1939 
one Service Unit voluntarily choosing to receive 
service at another Service Unit; 
‘‘(B) an analysis of the effect of patient 
movement on the quality of services for those 
Service Units experiencing an increase in the 
number of patients served; and 
‘‘(C) what funding changes are necessary 
to maintain a consistent quality of service at 
Service Units that have an increase in the num-
ber of patients served. 
‘‘(23) A report on the extent to which health 
care facilities of the Service, Indian Tribes, Tribal 
Organizations, and urban Indian organizations com-
ply with credentialing requirements of the Service or 
licensure requirements of States. 
‘‘SEC. 802. REGULATIONS. 
‘‘(a) DEADLINES.— 
‘‘(1) PROCEDURES.—Not later than 90 days 
after the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2009, the 
Secretary shall initiate procedures under subchapter 
III of chapter 5 of title 5, United States Code, to 
negotiate and promulgate such regulations or 
amendments thereto that are necessary to carry out 
this Act, except sections 105, 115, 117, 202, and 
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1940 
409 through 414. The Secretary may promulgate 
regulations to carry out such sections using the pro-
cedures required by chapter 5 of title 5, United 
States Code (commonly known as the ‘Administra-
tive Procedure Act’). 
‘‘(2) PROPOSED REGULATIONS.—Proposed reg-
ulations to implement this Act shall be published in 
the Federal Register by the Secretary no later than 
2 years after the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2009 
and shall have no less than a 120-day comment pe-
riod. 
‘‘(3) FINAL
REGULATIONS.—The Secretary 
shall publish in the Federal Register final regula-
tions to implement this Act by not later than 3 years 
after the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2009. 
‘‘(b) COMMITTEE.—A negotiated rulemaking com-
mittee established pursuant to section 565 of title 5, 
United States Code, to carry out this section shall have 
as its members only representatives of the Federal Gov-
ernment and representatives of Indian Tribes, and Tribal 
Organizations, a majority of whom shall be nominated by 
and be representatives of Indian Tribes and Tribal Orga-
nizations from each Service Area. 
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‘‘(c) ADAPTATION OF PROCEDURES.—The Secretary 
shall adapt the negotiated rulemaking procedures to the 
unique context of self-governance and the government-to- 
government relationship between the United States and 
Indian Tribes. 
‘‘(d) LACK OF REGULATIONS.—The lack of promul-
gated regulations shall not limit the effect of this Act. 
‘‘SEC. 803. PLAN OF IMPLEMENTATION. 
‘‘(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of the Indian Health Care Improvement 
Act Amendments of 2009, the Secretary, in consultation 
with Indian Tribes, Tribal Organizations, and urban In-
dian organizations, shall submit to Congress a plan ex-
plaining the manner and schedule, by title and section, 
by which the Secretary will implement the provisions of 
this Act. This consultation may be conducted jointly with 
the annual budget consultation pursuant to the Indian 
Self-Determination and Education Assistance Act (25 
U.S.C. 450 et seq.). 
‘‘(b) LACK OF PLAN.—The lack of (or failure to sub-
mit) such a plan shall not limit the effect, or prevent the 
implementation, of this Act. 
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‘‘SEC. 804. LIMITATION ON USE OF FUNDS APPROPRIATED 
TO INDIAN HEALTH SERVICE. 
‘‘Any limitation on the use of funds contained in an 
Act providing appropriations for the Department for a pe-
riod with respect to the performance of abortions shall 
apply for that period with respect to the performance of 
abortions using funds contained in an Act providing ap-
propriations for the Service. 
‘‘SEC. 805. ELIGIBILITY OF CALIFORNIA INDIANS. 
‘‘(a) IN GENERAL.—The following California Indians 
shall be eligible for health services provided by the Service: 
‘‘(1) Any member of a federally recognized In-
dian Tribe. 
‘‘(2) Any descendant of an Indian who was re-
siding in California on June 1, 1852, if such de-
scendant— 
‘‘(A) is a member of the Indian community 
served by a local program of the Service; and 
‘‘(B) is regarded as an Indian by the com-
munity in which such descendant lives. 
‘‘(3) Any Indian who holds trust interests in 
public domain, national forest, or reservation allot-
ments in California. 
‘‘(4) Any Indian in California who is listed on 
the plans for distribution of the assets of rancherias 
and reservations located within the State of Cali-
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fornia under the Act of August 18, 1958 (72 Stat. 
619), and any descendant of such an Indian. 
‘‘(b) CLARIFICATION.—Nothing in this section may 
be construed as expanding the eligibility of California Indi-
ans for health services provided by the Service beyond the 
scope of eligibility for such health services that applied on 
May 1, 1986. 
‘‘SEC. 806. HEALTH SERVICES FOR INELIGIBLE PERSONS. 
‘‘(a) CHILDREN.—Any individual who— 
‘‘(1) has not attained 19 years of age; 
‘‘(2) is the natural or adopted child, stepchild, 
foster child, legal ward, or orphan of an eligible In-
dian; and 
‘‘(3) is not otherwise eligible for health services 
provided by the Service, 
shall be eligible for all health services provided by the 
Service on the same basis and subject to the same rules 
that apply to eligible Indians until such individual attains 
19 years of age. The existing and potential health needs 
of all such individuals shall be taken into consideration 
by the Service in determining the need for, or the alloca-
tion of, the health resources of the Service. If such an indi-
vidual has been determined to be legally incompetent prior 
to attaining 19 years of age, such individual shall remain 
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eligible for such services until 1 year after the date of a 
determination of competency. 
‘‘(b) SPOUSES.—Any spouse of an eligible Indian who 
is not an Indian, or who is of Indian descent but is not 
otherwise eligible for the health services provided by the 
Service, shall be eligible for such health services if all such 
spouses or spouses who are married to members of each 
Indian Tribe being served are made eligible, as a class, 
by an appropriate resolution of the governing body of the 
Indian Tribe or Tribal Organization providing such serv-
ices. The health needs of persons made eligible under this 
paragraph shall not be taken into consideration by the 
Service in determining the need for, or allocation of, its 
health resources. 
