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‘‘SEC. 412. TREATMENT UNDER MEDICAID AND SCHIP MAN-
AGED CARE. 
‘‘For provisions relating to the treatment of Indians 
enrolled in a managed care entity under the Medicaid pro-
gram under title XIX of the Social Security Act and In-
dian Health Programs and urban Indian organizations 
that are providers of items or services to such Indian en-
rollees, see sections 1932(h) and 2107(e)(1)(H) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1396u–2(h), 
1397gg(e)(1)(H)). 
‘‘SEC. 413. NAVAJO NATION MEDICAID AGENCY FEASI-
BILITY STUDY. 
‘‘(a) STUDY.—The Secretary shall conduct a study 
to determine the feasibility of treating the Navajo Nation 
as a State for the purposes of title XIX of the Social Secu-
rity Act, to provide services to Indians living within the 
boundaries of the Navajo Nation through an entity estab-
lished having the same authority and performing the same 
functions as single-State Medicaid agencies responsible for 
the administration of the State plan under title XIX of 
the Social Security Act. 
‘‘(b) CONSIDERATIONS.—In conducting the study, 
the Secretary shall consider the feasibility of— 
‘‘(1) assigning and paying all expenditures for 
the provision of services and related administration 
funds, under title XIX of the Social Security Act, to 
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Indians living within the boundaries of the Navajo 
Nation that are currently paid to or would otherwise 
be paid to the State of Arizona, New Mexico, or 
Utah; 
‘‘(2) providing assistance to the Navajo Nation 
in the development and implementation of such enti-
ty for the administration, eligibility, payment, and 
delivery of medical assistance under title XIX of the 
Social Security Act; 
‘‘(3) providing an appropriate level of matching 
funds for Federal medical assistance with respect to 
amounts such entity expends for medical assistance 
for services and related administrative costs; and 
‘‘(4) authorizing the Secretary, at the option of 
the Navajo Nation, to treat the Navajo Nation as a 
State for the purposes of title XIX of the Social Se-
curity Act (relating to the State children’s health in-
surance program) under terms equivalent to those 
described in paragraphs (2) through (4). 
‘‘(c) REPORT.—Not later than 3 years after the date 
of enactment of the Indian Health Care Improvement Act 
Amendments of 2009, the Secretary shall submit to the 
Committee on Indian Affairs and Committee on Finance 
of the Senate and the Committee on Natural Resources 
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and Committee on Energy and Commerce of the House 
of Representatives a report that includes— 
‘‘(1) the results of the study under this section; 
‘‘(2) a summary of any consultation that oc-
curred between the Secretary and the Navajo Na-
tion, other Indian Tribes, the States of Arizona, 
New Mexico, and Utah, counties which include Nav-
ajo Lands, and other interested parties, in con-
ducting this study; 
‘‘(3) projected costs or savings associated with 
establishment of such entity, and any estimated im-
pact on services provided as described in this section 
in relation to probable costs or savings; and 
‘‘(4) legislative actions that would be required 
to authorize the establishment of such entity if such 
entity is determined by the Secretary to be feasible. 
‘‘SEC. 414. EXCEPTION FOR EXCEPTED BENEFITS. 
‘‘The previous provisions of this title shall not apply 
to the provision of excepted benefits described in para-
graph (1)(A) or (3) of section 2791(c) of the Public 
Health Service Act (42 U.S.C. 300gg–91(c)). 
‘‘SEC. 415. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated such sums 
as may be necessary to carry out this title. 
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‘‘TITLE V—HEALTH SERVICES 
FOR URBAN INDIANS 
‘‘SEC. 501. PURPOSE. 
‘‘The purpose of this title is to establish and maintain 
programs in Urban Centers to make health services more 
accessible and available to Urban Indians. 
‘‘SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN IN-
DIAN ORGANIZATIONS. 
‘‘Under 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 enter into 
contracts with, or make grants to, urban Indian organiza-
tions to assist such organizations in the establishment and 
administration, within Urban Centers, of programs which 
meet the requirements set forth in this title. Subject to 
section 506, the Secretary, acting through the Service, 
shall include such conditions as the Secretary considers 
necessary to effect the purpose of this title in any contract 
into which the Secretary enters with, or in any grant the 
Secretary makes to, any urban Indian organization pursu-
ant to this title. 
‘‘SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION 
OF HEALTH CARE AND REFERRAL SERVICES. 
‘‘(a) REQUIREMENTS
FOR
GRANTS
AND
CON-
TRACTS.—Under authority of the Act of November 2, 
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1921 (25 U.S.C. 13) (commonly known as the ‘Snyder 
Act’), the Secretary, acting through the Service, shall 
enter into contracts with, and make grants to, urban In-
dian organizations for the provision of health care and re-
ferral services for Urban Indians. Any such contract or 
grant shall include requirements that the urban Indian or-
ganization successfully undertake to— 
‘‘(1) estimate the population of Urban Indians 
residing in the Urban Center or centers that the or-
ganization proposes to serve who are or could be re-
cipients of health care or referral services; 
‘‘(2) estimate the current health status of 
Urban Indians residing in such Urban Center or 
centers; 
‘‘(3) estimate the current health care needs of 
Urban Indians residing in such Urban Center or 
centers; 
‘‘(4) provide basic health education, including 
health promotion and disease prevention education, 
to Urban Indians; 
‘‘(5) make recommendations to the Secretary 
and Federal, State, local, and other resource agen-
cies on methods of improving health service pro-
grams to meet the needs of Urban Indians; and 
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‘‘(6) where necessary, provide, or enter into 
contracts for the provision of, health care services 
for Urban Indians. 
