1729 
‘‘(4) provides tutoring, counseling, and support 
to students who are enrolled in a health career pro-
gram of study at the respective college or university; 
and 
‘‘(5) to the maximum extent feasible, employs 
qualified Indians in the program. 
‘‘SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY 
COLLEGES. 
‘‘(a) GRANTS TO ESTABLISH PROGRAMS.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Service, shall award grants to accredited 
and accessible community colleges for the purpose of 
assisting such community colleges in the establish-
ment of programs which provide education in a 
health profession leading to a degree or diploma in 
a health profession for individuals who desire to 
practice such profession on or near a reservation or 
in an Indian Health Program. 
‘‘(2) AMOUNT OF GRANTS.—The amount of any 
grant awarded to a community college under para-
graph (1) for the first year in which such a grant 
is provided to the community college shall not exceed 
$250,000. 
‘‘(b) GRANTS
FOR MAINTENANCE
AND RECRUIT-
ING.—
1730 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Service, shall award grants to accredited 
and accessible community colleges that have estab-
lished a program described in subsection (a)(1) for 
the purpose of maintaining the program and recruit-
ing students for the program. 
‘‘(2) REQUIREMENTS.—Grants may only be 
made under this section to a community college 
which— 
‘‘(A) is accredited; 
‘‘(B) has a relationship with a hospital fa-
cility, Service facility, or hospital that could 
provide training of nurses or health profes-
sionals; 
‘‘(C) has entered into an agreement with 
an accredited college or university medical 
school, the terms of which— 
‘‘(i) provide a program that enhances 
the transition and recruitment of students 
into advanced baccalaureate or graduate 
programs that train health professionals; 
and 
‘‘(ii) stipulate certifications necessary 
to approve internship and field placement 
opportunities at Indian Health Programs;
1731 
‘‘(D) has a qualified staff which has the 
appropriate certifications; 
‘‘(E) is capable of obtaining State or re-
gional accreditation of the program described in 
subsection (a)(1); and 
‘‘(F) agrees to provide for Indian pref-
erence for applicants for programs under this 
section. 
‘‘(c) TECHNICAL ASSISTANCE.—The Secretary shall 
encourage community colleges described in subsection 
(b)(2) to establish and maintain programs described in 
subsection (a)(1) by— 
‘‘(1) entering into agreements with such col-
leges for the provision of qualified personnel of the 
Service to teach courses of study in such programs; 
and 
‘‘(2) providing technical assistance and support 
to such colleges. 
‘‘(d) ADVANCED TRAINING.— 
‘‘(1) REQUIRED.—Any program receiving as-
sistance under this section that is conducted with re-
spect to a health profession shall also offer courses 
of study which provide advanced training for any 
health professional who—
1732 
‘‘(A) has already received a degree or di-
ploma in such health profession; and 
‘‘(B) provides clinical services on or near a 
reservation or for an Indian Health Program. 
‘‘(2) MAY BE OFFERED AT ALTERNATE SITE.— 
Such courses of study may be offered in conjunction 
with the college or university with which the commu-
nity college has entered into the agreement required 
under subsection (b)(2)(C). 
‘‘(e) PRIORITY.—Where the requirements of sub-
section (b) are met, grant award priority shall be provided 
to tribal colleges and universities in Service Areas where 
they exist. 
‘‘SEC. 119. RETENTION BONUS. 
‘‘(a) BONUS AUTHORIZED.—The Secretary may pay 
a retention bonus to any health professional employed by, 
or assigned to, and serving in, an Indian Health Program 
or urban Indian organization either as a civilian employee 
or as a commissioned officer in the Regular or Reserve 
Corps of the Public Health Service who— 
‘‘(1) is assigned to, and serving in, a position 
for which recruitment or retention of personnel is 
difficult;
1733 
‘‘(2) the Secretary determines is needed by In-
dian Health Programs and urban Indian organiza-
tions; 
‘‘(3) has— 
‘‘(A) completed 2 years of employment 
with an Indian Health Program or urban In-
dian organization; or 
‘‘(B) completed any service obligations in-
curred as a requirement of— 
‘‘(i) any Federal scholarship program; 
or 
‘‘(ii) any Federal education loan re-
payment program; and 
‘‘(4) enters into an agreement with an Indian 
Health Program or urban Indian organization for 
continued employment for a period of not less than 
1 year. 
‘‘(b) RATES.—The Secretary may establish rates for 
the retention bonus which shall provide for a higher an-
nual rate for multiyear agreements than for single year 
agreements referred to in subsection (a)(4), but in no 
event shall the annual rate be more than $25,000 per 
annum. 
‘‘(c) DEFAULT OF RETENTION AGREEMENT.—Any 
health professional failing to complete the agreed upon
1734 
term of service, except where such failure is through no 
fault of the individual, shall be obligated to refund to the 
Government the full amount of the retention bonus for the 
period covered by the agreement, plus interest as deter-
mined by the Secretary in accordance with section 
110(l)(2)(B). 
‘‘(d) OTHER RETENTION BONUS.—The Secretary 
may pay a retention bonus to any health professional em-
ployed by a Tribal Health Program if such health profes-
sional is serving in a position which the Secretary deter-
mines is— 
‘‘(1) a position for which recruitment or reten-
tion is difficult; and 
‘‘(2) necessary for providing health care services 
to Indians. 
‘‘SEC. 120. NURSING RESIDENCY PROGRAM. 
‘‘(a) ESTABLISHMENT
OF
PROGRAM.—The Sec-
retary, acting through the Service, shall establish a pro-
gram to enable Indians who are licensed practical nurses, 
licensed vocational nurses, and registered nurses who are 
working in an Indian Health Program or urban Indian 
organization, and have done so for a period of not less 
than 1 year, to pursue advanced training. Such program 
shall include a combination of education and work study 
in an Indian Health Program or urban Indian organiza-
1735 
tion leading to an associate or bachelor’s degree (in the 
case of a licensed practical nurse or licensed vocational 
nurse), a bachelor’s degree (in the case of a registered 
nurse), or advanced degrees or certifications in nursing 
and public health. 
