1629 
SEC. 2591. ONLINE HEALTH WORKFORCE TRAINING PRO-
GRAMS. 
Section 171 of the Workforce Investment Act of 1998 
(29 U.S.C. 2916) is amended by adding at the end the 
following: 
‘‘(f) ONLINE HEALTH WORKFORCE TRAINING PRO-
GRAM.— 
‘‘(1) GRANT PROGRAM.— 
‘‘(A) IN GENERAL.—The Secretary in con-
sultation with the Secretary of Health and 
Human Services, shall award National Health 
Workforce Online Training Grants on a com-
petitive basis to eligible entities to enable such 
entities to carry out training for individuals to 
attain or advance in health care occupations. 
An entity may leverage such grant with other 
Federal, State, local, and private resources, in 
order to expand the participation of businesses, 
employees, and individuals in such training pro-
grams. 
‘‘(B) ELIGIBILITY.—In order to receive a 
grant under the program established under this 
paragraph— 
‘‘(i) an entity shall be an educational 
institution, community-based organization, 
nonprofit organization, workforce invest-
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ment board, or local or county government; 
and 
‘‘(ii) an entity shall provide online 
workforce training for individuals seeking 
to attain or advance in health care occupa-
tions, including nursing, nursing assist-
ants, dentistry, pharmacy, health care 
management and administration, public 
health, health information systems anal-
ysis, medical assistants, and other health 
care practitioner and support occupations. 
‘‘(C) PRIORITY.—Priority in awarding 
grants under this paragraph shall be given to 
entities that— 
‘‘(i) have demonstrated experience in 
implementing and operating online worker 
skills training and education programs; 
‘‘(ii) have demonstrated experience co-
ordinating activities, where appropriate, 
with the workforce investment system; and 
‘‘(iii) conduct training for occupations 
with national or local shortages. 
‘‘(D) DATA COLLECTION.—Grantees under 
this paragraph shall collect and report informa-
tion on— 
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‘‘(i) the number of participants; 
‘‘(ii) the services received by the par-
ticipants; 
‘‘(iii) program completion rates; 
‘‘(iv) factors determined as signifi-
cantly interfering with program participa-
tion or completion; 
‘‘(v) the rate of job placement; and 
‘‘(vi) other information as determined 
as needed by the Secretary. 
‘‘(E) OUTREACH.—Grantees under this 
paragraph shall conduct outreach activities to 
disseminate information about their program 
and results to workforce investment boards, 
local governments, educational institutions, and 
other workforce training organizations. 
‘‘(F) PERFORMANCE
LEVELS.—The Sec-
retary shall establish indicators of performance 
that will be used to evaluate the performance of 
grantees under this paragraph in carrying out 
the activities described in this paragraph. The 
Secretary shall negotiate and reach agreement 
with each grantee regarding the levels of per-
formance expected to be achieved by the grant-
ee on the indicators of performance. 
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‘‘(G) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—There are authorized to be appro-
priated to the Secretary to carry out this sub-
section $50,000,000 for fiscal years 2011 
through 2020. 
‘‘(2) ONLINE HEALTH PROFESSIONS TRAINING 
PROGRAM CLEARINGHOUSE.— 
‘‘(A) DESCRIPTION OF GRANT.—The Sec-
retary may award one or more grants to eligible 
postsecondary educational institutions to pro-
vide the services described in this paragraph. 
‘‘(B) ELIGIBILITY.—To be eligible to re-
ceive a grant under this paragraph, a postsec-
ondary educational institution shall— 
‘‘(i) have demonstrated the ability to 
disseminate research on best practices for 
implementing workforce investment pro-
grams; and 
‘‘(ii) be a national leader in producing 
cutting-edge research on technology related 
to workforce investment systems under 
subtitle B. 
‘‘(C) SERVICES.—The postsecondary edu-
cational institution that receives a grant under 
this paragraph shall use such grant— 
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‘‘(i) to provide technical assistance to 
entities that receive grants under para-
graph (1); 
‘‘(ii) to collect and nationally dissemi-
nate the data gathered by entities that re-
ceive grants under paragraph (1); and 
‘‘(iii) to disseminate the best practices 
identified by the National Health Work-
force Online Training Grant Program to 
other workforce training organizations. 
