301 
‘‘(9) SYSTEMS OF CARE.—The term ‘Systems of 
Care’ means a system for delivering services to chil-
dren and their families that is child-centered, family- 
focused and family-driven, community-based, and 
culturally competent and responsive to the needs of 
the children and families being served. The systems 
of care approach values prevention and early identi-
fication, smooth transitions for children and fami-
lies, child and family participation and advocacy, 
comprehensive array of services, individualized serv-
ice planning, services in the least restrictive environ-
ment, and integrated services with coordinated plan-
ning across the child-serving systems. 
‘‘SEC. 717. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There is authorized to be appropriated such sums 
as may be necessary for each fiscal year through fiscal 
year 2025 to carry out the provisions of this title. 
‘‘TITLE VIII—MISCELLANEOUS 
‘‘SEC. 801. REPORTS. 
‘‘For each fiscal year following the date of enactment 
of the Indian Health Care Improvement Act Amendments 
of 2009, the Secretary shall transmit to Congress a report 
containing the following: 
‘‘(1) A report on the progress made in meeting 
the objectives of this Act, including a review of pro-
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grams established or assisted pursuant to this Act 
and assessments and recommendations of additional 
programs or additional assistance necessary to, at a 
minimum, provide health services to Indians and en-
sure a health status for Indians, which are at a par-
ity with the health services available to and the 
health status of the general population. 
‘‘(2) A report on whether, and to what extent, 
new national health care programs, benefits, initia-
tives, or financing systems have had an impact on 
the purposes of this Act and any steps that the Sec-
retary may have taken to consult with Indian Tribes, 
Tribal Organizations, and urban Indian organiza-
tions to address such impact, including a report on 
proposed changes in allocation of funding pursuant 
to section 807. 
‘‘(3) A report on the use of health services by 
Indians— 
‘‘(A) on a national and area or other rel-
evant geographical basis; 
‘‘(B) by gender and age; 
‘‘(C) by source of payment and type of 
service; 
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‘‘(D) comparing such rates of use with 
rates of use among comparable non-Indian pop-
ulations; and 
‘‘(E) provided under contracts. 
‘‘(4) A report of contractors to the Secretary on 
Health Care Educational Loan Repayments every 6 
months required by section 110. 
‘‘(5) A general audit report of the Secretary on 
the Health Care Educational Loan Repayment Pro-
gram as required by section 110(m). 
‘‘(6) A report of the findings and conclusions of 
demonstration programs on development of edu-
cational curricula for substance abuse counseling as 
required in section 125(f). 
‘‘(7) A separate statement which specifies the 
amount of funds requested to carry out the provi-
sions of section 201. 
‘‘(8) A report of the evaluations of health pro-
motion and disease prevention as required in section 
203(c). 
‘‘(9) A biennial report to Congress on infectious 
diseases as required by section 212. 
‘‘(10) A report on environmental and nuclear 
health hazards as required by section 215. 
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‘‘(11) An annual report on the status of all 
health care facilities needs as required by section 
301(c)(2)(B) and 301(d). 
‘‘(12) Reports on safe water and sanitary waste 
disposal facilities as required by section 302(h). 
‘‘(13) An annual report on the expenditure of 
non-Service funds for renovation as required by sec-
tions 304(b)(2). 
‘‘(14) A report identifying the backlog of main-
tenance and repair required at Service and tribal fa-
cilities required by section 313(a). 
‘‘(15) A report providing an accounting of reim-
bursement funds made available to the Secretary 
under titles XVIII, XIX, and XXI of the Social Se-
curity Act. 
‘‘(16) A report on any arrangements for the 
sharing of medical facilities or services, as author-
ized by section 406. 
‘‘(17) A report on evaluation and renewal of 
urban Indian programs under section 505. 
‘‘(18) A report on the evaluation of programs 
as required by section 513(d). 
‘‘(19) A report on alcohol and substance abuse 
as required by section 701(f). 
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‘‘(20) A report on Indian youth mental health 
services as required by section 707(h). 
‘‘(21) A report on the reallocation of base re-
sources if required by section 807. 
