295 
‘‘(2) REPORT.—Not later than 18 months after 
the date of enactment of the Indian Health Care Im-
provement Act Amendments of 2008, the Secretary 
shall submit to the Committee on Indian Affairs of 
the Senate and the Committee on Natural Resources 
of the House of Representatives a report that de-
scribes the means and extent to which the Secretary 
has carried out paragraph (1). 
‘‘(d) COORDINATION.— 
‘‘(1) IN GENERAL.—The Secretary, in coordina-
tion with the Attorney General, Federal and tribal 
law enforcement agencies, Indian Health Programs, 
and domestic violence or sexual assault victim orga-
nizations, shall develop appropriate victim services 
and victim advocate training programs— 
‘‘(A) to improve domestic violence or sex-
ual abuse responses; 
‘‘(B) to improve forensic examinations and 
collection; 
‘‘(C) to identify problems or obstacles in 
the prosecution of domestic violence or sexual 
abuse; and 
‘‘(D) to meet other needs or carry out 
other activities required to prevent, treat, and 
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improve prosecutions of domestic violence and 
sexual abuse. 
‘‘(2) REPORT.—Not later than 2 years after the 
date of enactment of the Indian Health Care Im-
provement Act Amendments of 2008, the Secretary 
shall submit to the Committee on Indian Affairs of 
the Senate and the Committee on Natural Resources 
of the House of Representatives a report that de-
scribes, with respect to the matters described in 
paragraph (1), the improvements made and needed, 
problems or obstacles identified, and costs necessary 
to address the problems or obstacles, and any other 
recommendations that the Secretary determines to 
be appropriate. 
‘‘SEC. 715. BEHAVIORAL HEALTH RESEARCH. 
‘‘The Secretary, in consultation with appropriate 
Federal agencies, shall make grants to, or enter into con-
tracts with, Indian Tribes, Tribal Organizations, and 
urban Indian organizations or enter into contracts with, 
or make grants to appropriate institutions for, the conduct 
of research on the incidence and prevalence of behavioral 
health problems among Indians served by the Service, In-
dian Tribes, or Tribal Organizations and among Indians 
in urban areas. Research priorities under this section shall 
include— 
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297 
‘‘(1) the multifactorial causes of Indian youth 
suicide, including— 
‘‘(A) protective and risk factors and sci-
entific data that identifies those factors; and 
‘‘(B) the effects of loss of cultural identity 
and the development of scientific data on those 
effects; 
‘‘(2) the interrelationship and interdependence 
of behavioral health problems with alcoholism and 
other substance abuse, suicide, homicides, other in-
juries, and the incidence of family violence; and 
‘‘(3) the development of models of prevention 
techniques. 
The effect of the interrelationships and interdependencies 
referred to in paragraph (2) on children, and the develop-
ment of prevention techniques under paragraph (3) appli-
cable to children, shall be emphasized. 
‘‘SEC. 716. DEFINITIONS. 
‘‘For the purpose of this title, the following defini-
tions shall apply: 
‘‘(1) ASSESSMENT.—The term ‘assessment’ 
means the systematic collection, analysis, and dis-
semination of information on health status, health 
needs, and health problems. 
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298 
‘‘(2) 
ALCOHOL-RELATED 
NEURODEVELOPMENTAL DISORDERS OR ARND.—The 
term ‘alcohol-related neurodevelopmental disorders’ 
or ‘ARND’ means, with a history of maternal alco-
hol consumption during pregnancy, central nervous 
system involvement such as developmental delay, in-
tellectual deficit, or neurologic abnormalities. Behav-
iorally, there can be problems with irritability, and 
failure to thrive as infants. As children become older 
there will likely be hyperactivity, attention deficit, 
language dysfunction, and perceptual and judgment 
problems. 
‘‘(3) BEHAVIORAL HEALTH AFTERCARE.—The 
term ‘behavioral health aftercare’ includes those ac-
tivities and resources used to support recovery fol-
lowing inpatient, residential, intensive substance 
abuse, or mental health outpatient or outpatient 
treatment. The purpose is to help prevent or deal 
with relapse by ensuring that by the time a client or 
patient is discharged from a level of care, such as 
outpatient treatment, an aftercare plan has been de-
veloped with the client. An aftercare plan may use 
such resources as a community-based therapeutic 
group, transitional living facilities, a 12-step spon-
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299 
sor, a local 12-step or other related support group, 
and other community-based providers. 
‘‘(4) DUAL DIAGNOSIS.—The term ‘dual diag-
nosis’ means coexisting substance abuse and mental 
illness conditions or diagnosis. Such clients are 
sometimes referred to as mentally ill chemical abus-
ers (MICAs). 
‘‘(5) 
FETAL
ALCOHOL
SPECTRUM
DIS-
ORDERS.— 
‘‘(A) IN GENERAL.—The term ‘fetal alco-
hol spectrum disorders’ includes a range of ef-
fects that can occur in an individual whose 
mother drank alcohol during pregnancy, includ-
ing physical, mental, behavioral, and/or learning 
disabilities with possible lifelong implications. 
‘‘(B) INCLUSIONS.—The term ‘fetal alcohol 
spectrum disorders’ may include— 
‘‘(i) fetal alcohol syndrome (FAS); 
‘‘(ii) fetal alcohol effect (FAE); 
‘‘(iii) alcohol-related birth defects; and 
‘‘(iv) 
alcohol-related 
neurodevelopmental disorders (ARND). 
