1685 
in accordance with paragraph (2), on behalf of the 
individual of the principal, interest, and related ex-
penses on government and commercial loans received 
by the individual regarding the undergraduate or 
graduate education of the individual (or both), which 
loans were made for— 
‘‘(A) tuition expenses; 
‘‘(B) all other reasonable educational ex-
penses, including fees, books, and laboratory ex-
penses, incurred by the individual; and 
‘‘(C) reasonable living expenses as deter-
mined by the Secretary. 
‘‘(2) AMOUNT.—For each year of obligated 
service that an individual contracts to serve under 
subsection (e), the Secretary may pay up to $35,000 
or an amount equal to the amount specified in sec-
tion 338B(g)(2)(A) of the Public Health Service 
Act, whichever is more, on behalf of the individual 
for loans described in paragraph (1). In making a 
determination of the amount to pay for a year of 
such service by an individual, the Secretary shall 
consider the extent to which each such determina-
tion— 
‘‘(A) affects the ability of the Secretary to 
maximize the number of contracts that can be 
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provided under the Loan Repayment Program 
from the amounts appropriated for such con-
tracts; 
‘‘(B) provides an incentive to serve in In-
dian Health Programs and urban Indian orga-
nizations with the greatest shortages of health 
professionals; and 
‘‘(C) provides an incentive with respect to 
the health professional involved remaining in an 
Indian Health Program or urban Indian organi-
zation with such a health professional shortage, 
and continuing to provide primary health serv-
ices, after the completion of the period of obli-
gated service under the Loan Repayment Pro-
gram. 
‘‘(3) TIMING.—Any arrangement made by the 
Secretary for the making of loan repayments in ac-
cordance with this subsection shall provide that any 
repayments for a year of obligated service shall be 
made no later than the end of the fiscal year in 
which the individual completes such year of service. 
‘‘(4) REIMBURSEMENTS FOR TAX LIABILITY.— 
For the purpose of providing reimbursements for tax 
liability resulting from a payment under paragraph 
(2) on behalf of an individual, the Secretary— 
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‘‘(A) in addition to such payments, may 
make payments to the individual in an amount 
equal to not less than 20 percent and not more 
than 39 percent of the total amount of loan re-
payments made for the taxable year involved; 
and 
‘‘(B) may make such additional payments 
as the Secretary determines to be appropriate 
with respect to such purpose. 
‘‘(5) PAYMENT
SCHEDULE.—The Secretary 
may enter into an agreement with the holder of any 
loan for which payments are made under the Loan 
Repayment Program to establish a schedule for the 
making of such payments. 
‘‘(h) EMPLOYMENT CEILING.—Notwithstanding any 
other provision of law, individuals who have entered into 
written contracts with the Secretary under this section 
shall not be counted against any employment ceiling af-
fecting the Department while those individuals are under-
going academic training. 
‘‘(i) RECRUITMENT.—The Secretary shall conduct re-
cruiting programs for the Loan Repayment Program and 
other manpower programs of the Service at educational 
institutions training health professionals or specialists 
identified in subsection (a). 
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‘‘(j) APPLICABILITY OF LAW.—Section 214 of the 
Public Health Service Act (42 U.S.C. 215) shall not apply 
to individuals during their period of obligated service 
under the Loan Repayment Program. 
‘‘(k) ASSIGNMENT OF INDIVIDUALS.—The Secretary, 
in assigning individuals to serve in Indian Health Pro-
grams or urban Indian organizations pursuant to con-
tracts entered into under this section, shall— 
‘‘(1) ensure that the staffing needs of Tribal 
Health Programs and urban Indian organizations 
receive consideration on an equal basis with pro-
grams that are administered directly by the Service; 
and 
‘‘(2) give priority to assigning individuals to In-
dian Health Programs and urban Indian organiza-
tions that have a need for health professionals to 
provide health care services as a result of individuals 
having breached contracts entered into under this 
section. 
‘‘(l) BREACH OF CONTRACT.— 
‘‘(1) SPECIFIC BREACHES.—An individual who 
has entered into a written contract with the Sec-
retary under this section and has not received a 
waiver under subsection (m) shall be liable, in lieu 
of any service obligation arising under such contract, 
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to the United States for the amount which has been 
paid on such individual’s behalf under the contract 
if that individual— 
‘‘(A) is enrolled in the final year of a 
course of study and— 
‘‘(i) fails to maintain an acceptable 
level of academic standing in the edu-
cational institution in which he or she is 
enrolled (such level determined by the edu-
cational institution under regulations of 
the Secretary); 
‘‘(ii) voluntarily terminates such en-
rollment; or 
‘‘(iii) is dismissed from such edu-
cational institution before completion of 
such course of study; or 
‘‘(B) is enrolled in a graduate training pro-
gram and fails to complete such training pro-
gram. 
