1693 
Indian organization, in the same Service Area 
where the Tribal Health Program providing the 
scholarship is located, for— 
‘‘(i) a number of years for which the 
scholarship is provided (or the part-time 
equivalent thereof, as determined by the 
Secretary), or for a period of 2 years, 
whichever period is greater; or 
‘‘(ii) such greater period of time as 
the recipient and the Tribal Health Pro-
gram may agree; 
‘‘(B) provide that the amount of the schol-
arship— 
‘‘(i) may only be expended for— 
‘‘(I) tuition expenses, other rea-
sonable educational expenses, and rea-
sonable living expenses incurred in at-
tendance at the educational institu-
tion; and 
‘‘(II) payment to the recipient of 
a monthly stipend of not more than 
the amount authorized by section 
338(g)(1)(B) of the Public Health 
Service 
Act 
(42 
U.S.C. 
254m(g)(1)(B)), with such amount to
1694 
be reduced pro rata (as determined by 
the Secretary) based on the number of 
hours such student is enrolled, and 
not to exceed, for any year of attend-
ance for which the scholarship is pro-
vided, the total amount required for 
the year for the purposes authorized 
in this clause; and 
‘‘(ii) may not exceed, for any year of 
attendance for which the scholarship is 
provided, the total amount required for the 
year for the purposes authorized in clause 
(i); 
‘‘(C) require the recipient of such scholar-
ship to maintain an acceptable level of academic 
standing as determined by the educational insti-
tution in accordance with regulations issued 
pursuant to this Act; and 
‘‘(D) require the recipient of such scholar-
ship to meet the educational and licensure re-
quirements appropriate to each health profes-
sion. 
‘‘(3) SERVICE IN OTHER SERVICE AREAS.—The 
contract may allow the recipient to serve in another 
Service Area, provided the Tribal Health Program
1695 
and Secretary approve and services are not dimin-
ished to Indians in the Service Area where the Trib-
al Health Program providing the scholarship is lo-
cated. 
‘‘(e) BREACH OF CONTRACT.— 
‘‘(1) SPECIFIC BREACHES.—An individual who 
has entered into a written contract with the Sec-
retary and a Tribal Health Program under sub-
section (d) shall be liable to the United States for 
the Federal share of the amount which has been 
paid to him or her, or on his or her behalf, under 
the contract if that individual— 
‘‘(A) fails to maintain an acceptable level 
of academic standing in the educational institu-
tion in which he or she is enrolled (such level 
as determined by the educational institution 
under regulations of the Secretary); 
‘‘(B) is dismissed from such educational 
institution for disciplinary reasons; 
‘‘(C) voluntarily terminates the training in 
such an educational institution for which he or 
she is provided a scholarship under such con-
tract before the completion of such training; or 
‘‘(D) fails to accept payment, or instructs 
the educational institution in which he or she is
1696 
enrolled not to accept payment, in whole or in 
part, of a scholarship under such contract, in 
lieu of any service obligation arising under such 
contract. 
‘‘(2) OTHER BREACHES.—If for any reason not 
specified in paragraph (1), an individual breaches a 
written contract by failing to either begin such indi-
vidual’s service obligation required under such con-
tract or to complete such service obligation, the 
United States shall be entitled to recover from the 
individual an amount determined in accordance with 
the formula specified in subsection (l) of section 110 
in the manner provided for in such subsection. 
‘‘(3) CANCELLATION UPON DEATH OF RECIPI-
ENT.—Upon the death of an individual who receives 
an Indian Health Scholarship, any outstanding obli-
gation of that individual for service or payment that 
relates to that scholarship shall be canceled. 
‘‘(4) INFORMATION.—The Secretary may carry 
out this subsection on the basis of information re-
ceived from Tribal Health Programs involved or on 
the basis of information collected through such other 
means as the Secretary deems appropriate. 
