II 

109TH CONGRESS 

2D SESSION S. 4122 

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

that Act. 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 8, 2006 

Mr. MCCAIN (for himself, Mr. DORGAN, Mr. ENZI, and Ms. MURKOWSKI) introduced the following bill; which was read twice and referred to the Committee on Indian Affairs 

A BILL 

To amend the Indian Health Care Improvement Act to revise 

and extend that Act. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Indian Health Care Improvement Act Amendments of 

6 2006’’. 

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

8 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—AMENDMENTS TO INDIAN LAWS 


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Sec. 101. Indian Health Care Improvement Act amended. 

Sec. 102. Soboba sanitation facilities. 

Sec. 103. Native American Health and Wellness Foundation. 

TITLE II—IMPROVEMENT OF INDIAN HEALTH CARE PROVIDED 

UNDER THE SOCIAL SECURITY ACT 

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

covered services furnished by Indian Health Programs. 

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

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

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

certain Indian property from Medicaid estate recovery. 

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

Federal health care programs. 

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

funded under the Social Security Act involving Indian Health 

Programs and Urban Indian Organizations. 

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

safe harbor transactions under the Social Security Act. 

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

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

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

programs. 

1 TITLE I—AMENDMENTS TO 

2 INDIAN LAWS 

3 SEC. 101. INDIAN HEALTH CARE IMPROVEMENT ACT 

4 AMENDED. 

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

6 1601 et seq.) is amended to read as follows: 

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

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

9 ‘Indian Health Care Improvement Act’. 

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

11 for this Act is as follows: 

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

‘‘Sec. 2. Findings. 


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

‘‘Sec. 4. Definitions. 

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

DEVELOPMENT 

‘‘Sec. 101. Purpose. 

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

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

‘‘Sec. 104. Indian health professions scholarships. 

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

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

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

‘‘Sec. 108. Continuing education allowances. 

‘‘Sec. 109. Community Health Representative Program. 

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

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

‘‘Sec. 112. Recruitment activities. 

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

‘‘Sec. 114. Advanced training and research. 

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

‘‘Sec. 116. Tribal cultural orientation. 

‘‘Sec. 117. INMED Program. 

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

‘‘Sec. 119. Retention bonus. 

‘‘Sec. 120. Nursing residency program. 

‘‘Sec. 121. Community Health Aide Program. 

‘‘Sec. 122. Tribal Health Program administration. 

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

‘‘Sec. 124. National Health Service Corps. 

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

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

‘‘Sec. 127. Authorization of appropriations. 

‘‘TITLE II—HEALTH SERVICES 

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

‘‘Sec. 202. Catastrophic Health Emergency Fund. 

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

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

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

‘‘Sec. 206. Health services research. 

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

‘‘Sec. 208. Patient travel costs. 

‘‘Sec. 209. Epidemiology centers. 

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

‘‘Sec. 211. Indian youth program. 

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

diseases. 

‘‘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. 


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‘‘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. 

‘‘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. 


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

‘‘Sec. 415. Authorization of appropriations. 

‘‘TITLE V—HEALTH SERVICES FOR URBAN INDIANS 

‘‘Sec. 501. Purpose. 

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

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

services. 

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

needs. 

‘‘Sec. 505. Evaluations; renewals. 

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

‘‘Sec. 507. Reports and records. 

‘‘Sec. 508. Limitation on contract authority. 

‘‘Sec. 509. Facilities. 

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

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

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

‘‘Sec. 513. Urban NIAAA transferred programs. 

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

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

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

‘‘Sec. 517. Community Health Representatives. 

‘‘Sec. 518. Effective date. 

‘‘Sec. 519. Eligibility for services. 

‘‘Sec. 520. Authorization of appropriations. 

‘‘TITLE VI—ORGANIZATIONAL IMPROVEMENTS 

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

Public Health Service. 

‘‘Sec. 602. Automated management information system. 

‘‘Sec. 603. Authorization of appropriations. 

‘‘TITLE VII—BEHAVIORAL HEALTH PROGRAMS 

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

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

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

‘‘Sec. 704. Mental health technician program. 

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

‘‘Sec. 706. Indian women treatment programs. 

‘‘Sec. 707. Indian youth program. 

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

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

‘‘Sec. 710. Training and community education. 

‘‘Sec. 711. Behavioral health program. 

‘‘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 


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‘‘Sec. 801. Reports. 

‘‘Sec. 802. Regulations. 

‘‘Sec. 803. Plan of implementation. 

‘‘Sec. 804. Availability of funds. 

‘‘Sec. 805. Limitations. 

‘‘Sec. 806. Eligibility of California Indians. 

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

‘‘Sec. 808. Reallocation of base resources. 

‘‘Sec. 809. Results of demonstration projects. 

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

‘‘Sec. 811. Moratorium. 

‘‘Sec. 812. Tribal employment. 

‘‘Sec. 813. Severability provisions. 

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

Care. 

‘‘Sec. 815. Appropriations; availability. 

‘‘Sec. 816. Authorization of appropriations. 

1 ‘‘SEC. 2. FINDINGS. 

2 ‘‘Congress makes the following findings: 

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

4 improve the health of the Indians are consonant 

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

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

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

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

13 planning and management of those services. 

14 ‘‘(3) Federal health services to Indians have re15 sulted in a reduction in the prevalence and incidence 

16 of preventable illnesses among, and unnecessary and 

17 premature deaths of, Indians. 


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

2 needs of the American Indian people are severe and 

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

4 the general population of the United States. 

5 ‘‘SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POL6 ICY. 

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

8 in fulfillment of its special trust responsibilities and legal 

9 obligations to Indians— 

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

11 for Indians and to provide all resources necessary to 

12 effect that policy; 

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

14 year 2010 to at least the levels set forth in the goals 

15 contained within the Healthy People 2010 or suc16 cessor objectives; 

17 ‘‘(3) to the greatest extent possible, to allow In18 dians to set their own health care priorities and es19 tablish goals that reflect their unmet needs; 

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

21 the health professions and allied and associated 

22 health professions awarded to Indians so that the 

23 proportion of Indian health professionals in each 

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

25 the general population; 


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1 ‘‘(5) to require meaningful consultation with In2 dian Tribes, Tribal Organizations, and Urban Indian 

3 Organizations to implement this Act and the na4 tional policy of Indian self-determination; and 

5 ‘‘(6) to provide funding for programs and facili6 ties operated by Indian Tribes and Tribal Organiza7 tions in amounts that are not less than the amounts 

8 provided to programs and facilities operated directly 

9 by the Service. 

10 ‘‘SEC. 4. DEFINITIONS. 

11 ‘‘For purposes of this Act: 

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

13 on or near a reservation and accredited by a na14 tional or regional organization with accrediting au15 thority. 

16 ‘‘(2) The term ‘Area Office’ means an adminis17 trative entity, including a program office, within the 

18 Service through which services and funds are pro19 vided to the Service Units within a defined geo20 graphic area. 

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

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

23 tobacco) abuse and mental health prevention and 

24 treatment, for the purpose of providing comprehen25 sive services. 


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

2 joint development of substance abuse and mental 

3 health treatment planning and coordinated case 

4 management using a multidisciplinary approach. 

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

6 Indians who are eligible for health services of the 

7 Service pursuant to section 806. 

8 ‘‘(5) The term ‘community college’ means— 

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

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

11 ‘‘(6) The term ‘contract health service’ means 

12 health services provided at the expense of the Serv13 ice or a Tribal Health Program by public or private 

14 medical providers or hospitals, other than the Serv15 ice Unit or the Tribal Health Program at whose ex16 pense the services are provided. 

17 ‘‘(7) The term ‘Department’ means, unless oth18 erwise designated, the Department of Health and 

19 Human Services. 

20 ‘‘(8) The term ‘Director’ means the Director of 

21 the Service. 

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

23 reduction, limitation, and prevention of disease and 

24 its complications and reduction in the consequences 

25 of disease, including— 


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1 ‘‘(A) controlling— 

2 ‘‘(i) the development of diabetes; 

3 ‘‘(ii) high blood pressure; 

4 ‘‘(iii) infectious agents; 

5 ‘‘(iv) injuries; 

6 ‘‘(v) occupational hazards and disabil7 ities; 

8 ‘‘(vi) sexually transmittable diseases; 

9 and 

10 ‘‘(vii) toxic agents; and 

11 ‘‘(B) providing— 

12 ‘‘(i) fluoridation of water; and 

13 ‘‘(ii) immunizations. 

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

15 allopathic medicine, family medicine, internal medi16 cine, pediatrics, geriatric medicine, obstetrics and 

17 gynecology, podiatric medicine, nursing, public 

18 health nursing, dentistry, psychiatry, osteopathy, op19 tometry, pharmacy, psychology, public health, social 

20 work, marriage and family therapy, chiropractic 

21 medicine, environmental health and engineering, al22 lied health professions, and any other health profes23 sion. 

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


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1 ‘‘(A) fostering social, economic, environ2 mental, and personal factors conducive to 

3 health, including raising public awareness about 

4 health matters and enabling the people to cope 

5 with health problems by increasing their knowl6 edge and providing them with valid information; 

7 ‘‘(B) encouraging adequate and appro8 priate diet, exercise, and sleep; 

9 ‘‘(C) promoting education and work in con10 formity with physical and mental capacity; 

11 ‘‘(D) making available safe water and sani12 tary facilities; 

13 ‘‘(E) improving the physical, economic, cul14 tural, psychological, and social environment; 

15 ‘‘(F) promoting culturally competent care; 

16 and 

17 ‘‘(G) providing adequate and appropriate 

18 programs, which may include— 

19 ‘‘(i) abuse prevention (mental and 

20 physical); 

21 ‘‘(ii) community health; 

22 ‘‘(iii) community safety; 

23 ‘‘(iv) consumer health education; 

24 ‘‘(v) diet and nutrition; 


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1 ‘‘(vi) immunization and other preven2 tion of communicable diseases, including 

3 HIV/AIDS; 

4 ‘‘(vii) environmental health; 

5 ‘‘(viii) exercise and physical fitness; 

6 ‘‘(ix) avoidance of fetal alcohol dis7 orders; 

8 ‘‘(x) first aid and CPR education; 

9 ‘‘(xi) human growth and development; 

10 ‘‘(xii) injury prevention and personal 

11 safety; 

12 ‘‘(xiii) behavioral health; 

13 ‘‘(xiv) monitoring of disease indicators 

14 between health care provider visits, 

15 through appropriate means, including 

16 Internet-based health care management 

17 systems; 

18 ‘‘(xv) personal health and wellness 

19 practices; 

20 ‘‘(xvi) personal capacity building; 

21 ‘‘(xvii) prenatal, pregnancy, and in22 fant care; 

23 ‘‘(xviii) psychological well-being; 

24 ‘‘(xix) safe and adequate water; 

25 ‘‘(xx) healthy work environments; 


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1 ‘‘(xxi) elimination, reduction, and pre2 vention of contaminants that create 

3 unhealthy household conditions (including 

4 mold and other allergens); 

5 ‘‘(xxii) stress control; 

6 ‘‘(xxiii) substance abuse; 

7 ‘‘(xxiv) sanitary facilities; 

8 ‘‘(xxv) sudden infant death syndrome 

9 prevention; 

10 ‘‘(xxvi) tobacco use cessation and re11 duction; 

12 ‘‘(xxvii) violence prevention; and 

13 ‘‘(xxviii) such other activities identi14 fied by the Service, a Tribal Health Pro15 gram, or an Urban Indian Organization, to 

16 promote achievement of any of the objec17 tives described in section 3(2). 

18 ‘‘(12) The term ‘Indian’, unless otherwise des19 ignated, means any person who is a member of an 

20 Indian Tribe or is eligible for health services under 

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

22 102 and 103, the term also means any individual 

23 who— 

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1 ber of a tribe, band, or other organized group 

2 of Indians, including those tribes, bands, or 

3 groups terminated since 1940 and those recog4 nized now or in the future by the State in 

5 which they reside; or 

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

7 degree, of any such member; 

8 ‘‘(B) is an Eskimo or Aleut or other Alas9 ka Native; 

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

11 Interior to be an Indian for any purpose; or 

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

13 regulations promulgated by the Secretary. 

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

15 means— 

16 ‘‘(A) any health program administered di17 rectly by the Service; 

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

19 ‘‘(C) any Indian Tribe or Tribal Organiza20 tion to which the Secretary provides funding 

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

22 1910 (25 U.S.C. 47) (commonly known as the 

23 ‘Buy Indian Act’). 


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

2 given the term in the Indian Self-Determination and 

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

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

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

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

7 1058(e)). 

8 ‘‘(16) The term ‘reservation’ means any feder9 ally recognized Indian Tribe’s reservation, Pueblo, or 

10 colony, including former reservations in Oklahoma, 

11 Indian allotments, and Alaska Native Regions estab12 lished pursuant to the Alaska Native Claims Settle13 ment Act (25 U.S.C. 1601 et seq.). 

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

15 designated, means the Secretary of Health and 

16 Human Services. 

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

18 Health Service. 

19 ‘‘(19) The term ‘Service Area’ means the geo20 graphical area served by each Area Office. 

21 ‘‘(20) The term ‘Service Unit’ means an admin22 istrative entity of the Service, or a Tribal Health 

23 Program through which services are provided, di24 rectly or by contract, to eligible Indians within a de25 fined geographic area. 


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

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

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

4 ‘‘(22) The term ‘telemedicine’ means a tele5 communications link to an end user through the use 

6 of eligible equipment that electronically links health 

7 professionals or patients and health professionals at 

8 separate sites in order to exchange health care infor9 mation in audio, video, graphic, or other format for 

10 the purpose of providing improved health care serv11 ices. 

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

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

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

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

16 an Indian Tribe or Tribal Organization that oper17 ates any health program, service, function, activity, 

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

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

20 with the Service under the Indian Self-Determina21 tion and Education Assistance Act (25 U.S.C. 450 

22 et seq.). 

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

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

2 450 et seq.). 

3 ‘‘(26) The term ‘Urban Center’ means any com4 munity which has a sufficient Urban Indian popu5 lation with unmet health needs to warrant assistance 

6 under title V of this Act, as determined by the Sec7 retary. 

8 ‘‘(27) The term ‘Urban Indian’ means any indi9 vidual who resides in an Urban Center and who 

10 meets 1 or more of the following criteria: 

11 ‘‘(A) Irrespective of whether the individual 

12 lives on or near a reservation, the individual is 

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

14 group of Indians, including those tribes, bands, 

15 or groups terminated since 1940 and those 

16 tribes, bands, or groups that are recognized by 

17 the States in which they reside, or who is a de18 scendant in the first or second degree of any 

19 such member. 

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

21 or other Alaska Native. 

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

23 Secretary of the Interior to be an Indian for 

24 any purpose. 


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

2 Indian under regulations promulgated by the 

3 Secretary. 

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

5 means a nonprofit corporate body that (A) is situ6 ated in an Urban Center; (B) is governed by an 

7 Urban Indian-controlled board of directors; (C) pro8 vides for the participation of all interested Indian 

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

10 cooperating with other public and private entities for 

11 the purpose of performing the activities described in 

12 section 503(a). 

13 ‘‘TITLE I—INDIAN HEALTH, 

14 HUMAN RESOURCES, AND DE15 VELOPMENT 

16 ‘‘SEC. 101. PURPOSE. 

17 ‘‘The purpose of this title is to increase, to the max18 imum extent feasible, the number of Indians entering the 

19 health professions and providing health services, and to 

20 assure an optimum supply of health professionals to the 

21 Indian Health Programs and Urban Indian Organizations 

22 involved in the provision of health services to Indians. 


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1 ‘‘SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM 

2 FOR INDIANS. 

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

4 the Service, shall make grants to public or nonprofit pri5 vate health or educational entities, Tribal Health Pro6 grams, or Urban Indian Organizations to assist such enti7 ties in meeting the costs of— 

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

9 education or training in the health professions and 

10 encouraging and assisting them— 

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

12 health professions; or 

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

14 any such courses of study, to undertake such 

15 postsecondary education or training as may be 

16 required to qualify them for enrollment; 

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

18 available to Indians enrolled in any course of study 

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

20 training necessary to qualify them to enroll in any 

21 such course of study; or 

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

25 and completion by them of, courses of study referred 

26 to in paragraph (1). 


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1 ‘‘(b) GRANTS.— 

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

3 make a grant under this section unless an applica4 tion has been submitted to, and approved by, the 

5 Secretary. Such application shall be in such form, 

6 submitted in such manner, and contain such infor7 mation, as the Secretary shall by regulation pre8 scribe pursuant to this Act. The Secretary shall give 

9 a preference to applications submitted by Tribal 

10 Health Programs or Urban Indian Organizations. 

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

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

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

17 to this Act. To the extent not otherwise prohibited 

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

19 regulations issued pursuant to this Act. 

20 ‘‘SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOL21 ARSHIP PROGRAM FOR INDIANS. 

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

23 acting through the Service, shall provide scholarship 

24 grants to Indians who— 


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1 ‘‘(1) have successfully completed their high 

2 school education or high school equivalency; and 

3 ‘‘(2) have demonstrated the potential to suc4 cessfully complete courses of study in the health pro5 fessions. 

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

8 ‘‘(1) Compensatory preprofessional education of 

9 any recipient, such scholarship not to exceed 2 years 

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

11 thereof, as determined by the Secretary pursuant to 

12 regulations issued under this Act). 

13 ‘‘(2) Pregraduate education of any recipient 

14 leading to a baccalaureate degree in an approved 

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

16 health profession, such scholarship not to exceed 4 

17 years. An extension of up to 2 years (or the part18 time equivalent thereof, as determined by the Sec19 retary pursuant to regulations issued pursuant to 

20 this Act) may be approved. 

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

22 section— 

23 ‘‘(1) may cover costs of tuition, books, trans24 portation, board, and other necessary related ex25 penses of a recipient while attending school; 


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

2 the applicant’s scholastic achievement if such appli3 cant has been admitted to, or maintained good 

4 standing at, an accredited institution; and 

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

6 applicant’s eligibility for assistance or benefits under 

7 any other Federal program. 

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

9 ‘‘(a) IN GENERAL.— 

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

11 through the Service, shall make scholarship grants 

12 to Indians who are enrolled full or part time in ac13 credited schools pursuing courses of study in the 

14 health professions. Such scholarships shall be des15 ignated Indian Health Scholarships and shall be 

16 made in accordance with section 338A of the Public 

17 Health Services Act (42 U.S.C. 254l), except as pro18 vided in subsection (b) of this section. 

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

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

22 ‘‘(A) who shall receive scholarship grants 

23 under subsection (a); and 

24 ‘‘(B) the distribution of the scholarships 

25 among health professions on the basis of the 


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1 relative needs of Indians for additional service 

2 in the health professions. 

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

4 The administration of this section shall be a respon5 sibility of the Director and shall not be delegated in 

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

8 450 et seq.). 

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

10 ‘‘(1) OBLIGATION MET.—The active duty serv11 ice obligation under a written contract with the Sec12 retary under this section that an Indian has entered 

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

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

16 participant receives a scholarship award under this 

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

18 1 or more of the following: 

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

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

21 of this Act. 

22 ‘‘(C) In the private practice of the applica23 ble profession if, as determined by the Sec24 retary, in accordance with guidelines promul25 gated by the Secretary, such practice is situated 


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1 in a physician or other health professional 

2 shortage area and addresses the health care 

3 needs of a substantial number of Indians. 

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

6 health profession program) if, as determined by 

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

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

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

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

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

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

18 that is required for the practice of that health pro19 fession, for an appropriate period (in years, as deter20 mined by the Secretary), subject to the following 

21 conditions: 

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

23 other advanced clinical training shall be counted 

24 as satisfying any period of obligated service 

25 under this subsection. 


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

2 that individual shall commence not later than 

3 90 days after the completion of that advanced 

4 clinical training (or by a date specified by the 

5 Secretary). 

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

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

9 (1). 

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

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

12 meet the active duty service obligation described 

13 in paragraph (1) by service in a program speci14 fied under that paragraph that— 

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

16 the Indian Tribe in which the recipient is 

17 enrolled; or 

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

19 the recipient is enrolled. 

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

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

22 assignments of Indian Health Scholarship recipients 

23 required to meet the active duty service obligation 

24 described in paragraph (1), shall give priority to as25 signing individuals to service in those programs 


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

2 health professionals to provide health care services 

3 as a result of individuals having breached contracts 

4 entered into under this section. 

5 ‘‘(c) PART-TIME STUDENTS.—In the case of an indi6 vidual receiving a scholarship under this section who is 

7 enrolled part time in an approved course of study— 

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

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

10 years, as determined by the Secretary; 

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

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

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

14 each year for which the individual was provided 

15 a scholarship (as determined by the Secretary); 

16 or 

17 ‘‘(B) 2 years; and 

18 ‘‘(3) the amount of the monthly stipend speci19 fied in section 338A(g)(1)(B) of the Public Health 

20 Service Act (42 U.S.C. 254l(g)(1)(B)) shall be re21 duced pro rata (as determined by the Secretary) 

22 based on the number of hours such student is en23 rolled. 

24 ‘‘(d) BREACH OF CONTRACT.— 


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

2 shall be liable to the United States for the amount 

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

4 of the individual, under a contract entered into with 

5 the Secretary under this section on or after the date 

6 of enactment of the Indian Health Care Improve7 ment Act Amendments of 2006 if that individual— 

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

9 of academic standing in the educational institu10 tion in which he or she is enrolled (such level 

11 determined by the educational institution under 

12 regulations of the Secretary); 

13 ‘‘(B) is dismissed from such educational 

14 institution for disciplinary reasons; 

15 ‘‘(C) voluntarily terminates the training in 

16 such an educational institution for which he or 

17 she is provided a scholarship under such con18 tract before the completion of such training; or 

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

20 the educational institution in which he or she is 

21 enrolled not to accept payment, in whole or in 

22 part, of a scholarship under such contract, in 

23 lieu of any service obligation arising under such 

24 contract. 


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

2 specified in paragraph (1) an individual breaches a 

3 written contract by failing either to begin such indi4 vidual’s service obligation required under such con5 tract or to complete such service obligation, the 

6 United States shall be entitled to recover from the 

7 individual an amount determined in accordance with 

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

9 in the manner provided for in such subsection. 

10 ‘‘(3) CANCELLATION UPON DEATH OF RECIPI11 ENT.—Upon the death of an individual who receives 

12 an Indian Health Scholarship, any outstanding obli13 gation of that individual for service or payment that 

14 relates to that scholarship shall be canceled. 

15 ‘‘(4) WAIVERS AND SUSPENSIONS.— 

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

17 provide for the partial or total waiver or sus18 pension of any obligation of service or payment 

19 of a recipient of an Indian Health Scholarship 

20 if the Secretary determines that— 

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

22 to meet that obligation or make that pay23 ment; 

24 ‘‘(ii) requiring that recipient to meet 

25 that obligation or make that payment 


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1 would result in extreme hardship to the re2 cipient; or 

3 ‘‘(iii) the enforcement of the require4 ment to meet the obligation or make the 

5 payment would be unconscionable. 

6 ‘‘(B) FACTORS FOR CONSIDERATION.—Be7 fore waiving or suspending an obligation of 

8 service or payment under subparagraph (A), the 

9 Secretary shall consult with the affected Area 

10 Office, Indian Tribes, Tribal Organizations, or 

11 Urban Indian Organizations, and may take into 

12 consideration whether the obligation may be 

13 satisfied in a teaching capacity at a tribal col14 lege or university nursing program under sub15 section (b)(1)(D). 

16 ‘‘(5) EXTREME HARDSHIP.—Notwithstanding 

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

18 hardship or for other good cause shown, the Sec19 retary may waive, in whole or in part, the right of 

20 the United States to recover funds made available 

21 under this section. 

22 ‘‘(6) BANKRUPTCY.—Notwithstanding any 

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

24 an Indian Health Scholarship, no obligation for pay25 ment may be released by a discharge in bankruptcy 


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1 under title 11, United States Code, unless that dis2 charge is granted after the expiration of the 5-year 

3 period beginning on the initial date on which that 

4 payment is due, and only if the bankruptcy court 

5 finds that the nondischarge of the obligation would 

6 be unconscionable. 

7 ‘‘SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PRO8 GRAM. 

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

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

11 $300,000 to each of 9 colleges and universities for the pur12 pose of developing and maintaining Indian psychology ca13 reer recruitment programs as a means of encouraging In14 dians to enter the behavioral health field. These programs 

15 shall be located at various locations throughout the coun16 try to maximize their availability to Indian students and 

17 new programs shall be established in different locations 

18 from time to time. 

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

20 Secretary shall provide a grant authorized under sub21 section (a) to develop and maintain a program at the Uni22 versity of North Dakota to be known as the ‘Quentin N. 

23 Burdick American Indians Into Psychology Program’. 

24 Such program shall, to the maximum extent feasible, co25 ordinate with the Quentin N. Burdick Indian Health ProVerDate Aug 31 2005 02:12 Dec 13, 2006 Jkt 059200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 grams authorized under section 117(b), the Quentin N. 

2 Burdick American Indians Into Nursing Program author3 ized under section 115(e), and existing university research 

4 and communications networks. 

5 ‘‘(c) REGULATIONS.—The Secretary shall issue regu6 lations pursuant to this Act for the competitive awarding 

7 of grants provided under this section. 

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

9 section shall agree to provide a program which, at a min10 imum— 

11 ‘‘(1) provides outreach and recruitment for 

12 health professions to Indian communities including 

13 elementary, secondary, and accredited and accessible 

14 community colleges that will be served by the pro15 gram; 

16 ‘‘(2) incorporates a program advisory board 

17 comprised of representatives from the tribes and 

18 communities that will be served by the program; 

19 ‘‘(3) provides summer enrichment programs to 

20 expose Indian students to the various fields of psy21 chology through research, clinical, and experimental 

22 activities; 

23 ‘‘(4) provides stipends to undergraduate and 

24 graduate students to pursue a career in psychology; 


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1 ‘‘(5) develops affiliation agreements with tribal 

2 colleges and universities, the Service, university af3 filiated programs, and other appropriate accredited 

4 and accessible entities to enhance the education of 

5 Indian students; 

6 ‘‘(6) to the maximum extent feasible, uses exist7 ing university tutoring, counseling, and student sup8 port services; and 

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

10 qualified Indians in the program. 

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

12 active duty service obligation prescribed under section 

13 338C of the Public Health Service Act (42 U.S.C. 254m) 

14 shall be met by each graduate who receives a stipend de15 scribed in subsection (d)(4) that is funded under this sec16 tion. Such obligation shall be met by service— 

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

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

19 Act; or 

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

21 determined by the Secretary, in accordance with 

22 guidelines promulgated by the Secretary, such prac23 tice is situated in a physician or other health profes24 sional shortage area and addresses the health care 

25 needs of a substantial number of Indians. 


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

2 is authorized to be appropriated to carry out this section 

3 $2,700,000 for each of fiscal years 2007 through 2016. 

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

5 ‘‘(a) IN GENERAL.— 

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

7 acting through the Service, shall make grants to 

8 Tribal Health Programs for the purpose of providing 

9 scholarships for Indians to serve as health profes10 sionals in Indian communities. 

11 ‘‘(2) AMOUNT.—Amounts available under para12 graph (1) for any fiscal year shall not exceed 5 per13 cent of the amounts available for each fiscal year for 

14 Indian Health Scholarships under section 104. 

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

16 under paragraph (1) shall be in such form and con17 tain such agreements, assurances, and information 

18 as consistent with this section. 

19 ‘‘(b) REQUIREMENTS.— 

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

21 receiving a grant under subsection (a) shall provide 

22 scholarships to Indians in accordance with the re23 quirements of this section. 

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

25 any scholarship pursuant to subsection (a)— 


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1 ‘‘(A) 80 percent of the costs of the scholar2 ship shall be paid from the funds made avail3 able pursuant to subsection (a)(1) provided to 

4 the Tribal Health Program; and 

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

6 from any other source of funds. 

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

8 shall provide scholarships under this section only to Indi9 ans enrolled or accepted for enrollment in a course of 

10 study (approved by the Secretary) in 1 of the health pro11 fessions contemplated by this Act. 

12 ‘‘(d) CONTRACT.— 

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

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

15 Health Program shall enter into a written contract 

16 with each recipient of such scholarship. 

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

18 ‘‘(A) obligate such recipient to provide 

19 service in an Indian Health Program or Urban 

20 Indian Organization, in the same Service Area 

21 where the Tribal Health Program providing the 

22 scholarship is located, for— 

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

24 scholarship is provided (or the part-time 

25 equivalent thereof, as determined by the 


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

2 whichever period is greater; or 

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

4 the recipient and the Tribal Health Pro5 gram may agree; 

6 ‘‘(B) provide that the amount of the schol7 arship— 

8 ‘‘(i) may only be expended for— 

9 ‘‘(I) tuition expenses, other rea10 sonable educational expenses, and rea11 sonable living expenses incurred in at12 tendance at the educational institu13 tion; and 

14 ‘‘(II) payment to the recipient of 

15 a monthly stipend of not more than 

16 the amount authorized by section 

17 338(g)(1)(B) of the Public Health 

18 Service Act (42 U.S.C. 

19 254m(g)(1)(B)), with such amount to 

20 be reduced pro rata (as determined by 

21 the Secretary) based on the number of 

22 hours such student is enrolled, and 

23 not to exceed, for any year of attend24 ance for which the scholarship is pro25 vided, the total amount required for 


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1 the year for the purposes authorized 

2 in this clause; and 

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

4 attendance for which the scholarship is 

5 provided, the total amount required for the 

6 year for the purposes authorized in clause 

7 (i); 

8 ‘‘(C) require the recipient of such scholar9 ship to maintain an acceptable level of academic 

10 standing as determined by the educational insti11 tution in accordance with regulations issued 

12 pursuant to this Act; and 

13 ‘‘(D) require the recipient of such scholar14 ship to meet the educational and licensure re15 quirements appropriate to each health profes16 sion. 

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

18 contract may allow the recipient to serve in another 

19 Service Area, provided the Tribal Health Program 

20 and Secretary approve and services are not dimin21 ished to Indians in the Service Area where the Trib22 al Health Program providing the scholarship is lo23 cated. 

24 ‘‘(e) BREACH OF CONTRACT.— 


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

2 has entered into a written contract with the Sec3 retary and a Tribal Health Program under sub4 section (d) shall be liable to the United States for 

5 the Federal share of the amount which has been 

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

7 the contract if that individual— 

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

9 of academic standing in the educational institu10 tion in which he or she is enrolled (such level 

11 as determined by the educational institution 

12 under regulations of the Secretary); 

13 ‘‘(B) is dismissed from such educational 

14 institution for disciplinary reasons; 

15 ‘‘(C) voluntarily terminates the training in 

16 such an educational institution for which he or 

17 she is provided a scholarship under such con18 tract before the completion of such training; or 

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

20 the educational institution in which he or she is 

21 enrolled not to accept payment, in whole or in 

22 part, of a scholarship under such contract, in 

23 lieu of any service obligation arising under such 

24 contract. 


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

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

3 written contract by failing to either begin such indi4 vidual’s service obligation required under such con5 tract or to complete such service obligation, the 

6 United States shall be entitled to recover from the 

7 individual an amount determined in accordance with 

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

9 in the manner provided for in such subsection. 

10 ‘‘(3) CANCELLATION UPON DEATH OF RECIPI11 ENT.—Upon the death of an individual who receives 

12 an Indian Health Scholarship, any outstanding obli13 gation of that individual for service or payment that 

14 relates to that scholarship shall be canceled. 

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

16 out this subsection on the basis of information re17 ceived from Tribal Health Programs involved or on 

18 the basis of information collected through such other 

19 means as the Secretary deems appropriate. 

20 ‘‘(f) RELATION TO SOCIAL SECURITY ACT.—The re21 cipient of a scholarship under this section shall agree, in 

22 providing health care pursuant to the requirements here23 in— 

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

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1 vidual to pay for such care or on the basis that pay2 ment for such care will be made pursuant to a pro3 gram established in title XVIII of the Social Secu4 rity Act or pursuant to the programs established in 

5 title XIX or title XXI of such Act; and 

6 ‘‘(2) to accept assignment under section 

7 1842(b)(3)(B)(ii) of the Social Security Act for all 

8 services for which payment may be made under part 

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

10 appropriate agreement with the State agency that 

11 administers the State plan for medical assistance 

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

13 title XXI, of such Act to provide service to individ14 uals entitled to medical assistance or child health as15 sistance, respectively, under the plan. 

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

17 shall make payments under this section to a Tribal Health 

18 Program for any fiscal year subsequent to the first fiscal 

19 year of such payments unless the Secretary determines 

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

21 Health Program has not complied with the requirements 

22 of this section. 

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

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

25 who receives a scholarship pursuant to section 104 or 106 


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1 shall be given preference for employment in the Service, 

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

3 Urban Indian Organization, or other agencies of the De4 partment as available, during any nonacademic period of 

5 the year. 

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

7 OBLIGATION.—Periods of employment pursuant to this 

8 subsection shall not be counted in determining fulfillment 

9 of the service obligation incurred as a condition of the 

10 scholarship. 

11 ‘‘(c) TIMING; LENGTH OF EMPLOYMENT.—Any indi12 vidual enrolled in a program, including a high school pro13 gram, authorized under section 102(a) may be employed 

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

15 Indian Organization during any nonacademic period of the 

16 year. Any such employment shall not exceed 120 days dur17 ing any calendar year. 

18 ‘‘(d) NONAPPLICABILITY OF COMPETITIVE PER19 SONNEL SYSTEM.—Any employment pursuant to this sec20 tion shall be made without regard to any competitive per21 sonnel system or agency personnel limitation and to a po22 sition which will enable the individual so employed to re23 ceive practical experience in the health profession in which 

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

25 shall receive payment for his or her services comparable 


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•S 4122 IS

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

2 employed in the competitive system. Any individual so em3 ployed shall not be counted against any employment ceil4 ing affecting the Service or the Department. 

5 ‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES. 

6 ‘‘In order to encourage scholarship and stipend re7 cipients under sections 104, 105, 106, and 115 and health 

8 professionals, including community health representatives 

9 and emergency medical technicians, to join or continue in 

10 an Indian Health Program and to provide their services 

11 in the rural and remote areas where a significant portion 

12 of Indians reside, the Secretary, acting through the Serv13 ice, may— 

14 ‘‘(1) provide programs or allowances to transi15 tion into an Indian Health Program, including li16 censing, board or certification examination assist17 ance, and technical assistance in fulfilling service ob18 ligations under sections 104, 105, 106, and 115; and 

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

20 professionals employed in an Indian Health Program 

21 to enable them for a period of time each year pre22 scribed by regulation of the Secretary to take leave 

23 of their duty stations for professional consultation, 

24 management, leadership, and refresher training 

25 courses. 


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1 ‘‘SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PRO2 GRAM. 

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

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

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

6 Service, shall maintain a Community Health Representa7 tive Program under which Indian Health Programs— 

8 ‘‘(1) provide for the training of Indians as com9 munity health representatives; and 

10 ‘‘(2) use such community health representatives 

11 in the provision of health care, health promotion, 

12 and disease prevention services to Indian commu13 nities. 

14 ‘‘(b) DUTIES.—The Community Health Representa15 tive Program of the Service, shall— 

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

17 community health representatives to ensure that the 

18 community health representatives provide quality 

19 health care, health promotion, and disease preven20 tion services to the Indian communities served by 

21 the Program; 

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

23 and maintain a curriculum that— 

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

25 health care with supervised practical experience 

26 in the provision of health care; and 


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1 ‘‘(B) provides instruction and practical ex2 perience in health promotion and disease pre3 vention activities, with appropriate consider4 ation given to lifestyle factors that have an im5 pact on Indian health status, such as alco6 holism, family dysfunction, and poverty; 

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

8 needs of community health representatives for con9 tinuing education in health care, health promotion, 

10 and disease prevention and develop programs that 

11 meet the needs for continuing education; 

12 ‘‘(4) maintain a system that provides close su13 pervision of Community Health Representatives; 

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

15 of Community Health Representatives is reviewed 

16 and evaluated; and 

17 ‘‘(6) promote traditional health care practices 

18 of the Indian Tribes served consistent with the Serv19 ice standards for the provision of health care, health 

20 promotion, and disease prevention. 

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

22 PROGRAM. 

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

24 through the Service, shall establish and administer a pro25 gram to be known as the Service Loan Repayment ProVerDate Aug 31 2005 02:12 Dec 13, 2006 Jkt 059200 PO 00000 Frm 00043 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 gram (hereinafter referred to as the ‘Loan Repayment 

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

3 trained health professionals necessary to maintain accredi4 tation of, and provide health care services to Indians 

5 through, Indian Health Programs and Urban Indian Or6 ganizations. 

7 ‘‘(b) ELIGIBLE INDIVIDUALS.—To be eligible to par8 ticipate in the Loan Repayment Program, an individual 

9 must— 

10 ‘‘(1)(A) be enrolled— 

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

12 accredited educational institution (as deter13 mined by the Secretary under section 

14 338B(b)(1)(c)(i) of the Public Health Service 

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

16 scheduled to complete such course of study in 

17 the same year such individual applies to partici18 pate in such program; or 

19 ‘‘(ii) in an approved graduate training pro20 gram in a health profession; or 

21 ‘‘(B) have— 

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

23 ‘‘(ii) a license to practice a health profes24 sion; 


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

2 as a commissioned officer in the Regular or Reserve 

3 Corps of the Public Health Service; 

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

5 in the Regular or Reserve Corps of the Public 

6 Health Service; 

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

8 service employment in the Service; or 

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

10 or Urban Indian Organization without a service obli11 gation; and 

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

13 a contract described in subsection (e). 

14 ‘‘(c) APPLICATION.— 

15 ‘‘(1) INFORMATION TO BE INCLUDED WITH

16 FORMS.—In disseminating application forms and 

17 contract forms to individuals desiring to participate 

18 in the Loan Repayment Program, the Secretary 

19 shall include with such forms a fair summary of the 

20 rights and liabilities of an individual whose applica21 tion is approved (and whose contract is accepted) by 

22 the Secretary, including in the summary a clear ex23 planation of the damages to which the United States 

24 is entitled under subsection (l) in the case of the in25 dividual’s breach of contract. The Secretary shall 


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1 provide such individuals with sufficient information 

2 regarding the advantages and disadvantages of serv3 ice as a commissioned officer in the Regular or Re4 serve Corps of the Public Health Service or a civil5 ian employee of the Service to enable the individual 

6 to make a decision on an informed basis. 

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

8 contract form, and all other information furnished 

9 by the Secretary under this section shall be written 

10 in a manner calculated to be understood by the aver11 age individual applying to participate in the Loan 

12 Repayment Program. 

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

14 Secretary shall make such application forms, con15 tract forms, and other information available to indi16 viduals desiring to participate in the Loan Repay17 ment Program on a date sufficiently early to ensure 

18 that such individuals have adequate time to carefully 

19 review and evaluate such forms and information. 

20 ‘‘(d) PRIORITIES.— 

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

22 Secretary shall annually— 

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

24 Health Program or Urban Indian Organization 

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


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1 ‘‘(B) rank those positions in order of pri2 ority. 

3 ‘‘(2) APPROVALS.—Notwithstanding the pri4 ority determined under paragraph (1), the Secretary, 

5 in determining which applications under the Loan 

6 Repayment Program to approve (and which con7 tracts to accept), shall— 

8 ‘‘(A) give first priority to applications 

9 made by individual Indians; and 

10 ‘‘(B) after making determinations on all 

11 applications submitted by individual Indians as 

12 required under subparagraph (A), give priority 

13 to— 

14 ‘‘(i) individuals recruited through the 

15 efforts of an Indian Health Program or 

16 Urban Indian Organization; and 

17 ‘‘(ii) other individuals based on the 

18 priority rankings under paragraph (1). 

19 ‘‘(e) RECIPIENT CONTRACTS.— 

20 ‘‘(1) CONTRACT REQUIRED.—An individual be21 comes a participant in the Loan Repayment Pro22 gram only upon the Secretary and the individual en23 tering into a written contract described in paragraph 

24 (2). 


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

2 contract referred to in this section between the Sec3 retary and an individual shall contain— 

4 ‘‘(A) an agreement under which— 

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

6 Secretary agrees— 

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

8 individual in accordance with the pro9 visions of this section; and 

10 ‘‘(II) to accept (subject to the 

11 availability of appropriated funds for 

12 carrying out this section) the indi13 vidual into the Service or place the in14 dividual with a Tribal Health Pro15 gram or Urban Indian Organization 

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

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

18 individual agrees— 

19 ‘‘(I) to accept loan payments on 

20 behalf of the individual; 

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

22 described in subsection (b)(1)— 

23 ‘‘(aa) to maintain enrollment 

24 in a course of study or training 

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


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1 until the individual completes the 

2 course of study or training; and 

3 ‘‘(bb) while enrolled in such 

4 course of study or training, to 

5 maintain an acceptable level of 

6 academic standing (as deter7 mined under regulations of the 

8 Secretary by the educational in9 stitution offering such course of 

10 study or training); and 

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

12 (hereinafter in this section referred to 

13 as the ‘period of obligated service’) 

14 equal to 2 years or such longer period 

15 as the individual may agree to serve 

16 in the full-time clinical practice of 

17 such individual’s profession in an In18 dian Health Program or Urban In19 dian Organization to which the indi20 vidual may be assigned by the Sec21 retary; 

22 ‘‘(B) a provision permitting the Secretary 

23 to extend for such longer additional periods, as 

24 the individual may agree to, the period of obliVerDate Aug 31 2005 02:12 Dec 13, 2006 Jkt 059200 PO 00000 Frm 00049 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 gated service agreed to by the individual under 

2 subparagraph (A)(ii)(III); 

3 ‘‘(C) a provision that any financial obliga4 tion of the United States arising out of a con5 tract entered into under this section and any 

6 obligation of the individual which is conditioned 

7 thereon is contingent upon funds being appro8 priated for loan repayments under this section; 

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

10 the United States is entitled under subsection 

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

12 and 

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

14 and liabilities of the Secretary and of the indi15 vidual, not inconsistent with this section. 

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

17 The Secretary shall provide written notice to an individual 

18 within 21 days on— 

19 ‘‘(1) the Secretary’s approving, under sub20 section (e)(1), of the individual’s participation in the 

21 Loan Repayment Program, including extensions re22 sulting in an aggregate period of obligated service in 

23 excess of 4 years; or 

24 ‘‘(2) the Secretary’s disapproving an individ25 ual’s participation in such Program. 


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1 ‘‘(g) PAYMENTS.— 

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

3 for an individual under a written contract under the 

4 Loan Repayment Program shall consist of payment, 

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

6 individual of the principal, interest, and related ex7 penses on government and commercial loans received 

8 by the individual regarding the undergraduate or 

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

10 loans were made for— 

11 ‘‘(A) tuition expenses; 

12 ‘‘(B) all other reasonable educational ex13 penses, including fees, books, and laboratory ex14 penses, incurred by the individual; and 

15 ‘‘(C) reasonable living expenses as deter16 mined by the Secretary. 

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

18 service that an individual contracts to serve under 

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

20 or an amount equal to the amount specified in sec21 tion 338B(g)(2)(A) of the Public Health Service 

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

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

24 determination of the amount to pay for a year of 

25 such service by an individual, the Secretary shall 


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•S 4122 IS

1 consider the extent to which each such determina2 tion— 

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

4 maximize the number of contracts that can be 

5 provided under the Loan Repayment Program 

6 from the amounts appropriated for such con7 tracts; 

8 ‘‘(B) provides an incentive to serve in In9 dian Health Programs and Urban Indian Orga10 nizations with the greatest shortages of health 

11 professionals; and 

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

13 the health professional involved remaining in an 

14 Indian Health Program or Urban Indian Orga15 nization with such a health professional short16 age, and continuing to provide primary health 

17 services, after the completion of the period of 

18 obligated service under the Loan Repayment 

19 Program. 

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

21 Secretary for the making of loan repayments in ac22 cordance with this subsection shall provide that any 

23 repayments for a year of obligated service shall be 

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

25 which the individual completes such year of service. 


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

2 For the purpose of providing reimbursements for tax 

3 liability resulting from a payment under paragraph 

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

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

6 make payments to the individual in an amount 

7 equal to not less than 20 percent and not more 

8 than 39 percent of the total amount of loan re9 payments made for the taxable year involved; 

10 and 

11 ‘‘(B) may make such additional payments 

12 as the Secretary determines to be appropriate 

13 with respect to such purpose. 

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

15 may enter into an agreement with the holder of any 

16 loan for which payments are made under the Loan 

17 Repayment Program to establish a schedule for the 

18 making of such payments. 

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

20 other provision of law, individuals who have entered into 

21 written contracts with the Secretary under this section 

22 shall not be counted against any employment ceiling af23 fecting the Department while those individuals are under24 going academic training. 


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1 ‘‘(i) RECRUITMENT.—The Secretary shall conduct re2 cruiting programs for the Loan Repayment Program and 

3 other manpower programs of the Service at educational 

4 institutions training health professionals or specialists 

5 identified in subsection (a). 

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

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

8 to individuals during their period of obligated service 

9 under the Loan Repayment Program. 

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

11 in assigning individuals to serve in Indian Health Pro12 grams or Urban Indian Organizations pursuant to con13 tracts entered into under this section, shall— 

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

15 Health Programs and Urban Indian Organizations 

16 receive consideration on an equal basis with pro17 grams that are administered directly by the Service; 

18 and 

19 ‘‘(2) give priority to assigning individuals to In20 dian Health Programs and Urban Indian Organiza21 tions that have a need for health professionals to 

22 provide health care services as a result of individuals 

23 having breached contracts entered into under this 

24 section. 

25 ‘‘(l) BREACH OF CONTRACT.— 


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

2 has entered into a written contract with the Sec3 retary under this section and has not received a 

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

5 of any service obligation arising under such contract, 

6 to the United States for the amount which has been 

7 paid on such individual’s behalf under the contract 

8 if that individual— 

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

10 course of study and— 

11 ‘‘(i) fails to maintain an acceptable 

12 level of academic standing in the edu13 cational institution in which he or she is 

14 enrolled (such level determined by the edu15 cational institution under regulations of 

16 the Secretary); 

17 ‘‘(ii) voluntarily terminates such en18 rollment; or 

19 ‘‘(iii) is dismissed from such edu20 cational institution before completion of 

21 such course of study; or 

22 ‘‘(B) is enrolled in a graduate training pro23 gram and fails to complete such training pro24 gram. 


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1 ‘‘(2) OTHER BREACHES; FORMULAFOR

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

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

4 written contract under this section by failing either 

5 to begin, or complete, such individual’s period of ob6 ligated service in accordance with subsection (e)(2), 

7 the United States shall be entitled to recover from 

8 such individual an amount to be determined in ac9 cordance with the following formula: A=3Z(t¥s/t) 

10 in which— 

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

12 is entitled to recover; 

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

14 under this section to, or on behalf of, the indi15 vidual and the interest on such amounts which 

16 would be payable if, at the time the amounts 

17 were paid, they were loans bearing interest at 

18 the maximum legal prevailing rate, as deter19 mined by the Secretary of the Treasury; 

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

21 the individual’s period of obligated service in 

22 accordance with subsection (f); and 

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

24 period served by such individual in accordance 

25 with this section. 


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

2 Amounts not paid within such period shall be sub3 ject to collection through deductions in Medicare 

4 payments pursuant to section 1892 of the Social Se5 curity Act. 

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

7 amount of damages which the United States is enti8 tled to recover under this subsection shall be paid to 

9 the United States within the 1-year period beginning 

10 on the date of the breach or such longer period be11 ginning on such date as shall be specified by the 

12 Secretary. 

13 ‘‘(5) RECOVERY OF DELINQUENCY.— 

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

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

16 the Secretary shall, for the purpose of recov17 ering such damages— 

18 ‘‘(i) use collection agencies contracted 

19 with by the Administrator of General Serv20 ices; or 

21 ‘‘(ii) enter into contracts for the re22 covery of such damages with collection 

23 agencies selected by the Secretary. 

24 ‘‘(B) REPORT.—Each contract for recov25 ering damages pursuant to this subsection shall 


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1 provide that the contractor will, not less than 

2 once each 6 months, submit to the Secretary a 

3 status report on the success of the contractor in 

4 collecting such damages. Section 3718 of title 

5 31, United States Code, shall apply to any such 

6 contract to the extent not inconsistent with this 

7 subsection. 

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

9 ‘‘(1) IN GENERAL.—The Secretary shall by reg10 ulation provide for the partial or total waiver or sus11 pension of any obligation of service or payment by 

12 an individual under the Loan Repayment Program 

13 whenever compliance by the individual is impossible 

14 or would involve extreme hardship to the individual 

15 and if enforcement of such obligation with respect to 

16 any individual would be unconscionable. 

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

18 of an individual under the Loan Repayment Pro19 gram for service or payment of damages shall be 

20 canceled upon the death of the individual. 

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

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

23 States to recover amounts under this section in any 

24 case of extreme hardship or other good cause shown, 

25 as determined by the Secretary. 


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1 ‘‘(4) BANKRUPTCY.—Any obligation of an indi2 vidual under the Loan Repayment Program for pay3 ment of damages may be released by a discharge in 

4 bankruptcy under title 11 of the United States Code 

5 only if such discharge is granted after the expiration 

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

7 payment of such damages is required, and only if 

8 the bankruptcy court finds that nondischarge of the 

9 obligation would be unconscionable. 

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

11 President, for inclusion in the report required to be sub12 mitted to Congress under section 801, a report concerning 

13 the previous fiscal year which sets forth by Service Area 

14 the following: 

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

16 maintained by Indian Health Programs and Urban 

17 Indian Organizations for which recruitment or reten18 tion is difficult. 

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

20 applications filed with respect to each type of health 

21 profession. 

