1890 
tion by the organization as a condition of car-
rying forward the availability for expenditure of 
such funds. 
‘‘(2) SEMIANNUAL AND QUARTERLY PAYMENTS 
AND
REIMBURSEMENTS.—If the Secretary deter-
mines under paragraph (1)(A) that an urban Indian 
organization is not capable of administering an en-
tire single advance payment, on request of the urban 
Indian organization, the payments may be made— 
‘‘(A) in semiannual or quarterly payments 
by not later than 30 days after the date on 
which the funding period with respect to which 
the payments apply begins; or 
‘‘(B) by way of reimbursement. 
‘‘(c) REVISION OR AMENDMENT OF CONTRACTS.— 
Notwithstanding any provision of law to the contrary, the 
Secretary may, at the request and consent of an urban 
Indian organization, revise or amend any contract entered 
into by the Secretary with such organization under this 
title as necessary to carry out the purposes of this title. 
‘‘(d) FAIR AND UNIFORM SERVICES AND ASSIST-
ANCE.—Contracts with or grants to urban Indian organi-
zations and regulations adopted pursuant to this title shall 
include provisions to assure the fair and uniform provision
1891 
to urban Indians of services and assistance under such 
contracts or grants by such organizations. 
‘‘SEC. 508. REPORTS AND RECORDS. 
‘‘(a) REPORTS.— 
‘‘(1) IN GENERAL.—For each fiscal year during 
which an urban Indian organization receives or ex-
pends funds pursuant to a contract entered into or 
a grant received pursuant to this title, such urban 
Indian organization shall submit to the Secretary 
not more frequently than every 6 months, a report 
that includes the following: 
‘‘(A) In the case of a contract or grant 
under section 503, recommendations pursuant 
to section 503(a)(5). 
‘‘(B) Information on activities conducted 
by the organization pursuant to the contract or 
grant. 
‘‘(C) An accounting of the amounts and 
purpose for which Federal funds were ex-
pended. 
‘‘(D) A minimum set of data, using uni-
formly defined elements, as specified by the 
Secretary after consultation with urban Indian 
organizations. 
‘‘(2) HEALTH STATUS AND SERVICES.—
1892 
‘‘(A) IN
GENERAL.—Not later than 18 
months after the date of enactment of the In-
dian Health Care Improvement Act Amend-
ments of 2009, the Secretary, acting through 
the Service, shall submit to Congress a report 
evaluating— 
‘‘(i) the health status of urban Indi-
ans; 
‘‘(ii) the services provided to Indians 
pursuant to this title; and 
‘‘(iii) areas of unmet needs in the de-
livery of health services to urban Indians. 
‘‘(B) CONSULTATION
AND
CONTRACTS.— 
In preparing the report under paragraph (1), 
the Secretary— 
‘‘(i) shall consult with urban Indian 
organizations; and 
‘‘(ii) may enter into a contract with a 
national organization representing urban 
Indian organizations to conduct any aspect 
of the report. 
‘‘(b) AUDIT.—The reports and records of the urban 
Indian organization with respect to a contract or grant 
under this title shall be subject to audit by the Secretary 
and the Comptroller General of the United States.
1893 
‘‘(c) COSTS OF AUDITS.—The Secretary shall allow 
as a cost of any contract or grant entered into or awarded 
under section 502 or 503 the cost of an annual inde-
pendent financial audit conducted by— 
‘‘(1) a certified public accountant; or 
‘‘(2) a certified public accounting firm qualified 
to conduct Federal compliance audits. 
‘‘SEC. 509. LIMITATION ON CONTRACT AUTHORITY. 
‘‘The authority of the Secretary to enter into con-
tracts or to award grants under this title shall be to the 
extent, and in an amount, provided for in appropriation 
Acts. 
‘‘SEC. 510. FACILITIES. 
‘‘(a) GRANTS.—The Secretary, acting through the 
Service, may make grants to contractors or grant recipi-
ents under this title for the lease, purchase, renovation, 
construction, or expansion of facilities, including leased fa-
cilities, in order to assist such contractors or grant recipi-
ents in complying with applicable licensure or certification 
requirements. 
‘‘(b) LOAN FUND STUDY.—The Secretary, acting 
through the Service, may carry out a study to determine 
the feasibility of establishing a loan fund to provide to 
urban Indian organizations direct loans or guarantees for 
loans for the construction of health care facilities in a
1894 
manner consistent with section 309, including by submit-
ting a report in accordance with subsection (c) of that sec-
tion. 
‘‘SEC. 511. DIVISION OF URBAN INDIAN HEALTH. 
‘‘There is established within the Service a Division 
of Urban Indian Health, which shall be responsible for— 
‘‘(1) carrying out the provisions of this title; 
‘‘(2) providing central oversight of the pro-
grams and services authorized under this title; and 
‘‘(3) providing technical assistance to urban In-
dian organizations. 
‘‘SEC. 512. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE- 
RELATED SERVICES. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 
through the Service, may make grants for the provision 
of health-related services in prevention of, treatment of, 
rehabilitation of, or school- and community-based edu-
cation regarding, alcohol and substance abuse in Urban 
Centers to those urban Indian organizations with which 
the Secretary has entered into a contract under this title 
or under section 201. 
‘‘(b) GOALS.—Each grant made pursuant to sub-
section (a) shall set forth the goals to be accomplished 
pursuant to the grant. The goals shall be specific to each 
grant as agreed to between the Secretary and the grantee.
1895 
‘‘(c) CRITERIA.—The Secretary shall establish cri-
teria for the grants made under subsection (a), including 
criteria relating to the following: 
‘‘(1) The size of the urban Indian population. 
‘‘(2) Capability of the organization to ade-
quately perform the activities required under the 
grant. 
‘‘(3) Satisfactory performance standards for the 
organization in meeting the goals set forth in such 
grant. The standards shall be negotiated and agreed 
to between the Secretary and the grantee on a 
grant-by-grant basis. 
‘‘(4) Identification of the need for services. 
‘‘(d) ALLOCATION OF GRANTS.—The Secretary shall 
develop a methodology for allocating grants made pursu-
ant to this section based on the criteria established pursu-
ant to subsection (c). 
‘‘(e) GRANTS SUBJECT TO CRITERIA.—Any grant re-
ceived by an urban Indian organization under this Act for 
substance abuse prevention, treatment, and rehabilitation 
shall be subject to the criteria set forth in subsection (c).
1896 
‘‘SEC. 513. TREATMENT OF CERTAIN DEMONSTRATION 
PROJECTS. 
‘‘Notwithstanding any other provision of law, the 
Tulsa Clinic and Oklahoma City Clinic demonstration 
projects shall— 
‘‘(1) be permanent programs within the Serv-
ice’s direct care program; 
‘‘(2) continue to be treated as Service Units 
and Operating Units in the allocation of resources 
and coordination of care; and 
‘‘(3) continue to meet the requirements and 
definitions of an urban Indian organization in this 
Act, and shall not be subject to the provisions of the 
Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.). 
‘‘SEC. 514. URBAN NIAAA TRANSFERRED PROGRAMS. 
‘‘(a) GRANTS
AND
CONTRACTS.—The Secretary, 
through the Division of Urban Indian Health, shall make 
grants or enter into contracts with urban Indian organiza-
tions, to take effect not later than September 30, 2010, 
for the administration of urban Indian alcohol programs 
that were originally established under the National Insti-
tute on Alcoholism and Alcohol Abuse (hereafter in this 
section referred to as ‘NIAAA’) and transferred to the 
Service.
1897 
‘‘(b) USE OF FUNDS.—Grants provided or contracts 
entered into under this section shall be used to provide 
support for the continuation of alcohol prevention and 
treatment services for urban Indian populations and such 
other objectives as are agreed upon between the Service 
and a recipient of a grant or contract under this section. 
‘‘(c) ELIGIBILITY.—Urban Indian organizations that 
operate Indian alcohol programs originally funded under 
the NIAAA and subsequently transferred to the Service 
are eligible for grants or contracts under this section. 
‘‘(d) REPORT.—The Secretary shall evaluate and re-
port to Congress on the activities of programs funded 
under this section not less than every 5 years. 
‘‘SEC. 515. CONFERRING WITH URBAN INDIAN ORGANIZA-
TIONS. 
‘‘(a) IN GENERAL.—The Secretary shall ensure that 
the Service confers or conferences, to the greatest extent 
practicable, with Urban Indian Organizations. 
‘‘(b) DEFINITION
OF CONFER; CONFERENCE.—In 
this section, the terms ‘confer’ and ‘conference’ mean an 
open and free exchange of information and opinions 
that— 
‘‘(1) leads to mutual understanding and com-
prehension; and
1898 
‘‘(2) emphasizes trust, respect, and shared re-
sponsibility. 
‘‘SEC. 516. URBAN YOUTH TREATMENT CENTER DEM-
ONSTRATION. 
‘‘(a) CONSTRUCTION AND OPERATION.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Service, through grant or contract, shall 
fund the construction and operation of at least 1 
residential treatment center in each Service Area 
that meets the eligibility requirements set forth in 
subsection (b) to demonstrate the provision of alco-
hol and substance abuse treatment services to Urban 
Indian youth in a culturally competent residential 
setting. 
‘‘(2) TREATMENT.—Each residential treatment 
center described in paragraph (1) shall be in addi-
tion to any facilities constructed under section 
707(b). 
‘‘(b) ELIGIBILITY REQUIREMENTS.—To be eligible to 
obtain a facility under subsection (a)(1), a Service Area 
shall meet the following requirements: 
‘‘(1) There is an Urban Indian Organization in 
the Service Area.
1899 
‘‘(2) There reside in the Service Area Urban In-
dian youth with need for alcohol and substance 
abuse treatment services in a residential setting. 
‘‘(3) There is a significant shortage of cul-
turally competent residential treatment services for 
Urban Indian youth in the Service Area. 
‘‘SEC. 517. GRANTS FOR DIABETES PREVENTION, TREAT-
MENT, AND CONTROL. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary may 
make grants to those urban Indian organizations that 
have entered into a contract or have received a grant 
under this title for the provision of services for the preven-
tion and treatment of, and control of the complications 
resulting from, diabetes among urban Indians. 
‘‘(b) GOALS.—Each grant made pursuant to sub-
section (a) shall set forth the goals to be accomplished 
under the grant. The goals shall be specific to each grant 
as agreed to between the Secretary and the grantee. 
‘‘(c) ESTABLISHMENT OF CRITERIA.—The Secretary 
shall establish criteria for the grants made under sub-
section (a) relating to— 
‘‘(1) the size and location of the urban Indian 
population to be served; 
‘‘(2) the need for prevention of and treatment 
of, and control of the complications resulting from,
1900 
diabetes among the urban Indian population to be 
served; 
‘‘(3) performance standards for the organiza-
tion in meeting the goals set forth in such grant 
that are negotiated and agreed to by the Secretary 
and the grantee; 
‘‘(4) the capability of the organization to ade-
quately perform the activities required under the 
grant; and 
‘‘(5) the willingness of the organization to col-
laborate with the registry, if any, established by the 
Secretary under section 203(e)(1)(B) in the Area 
Office of the Service in which the organization is lo-
cated. 
‘‘(d) FUNDS SUBJECT TO CRITERIA.—Any funds re-
ceived by an urban Indian organization under this Act for 
the prevention, treatment, and control of diabetes among 
urban Indians shall be subject to the criteria developed 
by the Secretary under subsection (c). 
‘‘SEC. 518. COMMUNITY HEALTH REPRESENTATIVES. 
