I
106TH CONGRESS
1ST SESSION
H. R. 3397
To improve the implementation of the Federal responsibility for the care
and education of Indian people by improving the services and facilities
of Federal Indian health programs and encouraging maximum participa-
tion of Indians in such programs, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
NOVEMBER 16, 1999
Mr. GEORGE MILLER of California (for himself, Mr. YOUNG of Alaska, Mr.
BONIOR, Mr. WAXMAN, Mr. KILDEE, Mr. KENNEDY of Rhode Island, Mr.
ABERCROMBIE, Mr. HAYWORTH, Mr. INSLEE, Mr. FALEOMAVAEGA, Mr.
GALLEGLY, Mr. SMITH of Washington, Mrs. NAPOLITANO, Mr. KIND,
Mrs. CHRISTENSEN, Mr. BLUMENAUER, Ms. KILPATRICK, Ms. LEE, Ms.
BALDWIN, Ms. PELOSI, Mr. HINCHEY, Mr. JEFFERSON, Mr. FILNER,
Mr. OBERSTAR, Mr. DIAZ-BALART, Ms. STABENOW, Mr. NETHERCUTT,
and Mr. MARTINEZ) (all by request) introduced the following bill; which
was referred to the Committee on Resources, and in addition to the Com-
mittees on Commerce, Ways and Means, and Government Reform, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the com-
mittee concerned
A BILL
To improve the implementation of the Federal responsibility
for the care and education of Indian people by improving
the services and facilities of Federal Indian health pro-
grams and encouraging maximum participation of Indi-
ans in such programs, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Indian Health Care
Improvement Act Amendments of 2000’’.
SEC. 2. INDIAN HEALTH CARE IMPROVEMENT ACT AMEND-
ED.
The Indian Health Care Improvement Act (25 U.S.C.
1601 note) is amended to read as follows:
‘‘SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
‘‘(a) SHORT TITLE.—This Act may be cited as the
‘Indian Health Care Improvement Act’.
‘‘(b) TABLE OF CONTENTS.—The table of contents
for this Act is as follows:
‘‘Sec. 1. Short title; table of contents.
‘‘Sec. 2. Findings.
‘‘Sec. 3. Declaration of health objectives.
‘‘Sec. 4. Definitions.
‘‘TITLE I—INDIAN HEALTH, HUMAN RESOURCES, AND
DEVELOPMENT
‘‘Sec. 101. Purpose.
‘‘Sec. 102. General requirements.
‘‘Sec. 103. Health professions recruitment program for Indians.
‘‘Sec. 104. Health professions preparatory scholarship program for Indians.
‘‘Sec. 105. Indian health professions scholarships.
‘‘Sec. 106. American Indians into psychology program.
‘‘Sec. 107. Indian health service extern programs.
‘‘Sec. 108. Continuing education allowances.
‘‘Sec. 109. Community health representative program.
‘‘Sec. 110. Indian health service loan repayment program.
‘‘Sec. 111. Scholarship and loan repayment recovery fund.
‘‘Sec. 112. Recruitment activities.
‘‘Sec. 113. Tribal recruitment and retention program.
‘‘Sec. 114. Advanced training and research.
‘‘Sec. 115. Quentin B. Burdick American Indians into Nursing Program.
‘‘Sec. 116. Tribal cultural orientation.
‘‘Sec. 117. INMED program.
‘‘Sec. 118. Health training programs of community colleges.
‘‘Sec. 119. Retention bonus.
‘‘Sec. 120. Nursing residency program.
‘‘Sec. 121. Community health aide program for Alaska.
‘‘Sec. 122. Tribal health program administration.
‘‘Sec. 123. Health professional chronic shortage demonstration project.
‘‘Sec. 124. Treatment of scholarships for certain purposes.
‘‘Sec. 125. National health service corps.
‘‘Sec. 126. Substance abuse counselor education demonstration project.
‘‘Sec. 127. Mental health training and community education programs.
‘‘Sec. 128. Authorization of appropriations.
‘‘TITLE II—HEALTH SERVICES
‘‘Sec. 201. Indian health care improvement fund.
‘‘Sec. 202. Catastrophic health emergency fund.
‘‘Sec. 203. Health promotion and disease prevention services.
‘‘Sec. 204. Diabetes prevention, treatment, and control.
‘‘Sec. 205. Shared services.
