H. R. 2471—350 
compacts authorized by the Indian Self-Determination and Edu-
cation Assistance Act of 1975 (25 U.S.C. 450), shall be deemed 
to be obligated at the time of the grant or contract award and 
thereafter shall remain available to the tribe or tribal organization 
without fiscal year limitation: Provided further, That $2,500,000 
shall be available for grants or contracts with public or private 
institutions to provide alcohol or drug treatment services to Indians, 
including alcohol detoxification services: Provided further, That 
$984,887,000 for Purchased/Referred Care, including $53,000,000 
for the Indian Catastrophic Health Emergency Fund, shall remain 
available until expended: Provided further, That of the funds pro-
vided, up to $46,000,000 shall remain available until expended 
for implementation of the loan repayment program under section 
108 of the Indian Health Care Improvement Act: Provided further, 
That of the funds provided, $58,000,000 shall be for costs related 
to 
or 
resulting 
from 
accreditation 
emergencies, 
including 
supplementing activities funded under the heading ‘‘Indian Health 
Facilities,’’ of which up to $4,000,000 may be used to supplement 
amounts otherwise available for Purchased/Referred Care: Provided 
further, That the amounts collected by the Federal Government 
as authorized by sections 104 and 108 of the Indian Health Care 
Improvement Act (25 U.S.C. 1613a and 1616a) during the preceding 
fiscal year for breach of contracts shall be deposited in the Fund 
authorized by section 108A of that Act (25 U.S.C. 1616a–1) and 
shall remain available until expended and, notwithstanding section 
108A(c) of that Act (25 U.S.C. 1616a–1(c)), funds shall be available 
to make new awards under the loan repayment and scholarship 
programs under sections 104 and 108 of that Act (25 U.S.C. 1613a 
and 1616a): Provided further, That the amounts made available 
within this account for the Substance Abuse and Suicide Prevention 
Program, for Opioid Prevention, Treatment and Recovery Services, 
for the Domestic Violence Prevention Program, for the Zero Suicide 
Initiative, for the housing subsidy authority for civilian employees, 
for Aftercare Pilot Programs at Youth Regional Treatment Centers, 
for transformation and modernization costs of the Indian Health 
Service Electronic Health Record system, for national quality and 
oversight activities, to improve collections from public and private 
insurance at Indian Health Service and tribally operated facilities, 
for an initiative to treat or reduce the transmission of HIV and 
HCV, for a maternal health initiative, for the Telebehaviorial Health 
Center of Excellence, for Alzheimer’s grants, for Village Built 
Clinics, for a produce prescription pilot, and for accreditation emer-
gencies shall be allocated at the discretion of the Director of the 
Indian Health Service and shall remain available until expended: 
Provided further, That funds provided in this Act may be used 
for annual contracts and grants that fall within 2 fiscal years, 
provided the total obligation is recorded in the year the funds 
are appropriated: Provided further, That the amounts collected by 
the Secretary of Health and Human Services under the authority 
of title IV of the Indian Health Care Improvement Act (25 U.S.C. 
1613) shall remain available until expended for the purpose of 
achieving compliance with the applicable conditions and require-
ments of titles XVIII and XIX of the Social Security Act, except 
for those related to the planning, design, or construction of new 
facilities: Provided further, That funding contained herein for schol-
arship programs under the Indian Health Care Improvement Act 
(25 U.S.C. 1613) shall remain available until expended: Provided
H. R. 2471—351 
further, That amounts received by tribes and tribal organizations 
under title IV of the Indian Health Care Improvement Act shall 
be reported and accounted for and available to the receiving tribes 
and tribal organizations until expended: Provided further, That 
the Bureau of Indian Affairs may collect from the Indian Health 
Service, and from tribes and tribal organizations operating health 
facilities pursuant to Public Law 93–638, such individually identifi-
able health information relating to disabled children as may be 
necessary for the purpose of carrying out its functions under the 
Individuals with Disabilities Education Act (20 U.S.C. 1400 et seq.): 
Provided further, That of the funds provided, $74,138,000 is for 
the Indian Health Care Improvement Fund and may be used, 
as needed, to carry out activities typically funded under the Indian 
Health Facilities account: Provided further, That none of the funds 
appropriated by this Act, or any other Act, to the Indian Health 
Service for the Electronic Health Record system shall be available 
for obligation or expenditure for the selection or implementation 
of a new Information Technology infrastructure system, unless the 
Committees on Appropriations of the House of Representatives and 
the Senate are consulted 90 days in advance of such obligation. 