‘‘(2) 
OTHER
BREACHES; 
FORMULA
FOR 
AMOUNT OWED.—If, for any reason not specified in 
paragraph (1), an individual breaches his or her 
written contract under this section by failing either 
to begin, or complete, such individual’s period of ob-
ligated service in accordance with subsection (e)(2), 
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the United States shall be entitled to recover from 
such individual an amount to be determined in ac-
cordance with the following formula: A=3Z(t¥s/t) 
in which— 
‘‘(A) ‘A’ is the amount the United States 
is entitled to recover; 
‘‘(B) ‘Z’ is the sum of the amounts paid 
under this section to, or on behalf of, the indi-
vidual and the interest on such amounts which 
would be payable if, at the time the amounts 
were paid, they were loans bearing interest at 
the maximum legal prevailing rate, as deter-
mined by the Secretary of the Treasury; 
‘‘(C) ‘t’ is the total number of months in 
the individual’s period of obligated service; and 
‘‘(D) ‘s’ is the number of months of such 
period served by such individual in accordance 
with this section. 
‘‘(3) TIME
PERIOD
FOR
REPAYMENT.—Any 
amount of damages which the United States is enti-
tled to recover under this subsection shall be paid to 
the United States within the 1-year period beginning 
on the date of the breach or such longer period be-
ginning on such date as shall be specified by the 
Secretary. 
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‘‘(4) DEDUCTIONS IN MEDICARE PAYMENTS.— 
Amounts not paid within such period shall be sub-
ject to collection through deductions in Medicare 
payments pursuant to section 1892 of the Social Se-
curity Act. 
‘‘(5) RECOVERY OF DELINQUENCY.— 
‘‘(A) IN GENERAL.—If damages described 
in paragraph (4) are delinquent for 3 months, 
the Secretary shall, for the purpose of recov-
ering such damages— 
‘‘(i) use collection agencies contracted 
with by the Administrator of General Serv-
ices; or 
‘‘(ii) enter into contracts for the re-
covery of such damages with collection 
agencies selected by the Secretary. 
‘‘(B) REPORT.—Each contract for recov-
ering damages pursuant to this subsection shall 
provide that the contractor will, not less than 
once each 6 months, submit to the Secretary a 
status report on the success of the contractor in 
collecting such damages. Section 3718 of title 
31, United States Code, shall apply to any such 
contract to the extent not inconsistent with this 
subsection. 
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‘‘(m) WAIVER OR SUSPENSION OF OBLIGATION.— 
‘‘(1) IN GENERAL.—The Secretary shall by reg-
ulation provide for the partial or total waiver or sus-
pension of any obligation of service or payment by 
an individual under the Loan Repayment Program 
whenever compliance by the individual is impossible 
or would involve extreme hardship to the individual 
and if enforcement of such obligation with respect to 
any individual would be unconscionable. 
‘‘(2) CANCELED UPON DEATH.—Any obligation 
of an individual under the Loan Repayment Pro-
gram for service or payment of damages shall be 
canceled upon the death of the individual. 
‘‘(3) HARDSHIP WAIVER.—The Secretary may 
waive, in whole or in part, the rights of the United 
States to recover amounts under this section in any 
case of extreme hardship or other good cause shown, 
as determined by the Secretary. 
‘‘(4) BANKRUPTCY.—Any obligation of an indi-
vidual under the Loan Repayment Program for pay-
ment of damages may be released by a discharge in 
bankruptcy under title 11 of the United States Code 
only if such discharge is granted after the expiration 
of the 5-year period beginning on the first date that 
payment of such damages is required, and only if 
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the bankruptcy court finds that nondischarge of the 
obligation would be unconscionable. 
‘‘(n) REPORT.—The Secretary shall submit to the 
President, for inclusion in the report required to be sub-
mitted to Congress under section 801, a report concerning 
the previous fiscal year which sets forth by Service Area 
the following: 
‘‘(1) A list of the health professional positions 
maintained by Indian Health Programs and urban 
Indian organizations for which recruitment or reten-
tion is difficult. 
‘‘(2) The number of Loan Repayment Program 
applications filed with respect to each type of health 
profession. 
‘‘(3) The number of contracts described in sub-
section (e) that are entered into with respect to each 
health profession. 
‘‘(4) The amount of loan payments made under 
this section, in total and by health profession. 
‘‘(5) The number of scholarships that are pro-
vided under sections 104 and 106 with respect to 
each health profession. 