‘‘(6) FETAL
ALCOHOL
SYNDROME
OR
FAS.— 
The term ‘fetal alcohol syndrome’ or ‘FAS’ means 
any 1 of a spectrum of effects that may occur when 
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300 
a woman drinks alcohol during pregnancy, the diag-
nosis of which involves the confirmed presence of the 
following 3 criteria: 
‘‘(A) Craniofacial abnormalities. 
‘‘(B) Growth deficits. 
‘‘(C) Central nervous system abnormalities. 
‘‘(7) REHABILITATION.—The term ‘rehabilita-
tion’ means medical and health care services that— 
‘‘(A) are recommended by a physician or 
licensed practitioner of the healing arts within 
the scope of their practice under applicable law; 
‘‘(B) are furnished in a facility, home, or 
other setting in accordance with applicable 
standards; and 
‘‘(C) have as their purpose any of the fol-
lowing: 
‘‘(i) The maximum attainment of 
physical, mental, and developmental func-
tioning. 
‘‘(ii) Averting deterioration in physical 
or mental functional status. 
‘‘(iii) The maintenance of physical or 
mental health functional status. 
‘‘(8) SUBSTANCE ABUSE.—The term ‘substance 
abuse’ includes inhalant abuse. 
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307 
after the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2009. 
‘‘(b) COMMITTEE.—A negotiated rulemaking com-
mittee established pursuant to section 565 of title 5, 
United States Code, to carry out this section shall have 
as its members only representatives of the Federal Gov-
ernment and representatives of Indian Tribes, and Tribal 
Organizations, a majority of whom shall be nominated by 
and be representatives of Indian Tribes and Tribal Orga-
nizations from each Service Area. 
‘‘(c) ADAPTATION OF PROCEDURES.—The Secretary 
shall adapt the negotiated rulemaking procedures to the 
unique context of self-governance and the government-to- 
government relationship between the United States and 
Indian Tribes. 
‘‘(d) LACK OF REGULATIONS.—The lack of promul-
gated regulations shall not limit the effect of this Act. 
‘‘SEC. 803. PLAN OF IMPLEMENTATION. 
‘‘(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of the Indian Health Care Improvement 
Act Amendments of 2009, the Secretary, in consultation 
with Indian Tribes, Tribal Organizations, and urban In-
dian organizations, shall submit to Congress a plan ex-
plaining the manner and schedule, by title and section, 
by which the Secretary will implement the provisions of 
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357 
and inserting ‘‘program, other than a health care program 
operated or financed by the Indian Health Service or by 
an Indian Tribe, Tribal Organization, or urban Indian or-
ganization’’. 
(c) DEFINITIONS.—Section 2110(c) of such Act (42 
U.S.C. 1397jj(c)) is amended by adding at the end the 
following new paragraph: 
‘‘(9) INDIAN; INDIAN
HEALTH
PROGRAM; IN-
DIAN
TRIBE; ETC.—The terms ‘Indian’, ‘Indian 
Health Program’, ‘Indian Tribe’, ‘Tribal Organiza-
tion’, and ‘Urban Indian Organization’ have the 
meanings given those terms in section 4 of the In-
dian Health Care Improvement Act.’’. 
SEC. 204. NONDISCRIMINATION IN QUALIFICATIONS FOR 
PAYMENT FOR SERVICES UNDER FEDERAL 
HEALTH CARE PROGRAMS. 
Section 1139 of the Social Security Act (42 U.S.C. 
1320b–9), as amended by section 202, is amended by re-
designating subsection (c) as subsection (d), and inserting 
after subsection (b) the following new subsection: 
‘‘(c) NONDISCRIMINATION IN QUALIFICATIONS FOR 
PAYMENT
FOR SERVICES UNDER FEDERAL HEALTH 
CARE PROGRAMS.— 
‘‘(1) REQUIREMENT
TO
SATISFY
GENERALLY 
APPLICABLE PARTICIPATION REQUIREMENTS.— 
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358 
‘‘(A) IN GENERAL.—A Federal health care 
program must accept an entity that is operated 
by the Indian Health Service, an Indian Tribe, 
Tribal Organization, or Urban Indian Organiza-
tion as a provider eligible to receive payment 
under the program for health care services fur-
nished to an Indian on the same basis as any 
other provider qualified to participate as a pro-
vider of health care services under the program 
if the entity meets generally applicable State or 
other requirements for participation as a pro-
vider of health care services under the program. 
‘‘(B) SATISFACTION OF STATE OR LOCAL 
LICENSURE
OR
RECOGNITION
REQUIRE-
MENTS.—Any requirement for participation as 
a provider of health care services under a Fed-
eral health care program that an entity be li-
censed or recognized under the State or local 
law where the entity is located to furnish health 
care services shall be deemed to have been met 
in the case of an entity operated by the Indian 
Health Service, an Indian Tribe, Tribal Organi-
zation, or Urban Indian Organization if the en-
tity meets all the applicable standards for such 
licensure or recognition, regardless of whether 
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364 
sistance or child health assistance under such programs 
in their State of residence and who temporarily reside in 
an out-of-State boarding school or peripheral dormitory 
funded by the Bureau of Indian Affairs. 
(b) REPORT.—Not later than 18 months after the 
date of enactment of this Act, the Secretary, in consulta-
tion with directors of State Medicaid programs under title 
XIX of the Social Security Act and directors of State Chil-
dren’s Health Insurance Programs under title XXI of such 
Act, shall submit a report to Congress that contains rec-
ommendations for such legislative and administrative ac-
tions as the Secretary determines appropriate to address 
the enrollment and coverage coordination barriers identi-
fied through the study required under subsection (a). 
Æ 
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