‘‘Sec. 206. Health services research.
‘‘Sec. 207. Mammography and other cancer screening.
‘‘Sec. 208. Patient travel costs.
‘‘Sec. 209. Epidemiology centers.
‘‘Sec. 210. Comprehensive school health education programs.
‘‘Sec. 211. Indian youth program.
‘‘Sec. 212. Prevention, control, and elimination of communicable and infectious
diseases.
‘‘Sec. 213. Authority for provision of other services.
‘‘Sec. 214. Indian women’s health care.
‘‘Sec. 215. Environmental and nuclear health hazards.
‘‘Sec. 216. Arizona as a contract health service delivery area.
‘‘Sec. 217. California contract health services program.
‘‘Sec. 218. California as a contract health service delivery area.
‘‘Sec. 219. Contract health services for the Trenton service area.
‘‘Sec. 220. Programs operated by Indian tribes and tribal organizations.
‘‘Sec. 221. Licensing.
‘‘Sec. 222. Authorization for emergency contract health services.
‘‘Sec. 223. Prompt action on payment of claims.
‘‘Sec. 224. Liability for payment.
‘‘Sec. 225. Authorization of appropriations.
‘‘TITLE III—FACILITIES
‘‘Sec. 301. Consultation; construction and renovation of facilities; reports.
‘‘Sec. 302. Safe water and sanitary waste disposal facilities.
‘‘Sec. 303. Preference to Indians and Indian firms.
‘‘Sec. 304. Expenditure of nonservice funds for renovation.
‘‘Sec. 305. Funding for the construction, expansion, and modernization of small
ambulatory care facilities.
‘‘Sec. 306. Indian health care delivery demonstration project.
‘‘Sec. 307. Land transfer.
‘‘Sec. 308. Leases.
‘‘Sec. 309. Loans, loan guarantees, and loan repayment.
‘‘Sec. 310. Tribal leasing.
‘‘Sec. 311. Indian health service/tribal facilities joint venture program.
‘‘Sec. 312. Location of facilities.
‘‘Sec. 313. Maintenance and improvement of health care facilities.
‘‘Sec. 314. Tribal management of federally owned quarters.
‘‘Sec. 315. Applicability of buy American requirement.
‘‘Sec. 316. Other funding for facilities.
‘‘Sec. 317. Authorization of appropriations.
‘‘TITLE IV—ACCESS TO HEALTH SERVICES
‘‘Sec. 401. Treatment of payments under medicare program.
‘‘Sec. 402. Treatment of payments under medicaid program.
‘‘Sec. 403. Report.
‘‘Sec. 404. Grants to and funding agreements with the service, Indian tribes,
tribal organizations, and urban Indian organizations.
‘‘Sec. 405. Direct billing and reimbursement of medicare, medicaid, and other
third-party payors.
‘‘Sec. 406. Reimbursement from certain third parties of costs of health services.
‘‘Sec. 407. Crediting of reimbursements.
‘‘Sec. 408. Purchasing health care coverage.
‘‘Sec. 409. Indian health service, department of veterans affairs, and other Fed-
eral agency health facilities and services sharing.
‘‘Sec. 410. Payor of last resort.
‘‘Sec. 411. Payment or reimbursement for services.
‘‘Sec. 412. Tuba city demonstration project.
‘‘Sec. 413. Access to Federal insurance.
‘‘Sec. 414. Consultation and rulemaking.
‘‘Sec. 415. Limitation on secretary’s waiver authority.
‘‘Sec. 416. Children’s health insurance program funds.
‘‘Sec. 417. Waiver of medicare and medicaid sanctions.
‘‘Sec. 418. Safe harbor.
‘‘Sec. 419. Cost sharing.
‘‘Sec. 420. Managed care.
‘‘Sec. 421. Navajo nation medicaid agency.
‘‘Sec. 422. Indian advisory committees.
‘‘Sec. 423. Limitation on charges.
‘‘Sec. 424. Authorization of appropriations.
‘‘TITLE V—HEALTH SERVICES FOR URBAN INDIANS
‘‘Sec. 501. Purpose.
‘‘Sec. 502. Contracts with, and grants to, urban Indian organizations.
‘‘Sec. 503. Contracts and grants for the provision of health care and referral
services.
‘‘Sec. 504. Contracts and grants for the determination of unmet health care
needs.
‘‘Sec. 505. Evaluations; renewals.
