176
pend such funds for the provision of additional health
services.
‘‘(h) In any action brought to enforce the provisions
of this section, a prevailing plaintiff shall be awarded its
reasonable attorneys fees and costs of litigation.
‘‘(i) Where an insurance company or employee benefit
plan fails or refuses to pay the amount due under sub-
section (a) of this section for services provided to an indi-
vidual who is a beneficiary, participant, or insured of such
company or plan, the United States, Indian tribe, or tribal
organization shall have a right to assert and pursue all
the claims and remedies against such company or plan,
and against the fiduciaries of such company or plan, that
the individual could assert or pursue under applicable
Federal, State, or tribal law.
‘‘(j) Where an insurance company or employee benefit
plan fails or refuses to pay the amounts due under sub-
section (b) for health services provided to an individual
who is a beneficiary, participant, or insured of such com-
pany or plan, the urban Indian organization shall have a
right to assert and pursue all the claims and remedies
against such company or plan, and against the fiduciaries
of such company or plan, that the individual could assert
or pursue under applicable Federal or State law.
177
‘‘(k) Notwithstanding any other provision in law, the
Service, an Indian tribe, tribal organization, or an urban
Indian organization shall have a right of recovery for any
otherwise reimbursable claim filed on a current HCFA–
1500 or UB–92 form, or the current electronic format,
or their successors. No health plan shall deny payment
because a claim has not been submitted in a unique format
that differs from such forms.
‘‘SEC. 407. CREDITING OF REIMBURSEMENTS.
‘‘(a) Except as provided in section 202(d), this title,
and section 807, all reimbursements received or recovered,
under authority of this Act, Public Law 87–693 (42
U.S.C. 2651 et seq.), or any other provision of law, by
reason of the provision of health services by the Service
or by an Indian tribe or tribal organization under a fund-
ing agreement pursuant to the Indian Self-Determination
and Education Assistance Act or by an urban Indian orga-
nization funded under title V shall be retained by the Serv-
ice or that Tribe or tribal organization and shall be avail-
able for the facilities, and to carry out the programs, of
the Service or that Tribe or tribal organization to provide
health care services to Indians.
‘‘(b) The Service may not offset or limit the amount
of funds obligated to any service unit or entity receiving
178
funding from the Service because of the receipt of reim-
bursements under subsection (a).
‘‘SEC. 408. PURCHASING HEALTH CARE COVERAGE.
‘‘Tribes, tribal organizations, and urban Indian orga-
nizations are authorized to use funding from the Secretary
under this Act to purchase managed care coverage for In-
dian Health Services beneficiaries (including authority to
purchase insurance to limit the financial risks of such enti-
ties) from—
‘‘(1) a tribally owned and operated managed
care plan;
‘‘(2) a State or locally authorized or licensed
managed care plan; or
‘‘(3) a health insurance provider.
‘‘SEC. 409. INDIAN HEALTH SERVICE, DEPARTMENT OF VET-
ERANS AFFAIRS, AND OTHER FEDERAL AGEN-
CY HEALTH FACILITIES AND SERVICES SHAR-
ING.
‘‘(a) The Secretary shall examine the feasibility of en-
tering into arrangements or expanding existing arrange-
ments for the sharing of medical facilities and services be-
tween the Indian Health Service and the Veterans Admin-
istration, and other appropriate Federal agencies, includ-
ing those within the Department, and shall, in accordance
with subsection (b), prepare a report on the feasibility of
179
such an arrangement and submit such report to the Con-
gress by no later than September 30, 2001, provided that
the Secretary may not finalize any such agreement with-
out first consulting with the affected Indian tribes.
‘‘(b) The Secretary shall not take any action under
this section or under subchapter IV of chapter 81 of title
38, United States Code, which would impair—
‘‘(1) the priority access of any Indian to health
care services provided through the Indian Health
Service;
‘‘(2) the quality of health care services provided
to any Indian through the Indian Health Service;
‘‘(3) the priority access of any veteran to health
care services provided by the Veterans Administra-
tion;
‘‘(4) the quality of health care services provided
to any veteran by the Veterans Administration;
‘‘(5) the eligibility of any Indian to receive
health services through the Indian Health Service;
or
‘‘(6) the eligibility of any Indian who is a vet-
eran to receive health services through the Veterans
Administration (provided that the Service, the In-
dian tribe or tribal organization shall be reimbursed
by the Veterans Administration where services are
180
provided through the Service, Indian tribes or tribal
organizations to beneficiaries eligible for services
from the Veterans Administration, notwithstanding
any other provision of law).
‘‘(c) The Director is authorized to enter into agree-
ments with other Federal agencies to assist in achieving
parity in services for Indians. Nothing in this section may
be construed as creating any right of a veteran to obtain
health services from the Indian Health Service.
‘‘SEC. 410. PAYOR OF LAST RESORT.
‘‘The Indian Health Service, and programs operated
by Tribes, tribal organizations, or urban Indian organiza-
tions shall be the payor of last resort for services provided
to persons eligible for services from these programs, not-
withstanding any Federal, State, or local law to the con-
trary, unless such law explicitly provides otherwise.
‘‘SEC. 411. PAYMENT OR REIMBURSEMENT FOR SERVICES.
‘‘Notwithstanding any other provision of law, the In-
dian Health Service, Indian tribes, tribal organizations,
and urban Indian organizations (notwithstanding limita-
tions on who is eligible to receive services from such enti-
ty) shall be eligible to receive payment or reimbursement
for services provided by such entities from any federally
funded health care program, unless there is an explicit
181
prohibition on such payments in the applicable authorizing
statute.
‘‘SEC. 412. TUBA CITY DEMONSTRATION PROJECT.
‘‘Notwithstanding any other provision of law, includ-
ing the Anti-Deficiency Act, provided the Indian tribes to
be served approve, the Service in the Tuba City Service
Unit is authorized to enter into a demonstration project
with the State of Arizona under which the Service would
provide certain specified medicaid services to Indian
Health Services/medicaid eligibles in return for payment
on a capitated basis from the State of Arizona and is au-
thorized to purchase insurance to limit its financial risks
under this project. This project may be extended to other
service units in Arizona, subject to the approval of the In-
dian tribes to be served in such service units, the Service,
and the State of Arizona.
‘‘SEC. 413. ACCESS TO FEDERAL INSURANCE.
‘‘Notwithstanding the provisions of title 5, United
States Code, executive order, or administrative regulation,
an Indian tribe or tribal organization carrying out pro-
grams under the Indian Self-Determination and Edu-
cation Assistance Act or an urban Indian organization car-
rying out programs under title V of this Act shall be enti-
tled to purchase coverage, rights, and benefits for the em-
ployees of such Indian tribe, tribal organization, or urban
182
Indian organization under chapter 89 of title 5, United
States Code, (relating to health insurance) and chapter
87 of title 5, United States Code, (relating to life insur-
ance) if necessary employee deductions and agency con-
tributions in payment for the coverage, rights, and bene-
fits for the period of employment with such Indian tribe,
tribal organization, or urban Indian organization are cur-
rently deposited in the applicable Employee’s Fund under
title 5, United States Code.
‘‘SEC. 414. CONSULTATION AND RULEMAKING.
‘‘(a) CONSULTATION.—Prior to the adoption of any
policy or regulation by the Health Care Financing Admin-
istration, the Secretary shall—
‘‘(1) identify the impact such policy or regula-
tion may have on the Service, Indian tribes, tribal
organizations, and urban Indian organizations;
‘‘(2) provide to the Service, Indian tribes, tribal
organizations, and urban Indian organizations the
information described in paragraph (1); and
‘‘(3) engage in consultation with the Service,
Indian tribes, tribal organizations, and urban Indian
organizations prior to enacting any such policy or
regulation. Such consultation shall be consistent
with the requirements of Executive Order 13084 of
May 14, 1998.
183
‘‘(b) RULEMAKING.—The Health Care Financing Ad-
ministration shall participate in the negotiated rulemaking
provided for under title VIII of this Act with regard to
any regulations necessary to implement the provisions of
this title that relate to the Social Security Act.’’.
‘‘SEC. 415. LIMITATION ON SECRETARY’S WAIVER AUTHOR-
ITY.
‘‘Notwithstanding any other provision of law, the Sec-
retary may not waive the application of section
1902(a)(13)(D) to any State Plan under title XIX of the
Social Security Act.
‘‘SEC. 416. CHILDREN’S HEALTH INSURANCE PROGRAM
FUNDS.
‘‘(a) DIRECT FUNDING.—The Secretary is authorized
to enter into agreements directly with the Indian Health
Service and Indian tribes and tribal organizations under
which such entities will provide children’s health insurance
program-like services to Indians who reside in a service
area on or near an Indian reservation. Such agreements
may provide for funding under a block grant or such other
mechanism as is agreed upon by the Secretary and the
Indian Health Service, Indian tribe, or tribal organization.
Such agreements may not be made contingent on the ap-
proval of the State in which the Indians to be served re-
side.
184
‘‘(b) TRANSFER.—Notwithstanding any other provi-
sion of law, a State may transfer funds to which it is,
or would otherwise be, entitled under title XXI of the So-
cial Security Act to the Indian Health Service, Indian
tribes, and tribal organizations to be administered to
achieve the purposes and objectives of such title under
agreements between the State and recipient entity or
under an agreement directly between the recipient entity
and the Health Care Financing Administration.
‘‘SEC. 417. WAIVER OF MEDICARE AND MEDICAID SANC-
TIONS.
‘‘Notwithstanding any other provision of law, the In-
dian Health Service or an Indian tribe or tribal organiza-
tion operating a health program under the Indian Self-
Determination and Education Assistance Act shall be enti-
tled to seek a waiver of sanctions imposed under title
XVIII, XIX, or XXI of the Social Security Act as if it
were directly responsible for administering the State
health care program.
‘‘SEC. 418. SAFE HARBOR.
‘‘(a) The term ‘remuneration’ as used in sections
1128A and 1128B of the Social Security Act (42 U.S.C.
1320a–7a and 1320a–7b) shall not include any exchange
of anything of value between or among—
185
‘‘(1) any Indian tribe or tribal organization that
administers health programs under the authority of
the Indian Self-Determination and Education Assist-
ance Act (25 U.S.C. 450 et seq.);
‘‘(2) any such Indian tribe or tribal organiza-
tion and the Indian Health Service;
‘‘(3) any such Indian tribe or tribal organiza-
tion and any patient served or eligible for service
under such programs, including patients served or
eligible for service pursuant to section 813 of Public
Law 94–437 (25 U.S.C. 1680c); or
‘‘(4) any such Indian tribe or tribal organiza-
tion and any third party required by contract, sec-
tion 206 or 207 of Public Law 94–437 (42 U.S.C.
1621e or 1621f), or other applicable law, to pay or
reimburse the reasonable health care costs incurred
by the United States or any such Indian tribe or
tribal organization;
if the exchange arises from or relates to such health pro-
grams.
‘‘(b) An Indian tribe, tribal organization, or urban
Indian organization that administers health programs
under the authority of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.) or title
V of the Indian Health Care Improvement Act shall be
186
deemed to be an agency of the United States and immune
from liability under the Sherman Act (15 U.S.C. 1 et
seq.), the Clayton Act (15 U.S.C. 12 et seq.), the Robin-
son-Patman Act, the Federal Trade Commission Act (15
U.S.C. 41 et seq.), and any other Federal, State, or local
antitrust laws, with regard to any transaction, agreement,
or conduct that relates to such programs.
‘‘SEC. 419. COST SHARING.
‘‘(a) 
COINSURANCE, 
COPAYMENTS, 
AND
DEDUCTIBLES.—Notwithstanding any other provision of
Federal or State law, no Indian who is eligible for services
under title XVIII, XIX, or XXI of the Social Security Act,
or any other federally funded health programs may be
charged a deductible, copayment, or coinsurance for any
service provided by or through the Indian Health Service,
an Indian tribe, tribal organization, or urban Indian orga-
nization, nor may the payment or reimbursement due to
the Indian Health Service or an Indian tribe, tribal organi-
zation, or urban Indian organization be reduced by the
amount of the deductible, copayment, or coinsurance that
would be due from the Indian but for the operation of
this section. For the purposes of this section, ‘through’
shall include services provided directly, by referral, or
under contracts or other arrangements between the Indian
187
Health Service, Indian tribe, tribal organization, or urban
Indian organization and another health provider.
‘‘(b) PREMIUMS.—
‘‘(1) MEDICAID
AND
CHILD
HEALTH
INSUR-
ANCE PROGRAM.—Notwithstanding any other provi-
sion of Federal or State law, no Indian who is other-
wise eligible for services under title XIX (medicaid)
or title XXI (children’s health insurance program) of
the Social Security Act may be charged a premium
as a condition of receiving benefits from the pro-
gram.
‘‘(2) MEDICARE ENROLLMENT PREMIUM PEN-
ALTIES.—Notwithstanding any other provision of
Federal or State law, no Indian (as that term is de-
fined in section 4 of the Indian Health Care Im-
provement Act) who is eligible for Medicare, but for
the payment of premiums, shall be charged a penalty
for enrolling in Medicare at a time later than the
person might otherwise have been eligible. This pro-
hibition applies whether the Indian pays for the pre-
miums directly or the premiums are paid by another
person or entity, including a State, the Indian
Health Service, an Indian tribe, tribal organization,
or an urban Indian organization.
188
‘‘(c) MEDICALLY NEEDY PROGRAM SPEND-DOWN.—
For the purposes of any medically needy option under a
State’s Medicaid plan under title XIX of the Social Secu-
rity Act, the cost of providing services to an Indian in a
health program of the Indian Health Service, an Indian
tribe, tribal organization, or urban Indian organization
shall be deemed to have been an expenditure for health
care by the person applying for Medicaid.
‘‘(d) ESTATE
RECOVERY.—Notwithstanding any
other provision of Federal or State law, the following prop-
erty may not be included when determining eligibility for
services or implementing estate recovery rights under title
XVIII, XIX, or XXI of the Social Security Act, or other
health care programs funded in whole or part with Federal
moneys—
‘‘(1) income derived from rents, leases, or royal-
ties of property held in trust for individuals by the
Federal Government;
‘‘(2) income derived from rents, leases, royal-
ties, or natural resources (including timber and fish-
ing activities) resulting from the exercise of federally
protected rights, whether collected by an individual
or tribal group, and distributed to individuals;
‘‘(3) property, including interests in real prop-
erty currently or formerly held in trust by the Fed-
189
eral Government which is protected under applicable
Federal, State or tribal law or custom from recourse
and including public domain allotments; and
‘‘(4) property that has unique religious or cul-
tural significance or that supports subsistence or
traditional lifestyle according to applicable tribal law
or custom.
‘‘(e) MEDICAL CHILD SUPPORT RECOVERY.—Not-
withstanding any other provision of law, a parent shall not
be responsible for reimbursing a State or the Federal Gov-
ernment for the cost of medical services provided to a child
by or through the Indian Health Service, an Indian tribe,
tribal organization, or urban Indian organization. For the
purposes of this subsection, ‘through’ shall include services
provided directly, by referral, or under contracts or other
arrangements between the Indian Health Service, Indian
tribe, tribal organization or urban Indian organization and
another health provider.
‘‘SEC. 420. MANAGED CARE.
‘‘(a) RECOVERY FROM MANAGED CARE PLANS.—(1)
Notwithstanding any other provision in law, the Indian
Health Service, an Indian tribe, tribal organization, or
urban Indian organization shall have a right of recovery
under section 408 of this title from all private and public
health plans, including medicare, medicaid, children’s
190
health insurance, and privately managed care plans for the
reasonable costs of delivering health services to Indians
entitled to receive services from the Service, an Indian
tribe, tribal organization, or urban Indian organization.
‘‘(2) No provision of a contract, regulation or statute
may be relied upon or interpreted to deny or reduce pay-
ments otherwise due under this section, except to the ex-
tent the Service, Indian tribe, tribal organization, or urban
Indian organization has entered into an agreement with
the managed care plan regarding services to be provided
or rates to be paid, provided that such an agreement may
not be made a prerequisite for such payments to be made.