‘‘The Secretary, acting through the Service, may 
enter into contracts with, and make grants to, urban In-
dian organizations for the employment of Indians trained 
as health service providers through the Community Health 
Representatives Program under section 109 in the provi-
1901 
sion of health care, health promotion, and disease preven-
tion services to urban Indians. 
‘‘SEC. 519. EFFECTIVE DATE. 
‘‘The amendments made by the Indian Health Care 
Improvement Act Amendments of 2009 to this title shall 
take effect beginning on the date of enactment of that Act, 
regardless of whether the Secretary has promulgated regu-
lations implementing such amendments. 
‘‘SEC. 520. ELIGIBILITY FOR SERVICES. 
‘‘Urban Indians shall be eligible for, and the ultimate 
beneficiaries of, health care or referral services provided 
pursuant to this title. 
‘‘SEC. 521. AUTHORIZATION OF APPROPRIATIONS. 
‘‘(a) IN GENERAL.—There are authorized to be ap-
propriated such sums as may be necessary to carry out 
this title. 
‘‘(b) URBAN INDIAN ORGANIZATIONS.—The Sec-
retary, acting through the Service, is authorized to estab-
lish programs, including programs for the awarding of 
grants, for urban Indian organizations that are identical 
to any programs established pursuant to section 126 (be-
havioral health training), section 209 (school health edu-
cation), section 211 (prevention of communicable dis-
eases), section 701 (behavioral health prevention and
1902 
treatment services), and section 707(g) (multidrug abuse 
program). 
‘‘SEC. 522. HEALTH INFORMATION TECHNOLOGY. 
‘‘The Secretary, acting through the Service, may 
make grants to urban Indian organizations under this title 
for the development, adoption, and implementation of 
health information technology (as defined in section 
3000(5) of the American Recovery and Reinvestment Act), 
telemedicine services development, and related infrastruc-
ture. 
‘‘TITLE VI—ORGANIZATIONAL 
IMPROVEMENTS 
‘‘SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERV-
ICE AS AN AGENCY OF THE PUBLIC HEALTH 
SERVICE. 
‘‘(a) ESTABLISHMENT.— 
‘‘(1) IN GENERAL.—In order to more effectively 
and efficiently carry out the responsibilities, authori-
ties, and functions of the United States to provide 
health care services to Indians and Indian Tribes, as 
are or may be hereafter provided by Federal statute 
or treaties, there is established within the Public 
Health Service of the Department the Indian Health 
Service.
1903 
‘‘(2) 
ASSISTANT
SECRETARY
OF
INDIAN 
HEALTH.—The Service shall be administered by an 
Assistant Secretary of Indian Health, who shall be 
appointed by the President, by and with the advice 
and consent of the Senate. The Assistant Secretary 
shall report to the Secretary. Effective with respect 
to an individual appointed by the President, by and 
with the advice and consent of the Senate, after 
January 1, 2010, the term of service of the Assist-
ant Secretary shall be 4 years. An Assistant Sec-
retary may serve more than 1 term. 
‘‘(3) INCUMBENT.—The individual serving in 
the position of Director of the Service on the day be-
fore the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2009 shall 
serve as Assistant Secretary. 
‘‘(4) ADVOCACY AND CONSULTATION.—The po-
sition of Assistant Secretary is established to, in a 
manner consistent with the government-to-govern-
ment relationship between the United States and In-
dian Tribes— 
‘‘(A) facilitate advocacy for the develop-
ment of appropriate Indian health policy; and 
‘‘(B) promote consultation on matters re-
lating to Indian health.
1904 
‘‘(b) AGENCY.—The Service shall be an agency within 
the Public Health Service of the Department, and shall 
not be an office, component, or unit of any other agency 
of the Department. 
‘‘(c) DUTIES.—The Assistant Secretary shall— 
‘‘(1) perform all functions that were, on the day 
before the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2009, car-
ried out by or under the direction of the individual 
serving as Director of the Service on that day; 
‘‘(2) perform all functions of the Secretary re-
lating to the maintenance and operation of hospital 
and health facilities for Indians and the planning 
for, and provision and utilization of, health services 
for Indians; 
‘‘(3) administer all health programs under 
which health care is provided to Indians based upon 
their status as Indians which are administered by 
the Secretary, including programs under— 
‘‘(A) this Act; 
‘‘(B) the Act of November 2, 1921 (25 
U.S.C. 13); 
‘‘(C) the Act of August 5, 1954 (42 U.S.C. 
2001 et seq.);
1905 
‘‘(D) the Act of August 16, 1957 (42 
U.S.C. 2005 et seq.); and 
‘‘(E) the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et 
seq.); 
‘‘(4) administer all scholarship and loan func-
tions carried out under title I; 
‘‘(5) report directly to the Secretary concerning 
all policy- and budget-related matters affecting In-
dian health; 
‘‘(6) collaborate with the Assistant Secretary 
for Health concerning appropriate matters of Indian 
health that affect the agencies of the Public Health 
Service; 
‘‘(7) advise each Assistant Secretary of the De-
partment concerning matters of Indian health with 
respect to which that Assistant Secretary has au-
thority and responsibility; 
‘‘(8) advise the heads of other agencies and pro-
grams of the Department concerning matters of In-
dian health with respect to which those heads have 
authority and responsibility; 
‘‘(9) coordinate the activities of the Department 
concerning matters of Indian health; and
1906 
‘‘(10) perform such other functions as the Sec-
retary may designate. 
‘‘(d) AUTHORITY.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Assistant Secretary, shall have the au-
thority— 
‘‘(A) except to the extent provided for in 
paragraph (2), to appoint and compensate em-
ployees for the Service in accordance with title 
5, United States Code; 
‘‘(B) to enter into contracts for the pro-
curement of goods and services to carry out the 
functions of the Service; and 
‘‘(C) to manage, expend, and obligate all 
funds appropriated for the Service. 
‘‘(2) PERSONNEL
ACTIONS.—Notwithstanding 
any other provision of law, the provisions of section 
12 of the Act of June 18, 1934 (48 Stat. 986; 25 
U.S.C. 472), shall apply to all personnel actions 
taken with respect to new positions created within 
the Service as a result of its establishment under 
subsection (a). 
‘‘(e) REFERENCES.—Any reference to the Director of 
the Indian Health Service in any other Federal law, Exec-
utive order, rule, regulation, or delegation of authority, or
1907 
in any document of or relating to the Director of the In-
dian Health Service, shall be deemed to refer to the Assist-
ant Secretary. 
‘‘SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYS-
TEM. 
‘‘(a) ESTABLISHMENT.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish an automated management information system 
for the Service. 
‘‘(2) REQUIREMENTS OF SYSTEM.—The infor-
mation system established under paragraph (1) shall 
include— 
‘‘(A) a financial management system; 
‘‘(B) a patient care information system for 
each area served by the Service; 
‘‘(C) privacy protections consistent with 
the regulations promulgated under section 
264(c) of the Health Insurance Portability and 
Accountability Act of 1996 or, to the extent 
consistent with such regulations, other Federal 
rules applicable to privacy of automated man-
agement information systems of a Federal 
agency; 
‘‘(D) a services-based cost accounting com-
ponent that provides estimates of the costs as-
1909 
‘‘(d) AUTHORITY TO ENHANCE INFORMATION TECH-
NOLOGY.—The Secretary, acting through the Assistant 
Secretary, shall have the authority to enter into contracts, 
agreements, or joint ventures with other Federal agencies, 
States, private and nonprofit organizations, for the pur-
pose of enhancing information technology in Indian 
Health Programs and facilities. 
‘‘SEC. 603. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There is authorized to be appropriated such sums 
as may be necessary to carry out this title. 
‘‘TITLE VII—BEHAVIORAL 
HEALTH PROGRAMS 
‘‘SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREAT-
MENT SERVICES. 
‘‘(a) PURPOSES.—The purposes of this section are as 
follows: 
‘‘(1) To authorize and direct the Secretary, act-
ing through the Service, to develop a comprehensive 
behavioral health prevention and treatment program 
which emphasizes collaboration among alcohol and 
substance abuse, social services, and mental health 
programs. 
‘‘(2) To provide information, direction, and 
guidance relating to mental illness and dysfunction 
and self-destructive behavior, including child abuse
1910 
and family violence, to those Federal, tribal, State, 
and local agencies responsible for programs in In-
dian communities in areas of health care, education, 
social services, child and family welfare, alcohol and 
substance abuse, law enforcement, and judicial serv-
ices. 
‘‘(3) To assist Indian Tribes to identify services 
and resources available to address mental illness and 
dysfunctional and self-destructive behavior. 
‘‘(4) To provide authority and opportunities for 
Indian Tribes and Tribal Organizations to develop, 
implement, and coordinate with community-based 
programs which include identification, prevention, 
education, referral, and treatment services, including 
through multidisciplinary resource teams. 
‘‘(5) To ensure that Indians, as citizens of the 
United States and of the States in which they re-
side, have the same access to behavioral health serv-
ices to which all citizens have access. 
‘‘(6) To modify or supplement existing pro-
grams and authorities in the areas identified in 
paragraph (2). 
‘‘(b) PLANS.— 
‘‘(1) DEVELOPMENT.—The Secretary, acting 
through the Service, shall encourage Indian Tribes
1911 
and Tribal Organizations to develop tribal plans, 
and urban Indian organizations to develop local 
plans, and for all such groups to participate in de-
veloping areawide plans for Indian Behavioral 
Health Services. The plans shall include, to the ex-
tent feasible, the following components: 
‘‘(A) An assessment of the scope of alcohol 
or other substance abuse, mental illness, and 
dysfunctional and self-destructive behavior, in-
cluding suicide, child abuse, and family vio-
lence, among Indians, including— 
‘‘(i) the number of Indians served who 
are directly or indirectly affected by such 
illness or behavior; or 
‘‘(ii) an estimate of the financial and 
human cost attributable to such illness or 
behavior. 
‘‘(B) An assessment of the existing and 
additional resources necessary for the preven-
tion and treatment of such illness and behavior, 
including an assessment of the progress toward 
achieving the availability of the full continuum 
of care described in subsection (c). 
‘‘(C) An estimate of the additional funding 
needed by the Service, Indian Tribes, Tribal
1912 
Organizations, and urban Indian organizations 
to meet their responsibilities under the plans. 
‘‘(2) NATIONAL
CLEARINGHOUSE.—The Sec-
retary, acting through the Service, shall coordinate 
with existing national clearinghouses and informa-
tion centers to include at the clearinghouses and 
centers plans and reports on the outcomes of such 
plans developed by Indian Tribes, Tribal Organiza-
tions, urban Indian organizations, and Service Areas 
relating to behavioral health. The Secretary shall en-
sure access to these plans and outcomes by any In-
dian Tribe, Tribal Organization, urban Indian orga-
nization, or the Service. 
‘‘(3) TECHNICAL ASSISTANCE.—The Secretary 
shall provide technical assistance to Indian Tribes, 
Tribal Organizations, and urban Indian organiza-
tions in preparation of plans under this section and 
in developing standards of care that may be used 
and adopted locally. 
‘‘(c) PROGRAMS.—The Secretary, acting through the 
Service, shall provide, to the extent feasible and if funding 
is available, programs including the following: 
‘‘(1) COMPREHENSIVE CARE.—A comprehensive 
continuum of behavioral health care which pro-
vides—
1913 
‘‘(A) community-based prevention, inter-
vention, outpatient, and behavioral health 
aftercare; 
‘‘(B) detoxification (social and medical); 
‘‘(C) acute hospitalization; 
‘‘(D) intensive outpatient/day treatment; 
‘‘(E) residential treatment; 
‘‘(F) transitional living for those needing a 
temporary, stable living environment that is 
supportive of treatment and recovery goals; 
‘‘(G) emergency shelter; 
‘‘(H) intensive case management; and 
‘‘(I) diagnostic services. 
