEC. 812. SEVERABILITY PROVISIONS. 

7 ‘‘If any provision of this Act, any amendment made 

8 by the Act, or the application of such provision or amend9 ment to any person or circumstances is held to be invalid, 

10 the remainder of this Act, the remaining amendments 

11 made by this Act, and the application of such provisions 

12 to persons or circumstances other than those to which it 

13 is held invalid, shall not be affected thereby. 

14 ‘‘SEC. 813. ESTABLISHMENT OF NATIONAL BIPARTISAN 

15 COMMISSION ON INDIAN HEALTH CARE. 

16 ‘‘(a) ESTABLISHMENT.—There is established the Na17 tional Bipartisan Indian Health Care Commission (the 

18 ‘Commission’). 

19 ‘‘(b) DUTIES OF COMMISSION.—The duties of the 

20 Commission are the following: 

21 ‘‘(1) To establish a study committee composed 

22 of those members of the Commission appointed by 

23 the Director of the Service and at least 4 members 

24 of Congress from among the members of the Com25 mission, the duties of which shall be the following: 


ycherry on PROD1PC64 with BILLS
309 

•HR 1328 IH

1 ‘‘(A) To the extent necessary to carry out 

2 its duties, collect and compile data necessary to 

3 understand the extent of Indian needs with re4 gard to the provision of health services, regard5 less of the location of Indians, including holding 

6 hearings and soliciting the views of Indians, In7 dian Tribes, Tribal Organizations, and Urban 

8 Indian Organizations, which may include au9 thorizing and making funds available for feasi10 bility studies of various models for providing 

11 and funding health services for all Indian bene12 ficiaries, including those who live outside of a 

13 reservation, temporarily or permanently. 

14 ‘‘(B) To make legislative recommendations 

15 to the Commission regarding the delivery of 

16 Federal health care services to Indians. Such 

17 recommendations shall include those related to 

18 issues of eligibility, benefits, the range of serv19 ice providers, the cost of such services, financ20 ing such services, and the optimal manner in 

21 which to provide such services. 

22 ‘‘(C) To determine the effect of the enact23 ment of such recommendations on (i) the exist24 ing system of delivery of health services for InVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00309 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
310 

•HR 1328 IH

1 dians, and (ii) the sovereign status of Indian 

2 Tribes. 

3 ‘‘(D) Not later than 12 months after the 

4 appointment of all members of the Commission, 

5 to submit a written report of its findings and 

6 recommendations to the full Commission. The 

7 report shall include a statement of the minority 

8 and majority position of the Committee and 

9 shall be disseminated, at a minimum, to every 

10 Indian Tribe, Tribal Organization, and Urban 

11 Indian Organization for comment to the Com12 mission. 

13 ‘‘(E) To report regularly to the full Com14 mission regarding the findings and rec15 ommendations developed by the study com16 mittee in the course of carrying out its duties 

17 under this section. 

18 ‘‘(2) To review and analyze the recommenda19 tions of the report of the study committee. 

20 ‘‘(3) To make legislative recommendations to 

21 Congress regarding the delivery of Federal health 

22 care services to Indians. Such recommendations 

23 shall include those related to issues of eligibility, 

24 benefits, the range of service providers, the cost of 


ycherry on PROD1PC64 with BILLS
311 

•HR 1328 IH

1 such services, financing such services, and the opti2 mal manner in which to provide such services. 

3 ‘‘(4) Not later than 18 months following the 

4 date of appointment of all members of the Commis5 sion, submit a written report to Congress regarding 

6 the delivery of Federal health care services to Indi7 ans. Such recommendations shall include those re8 lated to issues of eligibility, benefits, the range of 

9 service providers, the cost of such services, financing 

10 such services, and the optimal manner in which to 

11 provide such services. 

12 ‘‘(c) MEMBERS.— 

13 ‘‘(1) APPOINTMENT.—The Commission shall be 

14 composed of 25 members, appointed as follows: 

15 ‘‘(A) Ten members of Congress, including 

16 3 from the House of Representatives and 2 

17 from the Senate, appointed by their respective 

18 majority leaders, and 3 from the House of Rep19 resentatives and 2 from the Senate, appointed 

20 by their respective minority leaders, and who 

21 shall be members of the standing committees of 

22 Congress that consider legislation affecting 

23 health care to Indians. 

24 ‘‘(B) Twelve persons chosen by the con25 gressional members of the Commission, 1 from 


ycherry on PROD1PC64 with BILLS
312 

•HR 1328 IH

1 each Service Area as currently designated by 

2 the Director of the Service to be chosen from 

3 among 3 nominees from each Service Area put 

4 forward by the Indian Tribes within the area, 

5 with due regard being given to the experience 

6 and expertise of the nominees in the provision 

7 of health care to Indians and to a reasonable 

8 representation on the commission of members 

9 who are familiar with various health care deliv10 ery modes and who represent Indian Tribes of 

11 various size populations. 

12 ‘‘(C) Three persons appointed by the Di13 rector who are knowledgeable about the provi14 sion of health care to Indians, at least 1 of 

15 whom shall be appointed from among 3 nomi16 nees put forward by those programs whose 

17 funds are provided in whole or in part by the 

18 Service primarily or exclusively for the benefit 

19 of Urban Indians. 

20 ‘‘(D) All those persons chosen by the con21 gressional members of the Commission and by 

22 the Director shall be members of federally rec23 ognized Indian Tribes. 


ycherry on PROD1PC64 with BILLS
313 

•HR 1328 IH

1 ‘‘(2) CHAIR; VICE CHAIR.—The Chair and Vice 

2 Chair of the Commission shall be selected by the 

3 congressional members of the Commission. 

4 ‘‘(3) TERMS.—The terms of members of the 

5 Commission shall be for the life of the Commission. 

6 ‘‘(4) DEADLINE FOR APPOINTMENTS.—Con7 gressional members of the Commission shall be ap8 pointed not later than 180 days after the date of en9 actment of the Indian Health Care Improvement Act 

10 Amendments of 2007, and the remaining members 

11 of the Commission shall be appointed not later than 

12 60 days following the appointment of the congres13 sional members. 

14 ‘‘(5) VACANCY.—A vacancy in the Commission 

15 shall be filled in the manner in which the original 

16 appointment was made. 

17 ‘‘(d) COMPENSATION.— 

18 ‘‘(1) CONGRESSIONAL MEMBERS.—Each con19 gressional member of the Commission shall receive 

20 no additional pay, allowances, or benefits by reason 

21 of their service on the Commission and shall receive 

22 travel expenses and per diem in lieu of subsistence 

23 in accordance with sections 5702 and 5703 of title 

24 5, United States Code. 


ycherry on PROD1PC64 with BILLS
314 

•HR 1328 IH

1 ‘‘(2) OTHER MEMBERS.—Remaining members 

2 of the Commission, while serving on the business of 

3 the Commission (including travel time), shall be en4 titled to receive compensation at the per diem equiv5 alent of the rate provided for level IV of the Execu6 tive Schedule under section 5315 of title 5, United 

7 States Code, and while so serving away from home 

8 and the member’s regular place of business, a mem9 ber may be allowed travel expenses, as authorized by 

10 the Chairman of the Commission. For purpose of 

11 pay (other than pay of members of the Commission) 

12 and employment benefits, rights, and privileges, all 

13 personnel of the Commission shall be treated as if 

14 they were employees of the United States Senate. 

15 ‘‘(e) MEETINGS.—The Commission shall meet at the 

16 call of the Chair. 

17 ‘‘(f) QUORUM.—A quorum of the Commission shall 

18 consist of not less than 15 members, provided that no less 

19 than 6 of the members of Congress who are Commission 

20 members are present and no less than 9 of the members 

21 who are Indians are present. 

22 ‘‘(g) EXECUTIVE DIRECTOR; STAFF; FACILITIES.— 

23 ‘‘(1) APPOINTMENT; PAY.—The Commission 

24 shall appoint an executive director of the CommisVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00314 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
315 

•HR 1328 IH

1 sion. The executive director shall be paid the rate of 

2 basic pay for level V of the Executive Schedule. 

3 ‘‘(2) STAFF APPOINTMENT.—With the approval 

4 of the Commission, the executive director may ap5 point such personnel as the executive director deems 

6 appropriate. 

7 ‘‘(3) STAFF PAY.—The staff of the Commission 

8 shall be appointed without regard to the provisions 

9 of title 5, United States Code, governing appoint10 ments in the competitive service, and shall be paid 

11 without regard to the provisions of chapter 51 and 

12 subchapter III of chapter 53 of such title (relating 

13 to classification and General Schedule pay rates). 

14 ‘‘(4) TEMPORARY SERVICES.—With the ap15 proval of the Commission, the executive director may 

16 procure temporary and intermittent services under 

17 section 3109(b) of title 5, United States Code. 

18 ‘‘(5) FACILITIES.—The Administrator of Gen19 eral Services shall locate suitable office space for the 

20 operation of the Commission. The facilities shall 

21 serve as the headquarters of the Commission and 

22 shall include all necessary equipment and incidentals 

23 required for the proper functioning of the Commis24 sion. 


ycherry on PROD1PC64 with BILLS
316 

•HR 1328 IH

1 ‘‘(h) HEARINGS.—(1) For the purpose of carrying 

2 out its duties, the Commission may hold such hearings 

3 and undertake such other activities as the Commission de4 termines to be necessary to carry out its duties, provided 

5 that at least 6 regional hearings are held in different areas 

6 of the United States in which large numbers of Indians 

7 are present. Such hearings are to be held to solicit the 

8 views of Indians regarding the delivery of health care serv9 ices to them. To constitute a hearing under this sub10 section, at least 5 members of the Commission, including 

11 at least 1 member of Congress, must be present. Hearings 

12 held by the study committee established in this section 

13 may count toward the number of regional hearings re14 quired by this subsection. 

15 ‘‘(2) Upon request of the Commission, the Comp16 troller General shall conduct such studies or investigations 

17 as the Commission determines to be necessary to carry 

18 out its duties. 

19 ‘‘(3)(A) The Director of the Congressional Budget 

20 Office or the Chief Actuary of the Centers for Medicare 

21 & Medicaid Services, or both, shall provide to the Commis22 sion, upon the request of the Commission, such cost esti23 mates as the Commission determines to be necessary to 

24 carry out its duties. 


ycherry on PROD1PC64 with BILLS
317 

•HR 1328 IH

1 ‘‘(B) The Commission shall reimburse the Director 

2 of the Congressional Budget Office for expenses relating 

3 to the employment in the office of that Director of such 

4 additional staff as may be necessary for the Director to 

5 comply with requests by the Commission under subpara6 graph (A). 

7 ‘‘(4) Upon the request of the Commission, the head 

8 of any Federal agency is authorized to detail, without re9 imbursement, any of the personnel of such agency to the 

10 Commission to assist the Commission in carrying out its 

11 duties. Any such detail shall not interrupt or otherwise 

12 affect the civil service status or privileges of the Federal 

13 employee. 

14 ‘‘(5) Upon the request of the Commission, the head 

15 of a Federal agency shall provide such technical assistance 

16 to the Commission as the Commission determines to be 

17 necessary to carry out its duties. 

18 ‘‘(6) The Commission may use the United States 

19 mails in the same manner and under the same conditions 

20 as Federal agencies and shall, for purposes of the frank, 

21 be considered a commission of Congress as described in 

22 section 3215 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 


ycherry on PROD1PC64 with BILLS
318 

•HR 1328 IH

1 section 552 of title 4, United States Code. Upon request 

2 of the Chairman of the Commission, the head of such 

3 agency shall furnish such information to the Commission. 

4 ‘‘(8) Upon the request of the Commission, the Ad5 ministrator of General Services shall provide to the Com6 mission on a reimbursable basis such administrative sup7 port services 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 

18 Advisory Committee Act (5 U.S.C. App.) shall not apply 

19 to the 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 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00318 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
319 

•HR 1328 IH

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 evi10 dence in any judicial or administrative proceeding, 

11 except as provided in subsection (c). 

12 ‘‘(2) TESTIMONY.—A person who reviews or 

13 creates medical quality assurance records for any In14 dian Health Program or Urban Indian Organization 

15 who participates in any proceeding that reviews or 

16 creates such records may not be permitted or re17 quired to testify in any judicial or administrative 

18 proceeding with respect to such records or with re19 spect to any finding, recommendation, evaluation, 

20 opinion, or action taken by such person or body in 

21 connection with such records except as provided in 

22 this section. 