‘‘(c) PROVISION OF SERVICES TO OTHER INDIVID-
UALS.— 
‘‘(1) IN GENERAL.—The Secretary is authorized 
to provide health services under this subsection 
through health programs operated directly by the 
Service to individuals who reside within the Service 
area of the Service Unit and who are not otherwise 
eligible for such health services if— 
‘‘(A) the Indian Tribes served by such 
Service Unit request such provision of health 
services to such individuals; and 
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‘‘(B) the Secretary and the served Indian 
Tribes have jointly determined that— 
‘‘(i) the provision of such health serv-
ices will not result in a denial or diminu-
tion of health services to eligible Indians; 
and 
‘‘(ii) there is no reasonable alternative 
health facilities or services, within or with-
out the Service Unit, available to meet the 
health needs of such individuals. 
‘‘(2) ISDEAA PROGRAMS.—In the case of 
health programs and facilities operated under a con-
tract or compact entered into under the Indian Self- 
Determination and Education Assistance Act (25 
U.S.C. 450 et seq.), the governing body of the In-
dian Tribe or Tribal Organization providing health 
services under such contract or compact is author-
ized to determine whether health services should be 
provided under such contract to individuals who are 
not eligible for such health services under any other 
subsection of this section or under any other provi-
sion of law. In making such determinations, the gov-
erning body of the Indian Tribe or Tribal Organiza-
tion shall take into account the considerations de-
scribed in paragraph (1)(B). 
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‘‘(3) PAYMENT FOR SERVICES.— 
‘‘(A) IN
GENERAL.—Persons receiving 
health services provided by the Service under 
this subsection shall be liable for payment of 
such health services under a schedule of charges 
prescribed by the Secretary which, in the judg-
ment of the Secretary, results in reimbursement 
in an amount not less than the actual cost of 
providing the health services. Notwithstanding 
section 404 of this Act or any other provision 
of law, amounts collected under this subsection, 
including Medicare, Medicaid, or SCHIP reim-
bursements under titles XVIII, XIX, and XXI 
of the Social Security Act, shall be credited to 
the account of the program providing the serv-
ice and shall be used for the purposes listed in 
section 401(d)(2) and amounts collected under 
this subsection shall be available for expendi-
ture within such program. 
‘‘(B) INDIGENT PEOPLE.—Health services 
may be provided by the Secretary through the 
Service under this subsection to an indigent in-
dividual who would not be otherwise eligible for 
such health services but for the provisions of 
paragraph (1) only if an agreement has been 
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1947 
entered into with a State or local government 
under which the State or local government 
agrees to reimburse the Service for the expenses 
incurred by the Service in providing such health 
services to such indigent individual. 
‘‘(4) REVOCATION
OF
CONSENT
FOR
SERV-
ICES.— 
‘‘(A) SINGLE
TRIBE
SERVICE
AREA.—In 
the case of a Service Area which serves only 1 
Indian Tribe, the authority of the Secretary to 
provide health services under paragraph (1) 
shall terminate at the end of the fiscal year suc-
ceeding the fiscal year in which the governing 
body of the Indian Tribe revokes its concur-
rence to the provision of such health services. 
‘‘(B) MULTITRIBAL
SERVICE
AREA.—In 
the case of a multitribal Service Area, the au-
thority of the Secretary to provide health serv-
ices under paragraph (1) shall terminate at the 
end of the fiscal year succeeding the fiscal year 
in which at least 51 percent of the number of 
Indian Tribes in the Service Area revoke their 
concurrence to the provisions of such health 
services. 
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1948 
‘‘(d) OTHER SERVICES.—The Service may provide 
health services under this subsection to individuals who 
are not eligible for health services provided by the Service 
under any other provision of law in order to— 
‘‘(1) achieve stability in a medical emergency; 
‘‘(2) prevent the spread of a communicable dis-
ease or otherwise deal with a public health hazard; 
‘‘(3) provide care to non-Indian women preg-
nant with an eligible Indian’s child for the duration 
of the pregnancy through postpartum; or 
‘‘(4) provide care to immediate family members 
of an eligible individual if such care is directly re-
lated to the treatment of the eligible individual. 
‘‘(e) HOSPITAL PRIVILEGES FOR PRACTITIONERS.— 
‘‘(1) IN
GENERAL.—Hospital privileges in 
health facilities operated and maintained by the 
Service or operated under a contract or compact 
pursuant to the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.) may 
be extended to non-Service health care practitioners 
who provide services to individuals described in sub-
section (a), (b), (c), or (d). Such non-Service health 
care practitioners may, as part of the privileging 
process, be designated as employees of the Federal 
Government for purposes of section 1346(b) and 
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1949 
chapter 171 of title 28, United States Code (relating 
to Federal tort claims) only with respect to acts or 
omissions which occur in the course of providing 
services to eligible individuals as a part of the condi-
tions under which such hospital privileges are ex-
tended. 
‘‘(2) DEFINITION.—For purposes of this sub-
section, the term ‘non-Service health care practi-
tioner’ means a practitioner who is not— 
‘‘(A) an employee of the Service; or 
‘‘(B) an employee of an Indian tribe or 
tribal organization operating a contract or com-
pact under the Indian Self-Determination and 
Education Assistance Act or an individual who 
provides health care services pursuant to a per-
sonal services contract with such Indian tribe or 
tribal organization. 
‘‘(f) ELIGIBLE INDIAN.—For purposes of this sec-
tion, the term ‘eligible Indian’ means any Indian who is 
eligible for health services provided by the Service without 
regard to the provisions of this section. 
‘‘SEC. 807. REALLOCATION OF BASE RESOURCES. 
