1658 
HR 3962 PCS 
SEC. 2595. IMPROVEMENT OF VITAL STATISTICS COLLEC-
TION. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
retary’’), acting through the Director of the Centers for 
Disease Control and Prevention and in collaboration with 
appropriate agencies and States, shall— 
(1) promote the education and training of phy-
sicians on the importance of birth and death certifi-
cate data and how to properly complete these docu-
ments in accordance with State law, including the 
collection of such data for diabetes and other chronic 
diseases as appropriate; 
(2) encourage State adoption of the latest 
standard revisions of birth and death certificates; 
and 
(3) work with States to re-engineer their vital 
statistics systems in order to provide cost-effective, 
timely, and accurate vital systems data. 
(b) DEATH CERTIFICATE ADDITIONAL LANGUAGE.— 
In carrying out this section, the Secretary may promote 
improvements to the collection of diabetes mortality data, 
including, as appropriate, the addition by States of a ques-
tion for the individual certifying the cause of death regard-
ing whether the deceased had diabetes. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01658
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1659 
HR 3962 PCS 
SEC. 2596. NATIONAL HEALTH SERVICES CORPS DEM-
ONSTRATION ON INCENTIVE PAYMENTS. 
(a) IN GENERAL.—The Secretary of Health and 
Human Services may establish a demonstration program 
under which, in addition to the salary and benefits other-
wise owed to a member of the National Health Services 
Corps, incentive payments are awarded to any such mem-
ber who is assigned to a health professional shortage area 
with extreme need. 
(b) REPORT.—The Secretary shall submit to the Con-
gress an annual report on the demonstration program 
under subsection (a). 
(c) DEFINITIONS.—In this section: 
(1) The term ‘‘health professional shortage area 
with extreme need’’ means a health professional 
shortage area that— 
(A) is described in section 333A(a)(1)(A) 
of the Public Health Service Act (42 U.S.C. 
254f–1(a)(1)(A)); 
(B) 
is 
described 
in 
section 
333(a)(1)(D)(ii)(IV) of such Act (42 U.S.C. 
254f(a)(1)(D)(ii)(IV)); and 
(C) has high rates of untreated disease, in-
cluding chronic conditions. 
(3) The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01659
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1660 
HR 3962 PCS 
(d) AUTHORIZATION OF APPROPRIATIONS.—To carry 
out this section, there are authorized to be appropriated 
such sums as may be necessary for each of fiscal years 
2011 through 2015. 
DIVISION D—INDIAN HEALTH 
CARE IMPROVEMENT 
SEC. 3001. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This division may be cited as the 
‘‘Indian Health Care Improvement Act Amendments of 
2009’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this division is as follows: 
Sec. 3001. Short title; table of contents. 
TITLE I—AMENDMENTS TO INDIAN LAWS 
Sec. 3101.
Indian Health Care Improvement Act amended. 
Sec. 3102. Native American Health and Wellness Foundation. 
Sec. 3103. GAO study and report on payments for contract health services. 
TITLE II—IMPROVEMENT OF INDIAN HEALTH CARE PROVIDED 
UNDER THE SOCIAL SECURITY ACT 
Sec. 3201. Expansion of payments under Medicare, Medicaid, and SCHIP for 
all covered services furnished by Indian Health Programs. 
Sec. 3202. Additional provisions to increase outreach to, and enrollment of, In-
dians in SCHIP and Medicaid. 
Sec. 3203. Solicitation of proposals for safe harbors under the Social Security 
Act for facilities of Indian Health Programs and urban Indian 
organizations. 
Sec. 3204. Annual report on Indians served by Social Security Act health ben-
efit programs. 
Sec. 3205. Development of recommendations to improve interstate coordination 
of Medicaid and SCHIP coverage of Indian children and other 
children who are outside of their State of residency because of 
educational or other needs. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01660
Fmt 6652
Sfmt 6211
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1661 
HR 3962 PCS 
TITLE I—AMENDMENTS TO 
INDIAN LAWS 
SEC. 3101. INDIAN HEALTH CARE IMPROVEMENT ACT 
AMENDED. 
(a) IN GENERAL.—The Indian Health Care Improve-
ment Act (25 U.S.C. 1601 et seq.) is amended to read 
as follows: 
‘‘SEC. 1. SHORT TITLE; TABLE OF CONTENTS. 
‘‘(a) SHORT TITLE.—This Act may be cited as the 
‘Indian Health Care Improvement Act’. 
‘‘(b) TABLE OF CONTENTS.—The table of contents 
for this Act is as follows: 
‘‘Sec. 1. Short title; table of contents. 
‘‘Sec. 2. Findings. 
‘‘Sec. 3. Declaration of national Indian health policy. 
‘‘Sec. 4. Definitions. 
‘‘TITLE I—INDIAN HEALTH, HUMAN RESOURCES, AND 
DEVELOPMENT 
‘‘Sec. 101. Purpose. 
‘‘Sec. 102. Health professions recruitment program for Indians. 
‘‘Sec. 103. Health professions preparatory scholarship program for Indians. 
‘‘Sec. 104. Indian health professions scholarships. 
‘‘Sec. 105. American Indians Into Psychology Program. 
‘‘Sec. 106. Scholarship programs for Indian Tribes. 
‘‘Sec. 107. Indian Health Service extern programs. 
‘‘Sec. 108. Continuing education allowances. 
‘‘Sec. 109. Community Health Representative Program. 
‘‘Sec. 110. Indian Health Service Loan Repayment Program. 
‘‘Sec. 111. Scholarship and Loan Repayment Recovery Fund. 
‘‘Sec. 112. Recruitment activities. 
‘‘Sec. 113. Indian recruitment and retention program. 
‘‘Sec. 114. Advanced training and research. 
‘‘Sec. 115. Quentin N. Burdick American Indians Into Nursing Program. 
‘‘Sec. 116. Tribal cultural orientation. 
‘‘Sec. 117. INMED Program. 
‘‘Sec. 118. Health training programs of community colleges. 
‘‘Sec. 119. Retention bonus. 
‘‘Sec. 120. Nursing residency program. 
‘‘Sec. 121. Community Health Aide Program. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01661
Fmt 6652
Sfmt 6211
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1662 
HR 3962 PCS 
‘‘Sec. 122. Tribal Health Program administration. 
‘‘Sec. 123. Health professional chronic shortage demonstration programs. 
‘‘Sec. 124. National Health Service Corps. 
‘‘Sec. 125. Substance abuse counselor educational curricula demonstration pro-
grams. 
‘‘Sec. 126. Behavioral health training and community education programs. 
‘‘Sec. 127. Exemption from payment of certain fees. 
‘‘Sec. 128. Authorization of appropriations. 
‘‘TITLE II—HEALTH SERVICES 
‘‘Sec. 201. Indian Health Care Improvement Fund. 
‘‘Sec. 202. Health promotion and disease prevention services. 
‘‘Sec. 203. Diabetes prevention, treatment, and control. 
‘‘Sec. 204. Shared services for long-term care. 
‘‘Sec. 205. Health services research. 
‘‘Sec. 206. Mammography and other cancer screening. 
‘‘Sec. 207. Patient travel costs. 
‘‘Sec. 208. Epidemiology centers. 
‘‘Sec. 209. Comprehensive school health education programs. 
‘‘Sec. 210. Indian youth program. 
‘‘Sec. 211. Prevention, control, and elimination of communicable and infectious 
diseases. 
‘‘Sec. 212. Other authority for provision of services. 
‘‘Sec. 213. Indian women’s health care. 
‘‘Sec. 214. Environmental and nuclear health hazards. 
‘‘Sec. 215. Arizona as a contract health service delivery area. 
‘‘Sec. 216. North Dakota and South Dakota as contract health service delivery 
area. 
‘‘Sec. 217. California contract health services program. 
‘‘Sec. 218. California as a contract health service delivery area. 
‘‘Sec. 219. Contract health services for the Trenton Service Area. 
‘‘Sec. 220. Programs operated by Indian Tribes and tribal organizations. 
‘‘Sec. 221. Licensing. 
‘‘Sec. 222. Notification of provision of emergency contract health services. 
‘‘Sec. 223. Prompt action on payment of claims. 
‘‘Sec. 224. Liability for payment. 
‘‘Sec. 225. Office of Indian Men’s Health. 
‘‘Sec. 226. Catastrophic health emergency fund. 
‘‘Sec. 227. Authorization of appropriations. 
‘‘TITLE III—FACILITIES 
‘‘Sec. 301. Consultation; construction and renovation of facilities; reports. 
‘‘Sec. 302. Sanitation facilities. 
‘‘Sec. 303. Preference to Indians and Indian firms. 
‘‘Sec. 304. Expenditure of non-Service funds for renovation. 
‘‘Sec. 305. Funding for the construction, expansion, and modernization of small 
ambulatory care facilities. 
‘‘Sec. 306. Indian health care delivery demonstration project. 
‘‘Sec. 307. Land transfer. 
‘‘Sec. 308. Leases, contracts, and other agreements. 
‘‘Sec. 309. Study on loans, loan guarantees, and loan repayment. 
‘‘Sec. 310. Tribal leasing. 
‘‘Sec. 311. Indian Health Service/tribal facilities joint venture program. 
‘‘Sec. 312. Location of facilities. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01662
Fmt 6652
Sfmt 6211
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1663 
HR 3962 PCS 
‘‘Sec. 313. Maintenance and improvement of health care facilities. 
‘‘Sec. 314. Tribal management of federally owned quarters. 
‘‘Sec. 315. Applicability of Buy American Act requirement. 
‘‘Sec. 316. Other funding for facilities. 
‘‘Sec. 317. Authorization of appropriations. 
‘‘TITLE IV—ACCESS TO HEALTH SERVICES 
‘‘Sec. 401. Treatment of payments under Social Security Act health benefits 
programs. 
‘‘Sec. 402. Grants to and contracts with the Service, Indian Tribes, Tribal Or-
ganizations, and urban Indian organizations to facilitate out-
reach, enrollment, and coverage of Indians under Social Secu-
rity Act health benefit programs. 
‘‘Sec. 403. Reimbursement from certain third parties of costs of health services. 
‘‘Sec. 404. Crediting of reimbursements. 
‘‘Sec. 405. Purchasing health care coverage. 
‘‘Sec. 406. Sharing arrangements with Federal agencies. 
‘‘Sec. 407. Eligible indian veteran services. 
‘‘Sec. 408. Payor of last resort. 
‘‘Sec. 409. Consultation. 
‘‘Sec. 410. State Children’s Health Insurance Program (SCHIP). 
‘‘Sec. 411. Premium and cost sharing protections and eligibility determinations 
under Medicaid and SCHIP and protection of certain Indian 
property from Medicaid estate recovery. 
‘‘Sec. 412. Treatment under Medicaid and SCHIP managed care. 
‘‘Sec. 413. Navajo Nation Medicaid Agency feasibility study. 
‘‘Sec. 414. Exception for excepted benefits. 
‘‘Sec. 415. Authorization of appropriations. 
‘‘TITLE V—HEALTH SERVICES FOR URBAN INDIANS 
‘‘Sec. 501. Purpose. 
‘‘Sec. 502. Contracts with, and grants to, urban Indian organizations. 
‘‘Sec. 503. Contracts and grants for the provision of health care and referral 
services. 
‘‘Sec. 504. Use of Federal Government Facilities and Sources of Supply. 
‘‘Sec. 505. Contracts and grants for the determination of unmet health care 
needs. 
‘‘Sec. 506. Evaluations; renewals. 
‘‘Sec. 507. Other contract and grant requirements. 
‘‘Sec. 508. Reports and records. 
‘‘Sec. 509. Limitation on contract authority. 
‘‘Sec. 510. Facilities. 
‘‘Sec. 511. Division of Urban Indian Health. 
‘‘Sec. 512. Grants for alcohol and substance abuse-related services. 
‘‘Sec. 513. Treatment of certain demonstration projects. 
‘‘Sec. 514. Urban NIAAA transferred programs. 
‘‘Sec. 515. Conferring with urban Indian organizations. 
‘‘Sec. 516. Urban youth treatment center demonstration. 
‘‘Sec. 517. Grants for diabetes prevention, treatment, and control. 
‘‘Sec. 518. Community health representatives. 
‘‘Sec. 519. Effective date. 
‘‘Sec. 520. Eligibility for services. 
‘‘Sec. 521. Authorization of appropriations. 
‘‘Sec. 522. Health information technology. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01663
Fmt 6652
Sfmt 6211
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1664 
HR 3962 PCS 
‘‘TITLE VI—ORGANIZATIONAL IMPROVEMENTS 
‘‘Sec. 601. Establishment of the Indian Health Service as an agency of the 
Public Health Service. 
‘‘Sec. 602. Automated management information system. 
‘‘Sec. 603. Authorization of appropriations. 
‘‘TITLE VII—BEHAVIORAL HEALTH PROGRAMS 
‘‘Sec. 701. Behavioral health prevention and treatment services. 
‘‘Sec. 702. Memoranda of agreement with the Department of the Interior. 
‘‘Sec. 703. Comprehensive behavioral health prevention and treatment program. 
‘‘Sec. 704. Mental health technician program. 
‘‘Sec. 705. Licensing requirement for mental health care workers. 
‘‘Sec. 706. Indian women treatment programs. 
‘‘Sec. 707. Indian youth program. 
‘‘Sec. 708. Indian youth telemental health demonstration project. 
‘‘Sec. 709. Inpatient and community-based mental health facilities design, con-
struction, and staffing. 
‘‘Sec. 710. Training and community education. 
‘‘Sec. 711. Behavioral health program. 
‘‘Sec. 712. Fetal alcohol disorder programs. 
‘‘Sec. 713. Child sexual abuse and prevention treatment programs. 
‘‘Sec. 714. Domestic and sexual violence prevention and treatment. 
‘‘Sec. 715. Behavioral health research. 
‘‘Sec. 716. Definitions. 
‘‘Sec. 717. Authorization of appropriations. 
‘‘TITLE VIII—MISCELLANEOUS 
‘‘Sec. 801. Reports. 
‘‘Sec. 802. Regulations. 
‘‘Sec. 803. Plan of implementation. 
‘‘Sec. 804. Limitation on use of funds appropriated to Indian Health Service. 
‘‘Sec. 805. Eligibility of California Indians. 
‘‘Sec. 806. Health services for ineligible persons. 
‘‘Sec. 807. Reallocation of base resources. 
‘‘Sec. 808. Results of demonstration projects. 
‘‘Sec. 809. Moratorium. 
‘‘Sec. 810. Severability provisions. 
‘‘Sec. 811. Use of patient safety organizations. 
‘‘Sec. 812. Confidentiality of medical quality assurance records; qualified immu-
nity for participants. 
‘‘Sec. 813. Claremore Indian Hospital. 
‘‘Sec. 814. Sense of Congress regarding law enforcement and methamphetamine 
issues in Indian country. 
‘‘Sec. 815. Permitting implementation through contracts with Tribal Health 
Programs. 
‘‘Sec. 816. Authorization of appropriations; availability. 
‘‘SEC. 2. FINDINGS. 