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

24 health profession. 


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

2 this section, in total and by health profession. 

3 ‘‘(5) The number of scholarships that are pro4 vided under sections 104 and 106 with respect to 

5 each health profession. 

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

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

8 profession. 

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

10 that will be needed by Indian Health Programs and 

11 Urban Indian Organizations, by location and profes12 sion, during the 3 fiscal years beginning after the 

13 date the report is filed. 

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

15 to fill the health professional positions maintained 

16 by Indian Health Programs or Urban Indian Orga17 nizations for which recruitment or retention is dif18 ficult. 

19 ‘‘SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOV20 ERY FUND. 

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

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

23 Indian Health Scholarship and Loan Repayment Recovery 

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

25 The LRRF shall consist of such amounts as may be colVerDate Aug 31 2005 02:12 Dec 13, 2006 Jkt 059200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 lected from individuals under section 104(d), section 

2 106(e), and section 110(l) for breach of contract, such 

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

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

5 appropriated, or earned relative to the LRRF shall remain 

6 available until expended. 

7 ‘‘(b) USE OF FUNDS.— 

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

9 may be expended by the Secretary, acting through 

10 the Service, to make payments to an Indian Health 

11 Program— 

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

13 section 104 and 106 or a loan repayment pro14 gram participant under section 110 has been 

15 assigned to meet the obligated service require16 ments pursuant to such sections; and 

17 ‘‘(B) that has a need for a health profes18 sional to provide health care services as a result 

19 of such recipient or participant having breached 

20 the contract entered into under section 104, 

21 106, or section 110. 

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

23 Health Program receiving payments pursuant to 

24 paragraph (1) may expend the payments to provide 

25 scholarships or recruit and employ, directly or by 


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•S 4122 IS

1 contract, health professionals to provide health care 

2 services. 

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

4 Treasury shall invest such amounts of the LRRF as the 

5 Secretary of Health and Human Services determines are 

6 not required to meet current withdrawals from the LRRF. 

7 Such investments may be made only in interest bearing 

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

9 obligations may be acquired on original issue at the issue 

10 price, or by purchase of outstanding obligations at the 

11 market price. 

12 ‘‘(d) SALE OF OBLIGATIONS.—Any obligation ac13 quired by the LRRF may be sold by the Secretary of the 

14 Treasury at the market price. 

15 ‘‘SEC. 112. RECRUITMENT ACTIVITIES. 

16 ‘‘(a) REIMBURSEMENT FOR TRAVEL.—The Sec17 retary, acting through the Service, may reimburse health 

18 professionals seeking positions with Indian Health Pro19 grams or Urban Indian Organizations, including individ20 uals considering entering into a contract under section 

21 110 and their spouses, for actual and reasonable expenses 

22 incurred in traveling to and from their places of residence 

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

24 of evaluating such area with respect to such assignment. 


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

2 acting through the Service, shall assign 1 individual in 

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

4 recruitment activities. 

5 ‘‘SEC. 113. INDIAN RECRUITMENT AND RETENTION PRO6 GRAM. 

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

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

9 demonstration projects for a period not to exceed 3 years 

10 to enable Tribal Health Programs and Urban Indian Or11 ganizations to recruit, place, and retain health profes12 sionals to meet their staffing needs. 

13 ‘‘(b) ELIGIBLE ENTITIES; APPLICATION.—Any Trib14 al Health Program or Urban Indian Organization may 

15 submit an application for funding of a project pursuant 

16 to this section. 

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

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

19 acting through the Service, shall establish a demonstration 

20 project to enable health professionals who have worked in 

21 an Indian Health Program or Urban Indian Organization 

22 for a substantial period of time to pursue advanced train23 ing or research areas of study for which the Secretary de24 termines a need exists. 


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1 ‘‘(b) SERVICE OBLIGATION.—An individual who par2 ticipates in a program under subsection (a), where the 

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

4 obligation to serve in an Indian Health Program or Urban 

5 Indian Organization for a period of obligated service equal 

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

7 participates in such program. In the event that the indi8 vidual fails to complete such obligated service, the indi9 vidual shall be liable to the United States for the period 

10 of service remaining. In such event, with respect to indi11 viduals entering the program after the date of enactment 

12 of the Indian Health Care Improvement Act Amendments 

13 of 2006, the United States shall be entitled to recover 

14 from such individual an amount to be determined in ac15 cordance with the formula specified in subsection (l) of 

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

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

18 Health professionals from Tribal Health Programs and 

19 Urban Indian Organizations shall be given an equal oppor20 tunity to participate in the program under subsection (a). 

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

22 NURSING PROGRAM. 

23 ‘‘(a) GRANTS AUTHORIZED.—For the purpose of in24 creasing the number of nurses, nurse midwives, and nurse 

25 practitioners who deliver health care services to Indians, 


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1 the Secretary, acting through the Service, shall provide 

2 grants to the following: 

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

4 ‘‘(2) Tribal colleges or universities. 

5 ‘‘(3) Nurse midwife programs and advanced 

6 practice nurse programs that are provided by any 

7 tribal college or university accredited nursing pro8 gram, or in the absence of such, any other public or 

9 private institutions. 

10 ‘‘(b) USE OF GRANTS.—Grants provided under sub11 section (a) may be used for 1 or more of the following: 

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

13 train individuals to be nurses, nurse midwives, or 

14 advanced practice nurses. 

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

16 in such programs that may pay the tuition charged 

17 for such program and other expenses incurred in 

18 connection with such program, including books, fees, 

19 room and board, and stipends for living expenses. 

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

21 nurses, nurse midwives, and advanced practice 

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

23 services to Indians. 

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

25 skills of, and provides continuing education to, 


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1 nurses, nurse midwives, and advanced practice 

2 nurses. 

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

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

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

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

7 Secretary may require to establish the connection between 

8 the program of the applicant and a health care facility 

9 that primarily serves Indians. 

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

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

12 extend a preference to the following: 

13 ‘‘(1) Programs that provide a preference to In14 dians. 

15 ‘‘(2) Programs that train nurse midwives or ad16 vanced practice nurses. 

17 ‘‘(3) Programs that are interdisciplinary. 

18 ‘‘(4) Programs that are conducted in coopera19 tion with a program for gifted and talented Indian 

20 students. 

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

22 universities. 

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

24 Secretary shall provide 1 of the grants authorized under 

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


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•S 4122 IS

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

2 N. Burdick American Indians Into Nursing Program’. 

3 Such program shall, to the maximum extent feasible, co4 ordinate with the Quentin N. Burdick Indian Health Pro5 grams established under section 117(b) and the Quentin 

6 N. Burdick American Indians Into Psychology Program 

7 established under section 105(b). 

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

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

11 be met by each individual who receives training or assist12 ance described in paragraph (1) or (2) of subsection (b) 

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

14 Such obligation shall be met by service— 

15 ‘‘(1) in the Service; 

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

17 Organization conducted under the Indian Self-Deter18 mination and Education Assistance Act (25 U.S.C. 

19 450 et seq.) (including programs under agreements 

20 with the Bureau of Indian Affairs); 

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

22 Act; 

23 ‘‘(4) in the private practice of nursing if, as de24 termined by the Secretary, in accordance with guide25 lines promulgated by the Secretary, such practice is 


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1 situated in a physician or other health shortage area 

2 and addresses the health care needs of a substantial 

3 number of Indians; or 

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

5 university nursing program (or a related health pro6 fession program) if, as determined by the Secretary, 

7 health services provided to Indians would not de8 crease. 

9 ‘‘SEC. 116. TRIBAL CULTURAL ORIENTATION. 

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

11 Secretary, acting through the Service, shall require that 

12 appropriate employees of the Service who serve Indian 

13 Tribes in each Service Area receive educational instruction 

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

15 relationship to the Service. 

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

17 Secretary shall establish a program which shall, to the ex18 tent feasible— 

19 ‘‘(1) be developed in consultation with the af20 fected Indian Tribes, Tribal Organizations, and 

21 Urban Indian Organizations; 

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

23 universities; 

24 ‘‘(3) include instruction in American Indian 

25 studies; and 


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•S 4122 IS

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

2 health care practices of the Indian Tribes in the 

3 Service Area. 

4 ‘‘SEC. 117. INMED PROGRAM. 

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

6 through the Service, is authorized to provide grants to col7 leges and universities for the purpose of maintaining and 

8 expanding the Indian health careers recruitment program 

9 known as the ‘Indians Into Medicine Program’ (herein10 after in this section referred to as ‘INMED’) as a means 

11 of encouraging Indians to enter the health professions. 

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

13 shall provide 1 of the grants authorized under subsection 

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

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

16 Indian Health Programs’, unless the Secretary makes a 

17 determination, based upon program reviews, that the pro18 gram is not meeting the purposes of this section. Such 

19 program shall, to the maximum extent feasible, coordinate 

20 with the Quentin N. Burdick American Indians Into Psy21 chology Program established under section 105(b) and the 

22 Quentin N. Burdick American Indians Into Nursing Pro23 gram established under section 115. 


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

2 Act, shall develop regulations to govern grants pursuant 

3 to this section. 

4 ‘‘(d) REQUIREMENTS.—Applicants for grants pro5 vided under this section shall agree to provide a program 

6 which— 

7 ‘‘(1) provides outreach and recruitment for 

8 health professions to Indian communities including 

9 elementary and secondary schools and community 

10 colleges located on reservations which will be served 

11 by the program; 

12 ‘‘(2) incorporates a program advisory board 

13 comprised of representatives from the Indian Tribes 

14 and Indian communities which will be served by the 

15 program; 

16 ‘‘(3) provides summer preparatory programs for 

17 Indian students who need enrichment in the subjects 

18 of math and science in order to pursue training in 

19 the health professions; 

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

21 to students who are enrolled in a health career pro22 gram of study at the respective college or university; 

23 and 

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

25 qualified Indians in the program. 


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

2 COLLEGES. 

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

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

5 through the Service, shall award grants to accredited 

6 and accessible community colleges for the purpose of 

7 assisting such community colleges in the establish8 ment of programs which provide education in a 

9 health profession leading to a degree or diploma in 

10 a health profession for individuals who desire to 

11 practice such profession on or near a reservation or 

12 in an Indian Health Program. 

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

14 grant awarded to a community college under para15 graph (1) for the first year in which such a grant 

16 is provided to the community college shall not exceed 

17 $250,000. 

18 ‘‘(b) GRANTS FOR MAINTENANCE AND RECRUIT19 ING.— 

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

21 through the Service, shall award grants to accredited 

22 and accessible community colleges that have estab23 lished a program described in subsection (a)(1) for 

24 the purpose of maintaining the program and recruit25 ing students for the program. 


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

2 made under this section to a community college 

3 which— 

4 ‘‘(A) is accredited; 

5 ‘‘(B) has a relationship with a hospital fa6 cility, Service facility, or hospital that could 

7 provide training of nurses or health profes8 sionals; 

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

10 an accredited college or university medical 

11 school, the terms of which— 

12 ‘‘(i) provide a program that enhances 

13 the transition and recruitment of students 

14 into advanced baccalaureate or graduate 

15 programs that train health professionals; 

16 and 

17 ‘‘(ii) stipulate certifications necessary 

18 to approve internship and field placement 

19 opportunities at Indian Health Programs; 

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

21 appropriate certifications; 

22 ‘‘(E) is capable of obtaining State or re23 gional accreditation of the program described in 

24 subsection (a)(1); and 


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1 ‘‘(F) agrees to provide for Indian pref2 erence for applicants for programs under this 

3 section. 

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

5 encourage community colleges described in subsection 

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

7 subsection (a)(1) by— 

8 ‘‘(1) entering into agreements with such col9 leges for the provision of qualified personnel of the 

10 Service to teach courses of study in such programs; 

11 and 

12 ‘‘(2) providing technical assistance and support 

13 to such colleges. 

14 ‘‘(d) ADVANCED TRAINING.— 

15 ‘‘(1) REQUIRED.—Any program receiving as16 sistance under this section that is conducted with re17 spect to a health profession shall also offer courses 

18 of study which provide advanced training for any 

19 health professional who— 

20 ‘‘(A) has already received a degree or di21 ploma in such health profession; and 

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

23 reservation or for an Indian Health Program. 

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

25 Such courses of study may be offered in conjunction 


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1 with the college or university with which the commu2 nity college has entered into the agreement required 

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

4 ‘‘(e) PRIORITY.—Where the requirements of sub5 section (b) are met, grant award priority shall be provided 

6 to tribal colleges and universities in Service Areas where 

7 they exist. 

8 ‘‘SEC. 119. RETENTION BONUS. 

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

10 a retention bonus to any health professional employed by, 

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

12 or Urban Indian Organization either as a civilian employee 

13 or as a commissioned officer in the Regular or Reserve 

14 Corps of the Public Health Service who— 

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

16 for which recruitment or retention of personnel is 

17 difficult; 

18 ‘‘(2) the Secretary determines is needed by In19 dian Health Programs and Urban Indian Organiza20 tions; 

21 ‘‘(3) has— 

22 ‘‘(A) completed 2 years of employment 

23 with an Indian Health Program or Urban In24 dian Organization; or 


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1 ‘‘(B) completed any service obligations in2 curred as a requirement of— 

3 ‘‘(i) any Federal scholarship program; 

4 or 

5 ‘‘(ii) any Federal education loan re6 payment program; and 

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

8 Health Program or Urban Indian Organization for 

9 continued employment for a period of not less than 

10 1 year. 

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

12 the retention bonus which shall provide for a higher an13 nual rate for multiyear agreements than for single year 

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

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

16 annum. 

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

18 health professional failing to complete the agreed upon 

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

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

21 Government the full amount of the retention bonus for the 

22 period covered by the agreement, plus interest as deter23 mined by the Secretary in accordance with section 

24 110(l)(2)(B). 


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

2 may pay a retention bonus to any health professional em3 ployed by a Tribal Health Program if such health profes4 sional is serving in a position which the Secretary deter5 mines is— 

6 ‘‘(1) a position for which recruitment or reten7 tion is difficult; and 

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

9 to Indians. 

10 ‘‘SEC. 120. NURSING RESIDENCY PROGRAM. 

11 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Sec12 retary, acting through the Service, shall establish a pro13 gram to enable Indians who are licensed practical nurses, 

14 licensed vocational nurses, and registered nurses who are 

15 working in an Indian Health Program or Urban Indian 

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

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

18 shall include a combination of education and work study 

19 in an Indian Health Program or Urban Indian Organiza20 tion leading to an associate or bachelor’s degree (in the 

21 case of a licensed practical nurse or licensed vocational 

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

23 nurse), or advanced degrees or certifications in nursing 

24 and public health. 


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1 ‘‘(b) SERVICE OBLIGATION.—An individual who par2 ticipates in a program under subsection (a), where the 

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

4 obligation to serve in an Indian Health Program or Urban 

5 Indian Organization for a period of obligated service equal 

6 to 1 year for every year that nonprofessional employee (li7 censed practical nurses, licensed vocational nurses, nurs8 ing assistants, and various health care technicals), or 2 

9 years for every year that professional nurse (associate de10 gree and bachelor-prepared registered nurses), partici11 pates in such program. In the event that the individual 

12 fails to complete such obligated service, the United States 

13 shall be entitled to recover from such individual an amount 

14 determined in accordance with the formula specified in 

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

16 in such subsection. 

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

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

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

20 (commonly known as the ‘Snyder Act’), the Secretary, act21 ing through the Service, shall develop and operate a Com22 munity Health Aide Program in Alaska under which the 

23 Service— 

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

25 as health aides or community health practitioners; 


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

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

5 ‘‘(3) provides for the establishment of tele6 conferencing capacity in health clinics located in or 

7 near such villages for use by community health aides 

8 or community health practitioners. 

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

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

13 provide a high standard of training to community 

14 health aides and community health practitioners to 

15 ensure that such aides and practitioners provide 

16 quality health care, health promotion, and disease 

17 prevention services to the villages served by the Pro18 gram; 

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

20 a curriculum that— 

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

22 health care with supervised practical experience 

23 in the provision of health care; 

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1 gency care, health promotion, disease preven2 tion, and the efficient and effective manage3 ment of clinic pharmacies, supplies, equipment, 

4 and facilities; and 

5 ‘‘(C) promotes the achievement of the 

6 health status objectives specified in section 

7 3(2); 

8 ‘‘(3) establish and maintain a Community 

9 Health Aide Certification Board to certify as com10 munity health aides or community health practi11 tioners individuals who have successfully completed 

12 the training described in paragraph (1) or can dem13 onstrate equivalent experience; 

14 ‘‘(4) develop and maintain a system which iden15 tifies the needs of community health aides and com16 munity health practitioners for continuing education 

17 in the provision of health care, including the areas 

18 described in paragraph (2)(B), and develop pro19 grams that meet the needs for such continuing edu20 cation; 

21 ‘‘(5) develop and maintain a system that pro22 vides close supervision of community health aides 

23 and community health practitioners; 

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

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1 titioners is reviewed and evaluated to assure the pro2 vision of quality health care, health promotion, and 

3 disease prevention services; and 

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

5 pulpotomies on deciduous teeth) or extraction of 

6 adult teeth can be performed by a dental health aide 

7 therapist only after consultation with a licensed den8 tist who determines that the procedure is a medical 

9 emergency that cannot be resolved with palliative 

10 treatment, and further that dental health aide thera11 pists are strictly prohibited from performing all 

12 other oral or jaw surgeries, provided that uncompli13 cated extractions shall not be considered oral sur14 gery under this section. 

15 ‘‘(c) PROGRAM REVIEW.— 

16 ‘‘(1) NEUTRAL PANEL.— 

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

18 acting through the Service, shall establish a 

19 neutral panel to carry out the study under 

20 paragraph (2). 

21 ‘‘(B) MEMBERSHIP.—Members of the neu22 tral panel shall be appointed by the Secretary 

23 from among clinicians, economists, community 

24 practitioners, oral epidemiologists, and Alaska 

25 Natives. 


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1 ‘‘(2) STUDY.— 

2 ‘‘(A) IN GENERAL.—The neutral panel es3 tablished under paragraph (1) shall conduct a 

4 study of the dental health aide therapist serv5 ices provided by the Community Health Aide 

6 Program under this section to ensure that the 

7 quality of care provided through those services 

8 is adequate and appropriate. 

9 ‘‘(B) PARAMETERS OF STUDY.—The Sec10 retary, in consultation with interested parties, 

11 including professional dental organizations, 

12 shall develop the parameters of the study. 

13 ‘‘(C) INCLUSIONS.—The study shall in14 clude a determination by the neutral panel with 

15 respect to— 

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

17 aide therapist services under this section to 

18 address the dental care needs of Alaska 

19 Natives; 

20 ‘‘(ii) the quality of care provided 

21 through those services, including any train22 ing, improvement, or additional oversight 

23 required to improve the quality of care; 

24 and 


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1 ‘‘(iii) whether safer and less costly al2 ternatives to the dental health aide thera3 pist services exist. 

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

5 study under this paragraph, the neutral panel 

6 shall consult with Alaska Tribal Organizations 

7 with respect to the adequacy and accuracy of 

8 the study. 

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

10 to the Secretary, the Committee on Indian Affairs of 

11 the Senate, and the Committee on Resources of the 

12 House of Representatives a report describing the re13 sults of the study under paragraph (2), including a 

14 description of— 

15 ‘‘(A) any determination of the neutral 

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

17 ‘‘(B) any comments received from an Alas18 ka Tribal Organization under paragraph 

19 (2)(D). 

20 ‘‘(d) NATIONALIZATION OF PROGRAM.— 

21 ‘‘(1) IN GENERAL.—Except as provided in para22 graph (2), the Secretary, acting through the Service, 

23 may establish a national Community Health Aide 

24 Program in accordance with the program under this 


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1 section, as the Secretary determines to be appro2 priate. 

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

4 Health Aide Program under paragraph (1) shall not 

5 include dental health aide therapist services. 

6 ‘‘(3) REQUIREMENT.—In establishing a na7 tional program under paragraph (1), the Secretary 

8 shall not reduce the amount of funds provided for 

9 the Community Health Aide Program described in 

10 subsections (a) and (b). 

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

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

13 contract or otherwise, provide training for Indians in the 

14 administration and planning of Tribal Health Programs. 

15 ‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE 

16 DEMONSTRATION PROGRAMS. 

17 ‘‘(a) DEMONSTRATION PROGRAMS AUTHORIZED.— 

18 The Secretary, acting through the Service, may fund dem19 onstration programs for Tribal Health Programs to ad20 dress the chronic shortages of health professionals. 

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

22 demonstration programs funded under subsection (a) shall 

23 be— 


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1 ‘‘(1) to provide direct clinical and practical ex2 perience at a Service Unit to health profession stu3 dents and residents from medical schools; 

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

5 Indians by assuring access to qualified health care 

6 professionals; and 

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

9 identifying all academic and scholarly resources of 

10 the region. 

11 ‘‘(c) ADVISORY BOARD.—The demonstration pro12 grams established pursuant to subsection (a) shall incor13 porate a program advisory board composed of representa14 tives from the Indian Tribes and Indian communities in 

15 the area which will be served by the program. 

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

17 ‘‘The Secretary shall not— 

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

19 Service Corps from an Indian Health Program or 

20 Urban Indian Organization; or 

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

22 member, unless the Secretary, acting through the 

23 Service, has ensured that the Indians receiving serv24 ices from such member will experience no reduction 

25 in services. 


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1 ‘‘SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL 

2 CURRICULA DEMONSTRATION PROGRAMS. 

3 ‘‘(a) CONTRACTS AND GRANTS.—The Secretary, act4 ing through the Service, may enter into contracts with, 

5 or make grants to, accredited tribal colleges and univer6 sities and eligible accredited and accessible community col7 leges to establish demonstration programs to develop edu8 cational curricula for substance abuse counseling. 

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

10 section shall be used only for developing and providing 

11 educational curriculum for substance abuse counseling (in12 cluding paying salaries for instructors). Such curricula 

13 may be provided through satellite campus programs. 

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

15 contract entered into or a grant provided under this sec16 tion shall be for a period of 3 years. Such contract or 

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

18 upon the approval of the Secretary. 

19 ‘‘(d) CRITERIAFOR REVIEW AND APPROVAL OF AP20 PLICATIONS.—Not later than 180 days after the date of 

21 enactment of the Indian Health Care Improvement Act 

22 Amendments of 2006, the Secretary, after consultation 

23 with Indian Tribes and administrators of tribal colleges 

24 and universities and eligible accredited and accessible com25 munity colleges, shall develop and issue criteria for the 

26 review and approval of applications for funding (including 


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1 applications for renewals of funding) under this section. 

2 Such criteria shall ensure that demonstration programs 

3 established under this section promote the development of 

4 the capacity of such entities to educate substance abuse 

5 counselors. 

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

7 technical and other assistance as may be necessary to en8 able grant recipients to comply with the provisions of this 

9 section. 

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

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

12 is required to be submitted under section 801 for that fis13 cal year, a report on the findings and conclusions derived 

14 from the demonstration programs conducted under this 

15 section during that fiscal year. 

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

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

18 following: 

19 ‘‘(1) Classroom education. 

20 ‘‘(2) Clinical work experience. 

21 ‘‘(3) Continuing education workshops. 

22 ‘‘SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMU23 NITY EDUCATION PROGRAMS. 

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

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1 tion with Indian Tribes and Tribal Organizations, shall 

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

3 positions specified in subsection (b) whose qualifications 

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

5 prevention, education, referral, or treatment of mental ill6 ness, or dysfunctional and self destructive behavior. 

7 ‘‘(b) POSITIONS.—The positions referred to in sub8 section (a) are— 

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

10 Affairs, including existing positions, in the fields 

11 of— 

12 ‘‘(A) elementary and secondary education; 

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

14 welfare; 

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

16 and 

17 ‘‘(D) alcohol and substance abuse; 

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

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

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

21 by Indian Tribes, Tribal Organizations (without re22 gard to the funding source), and Urban Indian Or23 ganizations. 

24 ‘‘(c) TRAINING CRITERIA.— 


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

2 shall provide training criteria appropriate to each 

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

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

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

6 such position. With respect to any such individual in 

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

8 the respective Secretaries shall provide appropriate 

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

10 Tribal Organization, or Urban Indian Organization 

11 for training of appropriate individuals. In the case of 

12 positions funded under a contract or compact under 

13 the Indian Self-Determination and Education Assist14 ance Act (25 U.S.C. 450 et seq.), the appropriate 

15 Secretary shall ensure that such training costs are 

16 included in the contract or compact, as the Sec17 retary determines necessary. 

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

19 Position specific training criteria shall be culturally 

20 relevant to Indians and Indian Tribes and shall en21 sure that appropriate information regarding tradi22 tional health care practices is provided. 

23 ‘‘(d) COMMUNITY EDUCATION ON MENTAL ILL24 NESS.—The Service shall develop and implement, on re25 quest of an Indian Tribe, Tribal Organization, or Urban 


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•S 4122 IS

1 Indian Organization, or assist the Indian Tribe, Tribal Or2 ganization, or Urban Indian Organization to develop and 

3 implement, a program of community education on mental 

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

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

6 Urban Indian Organization, provide technical assistance 

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

8 Organization to obtain and develop community edu9 cational materials on the identification, prevention, refer10 ral, and treatment of mental illness and dysfunctional and 

11 self-destructive behavior. 

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

13 of enactment of the Indian Health Care Improvement Act 

14 Amendments of 2006, the Secretary shall develop a plan 

15 under which the Service will increase the health care staff 

16 providing behavioral health services by at least 500 posi17 tions within 5 years after the date of enactment of this 

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

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

20 under this subsection shall be implemented under the Act 

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

22 as the ‘Snyder Act’). 


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1 ‘‘SEC. 127. 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 2016 to carry out this title. 

5 ‘‘TITLE II—HEALTH SERVICES 

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

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

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

9 under the authority of the Indian Self-Determination and 

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

11 are appropriated under the authority of this section, for 

12 the purposes of— 

13 ‘‘(1) eliminating the deficiencies in health sta14 tus and health resources of all Indian Tribes; 

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

16 health care services to Indians; 

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

18 efficient and equitable manner, including the use of 

19 telehealth and telemedicine when appropriate; 

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

21 direct care and contract health service programs; 

22 and 

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

24 meet the following health service responsibilities with 

25 respect to those Indian Tribes with the highest levels 


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1 of health status deficiencies and resource defi2 ciencies: 

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

4 outpatient care (including audiology, clinical 

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

6 and tertiary care, and long-term care. 

7 ‘‘(B) Preventive health, including mam8 mography and other cancer screening in accord9 ance with section 207. 

10 ‘‘(C) Dental care. 

11 ‘‘(D) Mental health, including community 

12 mental health services, inpatient mental health 

13 services, dormitory mental health services, 

14 therapeutic and residential treatment centers, 

15 and training of traditional health care practi16 tioners. 

17 ‘‘(E) Emergency medical services. 

18 ‘‘(F) Treatment and control of, and reha19 bilitative care related to, alcoholism and drug 

20 abuse (including fetal alcohol syndrome) among 

21 Indians. 

22 ‘‘(G) Injury prevention programs. 

23 ‘‘(H) Home health care. 

24 ‘‘(I) Community health representatives. 

25 ‘‘(J) Maintenance and improvement. 


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1 ‘‘(b) NO OFFSET OR LIMITATION.—Any funds appro2 priated under the authority of this section shall not be 

3 used to offset or limit any other appropriations made to 

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

5 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

6 or any other provision of law. 

7 ‘‘(c) ALLOCATION; USE.— 

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

9 the authority of this section shall be allocated to 

10 Service Units, Indian Tribes, or Tribal Organiza11 tions. The funds allocated to each Indian Tribe, 

12 Tribal Organization, or Service Unit under this 

13 paragraph shall be used by the Indian Tribe, Tribal 

14 Organization, or Service Unit under this paragraph 

15 to improve the health status and reduce the resource 

16 deficiency of each Indian Tribe served by such Serv17 ice Unit, Indian Tribe, or Tribal Organization. 

18 ‘‘(2) APPORTIONMENT OF ALLOCATED

19 FUNDS.—The apportionment of funds allocated to a 

20 Service Unit, Indian Tribe, or Tribal Organization 

21 under paragraph (1) among the health service re22 sponsibilities described in subsection (a)(5) shall be 

23 determined by the Service in consultation with, and 

24 with the active participation of, the affected Indian 

25 Tribes and Tribal Organizations. 


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1 ‘‘(d) PROVISIONS RELATING TO HEALTH STATUS

2 AND RESOURCE DEFICIENCIES.—For the purposes of this 

3 section, the following definitions apply: 

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

5 and resource deficiency’ means the extent to 

6 which— 

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

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

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

12 cost of providing health care services given local 

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

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

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

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

22 local governments. 

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

25 which allow any Indian Tribe or Tribal Organization 


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

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

7 authority of this section on an equal basis with programs 

8 that are administered directly by the Service. 

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

10 years after the date of enactment of the Indian Health 

11 Care Improvement Act Amendments of 2006, the Sec12 retary shall submit to Congress the current health status 

13 and resource deficiency report of the Service for each 

14 Service Unit, including newly recognized or acknowledged 

15 Indian Tribes. Such report shall set out— 

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

17 for determining Tribal health status and resource 

18 deficiencies, as well as the most recent application of 

19 that methodology; 

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

22 Service or a Tribal Health Program; 

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

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1 dian Tribes served by the Service or a Tribal Health 

2 Program; and 

3 ‘‘(4) an estimate of— 

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

5 appropriated under the authority of this Act, or 

6 any other Act, including the amount of any 

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

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

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

12 health services in each Service Unit or Indian 

13 Tribe or Tribal Organization; and 

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

15 Service resources made available to each Service 

16 Unit, Indian Tribe or Tribal Organization, and, 

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

19 services due to lack of resources. 

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

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


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

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

5 discourage the Service from undertaking additional efforts 

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

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

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

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

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

15 ‘‘(1) the amounts deposited under subsection 

16 (f); and 

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

18 this section. 

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

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

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


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

2 CHEF or its administration shall be subject to contract 

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

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

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

7 similar basis. 

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

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

13 provided under contract would qualify for payment 

14 from CHEF; 

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

17 from CHEF until its cost of treating any victim of 

18 such catastrophic illness or disaster has reached a 

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

21 ‘‘(A) the 2000 level of $19,000; and 

22 ‘‘(B) for any subsequent year, not less 

23 than the threshold cost of the previous year in24 creased by the percentage increase in the med25 ical care expenditure category of the consumer 


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1 price index for all urban consumers (United 

2 States city average) for the 12-month period 

3 ending with December of the previous year; 

4 ‘‘(3) establish a procedure for the reimburse5 ment of the portion of the costs that exceeds such 

6 threshold cost incurred by— 

7 ‘‘(A) Service Units; or 

8 ‘‘(B) whenever otherwise authorized by the 

9 Service, non-Service facilities or providers; 

10 ‘‘(4) establish a procedure for payment from 

11 CHEF in cases in which the exigencies of the med12 ical circumstances warrant treatment prior to the 

13 authorization of such treatment by the Service; and 

14 ‘‘(5) establish a procedure that will ensure that 

15 no payment shall be made from CHEF to any pro16 vider of treatment to the extent that such provider 

17 is eligible to receive payment for the treatment from 

18 any other Federal, State, local, or private source of 

19 reimbursement for which the patient is eligible. 

20 ‘‘(e) NO OFFSET OR LIMITATION.—Amounts appro21 priated to CHEF under this section shall not be used to 

22 offset or limit appropriations made to the Service under 

23 the authority of the Act of November 2, 1921 (25 U.S.C. 

24 13) (commonly known as the ‘Snyder Act’), or any other 

25 law. 


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1 ‘‘(f) DEPOSIT OF REIMBURSEMENT FUNDS.—There 

2 shall be deposited into CHEF all reimbursements to which 

3 the Service is entitled from any Federal, State, local, or 

4 private source (including third party insurance) by reason 

5 of treatment rendered to any victim of a disaster or cata6 strophic illness the cost of which was paid from CHEF. 

7 ‘‘SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION 

8 SERVICES. 

9 ‘‘(a) FINDINGS.—Congress finds that health pro10 motion and disease prevention activities— 

11 ‘‘(1) improve the health and well-being of Indi12 ans; and 

13 ‘‘(2) reduce the expenses for health care of In14 dians. 

15 ‘‘(b) PROVISION OF SERVICES.—The Secretary, act16 ing through the Service and Tribal Health Programs, shall 

17 provide health promotion and disease prevention services 

18 to Indians to achieve the health status objectives set forth 

19 in section 3(2). 

20 ‘‘(c) EVALUATION.—The Secretary, after obtaining 

21 input from the affected Tribal Health Programs, shall 

22 submit to the President for inclusion in the report which 

23 is required to be submitted to Congress under section 801 

24 an evaluation of— 


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1 ‘‘(1) the health promotion and disease preven2 tion needs of Indians; 

3 ‘‘(2) the health promotion and disease preven4 tion activities which would best meet such needs; 

5 ‘‘(3) the internal capacity of the Service and 

6 Tribal Health Programs to meet such needs; and 

7 ‘‘(4) the resources which would be required to 

8 enable the Service and Tribal Health Programs to 

9 undertake the health promotion and disease preven10 tion activities necessary to meet such needs. 

11 ‘‘SEC. 204. DIABETES PREVENTION, TREATMENT, AND CON12 TROL. 

13 ‘‘(a) DETERMINATIONS REGARDING DIABETES.— 

14 The Secretary, acting through the Service, and in con15 sultation with Indian Tribes and Tribal Organizations, 

16 shall determine— 

17 ‘‘(1) by Indian Tribe and by Service Unit, the 

18 incidence of, and the types of complications resulting 

19 from, diabetes among Indians; and 

20 ‘‘(2) based on the determinations made pursu21 ant to paragraph (1), the measures (including pa22 tient education and effective ongoing monitoring of 

23 disease indicators) each Service Unit should take to 

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1 trol the complications resulting from, diabetes 

2 among Indian Tribes within that Service Unit. 

3 ‘‘(b) DIABETES SCREENING.—To the extent medi4 cally indicated and with informed consent, the Secretary 

5 shall screen each Indian who receives services from the 

6 Service for diabetes and for conditions which indicate a 

7 high risk that the individual will become diabetic and es8 tablish a cost-effective approach to ensure ongoing moni9 toring of disease indicators. Such screening and moni10 toring may be conducted by a Tribal Health Program and 

11 may be conducted through appropriate Internet-based 

12 health care management programs. 

13 ‘‘(c) DIABETES PROJECTS.—The Secretary shall con14 tinue to maintain each model diabetes project in existence 

15 on the date of enactment of the Indian Health Care Im16 provement Act Amendments of 2006, any such other dia17 betes programs operated by the Service or Tribal Health 

18 Programs, and any additional diabetes projects, such as 

19 the Medical Vanguard program provided for in title IV 

20 of Public Law 108–87, as implemented to serve Indian 

21 Tribes. Tribal Health Programs shall receive recurring 

22 funding for the diabetes projects that they operate pursu23 ant to this section, both at the date of enactment of the 

24 Indian Health Care Improvement Act Amendments of 


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1 2006 and for projects which are added and funded there2 after. 

3 ‘‘(d) DIALYSIS PROGRAMS.—The Secretary is author4 ized to provide, through the Service, Indian Tribes, and 

5 Tribal Organizations, dialysis programs, including the 

6 purchase of dialysis equipment and the provision of nec7 essary staffing. 

8 ‘‘(e) OTHER DUTIES OF THE SECRETARY.— 

9 ‘‘(1) IN GENERAL.—The Secretary shall, to the 

10 extent funding is available— 

11 ‘‘(A) in each Area Office, consult with In12 dian Tribes and Tribal Organizations regarding 

13 programs for the prevention, treatment, and 

14 control of diabetes; 

15 ‘‘(B) establish in each Area Office a reg16 istry of patients with diabetes to track the inci17 dence of diabetes and the complications from 

18 diabetes in that area; and 

19 ‘‘(C) ensure that data collected in each 

20 Area Office regarding diabetes and related com21 plications among Indians are disseminated to 

22 all other Area Offices, subject to applicable pa23 tient privacy laws. 

24 ‘‘(2) DIABETES CONTROL OFFICERS.— 


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1 ‘‘(A) IN GENERAL.—The Secretary may es2 tablish and maintain in each Area Office a posi3 tion of diabetes control officer to coordinate and 

4 manage any activity of that Area Office relating 

5 to the prevention, treatment, or control of dia6 betes to assist the Secretary in carrying out a 

7 program under this section or section 330C of 

8 the Public Health Service Act (42 U.S.C. 254c– 

9 3). 

10 ‘‘(B) CERTAIN ACTIVITIES.—Any activity 

11 carried out by a diabetes control officer under 

12 subparagraph (A) that is the subject of a con13 tract or compact under the Indian Self-Deter14 mination and Education Assistance Act (25 

15 U.S.C. 450 et seq.), and any funds made avail16 able to carry out such an activity, shall not be 

17 divisible for purposes of that Act. 

18 ‘‘SEC. 205. SHARED SERVICES FOR LONG-TERM CARE. 

19 ‘‘(a) LONG-TERM CARE.—Notwithstanding any other 

20 provision of law, the Secretary, acting through the Service, 

21 is authorized to provide directly, or enter into contracts 

22 or compacts under the Indian Self-Determination and 

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

24 Indian Tribes or Tribal Organizations for, the delivery of 

25 long-term care (including health care services associated 


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1 with long-term care) provided in a facility to Indians. Such 

2 agreements shall provide for the sharing of staff or other 

3 services between the Service or a Tribal Health Program 

4 and a long-term care or related facility owned and oper5 ated (directly or through a contract or compact under the 

6 Indian Self-Determination and Education Assistance Act 

7 (25 U.S.C. 450 et seq.)) by such Indian Tribe or Tribal 

8 Organization. 

9 ‘‘(b) CONTENTS OF AGREEMENTS.—An agreement 

10 entered into pursuant to subsection (a)— 

11 ‘‘(1) may, at the request of the Indian Tribe or 

12 Tribal Organization, delegate to such Indian Tribe 

13 or Tribal Organization such powers of supervision 

14 and control over Service employees as the Secretary 

15 deems necessary to carry out the purposes of this 

16 section; 

17 ‘‘(2) shall provide that expenses (including sala18 ries) relating to services that are shared between the 

19 Service and the Tribal Health Program be allocated 

20 proportionately between the Service and the Indian 

21 Tribe or Tribal Organization; and 

22 ‘‘(3) may authorize such Indian Tribe or Tribal 

23 Organization to construct, renovate, or expand a 

24 long-term care or other similar facility (including the 


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1 construction of a facility attached to a Service facil2 ity). 

3 ‘‘(c) MINIMUM REQUIREMENT.—Any nursing facility 

4 provided for under this section shall meet the require5 ments for nursing facilities under section 1919 of the So6 cial Security Act. 

7 ‘‘(d) OTHER ASSISTANCE.—The Secretary shall pro8 vide such technical and other assistance as may be nec9 essary to enable applicants to comply with the provisions 

10 of this section. 

11 ‘‘(e) USE OF EXISTING OR UNDERUSED FACILI12 TIES.—The Secretary shall encourage the use of existing 

13 facilities that are underused or allow the use of swing beds 

14 for long-term or similar care. 

15 ‘‘SEC. 206. HEALTH SERVICES RESEARCH. 

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

17 the Service, shall make funding available for research to 

18 further the performance of the health service responsibil19 ities of Indian Health Programs. 

20 ‘‘(b) COORDINATION OF RESOURCES AND ACTIVI21 TIES.—The Secretary shall also, to the maximum extent 

22 practicable, coordinate departmental research resources 

23 and activities to address relevant Indian Health Program 

24 research needs. 


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1 ‘‘(c) AVAILABILITY.—Tribal Health Programs shall 

2 be given an equal opportunity to compete for, and receive, 

3 research funds under this section. 

4 ‘‘(d) USE OF FUNDS.—This funding may be used for 

5 both clinical and nonclinical research. 

6 ‘‘(e) EVALUATION AND DISSEMINATION.—The Sec7 retary shall periodically— 

8 ‘‘(1) evaluate the impact of research conducted 

9 under this section; and 

10 ‘‘(2) disseminate to Tribal Health Programs in11 formation regarding that research as the Secretary 

12 determines to be appropriate. 

13 ‘‘SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREEN14 ING. 

15 ‘‘The Secretary, acting through the Service or Tribal 

16 Health Programs, shall provide for screening as follows: 

17 ‘‘(1) Screening mammography (as defined in 

18 section 1861(jj) of the Social Security Act) for In19 dian women at a frequency appropriate to such 

20 women under accepted and appropriate national 

21 standards, and under such terms and conditions as 

22 are consistent with standards established by the Sec23 retary to ensure the safety and accuracy of screen24 ing mammography under part B of title XVIII of 

25 such Act. 


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1 ‘‘(2) Other cancer screening that receives an A 

2 or B rating as recommended by the United States 

3 Preventive Services Task Force established under 

4 section 915(a)(1) of the Public Health Service Act 

5 (42 U.S.C. 299b–4(a)(1)). The Secretary shall en6 sure that screening provided for under this para7 graph complies with the recommendations of the 

8 Task Force with respect to— 

9 ‘‘(A) frequency; 

10 ‘‘(B) the population to be served; 

11 ‘‘(C) the procedure or technology to be 

12 used; 

13 ‘‘(D) evidence of effectiveness; and 

14 ‘‘(E) other matters that the Secretary de15 termines appropriate. 

16 ‘‘SEC. 208. PATIENT TRAVEL COSTS. 

17 ‘‘(a) DEFINITION OF QUALIFIED ESCORT.—In this 

18 section, the term ‘qualified escort’ means— 

19 ‘‘(1) an adult escort (including a parent, guard20 ian, or other family member) who is required be21 cause of the physical or mental condition, or age, of 

22 the applicable patient; 

23 ‘‘(2) a health professional for the purpose of 

24 providing necessary medical care during travel by 

25 the applicable patient; or 


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1 ‘‘(3) other escorts, as the Secretary or applica2 ble Indian Health Program determines to be appro3 priate. 

4 ‘‘(b) PROVISION OF FUNDS.—The Secretary, acting 

5 through the Service and Tribal Health Programs, is au6 thorized to provide funds for the following patient travel 

7 costs, including qualified escorts, associated with receiving 

8 health care services provided (either through direct or con9 tract care or through a contract or compact under the In10 dian Self-Determination and Education Assistance Act 

11 (25 U.S.C. 450 et seq.)) under this Act— 

12 ‘‘(1) emergency air transportation and non13 emergency air transportation where ground trans14 portation is infeasible; 

15 ‘‘(2) transportation by private vehicle (where no 

16 other means of transportation is available), specially 

17 equipped vehicle, and ambulance; and 

18 ‘‘(3) transportation by such other means as 

19 may be available and required when air or motor ve20 hicle transportation is not available. 

21 ‘‘SEC. 209. EPIDEMIOLOGY CENTERS. 

22 ‘‘(a) 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 2006, and without reducing the funding 


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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 2006, 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 


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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. 


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1 ‘‘SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION 

2 PROGRAMS. 

3 ‘‘(a) FUNDING FOR DEVELOPMENT OF PROGRAMS.— 

4 In addition to carrying out any other program for health 

5 promotion or disease prevention, the Secretary, acting 

6 through the Service, is authorized to award grants to In7 dian Tribes, Tribal Organizations, and Urban Indian Or8 ganizations to develop comprehensive school health edu9 cation programs for children from pre-school through 

10 grade 12 in schools for the benefit of Indian and Urban 

11 Indian children. 

12 ‘‘(b) USE OF GRANT FUNDS.—A grant awarded 

13 under this section may be used for purposes which may 

14 include, but are not limited to, the following: 

15 ‘‘(1) Developing health education materials both 

16 for regular school programs and afterschool pro17 grams. 

18 ‘‘(2) Training teachers in comprehensive school 

19 health education materials. 

20 ‘‘(3) Integrating school-based, community21 based, and other public and private health promotion 

22 efforts. 

23 ‘‘(4) Encouraging healthy, tobacco-free school 

24 environments. 


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1 ‘‘(5) Coordinating school-based health programs 

2 with existing services and programs available in the 

3 community. 

4 ‘‘(6) Developing school programs on nutrition 

5 education, personal health, oral health, and fitness. 

6 ‘‘(7) Developing behavioral health wellness pro7 grams. 

8 ‘‘(8) Developing chronic disease prevention pro9 grams. 

10 ‘‘(9) Developing substance abuse prevention 

11 programs. 

12 ‘‘(10) Developing injury prevention and safety 

13 education programs. 

14 ‘‘(11) Developing activities for the prevention 

15 and control of communicable diseases. 

16 ‘‘(12) Developing community and environmental 

17 health education programs that include traditional 

18 health care practitioners. 

19 ‘‘(13) Violence prevention. 

20 ‘‘(14) Such other health issues as are appro21 priate. 

22 ‘‘(c) TECHNICAL ASSISTANCE.—Upon request, the 

23 Secretary, acting through the Service, shall provide tech24 nical assistance to Indian Tribes, Tribal Organizations, 

25 and Urban Indian Organizations in the development of 


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1 comprehensive health education plans and the dissemina2 tion of comprehensive health education materials and in3 formation on existing health programs and resources. 

4 ‘‘(d) CRITERIAFOR REVIEW AND APPROVAL OF AP5 PLICATIONS.—The Secretary, acting through the Service, 

6 and in consultation with Indian Tribes, Tribal Organiza7 tions, and Urban Indian Organizations, shall establish cri8 teria for the review and approval of applications for grants 

9 awarded under this section. 

10 ‘‘(e) DEVELOPMENT OF PROGRAM FOR BIA-FUNDED

11 SCHOOLS.— 

12 ‘‘(1) IN GENERAL.—The Secretary of the Inte13 rior, acting through the Bureau of Indian Affairs 

14 and in cooperation with the Secretary, acting 

15 through the Service, and affected Indian Tribes and 

16 Tribal Organizations, shall develop a comprehensive 

17 school health education program for children from 

18 preschool through grade 12 in schools for which sup19 port is provided by the Bureau of Indian Affairs. 

20 ‘‘(2) REQUIREMENTS FOR PROGRAMS.—Such 

21 programs shall include— 

22 ‘‘(A) school programs on nutrition edu23 cation, personal health, oral health, and fitness; 

24 ‘‘(B) behavioral health wellness programs; 

25 ‘‘(C) chronic disease prevention programs; 


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1 ‘‘(D) substance abuse prevention pro2 grams; 

3 ‘‘(E) injury prevention and safety edu4 cation programs; and 

5 ‘‘(F) activities for the prevention and con6 trol of communicable diseases. 

7 ‘‘(3) DUTIES OF THE SECRETARY.—The Sec8 retary of the Interior shall— 

9 ‘‘(A) provide training to teachers in com10 prehensive school health education materials; 

11 ‘‘(B) ensure the integration and coordina12 tion of school-based programs with existing 

13 services and health programs available in the 

14 community; and 

15 ‘‘(C) encourage healthy, tobacco-free school 

16 environments. 

17 ‘‘SEC. 211. INDIAN YOUTH PROGRAM. 

18 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 

19 through the Service, is authorized to establish and admin20 ister a program to provide grants to Indian Tribes, Tribal 

21 Organizations, and Urban Indian Organizations for inno22 vative mental and physical disease prevention and health 

23 promotion and treatment programs for Indian and Urban 

24 Indian preadolescent and adolescent youths. 

25 ‘‘(b) USE OF FUNDS.— 


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1 ‘‘(1) ALLOWABLE USES.—Funds made available 

2 under this section may be used to— 

3 ‘‘(A) develop prevention and treatment 

4 programs for Indian youth which promote men5 tal and physical health and incorporate cultural 

6 values, community and family involvement, and 

7 traditional health care practitioners; and 

8 ‘‘(B) develop and provide community train9 ing and education. 

10 ‘‘(2) PROHIBITED USE.—Funds made available 

11 under this section may not be used to provide serv12 ices described in section 707(c). 

13 ‘‘(c) DUTIES OF THE SECRETARY.—The Secretary 

14 shall— 

15 ‘‘(1) disseminate to Indian Tribes, Tribal Orga16 nizations, and Urban Indian Organizations informa17 tion regarding models for the delivery of comprehen18 sive health care services to Indian and Urban Indian 

19 adolescents; 

20 ‘‘(2) encourage the implementation of such 

21 models; and 

22 ‘‘(3) at the request of an Indian Tribe, Tribal 

23 Organization, or Urban Indian Organization, provide 

24 technical assistance in the implementation of such 

25 models. 


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1 ‘‘(d) CRITERIAFOR REVIEW AND APPROVAL OF AP2 PLICATIONS.—The Secretary, in consultation with Indian 

3 Tribes, Tribal Organizations, and Urban Indian Organiza4 tions, shall establish criteria for the review and approval 

5 of applications or proposals under this section. 

6 ‘‘SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF 

7 COMMUNICABLE AND INFECTIOUS DISEASES. 

8 ‘‘(a) FUNDING AUTHORIZED.—The Secretary, acting 

9 through the Service, and after consultation with the Cen10 ters for Disease Control and Prevention, may make fund11 ing available to Indian Tribes, Tribal Organizations, and 

12 Urban Indian Organizations for the following: 

13 ‘‘(1) Projects for the prevention, control, and 

14 elimination of communicable and infectious diseases, 

15 including tuberculosis, hepatitis, HIV, respiratory 

16 syncytial virus, hanta virus, sexually transmitted dis17 eases, and H. Pylori. 

18 ‘‘(2) Public information and education pro19 grams for the prevention, control, and elimination of 

20 communicable and infectious diseases. 

