I 

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. SA ́NCHEZ of 

California, Mr. KAGEN, Mr. LUJA ́N, 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. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Indian Health Care Improvement Act Amendments of 

6 2009’’. 


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

2 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. 

3 TITLE I—AMENDMENTS TO 

4 INDIAN LAWS 

5 SEC. 101. INDIAN HEALTH CARE IMPROVEMENT ACT 

6 AMENDED. 

7 (a) IN GENERAL.—The Indian Health Care Improve8 ment Act (25 U.S.C. 1601 et seq.) is amended to read 

9 as follows: 

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

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

12 ‘Indian Health Care Improvement Act’. 


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

2 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. 


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‘‘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). 


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‘‘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. 


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‘‘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. 

1 ‘‘SEC. 2. FINDINGS. 

2 ‘‘Congress makes the following findings: 

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

4 improve the health of the Indians are consonant 

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

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

9 is to provide the resources, processes, and structure 

10 that will enable Indian tribes and tribal members to 

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1 ices and opportunities that will eradicate the health 

2 dispartities between Indians the general population. 

3 ‘‘(3) A major national goal of the United States 

4 is to provide the quantity and quality of health serv5 ices which will permit the health status of Indians 

6 to be raised to the highest possible level and to en7 courage the maximum participation of Indians in the 

8 planning and management of those services. 

9 ‘‘(4) Federal health services to Indians have re10 sulted in a reduction in the prevalence and incidence 

11 of preventable illnesses among, and unnecessary and 

12 premature deaths of, Indians. 

13 ‘‘(5) Despite such services, the unmet health 

14 needs of the American Indian people are severe and 

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

16 the general population of the United States. 

17 ‘‘SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POL18 ICY. 

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

20 in fulfillment of its special trust responsibilities and legal 

21 obligations to Indians— 

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

23 for Indians and to provide all resources necessary to 

24 effect that policy; 


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

2 least the levels set forth in the goals contained with3 in the Health People 2010 or successor objectives; 

4 ‘‘(3) to the greatest extent possible, to allow In5 dians to set their own health care priorities and es6 tablish goals that reflect their unmet needs; 

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

8 the health professions and allied and associated 

9 health professions awarded to Indians so that the 

10 proportion of Indian health professionals in each 

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

12 the general population; 

13 ‘‘(5) to require meaningful consultation with In14 dian Tribes, Tribal Organizations, and urban Indian 

15 organizations to implement this Act and the national 

16 policy of Indian self-determination; and 

17 ‘‘(6) to provide funding for programs and facili18 ties operated by Indian Tribes and Tribal Organiza19 tions in amounts that are not less than the amounts 

20 provided to programs and facilities operated directly 

21 by the Service. 

22 ‘‘SEC. 4. DEFINITIONS. 

23 ‘‘For purposes of this Act: 

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

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1 tional or regional organization with accrediting au2 thority. 

3 ‘‘(2) The term ‘Area Office’ means an adminis4 trative entity, including a program office, within the 

5 Service through which services and funds are pro6 vided to the Service Units within a defined geo7 graphic area. 

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

9 Assistant Secretary of Indian Health. 

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

11 blending of substance (including alcohol, drugs, 

12 inhalants, and tobacco) abuse and mental health 

13 prevention and treatment, for the purpose of pro14 viding comprehensive services. 

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

16 joint development of substance abuse and mental 

17 health treatment planning and coordinated case 

18 management using a multidisciplinary approach. 

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

20 Indians who are eligible for health services of the 

21 Service pursuant to section 805. 

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

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

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


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

2 health services provided at the expense of the Serv3 ice or a Tribal Health Program by public or private 

4 medical providers or hospitals, other than the Serv5 ice Unit or the Tribal Health Program at whose ex6 pense the services are provided. 

7 ‘‘(8) The term ‘Department’ means, unless oth8 erwise designated, the Department of Health and 

9 Human Services. 

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

11 reduction, limitation, and prevention of disease and 

12 its complications and reduction in the consequences 

13 of disease, including— 

14 ‘‘(A) controlling— 

15 ‘‘(i) the development of diabetes; 

16 ‘‘(ii) high blood pressure; 

17 ‘‘(iii) infectious agents; 

18 ‘‘(iv) injuries; 

19 ‘‘(v) occupational hazards and disabil20 ities; 

21 ‘‘(vi) sexually transmittable diseases; 

22 and 

23 ‘‘(vii) toxic agents; and 

24 ‘‘(B) providing— 

25 ‘‘(i) fluoridation of water; and 


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1 ‘‘(ii) immunizations. 

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

3 allopathic medicine, family medicine, internal medi4 cine, pediatrics, geriatric medicine, obstetrics and 

5 gynecology, podiatric medicine, nursing, public 

6 health nursing, dentistry, psychiatry, osteopathy, op7 tometry, pharmacy, psychology, public health, social 

8 work, marriage and family therapy, chiropractic 

9 medicine, environmental health and engineering, al10 lied health professions, naturopathic medicine, and 

11 any other health profession. 

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

13 ‘‘(A) fostering social, economic, environ14 mental, and personal factors conducive to 

15 health, including raising public awareness about 

16 health matters and enabling the people to cope 

17 with health problems by increasing their knowl18 edge and providing them with valid information; 

19 ‘‘(B) encouraging adequate and appro20 priate diet, exercise, and sleep; 

21 ‘‘(C) promoting education and work in con22 formity with physical and mental capacity; 

23 ‘‘(D) making available safe water and sani24 tary facilities; 


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1 ‘‘(E) improving the physical, economic, cul2 tural, psychological, and social environment; 

3 ‘‘(F) promoting culturally competent care; 

4 and 

5 ‘‘(G) providing adequate and appropriate 

6 programs, which may include— 

7 ‘‘(i) abuse prevention (mental and 

8 physical); 

9 ‘‘(ii) community health; 

10 ‘‘(iii) community safety; 

11 ‘‘(iv) consumer health education; 

12 ‘‘(v) diet and nutrition; 

13 ‘‘(vi) immunization and other preven14 tion of communicable diseases, including 

15 HIV/AIDS; 

16 ‘‘(vii) environmental health; 

17 ‘‘(viii) exercise and physical fitness; 

18 ‘‘(ix) avoidance of fetal alcohol dis19 orders; 

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

21 ‘‘(xi) human growth and development; 

22 ‘‘(xii) injury prevention and personal 

23 safety; 

24 ‘‘(xiii) behavioral health; 


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1 ‘‘(xiv) monitoring of disease indicators 

2 between health care provider visits, 

3 through appropriate means, including 

4 Internet-based health care management 

5 systems; 

6 ‘‘(xv) personal health and wellness 

7 practices; 

8 ‘‘(xvi) personal capacity building; 

9 ‘‘(xvii) prenatal, pregnancy, and in10 fant care; 

11 ‘‘(xviii) psychological well-being; 

12 ‘‘(xix) reproductive health and family 

13 planning; 

14 ‘‘(xx) safe and adequate water; 

15 ‘‘(xxi) healthy work environments; 

16 ‘‘(xxii) elimination, reduction, and 

17 prevention of contaminants that create 

18 unhealthy household conditions (including 

19 mold and other allergens); 

20 ‘‘(xxiii) stress control; 

21 ‘‘(xxiv) substance abuse; 

22 ‘‘(xxv) sanitary facilities; 

23 ‘‘(xxvi) sudden infant death syndrome 

24 prevention; 


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

3 ‘‘(xxviii) violence prevention; and 

4 ‘‘(xxix) activities to promote achieve5 ment of any of the objectives described in 

6 section 3(2). 

7 ‘‘(12) The term ‘Indian’, unless otherwise des8 ignated, means any person who is a member of an 

9 Indian Tribe or is eligible for health services under 

10 section 805, except that, for the purpose of sections 

11 102 and 103, the term also means any individual 

12 who— 

13 ‘‘(A)(i) irrespective of whether the indi14 vidual lives on or near a reservation, is a mem15 ber of a tribe, band, or other organized group 

16 of Indians, including those tribes, bands, or 

17 groups terminated since 1940 and those recog18 nized now or in the future by the State in 

19 which they reside; or 

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

21 degree, of any such member; 

22 ‘‘(B) is an Eskimo or Aleut or other Alas23 ka Native; 

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

25 Interior to be an Indian for any purpose; or 


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

2 regulations promulgated by the Secretary. 

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

4 means— 

5 ‘‘(A) any health program administered di6 rectly by the Service; 

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

8 ‘‘(C) any Indian Tribe or Tribal Organiza9 tion to which the Secretary provides funding 

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

11 1910 (25 U.S.C. 47) (commonly known as the 

12 ‘Buy Indian Act’). 

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

14 given the term in the Indian Self-Determination and 

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

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

17 has the meaning given the term by section 312(f) of 

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

19 1058(f)). 

20 ‘‘(16) The term ‘reservation’ means any feder21 ally recognized Indian Tribe’s reservation, Pueblo, or 

22 colony, including former reservations in Oklahoma, 

23 Indian allotments, and Alaska Native Regions estab24 lished pursuant to the Alaska Native Claims Settle25 ment Act (43 U.S.C. 1601 et seq.). 


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

2 designated, means the Secretary of Health and 

3 Human Services. 

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

5 Health Service. 

6 ‘‘(19) The term ‘Service Area’ means the geo7 graphical area served by each Area Office. 

8 ‘‘(20) The term ‘Service Unit’ means an admin9 istrative entity of the Service, or a Tribal Health 

10 Program through which services are provided, di11 rectly or by contract, to eligible Indians within a de12 fined geographic area. 

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

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

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

16 ‘‘(22) The term ‘telemedicine’ means a tele17 communications link to an end user through the use 

18 of eligible equipment that electronically links health 

19 professionals or patients and health professionals at 

20 separate sites in order to exchange health care infor21 mation in audio, video, graphic, or other format for 

22 the purpose of providing improved health care serv23 ices. 


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

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

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

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

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

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

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

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

11 et seq.). 

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

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

15 450 et seq.). 

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

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

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

23 meets 1 or more of the following criteria: 

24 ‘‘(A) Irrespective of whether the individual 

25 lives on or near a reservation, the individual is 


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

2 group of Indians, including those tribes, bands, 

3 or groups terminated since 1940 and those 

4 tribes, bands, or groups that are recognized by 

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

7 such member. 

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

9 or other Alaska Native. 

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

11 Secretary of the Interior to be an Indian for 

12 any purpose. 

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

14 Indian under regulations promulgated by the 

15 Secretary. 

16 ‘‘(28) The term ‘urban Indian organization’ 

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

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

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

22 cooperating with other public and private entities for 

23 the purpose of performing the activities described in 

24 section 503(a). 


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1 ‘‘TITLE I—INDIAN HEALTH, 

2 HUMAN RESOURCES, AND DE3 VELOPMENT 

4 ‘‘SEC. 101. PURPOSE. 

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

7 health professions and providing health services, and to 

8 assure an optimum supply of health professionals to the 

9 Indian Health Programs and urban Indian organizations 

10 involved in the provision of health services to Indians. 

11 ‘‘SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM 

12 FOR INDIANS. 

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

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

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

19 education or training in the health professions and 

20 encouraging and assisting them— 

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

22 health professions; or 

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

24 any such courses of study, to undertake such 


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1 postsecondary education or training as may be 

2 required to qualify them for enrollment; 

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

4 available to Indians enrolled in any course of study 

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

6 training necessary to qualify them to enroll in any 

7 such course of study; or 

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

11 and completion by them of, courses of study referred 

12 to in paragraph (1). 

13 ‘‘(b) GRANTS.— 

14 ‘‘(1) APPLICATION.—No grant may be made 

15 under this section unless an application has been 

16 submitted to, and approved by, the Secretary. Such 

17 application shall be in such form, submitted in such 

18 manner, and contain such information, as the Sec19 retary shall by regulation prescribe pursuant to this 

20 Act. The Secretary shall give a preference to appli21 cations submitted by Tribal Health Programs or 

22 urban Indian organizations. 

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

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


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

4 to this Act. To the extent not otherwise prohibited 

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

6 regulations issued pursuant to this Act. 

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

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

10 acting through the Service, shall provide scholarship 

11 grants to Indians who— 

12 ‘‘(1) have successfully completed their high 

13 school education or high school equivalency; and 

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

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

19 ‘‘(1) Compensatory preprofessional education of 

20 any recipient, such scholarship not to exceed 2 years 

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

22 thereof, as determined by the Secretary pursuant to 

23 regulations issued under this Act). 

24 ‘‘(2) Pregraduate education of any recipient 

25 leading to a baccalaureate degree in an approved 


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

2 health profession, such scholarship not to exceed 4 

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

6 this Act) may be approved. 

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

8 section— 

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

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

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

15 standing at, an accredited institution; and 

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

17 applicant’s eligibility for assistance or benefits under 

18 any other Federal program. 

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

20 ‘‘(a) IN GENERAL.— 

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

22 through the Service, shall make scholarship grants 

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

25 health professions. Such scholarships shall be desVerDate Nov 24 2008 23:28 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00022 Fmt 6652 Sfmt 6201 E:\BILLS\H2708.IH H2708

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1 ignated Indian Health Scholarships and shall be 

2 made in accordance with section 338A of the Public 

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

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

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

8 ‘‘(A) who shall receive scholarship grants 

9 under subsection (a); and 

10 ‘‘(B) the distribution of the scholarships 

11 among health professions on the basis of the 

12 relative needs of Indians for additional service 

13 in the health professions. 

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

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

17 delegated in a contract or compact under the Indian 

18 Self-Determination and Education Assistance Act 

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

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

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

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


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

2 participant receives a scholarship award under this 

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

4 1 or more of the following: 

5 ‘‘(A) In an Indian Health Program. 

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

7 of this Act. 

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

12 in a physician or other health professional 

13 shortage area and addresses the health care 

14 needs of a substantial number of Indians. 

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

17 health profession program) if, as determined by 

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

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

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

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

25 the Secretary shall defer the active duty service obliVerDate Nov 24 2008 23:28 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H2708.IH H2708

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1 gation of that individual under that contract, in 

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

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

7 conditions: 

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

9 other advanced clinical training shall be counted 

10 as satisfying any period of obligated service 

11 under this subsection. 

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

13 that individual shall commence not later than 

14 90 days after the completion of that advanced 

15 clinical training (or by a date specified by the 

16 Secretary). 

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

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

20 (1). 

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

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

23 meet the active duty service obligation described 

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


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

2 the Indian Tribe in which the recipient is 

3 enrolled; or 

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

5 the recipient is enrolled. 

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

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

8 assignments of Indian Health Scholarship recipients 

9 required to meet the active duty service obligation 

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

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

13 health professionals to provide health care services 

14 as a result of individuals having breached contracts 

15 entered into under this section. 

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

18 enrolled part time in an approved course of study— 

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

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

21 years, as determined by the Secretary; 

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

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

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

25 each year for which the individual was provided 


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1 a scholarship (as determined by the Secretary); 

2 or 

3 ‘‘(B) 2 years; and 

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

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

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

10 ‘‘(d) BREACH OF CONTRACT.— 

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

12 shall be liable to the United States for the amount 

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

14 of the individual, under a contract entered into with 

15 the Secretary under this section on or after the date 

16 of enactment of the Indian Health Care Improve17 ment Act Amendments of 2009 if that individual— 

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

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

21 determined by the educational institution under 

22 regulations of the Secretary); 

23 ‘‘(B) is dismissed from such educational 

24 institution for disciplinary reasons; 


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1 ‘‘(C) voluntarily terminates the training in 

2 such an educational institution for which he or 

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

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

6 the educational institution in which he or she is 

7 enrolled not to accept payment, in whole or in 

8 part, of a scholarship under such contract, in 

9 lieu of any service obligation arising under such 

10 contract. 

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

12 specified in paragraph (1) an individual breaches a 

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

16 United States shall be entitled to recover from the 

17 individual an amount determined in accordance with 

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

19 in the manner provided for in such subsection. 

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

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

24 relates to that scholarship shall be canceled. 

25 ‘‘(4) WAIVERS AND SUSPENSIONS.— 


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

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

4 of a recipient of an Indian Health Scholarship 

5 if the Secretary determines that— 

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

7 to meet that obligation or make that pay8 ment; 

9 ‘‘(ii) requiring that recipient to meet 

10 that obligation or make that payment 

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

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

15 payment would be unconscionable. 

16 ‘‘(B) FACTORS FOR CONSIDERATION.— 

17 When waiving or suspending an obligation of 

18 service or payment under subparagraph (A), the 

19 Secretary shall consult with the Area Office, In20 dian Tribes, Tribal Organizations, or urban In21 dian organizations affected to consider whether 

22 the obligation may be satisfied in a teaching ca23 pacity at a tribal college or university nursing 

24 program under subsection (b)(1)(D). 


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1 ‘‘(5) EXTREME HARDSHIP.—Notwithstanding 

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

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

5 the United States to recover funds made available 

6 under this section. 

7 ‘‘(6) BANKRUPTCY.—Notwithstanding any 

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

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

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

13 period beginning on the initial date on which that 

14 payment is due, and only if the bankruptcy court 

15 finds that the nondischarge of the obligation would 

16 be unconscionable. 

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

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

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

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

25 shall be located at various locations throughout the counVerDate Nov 24 2008 23:28 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00030 Fmt 6652 Sfmt 6201 E:\BILLS\H2708.IH H2708

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1 try to maximize their availability to Indian students and 

2 new programs shall be established in different locations 

3 from time to time. 

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

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

8 Burdick American Indians Into Psychology Program’. 

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

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

14 and communications networks. 

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

17 of grants provided under this section. 

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

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

21 ‘‘(1) provides outreach and recruitment for 

22 health professions to Indian communities including 

23 elementary, secondary, and accredited and accessible 

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


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1 ‘‘(2) incorporates a program advisory board 

2 comprised of representatives from the tribes and 

3 communities that will be served by the program; 

4 ‘‘(3) provides summer enrichment programs to 

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

7 activities; 

8 ‘‘(4) provides stipends to undergraduate and 

9 graduate students to pursue a career in psychology; 

10 ‘‘(5) develops affiliation agreements with tribal 

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

13 and accessible entities to enhance the education of 

14 Indian students; 

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

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

19 qualified Indians in the program. 

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

21 active duty service obligation prescribed under section 

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

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


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1 ‘‘(1) in an Indian Health Program; 

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

3 Act; or 

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

5 determined by the Secretary, in accordance with 

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

9 needs of a substantial number of Indians. 

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

11 is authorized to be appropriated to carry out this section 

12 $2,700,000 for each of fiscal years 2010 through 2025. 

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

14 ‘‘(a) IN GENERAL.— 

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

16 acting through the Service, shall make grants to 

17 Tribal Health Programs for the purpose of providing 

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

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

23 Indian Health Scholarships under section 104. 

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

25 under paragraph (1) shall be in such form and conVerDate Nov 24 2008 23:28 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00033 Fmt 6652 Sfmt 6201 E:\BILLS\H2708.IH H2708

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1 tain such agreements, assurances, and information 

2 as consistent with this section. 

3 ‘‘(b) REQUIREMENTS.— 

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

5 receiving a grant under subsection (a) shall provide 

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

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

9 any scholarship pursuant to subsection (a)— 

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

13 the Tribal Health Program; and 

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

15 from any other source of funds. 

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

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

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

21 ‘‘(d) CONTRACT.— 

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

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

24 Health Program shall enter into a written contract 

25 with each recipient of such scholarship. 


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

2 ‘‘(A) obligate such recipient to provide 

3 service in an Indian Health Program or urban 

4 Indian organization, in the same Service Area 

5 where the Tribal Health Program providing the 

6 scholarship is located, for— 

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

8 scholarship is provided (or the part-time 

9 equivalent thereof, as determined by the 

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

11 whichever period is greater; or 

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

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

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

17 ‘‘(i) may only be expended for— 

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

23 ‘‘(II) payment to the recipient of 

24 a monthly stipend of not more than 

25 the amount authorized by section 


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

2 Service Act (42 U.S.C. 

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

4 be reduced pro rata (as determined by 

5 the Secretary) based on the number of 

6 hours such student is enrolled, and 

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

10 the year for the purposes authorized 

11 in this clause; and 

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

13 attendance for which the scholarship is 

14 provided, the total amount required for the 

15 year for the purposes authorized in clause 

16 (i); 

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

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

21 pursuant to this Act; and 

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


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

2 contract may allow the recipient to serve in another 

3 Service Area, provided the Tribal Health Program 

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

8 ‘‘(e) BREACH OF CONTRACT.— 

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

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

13 the Federal share of the amount which has been 

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

15 the contract if that individual— 

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

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

19 as determined by the educational institution 

20 under regulations of the Secretary); 

21 ‘‘(B) is dismissed from such educational 

22 institution for disciplinary reasons; 

23 ‘‘(C) voluntarily terminates the training in 

24 such an educational institution for which he or 


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

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

4 the educational institution in which he or she is 

5 enrolled not to accept payment, in whole or in 

6 part, of a scholarship under such contract, in 

7 lieu of any service obligation arising under such 

8 contract. 

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

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

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

14 United States shall be entitled to recover from the 

15 individual an amount determined in accordance with 

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

17 in the manner provided for in such subsection. 

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

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

22 relates to that scholarship shall be canceled. 

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

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


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1 the basis of information collected through such other 

2 means as the Secretary deems appropriate. 

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

5 providing health care pursuant to the requirements here6 in— 

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

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

13 title XIX or title XXI of such Act; and 

14 ‘‘(2) to accept assignment under section 

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

16 services for which payment may be made under part 

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

18 appropriate agreement with the State agency that 

19 administers the State plan for medical assistance 

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

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

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

25 shall make payments under this section to a Tribal Health 


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1 Program for any fiscal year subsequent to the first fiscal 

2 year of such payments unless the Secretary determines 

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

4 Health Program has not complied with the requirements 

5 of this section. 

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

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

8 who receives a scholarship pursuant to section 104 or 106 

9 shall be given preference for employment in the Service, 

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

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

13 the year. 

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

15 OBLIGATION.—Periods of employment pursuant to this 

16 subsection shall not be counted in determining fulfillment 

17 of the service obligation incurred as a condition of the 

18 scholarship. 

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

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

23 Indian organization during any nonacademic period of the 

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


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

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

8 shall receive payment for his or her services comparable 

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

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

13 ‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES. 

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

16 professionals, including community health representatives 

17 and emergency medical technicians, to join or continue in 

18 an Indian Health Program and to provide their services 

19 in the rural and remote areas where a significant portion 

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

22 ‘‘(1) provide programs or allowances to transi23 tion into an Indian Health Program, including li24 censing, board or certification examination assistVerDate Nov 24 2008 23:28 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00041 Fmt 6652 Sfmt 6201 E:\BILLS\H2708.IH H2708

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

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

4 professionals employed in an Indian Health Program 

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

7 of their duty stations for professional consultation, 

8 management, leadership, and refresher training 

9 courses. 

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

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

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

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

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

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

19 ‘‘(2) use such community health representatives 

20 in the provision of health care, health promotion, 

21 and disease prevention services to Indian commu22 nities. 

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


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

2 community health representatives to ensure that the 

3 community health representatives provide quality 

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

6 the Program; 

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

8 and maintain a curriculum that— 

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

10 health care with supervised practical experience 

11 in the provision of health care; and 

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

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

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

21 and disease prevention and develop programs that 

22 meet the needs for continuing education; 

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


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

2 of Community Health Representatives is reviewed 

3 and evaluated; and 

4 ‘‘(6) promote traditional health care practices 

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

7 promotion, and disease prevention. 

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

9 PROGRAM. 

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

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

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

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

17 through, Indian Health Programs and urban Indian orga18 nizations. 

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

21 must— 

22 ‘‘(1)(A) be enrolled— 

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

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


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

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

3 scheduled to complete such course of study in 

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

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

8 ‘‘(B) have— 

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

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

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

13 as a commissioned officer in the Regular or Reserve 

14 Corps of the Public Health Service; 

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

16 in the Regular or Reserve Corps of the Public 

17 Health Service; 

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

19 service employment in the Service; or 

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

21 or urban Indian organization without a service obli22 gation; and 

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

24 a contract described in subsection (e). 

25 ‘‘(c) APPLICATION.— 


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1 ‘‘(1) INFORMATION TO BE INCLUDED WITH

2 FORMS.—In disseminating application forms and 

3 contract forms to individuals desiring to participate 

4 in the Loan Repayment Program, the Secretary 

5 shall include with such forms a fair summary of the 

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

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

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

12 provide such individuals with sufficient information 

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

17 to make a decision on an informed basis. 

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

19 contract form, and all other information furnished 

20 by the Secretary under this section shall be written 

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

23 Repayment Program. 

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

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

4 that such individuals have adequate time to carefully 

5 review and evaluate such forms and information. 

6 ‘‘(d) PRIORITIES.— 

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

8 Secretary shall annually— 

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

10 Health Program or urban Indian organization 

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

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

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

16 in determining which applications under the Loan 

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

19 ‘‘(A) give first priority to applications 

20 made by individual Indians; and 

21 ‘‘(B) after making determinations on all 

22 applications submitted by individual Indians as 

23 required under subparagraph (A), give priority 

24 to— 


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1 ‘‘(i) individuals recruited through the 

2 efforts of an Indian Health Program or 

3 urban Indian organization; and 

4 ‘‘(ii) other individuals based on the 

5 priority rankings under paragraph (1). 

6 ‘‘(e) RECIPIENT CONTRACTS.— 

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

11 (2). 

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

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

15 ‘‘(A) an agreement under which— 

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

17 Secretary agrees— 

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

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

21 ‘‘(II) to accept (subject to the 

22 availability of appropriated funds for 

23 carrying out this section) the indi24 vidual into the Service or place the in25 dividual with a Tribal Health ProVerDate Nov 24 2008 23:28 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00048 Fmt 6652 Sfmt 6201 E:\BILLS\H2708.IH H2708

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1 gram or urban Indian organization as 

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

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

4 individual agrees— 

5 ‘‘(I) to accept loan payments on 

6 behalf of the individual; 

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

8 described in subsection (b)(1)— 

9 ‘‘(aa) to maintain enrollment 

10 in a course of study or training 

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

12 until the individual completes the 

13 course of study or training; and 

14 ‘‘(bb) while enrolled in such 

15 course of study or training, to 

16 maintain an acceptable level of 

17 academic standing (as deter18 mined under regulations of the 

19 Secretary by the educational in20 stitution offering such course of 

21 study or training); and 

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

23 (in this section referred to as the ‘pe24 riod of obligated service’) equal to 2 

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1 dividual may agree to serve in the 

2 full-time clinical practice of such indi3 vidual’s profession in an Indian 

4 Health Program or urban Indian or5 ganization to which the individual 

6 may be assigned by the Secretary; 

7 ‘‘(B) a provision permitting the Secretary 

8 to extend for such longer additional periods, as 

9 the individual may agree to, the period of obli10 gated service agreed to by the individual under 

11 subparagraph (A)(ii)(III); 

12 ‘‘(C) a provision that any financial obliga13 tion of the United States arising out of a con14 tract entered into under this section and any 

15 obligation of the individual which is conditioned 

16 thereon is contingent upon funds being appro17 priated for loan repayments under this section; 

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

19 the United States is entitled under subsection 

20 (k) for the individual’s breach of the contract; 

21 and 

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

23 and liabilities of the Secretary and of the indi24 vidual, not inconsistent with this section. 


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

2 The Secretary shall provide written notice to an individual 

3 within 21 days on— 

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

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

8 excess of 4 years; or 

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

11 ‘‘(g) PAYMENTS.— 

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

13 for an individual under a written contract under the 

14 Loan Repayment Program shall consist of payment, 

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

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

18 by the individual regarding the undergraduate or 

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

20 loans were made for— 

21 ‘‘(A) tuition expenses; 

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


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

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

4 service that an individual contracts to serve under 

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

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

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

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

10 determination of the amount to pay for a year of 

11 such service by an individual, the Secretary shall 

12 consider the extent to which each such determina13 tion— 

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

15 maximize the number of contracts that can be 

16 provided under the Loan Repayment Program 

17 from the amounts appropriated for such con18 tracts; 

19 ‘‘(B) provides an incentive to serve in In20 dian Health Programs and urban Indian orga21 nizations with the greatest shortages of health 

22 professionals; and 

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

24 the health professional involved remaining in an 

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1 zation with such a health professional shortage, 

2 and continuing to provide primary health serv3 ices, after the completion of the period of obli4 gated service under the Loan Repayment Pro5 gram. 

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

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

9 repayments for a year of obligated service shall be 

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

11 which the individual completes such year of service. 

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

13 For the purpose of providing reimbursements for tax 

14 liability resulting from a payment under paragraph 

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

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

17 make payments to the individual in an amount 

18 equal to not less than 20 percent and not more 

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

21 and 

22 ‘‘(B) may make such additional payments 

23 as the Secretary determines to be appropriate 

24 with respect to such purpose. 


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

2 may enter into an agreement with the holder of any 

3 loan for which payments are made under the Loan 

4 Repayment Program to establish a schedule for the 

5 making of such payments. 

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

7 other provision of law, individuals who have entered into 

8 written contracts with the Secretary under this section 

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

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

14 other manpower programs of the Service at educational 

15 institutions training health professionals or specialists 

16 identified in subsection (a). 

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

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

19 to individuals during their period of obligated service 

20 under the Loan Repayment Program. 

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

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


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

2 Health Programs and urban Indian organizations 

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

5 and 

6 ‘‘(2) give priority to assigning individuals to In7 dian Health Programs and urban Indian organiza8 tions that have a need for health professionals to 

9 provide health care services as a result of individuals 

10 having breached contracts entered into under this 

11 section. 

12 ‘‘(l) BREACH OF CONTRACT.— 

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

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

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

17 of any service obligation arising under such contract, 

18 to the United States for the amount which has been 

19 paid on such individual’s behalf under the contract 

20 if that individual— 

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

22 course of study and— 

23 ‘‘(i) fails to maintain an acceptable 

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


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•HR 2708 IH

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

3 the Secretary); 

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

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

8 such course of study; or 

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

12 ‘‘(2) OTHER BREACHES; FORMULA FOR

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

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

15 written contract under this section by failing either 

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

18 the United States shall be entitled to recover from 

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

21 in which— 

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

23 is entitled to recover; 

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

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1 vidual and the interest on such amounts which 

2 would be payable if, at the time the amounts 

3 were paid, they were loans bearing interest at 

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

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

7 the individual’s period of obligated service; and 

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

9 period served by such individual in accordance 

10 with this section. 

11 ‘‘(3) TIME PERIOD FOR REPAYMENT.—Any 

12 amount of damages which the United States is enti13 tled to recover under this subsection shall be paid to 

14 the United States within the 1-year period beginning 

15 on the date of the breach or such longer period be16 ginning on such date as shall be specified by the 

17 Secretary. 

18 ‘‘(4) DEDUCTIONS IN MEDICARE PAYMENTS.— 

19 Amounts not paid within such period shall be sub20 ject to collection through deductions in Medicare 

21 payments pursuant to section 1892 of the Social Se22 curity Act. 

23 ‘‘(5) RECOVERY OF DELINQUENCY.— 

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

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


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1 the Secretary shall, for the purpose of recov2 ering such damages— 

3 ‘‘(i) use collection agencies contracted 

4 with by the Administrator of General Serv5 ices; or 

6 ‘‘(ii) enter into contracts for the re7 covery of such damages with collection 

8 agencies selected by the Secretary. 

9 ‘‘(B) REPORT.—Each contract for recov10 ering damages pursuant to this subsection shall 

11 provide that the contractor will, not less than 

12 once each 6 months, submit to the Secretary a 

13 status report on the success of the contractor in 

14 collecting such damages. Section 3718 of title 

15 31, United States Code, shall apply to any such 

16 contract to the extent not inconsistent with this 

17 subsection. 

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

19 ‘‘(1) IN GENERAL.—The Secretary shall by reg20 ulation provide for the partial or total waiver or sus21 pension of any obligation of service or payment by 

22 an individual under the Loan Repayment Program 

23 whenever compliance by the individual is impossible 

24 or would involve extreme hardship to the individual 


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1 and if enforcement of such obligation with respect to 

2 any individual would be unconscionable. 

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

4 of an individual under the Loan Repayment Pro5 gram for service or payment of damages shall be 

6 canceled upon the death of the individual. 

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

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

9 States to recover amounts under this section in any 

10 case of extreme hardship or other good cause shown, 

11 as determined by the Secretary. 

12 ‘‘(4) BANKRUPTCY.—Any obligation of an indi13 vidual under the Loan Repayment Program for pay14 ment of damages may be released by a discharge in 

15 bankruptcy under title 11 of the United States Code 

16 only if such discharge is granted after the expiration 

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

18 payment of such damages is required, and only if 

19 the bankruptcy court finds that nondischarge of the 

20 obligation would be unconscionable. 

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

22 President, for inclusion in the report required to be sub23 mitted to Congress under section 801, a report concerning 

24 the previous fiscal year which sets forth by Service Area 

25 the following: 


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

2 maintained by Indian Health Programs and urban 

3 Indian organizations for which recruitment or reten4 tion is difficult. 

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

6 applications filed with respect to each type of health 

7 profession. 

8 ‘‘(3) The number of contracts described in sub9 section (e) that are entered into with respect to each 

10 health profession. 

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

12 this section, in total and by health profession. 

13 ‘‘(5) The number of scholarships that are pro14 vided under sections 104 and 106 with respect to 

15 each health profession. 

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

17 under sections 104 and 106, in total and by health 

18 profession. 

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

20 that will be needed by Indian Health Programs and 

21 urban Indian organizations, by location and profes22 sion, during the 3 fiscal years beginning after the 

23 date the report is filed. 

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

25 to fill the health professional positions maintained 


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1 by Indian Health Programs or urban Indian organi2 zations for which recruitment or retention is dif3 ficult. 

4 ‘‘SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOV5 ERY FUND. 

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

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

8 Indian Health Scholarship and Loan Repayment Recovery 

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

10 The LRRF shall consist of such amounts as may be col11 lected from individuals under section 104(d), section 

12 106(e), and section 110(l) for breach of contract, such 

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

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

15 appropriated, or earned relative to the LRRF shall remain 

16 available until expended. 

17 ‘‘(b) USE OF FUNDS.— 

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

19 may be expended by the Secretary, acting through 

20 the Service, to make payments to an Indian Health 

21 Program— 

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

23 section 104 and 106 or a loan repayment pro24 gram participant under section 110 has been 


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•HR 2708 IH

1 assigned to meet the obligated service require2 ments pursuant to such sections; and 

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

5 of such recipient or participant having breached 

6 the contract entered into under section 104, 

7 106, or 110. 

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

9 Health Program receiving payments pursuant to 

10 paragraph (1) may expend the payments to provide 

11 scholarships or recruit and employ, directly or by 

12 contract, health professionals to provide health care 

13 services. 

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

15 Treasury shall invest such amounts of the LRRF as the 

16 Secretary of Health and Human Services determines are 

17 not required to meet current withdrawals from the LRRF. 

18 Such investments may be made only in interest bearing 

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

20 obligations may be acquired on original issue at the issue 

21 price, or by purchase of outstanding obligations at the 

22 market price. 

23 ‘‘(d) SALE OF OBLIGATIONS.—Any obligation ac24 quired by the LRRF may be sold by the Secretary of the 

25 Treasury at the market price. 


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1 ‘‘SEC. 112. RECRUITMENT ACTIVITIES. 

2 ‘‘(a) REIMBURSEMENT FOR TRAVEL.—The Sec3 retary, acting through the Service, may reimburse health 

4 professionals seeking positions with Indian Health Pro5 grams or urban Indian organizations, including individ6 uals considering entering into a contract under section 

7 110 and their spouses, for actual and reasonable expenses 

8 incurred in traveling to and from their places of residence 

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

10 of evaluating such area with respect to such assignment. 

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

12 acting through the Service, shall assign 1 individual in 

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

14 recruitment activities. 

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

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

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

19 demonstration projects for a period not to exceed 3 years 

20 to enable Indian Health Programs and urban Indian orga21 nizations to recruit, place, and retain health professionals 

22 to meet their staffing needs. 

23 ‘‘(b) ELIGIBLE ENTITIES; APPLICATION.—Any In24 dian Health Program or Urban Indian organization may 

25 submit an application for funding of a project pursuant 

26 to this section. 


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

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

3 acting through the Service, shall establish a demonstration 

4 project to enable health professionals who have worked in 

5 an Indian Health Program or urban Indian organization 

6 for a substantial period of time to pursue advanced train7 ing or research areas of study for which the Secretary de8 termines a need exists. 

9 ‘‘(b) SERVICE OBLIGATION.—An individual who par10 ticipates in a program under subsection (a), where the 

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

12 obligation to serve in an Indian Health Program or urban 

13 Indian organization for a period of obligated service equal 

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

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

18 of service remaining. In such event, with respect to indi19 viduals entering the program after the date of enactment 

20 of the Indian Health Care Improvement Act Amendments 

21 of 2009, the United States shall be entitled to recover 

22 from such individual an amount to be determined in ac23 cordance with the formula specified in subsection (l) of 

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

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

26 Health professionals from Tribal Health Programs and 


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

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

4 NURSING PROGRAM. 

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

7 practitioners who deliver health care services to Indians, 

8 the Secretary, acting through the Service, shall provide 

9 grants to the following: 

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

11 ‘‘(2) Tribal colleges or universities. 

12 ‘‘(3) Nurse midwife programs and advanced 

13 practice nurse programs that are provided by any 

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

16 private institutions. 

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

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

20 train individuals to be nurses, nurse midwives, or 

21 advanced practice nurses. 

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

23 in such programs that may pay the tuition charged 

24 for such program and other expenses incurred in 


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1 connection with such program, including books, fees, 

2 room and board, and stipends for living expenses. 

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

4 nurses, nurse midwives, and advanced practice 

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

6 services to Indians. 

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

8 skills of, and provides continuing education to, 

9 nurses, nurse midwives, and advanced practice 

10 nurses. 

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

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

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

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

15 Secretary may require to establish the connection between 

16 the program of the applicant and a health care facility 

17 that primarily serves Indians. 

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

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

20 extend a preference to the following: 

21 ‘‘(1) Programs that provide a preference to In22 dians. 

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

25 ‘‘(3) Programs that are interdisciplinary. 


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1 ‘‘(4) Programs that are conducted in coopera2 tion with a program for gifted and talented Indian 

3 students. 

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

5 universities. 

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

7 Secretary shall provide 1 of the grants authorized under 

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

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

10 N. Burdick American Indians Into Nursing Program’. 

11 Such program shall, to the maximum extent feasible, co12 ordinate with the Quentin N. Burdick Indian Health Pro13 grams established under section 117(b) and the Quentin 

14 N. Burdick American Indians Into Psychology Program 

15 established under section 105(b). 

16 ‘‘(f) ACTIVE DUTY SERVICE OBLIGATION.—The ac17 tive duty service obligation prescribed under section 338C 

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

19 be met by each individual who receives training or assist20 ance described in paragraph (1) or (2) of subsection (b) 

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

22 Such obligation shall be met by service— 

23 ‘‘(1) in the Service; 

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

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

2 450 et seq.) (including programs under agreements 

3 with the Bureau of Indian Affairs); 

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

5 Act; 

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

9 situated in a physician or other health shortage area 

10 and addresses the health care needs of a substantial 

11 number of Indians; or 

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

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

15 health services provided to Indians would not de16 crease. 

17 ‘‘SEC. 116. TRIBAL CULTURAL ORIENTATION. 

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

19 Secretary, acting through the Service, shall require that 

20 appropriate employees of the Service who serve Indian 

21 Tribes in each Service Area receive educational instruction 

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

23 relationship to the Service. 


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

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

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

6 urban Indian organizations; 

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

8 universities; 

9 ‘‘(3) include instruction in American Indian 

10 studies; and 

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

12 health care practices of the Indian Tribes in the 

13 Service Area. 

14 ‘‘SEC. 117. INMED PROGRAM. 

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

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

18 expanding the Indian health careers recruitment program 

19 known as the ‘Indians Into Medicine Program’ (herein20 after in this section referred to as ‘INMED’) as a means 

21 of encouraging Indians to enter the health professions. 

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

23 shall provide 1 of the grants authorized under subsection 

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

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


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1 Indian Health Programs’, unless the Secretary makes a 

2 determination, based upon program reviews, that the pro3 gram is not meeting the purposes of this section. Such 

4 program shall, to the maximum extent feasible, coordinate 

5 with the Quentin N. Burdick American Indians Into Psy6 chology Program established under section 105(b) and the 

7 Quentin N. Burdick American Indians Into Nursing Pro8 gram established under section 115. 

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

10 Act, shall develop regulations to govern grants pursuant 

11 to this section. 

12 ‘‘(d) REQUIREMENTS.—Applicants for grants pro13 vided under this section shall agree to provide a program 

14 which— 

15 ‘‘(1) provides outreach and recruitment for 

16 health professions to Indian communities including 

17 elementary and secondary schools and community 

18 colleges located on reservations which will be served 

19 by the program; 

20 ‘‘(2) incorporates a program advisory board 

21 comprised of representatives from the Indian Tribes 

22 and Indian communities which will be served by the 

23 program; 

24 ‘‘(3) provides summer preparatory programs for 

25 Indian students who need enrichment in the subjects 


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1 of math and science in order to pursue training in 

2 the health professions; 

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

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

6 and 

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

8 qualified Indians in the program. 

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

10 COLLEGES. 

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

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

13 through the Service, shall award grants to accredited 

14 and accessible community colleges for the purpose of 

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

17 health profession leading to a degree or diploma in 

18 a health profession for individuals who desire to 

19 practice such profession on or near a reservation or 

20 in an Indian Health Program. 

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

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

24 is provided to the community college shall not exceed 

25 $250,000. 


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1 ‘‘(b) GRANTS FOR MAINTENANCE AND RECRUIT2 ING.— 

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

4 through the Service, shall award grants to accredited 

5 and accessible community colleges that have estab6 lished a program described in subsection (a)(1) for 

7 the purpose of maintaining the program and recruit8 ing students for the program. 

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

10 made under this section to a community college 

11 which— 

12 ‘‘(A) is accredited; 

13 ‘‘(B) has a relationship with a hospital fa14 cility, Service facility, or hospital that could 

15 provide training of nurses or health profes16 sionals; 

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

18 an accredited college or university medical 

19 school, the terms of which— 

20 ‘‘(i) provide a program that enhances 

21 the transition and recruitment of students 

22 into advanced baccalaureate or graduate 

23 programs that train health professionals; 

24 and 


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1 ‘‘(ii) stipulate certifications necessary 

2 to approve internship and field placement 

3 opportunities at Indian Health Programs; 

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

5 appropriate certifications; 

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

8 subsection (a)(1); and 

9 ‘‘(F) agrees to provide for Indian pref10 erence for applicants for programs under this 

11 section. 

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

13 encourage community colleges described in subsection 

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

15 subsection (a)(1) by— 

16 ‘‘(1) entering into agreements with such col17 leges for the provision of qualified personnel of the 

18 Service to teach courses of study in such programs; 

19 and 

20 ‘‘(2) providing technical assistance and support 

21 to such colleges. 

22 ‘‘(d) ADVANCED TRAINING.— 

23 ‘‘(1) REQUIRED.—Any program receiving as24 sistance under this section that is conducted with re25 spect to a health profession shall also offer courses 


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1 of study which provide advanced training for any 

2 health professional who— 

3 ‘‘(A) has already received a degree or di4 ploma in such health profession; and 

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

6 reservation or for an Indian Health Program. 

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

8 Such courses of study may be offered in conjunction 

9 with the college or university with which the commu10 nity college has entered into the agreement required 

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

12 ‘‘(e) PRIORITY.—Where the requirements of sub13 section (b) are met, grant award priority shall be provided 

14 to tribal colleges and universities in Service Areas where 

15 they exist. 

16 ‘‘SEC. 119. RETENTION BONUS. 

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

18 a retention bonus to any health professional employed by, 

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

20 or urban Indian organization either as a civilian employee 

21 or as a commissioned officer in the Regular or Reserve 

22 Corps of the Public Health Service who— 

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

24 for which recruitment or retention of personnel is 

25 difficult; 


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1 ‘‘(2) the Secretary determines is needed by In2 dian Health Programs and urban Indian organiza3 tions; 

4 ‘‘(3) has— 

5 ‘‘(A) completed 2 years of employment 

6 with an Indian Health Program or urban In7 dian organization; or 

8 ‘‘(B) completed any service obligations in9 curred as a requirement of— 

10 ‘‘(i) any Federal scholarship program; 

11 or 

12 ‘‘(ii) any Federal education loan re13 payment program; and 

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

15 Health Program or urban Indian organization for 

16 continued employment for a period of not less than 

17 1 year. 

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

19 the retention bonus which shall provide for a higher an20 nual rate for multiyear agreements than for single year 

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

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

23 annum. 

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

25 health professional failing to complete the agreed upon 


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

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

3 Government the full amount of the retention bonus for the 

4 period covered by the agreement, plus interest as deter5 mined by the Secretary in accordance with section 

6 110(l)(2)(B). 

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

8 may pay a retention bonus to any health professional em9 ployed by a Tribal Health Program if such health profes10 sional is serving in a position which the Secretary deter11 mines is— 

12 ‘‘(1) a position for which recruitment or reten13 tion is difficult; and 

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

15 to Indians. 

16 ‘‘SEC. 120. NURSING RESIDENCY PROGRAM. 

17 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Sec18 retary, acting through the Service, shall establish a pro19 gram to enable Indians who are licensed practical nurses, 

20 licensed vocational nurses, and registered nurses who are 

21 working in an Indian Health Program or urban Indian 

22 organization, and have done so for a period of not less 

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

24 shall include a combination of education and work study 

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1 tion leading to an associate or bachelor’s degree (in the 

2 case of a licensed practical nurse or licensed vocational 

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

4 nurse), or advanced degrees or certifications in nursing 

5 and public health. 

6 ‘‘(b) SERVICE OBLIGATION.—An individual who par7 ticipates in a program under subsection (a), where the 

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

9 obligation to serve in an Indian Health Program or urban 

10 Indian organization for a period of obligated service equal 

11 to 1 year for every year that nonprofessional employee (li12 censed practical nurses, licensed vocational nurses, nurs13 ing assistants, and various health care technicians), or 2 

14 years for every year that professional nurse (associate de15 gree and bachelor-prepared registered nurses), partici16 pates in such program. In the event that the individual 

17 fails to complete such obligated service, the United States 

18 shall be entitled to recover from such individual an amount 

19 determined in accordance with the formula specified in 

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

21 in such subsection. 

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

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

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

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1 ing through the Service, shall develop and operate a Com2 munity Health Aide Program in Alaska under which the 

3 Service— 

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

5 as health aides or community health practitioners; 

6 ‘‘(2) uses such aides or practitioners in the pro7 vision of health care, health promotion, and disease 

8 prevention services to Alaska Natives living in vil9 lages in rural Alaska; and 

10 ‘‘(3) provides for the establishment of tele11 conferencing capacity in health clinics located in or 

12 near such villages for use by community health aides 

13 or community health practitioners. 