‘‘(b) SERVICE OBLIGATION.—An individual who par-
ticipates in a program under subsection (a), where the 
educational costs are paid by the Service, shall incur an 
obligation to serve in an Indian Health Program or urban 
Indian organization for a period of obligated service equal 
to 1 year for every year that nonprofessional employee (li-
censed practical nurses, licensed vocational nurses, nurs-
ing assistants, and various health care technicians), or 2 
years for every year that professional nurse (associate de-
gree and bachelor-prepared registered nurses), partici-
pates in such program. In the event that the individual 
fails to complete such obligated service, the United States 
shall be entitled to recover from such individual an amount 
determined in accordance with the formula specified sub-
section (d)(1) of section 104 for individuals failing to 
graduate from their degree program and subsection (l) of 
Section 110 for individuals failing to start or complete the 
obligated service.
1736 
‘‘SEC. 121. COMMUNITY HEALTH AIDE PROGRAM. 
‘‘(a) GENERAL PURPOSES OF PROGRAM.—Under the 
authority of the Act of November 2, 1921 (25 U.S.C. 13) 
(commonly known as the ‘Snyder Act’), the Secretary, act-
ing through the Service, shall develop and operate a Com-
munity Health Aide Program in Alaska under which the 
Service— 
‘‘(1) provides for the training of Alaska Natives 
as health aides or community health practitioners; 
‘‘(2) uses such aides or practitioners in the pro-
vision of health care, health promotion, and disease 
prevention services to Alaska Natives living in vil-
lages in rural Alaska; and 
‘‘(3) provides for the establishment of tele-
conferencing capacity in health clinics located in or 
near such villages for use by community health aides 
or community health practitioners. 
‘‘(b) SPECIFIC PROGRAM REQUIREMENTS.—The Sec-
retary, acting through the Community Health Aide Pro-
gram of the Service, shall— 
‘‘(1) using trainers accredited by the Program, 
provide a high standard of training to community 
health aides and community health practitioners to 
ensure that such aides and practitioners provide 
quality health care, health promotion, and disease
1737 
prevention services to the villages served by the Pro-
gram; 
‘‘(2) in order to provide such training, develop 
a curriculum that— 
‘‘(A) combines education in the theory of 
health care with supervised practical experience 
in the provision of health care; 
‘‘(B) provides instruction and practical ex-
perience in the provision of acute care, emer-
gency care, health promotion, disease preven-
tion, and the efficient and effective manage-
ment of clinic pharmacies, supplies, equipment, 
and facilities; and 
‘‘(C) promotes the achievement of the 
health status objectives specified in section 
3(2); 
‘‘(3) establish and maintain a Community 
Health Aide Certification Board to certify as com-
munity health aides or community health practi-
tioners individuals who have successfully completed 
the training described in paragraph (1) or can dem-
onstrate equivalent experience; 
‘‘(4) develop and maintain a system which iden-
tifies the needs of community health aides and com-
munity health practitioners for continuing education
1738 
in the provision of health care, including the areas 
described in paragraph (2)(B), and develop pro-
grams that meet the needs for such continuing edu-
cation; 
‘‘(5) develop and maintain a system that pro-
vides close supervision of community health aides 
and community health practitioners; 
‘‘(6) develop a system under which the work of 
community health aides and community health prac-
titioners is reviewed and evaluated to assure the pro-
vision of quality health care, health promotion, and 
disease prevention services; and 
‘‘(7) ensure that pulpal therapy (not including 
pulpotomies on deciduous teeth) or extraction of 
adult teeth can be performed by a dental health aide 
therapist only after consultation with a licensed den-
tist who determines that the procedure is a medical 
emergency that cannot be resolved with palliative 
treatment, and further that dental health aide thera-
pists are strictly prohibited from performing all 
other oral or jaw surgeries, provided that uncompli-
cated extractions shall not be considered oral sur-
gery under this section. 
‘‘(c) PROGRAM REVIEW.— 
‘‘(1) NEUTRAL PANEL.—
1739 
‘‘(A) ESTABLISHMENT.—The Secretary, 
acting through the Service, shall establish a 
neutral panel to carry out the study under 
paragraph (2). 
‘‘(B) MEMBERSHIP.—Members of the neu-
tral panel shall be appointed by the Secretary 
from among clinicians, economists, community 
practitioners, oral epidemiologists, and Alaska 
Natives. 
‘‘(2) STUDY.— 
‘‘(A) IN GENERAL.—The neutral panel es-
tablished under paragraph (1) shall conduct a 
study of the dental health aide therapist serv-
ices provided by the Community Health Aide 
Program under this section to ensure that the 
quality of care provided through those services 
is adequate and appropriate. 
‘‘(B) PARAMETERS OF STUDY.—The Sec-
retary, in consultation with interested parties, 
including professional dental organizations, 
shall develop the parameters of the study. 
‘‘(C) INCLUSIONS.—The study shall in-
clude a determination by the neutral panel with 
respect to—
1740 
‘‘(i) the ability of the dental health 
aide therapist services under this section to 
address the dental care needs of Alaska 
Natives; 
‘‘(ii) the quality of care provided 
through those services, including any train-
ing, improvement, or additional oversight 
required to improve the quality of care; 
and 
‘‘(iii) whether safer and less costly al-
ternatives to the dental health aide thera-
pist services exist. 
‘‘(D) CONSULTATION.—In carrying out the 
study under this paragraph, the neutral panel 
shall consult with Alaska Tribal Organizations 
with respect to the adequacy and accuracy of 
the study. 