CONTRACT SUPPORT COSTS 
For payments to tribes and tribal organizations for contract 
support costs associated with Indian Self-Determination and Edu-
cation Assistance Act agreements with the Indian Health Service 
for fiscal year 2022, such sums as may be necessary: Provided, 
That notwithstanding any other provision of law, no amounts made 
available under this heading shall be available for transfer to 
another budget account: Provided further, That amounts obligated 
but not expended by a tribe or tribal organization for contract 
support costs for such agreements for the current fiscal year shall 
be applied to contract support costs due for such agreements for 
subsequent fiscal years. 
PAYMENTS FOR TRIBAL LEASES 
For payments to tribes and tribal organizations for leases 
pursuant to section 105(l) of the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 5324(l)) for fiscal year 2022, 
such sums as may be necessary, which shall be available for obliga-
tion through September 30, 2023: Provided, That notwithstanding 
any other provision of law, no amounts made available under this 
heading shall be available for transfer to another budget account. 
INDIAN HEALTH FACILITIES 
For construction, repair, maintenance, demolition, improve-
ment, and equipment of health and related auxiliary facilities, 
including quarters for personnel; preparation of plans, specifica-
tions, and drawings; acquisition of sites, purchase and erection 
of modular buildings, and purchases of trailers; and for provision 
of domestic and community sanitation facilities for Indians, as 
authorized by section 7 of the Act of August 5, 1954 (42 U.S.C. 
2004a), the Indian Self-Determination Act, and the Indian Health 
Care Improvement Act, and for expenses necessary to carry out 
such Acts and titles II and III of the Public Health Service Act 
with respect to environmental health and facilities support activities
H. R. 2471—352 
of the Indian Health Service, $940,328,000, to remain available 
until expended: Provided, That notwithstanding any other provision 
of law, funds appropriated for the planning, design, construction, 
renovation, or expansion of health facilities for the benefit of an 
Indian tribe or tribes may be used to purchase land on which 
such facilities will be located: Provided further, That not to exceed 
$500,000 may be used by the Indian Health Service to purchase 
TRANSAM equipment from the Department of Defense for distribu-
tion to the Indian Health Service and tribal facilities: Provided 
further, That of the amount appropriated under this heading for 
fiscal year 2022 for Sanitation Facilities Construction, $40,171,000 
shall be for projects specified for Sanitation Facilities Construction 
(CDS) in the table titled ‘‘Interior and Environment Incorporation 
of Community Project Funding Items/Congressionally Directed 
Spending Items’’ included for this division in the explanatory state-
ment described in section 4 (in the matter preceding division A 
of this consolidated Act): Provided further, That none of the funds 
appropriated to the Indian Health Service may be used for sanita-
tion facilities construction for new homes funded with grants by 
the housing programs of the United States Department of Housing 
and Urban Development. 
