1786 
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-
1787 
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.
1788 
‘‘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.
1789 
‘‘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
1790 
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
1791 
‘‘(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.
1792 
‘‘(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
1793 
‘‘(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.
1794 
‘‘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
1795 
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
1796 
‘‘(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
1797 
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-
1798 
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-
1799 
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-
1800 
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
1801 
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-
1802 
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—
1803 
‘‘(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
1804 
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
1805 
‘‘(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
1806 
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
1807 
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
1808 
in the health benefits gained through the provision 
of sanitation facilities. 
‘‘(c) FUNDING.—Notwithstanding any other provi-
sion of law— 
‘‘(1) the Secretary of Housing and Urban De-
velopment is authorized to transfer funds appro-
priated under the Native American Housing Assist-
ance and Self-Determination Act of 1996 (25 U.S.C. 
4101 et seq.) to the Secretary of Health and Human 
Services; 
‘‘(2) the Secretary of Health and Human Serv-
ices is authorized to accept and use such funds for 
the purpose of providing sanitation facilities and 
services for Indians under section 7 of the Act of 
August 5, 1954 (42 U.S.C. 2004a); 
‘‘(3) unless specifically authorized when funds 
are appropriated, the Secretary shall not use funds 
appropriated under section 7 of the Act of August 
5, 1954 (42 U.S.C. 2004a), to provide sanitation fa-
cilities to new homes constructed using funds pro-
vided by the Department of Housing and Urban De-
velopment; 
‘‘(4) the Secretary of Health and Human Serv-
ices is authorized to accept from any source, includ-
ing Federal and State agencies, funds for the pur-
1809 
pose of providing sanitation facilities and services 
and place these funds into contracts or compacts 
under the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.); 
‘‘(5) except as otherwise prohibited by this sec-
tion, the Secretary may use funds appropriated 
under the authority of section 7 of the Act of Au-
gust 5, 1954 (42 U.S.C. 2004a), to fund up to 100 
percent of the amount of an Indian Tribe’s loan ob-
tained under any Federal program for new projects 
to construct eligible sanitation facilities to serve In-
dian homes; 
‘‘(6) except as otherwise prohibited by this sec-
tion, the Secretary may use funds appropriated 
under the authority of section 7 of the Act of Au-
gust 5, 1954 (42 U.S.C. 2004a), to meet matching 
or cost participation requirements under other Fed-
eral and non-Federal programs for new projects to 
construct eligible sanitation facilities; 
‘‘(7) all Federal agencies are authorized to 
transfer to the Secretary funds identified, granted, 
loaned, or appropriated whereby the Department’s 
applicable policies, rules, and regulations shall apply 
in the implementation of such projects;
1810 
‘‘(8) the Secretary of Health and Human Serv-
ices shall enter into interagency agreements with 
Federal and State agencies for the purpose of pro-
viding financial assistance for sanitation facilities 
and services under this Act; 
‘‘(9) the Secretary of Health and Human Serv-
ices shall, by regulation, establish standards applica-
ble to the planning, design, and construction of sani-
tation facilities funded under this Act; and 
‘‘(10) the Secretary of Health and Human 
Services is authorized to accept payments for goods 
and services furnished by the Service from appro-
priate public authorities, nonprofit organizations or 
agencies, or Indian Tribes, as contributions by that 
authority, organization, agency, or tribe to agree-
ments made under section 7 of the Act of August 5, 
1954 (42 U.S.C. 2004a), and such payments shall 
be credited to the same or subsequent appropriation 
account as funds appropriated under the authority 
of section 7 of the Act of August 5, 1954 (42 U.S.C. 
2004a). 
‘‘(d) CERTAIN CAPABILITIES NOT PREREQUISITE.— 
The financial and technical capability of an Indian Tribe, 
Tribal Organization, or Indian community to safely oper-
ate, manage, and maintain a sanitation facility shall not
1811 
be a prerequisite to the provision or construction of sanita-
tion facilities by the Secretary. 
‘‘(e) FINANCIAL ASSISTANCE.—The Secretary is au-
thorized to provide financial assistance to Indian Tribes, 
Tribal Organizations, and Indian communities in an 
amount equal to the Federal share of the costs of oper-
ating, managing, and maintaining the facilities provided 
under the plan described in subsection (h)(1)(F). 
‘‘(f) OPERATION, MANAGEMENT, AND MAINTENANCE 
OF FACILITIES.—The Indian Tribe has the primary re-
sponsibility to establish, collect, and use reasonable user 
fees, or otherwise set aside funding, for the purpose of 
operating, managing, and maintaining sanitation facilities. 
If a sanitation facility serving a community that is oper-
ated by an Indian Tribe or Tribal Organization is threat-
ened with imminent failure and such operator lacks capac-
ity to maintain the integrity or the health benefits of the 
sanitation facility, then the Secretary is authorized to as-
sist the Indian Tribe, Tribal Organization, or Indian com-
munity in the resolution of the problem on a short-term 
basis through cooperation with the emergency coordinator 
or by providing operation, management, and maintenance 
service. 
‘‘(g) ISDEAA PROGRAM
FUNDED
ON
EQUAL 
BASIS.—Tribal Health Programs shall be eligible (on an
1832 
‘‘(1) the maximum principal amount of a loan 
or loan guarantee that should be offered to a recipi-
ent from the loan fund; 
‘‘(2) the percentage of eligible costs, not to ex-
ceed 100 percent, that may be covered by a loan or 
loan guarantee from the loan fund (including costs 
relating to planning, design, financing, site land de-
velopment, construction, rehabilitation, renovation, 
conversion, improvements, medical equipment and 
furnishings, and other facility-related costs and cap-
ital purchase (but excluding staffing)); 
‘‘(3) the cumulative total of the principal of di-
rect loans and loan guarantees, respectively, that 
may be outstanding at any 1 time; 
‘‘(4) the maximum term of a loan or loan guar-
antee that may be made for a facility from the loan 
fund; 
‘‘(5) the maximum percentage of funds from 
the loan fund that should be allocated for payment 
of costs associated with planning and applying for a 
loan or loan guarantee; 
‘‘(6) whether acceptance by the Secretary of an 
assignment of the revenue of an Indian Tribe or 
Tribal Organization as security for any direct loan