‘‘(b) CRITERIA.—The Secretary, acting through the 
Service, shall, by regulation, prescribe the criteria for se-
lecting urban Indian organizations to enter into contracts 
or receive grants under this section. Such criteria shall, 
among other factors, include— 
‘‘(1) the extent of unmet health care needs of 
Urban Indians in the Urban Center or centers in-
volved; 
‘‘(2) the size of the urban Indian population in 
the Urban Center or centers involved; 
‘‘(3) the extent, if any, to which the activities 
set forth in subsection (a) would duplicate any 
project funded under this title, or under any current 
public health service project funded in a manner 
other than pursuant to this title; 
‘‘(4) the capability of an urban Indian organiza-
tion to perform the activities set forth in subsection 
(a) and to enter into a contract with the Secretary 
or to meet the requirements for receiving a grant 
under this section; 
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‘‘(5) the satisfactory performance and success-
ful completion by an urban Indian organization of 
other contracts with the Secretary under this title; 
‘‘(6) the appropriateness and likely effectiveness 
of conducting the activities set forth in subsection 
(a) in an Urban Center or centers; and 
‘‘(7) the extent of existing or likely future par-
ticipation in the activities set forth in subsection (a) 
by appropriate health and health-related Federal, 
State, local, and other agencies. 
‘‘(c) ACCESS TO HEALTH PROMOTION AND DISEASE 
PREVENTION PROGRAMS.—The Secretary, acting through 
the Service, shall facilitate access to or provide health pro-
motion and disease prevention services for Urban Indians 
through grants made to urban Indian organizations ad-
ministering contracts entered into or receiving grants 
under subsection (a). 
‘‘(d) IMMUNIZATION SERVICES.— 
‘‘(1) ACCESS
OR
SERVICES
PROVIDED.—The 
Secretary, acting through the Service, shall facilitate 
access to, or provide, immunization services for 
Urban Indians through grants made to urban Indian 
organizations administering contracts entered into or 
receiving grants under this section. 
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‘‘(2) DEFINITION.—For purposes of this sub-
section, the term ‘immunization services’ means 
services to provide without charge immunizations 
against vaccine-preventable diseases. 
‘‘(e) BEHAVIORAL HEALTH SERVICES.— 
‘‘(1) ACCESS
OR
SERVICES
PROVIDED.—The 
Secretary, acting through the Service, shall facilitate 
access to, or provide, behavioral health services for 
Urban Indians through grants made to urban Indian 
organizations administering contracts entered into or 
receiving grants under subsection (a). 
‘‘(2) ASSESSMENT REQUIRED.—Except as pro-
vided by paragraph (3)(A), a grant may not be made 
under this subsection to an urban Indian organiza-
tion until that organization has prepared, and the 
Service has approved, an assessment of the fol-
lowing: 
‘‘(A) The behavioral health needs of the 
urban Indian population concerned. 
‘‘(B) The behavioral health services and 
other related resources available to that popu-
lation. 
‘‘(C) The barriers to obtaining those serv-
ices and resources. 
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‘‘(D) The needs that are unmet by such 
services and resources. 
‘‘(3) PURPOSES OF GRANTS.—Grants may be 
made under this subsection for the following: 
‘‘(A) To prepare assessments required 
under paragraph (2). 
‘‘(B) To provide outreach, educational, and 
referral services to Urban Indians regarding the 
availability of direct behavioral health services, 
to educate Urban Indians about behavioral 
health issues and services, and effect coordina-
tion with existing behavioral health providers in 
order to improve services to Urban Indians. 
‘‘(C) To provide outpatient behavioral 
health services to Urban Indians, including the 
identification and assessment of illness, thera-
peutic treatments, case management, support 
groups, family treatment, and other treatment. 
‘‘(D) To develop innovative behavioral 
health service delivery models which incorporate 
Indian cultural support systems and resources. 
‘‘(f) PREVENTION OF CHILD ABUSE.— 
‘‘(1) ACCESS
OR
SERVICES
PROVIDED.—The 
Secretary, acting through the Service, shall facilitate 
access to or provide services for Urban Indians 
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through grants to urban Indian organizations ad-
ministering contracts entered into or receiving 
grants under subsection (a) to prevent and treat 
child abuse (including sexual abuse) among Urban 
Indians. 
‘‘(2) EVALUATION REQUIRED.—Except as pro-
vided by paragraph (3)(A), a grant may not be made 
under this subsection to an urban Indian organiza-
tion until that organization has prepared, and the 
Service has approved, an assessment that documents 
the prevalence of child abuse in the urban Indian 
population concerned and specifies the services and 
programs (which may not duplicate existing services 
and programs) for which the grant is requested. 
‘‘(3) PURPOSES OF GRANTS.—Grants may be 
made under this subsection for the following: 
‘‘(A) To prepare assessments required 
under paragraph (2). 
‘‘(B) For the development of prevention, 
training, and education programs for Urban In-
dians, including child education, parent edu-
cation, provider training on identification and 
intervention, education on reporting require-
ments, prevention campaigns, and establishing 
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service networks of all those involved in Indian 
child protection. 
