164 
Tribal Organizations, shall carry out a study to determine 
the feasibility of establishing a loan fund to provide to In-
dian Tribes and Tribal Organizations direct loans or guar-
antees for loans for the construction of health care facili-
ties, including— 
‘‘(1) inpatient facilities; 
‘‘(2) outpatient facilities; 
‘‘(3) staff quarters; 
‘‘(4) hostels; and 
‘‘(5) specialized care facilities, such as behav-
ioral health and elder care facilities. 
‘‘(b) DETERMINATIONS.—In carrying out the study 
under subsection (a), the Secretary shall determine— 
‘‘(1) the maximum principal amount of a loan 
or loan guarantee that should be offered to a recipi-
ent from the loan fund; 
‘‘(2) the percentage of eligible costs, not to ex-
ceed 100 percent, that may be covered by a loan or 
loan guarantee from the loan fund (including costs 
relating to planning, design, financing, site land de-
velopment, construction, rehabilitation, renovation, 
conversion, improvements, medical equipment and 
furnishings, and other facility-related costs and cap-
ital purchase (but excluding staffing)); 
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‘‘(3) the cumulative total of the principal of di-
rect loans and loan guarantees, respectively, that 
may be outstanding at any 1 time; 
‘‘(4) the maximum term of a loan or loan guar-
antee that may be made for a facility from the loan 
fund; 
‘‘(5) the maximum percentage of funds from 
the loan fund that should be allocated for payment 
of costs associated with planning and applying for a 
loan or loan guarantee; 
‘‘(6) whether acceptance by the Secretary of an 
assignment of the revenue of an Indian Tribe or 
Tribal Organization as security for any direct loan 
or loan guarantee from the loan fund would be ap-
propriate; 
‘‘(7) whether, in the planning and design of 
health facilities under this section, users eligible 
under section 807(c) may be included in any projec-
tion of patient population; 
‘‘(8) whether funds of the Service provided 
through loans or loan guarantees from the loan fund 
should be eligible for use in matching other Federal 
funds under other programs; 
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‘‘(9) the appropriateness of, and best methods 
for, coordinating the loan fund with the health care 
priority system of the Service under section 301; and 
‘‘(10) any legislative or regulatory changes re-
quired to implement recommendations of the Sec-
retary based on results of the study. 
‘‘(c) REPORT.—Not later than September 30, 2007, 
the Secretary shall submit to the Committee on Indian Af-
fairs of the Senate and the Committee on Resources and 
the Committee on Energy and Commerce of the House 
of Representatives a report that describes— 
‘‘(1) the manner of consultation made as re-
quired by subsection (a); and 
‘‘(2) the results of the study, including any rec-
ommendations of the Secretary based on results of 
the study. 
‘‘SEC. 310. TRIBAL LEASING. 
‘‘A Tribal Health Program may lease permanent 
structures for the purpose of providing health care services 
without obtaining advance approval in appropriation Acts. 
‘‘SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES 
JOINT VENTURE PROGRAM. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Service, shall make arrangements with Indian Tribes 
and Tribal Organizations to establish joint venture dem-
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onstration projects under which an Indian Tribe or Tribal 
Organization shall expend tribal, private, or other avail-
able funds, for the acquisition or construction of a health 
facility for a minimum of 10 years, under a no-cost lease, 
in exchange for agreement by the Service to provide the 
equipment, supplies, and staffing for the operation and 
maintenance of such a health facility. An Indian Tribe or 
Tribal Organization may use tribal funds, private sector, 
or other available resources, including loan guarantees, to 
fulfill its commitment under a joint venture entered into 
under this subsection. An Indian Tribe or Tribal Organi-
zation shall be eligible to establish a joint venture project 
if, when it submits a letter of intent, it— 
‘‘(1) has begun but not completed the process 
of acquisition or construction of a health facility to 
be used in the joint venture project; or 
‘‘(2) has not begun the process of acquisition or 
construction of a health facility for use in the joint 
venture project. 
‘‘(b) REQUIREMENTS.—The Secretary shall make 
such an arrangement with an Indian Tribe or Tribal Orga-
nization only if— 
‘‘(1) the Secretary first determines that the In-
dian Tribe or Tribal Organization has the adminis-
trative and financial capabilities necessary to com-
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plete the timely acquisition or construction of the 
relevant health facility; and 
‘‘(2) the Indian Tribe or Tribal Organization 
meets the need criteria which shall be developed 
through the negotiated rulemaking process provided 
for under section 802. 
‘‘(c) CONTINUED OPERATION.—The Secretary shall 
negotiate an agreement with the Indian Tribe or Tribal 
Organization regarding the continued operation of the fa-
cility at the end of the initial 10 year no-cost lease period. 
‘‘(d) BREACH OF AGREEMENT.—An Indian Tribe or 
Tribal Organization that has entered into a written agree-
ment with the Secretary under this section, and that 
breaches or terminates without cause such agreement, 
shall be liable to the United States for the amount that 
has been paid to the Indian Tribe or Tribal Organization, 
or paid to a third party on the Indian Tribe’s or Tribal 
Organization’s behalf, under the agreement. The Sec-
retary has the right to recover tangible property (including 
supplies) and equipment, less depreciation, and any funds 
expended for operations and maintenance under this sec-
tion. The preceding sentence does not apply to any funds 
expended for the delivery of health care services, per-
sonnel, or staffing. 
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