129 
curity Act (relating to the State children’s health in-
surance program) under terms equivalent to those 
described in paragraphs (2) through (4). 
‘‘(c) REPORT.—Not later then 3 years after the date 
of enactment of the Indian Healthcare Improvement Act 
of 2017, the Secretary shall submit to the Committee on 
Indian Affairs and Committee on Finance of the Senate 
and the Committee on Natural Resources and Committee 
on Energy and Commerce of the House of Representatives 
a report that includes— 
‘‘(1) the results of the study under this section; 
‘‘(2) a summary of any consultation that oc-
curred between the Secretary and the Navajo Na-
tion, other Indian Tribes, the States of Arizona, 
New Mexico, and Utah, counties which include Nav-
ajo Lands, and other interested parties, in con-
ducting this study; 
‘‘(3) projected costs or savings associated with 
establishment of such entity, and any estimated im-
pact on services provided as described in this section 
in relation to probable costs or savings; and 
‘‘(4) legislative actions that would be required 
to authorize the establishment of such entity if such 
entity is determined by the Secretary to be fea-
sible.’’. 
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Subtitle E—Health Services for 
Urban Indians 
SEC. 161. FACILITIES RENOVATION. 
Section 509 of the Indian Health Care Improvement 
Act (25 U.S.C. 1659) is amended by inserting ‘‘or con-
struction or expansion of facilities’’ after ‘‘renovations to 
facilities’’. 
SEC. 162. TREATMENT OF CERTAIN DEMONSTRATION 
PROJECTS. 
Section 512 of the Indian Health Care Improvement 
Act (25 U.S.C. 1660b) is amended to read as follows: 
‘‘SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION 
PROJECTS. 
‘‘Notwithstanding any other provision of law, the 
Tulsa Clinic and Oklahoma City Clinic demonstration 
projects shall— 
‘‘(1) be permanent programs within the Serv-
ice’s direct care program; 
‘‘(2) continue to be treated as Service units and 
operating units in the allocation of resources and co-
ordination of care; and 
‘‘(3) continue to meet the requirements and 
definitions of an urban Indian organization in this 
Act, and shall not be subject to the provisions of the 
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Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.).’’. 
SEC. 163. REQUIREMENT TO CONFER WITH URBAN INDIAN 
ORGANIZATIONS. 
(a) CONFERRING WITH URBAN INDIAN ORGANIZA-
TIONS.—Title V of the Indian Health Care Improvement 
Act (25 U.S.C. 1651 et seq.) (as amended by section 
101(b)) is amended by adding at the end the following: 
‘‘SEC. 514. CONFERRING WITH URBAN INDIAN ORGANIZA-
TIONS. 
‘‘(a) DEFINITION OF CONFER.—In this section, the 
term ‘confer’ means to engage in an open and free ex-
change of information and opinions that— 
‘‘(1) leads to mutual understanding and com-
prehension; and 
‘‘(2) emphasizes trust, respect, and shared re-
sponsibility. 
‘‘(b) REQUIREMENT.—The Secretary shall ensure 
that the Service confers, to the maximum extent prac-
ticable, with urban Indian organizations in carrying out 
this Act.’’. 
(b) CONTRACTS WITH, AND GRANTS TO, URBAN IN-
DIAN ORGANIZATIONS.—Section 502 of the Indian Health 
Care Improvement Act (25 U.S.C. 1652) is amended to 
read as follows: 
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‘‘SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN IN-
DIAN ORGANIZATIONS. 
‘‘(a) IN GENERAL.—Pursuant to the Act of Novem-
ber 2, 1921 (25 U.S.C. 13) (commonly known as the ‘Sny-
der Act’), the Secretary, acting through the Service, shall 
enter into contracts with, or make grants to, urban Indian 
organizations to assist the urban Indian organizations in 
the establishment and administration, within urban cen-
ters, of programs that meet the requirements of this title. 
‘‘(b) CONDITIONS.—Subject to section 506, the Sec-
retary, acting through the Service, shall include such con-
ditions as the Secretary considers necessary to effect the 
purpose of this title in any contract into which the Sec-
retary enters with, or in any grant the Secretary makes 
to, any urban Indian organization pursuant to this title.’’. 
SEC. 164. EXPANDED PROGRAM AUTHORITY FOR URBAN IN-
DIAN ORGANIZATIONS. 
Title V of the Indian Health Care Improvement Act 
(25 U.S.C. 1651 et seq.) (as amended by section 163(a)) 
is amended by adding at the end the following: 
‘‘SEC. 515. EXPANDED PROGRAM AUTHORITY FOR URBAN 
INDIAN ORGANIZATIONS. 