23 ‘‘(c) AUTHORIZED DISCLOSURE AND TESTIMONY.— 

24 ‘‘(1) IN GENERAL.—Subject to paragraph (2), a 

25 medical quality assurance record described in subVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00319 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
320 

•HR 1328 IH

1 section (a) may be disclosed, and a person referred 

2 to in subsection (b) may give testimony in connec3 tion with such a record, only as follows: 

4 ‘‘(A) To a Federal executive agency or pri5 vate organization, if such medical quality assur6 ance record or testimony is needed by such 

7 agency or organization to perform licensing or 

8 accreditation functions related to any Indian 

9 Health Program or to a health program of an 

10 Urban Indian Organization to perform moni11 toring, required by law, of such program or or12 ganization. 

13 ‘‘(B) To an administrative or judicial pro14 ceeding commenced by a present or former In15 dian Health Program or Urban Indian Organi16 zation provider concerning the termination, sus17 pension, or limitation of clinical privileges of 

18 such health care provider. 

19 ‘‘(C) To a governmental board or agency 

20 or to a professional health care society or orga21 nization, if such medical quality assurance 

22 record or testimony is needed by such board, 

23 agency, society, or organization to perform li24 censing, credentialing, or the monitoring of pro25 fessional standards with respect to any health 


ycherry on PROD1PC64 with BILLS
321 

•HR 1328 IH

1 care provider who is or was an employee of any 

2 Indian Health Program or Urban Indian Orga3 nization. 

4 ‘‘(D) To a hospital, medical center, or 

5 other institution that provides health care serv6 ices, if such medical quality assurance record or 

7 testimony is needed by such institution to as8 sess the professional qualifications of any health 

9 care provider who is or was an employee of any 

10 Indian Health Program or Urban Indian Orga11 nization and who has applied for or been grant12 ed authority or employment to provide health 

13 care services in or on behalf of such program or 

14 organization. 

15 ‘‘(E) To an officer, employee, or contractor 

16 of the Indian Health Program or Urban Indian 

17 Organization that created the records or for 

18 which the records were created. If that officer, 

19 employee, or contractor has a need for such 

20 record or testimony to perform official duties. 

21 ‘‘(F) To a criminal or civil law enforce22 ment agency or instrumentality charged under 

23 applicable law with the protection of the public 

24 health or safety, if a qualified representative of 

25 such agency or instrumentality makes a written 


ycherry on PROD1PC64 with BILLS
322 

•HR 1328 IH

1 request that such record or testimony be pro2 vided 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 

7 to the subject of such proceeding. 

8 ‘‘(2) IDENTITY OF PARTICIPANTS.—With the 

9 exception of the subject of a quality assurance ac10 tion, the identity of any person receiving health care 

11 services from any Indian Health Program or Urban 

12 Indian Organization or the identity of any other per13 son associated with such program or organization 

14 for purposes of a medical quality assurance program 

15 that is disclosed in a medical quality assurance 

16 record described in subsection (a) shall be deleted 

17 from that record or document before any disclosure 

18 of such record is made outside such program or or19 ganization. Such requirement does not apply to the 

20 release of information pursuant to section 552a of 

21 title 5. 

22 ‘‘(d) DISCLOSURE FOR CERTAIN PURPOSES.— 

23 ‘‘(1) IN GENERAL.—Nothing in this section 

24 shall be construed as authorizing or requiring the 

25 withholding from any person or entity aggregate staVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00322 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
323 

•HR 1328 IH

1 tistical information regarding the results of any In2 dian Health Program or Urban Indian 

3 Organizations’s medical quality assurance programs. 

4 ‘‘(2) WITHHOLDING FROM CONGRESS.—Noth5 ing in this section shall be construed as authority to 

6 withhold any medical quality assurance record from 

7 a committee of either House of Congress, any joint 

8 committee of Congress, or the Government Account9 ability Office if such record pertains to any matter 

10 within their respective jurisdictions. 

11 ‘‘(e) PROHIBITION ON DISCLOSURE OF RECORD OR

12 TESTIMONY.—A person or entity having possession of or 

13 access to a record or testimony described by this section 

14 may not disclose the contents of such record or testimony 

15 in any manner or for any purpose except as provided in 

16 this section. 

17 ‘‘(f) EXEMPTION FROM FREEDOM OF INFORMATION

18 ACT.—Medical quality assurance records described in sub19 section (a) may not be made available to any person under 

20 section 552 of title 5. 

21 ‘‘(g) LIMITATION ON CIVIL LIABILITY.—A person 

22 who participates in or provides information to a person 

23 or body that reviews or creates medical quality assurance 

24 records described in subsection (a) shall not be civilly lia25 ble for such participation or for providing such informaVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00323 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
324 

•HR 1328 IH

1 tion if the participation or provision of information was 

2 in good faith based on prevailing professional standards 

3 at the time the medical quality assurance program activity 

4 took place. 

5 ‘‘(h) APPLICATION TO INFORMATION IN CERTAIN

6 OTHER RECORDS.—Nothing in this section shall be con7 strued as limiting access to the information in a record 

8 created and maintained outside a medical quality assur9 ance program, including a patient’s medical records, on 

10 the grounds that the information was presented during 

11 meetings of a review body that are part of a medical qual12 ity assurance program. 

13 ‘‘(i) REGULATIONS.—The Secretary, acting through 

14 the Service, shall promulgate regulations pursuant to sec15 tion 802. 

16 ‘‘(j) DEFINITIONS.—In this section: 

17 ‘‘(1) The term ‘health care provider’ means any 

18 health care professional, including community health 

19 aides and practitioners certified under section 121, 

20 who are granted clinical practice privileges or em21 ployed to provide health care services in an Indian 

22 Health Program or health program of an Urban In23 dian Organization, who is licensed or certified to 

24 perform health care services by a governmental 


ycherry on PROD1PC64 with BILLS
325 

•HR 1328 IH

1 board or agency or professional health care society 

2 or organization. 

3 ‘‘(2) The term ‘medical quality assurance pro4 gram’ means any activity carried out before, on, or 

5 after the date of enactment of this Act by or for any 

6 Indian Health Program or Urban Indian Organiza7 tion to assess the quality of medical care, including 

8 activities conducted by or on behalf of individuals, 

9 Indian Health Program or Urban Indian Organiza10 tion medical or dental treatment review committees, 

11 or other review bodies responsible for quality assur12 ance, credentials, infection control, patient care as13 sessment (including treatment procedures, blood, 

14 drugs, and therapeutics), medical records, health re15 sources management review and identification and 

16 prevention of medical or dental incidents and risks. 

17 ‘‘(3) The term ‘medical quality assurance 

18 record’ means the proceedings, records, minutes, and 

19 reports that emanate from quality assurance pro20 gram activities described in paragraph (2) and are 

21 produced or compiled by or for an Indian Health 

22 Program or Urban Indian Organization as part of a 

23 medical quality assurance program. 


ycherry on PROD1PC64 with BILLS
326 

•HR 1328 IH

1 ‘‘SEC. 815. APPROPRIATIONS; AVAILABILITY. 

2 ‘‘Any new spending authority (described in subpara3 graph (A) or (B) of section 401(c)(2) of the Congressional 

4 Budget Act of 1974 (Public Law 93–344; 88 Stat. 317)) 

5 which is provided under this Act shall be effective for any 

6 fiscal year only to such extent or in such amounts as are 

7 provided in appropriation Acts. 

8 ‘‘SEC. 816. AUTHORIZATION OF APPROPRIATIONS. 

9 ‘‘There are authorized to be appropriated such sums 

10 as may be necessary for each fiscal year through fiscal 

11 year 2017 to carry out this title.’’. 

12 (b) RATE OF PAY.— 

13 (1) POSITIONS AT LEVEL IV.—Section 5315 of 

14 title 5, United States Code, is amended by striking 

15 ‘‘Assistant Secretaries of Health and Human Serv16 ices (6).’’ and inserting ‘‘Assistant Secretaries of 

17 Health and Human Services (7)’’. 

18 (2) POSITIONS AT LEVEL V.—Section 5316 of 

19 title 5, United States Code, is amended by striking 

20 ‘‘Director, Indian Health Service, Department of 

21 Health and Human Services’’. 

22 (c) AMENDMENTS TO OTHER PROVISIONS OF LAW.— 

23 (1) Section 3307(b)(1)(C) of the Children’s 

24 Health Act of 2000 (25 U.S.C. 1671 note; Public 

25 Law 106–310) is amended by striking ‘‘Director of 


ycherry on PROD1PC64 with BILLS
327 

•HR 1328 IH

1 the Indian Health Service’’ and inserting ‘‘Assistant 

2 Secretary for Indian Health’’. 

3 (2) The Indian Lands Open Dump Cleanup Act 

4 of 1994 is amended— 

5 (A) in section 3 (25 U.S.C. 3902)— 

6 (i) by striking paragraph (2); 

7 (ii) by redesignating paragraphs (1), 

8 (3), (4), (5), and (6) as paragraphs (4), 

9 (5), (2), (6), and (1), respectively, and 

10 moving those paragraphs so as to appear 

11 in numerical order; and 

12 (iii) by inserting before paragraph (4) 

13 (as redesignated by subclause (II)) the fol14 lowing: 

15 ‘‘(3) ASSISTANT SECRETARY.—The term ‘As16 sistant Secretary’ means the Assistant Secretary for 

17 Indian Health.’’; 

18 (B) in section 5 (25 U.S.C. 3904), by 

19 striking the section designation and heading 

20 and inserting the following: 

21 ‘‘SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR IN22 DIAN HEALTH.’’; 

23 (C) in section 6(a) (25 U.S.C. 3905(a)), in 

24 the subsection heading, by striking ‘‘DIREC25 TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 


ycherry on PROD1PC64 with BILLS
328 

•HR 1328 IH

1 (D) in section 9(a) (25 U.S.C. 3908(a)), in 

2 the subsection heading, by striking ‘‘DIREC3 TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 

4 and 

5 (E) by striking ‘‘Director’’ each place it 

6 appears and inserting ‘‘Assistant Secretary’’. 

7 (3) Section 5504(d)(2) of the Augustus F. 

8 Hawkins-Robert T. Stafford Elementary and Sec9 ondary School Improvement Amendments of 1988 

10 (25 U.S.C. 2001 note; Public Law 100–297) is 

11 amended by striking ‘‘Director of the Indian Health 

12 Service’’ and inserting ‘‘Assistant Secretary for In13 dian Health’’. 

14 (4) Section 203(a)(1) of the Rehabilitation Act 

15 of 1973 (29 U.S.C. 763(a)(1)) is amended by strik16 ing ‘‘Director of the Indian Health Service’’ and in17 serting ‘‘Assistant Secretary for Indian Health’’. 

18 (5) Subsections (b) and (e) of section 518 of 

19 the Federal Water Pollution Control Act (33 U.S.C. 

20 1377) are amended by striking ‘‘Director of the In21 dian Health Service’’ each place it appears and in22 serting ‘‘Assistant Secretary for Indian Health’’. 

23 (6) Section 317M(b) of the Public Health Serv24 ice Act (42 U.S.C. 247b–14(b)) is amended— 


ycherry on PROD1PC64 with BILLS
329 

•HR 1328 IH

1 (A) by striking ‘‘Director of the Indian 

2 Health Service’’ each place it appears and in3 serting ‘‘Assistant Secretary for Indian 

4 Health’’; and 

5 (B) in paragraph (2)(A), by striking ‘‘the 

6 Directors referred to in such paragraph’’ and 

7 inserting ‘‘the Director of the Centers for Dis8 ease Control and Prevention and the Assistant 

9 Secretary for Indian Health’’. 

10 (7) Section 417C(b) of the Public Health Serv11 ice Act (42 U.S.C. 285–9(b)) is amended by striking 

12 ‘‘Director of the Indian Health Service’’ and insert13 ing ‘‘Assistant Secretary for Indian Health’’. 

14 (8) Section 1452(i) of the Safe Drinking Water 

15 Act (42 U.S.C. 300j–12(i)) is amended by striking 

16 ‘‘Director of the Indian Health Service’’ each place 

17 it appears and inserting ‘‘Assistant Secretary for In18 dian Health’’. 

19 (9) Section 803B(d)(1) of the Native American 

20 Programs Act of 1974 (42 U.S.C. 2991b–2(d)(1)) is 

21 amended in the last sentence by striking ‘‘Director 

22 of the Indian Health Service’’ and inserting ‘‘Assist23 ant Secretary for Indian Health’’. 