‘‘(a) REPORT
REQUIRED.—Notwithstanding any 
other provision of law, any allocation of Service funds for 
a fiscal year that reduces by 5 percent or more from the 
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1950 
previous fiscal year the funding for any recurring pro-
gram, project, or activity of a Service Unit may be imple-
mented only after the Secretary has submitted to Con-
gress, under section 801, a report on the proposed change 
in allocation of funding, including the reasons for the 
change and its likely effects. 
‘‘(b) EXCEPTION.—Subsection (a) shall not apply if 
the total amount appropriated to the Service for a fiscal 
year is at least 5 percent less than the amount appro-
priated to the Service for the previous fiscal year. 
‘‘SEC. 808. RESULTS OF DEMONSTRATION PROJECTS. 
‘‘The Secretary shall provide for the dissemination to 
Indian Tribes, Tribal Organizations, and urban Indian or-
ganizations of the findings and results of demonstration 
projects conducted under this Act. 
‘‘SEC. 809. PROVISION OF SERVICES IN MONTANA. 
‘‘(a) CONSISTENT WITH COURT DECISION.—The 
Secretary, acting through the Service, shall provide serv-
ices and benefits for Indians in Montana in a manner con-
sistent with the decision of the United States Court of Ap-
peals for the Ninth Circuit in McNabb for McNabb v. 
Bowen, 829 F.2d 787 (9th Cir. 1987). 
‘‘(b) CLARIFICATION.—The provisions of subsection 
(a) shall not be construed to be an expression of the sense 
of Congress on the application of the decision described 
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in subsection (a) with respect to the provision of services 
or benefits for Indians living in any State other than Mon-
tana. 
‘‘SEC. 810. MORATORIUM. 
‘‘During the period of the moratorium imposed on 
implementation of the final rule published in the Federal 
Register on September 16, 1987, by the Department of 
Health and Human Services, relating to eligibility for the 
health care services of the Indian Health Service, the In-
dian Health Service shall provide services pursuant to the 
criteria for eligibility for such services that were in effect 
on September 15, 1987, subject to the provisions of sec-
tions 805 and 806, until the Service has submitted to the 
Committees on Appropriations of the Senate and the 
House of Representatives a budget request reflecting the 
increased costs associated with the proposed final rule, 
and the request has been included in an appropriations 
Act and enacted into law. 
‘‘SEC. 811. SEVERABILITY PROVISIONS. 
‘‘If any provision of this Act, any amendment made 
by the Act, or the application of such provision or amend-
ment to any person or circumstances is held to be invalid, 
the remainder of this Act, the remaining amendments 
made by this Act, and the application of such provisions 
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1952 
to persons or circumstances other than those to which it 
is held invalid, shall not be affected thereby. 
‘‘SEC. 812. USE OF PATIENT SAFETY ORGANIZATIONS. 
‘‘The Service, an Indian Tribe, Tribal Organization, 
or urban Indian organization may provide for quality as-
surance activities through the use of a patient safety orga-
nization in accordance with title IX of the Public Health 
Service Act. 
‘‘SEC. 813. CONFIDENTIALITY OF MEDICAL QUALITY ASSUR-
ANCE RECORDS; QUALIFIED IMMUNITY FOR 
PARTICIPANTS. 
‘‘(a) CONFIDENTIALITY OF RECORDS.—Medical qual-
ity assurance records created by or for any Indian Health 
Program or a health program of an Urban Indian Organi-
zation as part of a medical quality assurance program are 
confidential and privileged. Such records may not be dis-
closed to any person or entity, except as provided in sub-
section (c). 
‘‘(b) PROHIBITION
ON DISCLOSURE
AND TESTI-
MONY.— 
‘‘(1) IN
GENERAL.—No part of any medical 
quality assurance record described in subsection (a) 
may be subject to discovery or admitted into evi-
dence in any judicial or administrative proceeding, 
except as provided in subsection (c). 
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1953 
‘‘(2) TESTIMONY.—A person who reviews or 
creates medical quality assurance records for any In-
dian Health Program or Urban Indian Organization 
who participates in any proceeding that reviews or 
creates such records may not be permitted or re-
quired to testify in any judicial or administrative 
proceeding with respect to such records or with re-
spect to any finding, recommendation, evaluation, 
opinion, or action taken by such person or body in 
connection with such records except as provided in 
this section. 
‘‘(c) AUTHORIZED DISCLOSURE AND TESTIMONY.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), a 
medical quality assurance record described in sub-
section (a) may be disclosed, and a person referred 
to in subsection (b) may give testimony in connec-
tion with such a record, only as follows: 
‘‘(A) To a Federal executive agency or pri-
vate organization, if such medical quality assur-
ance record or testimony is needed by such 
agency or organization to perform licensing or 
accreditation functions related to any Indian 
Health Program or to a health program of an 
Urban Indian Organization to perform moni-
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1954 
toring, required by law, of such program or or-
ganization. 
‘‘(B) To an administrative or judicial pro-
ceeding commenced by a present or former In-
dian Health Program or Urban Indian Organi-
zation provider concerning the termination, sus-
pension, or limitation of clinical privileges of 
such health care provider. 
‘‘(C) To a governmental board or agency 
or to a professional health care society or orga-
nization, if such medical quality assurance 
record or testimony is needed by such board, 
agency, society, or organization to perform li-
censing, credentialing, or the monitoring of pro-
fessional standards with respect to any health 
care provider who is or was an employee of any 
Indian Health Program or Urban Indian Orga-
nization. 
‘‘(D) To a hospital, medical center, or 
other institution that provides health care serv-
ices, if such medical quality assurance record or 
testimony is needed by such institution to as-
sess the professional qualifications of any health 
care provider who is or was an employee of any 
Indian Health Program or Urban Indian Orga-
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1955 
nization and who has applied for or been grant-
ed authority or employment to provide health 
care services in or on behalf of such program or 
organization. 
‘‘(E) To an officer, employee, or contractor 
of the Indian Health Program or Urban Indian 
Organization that created the records or for 
which the records were created. If that officer, 
employee, or contractor has a need for such 
record or testimony to perform official duties. 