‘‘Sec. 506. Other contract and grant requirements.
‘‘Sec. 507. Reports and records.
‘‘Sec. 508. Limitation on contract authority.
‘‘Sec. 509. Facilities.
‘‘Sec. 510. Office of urban Indian health.
‘‘Sec. 511. Grants for alcohol and substance abuse related services.
‘‘Sec. 512. Treatment of certain demonstration projects.
‘‘Sec. 513. Urban NIAAA transferred programs.
‘‘Sec. 514. Consultation with urban Indian organizations.
‘‘Sec. 515. Federal tort claims act coverage.
‘‘Sec. 516. Urban youth treatment center demonstration.
‘‘Sec. 517. Use of Federal government facilities and sources of supply.
‘‘Sec. 518. Grants for diabetes prevention, treatment, and control.
‘‘Sec. 519. Community health representatives.
‘‘Sec. 520. Regulations.
‘‘Sec. 521. Authorization of appropriations.
‘‘TITLE VI—ORGANIZATIONAL IMPROVEMENTS
‘‘Sec. 601. Establishment of the Indian health service as an agency of the pub-
lic health service.
‘‘Sec. 602. Automated management information system.
‘‘Sec. 603. Authorization of appropriations.
‘‘TITLE VII—BEHAVIORAL HEALTH PROGRAMS
‘‘Sec. 701. Behavioral health prevention and treatment services.
‘‘Sec. 702. Memoranda of agreement with the department of the interior.
‘‘Sec. 703. Comprehensive behavioral health prevention and treatment program.
‘‘Sec. 704. Mental health technician program.
‘‘Sec. 705. Licensing requirement for mental health care workers.
‘‘Sec. 706. Indian women treatment programs.
‘‘Sec. 707. Indian youth program.
‘‘Sec. 708. Inpatient and community-based mental health facilities design, con-
struction, and staffing.
‘‘Sec. 709. Training and community education.
‘‘Sec. 710. Behavioral health program.
‘‘Sec. 711. Fetal alcohol disorder funding.
‘‘Sec. 712. Child sexual abuse and prevention treatment programs.
‘‘Sec. 713. Behavioral health research.
‘‘Sec. 714. Definitions.
‘‘Sec. 715. Authorization of appropriations.
‘‘TITLE VIII—MISCELLANEOUS
‘‘Sec. 801. Reports.
‘‘Sec. 802. Regulations.
‘‘Sec. 803. Plan of implementation.
‘‘Sec. 804. Availability of funds.
‘‘Sec. 805. Limitation on use of funds appropriated to the Indian health serv-
ice.
‘‘Sec. 806. Eligibility of California Indians.
‘‘Sec. 807. Health services for ineligible persons.
‘‘Sec. 808. Reallocation of base resources.
‘‘Sec. 809. Results of demonstration projects.
‘‘Sec. 810. Provision of services in Montana.
‘‘Sec. 811. Moratorium.
‘‘Sec. 812. Tribal employment.
‘‘Sec. 813. Prime vendor.
‘‘Sec. 814. Severability provisions.
‘‘Sec. 815. Establishment of national bipartisan commission on Indian health
care entitlement.
‘‘Sec. 816. Appropriations; availability.
‘‘Sec. 817. Authorization of appropriations.
‘‘SEC. 2. FINDINGS.
‘‘The Congress finds the following:
‘‘(1) Federal delivery of health services and
funding of tribal and urban Indian health programs
to maintain and improve the health of the Indians
are consonant with and required by the Federal Gov-
ernment’s historical and unique legal relationship, as
reflected in the Constitution, treaties, Federal stat-
utes and the course of dealings of the United States
with Indian tribes and the United States resulting
Government to Government and trust responsibility
and obligations to the American Indian people.
‘‘(2) From the time of European occupation
and colonization through the 20th century policies
and practices of the United States caused and/or
contributed to the severe health conditions of Indi-
ans.
‘‘(3) Indian tribes, have, through the cession of
over 400,000,000 acres of land, to the United States
in exchange for promises, often reflected in treaties,
of health care secured a de facto contract which en-
titles Indians to health care in perpetuity, based on
the moral legal and historic obligation of the United
States.
‘‘(4) The population growth of the Indian peo-
ple that began in the later part of the 20th century
increases the need for Federal health care services.