‘‘Congress makes the following findings: 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01664
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1665 
HR 3962 PCS 
‘‘(1) Federal health services to maintain and 
improve the health of the Indians are consonant 
with and required by the Federal Government’s his-
torical and unique legal relationship with, and re-
sulting responsibility to, the American Indian people. 
‘‘(2) A major national goal of the United States 
is to provide the resources, processes, and structure 
that will enable Indian tribes and tribal members to 
obtain the quantity and quality of health care serv-
ices and opportunities that will eradicate the health 
disparities between Indians the general population. 
‘‘(3) A major national goal of the United States 
is to provide the quantity and quality of health serv-
ices which will permit the health status of Indians 
to be raised to the highest possible level and to en-
courage the maximum participation of Indians in the 
planning and management of those services. 
‘‘(4) Federal health services to Indians have re-
sulted in a reduction in the prevalence and incidence 
of preventable illnesses among, and unnecessary and 
premature deaths of, Indians. 
‘‘(5) Despite such services, the unmet health 
needs of the American Indian people are severe and 
the health status of the Indians is far below that of 
the general population of the United States. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01665
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1666 
HR 3962 PCS 
‘‘SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POL-
ICY. 
‘‘Congress declares that it is the policy of this Nation, 
in fulfillment of its special trust responsibilities and legal 
obligations to Indians— 
‘‘(1) to assure the highest possible health status 
for Indians and Urban Indians and to provide all re-
sources necessary to effect that policy; 
‘‘(2) to raise the health status of Indians and 
Urban Indians to at least the levels set forth in the 
goals contained within the Health People 2010 or 
successor objectives; 
‘‘(3) to the greatest extent possible, to allow In-
dians to set their own health care priorities and es-
tablish goals that reflect their unmet needs; 
‘‘(4) to increase the proportion of all degrees in 
the health professions and allied and associated 
health professions awarded to Indians so that the 
proportion of Indian health professionals in each 
Service Area is raised to at least the level of that of 
the general population; 
‘‘(5) to require meaningful consultation with In-
dian Tribes, Tribal Organizations, and urban Indian 
organizations to implement this Act and the national 
policy of Indian self-determination; and 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01666
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1667 
HR 3962 PCS 
‘‘(6) to provide funding for programs and facili-
ties operated by Indian Tribes, Tribal Organizations, 
and Urban Indian Organizations in amounts that 
are not less than the amounts provided to programs 
and facilities operated directly by the Service. 
‘‘SEC. 4. DEFINITIONS. 
‘‘For purposes of this Act: 
‘‘(1) The term ‘accredited and accessible’ means 
on or near a reservation and accredited by a na-
tional or regional organization with accrediting au-
thority. 
‘‘(2) The term ‘Area Office’ means an adminis-
trative entity, including a program office, within the 
Service through which services and funds are pro-
vided to the Service Units within a defined geo-
graphic area. 
‘‘(3) The term ‘Assistant Secretary’ means the 
Assistant Secretary of Indian Health. 
‘‘(4)(A) The term ‘behavioral health’ means the 
blending of substance (including alcohol, drugs, 
inhalants, and tobacco) abuse and mental health 
prevention and treatment, for the purpose of pro-
viding comprehensive services. 
‘‘(B) The term ‘behavioral health’ includes the 
joint development of substance abuse and mental 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01667
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1668 
HR 3962 PCS 
health treatment planning and coordinated case 
management using a multidisciplinary approach. 
‘‘(5) The term ‘California Indians’ means those 
Indians who are eligible for health services of the 
Service pursuant to section 805. 
‘‘(6) The term ‘community college’ means— 
‘‘(A) a tribal college or university, or 
‘‘(B) a junior or community college. 
‘‘(7) The term ‘contract health service’ means 
health services provided at the expense of the Serv-
ice or a Tribal Health Program by public or private 
medical providers or hospitals, other than the Serv-
ice Unit or the Tribal Health Program at whose ex-
pense the services are provided. 
‘‘(8) The term ‘Department’ means, unless oth-
erwise designated, the Department of Health and 
Human Services. 
‘‘(9) The term ‘disease prevention’ means the 
reduction, limitation, and prevention of disease and 
its complications and reduction in the consequences 
of disease, including— 
‘‘(A) controlling— 
‘‘(i) the development of diabetes; 
‘‘(ii) high blood pressure; 
‘‘(iii) infectious agents; 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01668
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1671 
HR 3962 PCS 
‘‘(ix) avoidance of fetal alcohol dis-
orders; 
‘‘(x) first aid and CPR education; 
‘‘(xi) human growth and development; 
‘‘(xii) injury prevention and personal 
safety; 
‘‘(xiii) behavioral health; 
‘‘(xiv) monitoring of disease indicators 
between 
health 
care 
provider 
visits, 
through 
appropriate 
means, 
including 
Internet-based health care management 
systems; 
‘‘(xv) personal health and wellness 
practices; 
‘‘(xvi) personal capacity building; 
‘‘(xvii) prenatal, pregnancy, and in-
fant care; 
‘‘(xviii) psychological well-being; 
‘‘(xix) reproductive health and family 
planning; 
‘‘(xx) safe and adequate water; 
‘‘(xxi) healthy work environments; 
‘‘(xxii) elimination, reduction, and 
prevention of contaminants that create 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01671
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1672 
HR 3962 PCS 
unhealthy household conditions (including 
mold and other allergens); 
‘‘(xxiii) stress control; 
‘‘(xxiv) substance abuse; 
‘‘(xxv) sanitary facilities; 
‘‘(xxvi) sudden infant death syndrome 
prevention; 
‘‘(xxvii) tobacco use cessation and re-
duction; 
‘‘(xxviii) violence prevention; and 
‘‘(xxix) activities to promote achieve-
ment of any of the objectives described in 
section 3(2). 
‘‘(12) The term ‘Indian’, unless otherwise des-
ignated, means any person who is a member of an 
Indian Tribe or is eligible for health services under 
section 805, except that, for the purpose of sections 
102 and 103, the term also means any individual 
who— 
‘‘(A)(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-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01672
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1673 
HR 3962 PCS 
nized now or in the future by the State in 
which they reside; or 
‘‘(ii) is a descendant, in the first or second 
degree, of any such member; 
‘‘(B) is an Eskimo or Aleut or other Alas-
ka Native; 
‘‘(C) is considered by the Secretary of the 
Interior to be an Indian for any purpose; or 
‘‘(D) is determined to be an Indian under 
regulations promulgated by the Secretary. 
‘‘(13) The term ‘Indian Health Program’ 
means— 
‘‘(A) any health program administered di-
rectly by the Service; 
‘‘(B) any Tribal Health Program; or 
‘‘(C) any Indian Tribe or Tribal Organiza-
tion to which the Secretary provides funding 
pursuant to section 23 of the Act of June 25, 
1910 (25 U.S.C. 47) (commonly known as the 
‘Buy Indian Act’). 
‘‘(14) The term ‘Indian Tribe’ has the meaning 
given the term in the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.). 
‘‘(15) The term ‘junior or community college’ 
has the meaning given the term by section 312(f) of 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01673
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1674 
HR 3962 PCS 
the Higher Education Act of 1965 (20 U.S.C. 
1058(f)). 
‘‘(16) The term ‘reservation’ means any feder-
ally recognized Indian Tribe’s reservation, Pueblo, or 
colony, including former reservations in Oklahoma, 
Indian allotments, and Alaska Native Regions estab-
lished pursuant to the Alaska Native Claims Settle-
ment Act (43 U.S.C. 1601 et seq.). 
‘‘(17) The term ‘Secretary’, unless otherwise 
designated, means the Secretary of Health and 
Human Services. 
‘‘(18) The term ‘Service’ means the Indian 
Health Service. 
‘‘(19) The term ‘Service Area’ means the geo-
graphical area served by each Area Office. 
‘‘(20) The term ‘Service Unit’ means an admin-
istrative entity of the Service, or a Tribal Health 
Program through which services are provided, di-
rectly or by contract, to eligible Indians within a de-
fined geographic area. 
‘‘(21) The term ‘telehealth’ has the meaning 
given the term in section 330K(a) of the Public 
Health Service Act (42 U.S.C. 254c–16(a)). 
‘‘(22) The term ‘telemedicine’ means a tele-
communications link to an end user through the use 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01674
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1675 
HR 3962 PCS 
of eligible equipment that electronically links health 
professionals or patients and health professionals at 
separate sites in order to exchange health care infor-
mation in audio, video, graphic, or other format for 
the purpose of providing improved health care serv-
ices. 
‘‘(23) The term ‘tribal college or university’ has 
the meaning given the term in section 316(b)(3) of 
the Higher Education Act (20 U.S.C. 1059c(b)(3)). 
‘‘(24) The term ‘Tribal Health Program’ means 
an Indian Tribe or Tribal Organization that oper-
ates any health program, service, function, activity, 
or facility funded, in whole or part, by the Service 
through, or provided for in, a contract or compact 
with the Service under the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C. 450 
et seq.). 
‘‘(25) The term ‘Tribal Organization’ has the 
meaning given the term in the Indian Self-Deter-
mination and Education Assistance Act (25 U.S.C. 
450 et seq.). 
‘‘(26) The term ‘Urban Center’ means any com-
munity which has a sufficient Urban Indian popu-
lation with unmet health needs to warrant assistance 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01675
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1676 
HR 3962 PCS 
under title V of this Act, as determined by the Sec-
retary. 
‘‘(27) The term ‘Urban Indian’ means any indi-
vidual who resides in an Urban Center and who 
meets 1 or more of the following criteria: 
‘‘(A) Irrespective of whether the individual 
lives on or near a reservation, the individual is 
a member of a tribe, band, or other organized 
group of Indians, including those tribes, bands, 
or groups terminated since 1940 and those 
tribes, bands, or groups that are recognized by 
the States in which they reside, or who is a de-
scendant in the first or second degree of any 
such member. 
‘‘(B) The individual is an Eskimo, Aleut, 
or other Alaska Native. 
‘‘(C) The individual is considered by the 
Secretary of the Interior to be an Indian for 
any purpose. 
‘‘(D) The individual is determined to be an 
Indian under regulations promulgated by the 
Secretary. 
‘‘(28) The term ‘urban Indian organization’ 
means a nonprofit corporate body that (A) is situ-
ated in an Urban Center; (B) is governed by an 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01676
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1677 
HR 3962 PCS 
Urban Indian-controlled board of directors; (C) pro-
vides for the participation of all interested Indian 
groups and individuals; and (D) is capable of legally 
cooperating with other public and private entities for 
the purpose of performing the activities described in 
section 503(a). 
‘‘TITLE 
I—INDIAN 
HEALTH, 
HUMAN RESOURCES, AND DE-
VELOPMENT 
‘‘SEC. 101. PURPOSE. 
‘‘The purpose of this title is to increase, to the max-
imum extent feasible, the number of Indians entering the 
health professions and providing health services, and to 
assure an optimum supply of health professionals to the 
Indian Health Programs and urban Indian organizations 
involved in the provision of health services to Indians. 
‘‘SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM 
FOR INDIANS. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Service, shall make grants to public or nonprofit pri-
vate health or educational entities, Tribal Health Pro-
grams, or urban Indian organizations to assist such enti-
ties in meeting the costs of— 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01677
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1678 
HR 3962 PCS 
‘‘(1) identifying Indians with a potential for 
education or training in the health professions and 
encouraging and assisting them— 
‘‘(A) to enroll in courses of study in such 
health professions; or 
‘‘(B) if they are not qualified to enroll in 
any such courses of study, to undertake such 
postsecondary education or training as may be 
required to qualify them for enrollment; 
‘‘(2) publicizing existing sources of financial aid 
available to Indians enrolled in any course of study 
referred to in paragraph (1) or who are undertaking 
training necessary to qualify them to enroll in any 
such course of study; or 
‘‘(3) establishing other programs which the Sec-
retary determines will enhance and facilitate the en-
rollment of Indians in, and the subsequent pursuit 
and completion by them of, courses of study referred 
to in paragraph (1). 
‘‘(b) GRANTS.— 
‘‘(1) APPLICATION.—No grant may be made 
under this section unless an application has been 
submitted to, and approved by, the Secretary. Such 
application shall be in such form, submitted in such 
manner, and contain such information, as the Sec-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01678
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1679 
HR 3962 PCS 
retary shall by regulation prescribe pursuant to this 
Act. The Secretary shall give a preference to appli-
cations submitted by Tribal Health Programs or 
urban Indian organizations. 
‘‘(2) AMOUNT
OF
GRANTS; PAYMENT.—The 
amount of a grant under this section shall be deter-
mined by the Secretary. Payments pursuant to this 
section may be made in advance or by way of reim-
bursement, and at such intervals and on such condi-
tions as provided for in regulations issued pursuant 
to this Act. To the extent not otherwise prohibited 
by law, grants shall be for 3 years, as provided in 
regulations issued pursuant to this Act. 
‘‘SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOL-
ARSHIP PROGRAM FOR INDIANS. 
‘‘(a) SCHOLARSHIPS AUTHORIZED.—The Secretary, 
acting through the Service, shall provide scholarship 
grants to Indians who— 
‘‘(1) have successfully completed their high 
school education or high school equivalency; and 
‘‘(2) have demonstrated the potential to suc-
cessfully complete courses of study in the health pro-
fessions. 
‘‘(b) PURPOSES.—Scholarship grants provided pursu-
ant to this section shall be for the following purposes: 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01679
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1680 
HR 3962 PCS 
‘‘(1) Compensatory preprofessional education of 
any recipient, such scholarship not to exceed 2 years 
on a full-time basis (or the part-time equivalent 
thereof, as determined by the Secretary pursuant to 
regulations issued under this Act). 
‘‘(2) Pregraduate education of any recipient 
leading to a baccalaureate degree in an approved 
course of study preparatory to a field of study in a 
health profession, such scholarship not to exceed 4 
years. An extension of up to 2 years (or the part- 
time equivalent thereof, as determined by the Sec-
retary pursuant to regulations issued pursuant to 
this Act) may be approved. 
‘‘(c) OTHER CONDITIONS.—Scholarships under this 
section— 
‘‘(1) may cover costs of tuition, books, trans-
portation, board, and other necessary related ex-
penses of a recipient while attending school; 
‘‘(2) shall not be denied solely on the basis of 
the applicant’s scholastic achievement if such appli-
cant has been admitted to, or maintained good 
standing at, an accredited institution; and 
‘‘(3) shall not be denied solely by reason of such 
applicant’s eligibility for assistance or benefits under 
any other Federal program. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01680
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1681 
HR 3962 PCS 
‘‘SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS. 
‘‘(a) IN GENERAL.— 
‘‘(1) 
AUTHORITY.—The 
Secretary, 
acting 
through the Service, shall make scholarship grants 
to Indians who are enrolled full or part time in ac-
credited schools pursuing courses of study in the 
health professions. Such scholarships shall be des-
ignated Indian Health Scholarships and shall be 
made in accordance with section 338A of the Public 
Health Services Act (42 U.S.C. 254l), except as pro-
vided in subsection (b) of this section. 
