I 
112TH CONGRESS 
1ST SESSION 
H. R. 536 
To amend the Indian Health Care Improvement Act to revise and extend 
that Act, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 8, 2011 
Mr. COLE (for himself, Mr. DUNCAN of South Carolina, Ms. FOXX, and Mr. 
SMITH of Nebraska) introduced the following bill; which was referred to 
the Committee on Natural Resources, and in addition to the Committees 
on Energy and Commerce, Ways and Means, and the Budget, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
A BILL 
To amend the Indian Health Care Improvement Act to revise 
and extend that Act, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Indian Healthcare Improvement Act of 2011’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
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TITLE I—INDIAN HEALTH CARE IMPROVEMENT ACT 
REAUTHORIZATION AND AMENDMENTS 
Sec. 101. Reauthorization. 
Sec. 102. Findings. 
Sec. 103. Declaration of national Indian health policy. 
Sec. 104. Definitions. 
Subtitle A—Indian Health Manpower 
Sec. 111. Community Health Aide Program. 
Sec. 112. Health professional chronic shortage demonstration programs. 
Sec. 113. Exemption from payment of certain fees. 
Subtitle B—Health Services 
Sec. 121. Indian Health Care Improvement Fund. 
Sec. 122. Catastrophic Health Emergency Fund. 
Sec. 123. Diabetes prevention, treatment, and control. 
Sec. 124. Other authority for provision of services; shared services for long- 
term care. 
Sec. 125. Reimbursement from certain third parties of costs of health services. 
Sec. 126. Crediting of reimbursements. 
Sec. 127. Behavioral health training and community education programs. 
Sec. 128. Cancer screenings. 
Sec. 129. Patient travel costs. 
Sec. 130. Epidemiology centers. 
Sec. 131. Indian youth grant program. 
Sec. 132. American Indians Into Psychology Program. 
Sec. 133. Prevention, control, and elimination of communicable and infectious 
diseases. 
Sec. 134. Methods to increase clinician recruitment and retention issues. 
Sec. 135. Liability for payment. 
Sec. 136. Offices of Indian Men’s Health and Indian Women’s Health. 
Sec. 137. Contract health service administration and disbursement formula. 
Subtitle C—Health Facilities 
Sec. 141. Health care facility priority system. 
Sec. 142. Priority of certain projects protected. 
Sec. 143. Indian health care delivery demonstration projects. 
Sec. 144. Tribal management of federally owned quarters. 
Sec. 145. Other funding, equipment, and supplies for facilities. 
Sec. 146. Indian country modular component facilities demonstration program. 
Sec. 147. Mobile health stations demonstration program. 
Subtitle D—Access to Health Services 
Sec. 151. Treatment of payments under Social Security Act health benefits pro-
grams. 
Sec. 152. Purchasing health care coverage. 
Sec. 153. Grants to and contracts with the Service, Indian tribes, tribal organi-
zations, and urban Indian organizations to facilitate outreach, 
enrollment, and coverage of Indians under Social Security Act 
health benefit programs and other health benefits programs. 
Sec. 154. Sharing arrangements with Federal agencies. 
Sec. 155. Eligible Indian veteran services. 
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Sec. 156. Nondiscrimination under Federal health care programs in qualifica-
tions for reimbursement for services. 
Sec. 157. Access to Federal insurance. 
Sec. 158. General exceptions. 
Sec. 159. Navajo Nation Medicaid Agency feasibility study. 
Subtitle E—Health Services for Urban Indians 
Sec. 161. Facilities renovation. 
Sec. 162. Treatment of certain demonstration projects. 
Sec. 163. Requirement to confer with urban Indian organizations. 
Sec. 164. Expanded program authority for urban Indian organizations. 
Sec. 165. Community health representatives. 
Sec. 166. Use of Federal Government facilities and sources of supply; health in-
formation technology. 
Subtitle F—Organizational Improvements 
Sec. 171. Establishment of the Indian Health Service as an agency of the Pub-
lic Health Service. 
Sec. 172. Office of Direct Service Tribes. 
Sec. 173. Nevada area office. 
Subtitle G—Behavioral Health Programs 
Sec. 181. Behavioral health programs. 
Subtitle H—Miscellaneous 
Sec. 191. Confidentiality of medical quality assurance records; qualified immu-
nity for participants. 
Sec. 192. Limitation on use of funds appropraited to the Indian Health Service. 
Sec. 193. Arizona, North Dakota, and South Dakota as contract health service 
delivery areas; eligibility of California Indians. 
Sec. 194. Methods to increase access to professionals of certain corps. 
Sec. 195. Health services for ineligible persons. 
Sec. 196. Annual budget submission. 
Sec. 197. Prescription drug monitoring. 
Sec. 198. Tribal health program option for cost sharing. 
Sec. 199. Disease and injury prevention report. 
Sec. 200. Other GAO reports. 
Sec. 201. Traditional health care practices. 
Sec. 202. Director of HIV/AIDS Prevention and Treatment. 
TITLE II—AMENDMENTS TO OTHER ACTS AND MISCELLANEOUS 
PROVISIONS 
Sec. 201. Elimination of sunset for reimbursement for all Medicare part B 
services furnished by certain Indian hospitals and clinics. 
Sec. 202. Including costs incurred by aids drug assistance programs and Indian 
health service in providing prescription drugs toward the an-
nual out-of-pocket threshold under part D. 
Sec. 203. Prohibition of use of Federal funds for abortion. 
Sec. 204. Reauthorization of Native Hawaiian health care programs. 
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TITLE I—INDIAN HEALTH CARE 
IMPROVEMENT 
ACT 
REAU-
THORIZATION 
AND 
AMEND-
MENTS 
SEC. 101. REAUTHORIZATION. 
(a) IN GENERAL.—Section 825 of the Indian Health 
Care Improvement Act (25 U.S.C. 1680o) is amended to 
read as follows: 
‘‘SEC. 825. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated such sums 
as are necessary to carry out this Act for fiscal year 2010 
and each fiscal year thereafter, to remain available until 
expended.’’. 
(b) REPEALS.—The following provisions of the In-
dian Health Care Improvement Act are repealed: 
(1) Section 123 (25 U.S.C. 1616p). 
(2) Paragraph (6) of section 209(m) (25 U.S.C. 
1621h(m)). 
(3) Subsection (g) of section 211 (25 U.S.C. 
1621j). 
(4) Subsection (e) of section 216 (25 U.S.C. 
1621o). 
(5) Section 224 (25 U.S.C. 1621w). 
(6) Section 309 (25 U.S.C. 1638a). 
(7) Section 407 (25 U.S.C. 1647). 
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(8) Subsection (c) of section 512 (25 U.S.C. 
1660b). 
(9) Section 514 (25 U.S.C. 1660d). 
(10) Section 603 (25 U.S.C. 1663). 
(11) Section 805 (25 U.S.C. 1675). 
(c) CONFORMING AMENDMENTS.— 
(1) Section 204(c)(1) of the Indian Health Care 
Improvement Act (25 U.S.C. 1621c(c)(1)) is amend-
ed by striking ‘‘through fiscal year 2000’’. 
(2) Section 213 of the Indian Health Care Im-
provement Act (25 U.S.C. 1621l) is amended by 
striking ‘‘(a) The Secretary’’ and inserting ‘‘The 
Secretary’’. 
(3) Section 310 of the Indian Health Care Im-
provement Act (25 U.S.C. 1638b) is amended by 
striking ‘‘funds provided pursuant to the authoriza-
tion contained in section 309’’ each place it appears 
and inserting ‘‘funds made available to carry out 
this title’’. 
SEC. 102. FINDINGS. 
Section 2 of the Indian Health Care Improvement 
Act (25 U.S.C. 1601) is amended— 
(1) by redesignating subsections (a), (b), (c), 
and (d) as paragraphs (1), (3), (4), and (5), respec-
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tively, and indenting the paragraphs appropriately; 
and 
(2) by inserting after paragraph (1) (as so re-
designated) the following: 
‘‘(2) A major national goal of the United States 
is to provide the resources, processes, and structure 
that will enable Indian tribes and tribal members to 
obtain the quantity and quality of health care serv-
ices and opportunities that will eradicate the health 
disparities between Indians and the general popu-
lation of the United States.’’. 
SEC. 103. DECLARATION OF NATIONAL INDIAN HEALTH 
POLICY. 
Section 3 of the Indian Health Care Improvement 
Act (25 U.S.C. 1602) is amended to read as follows: 
‘‘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 ensure the highest possible health status 
for Indians and urban Indians and to provide all re-
sources necessary to effect that policy; 
‘‘(2) to raise the health status of Indians and 
urban Indians to at least the levels set forth in the 
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goals contained within the Healthy People 2010 ini-
tiative or successor objectives; 
‘‘(3) to ensure maximum Indian participation in 
the direction of health care services so as to render 
the persons administering such services and the 
services themselves more responsive to the needs and 
desires of Indian communities; 
‘‘(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 that all actions under this Act 
shall be carried out with active and meaningful con-
sultation with Indian tribes and tribal organizations, 
and conference with urban Indian organizations, to 
implement this Act and the national policy of Indian 
self-determination; 
‘‘(6) to ensure that the United States and In-
dian tribes work in a government-to-government re-
lationship to ensure quality health care for all tribal 
members; and 
‘‘(7) to provide funding for programs and facili-
ties operated by Indian tribes and tribal organiza-
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tions in amounts that are not less than the amounts 
provided to programs and facilities operated directly 
by the Service.’’. 
SEC. 104. DEFINITIONS. 
Section 4 of the Indian Health Care Improvement 
Act (25 U.S.C. 1603) is amended— 
(1) by striking the matter preceding subsection 
(a) and inserting ‘‘In this Act:’’; 
(2) in each of subsections (c), (j), (k), and (l), 
by redesignating the paragraphs contained in the 
subsections as subparagraphs and indenting the sub-
paragraphs appropriately; 
(3) by redesignating subsections (a) through (q) 
as paragraphs (17), (18), (13), (14), (26), (28), 
(27), (29), (1), (20), (11), (7), (19), (10), (21), (8), 
and (9), respectively, indenting the paragraphs ap-
propriately, and moving the paragraphs so as to ap-
pear in numerical order; 
(4) in each paragraph (as so redesignated), by 
inserting a heading the text of which is comprised of 
the term defined in the paragraph; 
(5) by inserting ‘‘The term’’ after each para-
graph heading; 
(6) by inserting after paragraph (1) (as redesig-
nated by paragraph (3)) the following: 
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‘‘(2) BEHAVIORAL HEALTH.— 
‘‘(A) IN GENERAL.—The term ‘behavioral 
health’ means the blending of substance (alco-
hol, drugs, inhalants, and tobacco) abuse and 
mental health disorders prevention and treat-
ment for the purpose of providing comprehen-
sive services. 
‘‘(B) INCLUSIONS.—The term ‘behavioral 
health’ includes the joint development of sub-
stance abuse and mental health treatment plan-
ning and coordinated case management using a 
multidisciplinary approach. 
‘‘(3) CALIFORNIA
INDIAN.—The term ‘Cali-
fornia Indian’ means any Indian who is eligible for 
health services provided by the Service pursuant to 
section 809. 
‘‘(4) COMMUNITY COLLEGE.—The term ‘com-
munity college’ means— 
‘‘(A) a tribal college or university; or 
‘‘(B) a junior or community college. 
‘‘(5) CONTRACT HEALTH SERVICE.—The term 
‘contract health service’ means any health service 
that is— 
‘‘(A) delivered based on a referral by, or at 
the expense of, an Indian health program; and 
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‘‘(B) provided by a public or private med-
ical provider or hospital that is not a provider 
or hospital of the Indian health program. 
‘‘(6) DEPARTMENT.—The term ‘Department’, 
unless otherwise designated, means the Department 
of Health and Human Services.’’; 
(7) by striking paragraph (7) (as redesignated 
by paragraph (3)) and inserting the following: 
‘‘(7) DISEASE PREVENTION.— 
‘‘(A) IN GENERAL.—The term ‘disease pre-
vention’ means any activity for— 
‘‘(i) the reduction, limitation, and pre-
vention of— 
‘‘(I) disease; and 
‘‘(II) complications of disease; 
and 
‘‘(ii) the reduction of consequences of 
disease. 
‘‘(B) INCLUSIONS.—The term ‘disease pre-
vention’ includes an activity for— 
‘‘(i) controlling— 
‘‘(I) the development of diabetes; 
‘‘(II) high blood pressure; 
‘‘(III) infectious agents; 
‘‘(IV) injuries; 
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‘‘(V) occupational hazards and 
disabilities; 
‘‘(VI) sexually transmittable dis-
eases; or 
‘‘(VII) toxic agents; or 
‘‘(ii) providing— 
‘‘(I) fluoridation of water; or 
‘‘(II) immunizations.’’; 
(8) by striking paragraph (9) (as redesignated 
by paragraph (3)) and inserting the following: 
‘‘(9) FAS.—The term ‘fetal alcohol syndrome’ 
or ‘FAS’ means a syndrome in which, with a history 
of maternal alcohol consumption during pregnancy, 
the following criteria are met: 
‘‘(A) Central nervous system involvement 
such as mental retardation, developmental 
delay, intellectual deficit, microencephaly, or 
neurologic abnormalities. 
‘‘(B) Craniofacial abnormalities with at 
least 2 of the following: microophthalmia, short 
palpebral fissures, poorly developed philtrum, 
thin upper lip, flat nasal bridge, and short 
upturned nose. 
‘‘(C) Prenatal or postnatal growth delay.’’; 
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(9) by striking paragraphs (11) and (12) (as 
redesignated by paragraph (3)) and inserting the 
following: 
‘‘(11) HEALTH PROMOTION.—The term ‘health 
promotion’ means any activity for— 
‘‘(A) fostering social, economic, environ-
mental, and personal factors conducive to 
health, including raising public awareness re-
garding health matters and enabling individuals 
to cope with health problems by increasing 
knowledge and providing valid information; 
‘‘(B) encouraging adequate and appro-
priate diet, exercise, and sleep; 
‘‘(C) promoting education and work in ac-
cordance with physical and mental capacity; 
‘‘(D) making available safe water and sani-
tary facilities; 
‘‘(E) improving the physical, economic, cul-
tural, psychological, and social environment; 
‘‘(F) promoting culturally competent care; 
and 
‘‘(G) providing adequate and appropriate 
programs, including programs for— 
‘‘(i) abuse prevention (mental and 
physical); 
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‘‘(ii) community health; 
‘‘(iii) community safety; 
‘‘(iv) consumer health education; 
‘‘(v) diet and nutrition; 
‘‘(vi) immunization and other methods 
of prevention of communicable diseases, in-
cluding HIV/AIDS; 
‘‘(vii) environmental health; 
‘‘(viii) exercise and physical fitness; 
‘‘(ix) avoidance of fetal alcohol spec-
trum disorders; 
‘‘(x) first aid and CPR education; 
‘‘(xi) human growth and development; 
‘‘(xii) injury prevention and personal 
safety; 
‘‘(xiii) behavioral health; 
‘‘(xiv) monitoring of disease indicators 
between health care provider visits through 
appropriate means, including Internet- 
based health care management systems; 
‘‘(xv) personal health and wellness 
practices; 
‘‘(xvi) personal capacity building; 
‘‘(xvii) prenatal, pregnancy, and in-
fant care; 
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‘‘(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; 
‘‘(xxvii) tobacco use cessation and re-
duction; 
‘‘(xxviii) violence prevention; and 
‘‘(xxix) such other activities identified 
by the Service, a tribal health program, or 
an urban Indian organization to promote 
achievement of any of the objectives re-
ferred to in section 3(2). 
‘‘(12) INDIAN
HEALTH
PROGRAM.—The term 
‘Indian health program’ means— 
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‘‘(A) any health program administered di-
rectly by the Service; 
‘‘(B) any tribal health program; and 
‘‘(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’).’’; 
(10) by inserting after paragraph (14) (as re-
designated by paragraph (3)) the following: 
‘‘(15) JUNIOR OR COMMUNITY COLLEGE.—The 
term ‘junior or community college’ has the meaning 
given the term in section 312(e) of the Higher Edu-
cation Act of 1965 (20 U.S.C. 1058(e)). 
‘‘(16) RESERVATION.— 
‘‘(A) IN GENERAL.—The term ‘reservation’ 
means a reservation, Pueblo, or colony of any 
Indian tribe. 
‘‘(B) INCLUSIONS.—The term ‘reservation’ 
includes— 
‘‘(i) former reservations in Oklahoma; 
‘‘(ii) Indian allotments; and 
‘‘(iii) Alaska Native Regions estab-
lished pursuant to the Alaska Native 
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Claims Settlement Act (43 U.S.C. 1601 et 
seq.).’’; 
(11) by striking paragraph (20) (as redesig-
nated by paragraph (3)) and inserting the following: 
‘‘(20) SERVICE UNIT.—The term ‘Service unit’ 
means an administrative entity of the Service or a 
tribal health program through which services are 
provided, directly or by contract, to eligible Indians 
within a defined geographic area.’’; 
(12) by inserting after paragraph (21) (as re-
designated by paragraph (3)) the following: 
‘‘(22) TELEHEALTH.—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)). 
‘‘(23) TELEMEDICINE.—The term ‘telemedicine’ 
means a telecommunications link to an end user 
through the use of eligible equipment that electroni-
cally links health professionals or patients and 
health professionals at separate sites in order to ex-
change health care information in audio, video, 
graphic, or other format for the purpose of providing 
improved health care services. 
‘‘(24) TRIBAL COLLEGE OR UNIVERSITY.—The 
term ‘tribal college or university’ has the meaning 
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given the term in section 316(b) of the Higher Edu-
cation Act of 1965 (20 U.S.C. 1059c(b)). 
‘‘(25) TRIBAL HEALTH PROGRAM.—The term 
‘tribal health program’ means an Indian tribe or 
tribal organization that operates any health pro-
gram, service, function, activity, or facility funded, 
in whole or part, by the Service through, or provided 
for in, a contract or compact with the Service under 
the Indian Self-Determination and Education Assist-
ance Act (25 U.S.C. 450 et seq.).’’; and 
(13) by striking paragraph (26) (as redesig-
nated by paragraph (3)) and inserting the following: 
‘‘(26) TRIBAL ORGANIZATION.—The term ‘trib-
al organization’ has the meaning given the term in 
section 4 of the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450b).’’. 
Subtitle A—Indian Health 
Manpower 
SEC. 111. COMMUNITY HEALTH AIDE PROGRAM. 
Section 119 of the Indian Health Care Improvement 
Act (25 U.S.C. 1616l) is amended to read as follows: 
‘‘SEC. 119. COMMUNITY HEALTH AIDE PROGRAM. 
