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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2708 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 2708

 To amend the Indian Health Care Improvement Act to revise and extend 
                   that Act, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                              June 4, 2009

Mr. Pallone (for himself, Mr. Rahall, Mr. Kildee, Mr. Young of Alaska, 
   Mr. Grijalva, Ms. Bordallo, Mr. Boren, Mr. Inslee, Mr. Baca, Mr. 
Heinrich, Mr. Teague, Ms. McCollum, Ms. Linda T. Sanchez of California, 
  Mr. Kagen, Mr. Lujan, Mr. Salazar, Mr. Schauer, and Mrs. Bono Mack) 
 introduced the following bill; which was referred to the Committee on 
  Natural Resources, and in addition to the Committees on Energy and 
Commerce and Ways and Means, for a period to be subsequently determined 
 by the Speaker, in each case for consideration of such provisions as 
        fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

 
 To amend the Indian Health Care Improvement Act to revise and extend 
                   that Act, and for other purposes.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Indian Health Care 
Improvement Act Amendments of 2009''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
                   TITLE I--AMENDMENTS TO INDIAN LAWS

Sec. 101. Indian Health Care Improvement Act amended.
Sec. 102. Soboba sanitation facilities.
Sec. 103. Native American Health and Wellness Foundation.
Sec. 104. GAO study and report on payments for contract health 
                            services.
 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. Nondiscrimination in qualifications for payment for services 
                            under Federal health care programs.
Sec. 205. Solicitation of proposals for safe harbors under the Social 
                            Security Act for facilities of Indian 
                            Health Programs and urban Indian 
                            organizations.
Sec. 206. Annual report on Indians served by Social Security Act health 
                            benefit programs.
Sec. 207. Development of recommendations to improve interstate 
                            coordination of Medicaid and SCHIP coverage 
                            of Indian children and other children who 
                            are outside of their State of residency 
                            because of educational or other needs.

                   TITLE I--AMENDMENTS TO INDIAN LAWS

SEC. 101. INDIAN HEALTH CARE IMPROVEMENT ACT AMENDED.

    (a) In General.--The Indian Health Care Improvement Act (25 U.S.C. 
1601 et seq.) is amended to read as follows:

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

    ``(a) Short Title.--This Act may be cited as the `Indian Health 
Care Improvement Act'.
    ``(b) Table of Contents.--The table of contents for this Act is as 
follows:

``Sec. 1. Short title; table of contents.
``Sec. 2. Findings.
``Sec. 3. Declaration of national Indian health policy.
``Sec. 4. Definitions.
       ``TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT

``Sec. 101. Purpose.
``Sec. 102. Health professions recruitment program for Indians.
``Sec. 103. Health professions preparatory scholarship program for 
                            Indians.
``Sec. 104. Indian health professions scholarships.
``Sec. 105. American Indians Into Psychology Program.
``Sec. 106. Scholarship programs for Indian Tribes.
``Sec. 107. Indian Health Service extern programs.
``Sec. 108. Continuing education allowances.
``Sec. 109. Community Health Representative Program.
``Sec. 110. Indian Health Service Loan Repayment Program.
``Sec. 111. Scholarship and Loan Repayment Recovery Fund.
``Sec. 112. Recruitment activities.
``Sec. 113. Indian recruitment and retention program.
``Sec. 114. Advanced training and research.
``Sec. 115. Quentin N. Burdick American Indians Into Nursing Program.
``Sec. 116. Tribal cultural orientation.
``Sec. 117. INMED Program.
``Sec. 118. Health training programs of community colleges.
``Sec. 119. Retention bonus.
``Sec. 120. Nursing residency program.
``Sec. 121. Community Health Aide Program.
``Sec. 122. Tribal Health Program administration.
``Sec. 123. Health professional chronic shortage demonstration 
                            programs.
``Sec. 124. National Health Service Corps.
``Sec. 125. Substance abuse counselor educational curricula 
                            demonstration programs.
``Sec. 126. Behavioral health training and community education 
                            programs.
``Sec. 127. Exemption from payment of certain fees.
``Sec. 128. Authorization of appropriations.
                      ``TITLE II--HEALTH SERVICES

``Sec. 201. Indian Health Care Improvement Fund.
``Sec. 202. Health promotion and disease prevention services.
``Sec. 203. Diabetes prevention, treatment, and control.
``Sec. 204. Shared services for long-term care.
``Sec. 205. Health services research.
``Sec. 206. Mammography and other cancer screening.
``Sec. 207. Patient travel costs.
``Sec. 208. Epidemiology centers.
``Sec. 209. Comprehensive school health education programs.
``Sec. 210. Indian youth program.
``Sec. 211. Prevention, control, and elimination of communicable and 
                            infectious diseases.
``Sec. 212. Other authority for provision of services.
``Sec. 213. Indian women's health care.
``Sec. 214. Environmental and nuclear health hazards.
``Sec. 215. Arizona as a contract health service delivery area.
``Sec. 216. North Dakota and South Dakota as contract health service 
                            delivery area.
``Sec. 217. California contract health services program.
``Sec. 218. California as a contract health service delivery area.
``Sec. 219. Contract health services for the Trenton Service Area.
``Sec. 220. Programs operated by Indian Tribes and tribal 
                            organizations.
``Sec. 221. Licensing.
``Sec. 222. Notification of provision of emergency contract health 
                            services.
``Sec. 223. Prompt action on payment of claims.
``Sec. 224. Liability for payment.
``Sec. 225. Office of Indian Men's Health.
``Sec. 226. Authorization of appropriations.
                        ``TITLE III--FACILITIES

``Sec. 301. Consultation; construction and renovation of facilities; 
                            reports.
``Sec. 302. Sanitation facilities.
``Sec. 303. Preference to Indians and Indian firms.
``Sec. 304. Expenditure of non-Service funds for renovation.
``Sec. 305. Funding for the construction, expansion, and modernization 
                            of small ambulatory care facilities.
``Sec. 306. Indian health care delivery demonstration project.
``Sec. 307. Land transfer.
``Sec. 308. Leases, contracts, and other agreements.
``Sec. 309. Study on loans, loan guarantees, and loan repayment.
``Sec. 310. Tribal leasing.
``Sec. 311. Indian Health Service/tribal facilities joint venture 
                            program.
``Sec. 312. Location of facilities.
``Sec. 313. Maintenance and improvement of health care facilities.
``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.
``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. Eligible indian veteran services.
``Sec. 408. Payor of last resort.
``Sec. 409. Nondiscrimination under Federal health care programs in 
                            qualifications for reimbursement for 
                            services.
``Sec. 410. Consultation.
``Sec. 411. State Children's Health Insurance Program (SCHIP).
``Sec. 412. Exclusion waiver authority for affected Indian Health 
                            Programs and safe harbor transactions under 
                            the Social Security Act.
``Sec. 413. Premium and cost sharing protections and eligibility 
                            determinations under Medicaid and SCHIP and 
                            protection of certain Indian property from 
                            Medicaid estate recovery.
``Sec. 414. Treatment under Medicaid and SCHIP managed care.
``Sec. 415. Navajo Nation Medicaid Agency feasibility study.
``Sec. 416. Exception for excepted benefits.
``Sec. 417. 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. Use of Federal Government Facilities and Sources of Supply.
``Sec. 505. Contracts and grants for the determination of unmet health 
                            care needs.
``Sec. 506. Evaluations; renewals.
``Sec. 507. Other contract and grant requirements.
``Sec. 508. Reports and records.
``Sec. 509. Limitation on contract authority.
``Sec. 510. Facilities.
``Sec. 511. Division of Urban Indian Health.
``Sec. 512. Grants for alcohol and substance abuse-related services.
``Sec. 513. Treatment of certain demonstration projects.
``Sec. 514. Urban NIAAA transferred programs.
``Sec. 515. Conferring with urban Indian organizations.
``Sec. 516. Urban youth treatment center demonstration.
``Sec. 517. Grants for diabetes prevention, treatment, and control.
``Sec. 518. Community health representatives.
``Sec. 519. Effective date.
``Sec. 520. Eligibility for services.
``Sec. 521. Authorization of appropriations.
``Sec. 522. Health information technology.
                ``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. Domestic and sexual violence prevention and treatment.
``Sec. 715. Behavioral health research.
``Sec. 716. Definitions.
``Sec. 717. Authorization of appropriations.
                      ``TITLE VIII--MISCELLANEOUS

``Sec. 801. Reports.
``Sec. 802. Regulations.
``Sec. 803. Plan of implementation.
``Sec. 804. Limitation on use of funds appropriated to Indian Health 
                            Service.
``Sec. 805. Eligibility of California Indians.
``Sec. 806. Health services for ineligible persons.
``Sec. 807. Treatment of certain services and benefits.
``Sec. 808. Reallocation of base resources.
``Sec. 809. Results of demonstration projects.
``Sec. 810. Provision of services in Montana.
``Sec. 811. Moratorium.
``Sec. 812. Severability provisions.
``Sec. 813. Use of patient safety organizations.
``Sec. 814. Confidentiality of medical quality assurance records; 
                            qualified immunity for participants.
``Sec. 815. Claremore Indian Hospital.
``Sec. 816. Sense of Congress regarding law enforcement and 
                            methamphetamine issues in Indian country.
``Sec. 817. Permitting implementation through contracts with Tribal 
                            Health Programs.
``Sec. 818. Authorization of appropriations; availability.

``SEC. 2. FINDINGS.

    ``Congress makes the following findings:
            ``(1) Federal health services to maintain and improve the 
        health of the Indians are consonant with and required by the 
        Federal Government's historical and unique legal relationship 
        with, and resulting responsibility to, the American Indian 
        people.
            ``(2) A major national goal of the United States is to 
        provide the resources, processes, and structure that will 
        enable Indian tribes and tribal members to obtain the quantity 
        and quality of health care services and opportunities that will 
        eradicate the health dispartities between Indians the general 
        population.
            ``(3) A major national goal of the United States is to 
        provide the quantity and quality of health services which will 
        permit the health status of Indians to be raised to the highest 
        possible level and to encourage the maximum participation of 
        Indians in the planning and management of those services.
            ``(4) Federal health services to Indians have resulted in a 
        reduction in the prevalence and incidence of preventable 
        illnesses among, and unnecessary and premature deaths of, 
        Indians.
            ``(5) Despite such services, the unmet health needs of the 
        American Indian people are severe and the health status of the 
        Indians is far below that of the general population of the 
        United States.

``SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.

    ``Congress declares that it is the policy of this Nation, in 
fulfillment of its special trust responsibilities and legal obligations 
to Indians--
            ``(1) to assure the highest possible health status for 
        Indians and to provide all resources necessary to effect that 
        policy;
            ``(2) to raise the health status of Indians to at least the 
        levels set forth in the goals contained within the Health 
        People 2010 or successor objectives;
            ``(3) to the greatest extent possible, to allow Indians to 
        set their own health care priorities and establish goals that 
        reflect their unmet needs;
            ``(4) to increase the proportion of all degrees in the 
        health professions and allied and associated health professions 
        awarded to Indians so that the proportion of Indian health 
        professionals in each Service Area is raised to at least the 
        level of that of the general population;
            ``(5) to require meaningful consultation with Indian 
        Tribes, Tribal Organizations, and urban Indian organizations to 
        implement this Act and the national policy of Indian self-
        determination; and
            ``(6) to provide funding for programs and facilities 
        operated by Indian Tribes and Tribal Organizations in amounts 
        that are not less than the amounts provided to programs and 
        facilities operated directly by the Service.

``SEC. 4. DEFINITIONS.

    ``For purposes of this Act:
            ``(1) The term `accredited and accessible' means on or near 
        a reservation and accredited by a national or regional 
        organization with accrediting authority.
            ``(2) The term `Area Office' means an administrative 
        entity, including a program office, within the Service through 
        which services and funds are provided to the Service Units 
        within a defined geographic area.
            ``(3) The term `Assistant Secretary' means the Assistant 
        Secretary of Indian Health.
            ``(4)(A) The term `behavioral health' means the blending of 
        substance (including alcohol, drugs, inhalants, and tobacco) 
        abuse and mental health prevention and treatment, for the 
        purpose of providing comprehensive services.
            ``(B) The term `behavioral health' includes the joint 
        development of substance abuse and mental health treatment 
        planning and coordinated case management using a 
        multidisciplinary approach.
            ``(5) The term `California Indians' means those Indians who 
        are eligible for health services of the Service pursuant to 
        section 805.
            ``(6) The term `community college' means--
                    ``(A) a tribal college or university, or
                    ``(B) a junior or community college.
            ``(7) The term `contract health service' means health 
        services provided at the expense of the Service or a Tribal 
        Health Program by public or private medical providers or 
        hospitals, other than the Service Unit or the Tribal Health 
        Program at whose expense the services are provided.
            ``(8) The term `Department' means, unless otherwise 
        designated, the Department of Health and Human Services.
            ``(9) The term `disease prevention' means the reduction, 
        limitation, and prevention of disease and its complications and 
        reduction in the consequences of disease, including--
                    ``(A) controlling--
                            ``(i) the development of diabetes;
                            ``(ii) high blood pressure;
                            ``(iii) infectious agents;
                            ``(iv) injuries;
                            ``(v) occupational hazards and 
                        disabilities;
                            ``(vi) sexually transmittable diseases; and
                            ``(vii) toxic agents; and
                    ``(B) providing--
                            ``(i) fluoridation of water; and
                            ``(ii) immunizations.
            ``(10) The term `health profession' means allopathic 
        medicine, family medicine, internal medicine, pediatrics, 
        geriatric medicine, obstetrics and gynecology, podiatric 
        medicine, nursing, public health nursing, dentistry, 
        psychiatry, osteopathy, optometry, pharmacy, psychology, public 
        health, social work, marriage and family therapy, chiropractic 
        medicine, environmental health and engineering, allied health 
        professions, naturopathic medicine, and any other health 
        profession.
            ``(11) The term `health promotion' means--
                    ``(A) fostering social, economic, environmental, 
                and personal factors conducive to health, including 
                raising public awareness about health matters and 
                enabling the people to cope with health problems by 
                increasing their knowledge and providing them with 
                valid information;
                    ``(B) encouraging adequate and appropriate diet, 
                exercise, and sleep;
                    ``(C) promoting education and work in conformity 
                with physical and mental capacity;
                    ``(D) making available safe water and sanitary 
                facilities;
                    ``(E) improving the physical, economic, cultural, 
                psychological, and social environment;
                    ``(F) promoting culturally competent care; and
                    ``(G) providing adequate and appropriate programs, 
                which may include--
                            ``(i) abuse prevention (mental and 
                        physical);
                            ``(ii) community health;
                            ``(iii) community safety;
                            ``(iv) consumer health education;
                            ``(v) diet and nutrition;
                            ``(vi) immunization and other prevention of 
                        communicable diseases, including HIV/AIDS;
                            ``(vii) environmental health;
                            ``(viii) exercise and physical fitness;
                            ``(ix) avoidance of fetal alcohol 
                        disorders;
                            ``(x) first aid and CPR education;
                            ``(xi) human growth and development;
                            ``(xii) injury prevention and personal 
                        safety;
                            ``(xiii) behavioral health;
                            ``(xiv) monitoring of disease indicators 
                        between health care provider visits, through 
                        appropriate means, including Internet-based 
                        health care management systems;
                            ``(xv) personal health and wellness 
                        practices;
                            ``(xvi) personal capacity building;
                            ``(xvii) prenatal, pregnancy, and infant 
                        care;
                            ``(xviii) psychological well-being;
                            ``(xix) reproductive health and family 
                        planning;
                            ``(xx) safe and adequate water;
                            ``(xxi) healthy work environments;
                            ``(xxii) elimination, reduction, and 
                        prevention of contaminants that create 
                        unhealthy household conditions (including mold 
                        and other allergens);
                            ``(xxiii) stress control;
                            ``(xxiv) substance abuse;
                            ``(xxv) sanitary facilities;
                            ``(xxvi) sudden infant death syndrome 
                        prevention;
                            ``(xxvii) tobacco use cessation and 
                        reduction;
                            ``(xxviii) violence prevention; and
                            ``(xxix) activities to promote achievement 
                        of any of the objectives described in section 
                        3(2).
            ``(12) The term `Indian', unless otherwise designated, 
        means any person who is a member of an Indian Tribe or is 
        eligible for health services under section 805, except that, 
        for the purpose of sections 102 and 103, the term also means 
        any individual who--
                    ``(A)(i) irrespective of whether the individual 
                lives on or near a reservation, is a member of a tribe, 
                band, or other organized group of Indians, including 
                those tribes, bands, or groups terminated since 1940 
                and those recognized now or in the future by the State 
                in which they reside; or
                    ``(ii) is a descendant, in the first or second 
                degree, of any such member;
                    ``(B) is an Eskimo or Aleut or other Alaska Native;
                    ``(C) is considered by the Secretary of the 
                Interior to be an Indian for any purpose; or
                    ``(D) is determined to be an Indian under 
                regulations promulgated by the Secretary.
            ``(13) The term `Indian Health Program' means--
                    ``(A) any health program administered directly by 
                the Service;
                    ``(B) any Tribal Health Program; or
                    ``(C) any Indian Tribe or Tribal Organization to 
                which the Secretary provides funding pursuant to 
                section 23 of the Act of June 25, 1910 (25 U.S.C. 47) 
                (commonly known as the `Buy Indian Act').
            ``(14) The term `Indian Tribe' has the meaning given the 
        term in the Indian Self-Determination and Education Assistance 
        Act (25 U.S.C. 450 et seq.).
            ``(15) The term `junior or community college' has the 
        meaning given the term by section 312(f) of the Higher 
        Education Act of 1965 (20 U.S.C. 1058(f)).
            ``(16) The term `reservation' means any federally 
        recognized Indian Tribe's reservation, Pueblo, or colony, 
        including former reservations in Oklahoma, Indian allotments, 
        and Alaska Native Regions established pursuant to the Alaska 
        Native Claims Settlement Act (43 U.S.C. 1601 et seq.).
            ``(17) The term `Secretary', unless otherwise designated, 
        means the Secretary of Health and Human Services.
            ``(18) The term `Service' means the Indian Health Service.
            ``(19) The term `Service Area' means the geographical area 
        served by each Area Office.
            ``(20) The term `Service Unit' means an administrative 
        entity of the Service, or a Tribal Health Program through which 
        services are provided, directly or by contract, to eligible 
        Indians within a defined geographic area.
            ``(21) The term `telehealth' has the meaning given the term 
        in section 330K(a) of the Public Health Service Act (42 U.S.C. 
        254c-16(a)).
            ``(22) The term `telemedicine' means a telecommunications 
        link to an end user through the use of eligible equipment that 
        electronically links health professionals or patients and 
        health professionals at separate sites in order to exchange 
        health care information in audio, video, graphic, or other 
        format for the purpose of providing improved health care 
        services.
            ``(23) The term `tribal college or university' has the 
        meaning given the term in section 316(b)(3) of the Higher 
        Education Act (20 U.S.C. 1059c(b)(3)).
            ``(24) The term `Tribal Health Program' means an Indian 
        Tribe or Tribal Organization that operates any health program, 
        service, function, activity, or facility funded, in whole or 
        part, by the Service through, or provided for in, a contract or 
        compact with the Service under the Indian Self-Determination 
        and Education Assistance Act (25 U.S.C. 450 et seq.).
            ``(25) The term `Tribal Organization' has the meaning given 
        the term in the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.).
            ``(26) The term `Urban Center' means any community which 
        has a sufficient Urban Indian population with unmet health 
        needs to warrant assistance under title V of this Act, as 
        determined by the Secretary.
            ``(27) The term `Urban Indian' means any individual who 
        resides in an Urban Center and who meets 1 or more of the 
        following criteria:
                    ``(A) Irrespective of whether the individual lives 
                on or near a reservation, the individual is a member of 
                a tribe, band, or other organized group of Indians, 
                including those tribes, bands, or groups terminated 
                since 1940 and those tribes, bands, or groups that are 
                recognized by the States in which they reside, or who 
                is a descendant in the first or second degree of any 
                such member.
                    ``(B) The individual is an Eskimo, Aleut, or other 
                Alaska Native.
                    ``(C) The individual is considered by the Secretary 
                of the Interior to be an Indian for any purpose.
                    ``(D) The individual is determined to be an Indian 
                under regulations promulgated by the Secretary.
            ``(28) The term `urban Indian organization' means a 
        nonprofit corporate body that (A) is situated in an Urban 
        Center; (B) is governed by an Urban Indian-controlled board of 
        directors; (C) provides for the participation of all interested 
        Indian groups and individuals; and (D) is capable of legally 
        cooperating with other public and private entities for the 
        purpose of performing the activities described in section 
        503(a).

       ``TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT

``SEC. 101. PURPOSE.

    ``The purpose of this title is to increase, to the maximum extent 
feasible, the number of Indians entering the health professions and 
providing health services, and to assure an optimum supply of health 
professionals to the Indian Health Programs and urban Indian 
organizations involved in the provision of health services to Indians.

``SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR INDIANS.

    ``(a) In General.--The Secretary, acting through the Service, shall 
make grants to public or nonprofit private health or educational 
entities, Tribal Health Programs, or urban Indian organizations to 
assist such entities in meeting the costs of--
            ``(1) identifying Indians with a potential for education or 
        training in the health professions and encouraging and 
        assisting them--
                    ``(A) to enroll in courses of study in such health 
                professions; or
                    ``(B) if they are not qualified to enroll in any 
                such courses of study, to undertake such postsecondary 
                education or training as may be required to qualify 
                them for enrollment;
            ``(2) publicizing existing sources of financial aid 
        available to Indians enrolled in any course of study referred 
        to in paragraph (1) or who are undertaking training necessary 
        to qualify them to enroll in any such course of study; or
            ``(3) establishing other programs which the Secretary 
        determines will enhance and facilitate the enrollment of 
        Indians in, and the subsequent pursuit and completion by them 
        of, courses of study referred to in paragraph (1).
    ``(b) Grants.--
            ``(1) Application.--No grant may be made under this section 
        unless an application has been submitted to, and approved by, 
        the Secretary. Such application shall be in such form, 
        submitted in such manner, and contain such information, as the 
        Secretary shall by regulation prescribe pursuant to this Act. 
        The Secretary shall give a preference to applications submitted 
        by Tribal Health Programs or urban Indian organizations.
            ``(2) Amount of grants; payment.--The amount of a grant 
        under this section shall be determined by the Secretary. 
        Payments pursuant to this section may be made in advance or by 
        way of reimbursement, and at such intervals and on such 
        conditions as provided for in regulations issued pursuant to 
        this Act. To the extent not otherwise prohibited by law, grants 
        shall be for 3 years, as provided in regulations issued 
        pursuant to this Act.

``SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP PROGRAM FOR 
              INDIANS.

    ``(a) Scholarships Authorized.--The Secretary, acting through the 
Service, shall provide scholarship grants to Indians who--
            ``(1) have successfully completed their high school 
        education or high school equivalency; and
            ``(2) have demonstrated the potential to successfully 
        complete courses of study in the health professions.
    ``(b) Purposes.--Scholarship grants provided pursuant to this 
section shall be for the following purposes:
            ``(1) Compensatory preprofessional education of any 
        recipient, such scholarship not to exceed 2 years on a full-
        time basis (or the part-time equivalent thereof, as determined 
        by the Secretary pursuant to regulations issued under this 
        Act).
            ``(2) Pregraduate education of any recipient leading to a 
        baccalaureate degree in an approved course of study preparatory 
        to a field of study in a health profession, such scholarship 
        not to exceed 4 years. An extension of up to 2 years (or the 
        part-time equivalent thereof, as determined by the Secretary 
        pursuant to regulations issued pursuant to this Act) may be 
        approved.
    ``(c) Other Conditions.--Scholarships under this section--
            ``(1) may cover costs of tuition, books, transportation, 
        board, and other necessary related expenses of a recipient 
        while attending school;
            ``(2) shall not be denied solely on the basis of the 
        applicant's scholastic achievement if such applicant has been 
        admitted to, or maintained good standing at, an accredited 
        institution; and
            ``(3) shall not be denied solely by reason of such 
        applicant's eligibility for assistance or benefits under any 
        other Federal program.

``SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.

    ``(a) In General.--
            ``(1) Authority.--The Secretary, acting through the 
        Service, shall make scholarship grants to Indians who are 
        enrolled full or part time in accredited schools pursuing 
        courses of study in the health professions. Such scholarships 
        shall be designated Indian Health Scholarships and shall be 
        made in accordance with section 338A of the Public Health 
        Services Act (42 U.S.C. 254l), except as provided in subsection 
        (b) of this section.
            ``(2) Determinations by secretary.--The Secretary, acting 
        through the Service, shall determine--
                    ``(A) who shall receive scholarship grants under 
                subsection (a); and
                    ``(B) the distribution of the scholarships among 
                health professions on the basis of the relative needs 
                of Indians for additional service in the health 
                professions.
            ``(3) Certain delegation not allowed.--The administration 
        of this section shall be a responsibility of the Assistant 
        Secretary and shall not be delegated in a contract or compact 
        under the Indian Self-Determination and Education Assistance 
        Act (25 U.S.C. 450 et seq.).
    ``(b) Active Duty Service Obligation.--
            ``(1) Obligation met.--The active duty service obligation 
        under a written contract with the Secretary under this section 
        that an Indian has entered into shall, if that individual is a 
        recipient of an Indian Health Scholarship, be met in full-time 
        practice equal to 1 year for each school year for which the 
        participant receives a scholarship award under this part, or 2 
        years, whichever is greater, by service in 1 or more of the 
        following:
                    ``(A) In an Indian Health Program.
                    ``(B) In a program assisted under title V of this 
                Act.
                    ``(C) In the private practice of the applicable 
                profession if, as determined by the Secretary, in 
                accordance with guidelines promulgated by the 
                Secretary, such practice is situated in a physician or 
                other health professional shortage area and addresses 
                the health care needs of a substantial number of 
                Indians.
                    ``(D) In a teaching capacity in a tribal college or 
                university nursing program (or a related health 
                profession program) if, as determined by the Secretary, 
                the health service provided to Indians would not 
                decrease.
            ``(2) Obligation deferred.--At the request of any 
        individual who has entered into a contract referred to in 
        paragraph (1) and who receives a degree in medicine (including 
        osteopathic or allopathic medicine), dentistry, optometry, 
        podiatry, or pharmacy, the Secretary shall defer the active 
        duty service obligation of that individual under that contract, 
        in order that such individual may complete any internship, 
        residency, or other advanced clinical training that is required 
        for the practice of that health profession, for an appropriate 
        period (in years, as determined by the Secretary), subject to 
        the following conditions:
                    ``(A) No period of internship, residency, or other 
                advanced clinical training shall be counted as 
                satisfying any period of obligated service under this 
                subsection.
                    ``(B) The active duty service obligation of that 
                individual shall commence not later than 90 days after 
                the completion of that advanced clinical training (or 
                by a date specified by the Secretary).
                    ``(C) The active duty service obligation will be 
                served in the health profession of that individual in a 
                manner consistent with paragraph (1).
                    ``(D) A recipient of a scholarship under this 
                section may, at the election of the recipient, meet the 
                active duty service obligation described in paragraph 
                (1) by service in a program specified under that 
                paragraph that--
                            ``(i) is located on the reservation of the 
                        Indian Tribe in which the recipient is 
                        enrolled; or
                            ``(ii) serves the Indian Tribe in which the 
                        recipient is enrolled.
            ``(3) Priority when making assignments.--Subject to 
        paragraph (2), the Secretary, in making assignments of Indian 
        Health Scholarship recipients required to meet the active duty 
        service obligation described in paragraph (1), shall give 
        priority to assigning individuals to service in those programs 
        specified in paragraph (1) that have a need for health 
        professionals to provide health care services as a result of 
        individuals having breached contracts entered into under this 
        section.
    ``(c) Part-Time Students.--In the case of an individual receiving a 
scholarship under this section who is enrolled part time in an approved 
course of study--
            ``(1) such scholarship shall be for a period of years not 
        to exceed the part-time equivalent of 4 years, as determined by 
        the Secretary;
            ``(2) the period of obligated service described in 
        subsection (b)(1) shall be equal to the greater of--
                    ``(A) the part-time equivalent of 1 year for each 
                year for which the individual was provided a 
                scholarship (as determined by the Secretary); or
                    ``(B) 2 years; and
            ``(3) the amount of the monthly stipend specified in 
        section 338A(g)(1)(B) of the Public Health Service Act (42 
        U.S.C. 254l(g)(1)(B)) shall be reduced pro rata (as determined 
        by the Secretary) based on the number of hours such student is 
        enrolled.
    ``(d) Breach of Contract.--
            ``(1) Specified breaches.--An individual shall be liable to 
        the United States for the amount which has been paid to the 
        individual, or on behalf of the individual, under a contract 
        entered into with the Secretary under this section on or after 
        the date of enactment of the Indian Health Care Improvement Act 
        Amendments of 2009 if that individual--
                    ``(A) fails to maintain an acceptable level of 
                academic standing in the educational institution in 
                which he or she is enrolled (such level determined by 
                the educational institution under regulations of the 
                Secretary);
                    ``(B) is dismissed from such educational 
                institution for disciplinary reasons;
                    ``(C) voluntarily terminates the training in such 
                an educational institution for which he or she is 
                provided a scholarship under such contract before the 
                completion of such training; or
                    ``(D) fails to accept payment, or instructs the 
                educational institution in which he or she is enrolled 
                not to accept payment, in whole or in part, of a 
                scholarship under such contract, in lieu of any service 
                obligation arising under such contract.
            ``(2) Other breaches.--If for any reason not specified in 
        paragraph (1) an individual breaches a written contract by 
        failing either to begin such individual's service obligation 
        required under such contract or to complete such service 
        obligation, the United States shall be entitled to recover from 
        the individual an amount determined in accordance with the 
        formula specified in subsection (l) of section 110 in the 
        manner provided for in such subsection.
            ``(3) Cancellation upon death of recipient.--Upon the death 
        of an individual who receives an Indian Health Scholarship, any 
        outstanding obligation of that individual for service or 
        payment that relates to that scholarship shall be canceled.
            ``(4) Waivers and suspensions.--
                    ``(A) In general.--The Secretary shall provide for 
                the partial or total waiver or suspension of any 
                obligation of service or payment of a recipient of an 
                Indian Health Scholarship if the Secretary determines 
                that--
                            ``(i) it is not possible for the recipient 
                        to meet that obligation or make that payment;
                            ``(ii) requiring that recipient to meet 
                        that obligation or make that payment would 
                        result in extreme hardship to the recipient; or
                            ``(iii) the enforcement of the requirement 
                        to meet the obligation or make the payment 
                        would be unconscionable.
                    ``(B) Factors for consideration.--When waiving or 
                suspending an obligation of service or payment under 
                subparagraph (A), the Secretary shall consult with the 
                Area Office, Indian Tribes, Tribal Organizations, or 
                urban Indian organizations affected to consider whether 
                the obligation may be satisfied in a teaching capacity 
                at a tribal college or university nursing program under 
                subsection (b)(1)(D).
            ``(5) Extreme hardship.--Notwithstanding any other 
        provision of law, in any case of extreme hardship or for other 
        good cause shown, the Secretary may waive, in whole or in part, 
        the right of the United States to recover funds made available 
        under this section.
            ``(6) Bankruptcy.--Notwithstanding any other provision of 
        law, with respect to a recipient of an Indian Health 
        Scholarship, no obligation for payment may be released by a 
        discharge in bankruptcy under title 11, United States Code, 
        unless that discharge is granted after the expiration of the 5-
        year period beginning on the initial date on which that payment 
        is due, and only if the bankruptcy court finds that the 
        nondischarge of the obligation would be unconscionable.

``SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.

    ``(a) Grants Authorized.--The Secretary, acting through the 
Service, shall make grants of not more than $300,000 to each of 9 
colleges and universities for the purpose of developing and maintaining 
Indian psychology career recruitment programs as a means of encouraging 
Indians to enter the behavioral health field. These programs shall be 
located at various locations throughout the country to maximize their 
availability to Indian students and new programs shall be established 
in different locations from time to time.
    ``(b) Quentin N. Burdick Program Grant.--The Secretary shall 
provide a grant authorized under subsection (a) to develop and maintain 
a program at the University of North Dakota to be known as the `Quentin 
N. Burdick American Indians Into Psychology Program'. Such program 
shall, to the maximum extent feasible, coordinate with the Quentin N. 
Burdick Indian Health Programs authorized under section 117(b), the 
Quentin N. Burdick American Indians Into Nursing Program authorized 
under section 115(e), and existing university research and 
communications networks.
    ``(c) Regulations.--The Secretary shall issue regulations pursuant 
to this Act for the competitive awarding of grants provided under this 
section.
    ``(d) Conditions of Grant.--Applicants under this section shall 
agree to provide a program which, at a minimum--
            ``(1) provides outreach and recruitment for health 
        professions to Indian communities including elementary, 
        secondary, and accredited and accessible community colleges 
        that will be served by the program;
            ``(2) incorporates a program advisory board comprised of 
        representatives from the tribes and communities that will be 
        served by the program;
            ``(3) provides summer enrichment programs to expose Indian 
        students to the various fields of psychology through research, 
        clinical, and experimental activities;
            ``(4) provides stipends to undergraduate and graduate 
        students to pursue a career in psychology;
            ``(5) develops affiliation agreements with tribal colleges 
        and universities, the Service, university affiliated programs, 
        and other appropriate accredited and accessible entities to 
        enhance the education of Indian students;
            ``(6) to the maximum extent feasible, uses existing 
        university tutoring, counseling, and student support services; 
        and
            ``(7) to the maximum extent feasible, employs qualified 
        Indians in the program.
    ``(e) Active Duty Service Requirement.--The active duty service 
obligation prescribed under section 338C of the Public Health Service 
Act (42 U.S.C. 254m) shall be met by each graduate who receives a 
stipend described in subsection (d)(4) that is funded under this 
section. Such obligation shall be met by service--
            ``(1) in an Indian Health Program;
            ``(2) in a program assisted under title V of this Act; or
            ``(3) in the private practice of psychology if, as 
        determined by the Secretary, in accordance with guidelines 
        promulgated by the Secretary, such practice is situated in a 
        physician or other health professional shortage area and 
        addresses the health care needs of a substantial number of 
        Indians.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $2,700,000 for each of fiscal 
years 2010 through 2025.

``SEC. 106. SCHOLARSHIP PROGRAMS FOR INDIAN TRIBES.

    ``(a) In General.--
            ``(1) Grants authorized.--The Secretary, acting through the 
        Service, shall make grants to Tribal Health Programs for the 
        purpose of providing scholarships for Indians to serve as 
        health professionals in Indian communities.
            ``(2) Amount.--Amounts available under paragraph (1) for 
        any fiscal year shall not exceed 5 percent of the amounts 
        available for each fiscal year for Indian Health Scholarships 
        under section 104.
            ``(3) Application.--An application for a grant under 
        paragraph (1) shall be in such form and contain such 
        agreements, assurances, and information as consistent with this 
        section.
    ``(b) Requirements.--
            ``(1) In general.--A Tribal Health Program receiving a 
        grant under subsection (a) shall provide scholarships to 
        Indians in accordance with the requirements of this section.
            ``(2) Costs.--With respect to costs of providing any 
        scholarship pursuant to subsection (a)--
                    ``(A) 80 percent of the costs of the scholarship 
                shall be paid from the funds made available pursuant to 
                subsection (a)(1) provided to the Tribal Health 
                Program; and
                    ``(B) 20 percent of such costs may be paid from any 
                other source of funds.
    ``(c) Course of Study.--A Tribal Health Program shall provide 
scholarships under this section only to Indians enrolled or accepted 
for enrollment in a course of study (approved by the Secretary) in 1 of 
the health professions contemplated by this Act.
    ``(d) Contract.--
            ``(1) In general.--In providing scholarships under 
        subsection (b), the Secretary and the Tribal Health Program 
        shall enter into a written contract with each recipient of such 
        scholarship.
            ``(2) Requirements.--Such contract shall--
                    ``(A) obligate such recipient to provide service in 
                an Indian Health Program or urban Indian organization, 
                in the same Service Area where the Tribal Health 
                Program providing the scholarship is located, for--
                            ``(i) a number of years for which the 
                        scholarship is provided (or the part-time 
                        equivalent thereof, as determined by the 
                        Secretary), or for a period of 2 years, 
                        whichever period is greater; or
                            ``(ii) such greater period of time as the 
                        recipient and the Tribal Health Program may 
                        agree;
                    ``(B) provide that the amount of the scholarship--
                            ``(i) may only be expended for--
                                    ``(I) tuition expenses, other 
                                reasonable educational expenses, and 
                                reasonable living expenses incurred in 
                                attendance at the educational 
                                institution; and
                                    ``(II) payment to the recipient of 
                                a monthly stipend of not more than the 
                                amount authorized by section 
                                338(g)(1)(B) of the Public Health 
                                Service Act (42 U.S.C. 254m(g)(1)(B)), 
                                with such amount to be reduced pro rata 
                                (as determined by the Secretary) based 
                                on the number of hours such student is 
                                enrolled, and not to exceed, for any 
                                year of attendance for which the 
                                scholarship is provided, the total 
                                amount required for the year for the 
                                purposes authorized in this clause; and
                            ``(ii) may not exceed, for any year of 
                        attendance for which the scholarship is 
                        provided, the total amount required for the 
                        year for the purposes authorized in clause (i);
                    ``(C) require the recipient of such scholarship to 
                maintain an acceptable level of academic standing as 
                determined by the educational institution in accordance 
                with regulations issued pursuant to this Act; and
                    ``(D) require the recipient of such scholarship to 
                meet the educational and licensure requirements 
                appropriate to each health profession.
            ``(3) Service in other service areas.--The contract may 
        allow the recipient to serve in another Service Area, provided 
        the Tribal Health Program and Secretary approve and services 
        are not diminished to Indians in the Service Area where the 
        Tribal Health Program providing the scholarship is located.
    ``(e) Breach of Contract.--
            ``(1) Specific breaches.--An individual who has entered 
        into a written contract with the Secretary and a Tribal Health 
        Program under subsection (d) shall be liable to the United 
        States for the Federal share of the amount which has been paid 
        to him or her, or on his or her behalf, under the contract if 
        that individual--
                    ``(A) fails to maintain an acceptable level of 
                academic standing in the educational institution in 
                which he or she is enrolled (such level as determined 
                by the educational institution under regulations of the 
                Secretary);
                    ``(B) is dismissed from such educational 
                institution for disciplinary reasons;
                    ``(C) voluntarily terminates the training in such 
                an educational institution for which he or she is 
                provided a scholarship under such contract before the 
                completion of such training; or
                    ``(D) fails to accept payment, or instructs the 
                educational institution in which he or she is enrolled 
                not to accept payment, in whole or in part, of a 
                scholarship under such contract, in lieu of any service 
                obligation arising under such contract.
            ``(2) Other breaches.--If for any reason not specified in 
        paragraph (1), an individual breaches a written contract by 
        failing to either begin such individual's service obligation 
        required under such contract or to complete such service 
        obligation, the United States shall be entitled to recover from 
        the individual an amount determined in accordance with the 
        formula specified in subsection (l) of section 110 in the 
        manner provided for in such subsection.
            ``(3) Cancellation upon death of recipient.--Upon the death 
        of an individual who receives an Indian Health Scholarship, any 
        outstanding obligation of that individual for service or 
        payment that relates to that scholarship shall be canceled.
            ``(4) Information.--The Secretary may carry out this 
        subsection on the basis of information received from Tribal 
        Health Programs involved or on the basis of information 
        collected through such other means as the Secretary deems 
        appropriate.
    ``(f) Relation to Social Security Act.--The recipient of a 
scholarship under this section shall agree, in providing health care 
pursuant to the requirements herein--
            ``(1) not to discriminate against an individual seeking 
        care on the basis of the ability of the individual to pay for 
        such care or on the basis that payment for such care will be 
        made pursuant to a program established in title XVIII of the 
        Social Security Act or pursuant to the programs established in 
        title XIX or title XXI of such Act; and
            ``(2) to accept assignment under section 1842(b)(3)(B)(ii) 
        of the Social Security Act for all services for which payment 
        may be made under part B of title XVIII of such Act, and to 
        enter into an appropriate agreement with the State agency that 
        administers the State plan for medical assistance under title 
        XIX, or the State child health plan under title XXI, of such 
        Act to provide service to individuals entitled to medical 
        assistance or child health assistance, respectively, under the 
        plan.
    ``(g) Continuance of Funding.--The Secretary shall make payments 
under this section to a Tribal Health Program for any fiscal year 
subsequent to the first fiscal year of such payments unless the 
Secretary determines that, for the immediately preceding fiscal year, 
the Tribal Health Program has not complied with the requirements of 
this section.

``SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS.

    ``(a) Employment Preference.--Any individual who receives a 
scholarship pursuant to section 104 or 106 shall be given preference 
for employment in the Service, or may be employed by a Tribal Health 
Program or an urban Indian organization, or other agencies of the 
Department as available, during any nonacademic period of the year.
    ``(b) Not Counted Toward Active Duty Service Obligation.--Periods 
of employment pursuant to this subsection shall not be counted in 
determining fulfillment of the service obligation incurred as a 
condition of the scholarship.
    ``(c) Timing; Length of Employment.--Any individual enrolled in a 
program, including a high school program, authorized under section 
102(a) may be employed by the Service or by a Tribal Health Program or 
an urban Indian organization during any nonacademic period of the year. 
Any such employment shall not exceed 120 days during any calendar year.
    ``(d) Nonapplicability of Competitive Personnel System.--Any 
employment pursuant to this section shall be made without regard to any 
competitive personnel system or agency personnel limitation and to a 
position which will enable the individual so employed to receive 
practical experience in the health profession in which he or she is 
engaged in study. Any individual so employed shall receive payment for 
his or her services comparable to the salary he or she would receive if 
he or she were employed in the competitive system. Any individual so 
employed shall not be counted against any employment ceiling affecting 
the Service or the Department.

``SEC. 108. CONTINUING EDUCATION ALLOWANCES.

    ``In order to encourage scholarship and stipend recipients under 
sections 104, 105, 106, and 115 and health professionals, including 
community health representatives and emergency medical technicians, to 
join or continue in an Indian Health Program and to provide their 
services in the rural and remote areas where a significant portion of 
Indians reside, the Secretary, acting through the Service, may--
            ``(1) provide programs or allowances to transition into an 
        Indian Health Program, including licensing, board or 
        certification examination assistance, and technical assistance 
        in fulfilling service obligations under sections 104, 105, 106, 
        and 115; and
            ``(2) provide programs or allowances to health 
        professionals employed in an Indian Health Program to enable 
        them for a period of time each year prescribed by regulation of 
        the Secretary to take leave of their duty stations for 
        professional consultation, management, leadership, and 
        refresher training courses.

``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.

    ``(a) In General.--Under the authority of the Act of November 2, 
1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), the 
Secretary, acting through the Service, shall maintain a Community 
Health Representative Program under which Indian Health Programs--
            ``(1) provide for the training of Indians as community 
        health representatives; and
            ``(2) use such community health representatives in the 
        provision of health care, health promotion, and disease 
        prevention services to Indian communities.
    ``(b) Duties.--The Community Health Representative Program of the 
Service, shall--
            ``(1) provide a high standard of training for community 
        health representatives to ensure that the community health 
        representatives provide quality health care, health promotion, 
        and disease prevention services to the Indian communities 
        served by the Program;
            ``(2) in order to provide such training, develop and 
        maintain a curriculum that--
                    ``(A) combines education in the theory of health 
                care with supervised practical experience in the 
                provision of health care; and
                    ``(B) provides instruction and practical experience 
                in health promotion and disease prevention activities, 
                with appropriate consideration given to lifestyle 
                factors that have an impact on Indian health status, 
                such as alcoholism, family dysfunction, and poverty;
            ``(3) maintain a system which identifies the needs of 
        community health representatives for continuing education in 
        health care, health promotion, and disease prevention and 
        develop programs that meet the needs for continuing education;
            ``(4) maintain a system that provides close supervision of 
        Community Health Representatives;
            ``(5) maintain a system under which the work of Community 
        Health Representatives is reviewed and evaluated; and
            ``(6) promote traditional health care practices of the 
        Indian Tribes served consistent with the Service standards for 
        the provision of health care, health promotion, and disease 
        prevention.

``SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM.

    ``(a) Establishment.--The Secretary, acting through the Service, 
shall establish and administer a program to be known as the Service 
Loan Repayment Program (hereinafter referred to as the `Loan Repayment 
Program') in order to ensure an adequate supply of trained health 
professionals necessary to maintain accreditation of, and provide 
health care services to Indians through, Indian Health Programs and 
urban Indian organizations.
    ``(b) Eligible Individuals.--To be eligible to participate in the 
Loan Repayment Program, an individual must--
            ``(1)(A) be enrolled--
                    ``(i) in a course of study or program in an 
                accredited educational institution (as determined by 
                the Secretary under section 338B(b)(1)(c)(i) of the 
                Public Health Service Act (42 U.S.C. 254l-
                1(b)(1)(c)(i))) and be scheduled to complete such 
                course of study in the same year such individual 
                applies to participate in such program; or
                    ``(ii) in an approved graduate training program in 
                a health profession; or
            ``(B) have--
                    ``(i) a degree in a health profession; and
                    ``(ii) a license to practice a health profession;
            ``(2)(A) be eligible for, or hold, an appointment as a 
        commissioned officer in the Regular or Reserve Corps of the 
        Public Health Service;
            ``(B) be eligible for selection for civilian service in the 
        Regular or Reserve Corps of the Public Health Service;
            ``(C) meet the professional standards for civil service 
        employment in the Service; or
            ``(D) be employed in an Indian Health Program or urban 
        Indian organization without a service obligation; and
            ``(3) submit to the Secretary an application for a contract 
        described in subsection (e).
    ``(c) Application.--
            ``(1) Information to be included with forms.--In 
        disseminating application forms and contract forms to 
        individuals desiring to participate in the Loan Repayment 
        Program, the Secretary shall include with such forms a fair 
        summary of the rights and liabilities of an individual whose 
        application is approved (and whose contract is accepted) by the 
        Secretary, including in the summary a clear explanation of the 
        damages to which the United States is entitled under subsection 
        (k) in the case of the individual's breach of contract. The 
        Secretary shall provide such individuals with sufficient 
        information regarding the advantages and disadvantages of 
        service as a commissioned officer in the Regular or Reserve 
        Corps of the Public Health Service or a civilian employee of 
        the Service to enable the individual to make a decision on an 
        informed basis.
            ``(2) Clear language.--The application form, contract form, 
        and all other information furnished by the Secretary under this 
        section shall be written in a manner calculated to be 
        understood by the average individual applying to participate in 
        the Loan Repayment Program.
            ``(3) Timely availability of forms.--The Secretary shall 
        make such application forms, contract forms, and other 
        information available to individuals desiring to participate in 
        the Loan Repayment Program on a date sufficiently early to 
        ensure that such individuals have adequate time to carefully 
        review and evaluate such forms and information.
    ``(d) Priorities.--
            ``(1) List.--Consistent with subsection (j), the Secretary 
        shall annually--
                    ``(A) identify the positions in each Indian Health 
                Program or urban Indian organization for which there is 
                a need or a vacancy; and
                    ``(B) rank those positions in order of priority.
            ``(2) Approvals.--Notwithstanding the priority determined 
        under paragraph (1), the Secretary, in determining which 
        applications under the Loan Repayment Program to approve (and 
        which contracts to accept), shall--
                    ``(A) give first priority to applications made by 
                individual Indians; and
                    ``(B) after making determinations on all 
                applications submitted by individual Indians as 
                required under subparagraph (A), give priority to--
                            ``(i) individuals recruited through the 
                        efforts of an Indian Health Program or urban 
                        Indian organization; and
                            ``(ii) other individuals based on the 
                        priority rankings under paragraph (1).
    ``(e) Recipient Contracts.--
            ``(1) Contract required.--An individual becomes a 
        participant in the Loan Repayment Program only upon the 
        Secretary and the individual entering into a written contract 
        described in paragraph (2).
            ``(2) Contents of contract.--The written contract referred 
        to in this section between the Secretary and an individual 
        shall contain--
                    ``(A) an agreement under which--
                            ``(i) subject to subparagraph (C), the 
                        Secretary agrees--
                                    ``(I) to pay loans on behalf of the 
                                individual in accordance with the 
                                provisions of this section; and
                                    ``(II) to accept (subject to the 
                                availability of appropriated funds for 
                                carrying out this section) the 
                                individual into the Service or place 
                                the individual with a Tribal Health 
                                Program or urban Indian organization as 
                                provided in clause (ii)(III); and
                            ``(ii) subject to subparagraph (C), the 
                        individual agrees--
                                    ``(I) to accept loan payments on 
                                behalf of the individual;
                                    ``(II) in the case of an individual 
                                described in subsection (b)(1)--
                                            ``(aa) to maintain 
                                        enrollment in a course of study 
                                        or training described in 
                                        subsection (b)(1)(A) until the 
                                        individual completes the course 
                                        of study or training; and
                                            ``(bb) while enrolled in 
                                        such course of study or 
                                        training, to maintain an 
                                        acceptable level of academic 
                                        standing (as determined under 
                                        regulations of the Secretary by 
                                        the educational institution 
                                        offering such course of study 
                                        or training); and
                                    ``(III) to serve for a time period 
                                (in this section referred to as the 
                                `period of obligated service') equal to 
                                2 years or such longer period as the 
                                individual may agree to serve in the 
                                full-time clinical practice of such 
                                individual's profession in an Indian 
                                Health Program or urban Indian 
                                organization to which the individual 
                                may be assigned by the Secretary;
                    ``(B) a provision permitting the Secretary to 
                extend for such longer additional periods, as the 
                individual may agree to, the period of obligated 
                service agreed to by the individual under subparagraph 
                (A)(ii)(III);
                    ``(C) a provision that any financial obligation of 
                the United States arising out of a contract entered 
                into under this section and any obligation of the 
                individual which is conditioned thereon is contingent 
                upon funds being appropriated for loan repayments under 
                this section;
                    ``(D) a statement of the damages to which the 
                United States is entitled under subsection (k) for the 
                individual's breach of the contract; and
                    ``(E) such other statements of the rights and 
                liabilities of the Secretary and of the individual, not 
                inconsistent with this section.
    ``(f) Deadline for Decision on Application.--The Secretary shall 
provide written notice to an individual within 21 days on--
            ``(1) the Secretary's approving, under subsection (e)(1), 
        of the individual's participation in the Loan Repayment 
        Program, including extensions resulting in an aggregate period 
        of obligated service in excess of 4 years; or
            ``(2) the Secretary's disapproving an individual's 
        participation in such Program.
    ``(g) Payments.--
            ``(1) In general.--A loan repayment provided for an 
        individual under a written contract under the Loan Repayment 
        Program shall consist of payment, in accordance with paragraph 
        (2), on behalf of the individual of the principal, interest, 
        and related expenses on government and commercial loans 
        received by the individual regarding the undergraduate or 
        graduate education of the individual (or both), which loans 
        were made for--
                    ``(A) tuition expenses;
                    ``(B) all other reasonable educational expenses, 
                including fees, books, and laboratory expenses, 
                incurred by the individual; and
                    ``(C) reasonable living expenses as determined by 
                the Secretary.
            ``(2) Amount.--For each year of obligated service that an 
        individual contracts to serve under subsection (e), the 
        Secretary may pay up to $35,000 or an amount equal to the 
        amount specified in section 338B(g)(2)(A) of the Public Health 
        Service Act, whichever is more, on behalf of the individual for 
        loans described in paragraph (1). In making a determination of 
        the amount to pay for a year of such service by an individual, 
        the Secretary shall consider the extent to which each such 
        determination--
                    ``(A) affects the ability of the Secretary to 
                maximize the number of contracts that can be provided 
                under the Loan Repayment Program from the amounts 
                appropriated for such contracts;
                    ``(B) provides an incentive to serve in Indian 
                Health Programs and urban Indian organizations with the 
                greatest shortages of health professionals; and
                    ``(C) provides an incentive with respect to the 
                health professional involved remaining in an Indian 
                Health Program or urban Indian organization with such a 
                health professional shortage, and continuing to provide 
                primary health services, after the completion of the 
                period of obligated service under the Loan Repayment 
                Program.
            ``(3) Timing.--Any arrangement made by the Secretary for 
        the making of loan repayments in accordance with this 
        subsection shall provide that any repayments for a year of 
        obligated service shall be made no later than the end of the 
        fiscal year in which the individual completes such year of 
        service.
            ``(4) Reimbursements for tax liability.--For the purpose of 
        providing reimbursements for tax liability resulting from a 
        payment under paragraph (2) on behalf of an individual, the 
        Secretary--
                    ``(A) in addition to such payments, may make 
                payments to the individual in an amount equal to not 
                less than 20 percent and not more than 39 percent of 
                the total amount of loan repayments made for the 
                taxable year involved; and
                    ``(B) may make such additional payments as the 
                Secretary determines to be appropriate with respect to 
                such purpose.
            ``(5) Payment schedule.--The Secretary may enter into an 
        agreement with the holder of any loan for which payments are 
        made under the Loan Repayment Program to establish a schedule 
        for the making of such payments.
    ``(h) Employment Ceiling.--Notwithstanding any other provision of 
law, individuals who have entered into written contracts with the 
Secretary under this section shall not be counted against any 
employment ceiling affecting the Department while those individuals are 
undergoing academic training.
    ``(i) Recruitment.--The Secretary shall conduct recruiting programs 
for the Loan Repayment Program and other manpower programs of the 
Service at educational institutions training health professionals or 
specialists identified in subsection (a).
    ``(j) Applicability of Law.--Section 214 of the Public Health 
Service Act (42 U.S.C. 215) shall not apply to individuals during their 
period of obligated service under the Loan Repayment Program.
    ``(k) Assignment of Individuals.--The Secretary, in assigning 
individuals to serve in Indian Health Programs or urban Indian 
organizations pursuant to contracts entered into under this section, 
shall--
            ``(1) ensure that the staffing needs of Tribal Health 
        Programs and urban Indian organizations receive consideration 
        on an equal basis with programs that are administered directly 
        by the Service; and
            ``(2) give priority to assigning individuals to Indian 
        Health Programs and urban Indian organizations that have a need 
        for health professionals to provide health care services as a 
        result of individuals having breached contracts entered into 
        under this section.
    ``(l) Breach of Contract.--
            ``(1) Specific breaches.--An individual who has entered 
        into a written contract with the Secretary under this section 
        and has not received a waiver under subsection (m) shall be 
        liable, in lieu of any service obligation arising under such 
        contract, to the United States for the amount which has been 
        paid on such individual's behalf under the contract if that 
        individual--
                    ``(A) is enrolled in the final year of a course of 
                study and--
                            ``(i) fails to maintain an acceptable level 
                        of academic standing in the educational 
                        institution in which he or she is enrolled 
                        (such level determined by the educational 
                        institution under regulations of the 
                        Secretary);
                            ``(ii) voluntarily terminates such 
                        enrollment; or
                            ``(iii) is dismissed from such educational 
                        institution before completion of such course of 
                        study; or
                    ``(B) is enrolled in a graduate training program 
                and fails to complete such training program.
            ``(2) Other breaches; formula for amount owed.--If, for any 
        reason not specified in paragraph (1), an individual breaches 
        his or her written contract under this section by failing 
        either to begin, or complete, such individual's period of 
        obligated service in accordance with subsection (e)(2), the 
        United States shall be entitled to recover from such individual 
        an amount to be determined in accordance with the following 
        formula: A=3Z(t-s/t) in which--
                    ``(A) `A' is the amount the United States is 
                entitled to recover;
                    ``(B) `Z' is the sum of the amounts paid under this 
                section to, or on behalf of, the individual and the 
                interest on such amounts which would be payable if, at 
                the time the amounts were paid, they were loans bearing 
                interest at the maximum legal prevailing rate, as 
                determined by the Secretary of the Treasury;
                    ``(C) `t' is the total number of months in the 
                individual's period of obligated service; and
                    ``(D) `s' is the number of months of such period 
                served by such individual in accordance with this 
                section.
            ``(3) Time period for repayment.--Any amount of damages 
        which the United States is entitled to recover under this 
        subsection shall be paid to the United States within the 1-year 
        period beginning on the date of the breach or such longer 
        period beginning on such date as shall be specified by the 
        Secretary.
            ``(4) Deductions in medicare payments.--Amounts not paid 
        within such period shall be subject to collection through 
        deductions in Medicare payments pursuant to section 1892 of the 
        Social Security Act.
            ``(5) Recovery of delinquency.--
                    ``(A) In general.--If damages described in 
                paragraph (4) are delinquent for 3 months, the 
                Secretary shall, for the purpose of recovering such 
                damages--
                            ``(i) use collection agencies contracted 
                        with by the Administrator of General Services; 
                        or
                            ``(ii) enter into contracts for the 
                        recovery of such damages with collection 
                        agencies selected by the Secretary.
                    ``(B) Report.--Each contract for recovering damages 
                pursuant to this subsection shall provide that the 
                contractor will, not less than once each 6 months, 
                submit to the Secretary a status report on the success 
                of the contractor in collecting such damages. Section 
                3718 of title 31, United States Code, shall apply to 
                any such contract to the extent not inconsistent with 
                this subsection.
    ``(m) Waiver or Suspension of Obligation.--
            ``(1) In general.--The Secretary shall by regulation 
        provide for the partial or total waiver or suspension of any 
        obligation of service or payment by an individual under the 
        Loan Repayment Program whenever compliance by the individual is 
        impossible or would involve extreme hardship to the individual 
        and if enforcement of such obligation with respect to any 
        individual would be unconscionable.
            ``(2) Canceled upon death.--Any obligation of an individual 
        under the Loan Repayment Program for service or payment of 
        damages shall be canceled upon the death of the individual.
            ``(3) Hardship waiver.--The Secretary may waive, in whole 
        or in part, the rights of the United States to recover amounts 
        under this section in any case of extreme hardship or other 
        good cause shown, as determined by the Secretary.
            ``(4) Bankruptcy.--Any obligation of an individual under 
        the Loan Repayment Program for payment of damages may be 
        released by a discharge in bankruptcy under title 11 of the 
        United States Code only if such discharge is granted after the 
        expiration of the 5-year period beginning on the first date 
        that payment of such damages is required, and only if the 
        bankruptcy court finds that nondischarge of the obligation 
        would be unconscionable.
    ``(n) Report.--The Secretary shall submit to the President, for 
inclusion in the report required to be submitted to Congress under 
section 801, a report concerning the previous fiscal year which sets 
forth by Service Area the following:
            ``(1) A list of the health professional positions 
        maintained by Indian Health Programs and urban Indian 
        organizations for which recruitment or retention is difficult.
            ``(2) The number of Loan Repayment Program applications 
        filed with respect to each type of health profession.
            ``(3) The number of contracts described in subsection (e) 
        that are entered into with respect to each health profession.
            ``(4) The amount of loan payments made under this section, 
        in total and by health profession.
            ``(5) The number of scholarships that are provided under 
        sections 104 and 106 with respect to each health profession.
            ``(6) The amount of scholarship grants provided under 
        sections 104 and 106, in total and by health profession.
            ``(7) The number of providers of health care that will be 
        needed by Indian Health Programs and urban Indian 
        organizations, by location and profession, during the 3 fiscal 
        years beginning after the date the report is filed.
            ``(8) The measures the Secretary plans to take to fill the 
        health professional positions maintained by Indian Health 
        Programs or urban Indian organizations for which recruitment or 
        retention is difficult.

``SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND.

    ``(a) Establishment.--There is established in the Treasury of the 
United States a fund to be known as the Indian Health Scholarship and 
Loan Repayment Recovery Fund (hereafter in this section referred to as 
the `LRRF'). The LRRF shall consist of such amounts as may be collected 
from individuals under section 104(d), section 106(e), and section 
110(l) for breach of contract, such funds as may be appropriated to the 
LRRF, and interest earned on amounts in the LRRF. All amounts 
collected, appropriated, or earned relative to the LRRF shall remain 
available until expended.
    ``(b) Use of Funds.--
            ``(1) By secretary.--Amounts in the LRRF may be expended by 
        the Secretary, acting through the Service, to make payments to 
        an Indian Health Program--
                    ``(A) to which a scholarship recipient under 
                section 104 and 106 or a loan repayment program 
                participant under section 110 has been assigned to meet 
                the obligated service requirements pursuant to such 
                sections; and
                    ``(B) that has a need for a health professional to 
                provide health care services as a result of such 
                recipient or participant having breached the contract 
                entered into under section 104, 106, or 110.
            ``(2) By tribal health programs.--A Tribal Health Program 
        receiving payments pursuant to paragraph (1) may expend the 
        payments to provide scholarships or recruit and employ, 
        directly or by contract, health professionals to provide health 
        care services.
    ``(c) Investment of Funds.--The Secretary of the Treasury shall 
invest such amounts of the LRRF as the Secretary of Health and Human 
Services determines are not required to meet current withdrawals from 
the LRRF. Such investments may be made only in interest bearing 
obligations of the United States. For such purpose, such obligations 
may be acquired on original issue at the issue price, or by purchase of 
outstanding obligations at the market price.
    ``(d) Sale of Obligations.--Any obligation acquired by the LRRF may 
be sold by the Secretary of the Treasury at the market price.

``SEC. 112. RECRUITMENT ACTIVITIES.

    ``(a) Reimbursement for Travel.--The Secretary, acting through the 
Service, may reimburse health professionals seeking positions with 
Indian Health Programs or urban Indian organizations, including 
individuals considering entering into a contract under section 110 and 
their spouses, for actual and reasonable expenses incurred in traveling 
to and from their places of residence to an area in which they may be 
assigned for the purpose of evaluating such area with respect to such 
assignment.
    ``(b) Recruitment Personnel.--The Secretary, acting through the 
Service, shall assign 1 individual in each Area Office to be 
responsible on a full-time basis for recruitment activities.

``SEC. 113. INDIAN RECRUITMENT AND RETENTION PROGRAM.

    ``(a) In General.--The Secretary, acting through the Service, shall 
fund, on a competitive basis, innovative demonstration projects for a 
period not to exceed 3 years to enable Indian Health Programs and urban 
Indian organizations to recruit, place, and retain health professionals 
to meet their staffing needs.
    ``(b) Eligible Entities; Application.--Any Indian Health Program or 
Urban Indian organization may submit an application for funding of a 
project pursuant to this section.

``SEC. 114. ADVANCED TRAINING AND RESEARCH.

    ``(a) Demonstration Program.--The Secretary, acting through the 
Service, shall establish a demonstration project to enable health 
professionals who have worked in an Indian Health Program or urban 
Indian organization for a substantial period of time to pursue advanced 
training or research areas of study for which the Secretary determines 
a need exists.
    ``(b) Service Obligation.--An individual who participates in a 
program under subsection (a), where the educational costs are borne by 
the Service, shall incur an obligation to serve in an Indian Health 
Program or urban Indian organization for a period of obligated service 
equal to at least the period of time during which the individual 
participates in such program. In the event that the individual fails to 
complete such obligated service, the individual shall be liable to the 
United States for the period of service remaining. In such event, with 
respect to individuals entering the program after the date of enactment 
of the Indian Health Care Improvement Act Amendments of 2009, the 
United States shall be entitled to recover from such individual an 
amount to be determined in accordance with the formula specified in 
subsection (l) of section 110 in the manner provided for in such 
subsection.
    ``(c) Equal Opportunity for Participation.--Health professionals 
from Tribal Health Programs and urban Indian organizations shall be 
given an equal opportunity to participate in the program under 
subsection (a).

``SEC. 115. QUENTIN N. BURDICK AMERICAN INDIANS INTO NURSING PROGRAM.

    ``(a) Grants Authorized.--For the purpose of increasing the number 
of nurses, nurse midwives, and nurse practitioners who deliver health 
care services to Indians, the Secretary, acting through the Service, 
shall provide grants to the following:
            ``(1) Public or private schools of nursing.
            ``(2) Tribal colleges or universities.
            ``(3) Nurse midwife programs and advanced practice nurse 
        programs that are provided by any tribal college or university 
        accredited nursing program, or in the absence of such, any 
        other public or private institutions.
    ``(b) Use of Grants.--Grants provided under subsection (a) may be 
used for 1 or more of the following:
            ``(1) To recruit individuals for programs which train 
        individuals to be nurses, nurse midwives, or advanced practice 
        nurses.
            ``(2) To provide scholarships to Indians enrolled in such 
        programs that may pay the tuition charged for such program and 
        other expenses incurred in connection with such program, 
        including books, fees, room and board, and stipends for living 
        expenses.
            ``(3) To provide a program that encourages nurses, nurse 
        midwives, and advanced practice nurses to provide, or continue 
        to provide, health care services to Indians.
            ``(4) To provide a program that increases the skills of, 
        and provides continuing education to, nurses, nurse midwives, 
        and advanced practice nurses.
            ``(5) To provide any program that is designed to achieve 
        the purpose described in subsection (a).
    ``(c) Applications.--Each application for a grant under subsection 
(a) shall include such information as the Secretary may require to 
establish the connection between the program of the applicant and a 
health care facility that primarily serves Indians.
    ``(d) Preferences for Grant Recipients.--In providing grants under 
subsection (a), the Secretary shall extend a preference to the 
following:
            ``(1) Programs that provide a preference to Indians.
            ``(2) Programs that train nurse midwives or advanced 
        practice nurses.
            ``(3) Programs that are interdisciplinary.
            ``(4) Programs that are conducted in cooperation with a 
        program for gifted and talented Indian students.
            ``(5) Programs conducted by tribal colleges and 
        universities.
    ``(e) Quentin N. Burdick Program Grant.--The Secretary shall 
provide 1 of the grants authorized under subsection (a) to establish 
and maintain a program at the University of North Dakota to be known as 
the `Quentin N. Burdick American Indians Into Nursing Program'. Such 
program shall, to the maximum extent feasible, coordinate with the 
Quentin N. Burdick Indian Health Programs established under section 
117(b) and the Quentin N. Burdick American Indians Into Psychology 
Program established under section 105(b).
    ``(f) Active Duty Service Obligation.--The active duty service 
obligation prescribed under section 338C of the Public Health Service 
Act (42 U.S.C. 254m) shall be met by each individual who receives 
training or assistance described in paragraph (1) or (2) of subsection 
(b) that is funded by a grant provided under subsection (a). Such 
obligation shall be met by service--
            ``(1) in the Service;
            ``(2) in a program of an Indian Tribe or Tribal 
        Organization conducted under the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450 et seq.) (including 
        programs under agreements with the Bureau of Indian Affairs);
            ``(3) in a program assisted under title V of this Act;
            ``(4) in the private practice of nursing if, as determined 
        by the Secretary, in accordance with guidelines promulgated by 
        the Secretary, such practice is situated in a physician or 
        other health shortage area and addresses the health care needs 
        of a substantial number of Indians; or
            ``(5) in a teaching capacity in a tribal college or 
        university nursing program (or a related health profession 
        program) if, as determined by the Secretary, health services 
        provided to Indians would not decrease.

``SEC. 116. TRIBAL CULTURAL ORIENTATION.

    ``(a) Cultural Education of Employees.--The Secretary, acting 
through the Service, shall require that appropriate employees of the 
Service who serve Indian Tribes in each Service Area receive 
educational instruction in the history and culture of such Indian 
Tribes and their relationship to the Service.
    ``(b) Program.--In carrying out subsection (a), the Secretary shall 
establish a program which shall, to the extent feasible--
            ``(1) be developed in consultation with the affected Indian 
        Tribes, Tribal Organizations, and urban Indian organizations;
            ``(2) be carried out through tribal colleges or 
        universities;
            ``(3) include instruction in American Indian studies; and
            ``(4) describe the use and place of traditional health care 
        practices of the Indian Tribes in the Service Area.

``SEC. 117. INMED PROGRAM.

    ``(a) Grants Authorized.--The Secretary, acting through the 
Service, is authorized to provide grants to colleges and universities 
for the purpose of maintaining and expanding the Indian health careers 
recruitment program known as the `Indians Into Medicine Program' 
(hereinafter in this section referred to as `INMED') as a means of 
encouraging Indians to enter the health professions.
    ``(b) Quentin N. Burdick Grant.--The Secretary shall provide 1 of 
the grants authorized under subsection (a) to maintain the INMED 
program at the University of North Dakota, to be known as the `Quentin 
N. Burdick Indian Health Programs', unless the Secretary makes a 
determination, based upon program reviews, that the program is not 
meeting the purposes of this section. Such program shall, to the 
maximum extent feasible, coordinate with the Quentin N. Burdick 
American Indians Into Psychology Program established under section 
105(b) and the Quentin N. Burdick American Indians Into Nursing Program 
established under section 115.
    ``(c) Regulations.--The Secretary, pursuant to this Act, shall 
develop regulations to govern grants pursuant to this section.
    ``(d) Requirements.--Applicants for grants provided under this 
section shall agree to provide a program which--
            ``(1) provides outreach and recruitment for health 
        professions to Indian communities including elementary and 
        secondary schools and community colleges located on 
        reservations which will be served by the program;
            ``(2) incorporates a program advisory board comprised of 
        representatives from the Indian Tribes and Indian communities 
        which will be served by the program;
            ``(3) provides summer preparatory programs for Indian 
        students who need enrichment in the subjects of math and 
        science in order to pursue training in the health professions;
            ``(4) provides tutoring, counseling, and support to 
        students who are enrolled in a health career program of study 
        at the respective college or university; and
            ``(5) to the maximum extent feasible, employs qualified 
        Indians in the program.

``SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY COLLEGES.

    ``(a) Grants To Establish Programs.--
            ``(1) In general.--The Secretary, acting through the 
        Service, shall award grants to accredited and accessible 
        community colleges for the purpose of assisting such community 
        colleges in the establishment of programs which provide 
        education in a health profession leading to a degree or diploma 
        in a health profession for individuals who desire to practice 
        such profession on or near a reservation or in an Indian Health 
        Program.
            ``(2) Amount of grants.--The amount of any grant awarded to 
        a community college under paragraph (1) for the first year in 
        which such a grant is provided to the community college shall 
        not exceed $250,000.
    ``(b) Grants for Maintenance and Recruiting.--
            ``(1) In general.--The Secretary, acting through the 
        Service, shall award grants to accredited and accessible 
        community colleges that have established a program described in 
        subsection (a)(1) for the purpose of maintaining the program 
        and recruiting students for the program.
            ``(2) Requirements.--Grants may only be made under this 
        section to a community college which--
                    ``(A) is accredited;
                    ``(B) has a relationship with a hospital facility, 
                Service facility, or hospital that could provide 
                training of nurses or health professionals;
                    ``(C) has entered into an agreement with an 
                accredited college or university medical school, the 
                terms of which--
                            ``(i) provide a program that enhances the 
                        transition and recruitment of students into 
                        advanced baccalaureate or graduate programs 
                        that train health professionals; and
                            ``(ii) stipulate certifications necessary 
                        to approve internship and field placement 
                        opportunities at Indian Health Programs;
                    ``(D) has a qualified staff which has the 
                appropriate certifications;
                    ``(E) is capable of obtaining State or regional 
                accreditation of the program described in subsection 
                (a)(1); and
                    ``(F) agrees to provide for Indian preference for 
                applicants for programs under this section.
    ``(c) Technical Assistance.--The Secretary shall encourage 
community colleges described in subsection (b)(2) to establish and 
maintain programs described in subsection (a)(1) by--
            ``(1) entering into agreements with such colleges for the 
        provision of qualified personnel of the Service to teach 
        courses of study in such programs; and
            ``(2) providing technical assistance and support to such 
        colleges.
    ``(d) Advanced Training.--
            ``(1) Required.--Any program receiving assistance under 
        this section that is conducted with respect to a health 
        profession shall also offer courses of study which provide 
        advanced training for any health professional who--
                    ``(A) has already received a degree or diploma in 
                such health profession; and
                    ``(B) provides clinical services on or near a 
                reservation or for an Indian Health Program.
            ``(2) May be offered at alternate site.--Such courses of 
        study may be offered in conjunction with the college or 
        university with which the community college has entered into 
        the agreement required under subsection (b)(2)(C).
    ``(e) Priority.--Where the requirements of subsection (b) are met, 
grant award priority shall be provided to tribal colleges and 
universities in Service Areas where they exist.

``SEC. 119. RETENTION BONUS.

    ``(a) Bonus Authorized.--The Secretary may pay a retention bonus to 
any health professional employed by, or assigned to, and serving in, an 
Indian Health Program or urban Indian organization either as a civilian 
employee or as a commissioned officer in the Regular or Reserve Corps 
of the Public Health Service who--
            ``(1) is assigned to, and serving in, a position for which 
        recruitment or retention of personnel is difficult;
            ``(2) the Secretary determines is needed by Indian Health 
        Programs and urban Indian organizations;
            ``(3) has--
                    ``(A) completed 2 years of employment with an 
                Indian Health Program or urban Indian organization; or
                    ``(B) completed any service obligations incurred as 
                a requirement of--
                            ``(i) any Federal scholarship program; or
                            ``(ii) any Federal education loan repayment 
                        program; and
            ``(4) enters into an agreement with an Indian Health 
        Program or urban Indian organization for continued employment 
        for a period of not less than 1 year.
    ``(b) Rates.--The Secretary may establish rates for the retention 
bonus which shall provide for a higher annual rate for multiyear 
agreements than for single year agreements referred to in subsection 
(a)(4), but in no event shall the annual rate be more than $25,000 per 
annum.
    ``(c) Default of Retention Agreement.--Any health professional 
failing to complete the agreed upon term of service, except where such 
failure is through no fault of the individual, shall be obligated to 
refund to the Government the full amount of the retention bonus for the 
period covered by the agreement, plus interest as determined by the 
Secretary in accordance with section 110(l)(2)(B).
    ``(d) Other Retention Bonus.--The Secretary may pay a retention 
bonus to any health professional employed by a Tribal Health Program if 
such health professional is serving in a position which the Secretary 
determines is--
            ``(1) a position for which recruitment or retention is 
        difficult; and
            ``(2) necessary for providing health care services to 
        Indians.

``SEC. 120. NURSING RESIDENCY PROGRAM.

    ``(a) Establishment of Program.--The Secretary, acting through the 
Service, shall establish a program to enable Indians who are licensed 
practical nurses, licensed vocational nurses, and registered nurses who 
are working in an Indian Health Program or urban Indian organization, 
and have done so for a period of not less than 1 year, to pursue 
advanced training. Such program shall include a combination of 
education and work study in an Indian Health Program or urban Indian 
organization leading to an associate or bachelor's degree (in the case 
of a licensed practical nurse or licensed vocational nurse), a 
bachelor's degree (in the case of a registered nurse), or advanced 
degrees or certifications in nursing and public health.
    ``(b) Service Obligation.--An individual who participates in a 
program under subsection (a), where the educational costs are paid by 
the Service, shall incur an obligation to serve in an Indian Health 
Program or urban Indian organization for a period of obligated service 
equal to 1 year for every year that nonprofessional employee (licensed 
practical nurses, licensed vocational nurses, nursing assistants, and 
various health care technicians), or 2 years for every year that 
professional nurse (associate degree and bachelor-prepared registered 
nurses), participates in such program. In the event that the individual 
fails to complete such obligated service, the United States shall be 
entitled to recover from such individual an amount determined in 
accordance with the formula specified in subsection (l) of section 110 
in the manner provided for in such subsection.

``SEC. 121. COMMUNITY HEALTH AIDE PROGRAM.

    ``(a) General Purposes of Program.--Under the authority of the Act 
of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder 
Act'), the Secretary, acting through the Service, shall develop and 
operate a Community Health Aide Program in Alaska under which the 
Service--
            ``(1) provides for the training of Alaska Natives as health 
        aides or community health practitioners;
            ``(2) uses such aides or practitioners in the provision of 
        health care, health promotion, and disease prevention services 
        to Alaska Natives living in villages in rural Alaska; and
            ``(3) provides for the establishment of teleconferencing 
        capacity in health clinics located in or near such villages for 
        use by community health aides or community health 
        practitioners.
    ``(b) Specific Program Requirements.--The Secretary, acting through 
the Community Health Aide Program of the Service, shall--
            ``(1) using trainers accredited by the Program, provide a 
        high standard of training to community health aides and 
        community health practitioners to ensure that such aides and 
        practitioners provide quality health care, health promotion, 
        and disease prevention services to the villages served by the 
        Program;
            ``(2) in order to provide such training, develop a 
        curriculum that--
                    ``(A) combines education in the theory of health 
                care with supervised practical experience in the 
                provision of health care;
                    ``(B) provides instruction and practical experience 
                in the provision of acute care, emergency care, health 
                promotion, disease prevention, and the efficient and 
                effective management of clinic pharmacies, supplies, 
                equipment, and facilities; and
                    ``(C) promotes the achievement of the health status 
                objectives specified in section 3(2);
            ``(3) establish and maintain a Community Health Aide 
        Certification Board to certify as community health aides or 
        community health practitioners individuals who have 
        successfully completed the training described in paragraph (1) 
        or can demonstrate equivalent experience;
            ``(4) develop and maintain a system which identifies the 
        needs of community health aides and community health 
        practitioners for continuing education in the provision of 
        health care, including the areas described in paragraph (2)(B), 
        and develop programs that meet the needs for such continuing 
        education;
            ``(5) develop and maintain a system that provides close 
        supervision of community health aides and community health 
        practitioners;
            ``(6) develop a system under which the work of community 
        health aides and community health practitioners is reviewed and 
        evaluated to assure the provision of quality health care, 
        health promotion, and disease prevention services; and
            ``(7) ensure that pulpal therapy (not including pulpotomies 
        on deciduous teeth) or extraction of adult teeth can be 
        performed by a dental health aide therapist only after 
        consultation with a licensed dentist who determines that the 
        procedure is a medical emergency that cannot be resolved with 
        palliative treatment, and further that dental health aide 
        therapists are strictly prohibited from performing all other 
        oral or jaw surgeries, provided that uncomplicated extractions 
        shall not be considered oral surgery under this section.
    ``(c) Program Review.--
            ``(1) Neutral panel.--
                    ``(A) Establishment.--The Secretary, acting through 
                the Service, shall establish a neutral panel to carry 
                out the study under paragraph (2).
                    ``(B) Membership.--Members of the neutral panel 
                shall be appointed by the Secretary from among 
                clinicians, economists, community practitioners, oral 
                epidemiologists, and Alaska Natives.
            ``(2) Study.--
                    ``(A) In general.--The neutral panel established 
                under paragraph (1) shall conduct a study of the dental 
                health aide therapist services provided by the 
                Community Health Aide Program under this section to 
                ensure that the quality of care provided through those 
                services is adequate and appropriate.
                    ``(B) Parameters of study.--The Secretary, in 
                consultation with interested parties, including 
                professional dental organizations, shall develop the 
                parameters of the study.
                    ``(C) Inclusions.--The study shall include a 
                determination by the neutral panel with respect to--
                            ``(i) the ability of the dental health aide 
                        therapist services under this section to 
                        address the dental care needs of Alaska 
                        Natives;
                            ``(ii) the quality of care provided through 
                        those services, including any training, 
                        improvement, or additional oversight required 
                        to improve the quality of care; and
                            ``(iii) whether safer and less costly 
                        alternatives to the dental health aide 
                        therapist services exist.
                    ``(D) Consultation.--In carrying out the study 
                under this paragraph, the neutral panel shall consult 
                with Alaska Tribal Organizations with respect to the 
                adequacy and accuracy of the study.
            ``(3) Report.--The neutral panel shall submit to the 
        Secretary, the Committee on Indian Affairs of the Senate, and 
        the Committee on Natural Resources of the House of 
        Representatives a report describing the results of the study 
        under paragraph (2), including a description of--
                    ``(A) any determination of the neutral panel under 
                paragraph (2)(C); and
                    ``(B) any comments received from an Alaska Tribal 
                Organization under paragraph (2)(D).
    ``(d) Nationalization of Program.--
            ``(1) In general.--Except as provided in paragraph (2), the 
        Secretary, acting through the Service, may establish a national 
        Community Health Aide Program in accordance with the program 
        under this section, as the Secretary determines to be 
        appropriate.
            ``(2) Exception.--The national Community Health Aide 
        Program under paragraph (1) shall not include dental health 
        aide therapist services.
            ``(3) Requirement.--In establishing a national program 
        under paragraph (1), the Secretary shall not reduce the amount 
        of funds provided for the Community Health Aide Program 
        described in subsections (a) and (b).

``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.

    ``The Secretary shall, by contract or otherwise, provide training 
for individuals in the administration and planning of Tribal Health 
Programs, with priority to Indians.

``SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION 
              PROGRAMS.

    ``(a) Demonstration Programs Authorized.--The Secretary, acting 
through the Service, may fund demonstration programs for Tribal Health 
Programs to address the chronic shortages of health professionals.
    ``(b) Purposes of Programs.--The purposes of demonstration programs 
funded under subsection (a) shall be--
            ``(1) to provide direct clinical and practical experience 
        at a Service Unit to health profession students and residents 
        from medical schools;
            ``(2) to improve the quality of health care for Indians by 
        assuring access to qualified health care professionals; and
            ``(3) to provide academic and scholarly opportunities for 
        health professionals serving Indians by identifying all 
        academic and scholarly resources of the region.
    ``(c) Advisory Board.--The demonstration programs established 
pursuant to subsection (a) shall incorporate a program advisory board 
composed of representatives from the Indian Tribes and Indian 
communities in the area which will be served by the program.

``SEC. 124. NATIONAL HEALTH SERVICE CORPS.

    ``(a) No Reduction in Services.--The Secretary shall not--
            ``(1) remove a member of the National Health Service Corps 
        from an Indian Health Program or urban Indian organization; or
            ``(2) withdraw funding used to support such member, unless 
        the Secretary, acting through the Service, has ensured that the 
        Indians receiving services from such member will experience no 
        reduction in services.
    ``(b) Treatment of Indian Health Programs.--At the request of an 
Indian Health Program, the services of a member of the National Health 
Service Corps assigned to an Indian Health Program may be limited to 
the persons who are eligible for services from such Program.

``SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL CURRICULA 
              DEMONSTRATION PROGRAMS.

    ``(a) Contracts and Grants.--The Secretary, acting through the 
Service, may enter into contracts with, or make grants to, accredited 
tribal colleges and universities and eligible accredited and accessible 
community colleges to establish demonstration programs to develop 
educational curricula for substance abuse counseling.
    ``(b) Use of Funds.--Funds provided under this section shall be 
used only for developing and providing educational curriculum for 
substance abuse counseling (including paying salaries for instructors). 
Such curricula may be provided through satellite campus programs.
    ``(c) Time Period of Assistance; Renewal.--A contract entered into 
or a grant provided under this section shall be for a period of 3 
years. Such contract or grant may be renewed for an additional 2-year 
period upon the approval of the Secretary.
    ``(d) Criteria for Review and Approval of Applications.--Not later 
than 180 days after the date of enactment of the Indian Health Care 
Improvement Act Amendments of 2009, the Secretary, after consultation 
with Indian Tribes and administrators of tribal colleges and 
universities and eligible accredited and accessible community colleges, 
shall develop and issue criteria for the review and approval of 
applications for funding (including applications for renewals of 
funding) under this section. Such criteria shall ensure that 
demonstration programs established under this section promote the 
development of the capacity of such entities to educate substance abuse 
counselors.
    ``(e) Assistance.--The Secretary shall provide such technical and 
other assistance as may be necessary to enable grant recipients to 
comply with the provisions of this section.
    ``(f) Report.--Each fiscal year, the Secretary shall submit to the 
President, for inclusion in the report which is required to be 
submitted under section 801 for that fiscal year, a report on the 
findings and conclusions derived from the demonstration programs 
conducted under this section during that fiscal year.
    ``(g) Definition.--For the purposes of this section, the term 
`educational curriculum' means 1 or more of the following:
            ``(1) Classroom education.
            ``(2) Clinical work experience.
            ``(3) Continuing education workshops.

``SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMUNITY EDUCATION 
              PROGRAMS.

    ``(a) Study; List.--The Secretary, acting through the Service, and 
the Secretary of the Interior, in consultation with Indian Tribes and 
Tribal Organizations, shall conduct a study and compile a list of the 
types of staff positions specified in subsection (b) whose 
qualifications include, or should include, training in the 
identification, prevention, education, referral, or treatment of mental 
illness, or dysfunctional and self-destructive behavior.
    ``(b) Positions.--The positions referred to in subsection (a) are--
            ``(1) staff positions within the Bureau of Indian Affairs, 
        including existing positions, in the fields of--
                    ``(A) elementary and secondary education;
                    ``(B) social services and family and child welfare;
                    ``(C) law enforcement and judicial services; and
                    ``(D) alcohol and substance abuse;
            ``(2) staff positions within the Service; and
            ``(3) staff positions similar to those identified in 
        paragraphs (1) and (2) established and maintained by Indian 
        Tribes, Tribal Organizations (without regard to the funding 
        source), and urban Indian organizations.
    ``(c) Training Criteria.--
            ``(1) In general.--The appropriate Secretary shall provide 
        training criteria appropriate to each type of position 
        identified in subsection (b)(1) and (b)(2) and ensure that 
        appropriate training has been, or shall be provided to any 
        individual in any such position. With respect to any such 
        individual in a position identified pursuant to subsection 
        (b)(3), the respective Secretaries shall provide appropriate 
        training to, or provide funds to, an Indian Tribe, Tribal 
        Organization, or urban Indian organization for training of 
        appropriate individuals. In the case of positions funded under 
        a contract or compact under the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450 et seq.), the 
        appropriate Secretary shall ensure that such training costs are 
        included in the contract or compact, as the Secretary 
        determines necessary.
            ``(2) Position specific training criteria.--Position 
        specific training criteria shall be culturally relevant to 
        Indians and Indian Tribes and shall ensure that appropriate 
        information regarding traditional health care practices is 
        provided.
    ``(d) Community Education on Mental Illness.--The Service shall 
develop and implement, on request of an Indian Tribe, Tribal 
Organization, or urban Indian organization, or assist the Indian Tribe, 
Tribal Organization, or urban Indian organization to develop and 
implement, a program of community education on mental illness. In 
carrying out this subsection, the Service shall, upon request of an 
Indian Tribe, Tribal Organization, or urban Indian organization, 
provide technical assistance to the Indian Tribe, Tribal Organization, 
or urban Indian organization to obtain and develop community 
educational materials on the identification, prevention, referral, and 
treatment of mental illness and dysfunctional and self-destructive 
behavior.
    ``(e) Plan.--Not later than 90 days after the date of enactment of 
the Indian Health Care Improvement Act Amendments of 2009, the 
Secretary shall develop a plan under which the Service will increase 
the health care staff providing behavioral health services by at least 
500 positions within 5 years after the date of enactment of this 
section, with at least 200 of such positions devoted to child, 
adolescent, and family services. The plan developed under this 
subsection shall be implemented under the Act of November 2, 1921 (25 
U.S.C. 13) (commonly known as the `Snyder Act').

``SEC. 127. EXEMPTION FROM PAYMENT OF CERTAIN FEES.

    ``Employees of a Tribal Health Program or an Urban Indian 
Organization shall be exempt from payment of licensing, registraion, 
and other fees imposed by a Federal agency to the same extent that 
Commissioned Corps Officers or other employees of the Indian Health 
Service are exempt from such fees.

``SEC. 128. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2025 to carry out 
this title.

                      ``TITLE II--HEALTH SERVICES

``SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.

