1720 
applications for renewals of funding) under this section. 
Such criteria shall ensure that demonstration programs 
established under this section promote the development of 
the capacity of such entities to educate substance abuse 
counselors. 
‘‘(e) ASSISTANCE.—The Secretary shall provide such 
technical and other assistance as may be necessary to en-
able grant recipients to comply with the provisions of this 
section. 
‘‘(f) REPORT.—Each fiscal year, the Secretary shall 
submit to the President, for inclusion in the report which 
is required to be submitted under section 801 for that fis-
cal year, a report on the findings and conclusions derived 
from the demonstration programs conducted under this 
section during that fiscal year. 
‘‘(g) DEFINITION.—For the purposes of this section, 
the term ‘educational curriculum’ means 1 or more of the 
following: 
‘‘(1) Classroom education. 
‘‘(2) Clinical work experience. 
‘‘(3) Continuing education workshops. 
‘‘SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMU-
NITY EDUCATION PROGRAMS. 
‘‘(a) STUDY; LIST.—The Secretary, acting through 
the Service, and the Secretary of the Interior, in consulta-
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tion with Indian Tribes and Tribal Organizations, shall 
conduct a study and compile a list of the types of staff 
positions specified in subsection (b) whose qualifications 
include, or should include, training in the identification, 
prevention, education, referral, or treatment of mental ill-
ness, or dysfunctional and self-destructive behavior. 
‘‘(b) POSITIONS.—The positions referred to in sub-
section (a) are— 
‘‘(1) staff positions within the Bureau of Indian 
Affairs, including existing positions, in the fields 
of— 
‘‘(A) elementary and secondary education; 
‘‘(B) social services and family and child 
welfare; 
‘‘(C) law enforcement and judicial services; 
and 
‘‘(D) alcohol and substance abuse; 
‘‘(2) staff positions within the Service; and 
‘‘(3) staff positions similar to those identified in 
paragraphs (1) and (2) established and maintained 
by Indian Tribes, Tribal Organizations (without re-
gard to the funding source), and urban Indian orga-
nizations. 
‘‘(c) TRAINING CRITERIA.— 
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‘‘(1) IN GENERAL.—The appropriate Secretary 
shall provide training criteria appropriate to each 
type of position identified in subsection (b)(1) and 
(b)(2) and ensure that appropriate training has 
been, or shall be provided to any individual in any 
such position. With respect to any such individual in 
a position identified pursuant to subsection (b)(3), 
the respective Secretaries shall provide appropriate 
training to, or provide funds to, an Indian Tribe, 
Tribal Organization, or urban Indian organization 
for training of appropriate individuals. In the case of 
positions funded under a contract or compact under 
the Indian Self-Determination and Education Assist-
ance Act (25 U.S.C. 450 et seq.), the appropriate 
Secretary shall ensure that such training costs are 
included in the contract or compact, as the Sec-
retary determines necessary. 
‘‘(2) POSITION SPECIFIC TRAINING CRITERIA.— 
Position specific training criteria shall be culturally 
relevant to Indians and Indian Tribes and shall en-
sure that appropriate information regarding tradi-
tional health care practices is provided. 
‘‘(d) COMMUNITY EDUCATION
ON MENTAL ILL-
NESS.—The Service shall develop and implement, on re-
quest of an Indian Tribe, Tribal Organization, or urban 
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Indian organization, or assist the Indian Tribe, Tribal Or-
ganization, or urban Indian organization to develop and 
implement, a program of community education on mental 
illness. In carrying out this subsection, the Service shall, 
upon request of an Indian Tribe, Tribal Organization, or 
urban Indian organization, provide technical assistance to 
the Indian Tribe, Tribal Organization, or urban Indian or-
ganization to obtain and develop community educational 
materials on the identification, prevention, referral, and 
treatment of mental illness and dysfunctional and self-de-
structive behavior. 
‘‘(e) PLAN.—Not later than 90 days after the date 
of enactment of the Indian Health Care Improvement Act 
Amendments of 2009, the Secretary shall develop a plan 
under which the Service will increase the health care staff 
providing behavioral health services by at least 500 posi-
tions within 5 years after the date of enactment of this 
section, with at least 200 of such positions devoted to 
child, adolescent, and family services. The plan developed 
under this subsection shall be implemented under the Act 
of November 2, 1921 (25 U.S.C. 13) (commonly known 
as the ‘Snyder Act’). 
‘‘SEC. 127. EXEMPTION FROM PAYMENT OF CERTAIN FEES. 
‘‘Employees of a Tribal Health Program or an Urban 
Indian Organization shall be exempt from payment of li-
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censing, registration, and other fees imposed by a Federal 
agency to the same extent that Commissioned Corps Offi-
cers or other employees of the Indian Health Service are 
exempt from such fees. 
‘‘SEC. 128. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated such sums 
as may be necessary to carry out this title. 
‘‘TITLE II—HEALTH SERVICES 
‘‘SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. 
‘‘(a) USE OF FUNDS.—The Secretary, acting through 
the Service, is authorized to expend funds, directly or 
under the authority of the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.), which 
are appropriated under the authority of this section, for 
the purposes of— 
‘‘(1) eliminating the deficiencies in health sta-
tus and health resources of all Indian Tribes; 
‘‘(2) eliminating backlogs in the provision of 
health care services to Indians; 
‘‘(3) meeting the health needs of Indians in an 
efficient and equitable manner, including the use of 
telehealth and telemedicine when appropriate; 
‘‘(4) eliminating inequities in funding for both 
direct care and contract health service programs; 
and 
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‘‘(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 in accord-
ance with section 207. 
‘‘(C) Dental care. 
‘‘(D) Mental health, including community 
mental health services, inpatient mental health 
services, dormitory mental health services, 
therapeutic and residential treatment centers, 
and training of traditional health care practi-
tioners. 
‘‘(E) Emergency medical services. 
‘‘(F) Treatment and control of, and reha-
bilitative care related to, alcoholism and drug 
abuse (including fetal alcohol syndrome) among 
Indians. 
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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 section 3(2) are not being achieved; and 
‘‘(B) the Indian Tribe or Tribal Organiza-
tion does not have available to it the health re-
sources it needs, taking into account the actual 
cost of providing health care services given local 
geographic, climatic, rural, or other cir-
cumstances. 
‘‘(2) AVAILABLE RESOURCES.—The health re-
sources available to an Indian Tribe or Tribal Orga-
nization include health resources provided by the 
Service as well as health resources used by the In-
dian Tribe or Tribal Organization, including services 
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and financing systems provided by any Federal pro-
grams, private insurance, and programs of State or 
local governments. 
‘‘(3) PROCESS
FOR
REVIEW
OF
DETERMINA-
TIONS.—The Secretary shall establish procedures 
which allow any Indian Tribe or Tribal Organization 
to petition the Secretary for a review of any deter-
mination of the extent of the health status and re-
source deficiency of such Indian Tribe or Tribal Or-
ganization. 
‘‘(e) ELIGIBILITY FOR FUNDS.—Tribal Health Pro-
grams shall be eligible for funds appropriated under the 
authority of this section on an equal basis with programs 
that are administered directly by the Service. 
‘‘(f) REPORT.—By no later than the date that is 3 
years after the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2009, the Sec-
retary shall submit to Congress the current health status 
and resource deficiency report of the Service for each 
Service Unit, including newly recognized or acknowledged 
Indian Tribes. Such report shall set out— 
‘‘(1) the methodology then in use by the Service 
for determining Tribal health status and resource 
deficiencies, as well as the most recent application of 
that methodology; 
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‘‘(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 
‘‘(C) the number of Indians using the 
Service resources made available to each Service 
Unit, Indian Tribe or Tribal Organization, and, 
to the extent available, information on the wait-
ing lists and number of Indians turned away for 
services due to lack of resources. 