‘‘(22) A report on the movement of patients be-
tween Service Units, including— 
‘‘(A) a list of those Service Units that have 
a net increase and those that have a net de-
crease of patients due to patients assigned to 
one Service Unit voluntarily choosing to receive 
service at another Service Unit; 
‘‘(B) an analysis of the effect of patient 
movement on the quality of services for those 
Service Units experiencing an increase in the 
number of patients served; and 
‘‘(C) what funding changes are necessary 
to maintain a consistent quality of service at 
Service Units that have an increase in the num-
ber of patients served. 
‘‘(23) A report on the extent to which health 
care facilities of the Service, Indian Tribes, Tribal 
Organizations, and urban Indian organizations com-
ply with credentialing requirements of the Service or 
licensure requirements of States. 
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306 
‘‘SEC. 802. REGULATIONS. 
‘‘(a) DEADLINES.— 
‘‘(1) PROCEDURES.—Not later than 90 days 
after the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2009, the 
Secretary shall initiate procedures under subchapter 
III of chapter 5 of title 5, United States Code, to 
negotiate and promulgate such regulations or 
amendments thereto that are necessary to carry out 
this Act, except sections 105, 115, 117, 202, and 
409 through 416. The Secretary may promulgate 
regulations to carry out such sections using the pro-
cedures required by chapter 5 of title 5, United 
States Code (commonly known as the ‘Administra-
tive Procedure Act’). 
‘‘(2) PROPOSED REGULATIONS.—Proposed reg-
ulations to implement this Act shall be published in 
the Federal Register by the Secretary no later than 
2 years after the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2009 
and shall have no less than a 120-day comment pe-
riod. 
‘‘(3) FINAL
REGULATIONS.—The Secretary 
shall publish in the Federal Register final regula-
tions to implement this Act by not later than 3 years 
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308 
this Act. This consultation may be conducted jointly with 
the annual budget consultation pursuant to the Indian 
Self-Determination and Education Assistance Act (25 
U.S.C. 450 et seq.). 
‘‘(b) LACK OF PLAN.—The lack of (or failure to sub-
mit) such a plan shall not limit the effect, or prevent the 
implementation, of this Act. 
‘‘SEC. 804. LIMITATION ON USE OF FUNDS APPROPRIATED 
TO INDIAN HEALTH SERVICE. 
‘‘Any limitation on the use of funds contained in an 
Act providing appropriations for the Department for a pe-
riod with respect to the performance of abortions shall 
apply for that period with respect to the performance of 
abortions using funds contained in an Act providing ap-
propriations for the Service. 
‘‘SEC. 805. ELIGIBILITY OF CALIFORNIA INDIANS. 
‘‘(a) IN GENERAL.—The following California Indians 
shall be eligible for health services provided by the Service: 
‘‘(1) Any member of a federally recognized In-
dian Tribe. 
‘‘(2) Any descendant of an Indian who was re-
siding in California on June 1, 1852, if such de-
scendant— 
‘‘(A) is a member of the Indian community 
served by a local program of the Service; and 
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309 
‘‘(B) is regarded as an Indian by the com-
munity in which such descendant lives. 
‘‘(3) Any Indian who holds trust interests in 
public domain, national forest, or reservation allot-
ments in California. 
‘‘(4) Any Indian in California who is listed on 
the plans for distribution of the assets of rancherias 
and reservations located within the State of Cali-
fornia under the Act of August 18, 1958 (72 Stat. 
619), and any descendant of such an Indian. 
‘‘(b) CLARIFICATION.—Nothing in this section may 
be construed as expanding the eligibility of California Indi-
ans for health services provided by the Service beyond the 
scope of eligibility for such health services that applied on 
May 1, 1986. 
‘‘SEC. 806. HEALTH SERVICES FOR INELIGIBLE PERSONS. 