‘‘(f) RELATION TO SOCIAL SECURITY ACT.—The re-
cipient of a scholarship under this section shall agree, in
1697 
providing health care pursuant to the requirements here-
in— 
‘‘(1) not to discriminate against an individual 
seeking care on the basis of the ability of the indi-
vidual to pay for such care or on the basis that pay-
ment for such care will be made pursuant to a pro-
gram established in title XVIII of the Social Secu-
rity Act or pursuant to the programs established in 
title XIX or title XXI of such Act; and 
‘‘(2) to accept assignment under section 
1842(b)(3)(B)(ii) of the Social Security Act for all 
services for which payment may be made under part 
B of title XVIII of such Act, and to enter into an 
appropriate agreement with the State agency that 
administers the State plan for medical assistance 
under title XIX, or the State child health plan under 
title XXI, of such Act to provide service to individ-
uals entitled to medical assistance or child health as-
sistance, respectively, under the plan. 
‘‘(g) CONTINUANCE OF FUNDING.—The Secretary 
shall make payments under this section to a Tribal Health 
Program for any fiscal year subsequent to the first fiscal 
year of such payments unless the Secretary determines 
that, for the immediately preceding fiscal year, the Tribal
1698 
Health Program has not complied with the requirements 
of this section. 
‘‘SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS. 
‘‘(a) EMPLOYMENT PREFERENCE.—Any individual 
who receives a scholarship pursuant to section 104 or 106 
shall be given preference for employment in the Service, 
or may be employed by a Tribal Health Program or an 
urban Indian organization, or other agencies of the De-
partment as available, during any nonacademic period of 
the year. 
‘‘(b) NOT COUNTED TOWARD ACTIVE DUTY SERVICE 
OBLIGATION.—Periods of employment pursuant to this 
subsection shall not be counted in determining fulfillment 
of the service obligation incurred as a condition of the 
scholarship. 
‘‘(c) TIMING; LENGTH OF EMPLOYMENT.—Any indi-
vidual enrolled in a program, including a high school pro-
gram, authorized under section 102(a) may be employed 
by the Service or by a Tribal Health Program or an urban 
Indian organization during any nonacademic period of the 
year. Any such employment shall not exceed 120 days dur-
ing any calendar year. 
‘‘(d) NONAPPLICABILITY
OF
COMPETITIVE
PER-
SONNEL SYSTEM.—Any employment pursuant to this sec-
tion shall be made without regard to any competitive per-
1699 
sonnel system or agency personnel limitation and to a po-
sition which will enable the individual so employed to re-
ceive practical experience in the health profession in which 
he or she is engaged in study. Any individual so employed 
shall receive payment for his or her services comparable 
to the salary he or she would receive if he or she were 
employed in the competitive system. Any individual so em-
ployed shall not be counted against any employment ceil-
ing affecting the Service or the Department. 
‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES. 
‘‘In order to encourage scholarship and stipend re-
cipients under sections 104, 105, 106, and 115 and health 
professionals, including community health representatives 
and emergency medical technicians, to join or continue in 
an Indian Health Program and to provide their services 
in the rural and remote areas where a significant portion 
of Indians reside, the Secretary, acting through the Serv-
ice, may— 
‘‘(1) provide programs or allowances to transi-
tion into an Indian Health Program, including li-
censing, board or certification examination assist-
ance, and technical assistance in fulfilling service ob-
ligations under sections 104, 105, 106, and 115; and 
‘‘(2) provide programs or allowances to health 
professionals employed in an Indian Health Program
1700 
to enable them for a period of time each year pre-
scribed by regulation of the Secretary to take leave 
of their duty stations for professional consultation, 
management, leadership, and refresher training 
courses. 
‘‘SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PRO-
GRAM. 
‘‘(a) IN GENERAL.—Under the authority of the Act 
of November 2, 1921 (25 U.S.C. 13) (commonly known 
as the ‘Snyder Act’), the Secretary, acting through the 
Service, shall maintain a Community Health Representa-
tive Program under which Indian Health Programs— 
‘‘(1) provide for the training of Indians as com-
munity health representatives; and 
‘‘(2) use such community health representatives 
in the provision of health care, health promotion, 
and disease prevention services to Indian commu-
nities. 