24 (10) Section 203(b) of the Michigan Indian 

25 Land Claims Settlement Act (Public Law 105–143; 


ycherry on PROD1PC64 with BILLS
330 

•HR 1328 IH

1 111 Stat. 2666) is amended by striking ‘‘Director of 

2 the Indian Health Service’’ and inserting ‘‘Assistant 

3 Secretary for Indian Health’’. 

4 SEC. 102. SOBOBA SANITATION FACILITIES. 

5 The Act of December 17, 1970 (84 Stat. 1465), is 

6 amended by adding at the end the following: 

7 ‘‘SEC. 9. Nothing in this Act shall preclude the 

8 Soboba Band of Mission Indians and the Soboba Indian 

9 Reservation from being provided with sanitation facilities 

10 and services under the authority of section 7 of the Act 

11 of August 5, 1954 (68 Stat. 674), as amended by the Act 

12 of July 31, 1959 (73 Stat. 267).’’. 

13 SEC. 103. NATIVE AMERICAN HEALTH AND WELLNESS 

14 FOUNDATION. 

15 (a) IN GENERAL.—The Indian Self-Determination 

16 and Education Assistance Act (25 U.S.C. 450 et seq.) is 

17 amended by adding at the end the following: 

18 ‘‘TITLE VIII—NATIVE AMERICAN 

19 HEALTH AND WELLNESS 

20 FOUNDATION 

21 ‘‘SEC. 801. DEFINITIONS. 

22 ‘‘In this title: 

23 ‘‘(1) BOARD.—The term ‘Board’ means the 

24 Board of Directors of the Foundation. 


ycherry on PROD1PC64 with BILLS
331 

•HR 1328 IH

1 ‘‘(2) COMMITTEE.—The term ‘Committee’ 

2 means the Committee for the Establishment of Na3 tive American Health and Wellness Foundation es4 tablished under section 802(f). 

5 ‘‘(3) FOUNDATION.—The term ‘Foundation’ 

6 means the Native American Health and Wellness 

7 Foundation established under section 802. 

8 ‘‘(4) SECRETARY.—The term ‘Secretary’ means 

9 the Secretary of Health and Human Services. 

10 ‘‘(5) SERVICE.—The term ‘Service’ means the 

11 Indian Health Service of the Department of Health 

12 and Human Services. 

13 ‘‘SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS 

14 FOUNDATION. 

15 ‘‘(a) ESTABLISHMENT.— 

16 ‘‘(1) IN GENERAL.—As soon as practicable 

17 after the date of enactment of this title, the Sec18 retary shall establish, under the laws of the District 

19 of Columbia and in accordance with this title, the 

20 Native American Health and Wellness Foundation. 

21 ‘‘(2) FUNDING DETERMINATIONS.—No funds, 

22 gift, property, or other item of value (including any 

23 interest accrued on such an item) acquired by the 

24 Foundation shall— 


ycherry on PROD1PC64 with BILLS
332 

•HR 1328 IH

1 ‘‘(A) be taken into consideration for pur2 poses of determining Federal appropriations re3 lating to the provision of health care and serv4 ices to Indians; or 

5 ‘‘(B) otherwise limit, diminish, or affect 

6 the Federal responsibility for the provision of 

7 health care and services to Indians. 

8 ‘‘(b) PERPETUAL EXISTENCE.—The Foundation 

9 shall have perpetual existence. 

10 ‘‘(c) NATURE OF CORPORATION.—The Foundation— 

11 ‘‘(1) shall be a charitable and nonprofit feder12 ally chartered corporation; and 

13 ‘‘(2) shall not be an agency or instrumentality 

14 of the United States. 

15 ‘‘(d) PLACE OF INCORPORATION AND DOMICILE.— 

16 The Foundation shall be incorporated and domiciled in the 

17 District of Columbia. 

18 ‘‘(e) DUTIES.—The Foundation shall— 

19 ‘‘(1) encourage, accept, and administer private 

20 gifts of real and personal property, and any income 

21 from or interest in such gifts, for the benefit of, or 

22 in support of, the mission of the Service; 

23 ‘‘(2) undertake and conduct such other activi24 ties as will further the health and wellness activities 

25 and opportunities of Native Americans; and 


ycherry on PROD1PC64 with BILLS
333 

•HR 1328 IH

1 ‘‘(3) participate with and assist Federal, State, 

2 and tribal governments, agencies, entities, and indi3 viduals in undertaking and conducting activities that 

4 will further the health and wellness activities and op5 portunities of Native Americans. 

6 ‘‘(f) COMMITTEE FOR THE ESTABLISHMENT OF NA7 TIVE AMERICAN HEALTH AND WELLNESS FOUNDA8 TION.— 

9 ‘‘(1) IN GENERAL.—The Secretary shall estab10 lish the Committee for the Establishment of Native 

11 American Health and Wellness Foundation to assist 

12 the Secretary in establishing the Foundation. 

13 ‘‘(2) DUTIES.—Not later than 180 days after 

14 the date of enactment of this section, the Committee 

15 shall— 

16 ‘‘(A) carry out such activities as are nec17 essary to incorporate the Foundation under the 

18 laws of the District of Columbia, including act19 ing as incorporators of the Foundation; 

20 ‘‘(B) ensure that the Foundation qualifies 

21 for and maintains the status required to carry 

22 out this section, until the Board is established; 

23 ‘‘(C) establish the constitution and initial 

24 bylaws of the Foundation; 


ycherry on PROD1PC64 with BILLS
334 

•HR 1328 IH

1 ‘‘(D) provide for the initial operation of 

2 the Foundation, including providing for tem3 porary or interim quarters, equipment, and 

4 staff; and 

5 ‘‘(E) appoint the initial members of the 

6 Board in accordance with the constitution and 

7 initial bylaws of the Foundation. 

8 ‘‘(g) BOARD OF DIRECTORS.— 

9 ‘‘(1) IN GENERAL.—The Board of Directors 

10 shall be the governing body of the Foundation. 

11 ‘‘(2) POWERS.—The Board may exercise, or 

12 provide for the exercise of, the powers of the Foun13 dation. 

14 ‘‘(3) SELECTION.— 

15 ‘‘(A) IN GENERAL.—Subject to subpara16 graph (B), the number of members of the 

17 Board, the manner of selection of the members 

18 (including the filling of vacancies), and the 

19 terms of office of the members shall be as pro20 vided in the constitution and bylaws of the 

21 Foundation. 

22 ‘‘(B) REQUIREMENTS.— 

23 ‘‘(i) NUMBER OF MEMBERS.—The 

24 Board shall have at least 11 members, who 

25 shall have staggered terms. 


ycherry on PROD1PC64 with BILLS
335 

•HR 1328 IH

1 ‘‘(ii) INITIAL VOTING MEMBERS.—The 

2 initial voting members of the Board— 

3 ‘‘(I) shall be appointed by the 

4 Committee not later than 180 days 

5 after the date on which the Founda6 tion is established; and 

7 ‘‘(II) shall have staggered terms. 

8 ‘‘(iii) QUALIFICATION.—The members 

9 of the Board shall be United States citi10 zens who are knowledgeable or experienced 

11 in Native American health care and related 

12 matters. 

13 ‘‘(C) COMPENSATION.—A member of the 

14 Board shall not receive compensation for service 

15 as a member, but shall be reimbursed for actual 

16 and necessary travel and subsistence expenses 

17 incurred in the performance of the duties of the 

18 Foundation. 

19 ‘‘(h) OFFICERS.— 

20 ‘‘(1) IN GENERAL.—The officers of the Founda21 tion shall be— 

22 ‘‘(A) a secretary, elected from among the 

23 members of the Board; and 

24 ‘‘(B) any other officers provided for in the 

25 constitution and bylaws of the Foundation. 


ycherry on PROD1PC64 with BILLS
336 

•HR 1328 IH

1 ‘‘(2) CHIEF OPERATING OFFICER.—The sec2 retary of the Foundation may serve, at the direction 

3 of the Board, as the chief operating officer of the 

4 Foundation, or the Board may appoint a chief oper5 ating officer, who shall serve at the direction of the 

6 Board. 

7 ‘‘(3) ELECTION.—The manner of election, term 

8 of office, and duties of the officers of the Founda9 tion shall be as provided in the constitution and by10 laws of the Foundation. 

11 ‘‘(i) POWERS.—The Foundation— 

12 ‘‘(1) shall adopt a constitution and bylaws for 

13 the management of the property of the Foundation 

14 and the regulation of the affairs of the Foundation; 

15 ‘‘(2) may adopt and alter a corporate seal; 

16 ‘‘(3) may enter into contracts; 

17 ‘‘(4) may acquire (through a gift or otherwise), 

18 own, lease, encumber, and transfer real or personal 

19 property as necessary or convenient to carry out the 

20 purposes of the Foundation; 

21 ‘‘(5) may sue and be sued; and 

22 ‘‘(6) may perform any other act necessary and 

23 proper to carry out the purposes of the Foundation. 

24 ‘‘(j) PRINCIPAL OFFICE.— 


ycherry on PROD1PC64 with BILLS
337 

•HR 1328 IH

1 ‘‘(1) IN GENERAL.—The principal office of the 

2 Foundation shall be in the District of Columbia. 

3 ‘‘(2) ACTIVITIES; OFFICES.—The activities of 

4 the Foundation may be conducted, and offices may 

5 be maintained, throughout the United States in ac6 cordance with the constitution and bylaws of the 

7 Foundation. 

8 ‘‘(k) SERVICE OF PROCESS.—The Foundation shall 

9 comply with the law on service of process of each State 

10 in which the Foundation is incorporated and of each State 

11 in which the Foundation carries on activities. 

12 ‘‘(l) LIABILITY OF OFFICERS, EMPLOYEES, AND

13 AGENTS.— 

14 ‘‘(1) IN GENERAL.—The Foundation shall be 

15 liable for the acts of the officers, employees, and 

16 agents of the Foundation acting within the scope of 

17 their authority. 

18 ‘‘(2) PERSONAL LIABILITY.—A member of the 

19 Board shall be personally liable only for gross neg20 ligence in the performance of the duties of the mem21 ber. 

22 ‘‘(m) RESTRICTIONS.— 

23 ‘‘(1) LIMITATION ON SPENDING.—Beginning 

24 with the fiscal year following the first full fiscal year 

25 during which the Foundation is in operation, the adVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00337 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
338 

•HR 1328 IH

1 ministrative costs of the Foundation shall not exceed 

2 the percentage described in paragraph (2) of the 

3 sum of— 

4 ‘‘(A) the amounts transferred to the Foun5 dation under subsection (o) during the pre6 ceding fiscal year; and 

7 ‘‘(B) donations received from private 

8 sources during the preceding fiscal year. 

9 ‘‘(2) PERCENTAGES.—The percentages referred 

10 to in paragraph (1) are— 

11 ‘‘(A) for the first fiscal year described in 

12 that paragraph, 20 percent; 

13 ‘‘(B) for the following fiscal year, 15 per14 cent; and 

15 ‘‘(C) for each fiscal year thereafter, 10 

16 percent. 

17 ‘‘(3) APPOINTMENT AND HIRING.—The ap18 pointment of officers and employees of the Founda19 tion shall be subject to the availability of funds. 

20 ‘‘(4) STATUS.—A member of the Board or offi21 cer, employee, or agent of the Foundation shall not 

22 by reason of association with the Foundation be con23 sidered to be an officer, employee, or agent of the 

24 United States. 


ycherry on PROD1PC64 with BILLS
339 

•HR 1328 IH

1 ‘‘(n) AUDITS.—The Foundation shall comply with 

2 section 10101 of title 36, United States Code, as if the 

3 Foundation were a corporation under part B of subtitle 

4 II of that title. 

5 ‘‘(o) FUNDING.— 

6 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

7 There is authorized to be appropriated to carry out 

8 subsection (e)(1) $500,000 for each fiscal year, as 

9 adjusted to reflect changes in the Consumer Price 

10 Index for all-urban consumers published by the De11 partment of Labor. 

12 ‘‘(2) TRANSFER OF DONATED FUNDS.—The 

13 Secretary shall transfer to the Foundation funds 

14 held by the Department of Health and Human Serv15 ices under the Act of August 5, 1954 (42 U.S.C. 

16 2001 et seq.), if the transfer or use of the funds is 

17 not prohibited by any term under which the funds 

18 were donated. 