‘‘(2) CHILD CARE.—Behavioral health services 
for Indians from birth through age 17, including— 
‘‘(A) preschool and school age fetal alcohol 
disorder services, including assessment and be-
havioral intervention; 
‘‘(B) mental health and substance abuse 
services (emotional, organic, alcohol, drug, in-
halant, and tobacco); 
‘‘(C) identification and treatment of co-oc-
curring disorders and comorbidity; 
‘‘(D) prevention of alcohol, drug, inhalant, 
and tobacco use;
1914 
‘‘(E) early intervention, treatment, and 
aftercare; 
‘‘(F) promotion of healthy approaches to 
risk and safety issues; and 
‘‘(G) identification and treatment of ne-
glect and physical, mental, and sexual abuse. 
‘‘(3) ADULT CARE.—Behavioral health services 
for Indians from age 18 through 55, including— 
‘‘(A) early intervention, treatment, and 
aftercare; 
‘‘(B) mental health and substance abuse 
services (emotional, alcohol, drug, inhalant, and 
tobacco), including sex specific services; 
‘‘(C) identification and treatment of co-oc-
curring disorders (dual diagnosis) and comor-
bidity; 
‘‘(D) promotion of healthy approaches for 
risk-related behavior; 
‘‘(E) treatment services for women at risk 
of giving birth to a child with a fetal alcohol 
disorder; and 
‘‘(F) sex specific treatment for sexual as-
sault and domestic violence. 
‘‘(4) FAMILY CARE.—Behavioral health services 
for families, including—
1916 
‘‘(1) ESTABLISHMENT.—The governing body of 
any Indian Tribe, Tribal Organization, or urban In-
dian organization may adopt a resolution for the es-
tablishment of a community behavioral health plan 
providing for the identification and coordination of 
available resources and programs to identify, pre-
vent, or treat substance abuse, mental illness, or 
dysfunctional and self-destructive behavior, including 
child abuse and family violence, among its members 
or its service population. This plan should include 
behavioral health services, social services, intensive 
outpatient services, and continuing aftercare. 
‘‘(2) TECHNICAL ASSISTANCE.—At the request 
of an Indian Tribe, Tribal Organization, or urban 
Indian organization, the Bureau of Indian Affairs 
and the Service shall cooperate with and provide 
technical assistance to the Indian Tribe, Tribal Or-
ganization, or urban Indian organization in the de-
velopment and implementation of such plan. 
‘‘(3) FUNDING.—The Secretary, acting through 
the Service, may make funding available to Indian 
Tribes and Tribal Organizations which adopt a reso-
lution pursuant to paragraph (1) to obtain technical 
assistance for the development of a community be-
1917 
havioral health plan and to provide administrative 
support in the implementation of such plan. 
‘‘(e) COORDINATION FOR AVAILABILITY OF SERV-
ICES.—The Secretary, acting through the Service, shall 
coordinate behavioral health planning, to the extent fea-
sible, with other Federal agencies and with State agencies, 
to encourage comprehensive behavioral health services for 
Indians regardless of their place of residence. 
‘‘(f) MENTAL HEALTH CARE NEED ASSESSMENT.— 
Not later than 1 year after the date of enactment of the 
Indian Health Care Improvement Act Amendments of 
2009, the Secretary, acting through the Service, shall 
make an assessment of the need for inpatient mental 
health care among Indians and the availability and cost 
of inpatient mental health facilities which can meet such 
need. In making such assessment, the Secretary shall con-
sider the possible conversion of existing, underused Service 
hospital beds into psychiatric units to meet such need. 
‘‘SEC. 702. MEMORANDA OF AGREEMENT WITH THE DE-
PARTMENT OF THE INTERIOR. 
‘‘(a) CONTENTS.—Not later than 12 months after the 
date of enactment of the Indian Health Care Improvement 
Act Amendments of 2009, the Secretary, acting through 
the Service, and the Secretary of the Interior shall develop 
and enter into a memoranda of agreement, or review and
1918 
update any existing memoranda of agreement, as required 
by section 4205 of the Indian Alcohol and Substance 
Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 
2411) under which the Secretaries address the following: 
‘‘(1) The scope and nature of mental illness and 
dysfunctional and self-destructive behavior, including 
child abuse and family violence, among Indians. 
‘‘(2) The existing Federal, tribal, State, local, 
and private services, resources, and programs avail-
able to provide behavioral health services for Indi-
ans. 
‘‘(3) The unmet need for additional services, re-
sources, and programs necessary to meet the needs 
identified pursuant to paragraph (1). 
‘‘(4)(A) The right of Indians, as citizens of the 
United States and of the States in which they re-
side, to have access to behavioral health services to 
which all citizens have access. 
‘‘(B) The right of Indians to participate in, and 
receive the benefit of, such services. 
‘‘(C) The actions necessary to protect the exer-
cise of such right. 
‘‘(5) The responsibilities of the Bureau of In-
dian Affairs and the Service, including mental illness 
identification, prevention, education, referral, and
1919 
treatment services (including services through multi-
disciplinary resource teams), at the central, area, 
and agency and Service Unit, Service Area, and 
headquarters levels to address the problems identi-
fied in paragraph (1). 
‘‘(6) A strategy for the comprehensive coordina-
tion of the behavioral health services provided by the 
Bureau of Indian Affairs and the Service to meet 
the problems identified pursuant to paragraph (1), 
including— 
‘‘(A) the coordination of alcohol and sub-
stance abuse programs of the Service, the Bu-
reau of Indian Affairs, and Indian Tribes and 
Tribal Organizations (developed under the In-
dian Alcohol and Substance Abuse Prevention 
and Treatment Act of 1986 (25 U.S.C. 2401 et 
seq.)) with behavioral health initiatives pursu-
ant to this Act, particularly with respect to the 
referral and treatment of dually diagnosed indi-
viduals requiring behavioral health and sub-
stance abuse treatment; and 
‘‘(B) ensuring that the Bureau of Indian 
Affairs and Service programs and services (in-
cluding multidisciplinary resource teams) ad-
dressing child abuse and family violence are co-
1920 
ordinated with such non-Federal programs and 
services. 
‘‘(7) Directing appropriate officials of the Bu-
reau of Indian Affairs and the Service, particularly 
at the agency and Service Unit levels, to cooperate 
fully with tribal requests made pursuant to commu-
nity behavioral health plans adopted under section 
701(c) and section 4206 of the Indian Alcohol and 
Substance Abuse Prevention and Treatment Act of 
1986 (25 U.S.C. 2412). 
‘‘(8) Providing for an annual review of such 
agreement by the Secretaries which shall be provided 
to Congress and Indian Tribes and Tribal Organiza-
tions. 
‘‘(b) SPECIFIC PROVISIONS REQUIRED.—The memo-
randa of agreement updated or entered into pursuant to 
subsection (a) shall include specific provisions pursuant to 
which the Service shall assume responsibility for— 
‘‘(1) the determination of the scope of the prob-
lem of alcohol and substance abuse among Indians, 
including the number of Indians within the jurisdic-
tion of the Service who are directly or indirectly af-
fected by alcohol and substance abuse and the finan-
cial and human cost;
1921 
‘‘(2) an assessment of the existing and needed 
resources necessary for the prevention of alcohol and 
substance abuse and the treatment of Indians af-
fected by alcohol and substance abuse; and 
‘‘(3) an estimate of the funding necessary to 
adequately support a program of prevention of alco-
hol and substance abuse and treatment of Indians 
affected by alcohol and substance abuse. 
‘‘(c) PUBLICATION.—Each memorandum of agree-
ment entered into or renewed (and amendments or modi-
fications thereto) under subsection (a) shall be published 
in the Federal Register. At the same time as publication 
in the Federal Register, the Secretary shall provide a copy 
of such memoranda, amendment, or modification to each 
Indian Tribe, Tribal Organization, and urban Indian orga-
nization. 
‘‘SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PRE-
VENTION AND TREATMENT PROGRAM. 
‘‘(a) ESTABLISHMENT.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Service, shall provide a program of com-
prehensive behavioral health, prevention, treatment, 
and aftercare, including Systems of Care, which 
shall include—
1922 
‘‘(A) prevention, through educational inter-
vention, in Indian communities; 
‘‘(B) acute detoxification, psychiatric hos-
pitalization, residential, and intensive outpatient 
treatment; 
‘‘(C) community-based rehabilitation and 
aftercare; 
‘‘(D) community education and involve-
ment, including extensive training of health 
care, educational, and community-based per-
sonnel; 
‘‘(E) specialized residential treatment pro-
grams for high-risk populations, including preg-
nant and postpartum women and their children; 
and 
‘‘(F) diagnostic services. 
‘‘(2) TARGET POPULATIONS.—The target popu-
lation of such programs shall be members of Indian 
Tribes. Efforts to train and educate key members of 
the Indian community shall also target employees of 
health, education, judicial, law enforcement, legal, 
and social service programs. 
‘‘(b) CONTRACT HEALTH SERVICES.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Service, may enter into contracts with
1923 
public or private providers of behavioral health treat-
ment services for the purpose of carrying out the 
program required under subsection (a). 
‘‘(2) PROVISION OF ASSISTANCE.—In carrying 
out this subsection, the Secretary shall provide as-
sistance to Indian Tribes and Tribal Organizations 
to develop criteria for the certification of behavioral 
health service providers and accreditation of service 
facilities which meet minimum standards for such 
services and facilities. 
‘‘SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM. 
‘‘(a) IN GENERAL.—Under the authority of the Act 
of November 2, 1921 (25 U.S.C. 13) (commonly known 
as the ‘Snyder Act’), the Secretary shall establish and 
maintain a mental health technician program within the 
Service which— 
‘‘(1) provides for the training of Indians as 
mental health technicians; and 
‘‘(2) employs such technicians in the provision 
of community-based mental health care that includes 
identification, prevention, education, referral, and 
treatment services. 
‘‘(b) PARAPROFESSIONAL TRAINING.—In carrying 
out subsection (a), the Secretary, acting through the Serv-
ice, shall provide high-standard paraprofessional training
1924 
in mental health care necessary to provide quality care to 
the Indian communities to be served. Such training shall 
be based upon a curriculum developed or approved by the 
Secretary which combines education in the theory of men-
tal health care with supervised practical experience in the 
provision of such care. 
‘‘(c) SUPERVISION AND EVALUATION OF TECHNI-
CIANS.—The Secretary, acting through the Service, shall 
supervise and evaluate the mental health technicians in 
the training program. 
‘‘(d) TRADITIONAL HEALTH CARE PRACTICES.—The 
Secretary, acting through the Service, shall ensure that 
the program established pursuant to this subsection in-
volves the use and promotion of the traditional health care 
practices of the Indian Tribes to be served. 
‘‘SEC. 
705. 
LICENSING 
REQUIREMENT 
FOR 
MENTAL 
HEALTH CARE WORKERS. 
‘‘(a) IN GENERAL.—Subject to the provisions of sec-
tion 221, and except as provided in subsection (b), any 
individual employed as a psychologist, social worker, or 
marriage and family therapist for the purpose of providing 
mental health care services to Indians in a clinical setting 
under this Act is required to be licensed as a psychologist, 
social worker, or marriage and family therapist, respec-
tively.