‘‘(C) To provide direct outpatient treat-
ment services (including individual treatment, 
family treatment, group therapy, and support 
groups) to Urban Indians who are child victims 
of abuse (including sexual abuse) or adult sur-
vivors of child sexual abuse, to the families of 
such child victims, and to urban Indian per-
petrators of child abuse (including sexual 
abuse). 
‘‘(4) 
CONSIDERATIONS
WHEN
MAKING 
GRANTS.—In making grants to carry out this sub-
section, the Secretary shall take into consideration— 
‘‘(A) the support for the urban Indian or-
ganization demonstrated by the child protection 
authorities in the area, including committees or 
other services funded under the Indian Child 
Welfare Act of 1978 (25 U.S.C. 1901 et seq.), 
if any; 
‘‘(B) the capability and expertise dem-
onstrated by the urban Indian organization to 
address the complex problem of child sexual 
abuse in the community; and 
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‘‘(C) the assessment required under para-
graph (2). 
‘‘(g) 
OTHER
GRANTS.—The 
Secretary, 
acting 
through the Service, may enter into a contract with or 
make grants to an urban Indian organization that pro-
vides or arranges for the provision of health care services 
(through satellite facilities, provider networks, or other-
wise) to Urban Indians in more than 1 Urban Center. 
‘‘SEC. 504. USE OF FEDERAL GOVERNMENT FACILITIES AND 
SOURCES OF SUPPLY. 
‘‘(a) IN GENERAL.—The Secretary may permit an 
urban Indian organization that has entered into a contract 
or received a grant pursuant to this title, in carrying out 
such contract or grant, to use existing facilities and all 
equipment therein or pertaining thereto and other per-
sonal property owned by the Federal Government within 
the Secretary’s jurisdiction under such terms and condi-
tions as may be agreed upon for their use and mainte-
nance. 
‘‘(b) DONATIONS.—Subject to subsection (d), the 
Secretary may donate to an urban Indian organization 
that has entered into a contract or received a grant pursu-
ant to this title any personal or real property determined 
to be excess to the needs of the Indian Health Service or 
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the General Services Administration for the purposes of 
carrying out the contract or grant. 
‘‘(c) ACQUISITION
OF PROPERTY.—The Secretary 
may acquire excess or surplus government personal or real 
property for donation, subject to subsection (d) to an 
urban Indian organization that has entered into a contract 
or received a grant pursuant to this title if the Secretary 
determines that the property is appropriate for use by the 
urban Indian organization for a purpose for which a con-
tract or grant is authorized under this title. 
‘‘(d) PRIORITY.—In the event that the Secretary re-
ceives a request for a specific item of personal or real 
property described in subsections (b) or (c) from an urban 
Indian organization and from an Indian Tribe or Tribal 
Organization, the Secretary shall give priority to the re-
quest for donation to the Indian Tribe or Tribal Organiza-
tion if the Secretary receives the request from the Indian 
Tribe or Tribal Organization before the date the Secretary 
transfers title to the property or, if earlier, the date the 
Secretary transfers the property physically, to the urban 
Indian organization. 
‘‘(e) EXECUTIVE AGENCY STATUS.—For purposes of 
section 201(a) of the Federal Property and Administrative 
Services Act of 1949 (40 U.S.C. 481(a)) (relating to Fed-
eral sources of supply), an urban Indian organization that 
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has entered into a contract or received a grant pursuant 
to this title may be deemed to be an executive agency when 
carrying out such contract or grant. 
‘‘SEC. 505. CONTRACTS AND GRANTS FOR THE DETERMINA-
TION OF UNMET HEALTH CARE NEEDS. 
‘‘(a) GRANTS
AND
CONTRACTS
AUTHORIZED.— 
Under 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, may enter into con-
tracts with or make grants to urban Indian organizations 
situated in Urban Centers for which contracts have not 
been entered into or grants have not been made under sec-
tion 503. 
‘‘(b) PURPOSE.—The purpose of a contract or grant 
made under this section shall be the determination of the 
matters described in subsection (c)(1) in order to assist 
the Secretary in assessing the health status and health 
care needs of Urban Indians in the Urban Center involved 
and determining whether the Secretary should enter into 
a contract or make a grant under section 503 with respect 
to the urban Indian organization which the Secretary has 
entered into a contract with, or made a grant to, under 
this section. 
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‘‘(c) GRANT AND CONTRACT REQUIREMENTS.—Any 
contract entered into, or grant made, by the Secretary 
under this section shall include requirements that— 
‘‘(1) the urban Indian organization successfully 
undertakes to— 
‘‘(A) document the health care status and 
unmet health care needs of urban Indians in 
the Urban Center involved; and 
‘‘(B) with respect to urban Indians in the 
Urban Center involved, determine the matters 
described in paragraphs (2), (3), (4), and (7) of 
section 503(b); and 
‘‘(2) the urban Indian organization complete 
performance of the contract, or carry out the re-
quirements of the grant, within 1 year after the date 
on which the Secretary and such organization enter 
into such contract, or within 1 year after such orga-
nization receives such grant, whichever is applicable. 
‘‘(d) NO RENEWALS.—The Secretary may not renew 
any contract entered into or grant made under this sec-
tion. 
