370 
‘‘(3) CONSULTATION.—In preparing each report 
required under paragraph (2) (other than the initial 
report) the Secretary shall annually— 
‘‘(A) consult with, and obtain information 
on all healthcare facilities needs from, Indian 
tribes and tribal organizations including those 
tribes or tribal organizations operating health 
programs or facilities under any funding agree-
ment entered into with the Service under the 
Indian Self-Determination and Education As-
sistance Act; and 
‘‘(B) review the total unmet needs of all 
tribes and tribal organizations for healthcare 
facilities (including staff quarters), including 
needs for renovation and expansion of existing 
facilities. 
‘‘(4) CRITERIA.—For purposes of this sub-
section, the Secretary shall, in evaluating the needs 
of facilities operated under any funding agreement 
entered into with the Service under the Indian Self- 
Determination and Education Assistance Act, use 
the same criteria that the Secretary uses in evalu-
ating the needs of facilities operated directly by the 
Service.
371 
‘‘(5) EQUITABLE INTEGRATION.—The Secretary 
shall ensure that the planning, design, construction, 
and renovation needs of Service and non-Service fa-
cilities, operated under funding agreements in ac-
cordance with the Indian Self-Determination and 
Education Assistance Act are fully and equitably in-
tegrated into the healthcare facility priority system. 
‘‘(d) REVIEW OF NEED FOR FACILITIES.— 
‘‘(1) REPORT.—Beginning in 2007, the Sec-
retary shall annually submit to the President and 
Congress a report which sets forth the needs of the 
Service and all Indian tribes and tribal organiza-
tions, including urban Indian organizations, for in-
patient, outpatient and specialized care facilities, in-
cluding the needs for renovation and expansion of 
existing facilities. 
‘‘(2) CONSULTATION.—In preparing each report 
required under paragraph (1) (other than the initial 
report), the Secretary shall consult with Indian 
tribes and tribal organizations including those tribes 
or tribal organizations operating health programs or 
facilities under any funding agreement entered into 
with the Service under the Indian Self-Determina-
tion and Education Assistance Act, and with urban 
Indian organizations.
372 
‘‘(3) CRITERIA.—For purposes of this sub-
section, the Secretary shall, in evaluating the needs 
of facilities operated under any funding agreement 
entered into with the Service under the Indian Self- 
Determination and Education Assistance Act, use 
the same criteria that the Secretary uses in evalu-
ating the needs of facilities operated directly by the 
Service. 
‘‘(4) EQUITABLE INTEGRATION.—The Secretary 
shall ensure that the planning, design, construction, 
and renovation needs of facilities operated under 
funding agreements, in accordance with the Indian 
Self-Determination and Education Assistance Act, 
are fully and equitably integrated into the develop-
ment of the health facility priority system. 
‘‘(5) ANNUAL
NOMINATIONS.—Each year the 
Secretary shall provide an opportunity for the nomi-
nation of planning, design, and construction projects 
by the Service and all Indian tribes and tribal orga-
nizations for consideration under the healthcare fa-
cility priority system. 
‘‘(e) INCLUSION OF CERTAIN PROGRAMS.—All funds 
appropriated under the Act of November 2, 1921 (25 
U.S.C. 13), for the planning, design, construction, or ren-
ovation of health facilities for the benefit of an Indian
373 
tribe or tribes shall be subject to the provisions of section 
102 of the Indian Self-Determination and Education As-
sistance Act. 
‘‘(f) INNOVATIVE APPROACHES.—The Secretary shall 
consult and cooperate with Indian tribes, tribal organiza-
tions and urban Indian organizations in developing inno-
vative approaches to address all or part of the total unmet 
need for construction of health facilities, including those 
provided for in other sections of this title and other ap-
proaches. 
‘‘(g) LOCATION OF FACILITIES.— 
‘‘(1) PRIORITY.—The Bureau of Indian Affairs 
and the Service shall, in all matters involving the re-
organization or development of Service facilities, or 
in the establishment of related employment projects 
to address unemployment conditions in economically 
depressed areas, give priority to locating such facili-
ties and projects on Indian lands if requested by the 
Indian owner and the Indian tribe with jurisdiction 
over such lands or other lands owned or leased by 
the Indian tribe or tribal organization so long as pri-
ority is given to Indian land owned by an Indian 
tribe or tribes. 