21 ‘‘(3) Education, training, and clinical skills im22 provement activities in the prevention, control, and 

23 elimination of communicable and infectious diseases 

24 for health professionals, including allied health pro25 fessionals. 


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1 ‘‘(4) Demonstration projects for the screening, 

2 treatment, and prevention of hepatitis C virus 

3 (HCV). 

4 ‘‘(b) APPLICATION REQUIRED.—The Secretary may 

5 provide funding under subsection (a) only if an application 

6 or proposal for funding is submitted to the Secretary. 

7 ‘‘(c) COORDINATION WITH HEALTH AGENCIES.—In8 dian Tribes, Tribal Organizations, and Urban Indian Or9 ganizations receiving funding under this section are en10 couraged to coordinate their activities with the Centers for 

11 Disease Control and Prevention and State and local health 

12 agencies. 

13 ‘‘(d) TECHNICAL ASSISTANCE; REPORT.—In carrying 

14 out this section, the Secretary— 

15 ‘‘(1) may, at the request of an Indian Tribe, 

16 Tribal Organization, or Urban Indian Organization, 

17 provide technical assistance; and 

18 ‘‘(2) shall prepare and submit a report to Con19 gress biennially on the use of funds under this sec20 tion and on the progress made toward the preven21 tion, control, and elimination of communicable and 

22 infectious diseases among Indians and Urban Indi23 ans. 


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1 ‘‘SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERV2 ICES. 

3 ‘‘(a) FUNDING AUTHORIZED.—The Secretary, acting 

4 through the Service, Indian Tribes, and Tribal Organiza5 tions, may provide funding under this Act to meet the ob6 jectives set forth in section 3 through health care-related 

7 services and programs not otherwise described in this Act, 

8 including— 

9 ‘‘(1) hospice care; 

10 ‘‘(2) assisted living; 

11 ‘‘(3) long-term care; and 

12 ‘‘(4) home- and community-based services, in 

13 accordance with subsection (c). 

14 ‘‘(b) TERMS AND CONDITIONS.— 

15 ‘‘(1) IN GENERAL.—The Secretary shall require 

16 that any service provided under this section shall be 

17 in accordance with such terms and conditions as the 

18 Secretary determines to be consistent with accepted 

19 and appropriate standards relating to the service, in20 cluding any licensing term or condition under this 

21 Act. 

22 ‘‘(2) STANDARDS.— 

23 ‘‘(A) IN GENERAL.—In accordance with 

24 this Act and the Indian Self-Determination and 

25 Education Assistance Act (25 U.S.C. 450 et 

26 seq.), the Secretary may use the standards for 


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1 a service provided under this section required 

2 by the State in which the service is provided. 

3 ‘‘(B) INDIAN TRIBES.—If a service under 

4 this section is provided by an Indian Tribe or 

5 Tribal Organization pursuant to the Indian 

6 Self-Determination and Education Assistance 

7 Act (25 U.S.C. 450 et seq.), the verification by 

8 the Secretary that the service meets any stand9 ards required by the State in which the service 

10 is or will be provided shall be considered to 

11 meet the terms and conditions required under 

12 this subsection. 

13 ‘‘(3) ELIGIBILITY.—The following individuals 

14 shall be eligible to receive long-term care under this 

15 section: 

16 ‘‘(A) Individuals who are unable to per17 form a certain number of activities of daily liv18 ing without assistance. 

19 ‘‘(B) Individuals with a mental impair20 ment, such as dementia, Alzheimer’s disease, or 

21 another disabling mental illness, who may be 

22 able to perform activities of daily living under 

23 supervision. 


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1 ‘‘(C) Such other individuals as an applica2 ble Indian Health Program determines to be 

3 appropriate. 

4 ‘‘(c) DEFINITIONS.—For the purposes of this section, 

5 the following definitions shall apply: 

6 ‘‘(1) The term ‘home- and community-based 

7 services’ means 1 or more of the following services 

8 (whether provided by the Service or by an Indian 

9 Tribe or Tribal Organization under a contract, grant 

10 agreement, or cooperative agreement pursuant to the 

11 Indian Self-Determination and Education Assistance 

12 Act (25 U.S.C. 450 et seq.)) for which the Secretary 

13 has established standards pursuant to subsection 

14 (b): 

15 ‘‘(A) Home health aide services. 

16 ‘‘(B) Nursing care services provided out17 side of a nursing facility by, or under the super18 vision of, a registered nurse. 

19 ‘‘(C) Respite care. 

20 ‘‘(D) Adult day care. 

21 ‘‘(E) Such other services identified by an 

22 Indian Tribe or Tribal Organization for which 

23 the Secretary has established standards pursu24 ant to subsection (b). 


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1 ‘‘(2) The term ‘hospice care’ means the items 

2 and services specified in subparagraphs (A) through 

3 (H) of section 1861(dd)(1) of the Social Security 

4 Act (42 U.S.C. 1395x(dd)(1)), and such other serv5 ices which an Indian Tribe or Tribal Organization 

6 determines are necessary and appropriate to provide 

7 in furtherance of this care. 

8 ‘‘SEC. 214. INDIAN WOMEN’S HEALTH CARE. 

9 ‘‘The Secretary, acting through the Service and In10 dian Tribes, Tribal Organizations, and Urban Indian Or11 ganizations, shall monitor and improve the quality of 

12 health care for Indian women of all ages through the plan13 ning and delivery of programs administered by the Service, 

14 in order to improve and enhance the treatment models of 

15 care for Indian women. 

16 ‘‘SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZ17 ARDS. 

18 ‘‘(a) STUDIES AND MONITORING.—The Secretary 

19 and the Service shall conduct, in conjunction with other 

20 appropriate Federal agencies and in consultation with con21 cerned Indian Tribes and Tribal Organizations, studies 

22 and ongoing monitoring programs to determine trends in 

23 the health hazards to Indian miners and to Indians on 

24 or near reservations and Indian communities as a result 

25 of environmental hazards which may result in chronic or 


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1 life threatening health problems, such as nuclear resource 

2 development, petroleum contamination, and contamination 

3 of water source and of the food chain. Such studies shall 

4 include— 

5 ‘‘(1) an evaluation of the nature and extent of 

6 health problems caused by environmental hazards 

7 currently exhibited among Indians and the causes of 

8 such health problems; 

9 ‘‘(2) an analysis of the potential effect of ongo10 ing and future environmental resource development 

11 on or near reservations and Indian communities, in12 cluding the cumulative effect over time on health; 

13 ‘‘(3) an evaluation of the types and nature of 

14 activities, practices, and conditions causing or affect15 ing such health problems, including uranium mining 

16 and milling, uranium mine tailing deposits, nuclear 

17 power plant operation and construction, and nuclear 

18 waste disposal; oil and gas production or transpor19 tation on or near reservations or Indian commu20 nities; and other development that could affect the 

21 health of Indians and their water supply and food 

22 chain; 

23 ‘‘(4) a summary of any findings and rec24 ommendations provided in Federal and State stud25 ies, reports, investigations, and inspections during 


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1 the 5 years prior to the date of enactment of the In2 dian Health Care Improvement Act Amendments of 

3 2006 that directly or indirectly relate to the activi4 ties, practices, and conditions affecting the health or 

5 safety of such Indians; and 

6 ‘‘(5) the efforts that have been made by Federal 

7 and State agencies and resource and economic devel8 opment companies to effectively carry out an edu9 cation program for such Indians regarding the 

10 health and safety hazards of such development. 

11 ‘‘(b) HEALTH CARE PLANS.—Upon completion of 

12 such studies, the Secretary and the Service shall take into 

13 account the results of such studies and develop health care 

14 plans to address the health problems studied under sub15 section (a). The plans shall include— 

16 ‘‘(1) methods for diagnosing and treating Indi17 ans currently exhibiting such health problems; 

18 ‘‘(2) preventive care and testing for Indians 

19 who may be exposed to such health hazards, includ20 ing the monitoring of the health of individuals who 

21 have or may have been exposed to excessive amounts 

22 of radiation or affected by other activities that have 

23 had or could have a serious impact upon the health 

24 of such individuals; and 


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1 ‘‘(3) a program of education for Indians who, 

2 by reason of their work or geographic proximity to 

3 such nuclear or other development activities, may ex4 perience health problems. 

5 ‘‘(c) SUBMISSION OF REPORT AND PLAN TO CON6 GRESS.—The Secretary and the Service shall submit to 

7 Congress the study prepared under subsection (a) no later 

8 than 18 months after the date of enactment of the Indian 

9 Health Care Improvement Act Amendments of 2006. The 

10 health care plan prepared under subsection (b) shall be 

11 submitted in a report no later than 1 year after the study 

12 prepared under subsection (a) is submitted to Congress. 

13 Such report shall include recommended activities for the 

14 implementation of the plan, as well as an evaluation of 

15 any activities previously undertaken by the Service to ad16 dress such health problems. 

17 ‘‘(d) INTERGOVERNMENTAL TASK FORCE.— 

18 ‘‘(1) ESTABLISHMENT; MEMBERS.—There is es19 tablished an Intergovernmental Task Force to be 

20 composed of the following individuals (or their des21 ignees): 

22 ‘‘(A) The Secretary of Energy. 

23 ‘‘(B) The Secretary of the Environmental 

24 Protection Agency. 

25 ‘‘(C) The Director of the Bureau of Mines. 


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1 ‘‘(D) The Assistant Secretary for Occupa2 tional Safety and Health. 

3 ‘‘(E) The Secretary of the Interior. 

4 ‘‘(F) The Secretary of Health and Human 

5 Services. 

6 ‘‘(G) The Director of the Indian Health 

7 Service. 

8 ‘‘(2) DUTIES.—The Task Force shall— 

9 ‘‘(A) identify existing and potential oper10 ations related to nuclear resource development 

11 or other environmental hazards that affect or 

12 may affect the health of Indians on or near a 

13 reservation or in an Indian community; and 

14 ‘‘(B) enter into activities to correct exist15 ing health hazards and ensure that current and 

16 future health problems resulting from nuclear 

17 resource or other development activities are 

18 minimized or reduced. 

19 ‘‘(3) CHAIRMAN; MEETINGS.—The Secretary of 

20 Health and Human Services shall be the Chairman 

21 of the Task Force. The Task Force shall meet at 

22 least twice each year. 

23 ‘‘(e) HEALTH SERVICES TO CERTAIN EMPLOYEES.— 

24 In the case of any Indian who— 


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1 ‘‘(1) as a result of employment in or near a 

2 uranium mine or mill or near any other environ3 mental hazard, suffers from a work-related illness or 

4 condition; 

5 ‘‘(2) is eligible to receive diagnosis and treat6 ment services from an Indian Health Program; and 

7 ‘‘(3) by reason of such Indian’s employment, is 

8 entitled to medical care at the expense of such mine 

9 or mill operator or entity responsible for the environ10 mental hazard, the Indian Health Program shall, at 

11 the request of such Indian, render appropriate med12 ical care to such Indian for such illness or condition 

13 and may be reimbursed for any medical care so ren14 dered to which such Indian is entitled at the expense 

15 of such operator or entity from such operator or en16 tity. Nothing in this subsection shall affect the 

17 rights of such Indian to recover damages other than 

18 such amounts paid to the Indian Health Program 

19 from the employer for providing medical care for 

20 such illness or condition. 

21 ‘‘SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DE22 LIVERY AREA. 

23 ‘‘(a) IN GENERAL.—For fiscal years beginning with 

24 the fiscal year ending September 30, 1983, and ending 

25 with the fiscal year ending September 30, 2016, the State 


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1 of Arizona shall be designated as a contract health service 

2 delivery area by the Service for the purpose of providing 

3 contract health care services to members of federally rec4 ognized Indian Tribes of Arizona. 

5 ‘‘(b) MAINTENANCE OF SERVICES.—The Service 

6 shall not curtail any health care services provided to Indi7 ans residing on reservations in the State of Arizona if such 

8 curtailment is due to the provision of contract services in 

9 such State pursuant to the designation of such State as 

10 a contract health service delivery area pursuant to sub11 section (a). 

12 ‘‘SEC. 216A. NORTH DAKOTA AND SOUTH DAKOTA AS CON13 TRACT HEALTH SERVICE DELIVERY AREA. 

14 ‘‘(a) IN GENERAL.—Beginning in fiscal year 2003, 

15 the States of North Dakota and South Dakota shall be 

16 designated as a contract health service delivery area by 

17 the Service for the purpose of providing contract health 

18 care services to members of federally recognized Indian 

19 Tribes of North Dakota and South Dakota. 

20 ‘‘(b) LIMITATION.—The Service shall not curtail any 

21 health care services provided to Indians residing on any 

22 reservation, or in any county that has a common boundary 

23 with any reservation, in the State of North Dakota or 

24 South Dakota if such curtailment is due to the provision 

25 of contract services in such States pursuant to the desVerDate Aug 31 2005 02:12 Dec 13, 2006 Jkt 059200 PO 00000 Frm 00127 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 ignation of such States as a contract health service deliv2 ery area pursuant to subsection (a). 

3 ‘‘SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES PRO4 GRAM. 

5 ‘‘(a) FUNDING AUTHORIZED.—The Secretary is au6 thorized to fund a program using the California Rural In7 dian Health Board (hereafter in this section referred to 

8 as the ‘CRIHB’) as a contract care intermediary to im9 prove the accessibility of health services to California Indi10 ans. 

11 ‘‘(b) REIMBURSEMENT CONTRACT.—The Secretary 

12 shall enter into an agreement with the CRIHB to reim13 burse the CRIHB for costs (including reasonable adminis14 trative costs) incurred pursuant to this section, in pro15 viding medical treatment under contract to California In16 dians described in section 806(a) throughout the Cali17 fornia contract health services delivery area described in 

18 section 218 with respect to high cost contract care cases. 

19 ‘‘(c) ADMINISTRATIVE EXPENSES.—Not more than 5 

20 percent of the amounts provided to the CRIHB under this 

21 section for any fiscal year may be for reimbursement for 

22 administrative expenses incurred by the CRIHB during 

23 such fiscal year. 

24 ‘‘(d) LIMITATION ON PAYMENT.—No payment may 

25 be made for treatment provided hereunder to the extent 


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1 payment may be made for such treatment under the In2 dian Catastrophic Health Emergency Fund described in 

3 section 202 or from amounts appropriated or otherwise 

4 made available to the California contract health service de5 livery area for a fiscal year. 

6 ‘‘(e) ADVISORY BOARD.—There is established an ad7 visory board which shall advise the CRIHB in carrying 

8 out this section. The advisory board shall be composed of 

9 representatives, selected by the CRIHB, from not less 

10 than 8 Tribal Health Programs serving California Indians 

covered under this section at least 1 11 ⁄2 of whom of whom 

12 are not affiliated with the CRIHB. 

13 ‘‘SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE 

14 DELIVERY AREA. 

15 ‘‘The State of California, excluding the counties of 

16 Alameda, Contra Costa, Los Angeles, Marin, Orange, Sac17 ramento, San Francisco, San Mateo, Santa Clara, Kern, 

18 Merced, Monterey, Napa, San Benito, San Joaquin, San 

19 Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ven20 tura, shall be designated as a contract health service deliv21 ery area by the Service for the purpose of providing con22 tract health services to California Indians. However, any 

23 of the counties listed herein may only be included in the 

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1 cally provided by the Service for such services in those 

2 counties. 

3 ‘‘SEC. 219. CONTRACT HEALTH SERVICES FOR THE TREN4 TON SERVICE AREA. 

5 ‘‘(a) AUTHORIZATION FOR SERVICES.—The Sec6 retary, acting through the Service, is directed to provide 

7 contract health services to members of the Turtle Moun8 tain Band of Chippewa Indians that reside in the Trenton 

9 Service Area of Divide, McKenzie, and Williams counties 

10 in the State of North Dakota and the adjoining counties 

11 of Richland, Roosevelt, and Sheridan in the State of Mon12 tana. 

13 ‘‘(b) NO EXPANSION OF ELIGIBILITY.—Nothing in 

14 this section may be construed as expanding the eligibility 

15 of members of the Turtle Mountain Band of Chippewa In16 dians for health services provided by the Service beyond 

17 the scope of eligibility for such health services that applied 

18 on May 1, 1986. 

19 ‘‘SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND 

20 TRIBAL ORGANIZATIONS. 

21 ‘‘The Service shall provide funds for health care pro22 grams and facilities operated by Tribal Health Programs 

23 on the same basis as such funds are provided to programs 

24 and facilities operated directly by the Service. 


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1 ‘‘SEC. 221. LICENSING. 

2 ‘‘Health care professionals employed by a Tribal 

3 Health Program shall, if licensed in any State, be exempt 

4 from the licensing requirements of the State in which the 

5 Tribal Health Program performs the services described in 

6 its contract or compact under the Indian Self-Determina7 tion and Education Assistance Act (25 U.S.C. 450 et 

8 seq.). 

9 ‘‘SEC. 222. NOTIFICATION OF PROVISION OF EMERGENCY 

10 CONTRACT HEALTH SERVICES. 

11 ‘‘With respect to an elderly Indian or an Indian with 

12 a disability receiving emergency medical care or services 

13 from a non-Service provider or in a non-Service facility 

14 under the authority of this Act, the time limitation (as 

15 a condition of payment) for notifying the Service of such 

16 treatment or admission shall be 30 days. 

17 ‘‘SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS. 

18 ‘‘(a) DEADLINE FOR RESPONSE.—The Service shall 

19 respond to a notification of a claim by a provider of a 

20 contract care service with either an individual purchase 

21 order or a denial of the claim within 5 working days after 

22 the receipt of such notification. 

23 ‘‘(b) EFFECT OF UNTIMELY RESPONSE.—If the 

24 Service fails to respond to a notification of a claim in ac25 cordance with subsection (a), the Service shall accept as 


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1 valid the claim submitted by the provider of a contract 

2 care service. 

3 ‘‘(c) DEADLINE FOR PAYMENT OF VALID CLAIM.— 

4 The Service shall pay a valid contract care service claim 

5 within 30 days after the completion of the claim. 

6 ‘‘SEC. 224. LIABILITY FOR PAYMENT. 

7 ‘‘(a) NO PATIENT LIABILITY.—A patient who re8 ceives contract health care services that are authorized by 

9 the Service shall not be liable for the payment of any 

10 charges or costs associated with the provision of such serv11 ices. 

12 ‘‘(b) NOTIFICATION.—The Secretary shall notify a 

13 contract care provider and any patient who receives con14 tract health care services authorized by the Service that 

15 such patient is not liable for the payment of any charges 

16 or costs associated with the provision of such services not 

17 later than 5 business days after receipt of a notification 

18 of a claim by a provider of contract care services. 

19 ‘‘(c) NO RECOURSE.—Following receipt of the notice 

20 provided under subsection (b), or, if a claim has been 

21 deemed accepted under section 223(b), the provider shall 

22 have no further recourse against the patient who received 

23 the services. 


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1 ‘‘SEC. 225. OFFICE OF INDIAN MEN’S HEALTH. 

2 ‘‘(a) ESTABLISHMENT.—The Secretary may establish 

3 within the Service an office to be known as the ‘Office 

4 of Indian Men’s Health’ (referred to in this section as the 

5 ‘Office’). 

6 ‘‘(b) DIRECTOR.— 

7 ‘‘(1) IN GENERAL.—The Office shall be headed 

8 by a director, to be appointed by the Secretary. 

9 ‘‘(2) DUTIES.—The director shall coordinate 

10 and promote the status of the health of Indian men 

11 in the United States. 

12 ‘‘(c) REPORT.—Not later than 2 years after the date 

13 of enactment of the Indian Health Care Improvement Act 

14 Amendments of 2006, the Secretary, acting through the 

15 director of the Office, shall submit to Congress a report 

16 describing— 

17 ‘‘(1) any activity carried out by the director as 

18 of the date on which the report is prepared; and 

19 ‘‘(2) any finding of the director with respect to 

20 the health of Indian men. 

21 ‘‘SEC. 226. AUTHORIZATION OF APPROPRIATIONS. 

22 ‘‘There are authorized to be appropriated such sums 

23 as may be necessary for each fiscal year through fiscal 

24 year 2016 to carry out this title. 


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1 ‘‘TITLE III—FACILITIES 

2 ‘‘SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVA3 TION OF FACILITIES; REPORTS. 

4 ‘‘(a) PREREQUISITES FOR EXPENDITURE OF

5 FUNDS.—Prior to the expenditure of, or the making of 

6 any binding commitment to expend, any funds appro7 priated for the planning, design, construction, or renova8 tion of facilities pursuant to the Act of November 2, 1921 

9 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

10 the Secretary, acting through the Service, shall— 

11 ‘‘(1) consult with any Indian Tribe that would 

12 be significantly affected by such expenditure for the 

13 purpose of determining and, whenever practicable, 

14 honoring tribal preferences concerning size, location, 

15 type, and other characteristics of any facility on 

16 which such expenditure is to be made; and 

17 ‘‘(2) ensure, whenever practicable and applica18 ble, that such facility meets the construction stand19 ards of any accrediting body recognized by the Sec20 retary for the purposes of the Medicare, Medicaid, 

21 and SCHIP programs under titles XVIII, XIX, and 

22 XXI of the Social Security Act by not later than 1 

23 year after the date on which the construction or ren24 ovation of such facility is completed. 

25 ‘‘(b) CLOSURES.— 


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1 ‘‘(1) EVALUATION REQUIRED.—Notwith2 standing any other provision of law, no facility oper3 ated by the Service may be closed if the Secretary 

4 has not submitted to Congress at least 1 year prior 

5 to the date of the proposed closure an evaluation of 

6 the impact of the proposed closure which specifies, 

7 in addition to other considerations— 

8 ‘‘(A) the accessibility of alternative health 

9 care resources for the population served by such 

10 facility; 

11 ‘‘(B) the cost-effectiveness of such closure; 

12 ‘‘(C) the quality of health care to be pro13 vided to the population served by such facility 

14 after such closure; 

15 ‘‘(D) the availability of contract health 

16 care funds to maintain existing levels of service; 

17 ‘‘(E) the views of the Indian Tribes served 

18 by such facility concerning such closure; 

19 ‘‘(F) the level of use of such facility by all 

20 eligible Indians; and 

21 ‘‘(G) the distance between such facility and 

22 the nearest operating Service hospital. 

23 ‘‘(2) EXCEPTION FOR CERTAIN TEMPORARY

24 CLOSURES.—Paragraph (1) shall not apply to any 

25 temporary closure of a facility or any portion of a 


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1 facility if such closure is necessary for medical, envi2 ronmental, or construction safety reasons. 

3 ‘‘(c) HEALTH CARE FACILITY PRIORITY SYSTEM.— 

4 ‘‘(1) IN GENERAL.— 

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

6 acting through the Service, shall maintain a 

7 health care facility priority system, which— 

8 ‘‘(i) shall be developed in consultation 

9 with Indian Tribes and Tribal Organiza10 tions; 

11 ‘‘(ii) shall give Indian Tribes’ needs 

12 the highest priority; 

13 ‘‘(iii)(I) may include the lists required 

14 in paragraph (2)(B)(ii); and 

15 ‘‘(II) shall include the methodology re16 quired in paragraph (2)(B)(v); and 

17 ‘‘(III) may include such other facili18 ties, and such renovation or expansion 

19 needs of any health care facility, as the 

20 Service, Indian Tribes, and Tribal Organi21 zations may identify; and 

22 ‘‘(iv) shall provide an opportunity for 

23 the nomination of planning, design, and 

24 construction projects by the Service, In25 dian Tribes, and Tribal Organizations for 


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1 consideration under the priority system at 

2 least once every 3 years, or more fre3 quently as the Secretary determines to be 

4 appropriate. 

5 ‘‘(B) NEEDS OF FACILITIES UNDER

6 ISDEAA AGREEMENTS.—The Secretary shall en7 sure that the planning, design, construction, 

8 renovation, and expansion needs of Service and 

9 non-Service facilities operated under contracts 

10 or compacts in accordance with the Indian Self11 Determination and Education Assistance Act 

12 (25 U.S.C. 450 et seq.) are fully and equitably 

13 integrated into the health care facility priority 

14 system. 

15 ‘‘(C) CRITERIA FOR EVALUATING

16 NEEDS.—For purposes of this subsection, the 

17 Secretary, in evaluating the needs of facilities 

18 operated under a contract or compact under the 

19 Indian Self-Determination and Education As20 sistance Act (25 U.S.C. 450 et seq.), shall use 

21 the criteria used by the Secretary in evaluating 

22 the needs of facilities operated directly by the 

23 Service. 

24 ‘‘(D) PRIORITY OF CERTAIN PROJECTS

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1 lished under the construction priority system in 

2 effect on the date of enactment of the Indian 

3 Health Care Improvement Act Amendments of 

4 2006 shall not be affected by any change in the 

5 construction priority system taking place after 

6 that date if the project— 

7 ‘‘(i) was identified in the fiscal year 

8 2007 Service budget justification as— 

9 ‘‘(I) 1 of the 10 top-priority inpa10 tient projects; 

11 ‘‘(II) 1 of the 10 top-priority out12 patient projects; 

13 ‘‘(III) 1 of the 10 top-priority 

14 staff quarters developments; or 

15 ‘‘(IV) 1 of the 10 top-priority 

16 Youth Regional Treatment Centers; 

17 ‘‘(ii) had completed both Phase I and 

18 Phase II of the construction priority sys19 tem in effect on the date of enactment of 

20 such Act; or 

21 ‘‘(iii) is not included in clause (i) or 

22 (ii) and is selected, as determined by the 

23 Secretary— 

24 ‘‘(I) on the initiative of the Sec25 retary; or 


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1 ‘‘(II) pursuant to a request of an 

2 Indian Tribe or Tribal Organization. 

3 ‘‘(2) REPORT; CONTENTS.— 

4 ‘‘(A) INITIAL COMPREHENSIVE REPORT.— 

5 ‘‘(i) DEFINITIONS.—In this subpara6 graph: 

7 ‘‘(I) FACILITIES APPROPRIATION

8 ADVISORY BOARD.—The term ‘Facili9 ties Appropriation Advisory Board’ 

10 means the advisory board, comprised 

11 of 12 members representing Indian 

12 tribes and 2 members representing 

13 the Service, established at the discre14 tion of the Director— 

15 ‘‘(aa) to provide advice and 

16 recommendations for policies and 

17 procedures of the programs fund18 ed pursuant to facilities appro19 priations; and 

20 ‘‘(bb) to address other facili21 ties issues. 

22 ‘‘(II) FACILITIES NEEDS ASSESS23 MENT WORKGROUP.—The term ‘Fa24 cilities Needs Assessment Workgroup’ 


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1 means the workgroup established at 

2 the discretion of the Director— 

3 ‘‘(aa) to review the health 

4 care facilities construction pri5 ority system; and 

6 ‘‘(bb) to make recommenda7 tions to the Facilities Appropria8 tion Advisory Board for revising 

9 the priority system. 

10 ‘‘(ii) INITIAL REPORT.— 

11 ‘‘(I) IN GENERAL.—Not later 

12 than 1 year after the date of enact13 ment of the Indian Health Care Im14 provement Act Amendments of 2006, 

15 the Secretary shall submit to the 

16 Committee on Indian Affairs of the 

17 Senate and the Committee on Re18 sources of the House of Representa19 tives a report that describes the com20 prehensive, national, ranked list of all 

21 health care facilities needs for the 

22 Service, Indian Tribes, and Tribal Or23 ganizations (including inpatient health 

24 care facilities, outpatient health care 

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1 ties (such as for long-term care and 

2 alcohol and drug abuse treatment), 

3 wellness centers, staff quarters and 

4 hostels associated with health care fa5 cilities, and the renovation and expan6 sion needs, if any, of such facilities) 

7 developed by the Service, Indian 

8 Tribes, and Tribal Organizations for 

9 the Facilities Needs Assessment 

10 Workgroup and the Facilities Appro11 priation Advisory Board. 

12 ‘‘(II) INCLUSIONS.—The initial 

13 report shall include— 

14 ‘‘(aa) the methodology and 

15 criteria used by the Service in de16 termining the needs and estab17 lishing the ranking of the facili18 ties needs; and 

19 ‘‘(bb) such other information 

20 as the Secretary determines to be 

21 appropriate. 

22 ‘‘(iii) UPDATES OF REPORT.—Begin23 ning in calendar year 2010, the Secretary 

24 shall— 


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1 ‘‘(I) update the report under 

2 clause (ii) not less frequently that 

3 once every 5 years; and 

4 ‘‘(II) include the updated report 

5 in the appropriate annual report 

6 under subparagraph (B) for submis7 sion to Congress under section 801. 

8 ‘‘(B) ANNUAL REPORTS.—The Secretary 

9 shall submit to the President, for inclusion in 

10 the report required to be transmitted to Con11 gress under section 801, a report which sets 

12 forth the following: 

13 ‘‘(i) A description of the health care 

14 facility priority system of the Service es15 tablished under paragraph (1). 

16 ‘‘(ii) Health care facilities lists, which 

17 may include— 

18 ‘‘(I) the 10 top-priority inpatient 

19 health care facilities; 

20 ‘‘(II) the 10 top-priority out21 patient health care facilities; 

22 ‘‘(III) the 10 top-priority special23 ized health care facilities (such as 

24 long-term care and alcohol and drug 

25 abuse treatment); 


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1 ‘‘(IV) the 10 top-priority staff 

2 quarters developments associated with 

3 health care facilities; and 

4 ‘‘(V) the 10 top-priority hostels 

5 associated with health care facilities. 

6 ‘‘(iii) The justification for such order 

7 of priority. 

8 ‘‘(iv) The projected cost of such 

9 projects. 

10 ‘‘(v) The methodology adopted by the 

11 Service in establishing priorities under its 

12 health care facility priority system. 

13 ‘‘(3) REQUIREMENTS FOR PREPARATION OF RE14 PORTS.—In preparing the report required under 

15 paragraph (2), the Secretary shall— 

16 ‘‘(A) consult with and obtain information 

17 on all health care facilities needs from Indian 

18 Tribes, Tribal Organizations, and Urban Indian 

19 Organizations; and 

20 ‘‘(B) review the total unmet needs of all 

21 Indian Tribes, Tribal Organizations, and Urban 

22 Indian Organizations for health care facilities 

23 (including hostels and staff quarters), including 

24 needs for renovation and expansion of existing 

25 facilities. 


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1 ‘‘(d) REVIEW OF METHODOLOGY USED FOR HEALTH

2 FACILITIES CONSTRUCTION PRIORITY SYSTEM.— 

3 ‘‘(1) IN GENERAL.—Not later than 1 year after 

4 the establishment of the priority system under sub5 section (c)(1)(A), the Comptroller General of the 

6 United States shall prepare and finalize a report re7 viewing the methodologies applied, and the processes 

8 followed, by the Service in making each assessment 

9 of needs for the list under subsection (c)(2)(A)(ii) 

10 and developing the priority system under subsection 

11 (c)(1), including a review of— 

12 ‘‘(A) the recommendations of the Facilities 

13 Appropriation Advisory Board and the Facili14 ties Needs Assessment Workgroup (as those 

15 terms are defined in subsection (c)(2)(A)(i)); 

16 and 

17 ‘‘(B) the relevant criteria used in ranking 

18 or prioritizing facilities other than hospitals or 

19 clinics. 

20 ‘‘(2) SUBMISSION TO CONGRESS.—The Comp21 troller General of the United States shall submit the 

22 report under paragraph (1) to— 

23 ‘‘(A) the Committees on Indian Affairs and 

24 Appropriations of the Senate; 


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1 ‘‘(B) the Committees on Resources and 

2 Appropriations of the House of Representatives; 

3 and 

4 ‘‘(C) the Secretary. 

5 ‘‘(e) FUNDING CONDITION.—All funds appropriated 

6 under the Act of November 2, 1921 (25 U.S.C. 13) (com7 monly known as the ‘Snyder Act’), for the planning, de8 sign, construction, or renovation of health facilities for the 

9 benefit of 1 or more Indian Tribes shall be subject to the 

10 provisions of the Indian Self-Determination and Edu11 cation Assistance Act (25 U.S.C. 450 et seq.). 

12 ‘‘(f) DEVELOPMENT OF INNOVATIVE APPROACHES.— 

13 The Secretary shall consult and cooperate with Indian 

14 Tribes, Tribal Organizations, and Urban Indian Organiza15 tions in developing innovative approaches to address all 

16 or part of the total unmet need for construction of health 

17 facilities, including those provided for in other sections of 

18 this title and other approaches. 

19 ‘‘SEC. 302. SANITATION FACILITIES. 

20 ‘‘(a) FINDINGS.—Congress finds the following: 

21 ‘‘(1) The provision of sanitation facilities is pri22 marily a health consideration and function. 

23 ‘‘(2) Indian people suffer an inordinately high 

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1 tributable to the absence or inadequacy of sanitation 

2 facilities. 

3 ‘‘(3) The long-term cost to the United States of 

4 treating and curing such disease, injury, and illness 

5 is substantially greater than the short-term cost of 

6 providing sanitation facilities and other preventive 

7 health measures. 

8 ‘‘(4) Many Indian homes and Indian commu9 nities still lack sanitation facilities. 

10 ‘‘(5) It is in the interest of the United States, 

11 and it is the policy of the United States, that all In12 dian communities and Indian homes, new and exist13 ing, be provided with sanitation facilities. 

14 ‘‘(b) FACILITIES AND SERVICES.—In furtherance of 

15 the findings made in subsection (a), Congress reaffirms 

16 the primary responsibility and authority of the Service to 

17 provide the necessary sanitation facilities and services as 

18 provided in section 7 of the Act of August 5, 1954 (42 

19 U.S.C. 2004a). Under such authority, the Secretary, act20 ing through the Service, is authorized to provide the fol21 lowing: 

22 ‘‘(1) Financial and technical assistance to In23 dian Tribes, Tribal Organizations, and Indian com24 munities in the establishment, training, and equip25 ping of utility organizations to operate and maintain 


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1 sanitation facilities, including the provision of exist2 ing plans, standard details, and specifications avail3 able in the Department, to be used at the option of 

4 the Indian Tribe, Tribal Organization, or Indian 

5 community. 

6 ‘‘(2) Ongoing technical assistance and training 

7 to Indian Tribes, Tribal Organizations, and Indian 

8 communities in the management of utility organiza9 tions which operate and maintain sanitation facili10 ties. 

11 ‘‘(3) Priority funding for operation and mainte12 nance assistance for, and emergency repairs to, sani13 tation facilities operated by an Indian Tribe, Tribal 

14 Organization or Indian community when necessary 

15 to avoid an imminent health threat or to protect the 

16 investment in sanitation facilities and the investment 

17 in the health benefits gained through the provision 

18 of sanitation facilities. 

19 ‘‘(c) FUNDING.—Notwithstanding any other provi20 sion of law— 

21 ‘‘(1) the Secretary of Housing and Urban De22 velopment is authorized to transfer funds appro23 priated under the Native American Housing Assist24 ance and Self-Determination Act of 1996 (25 U.S.C. 


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1 4101 et seq.) to the Secretary of Health and Human 

2 Services; 

3 ‘‘(2) the Secretary of Health and Human Serv4 ices is authorized to accept and use such funds for 

5 the purpose of providing sanitation facilities and 

6 services for Indians under section 7 of the Act of 

7 August 5, 1954 (42 U.S.C. 2004a); 

8 ‘‘(3) unless specifically authorized when funds 

9 are appropriated, the Secretary shall not use funds 

10 appropriated under section 7 of the Act of August 

11 5, 1954 (42 U.S.C. 2004a), to provide sanitation fa12 cilities to new homes constructed using funds pro13 vided by the Department of Housing and Urban De14 velopment; 

15 ‘‘(4) the Secretary of Health and Human Serv16 ices is authorized to accept from any source, includ17 ing Federal and State agencies, funds for the pur18 pose of providing sanitation facilities and services 

19 and place these funds into contracts or compacts 

20 under the Indian Self-Determination and Education 

21 Assistance Act (25 U.S.C. 450 et seq.); 

22 ‘‘(5) except as otherwise prohibited by this sec23 tion, the Secretary may use funds appropriated 

24 under the authority of section 7 of the Act of Au25 gust 5, 1954 (42 U.S.C. 2004a) to meet matching 


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1 or cost participation requirements under other Fed2 eral and non-Federal programs for new projects to 

3 construct eligible sanitation facilities; 

4 ‘‘(6) all Federal agencies are authorized to 

5 transfer to the Secretary funds identified, granted, 

6 loaned, or appropriated whereby the Department’s 

7 applicable policies, rules, and regulations shall apply 

8 in the implementation of such projects; 

9 ‘‘(7) the Secretary of Health and Human Serv10 ices shall enter into interagency agreements with 

11 Federal and State agencies for the purpose of pro12 viding financial assistance for sanitation facilities 

13 and services under this Act; 

14 ‘‘(8) the Secretary of Health and Human Serv15 ices shall, by regulation, establish standards applica16 ble to the planning, design, and construction of sani17 tation facilities funded under this Act; and 

18 ‘‘(9) the Secretary of Health and Human Serv19 ices is authorized to accept payments for goods and 

20 services furnished by the Service from appropriate 

21 public authorities, nonprofit organizations or agen22 cies, or Indian Tribes, as contributions by that au23 thority, organization, agency, or tribe to agreements 

24 made under section 7 of the Act of August 5, 1954 

25 (42 U.S.C. 2004a), and such payments shall be 


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1 credited to the same or subsequent appropriation ac2 count as funds appropriated under the authority of 

3 section 7 of the Act of August 5, 1954 (42 U.S.C. 

4 2004a). 

5 ‘‘(d) CERTAIN CAPABILITIES NOT PREREQUISITE.— 

6 The financial and technical capability of an Indian Tribe, 

7 Tribal Organization, or Indian community to safely oper8 ate, manage, and maintain a sanitation facility shall not 

9 be a prerequisite to the provision or construction of sanita10 tion facilities by the Secretary. 

11 ‘‘(e) FINANCIAL ASSISTANCE.—The Secretary is au12 thorized to provide financial assistance to Indian Tribes, 

13 Tribal Organizations, and Indian communities for oper14 ation, management, and maintenance of their sanitation 

15 facilities. 

16 ‘‘(f) OPERATION, MANAGEMENT, AND MAINTENANCE

17 OF FACILITIES.—The Indian Tribe has the primary re18 sponsibility to establish, collect, and use reasonable user 

19 fees, or otherwise set aside funding, for the purpose of 

20 operating, managing, and maintaining sanitation facilities. 

21 If a sanitation facility serving a community that is oper22 ated by an Indian Tribe or Tribal Organization is threat23 ened with imminent failure and such operator lacks capac24 ity to maintain the integrity or the health benefits of the 

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1 sist the Indian Tribe, Tribal Organization, or Indian com2 munity in the resolution of the problem on a short-term 

3 basis through cooperation with the emergency coordinator 

4 or by providing operation, management, and maintenance 

5 service. 

6 ‘‘(g) ISDEAA PROGRAM FUNDED ON EQUAL

7 BASIS.—Tribal Health Programs shall be eligible (on an 

8 equal basis with programs that are administered directly 

9 by the Service) for— 

10 ‘‘(1) any funds appropriated pursuant to this 

11 section; and 

12 ‘‘(2) any funds appropriated for the purpose of 

13 providing sanitation facilities. 

14 ‘‘(h) REPORT.— 

15 ‘‘(1) REQUIRED; CONTENTS.—The Secretary, in 

16 consultation with the Secretary of Housing and 

17 Urban Development, Indian Tribes, Tribal Organiza18 tions, and tribally designated housing entities (as de19 fined in section 4 of the Native American Housing 

20 Assistance and Self-Determination Act of 1996 (25 

21 U.S.C. 4103)) shall submit to the President, for in22 clusion in the report required to be transmitted to 

23 Congress under section 801, a report which sets 

24 forth— 


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1 ‘‘(A) the current Indian sanitation facility 

2 priority system of the Service; 

3 ‘‘(B) the methodology for determining 

4 sanitation deficiencies and needs; 

5 ‘‘(C) the criteria on which the deficiencies 

6 and needs will be evaluated; 

7 ‘‘(D) the level of initial and final sanitation 

8 deficiency for each type of sanitation facility for 

9 each project of each Indian Tribe or Indian 

10 community; 

11 ‘‘(E) the amount and most effective use of 

12 funds, derived from whatever source, necessary 

13 to accommodate the sanitation facilities needs 

14 of new homes assisted with funds under the 

15 Native American Housing Assistance and Self16 Determination Act (25 U.S.C. 4101 et seq.), 

17 and to reduce the identified sanitation defi18 ciency levels of all Indian Tribes and Indian 

19 communities to level I sanitation deficiency as 

20 defined in paragraph (3)(A); and 

21 ‘‘(F) a 10-year plan to provide sanitation 

22 facilities to serve existing Indian homes and In23 dian communities and new and renovated In24 dian homes. 


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1 ‘‘(2) UNIFORM METHODOLOGY.—The method2 ology used by the Secretary in determining, pre3 paring cost estimates for, and reporting sanitation 

4 deficiencies for purposes of paragraph (1) shall be 

5 applied uniformly to all Indian Tribes and Indian 

6 communities. 

7 ‘‘(3) SANITATION DEFICIENCY LEVELS.—For 

8 purposes of this subsection, the sanitation deficiency 

9 levels for an individual, Indian Tribe, or Indian com10 munity sanitation facility to serve Indian homes are 

11 determined as follows: 

12 ‘‘(A) A level I deficiency exists if a sanita13 tion facility serving an individual, Indian Tribe, 

14 or Indian community— 

15 ‘‘(i) complies with all applicable water 

16 supply, pollution control, and solid waste 

17 disposal laws; and 

18 ‘‘(ii) deficiencies relate to routine re19 placement, repair, or maintenance needs. 

20 ‘‘(B) A level II deficiency exists if a sanita21 tion facility serving an individual, Indian Tribe, 

22 or Indian community substantially or recently 

23 complied with all applicable water supply, pollu24 tion control, and solid waste laws and any defi25 ciencies relate to— 


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1 ‘‘(i) small or minor capital improve2 ments needed to bring the facility back 

3 into compliance; 

4 ‘‘(ii) capital improvements that are 

5 necessary to enlarge or improve the facili6 ties in order to meet the current needs for 

7 domestic sanitation facilities; or 

8 ‘‘(iii) the lack of equipment or train9 ing by an Indian Tribe, Tribal Organiza10 tion, or an Indian community to properly 

11 operate and maintain the sanitation facili12 ties. 

13 ‘‘(C) A level III deficiency exists if a sani14 tation facility serving an individual, Indian 

15 Tribe or Indian community meets 1 or more of 

16 the following conditions— 

17 ‘‘(i) water or sewer service in the 

18 home is provided by a haul system with 

19 holding tanks and interior plumbing; 

20 ‘‘(ii) major significant interruptions to 

21 water supply or sewage disposal occur fre22 quently, requiring major capital improve23 ments to correct the deficiencies; or 


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1 ‘‘(iii) there is no access to or no ap2 proved or permitted solid waste facility 

3 available. 

4 ‘‘(D) A level IV deficiency exists— 

5 ‘‘(i) if a sanitation facility for an indi6 vidual home, an Indian Tribe, or an Indian 

7 community exists but— 

8 ‘‘(I) lacks— 

9 ‘‘(aa) a safe water supply 

10 system; or 

11 ‘‘(bb) a waste disposal sys12 tem; 

13 ‘‘(II) contains no piped water or 

14 sewer facilities; or 

15 ‘‘(III) has become inoperable due 

16 to a major component failure; or 

17 ‘‘(ii) if only a washeteria or central fa18 cility exists in the community. 

19 ‘‘(E) A level V deficiency exists in the ab20 sence of a sanitation facility, where individual 

21 homes do not have access to safe drinking 

22 water or adequate wastewater (including sew23 age) disposal. 

24 ‘‘(i) DEFINITIONS.—For purposes of this section, the 

25 following terms apply: 


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1 ‘‘(1) INDIAN COMMUNITY.—The term ‘Indian 

2 community’ means a geographic area, a significant 

3 proportion of whose inhabitants are Indians and 

4 which is served by or capable of being served by a 

5 facility described in this section. 

6 ‘‘(2) SANITATION FACILITIES.—The terms 

7 ‘sanitation facility’ and ‘sanitation facilities’ mean 

8 safe and adequate water supply systems, sanitary 

9 sewage disposal systems, and sanitary solid waste 

10 systems (and all related equipment and support in11 frastructure). 

12 ‘‘SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS. 

13 ‘‘(a) BUY INDIAN ACT.—The Secretary, acting 

14 through the Service, may use the negotiating authority of 

15 section 23 of the Act of June 25, 1910 (25 U.S.C. 47, 

16 commonly known as the ‘Buy Indian Act’), to give pref17 erence to any Indian or any enterprise, partnership, cor18 poration, or other type of business organization owned and 

19 controlled by an Indian or Indians including former or 

20 currently federally recognized Indian Tribes in the State 

21 of New York (hereinafter referred to as an ‘Indian firm’) 

22 in the construction and renovation of Service facilities pur23 suant to section 301 and in the construction of sanitation 

24 facilities pursuant to section 302. Such preference may be 

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1 suant to regulations, that the project or function to be 

2 contracted for will not be satisfactory or such project or 

3 function cannot be properly completed or maintained 

4 under the proposed contract. The Secretary, in arriving 

5 at such a finding, shall consider whether the Indian or 

6 Indian firm will be deficient with respect to— 

7 ‘‘(1) ownership and control by Indians; 

8 ‘‘(2) equipment; 

9 ‘‘(3) bookkeeping and accounting procedures; 

10 ‘‘(4) substantive knowledge of the project or 

11 function to be contracted for; 

12 ‘‘(5) adequately trained personnel; or 

13 ‘‘(6) other necessary components of contract 

14 performance. 

15 ‘‘(b) LABOR STANDARDS.— 

16 ‘‘(1) IN GENERAL.—For the purposes of imple17 menting the provisions of this title, contracts for the 

18 construction or renovation of health care facilities, 

19 staff quarters, and sanitation facilities, and related 

20 support infrastructure, funded in whole or in part 

21 with funds made available pursuant to this title, 

22 shall contain a provision requiring compliance with 

23 subchapter IV of chapter 31 of title 40, United 

24 States Code (commonly known as the ‘Davis-Bacon 

25 Act’), unless such construction or renovation— 


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1 ‘‘(A) is performed by a contractor pursu2 ant to a contract with an Indian Tribe or Trib3 al Organization with funds supplied through a 

4 contract or compact authorized by the Indian 

5 Self-Determination and Education Assistance 

6 Act (25 U.S.C. 450 et seq.), or other statutory 

7 authority; and 

8 ‘‘(B) is subject to prevailing wage rates for 

9 similar construction or renovation in the locality 

10 as determined by the Indian Tribes or Tribal 

11 Organizations to be served by the construction 

12 or renovation. 

13 ‘‘(2) EXCEPTION.—This subsection shall not 

14 apply to construction or renovation carried out by an 

15 Indian Tribe or Tribal Organization with its own 

16 employees. 

17 ‘‘SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR 

18 RENOVATION. 

19 ‘‘(a) IN GENERAL.—Notwithstanding any other pro20 vision of law, if the requirements of subsection (c) are met, 

21 the Secretary, acting through the Service, is authorized 

22 to accept any major expansion, renovation, or moderniza23 tion by any Indian Tribe or Tribal Organization of any 

24 Service facility or of any other Indian health facility oper25 ated pursuant to a contract or compact under the Indian 


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1 Self-Determination and Education Assistance Act (25 

2 U.S.C. 450 et seq.), including— 

3 ‘‘(1) any plans or designs for such expansion, 

4 renovation, or modernization; and 

5 ‘‘(2) any expansion, renovation, or moderniza6 tion for which funds appropriated under any Federal 

7 law were lawfully expended. 

8 ‘‘(b) PRIORITY LIST.— 

9 ‘‘(1) IN GENERAL.—The Secretary shall main10 tain a separate priority list to address the needs for 

11 increased operating expenses, personnel, or equip12 ment for such facilities. The methodology for estab13 lishing priorities shall be developed through regula14 tions. The list of priority facilities will be revised an15 nually in consultation with Indian Tribes and Tribal 

16 Organizations. 

17 ‘‘(2) REPORT.—The Secretary shall submit to 

18 the President, for inclusion in the report required to 

19 be transmitted to Congress under section 801, the 

20 priority list maintained pursuant to paragraph (1). 

21 ‘‘(c) REQUIREMENTS.—The requirements of this sub22 section are met with respect to any expansion, renovation, 

23 or modernization if— 

24 ‘‘(1) the Indian Tribe or Tribal Organization— 


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1 ‘‘(A) provides notice to the Secretary of its 

2 intent to expand, renovate, or modernize; and 

3 ‘‘(B) applies to the Secretary to be placed 

4 on a separate priority list to address the needs 

5 of such new facilities for increased operating ex6 penses, personnel, or equipment; and 

7 ‘‘(2) the expansion, renovation, or moderniza8 tion— 

9 ‘‘(A) is approved by the appropriate area 

10 director of the Service for Federal facilities; and 

11 ‘‘(B) is administered by the Indian Tribe 

12 or Tribal Organization in accordance with any 

13 applicable regulations prescribed by the Sec14 retary with respect to construction or renova15 tion of Service facilities. 

16 ‘‘(d) ADDITIONAL REQUIREMENT FOR EXPANSION.— 

17 In addition to the requirements under subsection (c), for 

18 any expansion, the Indian Tribe or Tribal Organization 

19 shall provide to the Secretary additional information pur20 suant to regulations, including additional staffing, equip21 ment, and other costs associated with the expansion. 