‘‘(3) Payments due under this section may not be less
than those paid to a ‘preferred provider’ under the man-
aged care plan or, in the event there is no such rate, the
usual and customary fee for equivalent services.
‘‘(4) A managed care plan may not deny payment
under this section because the insured or covered bene-
ficiary of the plan has not submitted a claim.
‘‘(5) Notwithstanding paragraphs (1) through (4) of
this section, the Indian Health Service, an Indian tribe,
tribal organization, or urban Indian organization that pro-
vides a health service to an Indian entitled under title XIX
(medicaid) or enrolled under title XXI (children’s health
insurance program) of the Social Security Act to receive
191
such services shall have the right to be paid directly by
the State’s Medicaid or children’s health insurance pro-
gram notwithstanding any agreements the State may have
entered into with managed care organizations or pro-
viders.
‘‘(6) A managed care organization that is enrolled in
a State Medicaid program must as a condition of such
enrollment offer a contract to health programs adminis-
tered by the Indian Health Service, an Indian tribe, tribal
organization, or urban Indian organization that provides
health services in the geographic area served by the man-
aged care organization and such contract (or other pro-
vider participation agreement) shall contain terms and
conditions of participation and payment no more restric-
tive or onerous than those provided for in this section.
‘‘(b) PROHIBIT
AUTO- 
AND
DEFAULT
ASSIGN-
MENT.—Notwithstanding any other provision of law or
any waiver granted by the Secretary, no Indian may be
assigned automatically or by default under any managed
care plan paid under title XIX (medicaid) or title XXI
(children’s health insurance program) of the Social Secu-
rity Act unless the person had the option of enrolling in
a managed care plan or health program administered by
the Service, an Indian tribe, tribal organization, or urban
Indian organization in which case an Indian may be as-
192
signed only to such a managed care plan or health pro-
gram.
‘‘(c) INDIAN
MANAGED
CARE
PLANS.—Notwith-
standing any other provision of law, any State entering
into agreements with one or more managed care organiza-
tions to provide services under title XIX or title XXI of
the Social Security Act must enter into such an agreement
with the Service, an Indian tribe, tribal organization, or
urban Indian organization that can provide services to In-
dians who may be eligible or required to enroll in such
a managed care plan similar to those to be offered by
other managed care organizations. The Secretary and the
State are hereby authorized to waive requirements regard-
ing discrimination, capitalization, and other matters that
might otherwise prevent the Indian managed care organi-
zation or health program from meeting Federal or State
standards applicable to such organizations, provided such
Indian managed care organization or health program must
be able to offer its Indian enrollees services of an equiva-
lent quality to that required of other managed care organi-
zations.
‘‘(d) ADVERTISING.—A managed care organization
entering into contracts to provide services to Indians on
or near an Indian reservation shall provide a certificate
of coverage or similar type of document that is written
193
in the Indian language of the majority of the Indian popu-
lation residing on such reservation.
‘‘SEC. 421. NAVAJO NATION MEDICAID AGENCY.
‘‘(a) Notwithstanding any other provision of law, the
Secretary is authorized to treat the Navajo Nation as a
State for the purposes of title XIX of the Social Security
Act, to provide services to Indians living within the bound-
aries of the Navajo Nation.
‘‘(b) Notwithstanding any other provision of law, the
Secretary shall have the authority to assign and pay all
funds for the provision of services to Indians living within
the boundaries of the Navajo Nation under title XIX of
the Social Security Act and related administrative funds
under title XIX (medicaid) of the Social Security Act,
which are currently paid to or would otherwise be paid
to the States of Arizona, New Mexico, and Utah, to an
entity established by the Navajo Nation and approved by
the Secretary, which shall be denominated the Navajo Na-
tion Medicaid Agency.
‘‘(c) The Navajo Nation Medicaid Agency shall serve
Indians living within the boundaries of the Navajo Nation
and shall have the same authority and perform the same
functions as other single State medicaid agencies.
‘‘(d) The Secretary is authorized to directly assist the
Navajo Nation in the development and implementation of
194
a Navajo Nation Medicaid Agency for the administration,
eligibility, payment, and delivery of Medicaid eligible serv-
ices, including western and traditional Navajo healing
services, within the Navajo Nation.
‘‘(e) Notwithstanding section 1905(b) of the Social
Security Act, the Federal medical assistance percentage
shall be 100 per centum with respect to amounts the Nav-
ajo Nation Medicaid Agency expends for medical assist-
ance for services and for related administrative costs.
‘‘(f) The Secretary is further authorized to assist the
Navajo Nation by providing funding including demonstra-
tion grant funding for this project.
‘‘(g) The Secretary shall have the authority to waive
applicable provisions of title XIX of the Social Security
Act to establish, develop, and implement the Navajo Na-
tion Medicaid Agency.
‘‘(h) In the option of the Navajo Nation, the Sec-
retary is authorized to treat the Navajo Nation as a State
for the purposes of title XXI (children’s health insurance
program) under terms equivalent to those described in
subsections (a) through (g) of this section.
‘‘SEC. 422. INDIAN ADVISORY COMMITTEES.
‘‘(a) NATIONAL
INDIAN
TECHNICAL
ADVISORY
GROUP.—The Health Care Financing Administration
shall establish and fund the expenses of a National Indian
195
Technical Advisory Group which shall have no fewer than
14 members including at least 1 member designated by
the Indian tribes and tribal organizations in each service
area, 1 urban Indian organization representative, and 1
member representing the Indian Health Service. The
scope of the activities of such group shall be established
under section 802. Such scope shall include providing com-
ment on and advice regarding the programs funded under
titles XVIII, XIX, and XXI of the Social Security Act or
any other health care program funded (in whole or part)
by the Health Care Financing Administration.
‘‘(b) INDIAN MEDICAID ADVISORY COMMITTEES.—
The Health Care Financing Administration shall establish
and provide funding for an Indian Medicaid Advisory
Committee made up of designees of the Indian Health
Service, Indian tribes, tribal organizations, and urban In-
dian organizations in each State in which the Indian
Health Service directly operates a health program or in
which there is 1 or more Indian tribe, tribal organization,
or urban Indian organization.
‘‘SEC. 423. LIMITATIONS ON CHARGES.
‘‘No provider of health services that is eligible to re-
ceive payments or reimbursements from under title XVIII,
XIX, or XXI of the Social Security Act or from any feder-
196
ally funded (whether in whole or part) health care pro-
gram may seek to recover payment for services—
‘‘(1) that are covered under and furnished to an
individual eligible for the contract health services
program operated by the Indian Health Service, by
an Indian tribe or tribal organization or furnished to
an urban Indian eligible for health services pur-
chased by an urban Indian organization (as those
terms are defined in section 4 of the Indian Health
Care Improvement Act), an amount in excess of the
lowest amount paid by any other payor for com-
parable services; or
‘‘(2) for examinations or other diagnostic proce-
dures that are not medically necessary if such proce-
dures have already been performed by the referring
Indian health program and reported to the provider.
‘‘SEC. 424. AUTHORIZATION OF APPROPRIATIONS.
‘‘There are authorized to be appropriated such sums
as may be necessary for each fiscal year through fiscal
year 2013 to carry out this title.
197
‘‘TITLE V—HEALTH SERVICES
FOR URBAN INDIANS
‘‘SEC. 501. PURPOSE.
‘‘The purpose of this title is to establish programs
in urban centers to make health services more accessible
and available to urban Indians.
‘‘SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN IN-
DIAN ORGANIZATIONS.
‘‘Under authority of the Act of November 2, 1921
(25 U.S.C. 13), popularly known as the Snyder Act, the
Secretary, through the Service, shall enter into contracts
with, or make grants to, urban Indian organizations to
assist such organizations in the establishment and admin-
istration, within urban centers, of programs which meet
the requirements set forth in this title. The Secretary,
through the Service, subject to subsection 506, shall in-
clude such conditions as the Secretary considers necessary
to effect the purpose of this title in any contract which
the Secretary enters into with, or in any grant the Sec-
retary makes to, any urban Indian organization pursuant
to this title.
‘‘SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION
OF HEALTH CARE AND REFERRAL SERVICES.
‘‘(a) Under authority of the Act of November 2, 1921
(25 U.S.C. 13), popularly known as the Snyder Act, the
198
Secretary, through the Service, shall enter into contracts
with, and make grants to, urban Indian organizations for
the provision of health care and referral services for urban
Indians. Any such contract or grant shall include require-
ments that the urban Indian organization successfully un-
dertake to—
‘‘(1) estimate the population of urban Indians
residing in the urban center or centers that the or-
ganization proposes to serve who are or could be re-
cipients of health care or referral services;
‘‘(2) estimate the current health status of
urban Indians residing in such urban center or cen-
ters;
‘‘(3) estimate the current health care needs of
urban Indians residing in such urban center or cen-
ters;
‘‘(4) provide basic health education, including
health promotion and disease prevention education,
to urban Indians;
‘‘(5) make recommendations to the Secretary
and Federal, State, local, and other resource agen-
cies on methods of improving health service pro-
grams to meet the needs of urban Indians; and
199
‘‘(6) where necessary, provide, or enter into
contracts for the provision of, health care services
for urban Indians.
‘‘(b) The Secretary, through the Service, shall by reg-
ulation adopted pursuant to section 520 prescribe the cri-
teria for selecting urban Indian organizations to enter into
contracts or receive grants under this section. Such cri-
teria shall, among other factors, include—
‘‘(1) the extent of unmet health care needs of
urban Indians in the urban center or centers in-
volved;
‘‘(2) the size of the urban Indian population in
the urban center or centers involved;
‘‘(3) the extent, if any, to which the activities
set forth in subsection (a) would duplicate any
project funded under this title;
‘‘(4) the capability of an urban Indian organiza-
tion to perform the activities set forth in subsection
(a) and to enter into a contract with the Secretary
or to meet the requirements for receiving a grant
under this section;
‘‘(5) the satisfactory performance and success-
ful completion by an urban Indian organization of
other contracts with the Secretary under this title;
200
‘‘(6) the appropriateness and likely effectiveness
of conducting the activities set forth in subsection
(a) in an urban center or centers; and
‘‘(7) the extent of existing or likely future par-
ticipation in the activities set forth in subsection (a)
by appropriate health and health-related Federal,
State, local, and other agencies.
‘‘(c) The Secretary shall facilitate access to, or pro-
vide, health promotion and disease prevention services for
urban Indians through grants made to urban Indian orga-
nizations administering contracts entered into pursuant to
this section or receiving grants under subsection (a).
‘‘(d)(1) The Secretary shall facilitate access to, or
provide, immunization services for urban Indians through
grants made to urban Indian organizations administering
contracts entered into or receiving grants under this sec-
tion.
‘‘(2) For purposes of this subsection, the term ‘immu-
nization services’ means services to provide without charge
immunizations against vaccine-preventable diseases.
‘‘(e)(1) The Secretary shall facilitate access to, or
provide, mental health services for urban Indians through
grants made to urban Indian organizations administering
contracts entered into pursuant to this section or receiving
grants under subsection (a).
201
‘‘(2) A grant may not be made under this subsection
to an urban Indian organization until that organization
has prepared, and the Service has approved, an assess-
ment of the mental health needs of the urban Indian popu-
lation concerned, the mental health services, and other re-
lated resources available to that population, the barriers
to obtaining those services and resources, and the needs
that are unmet by such services and resources.
‘‘(3) Grants may be made under this subsection—
‘‘(A) to prepare assessments required under
paragraph (2);
‘‘(B) to provide outreach, educational, and re-
ferral services to urban Indians regarding the avail-
ability of direct behavioral health services, to educate
urban Indians about behavioral health issues and
services, and effect coordination with existing behav-
ioral health providers in order to improve services to
urban Indians;
‘‘(C) to provide outpatient behavioral health
services to urban Indians, including the identifica-
tion and assessment of illness, therapeutic treat-
ments, case management, support groups, family
treatment, and other treatment; and
202
‘‘(D) to develop innovative behavioral health
service delivery models which incorporate Indian cul-
tural support systems and resources.
‘‘(f)(1) The Secretary shall facilitate access to, or
provide, services for urban Indians through grants to
urban Indian organizations administering contracts en-
tered into pursuant to this section or receiving grants
under subsection (a) to prevent and treat child abuse (in-
cluding sexual abuse) among urban Indians.
‘‘(2) A grant may not be made under this subsection
to an urban Indian organization until that organization
has prepared, and the Service has approved, an assess-
ment that documents the prevalence of child abuse in the
urban Indian population concerned and specifies the serv-
ices and programs (which may not duplicate existing serv-
ices and programs) for which the grant is requested.
‘‘(3) Grants may be made under this subsection—
‘‘(A) to prepare assessments required under
paragraph (2);
‘‘(B) for the development of prevention, train-
ing, and education programs for urban Indian popu-
lations, including child education, parent education,
provider training on identification and intervention,
education on reporting requirements, prevention
203
campaigns, and establishing service networks of all
those involved in Indian child protection; and
‘‘(C) to provide direct outpatient treatment
services (including individual treatment, family
treatment, group therapy, and support groups) to
urban Indians who are child victims of abuse (in-
cluding sexual abuse) or adult survivors of child sex-
ual abuse, to the families of such child victims, and
to urban Indian perpetrators of child abuse (includ-
ing sexual abuse).
‘‘(4) In making grants to carry out this subsection,
the Secretary shall take into consideration—
‘‘(A) the support for the urban Indian organiza-
tion demonstrated by the child protection authorities
in the area, including committees or other services
funded under the Indian Child Welfare Act of 1978
(25 U.S.C. 1901 et seq.), if any;
‘‘(B) the capability and expertise demonstrated
by the urban Indian organization to address the
complex problem of child sexual abuse in the com-
munity; and
‘‘(C) the assessment required under paragraph
(2).
‘‘(g) The Secretary, through the Service, may enter
into a contract with, or make grants to, an urban Indian
204
organization that provides or arranges for the provision
of health care services (through satellite facilities, provider
networks, or otherwise) to urban Indians in more than 1
urban center.
‘‘SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINA-
TION OF UNMET HEALTH CARE NEEDS.
‘‘(a) Under authority of the Act of November 2, 1921
(25 U.S.C. 13), popularly known as the Snyder Act, the
Secretary, through the Service, may enter into contracts
with, or make grants to, urban Indian organizations situ-
ated in urban centers for which contracts have not been
entered into, or grants have not been made, under section
503. The purpose of a contract or grant made under this
section shall be the determination of the matters described
in subsection (b)(1) in order to assist the Secretary in as-
sessing the health status and health care needs of urban
Indians in the urban center involved and determining
whether the Secretary should enter into a contract or
make a grant under section 503 with respect to the urban
Indian organization which the Secretary has entered into
a contract with, or made a grant to, under this section.
‘‘(b) Any contract entered into, or grant made, by
the Secretary under this section shall include requirements
that—
205
‘‘(1) the urban Indian organization successfully
undertakes to—
‘‘(A) document the health care status and
unmet health care needs of urban Indians in
the urban center involved; and
‘‘(B) with respect to urban Indians in the
urban center involved, determine the matters
described in paragraphs (2), (3), (4), and (7) of
section 503(b); and
‘‘(2) the urban Indian organization complete
performance of the contract, or carry out the re-
quirements of the grant, within 1 year after the date
on which the Secretary and such organization enter
into such contract, or within 1 year after such orga-
nization receives such grant, whichever is applicable.
‘‘(c) The Secretary may not renew any contract en-
tered into, or grant made, under this section.
‘‘SEC. 505. EVALUATIONS; RENEWALS.
‘‘(a) The Secretary shall develop procedures to evalu-
ate compliance with grant requirements under this title
and compliance with, and performance of contracts en-
tered into by urban Indian organizations under this title.
Such procedures shall include provisions for carrying out
the requirements of this section.
206
‘‘(b) The Secretary shall evaluate the compliance of
each urban Indian organization which has entered into a
contract or received a grant under section 503 with the
terms of such contract or grant. For purposes of this eval-
uation, the Secretary, in determining the capacity of an
urban Indian organization to deliver quality patient care
shall, at the option of the organization—
‘‘(1) through the Service conduct an annual on-
site evaluation of the organization; or
‘‘(2) accept in lieu of such onsite evaluation evi-
dence of the organization’s provisional or full accred-
itation by a private independent entity recognized by
the Secretary for purposes of conducting quality re-
views or providers participating in the Medicare pro-
gram under title XVIII of the Social Security Act.
