179 
gram pursuant to this subsection shall remain eligible 
for quarters improvement and repair funds to the 
same extent as all federally-owned quarters used to 
house personnel in Services-supported programs. 
‘‘(4) NOTICE
OF
RATE
CHANGE.—A Tribal 
Health Program which exercises the authority pro-
vided under this subsection shall provide occupants 
with no less than 60 days notice of any change in 
rental rates. 
‘‘(b) DIRECT COLLECTION OF RENT.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of law, and subject to paragraph (2), a 
Tribal Health Program shall have the authority to 
collect rents directly from Federal employees who oc-
cupy such quarters in accordance with the following: 
‘‘(A) The Tribal Health Program shall no-
tify the Secretary and the subject Federal em-
ployees of its election to exercise its authority to 
collect rents directly from such Federal employ-
ees. 
‘‘(B) Upon receipt of a notice described in 
subparagraph (A), the Federal employees shall 
pay rents for occupancy of such quarters directly 
to the Tribal Health Program and the Secretary 
shall have no further authority to collect rents 
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from such employees through payroll deduction 
or otherwise. 
‘‘(C) Such rent payments shall be retained 
by the Tribal Health Program and shall not be 
made payable to or otherwise be deposited with 
the United States. 
‘‘(D) Such rent payments shall be deposited 
into a separate account which shall be used by 
the Tribal Health Program for the maintenance 
(including capital repairs and replacement) and 
operation of the quarters and facilities as the 
Tribal Health Program shall determine. 
‘‘(2) RETROCESSION OF AUTHORITY.—If a Trib-
al Health Program which has made an election under 
paragraph (1) requests retrocession of its authority to 
directly collect rents from Federal employees occu-
pying federally-owned quarters, such retrocession 
shall become effective on the earlier of— 
‘‘(A) the first day of the month that begins 
no less than 180 days after the Tribal Health 
Program notifies the Secretary of its desire to 
retrocede; or 
‘‘(B) such other date as may be mutually 
agreed by the Secretary and the Tribal Health 
Program. 
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181 
‘‘(c) RATES IN ALASKA.—To the extent that a Tribal 
Health Program, pursuant to authority granted in sub-
section (a), establishes rental rates for federally-owned quar-
ters provided to a Federal employee in Alaska, such rents 
may be based on the cost of comparable private rental hous-
ing in the nearest established community with a year-round 
population of 1,500 or more individuals. 
‘‘SEC. 315. APPLICABILITY OF BUY AMERICAN ACT REQUIRE-
MENT. 
‘‘(a) APPLICABILITY.—The Secretary shall ensure that 
the requirements of the Buy American Act apply to all pro-
curements made with funds provided pursuant to section 
317. Indian Tribes and Tribal Organizations shall be ex-
empt from these requirements. 
‘‘(b) EFFECT OF VIOLATION.—If it has been finally de-
termined by a court or Federal agency that any person in-
tentionally affixed a label bearing a ‘Made in America’ in-
scription or any inscription with the same meaning, to any 
product sold in or shipped to the United States that is not 
made in the United States, such person shall be ineligible 
to receive any contract or subcontract made with funds pro-
vided pursuant to section 317, pursuant to the debarment, 
suspension, and ineligibility procedures described in sec-
tions 9.400 through 9.409 of title 48, Code of Federal Regu-
lations. 
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182 
‘‘(c) DEFINITIONS.—For purposes of this section, the 
term ‘Buy American Act’ means title III of the Act entitled 
‘An Act making appropriations for the Treasury and Post 
Office Departments for the fiscal year ending June 30, 
1934, and for other purposes’, approved March 3, 1933 (41 
U.S.C. 10a et seq.). 
‘‘SEC. 316. OTHER FUNDING FOR FACILITIES. 
‘‘(a) AUTHORITY TO ACCEPT FUNDS.—The Secretary 
is authorized to accept from any source, including Federal 
and State agencies, funds that are available for the con-
struction of health care facilities and use such funds to 
plan, design, and construct health care facilities for Indians 
and to place such funds into a contract or compact under 
the Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.). Receipt of such funds shall have 
no effect on the priorities established pursuant to section 
301. 
‘‘(b) INTERAGENCY AGREEMENTS.—The Secretary is 
authorized to enter into interagency agreements with other 
Federal agencies or State agencies and other entities and 
to accept funds from such Federal or State agencies or other 
sources to provide for the planning, design, and construc-
tion of health care facilities to be administered by Indian 
Health Programs in order to carry out the purposes of this 
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Act and the purposes for which the funds were appropriated 
or for which the funds were otherwise provided. 
‘‘(c) ESTABLISHMENT
OF
STANDARDS.—The Sec-
retary, through the Service, shall establish standards by reg-
ulation for the planning, design, and construction of health 
care facilities serving Indians under this Act. 
‘‘SEC. 317. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated such sums 
as may be necessary for each fiscal year through fiscal year 
2017 to carry out this title. 