14 ‘‘(b) SPECIFIC PROGRAM REQUIREMENTS.—The Sec15 retary, acting through the Community Health Aide Pro16 gram of the Service, shall— 

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

18 provide a high standard of training to community 

19 health aides and community health practitioners to 

20 ensure that such aides and practitioners provide 

21 quality health care, health promotion, and disease 

22 prevention services to the villages served by the Pro23 gram; 

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

25 a curriculum that— 


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

2 health care with supervised practical experience 

3 in the provision of health care; 

4 ‘‘(B) provides instruction and practical ex5 perience in the provision of acute care, emer6 gency care, health promotion, disease preven7 tion, and the efficient and effective manage8 ment of clinic pharmacies, supplies, equipment, 

9 and facilities; and 

10 ‘‘(C) promotes the achievement of the 

11 health status objectives specified in section 

12 3(2); 

13 ‘‘(3) establish and maintain a Community 

14 Health Aide Certification Board to certify as com15 munity health aides or community health practi16 tioners individuals who have successfully completed 

17 the training described in paragraph (1) or can dem18 onstrate equivalent experience; 

19 ‘‘(4) develop and maintain a system which iden20 tifies the needs of community health aides and com21 munity health practitioners for continuing education 

22 in the provision of health care, including the areas 

23 described in paragraph (2)(B), and develop pro24 grams that meet the needs for such continuing edu25 cation; 


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1 ‘‘(5) develop and maintain a system that pro2 vides close supervision of community health aides 

3 and community health practitioners; 

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

5 community health aides and community health prac6 titioners is reviewed and evaluated to assure the pro7 vision of quality health care, health promotion, and 

8 disease prevention services; and 

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

10 pulpotomies on deciduous teeth) or extraction of 

11 adult teeth can be performed by a dental health aide 

12 therapist only after consultation with a licensed den13 tist who determines that the procedure is a medical 

14 emergency that cannot be resolved with palliative 

15 treatment, and further that dental health aide thera16 pists are strictly prohibited from performing all 

17 other oral or jaw surgeries, provided that uncompli18 cated extractions shall not be considered oral sur19 gery under this section. 

20 ‘‘(c) PROGRAM REVIEW.— 

21 ‘‘(1) NEUTRAL PANEL.— 

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

23 acting through the Service, shall establish a 

24 neutral panel to carry out the study under 

25 paragraph (2). 


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1 ‘‘(B) MEMBERSHIP.—Members of the neu2 tral panel shall be appointed by the Secretary 

3 from among clinicians, economists, community 

4 practitioners, oral epidemiologists, and Alaska 

5 Natives. 

6 ‘‘(2) STUDY.— 

7 ‘‘(A) IN GENERAL.—The neutral panel es8 tablished under paragraph (1) shall conduct a 

9 study of the dental health aide therapist serv10 ices provided by the Community Health Aide 

11 Program under this section to ensure that the 

12 quality of care provided through those services 

13 is adequate and appropriate. 

14 ‘‘(B) PARAMETERS OF STUDY.—The Sec15 retary, in consultation with interested parties, 

16 including professional dental organizations, 

17 shall develop the parameters of the study. 

18 ‘‘(C) INCLUSIONS.—The study shall in19 clude a determination by the neutral panel with 

20 respect to— 

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

22 aide therapist services under this section to 

23 address the dental care needs of Alaska 

24 Natives; 


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1 ‘‘(ii) the quality of care provided 

2 through those services, including any train3 ing, improvement, or additional oversight 

4 required to improve the quality of care; 

5 and 

6 ‘‘(iii) whether safer and less costly al7 ternatives to the dental health aide thera8 pist services exist. 

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

10 study under this paragraph, the neutral panel 

11 shall consult with Alaska Tribal Organizations 

12 with respect to the adequacy and accuracy of 

13 the study. 

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

15 to the Secretary, the Committee on Indian Affairs of 

16 the Senate, and the Committee on Natural Re17 sources of the House of Representatives a report de18 scribing the results of the study under paragraph 

19 (2), including a description of— 

20 ‘‘(A) any determination of the neutral 

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

22 ‘‘(B) any comments received from an Alas23 ka Tribal Organization under paragraph 

24 (2)(D). 

25 ‘‘(d) NATIONALIZATION OF PROGRAM.— 


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1 ‘‘(1) IN GENERAL.—Except as provided in para2 graph (2), the Secretary, acting through the Service, 

3 may establish a national Community Health Aide 

4 Program in accordance with the program under this 

5 section, as the Secretary determines to be appro6 priate. 

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

8 Health Aide Program under paragraph (1) shall not 

9 include dental health aide therapist services. 

10 ‘‘(3) REQUIREMENT.—In establishing a na11 tional program under paragraph (1), the Secretary 

12 shall not reduce the amount of funds provided for 

13 the Community Health Aide Program described in 

14 subsections (a) and (b). 

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

16 ‘‘The Secretary shall, by contract or otherwise, pro17 vide training for individuals in the administration and 

18 planning of Tribal Health Programs, with priority to Indi19 ans. 

20 ‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE 

21 DEMONSTRATION PROGRAMS. 

22 ‘‘(a) DEMONSTRATION PROGRAMS AUTHORIZED.— 

23 The Secretary, acting through the Service, may fund dem24 onstration programs for Tribal Health Programs to ad25 dress the chronic shortages of health professionals. 


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

2 demonstration programs funded under subsection (a) shall 

3 be— 

4 ‘‘(1) to provide direct clinical and practical ex5 perience at a Service Unit to health profession stu6 dents and residents from medical schools; 

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

8 Indians by assuring access to qualified health care 

9 professionals; and 

10 ‘‘(3) to provide academic and scholarly opportu11 nities for health professionals serving Indians by 

12 identifying all academic and scholarly resources of 

13 the region. 

14 ‘‘(c) ADVISORY BOARD.—The demonstration pro15 grams established pursuant to subsection (a) shall incor16 porate a program advisory board composed of representa17 tives from the Indian Tribes and Indian communities in 

18 the area which will be served by the program. 

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

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

21 shall not— 

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

23 Service Corps from an Indian Health Program or 

24 urban Indian organization; or 


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

2 member, unless the Secretary, acting through the 

3 Service, has ensured that the Indians receiving serv4 ices from such member will experience no reduction 

5 in services. 

6 ‘‘(b) TREATMENT OF INDIAN HEALTH PROGRAMS.— 

7 At the request of an Indian Health Program, the services 

8 of a member of the National Health Service Corps as9 signed to an Indian Health Program may be limited to 

10 the persons who are eligible for services from such Pro11 gram. 

12 ‘‘SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL 

13 CURRICULA DEMONSTRATION PROGRAMS. 

14 ‘‘(a) CONTRACTS AND GRANTS.—The Secretary, act15 ing through the Service, may enter into contracts with, 

16 or make grants to, accredited tribal colleges and univer17 sities and eligible accredited and accessible community col18 leges to establish demonstration programs to develop edu19 cational curricula for substance abuse counseling. 

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

21 section shall be used only for developing and providing 

22 educational curriculum for substance abuse counseling (in23 cluding paying salaries for instructors). Such curricula 

24 may be provided through satellite campus programs. 


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

2 contract entered into or a grant provided under this sec3 tion shall be for a period of 3 years. Such contract or 

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

5 upon the approval of the Secretary. 

6 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP7 PLICATIONS.—Not later than 180 days after the date of 

8 enactment of the Indian Health Care Improvement Act 

9 Amendments of 2009, the Secretary, after consultation 

10 with Indian Tribes and administrators of tribal colleges 

11 and universities and eligible accredited and accessible com12 munity colleges, shall develop and issue criteria for the 

13 review and approval of applications for funding (including 

14 applications for renewals of funding) under this section. 

15 Such criteria shall ensure that demonstration programs 

16 established under this section promote the development of 

17 the capacity of such entities to educate substance abuse 

18 counselors. 

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

20 technical and other assistance as may be necessary to en21 able grant recipients to comply with the provisions of this 

22 section. 

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

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

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1 cal year, a report on the findings and conclusions derived 

2 from the demonstration programs conducted under this 

3 section during that fiscal year. 

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

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

6 following: 

7 ‘‘(1) Classroom education. 

8 ‘‘(2) Clinical work experience. 

9 ‘‘(3) Continuing education workshops. 

10 ‘‘SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMU11 NITY EDUCATION PROGRAMS. 

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

13 the Service, and the Secretary of the Interior, in consulta14 tion with Indian Tribes and Tribal Organizations, shall 

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

16 positions specified in subsection (b) whose qualifications 

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

18 prevention, education, referral, or treatment of mental ill19 ness, or dysfunctional and self-destructive behavior. 

20 ‘‘(b) POSITIONS.—The positions referred to in sub21 section (a) are— 

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

23 Affairs, including existing positions, in the fields 

24 of— 

25 ‘‘(A) elementary and secondary education; 


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

2 welfare; 

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

4 and 

5 ‘‘(D) alcohol and substance abuse; 

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

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

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

9 by Indian Tribes, Tribal Organizations (without re10 gard to the funding source), and urban Indian orga11 nizations. 

12 ‘‘(c) TRAINING CRITERIA.— 

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

14 shall provide training criteria appropriate to each 

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

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

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

18 such position. With respect to any such individual in 

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

20 the respective Secretaries shall provide appropriate 

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

22 Tribal Organization, or urban Indian organization 

23 for training of appropriate individuals. In the case of 

24 positions funded under a contract or compact under 

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1 ance Act (25 U.S.C. 450 et seq.), the appropriate 

2 Secretary shall ensure that such training costs are 

3 included in the contract or compact, as the Sec4 retary determines necessary. 

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

6 Position specific training criteria shall be culturally 

7 relevant to Indians and Indian Tribes and shall en8 sure that appropriate information regarding tradi9 tional health care practices is provided. 

10 ‘‘(d) COMMUNITY EDUCATION ON MENTAL ILL11 NESS.—The Service shall develop and implement, on re12 quest of an Indian Tribe, Tribal Organization, or urban 

13 Indian organization, or assist the Indian Tribe, Tribal Or14 ganization, or urban Indian organization to develop and 

15 implement, a program of community education on mental 

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

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

18 urban Indian organization, provide technical assistance to 

19 the Indian Tribe, Tribal Organization, or urban Indian or20 ganization to obtain and develop community educational 

21 materials on the identification, prevention, referral, and 

22 treatment of mental illness and dysfunctional and self-de23 structive behavior. 

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

25 of enactment of the Indian Health Care Improvement Act 


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1 Amendments of 2009, the Secretary shall develop a plan 

2 under which the Service will increase the health care staff 

3 providing behavioral health services by at least 500 posi4 tions within 5 years after the date of enactment of this 

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

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

7 under this subsection shall be implemented under the Act 

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

9 as the ‘Snyder Act’). 

10 ‘‘SEC. 127. EXEMPTION FROM PAYMENT OF CERTAIN FEES. 

11 ‘‘Employees of a Tribal Health Program or an Urban 

12 Indian Organization shall be exempt from payment of li13 censing, registraion, and other fees imposed by a Federal 

14 agency to the same extent that Commissioned Corps Offi15 cers or other employees of the Indian Health Service are 

16 exempt from such fees. 

17 ‘‘SEC. 128. AUTHORIZATION OF APPROPRIATIONS. 

18 ‘‘There are authorized to be appropriated such sums 

19 as may be necessary for each fiscal year through fiscal 

20 year 2025 to carry out this title. 

21 ‘‘TITLE II—HEALTH SERVICES 

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

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

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

25 under the authority of the Indian Self-Determination and 


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

2 are appropriated under the authority of this section, for 

3 the purposes of— 

4 ‘‘(1) eliminating the deficiencies in health sta5 tus and health resources of all Indian Tribes; 

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

7 health care services to Indians; 

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

9 efficient and equitable manner, including the use of 

10 telehealth and telemedicine when appropriate; 

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

12 direct care and contract health service programs; 

13 and 

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

15 meet the following health service responsibilities with 

16 respect to those Indian Tribes with the highest levels 

17 of health status deficiencies and resource defi18 ciencies: 

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

20 outpatient care (including audiology, clinical 

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

22 and tertiary care, and long-term care. 

23 ‘‘(B) Preventive health, including mam24 mography and other cancer screening in accord25 ance with section 207. 


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1 ‘‘(C) Dental care. 

2 ‘‘(D) Mental health, including community 

3 mental health services, inpatient mental health 

4 services, dormitory mental health services, 

5 therapeutic and residential treatment centers, 

6 and training of traditional health care practi7 tioners. 

8 ‘‘(E) Emergency medical services. 

9 ‘‘(F) Treatment and control of, and reha10 bilitative care related to, alcoholism and drug 

11 abuse (including fetal alcohol syndrome) among 

12 Indians. 

13 ‘‘(G) Injury prevention programs, includ14 ing data collection and evaluation, demonstra15 tion projects, training, and capacity building. 

16 ‘‘(H) Home health care. 

17 ‘‘(I) Community health representatives. 

18 ‘‘(J) Maintenance and improvement. 

19 ‘‘(b) NO OFFSET OR LIMITATION.—Any funds appro20 priated under the authority of this section shall not be 

21 used to offset or limit any other appropriations made to 

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

23 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

24 or any other provision of law. 

25 ‘‘(c) ALLOCATION; USE.— 


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

2 the authority of this section shall be allocated to 

3 Service Units, Indian Tribes, or Tribal Organiza4 tions. The funds allocated to each Indian Tribe, 

5 Tribal Organization, or Service Unit under this 

6 paragraph shall be used by the Indian Tribe, Tribal 

7 Organization, or Service Unit under this paragraph 

8 to improve the health status and reduce the resource 

9 deficiency of each Indian Tribe served by such Serv10 ice Unit, Indian Tribe, or Tribal Organization. 

11 ‘‘(2) APPORTIONMENT OF ALLOCATED

12 FUNDS.—The apportionment of funds allocated to a 

13 Service Unit, Indian Tribe, or Tribal Organization 

14 under paragraph (1) among the health service re15 sponsibilities described in subsection (a)(5) shall be 

16 determined by the Service in consultation with, and 

17 with the active participation of, the affected Indian 

18 Tribes and Tribal Organizations. 

19 ‘‘(d) PROVISIONS RELATING TO HEALTH STATUS

20 AND RESOURCE DEFICIENCIES.—For the purposes of this 

21 section, the following definitions apply: 

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

23 and resource deficiency’ means the extent to 

24 which— 


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

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

3 ‘‘(B) the Indian Tribe or Tribal Organiza4 tion does not have available to it the health re5 sources it needs, taking into account the actual 

6 cost of providing health care services given local 

7 geographic, climatic, rural, or other cir8 cumstances. 

9 ‘‘(2) AVAILABLE RESOURCES.—The health re10 sources available to an Indian Tribe or Tribal Orga11 nization include health resources provided by the 

12 Service as well as health resources used by the In13 dian Tribe or Tribal Organization, including services 

14 and financing systems provided by any Federal pro15 grams, private insurance, and programs of State or 

16 local governments. 

17 ‘‘(3) PROCESS FOR REVIEW OF DETERMINA18 TIONS.—The Secretary shall establish procedures 

19 which allow any Indian Tribe or Tribal Organization 

20 to petition the Secretary for a review of any deter21 mination of the extent of the health status and re22 source deficiency of such Indian Tribe or Tribal Or23 ganization. 

24 ‘‘(e) ELIGIBILITY FOR FUNDS.—Tribal Health Pro25 grams shall be eligible for funds appropriated under the 


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1 authority of this section on an equal basis with programs 

2 that are administered directly by the Service. 

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

4 years after the date of enactment of the Indian Health 

5 Care Improvement Act Amendments of 2009, the Sec6 retary shall submit to Congress the current health status 

7 and resource deficiency report of the Service for each 

8 Service Unit, including newly recognized or acknowledged 

9 Indian Tribes. Such report shall set out— 

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

11 for determining Tribal health status and resource 

12 deficiencies, as well as the most recent application of 

13 that methodology; 

14 ‘‘(2) the extent of the health status and re15 source deficiency of each Indian Tribe served by the 

16 Service or a Tribal Health Program; 

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

18 the health status and resource deficiencies of all In19 dian Tribes served by the Service or a Tribal Health 

20 Program; and 

21 ‘‘(4) an estimate of— 

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

23 appropriated under the authority of this Act, or 

24 any other Act, including the amount of any 

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1 ceding fiscal year which is allocated to each 

2 Service Unit, Indian Tribe, or Tribal Organiza3 tion; 

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

5 health services in each Service Unit or Indian 

6 Tribe or Tribal Organization; and 

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

8 Service resources made available to each Service 

9 Unit, Indian Tribe or Tribal Organization, and, 

10 to the extent available, information on the wait11 ing lists and number of Indians turned away for 

12 services due to lack of resources. 

13 ‘‘(g) INCLUSION IN BASE BUDGET.—Funds appro14 priated under this section for any fiscal year shall be in15 cluded in the base budget of the Service for the purpose 

16 of determining appropriations under this section in subse17 quent fiscal years. 

18 ‘‘(h) CLARIFICATION.—Nothing in this section is in19 tended to diminish the primary responsibility of the Serv20 ice to eliminate existing backlogs in unmet health care 

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

22 discourage the Service from undertaking additional efforts 

23 to achieve equity among Indian Tribes and Tribal Organi24 zations. 


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1 ‘‘(i) FUNDING DESIGNATION.—Any funds appro2 priated under the authority of this section shall be des3 ignated as the ‘Indian Health Care Improvement Fund’. 

4 ‘‘SEC. 202. HEALTH PROMOTION AND DISEASE PREVENTION 

5 SERVICES. 

6 ‘‘(a) FINDINGS.—Congress finds that health pro7 motion and disease prevention activities— 

8 ‘‘(1) improve the health and well-being of Indi9 ans; and 

10 ‘‘(2) reduce the expenses for health care of In11 dians. 

12 ‘‘(b) PROVISION OF SERVICES.—The Secretary, act13 ing through the Service, shall provide health promotion 

14 and disease prevention services to Indians to achieve the 

15 health status objectives set forth in section 3(2). 

16 ‘‘(c) EVALUATION.—The Secretary, after obtaining 

17 input from the affected Tribal Health Programs, shall 

18 submit to the President for inclusion in the report which 

19 is required to be submitted to Congress under section 801 

20 an evaluation of— 

21 ‘‘(1) the health promotion and disease preven22 tion needs of Indians; 

23 ‘‘(2) the health promotion and disease preven24 tion activities which would best meet such needs; 


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1 ‘‘(3) the internal capacity of the Service and 

2 Tribal Health Programs to meet such needs; and 

3 ‘‘(4) the resources which would be required to 

4 enable the Service and Tribal Health Programs to 

5 undertake the health promotion and disease preven6 tion activities necessary to meet such needs. 

7 ‘‘SEC. 203. DIABETES PREVENTION, TREATMENT, AND CON8 TROL. 

9 ‘‘(a) DETERMINATIONS REGARDING DIABETES.— 

10 The Secretary, acting through the Service, and in con11 sultation with Indian Tribes and Tribal Organizations, 

12 shall determine— 

13 ‘‘(1) by Indian Tribe and by Service Unit, the 

14 incidence of, and the types of complications resulting 

15 from, diabetes among Indians; and 

16 ‘‘(2) based on the determinations made pursu17 ant to paragraph (1), the measures (including pa18 tient education and effective ongoing monitoring of 

19 disease indicators) each Service Unit should take to 

20 reduce the incidence of, and prevent, treat, and con21 trol the complications resulting from, diabetes 

22 among Indian Tribes within that Service Unit. 

23 ‘‘(b) DIABETES SCREENING.—To the extent medi24 cally indicated and with informed consent, the Secretary 

25 shall screen each Indian who receives services from the 


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1 Service for diabetes and for conditions which indicate a 

2 high risk that the individual will become diabetic and es3 tablish a cost-effective approach to ensure ongoing moni4 toring of disease indicators. Such screening and moni5 toring may be conducted by a Tribal Health Program and 

6 may be conducted through appropriate Internet-based 

7 health care management programs. 

8 ‘‘(c) DIABETES PROJECTS.—The Secretary shall con9 tinue to maintain each model diabetes project in existence 

10 on the date of enactment of the Indian Health Care Im11 provement Act Amendments of 2009. 

12 ‘‘(d) DIALYSIS PROGRAMS.—The Secretary is author13 ized to provide, through the Service, Indian Tribes, and 

14 Tribal Organizations, dialysis programs, including the 

15 purchase of dialysis equipment and the provision of nec16 essary staffing. 

17 ‘‘(e) OTHER DUTIES OF THE SECRETARY.— 

18 ‘‘(1) IN GENERAL.—The Secretary shall, to the 

19 extent funding is available— 

20 ‘‘(A) in each Area Office, consult with In21 dian Tribes and Tribal Organizations regarding 

22 programs for the prevention, treatment, and 

23 control of diabetes; 

24 ‘‘(B) establish in each Area Office a reg25 istry of patients with diabetes to track the inciVerDate Nov 24 2008 23:28 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00099 Fmt 6652 Sfmt 6201 E:\BILLS\H2708.IH H2708

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1 dence of diabetes and the complications from 

2 diabetes in that area; and 

3 ‘‘(C) ensure that data collected in each 

4 Area Office regarding diabetes and related com5 plications among Indians are disseminated to 

6 all other Area Offices, subject to applicable pa7 tient privacy laws. 

8 ‘‘(2) DIABETES CONTROL OFFICERS.— 

9 ‘‘(A) IN GENERAL.—The Secretary may es10 tablish and maintain in each Area Office a posi11 tion of diabetes control officer to coordinate and 

12 manage any activity of that Area Office relating 

13 to the prevention, treatment, or control of dia14 betes to assist the Secretary in carrying out a 

15 program under this section or section 330C of 

16 the Public Health Service Act (42 U.S.C. 254c– 

17 3). 

18 ‘‘(B) CERTAIN ACTIVITIES.—Any activity 

19 carried out by a diabetes control officer under 

20 subparagraph (A) that is the subject of a con21 tract or compact under the Indian Self-Deter22 mination and Education Assistance Act (25 

23 U.S.C. 450 et seq.), and any funds made avail24 able to carry out such an activity, shall not be 

25 divisible for purposes of that Act. 


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1 ‘‘SEC. 204. SHARED SERVICES FOR LONG-TERM CARE. 

2 ‘‘(a) LONG-TERM CARE.—Notwithstanding any other 

3 provision of law, the Secretary, acting through the Service, 

4 is authorized to provide directly, or enter into contracts 

5 or compacts under the Indian Self-Determination and 

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

7 Indian Tribes or Tribal Organizations for, the delivery of 

8 long-term care (including health care services associated 

9 with long-term care) provided in a facility to Indians. Such 

10 agreements shall provide for the sharing of staff or other 

11 services between the Service or a Tribal Health Program 

12 and a long-term care or related facility owned and oper13 ated (directly or through a contract or compact under the 

14 Indian Self-Determination and Education Assistance Act 

15 (25 U.S.C. 450 et seq.)) by such Indian Tribe or Tribal 

16 Organization. 

17 ‘‘(b) CONTENTS OF AGREEMENTS.—An agreement 

18 entered into pursuant to subsection (a)— 

19 ‘‘(1) may, at the request of the Indian Tribe or 

20 Tribal Organization, delegate to such Indian Tribe 

21 or Tribal Organization such powers of supervision 

22 and control over Service employees as the Secretary 

23 deems necessary to carry out the purposes of this 

24 section; 

25 ‘‘(2) shall provide that expenses (including sala26 ries) relating to services that are shared between the 


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1 Service and the Tribal Health Program be allocated 

2 proportionately between the Service and the Indian 

3 Tribe or Tribal Organization; and 

4 ‘‘(3) may authorize such Indian Tribe or Tribal 

5 Organization to construct, renovate, or expand a 

6 long-term care or other similar facility (including the 

7 construction of a facility attached to a Service facil8 ity). 

9 ‘‘(c) MINIMUM REQUIREMENT.—Any nursing facility 

10 provided for under this section shall meet the require11 ments for nursing facilities under section 1919 of the So12 cial Security Act. 

13 ‘‘(d) OTHER ASSISTANCE.—The Secretary shall pro14 vide such technical and other assistance as may be nec15 essary to enable applicants to comply with the provisions 

16 of this section. 

17 ‘‘(e) USE OF EXISTING OR UNDERUSED FACILI18 TIES.—The Secretary shall encourage the use of existing 

19 facilities that are underused or allow the use of swing beds 

20 for long-term or similar care. 

21 ‘‘SEC. 205. HEALTH SERVICES RESEARCH. 

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

23 the Service, shall make funding available for research to 

24 further the performance of the health service responsibil25 ities of Indian Health Programs. 


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1 ‘‘(b) COORDINATION OF RESOURCES AND ACTIVI2 TIES.—The Secretary shall also, to the maximum extent 

3 practicable, coordinate departmental research resources 

4 and activities to address relevant Indian Health Program 

5 research needs. 

6 ‘‘(c) AVAILABILITY.—Tribal Health Programs shall 

7 be given an equal opportunity to compete for, and receive, 

8 research funds under this section. 

9 ‘‘(d) USE OF FUNDS.—This funding may be used for 

10 both clinical and nonclinical research. 

11 ‘‘(e) EVALUATION AND DISSEMINATION.—The Sec12 retary shall periodically— 

13 ‘‘(1) evaluate the impact of research conducted 

14 under this section; and 

15 ‘‘(2) disseminate to Tribal Health Programs in16 formation regarding that research as the Secretary 

17 determines to be appropriate. 

18 ‘‘SEC. 206. MAMMOGRAPHY AND OTHER CANCER SCREEN19 ING. 

20 ‘‘The Secretary, acting through the Service, shall pro21 vide for screening as follows: 

22 ‘‘(1) Screening mammography (as defined in 

23 section 1861(jj) of the Social Security Act) for In24 dian women at a frequency appropriate to such 

25 women under accepted and appropriate national 


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1 standards, and under such terms and conditions as 

2 are consistent with standards established by the Sec3 retary to ensure the safety and accuracy of screen4 ing mammography under part B of title XVIII of 

5 such Act. 

6 ‘‘(2) Other cancer screening that receives an A 

7 or B rating as recommended by the United States 

8 Preventive Services Task Force established under 

9 section 915(a)(1) of the Public Health Service Act 

10 (42 U.S.C. 299b–4(a)(1)). The Secretary shall en11 sure that screening provided for under this para12 graph complies with the recommendations of the 

13 Task Force with respect to— 

14 ‘‘(A) frequency; 

15 ‘‘(B) the population to be served; 

16 ‘‘(C) the procedure or technology to be 

17 used; 

18 ‘‘(D) evidence of effectiveness; and 

19 ‘‘(E) other matters that the Secretary de20 termines appropriate. 

21 ‘‘SEC. 207. PATIENT TRAVEL COSTS. 

22 ‘‘(a) DEFINITION OF QUALIFIED ESCORT.—In this 

23 section, the term ‘qualified escort’ means— 

24 ‘‘(1) an adult escort (including a parent, guard25 ian, or other family member) who is required beVerDate Nov 24 2008 23:28 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00104 Fmt 6652 Sfmt 6201 E:\BILLS\H2708.IH H2708

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1 cause of the physical or mental condition, or age, of 

2 the applicable patient; 

3 ‘‘(2) a health professional for the purpose of 

4 providing necessary medical care during travel by 

5 the applicable patient; or 

6 ‘‘(3) other escorts, as the Secretary or applica7 ble Indian Health Program determines to be appro8 priate. 

9 ‘‘(b) PROVISION OF FUNDS.—The Secretary, acting 

10 through the Service, is authorized to provide funds for the 

11 following patient travel costs, including qualified escorts, 

12 associated with receiving health care services provided (ei13 ther through direct or contract care or through a contract 

14 or compact under the Indian Self-Determination and Edu15 cation Assistance Act (25 U.S.C. 450 et seq.)) under this 

16 Act— 

17 ‘‘(1) emergency air transportation and non18 emergency air transportation where ground trans19 portation is infeasible; 

20 ‘‘(2) transportation by private vehicle (where no 

21 other means of transportation is available), specially 

22 equipped vehicle, and ambulance; and 

23 ‘‘(3) transportation by such other means as 

24 may be available and required when air or motor ve25 hicle transportation is not available. 


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1 ‘‘SEC. 208. EPIDEMIOLOGY CENTERS. 

2 ‘‘(a) ESTABLISHMENT OF CENTERS.—The Secretary 

3 shall establish an epidemiology center in each Service Area 

4 to carry out the functions described in subsection (b). Any 

5 new center established after the date of enactment of the 

6 Indian Health Care Improvement Act Amendments of 

7 2008 may be operated under a grant authorized by sub8 section (d), but funding under such a grant shall not be 

9 divisible. 

10 ‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 

11 and upon the request of Indian Tribes, Tribal Organiza12 tions, and Urban Indian communities, each Service Area 

13 epidemiology center established under this section shall, 

14 with respect to such Service Area— 

15 ‘‘(1) collect data relating to, and monitor 

16 progress made toward meeting, each of the health 

17 status objectives of the Service, the Indian Tribes, 

18 Tribal Organizations, and Urban Indian commu19 nities in the Service Area; 

20 ‘‘(2) evaluate existing delivery systems, data 

21 systems, and other systems that impact the improve22 ment of Indian health; 

23 ‘‘(3) assist Indian Tribes, Tribal Organizations, 

24 and Urban Indian Organizations in identifying their 

25 highest priority health status objectives and the 


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1 services needed to achieve such objectives, based on 

2 epidemiological data; 

3 ‘‘(4) make recommendations for the targeting 

4 of services needed by the populations served; 

5 ‘‘(5) make recommendations to improve health 

6 care delivery systems for Indians and Urban Indi7 ans; 

8 ‘‘(6) provide requested technical assistance to 

9 Indian Tribes, Tribal Organizations, and Urban In10 dian Organizations in the development of local 

11 health service priorities and incidence and prevalence 

12 rates of disease and other illness in the community; 

13 and 

14 ‘‘(7) provide disease surveillance and assist In15 dian Tribes, Tribal Organizations, and Urban Indian 

16 communities to promote public health. 

17 ‘‘(c) TECHNICAL ASSISTANCE.—The Director of the 

18 Centers for Disease Control and Prevention shall provide 

19 technical assistance to the centers in carrying out the re20 quirements of this section. 

21 ‘‘(d) GRANTS FOR STUDIES.— 

22 ‘‘(1) IN GENERAL.—The Secretary may make 

23 grants to Indian Tribes, Tribal Organizations, In24 dian organizations, and eligible intertribal consortia 


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1 to conduct epidemiological studies of Indian commu2 nities. 

3 ‘‘(2) ELIGIBLE INTERTRIBAL CONSORTIA.—An 

4 intertribal consortium or Indian organization is eligi5 ble to receive a grant under this subsection if— 

6 ‘‘(A) the intertribal consortium is incor7 porated for the primary purpose of improving 

8 Indian health; and 

9 ‘‘(B) the intertribal consortium is rep10 resentative of the Indian Tribes or urban In11 dian communities in which the intertribal con12 sortium is located. 

13 ‘‘(3) APPLICATIONS.—An application for a 

14 grant under this subsection shall be submitted in 

15 such manner and at such time as the Secretary shall 

16 prescribe. 

17 ‘‘(4) REQUIREMENTS.—An applicant for a 

18 grant under this subsection shall— 

19 ‘‘(A) demonstrate the technical, adminis20 trative, and financial expertise necessary to 

21 carry out the functions described in paragraph 

22 (5); 

23 ‘‘(B) consult and cooperate with providers 

24 of related health and social services in order to 

25 avoid duplication of existing services; and 


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1 ‘‘(C) demonstrate cooperation from Indian 

2 Tribes or Urban Indian Organizations in the 

3 area to be served. 

4 ‘‘(5) USE OF FUNDS.—A grant awarded under 

5 paragraph (1) may be used— 

6 ‘‘(A) to carry out the functions described 

7 in subsection (b); 

8 ‘‘(B) to provide information to and consult 

9 with tribal leaders, urban Indian community 

10 leaders, and related health staff on health care 

11 and health service management issues; and 

12 ‘‘(C) in collaboration with Indian Tribes, 

13 Tribal Organizations, and urban Indian com14 munities, to provide the Service with informa15 tion regarding ways to improve the health sta16 tus of Indians. 

17 ‘‘(e) ACCESS TO INFORMATION.— 

18 ‘‘(1) An epidemiology center operated by a 

19 grantee pursuant to a grant awarded under sub20 section (d) shall be treated as a public health au21 thority for purposes of the Health Insurance Port22 ability and Accountability Act of 1996, as such enti23 ties are defined in part 164.501 of title 45, Code of 

24 Federal Regulations. 


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1 ‘‘(2) The Secretary shall grant to such epidemi2 ology center access to use of the data, data sets, 

3 monitoring systems, delivery systems, and other pro4 tected health information in the possession of the 

5 Secretary. 

6 ‘‘(3) The activities of such an epidemiology cen7 ter shall be for the purposes of research and for pre8 venting and controlling disease, injury, or disability 

9 for purposes of the Health Insurance Portability and 

10 Accountability Act of 1996 (Public Law 104–191; 

11 110 Stat. 2033), as such activities are described in 

12 part 164.512 of title 45, Code of Federal Regula13 tions (or a successor regulation). 

14 ‘‘(f) FUNDS NOT DIVISIBLE.—An epidemiology cen15 ter established under this section shall be subject to the 

16 provisions of the Indian Self-Determination and Edu17 cation Assistance Act (25 U.S.C. 450 et seq.), but the 

18 funds for such center shall not be divisible. 

19 ‘‘SEC. 209. COMPREHENSIVE SCHOOL HEALTH EDUCATION 

20 PROGRAMS. 

21 ‘‘(a) FUNDING FOR DEVELOPMENT OF PROGRAMS.— 

22 In addition to carrying out any other program for health 

23 promotion or disease prevention, the Secretary, acting 

24 through the Service, is authorized to award grants to In25 dian Tribes and Tribal Organizations to develop comVerDate Nov 24 2008 20:26 Jun 07, 2009 Jkt 079200 PO 00000 Frm 00110 Fmt 6652 Sfmt 6201 E:\BILLS\H2708.IH H2708

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1 prehensive school health education programs for children 

2 from pre-school through grade 12 in schools for the benefit 

3 of Indian children. 

4 ‘‘(b) USE OF GRANT FUNDS.—A grant awarded 

5 under this section may be used for purposes which may 

6 include, but are not limited to, the following: 

7 ‘‘(1) Developing health education materials both 

8 for regular school programs and afterschool pro9 grams. 

10 ‘‘(2) Training teachers in comprehensive school 

11 health education materials. 

12 ‘‘(3) Integrating school-based, community13 based, and other public and private health promotion 

14 efforts. 

15 ‘‘(4) Encouraging healthy, tobacco-free school 

16 environments. 

17 ‘‘(5) Coordinating school-based health programs 

18 with existing services and programs available in the 

19 community. 

20 ‘‘(6) Developing school programs on nutrition 

21 education, personal health, oral health, and fitness. 

22 ‘‘(7) Developing behavioral health wellness pro23 grams. 

24 ‘‘(8) Developing chronic disease prevention pro25 grams. 


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1 ‘‘(9) Developing substance abuse prevention 

2 programs. 

3 ‘‘(10) Developing injury prevention and safety 

4 education programs. 

5 ‘‘(11) Developing activities for the prevention 

6 and control of communicable diseases. 

7 ‘‘(12) Developing community and environmental 

8 health education programs that include traditional 

9 health care practitioners. 

10 ‘‘(13) Violence prevention. 

11 ‘‘(14) Such other health issues as are appro12 priate. 

13 ‘‘(c) TECHNICAL ASSISTANCE.—Upon request, the 

14 Secretary, acting through the Service, shall provide tech15 nical assistance to Indian Tribes and Tribal Organizations 

16 in the development of comprehensive health education 

17 plans and the dissemination of comprehensive health edu18 cation materials and information on existing health pro19 grams and resources. 

20 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP21 PLICATIONS.—The Secretary, acting through the Service, 

22 and in consultation with Indian Tribes and Tribal Organi23 zations, shall establish criteria for the review and approval 

24 of applications for grants awarded under this section. 


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1 ‘‘(e) DEVELOPMENT OF PROGRAM FOR BIA-FUNDED

2 SCHOOLS.— 

3 ‘‘(1) IN GENERAL.—The Secretary of the Inte4 rior, acting through the Bureau of Indian Affairs 

5 and in cooperation with the Secretary, acting 

6 through the Service, shall develop a comprehensive 

7 school health education program for children from 

8 preschool through grade 12 in schools for which sup9 port is provided by the Bureau of Indian Affairs. 

10 ‘‘(2) REQUIREMENTS FOR PROGRAMS.—Such 

11 programs shall include— 

12 ‘‘(A) school programs on nutrition edu13 cation, personal health, oral health, and fitness; 

14 ‘‘(B) behavioral health wellness programs; 

15 ‘‘(C) chronic disease prevention programs; 

16 ‘‘(D) substance abuse prevention pro17 grams; 

18 ‘‘(E) injury prevention and safety edu19 cation programs; and 

20 ‘‘(F) activities for the prevention and con21 trol of communicable diseases. 

22 ‘‘(3) DUTIES OF THE SECRETARY.—The Sec23 retary of the Interior shall— 

24 ‘‘(A) provide training to teachers in com25 prehensive school health education materials; 


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1 ‘‘(B) ensure the integration and coordina2 tion of school-based programs with existing 

3 services and health programs available in the 

4 community; and 

5 ‘‘(C) encourage healthy, tobacco-free school 

6 environments. 

7 ‘‘SEC. 210. INDIAN YOUTH PROGRAM. 

8 ‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 

9 through the Service, is authorized to establish and admin10 ister a program to provide grants to Indian Tribes, Tribal 

11 Organizations, and urban Indian organizations for innova12 tive mental and physical disease prevention and health 

13 promotion and treatment programs for Indian and urban 

14 Indian preadolescent and adolescent youths. 

15 ‘‘(b) USE OF FUNDS.— 

16 ‘‘(1) ALLOWABLE USES.—Funds made available 

17 under this section may be used to— 

18 ‘‘(A) develop prevention and treatment 

19 programs for Indian youth which promote men20 tal and physical health and incorporate cultural 

21 values, community and family involvement, and 

22 traditional health care practitioners; and 

23 ‘‘(B) develop and provide community train24 ing and education. 


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1 ‘‘(2) PROHIBITED USE.—Funds made available 

2 under this section may not be used to provide serv3 ices described in section 707(c). 

4 ‘‘(c) DUTIES OF THE SECRETARY.—The Secretary 

5 shall— 

6 ‘‘(1) disseminate to Indian Tribes, Tribal Orga7 nizations, and urban Indian organizations informa8 tion regarding models for the delivery of comprehen9 sive health care services to Indian and urban Indian 

10 adolescents; 

11 ‘‘(2) encourage the implementation of such 

12 models; and 

13 ‘‘(3) at the request of an Indian Tribe, Tribal 

14 Organization, or urban Indian organization, provide 

15 technical assistance in the implementation of such 

16 models. 

17 ‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP18 PLICATIONS.—The Secretary, in consultation with Indian 

19 Tribes, Tribal Organizations, and urban Indian organiza20 tions, shall establish criteria for the review and approval 

21 of applications or proposals under this section. 

22 ‘‘SEC. 211. PREVENTION, CONTROL, AND ELIMINATION OF 

23 COMMUNICABLE AND INFECTIOUS DISEASES. 

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

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1 ters for Disease Control and Prevention, may make grants 

2 available to Indian Tribes, Tribal Organizations, and 

3 urban Indian organizations for the following: 

4 ‘‘(1) Projects for the prevention, control, and 

5 elimination of communicable and infectious diseases, 

6 including tuberculosis, hepatitis, HIV, respiratory 

7 syncytial virus, hanta virus, sexually transmitted dis8 eases, and H. Pylori. 

9 ‘‘(2) Public information and education pro10 grams for the prevention, control, and elimination of 

11 communicable and infectious diseases. 

12 ‘‘(3) Education, training, and clinical skills im13 provement activities in the prevention, control, and 

14 elimination of communicable and infectious diseases 

15 for health professionals, including allied health pro16 fessionals. 

17 ‘‘(4) Demonstration projects for the screening, 

18 treatment, and prevention of hepatitis C virus 

19 (HCV). 

20 ‘‘(b) APPLICATION REQUIRED.—The Secretary may 

21 provide funding under subsection (a) only if an application 

22 or proposal for funding is submitted to the Secretary. 

23 ‘‘(c) COORDINATION WITH HEALTH AGENCIES.—In24 dian Tribes, Tribal Organizations, and urban Indian orga25 nizations receiving funding under this section are encourVerDate Nov 24 2008 23:28 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00116 Fmt 6652 Sfmt 6201 E:\BILLS\H2708.IH H2708

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1 aged to coordinate their activities with the Centers for 

2 Disease Control and Prevention and State and local health 

3 agencies. 

4 ‘‘(d) TECHNICAL ASSISTANCE; REPORT.—In carrying 

5 out this section, the Secretary— 

6 ‘‘(1) may, at the request of an Indian Tribe, 

7 Tribal Organization, or urban Indian organization, 

8 provide technical assistance; and 

9 ‘‘(2) shall prepare and submit a report to Con10 gress biennially on the use of funds under this sec11 tion and on the progress made toward the preven12 tion, control, and elimination of communicable and 

13 infectious diseases among Indians and Urban Indi14 ans. 

15 ‘‘SEC. 212. OTHER AUTHORITY FOR PROVISION OF SERV16 ICES. 

17 ‘‘(a) FUNDING AUTHORIZED.—The Secretary, acting 

18 through the Service, Indian Tribes, and Tribal Organiza19 tions, may provide funding under this Act to meet the ob20 jectives set forth in section 3 of this Act through health 

21 care-related services and programs not otherwise described 

22 in this Act for the following services: 

23 ‘‘(1) Hospice care. 

24 ‘‘(2) Assisted living services. 

25 ‘‘(3) Long-term care services. 


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1 ‘‘(4) Home- and community-based services. 

2 ‘‘(b) ELIGIBILITY.—The following individuals shall be 

3 eligible to receive long-term care under this section: 

4 ‘‘(1) Individuals who are unable to perform a 

5 certain number of activities of daily living without 

6 assistance. 

7 ‘‘(2) Individuals with a mental impairment, 

8 such as dementia, Alzheimer’s disease, or another 

9 disabling mental illness, who may be able to perform 

10 activities of daily living under supervision. 

11 ‘‘(3) Such other individuals as an applicable In12 dian Health Program determines to be appropriate. 

13 ‘‘(c) DEFINITIONS.—For the purposes of this section, 

14 the following definitions shall apply: 

15 ‘‘(1) The term ‘assisted living services’ means 

16 any service provided by an assisted living facility (as 

17 defined in section 232(b) of the National Housing 

18 Act (12 U.S.C. 1715w(b))), except that such an as19 sisted living facility— 

20 ‘‘(A) shall not be required to obtain a li21 cense; but 

22 ‘‘(B) shall meet all applicable standards 

23 for licensure. 

24 ‘‘(2) The term ‘home- and community-based 

25 services’ means 1 or more of the services specified 


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1 in paragraphs (1) through (9) of section 1929(a) of 

2 the Social Security Act (42 U.S.C. 1396t(a)) 

3 (whether provided by the Service or by an Indian 

4 Tribe or Tribal Organization pursuant to the Indian 

5 Self-Determination and Education Assistance Act 

6 (25 U.S.C. 450 et seq.)) that are or will be provided 

7 in accordance with applicable standards. 

8 ‘‘(3) The term ‘hospice care’ means the items 

9 and services specified in subparagraphs (A) through 

10 (H) of section 1861(dd)(1) of the Social Security 

11 Act (42 U.S.C. 1395x(dd)(1)), and such other serv12 ices which an Indian Tribe or Tribal Organization 

13 determines are necessary and appropriate to provide 

14 in furtherance of this care. 

15 ‘‘(4) The term ‘long-term care services’ has the 

16 meaning given the term ‘qualified long-term care 

17 services’ in section 7702B(c) of the Internal Rev18 enue Code of 1986. 

19 ‘‘(d) AUTHORIZATION OF CONVENIENT CARE SERV20 ICES.—The Secretary, acting through the Service, Indian 

21 Tribes, and Tribal Organizations, may also provide fund22 ing under this Act to meet the objectives set forth in sec23 tion 3 of this Act for convenient care services programs 

24 pursuant to section 306(c)(2)(A). 


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1 ‘‘SEC. 213. INDIAN WOMEN’S HEALTH CARE. 

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

3 monitor and improve the quality of health care for Indian 

4 women of all ages through the planning and delivery of 

5 programs administered by the Service, in order to improve 

6 and enhance the treatment models of care for Indian 

7 women. 

8 ‘‘SEC. 214. ENVIRONMENTAL AND NUCLEAR HEALTH HAZ9 ARDS. 

10 ‘‘(a) STUDIES AND MONITORING.—The Secretary 

11 and the Service shall conduct, in conjunction with other 

12 appropriate Federal agencies and in consultation with con13 cerned Indian Tribes and Tribal Organizations, studies 

14 and ongoing monitoring programs to determine trends in 

15 the health hazards to Indian miners and to Indians on 

16 or near reservations and Indian communities as a result 

17 of environmental hazards which may result in chronic or 

18 life threatening health problems, such as nuclear resource 

19 development, petroleum contamination, and contamination 

20 of water source and of the food chain. Such studies shall 

21 include— 

22 ‘‘(1) an evaluation of the nature and extent of 

23 health problems caused by environmental hazards 

24 currently exhibited among Indians and the causes of 

25 such health problems; 


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1 ‘‘(2) an analysis of the potential effect of ongo2 ing and future environmental resource development 

3 on or near reservations and Indian communities, in4 cluding the cumulative effect over time on health; 

5 ‘‘(3) an evaluation of the types and nature of 

6 activities, practices, and conditions causing or affect7 ing such health problems, including uranium mining 

8 and milling, uranium mine tailing deposits, nuclear 

9 power plant operation and construction, and nuclear 

10 waste disposal; oil and gas production or transpor11 tation on or near reservations or Indian commu12 nities; and other development that could affect the 

13 health of Indians and their water supply and food 

14 chain; 

15 ‘‘(4) a summary of any findings and rec16 ommendations provided in Federal and State stud17 ies, reports, investigations, and inspections during 

18 the 5 years prior to the date of enactment of the In19 dian Health Care Improvement Act Amendments of 

20 2009 that directly or indirectly relate to the activi21 ties, practices, and conditions affecting the health or 

22 safety of such Indians; and 

23 ‘‘(5) the efforts that have been made by Federal 

24 and State agencies and resource and economic devel25 opment companies to effectively carry out an eduVerDate Nov 24 2008 23:28 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00121 Fmt 6652 Sfmt 6201 E:\BILLS\H2708.IH H2708

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1 cation program for such Indians regarding the 

2 health and safety hazards of such development. 