ADMINISTRATIVE PROVISIONS—INDIAN HEALTH SERVICE 
Appropriations provided in this Act to the Indian Health Service 
shall be available for services as authorized by 5 U.S.C. 3109 
at rates not to exceed the per diem rate equivalent to the maximum 
rate payable for senior-level positions under 5 U.S.C. 5376; hire 
of passenger motor vehicles and aircraft; purchase of medical equip-
ment; purchase of reprints; purchase, renovation, and erection of 
modular buildings and renovation of existing facilities; payments 
for telephone service in private residences in the field, when author-
ized under regulations approved by the Secretary of Health and 
Human Services; uniforms, or allowances therefor as authorized 
by 5 U.S.C. 5901–5902; and for expenses of attendance at meetings 
that relate to the functions or activities of the Indian Health Service: 
Provided, That in accordance with the provisions of the Indian 
Health Care Improvement Act, non-Indian patients may be 
extended health care at all tribally administered or Indian Health 
Service facilities, subject to charges, and the proceeds along with 
funds recovered under the Federal Medical Care Recovery Act (42 
U.S.C. 2651–2653) shall be credited to the account of the facility 
providing the service and shall be available without fiscal year 
limitation: Provided further, That notwithstanding any other law 
or regulation, funds transferred from the Department of Housing 
and Urban Development to the Indian Health Service shall be 
administered under Public Law 86–121, the Indian Sanitation 
Facilities Act and Public Law 93–638: Provided further, That funds 
appropriated to the Indian Health Service in this Act, except those 
used for administrative and program direction purposes, shall not 
be subject to limitations directed at curtailing Federal travel and 
transportation: Provided further, That none of the funds made 
available to the Indian Health Service in this Act shall be used 
for any assessments or charges by the Department of Health and 
Human Services unless identified in the budget justification and
H. R. 2471—353 
provided in this Act, or approved by the House and Senate Commit-
tees on Appropriations through the reprogramming process: Pro-
vided further, That notwithstanding any other provision of law, 
funds previously or herein made available to a tribe or tribal 
organization through a contract, grant, or agreement authorized 
by title I or title V of the Indian Self-Determination and Education 
Assistance Act of 1975 (25 U.S.C. 450 et seq.), may be deobligated 
and reobligated to a self-determination contract under title I, or 
a self-governance agreement under title V of such Act and thereafter 
shall remain available to the tribe or tribal organization without 
fiscal year limitation: Provided further, That none of the funds 
made available to the Indian Health Service in this Act shall 
be used to implement the final rule published in the Federal Reg-
ister on September 16, 1987, by the Department of Health and 
Human Services, relating to the eligibility for the health care serv-
ices of the Indian Health Service until the Indian Health Service 
has submitted a budget request reflecting the increased costs associ-
ated with the proposed final rule, and such request has been 
included in an appropriations Act and enacted into law: Provided 
further, That with respect to functions transferred by the Indian 
Health Service to tribes or tribal organizations, the Indian Health 
Service is authorized to provide goods and services to those entities 
on a reimbursable basis, including payments in advance with subse-
quent adjustment, and the reimbursements received therefrom, 
along with the funds received from those entities pursuant to the 
Indian Self-Determination Act, may be credited to the same or 
subsequent appropriation account from which the funds were origi-
nally derived, with such amounts to remain available until 
expended: Provided further, That reimbursements for training, tech-
nical assistance, or services provided by the Indian Health Service 
will contain total costs, including direct, administrative, and over-
head costs associated with the provision of goods, services, or tech-
nical assistance: Provided further, That the Indian Health Service 
may provide to civilian medical personnel serving in hospitals oper-
ated by the Indian Health Service housing allowances equivalent 
to those that would be provided to members of the Commissioned 
Corps of the United States Public Health Service serving in similar 
positions at such hospitals: Provided further, That the appropriation 
structure for the Indian Health Service may not be altered without 
advance notification to the House and Senate Committees on Appro-
priations. 
NATIONAL INSTITUTES OF HEALTH 
NATIONAL INSTITUTE OF ENVIRONMENTAL HEALTH SCIENCES 
For necessary expenses for the National Institute of Environ-
mental Health Sciences in carrying out activities set forth in section 
311(a) of the Comprehensive Environmental Response, Compensa-
tion, and Liability Act of 1980 (42 U.S.C. 9660(a)) and section 
126(g) of the Superfund Amendments and Reauthorization Act of 
1986, $82,540,000.