‘‘TITLE IV—ACCESS TO HEALTH 
SERVICES 
‘‘SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECU-
RITY ACT HEALTH BENEFITS PROGRAMS. 
‘‘(a) DISREGARD
OF
MEDICARE, MEDICAID, AND 
SCHIP PAYMENTS IN DETERMINING APPROPRIATIONS.— 
Any payments received by an Indian Health Program or 
by an Urban Indian Organization under title XVIII, XIX, 
or XXI of the Social Security Act for services provided to 
Indians eligible for benefits under such respective titles shall 
not be considered in determining appropriations for the 
provision of health care and services to Indians. 
‘‘(b) NONPREFERENTIAL TREATMENT.—Nothing in 
this Act authorizes the Secretary to provide services to an 
Indian with coverage under title XVIII, XIX, or XXI of 
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184 
the Social Security Act in preference to an Indian without 
such coverage. 
‘‘(c) USE OF FUNDS.— 
‘‘(1) SPECIAL FUND.— 
‘‘(A) 100 PERCENT PASS-THROUGH OF PAY-
MENTS
DUE
TO
FACILITIES.—Notwithstanding 
any other provision of law, but subject to para-
graph (2), payments to which a facility of the 
Service is entitled by reason of a provision of the 
Social Security Act shall be placed in a special 
fund to be held by the Secretary. In making pay-
ments from such fund, the Secretary shall ensure 
that each Service Unit of the Service receives 100 
percent of the amount to which the facilities of 
the Service, for which such Service Unit makes 
collections, are entitled by reason of a provision 
of the Social Security Act. 
‘‘(B) USE OF FUNDS.—Amounts received by 
a facility of the Service under subparagraph (A) 
shall first be used (to such extent or in such 
amounts as are provided in appropriation Acts) 
for the purpose of making any improvements in 
the programs of the Service operated by or 
through such facility which may be necessary to 
achieve or maintain compliance with the appli-
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cable conditions and requirements of titles XVIII 
and XIX of the Social Security Act. Any 
amounts so received that are in excess of the 
amount necessary to achieve or maintain such 
conditions and requirements shall, subject to con-
sultation with the Indian Tribes being served by 
the Service Unit, be used for reducing the health 
resource deficiencies (as determined under sec-
tion 201(d)) of such Indian Tribes. 
‘‘(2) DIRECT PAYMENT OPTION.—Paragraph (1) 
shall not apply to a Tribal Health Program upon the 
election of such Program under subsection (d) to re-
ceive payments directly. No payment may be made 
out of the special fund described in such paragraph 
with respect to reimbursement made for services pro-
vided by such Program during the period of such elec-
tion. 
‘‘(d) DIRECT BILLING.— 
‘‘(1) IN GENERAL.—Subject to complying with 
the requirements of paragraph (2), a Tribal Health 
Program may elect to directly bill for, and receive 
payment for, health care items and services provided 
by such Program for which payment is made under 
title XVIII or XIX of the Social Security Act or from 
any other third party payor. 
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‘‘(2) DIRECT REIMBURSEMENT.— 
‘‘(A) USE OF FUNDS.—Each Tribal Health 
Program making the election described in para-
graph (1) with respect to a program under a 
title of the Social Security Act shall be reim-
bursed directly by that program for items and 
services furnished without regard to subsection 
(c)(1), but all amounts so reimbursed shall be 
used by the Tribal Health Program for the pur-
pose of making any improvements in facilities of 
the Tribal Health Program that may be nec-
essary to achieve or maintain compliance with 
the conditions and requirements applicable gen-
erally to such items and services under the pro-
gram under such title and to provide additional 
health care services, improvements in health care 
facilities and Tribal Health Programs, any 
health care related purpose, or otherwise to 
achieve the objectives provided in section 3 of 
this Act. 
‘‘(B) AUDITS.—The amounts paid to a 
Tribal Health Program making the election de-
scribed in paragraph (1) with respect to a pro-
gram under a title of the Social Security Act 
shall be subject to all auditing requirements ap-
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plicable to the program under such title, as well 
as all auditing requirements applicable to pro-
grams administered by an Indian Health Pro-
gram. Nothing in the preceding sentence shall be 
construed as limiting the application of auditing 
requirements applicable to amounts paid under 
title XVIII, XIX, or XXI of the Social Security 
Act. 
‘‘(C) IDENTIFICATION OF SOURCE OF PAY-
MENTS.—Any Tribal Health Program that re-
ceives reimbursements or payments under title 
XVIII, XIX, or XXI of the Social Security Act, 
shall provide to the Service a list of each pro-
vider enrollment number (or other identifier) 
under which such Program receives such reim-
bursements or payments. 
‘‘(3) EXAMINATION
AND
IMPLEMENTATION
OF 
CHANGES.— 
‘‘(A) IN GENERAL.—The Secretary, acting 
through the Service and with the assistance of 
the Administrator of the Centers for Medicare & 
Medicaid Services, shall examine on an ongoing 
basis and implement any administrative changes 
that may be necessary to facilitate direct billing 
and reimbursement under the program estab-
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