1774 
‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP-
PLICATIONS.—The Secretary, in consultation with Indian 
Tribes, Tribal Organizations, and urban Indian organiza-
tions, shall establish criteria for the review and approval 
of applications or proposals under this section. 
‘‘SEC. 211. PREVENTION, CONTROL, AND ELIMINATION OF 
COMMUNICABLE AND INFECTIOUS DISEASES. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 
through the Service, and after consultation with the Cen-
ters for Disease Control and Prevention, may make grants 
available to Indian Tribes, Tribal Organizations, and 
urban Indian organizations for the following: 
‘‘(1) Projects for the prevention, control, and 
elimination of communicable and infectious diseases, 
including tuberculosis, hepatitis, HIV, respiratory 
syncytial virus, hanta virus, sexually transmitted dis-
eases, and H. Pylori. 
‘‘(2) Public information and education pro-
grams for the prevention, control, and elimination of 
communicable and infectious diseases. 
‘‘(3) Education, training, and clinical skills im-
provement activities in the prevention, control, and 
elimination of communicable and infectious diseases 
for health professionals, including allied health pro-
fessionals.
1775 
‘‘(4) Demonstration projects for the screening, 
treatment, and prevention of hepatitis C virus 
(HCV). 
‘‘(b) APPLICATION REQUIRED.—The Secretary may 
provide funding under subsection (a) only if an application 
or proposal for funding is submitted to the Secretary. 
‘‘(c) COORDINATION WITH HEALTH AGENCIES.—In-
dian Tribes, Tribal Organizations, and urban Indian orga-
nizations receiving funding under this section are encour-
aged to coordinate their activities with the Centers for 
Disease Control and Prevention and State and local health 
agencies. 
‘‘(d) TECHNICAL ASSISTANCE; REPORT.—In carrying 
out this section, the Secretary— 
‘‘(1) may, at the request of an Indian Tribe, 
Tribal Organization, or urban Indian organization, 
provide technical assistance; and 
‘‘(2) shall prepare and submit a report to Con-
gress biennially on the use of funds under this sec-
tion and on the progress made toward the preven-
tion, control, and elimination of communicable and 
infectious diseases among Indians and Urban Indi-
ans.
1776 
‘‘SEC. 212. OTHER AUTHORITY FOR PROVISION OF SERV-
ICES. 
‘‘(a) FUNDING AUTHORIZED.—The Secretary may 
provide funding under this Act to meet the objectives set 
forth in section 3 of this Act through health care-related 
services and programs of the Service, Indian Tribes, and 
Tribal Organizations not otherwise described in this Act 
for the following services: 
‘‘(1) Hospice care. 
‘‘(2) Assisted living services. 
‘‘(3) Long-term care services. 
‘‘(4) Home- and community-based services. 
‘‘(b) ELIGIBILITY.—The following individuals shall be 
eligible to receive long-term care under this section: 
‘‘(1) Individuals who are unable to perform a 
certain number of activities of daily living without 
assistance. 
‘‘(2) Individuals with a mental impairment, 
such as dementia, Alzheimer’s disease, or another 
disabling mental illness, who may be able to perform 
activities of daily living under supervision. 
‘‘(3) Such other individuals as an applicable In-
dian Health Program determines to be appropriate. 
‘‘(c) DEFINITIONS.—For the purposes of this section, 
the following definitions shall apply:
1777 
‘‘(1) The term ‘assisted living services’ means 
any service provided by an assisted living facility (as 
defined in section 232(b) of the National Housing 
Act (12 U.S.C. 1715w(b))), except that such an as-
sisted living facility— 
‘‘(A) shall not be required to obtain a li-
cense; but 
‘‘(B) shall meet all applicable standards 
for licensure. 
‘‘(2) The term ‘home- and community-based 
services’ means 1 or more of the services specified 
in paragraphs (1) through (9) of section 1929(a) of 
the Social Security Act (42 U.S.C. 1396t(a)) 
(whether provided by the Service or by an Indian 
Tribe or Tribal Organization pursuant to the Indian 
Self-Determination and Education Assistance Act 
(25 U.S.C. 450 et seq.)) that are or will be provided 
in accordance with applicable standards. 
‘‘(3) The term ‘hospice care’ means the items 
and services specified in subparagraphs (A) through 
(H) of section 1861(dd)(1) of the Social Security 
Act (42 U.S.C. 1395x(dd)(1)), and such other serv-
ices which an Indian Tribe or Tribal Organization 
determines are necessary and appropriate to provide 
in furtherance of this care.