‘‘(3) REPORT.—The neutral panel shall submit 
to the Secretary, the Committee on Indian Affairs of 
the Senate, and the Committee on Natural Re-
sources of the House of Representatives a report de-
scribing the results of the study under paragraph 
(2), including a description of— 
‘‘(A) any determination of the neutral 
panel under paragraph (2)(C); and
1741 
‘‘(B) any comments received from an Alas-
ka 
Tribal 
Organization 
under 
paragraph 
(2)(D). 
‘‘(d) NATIONALIZATION OF PROGRAM.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), the Secretary, acting through the Service, 
may establish a national Community Health Aide 
Program in accordance with the program under this 
section, as the Secretary determines to be appro-
priate. 
‘‘(2) EXCEPTION.—The national Community 
Health Aide Program under paragraph (1) shall not 
include dental health aide therapist services. 
‘‘(3) REQUIREMENT.—In establishing a na-
tional program under paragraph (1), the Secretary 
shall not reduce the amount of funds provided for 
the Community Health Aide Program described in 
subsections (a) and (b). 
‘‘SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION. 
‘‘The Secretary shall, by contract or otherwise, pro-
vide training for individuals in the administration and 
planning of Tribal Health Programs, with priority to Indi-
ans.
1742 
‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE 
DEMONSTRATION PROGRAMS. 
‘‘(a) DEMONSTRATION PROGRAMS AUTHORIZED.— 
The Secretary, acting through the Service, may fund dem-
onstration programs for Tribal Health Programs to ad-
dress the chronic shortages of health professionals. 
‘‘(b) PURPOSES OF PROGRAMS.—The purposes of 
demonstration programs funded under subsection (a) shall 
be— 
‘‘(1) to provide direct clinical and practical ex-
perience at a Service Unit to health profession stu-
dents and residents from medical schools; 
‘‘(2) to improve the quality of health care for 
Indians by assuring access to qualified health care 
professionals; and 
‘‘(3) to provide academic and scholarly opportu-
nities for health professionals serving Indians by 
identifying all academic and scholarly resources of 
the region. 
‘‘(c) ADVISORY BOARD.—The demonstration pro-
grams established pursuant to subsection (a) shall incor-
porate a program advisory board composed of representa-
tives from the Indian Tribes and Indian communities in 
the area which will be served by the program.
1743 
‘‘SEC. 124. NATIONAL HEALTH SERVICE CORPS. 
‘‘(a) NO REDUCTION IN SERVICES.—The Secretary 
shall not— 
‘‘(1) remove a member of the National Health 
Service Corps from an Indian Health Program or 
urban Indian organization; or 
‘‘(2) withdraw funding used to support such 
member, unless the Secretary, acting through the 
Service, has ensured that the Indians receiving serv-
ices from such member will experience no reduction 
in services. 
‘‘(b) TREATMENT OF INDIAN HEALTH PROGRAMS.— 
At the request of an Indian Health Program, the services 
of a member of the National Health Service Corps as-
signed to an Indian Health Program may be limited to 
the persons who are eligible for services from such Pro-
gram. 
‘‘SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL 
CURRICULA DEMONSTRATION PROGRAMS. 
‘‘(a) CONTRACTS AND GRANTS.—The Secretary, act-
ing through the Service, may enter into contracts with, 
or make grants to, accredited tribal colleges and univer-
sities and eligible accredited and accessible community col-
leges to establish demonstration programs to develop edu-
cational curricula for substance abuse counseling.
1744 
‘‘(b) USE OF FUNDS.—Funds provided under this 
section shall be used only for developing and providing 
educational curriculum for substance abuse counseling (in-
cluding paying salaries for instructors). Such curricula 
may be provided through satellite campus programs. 
‘‘(c) TIME PERIOD OF ASSISTANCE; RENEWAL.—A 
contract entered into or a grant provided under this sec-
tion shall be for a period of 3 years. Such contract or 
grant may be renewed for an additional 2-year period 
upon the approval of the Secretary. 
‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP-
PLICATIONS.—Not later than 180 days after the date of 
enactment of the Indian Health Care Improvement Act 
Amendments of 2009, the Secretary, after consultation 
with Indian Tribes and administrators of tribal colleges 
and universities and eligible accredited and accessible com-
munity colleges, shall develop and issue criteria for the 
review and approval of applications for funding (including 
applications for renewals of funding) under this section. 
Such criteria shall ensure that demonstration programs 
established under this section promote the development of 
the capacity of such entities to educate substance abuse 
counselors. 
‘‘(e) ASSISTANCE.—The Secretary shall provide such 
technical and other assistance as may be necessary to en-
1745 
able grant recipients to comply with the provisions of this 
section. 
‘‘(f) REPORT.—Each fiscal year, the Secretary shall 
submit to the President, for inclusion in the report which 
is required to be submitted under section 801 for that fis-
cal year, a report on the findings and conclusions derived 
from the demonstration programs conducted under this 
section during that fiscal year. 
‘‘(g) DEFINITION.—For the purposes of this section, 
the term ‘educational curriculum’ means 1 or more of the 
following: 
‘‘(1) Classroom education. 
‘‘(2) Clinical work experience. 
‘‘(3) Continuing education workshops. 
‘‘SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMU-
NITY EDUCATION PROGRAMS. 
‘‘(a) STUDY; LIST.—The Secretary, acting through 
the Service, and the Secretary of the Interior, in consulta-
tion with Indian Tribes and Tribal Organizations, shall 
conduct a study and compile a list of the types of staff 
positions specified in subsection (b) whose qualifications 
include, or should include, training in the identification, 
prevention, education, referral, or treatment of mental ill-
ness, or dysfunctional and self-destructive behavior.