3 ‘‘(b) HEALTH CARE PLANS.—Upon completion of 

4 such studies, the Secretary and the Service shall take into 

5 account the results of such studies and develop health care 

6 plans to address the health problems studied under sub7 section (a). The plans shall include— 

8 ‘‘(1) methods for diagnosing and treating Indi9 ans currently exhibiting such health problems; 

10 ‘‘(2) preventive care and testing for Indians 

11 who may be exposed to such health hazards, includ12 ing the monitoring of the health of individuals who 

13 have or may have been exposed to excessive amounts 

14 of radiation or affected by other activities that have 

15 had or could have a serious impact upon the health 

16 of such individuals; and 

17 ‘‘(3) a program of education for Indians who, 

18 by reason of their work or geographic proximity to 

19 such nuclear or other development activities, may ex20 perience health problems. 

21 ‘‘(c) SUBMISSION OF REPORT AND PLAN TO CON22 GRESS.—The Secretary and the Service shall submit to 

23 Congress the study prepared under subsection (a) no later 

24 than 18 months after the date of enactment of the Indian 

25 Health Care Improvement Act Amendments of 2009. The 


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1 health care plan prepared under subsection (b) shall be 

2 submitted in a report no later than 1 year after the study 

3 prepared under subsection (a) is submitted to Congress. 

4 Such report shall include recommended activities for the 

5 implementation of the plan, as well as an evaluation of 

6 any activities previously undertaken by the Service to ad7 dress such health problems. 

8 ‘‘(d) INTERGOVERNMENTAL TASK FORCE.— 

9 ‘‘(1) ESTABLISHMENT; MEMBERS.—There is es10 tablished an Intergovernmental Task Force to be 

11 composed of the following individuals (or their des12 ignees): 

13 ‘‘(A) The Secretary of Energy. 

14 ‘‘(B) The Secretary of the Environmental 

15 Protection Agency. 

16 ‘‘(C) The Director of the Bureau of Mines. 

17 ‘‘(D) The Assistant Secretary for Occupa18 tional Safety and Health. 

19 ‘‘(E) The Secretary of the Interior. 

20 ‘‘(F) The Secretary of Health and Human 

21 Services. 

22 ‘‘(G) The Director of the Indian Health 

23 Service. 

24 ‘‘(2) DUTIES.—The Task Force shall— 


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1 ‘‘(A) identify existing and potential oper2 ations related to nuclear resource development 

3 or other environmental hazards that affect or 

4 may affect the health of Indians on or near a 

5 reservation or in an Indian community; and 

6 ‘‘(B) enter into activities to correct exist7 ing health hazards and ensure that current and 

8 future health problems resulting from nuclear 

9 resource or other development activities are 

10 minimized or reduced. 

11 ‘‘(3) CHAIRMAN; MEETINGS.—The Secretary of 

12 Health and Human Services shall be the Chairman 

13 of the Task Force. The Task Force shall meet at 

14 least twice each year. 

15 ‘‘(e) HEALTH SERVICES TO CERTAIN EMPLOYEES.— 

16 In the case of any Indian who— 

17 ‘‘(1) as a result of employment in or near a 

18 uranium mine or mill or near any other environ19 mental hazard, suffers from a work-related illness or 

20 condition; 

21 ‘‘(2) is eligible to receive diagnosis and treat22 ment services from an Indian Health Program; and 

23 ‘‘(3) by reason of such Indian’s employment, is 

24 entitled to medical care at the expense of such mine 

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1 mental hazard, the Indian Health Program shall, at 

2 the request of such Indian, render appropriate med3 ical care to such Indian for such illness or condition 

4 and may be reimbursed for any medical care so ren5 dered to which such Indian is entitled at the expense 

6 of such operator or entity from such operator or en7 tity. Nothing in this subsection shall affect the 

8 rights of such Indian to recover damages other than 

9 such amounts paid to the Indian Health Program 

10 from the employer for providing medical care for 

11 such illness or condition. 

12 ‘‘SEC. 215. ARIZONA AS A CONTRACT HEALTH SERVICE DE13 LIVERY AREA. 

14 ‘‘(a) IN GENERAL.—For fiscal years beginning with 

15 the fiscal year ending September 30, 1983, and ending 

16 with the fiscal year ending September 30, 2025, the State 

17 of Arizona shall be designated as a contract health service 

18 delivery area by the Service for the purpose of providing 

19 contract health care services to members of federally rec20 ognized Indian Tribes of Arizona. 

21 ‘‘(b) MAINTENANCE OF SERVICES.—The Service 

22 shall not curtail any health care services provided to Indi23 ans residing on reservations in the State of Arizona if such 

24 curtailment is due to the provision of contract services in 

25 such State pursuant to the designation of such State as 


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1 a contract health service delivery area pursuant to sub2 section (a). 

3 ‘‘SEC. 216. NORTH DAKOTA AND SOUTH DAKOTA AS CON4 TRACT HEALTH SERVICE DELIVERY AREA. 

5 ‘‘(a) IN GENERAL.—Beginning in fiscal year 2003, 

6 the States of North Dakota and South Dakota shall be 

7 designated as a contract health service delivery area by 

8 the Service for the purpose of providing contract health 

9 care services to members of federally recognized Indian 

10 Tribes of North Dakota and South Dakota. 

11 ‘‘(b) LIMITATION.—The Service shall not curtail any 

12 health care services provided to Indians residing on any 

13 reservation, or in any county that has a common boundary 

14 with any reservation, in the State of North Dakota or 

15 South Dakota if such curtailment is due to the provision 

16 of contract services in such States pursuant to the des17 ignation of such States as a contract health service deliv18 ery area pursuant to subsection (a). 

19 ‘‘SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES PRO20 GRAM. 

21 ‘‘(a) FUNDING AUTHORIZED.—The Secretary is au22 thorized to fund a program using the California Rural In23 dian Health Board (hereafter in this section referred to 

24 as the ‘CRIHB’) as a contract care intermediary to imVerDate Nov 24 2008 23:28 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00126 Fmt 6652 Sfmt 6201 E:\BILLS\H2708.IH H2708

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1 prove the accessibility of health services to California Indi2 ans. 

3 ‘‘(b) REIMBURSEMENT CONTRACT.—The Secretary 

4 shall enter into an agreement with the CRIHB to reim5 burse the CRIHB for costs (including reasonable adminis6 trative costs) incurred pursuant to this section, in pro7 viding medical treatment under contract to California In8 dians described in section 805(a) throughout the Cali9 fornia contract health services delivery area described in 

10 section 219 with respect to high cost contract care cases. 

11 ‘‘(c) ADMINISTRATIVE EXPENSES.—Not more than 5 

12 percent of the amounts provided to the CRIHB under this 

13 section for any fiscal year may be for reimbursement for 

14 administrative expenses incurred by the CRIHB during 

15 such fiscal year. 

16 ‘‘(d) LIMITATION ON PAYMENT.—No payment may 

17 be made for treatment provided hereunder to the extent 

18 payment may be made for such treatment under the In19 dian Catastrophic Health Emergency Fund described in 

20 section 202 or from amounts appropriated or otherwise 

21 made available to the California contract health service de22 livery area for a fiscal year. 

23 ‘‘(e) ADVISORY BOARD.—There is established an ad24 visory board which shall advise the CRIHB in carrying 

25 out this section. The advisory board shall be composed of 


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1 representatives, selected by the CRIHB, from not less 

2 than 8 Tribal Health Programs serving California Indians 

covered under this section at least 1 3 ⁄2 of whom of whom 

4 are not affiliated with the CRIHB. 

5 ‘‘SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE 

6 DELIVERY AREA. 

7 ‘‘The State of California, excluding the counties of 

8 Alameda, Contra Costa, Los Angeles, Marin, Orange, Sac9 ramento, San Francisco, San Mateo, Santa Clara, Kern, 

10 Merced, Monterey, Napa, San Benito, San Joaquin, San 

11 Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ven12 tura, shall be designated as a contract health service deliv13 ery area by the Service for the purpose of providing con14 tract health services to California Indians. However, any 

15 of the counties listed herein may only be included in the 

16 contract health services delivery area if funding is specifi17 cally provided by the Service for such services in those 

18 counties. 

19 ‘‘SEC. 219. CONTRACT HEALTH SERVICES FOR THE TREN20 TON SERVICE AREA. 

21 ‘‘(a) AUTHORIZATION FOR SERVICES.—The Sec22 retary, acting through the Service, is directed to provide 

23 contract health services to members of the Turtle Moun24 tain Band of Chippewa Indians that reside in the Trenton 

25 Service Area of Divide, McKenzie, and Williams counties 


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1 in the State of North Dakota and the adjoining counties 

2 of Richland, Roosevelt, and Sheridan in the State of Mon3 tana. 

4 ‘‘(b) NO EXPANSION OF ELIGIBILITY.—Nothing in 

5 this section may be construed as expanding the eligibility 

6 of members of the Turtle Mountain Band of Chippewa In7 dians for health services provided by the Service beyond 

8 the scope of eligibility for such health services that applied 

9 on May 1, 1986. 

10 ‘‘SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND 

11 TRIBAL ORGANIZATIONS. 

12 ‘‘The Service shall provide funds for health care pro13 grams, functions, services, activities, information tech14 nology, and facilities operated by Tribal Health Programs 

15 on the same basis as such funds are provided to programs, 

16 functions, services, activities, information technology, and 

17 facilities operated directly by the Service. 

18 ‘‘SEC. 221. LICENSING. 

19 ‘‘Licensed health care professionals employed by a 

20 Tribal Health Program shall, if licensed in any State, be 

21 exempt from the licensing requirements of the State in 

22 which the Tribal Health Program performs the services 

23 described in its contract or compact under the Indian Self24 Determination and Education Assistance Act (25 U.S.C. 

25 450 et seq.) while performing such services. 


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1 ‘‘SEC. 222. NOTIFICATION OF PROVISION OF EMERGENCY 

2 CONTRACT HEALTH SERVICES. 

3 ‘‘With respect to an elderly Indian or an Indian with 

4 a disability receiving emergency medical care or services 

5 from a non-Service provider or in a non-Service facility 

6 under the authority of this Act, the time limitation (as 

7 a condition of payment) for notifying the Service of such 

8 treatment or admission shall be 30 days. 

9 ‘‘SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS. 

10 ‘‘(a) DEADLINE FOR RESPONSE.—The Service shall 

11 respond to a notification of a claim by a provider of a 

12 contract care service with either an individual purchase 

13 order or a denial of the claim within 5 working days after 

14 the receipt of such notification. 

15 ‘‘(b) EFFECT OF UNTIMELY RESPONSE.—If the 

16 Service fails to respond to a notification of a claim in ac17 cordance with subsection (a), the Service shall accept as 

18 valid the claim submitted by the provider of a contract 

19 care service. 

20 ‘‘(c) DEADLINE FOR PAYMENT OF VALID CLAIM.— 

21 The Service shall pay a valid contract care service claim 

22 within 30 days after the completion of the claim. 

23 ‘‘SEC. 224. LIABILITY FOR PAYMENT. 

24 ‘‘(a) NO PATIENT LIABILITY.—A patient who re25 ceives contract health care services that are authorized by 

26 the Service shall not be liable for the payment of any 


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1 charges or costs associated with the provision of such serv2 ices. 

3 ‘‘(b) NOTIFICATION.—The Secretary shall notify a 

4 contract care provider and any patient who receives con5 tract health care services authorized by the Service that 

6 such patient is not liable for the payment of any charges 

7 or costs associated with the provision of such services not 

8 later than 5 business days after receipt of a notification 

9 of a claim by a provider of contract care services. 

10 ‘‘(c) NO RECOURSE.—Following receipt of the notice 

11 provided under subsection (b), or, if a claim has been 

12 deemed accepted under section 224(b), the provider shall 

13 have no further recourse against the patient who received 

14 the services. 

15 ‘‘SEC. 225. OFFICE OF INDIAN MEN’S HEALTH. 

16 ‘‘(a) ESTABLISHMENT.—The Secretary may establish 

17 within the Service an office to be known as the ‘Office 

18 of Indian Men’s Health’ (referred to in this section as the 

19 ‘Office’). 

20 ‘‘(b) DIRECTOR.— 

21 ‘‘(1) IN GENERAL.—The Office shall be headed 

22 by a director, to be appointed by the Secretary. 

23 ‘‘(2) DUTIES.—The director shall coordinate 

24 and promote the status of the health of Indian men 

25 in the United States. 


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1 ‘‘(c) REPORT.—Not later than 2 years after the date 

2 of enactment of the Indian Health Care Improvement Act 

3 Amendments of 2009, the Secretary, acting through the 

4 director of the Office, shall submit to Congress a report 

5 describing— 

6 ‘‘(1) any activity carried out by the director as 

7 of the date on which the report is prepared; and 

8 ‘‘(2) any finding of the director with respect to 

9 the health of Indian men. 

10 ‘‘SEC. 226. AUTHORIZATION OF APPROPRIATIONS. 

11 ‘‘There are authorized to be appropriated such sums 

12 as may be necessary for each fiscal year through fiscal 

13 year 2025 to carry out this title. 

14 ‘‘TITLE III—FACILITIES 

15 ‘‘SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVA16 TION OF FACILITIES; REPORTS. 

17 ‘‘(a) PREREQUISITES FOR EXPENDITURE OF

18 FUNDS.—Prior to the expenditure of, or the making of 

19 any binding commitment to expend, any funds appro20 priated for the planning, design, construction, or renova21 tion of facilities pursuant to the Act of November 2, 1921 

22 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

23 the Secretary, acting through the Service, shall— 

24 ‘‘(1) consult with any Indian Tribe that would 

25 be significantly affected by such expenditure for the 


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1 purpose of determining and, whenever practicable, 

2 honoring tribal preferences concerning size, location, 

3 type, and other characteristics of any facility on 

4 which such expenditure is to be made; and 

5 ‘‘(2) ensure, whenever practicable and applica6 ble, that such facility meets the construction stand7 ards of any accrediting body recognized by the Sec8 retary for the purposes of the Medicare, Medicaid, 

9 and SCHIP programs under titles XVIII, XIX, and 

10 XXI of the Social Security Act by not later than 1 

11 year after the date on which the construction or ren12 ovation of such facility is completed. 

13 ‘‘(b) CLOSURES.— 

14 ‘‘(1) EVALUATION REQUIRED.—Notwith15 standing any other provision of law, no facility oper16 ated by the Service may be closed if the Secretary 

17 has not submitted to Congress, not less than 1 year 

18 and not more than 2 years before the date of the 

19 proposed closure, an evaluation, completed not more 

20 than 2 years before such submission, of the impact 

21 of the proposed closure that specifies, in addition to 

22 other considerations— 

23 ‘‘(A) the accessibility of alternative health 

24 care resources for the population served by such 

25 facility; 


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1 ‘‘(B) the cost-effectiveness of such closure; 

2 ‘‘(C) the quality of health care to be pro3 vided to the population served by such facility 

4 after such closure; 

5 ‘‘(D) the availability of contract health 

6 care funds to maintain existing levels of service; 

7 ‘‘(E) the views of the Indian Tribes served 

8 by such facility concerning such closure; 

9 ‘‘(F) the level of use of such facility by all 

10 eligible Indians; and 

11 ‘‘(G) the distance between such facility and 

12 the nearest operating Service hospital. 

13 ‘‘(2) EXCEPTION FOR CERTAIN TEMPORARY

14 CLOSURES.—Paragraph (1) shall not apply to any 

15 temporary closure of a facility or any portion of a 

16 facility if such closure is necessary for medical, envi17 ronmental, or construction safety reasons. 

18 ‘‘(c) HEALTH CARE FACILITY PRIORITY SYSTEM.— 

19 ‘‘(1) IN GENERAL.— 

20 ‘‘(A) PRIORITY SYSTEM.—The Secretary, 

21 acting through the Service, shall maintain a 

22 health care facility priority system, which— 

23 ‘‘(i) shall be developed in consultation 

24 with Indian Tribes and Tribal Organiza25 tions; 


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1 ‘‘(ii) shall give Indian Tribes’ needs 

2 the highest priority; 

3 ‘‘(iii)(I) may include the lists required 

4 in paragraph (2)(B)(ii); and 

5 ‘‘(II) shall include the methodology re6 quired in paragraph (2)(B)(v); and 

7 ‘‘(III) may include such other facili8 ties, and such renovation or expansion 

9 needs of any health care facility, as the 

10 Service, Indian Tribes, and Tribal Organi11 zations may identify; and 

12 ‘‘(iv) shall provide an opportunity for 

13 the nomination of planning, design, and 

14 construction projects by the Service, In15 dian Tribes, and Tribal Organizations for 

16 consideration under the priority system at 

17 least once every 3 years, or more fre18 quently as the Secretary determines to be 

19 appropriate. 

20 ‘‘(B) NEEDS OF FACILITIES UNDER

21 ISDEAA AGREEMENTS.—The Secretary shall en22 sure that the planning, design, construction, 

23 renovation, and expansion needs of Service and 

24 non-Service facilities operated under contracts 

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1 Determination and Education Assistance Act 

2 (25 U.S.C. 450 et seq.) are fully and equitably 

3 integrated into the health care facility priority 

4 system. 

5 ‘‘(C) CRITERIA FOR EVALUATING

6 NEEDS.—For purposes of this subsection, the 

7 Secretary, in evaluating the needs of facilities 

8 operated under a contract or compact under the 

9 Indian Self-Determination and Education As10 sistance Act (25 U.S.C. 450 et seq.), shall use 

11 the criteria used by the Secretary in evaluating 

12 the needs of facilities operated directly by the 

13 Service. 

14 ‘‘(D) PRIORITY OF CERTAIN PROJECTS

15 PROTECTED.—The priority of any project estab16 lished under the construction priority system in 

17 effect on the date of enactment of the Indian 

18 Health Care Improvement Act Amendments of 

19 2009 shall not be affected by any change in the 

20 construction priority system taking place after 

21 that date if the project— 

22 ‘‘(i) was identified in the fiscal year 

23 2008 Service budget justification as— 

24 ‘‘(I) 1 of the 10 top-priority inpa25 tient projects; 


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1 ‘‘(II) 1 of the 10 top-priority out2 patient projects; 

3 ‘‘(III) 1 of the 10 top-priority 

4 staff quarters developments; or 

5 ‘‘(IV) 1 of the 10 top-priority 

6 Youth Regional Treatment Centers; 

7 ‘‘(ii) had completed both Phase I and 

8 Phase II of the construction priority sys9 tem in effect on the date of enactment of 

10 such Act; or 

11 ‘‘(iii) is not included in clause (i) or 

12 (ii) and is selected, as determined by the 

13 Secretary— 

14 ‘‘(I) on the initiative of the Sec15 retary; or 

16 ‘‘(II) pursuant to a request of an 

17 Indian Tribe or Tribal Organization. 

18 ‘‘(2) REPORT; CONTENTS.— 

19 ‘‘(A) INITIAL COMPREHENSIVE REPORT.— 

20 ‘‘(i) DEFINITIONS.—In this subpara21 graph: 

22 ‘‘(I) FACILITIES APPROPRIATION

23 ADVISORY BOARD.—The term ‘Facili24 ties Appropriation Advisory Board’ 

25 means the advisory board, comprised 


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1 of 12 members representing Indian 

2 tribes and 2 members representing 

3 the Service, established at the discre4 tion of the Assistant Secretary— 

5 ‘‘(aa) to provide advice and 

6 recommendations for policies and 

7 procedures of the programs fund8 ed pursuant to facilities appro9 priations; and 

10 ‘‘(bb) to address other facili11 ties issues. 

12 ‘‘(II) FACILITIES NEEDS ASSESS13 MENT WORKGROUP.—The term ‘Fa14 cilities Needs Assessment Workgroup’ 

15 means the workgroup established at 

16 the discretion of the Assistant Sec17 retary— 

18 ‘‘(aa) to review the health 

19 care facilities construction pri20 ority system; and 

21 ‘‘(bb) to make recommenda22 tions to the Facilities Appropria23 tion Advisory Board for revising 

24 the priority system. 

25 ‘‘(ii) INITIAL REPORT.— 


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1 ‘‘(I) IN GENERAL.—Not later 

2 than 1 year after the date of enact3 ment of the Indian Health Care Im4 provement Act Amendments of 2009, 

5 the Secretary shall submit to the 

6 Committee on Indian Affairs of the 

7 Senate and the Committee on Natural 

8 Resources of the House of Represent9 atives a report that describes the com10 prehensive, national, ranked list of all 

11 health care facilities needs for the 

12 Service, Indian Tribes, and Tribal Or13 ganizations (including inpatient health 

14 care facilities, outpatient health care 

15 facilities, specialized health care facili16 ties (such as for long-term care and 

17 alcohol and drug abuse treatment), 

18 wellness centers, staff quarters and 

19 hostels associated with health care fa20 cilities, and the renovation and expan21 sion needs, if any, of such facilities) 

22 developed by the Service, Indian 

23 Tribes, and Tribal Organizations for 

24 the Facilities Needs Assessment 


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1 Workgroup and the Facilities Appro2 priation Advisory Board. 

3 ‘‘(II) INCLUSIONS.—The initial 

4 report shall include— 

5 ‘‘(aa) the methodology and 

6 criteria used by the Service in de7 termining the needs and estab8 lishing the ranking of the facili9 ties needs; and 

10 ‘‘(bb) such other information 

11 as the Secretary determines to be 

12 appropriate. 

13 ‘‘(iii) UPDATES OF REPORT.—Begin14 ning in calendar year 2011, the Secretary 

15 shall— 

16 ‘‘(I) update the report under 

17 clause (ii) not less frequently that 

18 once every 5 years; and 

19 ‘‘(II) include the updated report 

20 in the appropriate annual report 

21 under subparagraph (B) for submis22 sion to Congress under section 801. 

23 ‘‘(B) ANNUAL REPORTS.—The Secretary 

24 shall submit to the President, for inclusion in 

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1 gress under section 801, a report which sets 

2 forth the following: 

3 ‘‘(i) A description of the health care 

4 facility priority system of the Service es5 tablished under paragraph (1). 

6 ‘‘(ii) Health care facilities lists, which 

7 may include— 

8 ‘‘(I) the 10 top-priority inpatient 

9 health care facilities; 

10 ‘‘(II) the 10 top-priority out11 patient health care facilities; 

12 ‘‘(III) the 10 top-priority special13 ized health care facilities (such as 

14 long-term care and alcohol and drug 

15 abuse treatment); 

16 ‘‘(IV) the 10 top-priority staff 

17 quarters developments associated with 

18 health care facilities; and 

19 ‘‘(V) the 10 top-priority hostels 

20 associated with health care facilities. 

21 ‘‘(iii) The justification for such order 

22 of priority. 

23 ‘‘(iv) The projected cost of such 

24 projects. 


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1 ‘‘(v) The methodology adopted by the 

2 Service in establishing priorities under its 

3 health care facility priority system. 

4 ‘‘(3) REQUIREMENTS FOR PREPARATION OF RE5 PORTS.—In preparing the report required under 

6 paragraph (2), the Secretary shall— 

7 ‘‘(A) consult with and obtain information 

8 on all health care facilities needs from Indian 

9 Tribes, Tribal Organizations, and urban Indian 

10 organizations; and 

11 ‘‘(B) review the total unmet needs of all 

12 Indian Tribes, Tribal Organizations, and urban 

13 Indian organizations for health care facilities 

14 (including hostels and staff quarters), including 

15 needs for renovation and expansion of existing 

16 facilities. 

17 ‘‘(d) REVIEW OF METHODOLOGY USED FOR HEALTH

18 FACILITIES CONSTRUCTION PRIORITY SYSTEM.— 

19 ‘‘(1) IN GENERAL.—Not later than 1 year after 

20 the establishment of the priority system under sub21 section (c)(1)(A), the Comptroller General of the 

22 United States shall prepare and finalize a report re23 viewing the methodologies applied, and the processes 

24 followed, by the Service in making each assessment 

25 of needs for the list under subsection (c)(2)(A)(ii) 


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1 and developing the priority system under subsection 

2 (c)(1), including a review of— 

3 ‘‘(A) the recommendations of the Facilities 

4 Appropriation Advisory Board and the Facili5 ties Needs Assessment Workgroup (as those 

6 terms are defined in subsection (c)(2)(A)(i)); 

7 and 

8 ‘‘(B) the relevant criteria used in ranking 

9 or prioritizing facilities other than hospitals or 

10 clinics. 

11 ‘‘(2) SUBMISSION TO CONGRESS.—The Comp12 troller General of the United States shall submit the 

13 report under paragraph (1) to— 

14 ‘‘(A) the Committees on Indian Affairs and 

15 Appropriations of the Senate; 

16 ‘‘(B) the Committees on Natural Re17 sources and Appropriations of the House of 

18 Representatives; and 

19 ‘‘(C) the Secretary. 

20 ‘‘(e) FUNDING CONDITION.—All funds appropriated 

21 under the Act of November 2, 1921 (25 U.S.C. 13) (com22 monly known as the ‘Snyder Act’), for the planning, de23 sign, construction, or renovation of health facilities for the 

24 benefit of 1 or more Indian Tribes shall be subject to the 


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1 provisions of the Indian Self-Determination and Edu2 cation Assistance Act (25 U.S.C. 450 et seq.). 

3 ‘‘(f) DEVELOPMENT OF INNOVATIVE APPROACHES.— 

4 The Secretary shall consult and cooperate with Indian 

5 Tribes, Tribal Organizations, and urban Indian organiza6 tions in developing innovative approaches to address all 

7 or part of the total unmet need for construction of health 

8 facilities, including those provided for in other sections of 

9 this title and other approaches. 

10 ‘‘SEC. 302. SANITATION FACILITIES. 

11 ‘‘(a) FINDINGS.—Congress finds the following: 

12 ‘‘(1) The provision of sanitation facilities is pri13 marily a health consideration and function. 

14 ‘‘(2) Indian people suffer an inordinately high 

15 incidence of disease, injury, and illness directly at16 tributable to the absence or inadequacy of sanitation 

17 facilities. 

18 ‘‘(3) The long-term cost to the United States of 

19 treating and curing such disease, injury, and illness 

20 is substantially greater than the short-term cost of 

21 providing sanitation facilities and other preventive 

22 health measures. 

23 ‘‘(4) Many Indian homes and Indian commu24 nities still lack sanitation facilities. 


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1 ‘‘(5) It is in the interest of the United States, 

2 and it is the policy of the United States, that all In3 dian communities and Indian homes, new and exist4 ing, be provided with sanitation facilities. 

5 ‘‘(b) FACILITIES AND SERVICES.—In furtherance of 

6 the findings made in subsection (a), Congress reaffirms 

7 the primary responsibility and authority of the Service to 

8 provide the necessary sanitation facilities and services as 

9 provided in section 7 of the Act of August 5, 1954 (42 

10 U.S.C. 2004a). Under such authority, the Secretary, act11 ing through the Service, is authorized to provide the fol12 lowing: 

13 ‘‘(1) Financial and technical assistance to In14 dian Tribes, Tribal Organizations, and Indian com15 munities in the establishment, training, and equip16 ping of utility organizations to operate and maintain 

17 sanitation facilities, including the provision of exist18 ing plans, standard details, and specifications avail19 able in the Department, to be used at the option of 

20 the Indian Tribe, Tribal Organization, or Indian 

21 community. 

22 ‘‘(2) Ongoing technical assistance and training 

23 to Indian Tribes, Tribal Organizations, and Indian 

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1 tions which operate and maintain sanitation facili2 ties. 

3 ‘‘(3) Priority funding for operation and mainte4 nance assistance for, and emergency repairs to, sani5 tation facilities operated by an Indian Tribe, Tribal 

6 Organization or Indian community when necessary 

7 to avoid an imminent health threat or to protect the 

8 investment in sanitation facilities and the investment 

9 in the health benefits gained through the provision 

10 of sanitation facilities. 

11 ‘‘(c) FUNDING.—Notwithstanding any other provi12 sion of law— 

13 ‘‘(1) the Secretary of Housing and Urban De14 velopment is authorized to transfer funds appro15 priated under the Native American Housing Assist16 ance and Self-Determination Act of 1996 (25 U.S.C. 

17 4101 et seq.) to the Secretary of Health and Human 

18 Services; 

19 ‘‘(2) the Secretary of Health and Human Serv20 ices is authorized to accept and use such funds for 

21 the purpose of providing sanitation facilities and 

22 services for Indians under section 7 of the Act of 

23 August 5, 1954 (42 U.S.C. 2004a); 

24 ‘‘(3) unless specifically authorized when funds 

25 are appropriated, the Secretary shall not use funds 


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1 appropriated under section 7 of the Act of August 

2 5, 1954 (42 U.S.C. 2004a), to provide sanitation fa3 cilities to new homes constructed using funds pro4 vided by the Department of Housing and Urban De5 velopment; 

6 ‘‘(4) the Secretary of Health and Human Serv7 ices is authorized to accept from any source, includ8 ing Federal and State agencies, funds for the pur9 pose of providing sanitation facilities and services 

10 and place these funds into contracts or compacts 

11 under the Indian Self-Determination and Education 

12 Assistance Act (25 U.S.C. 450 et seq.); 

13 ‘‘(5) except as otherwise prohibited by this sec14 tion, the Secretary may use funds appropriated 

15 under the authority of section 7 of the Act of Au16 gust 5, 1954 (42 U.S.C. 2004a), to fund up to 100 

17 percent of the amount of an Indian Tribe’s loan ob18 tained under any Federal program for new projects 

19 to construct eligible sanitation facilities to serve In20 dian homes; 

21 ‘‘(6) except as otherwise prohibited by this sec22 tion, the Secretary may use funds appropriated 

23 under the authority of section 7 of the Act of Au24 gust 5, 1954 (42 U.S.C. 2004a), to meet matching 

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1 eral and non-Federal programs for new projects to 

2 construct eligible sanitation facilities; 

3 ‘‘(7) all Federal agencies are authorized to 

4 transfer to the Secretary funds identified, granted, 

5 loaned, or appropriated whereby the Department’s 

6 applicable policies, rules, and regulations shall apply 

7 in the implementation of such projects; 

8 ‘‘(8) the Secretary of Health and Human Serv9 ices shall enter into interagency agreements with 

10 Federal and State agencies for the purpose of pro11 viding financial assistance for sanitation facilities 

12 and services under this Act; 

13 ‘‘(9) the Secretary of Health and Human Serv14 ices shall, by regulation, establish standards applica15 ble to the planning, design, and construction of sani16 tation facilities funded under this Act; and 

17 ‘‘(10) the Secretary of Health and Human 

18 Services is authorized to accept payments for goods 

19 and services furnished by the Service from appro20 priate public authorities, nonprofit organizations or 

21 agencies, or Indian Tribes, as contributions by that 

22 authority, organization, agency, or tribe to agree23 ments made under section 7 of the Act of August 5, 

24 1954 (42 U.S.C. 2004a), and such payments shall 

25 be credited to the same or subsequent appropriation 


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1 account as funds appropriated under the authority 

2 of section 7 of the Act of August 5, 1954 (42 U.S.C. 

3 2004a). 

4 ‘‘(d) CERTAIN CAPABILITIES NOT PREREQUISITE.— 

5 The financial and technical capability of an Indian Tribe, 

6 Tribal Organization, or Indian community to safely oper7 ate, manage, and maintain a sanitation facility shall not 

8 be a prerequisite to the provision or construction of sanita9 tion facilities by the Secretary. 

10 ‘‘(e) FINANCIAL ASSISTANCE.—The Secretary is au11 thorized to provide financial assistance to Indian Tribes, 

12 Tribal Organizations, and Indian communities in an 

13 amount equal to the Federal share of the costs of oper14 ating, managing, and maintaining the facilities provided 

15 under the plan described in subsection (h)(1)(F). 

16 ‘‘(f) OPERATION, MANAGEMENT, AND MAINTENANCE

17 OF FACILITIES.—The Indian Tribe has the primary re18 sponsibility to establish, collect, and use reasonable user 

19 fees, or otherwise set aside funding, for the purpose of 

20 operating, managing, and maintaining sanitation facilities. 

21 If a sanitation facility serving a community that is oper22 ated by an Indian Tribe or Tribal Organization is threat23 ened with imminent failure and such operator lacks capac24 ity to maintain the integrity or the health benefits of the 

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1 sist the Indian Tribe, Tribal Organization, or Indian com2 munity in the resolution of the problem on a short-term 

3 basis through cooperation with the emergency coordinator 

4 or by providing operation, management, and maintenance 

5 service. 

6 ‘‘(g) ISDEAA PROGRAM FUNDED ON EQUAL

7 BASIS.—Tribal Health Programs shall be eligible (on an 

8 equal basis with programs that are administered directly 

9 by the Service) for— 

10 ‘‘(1) any funds appropriated pursuant to this 

11 section; and 

12 ‘‘(2) any funds appropriated for the purpose of 

13 providing sanitation facilities. 

14 ‘‘(h) REPORT.— 

15 ‘‘(1) REQUIRED; CONTENTS.—The Secretary, in 

16 consultation with the Secretary of Housing and 

17 Urban Development, Indian Tribes, Tribal Organiza18 tions, and tribally designated housing entities (as de19 fined in section 4 of the Native American Housing 

20 Assistance and Self-Determination Act of 1996 (25 

21 U.S.C. 4103)) shall submit to the President, for in22 clusion in the report required to be transmitted to 

23 Congress under section 801, a report which sets 

24 forth— 


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1 ‘‘(A) the current Indian sanitation facility 

2 priority system of the Service; 

3 ‘‘(B) the methodology for determining 

4 sanitation deficiencies and needs; 

5 ‘‘(C) the criteria on which the deficiencies 

6 and needs will be evaluated; 

7 ‘‘(D) the level of initial and final sanitation 

8 deficiency for each type of sanitation facility for 

9 each project of each Indian Tribe or Indian 

10 community; 

11 ‘‘(E) the amount and most effective use of 

12 funds, derived from whatever source, necessary 

13 to accommodate the sanitation facilities needs 

14 of new homes assisted with funds under the 

15 Native American Housing Assistance and Self16 Determination Act (25 U.S.C. 4101 et seq.), 

17 and to reduce the identified sanitation defi18 ciency levels of all Indian Tribes and Indian 

19 communities to level I sanitation deficiency as 

20 defined in paragraph (3)(A); and 

21 ‘‘(F) a 10-year plan to provide sanitation 

22 facilities to serve existing Indian homes and In23 dian communities and new and renovated In24 dian homes. 


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1 ‘‘(2) UNIFORM METHODOLOGY.—The method2 ology used by the Secretary in determining, pre3 paring cost estimates for, and reporting sanitation 

4 deficiencies for purposes of paragraph (1) shall be 

5 applied uniformly to all Indian Tribes and Indian 

6 communities. 

7 ‘‘(3) SANITATION DEFICIENCY LEVELS.—For 

8 purposes of this subsection, the sanitation deficiency 

9 levels for an individual, Indian Tribe, or Indian com10 munity sanitation facility to serve Indian homes are 

11 determined as follows: 

12 ‘‘(A) A level I deficiency exists if a sanita13 tion facility serving an individual, Indian Tribe, 

14 or Indian community— 

15 ‘‘(i) complies with all applicable water 

16 supply, pollution control, and solid waste 

17 disposal laws; and 

18 ‘‘(ii) deficiencies relate to routine re19 placement, repair, or maintenance needs. 

20 ‘‘(B) A level II deficiency exists if a sanita21 tion facility serving an individual, Indian Tribe, 

22 or Indian community substantially or recently 

23 complied with all applicable water supply, pollu24 tion control, and solid waste laws and any defi25 ciencies relate to— 


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1 ‘‘(i) small or minor capital improve2 ments needed to bring the facility back 

3 into compliance; 

4 ‘‘(ii) capital improvements that are 

5 necessary to enlarge or improve the facili6 ties in order to meet the current needs for 

7 domestic sanitation facilities; or 

8 ‘‘(iii) the lack of equipment or train9 ing by an Indian Tribe, Tribal Organiza10 tion, or an Indian community to properly 

11 operate and maintain the sanitation facili12 ties. 

13 ‘‘(C) A level III deficiency exists if a sani14 tation facility serving an individual, Indian 

15 Tribe or Indian community meets 1 or more of 

16 the following conditions— 

17 ‘‘(i) water or sewer service in the 

18 home is provided by a haul system with 

19 holding tanks and interior plumbing; 

20 ‘‘(ii) major significant interruptions to 

21 water supply or sewage disposal occur fre22 quently, requiring major capital improve23 ments to correct the deficiencies; or 


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1 ‘‘(iii) there is no access to or no ap2 proved or permitted solid waste facility 

3 available. 

4 ‘‘(D) A level IV deficiency exists— 

5 ‘‘(i) if a sanitation facility for an indi6 vidual home, an Indian Tribe, or an Indian 

7 community exists but— 

8 ‘‘(I) lacks— 

9 ‘‘(aa) a safe water supply 

10 system; or 

11 ‘‘(bb) a waste disposal sys12 tem; 

13 ‘‘(II) contains no piped water or 

14 sewer facilities; or 

15 ‘‘(III) has become inoperable due 

16 to a major component failure; or 

17 ‘‘(ii) if only a washeteria or central fa18 cility exists in the community. 

19 ‘‘(E) A level V deficiency exists in the ab20 sence of a sanitation facility, where individual 

21 homes do not have access to safe drinking 

22 water or adequate wastewater (including sew23 age) disposal. 

24 ‘‘(i) DEFINITIONS.—For purposes of this section, the 

25 following terms apply: 


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1 ‘‘(1) INDIAN COMMUNITY.—The term ‘Indian 

2 community’ means a geographic area, a significant 

3 proportion of whose inhabitants are Indians and 

4 which is served by or capable of being served by a 

5 facility described in this section. 

6 ‘‘(2) SANITATION FACILITIES.—The terms 

7 ‘sanitation facility’ and ‘sanitation facilities’ mean 

8 safe and adequate water supply systems, sanitary 

9 sewage disposal systems, and sanitary solid waste 

10 systems (and all related equipment and support in11 frastructure). 

12 ‘‘SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS. 

13 ‘‘(a) BUY INDIAN ACT.—The Secretary, acting 

14 through the Service, may use the negotiating authority of 

15 section 23 of the Act of June 25, 1910 (25 U.S.C. 47, 

16 commonly known as the ‘Buy Indian Act’), to give pref17 erence to any Indian or any enterprise, partnership, cor18 poration, or other type of business organization owned and 

19 controlled by an Indian or Indians including former or 

20 currently federally recognized Indian Tribes in the State 

21 of New York (hereinafter referred to as an ‘Indian firm’) 

22 in the construction and renovation of Service facilities pur23 suant to section 301 and in the construction of sanitation 

24 facilities pursuant to section 302. Such preference may be 

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1 suant to regulations, that the project or function to be 

2 contracted for will not be satisfactory or such project or 

3 function cannot be properly completed or maintained 

4 under the proposed contract. The Secretary, in arriving 

5 at such a finding, shall consider whether the Indian or 

6 Indian firm will be deficient with respect to— 

7 ‘‘(1) ownership and control by Indians; 

8 ‘‘(2) equipment; 

9 ‘‘(3) bookkeeping and accounting procedures; 

10 ‘‘(4) substantive knowledge of the project or 

11 function to be contracted for; 

12 ‘‘(5) adequately trained personnel; or 

13 ‘‘(6) other necessary components of contract 

14 performance. 

15 ‘‘(b) PAY RATES.—For the purposes of implementing 

16 the provisions of this title, the Secretary shall assure that 

17 the rates of pay for personnel engaged in the construction 

18 or renovation of facilities constructed or renovated in 

19 whole or in part by funds made available pursuant to this 

20 title are not less than the prevailing local wage rates for 

21 similar work as determined in accordance with the Act of 

22 March 3, 1931 (40 U.S.C. 276a–276a-5, known as the 

23 Davis-Bacon Act). 

24 ‘‘(c) LABOR STANDARDS.—For the purposes of im25 plementing the provisions of this title, contracts for the 


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1 construction or renovation of health care facilities, staff 

2 quarters, and sanitation facilities, and related support in3 frastructure, funded in whole or in part with funds made 

4 available pursuant to this title, shall contain a provision 

5 requiring compliance with subchapter IV of chapter 31 of 

6 title 40, United States Code (commonly known as the 

7 ‘Davis-Bacon Act’). 

8 ‘‘SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR 

9 RENOVATION. 

10 ‘‘(a) IN GENERAL.—Notwithstanding any other pro11 vision of law, if the requirements of subsection (c) are met, 

12 the Secretary, acting through the Service, is authorized 

13 to accept any major expansion, renovation, or moderniza14 tion by any Indian Tribe or Tribal Organization of any 

15 Service facility or of any other Indian health facility oper16 ated pursuant to a contract or compact under the Indian 

17 Self-Determination and Education Assistance Act (25 

18 U.S.C. 450 et seq.), including— 

19 ‘‘(1) any plans or designs for such expansion, 

20 renovation, or modernization; and 

21 ‘‘(2) any expansion, renovation, or moderniza22 tion for which funds appropriated under any Federal 

23 law were lawfully expended. 

24 ‘‘(b) PRIORITY LIST.— 


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1 ‘‘(1) IN GENERAL.—The Secretary shall main2 tain a separate priority list to address the needs for 

3 increased operating expenses, personnel, or equip4 ment for such facilities. The methodology for estab5 lishing priorities shall be developed through regula6 tions. The list of priority facilities will be revised an7 nually in consultation with Indian Tribes and Tribal 

8 Organizations. 

9 ‘‘(2) REPORT.—The Secretary shall submit to 

10 the President, for inclusion in the report required to 

11 be transmitted to Congress under section 801, the 

12 priority list maintained pursuant to paragraph (1). 

13 ‘‘(c) REQUIREMENTS.—The requirements of this sub14 section are met with respect to any expansion, renovation, 

15 or modernization if— 

16 ‘‘(1) the Indian Tribe or Tribal Organization— 

17 ‘‘(A) provides notice to the Secretary of its 

18 intent to expand, renovate, or modernize; and 

19 ‘‘(B) applies to the Secretary to be placed 

20 on a separate priority list to address the needs 

21 of such new facilities for increased operating ex22 penses, personnel, or equipment; and 

23 ‘‘(2) the expansion, renovation, or moderniza24 tion— 


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1 ‘‘(A) is approved by the appropriate area 

2 director of the Service for Federal facilities; and 

3 ‘‘(B) is administered by the Indian Tribe 

4 or Tribal Organization in accordance with any 

5 applicable regulations prescribed by the Sec6 retary with respect to construction or renova7 tion of Service facilities. 

8 ‘‘(d) ADDITIONAL REQUIREMENT FOR EXPANSION.— 

9 In addition to the requirements under subsection (c), for 

10 any expansion, the Indian Tribe or Tribal Organization 

11 shall provide to the Secretary additional information pur12 suant to regulations, including additional staffing, equip13 ment, and other costs associated with the expansion. 

14 ‘‘(e) CLOSURE OR CONVERSION OF FACILITIES.—If 

15 any Service facility which has been expanded, renovated, 

16 or modernized by an Indian Tribe or Tribal Organization 

17 under this section ceases to be used as a Service facility 

18 during the 20-year period beginning on the date such ex19 pansion, renovation, or modernization is completed, such 

20 Indian Tribe or Tribal Organization shall be entitled to 

21 recover from the United States an amount which bears 

22 the same ratio to the value of such facility at the time 

23 of such cessation as the value of such expansion, renova24 tion, or modernization (less the total amount of any funds 

25 provided specifically for such facility under any Federal 


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1 program that were expended for such expansion, renova2 tion, or modernization) bore to the value of such facility 

3 at the time of the completion of such expansion, renova4 tion, or modernization. 

5 ‘‘SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, 

6 AND MODERNIZATION OF SMALL AMBULA7 TORY CARE FACILITIES. 

8 ‘‘(a) GRANTS.— 

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

10 through the Service, shall make grants to Indian 

11 Tribes and Tribal Organizations for the construc12 tion, expansion, or modernization of facilities for the 

13 provision of ambulatory care services to eligible Indi14 ans (and noneligible persons pursuant to subsections 

15 (b)(2) and (c)(1)(C)). A grant made under this sec16 tion may cover up to 100 percent of the costs of 

17 such construction, expansion, or modernization. For 

18 the purposes of this section, the term ‘construction’ 

19 includes the replacement of an existing facility. 

20 ‘‘(2) GRANT AGREEMENT REQUIRED.—A grant 

21 under paragraph (1) may only be made available to 

22 a Tribal Health Program operating an Indian health 

23 facility (other than a facility owned or constructed 

24 by the Service, including a facility originally owned 


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1 or constructed by the Service and transferred to an 

2 Indian Tribe or Tribal Organization). 

3 ‘‘(b) USE OF GRANT FUNDS.— 

4 ‘‘(1) ALLOWABLE USES.—A grant awarded 

5 under this section may be used for the construction, 

6 expansion, or modernization (including the planning 

7 and design of such construction, expansion, or mod8 ernization) of an ambulatory care facility— 

9 ‘‘(A) located apart from a hospital; 

10 ‘‘(B) not funded under section 301 or sec11 tion 306; and 

12 ‘‘(C) which, upon completion of such con13 struction or modernization will— 

14 ‘‘(i) have a total capacity appropriate 

15 to its projected service population; 

16 ‘‘(ii) provide annually no fewer than 

17 150 patient visits by eligible Indians and 

18 other users who are eligible for services in 

19 such facility in accordance with section 

20 807(c)(2); and 

21 ‘‘(iii) provide ambulatory care in a 

22 Service Area (specified in the contract or 

23 compact under the Indian Self-Determina24 tion and Education Assistance Act (25 

25 U.S.C. 450 et seq.)) with a population of 


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1 no fewer than 1,500 eligible Indians and 

2 other users who are eligible for services in 

3 such facility in accordance with section 

4 807(c)(2). 

5 ‘‘(2) ADDITIONAL ALLOWABLE USE.—The Sec6 retary may also reserve a portion of the funding pro7 vided under this section and use those reserved 

8 funds to reduce an outstanding debt incurred by In9 dian Tribes or Tribal Organizations for the con10 struction, expansion, or modernization of an ambula11 tory care facility that meets the requirements under 

12 paragraph (1). The provisions of this section shall 

13 apply, except that such applications for funding 

14 under this paragraph shall be considered separately 

15 from applications for funding under paragraph (1). 

16 ‘‘(3) USE ONLY FOR CERTAIN PORTION OF

17 COSTS.—A grant provided under this section may be 

18 used only for the cost of that portion of a construc19 tion, expansion, or modernization project that bene20 fits the Service population identified above in sub21 section (b)(1)(C) (ii) and (iii). The requirements of 

22 clauses (ii) and (iii) of paragraph (1)(C) shall not 

23 apply to an Indian Tribe or Tribal Organization ap24 plying for a grant under this section for a health 

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1 land or when such facility is not located on a road 

2 system providing direct access to an inpatient hos3 pital where care is available to the Service popu4 lation. 

5 ‘‘(c) GRANTS.— 

6 ‘‘(1) APPLICATION.—No grant may be made 

7 under this section unless an application or proposal 

8 for the grant has been approved by the Secretary in 

9 accordance with applicable regulations and has set 

10 forth reasonable assurance by the applicant that, at 

11 all times after the construction, expansion, or mod12 ernization of a facility carried out using a grant re13 ceived under this section— 

14 ‘‘(A) adequate financial support will be 

15 available for the provision of services at such 

16 facility; 

17 ‘‘(B) such facility will be available to eligi18 ble Indians without regard to ability to pay or 

19 source of payment; and 

20 ‘‘(C) such facility will, as feasible without 

21 diminishing the quality or quantity of services 

22 provided to eligible Indians, serve noneligible 

23 persons on a cost basis. 