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‘‘(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 Organi-
zations. 
‘‘(i) FUNDING DESIGNATION.—Any funds appro-
priated under the authority of this section shall be des-
ignated as the ‘Indian Health Care Improvement Fund’. 
‘‘SEC. 202. HEALTH PROMOTION AND DISEASE PREVENTION 
SERVICES. 
‘‘(a) FINDINGS.—Congress finds that health pro-
motion and disease prevention activities— 
‘‘(1) improve the health and well-being of Indi-
ans; and 
‘‘(2) reduce the expenses for health care of In-
dians. 
‘‘(b) PROVISION OF SERVICES.—The Secretary, act-
ing through the Service, shall provide health promotion 
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and disease prevention services to Indians to achieve the 
health status objectives set forth in section 3(2). 
‘‘(c) EVALUATION.—The Secretary, after obtaining 
input from the affected Tribal Health Programs, shall 
submit to the President for inclusion in the report which 
is required to be submitted to Congress under section 801 
an evaluation of— 
‘‘(1) the health promotion and disease preven-
tion needs of Indians; 
‘‘(2) the health promotion and disease preven-
tion activities which would best meet such needs; 
‘‘(3) the internal capacity of the Service and 
Tribal Health Programs to meet such needs; and 
‘‘(4) the resources which would be required to 
enable the Service and Tribal Health Programs to 
undertake the health promotion and disease preven-
tion activities necessary to meet such needs. 
‘‘SEC. 203. DIABETES PREVENTION, TREATMENT, AND CON-
TROL. 
‘‘(a) DETERMINATIONS REGARDING DIABETES.— 
The Secretary, acting through the Service, and in con-
sultation with Indian Tribes and Tribal Organizations, 
shall determine— 
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‘‘(1) by Indian Tribe and by Service Unit, the 
incidence of, and the types of complications resulting 
from, diabetes among Indians; and 
‘‘(2) based on the determinations made pursu-
ant to paragraph (1), the measures (including pa-
tient education and effective ongoing monitoring of 
disease indicators) each Service Unit should take to 
reduce the incidence of, and prevent, treat, and con-
trol the complications resulting from, diabetes 
among Indian Tribes within that Service Unit. 
‘‘(b) DIABETES SCREENING.—To the extent medi-
cally indicated and with informed consent, the Secretary 
shall screen each Indian who receives services from the 
Service for diabetes and for conditions which indicate a 
high risk that the individual will become diabetic and es-
tablish a cost-effective approach to ensure ongoing moni-
toring of disease indicators. Such screening and moni-
toring may be conducted by a Tribal Health Program and 
may be conducted through appropriate Internet-based 
health care management programs. 
‘‘(c) DIABETES PROJECTS.—The Secretary shall con-
tinue to maintain each model diabetes project in existence 
on the date of enactment of the Indian Health Care Im-
provement Act Amendments of 2009. 
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‘‘(d) DIALYSIS PROGRAMS.—The Secretary is author-
ized to provide, through the Service, Indian Tribes, and 
Tribal Organizations, dialysis programs, including the 
purchase of dialysis equipment and the provision of nec-
essary staffing. 
‘‘(e) OTHER DUTIES OF THE SECRETARY.— 
‘‘(1) IN GENERAL.—The Secretary shall, to the 
extent funding is available— 
‘‘(A) in each Area Office, consult with In-
dian Tribes and Tribal Organizations regarding 
programs for the prevention, treatment, and 
control of diabetes; 
‘‘(B) establish in each Area Office a reg-
istry of patients with diabetes to track the inci-
dence of diabetes and the complications from 
diabetes in that area; and 
‘‘(C) ensure that data collected in each 
Area Office regarding diabetes and related com-
plications among Indians are disseminated to 
all other Area Offices, subject to applicable pa-
tient privacy laws. 
‘‘(2) DIABETES CONTROL OFFICERS.— 
‘‘(A) IN GENERAL.—The Secretary may es-
tablish and maintain in each Area Office a posi-
tion of diabetes control officer to coordinate and 
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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-
able to carry out such an activity, shall not be 
divisible for purposes of that Act. 
‘‘SEC. 204. SHARED SERVICES FOR LONG-TERM CARE. 
‘‘(a) LONG-TERM CARE.—Notwithstanding any other 
provision of law, the Secretary, acting through the Service, 
is authorized to provide directly, or enter into contracts 
or compacts under the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.) with 
Indian Tribes or Tribal Organizations for, the delivery of 
long-term care (including health care services associated 
with long-term care) provided in a facility to Indians. Such 
agreements shall provide for the sharing of staff or other 
services between the Service or a Tribal Health Program 
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and a long-term care or related facility owned and oper-
ated (directly or through a contract or compact under the 
Indian Self-Determination and Education Assistance Act 
(25 U.S.C. 450 et seq.)) by such Indian Tribe or Tribal 
Organization. 
‘‘(b) CONTENTS OF AGREEMENTS.—An agreement 
entered into pursuant to subsection (a)— 
‘‘(1) may, at the request of the Indian Tribe or 
Tribal Organization, delegate to such Indian Tribe 
or Tribal Organization such powers of supervision 
and control over Service employees as the Secretary 
deems necessary to carry out the purposes of this 
section; 
‘‘(2) shall provide that expenses (including sala-
ries) relating to services that are shared between the 
Service and the Tribal Health Program be allocated 
proportionately between the Service and the Indian 
Tribe or Tribal Organization; and 
‘‘(3) may authorize such Indian Tribe or Tribal 
Organization to construct, renovate, or expand a 
long-term care or other similar facility (including the 
construction of a facility attached to a Service facil-
ity). 
‘‘(c) MINIMUM REQUIREMENT.—Any nursing facility 
provided for under this section shall meet the require-
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ments for nursing facilities under section 1919 of the So-
cial Security Act. 
‘‘(d) OTHER ASSISTANCE.—The Secretary shall pro-
vide such technical and other assistance as may be nec-
essary to enable applicants to comply with the provisions 
of this section. 
‘‘(e) USE
OF EXISTING
OR UNDERUSED FACILI-
TIES.—The Secretary shall encourage the use of existing 
facilities that are underused or allow the use of swing beds 
for long-term or similar care. 
‘‘SEC. 205. HEALTH SERVICES RESEARCH. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Service, shall make funding available for research to 
further the performance of the health service responsibil-
ities of Indian Health Programs. 
‘‘(b) COORDINATION OF RESOURCES AND ACTIVI-
TIES.—The Secretary shall also, to the maximum extent 
practicable, coordinate departmental research resources 
and activities to address relevant Indian Health Program 
research needs. 
‘‘(c) AVAILABILITY.—Tribal Health Programs shall 
be given an equal opportunity to compete for, and receive, 
research funds under this section. 
‘‘(d) USE OF FUNDS.—This funding may be used for 
both clinical and nonclinical research. 
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‘‘(e) EVALUATION AND DISSEMINATION.—The Sec-
retary shall periodically— 
‘‘(1) evaluate the impact of research conducted 
under this section; and 
‘‘(2) disseminate to Tribal Health Programs in-
formation regarding that research as the Secretary 
determines to be appropriate. 
‘‘SEC. 206. MAMMOGRAPHY AND OTHER CANCER SCREEN-
ING. 
‘‘The Secretary, acting through the Service, shall pro-
vide for screening as follows: 
‘‘(1) Screening mammography (as defined in 
section 1861(jj) of the Social Security Act) for In-
dian women at a frequency appropriate to such 
women under accepted and appropriate national 
standards, and under such terms and conditions as 
are consistent with standards established by the Sec-
retary to ensure the safety and accuracy of screen-
ing mammography under part B of title XVIII of 
such Act. 
