1796 
any expansion, the Indian Tribe or Tribal Organization 
shall provide to the Secretary additional information pur-
suant to regulations, including additional staffing, equip-
ment, and other costs associated with the expansion. 
‘‘(e) CLOSURE OR CONVERSION OF FACILITIES.—If 
any Service facility which has been expanded, renovated, 
or modernized by an Indian Tribe or Tribal Organization 
under this section ceases to be used as a Service facility 
during the 20-year period beginning on the date such ex-
pansion, renovation, or modernization is completed, such 
Indian Tribe or Tribal Organization shall be entitled to 
recover from the United States an amount which bears 
the same ratio to the value of such facility at the time 
of such cessation as the value of such expansion, renova-
tion, or modernization (less the total amount of any funds 
provided specifically for such facility under any Federal 
program that were expended for such expansion, renova-
tion, or modernization) bore to the value of such facility 
at the time of the completion of such expansion, renova-
tion, or modernization. 
‘‘SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, 
AND MODERNIZATION OF SMALL AMBULA-
TORY CARE FACILITIES. 
‘‘(a) GRANTS.— 
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‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Service, shall make grants to Indian 
Tribes and Tribal Organizations for the construc-
tion, expansion, or modernization of facilities for the 
provision of ambulatory care services to eligible Indi-
ans (and noneligible persons pursuant to subsections 
(b)(2) and (c)(1)(C)). A grant made under this sec-
tion may cover up to 100 percent of the costs of 
such construction, expansion, or modernization. For 
the purposes of this section, the term ‘construction’ 
includes the replacement of an existing facility. 
‘‘(2) GRANT AGREEMENT REQUIRED.—A grant 
under paragraph (1) may only be made available to 
a Tribal Health Program operating an Indian health 
facility (other than a facility owned or constructed 
by the Service, including a facility originally owned 
or constructed by the Service and transferred to an 
Indian Tribe or Tribal Organization). 
‘‘(b) USE OF GRANT FUNDS.— 
‘‘(1) ALLOWABLE
USES.—A grant awarded 
under this section may be used for the construction, 
expansion, or modernization (including the planning 
and design of such construction, expansion, or mod-
ernization) of an ambulatory care facility— 
‘‘(A) located apart from a hospital; 
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‘‘(B) not funded under section 301 or sec-
tion 306; and 
‘‘(C) which, upon completion of such con-
struction or modernization will— 
‘‘(i) have a total capacity appropriate 
to its projected service population; 
‘‘(ii) provide annually no fewer than 
150 patient visits by eligible Indians and 
other users who are eligible for services in 
such facility in accordance with section 
806(c)(2); and 
‘‘(iii) provide ambulatory care in a 
Service Area (specified in the contract or 
compact under the Indian Self-Determina-
tion and Education Assistance Act (25 
U.S.C. 450 et seq.)) with a population of 
no fewer than 1,500 eligible Indians and 
other users who are eligible for services in 
such facility in accordance with section 
806(c)(2). 
‘‘(2) ADDITIONAL ALLOWABLE USE.—The Sec-
retary may also reserve a portion of the funding pro-
vided under this section and use those reserved 
funds to reduce an outstanding debt incurred by In-
dian Tribes or Tribal Organizations for the con-
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struction, expansion, or modernization of an ambula-
tory care facility that meets the requirements under 
paragraph (1). The provisions of this section shall 
apply, except that such applications for funding 
under this paragraph shall be considered separately 
from applications for funding under paragraph (1). 
‘‘(3) USE
ONLY
FOR
CERTAIN
PORTION
OF 
COSTS.—A grant provided under this section may be 
used only for the cost of that portion of a construc-
tion, expansion, or modernization project that bene-
fits the Service population identified above in sub-
section (b)(1)(C) (ii) and (iii). The requirements of 
clauses (ii) and (iii) of paragraph (1)(C) shall not 
apply to an Indian Tribe or Tribal Organization ap-
plying for a grant under this section for a health 
care facility located or to be constructed on an is-
land or when such facility is not located on a road 
system providing direct access to an inpatient hos-
pital where care is available to the Service popu-
lation. 