‘‘(6) The amount of scholarship grants provided 
under sections 104 and 106, in total and by health 
profession. 
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‘‘(7) The number of providers of health care 
that will be needed by Indian Health Programs and 
urban Indian organizations, by location and profes-
sion, during the 3 fiscal years beginning after the 
date the report is filed. 
‘‘(8) The measures the Secretary plans to take 
to fill the health professional positions maintained 
by Indian Health Programs or urban Indian organi-
zations for which recruitment or retention is dif-
ficult. 
‘‘SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOV-
ERY FUND. 
‘‘(a) ESTABLISHMENT.—There is established in the 
Treasury of the United States a fund to be known as the 
Indian Health Scholarship and Loan Repayment Recovery 
Fund (hereafter in this section referred to as the ‘LRRF’). 
The LRRF shall consist of such amounts as may be col-
lected from individuals under section 104(d), section 
106(e), and section 110(l) for breach of contract, such 
funds as may be appropriated to the LRRF, and interest 
earned on amounts in the LRRF. All amounts collected, 
appropriated, or earned relative to the LRRF shall remain 
available until expended. 
‘‘(b) USE OF FUNDS.— 
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‘‘(1) BY SECRETARY.—Amounts in the LRRF 
may be expended by the Secretary, acting through 
the Service, to make payments to an Indian Health 
Program— 
‘‘(A) to which a scholarship recipient under 
section 104 and 106 or a loan repayment pro-
gram participant under section 110 has been 
assigned to meet the obligated service require-
ments pursuant to such sections; and 
‘‘(B) that has a need for a health profes-
sional to provide health care services as a result 
of such recipient or participant having breached 
the contract entered into under section 104, 
106, or 110. 
‘‘(2) BY TRIBAL HEALTH PROGRAMS.—A Tribal 
Health Program receiving payments pursuant to 
paragraph (1) may expend the payments to provide 
scholarships or recruit and employ, directly or by 
contract, health professionals to provide health care 
services. 
‘‘(c) INVESTMENT OF FUNDS.—The Secretary of the 
Treasury shall invest such amounts of the LRRF as the 
Secretary of Health and Human Services determines are 
not required to meet current withdrawals from the LRRF. 
Such investments may be made only in interest bearing 
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obligations of the United States. For such purpose, such 
obligations may be acquired on original issue at the issue 
price, or by purchase of outstanding obligations at the 
market price. 
‘‘(d) SALE
OF OBLIGATIONS.—Any obligation ac-
quired by the LRRF may be sold by the Secretary of the 
Treasury at the market price. 
‘‘SEC. 112. RECRUITMENT ACTIVITIES. 
‘‘(a) REIMBURSEMENT
FOR
TRAVEL.—The Sec-
retary, acting through the Service, may reimburse health 
professionals seeking positions with Indian Health Pro-
grams or urban Indian organizations, including individ-
uals considering entering into a contract under section 
110 and their spouses, for actual and reasonable expenses 
incurred in traveling to and from their places of residence 
to an area in which they may be assigned for the purpose 
of evaluating such area with respect to such assignment. 
‘‘(b) RECRUITMENT PERSONNEL.—The Secretary, 
acting through the Service, shall assign 1 individual in 
each Area Office to be responsible on a full-time basis for 
recruitment activities. 
‘‘SEC. 113. INDIAN RECRUITMENT AND RETENTION PRO-
GRAM. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Service, shall fund, on a competitive basis, innovative 
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of service remaining. In such event, with respect to indi-
viduals entering the program after the date of enactment 
of the Indian Health Care Improvement Act Amendments 
of 2009, the United States shall be entitled to recover 
from such individual an amount to be determined in ac-
cordance with the formula specified in subsection (l) of 
section 110 in the manner provided for in such subsection. 
‘‘(c) EQUAL OPPORTUNITY FOR PARTICIPATION.— 
Health professionals from Tribal Health Programs and 
urban Indian organizations shall be given an equal oppor-
tunity to participate in the program under subsection (a). 
‘‘SEC. 115. QUENTIN N. BURDICK AMERICAN INDIANS INTO 
NURSING PROGRAM. 
‘‘(a) GRANTS AUTHORIZED.—For the purpose of in-
creasing the number of nurses, nurse midwives, and nurse 
practitioners who deliver health care services to Indians, 
the Secretary, acting through the Service, shall provide 
grants to the following: 
‘‘(1) Public or private schools of nursing. 
‘‘(2) Tribal colleges or universities. 