‘‘(c) If, as a result of the evaluations conducted under
this section, the Secretary determines that an urban In-
dian organization has not complied with the requirements
of a grant or complied with or satisfactorily performed a
contract under section 503, the Secretary shall, prior to
renewing such contract or grant, attempt to resolve with
such organization the areas of noncompliance or unsatis-
factory performance and modify such contract or grant to
prevent future occurrences of such noncompliance or un-
satisfactory performance. If the Secretary determines that
207
such noncompliance or unsatisfactory performance cannot
be resolved and prevented in the future, the Secretary
shall not renew such contract or grant with such organiza-
tion and is authorized to enter into a contract or make
a grant under section 503 with another urban Indian or-
ganization which is situated in the same urban center as
the urban Indian organization whose contract or grant is
not renewed under this section.
‘‘(d) In determining whether to renew a contract or
grant with an urban Indian organization under section
503 which has completed performance of a contract or
grant under section 504, the Secretary shall review the
records of the urban Indian organization, the reports sub-
mitted under section 507, and, in the case of a renewal
of a contract or grant under section 503, shall consider
the results of the onsite evaluations or accreditations
under subsection (b).
‘‘SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS.
‘‘(a) Contracts with urban Indian organizations en-
tered into pursuant to this title shall be in accordance with
all Federal contracting laws and regulations relating to
procurement except that in the discretion of the Secretary,
such contracts may be negotiated without advertising and
need not conform to the provisions of the Act of August
24, 1935 (40 U.S.C. 270a et seq.).
208
‘‘(b) Payments under any contracts or grants pursu-
ant to this title shall, notwithstanding any term or condi-
tion of such contract or grant—
‘‘(1) be made in their entirety by the Secretary
to the urban Indian organization by no later than
the end of the first 30 days of the funding period
with respect to which the payments apply, unless the
Secretary determines through an evaluation under
section 505 that the organization is not capable of
administering such payments in their entirety; and
‘‘(2) if unexpended by the urban Indian organi-
zation during the funding period with respect to
which the payments initially apply, shall be carried
forward for expenditure with respect to allowable or
reimbursable costs incurred by the organization dur-
ing one or more subsequent funding periods without
additional justification or documentation by the or-
ganization as a condition of carrying forward the ex-
penditure of such funds.
‘‘(c) Notwithstanding any provision of law to the con-
trary, the Secretary may, at the request or consent of an
urban Indian organization, revise or amend any contract
entered into by the Secretary with such organization under
this title as necessary to carry out the purposes of this
title.
209
‘‘(d) Contracts with or grants to urban Indian organi-
zations and regulations adopted pursuant to this title shall
include provisions to assure the fair and uniform provision
to urban Indians of services and assistance under such
contracts or grants by such organizations.
‘‘(e) Urban Indians, as defined under section 4(t) of
this Act, shall be eligible for health care or referral serv-
ices provided pursuant to this title.
‘‘SEC. 507. REPORTS AND RECORDS.
‘‘(a) For each fiscal year during which an urban In-
dian organization receives or expends funds pursuant to
a contract entered into, or a grant received, pursuant to
this title, such organization shall submit to the Secretary
on a basis no more frequent than every 6 months,
including—
‘‘(1) in the case of a contract or grant under
section 503, information gathered pursuant to para-
graph (5) of subsection (a) of such section;
‘‘(2) information on activities conducted by the
organization pursuant to the contract or grant;
‘‘(3) an accounting of the amounts and purpose
for which Federal funds were expended; and
‘‘(4) a minimum set of data, using uniformly
defined elements, that is specified by the Secretary
210
in consultation consistent with section 514, with
urban Indian organizations.
‘‘(b) The reports and records of the urban Indian or-
ganization with respect to a contract or grant under this
title shall be subject to audit by the Secretary and the
Comptroller General of the United States.
‘‘(c) The Secretary shall allow as a cost of any con-
tract or grant entered into or awarded under section 502
or 503 the cost of an annual independent financial audit
conducted by—
‘‘(1) a certified public accountant; or
‘‘(2) a certified public accounting firm qualified
to conduct Federal compliance audits.
‘‘SEC. 508. LIMITATION ON CONTRACT AUTHORITY.
‘‘The authority of the Secretary to enter into con-
tracts or to award grants under this title shall be to the
extent, and in an amount, provided for in appropriation
Acts.
‘‘SEC. 509. FACILITIES.
‘‘(a) The Secretary may make grants to contractors
or grant recipients under this title for the lease, purchase,
renovation, construction, or expansion of facilities, includ-
ing leased facilities, in order to assist such contractors or
grant recipients in complying with applicable licensure or
certification requirements.
211
‘‘(b) The Secretary, acting through the Service or
through the Health Resources and Services Administra-
tion, may provide to contractors or grant recipients under
this title loans from the Urban Indian Health Care Facili-
ties Revolving Loan Fund (hereinafter in this section re-
ferred to as the ‘URLF’) described in subsection (c), or
guarantees for loans, for the construction, renovation, ex-
pansion, or purchase of health care facilities, subject to
the following requirements:
‘‘(1) The principal amount of a loan or loan
guarantee may cover 100 percent of the costs (other
than staffing) relating to the facility, including plan-
ning, design, financing, site land development, con-
struction, 
rehabilitation, 
renovation, 
conversion,
medical equipment, furnishings, and capital pur-
chase.
‘‘(2) The total of the principal of loans and loan
guarantees, respectively, outstanding at any one
time shall not exceed such limitations as may be
specified in appropriation Acts.
‘‘(3) The loan or loan guarantee may have a
term of the shorter of the estimated useful life of the
facility, or 25 years.
‘‘(4) An urban Indian organization may assign,
and the Secretary may accept assignment of, the
212
revenue of the organization as security for a loan or
loan guarantee under this subsection.
‘‘(5) The Secretary shall not collect application,
processing, or similar fees from urban Indian organi-
zations applying for loans or loan guarantees under
this subsection.
‘‘(c)(1) There is established in the Treasury of the
United States a fund to be known as the Urban Indian
Health Care Facilities Revolving Loan Fund. The URLF
shall consist of—
‘‘(A) such amounts as may be appropriated to
the URLF;
‘‘(B) amounts received from urban Indian orga-
nizations in repayment of loans made to such orga-
nizations under paragraph (2); and
‘‘(C) interest earned on amounts in the URLF
under paragraph (3).
‘‘(2) Amounts in the URLF may be expended by the
Secretary, acting through the Service or the Health Re-
sources and Services Administration, to make loans avail-
able to urban Indian organizations receiving grants or con-
tracts under this title for the purposes, and subject to the
requirements, described in subsection (b). Amounts appro-
priated to the URLF, amounts received from urban In-
dian organizations in repayment of loans, and interest on
213
amounts in the URLF shall remain available until ex-
pended.
‘‘(3) The Secretary of the Treasury shall invest such
amounts of the URLF as such Secretary determines are
not required to meet current withdrawals from the URLF.
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. Any obligation acquired by the URLF may
be sold by the Secretary of the Treasury at the market
price.
‘‘SEC. 510. OFFICE OF URBAN INDIAN HEALTH.
‘‘There is hereby established within the Service an
Office of Urban Indian Health, which shall be responsible
for—
‘‘(1) carrying out the provisions of this title;
‘‘(2) providing central oversight of the pro-
grams and services authorized under this title; and
‘‘(3) providing technical assistance to urban In-
dian organizations.
‘‘SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE
RELATED SERVICES.
‘‘(a) The Secretary may make grants for the provi-
sion of health-related services in prevention of, treatment
214
of, rehabilitation of, or school and community-based edu-
cation in, alcohol and substance abuse in urban centers
to those urban Indian organizations with which the Sec-
retary has entered into a contract under this title or under
section 201.
‘‘(b) Each grant made pursuant to subsection (a)
shall set forth the goals to be accomplished pursuant to
the grant. The goals shall be specific to each grant as
agreed to between the Secretary and the grantee.
‘‘(c) The Secretary shall establish criteria for the
grants made under subsection (a), including criteria relat-
ing to the—
‘‘(1) size of the urban Indian population;
‘‘(2) capability of the organization to adequately
perform the activities required under the grant;
‘‘(3) satisfactory performance standards for the
organization in meeting the goals set forth in such
grant, which standards shall be negotiated and
agreed to between the Secretary and the grantee on
a grant-by-grant basis; and
‘‘(4) identification of need for services.
The Secretary shall develop a methodology for allocating
grants made pursuant to this section based on such cri-
teria.
215
‘‘(d) Any funds received by an urban Indian organiza-
tion under this Act for substance abuse prevention, treat-
ment, and rehabilitation shall be subject to the criteria set
forth in subsection (c).
‘‘SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION
PROJECTS.
‘‘(a)(1) Notwithstanding any other provision of law,
the Oklahoma City Clinic demonstration project shall be
treated as a service unit in the allocation of resources and
coordination of care and shall not be subject to the provi-
sions of the Indian Self-Determination and Education As-
sistance Act for the term of such project. The Secretary
shall provide assistance to such project in the development
of resources and equipment and facility needs.
‘‘(2) The Secretary shall submit to the President, for
inclusion in the report required to be submitted to the
Congress under section 801 for fiscal year 2000, a report
on the findings and conclusions derived from the dem-
onstration project specified in paragraph (1).
‘‘(b) Notwithstanding any other provision of law, the
Tulsa Clinic demonstration project shall become perma-
nent programs within the Service’s direct care program
and continue to be treated as service units in the allocation
of resources and coordination of care, and shall continue
to meet the requirements and definitions of an urban In-
216
dian organization in this title, and as such will not be sub-
ject to the provisions of the Indian Self-Determination and
Education Assistance Act.
‘‘SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.
‘‘(a) The Secretary shall, through the Office of Urban
Indian Health of the Service, make grants or enter into
contracts effective no later than September 30, 2002, with
urban Indian organizations for the administration of
urban Indian alcohol programs that were originally estab-
lished under the National Institute on Alcoholism and Al-
cohol Abuse (hereafter in this section referred to as
‘NIAAA’) and transferred to the Service.
‘‘(b) Grants provided or contracts entered into under
this section shall be used to provide support for the con-
tinuation of alcohol prevention and treatment services for
urban Indian populations and such other objectives as are
agreed upon between the Service and a recipient of a grant
or contract under this section.
‘‘(c) Urban Indian organizations that operate Indian
alcohol programs originally funded under the NIAAA and
subsequently transferred to the Service are eligible for
grants or contracts under this section.
‘‘(d) The Secretary shall evaluate and report to the
Congress on the activities of programs funded under this
section at least every 5 years.
217
‘‘SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZA-
TIONS.
‘‘(a) The Secretary shall ensure that the Service, the
Health Care Financing Administration, and other oper-
ating divisions and staff divisions of the Department con-
sult, to the greatest extent practicable, with urban Indian
organizations (as defined in section 4(w)) prior to taking
any action, or approving Federal financial assistance for
any action of a State, that may affect urban Indians or
urban Indian organizations.
‘‘(b) For purposes of subsection (a), consultation is
the open and free exchange of information and opinion
among urban Indian organizations and the operating and
staff divisions of the Department which leads to mutual
understanding and comprehension and which emphasizes
trust, respect, and shared responsibility.
‘‘SEC. 515. FEDERAL TORT CLAIMS ACT COVERAGE.
‘‘For purposes of section 224 of the Public Health
Service Act of July 1, 1944 (42 U.S.C. 233(a)) with re-
spect to claims by any person, initially filed on or after
October 1, 2000, whether or not such person is an Indian
or Alaska Native or is served on a fee basis or under other
circumstances as permitted by Federal law or regulations,
for personal injury, including death, resulting from the
performance prior to, including, or after October 1, 2000,
of medical, surgical, dental, or related functions, including
218
the conduct of clinical studies or investigations, or for pur-
poses of section 2679 of title 28, United States Code, with
respect to claims by any such person, on or after October
1, 2000, for personal injury, including death, resulting
from the operation of an emergency motor vehicle, an
urban Indian organization that has entered into a contract
or received a grant pursuant to this title is deemed to be
part of the Public Health Service in the Department of
Health and Human Services while carrying out any such
contract or grant and its employees (including those act-
ing on behalf of the organization as provided in section
2671 of title 28, United States Code, and including an
individual who provides health care services pursuant to
a personal services contract with an urban Indian organi-
zation for the provision of services in any facility owned,
operated, or constructed under the jurisdiction of the In-
dian Health Service) are deemed employees of the Service
while acting within the scope of their employment in car-
rying out the contract or grant. Such employees shall be
deemed to be acting within the scope of their employment
in carrying out the contract or grant when they are re-
quired, by reason of their employment, to perform medical,
surgical, dental, or related functions at a facility other
than a facility operated by the urban Indian organization
pursuant to such contract or grant, but only if such em-
219
ployees are not compensated for the performance of such
functions by a person or entity other than the urban In-
dian organization.
‘‘SEC. 516. URBAN YOUTH TREATMENT CENTER DEM-
ONSTRATION.
‘‘(a) The Secretary shall, through grant or contract,
make payment for the construction and operation of at
least 2 residential treatment centers in each State de-
scribed in subsection (b) to demonstrate the provision of
alcohol and substance abuse treatment services to urban
Indian youth in a culturally competent residential setting.
‘‘(b) A State described in this subsection is a State
in which—
‘‘(1) there reside urban Indian youth with need
for alcohol and substance abuse treatment services
in a residential setting; and
‘‘(2) there is a significant shortage of culturally
competent residential treatment services for urban
Indian youth.
‘‘SEC. 517. USE OF FEDERAL GOVERNMENT FACILITIES AND
SOURCES OF SUPPLY.
‘‘(a) The Secretary shall permit an urban Indian or-
ganization that has entered into a contract or received a
grant pursuant to this title, in carrying out such contract
or grant, to use existing facilities and all equipment there-
220
in or pertaining thereto and other personal property
owned by the Federal Government within the Secretary’s
jurisdiction under such terms and conditions as may be
agreed upon for their use and maintenance.
‘‘(b) Subject to subsection (d), the Secretary may do-
nate to an urban Indian organization that has entered into
a contract or received a grant pursuant to this title any
personal or real property determined to be excess to the
needs of the Indian Health Service or the General Services
Administration for purposes of carrying out the contract
or grant.
‘‘(c) The Secretary may acquire excess or surplus
government personal or real property for donation, subject
to subsection (d), to an urban Indian organization that
has entered into a contract or received a grant pursuant
to this title if the Secretary determines that the property
is appropriate for use by the urban Indian organization
for a purpose for which a contract or grant is authorized
under this title.
‘‘(d) In the event that the Secretary receives a re-
quest for a specific item of personal or real property de-
scribed in subsection (b) or (c) from an urban Indian orga-
nization and from an Indian tribe or tribal organization,
the Secretary shall give priority to the request for dona-
tion of the Indian tribe or tribal organization if the Sec-
221
retary receives the request from the Indian tribe or tribal
organization before the date the Secretary transfers title
to the property or, if earlier, the date the Secretary trans-
fers the property physically, to the urban Indian organiza-
tion.
‘‘(e) For purposes of section 201(a) of the Federal
Property and Administrative Services Act of 1949 (40
U.S.C. 481(a)) (relating to Federal sources of supply, in-
cluding lodging providers, airlines, and other transpor-
tation providers), an urban Indian organization that has
entered into a contract or received a grant pursuant to
this title shall be deemed an executive agency when car-
rying out such contract or grant, and the employees of
the urban Indian organization shall be eligible to have ac-
cess to such sources of supply on the same basis as em-
ployees of an executive agency have such access.
‘‘SEC. 518. GRANTS FOR DIABETES PREVENTION, TREAT-
MENT, AND CONTROL.
‘‘(a) The Secretary may make grants to those urban
Indian organizations that have entered into a contract or
have received a grant under this title for the provision of
services for the prevention, treatment, and control of the
complications resulting from, diabetes among urban Indi-
ans.