‘‘(c) GRANTS.— 
‘‘(1) APPLICATION.—No grant may be made 
under this section unless an application or proposal 
for the grant has been approved by the Secretary in 
accordance with applicable regulations and has set 
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forth reasonable assurance by the applicant that, at 
all times after the construction, expansion, or mod-
ernization of a facility carried out using a grant re-
ceived under this section— 
‘‘(A) adequate financial support will be 
available for the provision of services at such 
facility; 
‘‘(B) such facility will be available to eligi-
ble Indians without regard to ability to pay or 
source of payment; and 
‘‘(C) such facility will, as feasible without 
diminishing the quality or quantity of services 
provided to eligible Indians, serve noneligible 
persons on a cost basis. 
‘‘(2) PRIORITY.—In awarding grants under this 
section, the Secretary shall give priority to Indian 
Tribes and Tribal Organizations that demonstrate— 
‘‘(A) a need for increased ambulatory care 
services; and 
‘‘(B) insufficient capacity to deliver such 
services. 
‘‘(3) PEER
REVIEW
PANELS.—The Secretary 
may provide for the establishment of peer review 
panels, as necessary, to review and evaluate applica-
tions and proposals and to advise the Secretary re-
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garding such applications using the criteria devel-
oped pursuant to subsection (a)(1). 
‘‘(d) REVERSION OF FACILITIES.—If any facility (or 
portion thereof) with respect to which funds have been 
paid under this section, ceases, at any time after comple-
tion of the construction, expansion, or modernization car-
ried out with such funds, to be used for the purposes of 
providing health care services to eligible Indians, all of the 
right, title, and interest in and to such facility (or portion 
thereof) shall transfer to the United States unless other-
wise negotiated by the Service and the Indian Tribe or 
Tribal Organization. 
‘‘(e) FUNDING NONRECURRING.—Funding provided 
under this section shall be nonrecurring and shall not be 
available for inclusion in any individual Indian Tribe’s 
tribal share for an award under the Indian Self-Deter-
mination and Education Assistance Act (25 U.S.C. 450 
et seq.) or for reallocation or redesign thereunder. 
‘‘SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRA-
TION PROJECT. 
‘‘(a) HEALTH CARE DEMONSTRATION PROJECTS.— 
The Secretary, acting through the Service, is authorized 
to make grants to, and enter into construction contracts 
or construction project agreements with, Indian Tribes or 
Tribal Organizations under the Indian Self-Determination 
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and Education Assistance Act (25 U.S.C. 450 et seq.) for 
the purpose of carrying out a health care delivery dem-
onstration project to test alternative means of delivering 
health care and services to Indians through facilities. 
‘‘(b) USE OF FUNDS.—The Secretary, in approving 
projects pursuant to this section, may authorize such con-
tracts for the construction and renovation of hospitals, 
health centers, health stations, and other facilities to de-
liver health care services and is authorized to— 
‘‘(1) waive any leasing prohibition; 
‘‘(2) permit carryover of funds appropriated for 
the provision of health care services; 
‘‘(3) permit the use of other available funds; 
‘‘(4) permit the use of funds or property do-
nated from any source for project purposes; 
‘‘(5) provide for the reversion of donated real or 
personal property to the donor; and 
‘‘(6) permit the use of Service funds to match 
other funds, including Federal funds. 
‘‘(c) REGULATIONS.—The Secretary shall develop 
and promulgate regulations, not later than 1 year after 
the date of enactment of the Indian Health Care Improve-
ment Act Amendments of 2009, for the review and ap-
proval of applications submitted under this section. 
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‘‘(d) CRITERIA.—The Secretary may approve projects 
that meet the following criteria: 
‘‘(1) There is a need for a new facility or pro-
gram or the reorientation of an existing facility or 
program. 
‘‘(2) A significant number of Indians, including 
those with low health status, will be served by the 
project. 
‘‘(3) The project has the potential to deliver 
services in an efficient and effective manner. 