‘‘(5) A major national goal of the United States
is to provide the quantity and quality of health serv-
ices which will permit the health status of Indians
regardless of where they live to be raised to the
highest possible level that is no less than that of the
general population and to provide for the maximum
participation of Indian tribes, tribal organizations,
and urban Indian organizations in the planning, de-
livery and management of those services.
‘‘(6) Federal health services to Indians have re-
sulted in a reduction in the prevalence and incidence
of illnesses among, and unnecessary and premature
deaths of, Indians.
‘‘(7) Despite such services, the unmet health
needs of the American Indian people remain alarm-
ingly severe, and even continue to decline, and the
health status of Indians is far below the health sta-
tus of the general population of the United States.
‘‘(8) The disparity to be addressed is formi-
dable. In death rates, for example, Indian people
suffer a death rate for diabetes mellitus that is 249
percent higher than the all races rate for the United
States, a pneumonia and influenza death rate 71
percent greater, a tuberculosis death rate that is
533 percent greater, and a death rate from alco-
holism that is 627 percent higher than that of the
all races United States rate.
‘‘SEC. 3. DECLARATION OF HEALTH OBJECTIVES.
‘‘(a) The Congress hereby declares that it is the pol-
icy of this Nation, in fulfillment of its special trust respon-
sibilities and legal obligations to the American Indian
people—
‘‘(1) to assure the highest possible health status
for Indians and to provide all resources necessary to
effect that policy;
‘‘(2) to raise the health status of Indians by the
year 2010 to at least the levels set forth in the goals
contained within the Healthy People 2000 or suc-
cessor standards;
‘‘(3) to the greatest extent possible, to allow In-
dian people to set their own health care priorities
and establish goals that reflect their unmet needs;
‘‘(4) to increase the proportion of all degrees in
the health professions and allied and associated
health professions awarded to Indians so that the
proportion of Indian health professionals in each ge-
ographic service area is raised to at least the level
of that of the general population;
‘‘(5) to require meaningful consultation with In-
dian tribes, Indian organizations, and urban Indian
organizations to implement this Act and the national
policy of Indian self-determination; and
‘‘(6) to provide for health care programs and
facilities operated by Tribes and tribal organizations
in amounts that are not less funds than are provided
to programs and facilities operated directly by the
Service.
‘‘SEC. 4. DEFINITIONS.
‘‘For purposes of this Act:
‘‘(1) The term ‘accredited and accessible’ means
a community college or other appropriate entity on
or near a Reservation and accredited by a national
or regional organization with accrediting authority.
‘‘(2) The term ‘Area Office’ means an adminis-
trative entity including a program office, within the
Indian Health Service through which services and
funds are provided to the service units within a de-
fined geographic area.
‘‘(3) The term ‘contract health service’ means
health services provided at the expense of the Serv-
ice, Indian tribe or tribal organization from public or
private medical providers or hospitals, other than
those funded under the Indian Self-Determination
and Education Assistance Act.
‘‘(4) The term ‘Department’ means, unless oth-
erwise designated, the Department of Health and
Human Services.
‘‘(5) The term ‘Director’ means the Director of
the Indian Health Service.
‘‘(6) The term ‘disease prevention’ is the reduc-
tion, limitation, and prevention of disease and its
complications and reduction in the consequences of
such diseases including, but not limited to—
‘‘(A) controlling—
‘‘(i) development of diabetes;
‘‘(ii) high blood pressure;
‘‘(iii) infectious agents;
‘‘(iv) injuries;
‘‘(v) occupational hazards and disabil-
ities;
‘‘(vi) sexually transmittable diseases;
and
‘‘(vii) toxic agents; and
‘‘(B) providing—
‘‘(i) fluoridation of water; and
‘‘(ii) immunizations.
‘‘(7) The term ‘fund’ or ‘funding’ means the
transfer of moneys from the Department to any eli-
gible entity or individual under this Act by any legal
means, including funding agreements, contracts,
memoranda of understanding, Buy Indian Act con-
tracts or otherwise.
‘‘(8) The term ‘funding agreement’ means any
agreement to transfer funds for the planning, con-
duct, and administration of programs, functions,
services and activities to Tribes and tribal organiza-
tions from the Secretary under the Indian Self-De-
termination and Education Assistance Act.