‘‘(2) DEFINITION.—In this subsection, the term 
‘Indian lands’ means—
374 
‘‘(A) all lands within the exterior bound-
aries of any Indian reservation; 
‘‘(B) any lands title to which is held in 
trust by the United States for the benefit of 
any Indian tribe or individual Indian, or held by 
any Indian tribe or individual Indian subject to 
restriction by the United States against alien-
ation and over which an Indian tribe exercises 
governmental power; and 
‘‘(C) all lands in Alaska owned by any 
Alaska Native village, or any village or regional 
corporation under the Alaska Native Claims 
Settlement Act, or any land allotted to any 
Alaska Native. 
‘‘(h) DEFINITIONS.—For purposes of this section, the 
definitions contained in section 4 of the Indian Health 
Care Improvement Act shall apply. 
‘‘SEC. 
2951C. 
RECONSTRUCTION 
AND 
IMPROVEMENT 
GRANTS FOR PUBLIC HEALTH CARE FACILI-
TIES SERVING PACIFIC ISLANDERS AND THE 
INSULAR AREAS. 
‘‘(a) IN GENERAL.—The Secretary shall provide di-
rect financial assistance to designated healthcare providers 
and community health centers in American Samoa, Guam, 
the Commonwealth of the Northern Mariana Islands, the
375 
United States Virgin Islands, Puerto Rico, and Hawaii for 
the purposes of reconstructing and improving health care 
facilities and services. 
‘‘(b) ELIGIBILITY.—To be eligible to receive direct fi-
nancial assistance under subsection (a), an entity shall be 
a public health facility or community health center located 
in American Samoa, Guam, or the Commonwealth of the 
Northern Mariana Islands, the United States Virgin Is-
lands, Puerto Rico, and Hawaii that— 
‘‘(1) is owned or operated by— 
‘‘(A) the government of American Samoa, 
Guam, or the Commonwealth of the Northern 
Mariana Islands, the United States Virgin Is-
lands, Puerto Rico, and Hawaii or a unit of 
local government; or 
‘‘(B) a nonprofit organization; and 
‘‘(2)(A) provides care or treatment for a sub-
stantial number of patients who are uninsured, re-
ceiving assistance under a State program under a 
title XVIII of the Social Security Act, or a State 
program under title XIX of such Act, or who are 
members of a vulnerable population, as determined 
by the Secretary; or 
‘‘(B) serves a disproportionate percentage of 
local, minority racial and ethnic patients.
376 
‘‘(c) REPORT.—Not later than 180 days after the 
date of enactment of this title and annually thereafter, the 
Secretary shall submit to the Congress and the President 
a report that includes an assessment of health resources 
and facilities serving populations in American Samoa, 
Guam, and the Commonwealth of the Northern Mariana 
Islands, the United States Virgin Islands, Puerto Rico, 
and Hawaii. In preparing such report, the Secretary 
shall— 
‘‘(1) consult with and obtain information on all 
healthcare facilities needs from the entities described 
in subsection (b); and 
‘‘(2) include all amounts of Federal assistance 
received by each entity in the preceding fiscal year; 
‘‘(3) review the total unmet needs of each juris-
diction for healthcare facilities, including needs for 
renovation and expansion of existing facilities; and 
‘‘(4) include a strategic plan for addressing the 
needs of each jurisdiction identified in the report. 
‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated such sums as necessary 
to carry out this section.
377 
‘‘CHAPTER 2—NATIONAL HEALTH SAFETY 
NET INFRASTRUCTURE 
‘‘Subchapter A—General Provisions 
‘‘SEC. 2952. PAYMENTS TO HEALTHCARE FACILITIES. 
‘‘(a) IN GENERAL.—The Secretary, with the approval 
of the Health Safety Net Infrastructure Trust Fund 
Board of Trustees described in section 2972C(d) (here-
after in this subtitle referred to as the ‘Trust Fund 
Board’), shall make payments, from amounts in the 
Health Safety Net Infrastructure Trust Fund established 
under section 2972C(a) (hereafter in this subtitle referred 
to as the ‘Trust Fund’), for capital financing assistance 
to eligible healthcare facilities whose applications for as-
sistance have been approved under this subtitle. 