‘‘(F) To a criminal or civil law enforce-
ment agency or instrumentality charged under 
applicable law with the protection of the public 
health or safety, if a qualified representative of 
such agency or instrumentality makes a written 
request that such record or testimony be pro-
vided for a purpose authorized by law. 
‘‘(G) In an administrative or judicial pro-
ceeding commenced by a criminal or civil law 
enforcement agency or instrumentality referred 
to in subparagraph (F), but only with respect 
to the subject of such proceeding. 
‘‘(2) IDENTITY
OF
PARTICIPANTS.—With the 
exception of the subject of a quality assurance ac-
tion, the identity of any person receiving health care 
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1956 
services from any Indian Health Program or Urban 
Indian Organization or the identity of any other per-
son associated with such program or organization 
for purposes of a medical quality assurance program 
that is disclosed in a medical quality assurance 
record described in subsection (a) shall be deleted 
from that record or document before any disclosure 
of such record is made outside such program or or-
ganization. 
‘‘(d) DISCLOSURE FOR CERTAIN PURPOSES.— 
‘‘(1) IN
GENERAL.—Nothing in this section 
shall be construed as authorizing or requiring the 
withholding from any person or entity aggregate sta-
tistical information regarding the results of any In-
dian 
Health 
Program 
or 
Urban 
Indian 
Organizations’s medical quality assurance programs. 
‘‘(2) WITHHOLDING
FROM
CONGRESS.—Noth-
ing in this section shall be construed as authority to 
withhold any medical quality assurance record from 
a committee of either House of Congress, any joint 
committee of Congress, or the Government Account-
ability Office if such record pertains to any matter 
within their respective jurisdictions. 
‘‘(e) PROHIBITION ON DISCLOSURE OF RECORD OR 
TESTIMONY.—A person or entity having possession of or 
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1957 
access to a record or testimony described by this section 
may not disclose the contents of such record or testimony 
in any manner or for any purpose except as provided in 
this section. 
‘‘(f) EXEMPTION FROM FREEDOM OF INFORMATION 
ACT.—Medical quality assurance records described in sub-
section (a) may not be made available to any person under 
section 552 of title 5, United States Code. 
‘‘(g) LIMITATION ON CIVIL LIABILITY.—A person 
who participates in or provides information to a person 
or body that reviews or creates medical quality assurance 
records described in subsection (a) shall not be civilly lia-
ble for such participation or for providing such informa-
tion if the participation or provision of information was 
in good faith based on prevailing professional standards 
at the time the medical quality assurance program activity 
took place. 
‘‘(h) APPLICATION
TO INFORMATION
IN CERTAIN 
OTHER RECORDS.—Nothing in this section shall be con-
strued as limiting access to the information in a record 
created and maintained outside a medical quality assur-
ance program, including a patient’s medical records, on 
the grounds that the information was presented during 
meetings of a review body that are part of a medical qual-
ity assurance program. 
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1958 
‘‘(i) REGULATIONS.—The Secretary, acting through 
the Service, shall promulgate regulations pursuant to sec-
tion 802. 
‘‘(j) DEFINITIONS.—In this section: 
‘‘(1) The term ‘health care provider’ means any 
health care professional, including community health 
aides and practitioners certified under section 121, 
who are granted clinical practice privileges or em-
ployed to provide health care services in an Indian 
Health Program or health program of an Urban In-
dian Organization, who is licensed or certified to 
perform health care services by a governmental 
board or agency or professional health care society 
or organization. 
‘‘(2) The term ‘medical quality assurance pro-
gram’ means any activity carried out before, on, or 
after the date of enactment of this Act by or for any 
Indian Health Program or Urban Indian Organiza-
tion to assess the quality of medical care, including 
activities conducted by or on behalf of individuals, 
Indian Health Program or Urban Indian Organiza-
tion medical or dental treatment review committees, 
or other review bodies responsible for quality assur-
ance, credentials, infection control, patient safety, 
patient care assessment (including treatment proce-
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1959 
dures, blood, drugs, and therapeutics), medical 
records, health resources management review and 
identification and prevention of medical or dental in-
cidents and risks. 
‘‘(3) The term ‘medical quality assurance 
record’ means the proceedings, records, minutes, and 
reports that emanate from quality assurance pro-
gram activities described in paragraph (2) and are 
produced or compiled by or for an Indian Health 
Program or Urban Indian Organization as part of a 
medical quality assurance program. 
‘‘(k) CONTINUED PROTECTION.—Disclosure under 
subsection (c) does not permit redisclosure except to the 
extent such further disclosure is authorized under sub-
section (c) or is otherwise authorized to be disclosed under 
this section. 
‘‘(l) INCONSISTENCIES.—To the extent that the pro-
tections under the Patient Safety and Quality Improve-
ment Act of 2005 and this section are inconsistent, the 
provisions of whichever is more protective shall control. 
‘‘(m) RELATIONSHIP TO OTHER LAW.—This section 
shall continue in force and effect, except as otherwise spe-
cifically provided in any Federal law enacted after the date 
of enactment of the Indian Health Care Improvement Act 
Amendments of 2009. 
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‘‘SEC. 814. CLAREMORE INDIAN HOSPITAL. 
‘‘The Claremore Indian Hospital shall be deemed to 
be a dependant Indian community for the purposes of sec-
tion 1151 of title 18, United States Code. 
‘‘SEC. 815. SENSE OF CONGRESS REGARDING LAW EN-
FORCEMENT 
AND 
METHAMPHETAMINE 
ISSUES IN INDIAN COUNTRY. 
‘‘It is the sense of Congress that Congress encourages 
State, local, and Indian tribal law enforcement agencies 
to enter into memoranda of agreement between and 
among those agencies for purposes of streamlining law en-
forcement activities and maximizing the use of limited re-
sources— 
‘‘(1) to improve law enforcement services pro-
vided to Indian tribal communities; and 
‘‘(2) to increase the effectiveness of measures to 
address problems relating to methamphetamine use 
in Indian country (as defined in section 1151 of title 
18, United States Code). 
