1980 
request that such record or testimony be pro-
vided for a purpose authorized by law. 
‘‘(G) In an administrative or judicial pro-
ceeding commenced by a criminal or civil law 
enforcement agency or instrumentality referred 
to in subparagraph (F), but only with respect 
to the subject of such proceeding. 
‘‘(2) IDENTITY
OF
PARTICIPANTS.—With the 
exception of the subject of a quality assurance ac-
tion, the identity of any person receiving health care 
services from any Indian Health Program or Urban 
Indian Organization or the identity of any other per-
son associated with such program or organization 
for purposes of a medical quality assurance program 
that is disclosed in a medical quality assurance 
record described in subsection (a) shall be deleted 
from that record or document before any disclosure 
of such record is made outside such program or or-
ganization. 
‘‘(d) DISCLOSURE FOR CERTAIN PURPOSES.— 
‘‘(1) IN
GENERAL.—Nothing in this section 
shall be construed as authorizing or requiring the 
withholding from any person or entity aggregate sta-
tistical information regarding the results of any In-
1981 
dian 
Health 
Program 
or 
Urban 
Indian 
Organizations’s medical quality assurance programs. 
‘‘(2) WITHHOLDING
FROM
CONGRESS.—Noth-
ing in this section shall be construed as authority to 
withhold any medical quality assurance record from 
a committee of either House of Congress, any joint 
committee of Congress, or the Government Account-
ability Office if such record pertains to any matter 
within their respective jurisdictions. 
‘‘(e) PROHIBITION ON DISCLOSURE OF RECORD OR 
TESTIMONY.—A person or entity having possession of or 
access to a record or testimony described by this section 
may not disclose the contents of such record or testimony 
in any manner or for any purpose except as provided in 
this section. 
‘‘(f) EXEMPTION FROM FREEDOM OF INFORMATION 
ACT.—Medical quality assurance records described in sub-
section (a) may not be made available to any person under 
section 552 of title 5, United States Code. 
‘‘(g) LIMITATION ON CIVIL LIABILITY.—A person 
who participates in or provides information to a person 
or body that reviews or creates medical quality assurance 
records described in subsection (a) shall not be civilly lia-
ble for such participation or for providing such informa-
tion if the participation or provision of information was
1982 
in good faith based on prevailing professional standards 
at the time the medical quality assurance program activity 
took place. 
‘‘(h) APPLICATION
TO INFORMATION
IN CERTAIN 
OTHER RECORDS.—Nothing in this section shall be con-
strued as limiting access to the information in a record 
created and maintained outside a medical quality assur-
ance program, including a patient’s medical records, on 
the grounds that the information was presented during 
meetings of a review body that are part of a medical qual-
ity assurance program. 
‘‘(i) REGULATIONS.—The Secretary, acting through 
the Service, shall promulgate regulations pursuant to sec-
tion 802. 
‘‘(j) DEFINITIONS.—In this section: 
‘‘(1) The term ‘health care provider’ means any 
health care professional, including community health 
aides and practitioners certified under section 121, 
who are granted clinical practice privileges or em-
ployed to provide health care services in an Indian 
Health Program or health program of an Urban In-
dian Organization, who is licensed or certified to 
perform health care services by a governmental 
board or agency or professional health care society 
or organization.
1983 
‘‘(2) The term ‘medical quality assurance pro-
gram’ means any activity carried out before, on, or 
after the date of enactment of this Act by or for any 
Indian Health Program or Urban Indian Organiza-
tion to assess the quality of medical care, including 
activities conducted by or on behalf of individuals, 
Indian Health Program or Urban Indian Organiza-
tion medical or dental treatment review committees, 
or other review bodies responsible for quality assur-
ance, credentials, infection control, patient safety, 
patient care assessment (including treatment proce-
dures, blood, drugs, and therapeutics), medical 
records, health resources management review and 
identification and prevention of medical or dental in-
cidents and risks. 