‘‘Notwithstanding any other provision of this Act, the 
Secretary, acting through the Service, is authorized to es-
tablish programs, including programs for awarding grants, 
for urban Indian organizations that are identical to any 
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programs established pursuant to sections 218, 702, and 
708(g).’’. 
SEC. 165. COMMUNITY HEALTH REPRESENTATIVES. 
Title V of the Indian Health Care Improvement Act 
(25 U.S.C. 1651 et seq.) (as amended by section 164) is 
amended by adding at the end the following: 
‘‘SEC. 516. COMMUNITY HEALTH REPRESENTATIVES. 
‘‘The Secretary, acting through the Service, may 
enter into contracts with, and make grants to, urban In-
dian organizations for the employment of Indians trained 
as health service providers through the Community Health 
Representative Program under section 107 in the provi-
sion of health care, health promotion, and disease preven-
tion services to urban Indians.’’. 
SEC. 166. USE OF FEDERAL GOVERNMENT FACILITIES AND 
SOURCES OF SUPPLY; HEALTH INFORMATION 
TECHNOLOGY. 
Title V of the Indian Health Care Improvement Act 
(25 U.S.C. 1651 et seq.) (as amended by section 165) is 
amended by adding at the end the following: 
‘‘SEC. 517. USE OF FEDERAL GOVERNMENT FACILITIES AND 
SOURCES OF SUPPLY. 
‘‘(a) IN GENERAL.—The Secretary may permit an 
urban Indian organization that has entered into a contract 
or received a grant pursuant to this title, in carrying out 
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the contract or grant, to use, in accordance with such 
terms and conditions for use and maintenance as are 
agreed on by the Secretary and the urban Indian organiza-
tions— 
‘‘(1) any existing facility under the jurisdiction 
of the Secretary; 
‘‘(2) all equipment contained in or pertaining to 
such an existing facility; and 
‘‘(3) any other personal property of the Federal 
Government under the jurisdiction of the Secretary. 
‘‘(b) DONATIONS.—Subject to subsection (d), the 
Secretary may donate to an urban Indian organization 
that has entered into a contract or received a grant pursu-
ant to this title any personal or real property determined 
to be excess to the needs of the Service or the General 
Services Administration for the purposes of carrying out 
the contract or grant. 
‘‘(c) ACQUISITION
OF PROPERTY.—The Secretary 
may acquire excess or surplus personal or real property 
of the Federal Government for donation, subject to sub-
section (d), to an urban Indian organization that has en-
tered into a contract or received a grant pursuant to this 
title if the Secretary determines that the property is ap-
propriate for use by the urban Indian organization for 
purposes of the contract or grant. 
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of the Public Health Service Act (42 U.S.C. 300jj)), tele-
medicine services development, and related infrastruc-
ture.’’. 
Subtitle F—Organizational 
Improvements 
SEC. 171. ESTABLISHMENT OF THE INDIAN HEALTH SERV-
ICE AS AN AGENCY OF THE PUBLIC HEALTH 
SERVICE. 
Section 601 of the Indian Health Care Improvement 
Act (25 U.S.C. 1661) is amended to read as follows: 
‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV-
ICE AS AN AGENCY OF THE PUBLIC HEALTH 
SERVICE. 
‘‘(a) ESTABLISHMENT.— 
‘‘(1) IN GENERAL.—In order to more effectively 
and efficiently carry out the responsibilities, authori-
ties, 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 the Public 
Health Service of the Department the Indian Health 
Service. 
‘‘(2) DIRECTOR.—The Service shall be adminis-
tered by a Director, who shall be appointed by the 
President, by and with the advice and consent of the 
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137 
Senate. The Director shall report to the Secretary. 
Effective with respect to an individual appointed by 
the President, by and with the advice and consent 
of the Senate, after January 1, 2008, the term of 
service of the Director shall be 4 years. A Director 
may serve more than 1 term. 
‘‘(3) INCUMBENT.—The individual serving in 
the position of Director of the Service on the day be-
fore the date of enactment of the Indian Healthcare 
Improvement Act of 2017 shall serve as Director. 
‘‘(4) ADVOCACY AND CONSULTATION.—The po-
sition of Director is established to, in a manner con-
sistent with the government-to-government relation-
ship between the United States and Indian Tribes— 
‘‘(A) facilitate advocacy for the develop-
ment of appropriate Indian health policy; and 
‘‘(B) promote consultation on matters re-
lating to Indian health. 