‘‘SEC. 506. EVALUATIONS; RENEWALS. 
‘‘(a) PROCEDURES
FOR EVALUATIONS.—The Sec-
retary, acting through the Service, shall develop proce-
dures to evaluate compliance with grant requirements and 
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compliance with and performance of contracts entered into 
by urban Indian organizations under this title. Such pro-
cedures shall include provisions for carrying out the re-
quirements of this section. 
‘‘(b) EVALUATIONS.—The Secretary, acting through 
the Service, shall evaluate the compliance of each Urban 
Indian Organization which has entered into a contract or 
received a grant under section 503 with the terms of such 
contract or grant. For purposes of this evaluation, the 
Secretary shall— 
‘‘(1) acting through the Service, conduct an an-
nual onsite evaluation of the organization; or 
‘‘(2) accept in lieu of such onsite evaluation evi-
dence of the organization’s provisional or full accred-
itation by a private independent entity recognized by 
the Secretary for purposes of conducting quality re-
views of providers participating in the Medicare pro-
gram under title XVIII of the Social Security Act. 
‘‘(c) NONCOMPLIANCE; UNSATISFACTORY PERFORM-
ANCE.—If, as a result of the evaluations conducted under 
this section, the Secretary determines that an urban In-
dian organization has not complied with the requirements 
of a grant or complied with or satisfactorily performed a 
contract under section 503, the Secretary shall, prior to 
renewing such contract or grant, attempt to resolve with 
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the organization the areas of noncompliance or unsatisfac-
tory performance and modify the contract or grant to pre-
vent future occurrences of noncompliance or unsatisfac-
tory performance. If the Secretary determines that the 
noncompliance or unsatisfactory performance cannot be 
resolved and prevented in the future, the Secretary shall 
not renew the contract or grant with the organization and 
is authorized to enter into a contract or make a grant 
under section 503 with another urban Indian organization 
which is situated in the same Urban Center as the urban 
Indian organization whose contract or grant is not re-
newed under this section. 
‘‘(d) CONSIDERATIONS FOR RENEWALS.—In deter-
mining whether to renew a contract or grant with an 
urban Indian organization under section 503 which has 
completed performance of a contract or grant under sec-
tion 504, the Secretary shall review the records of the 
urban Indian organization, the reports submitted under 
section 507, and shall consider the results of the onsite 
evaluations or accreditations under subsection (b). 
‘‘SEC. 507. OTHER CONTRACT AND GRANT REQUIREMENTS. 
‘‘(a) PROCUREMENT.—Contracts with urban Indian 
organizations entered into pursuant to this title shall be 
in accordance with all Federal contracting laws and regu-
lations relating to procurement except that in the discre-
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tion of the Secretary, such contracts may be negotiated 
without advertising and need not conform to the provisions 
of sections 1304 and 3131 through 3133 of title 40, 
United States Code. 
‘‘(b) PAYMENTS UNDER CONTRACTS OR GRANTS.— 
‘‘(1) IN GENERAL.—Payments under any con-
tracts or grants pursuant to this title, notwith-
standing any term or condition of such contract or 
grant— 
‘‘(A) may be made in a single advance pay-
ment by the Secretary to the urban Indian or-
ganization by no later than the end of the first 
30 days of the funding period with respect to 
which the payments apply, unless the Secretary 
determines through an evaluation under section 
505 that the organization is not capable of ad-
ministering such a single advance payment; and 
‘‘(B) if any portion thereof is unexpended 
by the urban Indian organization during the 
funding period with respect to which the pay-
ments initially apply, shall be carried forward 
for expenditure with respect to allowable or re-
imbursable costs incurred by the organization 
during 1 or more subsequent funding periods 
without additional justification or documenta-
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tion by the organization as a condition of car-
rying forward the availability for expenditure of 
such funds. 
‘‘(2) SEMIANNUAL AND QUARTERLY PAYMENTS 
AND
REIMBURSEMENTS.—If the Secretary deter-
mines under paragraph (1)(A) that an urban Indian 
organization is not capable of administering an en-
tire single advance payment, on request of the urban 
Indian organization, the payments may be made— 
‘‘(A) in semiannual or quarterly payments 
by not later than 30 days after the date on 
which the funding period with respect to which 
the payments apply begins; or 
‘‘(B) by way of reimbursement. 
‘‘(c) REVISION OR AMENDMENT OF CONTRACTS.— 
Notwithstanding any provision of law to the contrary, the 
Secretary may, at the request and consent of an urban 
Indian organization, revise or amend any contract entered 
into by the Secretary with such organization under this 
title as necessary to carry out the purposes of this title. 
‘‘(d) FAIR AND UNIFORM SERVICES AND ASSIST-
ANCE.—Contracts with or grants to urban Indian organi-
zations and regulations adopted pursuant to this title shall 
include provisions to assure the fair and uniform provision 
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to urban Indians of services and assistance under such 
contracts or grants by such organizations. 
‘‘SEC. 508. REPORTS AND RECORDS. 
‘‘(a) REPORTS.— 
‘‘(1) IN GENERAL.—For each fiscal year during 
which an urban Indian organization receives or ex-
pends funds pursuant to a contract entered into or 
a grant received pursuant to this title, such urban 
Indian organization shall submit to the Secretary 
not more frequently than every 6 months, a report 
that includes the following: 
‘‘(A) In the case of a contract or grant 
under section 503, recommendations pursuant 
to section 503(a)(5). 
