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HR 3962 PCS 
‘‘(l) LIABILITY
OF OFFICERS, EMPLOYEES, AND 
AGENTS.— 
‘‘(1) IN GENERAL.—The Foundation shall be 
liable for the acts of the officers, employees, and 
agents of the Foundation acting within the scope of 
their authority. 
‘‘(2) PERSONAL LIABILITY.—A member of the 
Board shall be personally liable only for gross neg-
ligence in the performance of the duties of the mem-
ber. 
‘‘(m) RESTRICTIONS.— 
‘‘(1) LIMITATION
ON
SPENDING.—Beginning 
with the fiscal year following the first full fiscal year 
during which the Foundation is in operation, the ad-
ministrative costs of the Foundation shall not exceed 
the percentage described in paragraph (2) of the 
sum of— 
‘‘(A) the amounts transferred to the Foun-
dation under subsection (o) during the pre-
ceding fiscal year; and 
‘‘(B) donations received from private 
sources during the preceding fiscal year. 
‘‘(2) PERCENTAGES.—The percentages referred 
to in paragraph (1) are— 
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‘‘(A) for the first fiscal year described in 
that paragraph, 20 percent; 
‘‘(B) for the following fiscal year, 15 per-
cent; and 
‘‘(C) for each fiscal year thereafter, 10 
percent. 
‘‘(3) APPOINTMENT
AND
HIRING.—The ap-
pointment of officers and employees of the Founda-
tion shall be subject to the availability of funds. 
‘‘(4) STATUS.—A member of the Board or offi-
cer, employee, or agent of the Foundation shall not 
by reason of association with the Foundation be con-
sidered to be an officer, employee, or agent of the 
United States. 
‘‘(n) AUDITS.—The Foundation shall comply with 
section 10101 of title 36, United States Code, as if the 
Foundation were a corporation under part B of subtitle 
II of that title. 
‘‘(o) FUNDING.— 
‘‘(1) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to carry out 
subsection (e)(1) $500,000 for each fiscal year, as 
adjusted to reflect changes in the Consumer Price 
Index for all-urban consumers published by the De-
partment of Labor. 
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HR 3962 PCS 
‘‘(2) TRANSFER
OF
DONATED
FUNDS.—The 
Secretary shall transfer to the Foundation funds 
held by the Department of Health and Human Serv-
ices under the Act of August 5, 1954 (42 U.S.C. 
2001 et seq.), if the transfer or use of the funds is 
not prohibited by any term under which the funds 
were donated. 
‘‘SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT. 
‘‘(a) PROVISION OF SUPPORT BY SECRETARY.—Sub-
ject to subsection (b), during the 5-year period beginning 
on the date on which the Foundation is established, the 
Secretary— 
‘‘(1) may provide personnel, facilities, and other 
administrative support services to the Foundation; 
‘‘(2) may provide funds for initial operating 
costs and to reimburse the travel expenses of the 
members of the Board; and 
‘‘(3) shall require and accept reimbursements 
from the Foundation for— 
‘‘(A) services provided under paragraph 
(1); and 
‘‘(B) funds provided under paragraph (2). 
‘‘(b) REIMBURSEMENT.—Reimbursements accepted 
under subsection (a)(3)— 
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‘‘(1) shall be deposited in the Treasury of the 
United States to the credit of the applicable appro-
priations account; and 
‘‘(2) shall be chargeable for the cost of pro-
viding services described in subsection (a)(1) and 
travel expenses described in subsection (a)(2). 
‘‘(c) CONTINUATION OF CERTAIN SERVICES.—The 
Secretary may continue to provide facilities and necessary 
support services to the Foundation after the termination 
of the 5-year period specified in subsection (a) if the facili-
ties and services— 
‘‘(1) are available; and 
‘‘(2) are provided on reimbursable cost basis.’’. 
(b) TECHNICAL AMENDMENTS.—The Indian Self-De-
termination and Education Assistance Act is amended— 
(1) by redesignating title V (25 U.S.C. 458bbb 
et seq.) as title VII; 
(2) by redesignating sections 501, 502, and 503 
(25 U.S.C. 458bbb, 458bbb–1, 458bbb–2) as sec-
tions 701, 702, and 703, respectively; and 
(3) in subsection (a)(2) of section 702 and 
paragraph (2) of section 703 (as redesignated by 
paragraph (2)), by striking ‘‘section 501’’ and in-
serting ‘‘section 701’’. 