‘‘(b) AGENCY.—The Service shall be an agency within 
the Public Health Service of the Department, and shall 
not be an office, component, or unit of any other agency 
of the Department. 
‘‘(c) DUTIES.—The Director shall— 
‘‘(1) perform all functions that were, on the day 
before the date of enactment of the Indian 
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Healthcare Improvement Act of 2017, carried out by 
or under the direction of the individual serving as 
Director of the Service on that day; 
‘‘(2) perform all functions of the Secretary re-
lating to the maintenance and operation of hospital 
and health facilities for Indians and the planning 
for, and provision and utilization of, health services 
for Indians, including by ensuring that all agency di-
rectors, managers, and chief executive officers have 
appropriate and adequate training, experience, skill 
levels, knowledge, abilities, and education (including 
continuing training requirements) to competently 
fulfill the duties of the positions and the mission of 
the Service; 
‘‘(3) administer all health programs under 
which health care is provided to Indians based upon 
their status as Indians which are administered by 
the Secretary, including 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 
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‘‘(E) the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et 
seq.); 
‘‘(4) administer all scholarship and loan func-
tions carried out under title I; 
‘‘(5) directly advise the Secretary concerning 
the development of all policy- and budget-related 
matters affecting Indian health; 
‘‘(6) collaborate with the Assistant Secretary 
for Health concerning appropriate matters of Indian 
health that affect the agencies of the Public Health 
Service; 
‘‘(7) advise each Assistant Secretary of the De-
partment concerning matters of Indian health with 
respect to which that Assistant Secretary has au-
thority and responsibility; 
‘‘(8) advise the heads of other agencies and pro-
grams of the Department concerning matters of In-
dian health with respect to which those heads have 
authority and responsibility; 
‘‘(9) coordinate the activities of the Department 
concerning matters of Indian health; and 
‘‘(10) perform such other functions as the Sec-
retary may designate. 
‘‘(d) AUTHORITY.— 
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‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Director, shall have the authority— 
‘‘(A) except to the extent provided for in 
paragraph (2), to appoint and compensate em-
ployees for the Service in accordance with title 
5, United States Code; 
‘‘(B) to enter into contracts for the pro-
curement of goods and services to carry out the 
functions of the Service; and 
‘‘(C) to manage, expend, and obligate all 
funds appropriated for the Service. 
‘‘(2) PERSONNEL
ACTIONS.—Notwithstanding 
any other provision of 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).’’. 
SEC. 172. OFFICE OF DIRECT SERVICE TRIBES. 
Title VI of the Indian Health Care Improvement Act 
(25 U.S.C. 1661 et seq.) (as amended by section 101(b)) 
is amended by adding at the end the following: 
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‘‘SEC. 603. OFFICE OF DIRECT SERVICE TRIBES. 
‘‘(a) ESTABLISHMENT.—There is established within 
the Service an office, to be known as the ‘Office of Direct 
Service Tribes’. 
‘‘(b) TREATMENT.—The Office of Direct Service 
Tribes shall be located in the Office of the Director. 
‘‘(c) DUTIES.—The Office of Direct Service Tribes 
shall be responsible for— 
‘‘(1) providing Service-wide leadership, guidance 
and support for direct service tribes to include stra-
tegic planning and program evaluation; 
‘‘(2) ensuring maximum flexibility to tribal 
health and related support systems for Indian bene-
ficiaries; 
‘‘(3) serving as the focal point for consultation 
and participation between direct service tribes and 
organizations and the Service in the development of 
Service policy; 
‘‘(4) holding no less than biannual consultations 
with direct service tribes in appropriate locations to 
gather information and aid in the development of 
health policy; and 
‘‘(5) directing a national program and providing 
leadership and advocacy in the development of 
health policy, program management, budget formu-
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lation, resource allocation, and delegation support 
for direct service tribes.’’. 
SEC. 173. NEVADA AREA OFFICE. 
Title VI of the Indian Health Care Improvement Act 
(25 U.S.C. 1661 et seq.) (as amended by section 172) is 
amended by adding at the end the following: 
‘‘SEC. 604. NEVADA AREA OFFICE. 
‘‘(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of this section, in a manner consistent 
with the tribal consultation policy of the Service, the Sec-
retary shall submit to Congress a plan describing the man-
ner and schedule by which an area office, separate and 
distinct from the Phoenix Area Office of the Service, can 
be established in the State of Nevada. 
‘‘(b) FAILURE TO SUBMIT PLAN.— 
‘‘(1) DEFINITION OF OPERATIONS FUNDS.—In 
this subsection, the term ‘operations funds’ means 
only the funds used for— 
‘‘(A) the administration of services, includ-
ing functional expenses such as overtime, per-
sonnel salaries, and associated benefits; or 
‘‘(B) related tasks that directly affect the 
operations described in subparagraph (A). 