‘‘(b) DUTIES.—The Community Health Representa-
tive Program of the Service, shall— 
‘‘(1) provide a high standard of training for 
community health representatives to ensure that the 
community health representatives provide quality 
health care, health promotion, and disease preven-
1701 
tion services to the Indian communities served by 
the Program; 
‘‘(2) in order to provide such training, develop 
and maintain a curriculum that— 
‘‘(A) combines education in the theory of 
health care with supervised practical experience 
in the provision of health care; and 
‘‘(B) provides instruction and practical ex-
perience in health promotion and disease pre-
vention activities, with appropriate consider-
ation given to lifestyle factors that have an im-
pact on Indian health status, such as alco-
holism, family dysfunction, and poverty; 
‘‘(3) maintain a system which identifies the 
needs of community health representatives for con-
tinuing education in health care, health promotion, 
and disease prevention and develop programs that 
meet the needs for continuing education; 
‘‘(4) maintain a system that provides close su-
pervision of Community Health Representatives; 
‘‘(5) maintain a system under which the work 
of Community Health Representatives is reviewed 
and evaluated; and 
‘‘(6) promote traditional health care practices 
of the Indian Tribes served consistent with the Serv-
1702 
ice standards for the provision of health care, health 
promotion, and disease prevention. 
‘‘SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT 
PROGRAM. 
‘‘(a) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the Service, shall establish and administer a pro-
gram to be known as the Service Loan Repayment Pro-
gram (hereinafter referred to as the ‘Loan Repayment 
Program’) in order to ensure an adequate supply of 
trained health professionals necessary to maintain accredi-
tation of, and provide health care services to Indians 
through, Indian Health Programs and urban Indian orga-
nizations. 
‘‘(b) ELIGIBLE INDIVIDUALS.—To be eligible to par-
ticipate in the Loan Repayment Program, an individual 
must— 
‘‘(1)(A) be enrolled— 
‘‘(i) in a course of study or program in an 
accredited educational institution (as deter-
mined 
by 
the 
Secretary 
under 
section 
338B(b)(1)(c)(i) of the Public Health Service 
Act (42 U.S.C. 254l–1(b)(1)(c)(i))) and be 
scheduled to complete such course of study in 
the same year such individual applies to partici-
pate in such program; or
1703 
‘‘(ii) in an approved graduate training pro-
gram in a health profession; or 
‘‘(B) have— 
‘‘(i) a degree in a health profession; and 
‘‘(ii) a license to practice a health profes-
sion; 
‘‘(2)(A) be eligible for, or hold, an appointment 
as a commissioned officer in the Regular or Reserve 
Corps of the Public Health Service; 
‘‘(B) meet the professional standards for civil 
service employment in the Service; or 
‘‘(C) be employed in an Indian Health Program 
or urban Indian organization without a service obli-
gation; and 
‘‘(3) submit to the Secretary an application for 
a contract described in subsection (e). 
‘‘(c) APPLICATION.— 
‘‘(1) INFORMATION
TO
BE
INCLUDED
WITH 
FORMS.—In disseminating application forms and 
contract forms to individuals desiring to participate 
in the Loan Repayment Program, the Secretary 
shall include with such forms a fair summary of the 
rights and liabilities of an individual whose applica-
tion is approved (and whose contract is accepted) by 
the Secretary, including in the summary a clear ex-
1704 
planation of the damages to which the United States 
is entitled under subsection (l) in the case of the in-
dividual’s breach of contract. The Secretary shall 
provide such individuals with sufficient information 
regarding the advantages and disadvantages of serv-
ice as a commissioned officer in the Regular or Re-
serve Corps of the Public Health Service or a civil-
ian employee of the Service to enable the individual 
to make a decision on an informed basis. 
‘‘(2) CLEAR LANGUAGE.—The application form, 
contract form, and all other information furnished 
by the Secretary under this section shall be written 
in a manner calculated to be understood by the aver-
age individual applying to participate in the Loan 
Repayment Program. 