22 ‘‘(e) CLOSURE OR CONVERSION OF FACILITIES.—If 

23 any Service facility which has been expanded, renovated, 

24 or modernized by an Indian Tribe or Tribal Organization 

25 under this section ceases to be used as a Service facility 


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1 during the 20-year period beginning on the date such ex2 pansion, renovation, or modernization is completed, such 

3 Indian Tribe or Tribal Organization shall be entitled to 

4 recover from the United States an amount which bears 

5 the same ratio to the value of such facility at the time 

6 of such cessation as the value of such expansion, renova7 tion, or modernization (less the total amount of any funds 

8 provided specifically for such facility under any Federal 

9 program that were expended for such expansion, renova10 tion, or modernization) bore to the value of such facility 

11 at the time of the completion of such expansion, renova12 tion, or modernization. 

13 ‘‘SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, 

14 AND MODERNIZATION OF SMALL AMBULA15 TORY CARE FACILITIES. 

16 ‘‘(a) GRANTS.— 

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

18 through the Service, shall make grants to Indian 

19 Tribes and Tribal Organizations for the construc20 tion, expansion, or modernization of facilities for the 

21 provision of ambulatory care services to eligible Indi22 ans (and noneligible persons pursuant to subsections 

23 (b)(2) and (c)(1)(C)). A grant made under this sec24 tion may cover up to 100 percent of the costs of 

25 such construction, expansion, or modernization. For 


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1 the purposes of this section, the term ‘construction’ 

2 includes the replacement of an existing facility. 

3 ‘‘(2) GRANT AGREEMENT REQUIRED.—A grant 

4 under paragraph (1) may only be made available to 

5 a Tribal Health Program operating an Indian health 

6 facility (other than a facility owned or constructed 

7 by the Service, including a facility originally owned 

8 or constructed by the Service and transferred to an 

9 Indian Tribe or Tribal Organization). 

10 ‘‘(b) USE OF GRANT FUNDS.— 

11 ‘‘(1) ALLOWABLE USES.—A grant awarded 

12 under this section may be used for the construction, 

13 expansion, or modernization (including the planning 

14 and design of such construction, expansion, or mod15 ernization) of an ambulatory care facility— 

16 ‘‘(A) located apart from a hospital; 

17 ‘‘(B) not funded under section 301 or sec18 tion 307; and 

19 ‘‘(C) which, upon completion of such con20 struction or modernization will— 

21 ‘‘(i) have a total capacity appropriate 

22 to its projected service population; 

23 ‘‘(ii) provide annually no fewer than 

24 150 patient visits by eligible Indians and 

25 other users who are eligible for services in 


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1 such facility in accordance with section 

2 807(c)(2); and 

3 ‘‘(iii) provide ambulatory care in a 

4 Service Area (specified in the contract or 

5 compact under the Indian Self-Determina6 tion and Education Assistance Act (25 

7 U.S.C. 450 et seq.)) with a population of 

8 no fewer than 1,500 eligible Indians and 

9 other users who are eligible for services in 

10 such facility in accordance with section 

11 807(c)(2). 

12 ‘‘(2) ADDITIONAL ALLOWABLE USE.—The Sec13 retary may also reserve a portion of the funding pro14 vided under this section and use those reserved 

15 funds to reduce an outstanding debt incurred by In16 dian Tribes or Tribal Organizations for the con17 struction, expansion, or modernization of an ambula18 tory care facility that meets the requirements under 

19 paragraph (1). The provisions of this section shall 

20 apply, except that such applications for funding 

21 under this paragraph shall be considered separately 

22 from applications for funding under paragraph (1). 

23 ‘‘(3) USE ONLY FOR CERTAIN PORTION OF

24 COSTS.—A grant provided under this section may be 

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1 tion, expansion, or modernization project that bene2 fits the Service population identified above in sub3 section (b)(1)(C) (ii) and (iii). The requirements of 

4 clauses (ii) and (iii) of paragraph (1)(C) shall not 

5 apply to an Indian Tribe or Tribal Organization ap6 plying for a grant under this section for a health 

7 care facility located or to be constructed on an is8 land or when such facility is not located on a road 

9 system providing direct access to an inpatient hos10 pital where care is available to the Service popu11 lation. 

12 ‘‘(c) GRANTS.— 

13 ‘‘(1) APPLICATION.—No grant may be made 

14 under this section unless an application or proposal 

15 for the grant has been approved by the Secretary in 

16 accordance with applicable regulations and has set 

17 forth reasonable assurance by the applicant that, at 

18 all times after the construction, expansion, or mod19 ernization of a facility carried out using a grant re20 ceived under this section— 

21 ‘‘(A) adequate financial support will be 

22 available for the provision of services at such 

23 facility; 


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1 ‘‘(B) such facility will be available to eligi2 ble Indians without regard to ability to pay or 

3 source of payment; and 

4 ‘‘(C) such facility will, as feasible without 

5 diminishing the quality or quantity of services 

6 provided to eligible Indians, serve noneligible 

7 persons on a cost basis. 

8 ‘‘(2) PRIORITY.—In awarding grants under this 

9 section, the Secretary shall give priority to Indian 

10 Tribes and Tribal Organizations that demonstrate— 

11 ‘‘(A) a need for increased ambulatory care 

12 services; and 

13 ‘‘(B) insufficient capacity to deliver such 

14 services. 

15 ‘‘(3) PEER REVIEW PANELS.—The Secretary 

16 may provide for the establishment of peer review 

17 panels, as necessary, to review and evaluate applica18 tions and proposals and to advise the Secretary re19 garding such applications using the criteria devel20 oped pursuant to subsection (a)(1). 

21 ‘‘(d) REVERSION OF FACILITIES.—If any facility (or 

22 portion thereof) with respect to which funds have been 

23 paid under this section, ceases, at any time after comple24 tion of the construction, expansion, or modernization car25 ried out with such funds, to be used for the purposes of 


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1 providing health care services to eligible Indians, all of the 

2 right, title, and interest in and to such facility (or portion 

3 thereof) shall transfer to the United States unless other4 wise negotiated by the Service and the Indian Tribe or 

5 Tribal Organization. 

6 ‘‘(e) FUNDING NONRECURRING.—Funding provided 

7 under this section shall be nonrecurring and shall not be 

8 available for inclusion in any individual Indian Tribe’s 

9 tribal share for an award under the Indian Self-Deter10 mination and Education Assistance Act (25 U.S.C. 450 

11 et seq.) or for reallocation or redesign thereunder. 

12 ‘‘SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRA13 TION PROJECT. 

14 ‘‘(a) HEALTH CARE DEMONSTRATION PROJECTS.— 

15 The Secretary, acting through the Service, is authorized 

16 to enter into construction agreements under the Indian 

17 Self-Determination and Education Assistance Act (25 

18 U.S.C. 450 et seq.) with Indian Tribes or Tribal Organiza19 tions for the purpose of carrying out a health care delivery 

20 demonstration project to test alternative means of deliv21 ering health care and services to Indians through facilities. 

22 ‘‘(b) USE OF FUNDS.—The Secretary, in approving 

23 projects pursuant to this section, may authorize funding 

24 for the construction and renovation of hospitals, health 


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1 centers, health stations, and other facilities to deliver 

2 health care services and is authorized to— 

3 ‘‘(1) waive any leasing prohibition; 

4 ‘‘(2) permit carryover of funds appropriated for 

5 the provision of health care services; 

6 ‘‘(3) permit the use of other available funds; 

7 ‘‘(4) permit the use of funds or property do8 nated from any source for project purposes; 

9 ‘‘(5) provide for the reversion of donated real or 

10 personal property to the donor; and 

11 ‘‘(6) permit the use of Service funds to match 

12 other funds, including Federal funds. 

13 ‘‘(c) REGULATIONS.—The Secretary shall develop 

14 and promulgate regulations, not later than 1 year after 

15 the date of enactment of the Indian Health Care Improve16 ment Act Amendments of 2006, for the review and ap17 proval of applications submitted under this section. 

18 ‘‘(d) CRITERIA.—The Secretary may approve projects 

19 that meet the following criteria: 

20 ‘‘(1) There is a need for a new facility or pro21 gram or the reorientation of an existing facility or 

22 program. 

23 ‘‘(2) A significant number of Indians, including 

24 those with low health status, will be served by the 

25 project. 


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1 ‘‘(3) The project has the potential to deliver 

2 services in an efficient and effective manner. 

3 ‘‘(4) The project is economically viable. 

4 ‘‘(5) The Indian Tribe or Tribal Organization 

5 has the administrative and financial capability to ad6 minister the project. 

7 ‘‘(6) The project is integrated with providers of 

8 related health and social services and is coordinated 

9 with, and avoids duplication of, existing services. 

10 ‘‘(e) PEER REVIEW PANELS.—The Secretary may 

11 provide for the establishment of peer review panels, as nec12 essary, to review and evaluate applications using the cri13 teria developed pursuant to subsection (d). 

14 ‘‘(f) PRIORITY.—The Secretary shall give priority to 

15 applications for demonstration projects in each of the fol16 lowing Service Units to the extent that such applications 

17 are timely filed and meet the criteria specified in sub18 section (d): 

19 ‘‘(1) Cass Lake, Minnesota. 

20 ‘‘(2) Clinton, Oklahoma. 

21 ‘‘(3) Harlem, Montana. 

22 ‘‘(4) Mescalero, New Mexico. 

23 ‘‘(5) Owyhee, Nevada. 

24 ‘‘(6) Parker, Arizona. 

25 ‘‘(7) Schurz, Nevada. 


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1 ‘‘(8) Winnebago, Nebraska. 

2 ‘‘(9) Ft. Yuma, California. 

3 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 

4 provide such technical and other assistance as may be nec5 essary to enable applicants to comply with the provisions 

6 of this section. 

7 ‘‘(h) SERVICE TO INELIGIBLE PERSONS.—Subject to 

8 section 807, the authority to provide services to persons 

9 otherwise ineligible for the health care benefits of the 

10 Service and the authority to extend hospital privileges in 

11 Service facilities to non-Service health practitioners as 

12 provided in section 807 may be included, subject to the 

13 terms of such section, in any demonstration project ap14 proved pursuant to this section. 

15 ‘‘(i) EQUITABLE TREATMENT.—For purposes of sub16 section (d)(1), the Secretary shall, in evaluating facilities 

17 operated under any contract or compact under the Indian 

18 Self-Determination and Education Assistance Act (25 

19 U.S.C. 450 et seq.), use the same criteria that the Sec20 retary uses in evaluating facilities operated directly by the 

21 Service. 

22 ‘‘(j) EQUITABLE INTEGRATION OF FACILITIES.—The 

23 Secretary shall ensure that the planning, design, construc24 tion, renovation, and expansion needs of Service and non25 Service facilities which are the subject of a contract or 


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1 compact under the Indian Self-Determination and Edu2 cation Assistance Act (25 U.S.C. 450 et seq.) for health 

3 services are fully and equitably integrated into the imple4 mentation of the health care delivery demonstration 

5 projects under this section. 

6 ‘‘SEC. 307. LAND TRANSFER. 

7 ‘‘Notwithstanding any other provision of law, the Bu8 reau of Indian Affairs and all other agencies and depart9 ments of the United States are authorized to transfer, at 

10 no cost, land and improvements to the Service for the pro11 vision of health care services. The Secretary is authorized 

12 to accept such land and improvements for such purposes. 

13 ‘‘SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS. 

14 ‘‘The Secretary, acting through the Service, may 

15 enter into leases, contracts, and other agreements with In16 dian Tribes and Tribal Organizations which hold (1) title 

17 to, (2) a leasehold interest in, or (3) a beneficial interest 

18 in (when title is held by the United States in trust for 

19 the benefit of an Indian Tribe) facilities used or to be used 

20 for the administration and delivery of health services by 

21 an Indian Health Program. Such leases, contracts, or 

22 agreements may include provisions for construction or ren23 ovation and provide for compensation to the Indian Tribe 

24 or Tribal Organization of rental and other costs consistent 

25 with section 105(l) of the Indian Self-Determination and 


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1 Education Assistance Act (25 U.S.C. 450j(l)) and regula2 tions thereunder. 

3 ‘‘SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND 

4 LOAN REPAYMENT. 

5 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

6 with the Secretary of the Treasury, Indian Tribes, and 

7 Tribal Organizations, shall carry out a study to determine 

8 the feasibility of establishing a loan fund to provide to In9 dian Tribes and Tribal Organizations direct loans or guar10 antees for loans for the construction of health care facili11 ties, including— 

12 ‘‘(1) inpatient facilities; 

13 ‘‘(2) outpatient facilities; 

14 ‘‘(3) staff quarters; 

15 ‘‘(4) hostels; and 

16 ‘‘(5) specialized care facilities, such as behav17 ioral health and elder care facilities. 

18 ‘‘(b) DETERMINATIONS.—In carrying out the study 

19 under subsection (a), the Secretary shall determine— 

20 ‘‘(1) the maximum principal amount of a loan 

21 or loan guarantee that should be offered to a recipi22 ent from the loan fund; 

23 ‘‘(2) the percentage of eligible costs, not to ex24 ceed 100 percent, that may be covered by a loan or 

25 loan guarantee from the loan fund (including costs 


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1 relating to planning, design, financing, site land de2 velopment, construction, rehabilitation, renovation, 

3 conversion, improvements, medical equipment and 

4 furnishings, and other facility-related costs and cap5 ital purchase (but excluding staffing)); 

6 ‘‘(3) the cumulative total of the principal of di7 rect loans and loan guarantees, respectively, that 

8 may be outstanding at any 1 time; 

9 ‘‘(4) the maximum term of a loan or loan guar10 antee that may be made for a facility from the loan 

11 fund; 

12 ‘‘(5) the maximum percentage of funds from 

13 the loan fund that should be allocated for payment 

14 of costs associated with planning and applying for a 

15 loan or loan guarantee; 

16 ‘‘(6) whether acceptance by the Secretary of an 

17 assignment of the revenue of an Indian Tribe or 

18 Tribal Organization as security for any direct loan 

19 or loan guarantee from the loan fund would be ap20 propriate; 

21 ‘‘(7) whether, in the planning and design of 

22 health facilities under this section, users eligible 

23 under section 807(c) may be included in any projec24 tion of patient population; 


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1 ‘‘(8) whether funds of the Service provided 

2 through loans or loan guarantees from the loan fund 

3 should be eligible for use in matching other Federal 

4 funds under other programs; 

5 ‘‘(9) the appropriateness of, and best methods 

6 for, coordinating the loan fund with the health care 

7 priority system of the Service under section 301; and 

8 ‘‘(10) any legislative or regulatory changes re9 quired to implement recommendations of the Sec10 retary based on results of the study. 

11 ‘‘(c) REPORT.—Not later than September 30, 2008, 

12 the Secretary shall submit to the Committee on Indian Af13 fairs of the Senate and the Committee on Resources and 

14 the Committee on Energy and Commerce of the House 

15 of Representatives a report that describes— 

16 ‘‘(1) the manner of consultation made as re17 quired by subsection (a); and 

18 ‘‘(2) the results of the study, including any rec19 ommendations of the Secretary based on results of 

20 the study. 

21 ‘‘SEC. 310. TRIBAL LEASING. 

22 ‘‘A Tribal Health Program may lease permanent 

23 structures for the purpose of providing health care services 

24 without obtaining advance approval in appropriation Acts. 


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1 ‘‘SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES 

2 JOINT VENTURE PROGRAM. 

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

4 the Service, shall make arrangements with Indian Tribes 

5 and Tribal Organizations to establish joint venture dem6 onstration projects under which an Indian Tribe or Tribal 

7 Organization shall expend tribal, private, or other avail8 able funds, for the acquisition or construction of a health 

9 facility for a minimum of 10 years, under a no-cost lease, 

10 in exchange for agreement by the Service to provide the 

11 equipment, supplies, and staffing for the operation and 

12 maintenance of such a health facility. An Indian Tribe or 

13 Tribal Organization may use tribal funds, private sector, 

14 or other available resources, including loan guarantees, to 

15 fulfill its commitment under a joint venture entered into 

16 under this subsection. An Indian Tribe or Tribal Organi17 zation shall be eligible to establish a joint venture project 

18 if, when it submits a letter of intent, it— 

19 ‘‘(1) has begun but not completed the process 

20 of acquisition or construction of a health facility to 

21 be used in the joint venture project; or 

22 ‘‘(2) has not begun the process of acquisition or 

23 construction of a health facility for use in the joint 

24 venture project. 


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1 ‘‘(b) REQUIREMENTS.—The Secretary shall make 

2 such an arrangement with an Indian Tribe or Tribal Orga3 nization only if— 

4 ‘‘(1) the Secretary first determines that the In5 dian Tribe or Tribal Organization has the adminis6 trative and financial capabilities necessary to com7 plete the timely acquisition or construction of the 

8 relevant health facility; and 

9 ‘‘(2) the Indian Tribe or Tribal Organization 

10 meets the need criteria determined using the criteria 

11 developed under the health care facility priority sys12 tem under section 301, unless the Secretary deter13 mines, pursuant to regulations, that other criteria 

14 will result in a more cost-effective and efficient 

15 method of facilitating and completing construction of 

16 health care facilities. 

17 ‘‘(c) CONTINUED OPERATION.—The Secretary shall 

18 negotiate an agreement with the Indian Tribe or Tribal 

19 Organization regarding the continued operation of the fa20 cility at the end of the initial 10 year no-cost lease period. 

21 ‘‘(d) BREACH OF AGREEMENT.—An Indian Tribe or 

22 Tribal Organization that has entered into a written agree23 ment with the Secretary under this section, and that 

24 breaches or terminates without cause such agreement, 

25 shall be liable to the United States for the amount that 


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1 has been paid to the Indian Tribe or Tribal Organization, 

2 or paid to a third party on the Indian Tribe’s or Tribal 

3 Organization’s behalf, under the agreement. The Sec4 retary has the right to recover tangible property (including 

5 supplies) and equipment, less depreciation, and any funds 

6 expended for operations and maintenance under this sec7 tion. The preceding sentence does not apply to any funds 

8 expended for the delivery of health care services, per9 sonnel, or staffing. 

10 ‘‘(e) RECOVERY FOR NONUSE.—An Indian Tribe or 

11 Tribal Organization that has entered into a written agree12 ment with the Secretary under this subsection shall be en13 titled to recover from the United States an amount that 

14 is proportional to the value of such facility if, at any time 

15 within the 10-year term of the agreement, the Service 

16 ceases to use the facility or otherwise breaches the agree17 ment. 

18 ‘‘(f) DEFINITION.—For the purposes of this section, 

19 the term ‘health facility’ or ‘health facilities’ includes 

20 quarters needed to provide housing for staff of the rel21 evant Tribal Health Program. 

22 ‘‘SEC. 312. LOCATION OF FACILITIES. 

23 ‘‘(a) IN GENERAL.—In all matters involving the reor24 ganization or development of Service facilities or in the 

25 establishment of related employment projects to address 


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1 unemployment conditions in economically depressed areas, 

2 the Bureau of Indian Affairs and the Service shall give 

3 priority to locating such facilities and projects on Indian 

4 lands, or lands in Alaska owned by any Alaska Native vil5 lage, or village or regional corporation under the Alaska 

6 Native Claims Settlement Act (25 U.S.C. 1601 et seq.), 

7 or any land allotted to any Alaska Native, if requested 

8 by the Indian owner and the Indian Tribe with jurisdiction 

9 over such lands or other lands owned or leased by the In10 dian Tribe or Tribal Organization. Top priority shall be 

11 given to Indian land owned by 1 or more Indian Tribes. 

12 ‘‘(b) DEFINITION.—For purposes of this section, the 

13 term ‘Indian lands’ means— 

14 ‘‘(1) all lands within the exterior boundaries of 

15 any reservation; and 

16 ‘‘(2) any lands title to which is held in trust by 

17 the United States for the benefit of any Indian 

18 Tribe or individual Indian or held by any Indian 

19 Tribe or individual Indian subject to restriction by 

20 the United States against alienation. 

21 ‘‘SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH 

22 CARE FACILITIES. 

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

24 President, for inclusion in the report required to be trans25 mitted to Congress under section 801, a report which idenVerDate Aug 31 2005 02:12 Dec 13, 2006 Jkt 059200 PO 00000 Frm 00177 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 tifies the backlog of maintenance and repair work required 

2 at both Service and tribal health care facilities, including 

3 new health care facilities expected to be in operation in 

4 the next fiscal year. The report shall also identify the need 

5 for renovation and expansion of existing facilities to sup6 port the growth of health care programs. 

7 ‘‘(b) MAINTENANCE OF NEWLY CONSTRUCTED

8 SPACE.—The Secretary, acting through the Service, is au9 thorized to expend maintenance and improvement funds 

10 to support maintenance of newly constructed space only 

11 if such space falls within the approved supportable space 

12 allocation for the Indian Tribe or Tribal Organization. 

13 Supportable space allocation shall be defined through the 

14 health care facility priority system under section 301(c). 

15 ‘‘(c) REPLACEMENT FACILITIES.—In addition to 

16 using maintenance and improvement funds for renovation, 

17 modernization, and expansion of facilities, an Indian Tribe 

18 or Tribal Organization may use maintenance and improve19 ment funds for construction of a replacement facility if 

20 the costs of renovation of such facility would exceed a 

21 maximum renovation cost threshold. The maximum ren22 ovation cost threshold shall be determined through the ne23 gotiated rulemaking process provided for under section 

24 802. 


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1 ‘‘SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY-OWNED 

2 QUARTERS. 

3 ‘‘(a) RENTAL RATES.— 

4 ‘‘(1) ESTABLISHMENT.—Notwithstanding any 

5 other provision of law, a Tribal Health Program 

6 which operates a hospital or other health facility and 

7 the federally-owned quarters associated therewith 

8 pursuant to a contract or compact under the Indian 

9 Self-Determination and Education Assistance Act 

10 (25 U.S.C. 450 et seq.) shall have the authority to 

11 establish the rental rates charged to the occupants 

12 of such quarters by providing notice to the Secretary 

13 of its election to exercise such authority, provided 

14 that the method for establishing such rates be iden15 tified according to guidelines (such as OMB Circular 

16 A–45) which will ensure that rents shall be collected, 

17 that the rents are fair and reasonable, and that the 

18 tenants are not treated inequitably relative to other 

19 similar quarters, such as for the Bureau of Indian 

20 Affairs. 

21 ‘‘(2) OBJECTIVES.—In establishing rental rates 

22 pursuant to authority of this subsection, a Tribal 

23 Health Program shall endeavor to achieve the fol24 lowing objectives: 


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1 ‘‘(A) To base such rental rates on the rea2 sonable value of the quarters to the occupants 

3 thereof. 

4 ‘‘(B) To generate sufficient funds to pru5 dently provide for the operation and mainte6 nance of the quarters, and subject to the discre7 tion of the Tribal Health Program, to supply 

8 reserve funds for capital repairs and replace9 ment of the quarters. 

10 ‘‘(3) EQUITABLE FUNDING.—Any quarters 

11 whose rental rates are established by a Tribal 

12 Health Program pursuant to this subsection shall 

13 remain eligible for quarters improvement and repair 

14 funds to the same extent as all federally-owned quar15 ters used to house personnel in Services-supported 

16 programs. 

17 ‘‘(4) NOTICE OF RATE CHANGE.—A Tribal 

18 Health Program which exercises the authority pro19 vided under this subsection shall provide occupants 

20 with no less than 60 days notice of any change in 

21 rental rates. 

22 ‘‘(b) DIRECT COLLECTION OF RENT.— 

23 ‘‘(1) IN GENERAL.—Notwithstanding any other 

24 provision of law, and subject to paragraph (2), a 

25 Tribal Health Program shall have the authority to 


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1 collect rents directly from Federal employees who oc2 cupy such quarters in accordance with the following: 

3 ‘‘(A) The Tribal Health Program shall no4 tify the Secretary and the subject Federal em5 ployees of its election to exercise its authority 

6 to collect rents directly from such Federal em7 ployees. 

8 ‘‘(B) Upon receipt of a notice described in 

9 subparagraph (A), the Federal employees shall 

10 pay rents for occupancy of such quarters di11 rectly to the Tribal Health Program and the 

12 Secretary shall have no further authority to col13 lect rents from such employees through payroll 

14 deduction or otherwise. 

15 ‘‘(C) Such rent payments shall be retained 

16 by the Tribal Health Program and shall not be 

17 made payable to or otherwise be deposited with 

18 the United States. 

19 ‘‘(D) Such rent payments shall be depos20 ited into a separate account which shall be used 

21 by the Tribal Health Program for the mainte22 nance (including capital repairs and replace23 ment) and operation of the quarters and facili24 ties as the Tribal Health Program shall deter25 mine. 


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1 ‘‘(2) RETROCESSION OF AUTHORITY.—If a 

2 Tribal Health Program which has made an election 

3 under paragraph (1) requests retrocession of its au4 thority to directly collect rents from Federal employ5 ees occupying federally-owned quarters, such ret6 rocession shall become effective on the earlier of— 

7 ‘‘(A) the first day of the month that begins 

8 no less than 180 days after the Tribal Health 

9 Program notifies the Secretary of its desire to 

10 retrocede; or 

11 ‘‘(B) such other date as may be mutually 

12 agreed by the Secretary and the Tribal Health 

13 Program. 

14 ‘‘(c) RATES IN ALASKA.—To the extent that a Tribal 

15 Health Program, pursuant to authority granted in sub16 section (a), establishes rental rates for federally-owned 

17 quarters provided to a Federal employee in Alaska, such 

18 rents may be based on the cost of comparable private rent19 al housing in the nearest established community with a 

20 year-round population of 1,500 or more individuals. 

21 ‘‘SEC. 315. APPLICABILITY OF BUY AMERICAN ACT RE22 QUIREMENT. 

23 ‘‘(a) APPLICABILITY.—The Secretary shall ensure 

24 that the requirements of the Buy American Act apply to 

25 all procurements made with funds provided pursuant to 


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1 section 317. Indian Tribes and Tribal Organizations shall 

2 be exempt from these requirements. 

3 ‘‘(b) EFFECT OF VIOLATION.—If it has been finally 

4 determined by a court or Federal agency that any person 

5 intentionally affixed a label bearing a ‘Made in America’ 

6 inscription or any inscription with the same meaning, to 

7 any product sold in or shipped to the United States that 

8 is not made in the United States, such person shall be 

9 ineligible to receive any contract or subcontract made with 

10 funds provided pursuant to section 317, pursuant to the 

11 debarment, suspension, and ineligibility procedures de12 scribed in sections 9.400 through 9.409 of title 48, Code 

13 of Federal Regulations. 

14 ‘‘(c) DEFINITIONS.—For purposes of this section, the 

15 term ‘Buy American Act’ means title III of the Act enti16 tled ‘An Act making appropriations for the Treasury and 

17 Post Office Departments for the fiscal year ending June 

18 30, 1934, and for other purposes’, approved March 3, 

19 1933 (41 U.S.C. 10a et seq.). 

20 ‘‘SEC. 316. OTHER FUNDING FOR FACILITIES. 

21 ‘‘(a) AUTHORITY TO ACCEPT FUNDS.—The Sec22 retary is authorized to accept from any source, including 

23 Federal and State agencies, funds that are available for 

24 the construction of health care facilities and use such 

25 funds to plan, design, and construct health care facilities 


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1 for Indians and to place such funds into a contract or com2 pact under the Indian Self-Determination and Education 

3 Assistance Act (25 U.S.C. 450 et seq.). Receipt of such 

4 funds shall have no effect on the priorities established pur5 suant to section 301. 

6 ‘‘(b) INTERAGENCY AGREEMENTS.—The Secretary is 

7 authorized to enter into interagency agreements with 

8 other Federal agencies or State agencies and other entities 

9 and to accept funds from such Federal or State agencies 

10 or other sources to provide for the planning, design, and 

11 construction of health care facilities to be administered by 

12 Indian Health Programs in order to carry out the pur13 poses of this Act and the purposes for which the funds 

14 were appropriated or for which the funds were otherwise 

15 provided. 

16 ‘‘(c) ESTABLISHMENT OF STANDARDS.—The Sec17 retary, through the Service, shall establish standards by 

18 regulation for the planning, design, and construction of 

19 health care facilities serving Indians under this Act. 

20 ‘‘SEC. 317. AUTHORIZATION OF APPROPRIATIONS. 

21 ‘‘There are authorized to be appropriated such sums 

22 as may be necessary for each fiscal year through fiscal 

23 year 2016 to carry out this title. 


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1 ‘‘TITLE IV—ACCESS TO HEALTH 

2 SERVICES 

3 ‘‘SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SE4 CURITY ACT HEALTH BENEFITS PROGRAMS. 

5 ‘‘(a) DISREGARD OF MEDICARE, MEDICAID, AND

6 SCHIP PAYMENTS IN DETERMINING APPROPRIATIONS.— 

7 Any payments received by an Indian Health Program or 

8 by an Urban Indian Organization under title XVIII, XIX, 

9 or XXI of the Social Security Act for services provided 

10 to Indians eligible for benefits under such respective titles 

11 shall not be considered in determining appropriations for 

12 the provision of health care and services to Indians. 

13 ‘‘(b) NONPREFERENTIAL TREATMENT.—Nothing in 

14 this Act authorizes the Secretary to provide services to an 

15 Indian with coverage under title XVIII, XIX, or XXI of 

16 the Social Security Act in preference to an Indian without 

17 such coverage. 

18 ‘‘(c) USE OF FUNDS.— 

19 ‘‘(1) SPECIAL FUND.— 

20 ‘‘(A) 100 PERCENT PASS-THROUGH OF

21 PAYMENTS DUE TO FACILITIES.—Notwith22 standing any other provision of law, but subject 

23 to paragraph (2), payments to which a facility 

24 of the Service is entitled by reason of a provi25 sion of the Social Security Act shall be placed 


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1 in a special fund to be held by the Secretary. 

2 In making payments from such fund, the Sec3 retary shall ensure that each Service Unit of 

4 the Service receives 100 percent of the amount 

5 to which the facilities of the Service, for which 

6 such Service Unit makes collections, are enti7 tled by reason of a provision of the Social Secu8 rity Act. 

9 ‘‘(B) USE OF FUNDS.—Amounts received 

10 by a facility of the Service under subparagraph 

11 (A) shall first be used (to such extent or in 

12 such amounts as are provided in appropriation 

13 Acts) for the purpose of making any improve14 ments in the programs of the Service operated 

15 by or through such facility which may be nec16 essary to achieve or maintain compliance with 

17 the applicable conditions and requirements of 

18 titles XVIII and XIX of the Social Security 

19 Act. Any amounts so received that are in excess 

20 of the amount necessary to achieve or maintain 

21 such conditions and requirements shall, subject 

22 to consultation with the Indian Tribes being 

23 served by the Service Unit, be used for reducing 

24 the health resource deficiencies (as determined 

25 under section 201(d)) of such Indian Tribes. 


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1 ‘‘(2) DIRECT PAYMENT OPTION.—Paragraph 

2 (1) shall not apply to a Tribal Health Program upon 

3 the election of such Program under subsection (d) to 

4 receive payments directly. No payment may be made 

5 out of the special fund described in such paragraph 

6 with respect to reimbursement made for services 

7 provided by such Program during the period of such 

8 election. 

9 ‘‘(d) DIRECT BILLING.— 

10 ‘‘(1) IN GENERAL.—Subject to complying with 

11 the requirements of paragraph (2), a Tribal Health 

12 Program may elect to directly bill for, and receive 

13 payment for, health care items and services provided 

14 by such Program for which payment is made under 

15 title XVIII or XIX of the Social Security Act or 

16 from any other third party payor. 

17 ‘‘(2) DIRECT REIMBURSEMENT.— 

18 ‘‘(A) USE OF FUNDS.—Each Tribal Health 

19 Program making the election described in para20 graph (1) with respect to a program under a 

21 title of the Social Security Act shall be reim22 bursed directly by that program for items and 

23 services furnished without regard to subsection 

24 (c)(1), but all amounts so reimbursed shall be 

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1 pose of making any improvements in facilities 

2 of the Tribal Health Program that may be nec3 essary to achieve or maintain compliance with 

4 the conditions and requirements applicable gen5 erally to such items and services under the pro6 gram under such title and to provide additional 

7 health care services, improvements in health 

8 care facilities and Tribal Health Programs, any 

9 health care related purpose, or otherwise to 

10 achieve the objectives provided in section 3 of 

11 this Act. 

12 ‘‘(B) AUDITS.—The amounts paid to a 

13 Tribal Health Program making the election de14 scribed in paragraph (1) with respect to a pro15 gram under a title of the Social Security Act 

16 shall be subject to all auditing requirements ap17 plicable to the program under such title, as well 

18 as all auditing requirements applicable to pro19 grams administered by an Indian Health Pro20 gram. Nothing in the preceding sentence shall 

21 be construed as limiting the application of au22 diting requirements applicable to amounts paid 

23 under title XVIII, XIX, or XXI of the Social 

24 Security Act. 


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1 ‘‘(C) IDENTIFICATION OF SOURCE OF PAY2 MENTS.—Any Tribal Health Program that re3 ceives reimbursements or payments under title 

4 XVIII, XIX, or XXI of the Social Security Act, 

5 shall provide to the Service a list of each pro6 vider enrollment number (or other identifier) 

7 under which such Program receives such reim8 bursements or payments. 

9 ‘‘(3) EXAMINATION AND IMPLEMENTATION OF

10 CHANGES.— 

11 ‘‘(A) IN GENERAL.—The Secretary, acting 

12 through the Service and with the assistance of 

13 the Administrator of the Centers for Medicare 

14 & Medicaid Services, shall examine on an ongo15 ing basis and implement any administrative 

16 changes that may be necessary to facilitate di17 rect billing and reimbursement under the pro18 gram established under this subsection, includ19 ing any agreements with States that may be 

20 necessary to provide for direct billing under a 

21 program under a title of the Social Security 

22 Act. 

23 ‘‘(B) COORDINATION OF INFORMATION.— 

24 The Service shall provide the Administrator of 

25 the Centers for Medicare & Medicaid Services 


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1 with copies of the lists submitted to the Service 

2 under paragraph (2)(C), enrollment data re3 garding patients served by the Service (and by 

4 Tribal Health Programs, to the extent such 

5 data is available to the Service), and such other 

6 information as the Administrator may require 

7 for purposes of administering title XVIII, XIX, 

8 or XXI of the Social Security Act. 

9 ‘‘(4) WITHDRAWAL FROM PROGRAM.—A Tribal 

10 Health Program that bills directly under the pro11 gram established under this subsection may with12 draw from participation in the same manner and 

13 under the same conditions that an Indian Tribe or 

14 Tribal Organization may retrocede a contracted pro15 gram to the Secretary under the authority of the In16 dian Self-Determination and Education Assistance 

17 Act (25 U.S.C. 450 et seq.). All cost accounting and 

18 billing authority under the program established 

19 under this subsection shall be returned to the Sec20 retary upon the Secretary’s acceptance of the with21 drawal of participation in this program. 

22 ‘‘(5) TERMINATION FOR FAILURE TO COMPLY

23 WITH REQUIREMENTS.—The Secretary may termi24 nate the participation of a Tribal Health Program or 

25 in the direct billing program established under this 


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1 subsection if the Secretary determines that the Pro2 gram has failed to comply with the requirements of 

3 paragraph (2). The Secretary shall provide a Tribal 

4 Health Program with notice of a determination that 

5 the Program has failed to comply with any such re6 quirement and a reasonable opportunity to correct 

7 such noncompliance prior to terminating the Pro8 gram’s participation in the direct billing program es9 tablished under this subsection. 

10 ‘‘(e) RELATED PROVISIONS UNDER THE SOCIAL SE11 CURITY ACT.—For provisions related to subsections (c) 

12 and (d), see sections 1880, 1911, and 2107(e)(1)(D) of 

13 the Social Security Act. 

14 ‘‘SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERV15 ICE, INDIAN TRIBES, TRIBAL ORGANIZA16 TIONS, AND URBAN INDIAN ORGANIZATIONS 

17 TO FACILITATE OUTREACH, ENROLLMENT, 

18 AND COVERAGE OF INDIANS UNDER SOCIAL 

19 SECURITY ACT HEALTH BENEFIT PROGRAMS 

20 AND OTHER HEALTH BENEFITS PROGRAMS. 

21 ‘‘(a) INDIAN TRIBES AND TRIBAL ORGANIZA22 TIONS.—From funds appropriated to carry out this title 

23 in accordance with section 415, the Secretary, acting 

24 through the Service, shall make grants to or enter into 

25 contracts with Indian Tribes and Tribal Organizations to 


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1 assist such Tribes and Tribal Organizations in estab2 lishing and administering programs on or near reserva3 tions and trust lands to assist individual Indians— 

4 ‘‘(1) to enroll for benefits under a program es5 tablished under title XVIII, XIX, or XXI of the So6 cial Security Act and other health benefits pro7 grams; and 

8 ‘‘(2) with respect to such programs for which 

9 the charging of premiums and cost sharing is not 

10 prohibited under such programs, to pay premiums or 

11 cost sharing for coverage for such benefits, which 

12 may be based on financial need (as determined by 

13 the Indian Tribe or Tribes or Tribal Organizations 

14 being served based on a schedule of income levels de15 veloped or implemented by such Tribe, Tribes, or 

16 Tribal Organizations). 

17 ‘‘(b) CONDITIONS.—The Secretary, acting through 

18 the Service, shall place conditions as deemed necessary to 

19 effect the purpose of this section in any grant or contract 

20 which the Secretary makes with any Indian Tribe or Trib21 al Organization pursuant to this section. Such conditions 

22 shall include requirements that the Indian Tribe or Tribal 

23 Organization successfully undertake— 

24 ‘‘(1) to determine the population of Indians eli25 gible for the benefits described in subsection (a); 


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1 ‘‘(2) to educate Indians with respect to the ben2 efits available under the respective programs; 

3 ‘‘(3) to provide transportation for such indi4 vidual Indians to the appropriate offices for enroll5 ment or applications for such benefits; and 

6 ‘‘(4) to develop and implement methods of im7 proving the participation of Indians in receiving ben8 efits under such programs. 

9 ‘‘(c) APPLICATION TO URBAN INDIAN ORGANIZA10 TIONS.— 

11 ‘‘(1) IN GENERAL.—The provisions of sub12 section (a) shall apply with respect to grants and 

13 other funding to Urban Indian Organizations with 

14 respect to populations served by such organizations 

15 in the same manner they apply to grants and con16 tracts with Indian Tribes and Tribal Organizations 

17 with respect to programs on or near reservations. 

18 ‘‘(2) REQUIREMENTS.—The Secretary shall in19 clude in the grants or contracts made or provided 

20 under paragraph (1) requirements that are— 

21 ‘‘(A) consistent with the requirements im22 posed by the Secretary under subsection (b); 

23 ‘‘(B) appropriate to Urban Indian Organi24 zations and Urban Indians; and 


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1 ‘‘(C) necessary to effect the purposes of 

2 this section. 

3 ‘‘(d) FACILITATING COOPERATION.—The Secretary, 

4 acting through the Centers for Medicare & Medicaid Serv5 ices, shall take such steps as are necessary to facilitate 

6 cooperation with, and agreements between, States and the 

7 Service, Indian Tribes, Tribal Organizations, or Urban In8 dian Organizations with respect to the provision of health 

9 care items and services to Indians under the programs es10 tablished under title XVIII, XIX, or XXI of the Social 

11 Security Act. 

12 ‘‘(e) AGREEMENTS RELATING TO IMPROVING EN13 ROLLMENT OF INDIANS UNDER SOCIAL SECURITY ACT

14 HEALTH BENEFITS PROGRAMS.—For provisions relating 

15 to agreements between the Secretary, acting through the 

16 Service, and Indian Tribes, Tribal Organizations, and 

17 Urban Indian Organization for the collection, preparation, 

18 and submission of applications by Indians for assistance 

19 under the Medicaid and State children’s health insurance 

20 programs established under titles XIX and XXI of the So21 cial Security Act, and benefits under the Medicare pro22 gram established under title XVIII of such Act, see sub23 sections (a) and (b) of section 1139 of the Social Security 

24 Act. 


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1 ‘‘(f) DEFINITION OF PREMIUMS AND COST SHAR2 ING.—In this section: 

3 ‘‘(1) PREMIUM.—The term ‘premium’ includes 

4 any enrollment fee or similar charge. 

5 ‘‘(2) COST SHARING.—The term ‘cost sharing’ 

6 includes any deduction, deductible, copayment, coin7 surance, or similar charge. 

8 ‘‘SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PAR9 TIES OF COSTS OF HEALTH SERVICES. 

10 ‘‘(a) RIGHT OF RECOVERY.—Except as provided in 

11 subsection (f), the United States, an Indian Tribe, or 

12 Tribal Organization shall have the right to recover from 

13 an insurance company, health maintenance organization, 

14 employee benefit plan, third-party tortfeasor, or any other 

15 responsible or liable third party (including a political sub16 division or local governmental entity of a State) the rea17 sonable expenses incurred and billed by the Secretary, an 

18 Indian Tribe, or Tribal Organization in providing health 

19 services through the Service, an Indian Tribe, or Tribal 

20 Organization to any individual to the same extent that 

21 such individual, or any nongovernmental provider of such 

22 services, would be eligible to receive damages, reimburse23 ment, or indemnification for such charges or expenses if— 

24 ‘‘(1) such services had been provided by a non25 governmental provider; and 


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1 ‘‘(2) such individual had been required to pay 

2 such charges or expenses and did pay such charges 

3 or expenses. 

4 ‘‘(b) LIMITATIONS ON RECOVERIES FROM STATES.— 

5 Subsection (a) shall provide a right of recovery against 

6 any State, only if the injury, illness, or disability for which 

7 health services were provided is covered under— 

8 ‘‘(1) workers’ compensation laws; or 

9 ‘‘(2) a no-fault automobile accident insurance 

10 plan or program. 

11 ‘‘(c) NONAPPLICATION OF OTHER LAWS.—No law of 

12 any State, or of any political subdivision of a State and 

13 no provision of any contract, insurance or health mainte14 nance organization policy, employee benefit plan, self-in15 surance plan, managed care plan, or other health care plan 

16 or program entered into or renewed after the date of the 

17 enactment of the Indian Health Care Amendments of 

18 1988, shall prevent or hinder the right of recovery of the 

19 United States, an Indian Tribe, or Tribal Organization 

20 under subsection (a). 

21 ‘‘(d) NO EFFECT ON PRIVATE RIGHTS OF ACTION.— 

22 No action taken by the United States, an Indian Tribe, 

23 or Tribal Organization to enforce the right of recovery 

24 provided under this section shall operate to deny to the 


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1 injured person the recovery for that portion of the person’s 

2 damage not covered hereunder. 

3 ‘‘(e) ENFORCEMENT.— 

4 ‘‘(1) IN GENERAL.—The United States, an In5 dian Tribe, or Tribal Organization may enforce the 

6 right of recovery provided under subsection (a) by— 

7 ‘‘(A) intervening or joining in any civil ac8 tion or proceeding brought— 

9 ‘‘(i) by the individual for whom health 

10 services were provided by the Secretary, an 

11 Indian Tribe, or Tribal Organization; or 

12 ‘‘(ii) by any representative or heirs of 

13 such individual, or 

14 ‘‘(B) instituting a civil action, including a 

15 civil action for injunctive relief and other relief 

16 and including, with respect to a political sub17 division or local governmental entity of a State, 

18 such an action against an official thereof. 

19 ‘‘(2) NOTICE.—All reasonable efforts shall be 

20 made to provide notice of action instituted under 

21 paragraph (1)(B) to the individual to whom health 

22 services were provided, either before or during the 

23 pendency of such action. 

24 ‘‘(f) LIMITATION.—Absent specific written authoriza25 tion by the governing body of an Indian Tribe for the peVerDate Aug 31 2005 02:12 Dec 13, 2006 Jkt 059200 PO 00000 Frm 00197 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 riod of such authorization (which may not be for a period 

2 of more than 1 year and which may be revoked at any 

3 time upon written notice by the governing body to the 

4 Service), the United States shall not have a right of recov5 ery under this section if the injury, illness, or disability 

6 for which health services were provided is covered under 

7 a self-insurance plan funded by an Indian Tribe, Tribal 

8 Organization, or Urban Indian Organization. Where such 

9 authorization is provided, the Service may receive and ex10 pend such amounts for the provision of additional health 

11 services consistent with such authorization. 

12 ‘‘(g) COSTS AND ATTORNEYS’ FEES.—In any action 

13 brought to enforce the provisions of this section, a pre14 vailing plaintiff shall be awarded its reasonable attorneys’ 

15 fees and costs of litigation. 

16 ‘‘(h) NONAPPLICATION OF CLAIMS FILING REQUIRE17 MENTS.—An insurance company, health maintenance or18 ganization, self-insurance plan, managed care plan, or 

19 other health care plan or program (under the Social Secu20 rity Act or otherwise) may not deny a claim for benefits 

21 submitted by the Service or by an Indian Tribe or Tribal 

22 Organization based on the format in which the claim is 

23 submitted if such format complies with the format re24 quired for submission of claims under title XVIII of the 


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1 Social Security Act or recognized under section 1175 of 

2 such Act. 

3 ‘‘(i) APPLICATION TO URBAN INDIAN ORGANIZA4 TIONS.—The previous provisions of this section shall apply 

5 to Urban Indian Organizations with respect to populations 

6 served by such Organizations in the same manner they 

7 apply to Indian Tribes and Tribal Organizations with re8 spect to populations served by such Indian Tribes and 

9 Tribal Organizations. 

10 ‘‘(j) STATUTE OF LIMITATIONS.—The provisions of 

11 section 2415 of title 28, United States Code, shall apply 

12 to all actions commenced under this section, and the ref13 erences therein to the United States are deemed to include 

14 Indian Tribes, Tribal Organizations, and Urban Indian 

15 Organizations. 

16 ‘‘(k) SAVINGS.—Nothing in this section shall be con17 strued to limit any right of recovery available to the 

18 United States, an Indian Tribe, or Tribal Organization 

19 under the provisions of any applicable, Federal, State, or 

20 Tribal law, including medical lien laws and the Federal 

21 Medical Care Recovery Act (42 U.S.C. 2651 et seq.). 

22 ‘‘SEC. 404. CREDITING OF REIMBURSEMENTS. 

23 ‘‘(a) USE OF AMOUNTS.— 

24 ‘‘(1) RETENTION BY PROGRAM.—Except as pro25 vided in section 202(g) (relating to the Catastrophic 


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1 Health Emergency Fund) and section 807 (relating 

2 to health services for ineligible persons), all reim3 bursements received or recovered under any of the 

4 programs described in paragraph (2), including 

5 under section 807, by reason of the provision of 

6 health services by the Service, by an Indian Tribe or 

7 Tribal Organization, or by an Urban Indian Organi8 zation, shall be credited to the Service, such Indian 

9 Tribe or Tribal Organization, or such Urban Indian 

10 Organization, respectively, and may be used as pro11 vided in section 401. In the case of such a service 

12 provided by or through a Service Unit, such 

13 amounts shall be credited to such unit and used for 

14 such purposes. 

15 ‘‘(2) PROGRAMS COVERED.—The programs re16 ferred to in paragraph (1) are the following: 

17 ‘‘(A) Titles XVIII, XIX, and XXI of the 

18 Social Security Act. 

19 ‘‘(B) This Act, including section 807. 

20 ‘‘(C) Public Law 87–693. 

21 ‘‘(D) Any other provision of law. 

22 ‘‘(b) NO OFFSET OF AMOUNTS.—The Service may 

23 not offset or limit any amount obligated to any Service 

24 Unit or entity receiving funding from the Service because 

25 of the receipt of reimbursements under subsection (a). 


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1 ‘‘SEC. 405. PURCHASING HEALTH CARE COVERAGE. 

2 ‘‘(a) IN GENERAL.—Insofar as amounts are made 

3 available under law (including a provision of the Social 

4 Security Act, the Indian Self-Determination and Edu5 cation Assistance Act (25 U.S.C. 450 et seq.), or other 

6 law, other than under section 402) to Indian Tribes, Trib7 al Organizations, and Urban Indian Organizations for 

8 health benefits for Service beneficiaries, Indian Tribes, 

9 Tribal Organizations, and Urban Indian Organizations 

10 may use such amounts to purchase health benefits cov11 erage for such beneficiaries in any manner, including 

12 through— 

13 ‘‘(1) a tribally owned and operated health care 

14 plan; 

15 ‘‘(2) a State or locally authorized or licensed 

16 health care plan; 

17 ‘‘(3) a health insurance provider or managed 

18 care organization; or 

19 ‘‘(4) a self-insured plan. 

20 The purchase of such coverage by an Indian Tribe, Tribal 

21 Organization, or Urban Indian Organization may be based 

22 on the financial needs of such beneficiaries (as determined 

23 by the Indian Tribe or Tribes being served based on a 

24 schedule of income levels developed or implemented by 

25 such Indian Tribe or Tribes). 


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1 ‘‘(b) EXPENSES FOR SELF-INSURED PLAN.—In the 

2 case of a self-insured plan under subsection (a)(4), the 

3 amounts may be used for expenses of operating the plan, 

4 including administration and insurance to limit the finan5 cial risks to the entity offering the plan. 

6 ‘‘(c) CONSTRUCTION.—Nothing in this section shall 

7 be construed as affecting the use of any amounts not re8 ferred to in subsection (a). 

9 ‘‘SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGEN10 CIES. 

11 ‘‘(a) AUTHORITY.— 

12 ‘‘(1) IN GENERAL.—The Secretary may enter 

13 into (or expand) arrangements for the sharing of 

14 medical facilities and services between the Service, 

15 Indian Tribes, and Tribal Organizations and the De16 partment of Veterans Affairs and the Department of 

17 Defense. 

18 ‘‘(2) CONSULTATION BY SECRETARY RE19 QUIRED.—The Secretary may not finalize any ar20 rangement between the Service and a Department 

21 described in paragraph (1) without first consulting 

22 with the Indian Tribes which will be significantly af23 fected by the arrangement. 