‘‘(a) GENERAL PURPOSES OF PROGRAM.—Pursuant 
to the Act of November 2, 1921 (25 U.S.C. 13) (commonly 
known as the ‘Snyder Act’), the Secretary, acting through 
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the Service, shall develop and operate a Community 
Health Aide Program in the State of Alaska under which 
the Service— 
‘‘(1) provides for the training of Alaska Natives 
as health aides or community health practitioners; 
‘‘(2) uses those aides or practitioners in the 
provision of health care, health promotion, and dis-
ease prevention services to Alaska Natives living in 
villages in rural Alaska; and 
‘‘(3) provides for the establishment of tele-
conferencing capacity in health clinics located in or 
near those villages for use by community health 
aides or community health practitioners. 
‘‘(b) SPECIFIC PROGRAM REQUIREMENTS.—The Sec-
retary, acting through the Community Health Aide Pro-
gram of the Service, shall— 
‘‘(1) using trainers accredited by the Program, 
provide a high standard of training to community 
health aides and community health practitioners to 
ensure that those aides and practitioners provide 
quality health care, health promotion, and disease 
prevention services to the villages served by the Pro-
gram; 
‘‘(2) in order to provide such training, develop 
a curriculum that— 
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‘‘(A) combines education regarding the 
theory of health care with supervised practical 
experience in the provision of health care; 
‘‘(B) provides instruction and practical ex-
perience in the provision of acute care, emer-
gency care, health promotion, disease preven-
tion, and the efficient and effective manage-
ment of clinic pharmacies, supplies, equipment, 
and facilities; and 
‘‘(C) promotes the achievement of the 
health status objectives specified in section 
3(2); 
‘‘(3) establish and maintain a Community 
Health Aide Certification Board to certify as com-
munity health aides or community health practi-
tioners individuals who have successfully completed 
the training described in paragraph (1) or can dem-
onstrate equivalent experience; 
‘‘(4) develop and maintain a system that identi-
fies the needs of community health aides and com-
munity health practitioners for continuing education 
in the provision of health care, including the areas 
described in paragraph (2)(B), and develop pro-
grams that meet the needs for such continuing edu-
cation; 
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‘‘(5) develop and maintain a system that pro-
vides close supervision of community health aides 
and community health practitioners; 
‘‘(6) develop a system under which the work of 
community health aides and community health prac-
titioners is reviewed and evaluated to ensure the pro-
vision of quality health care, health promotion, and 
disease prevention services; and 
‘‘(7) ensure that— 
‘‘(A) 
pulpal 
therapy 
(not 
including 
pulpotomies on deciduous teeth) or extraction of 
adult teeth can be performed by a dental health 
aide therapist only after consultation with a li-
censed dentist who determines that the proce-
dure is a medical emergency that cannot be re-
solved with palliative treatment; and 
‘‘(B) dental health aide therapists are 
strictly prohibited from performing all other 
oral or jaw surgeries, subject to the condition 
that uncomplicated extractions shall not be con-
sidered oral surgery under this section. 
‘‘(c) PROGRAM REVIEW.— 
‘‘(1) NEUTRAL PANEL.— 
‘‘(A) ESTABLISHMENT.—The Secretary, 
acting through the Service, shall establish a 
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neutral panel to carry out the study under 
paragraph (2). 
‘‘(B) MEMBERSHIP.—Members of the neu-
tral panel shall be appointed by the Secretary 
from among clinicians, economists, community 
practitioners, oral epidemiologists, and Alaska 
Natives. 
‘‘(2) STUDY.— 
‘‘(A) IN GENERAL.—The neutral panel es-
tablished under paragraph (1) shall conduct a 
study of the dental health aide therapist serv-
ices provided by the Community Health Aide 
Program under this section to ensure that the 
quality of care provided through those services 
is adequate and appropriate. 
‘‘(B) PARAMETERS OF STUDY.—The Sec-
retary, in consultation with interested parties, 
including professional dental organizations, 
shall develop the parameters of the study. 
‘‘(C) INCLUSIONS.—The study shall in-
clude a determination by the neutral panel with 
respect to— 
‘‘(i) the ability of the dental health 
aide therapist services under this section to 
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address the dental care needs of Alaska 
Natives; 
‘‘(ii) the quality of care provided 
through those services, including any train-
ing, improvement, or additional oversight 
required to improve the quality of care; 
and 
‘‘(iii) whether safer and less costly al-
ternatives to the dental health aide thera-
pist services exist. 
‘‘(D) CONSULTATION.—In carrying out the 
study under this paragraph, the neutral panel 
shall consult with Alaska tribal organizations 
with respect to the adequacy and accuracy of 
the study. 
‘‘(3) REPORT.—The neutral panel shall submit 
to the Secretary, the Committee on Indian Affairs of 
the Senate, and the Committee on Natural Re-
sources of the House of Representatives a report de-
scribing the results of the study under paragraph 
(2), including a description of— 
‘‘(A) any determination of the neutral 
panel under paragraph (2)(C); and 
‘‘(B) any comments received from Alaska 
tribal organizations under paragraph (2)(D). 
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‘‘(d) NATIONALIZATION OF PROGRAM.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), the Secretary, acting through the Service, 
may establish a national Community Health Aide 
Program in accordance with the program under this 
section, as the Secretary determines to be appro-
priate. 
‘‘(2) REQUIREMENT; EXCLUSION.—Subject to 
paragraphs (3) and (4), in establishing a national 
program under paragraph (1), the Secretary— 
‘‘(A) shall not reduce the amounts pro-
vided for the Community Health Aide Program 
described in subsections (a) and (b); and 
‘‘(B) shall exclude dental health aide thera-
pist services from services covered under the 
program. 
‘‘(3) ELECTION OF INDIAN TRIBE OR TRIBAL 
ORGANIZATION.— 
‘‘(A) IN GENERAL.—Subparagraph (B) of 
paragraph (2) shall not apply in the case of an 
election made by an Indian tribe or tribal orga-
nization located in a State (other than Alaska) 
in which the use of dental health aide therapist 
services or midlevel dental health provider serv-
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ices is authorized under State law to supply 
such services in accordance with State law. 
‘‘(B) ACTION BY SECRETARY.—On an elec-
tion by an Indian tribe or tribal organization 
under subparagraph (A), the Secretary, acting 
through the Service, shall facilitate implementa-
tion of the services elected. 
‘‘(4) VACANCIES.—The Secretary shall not fill 
any vacancy for a certified dentist in a program op-
erated by the Service with a dental health aide ther-
apist. 
‘‘(e) EFFECT OF SECTION.—Nothing in this section 
shall restrict the ability of the Service, an Indian tribe, 
or a tribal organization to participate in any program or 
to provide any service authorized by any other Federal 
law.’’. 
SEC. 112. HEALTH PROFESSIONAL CHRONIC SHORTAGE 
DEMONSTRATION PROGRAMS. 
Title I of the Indian Health Care Improvement Act 
(25 U.S.C. 1611 et seq.) (as amended by section 101(b)) 
is amended by adding at the end the following: 
‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE 
DEMONSTRATION PROGRAMS. 
‘‘(a) DEMONSTRATION PROGRAMS.—The Secretary, 
acting through the Service, may fund demonstration pro-
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grams for Indian health programs to address the chronic 
shortages of health professionals. 
‘‘(b) PURPOSES OF PROGRAMS.—The purposes of 
demonstration programs under subsection (a) shall be— 
‘‘(1) to provide direct clinical and practical ex-
perience within an Indian health program to health 
profession students and residents from medical 
schools; 
‘‘(2) to improve the quality of health care for 
Indians by ensuring access to qualified health pro-
fessionals; 
‘‘(3) to provide academic and scholarly opportu-
nities for health professionals serving Indians by 
identifying all academic and scholarly resources of 
the region; and 
‘‘(4) to provide training and support for alter-
native provider types, such as community health rep-
resentatives, and community health aides. 
‘‘(c) ADVISORY BOARD.—The demonstration pro-
grams established pursuant to subsection (a) shall incor-
porate a program advisory board, which may be composed 
of representatives of tribal governments, Indian health 
programs, and Indian communities in the areas to be 
served by the demonstration programs.’’. 
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SEC. 113. EXEMPTION FROM PAYMENT OF CERTAIN FEES. 
Title I of the Indian Health Care Improvement Act 
(25 U.S.C. 1611 et seq.) (as amended by section 112) is 
amended by adding at the end the following: 
‘‘SEC. 124. EXEMPTION FROM PAYMENT OF CERTAIN FEES. 
‘‘Employees of a tribal health program or urban In-
dian organization shall be exempt from payment of licens-
ing, registration, and any other fees imposed by a Federal 
agency to the same extent that officers of the commis-
sioned corps of the Public Health Service and other em-
ployees of the Service are exempt from those fees.’’. 
Subtitle B—Health Services 
SEC. 121. INDIAN HEALTH CARE IMPROVEMENT FUND. 
Section 201 of the Indian Health Care Improvement 
Act (25 U.S.C. 1621) is amended to read as follows: 
‘‘SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. 
‘‘(a) USE OF FUNDS.—The Secretary, acting through 
the Service, is authorized to expend funds, directly or 
under the authority of the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.), which 
are appropriated under the authority of this section, for 
the purposes of— 
‘‘(1) eliminating the deficiencies in health sta-
tus and health resources of all Indian tribes; 
‘‘(2) eliminating backlogs in the provision of 
health care services to Indians; 
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‘‘(3) meeting the health needs of Indians in an 
efficient and equitable manner, including the use of 
telehealth and telemedicine when appropriate; 
‘‘(4) eliminating inequities in funding for both 
direct care and contract health service programs; 
and 
‘‘(5) augmenting the ability of the Service to 
meet the following health service responsibilities with 
respect to those Indian tribes with the highest levels 
of health status deficiencies and resource defi-
ciencies: 
‘‘(A) Clinical care, including inpatient care, 
outpatient care (including audiology, clinical 
eye, and vision care), primary care, secondary 
and tertiary care, and long-term care. 
‘‘(B) Preventive health, including mam-
mography and other cancer screening. 
‘‘(C) Dental care. 
‘‘(D) Mental health, including community 
mental health services, inpatient mental health 
services, dormitory mental health services, 
therapeutic and residential treatment centers, 
and training of traditional health care practi-
tioners. 
‘‘(E) Emergency medical services. 
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‘‘(F) Treatment and control of, and reha-
bilitative care related to, alcoholism and drug 
abuse (including fetal alcohol syndrome) among 
Indians. 
‘‘(G) Injury prevention programs, includ-
ing data collection and evaluation, demonstra-
tion projects, training, and capacity building. 
‘‘(H) Home health care. 
‘‘(I) Community health representatives. 
‘‘(J) Maintenance and improvement. 
‘‘(b) NO OFFSET OR LIMITATION.—Any funds appro-
priated under the authority of this section shall not be 
used to offset or limit any other appropriations made to 
the Service under this Act or the Act of November 2, 1921 
(25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 
or any other provision of law. 
‘‘(c) ALLOCATION; USE.— 
‘‘(1) IN GENERAL.—Funds appropriated under 
the authority of this section shall be allocated to 
Service units, Indian tribes, or tribal organizations. 
The funds allocated to each Indian tribe, tribal orga-
nization, or Service unit under this paragraph shall 
be used by the Indian tribe, tribal organization, or 
Service unit under this paragraph to improve the 
health status and reduce the resource deficiency of 
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each Indian tribe served by such Service unit, Indian 
tribe, or tribal organization. 
‘‘(2) 
APPORTIONMENT
OF
ALLOCATED 
FUNDS.—The apportionment of funds allocated to a 
Service unit, Indian tribe, or tribal organization 
under paragraph (1) among the health service re-
sponsibilities described in subsection (a)(5) shall be 
determined by the Service in consultation with, and 
with the active participation of, the affected Indian 
tribes and tribal organizations. 
‘‘(d) PROVISIONS RELATING
TO HEALTH STATUS 
AND RESOURCE DEFICIENCIES.—For the purposes of this 
section, the following definitions apply: 
‘‘(1) DEFINITION.—The term ‘health status 
and resource deficiency’ means the extent to 
which— 
‘‘(A) the health status objectives set forth 
in sections 3(1) and 3(2) are not being 
achieved; and 
‘‘(B) the Indian tribe or tribal organization 
does not have available to it the health re-
sources it needs, taking into account the actual 
cost of providing health care services given local 
geographic, climatic, rural, or other cir-
cumstances. 
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‘‘(2) AVAILABLE RESOURCES.—The health re-
sources available to an Indian tribe or tribal organi-
zation include health resources provided by the Serv-
ice as well as health resources used by the Indian 
tribe or tribal organization, including services and fi-
nancing systems provided by any Federal programs, 
private insurance, and programs of State or local 
governments. 
‘‘(3) PROCESS
FOR
REVIEW
OF
DETERMINA-
TIONS.—The Secretary shall establish procedures 
which allow any Indian tribe or tribal organization 
to petition the Secretary for a review of any deter-
mination of the extent of the health status and re-
source deficiency of such Indian tribe or tribal orga-
nization. 
‘‘(e) ELIGIBILITY FOR FUNDS.—Tribal health pro-
grams shall be eligible for funds appropriated under the 
authority of this section on an equal basis with programs 
that are administered directly by the Service. 
‘‘(f) REPORT.—By no later than the date that is 3 
years after the date of enactment of the Indian Healthcare 
Improvement Act of 2011, the Secretary shall submit to 
Congress the current health status and resource deficiency 
report of the Service for each Service unit, including newly 
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recognized or acknowledged Indian tribes. Such report 
shall set out— 
‘‘(1) the methodology then in use by the Service 
for determining tribal health status and resource de-
ficiencies, as well as the most recent application of 
that methodology; 
‘‘(2) the extent of the health status and re-
source deficiency of each Indian tribe served by the 
Service or a tribal health program; 
‘‘(3) the amount of funds necessary to eliminate 
the health status and resource deficiencies of all In-
dian tribes served by the Service or a tribal health 
program; and 
‘‘(4) an estimate of— 
‘‘(A) the amount of health service funds 
appropriated under the authority of this Act, or 
any other Act, including the amount of any 
funds transferred to the Service for the pre-
ceding fiscal year which is allocated to each 
Service unit, Indian tribe, or tribal organiza-
tion; 
‘‘(B) the number of Indians eligible for 
health services in each Service unit or Indian 
tribe or tribal organization; and 
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‘‘(C) the number of Indians using the 
Service resources made available to each Service 
unit, Indian tribe or tribal organization, and, to 
the extent available, information on the waiting 
lists and number of Indians turned away for 
services due to lack of resources. 
‘‘(g) INCLUSION IN BASE BUDGET.—Funds appro-
priated under this section for any fiscal year shall be in-
cluded in the base budget of the Service for the purpose 
of determining appropriations under this section in subse-
quent fiscal years. 
‘‘(h) CLARIFICATION.—Nothing in this section is in-
tended to diminish the primary responsibility of the Serv-
ice to eliminate existing backlogs in unmet health care 
needs, nor are the provisions of this section intended to 
discourage the Service from undertaking additional efforts 
to achieve equity among Indian tribes and tribal organiza-
tions. 
‘‘(i) FUNDING DESIGNATION.—Any funds appro-
priated under the authority of this section shall be des-
ignated as the ‘Indian Health Care Improvement Fund’.’’. 
SEC. 122. CATASTROPHIC HEALTH EMERGENCY FUND. 
Section 202 of the Indian Health Care Improvement 
Act (25 U.S.C. 1621a) is amended to read as follows: 
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‘‘SEC. 202. 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. 
‘‘(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 
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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 
‘‘(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-
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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.’’. 
SEC. 123. DIABETES PREVENTION, TREATMENT, AND CON-
TROL. 
Section 204 of the Indian Health Care Improvement 
Act (25 U.S.C. 1621c) is amended to read as follows: 
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‘‘SEC. 204. DIABETES PREVENTION, TREATMENT, AND CON-
TROL. 
‘‘(a) DETERMINATIONS REGARDING DIABETES.— 
The Secretary, acting through the Service, and in con-
sultation with Indian tribes and tribal organizations, shall 
determine— 
‘‘(1) by Indian tribe and by Service unit, the in-
cidence of, and the types of complications resulting 
from, diabetes among Indians; and 
‘‘(2) based on the determinations made pursu-
ant to paragraph (1), the measures (including pa-
tient education and effective ongoing monitoring of 
disease indicators) each Service unit should take to 
reduce the incidence of, and prevent, treat, and con-
trol the complications resulting from, diabetes 
among Indian tribes within that Service unit. 
‘‘(b) DIABETES SCREENING.—To the extent medi-
cally indicated and with informed consent, the Secretary 
shall screen each Indian who receives services from the 
Service for diabetes and for conditions which indicate a 
high risk that the individual will become diabetic and es-
tablish a cost-effective approach to ensure ongoing moni-
toring of disease indicators. Such screening and moni-
toring may be conducted by a tribal health program and 
may be conducted through appropriate Internet-based 
health care management programs. 
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‘‘(c) DIABETES PROJECTS.—The Secretary shall con-
tinue to maintain each model diabetes project in existence 
on the date of enactment of the Indian Healthcare Im-
provement Act of 2011, any such other diabetes programs 
operated by the Service or tribal health programs, and any 
additional diabetes projects, such as the Medical Vanguard 
program provided for in title IV of Public Law 108–87, 
as implemented to serve Indian tribes. Tribal health pro-
grams shall receive recurring funding for the diabetes 
projects that they operate pursuant to this section, both 
at the date of enactment of the Indian Healthcare Im-
provement Act of 2011 and for projects which are added 
and funded thereafter. 
‘‘(d) DIALYSIS PROGRAMS.—The Secretary is author-
ized to provide, through the Service, Indian tribes, and 
tribal organizations, dialysis programs, including the pur-
chase of dialysis equipment and the provision of necessary 
staffing. 
‘‘(e) OTHER DUTIES OF THE SECRETARY.— 
‘‘(1) IN GENERAL.—The Secretary shall, to the 
extent funding is available— 
‘‘(A) in each area office, consult with In-
dian tribes and tribal organizations regarding 
programs for the prevention, treatment, and 
control of diabetes; 
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‘‘(B) establish in each area office a reg-
istry of patients with diabetes to track the inci-
dence of diabetes and the complications from 
diabetes in that area; and 
‘‘(C) ensure that data collected in each 
area office regarding diabetes and related com-
plications among Indians are disseminated to 
all other area offices, subject to applicable pa-
tient privacy laws. 