‘‘(3) TIMELY
AVAILABILITY
OF
FORMS.—The 
Secretary shall make such application forms, con-
tract forms, and other information available to indi-
viduals desiring to participate in the Loan Repay-
ment Program on a date sufficiently early to ensure 
that such individuals have adequate time to carefully 
review and evaluate such forms and information. 
‘‘(d) PRIORITIES.— 
‘‘(1) LIST.—Consistent with subsection (j), the 
Secretary shall annually—
1705 
‘‘(A) identify the positions in each Indian 
Health Program or urban Indian organization 
for which there is a need or a vacancy; and 
‘‘(B) rank those positions in order of pri-
ority. 
‘‘(2) APPROVALS.—Consistent with the priority 
determined under paragraph (1), the Secretary, in 
determining which applications under the Loan Re-
payment Program to approve (and which contracts 
to accept), shall— 
‘‘(A) give first priority to applications 
made by individual Indians; and 
‘‘(B) after making determinations on all 
applications submitted by individual Indians as 
required under subparagraph (A), give priority 
to— 
‘‘(i) individuals recruited through the 
efforts of an Indian Health Program or 
urban Indian organization; and 
‘‘(ii) other individuals based on the 
priority rankings under paragraph (1). 
‘‘(e) RECIPIENT CONTRACTS.— 
‘‘(1) CONTRACT REQUIRED.—An individual be-
comes a participant in the Loan Repayment Pro-
gram only upon the Secretary and the individual en-
1706 
tering into a written contract described in paragraph 
(2). 
‘‘(2) CONTENTS
OF
CONTRACT.—The written 
contract referred to in this section between the Sec-
retary and an individual shall contain— 
‘‘(A) an agreement under which— 
‘‘(i) subject to subparagraph (C), the 
Secretary agrees— 
‘‘(I) to pay loans on behalf of the 
individual in accordance with the pro-
visions of this section; and 
‘‘(II) to accept (subject to the 
availability of appropriated funds for 
carrying out this section) the indi-
vidual into the Service or place the in-
dividual with a Tribal Health Pro-
gram or urban Indian organization as 
provided in clause (ii)(III); and 
‘‘(ii) subject to subparagraph (C), the 
individual agrees— 
‘‘(I) to accept loan payments on 
behalf of the individual; 
‘‘(II) in the case of an individual 
described in subsection (b)(1)—
1707 
‘‘(aa) to maintain enrollment 
in a course of study or training 
described in subsection (b)(1)(A) 
until the individual completes the 
course of study or training; and 
‘‘(bb) while enrolled in such 
course of study or training, to 
maintain an acceptable level of 
academic standing (as deter-
mined under regulations of the 
Secretary by the educational in-
stitution offering such course of 
study or training); and 
‘‘(III) to serve for a time period 
(in this section referred to as the ‘pe-
riod of obligated service’) equal to 2 
years or such longer period as the in-
dividual may agree to serve in the 
full-time clinical practice of such indi-
vidual’s 
profession 
in 
an 
Indian 
Health Program or urban Indian or-
ganization to which the individual 
may be assigned by the Secretary; 
‘‘(B) a provision permitting the Secretary 
to extend for such longer additional periods, as
1708 
the individual may agree to, the period of obli-
gated service agreed to by the individual under 
subparagraph (A)(ii)(III); 
‘‘(C) a provision that any financial obliga-
tion of the United States arising out of a con-
tract entered into under this section and any 
obligation of the individual which is conditioned 
thereon is contingent upon funds being appro-
priated for loan repayments under this section; 
‘‘(D) a statement of the damages to which 
the United States is entitled under subsection 
(k) for the individual’s breach of the contract; 
and 
‘‘(E) such other statements of the rights 
and liabilities of the Secretary and of the indi-
vidual, not inconsistent with this section. 
‘‘(f) DEADLINE FOR DECISION ON APPLICATION.— 
The Secretary shall provide written notice to an individual 
within 21 days on— 
‘‘(1) the Secretary’s approving, under sub-
section (e)(1), of the individual’s participation in the 
Loan Repayment Program, including extensions re-
sulting in an aggregate period of obligated service in 
excess of 4 years; or
1709 
‘‘(2) the Secretary’s disapproving an individ-
ual’s participation in such Program. 
