297 
5, United States Code (commonly known as the ‘Ad-
ministrative 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 2007 
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 2007. 
‘‘(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. 
‘‘(c) ADAPTATION OF PROCEDURES.—The Secretary 
shall adapt the negotiated rulemaking procedures to the 
unique context of self-governance and the government-to- 
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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. 
‘‘(e) INCONSISTENT REGULATIONS.—The provisions 
of this Act shall supersede any conflicting provisions of 
law in effect on the day before the date of enactment of 
the Indian Health Care Improvement Act Amendments of 
2007, and the Secretary is authorized to repeal any regu-
lation inconsistent with the provisions of this Act. 
‘‘SEC. 803. PLAN OF IMPLEMENTATION. 
‘‘Not later than 9 months after the date of enactment 
of the Indian Health Care Improvement Act Amendments 
of 2007, the Secretary, in consultation with Indian Tribes, 
Tribal Organizations, and Urban Indian Organizations, 
shall submit to Congress a plan explaining 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 consulta-
tion pursuant to the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq). 
‘‘SEC. 804. AVAILABILITY OF FUNDS. 
‘‘The funds appropriated pursuant to this Act shall 
remain available until expended. 
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‘‘SEC. 805. 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. 806. 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. 807. 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 
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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304 
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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‘‘(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.— 
Hospital privileges in health facilities operated and main-
tained by the Service or operated under a contract or com-
pact pursuant to the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.) may be ex-
tended to non-Service health care practitioners who pro-
vide services to individuals described in subsection (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 sec-
tion 1346(b) and chapter 171 of title 28, United States 
Code (relating to Federal tort claims) only with respect 
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to acts or omissions which occur in the course of providing 
services to eligible individuals as a part of the conditions 
under which such hospital privileges are extended. 
‘‘(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. 808. 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 
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. 809. RESULTS OF DEMONSTRATION PROJECTS. 
‘‘The Secretary shall provide for the dissemination to 
Indian Tribes, Tribal Organizations, and Urban Indian 
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Organizations of the findings and results of demonstration 
projects conducted under this Act. 
‘‘SEC. 810. 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 
in subsection (a) with respect to the provision of services 
or benefits for Indians living in any State other than Mon-
tana. 
‘‘SEC. 811. 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 806 and 807, until the Service has submitted to the 
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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. 812. 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 
to persons or circumstances other than those to which it 
is held invalid, shall not be affected thereby. 
‘‘SEC. 813. ESTABLISHMENT OF NATIONAL BIPARTISAN 
COMMISSION ON INDIAN HEALTH CARE. 
‘‘(a) ESTABLISHMENT.—There is established the Na-
tional Bipartisan Indian Health Care Commission (the 
‘Commission’). 
‘‘(b) DUTIES OF COMMISSION.—The duties of the 
Commission are the following: 
‘‘(1) To establish a study committee composed 
of those members of the Commission appointed by 
the Director of the Service and at least 4 members 
of Congress from among the members of the Com-
mission, the duties of which shall be the following: 
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309 
‘‘(A) To the extent necessary to carry out 
its duties, collect and compile data necessary to 
understand the extent of Indian needs with re-
gard to the provision of health services, regard-
less of the location of Indians, including holding 
hearings and soliciting the views of Indians, In-
dian Tribes, Tribal Organizations, and Urban 
Indian Organizations, which may include au-
thorizing and making funds available for feasi-
bility studies of various models for providing 
and funding health services for all Indian bene-
ficiaries, including those who live outside of a 
reservation, temporarily or permanently. 
‘‘(B) To make legislative recommendations 
to the Commission regarding the delivery of 
Federal health care services to Indians. Such 
recommendations shall include those related to 
issues of eligibility, benefits, the range of serv-
ice providers, the cost of such services, financ-
ing such services, and the optimal manner in 
which to provide such services. 
‘‘(C) To determine the effect of the enact-
ment of such recommendations on (i) the exist-
ing system of delivery of health services for In-
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dians, and (ii) the sovereign status of Indian 
Tribes. 
‘‘(D) Not later than 12 months after the 
appointment of all members of the Commission, 
to submit a written report of its findings and 
recommendations to the full Commission. The 
report shall include a statement of the minority 
and majority position of the Committee and 
shall be disseminated, at a minimum, to every 
Indian Tribe, Tribal Organization, and Urban 
Indian Organization for comment to the Com-
mission. 
‘‘(E) To report regularly to the full Com-
mission 
regarding 
the 
findings 
and 
rec-
ommendations developed by the study com-
mittee in the course of carrying out its duties 
under this section. 
‘‘(2) To review and analyze the recommenda-
tions of the report of the study committee. 
‘‘(3) To make legislative recommendations to 
Congress regarding the delivery of Federal health 
care services to Indians. Such recommendations 
shall include those related to issues of eligibility, 
benefits, the range of service providers, the cost of 
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such services, financing such services, and the opti-
mal manner in which to provide such services. 
‘‘(4) Not later than 18 months following the 
date of appointment of all members of the Commis-
sion, submit a written report to Congress regarding 
the delivery of Federal health care services to Indi-
ans. Such recommendations shall include those re-
lated to issues of eligibility, benefits, the range of 
service providers, the cost of such services, financing 
such services, and the optimal manner in which to 
provide such services. 
‘‘(c) MEMBERS.— 
‘‘(1) APPOINTMENT.—The Commission shall be 
composed of 25 members, appointed as follows: 
‘‘(A) Ten members of Congress, including 
3 from the House of Representatives and 2 
from the Senate, appointed by their respective 
majority leaders, and 3 from the House of Rep-
resentatives and 2 from the Senate, appointed 
by their respective minority leaders, and who 
shall be members of the standing committees of 
Congress that consider legislation affecting 
health care to Indians. 