‘‘(2) DIABETES CONTROL OFFICERS.— 
‘‘(A) IN GENERAL.—The Secretary may es-
tablish and maintain in each area office a posi-
tion of diabetes control officer to coordinate and 
manage any activity of that area office relating 
to the prevention, treatment, or control of dia-
betes to assist the Secretary in carrying out a 
program under this section or section 330C of 
the Public Health Service Act (42 U.S.C. 254c– 
3). 
‘‘(B) CERTAIN
ACTIVITIES.—Any activity 
carried out by a diabetes control officer under 
subparagraph (A) that is the subject of a con-
tract or compact under the Indian Self-Deter-
mination and Education Assistance Act (25 
U.S.C. 450 et seq.), and any funds made avail-
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able to carry out such an activity, shall not be 
divisible for purposes of that Act.’’. 
SEC. 124. OTHER AUTHORITY FOR PROVISION OF SERV-
ICES; SHARED SERVICES FOR LONG-TERM 
CARE. 
(a) OTHER AUTHORITY FOR PROVISION OF SERV-
ICES.— 
(1) IN GENERAL.—Section 205 of the Indian 
Health Care Improvement Act (25 U.S.C. 1621d) is 
amended to read as follows: 
‘‘SEC. 205. OTHER AUTHORITY FOR PROVISION OF SERV-
ICES. 
‘‘(a) DEFINITIONS.—In this section: 
‘‘(1) ASSISTED LIVING SERVICE.—The term ‘as-
sisted living service’ means any service provided by 
an assisted living facility (as defined in section 
232(b) of the National Housing Act (12 U.S.C. 
1715w(b))), except that such an assisted living facil-
ity— 
‘‘(A) shall not be required to obtain a li-
cense; but 
‘‘(B) shall meet all applicable standards 
for licensure. 
‘‘(2) HOME- AND
COMMUNITY-BASED
SERV-
ICE.—The term ‘home- and community-based serv-
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ice’ means 1 or more of the services specified in 
paragraphs (1) through (9) of section 1929(a) of the 
Social Security Act (42 U.S.C. 1396t(a)) (whether 
provided by the Service or by an Indian tribe or trib-
al organization pursuant to the Indian Self-Deter-
mination and Education Assistance Act (25 U.S.C. 
450 et seq.)) that are or will be provided in accord-
ance with applicable standards. 
‘‘(3) HOSPICE CARE.—The term ‘hospice care’ 
means— 
‘‘(A) the items and services specified in 
subparagraphs (A) through (H) of section 
1861(dd)(1) of the Social Security Act (42 
U.S.C. 1395x(dd)(1)); and 
‘‘(B) such other services as an Indian tribe 
or tribal organization determines are necessary 
and appropriate to provide in furtherance of 
that care. 
‘‘(4) LONG-TERM CARE SERVICES.—The term 
‘long-term care services’ has the meaning given the 
term ‘qualified long-term care services’ in section 
7702B(c) of the Internal Revenue Code of 1986. 
‘‘(b) FUNDING AUTHORIZED.—The Secretary, acting 
through the Service, Indian tribes, and tribal organiza-
tions, may provide funding under this Act to meet the ob-
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jectives set forth in section 3 through health care-related 
services and programs not otherwise described in this Act 
for the following services: 
‘‘(1) Hospice care. 
‘‘(2) Assisted living services. 
‘‘(3) Long-term care services. 
‘‘(4) Home- and community-based services. 
‘‘(c) ELIGIBILITY.—The following individuals shall be 
eligible to receive long-term care services under this sec-
tion: 
‘‘(1) Individuals who are unable to perform a 
certain number of activities of daily living without 
assistance. 
‘‘(2) Individuals with a mental impairment, 
such as dementia, Alzheimer’s disease, or another 
disabling mental illness, who may be able to perform 
activities of daily living under supervision. 
‘‘(3) Such other individuals as an applicable 
tribal health program determines to be appropriate. 
‘‘(d) AUTHORIZATION OF CONVENIENT CARE SERV-
ICES.—The Secretary, acting through the Service, Indian 
tribes, and tribal organizations, may also provide funding 
under this Act to meet the objectives set forth in section 
3 for convenient care services programs pursuant to sec-
tion 307(c)(2)(A).’’. 
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(2) REPEAL.—Section 821 of the Indian Health 
Care Improvement Act (25 U.S.C. 1680k) is re-
pealed. 
(b) SHARED SERVICES FOR LONG-TERM CARE.— 
Section 822 of the Indian Health Care Improvement Act 
(25 U.S.C. 1680l) is amended to read as follows: 
‘‘SEC. 822. SHARED SERVICES FOR LONG-TERM CARE. 
‘‘(a) LONG-TERM CARE.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of law, the Secretary, acting through the 
Service, is authorized to provide directly, or enter 
into contracts or compacts under the Indian Self-De-
termination and Education Assistance Act (25 
U.S.C. 450 et seq.) with Indian tribes or tribal orga-
nizations for, the delivery of long-term care (includ-
ing health care services associated with long-term 
care) provided in a facility to Indians. 
‘‘(2) 
INCLUSIONS.—Each 
agreement 
under 
paragraph (1) shall provide for the sharing of staff 
or other services between the Service or a tribal 
health program and a long-term care or related facil-
ity owned and operated (directly or through a con-
tract or compact under the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C. 450 
et seq.)) by the Indian tribe or tribal organization. 
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‘‘(b) CONTENTS OF AGREEMENTS.—An agreement 
entered into pursuant to subsection (a)— 
‘‘(1) may, at the request of the Indian tribe or 
tribal organization, delegate to the Indian tribe or 
tribal organization such powers of supervision and 
control over Service employees as the Secretary de-
termines to be necessary to carry out the purposes 
of this section; 
‘‘(2) shall provide that expenses (including sala-
ries) relating to services that are shared between the 
Service and the tribal health program be allocated 
proportionately between the Service and the Indian 
tribe or tribal organization; and 
‘‘(3) may authorize the Indian tribe or tribal 
organization to construct, renovate, or expand a 
long-term care or other similar facility (including the 
construction of a facility attached to a Service facil-
ity). 
‘‘(c) MINIMUM REQUIREMENT.—Any nursing facility 
provided for under this section shall meet the require-
ments for nursing facilities under section 1919 of the So-
cial Security Act (42 U.S.C. 1396r). 
‘‘(d) OTHER ASSISTANCE.—The Secretary shall pro-
vide such technical and other assistance as may be nec-
essary to enable applicants to comply with this section. 
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‘‘(e) USE
OF EXISTING
OR UNDERUSED FACILI-
TIES.—The Secretary shall encourage the use of existing 
facilities that are underused, or allow the use of swing 
beds, for long-term or similar care.’’. 
SEC. 125. REIMBURSEMENT FROM CERTAIN THIRD PAR-
TIES OF COSTS OF HEALTH SERVICES. 
Section 206 of the Indian Health Care Improvement 
Act (25 U.S.C. 1621e) is amended to read as follows: 
‘‘SEC. 206. REIMBURSEMENT FROM CERTAIN THIRD PAR-
TIES OF COSTS OF HEALTH SERVICES. 
‘‘(a) RIGHT OF RECOVERY.—Except as provided in 
subsection (f), the United States, an Indian tribe, or tribal 
organization shall have the right to recover from an insur-
ance company, health maintenance organization, employee 
benefit plan, third-party tortfeasor, or any other respon-
sible or liable third party (including a political subdivision 
or local governmental entity of a State) the reasonable 
charges billed by the Secretary, an Indian tribe, or tribal 
organization in providing health services through the Serv-
ice, an Indian tribe, or tribal organization, or, if higher, 
the highest amount the third party would pay for care and 
services furnished by providers other than governmental 
entities, to any individual to the same extent that such 
individual, or any nongovernmental provider of such serv-
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ices, would be eligible to receive damages, reimbursement, 
or indemnification for such charges or expenses if— 
‘‘(1) such services had been provided by a non-
governmental provider; and 
‘‘(2) such individual had been required to pay 
such charges or expenses and did pay such charges 
or expenses. 
‘‘(b) LIMITATIONS ON RECOVERIES FROM STATES.— 
Subsection (a) shall provide a right of recovery against 
any State, only if the injury, illness, or disability for which 
health services were provided is covered under— 
‘‘(1) workers’ compensation laws; or 
‘‘(2) a no-fault automobile accident insurance 
plan or program. 
‘‘(c) NONAPPLICABILITY OF OTHER LAWS.—No law 
of any State, or of any political subdivision of a State and 
no provision of any contract, insurance or health mainte-
nance organization policy, employee benefit plan, self-in-
surance plan, managed care plan, or other health care plan 
or program entered into or renewed after the date of en-
actment of the Indian Health Care Amendments of 1988, 
shall prevent or hinder the right of recovery of the United 
States, an Indian tribe, or tribal organization under sub-
section (a). 
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‘‘(d) NO EFFECT ON PRIVATE RIGHTS OF ACTION.— 
No action taken by the United States, an Indian tribe, 
or tribal organization to enforce the right of recovery pro-
vided under this section shall operate to deny to the in-
jured person the recovery for that portion of the person’s 
damage not covered hereunder. 
‘‘(e) ENFORCEMENT.— 
‘‘(1) IN GENERAL.—The United States, an In-
dian tribe, or tribal organization may enforce the 
right of recovery provided under subsection (a) by— 
‘‘(A) intervening or joining in any civil ac-
tion or proceeding brought— 
‘‘(i) by the individual for whom health 
services were provided by the Secretary, an 
Indian tribe, or tribal organization; or 
‘‘(ii) by any representative or heirs of 
such individual, or 
‘‘(B) instituting a separate civil action, in-
cluding a civil action for injunctive relief and 
other relief and including, with respect to a po-
litical subdivision or local governmental entity 
of a State, such an action against an official 
thereof. 
‘‘(2) NOTICE.—All reasonable efforts shall be 
made to provide notice of action instituted under 
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paragraph (1)(B) to the individual to whom health 
services were provided, either before or during the 
pendency of such action. 
‘‘(3) RECOVERY FROM TORTFEASORS.— 
‘‘(A) IN GENERAL.—In any case in which 
an Indian tribe or tribal organization that is 
authorized or required under a compact or con-
tract issued pursuant to the Indian Self-Deter-
mination and Education Assistance Act (25 
U.S.C. 450 et seq.) to furnish or pay for health 
services to a person who is injured or suffers a 
disease on or after the date of enactment of the 
Indian Healthcare Improvement Act of 2011 
under circumstances that establish grounds for 
a claim of liability against the tortfeasor with 
respect to the injury or disease, the Indian tribe 
or tribal organization shall have a right to re-
cover from the tortfeasor (or an insurer of the 
tortfeasor) the reasonable value of the health 
services so furnished, paid for, or to be paid 
for, in accordance with the Federal Medical 
Care Recovery Act (42 U.S.C. 2651 et seq.), to 
the same extent and under the same cir-
cumstances as the United States may recover 
under that Act. 
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‘‘(B) TREATMENT.—The right of an In-
dian tribe or tribal organization to recover 
under subparagraph (A) shall be independent of 
the rights of the injured or diseased person 
served by the Indian tribe or tribal organiza-
tion. 
‘‘(f) LIMITATION.—Absent specific written authoriza-
tion by the governing body of an Indian tribe for the pe-
riod of such authorization (which may not be for a period 
of more than 1 year and which may be revoked at any 
time upon written notice by the governing body to the 
Service), the United States shall not have a right of recov-
ery under this section if the injury, illness, or disability 
for which health services were provided is covered under 
a self-insurance plan funded by an Indian tribe, tribal or-
ganization, or urban Indian organization. Where such au-
thorization is provided, the Service may receive and ex-
pend such amounts for the provision of additional health 
services consistent with such authorization. 
‘‘(g) COSTS AND ATTORNEY’S FEES.—In any action 
brought to enforce the provisions of this section, a pre-
vailing plaintiff shall be awarded its reasonable attorney’s 
fees and costs of litigation. 
‘‘(h) NONAPPLICABILITY
OF CLAIMS FILING RE-
QUIREMENTS.—An insurance company, health mainte-
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nance organization, self-insurance plan, managed care 
plan, or other health care plan or program (under the So-
cial Security Act or otherwise) may not deny a claim for 
benefits submitted by the Service or by an Indian tribe 
or tribal organization based on the format in which the 
claim is submitted if such format complies with the format 
required for submission of claims under title XVIII of the 
Social Security Act or recognized under section 1175 of 
such Act. 
‘‘(i) APPLICATION
TO URBAN INDIAN ORGANIZA-
TIONS.—The previous provisions of this section shall apply 
to urban Indian organizations with respect to populations 
served by such Organizations in the same manner they 
apply to Indian tribes and tribal organizations with re-
spect to populations served by such Indian tribes and trib-
al organizations. 
‘‘(j) STATUTE OF LIMITATIONS.—The provisions of 
section 2415 of title 28, United States Code, shall apply 
to all actions commenced under this section, and the ref-
erences therein to the United States are deemed to include 
Indian tribes, tribal organizations, and urban Indian orga-
nizations. 
‘‘(k) SAVINGS.—Nothing in this section shall be con-
strued to limit any right of recovery available to the 
United States, an Indian tribe, or tribal organization 
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under the provisions of any applicable, Federal, State, or 
tribal law, including medical lien laws.’’. 
SEC. 126. CREDITING OF REIMBURSEMENTS. 
Section 207 of the Indian Health Care Improvement 
Act (25 U.S.C. 1621f) is amended to read as follows: 
‘‘SEC. 207. CREDITING OF REIMBURSEMENTS. 
‘‘(a) USE OF AMOUNTS.— 
‘‘(1) RETENTION BY PROGRAM.—Except as pro-
vided in sections 202(a)(2) and 813, all reimburse-
ments received or recovered under any of the pro-
grams described in paragraph (2), including under 
section 813, by reason of the provision of health 
services by the Service, by an Indian tribe or tribal 
organization, or by an urban Indian organization, 
shall be credited to the Service, such Indian tribe or 
tribal organization, or such urban Indian organiza-
tion, respectively, and may be used as provided in 
section 401. In the case of such a service provided 
by or through a Service Unit, such amounts shall be 
credited to such unit and used for such purposes. 
‘‘(2) PROGRAMS COVERED.—The programs re-
ferred to in paragraph (1) are the following: 
‘‘(A) Titles XVIII, XIX, and XXI of the 
Social Security Act. 
‘‘(B) This Act, including section 813. 
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‘‘(C) Public Law 87–693. 
‘‘(D) Any other provision of law. 
‘‘(b) NO OFFSET OF AMOUNTS.—The Service may 
not offset or limit any amount obligated to any Service 
Unit or entity receiving funding from the Service because 
of the receipt of reimbursements under subsection (a).’’. 
SEC. 127. BEHAVIORAL HEALTH TRAINING AND COMMU-
NITY EDUCATION PROGRAMS. 
Section 209 of the Indian Health Care Improvement 
Act (25 U.S.C. 1621h) is amended by striking subsection 
(d) and inserting the following: 
‘‘(d) BEHAVIORAL HEALTH TRAINING AND COMMU-
NITY EDUCATION PROGRAMS.— 
‘‘(1) STUDY; 
LIST.—The Secretary, acting 
through the Service, and the Secretary of the Inte-
rior, in consultation with Indian tribes and tribal or-
ganizations, shall conduct a study and compile a list 
of the types of staff positions specified in paragraph 
(2) whose qualifications include, or should include, 
training in the identification, prevention, education, 
referral, or treatment of mental illness, or dysfunc-
tional and self destructive behavior. 
‘‘(2) POSITIONS.—The positions referred to in 
paragraph (1) are— 
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‘‘(A) staff positions within the Bureau of 
Indian Affairs, including existing positions, in 
the fields of— 
‘‘(i) elementary and secondary edu-
cation; 
‘‘(ii) social services and family and 
child welfare; 
‘‘(iii) law enforcement and judicial 
services; and 
‘‘(iv) alcohol and substance abuse; 
‘‘(B) staff positions within the Service; and 
‘‘(C) staff positions similar to those identi-
fied in subparagraphs (A) and (B) established 
and maintained by Indian tribes and tribal or-
ganizations (without regard to the funding 
source). 
‘‘(3) TRAINING CRITERIA.— 
‘‘(A) IN GENERAL.—The appropriate Sec-
retary shall provide training criteria appropriate 
to each type of position identified in paragraphs 
(2)(A) and (2)(B) and ensure that appropriate 
training has been, or shall be provided to any 
individual in any such position. With respect to 
any such individual in a position identified pur-
suant to paragraph (2)(C), the respective Secre-
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taries shall provide appropriate training to, or 
provide funds to, an Indian tribe or tribal orga-
nization for training of appropriate individuals. 
In the case of positions funded under a contract 
or compact under the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C. 
450 et seq.), the appropriate Secretary shall en-
sure that such training costs are included in the 
contract or compact, as the Secretary deter-
mines necessary. 
‘‘(B) POSITION
SPECIFIC
TRAINING
CRI-
TERIA.—Position specific training criteria shall 
be culturally relevant to Indians and Indian 
tribes and shall ensure that appropriate infor-
mation regarding traditional health care prac-
tices is provided. 
‘‘(4) COMMUNITY EDUCATION ON MENTAL ILL-
NESS.—The Service shall develop and implement, on 
request of an Indian tribe, tribal organization, or 
urban Indian organization, or assist the Indian tribe, 
tribal organization, or urban Indian organization to 
develop and implement, a program of community 
education on mental illness. In carrying out this 
paragraph, the Service shall, upon request of an In-
dian tribe, tribal organization, or urban Indian orga-
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nization, provide technical assistance to the Indian 
tribe, tribal organization, or urban Indian organiza-
tion to obtain and develop community educational 
materials on the identification, prevention, referral, 
and treatment of mental illness and dysfunctional 
and self-destructive behavior. 
‘‘(5) PLAN.—Not later than 90 days after the 
date of enactment of the Indian Healthcare Im-
provement Act of 2011, the Secretary shall develop 
a plan under which the Service will increase the 
health care staff providing behavioral health services 
by at least 500 positions within 5 years after the 
date of enactment of that Act, with at least 200 of 
such positions devoted to child, adolescent, and fam-
ily services. The plan developed under this para-
graph shall be implemented under the Act of No-
vember 2, 1921 (25 U.S.C. 13) (commonly known as 
the ‘Snyder Act’).’’. 
SEC. 128. CANCER SCREENINGS. 
Section 212 of the Indian Health Care Improvement 
Act (25 U.S.C. 1621k) is amended by inserting ‘‘and other 
cancer screenings’’ before the period at the end. 
SEC. 129. PATIENT TRAVEL COSTS. 