‘‘(g) PAYMENTS.— 
‘‘(1) IN GENERAL.—A loan repayment provided 
for an individual under a written contract under the 
Loan Repayment Program shall consist of payment, 
in accordance with paragraph (2), on behalf of the 
individual of the principal, interest, and related ex-
penses on government and commercial loans received 
by the individual regarding the undergraduate or 
graduate education of the individual (or both), which 
loans were made for— 
‘‘(A) tuition expenses; 
‘‘(B) all other reasonable educational ex-
penses, including fees, books, and laboratory ex-
penses, incurred by the individual; and 
‘‘(C) reasonable living expenses as deter-
mined by the Secretary. 
‘‘(2) AMOUNT.—For each year of obligated 
service that an individual contracts to serve under 
subsection (e), the Secretary may pay up to $35,000 
or an amount equal to the amount specified in sec-
tion 338B(g)(2)(A) of the Public Health Service 
Act, whichever is more, on behalf of the individual 
for loans described in paragraph (1). In making a
1710 
determination of the amount to pay for a year of 
such service by an individual, the Secretary shall 
consider the extent to which each such determina-
tion— 
‘‘(A) affects the ability of the Secretary to 
maximize the number of contracts that can be 
provided under the Loan Repayment Program 
from the amounts appropriated for such con-
tracts; 
‘‘(B) provides an incentive to serve in In-
dian Health Programs and urban Indian orga-
nizations with the greatest shortages of health 
professionals; and 
‘‘(C) provides an incentive with respect to 
the health professional involved remaining in an 
Indian Health Program or urban Indian organi-
zation with such a health professional shortage, 
and continuing to provide primary health serv-
ices, after the completion of the period of obli-
gated service under the Loan Repayment Pro-
gram. 
‘‘(3) TIMING.—Any arrangement made by the 
Secretary for the making of loan repayments in ac-
cordance with this subsection shall provide that any 
repayments for a year of obligated service shall be
1711 
made no later than the end of the fiscal year in 
which the individual completes such year of service. 
‘‘(4) REIMBURSEMENTS FOR TAX LIABILITY.— 
For the purpose of providing reimbursements for tax 
liability resulting from a payment under paragraph 
(2) on behalf of an individual, the Secretary— 
‘‘(A) in addition to such payments, may 
make payments to the individual in an amount 
equal to not less than 20 percent and not more 
than 39 percent of the total amount of loan re-
payments made for the taxable year involved; 
and 
‘‘(B) may make such additional payments 
as the Secretary determines to be appropriate 
with respect to such purpose. 
‘‘(5) PAYMENT
SCHEDULE.—The Secretary 
may enter into an agreement with the holder of any 
loan for which payments are made under the Loan 
Repayment Program to establish a schedule for the 
making of such payments. 
‘‘(h) EMPLOYMENT CEILING.—Notwithstanding any 
other provision of law, individuals who have entered into 
written contracts with the Secretary under this section 
shall not be counted against any employment ceiling af-
1712 
fecting the Department while those individuals are under-
going academic training. 
‘‘(i) RECRUITMENT.—The Secretary shall conduct re-
cruiting programs for the Loan Repayment Program and 
other manpower programs of the Service at educational 
institutions training health professionals or specialists 
identified in subsection (a). 
‘‘(j) APPLICABILITY OF LAW.—Section 214 of the 
Public Health Service Act (42 U.S.C. 215) shall not apply 
to individuals during their period of obligated service 
under the Loan Repayment Program. 
‘‘(k) ASSIGNMENT OF INDIVIDUALS.—The Secretary, 
in assigning individuals to serve in Indian Health Pro-
grams or urban Indian organizations pursuant to con-
tracts entered into under this section, shall— 
‘‘(1) ensure that the staffing needs of Tribal 
Health Programs and urban Indian organizations 
receive consideration on an equal basis with pro-
grams that are administered directly by the Service; 
and 
‘‘(2) give priority to assigning individuals to In-
dian Health Programs and urban Indian organiza-
tions that have a need for health professionals to 
provide health care services as a result of individuals
1713 
having breached contracts entered into under this 
section. 