‘‘(a) CHILDREN.—Any individual who— 
‘‘(1) has not attained 19 years of age; 
‘‘(2) is the natural or adopted child, stepchild, 
foster child, legal ward, or orphan of an eligible In-
dian; and 
‘‘(3) is not otherwise eligible for health services 
provided by the Service, 
shall be eligible for all health services provided by the 
Service on the same basis and subject to the same rules 
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310 
that apply to eligible Indians until such individual attains 
19 years of age. The existing and potential health needs 
of all such individuals shall be taken into consideration 
by the Service in determining the need for, or the alloca-
tion of, the health resources of the Service. If such an indi-
vidual has been determined to be legally incompetent prior 
to attaining 19 years of age, such individual shall remain 
eligible for such services until 1 year after the date of a 
determination of competency. 
‘‘(b) SPOUSES.—Any spouse of an eligible Indian who 
is not an Indian, or who is of Indian descent but is not 
otherwise eligible for the health services provided by the 
Service, shall be eligible for such health services if all such 
spouses or spouses who are married to members of each 
Indian Tribe being served are made eligible, as a class, 
by an appropriate resolution of the governing body of the 
Indian Tribe or Tribal Organization providing such serv-
ices. The health needs of persons made eligible under this 
paragraph shall not be taken into consideration by the 
Service in determining the need for, or allocation of, its 
health resources. 
‘‘(c) PROVISION OF SERVICES TO OTHER INDIVID-
UALS.— 
‘‘(1) IN GENERAL.—The Secretary is authorized 
to provide health services under this subsection 
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through health programs operated directly by the 
Service to individuals who reside within the Service 
area of the Service Unit and who are not otherwise 
eligible for such health services if— 
‘‘(A) the Indian Tribes served by such 
Service Unit request such provision of health 
services to such individuals; and 
‘‘(B) the Secretary and the served Indian 
Tribes have jointly determined that— 
‘‘(i) the provision of such health serv-
ices will not result in a denial or diminu-
tion of health services to eligible Indians; 
and 
‘‘(ii) there is no reasonable alternative 
health facilities or services, within or with-
out the Service Unit, available to meet the 
health needs of such individuals. 
‘‘(2) ISDEAA PROGRAMS.—In the case of 
health programs and facilities operated under a con-
tract or compact entered into under the Indian Self- 
Determination and Education Assistance Act (25 
U.S.C. 450 et seq.), the governing body of the In-
dian Tribe or Tribal Organization providing health 
services under such contract or compact is author-
ized to determine whether health services should be 
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provided under such contract to individuals who are 
not eligible for such health services under any other 
subsection of this section or under any other provi-
sion of law. In making such determinations, the gov-
erning body of the Indian Tribe or Tribal Organiza-
tion shall take into account the considerations de-
scribed in paragraph (1)(B). 
‘‘(3) PAYMENT FOR SERVICES.— 
‘‘(A) IN
GENERAL.—Persons receiving 
health services provided by the Service under 
this subsection shall be liable for payment of 
such health services under a schedule of charges 
prescribed by the Secretary which, in the judg-
ment of the Secretary, results in reimbursement 
in an amount not less than the actual cost of 
providing the health services. Notwithstanding 
section 404 of this Act or any other provision 
of law, amounts collected under this subsection, 
including Medicare, Medicaid, or SCHIP reim-
bursements under titles XVIII, XIX, and XXI 
of the Social Security Act, shall be credited to 
the account of the program providing the serv-
ice and shall be used for the purposes listed in 
section 401(d)(2) and amounts collected under 
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313 
this subsection shall be available for expendi-
ture within such program. 
‘‘(B) INDIGENT PEOPLE.—Health services 
may be provided by the Secretary through the 
Service under this subsection to an indigent in-
dividual who would not be otherwise eligible for 
such health services but for the provisions of 
paragraph (1) only if an agreement has been 
entered into with a State or local government 
under which the State or local government 
agrees to reimburse the Service for the expenses 
incurred by the Service in providing such health 
services to such indigent individual. 
‘‘(4) REVOCATION
OF
CONSENT
FOR
SERV-
ICES.— 
‘‘(A) SINGLE
TRIBE
SERVICE
AREA.—In 
the case of a Service Area which serves only 1 
Indian Tribe, the authority of the Secretary to 
provide health services under paragraph (1) 
shall terminate at the end of the fiscal year suc-
ceeding the fiscal year in which the governing 
body of the Indian Tribe revokes its concur-
rence to the provision of such health services. 