‘‘(2) WITHHOLDING
OF
FUNDS.—If the Sec-
retary fails to submit a plan in accordance with sub-
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143 
section (a), the Secretary shall withhold the oper-
ations funds reserved for the Office of the Director, 
subject to the condition that the withholding shall 
not adversely impact the capacity of the Service to 
deliver health care services. 
‘‘(3) RESTORATION.—The operations funds 
withheld pursuant to paragraph (2) may be restored, 
at the discretion of the Secretary, to the Office of 
the Director on achievement by that Office of com-
pliance with this section.’’. 
Subtitle G—Behavioral Health 
Programs 
SEC. 181. BEHAVIORAL HEALTH PROGRAMS. 
Title VII of the Indian Health Care Improvement Act 
(25 U.S.C. 1665 et seq.) is amended to read as follows: 
‘‘TITLE VII—BEHAVIORAL 
HEALTH PROGRAMS 
‘‘Subtitle A—General Programs 
‘‘SEC. 701. DEFINITIONS. 
‘‘In this subtitle: 
‘‘(1) 
ALCOHOL-RELATED 
NEURODEVELOPMENTAL
DISORDERS; 
ARND.—The 
term ‘alcohol-related neurodevelopmental disorders’ 
or ‘ARND’ means, with a history of maternal alco-
hol consumption during pregnancy, central nervous 
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system abnormalities, which may range from minor 
intellectual deficits and developmental delays to 
mental retardation. ARND children may have behav-
ioral problems, learning disabilities, problems with 
executive functioning, and attention disorders. The 
neurological defects of ARND may be as severe as 
FAS, but facial anomalies and other physical char-
acteristics are not present in ARND, thus making 
diagnosis difficult. 
‘‘(2) ASSESSMENT.—The term ‘assessment’ 
means the systematic collection, analysis, and dis-
semination of information on health status, health 
needs, and health problems. 
‘‘(3) BEHAVIORAL HEALTH AFTERCARE.—The 
term ‘behavioral health aftercare’ includes those ac-
tivities 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 a community-based therapeutic 
group, transitional living facilities, a 12-step spon-
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sor, a local 12-step or other related support group, 
and other community-based providers. 
‘‘(4) DUAL DIAGNOSIS.—The term ‘dual diag-
nosis’ means coexisting substance abuse and mental 
illness conditions or diagnosis. Such clients are 
sometimes referred to as mentally ill chemical abus-
ers (MICAs). 
‘‘(5) 
FETAL
ALCOHOL
SPECTRUM
DIS-
ORDERS.— 
‘‘(A) IN GENERAL.—The term ‘fetal alco-
hol spectrum disorders’ includes a range of ef-
fects that can occur in an individual whose 
mother drank alcohol during pregnancy, includ-
ing physical, mental, behavioral, and/or learning 
disabilities with possible lifelong implications. 
‘‘(B) INCLUSIONS.—The term ‘fetal alcohol 
spectrum disorders’ may include— 
‘‘(i) fetal alcohol syndrome (FAS); 
‘‘(ii) partial fetal alcohol syndrome 
(partial FAS); 
‘‘(iii) 
alcohol-related 
birth 
defects 
(ARBD); and 
‘‘(iv) 
alcohol-related 
neurodevelopmental disorders (ARND). 
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‘‘(6) FAS OR FETAL ALCOHOL SYNDROME.— 
The term ‘FAS’ or ‘fetal alcohol syndrome’ means a 
syndrome in which, with a history of maternal alco-
hol consumption during pregnancy, the following cri-
teria are met: 
‘‘(A) Central nervous system involvement, 
such as mental retardation, developmental 
delay, intellectual deficit, microencephaly, or 
neurological abnormalities. 
‘‘(B) Craniofacial abnormalities with at 
least 2 of the following: 
‘‘(i) Microophthalmia. 
‘‘(ii) Short palpebral fissures. 
‘‘(iii) Poorly developed philtrum. 
‘‘(iv) Thin upper lip. 
‘‘(v) Flat nasal bridge. 
‘‘(vi) Short upturned nose. 
‘‘(C) Prenatal or postnatal growth delay. 
‘‘(7) REHABILITATION.—The term ‘rehabilita-
tion’ means medical and health care services that— 
‘‘(A) are recommended by a physician or 
licensed practitioner of the healing arts within 
the scope of their practice under applicable law; 
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