1746 
‘‘(b) POSITIONS.—The positions referred to in sub-
section (a) are— 
‘‘(1) staff positions within the Bureau of Indian 
Affairs, including existing positions, in the fields 
of— 
‘‘(A) elementary and secondary education; 
‘‘(B) social services and family and child 
welfare; 
‘‘(C) law enforcement and judicial services; 
and 
‘‘(D) alcohol and substance abuse; 
‘‘(2) staff positions within the Service; and 
‘‘(3) staff positions similar to those identified in 
paragraphs (1) and (2) established and maintained 
by Indian Tribes, Tribal Organizations (without re-
gard to the funding source), and urban Indian orga-
nizations. 
‘‘(c) TRAINING CRITERIA.— 
‘‘(1) IN GENERAL.—The appropriate Secretary 
shall provide training criteria appropriate to each 
type of position identified in subsection (b)(1) and 
(b)(2) and ensure that appropriate training has 
been, or shall be provided to any individual in any 
such position. With respect to any such individual in 
a position identified pursuant to subsection (b)(3),
1747 
the respective Secretaries shall provide appropriate 
training to, or provide funds to, an Indian Tribe, 
Tribal Organization, or urban Indian organization 
for training of appropriate individuals. In the case of 
positions funded under a contract or compact under 
the Indian Self-Determination and Education Assist-
ance Act (25 U.S.C. 450 et seq.), the appropriate 
Secretary shall ensure that such training costs are 
included in the contract or compact, as the Sec-
retary determines necessary. 
‘‘(2) POSITION SPECIFIC TRAINING CRITERIA.— 
Position specific training criteria shall be culturally 
relevant to Indians and Indian Tribes and shall en-
sure that appropriate information regarding tradi-
tional health care practices is provided. 
‘‘(d) COMMUNITY EDUCATION
ON MENTAL ILL-
NESS.—The Service shall develop and implement, on re-
quest of an Indian Tribe, Tribal Organization, or urban 
Indian organization, or assist the Indian Tribe, Tribal Or-
ganization, or urban Indian organization to develop and 
implement, a program of community education on mental 
illness. In carrying out this subsection, the Service shall, 
upon request of an Indian Tribe, Tribal Organization, or 
urban Indian organization, provide technical assistance to 
the Indian Tribe, Tribal Organization, or urban Indian or-
1748 
ganization to obtain and develop community educational 
materials on the identification, prevention, referral, and 
treatment of mental illness and dysfunctional and self-de-
structive behavior. 
‘‘(e) PLAN.—Not later than 90 days after the date 
of enactment of the Indian Health Care Improvement Act 
Amendments of 2009, the Secretary shall develop a plan 
under which the Service will increase the health care staff 
providing behavioral health services by at least 500 posi-
tions within 5 years after the date of enactment of this 
section, with at least 200 of such positions devoted to 
child, adolescent, and family services. The plan developed 
under this subsection shall be implemented under the Act 
of November 2, 1921 (25 U.S.C. 13) (commonly known 
as the ‘Snyder Act’). 
‘‘SEC. 127. EXEMPTION FROM PAYMENT OF CERTAIN FEES. 
‘‘Employees of a Tribal Health Program or an Urban 
Indian Organization shall be exempt from payment of li-
censing, registration, and other fees imposed by a Federal 
agency to the same extent that Commissioned Corps Offi-
cers or other employees of the Indian Health Service are 
exempt from such fees. 
‘‘SEC. 128. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated such sums 
as may be necessary to carry out this title.
1749 
‘‘TITLE II—HEALTH SERVICES 
‘‘SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. 
‘‘(a) USE OF FUNDS.—The Secretary, acting through 
the Service, is authorized to expend funds, directly or 
under the authority of the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.), which 
are appropriated under the authority of this section, for 
the purposes of— 
‘‘(1) eliminating the deficiencies in health sta-
tus and health resources of all Indian Tribes; 
‘‘(2) eliminating backlogs in the provision of 
health care services to Indians; 
‘‘(3) meeting the health needs of Indians in an 
efficient and equitable manner, including the use of 
telehealth and telemedicine when appropriate; 
‘‘(4) eliminating inequities in funding for both 
direct care and contract health service programs; 
and 
‘‘(5) augmenting the ability of the Service to 
meet the following health service responsibilities with 
respect to those Indian Tribes with the highest levels 
of health status deficiencies and resource defi-
ciencies: 
‘‘(A) Clinical care, including inpatient care, 
outpatient care (including audiology, clinical
1750 
eye, and vision care), primary care, secondary 
and tertiary care, and long-term care. 
‘‘(B) Preventive health, including mam-
mography and other cancer screening in accord-
ance with section 207. 
‘‘(C) Dental care. 
‘‘(D) Mental health, including community 
mental health services, inpatient mental health 
services, dormitory mental health services, 
therapeutic and residential treatment centers, 
and training of traditional health care practi-
tioners. 
‘‘(E) Emergency medical services. 
‘‘(F) Treatment and control of, and reha-
bilitative care related to, alcoholism and drug 
abuse (including fetal alcohol syndrome) among 
Indians. 
‘‘(G) Injury prevention programs, includ-
ing data collection and evaluation, demonstra-
tion projects, training, and capacity building. 
‘‘(H) Home health care. 
‘‘(I) Community health representatives. 
‘‘(J) Maintenance and improvement. 
‘‘(b) NO OFFSET OR LIMITATION.—Any funds appro-
priated under the authority of this section shall not be
1751 
used to offset or limit any other appropriations made to 
the Service under this Act or the Act of November 2, 1921 
(25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 
or any other provision of law. 
‘‘(c) ALLOCATION; USE.— 
‘‘(1) IN GENERAL.—Funds appropriated under 
the authority of this section shall be allocated to 
Service Units, Indian Tribes, or Tribal Organiza-
tions. The funds allocated to each Indian Tribe, 
Tribal Organization, or Service Unit under this 
paragraph shall be used by the Indian Tribe, Tribal 
Organization, or Service Unit under this paragraph 
to improve the health status and reduce the resource 
deficiency of each Indian Tribe served by such Serv-
ice Unit, Indian Tribe, or Tribal Organization. 