‘‘(2) DETERMINATIONS
BY
SECRETARY.—The 
Secretary, acting through the Service, shall deter-
mine— 
‘‘(A) who shall receive scholarship grants 
under subsection (a); and 
‘‘(B) the distribution of the scholarships 
among health professions on the basis of the 
relative needs of Indians for additional service 
in the health professions. 
‘‘(3) CERTAIN DELEGATION NOT ALLOWED.— 
The administration of this section shall be a respon-
sibility of the Assistant Secretary and shall not be 
delegated in a contract or compact under the Indian 
Self-Determination and Education Assistance Act 
(25 U.S.C. 450 et seq.). 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01681
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1682 
HR 3962 PCS 
‘‘(b) ACTIVE DUTY SERVICE OBLIGATION.— 
‘‘(1) OBLIGATION MET.—The active duty serv-
ice obligation under a written contract with the Sec-
retary under this section that an Indian has entered 
into shall, if that individual is a recipient of an In-
dian Health Scholarship, be met in full-time practice 
equal to 1 year for each school year for which the 
participant receives a scholarship award under this 
part, or 2 years, whichever is greater, by service in 
1 or more of the following: 
‘‘(A) In an Indian Health Program. 
‘‘(B) In a program assisted under title V 
of this Act. 
‘‘(C) In the private practice of the applica-
ble profession if, as determined by the Sec-
retary, in accordance with guidelines promul-
gated by the Secretary, such practice is situated 
in a physician or other health professional 
shortage area and addresses the health care 
needs of a substantial number of Indians. 
‘‘(D) In a teaching capacity in a tribal col-
lege or university nursing program (or a related 
health profession program) if, as determined by 
the Secretary, the health service provided to In-
dians would not decrease. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01682
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1683 
HR 3962 PCS 
‘‘(2) OBLIGATION DEFERRED.—At the request 
of any individual who has entered into a contract re-
ferred to in paragraph (1) and who receives a health 
professions degree requiring postgraduate training 
for licensure or to improve clinical skills, the Sec-
retary shall defer the active duty service obligation 
of that individual under that contract, in order that 
such individual may complete any internship, resi-
dency, or other advanced clinical training that is re-
quired for the practice of that health profession, for 
an appropriate period (in years, as determined by 
the Secretary), subject to the following conditions: 
‘‘(A) No period of internship, residency, or 
other advanced clinical training shall be counted 
as satisfying any period of obligated service 
under this subsection. 
‘‘(B) The active duty service obligation of 
that individual shall commence not later than 
90 days after the completion of that advanced 
clinical training (or by a date specified by the 
Secretary). 
‘‘(C) The active duty service obligation will 
be served in the health profession of that indi-
vidual in a manner consistent with paragraph 
(1). 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01683
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1684 
HR 3962 PCS 
‘‘(D) A recipient of a scholarship under 
this section may, at the election of the recipient, 
meet the active duty service obligation described 
in paragraph (1) by service in a program speci-
fied under that paragraph that— 
‘‘(i) is located on the reservation of 
the Indian Tribe in which the recipient is 
enrolled; or 
‘‘(ii) serves the Indian Tribe in which 
the recipient is enrolled. 
‘‘(3) PRIORITY WHEN MAKING ASSIGNMENTS.— 
Subject to paragraph (2), the Secretary, in making 
assignments of Indian Health Scholarship recipients 
required to meet the active duty service obligation 
described in paragraph (1), shall give priority to as-
signing individuals to service in those programs 
specified in paragraph (1) that have a need for 
health professionals to provide health care services 
as a result of individuals having breached contracts 
entered into under this section. 
‘‘(c) PART-TIME STUDENTS.—In the case of an indi-
vidual receiving a scholarship under this section who is 
enrolled part time in an approved course of study— 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01684
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1685 
HR 3962 PCS 
‘‘(1) such scholarship shall be for a period of 
years not to exceed the part-time equivalent of 4 
years, as determined by the Secretary; 
‘‘(2) the period of obligated service described in 
subsection (b)(1) shall be equal to the greater of— 
‘‘(A) the part-time equivalent of 1 year for 
each year for which the individual was provided 
a scholarship (as determined by the Secretary); 
or 
‘‘(B) 2 years; and 
‘‘(3) the amount of the monthly stipend speci-
fied in section 338A(g)(1)(B) of the Public Health 
Service Act (42 U.S.C. 254l(g)(1)(B)) shall be re-
duced pro rata (as determined by the Secretary) 
based on the number of hours such student is en-
rolled. 
‘‘(d) BREACH OF CONTRACT.— 
‘‘(1) SPECIFIED
BREACHES.—An individual 
shall be liable to the United States for the amount 
which has been paid to the individual, or on behalf 
of the individual, under a contract entered into with 
the Secretary under this section on or after the date 
of enactment of the Indian Health Care Improve-
ment Act Amendments of 2009 if that individual— 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01685
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1686 
HR 3962 PCS 
‘‘(A) fails to maintain an acceptable level 
of academic standing in the educational institu-
tion in which he or she is enrolled (such level 
determined by the educational institution under 
regulations of the Secretary); 
‘‘(B) is dismissed from such educational 
institution for disciplinary reasons; 
‘‘(C) voluntarily terminates the training in 
such an educational institution for which he or 
she is provided a scholarship under such con-
tract before the completion of such training; or 
‘‘(D) fails to accept payment, or instructs 
the educational institution in which he or she is 
enrolled not to accept payment, in whole or in 
part, of a scholarship under such contract, in 
lieu of any service obligation arising under such 
contract. 
‘‘(2) OTHER BREACHES.—If for any reason not 
specified in paragraph (1) an individual breaches a 
written contract by failing either to begin such indi-
vidual’s service obligation required under such con-
tract or to complete such service obligation, the 
United States shall be entitled to recover from the 
individual an amount determined in accordance with 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01686
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1687 
HR 3962 PCS 
the formula specified in subsection (l) of section 110 
in the manner provided for in such subsection. 
‘‘(3) CANCELLATION UPON DEATH OF RECIPI-
ENT.—Upon the death of an individual who receives 
an Indian Health Scholarship, any outstanding obli-
gation of that individual for service or payment that 
relates to that scholarship shall be canceled. 
‘‘(4) WAIVERS
AND
SUSPENSIONS.—The Sec-
retary shall provide for the partial or total waiver or 
suspension of any obligation of service or payment of 
a recipient of an Indian Health Scholarship if the 
Secretary determines that— 
‘‘(A) it is not possible for the recipient to 
meet that obligation or make that payment; 
‘‘(B) requiring that recipient to meet that 
obligation or make that payment would result 
in extreme hardship to the recipient; or 
‘‘(C) the enforcement of the requirement to 
meet the obligation or make the payment would 
be unconscionable. 
‘‘(5) EXTREME
HARDSHIP.—Notwithstanding 
any other provision of law, in any case of extreme 
hardship or for other good cause shown, the Sec-
retary may waive, in whole or in part, the right of 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01687
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1688 
HR 3962 PCS 
the United States to recover funds made available 
under this section. 
‘‘(6) 
BANKRUPTCY.—Notwithstanding 
any 
other provision of law, with respect to a recipient of 
an Indian Health Scholarship, no obligation for pay-
ment may be released by a discharge in bankruptcy 
under title 11, United States Code, unless that dis-
charge is granted after the expiration of the 5-year 
period beginning on the initial date on which that 
payment is due, and only if the bankruptcy court 
finds that the nondischarge of the obligation would 
be unconscionable. 
‘‘SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PRO-
GRAM. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 
through the Service, shall make grants of not more than 
$300,000 to each of 9 colleges and universities for the pur-
pose of developing and maintaining Indian psychology ca-
reer recruitment programs as a means of encouraging In-
dians to enter the behavioral health field. These programs 
shall be located at various locations throughout the coun-
try to maximize their availability to Indian students and 
new programs shall be established in different locations 
from time to time. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01688
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1689 
HR 3962 PCS 
‘‘(b) QUENTIN N. BURDICK PROGRAM GRANT.—The 
Secretary shall provide a grant authorized under sub-
section (a) to develop and maintain a program at the Uni-
versity of North Dakota to be known as the ‘Quentin N. 
Burdick American Indians Into Psychology Program’. 
Such program shall, to the maximum extent feasible, co-
ordinate with the Quentin N. Burdick Indian Health Pro-
grams authorized under section 117(b), the Quentin N. 
Burdick American Indians Into Nursing Program author-
ized under section 115(e), and existing university research 
and communications networks. 
‘‘(c) REGULATIONS.—The Secretary shall issue regu-
lations pursuant to this Act for the competitive awarding 
of grants provided under this section. 
‘‘(d) CONDITIONS OF GRANT.—Applicants under this 
section shall agree to provide a program which, at a min-
imum— 
‘‘(1) provides outreach and recruitment for 
health professions to Indian communities including 
elementary, secondary, and accredited and accessible 
community colleges that will be served by the pro-
gram; 
‘‘(2) incorporates a program advisory board 
comprised of representatives from the tribes and 
communities that will be served by the program; 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01689
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1690 
HR 3962 PCS 
‘‘(3) provides summer enrichment programs to 
expose Indian students to the various fields of psy-
chology through research, clinical, and experimental 
activities; 
‘‘(4) provides stipends to undergraduate and 
graduate students to pursue a career in psychology; 
‘‘(5) develops affiliation agreements with tribal 
colleges and universities, the Service, university af-
filiated programs, and other appropriate accredited 
and accessible entities to enhance the education of 
Indian students; 
‘‘(6) to the maximum extent feasible, uses exist-
ing university tutoring, counseling, and student sup-
port services; and 
‘‘(7) to the maximum extent feasible, employs 
qualified Indians in the program. 
‘‘(e) ACTIVE DUTY SERVICE REQUIREMENT.—The 
active duty service obligation prescribed under section 
338C of the Public Health Service Act (42 U.S.C. 254m) 
shall be met by each graduate who receives a stipend de-
scribed in subsection (d)(4) that is funded under this sec-
tion. Such obligation shall be met by service— 
‘‘(1) in an Indian Health Program; 
‘‘(2) in a program assisted under title V of this 
Act; or 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01690
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1691 
HR 3962 PCS 
‘‘(3) in the private practice of psychology if, as 
determined by the Secretary, in accordance with 
guidelines promulgated by the Secretary, such prac-
tice is situated in a physician or other health profes-
sional shortage area and addresses the health care 
needs of a substantial number of Indians. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated such sums as may be nec-
essary to carry out this section. 
‘‘SEC. 106. SCHOLARSHIP PROGRAMS FOR INDIAN TRIBES. 
‘‘(a) IN GENERAL.— 
‘‘(1) GRANTS
AUTHORIZED.—The Secretary, 
acting through the Service, shall make grants to 
Tribal Health Programs for the purpose of providing 
scholarships for Indians to serve as health profes-
sionals in Indian communities. 
‘‘(2) AMOUNT.—Amounts available under para-
graph (1) for any fiscal year shall not exceed 5 per-
cent of the amounts available for each fiscal year for 
Indian Health Scholarships under section 104. 
‘‘(3) APPLICATION.—An application for a grant 
under paragraph (1) shall be in such form and con-
tain such agreements, assurances, and information 
as consistent with this section. 
‘‘(b) REQUIREMENTS.— 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01691
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1692 
HR 3962 PCS 
‘‘(1) IN GENERAL.—A Tribal Health Program 
receiving a grant under subsection (a) shall provide 
scholarships to Indians in accordance with the re-
quirements of this section. 
‘‘(2) COSTS.—With respect to costs of providing 
any scholarship pursuant to subsection (a)— 
‘‘(A) 80 percent of the costs of the scholar-
ship shall be paid from the funds made avail-
able pursuant to subsection (a)(1) provided to 
the Tribal Health Program; and 
‘‘(B) 20 percent of such costs may be paid 
from any other source of funds. 
‘‘(c) COURSE OF STUDY.—A Tribal Health Program 
shall provide scholarships under this section only to Indi-
ans enrolled or accepted for enrollment in a course of 
study (approved by the Secretary) in 1 of the health pro-
fessions contemplated by this Act. 
‘‘(d) CONTRACT.— 
‘‘(1) IN GENERAL.—In providing scholarships 
under subsection (b), the Secretary and the Tribal 
Health Program shall enter into a written contract 
with each recipient of such scholarship. 
‘‘(2) REQUIREMENTS.—Such contract shall— 
‘‘(A) obligate such recipient to provide 
service in an Indian Health Program or urban 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01692
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1693 
HR 3962 PCS 
Indian organization, in the same Service Area 
where the Tribal Health Program providing the 
scholarship is located, for— 
‘‘(i) a number of years for which the 
scholarship is provided (or the part-time 
equivalent thereof, as determined by the 
Secretary), or for a period of 2 years, 
whichever period is greater; or 
‘‘(ii) such greater period of time as 
the recipient and the Tribal Health Pro-
gram may agree; 
‘‘(B) provide that the amount of the schol-
arship— 
‘‘(i) may only be expended for— 
‘‘(I) tuition expenses, other rea-
sonable educational expenses, and rea-
sonable living expenses incurred in at-
tendance at the educational institu-
tion; and 
‘‘(II) payment to the recipient of 
a monthly stipend of not more than 
the amount authorized by section 
338(g)(1)(B) of the Public Health 
Service 
Act 
(42 
U.S.C. 
254m(g)(1)(B)), with such amount to 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01693
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1694 
HR 3962 PCS 
be reduced pro rata (as determined by 
the Secretary) based on the number of 
hours such student is enrolled, and 
not to exceed, for any year of attend-
ance for which the scholarship is pro-
vided, the total amount required for 
the year for the purposes authorized 
in this clause; and 
‘‘(ii) may not exceed, for any year of 
attendance for which the scholarship is 
provided, the total amount required for the 
year for the purposes authorized in clause 
(i); 
‘‘(C) require the recipient of such scholar-
ship to maintain an acceptable level of academic 
standing as determined by the educational insti-
tution in accordance with regulations issued 
pursuant to this Act; and 
‘‘(D) require the recipient of such scholar-
ship to meet the educational and licensure re-
quirements appropriate to each health profes-
sion. 
‘‘(3) SERVICE IN OTHER SERVICE AREAS.—The 
contract may allow the recipient to serve in another 
Service Area, provided the Tribal Health Program 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01694
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1695 
HR 3962 PCS 
and Secretary approve and services are not dimin-
ished to Indians in the Service Area where the Trib-
al Health Program providing the scholarship is lo-
cated. 
‘‘(e) BREACH OF CONTRACT.— 
‘‘(1) SPECIFIC BREACHES.—An individual who 
has entered into a written contract with the Sec-
retary and a Tribal Health Program under sub-
section (d) shall be liable to the United States for 
the Federal share of the amount which has been 
paid to him or her, or on his or her behalf, under 
the contract if that individual— 
‘‘(A) fails to maintain an acceptable level 
of academic standing in the educational institu-
tion in which he or she is enrolled (such level 
as determined by the educational institution 
under regulations of the Secretary); 
‘‘(B) is dismissed from such educational 
institution for disciplinary reasons; 
‘‘(C) voluntarily terminates the training in 
such an educational institution for which he or 
she is provided a scholarship under such con-
tract before the completion of such training; or 
‘‘(D) fails to accept payment, or instructs 
the educational institution in which he or she is 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01695
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1696 
HR 3962 PCS 
enrolled not to accept payment, in whole or in 
part, of a scholarship under such contract, in 
lieu of any service obligation arising under such 
contract. 
