111 
ers; and for provision of domestic and community sanita-
tion facilities for Indians, as authorized by section 7 of 
the Act of August 5, 1954 (42 U.S.C. 2004a), the Indian 
Self-Determination Act, and the Indian Health Care Im-
provement Act, and for expenses necessary to carry out 
such Acts and titles II and III of the Public Health Serv-
ice Act with respect to environmental health and facilities 
support 
activities 
of 
the 
Indian 
Health 
Service, 
$557,946,000, to remain available until expended: Pro-
vided, That notwithstanding any other provision of law, 
funds appropriated for the planning, design, construction, 
renovation or expansion of health facilities for the benefit 
of an Indian tribe or tribes may be used to purchase land 
on which such facilities will be located: Provided further, 
That not to exceed $500,000 may be used by the Indian 
Health Service to purchase TRANSAM equipment from 
the Department of Defense for distribution to the Indian 
Health Service and tribal facilities: Provided further, That 
none of the funds appropriated to the Indian Health Serv-
ice may be used for sanitation facilities construction for 
new homes funded with grants by the housing programs 
of the United States Department of Housing and Urban 
Development: Provided further, That not to exceed 
$2,700,000 from this account and the ‘‘Indian Health 
Services’’ account may be used by the Indian Health Serv-
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112 
ice to obtain ambulances for the Indian Health Service 
and tribal facilities in conjunction with an existing inter-
agency agreement between the Indian Health Service and 
the General Services Administration: Provided further, 
That not to exceed $500,000 may be placed in a Demoli-
tion Fund, to remain available until expended, and be used 
by the Indian Health Service for the demolition of Federal 
buildings. 
ADMINISTRATIVE PROVISIONS—INDIAN HEALTH SERVICE 
Appropriations provided in this Act to the Indian 
Health Service shall be available for services as authorized 
by 5 U.S.C. 3109 at rates not to exceed the per diem rate 
equivalent to the maximum rate payable for senior-level 
positions under 5 U.S.C. 5376; hire of passenger motor 
vehicles and aircraft; purchase of medical equipment; pur-
chase of reprints; purchase, renovation and erection of 
modular buildings and renovation of existing facilities; 
payments for telephone service in private residences in the 
field, when authorized under regulations approved by the 
Secretary; uniforms or allowances therefor as authorized 
by 5 U.S.C. 5901–5902; and for expenses of attendance 
at meetings that relate to the functions or activities of the 
Indian Health Service: Provided, That in accordance with 
the provisions of the Indian Health Care Improvement 
Act, non-Indian patients may be extended health care at 
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113 
all tribally administered or Indian Health Service facili-
ties, subject to charges, and the proceeds along with funds 
recovered under the Federal Medical Care Recovery Act 
(42 U.S.C. 2651–2653) shall be credited to the account 
of the facility providing the service and shall be available 
without fiscal year limitation: Provided further, That not-
withstanding any other law or regulation, funds trans-
ferred from the Department of Housing and Urban Devel-
opment to the Indian Health Service shall be administered 
under Public Law 86–121, the Indian Sanitation Facilities 
Act and Public Law 93–638: Provided further, That funds 
appropriated to the Indian Health Service in this Act, ex-
cept those used for administrative and program direction 
purposes, shall not be subject to limitations directed at 
curtailing Federal travel and transportation: Provided fur-
ther, That none of the funds made available to the Indian 
Health Service in this Act shall be used for any assess-
ments or charges by the Department of Health and 
Human Services unless identified in the budget justifica-
tion and provided in this Act, or approved by the House 
and Senate Committees on Appropriations through the re-
programming process: Provided further, That notwith-
standing any other provision of law, funds previously or 
herein made available to a tribe or tribal organization 
through a contract, grant, or agreement authorized by 
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114 
title I or title V of the Indian Self-Determination and 
Education Assistance Act of 1975 (25 U.S.C. 450), may 
be deobligated and reobligated to a self-determination con-
tract under title I, or a self-governance agreement under 
title V of such Act and thereafter shall remain available 
to the tribe or tribal organization without fiscal year limi-
tation: Provided further, That none of the funds made 
available to the Indian Health Service in this Act shall 
be used to implement the final rule published in the Fed-
eral Register on September 16, 1987, by the Department 
of Health and Human Services, relating to the eligibility 
for the health care services of the Indian Health Service 
until the Indian Health Service has submitted a budget 
request reflecting the increased costs associated with the 
proposed final rule, and such request has been included 
in an appropriations Act and enacted into law: Provided 
further, That with respect to functions transferred by the 
Indian Health Service to tribes or tribal organizations, the 
Indian Health Service is authorized to provide goods and 
services to those entities on a reimbursable basis, includ-
ing payments in advance with subsequent adjustment, and 
the reimbursements received therefrom, along with the 
funds received from those entities pursuant to the Indian 
Self-Determination Act, may be credited to the same or 
subsequent appropriation account from which the funds 
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were originally derived, with such amounts to remain 
available until expended: Provided further, That reim-
bursements for training, technical assistance, or services 
provided by the Indian Health Service will contain total 
costs, including direct, administrative, and overhead asso-
ciated with the provision of goods, services, or technical 
assistance: Provided further, That the appropriation struc-
ture for the Indian Health Service may not be altered 
without advance notification to the House and Senate 
Committees on Appropriations. 
NATIONAL INSTITUTES OF HEALTH 
NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH 
SCIENCES 
For necessary expenses for the National Institute of 
Environmental Health Sciences in carrying out activities 
set forth in section 311(a) of the Comprehensive Environ-
mental Response, Compensation, and Liability Act of 
1980 (42 U.S.C. 9660(a)) and section 126(g) of the 
Superfund Amendments and Reauthorization Act of 1986, 
$77,349,000. 
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the implementation of, and evaluate metrics of quality 
care, patient safety and satisfaction, and finance: Provided 
further, that the governance board shall work with the In-
dian Health Service on developing standards and proce-
dures for employee recruitment, retention, training, com-
munication, and dismissal to assure consistency with other 
high performing federally run health facilities: Provided 
further, that the hospital shall have a chief executive offi-
cer hired and accountable to the Director of the Indian 
Health Service who shall be a liaison between the Indian 
Health Service and the governance board: Provided fur-
ther, that the chief executive officer shall retain authority 
for all hospital personnel matters in accordance with exist-
ing law: Provided further, that the chief executive officer 
and the governance board shall sign a memorandum of 
understanding to share all pertinent hospital information 
while protecting individual privacy rights in accordance 
with existing law: Provided further, that the Secretary 
shall replace the chief executive officer upon receipt of a 
written request by the governance board: Provided further, 
that the governance board shall meet at the hospital regu-
larly: Provided further, that the governance board shall 
regularly communicate to the affected tribe or tribes, to 
the Secretary, and to the Congress: Provided further, that 
at the end of the trial period, the governance board shall 
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