‘‘(2) 
APPORTIONMENT
OF
ALLOCATED 
FUNDS.—The apportionment of funds allocated to a 
Service Unit, Indian Tribe, or Tribal Organization 
under paragraph (1) among the health service re-
sponsibilities described in subsection (a)(5) shall be 
determined by the Service in consultation with, and 
with the active participation of, the affected Indian 
Tribes and Tribal Organizations.
1752 
‘‘(d) PROVISIONS RELATING
TO HEALTH STATUS 
AND RESOURCE DEFICIENCIES.—For the purposes of this 
section, the following definitions apply: 
‘‘(1) DEFINITION.—The term ‘health status 
and resource deficiency’ means the extent to 
which— 
‘‘(A) the health status objectives set forth 
in section 3(2) are not being achieved; and 
‘‘(B) the Indian Tribe or Tribal Organiza-
tion does not have available to it the health re-
sources it needs, taking into account the actual 
cost of providing health care services given local 
geographic, climatic, rural, or other cir-
cumstances. 
‘‘(2) AVAILABLE RESOURCES.—The health re-
sources available to an Indian Tribe or Tribal Orga-
nization include health resources provided by the 
Service as well as health resources used by the In-
dian Tribe or Tribal Organization, including services 
and financing systems provided by any Federal pro-
grams, private insurance, and programs of State or 
local governments. 
‘‘(3) PROCESS
FOR
REVIEW
OF
DETERMINA-
TIONS.—The Secretary shall establish procedures 
which allow any Indian Tribe or Tribal Organization
1753 
to petition the Secretary for a review of any deter-
mination of the extent of the health status and re-
source deficiency of such Indian Tribe or Tribal Or-
ganization. 
‘‘(e) ELIGIBILITY FOR FUNDS.—Tribal Health Pro-
grams shall be eligible for funds appropriated under the 
authority of this section on an equal basis with programs 
that are administered directly by the Service. 
‘‘(f) REPORT.—By no later than the date that is 3 
years after the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2009, the Sec-
retary shall submit to Congress the current health status 
and resource deficiency report of the Service for each 
Service Unit, including newly recognized or acknowledged 
Indian Tribes. Such report shall set out— 
‘‘(1) the methodology then in use by the Service 
for determining Tribal health status and resource 
deficiencies, as well as the most recent application of 
that methodology; 
‘‘(2) the extent of the health status and re-
source deficiency of each Indian Tribe served by the 
Service or a Tribal Health Program; 
‘‘(3) the amount of funds necessary to eliminate 
the health status and resource deficiencies of all In-
1754 
dian Tribes served by the Service or a Tribal Health 
Program; and 
‘‘(4) an estimate of— 
‘‘(A) the amount of health service funds 
appropriated under the authority of this Act, or 
any other Act, including the amount of any 
funds transferred to the Service for the pre-
ceding fiscal year which is allocated to each 
Service Unit, Indian Tribe, or Tribal Organiza-
tion; 
‘‘(B) the number of Indians eligible for 
health services in each Service Unit or Indian 
Tribe or Tribal Organization; and 
‘‘(C) the number of Indians using the 
Service resources made available to each Service 
Unit, Indian Tribe or Tribal Organization, and, 
to the extent available, information on the wait-
ing lists and number of Indians turned away for 
services due to lack of resources. 
‘‘(g) INCLUSION IN BASE BUDGET.—Funds appro-
priated under this section for any fiscal year shall be in-
cluded in the base budget of the Service for the purpose 
of determining appropriations under this section in subse-
quent fiscal years.
1755 
‘‘(h) CLARIFICATION.—Nothing in this section is in-
tended to diminish the primary responsibility of the Serv-
ice to eliminate existing backlogs in unmet health care 
needs, nor are the provisions of this section intended to 
discourage the Service from undertaking additional efforts 
to achieve equity among Indian Tribes and Tribal Organi-
zations. 
‘‘(i) FUNDING DESIGNATION.—Any funds appro-
priated under the authority of this section shall be des-
ignated as the ‘Indian Health Care Improvement Fund’. 
‘‘SEC. 202. HEALTH PROMOTION AND DISEASE PREVENTION 
SERVICES. 
‘‘(a) FINDINGS.—Congress finds that health pro-
motion and disease prevention activities— 
‘‘(1) improve the health and well-being of Indi-
ans; and 
‘‘(2) reduce the expenses for health care of In-
dians. 
‘‘(b) PROVISION OF SERVICES.—The Secretary, act-
ing through the Service, shall provide health promotion 
and disease prevention services to Indians to achieve the 
health status objectives set forth in section 3(2). 
‘‘(c) EVALUATION.—The Secretary, after obtaining 
input from the affected Tribal Health Programs, shall 
submit to the President for inclusion in the report which
1756 
is required to be submitted to Congress under section 801 
an evaluation of— 
‘‘(1) the health promotion and disease preven-
tion needs of Indians; 
‘‘(2) the health promotion and disease preven-
tion activities which would best meet such needs; 
‘‘(3) the internal capacity of the Service and 
Tribal Health Programs to meet such needs; and 
‘‘(4) the resources which would be required to 
enable the Service and Tribal Health Programs to 
undertake the health promotion and disease preven-
tion activities necessary to meet such needs. 
‘‘SEC. 203. DIABETES PREVENTION, TREATMENT, AND CON-
TROL. 