‘‘(9) The term ‘health profession’ means
allopathic medicine, family medicine, internal medi-
cine, pediatrics, geriatric medicine, obstetrics and
gynecology, podiatric medicine, nursing, public
health nursing, dentistry, psychiatry, osteopathy, op-
tometry, pharmacy, psychology, public health, social
work, marriage and family therapy, chiropractic
medicine, environmental health and engineering, and
allied health professions, or any other health profes-
sion.
‘‘(10) The ‘health promotion’ means fostering
social, economic, environmental, and personal factors
conducive to health, including raising people’s
awareness about health matters and enabling them
to cope with health problems by increasing their
knowledge and providing them with valid informa-
tion; encouraging adequate and appropriate diet, ex-
ercise, and enough sleep; promoting education and
work in conformity with physical and mental capac-
ity; making available suitable housing, safe water,
and sanitary facilities; improving the physical, eco-
nomic, cultural, psychological, and social environ-
ment; and promoting adequate opportunity for spir-
itual, religious, and traditional practices; and ade-
quate and appropriate programs including, but not
limited to—
‘‘(A) abuse prevention (mental and phys-
ical);
‘‘(B) community health;
‘‘(C) community safety;
‘‘(D) consumer health education;
‘‘(E) diet and nutrition;
‘‘(F) disease prevention (communicable,
immunizations, HIV/AIDS);
‘‘(G) environmental health;
‘‘(H) exercise and physical fitness;
‘‘(I) fetal alcohol disorders;
‘‘(J) first aid and CPR education;
‘‘(K) human growth and development;
‘‘(L) injury prevention and personal safety;
‘‘(M) mental health (emotional, self-worth);
‘‘(N) personal health and wellness prac-
tices;
‘‘(O) personal capacity building;
‘‘(P) prenatal, pregnancy, and infant care;
‘‘(Q) psychological well-being;
‘‘(R) reproductive health (family planning);
‘‘(S) safe and adequate water;
‘‘(T) safe housing;
‘‘(U) safe work environments;
‘‘(V) stress control;
‘‘(W) substance abuse;
‘‘(X) sanitary facilities;
‘‘(Y) tobacco use cessation and reduction;
‘‘(Z) violence prevention; and
‘‘(AA) such other activities identified by
the Indian Health Service, or an Indian tribe or
tribal organization, to promote achievement of
any of the objectives described in section 3(b).
‘‘(11) The term ‘Indians’ or ‘Indian’ shall have
the same meaning as provided in the Indian Self-De-
termination and Education Assistance Act.
‘‘(12) The term ‘Indian health program’ means
any health program or facility funded, in whole or
part, by the Service for the benefit of Indians and
administered—
‘‘(i) directly by the Service;
‘‘(ii) by any Indian tribe or tribal organiza-
tion pursuant to a funding agreement under—
‘‘(I) the Indian Self-Determination
and Educational Assistance Act; or
‘‘(II) section 23 of the Act of April
30, 1908 (25 U.S.C. 47), popularly known
as the ‘Buy-Indian Act’’; or
‘‘(iii) by an urban Indian organization pur-
suant to title V of this Act.
‘‘(13) The term ‘Indian tribe’ shall have the
same meaning as provided in the Indian Self-Deter-
mination and Education Assistance Act.
‘‘(14) The term ‘reservation’ means any feder-
ally recognized Indian tribe’s reservation, Pueblo or
colony, including former reservations in Oklahoma,
Alaska Native Regions established pursuant to the
Alaska Native Claims Settlement Act, and Indian al-
lotments.
‘‘(15) The term ‘Secretary’, unless otherwise
designated, means the Secretary of Health and
Human Services.
‘‘(16) The term ‘Service’ means the Indian
Health Service.
‘‘(17) The term ‘service area’ means the geo-
graphical area served by each Area Office.
‘‘(18) The term ‘Service Unit’ means—
‘‘(A) an administrative entity within the
Indian Health Service, or
‘‘(B) a Tribe or tribal organization oper-
ating health care programs or facilities with
funds from the Service under the Indian Self-
Determination and Education Assistance Act,
through which services are provided, directly or
by contract, to the eligible Indian population
within a defined geographic area.
‘‘(19) The term ‘traditional health care prac-
tices’ means the application by Native healing prac-
titioners of the Native healing sciences (as opposed
or in contradistinction to Western Healing Sciences)
which embodies the influences or forces of innate
tribal discovery, history, description, explanation and
knowledge of the states of wellness and illness and
which calls upon these influences or forces, including
physical, mental, and spiritual forces in the pro-
motion, restoration, preservation and maintenance of
health, well-being, and life’s harmony.