‘‘(l) BREACH OF CONTRACT.— 
‘‘(1) SPECIFIC BREACHES.—An individual who 
has entered into a written contract with the Sec-
retary under this section and has not received a 
waiver under subsection (m) shall be liable, in lieu 
of any service obligation arising under such contract, 
to the United States for the amount which has been 
paid on such individual’s behalf under the contract 
if that individual— 
‘‘(A) is enrolled in the final year of a 
course of study and— 
‘‘(i) fails to maintain an acceptable 
level of academic standing in the edu-
cational institution in which he or she is 
enrolled (such level determined by the edu-
cational institution under regulations of 
the Secretary); 
‘‘(ii) voluntarily terminates such en-
rollment; or 
‘‘(iii) is dismissed from such edu-
cational institution before completion of 
such course of study; or
1714 
‘‘(B) is enrolled in a graduate training pro-
gram and fails to complete such training pro-
gram. 
‘‘(2) 
OTHER
BREACHES; 
FORMULA
FOR 
AMOUNT OWED.—If, for any reason not specified in 
paragraph (1), an individual breaches his or her 
written contract under this section by failing either 
to begin, or complete, such individual’s period of ob-
ligated service in accordance with subsection (e)(2), 
the United States shall be entitled to recover from 
such individual an amount to be determined in ac-
cordance with the following formula: A=3Z(t¥s/t) 
in which— 
‘‘(A) ‘A’ is the amount the United States 
is entitled to recover; 
‘‘(B) ‘Z’ is the sum of the amounts paid 
under this section to, or on behalf of, the indi-
vidual and the interest on such amounts which 
would be payable if, at the time the amounts 
were paid, they were loans bearing interest at 
the maximum legal prevailing rate, as deter-
mined by the Secretary of the Treasury; 
‘‘(C) ‘t’ is the total number of months in 
the individual’s period of obligated service; and
1715 
‘‘(D) ‘s’ is the number of months of such 
period served by such individual in accordance 
with this section. 
‘‘(3) TIME
PERIOD
FOR
REPAYMENT.—Any 
amount of damages which the United States is enti-
tled to recover under this subsection shall be paid to 
the United States within the 1-year period beginning 
on the date of the breach or such longer period be-
ginning on such date as shall be specified by the 
Secretary. 
‘‘(4) DEDUCTIONS IN MEDICARE PAYMENTS.— 
Amounts not paid within such period shall be sub-
ject to collection through deductions in Medicare 
payments pursuant to section 1892 of the Social Se-
curity Act. 
‘‘(5) RECOVERY OF DELINQUENCY.— 
‘‘(A) IN GENERAL.—If damages described 
in paragraph (4) are delinquent for 3 months, 
the Secretary shall, for the purpose of recov-
ering such damages— 
‘‘(i) use collection agencies contracted 
with by the Administrator of General Serv-
ices; or
1716 
‘‘(ii) enter into contracts for the re-
covery of such damages with collection 
agencies selected by the Secretary. 
‘‘(B) REPORT.—Each contract for recov-
ering damages pursuant to this subsection shall 
provide that the contractor will, not less than 
once each 6 months, submit to the Secretary a 
status report on the success of the contractor in 
collecting such damages. Section 3718 of title 
31, United States Code, shall apply to any such 
contract to the extent not inconsistent with this 
subsection. 
‘‘(m) WAIVER OR SUSPENSION OF OBLIGATION.— 
‘‘(1) IN GENERAL.—The Secretary shall by reg-
ulation provide for the partial or total waiver or sus-
pension of any obligation of service or payment by 
an individual under the Loan Repayment Program 
whenever compliance by the individual is impossible 
or would involve extreme hardship to the individual 
and if enforcement of such obligation with respect to 
any individual would be unconscionable. 