‘‘(2) OTHER BREACHES.—If for any reason not 
specified in paragraph (1), an individual breaches a 
written contract by failing to either begin such indi-
vidual’s service obligation required under such con-
tract or to complete such service obligation, the 
United States shall be entitled to recover from the 
individual an amount determined in accordance with 
the formula specified in subsection (l) of section 110 
in the manner provided for in such subsection. 
‘‘(3) CANCELLATION UPON DEATH OF RECIPI-
ENT.—Upon the death of an individual who receives 
an Indian Health Scholarship, any outstanding obli-
gation of that individual for service or payment that 
relates to that scholarship shall be canceled. 
‘‘(4) INFORMATION.—The Secretary may carry 
out this subsection on the basis of information re-
ceived from Tribal Health Programs involved or on 
the basis of information collected through such other 
means as the Secretary deems appropriate. 
‘‘(f) RELATION TO SOCIAL SECURITY ACT.—The re-
cipient of a scholarship under this section shall agree, in 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01696
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1697 
HR 3962 PCS 
providing health care pursuant to the requirements here-
in— 
‘‘(1) not to discriminate against an individual 
seeking care on the basis of the ability of the indi-
vidual to pay for such care or on the basis that pay-
ment for such care will be made pursuant to a pro-
gram established in title XVIII of the Social Secu-
rity Act or pursuant to the programs established in 
title XIX or title XXI of such Act; and 
‘‘(2) to accept assignment under section 
1842(b)(3)(B)(ii) of the Social Security Act for all 
services for which payment may be made under part 
B of title XVIII of such Act, and to enter into an 
appropriate agreement with the State agency that 
administers the State plan for medical assistance 
under title XIX, or the State child health plan under 
title XXI, of such Act to provide service to individ-
uals entitled to medical assistance or child health as-
sistance, respectively, under the plan. 
‘‘(g) CONTINUANCE OF FUNDING.—The Secretary 
shall make payments under this section to a Tribal Health 
Program for any fiscal year subsequent to the first fiscal 
year of such payments unless the Secretary determines 
that, for the immediately preceding fiscal year, the Tribal 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01697
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1698 
HR 3962 PCS 
Health Program has not complied with the requirements 
of this section. 
‘‘SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS. 
‘‘(a) EMPLOYMENT PREFERENCE.—Any individual 
who receives a scholarship pursuant to section 104 or 106 
shall be given preference for employment in the Service, 
or may be employed by a Tribal Health Program or an 
urban Indian organization, or other agencies of the De-
partment as available, during any nonacademic period of 
the year. 
‘‘(b) NOT COUNTED TOWARD ACTIVE DUTY SERVICE 
OBLIGATION.—Periods of employment pursuant to this 
subsection shall not be counted in determining fulfillment 
of the service obligation incurred as a condition of the 
scholarship. 
‘‘(c) TIMING; LENGTH OF EMPLOYMENT.—Any indi-
vidual enrolled in a program, including a high school pro-
gram, authorized under section 102(a) may be employed 
by the Service or by a Tribal Health Program or an urban 
Indian organization during any nonacademic period of the 
year. Any such employment shall not exceed 120 days dur-
ing any calendar year. 
‘‘(d) NONAPPLICABILITY
OF
COMPETITIVE
PER-
SONNEL SYSTEM.—Any employment pursuant to this sec-
tion shall be made without regard to any competitive per-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01698
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1699 
HR 3962 PCS 
sonnel system or agency personnel limitation and to a po-
sition which will enable the individual so employed to re-
ceive practical experience in the health profession in which 
he or she is engaged in study. Any individual so employed 
shall receive payment for his or her services comparable 
to the salary he or she would receive if he or she were 
employed in the competitive system. Any individual so em-
ployed shall not be counted against any employment ceil-
ing affecting the Service or the Department. 
‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES. 
‘‘In order to encourage scholarship and stipend re-
cipients under sections 104, 105, 106, and 115 and health 
professionals, including community health representatives 
and emergency medical technicians, to join or continue in 
an Indian Health Program and to provide their services 
in the rural and remote areas where a significant portion 
of Indians reside, the Secretary, acting through the Serv-
ice, may— 
‘‘(1) provide programs or allowances to transi-
tion into an Indian Health Program, including li-
censing, board or certification examination assist-
ance, and technical assistance in fulfilling service ob-
ligations under sections 104, 105, 106, and 115; and 
‘‘(2) provide programs or allowances to health 
professionals employed in an Indian Health Program 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01699
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1700 
HR 3962 PCS 
to enable them for a period of time each year pre-
scribed by regulation of the Secretary to take leave 
of their duty stations for professional consultation, 
management, leadership, and refresher training 
courses. 
‘‘SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PRO-
GRAM. 
‘‘(a) IN GENERAL.—Under the authority of the Act 
of November 2, 1921 (25 U.S.C. 13) (commonly known 
as the ‘Snyder Act’), the Secretary, acting through the 
Service, shall maintain a Community Health Representa-
tive Program under which Indian Health Programs— 
‘‘(1) provide for the training of Indians as com-
munity health representatives; and 
‘‘(2) use such community health representatives 
in the provision of health care, health promotion, 
and disease prevention services to Indian commu-
nities. 
‘‘(b) DUTIES.—The Community Health Representa-
tive Program of the Service, shall— 
‘‘(1) provide a high standard of training for 
community health representatives to ensure that the 
community health representatives provide quality 
health care, health promotion, and disease preven-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01700
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1701 
HR 3962 PCS 
tion services to the Indian communities served by 
the Program; 
‘‘(2) in order to provide such training, develop 
and maintain a curriculum that— 
‘‘(A) combines education in the theory of 
health care with supervised practical experience 
in the provision of health care; and 
‘‘(B) provides instruction and practical ex-
perience in health promotion and disease pre-
vention activities, with appropriate consider-
ation given to lifestyle factors that have an im-
pact on Indian health status, such as alco-
holism, family dysfunction, and poverty; 
‘‘(3) maintain a system which identifies the 
needs of community health representatives for con-
tinuing education in health care, health promotion, 
and disease prevention and develop programs that 
meet the needs for continuing education; 
‘‘(4) maintain a system that provides close su-
pervision of Community Health Representatives; 
‘‘(5) maintain a system under which the work 
of Community Health Representatives is reviewed 
and evaluated; and 
‘‘(6) promote traditional health care practices 
of the Indian Tribes served consistent with the Serv-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01701
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1702 
HR 3962 PCS 
ice standards for the provision of health care, health 
promotion, and disease prevention. 
‘‘SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT 
PROGRAM. 
‘‘(a) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the Service, shall establish and administer a pro-
gram to be known as the Service Loan Repayment Pro-
gram (hereinafter referred to as the ‘Loan Repayment 
Program’) in order to ensure an adequate supply of 
trained health professionals necessary to maintain accredi-
tation of, and provide health care services to Indians 
through, Indian Health Programs and urban Indian orga-
nizations. 
‘‘(b) ELIGIBLE INDIVIDUALS.—To be eligible to par-
ticipate in the Loan Repayment Program, an individual 
must— 
‘‘(1)(A) be enrolled— 
‘‘(i) in a course of study or program in an 
accredited educational institution (as deter-
mined 
by 
the 
Secretary 
under 
section 
338B(b)(1)(c)(i) of the Public Health Service 
Act (42 U.S.C. 254l–1(b)(1)(c)(i))) and be 
scheduled to complete such course of study in 
the same year such individual applies to partici-
pate in such program; or 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01702
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1703 
HR 3962 PCS 
‘‘(ii) in an approved graduate training pro-
gram in a health profession; or 
‘‘(B) have— 
‘‘(i) a degree in a health profession; and 
‘‘(ii) a license to practice a health profes-
sion; 
‘‘(2)(A) be eligible for, or hold, an appointment 
as a commissioned officer in the Regular or Reserve 
Corps of the Public Health Service; 
‘‘(B) meet the professional standards for civil 
service employment in the Service; or 
‘‘(C) be employed in an Indian Health Program 
or urban Indian organization without a service obli-
gation; and 
‘‘(3) submit to the Secretary an application for 
a contract described in subsection (e). 
‘‘(c) APPLICATION.— 
‘‘(1) INFORMATION
TO
BE
INCLUDED
WITH 
FORMS.—In disseminating application forms and 
contract forms to individuals desiring to participate 
in the Loan Repayment Program, the Secretary 
shall include with such forms a fair summary of the 
rights and liabilities of an individual whose applica-
tion is approved (and whose contract is accepted) by 
the Secretary, including in the summary a clear ex-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01703
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1704 
HR 3962 PCS 
planation of the damages to which the United States 
is entitled under subsection (l) in the case of the in-
dividual’s breach of contract. The Secretary shall 
provide such individuals with sufficient information 
regarding the advantages and disadvantages of serv-
ice as a commissioned officer in the Regular or Re-
serve Corps of the Public Health Service or a civil-
ian employee of the Service to enable the individual 
to make a decision on an informed basis. 
‘‘(2) CLEAR LANGUAGE.—The application form, 
contract form, and all other information furnished 
by the Secretary under this section shall be written 
in a manner calculated to be understood by the aver-
age individual applying to participate in the Loan 
Repayment Program. 
‘‘(3) TIMELY
AVAILABILITY
OF
FORMS.—The 
Secretary shall make such application forms, con-
tract forms, and other information available to indi-
viduals desiring to participate in the Loan Repay-
ment Program on a date sufficiently early to ensure 
that such individuals have adequate time to carefully 
review and evaluate such forms and information. 
‘‘(d) PRIORITIES.— 
‘‘(1) LIST.—Consistent with subsection (j), the 
Secretary shall annually— 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01704
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1705 
HR 3962 PCS 
‘‘(A) identify the positions in each Indian 
Health Program or urban Indian organization 
for which there is a need or a vacancy; and 
‘‘(B) rank those positions in order of pri-
ority. 
‘‘(2) APPROVALS.—Consistent with the priority 
determined under paragraph (1), the Secretary, in 
determining which applications under the Loan Re-
payment Program to approve (and which contracts 
to accept), shall— 
‘‘(A) give first priority to applications 
made by individual Indians; and 
‘‘(B) after making determinations on all 
applications submitted by individual Indians as 
required under subparagraph (A), give priority 
to— 
‘‘(i) individuals recruited through the 
efforts of an Indian Health Program or 
urban Indian organization; and 
‘‘(ii) other individuals based on the 
priority rankings under paragraph (1). 
‘‘(e) RECIPIENT CONTRACTS.— 
‘‘(1) CONTRACT REQUIRED.—An individual be-
comes a participant in the Loan Repayment Pro-
gram only upon the Secretary and the individual en-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01705
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1706 
HR 3962 PCS 
tering into a written contract described in paragraph 
(2). 
‘‘(2) CONTENTS
OF
CONTRACT.—The written 
contract referred to in this section between the Sec-
retary and an individual shall contain— 
‘‘(A) an agreement under which— 
‘‘(i) subject to subparagraph (C), the 
Secretary agrees— 
‘‘(I) to pay loans on behalf of the 
individual in accordance with the pro-
visions of this section; and 
‘‘(II) to accept (subject to the 
availability of appropriated funds for 
carrying out this section) the indi-
vidual into the Service or place the in-
dividual with a Tribal Health Pro-
gram or urban Indian organization as 
provided in clause (ii)(III); and 
‘‘(ii) subject to subparagraph (C), the 
individual agrees— 
‘‘(I) to accept loan payments on 
behalf of the individual; 
‘‘(II) in the case of an individual 
described in subsection (b)(1)— 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01706
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1707 
HR 3962 PCS 
‘‘(aa) to maintain enrollment 
in a course of study or training 
described in subsection (b)(1)(A) 
until the individual completes the 
course of study or training; and 
‘‘(bb) while enrolled in such 
course of study or training, to 
maintain an acceptable level of 
academic standing (as deter-
mined under regulations of the 
Secretary by the educational in-
stitution offering such course of 
study or training); and 
‘‘(III) to serve for a time period 
(in this section referred to as the ‘pe-
riod of obligated service’) equal to 2 
years or such longer period as the in-
dividual may agree to serve in the 
full-time clinical practice of such indi-
vidual’s 
profession 
in 
an 
Indian 
Health Program or urban Indian or-
ganization to which the individual 
may be assigned by the Secretary; 
‘‘(B) a provision permitting the Secretary 
to extend for such longer additional periods, as 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01707
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1708 
HR 3962 PCS 
the individual may agree to, the period of obli-
gated service agreed to by the individual under 
subparagraph (A)(ii)(III); 
‘‘(C) a provision that any financial obliga-
tion of the United States arising out of a con-
tract entered into under this section and any 
obligation of the individual which is conditioned 
thereon is contingent upon funds being appro-
priated for loan repayments under this section; 
‘‘(D) a statement of the damages to which 
the United States is entitled under subsection 
(k) for the individual’s breach of the contract; 
and 
‘‘(E) such other statements of the rights 
and liabilities of the Secretary and of the indi-
vidual, not inconsistent with this section. 
‘‘(f) DEADLINE FOR DECISION ON APPLICATION.— 
The Secretary shall provide written notice to an individual 
within 21 days on— 
‘‘(1) the Secretary’s approving, under sub-
section (e)(1), of the individual’s participation in the 
Loan Repayment Program, including extensions re-
sulting in an aggregate period of obligated service in 
excess of 4 years; or 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01708
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1709 
HR 3962 PCS 
‘‘(2) the Secretary’s disapproving an individ-
ual’s participation in such Program. 
‘‘(g) PAYMENTS.— 
‘‘(1) IN GENERAL.—A loan repayment provided 
for an individual under a written contract under the 
Loan Repayment Program shall consist of payment, 
in accordance with paragraph (2), on behalf of the 
individual of the principal, interest, and related ex-
penses on government and commercial loans received 
by the individual regarding the undergraduate or 
graduate education of the individual (or both), which 
loans were made for— 
‘‘(A) tuition expenses; 
‘‘(B) all other reasonable educational ex-
penses, including fees, books, and laboratory ex-
penses, incurred by the individual; and 
‘‘(C) reasonable living expenses as deter-
mined by the Secretary. 