Section 213 of the Indian Health Care Improvement 
Act (25 U.S.C. 1621l) is amended to read as follows: 
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‘‘SEC. 213. PATIENT TRAVEL COSTS. 
‘‘(a) DEFINITION OF QUALIFIED ESCORT.—In this 
section, the term ‘qualified escort’ means— 
‘‘(1) an adult escort (including a parent, guard-
ian, or other family member) who is required be-
cause of the physical or mental condition, or age, of 
the applicable patient; 
‘‘(2) a health professional for the purpose of 
providing necessary medical care during travel by 
the applicable patient; or 
‘‘(3) other escorts, as the Secretary or applica-
ble Indian Health Program determines to be appro-
priate. 
‘‘(b) PROVISION OF FUNDS.—The Secretary, acting 
through the Service and Tribal Health Programs, is au-
thorized to provide funds for the following patient travel 
costs, including qualified escorts, associated with receiving 
health care services provided (either through direct or con-
tract care or through a contract or compact under the In-
dian Self-Determination and Education Assistance Act 
(25 U.S.C. 450 et seq.)) under this Act— 
‘‘(1) emergency air transportation and non- 
emergency air transportation where ground trans-
portation is infeasible; 
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‘‘(2) transportation by private vehicle (where no 
other means of transportation is available), specially 
equipped vehicle, and ambulance; and 
‘‘(3) transportation by such other means as 
may be available and required when air or motor ve-
hicle transportation is not available.’’. 
SEC. 130. EPIDEMIOLOGY CENTERS. 
Section 214 of the Indian Health Care Improvement 
Act (25 U.S.C. 1621m) is amended to read as follows: 
‘‘SEC. 214. EPIDEMIOLOGY CENTERS. 
‘‘(a) ESTABLISHMENT OF CENTERS.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish an epidemiology center in each Service area to 
carry out the functions described in subsection (b). 
‘‘(2) NEW CENTERS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), any new center established after the 
date of enactment of the Indian Healthcare Im-
provement Act of 2011 may be operated under 
a grant authorized by subsection (d). 
‘‘(B) REQUIREMENT.—Funding provided 
in a grant described in subparagraph (A) shall 
not be divisible. 
‘‘(3) FUNDS NOT DIVISIBLE.—An epidemiology 
center established under this subsection shall be sub-
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ject to the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.), but the 
funds for the center shall not be divisible. 
‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 
and on the request of Indian tribes, tribal organizations, 
and urban Indian organizations, each Service area epide-
miology center established under this section shall, with 
respect to the applicable Service area— 
‘‘(1) collect data relating to, and monitor 
progress made toward meeting, each of the health 
status objectives of the Service, the Indian tribes, 
tribal organizations, and urban Indian organizations 
in the Service area; 
‘‘(2) evaluate existing delivery systems, data 
systems, and other systems that impact the improve-
ment of Indian health; 
‘‘(3) assist Indian tribes, tribal organizations, 
and urban Indian organizations in identifying high-
est-priority health status objectives and the services 
needed to achieve those objectives, based on epide-
miological data; 
‘‘(4) make recommendations for the targeting 
of services needed by the populations served; 
‘‘(5) make recommendations to improve health 
care delivery systems for Indians and urban Indians; 
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‘‘(6) provide requested technical assistance to 
Indian tribes, tribal organizations, and urban Indian 
organizations in the development of local health 
service priorities and incidence and prevalence rates 
of disease and other illness in the community; and 
‘‘(7) provide disease surveillance and assist In-
dian tribes, tribal organizations, and urban Indian 
communities to promote public health. 
‘‘(c) TECHNICAL ASSISTANCE.—The Director of the 
Centers for Disease Control and Prevention shall provide 
technical assistance to the centers in carrying out this sec-
tion. 
‘‘(d) GRANTS FOR STUDIES.— 
‘‘(1) IN GENERAL.—The Secretary may make 
grants to Indian tribes, tribal organizations, Indian 
organizations, and eligible intertribal consortia to 
conduct epidemiological studies of Indian commu-
nities. 
‘‘(2) ELIGIBLE INTERTRIBAL CONSORTIA.—An 
intertribal consortium or Indian organization shall 
be eligible to receive a grant under this subsection 
if the intertribal consortium is— 
‘‘(A) incorporated for the primary purpose 
of improving Indian health; and 
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‘‘(B) representative of the Indian tribes or 
urban Indian communities residing in the area 
in which the intertribal consortium is located. 
‘‘(3) APPLICATIONS.—An application for a 
grant under this subsection shall be submitted in 
such manner and at such time as the Secretary shall 
prescribe. 
‘‘(4) REQUIREMENTS.—An applicant for a 
grant under this subsection shall— 
‘‘(A) demonstrate the technical, adminis-
trative, and financial expertise necessary to 
carry out the functions described in paragraph 
(5); 
‘‘(B) consult and cooperate with providers 
of related health and social services in order to 
avoid duplication of existing services; and 
‘‘(C) demonstrate cooperation from Indian 
tribes or urban Indian organizations in the area 
to be served. 
‘‘(5) USE OF FUNDS.—A grant provided under 
paragraph (1) may be used— 
‘‘(A) to carry out the functions described 
in subsection (b); 
‘‘(B) to provide information to, and consult 
with, tribal leaders, urban Indian community 
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leaders, and related health staff regarding 
health care and health service management 
issues; and 
‘‘(C) in collaboration with Indian tribes, 
tribal organizations, and urban Indian organi-
zations, to provide to the Service information 
regarding ways to improve the health status of 
Indians. 
‘‘(e) ACCESS TO INFORMATION.— 
‘‘(1) IN GENERAL.—An epidemiology center op-
erated by a grantee pursuant to a grant awarded 
under subsection (d) shall be treated as a public 
health authority (as defined in section 164.501 of 
title 45, Code of Federal Regulations (or a successor 
regulation)) for purposes of the Health Insurance 
Portability and Accountability Act of 1996 (Public 
Law 104–191; 110 Stat. 1936). 
‘‘(2) ACCESS TO INFORMATION.—The Secretary 
shall grant to each epidemiology center described in 
paragraph (1) access to use of the data, data sets, 
monitoring systems, delivery systems, and other pro-
tected health information in the possession of the 
Secretary. 
‘‘(3) REQUIREMENT.—The activities of an epi-
demiology center described in paragraph (1) shall be 
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for the purposes of research and for preventing and 
controlling disease, injury, or disability (as those ac-
tivities are described in section 164.512 of title 45, 
Code of Federal Regulations (or a successor regula-
tion)), for purposes of the Health Insurance Port-
ability and Accountability Act of 1996 (Public Law 
104–191; 110 Stat. 1936).’’. 
SEC. 131. INDIAN YOUTH GRANT PROGRAM. 
Section 216(b)(2) of the Indian Health Care Im-
provement Act (25 U.S.C. 1621o(b)(2)) is amended by 
striking ‘‘section 209(m)’’ and inserting ‘‘section 708(c)’’. 
SEC. 132. AMERICAN INDIANS INTO PSYCHOLOGY PRO-
GRAM. 
Section 217 of the Indian Health Care Improvement 
Act (25 U.S.C. 1621p) is amended to read as follows: 
‘‘SEC. 217. 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 
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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-
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; 
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‘‘(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 
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— 
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‘‘(1) in an Indian health program; 
‘‘(2) in a program assisted under title V; 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 to carry out this section 
$2,700,000 for fiscal year 2011 and each fiscal year there-
after.’’. 
SEC. 133. PREVENTION, CONTROL, AND ELIMINATION OF 
COMMUNICABLE AND INFECTIOUS DISEASES. 
Section 218 of the Indian Health Care Improvement 
Act (25 U.S.C. 1621q) is amended to read as follows: 
‘‘SEC. 218. PREVENTION, CONTROL, AND ELIMINATION OF 
COMMUNICABLE AND INFECTIOUS DISEASES. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 
through the Service, and after consultation with the Cen-
ters for Disease Control and Prevention, may make grants 
available to Indian tribes and tribal organizations for the 
following: 
‘‘(1) Projects for the prevention, control, and 
elimination of communicable and infectious diseases, 
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including tuberculosis, hepatitis, HIV, respiratory 
syncytial virus, hanta virus, sexually transmitted dis-
eases, and H. pylori. 
‘‘(2) Public information and education pro-
grams for the prevention, control, and elimination of 
communicable and infectious diseases. 
‘‘(3) Education, training, and clinical skills im-
provement activities in the prevention, control, and 
elimination of communicable and infectious diseases 
for health professionals, including allied health pro-
fessionals. 
‘‘(4) Demonstration projects for the screening, 
treatment, and prevention of hepatitis C virus 
(HCV). 
‘‘(b) APPLICATION REQUIRED.—The Secretary may 
provide funding under subsection (a) only if an application 
or proposal for funding is submitted to the Secretary. 
‘‘(c) COORDINATION WITH HEALTH AGENCIES.—In-
dian tribes and tribal organizations receiving funding 
under this section are encouraged to coordinate their ac-
tivities with the Centers for Disease Control and Preven-
tion and State and local health agencies. 
‘‘(d) TECHNICAL ASSISTANCE; REPORT.—In carrying 
out this section, the Secretary— 
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‘‘(1) may, at the request of an Indian tribe or 
tribal organization, provide technical assistance; and 
‘‘(2) shall prepare and submit a report to Con-
gress biennially on the use of funds under this sec-
tion and on the progress made toward the preven-
tion, control, and elimination of communicable and 
infectious diseases among Indians and urban Indi-
ans.’’. 
SEC. 134. METHODS TO INCREASE CLINICIAN RECRUIT-
MENT AND RETENTION ISSUES. 
(a) LICENSING.—Section 221 of the Indian Health 
Care Improvement Act (25 U.S.C. 1621t) is amended to 
read as follows: 
‘‘SEC. 221. LICENSING. 
‘‘Licensed health professionals employed by a tribal 
health program shall be exempt, if licensed in any State, 
from the licensing requirements of the State in which the 
tribal health program performs the services described in 
the contract or compact of the tribal health program under 
the Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.).’’. 
(b) CONTINUING EDUCATION ALLOWANCES.—Sec-
tion 106 of the Indian Health Care Improvement Act (25 
U.S.C. 1615) is amended to read as follows: 
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‘‘SEC. 106. CONTINUING EDUCATION ALLOWANCES. 
‘‘In order to encourage scholarship and stipend re-
cipients under sections 104, 105, and 115 and health pro-
fessionals, including community health representatives 
and emergency medical technicians, to join or continue in 
an Indian health program and to provide services in the 
rural and remote areas in which a significant portion of 
Indians reside, the Secretary, acting through the Service, 
may— 
‘‘(1) provide programs or allowances to transi-
tion into an Indian health program, including licens-
ing, board or certification examination assistance, 
and technical assistance in fulfilling service obliga-
tions under sections 104, 105, and 115; and 
‘‘(2) provide programs or allowances to health 
professionals employed in an Indian health program 
to enable those professionals, for a period of time 
each year prescribed by regulation of the Secretary, 
to take leave of the duty stations of the professionals 
for professional consultation, management, leader-
ship, and refresher training courses.’’. 
SEC. 135. LIABILITY FOR PAYMENT. 
Section 222 of the Indian Health Care Improvement 
Act (25 U.S.C. 1621u) is amended to read as follows: 
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‘‘SEC. 222. 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 
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 220(b), the provider shall 
have no further recourse against the patient who received 
the services.’’. 
SEC. 136. OFFICES OF INDIAN MEN’S HEALTH AND INDIAN 
WOMEN’S HEALTH. 
Section 223 of the Indian Health Care Improvement 
Act (25 U.S.C. 1621v) is amended— 
(1) by striking the section designation and 
heading and all that follows through ‘‘oversee efforts 
of the Service to’’ and inserting the following: 
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‘‘SEC. 223. OFFICES OF INDIAN MEN’S HEALTH AND INDIAN 
WOMEN’S HEALTH. 
‘‘(a) OFFICE OF INDIAN MEN’S HEALTH.— 
‘‘(1) ESTABLISHMENT.—The Secretary may es-
tablish within the Service an office, to be known as 
the ‘Office of Indian Men’s Health’. 
‘‘(2) DIRECTOR.— 
‘‘(A) IN GENERAL.—The Office of Indian 
Men’s Health shall be headed by a director, to 
be appointed by the Secretary. 
‘‘(B) DUTIES.—The director shall coordi-
nate and promote the health status of Indian 
men in the United States. 
‘‘(3) REPORT.—Not later than 2 years after the 
date of enactment of the Indian Healthcare Im-
provement Act of 2011, the Secretary, acting 
through the Service, shall submit to Congress a re-
port describing— 
‘‘(A) any activity carried out by the direc-
tor as of the date on which the report is pre-
pared; and 
‘‘(B) any finding of the director with re-
spect to the health of Indian men. 
‘‘(b) OFFICE OF INDIAN WOMEN’S HEALTH.—The 
Secretary, acting through the Service, shall establish an 
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office, to be known as the ‘Office of Indian Women’s 
Health’, to’’; and 
(2) in subsection (b) (as so redesignated) by in-
serting ‘‘(including urban Indian women)’’ before 
‘‘of all ages’’. 
SEC. 137. CONTRACT HEALTH SERVICE ADMINISTRATION 
AND DISBURSEMENT FORMULA. 
Title II of the Indian Health Care Improvement Act 
(25 U.S.C. 1621 et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 226. CONTRACT HEALTH SERVICE ADMINISTRATION 
AND DISBURSEMENT FORMULA. 
‘‘(a) SUBMISSION OF REPORT.—As soon as prac-
ticable after the date of enactment of the Indian 
Healthcare Improvement Act of 2011, the Comptroller 
General of the United States shall submit to the Sec-
retary, the Committee on Indian Affairs of the Senate, 
and the Committee on Natural Resources of the House 
of Representatives, and make available to each Indian 
tribe, a report describing the results of the study of the 
Comptroller General regarding the funding of the contract 
health service program (including historic funding levels 
and a recommendation of the funding level needed for the 
program) and the administration of the contract health 
service program (including the distribution of funds pur-
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suant to the program), as requested by Congress in March 
2009, or pursuant to section 830. 
‘‘(b) CONSULTATION WITH TRIBES.—On receipt of 
the report under subsection (a), the Secretary shall con-
sult with Indian tribes regarding the contract health serv-
ice program, including the distribution of funds pursuant 
to the program— 
‘‘(1) to determine whether the current distribu-
tion formula would require modification if the con-
tract health service program were funded at the level 
recommended by the Comptroller General; 
‘‘(2) to identify any inequities in the current 
distribution formula under the current funding level 
or inequitable results for any Indian tribe under the 
funding level recommended by the Comptroller Gen-
eral; 
‘‘(3) to identify any areas of program adminis-
tration that may result in the inefficient or ineffec-
tive management of the program; and 
‘‘(4) to identify any other issues and rec-
ommendations to improve the administration of the 
contract health services program and correct any un-
fair results or funding disparities identified under 
paragraph (2). 
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‘‘(c) SUBSEQUENT ACTION BY SECRETARY.—If, after 
consultation with Indian tribes under subsection (b), the 
Secretary determines that any issue described in sub-
section (b)(2) exists, the Secretary may initiate procedures 
under subchapter III of chapter 5 of title 5, United States 
Code, to negotiate or promulgate regulations to establish 
a disbursement formula for the contract health service 
program funding.’’. 
Subtitle C—Health Facilities 
SEC. 141. HEALTH CARE FACILITY PRIORITY SYSTEM. 
Section 301 of the Indian Health Care Improvement 
Act (25 U.S.C. 1631) is amended— 
(1) by redesignating subsection (d) as sub-
section (h); and 
(2) by striking subsection (c) and inserting the 
following: 
‘‘(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 organizations; 
‘‘(ii) shall give Indian tribes’ needs 
the highest priority; 
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‘‘(iii)(I) may include the lists required 
in paragraph (2)(B)(ii); 
‘‘(II) shall include the methodology re-
quired in paragraph (2)(B)(v); and 
‘‘(III) may include such health care 
facilities, and such renovation or expansion 
needs of any health care facility, as the 
Service 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 
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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-
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 
Healthcare Improvement Act of 2011 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; 
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‘‘(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-
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 
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the Service, established at the discre-
tion of the Director— 
‘‘(aa) to provide advice and 
recommendations for policies and 
procedures of the programs fund-
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 Director— 
‘‘(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 Healthcare Im-
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provement Act of 2011, the Secretary 
shall submit to the Committee on In-
dian Affairs of the Senate and the 
Committee on Natural Resources of 
the House of Representatives a report 
that describes the comprehensive, na-
tional, ranked list of all health care 
facilities needs for the Service, Indian 
tribes, and tribal organizations (in-
cluding inpatient health care facilities, 
outpatient health care facilities, spe-
cialized health care facilities (such as 
for long-term care and alcohol and 
drug abuse treatment), wellness cen-
ters, and staff quarters, and the ren-
ovation and expansion needs, if any, 
of such facilities) developed by the 
Service, Indian tribes, and tribal orga-
nizations for the Facilities Needs As-
sessment Workgroup and the Facili-
ties Appropriation Advisory Board. 
‘‘(II) INCLUSIONS.—The initial 
report shall include— 
‘‘(aa) the methodology and 
criteria used by the Service in de-
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termining the needs and estab-
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). 
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‘‘(ii) Health care facilities lists, which 
may include— 
‘‘(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); and 
‘‘(IV) the 10 top-priority staff 
quarters developments 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— 
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‘‘(A) consult with and obtain information 
on all health care facilities needs from Indian 
tribes and tribal organizations; and 
‘‘(B) review the total unmet needs of all 
Indian tribes and tribal organizations for health 
care facilities (including staff quarters), includ-
ing needs for renovation and expansion of exist-
ing 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 
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‘‘(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 section 102 of the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450f) or sec-
tions 504 and 505 of that Act (25 U.S.C. 458aaa–3, 
458aaa–4). 
‘‘(f) DEVELOPMENT OF INNOVATIVE APPROACHES.— 
The Secretary shall consult and cooperate with Indian 
tribes and tribal organizations, and confer with urban In-
dian organizations, in developing innovative approaches to 
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address all or part of the total unmet need for construc-
tion of health facilities, that may include— 
‘‘(1) the establishment of an area distribution 
fund in which a portion of health facility construc-
tion funding could be devoted to all Service areas; 
‘‘(2) approaches provided for in other provisions 
of this title; and 
‘‘(3) other approaches, as the Secretary deter-
mines to be appropriate.’’. 
SEC. 142. PRIORITY OF CERTAIN PROJECTS PROTECTED. 