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1 ‘‘(2) PRIORITY.—In awarding grants under this 

2 section, the Secretary shall give priority to Indian 

3 Tribes and Tribal Organizations that demonstrate— 

4 ‘‘(A) a need for increased ambulatory care 

5 services; and 

6 ‘‘(B) insufficient capacity to deliver such 

7 services. 

8 ‘‘(3) PEER REVIEW PANELS.—The Secretary 

9 may provide for the establishment of peer review 

10 panels, as necessary, to review and evaluate applica11 tions and proposals and to advise the Secretary re12 garding such applications using the criteria devel13 oped pursuant to subsection (a)(1). 

14 ‘‘(d) REVERSION OF FACILITIES.—If any facility (or 

15 portion thereof) with respect to which funds have been 

16 paid under this section, ceases, at any time after comple17 tion of the construction, expansion, or modernization car18 ried out with such funds, to be used for the purposes of 

19 providing health care services to eligible Indians, all of the 

20 right, title, and interest in and to such facility (or portion 

21 thereof) shall transfer to the United States unless other22 wise negotiated by the Service and the Indian Tribe or 

23 Tribal Organization. 

24 ‘‘(e) FUNDING NONRECURRING.—Funding provided 

25 under this section shall be nonrecurring and shall not be 


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1 available for inclusion in any individual Indian Tribe’s 

2 tribal share for an award under the Indian Self-Deter3 mination and Education Assistance Act (25 U.S.C. 450 

4 et seq.) or for reallocation or redesign thereunder. 

5 ‘‘SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRA6 TION PROJECT. 

7 ‘‘(a) HEALTH CARE DEMONSTRATION PROJECTS.— 

8 The Secretary, acting through the Service, is authorized 

9 to make grants to, and enter into construction contracts 

10 or construction project agreements with, Indian Tribes or 

11 Tribal Organizations under the Indian Self-Determination 

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

13 the purpose of carrying out a health care delivery dem14 onstration project to test alternative means of delivering 

15 health care and services to Indians through facilities. 

16 ‘‘(b) USE OF FUNDS.—The Secretary, in approving 

17 projects pursuant to this section, may authorize such con18 tracts for the construction and renovation of hospitals, 

19 health centers, health stations, and other facilities to de20 liver health care services and is authorized to— 

21 ‘‘(1) waive any leasing prohibition; 

22 ‘‘(2) permit carryover of funds appropriated for 

23 the provision of health care services; 

24 ‘‘(3) permit the use of other available funds; 


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1 ‘‘(4) permit the use of funds or property do2 nated from any source for project purposes; 

3 ‘‘(5) provide for the reversion of donated real or 

4 personal property to the donor; and 

5 ‘‘(6) permit the use of Service funds to match 

6 other funds, including Federal funds. 

7 ‘‘(c) REGULATIONS.—The Secretary shall develop 

8 and promulgate regulations, not later than 1 year after 

9 the date of enactment of the Indian Health Care Improve10 ment Act Amendments of 2009, for the review and ap11 proval of applications submitted under this section. 

12 ‘‘(d) CRITERIA.—The Secretary may approve projects 

13 that meet the following criteria: 

14 ‘‘(1) There is a need for a new facility or pro15 gram or the reorientation of an existing facility or 

16 program. 

17 ‘‘(2) A significant number of Indians, including 

18 those with low health status, will be served by the 

19 project. 

20 ‘‘(3) The project has the potential to deliver 

21 services in an efficient and effective manner. 

22 ‘‘(4) The project is economically viable. 

23 ‘‘(5) The Indian Tribe or Tribal Organization 

24 has the administrative and financial capability to ad25 minister the project. 


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1 ‘‘(6) The project is integrated with providers of 

2 related health and social services and is coordinated 

3 with, and avoids duplication of, existing services. 

4 ‘‘(e) PEER REVIEW PANELS.—The Secretary may 

5 provide for the establishment of peer review panels, as nec6 essary, to review and evaluate applications using the cri7 teria developed pursuant to subsection (d). 

8 ‘‘(f) PRIORITY.—The Secretary shall give priority to 

9 applications for demonstration projects in each of the fol10 lowing Service Units to the extent that such applications 

11 are timely filed and meet the criteria specified in sub12 section (d): 

13 ‘‘(1) Cass Lake, Minnesota. 

14 ‘‘(2) Mescalero, New Mexico. 

15 ‘‘(3) Owyhee, Nevada. 

16 ‘‘(4) Schurz, Nevada. 

17 ‘‘(5) Ft. Yuma, California. 

18 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 

19 provide such technical and other assistance as may be nec20 essary to enable applicants to comply with the provisions 

21 of this section. 

22 ‘‘(h) SERVICE TO INELIGIBLE PERSONS.—Subject to 

23 section 806, the authority to provide services to persons 

24 otherwise ineligible for the health care benefits of the 

25 Service and the authority to extend hospital privileges in 


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1 Service facilities to non-Service health practitioners as 

2 provided in section 806 may be included, subject to the 

3 terms of such section, in any demonstration project ap4 proved pursuant to this section. 

5 ‘‘(i) EQUITABLE TREATMENT.—For purposes of sub6 section (d)(1), the Secretary shall, in evaluating facilities 

7 operated under any contract or compact under the Indian 

8 Self-Determination and Education Assistance Act (25 

9 U.S.C. 450 et seq.), use the same criteria that the Sec10 retary uses in evaluating facilities operated directly by the 

11 Service. 

12 ‘‘(j) EQUITABLE INTEGRATION OF FACILITIES.—The 

13 Secretary shall ensure that the planning, design, construc14 tion, renovation, and expansion needs of Service and non15 Service facilities which are the subject of a contract or 

16 compact under the Indian Self-Determination and Edu17 cation Assistance Act (25 U.S.C. 450 et seq.) for health 

18 services are fully and equitably integrated into the imple19 mentation of the health care delivery demonstration 

20 projects under this section. 

21 ‘‘SEC. 307. LAND TRANSFER. 

22 ‘‘Notwithstanding any other provision of law, the Bu23 reau of Indian Affairs and all other agencies and depart24 ments of the United States are authorized to transfer, at 

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1 vision of health care services. The Secretary is authorized 

2 to accept such land and improvements for such purposes. 

3 ‘‘SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS. 

4 ‘‘The Secretary, acting through the Service, may 

5 enter into leases, contracts, and other agreements with In6 dian Tribes and Tribal Organizations which hold (1) title 

7 to, (2) a leasehold interest in, or (3) a beneficial interest 

8 in (when title is held by the United States in trust for 

9 the benefit of an Indian Tribe) facilities used or to be used 

10 for the administration and delivery of health services by 

11 an Indian Health Program. Such leases, contracts, or 

12 agreements may include provisions for construction or ren13 ovation and provide for compensation to the Indian Tribe 

14 or Tribal Organization of rental and other costs consistent 

15 with section 105(l) of the Indian Self-Determination and 

16 Education Assistance Act (25 U.S.C. 450j(l)) and regula17 tions thereunder. 

18 ‘‘SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND 

19 LOAN REPAYMENT. 

20 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

21 with the Secretary of the Treasury, Indian Tribes, and 

22 Tribal Organizations, shall carry out a study to determine 

23 the feasibility of establishing a loan fund to provide to In24 dian Tribes and Tribal Organizations direct loans or guarVerDate Nov 24 2008 23:28 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00169 Fmt 6652 Sfmt 6201 E:\BILLS\H2708.IH H2708

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1 antees for loans for the construction of health care facili2 ties, including— 

3 ‘‘(1) inpatient facilities; 

4 ‘‘(2) outpatient facilities; 

5 ‘‘(3) staff quarters; 

6 ‘‘(4) hostels; and 

7 ‘‘(5) specialized care facilities, such as behav8 ioral health and elder care facilities. 

9 ‘‘(b) DETERMINATIONS.—In carrying out the study 

10 under subsection (a), the Secretary shall determine— 

11 ‘‘(1) the maximum principal amount of a loan 

12 or loan guarantee that should be offered to a recipi13 ent from the loan fund; 

14 ‘‘(2) the percentage of eligible costs, not to ex15 ceed 100 percent, that may be covered by a loan or 

16 loan guarantee from the loan fund (including costs 

17 relating to planning, design, financing, site land de18 velopment, construction, rehabilitation, renovation, 

19 conversion, improvements, medical equipment and 

20 furnishings, and other facility-related costs and cap21 ital purchase (but excluding staffing)); 

22 ‘‘(3) the cumulative total of the principal of di23 rect loans and loan guarantees, respectively, that 

24 may be outstanding at any 1 time; 


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1 ‘‘(4) the maximum term of a loan or loan guar2 antee that may be made for a facility from the loan 

3 fund; 

4 ‘‘(5) the maximum percentage of funds from 

5 the loan fund that should be allocated for payment 

6 of costs associated with planning and applying for a 

7 loan or loan guarantee; 

8 ‘‘(6) whether acceptance by the Secretary of an 

9 assignment of the revenue of an Indian Tribe or 

10 Tribal Organization as security for any direct loan 

11 or loan guarantee from the loan fund would be ap12 propriate; 

13 ‘‘(7) whether, in the planning and design of 

14 health facilities under this section, users eligible 

15 under section 806(c) may be included in any projec16 tion of patient population; 

17 ‘‘(8) whether funds of the Service provided 

18 through loans or loan guarantees from the loan fund 

19 should be eligible for use in matching other Federal 

20 funds under other programs; 

21 ‘‘(9) the appropriateness of, and best methods 

22 for, coordinating the loan fund with the health care 

23 priority system of the Service under section 301; and 


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1 ‘‘(10) any legislative or regulatory changes re2 quired to implement recommendations of the Sec3 retary based on results of the study. 

4 ‘‘(c) REPORT.—Not later than September 30, 2010, 

5 the Secretary shall submit to the Committee on Indian Af6 fairs of the Senate and the Committee on Natural Re7 sources and the Committee on Energy and Commerce of 

8 the House of Representatives a report that describes— 

9 ‘‘(1) the manner of consultation made as re10 quired by subsection (a); and 

11 ‘‘(2) the results of the study, including any rec12 ommendations of the Secretary based on results of 

13 the study. 

14 ‘‘SEC. 310. TRIBAL LEASING. 

15 ‘‘A Tribal Health Program may lease permanent 

16 structures for the purpose of providing health care services 

17 without obtaining advance approval in appropriation Acts. 

18 ‘‘SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES 

19 JOINT VENTURE PROGRAM. 

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

21 the Service, shall make arrangements with Indian Tribes 

22 and Tribal Organizations to establish joint venture dem23 onstration projects under which an Indian Tribe or Tribal 

24 Organization shall expend tribal, private, or other avail25 able funds, for the acquisition or construction of a health 


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1 facility for a minimum of 10 years, under a no-cost lease, 

2 in exchange for agreement by the Service to provide the 

3 equipment, supplies, and staffing for the operation and 

4 maintenance of such a health facility. An Indian Tribe or 

5 Tribal Organization may use tribal funds, private sector, 

6 or other available resources, including loan guarantees, to 

7 fulfill its commitment under a joint venture entered into 

8 under this subsection. An Indian Tribe or Tribal Organi9 zation shall be eligible to establish a joint venture project 

10 if, when it submits a letter of intent, it— 

11 ‘‘(1) has begun but not completed the process 

12 of acquisition or construction of a health facility to 

13 be used in the joint venture project; 

14 ‘‘(2) has not begun the process of acquisition or 

15 construction of a health facility for use in the joint 

16 venture project; or 

17 ‘‘(3) in its application for a joint venture agree18 ment, agrees— 

19 ‘‘(A) to construct a facility for the joint 

20 venture which complies with the size and space 

21 criteria established by the Service; or 

22 ‘‘(B) if the facility it proposes for the joint 

23 venture is already in existence or under con24 struction, that only the portion of such facility 

25 which complies with the size and space criteria 


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1 of the Service will be eligible for the joint ven2 ture agreement. 

3 ‘‘(b) REQUIREMENTS.—The Secretary shall make 

4 such an arrangement with an Indian Tribe or Tribal Orga5 nization only if— 

6 ‘‘(1) the Secretary first determines that the In7 dian Tribe or Tribal Organization has the adminis8 trative and financial capabilities necessary to com9 plete the timely acquisition or construction of the 

10 relevant health facility; and 

11 ‘‘(2) the Indian Tribe or Tribal Organization 

12 meets the need criteria determined using the criteria 

13 developed under the health care facility priority sys14 tem under section 301, unless the Secretary deter15 mines, pursuant to regulations, that other criteria 

16 will result in a more cost-effective and efficient 

17 method of facilitating and completing construction of 

18 health care facilities. 

19 ‘‘(c) CONTINUED OPERATION.—The Secretary shall 

20 negotiate an agreement with the Indian Tribe or Tribal 

21 Organization regarding the continued operation of the fa22 cility at the end of the initial 10 year no-cost lease period. 

23 ‘‘(d) BREACH OF AGREEMENT.—An Indian Tribe or 

24 Tribal Organization that has entered into a written agree25 ment with the Secretary under this section, and that 


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1 breaches or terminates without cause such agreement, 

2 shall be liable to the United States for the amount that 

3 has been paid to the Indian Tribe or Tribal Organization, 

4 or paid to a third party on the Indian Tribe’s or Tribal 

5 Organization’s behalf, under the agreement. The Sec6 retary has the right to recover tangible property (including 

7 supplies) and equipment, less depreciation, and any funds 

8 expended for operations and maintenance under this sec9 tion. The preceding sentence does not apply to any funds 

10 expended for the delivery of health care services, per11 sonnel, or staffing. 

12 ‘‘(e) RECOVERY FOR NONUSE.—An Indian Tribe or 

13 Tribal Organization that has entered into a written agree14 ment with the Secretary under this subsection shall be en15 titled to recover from the United States an amount that 

16 is proportional to the value of such facility if, at any time 

17 within the 10-year term of the agreement, the Service 

18 ceases to use the facility or otherwise breaches the agree19 ment. 

20 ‘‘(f) DEFINITION.—For the purposes of this section, 

21 the term ‘health facility’ or ‘health facilities’ includes 

22 quarters needed to provide housing for staff of the rel23 evant Tribal Health Program. 


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1 ‘‘SEC. 312. LOCATION OF FACILITIES. 

2 ‘‘(a) IN GENERAL.—In all matters involving the reor3 ganization or development of Service facilities or in the 

4 establishment of related employment projects to address 

5 unemployment conditions in economically depressed areas, 

6 the Bureau of Indian Affairs and the Service shall give 

7 priority to locating such facilities and projects on Indian 

8 lands, or lands in Alaska owned by any Alaska Native vil9 lage, or village or regional corporation under the Alaska 

10 Native Claims Settlement Act (43 U.S.C. 1601 et seq.), 

11 or any land allotted to any Alaska Native, if requested 

12 by the Indian owner and the Indian Tribe with jurisdiction 

13 over such lands or other lands owned or leased by the In14 dian Tribe or Tribal Organization. Top priority shall be 

15 given to Indian land owned by 1 or more Indian Tribes. 

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

17 term ‘Indian lands’ means— 

18 ‘‘(1) all lands within the exterior boundaries of 

19 any reservation; and 

20 ‘‘(2) any lands title to which is held in trust by 

21 the United States for the benefit of any Indian 

22 Tribe or individual Indian or held by any Indian 

23 Tribe or individual Indian subject to restriction by 

24 the United States against alienation. 


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1 ‘‘SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH 

2 CARE FACILITIES. 

3 ‘‘(a) REPORT.—The Secretary shall submit to the 

4 President, for inclusion in the report required to be trans5 mitted to Congress under section 801, a report which iden6 tifies the backlog of maintenance and repair work required 

7 at both Service and tribal health care facilities, including 

8 new health care facilities expected to be in operation in 

9 the next fiscal year. The report shall also identify the need 

10 for renovation and expansion of existing facilities to sup11 port the growth of health care programs. 

12 ‘‘(b) MAINTENANCE OF NEWLY CONSTRUCTED

13 SPACE.—The Secretary, acting through the Service, is au14 thorized to expend maintenance and improvement funds 

15 to support maintenance of newly constructed space only 

16 if such space falls within the approved supportable space 

17 allocation for the Indian Tribe or Tribal Organization. 

18 Supportable space allocation shall be defined through the 

19 health care facility priority system under section 301(c). 

20 ‘‘(c) REPLACEMENT FACILITIES.—In addition to 

21 using maintenance and improvement funds for renovation, 

22 modernization, and expansion of facilities, an Indian Tribe 

23 or Tribal Organization may use maintenance and improve24 ment funds for construction of a replacement facility if 

25 the costs of renovation of such facility would exceed a 

26 maximum renovation cost threshold. The Secretary shall 


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1 consult with Indian Tribes and Tribal Organizations in de2 termining the maximum renovation cost threshold. 

3 ‘‘SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY OWNED 

4 QUARTERS. 

5 ‘‘(a) RENTAL RATES.— 

6 ‘‘(1) ESTABLISHMENT.—Notwithstanding any 

7 other provision of law, a Tribal Health Program 

8 which operates a hospital or other health facility and 

9 the federally owned quarters associated therewith 

10 pursuant to a contract or compact under the Indian 

11 Self-Determination and Education Assistance Act 

12 (25 U.S.C. 450 et seq.) shall have the authority to 

13 establish the rental rates charged to the occupants 

14 of such quarters by providing notice to the Secretary 

15 of its election to exercise such authority. 

16 ‘‘(2) OBJECTIVES.—In establishing rental rates 

17 pursuant to authority of this subsection, a Tribal 

18 Health Program shall endeavor to achieve the fol19 lowing objectives: 

20 ‘‘(A) To base such rental rates on the rea21 sonable value of the quarters to the occupants 

22 thereof. 

23 ‘‘(B) To generate sufficient funds to pru24 dently provide for the operation and mainte25 nance of the quarters, and subject to the discreVerDate Nov 24 2008 23:28 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00178 Fmt 6652 Sfmt 6201 E:\BILLS\H2708.IH H2708

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1 tion of the Tribal Health Program, to supply 

2 reserve funds for capital repairs and replace3 ment of the quarters. 

4 ‘‘(3) EQUITABLE FUNDING.—Any quarters 

5 whose rental rates are established by a Tribal 

6 Health Program pursuant to this subsection shall 

7 remain eligible for quarters improvement and repair 

8 funds to the same extent as all federally owned 

9 quarters used to house personnel in Services-sup10 ported programs. 

11 ‘‘(4) NOTICE OF RATE CHANGE.—A Tribal 

12 Health Program which exercises the authority pro13 vided under this subsection shall provide occupants 

14 with no less than 60 days notice of any change in 

15 rental rates. 

16 ‘‘(b) DIRECT COLLECTION OF RENT.— 

17 ‘‘(1) IN GENERAL.—Notwithstanding any other 

18 provision of law, and subject to paragraph (2), a 

19 Tribal Health Program shall have the authority to 

20 collect rents directly from Federal employees who oc21 cupy such quarters in accordance with the following: 

22 ‘‘(A) The Tribal Health Program shall no23 tify the Secretary and the subject Federal em24 ployees of its election to exercise its authority 


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1 to collect rents directly from such Federal em2 ployees. 

3 ‘‘(B) Upon receipt of a notice described in 

4 subparagraph (A), the Federal employees shall 

5 pay rents for occupancy of such quarters di6 rectly to the Tribal Health Program and the 

7 Secretary shall have no further authority to col8 lect rents from such employees through payroll 

9 deduction or otherwise. 

10 ‘‘(C) Such rent payments shall be retained 

11 by the Tribal Health Program and shall not be 

12 made payable to or otherwise be deposited with 

13 the United States. 

14 ‘‘(D) Such rent payments shall be depos15 ited into a separate account which shall be used 

16 by the Tribal Health Program for the mainte17 nance (including capital repairs and replace18 ment) and operation of the quarters and facili19 ties as the Tribal Health Program shall deter20 mine. 

21 ‘‘(2) RETROCESSION OF AUTHORITY.—If a 

22 Tribal Health Program which has made an election 

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1 ees occupying federally owned quarters, such ret2 rocession shall become effective on the earlier of— 

3 ‘‘(A) the first day of the month that begins 

4 no less than 180 days after the Tribal Health 

5 Program notifies the Secretary of its desire to 

6 retrocede; or 

7 ‘‘(B) such other date as may be mutually 

8 agreed by the Secretary and the Tribal Health 

9 Program. 

10 ‘‘(c) RATES IN ALASKA.—To the extent that a Tribal 

11 Health Program, pursuant to authority granted in sub12 section (a), establishes rental rates for federally owned 

13 quarters provided to a Federal employee in Alaska, such 

14 rents may be based on the cost of comparable private rent15 al housing in the nearest established community with a 

16 year-round population of 1,500 or more individuals. 

17 ‘‘SEC. 315. APPLICABILITY OF BUY AMERICAN ACT RE18 QUIREMENT. 

19 ‘‘(a) APPLICABILITY.—The Secretary shall ensure 

20 that the requirements of the Buy American Act apply to 

21 all procurements made with funds provided pursuant to 

22 section 317. Indian Tribes and Tribal Organizations shall 

23 be exempt from these requirements. 

24 ‘‘(b) EFFECT OF VIOLATION.—If it has been finally 

25 determined by a court or Federal agency that any person 


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1 intentionally affixed a label bearing a ‘Made in America’ 

2 inscription or any inscription with the same meaning, to 

3 any product sold in or shipped to the United States that 

4 is not made in the United States, such person shall be 

5 ineligible to receive any contract or subcontract made with 

6 funds provided pursuant to section 317, pursuant to the 

7 debarment, suspension, and ineligibility procedures de8 scribed in sections 9.400 through 9.409 of title 48, Code 

9 of Federal Regulations. 

10 ‘‘(c) DEFINITIONS.—For purposes of this section, the 

11 term ‘Buy American Act’ means title III of the Act enti12 tled ‘An Act making appropriations for the Treasury and 

13 Post Office Departments for the fiscal year ending June 

14 30, 1934, and for other purposes’, approved March 3, 

15 1933 (41 U.S.C. 10a et seq.). 

16 ‘‘SEC. 316. OTHER FUNDING FOR FACILITIES. 

17 ‘‘(a) AUTHORITY TO ACCEPT FUNDS.—The Sec18 retary is authorized to accept from any source, including 

19 Federal and State agencies, funds that are available for 

20 the construction of health care facilities and use such 

21 funds to plan, design, and construct health care facilities 

22 for Indians and to place such funds into a contract or com23 pact under the Indian Self-Determination and Education 

24 Assistance Act (25 U.S.C. 450 et seq.). Receipt of such 


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1 funds shall have no effect on the priorities established pur2 suant to section 301. 

3 ‘‘(b) INTERAGENCY AGREEMENTS.—The Secretary is 

4 authorized to enter into interagency agreements with 

5 other Federal agencies or State agencies and other entities 

6 and to accept funds from such Federal or State agencies 

7 or other sources to provide for the planning, design, and 

8 construction of health care facilities to be administered by 

9 Indian Health Programs in order to carry out the pur10 poses of this Act and the purposes for which the funds 

11 were appropriated or for which the funds were otherwise 

12 provided. 

13 ‘‘(c) TRANSFERRED FUNDS.—Any Federal agency to 

14 which funds for the construction of health care facilities 

15 are appropriated is authorized to transfer such funds to 

16 the Secretary for the construction of health care facilities 

17 to carry out the purposes of this Act as well as the pur18 poses for which such funds are appropriated to such other 

19 Federal agency. 

20 ‘‘(d) ESTABLISHMENT OF STANDARDS.—The Sec21 retary, through the Service, shall establish standards by 

22 regulation for the planning, design, and construction of 

23 health care facilities serving Indians under this Act. 


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1 ‘‘SEC. 317. AUTHORIZATION OF APPROPRIATIONS. 

2 ‘‘There are authorized to be appropriated such sums 

3 as may be necessary for each fiscal year through fiscal 

4 year 2025 to carry out this title. 

5 ‘‘TITLE IV—ACCESS TO HEALTH 

6 SERVICES 

7 ‘‘SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SE8 CURITY ACT HEALTH BENEFITS PROGRAMS. 

9 ‘‘(a) DISREGARD OF MEDICARE, MEDICAID, AND

10 SCHIP PAYMENTS IN DETERMINING APPROPRIATIONS.— 

11 Any payments received by an Indian Health Program or 

12 by an urban Indian organization under title XVIII, XIX, 

13 or XXI of the Social Security Act for services provided 

14 to Indians eligible for benefits under such respective titles 

15 shall not be considered in determining appropriations for 

16 the provision of health care and services to Indians. 

17 ‘‘(b) NONPREFERENTIAL TREATMENT.—Nothing in 

18 this Act authorizes the Secretary to provide services to an 

19 Indian with coverage under title XVIII, XIX, or XXI of 

20 the Social Security Act in preference to an Indian without 

21 such coverage. 

22 ‘‘(c) USE OF FUNDS.— 

23 ‘‘(1) SPECIAL FUND.— 

24 ‘‘(A) 100 PERCENT PASS-THROUGH OF

25 PAYMENTS DUE TO FACILITIES.—Notwith26 standing any other provision of law, but subject 


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1 to paragraph (2), payments to which a facility 

2 of the Service is entitled by reason of a provi3 sion of title XVIII or XIX of the Social Secu4 rity Act shall be placed in a special fund to be 

5 held by the Secretary. In making payments 

6 from such fund, the Secretary shall ensure that 

7 each Service Unit of the Service receives 100 

8 percent of the amount to which the facilities of 

9 the Service, for which such Service Unit makes 

10 collections, are entitled by reason of a provision 

11 of either such title. 

12 ‘‘(B) USE OF FUNDS.—Amounts received 

13 by a facility of the Service under subparagraph 

14 (A) by reason of a provision of title XVIII or 

15 XIX of the Social Security Act shall first be 

16 used (to such extent or in such amounts as are 

17 provided in appropriation Acts) for the purpose 

18 of making any improvements in the programs 

19 of the Service operated by or through such fa20 cility which may be necessary to achieve or 

21 maintain compliance with the applicable condi22 tions and requirements of such respective title. 

23 Any amounts so received that are in excess of 

24 the amount necessary to achieve or maintain 

25 such conditions and requirements shall, subject 


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1 to consultation with the Indian Tribes being 

2 served by the Service Unit, be used for increas3 ing the facility’s capacity to provide, or improv4 ing the quality or accessibility of, services. 

5 ‘‘(2) DIRECT PAYMENT OPTION.—Paragraph 

6 (1) shall not apply to a Tribal Health Program upon 

7 the election of such Program under subsection (d) to 

8 receive payments directly. No payment may be made 

9 out of the special fund described in such paragraph 

10 with respect to reimbursement made for services 

11 provided by such Program during the period of such 

12 election. 

13 ‘‘(d) DIRECT BILLING.— 

14 ‘‘(1) IN GENERAL.—Subject to complying with 

15 the requirements of paragraph (2), a Tribal Health 

16 Program may elect to directly bill for, and receive 

17 payment for, health care items and services provided 

18 by such Program for which payment is made under 

19 title XVIII, XIX, or XXI of the Social Security Act. 

20 ‘‘(2) DIRECT REIMBURSEMENT.— 

21 ‘‘(A) USE OF FUNDS.—Each Tribal Health 

22 Program making the election described in para23 graph (1) with respect to a program under title 

24 XVIII, XIX, or XXI of the Social Security Act 

25 shall be reimbursed directly by that program 


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1 for items and services furnished without regard 

2 to subsection (c)(1), but all amounts so reim3 bursed shall be used by the Tribal Health Pro4 gram for the same purposes with respect to 

5 such Program for which payment under sub6 paragraph (A) of subsection (c)(1) to a facility 

7 of the Service may be used pursuant to sub8 paragraph (B) of such subsection with respect 

9 to the Service. 

10 ‘‘(B) AUDITS.—The amounts paid to a 

11 Tribal Health Program making the election de12 scribed in paragraph (1) with respect to a pro13 gram under title XVIII, XIX, or XXI of the So14 cial Security Act shall be subject to all auditing 

15 requirements applicable to the program under 

16 such title, as well as all auditing requirements 

17 applicable to programs administered by an In18 dian Health Program. Nothing in the preceding 

19 sentence shall be construed as limiting the ap20 plication of auditing requirements applicable to 

21 amounts paid under title XVIII, XIX, or XXI 

22 of the Social Security Act. 

23 ‘‘(C) IDENTIFICATION OF SOURCE OF PAY24 MENTS.—Any Tribal Health Program that re25 ceives reimbursements or payments under title 


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1 XVIII, XIX, or XXI of the Social Security Act 

2 shall provide to the Service a list of each pro3 vider enrollment number (or other identifier) 

4 under which such Program receives such reim5 bursements or payments. 

6 ‘‘(3) EXAMINATION AND IMPLEMENTATION OF

7 CHANGES.— 

8 ‘‘(A) IN GENERAL.—The Secretary, acting 

9 through the Service and with the assistance of 

10 the Administrator of the Centers for Medicare 

11 & Medicaid Services, shall examine on an ongo12 ing basis and implement any administrative 

13 changes that may be necessary to facilitate di14 rect billing and reimbursement under the pro15 gram established under this subsection, includ16 ing any agreements with States that may be 

17 necessary to provide for direct billing under a 

18 program under title XIX or XXI of the Social 

19 Security Act. 

20 ‘‘(B) COORDINATION OF INFORMATION.— 

21 The Service shall provide the Administrator of 

22 the Centers for Medicare & Medicaid Services 

23 with copies of the lists submitted to the Service 

24 under paragraph (2)(C), enrollment data re25 garding patients served by the Service (and by 


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1 Tribal Health Programs, to the extent such 

2 data is available to the Service), and such other 

3 information as the Administrator may require 

4 for purposes of administering title XVIII, XIX, 

5 or XXI of the Social Security Act. 

6 ‘‘(4) WITHDRAWAL FROM PROGRAM.—A Tribal 

7 Health Program that bills directly under the pro8 gram established under this subsection may with9 draw from participation in the same manner and 

10 under the same conditions that an Indian Tribe or 

11 Tribal Organization may retrocede a contracted pro12 gram to the Secretary under the authority of the In13 dian Self-Determination and Education Assistance 

14 Act (25 U.S.C. 450 et seq.). All cost accounting and 

15 billing authority under the program established 

16 under this subsection shall be returned to the Sec17 retary upon the Secretary’s acceptance of the with18 drawal of participation in this program. 

19 ‘‘(5) TERMINATION FOR FAILURE TO COMPLY

20 WITH REQUIREMENTS.—The Secretary may termi21 nate the participation of a Tribal Health Program or 

22 in the direct billing program established under this 

23 subsection if the Secretary determines that the Pro24 gram has failed to comply with the requirements of 

25 paragraph (2). The Secretary shall provide a Tribal 


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1 Health Program with notice of a determination that 

2 the Program has failed to comply with any such re3 quirement and a reasonable opportunity to correct 

4 such noncompliance prior to terminating the Pro5 gram’s participation in the direct billing program es6 tablished under this subsection. 

7 ‘‘(e) RELATED PROVISIONS UNDER THE SOCIAL SE8 CURITY ACT.—For provisions related to subsections (c) 

9 and (d), see sections 1880, 1911, and 2107(e)(1)(D) of 

10 the Social Security Act. 

11 ‘‘SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERV12 ICE, INDIAN TRIBES, TRIBAL ORGANIZA13 TIONS, AND URBAN INDIAN ORGANIZATIONS 

14 TO FACILITATE OUTREACH, ENROLLMENT, 

15 AND COVERAGE OF INDIANS UNDER SOCIAL 

16 SECURITY ACT HEALTH BENEFIT PROGRAMS. 

17 ‘‘(a) INDIAN TRIBES AND TRIBAL ORGANIZA18 TIONS.—From funds appropriated to carry out this title 

19 in accordance with section 414, the Secretary, acting 

20 through the Service, shall make grants to or enter into 

21 contracts with Indian Tribes and Tribal Organizations to 

22 assist such Tribes and Tribal Organizations in estab23 lishing and administering programs on or near reserva24 tions and trust lands, including programs to provide out25 reach and enrollment through video, electronic delivery 


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1 methods, or telecommunication devices that allow real2 time or time-delayed communication between individual 

3 Indians and the benefit program, to assist individual Indi4 ans— 

5 ‘‘(1) to enroll for benefits under a program es6 tablished under title XVIII, XIX, or XXI of the So7 cial Security Act; and 

8 ‘‘(2) with respect to such programs for which 

9 the charging of premiums and cost sharing is not 

10 prohibited under such programs, to pay premiums or 

11 cost sharing for coverage for such benefits, which 

12 may be based on financial need (as determined by 

13 the Indian Tribe or Tribes or Tribal Organizations 

14 being served based on a schedule of income levels de15 veloped or implemented by such Tribe, Tribes, or 

16 Tribal Organizations). 

17 ‘‘(b) CONDITIONS.—The Secretary, acting through 

18 the Service, shall place conditions as deemed necessary to 

19 effect the purpose of this section in any grant or contract 

20 which the Secretary makes with any Indian Tribe or Trib21 al Organization pursuant to this section. Such conditions 

22 shall include requirements that the Indian Tribe or Tribal 

23 Organization successfully undertake— 

24 ‘‘(1) to determine the population of Indians eli25 gible for the benefits described in subsection (a); 


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1 ‘‘(2) to educate Indians with respect to the ben2 efits available under the respective programs; 

3 ‘‘(3) to provide transportation for such indi4 vidual Indians to the appropriate offices for enroll5 ment or applications for such benefits; and 

6 ‘‘(4) to develop and implement methods of im7 proving the participation of Indians in receiving ben8 efits under such programs. 

9 ‘‘(c) APPLICATION TO URBAN INDIAN ORGANIZA10 TIONS.— 

11 ‘‘(1) IN GENERAL.—The provisions of sub12 section (a) shall apply with respect to grants and 

13 other funding to urban Indian organizations with re14 spect to populations served by such organizations in 

15 the same manner they apply to grants and contracts 

16 with Indian Tribes and Tribal Organizations with 

17 respect to programs on or near reservations. 

18 ‘‘(2) REQUIREMENTS.—The Secretary shall in19 clude in the grants or contracts made or provided 

20 under paragraph (1) requirements that are— 

21 ‘‘(A) consistent with the requirements im22 posed by the Secretary under subsection (b); 

23 ‘‘(B) appropriate to urban Indian organi24 zations and urban Indians; and 


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1 ‘‘(C) necessary to effect the purposes of 

2 this section. 

3 ‘‘(d) FACILITATING COOPERATION IN ENROLLMENT

4 AND RETENTION.—The Secretary, acting through the 

5 Centers for Medicare & Medicaid Services, shall consult 

6 with States, the Service, Indian Tribes, Tribal Organiza7 tions, and urban Indian organizations to develop and dis8 seminate best practices with respect to facilitating agree9 ments between the States and Indian Tribes, Tribal Orga10 nizations, and urban Indian organizations relating to en11 rollment and retention of Indians in programs established 

12 under titles XVIII, XIX, and XXI of the Social Security 

13 Act. 

14 ‘‘(e) AGREEMENTS TO IMPROVE ENROLLMENT OF

15 INDIANS UNDER SOCIAL SECURITY ACT HEALTH BENE16 FITS PROGRAMS.—For provisions relating to agreements 

17 between the Secretary and the Service, Indian Tribes, 

18 Tribal Organizations, and urban Indian organizations for 

19 the collection, preparation, and submission of applications 

20 by Indians for assistance under the Medicaid and chil21 dren’s health insurance programs established under titles 

22 XIX and XXI of the Social Security Act, and benefits 

23 under the Medicare program established under title XVIII 

24 of such Act, see subsections (a) and (b) of section 1139 

25 of the Social Security Act. 


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1 ‘‘(f) DEFINITIONS.—In this section: 

2 ‘‘(1) PREMIUM.—The term ‘premium’ includes 

3 any enrollment fee or similar charge. 

4 ‘‘(2) COST SHARING.—The term ‘cost sharing’ 

5 includes any deduction, deductible, copayment, coin6 surance, or similar charge. 

7 ‘‘(3) BENEFITS.—The term ‘benefits’ means, 

8 with respect to— 

9 ‘‘(A) title XVIII of the Social Security Act, 

10 benefits under such title; 

11 ‘‘(B) title XIX of such Act, medical assist12 ance under such title; and 

13 ‘‘(C) title XXI of such Act, assistance 

14 under such title. 

15 ‘‘SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PAR16 TIES OF COSTS OF HEALTH SERVICES. 

17 ‘‘(a) RIGHT OF RECOVERY.—Except as provided in 

18 subsection (f), the United States, an Indian Tribe, or 

19 Tribal Organization shall have the right to recover from 

20 an insurance company, health maintenance organization, 

21 employee benefit plan, third-party tortfeasor, or any other 

22 responsible or liable third party (including a political sub23 division or local governmental entity of a State) the rea24 sonable charges billed by the Secretary, an Indian Tribe, 

25 or Tribal Organization, or, if higher, the highest amount 


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1 the third party would pay for care and services furnished 

2 by providers other than governmental entities, in providing 

3 health services through the Service, an Indian Tribe, or 

4 Tribal Organization to any individual to the same extent 

5 that such individual, or any nongovernmental provider of 

6 such services, would be eligible to receive damages, reim7 bursement, or indemnification for such charges if— 

8 ‘‘(1) such services had been provided by a non9 governmental provider; and 

10 ‘‘(2) such individual had been required to pay 

11 such charges or expenses and did pay such charges 

12 or expenses. 

13 ‘‘(b) LIMITATIONS ON RECOVERIES FROM STATES.— 

14 Subsection (a) shall provide a right of recovery against 

15 any State, only if the injury, illness, or disability for which 

16 health services were provided is covered under— 

17 ‘‘(1) workers’ compensation laws; or 

18 ‘‘(2) a no-fault automobile accident insurance 

19 plan or program. 

20 ‘‘(c) NONAPPLICATION OF OTHER LAWS.—No law of 

21 any State, or of any political subdivision of a State and 

22 no provision of any contract, insurance or health mainte23 nance organization policy, employee benefit plan, self-in24 surance plan, managed care plan, or other health care plan 

25 or program entered into or renewed after the date of the 


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1 enactment of the Indian Health Care Amendments of 

2 1988, shall prevent or hinder the right of recovery of the 

3 United States, an Indian Tribe, or Tribal Organization 

4 under subsection (a). 

5 ‘‘(d) NO EFFECT ON PRIVATE RIGHTS OF ACTION.— 

6 No action taken by the United States, an Indian Tribe, 

7 or Tribal Organization to enforce the right of recovery 

8 provided under this section shall operate to deny to the 

9 injured person the recovery for that portion of the person’s 

10 damage not covered hereunder. 

11 ‘‘(e) ENFORCEMENT.— 

12 ‘‘(1) IN GENERAL.—The United States, an In13 dian Tribe, or Tribal Organization may enforce the 

14 right of recovery provided under subsection (a) by— 

15 ‘‘(A) intervening or joining in any civil ac16 tion or proceeding brought— 

17 ‘‘(i) by the individual for whom health 

18 services were provided by the Secretary, an 

19 Indian Tribe, or Tribal Organization; or 

20 ‘‘(ii) by any representative or heirs of 

21 such individual, or 

22 ‘‘(B) instituting a civil action, including a 

23 civil action for injunctive relief and other relief 

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1 division or local governmental entity of a State, 

2 such an action against an official thereof. 

3 ‘‘(2) NOTICE.—All reasonable efforts shall be 

4 made to provide notice of action instituted under 

5 paragraph (1)(B) to the individual to whom health 

6 services were provided, either before or during the 

7 pendency of such action. 

8 ‘‘(3) RECOVERY FROM TORTFEASORS.— 

9 ‘‘(A) IN GENERAL.—In any case in which 

10 an Indian Tribe or Tribal Organization that is 

11 authorized or required under a compact or con12 tract issued pursuant to the Indian Self-Deter13 mination and Education Assistance Act (25 

14 U.S.C. 450 et seq.) to furnish or pay for health 

15 services to a person who is injured or suffers a 

16 disease on or after the date of enactment of the 

17 Indian Health Care Improvement Act Amend18 ments of 2009 under circumstances that estab19 lish grounds for a claim of liability against the 

20 tortfeasor with respect to the injury or disease, 

21 the Indian Tribe or Tribal Organization shall 

22 have a right to recover from the tortfeasor (or 

23 an insurer of the tortfeasor) the reasonable 

24 value of the health services so furnished, paid 

25 for, or to be paid for, in accordance with the 


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1 Federal Medical Care Recovery Act (42 U.S.C. 

2 2651 et seq.), to the same extent and under the 

3 same circumstances as the United States may 

4 recover under that Act. 

5 ‘‘(B) TREATMENT.—The right of an In6 dian Tribe or Tribal Organization to recover 

7 under subparagraph (A) shall be independent of 

8 the rights of the injured or diseased person 

9 served by the Indian Tribe or Tribal Organiza10 tion. 

11 ‘‘(f) LIMITATION.—Absent specific written authoriza12 tion by the governing body of an Indian Tribe for the pe13 riod of such authorization (which may not be for a period 

14 of more than 1 year and which may be revoked at any 

15 time upon written notice by the governing body to the 

16 Service), the United States shall not have a right of recov17 ery under this section if the injury, illness, or disability 

18 for which health services were provided is covered under 

19 a self-insurance plan funded by an Indian Tribe, Tribal 

20 Organization, or urban Indian organization. Where such 

21 authorization is provided, the Service may receive and ex22 pend such amounts for the provision of additional health 

23 services consistent with such authorization. 

24 ‘‘(g) COSTS AND ATTORNEYS’ FEES.—In any action 

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1 vailing plaintiff shall be awarded its reasonable attorneys’ 

2 fees and costs of litigation. 

3 ‘‘(h) NONAPPLICATION OF CLAIMS FILING REQUIRE4 MENTS.—An insurance company, health maintenance or5 ganization, self-insurance plan, managed care plan, or 

6 other health care plan or program (under the Social Secu7 rity Act or otherwise) may not deny a claim for benefits 

8 submitted by the Service or by an Indian Tribe or Tribal 

9 Organization based on the format in which the claim is 

10 submitted if such format complies with the format re11 quired for submission of claims under title XVIII of the 

12 Social Security Act or recognized under section 1175 of 

13 such Act. 

14 ‘‘(i) APPLICATION TO URBAN INDIAN ORGANIZA15 TIONS.—The previous provisions of this section shall apply 

16 to urban Indian organizations with respect to populations 

17 served by such Organizations in the same manner they 

18 apply to Indian Tribes and Tribal Organizations with re19 spect to populations served by such Indian Tribes and 

20 Tribal Organizations. 

21 ‘‘(j) STATUTE OF LIMITATIONS.—The provisions of 

22 section 2415 of title 28, United States Code, shall apply 

23 to all actions commenced under this section, and the ref24 erences therein to the United States are deemed to include 


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1 Indian Tribes, Tribal Organizations, and urban Indian or2 ganizations. 

3 ‘‘(k) SAVINGS.—Nothing in this section shall be con4 strued to limit any right of recovery available to the 

5 United States, an Indian Tribe, or Tribal Organization 

6 under the provisions of any applicable, Federal, State, or 

7 Tribal law, including medical lien laws. 

8 ‘‘SEC. 404. CREDITING OF REIMBURSEMENTS. 

9 ‘‘(a) RETENTION OF AMOUNTS FOR USE BY PRO10 GRAM.—Except as provided in section 202(f) (relating to 

11 the Catastrophic Health Emergency Fund) and section 

12 806 (relating to health services for ineligible persons), all 

13 reimbursements received or recovered, including under 

14 section 806, by reason of the provision of health services 

15 by the Service, by an Indian Tribe or Tribal Organization, 

16 or by an urban Indian organization, shall be credited to 

17 the Service, such Indian Tribe or Tribal Organization, or 

18 such urban Indian organization, respectively, and may be 

19 used as provided in section 401. In the case of such a 

20 service provided by or through a Service Unit, such 

21 amounts shall be credited to such unit and used for such 

22 purposes. 

23 ‘‘(b) NO OFFSET OF AMOUNTS.—The Service may 

24 not offset or limit any amount obligated to any Service 


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1 Unit or entity receiving funding from the Service because 

2 of the receipt of reimbursements under subsection (a). 

3 ‘‘SEC. 405. PURCHASING HEALTH CARE COVERAGE. 

4 ‘‘(a) PURCHASING COVERAGE.— 

5 ‘‘(1) IN GENERAL.—Insofar as amounts are 

6 made available under law (including a provision of 

7 the Social Security Act, the Indian Self-Determina8 tion and Education Assistance Act (25 U.S.C. 450 

9 et seq.), or other law, other than under section 402) 

10 to Indian Tribes, Tribal Organizations, and urban 

11 Indian organizations for health benefits for Service 

12 beneficiaries, Indian Tribes, Tribal Organizations, 

13 and urban Indian organizations may use such 

14 amounts to purchase health benefits coverage that 

15 qualifies as creditable coverage under section 

16 2701(c)(1) of the Public Health Service Act for such 

17 beneficiaries, including, subject to paragraph (2), 

18 through— 

19 ‘‘(A) a tribally owned and operated health 

20 care plan; 

21 ‘‘(B) a State or locally authorized or li22 censed health care plan; 

23 ‘‘(C) a health insurance provider or man24 aged care organization; or 

25 ‘‘(D) a self-insured plan. 


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1 ‘‘(2) EXCEPTION.—The coverage provided 

2 under paragraph (1) may not include coverage con3 sisting of— 

4 ‘‘(A) benefits provided under a health flexi5 ble spending arrangement (as defined in section 

6 106(c)(2) of the Internal Revenue Code of 

7 1986); or 

8 ‘‘(B) a high deductible health plan (as de9 fined in section 223(c)(2) of such Code), with10 out regard to whether the plan is purchased in 

11 conjunction with a health savings account (as 

12 defined under section 223(d) of such Code). 

13 ‘‘(3) PERMITTING PURCHASE OF COVERAGE

14 BASED ON FINANCIAL NEED.—The purchase of cov15 erage by an Indian Tribe, Tribal Organization, or 

16 urban Indian organization under this subsection may 

17 be based on the financial needs of beneficiaries (as 

18 determined by the Indian Tribe or Tribes being 

19 served based on a schedule of income levels devel20 oped or implemented by such Indian Tribe or 

21 Tribes). 

22 ‘‘(b) EXPENSES FOR SELF-INSURED PLAN.—In the 

23 case of a self-insured plan under subsection (a)(4), the 

24 amounts may be used for expenses of operating the plan, 


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1 including administration and insurance to limit the finan2 cial risks to the entity offering the plan. 

3 ‘‘(c) CONSTRUCTION.—Nothing in this section shall 

4 be construed as affecting the use of any amounts not re5 ferred to in subsection (a). 

6 ‘‘SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGEN7 CIES. 