‘‘(2) AMOUNT.—For each year of obligated 
service that an individual contracts to serve under 
subsection (e), the Secretary may pay up to $35,000 
or an amount equal to the amount specified in sec-
tion 338B(g)(2)(A) of the Public Health Service 
Act, whichever is more, on behalf of the individual 
for loans described in paragraph (1). In making a 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01709
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1710 
HR 3962 PCS 
determination of the amount to pay for a year of 
such service by an individual, the Secretary shall 
consider the extent to which each such determina-
tion— 
‘‘(A) affects the ability of the Secretary to 
maximize the number of contracts that can be 
provided under the Loan Repayment Program 
from the amounts appropriated for such con-
tracts; 
‘‘(B) provides an incentive to serve in In-
dian Health Programs and urban Indian orga-
nizations with the greatest shortages of health 
professionals; and 
‘‘(C) provides an incentive with respect to 
the health professional involved remaining in an 
Indian Health Program or urban Indian organi-
zation with such a health professional shortage, 
and continuing to provide primary health serv-
ices, after the completion of the period of obli-
gated service under the Loan Repayment Pro-
gram. 
‘‘(3) TIMING.—Any arrangement made by the 
Secretary for the making of loan repayments in ac-
cordance with this subsection shall provide that any 
repayments for a year of obligated service shall be 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01710
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1711 
HR 3962 PCS 
made no later than the end of the fiscal year in 
which the individual completes such year of service. 
‘‘(4) REIMBURSEMENTS FOR TAX LIABILITY.— 
For the purpose of providing reimbursements for tax 
liability resulting from a payment under paragraph 
(2) on behalf of an individual, the Secretary— 
‘‘(A) in addition to such payments, may 
make payments to the individual in an amount 
equal to not less than 20 percent and not more 
than 39 percent of the total amount of loan re-
payments made for the taxable year involved; 
and 
‘‘(B) may make such additional payments 
as the Secretary determines to be appropriate 
with respect to such purpose. 
‘‘(5) PAYMENT
SCHEDULE.—The Secretary 
may enter into an agreement with the holder of any 
loan for which payments are made under the Loan 
Repayment Program to establish a schedule for the 
making of such payments. 
‘‘(h) EMPLOYMENT CEILING.—Notwithstanding any 
other provision of law, individuals who have entered into 
written contracts with the Secretary under this section 
shall not be counted against any employment ceiling af-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01711
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1712 
HR 3962 PCS 
fecting the Department while those individuals are under-
going academic training. 
‘‘(i) RECRUITMENT.—The Secretary shall conduct re-
cruiting programs for the Loan Repayment Program and 
other manpower programs of the Service at educational 
institutions training health professionals or specialists 
identified in subsection (a). 
‘‘(j) APPLICABILITY OF LAW.—Section 214 of the 
Public Health Service Act (42 U.S.C. 215) shall not apply 
to individuals during their period of obligated service 
under the Loan Repayment Program. 
‘‘(k) ASSIGNMENT OF INDIVIDUALS.—The Secretary, 
in assigning individuals to serve in Indian Health Pro-
grams or urban Indian organizations pursuant to con-
tracts entered into under this section, shall— 
‘‘(1) ensure that the staffing needs of Tribal 
Health Programs and urban Indian organizations 
receive consideration on an equal basis with pro-
grams that are administered directly by the Service; 
and 
‘‘(2) give priority to assigning individuals to In-
dian Health Programs and urban Indian organiza-
tions that have a need for health professionals to 
provide health care services as a result of individuals 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01712
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1713 
HR 3962 PCS 
having breached contracts entered into under this 
section. 
‘‘(l) BREACH OF CONTRACT.— 
‘‘(1) SPECIFIC BREACHES.—An individual who 
has entered into a written contract with the Sec-
retary under this section and has not received a 
waiver under subsection (m) shall be liable, in lieu 
of any service obligation arising under such contract, 
to the United States for the amount which has been 
paid on such individual’s behalf under the contract 
if that individual— 
‘‘(A) is enrolled in the final year of a 
course of study and— 
‘‘(i) fails to maintain an acceptable 
level of academic standing in the edu-
cational institution in which he or she is 
enrolled (such level determined by the edu-
cational institution under regulations of 
the Secretary); 
‘‘(ii) voluntarily terminates such en-
rollment; or 
‘‘(iii) is dismissed from such edu-
cational institution before completion of 
such course of study; or 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01713
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1714 
HR 3962 PCS 
‘‘(B) is enrolled in a graduate training pro-
gram and fails to complete such training pro-
gram. 
‘‘(2) 
OTHER
BREACHES; 
FORMULA
FOR 
AMOUNT OWED.—If, for any reason not specified in 
paragraph (1), an individual breaches his or her 
written contract under this section by failing either 
to begin, or complete, such individual’s period of ob-
ligated service in accordance with subsection (e)(2), 
the United States shall be entitled to recover from 
such individual an amount to be determined in ac-
cordance with the following formula: A=3Z(t¥s/t) 
in which— 
‘‘(A) ‘A’ is the amount the United States 
is entitled to recover; 
‘‘(B) ‘Z’ is the sum of the amounts paid 
under this section to, or on behalf of, the indi-
vidual and the interest on such amounts which 
would be payable if, at the time the amounts 
were paid, they were loans bearing interest at 
the maximum legal prevailing rate, as deter-
mined by the Secretary of the Treasury; 
‘‘(C) ‘t’ is the total number of months in 
the individual’s period of obligated service; and 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01714
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1715 
HR 3962 PCS 
‘‘(D) ‘s’ is the number of months of such 
period served by such individual in accordance 
with this section. 
‘‘(3) TIME
PERIOD
FOR
REPAYMENT.—Any 
amount of damages which the United States is enti-
tled to recover under this subsection shall be paid to 
the United States within the 1-year period beginning 
on the date of the breach or such longer period be-
ginning on such date as shall be specified by the 
Secretary. 
‘‘(4) DEDUCTIONS IN MEDICARE PAYMENTS.— 
Amounts not paid within such period shall be sub-
ject to collection through deductions in Medicare 
payments pursuant to section 1892 of the Social Se-
curity Act. 
‘‘(5) RECOVERY OF DELINQUENCY.— 
‘‘(A) IN GENERAL.—If damages described 
in paragraph (4) are delinquent for 3 months, 
the Secretary shall, for the purpose of recov-
ering such damages— 
‘‘(i) use collection agencies contracted 
with by the Administrator of General Serv-
ices; or 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01715
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1716 
HR 3962 PCS 
‘‘(ii) enter into contracts for the re-
covery of such damages with collection 
agencies selected by the Secretary. 
‘‘(B) REPORT.—Each contract for recov-
ering damages pursuant to this subsection shall 
provide that the contractor will, not less than 
once each 6 months, submit to the Secretary a 
status report on the success of the contractor in 
collecting such damages. Section 3718 of title 
31, United States Code, shall apply to any such 
contract to the extent not inconsistent with this 
subsection. 
‘‘(m) WAIVER OR SUSPENSION OF OBLIGATION.— 
‘‘(1) IN GENERAL.—The Secretary shall by reg-
ulation provide for the partial or total waiver or sus-
pension of any obligation of service or payment by 
an individual under the Loan Repayment Program 
whenever compliance by the individual is impossible 
or would involve extreme hardship to the individual 
and if enforcement of such obligation with respect to 
any individual would be unconscionable. 
‘‘(2) CANCELED UPON DEATH.—Any obligation 
of an individual under the Loan Repayment Pro-
gram for service or payment of damages shall be 
canceled upon the death of the individual. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01716
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1717 
HR 3962 PCS 
‘‘(3) HARDSHIP WAIVER.—The Secretary may 
waive, in whole or in part, the rights of the United 
States to recover amounts under this section in any 
case of extreme hardship or other good cause shown, 
as determined by the Secretary. 
‘‘(4) BANKRUPTCY.—Any obligation of an indi-
vidual under the Loan Repayment Program for pay-
ment of damages may be released by a discharge in 
bankruptcy under title 11, United States Code, only 
if such discharge is granted after the expiration of 
the 5-year period beginning on the first date that 
payment of such damages is required, and only if 
the bankruptcy court finds that nondischarge of the 
obligation would be unconscionable. 
‘‘(n) REPORT.—The Secretary shall submit to the 
President, for inclusion in the report required to be sub-
mitted to Congress under section 801, a report concerning 
the previous fiscal year which sets forth by Service Area 
the following: 
‘‘(1) A list of the health professional positions 
maintained by Indian Health Programs and urban 
Indian organizations for which recruitment or reten-
tion is difficult. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01717
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1718 
HR 3962 PCS 
‘‘(2) The number of Loan Repayment Program 
applications filed with respect to each type of health 
profession. 
‘‘(3) The number of contracts described in sub-
section (e) that are entered into with respect to each 
health profession. 
‘‘(4) The amount of loan payments made under 
this section, in total and by health profession. 
‘‘(5) The number of scholarships that are pro-
vided under sections 104 and 106 with respect to 
each health profession. 
‘‘(6) The amount of scholarship grants provided 
under sections 104 and 106, in total and by health 
profession. 
‘‘(7) The number of providers of health care 
that will be needed by Indian Health Programs and 
urban Indian organizations, by location and profes-
sion, during the 3 fiscal years beginning after the 
date the report is filed. 
‘‘(8) The measures the Secretary plans to take 
to fill the health professional positions maintained 
by Indian Health Programs or urban Indian organi-
zations for which recruitment or retention is dif-
ficult. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01718
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1719 
HR 3962 PCS 
‘‘SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOV-
ERY FUND. 
‘‘(a) ESTABLISHMENT.—There is established in the 
Treasury of the United States a fund to be known as the 
Indian Health Scholarship and Loan Repayment Recovery 
Fund (hereafter in this section referred to as the ‘LRRF’). 
The LRRF shall consist of such amounts as may be col-
lected from individuals under section 104(d), section 
106(e), and section 110(l) for breach of contract, such 
funds as may be appropriated to the LRRF, and interest 
earned on amounts in the LRRF. All amounts collected, 
appropriated, or earned relative to the LRRF shall remain 
available until expended. 
‘‘(b) USE OF FUNDS.— 
‘‘(1) BY SECRETARY.—Amounts in the LRRF 
may be expended by the Secretary, acting through 
the Service, to make payments to an Indian Health 
Program— 
‘‘(A) to which a scholarship recipient under 
section 104 and 106 or a loan repayment pro-
gram participant under section 110 has been 
assigned to meet the obligated service require-
ments pursuant to such sections; and 
‘‘(B) that has a need for a health profes-
sional to provide health care services as a result 
of such recipient or participant having breached 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01719
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1720 
HR 3962 PCS 
the contract entered into under section 104, 
106, or 110. 
‘‘(2) BY TRIBAL HEALTH PROGRAMS.—A Tribal 
Health Program receiving payments pursuant to 
paragraph (1) may expend the payments to provide 
scholarships or recruit and employ, directly or by 
contract, health professionals to provide health care 
services. 
‘‘(c) INVESTMENT OF FUNDS.—The Secretary of the 
Treasury shall invest such amounts of the LRRF as the 
Secretary of Health and Human Services determines are 
not required to meet current withdrawals from the LRRF. 
Such investments may be made only in interest bearing 
obligations of the United States. For such purpose, such 
obligations may be acquired on original issue at the issue 
price, or by purchase of outstanding obligations at the 
market price. 
‘‘(d) SALE
OF OBLIGATIONS.—Any obligation ac-
quired by the LRRF may be sold by the Secretary of the 
Treasury at the market price. 
‘‘SEC. 112. RECRUITMENT ACTIVITIES. 
‘‘(a) REIMBURSEMENT
FOR
TRAVEL.—The Sec-
retary, acting through the Service, may reimburse health 
professionals seeking positions with Indian Health Pro-
grams or urban Indian organizations, including individ-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01720
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1721 
HR 3962 PCS 
uals considering entering into a contract under section 
110 and their spouses, for actual and reasonable expenses 
incurred in traveling to and from their places of residence 
to an area in which they may be assigned for the purpose 
of evaluating such area with respect to such assignment. 
‘‘(b) RECRUITMENT PERSONNEL.—The Secretary, 
acting through the Service, shall assign 1 individual in 
each Area Office to be responsible on a full-time basis for 
recruitment activities. 
‘‘SEC. 113. INDIAN RECRUITMENT AND RETENTION PRO-
GRAM. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Service, shall fund, on a competitive basis, innovative 
demonstration projects for a period not to exceed 3 years 
to enable Indian Health Programs and urban Indian orga-
nizations to recruit, place, and retain health professionals 
to meet their staffing needs. 
‘‘(b) ELIGIBLE ENTITIES; APPLICATION.—Any In-
dian Health Program or Urban Indian organization may 
submit an application for funding of a project pursuant 
to this section. 
‘‘SEC. 114. ADVANCED TRAINING AND RESEARCH. 
‘‘(a) DEMONSTRATION PROGRAM.—The Secretary, 
acting through the Service, shall establish a demonstration 
project to enable health professionals who have worked in 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01721
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1722 
HR 3962 PCS 
an Indian Health Program or urban Indian organization 
for a substantial period of time to pursue advanced train-
ing or research areas of study for which the Secretary de-
termines a need exists. 
‘‘(b) SERVICE OBLIGATION.—An individual who par-
ticipates in a program under subsection (a), where the 
educational costs are borne 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 at least the period of time during which the individual 
participates in such program. In the event that the indi-
vidual fails to complete such obligated service, the indi-
vidual shall be liable to the United States for the period 
of service remaining. In such event, with respect to indi-
viduals entering the program after the date of enactment 
of the Indian Health Care Improvement Act Amendments 
of 2009, the United States shall be entitled to recover 
from such individual an amount to be determined in ac-
cordance with the formula specified in subsection (l) of 
section 110 in the manner provided for in such subsection. 
‘‘(c) EQUAL OPPORTUNITY FOR PARTICIPATION.— 
Health professionals from Tribal Health Programs and 
urban Indian organizations shall be given an equal oppor-
tunity to participate in the program under subsection (a). 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01722
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1723 
HR 3962 PCS 
‘‘SEC. 115. QUENTIN N. BURDICK AMERICAN INDIANS INTO 
NURSING PROGRAM. 
‘‘(a) GRANTS AUTHORIZED.—For the purpose of in-
creasing the number of nurses, nurse midwives, and nurse 
practitioners who deliver health care services to Indians, 
the Secretary, acting through the Service, shall provide 
grants to the following: 
‘‘(1) Public or private schools of nursing. 
‘‘(2) Tribal colleges or universities. 
‘‘(3) Nurse midwife programs and advanced 
practice nurse programs that are provided by any 
tribal college or university accredited nursing pro-
gram, or in the absence of such, any other public or 
private institutions. 
‘‘(b) USE OF GRANTS.—Grants provided under sub-
section (a) may be used for 1 or more of the following: 
‘‘(1) To recruit individuals for programs which 
train individuals to be nurses, nurse midwives, or 
advanced practice nurses. 
‘‘(2) To provide scholarships to Indians enrolled 
in such programs that may pay the tuition charged 
for such program and other expenses incurred in 
connection with such program, including books, fees, 
room and board, and stipends for living expenses. 
‘‘(3) To provide a program that encourages 
nurses, nurse midwives, and advanced practice 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01723
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1724 
HR 3962 PCS 
nurses to provide, or continue to provide, health care 
services to Indians. 
‘‘(4) To provide a program that increases the 
skills of, and provides continuing education to, 
nurses, nurse midwives, and advanced practice 
nurses. 
‘‘(5) To provide any program that is designed 
to achieve the purpose described in subsection (a). 