24 ‘‘(b) LIMITATIONS.—The Secretary shall not take 

25 any action under this section or under subchapter IV of 


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1 chapter 81 of title 38, United States Code, which would 

2 impair— 

3 ‘‘(1) the priority access of any Indian to health 

4 care services provided through the Service and the 

5 eligibility of any Indian to receive health services 

6 through the Service; 

7 ‘‘(2) the quality of health care services provided 

8 to any Indian through the Service; 

9 ‘‘(3) the priority access of any veteran to health 

10 care services provided by the Department of Vet11 erans Affairs; 

12 ‘‘(4) the quality of health care services provided 

13 by the Department of Veterans Affairs or the De14 partment of Defense; or 

15 ‘‘(5) the eligibility of any Indian who is a vet16 eran to receive health services through the Depart17 ment of Veterans Affairs. 

18 ‘‘(c) REIMBURSEMENT.—The Service, Indian Tribe, 

19 or Tribal Organization shall be reimbursed by the Depart20 ment of Veterans Affairs or the Department of Defense 

21 (as the case may be) where services are provided through 

22 the Service, an Indian Tribe, or a Tribal Organization to 

23 beneficiaries eligible for services from either such Depart24 ment, notwithstanding any other provision of law. 


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1 ‘‘(d) CONSTRUCTION.—Nothing in this section may 

2 be construed as creating any right of a non-Indian veteran 

3 to obtain health services from the Service. 

4 ‘‘SEC. 407. PAYOR OF LAST RESORT. 

5 ‘‘Indian Health Programs and health care programs 

6 operated by Urban Indian Organizations shall be the 

7 payor of last resort for services provided to persons eligible 

8 for services from Indian Health Programs and Urban In9 dian Organizations, notwithstanding any Federal, State, 

10 or local law to the contrary. 

11 ‘‘SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH 

12 CARE PROGRAMS IN QUALIFICATIONS FOR 

13 REIMBURSEMENT FOR SERVICES. 

14 ‘‘(a) REQUIREMENT TO SATISFY GENERALLY APPLI15 CABLE PARTICIPATION REQUIREMENTS.— 

16 ‘‘(1) IN GENERAL.—A Federal health care pro17 gram must accept an entity that is operated by the 

18 Service, an Indian Tribe, Tribal Organization, or 

19 Urban Indian Organization as a provider eligible to 

20 receive payment under the program for health care 

21 services furnished to an Indian on the same basis as 

22 any other provider qualified to participate as a pro23 vider of health care services under the program if 

24 the entity meets generally applicable State or other 


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1 requirements for participation as a provider of 

2 health care services under the program. 

3 ‘‘(2) SATISFACTION OF STATE OR LOCAL LICEN4 SURE OR RECOGNITION REQUIREMENTS.—Any re5 quirement for participation as a provider of health 

6 care services under a Federal health care program 

7 that an entity be licensed or recognized under the 

8 State or local law where the entity is located to fur9 nish health care services shall be deemed to have 

10 been met in the case of an entity operated by the 

11 Service, an Indian Tribe, Tribal Organization, or 

12 Urban Indian Organization if the entity meets all 

13 the applicable standards for such licensure or rec14 ognition, regardless of whether the entity obtains a 

15 license or other documentation under such State or 

16 local law. In accordance with section 221, the ab17 sence of the licensure of a health care professional 

18 employed by such an entity under the State or local 

19 law where the entity is located shall not be taken 

20 into account for purposes of determining whether 

21 the entity meets such standards, if the professional 

22 is licensed in another State. 

23 ‘‘(b) APPLICATION OF EXCLUSION FROM PARTICIPA24 TION IN FEDERAL HEALTH CARE PROGRAMS.— 


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1 ‘‘(1) EXCLUDED ENTITIES.—No entity operated 

2 by the Service, an Indian Tribe, Tribal Organiza3 tion, or Urban Indian Organization that has been 

4 excluded from participation in any Federal health 

5 care program or for which a license is under suspen6 sion or has been revoked by the State where the en7 tity is located shall be eligible to receive payment or 

8 reimbursement under any such program for health 

9 care services furnished to an Indian. 

10 ‘‘(2) EXCLUDED INDIVIDUALS.—No individual 

11 who has been excluded from participation in any 

12 Federal health care program or whose State license 

13 is under suspension shall be eligible to receive pay14 ment or reimbursement under any such program for 

15 health care services furnished by that individual, di16 rectly or through an entity that is otherwise eligible 

17 to receive payment for health care services, to an In18 dian. 

19 ‘‘(3) FEDERAL HEALTH CARE PROGRAM DE20 FINED.—In this subsection, the term, ‘Federal 

21 health care program’ has the meaning given that 

22 term in section 1128B(f) of the Social Security Act 

23 (42 U.S.C. 1320a–7b(f)), except that, for purposes 

24 of this subsection, such term shall include the health 


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1 insurance program under chapter 89 of title 5, 

2 United States Code. 

3 ‘‘(c) RELATED PROVISIONS.—For provisions related 

4 to nondiscrimination against providers operated by the 

5 Service, an Indian Tribe, Tribal Organization, or Urban 

6 Indian Organization, see section 1139(c) of the Social Se7 curity Act (42 U.S.C. 1320b–9(c)). 

8 ‘‘SEC. 409. CONSULTATION. 

9 ‘‘For provisions related to consultation with rep10 resentatives of Indian Health Programs and Urban Indian 

11 Organizations with respect to the health care programs 

12 established under titles XVIII, XIX, and XXI of the Social 

13 Security Act, see section 1139(d) of the Social Security 

14 Act (42 U.S.C. 1320b–9(d)). 

15 ‘‘SEC. 410. STATE CHILDREN’S HEALTH INSURANCE PRO16 GRAM (SCHIP). 

17 ‘‘For provisions relating to— 

18 ‘‘(1) outreach to families of Indian children 

19 likely to be eligible for child health assistance under 

20 the State children’s health insurance program estab21 lished under title XXI of the Social Security Act, see 

22 sections 2105(c)(2)(C) and 1139(a) of such Act (42 

23 U.S.C. 1397ee(c)(2), 1320b–9); and 

24 ‘‘(2) ensuring that child health assistance is 

25 provided under such program to targeted low-income 


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1 children who are Indians and that payments are 

2 made under such program to Indian Health Pro3 grams and Urban Indian Organizations operating in 

4 the State that provide such assistance, see sections 

5 2102(b)(3)(D) and 2105(c)(6)(B) of such Act (42 

6 U.S.C. 1397bb(b)(3)(D), 1397ee(c)(6)(B)). 

7 ‘‘SEC. 411. EXCLUSION WAIVER AUTHORITY FOR AFFECTED 

8 INDIAN HEALTH PROGRAMS AND SAFE HAR9 BOR TRANSACTIONS UNDER THE SOCIAL SE10 CURITY ACT. 

11 ‘‘For provisions relating to— 

12 ‘‘(1) exclusion waiver authority for affected In13 dian Health Programs under the Social Security 

14 Act, see section 1128(k) of the Social Security Act 

15 (42 U.S.C. 1320a–7(k)); and 

16 ‘‘(2) certain transactions involving Indian 

17 Health Programs deemed to be in safe harbors 

18 under that Act, see section 1128B(b)(4) of the So19 cial Security Act (42 U.S.C. 1320a–7b(b)(4)). 

20 ‘‘SEC. 412. PREMIUM AND COST SHARING PROTECTIONS 

21 AND ELIGIBILITY DETERMINATIONS UNDER 

22 MEDICAID AND SCHIP AND PROTECTION OF 

23 CERTAIN INDIAN PROPERTY FROM MEDICAID 

24 ESTATE RECOVERY. 

25 ‘‘For provisions relating to— 


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1 ‘‘(1) premiums or cost sharing protections for 

2 Indians furnished items or services directly by In3 dian Health Programs or through referral under the 

4 contract health service under the Medicaid program 

5 established under title XIX of the Social Security 

6 Act, see sections 1916(j) and 1916A(a)(1) of the So7 cial Security Act (42 U.S.C. 1396o(j), 1396o– 

8 1(a)(1)); 

9 ‘‘(2) rules regarding the treatment of certain 

10 property for purposes of determining eligibility 

11 under such programs, see sections 1902(e)(13) and 

12 2107(e)(1)(B) of such Act (42 U.S.C. 1396a(e)(13), 

13 1397gg(e)(1)(B)); and 

14 ‘‘(3) the protection of certain property from es15 tate recovery provisions under the Medicaid pro16 gram, see section 1917(b)(3)(B) of such Act (42 

17 U.S.C. 1396p(b)(3)(B)). 

18 ‘‘SEC. 413. TREATMENT UNDER MEDICAID AND SCHIP MAN19 AGED CARE. 

20 ‘‘For provisions relating to the treatment of Indians 

21 enrolled in a managed care entity under the Medicaid pro22 gram under title XIX of the Social Security Act and In23 dian Health Programs and Urban Indian Organizations 

24 that are providers of items or services to such Indian en25 rollees, see sections 1932(h) and 2107(e)(1)(H) of the SoVerDate Aug 31 2005 02:12 Dec 13, 2006 Jkt 059200 PO 00000 Frm 00209 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 cial Security Act (42 U.S.C. 1396u–2(h), 

2 1397gg(e)(1)(H)). 

3 ‘‘SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASI4 BILITY STUDY. 

5 ‘‘(a) STUDY.—The Secretary shall conduct a study 

6 to determine the feasibility of treating the Navajo Nation 

7 as a State for the purposes of title XIX of the Social Secu8 rity Act, to provide services to Indians living within the 

9 boundaries of the Navajo Nation through an entity estab10 lished having the same authority and performing the same 

11 functions as single-State medicaid agencies responsible for 

12 the administration of the State plan under title XIX of 

13 the Social Security Act. 

14 ‘‘(b) CONSIDERATIONS.—In conducting the study, 

15 the Secretary shall consider the feasibility of— 

16 ‘‘(1) assigning and paying all expenditures for 

17 the provision of services and related administration 

18 funds, under title XIX of the Social Security Act, to 

19 Indians living within the boundaries of the Navajo 

20 Nation that are currently paid to or would otherwise 

21 be paid to the State of Arizona, New Mexico, or 

22 Utah; 

23 ‘‘(2) providing assistance to the Navajo Nation 

24 in the development and implementation of such enti25 ty for the administration, eligibility, payment, and 


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1 delivery of medical assistance under title XIX of the 

2 Social Security Act; 

3 ‘‘(3) providing an appropriate level of matching 

4 funds for Federal medical assistance with respect to 

5 amounts such entity expends for medical assistance 

6 for services and related administrative costs; and 

7 ‘‘(4) authorizing the Secretary, at the option of 

8 the Navajo Nation, to treat the Navajo Nation as a 

9 State for the purposes of title XIX of the Social Se10 curity Act (relating to the State children’s health in11 surance program) under terms equivalent to those 

12 described in paragraphs (2) through (4). 

13 ‘‘(c) REPORT.—Not later then 3 years after the date 

14 of enactment of the Indian Health Care Improvement Act 

15 Amendments of 2006, the Secretary shall submit to the 

16 Committee on Indian Affairs and Committee on Finance 

17 of the Senate and the Committee on Resources and Com18 mittee on Energy and Commerce of the House of Rep19 resentatives a report that includes— 

20 ‘‘(1) the results of the study under this section; 

21 ‘‘(2) a summary of any consultation that oc22 curred between the Secretary and the Navajo Na23 tion, other Indian Tribes, the States of Arizona, 

24 New Mexico, and Utah, counties which include NavVerDate Aug 31 2005 02:12 Dec 13, 2006 Jkt 059200 PO 00000 Frm 00211 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 ajo Lands, and other interested parties, in con2 ducting this study; 

3 ‘‘(3) projected costs or savings associated with 

4 establishment of such entity, and any estimated im5 pact on services provided as described in this section 

6 in relation to probable costs or savings; and 

7 ‘‘(4) legislative actions that would be required 

8 to authorize the establishment of such entity if such 

9 entity is determined by the Secretary to be feasible. 

10 ‘‘SEC. 415. AUTHORIZATION OF APPROPRIATIONS. 

11 ‘‘There are authorized to be appropriated such sums 

12 as may be necessary for each fiscal year through fiscal 

13 year 2016 to carry out this title. 

14 ‘‘TITLE V—HEALTH SERVICES 

15 FOR URBAN INDIANS 

16 ‘‘SEC. 501. PURPOSE. 

17 ‘‘The purpose of this title is to establish and maintain 

18 programs in Urban Centers to make health services more 

19 accessible and available to Urban Indians. 

20 ‘‘SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN IN21 DIAN ORGANIZATIONS. 

22 ‘‘Under authority of the Act of November 2, 1921 

23 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

24 the Secretary, acting through the Service, shall enter into 

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1 zations to assist such organizations in the establishment 

2 and administration, within Urban Centers, of programs 

3 which meet the requirements set forth in this title. Subject 

4 to section 506, the Secretary, acting through the Service, 

5 shall include such conditions as the Secretary considers 

6 necessary to effect the purpose of this title in any contract 

7 into which the Secretary enters with, or in any grant the 

8 Secretary makes to, any Urban Indian Organization pur9 suant to this title. 

10 ‘‘SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION 

11 OF HEALTH CARE AND REFERRAL SERVICES. 

12 ‘‘(a) REQUIREMENTS FOR GRANTS AND CON13 TRACTS.—Under authority of the Act of November 2, 

14 1921 (25 U.S.C. 13) (commonly known as the ‘Snyder 

15 Act’), the Secretary, acting through the Service, shall 

16 enter into contracts with, and make grants to, Urban In17 dian Organizations for the provision of health care and 

18 referral services for Urban Indians. Any such contract or 

19 grant shall include requirements that the Urban Indian 

20 Organization successfully undertake to— 

21 ‘‘(1) estimate the population of Urban Indians 

22 residing in the Urban Center or centers that the or23 ganization proposes to serve who are or could be re24 cipients of health care or referral services; 


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1 ‘‘(2) estimate the current health status of 

2 Urban Indians residing in such Urban Center or 

3 centers; 

4 ‘‘(3) estimate the current health care needs of 

5 Urban Indians residing in such Urban Center or 

6 centers; 

7 ‘‘(4) provide basic health education, including 

8 health promotion and disease prevention education, 

9 to Urban Indians; 

10 ‘‘(5) make recommendations to the Secretary 

11 and Federal, State, local, and other resource agen12 cies on methods of improving health service pro13 grams to meet the needs of Urban Indians; and 

14 ‘‘(6) where necessary, provide, or enter into 

15 contracts for the provision of, health care services 

16 for Urban Indians. 

17 ‘‘(b) CRITERIA.—The Secretary, acting through the 

18 Service, shall, by regulation, prescribe the criteria for se19 lecting Urban Indian Organizations to enter into contracts 

20 or receive grants under this section. Such criteria shall, 

21 among other factors, include— 

22 ‘‘(1) the extent of unmet health care needs of 

23 Urban Indians in the Urban Center or centers in24 volved; 


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1 ‘‘(2) the size of the Urban Indian population in 

2 the Urban Center or centers involved; 

3 ‘‘(3) the extent, if any, to which the activities 

4 set forth in subsection (a) would duplicate any 

5 project funded under this title, or under any current 

6 public health service project funded in a manner 

7 other than pursuant to this title; 

8 ‘‘(4) the capability of an Urban Indian Organi9 zation to perform the activities set forth in sub10 section (a) and to enter into a contract with the Sec11 retary or to meet the requirements for receiving a 

12 grant under this section; 

13 ‘‘(5) the satisfactory performance and success14 ful completion by an Urban Indian Organization of 

15 other contracts with the Secretary under this title; 

16 ‘‘(6) the appropriateness and likely effectiveness 

17 of conducting the activities set forth in subsection 

18 (a) in an Urban Center or centers; and 

19 ‘‘(7) the extent of existing or likely future par20 ticipation in the activities set forth in subsection (a) 

21 by appropriate health and health-related Federal, 

22 State, local, and other agencies. 

23 ‘‘(c) ACCESS TO HEALTH PROMOTION AND DISEASE

24 PREVENTION PROGRAMS.—The Secretary, acting through 

25 the Service, shall facilitate access to or provide health proVerDate Aug 31 2005 02:12 Dec 13, 2006 Jkt 059200 PO 00000 Frm 00215 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 motion and disease prevention services for Urban Indians 

2 through grants made to Urban Indian Organizations ad3 ministering contracts entered into or receiving grants 

4 under subsection (a). 

5 ‘‘(d) IMMUNIZATION SERVICES.— 

6 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

7 Secretary, acting through the Service, shall facilitate 

8 access to, or provide, immunization services for 

9 Urban Indians through grants made to Urban In10 dian Organizations administering contracts entered 

11 into or receiving grants under this section. 

12 ‘‘(2) DEFINITION.—For purposes of this sub13 section, the term ‘immunization services’ means 

14 services to provide without charge immunizations 

15 against vaccine-preventable diseases. 

16 ‘‘(e) BEHAVIORAL HEALTH SERVICES.— 

17 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

18 Secretary, acting through the Service, shall facilitate 

19 access to, or provide, behavioral health services for 

20 Urban Indians through grants made to Urban In21 dian Organizations administering contracts entered 

22 into or receiving grants under subsection (a). 

23 ‘‘(2) ASSESSMENT REQUIRED.—Except as pro24 vided by paragraph (3)(A), a grant may not be made 

25 under this subsection to an Urban Indian OrganizaVerDate Aug 31 2005 02:12 Dec 13, 2006 Jkt 059200 PO 00000 Frm 00216 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 tion until that organization has prepared, and the 

2 Service has approved, an assessment of the fol3 lowing: 

4 ‘‘(A) The behavioral health needs of the 

5 Urban Indian population concerned. 

6 ‘‘(B) The behavioral health services and 

7 other related resources available to that popu8 lation. 

9 ‘‘(C) The barriers to obtaining those serv10 ices and resources. 

11 ‘‘(D) The needs that are unmet by such 

12 services and resources. 

13 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

14 made under this subsection for the following: 

15 ‘‘(A) To prepare assessments required 

16 under paragraph (2). 

17 ‘‘(B) To provide outreach, educational, and 

18 referral services to Urban Indians regarding the 

19 availability of direct behavioral health services, 

20 to educate Urban Indians about behavioral 

21 health issues and services, and effect coordina22 tion with existing behavioral health providers in 

23 order to improve services to Urban Indians. 

24 ‘‘(C) To provide outpatient behavioral 

25 health services to Urban Indians, including the 


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1 identification and assessment of illness, thera2 peutic treatments, case management, support 

3 groups, family treatment, and other treatment. 

4 ‘‘(D) To develop innovative behavioral 

5 health service delivery models which incorporate 

6 Indian cultural support systems and resources. 

7 ‘‘(f) PREVENTION OF CHILD ABUSE.— 

8 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

9 Secretary, acting through the Service, shall facilitate 

10 access to or provide services for Urban Indians 

11 through grants to Urban Indian Organizations ad12 ministering contracts entered into or receiving 

13 grants under subsection (a) to prevent and treat 

14 child abuse (including sexual abuse) among Urban 

15 Indians. 

16 ‘‘(2) EVALUATION REQUIRED.—Except as pro17 vided by paragraph (3)(A), a grant may not be made 

18 under this subsection to an Urban Indian Organiza19 tion until that organization has prepared, and the 

20 Service has approved, an assessment that documents 

21 the prevalence of child abuse in the Urban Indian 

22 population concerned and specifies the services and 

23 programs (which may not duplicate existing services 

24 and programs) for which the grant is requested. 


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1 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

2 made under this subsection for the following: 

3 ‘‘(A) To prepare assessments required 

4 under paragraph (2). 

5 ‘‘(B) For the development of prevention, 

6 training, and education programs for Urban In7 dians, including child education, parent edu8 cation, provider training on identification and 

9 intervention, education on reporting require10 ments, prevention campaigns, and establishing 

11 service networks of all those involved in Indian 

12 child protection. 

13 ‘‘(C) To provide direct outpatient treat14 ment services (including individual treatment, 

15 family treatment, group therapy, and support 

16 groups) to Urban Indians who are child victims 

17 of abuse (including sexual abuse) or adult sur18 vivors of child sexual abuse, to the families of 

19 such child victims, and to Urban Indian per20 petrators of child abuse (including sexual 

21 abuse). 

22 ‘‘(4) CONSIDERATIONS WHEN MAKING

23 GRANTS.—In making grants to carry out this sub24 section, the Secretary shall take into consideration— 


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1 ‘‘(A) the support for the Urban Indian Or2 ganization demonstrated by the child protection 

3 authorities in the area, including committees or 

4 other services funded under the Indian Child 

5 Welfare Act of 1978 (25 U.S.C. 1901 et seq.), 

6 if any; 

7 ‘‘(B) the capability and expertise dem8 onstrated by the Urban Indian Organization to 

9 address the complex problem of child sexual 

10 abuse in the community; and 

11 ‘‘(C) the assessment required under para12 graph (2). 

13 ‘‘(g) OTHER GRANTS.—The Secretary, acting 

14 through the Service, may enter into a contract with or 

15 make grants to an Urban Indian Organization that pro16 vides or arranges for the provision of health care services 

17 (through satellite facilities, provider networks, or other18 wise) to Urban Indians in more than 1 Urban Center. 

19 ‘‘SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINA20 TION OF UNMET HEALTH CARE NEEDS. 

21 ‘‘(a) GRANTS AND CONTRACTS AUTHORIZED.— 

22 Under authority of the Act of November 2, 1921 (25 

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

24 Secretary, acting through the Service, may enter into con25 tracts with or make grants to Urban Indian Organizations 


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1 situated in Urban Centers for which contracts have not 

2 been entered into or grants have not been made under sec3 tion 503. 

4 ‘‘(b) PURPOSE.—The purpose of a contract or grant 

5 made under this section shall be the determination of the 

6 matters described in subsection (c)(1) in order to assist 

7 the Secretary in assessing the health status and health 

8 care needs of Urban Indians in the Urban Center involved 

9 and determining whether the Secretary should enter into 

10 a contract or make a grant under section 503 with respect 

11 to the Urban Indian Organization which the Secretary has 

12 entered into a contract with, or made a grant to, under 

13 this section. 

14 ‘‘(c) GRANT AND CONTRACT REQUIREMENTS.—Any 

15 contract entered into, or grant made, by the Secretary 

16 under this section shall include requirements that— 

17 ‘‘(1) the Urban Indian Organization success18 fully undertakes to— 

19 ‘‘(A) document the health care status and 

20 unmet health care needs of Urban Indians in 

21 the Urban Center involved; and 

22 ‘‘(B) with respect to Urban Indians in the 

23 Urban Center involved, determine the matters 

24 described in paragraphs (2), (3), (4), and (7) of 

25 section 503(b); and 


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1 ‘‘(2) the Urban Indian Organization complete 

2 performance of the contract, or carry out the re3 quirements of the grant, within 1 year after the date 

4 on which the Secretary and such organization enter 

5 into such contract, or within 1 year after such orga6 nization receives such grant, whichever is applicable. 

7 ‘‘(d) NO RENEWALS.—The Secretary may not renew 

8 any contract entered into or grant made under this sec9 tion. 

10 ‘‘SEC. 505. EVALUATIONS; RENEWALS. 

11 ‘‘(a) PROCEDURES FOR EVALUATIONS.—The Sec12 retary, acting through the Service, shall develop proce13 dures to evaluate compliance with grant requirements and 

14 compliance with and performance of contracts entered into 

15 by Urban Indian Organizations under this title. Such pro16 cedures shall include provisions for carrying out the re17 quirements of this section. 

18 ‘‘(b) EVALUATIONS.—The Secretary, acting through 

19 the Service, shall evaluate the compliance of each Urban 

20 Indian Organization which has entered into a contract or 

21 received a grant under section 503 with the terms of such 

22 contract or grant. For purposes of this evaluation, the 

23 Secretary shall— 

24 ‘‘(1) acting through the Service, conduct an an25 nual onsite evaluation of the organization; or 


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1 ‘‘(2) accept in lieu of such onsite evaluation evi2 dence of the organization’s provisional or full accred3 itation by a private independent entity recognized by 

4 the Secretary for purposes of conducting quality re5 views of providers participating in the Medicare pro6 gram under title XVIII of the Social Security Act. 

7 ‘‘(c) NONCOMPLIANCE; UNSATISFACTORY PERFORM8 ANCE.—If, as a result of the evaluations conducted under 

9 this section, the Secretary determines that an Urban In10 dian Organization has not complied with the requirements 

11 of a grant or complied with or satisfactorily performed a 

12 contract under section 503, the Secretary shall, prior to 

13 renewing such contract or grant, attempt to resolve with 

14 the organization the areas of noncompliance or unsatisfac15 tory performance and modify the contract or grant to pre16 vent future occurrences of noncompliance or unsatisfac17 tory performance. If the Secretary determines that the 

18 noncompliance or unsatisfactory performance cannot be 

19 resolved and prevented in the future, the Secretary shall 

20 not renew the contract or grant with the organization and 

21 is authorized to enter into a contract or make a grant 

22 under section 503 with another Urban Indian Organiza23 tion which is situated in the same Urban Center as the 

24 Urban Indian Organization whose contract or grant is not 

25 renewed under this section. 


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1 ‘‘(d) CONSIDERATIONS FOR RENEWALS.—In deter2 mining whether to renew a contract or grant with an 

3 Urban Indian Organization under section 503 which has 

4 completed performance of a contract or grant under sec5 tion 504, the Secretary shall review the records of the 

6 Urban Indian Organization, the reports submitted under 

7 section 507, and shall consider the results of the onsite 

8 evaluations or accreditations under subsection (b). 

9 ‘‘SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS. 

10 ‘‘(a) PROCUREMENT.—Contracts with Urban Indian 

11 Organizations entered into pursuant to this title shall be 

12 in accordance with all Federal contracting laws and regu13 lations relating to procurement except that in the discre14 tion of the Secretary, such contracts may be negotiated 

15 without advertising and need not conform to the provisions 

16 of sections 1304 and 3131 through 3133 of title 40, 

17 United States Code. 

18 ‘‘(b) PAYMENTS UNDER CONTRACTS OR GRANTS.— 

19 ‘‘(1) IN GENERAL.—Payments under any con20 tracts or grants pursuant to this title, notwith21 standing any term or condition of such contract or 

22 grant— 

23 ‘‘(A) may be made in a single advance pay24 ment by the Secretary to the Urban Indian Or25 ganization by no later than the end of the first 


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1 30 days of the funding period with respect to 

2 which the payments apply, unless the Secretary 

3 determines through an evaluation under section 

4 505 that the organization is not capable of ad5 ministering such a single advance payment; and 

6 ‘‘(B) if any portion thereof is unexpended 

7 by the Urban Indian Organization during the 

8 funding period with respect to which the pay9 ments initially apply, shall be carried forward 

10 for expenditure with respect to allowable or re11 imbursable costs incurred by the organization 

12 during 1 or more subsequent funding periods 

13 without additional justification or documenta14 tion by the organization as a condition of car15 rying forward the availability for expenditure of 

16 such funds. 

17 ‘‘(2) SEMIANNUAL AND QUARTERLY PAYMENTS

18 AND REIMBURSEMENTS.—If the Secretary deter19 mines under paragraph (1)(A) that an Urban Indian 

20 Organization is not capable of administering an en21 tire single advance payment, on request of the 

22 Urban Indian Organization, the payments may be 

23 made— 

24 ‘‘(A) in semiannual or quarterly payments 

25 by not later than 30 days after the date on 


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1 which the funding period with respect to which 

2 the payments apply begins; or 

3 ‘‘(B) by way of reimbursement. 

4 ‘‘(c) REVISION OR AMENDMENT OF CONTRACTS.— 

5 Notwithstanding any provision of law to the contrary, the 

6 Secretary may, at the request and consent of an Urban 

7 Indian Organization, revise or amend any contract entered 

8 into by the Secretary with such organization under this 

9 title as necessary to carry out the purposes of this title. 

10 ‘‘(d) FAIR AND UNIFORM SERVICES AND ASSIST11 ANCE.—Contracts with or grants to Urban Indian Organi12 zations and regulations adopted pursuant to this title shall 

13 include provisions to assure the fair and uniform provision 

14 to Urban Indians of services and assistance under such 

15 contracts or grants by such organizations. 

16 ‘‘SEC. 507. REPORTS AND RECORDS. 

17 ‘‘(a) REPORTS.— 

18 ‘‘(1) IN GENERAL.—For each fiscal year during 

19 which an Urban Indian Organization receives or ex20 pends funds pursuant to a contract entered into or 

21 a grant received pursuant to this title, such Urban 

22 Indian Organization shall submit to the Secretary 

23 not more frequently than every 6 months, a report 

24 that includes the following: 


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1 ‘‘(A) In the case of a contract or grant 

2 under section 503, recommendations pursuant 

3 to section 503(a)(5). 

4 ‘‘(B) Information on activities conducted 

5 by the organization pursuant to the contract or 

6 grant. 

7 ‘‘(C) An accounting of the amounts and 

8 purpose for which Federal funds were ex9 pended. 

10 ‘‘(D) A minimum set of data, using uni11 formly defined elements, as specified by the 

12 Secretary after consultation with Urban Indian 

13 Organizations. 

14 ‘‘(2) HEALTH STATUS AND SERVICES.— 

15 ‘‘(A) IN GENERAL.—Not later than 18 

16 months after the date of enactment of the In17 dian Health Care Improvement Act Amend18 ments of 2006, the Secretary, acting through 

19 the Service, shall submit to Congress a report 

20 evaluating— 

21 ‘‘(i) the health status of Urban Indi22 ans; 

23 ‘‘(ii) the services provided to Indians 

24 pursuant to this title; and 


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1 ‘‘(iii) areas of unmet needs in the de2 livery of health services to Urban Indians. 

3 ‘‘(B) CONSULTATION AND CONTRACTS.— 

4 In preparing the report under paragraph (1), 

5 the Secretary— 

6 ‘‘(i) shall consult with Urban Indian 

7 Organizations; and 

8 ‘‘(ii) may enter into a contract with a 

9 national organization representing Urban 

10 Indian Organizations to conduct any as11 pect of the report. 

12 ‘‘(b) AUDIT.—The reports and records of the Urban 

13 Indian Organization with respect to a contract or grant 

14 under this title shall be subject to audit by the Secretary 

15 and the Comptroller General of the United States. 

16 ‘‘(c) COSTS OF AUDITS.—The Secretary shall allow 

17 as a cost of any contract or grant entered into or awarded 

18 under section 502 or 503 the cost of an annual inde19 pendent financial audit conducted by— 

20 ‘‘(1) a certified public accountant; or 

21 ‘‘(2) a certified public accounting firm qualified 

22 to conduct Federal compliance audits. 

23 ‘‘SEC. 508. LIMITATION ON CONTRACT AUTHORITY. 

24 ‘‘The authority of the Secretary to enter into con25 tracts or to award grants under this title shall be to the 


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1 extent, and in an amount, provided for in appropriation 

2 Acts. 

3 ‘‘SEC. 509. FACILITIES. 

4 ‘‘(a) GRANTS.—The Secretary, acting through the 

5 Service, may make grants to contractors or grant recipi6 ents under this title for the lease, purchase, renovation, 

7 construction, or expansion of facilities, including leased fa8 cilities, in order to assist such contractors or grant recipi9 ents in complying with applicable licensure or certification 

10 requirements. 

11 ‘‘(b) LOAN FUND STUDY.—The Secretary, acting 

12 through the Service, may carry out a study to determine 

13 the feasibility of establishing a loan fund to provide to 

14 Urban Indian Organizations direct loans or guarantees for 

15 loans for the construction of health care facilities in a 

16 manner consistent with section 309. 

17 ‘‘SEC. 510. DIVISION OF URBAN INDIAN HEALTH. 

18 ‘‘There is established within the Service a Division 

19 of Urban Indian Health, which shall be responsible for— 

20 ‘‘(1) carrying out the provisions of this title; 

21 ‘‘(2) providing central oversight of the pro22 grams and services authorized under this title; and 

23 ‘‘(3) providing technical assistance to Urban In24 dian Organizations. 


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1 ‘‘SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE2 RELATED SERVICES. 

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

4 through the Service, may make grants for the provision 

5 of health-related services in prevention of, treatment of, 

6 rehabilitation of, or school- and community-based edu7 cation regarding, alcohol and substance abuse in Urban 

8 Centers to those Urban Indian Organizations with which 

9 the Secretary has entered into a contract under this title 

10 or under section 201. 

11 ‘‘(b) GOALS.—Each grant made pursuant to sub12 section (a) shall set forth the goals to be accomplished 

13 pursuant to the grant. The goals shall be specific to each 

14 grant as agreed to between the Secretary and the grantee. 

15 ‘‘(c) CRITERIA.—The Secretary shall establish cri16 teria for the grants made under subsection (a), including 

17 criteria relating to the following: 

18 ‘‘(1) The size of the Urban Indian population. 

19 ‘‘(2) Capability of the organization to ade20 quately perform the activities required under the 

21 grant. 

22 ‘‘(3) Satisfactory performance standards for the 

23 organization in meeting the goals set forth in such 

24 grant. The standards shall be negotiated and agreed 

25 to between the Secretary and the grantee on a 

26 grant-by-grant basis. 


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1 ‘‘(4) Identification of the need for services. 

2 ‘‘(d) ALLOCATION OF GRANTS.—The Secretary shall 

3 develop a methodology for allocating grants made pursu4 ant to this section based on the criteria established pursu5 ant to subsection (c). 

6 ‘‘(e) GRANTS SUBJECT TO CRITERIA.—Any grant re7 ceived by an Urban Indian Organization under this Act 

8 for substance abuse prevention, treatment, and rehabilita9 tion shall be subject to the criteria set forth in subsection 

10 (c). 

11 ‘‘SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION 

12 PROJECTS. 

13 ‘‘Notwithstanding any other provision of law, the 

14 Tulsa Clinic and Oklahoma City Clinic demonstration 

15 projects shall— 

16 ‘‘(1) be permanent programs within the Serv17 ice’s direct care program; 

18 ‘‘(2) continue to be treated as Service Units 

19 and Operating Units in the allocation of resources 

20 and coordination of care; and 

21 ‘‘(3) continue to meet the requirements and 

22 definitions of an Urban Indian Organization in this 

23 Act, and shall not be subject to the provisions of the 

24 Indian Self-Determination and Education Assistance 

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


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1 ‘‘SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS. 

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

3 through the Division of Urban Indian Health, shall make 

4 grants or enter into contracts with Urban Indian Organi5 zations, to take effect not later than September 30, 2008, 

6 for the administration of Urban Indian alcohol programs 

7 that were originally established under the National Insti8 tute on Alcoholism and Alcohol Abuse (hereafter in this 

9 section referred to as ‘NIAAA’) and transferred to the 

10 Service. 

11 ‘‘(b) USE OF FUNDS.—Grants provided or contracts 

12 entered into under this section shall be used to provide 

13 support for the continuation of alcohol prevention and 

14 treatment services for Urban Indian populations and such 

15 other objectives as are agreed upon between the Service 

16 and a recipient of a grant or contract under this section. 

17 ‘‘(c) ELIGIBILITY.—Urban Indian Organizations that 

18 operate Indian alcohol programs originally funded under 

19 the NIAAA and subsequently transferred to the Service 

20 are eligible for grants or contracts under this section. 

21 ‘‘(d) REPORT.—The Secretary shall evaluate and re22 port to Congress on the activities of programs funded 

23 under this section not less than every 5 years. 


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1 ‘‘SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZA2 TIONS. 

3 ‘‘(a) IN GENERAL.—The Secretary shall ensure that 

4 the Service consults, to the greatest extent practicable, 

5 with Urban Indian Organizations. 

6 ‘‘(b) DEFINITION OF CONSULTATION.—For purposes 

7 of subsection (a), consultation is the open and free ex8 change of information and opinions which leads to mutual 

9 understanding and comprehension and which emphasizes 

10 trust, respect, and shared responsibility. 

11 ‘‘SEC. 515. URBAN YOUTH TREATMENT CENTER DEM12 ONSTRATION. 

13 ‘‘(a) CONSTRUCTION AND OPERATION.—The Sec14 retary, acting through the Service, through grant or con15 tract, is authorized to fund the construction and operation 

16 of at least 2 residential treatment centers in each State 

17 described in subsection (b) to demonstrate the provision 

18 of alcohol and substance abuse treatment services to 

19 Urban Indian youth in a culturally competent residential 

20 setting. 

21 ‘‘(b) DEFINITION OF STATE.—A State described in 

22 this subsection is a State in which— 

23 ‘‘(1) there resides Urban Indian youth with 

24 need for alcohol and substance abuse treatment serv25 ices in a residential setting; and 


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1 ‘‘(2) there is a significant shortage of culturally 

2 competent residential treatment services for Urban 

3 Indian youth. 

4 ‘‘SEC. 516. GRANTS FOR DIABETES PREVENTION, TREAT5 MENT, AND CONTROL. 

6 ‘‘(a) GRANTS AUTHORIZED.—The Secretary may 

7 make grants to those Urban Indian Organizations that 

8 have entered into a contract or have received a grant 

9 under this title for the provision of services for the preven10 tion and treatment of, and control of the complications 

11 resulting from, diabetes among Urban Indians. 

12 ‘‘(b) GOALS.—Each grant made pursuant to sub13 section (a) shall set forth the goals to be accomplished 

14 under the grant. The goals shall be specific to each grant 

15 as agreed to between the Secretary and the grantee. 

16 ‘‘(c) ESTABLISHMENT OF CRITERIA.—The Secretary 

17 shall establish criteria for the grants made under sub18 section (a) relating to— 

19 ‘‘(1) the size and location of the Urban Indian 

20 population to be served; 

21 ‘‘(2) the need for prevention of and treatment 

22 of, and control of the complications resulting from, 

23 diabetes among the Urban Indian population to be 

24 served; 


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1 ‘‘(3) performance standards for the organiza2 tion in meeting the goals set forth in such grant 

3 that are negotiated and agreed to by the Secretary 

4 and the grantee; 

5 ‘‘(4) the capability of the organization to ade6 quately perform the activities required under the 

7 grant; and 

8 ‘‘(5) the willingness of the organization to col9 laborate with the registry, if any, established by the 

10 Secretary under section 204(e) in the Area Office of 

11 the Service in which the organization is located. 

12 ‘‘(d) FUNDS SUBJECT TO CRITERIA.—Any funds re13 ceived by an Urban Indian Organization under this Act 

14 for the prevention, treatment, and control of diabetes 

15 among Urban Indians shall be subject to the criteria devel16 oped by the Secretary under subsection (c). 

17 ‘‘SEC. 517. COMMUNITY HEALTH REPRESENTATIVES. 

18 ‘‘The Secretary, acting through the Service, may 

19 enter into contracts with, and make grants to, Urban In20 dian Organizations for the employment of Indians trained 

21 as health service providers through the Community Health 

22 Representatives Program under section 109 in the provi23 sion of health care, health promotion, and disease preven24 tion services to Urban Indians. 


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1 ‘‘SEC. 518. EFFECTIVE DATE. 

2 ‘‘The amendments made by the Indian Health Care 

3 Improvement Act Amendments of 2006 to this title shall 

4 take effect beginning on the date of enactment of that Act, 

5 regardless of whether the Secretary has promulgated regu6 lations implementing such amendments. 

7 ‘‘SEC. 519. ELIGIBILITY FOR SERVICES. 

8 ‘‘Urban Indians shall be eligible and the ultimate 

9 beneficiaries for health care or referral services provided 

10 pursuant to this title. 

11 ‘‘SEC. 520. AUTHORIZATION OF APPROPRIATIONS. 

12 ‘‘There are authorized to be appropriated such sums 

13 as may be necessary for each fiscal year through fiscal 

14 year 2016 to carry out this title. 

15 ‘‘TITLE VI—ORGANIZATIONAL 

16 IMPROVEMENTS 

17 ‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV18 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

19 SERVICE. 

20 ‘‘(a) ESTABLISHMENT.— 

21 ‘‘(1) IN GENERAL.—In order to more effectively 

22 and efficiently carry out the responsibilities, authori23 ties, and functions of the United States to provide 

24 health care services to Indians and Indian Tribes, as 

25 are or may be hereafter provided by Federal statute 

26 or treaties, there is established within the Public 


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1 Health Service of the Department the Indian Health 

2 Service. 

3 ‘‘(2) DIRECTOR OF INDIAN HEALTH SERVICE.— 

4 The Service shall be administered by a Director, who 

5 shall be appointed by the President, by and with the 

6 advice and consent of the Senate. The Director shall 

7 report to the Secretary. Effective with respect to an 

8 individual appointed by the President, by and with 

9 the advice and consent of the Senate, after January 

10 1, 2006, the term of service of the Director shall be 

11 4 years. A Director may serve more than 1 term. 

12 ‘‘(3) INCUMBENT.—The individual serving in 

13 the position of Director of the Service on the day be14 fore the date of enactment of the Indian Health 

15 Care Improvement Act Amendments of 2006 shall 

16 serve as Director. 

17 ‘‘(4) ADVOCACY AND CONSULTATION.—The po18 sition of Director is established to, in a manner con19 sistent with the government-to-government relation20 ship between the United States and Indian Tribes— 

21 ‘‘(A) facilitate advocacy for the develop22 ment of appropriate Indian health policy; and 

23 ‘‘(B) promote consultation on matters re24 lating to Indian health. 


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1 ‘‘(b) AGENCY.—The Service shall be an agency within 

2 the Public Health Service of the Department, and shall 

3 not be an office, component, or unit of any other agency 

4 of the Department. 

5 ‘‘(c) DUTIES.—The Director shall— 

6 ‘‘(1) perform all functions that were, on the day 

7 before the date of enactment of the Indian Health 

8 Care Improvement Act Amendments of 2006, car9 ried out by or under the direction of the individual 

10 serving as Director of the Service on that day; 

11 ‘‘(2) perform all functions of the Secretary re12 lating to the maintenance and operation of hospital 

13 and health facilities for Indians and the planning 

14 for, and provision and utilization of, health services 

15 for Indians; 

16 ‘‘(3) administer all health programs under 

17 which health care is provided to Indians based upon 

18 their status as Indians which are administered by 

19 the Secretary, including programs under— 

20 ‘‘(A) this Act; 

21 ‘‘(B) the Act of November 2, 1921 (25 

22 U.S.C. 13); 

23 ‘‘(C) the Act of August 5, 1954 (42 U.S.C. 

24 2001 et seq.); 


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1 ‘‘(D) the Act of August 16, 1957 (42 

2 U.S.C. 2005 et seq.); and 

3 ‘‘(E) the Indian Self-Determination and 

4 Education Assistance Act (25 U.S.C. 450 et 

5 seq.); 

6 ‘‘(4) administer all scholarship and loan func7 tions carried out under title I; 

8 ‘‘(5) report directly to the Secretary concerning 

9 all policy- and budget-related matters affecting In10 dian health; 

11 ‘‘(6) collaborate with the Assistant Secretary 

12 for Health concerning appropriate matters of Indian 

13 health that affect the agencies of the Public Health 

14 Service; 

15 ‘‘(7) advise each Assistant Secretary of the De16 partment concerning matters of Indian health with 

17 respect to which that Assistant Secretary has au18 thority and responsibility; 

19 ‘‘(8) advise the heads of other agencies and pro20 grams of the Department concerning matters of In21 dian health with respect to which those heads have 

22 authority and responsibility; 

23 ‘‘(9) coordinate the activities of the Department 

24 concerning matters of Indian health; and 


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1 ‘‘(10) perform such other functions as the Sec2 retary may designate. 

3 ‘‘(d) AUTHORITY.— 

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

5 through the Director, shall have the authority— 

6 ‘‘(A) except to the extent provided for in 

7 paragraph (2), to appoint and compensate em8 ployees for the Service in accordance with title 

9 5, United States Code; 

10 ‘‘(B) to enter into contracts for the pro11 curement of goods and services to carry out the 

12 functions of the Service; and 

13 ‘‘(C) to manage, expend, and obligate all 

14 funds appropriated for the Service. 

15 ‘‘(2) PERSONNEL ACTIONS.—Notwithstanding 

16 any other provision of law, the provisions of section 

17 12 of the Act of June 18, 1934 (48 Stat. 986; 25 

18 U.S.C. 472), shall apply to all personnel actions 

19 taken with respect to new positions created within 

20 the Service as a result of its establishment under 

21 subsection (a). 

22 ‘‘SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYS23 TEM. 

24 ‘‘(a) ESTABLISHMENT.— 


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1 ‘‘(1) IN GENERAL.—The Secretary shall estab2 lish an automated management information system 

3 for the Service. 

4 ‘‘(2) REQUIREMENTS OF SYSTEM.—The infor5 mation system established under paragraph (1) shall 

6 include— 

7 ‘‘(A) a financial management system; 

8 ‘‘(B) a patient care information system for 

9 each area served by the Service; 

10 ‘‘(C) a privacy component that protects the 

11 privacy of patient information held by, or on be12 half of, the Service; 

13 ‘‘(D) a services-based cost accounting com14 ponent that provides estimates of the costs as15 sociated with the provision of specific medical 

16 treatments or services in each Area office of the 

17 Service; 

18 ‘‘(E) an interface mechanism for patient 

19 billing and accounts receivable system; and 

20 ‘‘(F) a training component. 

21 ‘‘(b) PROVISION OF SYSTEMS TO TRIBES AND ORGA22 NIZATIONS.—The Secretary shall provide each Tribal 

23 Health Program automated management information sys24 tems which— 


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1 ‘‘(1) meet the management information needs 

2 of such Tribal Health Program with respect to the 

3 treatment by the Tribal Health Program of patients 

4 of the Service; and 

5 ‘‘(2) meet the management information needs 

6 of the Service. 

7 ‘‘(c) ACCESS TO RECORDS.—Notwithstanding any 

8 other provision of law, each patient shall have reasonable 

9 access to the medical or health records of such patient 

10 which are held by, or on behalf of, the Service. 

11 ‘‘(d) AUTHORITY TO ENHANCE INFORMATION TECH12 NOLOGY.—The Secretary, acting through the Service, 

13 shall have the authority to enter into contracts, agree14 ments, 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 2016 to carry out this title. 


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1 ‘‘TITLE VII—BEHAVIORAL 

2 HEALTH PROGRAMS 

3 ‘‘SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREAT4 MENT SERVICES. 

5 ‘‘(a) PURPOSES.—The purposes of this section are as 

6 follows: 

7 ‘‘(1) To authorize and direct the Secretary, act8 ing through the Service, Indian Tribes, Tribal Orga9 nizations, and Urban Indian Organizations, to de10 velop a comprehensive behavioral health prevention 

11 and treatment program which emphasizes collabora12 tion among alcohol and substance abuse, social serv13 ices, and mental health programs. 

14 ‘‘(2) To provide information, direction, and 

15 guidance relating to mental illness and dysfunction 

16 and self-destructive behavior, including child abuse 

17 and family violence, to those Federal, tribal, State, 

18 and local agencies responsible for programs in In19 dian communities in areas of health care, education, 

20 social services, child and family welfare, alcohol and 

21 substance abuse, law enforcement, and judicial serv22 ices. 

23 ‘‘(3) To assist Indian Tribes to identify services 

24 and resources available to address mental illness and 

25 dysfunctional and self-destructive behavior. 


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1 ‘‘(4) To provide authority and opportunities for 

2 Indian Tribes and Tribal Organizations to develop, 

3 implement, and coordinate with community-based 

4 programs which include identification, prevention, 

5 education, referral, and treatment services, including 

6 through multidisciplinary resource teams. 

7 ‘‘(5) To ensure that Indians, as citizens of the 

8 United States and of the States in which they re9 side, have the same access to behavioral health serv10 ices to which all citizens have access. 

11 ‘‘(6) To modify or supplement existing pro12 grams and authorities in the areas identified in 

13 paragraph (2). 

14 ‘‘(b) PLANS.— 

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

16 through the Service, Indian Tribes, Tribal Organiza17 tions, and Urban Indian Organizations, shall encour18 age Indian Tribes and Tribal Organizations to de19 velop tribal plans, and Urban Indian Organizations 

20 to develop local plans, and for all such groups to 

21 participate in developing areawide plans for Indian 

22 Behavioral Health Services. The plans shall include, 

23 to the extent feasible, the following components: 

24 ‘‘(A) An assessment of the scope of alcohol 

25 or other substance abuse, mental illness, and 


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1 dysfunctional and self-destructive behavior, in2 cluding suicide, child abuse, and family vio3 lence, among Indians, including— 

4 ‘‘(i) the number of Indians served who 

5 are directly or indirectly affected by such 

6 illness or behavior; or 

7 ‘‘(ii) an estimate of the financial and 

8 human cost attributable to such illness or 

9 behavior. 

10 ‘‘(B) An assessment of the existing and 

11 additional resources necessary for the preven12 tion and treatment of such illness and behavior, 

13 including an assessment of the progress toward 

14 achieving the availability of the full continuum 

15 of care described in subsection (c). 

16 ‘‘(C) An estimate of the additional funding 

17 needed by the Service, Indian Tribes, Tribal 

18 Organizations, and Urban Indian Organizations 

19 to meet their responsibilities under the plans. 

20 ‘‘(2) NATIONAL CLEARINGHOUSE.—The Sec21 retary, acting through the Service, shall coordinate 

22 with existing national clearinghouses and informa23 tion centers to include at the clearinghouses and 

24 centers plans and reports on the outcomes of such 

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1 tions, Urban Indian Organizations, and Service 

2 Areas relating to behavioral health. The Secretary 

3 shall ensure access to these plans and outcomes by 

4 any Indian Tribe, Tribal Organization, Urban In5 dian Organization, or the Service. 