    ``(a) Use of Funds.--The Secretary, acting through the Service, is 
authorized to expend funds, directly or under the authority of the 
Indian Self-Determination and Education Assistance Act (25 U.S.C. 450 
et seq.), which are appropriated under the authority of this section, 
for the purposes of--
            ``(1) eliminating the deficiencies in health status and 
        health resources of all Indian Tribes;
            ``(2) eliminating backlogs in the provision of health care 
        services to Indians;
            ``(3) meeting the health needs of Indians in an efficient 
        and equitable manner, including the use of telehealth and 
        telemedicine when appropriate;
            ``(4) eliminating inequities in funding for both direct 
        care and contract health service programs; and
            ``(5) augmenting the ability of the Service to meet the 
        following health service responsibilities with respect to those 
        Indian Tribes with the highest levels of health status 
        deficiencies and resource deficiencies:
                    ``(A) Clinical care, including inpatient care, 
                outpatient care (including audiology, clinical eye, and 
                vision care), primary care, secondary and tertiary 
                care, and long-term care.
                    ``(B) Preventive health, including mammography and 
                other cancer screening in accordance with section 207.
                    ``(C) Dental care.
                    ``(D) Mental health, including community mental 
                health services, inpatient mental health services, 
                dormitory mental health services, therapeutic and 
                residential treatment centers, and training of 
                traditional health care practitioners.
                    ``(E) Emergency medical services.
                    ``(F) Treatment and control of, and rehabilitative 
                care related to, alcoholism and drug abuse (including 
                fetal alcohol syndrome) among Indians.
                    ``(G) Injury prevention programs, including data 
                collection and evaluation, demonstration projects, 
                training, and capacity building.
                    ``(H) Home health care.
                    ``(I) Community health representatives.
                    ``(J) Maintenance and improvement.
    ``(b) No Offset or Limitation.--Any funds appropriated under the 
authority of this section shall not be used to offset or limit any 
other appropriations made to the Service under this Act or the Act of 
November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), 
or any other provision of law.
    ``(c) Allocation; Use.--
            ``(1) In general.--Funds appropriated under the authority 
        of this section shall be allocated to Service Units, Indian 
        Tribes, or Tribal Organizations. The funds allocated to each 
        Indian Tribe, Tribal Organization, or Service Unit under this 
        paragraph shall be used by the Indian Tribe, Tribal 
        Organization, or Service Unit under this paragraph to improve 
        the health status and reduce the resource deficiency of each 
        Indian Tribe served by such Service Unit, Indian Tribe, or 
        Tribal Organization.
            ``(2) Apportionment of allocated funds.--The apportionment 
        of funds allocated to a Service Unit, Indian Tribe, or Tribal 
        Organization under paragraph (1) among the health service 
        responsibilities described in subsection (a)(5) shall be 
        determined by the Service in consultation with, and with the 
        active participation of, the affected Indian Tribes and Tribal 
        Organizations.
    ``(d) Provisions Relating to Health Status and Resource 
Deficiencies.--For the purposes of this section, the following 
definitions apply:
            ``(1) Definition.--The term `health status and resource 
        deficiency' means the extent to which--
                    ``(A) the health status objectives set forth in 
                section 3(2) are not being achieved; and
                    ``(B) the Indian Tribe or Tribal Organization does 
                not have available to it the health resources it needs, 
                taking into account the actual cost of providing health 
                care services given local geographic, climatic, rural, 
                or other circumstances.
            ``(2) Available resources.--The health resources available 
        to an Indian Tribe or Tribal Organization include health 
        resources provided by the Service as well as health resources 
        used by the Indian Tribe or Tribal Organization, including 
        services and financing systems provided by any Federal 
        programs, private insurance, and programs of State or local 
        governments.
            ``(3) Process for review of determinations.--The Secretary 
        shall establish procedures which allow any Indian Tribe or 
        Tribal Organization to petition the Secretary for a review of 
        any determination of the extent of the health status and 
        resource deficiency of such Indian Tribe or Tribal 
        Organization.
    ``(e) Eligibility for Funds.--Tribal Health Programs shall be 
eligible for funds appropriated under the authority of this section on 
an equal basis with programs that are administered directly by the 
Service.
    ``(f) Report.--By no later than the date that is 3 years after the 
date of enactment of the Indian Health Care Improvement Act Amendments 
of 2009, the Secretary shall submit to Congress the current health 
status and resource deficiency report of the Service for each Service 
Unit, including newly recognized or acknowledged Indian Tribes. Such 
report shall set out--
            ``(1) the methodology then in use by the Service for 
        determining Tribal health status and resource deficiencies, as 
        well as the most recent application of that methodology;
            ``(2) the extent of the health status and resource 
        deficiency of each Indian Tribe served by the Service or a 
        Tribal Health Program;
            ``(3) the amount of funds necessary to eliminate the health 
        status and resource deficiencies of all Indian Tribes served by 
        the Service or a Tribal Health Program; and
            ``(4) an estimate of--
                    ``(A) the amount of health service funds 
                appropriated under the authority of this Act, or any 
                other Act, including the amount of any funds 
                transferred to the Service for the preceding fiscal 
                year which is allocated to each Service Unit, Indian 
                Tribe, or Tribal Organization;
                    ``(B) the number of Indians eligible for health 
                services in each Service Unit or Indian Tribe or Tribal 
                Organization; and
                    ``(C) the number of Indians using the Service 
                resources made available to each Service Unit, Indian 
                Tribe or Tribal Organization, and, to the extent 
                available, information on the waiting lists and number 
                of Indians turned away for services due to lack of 
                resources.
    ``(g) Inclusion in Base Budget.--Funds appropriated under this 
section for any fiscal year shall be included in the base budget of the 
Service for the purpose of determining appropriations under this 
section in subsequent fiscal years.
    ``(h) Clarification.--Nothing in this section is intended to 
diminish the primary responsibility of the Service to eliminate 
existing backlogs in unmet health care needs, nor are the provisions of 
this section intended to discourage the Service from undertaking 
additional efforts to achieve equity among Indian Tribes and Tribal 
Organizations.
    ``(i) Funding Designation.--Any funds appropriated under the 
authority of this section shall be designated as the `Indian Health 
Care Improvement Fund'.

``SEC. 202. HEALTH PROMOTION AND DISEASE PREVENTION SERVICES.

    ``(a) Findings.--Congress finds that health promotion and disease 
prevention activities--
            ``(1) improve the health and well-being of Indians; and
            ``(2) reduce the expenses for health care of Indians.
    ``(b) Provision of Services.--The Secretary, acting through the 
Service, shall provide health promotion and disease prevention services 
to Indians to achieve the health status objectives set forth in section 
3(2).
    ``(c) Evaluation.--The Secretary, after obtaining input from the 
affected Tribal Health Programs, shall submit to the President for 
inclusion in the report which is required to be submitted to Congress 
under section 801 an evaluation of--
            ``(1) the health promotion and disease prevention needs of 
        Indians;
            ``(2) the health promotion and disease prevention 
        activities which would best meet such needs;
            ``(3) the internal capacity of the Service and Tribal 
        Health Programs to meet such needs; and
            ``(4) the resources which would be required to enable the 
        Service and Tribal Health Programs to undertake the health 
        promotion and disease prevention activities necessary to meet 
        such needs.

``SEC. 203. DIABETES PREVENTION, TREATMENT, AND CONTROL.

    ``(a) Determinations Regarding Diabetes.--The Secretary, acting 
through the Service, and in consultation with Indian Tribes and Tribal 
Organizations, shall determine--
            ``(1) by Indian Tribe and by Service Unit, the incidence 
        of, and the types of complications resulting from, diabetes 
        among Indians; and
            ``(2) based on the determinations made pursuant to 
        paragraph (1), the measures (including patient education and 
        effective ongoing monitoring of disease indicators) each 
        Service Unit should take to reduce the incidence of, and 
        prevent, treat, and control the complications resulting from, 
        diabetes among Indian Tribes within that Service Unit.
    ``(b) Diabetes Screening.--To the extent medically indicated and 
with informed consent, the Secretary shall screen each Indian who 
receives services from the Service for diabetes and for conditions 
which indicate a high risk that the individual will become diabetic and 
establish a cost-effective approach to ensure ongoing monitoring of 
disease indicators. Such screening and monitoring may be conducted by a 
Tribal Health Program and may be conducted through appropriate 
Internet-based health care management programs.
    ``(c) Diabetes Projects.--The Secretary shall continue to maintain 
each model diabetes project in existence on the date of enactment of 
the Indian Health Care Improvement Act Amendments of 2009.
    ``(d) Dialysis Programs.--The Secretary is authorized to provide, 
through the Service, Indian Tribes, and Tribal Organizations, dialysis 
programs, including the purchase of dialysis equipment and the 
provision of necessary staffing.
    ``(e) Other Duties of the Secretary.--
            ``(1) In general.--The Secretary shall, to the extent 
        funding is available--
                    ``(A) in each Area Office, consult with Indian 
                Tribes and Tribal Organizations regarding programs for 
                the prevention, treatment, and control of diabetes;
                    ``(B) establish in each Area Office a registry of 
                patients with diabetes to track the incidence of 
                diabetes and the complications from diabetes in that 
                area; and
                    ``(C) ensure that data collected in each Area 
                Office regarding diabetes and related complications 
                among Indians are disseminated to all other Area 
                Offices, subject to applicable patient privacy laws.
            ``(2) Diabetes control officers.--
                    ``(A) In general.--The Secretary may establish and 
                maintain in each Area Office a position of diabetes 
                control officer to coordinate and manage any activity 
                of that Area Office relating to the prevention, 
                treatment, or control of diabetes to assist the 
                Secretary in carrying out a program under this section 
                or section 330C of the Public Health Service Act (42 
                U.S.C. 254c-3).
                    ``(B) Certain activities.--Any activity carried out 
                by a diabetes control officer under subparagraph (A) 
                that is the subject of a contract or compact under the 
                Indian Self-Determination and Education Assistance Act 
                (25 U.S.C. 450 et seq.), and any funds made available 
                to carry out such an activity, shall not be divisible 
                for purposes of that Act.

``SEC. 204. SHARED SERVICES FOR LONG-TERM CARE.

    ``(a) Long-Term Care.--Notwithstanding any other provision of law, 
the Secretary, acting through the Service, is authorized to provide 
directly, or enter into contracts or compacts under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et seq.) with 
Indian Tribes or Tribal Organizations for, the delivery of long-term 
care (including health care services associated with long-term care) 
provided in a facility to Indians. Such agreements shall provide for 
the sharing of staff or other services between the Service or a Tribal 
Health Program and a long-term care or related facility owned and 
operated (directly or through a contract or compact under the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 et 
seq.)) by such Indian Tribe or Tribal Organization.
    ``(b) Contents of Agreements.--An agreement entered into pursuant 
to subsection (a)--
            ``(1) may, at the request of the Indian Tribe or Tribal 
        Organization, delegate to such Indian Tribe or Tribal 
        Organization such powers of supervision and control over 
        Service employees as the Secretary deems necessary to carry out 
        the purposes of this section;
            ``(2) shall provide that expenses (including salaries) 
        relating to services that are shared between the Service and 
        the Tribal Health Program be allocated proportionately between 
        the Service and the Indian Tribe or Tribal Organization; and
            ``(3) may authorize such Indian Tribe or Tribal 
        Organization to construct, renovate, or expand a long-term care 
        or other similar facility (including the construction of a 
        facility attached to a Service facility).
    ``(c) Minimum Requirement.--Any nursing facility provided for under 
this section shall meet the requirements for nursing facilities under 
section 1919 of the Social Security Act.
    ``(d) Other Assistance.--The Secretary shall provide such technical 
and other assistance as may be necessary to enable applicants to comply 
with the provisions of this section.
    ``(e) Use of Existing or Underused Facilities.--The Secretary shall 
encourage the use of existing facilities that are underused or allow 
the use of swing beds for long-term or similar care.

``SEC. 205. HEALTH SERVICES RESEARCH.

    ``(a) In General.--The Secretary, acting through the Service, shall 
make funding available for research to further the performance of the 
health service responsibilities of Indian Health Programs.
    ``(b) Coordination of Resources and Activities.--The Secretary 
shall also, to the maximum extent practicable, coordinate departmental 
research resources and activities to address relevant Indian Health 
Program research needs.
    ``(c) Availability.--Tribal Health Programs shall be given an equal 
opportunity to compete for, and receive, research funds under this 
section.
    ``(d) Use of Funds.--This funding may be used for both clinical and 
nonclinical research.
    ``(e) Evaluation and Dissemination.--The Secretary shall 
periodically--
            ``(1) evaluate the impact of research conducted under this 
        section; and
            ``(2) disseminate to Tribal Health Programs information 
        regarding that research as the Secretary determines to be 
        appropriate.

``SEC. 206. MAMMOGRAPHY AND OTHER CANCER SCREENING.

    ``The Secretary, acting through the Service, shall provide for 
screening as follows:
            ``(1) Screening mammography (as defined in section 1861(jj) 
        of the Social Security Act) for Indian women at a frequency 
        appropriate to such women under accepted and appropriate 
        national standards, and under such terms and conditions as are 
        consistent with standards established by the Secretary to 
        ensure the safety and accuracy of screening mammography under 
        part B of title XVIII of such Act.
            ``(2) Other cancer screening that receives an A or B rating 
        as recommended by the United States Preventive Services Task 
        Force established under section 915(a)(1) of the Public Health 
        Service Act (42 U.S.C. 299b-4(a)(1)). The Secretary shall 
        ensure that screening provided for under this paragraph 
        complies with the recommendations of the Task Force with 
        respect to--
                    ``(A) frequency;
                    ``(B) the population to be served;
                    ``(C) the procedure or technology to be used;
                    ``(D) evidence of effectiveness; and
                    ``(E) other matters that the Secretary determines 
                appropriate.

``SEC. 207. PATIENT TRAVEL COSTS.

    ``(a) Definition of Qualified Escort.--In this section, the term 
`qualified escort' means--
            ``(1) an adult escort (including a parent, guardian, or 
        other family member) who is required because of the physical or 
        mental condition, or age, of the applicable patient;
            ``(2) a health professional for the purpose of providing 
        necessary medical care during travel by the applicable patient; 
        or
            ``(3) other escorts, as the Secretary or applicable Indian 
        Health Program determines to be appropriate.
    ``(b) Provision of Funds.--The Secretary, acting through the 
Service, is authorized to provide funds for the following patient 
travel costs, including qualified escorts, associated with receiving 
health care services provided (either through direct or contract care 
or through a contract or compact under the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.)) under this Act--
            ``(1) emergency air transportation and non-emergency air 
        transportation where ground transportation is infeasible;
            ``(2) transportation by private vehicle (where no other 
        means of transportation is available), specially equipped 
        vehicle, and ambulance; and
            ``(3) transportation by such other means as may be 
        available and required when air or motor vehicle transportation 
        is not available.

``SEC. 208. EPIDEMIOLOGY CENTERS.

    ``(a) Establishment of Centers.--The Secretary shall establish an 
epidemiology center in each Service Area to carry out the functions 
described in subsection (b). Any new center established after the date 
of enactment of the Indian Health Care Improvement Act Amendments of 
2008 may be operated under a grant authorized by subsection (d), but 
funding under such a grant shall not be divisible.
    ``(b) Functions of Centers.--In consultation with and upon the 
request of Indian Tribes, Tribal Organizations, and Urban Indian 
communities, each Service Area epidemiology center established under 
this section shall, with respect to such Service Area--
            ``(1) collect data relating to, and monitor progress made 
        toward meeting, each of the health status objectives of the 
        Service, the Indian Tribes, Tribal Organizations, and Urban 
        Indian communities in the Service Area;
            ``(2) evaluate existing delivery systems, data systems, and 
        other systems that impact the improvement of Indian health;
            ``(3) assist Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations in identifying their highest priority 
        health status objectives and the services needed to achieve 
        such objectives, based on epidemiological data;
            ``(4) make recommendations for the targeting of services 
        needed by the populations served;
            ``(5) make recommendations to improve health care delivery 
        systems for Indians and Urban Indians;
            ``(6) provide requested technical assistance to Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations in 
        the development of local health service priorities and 
        incidence and prevalence rates of disease and other illness in 
        the community; and
            ``(7) provide disease surveillance and assist Indian 
        Tribes, Tribal Organizations, and Urban Indian communities to 
        promote public health.
    ``(c) Technical Assistance.--The Director of the Centers for 
Disease Control and Prevention shall provide technical assistance to 
the centers in carrying out the requirements of this section.
    ``(d) Grants for Studies.--
            ``(1) In general.--The Secretary may make grants to Indian 
        Tribes, Tribal Organizations, Indian organizations, and 
        eligible intertribal consortia to conduct epidemiological 
        studies of Indian communities.
            ``(2) Eligible intertribal consortia.--An intertribal 
        consortium or Indian organization is eligible to receive a 
        grant under this subsection if--
                    ``(A) the intertribal consortium is incorporated 
                for the primary purpose of improving Indian health; and
                    ``(B) the intertribal consortium is representative 
                of the Indian Tribes or urban Indian communities in 
                which the intertribal consortium is located.
            ``(3) Applications.--An application for a grant under this 
        subsection shall be submitted in such manner and at such time 
        as the Secretary shall prescribe.
            ``(4) Requirements.--An applicant for a grant under this 
        subsection shall--
                    ``(A) demonstrate the technical, administrative, 
                and financial expertise necessary to carry out the 
                functions described in paragraph (5);
                    ``(B) consult and cooperate with providers of 
                related health and social services in order to avoid 
                duplication of existing services; and
                    ``(C) demonstrate cooperation from Indian Tribes or 
                Urban Indian Organizations in the area to be served.
            ``(5) Use of funds.--A grant awarded under paragraph (1) 
        may be used--
                    ``(A) to carry out the functions described in 
                subsection (b);
                    ``(B) to provide information to and consult with 
                tribal leaders, urban Indian community leaders, and 
                related health staff on health care and health service 
                management issues; and
                    ``(C) in collaboration with Indian Tribes, Tribal 
                Organizations, and urban Indian communities, to provide 
                the Service with information regarding ways to improve 
                the health status of Indians.
    ``(e) Access to Information.--
            ``(1) An epidemiology center operated by a grantee pursuant 
        to a grant awarded under subsection (d) shall be treated as a 
        public health authority for purposes of the Health Insurance 
        Portability and Accountability Act of 1996, as such entities 
        are defined in part 164.501 of title 45, Code of Federal 
        Regulations.
            ``(2) The Secretary shall grant to such epidemiology center 
        access to use of the data, data sets, monitoring systems, 
        delivery systems, and other protected health information in the 
        possession of the Secretary.
            ``(3) The activities of such an epidemiology center shall 
        be for the purposes of research and for preventing and 
        controlling disease, injury, or disability for purposes of the 
        Health Insurance Portability and Accountability Act of 1996 
        (Public Law 104-191; 110 Stat. 2033), as such activities are 
        described in part 164.512 of title 45, Code of Federal 
        Regulations (or a successor regulation).
    ``(f) Funds Not Divisible.--An epidemiology center established 
under this section shall be subject to the provisions of the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 et 
seq.), but the funds for such center shall not be divisible.

``SEC. 209. COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS.

    ``(a) Funding for Development of Programs.--In addition to carrying 
out any other program for health promotion or disease prevention, the 
Secretary, acting through the Service, is authorized to award grants to 
Indian Tribes and Tribal Organizations to develop comprehensive school 
health education programs for children from pre-school through grade 12 
in schools for the benefit of Indian children.
    ``(b) Use of Grant Funds.--A grant awarded under this section may 
be used for purposes which may include, but are not limited to, the 
following:
            ``(1) Developing health education materials both for 
        regular school programs and afterschool programs.
            ``(2) Training teachers in comprehensive school health 
        education materials.
            ``(3) Integrating school-based, community-based, and other 
        public and private health promotion efforts.
            ``(4) Encouraging healthy, tobacco-free school 
        environments.
            ``(5) Coordinating school-based health programs with 
        existing services and programs available in the community.
            ``(6) Developing school programs on nutrition education, 
        personal health, oral health, and fitness.
            ``(7) Developing behavioral health wellness programs.
            ``(8) Developing chronic disease prevention programs.
            ``(9) Developing substance abuse prevention programs.
            ``(10) Developing injury prevention and safety education 
        programs.
            ``(11) Developing activities for the prevention and control 
        of communicable diseases.
            ``(12) Developing community and environmental health 
        education programs that include traditional health care 
        practitioners.
            ``(13) Violence prevention.
            ``(14) Such other health issues as are appropriate.
    ``(c) Technical Assistance.--Upon request, the Secretary, acting 
through the Service, shall provide technical assistance to Indian 
Tribes and Tribal Organizations in the development of comprehensive 
health education plans and the dissemination of comprehensive health 
education materials and information on existing health programs and 
resources.
    ``(d) Criteria for Review and Approval of Applications.--The 
Secretary, acting through the Service, and in consultation with Indian 
Tribes and Tribal Organizations, shall establish criteria for the 
review and approval of applications for grants awarded under this 
section.
    ``(e) Development of Program for BIA-Funded Schools.--
            ``(1) In general.--The Secretary of the Interior, acting 
        through the Bureau of Indian Affairs and in cooperation with 
        the Secretary, acting through the Service, shall develop a 
        comprehensive school health education program for children from 
        preschool through grade 12 in schools for which support is 
        provided by the Bureau of Indian Affairs.
            ``(2) Requirements for programs.--Such programs shall 
        include--
                    ``(A) school programs on nutrition education, 
                personal health, oral health, and fitness;
                    ``(B) behavioral health wellness programs;
                    ``(C) chronic disease prevention programs;
                    ``(D) substance abuse prevention programs;
                    ``(E) injury prevention and safety education 
                programs; and
                    ``(F) activities for the prevention and control of 
                communicable diseases.
            ``(3) Duties of the secretary.--The Secretary of the 
        Interior shall--
                    ``(A) provide training to teachers in comprehensive 
                school health education materials;
                    ``(B) ensure the integration and coordination of 
                school-based programs with existing services and health 
                programs available in the community; and
                    ``(C) encourage healthy, tobacco-free school 
                environments.

``SEC. 210. INDIAN YOUTH PROGRAM.

    ``(a) Program Authorized.--The Secretary, acting through the 
Service, is authorized to establish and administer a program to provide 
grants to Indian Tribes, Tribal Organizations, and urban Indian 
organizations for innovative mental and physical disease prevention and 
health promotion and treatment programs for Indian and urban Indian 
preadolescent and adolescent youths.
    ``(b) Use of Funds.--
            ``(1) Allowable uses.--Funds made available under this 
        section may be used to--
                    ``(A) develop prevention and treatment programs for 
                Indian youth which promote mental and physical health 
                and incorporate cultural values, community and family 
                involvement, and traditional health care practitioners; 
                and
                    ``(B) develop and provide community training and 
                education.
            ``(2) Prohibited use.--Funds made available under this 
        section may not be used to provide services described in 
        section 707(c).
    ``(c) Duties of the Secretary.--The Secretary shall--
            ``(1) disseminate to Indian Tribes, Tribal Organizations, 
        and urban Indian organizations information regarding models for 
        the delivery of comprehensive health care services to Indian 
        and urban Indian adolescents;
            ``(2) encourage the implementation of such models; and
            ``(3) at the request of an Indian Tribe, Tribal 
        Organization, or urban Indian organization, provide technical 
        assistance in the implementation of such models.
    ``(d) Criteria for Review and Approval of Applications.--The 
Secretary, in consultation with Indian Tribes, Tribal Organizations, 
and urban Indian organizations, shall establish criteria for the review 
and approval of applications or proposals under this section.

``SEC. 211. PREVENTION, CONTROL, AND ELIMINATION OF COMMUNICABLE AND 
              INFECTIOUS DISEASES.

    ``(a) Grants Authorized.--The Secretary, acting through the 
Service, and after consultation with the Centers for Disease Control 
and Prevention, may make grants available to Indian Tribes, Tribal 
Organizations, and urban Indian organizations for the following:
            ``(1) Projects for the prevention, control, and elimination 
        of communicable and infectious diseases, including 
        tuberculosis, hepatitis, HIV, respiratory syncytial virus, 
        hanta virus, sexually transmitted diseases, and H. Pylori.
            ``(2) Public information and education programs for the 
        prevention, control, and elimination of communicable and 
        infectious diseases.
            ``(3) Education, training, and clinical skills improvement 
        activities in the prevention, control, and elimination of 
        communicable and infectious diseases for health professionals, 
        including allied health professionals.
            ``(4) Demonstration projects for the screening, treatment, 
        and prevention of hepatitis C virus (HCV).
    ``(b) Application Required.--The Secretary may provide funding 
under subsection (a) only if an application or proposal for funding is 
submitted to the Secretary.
    ``(c) Coordination With Health Agencies.--Indian Tribes, Tribal 
Organizations, and urban Indian organizations receiving funding under 
this section are encouraged to coordinate their activities with the 
Centers for Disease Control and Prevention and State and local health 
agencies.
    ``(d) Technical Assistance; Report.--In carrying out this section, 
the Secretary--
            ``(1) may, at the request of an Indian Tribe, Tribal 
        Organization, or urban Indian organization, provide technical 
        assistance; and
            ``(2) shall prepare and submit a report to Congress 
        biennially on the use of funds under this section and on the 
        progress made toward the prevention, control, and elimination 
        of communicable and infectious diseases among Indians and Urban 
        Indians.

``SEC. 212. OTHER AUTHORITY FOR PROVISION OF SERVICES.

    ``(a) Funding Authorized.--The Secretary, acting through the 
Service, Indian Tribes, and Tribal Organizations, may provide funding 
under this Act to meet the objectives set forth in section 3 of this 
Act through health care-related services and programs not otherwise 
described in this Act for the following services:
            ``(1) Hospice care.
            ``(2) Assisted living services.
            ``(3) Long-term care services.
            ``(4) Home- and community-based services.
    ``(b) Eligibility.--The following individuals shall be eligible to 
receive long-term care under this section:
            ``(1) Individuals who are unable to perform a certain 
        number of activities of daily living without assistance.
            ``(2) Individuals with a mental impairment, such as 
        dementia, Alzheimer's disease, or another disabling mental 
        illness, who may be able to perform activities of daily living 
        under supervision.
            ``(3) Such other individuals as an applicable Indian Health 
        Program determines to be appropriate.
    ``(c) Definitions.--For the purposes of this section, the following 
definitions shall apply:
            ``(1) The term `assisted living services' means any service 
        provided by an assisted living facility (as defined in section 
        232(b) of the National Housing Act (12 U.S.C. 1715w(b))), 
        except that such an assisted living facility--
                    ``(A) shall not be required to obtain a license; 
                but
                    ``(B) shall meet all applicable standards for 
                licensure.
            ``(2) The term `home- and community-based services' means 1 
        or more of the services specified in paragraphs (1) through (9) 
        of section 1929(a) of the Social Security Act (42 U.S.C. 
        1396t(a)) (whether provided by the Service or by an Indian 
        Tribe or Tribal Organization pursuant to the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 450 et 
        seq.)) that are or will be provided in accordance with 
        applicable standards.
            ``(3) The term `hospice care' means the items and services 
        specified in subparagraphs (A) through (H) of section 
        1861(dd)(1) of the Social Security Act (42 U.S.C. 
        1395x(dd)(1)), and such other services which an Indian Tribe or 
        Tribal Organization determines are necessary and appropriate to 
        provide in furtherance of this care.
            ``(4) The term `long-term care services' has the meaning 
        given the term `qualified long-term care services' in section 
        7702B(c) of the Internal Revenue Code of 1986.
    ``(d) Authorization of Convenient Care Services.--The Secretary, 
acting through the Service, Indian Tribes, and Tribal Organizations, 
may also provide funding under this Act to meet the objectives set 
forth in section 3 of this Act for convenient care services programs 
pursuant to section 306(c)(2)(A).

``SEC. 213. INDIAN WOMEN'S HEALTH CARE.

    ``The Secretary, acting through the Service, shall monitor and 
improve the quality of health care for Indian women of all ages through 
the planning and delivery of programs administered by the Service, in 
order to improve and enhance the treatment models of care for Indian 
women.

``SEC. 214. ENVIRONMENTAL AND NUCLEAR HEALTH HAZARDS.

    ``(a) Studies and Monitoring.--The Secretary and the Service shall 
conduct, in conjunction with other appropriate Federal agencies and in 
consultation with concerned Indian Tribes and Tribal Organizations, 
studies and ongoing monitoring programs to determine trends in the 
health hazards to Indian miners and to Indians on or near reservations 
and Indian communities as a result of environmental hazards which may 
result in chronic or life threatening health problems, such as nuclear 
resource development, petroleum contamination, and contamination of 
water source and of the food chain. Such studies shall include--
            ``(1) an evaluation of the nature and extent of health 
        problems caused by environmental hazards currently exhibited 
        among Indians and the causes of such health problems;
            ``(2) an analysis of the potential effect of ongoing and 
        future environmental resource development on or near 
        reservations and Indian communities, including the cumulative 
        effect over time on health;
            ``(3) an evaluation of the types and nature of activities, 
        practices, and conditions causing or affecting such health 
        problems, including uranium mining and milling, uranium mine 
        tailing deposits, nuclear power plant operation and 
        construction, and nuclear waste disposal; oil and gas 
        production or transportation on or near reservations or Indian 
        communities; and other development that could affect the health 
        of Indians and their water supply and food chain;
            ``(4) a summary of any findings and recommendations 
        provided in Federal and State studies, reports, investigations, 
        and inspections during the 5 years prior to the date of 
        enactment of the Indian Health Care Improvement Act Amendments 
        of 2009 that directly or indirectly relate to the activities, 
        practices, and conditions affecting the health or safety of 
        such Indians; and
            ``(5) the efforts that have been made by Federal and State 
        agencies and resource and economic development companies to 
        effectively carry out an education program for such Indians 
        regarding the health and safety hazards of such development.
    ``(b) Health Care Plans.--Upon completion of such studies, the 
Secretary and the Service shall take into account the results of such 
studies and develop health care plans to address the health problems 
studied under subsection (a). The plans shall include--
            ``(1) methods for diagnosing and treating Indians currently 
        exhibiting such health problems;
            ``(2) preventive care and testing for Indians who may be 
        exposed to such health hazards, including the monitoring of the 
        health of individuals who have or may have been exposed to 
        excessive amounts of radiation or affected by other activities 
        that have had or could have a serious impact upon the health of 
        such individuals; and
            ``(3) a program of education for Indians who, by reason of 
        their work or geographic proximity to such nuclear or other 
        development activities, may experience health problems.
    ``(c) Submission of Report and Plan to Congress.--The Secretary and 
the Service shall submit to Congress the study prepared under 
subsection (a) no later than 18 months after the date of enactment of 
the Indian Health Care Improvement Act Amendments of 2009. The health 
care plan prepared under subsection (b) shall be submitted in a report 
no later than 1 year after the study prepared under subsection (a) is 
submitted to Congress. Such report shall include recommended activities 
for the implementation of the plan, as well as an evaluation of any 
activities previously undertaken by the Service to address such health 
problems.
    ``(d) Intergovernmental Task Force.--
            ``(1) Establishment; members.--There is established an 
        Intergovernmental Task Force to be composed of the following 
        individuals (or their designees):
                    ``(A) The Secretary of Energy.
                    ``(B) The Secretary of the Environmental Protection 
                Agency.
                    ``(C) The Director of the Bureau of Mines.
                    ``(D) The Assistant Secretary for Occupational 
                Safety and Health.
                    ``(E) The Secretary of the Interior.
                    ``(F) The Secretary of Health and Human Services.
                    ``(G) The Director of the Indian Health Service.
            ``(2) Duties.--The Task Force shall--
                    ``(A) identify existing and potential operations 
                related to nuclear resource development or other 
                environmental hazards that affect or may affect the 
                health of Indians on or near a reservation or in an 
                Indian community; and
                    ``(B) enter into activities to correct existing 
                health hazards and ensure that current and future 
                health problems resulting from nuclear resource or 
                other development activities are minimized or reduced.
            ``(3) Chairman; meetings.--The Secretary of Health and 
        Human Services shall be the Chairman of the Task Force. The 
        Task Force shall meet at least twice each year.
    ``(e) Health Services to Certain Employees.--In the case of any 
Indian who--
            ``(1) as a result of employment in or near a uranium mine 
        or mill or near any other environmental hazard, suffers from a 
        work-related illness or condition;
            ``(2) is eligible to receive diagnosis and treatment 
        services from an Indian Health Program; and
            ``(3) by reason of such Indian's employment, is entitled to 
        medical care at the expense of such mine or mill operator or 
        entity responsible for the environmental hazard, the Indian 
        Health Program shall, at the request of such Indian, render 
        appropriate medical care to such Indian for such illness or 
        condition and may be reimbursed for any medical care so 
        rendered to which such Indian is entitled at the expense of 
        such operator or entity from such operator or entity. Nothing 
        in this subsection shall affect the rights of such Indian to 
        recover damages other than such amounts paid to the Indian 
        Health Program from the employer for providing medical care for 
        such illness or condition.

``SEC. 215. ARIZONA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.

    ``(a) In General.--For fiscal years beginning with the fiscal year 
ending September 30, 1983, and ending with the fiscal year ending 
September 30, 2025, the State of Arizona shall be designated as a 
contract health service delivery area by the Service for the purpose of 
providing contract health care services to members of federally 
recognized Indian Tribes of Arizona.
    ``(b) Maintenance of Services.--The Service shall not curtail any 
health care services provided to Indians residing on reservations in 
the State of Arizona if such curtailment is due to the provision of 
contract services in such State pursuant to the designation of such 
State as a contract health service delivery area pursuant to subsection 
(a).

``SEC. 216. NORTH DAKOTA AND SOUTH DAKOTA AS CONTRACT HEALTH SERVICE 
              DELIVERY AREA.

    ``(a) In General.--Beginning in fiscal year 2003, the States of 
North Dakota and South Dakota shall be designated as a contract health 
service delivery area by the Service for the purpose of providing 
contract health care services to members of federally recognized Indian 
Tribes of North Dakota and South Dakota.
    ``(b) Limitation.--The Service shall not curtail any health care 
services provided to Indians residing on any reservation, or in any 
county that has a common boundary with any reservation, in the State of 
North Dakota or South Dakota if such curtailment is due to the 
provision of contract services in such States pursuant to the 
designation of such States as a contract health service delivery area 
pursuant to subsection (a).

``SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES PROGRAM.

    ``(a) Funding Authorized.--The Secretary is authorized to fund a 
program using the California Rural Indian Health Board (hereafter in 
this section referred to as the `CRIHB') as a contract care 
intermediary to improve the accessibility of health services to 
California Indians.
    ``(b) Reimbursement Contract.--The Secretary shall enter into an 
agreement with the CRIHB to reimburse the CRIHB for costs (including 
reasonable administrative costs) incurred pursuant to this section, in 
providing medical treatment under contract to California Indians 
described in section 805(a) throughout the California contract health 
services delivery area described in section 219 with respect to high 
cost contract care cases.
    ``(c) Administrative Expenses.--Not more than 5 percent of the 
amounts provided to the CRIHB under this section for any fiscal year 
may be for reimbursement for administrative expenses incurred by the 
CRIHB during such fiscal year.
    ``(d) Limitation on Payment.--No payment may be made for treatment 
provided hereunder to the extent payment may be made for such treatment 
under the Indian Catastrophic Health Emergency Fund described in 
section 202 or from amounts appropriated or otherwise made available to 
the California contract health service delivery area for a fiscal year.
    ``(e) Advisory Board.--There is established an advisory board which 
shall advise the CRIHB in carrying out this section. The advisory board 
shall be composed of representatives, selected by the CRIHB, from not 
less than 8 Tribal Health Programs serving California Indians covered 
under this section at least \1/2\ of whom of whom are not affiliated 
with the CRIHB.

``SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.

    ``The State of California, excluding the counties of Alameda, 
Contra Costa, Los Angeles, Marin, Orange, Sacramento, San Francisco, 
San Mateo, Santa Clara, Kern, Merced, Monterey, Napa, San Benito, San 
Joaquin, San Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ventura, 
shall be designated as a contract health service delivery area by the 
Service for the purpose of providing contract health services to 
California Indians. However, any of the counties listed herein may only 
be included in the contract health services delivery area if funding is 
specifically provided by the Service for such services in those 
counties.

``SEC. 219. CONTRACT HEALTH SERVICES FOR THE TRENTON SERVICE AREA.

    ``(a) Authorization for Services.--The Secretary, acting through 
the Service, is directed to provide contract health services to members 
of the Turtle Mountain Band of Chippewa Indians that reside in the 
Trenton Service Area of Divide, McKenzie, and Williams counties in the 
State of North Dakota and the adjoining counties of Richland, 
Roosevelt, and Sheridan in the State of Montana.
    ``(b) No Expansion of Eligibility.--Nothing in this section may be 
construed as expanding the eligibility of members of the Turtle 
Mountain Band of Chippewa Indians for health services provided by the 
Service beyond the scope of eligibility for such health services that 
applied on May 1, 1986.

``SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL 
              ORGANIZATIONS.

    ``The Service shall provide funds for health care programs, 
functions, services, activities, information technology, and facilities 
operated by Tribal Health Programs on the same basis as such funds are 
provided to programs, functions, services, activities, information 
technology, and facilities operated directly by the Service.

``SEC. 221. LICENSING.

    ``Licensed health care professionals employed by a Tribal Health 
Program shall, if licensed in any State, be exempt from the licensing 
requirements of the State in which the Tribal Health Program performs 
the services described in its contract or compact under the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 
while performing such services.

``SEC. 222. NOTIFICATION OF PROVISION OF EMERGENCY CONTRACT HEALTH 
              SERVICES.

    ``With respect to an elderly Indian or an Indian with a disability 
receiving emergency medical care or services from a non-Service 
provider or in a non-Service facility under the authority of this Act, 
the time limitation (as a condition of payment) for notifying the 
Service of such treatment or admission shall be 30 days.

``SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS.

    ``(a) Deadline for Response.--The Service shall respond to a 
notification of a claim by a provider of a contract care service with 
either an individual purchase order or a denial of the claim within 5 
working days after the receipt of such notification.
    ``(b) Effect of Untimely Response.--If the Service fails to respond 
to a notification of a claim in accordance with subsection (a), the 
Service shall accept as valid the claim submitted by the provider of a 
contract care service.
    ``(c) Deadline for Payment of Valid Claim.--The Service shall pay a 
valid contract care service claim within 30 days after the completion 
of the claim.

``SEC. 224. LIABILITY FOR PAYMENT.

    ``(a) No Patient Liability.--A patient who receives contract health 
care services that are authorized by the Service shall not be liable 
for the payment of any charges or costs associated with the provision 
of such services.
    ``(b) Notification.--The Secretary shall notify a contract care 
provider and any patient who receives contract health care services 
authorized by the Service that such patient is not liable for the 
payment of any charges or costs associated with the provision of such 
services not later than 5 business days after receipt of a notification 
of a claim by a provider of contract care services.
    ``(c) No Recourse.--Following receipt of the notice provided under 
subsection (b), or, if a claim has been deemed accepted under section 
224(b), the provider shall have no further recourse against the patient 
who received the services.

``SEC. 225. OFFICE OF INDIAN MEN'S HEALTH.

    ``(a) Establishment.--The Secretary may establish within the 
Service an office to be known as the `Office of Indian Men's Health' 
(referred to in this section as the `Office').
    ``(b) Director.--
            ``(1) In general.--The Office shall be headed by a 
        director, to be appointed by the Secretary.
            ``(2) Duties.--The director shall coordinate and promote 
        the status of the health of Indian men in the United States.
    ``(c) Report.--Not later than 2 years after the date of enactment 
of the Indian Health Care Improvement Act Amendments of 2009, the 
Secretary, acting through the director of the Office, shall submit to 
Congress a report describing--
            ``(1) any activity carried out by the director as of the 
        date on which the report is prepared; and
            ``(2) any finding of the director with respect to the 
        health of Indian men.

``SEC. 226. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2025 to carry out 
this title.

                        ``TITLE III--FACILITIES

``SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVATION OF FACILITIES; 
              REPORTS.