‘‘(c) APPLICATIONS.—Each application for a grant 
under subsection (a) shall include such information as the 
Secretary may require to establish the connection between 
the program of the applicant and a health care facility 
that primarily serves Indians. 
‘‘(d) PREFERENCES FOR GRANT RECIPIENTS.—In 
providing grants under subsection (a), the Secretary shall 
extend a preference to the following: 
‘‘(1) Programs that provide a preference to In-
dians. 
‘‘(2) Programs that train nurse midwives or ad-
vanced practice nurses. 
‘‘(3) Programs that are interdisciplinary. 
‘‘(4) Programs that are conducted in coopera-
tion with a program for gifted and talented Indian 
students. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01724
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1725 
HR 3962 PCS 
‘‘(5) Programs conducted by tribal colleges and 
universities. 
‘‘(e) QUENTIN N. BURDICK PROGRAM GRANT.—The 
Secretary shall provide 1 of the grants authorized under 
subsection (a) to establish and maintain a program at the 
University of North Dakota to be known as the ‘Quentin 
N. Burdick American Indians Into Nursing Program’. 
Such program shall, to the maximum extent feasible, co-
ordinate with the Quentin N. Burdick Indian Health Pro-
grams established under section 117(b) and the Quentin 
N. Burdick American Indians Into Psychology Program 
established under section 105(b). 
‘‘(f) ACTIVE DUTY SERVICE OBLIGATION.—The ac-
tive duty service obligation prescribed under section 338C 
of the Public Health Service Act (42 U.S.C. 254m) shall 
be met by each individual who receives training or assist-
ance described in paragraph (1) or (2) of subsection (b) 
that is funded by a grant provided under subsection (a). 
Such obligation shall be met by service— 
‘‘(1) in the Service; 
‘‘(2) in a program of an Indian Tribe or Tribal 
Organization conducted under the Indian Self-Deter-
mination and Education Assistance Act (25 U.S.C. 
450 et seq.) (including programs under agreements 
with the Bureau of Indian Affairs); 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01725
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1726 
HR 3962 PCS 
‘‘(3) in a program assisted under title V of this 
Act; 
‘‘(4) in the private practice of nursing if, as de-
termined by the Secretary, in accordance with guide-
lines promulgated by the Secretary, such practice is 
situated in a physician or other health shortage area 
and addresses the health care needs of a substantial 
number of Indians; or 
‘‘(5) in a teaching capacity in a tribal college or 
university nursing program (or a related health pro-
fession program) if, as determined by the Secretary, 
health services provided to Indians would not de-
crease. 
‘‘SEC. 116. TRIBAL CULTURAL ORIENTATION. 
‘‘(a) CULTURAL EDUCATION OF EMPLOYEES.—The 
Secretary, acting through the Service, shall require that 
appropriate employees of the Service who serve Indian 
Tribes in each Service Area receive educational instruction 
in the history and culture of such Indian Tribes and their 
relationship to the Service. 
‘‘(b) PROGRAM.—In carrying out subsection (a), the 
Secretary shall establish a program which shall, to the ex-
tent feasible— 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01726
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1727 
HR 3962 PCS 
‘‘(1) be developed in consultation with the af-
fected Indian Tribes, Tribal Organizations, and 
urban Indian organizations; 
‘‘(2) be carried out through tribal colleges or 
universities; 
‘‘(3) include instruction in American Indian 
studies; and 
‘‘(4) describe the use and place of traditional 
health care practices of the Indian Tribes in the 
Service Area. 
‘‘SEC. 117. INMED PROGRAM. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 
through the Service, is authorized to provide grants to col-
leges and universities for the purpose of maintaining and 
expanding the Indian health careers recruitment program 
known as the ‘Indians Into Medicine Program’ (herein-
after in this section referred to as ‘INMED’) as a means 
of encouraging Indians to enter the health professions. 
‘‘(b) QUENTIN N. BURDICK GRANT.—The Secretary 
shall provide 1 of the grants authorized under subsection 
(a) to maintain the INMED program at the University 
of North Dakota, to be known as the ‘Quentin N. Burdick 
Indian Health Programs’, unless the Secretary makes a 
determination, based upon program reviews, that the pro-
gram is not meeting the purposes of this section. Such 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01727
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1728 
HR 3962 PCS 
program shall, to the maximum extent feasible, coordinate 
with the Quentin N. Burdick American Indians Into Psy-
chology Program established under section 105(b) and the 
Quentin N. Burdick American Indians Into Nursing Pro-
gram established under section 115. 
‘‘(c) REGULATIONS.—The Secretary, pursuant to this 
Act, shall develop regulations to govern grants pursuant 
to this section. 
‘‘(d) REQUIREMENTS.—Applicants for grants pro-
vided under this section shall agree to provide a program 
which— 
‘‘(1) provides outreach and recruitment for 
health professions to Indian communities including 
elementary and secondary schools and community 
colleges located on reservations which will be served 
by the program; 
‘‘(2) incorporates a program advisory board 
comprised of representatives from the Indian Tribes 
and Indian communities which will be served by the 
program; 
‘‘(3) provides summer preparatory programs for 
Indian students who need enrichment in the subjects 
of math and science in order to pursue training in 
the health professions; 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01728
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1729 
HR 3962 PCS 
‘‘(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.— 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01729
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1730 
HR 3962 PCS 
‘‘(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; 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01730
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1731 
HR 3962 PCS 
‘‘(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— 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01731
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1732 
HR 3962 PCS 
‘‘(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; 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01732
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1733 
HR 3962 PCS 
‘‘(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 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01733
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1734 
HR 3962 PCS 
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-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01734
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1735 
HR 3962 PCS 
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. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01735
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1736 
HR 3962 PCS 
‘‘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 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01736
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1737 
HR 3962 PCS 
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 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01737
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1738 
HR 3962 PCS 
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.— 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01738
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1739 
HR 3962 PCS 
‘‘(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— 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01739
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1740 
HR 3962 PCS 
‘‘(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 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01740
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1741 
HR 3962 PCS 
‘‘(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. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01741
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1742 
HR 3962 PCS 
‘‘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. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01742
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1743 
HR 3962 PCS 
‘‘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. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01743
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1744 
HR 3962 PCS 
‘‘(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-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01744
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1745 
HR 3962 PCS 
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. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01745
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1746 
HR 3962 PCS 
‘‘(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), 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01746
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1747 
HR 3962 PCS 
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-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01747
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1748 
HR 3962 PCS 
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. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01748
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1749 
HR 3962 PCS 
‘‘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 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01749
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1750 
HR 3962 PCS 
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 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01750
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1751 
HR 3962 PCS 
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. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01751
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1752 
HR 3962 PCS 
‘‘(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 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01752
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1753 
HR 3962 PCS 
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-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01753
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1754 
HR 3962 PCS 
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. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01754
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1755 
HR 3962 PCS 
‘‘(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 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01755
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1756 
HR 3962 PCS 
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 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01756
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1757 
HR 3962 PCS 
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— 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01757
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1758 
HR 3962 PCS 
‘‘(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 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01758
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1759 
HR 3962 PCS 
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)— 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01759
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1760 
HR 3962 PCS 
‘‘(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. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01760
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1761 
HR 3962 PCS 
‘‘(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 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01761
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1762 
HR 3962 PCS 
‘‘(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; 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01762
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1763 
HR 3962 PCS 
‘‘(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-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01763
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1764 
HR 3962 PCS 
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— 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01764
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1765 
HR 3962 PCS 
‘‘(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 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01765
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1766 
HR 3962 PCS 
‘‘(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 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01766
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1767 
HR 3962 PCS 
such manner and at such time as the Secretary shall 
prescribe. 
‘‘(4) REQUIREMENTS.—An applicant for a 
grant under this subsection shall— 
‘‘(A) demonstrate the technical, adminis-
trative, and financial expertise necessary to 
carry out the functions described in paragraph 
(5); 
‘‘(B) consult and cooperate with providers 
of related health and social services in order to 
avoid duplication of existing services; and 
‘‘(C) demonstrate cooperation from Indian 
Tribes or Urban Indian Organizations in the 
area to be served. 
‘‘(5) USE OF FUNDS.—A grant awarded under 
paragraph (1) may be used— 
‘‘(A) to carry out the functions described 
in subsection (b); 
‘‘(B) to provide information to and consult 
with tribal leaders, urban Indian community 
leaders, and related health staff on health care 
and health service management issues; and 
‘‘(C) in collaboration with Indian Tribes, 
Tribal Organizations, and urban Indian com-
munities, to provide the Service with informa-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01767
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1768 
HR 3962 PCS 
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 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01768
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1769 
HR 3962 PCS 
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. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01769
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1770 
HR 3962 PCS 
‘‘(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-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01770
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1771 
HR 3962 PCS 
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; 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01771
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1772 
HR 3962 PCS 
‘‘(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.— 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01772
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1773 
HR 3962 PCS 
‘‘(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. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01773
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1774 
HR 3962 PCS 
‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP-
PLICATIONS.—The Secretary, in consultation with Indian 
Tribes, Tribal Organizations, and urban Indian organiza-
tions, shall establish criteria for the review and approval 
of applications or proposals under this section. 
‘‘SEC. 211. PREVENTION, CONTROL, AND ELIMINATION OF 
COMMUNICABLE AND INFECTIOUS DISEASES. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 
through the Service, and after consultation with the Cen-
ters for Disease Control and Prevention, may make grants 
available to Indian Tribes, Tribal Organizations, and 
urban Indian organizations for the following: 
‘‘(1) Projects for the prevention, control, and 
elimination of communicable and infectious diseases, 
including tuberculosis, hepatitis, HIV, respiratory 
syncytial virus, hanta virus, sexually transmitted dis-
eases, and H. Pylori. 
‘‘(2) Public information and education pro-
grams for the prevention, control, and elimination of 
communicable and infectious diseases. 
‘‘(3) Education, training, and clinical skills im-
provement activities in the prevention, control, and 
elimination of communicable and infectious diseases 
for health professionals, including allied health pro-
fessionals. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01774
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1775 
HR 3962 PCS 
‘‘(4) Demonstration projects for the screening, 
treatment, and prevention of hepatitis C virus 
(HCV). 
‘‘(b) APPLICATION REQUIRED.—The Secretary may 
provide funding under subsection (a) only if an application 
or proposal for funding is submitted to the Secretary. 
‘‘(c) COORDINATION WITH HEALTH AGENCIES.—In-
dian Tribes, Tribal Organizations, and urban Indian orga-
nizations receiving funding under this section are encour-
aged to coordinate their activities with the Centers for 
Disease Control and Prevention and State and local health 
agencies. 
‘‘(d) TECHNICAL ASSISTANCE; REPORT.—In carrying 
out this section, the Secretary— 
‘‘(1) may, at the request of an Indian Tribe, 
Tribal Organization, or urban Indian organization, 
provide technical assistance; and 
‘‘(2) shall prepare and submit a report to Con-
gress biennially on the use of funds under this sec-
tion and on the progress made toward the preven-
tion, control, and elimination of communicable and 
infectious diseases among Indians and Urban Indi-
ans. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01775
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1776 
HR 3962 PCS 
‘‘SEC. 212. OTHER AUTHORITY FOR PROVISION OF SERV-
ICES. 
‘‘(a) FUNDING AUTHORIZED.—The Secretary may 
provide funding under this Act to meet the objectives set 
forth in section 3 of this Act through health care-related 
services and programs of the Service, Indian Tribes, and 
Tribal Organizations not otherwise described in this Act 
for the following services: 
‘‘(1) Hospice care. 
‘‘(2) Assisted living services. 
‘‘(3) Long-term care services. 
‘‘(4) Home- and community-based services. 
‘‘(b) ELIGIBILITY.—The following individuals shall be 
eligible to receive long-term care under this section: 
‘‘(1) Individuals who are unable to perform a 
certain number of activities of daily living without 
assistance. 
‘‘(2) Individuals with a mental impairment, 
such as dementia, Alzheimer’s disease, or another 
disabling mental illness, who may be able to perform 
activities of daily living under supervision. 
‘‘(3) Such other individuals as an applicable In-
dian Health Program determines to be appropriate. 
‘‘(c) DEFINITIONS.—For the purposes of this section, 
the following definitions shall apply: 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01776
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1777 
HR 3962 PCS 
‘‘(1) The term ‘assisted living services’ means 
any service provided by an assisted living facility (as 
defined in section 232(b) of the National Housing 
Act (12 U.S.C. 1715w(b))), except that such an as-
sisted living facility— 
‘‘(A) shall not be required to obtain a li-
cense; but 
‘‘(B) shall meet all applicable standards 
for licensure. 
‘‘(2) The term ‘home- and community-based 
services’ means 1 or more of the services specified 
in paragraphs (1) through (9) of section 1929(a) of 
the Social Security Act (42 U.S.C. 1396t(a)) 
(whether provided by the Service or by an Indian 
Tribe or Tribal Organization pursuant to the Indian 
Self-Determination and Education Assistance Act 
(25 U.S.C. 450 et seq.)) that are or will be provided 
in accordance with applicable standards. 
‘‘(3) The term ‘hospice care’ means the items 
and services specified in subparagraphs (A) through 
(H) of section 1861(dd)(1) of the Social Security 
Act (42 U.S.C. 1395x(dd)(1)), and such other serv-
ices which an Indian Tribe or Tribal Organization 
determines are necessary and appropriate to provide 
in furtherance of this care. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01777
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1778 
HR 3962 PCS 
‘‘(4) The term ‘long-term care services’ has the 
meaning given the term ‘qualified long-term care 
services’ in section 7702B(c) of the Internal Rev-
enue Code of 1986. 
‘‘(d) AUTHORIZATION OF CONVENIENT CARE SERV-
ICES.—The Secretary, acting through the Service, Indian 
Tribes, and Tribal Organizations, may also provide fund-
ing under this Act to meet the objectives set forth in sec-
tion 3 of this Act for convenient care services programs 
pursuant to section 306(c)(2)(A). 
‘‘SEC. 213. INDIAN WOMEN’S HEALTH CARE. 
‘‘The Secretary, acting through the Service and In-
dian Tribes, Tribal Organizations, and Urban Indian Or-
ganizations, shall monitor and improve the quality of 
health care for Indian women of all ages through the plan-
ning and delivery of programs administered by the Service, 
in order to improve and enhance the treatment models of 
care for Indian women. 
‘‘SEC. 214. ENVIRONMENTAL AND NUCLEAR HEALTH HAZ-
ARDS. 