‘‘(B) MULTITRIBAL
SERVICE
AREA.—In 
the case of a multitribal Service Area, the au-
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314 
thority of the Secretary to provide health serv-
ices under paragraph (1) shall terminate at the 
end of the fiscal year succeeding the fiscal year 
in which at least 51 percent of the number of 
Indian Tribes in the Service Area revoke their 
concurrence to the provisions of such health 
services. 
‘‘(d) OTHER SERVICES.—The Service may provide 
health services under this subsection to individuals who 
are not eligible for health services provided by the Service 
under any other provision of law in order to— 
‘‘(1) achieve stability in a medical emergency; 
‘‘(2) prevent the spread of a communicable dis-
ease or otherwise deal with a public health hazard; 
‘‘(3) provide care to non-Indian women preg-
nant with an eligible Indian’s child for the duration 
of the pregnancy through postpartum; or 
‘‘(4) provide care to immediate family members 
of an eligible individual if such care is directly re-
lated to the treatment of the eligible individual. 
‘‘(e) HOSPITAL PRIVILEGES FOR PRACTITIONERS.— 
‘‘(1) IN
GENERAL.—Hospital privileges in 
health facilities operated and maintained by the 
Service or operated under a contract or compact 
pursuant to the Indian Self-Determination and Edu-
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315 
cation Assistance Act (25 U.S.C. 450 et seq.) may 
be extended to non-Service health care practitioners 
who provide services to individuals described in sub-
section (a), (b), (c), or (d). Such non-Service health 
care practitioners may, as part of the privileging 
process, be designated as employees of the Federal 
Government for purposes of section 1346(b) and 
chapter 171 of title 28, United States Code (relating 
to Federal tort claims) only with respect to acts or 
omissions which occur in the course of providing 
services to eligible individuals as a part of the condi-
tions under which such hospital privileges are ex-
tended. 
‘‘(2) DEFINITION.—For purposes of this sub-
section, the term ‘non-Service health care practi-
tioner’ means a practitioner who is not— 
‘‘(A) an employee of the Service; or 
‘‘(B) an employee of an Indian tribe or 
tribal organization operating a contract or com-
pact under the Indian Self-Determination and 
Education Assistance Act or an individual who 
provides health care services pursuant to a per-
sonal services contract with such Indian tribe or 
tribal organization. 
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316 
‘‘(f) ELIGIBLE INDIAN.—For purposes of this sec-
tion, the term ‘eligible Indian’ means any Indian who is 
eligible for health services provided by the Service without 
regard to the provisions of this section. 
‘‘SEC. 807. TREATMENT OF CERTAIN SERVICES AND BENE-
FITS. 
‘‘(a) Gross income does not include (1) health services 
or benefits provided or purchased by the Indian Health 
Service, either directly or indirectly, through a grant to 
or a contract or compact with an Indian tribe or tribal 
organization, or grants to or other programs of third par-
ties funded by the Indian Health Service; (2) health serv-
ices, health benefits or other amounts for health care serv-
ices, including preventive care and treatment of personal 
injuries or sickness and other health conditions, provided 
by an Indian tribe or tribal organization to an Indian ei-
ther directly, through purchased services, or through acci-
dent or health insurance (or through an arrangement hav-
ing the effect of accident or health insurance); (3) the 
value of health coverage provided or premiums paid by an 
Indian tribe or tribal organization to or on behalf of an 
Indian under an accident or health plan (or through an 
arrangement having the effect of accident or health insur-
ance); or (4) any other benefit or service provided by an 
Indian tribe that supplements the programs and services 
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provided by the Federal government to Indian tribes or 
Indians, or other general welfare benefits or services pro-
vided by Indian tribes to Indians. 
‘‘(b) DEFINITIONS.—For the purposes of this section: 
‘‘(1) The terms ‘accident or health insurance’ 
and ‘personal injuries and sickness’ have the mean-
ing given those terms in section 104 of the Internal 
Revenue Code of 1986. 
‘‘(2) The term ‘Indian tribe’ has the meaning 
given that term in section 4(e) of the Indian Self- 
Determination and Education Assistance Act (25 
U.S.C. 450b(e)). 