‘‘SEC. 816. PERMITTING IMPLEMENTATION THROUGH CON-
TRACTS WITH TRIBAL HEALTH PROGRAMS. 
‘‘Nothing in this Act shall be construed as preventing 
the Secretary from— 
‘‘(1) carrying out any section of this Act 
through contracts with Tribal Health Programs; and 
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‘‘(2) carrying out sections through 214, 
701(a)(1), 701(b)(1), 701(c), 707(g), and 712(b), 
through contracts with urban Indian organizations. 
The previous sentence shall not affect the authority the 
Secretary may otherwise have to carry out other provisions 
of this Act through such contracts. 
‘‘SEC. 817. AUTHORIZATION OF APPROPRIATIONS; AVAIL-
ABILITY. 
‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this title. 
‘‘(b) LIMITATION ON NEW SPENDING AUTHORITY.— 
Any new spending authority (described in subparagraph 
(A) or (B) of section 401(c)(2) of the Congressional Budg-
et Act of 1974 (Public Law 93–344; 88 Stat. 317)) which 
is provided under this Act shall be effective for any fiscal 
year only to such extent or in such amounts as are pro-
vided in appropriation Acts. 
‘‘(c) AVAILABILITY.—The funds appropriated pursu-
ant to this Act shall remain available until expended.’’. 
(b) RATE OF PAY.— 
(1) POSITIONS AT LEVEL IV.—Section 5315 of 
title 5, United States Code, is amended by striking 
‘‘Assistant Secretaries of Health and Human Serv-
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ices (6).’’ and inserting ‘‘Assistant Secretaries of 
Health and Human Services (7)’’. 
(2) POSITIONS AT LEVEL V.—Section 5316 of 
title 5, United States Code, is amended by striking 
‘‘Director, Indian Health Service, Department of 
Health and Human Services’’. 
(c) AMENDMENTS TO OTHER PROVISIONS OF LAW.— 
(1) Section 3307(b)(1)(C) of the Children’s 
Health Act of 2000 (25 U.S.C. 1671 note; Public 
Law 106–310) is amended by striking ‘‘Director of 
the Indian Health Service’’ and inserting ‘‘Assistant 
Secretary for Indian Health’’. 
(2) The Indian Lands Open Dump Cleanup Act 
of 1994 is amended— 
(A) in section 3 (25 U.S.C. 3902)— 
(i) by striking paragraph (2); 
(ii) by redesignating paragraphs (1), 
(3), (4), (5), and (6) as paragraphs (4), 
(5), (2), (6), and (1), respectively, and 
moving those paragraphs so as to appear 
in numerical order; and 
(iii) by inserting before paragraph (4) 
(as redesignated by subclause (II)) the fol-
lowing: 
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‘‘(3) ASSISTANT
SECRETARY.—The term ‘As-
sistant Secretary’ means the Assistant Secretary for 
Indian Health.’’; 
(B) in section 5 (25 U.S.C. 3904), by 
striking the section designation and heading 
and inserting the following: 
‘‘SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR IN-
DIAN HEALTH.’’; 
(C) in section 6(a) (25 U.S.C. 3905(a)), in 
the subsection heading, by striking ‘‘DIREC-
TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 
(D) in section 9(a) (25 U.S.C. 3908(a)), in 
the subsection heading, by striking ‘‘DIREC-
TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 
and 
(E) by striking ‘‘Director’’ each place it 
appears and inserting ‘‘Assistant Secretary’’. 
(3) Section 5504(d)(2) of the Augustus F. 
Hawkins-Robert T. Stafford Elementary and Sec-
ondary School Improvement Amendments of 1988 
(25 U.S.C. 2001 note; Public Law 100–297) is 
amended by striking ‘‘Director of the Indian Health 
Service’’ and inserting ‘‘Assistant Secretary for In-
dian Health’’. 
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(4) Section 203(a)(1) of the Rehabilitation Act 
of 1973 (29 U.S.C. 763(a)(1)) is amended by strik-
ing ‘‘Director of the Indian Health Service’’ and in-
serting ‘‘Assistant Secretary for Indian Health’’. 
(5) Subsections (b) and (e) of section 518 of 
the Federal Water Pollution Control Act (33 U.S.C. 
1377) are amended by striking ‘‘Director of the In-
dian Health Service’’ each place it appears and in-
serting ‘‘Assistant Secretary for Indian Health’’. 
(6) Section 317M(b) of the Public Health Serv-
ice Act (42 U.S.C. 247b–14(b)) is amended— 
(A) by striking ‘‘Director of the Indian 
Health Service’’ each place it appears and in-
serting 
‘‘Assistant 
Secretary 
for 
Indian 
Health’’; and 
(B) in paragraph (2)(A), by striking ‘‘the 
Directors referred to in such paragraph’’ and 
inserting ‘‘the Director of the Centers for Dis-
ease Control and Prevention and the Assistant 
Secretary for Indian Health’’. 
(7) Section 417C(b) of the Public Health Serv-
ice Act (42 U.S.C. 285–9(b)) is amended by striking 
‘‘Director of the Indian Health Service’’ and insert-
ing ‘‘Assistant Secretary for Indian Health’’. 
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(8) Section 1452(i) of the Safe Drinking Water 
Act (42 U.S.C. 300j–12(i)) is amended by striking 
‘‘Director of the Indian Health Service’’ each place 
it appears and inserting ‘‘Assistant Secretary for In-
dian Health’’. 
(9) Section 803B(d)(1) of the Native American 
Programs Act of 1974 (42 U.S.C. 2991b–2(d)(1)) is 
amended in the last sentence by striking ‘‘Director 
of the Indian Health Service’’ and inserting ‘‘Assist-
ant Secretary for Indian Health’’. 
(10) Section 203(b) of the Michigan Indian 
Land Claims Settlement Act (Public Law 105–143; 
111 Stat. 2666) is amended by striking ‘‘Director of 
the Indian Health Service’’ and inserting ‘‘Assistant 
Secretary for Indian Health’’. 