‘‘(a) STUDIES
AND MONITORING.—The Secretary 
and the Service shall conduct, in conjunction with other 
appropriate Federal agencies and in consultation with con-
cerned Indian Tribes and Tribal Organizations, studies 
and ongoing monitoring programs to determine trends in 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01778
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1779 
HR 3962 PCS 
the health hazards to Indian miners and to Indians on 
or near reservations and Indian communities as a result 
of environmental hazards which may result in chronic or 
life threatening health problems, such as nuclear resource 
development, petroleum contamination, and contamination 
of water source and of the food chain. Such studies shall 
include— 
‘‘(1) an evaluation of the nature and extent of 
health problems caused by environmental hazards 
currently exhibited among Indians and the causes of 
such health problems; 
‘‘(2) an analysis of the potential effect of ongo-
ing and future environmental resource development 
on or near reservations and Indian communities, in-
cluding the cumulative effect over time on health; 
‘‘(3) an evaluation of the types and nature of 
activities, practices, and conditions causing or affect-
ing such health problems, including uranium mining 
and milling, uranium mine tailing deposits, nuclear 
power plant operation and construction, and nuclear 
waste disposal; oil and gas production or transpor-
tation on or near reservations or Indian commu-
nities; and other development that could affect the 
health of Indians and their water supply and food 
chain; 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01779
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1780 
HR 3962 PCS 
‘‘(4) a summary of any findings and rec-
ommendations provided in Federal and State stud-
ies, reports, investigations, and inspections during 
the 5 years prior to the date of enactment of the In-
dian Health Care Improvement Act Amendments of 
2009 that directly or indirectly relate to the activi-
ties, practices, and conditions affecting the health or 
safety of such Indians; and 
‘‘(5) the efforts that have been made by Federal 
and State agencies and resource and economic devel-
opment companies to effectively carry out an edu-
cation program for such Indians regarding the 
health and safety hazards of such development. 
‘‘(b) HEALTH CARE PLANS.—Upon completion of 
such studies, the Secretary and the Service shall take into 
account the results of such studies and develop health care 
plans to address the health problems studied under sub-
section (a). The plans shall include— 
‘‘(1) methods for diagnosing and treating Indi-
ans currently exhibiting such health problems; 
‘‘(2) preventive care and testing for Indians 
who may be exposed to such health hazards, includ-
ing the monitoring of the health of individuals who 
have or may have been exposed to excessive amounts 
of radiation or affected by other activities that have 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01780
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1781 
HR 3962 PCS 
had or could have a serious impact upon the health 
of such individuals; and 
‘‘(3) a program of education for Indians who, 
by reason of their work or geographic proximity to 
such nuclear or other development activities, may ex-
perience health problems. 
‘‘(c) SUBMISSION OF REPORT AND PLAN TO CON-
GRESS.—The Secretary and the Service shall submit to 
Congress the study prepared under subsection (a) no later 
than 18 months after the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2009. The 
health care plan prepared under subsection (b) shall be 
submitted in a report no later than 1 year after the study 
prepared under subsection (a) is submitted to Congress. 
Such report shall include recommended activities for the 
implementation of the plan, as well as an evaluation of 
any activities previously undertaken by the Service to ad-
dress such health problems. 
‘‘(d) INTERGOVERNMENTAL TASK FORCE.— 
‘‘(1) ESTABLISHMENT; MEMBERS.—There is es-
tablished an Intergovernmental Task Force to be 
composed of the following individuals (or their des-
ignees): 
‘‘(A) The Secretary of Energy. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01781
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1782 
HR 3962 PCS 
‘‘(B) The Secretary of the Environmental 
Protection Agency. 
‘‘(C) The Director of the Bureau of Mines. 
‘‘(D) The Assistant Secretary for Occupa-
tional Safety and Health. 
‘‘(E) The Secretary of the Interior. 
‘‘(F) The Secretary of Health and Human 
Services. 
‘‘(G) The Director of the Indian Health 
Service. 
‘‘(2) DUTIES.—The Task Force shall— 
‘‘(A) identify existing and potential oper-
ations related to nuclear resource development 
or other environmental hazards that affect or 
may affect the health of Indians on or near a 
reservation or in an Indian community; and 
‘‘(B) enter into activities to correct exist-
ing health hazards and ensure that current and 
future health problems resulting from nuclear 
resource or other development activities are 
minimized or reduced. 
‘‘(3) CHAIRMAN; MEETINGS.—The Secretary of 
Health and Human Services shall be the Chairman 
of the Task Force. The Task Force shall meet at 
least twice each year. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01782
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1784 
HR 3962 PCS 
‘‘SEC. 215. ARIZONA AS A CONTRACT HEALTH SERVICE DE-
LIVERY AREA. 
‘‘(a) IN GENERAL.—For fiscal years beginning with 
the fiscal year ending September 30, 1983, and ending 
with the fiscal year ending September 30, 2025, the State 
of Arizona shall be designated as a contract health service 
delivery area by the Service for the purpose of providing 
contract health care services to members of federally rec-
ognized Indian Tribes of Arizona. 
‘‘(b) MAINTENANCE
OF
SERVICES.—The Service 
shall not curtail any health care services provided to Indi-
ans residing on reservations in the State of Arizona if such 
curtailment is due to the provision of contract services in 
such State pursuant to the designation of such State as 
a contract health service delivery area pursuant to sub-
section (a). 
‘‘SEC. 216. NORTH DAKOTA AND SOUTH DAKOTA AS CON-
TRACT HEALTH SERVICE DELIVERY AREA. 
‘‘(a) IN GENERAL.—Beginning in fiscal year 2003, 
the States of North Dakota and South Dakota shall be 
designated as a contract health service delivery area by 
the Service for the purpose of providing contract health 
care services to members of federally recognized Indian 
Tribes of North Dakota and South Dakota. 
‘‘(b) LIMITATION.—The Service shall not curtail any 
health care services provided to Indians residing on any 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01784
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1785 
HR 3962 PCS 
reservation, or in any county that has a common boundary 
with any reservation, in the State of North Dakota or 
South Dakota if such curtailment is due to the provision 
of contract services in such States pursuant to the des-
ignation of such States as a contract health service deliv-
ery area pursuant to subsection (a). 
‘‘SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES PRO-
GRAM. 
‘‘(a) FUNDING AUTHORIZED.—The Secretary is au-
thorized to fund a program using an intertribal consor-
tium as a contract care intermediary to improve the acces-
sibility of health services to California Indians. 
‘‘(b) REIMBURSEMENT CONTRACT.—The Secretary 
shall enter into an agreement with the intertribal consor-
tium to reimburse the intertribal consortium for costs (in-
cluding reasonable administrative costs) incurred pursu-
ant to this section, in providing medical treatment under 
contract to California Indians described in section 805(a) 
throughout the California contract health services delivery 
area described in section 219 with respect to high cost 
contract care cases. 
‘‘(c) ADMINISTRATIVE EXPENSES.—Not more than 5 
percent of the amounts provided to the intertribal consor-
tium under this section for any fiscal year may be for re-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01785
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1786 
HR 3962 PCS 
imbursement for administrative expenses incurred by the 
intertribal consortium during such fiscal year. 
‘‘(d) LIMITATION ON PAYMENT.—No payment may 
be made for treatment provided hereunder to the extent 
payment may be made for such treatment under the In-
dian Catastrophic Health Emergency Fund described in 
section 202 or from amounts appropriated or otherwise 
made available to the California contract health service de-
livery area for a fiscal year. 
‘‘(e) ADVISORY BOARD.—There is established an ad-
visory board which shall advise the intertribal consortium 
in carrying out this section. The advisory board shall be 
composed of representatives, selected by the intertribal 
consortium, from not less than 8 Tribal Health Programs 
serving California Indians covered under this section at 
least 1⁄2 of whom are not affiliated with the intertribal con-
sortium. 
‘‘SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE 
DELIVERY AREA. 
‘‘The State of California, excluding the counties of 
Alameda, Contra Costa, Los Angeles, Marin, Orange, Sac-
ramento, San Francisco, San Mateo, Santa Clara, Kern, 
Merced, Monterey, Napa, San Benito, San Joaquin, San 
Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ven-
tura, shall be designated as a contract health service deliv-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01786
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1787 
HR 3962 PCS 
ery area by the Service for the purpose of providing con-
tract health services to California Indians. However, any 
of the counties listed herein may only be included in the 
contract health services delivery area if funding is specifi-
cally provided by the Service for such services in those 
counties. 
‘‘SEC. 219. CONTRACT HEALTH SERVICES FOR THE TREN-
TON SERVICE AREA. 
‘‘(a) AUTHORIZATION
FOR SERVICES.—The Sec-
retary, acting through the Service, is directed to provide 
contract health services to members of the Turtle Moun-
tain Band of Chippewa Indians that reside in the Trenton 
Service Area of Divide, McKenzie, and Williams counties 
in the State of North Dakota and the adjoining counties 
of Richland, Roosevelt, and Sheridan in the State of Mon-
tana. 
‘‘(b) NO EXPANSION OF ELIGIBILITY.—Nothing in 
this section may be construed as expanding the eligibility 
of members of the Turtle Mountain Band of Chippewa In-
dians for health services provided by the Service beyond 
the scope of eligibility for such health services that applied 
on May 1, 1986. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01787
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1788 
HR 3962 PCS 
‘‘SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND 
TRIBAL ORGANIZATIONS. 
‘‘The Service shall provide funds for health care pro-
grams, functions, services, activities, information tech-
nology, and facilities operated by Tribal Health Programs 
on the same basis as such funds are provided to programs, 
functions, services, activities, information technology, and 
facilities operated directly by the Service. 
‘‘SEC. 221. LICENSING. 
‘‘Licensed health care professionals employed by a 
Tribal Health Program shall, if licensed in any State, be 
exempt from the licensing requirements of the State in 
which the Tribal Health Program performs the services 
described in its contract or compact under the Indian Self- 
Determination and Education Assistance Act (25 U.S.C. 
450 et seq.) while performing such services. 
‘‘SEC. 222. NOTIFICATION OF PROVISION OF EMERGENCY 
CONTRACT HEALTH SERVICES. 
‘‘With respect to an elderly Indian or an Indian with 
a disability receiving emergency medical care or services 
from a non-Service provider or in a non-Service facility 
under the authority of this Act, the time limitation (as 
a condition of payment) for notifying the Service of such 
treatment or admission shall be 30 days. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01788
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1789 
HR 3962 PCS 
‘‘SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS. 
‘‘(a) DEADLINE FOR RESPONSE.—The Service shall 
respond to a notification of a claim by a provider of a 
contract care service with either an individual purchase 
order or a denial of the claim within 5 working days after 
the receipt of such notification. 
‘‘(b) EFFECT
OF UNTIMELY RESPONSE.—If the 
Service fails to respond to a notification of a claim in ac-
cordance with subsection (a), the Service shall accept as 
valid the claim submitted by the provider of a contract 
care service. 
‘‘(c) DEADLINE FOR PAYMENT OF VALID CLAIM.— 
The Service shall pay a valid contract care service claim 
within 30 days after the completion of the claim. 
‘‘SEC. 224. LIABILITY FOR PAYMENT. 
‘‘(a) NO PATIENT LIABILITY.—A patient who re-
ceives contract health care services that are authorized by 
the Service shall not be liable for the payment of any 
charges or costs associated with the provision of such serv-
ices. 
‘‘(b) NOTIFICATION.—The Secretary shall notify a 
contract care provider and any patient who receives con-
tract health care services authorized by the Service that 
such patient is not liable for the payment of any charges 
or costs associated with the provision of such services not 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01789
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1790 
HR 3962 PCS 
later than 5 business days after receipt of a notification 
of a claim by a provider of contract care services. 
‘‘(c) NO RECOURSE.—Following receipt of the notice 
provided under subsection (b), or, if a claim has been 
deemed accepted under section 224(b), the provider shall 
have no further recourse against the patient who received 
the services. 
‘‘SEC. 225. OFFICE OF INDIAN MEN’S HEALTH. 
‘‘(a) ESTABLISHMENT.—The Secretary may establish 
within the Service an office to be known as the ‘Office 
of Indian Men’s Health’ (referred to in this section as the 
‘Office’). 
‘‘(b) DIRECTOR.— 
‘‘(1) IN GENERAL.—The Office shall be headed 
by a director, to be appointed by the Secretary. 
‘‘(2) DUTIES.—The director shall coordinate 
and promote the status of the health of Indian men 
in the United States. 
‘‘(c) REPORT.—Not later than 2 years after the date 
of enactment of the Indian Health Care Improvement Act 
Amendments of 2009, the Secretary, acting through the 
director of the Office, shall submit to Congress a report 
describing— 
‘‘(1) any activity carried out by the director as 
of the date on which the report is prepared; and 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01790
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1791 
HR 3962 PCS 
‘‘(2) any finding of the director with respect to 
the health of Indian men. 
‘‘SEC. 226. CATASTROPHIC HEALTH EMERGENCY FUND. 
‘‘(a) ESTABLISHMENT.—There is established an In-
dian Catastrophic Health Emergency Fund (hereafter in 
this section referred to as the ‘CHEF’) consisting of— 
‘‘(1) the amounts deposited under subsection 
(f); and 
‘‘(2) the amounts appropriated to CHEF under 
this section. 
‘‘(b) ADMINISTRATION.—CHEF shall be adminis-
tered by the Secretary, acting through the headquarters 
of the Service, solely for the purpose of meeting the ex-
traordinary medical costs associated with the treatment of 
victims of disasters or catastrophic illnesses who are with-
in the responsibility of the Service. 
‘‘(c) CONDITIONS ON USE OF FUND.—No part of 
CHEF or its administration shall be subject to contract 
or grant under any law, including the Indian Self-Deter-
mination and Education Assistance Act (25 U.S.C. 450 
et seq.), nor shall CHEF funds be allocated, apportioned, 
or delegated on an Area Office, Service Unit, or other 
similar basis. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01791
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1792 
HR 3962 PCS 
‘‘(d) REGULATIONS.—The Secretary shall promul-
gate regulations consistent with the provisions of this sec-
tion to— 
‘‘(1) establish a definition of disasters and cata-
strophic illnesses for which the cost of the treatment 
provided under contract would qualify for payment 
from CHEF; 
‘‘(2) provide that a Service Unit shall not be el-
igible for reimbursement for the cost of treatment 
from CHEF until its cost of treating any victim of 
such catastrophic illness or disaster has reached a 
certain threshold cost which the Secretary shall es-
tablish at— 
‘‘(A) the 2000 level of $19,000; and 
‘‘(B) for any subsequent year, not less 
than the threshold cost of the previous year in-
creased by the percentage increase in the med-
ical care expenditure category of the consumer 
price index for all urban consumers (United 
States city average) for the 12-month period 
ending with December of the previous year; 
‘‘(3) establish a procedure for the reimburse-
ment of the portion of the costs that exceeds such 
threshold cost incurred by— 
‘‘(A) Service Units; or 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01792
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1793 
HR 3962 PCS 
‘‘(B) whenever otherwise authorized by the 
Service, non-Service facilities or providers; 
‘‘(4) establish a procedure for payment from 
CHEF in cases in which the exigencies of the med-
ical circumstances warrant treatment prior to the 
authorization of such treatment by the Service; and 
‘‘(5) establish a procedure that will ensure that 
no payment shall be made from CHEF to any pro-
vider of treatment to the extent that such provider 
is eligible to receive payment for the treatment from 
any other Federal, State, local, or private source of 
reimbursement for which the patient is eligible. 
‘‘(e) NO OFFSET OR LIMITATION.—Amounts appro-
priated to CHEF under this section shall not be used to 
offset or limit appropriations made to the Service under 
the authority of the Act of November 2, 1921 (25 U.S.C. 