222
‘‘(b) Each grant made pursuant to subsection (a)
shall set forth the goals to be accomplished under the
grant. The goals shall be specific to each grant as agreed
to between the Secretary and the grantee.
‘‘(c) The Secretary shall establish criteria for the
grants made under subsection (a) relating to—
‘‘(1) the size and location of the urban Indian
population to be served;
‘‘(2) the need for prevention of, treatment of,
and control of the complications resulting from dia-
betes among the urban Indian population to be
served;
‘‘(3) performance standards for the organiza-
tion in meeting the goals set forth in such grant
that are negotiated and agreed to by the Secretary
and the grantee;
‘‘(4) the capability of the organization to ade-
quately perform the activities required under the
grant; and
‘‘(5) the willingness of the organization to col-
laborate with the registry, if any, established by the
Secretary under section 204(e) in the Area Office of
the Service in which the organization is located.
‘‘(d) Any funds received by an urban Indian organiza-
tion under this Act for the prevention, treatment, and con-
223
trol of diabetes among urban Indians shall be subject to
the criteria developed by the Secretary under subsection
(c).
‘‘SEC. 519. COMMUNITY HEALTH REPRESENTATIVES.
‘‘The Secretary, through the Service, may enter into
contracts with, and make grants to, urban Indian organi-
zations for the use of Indians trained as health service
providers through the Community Health Representatives
Program under section 107(b) in the provision of health
care, health promotion, and disease prevention services to
urban Indians.
‘‘SEC. 520. REGULATIONS.
‘‘(a) The amendments to this title made by the Indian
Health Care Improvement Act Amendments of 2001 shall
be effective on the date of enactment of such amendments,
regardless of whether the Secretary has promulgated regu-
lations implementing such amendments have been promul-
gated.
‘‘(b) The Secretary may promulgate regulations to
implement the provisions of this title.
‘‘(1) Proposed regulations to implement this
Act shall be published in the Federal Register by the
Secretary no later than 270 days after the date of
enactment of this Act and shall have no less than a
120-day comment period.
224
‘‘(2) The authority to promulgate regulations
under this Act shall expire 18 months from the date
of enactment of this Act.
‘‘(c) The negotiated rulemaking committee described
in this section shall be established pursuant to section 565
of title 5, United States Code, and shall have as the major-
ity of its members representatives of urban Indian organi-
zations from each service area in addition to Federal rep-
resentatives.
‘‘(d) The Secretary shall adapt the negotiated rule-
making procedures to the unique context of this Act.
‘‘SEC. 521. AUTHORIZATION OF APPROPRIATIONS.
‘‘There are authorized to be appropriated such sums
as may be necessary for each fiscal year through fiscal
year 2013 to carry out this title.
‘‘TITLE VI—ORGANIZATIONAL
IMPROVEMENTS
‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV-
ICE AS AN AGENCY OF THE PUBLIC HEALTH
SERVICE.
‘‘(a) In order to more effectively and efficiently carry
out the responsibilities, authorities, and functions of the
United States to provide health care services to Indians
and Indian tribes, as are or may be hereafter provided
by Federal statute or treaties, there is established within
225
the Public Health Service of the Department of Health
and Human Services the Indian Health Service. The In-
dian Health Service shall be administered by a Director,
who shall be appointed by the President, by and with the
advice and consent of the Senate. The Director of the In-
dian Health Service shall report to the Secretary through
the Assistant Secretary for Health of the Department of
Health and Human Services. Effective with respect to an
individual appointed by the President, by and with the ad-
vice and consent of the Senate, after January 1, 1993,
the term of service of the Director shall be 4 years. A
Director may serve more than 1 term.
‘‘(b) The Indian Health Service shall be an agency
within the Public Health Service of the Department of
Health and Human Services, and shall not be an office,
component, or unit of any other agency of the Depart-
ment.
‘‘(c) The Secretary shall carry out through the Direc-
tor of the Indian Health Service—
‘‘(1) all functions which were, on the day before
the date of enactment of the Indian Health Care
Amendments of 1988, carried out by or under the
direction of the individual serving as Director of the
Indian Health Service on such day;
226
‘‘(2) all functions of the Secretary relating to
the maintenance and operation of hospital and
health facilities for Indians and the planning for,
and provision and use of, health services for Indians;
‘‘(3) all health programs under which health
care is provided to Indians based upon their status
as Indians which are administered by the Secretary,
including but not limited to programs under—
‘‘(A) this Act;
‘‘(B) the Act of November 2, 1921 (25
U.S.C. 13);
‘‘(C) the Act of August 5, 1954 (42 U.S.C.
2001 et seq.);
‘‘(D) the Act of August 16, 1957 (42
U.S.C. 2005 et seq.); and
‘‘(E) the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450f et
seq.); and
‘‘(4) all scholarship and loan functions carried
out under title I.
‘‘(d)(1) The Director shall have the authority—
‘‘(A) except to the extent provided in paragraph
(2), to appoint and compensate employees for the
Service in accordance with title 5, United States
Code;
227
‘‘(B) to enter into contracts for the procure-
ment of goods and services to carry out the func-
tions of the Service; and
‘‘(C) to manage, expend, and obligate all funds
appropriated for the Service.
‘‘(2) Notwithstanding any other law, the provisions
of section 12 of the Act of June 18, 1934 (48 Stat. 986;
25 U.S.C. 472), shall apply to all personnel actions taken
with respect to new positions created within the Service
as a result of its establishment under subsection (a).
‘‘(e) All personnel, records, equipment, facilities, and
interests in property that are administered by the Indian
Health Service shall be transferred to the Indian Health
Service established by the amendment made by subsection
(a) of this section. All transfers must be accomplished
within 9 months of the date of enactment of this section.
The Secretary is authorize to waive the Indian preference
laws on a case-by-case basis for temporary transfers in-
volved in implementing this section during such 9-month
period.
‘‘(f)(1) Except as provided in paragraph (2), section
601 of the Indian Health Care Improvement Act shall take
effect 9 months from the date of the enactment of this
section.
228
‘‘(2) Notwithstanding subsections (e) and (f)(1), any
action which carries out such section 601 that is taken
by the Secretary before the effective date of such section
601 shall be effective beginning on the date such action
was taken.
‘‘SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYS-
TEM.
‘‘(a)(1) The Secretary shall establish an automated
management information system for the Service.
‘‘(2) The information system established under para-
graph (1) shall include—
‘‘(A) a financial management system;
‘‘(B) a patient care information system for each
area served by the Service;
‘‘(C) a privacy component that protects the pri-
vacy of patient information held by, or on behalf of,
the Service;
‘‘(D) a services-based cost accounting compo-
nent that provides estimates of the costs associated
with the provision of specific medical treatments or
services in each Area Office of the Service;
‘‘(E) an interface mechanism for patient billing
and accounts receivable system; and
‘‘(F) a training component.
229
‘‘(b) The Secretary shall provide each Indian tribe
and tribal organization that provides health services under
a contract entered into with the Service under the Indian
Self-Determination and Education Assistance Act auto-
mated management information systems which—
‘‘(1) meet the management information needs
of such Indian tribe or tribal organization with re-
spect to the treatment by the Indian tribe or tribal
organization of patients of the Service; and
‘‘(2) meet the management information needs
of the Service.
‘‘(c) Notwithstanding any other provision of law, each
patient shall have reasonable access to the medical or
health records of such patient which are held by, or on
behalf of, the Service.
‘‘(d) The Director shall have the authority to enter
into contracts, agreements, or joint ventures with other
Federal agencies, States, private and nonprofit organiza-
tions, for the purpose of enhancing information technology
in Indian health programs and facilities.
‘‘SEC. 603. AUTHORIZATION OF APPROPRIATIONS.
‘‘There are authorized to be appropriated such sums
as may be necessary for each fiscal year through fiscal
year 2013 to carry out this title.
230
‘‘TITLE VII—BEHAVIORAL
HEALTH PROGRAMS
‘‘SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREAT-
MENT SERVICES.
‘‘(a) The purposes of this section are to—
‘‘(1) authorize and direct the Secretary, acting
through the Indian Health Service, and willing In-
dian tribes, tribal organizations, and urban Indian
organizations, to develop a comprehensive behavioral
health prevention and treatment program which em-
phasizes collaboration among alcohol and substance
abuse, social services, and mental health programs;
‘‘(2) provide information, direction, and guid-
ance relating to mental illness and dysfunction and
self-destructive behavior, including child abuse and
family violence, to those Federal, tribal, State, and
local agencies responsible for programs in Indian
communities in areas of health care, education, so-
cial services, child and family welfare, alcohol and
substance abuse, law enforcement, and judicial serv-
ices;
‘‘(3) assist Indian tribes to identify services and
resources available to address mental illness and
dysfunctional and self-destructive behavior;
231
‘‘(4) provide authority and opportunities for In-
dian tribes to develop and implement, and coordinate
with, community-based programs which include iden-
tification, prevention, education, referral, and treat-
ment services, including through multidisciplinary
resource teams;
‘‘(5) ensure that Indians, as citizens of the
United States and of the States in which they re-
side, have the same access to behavioral health serv-
ices to which all citizens have access; and
‘‘(6) modify or supplement existing programs
and authorities in the areas identified in paragraph
(2).
‘‘(b)(1) The Secretary, acting through the Service,
and willing Indian tribes, tribal organizations, and urban
Indian organizations, shall encourage Indian tribes and
tribal organizations to develop tribal plans, and urban In-
dian organizations to develop local plans, and for all such
groups to participate in developing area-wide plans for In-
dian Behavioral Health Services. The plans shall include,
to the extent feasible, the following components:
‘‘(A) An assessment of the scope of the problem
of alcohol or other substance abuse, mental illness,
and dysfunctional and self-destructive behavior, in-
232
cluding suicide, child abuse, and family violence,
among Indians, including—
‘‘(i) the number of Indians served who are
directly or indirectly affected by such illness or
behavior, and
‘‘(ii) an estimate of the financial and
human cost attributable to such illness or be-
havior.
‘‘(B) An assessment of the existing and addi-
tional resources necessary for the prevention and
treatment of such illness and behavior, including an
assessment of the progress toward achieving the
availability of the full continuum of care described in
subsection (c).
‘‘(C) An estimate of the additional funding
needed by the Service, Indian tribes, tribal organiza-
tions, and urban Indian organizations to meet their
responsibilities under the plans.
‘‘(2) The Secretary shall establish a national clearing-
house of plans and reports on the outcomes of such plans
developed by Indian tribes, tribal organizations, and by
Areas relating to Behavioral Health. The Secretary shall
ensure access to these plans and outcomes by any Indian
tribe, tribal organization, urban organization, or the Serv-
ice.
233
‘‘(3) The Secretary shall provide technical assistance
to Indian tribes, tribal organizations, and urban Indian
organizations in preparation of their plans and in devel-
oping standards of care that may be used and adopted
locally.
‘‘(c) The Secretary, acting through the Service and
willing Indian tribes and tribal organizations, shall pro-
vide, to the extent feasible and funding is available, pro-
grams including, but not limited to, the following:
‘‘(1) A comprehensive continuum of behavioral
health care which provides—
‘‘(A) community-based prevention, inter-
vention, outpatient, and behavioral health
aftercare;
‘‘(B) detoxification (social and medical);
‘‘(C) acute hospitalization;
‘‘(D) intensive outpatient/day treatment;
‘‘(E) residential treatment;
‘‘(F) transitional living for those needing a
temporary stable living environment that is sup-
portive of treatment/recovery goals;
‘‘(G) emergency shelter;
‘‘(H) intensive case management; and
‘‘(I) traditional health care practices.
234
‘‘(2) Behavioral health services by the following
services and populations:
‘‘(A) Child Behavioral Health Services for
persons from birth through age 17, including—
‘‘(i) preschool and school age fetal al-
cohol disorder services, including assess-
ment and behavioral intervention;
‘‘(ii) mental health/substance abuse
services (emotional, organic, alcohol, drug,
inhalant and, tobacco);
‘‘(iii) co-occurring disorders (multiple
diagnosis);
‘‘(iv) prevention focused on ages 5
through 10 (alcohol, drug, inhalant, and
tobacco);
‘‘(v) early intervention, treatment and
aftercare focused on ages 11–17;
‘‘(vi) healthy choices/lifestyle (related
to sexually transmitted diseases, domestic
violence, sexual abuse; suicide, teen preg-
nancy, 
obesity, 
and 
other 
risk/safety
issues); and
‘‘(vii) co-morbidity.
‘‘(B) Adult Behavioral Health Services
(ages 18 through 55):
235
‘‘(i) Early intervention, treatment,
and aftercare.
‘‘(ii) Mental health/substance abuse
services (emotional, alcohol, drug, inhalant
and tobacco).
‘‘(iii) Co-occurring disorders (dual di-
agnosis) and co-morbidity.
‘‘(iv) Healthy choices/lifestyle (related
to parenting, partners, domestic violence,
sexual abuse, suicide, obesity, and other
risk-related behavior).
‘‘(v)(I) Treatment services for women
at risk of giving birth to a child with a
fetal alcohol disorder.
‘‘(II) Treatment for substance abuse
requiring gender-specific services.
‘‘(III) Treatment for sexual assault
and domestic violence.
‘‘(IV) Healthy choices/lifestyle (par-
enting, partners, obesity, suicide, and other
related behavioral risk).
‘‘(vi) Men-specific:
‘‘(I) Treatment for substance
abuse requiring gender-specific serv-
ices.
236
‘‘(II) Treatment for sexual as-
sault and domestic violence.
‘‘(III) Healthy choices/lifestyle
(parenting, partners, obesity, suicide,
and other risk-related behavior).
‘‘(C) Family Behavioral Health Services:
‘‘(i) Early intervention, treatment,
and aftercare for affected families.
‘‘(ii) Treatment for sexual as-
sault and domestic violence.
‘‘(iii) 
Healthy 
choices/lifestyle
(related to parenting, partners, do-
mestic violence, and other abuse
issues).
‘‘(D) Elder Behavioral Health Services
(age 56 and above):
‘‘(i) Early intervention, treatment,
and aftercare.
‘‘(I) 
Mental 
health/substance
abuse services (emotional, alcohol,
drug, inhalant, and tobacco).
‘‘(II) 
Co-occurring 
disorders
(dual diagnosis) and co-morbidity.
237
‘‘(III) Healthy choices/lifestyle
(managing 
conditions 
related 
to
aging).
‘‘(ii) Elder women-specific:
‘‘(I) Treatment for substance
abuse requiring gender-specific serv-
ices.
‘‘(II) Treatment for sexual as-
sault, domestic violence, and neglect.
‘‘(iii) Elder men-specific:
‘‘(I) Treatment for substance
abuse requiring gender-specific serv-
ices.
‘‘(II) Treatment for sexual as-
sault, domestic violence, and neglect.
‘‘(iv) Dementias regardless of cause.
‘‘(d)(1) The governing body of any Indian tribe, or
tribal organization, or urban Indian organization may, at
its discretion, adopt a resolution for the establishment of
a community behavioral health plan providing for the iden-
tification and coordination of available resources and pro-
grams to identify, prevent, or treat alcohol and other sub-
stance abuse, mental illness, or dysfunctional and self-de-
structive behavior, including child abuse and family vio-
lence, among its members or its service population. This
238
plan should include, but not be limited to, behavioral
health services, social services, intensive outpatient serv-
ices, and continuing after care.
‘‘(2) In furtherance of a plan established pursuant
to paragraph (1) and at the request of a Tribe, the appro-
priate agency, service unit, or other officials of the Bureau
of Indian Affairs and the Service shall cooperate with, and
provide technical assistance to, the Indian tribe or tribal
organization in the development of such plan. Upon the
establishment of such a plan and at the request of the
Indian tribe or tribal organization, such officials shall co-
operate with the Indian tribe or tribal organization in the
implementation of such plan.
‘‘(3) The Secretary may make funding available to
Indian tribes and tribal organizations adopting a resolu-
tion pursuant to paragraph (1) to obtain technical assist-
ance for the development of a community mental health
plan and to provide administrative support in the imple-
mentation of such plan.