‘‘(3) The term ‘Indians’ and ‘Indian’ means any 
person who— 
‘‘(A) is a member of an Indian tribe, as 
defined in paragraph (2); and 
‘‘(B)(i) irrespective of whether the indi-
vidual lives on or near a reservation, is a mem-
ber of a tribe, band, or other organized group 
of Indians, including those tribes, bands, or 
groups terminated since 1940 and those recog-
nized by the State in which they reside; 
‘‘(ii) is a descendant, in the first or second 
degree, of any such member; 
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318 
‘‘(iii) is an Eskimo or Aleut or other Alas-
ka Native; 
‘‘(iv) is otherwise eligible for services pro-
vided or funded by the Indian Health Service 
under applicable law; or 
‘‘(v) is considered by the Secretary of the 
Interior to be an Indian for any purpose. 
‘‘(4) The term ‘tribal organization’ has the 
meaning given that term in section 4(l) of the In-
dian Self-Determination and Education Assistance 
Act (25 U.S.C. 450b(l)). 
‘‘(c) NO INFERENCE.—Nothing in this section is in-
tended as an inference to the tax treatment of govern-
mental benefits (including health care benefits not covered 
under this section) provided by Indian tribes to Indians 
after the date of the enactment of this section. 
‘‘SEC. 808. REALLOCATION OF BASE RESOURCES. 
‘‘(a) REPORT
REQUIRED.—Notwithstanding any 
other provision of law, any allocation of Service funds for 
a fiscal year that reduces by 5 percent or more from the 
previous fiscal year the funding for any recurring pro-
gram, project, or activity of a Service Unit may be imple-
mented only after the Secretary has submitted to Con-
gress, under section 801, a report on the proposed change 
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in allocation of funding, including the reasons for the 
change and its likely effects. 
‘‘(b) EXCEPTION.—Subsection (a) shall not apply if 
the total amount appropriated to the Service for a fiscal 
year is at least 5 percent less than the amount appro-
priated to the Service for the previous fiscal year. 
‘‘SEC. 809. RESULTS OF DEMONSTRATION PROJECTS. 
‘‘The Secretary shall provide for the dissemination to 
Indian Tribes, Tribal Organizations, and urban Indian or-
ganizations of the findings and results of demonstration 
projects conducted under this Act. 
‘‘SEC. 810. PROVISION OF SERVICES IN MONTANA. 
‘‘(a) CONSISTENT WITH COURT DECISION.—The 
Secretary, acting through the Service, shall provide serv-
ices and benefits for Indians in Montana in a manner con-
sistent with the decision of the United States Court of Ap-
peals for the Ninth Circuit in McNabb for McNabb v. 
Bowen, 829 F.2d 787 (9th Cir. 1987). 
‘‘(b) CLARIFICATION.—The provisions of subsection 
(a) shall not be construed to be an expression of the sense 
of Congress on the application of the decision described 
in subsection (a) with respect to the provision of services 
or benefits for Indians living in any State other than Mon-
tana. 
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320 
‘‘SEC. 811. MORATORIUM. 
‘‘During the period of the moratorium imposed on 
implementation of the final rule published in the Federal 
Register on September 16, 1987, by the Department of 
Health and Human Services, relating to eligibility for the 
health care services of the Indian Health Service, the In-
dian Health Service shall provide services pursuant to the 
criteria for eligibility for such services that were in effect 
on September 15, 1987, subject to the provisions of sec-
tions 805 and 806, until the Service has submitted to the 
Committees on Appropriations of the Senate and the 
House of Representatives a budget request reflecting the 
increased costs associated with the proposed final rule, 
and the request has been included in an appropriations 
Act and enacted into law. 
‘‘SEC. 812. SEVERABILITY PROVISIONS. 
‘‘If any provision of this Act, any amendment made 
by the Act, or the application of such provision or amend-
ment to any person or circumstances is held to be invalid, 
the remainder of this Act, the remaining amendments 
made by this Act, and the application of such provisions 
to persons or circumstances other than those to which it 
is held invalid, shall not be affected thereby. 