1925 
‘‘(b) TRAINEES.—An individual may be employed as 
a trainee in psychology, social work, or marriage and fam-
ily therapy to provide mental health care services de-
scribed in subsection (a) if such individual— 
‘‘(1) works under the direct supervision of a li-
censed psychologist, social worker, or marriage and 
family therapist, respectively; 
‘‘(2) is enrolled in or has completed at least 2 
years of course work at a post-secondary, accredited 
education program for psychology, social work, mar-
riage and family therapy, or counseling; and 
‘‘(3) meets such other training, supervision, and 
quality review requirements as the Secretary may es-
tablish. 
‘‘SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS. 
‘‘(a) GRANTS.—The Secretary, consistent with sec-
tion 701, may make grants to Indian Tribes, Tribal Orga-
nizations, and urban Indian organizations to develop and 
implement a comprehensive behavioral health program of 
prevention, intervention, treatment, and relapse preven-
tion services that specifically addresses the cultural, his-
torical, social, and child care needs of Indian women, re-
gardless of age. 
‘‘(b) USE OF GRANT FUNDS.—A grant made pursu-
ant to this section may be used to—
1926 
‘‘(1) develop and provide community training, 
education, and prevention programs for Indian 
women relating to behavioral health issues, including 
fetal alcohol disorders; 
‘‘(2) identify and provide psychological services, 
counseling, advocacy, support, and relapse preven-
tion to Indian women and their families; and 
‘‘(3) develop prevention and intervention models 
for Indian women which incorporate traditional 
health care practices, cultural values, and commu-
nity and family involvement. 
‘‘(c) CRITERIA.—The Secretary, in consultation with 
Indian Tribes and Tribal Organizations, shall establish 
criteria for the review and approval of applications and 
proposals for funding under this section. 
‘‘(d) ALLOCATION OF FUNDS FOR URBAN INDIAN 
ORGANIZATIONS.—Twenty percent of the funds appro-
priated pursuant to this section shall be used to make 
grants to urban Indian organizations. 
‘‘SEC. 707. INDIAN YOUTH PROGRAM. 
‘‘(a) DETOXIFICATION AND REHABILITATION.—The 
Secretary, acting through the Service, consistent with sec-
tion 701, shall develop and implement a program for acute 
detoxification and treatment for Indian youths, including 
behavioral health services. The program shall include re-
1927 
gional treatment centers designed to include detoxification 
and rehabilitation for both sexes on a referral basis and 
programs developed and implemented by Indian Tribes or 
Tribal Organizations at the local level under the Indian 
Self-Determination and Education Assistance Act (25 
U.S.C. 450 et seq.). Regional centers shall be integrated 
with the intake and rehabilitation programs based in the 
referring Indian community. 
‘‘(b) ALCOHOL AND SUBSTANCE ABUSE TREATMENT 
CENTERS OR FACILITIES.— 
‘‘(1) ESTABLISHMENT.— 
‘‘(A) IN GENERAL.—The Secretary, acting 
through the Service, shall construct, renovate, 
or, as necessary, purchase, and appropriately 
staff and operate, at least 1 youth regional 
treatment center or treatment network in each 
area under the jurisdiction of an Area Office. 
‘‘(B) AREA OFFICE IN CALIFORNIA.—For 
the purposes of this subsection, the Area Office 
in California shall be considered to be 2 Area 
Offices, 1 office whose jurisdiction shall be con-
sidered to encompass the northern area of the 
State of California, and 1 office whose jurisdic-
tion shall be considered to encompass the re-
mainder of the State of California for the pur-
1928 
pose of implementing California treatment net-
works. 
‘‘(2) FUNDING.—For the purpose of staffing 
and operating such centers or facilities, funding 
shall be pursuant to the Act of November 2, 1921 
(25 U.S.C. 13). 
‘‘(3) LOCATION.—A youth treatment center 
constructed or purchased under this subsection shall 
be constructed or purchased at a location within the 
area described in paragraph (1) agreed upon (by ap-
propriate tribal resolution) by a majority of the In-
dian Tribes to be served by such center. 
‘‘(4) SPECIFIC PROVISION OF FUNDS.— 
‘‘(A) IN GENERAL.—Notwithstanding any 
other provision of this title, the Secretary may, 
from amounts authorized to be appropriated for 
the purposes of carrying out this section, make 
funds available to— 
‘‘(i) the Tanana Chiefs Conference, 
Incorporated, for the purpose of leasing, 
constructing, renovating, operating, and 
maintaining a residential youth treatment 
facility in Fairbanks, Alaska; and 
‘‘(ii) the Southeast Alaska Regional 
Health Corporation to staff and operate a
1929 
residential youth treatment facility without 
regard to the proviso set forth in section 
4(l) of the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 
450b(l)). 
‘‘(B) PROVISION OF SERVICES TO ELIGI-
BLE
YOUTHS.—Until 
additional 
residential 
youth treatment facilities are established in 
Alaska pursuant to this section, the facilities 
specified in subparagraph (A) shall make every 
effort to provide services to all eligible Indian 
youths residing in Alaska. 
‘‘(c) INTERMEDIATE
ADOLESCENT
BEHAVIORAL 
HEALTH SERVICES.— 
‘‘(1) IN
GENERAL.—The Secretary, acting 
through the Service, may provide intermediate be-
havioral health services, which may incorporate Sys-
tems of Care, to Indian children and adolescents, in-
cluding— 
‘‘(A) pretreatment assistance; 
‘‘(B) inpatient, outpatient, and aftercare 
services; 
‘‘(C) emergency care; 
‘‘(D) suicide prevention and crisis interven-
tion; and
1930 
‘‘(E) prevention and treatment of mental 
illness and dysfunctional and self-destructive 
behavior, including child abuse and family vio-
lence. 
‘‘(2) USE OF FUNDS.—Funds provided under 
this subsection may be used— 
‘‘(A) to construct or renovate an existing 
health facility to provide intermediate behav-
ioral health services; 
‘‘(B) to hire behavioral health profes-
sionals; 
‘‘(C) to staff, operate, and maintain an in-
termediate mental health facility, group home, 
sober housing, transitional housing or similar 
facilities, or youth shelter where intermediate 
behavioral health services are being provided; 
‘‘(D) to make renovations and hire appro-
priate staff to convert existing hospital beds 
into adolescent psychiatric units; and 
‘‘(E) for intensive home- and community- 
based services. 
‘‘(3) CRITERIA.—The Secretary, acting through 
the Service, shall, in consultation with Indian Tribes 
and Tribal Organizations, establish criteria for the
1931 
review and approval of applications or proposals for 
funding made available pursuant to this subsection. 
‘‘(d) FEDERALLY OWNED STRUCTURES.— 
‘‘(1) IN GENERAL.—The Secretary, in consulta-
tion with Indian Tribes and Tribal Organizations, 
shall— 
‘‘(A) identify and use, where appropriate, 
federally owned structures suitable for local res-
idential or regional behavioral health treatment 
for Indian youths; and 
‘‘(B) establish guidelines for determining 
the suitability of any such federally owned 
structure to be used for local residential or re-
gional behavioral health treatment for Indian 
youths. 
‘‘(2) TERMS
AND
CONDITIONS
FOR
USE
OF 
STRUCTURE.—Any structure described in paragraph 
(1) may be used under such terms and conditions as 
may be agreed upon by the Secretary and the agency 
having responsibility for the structure and any In-
dian Tribe or Tribal Organization operating the pro-
gram. 
‘‘(e) REHABILITATION AND AFTERCARE SERVICES.— 
‘‘(1) IN
GENERAL.—The Secretary, Indian 
Tribes, or Tribal Organizations, in cooperation with
1932 
the Secretary of the Interior, shall develop and im-
plement within each Service Unit, community-based 
rehabilitation and follow-up services for Indian 
youths who are having significant behavioral health 
problems, and require long-term treatment, commu-
nity reintegration, and monitoring to support the In-
dian youths after their return to their home commu-
nity. 
‘‘(2) ADMINISTRATION.—Services under para-
graph (1) shall be provided by trained staff within 
the community who can assist the Indian youths in 
their continuing development of self-image, positive 
problem-solving skills, and nonalcohol or substance 
abusing behaviors. Such staff may include alcohol 
and substance abuse counselors, mental health pro-
fessionals, and other health professionals and para-
professionals, including community health represent-
atives. 
‘‘(f) INCLUSION OF FAMILY IN YOUTH TREATMENT 
PROGRAM.—In providing the treatment and other services 
to Indian youths authorized by this section, the Secretary, 
acting through the Service, shall provide for the inclusion 
of family members of such youths in the treatment pro-
grams or other services as may be appropriate. Not less 
than 10 percent of the funds appropriated for the pur-
1933 
poses of carrying out subsection (e) shall be used for out-
patient care of adult family members related to the treat-
ment of an Indian youth under that subsection. 
‘‘(g) MULTIDRUG ABUSE PROGRAM.—The Secretary, 
acting through the Service, shall provide, consistent with 
section 701, programs and services to prevent and treat 
the abuse of multiple forms of substances, including alco-
hol, drugs, inhalants, and tobacco, among Indian youths 
residing in Indian communities, on or near reservations, 
and in urban areas and provide appropriate mental health 
services to address the incidence of mental illness among 
such youths. 
‘‘(h) INDIAN YOUTH MENTAL HEALTH.—The Sec-
retary, acting through the Service, shall collect data for 
the report under section 801 with respect to— 
‘‘(1) the number of Indian youth who are being 
provided mental health services through the Service 
and Tribal Health Programs; 
‘‘(2) a description of, and costs associated with, 
the mental health services provided for Indian youth 
through the Service and Tribal Health Programs; 
‘‘(3) the number of youth referred to the Serv-
ice or Tribal Health Programs for mental health 
services;
1934 
‘‘(4) the number of Indian youth provided resi-
dential treatment for mental health and behavioral 
problems through the Service and Tribal Health 
Programs, reported separately for on- and off-res-
ervation facilities; and 
‘‘(5) the costs of the services described in para-
graph (4). 
‘‘SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEM-
ONSTRATION PROJECT. 
‘‘(a) PURPOSE.—The purpose of this section is to au-
thorize the Secretary to carry out a demonstration project 
to test the use of telemental health services in suicide pre-
vention, intervention and treatment of Indian youth, in-
cluding through— 
‘‘(1) the use of psychotherapy, psychiatric as-
sessments, diagnostic interviews, therapies for men-
tal health conditions predisposing to suicide, and al-
cohol and substance abuse treatment; 
‘‘(2) the provision of clinical expertise to, con-
sultation services with, and medical advice and train-
ing for frontline health care providers working with 
Indian youth; 
‘‘(3) training and related support for commu-
nity leaders, family members and health and edu-
cation workers who work with Indian youth;
1935 
‘‘(4) the development of culturally relevant edu-
cational materials on suicide; and 
‘‘(5) data collection and reporting. 
‘‘(b) DEFINITIONS.—For the purpose of this section, 
the following definitions shall apply: 
‘‘(1) DEMONSTRATION
PROJECT.—The term 
‘demonstration project’ means the Indian youth tele-
mental health demonstration project authorized 
under subsection (c). 
‘‘(2) TELEMENTAL HEALTH.—The term ‘tele-
mental health’ means the use of electronic informa-
tion and telecommunications technologies to support 
long distance mental health care, patient and profes-
sional-related education, public health, and health 
administration. 
‘‘(c) AUTHORIZATION.— 
‘‘(1) IN GENERAL.—The Secretary is authorized 
to award grants under the demonstration project for 
the provision of telemental health services to Indian 
youth who— 
‘‘(A) have expressed suicidal ideas; 
‘‘(B) have attempted suicide; or 
‘‘(C) have mental health conditions that in-
crease or could increase the risk of suicide.