‘‘(e) The Secretary, acting through the Service and
willing Indian tribes, tribal organizations, and urban In-
dian organizations, shall coordinate behavioral health
planning, to the extent feasible, with other Federal agen-
cies and with State agencies, to encourage comprehensive
239
behavioral health services are available to Indians without
regard to their place of residence.
‘‘(f) Within 1 year after the date of the enactment
of the Indian Health Care Improvement Act Amendments
of 2001, the Secretary shall make an assessment of the
need for inpatient mental health care among Indians and
the availability and cost of inpatient mental health facili-
ties which can meet such need. In making such assess-
ment, the Secretary shall consider the possible conversion
of existing, underused service hospital beds into psy-
chiatric units to meet such need.
‘‘SEC. 702. MEMORANDA OF AGREEMENT WITH THE DE-
PARTMENT OF THE INTERIOR.
‘‘(a) Not later than 12 months after the date of the
enactment of the Indian Health Care Improvement Act
Amendments of 2001, the Secretary and the Secretary of
the Interior shall develop and enter into memoranda of
agreement, or review and update any existing memoranda
of agreement, as required by section 4205 of the Indian
Alcohol and Substance Abuse Prevention and Treatment
Act of 1986 (25 U.S.C. 2411) and under which the Secre-
taries address—
‘‘(1) the scope and nature of mental illness and
dysfunctional and self-destructive behavior, including
child abuse and family violence, among Indians;
240
‘‘(2) the existing Federal, tribal, State, local,
and private services, resources, and programs avail-
able to provide mental health services for Indians;
‘‘(3) the unmet need for additional services, re-
sources, and programs necessary to meet the needs
identified pursuant to paragraph (1);
‘‘(4)(A) the right of Indians, as citizens of the
United States and of the States in which they re-
side, to have access to mental health services to
which all citizens have access;
‘‘(B) the right of Indians to participate in, and
receive the benefit of, such services; and
‘‘(C) take actions necessary to protect the exer-
cise of such right;
‘‘(5) the responsibilities of the Bureau of Indian
Affairs and the Service, including mental health
identification, prevention, education, referral, and
treatment services (including services through multi-
disciplinary resource teams), at the central, area,
and agency and service unit levels to address the
problems identified in paragraph (1);
‘‘(6) a strategy for the comprehensive coordina-
tion of the mental health services provided by the
Bureau of Indian Affairs and the Service to meet
241
the needs identified pursuant to paragraph (1),
including—
‘‘(A) the coordination of alcohol and sub-
stance abuse programs of the Service, the Bu-
reau of Indian Affairs, and the various Indian
tribes (developed under the Indian Alcohol and
Substance Abuse Prevention and Treatment
Act of 1986) with the mental health initiatives
pursuant to this Act, particularly with respect
to the referral and treatment of dually diag-
nosed individuals requiring mental health and
substance abuse treatment; and
‘‘(B) ensuring that the Bureau of Indian
Affairs and Service programs and services (in-
cluding multi-disciplinary resource teams) ad-
dressing child abuse and family violence are co-
ordinated with such non-Federal programs and
services;
‘‘(7) direct appropriate officials of the Bureau
of Indian Affairs and the Service, particularly at the
agency and service unit levels, to cooperate fully
with tribal requests made pursuant to community
behavioral health plans adopted under section 701(c)
and section 4206 of the Indian Alcohol and Sub-
242
stance Abuse Prevention and Treatment Act of 1986
(25 U.S.C. 2412); and
‘‘(8) provide for an annual review of such
agreement by the 2 Secretaries which shall be pro-
vided to Congress and the Indian tribes.
‘‘(b) The memoranda of agreement updated or en-
tered into pursuant to subsection (a) shall include specific
provisions pursuant to which the Service shall assume re-
sponsibility for—
‘‘(1) the determination of the scope of the prob-
lem of alcohol and substance abuse among Indian
people, including the number of Indians within the
jurisdiction of the Service who are directly or indi-
rectly affected by alcohol and substance abuse and
the financial and human cost;
‘‘(2) an assessment of the existing and needed
resources necessary for the prevention of alcohol and
substance abuse and the treatment of Indians af-
fected by alcohol and substance abuse; and
‘‘(3) an estimate of the funding necessary to
adequately support a program of prevention of alco-
hol and substance abuse and treatment of Indians
affected by alcohol and substance abuse.
‘‘(c) The Secretary and the Secretary of the Interior
shall, in developing the memoranda of agreement under
243
subsection (a) of this section, consult with and solicit the
comments of—
‘‘(1) Indian tribes and tribal organizations;
‘‘(2) Indian individuals;
‘‘(3) urban Indian organizations and other In-
dian organizations; and
‘‘(4) behavioral health service providers.
‘‘(d) The memoranda of agreement under subsection
(a) of this section shall be published in the Federal Reg-
ister. At the same time as publication in the Federal Reg-
ister, the Secretary shall provide a copy of such memo-
randa to each Indian tribe, tribal organization, and urban
Indian organization.
‘‘SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PRE-
VENTION AND TREATMENT PROGRAM.
‘‘(a)(1) The Secretary, acting through the Service
and willing Indian tribes, and tribal organizations, con-
sistent with section 701, shall provide a program of com-
prehensive behavioral health, prevention, treatment, and
aftercare, including traditional health care practices,
which shall include—
‘‘(A) prevention, through educational interven-
tion, in Indian communities;
244
‘‘(B) acute detoxification and psychiatric hos-
pitalization and treatment (residential and intensive
outpatient);
‘‘(C) 
community-based 
rehabilitation 
and
aftercare;
‘‘(D) community education and involvement, in-
cluding extensive training of health care, edu-
cational, and community-based personnel; and
‘‘(E) specialized residential treatment programs
for high-risk populations, including but not limited
to pregnant and post partum women and their chil-
dren.
‘‘(2) The target population of such program shall be
members of Indian tribes. Efforts to train and educate key
members of the Indian community shall target employees
of health, education, judicial, law enforcement, legal, and
social service programs.
‘‘(b)(1) The Secretary, acting through the Service
and willing Indian tribes and tribal organizations, may,
enter into contracts with public or private providers of be-
havioral health treatment services for the purpose of car-
rying out the program required under subsection (a).
‘‘(2) In carrying out this subsection, the Secretary
shall provide assistance to Indian tribes and tribal organi-
zations to develop criteria for the certification of behav-
245
ioral health service providers and accreditation of service
facilities which meet minimum standards for such services
and facilities.
‘‘SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.
‘‘(a) Under the authority of the Snyder Act of No-
vember 2, 1921 (25 U.S.C. 13), the Secretary shall estab-
lish and maintain a mental health technician program
within the Service which—
‘‘(1) provides for the training of Indians as
mental health technicians; and
‘‘(2) employs such technicians in the provision
of community-based mental health care that includes
identification, prevention, education, referral, and
treatment services.
‘‘(b) In carrying out subsection (a), the Secretary
shall provide high-standard paraprofessional training in
mental health care necessary to provide quality care to the
Indian communities to be served. Such training shall be
based upon a curriculum developed or approved by the
Secretary which combines education in the theory of men-
tal health care with supervised practical experience in the
provision of such care.
‘‘(c) The Secretary shall supervise and evaluate the
mental health technicians in the training program.
246
‘‘(d) The Secretary shall ensure that the program es-
tablished pursuant to this subsection involves the use and
promotion of the traditional health care practices of the
Indian tribes to be served.
‘‘SEC. 
705. 
LICENSING 
REQUIREMENT 
FOR 
MENTAL
HEALTH CARE WORKERS.
‘‘Subject to the provisions of section 220, any person
employed as a psychologist, social worker, or marriage and
family therapist for the purpose of providing mental health
care services to Indians in a clinical setting under the au-
thority of this Act or through a funding agreement pursu-
ant to the Indian Self-Determination and Education As-
sistance Act shall—
‘‘(1) in the case of a person employed as a psy-
chologist, be licensed as a clinical psychologist or
working under the direct supervision of a licensed
clinical psychologist;
‘‘(2) in the case of a person employed as a so-
cial worker, be licensed as a social worker or work-
ing under the direct supervision of a licensed social
worker; or
‘‘(3) in the case of a person employed as a mar-
riage and family therapist, be licensed as a marriage
and family therapist or working under the direct su-
247
pervision of a licensed marriage and family thera-
pist.
‘‘SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.
‘‘(a) The Secretary, consistent with section 701, shall
make funding available to Indian tribes, tribal organiza-
tions, and urban Indian organizations to develop and im-
plement a comprehensive behavioral health program of
prevention, intervention, treatment, and relapse preven-
tion services that specifically addresses the spiritual, cul-
tural, historical, social, and child care needs of Indian
women, regardless of age.
‘‘(b) Funding made available pursuant to this section
may be used to—
‘‘(1) develop and provide community training,
education, and prevention programs for Indian
women relating to behavioral health issues, including
fetal alcohol disorders;
‘‘(2) identify and provide psychological services,
counseling, advocacy, support, and relapse preven-
tion to Indian women and their families; and
‘‘(3) develop prevention and intervention models
for Indian women which incorporate traditional
health care practices, cultural values, and commu-
nity and family involvement.
248
‘‘(c) The Secretary, in consultation with Indian tribes
and tribal organizations, shall establish criteria for the re-
view and approval of applications and proposals for fund-
ing under this section.
‘‘(d) Twenty percent of the funds appropriated pursu-
ant to this section shall be used to make grants to urban
Indian organizations funded under title V.
‘‘SEC. 707. INDIAN YOUTH PROGRAM.
‘‘(a) The Secretary, consistent with section 701, shall
develop and implement a program for acute detoxification
and treatment for Indian youth, including behavioral
health services. The program shall include regional treat-
ment centers designed to include detoxification and reha-
bilitation for both sexes on a referral basis and programs
developed and implemented by Indian tribes or tribal orga-
nizations at the local level under the Indian Self-Deter-
mination and Education Assistance Act. Regional centers
shall be integrated with the intake and rehabilitation pro-
grams based in the referring Indian community.
‘‘(b)(1) The Secretary, acting through the Service or
willing Indian tribes, or tribal organizations, shall con-
struct, renovate, or, as necessary, purchase, and appro-
priately staff and operate, at least 1 youth regional treat-
ment center or treatment network in each area under the
jurisdiction of an Area Office. For the purposes of this
249
subsection, the Area Office in California shall be consid-
ered to be 2 Area Offices, 1 office whose jurisdiction shall
be considered to encompass the northern area of the State
of California, and 1 office whose jurisdiction shall be con-
sidered to encompass the remainder of the State of Cali-
fornia for the purpose of implementing California treat-
ment networks.
‘‘(2) For the purpose of staffing and operating such
centers or facilities, funding shall be pursuant to the Act
of November 2, 1921 (25 U.S.C. 13).
‘‘(3) A youth treatment center constructed or pur-
chased under this subsection shall be constructed or pur-
chased at a location within the area described in para-
graph (1) agreed upon (by appropriate tribal resolution)
by a majority of the Indian tribes to be served by such
center.
‘‘(4)(A) Notwithstanding any other provision of this
title, the Secretary may, from amounts authorized to be
appropriated for the purposes of carrying out this section,
make funds available to—
‘‘(i) the Tanana Chiefs Conference, Incor-
porated, for the purpose of leasing, constructing,
renovating, operating, and maintaining a residential
youth treatment facility in Fairbanks, Alaska; and
250
‘‘(ii) the Southeast Alaska Regional Health
Corporation to staff and operate a residential youth
treatment facility without regard to the proviso set
forth in section 4(l) of the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C.
450b(l)).
‘‘(B) Until additional residential youth treatment fa-
cilities are established in Alaska pursuant to this section,
the facilities specified in subparagraph (A) shall make
every effort to provide services to all eligible Indian youth
residing in such State.
‘‘(c)(1) The Secretary, acting through the Service
and willing Indian tribes and tribal organizations, may
provide intermediate behavioral health services, which may
incorporate traditional health care practices, to Indian
children and adolescents, including—
‘‘(A) pretreatment assistance;
‘‘(B) inpatient, outpatient, and after-care serv-
ices;
‘‘(C) emergency care;
‘‘(D) suicide prevention and crisis intervention;
and
‘‘(E) prevention and treatment of mental illness
and dysfunctional and self-destructive behavior, in-
cluding child abuse and family violence.
251
‘‘(2) Funds provided under this subsection may be
used—
‘‘(A) to construct or renovate an existing health
facility to provide intermediate behavioral health
services;
‘‘(B) to hire behavioral health professionals;
‘‘(C) to staff, operate, and maintain an inter-
mediate mental health facility, group home, sober
housing, transitional housing or similar facilities, or
youth shelter where intermediate behavioral health
services are being provided;
‘‘(D) to make renovations and hire appropriate
staff to convert existing hospital beds into adolescent
psychiatric units; and
‘‘(E) for intensive home- and community-based
services.
‘‘(3) The Secretary shall, in consultation with Indian
tribes and tribal organizations, establish criteria for the
review and approval of applications or proposals for fund-
ing made available pursuant to this subsection.
‘‘(d)(1) The Secretary, in consultation with Indian
tribes and tribal organizations, shall—
‘‘(A) identify and use, where appropriate, feder-
ally owned structures suitable for local residential or
252
regional behavioral health treatment for Indian
youth; and
‘‘(B) establish guidelines, in consultation with
Indian tribes and tribal organizations, for deter-
mining the suitability of any such federally owned
structure to be used for local residential or regional
behavioral health treatment for Indian youth.
‘‘(2) Any structure described in paragraph (1) may
be used under such terms and conditions as may be agreed
upon by the Secretary and the agency having responsi-
bility for the structure and any Tribe or tribal organiza-
tion operating the program.
‘‘(e)(1) The Secretary, Indian tribes or tribal organi-
zations, in cooperation with the Secretary of the Interior,
shall develop and implement within each service unit, com-
munity-based rehabilitation and follow-up services for In-
dian youth who are having significant behavioral health
problems, and require long-term treatment, community re-
integration, and monitoring to support the Indian youth
after their return to their home community.
‘‘(2) Services under paragraph (1) shall be ad-
ministered within each service unit or tribal program
by trained staff within the community who can as-
sist the Indian youth in continuing development of
self-image, positive problem-solving skills, and non-
253
alcohol or substance abusing behaviors. Such staff
may include alcohol and substance abuse counselors,
mental health professionals, and other health profes-
sionals and paraprofessionals, including community
health representatives.
‘‘(f) In providing the treatment and other services to
Indian youth authorized by this section, the Secretary, In-
dian tribes, and tribal organizations shall provide for the
inclusion of family members of such youth in the treat-
ment programs or other services as may be appropriate.
Not less than 10 percent of the funds appropriated for
the purposes of carrying out subsection (e) shall be used
for outpatient care of adult family members related to the
treatment of an Indian youth under that subsection.
‘‘(g) The Secretary, acting through the Service and
willing Indian tribes, tribal organizations, and urban In-
dian organizations, shall provide, consistent with section
701, programs and services to prevent and treat the abuse
of multiple forms of substances, including, but not limited
to, alcohol, drugs, inhalants, and tobacco, among Indian
youth residing in Indian communities, on Indian reserva-
tions, and in urban areas and provide appropriate mental
health services to address the incidence of mental illness
among such youth.
254
‘‘SEC. 708. INPATIENT AND COMMUNITY-BASED MENTAL
HEALTH 
FACILITIES 
DESIGN, 
CONSTRUC-
TION, AND STAFFING.
‘‘Within 1 year after the date of enactment of the
Indian Health Care Improvement Act Amendments of
2001, the Secretary, acting through the Service and will-
ing Indian tribes and tribal organizations, shall provide,
in each area of the Service, not less than 1 inpatient men-
tal health care facility, or the equivalent, for Indians with
behavioral health problems. For the purposes of this sub-
section, California shall be considered to be 2 Area Offices,
1 office whose location shall be considered to encompass
the northern area of the State of California and 1 office
whose jurisdiction shall be considered to encompass the
remainder of the State of California. The Secretary shall
consider the possible conversion of existing, underused
service hospital beds into psychiatric units to meet such
need.
‘‘SEC. 709. TRAINING AND COMMUNITY EDUCATION.