Section 301 of the Indian Health Care Improvement 
Act (25 U.S.C. 1631) (as amended by section 141) is 
amended by adding at the end the following: 
‘‘(g) PRIORITY
OF
CERTAIN
PROJECTS
PRO-
TECTED.—The priority of any project established under 
the construction priority system in effect on the date of 
enactment of this Indian Healthcare Improvement Act of 
2011 shall not be affected by any change in the construc-
tion priority system taking place after that date if the 
project— 
‘‘(1) was identified in the fiscal year 2008 Serv-
ice budget justification as— 
‘‘(A) 1 of the 10 top-priority inpatient 
projects; 
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‘‘(B) 1 of the 10 top-priority outpatient 
projects; 
‘‘(C) 1 of the 10 top-priority staff quarters 
developments; or 
‘‘(D) 1 of the 10 top-priority Youth Re-
gional Treatment Centers; 
‘‘(2) had completed both Phase I and Phase II 
of the construction priority system in effect on the 
date of enactment of such Act; or 
‘‘(3) is not included in clause (i) or (ii) and is 
selected, as determined by the Secretary— 
‘‘(A) on the initiative of the Secretary; or 
‘‘(B) pursuant to a request of an Indian 
tribe or tribal organization.’’. 
SEC. 143. INDIAN HEALTH CARE DELIVERY DEMONSTRA-
TION PROJECTS. 
Section 307 of the Indian Health Care Improvement 
Act (25 U.S.C. 1637) is amended to read as follows: 
‘‘SEC. 307. INDIAN HEALTH CARE DELIVERY DEMONSTRA-
TION PROJECTS. 
‘‘(a) PURPOSE AND GENERAL AUTHORITY.— 
‘‘(1) PURPOSE.—The purpose of this section is 
to encourage the establishment of demonstration 
projects that meet the applicable criteria of this sec-
tion to be carried out by the Secretary, acting 
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through the Service, or Indian tribes or tribal orga-
nizations acting pursuant to contracts or compacts 
under the Indian Self Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.)— 
‘‘(A) to test alternative means of delivering 
health care and services to Indians through fa-
cilities; or 
‘‘(B) to use alternative or innovative meth-
ods or models of delivering health care services 
to Indians (including primary care services, 
contract health services, or any other program 
or service authorized by this Act) through con-
venient care services (as defined in subsection 
(c)), community health centers, or cooperative 
agreements or arrangements with other health 
care providers that share or coordinate the use 
of facilities, funding, or other resources, or oth-
erwise coordinate or improve the coordination of 
activities of the Service, Indian tribes, or tribal 
organizations, with those of the other health 
care providers. 
‘‘(2) 
AUTHORITY.—The 
Secretary, 
acting 
through the Service, is authorized to carry out, or to 
enter into contracts or compacts under the Indian 
Self-Determination and Education Assistance Act 
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(25 U.S.C. 450 et seq.) with Indian tribes or tribal 
organizations to carry out, health care delivery dem-
onstration projects that— 
‘‘(A) test alternative means of delivering 
health care and services to Indians through fa-
cilities; or 
‘‘(B) otherwise carry out the purposes of 
this section. 
‘‘(b) USE OF FUNDS.—The Secretary, in approving 
projects pursuant to this section— 
‘‘(1) may authorize such contracts for the con-
struction and renovation of hospitals, health centers, 
health stations, and other facilities to deliver health 
care services; and 
‘‘(2) is authorized— 
‘‘(A) to waive any leasing prohibition; 
‘‘(B) to permit use and carryover of funds 
appropriated for the provision of health care 
services under this Act (including for the pur-
chase of health benefits coverage, as authorized 
by section 402(a)); 
‘‘(C) to permit the use of other available 
funds, including other Federal funds, funds 
from third-party collections in accordance with 
sections 206, 207, and 401, and non-Federal 
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funds contributed by State or local govern-
mental agencies or facilities or private health 
care providers pursuant to cooperative or other 
agreements with the Service, 1 or more Indian 
tribes, or tribal organizations; 
‘‘(D) to permit the use of funds or prop-
erty donated or otherwise provided from any 
source for project purposes; 
‘‘(E) to provide for the reversion of do-
nated real or personal property to the donor; 
and 
‘‘(F) to permit the use of Service funds to 
match other funds, including Federal funds. 
‘‘(c) HEALTH CARE DEMONSTRATION PROJECTS.— 
‘‘(1) DEFINITION OF CONVENIENT CARE SERV-
ICE.—In this subsection, the term ‘convenient care 
service’ means any primary health care service, such 
as urgent care services, nonemergent care services, 
prevention services and screenings, and any service 
authorized by section 203 or 205(d), that is of-
fered— 
‘‘(A) at an alternative setting; or 
‘‘(B) during hours other than regular 
working hours. 
‘‘(2) GENERAL PROJECTS.— 
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‘‘(A) CRITERIA.—The Secretary may ap-
prove under this section demonstration projects 
that meet the following criteria: 
‘‘(i) There is a need for a new facility 
or program, such as a program for conven-
ient care services, or an improvement in, 
increased efficiency at, or reorientation of 
an existing facility or program. 
‘‘(ii) A significant number of Indians, 
including Indians with low health status, 
will be served by the project. 
‘‘(iii) The project has the potential to 
deliver services in an efficient and effective 
manner. 
‘‘(iv) The project is economically via-
ble. 
‘‘(v) For projects carried out by an 
Indian tribe or tribal organization, the In-
dian tribe or tribal organization has the 
administrative and financial capability to 
administer the project. 
‘‘(vi) The project is integrated with 
providers of related health or social serv-
ices (including State and local health care 
agencies or other health care providers) 
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and is coordinated with, and avoids dupli-
cation of, existing services in order to ex-
pand the availability of services. 
‘‘(B) PRIORITY.—In approving demonstra-
tion projects under this paragraph, the Sec-
retary shall give priority to demonstration 
projects, to the extent the projects meet the cri-
teria described in subparagraph (A), located in 
any of the following Service units: 
‘‘(i) Cass Lake, Minnesota. 
‘‘(ii) Mescalero, New Mexico. 
‘‘(iii) Owyhee and Elko, Nevada. 
‘‘(iv) Schurz, Nevada. 
‘‘(v) Ft. Yuma, California. 
‘‘(3) INNOVATIVE HEALTH SERVICES DELIVERY 
DEMONSTRATION PROJECT.— 
‘‘(A) APPLICATION OR REQUEST.—On re-
ceipt of an application or request from an In-
dian tribe, a consortium of Indian tribes, or a 
tribal organization within a Service area, the 
Secretary shall take into consideration alter-
native or innovated methods to deliver health 
care services within the Service area (or a por-
tion of, or facility within, the Service area) as 
described in the application or request, includ-
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ing medical, dental, pharmaceutical, nursing, 
clinical laboratory, contract health services, con-
venient care services, community health centers, 
or any other health care services delivery mod-
els designed to improve access to, or efficiency 
or quality of, the health care, health promotion, 
or disease prevention services and programs 
under this Act. 
‘‘(B) APPROVAL.—In addition to projects 
described in paragraph (2), in any fiscal year, 
the Secretary is authorized under this para-
graph to approve not more than 10 applications 
for health care delivery demonstration projects 
that meet the criteria described in subpara-
graph (C). 
‘‘(C) CRITERIA.—The Secretary shall ap-
prove under subparagraph (B) demonstration 
projects that meet all of the following criteria: 
‘‘(i) The criteria set forth in para-
graph (2)(A). 
‘‘(ii) There is a lack of access to 
health care services at existing health care 
facilities, which may be due to limited 
hours of operation at those facilities or 
other factors. 
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‘‘(iii) The project— 
‘‘(I) expands the availability of 
services; or 
‘‘(II) reduces— 
‘‘(aa) the burden on Con-
tract Health Services; or 
‘‘(bb) the need for emer-
gency room visits. 
‘‘(d) TECHNICAL ASSISTANCE.—On receipt of an ap-
plication or request from an Indian tribe, a consortium 
of Indian tribes, or a tribal organization, the Secretary 
shall provide such technical and other assistance as may 
be necessary to enable applicants to comply with this sec-
tion, including information regarding the Service unit 
budget and available funding for carrying out the pro-
posed demonstration project. 
‘‘(e) SERVICE TO INELIGIBLE PERSONS.—Subject to 
section 813, the authority to provide services to persons 
otherwise ineligible for the health care benefits of the 
Service, and the authority to extend hospital privileges in 
Service facilities to non-Service health practitioners as 
provided in section 813, may be included, subject to the 
terms of that section, in any demonstration project ap-
proved pursuant to this section. 
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‘‘(f) EQUITABLE TREATMENT.—For purposes of sub-
section (c), the Secretary, in evaluating facilities operated 
under any contract or compact under the Indian Self-De-
termination and Education Assistance Act (25 U.S.C. 450 
et seq.), shall use the same criteria that the Secretary uses 
in evaluating facilities operated directly by the Service. 
‘‘(g) EQUITABLE INTEGRATION
OF FACILITIES.— 
The Secretary shall ensure that the planning, design, con-
struction, renovation, and expansion needs of Service and 
non-Service facilities that are the subject of a contract or 
compact under the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.) for health 
services are fully and equitably integrated into the imple-
mentation of the health care delivery demonstration 
projects under this section.’’. 
SEC. 144. TRIBAL MANAGEMENT OF FEDERALLY OWNED 
QUARTERS. 
Title III of the Indian Health Care Improvement Act 
(as amended by section 101(b)) is amended by inserting 
after section 308 (25 U.S.C. 1638) the following: 
‘‘SEC. 309. TRIBAL MANAGEMENT OF FEDERALLY OWNED 
QUARTERS. 
‘‘(a) RENTAL RATES.— 
‘‘(1) ESTABLISHMENT.—Notwithstanding any 
other provision of law, a tribal health program that 
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operates a hospital or other health facility and the 
federally owned quarters associated with such a fa-
cility pursuant to a contract or compact under the 
Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.) may establish the rental 
rates charged to the occupants of those quarters, on 
providing notice to the Secretary. 
‘‘(2) OBJECTIVES.—In establishing rental rates 
under this subsection, a tribal health program shall 
attempt— 
‘‘(A) to base the rental rates on the rea-
sonable value of the quarters to the occupants 
of the quarters; and 
‘‘(B) to generate sufficient funds to pru-
dently provide for the operation and mainte-
nance of the quarters, and at the discretion of 
the tribal health program, to supply reserve 
funds for capital repairs and replacement of the 
quarters. 
‘‘(3) EQUITABLE FUNDING.—A federally owned 
quarters the rental rates for which are established 
by a tribal health program under this subsection 
shall remain eligible to receive improvement and re-
pair funds to the same extent that all federally 
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owned quarters used to house personnel in programs 
of the Service are eligible to receive those funds. 
‘‘(4) NOTICE
OF
RATE
CHANGE.—A tribal 
health program that establishes a rental rate under 
this subsection shall provide occupants of the feder-
ally owned quarters a notice of any change in the 
rental rate by not later than the date that is 60 days 
notice before the effective date of the change. 
‘‘(5) RATES IN ALASKA.—A rental rate estab-
lished by a tribal health program under this section 
for a federally owned quarters in the State of Alaska 
may be based on the cost of comparable private 
rental housing in the nearest established community 
with a year-round population of 1,500 or more indi-
viduals. 
‘‘(b) DIRECT COLLECTION OF RENT.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of law, and subject to paragraph (2), a 
tribal health program may collect rent directly from 
Federal employees who occupy federally owned quar-
ters if the tribal health program submits to the Sec-
retary and the employees a notice of the election of 
the tribal health program to collect rents directly 
from the employees. 
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‘‘(2) ACTION BY EMPLOYEES.—On receipt of a 
notice described in paragraph (1)— 
‘‘(A) the affected Federal employees shall 
pay rent for occupancy of a federally owned 
quarters directly to the applicable tribal health 
program; and 
‘‘(B) the Secretary shall not have the au-
thority to collect rent from the employees 
through payroll deduction or otherwise. 
‘‘(3) USE OF PAYMENTS.—The rent payments 
under this subsection— 
‘‘(A) shall be retained by the applicable 
tribal health program in a separate account, 
which shall be used by the tribal health pro-
gram for the maintenance (including capital re-
pairs and replacement) and operation of the 
quarters, as the tribal health program deter-
mines to be appropriate; and 
‘‘(B) shall not be made payable to, or oth-
erwise be deposited with, the United States. 
‘‘(4) RETROCESSION OF AUTHORITY.—If a trib-
al health program that elected to collect rent directly 
under paragraph (1) requests retrocession of the au-
thority of the tribal health program to collect that 
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rent, the retrocession shall take effect on the earlier 
of— 
‘‘(A) the first day of the month that begins 
not less than 180 days after the tribal health 
program submits the request; and 
‘‘(B) such other date as may be mutually 
agreed on by the Secretary and the tribal health 
program.’’. 
SEC. 145. OTHER FUNDING, EQUIPMENT, AND SUPPLIES 
FOR FACILITIES. 
Title III of the Indian Health Care Improvement Act 
(25 U.S.C. 1631 et seq.) is amended by adding at the end 
the following: 
‘‘SEC. 311. OTHER FUNDING, EQUIPMENT, AND SUPPLIES 
FOR FACILITIES. 
‘‘(a) AUTHORIZATION.— 
‘‘(1) AUTHORITY TO TRANSFER FUNDS.—The 
head of any Federal agency to which funds, equip-
ment, or other supplies are made available for the 
planning, design, construction, or operation of a 
health care or sanitation facility may transfer the 
funds, equipment, or supplies to the Secretary for 
the planning, design, construction, or operation of a 
health care or sanitation facility to achieve— 
‘‘(A) the purposes of this Act; and 
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‘‘(B) the purposes for which the funds, 
equipment, or supplies were made available to 
the Federal agency. 
‘‘(2) AUTHORITY TO ACCEPT FUNDS.—The Sec-
retary may— 
‘‘(A) accept from any source, including 
Federal and State agencies, funds, equipment, 
or supplies that are available for the construc-
tion or operation of health care or sanitation fa-
cilities; and 
‘‘(B) use those funds, equipment, and sup-
plies to plan, design, construct, and operate 
health care or sanitation facilities for Indians, 
including pursuant to a contract or compact 
under the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.). 
‘‘(3) EFFECT OF RECEIPT.—Receipt of funds 
by the Secretary under this subsection shall not af-
fect any priority established under section 301. 
‘‘(b) INTERAGENCY AGREEMENTS.—The Secretary 
may enter into interagency agreements with Federal or 
State agencies and other entities, and accept funds, equip-
ment, or other supplies from those entities, to provide for 
the planning, design, construction, and operation of health 
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care or sanitation facilities to be administered by Indian 
health programs to achieve— 
‘‘(1) the purposes of this Act; and 
‘‘(2) the purposes for which the funds were ap-
propriated or otherwise provided.’’ 
‘‘(c) ESTABLISHMENT OF STANDARDS.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Service, shall establish, by regulation, 
standards for the planning, design, construction, and 
operation of health care or sanitation facilities serv-
ing Indians under this Act. 
‘‘(2) OTHER
REGULATIONS.—Notwithstanding 
any other provision of law, any other applicable reg-
ulations of the Department shall apply in carrying 
out projects using funds transferred under this sec-
tion. 
‘‘(d) DEFINITION OF SANITATION FACILITY.—In this 
section, the term ‘sanitation facility’ means a safe and 
adequate water supply system, sanitary sewage disposal 
system, or sanitary solid waste system (including all re-
lated equipment and support infrastructure).’’. 
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SEC. 146. INDIAN COUNTRY MODULAR COMPONENT FACILI-
TIES DEMONSTRATION PROGRAM. 
Title III of the Indian Health Care Improvement Act 
(25 U.S.C. 1631 et seq.) (as amended by section 145) is 
amended by adding at the end the following: 
‘‘SEC. 312. INDIAN COUNTRY MODULAR COMPONENT FA-
CILITIES DEMONSTRATION PROGRAM. 
‘‘(a) 
DEFINITION
OF
MODULAR
COMPONENT 
HEALTH CARE FACILITY.—In this section, the term ‘mod-
ular component health care facility’ means a health care 
facility that is constructed— 
‘‘(1) off-site using prefabricated component 
units for subsequent transport to the destination lo-
cation; and 
‘‘(2) represents a more economical method for 
provision of health care facility than a traditionally 
constructed health care building. 
‘‘(b) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the Service, shall establish a demonstration pro-
gram under which the Secretary shall award no less than 
3 grants for purchase, installation and maintenance of 
modular component health care facilities in Indian com-
munities for provision of health care services. 
‘‘(c) SELECTION OF LOCATIONS.— 
‘‘(1) PETITIONS.— 
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‘‘(A) SOLICITATION.—The Secretary shall 
solicit from Indian tribes petitions for location 
of the modular component health care facilities 
in the Service areas of the petitioning Indian 
tribes. 
‘‘(B) PETITION.—To be eligible to receive 
a grant under this section, an Indian tribe or 
tribal organization must submit to the Sec-
retary a petition to construct a modular compo-
nent health care facility in the Indian commu-
nity of the Indian tribe, at such time, in such 
manner, and containing such information as the 
Secretary may require. 
‘‘(2) SELECTION.—In selecting the location of 
each modular component health care facility to be 
provided under the demonstration program, the Sec-
retary shall give priority to projects already on the 
Indian Health Service facilities construction priority 
list and petitions which demonstrate that erection of 
a modular component health facility— 
‘‘(A) is more economical than construction 
of a traditionally constructed health care facil-
ity; 
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100 
‘‘(B) can be constructed and erected on the 
selected location in less time than traditional 
construction; and 
‘‘(C) can adequately house the health care 
services needed by the Indian population to be 
served. 
‘‘(3) EFFECT OF SELECTION.—A modular com-
ponent health care facility project selected for par-
ticipation in the demonstration program shall not be 
eligible for entry on the facilities construction prior-
ities list entitled ‘IHS Health Care Facilities FY 
2011 Planned Construction Budget’ and dated May 
7, 2009 (or any successor list). 
‘‘(d) ELIGIBILITY.— 
‘‘(1) IN GENERAL.—An Indian tribe may sub-
mit a petition under subsection (c)(1)(B) regardless 
of whether the Indian tribe is a party to any con-
tract or compact under the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C. 450 
et seq.). 
‘‘(2) ADMINISTRATION.—At the election of an 
Indian tribe or tribal organization selected for par-
ticipation in the demonstration program, the funds 
provided for the project shall be subject to the provi-
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101 
sions of the Indian Self-Determination and Edu-
cation Assistance Act. 
