to the prevention and treatment of disease that 
is consistent with locally prevailing rates or 
charges and is designed to cover its reasonable 
costs of operation; and
‘‘(B) a corresponding schedule of discounts 
to be applied to the payment of such fees or 
payments, which discounts are adjusted on the 
basis of the ability of the patient to pay. 
‘‘(2) RULE
OF
CONSTRUCTION.—Nothing in 
this section shall be construed to require payment 
for navigation services or to require payment for 
health care services in cases where care is provided 
free of charge, including the case of services pro-
vided through programs of the Indian Health Serv-
ice. 
‘‘(d) MODEL.—Not later than five years after the 
date of the enactment of this section, the Director of the 
Institute shall develop a peer-reviewed model of systems 
for the services provided by this section. The Director shall 
update such model as may be necessary to ensure that 
the best practices are being utilized. 
‘‘(e) DURATION
OF GRANT.—The period during 
which payments are made to an entity from a grant under 
subsection (a)(1) or (b)(1) may not exceed five years. The 
provision of such payments are subject to annual approval
by the Director of the Institute of the payments and sub-
ject to the availability of appropriations for the fiscal year 
involved to make the payments. This subsection may not 
be construed as establishing a limitation on the number 
of grants under such subsection that may be made to an 
entity. 
‘‘(f) DEFINITIONS.—For purposes of this section: 
‘‘(1) The term ‘culturally competent’, with re-
spect to providing health-related services, means 
services that, in accordance with standards and 
measures of the Secretary, are designed to effec-
tively and efficiently respond to the cultural and lin-
guistic needs of patients. 
‘‘(2) the term ‘appropriate follow-up care’ in-
cludes palliative and end-of-life care. 
‘‘(3) the term ‘health disparity population’ 
means a population where there exists a significant 
disparity in the overall rate of disease incidence, 
morbidity, mortality, or survival rates in the popu-
lation as compared to the health status of the gen-
eral population. Such term includes—
‘‘(A) racial and ethnic minority groups as 
defined in section 1707; and
‘‘(B) medically underserved groups, such 
as rural and low-income individuals and individ-
uals with low levels of literacy. 
‘‘(4)(A) the term ‘patient navigator’ means an 
individual whose functions include—
‘‘(i) assisting and guiding patients with a 
symptom or an abnormal finding or diagnosis of 
cancer or other chronic disease within the 
health care system to accomplish the follow-up 
and diagnosis of an abnormal finding as well as 
the treatment and appropriate follow-up care of 
cancer or other chronic disease, including pro-
viding information about clinical trials; and 
‘‘(ii) identifying, anticipating, and helping 
patients overcome barriers within the health 
care system to ensure prompt diagnostic and 
treatment resolution of an abnormal finding of 
cancer or other chronic disease. 
‘‘(B) Such term includes representatives of the 
target health disparity population, such as nurses, 
social workers, cancer survivors, and patient advo-
cates. 
‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—
‘‘(1) MODEL PROGRAMS.—For the purpose of 
carrying out subsection (a), there are authorized to
be appropriated such sums as may be necessary for 
each of the fiscal years 2004 through 2008. 
‘‘(2) PATIENT NAVIGATORS.—For the purpose 
of carrying out subsection (b), there are authorized 
to be appropriated such sums as may be necessary 
for each of the fiscal years 2004 through 2008. 
‘‘(3) RELATION TO OTHER AUTHORIZATIONS.—
Authorizations of appropriations under paragraphs 
(1) and (2) are in addition to other authorizations 
of appropriations that are available for the purposes 
described in such paragraphs.’’. 
SEC. 5. IHS GRANTS FOR MODEL COMMUNITY CANCER AND 
CHRONIC DISEASE CARE AND PREVENTION; 
IHS GRANTS FOR PATIENT NAVIGATORS. 
(a) MODEL COMMUNITY CANCER AND CHRONIC DIS-
EASE CARE AND PREVENTION.—
(1) IN GENERAL.—The Director of the Indian 
Health Service may make grants to Indian Health 
Service Centers, tribal governments, urban Indian 
organizations, tribal organizations, and qualified 
nonprofit entities demonstrating the ability to per-
form all of the functions outlined in this subsection 
and subsections (b) and (c) that partner with pro-
viders or centers providing health care serving Na-
tive American populations to provide navigation
services, for the development and operation of model 
programs that—
(A) provide to individuals of health dis-
parity populations prevention, early detection,
treatment, and appropriate follow-up care serv-
ices for cancer and chronic diseases; 
(B) ensure that the health services are pro-
vided to such individuals in a culturally com-
petent manner; 
(C) assign patient navigators, in accord-
ance with applicable criteria of the Secretary, 
for managing the care of individuals of health 
disparity populations to—
(i) accomplish, to the extent possible, 
the follow-up and diagnosis of an abnormal 
finding and the treatment and appropriate 
follow-up care of cancer or other chronic 
disease; and 
(ii) facilitate access to appropriate 
health care services within the health care 
system to ensure optimal patient utiliza-
tion of such services, including aid in co-
ordinating and scheduling appointments 
and referrals, community outreach, assist-
ance with transportation arrangements,
and assistance with insurance issues and 
other barriers to care and providing infor-
mation about clinical trials; 
(D) require training for patient navigators 
employed through such model programs to en-
sure the ability of navigators to perform all of 
the duties required in this subsection and in 
subsection (b), including training to ensure that 
navigators are informed about health insurance 
systems and are able to aid patients in resolv-
ing access issues; and 
(E) ensure that consumers have direct ac-
cess to patient navigators during regularly 
scheduled hours of business operation. 
(2) OUTREACH SERVICES.—A condition for the 
receipt of a grant under paragraph (1) is that the 
applicant involved agree to provide ongoing outreach 
activities while receiving the grant, in a manner that 
is culturally competent for the health disparity popu-
lation served by the program, to inform the public 
and the specific community that the program is 
serving of the services of the model program under 
the grant. Such activities shall include facilitating 
access to appropriate health care services and pa-