‘‘(a) DETERMINATIONS REGARDING DIABETES.— 
The Secretary, acting through the Service, and in con-
sultation with Indian Tribes and Tribal Organizations, 
shall determine— 
‘‘(1) by Indian Tribe and by Service Unit, the 
incidence of, and the types of complications resulting 
from, diabetes among Indians; and 
‘‘(2) based on the determinations made pursu-
ant to paragraph (1), the measures (including pa-
tient education and effective ongoing monitoring of 
disease indicators) each Service Unit should take to
1757 
reduce the incidence of, and prevent, treat, and con-
trol the complications resulting from, diabetes 
among Indian Tribes within that Service Unit. 
‘‘(b) DIABETES SCREENING.—To the extent medi-
cally indicated and with informed consent, the Secretary 
shall screen each Indian who receives services from the 
Service for diabetes and for conditions which indicate a 
high risk that the individual will become diabetic and es-
tablish a cost-effective approach to ensure ongoing moni-
toring of disease indicators. Such screening and moni-
toring may be conducted by a Tribal Health Program and 
may be conducted through appropriate Internet-based 
health care management programs. 
‘‘(c) DIABETES PROJECTS.—The Secretary shall con-
tinue to maintain each model diabetes project in existence 
on the date of enactment of the Indian Health Care Im-
provement Act Amendments of 2009. 
‘‘(d) DIALYSIS PROGRAMS.—The Secretary is author-
ized to provide, through the Service, Indian Tribes, and 
Tribal Organizations, dialysis programs, including the 
purchase of dialysis equipment and the provision of nec-
essary staffing. 
‘‘(e) OTHER DUTIES OF THE SECRETARY.— 
‘‘(1) IN GENERAL.—The Secretary shall, to the 
extent funding is available—
1758 
‘‘(A) in each Area Office, consult with In-
dian Tribes and Tribal Organizations regarding 
programs for the prevention, treatment, and 
control of diabetes; 
‘‘(B) establish in each Area Office a reg-
istry of patients with diabetes to track the inci-
dence of diabetes and the complications from 
diabetes in that area; and 
‘‘(C) ensure that data collected in each 
Area Office regarding diabetes and related com-
plications among Indians are disseminated to 
all other Area Offices, subject to applicable pa-
tient privacy laws. 
‘‘(2) DIABETES CONTROL OFFICERS.— 
‘‘(A) IN GENERAL.—The Secretary may es-
tablish and maintain in each Area Office a posi-
tion of diabetes control officer to coordinate and 
manage any activity of that Area Office relating 
to the prevention, treatment, or control of dia-
betes to assist the Secretary in carrying out a 
program under this section or section 330C of 
the Public Health Service Act (42 U.S.C. 254c– 
3). 
‘‘(B) CERTAIN
ACTIVITIES.—Any activity 
carried out by a diabetes control officer under
1759 
subparagraph (A) that is the subject of a con-
tract or compact under the Indian Self-Deter-
mination and Education Assistance Act (25 
U.S.C. 450 et seq.), and any funds made avail-
able to carry out such an activity, shall not be 
divisible for purposes of that Act. 
‘‘SEC. 204. SHARED SERVICES FOR LONG-TERM CARE. 
‘‘(a) LONG-TERM CARE.—Notwithstanding any other 
provision of law, the Secretary, acting through the Service, 
is authorized to provide directly, or enter into contracts 
or compacts under the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.) with 
Indian Tribes or Tribal Organizations for, the delivery of 
long-term care (including health care services associated 
with long-term care) provided in a facility to Indians. Such 
agreements shall provide for the sharing of staff or other 
services between the Service or a Tribal Health Program 
and a long-term care or related facility owned and oper-
ated (directly or through a contract or compact under the 
Indian Self-Determination and Education Assistance Act 
(25 U.S.C. 450 et seq.)) by such Indian Tribe or Tribal 
Organization. 
‘‘(b) CONTENTS OF AGREEMENTS.—An agreement 
entered into pursuant to subsection (a)—
1760 
‘‘(1) may, at the request of the Indian Tribe or 
Tribal Organization, delegate to such Indian Tribe 
or Tribal Organization such powers of supervision 
and control over Service employees as the Secretary 
deems necessary to carry out the purposes of this 
section; 
‘‘(2) shall provide that expenses (including sala-
ries) relating to services that are shared between the 
Service and the Tribal Health Program be allocated 
proportionately between the Service and the Indian 
Tribe or Tribal Organization; and 
‘‘(3) may authorize such Indian Tribe or Tribal 
Organization to construct, renovate, or expand a 
long-term care or other similar facility (including the 
construction of a facility attached to a Service facil-
ity). 
‘‘(c) MINIMUM REQUIREMENT.—Any nursing facility 
provided for under this section shall meet the require-
ments for nursing facilities under section 1919 of the So-
cial Security Act. 
‘‘(d) OTHER ASSISTANCE.—The Secretary shall pro-
vide such technical and other assistance as may be nec-
essary to enable applicants to comply with the provisions 
of this section.
1761 
‘‘(e) USE
OF EXISTING
OR UNDERUSED FACILI-
TIES.—The Secretary shall encourage the use of existing 
facilities that are underused or allow the use of swing beds 
for long-term or similar care. 
‘‘SEC. 205. HEALTH SERVICES RESEARCH. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Service, shall make funding available for research to 
further the performance of the health service responsibil-
ities of Indian Health Programs. 
‘‘(b) COORDINATION OF RESOURCES AND ACTIVI-
TIES.—The Secretary shall also, to the maximum extent 
practicable, coordinate departmental research resources 
and activities to address relevant Indian Health Program 
research needs. 
‘‘(c) AVAILABILITY.—Tribal Health Programs shall 
be given an equal opportunity to compete for, and receive, 
research funds under this section. 
‘‘(d) USE OF FUNDS.—This funding may be used for 
both clinical and nonclinical research. 