6 ‘‘(3) TECHNICAL ASSISTANCE.—The Secretary 

7 shall provide technical assistance to Indian Tribes, 

8 Tribal Organizations, and Urban Indian Organiza9 tions in preparation of plans under this section and 

10 in developing standards of care that may be used 

11 and adopted locally. 

12 ‘‘(c) PROGRAMS.—The Secretary, acting through the 

13 Service, Indian Tribes, and Tribal Organizations, shall 

14 provide, to the extent feasible and if funding is available, 

15 programs including the following: 

16 ‘‘(1) COMPREHENSIVE CARE.—A comprehensive 

17 continuum of behavioral health care which pro18 vides— 

19 ‘‘(A) community-based prevention, inter20 vention, outpatient, and behavioral health 

21 aftercare; 

22 ‘‘(B) detoxification (social and medical); 

23 ‘‘(C) acute hospitalization; 

24 ‘‘(D) intensive outpatient/day treatment; 

25 ‘‘(E) residential treatment; 


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1 ‘‘(F) transitional living for those needing a 

2 temporary, stable living environment that is 

3 supportive of treatment and recovery goals; 

4 ‘‘(G) emergency shelter; 

5 ‘‘(H) intensive case management; and 

6 ‘‘(I) diagnostic services. 

7 ‘‘(2) CHILD CARE.—Behavioral health services 

8 for Indians from birth through age 17, including— 

9 ‘‘(A) preschool and school age fetal alcohol 

10 disorder services, including assessment and be11 havioral intervention; 

12 ‘‘(B) mental health and substance abuse 

13 services (emotional, organic, alcohol, drug, in14 halant, and tobacco); 

15 ‘‘(C) identification and treatment of co-oc16 curring disorders and comorbidity; 

17 ‘‘(D) prevention of alcohol, drug, inhalant, 

18 and tobacco use; 

19 ‘‘(E) early intervention, treatment, and 

20 aftercare; 

21 ‘‘(F) promotion of healthy approaches to 

22 risk and safety issues; and 

23 ‘‘(G) identification and treatment of ne24 glect and physical, mental, and sexual abuse. 


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1 ‘‘(3) ADULT CARE.—Behavioral health services 

2 for Indians from age 18 through 55, including— 

3 ‘‘(A) early intervention, treatment, and 

4 aftercare; 

5 ‘‘(B) mental health and substance abuse 

6 services (emotional, alcohol, drug, inhalant, and 

7 tobacco), including sex specific services; 

8 ‘‘(C) identification and treatment of co-oc9 curring disorders (dual diagnosis) and comor10 bidity; 

11 ‘‘(D) promotion of healthy approaches for 

12 risk-related behavior; 

13 ‘‘(E) treatment services for women at risk 

14 of giving birth to a child with a fetal alcohol 

15 disorder; and 

16 ‘‘(F) sex specific treatment for sexual as17 sault and domestic violence. 

18 ‘‘(4) FAMILY CARE.—Behavioral health services 

19 for families, including— 

20 ‘‘(A) early intervention, treatment, and 

21 aftercare for affected families; 

22 ‘‘(B) treatment for sexual assault and do23 mestic violence; and 


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1 ‘‘(C) promotion of healthy approaches re2 lating to parenting, domestic violence, and other 

3 abuse issues. 

4 ‘‘(5) ELDER CARE.—Behavioral health services 

5 for Indians 56 years of age and older, including— 

6 ‘‘(A) early intervention, treatment, and 

7 aftercare; 

8 ‘‘(B) mental health and substance abuse 

9 services (emotional, alcohol, drug, inhalant, and 

10 tobacco), including sex specific services; 

11 ‘‘(C) identification and treatment of co-oc12 curring disorders (dual diagnosis) and comor13 bidity; 

14 ‘‘(D) promotion of healthy approaches to 

15 managing conditions related to aging; 

16 ‘‘(E) sex specific treatment for sexual as17 sault, domestic violence, neglect, physical and 

18 mental abuse and exploitation; and 

19 ‘‘(F) identification and treatment of de20 mentias regardless of cause. 

21 ‘‘(d) COMMUNITY BEHAVIORAL HEALTH PLAN.— 

22 ‘‘(1) ESTABLISHMENT.—The governing body of 

23 any Indian Tribe, Tribal Organization, or Urban In24 dian Organization may adopt a resolution for the es25 tablishment of a community behavioral health plan 


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1 providing for the identification and coordination of 

2 available resources and programs to identify, pre3 vent, or treat substance abuse, mental illness, or 

4 dysfunctional and self-destructive behavior, including 

5 child abuse and family violence, among its members 

6 or its service population. This plan should include 

7 behavioral health services, social services, intensive 

8 outpatient services, and continuing aftercare. 

9 ‘‘(2) TECHNICAL ASSISTANCE.—At the request 

10 of an Indian Tribe, Tribal Organization, or Urban 

11 Indian Organization, the Bureau of Indian Affairs 

12 and the Service shall cooperate with and provide 

13 technical assistance to the Indian Tribe, Tribal Or14 ganization, or Urban Indian Organization in the de15 velopment and implementation of such plan. 

16 ‘‘(3) FUNDING.—The Secretary, acting through 

17 the Service, may make funding available to Indian 

18 Tribes and Tribal Organizations which adopt a reso19 lution pursuant to paragraph (1) to obtain technical 

20 assistance for the development of a community be21 havioral health plan and to provide administrative 

22 support in the implementation of such plan. 

23 ‘‘(e) COORDINATION FOR AVAILABILITY OF SERV24 ICES.—The Secretary, acting through the Service, Indian 

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1 tions, shall coordinate behavioral health planning, to the 

2 extent feasible, with other Federal agencies and with State 

3 agencies, to encourage comprehensive behavioral health 

4 services for Indians regardless of their place of residence. 

5 ‘‘(f) MENTAL HEALTH CARE NEED ASSESSMENT.— 

6 Not later than 1 year after the date of enactment of the 

7 Indian Health Care Improvement Act Amendments of 

8 2006, 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 2006, the Secretary, acting through 

20 the Service, and the Secretary of the Interior shall develop 

21 and enter into a memoranda of agreement, or review and 

22 update any existing memoranda of agreement, as required 

23 by section 4205 of the Indian Alcohol and Substance 

24 Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 

25 2411) under which the Secretaries address the following: 


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1 ‘‘(1) The scope and nature of mental illness and 

2 dysfunctional and self-destructive behavior, including 

3 child abuse and family violence, among Indians. 

4 ‘‘(2) The existing Federal, tribal, State, local, 

5 and private services, resources, and programs avail6 able to provide behavioral health services for Indi7 ans. 

8 ‘‘(3) The unmet need for additional services, re9 sources, and programs necessary to meet the needs 

10 identified pursuant to paragraph (1). 

11 ‘‘(4)(A) The right of Indians, as citizens of the 

12 United States and of the States in which they re13 side, to have access to behavioral health services to 

14 which all citizens have access. 

15 ‘‘(B) The right of Indians to participate in, and 

16 receive the benefit of, such services. 

17 ‘‘(C) The actions necessary to protect the exer18 cise of such right. 

19 ‘‘(5) The responsibilities of the Bureau of In20 dian Affairs and the Service, including mental illness 

21 identification, prevention, education, referral, and 

22 treatment services (including services through multi23 disciplinary resource teams), at the central, area, 

24 and agency and Service Unit, Service Area, and 


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1 headquarters levels to address the problems identi2 fied in paragraph (1). 

3 ‘‘(6) A strategy for the comprehensive coordina4 tion of the behavioral health services provided by the 

5 Bureau of Indian Affairs and the Service to meet 

6 the problems identified pursuant to paragraph (1), 

7 including— 

8 ‘‘(A) the coordination of alcohol and sub9 stance abuse programs of the Service, the Bu10 reau of Indian Affairs, and Indian Tribes and 

11 Tribal Organizations (developed under the In12 dian Alcohol and Substance Abuse Prevention 

13 and Treatment Act of 1986 (25 U.S.C. 2401 et 

14 seq.)) with behavioral health initiatives pursu15 ant to this Act, particularly with respect to the 

16 referral and treatment of dually diagnosed indi17 viduals requiring behavioral health and sub18 stance abuse treatment; and 

19 ‘‘(B) ensuring that the Bureau of Indian 

20 Affairs and Service programs and services (in21 cluding multidisciplinary resource teams) ad22 dressing child abuse and family violence are co23 ordinated with such non-Federal programs and 

24 services. 


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1 ‘‘(7) Directing appropriate officials of the Bu2 reau of Indian Affairs and the Service, particularly 

3 at the agency and Service Unit levels, to cooperate 

4 fully with tribal requests made pursuant to commu5 nity behavioral health plans adopted under section 

6 701(c) and section 4206 of the Indian Alcohol and 

7 Substance Abuse Prevention and Treatment Act of 

8 1986 (25 U.S.C. 2412). 

9 ‘‘(8) Providing for an annual review of such 

10 agreement by the Secretaries which shall be provided 

11 to Congress and Indian Tribes and Tribal Organiza12 tions. 

13 ‘‘(b) SPECIFIC PROVISIONS REQUIRED.—The memo14 randa of agreement updated or entered into pursuant to 

15 subsection (a) shall include specific provisions pursuant to 

16 which the Service shall assume responsibility for— 

17 ‘‘(1) the determination of the scope of the prob18 lem of alcohol and substance abuse among Indians, 

19 including the number of Indians within the jurisdic20 tion of the Service who are directly or indirectly af21 fected by alcohol and substance abuse and the finan22 cial and human cost; 

23 ‘‘(2) an assessment of the existing and needed 

24 resources necessary for the prevention of alcohol and 


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1 substance abuse and the treatment of Indians af2 fected by alcohol and substance abuse; and 

3 ‘‘(3) an estimate of the funding necessary to 

4 adequately support a program of prevention of alco5 hol and substance abuse and treatment of Indians 

6 affected by alcohol and substance abuse. 

7 ‘‘(c) PUBLICATION.—Each memorandum of agree8 ment entered into or renewed (and amendments or modi9 fications thereto) under subsection (a) shall be published 

10 in the Federal Register. At the same time as publication 

11 in the Federal Register, the Secretary shall provide a copy 

12 of such memoranda, amendment, or modification to each 

13 Indian Tribe, Tribal Organization, and Urban Indian Or14 ganization. 

15 ‘‘SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PRE16 VENTION AND TREATMENT PROGRAM. 

17 ‘‘(a) ESTABLISHMENT.— 

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

19 through the Service, Indian Tribes, and Tribal Orga20 nizations, shall provide a program of comprehensive 

21 behavioral health, prevention, treatment, and 

22 aftercare, which shall include— 

23 ‘‘(A) prevention, through educational inter24 vention, in Indian communities; 


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1 ‘‘(B) acute detoxification, psychiatric hos2 pitalization, residential, and intensive outpatient 

3 treatment; 

4 ‘‘(C) community-based rehabilitation and 

5 aftercare; 

6 ‘‘(D) community education and involve7 ment, including extensive training of health 

8 care, educational, and community-based per9 sonnel; 

10 ‘‘(E) specialized residential treatment pro11 grams for high-risk populations, including preg12 nant and postpartum women and their children; 

13 and 

14 ‘‘(F) diagnostic services. 

15 ‘‘(2) TARGET POPULATIONS.—The target popu16 lation of such programs shall be members of Indian 

17 Tribes. Efforts to train and educate key members of 

18 the Indian community shall also target employees of 

19 health, education, judicial, law enforcement, legal, 

20 and social service programs. 

21 ‘‘(b) CONTRACT HEALTH SERVICES.— 

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

23 through the Service, Indian Tribes, and Tribal Orga24 nizations, may enter into contracts with public or 

25 private providers of behavioral health treatment 


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1 services for the purpose of carrying out the program 

2 required under subsection (a). 

3 ‘‘(2) PROVISION OF ASSISTANCE.—In carrying 

4 out this subsection, the Secretary shall provide as5 sistance to Indian Tribes and Tribal Organizations 

6 to develop criteria for the certification of behavioral 

7 health service providers and accreditation of service 

8 facilities which meet minimum standards for such 

9 services and facilities. 

10 ‘‘SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM. 

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

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

13 as the ‘Snyder Act’), the Secretary shall establish and 

14 maintain a mental health technician program within the 

15 Service which— 

16 ‘‘(1) provides for the training of Indians as 

17 mental health technicians; and 

18 ‘‘(2) employs such technicians in the provision 

19 of community-based mental health care that includes 

20 identification, prevention, education, referral, and 

21 treatment services. 

22 ‘‘(b) PARAPROFESSIONAL TRAINING.—In carrying 

23 out subsection (a), the Secretary, acting through the Serv24 ice, Indian Tribes, and Tribal Organizations, shall provide 

25 high-standard paraprofessional training in mental health 


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1 care necessary to provide quality care to the Indian com2 munities to be served. Such training shall be based upon 

3 a curriculum developed or approved by the Secretary 

4 which combines education in the theory of mental health 

5 care with supervised practical experience in the provision 

6 of such care. 

7 ‘‘(c) SUPERVISION AND EVALUATION OF TECHNI8 CIANS.—The Secretary, acting through the Service, Indian 

9 Tribes, and Tribal Organizations, shall supervise and 

10 evaluate the mental health technicians in the training pro11 gram. 

12 ‘‘(d) TRADITIONAL HEALTH CARE PRACTICES.—The 

13 Secretary, acting through the Service, shall ensure that 

14 the program established pursuant to this subsection in15 volves the use and promotion of the traditional health care 

16 practices of the Indian Tribes to be served. 

17 ‘‘SEC. 705. LICENSING REQUIREMENT FOR MENTAL 

18 HEALTH CARE WORKERS. 

19 ‘‘(a) IN GENERAL.—Subject to the provisions of sec20 tion 221, and except as provided in subsection (b), any 

21 individual employed as a psychologist, social worker, or 

22 marriage and family therapist for the purpose of providing 

23 mental health care services to Indians in a clinical setting 

24 under this Act is required to be licensed as a psychologist, 


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1 social worker, or marriage and family therapist, respec2 tively. 

3 ‘‘(b) TRAINEES.—An individual may be employed as 

4 a trainee in psychology, social work, or marriage and fam5 ily therapy to provide mental health care services de6 scribed in subsection (a) if such individual— 

7 ‘‘(1) works under the direct supervision of a li8 censed psychologist, social worker, or marriage and 

9 family therapist, respectively; 

10 ‘‘(2) is enrolled in or has completed at least 2 

11 years of course work at a post-secondary, accredited 

12 education program for psychology, social work, mar13 riage and family therapy, or counseling; and 

14 ‘‘(3) meets such other training, supervision, and 

15 quality review requirements as the Secretary may es16 tablish. 

17 ‘‘SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS. 

18 ‘‘(a) GRANTS.—The Secretary, consistent with sec19 tion 701, may make grants to Indian Tribes, Tribal Orga20 nizations, and Urban Indian Organizations to develop and 

21 implement a comprehensive behavioral health program of 

22 prevention, intervention, treatment, and relapse preven23 tion services that specifically addresses the cultural, his24 torical, social, and child care needs of Indian women, re25 gardless of age. 


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1 ‘‘(b) USE OF GRANT FUNDS.—A grant made pursu2 ant to this section may be used to— 

3 ‘‘(1) develop and provide community training, 

4 education, and prevention programs for Indian 

5 women relating to behavioral health issues, including 

6 fetal alcohol disorders; 

7 ‘‘(2) identify and provide psychological services, 

8 counseling, advocacy, support, and relapse preven9 tion to Indian women and their families; and 

10 ‘‘(3) develop prevention and intervention models 

11 for Indian women which incorporate traditional 

12 health care practices, cultural values, and commu13 nity and family involvement. 

14 ‘‘(c) CRITERIA.—The Secretary, in consultation with 

15 Indian Tribes and Tribal Organizations, shall establish 

16 criteria for the review and approval of applications and 

17 proposals for funding under this section. 

18 ‘‘(d) EARMARK OF CERTAIN FUNDS.—Twenty per19 cent of the funds appropriated pursuant to this section 

20 shall be used to make grants to Urban Indian Organiza21 tions. 

22 ‘‘SEC. 707. INDIAN YOUTH PROGRAM. 

23 ‘‘(a) DETOXIFICATION AND REHABILITATION.—The 

24 Secretary, acting through the Service, consistent with sec25 tion 701, shall develop and implement a program for acute 


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1 detoxification and treatment for Indian youths, including 

2 behavioral health services. The program shall include re3 gional treatment centers designed to include detoxification 

4 and rehabilitation for both sexes on a referral basis and 

5 programs developed and implemented by Indian Tribes or 

6 Tribal Organizations at the local level under the Indian 

7 Self-Determination and Education Assistance Act (25 

8 U.S.C. 450 et seq.). Regional centers shall be integrated 

9 with the intake and rehabilitation programs based in the 

10 referring Indian community. 

11 ‘‘(b) ALCOHOL AND SUBSTANCE ABUSE TREATMENT

12 CENTERS OR FACILITIES.— 

13 ‘‘(1) ESTABLISHMENT.— 

14 ‘‘(A) IN GENERAL.—The Secretary, acting 

15 through the Service, Indian Tribes, and Tribal 

16 Organizations, shall construct, renovate, or, as 

17 necessary, purchase, and appropriately staff 

18 and operate, at least 1 youth regional treatment 

19 center or treatment network in each area under 

20 the jurisdiction of an Area Office. 

21 ‘‘(B) AREAOFFICE IN CALIFORNIA.—For 

22 the purposes of this subsection, the Area Office 

23 in California shall be considered to be 2 Area 

24 Offices, 1 office whose jurisdiction shall be con25 sidered to encompass the northern area of the 


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1 State of California, and 1 office whose jurisdic2 tion shall be considered to encompass the re3 mainder of the State of California for the pur4 pose of implementing California treatment net5 works. 

6 ‘‘(2) FUNDING.—For the purpose of staffing 

7 and operating such centers or facilities, funding 

8 shall be pursuant to the Act of November 2, 1921 

9 (25 U.S.C. 13). 

10 ‘‘(3) LOCATION.—A youth treatment center 

11 constructed or purchased under this subsection shall 

12 be constructed or purchased at a location within the 

13 area described in paragraph (1) agreed upon (by ap14 propriate tribal resolution) by a majority of the In15 dian Tribes to be served by such center. 

16 ‘‘(4) SPECIFIC PROVISION OF FUNDS.— 

17 ‘‘(A) IN GENERAL.—Notwithstanding any 

18 other provision of this title, the Secretary may, 

19 from amounts authorized to be appropriated for 

20 the purposes of carrying out this section, make 

21 funds available to— 

22 ‘‘(i) the Tanana Chiefs Conference, 

23 Incorporated, for the purpose of leasing, 

24 constructing, renovating, operating, and 


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1 maintaining a residential youth treatment 

2 facility in Fairbanks, Alaska; and 

3 ‘‘(ii) the Southeast Alaska Regional 

4 Health Corporation to staff and operate a 

5 residential youth treatment facility without 

6 regard to the proviso set forth in section 

7 4(l) of the Indian Self-Determination and 

8 Education Assistance Act (25 U.S.C. 

9 450b(l)). 

10 ‘‘(B) PROVISION OF SERVICES TO ELIGI11 BLE YOUTHS.—Until additional residential 

12 youth treatment facilities are established in 

13 Alaska pursuant to this section, the facilities 

14 specified in subparagraph (A) shall make every 

15 effort to provide services to all eligible Indian 

16 youths residing in Alaska. 

17 ‘‘(c) INTERMEDIATE ADOLESCENT BEHAVIORAL

18 HEALTH SERVICES.— 

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

20 through the Service, Indian Tribes, and Tribal Orga21 nizations, may provide intermediate behavioral 

22 health services to Indian children and adolescents, 

23 including— 

24 ‘‘(A) pretreatment assistance; 


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1 ‘‘(B) inpatient, outpatient, and aftercare 

2 services; 

3 ‘‘(C) emergency care; 

4 ‘‘(D) suicide prevention and crisis interven5 tion; and 

6 ‘‘(E) prevention and treatment of mental 

7 illness and dysfunctional and self-destructive 

8 behavior, including child abuse and family vio9 lence. 

10 ‘‘(2) USE OF FUNDS.—Funds provided under 

11 this subsection may be used— 

12 ‘‘(A) to construct or renovate an existing 

13 health facility to provide intermediate behav14 ioral health services; 

15 ‘‘(B) to hire behavioral health profes16 sionals; 

17 ‘‘(C) to staff, operate, and maintain an in18 termediate mental health facility, group home, 

19 sober housing, transitional housing or similar 

20 facilities, or youth shelter where intermediate 

21 behavioral health services are being provided; 

22 ‘‘(D) to make renovations and hire appro23 priate staff to convert existing hospital beds 

24 into adolescent psychiatric units; and 


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1 ‘‘(E) for intensive home- and community2 based services. 

3 ‘‘(3) CRITERIA.—The Secretary, acting through 

4 the Service, shall, in consultation with Indian Tribes 

5 and Tribal Organizations, establish criteria for the 

6 review and approval of applications or proposals for 

7 funding made available pursuant to this subsection. 

8 ‘‘(d) FEDERALLY-OWNED STRUCTURES.— 

9 ‘‘(1) IN GENERAL.—The Secretary, in consulta10 tion with Indian Tribes and Tribal Organizations, 

11 shall— 

12 ‘‘(A) identify and use, where appropriate, 

13 federally-owned structures suitable for local res14 idential or regional behavioral health treatment 

15 for Indian youths; and 

16 ‘‘(B) establish guidelines for determining 

17 the suitability of any such federally-owned 

18 structure to be used for local residential or re19 gional behavioral health treatment for Indian 

20 youths. 

21 ‘‘(2) TERMS AND CONDITIONS FOR USE OF

22 STRUCTURE.—Any structure described in paragraph 

23 (1) may be used under such terms and conditions as 

24 may be agreed upon by the Secretary and the agency 

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1 dian Tribe or Tribal Organization operating the pro2 gram. 

3 ‘‘(e) REHABILITATION AND AFTERCARE SERVICES.— 

4 ‘‘(1) IN GENERAL.—The Secretary, Indian 

5 Tribes, or Tribal Organizations, in cooperation with 

6 the Secretary of the Interior, shall develop and im7 plement within each Service Unit, community-based 

8 rehabilitation and follow-up services for Indian 

9 youths who are having significant behavioral health 

10 problems, and require long-term treatment, commu11 nity reintegration, and monitoring to support the In12 dian youths after their return to their home commu13 nity. 

14 ‘‘(2) ADMINISTRATION.—Services under para15 graph (1) shall be provided by trained staff within 

16 the community who can assist the Indian youths in 

17 their continuing development of self-image, positive 

18 problem-solving skills, and nonalcohol or substance 

19 abusing behaviors. Such staff may include alcohol 

20 and substance abuse counselors, mental health pro21 fessionals, and other health professionals and para22 professionals, including community health represent23 atives. 

24 ‘‘(f) INCLUSION OF FAMILY IN YOUTH TREATMENT

25 PROGRAM.—In providing the treatment and other services 


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1 to Indian youths authorized by this section, the Secretary, 

2 acting through the Service, Indian Tribes, and Tribal Or3 ganizations, shall provide for the inclusion of family mem4 bers of such youths in the treatment programs or other 

5 services as may be appropriate. Not less than 10 percent 

6 of the funds appropriated for the purposes of carrying out 

7 subsection (e) shall be used for outpatient care of adult 

8 family members related to the treatment of an Indian 

9 youth under that subsection. 

10 ‘‘(g) MULTIDRUG ABUSE PROGRAM.—The Secretary, 

11 acting through the Service, Indian Tribes, Tribal Organi12 zations, and Urban Indian Organizations, shall provide, 

13 consistent with section 701, programs and services to pre14 vent and treat the abuse of multiple forms of substances, 

15 including alcohol, drugs, inhalants, and tobacco, among 

16 Indian youths residing in Indian communities, on or near 

17 reservations, and in urban areas and provide appropriate 

18 mental health services to address the incidence of mental 

19 illness among such youths. 

20 ‘‘(h) INDIAN YOUTH MENTAL HEALTH.—The Sec21 retary, acting through the Service, shall collect data for 

22 the report under section 801 with respect to— 

23 ‘‘(1) the number of Indian youth who are being 

24 provided mental health services through the Service 

25 and Tribal Health Programs; 


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1 ‘‘(2) a description of, and costs associated with, 

2 the mental health services provided for Indian youth 

3 through the Service and Tribal Health Programs; 

4 ‘‘(3) the number of youth referred to the Serv5 ice or Tribal Health Programs for mental health 

6 services; 

7 ‘‘(4) the number of Indian youth provided resi8 dential treatment for mental health and behavioral 

9 problems through the Service and Tribal Health 

10 Programs, reported separately for on- and off-res11 ervation facilities; and 

12 ‘‘(5) the costs of the services described in para13 graph (4). 

14 ‘‘SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEM15 ONSTRATION PROJECT. 

16 ‘‘(a) PURPOSE.—The purpose of this section is to au17 thorize the Secretary to carry out a demonstration project 

18 to test the use of telemental health services in suicide pre19 vention, intervention and treatment of Indian youth, in20 cluding through— 

21 ‘‘(1) the use of psychotherapy, psychiatric as22 sessments, diagnostic interviews, therapies for men23 tal health conditions predisposing to suicide, and al24 cohol and substance abuse treatment; 


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1 ‘‘(2) the provision of clinical expertise to, con2 sultation services with, and medical advice and train3 ing for frontline health care providers working with 

4 Indian youth; 

5 ‘‘(3) training and related support for commu6 nity leaders, family members and health and edu7 cation workers who work with Indian youth; 

8 ‘‘(4) the development of culturally-relevant edu9 cational materials on suicide; and 

10 ‘‘(5) data collection and reporting. 

11 ‘‘(b) DEFINITIONS.—For the purpose of this section, 

12 the following definitions shall apply: 

13 ‘‘(1) DEMONSTRATION PROJECT.—The term 

14 ‘demonstration project’ means the Indian youth tele15 mental health demonstration project authorized 

16 under subsection (c). 

17 ‘‘(2) TELEMENTAL HEALTH.—The term ‘tele18 mental health’ means the use of electronic informa19 tion and telecommunications technologies to support 

20 long distance mental health care, patient and profes21 sional-related education, public health, and health 

22 administration. 

23 ‘‘(c) AUTHORIZATION.— 

24 ‘‘(1) IN GENERAL.—The Secretary is authorized 

25 to award grants under the demonstration project for 


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1 the provision of telemental health services to Indian 

2 youth who— 

3 ‘‘(A) have expressed suicidal ideas; 

4 ‘‘(B) have attempted suicide; or 

5 ‘‘(C) have mental health conditions that in6 crease or could increase the risk of suicide. 

7 ‘‘(2) ELIGIBILITY FOR GRANTS.—Such grants 

8 shall be awarded to Indian Tribes, Tribal Organiza9 tions, and Urban Indian Organizations that operate 

10 1 or more facilities— 

11 ‘‘(A) located in Alaska and part of the 

12 Alaska Federal Health Care Access Network; 

13 ‘‘(B) reporting active clinical telehealth ca14 pabilities; or 

15 ‘‘(C) offering school-based telemental 

16 health services relating to psychiatry to Indian 

17 youth. 

18 ‘‘(3) GRANT PERIOD.—The Secretary shall 

19 award grants under this section for a period of up 

20 to 4 years. 

21 ‘‘(4) AWARDING OF GRANTS.—Not more than 5 

22 grants shall be provided under paragraph (1), with 

23 priority consideration given to Indian Tribes, Tribal 

24 Organizations, and Urban Indian Organizations 

25 that— 


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1 ‘‘(A) serve a particular community or geo2 graphic area where there is a demonstrated 

3 need to address Indian youth suicide; 

4 ‘‘(B) enter in to collaborative partnerships 

5 with Indian Health Service or other Tribal 

6 Health Programs or facilities to provide services 

7 under 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 youth are detained. 

13 ‘‘(d) USE OF FUNDS.— 

14 ‘‘(1) IN GENERAL.—An Indian Tribe, Tribal 

15 Organization, or Urban Indian Organization shall 

16 use a grant received under subsection (c) for the fol17 lowing purposes: 

18 ‘‘(A) To provide telemental health services 

19 to Indian youth, including the provision of— 

20 ‘‘(i) psychotherapy; 

21 ‘‘(ii) psychiatric assessments and di22 agnostic interviews, therapies for mental 

23 health conditions predisposing to suicide, 

24 and treatment; and 


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1 ‘‘(iii) alcohol and substance abuse 

2 treatment. 

3 ‘‘(B) To provide clinician-interactive med4 ical advice, guidance and training, assistance in 

5 diagnosis and interpretation, crisis counseling 

6 and intervention, and related assistance to 

7 Service, tribal, or urban clinicians and health 

8 services providers working with youth being 

9 served under this demonstration project. 

10 ‘‘(C) To assist, educate and train commu11 nity leaders, health education professionals and 

12 paraprofessionals, tribal outreach workers, and 

13 family members who work with the youth re14 ceiving telemental health services under this 

15 demonstration project, including with identifica16 tion of suicidal tendencies, crisis intervention 

17 and suicide prevention, emergency skill develop18 ment, and building and expanding networks 

19 among these individuals and with State and 

20 local health services providers. 

21 ‘‘(D) To develop and distribute culturally 

22 appropriate community educational materials 

23 on— 

24 ‘‘(i) suicide prevention; 

25 ‘‘(ii) suicide education; 


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1 ‘‘(iii) suicide screening; 

2 ‘‘(iv) suicide intervention; and 

3 ‘‘(v) ways to mobilize communities 

4 with respect to the identification of risk 

5 factors for suicide. 

6 ‘‘(E) For data collection and reporting re7 lated to Indian youth suicide prevention efforts. 

8 ‘‘(2) TRADITIONAL HEALTH CARE PRAC9 TICES.—In carrying out the purposes described in 

10 paragraph (1), an Indian Tribe, Tribal Organization, 

11 or Urban Indian Organization may use and promote 

12 the traditional health care practices of the Indian 

13 Tribes of the youth to be served. 

14 ‘‘(e) APPLICATIONS.—To be eligible to receive a grant 

15 under subsection (c), an Indian Tribe, Tribal Organiza16 tion, or Urban Indian Organization shall prepare and sub17 mit to the Secretary an application, at such time, in such 

18 manner, and containing such information as the Secretary 

19 may require, including— 

20 ‘‘(1) a description of the project that the Indian 

21 Tribe, Tribal Organization, or Urban Indian Organi22 zation will carry out using the funds provided under 

23 the grant; 

24 ‘‘(2) a description of the manner in which the 

25 project funded under the grant would— 


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1 ‘‘(A) meet the telemental health care needs 

2 of the Indian youth population to be served by 

3 the project; or 

4 ‘‘(B) improve the access of the Indian 

5 youth population to be served to suicide preven6 tion and treatment services; 

7 ‘‘(3) evidence of support for the project from 

8 the local community to be served by the project; 

9 ‘‘(4) a description of how the families and lead10 ership of the communities or populations to be 

11 served by the project would be involved in the devel12 opment and ongoing operations of the project; 

13 ‘‘(5) a plan to involve the tribal community of 

14 the youth who are provided services by the project 

15 in planning and evaluating the mental health care 

16 and suicide prevention efforts provided, in order to 

17 ensure the integration of community, clinical, envi18 ronmental, and cultural components of the treat19 ment; and 

20 ‘‘(6) a plan for sustaining the project after Fed21 eral assistance for the demonstration project has ter22 minated. 

23 ‘‘(f) COLLABORATION; REPORTING TO NATIONAL

24 CLEARINGHOUSE.— 


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1 ‘‘(1) COLLABORATION.—The Secretary, acting 

2 through the Service, shall encourage Indian Tribes, 

3 Tribal Organizations, and Urban Indian Organiza4 tions receiving grants under this section to collabo5 rate to enable comparisons about best practices 

6 across projects. 

7 ‘‘(2) REPORTING TO NATIONAL CLEARING8 HOUSE.—The Secretary, acting through the Service, 

9 shall also encourage Indian Tribes, Tribal Organiza10 tions, and Urban Indian Organizations receiving 

11 grants under this section to submit relevant, declas12 sified project information to the national clearing13 house authorized under section 701(b)(2) in order to 

14 better facilitate program performance and improve 

15 suicide prevention, intervention, and treatment serv16 ices. 

17 ‘‘(g) ANNUAL REPORT.—Each grant recipient shall 

18 submit to the Secretary an annual report that— 

19 ‘‘(1) describes the number of telemental health 

20 services provided; and 

21 ‘‘(2) includes any other information that the 

22 Secretary may require. 

23 ‘‘(h) REPORT TO CONGRESS.—Not later than 270 

24 days after the termination of the demonstration project, 

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1 fairs of the Senate and the Committee on Resources and 

2 Committee on Energy and Commerce of the House of 

3 Representatives a final report, based on the annual reports 

4 provided by grant recipients under subsection (h), that— 

5 ‘‘(1) describes the results of the projects funded 

6 by grants awarded under this section, including any 

7 data available which indicates the number of at8 tempted suicides; and 

9 ‘‘(2) evaluates the impact of the telemental 

10 health services funded by the grants in reducing the 

11 number of completed suicides among Indian youth. 

12 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

13 authorized to be appropriated to carry out this section 

14 $1,500,000 for each of fiscal years 2007 through 2010. 

15 ‘‘SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL 

16 HEALTH FACILITIES DESIGN, CONSTRUC17 TION, AND STAFFING. 

18 ‘‘Not later than 1 year after the date of enactment 

19 of the Indian Health Care Improvement Act Amendments 

20 of 2006, the Secretary, acting through the Service, Indian 

21 Tribes, and Tribal Organizations, may provide, in each 

22 area of the Service, not less than 1 inpatient mental health 

23 care facility, or the equivalent, for Indians with behavioral 

24 health problems. For the purposes of this subsection, Cali25 fornia shall be considered to be 2 Area Offices, 1 office 


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1 whose location shall be considered to encompass the north2 ern area of the State of California and 1 office whose ju3 risdiction shall be considered to encompass the remainder 

4 of the State of California. The Secretary shall consider 

5 the possible conversion of existing, underused Service hos6 pital beds into psychiatric units to meet such need. 

7 ‘‘SEC. 710. TRAINING AND COMMUNITY EDUCATION. 

8 ‘‘(a) PROGRAM.—The Secretary, in cooperation with 

9 the Secretary of the Interior, shall develop and implement 

10 or assist Indian Tribes and Tribal Organizations to de11 velop and implement, within each Service Unit or tribal 

12 program, a program of community education and involve13 ment which shall be designed to provide concise and timely 

14 information to the community leadership of each tribal 

15 community. Such program shall include education about 

16 behavioral health issues to political leaders, Tribal judges, 

17 law enforcement personnel, members of tribal health and 

18 education boards, health care providers including tradi19 tional practitioners, and other critical members of each 

20 tribal community. Such program may also include commu21 nity-based training to develop local capacity and tribal 

22 community provider training for prevention, intervention, 

23 treatment, and aftercare. 

24 ‘‘(b) INSTRUCTION.—The Secretary, acting through 

25 the Service, shall, either directly or through Indian Tribes 


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1 and Tribal Organizations, provide instruction in the area 

2 of behavioral health issues, including instruction in crisis 

3 intervention and family relations in the context of alcohol 

4 and substance abuse, child sexual abuse, youth alcohol and 

5 substance abuse, and the causes and effects of fetal alco6 hol disorders to appropriate employees of the Bureau of 

7 Indian Affairs and the Service, and to personnel in schools 

8 or programs operated under any contract with the Bureau 

9 of Indian Affairs or the Service, including supervisors of 

10 emergency shelters and halfway houses described in sec11 tion 4213 of the Indian Alcohol and Substance Abuse Pre12 vention and Treatment Act of 1986 (25 U.S.C. 2433). 

13 ‘‘(c) TRAINING MODELS.—In carrying out the edu14 cation and training programs required by this section, the 

15 Secretary, in consultation with Indian Tribes, Tribal Or16 ganizations, Indian behavioral health experts, and Indian 

17 alcohol and substance abuse prevention experts, shall de18 velop and provide community-based training models. Such 

19 models shall address— 

20 ‘‘(1) the elevated risk of alcohol and behavioral 

21 health problems faced by children of alcoholics; 

22 ‘‘(2) the cultural, spiritual, and 

23 multigenerational aspects of behavioral health prob24 lem prevention and recovery; and 


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1 ‘‘(3) community-based and multidisciplinary 

2 strategies for preventing and treating behavioral 

3 health problems. 

4 ‘‘SEC. 711. BEHAVIORAL HEALTH PROGRAM. 

5 ‘‘(a) INNOVATIVE PROGRAMS.—The Secretary, acting 

6 through the Service, Indian Tribes, and Tribal Organiza7 tions, consistent with section 701, may plan, develop, im8 plement, and carry out programs to deliver innovative 

9 community-based behavioral health services to Indians. 

10 ‘‘(b) AWARDS; CRITERIA.—The Secretary may award 

11 a grant for a project under subsection (a) to an Indian 

12 Tribe or Tribal Organization and may consider the fol13 lowing criteria: 

14 ‘‘(1) The project will address significant unmet 

15 behavioral health needs among Indians. 

16 ‘‘(2) The project will serve a significant number 

17 of Indians. 

18 ‘‘(3) The project has the potential to deliver 

19 services in an efficient and effective manner. 

20 ‘‘(4) The Indian Tribe or Tribal Organization 

21 has the administrative and financial capability to ad22 minister the project. 

23 ‘‘(5) The project may deliver services in a man24 ner consistent with traditional health care practices. 


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1 ‘‘(6) The project is coordinated with, and avoids 

2 duplication of, existing services. 

3 ‘‘(c) EQUITABLE TREATMENT.—For purposes of this 

4 subsection, the Secretary shall, in evaluating project appli5 cations or proposals, use the same criteria that the Sec6 retary uses in evaluating any other application or proposal 

7 for such funding. 

8 ‘‘SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS. 

9 ‘‘(a) PROGRAMS.— 

10 ‘‘(1) ESTABLISHMENT.—The Secretary, con11 sistent with section 701, acting through the Service, 

12 Indian Tribes, and Tribal Organizations, is author13 ized to establish and operate fetal alcohol disorder 

14 programs as provided in this section for the pur15 poses of meeting the health status objectives speci16 fied in section 3. 

17 ‘‘(2) USE OF FUNDS.— 

18 ‘‘(A) IN GENERAL.—Funding provided 

19 pursuant to this section shall be used for the 

20 following: 

21 ‘‘(i) To develop and provide for Indi22 ans community and in-school training, edu23 cation, and prevention programs relating 

24 to fetal alcohol disorders. 


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1 ‘‘(ii) To identify and provide behav2 ioral health treatment to high-risk Indian 

3 women and high-risk women pregnant with 

4 an Indian’s child. 

5 ‘‘(iii) To identify and provide appro6 priate psychological services, educational 

7 and vocational support, counseling, advo8 cacy, and information to fetal alcohol dis9 order affected Indians and their families or 

10 caretakers. 

11 ‘‘(iv) To develop and implement coun12 seling and support programs in schools for 

13 fetal alcohol disorder affected Indian chil14 dren. 

15 ‘‘(v) To develop prevention and inter16 vention models which incorporate practi17 tioners of traditional health care practices, 

18 cultural values, and community involve19 ment. 

20 ‘‘(vi) To develop, print, and dissemi21 nate education and prevention materials on 

22 fetal alcohol disorder. 

23 ‘‘(vii) To develop and implement, in 

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1 tions, culturally sensitive assessment and 

2 diagnostic tools including dysmorphology 

3 clinics and multidisciplinary fetal alcohol 

4 disorder clinics for use in Indian commu5 nities and Urban Centers. 

6 ‘‘(B) ADDITIONAL USES.—In addition to 

7 any purpose under subparagraph (A), funding 

8 provided pursuant to this section may be used 

9 for 1 or more of the following: 

10 ‘‘(i) Early childhood intervention 

11 projects from birth on to mitigate the ef12 fects of fetal alcohol disorder among Indi13 ans. 

14 ‘‘(ii) Community-based support serv15 ices for Indians and women pregnant with 

16 Indian children. 

17 ‘‘(iii) Community-based housing for 

18 adult Indians with fetal alcohol disorder. 

19 ‘‘(3) CRITERIA FOR APPLICATIONS.—The Sec20 retary shall establish criteria for the review and ap21 proval of applications for funding under this section. 

22 ‘‘(b) SERVICES.—The Secretary, acting through the 

23 Service and Indian Tribes, Tribal Organizations, and 

24 Urban Indian Organizations, shall— 


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1 ‘‘(1) develop and provide services for the pre2 vention, intervention, treatment, and aftercare for 

3 those affected by fetal alcohol disorder in Indian 

4 communities; and 

5 ‘‘(2) provide supportive services, including serv6 ices to meet the special educational, vocational, 

7 school-to-work transition, and independent living 

8 needs of adolescent and adult Indians with fetal al9 cohol disorder. 

10 ‘‘(c) TASK FORCE.—The Secretary shall establish a 

11 task force to be known as the Fetal Alcohol Disorder Task 

12 Force to advise the Secretary in carrying out subsection 

13 (b). Such task force shall be composed of representatives 

14 from the following: 

15 ‘‘(1) The National Institute on Drug Abuse. 

16 ‘‘(2) The National Institute on Alcohol and Al17 coholism. 

18 ‘‘(3) The Office of Substance Abuse Prevention. 

19 ‘‘(4) The National Institute of Mental Health. 

20 ‘‘(5) The Service. 

21 ‘‘(6) The Office of Minority Health of the De22 partment of Health and Human Services. 

23 ‘‘(7) The Administration for Native Americans. 

24 ‘‘(8) The National Institute of Child Health 

25 and Human Development (NICHD). 


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1 ‘‘(9) The Centers for Disease Control and Pre2 vention. 

3 ‘‘(10) The Bureau of Indian Affairs. 

4 ‘‘(11) Indian Tribes. 

5 ‘‘(12) Tribal Organizations. 

6 ‘‘(13) Urban Indian Organizations. 

7 ‘‘(14) Indian fetal alcohol disorder experts. 

8 ‘‘(d) APPLIED RESEARCH PROJECTS.—The Sec9 retary, acting through the Substance Abuse and Mental 

10 Health Services Administration, shall make grants to In11 dian Tribes, Tribal Organizations, and Urban Indian Or12 ganizations for applied research projects which propose to 

13 elevate the understanding of methods to prevent, inter14 vene, treat, or provide rehabilitation and behavioral health 

15 aftercare for Indians and Urban Indians affected by fetal 

16 alcohol disorder. 

17 ‘‘(e) FUNDING FOR URBAN INDIAN ORGANIZA18 TIONS.—Ten percent of the funds appropriated pursuant 

19 to this section shall be used to make grants to Urban In20 dian Organizations funded under title V. 

21 ‘‘SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREAT22 MENT PROGRAMS. 

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

24 through the Service, and the Secretary of the Interior, In25 dian Tribes, and Tribal Organizations, shall establish, 


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1 consistent with section 701, in every Service Area, pro2 grams involving treatment for— 

3 ‘‘(1) victims of sexual abuse who are Indian 

4 children or children in an Indian household; and 

5 ‘‘(2) perpetrators of child sexual abuse who are 

6 Indian or members of an Indian household. 

7 ‘‘(b) USE OF FUNDS.—Funding provided pursuant to 

8 this section shall be used for the following: 

9 ‘‘(1) To develop and provide community edu10 cation and prevention programs related to sexual 

11 abuse of Indian children or children in an Indian 

12 household. 

13 ‘‘(2) To identify and provide behavioral health 

14 treatment to victims of sexual abuse who are Indian 

15 children or children in an Indian household, and to 

16 their family members who are affected by sexual 

17 abuse. 

18 ‘‘(3) To develop prevention and intervention 

19 models which incorporate traditional health care 

20 practices, cultural values, and community involve21 ment. 

22 ‘‘(4) To develop and implement culturally sen23 sitive assessment and diagnostic tools for use in In24 dian communities and Urban Centers. 


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1 ‘‘(5) To identify and provide behavioral health 

2 treatment to Indian perpetrators and perpetrators 

3 who are members of an Indian household— 

4 ‘‘(A) making efforts to begin offender and 

5 behavioral health treatment while the perpe6 trator is incarcerated or at the earliest possible 

7 date if the perpetrator is not incarcerated; and 

8 ‘‘(B) providing treatment after the perpe9 trator is released, until it is determined that the 

10 perpetrator is not a threat to children. 

11 ‘‘SEC. 714. BEHAVIORAL HEALTH RESEARCH. 

12 ‘‘The Secretary, in consultation with appropriate 

13 Federal agencies, shall make grants to, or enter into con14 tracts with, Indian Tribes, Tribal Organizations, and 

15 Urban Indian Organizations or enter into contracts with, 

16 or make grants to appropriate institutions for, the conduct 

17 of research on the incidence and prevalence of behavioral 

18 health problems among Indians served by the Service, In19 dian Tribes, or Tribal Organizations and among Indians 

20 in urban areas. Research priorities under this section shall 

21 include— 

22 ‘‘(1) the multifactorial causes of Indian youth 

23 suicide, including— 

24 ‘‘(A) protective and risk factors and sci25 entific data that identifies those factors; and 


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1 ‘‘(B) the effects of loss of cultural identity 

2 and the development of scientific data on those 

3 effects; 

4 ‘‘(2) the interrelationship and interdependence 

5 of behavioral health problems with alcoholism and 

6 other substance abuse, suicide, homicides, other in7 juries, and the incidence of family violence; and 

8 ‘‘(3) the development of models of prevention 

9 techniques. 

10 The effect of the interrelationships and interdependencies 

11 referred to in paragraph (2) on children, and the develop12 ment of prevention techniques under paragraph (3) appli13 cable to children, shall be emphasized. 

14 ‘‘SEC. 715. DEFINITIONS. 

15 ‘‘For the purpose of this title, the following defini16 tions shall apply: 

17 ‘‘(1) ASSESSMENT.—The term ‘assessment’ 

18 means the systematic collection, analysis, and dis19 semination of information on health status, health 

20 needs, and health problems. 

21 ‘‘(2) ALCOHOL-RELATED

22 NEURODEVELOPMENTAL DISORDERS OR ARND.—The 

23 term ‘alcohol-related neurodevelopmental disorders’ 

24 or ‘ARND’ means, with a history of maternal alco25 hol consumption during pregnancy, central nervous 


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1 system involvement such as developmental delay, in2 tellectual deficit, or neurologic abnormalities. Behav3 iorally, there can be problems with irritability, and 

4 failure to thrive as infants. As children become older 

5 there will likely be hyperactivity, attention deficit, 

6 language dysfunction, and perceptual and judgment 

7 problems. 

8 ‘‘(3) BEHAVIORAL HEALTH AFTERCARE.—The 

9 term ‘behavioral health aftercare’ includes those ac10 tivities and resources used to support recovery fol11 lowing inpatient, residential, intensive substance 

12 abuse, or mental health outpatient or outpatient 

13 treatment. The purpose is to help prevent or deal 

14 with relapse by ensuring that by the time a client or 

15 patient is discharged from a level of care, such as 

16 outpatient treatment, an aftercare plan has been de17 veloped with the client. An aftercare plan may use 

18 such resources as a community-based therapeutic 

19 group, transitional living facilities, a 12-step spon20 sor, a local 12-step or other related support group, 

21 and other community-based providers. 

22 ‘‘(4) DUAL DIAGNOSIS.—The term ‘dual diag23 nosis’ means coexisting substance abuse and mental 

24 illness conditions or diagnosis. Such clients are 


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1 sometimes referred to as mentally ill chemical abus2 ers (MICAs). 

3 ‘‘(5) FETAL ALCOHOL DISORDERS.—The term 

4 ‘fetal alcohol disorders’ means fetal alcohol syn5 drome, partial fetal alcohol syndrome and alcohol re6 lated neurodevelopmental disorder (ARND). 

7 ‘‘(6) FETAL ALCOHOL SYNDROME OR FAS.— 

8 The term ‘fetal alcohol syndrome’ or ‘FAS’ means a 

9 syndrome in which, with a history of maternal alco10 hol consumption during pregnancy, the following cri11 teria are met: 

12 ‘‘(A) Central nervous system involvement 

13 such as developmental delay, intellectual deficit, 

14 microencephaly, or neurologic abnormalities. 

15 ‘‘(B) Craniofacial abnormalities with at 

16 least 2 of the following: microophthalmia, short 

17 palpebral fissures, poorly developed philtrum, 

18 thin upper lip, flat nasal bridge, and short 

19 upturned nose. 

20 ‘‘(C) Prenatal or postnatal growth delay. 

21 ‘‘(7) PARTIAL FAS.—The term ‘partial FAS’ 

22 means, with a history of maternal alcohol consump23 tion during pregnancy, having most of the criteria of 

24 FAS, though not meeting a minimum of at least 2 

25 of the following: microophthalmia, short palpebral 


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1 fissures, poorly developed philtrum, thin upper lip, 

2 flat nasal bridge, and short upturned nose. 

3 ‘‘(8) REHABILITATION.—The term ‘rehabilita4 tion’ means to restore the ability or capacity to en5 gage in usual and customary life activities through 

6 education and therapy. 

7 ‘‘(9) SUBSTANCE ABUSE.—The term ‘substance 

8 abuse’ includes inhalant abuse. 

9 ‘‘SEC. 716. AUTHORIZATION OF APPROPRIATIONS. 

10 ‘‘There is authorized to be appropriated such sums 

11 as may be necessary for each fiscal year through fiscal 

12 year 2016 to carry out the provisions of this title. 