    ``(a) Prerequisites for Expenditure of Funds.--Prior to the 
expenditure of, or the making of any binding commitment to expend, any 
funds appropriated for the planning, design, construction, or 
renovation of facilities pursuant to the Act of November 2, 1921 (25 
U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary, acting 
through the Service, shall--
            ``(1) consult with any Indian Tribe that would be 
        significantly affected by such expenditure for the purpose of 
        determining and, whenever practicable, honoring tribal 
        preferences concerning size, location, type, and other 
        characteristics of any facility on which such expenditure is to 
        be made; and
            ``(2) ensure, whenever practicable and applicable, that 
        such facility meets the construction standards of any 
        accrediting body recognized by the Secretary for the purposes 
        of the Medicare, Medicaid, and SCHIP programs under titles 
        XVIII, XIX, and XXI of the Social Security Act by not later 
        than 1 year after the date on which the construction or 
        renovation of such facility is completed.
    ``(b) Closures.--
            ``(1) Evaluation required.--Notwithstanding any other 
        provision of law, no facility operated by the Service may be 
        closed if the Secretary has not submitted to Congress, not less 
        than 1 year and not more than 2 years before the date of the 
        proposed closure, an evaluation, completed not more than 2 
        years before such submission, of the impact of the proposed 
        closure that specifies, in addition to other considerations--
                    ``(A) the accessibility of alternative health care 
                resources for the population served by such facility;
                    ``(B) the cost-effectiveness of such closure;
                    ``(C) the quality of health care to be provided to 
                the population served by such facility after such 
                closure;
                    ``(D) the availability of contract health care 
                funds to maintain existing levels of service;
                    ``(E) the views of the Indian Tribes served by such 
                facility concerning such closure;
                    ``(F) the level of use of such facility by all 
                eligible Indians; and
                    ``(G) the distance between such facility and the 
                nearest operating Service hospital.
            ``(2) Exception for certain temporary closures.--Paragraph 
        (1) shall not apply to any temporary closure of a facility or 
        any portion of a facility if such closure is necessary for 
        medical, environmental, or construction safety reasons.
    ``(c) Health Care Facility Priority System.--
            ``(1) In general.--
                    ``(A) Priority system.--The Secretary, acting 
                through the Service, shall maintain a health care 
                facility priority system, which--
                            ``(i) shall be developed in consultation 
                        with Indian Tribes and Tribal Organizations;
                            ``(ii) shall give Indian Tribes' needs the 
                        highest priority;
                            ``(iii)(I) may include the lists required 
                        in paragraph (2)(B)(ii); and
                            ``(II) shall include the methodology 
                        required in paragraph (2)(B)(v); and
                            ``(III) may include such other facilities, 
                        and such renovation or expansion needs of any 
                        health care facility, as the Service, Indian 
                        Tribes, and Tribal Organizations may identify; 
                        and
                            ``(iv) shall provide an opportunity for the 
                        nomination of planning, design, and 
                        construction projects by the Service, Indian 
                        Tribes, and Tribal Organizations for 
                        consideration under the priority system at 
                        least once every 3 years, or more frequently as 
                        the Secretary determines to be appropriate.
                    ``(B) Needs of facilities under isdeaa 
                agreements.--The Secretary shall ensure that the 
                planning, design, construction, renovation, and 
                expansion needs of Service and non-Service facilities 
                operated under contracts or compacts in accordance with 
                the Indian Self-Determination and Education Assistance 
                Act (25 U.S.C. 450 et seq.) are fully and equitably 
                integrated into the health care facility priority 
                system.
                    ``(C) Criteria for evaluating needs.--For purposes 
                of this subsection, the Secretary, in evaluating the 
                needs of facilities operated under a contract or 
                compact under the Indian Self-Determination and 
                Education Assistance Act (25 U.S.C. 450 et seq.), shall 
                use the criteria used by the Secretary in evaluating 
                the needs of facilities operated directly by the 
                Service.
                    ``(D) Priority of certain projects protected.--The 
                priority of any project established under the 
                construction priority system in effect on the date of 
                enactment of the Indian Health Care Improvement Act 
                Amendments of 2009 shall not be affected by any change 
                in the construction priority system taking place after 
                that date if the project--
                            ``(i) was identified in the fiscal year 
                        2008 Service budget justification as--
                                    ``(I) 1 of the 10 top-priority 
                                inpatient projects;
                                    ``(II) 1 of the 10 top-priority 
                                outpatient projects;
                                    ``(III) 1 of the 10 top-priority 
                                staff quarters developments; or
                                    ``(IV) 1 of the 10 top-priority 
                                Youth Regional Treatment Centers;
                            ``(ii) had completed both Phase I and Phase 
                        II of the construction priority system in 
                        effect on the date of enactment of such Act; or
                            ``(iii) is not included in clause (i) or 
                        (ii) and is selected, as determined by the 
                        Secretary--
                                    ``(I) on the initiative of the 
                                Secretary; or
                                    ``(II) pursuant to a request of an 
                                Indian Tribe or Tribal Organization.
            ``(2) Report; contents.--
                    ``(A) Initial comprehensive report.--
                            ``(i) Definitions.--In this subparagraph:
                                    ``(I) Facilities appropriation 
                                advisory board.--The term `Facilities 
                                Appropriation Advisory Board' means the 
                                advisory board, comprised of 12 members 
                                representing Indian tribes and 2 
                                members representing the Service, 
                                established at the discretion of the 
                                Assistant Secretary--
                                            ``(aa) to provide advice 
                                        and recommendations for 
                                        policies and procedures of the 
                                        programs funded pursuant to 
                                        facilities appropriations; and
                                            ``(bb) to address other 
                                        facilities issues.
                                    ``(II) Facilities needs assessment 
                                workgroup.--The term `Facilities Needs 
                                Assessment Workgroup' means the 
                                workgroup established at the discretion 
                                of the Assistant Secretary--
                                            ``(aa) to review the health 
                                        care facilities construction 
                                        priority system; and
                                            ``(bb) to make 
                                        recommendations to the 
                                        Facilities Appropriation 
                                        Advisory Board for revising the 
                                        priority system.
                            ``(ii) Initial report.--
                                    ``(I) In general.--Not later than 1 
                                year after the date of enactment of the 
                                Indian Health Care Improvement Act 
                                Amendments of 2009, the Secretary shall 
                                submit to the Committee on Indian 
                                Affairs of the Senate and the Committee 
                                on Natural Resources of the House of 
                                Representatives a report that describes 
                                the comprehensive, national, ranked 
                                list of all health care facilities 
                                needs for the Service, Indian Tribes, 
                                and Tribal Organizations (including 
                                inpatient health care facilities, 
                                outpatient health care facilities, 
                                specialized health care facilities 
                                (such as for long-term care and alcohol 
                                and drug abuse treatment), wellness 
                                centers, staff quarters and hostels 
                                associated with health care facilities, 
                                and the renovation and expansion needs, 
                                if any, of such facilities) developed 
                                by the Service, Indian Tribes, and 
                                Tribal Organizations for the Facilities 
                                Needs Assessment Workgroup and the 
                                Facilities Appropriation Advisory 
                                Board.
                                    ``(II) Inclusions.--The initial 
                                report shall include--
                                            ``(aa) the methodology and 
                                        criteria used by the Service in 
                                        determining the needs and 
                                        establishing the ranking of the 
                                        facilities needs; and
                                            ``(bb) such other 
                                        information as the Secretary 
                                        determines to be appropriate.
                            ``(iii) Updates of report.--Beginning in 
                        calendar year 2011, the Secretary shall--
                                    ``(I) update the report under 
                                clause (ii) not less frequently that 
                                once every 5 years; and
                                    ``(II) include the updated report 
                                in the appropriate annual report under 
                                subparagraph (B) for submission to 
                                Congress under section 801.
                    ``(B) Annual reports.--The Secretary shall submit 
                to the President, for inclusion in the report required 
                to be transmitted to Congress under section 801, a 
                report which sets forth the following:
                            ``(i) A description of the health care 
                        facility priority system of the Service 
                        established under paragraph (1).
                            ``(ii) Health care facilities lists, which 
                        may include--
                                    ``(I) the 10 top-priority inpatient 
                                health care facilities;
                                    ``(II) the 10 top-priority 
                                outpatient health care facilities;
                                    ``(III) the 10 top-priority 
                                specialized health care facilities 
                                (such as long-term care and alcohol and 
                                drug abuse treatment);
                                    ``(IV) the 10 top-priority staff 
                                quarters developments associated with 
                                health care facilities; and
                                    ``(V) the 10 top-priority hostels 
                                associated with health care facilities.
                            ``(iii) The justification for such order of 
                        priority.
                            ``(iv) The projected cost of such projects.
                            ``(v) The methodology adopted by the 
                        Service in establishing priorities under its 
                        health care facility priority system.
            ``(3) Requirements for preparation of reports.--In 
        preparing the report required under paragraph (2), the 
        Secretary shall--
                    ``(A) consult with and obtain information on all 
                health care facilities needs from Indian Tribes, Tribal 
                Organizations, and urban Indian organizations; and
                    ``(B) review the total unmet needs of all Indian 
                Tribes, Tribal Organizations, and urban Indian 
                organizations for health care facilities (including 
                hostels and staff quarters), including needs for 
                renovation and expansion of existing facilities.
    ``(d) Review of Methodology Used for Health Facilities Construction 
Priority System.--
            ``(1) In general.--Not later than 1 year after the 
        establishment of the priority system under subsection 
        (c)(1)(A), the Comptroller General of the United States shall 
        prepare and finalize a report reviewing the methodologies 
        applied, and the processes followed, by the Service in making 
        each assessment of needs for the list under subsection 
        (c)(2)(A)(ii) and developing the priority system under 
        subsection (c)(1), including a review of--
                    ``(A) the recommendations of the Facilities 
                Appropriation Advisory Board and the Facilities Needs 
                Assessment Workgroup (as those terms are defined in 
                subsection (c)(2)(A)(i)); and
                    ``(B) the relevant criteria used in ranking or 
                prioritizing facilities other than hospitals or 
                clinics.
            ``(2) Submission to congress.--The Comptroller General of 
        the United States shall submit the report under paragraph (1) 
        to--
                    ``(A) the Committees on Indian Affairs and 
                Appropriations of the Senate;
                    ``(B) the Committees on Natural Resources and 
                Appropriations of the House of Representatives; and
                    ``(C) the Secretary.
    ``(e) Funding Condition.--All funds appropriated under the Act of 
November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), 
for the planning, design, construction, or renovation of health 
facilities for the benefit of 1 or more Indian Tribes shall be subject 
to the provisions of the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.).
    ``(f) Development of Innovative Approaches.--The Secretary shall 
consult and cooperate with Indian Tribes, Tribal Organizations, and 
urban Indian organizations in developing innovative approaches to 
address all or part of the total unmet need for construction of health 
facilities, including those provided for in other sections of this 
title and other approaches.

``SEC. 302. SANITATION FACILITIES.

    ``(a) Findings.--Congress finds the following:
            ``(1) The provision of sanitation facilities is primarily a 
        health consideration and function.
            ``(2) Indian people suffer an inordinately high incidence 
        of disease, injury, and illness directly attributable to the 
        absence or inadequacy of sanitation facilities.
            ``(3) The long-term cost to the United States of treating 
        and curing such disease, injury, and illness is substantially 
        greater than the short-term cost of providing sanitation 
        facilities and other preventive health measures.
            ``(4) Many Indian homes and Indian communities still lack 
        sanitation facilities.
            ``(5) It is in the interest of the United States, and it is 
        the policy of the United States, that all Indian communities 
        and Indian homes, new and existing, be provided with sanitation 
        facilities.
    ``(b) Facilities and Services.--In furtherance of the findings made 
in subsection (a), Congress reaffirms the primary responsibility and 
authority of the Service to provide the necessary sanitation facilities 
and services as provided in section 7 of the Act of August 5, 1954 (42 
U.S.C. 2004a). Under such authority, the Secretary, acting through the 
Service, is authorized to provide the following:
            ``(1) Financial and technical assistance to Indian Tribes, 
        Tribal Organizations, and Indian communities in the 
        establishment, training, and equipping of utility organizations 
        to operate and maintain sanitation facilities, including the 
        provision of existing plans, standard details, and 
        specifications available in the Department, to be used at the 
        option of the Indian Tribe, Tribal Organization, or Indian 
        community.
            ``(2) Ongoing technical assistance and training to Indian 
        Tribes, Tribal Organizations, and Indian communities in the 
        management of utility organizations which operate and maintain 
        sanitation facilities.
            ``(3) Priority funding for operation and maintenance 
        assistance for, and emergency repairs to, sanitation facilities 
        operated by an Indian Tribe, Tribal Organization or Indian 
        community when necessary to avoid an imminent health threat or 
        to protect the investment in sanitation facilities and the 
        investment in the health benefits gained through the provision 
        of sanitation facilities.
    ``(c) Funding.--Notwithstanding any other provision of law--
            ``(1) the Secretary of Housing and Urban Development is 
        authorized to transfer funds appropriated under the Native 
        American Housing Assistance and Self-Determination Act of 1996 
        (25 U.S.C. 4101 et seq.) to the Secretary of Health and Human 
        Services;
            ``(2) the Secretary of Health and Human Services is 
        authorized to accept and use such funds for the purpose of 
        providing sanitation facilities and services for Indians under 
        section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a);
            ``(3) unless specifically authorized when funds are 
        appropriated, the Secretary shall not use funds appropriated 
        under section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), 
        to provide sanitation facilities to new homes constructed using 
        funds provided by the Department of Housing and Urban 
        Development;
            ``(4) the Secretary of Health and Human Services is 
        authorized to accept from any source, including Federal and 
        State agencies, funds for the purpose of providing sanitation 
        facilities and services and place these funds into contracts or 
        compacts under the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.);
            ``(5) except as otherwise prohibited by this section, the 
        Secretary may use funds appropriated under the authority of 
        section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), to 
        fund up to 100 percent of the amount of an Indian Tribe's loan 
        obtained under any Federal program for new projects to 
        construct eligible sanitation facilities to serve Indian homes;
            ``(6) except as otherwise prohibited by this section, the 
        Secretary may use funds appropriated under the authority of 
        section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), to 
        meet matching or cost participation requirements under other 
        Federal and non-Federal programs for new projects to construct 
        eligible sanitation facilities;
            ``(7) all Federal agencies are authorized to transfer to 
        the Secretary funds identified, granted, loaned, or 
        appropriated whereby the Department's applicable policies, 
        rules, and regulations shall apply in the implementation of 
        such projects;
            ``(8) the Secretary of Health and Human Services shall 
        enter into interagency agreements with Federal and State 
        agencies for the purpose of providing financial assistance for 
        sanitation facilities and services under this Act;
            ``(9) the Secretary of Health and Human Services shall, by 
        regulation, establish standards applicable to the planning, 
        design, and construction of sanitation facilities funded under 
        this Act; and
            ``(10) the Secretary of Health and Human Services is 
        authorized to accept payments for goods and services furnished 
        by the Service from appropriate public authorities, nonprofit 
        organizations or agencies, or Indian Tribes, as contributions 
        by that authority, organization, agency, or tribe to agreements 
        made under section 7 of the Act of August 5, 1954 (42 U.S.C. 
        2004a), and such payments shall be credited to the same or 
        subsequent appropriation account as funds appropriated under 
        the authority of section 7 of the Act of August 5, 1954 (42 
        U.S.C. 2004a).
    ``(d) Certain Capabilities Not Prerequisite.--The financial and 
technical capability of an Indian Tribe, Tribal Organization, or Indian 
community to safely operate, manage, and maintain a sanitation facility 
shall not be a prerequisite to the provision or construction of 
sanitation facilities by the Secretary.
    ``(e) Financial Assistance.--The Secretary is authorized to provide 
financial assistance to Indian Tribes, Tribal Organizations, and Indian 
communities in an amount equal to the Federal share of the costs of 
operating, managing, and maintaining the facilities provided under the 
plan described in subsection (h)(1)(F).
    ``(f) Operation, Management, and Maintenance of Facilities.--The 
Indian Tribe has the primary responsibility to establish, collect, and 
use reasonable user fees, or otherwise set aside funding, for the 
purpose of operating, managing, and maintaining sanitation facilities. 
If a sanitation facility serving a community that is operated by an 
Indian Tribe or Tribal Organization is threatened with imminent failure 
and such operator lacks capacity to maintain the integrity or the 
health benefits of the sanitation facility, then the Secretary is 
authorized to assist the Indian Tribe, Tribal Organization, or Indian 
community in the resolution of the problem on a short-term basis 
through cooperation with the emergency coordinator or by providing 
operation, management, and maintenance service.
    ``(g) ISDEAA Program Funded on Equal Basis.--Tribal Health Programs 
shall be eligible (on an equal basis with programs that are 
administered directly by the Service) for--
            ``(1) any funds appropriated pursuant to this section; and
            ``(2) any funds appropriated for the purpose of providing 
        sanitation facilities.
    ``(h) Report.--
            ``(1) Required; contents.--The Secretary, in consultation 
        with the Secretary of Housing and Urban Development, Indian 
        Tribes, Tribal Organizations, and tribally designated housing 
        entities (as defined in section 4 of the Native American 
        Housing Assistance and Self-Determination Act of 1996 (25 
        U.S.C. 4103)) shall submit to the President, for inclusion in 
        the report required to be transmitted to Congress under section 
        801, a report which sets forth--
                    ``(A) the current Indian sanitation facility 
                priority system of the Service;
                    ``(B) the methodology for determining sanitation 
                deficiencies and needs;
                    ``(C) the criteria on which the deficiencies and 
                needs will be evaluated;
                    ``(D) the level of initial and final sanitation 
                deficiency for each type of sanitation facility for 
                each project of each Indian Tribe or Indian community;
                    ``(E) the amount and most effective use of funds, 
                derived from whatever source, necessary to accommodate 
                the sanitation facilities needs of new homes assisted 
                with funds under the Native American Housing Assistance 
                and Self-Determination Act (25 U.S.C. 4101 et seq.), 
                and to reduce the identified sanitation deficiency 
                levels of all Indian Tribes and Indian communities to 
                level I sanitation deficiency as defined in paragraph 
                (3)(A); and
                    ``(F) a 10-year plan to provide sanitation 
                facilities to serve existing Indian homes and Indian 
                communities and new and renovated Indian homes.
            ``(2) Uniform methodology.--The methodology used by the 
        Secretary in determining, preparing cost estimates for, and 
        reporting sanitation deficiencies for purposes of paragraph (1) 
        shall be applied uniformly to all Indian Tribes and Indian 
        communities.
            ``(3) Sanitation deficiency levels.--For purposes of this 
        subsection, the sanitation deficiency levels for an individual, 
        Indian Tribe, or Indian community sanitation facility to serve 
        Indian homes are determined as follows:
                    ``(A) A level I deficiency exists if a sanitation 
                facility serving an individual, Indian Tribe, or Indian 
                community--
                            ``(i) complies with all applicable water 
                        supply, pollution control, and solid waste 
                        disposal laws; and
                            ``(ii) deficiencies relate to routine 
                        replacement, repair, or maintenance needs.
                    ``(B) A level II deficiency exists if a sanitation 
                facility serving an individual, Indian Tribe, or Indian 
                community substantially or recently complied with all 
                applicable water supply, pollution control, and solid 
                waste laws and any deficiencies relate to--
                            ``(i) small or minor capital improvements 
                        needed to bring the facility back into 
                        compliance;
                            ``(ii) capital improvements that are 
                        necessary to enlarge or improve the facilities 
                        in order to meet the current needs for domestic 
                        sanitation facilities; or
                            ``(iii) the lack of equipment or training 
                        by an Indian Tribe, Tribal Organization, or an 
                        Indian community to properly operate and 
                        maintain the sanitation facilities.
                    ``(C) A level III deficiency exists if a sanitation 
                facility serving an individual, Indian Tribe or Indian 
                community meets 1 or more of the following conditions--
                            ``(i) water or sewer service in the home is 
                        provided by a haul system with holding tanks 
                        and interior plumbing;
                            ``(ii) major significant interruptions to 
                        water supply or sewage disposal occur 
                        frequently, requiring major capital 
                        improvements to correct the deficiencies; or
                            ``(iii) there is no access to or no 
                        approved or permitted solid waste facility 
                        available.
                    ``(D) A level IV deficiency exists--
                            ``(i) if a sanitation facility for an 
                        individual home, an Indian Tribe, or an Indian 
                        community exists but--
                                    ``(I) lacks--
                                            ``(aa) a safe water supply 
                                        system; or
                                            ``(bb) a waste disposal 
                                        system;
                                    ``(II) contains no piped water or 
                                sewer facilities; or
                                    ``(III) has become inoperable due 
                                to a major component failure; or
                            ``(ii) if only a washeteria or central 
                        facility exists in the community.
                    ``(E) A level V deficiency exists in the absence of 
                a sanitation facility, where individual homes do not 
                have access to safe drinking water or adequate 
                wastewater (including sewage) disposal.
    ``(i) Definitions.--For purposes of this section, the following 
terms apply:
            ``(1) Indian community.--The term `Indian community' means 
        a geographic area, a significant proportion of whose 
        inhabitants are Indians and which is served by or capable of 
        being served by a facility described in this section.
            ``(2) Sanitation facilities.--The terms `sanitation 
        facility' and `sanitation facilities' mean safe and adequate 
        water supply systems, sanitary sewage disposal systems, and 
        sanitary solid waste systems (and all related equipment and 
        support infrastructure).

``SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS.

    ``(a) Buy Indian Act.--The Secretary, acting through the Service, 
may use the negotiating authority of section 23 of the Act of June 25, 
1910 (25 U.S.C. 47, commonly known as the `Buy Indian Act'), to give 
preference to any Indian or any enterprise, partnership, corporation, 
or other type of business organization owned and controlled by an 
Indian or Indians including former or currently federally recognized 
Indian Tribes in the State of New York (hereinafter referred to as an 
`Indian firm') in the construction and renovation of Service facilities 
pursuant to section 301 and in the construction of sanitation 
facilities pursuant to section 302. Such preference may be accorded by 
the Secretary unless the Secretary finds, pursuant to regulations, that 
the project or function to be contracted for will not be satisfactory 
or such project or function cannot be properly completed or maintained 
under the proposed contract. The Secretary, in arriving at such a 
finding, shall consider whether the Indian or Indian firm will be 
deficient with respect to--
            ``(1) ownership and control by Indians;
            ``(2) equipment;
            ``(3) bookkeeping and accounting procedures;
            ``(4) substantive knowledge of the project or function to 
        be contracted for;
            ``(5) adequately trained personnel; or
            ``(6) other necessary components of contract performance.
    ``(b) Pay Rates.--For the purposes of implementing the provisions 
of this title, the Secretary shall assure that the rates of pay for 
personnel engaged in the construction or renovation of facilities 
constructed or renovated in whole or in part by funds made available 
pursuant to this title are not less than the prevailing local wage 
rates for similar work as determined in accordance with the Act of 
March 3, 1931 (40 U.S.C. 276a-276a-5, known as the Davis-Bacon Act).
    ``(c) Labor Standards.--For the purposes of implementing the 
provisions of this title, contracts for the construction or renovation 
of health care facilities, staff quarters, and sanitation facilities, 
and related support infrastructure, funded in whole or in part with 
funds made available pursuant to this title, shall contain a provision 
requiring compliance with subchapter IV of chapter 31 of title 40, 
United States Code (commonly known as the `Davis-Bacon Act').

``SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR RENOVATION.

    ``(a) In General.--Notwithstanding any other provision of law, if 
the requirements of subsection (c) are met, the Secretary, acting 
through the Service, is authorized to accept any major expansion, 
renovation, or modernization by any Indian Tribe or Tribal Organization 
of any Service facility or of any other Indian health facility operated 
pursuant to a contract or compact under the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.), including--
            ``(1) any plans or designs for such expansion, renovation, 
        or modernization; and
            ``(2) any expansion, renovation, or modernization for which 
        funds appropriated under any Federal law were lawfully 
        expended.
    ``(b) Priority List.--
            ``(1) In general.--The Secretary shall maintain a separate 
        priority list to address the needs for increased operating 
        expenses, personnel, or equipment for such facilities. The 
        methodology for establishing priorities shall be developed 
        through regulations. The list of priority facilities will be 
        revised annually in consultation with Indian Tribes and Tribal 
        Organizations.
            ``(2) Report.--The Secretary shall submit to the President, 
        for inclusion in the report required to be transmitted to 
        Congress under section 801, the priority list maintained 
        pursuant to paragraph (1).
    ``(c) Requirements.--The requirements of this subsection are met 
with respect to any expansion, renovation, or modernization if--
            ``(1) the Indian Tribe or Tribal Organization--
                    ``(A) provides notice to the Secretary of its 
                intent to expand, renovate, or modernize; and
                    ``(B) applies to the Secretary to be placed on a 
                separate priority list to address the needs of such new 
                facilities for increased operating expenses, personnel, 
                or equipment; and
            ``(2) the expansion, renovation, or modernization--
                    ``(A) is approved by the appropriate area director 
                of the Service for Federal facilities; and
                    ``(B) is administered by the Indian Tribe or Tribal 
                Organization in accordance with any applicable 
                regulations prescribed by the Secretary with respect to 
                construction or renovation of Service facilities.
    ``(d) Additional Requirement for Expansion.--In addition to the 
requirements under subsection (c), for any expansion, the Indian Tribe 
or Tribal Organization shall provide to the Secretary additional 
information pursuant to regulations, including additional staffing, 
equipment, and other costs associated with the expansion.
    ``(e) Closure or Conversion of Facilities.--If any Service facility 
which has been expanded, renovated, or modernized by an Indian Tribe or 
Tribal Organization under this section ceases to be used as a Service 
facility during the 20-year period beginning on the date such 
expansion, renovation, or modernization is completed, such Indian Tribe 
or Tribal Organization shall be entitled to recover from the United 
States an amount which bears the same ratio to the value of such 
facility at the time of such cessation as the value of such expansion, 
renovation, or modernization (less the total amount of any funds 
provided specifically for such facility under any Federal program that 
were expended for such expansion, renovation, or modernization) bore to 
the value of such facility at the time of the completion of such 
expansion, renovation, or modernization.

``SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND MODERNIZATION 
              OF SMALL AMBULATORY CARE FACILITIES.

    ``(a) Grants.--
            ``(1) In general.--The Secretary, acting through the 
        Service, shall make grants to Indian Tribes and Tribal 
        Organizations for the construction, expansion, or modernization 
        of facilities for the provision of ambulatory care services to 
        eligible Indians (and noneligible persons pursuant to 
        subsections (b)(2) and (c)(1)(C)). A grant made under this 
        section may cover up to 100 percent of the costs of such 
        construction, expansion, or modernization. For the purposes of 
        this section, the term `construction' includes the replacement 
        of an existing facility.
            ``(2) Grant agreement required.--A grant under paragraph 
        (1) may only be made available to a Tribal Health Program 
        operating an Indian health facility (other than a facility 
        owned or constructed by the Service, including a facility 
        originally owned or constructed by the Service and transferred 
        to an Indian Tribe or Tribal Organization).
    ``(b) Use of Grant Funds.--
            ``(1) Allowable uses.--A grant awarded under this section 
        may be used for the construction, expansion, or modernization 
        (including the planning and design of such construction, 
        expansion, or modernization) of an ambulatory care facility--
                    ``(A) located apart from a hospital;
                    ``(B) not funded under section 301 or section 306; 
                and
                    ``(C) which, upon completion of such construction 
                or modernization will--
                            ``(i) have a total capacity appropriate to 
                        its projected service population;
                            ``(ii) provide annually no fewer than 150 
                        patient visits by eligible Indians and other 
                        users who are eligible for services in such 
                        facility in accordance with section 807(c)(2); 
                        and
                            ``(iii) provide ambulatory care in a 
                        Service Area (specified in the contract or 
                        compact under the Indian Self-Determination and 
                        Education Assistance Act (25 U.S.C. 450 et 
                        seq.)) with a population of no fewer than 1,500 
                        eligible Indians and other users who are 
                        eligible for services in such facility in 
                        accordance with section 807(c)(2).
            ``(2) Additional allowable use.--The Secretary may also 
        reserve a portion of the funding provided under this section 
        and use those reserved funds to reduce an outstanding debt 
        incurred by Indian Tribes or Tribal Organizations for the 
        construction, expansion, or modernization of an ambulatory care 
        facility that meets the requirements under paragraph (1). The 
        provisions of this section shall apply, except that such 
        applications for funding under this paragraph shall be 
        considered separately from applications for funding under 
        paragraph (1).
            ``(3) Use only for certain portion of costs.--A grant 
        provided under this section may be used only for the cost of 
        that portion of a construction, expansion, or modernization 
        project that benefits the Service population identified above 
        in subsection (b)(1)(C) (ii) and (iii). The requirements of 
        clauses (ii) and (iii) of paragraph (1)(C) shall not apply to 
        an Indian Tribe or Tribal Organization applying for a grant 
        under this section for a health care facility located or to be 
        constructed on an island or when such facility is not located 
        on a road system providing direct access to an inpatient 
        hospital where care is available to the Service population.
    ``(c) Grants.--
            ``(1) Application.--No grant may be made under this section 
        unless an application or proposal for the grant has been 
        approved by the Secretary in accordance with applicable 
        regulations and has set forth reasonable assurance by the 
        applicant that, at all times after the construction, expansion, 
        or modernization of a facility carried out using a grant 
        received under this section--
                    ``(A) adequate financial support will be available 
                for the provision of services at such facility;
                    ``(B) such facility will be available to eligible 
                Indians without regard to ability to pay or source of 
                payment; and
                    ``(C) such facility will, as feasible without 
                diminishing the quality or quantity of services 
                provided to eligible Indians, serve noneligible persons 
                on a cost basis.
            ``(2) Priority.--In awarding grants under this section, the 
        Secretary shall give priority to Indian Tribes and Tribal 
        Organizations that demonstrate--
                    ``(A) a need for increased ambulatory care 
                services; and
                    ``(B) insufficient capacity to deliver such 
                services.
            ``(3) Peer review panels.--The Secretary may provide for 
        the establishment of peer review panels, as necessary, to 
        review and evaluate applications and proposals and to advise 
        the Secretary regarding such applications using the criteria 
        developed pursuant to subsection (a)(1).
    ``(d) Reversion of Facilities.--If any facility (or portion 
thereof) with respect to which funds have been paid under this section, 
ceases, at any time after completion of the construction, expansion, or 
modernization carried out with such funds, to be used for the purposes 
of providing health care services to eligible Indians, all of the 
right, title, and interest in and to such facility (or portion thereof) 
shall transfer to the United States unless otherwise negotiated by the 
Service and the Indian Tribe or Tribal Organization.
    ``(e) Funding Nonrecurring.--Funding provided under this section 
shall be nonrecurring and shall not be available for inclusion in any 
individual Indian Tribe's tribal share for an award under the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.) 
or for reallocation or redesign thereunder.

``SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECT.

    ``(a) Health Care Demonstration Projects.--The Secretary, acting 
through the Service, is authorized to make grants to, and enter into 
construction contracts or construction project agreements with, Indian 
Tribes or Tribal Organizations under the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.) for the purpose of 
carrying out a health care delivery demonstration project to test 
alternative means of delivering health care and services to Indians 
through facilities.
    ``(b) Use of Funds.--The Secretary, in approving projects pursuant 
to this section, may authorize such contracts for the construction and 
renovation of hospitals, health centers, health stations, and other 
facilities to deliver health care services and is authorized to--
            ``(1) waive any leasing prohibition;
            ``(2) permit carryover of funds appropriated for the 
        provision of health care services;
            ``(3) permit the use of other available funds;
            ``(4) permit the use of funds or property donated from any 
        source for project purposes;
            ``(5) provide for the reversion of donated real or personal 
        property to the donor; and
            ``(6) permit the use of Service funds to match other funds, 
        including Federal funds.
    ``(c) Regulations.--The Secretary shall develop and promulgate 
regulations, not later than 1 year after the date of enactment of the 
Indian Health Care Improvement Act Amendments of 2009, for the review 
and approval of applications submitted under this section.
    ``(d) Criteria.--The Secretary may approve projects that meet the 
following criteria:
            ``(1) There is a need for a new facility or program or the 
        reorientation of an existing facility or program.
            ``(2) A significant number of Indians, including those with 
        low health status, will be served by the project.
            ``(3) The project has the potential to deliver services in 
        an efficient and effective manner.
            ``(4) The project is economically viable.
            ``(5) The Indian Tribe or Tribal Organization has the 
        administrative and financial capability to administer the 
        project.
            ``(6) The project is integrated with providers of related 
        health and social services and is coordinated with, and avoids 
        duplication of, existing services.
    ``(e) Peer Review Panels.--The Secretary may provide for the 
establishment of peer review panels, as necessary, to review and 
evaluate applications using the criteria developed pursuant to 
subsection (d).
    ``(f) Priority.--The Secretary shall give priority to applications 
for demonstration projects in each of the following Service Units to 
the extent that such applications are timely filed and meet the 
criteria specified in subsection (d):
            ``(1) Cass Lake, Minnesota.
            ``(2) Mescalero, New Mexico.
            ``(3) Owyhee, Nevada.
            ``(4) Schurz, Nevada.
            ``(5) Ft. Yuma, California.
    ``(g) Technical Assistance.--The Secretary shall provide such 
technical and other assistance as may be necessary to enable applicants 
to comply with the provisions of this section.
    ``(h) Service to Ineligible Persons.--Subject to section 806, the 
authority to provide services to persons otherwise ineligible for the 
health care benefits of the Service and the authority to extend 
hospital privileges in Service facilities to non-Service health 
practitioners as provided in section 806 may be included, subject to 
the terms of such section, in any demonstration project approved 
pursuant to this section.
    ``(i) Equitable Treatment.--For purposes of subsection (d)(1), the 
Secretary shall, in evaluating facilities operated under any contract 
or compact under the Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.), use the same criteria that the Secretary 
uses in evaluating facilities operated directly by the Service.
    ``(j) Equitable Integration of Facilities.--The Secretary shall 
ensure that the planning, design, construction, renovation, and 
expansion needs of Service and non-Service facilities which are the 
subject of a contract or compact under the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.) for health 
services are fully and equitably integrated into the implementation of 
the health care delivery demonstration projects under this section.

``SEC. 307. LAND TRANSFER.

    ``Notwithstanding any other provision of law, the Bureau of Indian 
Affairs and all other agencies and departments of the United States are 
authorized to transfer, at no cost, land and improvements to the 
Service for the provision of health care services. The Secretary is 
authorized to accept such land and improvements for such purposes.

``SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS.

    ``The Secretary, acting through the Service, may enter into leases, 
contracts, and other agreements with Indian Tribes and Tribal 
Organizations which hold (1) title to, (2) a leasehold interest in, or 
(3) a beneficial interest in (when title is held by the United States 
in trust for the benefit of an Indian Tribe) facilities used or to be 
used for the administration and delivery of health services by an 
Indian Health Program. Such leases, contracts, or agreements may 
include provisions for construction or renovation and provide for 
compensation to the Indian Tribe or Tribal Organization of rental and 
other costs consistent with section 105(l) of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450j(l)) and 
regulations thereunder.

``SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND LOAN REPAYMENT.

    ``(a) In General.--The Secretary, in consultation with the 
Secretary of the Treasury, Indian Tribes, and Tribal Organizations, 
shall carry out a study to determine the feasibility of establishing a 
loan fund to provide to Indian Tribes and Tribal Organizations direct 
loans or guarantees for loans for the construction of health care 
facilities, including--
            ``(1) inpatient facilities;
            ``(2) outpatient facilities;
            ``(3) staff quarters;
            ``(4) hostels; and
            ``(5) specialized care facilities, such as behavioral 
        health and elder care facilities.
    ``(b) Determinations.--In carrying out the study under subsection 
(a), the Secretary shall determine--
            ``(1) the maximum principal amount of a loan or loan 
        guarantee that should be offered to a recipient from the loan 
        fund;
            ``(2) the percentage of eligible costs, not to exceed 100 
        percent, that may be covered by a loan or loan guarantee from 
        the loan fund (including costs relating to planning, design, 
        financing, site land development, construction, rehabilitation, 
        renovation, conversion, improvements, medical equipment and 
        furnishings, and other facility-related costs and capital 
        purchase (but excluding staffing));
            ``(3) the cumulative total of the principal of direct loans 
        and loan guarantees, respectively, that may be outstanding at 
        any 1 time;
            ``(4) the maximum term of a loan or loan guarantee that may 
        be made for a facility from the loan fund;
            ``(5) the maximum percentage of funds from the loan fund 
        that should be allocated for payment of costs associated with 
        planning and applying for a loan or loan guarantee;
            ``(6) whether acceptance by the Secretary of an assignment 
        of the revenue of an Indian Tribe or Tribal Organization as 
        security for any direct loan or loan guarantee from the loan 
        fund would be appropriate;
            ``(7) whether, in the planning and design of health 
        facilities under this section, users eligible under section 
        806(c) may be included in any projection of patient population;
            ``(8) whether funds of the Service provided through loans 
        or loan guarantees from the loan fund should be eligible for 
        use in matching other Federal funds under other programs;
            ``(9) the appropriateness of, and best methods for, 
        coordinating the loan fund with the health care priority system 
        of the Service under section 301; and
            ``(10) any legislative or regulatory changes required to 
        implement recommendations of the Secretary based on results of 
        the study.
    ``(c) Report.--Not later than September 30, 2010, the Secretary 
shall submit to the Committee on Indian Affairs of the Senate and the 
Committee on Natural Resources and the Committee on Energy and Commerce 
of the House of Representatives a report that describes--
            ``(1) the manner of consultation made as required by 
        subsection (a); and
            ``(2) the results of the study, including any 
        recommendations of the Secretary based on results of the study.

``SEC. 310. TRIBAL LEASING.

    ``A Tribal Health Program may lease permanent structures for the 
purpose of providing health care services without obtaining advance 
approval in appropriation Acts.

``SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT VENTURE 
              PROGRAM.

    ``(a) In General.--The Secretary, acting through the Service, shall 
make arrangements with Indian Tribes and Tribal Organizations to 
establish joint venture demonstration projects under which an Indian 
Tribe or Tribal Organization shall expend tribal, private, or other 
available funds, for the acquisition or construction of a health 
facility for a minimum of 10 years, under a no-cost lease, in exchange 
for agreement by the Service to provide the equipment, supplies, and 
staffing for the operation and maintenance of such a health facility. 
An Indian Tribe or Tribal Organization may use tribal funds, private 
sector, or other available resources, including loan guarantees, to 
fulfill its commitment under a joint venture entered into under this 
subsection. An Indian Tribe or Tribal Organization shall be eligible to 
establish a joint venture project if, when it submits a letter of 
intent, it--
            ``(1) has begun but not completed the process of 
        acquisition or construction of a health facility to be used in 
        the joint venture project;
            ``(2) has not begun the process of acquisition or 
        construction of a health facility for use in the joint venture 
        project; or
            ``(3) in its application for a joint venture agreement, 
        agrees--
                    ``(A) to construct a facility for the joint venture 
                which complies with the size and space criteria 
                established by the Service; or
                    ``(B) if the facility it proposes for the joint 
                venture is already in existence or under construction, 
                that only the portion of such facility which complies 
                with the size and space criteria of the Service will be 
                eligible for the joint venture agreement.
    ``(b) Requirements.--The Secretary shall make such an arrangement 
with an Indian Tribe or Tribal Organization only if--
            ``(1) the Secretary first determines that the Indian Tribe 
        or Tribal Organization has the administrative and financial 
        capabilities necessary to complete the timely acquisition or 
        construction of the relevant health facility; and
            ``(2) the Indian Tribe or Tribal Organization meets the 
        need criteria determined using the criteria developed under the 
        health care facility priority system under section 301, unless 
        the Secretary determines, pursuant to regulations, that other 
        criteria will result in a more cost-effective and efficient 
        method of facilitating and completing construction of health 
        care facilities.
    ``(c) Continued Operation.--The Secretary shall negotiate an 
agreement with the Indian Tribe or Tribal Organization regarding the 
continued operation of the facility at the end of the initial 10 year 
no-cost lease period.
    ``(d) Breach of Agreement.--An Indian Tribe or Tribal Organization 
that has entered into a written agreement with the Secretary under this 
section, and that breaches or terminates without cause such agreement, 
shall be liable to the United States for the amount that has been paid 
to the Indian Tribe or Tribal Organization, or paid to a third party on 
the Indian Tribe's or Tribal Organization's behalf, under the 
agreement. The Secretary has the right to recover tangible property 
(including supplies) and equipment, less depreciation, and any funds 
expended for operations and maintenance under this section. The 
preceding sentence does not apply to any funds expended for the 
delivery of health care services, personnel, or staffing.
    ``(e) Recovery for Nonuse.--An Indian Tribe or Tribal Organization 
that has entered into a written agreement with the Secretary under this 
subsection shall be entitled to recover from the United States an 
amount that is proportional to the value of such facility if, at any 
time within the 10-year term of the agreement, the Service ceases to 
use the facility or otherwise breaches the agreement.
    ``(f) Definition.--For the purposes of this section, the term 
`health facility' or `health facilities' includes quarters needed to 
provide housing for staff of the relevant Tribal Health Program.

``SEC. 312. LOCATION OF FACILITIES.

    ``(a) In General.--In all matters involving the reorganization or 
development of Service facilities or in the establishment of related 
employment projects to address unemployment conditions in economically 
depressed areas, the Bureau of Indian Affairs and the Service shall 
give priority to locating such facilities and projects on Indian lands, 
or lands in Alaska owned by any Alaska Native village, or village or 
regional corporation under the Alaska Native Claims Settlement Act (43 
U.S.C. 1601 et seq.), or any land allotted to any Alaska Native, if 
requested by the Indian owner and the Indian Tribe with jurisdiction 
over such lands or other lands owned or leased by the Indian Tribe or 
Tribal Organization. Top priority shall be given to Indian land owned 
by 1 or more Indian Tribes.
    ``(b) Definition.--For purposes of this section, the term `Indian 
lands' means--
            ``(1) all lands within the exterior boundaries of any 
        reservation; and
            ``(2) any lands title to which is held in trust by the 
        United States for the benefit of any Indian Tribe or individual 
        Indian or held by any Indian Tribe or individual Indian subject 
        to restriction by the United States against alienation.

``SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE FACILITIES.

    ``(a) Report.--The Secretary shall submit to the President, for 
inclusion in the report required to be transmitted to Congress under 
section 801, a report which identifies the backlog of maintenance and 
repair work required at both Service and tribal health care facilities, 
including new health care facilities expected to be in operation in the 
next fiscal year. The report shall also identify the need for 
renovation and expansion of existing facilities to support the growth 
of health care programs.
    ``(b) Maintenance of Newly Constructed Space.--The Secretary, 
acting through the Service, is authorized to expend maintenance and 
improvement funds to support maintenance of newly constructed space 
only if such space falls within the approved supportable space 
allocation for the Indian Tribe or Tribal Organization. Supportable 
space allocation shall be defined through the health care facility 
priority system under section 301(c).
    ``(c) Replacement Facilities.--In addition to using maintenance and 
improvement funds for renovation, modernization, and expansion of 
facilities, an Indian Tribe or Tribal Organization may use maintenance 
and improvement funds for construction of a replacement facility if the 
costs of renovation of such facility would exceed a maximum renovation 
cost threshold. The Secretary shall consult with Indian Tribes and 
Tribal Organizations in determining the maximum renovation cost 
threshold.

``SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY OWNED QUARTERS.

    ``(a) Rental Rates.--
            ``(1) Establishment.--Notwithstanding any other provision 
        of law, a Tribal Health Program which operates a hospital or 
        other health facility and the federally owned quarters 
        associated therewith pursuant to a contract or compact under 
        the Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 450 et seq.) shall have the authority to establish the 
        rental rates charged to the occupants of such quarters by 
        providing notice to the Secretary of its election to exercise 
        such authority.
            ``(2) Objectives.--In establishing rental rates pursuant to 
        authority of this subsection, a Tribal Health Program shall 
        endeavor to achieve the following objectives:
                    ``(A) To base such rental rates on the reasonable 
                value of the quarters to the occupants thereof.
                    ``(B) To generate sufficient funds to prudently 
                provide for the operation and maintenance of the 
                quarters, and subject to the discretion of the Tribal 
                Health Program, to supply reserve funds for capital 
                repairs and replacement of the quarters.
            ``(3) Equitable funding.--Any quarters whose rental rates 
        are established by a Tribal Health Program pursuant to this 
        subsection shall remain eligible for quarters improvement and 
        repair funds to the same extent as all federally owned quarters 
        used to house personnel in Services-supported programs.
            ``(4) Notice of rate change.--A Tribal Health Program which 
        exercises the authority provided under this subsection shall 
        provide occupants with no less than 60 days notice of any 
        change in rental rates.
    ``(b) Direct Collection of Rent.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, and subject to paragraph (2), a Tribal Health Program 
        shall have the authority to collect rents directly from Federal 
        employees who occupy such quarters in accordance with the 
        following:
                    ``(A) The Tribal Health Program shall notify the 
                Secretary and the subject Federal employees of its 
                election to exercise its authority to collect rents 
                directly from such Federal employees.
                    ``(B) Upon receipt of a notice described in 
                subparagraph (A), the Federal employees shall pay rents 
                for occupancy of such quarters directly to the Tribal 
                Health Program and the Secretary shall have no further 
                authority to collect rents from such employees through 
                payroll deduction or otherwise.
                    ``(C) Such rent payments shall be retained by the 
                Tribal Health Program and shall not be made payable to 
                or otherwise be deposited with the United States.
                    ``(D) Such rent payments shall be deposited into a 
                separate account which shall be used by the Tribal 
                Health Program for the maintenance (including capital 
                repairs and replacement) and operation of the quarters 
                and facilities as the Tribal Health Program shall 
                determine.
            ``(2) Retrocession of authority.--If a Tribal Health 
        Program which has made an election under paragraph (1) requests 
        retrocession of its authority to directly collect rents from 
        Federal employees occupying federally owned quarters, such 
        retrocession shall become effective on the earlier of--
                    ``(A) the first day of the month that begins no 
                less than 180 days after the Tribal Health Program 
                notifies the Secretary of its desire to retrocede; or
                    ``(B) such other date as may be mutually agreed by 
                the Secretary and the Tribal Health Program.
    ``(c) Rates in Alaska.--To the extent that a Tribal Health Program, 
pursuant to authority granted in subsection (a), establishes rental 
rates for federally owned quarters provided to a Federal employee in 
Alaska, such rents may be based on the cost of comparable private 
rental housing in the nearest established community with a year-round 
population of 1,500 or more individuals.

``SEC. 315. APPLICABILITY OF BUY AMERICAN ACT REQUIREMENT.

    ``(a) Applicability.--The Secretary shall ensure that the 
requirements of the Buy American Act apply to all procurements made 
with funds provided pursuant to section 317. Indian Tribes and Tribal 
Organizations shall be exempt from these requirements.
    ``(b) Effect of Violation.--If it has been finally determined by a 
court or Federal agency that any person intentionally affixed a label 
bearing a `Made in America' inscription or any inscription with the 
same meaning, to any product sold in or shipped to the United States 
that is not made in the United States, such person shall be ineligible 
to receive any contract or subcontract made with funds provided 
pursuant to section 317, pursuant to the debarment, suspension, and 
ineligibility procedures described in sections 9.400 through 9.409 of 
title 48, Code of Federal Regulations.
    ``(c) Definitions.--For purposes of this section, the term `Buy 
American Act' means title III of the Act entitled `An Act making 
appropriations for the Treasury and Post Office Departments for the 
fiscal year ending June 30, 1934, and for other purposes', approved 
March 3, 1933 (41 U.S.C. 10a et seq.).

``SEC. 316. OTHER FUNDING FOR FACILITIES.