19 ‘‘SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT. 

20 ‘‘(a) PROVISION OF SUPPORT BY SECRETARY.—Sub21 ject to subsection (b), during the 5-year period beginning 

22 on the date on which the Foundation is established, the 

23 Secretary— 

24 ‘‘(1) may provide personnel, facilities, and other 

25 administrative support services to the Foundation; 


ycherry on PROD1PC64 with BILLS
340 

•HR 1328 IH

1 ‘‘(2) may provide funds for initial operating 

2 costs and to reimburse the travel expenses of the 

3 members of the Board; and 

4 ‘‘(3) shall require and accept reimbursements 

5 from the Foundation for— 

6 ‘‘(A) services provided under paragraph 

7 (1); and 

8 ‘‘(B) funds provided under paragraph (2). 

9 ‘‘(b) REIMBURSEMENT.—Reimbursements accepted 

10 under subsection (a)(3)— 

11 ‘‘(1) shall be deposited in the Treasury of the 

12 United States to the credit of the applicable appro13 priations account; and 

14 ‘‘(2) shall be chargeable for the cost of pro15 viding services described in subsection (a)(1) and 

16 travel expenses described in subsection (a)(2). 

17 ‘‘(c) CONTINUATION OF CERTAIN SERVICES.—The 

18 Secretary may continue to provide facilities and necessary 

19 support services to the Foundation after the termination 

20 of the 5-year period specified in subsection (a) if the facili21 ties and services— 

22 ‘‘(1) are available; and 

23 ‘‘(2) are provided on reimbursable cost basis.’’. 

24 (b) TECHNICAL AMENDMENTS.—The Indian Self-De25 termination and Education Assistance Act is amended— 


ycherry on PROD1PC64 with BILLS
341 

•HR 1328 IH

1 (1) by redesignating title V (25 U.S.C. 458bbb 

2 et seq.) as title VII; 

3 (2) by redesignating sections 501, 502, and 503 

4 (25 U.S.C. 458bbb, 458bbb–1, 458bbb–2) as sec5 tions 701, 702, and 703, respectively; and 

6 (3) in subsection (a)(2) of section 702 and 

7 paragraph (2) of section 703 (as redesignated by 

8 paragraph (2)), by striking ‘‘section 501’’ and in9 serting ‘‘section 701’’. 

10 TITLE II—IMPROVEMENT OF IN11 DIAN HEALTH CARE PRO12 VIDED UNDER THE SOCIAL 

13 SECURITY ACT 

14 SEC. 201. EXPANSION OF PAYMENTS UNDER MEDICARE, 

15 MEDICAID, AND SCHIP FOR ALL COVERED 

16 SERVICES FURNISHED BY INDIAN HEALTH 

17 PROGRAMS. 

18 (a) MEDICAID.— 

19 (1) EXPANSION TO ALL COVERED SERVICES.— 

20 Section 1911 of the Social Security Act (42 U.S.C. 

21 1396j) is amended— 

22 (A) by amending the heading to read as 

23 follows: 


ycherry on PROD1PC64 with BILLS
342 

•HR 1328 IH

1 ‘‘SEC. 1911. INDIAN HEALTH PROGRAMS.’’; and 

2 (B) by amending subsection (a) to read as 

3 follows: 

4 ‘‘(a) ELIGIBILITY FOR PAYMENT FOR MEDICAL AS5 SISTANCE.—The Indian Health Service and an Indian 

6 Tribe, Tribal Organization, or an Urban Indian Organiza7 tion shall be eligible for payment for medical assistance 

8 provided under a State plan or under waiver authority 

9 with respect to items and services furnished by the Indian 

10 Health Service, Indian Tribe, Tribal Organization, or 

11 Urban Indian Organization if the furnishing of such serv12 ices meets all the conditions and requirements which are 

13 applicable generally to the furnishing of items and services 

14 under this title and under such plan or waiver authority.’’. 

15 (2) COMPLIANCE WITH CONDITIONS AND RE16 QUIREMENTS.—Subsection (b) of such section is 

17 amended to read as follows: 

18 ‘‘(b) COMPLIANCE WITH CONDITIONS AND REQUIRE19 MENTS.—A facility of the Indian Health Service or an In20 dian Tribe, Tribal Organization, or an Urban Indian Or21 ganization which is eligible for payment under subsection 

22 (a) with respect to the furnishing of items and services, 

23 but which does not meet all of the conditions and require24 ments of this title and under a State plan or waiver au25 thority which are applicable generally to such facility, shall 

26 make such improvements as are necessary to achieve or 


ycherry on PROD1PC64 with BILLS
343 

•HR 1328 IH

1 maintain compliance with such conditions and require2 ments in accordance with a plan submitted to and accept3 ed by the Secretary for achieving or maintaining compli4 ance with such conditions and requirements, and shall be 

5 deemed to meet such conditions and requirements (and to 

6 be eligible for payment under this title), without regard 

7 to the extent of its actual compliance with such conditions 

8 and requirements, during the first 12 months after the 

9 month in which such plan is submitted.’’. 

10 (3) REVISION OF AUTHORITY TO ENTER INTO

11 AGREEMENTS.—Subsection (c) of such section is 

12 amended to read as follows: 

13 ‘‘(c) AUTHORITY TO ENTER INTO AGREEMENTS.— 

14 The Secretary may enter into an agreement with a State 

15 for the purpose of reimbursing the State for medical as16 sistance provided by the Indian Health Service, an Indian 

17 Tribe, Tribal Organization, or an Urban Indian Organiza18 tion (as so defined), directly, through referral, or under 

19 contracts or other arrangements between the Indian 

20 Health Service, an Indian Tribe, Tribal Organization, or 

21 an Urban Indian Organization and another health care 

22 provider to Indians who are eligible for medical assistance 

23 under the State plan or under waiver authority.’’. 

24 (4) CROSS-REFERENCES TO SPECIAL FUND FOR

25 IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING


ycherry on PROD1PC64 with BILLS
344 

•HR 1328 IH

1 OPTION; DEFINITIONS.—Such section is further 

2 amended by striking subsection (d) and adding at 

3 the end the following new subsections: 

4 ‘‘(d) SPECIAL FUND FOR IMPROVEMENT OF IHS FA5 CILITIES.—For provisions relating to the authority of the 

6 Secretary to place payments to which a facility of the In7 dian Health Service is eligible for payment under this title 

8 into a special fund established under section 401(c)(1) of 

9 the Indian Health Care Improvement Act, and the require10 ment to use amounts paid from such fund for making im11 provements in accordance with subsection (b), see sub12 paragraphs (A) and (B) of section 401(c)(1) of such Act. 

13 ‘‘(e) DIRECT BILLING.—For provisions relating to 

14 the authority of a Tribal Health Program or an Urban 

15 Indian Organization to elect to directly bill for, and receive 

16 payment for, health care items and services provided by 

17 such Program or Organization for which payment is made 

18 under this title, see section 401(d) of the Indian Health 

19 Care Improvement Act. 

20 ‘‘(f) DEFINITIONS.—In this section, the terms ‘In21 dian Health Program’, ‘Indian Tribe’, ‘Tribal Health Pro22 gram’, ‘Tribal Organization’, and ‘Urban Indian Organi23 zation’ have the meanings given those terms in section 4 

24 of the Indian Health Care Improvement Act.’’. 

25 (b) MEDICARE.— 


ycherry on PROD1PC64 with BILLS
345 

•HR 1328 IH

1 (1) EXPANSION TO ALL COVERED SERVICES.— 

2 Section 1880 of such Act (42 U.S.C. 1395qq) is 

3 amended— 

4 (A) by amending the heading to read as 

5 follows: 

6 ‘‘SEC. 1880. INDIAN HEALTH PROGRAMS.’’; and 

7 (B) by amending subsection (a) to read as 

8 follows: 

9 ‘‘(a) ELIGIBILITY FOR PAYMENTS.—Subject to sub10 section (e), the Indian Health Service and an Indian 

11 Tribe, Tribal Organization, or an Urban Indian Organiza12 tion shall be eligible for payments under this title with 

13 respect to items and services furnished by the Indian 

14 Health Service, Indian Tribe, Tribal Organization, or 

15 Urban Indian Organization if the furnishing of such serv16 ices meets all the conditions and requirements which are 

17 applicable generally to the furnishing of items and services 

18 under this title.’’. 

19 (2) COMPLIANCE WITH CONDITIONS AND RE20 QUIREMENTS.—Subsection (b) of such section is 

21 amended to read as follows: 

22 ‘‘(b) COMPLIANCE WITH CONDITIONS AND REQUIRE23 MENTS.—Subject to subsection (e), a facility of the Indian 

24 Health Service or an Indian Tribe, Tribal Organization, 

25 or an Urban Indian Organization which is eligible for payVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00345 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
346 

•HR 1328 IH

1 ment under subsection (a) with respect to the furnishing 

2 of items and services, but which does not meet all of the 

3 conditions and requirements of this title which are applica4 ble generally to such facility, shall make such improve5 ments as are necessary to achieve or maintain compliance 

6 with such conditions and requirements in accordance with 

7 a plan submitted to and accepted by the Secretary for 

8 achieving or maintaining compliance with such conditions 

9 and requirements, and shall be deemed to meet such con10 ditions and requirements (and to be eligible for payment 

11 under this title), without regard to the extent of its actual 

12 compliance with such conditions and requirements, during 

13 the first 12 months after the month in which such plan 

14 is submitted.’’. 

15 (3) CROSS-REFERENCES TO SPECIAL FUND FOR

16 IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING

17 OPTION; DEFINITIONS.— 

18 (A) IN GENERAL.—Such section is further 

19 amended by striking subsections (c) and (d) 

20 and inserting the following new subsections: 

21 ‘‘(c) SPECIAL FUND FOR IMPROVEMENT OF IHS FA22 CILITIES.—For provisions relating to the authority of the 

23 Secretary to place payments to which a facility of the In24 dian Health Service is eligible for payment under this title 

25 into a special fund established under section 401(c)(1) of 


ycherry on PROD1PC64 with BILLS
347 

•HR 1328 IH

1 the Indian Health Care Improvement Act, and the require2 ment to use amounts paid from such fund for making im3 provements in accordance with subsection (b), see sub4 paragraphs (A) and (B) of section 401(c)(1) of such Act. 

5 ‘‘(d) DIRECT BILLING.—For provisions relating to 

6 the authority of a Tribal Health Program or an Urban 

7 Indian Organization to elect to directly bill for, and receive 

8 payment for, health care items and services provided by 

9 such Program or Organization for which payment is made 

10 under this title, see section 401(d) of the Indian Health 

11 Care Improvement Act.’’. 

12 (B) CONFORMING AMENDMENT.—Para13 graph (3) of section 1880(e) of such Act (42 

14 U.S.C. 1395qq(e)) is amended by inserting 

15 ‘‘and section 401(c)(1) of the Indian Health 

16 Care Improvement Act’’ after ‘‘Subsection (c)’’. 

17 (4) DEFINITIONS.—Such section is further 

18 amended by amending subsection (f) to read as fol19 lows: 

20 ‘‘(f) DEFINITIONS.—In this section, the terms ‘In21 dian Health Program’, ‘Indian Tribe’, ‘Service Unit’, 

22 ‘Tribal Health Program’, ‘Tribal Organization’, and 

23 ‘Urban Indian Organization’ have the meanings given 

24 those terms in section 4 of the Indian Health Care Im25 provement Act.’’. 


ycherry on PROD1PC64 with BILLS
348 

•HR 1328 IH

1 (c) APPLICATION TO SCHIP.—Section 2107(e)(1) of 

2 the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 

3 amended— 

4 (1) by redesignating subparagraph (D) as sub5 paragraph (E); and 

6 (2) by inserting after subparagraph (C), the fol7 lowing new subparagraph: 

8 ‘‘(D) Section 1911 (relating to Indian 

9 Health Programs, other than subsection (d) of 

10 such section).’’. 