‘‘(2) CANCELED UPON DEATH.—Any obligation 
of an individual under the Loan Repayment Pro-
gram for service or payment of damages shall be 
canceled upon the death of the individual.
1717 
‘‘(3) HARDSHIP WAIVER.—The Secretary may 
waive, in whole or in part, the rights of the United 
States to recover amounts under this section in any 
case of extreme hardship or other good cause shown, 
as determined by the Secretary. 
‘‘(4) BANKRUPTCY.—Any obligation of an indi-
vidual under the Loan Repayment Program for pay-
ment of damages may be released by a discharge in 
bankruptcy under title 11, United States Code, only 
if such discharge is granted after the expiration of 
the 5-year period beginning on the first date that 
payment of such damages is required, and only if 
the bankruptcy court finds that nondischarge of the 
obligation would be unconscionable. 
‘‘(n) REPORT.—The Secretary shall submit to the 
President, for inclusion in the report required to be sub-
mitted to Congress under section 801, a report concerning 
the previous fiscal year which sets forth by Service Area 
the following: 
‘‘(1) A list of the health professional positions 
maintained by Indian Health Programs and urban 
Indian organizations for which recruitment or reten-
tion is difficult.
1718 
‘‘(2) The number of Loan Repayment Program 
applications filed with respect to each type of health 
profession. 
‘‘(3) The number of contracts described in sub-
section (e) that are entered into with respect to each 
health profession. 
‘‘(4) The amount of loan payments made under 
this section, in total and by health profession. 
‘‘(5) The number of scholarships that are pro-
vided under sections 104 and 106 with respect to 
each health profession. 
‘‘(6) The amount of scholarship grants provided 
under sections 104 and 106, in total and by health 
profession. 
‘‘(7) The number of providers of health care 
that will be needed by Indian Health Programs and 
urban Indian organizations, by location and profes-
sion, during the 3 fiscal years beginning after the 
date the report is filed. 
‘‘(8) The measures the Secretary plans to take 
to fill the health professional positions maintained 
by Indian Health Programs or urban Indian organi-
zations for which recruitment or retention is dif-
ficult.
1719 
‘‘SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOV-
ERY FUND. 
‘‘(a) ESTABLISHMENT.—There is established in the 
Treasury of the United States a fund to be known as the 
Indian Health Scholarship and Loan Repayment Recovery 
Fund (hereafter in this section referred to as the ‘LRRF’). 
The LRRF shall consist of such amounts as may be col-
lected from individuals under section 104(d), section 
106(e), and section 110(l) for breach of contract, such 
funds as may be appropriated to the LRRF, and interest 
earned on amounts in the LRRF. All amounts collected, 
appropriated, or earned relative to the LRRF shall remain 
available until expended. 
‘‘(b) USE OF FUNDS.— 
‘‘(1) BY SECRETARY.—Amounts in the LRRF 
may be expended by the Secretary, acting through 
the Service, to make payments to an Indian Health 
Program— 
‘‘(A) to which a scholarship recipient under 
section 104 and 106 or a loan repayment pro-
gram participant under section 110 has been 
assigned to meet the obligated service require-
ments pursuant to such sections; and 
‘‘(B) that has a need for a health profes-
sional to provide health care services as a result 
of such recipient or participant having breached
1720 
the contract entered into under section 104, 
106, or 110. 
‘‘(2) BY TRIBAL HEALTH PROGRAMS.—A Tribal 
Health Program receiving payments pursuant to 
paragraph (1) may expend the payments to provide 
scholarships or recruit and employ, directly or by 
contract, health professionals to provide health care 
services. 
‘‘(c) INVESTMENT OF FUNDS.—The Secretary of the 
Treasury shall invest such amounts of the LRRF as the 
Secretary of Health and Human Services determines are 
not required to meet current withdrawals from the LRRF. 
Such investments may be made only in interest bearing 
obligations of the United States. For such purpose, such 
obligations may be acquired on original issue at the issue 
price, or by purchase of outstanding obligations at the 
market price. 