SEC. 3102. SOBOBA SANITATION FACILITIES. 
The Act of December 17, 1970 (84 Stat. 1465), is 
amended by adding at the end the following: 
‘‘SEC. 9. Nothing in this Act shall preclude the 
Soboba Band of Mission Indians and the Soboba Indian 
Reservation from being provided with sanitation facilities 
and services under the authority of section 7 of the Act 
of August 5, 1954 (68 Stat. 674), as amended by the Act 
of July 31, 1959 (73 Stat. 267).’’. 
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SEC. 3103. NATIVE AMERICAN HEALTH AND WELLNESS 
FOUNDATION. 
(a) IN GENERAL.—The Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.) is 
amended by adding at the end the following: 
‘‘TITLE VIII—NATIVE AMERICAN 
HEALTH 
AND 
WELLNESS 
FOUNDATION 
‘‘SEC. 801. DEFINITIONS. 
‘‘In this title: 
‘‘(1) BOARD.—The term ‘Board’ means the 
Board of Directors of the Foundation. 
‘‘(2) 
COMMITTEE.—The 
term 
‘Committee’ 
means the Committee for the Establishment of Na-
tive American Health and Wellness Foundation es-
tablished under section 802(f). 
‘‘(3) FOUNDATION.—The term ‘Foundation’ 
means the Native American Health and Wellness 
Foundation established under section 802. 
‘‘(4) SECRETARY.—The term ‘Secretary’ means 
the Secretary of Health and Human Services. 
‘‘(5) SERVICE.—The term ‘Service’ means the 
Indian Health Service of the Department of Health 
and Human Services. 
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‘‘SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS 
FOUNDATION. 
‘‘(a) ESTABLISHMENT.— 
‘‘(1) IN
GENERAL.—As soon as practicable 
after the date of enactment of this title, the Sec-
retary shall establish, under the laws of the District 
of Columbia and in accordance with this title, the 
Native American Health and Wellness Foundation. 
‘‘(2) FUNDING
DETERMINATIONS.—No funds, 
gift, property, or other item of value (including any 
interest accrued on such an item) acquired by the 
Foundation shall— 
‘‘(A) be taken into consideration for pur-
poses of determining Federal appropriations re-
lating to the provision of health care and serv-
ices to Indians; or 
‘‘(B) otherwise limit, diminish, or affect 
the Federal responsibility for the provision of 
health care and services to Indians. 
‘‘(b) PERPETUAL
EXISTENCE.—The Foundation 
shall have perpetual existence. 
‘‘(c) NATURE OF CORPORATION.—The Foundation— 
‘‘(1) shall be a charitable and nonprofit feder-
ally chartered corporation; and 
‘‘(2) shall not be an agency or instrumentality 
of the United States. 
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‘‘(d) PLACE OF INCORPORATION AND DOMICILE.— 
The Foundation shall be incorporated and domiciled in the 
District of Columbia. 
‘‘(e) DUTIES.—The Foundation shall— 
‘‘(1) encourage, accept, and administer private 
gifts of real and personal property, and any income 
from or interest in such gifts, for the benefit of, or 
in support of, the mission of the Service; 
‘‘(2) undertake and conduct such other activi-
ties as will further the health and wellness activities 
and opportunities of Native Americans; and 
‘‘(3) participate with and assist Federal, State, 
and tribal governments, agencies, entities, and indi-
viduals in undertaking and conducting activities that 
will further the health and wellness activities and op-
portunities of Native Americans. 
‘‘(f) COMMITTEE FOR THE ESTABLISHMENT OF NA-
TIVE AMERICAN HEALTH
AND WELLNESS FOUNDA-
TION.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish the Committee for the Establishment of Native 
American Health and Wellness Foundation to assist 
the Secretary in establishing the Foundation. 
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1970 
‘‘(3) SELECTION.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the number of members of the 
Board, the manner of selection of the members 
(including the filling of vacancies), and the 
terms of office of the members shall be as pro-
vided in the constitution and bylaws of the 
Foundation. 
‘‘(B) REQUIREMENTS.— 
‘‘(i) NUMBER
OF
MEMBERS.—The 
Board shall have at least 11 members, who 
shall have staggered terms. 
‘‘(ii) INITIAL VOTING MEMBERS.—The 
initial voting members of the Board— 
‘‘(I) shall be appointed by the 
Committee not later than 180 days 
after the date on which the Founda-
tion is established; and 
‘‘(II) shall have staggered terms. 
‘‘(iii) QUALIFICATION.—The members 
of the Board shall be United States citi-
zens who are knowledgeable or experienced 
in Native American health care and related 
matters. 
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1973 
‘‘(l) LIABILITY
OF OFFICERS, EMPLOYEES, AND 
AGENTS.— 
‘‘(1) IN GENERAL.—The Foundation shall be 
liable for the acts of the officers, employees, and 
agents of the Foundation acting within the scope of 
their authority. 
‘‘(2) PERSONAL LIABILITY.—A member of the 
Board shall be personally liable only for gross neg-
ligence in the performance of the duties of the mem-
ber. 
‘‘(m) RESTRICTIONS.— 
‘‘(1) LIMITATION
ON
SPENDING.—Beginning 
with the fiscal year following the first full fiscal year 
during which the Foundation is in operation, the ad-
ministrative costs of the Foundation shall not exceed 
the percentage described in paragraph (2) of the 
sum of— 
‘‘(A) the amounts transferred to the Foun-
dation under subsection (o) during the pre-
ceding fiscal year; and 
‘‘(B) donations received from private 
sources during the preceding fiscal year. 
‘‘(2) PERCENTAGES.—The percentages referred 
to in paragraph (1) are— 
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1974 
‘‘(A) for the first fiscal year described in 
that paragraph, 20 percent; 
‘‘(B) for the following fiscal year, 15 per-
cent; and 
‘‘(C) for each fiscal year thereafter, 10 
percent. 