‘‘(B) Information on activities conducted 
by the organization pursuant to the contract or 
grant. 
‘‘(C) An accounting of the amounts and 
purpose for which Federal funds were ex-
pended. 
‘‘(D) A minimum set of data, using uni-
formly defined elements, as specified by the 
Secretary after consultation with urban Indian 
organizations. 
‘‘(2) HEALTH STATUS AND SERVICES.— 
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‘‘(A) IN
GENERAL.—Not later than 18 
months after the date of enactment of the In-
dian Health Care Improvement Act Amend-
ments of 2009, the Secretary, acting through 
the Service, shall submit to Congress a report 
evaluating— 
‘‘(i) the health status of urban Indi-
ans; 
‘‘(ii) the services provided to Indians 
pursuant to this title; and 
‘‘(iii) areas of unmet needs in the de-
livery of health services to urban Indians. 
‘‘(B) CONSULTATION
AND
CONTRACTS.— 
In preparing the report under paragraph (1), 
the Secretary— 
‘‘(i) shall consult with urban Indian 
organizations; and 
‘‘(ii) may enter into a contract with a 
national organization representing urban 
Indian organizations to conduct any aspect 
of the report. 
‘‘(b) AUDIT.—The reports and records of the urban 
Indian organization with respect to a contract or grant 
under this title shall be subject to audit by the Secretary 
and the Comptroller General of the United States. 
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‘‘(c) COSTS OF AUDITS.—The Secretary shall allow 
as a cost of any contract or grant entered into or awarded 
under section 502 or 503 the cost of an annual inde-
pendent financial audit conducted by— 
‘‘(1) a certified public accountant; or 
‘‘(2) a certified public accounting firm qualified 
to conduct Federal compliance audits. 
‘‘SEC. 509. LIMITATION ON CONTRACT AUTHORITY. 
‘‘The authority of the Secretary to enter into con-
tracts or to award grants under this title shall be to the 
extent, and in an amount, provided for in appropriation 
Acts. 
‘‘SEC. 510. FACILITIES. 
‘‘(a) GRANTS.—The Secretary, acting through the 
Service, may make grants to contractors or grant recipi-
ents under this title for the lease, purchase, renovation, 
construction, or expansion of facilities, including leased fa-
cilities, in order to assist such contractors or grant recipi-
ents in complying with applicable licensure or certification 
requirements. 
‘‘(b) LOAN FUND STUDY.—The Secretary, acting 
through the Service, may carry out a study to determine 
the feasibility of establishing a loan fund to provide to 
urban Indian organizations direct loans or guarantees for 
loans for the construction of health care facilities in a 
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manner consistent with section 309, including by submit-
ting a report in accordance with subsection (c) of that sec-
tion. 
‘‘SEC. 511. DIVISION OF URBAN INDIAN HEALTH. 
‘‘There is established within the Service a Division 
of Urban Indian Health, which shall be responsible for— 
‘‘(1) carrying out the provisions of this title; 
‘‘(2) providing central oversight of the pro-
grams and services authorized under this title; and 
‘‘(3) providing technical assistance to urban In-
dian organizations. 
‘‘SEC. 512. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE- 
RELATED SERVICES. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 
through the Service, may make grants for the provision 
of health-related services in prevention of, treatment of, 
rehabilitation of, or school- and community-based edu-
cation regarding, alcohol and substance abuse in Urban 
Centers to those urban Indian organizations with which 
the Secretary has entered into a contract under this title 
or under section 201. 
‘‘(b) GOALS.—Each grant made pursuant to sub-
section (a) shall set forth the goals to be accomplished 
pursuant to the grant. The goals shall be specific to each 
grant as agreed to between the Secretary and the grantee. 
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‘‘(c) CRITERIA.—The Secretary shall establish cri-
teria for the grants made under subsection (a), including 
criteria relating to the following: 
‘‘(1) The size of the urban Indian population. 
‘‘(2) Capability of the organization to ade-
quately perform the activities required under the 
grant. 
‘‘(3) Satisfactory performance standards for the 
organization in meeting the goals set forth in such 
grant. The standards shall be negotiated and agreed 
to between the Secretary and the grantee on a 
grant-by-grant basis. 
‘‘(4) Identification of the need for services. 
‘‘(d) ALLOCATION OF GRANTS.—The Secretary shall 
develop a methodology for allocating grants made pursu-
ant to this section based on the criteria established pursu-
ant to subsection (c). 
‘‘(e) GRANTS SUBJECT TO CRITERIA.—Any grant re-
ceived by an urban Indian organization under this Act for 
substance abuse prevention, treatment, and rehabilitation 
shall be subject to the criteria set forth in subsection (c). 
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‘‘SEC. 513. TREATMENT OF CERTAIN DEMONSTRATION 
PROJECTS. 
‘‘Notwithstanding any other provision of law, the 
Tulsa Clinic and Oklahoma City Clinic demonstration 
projects shall— 
‘‘(1) be permanent programs within the Serv-
ice’s direct care program; 
‘‘(2) continue to be treated as Service Units 
and Operating Units in the allocation of resources 
and coordination of care; and 
‘‘(3) continue to meet the requirements and 
definitions of an urban Indian organization in this 
Act, and shall not be subject to the provisions of the 
Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.). 