‘‘(B) Twelve persons chosen by the con-
gressional members of the Commission, 1 from 
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312 
each Service Area as currently designated by 
the Director of the Service to be chosen from 
among 3 nominees from each Service Area put 
forward by the Indian Tribes within the area, 
with due regard being given to the experience 
and expertise of the nominees in the provision 
of health care to Indians and to a reasonable 
representation on the commission of members 
who are familiar with various health care deliv-
ery modes and who represent Indian Tribes of 
various size populations. 
‘‘(C) Three persons appointed by the Di-
rector who are knowledgeable about the provi-
sion of health care to Indians, at least 1 of 
whom shall be appointed from among 3 nomi-
nees put forward by those programs whose 
funds are provided in whole or in part by the 
Service primarily or exclusively for the benefit 
of Urban Indians. 
‘‘(D) All those persons chosen by the con-
gressional members of the Commission and by 
the Director shall be members of federally rec-
ognized Indian Tribes. 
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313 
‘‘(2) CHAIR; VICE CHAIR.—The Chair and Vice 
Chair of the Commission shall be selected by the 
congressional members of the Commission. 
‘‘(3) TERMS.—The terms of members of the 
Commission shall be for the life of the Commission. 
‘‘(4) DEADLINE
FOR
APPOINTMENTS.—Con-
gressional members of the Commission shall be ap-
pointed not later than 180 days after the date of en-
actment of the Indian Health Care Improvement Act 
Amendments of 2007, and the remaining members 
of the Commission shall be appointed not later than 
60 days following the appointment of the congres-
sional members. 
‘‘(5) VACANCY.—A vacancy in the Commission 
shall be filled in the manner in which the original 
appointment was made. 
‘‘(d) COMPENSATION.— 
‘‘(1) CONGRESSIONAL
MEMBERS.—Each con-
gressional member of the Commission shall receive 
no additional pay, allowances, or benefits by reason 
of their service on the Commission and shall receive 
travel expenses and per diem in lieu of subsistence 
in accordance with sections 5702 and 5703 of title 
5, United States Code. 
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314 
‘‘(2) OTHER
MEMBERS.—Remaining members 
of the Commission, while serving on the business of 
the Commission (including travel time), shall be en-
titled to receive compensation at the per diem equiv-
alent of the rate provided for level IV of the Execu-
tive Schedule under section 5315 of title 5, United 
States Code, and while so serving away from home 
and the member’s regular place of business, a mem-
ber may be allowed travel expenses, as authorized by 
the Chairman of the Commission. For purpose of 
pay (other than pay of members of the Commission) 
and employment benefits, rights, and privileges, all 
personnel of the Commission shall be treated as if 
they were employees of the United States Senate. 
‘‘(e) MEETINGS.—The Commission shall meet at the 
call of the Chair. 
‘‘(f) QUORUM.—A quorum of the Commission shall 
consist of not less than 15 members, provided that no less 
than 6 of the members of Congress who are Commission 
members are present and no less than 9 of the members 
who are Indians are present. 
‘‘(g) EXECUTIVE DIRECTOR; STAFF; FACILITIES.— 
‘‘(1) APPOINTMENT; PAY.—The Commission 
shall appoint an executive director of the Commis-
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315 
sion. The executive director shall be paid the rate of 
basic pay for level V of the Executive Schedule. 
‘‘(2) STAFF APPOINTMENT.—With the approval 
of the Commission, the executive director may ap-
point such personnel as the executive director deems 
appropriate. 
‘‘(3) STAFF PAY.—The staff of the Commission 
shall be appointed without regard to the provisions 
of title 5, United States Code, governing appoint-
ments in the competitive service, and shall be paid 
without regard to the provisions of chapter 51 and 
subchapter III of chapter 53 of such title (relating 
to classification and General Schedule pay rates). 
‘‘(4) TEMPORARY
SERVICES.—With the ap-
proval of the Commission, the executive director may 
procure temporary and intermittent services under 
section 3109(b) of title 5, United States Code. 
‘‘(5) FACILITIES.—The Administrator of Gen-
eral Services shall locate suitable office space for the 
operation of the Commission. The facilities shall 
serve as the headquarters of the Commission and 
shall include all necessary equipment and incidentals 
required for the proper functioning of the Commis-
sion. 
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‘‘(h) HEARINGS.—(1) For the purpose of carrying 
out its duties, the Commission may hold such hearings 
and undertake such other activities as the Commission de-
termines to be necessary to carry out its duties, provided 
that at least 6 regional hearings are held in different areas 
of the United States in which large numbers of Indians 
are present. Such hearings are to be held to solicit the 
views of Indians regarding the delivery of health care serv-
ices to them. To constitute a hearing under this sub-
section, at least 5 members of the Commission, including 
at least 1 member of Congress, must be present. Hearings 
held by the study committee established in this section 
may count toward the number of regional hearings re-
quired by this subsection. 
‘‘(2) Upon request of the Commission, the Comp-
troller General shall conduct such studies or investigations 
as the Commission determines to be necessary to carry 
out its duties. 
‘‘(3)(A) The Director of the Congressional Budget 
Office or the Chief Actuary of the Centers for Medicare 
& Medicaid Services, or both, shall provide to the Commis-
sion, upon the request of the Commission, such cost esti-
mates as the Commission determines to be necessary to 
carry out its duties. 
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