1936 
‘‘(2) ELIGIBILITY FOR GRANTS.—Such grants 
shall be awarded to Indian Tribes and Tribal Orga-
nizations that operate 1 or more facilities— 
‘‘(A) located in Alaska and part of the 
Alaska Federal Health Care Access Network; 
‘‘(B) reporting active clinical telehealth ca-
pabilities; or 
‘‘(C) 
offering 
school-based 
telemental 
health services relating to psychiatry to Indian 
youth. 
‘‘(3) GRANT
PERIOD.—The Secretary shall 
award grants under this section for a period of up 
to 4 years. 
‘‘(4) AWARDING OF GRANTS.—Not more than 5 
grants shall be provided under paragraph (1), with 
priority consideration given to Indian Tribes and 
Tribal Organizations that— 
‘‘(A) serve a particular community or geo-
graphic area where there is a demonstrated 
need to address Indian youth suicide; 
‘‘(B) enter in to collaborative partnerships 
with Indian Health Service or Tribal Health 
Programs or facilities to provide services under 
this demonstration project;
1937 
‘‘(C) serve an isolated community or geo-
graphic area which has limited or no access to 
behavioral health services; or 
‘‘(D) operate a detention facility at which 
Indian youth are detained. 
‘‘(d) USE OF FUNDS.— 
‘‘(1) IN GENERAL.—An Indian Tribe or Tribal 
Organization shall use a grant received under sub-
section (c) for the following purposes: 
‘‘(A) To provide telemental health services 
to Indian youth, including the provision of— 
‘‘(i) psychotherapy; 
‘‘(ii) psychiatric assessments and di-
agnostic interviews, therapies for mental 
health conditions predisposing to suicide, 
and treatment; and 
‘‘(iii) alcohol and substance abuse 
treatment. 
‘‘(B) To provide clinician-interactive med-
ical advice, guidance and training, assistance in 
diagnosis and interpretation, crisis counseling 
and intervention, and related assistance to 
Service, tribal, or urban clinicians and health 
services providers working with youth being 
served under this demonstration project.
1938 
‘‘(C) To assist, educate and train commu-
nity leaders, health education professionals and 
paraprofessionals, tribal outreach workers, and 
family members who work with the youth re-
ceiving telemental health services under this 
demonstration project, including with identifica-
tion of suicidal tendencies, crisis intervention 
and suicide prevention, emergency skill develop-
ment, and building and expanding networks 
among these individuals and with State and 
local health services providers. 
‘‘(D) To develop and distribute culturally 
appropriate community educational materials 
on— 
‘‘(i) suicide prevention; 
‘‘(ii) suicide education; 
‘‘(iii) suicide screening; 
‘‘(iv) suicide intervention; and 
‘‘(v) ways to mobilize communities 
with respect to the identification of risk 
factors for suicide. 
‘‘(E) For data collection and reporting re-
lated to Indian youth suicide prevention efforts. 
‘‘(2) 
TRADITIONAL
HEALTH
CARE
PRAC-
TICES.—In carrying out the purposes described in
1939 
paragraph (1), an Indian Tribe or Tribal Organiza-
tion may use and promote the traditional health care 
practices of the Indian Tribes of the youth to be 
served. 
‘‘(e) APPLICATIONS.—To be eligible to receive a grant 
under subsection (c), an Indian Tribe or Tribal Organiza-
tion shall prepare and submit to the Secretary an applica-
tion, at such time, in such manner, and containing such 
information as the Secretary may require, including— 
‘‘(1) a description of the project that the Indian 
Tribe or Tribal Organization will carry out using the 
funds provided under the grant; 
‘‘(2) a description of the manner in which the 
project funded under the grant would— 
‘‘(A) meet the telemental health care needs 
of the Indian youth population to be served by 
the project; or 
‘‘(B) improve the access of the Indian 
youth population to be served to suicide preven-
tion and treatment services; 
‘‘(3) evidence of support for the project from 
the local community to be served by the project; 
‘‘(4) a description of how the families and lead-
ership of the communities or populations to be
1940 
served by the project would be involved in the devel-
opment and ongoing operations of the project; 
‘‘(5) a plan to involve the tribal community of 
the youth who are provided services by the project 
in planning and evaluating the mental health care 
and suicide prevention efforts provided, in order to 
ensure the integration of community, clinical, envi-
ronmental, and cultural components of the treat-
ment; and 
‘‘(6) a plan for sustaining the project after Fed-
eral assistance for the demonstration project has ter-
minated. 
‘‘(f) COLLABORATION; REPORTING
TO NATIONAL 
CLEARINGHOUSE.— 
‘‘(1) COLLABORATION.—The Secretary, acting 
through the Service, shall encourage Indian Tribes 
and Tribal Organizations receiving grants under this 
section to collaborate to enable comparisons about 
best practices across projects. 
‘‘(2) REPORTING
TO
NATIONAL
CLEARING-
HOUSE.—The Secretary, acting through the Service, 
shall also encourage Indian Tribes and Tribal Orga-
nizations receiving grants under this section to sub-
mit relevant, declassified project information to the 
national clearinghouse authorized under section
1941 
701(b)(2) in order to better facilitate program per-
formance and improve suicide prevention, interven-
tion, and treatment services. 
‘‘(g) ANNUAL REPORT.—Each grant recipient shall 
submit to the Secretary an annual report that— 
‘‘(1) describes the number of telemental health 
services provided; and 
‘‘(2) includes any other information that the 
Secretary may require. 
‘‘(h) REPORT TO CONGRESS.—Not later than 270 
days after the termination of the demonstration project, 
the Secretary shall submit to the Committee on Indian Af-
fairs of the Senate and the Committee on Natural Re-
sources and Committee on Energy and Commerce of the 
House of Representatives a final report, based on the an-
nual reports provided by grant recipients under subsection 
(h), that— 
‘‘(1) describes the results of the projects funded 
by grants awarded under this section, including any 
data available which indicates the number of at-
tempted suicides; 
‘‘(2) evaluates the impact of the telemental 
health services funded by the grants in reducing the 
number of completed suicides among Indian youth;
1942 
‘‘(3) evaluates whether the demonstration 
project should be— 
‘‘(A) expanded to provide more than 5 
grants; and 
‘‘(B) designated a permanent program; 
and 
‘‘(4) evaluates the benefits of expanding the 
demonstration project to include urban Indian orga-
nizations. 
‘‘(i) AUTHORIZATION OF APPROPRIATIONS.—There is 
authorized to be appropriated such sums as may be nec-
essary to carry out this section. 
‘‘SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL 
HEALTH 
FACILITIES 
DESIGN, 
CONSTRUC-
TION, AND STAFFING. 
‘‘Not later than 1 year after the date of enactment 
of the Indian Health Care Improvement Act Amendments 
of 2009, the Secretary, acting through the Service, may 
provide, in each area of the Service, not less than 1 inpa-
tient mental health care facility, or the equivalent, for In-
dians with behavioral health problems. For the purposes 
of this subsection, California shall be considered to be 2 
Area Offices, 1 office whose location shall be considered 
to encompass the northern area of the State of California 
and 1 office whose jurisdiction shall be considered to en-
1943 
compass the remainder of the State of California. The Sec-
retary shall consider the possible conversion of existing, 
underused Service hospital beds into psychiatric units to 
meet such need. 
‘‘SEC. 710. TRAINING AND COMMUNITY EDUCATION. 
‘‘(a) PROGRAM.—The Secretary, in cooperation with 
the Secretary of the Interior, shall develop and implement 
or assist Indian Tribes and Tribal Organizations to de-
velop and implement, within each Service Unit or tribal 
program, a program of community education and involve-
ment which shall be designed to provide concise and timely 
information to the community leadership of each tribal 
community. Such program shall include education about 
behavioral health issues to political leaders, Tribal judges, 
law enforcement personnel, members of tribal health and 
education boards, health care providers including tradi-
tional practitioners, and other critical members of each 
tribal community. Such program may also include commu-
nity-based training to develop local capacity and tribal 
community provider training for prevention, intervention, 
treatment, and aftercare. 
‘‘(b) INSTRUCTION.—The Secretary, acting through 
the Service, shall provide instruction in the area of behav-
ioral health issues, including instruction in crisis interven-
tion and family relations in the context of alcohol and sub-
1944 
stance abuse, child sexual abuse, youth alcohol and sub-
stance abuse, and the causes and effects of fetal alcohol 
disorders to appropriate employees of the Bureau of In-
dian Affairs and the Service, and to personnel in schools 
or programs operated under any contract with the Bureau 
of Indian Affairs or the Service, including supervisors of 
emergency shelters and halfway houses described in sec-
tion 4213 of the Indian Alcohol and Substance Abuse Pre-
vention and Treatment Act of 1986 (25 U.S.C. 2433). 
‘‘(c) TRAINING MODELS.—In carrying out the edu-
cation and training programs required by this section, the 
Secretary, in consultation with Indian Tribes, Tribal Or-
ganizations, Indian behavioral health experts, and Indian 
alcohol and substance abuse prevention experts, shall de-
velop and provide community-based training models. Such 
models shall address— 
‘‘(1) the elevated risk of alcohol and behavioral 
health problems faced by children of alcoholics; 
‘‘(2) 
the 
cultural, 
spiritual, 
and 
multigenerational aspects of behavioral health prob-
lem prevention and recovery; and 
‘‘(3) community-based and multidisciplinary 
strategies, including Systems of Care, for preventing 
and treating behavioral health problems.
1945 
‘‘SEC. 711. BEHAVIORAL HEALTH PROGRAM. 
‘‘(a) INNOVATIVE PROGRAMS.—The Secretary, acting 
through the Service, consistent with section 701, may 
plan, develop, implement, and carry out programs to de-
liver innovative community-based behavioral health serv-
ices to Indians. 
‘‘(b) AWARDS; CRITERIA.—The Secretary may award 
a grant for a project under subsection (a) to an Indian 
Tribe or Tribal Organization and may consider the fol-
lowing criteria: 
‘‘(1) The project will address significant unmet 
behavioral health needs among Indians. 
‘‘(2) The project will serve a significant number 
of Indians. 
‘‘(3) The project has the potential to deliver 
services in an efficient and effective manner. 
‘‘(4) The Indian Tribe or Tribal Organization 
has the administrative and financial capability to ad-
minister the project. 
‘‘(5) The project may deliver services in a man-
ner consistent with traditional health care practices. 
‘‘(6) The project is coordinated with, and avoids 
duplication of, existing services. 
‘‘(c) EQUITABLE TREATMENT.—For purposes of this 
subsection, the Secretary shall, in evaluating project appli-
cations or proposals, use the same criteria that the Sec-
1946 
retary uses in evaluating any other application or proposal 
for such funding. 
‘‘SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS. 
‘‘(a) PROGRAMS.— 
‘‘(1) ESTABLISHMENT.—The Secretary, con-
sistent with section 701 and acting through the 
Service, is authorized to establish and operate fetal 
alcohol disorder programs as provided in this section 
for the purposes of meeting the health status objec-
tives specified in section 3. 
‘‘(2) USE OF FUNDS.— 
‘‘(A) IN
GENERAL.—Funding provided 
pursuant to this section shall be used for the 
following: 
‘‘(i) To develop and provide for Indi-
ans community and in-school training, edu-
cation, and prevention programs relating 
to fetal alcohol disorders. 
‘‘(ii) To identify and provide behav-
ioral health treatment to high-risk Indian 
women and high-risk women pregnant with 
an Indian’s child. 
‘‘(iii) To identify and provide appro-
priate psychological services, educational 
and vocational support, counseling, advo-
1947 
cacy, and information to fetal alcohol dis-
order affected Indians and their families or 
caretakers. 