8 ‘‘(a) AUTHORITY.— 

9 ‘‘(1) IN GENERAL.—The Secretary may enter 

10 into (or expand) arrangements for the sharing of 

11 medical facilities and services between the Service, 

12 Indian Tribes, and Tribal Organizations and the De13 partment of Veterans Affairs and the Department of 

14 Defense. 

15 ‘‘(2) CONSULTATION BY SECRETARY RE16 QUIRED.—The Secretary may not finalize any ar17 rangement between the Service and a Department 

18 described in paragraph (1) without first consulting 

19 with the Indian Tribes which will be significantly af20 fected by the arrangement. 

21 ‘‘(b) LIMITATIONS.—The Secretary shall not take 

22 any action under this section or under subchapter IV of 

23 chapter 81 of title 38, United States Code, which would 

24 impair— 


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1 ‘‘(1) the priority access of any Indian to health 

2 care services provided through the Service and the 

3 eligibility of any Indian to receive health services 

4 through the Service; 

5 ‘‘(2) the quality of health care services provided 

6 to any Indian through the Service; 

7 ‘‘(3) the priority access of any veteran to health 

8 care services provided by the Department of Vet9 erans Affairs; 

10 ‘‘(4) the quality of health care services provided 

11 by the Department of Veterans Affairs or the De12 partment of Defense; or 

13 ‘‘(5) the eligibility of any Indian who is a vet14 eran to receive health services through the Depart15 ment of Veterans Affairs. 

16 ‘‘(c) REIMBURSEMENT.—The Service, Indian Tribe, 

17 or Tribal Organization shall be reimbursed by the Depart18 ment of Veterans Affairs or the Department of Defense 

19 (as the case may be) where services are provided through 

20 the Service, an Indian Tribe, or a Tribal Organization to 

21 beneficiaries eligible for services from either such Depart22 ment, notwithstanding any other provision of law. 

23 ‘‘(d) CONSTRUCTION.—Nothing in this section may 

24 be construed as creating any right of a non-Indian veteran 

25 to obtain health services from the Service. 


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1 ‘‘SEC. 407. ELIGIBLE INDIAN VETERAN SERVICES. 

2 ‘‘(a) FINDINGS; PURPOSE.— 

3 ‘‘(1) FINDINGS.—Congress finds that— 

4 ‘‘(A) collaborations between the Secretary 

5 and the Secretary of Veterans Affairs regarding 

6 the treatment of Indian veterans at facilities of 

7 the Service should be encouraged to the max8 imum extent practicable; and 

9 ‘‘(B) increased enrollment for services of 

10 the Department of Veterans Affairs by veterans 

11 who are members of Indian tribes should be en12 couraged to the maximum extent practicable. 

13 ‘‘(2) PURPOSE.—The purpose of this section is 

14 to reaffirm the goals stated in the document entitled 

15 ‘Memorandum of Understanding Between the VA/ 

16 Veterans Health Administration And HHS/Indian 

17 Health Service’ and dated February 25, 2003 (relat18 ing to cooperation and resource sharing between the 

19 Veterans Health Administration and Service). 

20 ‘‘(b) DEFINITIONS.—In this section: 

21 ‘‘(1) ELIGIBLE INDIAN VETERAN.—The term 

22 ‘eligible Indian veteran’ means an Indian or Alaska 

23 Native veteran who receives any medical service that 

24 is— 

25 ‘‘(A) authorized under the laws adminis26 tered by the Secretary of Veterans Affairs; and 


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1 ‘‘(B) administered at a facility of the Serv2 ice (including a facility operated by an Indian 

3 tribe or tribal organization through a contract 

4 or compact with the Service under the Indian 

5 Self-Determination and Education Assistance 

6 Act (25 U.S.C. 450 et seq.)) pursuant to a local 

7 memorandum of understanding. 

8 ‘‘(2) LOCAL MEMORANDUM OF UNDER9 STANDING.—The term ‘local memorandum of under10 standing’ means a memorandum of understanding 

11 between the Secretary (or a designee, including the 

12 director of any Area Office of the Service) and the 

13 Secretary of Veterans Affairs (or a designee) to im14 plement the document entitled ‘Memorandum of Un15 derstanding Between the VA/Veterans Health Ad16 ministration And HHS/Indian Health Service’ and 

17 dated February 25, 2003 (relating to cooperation 

18 and resource sharing between the Veterans Health 

19 Administration and Indian Health Service). 

20 ‘‘(c) ELIGIBLE INDIAN VETERANS’ EXPENSES.— 

21 ‘‘(1) IN GENERAL.—Notwithstanding any other 

22 provision of law, the Secretary shall provide for vet23 eran-related expenses incurred by eligible Indian vet24 erans as described in subsection (b)(1)(B). 


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1 ‘‘(2) METHOD OF PAYMENT.—The Secretary 

2 shall establish such guidelines as the Secretary de3 termines to be appropriate regarding the method of 

4 payments to the Secretary of Veterans Affairs under 

5 paragraph (1). 

6 ‘‘(d) TRIBAL APPROVAL OF MEMORANDA.—In nego7 tiating a local memorandum of understanding with the 

8 Secretary of Veterans Affairs regarding the provision of 

9 services to eligible Indian veterans, the Secretary shall 

10 consult with each Indian tribe that would be affected by 

11 the local memorandum of understanding. 

12 ‘‘(e) FUNDING.— 

13 ‘‘(1) TREATMENT.—Expenses incurred by the 

14 Secretary in carrying out subsection (c)(1) shall not 

15 be considered to be Contract Health Service ex16 penses. 

17 ‘‘(2) USE OF FUNDS.—Of funds made available 

18 to the Secretary in appropriations Acts for the Serv19 ice (excluding funds made available for facilities, 

20 Contract Health Services, or contract support costs), 

21 the Secretary shall use such sums as are necessary 

22 to carry out this section. 

23 ‘‘SEC. 408. PAYOR OF LAST RESORT. 

24 ‘‘Indian Health Programs and health care programs 

25 operated by Urban Indian Organizations shall be the 


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1 payor of last resort for services provided to persons eligible 

2 for services from Indian Health Programs and Urban In3 dian Organizations, notwithstanding any Federal, State, 

4 or local law to the contrary. 

5 ‘‘SEC. 409. NONDISCRIMINATION UNDER FEDERAL HEALTH 

6 CARE PROGRAMS IN QUALIFICATIONS FOR 

7 REIMBURSEMENT FOR SERVICES. 

8 ‘‘(a) REQUIREMENT TO SATISFY GENERALLY APPLI9 CABLE PARTICIPATION REQUIREMENTS.— 

10 ‘‘(1) IN GENERAL.—A Federal health care pro11 gram must accept an entity that is operated by the 

12 Service, an Indian Tribe, Tribal Organization, or 

13 Urban Indian Organization as a provider eligible to 

14 receive payment under the program for health care 

15 services furnished to an Indian on the same basis as 

16 any other provider qualified to participate as a pro17 vider of health care services under the program if 

18 the entity meets generally applicable State or other 

19 requirements for participation as a provider of 

20 health care services under the program. 

21 ‘‘(2) SATISFACTION OF STATE OR LOCAL LICEN22 SURE OR RECOGNITION REQUIREMENTS.—Any re23 quirement for participation as a provider of health 

24 care services under a Federal health care program 

25 that an entity be licensed or recognized under the 


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1 State or local law where the entity is located to fur2 nish health care services shall be deemed to have 

3 been met in the case of an entity operated by the 

4 Service, an Indian Tribe, Tribal Organization, or 

5 Urban Indian Organization if the entity meets all 

6 the applicable standards for such licensure or rec7 ognition, regardless of whether the entity obtains a 

8 license or other documentation under such State or 

9 local law. In accordance with section 221, the ab10 sence of the licensure of a health care professional 

11 employed by such an entity under the State or local 

12 law where the entity is located shall not be taken 

13 into account for purposes of determining whether 

14 the entity meets such standards, if the professional 

15 is licensed in another State. 

16 ‘‘(b) APPLICATION OF EXCLUSION FROM PARTICIPA17 TION IN FEDERAL HEALTH CARE PROGRAMS.— 

18 ‘‘(1) EXCLUDED ENTITIES.—No entity operated 

19 by the Service, an Indian Tribe, Tribal Organiza20 tion, or Urban Indian Organization that has been 

21 excluded from participation in any Federal health 

22 care program or for which a license is under suspen23 sion or has been revoked by the State where the en24 tity is located shall be eligible to receive payment or 


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1 reimbursement under any such program for health 

2 care services furnished to an Indian. 

3 ‘‘(2) EXCLUDED INDIVIDUALS.—No individual 

4 who has been excluded from participation in any 

5 Federal health care program or whose State license 

6 is under suspension shall be eligible to receive pay7 ment or reimbursement under any such program for 

8 health care services furnished by that individual, di9 rectly or through an entity that is otherwise eligible 

10 to receive payment for health care services, to an In11 dian. 

12 ‘‘(3) FEDERAL HEALTH CARE PROGRAM DE13 FINED.—In this subsection, the term, ‘Federal 

14 health care program’ has the meaning given that 

15 term in section 1128B(f) of the Social Security Act 

16 (42 U.S.C. 1320a–7b(f)), except that, for purposes 

17 of this subsection, such term shall include the health 

18 insurance program under chapter 89 of title 5, 

19 United States Code. 

20 ‘‘(c) RELATED PROVISIONS.—For provisions related 

21 to nondiscrimination against providers operated by the 

22 Service, an Indian Tribe, Tribal Organization, or Urban 

23 Indian Organization, see section 1139(c) of the Social Se24 curity Act (42 U.S.C. 1320b–9(c)). 


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1 ‘‘SEC. 410. CONSULTATION. 

2 ‘‘For provisions related to consultation with rep3 resentatives of Indian Health Programs and urban Indian 

4 organizations with respect to the health care programs es5 tablished under titles XVIII, XIX, and XXI of the Social 

6 Security Act, see section 1139(d) of the Social Security 

7 Act (42 U.S.C. 1320b–9(d)). 

8 ‘‘SEC. 411. STATE CHILDREN’S HEALTH INSURANCE PRO9 GRAM (SCHIP). 

10 ‘‘For provisions relating to— 

11 ‘‘(1) outreach to families of Indian children 

12 likely to be eligible for child health assistance under 

13 the State children’s health insurance program estab14 lished under title XXI of the Social Security Act, see 

15 sections 2105(c)(2)(C) and 1139(a) of such Act (42 

16 U.S.C. 1397ee(c)(2), 1320b–9); and 

17 ‘‘(2) ensuring that child health assistance is 

18 provided under such program to targeted low-income 

19 children who are Indians and that payments are 

20 made under such program to Indian Health Pro21 grams and urban Indian organizations operating in 

22 the State that provide such assistance, see sections 

23 2102(b)(3)(D) and 2105(c)(6)(B) of such Act (42 

24 U.S.C. 1397bb(b)(3)(D), 1397ee(c)(6)(B)). 


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1 ‘‘SEC. 412. EXCLUSION WAIVER AUTHORITY FOR AFFECTED 

2 INDIAN HEALTH PROGRAMS AND SAFE HAR3 BOR TRANSACTIONS UNDER THE SOCIAL SE4 CURITY ACT. 

5 ‘‘For provisions relating to— 

6 ‘‘(1) exclusion waiver authority for affected In7 dian Health Programs under the Social Security 

8 Act, see section 1128(k) of the Social Security Act 

9 (42 U.S.C. 1320a–7(k)); and 

10 ‘‘(2) certain transactions involving Indian 

11 Health Programs deemed to be in safe harbors 

12 under that Act, see section 1128B(b)(4) of the So13 cial Security Act (42 U.S.C. 1320a–7b(b)(4)). 

14 ‘‘SEC. 413. PREMIUM AND COST SHARING PROTECTIONS 

15 AND ELIGIBILITY DETERMINATIONS UNDER 

16 MEDICAID AND SCHIP AND PROTECTION OF 

17 CERTAIN INDIAN PROPERTY FROM MEDICAID 

18 ESTATE RECOVERY. 

19 ‘‘For provisions relating to— 

20 ‘‘(1) premiums or cost sharing protections for 

21 Indians furnished items or services directly by In22 dian Health Programs or through referral under the 

23 contract health service under the Medicaid program 

24 established under title XIX of the Social Security 

25 Act, see sections 1916(j) and 1916A(a)(1) of the SoVerDate Nov 24 2008 23:28 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00212 Fmt 6652 Sfmt 6201 E:\BILLS\H2708.IH H2708

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1 cial Security Act (42 U.S.C. 1396o(j), 1396o– 

2 1(a)(1)); 

3 ‘‘(2) rules regarding the treatment of certain 

4 property for purposes of determining eligibility 

5 under such programs, see sections 1902(e)(13) and 

6 2107(e)(1)(B) of such Act (42 U.S.C. 1396a(e)(13), 

7 1397gg(e)(1)(B)); and 

8 ‘‘(3) the protection of certain property from es9 tate recovery provisions under the Medicaid pro10 gram, see section 1917(b)(3)(B) of such Act (42 

11 U.S.C. 1396p(b)(3)(B)). 

12 ‘‘SEC. 414. TREATMENT UNDER MEDICAID AND SCHIP MAN13 AGED CARE. 

14 ‘‘For provisions relating to the treatment of Indians 

15 enrolled in a managed care entity under the Medicaid pro16 gram under title XIX of the Social Security Act and In17 dian Health Programs and urban Indian organizations 

18 that are providers of items or services to such Indian en19 rollees, see sections 1932(h) and 2107(e)(1)(H) of the So20 cial Security Act (42 U.S.C. 1396u–2(h), 

21 1397gg(e)(1)(H)). 

22 ‘‘SEC. 415. NAVAJO NATION MEDICAID AGENCY FEASI23 BILITY STUDY. 

24 ‘‘(a) STUDY.—The Secretary shall conduct a study 

25 to determine the feasibility of treating the Navajo Nation 


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1 as a State for the purposes of title XIX of the Social Secu2 rity Act, to provide services to Indians living within the 

3 boundaries of the Navajo Nation through an entity estab4 lished having the same authority and performing the same 

5 functions as single-State Medicaid agencies responsible for 

6 the administration of the State plan under title XIX of 

7 the Social Security Act. 

8 ‘‘(b) CONSIDERATIONS.—In conducting the study, 

9 the Secretary shall consider the feasibility of— 

10 ‘‘(1) assigning and paying all expenditures for 

11 the provision of services and related administration 

12 funds, under title XIX of the Social Security Act, to 

13 Indians living within the boundaries of the Navajo 

14 Nation that are currently paid to or would otherwise 

15 be paid to the State of Arizona, New Mexico, or 

16 Utah; 

17 ‘‘(2) providing assistance to the Navajo Nation 

18 in the development and implementation of such enti19 ty for the administration, eligibility, payment, and 

20 delivery of medical assistance under title XIX of the 

21 Social Security Act; 

22 ‘‘(3) providing an appropriate level of matching 

23 funds for Federal medical assistance with respect to 

24 amounts such entity expends for medical assistance 

25 for services and related administrative costs; and 


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1 ‘‘(4) authorizing the Secretary, at the option of 

2 the Navajo Nation, to treat the Navajo Nation as a 

3 State for the purposes of title XIX of the Social Se4 curity Act (relating to the State children’s health in5 surance program) under terms equivalent to those 

6 described in paragraphs (2) through (4). 

7 ‘‘(c) REPORT.—Not later than 3 years after the date 

8 of enactment of the Indian Health Care Improvement Act 

9 Amendments of 2009, the Secretary shall submit to the 

10 Committee on Indian Affairs and Committee on Finance 

11 of the Senate and the Committee on Natural Resources 

12 and Committee on Energy and Commerce of the House 

13 of Representatives a report that includes— 

14 ‘‘(1) the results of the study under this section; 

15 ‘‘(2) a summary of any consultation that oc16 curred between the Secretary and the Navajo Na17 tion, other Indian Tribes, the States of Arizona, 

18 New Mexico, and Utah, counties which include Nav19 ajo Lands, and other interested parties, in con20 ducting this study; 

21 ‘‘(3) projected costs or savings associated with 

22 establishment of such entity, and any estimated im23 pact on services provided as described in this section 

24 in relation to probable costs or savings; and 


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1 ‘‘(4) legislative actions that would be required 

2 to authorize the establishment of such entity if such 

3 entity is determined by the Secretary to be feasible. 

4 ‘‘SEC. 416. EXCEPTION FOR EXCEPTED BENEFITS. 

5 ‘‘The previous provisions of this title shall not apply 

6 to the provision of excepted benefits described in para7 graph (1)(A) or (3) of section 2791(c) of the Public 

8 Health Service Act (42 U.S.C. 300gg–91(c)). 

9 ‘‘SEC. 417. AUTHORIZATION OF APPROPRIATIONS. 

10 ‘‘There are authorized to be appropriated such sums 

11 as may be necessary to carry out this title. 

12 ‘‘TITLE V—HEALTH SERVICES 

13 FOR URBAN INDIANS 

14 ‘‘SEC. 501. PURPOSE. 

15 ‘‘The purpose of this title is to establish and maintain 

16 programs in Urban Centers to make health services more 

17 accessible and available to Urban Indians. 

18 ‘‘SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN IN19 DIAN ORGANIZATIONS. 

20 ‘‘Under authority of the Act of November 2, 1921 

21 (25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 

22 the Secretary, acting through the Service, shall enter into 

23 contracts with, or make grants to, urban Indian organiza24 tions to assist such organizations in the establishment and 

25 administration, within Urban Centers, of programs which 


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1 meet the requirements set forth in this title. Subject to 

2 section 506, the Secretary, acting through the Service, 

3 shall include such conditions as the Secretary considers 

4 necessary to effect the purpose of this title in any contract 

5 into which the Secretary enters with, or in any grant the 

6 Secretary makes to, any urban Indian organization pursu7 ant to this title. 

8 ‘‘SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION 

9 OF HEALTH CARE AND REFERRAL SERVICES. 

10 ‘‘(a) REQUIREMENTS FOR GRANTS AND CON11 TRACTS.—Under authority of the Act of November 2, 

12 1921 (25 U.S.C. 13) (commonly known as the ‘Snyder 

13 Act’), the Secretary, acting through the Service, shall 

14 enter into contracts with, and make grants to, urban In15 dian organizations for the provision of health care and re16 ferral services for Urban Indians. Any such contract or 

17 grant shall include requirements that the urban Indian or18 ganization successfully undertake to— 

19 ‘‘(1) estimate the population of Urban Indians 

20 residing in the Urban Center or centers that the or21 ganization proposes to serve who are or could be re22 cipients of health care or referral services; 

23 ‘‘(2) estimate the current health status of 

24 Urban Indians residing in such Urban Center or 

25 centers; 


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1 ‘‘(3) estimate the current health care needs of 

2 Urban Indians residing in such Urban Center or 

3 centers; 

4 ‘‘(4) provide basic health education, including 

5 health promotion and disease prevention education, 

6 to Urban Indians; 

7 ‘‘(5) make recommendations to the Secretary 

8 and Federal, State, local, and other resource agen9 cies on methods of improving health service pro10 grams to meet the needs of Urban Indians; and 

11 ‘‘(6) where necessary, provide, or enter into 

12 contracts for the provision of, health care services 

13 for Urban Indians. 

14 ‘‘(b) CRITERIA.—The Secretary, acting through the 

15 Service, shall, by regulation, prescribe the criteria for se16 lecting urban Indian organizations to enter into contracts 

17 or receive grants under this section. Such criteria shall, 

18 among other factors, include— 

19 ‘‘(1) the extent of unmet health care needs of 

20 Urban Indians in the Urban Center or centers in21 volved; 

22 ‘‘(2) the size of the urban Indian population in 

23 the Urban Center or centers involved; 

24 ‘‘(3) the extent, if any, to which the activities 

25 set forth in subsection (a) would duplicate any 


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1 project funded under this title, or under any current 

2 public health service project funded in a manner 

3 other than pursuant to this title; 

4 ‘‘(4) the capability of an urban Indian organiza5 tion to perform the activities set forth in subsection 

6 (a) and to enter into a contract with the Secretary 

7 or to meet the requirements for receiving a grant 

8 under this section; 

9 ‘‘(5) the satisfactory performance and success10 ful completion by an urban Indian organization of 

11 other contracts with the Secretary under this title; 

12 ‘‘(6) the appropriateness and likely effectiveness 

13 of conducting the activities set forth in subsection 

14 (a) in an Urban Center or centers; and 

15 ‘‘(7) the extent of existing or likely future par16 ticipation in the activities set forth in subsection (a) 

17 by appropriate health and health-related Federal, 

18 State, local, and other agencies. 

19 ‘‘(c) ACCESS TO HEALTH PROMOTION AND DISEASE

20 PREVENTION PROGRAMS.—The Secretary, acting through 

21 the Service, shall facilitate access to or provide health pro22 motion and disease prevention services for Urban Indians 

23 through grants made to urban Indian organizations ad24 ministering contracts entered into or receiving grants 

25 under subsection (a). 


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1 ‘‘(d) IMMUNIZATION SERVICES.— 

2 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

3 Secretary, acting through the Service, shall facilitate 

4 access to, or provide, immunization services for 

5 Urban Indians through grants made to urban Indian 

6 organizations administering contracts entered into or 

7 receiving grants under this section. 

8 ‘‘(2) DEFINITION.—For purposes of this sub9 section, the term ‘immunization services’ means 

10 services to provide without charge immunizations 

11 against vaccine-preventable diseases. 

12 ‘‘(e) BEHAVIORAL HEALTH SERVICES.— 

13 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

14 Secretary, acting through the Service, shall facilitate 

15 access to, or provide, behavioral health services for 

16 Urban Indians through grants made to urban Indian 

17 organizations administering contracts entered into or 

18 receiving grants under subsection (a). 

19 ‘‘(2) ASSESSMENT REQUIRED.—Except as pro20 vided by paragraph (3)(A), a grant may not be made 

21 under this subsection to an urban Indian organiza22 tion until that organization has prepared, and the 

23 Service has approved, an assessment of the fol24 lowing: 


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1 ‘‘(A) The behavioral health needs of the 

2 urban Indian population concerned. 

3 ‘‘(B) The behavioral health services and 

4 other related resources available to that popu5 lation. 

6 ‘‘(C) The barriers to obtaining those serv7 ices and resources. 

8 ‘‘(D) The needs that are unmet by such 

9 services and resources. 

10 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

11 made under this subsection for the following: 

12 ‘‘(A) To prepare assessments required 

13 under paragraph (2). 

14 ‘‘(B) To provide outreach, educational, and 

15 referral services to Urban Indians regarding the 

16 availability of direct behavioral health services, 

17 to educate Urban Indians about behavioral 

18 health issues and services, and effect coordina19 tion with existing behavioral health providers in 

20 order to improve services to Urban Indians. 

21 ‘‘(C) To provide outpatient behavioral 

22 health services to Urban Indians, including the 

23 identification and assessment of illness, thera24 peutic treatments, case management, support 

25 groups, family treatment, and other treatment. 


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1 ‘‘(D) To develop innovative behavioral 

2 health service delivery models which incorporate 

3 Indian cultural support systems and resources. 

4 ‘‘(f) PREVENTION OF CHILD ABUSE.— 

5 ‘‘(1) ACCESS OR SERVICES PROVIDED.—The 

6 Secretary, acting through the Service, shall facilitate 

7 access to or provide services for Urban Indians 

8 through grants to urban Indian organizations ad9 ministering contracts entered into or receiving 

10 grants under subsection (a) to prevent and treat 

11 child abuse (including sexual abuse) among Urban 

12 Indians. 

13 ‘‘(2) EVALUATION REQUIRED.—Except as pro14 vided by paragraph (3)(A), a grant may not be made 

15 under this subsection to an urban Indian organiza16 tion until that organization has prepared, and the 

17 Service has approved, an assessment that documents 

18 the prevalence of child abuse in the urban Indian 

19 population concerned and specifies the services and 

20 programs (which may not duplicate existing services 

21 and programs) for which the grant is requested. 

22 ‘‘(3) PURPOSES OF GRANTS.—Grants may be 

23 made under this subsection for the following: 

24 ‘‘(A) To prepare assessments required 

25 under paragraph (2). 


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1 ‘‘(B) For the development of prevention, 

2 training, and education programs for Urban In3 dians, including child education, parent edu4 cation, provider training on identification and 

5 intervention, education on reporting require6 ments, prevention campaigns, and establishing 

7 service networks of all those involved in Indian 

8 child protection. 

9 ‘‘(C) To provide direct outpatient treat10 ment services (including individual treatment, 

11 family treatment, group therapy, and support 

12 groups) to Urban Indians who are child victims 

13 of abuse (including sexual abuse) or adult sur14 vivors of child sexual abuse, to the families of 

15 such child victims, and to urban Indian per16 petrators of child abuse (including sexual 

17 abuse). 

18 ‘‘(4) CONSIDERATIONS WHEN MAKING

19 GRANTS.—In making grants to carry out this sub20 section, the Secretary shall take into consideration— 

21 ‘‘(A) the support for the urban Indian or22 ganization demonstrated by the child protection 

23 authorities in the area, including committees or 

24 other services funded under the Indian Child 


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1 Welfare Act of 1978 (25 U.S.C. 1901 et seq.), 

2 if any; 

3 ‘‘(B) the capability and expertise dem4 onstrated by the urban Indian organization to 

5 address the complex problem of child sexual 

6 abuse in the community; and 

7 ‘‘(C) the assessment required under para8 graph (2). 

9 ‘‘(g) OTHER GRANTS.—The Secretary, acting 

10 through the Service, may enter into a contract with or 

11 make grants to an urban Indian organization that pro12 vides or arranges for the provision of health care services 

13 (through satellite facilities, provider networks, or other14 wise) to Urban Indians in more than 1 Urban Center. 

15 ‘‘SEC. 504. USE OF FEDERAL GOVERNMENT FACILITIES AND 

16 SOURCES OF SUPPLY. 

17 ‘‘(a) IN GENERAL.—The Secretary may permit an 

18 urban Indian organization that has entered into a contract 

19 or received a grant pursuant to this title, in carrying out 

20 such contract or grant, to use existing facilities and all 

21 equipment therein or pertaining thereto and other per22 sonal property owned by the Federal Government within 

23 the Secretary’s jurisdiction under such terms and condi24 tions as may be agreed upon for their use and mainte25 nance. 


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1 ‘‘(b) DONATIONS.—Subject to subsection (d), the 

2 Secretary may donate to an urban Indian organization 

3 that has entered into a contract or received a grant pursu4 ant to this title any personal or real property determined 

5 to be excess to the needs of the Indian Health Service or 

6 the General Services Administration for the purposes of 

7 carrying out the contract or grant. 

8 ‘‘(c) ACQUISITION OF PROPERTY.—The Secretary 

9 may acquire excess or surplus government personal or real 

10 property for donation, subject to subsection (d) to an 

11 urban Indian organization that has entered into a contract 

12 or received a grant pursuant to this title if the Secretary 

13 determines that the property is appropriate for use by the 

14 urban Indian organization for a purpose for which a con15 tract or grant is authorized under this title. 

16 ‘‘(d) PRIORITY.—In the event that the Secretary re17 ceives a request for a specific item of personal or real 

18 property described in subsections (b) or (c) from an urban 

19 Indian organization and from an Indian Tribe or Tribal 

20 Organization, the Secretary shall give priority to the re21 quest for donation to the Indian Tribe or Tribal Organiza22 tion if the Secretary receives the request from the Indian 

23 Tribe or Tribal Organization before the date the Secretary 

24 transfers title to the property or, if earlier, the date the 


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1 Secretary transfers the property physically, to the urban 

2 Indian organization. 

3 ‘‘(e) EXECUTIVE AGENCY STATUS.—For purposes of 

4 section 201(a) of the Federal Property and Administrative 

5 Services Act of 1949 (40 U.S.C 481(a)) (relating to Fed6 eral sources of supply), an urban Indian organization that 

7 has entered into a contract or received a grant pursuant 

8 to this title may be deemed to be an executive agency when 

9 carrying out such contract or grant. 

10 ‘‘SEC. 505. CONTRACTS AND GRANTS FOR THE DETERMINA11 TION OF UNMET HEALTH CARE NEEDS. 

12 ‘‘(a) GRANTS AND CONTRACTS AUTHORIZED.— 

13 Under authority of the Act of November 2, 1921 (25 

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

15 Secretary, acting through the Service, may enter into con16 tracts with or make grants to urban Indian organizations 

17 situated in Urban Centers for which contracts have not 

18 been entered into or grants have not been made under sec19 tion 503. 

20 ‘‘(b) PURPOSE.—The purpose of a contract or grant 

21 made under this section shall be the determination of the 

22 matters described in subsection (c)(1) in order to assist 

23 the Secretary in assessing the health status and health 

24 care needs of Urban Indians in the Urban Center involved 

25 and determining whether the Secretary should enter into 


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1 a contract or make a grant under section 503 with respect 

2 to the urban Indian organization which the Secretary has 

3 entered into a contract with, or made a grant to, under 

4 this section. 

5 ‘‘(c) GRANT AND CONTRACT REQUIREMENTS.—Any 

6 contract entered into, or grant made, by the Secretary 

7 under this section shall include requirements that— 

8 ‘‘(1) the urban Indian organization successfully 

9 undertakes to— 

10 ‘‘(A) document the health care status and 

11 unmet health care needs of urban Indians in 

12 the Urban Center involved; and 

13 ‘‘(B) with respect to urban Indians in the 

14 Urban Center involved, determine the matters 

15 described in paragraphs (2), (3), (4), and (7) of 

16 section 503(b); and 

17 ‘‘(2) the urban Indian organization complete 

18 performance of the contract, or carry out the re19 quirements of the grant, within 1 year after the date 

20 on which the Secretary and such organization enter 

21 into such contract, or within 1 year after such orga22 nization receives such grant, whichever is applicable. 

23 ‘‘(d) NO RENEWALS.—The Secretary may not renew 

24 any contract entered into or grant made under this sec25 tion. 


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1 ‘‘SEC. 506. EVALUATIONS; RENEWALS. 

2 ‘‘(a) PROCEDURES FOR EVALUATIONS.—The Sec3 retary, acting through the Service, shall develop proce4 dures to evaluate compliance with grant requirements and 

5 compliance with and performance of contracts entered into 

6 by urban Indian organizations under this title. Such pro7 cedures shall include provisions for carrying out the re8 quirements of this section. 

9 ‘‘(b) EVALUATIONS.—The Secretary, acting through 

10 the Service, shall evaluate the compliance of each Urban 

11 Indian Organization which has entered into a contract or 

12 received a grant under section 503 with the terms of such 

13 contract or grant. For purposes of this evaluation, the 

14 Secretary shall— 

15 ‘‘(1) acting through the Service, conduct an an16 nual onsite evaluation of the organization; or 

17 ‘‘(2) accept in lieu of such onsite evaluation evi18 dence of the organization’s provisional or full accred19 itation by a private independent entity recognized by 

20 the Secretary for purposes of conducting quality re21 views of providers participating in the Medicare pro22 gram under title XVIII of the Social Security Act. 

23 ‘‘(c) NONCOMPLIANCE; UNSATISFACTORY PERFORM24 ANCE.—If, as a result of the evaluations conducted under 

25 this section, the Secretary determines that an urban In26 dian organization has not complied with the requirements 


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1 of a grant or complied with or satisfactorily performed a 

2 contract under section 503, the Secretary shall, prior to 

3 renewing such contract or grant, attempt to resolve with 

4 the organization the areas of noncompliance or unsatisfac5 tory performance and modify the contract or grant to pre6 vent future occurrences of noncompliance or unsatisfac7 tory performance. If the Secretary determines that the 

8 noncompliance or unsatisfactory performance cannot be 

9 resolved and prevented in the future, the Secretary shall 

10 not renew the contract or grant with the organization and 

11 is authorized to enter into a contract or make a grant 

12 under section 503 with another urban Indian organization 

13 which is situated in the same Urban Center as the urban 

14 Indian organization whose contract or grant is not re15 newed under this section. 

16 ‘‘(d) CONSIDERATIONS FOR RENEWALS.—In deter17 mining whether to renew a contract or grant with an 

18 urban Indian organization under section 503 which has 

19 completed performance of a contract or grant under sec20 tion 504, the Secretary shall review the records of the 

21 urban Indian organization, the reports submitted under 

22 section 507, and shall consider the results of the onsite 

23 evaluations or accreditations under subsection (b). 


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1 ‘‘SEC. 507. OTHER CONTRACT AND GRANT REQUIREMENTS. 

2 ‘‘(a) PROCUREMENT.—Contracts with urban Indian 

3 organizations entered into pursuant to this title shall be 

4 in accordance with all Federal contracting laws and regu5 lations relating to procurement except that in the discre6 tion of the Secretary, such contracts may be negotiated 

7 without advertising and need not conform to the provisions 

8 of sections 1304 and 3131 through 3133 of title 40, 

9 United States Code. 

10 ‘‘(b) PAYMENTS UNDER CONTRACTS OR GRANTS.— 

11 ‘‘(1) IN GENERAL.—Payments under any con12 tracts or grants pursuant to this title, notwith13 standing any term or condition of such contract or 

14 grant— 

15 ‘‘(A) may be made in a single advance pay16 ment by the Secretary to the urban Indian or17 ganization by no later than the end of the first 

18 30 days of the funding period with respect to 

19 which the payments apply, unless the Secretary 

20 determines through an evaluation under section 

21 505 that the organization is not capable of ad22 ministering such a single advance payment; and 

23 ‘‘(B) if any portion thereof is unexpended 

24 by the urban Indian organization during the 

25 funding period with respect to which the pay26 ments initially apply, shall be carried forward 


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1 for expenditure with respect to allowable or re2 imbursable costs incurred by the organization 

3 during 1 or more subsequent funding periods 

4 without additional justification or documenta5 tion by the organization as a condition of car6 rying forward the availability for expenditure of 

7 such funds. 

8 ‘‘(2) SEMIANNUAL AND QUARTERLY PAYMENTS

9 AND REIMBURSEMENTS.—If the Secretary deter10 mines under paragraph (1)(A) that an urban Indian 

11 organization is not capable of administering an en12 tire single advance payment, on request of the urban 

13 Indian organization, the payments may be made— 

14 ‘‘(A) in semiannual or quarterly payments 

15 by not later than 30 days after the date on 

16 which the funding period with respect to which 

17 the payments apply begins; or 

18 ‘‘(B) by way of reimbursement. 

19 ‘‘(c) REVISION OR AMENDMENT OF CONTRACTS.— 

20 Notwithstanding any provision of law to the contrary, the 

21 Secretary may, at the request and consent of an urban 

22 Indian organization, revise or amend any contract entered 

23 into by the Secretary with such organization under this 

24 title as necessary to carry out the purposes of this title. 


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1 ‘‘(d) FAIR AND UNIFORM SERVICES AND ASSIST2 ANCE.—Contracts with or grants to urban Indian organi3 zations and regulations adopted pursuant to this title shall 

4 include provisions to assure the fair and uniform provision 

5 to urban Indians of services and assistance under such 

6 contracts or grants by such organizations. 

7 ‘‘SEC. 508. REPORTS AND RECORDS. 

8 ‘‘(a) REPORTS.— 

9 ‘‘(1) IN GENERAL.—For each fiscal year during 

10 which an urban Indian organization receives or ex11 pends funds pursuant to a contract entered into or 

12 a grant received pursuant to this title, such urban 

13 Indian organization shall submit to the Secretary 

14 not more frequently than every 6 months, a report 

15 that includes the following: 

16 ‘‘(A) In the case of a contract or grant 

17 under section 503, recommendations pursuant 

18 to section 503(a)(5). 

19 ‘‘(B) Information on activities conducted 

20 by the organization pursuant to the contract or 

21 grant. 

22 ‘‘(C) An accounting of the amounts and 

23 purpose for which Federal funds were ex24 pended. 


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1 ‘‘(D) A minimum set of data, using uni2 formly defined elements, as specified by the 

3 Secretary after consultation with urban Indian 

4 organizations. 

5 ‘‘(2) HEALTH STATUS AND SERVICES.— 

6 ‘‘(A) IN GENERAL.—Not later than 18 

7 months after the date of enactment of the In8 dian Health Care Improvement Act Amend9 ments of 2009, the Secretary, acting through 

10 the Service, shall submit to Congress a report 

11 evaluating— 

12 ‘‘(i) the health status of urban Indi13 ans; 

14 ‘‘(ii) the services provided to Indians 

15 pursuant to this title; and 

16 ‘‘(iii) areas of unmet needs in the de17 livery of health services to urban Indians. 

18 ‘‘(B) CONSULTATION AND CONTRACTS.— 

19 In preparing the report under paragraph (1), 

20 the Secretary— 

21 ‘‘(i) shall consult with urban Indian 

22 organizations; and 

23 ‘‘(ii) may enter into a contract with a 

24 national organization representing urban 


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1 Indian organizations to conduct any aspect 

2 of the report. 

3 ‘‘(b) AUDIT.—The reports and records of the urban 

4 Indian organization with respect to a contract or grant 

5 under this title shall be subject to audit by the Secretary 

6 and the Comptroller General of the United States. 

7 ‘‘(c) COSTS OF AUDITS.—The Secretary shall allow 

8 as a cost of any contract or grant entered into or awarded 

9 under section 502 or 503 the cost of an annual inde10 pendent financial audit conducted by— 

11 ‘‘(1) a certified public accountant; or 

12 ‘‘(2) a certified public accounting firm qualified 

13 to conduct Federal compliance audits. 

14 ‘‘SEC. 509. LIMITATION ON CONTRACT AUTHORITY. 

15 ‘‘The authority of the Secretary to enter into con16 tracts or to award grants under this title shall be to the 

17 extent, and in an amount, provided for in appropriation 

18 Acts. 

19 ‘‘SEC. 510. FACILITIES. 

20 ‘‘(a) GRANTS.—The Secretary, acting through the 

21 Service, may make grants to contractors or grant recipi22 ents under this title for the lease, purchase, renovation, 

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1 ents in complying with applicable licensure or certification 

2 requirements. 

3 ‘‘(b) LOAN FUND STUDY.—The Secretary, acting 

4 through the Service, may carry out a study to determine 

5 the feasibility of establishing a loan fund to provide to 

6 urban Indian organizations direct loans or guarantees for 

7 loans for the construction of health care facilities in a 

8 manner consistent with section 309, including by submit9 ting a report in accordance with subsection (c) of that sec10 tion. 

11 ‘‘SEC. 511. DIVISION OF URBAN INDIAN HEALTH. 

12 ‘‘There is established within the Service a Division 

13 of Urban Indian Health, which shall be responsible for— 

14 ‘‘(1) carrying out the provisions of this title; 

15 ‘‘(2) providing central oversight of the pro16 grams and services authorized under this title; and 

17 ‘‘(3) providing technical assistance to urban In18 dian organizations. 

19 ‘‘SEC. 512. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE20 RELATED SERVICES. 

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

22 through the Service, may make grants for the provision 

23 of health-related services in prevention of, treatment of, 

24 rehabilitation of, or school- and community-based edu25 cation regarding, alcohol and substance abuse in Urban 


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1 Centers to those urban Indian organizations with which 

2 the Secretary has entered into a contract under this title 

3 or under section 201. 

4 ‘‘(b) GOALS.—Each grant made pursuant to sub5 section (a) shall set forth the goals to be accomplished 

6 pursuant to the grant. The goals shall be specific to each 

7 grant as agreed to between the Secretary and the grantee. 

8 ‘‘(c) CRITERIA.—The Secretary shall establish cri9 teria for the grants made under subsection (a), including 

10 criteria relating to the following: 

11 ‘‘(1) The size of the urban Indian population. 

12 ‘‘(2) Capability of the organization to ade13 quately perform the activities required under the 

14 grant. 

15 ‘‘(3) Satisfactory performance standards for the 

16 organization in meeting the goals set forth in such 

17 grant. The standards shall be negotiated and agreed 

18 to between the Secretary and the grantee on a 

19 grant-by-grant basis. 

20 ‘‘(4) Identification of the need for services. 

21 ‘‘(d) ALLOCATION OF GRANTS.—The Secretary shall 

22 develop a methodology for allocating grants made pursu23 ant to this section based on the criteria established pursu24 ant to subsection (c). 


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1 ‘‘(e) GRANTS SUBJECT TO CRITERIA.—Any grant re2 ceived by an urban Indian organization under this Act for 

3 substance abuse prevention, treatment, and rehabilitation 

4 shall be subject to the criteria set forth in subsection (c). 

5 ‘‘SEC. 513. TREATMENT OF CERTAIN DEMONSTRATION 

6 PROJECTS. 

7 ‘‘Notwithstanding any other provision of law, the 

8 Tulsa Clinic and Oklahoma City Clinic demonstration 

9 projects shall— 

10 ‘‘(1) be permanent programs within the Serv11 ice’s direct care program; 

12 ‘‘(2) continue to be treated as Service Units 

13 and Operating Units in the allocation of resources 

14 and coordination of care; and 

15 ‘‘(3) continue to meet the requirements and 

16 definitions of an urban Indian organization in this 

17 Act, and shall not be subject to the provisions of the 

18 Indian Self-Determination and Education Assistance 

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

20 ‘‘SEC. 514. URBAN NIAAA TRANSFERRED PROGRAMS. 

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

22 through the Division of Urban Indian Health, shall make 

23 grants or enter into contracts with urban Indian organiza24 tions, to take effect not later than September 30, 2010, 

25 for the administration of urban Indian alcohol programs 


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1 that were originally established under the National Insti2 tute on Alcoholism and Alcohol Abuse (hereafter in this 

3 section referred to as ‘NIAAA’) and transferred to the 

4 Service. 

5 ‘‘(b) USE OF FUNDS.—Grants provided or contracts 

6 entered into under this section shall be used to provide 

7 support for the continuation of alcohol prevention and 

8 treatment services for urban Indian populations and such 

9 other objectives as are agreed upon between the Service 

10 and a recipient of a grant or contract under this section. 

11 ‘‘(c) ELIGIBILITY.—Urban Indian organizations that 

12 operate Indian alcohol programs originally funded under 

13 the NIAAA and subsequently transferred to the Service 

14 are eligible for grants or contracts under this section. 

15 ‘‘(d) REPORT.—The Secretary shall evaluate and re16 port to Congress on the activities of programs funded 

17 under this section not less than every 5 years. 

18 ‘‘SEC. 515. CONFERRING WITH URBAN INDIAN ORGANIZA19 TIONS. 

20 ‘‘(a) IN GENERAL.—The Secretary shall ensure that 

21 the Service confers or conferences, to the greatest extent 

22 practicable, with Urban Indian Organizations. 

23 ‘‘(b) DEFINITION OF CONFER; CONFERENCE.—In 

24 this section, the terms ‘confer’ and ‘conference’ mean an 


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1 open and free exchange of information and opinions 

2 that— 

3 ‘‘(1) leads to mutual understanding and com4 prehension; and 

5 ‘‘(2) emphasizes trust, respect, and shared re6 sponsibility. 

7 ‘‘SEC. 516. URBAN YOUTH TREATMENT CENTER DEM8 ONSTRATION. 

9 ‘‘(a) CONSTRUCTION AND OPERATION.— 

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

11 through the Service, through grant or contract, shall 

12 fund the construction and operation of at least 1 

13 residential treatment center in each Service Area 

14 that meets the eligibility requirements set forth in 

15 subsection (b) to demonstrate the provision of alco16 hol and substance abuse treatment services to Urban 

17 Indian youth in a culturally competent residential 

18 setting. 

19 ‘‘(2) TREATMENT.—Each residential treatment 

20 center described in paragraph (1) shall be in addi21 tion to any facilities constructed under section 

22 707(b). 

23 ‘‘(b) ELIGIBILITY REQUIREMENTS.—To be eligible to 

24 obtain a facility under subsection (a)(1), a Service Area 

25 shall meet the following requirements: 


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1 ‘‘(1) There is an Urban Indian Organization in 

2 the Service Area. 

3 ‘‘(2) There reside in the Service Area Urban In4 dian youth with need for alcohol and substance 

5 abuse treatment services in a residential setting. 

6 ‘‘(3) There is a significant shortage of cul7 turally competent residential treatment services for 

8 Urban Indian youth in the Service Area. 

9 ‘‘SEC. 517. GRANTS FOR DIABETES PREVENTION, TREAT10 MENT, AND CONTROL. 

11 ‘‘(a) GRANTS AUTHORIZED.—The Secretary may 

12 make grants to those urban Indian organizations that 

13 have entered into a contract or have received a grant 

14 under this title for the provision of services for the preven15 tion and treatment of, and control of the complications 

16 resulting from, diabetes among urban Indians. 

17 ‘‘(b) GOALS.—Each grant made pursuant to sub18 section (a) shall set forth the goals to be accomplished 

19 under the grant. The goals shall be specific to each grant 

20 as agreed to between the Secretary and the grantee. 

21 ‘‘(c) ESTABLISHMENT OF CRITERIA.—The Secretary 

22 shall establish criteria for the grants made under sub23 section (a) relating to— 

24 ‘‘(1) the size and location of the urban Indian 

25 population to be served; 


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1 ‘‘(2) the need for prevention of and treatment 

2 of, and control of the complications resulting from, 

3 diabetes among the urban Indian population to be 

4 served; 

5 ‘‘(3) performance standards for the organiza6 tion in meeting the goals set forth in such grant 

7 that are negotiated and agreed to by the Secretary 

8 and the grantee; 

9 ‘‘(4) the capability of the organization to ade10 quately perform the activities required under the 

11 grant; and 

12 ‘‘(5) the willingness of the organization to col13 laborate with the registry, if any, established by the 

14 Secretary under section 204(e) in the Area Office of 

15 the Service in which the organization is located. 

16 ‘‘(d) FUNDS SUBJECT TO CRITERIA.—Any funds re17 ceived by an urban Indian organization under this Act for 

18 the prevention, treatment, and control of diabetes among 

19 urban Indians shall be subject to the criteria developed 

20 by the Secretary under subsection (c). 

21 ‘‘SEC. 518. COMMUNITY HEALTH REPRESENTATIVES. 

22 ‘‘The Secretary, acting through the Service, may 

23 enter into contracts with, and make grants to, urban In24 dian organizations for the employment of Indians trained 

25 as health service providers through the Community Health 


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1 Representatives Program under section 109 in the provi2 sion of health care, health promotion, and disease preven3 tion services to urban Indians. 

4 ‘‘SEC. 519. EFFECTIVE DATE. 

5 ‘‘The amendments made by the Indian Health Care 

6 Improvement Act Amendments of 2009 to this title shall 

7 take effect beginning on the date of enactment of that Act, 

8 regardless of whether the Secretary has promulgated regu9 lations implementing such amendments. 

10 ‘‘SEC. 520. ELIGIBILITY FOR SERVICES. 

11 ‘‘Urban Indians shall be eligible for, and the ultimate 

12 beneficiaries of, health care or referral services provided 

13 pursuant to this title. 

14 ‘‘SEC. 521. AUTHORIZATION OF APPROPRIATIONS. 

15 ‘‘(a) IN GENERAL.—There are authorized to be ap16 propriated such sums as may be necessary for each fiscal 

17 year through fiscal year 2025 to carry out this title. 