‘‘(4) The project is economically viable. 
‘‘(5) The Indian Tribe or Tribal Organization 
has the administrative and financial capability to ad-
minister the project. 
‘‘(6) The project is integrated with providers of 
related health and social services and is coordinated 
with, and avoids duplication of, existing services. 
‘‘(e) PEER REVIEW PANELS.—The Secretary may 
provide for the establishment of peer review panels, as nec-
essary, to review and evaluate applications using the cri-
teria developed pursuant to subsection (d). 
‘‘(f) PRIORITY.—The Secretary shall give priority to 
applications for demonstration projects in each of the fol-
lowing Service Units to the extent that such applications 
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are timely filed and meet the criteria specified in sub-
section (d): 
‘‘(1) Cass Lake, Minnesota. 
‘‘(2) Mescalero, New Mexico. 
‘‘(3) Owyhee, Nevada. 
‘‘(4) Schurz, Nevada. 
‘‘(5) Ft. Yuma, California. 
‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall 
provide such technical and other assistance as may be nec-
essary to enable applicants to comply with the provisions 
of this section. 
‘‘(h) SERVICE TO INELIGIBLE PERSONS.—Subject to 
section 806, the authority to provide services to persons 
otherwise ineligible for the health care benefits of the 
Service and the authority to extend hospital privileges in 
Service facilities to non-Service health practitioners as 
provided in section 806 may be included, subject to the 
terms of such section, in any demonstration project ap-
proved pursuant to this section. 
‘‘(i) EQUITABLE TREATMENT.—For purposes of sub-
section (d)(1), the Secretary shall, in evaluating facilities 
operated under any contract or compact under the Indian 
Self-Determination and Education Assistance Act (25 
U.S.C. 450 et seq.), use the same criteria that the Sec-
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retary uses in evaluating facilities operated directly by the 
Service. 
‘‘(j) EQUITABLE INTEGRATION OF FACILITIES.—The 
Secretary shall ensure that the planning, design, construc-
tion, renovation, and expansion needs of Service and non- 
Service facilities which are the subject of a contract or 
compact under the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.) for health 
services are fully and equitably integrated into the imple-
mentation of the health care delivery demonstration 
projects under this section. 
‘‘SEC. 307. LAND TRANSFER. 
‘‘Notwithstanding any other provision of law, the Bu-
reau of Indian Affairs and all other agencies and depart-
ments of the United States are authorized to transfer, at 
no cost, land and improvements to the Service for the pro-
vision of health care services. The Secretary is authorized 
to accept such land and improvements for such purposes. 
‘‘SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS. 
‘‘The Secretary, acting through the Service, may 
enter into leases, contracts, and other agreements with In-
dian Tribes and Tribal Organizations which hold (1) title 
to, (2) a leasehold interest in, or (3) a beneficial interest 
in (when title is held by the United States in trust for 
the benefit of an Indian Tribe) facilities used or to be used 
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for the administration and delivery of health services by 
an Indian Health Program. Such leases, contracts, or 
agreements may include provisions for construction or ren-
ovation and provide for compensation to the Indian Tribe 
or Tribal Organization of rental and other costs consistent 
with section 105(l) of the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450j(l)) and regula-
tions thereunder. 
‘‘SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND 
LOAN REPAYMENT. 
‘‘(a) IN GENERAL.—The Secretary, in consultation 
with the Secretary of the Treasury, Indian Tribes, and 
Tribal Organizations, shall carry out a study to determine 
the feasibility of establishing a loan fund to provide to In-
dian Tribes and Tribal Organizations direct loans or guar-
antees for loans for the construction of health care facili-
ties, including— 
‘‘(1) inpatient facilities; 
‘‘(2) outpatient facilities; 
‘‘(3) staff quarters; 
‘‘(4) hostels; and 
‘‘(5) specialized care facilities, such as behav-
ioral health and elder care facilities. 
‘‘(b) DETERMINATIONS.—In carrying out the study 
under subsection (a), the Secretary shall determine— 
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