‘‘(iv) To develop and implement coun-
seling and support programs in schools for 
fetal alcohol disorder affected Indian chil-
dren. 
‘‘(v) To develop prevention and inter-
vention models which incorporate practi-
tioners of traditional health care practices, 
cultural values, and community involve-
ment. 
‘‘(vi) To develop, print, and dissemi-
nate education and prevention materials on 
fetal alcohol disorder. 
‘‘(vii) To develop and implement, in 
consultation with Indian Tribes, Tribal Or-
ganizations, and urban Indian organiza-
tions, culturally sensitive assessment and 
diagnostic tools including dysmorphology 
clinics and multidisciplinary fetal alcohol 
disorder clinics for use in Indian commu-
nities and Urban Centers. 
‘‘(B) ADDITIONAL USES.—In addition to 
any purpose under subparagraph (A), funding
1948 
provided pursuant to this section may be used 
for 1 or more of the following: 
‘‘(i) 
Early 
childhood 
intervention 
projects from birth on to mitigate the ef-
fects of fetal alcohol disorder among Indi-
ans. 
‘‘(ii) Community-based support serv-
ices for Indians and women pregnant with 
Indian children. 
‘‘(iii) Community-based housing for 
adult Indians with fetal alcohol disorder. 
‘‘(3) CRITERIA FOR APPLICATIONS.—The Sec-
retary shall establish criteria for the review and ap-
proval of applications for funding under this section. 
‘‘(b) SERVICES.—The Secretary, acting through the 
Service, shall— 
‘‘(1) develop and provide services for the pre-
vention, intervention, treatment, and aftercare for 
those affected by fetal alcohol disorder in Indian 
communities; and 
‘‘(2) provide supportive services, including serv-
ices to meet the special educational, vocational, 
school-to-work transition, and independent living 
needs of adolescent and adult Indians with fetal al-
cohol disorder.
1949 
‘‘(c) TASK FORCE.—The Secretary shall establish a 
task force to be known as the Fetal Alcohol Disorder Task 
Force to advise the Secretary in carrying out subsection 
(b). Such task force shall be composed of representatives 
from the following: 
‘‘(1) The National Institute on Drug Abuse. 
‘‘(2) The National Institute on Alcohol and Al-
coholism. 
‘‘(3) The Office of Substance Abuse Prevention. 
‘‘(4) The National Institute of Mental Health. 
‘‘(5) The Service. 
‘‘(6) The Office of Minority Health of the De-
partment of Health and Human Services. 
‘‘(7) The Administration for Native Americans. 
‘‘(8) The National Institute of Child Health 
and Human Development (NICHD). 
‘‘(9) The Centers for Disease Control and Pre-
vention. 
‘‘(10) The Bureau of Indian Affairs. 
‘‘(11) Indian Tribes. 
‘‘(12) Tribal Organizations. 
‘‘(13) Urban Indian organizations. 
‘‘(14) Indian fetal alcohol spectrum disorders 
experts.
1950 
‘‘(d) APPLIED
RESEARCH
PROJECTS.—The Sec-
retary, acting through the Substance Abuse and Mental 
Health Services Administration, shall make grants to In-
dian Tribes, Tribal Organizations, and urban Indian orga-
nizations for applied research projects which propose to 
elevate the understanding of methods to prevent, inter-
vene, treat, or provide rehabilitation and behavioral health 
aftercare for Indians and urban Indians affected by fetal 
alcohol spectrum disorders. 
‘‘(e) FUNDING
FOR
URBAN
INDIAN
ORGANIZA-
TIONS.—Ten percent of the funds appropriated pursuant 
to this section shall be used to make grants to urban In-
dian organizations funded under title V. 
‘‘SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREAT-
MENT PROGRAMS. 
‘‘(a) 
ESTABLISHMENT.—The 
Secretary, 
acting 
through the Service, shall establish, consistent with section 
701, in every Service Area, programs involving treatment 
for— 
‘‘(1) victims of sexual abuse who are Indian 
children or children in an Indian household; and 
‘‘(2) perpetrators of child sexual abuse who are 
Indian or members of an Indian household. 
‘‘(b) USE OF FUNDS.—Funding provided pursuant to 
this section shall be used for the following:
1951 
‘‘(1) To develop and provide community edu-
cation and prevention programs related to sexual 
abuse of Indian children or children in an Indian 
household. 
‘‘(2) To identify and provide behavioral health 
treatment to victims of sexual abuse who are Indian 
children or children in an Indian household, and to 
their family members who are affected by sexual 
abuse. 
‘‘(3) To develop prevention and intervention 
models which incorporate traditional health care 
practices, cultural values, and community involve-
ment. 
‘‘(4) To develop and implement culturally sen-
sitive assessment and diagnostic tools for use in In-
dian communities and Urban Centers. 
‘‘(5) To identify and provide behavioral health 
treatment to Indian perpetrators and perpetrators 
who are members of an Indian household— 
‘‘(A) making efforts to begin offender and 
behavioral health treatment while the perpe-
trator is incarcerated or at the earliest possible 
date if the perpetrator is not incarcerated; and
1952 
‘‘(B) providing treatment after the perpe-
trator is released, until it is determined that the 
perpetrator is not a threat to children. 
‘‘(c) COORDINATION.—The programs established 
under subsection (a) shall be carried out in coordination 
with programs and services authorized under the Indian 
Child Protection and Family Violence Prevention Act (25 
U.S.C. 3201 et seq.). 
‘‘SEC. 714. DOMESTIC AND SEXUAL VIOLENCE PREVENTION 
AND TREATMENT. 
‘‘(a) IN GENERAL.—The Secretary, in accordance 
with section 701, is authorized to establish in each Service 
Area programs involving the prevention and treatment 
of— 
‘‘(1) Indian victims of domestic violence or sex-
ual abuse; and 
‘‘(2) perpetrators of domestic violence or sexual 
abuse who are Indian or members of an Indian 
household. 
‘‘(b) USE OF FUNDS.—Funds made available to carry 
out this section shall be used— 
‘‘(1) to develop and implement prevention pro-
grams and community education programs relating 
to domestic violence and sexual abuse;
1953 
‘‘(2) to provide behavioral health services, in-
cluding victim support services, and medical treat-
ment (including examinations performed by sexual 
assault nurse examiners) to Indian victims of domes-
tic violence or sexual abuse; 
‘‘(3) to purchase rape kits; 
‘‘(4) to develop prevention and intervention 
models, which may incorporate traditional health 
care practices; and 
‘‘(5) to identify and provide behavioral health 
treatment to perpetrators who are Indian or mem-
bers of an Indian household. 
‘‘(c) TRAINING AND CERTIFICATION.— 
‘‘(1) IN GENERAL.—Not later than 1 year after 
the date of enactment of the Indian Health Care Im-
provement Act Amendments of 2009, the Secretary 
shall establish appropriate protocols, policies, proce-
dures, standards of practice, and, if not available 
elsewhere, training curricula and training and cer-
tification requirements for services for victims of do-
mestic violence and sexual abuse. 
‘‘(2) REPORT.—Not later than 18 months after 
the date of enactment of the Indian Health Care Im-
provement Act Amendments of 2008, the Secretary 
shall submit to the Committee on Indian Affairs of
1954 
the Senate and the Committee on Natural Resources 
of the House of Representatives a report that de-
scribes the means and extent to which the Secretary 
has carried out paragraph (1). 
‘‘(d) COORDINATION.— 
‘‘(1) IN GENERAL.—The Secretary, in coordina-
tion with the Attorney General, Federal and tribal 
law enforcement agencies, Indian Health Programs, 
and domestic violence or sexual assault victim orga-
nizations, shall develop appropriate victim services 
and victim advocate training programs— 
‘‘(A) to improve domestic violence or sex-
ual abuse responses; 
‘‘(B) to improve forensic examinations and 
collection; 
‘‘(C) to identify problems or obstacles in 
the prosecution of domestic violence or sexual 
abuse; and 
‘‘(D) to meet other needs or carry out 
other activities required to prevent, treat, and 
improve prosecutions of domestic violence and 
sexual abuse. 
‘‘(2) REPORT.—Not later than 2 years after the 
date of enactment of the Indian Health Care Im-
provement Act Amendments of 2008, the Secretary
1955 
shall submit to the Committee on Indian Affairs of 
the Senate and the Committee on Natural Resources 
of the House of Representatives a report that de-
scribes, with respect to the matters described in 
paragraph (1), the improvements made and needed, 
problems or obstacles identified, and costs necessary 
to address the problems or obstacles, and any other 
recommendations that the Secretary determines to 
be appropriate. 
‘‘SEC. 715. BEHAVIORAL HEALTH RESEARCH. 
‘‘The Secretary, in consultation with appropriate 
Federal agencies, shall make grants to, or enter into con-
tracts with, Indian Tribes, Tribal Organizations, and 
urban Indian organizations or enter into contracts with, 
or make grants to appropriate institutions for, the conduct 
of research on the incidence and prevalence of behavioral 
health problems among Indians served by the Service, In-
dian Tribes, or Tribal Organizations and among Indians 
in urban areas. Research priorities under this section shall 
include— 
‘‘(1) the multifactorial causes of Indian youth 
suicide, including— 
‘‘(A) protective and risk factors and sci-
entific data that identifies those factors; and
1956 
‘‘(B) the effects of loss of cultural identity 
and the development of scientific data on those 
effects; 
‘‘(2) the interrelationship and interdependence 
of behavioral health problems with alcoholism and 
other substance abuse, suicide, homicides, other in-
juries, and the incidence of family violence; and 
‘‘(3) the development of models of prevention 
techniques. 
The effect of the interrelationships and interdependencies 
referred to in paragraph (2) on children, and the develop-
ment of prevention techniques under paragraph (3) appli-
cable to children, shall be emphasized. 
‘‘SEC. 716. DEFINITIONS. 
‘‘For the purpose of this title, the following defini-
tions shall apply: 
‘‘(1) ASSESSMENT.—The term ‘assessment’ 
means the systematic collection, analysis, and dis-
semination of information on health status, health 
needs, and health problems. 
‘‘(2) 
ALCOHOL-RELATED 
NEURODEVELOPMENTAL DISORDERS OR ARND.—The 
term ‘alcohol-related neurodevelopmental disorders’ 
or ‘ARND’ means, with a history of maternal alco-
hol consumption during pregnancy, central nervous
1957 
system involvement such as developmental delay, in-
tellectual deficit, or neurologic abnormalities. Behav-
iorally, there can be problems with irritability, and 
failure to thrive as infants. As children become older 
there will likely be hyperactivity, attention deficit, 
language dysfunction, and perceptual and judgment 
problems. 
‘‘(3) BEHAVIORAL HEALTH AFTERCARE.—The 
term ‘behavioral health aftercare’ includes those ac-
tivities and resources used to support recovery fol-
lowing inpatient, residential, intensive substance 
abuse, or mental health outpatient or outpatient 
treatment. The purpose is to help prevent or deal 
with relapse by ensuring that by the time a client or 
patient is discharged from a level of care, such as 
outpatient treatment, an aftercare plan has been de-
veloped with the client. An aftercare plan may use 
such resources as a community-based therapeutic 
group, transitional living facilities, a 12-step spon-
sor, a local 12-step or other related support group, 
and other community-based providers. 
‘‘(4) DUAL DIAGNOSIS.—The term ‘dual diag-
nosis’ means coexisting substance abuse and mental 
illness conditions or diagnosis. Such clients are
1958 
sometimes referred to as mentally ill chemical abus-
ers (MICAs). 