‘‘(3) The term ‘medical quality assurance 
record’ means the proceedings, records, minutes, and 
reports that emanate from quality assurance pro-
gram activities described in paragraph (2) and are 
produced or compiled by or for an Indian Health 
Program or Urban Indian Organization as part of a 
medical quality assurance program. 
‘‘(k) CONTINUED PROTECTION.—Disclosure under 
subsection (c) does not permit redisclosure except to the 
extent such further disclosure is authorized under sub-
1984 
section (c) or is otherwise authorized to be disclosed under 
this section. 
‘‘(l) INCONSISTENCIES.—To the extent that the pro-
tections under the Patient Safety and Quality Improve-
ment Act of 2005 and this section are inconsistent, the 
provisions of whichever is more protective shall control. 
‘‘(m) RELATIONSHIP TO OTHER LAW.—This section 
shall continue in force and effect, except as otherwise spe-
cifically provided in any Federal law enacted after the date 
of enactment of the Indian Health Care Improvement Act 
Amendments of 2009. 
‘‘SEC. 813. CLAREMORE INDIAN HOSPITAL. 
‘‘The Claremore Indian Hospital shall be deemed to 
be a dependant Indian community for the purposes of sec-
tion 1151 of title 18, United States Code. 
‘‘SEC. 814. SENSE OF CONGRESS REGARDING LAW EN-
FORCEMENT 
AND 
METHAMPHETAMINE 
ISSUES IN INDIAN COUNTRY. 
‘‘It is the sense of Congress that Congress encourages 
State, local, and Indian tribal law enforcement agencies 
to enter into memoranda of agreement between and 
among those agencies for purposes of streamlining law en-
forcement activities and maximizing the use of limited re-
sources—
1985 
‘‘(1) to improve law enforcement services pro-
vided to Indian tribal communities; and 
‘‘(2) to increase the effectiveness of measures to 
address problems relating to methamphetamine use 
in Indian country (as defined in section 1151 of title 
18, United States Code). 
‘‘SEC. 815. PERMITTING IMPLEMENTATION THROUGH CON-
TRACTS WITH TRIBAL HEALTH PROGRAMS. 
‘‘Nothing in this Act shall be construed as preventing 
the Secretary from— 
‘‘(1) carrying out any section of this Act 
through contracts with Tribal Health Programs; and 
‘‘(2) carrying out sections through 214, 
701(a)(1), 701(b)(1), 701(c), 707(g), and 712(b), 
through contracts with urban Indian organizations. 
The previous sentence shall not affect the authority the 
Secretary may otherwise have to carry out other provisions 
of this Act through such contracts. 
‘‘SEC. 816. AUTHORIZATION OF APPROPRIATIONS; AVAIL-
ABILITY. 
‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this title. 
‘‘(b) LIMITATION ON NEW SPENDING AUTHORITY.— 
Any new spending authority (described in subparagraph
1986 
(A) or (B) of section 401(c)(2) of the Congressional Budg-
et Act of 1974 (Public Law 93–344; 88 Stat. 317)) which 
is provided under this Act shall be effective for any fiscal 
year only to such extent or in such amounts as are pro-
vided in appropriation Acts. 
‘‘(c) AVAILABILITY.—The funds appropriated pursu-
ant to this Act shall remain available until expended.’’. 
(b) RATE OF PAY.— 
(1) POSITIONS AT LEVEL IV.—Section 5315 of 
title 5, United States Code, is amended by striking 
‘‘Assistant Secretaries of Health and Human Serv-
ices (6).’’ and inserting ‘‘Assistant Secretaries of 
Health and Human Services (7)’’. 
(2) POSITIONS AT LEVEL V.—Section 5316 of 
title 5, United States Code, is amended by striking 
‘‘Director, Indian Health Service, Department of 
Health and Human Services’’. 