11 SEC. 202. INCREASED OUTREACH TO INDIANS UNDER MED12 ICAID AND SCHIP AND IMPROVED COOPERA13 TION IN THE PROVISION OF ITEMS AND 

14 SERVICES TO INDIANS UNDER SOCIAL SECU15 RITY ACT HEALTH BENEFIT PROGRAMS. 

16 Section 1139 of the Social Security Act (42 U.S.C. 

17 1320b–9) is amended to read as follows: 

18 ‘‘SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, 

19 HEALTH CARE FOR INDIANS UNDER TITLES 

20 XVIII, XIX, AND XXI. 

21 ‘‘(a) AGREEMENTS WITH STATES FOR MEDICAID

22 AND SCHIP OUTREACH ON OR NEAR RESERVATIONS TO

23 INCREASE THE ENROLLMENT OF INDIANS IN THOSE

24 PROGRAMS.— 


ycherry on PROD1PC64 with BILLS
349 

•HR 1328 IH

1 ‘‘(1) IN GENERAL.—In order to improve the ac2 cess of Indians residing on or near a reservation to 

3 obtain benefits under the Medicaid and State chil4 dren’s health insurance programs established under 

5 titles XIX and XXI, the Secretary shall encourage 

6 the State to take steps to provide for enrollment on 

7 or near the reservation. Such steps may include out8 reach efforts such as the outstationing of eligibility 

9 workers, entering into agreements with the Indian 

10 Health Service, Indian Tribes, Tribal Organizations, 

11 and Urban Indian Organizations to provide out12 reach, education regarding eligibility and benefits, 

13 enrollment, and translation services when such serv14 ices are appropriate. 

15 ‘‘(2) CONSTRUCTION.—Nothing in subpara16 graph (A) shall be construed as affecting arrange17 ments entered into between States and the Indian 

18 Health Service, Indian Tribes, Tribal Organizations, 

19 or Urban Indian Organizations for such Service, 

20 Tribes, or Organizations to conduct administrative 

21 activities under such titles. 

22 ‘‘(b) REQUIREMENT TO FACILITATE COOPERA23 TION.—The Secretary, acting through the Centers for 

24 Medicare & Medicaid Services, shall take such steps as are 

25 necessary to facilitate cooperation with, and agreements 


ycherry on PROD1PC64 with BILLS
350 

•HR 1328 IH

1 between, States and the Indian Health Service, Indian 

2 Tribes, Tribal Organizations, or Urban Indian Organiza3 tions with respect to the provision of health care items 

4 and services to Indians under the programs established 

5 under title XVIII, XIX, or XXI. 

6 ‘‘(c) DEFINITION OF INDIAN; INDIAN TRIBE; INDIAN

7 HEALTH PROGRAM; TRIBAL ORGANIZATION; URBAN IN8 DIAN ORGANIZATION.—In this section, the terms ‘Indian’, 

9 ‘Indian Tribe’, ‘Indian Health Program’, ‘Tribal Organi10 zation’, and ‘Urban Indian Organization’ have the mean11 ings given those terms in section 4 of the Indian Health 

12 Care Improvement Act.’’. 

13 SEC. 203. ADDITIONAL PROVISIONS TO INCREASE OUT14 REACH TO, AND ENROLLMENT OF, INDIANS 

15 IN SCHIP AND MEDICAID. 

16 (a) NONAPPLICATION OF 10 PERCENT LIMIT ON

17 OUTREACH AND CERTAIN OTHER EXPENDITURES.—Sec18 tion 2105(c)(2) of the Social Security Act (42 U.S.C. 

19 1397ee(c)(2)) is amended by adding at the end the fol20 lowing new subparagraph: 

21 ‘‘(C) NONAPPLICATION TO EXPENDITURES

22 FOR OUTREACH TO INCREASE THE ENROLL23 MENT OF INDIAN CHILDREN UNDER THIS TITLE

24 AND TITLE XIX.—The limitation under sub25 paragraph (A) on expenditures for items deVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00350 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
351 

•HR 1328 IH

1 scribed in subsection (a)(1)(D) shall not apply 

2 in the case of expenditures for outreach activi3 ties to families of Indian children likely to be el4 igible for child health assistance under the plan 

5 or medical assistance under the State plan 

6 under title XIX (or under a waiver of such 

7 plan), to inform such families of the availability 

8 of, and to assist them in enrolling their children 

9 in, such plans, including such activities con10 ducted under grants, contracts, or agreements 

11 entered into under section 1139(a).’’. 

12 (b) ASSURANCE OF PAYMENTS TO INDIAN HEALTH

13 CARE PROVIDERS FOR CHILD HEALTH ASSISTANCE.— 

14 Section 2102(b)(3)(D) of such Act (42 U.S.C. 

15 1397bb(b)(3)(D)) is amended by striking ‘‘(as defined in 

16 section 4(c) of the Indian Health Care Improvement Act, 

17 25 U.S.C. 1603(c))’’ and inserting ‘‘, including how the 

18 State will ensure that payments are made to Indian 

19 Health Programs and Urban Indian Organizations oper20 ating in the State for the provision of such assistance’’. 

21 (c) INCLUSION OF OTHER INDIAN FINANCED

22 HEALTH CARE PROGRAMS IN EXEMPTION FROM PROHI23 BITION ON CERTAIN PAYMENTS.—Section 2105(c)(6)(B) 

24 of such Act (42 U.S.C. 1397ee(c)(6)(B)) is amended by 

25 striking ‘‘insurance program, other than an insurance proVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00351 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
352 

•HR 1328 IH

1 gram operated or financed by the Indian Health Service’’ 

2 and inserting ‘‘program, other than a health care program 

3 operated or financed by the Indian Health Service or by 

4 an Indian Tribe, Tribal Organization, or Urban Indian 

5 Organization’’. 

6 (d) SATISFACTION OF MEDICAID DOCUMENTATION

7 REQUIREMENTS.— 

8 (1) IN GENERAL.—Section 1903(x)(3)(B) of the 

9 Social Security Act (42 U.S.C. 1396b(x)(3)(B)) is 

10 amended— 

11 (A) by redesignating clause (v) as clause 

12 (vi); and 

13 (B) by inserting after clause (iv), the fol14 lowing new clause: 

15 ‘‘(v)(I) Except as provided in subclause (II), a 

16 document issued by a federally-recognized Indian 

17 tribe evidencing membership or enrollment in, or af18 filiation with, such tribe. 

19 ‘‘(II) With respect to those federally-recognized 

20 Indian tribes located within States having an inter21 national border whose membership includes individ22 uals who are not citizens of the United States, the 

23 Secretary shall, after consulting with such tribes, 

24 issue regulations authorizing the presentation of 

25 such other forms of documentation (including tribal 


ycherry on PROD1PC64 with BILLS
353 

•HR 1328 IH

1 documentation, if appropriate) that the Secretary 

2 determines to be satisfactory documentary evidence 

3 of citizenship or nationality for purposes of satis4 fying the requirement of this subsection.’’. 

5 (2) TRANSITION RULE.—During the period that 

6 begins on July 1, 2006, and ends on the effective 

7 date of final regulations issued under subclause (II) 

8 of section 1903(x)(3)(B)(v) of the Social Security 

9 Act (42 U.S.C. 1396b(x)(3)(B)(v)) (as added by 

10 paragraph (1)), an individual who is a member of a 

11 federally-recognized Indian tribe described in sub12 clause (II) of that section who presents a document 

13 described in subclause (I) of such section that is 

14 issued by such Indian tribe, shall be deemed to have 

15 presented satisfactory evidence of citizenship or na16 tionality for purposes of satisfying the requirement 

17 of subsection (x) of section 1903 of such Act. 

18 (e) DEFINITIONS.—Section 2110(c) of such Act (42 

19 U.S.C. 1397jj(c)) is amended by adding at the end the 

20 following new paragraph: 

21 ‘‘(9) INDIAN; INDIAN HEALTH PROGRAM; IN22 DIAN TRIBE; ETC.—The terms ‘Indian’, ‘Indian 

23 Health Program’, ‘Indian Tribe’, ‘Tribal Organiza24 tion’, and ‘Urban Indian Organization’ have the 


ycherry on PROD1PC64 with BILLS
354 

•HR 1328 IH

1 meanings given those terms in section 4 of the In2 dian Health Care Improvement Act.’’. 

3 SEC. 204. PREMIUMS AND COST SHARING PROTECTIONS 

4 UNDER MEDICAID, ELIGIBILITY DETERMINA5 TIONS UNDER MEDICAID AND SCHIP, AND 

6 PROTECTION OF CERTAIN INDIAN PROPERTY 

7 FROM MEDICAID ESTATE RECOVERY. 

8 (a) PREMIUMS AND COST SHARING PROTECTION

9 UNDER MEDICAID.— 

10 (1) IN GENERAL.—Section 1916 of the Social 

11 Security Act (42 U.S.C. 1396o) is amended— 

12 (A) in subsection (a), in the matter pre13 ceding paragraph (1), by striking ‘‘and (i)’’ and 

14 inserting ‘‘, (i), and (j)’’; and 

15 (B) by adding at the end the following new 

16 subsection: 

17 ‘‘(j) NO PREMIUMS OR COST SHARING FOR INDIANS

18 FURNISHED ITEMS OR SERVICES DIRECTLY BY INDIAN

19 HEALTH PROGRAMS OR THROUGH REFERRAL UNDER

20 THE CONTRACT HEALTH SERVICE.— 

21 ‘‘(1) NO COST SHARING FOR ITEMS OR SERV22 ICES FURNISHED TO INDIANS THROUGH INDIAN

23 HEALTH PROGRAMS.— 

24 ‘‘(A) IN GENERAL.—No enrollment fee, 

25 premium, or similar charge, and no deduction, 


ycherry on PROD1PC64 with BILLS
355 

•HR 1328 IH

1 copayment, cost sharing, or similar charge shall 

2 be imposed against an Indian who is furnished 

3 an item or service directly by the Indian Health 

4 Service, an Indian Tribe, Tribal Organization, 

5 or Urban Indian Organization or through refer6 ral under the contract health service for which 

7 payment may be made under this title. 

8 ‘‘(B) NO REDUCTION IN AMOUNT OF PAY9 MENT TO INDIAN HEALTH PROVIDERS.—Pay10 ment due under this title to the Indian Health 

11 Service, an Indian Tribe, Tribal Organization, 

12 or Urban Indian Organization, or a health care 

13 provider through referral under the contract 

14 health service for the furnishing of an item or 

15 service to an Indian who is eligible for assist16 ance under such title, may not be reduced by 

17 the amount of any enrollment fee, premium, or 

18 similar charge, or any deduction, copayment, 

19 cost sharing, or similar charge that would be 

20 due from the Indian but for the operation of 

21 subparagraph (A). 

22 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

23 this subsection shall be construed as restricting the 

24 application of any other limitations on the imposi25 tion of premiums or cost sharing that may apply to 


ycherry on PROD1PC64 with BILLS
356 

•HR 1328 IH

1 an individual receiving medical assistance under this 

2 title who is an Indian. 

3 ‘‘(3) DEFINITIONS.—In this subsection, the 

4 terms ‘contract health service’, ‘Indian’, ‘Indian 

5 Tribe’, ‘Tribal Organization’, and ‘Urban Indian Or6 ganization’ have the meanings given those terms in 

7 section 4 of the Indian Health Care Improvement 

8 Act.’’. 

9 (2) CONFORMING AMENDMENT.—Section 

10 1916A (a)(1) of such Act (42 U.S.C. 1396o–1(a)(1)) 

11 is amended by striking ‘‘section 1916(g)’’ and in12 serting ‘‘subsections (g), (i), or (j) of section 1916’’. 

13 (b) TREATMENT OF CERTAIN PROPERTY FOR MED14 ICAID AND SCHIP ELIGIBILITY.— 

15 (1) MEDICAID.—Section 1902(e) of the Social 

16 Security Act (42 U.S.C. 1396a) is amended by add17 ing at the end the following new paragraph: 

18 ‘‘(13) Notwithstanding any other requirement 

19 of this title or any other provision of Federal or 

20 State law, a State shall disregard the following prop21 erty for purposes of determining the eligibility of an 

22 individual who is an Indian (as defined in section 4 

23 of the Indian Health Care Improvement Act) for 

24 medical assistance under this title: 


ycherry on PROD1PC64 with BILLS
357 

•HR 1328 IH

1 ‘‘(A) Property, including real property and 

2 improvements, that is held in trust, subject to 

3 Federal restrictions, or otherwise under the su4 pervision of the Secretary of the Interior, lo5 cated on a reservation, including any federally 

6 recognized Indian Tribe’s reservation, pueblo, 

7 or colony, including former reservations in 

8 Oklahoma, Alaska Native regions established by 

9 the Alaska Native Claims Settlement Act, and 

10 Indian allotments on or near a reservation as 

11 designated and approved by the Bureau of In12 dian Affairs of the Department of the Interior. 