‘‘(3) APPOINTMENT
AND
HIRING.—The ap-
pointment of officers and employees of the Founda-
tion shall be subject to the availability of funds. 
‘‘(4) STATUS.—A member of the Board or offi-
cer, employee, or agent of the Foundation shall not 
by reason of association with the Foundation be con-
sidered to be an officer, employee, or agent of the 
United States. 
‘‘(n) AUDITS.—The Foundation shall comply with 
section 10101 of title 36, United States Code, as if the 
Foundation were a corporation under part B of subtitle 
II of that title. 
‘‘(o) FUNDING.— 
‘‘(1) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to carry out 
subsection (e)(1) $500,000 for each fiscal year, as 
adjusted to reflect changes in the Consumer Price 
Index for all-urban consumers published by the De-
partment of Labor. 
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1975 
‘‘(2) TRANSFER
OF
DONATED
FUNDS.—The 
Secretary shall transfer to the Foundation funds 
held by the Department of Health and Human Serv-
ices under the Act of August 5, 1954 (42 U.S.C. 
2001 et seq.), if the transfer or use of the funds is 
not prohibited by any term under which the funds 
were donated. 
‘‘SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT. 
‘‘(a) PROVISION OF SUPPORT BY SECRETARY.—Sub-
ject to subsection (b), during the 5-year period beginning 
on the date on which the Foundation is established, the 
Secretary— 
‘‘(1) may provide personnel, facilities, and other 
administrative support services to the Foundation; 
‘‘(2) may provide funds for initial operating 
costs and to reimburse the travel expenses of the 
members of the Board; and 
‘‘(3) shall require and accept reimbursements 
from the Foundation for— 
‘‘(A) services provided under paragraph 
(1); and 
‘‘(B) funds provided under paragraph (2). 
‘‘(b) REIMBURSEMENT.—Reimbursements accepted 
under subsection (a)(3)— 
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1976 
‘‘(1) shall be deposited in the Treasury of the 
United States to the credit of the applicable appro-
priations account; and 
‘‘(2) shall be chargeable for the cost of pro-
viding services described in subsection (a)(1) and 
travel expenses described in subsection (a)(2). 
‘‘(c) CONTINUATION OF CERTAIN SERVICES.—The 
Secretary may continue to provide facilities and necessary 
support services to the Foundation after the termination 
of the 5-year period specified in subsection (a) if the facili-
ties and services— 
‘‘(1) are available; and 
‘‘(2) are provided on reimbursable cost basis.’’. 
(b) TECHNICAL AMENDMENTS.—The Indian Self-De-
termination and Education Assistance Act is amended— 
(1) by redesignating title V (25 U.S.C. 458bbb 
et seq.) as title VII; 
(2) by redesignating sections 501, 502, and 503 
(25 U.S.C. 458bbb, 458bbb–1, 458bbb–2) as sec-
tions 701, 702, and 703, respectively; and 
(3) in subsection (a)(2) of section 702 and 
paragraph (2) of section 703 (as redesignated by 
paragraph (2)), by striking ‘‘section 501’’ and in-
serting ‘‘section 701’’. 
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1977 
SEC. 3104. GAO STUDY AND REPORT ON PAYMENTS FOR 
CONTRACT HEALTH SERVICES. 
(a) STUDY.— 
(1) IN GENERAL.—The Comptroller General of 
the United States (in this section referred to as the 
‘‘Comptroller General’’) shall conduct a study on the 
utilization of health care furnished by health care 
providers under the contract health services program 
funded by the Indian Health Service and operated 
by the Indian Health Service, an Indian Tribe, or a 
Tribal Organization (as those terms are defined in 
section 4 of the Indian Health Care Improvement 
Act). 
(2) ANALYSIS.—The study conducted under 
paragraph (1) shall include an analysis of— 
(A) the amounts reimbursed under the 
contract health services program described in 
paragraph (1) for health care furnished by enti-
ties, individual providers, and suppliers, includ-
ing a comparison of reimbursement for such 
health care through other public programs and 
in the private sector; 
(B) barriers to accessing care under such 
contract health services program, including, but 
not limited to, barriers relating to travel dis-
tances, cultural differences, and public and pri-
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1978 
vate sector reluctance to furnish care to pa-
tients under such program; 
(C) the adequacy of existing Federal fund-
ing for health care under such contract health 
services program; and 
(D) any other items determined appro-
priate by the Comptroller General. 
(b) REPORT.—Not later than 18 months after the 
date of enactment of this Act, the Comptroller General 
shall submit to Congress a report on the study conducted 
under subsection (a), together with recommendations re-
garding— 
(1) the appropriate level of Federal funding 
that should be established for health care under the 
contract health services program described in sub-
section (a)(1); and 
(2) how to most efficiently utilize such funding. 
(c) CONSULTATION.—In conducting the study under 
subsection (a) and preparing the report under subsection 
(b), the Comptroller General shall consult with the Indian 
Health Service, Indian Tribes, and Tribal Organizations. 
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1979 
TITLE II—IMPROVEMENT OF IN-
DIAN 
HEALTH 
CARE 
PRO-
VIDED UNDER THE SOCIAL 
SECURITY ACT 
SEC. 3201. EXPANSION OF PAYMENTS UNDER MEDICARE, 
MEDICAID, AND SCHIP FOR ALL COVERED 
SERVICES FURNISHED BY INDIAN HEALTH 
PROGRAMS. 
(a) MEDICAID.— 
(1) EXPANSION TO ALL COVERED SERVICES.— 
Section 1911 of the Social Security Act (42 U.S.C. 
1396j) is amended— 
(A) by amending the heading to read as 
follows: 
‘‘SEC. 1911. INDIAN HEALTH PROGRAMS.’’; 
and 
(B) by amending subsection (a) to read as 
follows: 
‘‘(a) ELIGIBILITY FOR PAYMENT FOR MEDICAL AS-
SISTANCE.—An Indian Health Program shall be eligible 
for payment for medical assistance provided under a State 
plan or under waiver authority with respect to items and 
services furnished by the Program if the furnishing of 
such services meets all the conditions and requirements 
which are applicable generally to the furnishing of items 
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1980 
and services under this title and under such plan or waiver 
authority.’’. 