‘‘SEC. 813. USE OF PATIENT SAFETY ORGANIZATIONS. 
‘‘The Service, an Indian Tribe, Tribal Organization, 
or urban Indian organization may provide for quality as-
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321 
surance activities through the use of a patient safety orga-
nization in accordance with title IX of the Public Health 
Service Act. 
‘‘SEC. 814. CONFIDENTIALITY OF MEDICAL QUALITY ASSUR-
ANCE RECORDS; QUALIFIED IMMUNITY FOR 
PARTICIPANTS. 
‘‘(a) CONFIDENTIALITY OF RECORDS.—Medical qual-
ity assurance records created by or for any Indian Health 
Program or a health program of an Urban Indian Organi-
zation as part of a medical quality assurance program are 
confidential and privileged. Such records may not be dis-
closed to any person or entity, except as provided in sub-
section (c). 
‘‘(b) PROHIBITION
ON DISCLOSURE
AND TESTI-
MONY.— 
‘‘(1) IN
GENERAL.—No part of any medical 
quality assurance record described in subsection (a) 
may be subject to discovery or admitted into evi-
dence in any judicial or administrative proceeding, 
except as provided in subsection (c). 
‘‘(2) TESTIMONY.—A person who reviews or 
creates medical quality assurance records for any In-
dian Health Program or Urban Indian Organization 
who participates in any proceeding that reviews or 
creates such records may not be permitted or re-
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quired to testify in any judicial or administrative 
proceeding with respect to such records or with re-
spect to any finding, recommendation, evaluation, 
opinion, or action taken by such person or body in 
connection with such records except as provided in 
this section. 
‘‘(c) AUTHORIZED DISCLOSURE AND TESTIMONY.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), a 
medical quality assurance record described in sub-
section (a) may be disclosed, and a person referred 
to in subsection (b) may give testimony in connec-
tion with such a record, only as follows: 
‘‘(A) To a Federal executive agency or pri-
vate organization, if such medical quality assur-
ance record or testimony is needed by such 
agency or organization to perform licensing or 
accreditation functions related to any Indian 
Health Program or to a health program of an 
Urban Indian Organization to perform moni-
toring, required by law, of such program or or-
ganization. 
‘‘(B) To an administrative or judicial pro-
ceeding commenced by a present or former In-
dian Health Program or Urban Indian Organi-
zation provider concerning the termination, sus-
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pension, or limitation of clinical privileges of 
such health care provider. 
‘‘(C) To a governmental board or agency 
or to a professional health care society or orga-
nization, if such medical quality assurance 
record or testimony is needed by such board, 
agency, society, or organization to perform li-
censing, credentialing, or the monitoring of pro-
fessional standards with respect to any health 
care provider who is or was an employee of any 
Indian Health Program or Urban Indian Orga-
nization. 
‘‘(D) To a hospital, medical center, or 
other institution that provides health care serv-
ices, if such medical quality assurance record or 
testimony is needed by such institution to as-
sess the professional qualifications of any health 
care provider who is or was an employee of any 
Indian Health Program or Urban Indian Orga-
nization and who has applied for or been grant-
ed authority or employment to provide health 
care services in or on behalf of such program or 
organization. 
‘‘(E) To an officer, employee, or contractor 
of the Indian Health Program or Urban Indian 
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324 
Organization that created the records or for 
which the records were created. If that officer, 
employee, or contractor has a need for such 
record or testimony to perform official duties. 
‘‘(F) To a criminal or civil law enforce-
ment agency or instrumentality charged under 
applicable law with the protection of the public 
health or safety, if a qualified representative of 
such agency or instrumentality makes a written 
request that such record or testimony be pro-
vided for a purpose authorized by law. 
‘‘(G) In an administrative or judicial pro-
ceeding commenced by a criminal or civil law 
enforcement agency or instrumentality referred 
to in subparagraph (F), but only with respect 
to the subject of such proceeding. 
‘‘(2) IDENTITY
OF
PARTICIPANTS.—With the 
exception of the subject of a quality assurance ac-
tion, the identity of any person receiving health care 
services from any Indian Health Program or Urban 
Indian Organization or the identity of any other per-
son associated with such program or organization 
for purposes of a medical quality assurance program 
that is disclosed in a medical quality assurance 
record described in subsection (a) shall be deleted 
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325 
from that record or document before any disclosure 
of such record is made outside such program or or-
ganization. 