‘‘(e) REPORTS.—Not later than 1 year after the date 
on which funds are made available for the demonstration 
program and annually thereafter, the Secretary shall sub-
mit to Congress a report describing— 
‘‘(1) each activity carried out under the dem-
onstration program, including an evaluation of the 
success of the activity; and 
‘‘(2) the potential benefits of increased use of 
modular component health care facilities in other In-
dian communities. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated $50,000,000 to carry 
out the demonstration program under this section for the 
first 5 fiscal years, and such sums as may be necessary 
to carry out the program in subsequent fiscal years.’’. 
SEC. 147. MOBILE HEALTH STATIONS DEMONSTRATION 
PROGRAM. 
Title III of the Indian Health Care Improvement Act 
(25 U.S.C. 1631 et seq.) (as amended by section 146) is 
amended by adding at the end the following: 
‘‘SEC. 313. MOBILE HEALTH STATIONS DEMONSTRATION 
PROGRAM. 
‘‘(a) DEFINITIONS.—In this section: 
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102 
‘‘(1) ELIGIBLE
TRIBAL
CONSORTIUM.—The 
term ‘eligible tribal consortium’ means a consortium 
composed of 2 or more Service units between which 
a mobile health station can be transported by road 
in up to 8 hours. A Service unit operated by the 
Service or by an Indian tribe or tribal organization 
shall be equally eligible for participation in such con-
sortium. 
‘‘(2) MOBILE
HEALTH
STATION.—The term 
‘mobile health station’ means a health care unit 
that— 
‘‘(A) is constructed, maintained, and capa-
ble of being transported within a semi-trailer 
truck or similar vehicle; 
‘‘(B) is equipped for the provision of 1 or 
more specialty health care services; and 
‘‘(C) can be equipped to be docked to a 
stationary health care facility when appropriate. 
‘‘(3) SPECIALTY HEALTH CARE SERVICE.— 
‘‘(A) IN
GENERAL.—The term ‘specialty 
health care service’ means a health care service 
which requires the services of a health care pro-
fessional with specialized knowledge or experi-
ence. 
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103 
‘‘(B) INCLUSIONS.—The term ‘specialty 
health care service’ includes any service relating 
to— 
‘‘(i) dialysis; 
‘‘(ii) surgery; 
‘‘(iii) mammography; 
‘‘(iv) dentistry; or 
‘‘(v) any other specialty health care 
service. 
‘‘(b) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the Service, shall establish a demonstration pro-
gram under which the Secretary shall provide at least 3 
mobile health station projects. 
‘‘(c) PETITION.—To be eligible to receive a mobile 
health station under the demonstration program, an eligi-
ble tribal consortium shall submit to the Secretary, a peti-
tion at such time, in such manner, and containing— 
‘‘(1) a description of the Indian population to 
be served; 
‘‘(2) a description of the specialty service or 
services for which the mobile health station is re-
quested and the extent to which such service or serv-
ices are currently available to the Indian population 
to be served; and 
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104 
‘‘(3) such other information as the Secretary 
may require. 
‘‘(d) USE
OF FUNDS.—The Secretary shall use 
amounts made available to carry out the demonstration 
program under this section— 
‘‘(1)(A) to establish, purchase, lease, or main-
tain mobile health stations for the eligible tribal con-
sortia selected for projects; and 
‘‘(B) to provide, through the mobile health sta-
tion, such specialty health care services as the af-
fected eligible tribal consortium determines to be 
necessary for the Indian population served; 
‘‘(2) to employ an existing mobile health station 
(regardless of whether the mobile health station is 
owned or rented and operated by the Service) to pro-
vide specialty health care services to an eligible trib-
al consortium; and 
‘‘(3) to establish, purchase, or maintain docking 
equipment for a mobile health station, including the 
establishment or maintenance of such equipment at 
a modular component health care facility (as defined 
in section 312(a)), if applicable. 
‘‘(e) REPORTS.—Not later than 1 year after the date 
on which the demonstration program is established under 
subsection (b) and annually thereafter, the Secretary, act-
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105 
ing through the Service, shall submit to Congress a report 
describing— 
‘‘(1) each activity carried out under the dem-
onstration program including an evaluation of the 
success of the activity; and 
‘‘(2) the potential benefits of increased use of 
mobile health stations to provide specialty health 
care services for Indian communities. 
‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated $5,000,000 per year to 
carry out the demonstration program under this section 
for the first 5 fiscal years, and such sums as may be need-
ed to carry out the program in subsequent fiscal years.’’. 
Subtitle D—Access to Health 
Services 
SEC. 151. TREATMENT OF PAYMENTS UNDER SOCIAL SECU-
RITY ACT HEALTH BENEFITS PROGRAMS. 
Section 401 of the Indian Health Care Improvement 
Act (25 U.S.C. 1641) is amended to read as follows: 
‘‘SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SE-
CURITY ACT HEALTH BENEFITS PROGRAMS. 
‘‘(a) DISREGARD
OF MEDICARE, MEDICAID, AND 
CHIP PAYMENTS IN DETERMINING APPROPRIATIONS.— 
Any payments received by an Indian health program or 
by an urban Indian organization under title XVIII, XIX, 
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106 
or XXI of the Social Security Act for services provided 
to Indians eligible for benefits under such respective titles 
shall not be considered in determining appropriations for 
the provision of health care and services to Indians. 
‘‘(b) NONPREFERENTIAL TREATMENT.—Nothing in 
this Act authorizes the Secretary to provide services to an 
Indian with coverage under title XVIII, XIX, or XI of the 
Social Security Act in preference to an Indian without 
such coverage. 
‘‘(c) USE OF FUNDS.— 
‘‘(1) SPECIAL FUND.— 
‘‘(A) 100 PERCENT
PASS-THROUGH
OF 
PAYMENTS
DUE
TO
FACILITIES.—Notwith-
standing any other provision of law, but subject 
to paragraph (2), payments to which a facility 
of the Service is entitled by reason of a provi-
sion of title XVIII or XIX of the Social Secu-
rity Act shall be placed in a special fund to be 
held by the Secretary. In making payments 
from such fund, the Secretary shall ensure that 
each Service unit of the Service receives 100 
percent of the amount to which the facilities of 
the Service, for which such Service unit makes 
collections, are entitled by reason of a provision 
of either such title. 
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‘‘(B) USE OF FUNDS.—Amounts received 
by a facility of the Service under subparagraph 
(A) by reason of a provision of title XVIII or 
XIX of the Social Security Act shall first be 
used (to such extent or in such amounts as are 
provided in appropriation Acts) for the purpose 
of making any improvements in the programs 
of the Service operated by or through such fa-
cility which may be necessary to achieve or 
maintain compliance with the applicable condi-
tions and requirements of such respective title. 
Any amounts so received that are in excess of 
the amount necessary to achieve or maintain 
such conditions and requirements shall, subject 
to consultation with the Indian tribes being 
served by the Service unit, be used for reducing 
the health resource deficiencies (as determined 
in section 201(c)) of such Indian tribes, includ-
ing the provision of services pursuant to section 
205. 
‘‘(2) DIRECT
PAYMENT
OPTION.—Paragraph 
(1) shall not apply to a tribal health program upon 
the election of such program under subsection (d) to 
receive payments directly. No payment may be made 
out of the special fund described in such paragraph 
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with respect to reimbursement made for services 
provided by such program during the period of such 
election. 
‘‘(d) DIRECT BILLING.— 
‘‘(1) IN GENERAL.—Subject to complying with 
the requirements of paragraph (2), a tribal health 
program may elect to directly bill for, and receive 
payment for, health care items and services provided 
by such program for which payment is made under 
title XVIII, XIX, or XXI of the Social Security Act 
or from any other third party payor. 
‘‘(2) DIRECT REIMBURSEMENT.— 
‘‘(A) USE OF FUNDS.—Each tribal health 
program making the election described in para-
graph (1) with respect to a program under a 
title of the Social Security Act shall be reim-
bursed directly by that program for items and 
services furnished without regard to subsection 
(c)(1), except that all amounts so reimbursed 
shall be used by the tribal health program for 
the purpose of making any improvements in fa-
cilities of the tribal health program that may be 
necessary to achieve or maintain compliance 
with the conditions and requirements applicable 
generally to such items and services under the 
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109 
program under such title and to provide addi-
tional health care services, improvements in 
health care facilities and tribal health pro-
grams, any health care-related purpose (includ-
ing coverage for a service or service within a 
contract health service delivery area or any por-
tion of a contract health service delivery area 
that would otherwise be provided as a contract 
health service), or otherwise to achieve the ob-
jectives provided in section 3 of this Act. 
‘‘(B) AUDITS.—The amounts paid to a 
tribal health program making the election de-
scribed in paragraph (1) with respect to a pro-
gram under title XVIII, XIX, or XXI of the So-
cial Security Act shall be subject to all auditing 
requirements applicable to the program under 
such title, as well as all auditing requirements 
applicable to programs administered by an In-
dian health program. Nothing in the preceding 
sentence shall be construed as limiting the ap-
plication of auditing requirements applicable to 
amounts paid under title XVIII, XIX, or XXI 
of the Social Security Act. 
‘‘(C) IDENTIFICATION OF SOURCE OF PAY-
MENTS.—Any tribal health program that re-
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110 
ceives reimbursements or payments under title 
XVIII, XIX, or XXI of the Social Security Act 
shall provide to the Service a list of each pro-
vider enrollment number (or other identifier) 
under which such program receives such reim-
bursements or payments. 
‘‘(3) EXAMINATION AND IMPLEMENTATION OF 
CHANGES.— 
‘‘(A) IN GENERAL.—The Secretary, acting 
through the Service and with the assistance of 
the Administrator of the Centers for Medicare 
& Medicaid Services, shall examine on an ongo-
ing basis and implement any administrative 
changes that may be necessary to facilitate di-
rect billing and reimbursement under the pro-
gram established under this subsection, includ-
ing any agreements with States that may be 
necessary to provide for direct billing under a 
program under title XIX or XXI of the Social 
Security Act. 
‘‘(B) COORDINATION OF INFORMATION.— 
The Service shall provide the Administrator of 
the Centers for Medicare & Medicaid Services 
with copies of the lists submitted to the Service 
under paragraph (2)(C), enrollment data re-
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garding patients served by the Service (and by 
tribal health programs, to the extent such data 
is available to the Service), and such other in-
formation as the Administrator may require for 
purposes of administering title XVIII, XIX, or 
XXI of the Social Security Act. 
‘‘(4) WITHDRAWAL FROM PROGRAM.—A tribal 
health program that bills directly under the program 
established under this subsection may withdraw 
from participation in the same manner and under 
the same conditions that an Indian tribe or tribal or-
ganization may retrocede a contracted program to 
the Secretary under the authority of the Indian Self- 
Determination and Education Assistance Act (25 
U.S.C. 450 et seq.). All cost accounting and billing 
authority under the program established under this 
subsection shall be returned to the Secretary upon 
the Secretary’s acceptance of the withdrawal of par-
ticipation in this program. 
‘‘(5) TERMINATION FOR FAILURE TO COMPLY 
WITH REQUIREMENTS.—The Secretary may termi-
nate the participation of a tribal health program or 
in the direct billing program established under this 
subsection if the Secretary determines that the pro-
gram has failed to comply with the requirements of 
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112 
paragraph (2). The Secretary shall provide a tribal 
health program with notice of a determination that 
the program has failed to comply with any such re-
quirement and a reasonable opportunity to correct 
such noncompliance prior to terminating the pro-
gram’s participation in the direct billing program es-
tablished under this subsection. 
‘‘(e) RELATED PROVISIONS UNDER THE SOCIAL SE-
CURITY ACT.—For provisions related to subsections (c) 
and (d), see sections 1880, 1911, and 2107(e)(1)(D) of 
the Social Security Act.’’. 
SEC. 152. PURCHASING HEALTH CARE COVERAGE. 
Section 402 of the Indian Health Care Improvement 
Act (25 U.S.C. 1642) is amended to read as follows: 
‘‘SEC. 402. PURCHASING HEALTH CARE COVERAGE. 
‘‘(a) IN GENERAL.—Insofar as amounts are made 
available under law (including a provision of the Social 
Security Act, the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.), or other 
law, other than under section 404) to Indian tribes, tribal 
organizations, and urban Indian organizations for health 
benefits for Service beneficiaries, Indian tribes, tribal or-
ganizations, and urban Indian organizations may use such 
amounts to purchase health benefits coverage (including 
coverage for a service, or service within a contract health 
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service delivery area, or any portion of a contract health 
service delivery area that would otherwise be provided as 
a contract health service) for such beneficiaries in any 
manner, including through— 
‘‘(1) a tribally owned and operated health care 
plan; 
‘‘(2) a State or locally authorized or licensed 
health care plan; 
‘‘(3) a health insurance provider or managed 
care organization; 
‘‘(4) a self-insured plan; or 
‘‘(5) a high deductible or health savings account 
plan. 
‘‘(b) FINANCIAL NEED.—The purchase of coverage 
under subsection (a) by an Indian tribe, tribal organiza-
tion, or urban Indian organization may be based on the 
financial needs of such beneficiaries (as determined by the 
1 or more Indian tribes being served based on a schedule 
of income levels developed or implemented by such 1 ore 
more Indian tribes). 
‘‘(c) EXPENSES FOR SELF-INSURED PLAN.—In the 
case of a self-insured plan under subsection (a)(4), the 
amounts may be used for expenses of operating the plan, 
including administration and insurance to limit the finan-
cial risks to the entity offering the plan. 
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114 
‘‘(d) CONSTRUCTION.—Nothing in this section shall 
be construed as affecting the use of any amounts not re-
ferred to in subsection (a).’’. 
SEC. 153. GRANTS TO AND CONTRACTS WITH THE SERVICE, 
INDIAN 
TRIBES, 
TRIBAL 
ORGANIZATIONS, 
AND URBAN INDIAN ORGANIZATIONS TO FA-
CILITATE 
OUTREACH, 
ENROLLMENT, 
AND 
COVERAGE OF INDIANS UNDER SOCIAL SECU-
RITY ACT HEALTH BENEFIT PROGRAMS AND 
OTHER HEALTH BENEFITS PROGRAMS. 
Section 404 of the Indian Health Care Improvement 
Act (25 U.S.C. 1644) is amended to read as follows: 
‘‘SEC. 404. GRANTS TO AND CONTRACTS WITH THE SERV-
ICE, 
INDIAN 
TRIBES, 
TRIBAL 
ORGANIZA-
TIONS, AND URBAN INDIAN ORGANIZATIONS 
TO FACILITATE OUTREACH, ENROLLMENT, 
AND COVERAGE OF INDIANS UNDER SOCIAL 
SECURITY ACT HEALTH BENEFIT PROGRAMS 
AND OTHER HEALTH BENEFITS PROGRAMS. 
‘‘(a) INDIAN
TRIBES
AND
TRIBAL
ORGANIZA-
TIONS.—The Secretary, acting through the Service, shall 
make grants to or enter into contracts with Indian tribes 
and tribal organizations to assist such tribes and tribal 
organizations in establishing and administering programs 
on or near reservations and trust lands, including pro-
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115 
grams to provide outreach and enrollment through video, 
electronic delivery methods, or telecommunication devices 
that allow real-time or time-delayed communication be-
tween individual Indians and the benefit program, to as-
sist individual Indians— 
‘‘(1) to enroll for benefits under a program es-
tablished under title XVIII, XIX, or XXI of the So-
cial Security Act and other health benefits pro-
grams; and 
‘‘(2) with respect to such programs for which 
the charging of premiums and cost sharing is not 
prohibited under such programs, to pay premiums or 
cost sharing for coverage for such benefits, which 
may be based on financial need (as determined by 
the Indian tribe or tribes or tribal organizations 
being served based on a schedule of income levels de-
veloped or implemented by such tribe, tribes, or trib-
al organizations). 
‘‘(b) CONDITIONS.—The Secretary, acting through 
the Service, shall place conditions as deemed necessary to 
effect the purpose of this section in any grant or contract 
which the Secretary makes with any Indian tribe or tribal 
organization pursuant to this section. Such conditions 
shall include requirements that the Indian tribe or tribal 
organization successfully undertake— 
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‘‘(1) to determine the population of Indians eli-
gible for the benefits described in subsection (a); 
‘‘(2) to educate Indians with respect to the ben-
efits available under the respective programs; 
‘‘(3) to provide transportation for such indi-
vidual Indians to the appropriate offices for enroll-
ment or applications for such benefits; and 
‘‘(4) to develop and implement methods of im-
proving the participation of Indians in receiving ben-
efits under such programs. 
‘‘(c) APPLICATION
TO URBAN INDIAN ORGANIZA-
TIONS.— 
‘‘(1) IN
GENERAL.—The provisions of sub-
section (a) shall apply with respect to grants and 
other funding to urban Indian organizations with re-
spect to populations served by such organizations in 
the same manner they apply to grants and contracts 
with Indian tribes and tribal organizations with re-
spect to programs on or near reservations. 
‘‘(2) REQUIREMENTS.—The Secretary shall in-
clude in the grants or contracts made or provided 
under paragraph (1) requirements that are— 
‘‘(A) consistent with the requirements im-
posed by the Secretary under subsection (b); 
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117 
‘‘(B) appropriate to urban Indian organi-
zations and urban Indians; and 
‘‘(C) necessary to effect the purposes of 
this section. 
‘‘(d) FACILITATING COOPERATION.—The Secretary, 
acting through the Centers for Medicare & Medicaid Serv-
ices, shall develop and disseminate best practices that will 
serve to facilitate cooperation with, and agreements be-
tween, States and the Service, Indian tribes, tribal organi-
zations, or urban Indian organizations with respect to the 
provision of health care items and services to Indians 
under the programs established under title XVIII, XIX, 
or XXI of the Social Security Act. 
‘‘(e) AGREEMENTS RELATING TO IMPROVING EN-
ROLLMENT OF INDIANS UNDER SOCIAL SECURITY ACT 
HEALTH BENEFITS PROGRAMS.—For provisions relating 
to agreements of the Secretary, acting through the Serv-
ice, for the collection, preparation, and submission of ap-
plications by Indians for assistance under the Medicaid 
and children’s health insurance programs established 
under titles XIX and XXI of the Social Security Act, and 
benefits under the Medicare program established under 
title XVIII of such Act, see subsections (a) and (b) of sec-
tion 1139 of the Social Security Act. 
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‘‘(f) DEFINITION OF PREMIUMS AND COST SHAR-
ING.—In this section: 
‘‘(1) PREMIUM.—The term ‘premium’ includes 
any enrollment fee or similar charge. 
‘‘(2) COST SHARING.—The term ‘cost sharing’ 
includes any deduction, deductible, copayment, coin-
surance, or similar charge.’’. 