‘‘(b) GENERAL ELIGIBILITY REQUIREMENTS FOR AS-
SISTANCE.— 
‘‘(1) ELIGIBLE
HEALTHCARE
FACILITIES
DE-
SCRIBED.— 
‘‘(A) IN GENERAL.—A healthcare facility 
shall be generally eligible for capital financing 
assistance under this subtitle if the healthcare 
facility— 
‘‘(i) receives an additional payment 
under section 1886(d)(5)(F) of the Social 
Security Act and is described in clause
378 
(i)(II) or clause (vii)(I) of such section, or 
is deemed a disproportionate share hospital 
under a State plan for medical assistance 
under title XIX of the Social Security Act 
on 
the 
basis 
described 
in 
section 
1923(b)(1) of such Act; 
‘‘(ii) is a hospital which meets the cri-
teria for designation by the Secretary as 
an essential access community hospital 
under section 1820(i)(1) of such Act or a 
rural primary care hospital under section 
1820(i)(2) of such Act (whether or not 
such hospital is actually designated under 
such section); 
‘‘(iii) is a Federally qualified health 
center (as defined in section 1905(l)(2)(B) 
of such Act); 
‘‘(iv) is a hospital which— 
‘‘(I) is a sole community pro-
vider; or 
‘‘(II) has closed within the pre-
ceding 12 months; 
‘‘(v) is a facility which— 
‘‘(I) provides service to ill or in-
jured individuals prior to the trans-
379 
portation of such individuals to a hos-
pital or provides inpatient care to in-
dividuals needing such care for a pe-
riod not longer than 96 hours; 
‘‘(II) is located in a county (or 
equivalent unit of local government) 
with fewer than 6 residents per 
square mile or is located more than 
35 road miles from the nearest hos-
pital; 
‘‘(III) permits a physician assist-
ant or nurse practitioner to admit and 
treat patients under the supervision of 
a physician not present in such facil-
ity; and 
‘‘(IV) has obtained a waiver from 
the Secretary permitting the facility 
to participate in the medicare pro-
gram under title XVIII of the Social 
Security Act; or 
‘‘(vi) is a hospital that the Secretary 
otherwise determines to be an appropriate 
recipient of assistance under this subtitle 
on the basis of the existence of a patient 
care operating deficit, a demonstrated in-
380 
ability to secure or repay financing for a 
qualifying project on reasonable terms, or 
such other criteria as the Secretary con-
siders appropriate. 
‘‘(B) DEVELOPMENT
OF
CRITERIA.—For 
purposes of subparagraph (A)(vi), with respect 
to rural hospitals which are at risk or critical 
to healthcare access, the Prospective Payment 
Review Commission, not later than January 1, 
2006, shall develop criteria to assist the Sec-
retary in deciding if such hospitals deserve as-
sistance, after considering, at a minimum, the 
following factors: 
‘‘(i) AT-RISK RURAL HOSPITALS.—In 
the case of rural hospitals the closure of 
which within the next year is imminent or 
the continued operation of which over a 2- 
to 5-year period is questionable, such fac-
tors as the level of health resources avail-
able in a community as measured by physi-
cian supply, the population base of the 
area served by the hospital and utilization 
of services by such population as measured 
by service area population, and financial 
indicators predictive of closure.
381 
‘‘(ii) RURAL HOSPITALS CRITICAL TO 
HEALTHCARE
ACCESS.—In the case of 
rural hospitals which provide access to es-
sential health services within a service area 
where no other provider of such essential 
services exists, such factors as the market 
share of the hospital for an area or popu-
lation, the number of outpatient visits, the 
proximity of the next closest provider of 
such services, and the degree to which the 
area population is medically underserved. 
‘‘(2) OWNERSHIP REQUIREMENTS.—In order to 
be eligible for assistance under this subtitle, a 
healthcare facility (other than a healthcare facility 
described in clauses (ii) and (v) of paragraph (1)) 
must— 
‘‘(A) be owned or operated by a unit of 
State or local government; 
‘‘(B) be a quasi-public corporation, defined 
as a private, nonprofit corporation or public 
benefit corporation which is formally granted 
one or more governmental powers by legislative 
action through (or is otherwise partially funded 
by) the State legislature, city or county council;