‘‘(d) DISCLOSURE FOR CERTAIN PURPOSES.— 
‘‘(1) IN
GENERAL.—Nothing in this section 
shall be construed as authorizing or requiring the 
withholding from any person or entity aggregate sta-
tistical information regarding the results of any In-
dian 
Health 
Program 
or 
Urban 
Indian 
Organizations’s medical quality assurance programs. 
‘‘(2) WITHHOLDING
FROM
CONGRESS.—Noth-
ing in this section shall be construed as authority to 
withhold any medical quality assurance record from 
a committee of either House of Congress, any joint 
committee of Congress, or the Government Account-
ability Office if such record pertains to any matter 
within their respective jurisdictions. 
‘‘(e) PROHIBITION ON DISCLOSURE OF RECORD OR 
TESTIMONY.—A person or entity having possession of or 
access to a record or testimony described by this section 
may not disclose the contents of such record or testimony 
in any manner or for any purpose except as provided in 
this section. 
‘‘(f) EXEMPTION FROM FREEDOM OF INFORMATION 
ACT.—Medical quality assurance records described in sub-
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326 
section (a) may not be made available to any person under 
section 552 of title 5, United States Code. 
‘‘(g) LIMITATION ON CIVIL LIABILITY.—A person 
who participates in or provides information to a person 
or body that reviews or creates medical quality assurance 
records described in subsection (a) shall not be civilly lia-
ble for such participation or for providing such informa-
tion if the participation or provision of information was 
in good faith based on prevailing professional standards 
at the time the medical quality assurance program activity 
took place. 
‘‘(h) APPLICATION
TO INFORMATION
IN CERTAIN 
OTHER RECORDS.—Nothing in this section shall be con-
strued as limiting access to the information in a record 
created and maintained outside a medical quality assur-
ance program, including a patient’s medical records, on 
the grounds that the information was presented during 
meetings of a review body that are part of a medical qual-
ity assurance program. 
‘‘(i) REGULATIONS.—The Secretary, acting through 
the Service, shall promulgate regulations pursuant to sec-
tion 802. 
‘‘(j) DEFINITIONS.—In this section: 
‘‘(1) The term ‘health care provider’ means any 
health care professional, including community health 
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327 
aides and practitioners certified under section 121, 
who are granted clinical practice privileges or em-
ployed to provide health care services in an Indian 
Health Program or health program of an Urban In-
dian Organization, who is licensed or certified to 
perform health care services by a governmental 
board or agency or professional health care society 
or organization. 
‘‘(2) The term ‘medical quality assurance pro-
gram’ means any activity carried out before, on, or 
after the date of enactment of this Act by or for any 
Indian Health Program or Urban Indian Organiza-
tion to assess the quality of medical care, including 
activities conducted by or on behalf of individuals, 
Indian Health Program or Urban Indian Organiza-
tion medical or dental treatment review committees, 
or other review bodies responsible for quality assur-
ance, credentials, infection control, patient safety, 
patient care assessment (including treatment proce-
dures, blood, drugs, and therapeutics), medical 
records, health resources management review and 
identification and prevention of medical or dental in-
cidents and risks. 
‘‘(3) The term ‘medical quality assurance 
record’ means the proceedings, records, minutes, and 
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328 
reports that emanate from quality assurance pro-
gram activities described in paragraph (2) and are 
produced or compiled by or for an Indian Health 
Program or Urban Indian Organization as part of a 
medical quality assurance program. 
‘‘(k) CONTINUED PROTECTION.—Disclosure under 
subsection (c) does not permit redisclosure except to the 
extent such further disclosure is authorized under sub-
section (c) or is otherwise authorized to be disclosed under 
this section. 
‘‘(l) INCONSISTENCIES.—To the extent that the pro-
tections under the Patient Safety and Quality Improve-
ment Act of 2005 and this section are inconsistent, the 
provisions of whichever is more protective shall control. 