‘‘(2) Other cancer screening that receives an A 
or B rating as recommended by the United States 
Preventive Services Task Force established under 
section 915(a)(1) of the Public Health Service Act 
(42 U.S.C. 299b–4(a)(1)). The Secretary shall en-
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sure that screening provided for under this para-
graph complies with the recommendations of the 
Task Force with respect to— 
‘‘(A) frequency; 
‘‘(B) the population to be served; 
‘‘(C) the procedure or technology to be 
used; 
‘‘(D) evidence of effectiveness; and 
‘‘(E) other matters that the Secretary de-
termines appropriate. 
‘‘SEC. 207. PATIENT TRAVEL COSTS. 
‘‘(a) DEFINITION OF QUALIFIED ESCORT.—In this 
section, the term ‘qualified escort’ means— 
‘‘(1) an adult escort (including a parent, guard-
ian, or other family member) who is required be-
cause of the physical or mental condition, or age, of 
the applicable patient; 
‘‘(2) a health professional for the purpose of 
providing necessary medical care during travel by 
the applicable patient; or 
‘‘(3) other escorts, as the Secretary or applica-
ble Indian Health Program determines to be appro-
priate. 
‘‘(b) PROVISION OF FUNDS.—The Secretary, acting 
through the Service, is authorized to provide funds for the 
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following patient travel costs, including qualified escorts, 
associated with receiving health care services provided (ei-
ther through direct or contract care or through a contract 
or compact under the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.)) under this 
Act— 
‘‘(1) emergency air transportation and non- 
emergency air transportation where ground trans-
portation is infeasible; 
‘‘(2) transportation by private vehicle (where no 
other means of transportation is available), specially 
equipped vehicle, and ambulance; and 
‘‘(3) transportation by such other means as 
may be available and required when air or motor ve-
hicle transportation is not available. 
‘‘SEC. 208. EPIDEMIOLOGY CENTERS. 
‘‘(a) ESTABLISHMENT OF CENTERS.—The Secretary 
shall establish an epidemiology center in each Service Area 
to carry out the functions described in subsection (b). Any 
new center established after the date of enactment of the 
Indian Health Care Improvement Act Amendments of 
2008 may be operated under a grant authorized by sub-
section (d), but funding under such a grant shall not be 
divisible. 
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‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 
and upon the request of Indian Tribes, Tribal Organiza-
tions, and Urban Indian communities, each Service Area 
epidemiology center established under this section shall, 
with respect to such Service Area— 
‘‘(1) collect data relating to, and monitor 
progress made toward meeting, each of the health 
status objectives of the Service, the Indian Tribes, 
Tribal Organizations, and Urban Indian commu-
nities in the Service Area; 
‘‘(2) evaluate existing delivery systems, data 
systems, and other systems that impact the improve-
ment of Indian health; 
‘‘(3) assist Indian Tribes, Tribal Organizations, 
and Urban Indian Organizations in identifying their 
highest priority health status objectives and the 
services needed to achieve such objectives, based on 
epidemiological data; 
‘‘(4) make recommendations for the targeting 
of services needed by the populations served; 
‘‘(5) make recommendations to improve health 
care delivery systems for Indians and Urban Indi-
ans; 
‘‘(6) provide requested technical assistance to 
Indian Tribes, Tribal Organizations, and Urban In-
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dian 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 the re-
quirements of this section. 
‘‘(d) GRANTS FOR STUDIES.— 
‘‘(1) IN GENERAL.—The Secretary may make 
grants to Indian Tribes, Tribal Organizations, In-
dian organizations, and eligible intertribal consortia 
to conduct epidemiological studies of Indian commu-
nities. 
‘‘(2) ELIGIBLE INTERTRIBAL CONSORTIA.—An 
intertribal consortium or Indian organization is eligi-
ble to receive a grant under this subsection if— 
‘‘(A) the intertribal consortium is incor-
porated for the primary purpose of improving 
Indian health; and 
‘‘(B) the intertribal consortium is rep-
resentative of the Indian Tribes or urban In-
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dian communities in which the intertribal con-
sortium 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 awarded under 
paragraph (1) may be used— 
‘‘(A) to carry out the functions described 
in subsection (b); 
‘‘(B) to provide information to and consult 
with tribal leaders, urban Indian community 
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leaders, and related health staff on health care 
and health service management issues; and 
‘‘(C) in collaboration with Indian Tribes, 
Tribal Organizations, and urban Indian com-
munities, to provide the Service with informa-
tion regarding ways to improve the health sta-
tus of Indians. 
‘‘(e) ACCESS TO INFORMATION.— 
‘‘(1) An epidemiology center operated by a 
grantee pursuant to a grant awarded under sub-
section (d) shall be treated as a public health au-
thority for purposes of the Health Insurance Port-
ability and Accountability Act of 1996, as such enti-
ties are defined in part 164.501 of title 45, Code of 
Federal Regulations. 
‘‘(2) The Secretary shall grant to such epidemi-
ology center access to use of the data, data sets, 
monitoring systems, delivery systems, and other pro-
tected health information in the possession of the 
Secretary. 
‘‘(3) The activities of such an epidemiology cen-
ter shall be for the purposes of research and for pre-
venting and controlling disease, injury, or disability 
for purposes of the Health Insurance Portability and 
Accountability Act of 1996 (Public Law 104–191; 
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110 Stat. 2033), as such activities are described in 
part 164.512 of title 45, Code of Federal Regula-
tions (or a successor regulation). 
‘‘(f) FUNDS NOT DIVISIBLE.—An epidemiology cen-
ter established under this section shall be subject to the 
provisions of the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.), but the 
funds for such center shall not be divisible. 
‘‘SEC. 209. COMPREHENSIVE SCHOOL HEALTH EDUCATION 
PROGRAMS. 
‘‘(a) FUNDING FOR DEVELOPMENT OF PROGRAMS.— 
In addition to carrying out any other program for health 
promotion or disease prevention, the Secretary, acting 
through the Service, is authorized to award grants to In-
dian Tribes and Tribal Organizations to develop com-
prehensive school health education programs for children 
from pre-school through grade 12 in schools for the benefit 
of Indian children. 
‘‘(b) USE
OF GRANT FUNDS.—A grant awarded 
under this section may be used for purposes which may 
include, but are not limited to, the following: 
‘‘(1) Developing health education materials both 
for regular school programs and afterschool pro-
grams. 
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‘‘(2) Training teachers in comprehensive school 
health education materials. 
‘‘(3) 
Integrating 
school-based, 
community- 
based, and other public and private health promotion 
efforts. 
‘‘(4) Encouraging healthy, tobacco-free school 
environments. 
‘‘(5) Coordinating school-based health programs 
with existing services and programs available in the 
community. 
‘‘(6) Developing school programs on nutrition 
education, personal health, oral health, and fitness. 
‘‘(7) Developing behavioral health wellness pro-
grams. 
‘‘(8) Developing chronic disease prevention pro-
grams. 
‘‘(9) Developing substance abuse prevention 
programs. 
‘‘(10) Developing injury prevention and safety 
education programs. 
‘‘(11) Developing activities for the prevention 
and control of communicable diseases. 
‘‘(12) Developing community and environmental 
health education programs that include traditional 
health care practitioners. 
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‘‘(13) Violence prevention. 
‘‘(14) Such other health issues as are appro-
priate. 
‘‘(c) TECHNICAL ASSISTANCE.—Upon request, the 
Secretary, acting through the Service, shall provide tech-
nical assistance to Indian Tribes and Tribal Organizations 
in the development of comprehensive health education 
plans and the dissemination of comprehensive health edu-
cation materials and information on existing health pro-
grams and resources. 
‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP-
PLICATIONS.—The Secretary, acting through the Service, 
and in consultation with Indian Tribes and Tribal Organi-
zations, shall establish criteria for the review and approval 
of applications for grants awarded under this section. 
‘‘(e) DEVELOPMENT OF PROGRAM FOR BIA-FUNDED 
SCHOOLS.— 
‘‘(1) IN GENERAL.—The Secretary of the Inte-
rior, acting through the Bureau of Indian Affairs 
and in cooperation with the Secretary, acting 
through the Service, shall develop a comprehensive 
school health education program for children from 
preschool through grade 12 in schools for which sup-
port is provided by the Bureau of Indian Affairs. 
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‘‘(2) REQUIREMENTS
FOR
PROGRAMS.—Such 
programs shall include— 
‘‘(A) school programs on nutrition edu-
cation, personal health, oral health, and fitness; 
‘‘(B) behavioral health wellness programs; 
‘‘(C) chronic disease prevention programs; 
‘‘(D) substance abuse prevention pro-
grams; 
‘‘(E) injury prevention and safety edu-
cation programs; and 
‘‘(F) activities for the prevention and con-
trol of communicable diseases. 
‘‘(3) DUTIES OF THE SECRETARY.—The Sec-
retary of the Interior shall— 
‘‘(A) provide training to teachers in com-
prehensive school health education materials; 
‘‘(B) ensure the integration and coordina-
tion of school-based programs with existing 
services and health programs available in the 
community; and 
‘‘(C) encourage healthy, tobacco-free school 
environments. 
‘‘SEC. 210. INDIAN YOUTH PROGRAM. 
‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 
through the Service, is authorized to establish and admin-
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ister a program to provide grants to Indian Tribes, Tribal 
Organizations, and urban Indian organizations for innova-
tive mental and physical disease prevention and health 
promotion and treatment programs for Indian and urban 
Indian preadolescent and adolescent youths. 
‘‘(b) USE OF FUNDS.— 
‘‘(1) ALLOWABLE USES.—Funds made available 
under this section may be used to— 
‘‘(A) develop prevention and treatment 
programs for Indian youth which promote men-
tal and physical health and incorporate cultural 
values, community and family involvement, and 
traditional health care practitioners; and 
‘‘(B) develop and provide community train-
ing and education. 
‘‘(2) PROHIBITED USE.—Funds made available 
under this section may not be used to provide serv-
ices described in section 707(c). 
‘‘(c) DUTIES OF THE SECRETARY.—The Secretary 
shall— 
‘‘(1) disseminate to Indian Tribes, Tribal Orga-
nizations, and urban Indian organizations informa-
tion regarding models for the delivery of comprehen-
sive health care services to Indian and urban Indian 
adolescents; 
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‘‘(2) encourage the implementation of such 
models; and 
‘‘(3) at the request of an Indian Tribe, Tribal 
Organization, or urban Indian organization, provide 
technical assistance in the implementation of such 
models. 
‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF AP-
PLICATIONS.—The Secretary, in consultation with Indian 
Tribes, Tribal Organizations, and urban Indian organiza-
tions, shall establish criteria for the review and approval 
of applications or proposals under this section. 
‘‘SEC. 211. PREVENTION, CONTROL, AND ELIMINATION OF 
COMMUNICABLE AND INFECTIOUS DISEASES. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 
through the Service, and after consultation with the Cen-
ters for Disease Control and Prevention, may make grants 
available to Indian Tribes, Tribal Organizations, and 
urban Indian organizations for the following: 
‘‘(1) Projects for the prevention, control, and 
elimination of communicable and infectious diseases, 
including tuberculosis, hepatitis, HIV, respiratory 
syncytial virus, hanta virus, sexually transmitted dis-
eases, and H. Pylori. 
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‘‘(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, Tribal Organizations, and urban Indian orga-
nizations receiving funding under this section are encour-
aged to coordinate their activities with the Centers for 
Disease Control and Prevention and State and local health 
agencies. 
‘‘(d) TECHNICAL ASSISTANCE; REPORT.—In carrying 
out this section, the Secretary— 
‘‘(1) may, at the request of an Indian Tribe, 
Tribal Organization, or urban Indian organization, 
provide technical assistance; and 
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‘‘(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. 212. OTHER AUTHORITY FOR PROVISION OF SERV-
ICES. 
‘‘(a) FUNDING AUTHORIZED.—The Secretary may 
provide funding under this Act to meet the objectives set 
forth in section 3 of this Act through health care-related 
services and programs of the Service, Indian Tribes, and 
Tribal Organizations not otherwise described in this Act 
for the following services: 
‘‘(1) Hospice care. 
‘‘(2) Assisted living services. 
‘‘(3) Long-term care services. 
‘‘(4) Home- and community-based services. 
‘‘(b) ELIGIBILITY.—The following individuals shall be 
eligible to receive long-term care under this section: 
‘‘(1) Individuals who are unable to perform a 
certain number of activities of daily living without 
assistance. 
‘‘(2) Individuals with a mental impairment, 
such as dementia, Alzheimer’s disease, or another 
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disabling mental illness, who may be able to perform 
activities of daily living under supervision. 
‘‘(3) Such other individuals as an applicable In-
dian Health Program determines to be appropriate. 
‘‘(c) DEFINITIONS.—For the purposes of this section, 
the following definitions shall apply: 
‘‘(1) The term ‘assisted living services’ means 
any service provided by an assisted living facility (as 
defined in section 232(b) of the National Housing 
Act (12 U.S.C. 1715w(b))), except that such an as-
sisted living facility— 
‘‘(A) shall not be required to obtain a li-
cense; but 
‘‘(B) shall meet all applicable standards 
for licensure. 
‘‘(2) The term ‘home- and community-based 
services’ means 1 or more of the services specified 
in paragraphs (1) through (9) of section 1929(a) of 
the Social Security Act (42 U.S.C. 1396t(a)) 
(whether provided by the Service or by an Indian 
Tribe or Tribal Organization pursuant to the Indian 
Self-Determination and Education Assistance Act 
(25 U.S.C. 450 et seq.)) that are or will be provided 
in accordance with applicable standards. 
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‘‘(3) The term ‘hospice care’ means the items 
and services specified in subparagraphs (A) through 
(H) of section 1861(dd)(1) of the Social Security 
Act (42 U.S.C. 1395x(dd)(1)), and such other serv-
ices which an Indian Tribe or Tribal Organization 
determines are necessary and appropriate to provide 
in furtherance of this care. 
‘‘(4) The term ‘long-term care services’ has the 
meaning given the term ‘qualified long-term care 
services’ in section 7702B(c) of the Internal Rev-
enue Code of 1986. 
‘‘(d) AUTHORIZATION OF CONVENIENT CARE SERV-
ICES.—The Secretary, acting through the Service, Indian 
Tribes, and Tribal Organizations, may also provide fund-
ing under this Act to meet the objectives set forth in sec-
tion 3 of this Act for convenient care services programs 
pursuant to section 306(c)(2)(A). 
‘‘SEC. 213. INDIAN WOMEN’S HEALTH CARE. 
‘‘The Secretary, acting through the Service and In-
dian Tribes, Tribal Organizations, and Urban Indian Or-
ganizations, shall monitor and improve the quality of 
health care for Indian women of all ages through the plan-
ning and delivery of programs administered by the Service, 
in order to improve and enhance the treatment models of 
care for Indian women. 
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‘‘SEC. 214. ENVIRONMENTAL AND NUCLEAR HEALTH HAZ-
ARDS. 