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HR 3962 PCS 
SEC. 3103. GAO STUDY AND REPORT ON PAYMENTS FOR 
CONTRACT HEALTH SERVICES. 
(a) STUDY.— 
(1) IN GENERAL.—The Comptroller General of 
the United States (in this section referred to as the 
‘‘Comptroller General’’) shall conduct a study on the 
utilization of health care furnished by health care 
providers under the contract health services program 
funded by the Indian Health Service and operated 
by the Indian Health Service, an Indian Tribe, or a 
Tribal Organization (as those terms are defined in 
section 4 of the Indian Health Care Improvement 
Act). 
(2) ANALYSIS.—The study conducted under 
paragraph (1) shall include an analysis of— 
(A) the amounts reimbursed under the 
contract health services program described in 
paragraph (1) for health care furnished by enti-
ties, individual providers, and suppliers, includ-
ing a comparison of reimbursement for such 
health care through other public programs and 
in the private sector; 
(B) barriers to accessing care under such 
contract health services program, including, but 
not limited to, barriers relating to travel dis-
tances, cultural differences, and public and pri-
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vate sector reluctance to furnish care to pa-
tients under such program; 
(C) the adequacy of existing Federal fund-
ing for health care under such contract health 
services program; and 
(D) any other items determined appro-
priate by the Comptroller General. 
(b) REPORT.—Not later than 18 months after the 
date of enactment of this Act, the Comptroller General 
shall submit to Congress a report on the study conducted 
under subsection (a), together with recommendations re-
garding— 
(1) the appropriate level of Federal funding 
that should be established for health care under the 
contract health services program described in sub-
section (a)(1); and 
(2) how to most efficiently utilize such funding. 
(c) CONSULTATION.—In conducting the study under 
subsection (a) and preparing the report under subsection 
(b), the Comptroller General shall consult with the Indian 
Health Service, Indian Tribes, and Tribal Organizations. 
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HR 3962 PCS 
TITLE II—IMPROVEMENT OF IN-
DIAN 
HEALTH 
CARE 
PRO-
VIDED UNDER THE SOCIAL 
SECURITY ACT 
SEC. 3201. EXPANSION OF PAYMENTS UNDER MEDICARE, 
MEDICAID, AND SCHIP FOR ALL COVERED 
SERVICES FURNISHED BY INDIAN HEALTH 
PROGRAMS. 
(a) MEDICAID.— 
(1) EXPANSION TO ALL COVERED SERVICES.— 
Section 1911 of the Social Security Act (42 U.S.C. 
1396j) is amended— 
(A) by amending the heading to read as 
follows: 
‘‘SEC. 1911. INDIAN HEALTH PROGRAMS.’’; 
and 
(B) by amending subsection (a) to read as 
follows: 
‘‘(a) ELIGIBILITY FOR PAYMENT FOR MEDICAL AS-
SISTANCE.—An Indian Health Program shall be eligible 
for payment for medical assistance provided under a State 
plan or under waiver authority with respect to items and 
services furnished by the Program if the furnishing of 
such services meets all the conditions and requirements 
which are applicable generally to the furnishing of items 
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HR 3962 PCS 
and services under this title and under such plan or waiver 
authority.’’. 
(2) REPEAL OF OBSOLETE PROVISION.—Sub-
section (b) of such section is repealed. 
(3) REVISION OF AUTHORITY TO ENTER INTO 
AGREEMENTS.—Subsection (c) of such section is 
amended to read as follows: 
‘‘(c) AUTHORITY TO ENTER INTO AGREEMENTS.— 
The Secretary may enter into an agreement with a State 
for the purpose of reimbursing the State for medical as-
sistance provided by the Indian Health Service, an Indian 
Tribe, Tribal Organization, or an Urban Indian Organiza-
tion (as so defined), directly, through referral, or under 
contracts or other arrangements between the Indian 
Health Service, an Indian Tribe, Tribal Organization, or 
an Urban Indian Organization and another health care 
provider to Indians who are eligible for medical assistance 
under the State plan or under waiver authority. This sub-
section shall not be construed to impair the entitlement 
of a State to reimbursement for such medical assistance 
under this title.’’. 