13 ‘‘TITLE VIII—MISCELLANEOUS 

14 ‘‘SEC. 801. REPORTS. 

15 ‘‘For each fiscal year following the date of enactment 

16 of the Indian Health Care Improvement Act Amendments 

17 of 2006, the Secretary shall transmit to Congress a report 

18 containing the following: 

19 ‘‘(1) A report on the progress made in meeting 

20 the objectives of this Act, including a review of pro21 grams established or assisted pursuant to this Act 

22 and assessments and recommendations of additional 

23 programs or additional assistance necessary to, at a 

24 minimum, provide health services to Indians and en25 sure a health status for Indians, which are at a parVerDate Aug 31 2005 02:12 Dec 13, 2006 Jkt 059200 PO 00000 Frm 00290 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 ity with the health services available to and the 

2 health status of the general population. 

3 ‘‘(2) A report on whether, and to what extent, 

4 new national health care programs, benefits, initia5 tives, or financing systems have had an impact on 

6 the purposes of this Act and any steps that the Sec7 retary may have taken to consult with Indian Tribes, 

8 Tribal Organizations, and Urban Indian Organiza9 tions to address such impact, including a report on 

10 proposed changes in allocation of funding pursuant 

11 to section 808. 

12 ‘‘(3) A report on the use of health services by 

13 Indians— 

14 ‘‘(A) on a national and area or other rel15 evant geographical basis; 

16 ‘‘(B) by gender and age; 

17 ‘‘(C) by source of payment and type of 

18 service; 

19 ‘‘(D) comparing such rates of use with 

20 rates of use among comparable non-Indian pop21 ulations; and 

22 ‘‘(E) provided under contracts. 

23 ‘‘(4) A report of contractors to the Secretary on 

24 Health Care Educational Loan Repayments every 6 

25 months required by section 110. 


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1 ‘‘(5) A general audit report of the Secretary on 

2 the Health Care Educational Loan Repayment Pro3 gram as required by section 110(n). 

4 ‘‘(6) A report of the findings and conclusions of 

5 demonstration programs on development of edu6 cational curricula for substance abuse counseling as 

7 required in section 125(f). 

8 ‘‘(7) A separate statement which specifies the 

9 amount of funds requested to carry out the provi10 sions of section 201. 

11 ‘‘(8) A report of the evaluations of health pro12 motion and disease prevention as required in section 

13 203(c). 

14 ‘‘(9) A biennial report to Congress on infectious 

15 diseases as required by section 212. 

16 ‘‘(10) A report on environmental and nuclear 

17 health hazards as required by section 215. 

18 ‘‘(11) An annual report on the status of all 

19 health care facilities needs as required by section 

20 301(c)(2)(B) and 301(d). 

21 ‘‘(12) Reports on safe water and sanitary waste 

22 disposal facilities as required by section 302(h). 

23 ‘‘(13) An annual report on the expenditure of 

24 non-Service funds for renovation as required by sec25 tions 304(b)(2). 


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1 ‘‘(14) A report identifying the backlog of main2 tenance and repair required at Service and tribal fa3 cilities required by section 313(a). 

4 ‘‘(15) A report providing an accounting of reim5 bursement funds made available to the Secretary 

6 under titles XVIII, XIX, and XXI of the Social Se7 curity Act. 

8 ‘‘(16) A report on any arrangements for the 

9 sharing of medical facilities or services, as author10 ized by section 406. 

11 ‘‘(17) A report on evaluation and renewal of 

12 Urban Indian programs under section 505. 

13 ‘‘(18) A report on the evaluation of programs 

14 as required by section 513(d). 

15 ‘‘(19) A report on alcohol and substance abuse 

16 as required by section 701(f). 

17 ‘‘(20) A report on Indian youth mental health 

18 services as required by section 707(h). 

19 ‘‘(21) A report on the reallocation of base re20 sources if required by section 808. 

21 ‘‘SEC. 802. REGULATIONS. 

22 ‘‘(a) DEADLINES.— 

23 ‘‘(1) PROCEDURES.—Not later than 90 days 

24 after the date of enactment of the Indian Health 

25 Care Improvement Act Amendments of 2006, the 


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1 Secretary shall initiate procedures under subchapter 

2 III of chapter 5 of title 5, United States Code, to 

3 negotiate and promulgate such regulations or 

4 amendments thereto that are necessary to carry out 

5 titles II (except section 202) and VII, the sections 

6 of title III for which negotiated rulemaking is spe7 cifically required, and sections 807 and 811. Unless 

8 otherwise required, the Secretary may promulgate 

9 regulations to carry out titles I, III, IV, and V, and 

10 section 202, using the procedures required by chap11 ter V of title 5, United States Code (commonly 

12 known as the ‘Administrative Procedure Act’). 

13 ‘‘(2) PROPOSED REGULATIONS.—Proposed reg14 ulations to implement this Act shall be published in 

15 the Federal Register by the Secretary no later than 

16 2 years after the date of enactment of the Indian 

17 Health Care Improvement Act Amendments of 2006 

18 and shall have no less than a 120-day comment pe19 riod. 

20 ‘‘(3) FINAL REGULATIONS.—The Secretary 

21 shall publish in the Federal Register final regula22 tions to implement this Act by not later than 3 years 

23 after the date of enactment of the Indian Health 

24 Care Improvement Act Amendments of 2006. 


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1 ‘‘(b) COMMITTEE.—A negotiated rulemaking com2 mittee established pursuant to section 565 of title 5, 

3 United States Code, to carry out this section shall have 

4 as its members only representatives of the Federal Gov5 ernment and representatives of Indian Tribes, and Tribal 

6 Organizations, a majority of whom shall be nominated by 

7 and be representatives of Indian Tribes and Tribal Orga8 nizations from each Service Area. 

9 ‘‘(c) ADAPTATION OF PROCEDURES.—The Secretary 

10 shall adapt the negotiated rulemaking procedures to the 

11 unique context of self-governance and the government-to12 government relationship between the United States and 

13 Indian Tribes. 

14 ‘‘(d) LACK OF REGULATIONS.—The lack of promul15 gated regulations shall not limit the effect of this Act. 

16 ‘‘(e) INCONSISTENT REGULATIONS.—The provisions 

17 of this Act shall supersede any conflicting provisions of 

18 law in effect on the day before the date of enactment of 

19 the Indian Health Care Improvement Act Amendments of 

20 2006, and the Secretary is authorized to repeal any regu21 lation inconsistent with the provisions of this Act. 

22 ‘‘SEC. 803. PLAN OF IMPLEMENTATION. 

23 ‘‘Not later than 9 months after the date of enactment 

24 of the Indian Health Care Improvement Act Amendments 

25 of 2006, the Secretary in consultation with Indian Tribes, 


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1 Tribal Organizations, and Urban Indian Organizations, 

2 shall submit to Congress a plan explaining the manner and 

3 schedule, by title and section, by which the Secretary will 

4 implement the provisions of this Act. This consultation 

5 may be conducted jointly with the annual budget consulta6 tion pursuant to the Indian Self-Determination and Edu7 cation Assistance Act (25 U.S.C. 450 et seq). 

8 ‘‘SEC. 804. AVAILABILITY OF FUNDS. 

9 ‘‘The funds appropriated pursuant to this Act shall 

10 remain available until expended. 

11 ‘‘SEC. 805. LIMITATIONS. 

12 ‘‘(a) IN GENERAL.—Any limitation on the use of 

13 funds contained in an Act providing appropriations for the 

14 Department for a period with respect to the performance 

15 of abortions shall apply for that period with respect to the 

16 performance of abortions using funds contained in an Act 

17 providing appropriations for the Service. 

18 ‘‘(b) NO LIABILITY.—Although the Secretary may 

19 promote traditional health care practices, consistent with 

20 the Service standards for the provision of health care, 

21 health promotion, and disease prevention under this Act, 

22 the United States is not liable for the acts or omissions 

23 of any person in providing traditional health care practices 

24 under this Act that result in damage, injury, death, or 

25 any other outcome to any patient. 


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1 ‘‘SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS. 

2 ‘‘(a) IN GENERAL.—The following California Indians 

3 shall be eligible for health services provided by the Service: 

4 ‘‘(1) Any member of a federally recognized In5 dian Tribe. 

6 ‘‘(2) Any descendant of an Indian who was re7 siding in California on June 1, 1852, if such de8 scendant— 

9 ‘‘(A) is a member of the Indian community 

10 served by a local program of the Service; and 

11 ‘‘(B) is regarded as an Indian by the com12 munity in which such descendant lives. 

13 ‘‘(3) Any Indian who holds trust interests in 

14 public domain, national forest, or reservation allot15 ments in California. 

16 ‘‘(4) Any Indian in California who is listed on 

17 the plans for distribution of the assets of rancherias 

18 and reservations located within the State of Cali19 fornia under the Act of August 18, 1958 (72 Stat. 

20 619), and any descendant of such an Indian. 

21 ‘‘(b) CLARIFICATION.—Nothing in this section may 

22 be construed as expanding the eligibility of California Indi23 ans for health services provided by the Service beyond the 

24 scope of eligibility for such health services that applied on 

25 May 1, 1986. 


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1 ‘‘SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS. 

2 ‘‘(a) CHILDREN.—Any individual who— 

3 ‘‘(1) has not attained 19 years of age; 

4 ‘‘(2) is the natural or adopted child, stepchild, 

5 foster child, legal ward, or orphan of an eligible In6 dian; and 

7 ‘‘(3) is not otherwise eligible for health services 

8 provided by the Service, 

9 shall be eligible for all health services provided by the 

10 Service on the same basis and subject to the same rules 

11 that apply to eligible Indians until such individual attains 

12 19 years of age. The existing and potential health needs 

13 of all such individuals shall be taken into consideration 

14 by the Service in determining the need for, or the alloca15 tion of, the health resources of the Service. If such an indi16 vidual has been determined to be legally incompetent prior 

17 to attaining 19 years of age, such individual shall remain 

18 eligible for such services until 1 year after the date of a 

19 determination of competency. 

20 ‘‘(b) SPOUSES.—Any spouse of an eligible Indian who 

21 is not an Indian, or who is of Indian descent but is not 

22 otherwise eligible for the health services provided by the 

23 Service, shall be eligible for such health services if all such 

24 spouses or spouses who are married to members of each 

25 Indian Tribe being served are made eligible, as a class, 

26 by an appropriate resolution of the governing body of the 


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1 Indian Tribe or Tribal Organization providing such serv2 ices. The health needs of persons made eligible under this 

3 paragraph shall not be taken into consideration by the 

4 Service in determining the need for, or allocation of, its 

5 health resources. 

6 ‘‘(c) PROVISION OF SERVICES TO OTHER INDIVID7 UALS.— 

8 ‘‘(1) IN GENERAL.—The Secretary is authorized 

9 to provide health services under this subsection 

10 through health programs operated directly by the 

11 Service to individuals who reside within the Service 

12 Unit and who are not otherwise eligible for such 

13 health services if— 

14 ‘‘(A) the Indian Tribes served by such 

15 Service Unit request such provision of health 

16 services to such individuals; and 

17 ‘‘(B) the Secretary and the served Indian 

18 Tribes have jointly determined that— 

19 ‘‘(i) the provision of such health serv20 ices will not result in a denial or diminu21 tion of health services to eligible Indians; 

22 and 

23 ‘‘(ii) there is no reasonable alternative 

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1 out the Service Unit, available to meet the 

2 health needs of such individuals. 

3 ‘‘(2) ISDEAA PROGRAMS.—In the case of 

4 health programs and facilities operated under a con5 tract or compact entered into under the Indian Self6 Determination and Education Assistance Act (25 

7 U.S.C. 450 et seq.), the governing body of the In8 dian Tribe or Tribal Organization providing health 

9 services under such contract or compact is author10 ized to determine whether health services should be 

11 provided under such contract to individuals who are 

12 not eligible for such health services under any other 

13 subsection of this section or under any other provi14 sion of law. In making such determinations, the gov15 erning body of the Indian Tribe or Tribal Organiza16 tion shall take into account the considerations de17 scribed in paragraph (1)(B). 

18 ‘‘(3) PAYMENT FOR SERVICES.— 

19 ‘‘(A) IN GENERAL.—Persons receiving 

20 health services provided by the Service under 

21 this subsection shall be liable for payment of 

22 such health services under a schedule of charges 

23 prescribed by the Secretary which, in the judg24 ment of the Secretary, results in reimbursement 

25 in an amount not less than the actual cost of 


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1 providing the health services. Notwithstanding 

2 section 404 of this Act or any other provision 

3 of law, amounts collected under this subsection, 

4 including Medicare, Medicaid, or SCHIP reim5 bursements under titles XVIII, XIX, and XXI 

6 of the Social Security Act, shall be credited to 

7 the account of the program providing the serv8 ice and shall be used for the purposes listed in 

9 section 401(d)(2) and amounts collected under 

10 this subsection shall be available for expendi11 ture within such program. 

12 ‘‘(B) INDIGENT PEOPLE.—Health services 

13 may be provided by the Secretary through the 

14 Service under this subsection to an indigent in15 dividual who would not be otherwise eligible for 

16 such health services but for the provisions of 

17 paragraph (1) only if an agreement has been 

18 entered into with a State or local government 

19 under which the State or local government 

20 agrees to reimburse the Service for the expenses 

21 incurred by the Service in providing such health 

22 services to such indigent individual. 

23 ‘‘(4) REVOCATION OF CONSENT FOR SERV24 ICES.— 


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1 ‘‘(A) SINGLE TRIBE SERVICE AREA.—In 

2 the case of a Service Area which serves only 1 

3 Indian Tribe, the authority of the Secretary to 

4 provide health services under paragraph (1) 

5 shall terminate at the end of the fiscal year suc6 ceeding the fiscal year in which the governing 

7 body of the Indian Tribe revokes its concur8 rence to the provision of such health services. 

9 ‘‘(B) MULTITRIBAL SERVICE AREA.—In 

10 the case of a multitribal Service Area, the au11 thority of the Secretary to provide health serv12 ices under paragraph (1) shall terminate at the 

13 end of the fiscal year succeeding the fiscal year 

14 in which at least 51 percent of the number of 

15 Indian Tribes in the Service Area revoke their 

16 concurrence to the provisions of such health 

17 services. 

18 ‘‘(d) OTHER SERVICES.—The Service may provide 

19 health services under this subsection to individuals who 

20 are not eligible for health services provided by the Service 

21 under any other provision of law in order to— 

22 ‘‘(1) achieve stability in a medical emergency; 

23 ‘‘(2) prevent the spread of a communicable dis24 ease or otherwise deal with a public health hazard; 


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1 ‘‘(3) provide care to non-Indian women preg2 nant with an eligible Indian’s child for the duration 

3 of the pregnancy through postpartum; or 

4 ‘‘(4) provide care to immediate family members 

5 of an eligible individual if such care is directly re6 lated to the treatment of the eligible individual. 

7 ‘‘(e) HOSPITAL PRIVILEGES FOR PRACTITIONERS.— 

8 Hospital privileges in health facilities operated and main9 tained by the Service or operated under a contract or com10 pact pursuant to the Indian Self-Determination and Edu11 cation Assistance Act (25 U.S.C. 450 et seq.) may be ex12 tended to non-Service health care practitioners who pro13 vide services to individuals described in subsection (a), (b), 

14 (c), or (d). Such non-Service health care practitioners 

15 may, as part of the privileging process, be designated as 

16 employees of the Federal Government for purposes of sec17 tion 1346(b) and chapter 171 of title 28, United States 

18 Code (relating to Federal tort claims) only with respect 

19 to acts or omissions which occur in the course of providing 

20 services to eligible individuals as a part of the conditions 

21 under which such hospital privileges are extended. 

22 ‘‘(f) ELIGIBLE INDIAN.—For purposes of this sec23 tion, the term ‘eligible Indian’ means any Indian who is 

24 eligible for health services provided by the Service without 

25 regard to the provisions of this section. 


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1 ‘‘SEC. 808. REALLOCATION OF BASE RESOURCES. 

2 ‘‘(a) REPORT REQUIRED.—Notwithstanding any 

3 other provision of law, any allocation of Service funds for 

4 a fiscal year that reduces by 5 percent or more from the 

5 previous fiscal year the funding for any recurring pro6 gram, project, or activity of a Service Unit may be imple7 mented only after the Secretary has submitted to Con8 gress, under section 801, a report on the proposed change 

9 in allocation of funding, including the reasons for the 

10 change and its likely effects. 

11 ‘‘(b) EXCEPTION.—Subsection (a) shall not apply if 

12 the total amount appropriated to the Service for a fiscal 

13 year is at least 5 percent less than the amount appro14 priated to the Service for the previous fiscal year. 

15 ‘‘SEC. 809. RESULTS OF DEMONSTRATION PROJECTS. 

16 ‘‘The Secretary shall provide for the dissemination to 

17 Indian Tribes, Tribal Organizations, and Urban Indian 

18 Organizations of the findings and results of demonstration 

19 projects conducted under this Act. 

20 ‘‘SEC. 810. PROVISION OF SERVICES IN MONTANA. 

21 ‘‘(a) CONSISTENT WITH COURT DECISION.—The 

22 Secretary, acting through the Service, shall provide serv23 ices and benefits for Indians in Montana in a manner con24 sistent with the decision of the United States Court of Ap25 peals for the Ninth Circuit in McNabb for McNabb v. 

26 Bowen, 829 F.2d 787 (9th Cir. 1987). 


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1 ‘‘(b) CLARIFICATION.—The provisions of subsection 

2 (a) shall not be construed to be an expression of the sense 

3 of Congress on the application of the decision described 

4 in subsection (a) with respect to the provision of services 

5 or benefits for Indians living in any State other than Mon6 tana. 

7 ‘‘SEC. 811. MORATORIUM. 

8 ‘‘During the period of the moratorium imposed on 

9 implementation of the final rule published in the Federal 

10 Register on September 16, 1987, by the Health Resources 

11 and Services Administration of the Public Health Service, 

12 relating to eligibility for the health care services of the 

13 Indian Health Service, the Indian Health Service shall 

14 provide services pursuant to the criteria for eligibility for 

15 such services that were in effect on September 15, 1987, 

16 subject to the provisions of sections 806 and 807 until 

17 such time as new criteria governing eligibility for services 

18 are developed in accordance with section 802. 

19 ‘‘SEC. 812. TRIBAL EMPLOYMENT. 

20 ‘‘For purposes of section 2(2) of the Act of July 5, 

21 1935 (49 Stat. 450, chapter 372), an Indian Tribe or 

22 Tribal Organization carrying out a contract or compact 

23 pursuant to the Indian Self-Determination and Education 

24 Assistance Act (25 U.S.C. 450 et seq.) shall not be consid25 ered an ‘employer’. 


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1 ‘‘SEC. 813. SEVERABILITY PROVISIONS. 

2 ‘‘If any provision of this Act, any amendment made 

3 by the Act, or the application of such provision or amend4 ment to any person or circumstances is held to be invalid, 

5 the remainder of this Act, the remaining amendments 

6 made by this Act, and the application of such provisions 

7 to persons or circumstances other than those to which it 

8 is held invalid, shall not be affected thereby. 

9 ‘‘SEC. 814. ESTABLISHMENT OF NATIONAL BIPARTISAN 

10 COMMISSION ON INDIAN HEALTH CARE. 

11 ‘‘(a) ESTABLISHMENT.—There is established the Na12 tional Bipartisan Indian Health Care Commission (the 

13 ‘Commission’). 

14 ‘‘(b) DUTIES OF COMMISSION.—The duties of the 

15 Commission are the following: 

16 ‘‘(1) To establish a study committee composed 

17 of those members of the Commission appointed by 

18 the Director and at least 4 members of Congress 

19 from among the members of the Commission, the 

20 duties of which shall be the following: 

21 ‘‘(A) To the extent necessary to carry out 

22 its duties, collect and compile data necessary to 

23 understand the extent of Indian needs with re24 gard to the provision of health services, regard25 less of the location of Indians, including holding 

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1 dian Tribes, Tribal Organizations, and Urban 

2 Indian Organizations, which may include au3 thorizing and making funds available for feasi4 bility studies of various models for providing 

5 and funding health services for all Indian bene6 ficiaries, including those who live outside of a 

7 reservation, temporarily or permanently. The 

8 study committee shall also evaluate utilization 

9 rates by Indians at Indian Health Programs 

10 and Urban Indian Organizations programs, ex11 isting or potential disincentives to any overutili12 zation of health care services, existing or poten13 tial incentives to spend health care resources 

14 prudently, and the concepts of, and potential in15 centives to, achieving personal responsibility of 

16 Indians or a more direct role of Indians in their 

17 personal health care management plans or deci18 sions. 

19 ‘‘(B) To make legislative recommendations 

20 to the Commission regarding the delivery of 

21 Federal health care services to Indians. Such 

22 recommendations shall include those related to 

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1 ing such services, and the optimal manner in 

2 which to provide such services. 

3 ‘‘(C) To determine the effect of the enact4 ment of such recommendations on (i) the exist5 ing system of delivery of health services for In6 dians, and (ii) the sovereign status of Indian 

7 Tribes. 

8 ‘‘(D) Not later than 12 months after the 

9 appointment of all members of the Commission, 

10 to submit a written report of its findings and 

11 recommendations to the full Commission. The 

12 report shall include a statement of the minority 

13 and majority position of the Committee and 

14 shall be disseminated, at a minimum, to every 

15 Indian Tribe, Tribal Organization, and Urban 

16 Indian Organization for comment to the Com17 mission. 

18 ‘‘(E) To report regularly to the full Com19 mission regarding the findings and rec20 ommendations developed by the study com21 mittee in the course of carrying out its duties 

22 under this section. 

23 ‘‘(2) To review and analyze the recommenda24 tions of the report of the study committee. 


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1 ‘‘(3) To make legislative recommendations to 

2 Congress regarding the delivery of Federal health 

3 care services to Indians. Such recommendations 

4 shall include those related to issues of eligibility, 

5 benefits, the range of service providers, the cost of 

6 such services, financing such services, and the opti7 mal manner in which to provide such services. 

8 ‘‘(4) Not later than 18 months following the 

9 date of appointment of all members of the Commis10 sion, submit a written report to Congress regarding 

11 the delivery of Federal health care services to Indi12 ans. Such recommendations shall include those re13 lated to issues of eligibility, benefits, the range of 

14 service providers, the cost of such services, financing 

15 such services, and the optimal manner in which to 

16 provide such services. 

17 ‘‘(c) MEMBERS.— 

18 ‘‘(1) APPOINTMENT.—The Commission shall be 

19 composed of 25 members, appointed as follows: 

20 ‘‘(A) Ten members of Congress, including 

21 3 from the House of Representatives and 2 

22 from the Senate, appointed by their respective 

23 majority leaders, and 3 from the House of Rep24 resentatives and 2 from the Senate, appointed 

25 by their respective minority leaders, and who 


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1 shall be members of the standing committees of 

2 Congress that consider legislation affecting 

3 health care to Indians. 

4 ‘‘(B) Twelve persons chosen by the con5 gressional members of the Commission, 1 from 

6 each Service Area as currently designated by 

7 the Director to be chosen from among 3 nomi8 nees from each Service Area put forward by the 

9 Indian Tribes within the area, with due regard 

10 being given to the experience and expertise of 

11 the nominees in the provision of health care to 

12 Indians and to a reasonable representation on 

13 the commission of members who are familiar 

14 with various health care delivery modes and 

15 who represent Indian Tribes of various size 

16 populations. 

17 ‘‘(C) Three persons appointed by the Di18 rector who are knowledgeable about the provi19 sion of health care to Indians, at least 1 of 

20 whom shall be appointed from among 3 nomi21 nees put forward by those programs whose 

22 funds are provided in whole or in part by the 

23 Service primarily or exclusively for the benefit 

24 of Urban Indians. 


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1 ‘‘(D) All those persons chosen by the con2 gressional members of the Commission and by 

3 the Director shall be members of federally rec4 ognized Indian Tribes. 

5 ‘‘(2) CHAIR; VICE CHAIR.—The Chair and Vice 

6 Chair of the Commission shall be selected by the 

7 congressional members of the Commission. 

8 ‘‘(3) TERMS.—The terms of members of the 

9 Commission shall be for the life of the Commission. 

10 ‘‘(4) DEADLINE FOR APPOINTMENTS.—Con11 gressional members of the Commission shall be ap12 pointed not later than 180 days after the date of en13 actment of the Indian Health Care Improvement Act 

14 Amendments of 2006, and the remaining members 

15 of the Commission shall be appointed not later than 

16 60 days following the appointment of the congres17 sional members. 

18 ‘‘(5) VACANCY.—A vacancy in the Commission 

19 shall be filled in the manner in which the original 

20 appointment was made. 

21 ‘‘(d) COMPENSATION.— 

22 ‘‘(1) CONGRESSIONAL MEMBERS.—Each con23 gressional member of the Commission shall receive 

24 no additional pay, allowances, or benefits by reason 

25 of their service on the Commission and shall receive 


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1 travel expenses and per diem in lieu of subsistence 

2 in accordance with sections 5702 and 5703 of title 

3 5, United States Code. 

4 ‘‘(2) OTHER MEMBERS.—Remaining members 

5 of the Commission, while serving on the business of 

6 the Commission (including travel time), shall be en7 titled to receive compensation at the per diem equiv8 alent of the rate provided for level IV of the Execu9 tive Schedule under section 5315 of title 5, United 

10 States Code, and while so serving away from home 

11 and the member’s regular place of business, a mem12 ber may be allowed travel expenses, as authorized by 

13 the Chairman of the Commission. For purpose of 

14 pay (other than pay of members of the Commission) 

15 and employment benefits, rights, and privileges, all 

16 personnel of the Commission shall be treated as if 

17 they were employees of the United States Senate. 

18 ‘‘(e) MEETINGS.—The Commission shall meet at the 

19 call of the Chair. 

20 ‘‘(f) QUORUM.—A quorum of the Commission shall 

21 consist of not less than 15 members, provided that no less 

22 than 6 of the members of Congress who are Commission 

23 members are present and no less than 9 of the members 

24 who are Indians are present. 

25 ‘‘(g) EXECUTIVE DIRECTOR; STAFF; FACILITIES.— 


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1 ‘‘(1) APPOINTMENT; PAY.—The Commission 

2 shall appoint an executive director of the Commis3 sion. The executive director shall be paid the rate of 

4 basic pay for level V of the Executive Schedule. 

5 ‘‘(2) STAFF APPOINTMENT.—With the approval 

6 of the Commission, the executive director may ap7 point such personnel as the executive director deems 

8 appropriate. 

9 ‘‘(3) STAFF PAY.—The staff of the Commission 

10 shall be appointed without regard to the provisions 

11 of title 5, United States Code, governing appoint12 ments in the competitive service, and shall be paid 

13 without regard to the provisions of chapter 51 and 

14 subchapter III of chapter 53 of such title (relating 

15 to classification and General Schedule pay rates). 

16 ‘‘(4) TEMPORARY SERVICES.—With the ap17 proval of the Commission, the executive director may 

18 procure temporary and intermittent services under 

19 section 3109(b) of title 5, United States Code. 

20 ‘‘(5) FACILITIES.—The Administrator of Gen21 eral Services shall locate suitable office space for the 

22 operation of the Commission. The facilities shall 

23 serve as the headquarters of the Commission and 

24 shall include all necessary equipment and incidentals 


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1 required for the proper functioning of the Commis2 sion. 

3 ‘‘(h) HEARINGS.—(1) For the purpose of carrying 

4 out its duties, the Commission may hold such hearings 

5 and undertake such other activities as the Commission de6 termines to be necessary to carry out its duties, provided 

7 that at least 6 regional hearings are held in different areas 

8 of the United States in which large numbers of Indians 

9 are present. Such hearings are to be held to solicit the 

10 views of Indians regarding the delivery of health care serv11 ices to them. To constitute a hearing under this sub12 section, at least 5 members of the Commission, including 

13 at least 1 member of Congress, must be present. Hearings 

14 held by the study committee established in this section 

15 may count toward the number of regional hearings re16 quired by this subsection. 

17 ‘‘(2) Upon request of the Commission, the Comp18 troller General shall conduct such studies or investigations 

19 as the Commission determines to be necessary to carry 

20 out its duties. 

21 ‘‘(3)(A) The Director of the Congressional Budget 

22 Office or the Chief Actuary of the Centers for Medicare 

23 & Medicaid Services, or both, shall provide to the Commis24 sion, upon the request of the Commission, such cost estiVerDate Aug 31 2005 02:12 Dec 13, 2006 Jkt 059200 PO 00000 Frm 00314 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 mates as the Commission determines to be necessary to 

2 carry out its duties. 

3 ‘‘(B) The Commission shall reimburse the Director 

4 of the Congressional Budget Office for expenses relating 

5 to the employment in the office of that Director of such 

6 additional staff as may be necessary for the Director to 

7 comply with requests by the Commission under subpara8 graph (A). 

9 ‘‘(4) Upon the request of the Commission, the head 

10 of any Federal agency is authorized to detail, without re11 imbursement, any of the personnel of such agency to the 

12 Commission to assist the Commission in carrying out its 

13 duties. Any such detail shall not interrupt or otherwise 

14 affect the civil service status or privileges of the Federal 

15 employee. 

16 ‘‘(5) Upon the request of the Commission, the head 

17 of a Federal agency shall provide such technical assistance 

18 to the Commission as the Commission determines to be 

19 necessary to carry out its duties. 

20 ‘‘(6) The Commission may use the United States 

21 mails in the same manner and under the same conditions 

22 as Federal agencies and shall, for purposes of the frank, 

23 be considered a commission of Congress as described in 

24 section 3215 of title 39, United States Code. 


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1 ‘‘(7) The Commission may secure directly from any 

2 Federal agency information necessary to enable it to carry 

3 out its duties, if the information may be disclosed under 

4 section 552 of title 4, United States Code. Upon request 

5 of the Chairman of the Commission, the head of such 

6 agency shall furnish such information to the Commission. 

7 ‘‘(8) Upon the request of the Commission, the Ad8 ministrator of General Services shall provide to the Com9 mission on a reimbursable basis such administrative sup10 port services as the Commission may request. 

11 ‘‘(9) For purposes of costs relating to printing and 

12 binding, including the cost of personnel detailed from the 

13 Government Printing Office, the Commission shall be 

14 deemed to be a committee of Congress. 

15 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

16 authorized to be appropriated $4,000,000 to carry out the 

17 provisions of this section, which sum shall not be deducted 

18 from or affect any other appropriation for health care for 

19 Indian persons. 

20 ‘‘(j) NONAPPLICABILITY OF FACA.—The Federal 

21 Advisory Committee Act (5 U.S.C. App.) shall not apply 

22 to the Commission. 

23 ‘‘SEC. 815. APPROPRIATIONS; AVAILABILITY. 

24 ‘‘Any new spending authority (described in subpara25 graph (A) or (B) of section 401(c)(2) of the Congressional 


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1 Budget Act of 1974 (Public Law 93–344; 88 Stat. 317)) 

2 which is provided under this Act shall be effective for any 

3 fiscal year only to such extent or in such amounts as are 

4 provided in appropriation Acts. 

5 ‘‘SEC. 816. AUTHORIZATION OF APPROPRIATIONS. 

6 ‘‘(a) IN GENERAL.—There are authorized to be ap7 propriated such sums as may be necessary for each fiscal 

8 year through fiscal year 2016 to carry out this title.’’. 

9 SEC. 102. SOBOBA SANITATION FACILITIES. 

10 The Act of December 17, 1970 (84 Stat. 1465), is 

11 amended by adding at the end the following: 

12 ‘‘SEC. 9. Nothing in this Act shall preclude the 

13 Soboba Band of Mission Indians and the Soboba Indian 

14 Reservation from being provided with sanitation facilities 

15 and services under the authority of section 7 of the Act 

16 of August 5, 1954 (68 Stat. 674), as amended by the Act 

17 of July 31, 1959 (73 Stat. 267).’’. 

18 SEC. 103. NATIVE AMERICAN HEALTH AND WELLNESS 

19 FOUNDATION. 

20 (a) IN GENERAL.—The Indian Self-Determination 

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

22 amended by adding at the end the following: 


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1 ‘‘TITLE VIII—NATIVE AMERICAN 

2 HEALTH AND WELLNESS 

3 FOUNDATION 

4 ‘‘SEC. 801. DEFINITIONS. 

5 ‘‘In this title: 

6 ‘‘(1) BOARD.—The term ‘Board’ means the 

7 Board of Directors of the Foundation. 

8 ‘‘(2) COMMITTEE.—The term ‘Committee’ 

9 means the Committee for the Establishment of Na10 tive American Health and Wellness Foundation es11 tablished under section 802(f). 

12 ‘‘(3) FOUNDATION.—The term ‘Foundation’ 

13 means the Native American Health and Wellness 

14 Foundation established under section 802. 

15 ‘‘(4) SECRETARY.—The term ‘Secretary’ means 

16 the Secretary of Health and Human Services. 

17 ‘‘(5) SERVICE.—The term ‘Service’ means the 

18 Indian Health Service of the Department of Health 

19 and Human Services. 

20 ‘‘SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS 

21 FOUNDATION. 

22 ‘‘(a) ESTABLISHMENT.— 

23 ‘‘(1) IN GENERAL.—As soon as practicable 

24 after the date of enactment of this title, the Sec25 retary shall establish, under the laws of the District 


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1 of Columbia and in accordance with this title, the 

2 Native American Health and Wellness Foundation. 

3 ‘‘(2) FUNDING DETERMINATIONS.—No funds, 

4 gift, property, or other item of value (including any 

5 interest accrued on such an item) acquired by the 

6 Foundation shall— 

7 ‘‘(A) be taken into consideration for pur8 poses of determining Federal appropriations re9 lating to the provision of health care and serv10 ices to Indians; or 

11 ‘‘(B) otherwise limit, diminish, or affect 

12 the Federal responsibility for the provision of 

13 health care and services to Indians. 

14 ‘‘(b) PERPETUAL EXISTENCE.—The Foundation 

15 shall have perpetual existence. 

16 ‘‘(c) NATURE OF CORPORATION.—The Foundation— 

17 ‘‘(1) shall be a charitable and nonprofit feder18 ally chartered corporation; and 

19 ‘‘(2) shall not be an agency or instrumentality 

20 of the United States. 

21 ‘‘(d) PLACE OF INCORPORATION AND DOMICILE.— 

22 The Foundation shall be incorporated and domiciled in the 

23 District of Columbia. 

24 ‘‘(e) DUTIES.—The Foundation shall— 


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1 ‘‘(1) encourage, accept, and administer private 

2 gifts of real and personal property, and any income 

3 from or interest in such gifts, for the benefit of, or 

4 in support of, the mission of the Service; 

5 ‘‘(2) undertake and conduct such other activi6 ties as will further the health and wellness activities 

7 and opportunities of Native Americans; and 

8 ‘‘(3) participate with and assist Federal, State, 

9 and tribal governments, agencies, entities, and indi10 viduals in undertaking and conducting activities that 

11 will further the health and wellness activities and op12 portunities of Native Americans. 

13 ‘‘(f) COMMITTEE FOR THE ESTABLISHMENT OF NA14 TIVE AMERICAN HEALTH AND WELLNESS FOUNDA15 TION.— 

16 ‘‘(1) IN GENERAL.—The Secretary shall estab17 lish the Committee for the Establishment of Native 

18 American Health and Wellness Foundation to assist 

19 the Secretary in establishing the Foundation. 

20 ‘‘(2) DUTIES.—Not later than 180 days after 

21 the date of enactment of this section, the Committee 

22 shall— 

23 ‘‘(A) carry out such activities as are nec24 essary to incorporate the Foundation under the 


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1 laws of the District of Columbia, including act2 ing as incorporators of the Foundation; 

3 ‘‘(B) ensure that the Foundation qualifies 

4 for and maintains the status required to carry 

5 out this section, until the Board is established; 

6 ‘‘(C) establish the constitution and initial 

7 bylaws of the Foundation; 

8 ‘‘(D) provide for the initial operation of 

9 the Foundation, including providing for tem10 porary or interim quarters, equipment, and 

11 staff; and 

12 ‘‘(E) appoint the initial members of the 

13 Board in accordance with the constitution and 

14 initial bylaws of the Foundation. 

15 ‘‘(g) BOARD OF DIRECTORS.— 

16 ‘‘(1) IN GENERAL.—The Board of Directors 

17 shall be the governing body of the Foundation. 

18 ‘‘(2) POWERS.—The Board may exercise, or 

19 provide for the exercise of, the powers of the Foun20 dation. 

21 ‘‘(3) SELECTION.— 

22 ‘‘(A) IN GENERAL.—Subject to subpara23 graph (B), the number of members of the 

24 Board, the manner of selection of the members 

25 (including the filling of vacancies), and the 


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1 terms of office of the members shall be as pro2 vided in the constitution and bylaws of the 

3 Foundation. 

4 ‘‘(B) REQUIREMENTS.— 

5 ‘‘(i) NUMBER OF MEMBERS.—The 

6 Board shall have at least 11 members, who 

7 shall have staggered terms. 

8 ‘‘(ii) INITIAL VOTING MEMBERS.—The 

9 initial voting members of the Board— 

10 ‘‘(I) shall be appointed by the 

11 Committee not later than 180 days 

12 after the date on which the Founda13 tion is established; and 

14 ‘‘(II) shall have staggered terms. 

15 ‘‘(iii) QUALIFICATION.—The members 

16 of the Board shall be United States citi17 zens who are knowledgeable or experienced 

18 in Native American health care and related 

19 matters. 

20 ‘‘(C) COMPENSATION.—A member of the 

21 Board shall not receive compensation for service 

22 as a member, but shall be reimbursed for actual 

23 and necessary travel and subsistence expenses 

24 incurred in the performance of the duties of the 

25 Foundation. 


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1 ‘‘(h) OFFICERS.— 

2 ‘‘(1) IN GENERAL.—The officers of the Founda3 tion shall be— 

4 ‘‘(A) a secretary, elected from among the 

5 members of the Board; and 

6 ‘‘(B) any other officers provided for in the 

7 constitution and bylaws of the Foundation. 

8 ‘‘(2) CHIEF OPERATING OFFICER.—The sec9 retary of the Foundation may serve, at the direction 

10 of the Board, as the chief operating officer of the 

11 Foundation, or the Board may appoint a chief oper12 ating officer, who shall serve at the direction of the 

13 Board. 

14 ‘‘(3) ELECTION.—The manner of election, term 

15 of office, and duties of the officers of the Founda16 tion shall be as provided in the constitution and by17 laws of the Foundation. 

18 ‘‘(i) POWERS.—The Foundation— 

19 ‘‘(1) shall adopt a constitution and bylaws for 

20 the management of the property of the Foundation 

21 and the regulation of the affairs of the Foundation; 

22 ‘‘(2) may adopt and alter a corporate seal; 

23 ‘‘(3) may enter into contracts; 

24 ‘‘(4) may acquire (through a gift or otherwise), 

25 own, lease, encumber, and transfer real or personal 


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1 property as necessary or convenient to carry out the 

2 purposes of the Foundation; 

3 ‘‘(5) may sue and be sued; and 

4 ‘‘(6) may perform any other act necessary and 

5 proper to carry out the purposes of the Foundation. 

6 ‘‘(j) PRINCIPAL OFFICE.— 

7 ‘‘(1) IN GENERAL.—The principal office of the 

8 Foundation shall be in the District of Columbia. 

9 ‘‘(2) ACTIVITIES; OFFICES.—The activities of 

10 the Foundation may be conducted, and offices may 

11 be maintained, throughout the United States in ac12 cordance with the constitution and bylaws of the 

13 Foundation. 

14 ‘‘(k) SERVICE OF PROCESS.—The Foundation shall 

15 comply with the law on service of process of each State 

16 in which the Foundation is incorporated and of each State 

17 in which the Foundation carries on activities. 

18 ‘‘(l) LIABILITY OF OFFICERS, EMPLOYEES, AND

19 AGENTS.— 

20 ‘‘(1) IN GENERAL.—The Foundation shall be 

21 liable for the acts of the officers, employees, and 

22 agents of the Foundation acting within the scope of 

23 their authority. 

24 ‘‘(2) PERSONAL LIABILITY.—A member of the 

25 Board shall be personally liable only for gross negVerDate Aug 31 2005 02:12 Dec 13, 2006 Jkt 059200 PO 00000 Frm 00324 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 ligence in the performance of the duties of the mem2 ber. 

3 ‘‘(m) RESTRICTIONS.— 

4 ‘‘(1) LIMITATION ON SPENDING.—Beginning 

5 with the fiscal year following the first full fiscal year 

6 during which the Foundation is in operation, the ad7 ministrative costs of the Foundation shall not exceed 

8 the percentage described in paragraph (2) of the 

9 sum of— 

10 ‘‘(A) the amounts transferred to the Foun11 dation under subsection (o) during the pre12 ceding fiscal year; and 

13 ‘‘(B) donations received from private 

14 sources during the preceding fiscal year. 

15 ‘‘(2) PERCENTAGES.—The percentages referred 

16 to in paragraph (1) are— 

17 ‘‘(A) for the first fiscal year described in 

18 that paragraph, 20 percent; 

19 ‘‘(B) for the following fiscal year, 15 per20 cent; and 

21 ‘‘(C) for each fiscal year thereafter, 10 

22 percent. 

23 ‘‘(3) APPOINTMENT AND HIRING.—The ap24 pointment of officers and employees of the Founda25 tion shall be subject to the availability of funds. 


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1 ‘‘(4) STATUS.—A member of the Board or offi2 cer, employee, or agent of the Foundation shall not 

3 by reason of association with the Foundation be con4 sidered to be an officer, employee, or agent of the 

5 United States. 

6 ‘‘(n) AUDITS.—The Foundation shall comply with 

7 section 10101 of title 36, United States Code, as if the 

8 Foundation were a corporation under part B of subtitle 

9 II of that title. 

10 ‘‘(o) FUNDING.— 

11 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

12 There is authorized to be appropriated to carry out 

13 subsection (e)(1) $500,000 for each fiscal year, as 

14 adjusted to reflect changes in the Consumer Price 

15 Index for all-urban consumers published by the De16 partment of Labor. 

17 ‘‘(2) TRANSFER OF DONATED FUNDS.—The 

18 Secretary shall transfer to the Foundation funds 

19 held by the Department of Health and Human Serv20 ices under the Act of August 5, 1954 (42 U.S.C. 

21 2001 et seq.), if the transfer or use of the funds is 

22 not prohibited by any term under which the funds 

23 were donated. 


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1 ‘‘SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT. 

2 ‘‘(a) PROVISION OF SUPPORT BY SECRETARY.—Sub3 ject to subsection (b), during the 5-year period beginning 

4 on the date on which the Foundation is established, the 

5 Secretary— 

6 ‘‘(1) may provide personnel, facilities, and other 

7 administrative support services to the Foundation; 

8 ‘‘(2) may provide funds for initial operating 

9 costs and to reimburse the travel expenses of the 

10 members of the Board; and 

11 ‘‘(3) shall require and accept reimbursements 

12 from the Foundation for— 

13 ‘‘(A) services provided under paragraph 

14 (1); and 

15 ‘‘(B) funds provided under paragraph (2). 

16 ‘‘(b) REIMBURSEMENT.—Reimbursements accepted 

17 under subsection (a)(3)— 

18 ‘‘(1) shall be deposited in the Treasury of the 

19 United States to the credit of the applicable appro20 priations account; and 

21 ‘‘(2) shall be chargeable for the cost of pro22 viding services described in subsection (a)(1) and 

23 travel expenses described in subsection (a)(2). 

24 ‘‘(c) CONTINUATION OF CERTAIN SERVICES.—The 

25 Secretary may continue to provide facilities and necessary 

26 support services to the Foundation after the termination 


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1 of the 5-year period specified in subsection (a) if the facili2 ties and services— 

3 ‘‘(1) are available; and 

4 ‘‘(2) are provided on reimbursable cost basis.’’. 

5 (b) TECHNICAL AMENDMENTS.—The Indian Self-De6 termination and Education Assistance Act is amended— 

7 (1) by redesignating title V (25 U.S.C. 458bbb 

8 et seq.) as title VII; 

9 (2) by redesignating sections 501, 502, and 503 

10 (25 U.S.C. 458bbb, 458bbb–1, 458bbb–2) as sec11 tions 701, 702, and 703, respectively; and 

12 (3) in subsection (a)(2) of section 702 and 

13 paragraph (2) of section 703 (as redesignated by 

14 paragraph (2)), by striking ‘‘section 501’’ and in15 serting ‘‘section 701’’. 

16 TITLE II—IMPROVEMENT OF IN17 DIAN HEALTH CARE PRO18 VIDED UNDER THE SOCIAL 

19 SECURITY ACT 

20 SEC. 201. EXPANSION OF PAYMENTS UNDER MEDICARE, 

21 MEDICAID, AND SCHIP FOR ALL COVERED 

22 SERVICES FURNISHED BY INDIAN HEALTH 

23 PROGRAMS. 

24 (a) MEDICAID.— 


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1 (1) EXPANSION TO ALL COVERED SERVICES.— 

2 Section 1911 of the Social Security Act (42 U.S.C. 

3 1396j) is amended— 

4 (A) by amending the heading to read as 

5 follows: 

6 ‘‘SEC. 1911. INDIAN HEALTH PROGRAMS.’’; and 

7 (B) by amending subsection (a) to read as 

8 follows: 

9 ‘‘(a) ELIGIBILITY FOR PAYMENT FOR MEDICAL AS10 SISTANCE.—The Indian Health Service and an Indian 

11 Tribe, Tribal Organization, or an Urban Indian Organiza12 tion shall be eligible for payment for medical assistance 

13 provided under a State plan or under waiver authority 

14 with respect to items and services furnished by the Indian 

15 Health Service, Indian Tribe, Tribal Organization, or 

16 Urban Indian Organization if the furnishing of such serv17 ices meets all the conditions and requirements which are 

18 applicable generally to the furnishing of items and services 

19 under this title and under such plan or waiver authority.’’. 

20 (2) COMPLIANCE WITH CONDITIONS AND RE21 QUIREMENTS.—Subsection (b) of such section is 

22 amended to read as follows: 

23 ‘‘(b) COMPLIANCE WITH CONDITIONS AND REQUIRE24 MENTS.—A facility of the Indian Health Service or an In25 dian Tribe, Tribal Organization, or an Urban Indian OrVerDate Aug 31 2005 02:12 Dec 13, 2006 Jkt 059200 PO 00000 Frm 00329 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 ganization which is eligible for payment under subsection 

2 (a) with respect to the furnishing of items and services, 

3 but which does not meet all of the conditions and require4 ments of this title and under a State plan or waiver au5 thority which are applicable generally to such facility, shall 

6 make such improvements as are necessary to achieve or 

7 maintain compliance with such conditions and require8 ments in accordance with a plan submitted to and accept9 ed by the Secretary for achieving or maintaining compli10 ance with such conditions and requirements, and shall be 

11 deemed to meet such conditions and requirements (and to 

12 be eligible for payment under this title), without regard 

13 to the extent of its actual compliance with such conditions 

14 and requirements, during the first 12 months after the 

15 month in which such plan is submitted.’’. 

16 (3) REVISION OF AUTHORITY TO ENTER INTO

17 AGREEMENTS.—Subsection (c) of such section is 

18 amended to read as follows: 

19 ‘‘(c) AUTHORITY TO ENTER INTO AGREEMENTS.— 

20 The Secretary may enter into an agreement with a State 

21 for the purpose of reimbursing the State for medical as22 sistance provided by the Indian Health Service, an Indian 

23 Tribe, Tribal Organization, or an Urban Indian Organiza24 tion (as so defined), directly, through referral, or under 

25 contracts or other arrangements between the Indian 


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1 Health Service, an Indian Tribe, Tribal Organization, or 

2 an Urban Indian Organization and another health care 

3 provider to Indians who are eligible for medical assistance 

4 under the State plan or under waiver authority.’’. 

5 (4) CROSS-REFERENCES TO SPECIAL FUND FOR

6 IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING

7 OPTION; DEFINITIONS.—Such section is further 

8 amended by striking subsection (d) and adding at 

9 the end the following new subsections: 

10 ‘‘(d) SPECIAL FUND FOR IMPROVEMENT OF IHS FA11 CILITIES.—For provisions relating to the authority of the 

12 Secretary to place payments to which a facility of the In13 dian Health Service is eligible for payment under this title 

14 into a special fund established under section 401(c)(1) of 

15 the Indian Health Care Improvement Act, and the require16 ment to use amounts paid from such fund for making im17 provements in accordance with subsection (b), see sub18 paragraphs (A) and (B) of section 401(c)(1) of such Act. 

19 ‘‘(e) DIRECT BILLING.—For provisions relating to 

20 the authority of a Tribal Health Program or an Urban 

21 Indian Organization to elect to directly bill for, and receive 

22 payment for, health care items and services provided by 

23 such Program or Organization for which payment is made 

24 under this title, see section 401(d) of the Indian Health 

25 Care Improvement Act. 


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1 ‘‘(f) DEFINITIONS.—In this section, the terms ‘In2 dian Health Program’, ‘Indian Tribe’,‘Tribal Health Pro3 gram’, ‘Tribal Organization’, and ‘Urban Indian Organi4 zation’ have the meanings given those terms in section 4 

5 of the Indian Health Care Improvement Act.’’. 