‘‘(m) RELATIONSHIP TO OTHER LAW.—This section 
shall continue in force and effect, except asotherwise spe-
cifically provided in any Federal law enacted after the date 
of enactment of the Indian Health Care Improvement Act 
Amendments of 2009. 
‘‘SEC. 815. CLAREMORE INDIAN HOSPITAL. 
‘‘The Claremore Indian Hospital shall be deemed to 
be a dependant Indian community for the purposes of sec-
tion 1151 of title 18, United States Code. 
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329 
‘‘SEC. 816. SENSE OF CONGRESS REGARDING LAW EN-
FORCEMENT 
AND 
METHAMPHETAMINE 
ISSUES IN INDIAN COUNTRY. 
‘‘It is the sense of Congress that Congress encourages 
State, local, and Indian tribal law enforcement agencies 
to enter into memoranda of agreement between and 
among those agencies for purposes of streamlining law en-
forcement activities and maximizing the use of limited re-
sources— 
‘‘(1) to improve law enforcement services pro-
vided to Indian tribal communities; and 
‘‘(2) to increase the effectiveness of measures to 
address problems relating to methamphetamine use 
in Indian country (as defined in section 1151 of title 
18, United States Code). 
‘‘SEC. 817. PERMITTING IMPLEMENTATION THROUGH CON-
TRACTS WITH TRIBAL HEALTH PROGRAMS. 
‘‘Nothing in this Act shall be construed as preventing 
the Secretary from— 
‘‘(1) carrying out any section of this Act 
through contracts with Tribal Health Programs; and 
‘‘(2) carrying out sections through 214, 
701(a)(1), 701(b)(1), 701(c), 707(g), and 712(b), 
through contracts with urban Indian organizations. 
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344 
‘‘SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT. 
‘‘(a) PROVISION OF SUPPORT BY SECRETARY.—Sub-
ject to subsection (b), during the 5-year period beginning 
on the date on which the Foundation is established, the 
Secretary— 
‘‘(1) may provide personnel, facilities, and other 
administrative support services to the Foundation; 
‘‘(2) may provide funds for initial operating 
costs and to reimburse the travel expenses of the 
members of the Board; and 
‘‘(3) shall require and accept reimbursements 
from the Foundation for— 
‘‘(A) services provided under paragraph 
(1); and 
‘‘(B) funds provided under paragraph (2). 
‘‘(b) REIMBURSEMENT.—Reimbursements accepted 
under subsection (a)(3)— 
‘‘(1) shall be deposited in the Treasury of the 
United States to the credit of the applicable appro-
priations account; and 
‘‘(2) shall be chargeable for the cost of pro-
viding services described in subsection (a)(1) and 
travel expenses described in subsection (a)(2). 
‘‘(c) CONTINUATION OF CERTAIN SERVICES.—The 
Secretary may continue to provide facilities and necessary 
support services to the Foundation after the termination 
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350 
is made under this title, see section 401(d) of the Indian 
Health Care Improvement Act.’’. 
(5) DEFINITIONS.—Section 1101(a) of such Act 
(42 U.S.C. 1301(a)) is amended by adding at the 
end the following new paragraph: 
‘‘(11) For purposes of this title and titles 
XVIII, XIX, and XXI, the terms ‘Indian Health 
Program’, ‘Indian Tribe’ (and ‘Indian tribe’), ‘Tribal 
Health Program’, ‘Tribal Organization’ (and ‘tribal 
organization’), and ‘urban Indian organization’ (and 
‘urban Indian organization’) have the meanings 
given those terms in section 4 of the Indian Health 
Care Improvement Act.’’. 
(b) MEDICARE.— 
(1) EXPANSION TO ALL COVERED SERVICES.— 
Section 1880 of such Act (42 U.S.C. 1395qq) is 
amended— 
(A) by amending the heading to read as 
follows: 
‘‘SEC. 1880. INDIAN HEALTH PROGRAMS.’’; 
and 
(B) by amending subsection (a) to read as 
follows: 
‘‘(a) ELIGIBILITY FOR PAYMENTS.—Subject to sub-
section (e), an Indian Health Program shall be eligible for 
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