‘‘(a) The Secretary, in cooperation with the Secretary
of the Interior, shall develop and implement or provide
funding for Indian tribes and tribal organizations to de-
velop and implement within each service unit or tribal pro-
gram a program of community education and involvement
which shall be designed to provide concise and timely in-
formation to the community leadership of each tribal com-
255
munity. Such program shall include education about be-
havioral health issues to political leaders, tribal judges,
law enforcement personnel, members of tribal health and
education boards, health care providers including tradi-
tional practitioners, and other critical members of each
tribal community. Community-based training (oriented to-
ward local capacity development) shall also include tribal
community provider training (designed for adult learners
from the communities receiving services for prevention,
intervention, treatment and aftercare).
‘‘(b) The Secretary shall, either directly or through
Indian tribes and tribal organizations, provide instruction
in the area of behavioral health issues, including instruc-
tion in crisis intervention and family relations in the con-
text of alcohol and substance abuse, child sexual abuse,
youth alcohol and substance abuse, and the causes and
effects of fetal alcohol disorders to appropriate employees
of the Bureau of Indian Affairs and the Service, and to
personnel in schools or programs operated under any con-
tract with the Bureau of Indian Affairs or the Service,
including supervisors of emergency shelters and halfway
houses described in section 4213 of the Indian Alcohol and
Substance Abuse Prevention and Treatment Act of 1986
(25 U.S.C. 2433).
256
‘‘(c) In carrying out the education and training pro-
grams required by this section, the Secretary, in consulta-
tion with Indian tribes, tribal organizations, Indian behav-
ioral health experts, and Indian alcohol and substance
abuse prevention experts, shall develop and provide com-
munity-based 
training 
models. 
Such 
models 
shall
address—
‘‘(1) the elevated risk of alcohol and behavioral
health problems faced by children of alcoholics;
‘‘(2) 
the 
cultural, 
spiritual 
and
multigenerational aspects of behavioral health prob-
lem prevention and recovery; and
‘‘(3) community-based and multidisciplinary
strategies for preventing and treating behavioral
health problems.
‘‘SEC. 710. BEHAVIORAL HEALTH PROGRAM.
‘‘(a) The Secretary, acting through the Service or
willing Indian tribes or tribal organizations, consistent
with section 701, may plan, develop, implement, and carry
out programs to deliver innovative community-based be-
havioral health services to Indians.
‘‘(b) The Secretary may award such funding for a
project under subsection (a) to an Indian tribe or tribal
organization and may consider the following criteria:
257
‘‘(1) The project will address significant unmet
behavioral health needs among Indians.
‘‘(2) The project will serve a significant number
of Indians.
‘‘(3) The project has the potential to deliver
services in an efficient and effective manner.
‘‘(4) The Tribe or tribal organization has the
administrative and financial capability to administer
the project.
‘‘(5) The project may deliver services in a man-
ner consistent with traditional health care practices.
‘‘(6) The project is coordinated with, and avoids
duplication of, existing services.
‘‘(c) For purposes of this subsection, the Secretary
shall, in evaluating applications or proposals for funding
for projects to be operated under any funding agreement
entered into with the Service under the Indian Self-Deter-
mination and Education Assistance Act, use the same cri-
teria that the Secretary uses in evaluating any other appli-
cation or proposal for such funding.
‘‘SEC. 711. FETAL ALCOHOL DISORDER FUNDING.
‘‘(a)(1) The Secretary, consistent with section 701,
acting through willing Indian tribes, tribal organizations,
and urban Indian organizations, shall establish and oper-
ate fetal alcohol disorders programs as provided in this
258
section for the purposes of meeting the health status ob-
jectives specified in section 3(b).
‘‘(2) Funding provided pursuant to this section shall
be used to—
‘‘(A) develop and provide community and in-
school training, education, and prevention programs
relating to fetal alcohol disorders;
‘‘(B) identify and provide behavioral health
treatment to high-risk women;
‘‘(C) identify and provide appropriate psycho-
logical services, educational and vocational support,
counseling, advocacy, and information to fetal alco-
hol disorder affected persons and their families or
caretakers;
‘‘(D) develop and implement counseling and
support programs in schools for fetal alcohol dis-
order affected children;
‘‘(E) develop prevention and intervention mod-
els which incorporate traditional practitioners, cul-
tural and spiritual values, and community involve-
ment;
‘‘(F) develop, print, and disseminate education
and prevention materials on fetal alcohol disorders;
‘‘(G) develop and implement, through the tribal
consultation process, culturally sensitive assessment
259
and diagnostic tools including dysmorphology clinics
and multidisciplinary fetal alcohol disorder clinics
for use in tribal and urban Indian communities;
‘‘(H) develop early childhood intervention
projects from birth on to mitigate the effects of fetal
alcohol disorders; and
‘‘(I) develop and fund community-based adult
fetal alcohol disorder housing and support services.
‘‘(3) The Secretary shall establish criteria for the re-
view and approval of applications for funding under this
section.
‘‘(b) The Secretary, acting through the Service and
willing Indian tribes, tribal organizations, and urban In-
dian organizations, shall—
‘‘(1) develop and provide services for the pre-
vention, intervention, treatment, and aftercare for
those affected by fetal alcohol disorders in Indian
communities; and
‘‘(2) provide supportive services, directly or
through an Indian tribe, tribal organization, or
urban Indian organization, including, which services
shall include but not be limited to, meeting the spe-
cial educational, vocational, school-to-work transi-
tion, and independent living needs of adolescent and
adult Indians with fetal alcohol disorders.
260
‘‘(c) The Secretary shall establish a task force to be
known as the Fetal Alcohol Disorders Task Force to ad-
vise the Secretary in carrying out subsection (b). Such
task force shall be composed of representatives from the
National Institute on Drug Abuse, the National Institute
on Alcohol and Alcoholism, the Office of Substance Abuse
Prevention, the National Institute of Mental Health, the
Service, the Office of Minority Health of the Department
of Health and Human Services, the Administration for
Native Americans, the National Institute of Child Health
and Human Development (NICHD), the Centers for Dis-
ease Control and Prevention, the Bureau of Indian Af-
fairs, Indian tribes, tribal organizations, urban Indian
communities, and Indian fetal alcohol disorders experts.
‘‘(d) The Secretary, acting through the Substance
Abuse and Mental Health Services Administration, shall
make funding available to Indian tribes, tribal organiza-
tions, and urban Indian organizations for applied research
projects which propose to elevate the understanding of
methods to prevent, intervene, treat, or provide rehabilita-
tion and behavioral health aftercare for Indians and urban
Indians affected by fetal alcohol disorders.
‘‘(e) Ten percent of the funds appropriated pursuant
to this section shall be used to make grants to urban In-
dian organizations funded under title V.
261
‘‘SEC. 712. CHILD SEXUAL ABUSE AND PREVENTION TREAT-
MENT PROGRAMS.
‘‘(a) The Secretary and the Secretary of the Interior,
acting through the Service and willing Indian tribes and
tribal organizations, shall establish, consistent with section
701, in every service area, programs involving treatment
for—
‘‘(1) victims of child sexual abuse; and
‘‘(2) perpetrators of child sexual abuse.
‘‘(b) Funding provided pursuant to this section shall
be used to—
‘‘(1) develop and provide community education
and prevention programs related to child sexual
abuse;
‘‘(2) identify and provide behavioral health
treatment to children who are victims of sexual
abuse and to their families who are affected by sex-
ual abuse;
‘‘(3) develop prevention and intervention models
which incorporate traditional health care practi-
tioners, cultural and spiritual values, and community
involvement;
‘‘(4) develop and implement, through the tribal
consultation process, culturally sensitive assessment
and diagnostic tools for use in tribal and urban In-
dian communities; and
262
‘‘(5) identify and provide behavioral health
treatment to perpetrators—
‘‘(A) efforts will be made to begin offender
and behavioral health treatment while the per-
petrator is incarcerated or at the earliest pos-
sible date if the perpetrator is not incarcerated;
and
‘‘(B) treatment should be provided after
release to the community, until it is determined
that the perpetrator is not a threat to children.
‘‘SEC. 713. BEHAVIORAL HEALTH RESEARCH.
‘‘The Secretary, in consultation with appropriate
Federal agencies, shall provide funding to Indian tribes,
tribal organizations, and urban Indian organizations or,
enter into contracts with, or make grants to appropriate
institutions for the conduct of research on the incidence
and prevalence of behavioral health problems among Indi-
ans served by the Service, Indian tribes, or tribal organiza-
tions and among Indians in urban areas. Research prior-
ities under this section shall include—
‘‘(1) the interrelationship and interdependence
of behavioral health problems with alcoholism and
other substance abuse, suicide, homicides, other in-
juries, and the incidence of family violence; and
263
‘‘(2) the development of models of prevention
techniques.
The effect of the interrelationships and interdependencies
referred to in paragraph (1) on children, and the develop-
ment of prevention techniques under paragraph (2) appli-
cable to children, shall be emphasized.
‘‘SEC. 714. DEFINITIONS.
‘‘For the purpose of this title, the following defini-
tions shall apply:
‘‘(1) ‘Assessment’ means the systematic collec-
tion, analysis, and dissemination of information on
health status, health needs, and health problems.
‘‘(2) ‘Alcohol related neurodevelopmental dis-
orders’ or ‘ARND’ means with a history of maternal
alcohol consumption during pregnancy, central nerv-
ous system involvement such as developmental delay,
intellectual deficit, or neurologic abnormalities. Be-
haviorally, there can be problems with irritability,
and failure to thrive as infants. As children become
older there will likely be hyperactivity, attention def-
icit, language dysfunction, and perceptual and judg-
ment problems.
‘‘(3) ‘Behavioral health’ means the blending of
substances (alcohol, drugs, inhalants, and tobacco)
abuse and mental health prevention and treatment,
264
for the purpose of providing comprehensive services.
This can include the joint development of substance
abuse and mental health treatment planning and co-
ordinated case management using a multidisci-
plinary approach.
‘‘(4) ‘Behavioral health aftercare’ includes those
activities and resources used to support recovery fol-
lowing inpatient, residential, intensive substance
abuse, or mental health outpatient or outpatient
treatment. The purpose is to help prevent or deal
with relapse by ensuring that by the time a client or
patient is discharged from a level of care, such as
outpatient treatment, an aftercare plan has been de-
veloped with the client. An aftercare plan may use
such resources as community-based therapeutic
group, transitional living, a 12-step sponsor, a local
12-step or other related support group, and other
community-based providers (mental health profes-
sionals, traditional health care practitioners, commu-
nity health aides, community health representatives,
mental health technicians, ministers, etc.)
‘‘(5) ‘Dual diagnosis’ means coexisting sub-
stance abuse and mental illness conditions or diag-
nosis. Patients/clients are sometimes referred to as
mentally ill chemical abusers (MICAs).
265
‘‘(6) ‘Fetal alcohol disorders’ means fetal alco-
hol syndrome, partial fetal alcohol syndrome and al-
cohol 
related 
neural 
developmental 
disorder
(ARNDD).
‘‘(7) ‘Fetal alcohol syndrome’ or ‘FAS’ means
a syndrome in which with a history of maternal alco-
hol consumption during pregnancy, the following cri-
teria should be met:
‘‘(A) Central nervous system involvement
such as developmental delay, intellectual deficit,
microcephaly, or neurologic abnormalities.
‘‘(B) Craniofacial abnormalities with at
least 2 of the following: microphthalmia, short
palpebral fissures, poorly developed philtrum,
thin upper lip, flat nasal bridge, and short
upturned nose.
‘‘(C) Prenatal or postnatal growth delay.
‘‘(8) ‘Partial FAS’ means with a history of ma-
ternal alcohol consumption during pregnancy having
most of the criteria of FAS, though not meeting a
minimum of at least 2 of the following: microoph-
thalmia, short palpebral fissures, poorly developed
philtrum, thin upper lip, flat nasal bridge, short
upturned nose.
266
‘‘(9) ‘Rehabilitation’ means to restore the abil-
ity or capacity to engage in usual and customary life
activities through education and therapy.
‘‘(10) ‘Substance abuse’ includes inhalant
abuse.
‘‘SEC. 715. AUTHORIZATION OF APPROPRIATIONS.
‘‘There are authorized to be appropriated such sums
as may be necessary for each fiscal year through fiscal
year 2013 to carry out the provisions of this title.
‘‘TITLE VIII—MISCELLANEOUS
‘‘SEC. 801. REPORTS.
‘‘The President shall, at the time the budget is sub-
mitted under section 1105 of title 31, United States Code,
for each fiscal year transmit to the Congress a report
containing—
‘‘(1) a report on the progress made in meeting
the objectives of this Act, including a review of pro-
grams established or assisted pursuant to this Act
and an assessment and recommendations of addi-
tional programs or additional assistance necessary
to, at a minimum, provide health services to Indians,
and ensure a health status for Indians, which are at
a parity with the health services available to and the
health status of, the general population including
267
specific comparisons of appropriations provided and
those required for such parity;
‘‘(2) a report on whether, and to what extent,
new national health care programs, benefits, initia-
tives, or financing systems have had an impact on
the purposes of this Act and any steps that the Sec-
retary may have taken to consult with Indian tribes,
tribal organizations, and urban Indian organizations
to address such impact, including a report on pro-
posed changes in allocation of funding pursuant to
section 808;
‘‘(3) a report on the use of health services by
Indians—
‘‘(A) on a national and area or other rel-
evant geographical basis;
‘‘(B) by gender and age;
‘‘(C) by source of payment and type of
service;
‘‘(D) comparing such rates of use with
rates of use among comparable non-Indian pop-
ulations; and
‘‘(E) on the services provided under fund-
ing agreements pursuant to the Indian Self-De-
termination and Education Assistance Act;
268
‘‘(4) a report of contractors to the Secretary on
Health Care Educational Loan Repayments every 6
months required by section 110;
‘‘(5) a General Audit Report of the Secretary
on the Health Care Educational Loan Repayment
Program as required by section 110(n);
‘‘(6) a separate statement which specifies the
amount of funds requested to carry out the provi-
sions of section 201;
‘‘(7) a biennial report to Congress on infectious
diseases as required by section 212;
‘‘(8) a report on environmental and nuclear
health hazards as required by section 214;
‘‘(9) an annual report on the status of all
health care facilities needs as required by section
301(c)(2) and 301(d);
‘‘(10) reports on safe water and sanitary waste
disposal facilities as required by section 302(h)(1);
‘‘(11) an annual report on the expenditure of
nonservice funds for renovation as required by sec-
tions 305(a)(2) and 305(a)(3);
‘‘(12) a report identifying the backlog of main-
tenance and repair required at Service and tribal fa-
cilities required by section 314(a);
269
‘‘(13) a report providing an accounting of reim-
bursement funds made available to the Secretary
under titles XVIII and XIX of the Social Security
Act required by section 403(a);
‘‘(14) a report on services sharing of Indian
Health Service, Veterans Affairs, and other Federal
agency health programs as required by section
412(c)(2);
‘‘(15) a report on evaluation and renewal of
urban Indian programs as required by section 505;
‘‘(16) a report on the findings and conclusions
derived from the demonstration project as required
by section 512(a)(2);
‘‘(17) a report on the evaluation of programs as
required by section 513; and
‘‘(18) a report on alcohol and substance abuse
as required by section 701(f).
‘‘SEC. 802. REGULATIONS.
‘‘(a)(1) Not later than 90 days after the date of en-
actment of this Act, 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 the
Indian Health Care Improvement Act, as amended.
270
‘‘(2) Proposed regulations to implement this Act shall
be published in the Federal Register by the Secretary no
later than 270 days after the date of enactment of this
Act and shall have no less than a 120-day comment pe-
riod.
‘‘(3) The authority to promulgate regulations under
this Act shall expire 18 months from the date of enact-
ment of this Act.
‘‘(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, tribal organiza-
tions, and urban Indian organizations 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-
government relationship between the United States and
Indian tribes.
‘‘(d) The lack of promulgated regulations shall not
limit the effect of this Act.
271
‘‘(e) The provisions of this Act shall supersede any
conflicting provisions of law (including any conflicting reg-
ulations) in effect on the day before the date of enactment
of the Indian Self-Determination Contract Reform Act of
1994, and the Secretary is authorized to repeal any regu-
lation inconsistent with the provisions of this Act.