    ``(a) Authority To Accept Funds.--The Secretary is authorized to 
accept from any source, including Federal and State agencies, funds 
that are available for the construction of health care facilities and 
use such funds to plan, design, and construct health care facilities 
for Indians and to place such funds into a contract or compact under 
the Indian Self-Determination and Education Assistance Act (25 U.S.C. 
450 et seq.). Receipt of such funds shall have no effect on the 
priorities established pursuant to section 301.
    ``(b) Interagency Agreements.--The Secretary is authorized to enter 
into interagency agreements with other Federal agencies or State 
agencies and other entities and to accept funds from such Federal or 
State agencies or other sources to provide for the planning, design, 
and construction of health care facilities to be administered by Indian 
Health Programs in order to carry out the purposes of this Act and the 
purposes for which the funds were appropriated or for which the funds 
were otherwise provided.
    ``(c) Transferred Funds.--Any Federal agency to which funds for the 
construction of health care facilities are appropriated is authorized 
to transfer such funds to the Secretary for the construction of health 
care facilities to carry out the purposes of this Act as well as the 
purposes for which such funds are appropriated to such other Federal 
agency.
    ``(d) Establishment of Standards.--The Secretary, through the 
Service, shall establish standards by regulation for the planning, 
design, and construction of health care facilities serving Indians 
under this Act.

``SEC. 317. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2025 to carry out 
this title.

                 ``TITLE IV--ACCESS TO HEALTH SERVICES

``SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT HEALTH 
              BENEFITS PROGRAMS.

    ``(a) Disregard of Medicare, Medicaid, and SCHIP Payments in 
Determining Appropriations.--Any payments received by an Indian Health 
Program or by an urban Indian organization under title XVIII, XIX, or 
XXI of the Social Security Act for services provided to Indians 
eligible for benefits under such respective titles shall not be 
considered in determining appropriations for the provision of health 
care and services to Indians.
    ``(b) Nonpreferential Treatment.--Nothing in this Act authorizes 
the Secretary to provide services to an Indian with coverage under 
title XVIII, XIX, or XXI of the Social Security Act in preference to an 
Indian without such coverage.
    ``(c) Use of Funds.--
            ``(1) Special fund.--
                    ``(A) 100 percent pass-through of payments due to 
                facilities.--Notwithstanding any other provision of 
                law, but subject to paragraph (2), payments to which a 
                facility of the Service is entitled by reason of a 
                provision of title XVIII or XIX of the Social Security 
                Act shall be placed in a special fund to be held by the 
                Secretary. In making payments from such fund, the 
                Secretary shall ensure that each Service Unit of the 
                Service receives 100 percent of the amount to which the 
                facilities of the Service, for which such Service Unit 
                makes collections, are entitled by reason of a 
                provision of either such title.
                    ``(B) Use of funds.--Amounts received by a facility 
                of the Service under subparagraph (A) by reason of a 
                provision of title XVIII or XIX of the Social Security 
                Act shall first be used (to such extent or in such 
                amounts as are provided in appropriation Acts) for the 
                purpose of making any improvements in the programs of 
                the Service operated by or through such facility which 
                may be necessary to achieve or maintain compliance with 
                the applicable conditions and requirements of such 
                respective title. Any amounts so received that are in 
                excess of the amount necessary to achieve or maintain 
                such conditions and requirements shall, subject to 
                consultation with the Indian Tribes being served by the 
                Service Unit, be used for increasing the facility's 
                capacity to provide, or improving the quality or 
                accessibility of, services.
            ``(2) Direct payment option.--Paragraph (1) shall not apply 
        to a Tribal Health Program upon the election of such Program 
        under subsection (d) to receive payments directly. No payment 
        may be made out of the special fund described in such paragraph 
        with respect to reimbursement made for services provided by 
        such Program during the period of such election.
    ``(d) Direct Billing.--
            ``(1) In general.--Subject to complying with the 
        requirements of paragraph (2), a Tribal Health Program may 
        elect to directly bill for, and receive payment for, health 
        care items and services provided by such Program for which 
        payment is made under title XVIII, XIX, or XXI of the Social 
        Security Act.
            ``(2) Direct reimbursement.--
                    ``(A) Use of funds.--Each Tribal Health Program 
                making the election described in paragraph (1) with 
                respect to a program under title XVIII, XIX, or XXI of 
                the Social Security Act shall be reimbursed directly by 
                that program for items and services furnished without 
                regard to subsection (c)(1), but all amounts so 
                reimbursed shall be used by the Tribal Health Program 
                for the same purposes with respect to such Program for 
                which payment under subparagraph (A) of subsection 
                (c)(1) to a facility of the Service may be used 
                pursuant to subparagraph (B) of such subsection with 
                respect to the Service.
                    ``(B) Audits.--The amounts paid to a Tribal Health 
                Program making the election described in paragraph (1) 
                with respect to a program under title XVIII, XIX, or 
                XXI of the Social Security Act shall be subject to all 
                auditing requirements applicable to the program under 
                such title, as well as all auditing requirements 
                applicable to programs administered by an Indian Health 
                Program. Nothing in the preceding sentence shall be 
                construed as limiting the application of auditing 
                requirements applicable to amounts paid under title 
                XVIII, XIX, or XXI of the Social Security Act.
                    ``(C) Identification of source of payments.--Any 
                Tribal Health Program that receives reimbursements or 
                payments under title XVIII, XIX, or XXI of the Social 
                Security Act shall provide to the Service a list of 
                each provider enrollment number (or other identifier) 
                under which such Program receives such reimbursements 
                or payments.
            ``(3) Examination and implementation of changes.--
                    ``(A) In general.--The Secretary, acting through 
                the Service and with the assistance of the 
                Administrator of the Centers for Medicare & Medicaid 
                Services, shall examine on an ongoing basis and 
                implement any administrative changes that may be 
                necessary to facilitate direct billing and 
                reimbursement under the program established under this 
                subsection, including any agreements with States that 
                may be necessary to provide for direct billing under a 
                program under title XIX or XXI of the Social Security 
                Act.
                    ``(B) Coordination of information.--The Service 
                shall provide the Administrator of the Centers for 
                Medicare & Medicaid Services with copies of the lists 
                submitted to the Service under paragraph (2)(C), 
                enrollment data regarding patients served by the 
                Service (and by Tribal Health Programs, to the extent 
                such data is available to the Service), and such other 
                information as the Administrator may require for 
                purposes of administering title XVIII, XIX, or XXI of 
                the Social Security Act.
            ``(4) Withdrawal from program.--A Tribal Health Program 
        that bills directly under the program established under this 
        subsection may withdraw from participation in the same manner 
        and under the same conditions that an Indian Tribe or Tribal 
        Organization may retrocede a contracted program to the 
        Secretary under the authority of the Indian Self-Determination 
        and Education Assistance Act (25 U.S.C. 450 et seq.). All cost 
        accounting and billing authority under the program established 
        under this subsection shall be returned to the Secretary upon 
        the Secretary's acceptance of the withdrawal of participation 
        in this program.
            ``(5) Termination for failure to comply with 
        requirements.--The Secretary may terminate the participation of 
        a Tribal Health Program or in the direct billing program 
        established under this subsection if the Secretary determines 
        that the Program has failed to comply with the requirements of 
        paragraph (2). The Secretary shall provide a Tribal Health 
        Program with notice of a determination that the Program has 
        failed to comply with any such requirement and a reasonable 
        opportunity to correct such noncompliance prior to terminating 
        the Program's participation in the direct billing program 
        established under this subsection.
    ``(e) Related Provisions Under the Social Security Act.--For 
provisions related to subsections (c) and (d), see sections 1880, 1911, 
and 2107(e)(1)(D) of the Social Security Act.

``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.

    ``(a) Indian Tribes and Tribal Organizations.--From funds 
appropriated to carry out this title in accordance with section 414, 
the Secretary, acting through the Service, shall make grants to or 
enter into contracts with Indian Tribes and Tribal Organizations to 
assist such Tribes and Tribal Organizations in establishing and 
administering programs on or near reservations and trust lands, 
including programs to provide outreach and enrollment through video, 
electronic delivery methods, or telecommunication devices that allow 
real-time or time-delayed communication between individual Indians and 
the benefit program, to assist individual Indians--
            ``(1) to enroll for benefits under a program established 
        under title XVIII, XIX, or XXI of the Social Security Act; and
            ``(2) with respect to such programs for which the charging 
        of premiums and cost sharing is not prohibited under such 
        programs, to pay premiums or cost sharing for coverage for such 
        benefits, which may be based on financial need (as determined 
        by the Indian Tribe or Tribes or Tribal Organizations being 
        served based on a schedule of income levels developed or 
        implemented by such Tribe, Tribes, or Tribal Organizations).
    ``(b) Conditions.--The Secretary, acting through the Service, shall 
place conditions as deemed necessary to effect the purpose of this 
section in any grant or contract which the Secretary makes with any 
Indian Tribe or Tribal Organization pursuant to this section. Such 
conditions shall include requirements that the Indian Tribe or Tribal 
Organization successfully undertake--
            ``(1) to determine the population of Indians eligible for 
        the benefits described in subsection (a);
            ``(2) to educate Indians with respect to the benefits 
        available under the respective programs;
            ``(3) to provide transportation for such individual Indians 
        to the appropriate offices for enrollment or applications for 
        such benefits; and
            ``(4) to develop and implement methods of improving the 
        participation of Indians in receiving benefits under such 
        programs.
    ``(c) Application to Urban Indian Organizations.--
            ``(1) In general.--The provisions of subsection (a) shall 
        apply with respect to grants and other funding to urban Indian 
        organizations with respect to populations served by such 
        organizations in the same manner they apply to grants and 
        contracts with Indian Tribes and Tribal Organizations with 
        respect to programs on or near reservations.
            ``(2) Requirements.--The Secretary shall include in the 
        grants or contracts made or provided under paragraph (1) 
        requirements that are--
                    ``(A) consistent with the requirements imposed by 
                the Secretary under subsection (b);
                    ``(B) appropriate to urban Indian organizations and 
                urban Indians; and
                    ``(C) necessary to effect the purposes of this 
                section.
    ``(d) Facilitating Cooperation in Enrollment and Retention.--The 
Secretary, acting through the Centers for Medicare & Medicaid Services, 
shall consult with States, the Service, Indian Tribes, Tribal 
Organizations, and urban Indian organizations to develop and 
disseminate best practices with respect to facilitating agreements 
between the States and Indian Tribes, Tribal Organizations, and urban 
Indian organizations relating to enrollment and retention of Indians in 
programs established under titles XVIII, XIX, and XXI of the Social 
Security Act.
    ``(e) Agreements To Improve Enrollment of Indians Under Social 
Security Act Health Benefits Programs.--For provisions relating to 
agreements between the Secretary and the Service, Indian Tribes, Tribal 
Organizations, and urban Indian organizations for the collection, 
preparation, and submission of applications by Indians for assistance 
under the Medicaid and children's health insurance programs established 
under titles XIX and XXI of the Social Security Act, and benefits under 
the Medicare program established under title XVIII of such Act, see 
subsections (a) and (b) of section 1139 of the Social Security Act.
    ``(f) Definitions.--In this section:
            ``(1) Premium.--The term `premium' includes any enrollment 
        fee or similar charge.
            ``(2) Cost sharing.--The term `cost sharing' includes any 
        deduction, deductible, copayment, coinsurance, or similar 
        charge.
            ``(3) Benefits.--The term `benefits' means, with respect 
        to--
                    ``(A) title XVIII of the Social Security Act, 
                benefits under such title;
                    ``(B) title XIX of such Act, medical assistance 
                under such title; and
                    ``(C) title XXI of such Act, assistance under such 
                title.

``SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF HEALTH 
              SERVICES.

    ``(a) Right of Recovery.--Except as provided in subsection (f), the 
United States, an Indian Tribe, or Tribal Organization shall have the 
right to recover from an insurance company, health maintenance 
organization, employee benefit plan, third-party tortfeasor, or any 
other responsible or liable third party (including a political 
subdivision or local governmental entity of a State) the reasonable 
charges billed by the Secretary, an Indian Tribe, or Tribal 
Organization, or, if higher, the highest amount the third party would 
pay for care and services furnished by providers other than 
governmental entities, in providing health services through the 
Service, an Indian Tribe, or Tribal Organization to any individual to 
the same extent that such individual, or any nongovernmental provider 
of such services, would be eligible to receive damages, reimbursement, 
or indemnification for such charges if--
            ``(1) such services had been provided by a nongovernmental 
        provider; and
            ``(2) such individual had been required to pay such charges 
        or expenses and did pay such charges or expenses.
    ``(b) Limitations on Recoveries From States.--Subsection (a) shall 
provide a right of recovery against any State, only if the injury, 
illness, or disability for which health services were provided is 
covered under--
            ``(1) workers' compensation laws; or
            ``(2) a no-fault automobile accident insurance plan or 
        program.
    ``(c) Nonapplication of Other Laws.--No law of any State, or of any 
political subdivision of a State and no provision of any contract, 
insurance or health maintenance organization policy, employee benefit 
plan, self-insurance plan, managed care plan, or other health care plan 
or program entered into or renewed after the date of the enactment of 
the Indian Health Care Amendments of 1988, shall prevent or hinder the 
right of recovery of the United States, an Indian Tribe, or Tribal 
Organization under subsection (a).
    ``(d) No Effect on Private Rights of Action.--No action taken by 
the United States, an Indian Tribe, or Tribal Organization to enforce 
the right of recovery provided under this section shall operate to deny 
to the injured person the recovery for that portion of the person's 
damage not covered hereunder.
    ``(e) Enforcement.--
            ``(1) In general.--The United States, an Indian Tribe, or 
        Tribal Organization may enforce the right of recovery provided 
        under subsection (a) by--
                    ``(A) intervening or joining in any civil action or 
                proceeding brought--
                            ``(i) by the individual for whom health 
                        services were provided by the Secretary, an 
                        Indian Tribe, or Tribal Organization; or
                            ``(ii) by any representative or heirs of 
                        such individual, or
                    ``(B) instituting a civil action, including a civil 
                action for injunctive relief and other relief and 
                including, with respect to a political subdivision or 
                local governmental entity of a State, such an action 
                against an official thereof.
            ``(2) Notice.--All reasonable efforts shall be made to 
        provide notice of action instituted under paragraph (1)(B) to 
        the individual to whom health services were provided, either 
        before or during the pendency of such action.
            ``(3) Recovery from tortfeasors.--
                    ``(A) In general.--In any case in which an Indian 
                Tribe or Tribal Organization that is authorized or 
                required under a compact or contract issued pursuant to 
                the Indian Self-Determination and Education Assistance 
                Act (25 U.S.C. 450 et seq.) to furnish or pay for 
                health services to a person who is injured or suffers a 
                disease on or after the date of enactment of the Indian 
                Health Care Improvement Act Amendments of 2009 under 
                circumstances that establish grounds for a claim of 
                liability against the tortfeasor with respect to the 
                injury or disease, the Indian Tribe or Tribal 
                Organization shall have a right to recover from the 
                tortfeasor (or an insurer of the tortfeasor) the 
                reasonable value of the health services so furnished, 
                paid for, or to be paid for, in accordance with the 
                Federal Medical Care Recovery Act (42 U.S.C. 2651 et 
                seq.), to the same extent and under the same 
                circumstances as the United States may recover under 
                that Act.
                    ``(B) Treatment.--The right of an Indian Tribe or 
                Tribal Organization to recover under subparagraph (A) 
                shall be independent of the rights of the injured or 
                diseased person served by the Indian Tribe or Tribal 
                Organization.
    ``(f) Limitation.--Absent specific written authorization by the 
governing body of an Indian Tribe for the period of such authorization 
(which may not be for a period of more than 1 year and which may be 
revoked at any time upon written notice by the governing body to the 
Service), the United States shall not have a right of recovery under 
this section if the injury, illness, or disability for which health 
services were provided is covered under a self-insurance plan funded by 
an Indian Tribe, Tribal Organization, or urban Indian organization. 
Where such authorization is provided, the Service may receive and 
expend such amounts for the provision of additional health services 
consistent with such authorization.
    ``(g) Costs and Attorneys' Fees.--In any action brought to enforce 
the provisions of this section, a prevailing plaintiff shall be awarded 
its reasonable attorneys' fees and costs of litigation.
    ``(h) Nonapplication of Claims Filing Requirements.--An insurance 
company, health maintenance organization, self-insurance plan, managed 
care plan, or other health care plan or program (under the Social 
Security Act or otherwise) may not deny a claim for benefits submitted 
by the Service or by an Indian Tribe or Tribal Organization based on 
the format in which the claim is submitted if such format complies with 
the format required for submission of claims under title XVIII of the 
Social Security Act or recognized under section 1175 of such Act.
    ``(i) Application to Urban Indian Organizations.--The previous 
provisions of this section shall apply to urban Indian organizations 
with respect to populations served by such Organizations in the same 
manner they apply to Indian Tribes and Tribal Organizations with 
respect to populations served by such Indian Tribes and Tribal 
Organizations.
    ``(j) Statute of Limitations.--The provisions of section 2415 of 
title 28, United States Code, shall apply to all actions commenced 
under this section, and the references therein to the United States are 
deemed to include Indian Tribes, Tribal Organizations, and urban Indian 
organizations.
    ``(k) Savings.--Nothing in this section shall be construed to limit 
any right of recovery available to the United States, an Indian Tribe, 
or Tribal Organization under the provisions of any applicable, Federal, 
State, or Tribal law, including medical lien laws.

``SEC. 404. CREDITING OF REIMBURSEMENTS.

    ``(a) Retention of Amounts for Use by Program.--Except as provided 
in section 202(f) (relating to the Catastrophic Health Emergency Fund) 
and section 806 (relating to health services for ineligible persons), 
all reimbursements received or recovered, including under section 806, 
by reason of the provision of health services by the Service, by an 
Indian Tribe or Tribal Organization, or by an urban Indian 
organization, shall be credited to the Service, such Indian Tribe or 
Tribal Organization, or such urban Indian organization, respectively, 
and may be used as provided in section 401. In the case of such a 
service provided by or through a Service Unit, such amounts shall be 
credited to such unit and used for such purposes.
    ``(b) No Offset of Amounts.--The Service may not offset or limit 
any amount obligated to any Service Unit or entity receiving funding 
from the Service because of the receipt of reimbursements under 
subsection (a).

``SEC. 405. PURCHASING HEALTH CARE COVERAGE.

    ``(a) Purchasing Coverage.--
            ``(1) In general.--Insofar as amounts are made available 
        under law (including a provision of the Social Security Act, 
        the Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 450 et seq.), or other law, other than under section 
        402) to Indian Tribes, Tribal Organizations, and urban Indian 
        organizations for health benefits for Service beneficiaries, 
        Indian Tribes, Tribal Organizations, and urban Indian 
        organizations may use such amounts to purchase health benefits 
        coverage that qualifies as creditable coverage under section 
        2701(c)(1) of the Public Health Service Act for such 
        beneficiaries, including, subject to paragraph (2), through--
                    ``(A) a tribally owned and operated health care 
                plan;
                    ``(B) a State or locally authorized or licensed 
                health care plan;
                    ``(C) a health insurance provider or managed care 
                organization; or
                    ``(D) a self-insured plan.
            ``(2) Exception.--The coverage provided under paragraph (1) 
        may not include coverage consisting of--
                    ``(A) benefits provided under a health flexible 
                spending arrangement (as defined in section 106(c)(2) 
                of the Internal Revenue Code of 1986); or
                    ``(B) a high deductible health plan (as defined in 
                section 223(c)(2) of such Code), without regard to 
                whether the plan is purchased in conjunction with a 
                health savings account (as defined under section 223(d) 
                of such Code).
            ``(3) Permitting purchase of coverage based on financial 
        need.--The purchase of coverage by an Indian Tribe, Tribal 
        Organization, or urban Indian organization under this 
        subsection may be based on the financial needs of beneficiaries 
        (as determined by the Indian Tribe or Tribes being served based 
        on a schedule of income levels developed or implemented by such 
        Indian Tribe or Tribes).
    ``(b) Expenses for Self-Insured Plan.--In the case of a self-
insured plan under subsection (a)(4), the amounts may be used for 
expenses of operating the plan, including administration and insurance 
to limit the financial risks to the entity offering the plan.
    ``(c) Construction.--Nothing in this section shall be construed as 
affecting the use of any amounts not referred to in subsection (a).

``SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.

    ``(a) Authority.--
            ``(1) In general.--The Secretary may enter into (or expand) 
        arrangements for the sharing of medical facilities and services 
        between the Service, Indian Tribes, and Tribal Organizations 
        and the Department of Veterans Affairs and the Department of 
        Defense.
            ``(2) Consultation by secretary required.--The Secretary 
        may not finalize any arrangement between the Service and a 
        Department described in paragraph (1) without first consulting 
        with the Indian Tribes which will be significantly affected by 
        the arrangement.
    ``(b) Limitations.--The Secretary shall not take any action under 
this section or under subchapter IV of chapter 81 of title 38, United 
States Code, which would impair--
            ``(1) the priority access of any Indian to health care 
        services provided through the Service and the eligibility of 
        any Indian to receive health services through the Service;
            ``(2) the quality of health care services provided to any 
        Indian through the Service;
            ``(3) the priority access of any veteran to health care 
        services provided by the Department of Veterans Affairs;
            ``(4) the quality of health care services provided by the 
        Department of Veterans Affairs or the Department of Defense; or
            ``(5) the eligibility of any Indian who is a veteran to 
        receive health services through the Department of Veterans 
        Affairs.
    ``(c) Reimbursement.--The Service, Indian Tribe, or Tribal 
Organization shall be reimbursed by the Department of Veterans Affairs 
or the Department of Defense (as the case may be) where services are 
provided through the Service, an Indian Tribe, or a Tribal Organization 
to beneficiaries eligible for services from either such Department, 
notwithstanding any other provision of law.
    ``(d) Construction.--Nothing in this section may be construed as 
creating any right of a non-Indian veteran to obtain health services 
from the Service.

``SEC. 407. ELIGIBLE INDIAN VETERAN SERVICES.

    ``(a) Findings; Purpose.--
            ``(1) Findings.--Congress finds that--
                    ``(A) collaborations between the Secretary and the 
                Secretary of Veterans Affairs regarding the treatment 
                of Indian veterans at facilities of the Service should 
                be encouraged to the maximum extent practicable; and
                    ``(B) increased enrollment for services of the 
                Department of Veterans Affairs by veterans who are 
                members of Indian tribes should be encouraged to the 
                maximum extent practicable.
            ``(2) Purpose.--The purpose of this section is to reaffirm 
        the goals stated in the document entitled `Memorandum of 
        Understanding Between the VA/Veterans Health Administration And 
        HHS/Indian Health Service' and dated February 25, 2003 
        (relating to cooperation and resource sharing between the 
        Veterans Health Administration and Service).
    ``(b) Definitions.--In this section:
            ``(1) Eligible indian veteran.--The term `eligible Indian 
        veteran' means an Indian or Alaska Native veteran who receives 
        any medical service that is--
                    ``(A) authorized under the laws administered by the 
                Secretary of Veterans Affairs; and
                    ``(B) administered at a facility of the Service 
                (including a facility operated by an Indian tribe or 
                tribal organization through a contract or compact with 
                the Service under the Indian Self-Determination and 
                Education Assistance Act (25 U.S.C. 450 et seq.)) 
                pursuant to a local memorandum of understanding.
            ``(2) Local memorandum of understanding.--The term `local 
        memorandum of understanding' means a memorandum of 
        understanding between the Secretary (or a designee, including 
        the director of any Area Office of the Service) and the 
        Secretary of Veterans Affairs (or a designee) to implement the 
        document entitled `Memorandum of Understanding Between the VA/
        Veterans Health Administration And HHS/Indian Health Service' 
        and dated February 25, 2003 (relating to cooperation and 
        resource sharing between the Veterans Health Administration and 
        Indian Health Service).
    ``(c) Eligible Indian Veterans' Expenses.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, the Secretary shall provide for veteran-related expenses 
        incurred by eligible Indian veterans as described in subsection 
        (b)(1)(B).
            ``(2) Method of payment.--The Secretary shall establish 
        such guidelines as the Secretary determines to be appropriate 
        regarding the method of payments to the Secretary of Veterans 
        Affairs under paragraph (1).
    ``(d) Tribal Approval of Memoranda.--In negotiating a local 
memorandum of understanding with the Secretary of Veterans Affairs 
regarding the provision of services to eligible Indian veterans, the 
Secretary shall consult with each Indian tribe that would be affected 
by the local memorandum of understanding.
    ``(e) Funding.--
            ``(1) Treatment.--Expenses incurred by the Secretary in 
        carrying out subsection (c)(1) shall not be considered to be 
        Contract Health Service expenses.
            ``(2) Use of funds.--Of funds made available to the 
        Secretary in appropriations Acts for the Service (excluding 
        funds made available for facilities, Contract Health Services, 
        or contract support costs), the Secretary shall use such sums 
        as are necessary to carry out this section.

``SEC. 408. PAYOR OF LAST RESORT.

    ``Indian Health Programs and health care programs operated by Urban 
Indian Organizations shall be the payor of last resort for services 
provided to persons eligible for services from Indian Health Programs 
and Urban Indian Organizations, notwithstanding any Federal, State, or 
local law to the contrary.

``SEC. 409. NONDISCRIMINATION UNDER FEDERAL HEALTH CARE PROGRAMS IN 
              QUALIFICATIONS FOR REIMBURSEMENT FOR SERVICES.

    ``(a) Requirement To Satisfy Generally Applicable Participation 
Requirements.--
            ``(1) In general.--A Federal health care program must 
        accept an entity that is operated by the Service, an Indian 
        Tribe, Tribal Organization, or Urban Indian Organization as a 
        provider eligible to receive payment under the program for 
        health care services furnished to an Indian on the same basis 
        as any other provider qualified to participate as a provider of 
        health care services under the program if the entity meets 
        generally applicable State or other requirements for 
        participation as a provider of health care services under the 
        program.
            ``(2) Satisfaction of state or local licensure or 
        recognition requirements.--Any requirement for participation as 
        a provider of health care services under a Federal health care 
        program that an entity be licensed or recognized under the 
        State or local law where the entity is located to furnish 
        health care services shall be deemed to have been met in the 
        case of an entity operated by the Service, an Indian Tribe, 
        Tribal Organization, or Urban Indian Organization if the entity 
        meets all the applicable standards for such licensure or 
        recognition, regardless of whether the entity obtains a license 
        or other documentation under such State or local law. In 
        accordance with section 221, the absence of the licensure of a 
        health care professional employed by such an entity under the 
        State or local law where the entity is located shall not be 
        taken into account for purposes of determining whether the 
        entity meets such standards, if the professional is licensed in 
        another State.
    ``(b) Application of Exclusion From Participation in Federal Health 
Care Programs.--
            ``(1) Excluded entities.--No entity operated by the 
        Service, an Indian Tribe, Tribal Organization, or Urban Indian 
        Organization that has been excluded from participation in any 
        Federal health care program or for which a license is under 
        suspension or has been revoked by the State where the entity is 
        located shall be eligible to receive payment or reimbursement 
        under any such program for health care services furnished to an 
        Indian.
            ``(2) Excluded individuals.--No individual who has been 
        excluded from participation in any Federal health care program 
        or whose State license is under suspension shall be eligible to 
        receive payment or reimbursement under any such program for 
        health care services furnished by that individual, directly or 
        through an entity that is otherwise eligible to receive payment 
        for health care services, to an Indian.
            ``(3) Federal health care program defined.--In this 
        subsection, the term, `Federal health care program' has the 
        meaning given that term in section 1128B(f) of the Social 
        Security Act (42 U.S.C. 1320a-7b(f)), except that, for purposes 
        of this subsection, such term shall include the health 
        insurance program under chapter 89 of title 5, United States 
        Code.
    ``(c) Related Provisions.--For provisions related to 
nondiscrimination against providers operated by the Service, an Indian 
Tribe, Tribal Organization, or Urban Indian Organization, see section 
1139(c) of the Social Security Act (42 U.S.C. 1320b-9(c)).

``SEC. 410. CONSULTATION.

    ``For provisions related to consultation with representatives of 
Indian Health Programs and urban Indian organizations with respect to 
the health care programs established under titles XVIII, XIX, and XXI 
of the Social Security Act, see section 1139(d) of the Social Security 
Act (42 U.S.C. 1320b-9(d)).

``SEC. 411. STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP).

    ``For provisions relating to--
            ``(1) outreach to families of Indian children likely to be 
        eligible for child health assistance under the State children's 
        health insurance program established under title XXI of the 
        Social Security Act, see sections 2105(c)(2)(C) and 1139(a) of 
        such Act (42 U.S.C. 1397ee(c)(2), 1320b-9); and
            ``(2) ensuring that child health assistance is provided 
        under such program to targeted low-income children who are 
        Indians and that payments are made under such program to Indian 
        Health Programs and urban Indian organizations operating in the 
        State that provide such assistance, see sections 2102(b)(3)(D) 
        and 2105(c)(6)(B) of such Act (42 U.S.C. 1397bb(b)(3)(D), 
        1397ee(c)(6)(B)).

``SEC. 412. EXCLUSION WAIVER AUTHORITY FOR AFFECTED INDIAN HEALTH 
              PROGRAMS AND SAFE HARBOR TRANSACTIONS UNDER THE SOCIAL 
              SECURITY ACT.

    ``For provisions relating to--
            ``(1) exclusion waiver authority for affected Indian Health 
        Programs under the Social Security Act, see section 1128(k) of 
        the Social Security Act (42 U.S.C. 1320a-7(k)); and
            ``(2) certain transactions involving Indian Health Programs 
        deemed to be in safe harbors under that Act, see section 
        1128B(b)(4) of the Social Security Act (42 U.S.C. 1320a-
        7b(b)(4)).

``SEC. 413. PREMIUM AND COST SHARING PROTECTIONS AND ELIGIBILITY 
              DETERMINATIONS UNDER MEDICAID AND SCHIP AND PROTECTION OF 
              CERTAIN INDIAN PROPERTY FROM MEDICAID ESTATE RECOVERY.

    ``For provisions relating to--
            ``(1) premiums or cost sharing protections for Indians 
        furnished items or services directly by Indian Health Programs 
        or through referral under the contract health service under the 
        Medicaid program established under title XIX of the Social 
        Security Act, see sections 1916(j) and 1916A(a)(1) of the 
        Social Security Act (42 U.S.C. 1396o(j), 1396o-1(a)(1));
            ``(2) rules regarding the treatment of certain property for 
        purposes of determining eligibility under such programs, see 
        sections 1902(e)(13) and 2107(e)(1)(B) of such Act (42 U.S.C. 
        1396a(e)(13), 1397gg(e)(1)(B)); and
            ``(3) the protection of certain property from estate 
        recovery provisions under the Medicaid program, see section 
        1917(b)(3)(B) of such Act (42 U.S.C. 1396p(b)(3)(B)).

``SEC. 414. TREATMENT UNDER MEDICAID AND SCHIP MANAGED CARE.

    ``For provisions relating to the treatment of Indians enrolled in a 
managed care entity under the Medicaid program under title XIX of the 
Social Security Act and Indian Health Programs and urban Indian 
organizations that are providers of items or services to such Indian 
enrollees, see sections 1932(h) and 2107(e)(1)(H) of the Social 
Security Act (42 U.S.C. 1396u-2(h), 1397gg(e)(1)(H)).

``SEC. 415. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY.

    ``(a) Study.--The Secretary shall conduct a study to determine the 
feasibility of treating the Navajo Nation as a State for the purposes 
of title XIX of the Social Security Act, to provide services to Indians 
living within the boundaries of the Navajo Nation through an entity 
established having the same authority and performing the same functions 
as single-State Medicaid agencies responsible for the administration of 
the State plan under title XIX of the Social Security Act.
    ``(b) Considerations.--In conducting the study, the Secretary shall 
consider the feasibility of--
            ``(1) assigning and paying all expenditures for the 
        provision of services and related administration funds, under 
        title XIX of the Social Security Act, to Indians living within 
        the boundaries of the Navajo Nation that are currently paid to 
        or would otherwise be paid to the State of Arizona, New Mexico, 
        or Utah;
            ``(2) providing assistance to the Navajo Nation in the 
        development and implementation of such entity for the 
        administration, eligibility, payment, and delivery of medical 
        assistance under title XIX of the Social Security Act;
            ``(3) providing an appropriate level of matching funds for 
        Federal medical assistance with respect to amounts such entity 
        expends for medical assistance for services and related 
        administrative costs; and
            ``(4) authorizing the Secretary, at the option of the 
        Navajo Nation, to treat the Navajo Nation as a State for the 
        purposes of title XIX of the Social Security Act (relating to 
        the State children's health insurance program) under terms 
        equivalent to those described in paragraphs (2) through (4).
    ``(c) Report.--Not later than 3 years after the date of enactment 
of the Indian Health Care Improvement Act Amendments of 2009, the 
Secretary shall submit to the Committee on Indian Affairs and Committee 
on Finance of the Senate and the Committee on Natural Resources and 
Committee on Energy and Commerce of the House of Representatives a 
report that includes--
            ``(1) the results of the study under this section;
            ``(2) a summary of any consultation that occurred between 
        the Secretary and the Navajo Nation, other Indian Tribes, the 
        States of Arizona, New Mexico, and Utah, counties which include 
        Navajo Lands, and other interested parties, in conducting this 
        study;
            ``(3) projected costs or savings associated with 
        establishment of such entity, and any estimated impact on 
        services provided as described in this section in relation to 
        probable costs or savings; and
            ``(4) legislative actions that would be required to 
        authorize the establishment of such entity if such entity is 
        determined by the Secretary to be feasible.

``SEC. 416. EXCEPTION FOR EXCEPTED BENEFITS.

    ``The previous provisions of this title shall not apply to the 
provision of excepted benefits described in paragraph (1)(A) or (3) of 
section 2791(c) of the Public Health Service Act (42 U.S.C. 300gg-
91(c)).

``SEC. 417. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated such sums as may be 
necessary to carry out this title.

              ``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

``SEC. 501. PURPOSE.

    ``The purpose of this title is to establish and maintain programs 
in Urban Centers to make health services more accessible and available 
to Urban Indians.

``SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN ORGANIZATIONS.

    ``Under authority of the Act of November 2, 1921 (25 U.S.C. 13) 
(commonly known as the `Snyder Act'), the Secretary, acting through the 
Service, shall enter into contracts with, or make grants to, urban 
Indian organizations to assist such organizations in the establishment 
and administration, within Urban Centers, of programs which meet the 
requirements set forth in this title. Subject to section 506, the 
Secretary, acting through the Service, shall include such conditions as 
the Secretary considers necessary to effect the purpose of this title 
in any contract into which the Secretary enters with, or in any grant 
the Secretary makes to, any urban Indian organization pursuant to this 
title.

``SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH CARE AND 
              REFERRAL SERVICES.

    ``(a) Requirements for Grants and Contracts.--Under authority of 
the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the 
`Snyder Act'), the Secretary, acting through the Service, shall enter 
into contracts with, and make grants to, urban Indian organizations for 
the provision of health care and referral services for Urban Indians. 
Any such contract or grant shall include requirements that the urban 
Indian organization successfully undertake to--
            ``(1) estimate the population of Urban Indians residing in 
        the Urban Center or centers that the organization proposes to 
        serve who are or could be recipients of health care or referral 
        services;
            ``(2) estimate the current health status of Urban Indians 
        residing in such Urban Center or centers;
            ``(3) estimate the current health care needs of Urban 
        Indians residing in such Urban Center or centers;
            ``(4) provide basic health education, including health 
        promotion and disease prevention education, to Urban Indians;
            ``(5) make recommendations to the Secretary and Federal, 
        State, local, and other resource agencies on methods of 
        improving health service programs to meet the needs of Urban 
        Indians; and
            ``(6) where necessary, provide, or enter into contracts for 
        the provision of, health care services for Urban Indians.
    ``(b) Criteria.--The Secretary, acting through the Service, shall, 
by regulation, prescribe the criteria for selecting urban Indian 
organizations to enter into contracts or receive grants under this 
section. Such criteria shall, among other factors, include--
            ``(1) the extent of unmet health care needs of Urban 
        Indians in the Urban Center or centers involved;
            ``(2) the size of the urban Indian population in the Urban 
        Center or centers involved;
            ``(3) the extent, if any, to which the activities set forth 
        in subsection (a) would duplicate any project funded under this 
        title, or under any current public health service project 
        funded in a manner other than pursuant to this title;
            ``(4) the capability of an urban Indian organization to 
        perform the activities set forth in subsection (a) and to enter 
        into a contract with the Secretary or to meet the requirements 
        for receiving a grant under this section;
            ``(5) the satisfactory performance and successful 
        completion by an urban Indian organization of other contracts 
        with the Secretary under this title;
            ``(6) the appropriateness and likely effectiveness of 
        conducting the activities set forth in subsection (a) in an 
        Urban Center or centers; and
            ``(7) the extent of existing or likely future participation 
        in the activities set forth in subsection (a) by appropriate 
        health and health-related Federal, State, local, and other 
        agencies.
    ``(c) Access to Health Promotion and Disease Prevention Programs.--
The Secretary, acting through the Service, shall facilitate access to 
or provide health promotion and disease prevention services for Urban 
Indians through grants made to urban Indian organizations administering 
contracts entered into or receiving grants under subsection (a).
    ``(d) Immunization Services.--
            ``(1) Access or services provided.--The Secretary, acting 
        through the Service, shall facilitate access to, or provide, 
        immunization services for Urban Indians through grants made to 
        urban Indian organizations administering contracts entered into 
        or receiving grants under this section.
            ``(2) Definition.--For purposes of this subsection, the 
        term `immunization services' means services to provide without 
        charge immunizations against vaccine-preventable diseases.
    ``(e) Behavioral Health Services.--
            ``(1) Access or services provided.--The Secretary, acting 
        through the Service, shall facilitate access to, or provide, 
        behavioral health services for Urban Indians through grants 
        made to urban Indian organizations administering contracts 
        entered into or receiving grants under subsection (a).
            ``(2) Assessment required.--Except as provided by paragraph 
        (3)(A), a grant may not be made under this subsection to an 
        urban Indian organization until that organization has prepared, 
        and the Service has approved, an assessment of the following:
                    ``(A) The behavioral health needs of the urban 
                Indian population concerned.
                    ``(B) The behavioral health services and other 
                related resources available to that population.
                    ``(C) The barriers to obtaining those services and 
                resources.
                    ``(D) The needs that are unmet by such services and 
                resources.
            ``(3) Purposes of grants.--Grants may be made under this 
        subsection for the following:
                    ``(A) To prepare assessments required under 
                paragraph (2).
                    ``(B) To provide outreach, educational, and 
                referral services to Urban Indians regarding the 
                availability of direct behavioral health services, to 
                educate Urban Indians about behavioral health issues 
                and services, and effect coordination with existing 
                behavioral health providers in order to improve 
                services to Urban Indians.
                    ``(C) To provide outpatient behavioral health 
                services to Urban Indians, including the identification 
                and assessment of illness, therapeutic treatments, case 
                management, support groups, family treatment, and other 
                treatment.
                    ``(D) To develop innovative behavioral health 
                service delivery models which incorporate Indian 
                cultural support systems and resources.
    ``(f) Prevention of Child Abuse.--
            ``(1) Access or services provided.--The Secretary, acting 
        through the Service, shall facilitate access to or provide 
        services for Urban Indians through grants to urban Indian 
        organizations administering contracts entered into or receiving 
        grants under subsection (a) to prevent and treat child abuse 
        (including sexual abuse) among Urban Indians.
            ``(2) Evaluation required.--Except as provided by paragraph 
        (3)(A), a grant may not be made under this subsection to an 
        urban Indian organization until that organization has prepared, 
        and the Service has approved, an assessment that documents the 
        prevalence of child abuse in the urban Indian population 
        concerned and specifies the services and programs (which may 
        not duplicate existing services and programs) for which the 
        grant is requested.
            ``(3) Purposes of grants.--Grants may be made under this 
        subsection for the following:
                    ``(A) To prepare assessments required under 
                paragraph (2).
                    ``(B) For the development of prevention, training, 
                and education programs for Urban Indians, including 
                child education, parent education, provider training on 
                identification and intervention, education on reporting 
                requirements, prevention campaigns, and establishing 
                service networks of all those involved in Indian child 
                protection.
                    ``(C) To provide direct outpatient treatment 
                services (including individual treatment, family 
                treatment, group therapy, and support groups) to Urban 
                Indians who are child victims of abuse (including 
                sexual abuse) or adult survivors of child sexual abuse, 
                to the families of such child victims, and to urban 
                Indian perpetrators of child abuse (including sexual 
                abuse).
            ``(4) Considerations when making grants.--In making grants 
        to carry out this subsection, the Secretary shall take into 
        consideration--
                    ``(A) the support for the urban Indian organization 
                demonstrated by the child protection authorities in the 
                area, including committees or other services funded 
                under the Indian Child Welfare Act of 1978 (25 U.S.C. 
                1901 et seq.), if any;
                    ``(B) the capability and expertise demonstrated by 
                the urban Indian organization to address the complex 
                problem of child sexual abuse in the community; and
                    ``(C) the assessment required under paragraph (2).
    ``(g) Other Grants.--The Secretary, acting through the Service, may 
enter into a contract with or make grants to an urban Indian 
organization that provides or arranges for the provision of health care 
services (through satellite facilities, provider networks, or 
otherwise) to Urban Indians in more than 1 Urban Center.

``SEC. 504. USE OF FEDERAL GOVERNMENT FACILITIES AND SOURCES OF SUPPLY.

    ``(a) In General.--The Secretary may permit an urban Indian 
organization that has entered into a contract or received a grant 
pursuant to this title, in carrying out such contract or grant, to use 
existing facilities and all equipment therein or pertaining thereto and 
other personal property owned by the Federal Government within the 
Secretary's jurisdiction under such terms and conditions as may be 
agreed upon for their use and maintenance.
    ``(b) Donations.--Subject to subsection (d), the Secretary may 
donate to an urban Indian organization that has entered into a contract 
or received a grant pursuant to this title any personal or real 
property determined to be excess to the needs of the Indian Health 
Service or the General Services Administration for the purposes of 
carrying out the contract or grant.
    ``(c) Acquisition of Property.--The Secretary may acquire excess or 
surplus government personal or real property for donation, subject to 
subsection (d) to an urban Indian organization that has entered into a 
contract or received a grant pursuant to this title if the Secretary 
determines that the property is appropriate for use by the urban Indian 
organization for a purpose for which a contract or grant is authorized 
under this title.
    ``(d) Priority.--In the event that the Secretary receives a request 
for a specific item of personal or real property described in 
subsections (b) or (c) from an urban Indian organization and from an 
Indian Tribe or Tribal Organization, the Secretary shall give priority 
to the request for donation to the Indian Tribe or Tribal Organization 
if the Secretary receives the request from the Indian Tribe or Tribal 
Organization before the date the Secretary transfers title to the 
property or, if earlier, the date the Secretary transfers the property 
physically, to the urban Indian organization.
    ``(e) Executive Agency Status.--For purposes of section 201(a) of 
the Federal Property and Administrative Services Act of 1949 (40 U.S.C 
481(a)) (relating to Federal sources of supply), an urban Indian 
organization that has entered into a contract or received a grant 
pursuant to this title may be deemed to be an executive agency when 
carrying out such contract or grant.

``SEC. 505. CONTRACTS AND GRANTS FOR THE DETERMINATION OF UNMET HEALTH 
              CARE NEEDS.

    ``(a) Grants and Contracts Authorized.--Under authority of the Act 
of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder 
Act'), the Secretary, acting through the Service, may enter into 
contracts with or make grants to urban Indian organizations situated in 
Urban Centers for which contracts have not been entered into or grants 
have not been made under section 503.
    ``(b) Purpose.--The purpose of a contract or grant made under this 
section shall be the determination of the matters described in 
subsection (c)(1) in order to assist the Secretary in assessing the 
health status and health care needs of Urban Indians in the Urban 
Center involved and determining whether the Secretary should enter into 
a contract or make a grant under section 503 with respect to the urban 
Indian organization which the Secretary has entered into a contract 
with, or made a grant to, under this section.
    ``(c) Grant and Contract Requirements.--Any contract entered into, 
or grant made, by the Secretary under this section shall include 
requirements that--
            ``(1) the urban Indian organization successfully undertakes 
        to--
                    ``(A) document the health care status and unmet 
                health care needs of urban Indians in the Urban Center 
                involved; and
                    ``(B) with respect to urban Indians in the Urban 
                Center involved, determine the matters described in 
                paragraphs (2), (3), (4), and (7) of section 503(b); 
                and
            ``(2) the urban Indian organization complete performance of 
        the contract, or carry out the requirements of the grant, 
        within 1 year after the date on which the Secretary and such 
        organization enter into such contract, or within 1 year after 
        such organization receives such grant, whichever is applicable.
    ``(d) No Renewals.--The Secretary may not renew any contract 
entered into or grant made under this section.