(4) CROSS-REFERENCES TO SPECIAL FUND FOR 
IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING 
OPTION; 
DEFINITIONS.—Such section is further 
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amended by striking subsection (d) and adding at 
the end the following new subsections: 
‘‘(c) SPECIAL FUND FOR IMPROVEMENT OF IHS FA-
CILITIES.—For provisions relating to the authority of the 
Secretary to place payments to which a facility of the In-
dian Health Service is eligible for payment under this title 
into a special fund established under section 401(c)(1) of 
the Indian Health Care Improvement Act, see subpara-
graphs (A) and (B) of section 401(c)(1) of such Act. 
‘‘(d) DIRECT BILLING.—For provisions relating to 
the authority of an Tribal Health Program to elect to di-
rectly bill for, and receive payment for, health care items 
and services provided by such Program for which payment 
is made under this title, see section 401(d) of the Indian 
Health Care Improvement Act.’’. 
(5) DEFINITIONS.—Section 1101(a) of such Act 
(42 U.S.C. 1301(a)) is amended by adding at the 
end the following new paragraph: 
‘‘(11) For purposes of this title and titles 
XVIII, XIX, and XXI, the terms ‘Indian Health 
Program’, ‘Indian Tribe’ (and ‘Indian tribe’), ‘Tribal 
Health Program’, ‘Tribal Organization’ (and ‘tribal 
organization’), and ‘urban Indian organization’ (and 
‘urban Indian organization’) have the meanings 
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given those terms in section 4 of the Indian Health 
Care Improvement Act.’’. 
(b) MEDICARE.— 
(1) EXPANSION TO ALL COVERED SERVICES.— 
Section 1880 of such Act (42 U.S.C. 1395qq) is 
amended— 
(A) by amending the heading to read as 
follows: 
‘‘SEC. 1880. INDIAN HEALTH PROGRAMS.’’; 
and 
(B) by amending subsection (a) to read as 
follows: 
‘‘(a) ELIGIBILITY FOR PAYMENTS.—Subject to sub-
section (e), an Indian Health Program shall be eligible for 
payments under this title with respect to items and serv-
ices furnished by the Program if the furnishing of such 
services meets all the conditions and requirements which 
are applicable generally to the furnishing of items and 
services under this title.’’. 
(2) REPEAL OF OBSOLETE PROVISION.—Sub-
section (b) of such section is repealed. 
(3) CROSS-REFERENCES TO SPECIAL FUND FOR 
IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING 
OPTION; DEFINITIONS.— 
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(A) IN GENERAL.—Such section is further 
amended by striking subsections (c) and (d) 
and inserting the following new subsections: 
‘‘(b) SPECIAL FUND FOR IMPROVEMENT OF IHS FA-
CILITIES.—For provisions relating to the authority of the 
Secretary to place payments to which a facility of the In-
dian Health Service is eligible for payment under this title 
into a special fund established under section 401(c)(1) of 
the Indian Health Care Improvement Act, and the require-
ment to use amounts paid from such fund for making im-
provements in accordance with subsection (b), see sub-
paragraphs (A) and (B) of section 401(c)(1) of such Act. 
‘‘(c) DIRECT BILLING.—For provisions relating to 
the authority of a Tribal Health Program to elect to di-
rectly bill for, and receive payment for, health care items 
and services provided by such Program for which payment 
is made under this title, see section 401(d) of the Indian 
Health Care Improvement Act.’’. 
(B) CONFORMING
AMENDMENTS.—Such 
section is further amended— 
(i) in subsection (e)(3), by striking 
‘‘Subsection (c)’’ and inserting ‘‘Subsection 
(b) and section 401(b)(1) of the Indian 
Health Care Improvement Act’’; 
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(ii) by redesignating subsection (e) as 
subsection (d); and 
(iii) by striking subsection (f). 
