‘‘(d) PROVISIONS RELATING
TO HEALTH STATUS 
AND RESOURCE DEFICIENCIES.—For the purposes of this 
section, the following definitions apply: 
‘‘(1) DEFINITION.—The term ‘health status 
and resource deficiency’ means the extent to 
which— 
‘‘(A) the health status objectives set forth 
in section 3(2) are not being achieved; and 
‘‘(B) the Indian Tribe or Tribal Organiza-
tion does not have available to it the health re-
sources it needs, taking into account the actual 
cost of providing health care services given local 
geographic, climatic, rural, or other cir-
cumstances. 
‘‘(2) AVAILABLE RESOURCES.—The health re-
sources available to an Indian Tribe or Tribal Orga-
nization include health resources provided by the 
Service as well as health resources used by the In-
dian Tribe or Tribal Organization, including services 
and financing systems provided by any Federal pro-
grams, private insurance, and programs of State or 
local governments. 
‘‘(3) PROCESS
FOR
REVIEW
OF
DETERMINA-
TIONS.—The Secretary shall establish procedures 
which allow any Indian Tribe or Tribal Organization 
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to petition the Secretary for a review of any deter-
mination of the extent of the health status and re-
source deficiency of such Indian Tribe or Tribal Or-
ganization. 
‘‘(e) ELIGIBILITY FOR FUNDS.—Tribal Health Pro-
grams shall be eligible for funds appropriated under the 
authority of this section on an equal basis with programs 
that are administered directly by the Service. 
‘‘(f) REPORT.—By no later than the date that is 3 
years after the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2007, the Sec-
retary shall submit to Congress the current health status 
and resource deficiency report of the Service for each 
Service Unit, including newly recognized or acknowledged 
Indian Tribes. Such report shall set out— 
‘‘(1) the methodology then in use by the Service 
for determining Tribal health status and resource 
deficiencies, as well as the most recent application of 
that methodology; 
‘‘(2) the extent of the health status and re-
source deficiency of each Indian Tribe served by the 
Service or a Tribal Health Program; 
‘‘(3) the amount of funds necessary to eliminate 
the health status and resource deficiencies of all In-
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dian Tribes served by the Service or a Tribal Health 
Program; and 
‘‘(4) an estimate of— 
‘‘(A) the amount of health service funds 
appropriated under the authority of this Act, or 
any other Act, including the amount of any 
funds transferred to the Service for the pre-
ceding fiscal year which is allocated to each 
Service Unit, Indian Tribe, or Tribal Organiza-
tion; 
‘‘(B) the number of Indians eligible for 
health services in each Service Unit or Indian 
Tribe or Tribal Organization; and 
‘‘(C) the number of Indians using the 
Service resources made available to each Service 
Unit, Indian Tribe or Tribal Organization, and, 
to the extent available, information on the wait-
ing lists and number of Indians turned away for 
services due to lack of resources. 
‘‘(g) INCLUSION IN BASE BUDGET.—Funds appro-
priated under this section for any fiscal year shall be in-
cluded in the base budget of the Service for the purpose 
of determining appropriations under this section in subse-
quent fiscal years. 
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‘‘(h) CLARIFICATION.—Nothing in this section is in-
tended to diminish the primary responsibility of the Serv-
ice to eliminate existing backlogs in unmet health care 
needs, nor are the provisions of this section intended to 
discourage the Service from undertaking additional efforts 
to achieve equity among Indian Tribes and Tribal Organi-
zations. 
‘‘(i) FUNDING DESIGNATION.—Any funds appro-
priated under the authority of this section shall be des-
ignated as the ‘Indian Health Care Improvement Fund’. 
‘‘SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. 
‘‘(a) ESTABLISHMENT.—There is established an In-
dian Catastrophic Health Emergency Fund (hereafter in 
this section referred to as the ‘CHEF’) consisting of— 
‘‘(1) the amounts deposited under subsection 
(f); and 
‘‘(2) the amounts appropriated to CHEF under 
this section. 
‘‘(b) ADMINISTRATION.—CHEF shall be adminis-
tered by the Secretary, acting through the headquarters 
of the Service, solely for the purpose of meeting the ex-
traordinary medical costs associated with the treatment of 
victims of disasters or catastrophic illnesses who are with-
in the responsibility of the Service. 
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