13) (commonly known as the ‘Snyder Act’), or any other 
law. 
‘‘(f) DEPOSIT OF REIMBURSEMENT FUNDS.—There 
shall be deposited into CHEF all reimbursements to which 
the Service is entitled from any Federal, State, local, or 
private source (including third party insurance) by reason 
of treatment rendered to any victim of a disaster or cata-
strophic illness the cost of which was paid from CHEF. 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01793
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1794 
HR 3962 PCS 
‘‘SEC. 227. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated such sums 
as may be necessary to carry out this title. 
‘‘TITLE III—FACILITIES 
‘‘SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVA-
TION OF FACILITIES; REPORTS. 
‘‘(a) 
PREREQUISITES
FOR
EXPENDITURE
OF 
FUNDS.—Prior to the expenditure of, or the making of 
any binding commitment to expend, any funds appro-
priated for the planning, design, construction, or renova-
tion of facilities pursuant to the Act of November 2, 1921 
(25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 
the Secretary, acting through the Service, shall— 
‘‘(1) consult with any Indian Tribe that would 
be significantly affected by such expenditure for the 
purpose of determining and, whenever practicable, 
honoring tribal preferences concerning size, location, 
type, and other characteristics of any facility on 
which such expenditure is to be made; and 
‘‘(2) ensure, whenever practicable and applica-
ble, that such facility meets the construction stand-
ards of any accrediting body recognized by the Sec-
retary for the purposes of the Medicare, Medicaid, 
and SCHIP programs under titles XVIII, XIX, and 
XXI of the Social Security Act by not later than 1 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01794
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1795 
HR 3962 PCS 
year after the date on which the construction or ren-
ovation of such facility is completed. 
‘‘(b) CLOSURES.— 
‘‘(1) 
EVALUATION
REQUIRED.—Notwith-
standing any other provision of law, no facility oper-
ated by the Service may be closed if the Secretary 
has not submitted to Congress, not less than 1 year 
and not more than 2 years before the date of the 
proposed closure, an evaluation, completed not more 
than 2 years before such submission, of the impact 
of the proposed closure that specifies, in addition to 
other considerations— 
‘‘(A) the accessibility of alternative health 
care resources for the population served by such 
facility; 
‘‘(B) the cost-effectiveness of such closure; 
‘‘(C) the quality of health care to be pro-
vided to the population served by such facility 
after such closure; 
‘‘(D) the availability of contract health 
care funds to maintain existing levels of service; 
‘‘(E) the views of the Indian Tribes served 
by such facility concerning such closure; 
‘‘(F) the level of use of such facility by all 
eligible Indians; and 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01795
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1796 
HR 3962 PCS 
‘‘(G) the distance between such facility and 
the nearest operating Service hospital. 
‘‘(2) EXCEPTION
FOR
CERTAIN
TEMPORARY 
CLOSURES.—Paragraph (1) shall not apply to any 
temporary closure of a facility or any portion of a 
facility if such closure is necessary for medical, envi-
ronmental, or construction safety reasons. 
‘‘(c) HEALTH CARE FACILITY PRIORITY SYSTEM.— 
‘‘(1) IN GENERAL.— 
‘‘(A) PRIORITY
SYSTEM.—The Secretary, 
acting through the Service, shall maintain a 
health care facility priority system, which— 
‘‘(i) shall be developed in consultation 
with Indian Tribes and Tribal Organiza-
tions; 
‘‘(ii) shall give Indian Tribes’ needs 
the highest priority; 
‘‘(iii)(I) may include the lists required 
in paragraph (2)(B)(ii); and 
‘‘(II) shall include the methodology re-
quired in paragraph (2)(B)(v); and 
‘‘(III) may include such other facili-
ties, and such renovation or expansion 
needs of any health care facility, as the 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01796
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1797 
HR 3962 PCS 
Service, Indian Tribes, and Tribal Organi-
zations may identify; and 
‘‘(iv) shall provide an opportunity for 
the nomination of planning, design, and 
construction projects by the Service, In-
dian Tribes, and Tribal Organizations for 
consideration under the priority system at 
least once every 3 years, or more fre-
quently as the Secretary determines to be 
appropriate. 
‘‘(B) 
NEEDS
OF
FACILITIES
UNDER 
ISDEAA AGREEMENTS.—The Secretary shall en-
sure that the planning, design, construction, 
renovation, and expansion needs of Service and 
non-Service facilities operated under contracts 
or compacts in accordance with the Indian Self- 
Determination and Education Assistance Act 
(25 U.S.C. 450 et seq.) are fully and equitably 
integrated into the health care facility priority 
system. 
‘‘(C) 
CRITERIA
FOR
EVALUATING 
NEEDS.—For purposes of this subsection, the 
Secretary, in evaluating the needs of facilities 
operated under a contract or compact under the 
Indian Self-Determination and Education As-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01797
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1798 
HR 3962 PCS 
sistance Act (25 U.S.C. 450 et seq.), shall use 
the criteria used by the Secretary in evaluating 
the needs of facilities operated directly by the 
Service. 
‘‘(D) PRIORITY
OF
CERTAIN
PROJECTS 
PROTECTED.—The priority of any project estab-
lished under the construction priority system in 
effect on the date of enactment of the Indian 
Health Care Improvement Act Amendments of 
2009 shall not be affected by any change in the 
construction priority system taking place after 
that date if the project— 
‘‘(i) was identified in the fiscal year 
2008 Service budget justification as— 
‘‘(I) 1 of the 10 top-priority inpa-
tient projects; 
‘‘(II) 1 of the 10 top-priority out-
patient projects; 
‘‘(III) 1 of the 10 top-priority 
staff quarters developments; or 
‘‘(IV) 1 of the 10 top-priority 
Youth Regional Treatment Centers; 
‘‘(ii) had completed both Phase I and 
Phase II of the construction priority sys-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01798
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1799 
HR 3962 PCS 
tem in effect on the date of enactment of 
such Act; or 
‘‘(iii) is not included in clause (i) or 
(ii) and is selected, as determined by the 
Secretary— 
‘‘(I) on the initiative of the Sec-
retary; or 
‘‘(II) pursuant to a request of an 
Indian Tribe or Tribal Organization. 
‘‘(2) REPORT; CONTENTS.— 
‘‘(A) INITIAL COMPREHENSIVE REPORT.— 
‘‘(i) DEFINITIONS.—In this subpara-
graph: 
‘‘(I) FACILITIES APPROPRIATION 
ADVISORY BOARD.—The term ‘Facili-
ties Appropriation Advisory Board’ 
means the advisory board, comprised 
of 12 members representing Indian 
tribes and 2 members representing 
the Service, established at the discre-
tion of the Assistant Secretary— 
‘‘(aa) to provide advice and 
recommendations for policies and 
procedures of the programs fund-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01799
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1800 
HR 3962 PCS 
ed pursuant to facilities appro-
priations; and 
‘‘(bb) to address other facili-
ties issues. 
‘‘(II) FACILITIES NEEDS ASSESS-
MENT
WORKGROUP.—The term ‘Fa-
cilities Needs Assessment Workgroup’ 
means the workgroup established at 
the discretion of the Assistant Sec-
retary— 
‘‘(aa) to review the health 
care facilities construction pri-
ority system; and 
‘‘(bb) to make recommenda-
tions to the Facilities Appropria-
tion Advisory Board for revising 
the priority system. 
‘‘(ii) INITIAL REPORT.— 
‘‘(I) IN
GENERAL.—Not later 
than 1 year after the date of enact-
ment of the Indian Health Care Im-
provement Act Amendments of 2009, 
the Secretary shall submit to the 
Committee on Indian Affairs of the 
Senate and the Committee on Natural 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01800
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1801 
HR 3962 PCS 
Resources of the House of Represent-
atives a report that describes the com-
prehensive, national, ranked list of all 
health care facilities needs for the 
Service, Indian Tribes, and Tribal Or-
ganizations (including inpatient health 
care facilities, outpatient health care 
facilities, specialized health care facili-
ties (such as for long-term care and 
alcohol and drug abuse treatment), 
wellness centers, staff quarters and 
hostels associated with health care fa-
cilities, and the renovation and expan-
sion needs, if any, of such facilities) 
developed by the Service, Indian 
Tribes, and Tribal Organizations for 
the 
Facilities 
Needs 
Assessment 
Workgroup and the Facilities Appro-
priation Advisory Board. 
‘‘(II) INCLUSIONS.—The initial 
report shall include— 
‘‘(aa) the methodology and 
criteria used by the Service in de-
termining the needs and estab-
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01801
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1802 
HR 3962 PCS 
lishing the ranking of the facili-
ties needs; and 
‘‘(bb) such other information 
as the Secretary determines to be 
appropriate. 
‘‘(iii) UPDATES OF REPORT.—Begin-
ning in calendar year 2011, the Secretary 
shall— 
‘‘(I) update the report under 
clause (ii) not less frequently that 
once every 5 years; and 
‘‘(II) include the updated report 
in the appropriate annual report 
under subparagraph (B) for submis-
sion to Congress under section 801. 
‘‘(B) ANNUAL
REPORTS.—The Secretary 
shall submit to the President, for inclusion in 
the report required to be transmitted to Con-
gress under section 801, a report which sets 
forth the following: 
‘‘(i) A description of the health care 
facility priority system of the Service es-
tablished under paragraph (1). 
‘‘(ii) Health care facilities lists, which 
may include— 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01802
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1803 
HR 3962 PCS 
‘‘(I) the 10 top-priority inpatient 
health care facilities; 
‘‘(II) the 10 top-priority out-
patient health care facilities; 
‘‘(III) the 10 top-priority special-
ized health care facilities (such as 
long-term care and alcohol and drug 
abuse treatment); 
‘‘(IV) the 10 top-priority staff 
quarters developments associated with 
health care facilities; and 
‘‘(V) the 10 top-priority hostels 
associated with health care facilities. 
‘‘(iii) The justification for such order 
of priority. 
‘‘(iv) The projected cost of such 
projects. 
‘‘(v) The methodology adopted by the 
Service in establishing priorities under its 
health care facility priority system. 
‘‘(3) REQUIREMENTS FOR PREPARATION OF RE-
PORTS.—In preparing the report required under 
paragraph (2), the Secretary shall— 
‘‘(A) consult with and obtain information 
on all health care facilities needs from Indian 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01803
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1804 
HR 3962 PCS 
Tribes, Tribal Organizations, and urban Indian 
organizations; and 
‘‘(B) review the total unmet needs of all 
Indian Tribes, Tribal Organizations, and urban 
Indian organizations for health care facilities 
(including hostels and staff quarters), including 
needs for renovation and expansion of existing 
facilities. 
‘‘(d) REVIEW OF METHODOLOGY USED FOR HEALTH 
FACILITIES CONSTRUCTION PRIORITY SYSTEM.— 
‘‘(1) IN GENERAL.—Not later than 1 year after 
the establishment of the priority system under sub-
section (c)(1)(A), the Comptroller General of the 
United States shall prepare and finalize a report re-
viewing the methodologies applied, and the processes 
followed, by the Service in making each assessment 
of needs for the list under subsection (c)(2)(A)(ii) 
and developing the priority system under subsection 
(c)(1), including a review of— 
‘‘(A) the recommendations of the Facilities 
Appropriation Advisory Board and the Facili-
ties Needs Assessment Workgroup (as those 
terms are defined in subsection (c)(2)(A)(i)); 
and 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01804
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1805 
HR 3962 PCS 
‘‘(B) the relevant criteria used in ranking 
or prioritizing facilities other than hospitals or 
clinics. 
‘‘(2) SUBMISSION TO CONGRESS.—The Comp-
troller General of the United States shall submit the 
report under paragraph (1) to— 
‘‘(A) the Committees on Indian Affairs and 
Appropriations of the Senate; 
‘‘(B) the Committees on Natural Re-
sources and Appropriations of the House of 
Representatives; and 
‘‘(C) the Secretary. 
‘‘(e) FUNDING CONDITION.—All funds appropriated 
under the Act of November 2, 1921 (25 U.S.C. 13) (com-
monly known as the ‘Snyder Act’), for the planning, de-
sign, construction, or renovation of health facilities for the 
benefit of 1 or more Indian Tribes shall be subject to the 
provisions of the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.). 
‘‘(f) DEVELOPMENT OF INNOVATIVE APPROACHES.— 
The Secretary shall consult and cooperate with Indian 
Tribes, Tribal Organizations, and urban Indian organiza-
tions in developing innovative approaches to address all 
or part of the total unmet need for construction of health 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01805
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1806 
HR 3962 PCS 
facilities, including those provided for in other sections of 
this title and other approaches. 
‘‘SEC. 302. SANITATION FACILITIES. 
‘‘(a) FINDINGS.—Congress finds the following: 
‘‘(1) The provision of sanitation facilities is pri-
marily a health consideration and function. 
‘‘(2) Indian people suffer an inordinately high 
incidence of disease, injury, and illness directly at-
tributable to the absence or inadequacy of sanitation 
facilities. 
‘‘(3) The long-term cost to the United States of 
treating and curing such disease, injury, and illness 
is substantially greater than the short-term cost of 
providing sanitation facilities and other preventive 
health measures. 
‘‘(4) Many Indian homes and Indian commu-
nities still lack sanitation facilities. 
‘‘(5) It is in the interest of the United States, 
and it is the policy of the United States, that all In-
dian communities and Indian homes, new and exist-
ing, be provided with sanitation facilities. 
‘‘(b) FACILITIES AND SERVICES.—In furtherance of 
the findings made in subsection (a), Congress reaffirms 
the primary responsibility and authority of the Service to 
provide the necessary sanitation facilities and services as 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01806
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS
1807 
HR 3962 PCS 
provided in section 7 of the Act of August 5, 1954 (42 
U.S.C. 2004a). Under such authority, the Secretary, act-
ing through the Service, is authorized to provide the fol-
lowing: 
‘‘(1) Financial and technical assistance to In-
dian Tribes, Tribal Organizations, and Indian com-
munities in the establishment, training, and equip-
ping of utility organizations to operate and maintain 
sanitation facilities, including the provision of exist-
ing plans, standard details, and specifications avail-
able in the Department, to be used at the option of 
the Indian Tribe, Tribal Organization, or Indian 
community. 
‘‘(2) Ongoing technical assistance and training 
to Indian Tribes, Tribal Organizations, and Indian 
communities in the management of utility organiza-
tions which operate and maintain sanitation facili-
ties. 
‘‘(3) Priority funding for operation and mainte-
nance assistance for, and emergency repairs to, sani-
tation facilities operated by an Indian Tribe, Tribal 
Organization or Indian community when necessary 
to avoid an imminent health threat or to protect the 
investment in sanitation facilities and the investment 
VerDate Nov 24 2008 
21:32 Nov 16, 2009
Jkt 089200
PO 00000
Frm 01807
Fmt 6652
Sfmt 6201
E:\BILLS\H3962.PCS
H3962
hsrobinson on DSK69SOYB1PROD with BILLS