(4) DEFINITIONS.—Such section is further 
amended by amending adding at the end the fol-
lowing new subsection: 
‘‘(e) DEFINITIONS.—In this section, the terms ‘In-
dian Health Program’, ‘Indian Tribe’, ‘Service Unit’, 
‘Tribal Health Program’, ‘Tribal Organization’, and 
‘Urban Indian Organization’ have the meanings given 
those terms in section 4 of the Indian Health Care Im-
provement Act.’’. 
(c) APPLICATION TO SCHIP.—Section 2107(e)(1) of 
the Social Security Act (42 U.S.C. 1397gg(e)(1)) is 
amended— 
(1) 
by 
redesignating 
subparagraphs 
(K) 
through (M) as subparagraphs (L) through (N), re-
spectively; and 
(2) by inserting after subparagraph (J), the fol-
lowing new subparagraph: 
‘‘(K) Section 1911 (relating to Indian 
Health Programs, other than subsection (c) of 
such section).’’. 
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HR 3962 PCS 
SEC. 3202. ADDITIONAL PROVISIONS TO INCREASE OUT-
REACH TO, AND ENROLLMENT OF, INDIANS 
IN SCHIP AND MEDICAID. 
(a) ASSURANCE OF PAYMENTS TO INDIAN HEALTH 
CARE PROVIDERS FOR CHILD HEALTH ASSISTANCE.— 
Section 2102(b)(3)(D) of the Social Security Act (42 
U.S.C. 1397bb(b)(3)(D)) is amended by striking ‘‘(as de-
fined in section 4(c) of the Indian Health Care Improve-
ment Act, 25 U.S.C. 1603(c))’’ and inserting ‘‘, including 
how the State will ensure that payments are made to In-
dian Health Programs and urban Indian organizations op-
erating in the State for the provision of such assistance’’. 
(b) INCLUSION
OF
OTHER
INDIAN
FINANCED 
HEALTH CARE PROGRAMS IN EXEMPTION FROM PROHI-
BITION ON CERTAIN PAYMENTS.—Section 2105(c)(6)(B) 
of such Act (42 U.S.C. 1397ee(c)(6)(B)) is amended by 
striking ‘‘insurance program, other than an insurance pro-
gram operated or financed by the Indian Health Service’’ 
and inserting ‘‘program, other than a health care program 
operated or financed by the Indian Health Service or by 
an Indian Tribe, Tribal Organization, or urban Indian or-
ganization’’. 
(c) DEFINITIONS.—Section 2110(c) of such Act (42 
U.S.C. 1397jj(c)) is amended by adding at the end the 
following new paragraph: 
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‘‘(9) INDIAN; INDIAN
HEALTH
PROGRAM; IN-
DIAN
TRIBE; ETC.—The terms ‘Indian’, ‘Indian 
Health Program’, ‘Indian Tribe’, ‘Tribal Organiza-
tion’, and ‘Urban Indian Organization’ have the 
meanings given those terms in section 4 of the In-
dian Health Care Improvement Act.’’. 
SEC. 3203. SOLICITATION OF PROPOSALS FOR SAFE HAR-
BORS UNDER THE SOCIAL SECURITY ACT 
FOR FACILITIES OF INDIAN HEALTH PRO-
GRAMS AND URBAN INDIAN ORGANIZATIONS. 
The Secretary of Health and Human Services, acting 
through the Office of the Inspector General of the Depart-
ment of Health and Human Services, shall publish a no-
tice, described in section 1128D(a)(1)(A) of the Social Se-
curity Act (42 U.S.C. 1320a–7d(a)(1)(A)), soliciting a 
proposal, not later than July 1, 2010, on the development 
of safe harbors described in such section relating to health 
care items and services provided by facilities of Indian 
Health Programs or an urban Indian organization (as 
such terms are defined in section 4 of the Indian Health 
Care Improvement Act). Such a safe harbor may relate 
to areas such as transportation, housing, or cost-sharing, 
assistance provided through such facilities or contract 
health services for Indians. 
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HR 3962 PCS 
SEC. 3204. ANNUAL REPORT ON INDIANS SERVED BY SO-
CIAL SECURITY ACT HEALTH BENEFIT PRO-
GRAMS. 