‘‘(a) STUDIES
AND MONITORING.—The Secretary 
and the Service shall conduct, in conjunction with other 
appropriate Federal agencies and in consultation with con-
cerned Indian Tribes and Tribal Organizations, studies 
and ongoing monitoring programs to determine trends in 
the health hazards to Indian miners and to Indians on 
or near reservations and Indian communities as a result 
of environmental hazards which may result in chronic or 
life threatening health problems, such as nuclear resource 
development, petroleum contamination, and contamination 
of water source and of the food chain. Such studies shall 
include— 
‘‘(1) an evaluation of the nature and extent of 
health problems caused by environmental hazards 
currently exhibited among Indians and the causes of 
such health problems; 
‘‘(2) an analysis of the potential effect of ongo-
ing and future environmental resource development 
on or near reservations and Indian communities, in-
cluding the cumulative effect over time on health; 
‘‘(3) an evaluation of the types and nature of 
activities, practices, and conditions causing or affect-
ing such health problems, including uranium mining 
and milling, uranium mine tailing deposits, nuclear 
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power plant operation and construction, and nuclear 
waste disposal; oil and gas production or transpor-
tation on or near reservations or Indian commu-
nities; and other development that could affect the 
health of Indians and their water supply and food 
chain; 
‘‘(4) a summary of any findings and rec-
ommendations provided in Federal and State stud-
ies, reports, investigations, and inspections during 
the 5 years prior to the date of enactment of the In-
dian Health Care Improvement Act Amendments of 
2009 that directly or indirectly relate to the activi-
ties, practices, and conditions affecting the health or 
safety of such Indians; and 
‘‘(5) the efforts that have been made by Federal 
and State agencies and resource and economic devel-
opment companies to effectively carry out an edu-
cation program for such Indians regarding the 
health and safety hazards of such development. 
‘‘(b) HEALTH CARE PLANS.—Upon completion of 
such studies, the Secretary and the Service shall take into 
account the results of such studies and develop health care 
plans to address the health problems studied under sub-
section (a). The plans shall include— 
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‘‘(1) methods for diagnosing and treating Indi-
ans currently exhibiting such health problems; 
‘‘(2) preventive care and testing for Indians 
who may be exposed to such health hazards, includ-
ing the monitoring of the health of individuals who 
have or may have been exposed to excessive amounts 
of radiation or affected by other activities that have 
had or could have a serious impact upon the health 
of such individuals; and 
‘‘(3) a program of education for Indians who, 
by reason of their work or geographic proximity to 
such nuclear or other development activities, may ex-
perience health problems. 
‘‘(c) SUBMISSION OF REPORT AND PLAN TO CON-
GRESS.—The Secretary and the Service shall submit to 
Congress the study prepared under subsection (a) no later 
than 18 months after the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2009. The 
health care plan prepared under subsection (b) shall be 
submitted in a report no later than 1 year after the study 
prepared under subsection (a) is submitted to Congress. 
Such report shall include recommended activities for the 
implementation of the plan, as well as an evaluation of 
any activities previously undertaken by the Service to ad-
dress such health problems. 
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‘‘(d) INTERGOVERNMENTAL TASK FORCE.— 
‘‘(1) ESTABLISHMENT; MEMBERS.—There is es-
tablished an Intergovernmental Task Force to be 
composed of the following individuals (or their des-
ignees): 
‘‘(A) The Secretary of Energy. 
‘‘(B) The Secretary of the Environmental 
Protection Agency. 
‘‘(C) The Director of the Bureau of Mines. 
‘‘(D) The Assistant Secretary for Occupa-
tional Safety and Health. 
‘‘(E) The Secretary of the Interior. 
‘‘(F) The Secretary of Health and Human 
Services. 
‘‘(G) The Director of the Indian Health 
Service. 
‘‘(2) DUTIES.—The Task Force shall— 
‘‘(A) identify existing and potential oper-
ations related to nuclear resource development 
or other environmental hazards that affect or 
may affect the health of Indians on or near a 
reservation or in an Indian community; and 
‘‘(B) enter into activities to correct exist-
ing health hazards and ensure that current and 
future health problems resulting from nuclear 
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resource or other development activities are 
minimized or reduced. 
‘‘(3) CHAIRMAN; MEETINGS.—The Secretary of 
Health and Human Services shall be the Chairman 
of the Task Force. The Task Force shall meet at 
least twice each year. 
‘‘(e) HEALTH SERVICES TO CERTAIN EMPLOYEES.— 
In the case of any Indian who— 
‘‘(1) as a result of employment in or near a 
uranium mine or mill or near any other environ-
mental hazard, suffers from a work-related illness or 
condition; 
‘‘(2) is eligible to receive diagnosis and treat-
ment services from an Indian Health Program; and 
‘‘(3) by reason of such Indian’s employment, is 
entitled to medical care at the expense of such mine 
or mill operator or entity responsible for the environ-
mental hazard, the Indian Health Program shall, at 
the request of such Indian, render appropriate med-
ical care to such Indian for such illness or condition 
and may be reimbursed for any medical care so ren-
dered to which such Indian is entitled at the expense 
of such operator or entity from such operator or en-
tity. Nothing in this subsection shall affect the 
rights of such Indian to recover damages other than 
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such amounts paid to the Indian Health Program 
from the employer for providing medical care for 
such illness or condition. 
‘‘SEC. 215. ARIZONA AS A CONTRACT HEALTH SERVICE DE-
LIVERY AREA. 
‘‘(a) IN GENERAL.—For fiscal years beginning with 
the fiscal year ending September 30, 1983, and ending 
with the fiscal year ending September 30, 2025, the State 
of Arizona shall be designated as a contract health service 
delivery area by the Service for the purpose of providing 
contract health care services to members of federally rec-
ognized Indian Tribes of Arizona. 
‘‘(b) MAINTENANCE
OF
SERVICES.—The Service 
shall not curtail any health care services provided to Indi-
ans residing on reservations in the State of Arizona if such 
curtailment is due to the provision of contract services in 
such State pursuant to the designation of such State as 
a contract health service delivery area pursuant to sub-
section (a). 
‘‘SEC. 216. NORTH DAKOTA AND SOUTH DAKOTA AS CON-
TRACT HEALTH SERVICE DELIVERY AREA. 
‘‘(a) IN GENERAL.—Beginning in fiscal year 2003, 
the States of North Dakota and South Dakota shall be 
designated as a contract health service delivery area by 
the Service for the purpose of providing contract health 
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care services to members of federally recognized Indian 
Tribes of North Dakota and South Dakota. 
‘‘(b) LIMITATION.—The Service shall not curtail any 
health care services provided to Indians residing on any 
reservation, or in any county that has a common boundary 
with any reservation, in the State of North Dakota or 
South Dakota if such curtailment is due to the provision 
of contract services in such States pursuant to the des-
ignation of such States as a contract health service deliv-
ery area pursuant to subsection (a). 
‘‘SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES PRO-
GRAM. 
‘‘(a) FUNDING AUTHORIZED.—The Secretary is au-
thorized to fund a program using the California Rural In-
dian Health Board (hereafter in this section referred to 
as the ‘CRIHB’) as a contract care intermediary to im-
prove the accessibility of health services to California Indi-
ans. 
‘‘(b) REIMBURSEMENT CONTRACT.—The Secretary 
shall enter into an agreement with the CRIHB to reim-
burse the CRIHB for costs (including reasonable adminis-
trative costs) incurred pursuant to this section, in pro-
viding medical treatment under contract to California In-
dians described in section 805(a) throughout the Cali-
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fornia contract health services delivery area described in 
section 219 with respect to high cost contract care cases. 