(c) AMENDMENTS TO OTHER PROVISIONS OF LAW.— 
(1) Section 3307(b)(1)(C) of the Children’s 
Health Act of 2000 (25 U.S.C. 1671 note; Public 
Law 106–310) is amended by striking ‘‘Director of 
the Indian Health Service’’ and inserting ‘‘Assistant 
Secretary for Indian Health’’. 
(2) The Indian Lands Open Dump Cleanup Act 
of 1994 is amended—
1987 
(A) in section 3 (25 U.S.C. 3902)— 
(i) by striking paragraph (2); 
(ii) by redesignating paragraphs (1), 
(3), (4), (5), and (6) as paragraphs (4), 
(5), (2), (6), and (1), respectively, and 
moving those paragraphs so as to appear 
in numerical order; and 
(iii) by inserting before paragraph (4) 
(as redesignated by subclause (II)) the fol-
lowing: 
‘‘(3) ASSISTANT
SECRETARY.—The term ‘As-
sistant Secretary’ means the Assistant Secretary for 
Indian Health.’’; 
(B) in section 5 (25 U.S.C. 3904), by 
striking the section designation and heading 
and inserting the following: 
‘‘SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR IN-
DIAN HEALTH.’’; 
(C) in section 6(a) (25 U.S.C. 3905(a)), in 
the subsection heading, by striking ‘‘DIREC-
TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 
(D) in section 9(a) (25 U.S.C. 3908(a)), in 
the subsection heading, by striking ‘‘DIREC-
TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 
and
1988 
(E) by striking ‘‘Director’’ each place it 
appears and inserting ‘‘Assistant Secretary’’. 
(3) Section 5504(d)(2) of the Augustus F. 
Hawkins-Robert T. Stafford Elementary and Sec-
ondary School Improvement Amendments of 1988 
(25 U.S.C. 2001 note; Public Law 100–297) is 
amended by striking ‘‘Director of the Indian Health 
Service’’ and inserting ‘‘Assistant Secretary for In-
dian Health’’. 
(4) Section 203(a)(1) of the Rehabilitation Act 
of 1973 (29 U.S.C. 763(a)(1)) is amended by strik-
ing ‘‘Director of the Indian Health Service’’ and in-
serting ‘‘Assistant Secretary for Indian Health’’. 
(5) Subsections (b) and (e) of section 518 of 
the Federal Water Pollution Control Act (33 U.S.C. 
1377) are amended by striking ‘‘Director of the In-
dian Health Service’’ each place it appears and in-
serting ‘‘Assistant Secretary for Indian Health’’. 
(6) Section 317M(b) of the Public Health Serv-
ice Act (42 U.S.C. 247b–14(b)) is amended— 
(A) by striking ‘‘Director of the Indian 
Health Service’’ each place it appears and in-
serting 
‘‘Assistant 
Secretary 
for 
Indian 
Health’’; and
1989 
(B) in paragraph (2)(A), by striking ‘‘the 
Directors referred to in such paragraph’’ and 
inserting ‘‘the Director of the Centers for Dis-
ease Control and Prevention and the Assistant 
Secretary for Indian Health’’. 
(7) Section 417C(b) of the Public Health Serv-
ice Act (42 U.S.C. 285–9(b)) is amended by striking 
‘‘Director of the Indian Health Service’’ and insert-
ing ‘‘Assistant Secretary for Indian Health’’. 
(8) Section 1452(i) of the Safe Drinking Water 
Act (42 U.S.C. 300j–12(i)) is amended by striking 
‘‘Director of the Indian Health Service’’ each place 
it appears and inserting ‘‘Assistant Secretary for In-
dian Health’’. 
(9) Section 803B(d)(1) of the Native American 
Programs Act of 1974 (42 U.S.C. 2991b–2(d)(1)) is 
amended in the last sentence by striking ‘‘Director 
of the Indian Health Service’’ and inserting ‘‘Assist-
ant Secretary for Indian Health’’. 
(10) Section 203(b) of the Michigan Indian 
Land Claims Settlement Act (Public Law 105–143; 
111 Stat. 2666) is amended by striking ‘‘Director of 
the Indian Health Service’’ and inserting ‘‘Assistant 
Secretary for Indian Health’’.