‘‘(e) EVALUATION AND DISSEMINATION.—The Sec-
retary shall periodically— 
‘‘(1) evaluate the impact of research conducted 
under this section; and
1762 
‘‘(2) disseminate to Tribal Health Programs in-
formation regarding that research as the Secretary 
determines to be appropriate. 
‘‘SEC. 206. MAMMOGRAPHY AND OTHER CANCER SCREEN-
ING. 
‘‘The Secretary, acting through the Service, shall pro-
vide for screening as follows: 
‘‘(1) Screening mammography (as defined in 
section 1861(jj) of the Social Security Act) for In-
dian women at a frequency appropriate to such 
women under accepted and appropriate national 
standards, and under such terms and conditions as 
are consistent with standards established by the Sec-
retary to ensure the safety and accuracy of screen-
ing mammography under part B of title XVIII of 
such Act. 
‘‘(2) Other cancer screening that receives an A 
or B rating as recommended by the United States 
Preventive Services Task Force established under 
section 915(a)(1) of the Public Health Service Act 
(42 U.S.C. 299b–4(a)(1)). The Secretary shall en-
sure that screening provided for under this para-
graph complies with the recommendations of the 
Task Force with respect to— 
‘‘(A) frequency;
1763 
‘‘(B) the population to be served; 
‘‘(C) the procedure or technology to be 
used; 
‘‘(D) evidence of effectiveness; and 
‘‘(E) other matters that the Secretary de-
termines appropriate. 
‘‘SEC. 207. PATIENT TRAVEL COSTS. 
‘‘(a) DEFINITION OF QUALIFIED ESCORT.—In this 
section, the term ‘qualified escort’ means— 
‘‘(1) an adult escort (including a parent, guard-
ian, or other family member) who is required be-
cause of the physical or mental condition, or age, of 
the applicable patient; 
‘‘(2) a health professional for the purpose of 
providing necessary medical care during travel by 
the applicable patient; or 
‘‘(3) other escorts, as the Secretary or applica-
ble Indian Health Program determines to be appro-
priate. 
‘‘(b) PROVISION OF FUNDS.—The Secretary, acting 
through the Service, is authorized to provide funds for the 
following patient travel costs, including qualified escorts, 
associated with receiving health care services provided (ei-
ther through direct or contract care or through a contract 
or compact under the Indian Self-Determination and Edu-
1764 
cation Assistance Act (25 U.S.C. 450 et seq.)) under this 
Act— 
‘‘(1) emergency air transportation and non- 
emergency air transportation where ground trans-
portation is infeasible; 
‘‘(2) transportation by private vehicle (where no 
other means of transportation is available), specially 
equipped vehicle, and ambulance; and 
‘‘(3) transportation by such other means as 
may be available and required when air or motor ve-
hicle transportation is not available. 
‘‘SEC. 208. EPIDEMIOLOGY CENTERS. 
‘‘(a) ESTABLISHMENT OF CENTERS.—The Secretary 
shall establish an epidemiology center in each Service Area 
to carry out the functions described in subsection (b). Any 
new center established after the date of enactment of the 
Indian Health Care Improvement Act Amendments of 
2008 may be operated under a grant authorized by sub-
section (d), but funding under such a grant shall not be 
divisible. 
‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 
and upon the request of Indian Tribes, Tribal Organiza-
tions, and Urban Indian communities, each Service Area 
epidemiology center established under this section shall, 
with respect to such Service Area—
1765 
‘‘(1) collect data relating to, and monitor 
progress made toward meeting, each of the health 
status objectives of the Service, the Indian Tribes, 
Tribal Organizations, and Urban Indian commu-
nities in the Service Area; 
‘‘(2) evaluate existing delivery systems, data 
systems, and other systems that impact the improve-
ment of Indian health; 
‘‘(3) assist Indian Tribes, Tribal Organizations, 
and Urban Indian Organizations in identifying their 
highest priority health status objectives and the 
services needed to achieve such objectives, based on 
epidemiological data; 
‘‘(4) make recommendations for the targeting 
of services needed by the populations served; 
‘‘(5) make recommendations to improve health 
care delivery systems for Indians and Urban Indi-
ans; 
‘‘(6) provide requested technical assistance to 
Indian Tribes, Tribal Organizations, and Urban In-
dian Organizations in the development of local 
health service priorities and incidence and prevalence 
rates of disease and other illness in the community; 
and
1766 
‘‘(7) provide disease surveillance and assist In-
dian Tribes, Tribal Organizations, and Urban Indian 
communities to promote public health. 
‘‘(c) TECHNICAL ASSISTANCE.—The Director of the 
Centers for Disease Control and Prevention shall provide 
technical assistance to the centers in carrying out the re-
quirements of this section. 
‘‘(d) GRANTS FOR STUDIES.— 
‘‘(1) IN GENERAL.—The Secretary may make 
grants to Indian Tribes, Tribal Organizations, In-
dian organizations, and eligible intertribal consortia 
to conduct epidemiological studies of Indian commu-
nities. 
‘‘(2) ELIGIBLE INTERTRIBAL CONSORTIA.—An 
intertribal consortium or Indian organization is eligi-
ble to receive a grant under this subsection if— 
‘‘(A) the intertribal consortium is incor-
porated for the primary purpose of improving 
Indian health; and 
‘‘(B) the intertribal consortium is rep-
resentative of the Indian Tribes or urban In-
dian communities in which the intertribal con-
sortium is located. 
‘‘(3) APPLICATIONS.—An application for a 
grant under this subsection shall be submitted in
1768 
tion regarding ways to improve the health sta-
tus of Indians. 
‘‘(e) ACCESS TO INFORMATION.— 
‘‘(1) An epidemiology center operated by a 
grantee pursuant to a grant awarded under sub-
section (d) shall be treated as a public health au-
thority for purposes of the Health Insurance Port-
ability and Accountability Act of 1996, as such enti-
ties are defined in part 164.501 of title 45, Code of 
Federal Regulations. 