‘‘(c) ADMINISTRATIVE EXPENSES.—Not more than 5 
percent of the amounts provided to the CRIHB under this 
section for any fiscal year may be for reimbursement for 
administrative expenses incurred by the CRIHB during 
such fiscal year. 
‘‘(d) LIMITATION ON PAYMENT.—No payment may 
be made for treatment provided hereunder to the extent 
payment may be made for such treatment under the In-
dian Catastrophic Health Emergency Fund described in 
section 202 or from amounts appropriated or otherwise 
made available to the California contract health service de-
livery area for a fiscal year. 
‘‘(e) ADVISORY BOARD.—There is established an ad-
visory board which shall advise the CRIHB in carrying 
out this section. The advisory board shall be composed of 
representatives, selected by the CRIHB, from not less 
than 8 Tribal Health Programs serving California Indians 
covered under this section at least 1⁄2 of whom of whom 
are not affiliated with the CRIHB. 
‘‘SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE 
DELIVERY AREA. 
‘‘The State of California, excluding the counties of 
Alameda, Contra Costa, Los Angeles, Marin, Orange, Sac-
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ramento, San Francisco, San Mateo, Santa Clara, Kern, 
Merced, Monterey, Napa, San Benito, San Joaquin, San 
Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ven-
tura, shall be designated as a contract health service deliv-
ery area by the Service for the purpose of providing con-
tract health services to California Indians. However, any 
of the counties listed herein may only be included in the 
contract health services delivery area if funding is specifi-
cally provided by the Service for such services in those 
counties. 
‘‘SEC. 219. CONTRACT HEALTH SERVICES FOR THE TREN-
TON SERVICE AREA. 
‘‘(a) AUTHORIZATION
FOR SERVICES.—The Sec-
retary, acting through the Service, is directed to provide 
contract health services to members of the Turtle Moun-
tain Band of Chippewa Indians that reside in the Trenton 
Service Area of Divide, McKenzie, and Williams counties 
in the State of North Dakota and the adjoining counties 
of Richland, Roosevelt, and Sheridan in the State of Mon-
tana. 
‘‘(b) NO EXPANSION OF ELIGIBILITY.—Nothing in 
this section may be construed as expanding the eligibility 
of members of the Turtle Mountain Band of Chippewa In-
dians for health services provided by the Service beyond 
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the scope of eligibility for such health services that applied 
on May 1, 1986. 
‘‘SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND 
TRIBAL ORGANIZATIONS. 
‘‘The Service shall provide funds for health care pro-
grams, functions, services, activities, information tech-
nology, and facilities operated by Tribal Health Programs 
on the same basis as such funds are provided to programs, 
functions, services, activities, information technology, and 
facilities operated directly by the Service. 
‘‘SEC. 221. LICENSING. 
‘‘Licensed health care professionals employed by a 
Tribal Health Program shall, if licensed in any State, be 
exempt from the licensing requirements of the State in 
which the Tribal Health Program performs the services 
described in its contract or compact under the Indian Self- 
Determination and Education Assistance Act (25 U.S.C. 
450 et seq.) while performing such services. 
‘‘SEC. 222. NOTIFICATION OF PROVISION OF EMERGENCY 
CONTRACT HEALTH SERVICES. 
‘‘With respect to an elderly Indian or an Indian with 
a disability receiving emergency medical care or services 
from a non-Service provider or in a non-Service facility 
under the authority of this Act, the time limitation (as 
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a condition of payment) for notifying the Service of such 
treatment or admission shall be 30 days. 
‘‘SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS. 
‘‘(a) DEADLINE FOR RESPONSE.—The Service shall 
respond to a notification of a claim by a provider of a 
contract care service with either an individual purchase 
order or a denial of the claim within 5 working days after 
the receipt of such notification. 
‘‘(b) EFFECT
OF UNTIMELY RESPONSE.—If the 
Service fails to respond to a notification of a claim in ac-
cordance with subsection (a), the Service shall accept as 
valid the claim submitted by the provider of a contract 
care service. 
‘‘(c) DEADLINE FOR PAYMENT OF VALID CLAIM.— 
The Service shall pay a valid contract care service claim 
within 30 days after the completion of the claim. 
‘‘SEC. 224. LIABILITY FOR PAYMENT. 
‘‘(a) NO PATIENT LIABILITY.—A patient who re-
ceives contract health care services that are authorized by 
the Service shall not be liable for the payment of any 
charges or costs associated with the provision of such serv-
ices. 
‘‘(b) NOTIFICATION.—The Secretary shall notify a 
contract care provider and any patient who receives con-
tract health care services authorized by the Service that 
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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 224(b), the provider shall 
have no further recourse against the patient who received 
the services. 
‘‘SEC. 225. OFFICE OF INDIAN MEN’S HEALTH. 
‘‘(a) ESTABLISHMENT.—The Secretary may establish 
within the Service an office to be known as the ‘Office 
of Indian Men’s Health’ (referred to in this section as the 
‘Office’). 
‘‘(b) DIRECTOR.— 
‘‘(1) IN GENERAL.—The Office shall be headed 
by a director, to be appointed by the Secretary. 
‘‘(2) DUTIES.—The director shall coordinate 
and promote the status of the health of Indian men 
in the United States. 
‘‘(c) REPORT.—Not later than 2 years after the date 
of enactment of the Indian Health Care Improvement Act 
Amendments of 2009, the Secretary, acting through the 
director of the Office, shall submit to Congress a report 
describing— 
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‘‘(1) any activity carried out by the director as 
of the date on which the report is prepared; and 
‘‘(2) any finding of the director with respect to 
the health of Indian men. 
‘‘SEC. 226. CATASTROPHIC HEALTH EMERGENCY FUND. 
‘‘(a) ESTABLISHMENT.—There is established an In-
dian Catastrophic Health Emergency Fund (hereafter in 
this section referred to as the ‘CHEF’) consisting of— 
‘‘(1) the amounts deposited under subsection 
(f); and 
‘‘(2) the amounts appropriated to CHEF under 
this section. 
‘‘(b) ADMINISTRATION.—CHEF shall be adminis-
tered by the Secretary, acting through the headquarters 
of the Service, solely for the purpose of meeting the ex-
traordinary medical costs associated with the treatment of 
victims of disasters or catastrophic illnesses who are with-
in the responsibility of the Service. 
‘‘(c) CONDITIONS ON USE OF FUND.—No part of 
CHEF or its administration shall be subject to contract 
or grant under any law, including the Indian Self-Deter-
mination and Education Assistance Act (25 U.S.C. 450 
et seq.), nor shall CHEF funds be allocated, apportioned, 
or delegated on an Area Office, Service Unit, or other 
similar basis. 
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‘‘(d) REGULATIONS.—The Secretary shall promul-
gate regulations consistent with the provisions of this sec-
tion to— 
‘‘(1) establish a definition of disasters and cata-
strophic illnesses for which the cost of the treatment 
provided under contract would qualify for payment 
from CHEF; 
‘‘(2) provide that a Service Unit shall not be el-
igible for reimbursement for the cost of treatment 
from CHEF until its cost of treating any victim of 
such catastrophic illness or disaster has reached a 
certain threshold cost which the Secretary shall es-
tablish at— 
‘‘(A) the 2000 level of $19,000; and 
‘‘(B) for any subsequent year, not less 
than the threshold cost of the previous year in-
creased by the percentage increase in the med-
ical care expenditure category of the consumer 
price index for all urban consumers (United 
States city average) for the 12-month period 
ending with December of the previous year; 
‘‘(3) establish a procedure for the reimburse-
ment of the portion of the costs that exceeds such 
threshold cost incurred by— 
‘‘(A) Service Units; or 
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‘‘(B) whenever otherwise authorized by the 
Service, non-Service facilities or providers; 
‘‘(4) establish a procedure for payment from 
CHEF in cases in which the exigencies of the med-
ical circumstances warrant treatment prior to the 
authorization of such treatment by the Service; and 
‘‘(5) establish a procedure that will ensure that 
no payment shall be made from CHEF to any pro-
vider of treatment to the extent that such provider 
is eligible to receive payment for the treatment from 
any other Federal, State, local, or private source of 
reimbursement for which the patient is eligible. 