1990 
SEC. 3102. NATIVE AMERICAN HEALTH AND WELLNESS 
FOUNDATION. 
(a) IN GENERAL.—The Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.) is 
amended by adding at the end the following: 
‘‘TITLE VIII—NATIVE AMERICAN 
HEALTH 
AND 
WELLNESS 
FOUNDATION 
‘‘SEC. 801. DEFINITIONS. 
‘‘In this title: 
‘‘(1) BOARD.—The term ‘Board’ means the 
Board of Directors of the Foundation. 
‘‘(2) 
COMMITTEE.—The 
term 
‘Committee’ 
means the Committee for the Establishment of Na-
tive American Health and Wellness Foundation es-
tablished under section 802(f). 
‘‘(3) FOUNDATION.—The term ‘Foundation’ 
means the Native American Health and Wellness 
Foundation established under section 802. 
‘‘(4) SECRETARY.—The term ‘Secretary’ means 
the Secretary of Health and Human Services. 
‘‘(5) SERVICE.—The term ‘Service’ means the 
Indian Health Service of the Department of Health 
and Human Services.
1991 
‘‘SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS 
FOUNDATION. 
‘‘(a) ESTABLISHMENT.— 
‘‘(1) IN
GENERAL.—As soon as practicable 
after the date of enactment of this title, the Sec-
retary shall establish, under the laws of the District 
of Columbia and in accordance with this title, the 
Native American Health and Wellness Foundation. 
‘‘(2) FUNDING
DETERMINATIONS.—No funds, 
gift, property, or other item of value (including any 
interest accrued on such an item) acquired by the 
Foundation shall— 
‘‘(A) be taken into consideration for pur-
poses of determining Federal appropriations re-
lating to the provision of health care and serv-
ices to Indians; or 
‘‘(B) otherwise limit, diminish, or affect 
the Federal responsibility for the provision of 
health care and services to Indians. 
‘‘(b) PERPETUAL
EXISTENCE.—The Foundation 
shall have perpetual existence. 
‘‘(c) NATURE OF CORPORATION.—The Foundation— 
‘‘(1) shall be a charitable and nonprofit feder-
ally chartered corporation; and 
‘‘(2) shall not be an agency or instrumentality 
of the United States.
1992 
‘‘(d) PLACE OF INCORPORATION AND DOMICILE.— 
The Foundation shall be incorporated and domiciled in the 
District of Columbia. 
‘‘(e) DUTIES.—The Foundation shall— 
‘‘(1) encourage, accept, and administer private 
gifts of real and personal property, and any income 
from or interest in such gifts, for the benefit of, or 
in support of, the mission of the Service; 
‘‘(2) undertake and conduct such other activi-
ties as will further the health and wellness activities 
and opportunities of Native Americans; and 
‘‘(3) participate with and assist Federal, State, 
and tribal governments, agencies, entities, and indi-
viduals in undertaking and conducting activities that 
will further the health and wellness activities and op-
portunities of Native Americans. 
‘‘(f) COMMITTEE FOR THE ESTABLISHMENT OF NA-
TIVE AMERICAN HEALTH
AND WELLNESS FOUNDA-
TION.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish the Committee for the Establishment of Native 
American Health and Wellness Foundation to assist 
the Secretary in establishing the Foundation.
1993 
‘‘(2) DUTIES.—Not later than 180 days after 
the date of enactment of this section, the Committee 
shall— 
‘‘(A) carry out such activities as are nec-
essary to incorporate the Foundation under the 
laws of the District of Columbia, including act-
ing as incorporators of the Foundation; 
‘‘(B) ensure that the Foundation qualifies 
for and maintains the status required to carry 
out this section, until the Board is established; 
‘‘(C) establish the constitution and initial 
bylaws of the Foundation; 
‘‘(D) provide for the initial operation of 
the Foundation, including providing for tem-
porary or interim quarters, equipment, and 
staff; and 
‘‘(E) appoint the initial members of the 
Board in accordance with the constitution and 
initial bylaws of the Foundation. 