‘‘(2) The Secretary shall grant to such epidemi-
ology center access to use of the data, data sets, 
monitoring systems, delivery systems, and other pro-
tected health information in the possession of the 
Secretary. 
‘‘(3) The activities of such an epidemiology cen-
ter shall be for the purposes of research and for pre-
venting and controlling disease, injury, or disability 
for purposes of the Health Insurance Portability and 
Accountability Act of 1996 (Public Law 104–191; 
110 Stat. 2033), as such activities are described in 
part 164.512 of title 45, Code of Federal Regula-
tions (or a successor regulation). 
‘‘(f) FUNDS NOT DIVISIBLE.—An epidemiology cen-
ter established under this section shall be subject to the
1769 
provisions of the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.), but the 
funds for such center shall not be divisible. 
‘‘SEC. 209. COMPREHENSIVE SCHOOL HEALTH EDUCATION 
PROGRAMS. 
‘‘(a) FUNDING FOR DEVELOPMENT OF PROGRAMS.— 
In addition to carrying out any other program for health 
promotion or disease prevention, the Secretary, acting 
through the Service, is authorized to award grants to In-
dian Tribes and Tribal Organizations to develop com-
prehensive school health education programs for children 
from pre-school through grade 12 in schools for the benefit 
of Indian children. 
‘‘(b) USE
OF GRANT FUNDS.—A grant awarded 
under this section may be used for purposes which may 
include, but are not limited to, the following: 
‘‘(1) Developing health education materials both 
for regular school programs and afterschool pro-
grams. 
‘‘(2) Training teachers in comprehensive school 
health education materials. 
‘‘(3) 
Integrating 
school-based, 
community- 
based, and other public and private health promotion 
efforts.
1770 
‘‘(4) Encouraging healthy, tobacco-free school 
environments. 
‘‘(5) Coordinating school-based health programs 
with existing services and programs available in the 
community. 
‘‘(6) Developing school programs on nutrition 
education, personal health, oral health, and fitness. 
‘‘(7) Developing behavioral health wellness pro-
grams. 
‘‘(8) Developing chronic disease prevention pro-
grams. 
‘‘(9) Developing substance abuse prevention 
programs. 
‘‘(10) Developing injury prevention and safety 
education programs. 
‘‘(11) Developing activities for the prevention 
and control of communicable diseases. 
‘‘(12) Developing community and environmental 
health education programs that include traditional 
health care practitioners. 
‘‘(13) Violence prevention. 
‘‘(14) Such other health issues as are appro-
priate. 
‘‘(c) TECHNICAL ASSISTANCE.—Upon request, the 
Secretary, acting through the Service, shall provide tech-
1771 
nical assistance to Indian Tribes and Tribal Organizations 
in the development of comprehensive health education 
plans and the dissemination of comprehensive health edu-
cation materials and information on existing health pro-
grams and resources. 
‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP-
PLICATIONS.—The Secretary, acting through the Service, 
and in consultation with Indian Tribes and Tribal Organi-
zations, shall establish criteria for the review and approval 
of applications for grants awarded under this section. 
‘‘(e) DEVELOPMENT OF PROGRAM FOR BIA-FUNDED 
SCHOOLS.— 
‘‘(1) IN GENERAL.—The Secretary of the Inte-
rior, acting through the Bureau of Indian Affairs 
and in cooperation with the Secretary, acting 
through the Service, shall develop a comprehensive 
school health education program for children from 
preschool through grade 12 in schools for which sup-
port is provided by the Bureau of Indian Affairs. 
‘‘(2) REQUIREMENTS
FOR
PROGRAMS.—Such 
programs shall include— 
‘‘(A) school programs on nutrition edu-
cation, personal health, oral health, and fitness; 
‘‘(B) behavioral health wellness programs; 
‘‘(C) chronic disease prevention programs;
1772 
‘‘(D) substance abuse prevention pro-
grams; 
‘‘(E) injury prevention and safety edu-
cation programs; and 
‘‘(F) activities for the prevention and con-
trol of communicable diseases. 
‘‘(3) DUTIES OF THE SECRETARY.—The Sec-
retary of the Interior shall— 
‘‘(A) provide training to teachers in com-
prehensive school health education materials; 
‘‘(B) ensure the integration and coordina-
tion of school-based programs with existing 
services and health programs available in the 
community; and 
‘‘(C) encourage healthy, tobacco-free school 
environments. 
‘‘SEC. 210. INDIAN YOUTH PROGRAM. 
‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 
through the Service, is authorized to establish and admin-
ister a program to provide grants to Indian Tribes, Tribal 
Organizations, and urban Indian organizations for innova-
tive mental and physical disease prevention and health 
promotion and treatment programs for Indian and urban 
Indian preadolescent and adolescent youths. 
‘‘(b) USE OF FUNDS.—
1773 
‘‘(1) ALLOWABLE USES.—Funds made available 
under this section may be used to— 
‘‘(A) develop prevention and treatment 
programs for Indian youth which promote men-
tal and physical health and incorporate cultural 
values, community and family involvement, and 
traditional health care practitioners; and 
‘‘(B) develop and provide community train-
ing and education. 
‘‘(2) PROHIBITED USE.—Funds made available 
under this section may not be used to provide serv-
ices described in section 707(c). 
‘‘(c) DUTIES OF THE SECRETARY.—The Secretary 
shall— 
‘‘(1) disseminate to Indian Tribes, Tribal Orga-
nizations, and urban Indian organizations informa-
tion regarding models for the delivery of comprehen-
sive health care services to Indian and urban Indian 
adolescents; 
‘‘(2) encourage the implementation of such 
models; and 
‘‘(3) at the request of an Indian Tribe, Tribal 
Organization, or urban Indian organization, provide 
technical assistance in the implementation of such 
models.