‘‘SEC. 803. PLAN OF IMPLEMENTATION.
‘‘Within 240 days after the date of the enactment of
the Indian Health Care Improvement Act Amendments of
2001, a plan will be prepared by the Secretary in consulta-
tion with Indian tribes, tribal organizations, and urban In-
dian organizations, and will be submitted to the Congress.
The plan will explain the manner and schedule (including
a schedule of appropriation requests), by title and section,
by which the Secretary will implement the provisions of
this Act.
‘‘SEC. 804. AVAILABILITY OF FUNDS.
‘‘The funds appropriated pursuant to this Act shall
remain available until expended.
‘‘SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED
TO THE 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
272
abortions using funds contained in an Act providing ap-
propriations for the Indian Health Service.
‘‘SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.
‘‘(a) Until such time as any subsequent law may oth-
erwise provide, 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, but only if
such descendant—
‘‘(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 Indian reservation
allotments in California.
‘‘(4) Any Indian in California who is listed on
the plans for distribution of the assets of California
rancherias and reservations under the Act of August
18, 1958 (72 Stat. 619), and any descendant of
such an Indian.
‘‘(b) Nothing in this section may be construed as ex-
panding the eligibility of California Indians for health
273
services provided by the Service beyond the scope of eligi-
bility for such health services that applied on May 1, 1986.
‘‘SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS.
‘‘(a)(1) Any individual who—
‘‘(A) has not attained 19 years of age;
‘‘(B) is the natural or adopted child, step-child,
foster-child, legal ward, or orphan of an eligible In-
dian; and
‘‘(C) 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
eligible for such services until 1 year after the date of a
determination of competency.
‘‘(2) Any spouse of an eligible Indian who is not an
Indian, or who is of Indian descent but not otherwise eligi-
ble for the health services provided by the Service, shall
be eligible for such health services if all such spouses or
274
spouses who are married to members of the Indian tribe(s)
being served are made eligible, as a class, by an appro-
priate resolution of the governing body of the Indian tribe
or tribal organization providing such services. The health
needs of persons made eligible under this paragraph shall
not be taken into consideration by the Service in deter-
mining the need for, or allocation of, its health resources.
‘‘(b)(1)(A) The Secretary is authorized to provide
health services under this subsection through health pro-
grams operated directly by the Service to individuals who
reside within the service area of a service unit and who
are not eligible for such health services under any other
subsection of this section or under any other provision of
law if—
‘‘(i) the Indian tribe (or, in the case of a multi-
tribal service area, all the Indian tribes) served by
such service unit requests such provision of health
services to such individuals; and
‘‘(ii) the Secretary and the Indian tribe or
tribes have jointly determined that—
‘‘(I) the provision of such health services
will not result in a denial or diminution of
health services to eligible Indians; and
‘‘(II) there is no reasonable alternative
health program, within or without the service
275
area of such service unit, available to meet the
health needs of such individuals.
‘‘(B) In the case of health programs operated under
a contract entered into under the Indian Self-Determina-
tion and Education Assistance Act, the governing body of
the Indian tribe or tribal organization providing health
services under such contract is authorized to determine
whether health services should be provided under such
funding agreement to individuals who are not eligible for
such health services under any other subsection in this
section or under any other provision of law. In making
such determinations, the governing body of the Indian
tribe or tribal organization shall take into account the con-
siderations described in subparagraph (A)(ii).
‘‘(2)(A) Persons receiving health services provided by
the Service by reason of 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 1880(c) of the
Social Security Act, section 402(a) of this Act, or any
other provision of law, amounts collected under this sub-
section, including medicare or medicaid reimbursements
under titles XVIII and XIX of the Social Security Act,
276
shall be credited to the account of the program providing
the service and shall be used solely for the provision of
health services within that program. Amounts collected
under this subsection shall be available for expenditure
within such program.
‘‘(B) Health services may be provided by the Sec-
retary through the Service under this subsection to an in-
digent person who would not be eligible for such health
services but for the provisions of paragraph (1) only if
an agreement has been 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 person.
‘‘(3)(A) In the case of a service area which serves
only one Indian tribe, the authority of the Secretary to
provide health services under paragraph (1)(A) shall ter-
minate at the end of the fiscal year succeeding the fiscal
year in which the governing body of the Indian tribe re-
vokes its concurrence to the provision of such health serv-
ices.
‘‘(B) In the case of a multi-tribal service area, the
authority of the Secretary to provide health services under
paragraph (1)(A) shall terminate at the end of the fiscal
year succeeding the fiscal year in which at least 51 percent
277
of the number of Indian tribes in the service area revoke
their concurrence to the provisions of such health services.
‘‘(c) 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
subsection of this section or 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 post partum; or
‘‘(4) provide care to immediate family members
of an eligible person if such care is directly related
to the treatment of the eligible person.
‘‘(d) Hospital privileges in health facilities operated
and maintained by the Service or operated under a con-
tract entered into under the Indian Self-Determination
and Education Assistance Act may be extended to non-
Service health care practitioners who provide services to
persons described in subsection (a) or (b). Such non-Serv-
ice health care practitioners may be regarded as employees
of the Federal Government for purposes of section
1346(b) and chapter 171 of title 28, United States Code
278
(relating to Federal tort claims) only with respect to acts
or omissions which occur in the course of providing serv-
ices to eligible persons as a part of the conditions under
which such hospital privileges are extended.
‘‘(e) For purposes of this section, the term ‘eligible
Indian’ means any Indian who is eligible for health serv-
ices provided by the Service without regard to the provi-
sions of this section.
‘‘SEC. 808. REALLOCATION OF BASE RESOURCES.
‘‘(a) 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 program, project, or activity of
a service unit may be implemented only after the Secretary
has submitted to the President, for inclusion in the report
required to be transmitted to the Congress under section
801, a report on the proposed change in allocation of fund-
ing, including the reasons for the change and its likely
effects.
‘‘(b) Subsection (a) shall not apply if the total
amount appropriated to the Service for a fiscal year is less
than the amount appropriated to the Service for the pre-
vious fiscal year.
279
‘‘SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.
‘‘The Secretary shall provide for the dissemination to
Indian tribes of the findings and results of demonstration
projects conducted under this Act.
‘‘SEC. 810. PROVISION OF SERVICES IN MONTANA.
‘‘(a) The Secretary shall provide services and benefits
for Indians in Montana in a manner consistent with the
decision of the United States Court of Appeals for the
Ninth Circuit in McNabb for McNabb v. Bowen, 829 F.2d
787 (9th Cir. 1987).
‘‘(b) The provisions of subsection (a) shall not be con-
strued to be an expression of the sense of the 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 Montana.
‘‘SEC. 811. MORATORIUM.
‘‘During the period of the moratorium imposed by
Public Law 100–446 on implementation of the final rule
published in the Federal Register on September 16, 1987,
by the Health Resources and Services Administration of
the Public Health Service, 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 of the Indian Health Care Improvement
280
Act, as amended by this Act until such time as new cri-
teria governing eligibility for services are developed in ac-
cordance with section 802 of this Act.
‘‘SEC. 812. TRIBAL EMPLOYMENT.
‘‘For purposes of section 2(2) of the Act of July 5,
1935, as amended (49 Stat. 450, chapter 372), an Indian
tribe or tribal organization carrying out a funding agree-
ment under the Indian Self-Determination and Education
Assistance Act shall not be considered an ‘employer’.
‘‘SEC. 813. PRIME VENDOR.
‘‘For purposes of section 4 of Public Law 102–585
(38 U.S.C. 812) tribes and tribal organizations carrying
out a grant, cooperative agreement of funding agreement
under the Indian Self-Determination and Education As-
sistance Act (25 U.S.C. 450 et seq.) shall be deemed to
be an executive agency and part of the Indian Health
Service in the Department of Health and Human Services
and, as such, may act as an ordering agent of the Indian
Health Service and the employees of the tribe or tribal
organization may order supplies on behalf thereof on the
same basis as employees of the Indian Health Service.
‘‘SEC. 814. 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,
281
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. 815. ESTABLISHMENT OF NATIONAL BIPARTISAN
COMMISSION ON INDIAN HEALTH CARE ENTI-
TLEMENT.
‘‘(a) There is hereby established the National Bipar-
tisan Indian Health Care Entitlement Commission (the
‘Commission’).
‘‘(b) DUTIES
OF COMMISSION.—The Commission
shall—
‘‘(1) review and analyze the recommendations
of the report of the Study Committee, as established
below, to the Commission;
‘‘(2) make recommendations to the Congress
for providing health services for Indian persons as
an entitlement, giving due regard to the effects of
such a program on existing health care delivery sys-
tems for Indian persons and the effect of such a pro-
gram on the sovereign status of Indian tribes;
‘‘(3) establish a Study Committee composed of
those members of the Commission appointed by the
Director of the Indian Health Service and at least
282
4 members of Congress from among the members of
the Commission which shall—
‘‘(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 In-
dian organizations, and which may include au-
thorizing and funding feasibility studies of var-
ious models for providing and funding health
services for all Indian beneficiaries including
those who live outside of a reservation, tempo-
rarily or permanently;
‘‘(B) make recommendations to the Com-
mission for legislation that will provide for the
delivery of health services for Indians as an en-
titlement, which will address, among other
things, issues of eligibility, benefits to be pro-
vided, including recommendations regarding
from whom such health services are to be pro-
vided and the cost, including mechanisms for
funding of the health services to be provided;
283
‘‘(C) determine the effect of the enactment
of such recommendations on the existing system
of delivery of health services for Indians;
‘‘(D) determine the effect of a health serv-
ices entitlement program for Indian persons on
the sovereign status of Indian tribes;
‘‘(E) not later than 12 months after the
appointment of all members of the Commission,
shall make a written report of its findings and
recommendations to the full Commission, which
report shall include a statement of the minority
and majority position of the Committee and
which shall be disseminated, at a minimum, to
every federally recognized Indian tribe, tribal
organization, and urban Indian organization for
comment to the Commission; and
‘‘(F) report regularly to the full Commis-
sion regarding the findings and recommenda-
tions developed by the Study Committee in the
course of carrying out its duties under this sec-
tion.
‘‘(4) By not later than 18 months following the
date of appointment of all members of the Commis-
sion, submit a written report to Congress containing
a recommendation of policies and legislation to im-
284
plement a policy that would establish a health care
system for Indians based on delivery of health serv-
ices as an entitlement, together with a determination
of the implications of such an entitlement system on
existing health care delivery systems for Indians and
on the sovereign status of Indian tribes.
‘‘(c)(1) The Commission shall be composed of 25
members, selected by as follows:
‘‘(A) 10 members of Congress, including 3 from
the United States House of Representatives and 2
from the United States Senate, appointed by their
respective majority leaders, and 3 from the United
States House of Representatives and 2 from the
United States Senate, appointed by their respective
minority leaders, and who shall be members of the
standing committees of Congress that consider legis-
lation affecting health care to Indians.
‘‘(B) 12 persons chosen by the Congressional
members of the Commission, 1 from each Indian
health care service area as currently designated by
the Director of the Indian Health Service, to be cho-
sen from among 3 nominees from each area put for-
ward by the 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
285
and with due regard being given to a reasonable rep-
resentation on the commission of members who are
familiar with various health care delivery modes and
who represent Tribes of various size populations.
‘‘(C) 3 persons appointed by the Director of the
Indian Health Service who are knowledgeable about
the provision of health care to Indians, at least one
of whom shall be appointed from among 3 nominees
put forward by those programs whose funding is
provided in whole or in part by the Indian Health
Service primarily or exclusively for the benefit of
urban Indians.
‘‘(D) All those persons chosen by the Congres-
sional members of the Commission and by the Presi-
dent shall be members of federally recognized Indian
tribes.
‘‘(E) The Chairman and Vice Chairman of the
Commission shall be selected by the Congressional
members of the Commission.
‘‘(c)(1) The terms of members of the Commission
shall be for the life of the Commission.
‘‘(2) Congressional members of the Commission shall
be appointed not later than 90 days after the approval
of this Act, and the remaining members of the Commis-
286
sion shall be appointed not later than 60 days following
the appointment of the Congressional members.
‘‘(3) A vacancy in the Commission shall be filled in
the manner in which the original appointment was made.
‘‘(d)(1) Each Congressional member of the Commis-
sion 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.
‘‘(2) Remaining members of the Commission,
while serving on the business of the Commission (in-
cluding travel time) shall be entitled to receive com-
pensation at the per diem equivalent of the rate pro-
vided for level IV of the Executive 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 member 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 employ-
ees of the United States Senate.
287
‘‘(e)(1) The Commission shall meet at the call of the
Chairman.
‘‘(2) 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.
‘‘(f)(1)(A) The Commission shall appoint an execu-
tive director of the Commission.
‘‘(B) The executive director shall be paid the rate of
basic pay for level V of the Executive Schedule.
‘‘(2) With the approval of the Commission, the execu-
tive director may appoint such personnel as the executive
director deems appropriate.
‘‘(3) The staff of the Commission shall be appointed
without regard to the provisions of title 5, United States
Code, governing appointments in the competitive service,
and shall be paid without regard to the provisions of chap-
ter 51 and subchapter III of chapter 53 of such title (re-
lating to classification and General Schedule pay rates).
‘‘(4) With the approval of the Commission, the execu-
tive director may procure temporary and intermittent
services under section 3109(b) of title 5, United States
Code.
288
‘‘(5) The Administrator of General Services shall lo-
cate suitable office space for the operation of the Commis-
sion. 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 Com-
mission.
‘‘(g)(1) For the purpose of carrying out its duties,
the Commission may hold such hearings and undertake
such other activities as the Commission determines 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 services
to them. To constitute a hearing under this subsection,
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 towards the number of regional hearings required
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.
289
‘‘(3)(A) The Director of the Congressional Budget
Office or the Chief Actuary of the Health Care Financing
Administration, or both, shall provide to the Commission,
upon the request of the Commission, such cost estimates
as the Commission determines to be necessary to carry
out its duties.
‘‘(B) The Commission shall reimburse the Director
of the Congressional Budget Office for expenses relating
to the employment in the office of the Director of such
additional staff as may be necessary for the Director to
comply with requests by the Commission under subpara-
graph (A).
‘‘(4) Upon the request of the Commission, the head
of any Federal agency is authorized to detail, without re-
imbursement, any of the personnel of such agency to the
Commission to assist the Commission in carrying out its
duties. Any such detail shall not interrupt or otherwise
affect the civil service status or privileges of the Federal
employee.
‘‘(5) Upon the request of the Commission, the head
of a Federal agency shall provide such technical assistance
to the Commission as the Commission determines to be
necessary to carry out its duties.
‘‘(6) The Commission may use the United States
mails in the same manner and under the same conditions
290
as Federal agencies and shall, for purposes of the frank,
be considered a commission of Congress as described in
section 3215 of title 39, United States Code.
‘‘(7) The Commission may secure directly from any
Federal agency information necessary to enable it to carry
out its duties, if the information may be disclosed under
section 552 of title 4, United States Code. Upon request
of the Chairman of the Commission, the head of such
agency shall furnish such information to the Commission.
‘‘(8) Upon the request of the Commission, the Ad-
ministrator of General Services shall provide to the Com-
mission on a reimbursable basis such administrative sup-
port services as the Commission may request.
‘‘(9) For purposes of costs relating to printing and
binding, including the cost of personnel detailed from the
Government Printing Office, the Commission shall be
deemed to be a committee of the Congress.
‘‘(h) There are authorized to be appropriated
$4,000,000 to carry out the provisions of this section,
which sum shall not be deducted from or affect any other
appropriation for health care for Indian persons.
‘‘SEC. 816. APPROPRIATIONS; AVAILABILITY.
‘‘Any new spending authority (described in subsection
(c)(2)(A) or (B) of section 401 of the Congressional Budg-
et Act of 1974) which is provided under this Act shall
291
be effective for any fiscal year only to such extent or in
such amounts as are provided in appropriation Acts.
‘‘SEC. 817. AUTHORIZATION OF APPROPRIATIONS.
‘‘There are authorized to be appropriated such sums
as may be necessary for each fiscal year through fiscal
year 2013 to carry out this title.’’.