(2) REPEAL OF OBSOLETE PROVISION.—Sub-
section (b) of such section is repealed. 
(3) REVISION OF AUTHORITY TO ENTER INTO 
AGREEMENTS.—Subsection (c) of such section is 
amended to read as follows: 
‘‘(c) AUTHORITY TO ENTER INTO AGREEMENTS.— 
The Secretary may enter into an agreement with a State 
for the purpose of reimbursing the State for medical as-
sistance provided by the Indian Health Service, an Indian 
Tribe, Tribal Organization, or an Urban Indian Organiza-
tion (as so defined), directly, through referral, or under 
contracts or other arrangements between the Indian 
Health Service, an Indian Tribe, Tribal Organization, or 
an Urban Indian Organization and another health care 
provider to Indians who are eligible for medical assistance 
under the State plan or under waiver authority. This sub-
section shall not be construed to impair the entitlement 
of a State to reimbursement for such medical assistance 
under this title.’’. 
(4) CROSS-REFERENCES TO SPECIAL FUND FOR 
IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING 
OPTION; 
DEFINITIONS.—Such section is further 
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1981 
amended by striking subsection (d) and adding at 
the end the following new subsections: 
‘‘(c) SPECIAL FUND FOR IMPROVEMENT OF IHS FA-
CILITIES.—For provisions relating to the authority of the 
Secretary to place payments to which a facility of the In-
dian Health Service is eligible for payment under this title 
into a special fund established under section 401(c)(1) of 
the Indian Health Care Improvement Act, see subpara-
graphs (A) and (B) of section 401(c)(1) of such Act. 
‘‘(d) DIRECT BILLING.—For provisions relating to 
the authority of an Tribal Health Program to elect to di-
rectly bill for, and receive payment for, health care items 
and services provided by such Program for which payment 
is made under this title, see section 401(d) of the Indian 
Health Care Improvement Act.’’. 
(5) DEFINITIONS.—Section 1101(a) of such Act 
(42 U.S.C. 1301(a)) is amended by adding at the 
end the following new paragraph: 
‘‘(11) For purposes of this title and titles 
XVIII, XIX, and XXI, the terms ‘Indian Health 
Program’, ‘Indian Tribe’ (and ‘Indian tribe’), ‘Tribal 
Health Program’, ‘Tribal Organization’ (and ‘tribal 
organization’), and ‘urban Indian organization’ (and 
‘urban Indian organization’) have the meanings 
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1982 
given those terms in section 4 of the Indian Health 
Care Improvement Act.’’. 
(b) MEDICARE.— 
(1) EXPANSION TO ALL COVERED SERVICES.— 
Section 1880 of such Act (42 U.S.C. 1395qq) is 
amended— 
(A) by amending the heading to read as 
follows: 
‘‘SEC. 1880. INDIAN HEALTH PROGRAMS.’’; 
and 
(B) by amending subsection (a) to read as 
follows: 
‘‘(a) ELIGIBILITY FOR PAYMENTS.—Subject to sub-
section (e), an Indian Health Program shall be eligible for 
payments under this title with respect to items and serv-
ices furnished by the Program if the furnishing of such 
services meets all the conditions and requirements which 
are applicable generally to the furnishing of items and 
services under this title.’’. 
(2) REPEAL OF OBSOLETE PROVISION.—Sub-
section (b) of such section is repealed. 
(3) CROSS-REFERENCES TO SPECIAL FUND FOR 
IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING 
OPTION; DEFINITIONS.— 
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(A) IN GENERAL.—Such section is further 
amended by striking subsections (c) and (d) 
and inserting the following new subsections: 
‘‘(b) SPECIAL FUND FOR IMPROVEMENT OF IHS FA-
CILITIES.—For provisions relating to the authority of the 
Secretary to place payments to which a facility of the In-
dian Health Service is eligible for payment under this title 
into a special fund established under section 401(c)(1) of 
the Indian Health Care Improvement Act, and the require-
ment to use amounts paid from such fund for making im-
provements in accordance with subsection (b), see sub-
paragraphs (A) and (B) of section 401(c)(1) of such Act. 
‘‘(c) DIRECT BILLING.—For provisions relating to 
the authority of a Tribal Health Program to elect to di-
rectly bill for, and receive payment for, health care items 
and services provided by such Program for which payment 
is made under this title, see section 401(d) of the Indian 
Health Care Improvement Act.’’. 
(B) CONFORMING
AMENDMENTS.—Such 
section is further amended— 
(i) in subsection (e)(3), by striking 
‘‘Subsection (c)’’ and inserting ‘‘Subsection 
(b) and section 401(b)(1) of the Indian 
Health Care Improvement Act’’; 
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(ii) by redesignating subsection (e) as 
subsection (d); and 
(iii) by striking subsection (f). 
(4) DEFINITIONS.—Such section is further 
amended by amending adding at the end the fol-
lowing new subsection: 
‘‘(e) DEFINITIONS.—In this section, the terms ‘In-
dian Health Program’, ‘Indian Tribe’, ‘Service Unit’, 
‘Tribal Health Program’, ‘Tribal Organization’, and 
‘Urban Indian Organization’ have the meanings given 
those terms in section 4 of the Indian Health Care Im-
provement Act.’’. 
(c) APPLICATION TO SCHIP.—Section 2107(e)(1) of 
the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 
amended— 
(1) 
by 
redesignating 
subparagraphs 
(K) 
through (M) as subparagraphs (L) through (N), re-
spectively; and 
(2) by inserting after subparagraph (J), the fol-
lowing new subparagraph: 
‘‘(K) Section 1911 (relating to Indian 
Health Programs, other than subsection (c) of 
such section).’’. 
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