‘‘(5) 
FETAL
ALCOHOL
SPECTRUM
DIS-
ORDERS.— 
‘‘(A) IN GENERAL.—The term ‘fetal alco-
hol spectrum disorders’ includes a range of ef-
fects that can occur in an individual whose 
mother drank alcohol during pregnancy, includ-
ing physical, mental, behavioral, and/or learning 
disabilities with possible lifelong implications. 
‘‘(B) INCLUSIONS.—The term ‘fetal alcohol 
spectrum disorders’ may include— 
‘‘(i) fetal alcohol syndrome (FAS); 
‘‘(ii) fetal alcohol effect (FAE); 
‘‘(iii) alcohol-related birth defects; and 
‘‘(iv) 
alcohol-related 
neurodevelopmental disorders (ARND). 
‘‘(6) FETAL
ALCOHOL
SYNDROME
OR
FAS.— 
The term ‘fetal alcohol syndrome’ or ‘FAS’ means 
any 1 of a spectrum of effects that may occur when 
a woman drinks alcohol during pregnancy, the diag-
nosis of which involves the confirmed presence of the 
following 3 criteria: 
‘‘(A) Craniofacial abnormalities. 
‘‘(B) Growth deficits.
1959 
‘‘(C) Central nervous system abnormalities. 
‘‘(7) REHABILITATION.—The term ‘rehabilita-
tion’ means medical and health care services that— 
‘‘(A) are recommended by a physician or 
licensed practitioner of the healing arts within 
the scope of their practice under applicable law; 
‘‘(B) are furnished in a facility, home, or 
other setting in accordance with applicable 
standards; and 
‘‘(C) have as their purpose any of the fol-
lowing: 
‘‘(i) The maximum attainment of 
physical, mental, and developmental func-
tioning. 
‘‘(ii) Averting deterioration in physical 
or mental functional status. 
‘‘(iii) The maintenance of physical or 
mental health functional status. 
‘‘(8) SUBSTANCE ABUSE.—The term ‘substance 
abuse’ includes inhalant abuse. 
‘‘(9) SYSTEMS OF CARE.—The term ‘Systems of 
Care’ means a system for delivering services to chil-
dren and their families that is child-centered, family- 
focused and family-driven, community-based, and 
culturally competent and responsive to the needs of
1960 
the children and families being served. The systems 
of care approach values prevention and early identi-
fication, smooth transitions for children and fami-
lies, child and family participation and advocacy, 
comprehensive array of services, individualized serv-
ice planning, services in the least restrictive environ-
ment, and integrated services with coordinated plan-
ning across the child-serving systems. 
‘‘SEC. 717. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There is authorized to be appropriated such sums 
as may be necessary to carry out the provisions of this 
title. 
‘‘TITLE VIII—MISCELLANEOUS 
‘‘SEC. 801. REPORTS. 
‘‘For each fiscal year following the date of enactment 
of the Indian Health Care Improvement Act Amendments 
of 2009, the Secretary shall transmit to Congress a report 
containing the following: 
‘‘(1) A report on the progress made in meeting 
the objectives of this Act, including a review of pro-
grams established or assisted pursuant to this Act 
and assessments and recommendations of additional 
programs or additional assistance necessary to, at a 
minimum, provide health services to Indians and en-
sure a health status for Indians, which are at a par-
1961 
ity with the health services available to and the 
health status of the general population. 
‘‘(2) A report on whether, and to what extent, 
new national health care programs, benefits, initia-
tives, or financing systems have had an impact on 
the purposes of this Act and any steps that the Sec-
retary may have taken to consult with Indian Tribes, 
Tribal Organizations, and urban Indian organiza-
tions to address such impact, including a report on 
proposed changes in allocation of funding pursuant 
to section 807. 
‘‘(3) A report on the use of health services by 
Indians— 
‘‘(A) on a national and area or other rel-
evant geographical basis; 
‘‘(B) by gender and age; 
‘‘(C) by source of payment and type of 
service; 
‘‘(D) comparing such rates of use with 
rates of use among comparable non-Indian pop-
ulations; and 
‘‘(E) provided under contracts. 
‘‘(4) A report of contractors to the Secretary on 
Health Care Educational Loan Repayments every 6 
months required by section 110.
1962 
‘‘(5) A general audit report of the Secretary on 
the Health Care Educational Loan Repayment Pro-
gram as required by section 110(m). 
‘‘(6) A report of the findings and conclusions of 
demonstration programs on development of edu-
cational curricula for substance abuse counseling as 
required in section 125(f). 
‘‘(7) A separate statement which specifies the 
amount of funds requested to carry out the provi-
sions of section 201. 
‘‘(8) A report of the evaluations of health pro-
motion and disease prevention as required in section 
203(c). 
‘‘(9) A biennial report to Congress on infectious 
diseases as required by section 212. 
‘‘(10) A report on environmental and nuclear 
health hazards as required by section 215. 
‘‘(11) An annual report on the status of all 
health care facilities needs as required by section 
301(c)(2)(B) and 301(d). 
‘‘(12) Reports on safe water and sanitary waste 
disposal facilities as required by section 302(h). 
‘‘(13) An annual report on the expenditure of 
non-Service funds for renovation as required by sec-
tions 304(b)(2).
1963 
‘‘(14) A report identifying the backlog of main-
tenance and repair required at Service and tribal fa-
cilities required by section 313(a). 
‘‘(15) A report providing an accounting of reim-
bursement funds made available to the Secretary 
under titles XVIII, XIX, and XXI of the Social Se-
curity Act. 
‘‘(16) A report on any arrangements for the 
sharing of medical facilities or services, as author-
ized by section 406. 
‘‘(17) A report on evaluation and renewal of 
urban Indian programs under section 505. 
‘‘(18) A report on the evaluation of programs 
as required by section 513(d). 
‘‘(19) A report on alcohol and substance abuse 
as required by section 701(f). 
‘‘(20) A report on Indian youth mental health 
services as required by section 707(h). 
‘‘(21) A report on the reallocation of base re-
sources if required by section 807. 
‘‘(22) A report on the movement of patients be-
tween Service Units, including— 
‘‘(A) a list of those Service Units that have 
a net increase and those that have a net de-
crease of patients due to patients assigned to
1964 
one Service Unit voluntarily choosing to receive 
service at another Service Unit; 
‘‘(B) an analysis of the effect of patient 
movement on the quality of services for those 
Service Units experiencing an increase in the 
number of patients served; and 
‘‘(C) what funding changes are necessary 
to maintain a consistent quality of service at 
Service Units that have an increase in the num-
ber of patients served. 
‘‘(23) A report on the extent to which health 
care facilities of the Service, Indian Tribes, Tribal 
Organizations, and urban Indian organizations com-
ply with credentialing requirements of the Service or 
licensure requirements of States. 
‘‘SEC. 802. REGULATIONS. 
‘‘(a) DEADLINES.— 
‘‘(1) PROCEDURES.—Not later than 90 days 
after the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2009, the 
Secretary shall initiate procedures under subchapter 
III of chapter 5 of title 5, United States Code, to 
negotiate and promulgate such regulations or 
amendments thereto that are necessary to carry out 
this Act, except sections 105, 115, 117, 202, and
1965 
409 through 414. The Secretary may promulgate 
regulations to carry out such sections using the pro-
cedures required by chapter 5 of title 5, United 
States Code (commonly known as the ‘Administra-
tive Procedure Act’). 
‘‘(2) PROPOSED REGULATIONS.—Proposed reg-
ulations to implement this Act shall be published in 
the Federal Register by the Secretary no later than 
2 years after the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2009 
and shall have no less than a 120-day comment pe-
riod. 
‘‘(3) FINAL
REGULATIONS.—The Secretary 
shall publish in the Federal Register final regula-
tions to implement this Act by not later than 3 years 
after the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2009. 
‘‘(b) COMMITTEE.—A negotiated rulemaking com-
mittee established pursuant to section 565 of title 5, 
United States Code, to carry out this section shall have 
as its members only representatives of the Federal Gov-
ernment and representatives of Indian Tribes, and Tribal 
Organizations, a majority of whom shall be nominated by 
and be representatives of Indian Tribes and Tribal Orga-
nizations from each Service Area.
1966 
‘‘(c) ADAPTATION OF PROCEDURES.—The Secretary 
shall adapt the negotiated rulemaking procedures to the 
unique context of self-governance and the government-to- 
government relationship between the United States and 
Indian Tribes. 
‘‘(d) LACK OF REGULATIONS.—The lack of promul-
gated regulations shall not limit the effect of this Act. 
‘‘SEC. 803. PLAN OF IMPLEMENTATION. 
‘‘(a) IN GENERAL.—Not later than 1 year after the 
date of enactment of the Indian Health Care Improvement 
Act Amendments of 2009, the Secretary, in consultation 
with Indian Tribes, Tribal Organizations, and urban In-
dian organizations, shall submit to Congress a plan ex-
plaining the manner and schedule, by title and section, 
by which the Secretary will implement the provisions of 
this Act. This consultation may be conducted jointly with 
the annual budget consultation pursuant to the Indian 
Self-Determination and Education Assistance Act (25 
U.S.C. 450 et seq.). 
‘‘(b) LACK OF PLAN.—The lack of (or failure to sub-
mit) such a plan shall not limit the effect, or prevent the 
implementation, of this Act.
1967 
‘‘SEC. 804. LIMITATION ON USE OF FUNDS APPROPRIATED 
TO INDIAN HEALTH SERVICE. 
‘‘Any limitation on the use of funds contained in an 
Act providing appropriations for the Department for a pe-
riod with respect to the performance of abortions shall 
apply for that period with respect to the performance of 
abortions using funds contained in an Act providing ap-
propriations for the Service. 
‘‘SEC. 805. ELIGIBILITY OF CALIFORNIA INDIANS. 
‘‘(a) IN GENERAL.—The following California Indians 
shall be eligible for health services provided by the Service: 
‘‘(1) Any member of a federally recognized In-
dian Tribe. 
‘‘(2) Any descendant of an Indian who was re-
siding in California on June 1, 1852, if such de-
scendant— 
‘‘(A) is a member of the Indian community 
served by a local program of the Service; and 
‘‘(B) is regarded as an Indian by the com-
munity in which such descendant lives. 
‘‘(3) Any Indian who holds trust interests in 
public domain, national forest, or reservation allot-
ments in California. 
‘‘(4) Any Indian in California who is listed on 
the plans for distribution of the assets of rancherias 
and reservations located within the State of Cali-
1968 
fornia under the Act of August 18, 1958 (72 Stat. 
619), and any descendant of such an Indian. 
‘‘(b) CLARIFICATION.—Nothing in this section may 
be construed as expanding the eligibility of California Indi-
ans for health services provided by the Service beyond the 
scope of eligibility for such health services that applied on 
May 1, 1986. 
‘‘SEC. 806. HEALTH SERVICES FOR INELIGIBLE PERSONS. 
‘‘(a) CHILDREN.—Any individual who— 
‘‘(1) has not attained 19 years of age; 
‘‘(2) is the natural or adopted child, stepchild, 
foster child, legal ward, or orphan of an eligible In-
dian; and 
‘‘(3) is not otherwise eligible for health services 
provided by the Service, 
shall be eligible for all health services provided by the 
Service on the same basis and subject to the same rules 
that apply to eligible Indians until such individual attains 
19 years of age. The existing and potential health needs 
of all such individuals shall be taken into consideration 
by the Service in determining the need for, or the alloca-
tion of, the health resources of the Service. If such an indi-
vidual has been determined to be legally incompetent prior 
to attaining 19 years of age, such individual shall remain
1969 
eligible for such services until 1 year after the date of a 
determination of competency. 