``SEC. 506. EVALUATIONS; RENEWALS.

    ``(a) Procedures for Evaluations.--The Secretary, acting through 
the Service, shall develop procedures to evaluate compliance with grant 
requirements and compliance with and performance of contracts entered 
into by urban Indian organizations under this title. Such procedures 
shall include provisions for carrying out the requirements of this 
section.
    ``(b) Evaluations.--The Secretary, acting through the Service, 
shall evaluate the compliance of each Urban Indian Organization which 
has entered into a contract or received a grant under section 503 with 
the terms of such contract or grant. For purposes of this evaluation, 
the Secretary shall--
            ``(1) acting through the Service, conduct an annual onsite 
        evaluation of the organization; or
            ``(2) accept in lieu of such onsite evaluation evidence of 
        the organization's provisional or full accreditation by a 
        private independent entity recognized by the Secretary for 
        purposes of conducting quality reviews of providers 
        participating in the Medicare program under title XVIII of the 
        Social Security Act.
    ``(c) Noncompliance; Unsatisfactory Performance.--If, as a result 
of the evaluations conducted under this section, the Secretary 
determines that an urban Indian organization has not complied with the 
requirements of a grant or complied with or satisfactorily performed a 
contract under section 503, the Secretary shall, prior to renewing such 
contract or grant, attempt to resolve with the organization the areas 
of noncompliance or unsatisfactory performance and modify the contract 
or grant to prevent future occurrences of noncompliance or 
unsatisfactory performance. If the Secretary determines that the 
noncompliance or unsatisfactory performance cannot be resolved and 
prevented in the future, the Secretary shall not renew the contract or 
grant with the organization and is authorized to enter into a contract 
or make a grant under section 503 with another urban Indian 
organization which is situated in the same Urban Center as the urban 
Indian organization whose contract or grant is not renewed under this 
section.
    ``(d) Considerations for Renewals.--In determining whether to renew 
a contract or grant with an urban Indian organization under section 503 
which has completed performance of a contract or grant under section 
504, the Secretary shall review the records of the urban Indian 
organization, the reports submitted under section 507, and shall 
consider the results of the onsite evaluations or accreditations under 
subsection (b).

``SEC. 507. OTHER CONTRACT AND GRANT REQUIREMENTS.

    ``(a) Procurement.--Contracts with urban Indian organizations 
entered into pursuant to this title shall be in accordance with all 
Federal contracting laws and regulations relating to procurement except 
that in the discretion of the Secretary, such contracts may be 
negotiated without advertising and need not conform to the provisions 
of sections 1304 and 3131 through 3133 of title 40, United States Code.
    ``(b) Payments Under Contracts or Grants.--
            ``(1) In general.--Payments under any contracts or grants 
        pursuant to this title, notwithstanding any term or condition 
        of such contract or grant--
                    ``(A) may be made in a single advance payment by 
                the Secretary to the urban Indian organization by no 
                later than the end of the first 30 days of the funding 
                period with respect to which the payments apply, unless 
                the Secretary determines through an evaluation under 
                section 505 that the organization is not capable of 
                administering such a single advance payment; and
                    ``(B) if any portion thereof is unexpended by the 
                urban Indian organization during the funding period 
                with respect to which the payments initially apply, 
                shall be carried forward for expenditure with respect 
                to allowable or reimbursable costs incurred by the 
                organization during 1 or more subsequent funding 
                periods without additional justification or 
                documentation by the organization as a condition of 
                carrying forward the availability for expenditure of 
                such funds.
            ``(2) Semiannual and quarterly payments and 
        reimbursements.--If the Secretary determines under paragraph 
        (1)(A) that an urban Indian organization is not capable of 
        administering an entire single advance payment, on request of 
        the urban Indian organization, the payments may be made--
                    ``(A) in semiannual or quarterly payments by not 
                later than 30 days after the date on which the funding 
                period with respect to which the payments apply begins; 
                or
                    ``(B) by way of reimbursement.
    ``(c) Revision or Amendment of Contracts.--Notwithstanding any 
provision of law to the contrary, the Secretary may, at the request and 
consent of an urban Indian organization, revise or amend any contract 
entered into by the Secretary with such organization under this title 
as necessary to carry out the purposes of this title.
    ``(d) Fair and Uniform Services and Assistance.--Contracts with or 
grants to urban Indian organizations and regulations adopted pursuant 
to this title shall include provisions to assure the fair and uniform 
provision to urban Indians of services and assistance under such 
contracts or grants by such organizations.

``SEC. 508. REPORTS AND RECORDS.

    ``(a) Reports.--
            ``(1) In general.--For each fiscal year during which an 
        urban Indian organization receives or expends funds pursuant to 
        a contract entered into or a grant received pursuant to this 
        title, such urban Indian organization shall submit to the 
        Secretary not more frequently than every 6 months, a report 
        that includes the following:
                    ``(A) In the case of a contract or grant under 
                section 503, recommendations pursuant to section 
                503(a)(5).
                    ``(B) Information on activities conducted by the 
                organization pursuant to the contract or grant.
                    ``(C) An accounting of the amounts and purpose for 
                which Federal funds were expended.
                    ``(D) A minimum set of data, using uniformly 
                defined elements, as specified by the Secretary after 
                consultation with urban Indian organizations.
            ``(2) Health status and services.--
                    ``(A) In general.--Not later than 18 months after 
                the date of enactment of the Indian Health Care 
                Improvement Act Amendments of 2009, the Secretary, 
                acting through the Service, shall submit to Congress a 
                report evaluating--
                            ``(i) the health status of urban Indians;
                            ``(ii) the services provided to Indians 
                        pursuant to this title; and
                            ``(iii) areas of unmet needs in the 
                        delivery of health services to urban Indians.
                    ``(B) Consultation and contracts.--In preparing the 
                report under paragraph (1), the Secretary--
                            ``(i) shall consult with urban Indian 
                        organizations; and
                            ``(ii) may enter into a contract with a 
                        national organization representing urban Indian 
                        organizations to conduct any aspect of the 
                        report.
    ``(b) Audit.--The reports and records of the urban Indian 
organization with respect to a contract or grant under this title shall 
be subject to audit by the Secretary and the Comptroller General of the 
United States.
    ``(c) Costs of Audits.--The Secretary shall allow as a cost of any 
contract or grant entered into or awarded under section 502 or 503 the 
cost of an annual independent financial audit conducted by--
            ``(1) a certified public accountant; or
            ``(2) a certified public accounting firm qualified to 
        conduct Federal compliance audits.

``SEC. 509. LIMITATION ON CONTRACT AUTHORITY.

    ``The authority of the Secretary to enter into contracts or to 
award grants under this title shall be to the extent, and in an amount, 
provided for in appropriation Acts.

``SEC. 510. FACILITIES.

    ``(a) Grants.--The Secretary, acting through the Service, may make 
grants to contractors or grant recipients under this title for the 
lease, purchase, renovation, construction, or expansion of facilities, 
including leased facilities, in order to assist such contractors or 
grant recipients in complying with applicable licensure or 
certification requirements.
    ``(b) Loan Fund Study.--The Secretary, acting through the Service, 
may carry out a study to determine the feasibility of establishing a 
loan fund to provide to urban Indian organizations direct loans or 
guarantees for loans for the construction of health care facilities in 
a manner consistent with section 309, including by submitting a report 
in accordance with subsection (c) of that section.

``SEC. 511. DIVISION OF URBAN INDIAN HEALTH.

    ``There is established within the Service a Division of Urban 
Indian Health, which shall be responsible for--
            ``(1) carrying out the provisions of this title;
            ``(2) providing central oversight of the programs and 
        services authorized under this title; and
            ``(3) providing technical assistance to urban Indian 
        organizations.

``SEC. 512. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE-RELATED SERVICES.

    ``(a) Grants Authorized.--The Secretary, acting through the 
Service, may make grants for the provision of health-related services 
in prevention of, treatment of, rehabilitation of, or school- and 
community-based education regarding, alcohol and substance abuse in 
Urban Centers to those urban Indian organizations with which the 
Secretary has entered into a contract under this title or under section 
201.
    ``(b) Goals.--Each grant made pursuant to subsection (a) shall set 
forth the goals to be accomplished pursuant to the grant. The goals 
shall be specific to each grant as agreed to between the Secretary and 
the grantee.
    ``(c) Criteria.--The Secretary shall establish criteria for the 
grants made under subsection (a), including criteria relating to the 
following:
            ``(1) The size of the urban Indian population.
            ``(2) Capability of the organization to adequately perform 
        the activities required under the grant.
            ``(3) Satisfactory performance standards for the 
        organization in meeting the goals set forth in such grant. The 
        standards shall be negotiated and agreed to between the 
        Secretary and the grantee on a grant-by-grant basis.
            ``(4) Identification of the need for services.
    ``(d) Allocation of Grants.--The Secretary shall develop a 
methodology for allocating grants made pursuant to this section based 
on the criteria established pursuant to subsection (c).
    ``(e) Grants Subject to Criteria.--Any grant received by an urban 
Indian organization under this Act for substance abuse prevention, 
treatment, and rehabilitation shall be subject to the criteria set 
forth in subsection (c).

``SEC. 513. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS.

    ``Notwithstanding any other provision of law, the Tulsa Clinic and 
Oklahoma City Clinic demonstration projects shall--
            ``(1) be permanent programs within the Service's direct 
        care program;
            ``(2) continue to be treated as Service Units and Operating 
        Units in the allocation of resources and coordination of care; 
        and
            ``(3) continue to meet the requirements and definitions of 
        an urban Indian organization in this Act, and shall not be 
        subject to the provisions of the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450 et seq.).

``SEC. 514. URBAN NIAAA TRANSFERRED PROGRAMS.

    ``(a) Grants and Contracts.--The Secretary, through the Division of 
Urban Indian Health, shall make grants or enter into contracts with 
urban Indian organizations, to take effect not later than September 30, 
2010, for the administration of urban Indian alcohol programs that were 
originally established under the National Institute on Alcoholism and 
Alcohol Abuse (hereafter in this section referred to as `NIAAA') and 
transferred to the Service.
    ``(b) Use of Funds.--Grants provided or contracts entered into 
under this section shall be used to provide support for the 
continuation of alcohol prevention and treatment services for urban 
Indian populations and such other objectives as are agreed upon between 
the Service and a recipient of a grant or contract under this section.
    ``(c) Eligibility.--Urban Indian organizations that operate Indian 
alcohol programs originally funded under the NIAAA and subsequently 
transferred to the Service are eligible for grants or contracts under 
this section.
    ``(d) Report.--The Secretary shall evaluate and report to Congress 
on the activities of programs funded under this section not less than 
every 5 years.

``SEC. 515. CONFERRING WITH URBAN INDIAN ORGANIZATIONS.

    ``(a) In General.--The Secretary shall ensure that the Service 
confers or conferences, to the greatest extent practicable, with Urban 
Indian Organizations.
    ``(b) Definition of Confer; Conference.--In this section, the terms 
`confer' and `conference' mean an open and free exchange of information 
and opinions that--
            ``(1) leads to mutual understanding and comprehension; and
            ``(2) emphasizes trust, respect, and shared responsibility.

``SEC. 516. URBAN YOUTH TREATMENT CENTER DEMONSTRATION.

    ``(a) Construction and Operation.--
            ``(1) In general.--The Secretary, acting through the 
        Service, through grant or contract, shall fund the construction 
        and operation of at least 1 residential treatment center in 
        each Service Area that meets the eligibility requirements set 
        forth in subsection (b) to demonstrate the provision of alcohol 
        and substance abuse treatment services to Urban Indian youth in 
        a culturally competent residential setting.
            ``(2) Treatment.--Each residential treatment center 
        described in paragraph (1) shall be in addition to any 
        facilities constructed under section 707(b).
    ``(b) Eligibility Requirements.--To be eligible to obtain a 
facility under subsection (a)(1), a Service Area shall meet the 
following requirements:
            ``(1) There is an Urban Indian Organization in the Service 
        Area.
            ``(2) There reside in the Service Area Urban Indian youth 
        with need for alcohol and substance abuse treatment services in 
        a residential setting.
            ``(3) There is a significant shortage of culturally 
        competent residential treatment services for Urban Indian youth 
        in the Service Area.

``SEC. 517. GRANTS FOR DIABETES PREVENTION, TREATMENT, AND CONTROL.

    ``(a) Grants Authorized.--The Secretary may make grants to those 
urban Indian organizations that have entered into a contract or have 
received a grant under this title for the provision of services for the 
prevention and treatment of, and control of the complications resulting 
from, diabetes among urban Indians.
    ``(b) Goals.--Each grant made pursuant to subsection (a) shall set 
forth the goals to be accomplished under the grant. The goals shall be 
specific to each grant as agreed to between the Secretary and the 
grantee.
    ``(c) Establishment of Criteria.--The Secretary shall establish 
criteria for the grants made under subsection (a) relating to--
            ``(1) the size and location of the urban Indian population 
        to be served;
            ``(2) the need for prevention of and treatment of, and 
        control of the complications resulting from, diabetes among the 
        urban Indian population to be served;
            ``(3) performance standards for the organization in meeting 
        the goals set forth in such grant that are negotiated and 
        agreed to by the Secretary and the grantee;
            ``(4) the capability of the organization to adequately 
        perform the activities required under the grant; and
            ``(5) the willingness of the organization to collaborate 
        with the registry, if any, established by the Secretary under 
        section 204(e) in the Area Office of the Service in which the 
        organization is located.
    ``(d) Funds Subject to Criteria.--Any funds received by an urban 
Indian organization under this Act for the prevention, treatment, and 
control of diabetes among urban Indians shall be subject to the 
criteria developed by the Secretary under subsection (c).

``SEC. 518. COMMUNITY HEALTH REPRESENTATIVES.

    ``The Secretary, acting through the Service, may enter into 
contracts with, and make grants to, urban Indian organizations for the 
employment of Indians trained as health service providers through the 
Community Health Representatives Program under section 109 in the 
provision of health care, health promotion, and disease prevention 
services to urban Indians.

``SEC. 519. EFFECTIVE DATE.

    ``The amendments made by the Indian Health Care Improvement Act 
Amendments of 2009 to this title shall take effect beginning on the 
date of enactment of that Act, regardless of whether the Secretary has 
promulgated regulations implementing such amendments.

``SEC. 520. ELIGIBILITY FOR SERVICES.

    ``Urban Indians shall be eligible for, and the ultimate 
beneficiaries of, health care or referral services provided pursuant to 
this title.

``SEC. 521. AUTHORIZATION OF APPROPRIATIONS.

    ``(a) In General.--There are authorized to be appropriated such 
sums as may be necessary for each fiscal year through fiscal year 2025 
to carry out this title.
    ``(b) Urban Indian Organizations.--The Secretary, acting through 
the Service, is authorized to establish programs, including programs 
for the awarding of grants, for urban Indian organizations that are 
identical to any programs established pursuant to section 126 
(behavioral health training), section 210 (school health education), 
section 212 (prevention of communicable diseases), section 701 
(behavioral health prevention and treatment services), and section 
707(g) (multidrug abuse program).

``SEC. 522. HEALTH INFORMATION TECHNOLOGY.

    ``The Secretary, acting through the Service, may make grants to 
urban Indian organizations under this title for the development, 
adoption, and implementation of health information technology (as 
defined in section 3000(5) of the American Recovery and Reinvestment 
Act), telemedicine services development, and related infrastructure.

                ``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

``SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN AGENCY OF 
              THE PUBLIC HEALTH SERVICE.

    ``(a) Establishment.--
            ``(1) In general.--In order to more effectively and 
        efficiently carry out the responsibilities, authorities, and 
        functions of the United States to provide health care services 
        to Indians and Indian Tribes, as are or may be hereafter 
        provided by Federal statute or treaties, there is established 
        within the Public Health Service of the Department the Indian 
        Health Service.
            ``(2) Assistant secretary of indian health.--The Service 
        shall be administered by an Assistant Secretary of Indian 
        Health, who shall be appointed by the President, by and with 
        the advice and consent of the Senate. The Assistant Secretary 
        shall report to the Secretary. Effective with respect to an 
        individual appointed by the President, by and with the advice 
        and consent of the Senate, after January 1, 2010, the term of 
        service of the Assistant Secretary shall be 4 years. An 
        Assistant Secretary may serve more than 1 term.
            ``(3) Incumbent.--The individual serving in the position of 
        Director of the Service on the day before the date of enactment 
        of the Indian Health Care Improvement Act Amendments of 2009 
        shall serve as Assistant Secretary.
            ``(4) Advocacy and consultation.--The position of Assistant 
        Secretary is established to, in a manner consistent with the 
        government-to-government relationship between the United States 
        and Indian Tribes--
                    ``(A) facilitate advocacy for the development of 
                appropriate Indian health policy; and
                    ``(B) promote consultation on matters relating to 
                Indian health.
    ``(b) Agency.--The Service shall be an agency within the Public 
Health Service of the Department, and shall not be an office, 
component, or unit of any other agency of the Department.
    ``(c) Duties.--The Assistant Secretary shall--
            ``(1) perform all functions that were, on the day before 
        the date of enactment of the Indian Health Care Improvement Act 
        Amendments of 2009, carried out by or under the direction of 
        the individual serving as Director of the Service on that day;
            ``(2) perform all functions of the Secretary relating to 
        the maintenance and operation of hospital and health facilities 
        for Indians and the planning for, and provision and utilization 
        of, health services for Indians;
            ``(3) administer all health programs under which health 
        care is provided to Indians based upon their status as Indians 
        which are administered by the Secretary, including programs 
        under--
                    ``(A) this Act;
                    ``(B) the Act of November 2, 1921 (25 U.S.C. 13);
                    ``(C) the Act of August 5, 1954 (42 U.S.C. 2001 et 
                seq.);
                    ``(D) the Act of August 16, 1957 (42 U.S.C. 2005 et 
                seq.); and
                    ``(E) the Indian Self-Determination and Education 
                Assistance Act (25 U.S.C. 450 et seq.);
            ``(4) administer all scholarship and loan functions carried 
        out under title I;
            ``(5) report directly to the Secretary concerning all 
        policy- and budget-related matters affecting Indian health;
            ``(6) collaborate with the Assistant Secretary for Health 
        concerning appropriate matters of Indian health that affect the 
        agencies of the Public Health Service;
            ``(7) advise each Assistant Secretary of the Department 
        concerning matters of Indian health with respect to which that 
        Assistant Secretary has authority and responsibility;
            ``(8) advise the heads of other agencies and programs of 
        the Department concerning matters of Indian health with respect 
        to which those heads have authority and responsibility;
            ``(9) coordinate the activities of the Department 
        concerning matters of Indian health; and
            ``(10) perform such other functions as the Secretary may 
        designate.
    ``(d) Authority.--
            ``(1) In general.--The Secretary, acting through the 
        Assistant Secretary, shall have the authority--
                    ``(A) except to the extent provided for in 
                paragraph (2), to appoint and compensate employees for 
                the Service in accordance with title 5, United States 
                Code;
                    ``(B) to enter into contracts for the procurement 
                of goods and services to carry out the functions of the 
                Service; and
                    ``(C) to manage, expend, and obligate all funds 
                appropriated for the Service.
            ``(2) Personnel actions.--Notwithstanding any other 
        provision of law, the provisions of section 12 of the Act of 
        June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to all 
        personnel actions taken with respect to new positions created 
        within the Service as a result of its establishment under 
        subsection (a).
    ``(e) References.--Any reference to the Director of the Indian 
Health Service in any other Federal law, Executive order, rule, 
regulation, or delegation of authority, or in any document of or 
relating to the Director of the Indian Health Service, shall be deemed 
to refer to the Assistant Secretary.

``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.

    ``(a) Establishment.--
            ``(1) In general.--The Secretary shall establish an 
        automated management information system for the Service.
            ``(2) Requirements of system.--The information system 
        established under paragraph (1) shall include--
                    ``(A) a financial management system;
                    ``(B) a patient care information system for each 
                area served by the Service;
                    ``(C) privacy protections consistent with the 
                regulations promulgated under section 264(c) of the 
                Health Insurance Portability and Accountability Act of 
                1996 or, to the extent consistent with such 
                regulations, other Federal rules applicable to privacy 
                of automated management information systems of a 
                Federal agency;
                    ``(D) a services-based cost accounting component 
                that provides estimates of the costs associated with 
                the provision of specific medical treatments or 
                services in each Area office of the Service;
                    ``(E) an interface mechanism for patient billing 
                and accounts receivable system; and
                    ``(F) a training component.
    ``(b) Provision of Systems to Tribes and Organizations.--The 
Secretary shall provide each Tribal Health Program automated management 
information systems which--
            ``(1) meet the management information needs of such Tribal 
        Health Program with respect to the treatment by the Tribal 
        Health Program of patients of the Service; and
            ``(2) meet the management information needs of the Service.
    ``(c) Access to Records.--The Service shall provide access of 
patients to their medical or health records which are held by, or on 
behalf of, the Service in accordance with the regulations promulgated 
under section 264(c) of the Health Insurance Portability and 
Accountability Act of 1996 or, to the extent consistent with such 
regulations, other Federal rules applicable to access to health care 
records.
    ``(d) Authority To Enhance Information Technology.--The Secretary, 
acting through the Assistant Secretary, shall have the authority to 
enter into contracts, agreements, or joint ventures with other Federal 
agencies, States, private and nonprofit organizations, for the purpose 
of enhancing information technology in Indian Health Programs and 
facilities.

``SEC. 603. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2025 to carry out 
this title.

                ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

``SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREATMENT SERVICES.

    ``(a) Purposes.--The purposes of this section are as follows:
            ``(1) To authorize and direct the Secretary, acting through 
        the Service, to develop a comprehensive behavioral health 
        prevention and treatment program which emphasizes collaboration 
        among alcohol and substance abuse, social services, and mental 
        health programs.
            ``(2) To provide information, direction, and guidance 
        relating to mental illness and dysfunction and self-destructive 
        behavior, including child abuse and family violence, to those 
        Federal, tribal, State, and local agencies responsible for 
        programs in Indian communities in areas of health care, 
        education, social services, child and family welfare, alcohol 
        and substance abuse, law enforcement, and judicial services.
            ``(3) To assist Indian Tribes to identify services and 
        resources available to address mental illness and dysfunctional 
        and self-destructive behavior.
            ``(4) To provide authority and opportunities for Indian 
        Tribes and Tribal Organizations to develop, implement, and 
        coordinate with community-based programs which include 
        identification, prevention, education, referral, and treatment 
        services, including through multidisciplinary resource teams.
            ``(5) To ensure that Indians, as citizens of the United 
        States and of the States in which they reside, have the same 
        access to behavioral health services to which all citizens have 
        access.
            ``(6) To modify or supplement existing programs and 
        authorities in the areas identified in paragraph (2).
    ``(b) Plans.--
            ``(1) Development.--The Secretary, acting through the 
        Service, shall encourage Indian Tribes and Tribal Organizations 
        to develop tribal plans, and urban Indian organizations to 
        develop local plans, and for all such groups to participate in 
        developing areawide plans for Indian Behavioral Health 
        Services. The plans shall include, to the extent feasible, the 
        following components:
                    ``(A) An assessment of the scope of alcohol or 
                other substance abuse, mental illness, and 
                dysfunctional and self-destructive behavior, including 
                suicide, child abuse, and family violence, among 
                Indians, including--
                            ``(i) the number of Indians served who are 
                        directly or indirectly affected by such illness 
                        or behavior; or
                            ``(ii) an estimate of the financial and 
                        human cost attributable to such illness or 
                        behavior.
                    ``(B) An assessment of the existing and additional 
                resources necessary for the prevention and treatment of 
                such illness and behavior, including an assessment of 
                the progress toward achieving the availability of the 
                full continuum of care described in subsection (c).
                    ``(C) An estimate of the additional funding needed 
                by the Service, Indian Tribes, Tribal Organizations, 
                and urban Indian organizations to meet their 
                responsibilities under the plans.
            ``(2) National clearinghouse.--The Secretary, acting 
        through the Service, shall coordinate with existing national 
        clearinghouses and information centers to include at the 
        clearinghouses and centers plans and reports on the outcomes of 
        such plans developed by Indian Tribes, Tribal Organizations, 
        urban Indian organizations, and Service Areas relating to 
        behavioral health. The Secretary shall ensure access to these 
        plans and outcomes by any Indian Tribe, Tribal Organization, 
        urban Indian organization, or the Service.
            ``(3) Technical assistance.--The Secretary shall provide 
        technical assistance to Indian Tribes, Tribal Organizations, 
        and urban Indian organizations in preparation of plans under 
        this section and in developing standards of care that may be 
        used and adopted locally.
    ``(c) Programs.--The Secretary, acting through the Service, shall 
provide, to the extent feasible and if funding is available, programs 
including the following:
            ``(1) Comprehensive care.--A comprehensive continuum of 
        behavioral health care which provides--
                    ``(A) community-based prevention, intervention, 
                outpatient, and behavioral health aftercare;
                    ``(B) detoxification (social and medical);
                    ``(C) acute hospitalization;
                    ``(D) intensive outpatient/day treatment;
                    ``(E) residential treatment;
                    ``(F) transitional living for those needing a 
                temporary, stable living environment that is supportive 
                of treatment and recovery goals;
                    ``(G) emergency shelter;
                    ``(H) intensive case management; and
                    ``(I) diagnostic services.
            ``(2) Child care.--Behavioral health services for Indians 
        from birth through age 17, including--
                    ``(A) preschool and school age fetal alcohol 
                disorder services, including assessment and behavioral 
                intervention;
                    ``(B) mental health and substance abuse services 
                (emotional, organic, alcohol, drug, inhalant, and 
                tobacco);
                    ``(C) identification and treatment of co-occurring 
                disorders and comorbidity;
                    ``(D) prevention of alcohol, drug, inhalant, and 
                tobacco use;
                    ``(E) early intervention, treatment, and aftercare;
                    ``(F) promotion of healthy approaches to risk and 
                safety issues; and
                    ``(G) identification and treatment of neglect and 
                physical, mental, and sexual abuse.
            ``(3) Adult care.--Behavioral health services for Indians 
        from age 18 through 55, including--
                    ``(A) early intervention, treatment, and aftercare;
                    ``(B) mental health and substance abuse services 
                (emotional, alcohol, drug, inhalant, and tobacco), 
                including sex specific services;
                    ``(C) identification and treatment of co-occurring 
                disorders (dual diagnosis) and comorbidity;
                    ``(D) promotion of healthy approaches for risk-
                related behavior;
                    ``(E) treatment services for women at risk of 
                giving birth to a child with a fetal alcohol disorder; 
                and
                    ``(F) sex specific treatment for sexual assault and 
                domestic violence.
            ``(4) Family care.--Behavioral health services for 
        families, including--
                    ``(A) early intervention, treatment, and aftercare 
                for affected families;
                    ``(B) treatment for sexual assault and domestic 
                violence; and
                    ``(C) promotion of healthy approaches relating to 
                parenting, domestic violence, and other abuse issues.
            ``(5) Elder care.--Behavioral health services for Indians 
        56 years of age and older, including--
                    ``(A) early intervention, treatment, and aftercare;
                    ``(B) mental health and substance abuse services 
                (emotional, alcohol, drug, inhalant, and tobacco), 
                including sex specific services;
                    ``(C) identification and treatment of co-occurring 
                disorders (dual diagnosis) and comorbidity;
                    ``(D) promotion of healthy approaches to managing 
                conditions related to aging;
                    ``(E) sex specific treatment for sexual assault, 
                domestic violence, neglect, physical and mental abuse 
                and exploitation; and
                    ``(F) identification and treatment of dementias 
                regardless of cause.
    ``(d) Community Behavioral Health Plan.--
            ``(1) Establishment.--The governing body of any Indian 
        Tribe, Tribal Organization, or urban Indian organization may 
        adopt a resolution for the establishment of a community 
        behavioral health plan providing for the identification and 
        coordination of available resources and programs to identify, 
        prevent, or treat substance abuse, mental illness, or 
        dysfunctional and self-destructive behavior, including child 
        abuse and family violence, among its members or its service 
        population. This plan should include behavioral health 
        services, social services, intensive outpatient services, and 
        continuing aftercare.
            ``(2) Technical assistance.--At the request of an Indian 
        Tribe, Tribal Organization, or urban Indian organization, the 
        Bureau of Indian Affairs and the Service shall cooperate with 
        and provide technical assistance to the Indian Tribe, Tribal 
        Organization, or urban Indian organization in the development 
        and implementation of such plan.
            ``(3) Funding.--The Secretary, acting through the Service, 
        may make funding available to Indian Tribes and Tribal 
        Organizations which adopt a resolution pursuant to paragraph 
        (1) to obtain technical assistance for the development of a 
        community behavioral health plan and to provide administrative 
        support in the implementation of such plan.
    ``(e) Coordination for Availability of Services.--The Secretary, 
acting through the Service, shall coordinate behavioral health 
planning, to the extent feasible, with other Federal agencies and with 
State agencies, to encourage comprehensive behavioral health services 
for Indians regardless of their place of residence.
    ``(f) Mental Health Care Need Assessment.--Not later than 1 year 
after the date of enactment of the Indian Health Care Improvement Act 
Amendments of 2009, the Secretary, acting through the Service, shall 
make an assessment of the need for inpatient mental health care among 
Indians and the availability and cost of inpatient mental health 
facilities which can meet such need. In making such assessment, the 
Secretary shall consider the possible conversion of existing, underused 
Service hospital beds into psychiatric units to meet such need.

``SEC. 702. MEMORANDA OF AGREEMENT WITH THE DEPARTMENT OF THE INTERIOR.

    ``(a) Contents.--Not later than 12 months after the date of 
enactment of the Indian Health Care Improvement Act Amendments of 2009, 
the Secretary, acting through the Service, and the Secretary of the 
Interior shall develop and enter into a memoranda of agreement, or 
review and update any existing memoranda of agreement, as required by 
section 4205 of the Indian Alcohol and Substance Abuse Prevention and 
Treatment Act of 1986 (25 U.S.C. 2411) under which the Secretaries 
address the following:
            ``(1) The scope and nature of mental illness and 
        dysfunctional and self-destructive behavior, including child 
        abuse and family violence, among Indians.
            ``(2) The existing Federal, tribal, State, local, and 
        private services, resources, and programs available to provide 
        behavioral health services for Indians.
            ``(3) The unmet need for additional services, resources, 
        and programs necessary to meet the needs identified pursuant to 
        paragraph (1).
            ``(4)(A) The right of Indians, as citizens of the United 
        States and of the States in which they reside, to have access 
        to behavioral health services to which all citizens have 
        access.
            ``(B) The right of Indians to participate in, and receive 
        the benefit of, such services.
            ``(C) The actions necessary to protect the exercise of such 
        right.
            ``(5) The responsibilities of the Bureau of Indian Affairs 
        and the Service, including mental illness identification, 
        prevention, education, referral, and treatment services 
        (including services through multidisciplinary resource teams), 
        at the central, area, and agency and Service Unit, Service 
        Area, and headquarters levels to address the problems 
        identified in paragraph (1).
            ``(6) A strategy for the comprehensive coordination of the 
        behavioral health services provided by the Bureau of Indian 
        Affairs and the Service to meet the problems identified 
        pursuant to paragraph (1), including--
                    ``(A) the coordination of alcohol and substance 
                abuse programs of the Service, the Bureau of Indian 
                Affairs, and Indian Tribes and Tribal Organizations 
                (developed under the Indian Alcohol and Substance Abuse 
                Prevention and Treatment Act of 1986 (25 U.S.C. 2401 et 
                seq.)) with behavioral health initiatives pursuant to 
                this Act, particularly with respect to the referral and 
                treatment of dually diagnosed individuals requiring 
                behavioral health and substance abuse treatment; and
                    ``(B) ensuring that the Bureau of Indian Affairs 
                and Service programs and services (including 
                multidisciplinary resource teams) addressing child 
                abuse and family violence are coordinated with such 
                non-Federal programs and services.
            ``(7) Directing appropriate officials of the Bureau of 
        Indian Affairs and the Service, particularly at the agency and 
        Service Unit levels, to cooperate fully with tribal requests 
        made pursuant to community behavioral health plans adopted 
        under section 701(c) and section 4206 of the Indian Alcohol and 
        Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 
        2412).
            ``(8) Providing for an annual review of such agreement by 
        the Secretaries which shall be provided to Congress and Indian 
        Tribes and Tribal Organizations.
    ``(b) Specific Provisions Required.--The memoranda of agreement 
updated or entered into pursuant to subsection (a) shall include 
specific provisions pursuant to which the Service shall assume 
responsibility for--
            ``(1) the determination of the scope of the problem of 
        alcohol and substance abuse among Indians, including the number 
        of Indians within the jurisdiction of the Service who are 
        directly or indirectly affected by alcohol and substance abuse 
        and the financial and human cost;
            ``(2) an assessment of the existing and needed resources 
        necessary for the prevention of alcohol and substance abuse and 
        the treatment of Indians affected by alcohol and substance 
        abuse; and
            ``(3) an estimate of the funding necessary to adequately 
        support a program of prevention of alcohol and substance abuse 
        and treatment of Indians affected by alcohol and substance 
        abuse.
    ``(c) Publication.--Each memorandum of agreement entered into or 
renewed (and amendments or modifications thereto) under subsection (a) 
shall be published in the Federal Register. At the same time as 
publication in the Federal Register, the Secretary shall provide a copy 
of such memoranda, amendment, or modification to each Indian Tribe, 
Tribal Organization, and urban Indian organization.

``SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND TREATMENT 
              PROGRAM.

    ``(a) Establishment.--
            ``(1) In general.--The Secretary, acting through the 
        Service, shall provide a program of comprehensive behavioral 
        health, prevention, treatment, and aftercare, including Systems 
        of Care, which shall include--
                    ``(A) prevention, through educational intervention, 
                in Indian communities;
                    ``(B) acute detoxification, psychiatric 
                hospitalization, residential, and intensive outpatient 
                treatment;
                    ``(C) community-based rehabilitation and aftercare;
                    ``(D) community education and involvement, 
                including extensive training of health care, 
                educational, and community-based personnel;
                    ``(E) specialized residential treatment programs 
                for high-risk populations, including pregnant and 
                postpartum women and their children; and
                    ``(F) diagnostic services.
            ``(2) Target populations.--The target population of such 
        programs shall be members of Indian Tribes. Efforts to train 
        and educate key members of the Indian community shall also 
        target employees of health, education, judicial, law 
        enforcement, legal, and social service programs.
    ``(b) Contract Health Services.--
            ``(1) In general.--The Secretary, acting through the 
        Service, may enter into contracts with public or private 
        providers of behavioral health treatment services for the 
        purpose of carrying out the program required under subsection 
        (a).
            ``(2) Provision of assistance.--In carrying out this 
        subsection, the Secretary shall provide assistance to Indian 
        Tribes and Tribal Organizations to develop criteria for the 
        certification of behavioral health service providers and 
        accreditation of service facilities which meet minimum 
        standards for such services and facilities.

``SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.

    ``(a) In General.--Under the authority of the Act of November 2, 
1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary 
shall establish and maintain a mental health technician program within 
the Service which--
            ``(1) provides for the training of Indians as mental health 
        technicians; and
            ``(2) employs such technicians in the provision of 
        community-based mental health care that includes 
        identification, prevention, education, referral, and treatment 
        services.
    ``(b) Paraprofessional Training.--In carrying out subsection (a), 
the Secretary, acting through the Service, shall provide high-standard 
paraprofessional training in mental health care necessary to provide 
quality care to the Indian communities to be served. Such training 
shall be based upon a curriculum developed or approved by the Secretary 
which combines education in the theory of mental health care with 
supervised practical experience in the provision of such care.
    ``(c) Supervision and Evaluation of Technicians.--The Secretary, 
acting through the Service, shall supervise and evaluate the mental 
health technicians in the training program.
    ``(d) Traditional Health Care Practices.--The Secretary, acting 
through the Service, shall ensure that the program established pursuant 
to this subsection involves the use and promotion of the traditional 
health care practices of the Indian Tribes to be served.

``SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE WORKERS.

    ``(a) In General.--Subject to the provisions of section 221, and 
except as provided in subsection (b), any individual employed as a 
psychologist, social worker, or marriage and family therapist for the 
purpose of providing mental health care services to Indians in a 
clinical setting under this Act is required to be licensed as a 
psychologist, social worker, or marriage and family therapist, 
respectively.
    ``(b) Trainees.--An individual may be employed as a trainee in 
psychology, social work, or marriage and family therapy to provide 
mental health care services described in subsection (a) if such 
individual--
            ``(1) works under the direct supervision of a licensed 
        psychologist, social worker, or marriage and family therapist, 
        respectively;
            ``(2) is enrolled in or has completed at least 2 years of 
        course work at a post-secondary, accredited education program 
        for psychology, social work, marriage and family therapy, or 
        counseling; and
            ``(3) meets such other training, supervision, and quality 
        review requirements as the Secretary may establish.

``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

    ``(a) Grants.--The Secretary, consistent with section 701, may make 
grants to Indian Tribes, Tribal Organizations, and urban Indian 
organizations to develop and implement a comprehensive behavioral 
health program of prevention, intervention, treatment, and relapse 
prevention services that specifically addresses the cultural, 
historical, social, and child care needs of Indian women, regardless of 
age.
    ``(b) Use of Grant Funds.--A grant made pursuant to this section 
may be used to--
            ``(1) develop and provide community training, education, 
        and prevention programs for Indian women relating to behavioral 
        health issues, including fetal alcohol disorders;
            ``(2) identify and provide psychological services, 
        counseling, advocacy, support, and relapse prevention to Indian 
        women and their families; and
            ``(3) develop prevention and intervention models for Indian 
        women which incorporate traditional health care practices, 
        cultural values, and community and family involvement.
    ``(c) Criteria.--The Secretary, in consultation with Indian Tribes 
and Tribal Organizations, shall establish criteria for the review and 
approval of applications and proposals for funding under this section.
    ``(d) Allocation of Funds for Urban Indian Organizations.--Twenty 
percent of the funds appropriated pursuant to this section shall be 
used to make grants to urban Indian organizations.

``SEC. 707. INDIAN YOUTH PROGRAM.

    ``(a) Detoxification and Rehabilitation.--The Secretary, acting 
through the Service, consistent with section 701, shall develop and 
implement a program for acute detoxification and treatment for Indian 
youths, including behavioral health services. The program shall include 
regional treatment centers designed to include detoxification and 
rehabilitation for both sexes on a referral basis and programs 
developed and implemented by Indian Tribes or Tribal Organizations at 
the local level under the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.). Regional centers shall be 
integrated with the intake and rehabilitation programs based in the 
referring Indian community.
    ``(b) Alcohol and Substance Abuse Treatment Centers or 
Facilities.--
            ``(1) Establishment.--
                    ``(A) In general.--The Secretary, acting through 
                the Service, shall construct, renovate, or, as 
                necessary, purchase, and appropriately staff and 
                operate, at least 1 youth regional treatment center or 
                treatment network in each area under the jurisdiction 
                of an Area Office.
                    ``(B) Area office in california.--For the purposes 
                of this subsection, the Area Office in California shall 
                be considered to be 2 Area Offices, 1 office whose 
                jurisdiction shall be considered to encompass the 
                northern area of the State of California, and 1 office 
                whose jurisdiction shall be considered to encompass the 
                remainder of the State of California for the purpose of 
                implementing California treatment networks.
            ``(2) Funding.--For the purpose of staffing and operating 
        such centers or facilities, funding shall be pursuant to the 
        Act of November 2, 1921 (25 U.S.C. 13).
            ``(3) Location.--A youth treatment center constructed or 
        purchased under this subsection shall be constructed or 
        purchased at a location within the area described in paragraph 
        (1) agreed upon (by appropriate tribal resolution) by a 
        majority of the Indian Tribes to be served by such center.
            ``(4) Specific provision of funds.--
                    ``(A) In general.--Notwithstanding any other 
                provision of this title, the Secretary may, from 
                amounts authorized to be appropriated for the purposes 
                of carrying out this section, make funds available to--
                            ``(i) the Tanana Chiefs Conference, 
                        Incorporated, for the purpose of leasing, 
                        constructing, renovating, operating, and 
                        maintaining a residential youth treatment 
                        facility in Fairbanks, Alaska; and
                            ``(ii) the Southeast Alaska Regional Health 
                        Corporation to staff and operate a residential 
                        youth treatment facility without regard to the 
                        proviso set forth in section 4(l) of the Indian 
                        Self-Determination and Education Assistance Act 
                        (25 U.S.C. 450b(l)).
                    ``(B) Provision of services to eligible youths.--
                Until additional residential youth treatment facilities 
                are established in Alaska pursuant to this section, the 
                facilities specified in subparagraph (A) shall make 
                every effort to provide services to all eligible Indian 
                youths residing in Alaska.
    ``(c) Intermediate Adolescent Behavioral Health Services.--
            ``(1) In general.--The Secretary, acting through the 
        Service, may provide intermediate behavioral health services, 
        which may incorporate Systems of Care, to Indian children and 
        adolescents, including--
                    ``(A) pretreatment assistance;
                    ``(B) inpatient, outpatient, and aftercare 
                services;
                    ``(C) emergency care;
                    ``(D) suicide prevention and crisis intervention; 
                and
                    ``(E) prevention and treatment of mental illness 
                and dysfunctional and self-destructive behavior, 
                including child abuse and family violence.
            ``(2) Use of funds.--Funds provided under this subsection 
        may be used--
                    ``(A) to construct or renovate an existing health 
                facility to provide intermediate behavioral health 
                services;
                    ``(B) to hire behavioral health professionals;
                    ``(C) to staff, operate, and maintain an 
                intermediate mental health facility, group home, sober 
                housing, transitional housing or similar facilities, or 
                youth shelter where intermediate behavioral health 
                services are being provided;
                    ``(D) to make renovations and hire appropriate 
                staff to convert existing hospital beds into adolescent 
                psychiatric units; and
                    ``(E) for intensive home- and community-based 
                services.
            ``(3) Criteria.--The Secretary, acting through the Service, 
        shall, in consultation with Indian Tribes and Tribal 
        Organizations, establish criteria for the review and approval 
        of applications or proposals for funding made available 
        pursuant to this subsection.
    ``(d) Federally Owned Structures.--
            ``(1) In general.--The Secretary, in consultation with 
        Indian Tribes and Tribal Organizations, shall--
                    ``(A) identify and use, where appropriate, 
                federally owned structures suitable for local 
                residential or regional behavioral health treatment for 
                Indian youths; and
                    ``(B) establish guidelines for determining the 
                suitability of any such federally owned structure to be 
                used for local residential or regional behavioral 
                health treatment for Indian youths.
            ``(2) Terms and conditions for use of structure.--Any 
        structure described in paragraph (1) may be used under such 
        terms and conditions as may be agreed upon by the Secretary and 
        the agency having responsibility for the structure and any 
        Indian Tribe or Tribal Organization operating the program.
    ``(e) Rehabilitation and Aftercare Services.--
            ``(1) In general.--The Secretary, Indian Tribes, or Tribal 
        Organizations, in cooperation with the Secretary of the 
        Interior, shall develop and implement within each Service Unit, 
        community-based rehabilitation and follow-up services for 
        Indian youths who are having significant behavioral health 
        problems, and require long-term treatment, community 
        reintegration, and monitoring to support the Indian youths 
        after their return to their home community.
            ``(2) Administration.--Services under paragraph (1) shall 
        be provided by trained staff within the community who can 
        assist the Indian youths in their continuing development of 
        self-image, positive problem-solving skills, and nonalcohol or 
        substance abusing behaviors. Such staff may include alcohol and 
        substance abuse counselors, mental health professionals, and 
        other health professionals and paraprofessionals, including 
        community health representatives.
    ``(f) Inclusion of Family in Youth Treatment Program.--In providing 
the treatment and other services to Indian youths authorized by this 
section, the Secretary, acting through the Service, shall provide for 
the inclusion of family members of such youths in the treatment 
programs or other services as may be appropriate. Not less than 10 
percent of the funds appropriated for the purposes of carrying out 
subsection (e) shall be used for outpatient care of adult family 
members related to the treatment of an Indian youth under that 
subsection.
    ``(g) Multidrug Abuse Program.--The Secretary, acting through the 
Service, shall provide, consistent with section 701, programs and 
services to prevent and treat the abuse of multiple forms of 
substances, including alcohol, drugs, inhalants, and tobacco, among 
Indian youths residing in Indian communities, on or near reservations, 
and in urban areas and provide appropriate mental health services to 
address the incidence of mental illness among such youths.
    ``(h) Indian Youth Mental Health.--The Secretary, acting through 
the Service, shall collect data for the report under section 801 with 
respect to--
            ``(1) the number of Indian youth who are being provided 
        mental health services through the Service and Tribal Health 
        Programs;
            ``(2) a description of, and costs associated with, the 
        mental health services provided for Indian youth through the 
        Service and Tribal Health Programs;
            ``(3) the number of youth referred to the Service or Tribal 
        Health Programs for mental health services;
            ``(4) the number of Indian youth provided residential 
        treatment for mental health and behavioral problems through the 
        Service and Tribal Health Programs, reported separately for on- 
        and off-reservation facilities; and
            ``(5) the costs of the services described in paragraph (4).

``SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT.

    ``(a) Purpose.--The purpose of this section is to authorize the 
Secretary to carry out a demonstration project to test the use of 
telemental health services in suicide prevention, intervention and 
treatment of Indian youth, including through--
            ``(1) the use of psychotherapy, psychiatric assessments, 
        diagnostic interviews, therapies for mental health conditions 
        predisposing to suicide, and alcohol and substance abuse 
        treatment;
            ``(2) the provision of clinical expertise to, consultation 
        services with, and medical advice and training for frontline 
        health care providers working with Indian youth;
            ``(3) training and related support for community leaders, 
        family members and health and education workers who work with 
        Indian youth;
            ``(4) the development of culturally relevant educational 
        materials on suicide; and
            ``(5) data collection and reporting.
    ``(b) Definitions.--For the purpose of this section, the following 
definitions shall apply:
            ``(1) Demonstration project.--The term `demonstration 
        project' means the Indian youth telemental health demonstration 
        project authorized under subsection (c).
            ``(2) Telemental health.--The term `telemental health' 
        means the use of electronic information and telecommunications 
        technologies to support long distance mental health care, 
        patient and professional-related education, public health, and 
        health administration.
    ``(c) Authorization.--
            ``(1) In general.--The Secretary is authorized to award 
        grants under the demonstration project for the provision of 
        telemental health services to Indian youth who--
                    ``(A) have expressed suicidal ideas;
                    ``(B) have attempted suicide; or
                    ``(C) have mental health conditions that increase 
                or could increase the risk of suicide.
            ``(2) Eligibility for grants.--Such grants shall be awarded 
        to Indian Tribes and Tribal Organizations that operate 1 or 
        more facilities--
                    ``(A) located in Alaska and part of the Alaska 
                Federal Health Care Access Network;
                    ``(B) reporting active clinical telehealth 
                capabilities; or
                    ``(C) offering school-based telemental health 
                services relating to psychiatry to Indian youth.
            ``(3) Grant period.--The Secretary shall award grants under 
        this section for a period of up to 4 years.
            ``(4) Awarding of grants.--Not more than 5 grants shall be 
        provided under paragraph (1), with priority consideration given 
        to Indian Tribes and Tribal Organizations that--
                    ``(A) serve a particular community or geographic 
                area where there is a demonstrated need to address 
                Indian youth suicide;
                    ``(B) enter in to collaborative partnerships with 
                Indian Health Service or Tribal Health Programs or 
                facilities to provide services under this demonstration 
                project;
                    ``(C) serve an isolated community or geographic 
                area which has limited or no access to behavioral 
                health services; or
                    ``(D) operate a detention facility at which Indian 
                youth are detained.
    ``(d) Use of Funds.--
            ``(1) In general.--An Indian Tribe or Tribal Organization 
        shall use a grant received under subsection (c) for the 
        following purposes:
                    ``(A) To provide telemental health services to 
                Indian youth, including the provision of--
                            ``(i) psychotherapy;
                            ``(ii) psychiatric assessments and 
                        diagnostic interviews, therapies for mental 
                        health conditions predisposing to suicide, and 
                        treatment; and
                            ``(iii) alcohol and substance abuse 
                        treatment.
                    ``(B) To provide clinician-interactive medical 
                advice, guidance and training, assistance in diagnosis 
                and interpretation, crisis counseling and intervention, 
                and related assistance to Service, tribal, or urban 
                clinicians and health services providers working with 
                youth being served under this demonstration project.
                    ``(C) To assist, educate and train community 
                leaders, health education professionals and 
                paraprofessionals, tribal outreach workers, and family 
                members who work with the youth receiving telemental 
                health services under this demonstration project, 
                including with identification of suicidal tendencies, 
                crisis intervention and suicide prevention, emergency 
                skill development, and building and expanding networks 
                among these individuals and with State and local health 
                services providers.
                    ``(D) To develop and distribute culturally 
                appropriate community educational materials on--
                            ``(i) suicide prevention;
                            ``(ii) suicide education;
                            ``(iii) suicide screening;
                            ``(iv) suicide intervention; and
                            ``(v) ways to mobilize communities with 
                        respect to the identification of risk factors 
                        for suicide.
                    ``(E) For data collection and reporting related to 
                Indian youth suicide prevention efforts.
            ``(2) Traditional health care practices.--In carrying out 
        the purposes described in paragraph (1), an Indian Tribe or 
        Tribal Organization may use and promote the traditional health 
        care practices of the Indian Tribes of the youth to be served.
    ``(e) Applications.--To be eligible to receive a grant under 
subsection (c), an Indian Tribe or Tribal Organization shall prepare 
and submit to the Secretary an application, at such time, in such 
manner, and containing such information as the Secretary may require, 
including--
            ``(1) a description of the project that the Indian Tribe or 
        Tribal Organization will carry out using the funds provided 
        under the grant;
            ``(2) a description of the manner in which the project 
        funded under the grant would--
                    ``(A) meet the telemental health care needs of the 
                Indian youth population to be served by the project; or
                    ``(B) improve the access of the Indian youth 
                population to be served to suicide prevention and 
                treatment services;
            ``(3) evidence of support for the project from the local 
        community to be served by the project;
            ``(4) a description of how the families and leadership of 
        the communities or populations to be served by the project 
        would be involved in the development and ongoing operations of 
        the project;
            ``(5) a plan to involve the tribal community of the youth 
        who are provided services by the project in planning and 
        evaluating the mental health care and suicide prevention 
        efforts provided, in order to ensure the integration of 
        community, clinical, environmental, and cultural components of 
        the treatment; and
            ``(6) a plan for sustaining the project after Federal 
        assistance for the demonstration project has terminated.
    ``(f) Collaboration; Reporting to National Clearinghouse.--
            ``(1) Collaboration.--The Secretary, acting through the 
        Service, shall encourage Indian Tribes and Tribal Organizations 
        receiving grants under this section to collaborate to enable 
        comparisons about best practices across projects.
            ``(2) Reporting to national clearinghouse.--The Secretary, 
        acting through the Service, shall also encourage Indian Tribes 
        and Tribal Organizations receiving grants under this section to 
        submit relevant, declassified project information to the 
        national clearinghouse authorized under section 701(b)(2) in 
        order to better facilitate program performance and improve 
        suicide prevention, intervention, and treatment services.
    ``(g) Annual Report.--Each grant recipient shall submit to the 
Secretary an annual report that--
            ``(1) describes the number of telemental health services 
        provided; and
            ``(2) includes any other information that the Secretary may 
        require.
    ``(h) Report to Congress.--Not later than 270 days after the 
termination of the demonstration project, the Secretary shall submit to 
the Committee on Indian Affairs of the Senate and the Committee on 
Natural Resources and Committee on Energy and Commerce of the House of 
Representatives a final report, based on the annual reports provided by 
grant recipients under subsection (h), that--
            ``(1) describes the results of the projects funded by 
        grants awarded under this section, including any data available 
        which indicates the number of attempted suicides;
            ``(2) evaluates the impact of the telemental health 
        services funded by the grants in reducing the number of 
        completed suicides among Indian youth;
            ``(3) evaluates whether the demonstration project should 
        be--
                    ``(A) expanded to provide more than 5 grants; and
                    ``(B) designated a permanent program; and
            ``(4) evaluates the benefits of expanding the demonstration 
        project to include urban Indian organizations.
    ``(i) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section $1,500,000 for each of fiscal 
years 2010 through 2025.

``SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL HEALTH FACILITIES 
              DESIGN, CONSTRUCTION, AND STAFFING.

    ``Not later than 1 year after the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2009, the Secretary, acting 
through the Service, may provide, in each area of the Service, not less 
than 1 inpatient mental health care facility, or the equivalent, for 
Indians with behavioral health problems. For the purposes of this 
subsection, California shall be considered to be 2 Area Offices, 1 
office whose location shall be considered to encompass the northern 
area of the State of California and 1 office whose jurisdiction shall 
be considered to encompass the remainder of the State of California. 
The Secretary shall consider the possible conversion of existing, 
underused Service hospital beds into psychiatric units to meet such 
need.

``SEC. 710. TRAINING AND COMMUNITY EDUCATION.

    ``(a) Program.--The Secretary, in cooperation with the Secretary of 
the Interior, shall develop and implement or assist Indian Tribes and 
Tribal Organizations to develop and implement, within each Service Unit 
or tribal program, a program of community education and involvement 
which shall be designed to provide concise and timely information to 
the community leadership of each tribal community. Such program shall 
include education about behavioral health issues to political leaders, 
Tribal judges, law enforcement personnel, members of tribal health and 
education boards, health care providers including traditional 
practitioners, and other critical members of each tribal community. 
Such program may also include community-based training to develop local 
capacity and tribal community provider training for prevention, 
intervention, treatment, and aftercare.
    ``(b) Instruction.--The Secretary, acting through the Service, 
shall provide instruction in the area of behavioral health issues, 
including instruction in crisis intervention and family relations in 
the context of alcohol and substance abuse, child sexual abuse, youth 
alcohol and substance abuse, and the causes and effects of fetal 
alcohol disorders to appropriate employees of the Bureau of Indian 
Affairs and the Service, and to personnel in schools or programs 
operated under any contract with the Bureau of Indian Affairs or the 
Service, including supervisors of emergency shelters and halfway houses 
described in section 4213 of the Indian Alcohol and Substance Abuse 
Prevention and Treatment Act of 1986 (25 U.S.C. 2433).
    ``(c) Training Models.--In carrying out the education and training 
programs required by this section, the Secretary, in consultation with 
Indian Tribes, Tribal Organizations, Indian behavioral health experts, 
and Indian alcohol and substance abuse prevention experts, shall 
develop and provide community-based training models. Such models shall 
address--
            ``(1) the elevated risk of alcohol and behavioral health 
        problems faced by children of alcoholics;
            ``(2) the cultural, spiritual, and multigenerational 
        aspects of behavioral health problem prevention and recovery; 
        and
            ``(3) community-based and multidisciplinary strategies, 
        including Systems of Care, for preventing and treating 
        behavioral health problems.

``SEC. 711. BEHAVIORAL HEALTH PROGRAM.

    ``(a) Innovative Programs.--The Secretary, acting through the 
Service, consistent with section 701, may plan, develop, implement, and 
carry out programs to deliver innovative community-based behavioral 
health services to Indians.
    ``(b) Awards; Criteria.--The Secretary may award a grant for a 
project under subsection (a) to an Indian Tribe or Tribal Organization 
and may consider the following criteria:
            ``(1) The project will address significant unmet behavioral 
        health needs among Indians.
            ``(2) The project will serve a significant number of 
        Indians.
            ``(3) The project has the potential to deliver services in 
        an efficient and effective manner.
            ``(4) The Indian Tribe or Tribal Organization has the 
        administrative and financial capability to administer the 
        project.
            ``(5) The project may deliver services in a manner 
        consistent with traditional health care practices.
            ``(6) The project is coordinated with, and avoids 
        duplication of, existing services.
    ``(c) Equitable Treatment.--For purposes of this subsection, the 
Secretary shall, in evaluating project applications or proposals, use 
the same criteria that the Secretary uses in evaluating any other 
application or proposal for such funding.

``SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS.

    ``(a) Programs.--
            ``(1) Establishment.--The Secretary, consistent with 
        section 701 and acting through the Service, is authorized to 
        establish and operate fetal alcohol disorder programs as 
        provided in this section for the purposes of meeting the health 
        status objectives specified in section 3.
            ``(2) Use of funds.--
                    ``(A) In general.--Funding provided pursuant to 
                this section shall be used for the following:
                            ``(i) To develop and provide for Indians 
                        community and in-school training, education, 
                        and prevention programs relating to fetal 
                        alcohol disorders.
                            ``(ii) To identify and provide behavioral 
                        health treatment to high-risk Indian women and 
                        high-risk women pregnant with an Indian's 
                        child.
                            ``(iii) To identify and provide appropriate 
                        psychological services, educational and 
                        vocational support, counseling, advocacy, and 
                        information to fetal alcohol disorder affected 
                        Indians and their families or caretakers.
                            ``(iv) To develop and implement counseling 
                        and support programs in schools for fetal 
                        alcohol disorder affected Indian children.
                            ``(v) To develop prevention and 
                        intervention models which incorporate 
                        practitioners of traditional health care 
                        practices, cultural values, and community 
                        involvement.
                            ``(vi) To develop, print, and disseminate 
                        education and prevention materials on fetal 
                        alcohol disorder.
                            ``(vii) To develop and implement, in 
                        consultation with Indian Tribes, Tribal 
                        Organizations, and urban Indian organizations, 
                        culturally sensitive assessment and diagnostic 
                        tools including dysmorphology clinics and 
                        multidisciplinary fetal alcohol disorder 
                        clinics for use in Indian communities and Urban 
                        Centers.
                    ``(B) Additional uses.--In addition to any purpose 
                under subparagraph (A), funding provided pursuant to 
                this section may be used for 1 or more of the 
                following:
                            ``(i) Early childhood intervention projects 
                        from birth on to mitigate the effects of fetal 
                        alcohol disorder among Indians.
                            ``(ii) Community-based support services for 
                        Indians and women pregnant with Indian 
                        children.
                            ``(iii) Community-based housing for adult 
                        Indians with fetal alcohol disorder.
            ``(3) Criteria for applications.--The Secretary shall 
        establish criteria for the review and approval of applications 
        for funding under this section.
    ``(b) Services.--The Secretary, acting through the Service, shall--
            ``(1) develop and provide services for the prevention, 
        intervention, treatment, and aftercare for those affected by 
        fetal alcohol disorder in Indian communities; and
            ``(2) provide supportive services, including services to 
        meet the special educational, vocational, school-to-work 
        transition, and independent living needs of adolescent and 
        adult Indians with fetal alcohol disorder.
    ``(c) Task Force.--The Secretary shall establish a task force to be 
known as the Fetal Alcohol Disorder Task Force to advise the Secretary 
in carrying out subsection (b). Such task force shall be composed of 
representatives from the following:
            ``(1) The National Institute on Drug Abuse.
            ``(2) The National Institute on Alcohol and Alcoholism.
            ``(3) The Office of Substance Abuse Prevention.
            ``(4) The National Institute of Mental Health.
            ``(5) The Service.
            ``(6) The Office of Minority Health of the Department of 
        Health and Human Services.
            ``(7) The Administration for Native Americans.
            ``(8) The National Institute of Child Health and Human 
        Development (NICHD).
            ``(9) The Centers for Disease Control and Prevention.
            ``(10) The Bureau of Indian Affairs.
            ``(11) Indian Tribes.
            ``(12) Tribal Organizations.
            ``(13) urban Indian organizations.
            ``(14) Indian fetal alcohol spectrum disorders experts.
    ``(d) Applied Research Projects.--The Secretary, acting through the 
Substance Abuse and Mental Health Services Administration, shall make 
grants to Indian Tribes, Tribal Organizations, and urban Indian 
organizations for applied research projects which propose to elevate 
the understanding of methods to prevent, intervene, treat, or provide 
rehabilitation and behavioral health aftercare for Indians and urban 
Indians affected by fetal alcohol spectrum disorders.
    ``(e) Funding for Urban Indian Organizations.--Ten percent of the 
funds appropriated pursuant to this section shall be used to make 
grants to urban Indian organizations funded under title V.

``SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREATMENT PROGRAMS.

    ``(a) Establishment.--The Secretary, acting through the Service, 
shall establish, consistent with section 701, in every Service Area, 
programs involving treatment for--
            ``(1) victims of sexual abuse who are Indian children or 
        children in an Indian household; and
            ``(2) perpetrators of child sexual abuse who are Indian or 
        members of an Indian household.
    ``(b) Use of Funds.--Funding provided pursuant to this section 
shall be used for the following:
            ``(1) To develop and provide community education and 
        prevention programs related to sexual abuse of Indian children 
        or children in an Indian household.
            ``(2) To identify and provide behavioral health treatment 
        to victims of sexual abuse who are Indian children or children 
        in an Indian household, and to their family members who are 
        affected by sexual abuse.
            ``(3) To develop prevention and intervention models which 
        incorporate traditional health care practices, cultural values, 
        and community involvement.
            ``(4) To develop and implement culturally sensitive 
        assessment and diagnostic tools for use in Indian communities 
        and Urban Centers.
            ``(5) To identify and provide behavioral health treatment 
        to Indian perpetrators and perpetrators who are members of an 
        Indian household--
                    ``(A) making efforts to begin offender and 
                behavioral health treatment while the perpetrator is 
                incarcerated or at the earliest possible date if the 
                perpetrator is not incarcerated; and
                    ``(B) providing treatment after the perpetrator is 
                released, until it is determined that the perpetrator 
                is not a threat to children.
    ``(c) Coordination.--The programs established under subsection (a) 
shall be carried out in coordination with programs and services 
authorized under the Indian Child Protection and Family Violence 
Prevention Act (25 U.S.C. 3201 et seq.).

``SEC. 714. DOMESTIC AND SEXUAL VIOLENCE PREVENTION AND TREATMENT.

    ``(a) In General.--The Secretary, in accordance with section 701, 
is authorized to establish in each Service Area programs involving the 
prevention and treatment of--
            ``(1) Indian victims of domestic violence or sexual abuse; 
        and
            ``(2) perpetrators of domestic violence or sexual abuse who 
        are Indian or members of an Indian household.
    ``(b) Use of Funds.--Funds made available to carry out this section 
shall be used--
            ``(1) to develop and implement prevention programs and 
        community education programs relating to domestic violence and 
        sexual abuse;
            ``(2) to provide behavioral health services, including 
        victim support services, and medical treatment (including 
        examinations performed by sexual assault nurse examiners) to 
        Indian victims of domestic violence or sexual abuse;
            ``(3) to purchase rape kits;
            ``(4) to develop prevention and intervention models, which 
        may incorporate traditional health care practices; and
            ``(5) to identify and provide behavioral health treatment 
        to perpetrators who are Indian or members of an Indian 
        household.
    ``(c) Training and Certification.--
            ``(1) In general.--Not later than 1 year after the date of 
        enactment of the Indian Health Care Improvement Act Amendments 
        of 2009, the Secretary shall establish appropriate protocols, 
        policies, procedures, standards of practice, and, if not 
        available elsewhere, training curricula and training and 
        certification requirements for services for victims of domestic 
        violence and sexual abuse.
            ``(2) Report.--Not later than 18 months after the date of 
        enactment of the Indian Health Care Improvement Act Amendments 
        of 2008, the Secretary shall submit to the Committee on Indian 
        Affairs of the Senate and the Committee on Natural Resources of 
        the House of Representatives a report that describes the means 
        and extent to which the Secretary has carried out paragraph 
        (1).
    ``(d) Coordination.--
            ``(1) In general.--The Secretary, in coordination with the 
        Attorney General, Federal and tribal law enforcement agencies, 
        Indian Health Programs, and domestic violence or sexual assault 
        victim organizations, shall develop appropriate victim services 
        and victim advocate training programs--
                    ``(A) to improve domestic violence or sexual abuse 
                responses;
                    ``(B) to improve forensic examinations and 
                collection;
                    ``(C) to identify problems or obstacles in the 
                prosecution of domestic violence or sexual abuse; and
                    ``(D) to meet other needs or carry out other 
                activities required to prevent, treat, and improve 
                prosecutions of domestic violence and sexual abuse.
            ``(2) Report.--Not later than 2 years after the date of 
        enactment of the Indian Health Care Improvement Act Amendments 
        of 2008, the Secretary shall submit to the Committee on Indian 
        Affairs of the Senate and the Committee on Natural Resources of 
        the House of Representatives a report that describes, with 
        respect to the matters described in paragraph (1), the 
        improvements made and needed, problems or obstacles identified, 
        and costs necessary to address the problems or obstacles, and 
        any other recommendations that the Secretary determines to be 
        appropriate.

``SEC. 715. BEHAVIORAL HEALTH RESEARCH.

    ``The Secretary, in consultation with appropriate Federal agencies, 
shall make grants to, or enter into contracts with, Indian Tribes, 
Tribal Organizations, and urban Indian organizations or enter into 
contracts with, or make grants to appropriate institutions for, the 
conduct of research on the incidence and prevalence of behavioral 
health problems among Indians served by the Service, Indian Tribes, or 
Tribal Organizations and among Indians in urban areas. Research 
priorities under this section shall include--
            ``(1) the multifactorial causes of Indian youth suicide, 
        including--
                    ``(A) protective and risk factors and scientific 
                data that identifies those factors; and
                    ``(B) the effects of loss of cultural identity and 
                the development of scientific data on those effects;
            ``(2) the interrelationship and interdependence of 
        behavioral health problems with alcoholism and other substance 
        abuse, suicide, homicides, other injuries, and the incidence of 
        family violence; and
            ``(3) the development of models of prevention techniques.
The effect of the interrelationships and interdependencies referred to 
in paragraph (2) on children, and the development of prevention 
techniques under paragraph (3) applicable to children, shall be 
emphasized.

``SEC. 716. DEFINITIONS.

    ``For the purpose of this title, the following definitions shall 
apply:
            ``(1) Assessment.--The term `assessment' means the 
        systematic collection, analysis, and dissemination of 
        information on health status, health needs, and health 
        problems.
            ``(2) Alcohol-related neurodevelopmental disorders or 
        arnd.--The term `alcohol-related neurodevelopmental disorders' 
        or `ARND' means, with a history of maternal alcohol consumption 
        during pregnancy, central nervous system involvement such as 
        developmental delay, intellectual deficit, or neurologic 
        abnormalities. Behaviorally, there can be problems with 
        irritability, and failure to thrive as infants. As children 
        become older there will likely be hyperactivity, attention 
        deficit, language dysfunction, and perceptual and judgment 
        problems.
            ``(3) Behavioral health aftercare.--The term `behavioral 
        health aftercare' includes those activities and resources used 
        to support recovery following inpatient, residential, intensive 
        substance abuse, or mental health outpatient or outpatient 
        treatment. The purpose is to help prevent or deal with relapse 
        by ensuring that by the time a client or patient is discharged 
        from a level of care, such as outpatient treatment, an 
        aftercare plan has been developed with the client. An aftercare 
        plan may use such resources as a community-based therapeutic 
        group, transitional living facilities, a 12-step sponsor, a 
        local 12-step or other related support group, and other 
        community-based providers.
            ``(4) Dual diagnosis.--The term `dual diagnosis' means 
        coexisting substance abuse and mental illness conditions or 
        diagnosis. Such clients are sometimes referred to as mentally 
        ill chemical abusers (MICAs).
            ``(5) Fetal alcohol spectrum disorders.--
                    ``(A) In general.--The term `fetal alcohol spectrum 
                disorders' includes a range of effects that can occur 
                in an individual whose mother drank alcohol during 
                pregnancy, including physical, mental, behavioral, and/
                or learning disabilities with possible lifelong 
                implications.
                    ``(B) Inclusions.--The term `fetal alcohol spectrum 
                disorders' may include--
                            ``(i) fetal alcohol syndrome (FAS);
                            ``(ii) fetal alcohol effect (FAE);
                            ``(iii) alcohol-related birth defects; and
                            ``(iv) alcohol-related neurodevelopmental 
                        disorders (ARND).
            ``(6) Fetal alcohol syndrome or fas.--The term `fetal 
        alcohol syndrome' or `FAS' means any 1 of a spectrum of effects 
        that may occur when a woman drinks alcohol during pregnancy, 
        the diagnosis of which involves the confirmed presence of the 
        following 3 criteria:
                    ``(A) Craniofacial abnormalities.
                    ``(B) Growth deficits.
                    ``(C) Central nervous system abnormalities.
            ``(7) Rehabilitation.--The term `rehabilitation' means 
        medical and health care services that--
                    ``(A) are recommended by a physician or licensed 
                practitioner of the healing arts within the scope of 
                their practice under applicable law;
                    ``(B) are furnished in a facility, home, or other 
                setting in accordance with applicable standards; and
                    ``(C) have as their purpose any of the following:
                            ``(i) The maximum attainment of physical, 
                        mental, and developmental functioning.
                            ``(ii) Averting deterioration in physical 
                        or mental functional status.
                            ``(iii) The maintenance of physical or 
                        mental health functional status.
            ``(8) Substance abuse.--The term `substance abuse' includes 
        inhalant abuse.
            ``(9) Systems of care.--The term `Systems of Care' means a 
        system for delivering services to children and their families 
        that is child-centered, family-focused and family-driven, 
        community-based, and culturally competent and responsive to the 
        needs of the children and families being served. The systems of 
        care approach values prevention and early identification, 
        smooth transitions for children and families, child and family 
        participation and advocacy, comprehensive array of services, 
        individualized service planning, services in the least 
        restrictive environment, and integrated services with 
        coordinated planning across the child-serving systems.

``SEC. 717. AUTHORIZATION OF APPROPRIATIONS.

    ``There is authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2025 to carry out 
the provisions of this title.

                      ``TITLE VIII--MISCELLANEOUS

``SEC. 801. REPORTS.

    ``For each fiscal year following the date of enactment of the 
Indian Health Care Improvement Act Amendments of 2009, the Secretary 
shall transmit to Congress a report containing the following:
            ``(1) A report on the progress made in meeting the 
        objectives of this Act, including a review of programs 
        established or assisted pursuant to this Act and assessments 
        and recommendations of additional programs or additional 
        assistance necessary to, at a minimum, provide health services 
        to Indians and ensure a health status for Indians, which are at 
        a parity with the health services available to and the health 
        status of the general population.
            ``(2) A report on whether, and to what extent, new national 
        health care programs, benefits, initiatives, or financing 
        systems have had an impact on the purposes of this Act and any 
        steps that the Secretary may have taken to consult with Indian 
        Tribes, Tribal Organizations, and urban Indian organizations to 
        address such impact, including a report on proposed changes in 
        allocation of funding pursuant to section 807.
            ``(3) A report on the use of health services by Indians--
                    ``(A) on a national and area or other relevant 
                geographical basis;
                    ``(B) by gender and age;
                    ``(C) by source of payment and type of service;
                    ``(D) comparing such rates of use with rates of use 
                among comparable non-Indian populations; and
                    ``(E) provided under contracts.
            ``(4) A report of contractors to the Secretary on Health 
        Care Educational Loan Repayments every 6 months required by 
        section 110.
            ``(5) A general audit report of the Secretary on the Health 
        Care Educational Loan Repayment Program as required by section 
        110(m).
            ``(6) A report of the findings and conclusions of 
        demonstration programs on development of educational curricula 
        for substance abuse counseling as required in section 125(f).
            ``(7) A separate statement which specifies the amount of 
        funds requested to carry out the provisions of section 201.
            ``(8) A report of the evaluations of health promotion and 
        disease prevention as required in section 203(c).
            ``(9) A biennial report to Congress on infectious diseases 
        as required by section 212.
            ``(10) A report on environmental and nuclear health hazards 
        as required by section 215.
            ``(11) An annual report on the status of all health care 
        facilities needs as required by section 301(c)(2)(B) and 
        301(d).
            ``(12) Reports on safe water and sanitary waste disposal 
        facilities as required by section 302(h).
            ``(13) An annual report on the expenditure of non-Service 
        funds for renovation as required by sections 304(b)(2).
            ``(14) A report identifying the backlog of maintenance and 
        repair required at Service and tribal facilities required by 
        section 313(a).
            ``(15) A report providing an accounting of reimbursement 
        funds made available to the Secretary under titles XVIII, XIX, 
        and XXI of the Social Security Act.
            ``(16) A report on any arrangements for the sharing of 
        medical facilities or services, as authorized by section 406.
            ``(17) A report on evaluation and renewal of urban Indian 
        programs under section 505.
            ``(18) A report on the evaluation of programs as required 
        by section 513(d).
            ``(19) A report on alcohol and substance abuse as required 
        by section 701(f).
            ``(20) A report on Indian youth mental health services as 
        required by section 707(h).
            ``(21) A report on the reallocation of base resources if 
        required by section 807.
            ``(22) A report on the movement of patients between Service 
        Units, including--
                    ``(A) a list of those Service Units that have a net 
                increase and those that have a net decrease of patients 
                due to patients assigned to one Service Unit 
                voluntarily choosing to receive service at another 
                Service Unit;
                    ``(B) an analysis of the effect of patient movement 
                on the quality of services for those Service Units 
                experiencing an increase in the number of patients 
                served; and
                    ``(C) what funding changes are necessary to 
                maintain a consistent quality of service at Service 
                Units that have an increase in the number of patients 
                served.
            ``(23) A report on the extent to which health care 
        facilities of the Service, Indian Tribes, Tribal Organizations, 
        and urban Indian organizations comply with credentialing 
        requirements of the Service or licensure requirements of 
        States.

``SEC. 802. REGULATIONS.

    ``(a) Deadlines.--
            ``(1) Procedures.--Not later than 90 days after the date of 
        enactment of the Indian Health Care Improvement Act Amendments 
        of 2009, the Secretary shall initiate procedures under 
        subchapter III of chapter 5 of title 5, United States Code, to 
        negotiate and promulgate such regulations or amendments thereto 
        that are necessary to carry out this Act, except sections 105, 
        115, 117, 202, and 409 through 416. The Secretary may 
        promulgate regulations to carry out such sections using the 
        procedures required by chapter 5 of title 5, United States Code 
        (commonly known as the `Administrative Procedure Act').
            ``(2) Proposed regulations.--Proposed regulations to 
        implement this Act shall be published in the Federal Register 
        by the Secretary no later than 2 years after the date of 
        enactment of the Indian Health Care Improvement Act Amendments 
        of 2009 and shall have no less than a 120-day comment period.
            ``(3) Final regulations.--The Secretary shall publish in 
        the Federal Register final regulations to implement this Act by 
        not later than 3 years after the date of enactment of the 
        Indian Health Care Improvement Act Amendments of 2009.
    ``(b) Committee.--A negotiated rulemaking committee established 
pursuant to section 565 of title 5, United States Code, to carry out 
this section shall have as its members only representatives of the 
Federal Government and representatives of Indian Tribes, and Tribal 
Organizations, a majority of whom shall be nominated by and be 
representatives of Indian Tribes and Tribal Organizations from each 
Service Area.
    ``(c) Adaptation of Procedures.--The Secretary shall adapt the 
negotiated rulemaking procedures to the unique context of self-
governance and the government-to-government relationship between the 
United States and Indian Tribes.
    ``(d) Lack of Regulations.--The lack of promulgated regulations 
shall not limit the effect of this Act.

``SEC. 803. PLAN OF IMPLEMENTATION.

    ``(a) In General.--Not later than 1 year after the date of 
enactment of the Indian Health Care Improvement Act Amendments of 2009, 
the Secretary, in consultation with Indian Tribes, Tribal 
Organizations, and urban Indian organizations, shall submit to Congress 
a plan explaining the manner and schedule, by title and section, by 
which the Secretary will implement the provisions of this Act. This 
consultation may be conducted jointly with the annual budget 
consultation pursuant to the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.).
    ``(b) Lack of Plan.--The lack of (or failure to submit) such a plan 
shall not limit the effect, or prevent the implementation, of this Act.

``SEC. 804. LIMITATION ON USE OF FUNDS APPROPRIATED TO INDIAN HEALTH 
              SERVICE.

    ``Any limitation on the use of funds contained in an Act providing 
appropriations for the Department for a period with respect to the 
performance of abortions shall apply for that period with respect to 
the performance of abortions using funds contained in an Act providing 
appropriations for the Service.

``SEC. 805. ELIGIBILITY OF CALIFORNIA INDIANS.

    ``(a) In General.--The following California Indians shall be 
eligible for health services provided by the Service:
            ``(1) Any member of a federally recognized Indian Tribe.
            ``(2) Any descendant of an Indian who was residing in 
        California on June 1, 1852, if such descendant--
                    ``(A) is a member of the Indian community served by 
                a local program of the Service; and
                    ``(B) is regarded as an Indian by the community in 
                which such descendant lives.
            ``(3) Any Indian who holds trust interests in public 
        domain, national forest, or reservation allotments in 
        California.
            ``(4) Any Indian in California who is listed on the plans 
        for distribution of the assets of rancherias and reservations 
        located within the State of California under the Act of August 
        18, 1958 (72 Stat. 619), and any descendant of such an Indian.
    ``(b) Clarification.--Nothing in this section may be construed as 
expanding the eligibility of California Indians for health services 
provided by the Service beyond the scope of eligibility for such health 
services that applied on May 1, 1986.

``SEC. 806. HEALTH SERVICES FOR INELIGIBLE PERSONS.

    ``(a) Children.--Any individual who--
            ``(1) has not attained 19 years of age;
            ``(2) is the natural or adopted child, stepchild, foster 
        child, legal ward, or orphan of an eligible Indian; and
            ``(3) is not otherwise eligible for health services 
        provided by the Service,
shall be eligible for all health services provided by the Service on 
the same basis and subject to the same rules that apply to eligible 
Indians until such individual attains 19 years of age. The existing and 
potential health needs of all such individuals shall be taken into 
consideration by the Service in determining the need for, or the 
allocation of, the health resources of the Service. If such an 
individual has been determined to be legally incompetent prior to 
attaining 19 years of age, such individual shall remain eligible for 
such services until 1 year after the date of a determination of 
competency.
    ``(b) Spouses.--Any spouse of an eligible Indian who is not an 
Indian, or who is of Indian descent but is not otherwise eligible for 
the health services provided by the Service, shall be eligible for such 
health services if all such spouses or spouses who are married to 
members of each Indian Tribe being served are made eligible, as a 
class, by an appropriate resolution of the governing body of the Indian 
Tribe or Tribal Organization providing such services. The health needs 
of persons made eligible under this paragraph shall not be taken into 
consideration by the Service in determining the need for, or allocation 
of, its health resources.
    ``(c) Provision of Services to Other Individuals.--
            ``(1) In general.--The Secretary is authorized to provide 
        health services under this subsection through health programs 
        operated directly by the Service to individuals who reside 
        within the Service area of the Service Unit and who are not 
        otherwise eligible for such health services if--
                    ``(A) the Indian Tribes served by such Service Unit 
                request such provision of health services to such 
                individuals; and
                    ``(B) the Secretary and the served Indian Tribes 
                have jointly determined that--
                            ``(i) the provision of such health services 
                        will not result in a denial or diminution of 
                        health services to eligible Indians; and
                            ``(ii) there is no reasonable alternative 
                        health facilities or services, within or 
                        without the Service Unit, available to meet the 
                        health needs of such individuals.
            ``(2) ISDEAA programs.--In the case of health programs and 
        facilities operated under a contract or compact entered into 
        under the Indian Self-Determination and Education Assistance 
        Act (25 U.S.C. 450 et seq.), the governing body of the Indian 
        Tribe or Tribal Organization providing health services under 
        such contract or compact is authorized to determine whether 
        health services should be provided under such contract to 
        individuals who are not eligible for such health services under 
        any other subsection of this section or under any other 
        provision of law. In making such determinations, the governing 
        body of the Indian Tribe or Tribal Organization shall take into 
        account the considerations described in paragraph (1)(B).
            ``(3) Payment for services.--
                    ``(A) In general.--Persons receiving health 
                services provided by the Service under this subsection 
                shall be liable for payment of such health services 
                under a schedule of charges prescribed by the Secretary 
                which, in the judgment of the Secretary, results in 
                reimbursement in an amount not less than the actual 
                cost of providing the health services. Notwithstanding 
                section 404 of this Act or any other provision of law, 
                amounts collected under this subsection, including 
                Medicare, Medicaid, or SCHIP reimbursements under 
                titles XVIII, XIX, and XXI of the Social Security Act, 
                shall be credited to the account of the program 
                providing the service and shall be used for the 
                purposes listed in section 401(d)(2) and amounts 
                collected under this subsection shall be available for 
                expenditure within such program.
                    ``(B) Indigent people.--Health services may be 
                provided by the Secretary through the Service under 
                this subsection to an indigent individual who would not 
                be otherwise eligible for such health services but for 
                the provisions of paragraph (1) only if an agreement 
                has been entered into with a State or local government 
                under which the State or local government agrees to 
                reimburse the Service for the expenses incurred by the 
                Service in providing such health services to such 
                indigent individual.
            ``(4) Revocation of consent for services.--
                    ``(A) Single tribe service area.--In the case of a 
                Service Area which serves only 1 Indian Tribe, the 
                authority of the Secretary to provide health services 
                under paragraph (1) shall terminate at the end of the 
                fiscal year succeeding the fiscal year in which the 
                governing body of the Indian Tribe revokes its 
                concurrence to the provision of such health services.
                    ``(B) Multitribal service area.--In the case of a 
                multitribal Service Area, the authority of the 
                Secretary to provide health services under paragraph 
                (1) shall terminate at the end of the fiscal year 
                succeeding the fiscal year in which at least 51 percent 
                of the number of Indian Tribes in the Service Area 
                revoke their concurrence to the provisions of such 
                health services.
    ``(d) Other Services.--The Service may provide health services 
under this subsection to individuals who are not eligible for health 
services provided by the Service under any other provision of law in 
order to--
            ``(1) achieve stability in a medical emergency;
            ``(2) prevent the spread of a communicable disease or 
        otherwise deal with a public health hazard;
            ``(3) provide care to non-Indian women pregnant with an 
        eligible Indian's child for the duration of the pregnancy 
        through postpartum; or
            ``(4) provide care to immediate family members of an 
        eligible individual if such care is directly related to the 
        treatment of the eligible individual.
    ``(e) Hospital Privileges for Practitioners.--
            ``(1) In general.--Hospital privileges in health facilities 
        operated and maintained by the Service or operated under a 
        contract or compact pursuant to the Indian Self-Determination 
        and Education Assistance Act (25 U.S.C. 450 et seq.) may be 
        extended to non-Service health care practitioners who provide 
        services to individuals described in subsection (a), (b), (c), 
        or (d). Such non-Service health care practitioners may, as part 
        of the privileging process, be designated as employees of the 
        Federal Government for purposes of section 1346(b) and chapter 
        171 of title 28, United States Code (relating to Federal tort 
        claims) only with respect to acts or omissions which occur in 
        the course of providing services to eligible individuals as a 
        part of the conditions under which such hospital privileges are 
        extended.
            ``(2) Definition.--For purposes of this subsection, the 
        term `non-Service health care practitioner' means a 
        practitioner who is not--
                    ``(A) an employee of the Service; or
                    ``(B) an employee of an Indian tribe or tribal 
                organization operating a contract or compact under the 
                Indian Self-Determination and Education Assistance Act 
                or an individual who provides health care services 
                pursuant to a personal services contract with such 
                Indian tribe or tribal organization.
    ``(f) Eligible Indian.--For purposes of this section, the term 
`eligible Indian' means any Indian who is eligible for health services 
provided by the Service without regard to the provisions of this 
section.

``SEC. 807. TREATMENT OF CERTAIN SERVICES AND BENEFITS.

    ``(a) Gross income does not include (1) health services or benefits 
provided or purchased by the Indian Health Service, either directly or 
indirectly, through a grant to or a contract or compact with an Indian 
tribe or tribal organization, or grants to or other programs of third 
parties funded by the Indian Health Service; (2) health services, 
health benefits or other amounts for health care services, including 
preventive care and treatment of personal injuries or sickness and 
other health conditions, provided by an Indian tribe or tribal 
organization to an Indian either directly, through purchased services, 
or through accident or health insurance (or through an arrangement 
having the effect of accident or health insurance); (3) the value of 
health coverage provided or premiums paid by an Indian tribe or tribal 
organization to or on behalf of an Indian under an accident or health 
plan (or through an arrangement having the effect of accident or health 
insurance); or (4) any other benefit or service provided by an Indian 
tribe that supplements the programs and services provided by the 
Federal government to Indian tribes or Indians, or other general 
welfare benefits or services provided by Indian tribes to Indians.
    ``(b) Definitions.--For the purposes of this section:
            ``(1) The terms `accident or health insurance' and 
        `personal injuries and sickness' have the meaning given those 
        terms in section 104 of the Internal Revenue Code of 1986.
            ``(2) The term `Indian tribe' has the meaning given that 
        term in section 4(e) of the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450b(e)).
            ``(3) The term `Indians' and `Indian' means any person 
        who--
                    ``(A) is a member of an Indian tribe, as defined in 
                paragraph (2); and
                    ``(B)(i) irrespective of whether the individual 
                lives on or near a reservation, is a member of a tribe, 
                band, or other organized group of Indians, including 
                those tribes, bands, or groups terminated since 1940 
                and those recognized by the State in which they reside;
                    ``(ii) is a descendant, in the first or second 
                degree, of any such member;
                    ``(iii) is an Eskimo or Aleut or other Alaska 
                Native;
                    ``(iv) is otherwise eligible for services provided 
                or funded by the Indian Health Service under applicable 
                law; or
                    ``(v) is considered by the Secretary of the 
                Interior to be an Indian for any purpose.
            ``(4) The term `tribal organization' has the meaning given 
        that term in section 4(l) of the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450b(l)).
    ``(c) No Inference.--Nothing in this section is intended as an 
inference to the tax treatment of governmental benefits (including 
health care benefits not covered under this section) provided by Indian 
tribes to Indians after the date of the enactment of this section.

``SEC. 808. REALLOCATION OF BASE RESOURCES.

    ``(a) Report Required.--Notwithstanding any other provision of law, 
any allocation of Service funds for a fiscal year that reduces by 5 
percent or more from the previous fiscal year the funding for any 
recurring program, project, or activity of a Service Unit may be 
implemented only after the Secretary has submitted to Congress, under 
section 801, a report on the proposed change in allocation of funding, 
including the reasons for the change and its likely effects.
    ``(b) Exception.--Subsection (a) shall not apply if the total 
amount appropriated to the Service for a fiscal year is at least 5 
percent less than the amount appropriated to the Service for the 
previous fiscal year.

``SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.

    ``The Secretary shall provide for the dissemination to Indian 
Tribes, Tribal Organizations, and urban Indian organizations of the 
findings and results of demonstration projects conducted under this 
Act.

``SEC. 810. PROVISION OF SERVICES IN MONTANA.

    ``(a) Consistent With Court Decision.--The Secretary, acting 
through the Service, shall provide services and benefits for Indians in 
Montana in a manner consistent with the decision of the United States 
Court of Appeals for the Ninth Circuit in McNabb for McNabb v. Bowen, 
829 F.2d 787 (9th Cir. 1987).
    ``(b) Clarification.--The provisions of subsection (a) shall not be 
construed to be an expression of the sense of Congress on the 
application of the decision described in subsection (a) with respect to 
the provision of services or benefits for Indians living in any State 
other than Montana.

``SEC. 811. MORATORIUM.