6 (b) MEDICARE.— 

7 (1) EXPANSION TO ALL COVERED SERVICES.— 

8 Section 1880 of such Act (42 U.S.C. 1395qq) is 

9 amended— 

10 (A) by amending the heading to read as 

11 follows: 

12 ‘‘SEC. 1880. INDIAN HEALTH PROGRAMS.’’; and 

13 (B) by amending subsection (a) to read as 

14 follows: 

15 ‘‘(a) ELIGIBILITY FOR PAYMENTS.—Subject to sub16 section (e), the Indian Health Service and an Indian 

17 Tribe, Tribal Organization, or an Urban Indian Organiza18 tion shall be eligible for payments under this title with 

19 respect to items and services furnished by the Indian 

20 Health Service, Indian Tribe, Tribal Organization, or 

21 Urban Indian Organization if the furnishing of such serv22 ices meets all the conditions and requirements which are 

23 applicable generally to the furnishing of items and services 

24 under this title.’’. 


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•S 4122 IS

1 (2) COMPLIANCE WITH CONDITIONS AND RE2 QUIREMENTS.—Subsection (b) of such section is 

3 amended to read as follows: 

4 ‘‘(b) COMPLIANCE WITH CONDITIONS AND REQUIRE5 MENTS.—Subject to subsection (e), a facility of the Indian 

6 Health Service or an Indian Tribe, Tribal Organization, 

7 or an Urban Indian Organization which is eligible for pay8 ment under subsection (a) with respect to the furnishing 

9 of items and services, but which does not meet all of the 

10 conditions and requirements of this title which are applica11 ble generally to such facility, shall make such improve12 ments as are necessary to achieve or maintain compliance 

13 with such conditions and requirements in accordance with 

14 a plan submitted to and accepted by the Secretary for 

15 achieving or maintaining compliance with such conditions 

16 and requirements, and shall be deemed to meet such con17 ditions and requirements (and to be eligible for payment 

18 under this title), without regard to the extent of its actual 

19 compliance with such conditions and requirements, during 

20 the first 12 months after the month in which such plan 

21 is submitted.’’. 

22 (3) CROSS-REFERENCES TO SPECIAL FUND FOR

23 IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING

24 OPTION; DEFINITIONS.— 


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•S 4122 IS

1 (A) IN GENERAL.—Such section is further 

2 amended by striking subsections (c) and (d) 

3 and inserting the following new subsections: 

4 ‘‘(c) 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 ‘‘(d) 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 (B) CONFORMING AMENDMENT.—Para21 graph (3) of section 1880(e) of such Act (42 

22 U.S.C. 1395qq(e)) is amended by inserting 

23 ‘‘and section 401(c)(1) of the Indian Health 

24 Care Improvement Act’’ after ‘‘Subsection (c)’’. 


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1 (4) DEFINITIONS.—Such section is further 

2 amended by amending subsection (f) to read as fol3 lows: 

4 ‘‘(f) DEFINITIONS.—In this section, the terms ‘In5 dian Health Program’, ‘Indian Tribe’, ‘Service Unit’, 

6 ‘Tribal Health Program’, ‘Tribal Organization’, and 

7 ‘Urban Indian Organization’ have the meanings given 

8 those terms in section 4 of the Indian Health Care Im9 provement Act.’’. 

10 (c) APPLICATION TO SCHIP.—Section 2107(e)(1) of 

11 the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 

12 amended— 

13 (1) by redesignating subparagraph (D) as sub14 paragraph (E); and 

15 (2) by inserting after subparagraph (C), the fol16 lowing new subparagraph: 

17 ‘‘(D) Section 1911 (relating to Indian 

18 Health Programs, other than subsection (d) of 

19 such section).’’. 


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1 SEC. 202. INCREASED OUTREACH TO INDIANS UNDER MED2 ICAID AND SCHIP AND IMPROVED COOPERA3 TION IN THE PROVISION OF ITEMS AND 

4 SERVICES TO INDIANS UNDER SOCIAL SECU5 RITY ACT HEALTH BENEFIT PROGRAMS. 

6 Section 1139 of the Social Security Act (42 U.S.C. 

7 1320b–9) is amended to read as follows: 

8 ‘‘SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, 

9 HEALTH CARE FOR INDIANS UNDER TITLES 

10 XVIII, XIX, AND XXI. 

11 ‘‘(a) AGREEMENTS WITH STATES FOR MEDICAID

12 AND SCHIP OUTREACH ON OR NEAR RESERVATIONS TO

13 INCREASE THE ENROLLMENT OF INDIANS IN THOSE

14 PROGRAMS.— 

15 ‘‘(1) IN GENERAL.—In order to improve the ac16 cess of Indians residing on or near a reservation to 

17 obtain benefits under the Medicaid and State chil18 dren’s health insurance programs established under 

19 titles XIX and XXI, the Secretary shall encourage 

20 the State to take steps to provide for enrollment on 

21 or near the reservation. Such steps may include out22 reach efforts such as the outstationing of eligibility 

23 workers, entering into agreements with the Indian 

24 Health Service, Indian Tribes, Tribal Organizations, 

25 and Urban Indian Organizations to provide out26 reach, education regarding eligibility and benefits, 


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•S 4122 IS

1 enrollment, and translation services when such serv2 ices are appropriate. 

3 ‘‘(2) CONSTRUCTION.—Nothing in subpara4 graph (A) shall be construed as affecting arrange5 ments entered into between States and the Indian 

6 Health Service, Indian Tribes, Tribal Organizations, 

7 or Urban Indian Organizations for such Service, 

8 Tribes, or Organizations to conduct administrative 

9 activities under such titles. 

10 ‘‘(b) REQUIREMENT TO FACILITATE COOPERA11 TION.—The Secretary, acting through the Centers for 

12 Medicare & Medicaid Services, shall take such steps as are 

13 necessary to facilitate cooperation with, and agreements 

14 between, States and the Indian Health Service, Indian 

15 Tribes, Tribal Organizations, or Urban Indian Organiza16 tions with respect to the provision of health care items 

17 and services to Indians under the programs established 

18 under title XVIII, XIX, or XXI. 

19 ‘‘(c) DEFINITION OF INDIAN; INDIAN TRIBE; INDIAN

20 HEALTH PROGRAM; TRIBAL ORGANIZATION; URBAN IN21 DIAN ORGANIZATION.—In this section, the terms ‘Indian’, 

22 ‘Indian Tribe’, ‘Indian Health Program’, ‘Tribal Organi23 zation’, and ‘Urban Indian Organization’ have the mean24 ings given those terms in section 4 of the Indian Health 

25 Care Improvement Act.’’. 


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1 SEC. 203. ADDITIONAL PROVISIONS TO INCREASE OUT2 REACH TO, AND ENROLLMENT OF, INDIANS 

3 IN SCHIP AND MEDICAID. 

4 (a) NONAPPLICATION OF 10 PERCENT LIMIT ON

5 OUTREACH AND CERTAIN OTHER EXPENDITURES.—Sec6 tion 2105(c)(2) of the Social Security Act (42 U.S.C. 

7 1397ee(c)(2)) is amended by adding at the end the fol8 lowing new subparagraph: 

9 ‘‘(C) NONAPPLICATION TO EXPENDITURES

10 FOR OUTREACH TO INCREASE THE ENROLL11 MENT OF INDIAN CHILDREN UNDER THIS TITLE

12 AND TITLE XIX.—The limitation under sub13 paragraph (A) on expenditures for items de14 scribed in subsection (a)(1)(D) shall not apply 

15 in the case of expenditures for outreach activi16 ties to families of Indian children likely to be el17 igible for child health assistance under the plan 

18 or medical assistance under the State plan 

19 under title XIX (or under a waiver of such 

20 plan), to inform such families of the availability 

21 of, and to assist them in enrolling their children 

22 in, such plans, including such activities con23 ducted under grants, contracts, or agreements 

24 entered into under section 1139(a).’’. 

25 (b) ASSURANCE OF PAYMENTS TO INDIAN HEALTH

26 CARE PROVIDERS FOR CHILD HEALTH ASSISTANCE.— 


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1 Section 2102(b)(3)(D) of such Act (42 U.S.C. 

2 1397bb(b)(3)(D)) is amended by striking ‘‘(as defined in 

3 section 4(c) of the Indian Health Care Improvement Act, 

4 25 U.S.C. 1603(c))’’ and inserting ‘‘, including how the 

5 State will ensure that payments are made to Indian 

6 Health Programs and Urban Indian Organizations oper7 ating in the State for the provision of such assistance’’. 

8 (c) INCLUSION OF OTHER INDIAN FINANCED

9 HEALTH CARE PROGRAMS IN EXEMPTION FROM PROHI10 BITION ON CERTAIN PAYMENTS.—Section 2105(c)(6)(B) 

11 of such Act (42 U.S.C. 1397ee(c)(6)(B)) is amended by 

12 striking ‘‘insurance program, other than an insurance pro13 gram operated or financed by the Indian Health Service’’ 

14 and inserting ‘‘program, other than a health care program 

15 operated or financed by the Indian Health Service or by 

16 an Indian Tribe, Tribal Organization, or Urban Indian 

17 Organization’’. 

18 (d) SATISFACTION OF MEDICAID DOCUMENTATION

19 REQUIREMENTS.— 

20 (1) IN GENERAL.—Section 1903(x)(3)(B) of the 

21 Social Security Act (42 U.S.C. 1396b(x)(3)(B)) is 

22 amended— 

23 (A) by redesignating clause (v) as clause 

24 (vi); and 


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1 (B) by inserting after clause (iv), the fol2 lowing new clause: 

3 ‘‘(v)(I) Except as provided in subclause (II), a 

4 document issued by a federally-recognized Indian 

5 tribe evidencing membership or enrollment in, or af6 filiation with, such tribe. 

7 ‘‘(II) With respect to those federally-recognized 

8 Indian tribes located within States having an inter9 national border whose membership includes individ10 uals who are not citizens of the United States, the 

11 Secretary shall, after consulting with such tribes, 

12 issue regulations authorizing the presentation of 

13 such other forms of documentation (including tribal 

14 documentation, if appropriate) that the Secretary 

15 determines to be satisfactory documentary evidence 

16 of citizenship or nationality for purposes of satis17 fying the requirement of this subsection.’’. 

18 (2) TRANSITION RULE.—During the period that 

19 begins on July 1, 2006, and ends on the effective 

20 date of final regulations issued under subclause (II) 

21 of section 1903(x)(3)(B)(v) of the Social Security 

22 Act (42 U.S.C. 1396b(x)(3)(B)(v)) (as added by 

23 paragraph (1)), an individual who is a member of a 

24 federally-recognized Indian tribe described in sub25 clause (II) of that section who presents a document 


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•S 4122 IS

1 described in subclause (I) of such section that is 

2 issued by such Indian tribe, shall be deemed to have 

3 presented satisfactory evidence of citizenship or na4 tionality for purposes of satisfying the requirement 

5 of subsection (x) of section 1903 of such Act. 

6 (e) DEFINITIONS.—Section 2110(c) of such Act (42 

7 U.S.C. 1397jj(c)) is amended by adding at the end the 

8 following new paragraph: 

9 ‘‘(9) INDIAN; INDIAN HEALTH PROGRAM; IN10 DIAN TRIBE; ETC.—The terms ‘Indian’, ‘Indian 

11 Health Program’, ‘Indian Tribe’, ‘Tribal Organiza12 tion’, and ‘Urban Indian Organization’ have the 

13 meanings given those terms in section 4 of the In14 dian Health Care Improvement Act.’’. 

15 SEC. 204. PREMIUMS AND COST SHARING PROTECTIONS 

16 UNDER MEDICAID, ELIGIBILITY DETERMINA17 TIONS UNDER MEDICAID AND SCHIP, AND 

18 PROTECTION OF CERTAIN INDIAN PROPERTY 

19 FROM MEDICAID ESTATE RECOVERY. 

20 (a) PREMIUMS AND COST SHARING PROTECTION

21 UNDER MEDICAID.— 

22 (1) IN GENERAL.—Section 1916 of the Social 

23 Security Act (42 U.S.C. 1396o) is amended— 


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1 (A) in subsection (a), in the matter pre2 ceding paragraph (1), by striking ‘‘and (i)’’ and 

3 inserting ‘‘, (i), and (j)’’; and 

4 (B) by adding at the end the following new 

5 subsection: 

6 ‘‘(j) NO PREMIUMS OR COST SHARING FOR INDIANS

7 FURNISHED ITEMS OR SERVICES DIRECTLY BY INDIAN

8 HEALTH PROGRAMS OR THROUGH REFERRAL UNDER

9 THE CONTRACT HEALTH SERVICE.— 

10 ‘‘(1) NO COST SHARING FOR ITEMS OR SERV11 ICES FURNISHED TO INDIANS THROUGH INDIAN

12 HEALTH PROGRAMS.— 

13 ‘‘(A) IN GENERAL.—No enrollment fee, 

14 premium, or similar charge, and no deduction, 

15 copayment, cost sharing, or similar charge shall 

16 be imposed against an Indian who is furnished 

17 an item or service directly by the Indian Health 

18 Service, an Indian Tribe, Tribal Organization, 

19 or Urban Indian Organization or through refer20 ral under the contract health service for which 

21 payment may be made under this title. 

22 ‘‘(B) NO REDUCTION IN AMOUNT OF PAY23 MENT TO INDIAN HEALTH PROVIDERS.—Pay24 ment due under this title to the Indian Health 

25 Service, an Indian Tribe, Tribal Organization, 


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1 or Urban Indian Organization, or a health care 

2 provider through referral under the contract 

3 health service for the furnishing of an item or 

4 service to an Indian who is eligible for assist5 ance under such title, may not be reduced by 

6 the amount of any enrollment fee, premium, or 

7 similar charge, or any deduction, copayment, 

8 cost sharing, or similar charge that would be 

9 due from the Indian but for the operation of 

10 subparagraph (A). 

11 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

12 this subsection shall be construed as restricting the 

13 application of any other limitations on the imposi14 tion of premiums or cost sharing that may apply to 

15 an individual receiving medical assistance under this 

16 title who is an Indian. 

17 ‘‘(3) DEFINITIONS.—In this subsection, the 

18 terms ‘contract health service’, ‘Indian’, ‘Indian 

19 Tribe’, ‘Tribal Organization’, and ‘Urban Indian Or20 ganization’ have the meanings given those terms in 

21 section 4 of the Indian Health Care Improvement 

22 Act.’’. 

23 (2) CONFORMING AMENDMENT.—Section 

24 1916A (a)(1) of such Act (42 U.S.C. 1396o–1(a)(1)) 


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1 is amended by striking ‘‘section 1916(g)’’ and in2 serting ‘‘subsections (g), (i), or (j) of section 1916’’. 

3 (b) TREATMENT OF CERTAIN PROPERTY FOR MED4 ICAID AND SCHIP ELIGIBILITY.— 

5 (1) MEDICAID.—Section 1902(e) of the Social 

6 Security Act (42 U.S.C. 1396a) is amended by add7 ing at the end the following new paragraph: 

8 ‘‘(13) Notwithstanding any other requirement 

9 of this title or any other provision of Federal or 

10 State law, a State shall disregard the following prop11 erty for purposes of determining the eligibility of an 

12 individual who is an Indian (as defined in section 4 

13 of the Indian Health Care Improvement Act) for 

14 medical assistance under this title: 

15 ‘‘(A) Property, including real property and 

16 improvements, that is held in trust, subject to 

17 Federal restrictions, or otherwise under the su18 pervision of the Secretary of the Interior, lo19 cated on a reservation, including any federally 

20 recognized Indian Tribe’s reservation, pueblo, 

21 or colony, including former reservations in 

22 Oklahoma, Alaska Native regions established by 

23 the Alaska Native Claims Settlement Act, and 

24 Indian allotments on or near a reservation as 


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•S 4122 IS

1 designated and approved by the Bureau of In2 dian Affairs of the Department of the Interior. 

3 ‘‘(B) For any federally recognized Tribe 

4 not described in subparagraph (A), property lo5 cated within the most recent boundaries of a 

6 prior Federal reservation. 

7 ‘‘(C) Ownership interests in rents, leases, 

8 royalties, or usage rights related to natural re9 sources (including extraction of natural re10 sources or harvesting of timber, other plants 

11 and plant products, animals, fish, and shellfish) 

12 resulting from the exercise of federally pro13 tected rights. 

14 ‘‘(D) Ownership interests in or usage 

15 rights to items not covered by subparagraphs 

16 (A) through (C) that have unique religious, 

17 spiritual, traditional, or cultural significance or 

18 rights that support subsistence or a traditional 

19 lifestyle according to applicable tribal law or 

20 custom.’’. 

21 (2) APPLICATION TO SCHIP.—Section 

22 2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)) is 

23 amended— 


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•S 4122 IS

1 (A) by redesignating subparagraphs (B) 

2 through (E), as subparagraphs (C) through 

3 (F), respectively; and 

4 (B) by inserting after subparagraph (A), 

5 the following new subparagraph: 

6 ‘‘(B) Section 1902(e)(13) (relating to dis7 regard of certain property for purposes of mak8 ing eligibility determinations).’’. 

9 (c) CONTINUATION OF CURRENT LAW PROTECTIONS

10 OF CERTAIN INDIAN PROPERTY FROM MEDICAID ESTATE

11 RECOVERY.—Section 1917(b)(3) of the Social Security 

12 Act (42 U.S.C. 1396p(b)(3)) is amended— 

13 (1) by inserting ‘‘(A)’’ after ‘‘(3)’’; and 

14 (2) by adding at the end the following new sub15 paragraph: 

16 ‘‘(B) The standards specified by the Sec17 retary under subparagraph (A) shall require 

18 that the procedures established by the State 

19 agency under subparagraph (A) exempt income, 

20 resources, and property that are exempt from 

21 the application of this subsection as of April 1, 

22 2003, under manual instructions issued to carry 

23 out this subsection (as in effect on such date) 

24 because of the Federal responsibility for Indian 

25 Tribes and Alaska Native Villages. Nothing in 


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1 this subparagraph shall be construed as pre2 venting the Secretary from providing additional 

3 estate recovery exemptions under this title for 

4 Indians.’’. 

5 SEC. 205. NONDISCRIMINATION IN QUALIFICATIONS FOR 

6 PAYMENT FOR SERVICES UNDER FEDERAL 

7 HEALTH CARE PROGRAMS. 

8 Section 1139 of the Social Security Act (42 U.S.C. 

9 1320b–9), as amended by section 202, is amended by re10 designating subsection (c) as subsection (d), and inserting 

11 after subsection (b) the following new subsection: 

12 ‘‘(c) NONDISCRIMINATION IN QUALIFICATIONS FOR

13 PAYMENT FOR SERVICES UNDER FEDERAL HEALTH

14 CARE PROGRAMS.— 

15 ‘‘(1) REQUIREMENT TO SATISFY GENERALLY

16 APPLICABLE PARTICIPATION REQUIREMENTS.— 

17 ‘‘(A) IN GENERAL.—A Federal health care 

18 program must accept an entity that is operated 

19 by the Indian Health Service, an Indian Tribe, 

20 Tribal Organization, or Urban Indian Organiza21 tion as a provider eligible to receive payment 

22 under the program for health care services fur23 nished to an Indian on the same basis as any 

24 other provider qualified to participate as a pro25 vider of health care services under the program 


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1 if the entity meets generally applicable State or 

2 other requirements for participation as a pro3 vider of health care services under the program. 

4 ‘‘(B) SATISFACTION OF STATE OR LOCAL

5 LICENSURE OR RECOGNITION REQUIRE6 MENTS.—Any requirement for participation as 

7 a provider of health care services under a Fed8 eral health care program that an entity be li9 censed or recognized under the State or local 

10 law where the entity is located to furnish health 

11 care services shall be deemed to have been met 

12 in the case of an entity operated by the Indian 

13 Health Service, an Indian Tribe, Tribal Organi14 zation, or Urban Indian Organization if the en15 tity meets all the applicable standards for such 

16 licensure or recognition, regardless of whether 

17 the entity obtains a license or other documenta18 tion under such State or local law. In accord19 ance with section 221 of the Indian Health 

20 Care Improvement Act, the absence of the licen21 sure of a health care professional employed by 

22 such an entity under the State or local law 

23 where the entity is located shall not be taken 

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1 er the entity meets such standards, if the pro2 fessional is licensed in another State. 

3 ‘‘(2) PROHIBITION ON FEDERAL PAYMENTS TO

4 ENTITIES OR INDIVIDUALS EXCLUDED FROM PAR5 TICIPATION IN FEDERAL HEALTH CARE PROGRAMS

6 OR WHOSE STATE LICENSES ARE UNDER SUSPEN7 SION OR HAVE BEEN REVOKED.— 

8 ‘‘(A) EXCLUDED ENTITIES.—No entity op9 erated by the Indian Health Service, an Indian 

10 Tribe, Tribal Organization, or Urban Indian 

11 Organization that has been excluded from par12 ticipation in any Federal health care program 

13 or for which a license is under suspension or 

14 has been revoked by the State where the entity 

15 is located shall be eligible to receive payment 

16 under any such program for health care serv17 ices furnished to an Indian. 

18 ‘‘(B) EXCLUDED INDIVIDUALS.—No indi19 vidual who has been excluded from participation 

20 in any Federal health care program or whose 

21 State license is under suspension or has been 

22 revoked shall be eligible to receive payment 

23 under any such program for health care serv24 ices furnished by that individual, directly or 

25 through an entity that is otherwise eligible to 


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1 receive payment for health care services, to an 

2 Indian. 

3 ‘‘(C) FEDERAL HEALTH CARE PROGRAM

4 DEFINED.—In this subsection, the term, ‘Fed5 eral health care program’ has the meaning 

6 given that term in section 1128B(f), except 

7 that, for purposes of this subsection, such term 

8 shall include the health insurance program 

9 under chapter 89 of title 5, United States 

10 Code.’’. 

11 SEC. 206. CONSULTATION ON MEDICAID, SCHIP, AND 

12 OTHER HEALTH CARE PROGRAMS FUNDED 

13 UNDER THE SOCIAL SECURITY ACT INVOLV14 ING INDIAN HEALTH PROGRAMS AND URBAN 

15 INDIAN ORGANIZATIONS. 

16 (a) IN GENERAL.—Section 1139 of the Social Secu17 rity Act (42 U.S.C. 1320b–9), as amended by sections 202 

18 and 205, is amended by redesignating subsection (d) as 

19 subsection (e), and inserting after subsection (c) the fol20 lowing new subsection: 

21 ‘‘(d) CONSULTATION WITH TRIBAL TECHNICAL AD22 VISORY GROUP (TTAG).—The Secretary shall maintain 

23 within the Centers for Medicaid & Medicare Services 

24 (CMS) a Tribal Technical Advisory Group, established in 

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1 tember 30, 2003, and in such group shall include a rep2 resentative of the Urban Indian Organizations and the 

3 Service. The representative of the Urban Indian Organiza4 tion shall be deemed to be an elected officer of a tribal 

5 government for purposes of applying section 204(b) of the 

6 Unfunded Mandates Reform Act of 1995 (2 U.S.C. 

7 1534(b)).’’. 

8 (b) SOLICITATION OF ADVICE UNDER MEDICAID AND

9 SCHIP.— 

10 (1) MEDICAID STATE PLAN AMENDMENT.—Sec11 tion 1902(a) of the Social Security Act (42 U.S.C. 

12 1396a(a)) is amended— 

13 (A) in paragraph (69), by striking ‘‘and’’ 

14 at the end; 

15 (B) in paragraph (70)(B)(iv), by striking 

16 the period at the end and inserting ‘‘; and’’; 

17 and 

18 (C) by inserting after paragraph 

19 (70)(B)(iv), the following new paragraph: 

20 ‘‘(71) in the case of any State in which the In21 dian Health Service operates or funds health care 

22 programs, or in which 1 or more Indian Health Pro23 grams or Urban Indian Organizations (as such 

24 terms are defined in section 4 of the Indian Health 

25 Care Improvement Act) provide health care in the 


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1 State for which medical assistance is available under 

2 such title, provide for a process under which the 

3 State seeks advice on a regular, ongoing basis from 

4 designees of such Indian Health Programs and 

5 Urban Indian Organizations on matters relating to 

6 the application of this title that are likely to have a 

7 direct effect on such Indian Health Programs and 

8 Urban Indian Organizations and that— 

9 ‘‘(A) shall include solicitation of advice 

10 prior to submission of any plan amendments, 

11 waiver requests, and proposals for demonstra12 tion projects likely to have a direct effect on In13 dians, Indian Health Programs, or Urban In14 dian Organizations; and 

15 ‘‘(B) may include appointment of an advi16 sory committee and of a designee of such In17 dian Health Programs and Urban Indian Orga18 nizations to the medical care advisory com19 mittee advising the State on its State plan 

20 under this title.’’. 

21 (2) APPLICATION TO SCHIP.—Section 

22 2107(e)(1) of such Act (42 U.S.C. 1397gg(e)(1)), as 

23 amended by section 204(b)(2), is amended— 


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1 (A) by redesignating subparagraphs (B) 

2 through (F) as subparagraphs (C) through (G), 

3 respectively; and 

4 (B) by inserting after subparagraph (A), 

5 the following new subparagraph: 

6 ‘‘(B) Section 1902(a)(71) (relating to the 

7 option of certain States to seek advice from 

8 designees of Indian Health Programs and 

9 Urban Indian Organizations).’’. 

10 (c) RULE OF CONSTRUCTION.—Nothing in the 

11 amendments made by this section shall be construed as 

12 superseding existing advisory committees, working groups, 

13 guidance, or other advisory procedures established by the 

14 Secretary of Health and Human Services or by any State 

15 with respect to the provision of health care to Indians. 

16 SEC. 207. EXCLUSION WAIVER AUTHORITY FOR AFFECTED 

17 INDIAN HEALTH PROGRAMS AND SAFE HAR18 BOR TRANSACTIONS UNDER THE SOCIAL SE19 CURITY ACT. 

20 (a) EXCLUSION WAIVER AUTHORITY.—Section 1128 

21 of the Social Security Act (42 U.S.C. 1320a–7) is amend22 ed by adding at the end the following new subsection: 

23 ‘‘(k) ADDITIONAL EXCLUSION WAIVER AUTHORITY

24 FOR AFFECTED INDIAN HEALTH PROGRAMS.—In addi25 tion to the authority granted the Secretary under subVerDate Aug 31 2005 02:12 Dec 13, 2006 Jkt 059200 PO 00000 Frm 00353 Fmt 6652 Sfmt 6201 E:\BILLS\S4122.IS S4122

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1 sections (c)(3)(B) and (d)(3)(B) to waive an exclusion 

2 under subsection (a)(1), (a)(3), (a)(4), or (b), the Sec3 retary may, in the case of an Indian Health Program, 

4 waive such an exclusion upon the request of the adminis5 trator of an affected Indian Health Program (as defined 

6 in section 4 of the Indian Health Care Improvement Act) 

7 who determines that the exclusion would impose a hard8 ship on individuals entitled to benefits under or enrolled 

9 in a Federal health care program.’’. 

10 (b) CERTAIN TRANSACTIONS INVOLVING INDIAN

11 HEALTH CARE PROGRAMS DEEMED TO BE IN SAFE HAR12 BORS.—Section 1128B(b) of the Social Security Act (42 

13 U.S.C. 1320a–7b(b)) is amended by adding at the end the 

14 following new paragraph: 

15 ‘‘(4) Subject to such conditions as the Secretary may 

16 promulgate from time to time as necessary to prevent 

17 fraud and abuse, for purposes of paragraphs (1) and (2) 

18 and section 1128A(a), the following transfers shall not be 

19 treated as remuneration: 

20 ‘‘(A) TRANSFERS BETWEEN INDIAN HEALTH

21 PROGRAMS, INDIAN TRIBES, TRIBAL ORGANIZATIONS, 

22 AND URBAN INDIAN ORGANIZATIONS.—Transfers of 

23 anything of value between or among an Indian 

24 Health Program, Indian Tribe, Tribal Organization, 

25 or Urban Indian Organization, that are made for the 


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•S 4122 IS

1 purpose of providing necessary health care items and 

2 services to any patient served by such Program, 

3 Tribe, or Organization and that consist of— 

4 ‘‘(i) services in connection with the collec5 tion, transport, analysis, or interpretation of di6 agnostic specimens or test data; 

7 ‘‘(ii) inventory or supplies; 

8 ‘‘(iii) staff; or 

9 ‘‘(iv) a waiver of all or part of premiums 

10 or cost sharing. 

11 ‘‘(B) TRANSFERS BETWEEN INDIAN HEALTH

12 PROGRAMS, INDIAN TRIBES, TRIBAL ORGANIZATIONS, 

13 OR URBAN INDIAN ORGANIZATIONS AND PA14 TIENTS.—Transfers of anything of value between an 

15 Indian Health Program, Indian Tribe, Tribal Orga16 nization, or Urban Indian Organization and any pa17 tient served or eligible for service from an Indian 

18 Health Program, Indian Tribe, Tribal Organization, 

19 or Urban Indian Organization, including any patient 

20 served or eligible for service pursuant to section 807 

21 of the Indian Health Care Improvement Act, but 

22 only if such transfers— 

23 ‘‘(i) consist of expenditures related to pro24 viding transportation for the patient for the 

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1 ices, provided that the provision of such trans2 portation is not advertised, nor an incentive of 

3 which the value is disproportionately large in 

4 relationship to the value of the health care item 

5 or service (with respect to the value of the item 

6 or service itself or, for preventative items or 

7 services, the future health care costs reasonably 

8 expected to be avoided); 

9 ‘‘(ii) consist of expenditures related to pro10 viding housing to the patient (including a preg11 nant patient) and immediate family members or 

12 an escort necessary to assuring the timely pro13 vision of health care items and services to the 

14 patient, provided that the provision of such 

15 housing is not advertised nor an incentive of 

16 which the value is disproportionately large in 

17 relationship to the value of the health care item 

18 or service (with respect to the value of the item 

19 or service itself or, for preventative items or 

20 services, the future health care costs reasonably 

21 expected to be avoided); or 

22 ‘‘(iii) are for the purpose of paying pre23 miums or cost sharing on behalf of such a pa24 tient, provided that the making of such pay25 ment is not subject to conditions other than 


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1 conditions agreed to under a contract for the 

2 delivery of contract health services. 

3 ‘‘(C) CONTRACT HEALTH SERVICES.—A trans4 fer of anything of value negotiated as part of a con5 tract entered into between an Indian Health Pro6 gram, Indian Tribe, Tribal Organization, Urban In7 dian Organization, or the Indian Health Service and 

8 a contract care provider for the delivery of contract 

9 health services authorized by the Indian Health 

10 Service, provided that— 

11 ‘‘(i) such a transfer is not tied to volume 

12 or value of referrals or other business generated 

13 by the parties; and 

14 ‘‘(ii) any such transfer is limited to the fair 

15 market value of the health care items or serv16 ices provided or, in the case of a transfer of 

17 items or services related to preventative care, 

18 the value of the future health care costs reason19 ably expected to be avoided. 

20 ‘‘(D) OTHER TRANSFERS.—Any other transfer 

21 of anything of value involving an Indian Health Pro22 gram, Indian Tribe, Tribal Organization, or Urban 

23 Indian Organization, or a patient served or eligible 

24 for service from an Indian Health Program, Indian 

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1 zation, that the Secretary, in consultation with the 

2 Attorney General, determines is appropriate, taking 

3 into account the special circumstances of such In4 dian Health Programs, Indian Tribes, Tribal Orga5 nizations, and Urban Indian Organizations, and of 

6 patients served by such Programs, Tribes, and Orga7 nizations.’’. 

8 SEC. 208. RULES APPLICABLE UNDER MEDICAID AND 

9 SCHIP TO MANAGED CARE ENTITIES WITH 

10 RESPECT TO INDIAN ENROLLEES AND IN11 DIAN HEALTH CARE PROVIDERS AND INDIAN 

12 MANAGED CARE ENTITIES. 

13 (a) IN GENERAL.—Section 1932 of the Social Secu14 rity Act (42 U.S.C. 1396u–2) is amended by adding at 

15 the end the following new subsection: 

16 ‘‘(h) SPECIAL RULES WITH RESPECT TO INDIAN EN17 ROLLEES, INDIAN HEALTH CARE PROVIDERS, AND IN18 DIAN MANAGED CARE ENTITIES.— 

19 ‘‘(1) ENROLLEE OPTION TO SELECT AN INDIAN

20 HEALTH CARE PROVIDER AS PRIMARY CARE PRO21 VIDER.—In the case of a non-Indian Medicaid man22 aged care entity that— 

23 ‘‘(A) has an Indian enrolled with the enti24 ty; and 


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1 ‘‘(B) has an Indian health care provider 

2 that is participating as a primary care provider 

3 within the network of the entity, 

4 insofar as the Indian is otherwise eligible to receive 

5 services from such Indian health care provider and 

6 the Indian health care provider has the capacity to 

7 provide primary care services to such Indian, the 

8 contract with the entity under section 1903(m) or 

9 under section 1905(t)(3) shall require, as a condi10 tion of receiving payment under such contract, that 

11 the Indian shall be allowed to choose such Indian 

12 health care provider as the Indian’s primary care 

13 provider under the entity. 

14 ‘‘(2) ASSURANCE OF PAYMENT TO INDIAN

15 HEALTH CARE PROVIDERS FOR PROVISION OF COV16 ERED SERVICES.—Each contract with a managed 

17 care entity under section 1903(m) or under section 

18 1905(t)(3) shall require any such entity that has a 

19 significant percentage of Indian enrollees (as deter20 mined by the Secretary), as a condition of receiving 

21 payment under such contract to satisfy the following 

22 requirements: 

23 ‘‘(A) DEMONSTRATION OF PARTICIPATING

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1 TION OF ALTERNATIVE PAYMENT ARRANGE2 MENTS.—Subject to subparagraph (E), to— 

3 ‘‘(i) demonstrate that the number of 

4 Indian health care providers that are par5 ticipating providers with respect to such 

6 entity are sufficient to ensure timely access 

7 to covered Medicaid managed care services 

8 for those enrollees who are eligible to re9 ceive services from such providers; or 

10 ‘‘(ii) agree to pay Indian health care 

11 providers who are not participating pro12 viders with the entity for covered Medicaid 

13 managed care services provided to those 

14 enrollees who are eligible to receive services 

15 from such providers at a rate equal to the 

16 rate negotiated between such entity and 

17 the provider involved or, if such a rate has 

18 not been negotiated, at a rate that is not 

19 less than the level and amount of payment 

20 which the entity would make for the serv21 ices if the services were furnished by a par22 ticipating provider which is not an Indian 

23 health care provider. 

24 ‘‘(B) PROMPT PAYMENT.—To agree to 

25 make prompt payment (in accordance with 


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1 rules applicable to managed care entities) to In2 dian health care providers that are participating 

3 providers with respect to such entity or, in the 

4 case of an entity to which subparagraph (A)(ii) 

5 or (E) applies, that the entity is required to pay 

6 in accordance with that subparagraph. 

7 ‘‘(C) SATISFACTION OF CLAIM REQUIRE8 MENT.—To deem any requirement for the sub9 mission of a claim or other documentation for 

10 services covered under subparagraph (A) by the 

11 enrollee to be satisfied through the submission 

12 of a claim or other documentation by an Indian 

13 health care provider that is consistent with sec14 tion 403(h) of the Indian Health Care Improve15 ment Act. 

16 ‘‘(D) COMPLIANCE WITH GENERALLY AP17 PLICABLE REQUIREMENTS.— 

18 ‘‘(i) IN GENERAL.—Subject to clause 

19 (ii), as a condition of payment under sub20 paragraph (A), an Indian health care pro21 vider shall comply with the generally appli22 cable requirements of this title, the State 

23 plan, and such entity with respect to cov24 ered Medicaid managed care services pro25 vided by the Indian health care provider to 


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1 the same extent that non-Indian providers 

2 participating with the entity must comply 

3 with such requirements. 

4 ‘‘(ii) LIMITATIONS ON COMPLIANCE

5 WITH MANAGED CARE ENTITY GENERALLY

6 APPLICABLE REQUIREMENTS.—An Indian 

7 health care provider— 

8 ‘‘(I) shall not be required to com9 ply with a generally applicable re10 quirement of a managed care entity 

11 described in clause (i) as a condition 

12 of payment under subparagraph (A) if 

13 such compliance would conflict with 

14 any other statutory or regulatory re15 quirements applicable to the Indian 

16 health care provider; and 

17 ‘‘(II) shall only need to comply 

18 with those generally applicable re19 quirements of a managed care entity 

20 described in clause (i) as a condition 

21 of payment under subparagraph (A) 

22 that are necessary for the entity’s 

23 compliance with the State plan, such 

24 as those related to care management, 


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1 quality assurance, and utilization 

2 management. 

3 ‘‘(E) APPLICATION OF SPECIAL PAYMENT

4 REQUIREMENTS FOR FEDERALLY-QUALIFIED

5 HEALTH CENTERS AND ENCOUNTER RATE FOR

6 SERVICES PROVIDED BY CERTAIN INDIAN

7 HEALTH CARE PROVIDERS.— 

8 ‘‘(i) FEDERALLY-QUALIFIED HEALTH

9 CENTERS.— 

10 ‘‘(I) MANAGED CARE ENTITY

11 PAYMENT REQUIREMENT.—To agree 

12 to pay any Indian health care provider 

13 that is a Federally-qualified health 

14 center but not a participating provider 

15 with respect to the entity, for the pro16 vision of covered Medicaid managed 

17 care services by such provider to an 

18 Indian enrollee of the entity at a rate 

19 equal to the amount of payment that 

20 the entity would pay a Federally21 qualified health center that is a par22 ticipating provider with respect to the 

23 entity but is not an Indian health care 

24 provider for such services. 


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1 ‘‘(II) CONTINUED APPLICATION

2 OF STATE REQUIREMENT TO MAKE

3 SUPPLEMENTAL PAYMENT.—Nothing 

4 in subclause (I) or subparagraph (A) 

5 or (B) shall be construed as waiving 

6 the application of section 1902(bb)(5) 

7 regarding the State plan requirement 

8 to make any supplemental payment 

9 due under such section to a Federally10 qualified health center for services 

11 furnished by such center to an en12 rollee of a managed care entity (re13 gardless of whether the Federally14 qualified health center is or is not a 

15 participating provider with the entity). 

16 ‘‘(ii) CONTINUED APPLICATION OF

17 ENCOUNTER RATE FOR SERVICES PRO18 VIDED BY CERTAIN INDIAN HEALTH CARE

19 PROVIDERS.—If the amount paid by a 

20 managed care entity to an Indian health 

21 care provider that is not a Federally-quali22 fied health center and that has elected to 

23 receive payment under this title as an In24 dian Health Service provider under the 

25 July 11, 1996, Memorandum of Agreement 


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1 between the Health Care Financing Ad2 ministration (now the Centers for Medicare 

3 & Medicaid Services) and the Indian 

4 Health Service for services provided by 

5 such provider to an Indian enrollee with 

6 the managed care entity is less than the 

7 encounter rate that applies to the provision 

8 of such services under such memorandum, 

9 the State plan shall provide for payment to 

10 the Indian health care provider of the dif11 ference between the applicable encounter 

12 rate under such memorandum and the 

13 amount paid by the managed care entity to 

14 the provider for such services. 

15 ‘‘(F) CONSTRUCTION.—Nothing in this 

16 paragraph shall be construed as waiving the ap17 plication of section 1902(a)(30)(A) (relating to 

18 application of standards to assure that pay19 ments are consistent with efficiency, economy, 

20 and quality of care). 

21 ‘‘(3) OFFERING OF MANAGED CARE THROUGH

22 INDIAN MEDICAID MANAGED CARE ENTITIES.—If— 

23 ‘‘(A) a State elects to provide services 

24 through Medicaid managed care entities under 

25 its Medicaid managed care program; and 


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•S 4122 IS

1 ‘‘(B) an Indian health care provider that is 

2 funded in whole or in part by the Indian Health 

3 Service, or a consortium composed of 1 or more 

4 Tribes, Tribal Organizations, or Urban Indian 

5 Organizations, and which also may include the 

6 Indian Health Service, has established an In7 dian Medicaid managed care entity in the State 

8 that meets generally applicable standards re9 quired of such an entity under such Medicaid 

10 managed care program, 

11 the State shall offer to enter into an agreement with 

12 the entity to serve as a Medicaid managed care enti13 ty with respect to eligible Indians served by such en14 tity under such program. 

15 ‘‘(4) SPECIAL RULES FOR INDIAN MANAGED

16 CARE ENTITIES.—The following are special rules re17 garding the application of a Medicaid managed care 

18 program to Indian Medicaid managed care entities: 

19 ‘‘(A) ENROLLMENT.— 

20 ‘‘(i) LIMITATION TO INDIANS.—An In21 dian Medicaid managed care entity may re22 strict enrollment under such program to 

23 Indians and to members of specific Tribes 

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1 grams may restrict the delivery of services 

2 to such Indians and tribal members. 

3 ‘‘(ii) NO LESS CHOICE OF PLANS.— 

4 Under such program the State may not 

5 limit the choice of an Indian among Med6 icaid managed care entities only to Indian 

7 Medicaid managed care entities or to be 

8 more restrictive than the choice of man9 aged care entities offered to individuals 

10 who are not Indians. 

11 ‘‘(iii) DEFAULT ENROLLMENT.— 

12 ‘‘(I) IN GENERAL.—If such pro13 gram of a State requires the enroll14 ment of Indians in a Medicaid man15 aged care entity in order to receive 

16 benefits, the State, taking into consid17 eration the criteria specified in sub18 section (a)(4)(D)(ii)(I), shall provide 

19 for the enrollment of Indians de20 scribed in subclause (II) who are not 

21 otherwise enrolled with such an entity 

22 in an Indian Medicaid managed care 

23 entity described in such clause. 

24 ‘‘(II) INDIAN DESCRIBED.—An 

25 Indian described in this subclause, 


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•S 4122 IS

1 with respect to an Indian Medicaid 

2 managed care entity, is an Indian 

3 who, based upon the service area and 

4 capacity of the entity, is eligible to be 

5 enrolled with the entity consistent 

6 with subparagraph (A). 

7 ‘‘(iv) EXCEPTION TO STATE LOCK8 IN.—A request by an Indian who is en9 rolled under such program with a non-In10 dian Medicaid managed care entity to 

11 change enrollment with that entity to en12 rollment with an Indian Medicaid managed 

13 care entity shall be considered cause for 

14 granting such request under procedures 

15 specified by the Secretary. 

16 ‘‘(B) FLEXIBILITY IN APPLICATION OF

17 SOLVENCY.—In applying section 1903(m)(1) to 

18 an Indian Medicaid managed care entity— 

19 ‘‘(i) any reference to a ‘State’ in sub20 paragraph (A)(ii) of that section shall be 

21 deemed to be a reference to the ‘Sec22 retary’; and 

23 ‘‘(ii) the entity shall be deemed to be 

24 a public entity described in subparagraph 

25 (C)(ii) of that section. 


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1 ‘‘(C) EXCEPTIONS TO ADVANCE DIREC2 TIVES.—The Secretary may modify or waive the 

3 requirements of section 1902(w) (relating to 

4 provision of written materials on advance direc5 tives) insofar as the Secretary finds that the re6 quirements otherwise imposed are not an appro7 priate or effective way of communicating the in8 formation to Indians. 

9 ‘‘(D) FLEXIBILITY IN INFORMATION AND

10 MARKETING.— 

11 ‘‘(i) MATERIALS.—The Secretary may 

12 modify requirements under subsection 

13 (a)(5) to ensure that information described 

14 in that subsection is provided to enrollees 

15 and potential enrollees of Indian Medicaid 

16 managed care entities in a culturally ap17 propriate and understandable manner that 

18 clearly communicates to such enrollees and 

19 potential enrollees their rights, protections, 

20 and benefits. 

21 ‘‘(ii) DISTRIBUTION OF MARKETING

22 MATERIALS.—The provisions of subsection 

23 (d)(2)(B) requiring the distribution of 

24 marketing materials to an entire service 

25 area shall be deemed satisfied in the case 


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1 of an Indian Medicaid managed care entity 

2 that distributes appropriate materials only 

3 to those Indians who are potentially eligi4 ble to enroll with the entity in the service 

5 area. 

6 ‘‘(5) MALPRACTICE INSURANCE.—Insofar as, 

7 under a Medicaid managed care program, a health 

8 care provider is required to have medical malpractice 

9 insurance coverage as a condition of contracting as 

10 a provider with a Medicaid managed care entity, an 

11 Indian health care provider that is— 

12 ‘‘(A) a Federally-qualified health center 

13 that is covered under the Federal Tort Claims 

14 Act (28 U.S.C. 1346(b), 2671 et seq.); 

15 ‘‘(B) providing health care services pursu16 ant to a contract or compact under the Indian 

17 Self-Determination and Education Assistance 

18 Act (25 U.S.C. 450 et seq.) that are covered 

19 under the Federal Tort Claims Act (28 U.S.C. 

20 1346(b), 2671 et seq.); or 

21 ‘‘(C) the Indian Health Service providing 

22 health care services that are covered under the 

23 Federal Tort Claims Act (28 U.S.C. 1346(b), 

24 2671 et seq.); 

25 are deemed to satisfy such requirement. 


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1 ‘‘(6) DEFINITIONS.—For purposes of this sub2 section: 

3 ‘‘(A) INDIAN HEALTH CARE PROVIDER.— 

4 The term ‘Indian health care provider’ means 

5 an Indian Health Program or an Urban Indian 

6 Organization. 

7 ‘‘(B) INDIAN; INDIAN HEALTH PROGRAM; 

8 SERVICE; TRIBE; TRIBAL ORGANIZATION; URBAN

9 INDIAN ORGANIZATION.—The terms ‘Indian’, 

10 ‘Indian Health Program’, ‘Service’, ‘Tribe’, 

11 ‘tribal organization’, ‘Urban Indian Organiza12 tion’ have the meanings given such terms in 

13 section 4 of the Indian Health Care Improve14 ment Act. 

15 ‘‘(C) INDIAN MEDICAID MANAGED CARE

16 ENTITY.—The term ‘Indian Medicaid managed 

17 care entity’ means a managed care entity that 

18 is controlled (within the meaning of the last 

19 sentence of section 1903(m)(1)(C)) by the In20 dian Health Service, a Tribe, Tribal Organiza21 tion, or Urban Indian Organization, or a con22 sortium, which may be composed of 1 or more 

23 Tribes, Tribal Organizations, or Urban Indian 

24 Organizations, and which also may include the 

25 Service. 


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1 ‘‘(D) NON-INDIAN MEDICAID MANAGED

2 CARE ENTITY.—The term ‘non-Indian Medicaid 

3 managed care entity’ means a managed care en4 tity that is not an Indian Medicaid managed 

5 care entity. 

6 ‘‘(E) COVERED MEDICAID MANAGED CARE

7 SERVICES.—The term ‘covered Medicaid man8 aged care services’ means, with respect to an 

9 individual enrolled with a managed care entity, 

10 items and services that are within the scope of 

11 items and services for which benefits are avail12 able with respect to the individual under the 

13 contract between the entity and the State in14 volved. 

15 ‘‘(F) MEDICAID MANAGED CARE PRO16 GRAM.—The term ‘Medicaid managed care pro17 gram’ means a program under sections 

18 1903(m) and 1932 and includes a managed 

19 care program operating under a waiver under 

20 section 1915(b) or 1115 or otherwise.’’. 

21 (b) APPLICATION TO SCHIP.—Section 2107(e)(1) of 

22 such Act (42 U.S.C. 1397gg(1)), as amended by section 

23 206(b)(2), is amended by adding at the end the following 

24 new subparagraph: 


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1 ‘‘(H) Subsections (a)(2)(C) and (h) of sec2 tion 1932.’’. 

3 SEC. 209. ANNUAL REPORT ON INDIANS SERVED BY SOCIAL 

4 SECURITY ACT HEALTH BENEFIT PROGRAMS. 

5 Section 1139 of the Social Security Act (42 U.S.C. 

6 1320b–9), as amended by the sections 202, 205, and 206, 

7 is amended by redesignating subsection (e) as subsection 

8 (f), and inserting after subsection (d) the following new 

9 subsection: 

10 ‘‘(e) ANNUAL REPORT ON INDIANS SERVED BY

11 HEALTH BENEFIT PROGRAMS FUNDED UNDER THIS

12 ACT.—Beginning January 1, 2007, and annually there13 after, the Secretary, acting through the Administrator of 

14 the Centers for Medicare & Medicaid Services and the Di15 rector of the Indian Health Service, shall submit a report 

16 to Congress regarding the enrollment and health status 

17 of Indians receiving items or services under health benefit 

18 programs funded under this Act during the preceding 

19 year. Each such report shall include the following: 

20 ‘‘(1) The total number of Indians enrolled in, or 

21 receiving items or services under, such programs, 

22 disaggregated with respect to each such program. 

23 ‘‘(2) The number of Indians described in para24 graph (1) that also received health benefits under 

25 programs funded by the Indian Health Service. 


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1 ‘‘(3) General information regarding the health 

2 status of the Indians described in paragraph (1), 

3 disaggregated with respect to specific diseases or 

4 conditions and presented in a manner that is con5 sistent with protections for privacy of individually 

6 identifiable health information under section 264(c) 

7 of the Health Insurance Portability and Account8 ability Act of 1996. 

9 ‘‘(4) A detailed statement of the status of facili10 ties of the Indian Health Service or an Indian Tribe, 

11 Tribal Organization, or an Urban Indian Organiza12 tion with respect to such facilities’ compliance with 

13 the applicable conditions and requirements of titles 

14 XVIII, XIX, and XXI, and, in the case of title XIX 

15 or XXI, under a State plan under such title or 

16 under waiver authority, and of the progress being 

17 made by such facilities (under plans submitted 

18 under section 1880(b), 1911(b) or otherwise) toward 

19 the achievement and maintenance of such compli20 ance. 

21 ‘‘(5) Such other information as the Secretary 

22 determines is appropriate.’’. 

Æ 


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