13 ‘‘(B) For any federally recognized Tribe 

14 not described in subparagraph (A), property lo15 cated within the most recent boundaries of a 

16 prior Federal reservation. 

17 ‘‘(C) Ownership interests in rents, leases, 

18 royalties, or usage rights related to natural re19 sources (including extraction of natural re20 sources or harvesting of timber, other plants 

21 and plant products, animals, fish, and shellfish) 

22 resulting from the exercise of federally pro23 tected rights. 

24 ‘‘(D) Ownership interests in or usage 

25 rights to items not covered by subparagraphs 


ycherry on PROD1PC64 with BILLS
358 

•HR 1328 IH

1 (A) through (C) that have unique religious, 

2 spiritual, traditional, or cultural significance or 

3 rights that support subsistence or a traditional 

4 lifestyle according to applicable tribal law or 

5 custom.’’. 

6 (2) APPLICATION TO SCHIP.—Section 

7 2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)) is 

8 amended— 

9 (A) by redesignating subparagraphs (B) 

10 through (E), as subparagraphs (C) through 

11 (F), respectively; and 

12 (B) by inserting after subparagraph (A), 

13 the following new subparagraph: 

14 ‘‘(B) Section 1902(e)(13) (relating to dis15 regard of certain property for purposes of mak16 ing eligibility determinations).’’. 

17 (c) CONTINUATION OF CURRENT LAW PROTECTIONS

18 OF CERTAIN INDIAN PROPERTY FROM MEDICAID ESTATE

19 RECOVERY.—Section 1917(b)(3) of the Social Security 

20 Act (42 U.S.C. 1396p(b)(3)) is amended— 

21 (1) by inserting ‘‘(A)’’ after ‘‘(3)’’; and 

22 (2) by adding at the end the following new sub23 paragraph: 

24 ‘‘(B) The standards specified by the Sec25 retary under subparagraph (A) shall require 


ycherry on PROD1PC64 with BILLS
359 

•HR 1328 IH

1 that the procedures established by the State 

2 agency under subparagraph (A) exempt income, 

3 resources, and property that are exempt from 

4 the application of this subsection as of April 1, 

5 2003, under manual instructions issued to carry 

6 out this subsection (as in effect on such date) 

7 because of the Federal responsibility for Indian 

8 Tribes and Alaska Native Villages. Nothing in 

9 this subparagraph shall be construed as pre10 venting the Secretary from providing additional 

11 estate recovery exemptions under this title for 

12 Indians.’’. 

13 SEC. 205. NONDISCRIMINATION IN QUALIFICATIONS FOR 

14 PAYMENT FOR SERVICES UNDER FEDERAL 

15 HEALTH CARE PROGRAMS. 

16 Section 1139 of the Social Security Act (42 U.S.C. 

17 1320b–9), as amended by section 202, is amended by re18 designating subsection (c) as subsection (d), and inserting 

19 after subsection (b) the following new subsection: 

20 ‘‘(c) NONDISCRIMINATION IN QUALIFICATIONS FOR

21 PAYMENT FOR SERVICES UNDER FEDERAL HEALTH

22 CARE PROGRAMS.— 

23 ‘‘(1) REQUIREMENT TO SATISFY GENERALLY

24 APPLICABLE PARTICIPATION REQUIREMENTS.— 


ycherry on PROD1PC64 with BILLS
360 

•HR 1328 IH

1 ‘‘(A) IN GENERAL.—A Federal health care 

2 program must accept an entity that is operated 

3 by the Indian Health Service, an Indian Tribe, 

4 Tribal Organization, or Urban Indian Organiza5 tion as a provider eligible to receive payment 

6 under the program for health care services fur7 nished to an Indian on the same basis as any 

8 other provider qualified to participate as a pro9 vider of health care services under the program 

10 if the entity meets generally applicable State or 

11 other requirements for participation as a pro12 vider of health care services under the program. 

13 ‘‘(B) SATISFACTION OF STATE OR LOCAL

14 LICENSURE OR RECOGNITION REQUIRE15 MENTS.—Any requirement for participation as 

16 a provider of health care services under a Fed17 eral health care program that an entity be li18 censed or recognized under the State or local 

19 law where the entity is located to furnish health 

20 care services shall be deemed to have been met 

21 in the case of an entity operated by the Indian 

22 Health Service, an Indian Tribe, Tribal Organi23 zation, or Urban Indian Organization if the en24 tity meets all the applicable standards for such 

25 licensure or recognition, regardless of whether 


ycherry on PROD1PC64 with BILLS
361 

•HR 1328 IH

1 the entity obtains a license or other documenta2 tion under such State or local law. In accord3 ance with section 221 of the Indian Health 

4 Care Improvement Act, the absence of the licen5 sure of a health care professional employed by 

6 such an entity under the State or local law 

7 where the entity is located shall not be taken 

8 into account for purposes of determining wheth9 er the entity meets such standards, if the pro10 fessional is licensed in another State. 

11 ‘‘(2) PROHIBITION ON FEDERAL PAYMENTS TO

12 ENTITIES OR INDIVIDUALS EXCLUDED FROM PAR13 TICIPATION IN FEDERAL HEALTH CARE PROGRAMS

14 OR WHOSE STATE LICENSES ARE UNDER SUSPEN15 SION OR HAVE BEEN REVOKED.— 

16 ‘‘(A) EXCLUDED ENTITIES.—No entity op17 erated by the Indian Health Service, an Indian 

18 Tribe, Tribal Organization, or Urban Indian 

19 Organization that has been excluded from par20 ticipation in any Federal health care program 

21 or for which a license is under suspension or 

22 has been revoked by the State where the entity 

23 is located shall be eligible to receive payment 

24 under any such program for health care serv25 ices furnished to an Indian. 


ycherry on PROD1PC64 with BILLS
362 

•HR 1328 IH

1 ‘‘(B) EXCLUDED INDIVIDUALS.—No indi2 vidual who has been excluded from participation 

3 in any Federal health care program or whose 

4 State license is under suspension or has been 

5 revoked shall be eligible to receive payment 

6 under any such program for health care serv7 ices furnished by that individual, directly or 

8 through an entity that is otherwise eligible to 

9 receive payment for health care services, to an 

10 Indian. 

11 ‘‘(C) FEDERAL HEALTH CARE PROGRAM

12 DEFINED.—In this subsection, the term, ‘Fed13 eral health care program’ has the meaning 

14 given that term in section 1128B(f), except 

15 that, for purposes of this subsection, such term 

16 shall include the health insurance program 

17 under chapter 89 of title 5, United States 

18 Code.’’. 

19 SEC. 206. CONSULTATION ON MEDICAID, SCHIP, AND 

20 OTHER HEALTH CARE PROGRAMS FUNDED 

21 UNDER THE SOCIAL SECURITY ACT INVOLV22 ING INDIAN HEALTH PROGRAMS AND URBAN 

23 INDIAN ORGANIZATIONS. 

24 (a) IN GENERAL.—Section 1139 of the Social Secu25 rity Act (42 U.S.C. 1320b–9), as amended by sections 202 


ycherry on PROD1PC64 with BILLS
363 

•HR 1328 IH

1 and 205, is amended by redesignating subsection (d) as 

2 subsection (e), and inserting after subsection (c) the fol3 lowing new subsection: 

4 ‘‘(d) CONSULTATION WITH TRIBAL TECHNICAL AD5 VISORY GROUP (TTAG).—The Secretary shall maintain 

6 within the Centers for Medicaid & Medicare Services 

7 (CMS) a Tribal Technical Advisory Group, established in 

8 accordance with requirements of the charter dated Sep9 tember 30, 2003, and in such group shall include a rep10 resentative of the Urban Indian Organizations and the 

11 Service. The representative of the Urban Indian Organiza12 tion shall be deemed to be an elected officer of a tribal 

13 government for purposes of applying section 204(b) of the 

14 Unfunded Mandates Reform Act of 1995 (2 U.S.C. 

15 1534(b)).’’. 

16 (b) SOLICITATION OF ADVICE UNDER MEDICAID AND

17 SCHIP.— 

18 (1) MEDICAID STATE PLAN AMENDMENT.—Sec19 tion 1902(a) of the Social Security Act (42 U.S.C. 

20 1396a(a)) is amended— 

21 (A) in paragraph (69), by striking ‘‘and’’ 

22 at the end; 

23 (B) in paragraph (70)(B)(iv), by striking 

24 the period at the end and inserting ‘‘; and’’; 

25 and 


ycherry on PROD1PC64 with BILLS
364 

•HR 1328 IH

1 (C) by inserting after paragraph 

2 (70)(B)(iv), the following new paragraph: 

3 ‘‘(71) in the case of any State in which the In4 dian Health Service operates or funds health care 

5 programs, or in which 1 or more Indian Health Pro6 grams or Urban Indian Organizations (as such 

7 terms are defined in section 4 of the Indian Health 

8 Care Improvement Act) provide health care in the 

9 State for which medical assistance is available under 

10 such title, provide for a process under which the 

11 State seeks advice on a regular, ongoing basis from 

12 designees of such Indian Health Programs and 

13 Urban Indian Organizations on matters relating to 

14 the application of this title that are likely to have a 

15 direct effect on such Indian Health Programs and 

16 Urban Indian Organizations and that— 

17 ‘‘(A) shall include solicitation of advice 

18 prior to submission of any plan amendments, 

19 waiver requests, and proposals for demonstra20 tion projects likely to have a direct effect on In21 dians, Indian Health Programs, or Urban In22 dian Organizations; and 

23 ‘‘(B) may include appointment of an advi24 sory committee and of a designee of such In25 dian Health Programs and Urban Indian OrgaVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00364 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
365 

•HR 1328 IH

1 nizations to the medical care advisory com2 mittee advising the State on its State plan 

3 under this title.’’. 

4 (2) APPLICATION TO SCHIP.—Section 

5 2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)), as 

6 amended by section 204(b)(2), is amended— 

7 (A) by redesignating subparagraphs (B) 

8 through (F) as subparagraphs (C) through (G), 

9 respectively; and 

10 (B) by inserting after subparagraph (A), 

11 the following new subparagraph: 

12 ‘‘(B) Section 1902(a)(71) (relating to the 

13 option of certain States to seek advice from 

14 designees of Indian Health Programs and 

15 Urban Indian Organizations).’’. 

16 (c) RULE OF CONSTRUCTION.—Nothing in the 

17 amendments made by this section shall be construed as 

18 superseding existing advisory committees, working groups, 

19 guidance, or other advisory procedures established by the 

20 Secretary of Health and Human Services or by any State 

21 with respect to the provision of health care to Indians. 


ycherry on PROD1PC64 with BILLS
366 

•HR 1328 IH

1 SEC. 207. EXCLUSION WAIVER AUTHORITY FOR AFFECTED 

2 INDIAN HEALTH PROGRAMS AND SAFE HAR3 BOR TRANSACTIONS UNDER THE SOCIAL SE4 CURITY ACT. 

5 (a) EXCLUSION WAIVER AUTHORITY.—Section 1128 

6 of the Social Security Act (42 U.S.C. 1320a–7) is amend7 ed by adding at the end the following new subsection: 

8 ‘‘(k) ADDITIONAL EXCLUSION WAIVER AUTHORITY

9 FOR AFFECTED INDIAN HEALTH PROGRAMS.—In addi10 tion to the authority granted the Secretary under sub11 sections (c)(3)(B) and (d)(3)(B) to waive an exclusion 

12 under subsection (a)(1), (a)(3), (a)(4), or (b), the Sec13 retary may, in the case of an Indian Health Program, 

14 waive such an exclusion upon the request of the adminis15 trator of an affected Indian Health Program (as defined 

16 in section 4 of the Indian Health Care Improvement Act) 

17 who determines that the exclusion would impose a hard18 ship on individuals entitled to benefits under or enrolled 

19 in a Federal health care program.’’. 