1778 
‘‘(4) The term ‘long-term care services’ has the 
meaning given the term ‘qualified long-term care 
services’ in section 7702B(c) of the Internal Rev-
enue Code of 1986. 
‘‘(d) AUTHORIZATION OF CONVENIENT CARE SERV-
ICES.—The Secretary, acting through the Service, Indian 
Tribes, and Tribal Organizations, may also provide fund-
ing under this Act to meet the objectives set forth in sec-
tion 3 of this Act for convenient care services programs 
pursuant to section 306(c)(2)(A). 
‘‘SEC. 213. INDIAN WOMEN’S HEALTH CARE. 
‘‘The Secretary, acting through the Service and In-
dian Tribes, Tribal Organizations, and Urban Indian Or-
ganizations, shall monitor and improve the quality of 
health care for Indian women of all ages through the plan-
ning and delivery of programs administered by the Service, 
in order to improve and enhance the treatment models of 
care for Indian women. 
‘‘SEC. 214. ENVIRONMENTAL AND NUCLEAR HEALTH HAZ-
ARDS. 
‘‘(a) STUDIES
AND MONITORING.—The Secretary 
and the Service shall conduct, in conjunction with other 
appropriate Federal agencies and in consultation with con-
cerned Indian Tribes and Tribal Organizations, studies 
and ongoing monitoring programs to determine trends in
1779 
the health hazards to Indian miners and to Indians on 
or near reservations and Indian communities as a result 
of environmental hazards which may result in chronic or 
life threatening health problems, such as nuclear resource 
development, petroleum contamination, and contamination 
of water source and of the food chain. Such studies shall 
include— 
‘‘(1) an evaluation of the nature and extent of 
health problems caused by environmental hazards 
currently exhibited among Indians and the causes of 
such health problems; 
‘‘(2) an analysis of the potential effect of ongo-
ing and future environmental resource development 
on or near reservations and Indian communities, in-
cluding the cumulative effect over time on health; 
‘‘(3) an evaluation of the types and nature of 
activities, practices, and conditions causing or affect-
ing such health problems, including uranium mining 
and milling, uranium mine tailing deposits, nuclear 
power plant operation and construction, and nuclear 
waste disposal; oil and gas production or transpor-
tation on or near reservations or Indian commu-
nities; and other development that could affect the 
health of Indians and their water supply and food 
chain;
1780 
‘‘(4) a summary of any findings and rec-
ommendations provided in Federal and State stud-
ies, reports, investigations, and inspections during 
the 5 years prior to the date of enactment of the In-
dian Health Care Improvement Act Amendments of 
2009 that directly or indirectly relate to the activi-
ties, practices, and conditions affecting the health or 
safety of such Indians; and 
‘‘(5) the efforts that have been made by Federal 
and State agencies and resource and economic devel-
opment companies to effectively carry out an edu-
cation program for such Indians regarding the 
health and safety hazards of such development. 
‘‘(b) HEALTH CARE PLANS.—Upon completion of 
such studies, the Secretary and the Service shall take into 
account the results of such studies and develop health care 
plans to address the health problems studied under sub-
section (a). The plans shall include— 
‘‘(1) methods for diagnosing and treating Indi-
ans currently exhibiting such health problems; 
‘‘(2) preventive care and testing for Indians 
who may be exposed to such health hazards, includ-
ing the monitoring of the health of individuals who 
have or may have been exposed to excessive amounts 
of radiation or affected by other activities that have
1781 
had or could have a serious impact upon the health 
of such individuals; and 
‘‘(3) a program of education for Indians who, 
by reason of their work or geographic proximity to 
such nuclear or other development activities, may ex-
perience health problems. 
‘‘(c) SUBMISSION OF REPORT AND PLAN TO CON-
GRESS.—The Secretary and the Service shall submit to 
Congress the study prepared under subsection (a) no later 
than 18 months after the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2009. The 
health care plan prepared under subsection (b) shall be 
submitted in a report no later than 1 year after the study 
prepared under subsection (a) is submitted to Congress. 
Such report shall include recommended activities for the 
implementation of the plan, as well as an evaluation of 
any activities previously undertaken by the Service to ad-
dress such health problems. 
‘‘(d) INTERGOVERNMENTAL TASK FORCE.— 
‘‘(1) ESTABLISHMENT; MEMBERS.—There is es-
tablished an Intergovernmental Task Force to be 
composed of the following individuals (or their des-
ignees): 
‘‘(A) The Secretary of Energy.
