H. J. Res. 31—236 
DEPARTMENT OF HEALTH AND HUMAN SERVICES 
INDIAN HEALTH SERVICE 
INDIAN HEALTH SERVICES 
For expenses necessary to carry out the Act of August 5, 1954 
(68 Stat. 674), the Indian Self-Determination and Education Assist-
ance Act, the Indian Health Care Improvement Act, and titles 
II and III of the Public Health Service Act with respect to the 
Indian Health Service, $4,103,190,000, to remain available until 
September 30, 2020, except as otherwise provided herein, together 
with payments received during the fiscal year pursuant to sections 
231(b) and 233 of the Public Health Service Act (42 U.S.C. 238(b), 
238b), for services furnished by the Indian Health Service: Provided, 
That funds made available to tribes and tribal organizations 
through contracts, grant agreements, or any other agreements or 
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 $2,000,000 
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 
$964,819,000 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 $44,000,000 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, $36,000,000 shall remain available 
until expended to supplement funds available for operational costs 
at tribal clinics operated under an Indian Self-Determination and 
Education Assistance Act compact or contract where health care 
is delivered in space acquired through a full service lease, which 
is not eligible for maintenance and improvement and equipment 
funds from the Indian Health Service, and $58,000,000 shall be 
for costs related to or resulting from accreditation emergencies, 
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 author-
ized by sections 104 and 108 of the Indian Health Care Improve-
ment Act (25 U.S.C. 1613a and 1616a) during the preceding fiscal 
year for breach of contracts shall be deposited to the Fund author-
ized 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, 
to improve collections from public and private insurance at Indian
H. J. Res. 31—237 
Health Service and tribally operated facilities, and for accreditation 
emergencies 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 for which the performance 
period falls 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 shall remain available until expended for the 
purpose of achieving compliance with the applicable conditions and 
requirements 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 scholarship programs under the Indian Health Care Improve-
ment Act shall remain available until expended: Provided 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, $72,280,000 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 the accreditation 
emergency funds may be used, as needed, to carry out activities 
typically funded under the Indian Health Facilities account. 
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 2019, 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. 
INDIAN HEALTH FACILITIES 
For construction, repair, maintenance, improvement, and equip-
ment of health and related auxiliary facilities, including quarters 
for personnel; preparation of plans, specifications, and drawings; 
acquisition of sites, purchase and erection of modular buildings, 
and purchases of trailers; and for provision of domestic and commu-
nity 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 environ-
mental health and facilities support activities of the Indian Health 
Service, $878,806,000, to remain available until expended: Provided,
H. J. Res. 31—238 
That notwithstanding any other provision of law, funds appro-
priated for the planning, design, construction, renovation or expan-
sion 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 equip-
ment from the Department of Defense for distribution to the Indian 
Health Service and tribal facilities: Provided further, That none 
of the funds appropriated to the Indian Health Service may be 
used for sanitation facilities construction for new homes funded 
with grants by the housing programs of the United States Depart-
ment of Housing and Urban Development: Provided further, That 
not to exceed $2,700,000 from this account and the ‘‘Indian Health 
Services’’ account may be used by the Indian Health Service to 
obtain ambulances for the Indian Health Service and tribal facilities 
in conjunction with an existing interagency agreement between 
the Indian Health Service and the General Services Administration: 
Provided further, That not to exceed $500,000 may be placed in 
a Demolition Fund, to remain available until expended, and be 
used by the Indian Health Service for the demolition of Federal 
buildings. 
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. J. Res. 31—239 
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. 5321 et seq. (title I), 5381 et 
seq. (title V)), may be deobligated and reobligated to a self-deter-
mination 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 Register on September 
16, 1987, by the Department of Health and Human Services, 
relating to the eligibility for the health care services of the Indian 
Health Service until the Indian Health Service has submitted a 
budget request reflecting the increased costs associated 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 author-
ized to provide goods and services to those entities on a reimburs-
able basis, including payments in advance with subsequent adjust-
ment, 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 originally derived, 
with such amounts to remain available until expended: Provided 
further, That reimbursements for training, technical assistance, 
or services provided by the Indian Health Service will contain 
total costs, including direct, administrative, and overhead costs 
associated with the provision of goods, services, or technical assist-
ance: Provided further, That the Indian Health Service may provide 
to civilian medical personnel serving in hospitals operated 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 Appropriations. 
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, $79,000,000.