‘‘SEC. 514. URBAN NIAAA TRANSFERRED PROGRAMS. 
‘‘(a) GRANTS
AND
CONTRACTS.—The Secretary, 
through the Division of Urban Indian Health, shall make 
grants or enter into contracts with urban Indian organiza-
tions, to take effect not later than September 30, 2010, 
for the administration of urban Indian alcohol programs 
that were originally established under the National Insti-
tute on Alcoholism and Alcohol Abuse (hereafter in this 
section referred to as ‘NIAAA’) and transferred to the 
Service. 
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‘‘(b) USE OF FUNDS.—Grants provided or contracts 
entered into under this section shall be used to provide 
support for the continuation of alcohol prevention and 
treatment services for urban Indian populations and such 
other objectives as are agreed upon between the Service 
and a recipient of a grant or contract under this section. 
‘‘(c) ELIGIBILITY.—Urban Indian organizations that 
operate Indian alcohol programs originally funded under 
the NIAAA and subsequently transferred to the Service 
are eligible for grants or contracts under this section. 
‘‘(d) REPORT.—The Secretary shall evaluate and re-
port to Congress on the activities of programs funded 
under this section not less than every 5 years. 
‘‘SEC. 515. CONFERRING WITH URBAN INDIAN ORGANIZA-
TIONS. 
‘‘(a) IN GENERAL.—The Secretary shall ensure that 
the Service confers or conferences, to the greatest extent 
practicable, with Urban Indian Organizations. 
‘‘(b) DEFINITION
OF CONFER; CONFERENCE.—In 
this section, the terms ‘confer’ and ‘conference’ mean an 
open and free exchange of information and opinions 
that— 
‘‘(1) leads to mutual understanding and com-
prehension; and 
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‘‘(2) emphasizes trust, respect, and shared re-
sponsibility. 
‘‘SEC. 516. URBAN YOUTH TREATMENT CENTER DEM-
ONSTRATION. 
‘‘(a) CONSTRUCTION AND OPERATION.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Service, through grant or contract, shall 
fund the construction and operation of at least 1 
residential treatment center in each Service Area 
that meets the eligibility requirements set forth in 
subsection (b) to demonstrate the provision of alco-
hol and substance abuse treatment services to Urban 
Indian youth in a culturally competent residential 
setting. 
‘‘(2) TREATMENT.—Each residential treatment 
center described in paragraph (1) shall be in addi-
tion to any facilities constructed under section 
707(b). 
‘‘(b) ELIGIBILITY REQUIREMENTS.—To be eligible to 
obtain a facility under subsection (a)(1), a Service Area 
shall meet the following requirements: 
‘‘(1) There is an Urban Indian Organization in 
the Service Area. 
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‘‘(2) There reside in the Service Area Urban In-
dian youth with need for alcohol and substance 
abuse treatment services in a residential setting. 
‘‘(3) There is a significant shortage of cul-
turally competent residential treatment services for 
Urban Indian youth in the Service Area. 
‘‘SEC. 517. GRANTS FOR DIABETES PREVENTION, TREAT-
MENT, AND CONTROL. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary may 
make grants to those urban Indian organizations that 
have entered into a contract or have received a grant 
under this title for the provision of services for the preven-
tion and treatment of, and control of the complications 
resulting from, diabetes among urban Indians. 
‘‘(b) GOALS.—Each grant made pursuant to sub-
section (a) shall set forth the goals to be accomplished 
under the grant. The goals shall be specific to each grant 
as agreed to between the Secretary and the grantee. 
‘‘(c) ESTABLISHMENT OF CRITERIA.—The Secretary 
shall establish criteria for the grants made under sub-
section (a) relating to— 
‘‘(1) the size and location of the urban Indian 
population to be served; 
‘‘(2) the need for prevention of and treatment 
of, and control of the complications resulting from, 
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diabetes among the urban Indian population to be 
served; 
‘‘(3) performance standards for the organiza-
tion in meeting the goals set forth in such grant 
that are negotiated and agreed to by the Secretary 
and the grantee; 
‘‘(4) the capability of the organization to ade-
quately perform the activities required under the 
grant; and 
‘‘(5) the willingness of the organization to col-
laborate with the registry, if any, established by the 
Secretary under section 203(e)(1)(B) in the Area 
Office of the Service in which the organization is lo-
cated. 
‘‘(d) FUNDS SUBJECT TO CRITERIA.—Any funds re-
ceived by an urban Indian organization under this Act for 
the prevention, treatment, and control of diabetes among 
urban Indians shall be subject to the criteria developed 
by the Secretary under subsection (c). 
‘‘SEC. 518. COMMUNITY HEALTH REPRESENTATIVES. 
‘‘The Secretary, acting through the Service, may 
enter into contracts with, and make grants to, urban In-
dian organizations for the employment of Indians trained 
as health service providers through the Community Health 
Representatives Program under section 109 in the provi-
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sion of health care, health promotion, and disease preven-
tion services to urban Indians. 
‘‘SEC. 519. EFFECTIVE DATE. 
‘‘The amendments made by the Indian Health Care 
Improvement Act Amendments of 2009 to this title shall 
take effect beginning on the date of enactment of that Act, 
regardless of whether the Secretary has promulgated regu-
lations implementing such amendments. 
‘‘SEC. 520. ELIGIBILITY FOR SERVICES. 