1782 
‘‘(B) The Secretary of the Environmental 
Protection Agency. 
‘‘(C) The Director of the Bureau of Mines. 
‘‘(D) The Assistant Secretary for Occupa-
tional Safety and Health. 
‘‘(E) The Secretary of the Interior. 
‘‘(F) The Secretary of Health and Human 
Services. 
‘‘(G) The Director of the Indian Health 
Service. 
‘‘(2) DUTIES.—The Task Force shall— 
‘‘(A) identify existing and potential oper-
ations related to nuclear resource development 
or other environmental hazards that affect or 
may affect the health of Indians on or near a 
reservation or in an Indian community; and 
‘‘(B) enter into activities to correct exist-
ing health hazards and ensure that current and 
future health problems resulting from nuclear 
resource or other development activities are 
minimized or reduced. 
‘‘(3) CHAIRMAN; MEETINGS.—The Secretary of 
Health and Human Services shall be the Chairman 
of the Task Force. The Task Force shall meet at 
least twice each year.
1783 
‘‘(e) HEALTH SERVICES TO CERTAIN EMPLOYEES.— 
In the case of any Indian who— 
‘‘(1) as a result of employment in or near a 
uranium mine or mill or near any other environ-
mental hazard, suffers from a work-related illness or 
condition; 
‘‘(2) is eligible to receive diagnosis and treat-
ment services from an Indian Health Program; and 
‘‘(3) by reason of such Indian’s employment, is 
entitled to medical care at the expense of such mine 
or mill operator or entity responsible for the environ-
mental hazard, the Indian Health Program shall, at 
the request of such Indian, render appropriate med-
ical care to such Indian for such illness or condition 
and may be reimbursed for any medical care so ren-
dered to which such Indian is entitled at the expense 
of such operator or entity from such operator or en-
tity. Nothing in this subsection shall affect the 
rights of such Indian to recover damages other than 
such amounts paid to the Indian Health Program 
from the employer for providing medical care for 
such illness or condition.
1784 
‘‘SEC. 215. ARIZONA AS A CONTRACT HEALTH SERVICE DE-
LIVERY AREA. 
‘‘(a) IN GENERAL.—For fiscal years beginning with 
the fiscal year ending September 30, 1983, and ending 
with the fiscal year ending September 30, 2025, the State 
of Arizona shall be designated as a contract health service 
delivery area by the Service for the purpose of providing 
contract health care services to members of federally rec-
ognized Indian Tribes of Arizona. 
‘‘(b) MAINTENANCE
OF
SERVICES.—The Service 
shall not curtail any health care services provided to Indi-
ans residing on reservations in the State of Arizona if such 
curtailment is due to the provision of contract services in 
such State pursuant to the designation of such State as 
a contract health service delivery area pursuant to sub-
section (a). 
‘‘SEC. 216. NORTH DAKOTA AND SOUTH DAKOTA AS CON-
TRACT HEALTH SERVICE DELIVERY AREA. 
‘‘(a) IN GENERAL.—Beginning in fiscal year 2003, 
the States of North Dakota and South Dakota shall be 
designated as a contract health service delivery area by 
the Service for the purpose of providing contract health 
care services to members of federally recognized Indian 
Tribes of North Dakota and South Dakota. 
‘‘(b) LIMITATION.—The Service shall not curtail any 
health care services provided to Indians residing on any
1785 
reservation, or in any county that has a common boundary 
with any reservation, in the State of North Dakota or 
South Dakota if such curtailment is due to the provision 
of contract services in such States pursuant to the des-
ignation of such States as a contract health service deliv-
ery area pursuant to subsection (a). 
‘‘SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES PRO-
GRAM. 
‘‘(a) FUNDING AUTHORIZED.—The Secretary is au-
thorized to fund a program using an intertribal consor-
tium as a contract care intermediary to improve the acces-
sibility of health services to California Indians. 
‘‘(b) REIMBURSEMENT CONTRACT.—The Secretary 
shall enter into an agreement with the intertribal consor-
tium to reimburse the intertribal consortium for costs (in-
cluding reasonable administrative costs) incurred pursu-
ant to this section, in providing medical treatment under 
contract to California Indians described in section 805(a) 
throughout the California contract health services delivery 
area described in section 219 with respect to high cost 
contract care cases. 
‘‘(c) ADMINISTRATIVE EXPENSES.—Not more than 5 
percent of the amounts provided to the intertribal consor-
tium under this section for any fiscal year may be for re-