‘‘(3) Nurse midwife programs and advanced 
practice nurse programs that are provided by any 
tribal college or university accredited nursing pro-
gram, or in the absence of such, any other public or 
private institutions. 
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‘‘(b) USE OF GRANTS.—Grants provided under sub-
section (a) may be used for 1 or more of the following: 
‘‘(1) To recruit individuals for programs which 
train individuals to be nurses, nurse midwives, or 
advanced practice nurses. 
‘‘(2) To provide scholarships to Indians enrolled 
in such programs that may pay the tuition charged 
for such program and other expenses incurred in 
connection with such program, including books, fees, 
room and board, and stipends for living expenses. 
‘‘(3) To provide a program that encourages 
nurses, nurse midwives, and advanced practice 
nurses to provide, or continue to provide, health care 
services to Indians. 
‘‘(4) To provide a program that increases the 
skills of, and provides continuing education to, 
nurses, nurse midwives, and advanced practice 
nurses. 
‘‘(5) To provide any program that is designed 
to achieve the purpose described in subsection (a). 
‘‘(c) APPLICATIONS.—Each application for a grant 
under subsection (a) shall include such information as the 
Secretary may require to establish the connection between 
the program of the applicant and a health care facility 
that primarily serves Indians. 
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‘‘(d) PREFERENCES FOR GRANT RECIPIENTS.—In 
providing grants under subsection (a), the Secretary shall 
extend a preference to the following: 
‘‘(1) Programs that provide a preference to In-
dians. 
‘‘(2) Programs that train nurse midwives or ad-
vanced practice nurses. 
‘‘(3) Programs that are interdisciplinary. 
‘‘(4) Programs that are conducted in coopera-
tion with a program for gifted and talented Indian 
students. 
‘‘(5) Programs conducted by tribal colleges and 
universities. 
‘‘(e) QUENTIN N. BURDICK PROGRAM GRANT.—The 
Secretary shall provide 1 of the grants authorized under 
subsection (a) to establish and maintain a program at the 
University of North Dakota to be known as the ‘Quentin 
N. Burdick American Indians Into Nursing Program’. 
Such program shall, to the maximum extent feasible, co-
ordinate with the Quentin N. Burdick Indian Health Pro-
grams established under section 117(b) and the Quentin 
N. Burdick American Indians Into Psychology Program 
established under section 105(b). 
‘‘(f) ACTIVE DUTY SERVICE OBLIGATION.—The ac-
tive duty service obligation prescribed under section 338C 
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of the Public Health Service Act (42 U.S.C. 254m) shall 
be met by each individual who receives training or assist-
ance described in paragraph (1) or (2) of subsection (b) 
that is funded by a grant provided under subsection (a). 
Such obligation shall be met by service— 
‘‘(1) in the Service; 
‘‘(2) in a program of an Indian Tribe or Tribal 
Organization conducted under the Indian Self-Deter-
mination and Education Assistance Act (25 U.S.C. 
450 et seq.) (including programs under agreements 
with the Bureau of Indian Affairs); 
‘‘(3) in a program assisted under title V of this 
Act; 
‘‘(4) in the private practice of nursing if, as de-
termined by the Secretary, in accordance with guide-
lines promulgated by the Secretary, such practice is 
situated in a physician or other health shortage area 
and addresses the health care needs of a substantial 
number of Indians; or 
‘‘(5) in a teaching capacity in a tribal college or 
university nursing program (or a related health pro-
fession program) if, as determined by the Secretary, 
health services provided to Indians would not de-
crease. 
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‘‘SEC. 116. TRIBAL CULTURAL ORIENTATION. 
‘‘(a) CULTURAL EDUCATION OF EMPLOYEES.—The 
Secretary, acting through the Service, shall require that 
appropriate employees of the Service who serve Indian 
Tribes in each Service Area receive educational instruction 
in the history and culture of such Indian Tribes and their 
relationship to the Service. 
‘‘(b) PROGRAM.—In carrying out subsection (a), the 
Secretary shall establish a program which shall, to the ex-
tent feasible— 
‘‘(1) be developed in consultation with the af-
fected Indian Tribes, Tribal Organizations, and 
urban Indian organizations; 
‘‘(2) be carried out through tribal colleges or 
universities; 
‘‘(3) include instruction in American Indian 
studies; and 
‘‘(4) describe the use and place of traditional 
health care practices of the Indian Tribes in the 
Service Area. 
‘‘SEC. 117. INMED PROGRAM. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 
through the Service, is authorized to provide grants to col-
leges and universities for the purpose of maintaining and 
expanding the Indian health careers recruitment program 
known as the ‘Indians Into Medicine Program’ (herein-
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