‘‘Urban Indians shall be eligible for, and the ultimate 
beneficiaries of, health care or referral services provided 
pursuant to this title. 
‘‘SEC. 521. AUTHORIZATION OF APPROPRIATIONS. 
‘‘(a) IN GENERAL.—There are authorized to be ap-
propriated such sums as may be necessary to carry out 
this title. 
‘‘(b) URBAN INDIAN ORGANIZATIONS.—The Sec-
retary, acting through the Service, is authorized to estab-
lish programs, including programs for the awarding of 
grants, for urban Indian organizations that are identical 
to any programs established pursuant to section 126 (be-
havioral health training), section 209 (school health edu-
cation), section 211 (prevention of communicable dis-
eases), section 701 (behavioral health prevention and 
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treatment services), and section 707(g) (multidrug abuse 
program). 
‘‘SEC. 522. HEALTH INFORMATION TECHNOLOGY. 
‘‘The Secretary, acting through the Service, may 
make grants to urban Indian organizations under this title 
for the development, adoption, and implementation of 
health information technology (as defined in section 
3000(5) of the American Recovery and Reinvestment Act), 
telemedicine services development, and related infrastruc-
ture. 
‘‘TITLE VI—ORGANIZATIONAL 
IMPROVEMENTS 
‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV-
ICE AS AN AGENCY OF THE PUBLIC HEALTH 
SERVICE. 
‘‘(a) ESTABLISHMENT.— 
‘‘(1) IN GENERAL.—In order to more effectively 
and efficiently carry out the responsibilities, authori-
ties, and functions of the United States to provide 
health care services to Indians and Indian Tribes, as 
are or may be hereafter provided by Federal statute 
or treaties, there is established within the Public 
Health Service of the Department the Indian Health 
Service. 
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‘‘(2) 
ASSISTANT
SECRETARY
OF
INDIAN 
HEALTH.—The Service shall be administered by an 
Assistant Secretary of Indian Health, who shall be 
appointed by the President, by and with the advice 
and consent of the Senate. The Assistant Secretary 
shall report to the Secretary. Effective with respect 
to an individual appointed by the President, by and 
with the advice and consent of the Senate, after 
January 1, 2010, the term of service of the Assist-
ant Secretary shall be 4 years. An Assistant Sec-
retary may serve more than 1 term. 
‘‘(3) INCUMBENT.—The individual serving in 
the position of Director of the Service on the day be-
fore the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2009 shall 
serve as Assistant Secretary. 
‘‘(4) ADVOCACY AND CONSULTATION.—The po-
sition of Assistant Secretary is established to, in a 
manner consistent with the government-to-govern-
ment relationship between the United States and In-
dian Tribes— 
‘‘(A) facilitate advocacy for the develop-
ment of appropriate Indian health policy; and 
‘‘(B) promote consultation on matters re-
lating to Indian health. 
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‘‘(b) AGENCY.—The Service shall be an agency within 
the Public Health Service of the Department, and shall 
not be an office, component, or unit of any other agency 
of the Department. 
‘‘(c) DUTIES.—The Assistant Secretary shall— 
‘‘(1) perform all functions that were, on the day 
before the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2009, car-
ried out by or under the direction of the individual 
serving as Director of the Service on that day; 
‘‘(2) perform all functions of the Secretary re-
lating to the maintenance and operation of hospital 
and health facilities for Indians and the planning 
for, and provision and utilization of, health services 
for Indians; 
‘‘(3) administer all health programs under 
which health care is provided to Indians based upon 
their status as Indians which are administered by 
the Secretary, including programs under— 
‘‘(A) this Act; 
‘‘(B) the Act of November 2, 1921 (25 
U.S.C. 13); 
‘‘(C) the Act of August 5, 1954 (42 U.S.C. 
2001 et seq.); 
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‘‘(D) the Act of August 16, 1957 (42 
U.S.C. 2005 et seq.); and 
‘‘(E) the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et 
seq.); 
‘‘(4) administer all scholarship and loan func-
tions carried out under title I; 
‘‘(5) report directly to the Secretary concerning 
all policy- and budget-related matters affecting In-
dian health; 
‘‘(6) collaborate with the Assistant Secretary 
for Health concerning appropriate matters of Indian 
health that affect the agencies of the Public Health 
Service; 
‘‘(7) advise each Assistant Secretary of the De-
partment concerning matters of Indian health with 
respect to which that Assistant Secretary has au-
thority and responsibility; 
‘‘(8) advise the heads of other agencies and pro-
grams of the Department concerning matters of In-
dian health with respect to which those heads have 
authority and responsibility; 
‘‘(9) coordinate the activities of the Department 
concerning matters of Indian health; and 
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‘‘(10) perform such other functions as the Sec-
retary may designate. 
‘‘(d) AUTHORITY.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Assistant Secretary, shall have the au-
thority— 
‘‘(A) except to the extent provided for in 
paragraph (2), to appoint and compensate em-
ployees for the Service in accordance with title 
5, United States Code; 
‘‘(B) to enter into contracts for the pro-
curement of goods and services to carry out the 
functions of the Service; and 
‘‘(C) to manage, expend, and obligate all 
funds appropriated for the Service. 