20 (b) CERTAIN TRANSACTIONS INVOLVING INDIAN

21 HEALTH CARE PROGRAMS DEEMED TO BE IN SAFE HAR22 BORS.—Section 1128B(b) of the Social Security Act (42 

23 U.S.C. 1320a–7b(b)) is amended by adding at the end the 

24 following new paragraph: 

25 ‘‘(4) Subject to such conditions as the Secretary may 

26 promulgate from time to time as necessary to prevent 


ycherry on PROD1PC64 with BILLS
367 

•HR 1328 IH

1 fraud and abuse, for purposes of paragraphs (1) and (2) 

2 and section 1128A(a), the following transfers shall not be 

3 treated as remuneration: 

4 ‘‘(A) TRANSFERS BETWEEN INDIAN HEALTH

5 PROGRAMS, INDIAN TRIBES, TRIBAL ORGANIZATIONS, 

6 AND URBAN INDIAN ORGANIZATIONS.—Transfers of 

7 anything of value between or among an Indian 

8 Health Program, Indian Tribe, Tribal Organization, 

9 or Urban Indian Organization, that are made for the 

10 purpose of providing necessary health care items and 

11 services to any patient served by such Program, 

12 Tribe, or Organization and that consist of— 

13 ‘‘(i) services in connection with the collec14 tion, transport, analysis, or interpretation of di15 agnostic specimens or test data; 

16 ‘‘(ii) inventory or supplies; 

17 ‘‘(iii) staff; or 

18 ‘‘(iv) a waiver of all or part of premiums 

19 or cost sharing. 

20 ‘‘(B) TRANSFERS BETWEEN INDIAN HEALTH

21 PROGRAMS, INDIAN TRIBES, TRIBAL ORGANIZATIONS, 

22 OR URBAN INDIAN ORGANIZATIONS AND PA23 TIENTS.—Transfers of anything of value between an 

24 Indian Health Program, Indian Tribe, Tribal Orga25 nization, or Urban Indian Organization and any paVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00367 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
368 

•HR 1328 IH

1 tient served or eligible for service from an Indian 

2 Health Program, Indian Tribe, Tribal Organization, 

3 or Urban Indian Organization, including any patient 

4 served or eligible for service pursuant to section 807 

5 of the Indian Health Care Improvement Act, but 

6 only if such transfers— 

7 ‘‘(i) consist of expenditures related to pro8 viding transportation for the patient for the 

9 provision of necessary health care items or serv10 ices, provided that the provision of such trans11 portation is not advertised, nor an incentive of 

12 which the value is disproportionately large in 

13 relationship to the value of the health care item 

14 or service (with respect to the value of the item 

15 or service itself or, for preventative items or 

16 services, the future health care costs reasonably 

17 expected to be avoided); 

18 ‘‘(ii) consist of expenditures related to pro19 viding housing to the patient (including a preg20 nant patient) and immediate family members or 

21 an escort necessary to assuring the timely pro22 vision of health care items and services to the 

23 patient, provided that the provision of such 

24 housing is not advertised nor an incentive of 

25 which the value is disproportionately large in 


ycherry on PROD1PC64 with BILLS
369 

•HR 1328 IH

1 relationship to the value of the health care item 

2 or service (with respect to the value of the item 

3 or service itself or, for preventative items or 

4 services, the future health care costs reasonably 

5 expected to be avoided); or 

6 ‘‘(iii) are for the purpose of paying pre7 miums or cost sharing on behalf of such a pa8 tient, provided that the making of such pay9 ment is not subject to conditions other than 

10 conditions agreed to under a contract for the 

11 delivery of contract health services. 

12 ‘‘(C) CONTRACT HEALTH SERVICES.—A trans13 fer of anything of value negotiated as part of a con14 tract entered into between an Indian Health Pro15 gram, Indian Tribe, Tribal Organization, Urban In16 dian Organization, or the Indian Health Service and 

17 a contract care provider for the delivery of contract 

18 health services authorized by the Indian Health 

19 Service, provided that— 

20 ‘‘(i) such a transfer is not tied to volume 

21 or value of referrals or other business generated 

22 by the parties; and 

23 ‘‘(ii) any such transfer is limited to the fair 

24 market value of the health care items or serv25 ices provided or, in the case of a transfer of 


ycherry on PROD1PC64 with BILLS
370 

•HR 1328 IH

1 items or services related to preventative care, 

2 the value of the future health care costs reason3 ably expected to be avoided. 

4 ‘‘(D) OTHER TRANSFERS.—Any other transfer 

5 of anything of value involving an Indian Health Pro6 gram, Indian Tribe, Tribal Organization, or Urban 

7 Indian Organization, or a patient served or eligible 

8 for service from an Indian Health Program, Indian 

9 Tribe, Tribal Organization, or Urban Indian Organi10 zation, that the Secretary, in consultation with the 

11 Attorney General, determines is appropriate, taking 

12 into account the special circumstances of such In13 dian Health Programs, Indian Tribes, Tribal Orga14 nizations, and Urban Indian Organizations, and of 

15 patients served by such Programs, Tribes, and Orga16 nizations.’’. 

17 SEC. 208. RULES APPLICABLE UNDER MEDICAID AND 

18 SCHIP TO MANAGED CARE ENTITIES WITH 

19 RESPECT TO INDIAN ENROLLEES AND IN20 DIAN HEALTH CARE PROVIDERS AND INDIAN 

21 MANAGED CARE ENTITIES. 

22 (a) IN GENERAL.—Section 1932 of the Social Secu23 rity Act (42 U.S.C. 1396u–2) is amended by adding at 

24 the end the following new subsection: 


ycherry on PROD1PC64 with BILLS
371 

•HR 1328 IH

1 ‘‘(h) SPECIAL RULES WITH RESPECT TO INDIAN EN2 ROLLEES, INDIAN HEALTH CARE PROVIDERS, AND IN3 DIAN MANAGED CARE ENTITIES.— 

4 ‘‘(1) ENROLLEE OPTION TO SELECT AN INDIAN

5 HEALTH CARE PROVIDER AS PRIMARY CARE PRO6 VIDER.—In the case of a non-Indian Medicaid man7 aged care entity that— 

8 ‘‘(A) has an Indian enrolled with the enti9 ty; and 

10 ‘‘(B) has an Indian health care provider 

11 that is participating as a primary care provider 

12 within the network of the entity, 

13 insofar as the Indian is otherwise eligible to receive 

14 services from such Indian health care provider and 

15 the Indian health care provider has the capacity to 

16 provide primary care services to such Indian, the 

17 contract with the entity under section 1903(m) or 

18 under section 1905(t)(3) shall require, as a condi19 tion of receiving payment under such contract, that 

20 the Indian shall be allowed to choose such Indian 

21 health care provider as the Indian’s primary care 

22 provider under the entity. 

23 ‘‘(2) ASSURANCE OF PAYMENT TO INDIAN

24 HEALTH CARE PROVIDERS FOR PROVISION OF COV25 ERED SERVICES.—Each contract with a managed 


ycherry on PROD1PC64 with BILLS
372 

•HR 1328 IH

1 care entity under section 1903(m) or under section 

2 1905(t)(3) shall require any such entity that has a 

3 significant percentage of Indian enrollees (as deter4 mined by the Secretary), as a condition of receiving 

5 payment under such contract to satisfy the following 

6 requirements: 

7 ‘‘(A) DEMONSTRATION OF PARTICIPATING

8 INDIAN HEALTH CARE PROVIDERS OR APPLICA9 TION OF ALTERNATIVE PAYMENT ARRANGE10 MENTS.—Subject to subparagraph (E), to— 

11 ‘‘(i) demonstrate that the number of 

12 Indian health care providers that are par13 ticipating providers with respect to such 

14 entity are sufficient to ensure timely access 

15 to covered Medicaid managed care services 

16 for those enrollees who are eligible to re17 ceive services from such providers; or 

18 ‘‘(ii) agree to pay Indian health care 

19 providers who are not participating pro20 viders with the entity for covered Medicaid 

21 managed care services provided to those 

22 enrollees who are eligible to receive services 

23 from such providers at a rate equal to the 

24 rate negotiated between such entity and 

25 the provider involved or, if such a rate has 


ycherry on PROD1PC64 with BILLS
373 

•HR 1328 IH

1 not been negotiated, at a rate that is not 

2 less than the level and amount of payment 

3 which the entity would make for the serv4 ices if the services were furnished by a par5 ticipating provider which is not an Indian 

6 health care provider. 

7 ‘‘(B) PROMPT PAYMENT.—To agree to 

8 make prompt payment (in accordance with 

9 rules applicable to managed care entities) to In10 dian health care providers that are participating 

11 providers with respect to such entity or, in the 

12 case of an entity to which subparagraph (A)(ii) 

13 or (E) applies, that the entity is required to pay 

14 in accordance with that subparagraph. 

15 ‘‘(C) SATISFACTION OF CLAIM REQUIRE16 MENT.—To deem any requirement for the sub17 mission of a claim or other documentation for 

18 services covered under subparagraph (A) by the 

19 enrollee to be satisfied through the submission 

20 of a claim or other documentation by an Indian 

21 health care provider that is consistent with sec22 tion 403(h) of the Indian Health Care Improve23 ment Act. 

24 ‘‘(D) COMPLIANCE WITH GENERALLY AP25 PLICABLE REQUIREMENTS.— 


ycherry on PROD1PC64 with BILLS
374 

•HR 1328 IH

1 ‘‘(i) IN GENERAL.—Subject to clause 

2 (ii), as a condition of payment under sub3 paragraph (A), an Indian health care pro4 vider shall comply with the generally appli5 cable requirements of this title, the State 

6 plan, and such entity with respect to cov7 ered Medicaid managed care services pro8 vided by the Indian health care provider to 

9 the same extent that non-Indian providers 

10 participating with the entity must comply 

11 with such requirements. 

12 ‘‘(ii) LIMITATIONS ON COMPLIANCE

13 WITH MANAGED CARE ENTITY GENERALLY

14 APPLICABLE REQUIREMENTS.—An Indian 

15 health care provider— 

16 ‘‘(I) shall not be required to com17 ply with a generally applicable re18 quirement of a managed care entity 

19 described in clause (i) as a condition 

20 of payment under subparagraph (A) if 

21 such compliance would conflict with 

22 any other statutory or regulatory re23 quirements applicable to the Indian 

24 health care provider; and 


ycherry on PROD1PC64 with BILLS
375 

•HR 1328 IH

1 ‘‘(II) shall only need to comply 

2 with those generally applicable re3 quirements of a managed care entity 

4 described in clause (i) as a condition 

5 of payment under subparagraph (A) 

6 that are necessary for the entity’s 

7 compliance with the State plan, such 

8 as those related to care management, 

9 quality assurance, and utilization 

10 management. 

11 ‘‘(E) APPLICATION OF SPECIAL PAYMENT

12 REQUIREMENTS FOR FEDERALLY-QUALIFIED

13 HEALTH CENTERS AND ENCOUNTER RATE FOR

14 SERVICES PROVIDED BY CERTAIN INDIAN

15 HEALTH CARE PROVIDERS.— 

16 ‘‘(i) FEDERALLY-QUALIFIED HEALTH

17 CENTERS.— 

18 ‘‘(I) MANAGED CARE ENTITY

19 PAYMENT REQUIREMENT.—To agree 

20 to pay any Indian health care provider 

21 that is a federally-qualified health 

22 center but not a participating provider 

23 with respect to the entity, for the pro24 vision of covered Medicaid managed 

25 care services by such provider to an 


ycherry on PROD1PC64 with BILLS
376 

•HR 1328 IH

1 Indian enrollee of the entity at a rate 

2 equal to the amount of payment that 

3 the entity would pay a federally-quali4 fied health center that is a partici5 pating provider with respect to the en6 tity but is not an Indian health care 

7 provider for such services. 

8 ‘‘(II) CONTINUED APPLICATION

9 OF STATE REQUIREMENT TO MAKE

10 SUPPLEMENTAL PAYMENT.—Nothing 

11 in subclause (I) or subparagraph (A) 

12 or (B) shall be construed as waiving 

13 the application of section 1902(bb)(5) 

14 regarding the State plan requirement 

15 to make any supplemental payment 

16 due under such section to a federally17 qualified health center for services 

18 furnished by such center to an en19 rollee of a managed care entity (re20 gardless of whether the federally21 qualified health center is or is not a 

22 participating provider with the entity). 

23 ‘‘(ii) CONTINUED APPLICATION OF

24 ENCOUNTER RATE FOR SERVICES PRO25 VIDED BY CERTAIN INDIAN HEALTH CARE


ycherry on PROD1PC64 with BILLS
377 

•HR 1328 IH

1 PROVIDERS.—If the amount paid by a 

2 managed care entity to an Indian health 

3 care provider that is not a federally-quali4 fied health center and that has elected to 

5 receive payment under this title as an In6 dian Health Service provider under the 

7 July 11, 1996, Memorandum of Agreement 

8 between the Health Care Financing Ad9 ministration (now the Centers for Medicare 

10 & Medicaid Services) and the Indian 

11 Health Service for services provided by 

12 such provider to an Indian enrollee with 

13 the managed care entity is less than the 

14 encounter rate that applies to the provision 

15 of such services under such memorandum, 

16 the State plan shall provide for payment to 

17 the Indian health care provider of the dif18 ference between the applicable encounter 

19 rate under such memorandum and the 

20 amount paid by the managed care entity to 

21 the provider for such services. 