‘‘(d) SALE
OF OBLIGATIONS.—Any obligation ac-
quired by the LRRF may be sold by the Secretary of the 
Treasury at the market price. 
‘‘SEC. 112. RECRUITMENT ACTIVITIES. 
‘‘(a) REIMBURSEMENT
FOR
TRAVEL.—The Sec-
retary, acting through the Service, may reimburse health 
professionals seeking positions with Indian Health Pro-
grams or urban Indian organizations, including individ-
1721 
uals considering entering into a contract under section 
110 and their spouses, for actual and reasonable expenses 
incurred in traveling to and from their places of residence 
to an area in which they may be assigned for the purpose 
of evaluating such area with respect to such assignment. 
‘‘(b) RECRUITMENT PERSONNEL.—The Secretary, 
acting through the Service, shall assign 1 individual in 
each Area Office to be responsible on a full-time basis for 
recruitment activities. 
‘‘SEC. 113. INDIAN RECRUITMENT AND RETENTION PRO-
GRAM. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Service, shall fund, on a competitive basis, innovative 
demonstration projects for a period not to exceed 3 years 
to enable Indian Health Programs and urban Indian orga-
nizations to recruit, place, and retain health professionals 
to meet their staffing needs. 
‘‘(b) ELIGIBLE ENTITIES; APPLICATION.—Any In-
dian Health Program or Urban Indian organization may 
submit an application for funding of a project pursuant 
to this section. 
‘‘SEC. 114. ADVANCED TRAINING AND RESEARCH. 
‘‘(a) DEMONSTRATION PROGRAM.—The Secretary, 
acting through the Service, shall establish a demonstration 
project to enable health professionals who have worked in
1722 
an Indian Health Program or urban Indian organization 
for a substantial period of time to pursue advanced train-
ing or research areas of study for which the Secretary de-
termines a need exists. 
‘‘(b) SERVICE OBLIGATION.—An individual who par-
ticipates in a program under subsection (a), where the 
educational costs are borne by the Service, shall incur an 
obligation to serve in an Indian Health Program or urban 
Indian organization for a period of obligated service equal 
to at least the period of time during which the individual 
participates in such program. In the event that the indi-
vidual fails to complete such obligated service, the indi-
vidual shall be liable to the United States for the period 
of service remaining. In such event, with respect to indi-
viduals entering the program after the date of enactment 
of the Indian Health Care Improvement Act Amendments 
of 2009, the United States shall be entitled to recover 
from such individual an amount to be determined in ac-
cordance with the formula specified in subsection (l) of 
section 110 in the manner provided for in such subsection. 
‘‘(c) EQUAL OPPORTUNITY FOR PARTICIPATION.— 
Health professionals from Tribal Health Programs and 
urban Indian organizations shall be given an equal oppor-
tunity to participate in the program under subsection (a).
1723 
‘‘SEC. 115. QUENTIN N. BURDICK AMERICAN INDIANS INTO 
NURSING PROGRAM. 
‘‘(a) GRANTS AUTHORIZED.—For the purpose of in-
creasing the number of nurses, nurse midwives, and nurse 
practitioners who deliver health care services to Indians, 
the Secretary, acting through the Service, shall provide 
grants to the following: 
‘‘(1) Public or private schools of nursing. 
‘‘(2) Tribal colleges or universities. 
‘‘(3) Nurse midwife programs and advanced 
practice nurse programs that are provided by any 
tribal college or university accredited nursing pro-
gram, or in the absence of such, any other public or 
private institutions. 
‘‘(b) USE OF GRANTS.—Grants provided under sub-
section (a) may be used for 1 or more of the following: 
‘‘(1) To recruit individuals for programs which 
train individuals to be nurses, nurse midwives, or 
advanced practice nurses. 
‘‘(2) To provide scholarships to Indians enrolled 
in such programs that may pay the tuition charged 
for such program and other expenses incurred in 
connection with such program, including books, fees, 
room and board, and stipends for living expenses. 
‘‘(3) To provide a program that encourages 
nurses, nurse midwives, and advanced practice