    ``During the period of the moratorium imposed on implementation of 
the final rule published in the Federal Register on September 16, 1987, 
by the Department of Health and Human Services, relating to eligibility 
for the health care services of the Indian Health Service, the Indian 
Health Service shall provide services pursuant to the criteria for 
eligibility for such services that were in effect on September 15, 
1987, subject to the provisions of sections 805 and 806, until the 
Service has submitted to the Committees on Appropriations of the Senate 
and the House of Representatives a budget request reflecting the 
increased costs associated with the proposed final rule, and the 
request has been included in an appropriations Act and enacted into 
law.

``SEC. 812. SEVERABILITY PROVISIONS.

    ``If any provision of this Act, any amendment made by the Act, or 
the application of such provision or amendment to any person or 
circumstances is held to be invalid, the remainder of this Act, the 
remaining amendments made by this Act, and the application of such 
provisions to persons or circumstances other than those to which it is 
held invalid, shall not be affected thereby.

``SEC. 813. USE OF PATIENT SAFETY ORGANIZATIONS.

    ``The Service, an Indian Tribe, Tribal Organization, or urban 
Indian organization may provide for quality assurance activities 
through the use of a patient safety organization in accordance with 
title IX of the Public Health Service Act.

``SEC. 814. CONFIDENTIALITY OF MEDICAL QUALITY ASSURANCE RECORDS; 
              QUALIFIED IMMUNITY FOR PARTICIPANTS.

    ``(a) Confidentiality of Records.--Medical quality assurance 
records created by or for any Indian Health Program or a health program 
of an Urban Indian Organization as part of a medical quality assurance 
program are confidential and privileged. Such records may not be 
disclosed to any person or entity, except as provided in subsection 
(c).
    ``(b) Prohibition on Disclosure and Testimony.--
            ``(1) In general.--No part of any medical quality assurance 
        record described in subsection (a) may be subject to discovery 
        or admitted into evidence in any judicial or administrative 
        proceeding, except as provided in subsection (c).
            ``(2) Testimony.--A person who reviews or creates medical 
        quality assurance records for any Indian Health Program or 
        Urban Indian Organization who participates in any proceeding 
        that reviews or creates such records may not be permitted or 
        required to testify in any judicial or administrative 
        proceeding with respect to such records or with respect to any 
        finding, recommendation, evaluation, opinion, or action taken 
        by such person or body in connection with such records except 
        as provided in this section.
    ``(c) Authorized Disclosure and Testimony.--
            ``(1) In general.--Subject to paragraph (2), a medical 
        quality assurance record described in subsection (a) may be 
        disclosed, and a person referred to in subsection (b) may give 
        testimony in connection with such a record, only as follows:
                    ``(A) To a Federal executive agency or private 
                organization, if such medical quality assurance record 
                or testimony is needed by such agency or organization 
                to perform licensing or accreditation functions related 
                to any Indian Health Program or to a health program of 
                an Urban Indian Organization to perform monitoring, 
                required by law, of such program or organization.
                    ``(B) To an administrative or judicial proceeding 
                commenced by a present or former Indian Health Program 
                or Urban Indian Organization provider concerning the 
                termination, suspension, or limitation of clinical 
                privileges of such health care provider.
                    ``(C) To a governmental board or agency or to a 
                professional health care society or organization, if 
                such medical quality assurance record or testimony is 
                needed by such board, agency, society, or organization 
                to perform licensing, credentialing, or the monitoring 
                of professional standards with respect to any health 
                care provider who is or was an employee of any Indian 
                Health Program or Urban Indian Organization.
                    ``(D) To a hospital, medical center, or other 
                institution that provides health care services, if such 
                medical quality assurance record or testimony is needed 
                by such institution to assess the professional 
                qualifications of any health care provider who is or 
                was an employee of any Indian Health Program or Urban 
                Indian Organization and who has applied for or been 
                granted authority or employment to provide health care 
                services in or on behalf of such program or 
                organization.
                    ``(E) To an officer, employee, or contractor of the 
                Indian Health Program or Urban Indian Organization that 
                created the records or for which the records were 
                created. If that officer, employee, or contractor has a 
                need for such record or testimony to perform official 
                duties.
                    ``(F) To a criminal or civil law enforcement agency 
                or instrumentality charged under applicable law with 
                the protection of the public health or safety, if a 
                qualified representative of such agency or 
                instrumentality makes a written request that such 
                record or testimony be provided for a purpose 
                authorized by law.
                    ``(G) In an administrative or judicial proceeding 
                commenced by a criminal or civil law enforcement agency 
                or instrumentality referred to in subparagraph (F), but 
                only with respect to the subject of such proceeding.
            ``(2) Identity of participants.--With the exception of the 
        subject of a quality assurance action, the identity of any 
        person receiving health care services from any Indian Health 
        Program or Urban Indian Organization or the identity of any 
        other person associated with such program or organization for 
        purposes of a medical quality assurance program that is 
        disclosed in a medical quality assurance record described in 
        subsection (a) shall be deleted from that record or document 
        before any disclosure of such record is made outside such 
        program or organization.
    ``(d) Disclosure for Certain Purposes.--
            ``(1) In general.--Nothing in this section shall be 
        construed as authorizing or requiring the withholding from any 
        person or entity aggregate statistical information regarding 
        the results of any Indian Health Program or Urban Indian 
        Organizations's medical quality assurance programs.
            ``(2) Withholding from congress.--Nothing in this section 
        shall be construed as authority to withhold any medical quality 
        assurance record from a committee of either House of Congress, 
        any joint committee of Congress, or the Government 
        Accountability Office if such record pertains to any matter 
        within their respective jurisdictions.
    ``(e) Prohibition on Disclosure of Record or Testimony.--A person 
or entity having possession of or access to a record or testimony 
described by this section may not disclose the contents of such record 
or testimony in any manner or for any purpose except as provided in 
this section.
    ``(f) Exemption From Freedom of Information Act.--Medical quality 
assurance records described in subsection (a) may not be made available 
to any person under section 552 of title 5, United States Code.
    ``(g) Limitation on Civil Liability.--A person who participates in 
or provides information to a person or body that reviews or creates 
medical quality assurance records described in subsection (a) shall not 
be civilly liable for such participation or for providing such 
information if the participation or provision of information was in 
good faith based on prevailing professional standards at the time the 
medical quality assurance program activity took place.
    ``(h) Application to Information in Certain Other Records.--Nothing 
in this section shall be construed as limiting access to the 
information in a record created and maintained outside a medical 
quality assurance program, including a patient's medical records, on 
the grounds that the information was presented during meetings of a 
review body that are part of a medical quality assurance program.
    ``(i) Regulations.--The Secretary, acting through the Service, 
shall promulgate regulations pursuant to section 802.
    ``(j) Definitions.--In this section:
            ``(1) The term `health care provider' means any health care 
        professional, including community health aides and 
        practitioners certified under section 121, who are granted 
        clinical practice privileges or employed to provide health care 
        services in an Indian Health Program or health program of an 
        Urban Indian Organization, who is licensed or certified to 
        perform health care services by a governmental board or agency 
        or professional health care society or organization.
            ``(2) The term `medical quality assurance program' means 
        any activity carried out before, on, or after the date of 
        enactment of this Act by or for any Indian Health Program or 
        Urban Indian Organization to assess the quality of medical 
        care, including activities conducted by or on behalf of 
        individuals, Indian Health Program or Urban Indian Organization 
        medical or dental treatment review committees, or other review 
        bodies responsible for quality assurance, credentials, 
        infection control, patient safety, patient care assessment 
        (including treatment procedures, blood, drugs, and 
        therapeutics), medical records, health resources management 
        review and identification and prevention of medical or dental 
        incidents and risks.
            ``(3) The term `medical quality assurance record' means the 
        proceedings, records, minutes, and reports that emanate from 
        quality assurance program activities described in paragraph (2) 
        and are produced or compiled by or for an Indian Health Program 
        or Urban Indian Organization as part of a medical quality 
        assurance program.
    ``(k) Continued Protection.--Disclosure under subsection (c) does 
not permit redisclosure except to the extent such further disclosure is 
authorized under subsection (c) or is otherwise authorized to be 
disclosed under this section.
    ``(l) Inconsistencies.--To the extent that the protections under 
the Patient Safety and Quality Improvement Act of 2005 and this section 
are inconsistent, the provisions of whichever is more protective shall 
control.
    ``(m) Relationship to Other Law.--This section shall continue in 
force and effect, except asotherwise specifically provided in any 
Federal law enacted after the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2009.

``SEC. 815. CLAREMORE INDIAN HOSPITAL.

    ``The Claremore Indian Hospital shall be deemed to be a dependant 
Indian community for the purposes of section 1151 of title 18, United 
States Code.

``SEC. 816. SENSE OF CONGRESS REGARDING LAW ENFORCEMENT AND 
              METHAMPHETAMINE ISSUES IN INDIAN COUNTRY.

    ``It is the sense of Congress that Congress encourages State, 
local, and Indian tribal law enforcement agencies to enter into 
memoranda of agreement between and among those agencies for purposes of 
streamlining law enforcement activities and maximizing the use of 
limited resources--
            ``(1) to improve law enforcement services provided to 
        Indian tribal communities; and
            ``(2) to increase the effectiveness of measures to address 
        problems relating to methamphetamine use in Indian country (as 
        defined in section 1151 of title 18, United States Code).

``SEC. 817. PERMITTING IMPLEMENTATION THROUGH CONTRACTS WITH TRIBAL 
              HEALTH PROGRAMS.

    ``Nothing in this Act shall be construed as preventing the 
Secretary from--
            ``(1) carrying out any section of this Act through 
        contracts with Tribal Health Programs; and
            ``(2) carrying out sections through 214, 701(a)(1), 
        701(b)(1), 701(c), 707(g), and 712(b), through contracts with 
        urban Indian organizations.
The previous sentence shall not affect the authority the Secretary may 
otherwise have to carry out other provisions of this Act through such 
contracts.

``SEC. 818. AUTHORIZATION OF APPROPRIATIONS; AVAILABILITY.

    ``(a) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this title.
    ``(b) Limitation on New Spending Authority.--Any new spending 
authority (described in subparagraph (A) or (B) of section 401(c)(2) of 
the Congressional Budget Act of 1974 (Public Law 93-344; 88 Stat. 317)) 
which is provided under this Act shall be effective for any fiscal year 
only to such extent or in such amounts as are provided in appropriation 
Acts.
    ``(c) Availability.--The funds appropriated pursuant to this Act 
shall remain available until expended.''.
    (b) Rate of Pay.--
            (1) Positions at level iv.--Section 5315 of title 5, United 
        States Code, is amended by striking ``Assistant Secretaries of 
        Health and Human Services (6).'' and inserting ``Assistant 
        Secretaries of Health and Human Services (7)''.
            (2) Positions at level v.--Section 5316 of title 5, United 
        States Code, is amended by striking ``Director, Indian Health 
        Service, Department of Health and Human Services''.
    (c) Amendments to Other Provisions of Law.--
            (1) Section 3307(b)(1)(C) of the Children's Health Act of 
        2000 (25 U.S.C. 1671 note; Public Law 106-310) is amended by 
        striking ``Director of the Indian Health Service'' and 
        inserting ``Assistant Secretary for Indian Health''.
            (2) The Indian Lands Open Dump Cleanup Act of 1994 is 
        amended--
                    (A) in section 3 (25 U.S.C. 3902)--
                            (i) by striking paragraph (2);
                            (ii) by redesignating paragraphs (1), (3), 
                        (4), (5), and (6) as paragraphs (4), (5), (2), 
                        (6), and (1), respectively, and moving those 
                        paragraphs so as to appear in numerical order; 
                        and
                            (iii) by inserting before paragraph (4) (as 
                        redesignated by subclause (II)) the following:
            ``(3) Assistant secretary.--The term `Assistant Secretary' 
        means the Assistant Secretary for Indian Health.'';
                    (B) in section 5 (25 U.S.C. 3904), by striking the 
                section designation and heading and inserting the 
                following:

``SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR INDIAN HEALTH.'';

                    (C) in section 6(a) (25 U.S.C. 3905(a)), in the 
                subsection heading, by striking ``Director'' and 
                inserting ``Assistant Secretary'';
                    (D) in section 9(a) (25 U.S.C. 3908(a)), in the 
                subsection heading, by striking ``Director'' and 
                inserting ``Assistant Secretary''; and
                    (E) by striking ``Director'' each place it appears 
                and inserting ``Assistant Secretary''.
            (3) Section 5504(d)(2) of the Augustus F. Hawkins-Robert T. 
        Stafford Elementary and Secondary School Improvement Amendments 
        of 1988 (25 U.S.C. 2001 note; Public Law 100-297) is amended by 
        striking ``Director of the Indian Health Service'' and 
        inserting ``Assistant Secretary for Indian Health''.
            (4) Section 203(a)(1) of the Rehabilitation Act of 1973 (29 
        U.S.C. 763(a)(1)) is amended by striking ``Director of the 
        Indian Health Service'' and inserting ``Assistant Secretary for 
        Indian Health''.
            (5) Subsections (b) and (e) of section 518 of the Federal 
        Water Pollution Control Act (33 U.S.C. 1377) are amended by 
        striking ``Director of the Indian Health Service'' each place 
        it appears and inserting ``Assistant Secretary for Indian 
        Health''.
            (6) Section 317M(b) of the Public Health Service Act (42 
        U.S.C. 247b-14(b)) is amended--
                    (A) by striking ``Director of the Indian Health 
                Service'' each place it appears and inserting 
                ``Assistant Secretary for Indian Health''; and
                    (B) in paragraph (2)(A), by striking ``the 
                Directors referred to in such paragraph'' and inserting 
                ``the Director of the Centers for Disease Control and 
                Prevention and the Assistant Secretary for Indian 
                Health''.
            (7) Section 417C(b) of the Public Health Service Act (42 
        U.S.C. 285-9(b)) is amended by striking ``Director of the 
        Indian Health Service'' and inserting ``Assistant Secretary for 
        Indian Health''.
            (8) Section 1452(i) of the Safe Drinking Water Act (42 
        U.S.C. 300j-12(i)) is amended by striking ``Director of the 
        Indian Health Service'' each place it appears and inserting 
        ``Assistant Secretary for Indian Health''.
            (9) Section 803B(d)(1) of the Native American Programs Act 
        of 1974 (42 U.S.C. 2991b-2(d)(1)) is amended in the last 
        sentence by striking ``Director of the Indian Health Service'' 
        and inserting ``Assistant Secretary for Indian Health''.
            (10) Section 203(b) of the Michigan Indian Land Claims 
        Settlement Act (Public Law 105-143; 111 Stat. 2666) is amended 
        by striking ``Director of the Indian Health Service'' and 
        inserting ``Assistant Secretary for Indian Health''.

SEC. 102. SOBOBA SANITATION FACILITIES.

    The Act of December 17, 1970 (84 Stat. 1465), is amended by adding 
at the end the following:
    ``Sec. 9.  Nothing in this Act shall preclude the Soboba Band of 
Mission Indians and the Soboba Indian Reservation from being provided 
with sanitation facilities and services under the authority of section 
7 of the Act of August 5, 1954 (68 Stat. 674), as amended by the Act of 
July 31, 1959 (73 Stat. 267).''.

SEC. 103. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.

    (a) In General.--The Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.) is amended by adding at the end 
the following:

      ``TITLE VIII--NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION

``SEC. 801. DEFINITIONS.

    ``In this title:
            ``(1) Board.--The term `Board' means the Board of Directors 
        of the Foundation.
            ``(2) Committee.--The term `Committee' means the Committee 
        for the Establishment of Native American Health and Wellness 
        Foundation established under section 802(f).
            ``(3) Foundation.--The term `Foundation' means the Native 
        American Health and Wellness Foundation established under 
        section 802.
            ``(4) Secretary.--The term `Secretary' means the Secretary 
        of Health and Human Services.
            ``(5) Service.--The term `Service' means the Indian Health 
        Service of the Department of Health and Human Services.

``SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.

    ``(a) Establishment.--
            ``(1) In general.--As soon as practicable after the date of 
        enactment of this title, the Secretary shall establish, under 
        the laws of the District of Columbia and in accordance with 
        this title, the Native American Health and Wellness Foundation.
            ``(2) Funding determinations.--No funds, gift, property, or 
        other item of value (including any interest accrued on such an 
        item) acquired by the Foundation shall--
                    ``(A) be taken into consideration for purposes of 
                determining Federal appropriations relating to the 
                provision of health care and services to Indians; or
                    ``(B) otherwise limit, diminish, or affect the 
                Federal responsibility for the provision of health care 
                and services to Indians.
    ``(b) Perpetual Existence.--The Foundation shall have perpetual 
existence.
    ``(c) Nature of Corporation.--The Foundation--
            ``(1) shall be a charitable and nonprofit federally 
        chartered corporation; and
            ``(2) shall not be an agency or instrumentality of the 
        United States.
    ``(d) Place of Incorporation and Domicile.--The Foundation shall be 
incorporated and domiciled in the District of Columbia.
    ``(e) Duties.--The Foundation shall--
            ``(1) encourage, accept, and administer private gifts of 
        real and personal property, and any income from or interest in 
        such gifts, for the benefit of, or in support of, the mission 
        of the Service;
            ``(2) undertake and conduct such other activities as will 
        further the health and wellness activities and opportunities of 
        Native Americans; and
            ``(3) participate with and assist Federal, State, and 
        tribal governments, agencies, entities, and individuals in 
        undertaking and conducting activities that will further the 
        health and wellness activities and opportunities of Native 
        Americans.
    ``(f) Committee for the Establishment of Native American Health and 
Wellness Foundation.--
            ``(1) In general.--The Secretary shall establish the 
        Committee for the Establishment of Native American Health and 
        Wellness Foundation to assist the Secretary in establishing the 
        Foundation.
            ``(2) Duties.--Not later than 180 days after the date of 
        enactment of this section, the Committee shall--
                    ``(A) carry out such activities as are necessary to 
                incorporate the Foundation under the laws of the 
                District of Columbia, including acting as incorporators 
                of the Foundation;
                    ``(B) ensure that the Foundation qualifies for and 
                maintains the status required to carry out this 
                section, until the Board is established;
                    ``(C) establish the constitution and initial bylaws 
                of the Foundation;
                    ``(D) provide for the initial operation of the 
                Foundation, including providing for temporary or 
                interim quarters, equipment, and staff; and
                    ``(E) appoint the initial members of the Board in 
                accordance with the constitution and initial bylaws of 
                the Foundation.
    ``(g) Board of Directors.--
            ``(1) In general.--The Board of Directors shall be the 
        governing body of the Foundation.
            ``(2) Powers.--The Board may exercise, or provide for the 
        exercise of, the powers of the Foundation.
            ``(3) Selection.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                number of members of the Board, the manner of selection 
                of the members (including the filling of vacancies), 
                and the terms of office of the members shall be as 
                provided in the constitution and bylaws of the 
                Foundation.
                    ``(B) Requirements.--
                            ``(i) Number of members.--The Board shall 
                        have at least 11 members, who shall have 
                        staggered terms.
                            ``(ii) Initial voting members.--The initial 
                        voting members of the Board--
                                    ``(I) shall be appointed by the 
                                Committee not later than 180 days after 
                                the date on which the Foundation is 
                                established; and
                                    ``(II) shall have staggered terms.
                            ``(iii) Qualification.--The members of the 
                        Board shall be United States citizens who are 
                        knowledgeable or experienced in Native American 
                        health care and related matters.
                    ``(C) Compensation.--A member of the Board shall 
                not receive compensation for service as a member, but 
                shall be reimbursed for actual and necessary travel and 
                subsistence expenses incurred in the performance of the 
                duties of the Foundation.
    ``(h) Officers.--
            ``(1) In general.--The officers of the Foundation shall 
        be--
                    ``(A) a secretary, elected from among the members 
                of the Board; and
                    ``(B) any other officers provided for in the 
                constitution and bylaws of the Foundation.
            ``(2) Chief operating officer.--The secretary of the 
        Foundation may serve, at the direction of the Board, as the 
        chief operating officer of the Foundation, or the Board may 
        appoint a chief operating officer, who shall serve at the 
        direction of the Board.
            ``(3) Election.--The manner of election, term of office, 
        and duties of the officers of the Foundation shall be as 
        provided in the constitution and bylaws of the Foundation.
    ``(i) Powers.--The Foundation--
            ``(1) shall adopt a constitution and bylaws for the 
        management of the property of the Foundation and the regulation 
        of the affairs of the Foundation;
            ``(2) may adopt and alter a corporate seal;
            ``(3) may enter into contracts;
            ``(4) may acquire (through a gift or otherwise), own, 
        lease, encumber, and transfer real or personal property as 
        necessary or convenient to carry out the purposes of the 
        Foundation;
            ``(5) may sue and be sued; and
            ``(6) may perform any other act necessary and proper to 
        carry out the purposes of the Foundation.
    ``(j) Principal Office.--
            ``(1) In general.--The principal office of the Foundation 
        shall be in the District of Columbia.
            ``(2) Activities; offices.--The activities of the 
        Foundation may be conducted, and offices may be maintained, 
        throughout the United States in accordance with the 
        constitution and bylaws of the Foundation.
    ``(k) Service of Process.--The Foundation shall comply with the law 
on service of process of each State in which the Foundation is 
incorporated and of each State in which the Foundation carries on 
activities.
    ``(l) Liability of Officers, Employees, and Agents.--
            ``(1) In general.--The Foundation shall be liable for the 
        acts of the officers, employees, and agents of the Foundation 
        acting within the scope of their authority.
            ``(2) Personal liability.--A member of the Board shall be 
        personally liable only for gross negligence in the performance 
        of the duties of the member.
    ``(m) Restrictions.--
            ``(1) Limitation on spending.--Beginning with the fiscal 
        year following the first full fiscal year during which the 
        Foundation is in operation, the administrative costs of the 
        Foundation shall not exceed the percentage described in 
        paragraph (2) of the sum of--
                    ``(A) the amounts transferred to the Foundation 
                under subsection (o) during the preceding fiscal year; 
                and
                    ``(B) donations received from private sources 
                during the preceding fiscal year.
            ``(2) Percentages.--The percentages referred to in 
        paragraph (1) are--
                    ``(A) for the first fiscal year described in that 
                paragraph, 20 percent;
                    ``(B) for the following fiscal year, 15 percent; 
                and
                    ``(C) for each fiscal year thereafter, 10 percent.
            ``(3) Appointment and hiring.--The appointment of officers 
        and employees of the Foundation shall be subject to the 
        availability of funds.
            ``(4) Status.--A member of the Board or officer, employee, 
        or agent of the Foundation shall not by reason of association 
        with the Foundation be considered to be an officer, employee, 
        or agent of the United States.
    ``(n) Audits.--The Foundation shall comply with section 10101 of 
title 36, United States Code, as if the Foundation were a corporation 
under part B of subtitle II of that title.
    ``(o) Funding.--
            ``(1) Authorization of appropriations.--There is authorized 
        to be appropriated to carry out subsection (e)(1) $500,000 for 
        each fiscal year, as adjusted to reflect changes in the 
        Consumer Price Index for all-urban consumers published by the 
        Department of Labor.
            ``(2) Transfer of donated funds.--The Secretary shall 
        transfer to the Foundation funds held by the Department of 
        Health and Human Services under the Act of August 5, 1954 (42 
        U.S.C. 2001 et seq.), if the transfer or use of the funds is 
        not prohibited by any term under which the funds were donated.

``SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT.

    ``(a) Provision of Support by Secretary.--Subject to subsection 
(b), during the 5-year period beginning on the date on which the 
Foundation is established, the Secretary--
            ``(1) may provide personnel, facilities, and other 
        administrative support services to the Foundation;
            ``(2) may provide funds for initial operating costs and to 
        reimburse the travel expenses of the members of the Board; and
            ``(3) shall require and accept reimbursements from the 
        Foundation for--
                    ``(A) services provided under paragraph (1); and
                    ``(B) funds provided under paragraph (2).
    ``(b) Reimbursement.--Reimbursements accepted under subsection 
(a)(3)--
            ``(1) shall be deposited in the Treasury of the United 
        States to the credit of the applicable appropriations account; 
        and
            ``(2) shall be chargeable for the cost of providing 
        services described in subsection (a)(1) and travel expenses 
        described in subsection (a)(2).
    ``(c) Continuation of Certain Services.--The Secretary may continue 
to provide facilities and necessary support services to the Foundation 
after the termination of the 5-year period specified in subsection (a) 
if the facilities and services--
            ``(1) are available; and
            ``(2) are provided on reimbursable cost basis.''.
    (b) Technical Amendments.--The Indian Self-Determination and 
Education Assistance Act is amended--
            (1) by redesignating title V (25 U.S.C. 458bbb et seq.) as 
        title VII;
            (2) by redesignating sections 501, 502, and 503 (25 U.S.C. 
        458bbb, 458bbb-1, 458bbb-2) as sections 701, 702, and 703, 
        respectively; and
            (3) in subsection (a)(2) of section 702 and paragraph (2) 
        of section 703 (as redesignated by paragraph (2)), by striking 
        ``section 501'' and inserting ``section 701''.

SEC. 104. GAO STUDY AND REPORT ON PAYMENTS FOR CONTRACT HEALTH 
              SERVICES.

    (a) Study.--
            (1) In general.--The Comptroller General of the United 
        States (in this section referred to as the ``Comptroller 
        General'') shall conduct a study on the utilization of health 
        care furnished by health care providers under the contract 
        health services program funded by the Indian Health Service and 
        operated by the Indian Health Service, an Indian Tribe, or a 
        Tribal Organization (as those terms are defined in section 4 of 
        the Indian Health Care Improvement Act).
            (2) Analysis.--The study conducted under paragraph (1) 
        shall include an analysis of--
                    (A) the amounts reimbursed under the contract 
                health services program described in paragraph (1) for 
                health care furnished by entities, individual 
                providers, and suppliers, including a comparison of 
                reimbursement for such health care through other public 
                programs and in the private sector;
                    (B) barriers to accessing care under such contract 
                health services program, including, but not limited to, 
                barriers relating to travel distances, cultural 
                differences, and public and private sector reluctance 
                to furnish care to patients under such program;
                    (C) the adequacy of existing Federal funding for 
                health care under such contract health services 
                program; and
                    (D) any other items determined appropriate by the 
                Comptroller General.
    (b) Report.--Not later than 18 months after the date of enactment 
of this Act, the Comptroller General shall submit to Congress a report 
on the study conducted under subsection (a), together with 
recommendations regarding--
            (1) the appropriate level of Federal funding that should be 
        established for health care under the contract health services 
        program described in subsection (a)(1); and
            (2) how to most efficiently utilize such funding.
    (c) Consultation.--In conducting the study under subsection (a) and 
preparing the report under subsection (b), the Comptroller General 
shall consult with the Indian Health Service, Indian Tribes, and Tribal 
Organizations.

 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.

    (a) Medicaid.--
            (1) Expansion to all covered services.--Section 1911 of the 
        Social Security Act (42 U.S.C. 1396j) is amended--
                    (A) by amending the heading to read as follows:

``SEC. 1911. INDIAN HEALTH PROGRAMS.'';

                and
                    (B) by amending subsection (a) to read as follows:
    ``(a) Eligibility for Payment for Medical Assistance.--An Indian 
Health Program shall be eligible for payment for medical assistance 
provided under a State plan or under waiver authority with respect to 
items and services furnished by the Program if the furnishing of such 
services meets all the conditions and requirements which are applicable 
generally to the furnishing of items and services under this title and 
under such plan or waiver authority.''.
            (2) Repeal of obsolete provision.--Subsection (b) of such 
        section is repealed.
            (3) Revision of authority to enter into agreements.--
        Subsection (c) of such section is amended to read as follows:
    ``(c) Authority To Enter Into Agreements.--The Secretary may enter 
into an agreement with a State for the purpose of reimbursing the State 
for medical assistance provided by the Indian Health Service, an Indian 
Tribe, Tribal Organization, or an Urban Indian Organization (as so 
defined), directly, through referral, or under contracts or other 
arrangements between the Indian Health Service, an Indian Tribe, Tribal 
Organization, or an Urban Indian Organization and another health care 
provider to Indians who are eligible for medical assistance under the 
State plan or under waiver authority. This subsection shall not be 
construed to impair the entitlement of a State to reimbursement for 
such medical assistance under this title.''.
            (4) Cross-references to special fund for improvement of ihs 
        facilities; direct billing option; definitions.--Such section 
        is further amended by striking subsection (d) and adding at the 
        end the following new subsections:
    ``(c) Special Fund for Improvement of IHS Facilities.--For 
provisions relating to the authority of the Secretary to place payments 
to which a facility of the Indian Health Service is eligible for 
payment under this title into a special fund established under section 
401(c)(1) of the Indian Health Care Improvement Act, see subparagraphs 
(A) and (B) of section 401(c)(1) of such Act.
    ``(d) Direct Billing.--For provisions relating to the authority of 
an Tribal Health Program to elect to directly bill for, and receive 
payment for, health care items and services provided by such Program 
for which payment is made under this title, see section 401(d) of the 
Indian Health Care Improvement Act.''.
            (5) Definitions.--Section 1101(a) of such Act (42 U.S.C. 
        1301(a)) is amended by adding at the end the following new 
        paragraph:
            ``(11) For purposes of this title and titles XVIII, XIX, 
        and XXI, the terms `Indian Health Program', `Indian Tribe' (and 
        `Indian tribe'), `Tribal Health Program', `Tribal Organization' 
        (and `tribal organization'), and `urban Indian organization' 
        (and `urban Indian organization') have the meanings given those 
        terms in section 4 of the Indian Health Care Improvement 
        Act.''.
    (b) Medicare.--
            (1) Expansion to all covered services.--Section 1880 of 
        such Act (42 U.S.C. 1395qq) is amended--
                    (A) by amending the heading to read as follows:

``SEC. 1880. INDIAN HEALTH PROGRAMS.'';

                and
                    (B) by amending subsection (a) to read as follows:
    ``(a) Eligibility for Payments.--Subject to subsection (e), an 
Indian Health Program shall be eligible for payments under this title 
with respect to items and services furnished by the Program if the 
furnishing of such services meets all the conditions and requirements 
which are applicable generally to the furnishing of items and services 
under this title.''.
            (2) Repeal of obsolete provision.--Subsection (b) of such 
        section is repealed.
            (3) Compliance with conditions and requirements.--
        Subsection (b) of such section is amended to read as follows:
    ``(b) Compliance With Conditions and Requirements.--Subject to 
subsection (e), a facility of the Indian Health Service or an Indian 
Tribe, Tribal Organization, or an Urban Indian Organization which is 
eligible for payment under subsection (a) with respect to the 
furnishing of items and services, but which does not meet all of the 
conditions and requirements of this title which are applicable 
generally to such facility, shall make such improvements as are 
necessary to achieve or maintain compliance with such conditions and 
requirements in accordance with a plan submitted to and accepted by the 
Secretary for achieving or maintaining compliance with such conditions 
and requirements, and shall be deemed to meet such conditions and 
requirements (and to be eligible for payment under this title), without 
regard to the extent of its actual compliance with such conditions and 
requirements, during the first 12 months after the month in which such 
plan is submitted.''.
            (4) Cross-references to special fund for improvement of ihs 
        facilities; direct billing option; definitions.--
                    (A) In general.--Such section is further amended by 
                striking subsections (c) and (d) and inserting the 
                following new subsections:
    ``(b) Special Fund for Improvement of IHS Facilities.--For 
provisions relating to the authority of the Secretary to place payments 
to which a facility of the Indian Health Service is eligible for 
payment under this title into a special fund established under section 
401(c)(1) of the Indian Health Care Improvement Act, and the 
requirement to use amounts paid from such fund for making improvements 
in accordance with subsection (b), see subparagraphs (A) and (B) of 
section 401(c)(1) of such Act.
    ``(c) Direct Billing.--For provisions relating to the authority of 
a Tribal Health Program to elect to directly bill for, and receive 
payment for, health care items and services provided by such Program 
for which payment is made under this title, see section 401(d) of the 
Indian Health Care Improvement Act.''.
                    (B) Conforming amendments.--Such section is further 
                amended--
                            (i) in subsection (e)(3), by striking 
                        ``Subsection (c)'' and inserting ``Subsection 
                        (b) and section 401(b)(1) of the Indian Health 
                        Care Improvement Act'';
                            (ii) by redesignating subsection (e) as 
                        subsection (d); and
                            (iii) by striking subsection (f).
            (5) Definitions.--Such section is further amended by 
        amending subsection (f) to read as follows:
    ``(f) Definitions.--In this section, the terms `Indian Health 
Program', `Indian Tribe', `Service Unit', `Tribal Health Program', 
`Tribal Organization', and `Urban Indian Organization' have the 
meanings given those terms in section 4 of the Indian Health Care 
Improvement Act.''.
    (c) Application to SCHIP.--Section 2107(e)(1) of the Social 
Security Act (42 U.S.C. 1397gg(e)(1)) is amended--
            (1) by redesignating subparagraph (D) as subparagraph (E); 
        and
            (2) by inserting after subparagraph (C), the following new 
        subparagraph:
                    ``(D) Section 1911 (relating to Indian Health 
                Programs, other than subsection (c) of such 
                section).''.

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.

    Section 1139 of the Social Security Act (42 U.S.C. 1320b-9) is 
amended to read as follows:

``SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE FOR 
              INDIANS UNDER TITLES XVIII, XIX, AND XXI.

    ``(a) Agreements With States for Medicaid and SCHIP Outreach On or 
Near Reservations To Increase the Enrollment of Indians in Those 
Programs.--
            ``(1) In general.--In order to improve the access of 
        Indians residing on or near a reservation to obtain benefits 
        under the Medicaid and State children's health insurance 
        programs established under titles XIX and XXI, the Secretary, 
        acting through the Centers for Medicare & Medicaid Services, 
        shall encourage each State with all or part of a reservation 
        within its borders to take steps to provide for enrollment on 
        or near such reservations. Such steps may include outreach 
        efforts such as the outstationing of eligibility workers, 
        entering into agreements with the Indian Health Service, Indian 
        Tribes, Tribal Organizations, and urban Indian organizations to 
        provide outreach, education regarding eligibility and benefits, 
        enrollment, and translation services when such services are 
        appropriate.
            ``(2) Construction.--Nothing in paragraph (1) shall be 
        construed as affecting arrangements entered into between States 
        and the Indian Health Service, Indian Tribes, Tribal 
        Organizations, or urban Indian organizations for such Service, 
        Tribes, or Organizations to conduct administrative activities 
        under such titles.
    ``(b) Facilitating Cooperation in Enrollment and Retention.--The 
Secretary, acting through the Centers for Medicare & Medicaid Services, 
shall consult with States, the Service, Indian Tribes, Tribal 
Organizations, and urban Indian organizations to develop and 
disseminate best practices with respect to facilitating agreements 
between the States and Indian Tribes, Tribal Organizations, and urban 
Indian organizations relating to enrollment and retention of Indians in 
programs established under titles XVIII, XIX, and XXI.
    ``(c) Definition of Indian; Indian Tribe; Indian Health Program; 
Tribal Organization; Urban Indian Organization.--In this section, the 
terms `Indian', `Indian Tribe', `Indian Health Program', `Tribal 
Organization', and `Urban Indian Organization' have the meanings given 
those terms in section 4 of the Indian Health Care Improvement Act.''.

SEC. 203. ADDITIONAL PROVISIONS TO INCREASE OUTREACH TO, AND ENROLLMENT 
              OF, INDIANS IN SCHIP AND MEDICAID.

    (a) Assurance of Payments to Indian Health Care Providers for Child 
Health Assistance.--Section 2102(b)(3)(D) of such Act (42 U.S.C. 
1397bb(b)(3)(D)) is amended by striking ``(as defined in section 4(c) 
of the Indian Health Care Improvement Act, 25 U.S.C. 1603(c))'' and 
inserting ``, including how the State will ensure that payments are 
made to Indian Health Programs and urban Indian organizations operating 
in the State for the provision of such assistance''.
    (b) Inclusion of Other Indian Financed Health Care Programs in 
Exemption From Prohibition on Certain Payments.--Section 2105(c)(6)(B) 
of such Act (42 U.S.C. 1397ee(c)(6)(B)) is amended by striking 
``insurance program, other than an insurance program operated or 
financed by the Indian Health Service'' and inserting ``program, other 
than a health care program operated or financed by the Indian Health 
Service or by an Indian Tribe, Tribal Organization, or urban Indian 
organization''.
    (c) Definitions.--Section 2110(c) of such Act (42 U.S.C. 1397jj(c)) 
is amended by adding at the end the following new paragraph:
            ``(9) Indian; indian health program; indian tribe; etc.--
        The terms `Indian', `Indian Health Program', `Indian Tribe', 
        `Tribal Organization', and `Urban Indian Organization' have the 
        meanings given those terms in section 4 of the Indian Health 
        Care Improvement Act.''.

SEC. 204. NONDISCRIMINATION IN QUALIFICATIONS FOR PAYMENT FOR SERVICES 
              UNDER FEDERAL HEALTH CARE PROGRAMS.

    Section 1139 of the Social Security Act (42 U.S.C. 1320b-9), as 
amended by section 202, is amended by redesignating subsection (c) as 
subsection (d), and inserting after subsection (b) the following new 
subsection:
    ``(c) Nondiscrimination in Qualifications for Payment for Services 
Under Federal Health Care Programs.--
            ``(1) Requirement to satisfy generally applicable 
        participation requirements.--
                    ``(A) In general.--A Federal health care program 
                must accept an entity that is operated by the Indian 
                Health Service, an Indian Tribe, Tribal Organization, 
                or Urban Indian Organization as a provider eligible to 
                receive payment under the program for health care 
                services furnished to an Indian on the same basis as 
                any other provider qualified to participate as a 
                provider of health care services under the program if 
                the entity meets generally applicable State or other 
                requirements for participation as a provider of health 
                care services under the program.
                    ``(B) Satisfaction of state or local licensure or 
                recognition requirements.--Any requirement for 
                participation as a provider of health care services 
                under a Federal health care program that an entity be 
                licensed or recognized under the State or local law 
                where the entity is located to furnish health care 
                services shall be deemed to have been met in the case 
                of an entity operated by the Indian Health Service, an 
                Indian Tribe, Tribal Organization, or Urban Indian 
                Organization if the entity meets all the applicable 
                standards for such licensure or recognition, regardless 
                of whether the entity obtains a license or other 
                documentation under such State or local law. In 
                accordance with section 221 of the Indian Health Care 
                Improvement Act, the absence of the licensure of a 
                health care professional employed by such an entity 
                under the State or local law where the entity is 
                located shall not be taken into account for purposes of 
                determining whether the entity meets such standards, if 
                the professional is licensed in another State.
            ``(2) Prohibition on federal payments to entities or 
        individuals excluded from participation in federal health care 
        programs or whose state licenses are under suspension or have 
        been revoked.--
                    ``(A) Excluded entities.--No entity operated by the 
                Indian Health Service, an Indian Tribe, Tribal 
                Organization, or Urban Indian Organization that has 
                been excluded from participation in any Federal health 
                care program or for which a license is under suspension 
                or has been revoked by the State where the entity is 
                located shall be eligible to receive payment under any 
                such program for health care services furnished to an 
                Indian.
                    ``(B) Excluded individuals.--No individual who has 
                been excluded from participation in any Federal health 
                care program or whose State license is under suspension 
                or has been revoked shall be eligible to receive 
                payment under any such program for health care services 
                furnished by that individual, directly or through an 
                entity that is otherwise eligible to receive payment 
                for health care services, to an Indian.
                    ``(C) Federal health care program defined.--In this 
                subsection, the term, `Federal health care program' has 
                the meaning given that term in section 1128B(f), except 
                that, for purposes of this subsection, such term shall 
                include the health insurance program under chapter 89 
                of title 5, United States Code.''.

SEC. 205. SOLICITATION OF PROPOSALS FOR SAFE HARBORS UNDER THE SOCIAL 
              SECURITY ACT FOR FACILITIES OF INDIAN HEALTH PROGRAMS AND 
              URBAN INDIAN ORGANIZATIONS.

    The Secretary of Health and Human Services, acting through the 
Office of the Inspector General of the Department of Health and Human 
Services, shall publish a notice, described in section 1128D(a)(1)(A) 
of the Social Security Act (42 U.S.C. 1320a-7d(a)(1)(A)), soliciting a 
proposal, not later than July 1, 2010, on the development of safe 
harbors described in such section relating to health care items and 
services provided by facilities of Indian Health Programs or an urban 
Indian organization (as such terms are defined in section 4 of the 
Indian Health Care Improvement Act). Such a safe harbor may relate to 
areas such as transportation, housing, or cost-sharing, assistance 
provided through such facilities or contract health services for 
Indians.

SEC. 206. ANNUAL REPORT ON INDIANS SERVED BY SOCIAL SECURITY ACT HEALTH 
              BENEFIT PROGRAMS.

    Section 1139 of the Social Security Act (42 U.S.C. 1320b-9), as 
amended by the sections 202, 205, and 206, is amended by redesignating 
subsection (e) as subsection (f), and inserting after subsection (d) 
the following new subsection:
    ``(e) Annual Report on Indians Served by Health Benefit Programs 
Funded Under This Act.--Beginning January 1, 2007, and annually 
thereafter, the Secretary, acting through the Administrator of the 
Centers for Medicare & Medicaid Services and the Director of the Indian 
Health Service, shall submit a report to Congress regarding the 
enrollment and health status of Indians receiving items or services 
under health benefit programs funded under this Act during the 
preceding year. Each such report shall include the following:
            ``(1) The total number of Indians enrolled in, or receiving 
        items or services under, such programs, disaggregated with 
        respect to each such program.
            ``(2) The number of Indians described in paragraph (1) that 
        also received health benefits under programs funded by the 
        Indian Health Service.
            ``(3) General information regarding the health status of 
        the Indians described in paragraph (1), disaggregated with 
        respect to specific diseases or conditions and presented in a 
        manner that is consistent with protections for privacy of 
        individually identifiable health information under section 
        264(c) of the Health Insurance Portability and Accountability 
        Act of 1996.
            ``(4) A detailed statement of the status of facilities of 
        the Indian Health Service or an Indian Tribe, Tribal 
        Organization, or an Urban Indian Organization with respect to 
        such facilities' compliance with the applicable conditions and 
        requirements of titles XVIII, XIX, and XXI, and, in the case of 
        title XIX or XXI, under a State plan under such title or under 
        waiver authority, and of the progress being made by such 
        facilities (under plans submitted under section 1880(b), 
        1911(b) or otherwise) toward the achievement and maintenance of 
        such compliance.
            ``(5) Such other information as the Secretary determines is 
        appropriate.''.

SEC. 207. DEVELOPMENT OF RECOMMENDATIONS TO IMPROVE INTERSTATE 
              COORDINATION OF MEDICAID AND SCHIP COVERAGE OF INDIAN 
              CHILDREN AND OTHER CHILDREN WHO ARE OUTSIDE OF THEIR 
              STATE OF RESIDENCY BECAUSE OF EDUCATIONAL OR OTHER NEEDS.

    (a) Study.--The Secretary shall conduct a study to identify 
barriers to interstate coordination of enrollment and coverage under 
the Medicaid program under title XIX of the Social Security Act and the 
State Children's Health Insurance Program under title XXI of such Act 
of children who are eligible for medical assistance or child health 
assistance under such programs and who, because of educational needs, 
migration of families, emergency evacuations, or otherwise, frequently 
change their State of residency or otherwise are temporarily present 
outside of the State of their residency. Such study shall include an 
examination of the enrollment and coverage coordination issues faced by 
Indian children who are eligible for medical assistance or child health 
assistance under such programs in their State of residence and who 
temporarily reside in an out-of-State boarding school or peripheral 
dormitory funded by the Bureau of Indian Affairs.
    (b) Report.--Not later than 18 months after the date of enactment 
of this Act, the Secretary, in consultation with directors of State 
Medicaid programs under title XIX of the Social Security Act and 
directors of State Children's Health Insurance Programs under title XXI 
of such Act, shall submit a report to Congress that contains 
recommendations for such legislative and administrative actions as the 
Secretary determines appropriate to address the enrollment and coverage 
coordination barriers identified through the study required under 
subsection (a).
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