18 ‘‘(b) URBAN INDIAN ORGANIZATIONS.—The Sec19 retary, acting through the Service, is authorized to estab20 lish programs, including programs for the awarding of 

21 grants, for urban Indian organizations that are identical 

22 to any programs established pursuant to section 126 (be23 havioral health training), section 210 (school health edu24 cation), section 212 (prevention of communicable dis25 eases), section 701 (behavioral health prevention and 


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1 treatment services), and section 707(g) (multidrug abuse 

2 program). 

3 ‘‘SEC. 522. HEALTH INFORMATION TECHNOLOGY. 

4 ‘‘The Secretary, acting through the Service, may 

5 make grants to urban Indian organizations under this title 

6 for the development, adoption, and implementation of 

7 health information technology (as defined in section 

8 3000(5) of the American Recovery and Reinvestment Act), 

9 telemedicine services development, and related infrastruc10 ture. 

11 ‘‘TITLE VI—ORGANIZATIONAL 

12 IMPROVEMENTS 

13 ‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV14 ICE AS AN AGENCY OF THE PUBLIC HEALTH 

15 SERVICE. 

16 ‘‘(a) ESTABLISHMENT.— 

17 ‘‘(1) IN GENERAL.—In order to more effectively 

18 and efficiently carry out the responsibilities, authori19 ties, and functions of the United States to provide 

20 health care services to Indians and Indian Tribes, as 

21 are or may be hereafter provided by Federal statute 

22 or treaties, there is established within the Public 

23 Health Service of the Department the Indian Health 

24 Service. 


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1 ‘‘(2) ASSISTANT SECRETARY OF INDIAN

2 HEALTH.—The Service shall be administered by an 

3 Assistant Secretary of Indian Health, who shall be 

4 appointed by the President, by and with the advice 

5 and consent of the Senate. The Assistant Secretary 

6 shall report to the Secretary. Effective with respect 

7 to an individual appointed by the President, by and 

8 with the advice and consent of the Senate, after 

9 January 1, 2010, the term of service of the Assist10 ant Secretary shall be 4 years. An Assistant Sec11 retary may serve more than 1 term. 

12 ‘‘(3) INCUMBENT.—The individual serving in 

13 the position of Director of the Service on the day be14 fore the date of enactment of the Indian Health 

15 Care Improvement Act Amendments of 2009 shall 

16 serve as Assistant Secretary. 

17 ‘‘(4) ADVOCACY AND CONSULTATION.—The po18 sition of Assistant Secretary is established to, in a 

19 manner consistent with the government-to-govern20 ment relationship between the United States and In21 dian Tribes— 

22 ‘‘(A) facilitate advocacy for the develop23 ment of appropriate Indian health policy; and 

24 ‘‘(B) promote consultation on matters re25 lating to Indian health. 


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1 ‘‘(b) AGENCY.—The Service shall be an agency within 

2 the Public Health Service of the Department, and shall 

3 not be an office, component, or unit of any other agency 

4 of the Department. 

5 ‘‘(c) DUTIES.—The Assistant Secretary shall— 

6 ‘‘(1) perform all functions that were, on the day 

7 before the date of enactment of the Indian Health 

8 Care Improvement Act Amendments of 2009, car9 ried out by or under the direction of the individual 

10 serving as Director of the Service on that day; 

11 ‘‘(2) perform all functions of the Secretary re12 lating to the maintenance and operation of hospital 

13 and health facilities for Indians and the planning 

14 for, and provision and utilization of, health services 

15 for Indians; 

16 ‘‘(3) administer all health programs under 

17 which health care is provided to Indians based upon 

18 their status as Indians which are administered by 

19 the Secretary, including programs under— 

20 ‘‘(A) this Act; 

21 ‘‘(B) the Act of November 2, 1921 (25 

22 U.S.C. 13); 

23 ‘‘(C) the Act of August 5, 1954 (42 U.S.C. 

24 2001 et seq.); 


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1 ‘‘(D) the Act of August 16, 1957 (42 

2 U.S.C. 2005 et seq.); and 

3 ‘‘(E) the Indian Self-Determination and 

4 Education Assistance Act (25 U.S.C. 450 et 

5 seq.); 

6 ‘‘(4) administer all scholarship and loan func7 tions carried out under title I; 

8 ‘‘(5) report directly to the Secretary concerning 

9 all policy- and budget-related matters affecting In10 dian health; 

11 ‘‘(6) collaborate with the Assistant Secretary 

12 for Health concerning appropriate matters of Indian 

13 health that affect the agencies of the Public Health 

14 Service; 

15 ‘‘(7) advise each Assistant Secretary of the De16 partment concerning matters of Indian health with 

17 respect to which that Assistant Secretary has au18 thority and responsibility; 

19 ‘‘(8) advise the heads of other agencies and pro20 grams of the Department concerning matters of In21 dian health with respect to which those heads have 

22 authority and responsibility; 

23 ‘‘(9) coordinate the activities of the Department 

24 concerning matters of Indian health; and 


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1 ‘‘(10) perform such other functions as the Sec2 retary may designate. 

3 ‘‘(d) AUTHORITY.— 

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

5 through the Assistant Secretary, shall have the au6 thority— 

7 ‘‘(A) except to the extent provided for in 

8 paragraph (2), to appoint and compensate em9 ployees for the Service in accordance with title 

10 5, United States Code; 

11 ‘‘(B) to enter into contracts for the pro12 curement of goods and services to carry out the 

13 functions of the Service; and 

14 ‘‘(C) to manage, expend, and obligate all 

15 funds appropriated for the Service. 

16 ‘‘(2) PERSONNEL ACTIONS.—Notwithstanding 

17 any other provision of law, the provisions of section 

18 12 of the Act of June 18, 1934 (48 Stat. 986; 25 

19 U.S.C. 472), shall apply to all personnel actions 

20 taken with respect to new positions created within 

21 the Service as a result of its establishment under 

22 subsection (a). 

23 ‘‘(e) REFERENCES.—Any reference to the Director of 

24 the Indian Health Service in any other Federal law, Exec25 utive order, rule, regulation, or delegation of authority, or 


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1 in any document of or relating to the Director of the In2 dian Health Service, shall be deemed to refer to the Assist3 ant Secretary. 

4 ‘‘SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYS5 TEM. 

6 ‘‘(a) ESTABLISHMENT.— 

7 ‘‘(1) IN GENERAL.—The Secretary shall estab8 lish an automated management information system 

9 for the Service. 

10 ‘‘(2) REQUIREMENTS OF SYSTEM.—The infor11 mation system established under paragraph (1) shall 

12 include— 

13 ‘‘(A) a financial management system; 

14 ‘‘(B) a patient care information system for 

15 each area served by the Service; 

16 ‘‘(C) privacy protections consistent with 

17 the regulations promulgated under section 

18 264(c) of the Health Insurance Portability and 

19 Accountability Act of 1996 or, to the extent 

20 consistent with such regulations, other Federal 

21 rules applicable to privacy of automated man22 agement information systems of a Federal 

23 agency; 

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1 sociated with the provision of specific medical 

2 treatments or services in each Area office of the 

3 Service; 

4 ‘‘(E) an interface mechanism for patient 

5 billing and accounts receivable system; and 

6 ‘‘(F) a training component. 

7 ‘‘(b) PROVISION OF SYSTEMS TO TRIBES AND ORGA8 NIZATIONS.—The Secretary shall provide each Tribal 

9 Health Program automated management information sys10 tems which— 

11 ‘‘(1) meet the management information needs 

12 of such Tribal Health Program with respect to the 

13 treatment by the Tribal Health Program of patients 

14 of the Service; and 

15 ‘‘(2) meet the management information needs 

16 of the Service. 

17 ‘‘(c) ACCESS TO RECORDS.—The Service shall pro18 vide access of patients to their medical or health records 

19 which are held by, or on behalf of, the Service in accord20 ance with the regulations promulgated under section 

21 264(c) of the Health Insurance Portability and Account22 ability Act of 1996 or, to the extent consistent with such 

23 regulations, other Federal rules applicable to access to 

24 health care records. 


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1 ‘‘(d) AUTHORITY TO ENHANCE INFORMATION TECH2 NOLOGY.—The Secretary, acting through the Assistant 

3 Secretary, shall have the authority to enter into contracts, 

4 agreements, or joint ventures with other Federal agencies, 

5 States, private and nonprofit organizations, for the pur6 pose of enhancing information technology in Indian 

7 Health Programs and facilities. 

8 ‘‘SEC. 603. AUTHORIZATION OF APPROPRIATIONS. 

9 ‘‘There is authorized to be appropriated such sums 

10 as may be necessary for each fiscal year through fiscal 

11 year 2025 to carry out this title. 

12 ‘‘TITLE VII—BEHAVIORAL 

13 HEALTH PROGRAMS 

14 ‘‘SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREAT15 MENT SERVICES. 

16 ‘‘(a) PURPOSES.—The purposes of this section are as 

17 follows: 

18 ‘‘(1) To authorize and direct the Secretary, act19 ing through the Service, to develop a comprehensive 

20 behavioral health prevention and treatment program 

21 which emphasizes collaboration among alcohol and 

22 substance abuse, social services, and mental health 

23 programs. 

24 ‘‘(2) To provide information, direction, and 

25 guidance relating to mental illness and dysfunction 


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1 and self-destructive behavior, including child abuse 

2 and family violence, to those Federal, tribal, State, 

3 and local agencies responsible for programs in In4 dian communities in areas of health care, education, 

5 social services, child and family welfare, alcohol and 

6 substance abuse, law enforcement, and judicial serv7 ices. 

8 ‘‘(3) To assist Indian Tribes to identify services 

9 and resources available to address mental illness and 

10 dysfunctional and self-destructive behavior. 

11 ‘‘(4) To provide authority and opportunities for 

12 Indian Tribes and Tribal Organizations to develop, 

13 implement, and coordinate with community-based 

14 programs which include identification, prevention, 

15 education, referral, and treatment services, including 

16 through multidisciplinary resource teams. 

17 ‘‘(5) To ensure that Indians, as citizens of the 

18 United States and of the States in which they re19 side, have the same access to behavioral health serv20 ices to which all citizens have access. 

21 ‘‘(6) To modify or supplement existing pro22 grams and authorities in the areas identified in 

23 paragraph (2). 

24 ‘‘(b) PLANS.— 


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1 ‘‘(1) DEVELOPMENT.—The Secretary, acting 

2 through the Service, shall encourage Indian Tribes 

3 and Tribal Organizations to develop tribal plans, 

4 and urban Indian organizations to develop local 

5 plans, and for all such groups to participate in de6 veloping areawide plans for Indian Behavioral 

7 Health Services. The plans shall include, to the ex8 tent feasible, the following components: 

9 ‘‘(A) An assessment of the scope of alcohol 

10 or other substance abuse, mental illness, and 

11 dysfunctional and self-destructive behavior, in12 cluding suicide, child abuse, and family vio13 lence, among Indians, including— 

14 ‘‘(i) the number of Indians served who 

15 are directly or indirectly affected by such 

16 illness or behavior; or 

17 ‘‘(ii) an estimate of the financial and 

18 human cost attributable to such illness or 

19 behavior. 

20 ‘‘(B) An assessment of the existing and 

21 additional resources necessary for the preven22 tion and treatment of such illness and behavior, 

23 including an assessment of the progress toward 

24 achieving the availability of the full continuum 

25 of care described in subsection (c). 


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1 ‘‘(C) An estimate of the additional funding 

2 needed by the Service, Indian Tribes, Tribal 

3 Organizations, and urban Indian organizations 

4 to meet their responsibilities under the plans. 

5 ‘‘(2) NATIONAL CLEARINGHOUSE.—The Sec6 retary, acting through the Service, shall coordinate 

7 with existing national clearinghouses and informa8 tion centers to include at the clearinghouses and 

9 centers plans and reports on the outcomes of such 

10 plans developed by Indian Tribes, Tribal Organiza11 tions, urban Indian organizations, and Service Areas 

12 relating to behavioral health. The Secretary shall en13 sure access to these plans and outcomes by any In14 dian Tribe, Tribal Organization, urban Indian orga15 nization, or the Service. 

16 ‘‘(3) TECHNICAL ASSISTANCE.—The Secretary 

17 shall provide technical assistance to Indian Tribes, 

18 Tribal Organizations, and urban Indian organiza19 tions in preparation of plans under this section and 

20 in developing standards of care that may be used 

21 and adopted locally. 

22 ‘‘(c) PROGRAMS.—The Secretary, acting through the 

23 Service, shall provide, to the extent feasible and if funding 

24 is available, programs including the following: 


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1 ‘‘(1) COMPREHENSIVE CARE.—A comprehensive 

2 continuum of behavioral health care which pro3 vides— 

4 ‘‘(A) community-based prevention, inter5 vention, outpatient, and behavioral health 

6 aftercare; 

7 ‘‘(B) detoxification (social and medical); 

8 ‘‘(C) acute hospitalization; 

9 ‘‘(D) intensive outpatient/day treatment; 

10 ‘‘(E) residential treatment; 

11 ‘‘(F) transitional living for those needing a 

12 temporary, stable living environment that is 

13 supportive of treatment and recovery goals; 

14 ‘‘(G) emergency shelter; 

15 ‘‘(H) intensive case management; and 

16 ‘‘(I) diagnostic services. 

17 ‘‘(2) CHILD CARE.—Behavioral health services 

18 for Indians from birth through age 17, including— 

19 ‘‘(A) preschool and school age fetal alcohol 

20 disorder services, including assessment and be21 havioral intervention; 

22 ‘‘(B) mental health and substance abuse 

23 services (emotional, organic, alcohol, drug, in24 halant, and tobacco); 


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1 ‘‘(C) identification and treatment of co-oc2 curring disorders and comorbidity; 

3 ‘‘(D) prevention of alcohol, drug, inhalant, 

4 and tobacco use; 

5 ‘‘(E) early intervention, treatment, and 

6 aftercare; 

7 ‘‘(F) promotion of healthy approaches to 

8 risk and safety issues; and 

9 ‘‘(G) identification and treatment of ne10 glect and physical, mental, and sexual abuse. 

11 ‘‘(3) ADULT CARE.—Behavioral health services 

12 for Indians from age 18 through 55, including— 

13 ‘‘(A) early intervention, treatment, and 

14 aftercare; 

15 ‘‘(B) mental health and substance abuse 

16 services (emotional, alcohol, drug, inhalant, and 

17 tobacco), including sex specific services; 

18 ‘‘(C) identification and treatment of co-oc19 curring disorders (dual diagnosis) and comor20 bidity; 

21 ‘‘(D) promotion of healthy approaches for 

22 risk-related behavior; 

23 ‘‘(E) treatment services for women at risk 

24 of giving birth to a child with a fetal alcohol 

25 disorder; and 


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1 ‘‘(F) sex specific treatment for sexual as2 sault and domestic violence. 

3 ‘‘(4) FAMILY CARE.—Behavioral health services 

4 for families, including— 

5 ‘‘(A) early intervention, treatment, and 

6 aftercare for affected families; 

7 ‘‘(B) treatment for sexual assault and do8 mestic violence; and 

9 ‘‘(C) promotion of healthy approaches re10 lating to parenting, domestic violence, and other 

11 abuse issues. 

12 ‘‘(5) ELDER CARE.—Behavioral health services 

13 for Indians 56 years of age and older, including— 

14 ‘‘(A) early intervention, treatment, and 

15 aftercare; 

16 ‘‘(B) mental health and substance abuse 

17 services (emotional, alcohol, drug, inhalant, and 

18 tobacco), including sex specific services; 

19 ‘‘(C) identification and treatment of co-oc20 curring disorders (dual diagnosis) and comor21 bidity; 

22 ‘‘(D) promotion of healthy approaches to 

23 managing conditions related to aging; 


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1 ‘‘(E) sex specific treatment for sexual as2 sault, domestic violence, neglect, physical and 

3 mental abuse and exploitation; and 

4 ‘‘(F) identification and treatment of de5 mentias regardless of cause. 

6 ‘‘(d) COMMUNITY BEHAVIORAL HEALTH PLAN.— 

7 ‘‘(1) ESTABLISHMENT.—The governing body of 

8 any Indian Tribe, Tribal Organization, or urban In9 dian organization may adopt a resolution for the es10 tablishment of a community behavioral health plan 

11 providing for the identification and coordination of 

12 available resources and programs to identify, pre13 vent, or treat substance abuse, mental illness, or 

14 dysfunctional and self-destructive behavior, including 

15 child abuse and family violence, among its members 

16 or its service population. This plan should include 

17 behavioral health services, social services, intensive 

18 outpatient services, and continuing aftercare. 

19 ‘‘(2) TECHNICAL ASSISTANCE.—At the request 

20 of an Indian Tribe, Tribal Organization, or urban 

21 Indian organization, the Bureau of Indian Affairs 

22 and the Service shall cooperate with and provide 

23 technical assistance to the Indian Tribe, Tribal Or24 ganization, or urban Indian organization in the de25 velopment and implementation of such plan. 


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1 ‘‘(3) FUNDING.—The Secretary, acting through 

2 the Service, may make funding available to Indian 

3 Tribes and Tribal Organizations which adopt a reso4 lution pursuant to paragraph (1) to obtain technical 

5 assistance for the development of a community be6 havioral health plan and to provide administrative 

7 support in the implementation of such plan. 

8 ‘‘(e) COORDINATION FOR AVAILABILITY OF SERV9 ICES.—The Secretary, acting through the Service, shall 

10 coordinate behavioral health planning, to the extent fea11 sible, with other Federal agencies and with State agencies, 

12 to encourage comprehensive behavioral health services for 

13 Indians regardless of their place of residence. 

14 ‘‘(f) MENTAL HEALTH CARE NEED ASSESSMENT.— 

15 Not later than 1 year after the date of enactment of the 

16 Indian Health Care Improvement Act Amendments of 

17 2009, the Secretary, acting through the Service, shall 

18 make an assessment of the need for inpatient mental 

19 health care among Indians and the availability and cost 

20 of inpatient mental health facilities which can meet such 

21 need. In making such assessment, the Secretary shall con22 sider the possible conversion of existing, underused Service 

23 hospital beds into psychiatric units to meet such need. 


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1 ‘‘SEC. 702. MEMORANDA OF AGREEMENT WITH THE DE2 PARTMENT OF THE INTERIOR. 

3 ‘‘(a) CONTENTS.—Not later than 12 months after the 

4 date of enactment of the Indian Health Care Improvement 

5 Act Amendments of 2009, the Secretary, acting through 

6 the Service, and the Secretary of the Interior shall develop 

7 and enter into a memoranda of agreement, or review and 

8 update any existing memoranda of agreement, as required 

9 by section 4205 of the Indian Alcohol and Substance 

10 Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 

11 2411) under which the Secretaries address the following: 

12 ‘‘(1) The scope and nature of mental illness and 

13 dysfunctional and self-destructive behavior, including 

14 child abuse and family violence, among Indians. 

15 ‘‘(2) The existing Federal, tribal, State, local, 

16 and private services, resources, and programs avail17 able to provide behavioral health services for Indi18 ans. 

19 ‘‘(3) The unmet need for additional services, re20 sources, and programs necessary to meet the needs 

21 identified pursuant to paragraph (1). 

22 ‘‘(4)(A) The right of Indians, as citizens of the 

23 United States and of the States in which they re24 side, to have access to behavioral health services to 

25 which all citizens have access. 


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1 ‘‘(B) The right of Indians to participate in, and 

2 receive the benefit of, such services. 

3 ‘‘(C) The actions necessary to protect the exer4 cise of such right. 

5 ‘‘(5) The responsibilities of the Bureau of In6 dian Affairs and the Service, including mental illness 

7 identification, prevention, education, referral, and 

8 treatment services (including services through multi9 disciplinary resource teams), at the central, area, 

10 and agency and Service Unit, Service Area, and 

11 headquarters levels to address the problems identi12 fied in paragraph (1). 

13 ‘‘(6) A strategy for the comprehensive coordina14 tion of the behavioral health services provided by the 

15 Bureau of Indian Affairs and the Service to meet 

16 the problems identified pursuant to paragraph (1), 

17 including— 

18 ‘‘(A) the coordination of alcohol and sub19 stance abuse programs of the Service, the Bu20 reau of Indian Affairs, and Indian Tribes and 

21 Tribal Organizations (developed under the In22 dian Alcohol and Substance Abuse Prevention 

23 and Treatment Act of 1986 (25 U.S.C. 2401 et 

24 seq.)) with behavioral health initiatives pursu25 ant to this Act, particularly with respect to the 


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1 referral and treatment of dually diagnosed indi2 viduals requiring behavioral health and sub3 stance abuse treatment; and 

4 ‘‘(B) ensuring that the Bureau of Indian 

5 Affairs and Service programs and services (in6 cluding multidisciplinary resource teams) ad7 dressing child abuse and family violence are co8 ordinated with such non-Federal programs and 

9 services. 

10 ‘‘(7) Directing appropriate officials of the Bu11 reau of Indian Affairs and the Service, particularly 

12 at the agency and Service Unit levels, to cooperate 

13 fully with tribal requests made pursuant to commu14 nity behavioral health plans adopted under section 

15 701(c) and section 4206 of the Indian Alcohol and 

16 Substance Abuse Prevention and Treatment Act of 

17 1986 (25 U.S.C. 2412). 

18 ‘‘(8) Providing for an annual review of such 

19 agreement by the Secretaries which shall be provided 

20 to Congress and Indian Tribes and Tribal Organiza21 tions. 

22 ‘‘(b) SPECIFIC PROVISIONS REQUIRED.—The memo23 randa of agreement updated or entered into pursuant to 

24 subsection (a) shall include specific provisions pursuant to 

25 which the Service shall assume responsibility for— 


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1 ‘‘(1) the determination of the scope of the prob2 lem of alcohol and substance abuse among Indians, 

3 including the number of Indians within the jurisdic4 tion of the Service who are directly or indirectly af5 fected by alcohol and substance abuse and the finan6 cial and human cost; 

7 ‘‘(2) an assessment of the existing and needed 

8 resources necessary for the prevention of alcohol and 

9 substance abuse and the treatment of Indians af10 fected by alcohol and substance abuse; and 

11 ‘‘(3) an estimate of the funding necessary to 

12 adequately support a program of prevention of alco13 hol and substance abuse and treatment of Indians 

14 affected by alcohol and substance abuse. 

15 ‘‘(c) PUBLICATION.—Each memorandum of agree16 ment entered into or renewed (and amendments or modi17 fications thereto) under subsection (a) shall be published 

18 in the Federal Register. At the same time as publication 

19 in the Federal Register, the Secretary shall provide a copy 

20 of such memoranda, amendment, or modification to each 

21 Indian Tribe, Tribal Organization, and urban Indian orga22 nization. 

23 ‘‘SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PRE24 VENTION AND TREATMENT PROGRAM. 

25 ‘‘(a) ESTABLISHMENT.— 


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

2 through the Service, shall provide a program of com3 prehensive behavioral health, prevention, treatment, 

4 and aftercare, including Systems of Care, which 

5 shall include— 

6 ‘‘(A) prevention, through educational inter7 vention, in Indian communities; 

8 ‘‘(B) acute detoxification, psychiatric hos9 pitalization, residential, and intensive outpatient 

10 treatment; 

11 ‘‘(C) community-based rehabilitation and 

12 aftercare; 

13 ‘‘(D) community education and involve14 ment, including extensive training of health 

15 care, educational, and community-based per16 sonnel; 

17 ‘‘(E) specialized residential treatment pro18 grams for high-risk populations, including preg19 nant and postpartum women and their children; 

20 and 

21 ‘‘(F) diagnostic services. 

22 ‘‘(2) TARGET POPULATIONS.—The target popu23 lation of such programs shall be members of Indian 

24 Tribes. Efforts to train and educate key members of 

25 the Indian community shall also target employees of 


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1 health, education, judicial, law enforcement, legal, 

2 and social service programs. 

3 ‘‘(b) CONTRACT HEALTH SERVICES.— 

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

5 through the Service, may enter into contracts with 

6 public or private providers of behavioral health treat7 ment services for the purpose of carrying out the 

8 program required under subsection (a). 

9 ‘‘(2) PROVISION OF ASSISTANCE.—In carrying 

10 out this subsection, the Secretary shall provide as11 sistance to Indian Tribes and Tribal Organizations 

12 to develop criteria for the certification of behavioral 

13 health service providers and accreditation of service 

14 facilities which meet minimum standards for such 

15 services and facilities. 

16 ‘‘SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM. 

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

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

19 as the ‘Snyder Act’), the Secretary shall establish and 

20 maintain a mental health technician program within the 

21 Service which— 

22 ‘‘(1) provides for the training of Indians as 

23 mental health technicians; and 

24 ‘‘(2) employs such technicians in the provision 

25 of community-based mental health care that includes 


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1 identification, prevention, education, referral, and 

2 treatment services. 

3 ‘‘(b) PARAPROFESSIONAL TRAINING.—In carrying 

4 out subsection (a), the Secretary, acting through the Serv5 ice, shall provide high-standard paraprofessional training 

6 in mental health care necessary to provide quality care to 

7 the Indian communities to be served. Such training shall 

8 be based upon a curriculum developed or approved by the 

9 Secretary which combines education in the theory of men10 tal health care with supervised practical experience in the 

11 provision of such care. 

12 ‘‘(c) SUPERVISION AND EVALUATION OF TECHNI13 CIANS.—The Secretary, acting through the Service, shall 

14 supervise and evaluate the mental health technicians in 

15 the training program. 

16 ‘‘(d) TRADITIONAL HEALTH CARE PRACTICES.—The 

17 Secretary, acting through the Service, shall ensure that 

18 the program established pursuant to this subsection in19 volves the use and promotion of the traditional health care 

20 practices of the Indian Tribes to be served. 

21 ‘‘SEC. 705. LICENSING REQUIREMENT FOR MENTAL 

22 HEALTH CARE WORKERS. 

23 ‘‘(a) IN GENERAL.—Subject to the provisions of sec24 tion 221, and except as provided in subsection (b), any 

25 individual employed as a psychologist, social worker, or 


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1 marriage and family therapist for the purpose of providing 

2 mental health care services to Indians in a clinical setting 

3 under this Act is required to be licensed as a psychologist, 

4 social worker, or marriage and family therapist, respec5 tively. 

6 ‘‘(b) TRAINEES.—An individual may be employed as 

7 a trainee in psychology, social work, or marriage and fam8 ily therapy to provide mental health care services de9 scribed in subsection (a) if such individual— 

10 ‘‘(1) works under the direct supervision of a li11 censed psychologist, social worker, or marriage and 

12 family therapist, respectively; 

13 ‘‘(2) is enrolled in or has completed at least 2 

14 years of course work at a post-secondary, accredited 

15 education program for psychology, social work, mar16 riage and family therapy, or counseling; and 

17 ‘‘(3) meets such other training, supervision, and 

18 quality review requirements as the Secretary may es19 tablish. 

20 ‘‘SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS. 

21 ‘‘(a) GRANTS.—The Secretary, consistent with sec22 tion 701, may make grants to Indian Tribes, Tribal Orga23 nizations, and urban Indian organizations to develop and 

24 implement a comprehensive behavioral health program of 

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1 tion services that specifically addresses the cultural, his2 torical, social, and child care needs of Indian women, re3 gardless of age. 

4 ‘‘(b) USE OF GRANT FUNDS.—A grant made pursu5 ant to this section may be used to— 

6 ‘‘(1) develop and provide community training, 

7 education, and prevention programs for Indian 

8 women relating to behavioral health issues, including 

9 fetal alcohol disorders; 

10 ‘‘(2) identify and provide psychological services, 

11 counseling, advocacy, support, and relapse preven12 tion to Indian women and their families; and 

13 ‘‘(3) develop prevention and intervention models 

14 for Indian women which incorporate traditional 

15 health care practices, cultural values, and commu16 nity and family involvement. 

17 ‘‘(c) CRITERIA.—The Secretary, in consultation with 

18 Indian Tribes and Tribal Organizations, shall establish 

19 criteria for the review and approval of applications and 

20 proposals for funding under this section. 

21 ‘‘(d) ALLOCATION OF FUNDS FOR URBAN INDIAN

22 ORGANIZATIONS.—Twenty percent of the funds appro23 priated pursuant to this section shall be used to make 

24 grants to urban Indian organizations. 


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1 ‘‘SEC. 707. INDIAN YOUTH PROGRAM. 

2 ‘‘(a) DETOXIFICATION AND REHABILITATION.—The 

3 Secretary, acting through the Service, consistent with sec4 tion 701, shall develop and implement a program for acute 

5 detoxification and treatment for Indian youths, including 

6 behavioral health services. The program shall include re7 gional treatment centers designed to include detoxification 

8 and rehabilitation for both sexes on a referral basis and 

9 programs developed and implemented by Indian Tribes or 

10 Tribal Organizations at the local level under the Indian 

11 Self-Determination and Education Assistance Act (25 

12 U.S.C. 450 et seq.). Regional centers shall be integrated 

13 with the intake and rehabilitation programs based in the 

14 referring Indian community. 

15 ‘‘(b) ALCOHOL AND SUBSTANCE ABUSE TREATMENT

16 CENTERS OR FACILITIES.— 

17 ‘‘(1) ESTABLISHMENT.— 

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

19 through the Service, shall construct, renovate, 

20 or, as necessary, purchase, and appropriately 

21 staff and operate, at least 1 youth regional 

22 treatment center or treatment network in each 

23 area under the jurisdiction of an Area Office. 

24 ‘‘(B) AREA OFFICE IN CALIFORNIA.—For 

25 the purposes of this subsection, the Area Office 

26 in California shall be considered to be 2 Area 


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1 Offices, 1 office whose jurisdiction shall be con2 sidered to encompass the northern area of the 

3 State of California, and 1 office whose jurisdic4 tion shall be considered to encompass the re5 mainder of the State of California for the pur6 pose of implementing California treatment net7 works. 

8 ‘‘(2) FUNDING.—For the purpose of staffing 

9 and operating such centers or facilities, funding 

10 shall be pursuant to the Act of November 2, 1921 

11 (25 U.S.C. 13). 

12 ‘‘(3) LOCATION.—A youth treatment center 

13 constructed or purchased under this subsection shall 

14 be constructed or purchased at a location within the 

15 area described in paragraph (1) agreed upon (by ap16 propriate tribal resolution) by a majority of the In17 dian Tribes to be served by such center. 

18 ‘‘(4) SPECIFIC PROVISION OF FUNDS.— 

19 ‘‘(A) IN GENERAL.—Notwithstanding any 

20 other provision of this title, the Secretary may, 

21 from amounts authorized to be appropriated for 

22 the purposes of carrying out this section, make 

23 funds available to— 

24 ‘‘(i) the Tanana Chiefs Conference, 

25 Incorporated, for the purpose of leasing, 


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1 constructing, renovating, operating, and 

2 maintaining a residential youth treatment 

3 facility in Fairbanks, Alaska; and 

4 ‘‘(ii) the Southeast Alaska Regional 

5 Health Corporation to staff and operate a 

6 residential youth treatment facility without 

7 regard to the proviso set forth in section 

8 4(l) of the Indian Self-Determination and 

9 Education Assistance Act (25 U.S.C. 

10 450b(l)). 

11 ‘‘(B) PROVISION OF SERVICES TO ELIGI12 BLE YOUTHS.—Until additional residential 

13 youth treatment facilities are established in 

14 Alaska pursuant to this section, the facilities 

15 specified in subparagraph (A) shall make every 

16 effort to provide services to all eligible Indian 

17 youths residing in Alaska. 

18 ‘‘(c) INTERMEDIATE ADOLESCENT BEHAVIORAL

19 HEALTH SERVICES.— 

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

21 through the Service, may provide intermediate be22 havioral health services, which may incorporate Sys23 tems of Care, to Indian children and adolescents, in24 cluding— 

25 ‘‘(A) pretreatment assistance; 


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1 ‘‘(B) inpatient, outpatient, and aftercare 

2 services; 

3 ‘‘(C) emergency care; 

4 ‘‘(D) suicide prevention and crisis interven5 tion; and 

6 ‘‘(E) prevention and treatment of mental 

7 illness and dysfunctional and self-destructive 

8 behavior, including child abuse and family vio9 lence. 

10 ‘‘(2) USE OF FUNDS.—Funds provided under 

11 this subsection may be used— 

12 ‘‘(A) to construct or renovate an existing 

13 health facility to provide intermediate behav14 ioral health services; 

15 ‘‘(B) to hire behavioral health profes16 sionals; 

17 ‘‘(C) to staff, operate, and maintain an in18 termediate mental health facility, group home, 

19 sober housing, transitional housing or similar 

20 facilities, or youth shelter where intermediate 

21 behavioral health services are being provided; 

22 ‘‘(D) to make renovations and hire appro23 priate staff to convert existing hospital beds 

24 into adolescent psychiatric units; and 


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1 ‘‘(E) for intensive home- and community2 based services. 

3 ‘‘(3) CRITERIA.—The Secretary, acting through 

4 the Service, shall, in consultation with Indian Tribes 

5 and Tribal Organizations, establish criteria for the 

6 review and approval of applications or proposals for 

7 funding made available pursuant to this subsection. 

8 ‘‘(d) FEDERALLY OWNED STRUCTURES.— 

9 ‘‘(1) IN GENERAL.—The Secretary, in consulta10 tion with Indian Tribes and Tribal Organizations, 

11 shall— 

12 ‘‘(A) identify and use, where appropriate, 

13 federally owned structures suitable for local res14 idential or regional behavioral health treatment 

15 for Indian youths; and 

16 ‘‘(B) establish guidelines for determining 

17 the suitability of any such federally owned 

18 structure to be used for local residential or re19 gional behavioral health treatment for Indian 

20 youths. 

21 ‘‘(2) TERMS AND CONDITIONS FOR USE OF

22 STRUCTURE.—Any structure described in paragraph 

23 (1) may be used under such terms and conditions as 

24 may be agreed upon by the Secretary and the agency 

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1 dian Tribe or Tribal Organization operating the pro2 gram. 

3 ‘‘(e) REHABILITATION AND AFTERCARE SERVICES.— 

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

5 Tribes, or Tribal Organizations, in cooperation with 

6 the Secretary of the Interior, shall develop and im7 plement within each Service Unit, community-based 

8 rehabilitation and follow-up services for Indian 

9 youths who are having significant behavioral health 

10 problems, and require long-term treatment, commu11 nity reintegration, and monitoring to support the In12 dian youths after their return to their home commu13 nity. 

14 ‘‘(2) ADMINISTRATION.—Services under para15 graph (1) shall be provided by trained staff within 

16 the community who can assist the Indian youths in 

17 their continuing development of self-image, positive 

18 problem-solving skills, and nonalcohol or substance 

19 abusing behaviors. Such staff may include alcohol 

20 and substance abuse counselors, mental health pro21 fessionals, and other health professionals and para22 professionals, including community health represent23 atives. 

24 ‘‘(f) INCLUSION OF FAMILY IN YOUTH TREATMENT

25 PROGRAM.—In providing the treatment and other services 


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1 to Indian youths authorized by this section, the Secretary, 

2 acting through the Service, shall provide for the inclusion 

3 of family members of such youths in the treatment pro4 grams or other services as may be appropriate. Not less 

5 than 10 percent of the funds appropriated for the pur6 poses of carrying out subsection (e) shall be used for out7 patient care of adult family members related to the treat8 ment of an Indian youth under that subsection. 

9 ‘‘(g) MULTIDRUG ABUSE PROGRAM.—The Secretary, 

10 acting through the Service, shall provide, consistent with 

11 section 701, programs and services to prevent and treat 

12 the abuse of multiple forms of substances, including alco13 hol, drugs, inhalants, and tobacco, among Indian youths 

14 residing in Indian communities, on or near reservations, 

15 and in urban areas and provide appropriate mental health 

16 services to address the incidence of mental illness among 

17 such youths. 

18 ‘‘(h) INDIAN YOUTH MENTAL HEALTH.—The Sec19 retary, acting through the Service, shall collect data for 

20 the report under section 801 with respect to— 

21 ‘‘(1) the number of Indian youth who are being 

22 provided mental health services through the Service 

23 and Tribal Health Programs; 


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1 ‘‘(2) a description of, and costs associated with, 

2 the mental health services provided for Indian youth 

3 through the Service and Tribal Health Programs; 

4 ‘‘(3) the number of youth referred to the Serv5 ice or Tribal Health Programs for mental health 

6 services; 

7 ‘‘(4) the number of Indian youth provided resi8 dential treatment for mental health and behavioral 

9 problems through the Service and Tribal Health 

10 Programs, reported separately for on- and off-res11 ervation facilities; and 

12 ‘‘(5) the costs of the services described in para13 graph (4). 

14 ‘‘SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEM15 ONSTRATION PROJECT. 

16 ‘‘(a) PURPOSE.—The purpose of this section is to au17 thorize the Secretary to carry out a demonstration project 

18 to test the use of telemental health services in suicide pre19 vention, intervention and treatment of Indian youth, in20 cluding through— 

21 ‘‘(1) the use of psychotherapy, psychiatric as22 sessments, diagnostic interviews, therapies for men23 tal health conditions predisposing to suicide, and al24 cohol and substance abuse treatment; 


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1 ‘‘(2) the provision of clinical expertise to, con2 sultation services with, and medical advice and train3 ing for frontline health care providers working with 

4 Indian youth; 

5 ‘‘(3) training and related support for commu6 nity leaders, family members and health and edu7 cation workers who work with Indian youth; 

8 ‘‘(4) the development of culturally relevant edu9 cational materials on suicide; and 

10 ‘‘(5) data collection and reporting. 

11 ‘‘(b) DEFINITIONS.—For the purpose of this section, 

12 the following definitions shall apply: 

13 ‘‘(1) DEMONSTRATION PROJECT.—The term 

14 ‘demonstration project’ means the Indian youth tele15 mental health demonstration project authorized 

16 under subsection (c). 

17 ‘‘(2) TELEMENTAL HEALTH.—The term ‘tele18 mental health’ means the use of electronic informa19 tion and telecommunications technologies to support 

20 long distance mental health care, patient and profes21 sional-related education, public health, and health 

22 administration. 

23 ‘‘(c) AUTHORIZATION.— 

24 ‘‘(1) IN GENERAL.—The Secretary is authorized 

25 to award grants under the demonstration project for 


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1 the provision of telemental health services to Indian 

2 youth who— 

3 ‘‘(A) have expressed suicidal ideas; 

4 ‘‘(B) have attempted suicide; or 

5 ‘‘(C) have mental health conditions that in6 crease or could increase the risk of suicide. 

7 ‘‘(2) ELIGIBILITY FOR GRANTS.—Such grants 

8 shall be awarded to Indian Tribes and Tribal Orga9 nizations that operate 1 or more facilities— 

10 ‘‘(A) located in Alaska and part of the 

11 Alaska Federal Health Care Access Network; 

12 ‘‘(B) reporting active clinical telehealth ca13 pabilities; or 

14 ‘‘(C) offering school-based telemental 

15 health services relating to psychiatry to Indian 

16 youth. 

17 ‘‘(3) GRANT PERIOD.—The Secretary shall 

18 award grants under this section for a period of up 

19 to 4 years. 

20 ‘‘(4) AWARDING OF GRANTS.—Not more than 5 

21 grants shall be provided under paragraph (1), with 

22 priority consideration given to Indian Tribes and 

23 Tribal Organizations that— 


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1 ‘‘(A) serve a particular community or geo2 graphic area where there is a demonstrated 

3 need to address Indian youth suicide; 

4 ‘‘(B) enter in to collaborative partnerships 

5 with Indian Health Service or Tribal Health 

6 Programs or facilities to provide services under 

7 this demonstration project; 

8 ‘‘(C) serve an isolated community or geo9 graphic area which has limited or no access to 

10 behavioral health services; or 

11 ‘‘(D) operate a detention facility at which 

12 Indian youth are detained. 

13 ‘‘(d) USE OF FUNDS.— 

14 ‘‘(1) IN GENERAL.—An Indian Tribe or Tribal 

15 Organization shall use a grant received under sub16 section (c) for the following purposes: 

17 ‘‘(A) To provide telemental health services 

18 to Indian youth, including the provision of— 

19 ‘‘(i) psychotherapy; 

20 ‘‘(ii) psychiatric assessments and di21 agnostic interviews, therapies for mental 

22 health conditions predisposing to suicide, 

23 and treatment; and 

24 ‘‘(iii) alcohol and substance abuse 

25 treatment. 


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1 ‘‘(B) To provide clinician-interactive med2 ical advice, guidance and training, assistance in 

3 diagnosis and interpretation, crisis counseling 

4 and intervention, and related assistance to 

5 Service, tribal, or urban clinicians and health 

6 services providers working with youth being 

7 served under this demonstration project. 

8 ‘‘(C) To assist, educate and train commu9 nity leaders, health education professionals and 

10 paraprofessionals, tribal outreach workers, and 

11 family members who work with the youth re12 ceiving telemental health services under this 

13 demonstration project, including with identifica14 tion of suicidal tendencies, crisis intervention 

15 and suicide prevention, emergency skill develop16 ment, and building and expanding networks 

17 among these individuals and with State and 

18 local health services providers. 

19 ‘‘(D) To develop and distribute culturally 

20 appropriate community educational materials 

21 on— 

22 ‘‘(i) suicide prevention; 

23 ‘‘(ii) suicide education; 

24 ‘‘(iii) suicide screening; 

25 ‘‘(iv) suicide intervention; and 


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1 ‘‘(v) ways to mobilize communities 

2 with respect to the identification of risk 

3 factors for suicide. 

4 ‘‘(E) For data collection and reporting re5 lated to Indian youth suicide prevention efforts. 

6 ‘‘(2) TRADITIONAL HEALTH CARE PRAC7 TICES.—In carrying out the purposes described in 

8 paragraph (1), an Indian Tribe or Tribal Organiza9 tion may use and promote the traditional health care 

10 practices of the Indian Tribes of the youth to be 

11 served. 

12 ‘‘(e) APPLICATIONS.—To be eligible to receive a grant 

13 under subsection (c), an Indian Tribe or Tribal Organiza14 tion shall prepare and submit to the Secretary an applica15 tion, at such time, in such manner, and containing such 

16 information as the Secretary may require, including— 

17 ‘‘(1) a description of the project that the Indian 

18 Tribe or Tribal Organization will carry out using the 

19 funds provided under the grant; 

20 ‘‘(2) a description of the manner in which the 

21 project funded under the grant would— 

22 ‘‘(A) meet the telemental health care needs 

23 of the Indian youth population to be served by 

24 the project; or 


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1 ‘‘(B) improve the access of the Indian 

2 youth population to be served to suicide preven3 tion and treatment services; 

4 ‘‘(3) evidence of support for the project from 

5 the local community to be served by the project; 

6 ‘‘(4) a description of how the families and lead7 ership of the communities or populations to be 

8 served by the project would be involved in the devel9 opment and ongoing operations of the project; 

10 ‘‘(5) a plan to involve the tribal community of 

11 the youth who are provided services by the project 

12 in planning and evaluating the mental health care 

13 and suicide prevention efforts provided, in order to 

14 ensure the integration of community, clinical, envi15 ronmental, and cultural components of the treat16 ment; and 

17 ‘‘(6) a plan for sustaining the project after Fed18 eral assistance for the demonstration project has ter19 minated. 

20 ‘‘(f) COLLABORATION; REPORTING TO NATIONAL

21 CLEARINGHOUSE.— 

22 ‘‘(1) COLLABORATION.—The Secretary, acting 

23 through the Service, shall encourage Indian Tribes 

24 and Tribal Organizations receiving grants under this 


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1 section to collaborate to enable comparisons about 

2 best practices across projects. 

3 ‘‘(2) REPORTING TO NATIONAL CLEARING4 HOUSE.—The Secretary, acting through the Service, 

5 shall also encourage Indian Tribes and Tribal Orga6 nizations receiving grants under this section to sub7 mit relevant, declassified project information to the 

8 national clearinghouse authorized under section 

9 701(b)(2) in order to better facilitate program per10 formance and improve suicide prevention, interven11 tion, and treatment services. 

12 ‘‘(g) ANNUAL REPORT.—Each grant recipient shall 

13 submit to the Secretary an annual report that— 

14 ‘‘(1) describes the number of telemental health 

15 services provided; and 

16 ‘‘(2) includes any other information that the 

17 Secretary may require. 

18 ‘‘(h) REPORT TO CONGRESS.—Not later than 270 

19 days after the termination of the demonstration project, 

20 the Secretary shall submit to the Committee on Indian Af21 fairs of the Senate and the Committee on Natural Re22 sources and Committee on Energy and Commerce of the 

23 House of Representatives a final report, based on the an24 nual reports provided by grant recipients under subsection 

25 (h), that— 


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1 ‘‘(1) describes the results of the projects funded 

2 by grants awarded under this section, including any 

3 data available which indicates the number of at4 tempted suicides; 

5 ‘‘(2) evaluates the impact of the telemental 

6 health services funded by the grants in reducing the 

7 number of completed suicides among Indian youth; 

8 ‘‘(3) evaluates whether the demonstration 

9 project should be— 

10 ‘‘(A) expanded to provide more than 5 

11 grants; and 

12 ‘‘(B) designated a permanent program; 

13 and 

14 ‘‘(4) evaluates the benefits of expanding the 

15 demonstration project to include urban Indian orga16 nizations. 

17 ‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 

18 authorized to be appropriated to carry out this section 

19 $1,500,000 for each of fiscal years 2010 through 2025. 

20 ‘‘SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL 

21 HEALTH FACILITIES DESIGN, CONSTRUC22 TION, AND STAFFING. 

23 ‘‘Not later than 1 year after the date of enactment 

24 of the Indian Health Care Improvement Act Amendments 

25 of 2009, the Secretary, acting through the Service, may 


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1 provide, in each area of the Service, not less than 1 inpa2 tient mental health care facility, or the equivalent, for In3 dians with behavioral health problems. For the purposes 

4 of this subsection, California shall be considered to be 2 

5 Area Offices, 1 office whose location shall be considered 

6 to encompass the northern area of the State of California 

7 and 1 office whose jurisdiction shall be considered to en8 compass the remainder of the State of California. The Sec9 retary shall consider the possible conversion of existing, 

10 underused Service hospital beds into psychiatric units to 

11 meet such need. 

12 ‘‘SEC. 710. TRAINING AND COMMUNITY EDUCATION. 

13 ‘‘(a) PROGRAM.—The Secretary, in cooperation with 

14 the Secretary of the Interior, shall develop and implement 

15 or assist Indian Tribes and Tribal Organizations to de16 velop and implement, within each Service Unit or tribal 

17 program, a program of community education and involve18 ment which shall be designed to provide concise and timely 

19 information to the community leadership of each tribal 

20 community. Such program shall include education about 

21 behavioral health issues to political leaders, Tribal judges, 

22 law enforcement personnel, members of tribal health and 

23 education boards, health care providers including tradi24 tional practitioners, and other critical members of each 

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1 nity-based training to develop local capacity and tribal 

2 community provider training for prevention, intervention, 

3 treatment, and aftercare. 