Section 1139 of the Social Security Act (42 U.S.C. 
1320b–9), as amended by the sections 3203 and 3204, 
is amended by redesignating subsection (e) as subsection 
(f), and inserting after subsection (d) the following new 
subsection: 
‘‘(e) ANNUAL REPORT
ON INDIANS SERVED
BY 
HEALTH BENEFIT PROGRAMS FUNDED UNDER THIS 
ACT.—Beginning January 1, 2011, and annually there-
after, the Secretary, acting through the Administrator of 
the Centers for Medicare & Medicaid Services and the Di-
rector of the Indian Health Service, shall submit a report 
to Congress regarding the enrollment and health status 
of Indians receiving items or services under health benefit 
programs funded under this Act during the preceding 
year. Each such report shall include the following: 
‘‘(1) The total number of Indians enrolled in, or 
receiving items or services under, such programs, 
disaggregated with respect to each such program. 
‘‘(2) The number of Indians described in para-
graph (1) that also received health benefits under 
programs funded by the Indian Health Service. 
‘‘(3) General information regarding the health 
status of the Indians described in paragraph (1), 
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disaggregated with respect to specific diseases or 
conditions and presented in a manner that is con-
sistent with protections for privacy of individually 
identifiable health information under section 264(c) 
of the Health Insurance Portability and Account-
ability Act of 1996. 
‘‘(4) A detailed statement of the status of facili-
ties of the Indian Health Service or an Indian Tribe, 
Tribal Organization, or an Urban Indian Organiza-
tion with respect to such facilities’ compliance with 
the applicable conditions and requirements of titles 
XVIII, XIX, and XXI, and, in the case of title XIX 
or XXI, under a State plan under such title or 
under waiver authority, and of the progress being 
made by such facilities (under plans submitted 
under 1911(b) or otherwise) toward the achievement 
and maintenance of such compliance. 
‘‘(5) Such other information as the Secretary 
determines is appropriate.’’. 
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HR 3962 PCS 
SEC. 3205. DEVELOPMENT OF RECOMMENDATIONS TO IM-
PROVE INTERSTATE COORDINATION OF MED-
ICAID AND SCHIP COVERAGE OF INDIAN 
CHILDREN AND OTHER CHILDREN WHO ARE 
OUTSIDE OF THEIR STATE OF RESIDENCY BE-
CAUSE OF EDUCATIONAL OR OTHER NEEDS. 
(a) STUDY.—The Secretary shall conduct a study to 
identify barriers to interstate coordination of enrollment 
and coverage under the Medicaid program under title XIX 
of the Social Security Act and the State Children’s Health 
Insurance Program under title XXI of such Act of chil-
dren who are eligible for medical assistance or child health 
assistance under such programs and who, because of edu-
cational needs, migration of families, emergency evacu-
ations, or otherwise, frequently change their State of resi-
dency or otherwise are temporarily present outside of the 
State of their residency. Such study shall include an exam-
ination of the enrollment and coverage coordination issues 
faced by Indian children who are eligible for medical as-
sistance or child health assistance under such programs 
in their State of residence and who temporarily reside in 
an out-of-State boarding school or peripheral dormitory 
funded by the Bureau of Indian Affairs. 
(b) REPORT.—Not later than 18 months after the 
date of enactment of this Act, the Secretary, in consulta-
tion with directors of State Medicaid programs under title 
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XIX of the Social Security Act and directors of State Chil-
dren’s Health Insurance Programs under title XXI of such 
Act, shall submit a report to Congress that contains rec-
ommendations for such legislative and administrative ac-
tions as the Secretary determines appropriate to address 
the enrollment and coverage coordination barriers identi-
fied through the study required under subsection (a). 
Passed the House of Representatives November 7, 
2009. 
Attest: 
LORRAINE C. MILLER, 
Clerk. 
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Calendar No. 210 
111TH CONGRESS 
1ST SESSION 
H. R. 3962 
AN ACT 
To provide affordable, quality health care for all 
Americans and reduce the growth in health care 
spending, and for other purposes. 
NOVEMBER 16, 2009 
Read the second time and placed on the calendar 
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