SEC. 154. SHARING ARRANGEMENTS WITH FEDERAL AGEN-
CIES. 
Section 405 of the Indian Health Care Improvement 
Act (25 U.S.C. 1645) is amended to read as follows: 
‘‘SEC. 405. SHARING ARRANGEMENTS WITH FEDERAL AGEN-
CIES. 
‘‘(a) AUTHORITY.— 
‘‘(1) IN GENERAL.—The Secretary may enter 
into (or expand) arrangements for the sharing of 
medical facilities and services between the Service, 
Indian tribes, and tribal organizations and the De-
partment of Veterans Affairs and the Department of 
Defense. 
‘‘(2) 
CONSULTATION
BY
SECRETARY
RE-
QUIRED.—The Secretary may not finalize any ar-
rangement between the Service and a Department 
described in paragraph (1) without first consulting 
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119 
with the Indian tribes which will be significantly af-
fected by the arrangement. 
‘‘(b) LIMITATIONS.—The Secretary shall not take 
any action under this section or under subchapter IV of 
chapter 81 of title 38, United States Code, which would 
impair— 
‘‘(1) the priority access of any Indian to health 
care services provided through the Service and the 
eligibility of any Indian to receive health services 
through the Service; 
‘‘(2) the quality of health care services provided 
to any Indian through the Service; 
‘‘(3) the priority access of any veteran to health 
care services provided by the Department of Vet-
erans Affairs; 
‘‘(4) the quality of health care services provided 
by the Department of Veterans Affairs or the De-
partment of Defense; or 
‘‘(5) the eligibility of any Indian who is a vet-
eran to receive health services through the Depart-
ment of Veterans Affairs. 
‘‘(c) REIMBURSEMENT.—The Service, Indian tribe, 
or tribal organization shall be reimbursed by the Depart-
ment of Veterans Affairs or the Department of Defense 
(as the case may be) where services are provided through 
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120 
the Service, an Indian tribe, or a tribal organization to 
beneficiaries eligible for services from either such Depart-
ment, notwithstanding any other provision of law. 
‘‘(d) CONSTRUCTION.—Nothing in this section may 
be construed as creating any right of a non-Indian veteran 
to obtain health services from the Service.’’. 
SEC. 155. ELIGIBLE INDIAN VETERAN SERVICES. 
Title IV of the Indian Health Care Improvement Act 
(25 U.S.C. 1641 et seq.) (as amended by section 101(b)) 
is amended by adding at the end the following: 
‘‘SEC. 407. ELIGIBLE INDIAN VETERAN SERVICES. 
‘‘(a) FINDINGS; PURPOSE.— 
‘‘(1) FINDINGS.—Congress finds that— 
‘‘(A) collaborations between the Secretary 
and the Secretary of Veterans Affairs regarding 
the treatment of Indian veterans at facilities of 
the Service should be encouraged to the max-
imum extent practicable; and 
‘‘(B) increased enrollment for services of 
the Department of Veterans Affairs by veterans 
who are members of Indian tribes should be en-
couraged to the maximum extent practicable. 
‘‘(2) PURPOSE.—The purpose of this section is 
to reaffirm the goals stated in the document entitled 
‘Memorandum of Understanding Between the VA/ 
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121 
Veterans Health Administration And HHS/Indian 
Health Service’ and dated February 25, 2003 (relat-
ing to cooperation and resource sharing between the 
Veterans Health Administration and Service). 
‘‘(b) DEFINITIONS.—In this section: 
‘‘(1) ELIGIBLE
INDIAN
VETERAN.—The term 
‘eligible Indian veteran’ means an Indian or Alaska 
Native veteran who receives any medical service that 
is— 
‘‘(A) authorized under the laws adminis-
tered by the Secretary of Veterans Affairs; and 
‘‘(B) administered at a facility of the Serv-
ice (including a facility operated by an Indian 
tribe or tribal organization through a contract 
or compact with the Service under the Indian 
Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.)) pursuant to a local 
memorandum of understanding. 
‘‘(2) 
LOCAL
MEMORANDUM
OF
UNDER-
STANDING.—The term ‘local memorandum of under-
standing’ means a memorandum of understanding 
between the Secretary (or a designee, including the 
director of any area office of the Service) and the 
Secretary of Veterans Affairs (or a designee) to im-
plement the document entitled ‘Memorandum of Un-
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122 
derstanding Between the VA/Veterans Health Ad-
ministration And HHS/Indian Health Service’ and 
dated February 25, 2003 (relating to cooperation 
and resource sharing between the Veterans Health 
Administration and Indian Health Service). 
‘‘(c) ELIGIBLE INDIAN VETERANS EXPENSES.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of law, the Secretary shall provide for vet-
eran-related expenses incurred by eligible Indian vet-
erans as described in subsection (b)(1)(B). 
‘‘(2) METHOD
OF
PAYMENT.—The Secretary 
shall establish such guidelines as the Secretary de-
termines to be appropriate regarding the method of 
payments to the Secretary of Veterans Affairs under 
paragraph (1). 
‘‘(d) TRIBAL APPROVAL OF MEMORANDA.—In nego-
tiating a local memorandum of understanding with the 
Secretary of Veterans Affairs regarding the provision of 
services to eligible Indian veterans, the Secretary shall 
consult with each Indian tribe that would be affected by 
the local memorandum of understanding. 
‘‘(e) FUNDING.— 
‘‘(1) TREATMENT.—Expenses incurred by the 
Secretary in carrying out subsection (c)(1) shall not 
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123 
be considered to be Contract Health Service ex-
penses. 
‘‘(2) USE OF FUNDS.—Of funds made available 
to the Secretary in appropriations Acts for the Serv-
ice (excluding funds made available for facilities, 
Contract Health Services, or contract support costs), 
the Secretary shall use such sums as are necessary 
to carry out this section.’’. 
SEC. 156. NONDISCRIMINATION UNDER FEDERAL HEALTH 
CARE PROGRAMS IN QUALIFICATIONS FOR 
REIMBURSEMENT FOR SERVICES. 
Title IV of the Indian Health Care Improvement Act 
(25 U.S.C. 1641 et seq.) (as amended by section 155) is 
amended by adding at the end the following: 
‘‘SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH 
CARE PROGRAMS IN QUALIFICATIONS FOR 
REIMBURSEMENT FOR SERVICES. 
‘‘(a) REQUIREMENT TO SATISFY GENERALLY APPLI-
CABLE PARTICIPATION REQUIREMENTS.— 
‘‘(1) IN GENERAL.—A Federal health care pro-
gram must accept an entity that is operated by the 
Service, an Indian tribe, tribal organization, or 
urban Indian organization as a provider eligible to 
receive payment under the program for health care 
services furnished to an Indian on the same basis as 
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124 
any other provider qualified to participate as a pro-
vider of health care services under the program if 
the entity meets generally applicable State or other 
requirements for participation as a provider of 
health care services under the program. 
‘‘(2) SATISFACTION OF STATE OR LOCAL LICEN-
SURE
OR
RECOGNITION
REQUIREMENTS.—Any re-
quirement for participation as a provider of health 
care services under a Federal health care program 
that an entity be licensed or recognized under the 
State or local law where the entity is located to fur-
nish health care services shall be deemed to have 
been met in the case of an entity operated by the 
Service, an Indian tribe, tribal organization, or 
urban Indian organization if the entity meets all the 
applicable standards for such licensure or recogni-
tion, regardless of whether the entity obtains a li-
cense or other documentation under such State or 
local law. In accordance with section 221, the ab-
sence of the licensure of a health professional em-
ployed by such an entity under the State or local law 
where the entity is located shall not be taken into 
account for purposes of determining whether the en-
tity meets such standards, if the professional is li-
censed in another State. 
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‘‘(b) APPLICATION OF EXCLUSION FROM PARTICIPA-
TION IN FEDERAL HEALTH CARE PROGRAMS.— 
‘‘(1) EXCLUDED ENTITIES.—No entity operated 
by the Service, an Indian tribe, tribal organization, 
or urban Indian organization that has been excluded 
from participation in any Federal health care pro-
gram or for which a license is under suspension or 
has been revoked by the State where the entity is lo-
cated shall be eligible to receive payment or reim-
bursement under any such program for health care 
services furnished to an Indian. 
‘‘(2) EXCLUDED INDIVIDUALS.—No individual 
who has been excluded from participation in any 
Federal health care program or whose State license 
is under suspension shall be eligible to receive pay-
ment or reimbursement under any such program for 
health care services furnished by that individual, di-
rectly or through an entity that is otherwise eligible 
to receive payment for health care services, to an In-
dian. 
‘‘(3) FEDERAL
HEALTH
CARE
PROGRAM
DE-
FINED.—In this subsection, the term, ‘Federal 
health care program’ has the meaning given that 
term in section 1128B(f) of the Social Security Act 
(42 U.S.C. 1320a–7b(f)), except that, for purposes 
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of this subsection, such term shall include the health 
insurance program under chapter 89 of title 5, 
United States Code. 
‘‘(c) RELATED PROVISIONS.—For provisions related 
to nondiscrimination against providers operated by the 
Service, an Indian tribe, tribal organization, or urban In-
dian organization, see section 1139(c) of the Social Secu-
rity Act (42 U.S.C. 1320b–9(c)).’’. 
SEC. 157. ACCESS TO FEDERAL INSURANCE. 
Title IV of the Indian Health Care Improvement Act 
(25 U.S.C. 1641 et seq.) (as amended by section 156) is 
amended by adding at the end the following: 
‘‘SEC. 409. ACCESS TO FEDERAL INSURANCE. 
‘‘Notwithstanding the provisions of title 5, United 
States Code, Executive order, or administrative regula-
tion, an Indian tribe or tribal organization carrying out 
programs under the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.) or an urban 
Indian organization carrying out programs under title V 
of this Act shall be entitled to purchase coverage, rights, 
and benefits for the employees of such Indian tribe or trib-
al organization, or urban Indian organization, under chap-
ter 89 of title 5, United States Code, and chapter 87 of 
such title if necessary employee deductions and agency 
contributions in payment for the coverage, rights, and ben-
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efits for the period of employment with such Indian tribe 
or tribal organization, or urban Indian organization, are 
currently deposited in the applicable Employee’s Fund 
under such title.’’. 
SEC. 158. GENERAL EXCEPTIONS. 
Title IV of the Indian Health Care Improvement Act 
(25 U.S.C. 1641 et seq.) (as amended by section 157) is 
amended by adding at the end the following: 
‘‘SEC. 410. GENERAL EXCEPTIONS. 
‘‘The requirements of this title shall not apply to any 
excepted benefits described in paragraph (1)(A) or (3) of 
section 2791(c) of the Public Health Service Act (42 
U.S.C. 300gg–91).’’. 
SEC. 159. NAVAJO NATION MEDICAID AGENCY FEASIBILITY 
STUDY. 
Title IV of the Indian Health Care Improvement Act 
(25 U.S.C. 1641 et seq.) (as amended by section 158) is 
amended by adding at the end the following: 
‘‘SEC. 411. 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-
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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 
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-
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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 then 3 years after the date 
of enactment of the Indian Healthcare Improvement Act 
of 2011, the Secretary shall submit to the Committee on 
Indian Affairs and Committee on Finance of the Senate 
and the Committee on Natural Resources 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 fea-
sible.’’. 
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Subtitle E—Health Services for 
Urban Indians 
SEC. 161. FACILITIES RENOVATION. 
Section 509 of the Indian Health Care Improvement 
Act (25 U.S.C. 1659) is amended by inserting ‘‘or con-
struction or expansion of facilities’’ after ‘‘renovations to 
facilities’’. 
SEC. 162. TREATMENT OF CERTAIN DEMONSTRATION 
PROJECTS. 
Section 512 of the Indian Health Care Improvement 
Act (25 U.S.C. 1660b) is amended to read as follows: 
‘‘SEC. 512. 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 co-
ordination 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 
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Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.).’’. 
SEC. 163. REQUIREMENT TO CONFER WITH URBAN INDIAN 
ORGANIZATIONS. 
(a) CONFERRING WITH URBAN INDIAN ORGANIZA-
TIONS.—Title V of the Indian Health Care Improvement 
Act (25 U.S.C. 1651 et seq.) (as amended by section 
101(b)) is amended by adding at the end the following: 
‘‘SEC. 514. CONFERRING WITH URBAN INDIAN ORGANIZA-
TIONS. 
‘‘(a) DEFINITION OF CONFER.—In this section, the 
term ‘confer’ means to engage in an open and free ex-
change of information and opinions that— 
‘‘(1) leads to mutual understanding and com-
prehension; and 
‘‘(2) emphasizes trust, respect, and shared re-
sponsibility. 
‘‘(b) REQUIREMENT.—The Secretary shall ensure 
that the Service confers, to the maximum extent prac-
ticable, with urban Indian organizations in carrying out 
this Act.’’. 
(b) CONTRACTS WITH, AND GRANTS TO, URBAN IN-
DIAN ORGANIZATIONS.—Section 502 of the Indian Health 
Care Improvement Act (25 U.S.C. 1652) is amended to 
read as follows: 
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‘‘SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN IN-
DIAN ORGANIZATIONS. 
‘‘(a) IN GENERAL.—Pursuant to the Act of Novem-
ber 2, 1921 (25 U.S.C. 13) (commonly known as the ‘Sny-
der Act’), the Secretary, acting through the Service, shall 
enter into contracts with, or make grants to, urban Indian 
organizations to assist the urban Indian organizations in 
the establishment and administration, within urban cen-
ters, of programs that meet the requirements of this title. 
‘‘(b) CONDITIONS.—Subject to section 506, the Sec-
retary, acting through the Service, shall include such con-
ditions as the Secretary considers necessary to effect the 
purpose of this title in any contract into which the Sec-
retary enters with, or in any grant the Secretary makes 
to, any urban Indian organization pursuant to this title.’’. 
SEC. 164. EXPANDED PROGRAM AUTHORITY FOR URBAN IN-
DIAN ORGANIZATIONS. 
Title V of the Indian Health Care Improvement Act 
(25 U.S.C. 1651 et seq.) (as amended by section 163(a)) 
is amended by adding at the end the following: 
‘‘SEC. 515. EXPANDED PROGRAM AUTHORITY FOR URBAN 
INDIAN ORGANIZATIONS. 
‘‘Notwithstanding any other provision of this Act, the 
Secretary, acting through the Service, is authorized to es-
tablish programs, including programs for awarding grants, 
for urban Indian organizations that are identical to any 
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programs established pursuant to sections 218, 702, and 
708(g).’’. 
SEC. 165. COMMUNITY HEALTH REPRESENTATIVES. 
Title V of the Indian Health Care Improvement Act 
(25 U.S.C. 1651 et seq.) (as amended by section 164) is 
amended by adding at the end the following: 
‘‘SEC. 516. 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 
Representative Program under section 107 in the provi-
sion of health care, health promotion, and disease preven-
tion services to urban Indians.’’. 
SEC. 166. USE OF FEDERAL GOVERNMENT FACILITIES AND 
SOURCES OF SUPPLY; HEALTH INFORMATION 
TECHNOLOGY. 
Title V of the Indian Health Care Improvement Act 
(25 U.S.C. 1651 et seq.) (as amended by section 165) is 
amended by adding at the end the following: 
‘‘SEC. 517. 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 
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the contract or grant, to use, in accordance with such 
terms and conditions for use and maintenance as are 
agreed on by the Secretary and the urban Indian organiza-
tions— 
‘‘(1) any existing facility under the jurisdiction 
of the Secretary; 
‘‘(2) all equipment contained in or pertaining to 
such an existing facility; and 
‘‘(3) any other personal property of the Federal 
Government under the jurisdiction of the Secretary. 
‘‘(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 Service or 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 personal or real property 
of the Federal Government for donation, subject to sub-
section (d), to an urban Indian organization that has en-
tered into a contract or received a grant pursuant to this 
title if the Secretary determines that the property is ap-
propriate for use by the urban Indian organization for 
purposes of the contract or grant. 
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‘‘(d) PRIORITY.—If the Secretary receives from an 
urban Indian organization or an Indian tribe or tribal or-
ganization a request for a specific item of personal or real 
property described in subsection (b) or (c), the Secretary 
shall give priority to the request for donation to the Indian 
tribe or tribal organization, if the Secretary receives the 
request from the Indian tribe or tribal organization before 
the earlier of— 
‘‘(1) the date on which the Secretary transfers 
title to the property to the urban Indian organiza-
tion; and 
‘‘(2) the date on which the Secretary transfers 
the property physically to the urban Indian organi-
zation. 
‘‘(e) EXECUTIVE AGENCY STATUS.—For purposes of 
section 501(a) of title 40, United States Code, an urban 
Indian organization that has entered into a contract or 
received a grant pursuant to this title may be considered 
to be an Executive agency in carrying out the contract 
or grant. 
‘‘SEC. 518. 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 
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of the Public Health Service Act (42 U.S.C. 300jj)), tele-
medicine services development, and related infrastruc-
ture.’’. 
Subtitle F—Organizational 
Improvements 
SEC. 171. ESTABLISHMENT OF THE INDIAN HEALTH SERV-
ICE AS AN AGENCY OF THE PUBLIC HEALTH 
SERVICE. 
Section 601 of the Indian Health Care Improvement 
Act (25 U.S.C. 1661) is amended to read as follows: 
‘‘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. 
‘‘(2) DIRECTOR.—The Service shall be adminis-
tered by a Director, who shall be appointed by the 
President, by and with the advice and consent of the 
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Senate. The Director 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, 2008, the term of 
service of the Director shall be 4 years. A Director 
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 Healthcare 
Improvement Act of 2011 shall serve as Director. 
‘‘(4) ADVOCACY AND CONSULTATION.—The po-
sition of Director is established to, in a manner con-
sistent with the government-to-government relation-
ship between the United States and Indian Tribes— 
‘‘(A) facilitate advocacy for the develop-
ment of appropriate Indian health policy; and 
‘‘(B) promote consultation on matters re-
lating to Indian health. 
‘‘(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 Director shall— 
‘‘(1) perform all functions that were, on the day 
before the date of enactment of the Indian 
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Healthcare Improvement Act of 2011, carried 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, including by ensuring that all agency di-
rectors, managers, and chief executive officers have 
appropriate and adequate training, experience, skill 
levels, knowledge, abilities, and education (including 
continuing training requirements) to competently 
fulfill the duties of the positions and the mission of 
the Service; 
‘‘(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.); 
‘‘(D) the Act of August 16, 1957 (42 
U.S.C. 2005 et seq.); and 
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‘‘(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) directly advise the Secretary concerning 
the development of all policy- and budget-related 
matters affecting Indian 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 
‘‘(10) perform such other functions as the Sec-
retary may designate. 