4 ‘‘(b) INSTRUCTION.—The Secretary, acting through 

5 the Service, shall provide instruction in the area of behav6 ioral health issues, including instruction in crisis interven7 tion and family relations in the context of alcohol and sub8 stance abuse, child sexual abuse, youth alcohol and sub9 stance abuse, and the causes and effects of fetal alcohol 

10 disorders to appropriate employees of the Bureau of In11 dian Affairs and the Service, and to personnel in schools 

12 or programs operated under any contract with the Bureau 

13 of Indian Affairs or the Service, including supervisors of 

14 emergency shelters and halfway houses described in sec15 tion 4213 of the Indian Alcohol and Substance Abuse Pre16 vention and Treatment Act of 1986 (25 U.S.C. 2433). 

17 ‘‘(c) TRAINING MODELS.—In carrying out the edu18 cation and training programs required by this section, the 

19 Secretary, in consultation with Indian Tribes, Tribal Or20 ganizations, Indian behavioral health experts, and Indian 

21 alcohol and substance abuse prevention experts, shall de22 velop and provide community-based training models. Such 

23 models shall address— 

24 ‘‘(1) the elevated risk of alcohol and behavioral 

25 health problems faced by children of alcoholics; 


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1 ‘‘(2) the cultural, spiritual, and 

2 multigenerational aspects of behavioral health prob3 lem prevention and recovery; and 

4 ‘‘(3) community-based and multidisciplinary 

5 strategies, including Systems of Care, for preventing 

6 and treating behavioral health problems. 

7 ‘‘SEC. 711. BEHAVIORAL HEALTH PROGRAM. 

8 ‘‘(a) INNOVATIVE PROGRAMS.—The Secretary, acting 

9 through the Service, consistent with section 701, may 

10 plan, develop, implement, and carry out programs to de11 liver innovative community-based behavioral health serv12 ices to Indians. 

13 ‘‘(b) AWARDS; CRITERIA.—The Secretary may award 

14 a grant for a project under subsection (a) to an Indian 

15 Tribe or Tribal Organization and may consider the fol16 lowing criteria: 

17 ‘‘(1) The project will address significant unmet 

18 behavioral health needs among Indians. 

19 ‘‘(2) The project will serve a significant number 

20 of Indians. 

21 ‘‘(3) The project has the potential to deliver 

22 services in an efficient and effective manner. 

23 ‘‘(4) The Indian Tribe or Tribal Organization 

24 has the administrative and financial capability to ad25 minister the project. 


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1 ‘‘(5) The project may deliver services in a man2 ner consistent with traditional health care practices. 

3 ‘‘(6) The project is coordinated with, and avoids 

4 duplication of, existing services. 

5 ‘‘(c) EQUITABLE TREATMENT.—For purposes of this 

6 subsection, the Secretary shall, in evaluating project appli7 cations or proposals, use the same criteria that the Sec8 retary uses in evaluating any other application or proposal 

9 for such funding. 

10 ‘‘SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS. 

11 ‘‘(a) PROGRAMS.— 

12 ‘‘(1) ESTABLISHMENT.—The Secretary, con13 sistent with section 701 and acting through the 

14 Service, is authorized to establish and operate fetal 

15 alcohol disorder programs as provided in this section 

16 for the purposes of meeting the health status objec17 tives specified in section 3. 

18 ‘‘(2) USE OF FUNDS.— 

19 ‘‘(A) IN GENERAL.—Funding provided 

20 pursuant to this section shall be used for the 

21 following: 

22 ‘‘(i) To develop and provide for Indi23 ans community and in-school training, edu24 cation, and prevention programs relating 

25 to fetal alcohol disorders. 


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1 ‘‘(ii) To identify and provide behav2 ioral health treatment to high-risk Indian 

3 women and high-risk women pregnant with 

4 an Indian’s child. 

5 ‘‘(iii) To identify and provide appro6 priate psychological services, educational 

7 and vocational support, counseling, advo8 cacy, and information to fetal alcohol dis9 order affected Indians and their families or 

10 caretakers. 

11 ‘‘(iv) To develop and implement coun12 seling and support programs in schools for 

13 fetal alcohol disorder affected Indian chil14 dren. 

15 ‘‘(v) To develop prevention and inter16 vention models which incorporate practi17 tioners of traditional health care practices, 

18 cultural values, and community involve19 ment. 

20 ‘‘(vi) To develop, print, and dissemi21 nate education and prevention materials on 

22 fetal alcohol disorder. 

23 ‘‘(vii) To develop and implement, in 

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1 tions, culturally sensitive assessment and 

2 diagnostic tools including dysmorphology 

3 clinics and multidisciplinary fetal alcohol 

4 disorder clinics for use in Indian commu5 nities and Urban Centers. 

6 ‘‘(B) ADDITIONAL USES.—In addition to 

7 any purpose under subparagraph (A), funding 

8 provided pursuant to this section may be used 

9 for 1 or more of the following: 

10 ‘‘(i) Early childhood intervention 

11 projects from birth on to mitigate the ef12 fects of fetal alcohol disorder among Indi13 ans. 

14 ‘‘(ii) Community-based support serv15 ices for Indians and women pregnant with 

16 Indian children. 

17 ‘‘(iii) Community-based housing for 

18 adult Indians with fetal alcohol disorder. 

19 ‘‘(3) CRITERIA FOR APPLICATIONS.—The Sec20 retary shall establish criteria for the review and ap21 proval of applications for funding under this section. 

22 ‘‘(b) SERVICES.—The Secretary, acting through the 

23 Service, shall— 

24 ‘‘(1) develop and provide services for the pre25 vention, intervention, treatment, and aftercare for 


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1 those affected by fetal alcohol disorder in Indian 

2 communities; and 

3 ‘‘(2) provide supportive services, including serv4 ices to meet the special educational, vocational, 

5 school-to-work transition, and independent living 

6 needs of adolescent and adult Indians with fetal al7 cohol disorder. 

8 ‘‘(c) TASK FORCE.—The Secretary shall establish a 

9 task force to be known as the Fetal Alcohol Disorder Task 

10 Force to advise the Secretary in carrying out subsection 

11 (b). Such task force shall be composed of representatives 

12 from the following: 

13 ‘‘(1) The National Institute on Drug Abuse. 

14 ‘‘(2) The National Institute on Alcohol and Al15 coholism. 

16 ‘‘(3) The Office of Substance Abuse Prevention. 

17 ‘‘(4) The National Institute of Mental Health. 

18 ‘‘(5) The Service. 

19 ‘‘(6) The Office of Minority Health of the De20 partment of Health and Human Services. 

21 ‘‘(7) The Administration for Native Americans. 

22 ‘‘(8) The National Institute of Child Health 

23 and Human Development (NICHD). 

24 ‘‘(9) The Centers for Disease Control and Pre25 vention. 


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1 ‘‘(10) The Bureau of Indian Affairs. 

2 ‘‘(11) Indian Tribes. 

3 ‘‘(12) Tribal Organizations. 

4 ‘‘(13) urban Indian organizations. 

5 ‘‘(14) Indian fetal alcohol spectrum disorders 

6 experts. 

7 ‘‘(d) APPLIED RESEARCH PROJECTS.—The Sec8 retary, acting through the Substance Abuse and Mental 

9 Health Services Administration, shall make grants to In10 dian Tribes, Tribal Organizations, and urban Indian orga11 nizations for applied research projects which propose to 

12 elevate the understanding of methods to prevent, inter13 vene, treat, or provide rehabilitation and behavioral health 

14 aftercare for Indians and urban Indians affected by fetal 

15 alcohol spectrum disorders. 

16 ‘‘(e) FUNDING FOR URBAN INDIAN ORGANIZA17 TIONS.—Ten percent of the funds appropriated pursuant 

18 to this section shall be used to make grants to urban In19 dian organizations funded under title V. 

20 ‘‘SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREAT21 MENT PROGRAMS. 

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

23 through the Service, shall establish, consistent with section 

24 701, in every Service Area, programs involving treatment 

25 for— 


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1 ‘‘(1) victims of sexual abuse who are Indian 

2 children or children in an Indian household; and 

3 ‘‘(2) perpetrators of child sexual abuse who are 

4 Indian or members of an Indian household. 

5 ‘‘(b) USE OF FUNDS.—Funding provided pursuant to 

6 this section shall be used for the following: 

7 ‘‘(1) To develop and provide community edu8 cation and prevention programs related to sexual 

9 abuse of Indian children or children in an Indian 

10 household. 

11 ‘‘(2) To identify and provide behavioral health 

12 treatment to victims of sexual abuse who are Indian 

13 children or children in an Indian household, and to 

14 their family members who are affected by sexual 

15 abuse. 

16 ‘‘(3) To develop prevention and intervention 

17 models which incorporate traditional health care 

18 practices, cultural values, and community involve19 ment. 

20 ‘‘(4) To develop and implement culturally sen21 sitive assessment and diagnostic tools for use in In22 dian communities and Urban Centers. 

23 ‘‘(5) To identify and provide behavioral health 

24 treatment to Indian perpetrators and perpetrators 

25 who are members of an Indian household— 


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1 ‘‘(A) making efforts to begin offender and 

2 behavioral health treatment while the perpe3 trator is incarcerated or at the earliest possible 

4 date if the perpetrator is not incarcerated; and 

5 ‘‘(B) providing treatment after the perpe6 trator is released, until it is determined that the 

7 perpetrator is not a threat to children. 

8 ‘‘(c) COORDINATION.—The programs established 

9 under subsection (a) shall be carried out in coordination 

10 with programs and services authorized under the Indian 

11 Child Protection and Family Violence Prevention Act (25 

12 U.S.C. 3201 et seq.). 

13 ‘‘SEC. 714. DOMESTIC AND SEXUAL VIOLENCE PREVENTION 

14 AND TREATMENT. 

15 ‘‘(a) IN GENERAL.—The Secretary, in accordance 

16 with section 701, is authorized to establish in each Service 

17 Area programs involving the prevention and treatment 

18 of— 

19 ‘‘(1) Indian victims of domestic violence or sex20 ual abuse; and 

21 ‘‘(2) perpetrators of domestic violence or sexual 

22 abuse who are Indian or members of an Indian 

23 household. 

24 ‘‘(b) USE OF FUNDS.—Funds made available to carry 

25 out this section shall be used— 


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1 ‘‘(1) to develop and implement prevention pro2 grams and community education programs relating 

3 to domestic violence and sexual abuse; 

4 ‘‘(2) to provide behavioral health services, in5 cluding victim support services, and medical treat6 ment (including examinations performed by sexual 

7 assault nurse examiners) to Indian victims of domes8 tic violence or sexual abuse; 

9 ‘‘(3) to purchase rape kits; 

10 ‘‘(4) to develop prevention and intervention 

11 models, which may incorporate traditional health 

12 care practices; and 

13 ‘‘(5) to identify and provide behavioral health 

14 treatment to perpetrators who are Indian or mem15 bers of an Indian household. 

16 ‘‘(c) TRAINING AND CERTIFICATION.— 

17 ‘‘(1) IN GENERAL.—Not later than 1 year after 

18 the date of enactment of the Indian Health Care Im19 provement Act Amendments of 2009, the Secretary 

20 shall establish appropriate protocols, policies, proce21 dures, standards of practice, and, if not available 

22 elsewhere, training curricula and training and cer23 tification requirements for services for victims of do24 mestic violence and sexual abuse. 


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1 ‘‘(2) REPORT.—Not later than 18 months after 

2 the date of enactment of the Indian Health Care Im3 provement Act Amendments of 2008, the Secretary 

4 shall submit to the Committee on Indian Affairs of 

5 the Senate and the Committee on Natural Resources 

6 of the House of Representatives a report that de7 scribes the means and extent to which the Secretary 

8 has carried out paragraph (1). 

9 ‘‘(d) COORDINATION.— 

10 ‘‘(1) IN GENERAL.—The Secretary, in coordina11 tion with the Attorney General, Federal and tribal 

12 law enforcement agencies, Indian Health Programs, 

13 and domestic violence or sexual assault victim orga14 nizations, shall develop appropriate victim services 

15 and victim advocate training programs— 

16 ‘‘(A) to improve domestic violence or sex17 ual abuse responses; 

18 ‘‘(B) to improve forensic examinations and 

19 collection; 

20 ‘‘(C) to identify problems or obstacles in 

21 the prosecution of domestic violence or sexual 

22 abuse; and 

23 ‘‘(D) to meet other needs or carry out 

24 other activities required to prevent, treat, and 


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1 improve prosecutions of domestic violence and 

2 sexual abuse. 

3 ‘‘(2) REPORT.—Not later than 2 years after the 

4 date of enactment of the Indian Health Care Im5 provement Act Amendments of 2008, the Secretary 

6 shall submit to the Committee on Indian Affairs of 

7 the Senate and the Committee on Natural Resources 

8 of the House of Representatives a report that de9 scribes, with respect to the matters described in 

10 paragraph (1), the improvements made and needed, 

11 problems or obstacles identified, and costs necessary 

12 to address the problems or obstacles, and any other 

13 recommendations that the Secretary determines to 

14 be appropriate. 

15 ‘‘SEC. 715. BEHAVIORAL HEALTH RESEARCH. 

16 ‘‘The Secretary, in consultation with appropriate 

17 Federal agencies, shall make grants to, or enter into con18 tracts with, Indian Tribes, Tribal Organizations, and 

19 urban Indian organizations or enter into contracts with, 

20 or make grants to appropriate institutions for, the conduct 

21 of research on the incidence and prevalence of behavioral 

22 health problems among Indians served by the Service, In23 dian Tribes, or Tribal Organizations and among Indians 

24 in urban areas. Research priorities under this section shall 

25 include— 


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1 ‘‘(1) the multifactorial causes of Indian youth 

2 suicide, including— 

3 ‘‘(A) protective and risk factors and sci4 entific data that identifies those factors; and 

5 ‘‘(B) the effects of loss of cultural identity 

6 and the development of scientific data on those 

7 effects; 

8 ‘‘(2) the interrelationship and interdependence 

9 of behavioral health problems with alcoholism and 

10 other substance abuse, suicide, homicides, other in11 juries, and the incidence of family violence; and 

12 ‘‘(3) the development of models of prevention 

13 techniques. 

14 The effect of the interrelationships and interdependencies 

15 referred to in paragraph (2) on children, and the develop16 ment of prevention techniques under paragraph (3) appli17 cable to children, shall be emphasized. 

18 ‘‘SEC. 716. DEFINITIONS. 

19 ‘‘For the purpose of this title, the following defini20 tions shall apply: 

21 ‘‘(1) ASSESSMENT.—The term ‘assessment’ 

22 means the systematic collection, analysis, and dis23 semination of information on health status, health 

24 needs, and health problems. 


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1 ‘‘(2) ALCOHOL-RELATED

2 NEURODEVELOPMENTAL DISORDERS OR ARND.—The 

3 term ‘alcohol-related neurodevelopmental disorders’ 

4 or ‘ARND’ means, with a history of maternal alco5 hol consumption during pregnancy, central nervous 

6 system involvement such as developmental delay, in7 tellectual deficit, or neurologic abnormalities. Behav8 iorally, there can be problems with irritability, and 

9 failure to thrive as infants. As children become older 

10 there will likely be hyperactivity, attention deficit, 

11 language dysfunction, and perceptual and judgment 

12 problems. 

13 ‘‘(3) BEHAVIORAL HEALTH AFTERCARE.—The 

14 term ‘behavioral health aftercare’ includes those ac15 tivities and resources used to support recovery fol16 lowing inpatient, residential, intensive substance 

17 abuse, or mental health outpatient or outpatient 

18 treatment. The purpose is to help prevent or deal 

19 with relapse by ensuring that by the time a client or 

20 patient is discharged from a level of care, such as 

21 outpatient treatment, an aftercare plan has been de22 veloped with the client. An aftercare plan may use 

23 such resources as a community-based therapeutic 

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1 sor, a local 12-step or other related support group, 

2 and other community-based providers. 

3 ‘‘(4) DUAL DIAGNOSIS.—The term ‘dual diag4 nosis’ means coexisting substance abuse and mental 

5 illness conditions or diagnosis. Such clients are 

6 sometimes referred to as mentally ill chemical abus7 ers (MICAs). 

8 ‘‘(5) FETAL ALCOHOL SPECTRUM DIS9 ORDERS.— 

10 ‘‘(A) IN GENERAL.—The term ‘fetal alco11 hol spectrum disorders’ includes a range of ef12 fects that can occur in an individual whose 

13 mother drank alcohol during pregnancy, includ14 ing physical, mental, behavioral, and/or learning 

15 disabilities with possible lifelong implications. 

16 ‘‘(B) INCLUSIONS.—The term ‘fetal alcohol 

17 spectrum disorders’ may include— 

18 ‘‘(i) fetal alcohol syndrome (FAS); 

19 ‘‘(ii) fetal alcohol effect (FAE); 

20 ‘‘(iii) alcohol-related birth defects; and 

21 ‘‘(iv) alcohol-related 

22 neurodevelopmental disorders (ARND). 

23 ‘‘(6) FETAL ALCOHOL SYNDROME OR FAS.— 

24 The term ‘fetal alcohol syndrome’ or ‘FAS’ means 

25 any 1 of a spectrum of effects that may occur when 


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1 a woman drinks alcohol during pregnancy, the diag2 nosis of which involves the confirmed presence of the 

3 following 3 criteria: 

4 ‘‘(A) Craniofacial abnormalities. 

5 ‘‘(B) Growth deficits. 

6 ‘‘(C) Central nervous system abnormalities. 

7 ‘‘(7) REHABILITATION.—The term ‘rehabilita8 tion’ means medical and health care services that— 

9 ‘‘(A) are recommended by a physician or 

10 licensed practitioner of the healing arts within 

11 the scope of their practice under applicable law; 

12 ‘‘(B) are furnished in a facility, home, or 

13 other setting in accordance with applicable 

14 standards; and 

15 ‘‘(C) have as their purpose any of the fol16 lowing: 

17 ‘‘(i) The maximum attainment of 

18 physical, mental, and developmental func19 tioning. 

20 ‘‘(ii) Averting deterioration in physical 

21 or mental functional status. 

22 ‘‘(iii) The maintenance of physical or 

23 mental health functional status. 

24 ‘‘(8) SUBSTANCE ABUSE.—The term ‘substance 

25 abuse’ includes inhalant abuse. 


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1 ‘‘(9) SYSTEMS OF CARE.—The term ‘Systems of 

2 Care’ means a system for delivering services to chil3 dren and their families that is child-centered, family4 focused and family-driven, community-based, and 

5 culturally competent and responsive to the needs of 

6 the children and families being served. The systems 

7 of care approach values prevention and early identi8 fication, smooth transitions for children and fami9 lies, child and family participation and advocacy, 

10 comprehensive array of services, individualized serv11 ice planning, services in the least restrictive environ12 ment, and integrated services with coordinated plan13 ning across the child-serving systems. 

14 ‘‘SEC. 717. AUTHORIZATION OF APPROPRIATIONS. 

15 ‘‘There is authorized to be appropriated such sums 

16 as may be necessary for each fiscal year through fiscal 

17 year 2025 to carry out the provisions of this title. 

18 ‘‘TITLE VIII—MISCELLANEOUS 

19 ‘‘SEC. 801. REPORTS. 

20 ‘‘For each fiscal year following the date of enactment 

21 of the Indian Health Care Improvement Act Amendments 

22 of 2009, the Secretary shall transmit to Congress a report 

23 containing the following: 

24 ‘‘(1) A report on the progress made in meeting 

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1 grams established or assisted pursuant to this Act 

2 and assessments and recommendations of additional 

3 programs or additional assistance necessary to, at a 

4 minimum, provide health services to Indians and en5 sure a health status for Indians, which are at a par6 ity with the health services available to and the 

7 health status of the general population. 

8 ‘‘(2) A report on whether, and to what extent, 

9 new national health care programs, benefits, initia10 tives, or financing systems have had an impact on 

11 the purposes of this Act and any steps that the Sec12 retary may have taken to consult with Indian Tribes, 

13 Tribal Organizations, and urban Indian organiza14 tions to address such impact, including a report on 

15 proposed changes in allocation of funding pursuant 

16 to section 807. 

17 ‘‘(3) A report on the use of health services by 

18 Indians— 

19 ‘‘(A) on a national and area or other rel20 evant geographical basis; 

21 ‘‘(B) by gender and age; 

22 ‘‘(C) by source of payment and type of 

23 service; 


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1 ‘‘(D) comparing such rates of use with 

2 rates of use among comparable non-Indian pop3 ulations; and 

4 ‘‘(E) provided under contracts. 

5 ‘‘(4) A report of contractors to the Secretary on 

6 Health Care Educational Loan Repayments every 6 

7 months required by section 110. 

8 ‘‘(5) A general audit report of the Secretary on 

9 the Health Care Educational Loan Repayment Pro10 gram as required by section 110(m). 

11 ‘‘(6) A report of the findings and conclusions of 

12 demonstration programs on development of edu13 cational curricula for substance abuse counseling as 

14 required in section 125(f). 

15 ‘‘(7) A separate statement which specifies the 

16 amount of funds requested to carry out the provi17 sions of section 201. 

18 ‘‘(8) A report of the evaluations of health pro19 motion and disease prevention as required in section 

20 203(c). 

21 ‘‘(9) A biennial report to Congress on infectious 

22 diseases as required by section 212. 

23 ‘‘(10) A report on environmental and nuclear 

24 health hazards as required by section 215. 


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1 ‘‘(11) An annual report on the status of all 

2 health care facilities needs as required by section 

3 301(c)(2)(B) and 301(d). 

4 ‘‘(12) Reports on safe water and sanitary waste 

5 disposal facilities as required by section 302(h). 

6 ‘‘(13) An annual report on the expenditure of 

7 non-Service funds for renovation as required by sec8 tions 304(b)(2). 

9 ‘‘(14) A report identifying the backlog of main10 tenance and repair required at Service and tribal fa11 cilities required by section 313(a). 

12 ‘‘(15) A report providing an accounting of reim13 bursement funds made available to the Secretary 

14 under titles XVIII, XIX, and XXI of the Social Se15 curity Act. 

16 ‘‘(16) A report on any arrangements for the 

17 sharing of medical facilities or services, as author18 ized by section 406. 

19 ‘‘(17) A report on evaluation and renewal of 

20 urban Indian programs under section 505. 

21 ‘‘(18) A report on the evaluation of programs 

22 as required by section 513(d). 

23 ‘‘(19) A report on alcohol and substance abuse 

24 as required by section 701(f). 


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1 ‘‘(20) A report on Indian youth mental health 

2 services as required by section 707(h). 

3 ‘‘(21) A report on the reallocation of base re4 sources if required by section 807. 

5 ‘‘(22) A report on the movement of patients be6 tween Service Units, including— 

7 ‘‘(A) a list of those Service Units that have 

8 a net increase and those that have a net de9 crease of patients due to patients assigned to 

10 one Service Unit voluntarily choosing to receive 

11 service at another Service Unit; 

12 ‘‘(B) an analysis of the effect of patient 

13 movement on the quality of services for those 

14 Service Units experiencing an increase in the 

15 number of patients served; and 

16 ‘‘(C) what funding changes are necessary 

17 to maintain a consistent quality of service at 

18 Service Units that have an increase in the num19 ber of patients served. 

20 ‘‘(23) A report on the extent to which health 

21 care facilities of the Service, Indian Tribes, Tribal 

22 Organizations, and urban Indian organizations com23 ply with credentialing requirements of the Service or 

24 licensure requirements of States. 


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1 ‘‘SEC. 802. REGULATIONS. 

2 ‘‘(a) DEADLINES.— 

3 ‘‘(1) PROCEDURES.—Not later than 90 days 

4 after the date of enactment of the Indian Health 

5 Care Improvement Act Amendments of 2009, the 

6 Secretary shall initiate procedures under subchapter 

7 III of chapter 5 of title 5, United States Code, to 

8 negotiate and promulgate such regulations or 

9 amendments thereto that are necessary to carry out 

10 this Act, except sections 105, 115, 117, 202, and 

11 409 through 416. The Secretary may promulgate 

12 regulations to carry out such sections using the pro13 cedures required by chapter 5 of title 5, United 

14 States Code (commonly known as the ‘Administra15 tive Procedure Act’). 

16 ‘‘(2) PROPOSED REGULATIONS.—Proposed reg17 ulations to implement this Act shall be published in 

18 the Federal Register by the Secretary no later than 

19 2 years after the date of enactment of the Indian 

20 Health Care Improvement Act Amendments of 2009 

21 and shall have no less than a 120-day comment pe22 riod. 

23 ‘‘(3) FINAL REGULATIONS.—The Secretary 

24 shall publish in the Federal Register final regula25 tions to implement this Act by not later than 3 years 


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1 after the date of enactment of the Indian Health 

2 Care Improvement Act Amendments of 2009. 

3 ‘‘(b) COMMITTEE.—A negotiated rulemaking com4 mittee established pursuant to section 565 of title 5, 

5 United States Code, to carry out this section shall have 

6 as its members only representatives of the Federal Gov7 ernment and representatives of Indian Tribes, and Tribal 

8 Organizations, a majority of whom shall be nominated by 

9 and be representatives of Indian Tribes and Tribal Orga10 nizations from each Service Area. 

11 ‘‘(c) ADAPTATION OF PROCEDURES.—The Secretary 

12 shall adapt the negotiated rulemaking procedures to the 

13 unique context of self-governance and the government-to14 government relationship between the United States and 

15 Indian Tribes. 

16 ‘‘(d) LACK OF REGULATIONS.—The lack of promul17 gated regulations shall not limit the effect of this Act. 

18 ‘‘SEC. 803. PLAN OF IMPLEMENTATION. 

19 ‘‘(a) IN GENERAL.—Not later than 1 year after the 

20 date of enactment of the Indian Health Care Improvement 

21 Act Amendments of 2009, the Secretary, in consultation 

22 with Indian Tribes, Tribal Organizations, and urban In23 dian organizations, shall submit to Congress a plan ex24 plaining the manner and schedule, by title and section, 

25 by which the Secretary will implement the provisions of 


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1 this Act. This consultation may be conducted jointly with 

2 the annual budget consultation pursuant to the Indian 

3 Self-Determination and Education Assistance Act (25 

4 U.S.C. 450 et seq.). 

5 ‘‘(b) LACK OF PLAN.—The lack of (or failure to sub6 mit) such a plan shall not limit the effect, or prevent the 

7 implementation, of this Act. 

8 ‘‘SEC. 804. LIMITATION ON USE OF FUNDS APPROPRIATED 

9 TO INDIAN HEALTH SERVICE. 

10 ‘‘Any limitation on the use of funds contained in an 

11 Act providing appropriations for the Department for a pe12 riod with respect to the performance of abortions shall 

13 apply for that period with respect to the performance of 

14 abortions using funds contained in an Act providing ap15 propriations for the Service. 

16 ‘‘SEC. 805. ELIGIBILITY OF CALIFORNIA INDIANS. 

17 ‘‘(a) IN GENERAL.—The following California Indians 

18 shall be eligible for health services provided by the Service: 

19 ‘‘(1) Any member of a federally recognized In20 dian Tribe. 

21 ‘‘(2) Any descendant of an Indian who was re22 siding in California on June 1, 1852, if such de23 scendant— 

24 ‘‘(A) is a member of the Indian community 

25 served by a local program of the Service; and 


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1 ‘‘(B) is regarded as an Indian by the com2 munity in which such descendant lives. 

3 ‘‘(3) Any Indian who holds trust interests in 

4 public domain, national forest, or reservation allot5 ments in California. 

6 ‘‘(4) Any Indian in California who is listed on 

7 the plans for distribution of the assets of rancherias 

8 and reservations located within the State of Cali9 fornia under the Act of August 18, 1958 (72 Stat. 

10 619), and any descendant of such an Indian. 

11 ‘‘(b) CLARIFICATION.—Nothing in this section may 

12 be construed as expanding the eligibility of California Indi13 ans for health services provided by the Service beyond the 

14 scope of eligibility for such health services that applied on 

15 May 1, 1986. 

16 ‘‘SEC. 806. HEALTH SERVICES FOR INELIGIBLE PERSONS. 

17 ‘‘(a) CHILDREN.—Any individual who— 

18 ‘‘(1) has not attained 19 years of age; 

19 ‘‘(2) is the natural or adopted child, stepchild, 

20 foster child, legal ward, or orphan of an eligible In21 dian; and 

22 ‘‘(3) is not otherwise eligible for health services 

23 provided by the Service, 

24 shall be eligible for all health services provided by the 

25 Service on the same basis and subject to the same rules 


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1 that apply to eligible Indians until such individual attains 

2 19 years of age. The existing and potential health needs 

3 of all such individuals shall be taken into consideration 

4 by the Service in determining the need for, or the alloca5 tion of, the health resources of the Service. If such an indi6 vidual has been determined to be legally incompetent prior 

7 to attaining 19 years of age, such individual shall remain 

8 eligible for such services until 1 year after the date of a 

9 determination of competency. 

10 ‘‘(b) SPOUSES.—Any spouse of an eligible Indian who 

11 is not an Indian, or who is of Indian descent but is not 

12 otherwise eligible for the health services provided by the 

13 Service, shall be eligible for such health services if all such 

14 spouses or spouses who are married to members of each 

15 Indian Tribe being served are made eligible, as a class, 

16 by an appropriate resolution of the governing body of the 

17 Indian Tribe or Tribal Organization providing such serv18 ices. The health needs of persons made eligible under this 

19 paragraph shall not be taken into consideration by the 

20 Service in determining the need for, or allocation of, its 

21 health resources. 

22 ‘‘(c) PROVISION OF SERVICES TO OTHER INDIVID23 UALS.— 

24 ‘‘(1) IN GENERAL.—The Secretary is authorized 

25 to provide health services under this subsection 


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1 through health programs operated directly by the 

2 Service to individuals who reside within the Service 

3 area of the Service Unit and who are not otherwise 

4 eligible for such health services if— 

5 ‘‘(A) the Indian Tribes served by such 

6 Service Unit request such provision of health 

7 services to such individuals; and 

8 ‘‘(B) the Secretary and the served Indian 

9 Tribes have jointly determined that— 

10 ‘‘(i) the provision of such health serv11 ices will not result in a denial or diminu12 tion of health services to eligible Indians; 

13 and 

14 ‘‘(ii) there is no reasonable alternative 

15 health facilities or services, within or with16 out the Service Unit, available to meet the 

17 health needs of such individuals. 

18 ‘‘(2) ISDEAA PROGRAMS.—In the case of 

19 health programs and facilities operated under a con20 tract or compact entered into under the Indian Self21 Determination and Education Assistance Act (25 

22 U.S.C. 450 et seq.), the governing body of the In23 dian Tribe or Tribal Organization providing health 

24 services under such contract or compact is author25 ized to determine whether health services should be 


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1 provided under such contract to individuals who are 

2 not eligible for such health services under any other 

3 subsection of this section or under any other provi4 sion of law. In making such determinations, the gov5 erning body of the Indian Tribe or Tribal Organiza6 tion shall take into account the considerations de7 scribed in paragraph (1)(B). 

8 ‘‘(3) PAYMENT FOR SERVICES.— 

9 ‘‘(A) IN GENERAL.—Persons receiving 

10 health services provided by the Service under 

11 this subsection shall be liable for payment of 

12 such health services under a schedule of charges 

13 prescribed by the Secretary which, in the judg14 ment of the Secretary, results in reimbursement 

15 in an amount not less than the actual cost of 

16 providing the health services. Notwithstanding 

17 section 404 of this Act or any other provision 

18 of law, amounts collected under this subsection, 

19 including Medicare, Medicaid, or SCHIP reim20 bursements under titles XVIII, XIX, and XXI 

21 of the Social Security Act, shall be credited to 

22 the account of the program providing the serv23 ice and shall be used for the purposes listed in 

24 section 401(d)(2) and amounts collected under 


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1 this subsection shall be available for expendi2 ture within such program. 

3 ‘‘(B) INDIGENT PEOPLE.—Health services 

4 may be provided by the Secretary through the 

5 Service under this subsection to an indigent in6 dividual who would not be otherwise eligible for 

7 such health services but for the provisions of 

8 paragraph (1) only if an agreement has been 

9 entered into with a State or local government 

10 under which the State or local government 

11 agrees to reimburse the Service for the expenses 

12 incurred by the Service in providing such health 

13 services to such indigent individual. 

14 ‘‘(4) REVOCATION OF CONSENT FOR SERV15 ICES.— 

16 ‘‘(A) SINGLE TRIBE SERVICE AREA.—In 

17 the case of a Service Area which serves only 1 

18 Indian Tribe, the authority of the Secretary to 

19 provide health services under paragraph (1) 

20 shall terminate at the end of the fiscal year suc21 ceeding the fiscal year in which the governing 

22 body of the Indian Tribe revokes its concur23 rence to the provision of such health services. 

24 ‘‘(B) MULTITRIBAL SERVICE AREA.—In 

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1 thority of the Secretary to provide health serv2 ices under paragraph (1) shall terminate at the 

3 end of the fiscal year succeeding the fiscal year 

4 in which at least 51 percent of the number of 

5 Indian Tribes in the Service Area revoke their 

6 concurrence to the provisions of such health 

7 services. 

8 ‘‘(d) OTHER SERVICES.—The Service may provide 

9 health services under this subsection to individuals who 

10 are not eligible for health services provided by the Service 

11 under any other provision of law in order to— 

12 ‘‘(1) achieve stability in a medical emergency; 

13 ‘‘(2) prevent the spread of a communicable dis14 ease or otherwise deal with a public health hazard; 

15 ‘‘(3) provide care to non-Indian women preg16 nant with an eligible Indian’s child for the duration 

17 of the pregnancy through postpartum; or 

18 ‘‘(4) provide care to immediate family members 

19 of an eligible individual if such care is directly re20 lated to the treatment of the eligible individual. 

21 ‘‘(e) HOSPITAL PRIVILEGES FOR PRACTITIONERS.— 

22 ‘‘(1) IN GENERAL.—Hospital privileges in 

23 health facilities operated and maintained by the 

24 Service or operated under a contract or compact 

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1 cation Assistance Act (25 U.S.C. 450 et seq.) may 

2 be extended to non-Service health care practitioners 

3 who provide services to individuals described in sub4 section (a), (b), (c), or (d). Such non-Service health 

5 care practitioners may, as part of the privileging 

6 process, be designated as employees of the Federal 

7 Government for purposes of section 1346(b) and 

8 chapter 171 of title 28, United States Code (relating 

9 to Federal tort claims) only with respect to acts or 

10 omissions which occur in the course of providing 

11 services to eligible individuals as a part of the condi12 tions under which such hospital privileges are ex13 tended. 

14 ‘‘(2) DEFINITION.—For purposes of this sub15 section, the term ‘non-Service health care practi16 tioner’ means a practitioner who is not— 

17 ‘‘(A) an employee of the Service; or 

18 ‘‘(B) an employee of an Indian tribe or 

19 tribal organization operating a contract or com20 pact under the Indian Self-Determination and 

21 Education Assistance Act or an individual who 

22 provides health care services pursuant to a per23 sonal services contract with such Indian tribe or 

24 tribal organization. 


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1 ‘‘(f) ELIGIBLE INDIAN.—For purposes of this sec2 tion, the term ‘eligible Indian’ means any Indian who is 

3 eligible for health services provided by the Service without 

4 regard to the provisions of this section. 

5 ‘‘SEC. 807. TREATMENT OF CERTAIN SERVICES AND BENE6 FITS. 

7 ‘‘(a) Gross income does not include (1) health services 

8 or benefits provided or purchased by the Indian Health 

9 Service, either directly or indirectly, through a grant to 

10 or a contract or compact with an Indian tribe or tribal 

11 organization, or grants to or other programs of third par12 ties funded by the Indian Health Service; (2) health serv13 ices, health benefits or other amounts for health care serv14 ices, including preventive care and treatment of personal 

15 injuries or sickness and other health conditions, provided 

16 by an Indian tribe or tribal organization to an Indian ei17 ther directly, through purchased services, or through acci18 dent or health insurance (or through an arrangement hav19 ing the effect of accident or health insurance); (3) the 

20 value of health coverage provided or premiums paid by an 

21 Indian tribe or tribal organization to or on behalf of an 

22 Indian under an accident or health plan (or through an 

23 arrangement having the effect of accident or health insur24 ance); or (4) any other benefit or service provided by an 

25 Indian tribe that supplements the programs and services 


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1 provided by the Federal government to Indian tribes or 

2 Indians, or other general welfare benefits or services pro3 vided by Indian tribes to Indians. 

4 ‘‘(b) DEFINITIONS.—For the purposes of this section: 

5 ‘‘(1) The terms ‘accident or health insurance’ 

6 and ‘personal injuries and sickness’ have the mean7 ing given those terms in section 104 of the Internal 

8 Revenue Code of 1986. 

9 ‘‘(2) The term ‘Indian tribe’ has the meaning 

10 given that term in section 4(e) of the Indian Self11 Determination and Education Assistance Act (25 

12 U.S.C. 450b(e)). 

13 ‘‘(3) The term ‘Indians’ and ‘Indian’ means any 

14 person who— 

15 ‘‘(A) is a member of an Indian tribe, as 

16 defined in paragraph (2); and 

17 ‘‘(B)(i) irrespective of whether the indi18 vidual lives on or near a reservation, is a mem19 ber of a tribe, band, or other organized group 

20 of Indians, including those tribes, bands, or 

21 groups terminated since 1940 and those recog22 nized by the State in which they reside; 

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

24 degree, of any such member; 


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1 ‘‘(iii) is an Eskimo or Aleut or other Alas2 ka Native; 

3 ‘‘(iv) is otherwise eligible for services pro4 vided or funded by the Indian Health Service 

5 under applicable law; or 

6 ‘‘(v) is considered by the Secretary of the 

7 Interior to be an Indian for any purpose. 

8 ‘‘(4) The term ‘tribal organization’ has the 

9 meaning given that term in section 4(l) of the In10 dian Self-Determination and Education Assistance 

11 Act (25 U.S.C. 450b(l)). 

12 ‘‘(c) NO INFERENCE.—Nothing in this section is in13 tended as an inference to the tax treatment of govern14 mental benefits (including health care benefits not covered 

15 under this section) provided by Indian tribes to Indians 

16 after the date of the enactment of this section. 

17 ‘‘SEC. 808. REALLOCATION OF BASE RESOURCES. 

18 ‘‘(a) REPORT REQUIRED.—Notwithstanding any 

19 other provision of law, any allocation of Service funds for 

20 a fiscal year that reduces by 5 percent or more from the 

21 previous fiscal year the funding for any recurring pro22 gram, project, or activity of a Service Unit may be imple23 mented only after the Secretary has submitted to Con24 gress, under section 801, a report on the proposed change 


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1 in allocation of funding, including the reasons for the 

2 change and its likely effects. 

3 ‘‘(b) EXCEPTION.—Subsection (a) shall not apply if 

4 the total amount appropriated to the Service for a fiscal 

5 year is at least 5 percent less than the amount appro6 priated to the Service for the previous fiscal year. 

7 ‘‘SEC. 809. RESULTS OF DEMONSTRATION PROJECTS. 

8 ‘‘The Secretary shall provide for the dissemination to 

9 Indian Tribes, Tribal Organizations, and urban Indian or10 ganizations of the findings and results of demonstration 

11 projects conducted under this Act. 

12 ‘‘SEC. 810. PROVISION OF SERVICES IN MONTANA. 

13 ‘‘(a) CONSISTENT WITH COURT DECISION.—The 

14 Secretary, acting through the Service, shall provide serv15 ices and benefits for Indians in Montana in a manner con16 sistent with the decision of the United States Court of Ap17 peals for the Ninth Circuit in McNabb for McNabb v. 

18 Bowen, 829 F.2d 787 (9th Cir. 1987). 

19 ‘‘(b) CLARIFICATION.—The provisions of subsection 

20 (a) shall not be construed to be an expression of the sense 

21 of Congress on the application of the decision described 

22 in subsection (a) with respect to the provision of services 

23 or benefits for Indians living in any State other than Mon24 tana. 


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1 ‘‘SEC. 811. MORATORIUM. 

2 ‘‘During the period of the moratorium imposed on 

3 implementation of the final rule published in the Federal 

4 Register on September 16, 1987, by the Department of 

5 Health and Human Services, relating to eligibility for the 

6 health care services of the Indian Health Service, the In7 dian Health Service shall provide services pursuant to the 

8 criteria for eligibility for such services that were in effect 

9 on September 15, 1987, subject to the provisions of sec10 tions 805 and 806, until the Service has submitted to the 

11 Committees on Appropriations of the Senate and the 

12 House of Representatives a budget request reflecting the 

13 increased costs associated with the proposed final rule, 

14 and the request has been included in an appropriations 

15 Act and enacted into law. 

16 ‘‘SEC. 812. SEVERABILITY PROVISIONS. 

17 ‘‘If any provision of this Act, any amendment made 

18 by the Act, or the application of such provision or amend19 ment to any person or circumstances is held to be invalid, 

20 the remainder of this Act, the remaining amendments 

21 made by this Act, and the application of such provisions 

22 to persons or circumstances other than those to which it 

23 is held invalid, shall not be affected thereby. 

24 ‘‘SEC. 813. USE OF PATIENT SAFETY ORGANIZATIONS. 

25 ‘‘The Service, an Indian Tribe, Tribal Organization, 

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1 surance activities through the use of a patient safety orga2 nization in accordance with title IX of the Public Health 

3 Service Act. 

4 ‘‘SEC. 814. CONFIDENTIALITY OF MEDICAL QUALITY ASSUR5 ANCE RECORDS; QUALIFIED IMMUNITY FOR 

6 PARTICIPANTS. 

7 ‘‘(a) CONFIDENTIALITY OF RECORDS.—Medical qual8 ity assurance records created by or for any Indian Health 

9 Program or a health program of an Urban Indian Organi10 zation as part of a medical quality assurance program are 

11 confidential and privileged. Such records may not be dis12 closed to any person or entity, except as provided in sub13 section (c). 

14 ‘‘(b) PROHIBITION ON DISCLOSURE AND TESTI15 MONY.— 

16 ‘‘(1) IN GENERAL.—No part of any medical 

17 quality assurance record described in subsection (a) 

18 may be subject to discovery or admitted into evi19 dence in any judicial or administrative proceeding, 

20 except as provided in subsection (c). 

21 ‘‘(2) TESTIMONY.—A person who reviews or 

22 creates medical quality assurance records for any In23 dian Health Program or Urban Indian Organization 

24 who participates in any proceeding that reviews or 

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1 quired to testify in any judicial or administrative 

2 proceeding with respect to such records or with re3 spect to any finding, recommendation, evaluation, 

4 opinion, or action taken by such person or body in 

5 connection with such records except as provided in 

6 this section. 

7 ‘‘(c) AUTHORIZED DISCLOSURE AND TESTIMONY.— 

8 ‘‘(1) IN GENERAL.—Subject to paragraph (2), a 

9 medical quality assurance record described in sub10 section (a) may be disclosed, and a person referred 

11 to in subsection (b) may give testimony in connec12 tion with such a record, only as follows: 

13 ‘‘(A) To a Federal executive agency or pri14 vate organization, if such medical quality assur15 ance record or testimony is needed by such 

16 agency or organization to perform licensing or 

17 accreditation functions related to any Indian 

18 Health Program or to a health program of an 

19 Urban Indian Organization to perform moni20 toring, required by law, of such program or or21 ganization. 

22 ‘‘(B) To an administrative or judicial pro23 ceeding commenced by a present or former In24 dian Health Program or Urban Indian Organi25 zation provider concerning the termination, susVerDate Nov 24 2008 23:28 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00322 Fmt 6652 Sfmt 6201 E:\BILLS\H2708.IH H2708

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1 pension, or limitation of clinical privileges of 

2 such health care provider. 

3 ‘‘(C) To a governmental board or agency 

4 or to a professional health care society or orga5 nization, if such medical quality assurance 

6 record or testimony is needed by such board, 

7 agency, society, or organization to perform li8 censing, credentialing, or the monitoring of pro9 fessional standards with respect to any health 

10 care provider who is or was an employee of any 

11 Indian Health Program or Urban Indian Orga12 nization. 

13 ‘‘(D) To a hospital, medical center, or 

14 other institution that provides health care serv15 ices, if such medical quality assurance record or 

16 testimony is needed by such institution to as17 sess the professional qualifications of any health 

18 care provider who is or was an employee of any 

19 Indian Health Program or Urban Indian Orga20 nization and who has applied for or been grant21 ed authority or employment to provide health 

22 care services in or on behalf of such program or 

23 organization. 

24 ‘‘(E) To an officer, employee, or contractor 

25 of the Indian Health Program or Urban Indian 


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1 Organization that created the records or for 

2 which the records were created. If that officer, 

3 employee, or contractor has a need for such 

4 record or testimony to perform official duties. 

5 ‘‘(F) To a criminal or civil law enforce6 ment agency or instrumentality charged under 

7 applicable law with the protection of the public 

8 health or safety, if a qualified representative of 

9 such agency or instrumentality makes a written 

10 request that such record or testimony be pro11 vided for a purpose authorized by law. 

12 ‘‘(G) In an administrative or judicial pro13 ceeding commenced by a criminal or civil law 

14 enforcement agency or instrumentality referred 

15 to in subparagraph (F), but only with respect 

16 to the subject of such proceeding. 

17 ‘‘(2) IDENTITY OF PARTICIPANTS.—With the 

18 exception of the subject of a quality assurance ac19 tion, the identity of any person receiving health care 

20 services from any Indian Health Program or Urban 

21 Indian Organization or the identity of any other per22 son associated with such program or organization 

23 for purposes of a medical quality assurance program 

24 that is disclosed in a medical quality assurance 

25 record described in subsection (a) shall be deleted 


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1 from that record or document before any disclosure 

2 of such record is made outside such program or or3 ganization. 

4 ‘‘(d) DISCLOSURE FOR CERTAIN PURPOSES.— 

5 ‘‘(1) IN GENERAL.—Nothing in this section 

6 shall be construed as authorizing or requiring the 

7 withholding from any person or entity aggregate sta8 tistical information regarding the results of any In9 dian Health Program or Urban Indian 

10 Organizations’s medical quality assurance programs. 

11 ‘‘(2) WITHHOLDING FROM CONGRESS.—Noth12 ing in this section shall be construed as authority to 

13 withhold any medical quality assurance record from 

14 a committee of either House of Congress, any joint 

15 committee of Congress, or the Government Account16 ability Office if such record pertains to any matter 

17 within their respective jurisdictions. 

18 ‘‘(e) PROHIBITION ON DISCLOSURE OF RECORD OR

19 TESTIMONY.—A person or entity having possession of or 

20 access to a record or testimony described by this section 

21 may not disclose the contents of such record or testimony 

22 in any manner or for any purpose except as provided in 

23 this section. 

24 ‘‘(f) EXEMPTION FROM FREEDOM OF INFORMATION

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1 section (a) may not be made available to any person under 

2 section 552 of title 5, United States Code. 

3 ‘‘(g) LIMITATION ON CIVIL LIABILITY.—A person 

4 who participates in or provides information to a person 

5 or body that reviews or creates medical quality assurance 

6 records described in subsection (a) shall not be civilly lia7 ble for such participation or for providing such informa8 tion if the participation or provision of information was 

9 in good faith based on prevailing professional standards 

10 at the time the medical quality assurance program activity 

11 took place. 