‘‘(20) The term ‘tribal organization’ shall have
the same meaning as provided in the Indian Self-De-
termination and Education Assistance Act.
‘‘(21) The term ‘tribally controlled community
college’ has the meaning given such term in section
2(a)(4) of the Tribally Controlled Community Col-
lege Assistance Act of 1978 (25 U.S.C. 1801(a)(4))
and the definition contained in the Indian Land
Grant Status Act (7 U.S.C. 301 note).
‘‘(22) The term ‘urban center’ means any com-
munity which has a sufficient urban Indian popu-
lation with unmet health needs to warrant assistance
under title V, as determined by the Secretary.
‘‘(23) The term ‘urban Indian’ means any indi-
vidual who resides in an urban center and who
meets one or more of the following criteria:
‘‘(A) Irrespective of whether the individual
lives on or near a reservation, the individual is
a member of a Tribe, band, or other organized
group of Indians, including those Tribes, bands,
or groups terminated since 1940.
‘‘(B) The individual is an Eskimo or Aleut
or other Alaskan Native.
‘‘(C) The individual is considered by the
Secretary of the Interior to be an Indian for
any purpose.
‘‘(D) The individual is determined to be an
Indian under regulations promulgated by the
Secretary.
‘‘(24) The term ‘urban Indian organization’
means a nonprofit corporate body situated in an
urban center, governed by an urban Indian con-
trolled board of directors, and providing for the par-
ticipation of all interested Indian groups and individ-
uals, which body is capable of legally cooperating
with other public and private entities for the purpose
of performing the activities described in section
503(a).
‘‘TITLE 
I—INDIAN 
HEALTH,
HUMAN RESOURCES, AND DE-
VELOPMENT
‘‘SEC. 101. PURPOSE.
‘‘The purpose of this title is to increase to the max-
imum feasible extent the number of Indians entering the
health professions and providing health services, and to
assure an optimum supply of health professionals to the
Service, Indian tribes, tribal organizations, and urban In-
dian organizations involved in the provision of health serv-
ices to Indian people.
‘‘SEC. 102. GENERAL REQUIREMENTS.
‘‘(a) SERVICE AREA PRIORITIES.—(1) Unless other-
wise specified, the funding for each program authorized
by this title shall be allocated by service area by formula
developed in consultation with Indian tribes, tribal organi-
zations, and urban Indian organizations. Such formula
shall consider the human resource and development needs
in each service area.
‘‘(2) Each Area Office shall undertake active and
continuing consultation with representatives of Indian
tribes, tribal organizations, and urban Indian organiza-
tions to prioritize the use of funds authorized and provided
under this title within the service area.
‘‘(3) Unless otherwise prohibited, the Area Office is
authorized to reallocate the funds available to it pursuant
to this title among the programs authorized by this title,
excepted that scholarship and loan repayment funds may
not be used for administrative functions.
‘‘(b) All individual recipients of scholarships, loans,
or other funding authorized by this title that exist on Sep-
tember 30, 1976 shall be excluded from operation of this
subsection through to the completion of the individual’s
course of study supported by funds appropriated to carry
out this title.
‘‘SEC. 103. HEALTH PROFESSIONS RECRUITMENT PROGRAM
FOR INDIANS.
‘‘(a) Subject to the requirements of section 102, the
Secretary shall make funds available to public or nonprofit
private health entities or Indian tribes or tribal organiza-
tions to assist such entities in meeting the costs of—
‘‘(1) identifying Indians with a potential for
education or training in the health professions and
encouraging and assisting them—
‘‘(A) to enroll in courses of study in such
health professions; or
‘‘(B) if they are not qualified to enroll in
any such courses of study, to undertake such
postsecondary education or training as may be
required to qualify them for enrollment;
‘‘(2) publicizing existing sources of financial aid
available to Indians enrolled in any course of study
referred to in paragraph (1) or who are undertaking
training necessary to quality them to enroll in any
such course of study; or
‘‘(3) establishing other programs which the
Area Office determines will enhance and facilitate
the enrollment of Indians in, and the subsequent
pursuit and completion by them of, courses of study
referred to in paragraph (1).