‘‘(g) BOARD OF DIRECTORS.— 
‘‘(1) IN
GENERAL.—The Board of Directors 
shall be the governing body of the Foundation. 
‘‘(2) POWERS.—The Board may exercise, or 
provide for the exercise of, the powers of the Foun-
dation.
1994 
‘‘(3) SELECTION.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the number of members of the 
Board, the manner of selection of the members 
(including the filling of vacancies), and the 
terms of office of the members shall be as pro-
vided in the constitution and bylaws of the 
Foundation. 
‘‘(B) REQUIREMENTS.— 
‘‘(i) NUMBER
OF
MEMBERS.—The 
Board shall have at least 11 members, who 
shall have staggered terms. 
‘‘(ii) INITIAL VOTING MEMBERS.—The 
initial voting members of the Board— 
‘‘(I) shall be appointed by the 
Committee not later than 180 days 
after the date on which the Founda-
tion is established; and 
‘‘(II) shall have staggered terms. 
‘‘(iii) QUALIFICATION.—The members 
of the Board shall be United States citi-
zens who are knowledgeable or experienced 
in Native American health care and related 
matters.
1995 
‘‘(C) COMPENSATION.—A member of the 
Board shall not receive compensation for service 
as a member, but shall be reimbursed for actual 
and necessary travel and subsistence expenses 
incurred in the performance of the duties of the 
Foundation. 
‘‘(h) OFFICERS.— 
‘‘(1) IN GENERAL.—The officers of the Founda-
tion shall be— 
‘‘(A) a secretary, elected from among the 
members of the Board; and 
‘‘(B) any other officers provided for in the 
constitution and bylaws of the Foundation. 
‘‘(2) CHIEF
OPERATING
OFFICER.—The sec-
retary of the Foundation may serve, at the direction 
of the Board, as the chief operating officer of the 
Foundation, or the Board may appoint a chief oper-
ating officer, who shall serve at the direction of the 
Board. 
‘‘(3) ELECTION.—The manner of election, term 
of office, and duties of the officers of the Founda-
tion shall be as provided in the constitution and by-
laws of the Foundation. 
‘‘(i) POWERS.—The Foundation—
1996 
‘‘(1) shall adopt a constitution and bylaws for 
the management of the property of the Foundation 
and the regulation of the affairs of the Foundation; 
‘‘(2) may adopt and alter a corporate seal; 
‘‘(3) may enter into contracts; 
‘‘(4) may acquire (through a gift or otherwise), 
own, lease, encumber, and transfer real or personal 
property as necessary or convenient to carry out the 
purposes of the Foundation; 
‘‘(5) may sue and be sued; and 
‘‘(6) may perform any other act necessary and 
proper to carry out the purposes of the Foundation. 
‘‘(j) PRINCIPAL OFFICE.— 
‘‘(1) IN GENERAL.—The principal office of the 
Foundation shall be in the District of Columbia. 
‘‘(2) ACTIVITIES; OFFICES.—The activities of 
the Foundation may be conducted, and offices may 
be maintained, throughout the United States in ac-
cordance with the constitution and bylaws of the 
Foundation. 
‘‘(k) SERVICE OF PROCESS.—The Foundation shall 
comply with the law on service of process of each State 
in which the Foundation is incorporated and of each State 
in which the Foundation carries on activities.
1997 
‘‘(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—
1998 
‘‘(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.
1999 
‘‘(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)—
2000 
‘‘(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’’.
2001 
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-
2002 
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.
2003 
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
2004 
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
2005 
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
2006 
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.—
2007 
(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’’;
2008 
(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).’’.
2009 
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:
2010 
‘‘(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.
2011 
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),
2012 
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.’’.
2013 
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
2014 
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: 
Clerk.
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.