‘‘(e) NO OFFSET OR LIMITATION.—Amounts appro-
priated to CHEF under this section shall not be used to 
offset or limit appropriations made to the Service under 
the authority of the Act of November 2, 1921 (25 U.S.C. 
13) (commonly known as the ‘Snyder Act’), or any other 
law. 
‘‘(f) DEPOSIT OF REIMBURSEMENT FUNDS.—There 
shall be deposited into CHEF all reimbursements to which 
the Service is entitled from any Federal, State, local, or 
private source (including third party insurance) by reason 
of treatment rendered to any victim of a disaster or cata-
strophic illness the cost of which was paid from CHEF. 
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‘‘SEC. 227. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated such sums 
as may be necessary to carry out this title. 
‘‘TITLE III—FACILITIES 
‘‘SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVA-
TION OF FACILITIES; REPORTS. 
‘‘(a) 
PREREQUISITES
FOR
EXPENDITURE
OF 
FUNDS.—Prior to the expenditure of, or the making of 
any binding commitment to expend, any funds appro-
priated for the planning, design, construction, or renova-
tion of facilities pursuant to the Act of November 2, 1921 
(25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 
the Secretary, acting through the Service, shall— 
‘‘(1) consult with any Indian Tribe that would 
be significantly affected by such expenditure for the 
purpose of determining and, whenever practicable, 
honoring tribal preferences concerning size, location, 
type, and other characteristics of any facility on 
which such expenditure is to be made; and 
‘‘(2) ensure, whenever practicable and applica-
ble, that such facility meets the construction stand-
ards of any accrediting body recognized by the Sec-
retary for the purposes of the Medicare, Medicaid, 
and SCHIP programs under titles XVIII, XIX, and 
XXI of the Social Security Act by not later than 1 
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year after the date on which the construction or ren-
ovation of such facility is completed. 
‘‘(b) CLOSURES.— 
‘‘(1) 
EVALUATION
REQUIRED.—Notwith-
standing any other provision of law, no facility oper-
ated by the Service may be closed if the Secretary 
has not submitted to Congress, not less than 1 year 
and not more than 2 years before the date of the 
proposed closure, an evaluation, completed not more 
than 2 years before such submission, of the impact 
of the proposed closure that specifies, in addition to 
other considerations— 
‘‘(A) the accessibility of alternative health 
care resources for the population served by such 
facility; 
‘‘(B) the cost-effectiveness of such closure; 
‘‘(C) the quality of health care to be pro-
vided to the population served by such facility 
after such closure; 
‘‘(D) the availability of contract health 
care funds to maintain existing levels of service; 
‘‘(E) the views of the Indian Tribes served 
by such facility concerning such closure; 
‘‘(F) the level of use of such facility by all 
eligible Indians; and 
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‘‘(G) the distance between such facility and 
the nearest operating Service hospital. 
‘‘(2) EXCEPTION
FOR
CERTAIN
TEMPORARY 
CLOSURES.—Paragraph (1) shall not apply to any 
temporary closure of a facility or any portion of a 
facility if such closure is necessary for medical, envi-
ronmental, or construction safety reasons. 
‘‘(c) HEALTH CARE FACILITY PRIORITY SYSTEM.— 
‘‘(1) IN GENERAL.— 
‘‘(A) PRIORITY
SYSTEM.—The Secretary, 
acting through the Service, shall maintain a 
health care facility priority system, which— 
‘‘(i) shall be developed in consultation 
with Indian Tribes and Tribal Organiza-
tions; 
‘‘(ii) shall give Indian Tribes’ needs 
the highest priority; 
‘‘(iii)(I) may include the lists required 
in paragraph (2)(B)(ii); and 
‘‘(II) shall include the methodology re-
quired in paragraph (2)(B)(v); and 
‘‘(III) may include such other facili-
ties, and such renovation or expansion 
needs of any health care facility, as the 
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Service, Indian Tribes, and Tribal Organi-
zations may identify; and 
‘‘(iv) shall provide an opportunity for 
the nomination of planning, design, and 
construction projects by the Service, In-
dian Tribes, and Tribal Organizations for 
consideration under the priority system at 
least once every 3 years, or more fre-
quently as the Secretary determines to be 
appropriate. 
‘‘(B) 
NEEDS
OF
FACILITIES
UNDER 
ISDEAA AGREEMENTS.—The Secretary shall en-
sure that the planning, design, construction, 
renovation, and expansion needs of Service and 
non-Service facilities operated under contracts 
or compacts in accordance with the Indian Self- 
Determination and Education Assistance Act 
(25 U.S.C. 450 et seq.) are fully and equitably 
integrated into the health care facility priority 
system. 
‘‘(C) 
CRITERIA
FOR
EVALUATING 
NEEDS.—For purposes of this subsection, the 
Secretary, in evaluating the needs of facilities 
operated under a contract or compact under the 
Indian Self-Determination and Education As-
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sistance Act (25 U.S.C. 450 et seq.), shall use 
the criteria used by the Secretary in evaluating 
the needs of facilities operated directly by the 
Service. 
‘‘(D) PRIORITY
OF
CERTAIN
PROJECTS 
PROTECTED.—The priority of any project estab-
lished under the construction priority system in 
effect on the date of enactment of the Indian 
Health Care Improvement Act Amendments of 
2009 shall not be affected by any change in the 
construction priority system taking place after 
that date if the project— 
‘‘(i) was identified in the fiscal year 
2008 Service budget justification as— 
‘‘(I) 1 of the 10 top-priority inpa-
tient projects; 
‘‘(II) 1 of the 10 top-priority out-
patient projects; 
‘‘(III) 1 of the 10 top-priority 
staff quarters developments; or 
‘‘(IV) 1 of the 10 top-priority 
Youth Regional Treatment Centers; 
‘‘(ii) had completed both Phase I and 
Phase II of the construction priority sys-
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tem in effect on the date of enactment of 
such Act; or 
‘‘(iii) is not included in clause (i) or 
(ii) and is selected, as determined by the 
Secretary— 
‘‘(I) on the initiative of the Sec-
retary; or 
‘‘(II) pursuant to a request of an 
Indian Tribe or Tribal Organization. 
‘‘(2) REPORT; CONTENTS.— 
‘‘(A) INITIAL COMPREHENSIVE REPORT.— 
‘‘(i) DEFINITIONS.—In this subpara-
graph: 
‘‘(I) FACILITIES APPROPRIATION 
ADVISORY BOARD.—The term ‘Facili-
ties Appropriation Advisory Board’ 
means the advisory board, comprised 
of 12 members representing Indian 
tribes and 2 members representing 
the Service, established at the discre-
tion of the Assistant Secretary— 
‘‘(aa) to provide advice and 
recommendations for policies and 
procedures of the programs fund-
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ed pursuant to facilities appro-
priations; and 
‘‘(bb) to address other facili-
ties issues. 
‘‘(II) FACILITIES NEEDS ASSESS-
MENT
WORKGROUP.—The term ‘Fa-
cilities Needs Assessment Workgroup’ 
means the workgroup established at 
the discretion of the Assistant Sec-
retary— 
‘‘(aa) to review the health 
care facilities construction pri-
ority system; and 
‘‘(bb) to make recommenda-
tions to the Facilities Appropria-
tion Advisory Board for revising 
the priority system. 
