132 
‘‘(c) REPORT.—Not later than 2 years after the date 
of enactment of the Indian Health Care Improvement Act 
Amendments of 2009, the Secretary, acting through the 
director of the Office, shall submit to Congress a report 
describing— 
‘‘(1) any activity carried out by the director as 
of the date on which the report is prepared; and 
‘‘(2) any finding of the director with respect to 
the health of Indian men. 
‘‘SEC. 226. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated such sums 
as may be necessary for each fiscal year through fiscal 
year 2025 to carry out this title. 
‘‘TITLE III—FACILITIES 
‘‘SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVA-
TION OF FACILITIES; REPORTS. 
‘‘(a) 
PREREQUISITES
FOR
EXPENDITURE
OF 
FUNDS.—Prior to the expenditure of, or the making of 
any binding commitment to expend, any funds appro-
priated for the planning, design, construction, or renova-
tion of facilities pursuant to the Act of November 2, 1921 
(25 U.S.C. 13) (commonly known as the ‘Snyder Act’), 
the Secretary, acting through the Service, shall— 
‘‘(1) consult with any Indian Tribe that would 
be significantly affected by such expenditure for the 
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purpose of determining and, whenever practicable, 
honoring tribal preferences concerning size, location, 
type, and other characteristics of any facility on 
which such expenditure is to be made; and 
‘‘(2) ensure, whenever practicable and applica-
ble, that such facility meets the construction stand-
ards of any accrediting body recognized by the Sec-
retary for the purposes of the Medicare, Medicaid, 
and SCHIP programs under titles XVIII, XIX, and 
XXI of the Social Security Act by not later than 1 
year after the date on which the construction or ren-
ovation of such facility is completed. 
‘‘(b) CLOSURES.— 
‘‘(1) 
EVALUATION
REQUIRED.—Notwith-
standing any other provision of law, no facility oper-
ated by the Service may be closed if the Secretary 
has not submitted to Congress, not less than 1 year 
and not more than 2 years before the date of the 
proposed closure, an evaluation, completed not more 
than 2 years before such submission, of the impact 
of the proposed closure that specifies, in addition to 
other considerations— 
‘‘(A) the accessibility of alternative health 
care resources for the population served by such 
facility; 
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‘‘(B) the cost-effectiveness of such closure; 
‘‘(C) the quality of health care to be pro-
vided to the population served by such facility 
after such closure; 
‘‘(D) the availability of contract health 
care funds to maintain existing levels of service; 
‘‘(E) the views of the Indian Tribes served 
by such facility concerning such closure; 
‘‘(F) the level of use of such facility by all 
eligible Indians; and 
‘‘(G) the distance between such facility and 
the nearest operating Service hospital. 
‘‘(2) EXCEPTION
FOR
CERTAIN
TEMPORARY 
CLOSURES.—Paragraph (1) shall not apply to any 
temporary closure of a facility or any portion of a 
facility if such closure is necessary for medical, envi-
ronmental, or construction safety reasons. 
‘‘(c) HEALTH CARE FACILITY PRIORITY SYSTEM.— 
‘‘(1) IN GENERAL.— 
‘‘(A) PRIORITY
SYSTEM.—The Secretary, 
acting through the Service, shall maintain a 
health care facility priority system, which— 
‘‘(i) shall be developed in consultation 
with Indian Tribes and Tribal Organiza-
tions; 
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135 
‘‘(ii) shall give Indian Tribes’ needs 
the highest priority; 
‘‘(iii)(I) may include the lists required 
in paragraph (2)(B)(ii); and 
‘‘(II) shall include the methodology re-
quired in paragraph (2)(B)(v); and 
‘‘(III) may include such other facili-
ties, and such renovation or expansion 
needs of any health care facility, as the 
Service, Indian Tribes, and Tribal Organi-
zations may identify; and 
‘‘(iv) shall provide an opportunity for 
the nomination of planning, design, and 
construction projects by the Service, In-
dian Tribes, and Tribal Organizations for 
consideration under the priority system at 
least once every 3 years, or more fre-
quently as the Secretary determines to be 
appropriate. 
‘‘(B) 
NEEDS
OF
FACILITIES
UNDER 
ISDEAA AGREEMENTS.—The Secretary shall en-
sure that the planning, design, construction, 
renovation, and expansion needs of Service and 
non-Service facilities operated under contracts 
or compacts in accordance with the Indian Self- 
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Determination and Education Assistance Act 
(25 U.S.C. 450 et seq.) are fully and equitably 
integrated into the health care facility priority 
system. 
‘‘(C) 
CRITERIA
FOR
EVALUATING 
NEEDS.—For purposes of this subsection, the 
Secretary, in evaluating the needs of facilities 
operated under a contract or compact under the 
Indian Self-Determination and Education As-
sistance Act (25 U.S.C. 450 et seq.), shall use 
the criteria used by the Secretary in evaluating 
the needs of facilities operated directly by the 
Service. 
‘‘(D) PRIORITY
OF
CERTAIN
PROJECTS 
PROTECTED.—The priority of any project estab-
lished under the construction priority system in 
effect on the date of enactment of the Indian 
Health Care Improvement Act Amendments of 
2009 shall not be affected by any change in the 
construction priority system taking place after 
that date if the project— 
‘‘(i) was identified in the fiscal year 
2008 Service budget justification as— 
‘‘(I) 1 of the 10 top-priority inpa-
tient projects; 
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