‘‘(D) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—There are authorized to be appro-
priated to the Secretary to carry out this sub-
section $1,000,000 for fiscal years 2011 
through 2020.’’. 
SEC. 2592. ACCESS FOR INDIVIDUALS WITH DISABILITIES. 
Title V of the Rehabilitation Act of 1973 (29 U.S.C. 
791 et seq.) is amended by adding at the end of the fol-
lowing: 
‘‘SEC. 510. STANDARDS FOR ACCESSIBILITY OF MEDICAL 
DIAGNOSTIC EQUIPMENT. 
‘‘(a) STANDARDS.—Not later than 9 months after the 
date of enactment of the Affordable Health Care for 
America Act, the Architectural and Transportation Bar-
riers Compliance Board (Access Board) shall issue guide-
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lines setting forth the minimum technical criteria for new 
medical diagnostic equipment to be purchased for use in 
(or in conjunction with) physician’s offices, clinics, emer-
gency rooms, hospitals, and other medical settings. The 
guidelines shall ensure that such equipment is accessible 
to, and usable by, individuals with disabilities, including 
provisions to ensure independent entry to, use of, and exit 
from the equipment by such individuals to the maximum 
extent possible. 
‘‘(b) 
MEDICAL
DIAGNOSTIC
EQUIPMENT
COV-
ERED.—The guidelines issued under subsection (a) for 
medical diagnostic equipment shall apply to new purchases 
of equipment that includes examination tables, examina-
tion chairs (including chairs used for eye examinations or 
procedures, and dental examinations or procedures), 
weight scales, mammography equipment, x-ray machines, 
and other equipment commonly used for diagnostic or ex-
amination purposes by health professionals. 
‘‘(c) REGULATIONS.—Not later than 6 months after 
the date of the issuance of the guidelines under subsection 
(a), each appropriate Federal agency authorized to pro-
mulgate regulations under this Act or under the Ameri-
cans with Disabilities Act shall— 
‘‘(1) prescribe regulations in an accessible for-
mat as necessary to carry out the provisions of such 
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Act and section 504 of this Act that include accessi-
bility standards that are consistent with the guide-
lines issued under subsection (a); and 
‘‘(2) ensure that health care providers and 
health care plans covered by the Affordable Health 
Care for America Act meet the requirements of the 
Americans with Disabilities Act and section 504, in-
cluding provisions ensuring that individuals with dis-
abilities receive equal access to all aspects of the 
health care delivery system. 
‘‘(d) REVIEW AND AMEND.—The Architectural and 
Transportation Barriers Compliance Board (Access 
Board) shall periodically review and, as appropriate, 
amend the guidelines as prescribed under subsection (a). 
Not later than 6 months after the date of the issuance 
of such revised guidelines, revised regulations consistent 
with such guidelines shall be promulgated in an accessible 
format by the appropriate Federal agencies described in 
subsection (c).’’. 
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’’. 
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(b) TABLE OF CONTENTS.—The table of contents of 
this division is as follows: 
DIVISION D—INDIAN HEALTH CARE IMPROVEMENT 
Sec. 3001. Short title; table of contents. 
TITLE I—AMENDMENTS TO INDIAN LAWS 
Sec. 3101. Indian Health Care Improvement At amended. 
Sec. 3102. Soboba sanitation facilities. 
Sec. 3103. Native American Health and Wellness Foundation. 
Sec. 3104. 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. 
TITLE I—AMENDMENTS TO 
INDIAN LAWS 
SEC. 3101. INDIAN HEALTH CARE IMPROVEMENT AMEND-
ED. 
(a) IN GENERAL.—The Indian Health Care Improve-
ment Act (25 U.S.C. 1601 et seq.) is amended to read 
as follows: 
‘‘SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
‘‘(a) SHORT TITLE.—This Act may be cited as the 
‘Indian Health Care Improvement Act’. 