‘‘(b) SPOUSES.—Any spouse of an eligible Indian who 
is not an Indian, or who is of Indian descent but is not 
otherwise eligible for the health services provided by the 
Service, shall be eligible for such health services if all such 
spouses or spouses who are married to members of each 
Indian Tribe being served are made eligible, as a class, 
by an appropriate resolution of the governing body of the 
Indian Tribe or Tribal Organization providing such serv-
ices. The health needs of persons made eligible under this 
paragraph shall not be taken into consideration by the 
Service in determining the need for, or allocation of, its 
health resources. 
‘‘(c) PROVISION OF SERVICES TO OTHER INDIVID-
UALS.— 
‘‘(1) IN GENERAL.—The Secretary is authorized 
to provide health services under this subsection 
through health programs operated directly by the 
Service to individuals who reside within the Service 
area of the Service Unit and who are not otherwise 
eligible for such health services if— 
‘‘(A) the Indian Tribes served by such 
Service Unit request such provision of health 
services to such individuals; and
1970 
‘‘(B) the Secretary and the served Indian 
Tribes have jointly determined that— 
‘‘(i) the provision of such health serv-
ices will not result in a denial or diminu-
tion of health services to eligible Indians; 
and 
‘‘(ii) there is no reasonable alternative 
health facilities or services, within or with-
out the Service Unit, available to meet the 
health needs of such individuals. 
‘‘(2) ISDEAA PROGRAMS.—In the case of 
health programs and facilities operated under a con-
tract or compact entered into under the Indian Self- 
Determination and Education Assistance Act (25 
U.S.C. 450 et seq.), the governing body of the In-
dian Tribe or Tribal Organization providing health 
services under such contract or compact is author-
ized to determine whether health services should be 
provided under such contract to individuals who are 
not eligible for such health services under any other 
subsection of this section or under any other provi-
sion of law. In making such determinations, the gov-
erning body of the Indian Tribe or Tribal Organiza-
tion shall take into account the considerations de-
scribed in paragraph (1)(B).
1971 
‘‘(3) PAYMENT FOR SERVICES.— 
‘‘(A) IN
GENERAL.—Persons receiving 
health services provided by the Service under 
this subsection shall be liable for payment of 
such health services under a schedule of charges 
prescribed by the Secretary which, in the judg-
ment of the Secretary, results in reimbursement 
in an amount not less than the actual cost of 
providing the health services. Notwithstanding 
section 404 of this Act or any other provision 
of law, amounts collected under this subsection, 
including Medicare, Medicaid, or SCHIP reim-
bursements under titles XVIII, XIX, and XXI 
of the Social Security Act, shall be credited to 
the account of the program providing the serv-
ice and shall be used for the purposes listed in 
section 401(d)(2) and amounts collected under 
this subsection shall be available for expendi-
ture within such program. 
‘‘(B) INDIGENT PEOPLE.—Health services 
may be provided by the Secretary through the 
Service under this subsection to an indigent in-
dividual who would not be otherwise eligible for 
such health services but for the provisions of 
paragraph (1) only if an agreement has been
1972 
entered into with a State or local government 
under which the State or local government 
agrees to reimburse the Service for the expenses 
incurred by the Service in providing such health 
services to such indigent individual. 
‘‘(4) REVOCATION
OF
CONSENT
FOR
SERV-
ICES.— 
‘‘(A) SINGLE
TRIBE
SERVICE
AREA.—In 
the case of a Service Area which serves only 1 
Indian Tribe, the authority of the Secretary to 
provide health services under paragraph (1) 
shall terminate at the end of the fiscal year suc-
ceeding the fiscal year in which the governing 
body of the Indian Tribe revokes its concur-
rence to the provision of such health services. 
‘‘(B) MULTITRIBAL
SERVICE
AREA.—In 
the case of a multitribal Service Area, the au-
thority of the Secretary to provide health serv-
ices under paragraph (1) shall terminate at the 
end of the fiscal year succeeding the fiscal year 
in which at least 51 percent of the number of 
Indian Tribes in the Service Area revoke their 
concurrence to the provisions of such health 
services.
1973 
‘‘(d) OTHER SERVICES.—The Service may provide 
health services under this subsection to individuals who 
are not eligible for health services provided by the Service 
under any other provision of law in order to— 
‘‘(1) achieve stability in a medical emergency; 
‘‘(2) prevent the spread of a communicable dis-
ease or otherwise deal with a public health hazard; 
‘‘(3) provide care to non-Indian women preg-
nant with an eligible Indian’s child for the duration 
of the pregnancy through postpartum; or 
‘‘(4) provide care to immediate family members 
of an eligible individual if such care is directly re-
lated to the treatment of the eligible individual. 
‘‘(e) HOSPITAL PRIVILEGES FOR PRACTITIONERS.— 
‘‘(1) IN
GENERAL.—Hospital privileges in 
health facilities operated and maintained by the 
Service or operated under a contract or compact 
pursuant to the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.) may 
be extended to non-Service health care practitioners 
who provide services to individuals described in sub-
section (a), (b), (c), or (d). Such non-Service health 
care practitioners may, as part of the privileging 
process, be designated as employees of the Federal 
Government for purposes of section 1346(b) and
1974 
chapter 171 of title 28, United States Code (relating 
to Federal tort claims) only with respect to acts or 
omissions which occur in the course of providing 
services to eligible individuals as a part of the condi-
tions under which such hospital privileges are ex-
tended. 
‘‘(2) DEFINITION.—For purposes of this sub-
section, the term ‘non-Service health care practi-
tioner’ means a practitioner who is not— 
‘‘(A) an employee of the Service; or 
‘‘(B) an employee of an Indian tribe or 
tribal organization operating a contract or com-
pact under the Indian Self-Determination and 
Education Assistance Act or an individual who 
provides health care services pursuant to a per-
sonal services contract with such Indian tribe or 
tribal organization. 
‘‘(f) ELIGIBLE INDIAN.—For purposes of this sec-
tion, the term ‘eligible Indian’ means any Indian who is 
eligible for health services provided by the Service without 
regard to the provisions of this section. 
‘‘SEC. 807. REALLOCATION OF BASE RESOURCES. 
‘‘(a) REPORT
REQUIRED.—Notwithstanding any 
other provision of law, any allocation of Service funds for 
a fiscal year that reduces by 5 percent or more from the
1975 
previous fiscal year the funding for any recurring pro-
gram, project, or activity of a Service Unit may be imple-
mented only after the Secretary has submitted to Con-
gress, under section 801, a report on the proposed change 
in allocation of funding, including the reasons for the 
change and its likely effects. 
‘‘(b) EXCEPTION.—Subsection (a) shall not apply if 
the total amount appropriated to the Service for a fiscal 
year is at least 5 percent less than the amount appro-
priated to the Service for the previous fiscal year. 
‘‘SEC. 808. RESULTS OF DEMONSTRATION PROJECTS. 
‘‘The Secretary shall provide for the dissemination to 
Indian Tribes, Tribal Organizations, and urban Indian or-
ganizations of the findings and results of demonstration 
projects conducted under this Act. 
‘‘SEC. 809. MORATORIUM. 
‘‘During the period of the moratorium imposed on 
implementation of the final rule published in the Federal 
Register on September 16, 1987, by the Department of 
Health and Human Services, relating to eligibility for the 
health care services of the Indian Health Service, the In-
dian Health Service shall provide services pursuant to the 
criteria for eligibility for such services that were in effect 
on September 15, 1987, subject to the provisions of sec-
tions 805 and 806, until the Service has submitted to the
1976 
Committees on Appropriations of the Senate and the 
House of Representatives a budget request reflecting the 
increased costs associated with the proposed final rule, 
and the request has been included in an appropriations 
Act and enacted into law. 
‘‘SEC. 810. SEVERABILITY PROVISIONS. 
‘‘If any provision of this Act, any amendment made 
by the Act, or the application of such provision or amend-
ment to any person or circumstances is held to be invalid, 
the remainder of this Act, the remaining amendments 
made by this Act, and the application of such provisions 
to persons or circumstances other than those to which it 
is held invalid, shall not be affected thereby. 
‘‘SEC. 811. USE OF PATIENT SAFETY ORGANIZATIONS. 
‘‘The Service, an Indian Tribe, Tribal Organization, 
or urban Indian organization may provide for quality as-
surance activities through the use of a patient safety orga-
nization in accordance with title IX of the Public Health 
Service Act. 
‘‘SEC. 812. CONFIDENTIALITY OF MEDICAL QUALITY ASSUR-
ANCE RECORDS; QUALIFIED IMMUNITY FOR 
PARTICIPANTS. 
‘‘(a) CONFIDENTIALITY OF RECORDS.—Medical qual-
ity assurance records created by or for any Indian Health 
Program or a health program of an Urban Indian Organi-
1977 
zation as part of a medical quality assurance program are 
confidential and privileged. Such records may not be dis-
closed to any person or entity, except as provided in sub-
section (c). 
‘‘(b) PROHIBITION
ON DISCLOSURE
AND TESTI-
MONY.— 
‘‘(1) IN
GENERAL.—No part of any medical 
quality assurance record described in subsection (a) 
may be subject to discovery or admitted into evi-
dence in any judicial or administrative proceeding, 
except as provided in subsection (c). 
‘‘(2) TESTIMONY.—A person who reviews or 
creates medical quality assurance records for any In-
dian Health Program or Urban Indian Organization 
who participates in any proceeding that reviews or 
creates such records may not be permitted or re-
quired to testify in any judicial or administrative 
proceeding with respect to such records or with re-
spect to any finding, recommendation, evaluation, 
opinion, or action taken by such person or body in 
connection with such records except as provided in 
this section. 
‘‘(c) AUTHORIZED DISCLOSURE AND TESTIMONY.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), a 
medical quality assurance record described in sub-
1978 
section (a) may be disclosed, and a person referred 
to in subsection (b) may give testimony in connec-
tion with such a record, only as follows: 
‘‘(A) To a Federal executive agency or pri-
vate organization, if such medical quality assur-
ance record or testimony is needed by such 
agency or organization to perform licensing or 
accreditation functions related to any Indian 
Health Program or to a health program of an 
Urban Indian Organization to perform moni-
toring, required by law, of such program or or-
ganization. 
‘‘(B) To an administrative or judicial pro-
ceeding commenced by a present or former In-
dian Health Program or Urban Indian Organi-
zation provider concerning the termination, sus-
pension, or limitation of clinical privileges of 
such health care provider. 
‘‘(C) To a governmental board or agency 
or to a professional health care society or orga-
nization, if such medical quality assurance 
record or testimony is needed by such board, 
agency, society, or organization to perform li-
censing, credentialing, or the monitoring of pro-
fessional standards with respect to any health
1979 
care provider who is or was an employee of any 
Indian Health Program or Urban Indian Orga-
nization. 
‘‘(D) To a hospital, medical center, or 
other institution that provides health care serv-
ices, if such medical quality assurance record or 
testimony is needed by such institution to as-
sess the professional qualifications of any health 
care provider who is or was an employee of any 
Indian Health Program or Urban Indian Orga-
nization and who has applied for or been grant-
ed authority or employment to provide health 
care services in or on behalf of such program or 
organization. 
‘‘(E) To an officer, employee, or contractor 
of the Indian Health Program or Urban Indian 
Organization that created the records or for 
which the records were created. If that officer, 
employee, or contractor has a need for such 
record or testimony to perform official duties. 
‘‘(F) To a criminal or civil law enforce-
ment agency or instrumentality charged under 
applicable law with the protection of the public 
health or safety, if a qualified representative of 
such agency or instrumentality makes a written