22 ‘‘(F) CONSTRUCTION.—Nothing in this 

23 paragraph shall be construed as waiving the ap24 plication of section 1902(a)(30)(A) (relating to 

25 application of standards to assure that payVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00377 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
378 

•HR 1328 IH

1 ments are consistent with efficiency, economy, 

2 and quality of care). 

3 ‘‘(3) OFFERING OF MANAGED CARE THROUGH

4 INDIAN MEDICAID MANAGED CARE ENTITIES.—If— 

5 ‘‘(A) a State elects to provide services 

6 through Medicaid managed care entities under 

7 its Medicaid managed care program; and 

8 ‘‘(B) an Indian health care provider that is 

9 funded in whole or in part by the Indian Health 

10 Service, or a consortium composed of 1 or more 

11 Tribes, Tribal Organizations, or Urban Indian 

12 Organizations, and which also may include the 

13 Indian Health Service, has established an In14 dian Medicaid managed care entity in the State 

15 that meets generally applicable standards re16 quired of such an entity under such Medicaid 

17 managed care program, 

18 the State shall offer to enter into an agreement with 

19 the entity to serve as a Medicaid managed care enti20 ty with respect to eligible Indians served by such en21 tity under such program. 

22 ‘‘(4) SPECIAL RULES FOR INDIAN MANAGED

23 CARE ENTITIES.—The following are special rules re24 garding the application of a Medicaid managed care 

25 program to Indian Medicaid managed care entities: 


ycherry on PROD1PC64 with BILLS
379 

•HR 1328 IH

1 ‘‘(A) ENROLLMENT.— 

2 ‘‘(i) LIMITATION TO INDIANS.—An In3 dian Medicaid managed care entity may re4 strict enrollment under such program to 

5 Indians and to members of specific Tribes 

6 in the same manner as Indian Health Pro7 grams may restrict the delivery of services 

8 to such Indians and tribal members. 

9 ‘‘(ii) NO LESS CHOICE OF PLANS.— 

10 Under such program the State may not 

11 limit the choice of an Indian among Med12 icaid managed care entities only to Indian 

13 Medicaid managed care entities or to be 

14 more restrictive than the choice of man15 aged care entities offered to individuals 

16 who are not Indians. 

17 ‘‘(iii) DEFAULT ENROLLMENT.— 

18 ‘‘(I) IN GENERAL.—If such pro19 gram of a State requires the enroll20 ment of Indians in a Medicaid man21 aged care entity in order to receive 

22 benefits, the State, taking into consid23 eration the criteria specified in sub24 section (a)(4)(D)(ii)(I), shall provide 

25 for the enrollment of Indians deVerDate Aug 31 2005 22:10 Mar 11, 2007 Jkt 059200 PO 00000 Frm 00379 Fmt 6652 Sfmt 6201 E:\BILLS\H1328.IH H1328

ycherry on PROD1PC64 with BILLS
380 

•HR 1328 IH

1 scribed in subclause (II) who are not 

2 otherwise enrolled with such an entity 

3 in an Indian Medicaid managed care 

4 entity described in such clause. 

5 ‘‘(II) INDIAN DESCRIBED.—An 

6 Indian described in this subclause, 

7 with respect to an Indian Medicaid 

8 managed care entity, is an Indian 

9 who, based upon the service area and 

10 capacity of the entity, is eligible to be 

11 enrolled with the entity consistent 

12 with subparagraph (A). 

13 ‘‘(iv) EXCEPTION TO STATE LOCK14 IN.—A request by an Indian who is en15 rolled under such program with a non-In16 dian Medicaid managed care entity to 

17 change enrollment with that entity to en18 rollment with an Indian Medicaid managed 

19 care entity shall be considered cause for 

20 granting such request under procedures 

21 specified by the Secretary. 

22 ‘‘(B) FLEXIBILITY IN APPLICATION OF

23 SOLVENCY.—In applying section 1903(m)(1) to 

24 an Indian Medicaid managed care entity— 


ycherry on PROD1PC64 with BILLS
381 

•HR 1328 IH

1 ‘‘(i) any reference to a ‘State’ in sub2 paragraph (A)(ii) of that section shall be 

3 deemed to be a reference to the ‘Sec4 retary’; and 

5 ‘‘(ii) the entity shall be deemed to be 

6 a public entity described in subparagraph 

7 (C)(ii) of that section. 

8 ‘‘(C) EXCEPTIONS TO ADVANCE DIREC9 TIVES.—The Secretary may modify or waive the 

10 requirements of section 1902(w) (relating to 

11 provision of written materials on advance direc12 tives) insofar as the Secretary finds that the re13 quirements otherwise imposed are not an appro14 priate or effective way of communicating the in15 formation to Indians. 

16 ‘‘(D) FLEXIBILITY IN INFORMATION AND

17 MARKETING.— 

18 ‘‘(i) MATERIALS.—The Secretary may 

19 modify requirements under subsection 

20 (a)(5) to ensure that information described 

21 in that subsection is provided to enrollees 

22 and potential enrollees of Indian Medicaid 

23 managed care entities in a culturally ap24 propriate and understandable manner that 

25 clearly communicates to such enrollees and 


ycherry on PROD1PC64 with BILLS
382 

•HR 1328 IH

1 potential enrollees their rights, protections, 

2 and benefits. 

3 ‘‘(ii) DISTRIBUTION OF MARKETING

4 MATERIALS.—The provisions of subsection 

5 (d)(2)(B) requiring the distribution of 

6 marketing materials to an entire service 

7 area shall be deemed satisfied in the case 

8 of an Indian Medicaid managed care entity 

9 that distributes appropriate materials only 

10 to those Indians who are potentially eligi11 ble to enroll with the entity in the service 

12 area. 

13 ‘‘(5) MALPRACTICE INSURANCE.—Insofar as, 

14 under a Medicaid managed care program, a health 

15 care provider is required to have medical malpractice 

16 insurance coverage as a condition of contracting as 

17 a provider with a Medicaid managed care entity, an 

18 Indian health care provider that is— 

19 ‘‘(A) a federally-qualified health center 

20 that is covered under the Federal Tort Claims 

21 Act (28 U.S.C. 1346(b), 2671 et seq.); 

22 ‘‘(B) providing health care services pursu23 ant to a contract or compact under the Indian 

24 Self-Determination and Education Assistance 

25 Act (25 U.S.C. 450 et seq.) that are covered 


ycherry on PROD1PC64 with BILLS
383 

•HR 1328 IH

1 under the Federal Tort Claims Act (28 U.S.C. 

2 1346(b), 2671 et seq.); or 

3 ‘‘(C) the Indian Health Service providing 

4 health care services that are covered under the 

5 Federal Tort Claims Act (28 U.S.C. 1346(b), 

6 2671 et seq.); 

7 are deemed to satisfy such requirement. 

8 ‘‘(6) DEFINITIONS.—For purposes of this sub9 section: 

10 ‘‘(A) INDIAN HEALTH CARE PROVIDER.— 

11 The term ‘Indian health care provider’ means 

12 an Indian Health Program or an Urban Indian 

13 Organization. 

14 ‘‘(B) INDIAN; INDIAN HEALTH PROGRAM; 

15 SERVICE; TRIBE; TRIBAL ORGANIZATION; URBAN

16 INDIAN ORGANIZATION.—The terms ‘Indian’, 

17 ‘Indian Health Program’, ‘Service’, ‘Tribe’, 

18 ‘tribal organization’, ‘Urban Indian Organiza19 tion’ have the meanings given such terms in 

20 section 4 of the Indian Health Care Improve21 ment Act. 

22 ‘‘(C) INDIAN MEDICAID MANAGED CARE

23 ENTITY.—The term ‘Indian Medicaid managed 

24 care entity’ means a managed care entity that 

25 is controlled (within the meaning of the last 


ycherry on PROD1PC64 with BILLS
384 

•HR 1328 IH

1 sentence of section 1903(m)(1)(C)) by the In2 dian Health Service, a Tribe, Tribal Organiza3 tion, or Urban Indian Organization, or a con4 sortium, which may be composed of 1 or more 

5 Tribes, Tribal Organizations, or Urban Indian 

6 Organizations, and which also may include the 

7 Service. 

8 ‘‘(D) NON-INDIAN MEDICAID MANAGED

9 CARE ENTITY.—The term ‘non-Indian Medicaid 

10 managed care entity’ means a managed care en11 tity that is not an Indian Medicaid managed 

12 care entity. 

13 ‘‘(E) COVERED MEDICAID MANAGED CARE

14 SERVICES.—The term ‘covered Medicaid man15 aged care services’ means, with respect to an 

16 individual enrolled with a managed care entity, 

17 items and services that are within the scope of 

18 items and services for which benefits are avail19 able with respect to the individual under the 

20 contract between the entity and the State in21 volved. 

22 ‘‘(F) MEDICAID MANAGED CARE PRO23 GRAM.—The term ‘Medicaid managed care pro24 gram’ means a program under sections 

25 1903(m) and 1932 and includes a managed 


ycherry on PROD1PC64 with BILLS
385 

•HR 1328 IH

1 care program operating under a waiver under 

2 section 1915(b) or 1115 or otherwise.’’. 

3 (b) APPLICATION TO SCHIP.—Section 2107(e)(1) of 

4 such Act (42 U.S.C. 1397gg(1)), as amended by section 

5 206(b)(2), is amended by adding at the end the following 

6 new subparagraph: 

7 ‘‘(H) Subsections (a)(2)(C) and (h) of sec8 tion 1932.’’. 

9 SEC. 209. ANNUAL REPORT ON INDIANS SERVED BY SOCIAL 

10 SECURITY ACT HEALTH BENEFIT PROGRAMS. 

11 Section 1139 of the Social Security Act (42 U.S.C. 

12 1320b–9), as amended by the sections 202, 205, and 206, 

13 is amended by redesignating subsection (e) as subsection 

14 (f), and inserting after subsection (d) the following new 

15 subsection: 

16 ‘‘(e) ANNUAL REPORT ON INDIANS SERVED BY

17 HEALTH BENEFIT PROGRAMS FUNDED UNDER THIS

18 ACT.—Beginning January 1, 2007, and annually there19 after, the Secretary, acting through the Administrator of 

20 the Centers for Medicare & Medicaid Services and the Di21 rector of the Indian Health Service, shall submit a report 

22 to Congress regarding the enrollment and health status 

23 of Indians receiving items or services under health benefit 

24 programs funded under this Act during the preceding 

25 year. Each such report shall include the following: 


ycherry on PROD1PC64 with BILLS
386 

•HR 1328 IH

1 ‘‘(1) The total number of Indians enrolled in, or 

2 receiving items or services under, such programs, 

3 disaggregated with respect to each such program. 

4 ‘‘(2) The number of Indians described in para5 graph (1) that also received health benefits under 

6 programs funded by the Indian Health Service. 

7 ‘‘(3) General information regarding the health 

8 status of the Indians described in paragraph (1), 

9 disaggregated with respect to specific diseases or 

10 conditions and presented in a manner that is con11 sistent with protections for privacy of individually 

12 identifiable health information under section 264(c) 

13 of the Health Insurance Portability and Account14 ability Act of 1996. 

15 ‘‘(4) A detailed statement of the status of facili16 ties of the Indian Health Service or an Indian Tribe, 

17 Tribal Organization, or an Urban Indian Organiza18 tion with respect to such facilities’ compliance with 

19 the applicable conditions and requirements of titles 

20 XVIII, XIX, and XXI, and, in the case of title XIX 

21 or XXI, under a State plan under such title or 

22 under waiver authority, and of the progress being 

23 made by such facilities (under plans submitted 

24 under section 1880(b), 1911(b) or otherwise) toward 


ycherry on PROD1PC64 with BILLS
387 

•HR 1328 IH

1 the achievement and maintenance of such compli2 ance. 

3 ‘‘(5) Such other information as the Secretary 

4 determines is appropriate.’’. 

Æ 


ycherry on PROD1PC64 with BILLS