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‘‘(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. 
‘‘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. 
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‘‘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. 
‘‘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). 
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‘‘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. 
‘‘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. 
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‘‘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. Provision of services in Montana. 
‘‘Sec. 810. Moratorium. 
‘‘Sec. 811. Severability provisions. 
‘‘Sec. 812. Use of patient safety organizations. 
‘‘Sec. 813. Confidentiality of medical quality assurance records; qualified immu-
nity for participants. 
‘‘Sec. 814. Claremore Indian Hospital. 
‘‘Sec. 815. Sense of Congress regarding law enforcement and methamphetamine 
issues in Indian country. 
‘‘Sec. 816. Permitting implementation through contracts with Tribal Health 
Programs. 
‘‘Sec. 817. Authorization of appropriations; availability. 
‘‘SEC. 2. FINDINGS. 
‘‘Congress makes the following findings: 
‘‘(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-
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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. 
‘‘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; 
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‘‘(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 
‘‘(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: 
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‘‘(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 
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 
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‘‘(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; 
‘‘(iv) injuries; 
‘‘(v) occupational hazards and disabil-
ities; 
‘‘(vi) sexually transmittable diseases; 
and 
‘‘(vii) toxic agents; and 
‘‘(B) providing— 
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‘‘(i) fluoridation of water; and 
‘‘(ii) immunizations. 
‘‘(10) The term ‘health profession’ means 
allopathic medicine, family medicine, internal medi-
cine, pediatrics, geriatric medicine, obstetrics and 
gynecology, podiatric medicine, nursing, public 
health nursing, dentistry, psychiatry, osteopathy, op-
tometry, pharmacy, psychology, public health, social 
work, marriage and family therapy, chiropractic 
medicine, environmental health and engineering, al-
lied health professions, naturopathic medicine, and 
any other health profession. 
‘‘(11) The term ‘health promotion’ means— 
‘‘(A) fostering social, economic, environ-
mental, and personal factors conducive to 
health, including raising public awareness about 
health matters and enabling the people to cope 
with health problems by increasing their knowl-
edge and providing them with valid information; 
‘‘(B) encouraging adequate and appro-
priate diet, exercise, and sleep; 
‘‘(C) promoting education and work in con-
formity with physical and mental capacity; 
‘‘(D) making available safe water and sani-
tary facilities; 
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‘‘(E) improving the physical, economic, cul-
tural, psychological, and social environment; 
‘‘(F) promoting culturally competent care; 
and 
‘‘(G) providing adequate and appropriate 
programs, which may include— 
‘‘(i) abuse prevention (mental and 
physical); 
‘‘(ii) community health; 
‘‘(iii) community safety; 
‘‘(iv) consumer health education; 
‘‘(v) diet and nutrition; 
‘‘(vi) immunization and other preven-
tion of communicable diseases, including 
HIV/AIDS; 
‘‘(vii) environmental health; 
‘‘(viii) exercise and physical fitness; 
‘‘(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; 
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‘‘(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 
unhealthy household conditions (including 
mold and other allergens); 
‘‘(xxiii) stress control; 
‘‘(xxiv) substance abuse; 
‘‘(xxv) sanitary facilities; 
‘‘(xxvi) sudden infant death syndrome 
prevention; 
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‘‘(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-
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 
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‘‘(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 
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.). 
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‘‘(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 
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. 
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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 
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). 
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‘‘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— 
‘‘(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 
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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-
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 
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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: 
‘‘(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 
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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. 
‘‘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-
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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.). 
‘‘(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 
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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. 
‘‘(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 
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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). 
‘‘(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— 
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‘‘(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— 
‘‘(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 
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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— 
‘‘(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; 
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‘‘(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 
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. 
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‘‘(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 
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 
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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. 
‘‘(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-
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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; 
‘‘(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 
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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 
‘‘(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. 
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‘‘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.— 
‘‘(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 
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‘‘(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 
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 
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12:56 Oct 30, 2009
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