‘‘(b)(1) Funds under this section shall require that
an application has been submitted to, and approved by,
the Secretary through the Area Office. Such application
shall be in such form, submitted in such manner, and con-
tain such information, as the Secretary shall by regulation
prescribe pursuant to this Act. The Area Office shall give
a preference to applications submitted by Indian tribes,
tribal organizations, or urban Indian organizations.
‘‘(2) The amount of funds provided to entities author-
ized under this section shall be determined by the Area
Office. Payments pursuant to this section may be made
in advance or by way of reimbursement, and at such inter-
vals and on such conditions as provided for in regulations
issued pursuant to this Act. To the extent not otherwise
prohibited by law, funding commitments shall be for 3
years, as provided for in regulations published pursuant
to this Act.
‘‘(c) For purposes of this section and sections 104
and 105, the term ‘Indian’ or ‘Indians’ shall, in addition
to the meaning contained in section 4, also mean any per-
son who—
‘‘(1) irrespective of whether he or she lives on
or near a reservation, is a member of a Tribe, band,
or other organized group of Indians, including those
Tribes, bands, or groups terminated since 1940;
‘‘(2) is an Eskimo or Aleut or other Alaska Na-
tive;
‘‘(3) is considered by the Secretary of the Inte-
rior to be an Indian for any purpose; or
‘‘(4) is determined to be an Indian under regu-
lations promulgated by the Secretary.
‘‘SEC. 104. HEALTH PROFESSIONS PREPARATORY SCHOL-
ARSHIP PROGRAM FOR INDIANS.
‘‘(a) Subject to the requirements of section 102, the
Secretary shall provide scholarships to Indians who—
‘‘(1) have successfully completed their high
school education or high school equivalency; and
‘‘(2) have demonstrated the potential to suc-
cessfully complete courses of study in the health pro-
fessions.
‘‘(b) Scholarships provided pursuant to this section
shall be for the following purposes:
‘‘(1) Compensatory preprofessional education of
any recipient, such scholarship not to exceed 2 years
on a full-time basis (or the part-time equivalent
thereof, as determined by the Area Office pursuant
to regulations issued under this Act).
‘‘(2) Pregraduate education of any recipient
leading to a baccalaureate degree in an approved
course of study preparatory to a field of study in a
health profession, such scholarship not to exceed 4
years. An extension of up to 2-years (or the part-
time equivalent thereof, as determined by the Area
Office pursuant to regulations issued pursuant to
this Act) may be approved.
‘‘(c) Scholarships under this section—
‘‘(1) may cover costs of tuition, books, trans-
portation, board, and other necessary related ex-
penses of a recipient while attending school;
‘‘(2) shall not be denied solely on the basis of
the applicant’s scholastic achievement if such appli-
cant has been admitted to, or maintained good
standing at, an accredited institution; and
‘‘(3) shall not be denied solely by reason of such
applicant’s eligibility for assistance or benefits under
any other Federal program.
‘‘SEC. 105. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.
‘‘(a) In order to meet the need for health profes-
sionals serving Indians, Indian tribes, tribal organizations,
and urban Indian organizations, subject to the require-
ments of section 102. The administration of this section
shall be a responsibility of the Director and shall not be
delegated in a funding agreement pursuant to the Indian
Self-Determination and Education Assistance Act. The
Secretary shall make scholarships to Indians who are en-
rolled full or part time in accredited schools and pursuing
courses of study in the health professions. Such scholar-
ships shall be designated Indian Health Scholarships and
shall be made in accordance with section 338A of the Pub-
lic Health Service Act (42 U.S.C. 254l), except as pro-
vided in subsection (b) of this section.
‘‘(b)(1) An Indian shall be eligible for a scholarship
under subsection (a) in any year in which such individual
is enrolled full or part time in a course of study referred
to in subsection (a).
‘‘(2)(A) The active duty service obligation under a
written contract with the Secretary under section 338A
of the Public Health Service Act (42 U.S.C. 254l) that
an Indian has entered into under that section shall, if that
individual is a recipient of an Indian Health Scholarship,
be met in full-time practice on an equivalent year for year
obligation, by service—
‘‘(i) in the Indian Health Service;
‘‘(ii) in a program conducted under a funding
agreement entered into under the Indian Self-Deter-
mination and Education Assistance Act;
‘‘(iii) in a program assisted under title V of this
Act; or
‘‘(iv) in the private practice of the applicable
profession if, as determined by the Secretary, in ac-
cordance with guidelines promulgated by the Sec-
retary, such practice is situated in a physician or
other health professional shortage area and address-
es the health care needs of a substantial number of
Indians.