SEC. 3. SOBOBA SANITATION FACILITIES.
The Act of December 17, 1970 (84 Stat. 1465), is
amended by adding at the end the following new section:
‘‘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).’’.
SEC. 4. SOCIAL SECURITY ACT AMENDMENTS.
(a) Section 1866(a)(1) of the Social Security Act (42
U.S.C. 1395cc(a)(1)) is amended by adding at the end the
following new subparagraph:
‘‘(T) in the case of hospitals and critical
access hospitals which provide inpatient hospital
services for which payment may be made under
this title, to accept as payment in full for serv-
ices that are covered under and furnished to an
individual eligible for the contract health serv-
292
ices program operated by the Indian Health
Service, by an Indian tribe or tribal organiza-
tion or furnished to an urban Indian eligible for
health services purchased by an urban Indian
organization (as those terms are defined in sec-
tion 4 of the Indian Health Care Improvement
Act), in accordance with such admission prac-
tices, and such payment methodology and
amounts, as are prescribed under regulations
issued by the Secretary in implementation of
such section.’’.
(b) Section 1880 of the Social Security Act is amend-
ed to read as follows:
‘‘SEC. 1880. INDIAN HEALTH PROGRAMS.
‘‘(a) The Indian Health Service and an Indian tribe
or tribal organization (as those terms are defined in sec-
tion 4 of the Indian Health Care Improvement Act), shall
be eligible for payments under this title, notwithstanding
sections 1814(c) and 1835(d), if and for so long as it
meets the conditions and requirements for such payments
which are applicable generally to the service or provider
type for which it seeks payment under this title and for
services and provider types provided by a qualified Indian
health program under section 1880A.
293
‘‘(b) Notwithstanding subsection (a), if the Indian
Health Service or an Indian tribe, tribal organization, or
urban Indian organization, does not meet all of the condi-
tions and requirements of this title which are applicable
generally to such service or provider type submits to the
Secretary within 6 months after the date on which it first
sought reimbursement for the service or provider type an
acceptable plan for achieving compliance with such condi-
tions and requirements, it shall be deemed to meet such
conditions and requirements (and to be eligible for reim-
bursement under this title), without regard to the extent
of its actual compliance with such conditions and require-
ments, during the first 12 months after the month in
which such plan is submitted.
‘‘(c) For provisions relating to the authority of cer-
tain Indian tribes and tribal organizations to elect to di-
rectly bill for, and receive payment for, health care services
provided by a hospital or clinic of such Tribes or tribal
organizations and for which payment may be made under
this title, see section 405 of the Indian Health Care Im-
provement Act.
‘‘(d) The Indian Health Service, an Indian tribe, or
tribal organization providing a service otherwise eligible
for payment under this section through the use of a com-
munity health aide or practitioner certified under the pro-
294
visions of section 121 of the Indian Health Care Improve-
ment Act (25 U.S.C. 1616l) shall be paid for such services
on the same basis that such services are reimbursed under
State Plans approved under title XIX of the Social Secu-
rity Act.
‘‘(e) Notwithstanding any other provision of law, a
health program operated by the Indian Health Service, an
Indian tribe, or tribal organization, which collaborates
with a hospital operated by the Indian Health Service or
an Indian tribe or tribal organization, shall, at the option
of the Indian tribe or tribal organization, be paid for serv-
ices for which it would otherwise be eligible under this sec-
tion as if it were an outpatient department of the hospital.
In situations where the health program is on a separate
campus from the hospital, billing as an outpatient depart-
ment of the hospital shall not subject such a health pro-
gram to the requirements of section 1867 (42 U.S.C.
1395dd) (the Emergency Medical Treatment and Active
Labor Act).
‘‘(f) The Indian Health Service, an Indian tribe, or
tribal organization providing visiting nurse services in a
Home Health Agency Shortage Area shall be paid for such
services on the same basis that such services are reim-
bursed for other primary care providers.
295
‘‘(g) Notwithstanding any other provision of law, the
Secretary shall have broad authority to identify and imple-
ment alternative methods of reimbursing Indian health
programs for Medicare services provided to Indians. The
Indian tribe, tribal organization, or urban Indian organi-
zation may opt to receive reimbursement under reimburse-
ment methodologies applicable to other providers of simi-
lar services, provided that the amount of reimbursement
resulting under such alternative methodology shall not be
less than 100 percent of the reasonable cost of the service
to which the methodology applies under section 1861(v).’’.
(c) Title XVIII of the Social Security Act is amended
by adding after section 1880A the following new section:
‘‘SEC. 1880B. QUALIFIED INDIAN HEALTH PROGRAM.
‘‘(a) A qualified Indian health program shall be eligi-
ble for payments under this title, notwithstanding sections
1814(c) and 1835(d), if and for so long as it meets all
the conditions and requirements set forth in this section.
‘‘(b)(1) The term ‘qualified Indian health program’
means a health program operated by—
‘‘(A) the Indian Health Service;
‘‘(B) an Indian tribe, tribal organization, or
urban Indian organization (as those terms are de-
fined in section 4 of the Indian Health Care Im-
provement Act) and which is funded in whole or part
296
by the Indian Health Service under the Indian Self-
Determination and Education Assistance Act; and
‘‘(C) an urban Indian organization (as that
term is defined in section 4 of the Indian Health
Care Improvement Act) and which is funded in
whole or part under title V of the Indian Health
Care Improvement Act.
‘‘(2) A qualified Indian health program may include
one or more hospitals, nursing homes, home health pro-
grams, clinics, ambulance services, or other health pro-
grams providing a service for which payments may be
made under this title and which is covered in the Medicare
or Medicaid cost report for such qualified Indian health
program.
‘‘(c)(1) Notwithstanding any other provision in the
law, a qualified Indian health program shall be entitled
to receive payment based on an all-inclusive rate which
shall be calculated to provide full cost recovery for the cost
of furnishing services provided under this section.
‘‘(2) The term ‘full cost recovery’ shall mean—
‘‘(A) the direct costs, which are reasonable,
adequate, and related to the cost of furnishing such
services, taking into account the unique nature, loca-
tion, and service population of the qualified Indian
health program, and which shall include direct pro-
297
gram, administrative, and overhead costs, without
regard to the customary or other charge or any fee
schedule that would otherwise be applicable, plus
‘‘(B) indirect costs which for a qualified Indian
health program operated by—
‘‘(i) an Indian tribe or tribal organization
for which an indirect cost rate (as that term is
defined in section 4(g) of the Indian Self-Deter-
mination and Education Assistance Act) has
been established or an urban Indian organiza-
tion for which an indirect cost rate has other-
wise been established shall be not less than an
amount determined on the basis of the indirect
cost rate; or
‘‘(ii) the Indian Health Service, an Indian
tribe, tribal organization, or urban Indian orga-
nization for which no such rate has been estab-
lished shall be not less than the administrative
costs specifically associated with the delivery of
the services being provided.
‘‘(C) Notwithstanding any other provision of
law, the amount determined to be payable as full
cost recovery may not be reduced for coinsurance,
copayments or deductibles when the service was pro-
vided to an Indian entitled under Federal law to re-
298
ceive service from the Indian Health Service, an In-
dian tribe, or tribal organization, or an urban Indian
organization or because of any limitations on pay-
ment provided for in any managed care plan.
‘‘(3) In addition to full cost recovery, a qualified In-
dian health program shall be entitled to reasonable
outstationing costs, which shall include all administrative
costs associated with outreach and acceptance of eligibility
applications for any Federal or State health program in-
cluding, but not limited to medicare, medicaid, and the
Children’s Health Insurance Program.
‘‘(4) Costs identified for services addressed in a cost
report submitted by the qualified Indian health program
shall be used to determine an all-inclusive encounter or
per diem payment amount for such services. Not all health
programs provided or administered by the Indian Health
Service, an Indian tribe or tribal organization, or an urban
Indian organization must be combined into a single cost
report. A full cost recovery payment for services not cov-
ered by such cost report shall be made on a fee-for-service,
encounter, or per diem basis.
‘‘(5) The full cost recovery rate provided for in para-
graphs (1) through (3) of this subsection may be deter-
mined, at the election of the qualified Indian health pro-
gram, by the Health Care Financing Administration or by
299
a State Medicaid agency and shall be valid for reimburse-
ment made under title XVIII (medicare), title XIX (med-
icaid), and title XXI (children’s health insurance program)
purposes. The costs described in subparagraph (A) of
paragraph (2) shall be calculated under whatever method-
ology yields the greatest aggregate payment for the cost
reporting period, provided that such methodology shall be
adjusted to include adjustments to such payment to take
into account for those qualified Indian health programs
that include hospitals—
‘‘(A) a significant decrease in discharges;
‘‘(B) costs for graduate medical education pro-
grams;
‘‘(C) additional payment as a disproportionate
share hospital with a payment adjustment factor of
10; and
‘‘(D) payment for outlier cases.
‘‘(6) A qualified Indian health program may elect to
receive payment for services provided under this section—
‘‘(A) on the full cost recovery basis provided in
subsection (c)(1)–(5)
‘‘(B) on the basis of the inpatient or outpatient
encounter rates established for Indian Health Serv-
ice facilities and published annually in the Federal
Register;
300
‘‘(C) on the same basis as other providers are
reimbursed under this title, provided that to this
amount shall be added the amounts determined
under subparagraph (B) of subsection (c)(2);
‘‘(D) on the basis of any other rate or method-
ology applicable to the Service, an Indian tribe, or
tribal organization; or
‘‘(E) on the basis of any rate or methodology
negotiated with the agency responsible for making
payment.
‘‘(d) A qualified Indian health program may under
this section provide and be reimbursed for any service the
Indian Health Service, an Indian tribe, or tribal organiza-
tion or an urban Indian organization may be reimbursed
under section 1880 for the medicare program and section
1911 for the Medicaid program, provided that in either
event such services may also include, at the election of
the qualified Indian health program—
‘‘(1) any service when furnished by an employee
of the qualified Indian health program who is li-
censed or certified to perform such a service to the
same extent that such service would be reimbursable
if performed by a physician and any service or sup-
plies furnished as incident to a physician’s service as
301
would otherwise be covered if furnished by a physi-
cian or as an incident to a physician’s service;
‘‘(2) screening, diagnostic, and therapeutic out-
patient services including, but not limited to, part-
time or intermittent screening, diagnostic and thera-
peutic skilled nursing care and related medical sup-
plies (other than drugs and biologicals), furnished by
an employee of the qualified Indian health program
who is licensed or certified to perform such a service
for an individual in the individual’s home or in a
community health setting under a written plan of
treatment established and periodically reviewed by a
physician, when furnished to an individual as an
outpatient of a qualified Indian health program;
‘‘(3) preventive primary health services as de-
scribed under sections 329, 330, and 340 of the
Public Health Service Act, when provided by an em-
ployee of the qualified Indian health program who is
licensed or certified to perform such a service, re-
gardless of the location in which the service is pro-
vided;
‘‘(4) for children, all services specified as part
of the State medicaid plan, Children’s Health Insur-
ance Program, and EPSDT;
302
‘‘(5) influenza and pneumococcal immuniza-
tions;
‘‘(6) other immunizations for prevention of
communicable diseases when targeted; and
‘‘(7) the cost of transportation for providers or
patients necessary to facilitate access for patients.’’.
(d) Section 1902(a)(13) of the Social Security Act
is amended by adding at the end the following:
‘‘(D)(i) for payment for services described
in subparagraph (C) of section 1905(a)(2)
under the plan furnished by an Indian tribe,
tribal organization, or urban Indian organiza-
tion (as defined in section 4 of the Indian
Health Care Improvement Act) of 100 percent
of costs which are reasonable and related to the
cost of furnishing such services or based on
other tests of reasonableness as the Secretary
prescribes 
in 
regulations 
under 
section
1833(a)(3), or, in the case of services to which
those regulations do not apply, the same meth-
odology used under section 1833(a)(3).
‘‘(ii) in carrying out clause (i) in the case
of services furnished by a federally qualified
health center that is operated by an Indian
tribe, tribal organization or urban Indian orga-
303
nization (as defined in section 4 of the Indian
Health Care Improvement Act) pursuant to a
contract between the center and an organization
under section 1903(m), for payment to the cen-
ter at least quarterly by the State of a supple-
mental payment equal to the amount (if any) by
which the amount determined under clause (i)
exceeds the amount of the payments provided
under such contract.’’.
(e) Section 1902(a) of the Social Security Act is
amended by adding at the end the following:
‘‘(66) if the Indian Health Service operates or
funds health programs in the State or if there are
Indian tribes, tribal organizations or urban Indian
organizations (as those terms are defined in section
4 of the Indian Health Care Improvement Act)
present in the State, provide for meaningful con-
sultation with such entities prior to the submission
of, and as a precondition of approval of, any pro-
posed amendment, waiver, demonstration project, or
other request that would have the effect of changing
any aspect of the State’s administration of the Med-
icaid program, provided that ‘meaningful consulta-
tion’ shall be defined through the negotiated rule-
making provided for under section 802 of the Indian
304
Health Care Improvement Act, provided that such
consultation must be carried out in collaboration
with the Indian Medicaid Advisory Committee estab-
lished under section 415(a)(3) of the Indian Health
Care Improvement Act.’’.
(f) The last sentence of section 1905(b) of the Social
Security Act is amended to read as follows: ‘‘Notwith-
standing the first sentence of this section, the Federal
medical assistance percentage shall be 100 percent with
respect to amounts expended as medical assistance for
services which are received through the Indian Health
Service or an Indian tribe, tribal organization, or urban
Indian organization (as defined in section 4 of the Indian
Health Care Improvement Act) under section 1911 of the
Social Security Act. ‘Through’ in this subsection shall in-
clude services provided directly, by referral, or under con-
tracts or other arrangements between the Indian Health
Service, Indian tribe, tribal organization, or urban Indian
organization and another health provider.’’.
(g) Section 1911 of the Social Security Act is amend-
ed to read as follows:
‘‘SEC. 1911. INDIAN HEALTH SERVICE PROGRAMS.
‘‘(a) The Indian Health Service and an Indian tribe,
tribal organization, or urban Indian organization (as those
terms are defined in section 4 of the Indian Health Care
305
Improvement Act) shall be eligible for reimbursement for
medical assistance provided under a State plan if and for
so long as it provides services or provider types of a type
otherwise covered under the State plan and meets the con-
ditions and requirements which are applicable generally to
the service for which it seeks reimbursement under this
title and for services provided by a qualified Indian health
program under section 1880A.
‘‘(b) Notwithstanding subsection (a), if the Indian
Health Service, an Indian tribe, or tribal organization,
which provides services of a type otherwise covered under
the State plan, does not meet all of the conditions and
requirements of this title which are applicable generally
to such services submits to the Secretary within 6 months
after the date on which it first sought reimbursement for
the service an acceptable plan for achieving compliance
with such conditions and requirements, it shall be deemed
to meet such conditions and requirements (and to be eligi-
ble for reimbursement under this title), without regard to
the extent of its actual compliance with such conditions
and requirements, during the first 12 months after the
month in which such plan is submitted.
‘‘(c) The Secretary is authorized to enter into agree-
ments with the State agency for the purpose of reimburs-
ing such agency for health care and services provided by
306
the Indian Health Service, Indian tribes, tribal organiza-
tions, and urban Indian organizations, directly, through
referral, or under contracts or other arrangements be-
tween the Indian Health Service, Indian tribe, tribal orga-
nization, or urban Indian organization and another health
provider to Indians who are eligible for medical assistance
under the State plan.’’.
(h) Section 2101(c) of the Social Security Act is
amended by adding at the end the following: ‘‘Without re-
gard to which option a State chooses under section
2101(a), the Federal medical assistance percentage shall
be 100 per centum with respect to amounts expended as
medical assistance for services which are provided through
a health program operated by the Indian Health Service,
an Indian tribe, or tribal organization (as those terms are
defined in section 4 of the Indian Health Care Improve-
ment Act).’’.
SEC. 5. REPEAL OF FACILITIES SURVEY AND REPORTING
REQUIREMENT.
Subsections (a) and (b) of section 506 of P.L. 101–
630 are repealed.
Æ