‘‘(d) AUTHORITY.— 
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‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director, shall have the authority— 
‘‘(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).’’. 
SEC. 172. OFFICE OF DIRECT SERVICE TRIBES. 
Title VI of the Indian Health Care Improvement Act 
(25 U.S.C. 1661 et seq.) (as amended by section 101(b)) 
is amended by adding at the end the following: 
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‘‘SEC. 603. OFFICE OF DIRECT SERVICE TRIBES. 
‘‘(a) ESTABLISHMENT.—There is established within 
the Service an office, to be known as the ‘Office of Direct 
Service Tribes’. 
‘‘(b) TREATMENT.—The Office of Direct Service 
Tribes shall be located in the Office of the Director. 
‘‘(c) DUTIES.—The Office of Direct Service Tribes 
shall be responsible for— 
‘‘(1) providing Service-wide leadership, guidance 
and support for direct service tribes to include stra-
tegic planning and program evaluation; 
‘‘(2) ensuring maximum flexibility to tribal 
health and related support systems for Indian bene-
ficiaries; 
‘‘(3) serving as the focal point for consultation 
and participation between direct service tribes and 
organizations and the Service in the development of 
Service policy; 
‘‘(4) holding no less than biannual consultations 
with direct service tribes in appropriate locations to 
gather information and aid in the development of 
health policy; and 
‘‘(5) directing a national program and providing 
leadership and advocacy in the development of 
health policy, program management, budget formu-
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lation, resource allocation, and delegation support 
for direct service tribes.’’. 
SEC. 173. NEVADA AREA OFFICE. 
Title VI of the Indian Health Care Improvement Act 
(25 U.S.C. 1661 et seq.) (as amended by section 172) is 
amended by adding at the end the following: 
‘‘SEC. 604. NEVADA AREA OFFICE. 
‘‘(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of this section, in a manner consistent 
with the tribal consultation policy of the Service, the Sec-
retary shall submit to Congress a plan describing the man-
ner and schedule by which an area office, separate and 
distinct from the Phoenix Area Office of the Service, can 
be established in the State of Nevada. 
‘‘(b) FAILURE TO SUBMIT PLAN.— 
‘‘(1) DEFINITION OF OPERATIONS FUNDS.—In 
this subsection, the term ‘operations funds’ means 
only the funds used for— 
‘‘(A) the administration of services, includ-
ing functional expenses such as overtime, per-
sonnel salaries, and associated benefits; or 
‘‘(B) related tasks that directly affect the 
operations described in subparagraph (A). 
‘‘(2) WITHHOLDING
OF
FUNDS.—If the Sec-
retary fails to submit a plan in accordance with sub-
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143 
section (a), the Secretary shall withhold the oper-
ations funds reserved for the Office of the Director, 
subject to the condition that the withholding shall 
not adversely impact the capacity of the Service to 
deliver health care services. 
‘‘(3) RESTORATION.—The operations funds 
withheld pursuant to paragraph (2) may be restored, 
at the discretion of the Secretary, to the Office of 
the Director on achievement by that Office of com-
pliance with this section.’’. 
Subtitle G—Behavioral Health 
Programs 
SEC. 181. BEHAVIORAL HEALTH PROGRAMS. 
Title VII of the Indian Health Care Improvement Act 
(25 U.S.C. 1665 et seq.) is amended to read as follows: 
‘‘TITLE VII—BEHAVIORAL 
HEALTH PROGRAMS 
‘‘Subtitle A—General Programs 
‘‘SEC. 701. DEFINITIONS. 
‘‘In this subtitle: 
‘‘(1) 
ALCOHOL-RELATED 
NEURODEVELOPMENTAL
DISORDERS; 
ARND.—The 
term ‘alcohol-related neurodevelopmental disorders’ 
or ‘ARND’ means, with a history of maternal alco-
hol consumption during pregnancy, central nervous 
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system abnormalities, which may range from minor 
intellectual deficits and developmental delays to 
mental retardation. ARND children may have behav-
ioral problems, learning disabilities, problems with 
executive functioning, and attention disorders. The 
neurological defects of ARND may be as severe as 
FAS, but facial anomalies and other physical char-
acteristics are not present in ARND, thus making 
diagnosis difficult. 
‘‘(2) ASSESSMENT.—The term ‘assessment’ 
means the systematic collection, analysis, and dis-
semination of information on health status, health 
needs, and health problems. 
‘‘(3) BEHAVIORAL HEALTH AFTERCARE.—The 
term ‘behavioral health aftercare’ includes those ac-
tivities and resources used to support recovery fol-
lowing inpatient, residential, intensive substance 
abuse, or mental health outpatient or outpatient 
treatment. The purpose is to help prevent or deal 
with relapse by ensuring that by the time a client or 
patient is discharged from a level of care, such as 
outpatient treatment, an aftercare plan has been de-
veloped with the client. An aftercare plan may use 
such resources as a community-based therapeutic 
group, transitional living facilities, a 12-step spon-
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sor, a local 12-step or other related support group, 
and other community-based providers. 
‘‘(4) DUAL DIAGNOSIS.—The term ‘dual diag-
nosis’ means coexisting substance abuse and mental 
illness conditions or diagnosis. Such clients are 
sometimes referred to as mentally ill chemical abus-
ers (MICAs). 
‘‘(5) 
FETAL
ALCOHOL
SPECTRUM
DIS-
ORDERS.— 
‘‘(A) IN GENERAL.—The term ‘fetal alco-
hol spectrum disorders’ includes a range of ef-
fects that can occur in an individual whose 
mother drank alcohol during pregnancy, includ-
ing physical, mental, behavioral, and/or learning 
disabilities with possible lifelong implications. 
‘‘(B) INCLUSIONS.—The term ‘fetal alcohol 
spectrum disorders’ may include— 
‘‘(i) fetal alcohol syndrome (FAS); 
‘‘(ii) partial fetal alcohol syndrome 
(partial FAS); 
‘‘(iii) 
alcohol-related 
birth 
defects 
(ARBD); and 
‘‘(iv) 
alcohol-related 
neurodevelopmental disorders (ARND). 
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‘‘(6) FAS OR FETAL ALCOHOL SYNDROME.— 
The term ‘FAS’ or ‘fetal alcohol syndrome’ means a 
syndrome in which, with a history of maternal alco-
hol consumption during pregnancy, the following cri-
teria are met: 
‘‘(A) Central nervous system involvement, 
such as mental retardation, developmental 
delay, intellectual deficit, microencephaly, or 
neurological abnormalities. 
‘‘(B) Craniofacial abnormalities with at 
least 2 of the following: 
‘‘(i) Microophthalmia. 
‘‘(ii) Short palpebral fissures. 
‘‘(iii) Poorly developed philtrum. 
‘‘(iv) Thin upper lip. 
‘‘(v) Flat nasal bridge. 
‘‘(vi) Short upturned nose. 
‘‘(C) Prenatal or postnatal growth delay. 
‘‘(7) REHABILITATION.—The term ‘rehabilita-
tion’ means medical and health care services that— 
‘‘(A) are recommended by a physician or 
licensed practitioner of the healing arts within 
the scope of their practice under applicable law; 
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‘‘(B) are furnished in a facility, home, or 
other setting in accordance with applicable 
standards; and 
‘‘(C) have as their purpose any of the fol-
lowing: 
‘‘(i) The maximum attainment of 
physical, mental, and developmental func-
tioning. 
‘‘(ii) Averting deterioration in physical 
or mental functional status. 
‘‘(iii) The maintenance of physical or 
mental health functional status. 
‘‘(8) SUBSTANCE ABUSE.—The term ‘substance 
abuse’ includes inhalant abuse. 
‘‘SEC. 702. 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, Indian tribes, and tribal or-
ganizations, to develop a comprehensive behavioral 
health prevention and treatment program which em-
phasizes collaboration among alcohol and substance 
abuse, social services, and mental health programs. 
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‘‘(2) To provide information, direction, and 
guidance relating to mental illness and dysfunction 
and self-destructive behavior, including child abuse 
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, im-
plement, and coordinate with community-based pro-
grams which include identification, prevention, edu-
cation, 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). 
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‘‘(b) PLANS.— 
‘‘(1) DEVELOPMENT.—The Secretary, acting 
through the Service, Indian tribes, and tribal organi-
zations, shall encourage Indian tribes and tribal or-
ganizations to develop tribal plans, and urban Indian 
organizations to develop local plans, and for all such 
groups to participate in developing areawide plans 
for Indian Behavioral Health Services. The plans 
shall include, to the extent 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 
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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 or-
ganizations, and urban Indian organizations to 
meet their responsibilities under the plans. 
‘‘(2) NATIONAL
CLEARINGHOUSE.—The Sec-
retary, acting through the Service, shall coordinate 
with existing national clearinghouses and informa-
tion centers to include at the clearinghouses and 
centers plans and reports on the outcomes of such 
plans developed by Indian tribes, tribal organiza-
tions, urban Indian organizations, and Service areas 
relating to behavioral health. The Secretary shall en-
sure access to these plans and outcomes by any In-
dian tribe, tribal organization, urban Indian organi-
zation, or the Service. 
‘‘(3) TECHNICAL ASSISTANCE.—The Secretary 
shall provide technical assistance to Indian tribes, 
tribal organizations, and urban Indian organizations 
in preparation of plans under this section and in de-
veloping standards of care that may be used and 
adopted locally. 
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‘‘(c) PROGRAMS.—The Secretary, acting through the 
Service, shall provide, to the extent feasible and if funding 
is available, programs including the following: 
‘‘(1) COMPREHENSIVE CARE.—A comprehensive 
continuum of behavioral health care which pro-
vides— 
‘‘(A) community-based prevention, inter-
vention, outpatient, and behavioral health 
aftercare; 
‘‘(B) detoxification (social and medical); 
‘‘(C) acute hospitalization; 
‘‘(D) intensive outpatient/day treatment; 
‘‘(E) residential treatment; 
‘‘(F) transitional living for those needing a 
temporary, stable living environment that is 
supportive of treatment and recovery goals; 
‘‘(G) emergency shelter; 
‘‘(H) intensive case management; 
‘‘(I) diagnostic services; and 
‘‘(J) promotion of healthy approaches to 
risk and safety issues, including injury preven-
tion. 
‘‘(2) CHILD CARE.—Behavioral health services 
for Indians from birth through age 17, including— 
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‘‘(A) preschool and school age fetal alcohol 
spectrum disorder services, including assess-
ment and behavioral intervention; 
‘‘(B) mental health and substance abuse 
services (emotional, organic, alcohol, drug, in-
halant, and tobacco); 
‘‘(C) identification and treatment of co-oc-
curring disorders and comorbidity; 
‘‘(D) prevention of alcohol, drug, inhalant, 
and tobacco use; 
‘‘(E) early intervention, treatment, and 
aftercare; 
‘‘(F) promotion of healthy approaches to 
risk and safety issues; and 
‘‘(G) identification and treatment of ne-
glect and physical, mental, and sexual abuse. 
‘‘(3) ADULT CARE.—Behavioral health services 
for Indians from age 18 through 55, including— 
‘‘(A) early intervention, treatment, and 
aftercare; 
‘‘(B) mental health and substance abuse 
services (emotional, alcohol, drug, inhalant, and 
tobacco), including sex specific services; 
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‘‘(C) identification and treatment of co-oc-
curring disorders (dual diagnosis) and comor-
bidity; 
‘‘(D) promotion of healthy approaches for 
risk-related behavior; 
‘‘(E) treatment services for women at risk 
of giving birth to a child with a fetal alcohol 
spectrum disorder; and 
‘‘(F) sex specific treatment for sexual as-
sault and domestic violence. 
‘‘(4) FAMILY CARE.—Behavioral health services 
for families, including— 
‘‘(A) early intervention, treatment, and 
aftercare for affected families; 
‘‘(B) treatment for sexual assault and do-
mestic violence; and 
‘‘(C) promotion of healthy approaches re-
lating to parenting, domestic violence, and other 
abuse issues. 
‘‘(5) ELDER CARE.—Behavioral health services 
for Indians 56 years of age and older, including— 
‘‘(A) early intervention, treatment, and 
aftercare; 
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‘‘(B) mental health and substance abuse 
services (emotional, alcohol, drug, inhalant, and 
tobacco), including sex specific services; 
‘‘(C) identification and treatment of co-oc-
curring disorders (dual diagnosis) and comor-
bidity; 
‘‘(D) promotion of healthy approaches to 
managing conditions related to aging; 
‘‘(E) sex specific treatment for sexual as-
sault, domestic violence, neglect, physical and 
mental abuse and exploitation; and 
‘‘(F) identification and treatment of de-
mentias regardless of cause. 
‘‘(d) COMMUNITY BEHAVIORAL HEALTH PLAN.— 
‘‘(1) ESTABLISHMENT.—The governing body of 
any Indian tribe, tribal organization, or urban In-
dian organization may adopt a resolution for the es-
tablishment of a community behavioral health plan 
providing for the identification and coordination of 
available resources and programs to identify, pre-
vent, or treat substance abuse, mental illness, or 
dysfunctional and self-destructive behavior, including 
child abuse and family violence, among its members 
or its service population. This plan should include 
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behavioral health services, social services, intensive 
outpatient services, and continuing aftercare. 
‘‘(2) TECHNICAL ASSISTANCE.—At the request 
of an Indian tribe, tribal organization, or urban In-
dian organization, the Bureau of Indian Affairs and 
the Service shall cooperate with and provide tech-
nical assistance to the Indian tribe, tribal organiza-
tion, or urban Indian organization in the develop-
ment and implementation of such plan. 
‘‘(3) FUNDING.—The Secretary, acting through 
the Service, Indian tribes, and tribal organizations, 
may make funding available to Indian tribes and 
tribal organizations which adopt a resolution pursu-
ant to paragraph (1) to obtain technical assistance 
for the development of a community behavioral 
health plan and to provide administrative support in 
the implementation of such plan. 
‘‘(e) COORDINATION FOR AVAILABILITY OF SERV-
ICES.—The Secretary, acting through the Service, shall 
coordinate behavioral health planning, to the extent fea-
sible, with other Federal agencies and with State agencies, 
to encourage comprehensive behavioral health services for 
Indians regardless of their place of residence. 
‘‘(f) MENTAL HEALTH CARE NEED ASSESSMENT.— 
Not later than 1 year after the date of enactment of the 
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Indian Healthcare Improvement Act of 2011, the Sec-
retary, acting through the Service, shall make an assess-
ment of the need for inpatient mental health care among 
Indians and the availability and cost of inpatient mental 
health facilities which can meet such need. In making such 
assessment, the Secretary shall consider the possible con-
version of existing, underused Service hospital beds into 
psychiatric units to meet such need. 
‘‘SEC. 703. MEMORANDA OF AGREEMENT WITH THE DE-
PARTMENT OF INTERIOR. 
‘‘(a) CONTENTS.—Not later than 1 year after the 
date of enactment of the Indian Healthcare Improvement 
Act of 2011, the Secretary, acting through the Service, 
and the Secretary of the Interior shall develop and enter 
into a memoranda of agreement, or review and update any 
existing memoranda of agreement, as required by section 
4205 of the Indian Alcohol and Substance Abuse Preven-
tion and Treatment Act of 1986 (25 U.S.C. 2411) under 
which the Secretaries address the following: 
‘‘(1) The scope and nature of mental illness and 
dysfunctional and self-destructive behavior, including 
child abuse and family violence, among Indians. 
‘‘(2) The existing Federal, tribal, State, local, 
and private services, resources, and programs avail-
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able to provide behavioral health services for Indi-
ans. 
‘‘(3) The unmet need for additional services, re-
sources, and programs necessary to meet the needs 
identified pursuant to paragraph (1). 
‘‘(4)(A) The right of Indians, as citizens of the 
United States and of the States in which they re-
side, to have access to behavioral health services to 
which all citizens have access. 
‘‘(B) The right of Indians to participate in, and 
receive the benefit of, such services. 
‘‘(C) The actions necessary to protect the exer-
cise of such right. 
‘‘(5) The responsibilities of the Bureau of In-
dian Affairs and the Service, including mental illness 
identification, prevention, education, referral, and 
treatment services (including services through multi-
disciplinary resource teams), at the central, area, 
and agency and Service unit, Service area, and head-
quarters levels to address the problems identified in 
paragraph (1). 
‘‘(6) A strategy for the comprehensive coordina-
tion of the behavioral health services provided by the 
Bureau of Indian Affairs and the Service to meet 
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the problems identified pursuant to paragraph (1), 
including— 
‘‘(A) the coordination of alcohol and sub-
stance abuse programs of the Service, the Bu-
reau of Indian Affairs, and Indian tribes and 
tribal organizations (developed under the Indian 
Alcohol and Substance Abuse Prevention and 
Treatment Act of 1986 (25 U.S.C. 2401 et 
seq.)) with behavioral health initiatives pursu-
ant to this Act, particularly with respect to the 
referral and treatment of dually diagnosed indi-
viduals requiring behavioral health and sub-
stance abuse treatment; and 
‘‘(B) ensuring that the Bureau of Indian 
Affairs and Service programs and services (in-
cluding multidisciplinary resource teams) ad-
dressing child abuse and family violence are co-
ordinated with such non-Federal programs and 
services. 
‘‘(7) Directing appropriate officials of the Bu-
reau of Indian Affairs and the Service, particularly 
at the agency and Service unit levels, to cooperate 
fully with tribal requests made pursuant to commu-
nity behavioral health plans adopted under section 
702(c) and section 4206 of the Indian Alcohol and 
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Substance Abuse Prevention and Treatment Act of 
1986 (25 U.S.C. 2412). 
‘‘(8) Providing for an annual review of such 
agreement by the Secretaries which shall be provided 
to Congress and Indian tribes and tribal organiza-
tions. 
‘‘(b) SPECIFIC PROVISIONS REQUIRED.—The memo-
randa of agreement updated or entered into pursuant to 
subsection (a) shall include specific provisions pursuant to 
which the Service shall assume responsibility for— 
‘‘(1) the determination of the scope of the prob-
lem of alcohol and substance abuse among Indians, 
including the number of Indians within the jurisdic-
tion of the Service who are directly or indirectly af-
fected by alcohol and substance abuse and the finan-
cial and human cost; 
‘‘(2) an assessment of the existing and needed 
resources necessary for the prevention of alcohol and 
substance abuse and the treatment of Indians af-
fected by alcohol and substance abuse; and 
‘‘(3) an estimate of the funding necessary to 
adequately support a program of prevention of alco-
hol and substance abuse and treatment of Indians 
affected by alcohol and substance abuse. 
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