12 ‘‘(h) APPLICATION TO INFORMATION IN CERTAIN

13 OTHER RECORDS.—Nothing in this section shall be con14 strued as limiting access to the information in a record 

15 created and maintained outside a medical quality assur16 ance program, including a patient’s medical records, on 

17 the grounds that the information was presented during 

18 meetings of a review body that are part of a medical qual19 ity assurance program. 

20 ‘‘(i) REGULATIONS.—The Secretary, acting through 

21 the Service, shall promulgate regulations pursuant to sec22 tion 802. 

23 ‘‘(j) DEFINITIONS.—In this section: 

24 ‘‘(1) The term ‘health care provider’ means any 

25 health care professional, including community health 


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1 aides and practitioners certified under section 121, 

2 who are granted clinical practice privileges or em3 ployed to provide health care services in an Indian 

4 Health Program or health program of an Urban In5 dian Organization, who is licensed or certified to 

6 perform health care services by a governmental 

7 board or agency or professional health care society 

8 or organization. 

9 ‘‘(2) The term ‘medical quality assurance pro10 gram’ means any activity carried out before, on, or 

11 after the date of enactment of this Act by or for any 

12 Indian Health Program or Urban Indian Organiza13 tion to assess the quality of medical care, including 

14 activities conducted by or on behalf of individuals, 

15 Indian Health Program or Urban Indian Organiza16 tion medical or dental treatment review committees, 

17 or other review bodies responsible for quality assur18 ance, credentials, infection control, patient safety, 

19 patient care assessment (including treatment proce20 dures, blood, drugs, and therapeutics), medical 

21 records, health resources management review and 

22 identification and prevention of medical or dental in23 cidents and risks. 

24 ‘‘(3) The term ‘medical quality assurance 

25 record’ means the proceedings, records, minutes, and 


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1 reports that emanate from quality assurance pro2 gram activities described in paragraph (2) and are 

3 produced or compiled by or for an Indian Health 

4 Program or Urban Indian Organization as part of a 

5 medical quality assurance program. 

6 ‘‘(k) CONTINUED PROTECTION.—Disclosure under 

7 subsection (c) does not permit redisclosure except to the 

8 extent such further disclosure is authorized under sub9 section (c) or is otherwise authorized to be disclosed under 

10 this section. 

11 ‘‘(l) INCONSISTENCIES.—To the extent that the pro12 tections under the Patient Safety and Quality Improve13 ment Act of 2005 and this section are inconsistent, the 

14 provisions of whichever is more protective shall control. 

15 ‘‘(m) RELATIONSHIP TO OTHER LAW.—This section 

16 shall continue in force and effect, except asotherwise spe17 cifically provided in any Federal law enacted after the date 

18 of enactment of the Indian Health Care Improvement Act 

19 Amendments of 2009. 

20 ‘‘SEC. 815. CLAREMORE INDIAN HOSPITAL. 

21 ‘‘The Claremore Indian Hospital shall be deemed to 

22 be a dependant Indian community for the purposes of sec23 tion 1151 of title 18, United States Code. 


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1 ‘‘SEC. 816. SENSE OF CONGRESS REGARDING LAW EN2 FORCEMENT AND METHAMPHETAMINE 

3 ISSUES IN INDIAN COUNTRY. 

4 ‘‘It is the sense of Congress that Congress encourages 

5 State, local, and Indian tribal law enforcement agencies 

6 to enter into memoranda of agreement between and 

7 among those agencies for purposes of streamlining law en8 forcement activities and maximizing the use of limited re9 sources— 

10 ‘‘(1) to improve law enforcement services pro11 vided to Indian tribal communities; and 

12 ‘‘(2) to increase the effectiveness of measures to 

13 address problems relating to methamphetamine use 

14 in Indian country (as defined in section 1151 of title 

15 18, United States Code). 

16 ‘‘SEC. 817. PERMITTING IMPLEMENTATION THROUGH CON17 TRACTS WITH TRIBAL HEALTH PROGRAMS. 

18 ‘‘Nothing in this Act shall be construed as preventing 

19 the Secretary from— 

20 ‘‘(1) carrying out any section of this Act 

21 through contracts with Tribal Health Programs; and 

22 ‘‘(2) carrying out sections through 214, 

23 701(a)(1), 701(b)(1), 701(c), 707(g), and 712(b), 

24 through contracts with urban Indian organizations. 


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1 The previous sentence shall not affect the authority the 

2 Secretary may otherwise have to carry out other provisions 

3 of this Act through such contracts. 

4 ‘‘SEC. 818. AUTHORIZATION OF APPROPRIATIONS; AVAIL5 ABILITY. 

6 ‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—There 

7 are authorized to be appropriated such sums as may be 

8 necessary to carry out this title. 

9 ‘‘(b) LIMITATION ON NEW SPENDING AUTHORITY.— 

10 Any new spending authority (described in subparagraph 

11 (A) or (B) of section 401(c)(2) of the Congressional Budg12 et Act of 1974 (Public Law 93–344; 88 Stat. 317)) which 

13 is provided under this Act shall be effective for any fiscal 

14 year only to such extent or in such amounts as are pro15 vided in appropriation Acts. 

16 ‘‘(c) AVAILABILITY.—The funds appropriated pursu17 ant to this Act shall remain available until expended.’’. 

18 (b) RATE OF PAY.— 

19 (1) POSITIONS AT LEVEL IV.—Section 5315 of 

20 title 5, United States Code, is amended by striking 

21 ‘‘Assistant Secretaries of Health and Human Serv22 ices (6).’’ and inserting ‘‘Assistant Secretaries of 

23 Health and Human Services (7)’’. 

24 (2) POSITIONS AT LEVEL V.—Section 5316 of 

25 title 5, United States Code, is amended by striking 


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1 ‘‘Director, Indian Health Service, Department of 

2 Health and Human Services’’. 

3 (c) AMENDMENTS TO OTHER PROVISIONS OF LAW.— 

4 (1) Section 3307(b)(1)(C) of the Children’s 

5 Health Act of 2000 (25 U.S.C. 1671 note; Public 

6 Law 106–310) is amended by striking ‘‘Director of 

7 the Indian Health Service’’ and inserting ‘‘Assistant 

8 Secretary for Indian Health’’. 

9 (2) The Indian Lands Open Dump Cleanup Act 

10 of 1994 is amended— 

11 (A) in section 3 (25 U.S.C. 3902)— 

12 (i) by striking paragraph (2); 

13 (ii) by redesignating paragraphs (1), 

14 (3), (4), (5), and (6) as paragraphs (4), 

15 (5), (2), (6), and (1), respectively, and 

16 moving those paragraphs so as to appear 

17 in numerical order; and 

18 (iii) by inserting before paragraph (4) 

19 (as redesignated by subclause (II)) the fol20 lowing: 

21 ‘‘(3) ASSISTANT SECRETARY.—The term ‘As22 sistant Secretary’ means the Assistant Secretary for 

23 Indian Health.’’; 


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1 (B) in section 5 (25 U.S.C. 3904), by 

2 striking the section designation and heading 

3 and inserting the following: 

4 ‘‘SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR IN5 DIAN HEALTH.’’; 

6 (C) in section 6(a) (25 U.S.C. 3905(a)), in 

7 the subsection heading, by striking ‘‘DIREC8 TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 

9 (D) in section 9(a) (25 U.S.C. 3908(a)), in 

10 the subsection heading, by striking ‘‘DIREC11 TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 

12 and 

13 (E) by striking ‘‘Director’’ each place it 

14 appears and inserting ‘‘Assistant Secretary’’. 

15 (3) Section 5504(d)(2) of the Augustus F. 

16 Hawkins-Robert T. Stafford Elementary and Sec17 ondary School Improvement Amendments of 1988 

18 (25 U.S.C. 2001 note; Public Law 100–297) is 

19 amended by striking ‘‘Director of the Indian Health 

20 Service’’ and inserting ‘‘Assistant Secretary for In21 dian Health’’. 

22 (4) Section 203(a)(1) of the Rehabilitation Act 

23 of 1973 (29 U.S.C. 763(a)(1)) is amended by strik24 ing ‘‘Director of the Indian Health Service’’ and in25 serting ‘‘Assistant Secretary for Indian Health’’. 


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1 (5) Subsections (b) and (e) of section 518 of 

2 the Federal Water Pollution Control Act (33 U.S.C. 

3 1377) are amended by striking ‘‘Director of the In4 dian Health Service’’ each place it appears and in5 serting ‘‘Assistant Secretary for Indian Health’’. 

6 (6) Section 317M(b) of the Public Health Serv7 ice Act (42 U.S.C. 247b–14(b)) is amended— 

8 (A) by striking ‘‘Director of the Indian 

9 Health Service’’ each place it appears and in10 serting ‘‘Assistant Secretary for Indian 

11 Health’’; and 

12 (B) in paragraph (2)(A), by striking ‘‘the 

13 Directors referred to in such paragraph’’ and 

14 inserting ‘‘the Director of the Centers for Dis15 ease Control and Prevention and the Assistant 

16 Secretary for Indian Health’’. 

17 (7) Section 417C(b) of the Public Health Serv18 ice Act (42 U.S.C. 285–9(b)) is amended by striking 

19 ‘‘Director of the Indian Health Service’’ and insert20 ing ‘‘Assistant Secretary for Indian Health’’. 

21 (8) Section 1452(i) of the Safe Drinking Water 

22 Act (42 U.S.C. 300j–12(i)) is amended by striking 

23 ‘‘Director of the Indian Health Service’’ each place 

24 it appears and inserting ‘‘Assistant Secretary for In25 dian Health’’. 


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1 (9) Section 803B(d)(1) of the Native American 

2 Programs Act of 1974 (42 U.S.C. 2991b–2(d)(1)) is 

3 amended in the last sentence by striking ‘‘Director 

4 of the Indian Health Service’’ and inserting ‘‘Assist5 ant Secretary for Indian Health’’. 

6 (10) Section 203(b) of the Michigan Indian 

7 Land Claims Settlement Act (Public Law 105–143; 

8 111 Stat. 2666) is amended by striking ‘‘Director of 

9 the Indian Health Service’’ and inserting ‘‘Assistant 

10 Secretary for Indian Health’’. 

11 SEC. 102. SOBOBA SANITATION FACILITIES. 

12 The Act of December 17, 1970 (84 Stat. 1465), is 

13 amended by adding at the end the following: 

14 ‘‘SEC. 9. Nothing in this Act shall preclude the 

15 Soboba Band of Mission Indians and the Soboba Indian 

16 Reservation from being provided with sanitation facilities 

17 and services under the authority of section 7 of the Act 

18 of August 5, 1954 (68 Stat. 674), as amended by the Act 

19 of July 31, 1959 (73 Stat. 267).’’. 

20 SEC. 103. NATIVE AMERICAN HEALTH AND WELLNESS 

21 FOUNDATION. 

22 (a) IN GENERAL.—The Indian Self-Determination 

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

24 amended by adding at the end the following: 


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1 ‘‘TITLE VIII—NATIVE AMERICAN 

2 HEALTH AND WELLNESS 

3 FOUNDATION 

4 ‘‘SEC. 801. DEFINITIONS. 

5 ‘‘In this title: 

6 ‘‘(1) BOARD.—The term ‘Board’ means the 

7 Board of Directors of the Foundation. 

8 ‘‘(2) COMMITTEE.—The term ‘Committee’ 

9 means the Committee for the Establishment of Na10 tive American Health and Wellness Foundation es11 tablished under section 802(f). 

12 ‘‘(3) FOUNDATION.—The term ‘Foundation’ 

13 means the Native American Health and Wellness 

14 Foundation established under section 802. 

15 ‘‘(4) SECRETARY.—The term ‘Secretary’ means 

16 the Secretary of Health and Human Services. 

17 ‘‘(5) SERVICE.—The term ‘Service’ means the 

18 Indian Health Service of the Department of Health 

19 and Human Services. 

20 ‘‘SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS 

21 FOUNDATION. 

22 ‘‘(a) ESTABLISHMENT.— 

23 ‘‘(1) IN GENERAL.—As soon as practicable 

24 after the date of enactment of this title, the Sec25 retary shall establish, under the laws of the District 


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1 of Columbia and in accordance with this title, the 

2 Native American Health and Wellness Foundation. 

3 ‘‘(2) FUNDING DETERMINATIONS.—No funds, 

4 gift, property, or other item of value (including any 

5 interest accrued on such an item) acquired by the 

6 Foundation shall— 

7 ‘‘(A) be taken into consideration for pur8 poses of determining Federal appropriations re9 lating to the provision of health care and serv10 ices to Indians; or 

11 ‘‘(B) otherwise limit, diminish, or affect 

12 the Federal responsibility for the provision of 

13 health care and services to Indians. 

14 ‘‘(b) PERPETUAL EXISTENCE.—The Foundation 

15 shall have perpetual existence. 

16 ‘‘(c) NATURE OF CORPORATION.—The Foundation— 

17 ‘‘(1) shall be a charitable and nonprofit feder18 ally chartered corporation; and 

19 ‘‘(2) shall not be an agency or instrumentality 

20 of the United States. 

21 ‘‘(d) PLACE OF INCORPORATION AND DOMICILE.— 

22 The Foundation shall be incorporated and domiciled in the 

23 District of Columbia. 

24 ‘‘(e) DUTIES.—The Foundation shall— 


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1 ‘‘(1) encourage, accept, and administer private 

2 gifts of real and personal property, and any income 

3 from or interest in such gifts, for the benefit of, or 

4 in support of, the mission of the Service; 

5 ‘‘(2) undertake and conduct such other activi6 ties as will further the health and wellness activities 

7 and opportunities of Native Americans; and 

8 ‘‘(3) participate with and assist Federal, State, 

9 and tribal governments, agencies, entities, and indi10 viduals in undertaking and conducting activities that 

11 will further the health and wellness activities and op12 portunities of Native Americans. 

13 ‘‘(f) COMMITTEE FOR THE ESTABLISHMENT OF NA14 TIVE AMERICAN HEALTH AND WELLNESS FOUNDA15 TION.— 

16 ‘‘(1) IN GENERAL.—The Secretary shall estab17 lish the Committee for the Establishment of Native 

18 American Health and Wellness Foundation to assist 

19 the Secretary in establishing the Foundation. 

20 ‘‘(2) DUTIES.—Not later than 180 days after 

21 the date of enactment of this section, the Committee 

22 shall— 

23 ‘‘(A) carry out such activities as are nec24 essary to incorporate the Foundation under the 


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1 laws of the District of Columbia, including act2 ing as incorporators of the Foundation; 

3 ‘‘(B) ensure that the Foundation qualifies 

4 for and maintains the status required to carry 

5 out this section, until the Board is established; 

6 ‘‘(C) establish the constitution and initial 

7 bylaws of the Foundation; 

8 ‘‘(D) provide for the initial operation of 

9 the Foundation, including providing for tem10 porary or interim quarters, equipment, and 

11 staff; and 

12 ‘‘(E) appoint the initial members of the 

13 Board in accordance with the constitution and 

14 initial bylaws of the Foundation. 

15 ‘‘(g) BOARD OF DIRECTORS.— 

16 ‘‘(1) IN GENERAL.—The Board of Directors 

17 shall be the governing body of the Foundation. 

18 ‘‘(2) POWERS.—The Board may exercise, or 

19 provide for the exercise of, the powers of the Foun20 dation. 

21 ‘‘(3) SELECTION.— 

22 ‘‘(A) IN GENERAL.—Subject to subpara23 graph (B), the number of members of the 

24 Board, the manner of selection of the members 

25 (including the filling of vacancies), and the 


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1 terms of office of the members shall be as pro2 vided in the constitution and bylaws of the 

3 Foundation. 

4 ‘‘(B) REQUIREMENTS.— 

5 ‘‘(i) NUMBER OF MEMBERS.—The 

6 Board shall have at least 11 members, who 

7 shall have staggered terms. 

8 ‘‘(ii) INITIAL VOTING MEMBERS.—The 

9 initial voting members of the Board— 

10 ‘‘(I) shall be appointed by the 

11 Committee not later than 180 days 

12 after the date on which the Founda13 tion is established; and 

14 ‘‘(II) shall have staggered terms. 

15 ‘‘(iii) QUALIFICATION.—The members 

16 of the Board shall be United States citi17 zens who are knowledgeable or experienced 

18 in Native American health care and related 

19 matters. 

20 ‘‘(C) COMPENSATION.—A member of the 

21 Board shall not receive compensation for service 

22 as a member, but shall be reimbursed for actual 

23 and necessary travel and subsistence expenses 

24 incurred in the performance of the duties of the 

25 Foundation. 


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1 ‘‘(h) OFFICERS.— 

2 ‘‘(1) IN GENERAL.—The officers of the Founda3 tion shall be— 

4 ‘‘(A) a secretary, elected from among the 

5 members of the Board; and 

6 ‘‘(B) any other officers provided for in the 

7 constitution and bylaws of the Foundation. 

8 ‘‘(2) CHIEF OPERATING OFFICER.—The sec9 retary of the Foundation may serve, at the direction 

10 of the Board, as the chief operating officer of the 

11 Foundation, or the Board may appoint a chief oper12 ating officer, who shall serve at the direction of the 

13 Board. 

14 ‘‘(3) ELECTION.—The manner of election, term 

15 of office, and duties of the officers of the Founda16 tion shall be as provided in the constitution and by17 laws of the Foundation. 

18 ‘‘(i) POWERS.—The Foundation— 

19 ‘‘(1) shall adopt a constitution and bylaws for 

20 the management of the property of the Foundation 

21 and the regulation of the affairs of the Foundation; 

22 ‘‘(2) may adopt and alter a corporate seal; 

23 ‘‘(3) may enter into contracts; 

24 ‘‘(4) may acquire (through a gift or otherwise), 

25 own, lease, encumber, and transfer real or personal 


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1 property as necessary or convenient to carry out the 

2 purposes of the Foundation; 

3 ‘‘(5) may sue and be sued; and 

4 ‘‘(6) may perform any other act necessary and 

5 proper to carry out the purposes of the Foundation. 

6 ‘‘(j) PRINCIPAL OFFICE.— 

7 ‘‘(1) IN GENERAL.—The principal office of the 

8 Foundation shall be in the District of Columbia. 

9 ‘‘(2) ACTIVITIES; OFFICES.—The activities of 

10 the Foundation may be conducted, and offices may 

11 be maintained, throughout the United States in ac12 cordance with the constitution and bylaws of the 

13 Foundation. 

14 ‘‘(k) SERVICE OF PROCESS.—The Foundation shall 

15 comply with the law on service of process of each State 

16 in which the Foundation is incorporated and of each State 

17 in which the Foundation carries on activities. 

18 ‘‘(l) LIABILITY OF OFFICERS, EMPLOYEES, AND

19 AGENTS.— 

20 ‘‘(1) IN GENERAL.—The Foundation shall be 

21 liable for the acts of the officers, employees, and 

22 agents of the Foundation acting within the scope of 

23 their authority. 

24 ‘‘(2) PERSONAL LIABILITY.—A member of the 

25 Board shall be personally liable only for gross negVerDate Nov 24 2008 23:28 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00341 Fmt 6652 Sfmt 6201 E:\BILLS\H2708.IH H2708

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1 ligence in the performance of the duties of the mem2 ber. 

3 ‘‘(m) RESTRICTIONS.— 

4 ‘‘(1) LIMITATION ON SPENDING.—Beginning 

5 with the fiscal year following the first full fiscal year 

6 during which the Foundation is in operation, the ad7 ministrative costs of the Foundation shall not exceed 

8 the percentage described in paragraph (2) of the 

9 sum of— 

10 ‘‘(A) the amounts transferred to the Foun11 dation under subsection (o) during the pre12 ceding fiscal year; and 

13 ‘‘(B) donations received from private 

14 sources during the preceding fiscal year. 

15 ‘‘(2) PERCENTAGES.—The percentages referred 

16 to in paragraph (1) are— 

17 ‘‘(A) for the first fiscal year described in 

18 that paragraph, 20 percent; 

19 ‘‘(B) for the following fiscal year, 15 per20 cent; and 

21 ‘‘(C) for each fiscal year thereafter, 10 

22 percent. 

23 ‘‘(3) APPOINTMENT AND HIRING.—The ap24 pointment of officers and employees of the Founda25 tion shall be subject to the availability of funds. 


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1 ‘‘(4) STATUS.—A member of the Board or offi2 cer, employee, or agent of the Foundation shall not 

3 by reason of association with the Foundation be con4 sidered to be an officer, employee, or agent of the 

5 United States. 

6 ‘‘(n) AUDITS.—The Foundation shall comply with 

7 section 10101 of title 36, United States Code, as if the 

8 Foundation were a corporation under part B of subtitle 

9 II of that title. 

10 ‘‘(o) FUNDING.— 

11 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS.— 

12 There is authorized to be appropriated to carry out 

13 subsection (e)(1) $500,000 for each fiscal year, as 

14 adjusted to reflect changes in the Consumer Price 

15 Index for all-urban consumers published by the De16 partment of Labor. 

17 ‘‘(2) TRANSFER OF DONATED FUNDS.—The 

18 Secretary shall transfer to the Foundation funds 

19 held by the Department of Health and Human Serv20 ices under the Act of August 5, 1954 (42 U.S.C. 

21 2001 et seq.), if the transfer or use of the funds is 

22 not prohibited by any term under which the funds 

23 were donated. 


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1 ‘‘SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT. 

2 ‘‘(a) PROVISION OF SUPPORT BY SECRETARY.—Sub3 ject to subsection (b), during the 5-year period beginning 

4 on the date on which the Foundation is established, the 

5 Secretary— 

6 ‘‘(1) may provide personnel, facilities, and other 

7 administrative support services to the Foundation; 

8 ‘‘(2) may provide funds for initial operating 

9 costs and to reimburse the travel expenses of the 

10 members of the Board; and 

11 ‘‘(3) shall require and accept reimbursements 

12 from the Foundation for— 

13 ‘‘(A) services provided under paragraph 

14 (1); and 

15 ‘‘(B) funds provided under paragraph (2). 

16 ‘‘(b) REIMBURSEMENT.—Reimbursements accepted 

17 under subsection (a)(3)— 

18 ‘‘(1) shall be deposited in the Treasury of the 

19 United States to the credit of the applicable appro20 priations account; and 

21 ‘‘(2) shall be chargeable for the cost of pro22 viding services described in subsection (a)(1) and 

23 travel expenses described in subsection (a)(2). 

24 ‘‘(c) CONTINUATION OF CERTAIN SERVICES.—The 

25 Secretary may continue to provide facilities and necessary 

26 support services to the Foundation after the termination 


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1 of the 5-year period specified in subsection (a) if the facili2 ties and services— 

3 ‘‘(1) are available; and 

4 ‘‘(2) are provided on reimbursable cost basis.’’. 

5 (b) TECHNICAL AMENDMENTS.—The Indian Self-De6 termination and Education Assistance Act is amended— 

7 (1) by redesignating title V (25 U.S.C. 458bbb 

8 et seq.) as title VII; 

9 (2) by redesignating sections 501, 502, and 503 

10 (25 U.S.C. 458bbb, 458bbb–1, 458bbb–2) as sec11 tions 701, 702, and 703, respectively; and 

12 (3) in subsection (a)(2) of section 702 and 

13 paragraph (2) of section 703 (as redesignated by 

14 paragraph (2)), by striking ‘‘section 501’’ and in15 serting ‘‘section 701’’. 

16 SEC. 104. GAO STUDY AND REPORT ON PAYMENTS FOR 

17 CONTRACT HEALTH SERVICES. 

18 (a) STUDY.— 

19 (1) IN GENERAL.—The Comptroller General of 

20 the United States (in this section referred to as the 

21 ‘‘Comptroller General’’) shall conduct a study on the 

22 utilization of health care furnished by health care 

23 providers under the contract health services program 

24 funded by the Indian Health Service and operated 

25 by the Indian Health Service, an Indian Tribe, or a 


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1 Tribal Organization (as those terms are defined in 

2 section 4 of the Indian Health Care Improvement 

3 Act). 

4 (2) ANALYSIS.—The study conducted under 

5 paragraph (1) shall include an analysis of— 

6 (A) the amounts reimbursed under the 

7 contract health services program described in 

8 paragraph (1) for health care furnished by enti9 ties, individual providers, and suppliers, includ10 ing a comparison of reimbursement for such 

11 health care through other public programs and 

12 in the private sector; 

13 (B) barriers to accessing care under such 

14 contract health services program, including, but 

15 not limited to, barriers relating to travel dis16 tances, cultural differences, and public and pri17 vate sector reluctance to furnish care to pa18 tients under such program; 

19 (C) the adequacy of existing Federal fund20 ing for health care under such contract health 

21 services program; and 

22 (D) any other items determined appro23 priate by the Comptroller General. 

24 (b) REPORT.—Not later than 18 months after the 

25 date of enactment of this Act, the Comptroller General 


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1 shall submit to Congress a report on the study conducted 

2 under subsection (a), together with recommendations re3 garding— 

4 (1) the appropriate level of Federal funding 

5 that should be established for health care under the 

6 contract health services program described in sub7 section (a)(1); and 

8 (2) how to most efficiently utilize such funding. 

9 (c) CONSULTATION.—In conducting the study under 

10 subsection (a) and preparing the report under subsection 

11 (b), the Comptroller General shall consult with the Indian 

12 Health Service, Indian Tribes, and Tribal Organizations. 

13 TITLE II—IMPROVEMENT OF IN14 DIAN HEALTH CARE PRO15 VIDED UNDER THE SOCIAL 

16 SECURITY ACT 

17 SEC. 201. EXPANSION OF PAYMENTS UNDER MEDICARE, 

18 MEDICAID, AND SCHIP FOR ALL COVERED 

19 SERVICES FURNISHED BY INDIAN HEALTH 

20 PROGRAMS. 

21 (a) MEDICAID.— 

22 (1) EXPANSION TO ALL COVERED SERVICES.— 

23 Section 1911 of the Social Security Act (42 U.S.C. 

24 1396j) is amended— 


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1 (A) by amending the heading to read as 

2 follows: 

3 ‘‘SEC. 1911. INDIAN HEALTH PROGRAMS.’’; 

4 and 

5 (B) by amending subsection (a) to read as 

6 follows: 

7 ‘‘(a) ELIGIBILITY FOR PAYMENT FOR MEDICAL AS8 SISTANCE.—An Indian Health Program shall be eligible 

9 for payment for medical assistance provided under a State 

10 plan or under waiver authority with respect to items and 

11 services furnished by the Program if the furnishing of 

12 such services meets all the conditions and requirements 

13 which are applicable generally to the furnishing of items 

14 and services under this title and under such plan or waiver 

15 authority.’’. 

16 (2) REPEAL OF OBSOLETE PROVISION.—Sub17 section (b) of such section is repealed. 

18 (3) REVISION OF AUTHORITY TO ENTER INTO

19 AGREEMENTS.—Subsection (c) of such section is 

20 amended to read as follows: 

21 ‘‘(c) AUTHORITY TO ENTER INTO AGREEMENTS.— 

22 The Secretary may enter into an agreement with a State 

23 for the purpose of reimbursing the State for medical as24 sistance provided by the Indian Health Service, an Indian 

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1 tion (as so defined), directly, through referral, or under 

2 contracts or other arrangements between the Indian 

3 Health Service, an Indian Tribe, Tribal Organization, or 

4 an Urban Indian Organization and another health care 

5 provider to Indians who are eligible for medical assistance 

6 under the State plan or under waiver authority. This sub7 section shall not be construed to impair the entitlement 

8 of a State to reimbursement for such medical assistance 

9 under this title.’’. 

10 (4) CROSS-REFERENCES TO SPECIAL FUND FOR

11 IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING

12 OPTION; DEFINITIONS.—Such section is further 

13 amended by striking subsection (d) and adding at 

14 the end the following new subsections: 

15 ‘‘(c) SPECIAL FUND FOR IMPROVEMENT OF IHS FA16 CILITIES.—For provisions relating to the authority of the 

17 Secretary to place payments to which a facility of the In18 dian Health Service is eligible for payment under this title 

19 into a special fund established under section 401(c)(1) of 

20 the Indian Health Care Improvement Act, see subpara21 graphs (A) and (B) of section 401(c)(1) of such Act. 

22 ‘‘(d) DIRECT BILLING.—For provisions relating to 

23 the authority of an Tribal Health Program to elect to di24 rectly bill for, and receive payment for, health care items 

25 and services provided by such Program for which payment 


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1 is made under this title, see section 401(d) of the Indian 

2 Health Care Improvement Act.’’. 

3 (5) DEFINITIONS.—Section 1101(a) of such Act 

4 (42 U.S.C. 1301(a)) is amended by adding at the 

5 end the following new paragraph: 

6 ‘‘(11) For purposes of this title and titles 

7 XVIII, XIX, and XXI, the terms ‘Indian Health 

8 Program’, ‘Indian Tribe’ (and ‘Indian tribe’), ‘Tribal 

9 Health Program’, ‘Tribal Organization’ (and ‘tribal 

10 organization’), and ‘urban Indian organization’ (and 

11 ‘urban Indian organization’) have the meanings 

12 given those terms in section 4 of the Indian Health 

13 Care Improvement Act.’’. 

14 (b) MEDICARE.— 

15 (1) EXPANSION TO ALL COVERED SERVICES.— 

16 Section 1880 of such Act (42 U.S.C. 1395qq) is 

17 amended— 

18 (A) by amending the heading to read as 

19 follows: 

20 ‘‘SEC. 1880. INDIAN HEALTH PROGRAMS.’’; 

21 and 

22 (B) by amending subsection (a) to read as 

23 follows: 

24 ‘‘(a) ELIGIBILITY FOR PAYMENTS.—Subject to sub25 section (e), an Indian Health Program shall be eligible for 


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1 payments under this title with respect to items and serv2 ices furnished by the Program if the furnishing of such 

3 services meets all the conditions and requirements which 

4 are applicable generally to the furnishing of items and 

5 services under this title.’’. 

6 (2) REPEAL OF OBSOLETE PROVISION.—Sub7 section (b) of such section is repealed. 

8 (3) COMPLIANCE WITH CONDITIONS AND RE9 QUIREMENTS.—Subsection (b) of such section is 

10 amended to read as follows: 

11 ‘‘(b) COMPLIANCE WITH CONDITIONS AND REQUIRE12 MENTS.—Subject to subsection (e), a facility of the Indian 

13 Health Service or an Indian Tribe, Tribal Organization, 

14 or an Urban Indian Organization which is eligible for pay15 ment under subsection (a) with respect to the furnishing 

16 of items and services, but which does not meet all of the 

17 conditions and requirements of this title which are applica18 ble generally to such facility, shall make such improve19 ments as are necessary to achieve or maintain compliance 

20 with such conditions and requirements in accordance with 

21 a plan submitted to and accepted by the Secretary for 

22 achieving or maintaining compliance with such conditions 

23 and requirements, and shall be deemed to meet such con24 ditions and requirements (and to be eligible for payment 

25 under this title), without regard to the extent of its actual 


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1 compliance with such conditions and requirements, during 

2 the first 12 months after the month in which such plan 

3 is submitted.’’. 

4 (4) CROSS-REFERENCES TO SPECIAL FUND FOR

5 IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING

6 OPTION; DEFINITIONS.— 

7 (A) IN GENERAL.—Such section is further 

8 amended by striking subsections (c) and (d) 

9 and inserting the following new subsections: 

10 ‘‘(b) SPECIAL FUND FOR IMPROVEMENT OF IHS FA11 CILITIES.—For provisions relating to the authority of the 

12 Secretary to place payments to which a facility of the In13 dian Health Service is eligible for payment under this title 

14 into a special fund established under section 401(c)(1) of 

15 the Indian Health Care Improvement Act, and the require16 ment to use amounts paid from such fund for making im17 provements in accordance with subsection (b), see sub18 paragraphs (A) and (B) of section 401(c)(1) of such Act. 

19 ‘‘(c) DIRECT BILLING.—For provisions relating to 

20 the authority of a Tribal Health Program to elect to di21 rectly bill for, and receive payment for, health care items 

22 and services provided by such Program for which payment 

23 is made under this title, see section 401(d) of the Indian 

24 Health Care Improvement Act.’’. 


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1 (B) CONFORMING AMENDMENTS.—Such 

2 section is further amended— 

3 (i) in subsection (e)(3), by striking 

4 ‘‘Subsection (c)’’ and inserting ‘‘Subsection 

5 (b) and section 401(b)(1) of the Indian 

6 Health Care Improvement Act’’; 

7 (ii) by redesignating subsection (e) as 

8 subsection (d); and 

9 (iii) by striking subsection (f). 

10 (5) DEFINITIONS.—Such section is further 

11 amended by amending subsection (f) to read as fol12 lows: 

13 ‘‘(f) DEFINITIONS.—In this section, the terms ‘In14 dian Health Program’, ‘Indian Tribe’, ‘Service Unit’, 

15 ‘Tribal Health Program’, ‘Tribal Organization’, and 

16 ‘Urban Indian Organization’ have the meanings given 

17 those terms in section 4 of the Indian Health Care Im18 provement Act.’’. 

19 (c) APPLICATION TO SCHIP.—Section 2107(e)(1) of 

20 the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 

21 amended— 

22 (1) by redesignating subparagraph (D) as sub23 paragraph (E); and 

24 (2) by inserting after subparagraph (C), the fol25 lowing new subparagraph: 


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1 ‘‘(D) Section 1911 (relating to Indian 

2 Health Programs, other than subsection (c) of 

3 such section).’’. 

4 SEC. 202. INCREASED OUTREACH TO INDIANS UNDER MED5 ICAID AND SCHIP AND IMPROVED COOPERA6 TION IN THE PROVISION OF ITEMS AND 

7 SERVICES TO INDIANS UNDER SOCIAL SECU8 RITY ACT HEALTH BENEFIT PROGRAMS. 

9 Section 1139 of the Social Security Act (42 U.S.C. 

10 1320b–9) is amended to read as follows: 

11 ‘‘SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, 

12 HEALTH CARE FOR INDIANS UNDER TITLES 

13 XVIII, XIX, AND XXI. 

14 ‘‘(a) AGREEMENTS WITH STATES FOR MEDICAID

15 AND SCHIP OUTREACH ON OR NEAR RESERVATIONS TO

16 INCREASE THE ENROLLMENT OF INDIANS IN THOSE

17 PROGRAMS.— 

18 ‘‘(1) IN GENERAL.—In order to improve the ac19 cess of Indians residing on or near a reservation to 

20 obtain benefits under the Medicaid and State chil21 dren’s health insurance programs established under 

22 titles XIX and XXI, the Secretary, acting through 

23 the Centers for Medicare & Medicaid Services, shall 

24 encourage each State with all or part of a reserva25 tion within its borders to take steps to provide for 


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1 enrollment on or near such reservations. Such steps 

2 may include outreach efforts such as the 

3 outstationing of eligibility workers, entering into 

4 agreements with the Indian Health Service, Indian 

5 Tribes, Tribal Organizations, and urban Indian or6 ganizations to provide outreach, education regarding 

7 eligibility and benefits, enrollment, and translation 

8 services when such services are appropriate. 

9 ‘‘(2) CONSTRUCTION.—Nothing in paragraph 

10 (1) shall be construed as affecting arrangements en11 tered into between States and the Indian Health 

12 Service, Indian Tribes, Tribal Organizations, or 

13 urban Indian organizations for such Service, Tribes, 

14 or Organizations to conduct administrative activities 

15 under such titles. 

16 ‘‘(b) FACILITATING COOPERATION IN ENROLLMENT

17 AND RETENTION.—The Secretary, acting through the 

18 Centers for Medicare & Medicaid Services, shall consult 

19 with States, the Service, Indian Tribes, Tribal Organiza20 tions, and urban Indian organizations to develop and dis21 seminate best practices with respect to facilitating agree22 ments between the States and Indian Tribes, Tribal Orga23 nizations, and urban Indian organizations relating to en24 rollment and retention of Indians in programs established 

25 under titles XVIII, XIX, and XXI. 


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1 ‘‘(c) DEFINITION OF INDIAN; INDIAN TRIBE; INDIAN

2 HEALTH PROGRAM; TRIBAL ORGANIZATION; URBAN IN3 DIAN ORGANIZATION.—In this section, the terms ‘Indian’, 

4 ‘Indian Tribe’, ‘Indian Health Program’, ‘Tribal Organi5 zation’, and ‘Urban Indian Organization’ have the mean6 ings given those terms in section 4 of the Indian Health 

7 Care Improvement Act.’’. 

8 SEC. 203. ADDITIONAL PROVISIONS TO INCREASE OUT9 REACH TO, AND ENROLLMENT OF, INDIANS 

10 IN SCHIP AND MEDICAID. 

11 (a) ASSURANCE OF PAYMENTS TO INDIAN HEALTH

12 CARE PROVIDERS FOR CHILD HEALTH ASSISTANCE.— 

13 Section 2102(b)(3)(D) of such Act (42 U.S.C. 

14 1397bb(b)(3)(D)) is amended by striking ‘‘(as defined in 

15 section 4(c) of the Indian Health Care Improvement Act, 

16 25 U.S.C. 1603(c))’’ and inserting ‘‘, including how the 

17 State will ensure that payments are made to Indian 

18 Health Programs and urban Indian organizations oper19 ating in the State for the provision of such assistance’’. 

20 (b) INCLUSION OF OTHER INDIAN FINANCED

21 HEALTH CARE PROGRAMS IN EXEMPTION FROM PROHI22 BITION ON CERTAIN PAYMENTS.—Section 2105(c)(6)(B) 

23 of such Act (42 U.S.C. 1397ee(c)(6)(B)) is amended by 

24 striking ‘‘insurance program, other than an insurance pro25 gram operated or financed by the Indian Health Service’’ 


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1 and inserting ‘‘program, other than a health care program 

2 operated or financed by the Indian Health Service or by 

3 an Indian Tribe, Tribal Organization, or urban Indian or4 ganization’’. 

5 (c) DEFINITIONS.—Section 2110(c) of such Act (42 

6 U.S.C. 1397jj(c)) is amended by adding at the end the 

7 following new paragraph: 

8 ‘‘(9) INDIAN; INDIAN HEALTH PROGRAM; IN9 DIAN TRIBE; ETC.—The terms ‘Indian’, ‘Indian 

10 Health Program’, ‘Indian Tribe’, ‘Tribal Organiza11 tion’, and ‘Urban Indian Organization’ have the 

12 meanings given those terms in section 4 of the In13 dian Health Care Improvement Act.’’. 

14 SEC. 204. NONDISCRIMINATION IN QUALIFICATIONS FOR 

15 PAYMENT FOR SERVICES UNDER FEDERAL 

16 HEALTH CARE PROGRAMS. 

17 Section 1139 of the Social Security Act (42 U.S.C. 

18 1320b–9), as amended by section 202, is amended by re19 designating subsection (c) as subsection (d), and inserting 

20 after subsection (b) the following new subsection: 

21 ‘‘(c) NONDISCRIMINATION IN QUALIFICATIONS FOR

22 PAYMENT FOR SERVICES UNDER FEDERAL HEALTH

23 CARE PROGRAMS.— 

24 ‘‘(1) REQUIREMENT TO SATISFY GENERALLY

25 APPLICABLE PARTICIPATION REQUIREMENTS.— 


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1 ‘‘(A) IN GENERAL.—A Federal health care 

2 program must accept an entity that is operated 

3 by the Indian Health Service, an Indian Tribe, 

4 Tribal Organization, or Urban Indian Organiza5 tion as a provider eligible to receive payment 

6 under the program for health care services fur7 nished to an Indian on the same basis as any 

8 other provider qualified to participate as a pro9 vider of health care services under the program 

10 if the entity meets generally applicable State or 

11 other requirements for participation as a pro12 vider of health care services under the program. 

13 ‘‘(B) SATISFACTION OF STATE OR LOCAL

14 LICENSURE OR RECOGNITION REQUIRE15 MENTS.—Any requirement for participation as 

16 a provider of health care services under a Fed17 eral health care program that an entity be li18 censed or recognized under the State or local 

19 law where the entity is located to furnish health 

20 care services shall be deemed to have been met 

21 in the case of an entity operated by the Indian 

22 Health Service, an Indian Tribe, Tribal Organi23 zation, or Urban Indian Organization if the en24 tity meets all the applicable standards for such 

25 licensure or recognition, regardless of whether 


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1 the entity obtains a license or other documenta2 tion under such State or local law. In accord3 ance with section 221 of the Indian Health 

4 Care Improvement Act, the absence of the licen5 sure of a health care professional employed by 

6 such an entity under the State or local law 

7 where the entity is located shall not be taken 

8 into account for purposes of determining wheth9 er the entity meets such standards, if the pro10 fessional is licensed in another State. 

11 ‘‘(2) PROHIBITION ON FEDERAL PAYMENTS TO

12 ENTITIES OR INDIVIDUALS EXCLUDED FROM PAR13 TICIPATION IN FEDERAL HEALTH CARE PROGRAMS

14 OR WHOSE STATE LICENSES ARE UNDER SUSPEN15 SION OR HAVE BEEN REVOKED.— 

16 ‘‘(A) EXCLUDED ENTITIES.—No entity op17 erated by the Indian Health Service, an Indian 

18 Tribe, Tribal Organization, or Urban Indian 

19 Organization that has been excluded from par20 ticipation in any Federal health care program 

21 or for which a license is under suspension or 

22 has been revoked by the State where the entity 

23 is located shall be eligible to receive payment 

24 under any such program for health care serv25 ices furnished to an Indian. 


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1 ‘‘(B) EXCLUDED INDIVIDUALS.—No indi2 vidual who has been excluded from participation 

3 in any Federal health care program or whose 

4 State license is under suspension or has been 

5 revoked shall be eligible to receive payment 

6 under any such program for health care serv7 ices furnished by that individual, directly or 

8 through an entity that is otherwise eligible to 

9 receive payment for health care services, to an 

10 Indian. 

11 ‘‘(C) FEDERAL HEALTH CARE PROGRAM

12 DEFINED.—In this subsection, the term, ‘Fed13 eral health care program’ has the meaning 

14 given that term in section 1128B(f), except 

15 that, for purposes of this subsection, such term 

16 shall include the health insurance program 

17 under chapter 89 of title 5, United States 

18 Code.’’. 

19 SEC. 205. SOLICITATION OF PROPOSALS FOR SAFE HAR20 BORS UNDER THE SOCIAL SECURITY ACT 

21 FOR FACILITIES OF INDIAN HEALTH PRO22 GRAMS AND URBAN INDIAN ORGANIZATIONS. 

23 The Secretary of Health and Human Services, acting 

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1 tice, described in section 1128D(a)(1)(A) of the Social Se2 curity Act (42 U.S.C. 1320a–7d(a)(1)(A)), soliciting a 

3 proposal, not later than July 1, 2010, on the development 

4 of safe harbors described in such section relating to health 

5 care items and services provided by facilities of Indian 

6 Health Programs or an urban Indian organization (as 

7 such terms are defined in section 4 of the Indian Health 

8 Care Improvement Act). Such a safe harbor may relate 

9 to areas such as transportation, housing, or cost-sharing, 

10 assistance provided through such facilities or contract 

11 health services for Indians. 

12 SEC. 206. ANNUAL REPORT ON INDIANS SERVED BY SOCIAL 

13 SECURITY ACT HEALTH BENEFIT PROGRAMS. 

14 Section 1139 of the Social Security Act (42 U.S.C. 

15 1320b–9), as amended by the sections 202, 205, and 206, 

16 is amended by redesignating subsection (e) as subsection 

17 (f), and inserting after subsection (d) the following new 

18 subsection: 

19 ‘‘(e) ANNUAL REPORT ON INDIANS SERVED BY

20 HEALTH BENEFIT PROGRAMS FUNDED UNDER THIS

21 ACT.—Beginning January 1, 2007, and annually there22 after, the Secretary, acting through the Administrator of 

23 the Centers for Medicare & Medicaid Services and the Di24 rector of the Indian Health Service, shall submit a report 

25 to Congress regarding the enrollment and health status 


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1 of Indians receiving items or services under health benefit 

2 programs funded under this Act during the preceding 

3 year. Each such report shall include the following: 

4 ‘‘(1) The total number of Indians enrolled in, or 

5 receiving items or services under, such programs, 

6 disaggregated with respect to each such program. 

7 ‘‘(2) The number of Indians described in para8 graph (1) that also received health benefits under 

9 programs funded by the Indian Health Service. 

10 ‘‘(3) General information regarding the health 

11 status of the Indians described in paragraph (1), 

12 disaggregated with respect to specific diseases or 

13 conditions and presented in a manner that is con14 sistent with protections for privacy of individually 

15 identifiable health information under section 264(c) 

16 of the Health Insurance Portability and Account17 ability Act of 1996. 

18 ‘‘(4) A detailed statement of the status of facili19 ties of the Indian Health Service or an Indian Tribe, 

20 Tribal Organization, or an Urban Indian Organiza21 tion with respect to such facilities’ compliance with 

22 the applicable conditions and requirements of titles 

23 XVIII, XIX, and XXI, and, in the case of title XIX 

24 or XXI, under a State plan under such title or 

25 under waiver authority, and of the progress being 


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1 made by such facilities (under plans submitted 

2 under section 1880(b), 1911(b) or otherwise) toward 

3 the achievement and maintenance of such compli4 ance. 

5 ‘‘(5) Such other information as the Secretary 

6 determines is appropriate.’’. 

7 SEC. 207. DEVELOPMENT OF RECOMMENDATIONS TO IM8 PROVE INTERSTATE COORDINATION OF MED9 ICAID AND SCHIP COVERAGE OF INDIAN 

10 CHILDREN AND OTHER CHILDREN WHO ARE 

11 OUTSIDE OF THEIR STATE OF RESIDENCY BE12 CAUSE OF EDUCATIONAL OR OTHER NEEDS. 

13 (a) STUDY.—The Secretary shall conduct a study to 

14 identify barriers to interstate coordination of enrollment 

15 and coverage under the Medicaid program under title XIX 

16 of the Social Security Act and the State Children’s Health 

17 Insurance Program under title XXI of such Act of chil18 dren who are eligible for medical assistance or child health 

19 assistance under such programs and who, because of edu20 cational needs, migration of families, emergency evacu21 ations, or otherwise, frequently change their State of resi22 dency or otherwise are temporarily present outside of the 

23 State of their residency. Such study shall include an exam24 ination of the enrollment and coverage coordination issues 

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1 sistance or child health assistance under such programs 

2 in their State of residence and who temporarily reside in 

3 an out-of-State boarding school or peripheral dormitory 

4 funded by the Bureau of Indian Affairs. 

5 (b) REPORT.—Not later than 18 months after the 

6 date of enactment of this Act, the Secretary, in consulta7 tion with directors of State Medicaid programs under title 

8 XIX of the Social Security Act and directors of State Chil9 dren’s Health Insurance Programs under title XXI of such 

10 Act, shall submit a report to Congress that contains rec11 ommendations for such legislative and administrative ac12 tions as the Secretary determines appropriate to address 

13 the enrollment and coverage coordination barriers identi14 fied through the study required under subsection (a). 

Æ 


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