‘‘(B) At the request of any individual who has entered
into a contract referred to in subparagraph (A) and who
receives a degree in medicine (including osteopathic or
allopathic medicine), dentistry, optometry, podiatry, or
pharmacy, the Secretary shall defer the active duty service
obligation of that individual under that contract, in order
that such individual may complete any internship, resi-
dency, or other advanced clinical training that is required
for the practice of that health profession, for an appro-
priate period (in years, as determined by the Secretary),
subject to the following conditions:
‘‘(i) No period of internship, residency, or other
advanced clinical training shall be counted as satis-
fying any period of obligated service that is required
under this section.
‘‘(ii) The active duty service obligation of that
individual shall commence not later than 90 days
after the completion of that advanced clinical train-
ing (or by a date specified by the Secretary).
‘‘(iii) The active duty service obligation will be
served in the health profession of that individual, or
in a field or specialty where a need is determined to
exist by the appropriate service area, in a manner
consistent with clauses (i) through (iv) of subpara-
graph (A).
‘‘(C) All new recipients of Indian Health Scholarships
awarded after 2001 shall meet the active duty service obli-
gation within the service area from which the scholarship
was awarded. Priority shall be given to a program that
funded the recipient. Under special circumstances, a re-
cipient may be placed in a different service area by agree-
ment between Areas or programs.
‘‘(D) Subject to subparagraph (C), the Area Office,
in making assignments of Indian Health Scholarship re-
cipients required to meet the active duty service obligation
described in subparagraph (A), shall give priority to as-
signing individuals to service in those programs specified
in subparagraph (A) that have a need for health profes-
sionals to provide health care services as a result of indi-
viduals having breached contracts entered into under this
section.
‘‘(3) In the case of an individual receiving a scholar-
ship under this section who is enrolled part time in an
approved course of study—
‘‘(A) such scholarship shall be for a period of
years not to exceed the part-time equivalent of 4
years, as determined by the Area Office;
‘‘(B) the period of obligated service described in
paragraph (2)(A) shall be equal to the greater of—
‘‘(i) the part-time equivalent of one year
for each year for which the individual was pro-
vided a scholarship (as determined by the Area
Office); or
‘‘(ii) 2 years; and
‘‘(C) the amount of the monthly stipend speci-
fied in section 338A(g)(1)(B) of the Public Health
Service Act (42 U.S.C. 254l(g)(1)(B)) shall be re-
duced pro rata (as determined by the Secretary)
based on the number of hours such student is en-
rolled.
‘‘(4)(A) An individual who has, on or after the date
of the enactment of this paragraph, entered into a written
contract with the Secretary under this section and who—
‘‘(i) fails to maintain an acceptable level of aca-
demic standing in the educational institution in
which he is enrolled (such level determined by the
educational institution under regulations of the Sec-
retary),
‘‘(ii) is dismissed from such educational institu-
tion for disciplinary reasons,
‘‘(iii) voluntarily terminates the training in such
an educational institution for which he is provided a
scholarship under such contract before the comple-
tion of such training, or
‘‘(iv) fails to accept payment, or instructs the
educational institution in which he is enrolled not to
accept payment, in whole or in part, of a scholarship
under such contract, in lieu of any service obligation
arising under such contract, shall be liable to the
United States for the amount which has been paid
to him, or on his behalf, under the contract.
‘‘(B) If for any reason not specified in subparagraph
(A) an individual breaches a written contract by failing
either to begin such individual’s service obligation under
this section or to complete such service obligation, the
United States shall be entitled to recover from the indi-
vidual an amount determined in accordance with the for-
mula specified in subsection (l) of section 108 in the man-
ner provided for in such subsection.
‘‘(C) Upon the death of an individual who receives
an Indian Health Scholarship, any obligation of that indi-
vidual for service or payment that relates to that scholar-
ship shall be canceled.
‘‘(D) The Secretary shall provide for the partial or
total waiver or suspension of any obligation of service or
payment of a recipient of an Indian Health Scholarship
if the Secretary, in consultation with the Area Office, In-
dian tribes, tribal organizations, and urban Indian organi-
zations, determines that—