‘‘(ii) INITIAL REPORT.— 
‘‘(I) IN
GENERAL.—Not later 
than 1 year after the date of enact-
ment of the Indian Health Care Im-
provement Act Amendments of 2009, 
the Secretary shall submit to the 
Committee on Indian Affairs of the 
Senate and the Committee on Natural 
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Resources of the House of Represent-
atives a report that describes the com-
prehensive, national, ranked list of all 
health care facilities needs for the 
Service, Indian Tribes, and Tribal Or-
ganizations (including inpatient health 
care facilities, outpatient health care 
facilities, specialized health care facili-
ties (such as for long-term care and 
alcohol and drug abuse treatment), 
wellness centers, staff quarters and 
hostels associated with health care fa-
cilities, and the renovation and expan-
sion needs, if any, of such facilities) 
developed by the Service, Indian 
Tribes, and Tribal Organizations for 
the 
Facilities 
Needs 
Assessment 
Workgroup and the Facilities Appro-
priation Advisory Board. 
‘‘(II) INCLUSIONS.—The initial 
report shall include— 
‘‘(aa) the methodology and 
criteria used by the Service in de-
termining the needs and estab-
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lishing the ranking of the facili-
ties needs; and 
‘‘(bb) such other information 
as the Secretary determines to be 
appropriate. 
‘‘(iii) UPDATES OF REPORT.—Begin-
ning in calendar year 2011, the Secretary 
shall— 
‘‘(I) update the report under 
clause (ii) not less frequently that 
once every 5 years; and 
‘‘(II) include the updated report 
in the appropriate annual report 
under subparagraph (B) for submis-
sion to Congress under section 801. 
‘‘(B) ANNUAL
REPORTS.—The Secretary 
shall submit to the President, for inclusion in 
the report required to be transmitted to Con-
gress under section 801, a report which sets 
forth the following: 
‘‘(i) A description of the health care 
facility priority system of the Service es-
tablished under paragraph (1). 
‘‘(ii) Health care facilities lists, which 
may include— 
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‘‘(I) the 10 top-priority inpatient 
health care facilities; 
‘‘(II) the 10 top-priority out-
patient health care facilities; 
‘‘(III) the 10 top-priority special-
ized health care facilities (such as 
long-term care and alcohol and drug 
abuse treatment); 
‘‘(IV) the 10 top-priority staff 
quarters developments associated with 
health care facilities; and 
‘‘(V) the 10 top-priority hostels 
associated with health care facilities. 
‘‘(iii) The justification for such order 
of priority. 
‘‘(iv) The projected cost of such 
projects. 
‘‘(v) The methodology adopted by the 
Service in establishing priorities under its 
health care facility priority system. 
‘‘(3) REQUIREMENTS FOR PREPARATION OF RE-
PORTS.—In preparing the report required under 
paragraph (2), the Secretary shall— 
‘‘(A) consult with and obtain information 
on all health care facilities needs from Indian 
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Tribes, Tribal Organizations, and urban Indian 
organizations; and 
‘‘(B) review the total unmet needs of all 
Indian Tribes, Tribal Organizations, and urban 
Indian organizations for health care facilities 
(including hostels and staff quarters), including 
needs for renovation and expansion of existing 
facilities. 
‘‘(d) REVIEW OF METHODOLOGY USED FOR HEALTH 
FACILITIES CONSTRUCTION PRIORITY SYSTEM.— 
‘‘(1) IN GENERAL.—Not later than 1 year after 
the establishment of the priority system under sub-
section (c)(1)(A), the Comptroller General of the 
United States shall prepare and finalize a report re-
viewing the methodologies applied, and the processes 
followed, by the Service in making each assessment 
of needs for the list under subsection (c)(2)(A)(ii) 
and developing the priority system under subsection 
(c)(1), including a review of— 
‘‘(A) the recommendations of the Facilities 
Appropriation Advisory Board and the Facili-
ties Needs Assessment Workgroup (as those 
terms are defined in subsection (c)(2)(A)(i)); 
and 
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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 the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.). 
‘‘(f) DEVELOPMENT OF INNOVATIVE APPROACHES.— 
The Secretary shall consult and cooperate with Indian 
Tribes, Tribal Organizations, and urban Indian organiza-
tions in developing innovative approaches to address all 
or part of the total unmet need for construction of health 
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facilities, including those provided for in other sections of 
this title and other approaches. 
‘‘SEC. 302. SANITATION FACILITIES. 
‘‘(a) FINDINGS.—Congress finds the following: 
‘‘(1) The provision of sanitation facilities is pri-
marily a health consideration and function. 
‘‘(2) Indian people suffer an inordinately high 
incidence of disease, injury, and illness directly at-
tributable to the absence or inadequacy of sanitation 
facilities. 
‘‘(3) The long-term cost to the United States of 
treating and curing such disease, injury, and illness 
is substantially greater than the short-term cost of 
providing sanitation facilities and other preventive 
health measures. 
‘‘(4) Many Indian homes and Indian commu-
nities still lack sanitation facilities. 
‘‘(5) It is in the interest of the United States, 
and it is the policy of the United States, that all In-
dian communities and Indian homes, new and exist-
ing, be provided with sanitation facilities. 
‘‘(b) FACILITIES AND SERVICES.—In furtherance of 
the findings made in subsection (a), Congress reaffirms 
the primary responsibility and authority of the Service to 
provide the necessary sanitation facilities and services as 
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provided in section 7 of the Act of August 5, 1954 (42 
U.S.C. 2004a). Under such authority, the Secretary, act-
ing through the Service, is authorized to provide the fol-
lowing: 
‘‘(1) Financial and technical assistance to In-
dian Tribes, Tribal Organizations, and Indian com-
munities in the establishment, training, and equip-
ping of utility organizations to operate and maintain 
sanitation facilities, including the provision of exist-
ing plans, standard details, and specifications avail-
able in the Department, to be used at the option of 
the Indian Tribe, Tribal Organization, or Indian 
community. 
‘‘(2) Ongoing technical assistance and training 
to Indian Tribes, Tribal Organizations, and Indian 
communities in the management of utility organiza-
tions which operate and maintain sanitation facili-
ties. 
‘‘(3) Priority funding for operation and mainte-
nance assistance for, and emergency repairs to, sani-
tation facilities operated by an Indian Tribe, Tribal 
Organization or Indian community when necessary 
to avoid an imminent health threat or to protect the 
investment in sanitation facilities and the investment 
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in the health benefits gained through the provision 
of sanitation facilities. 
‘‘(c) FUNDING.—Notwithstanding any other provi-
sion of law— 
‘‘(1) the Secretary of Housing and Urban De-
velopment is authorized to transfer funds appro-
priated under the Native American Housing Assist-
ance and Self-Determination Act of 1996 (25 U.S.C. 
4101 et seq.) to the Secretary of Health and Human 
Services; 
‘‘(2) the Secretary of Health and Human Serv-
ices is authorized to accept and use such funds for 
the purpose of providing sanitation facilities and 
services for Indians under section 7 of the Act of 
August 5, 1954 (42 U.S.C. 2004a); 
‘‘(3) unless specifically authorized when funds 
are appropriated, the Secretary shall not use funds 
appropriated under section 7 of the Act of August 
5, 1954 (42 U.S.C. 2004a), to provide sanitation fa-
cilities to new homes constructed using funds pro-
vided by the Department of Housing and Urban De-
velopment; 
‘‘(4) the Secretary of Health and Human Serv-
ices is authorized to accept from any source, includ-
ing Federal and State agencies, funds for the pur-
VerDate Nov 24 2008 
12:56 Oct 30, 2009
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H3962
rmajette on DSK29S0YB1PROD with BILLS