‘‘(2) PERSONNEL
ACTIONS.—Notwithstanding 
any other provision of law, the provisions of section 
12 of the Act of June 18, 1934 (48 Stat. 986; 25 
U.S.C. 472), shall apply to all personnel actions 
taken with respect to new positions created within 
the Service as a result of its establishment under 
subsection (a). 
‘‘(e) REFERENCES.—Any reference to the Director of 
the Indian Health Service in any other Federal law, Exec-
utive order, rule, regulation, or delegation of authority, or 
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in any document of or relating to the Director of the In-
dian Health Service, shall be deemed to refer to the Assist-
ant Secretary. 
‘‘SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYS-
TEM. 
‘‘(a) ESTABLISHMENT.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish an automated management information system 
for the Service. 
‘‘(2) REQUIREMENTS OF SYSTEM.—The infor-
mation system established under paragraph (1) shall 
include— 
‘‘(A) a financial management system; 
‘‘(B) a patient care information system for 
each area served by the Service; 
‘‘(C) privacy protections consistent with 
the regulations promulgated under section 
264(c) of the Health Insurance Portability and 
Accountability Act of 1996 or, to the extent 
consistent with such regulations, other Federal 
rules applicable to privacy of automated man-
agement information systems of a Federal 
agency; 
‘‘(D) a services-based cost accounting com-
ponent that provides estimates of the costs as-
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sociated with the provision of specific medical 
treatments or services in each Area office of the 
Service; 
‘‘(E) an interface mechanism for patient 
billing and accounts receivable system; and 
‘‘(F) a training component. 
‘‘(b) PROVISION OF SYSTEMS TO TRIBES AND ORGA-
NIZATIONS.—The Secretary shall provide each Tribal 
Health Program automated management information sys-
tems which— 
‘‘(1) meet the management information needs 
of such Tribal Health Program with respect to the 
treatment by the Tribal Health Program of patients 
of the Service; and 
‘‘(2) meet the management information needs 
of the Service. 
‘‘(c) ACCESS TO RECORDS.—The Service shall pro-
vide access of patients to their medical or health records 
which are held by, or on behalf of, the Service in accord-
ance with the regulations promulgated under section 
264(c) of the Health Insurance Portability and Account-
ability Act of 1996 or, to the extent consistent with such 
regulations, other Federal rules applicable to access to 
health care records. 
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‘‘(d) AUTHORITY TO ENHANCE INFORMATION TECH-
NOLOGY.—The Secretary, acting through the Assistant 
Secretary, shall have the authority to enter into contracts, 
agreements, or joint ventures with other Federal agencies, 
States, private and nonprofit organizations, for the pur-
pose of enhancing information technology in Indian 
Health Programs and facilities. 
‘‘SEC. 603. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There is authorized to be appropriated such sums 
as may be necessary to carry out this title. 
‘‘TITLE VII—BEHAVIORAL 
HEALTH PROGRAMS 
‘‘SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREAT-
MENT SERVICES. 
‘‘(a) PURPOSES.—The purposes of this section are as 
follows: 
‘‘(1) To authorize and direct the Secretary, act-
ing through the Service, to develop a comprehensive 
behavioral health prevention and treatment program 
which emphasizes collaboration among alcohol and 
substance abuse, social services, and mental health 
programs. 
‘‘(2) To provide information, direction, and 
guidance relating to mental illness and dysfunction 
and self-destructive behavior, including child abuse 
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and family violence, to those Federal, tribal, State, 
and local agencies responsible for programs in In-
dian communities in areas of health care, education, 
social services, child and family welfare, alcohol and 
substance abuse, law enforcement, and judicial serv-
ices. 
‘‘(3) To assist Indian Tribes to identify services 
and resources available to address mental illness and 
dysfunctional and self-destructive behavior. 
‘‘(4) To provide authority and opportunities for 
Indian Tribes and Tribal Organizations to develop, 
implement, and coordinate with community-based 
programs which include identification, prevention, 
education, referral, and treatment services, including 
through multidisciplinary resource teams. 
‘‘(5) To ensure that Indians, as citizens of the 
United States and of the States in which they re-
side, have the same access to behavioral health serv-
ices to which all citizens have access. 
‘‘(6) To modify or supplement existing pro-
grams and authorities in the areas identified in 
paragraph (2). 
‘‘(b) PLANS.— 
‘‘(1) DEVELOPMENT.—The Secretary, acting 
through the Service, shall encourage Indian Tribes 
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and Tribal Organizations to develop tribal plans, 
and urban Indian organizations to develop local 
plans, and for all such groups to participate in de-
veloping areawide plans for Indian Behavioral 
Health Services. The plans shall include, to the ex-
tent feasible, the following components: 
‘‘(A) An assessment of the scope of alcohol 
or other substance abuse, mental illness, and 
dysfunctional and self-destructive behavior, in-
cluding suicide, child abuse, and family vio-
lence, among Indians, including— 
‘‘(i) the number of Indians served who 
are directly or indirectly affected by such 
illness or behavior; or 
‘‘(ii) an estimate of the financial and 
human cost attributable to such illness or 
behavior. 
‘‘(B) An assessment of the existing and 
additional resources necessary for the preven-
tion and treatment of such illness and behavior, 
including an assessment of the progress toward 
achieving the availability of the full continuum 
of care described in subsection (c). 
‘‘(C) An estimate of the additional funding 
needed by the Service, Indian Tribes, Tribal 
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