330 
The previous sentence shall not affect the authority the 
Secretary may otherwise have to carry out other provisions 
of this Act through such contracts. 
‘‘SEC. 818. AUTHORIZATION OF APPROPRIATIONS; AVAIL-
ABILITY. 
‘‘(a) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated such sums as may be 
necessary to carry out this title. 
‘‘(b) LIMITATION ON NEW SPENDING AUTHORITY.— 
Any new spending authority (described in subparagraph 
(A) or (B) of section 401(c)(2) of the Congressional Budg-
et Act of 1974 (Public Law 93–344; 88 Stat. 317)) which 
is provided under this Act shall be effective for any fiscal 
year only to such extent or in such amounts as are pro-
vided in appropriation Acts. 
‘‘(c) AVAILABILITY.—The funds appropriated pursu-
ant to this Act shall remain available until expended.’’. 
(b) RATE OF PAY.— 
(1) POSITIONS AT LEVEL IV.—Section 5315 of 
title 5, United States Code, is amended by striking 
‘‘Assistant Secretaries of Health and Human Serv-
ices (6).’’ and inserting ‘‘Assistant Secretaries of 
Health and Human Services (7)’’. 
(2) POSITIONS AT LEVEL V.—Section 5316 of 
title 5, United States Code, is amended by striking 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00330
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
331 
‘‘Director, Indian Health Service, Department of 
Health and Human Services’’. 
(c) AMENDMENTS TO OTHER PROVISIONS OF LAW.— 
(1) Section 3307(b)(1)(C) of the Children’s 
Health Act of 2000 (25 U.S.C. 1671 note; Public 
Law 106–310) is amended by striking ‘‘Director of 
the Indian Health Service’’ and inserting ‘‘Assistant 
Secretary for Indian Health’’. 
(2) The Indian Lands Open Dump Cleanup Act 
of 1994 is amended— 
(A) in section 3 (25 U.S.C. 3902)— 
(i) by striking paragraph (2); 
(ii) by redesignating paragraphs (1), 
(3), (4), (5), and (6) as paragraphs (4), 
(5), (2), (6), and (1), respectively, and 
moving those paragraphs so as to appear 
in numerical order; and 
(iii) by inserting before paragraph (4) 
(as redesignated by subclause (II)) the fol-
lowing: 
‘‘(3) ASSISTANT
SECRETARY.—The term ‘As-
sistant Secretary’ means the Assistant Secretary for 
Indian Health.’’; 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00331
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
332 
(B) in section 5 (25 U.S.C. 3904), by 
striking the section designation and heading 
and inserting the following: 
‘‘SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR IN-
DIAN HEALTH.’’; 
(C) in section 6(a) (25 U.S.C. 3905(a)), in 
the subsection heading, by striking ‘‘DIREC-
TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 
(D) in section 9(a) (25 U.S.C. 3908(a)), in 
the subsection heading, by striking ‘‘DIREC-
TOR’’ and inserting ‘‘ASSISTANT SECRETARY’’; 
and 
(E) by striking ‘‘Director’’ each place it 
appears and inserting ‘‘Assistant Secretary’’. 
(3) Section 5504(d)(2) of the Augustus F. 
Hawkins-Robert T. Stafford Elementary and Sec-
ondary School Improvement Amendments of 1988 
(25 U.S.C. 2001 note; Public Law 100–297) is 
amended by striking ‘‘Director of the Indian Health 
Service’’ and inserting ‘‘Assistant Secretary for In-
dian Health’’. 
(4) Section 203(a)(1) of the Rehabilitation Act 
of 1973 (29 U.S.C. 763(a)(1)) is amended by strik-
ing ‘‘Director of the Indian Health Service’’ and in-
serting ‘‘Assistant Secretary for Indian Health’’. 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00332
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
333 
(5) Subsections (b) and (e) of section 518 of 
the Federal Water Pollution Control Act (33 U.S.C. 
1377) are amended by striking ‘‘Director of the In-
dian Health Service’’ each place it appears and in-
serting ‘‘Assistant Secretary for Indian Health’’. 
(6) Section 317M(b) of the Public Health Serv-
ice Act (42 U.S.C. 247b–14(b)) is amended— 
(A) by striking ‘‘Director of the Indian 
Health Service’’ each place it appears and in-
serting 
‘‘Assistant 
Secretary 
for 
Indian 
Health’’; and 
(B) in paragraph (2)(A), by striking ‘‘the 
Directors referred to in such paragraph’’ and 
inserting ‘‘the Director of the Centers for Dis-
ease Control and Prevention and the Assistant 
Secretary for Indian Health’’. 
(7) Section 417C(b) of the Public Health Serv-
ice Act (42 U.S.C. 285–9(b)) is amended by striking 
‘‘Director of the Indian Health Service’’ and insert-
ing ‘‘Assistant Secretary for Indian Health’’. 
(8) Section 1452(i) of the Safe Drinking Water 
Act (42 U.S.C. 300j–12(i)) is amended by striking 
‘‘Director of the Indian Health Service’’ each place 
it appears and inserting ‘‘Assistant Secretary for In-
dian Health’’. 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00333
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
334 
(9) Section 803B(d)(1) of the Native American 
Programs Act of 1974 (42 U.S.C. 2991b–2(d)(1)) is 
amended in the last sentence by striking ‘‘Director 
of the Indian Health Service’’ and inserting ‘‘Assist-
ant Secretary for Indian Health’’. 
(10) Section 203(b) of the Michigan Indian 
Land Claims Settlement Act (Public Law 105–143; 
111 Stat. 2666) is amended by striking ‘‘Director of 
the Indian Health Service’’ and inserting ‘‘Assistant 
Secretary for Indian Health’’. 
SEC. 102. SOBOBA SANITATION FACILITIES. 
The Act of December 17, 1970 (84 Stat. 1465), is 
amended by adding at the end the following: 
‘‘SEC. 9. Nothing in this Act shall preclude the 
Soboba Band of Mission Indians and the Soboba Indian 
Reservation from being provided with sanitation facilities 
and services under the authority of section 7 of the Act 
of August 5, 1954 (68 Stat. 674), as amended by the Act 
of July 31, 1959 (73 Stat. 267).’’. 
SEC. 103. NATIVE AMERICAN HEALTH AND WELLNESS 
FOUNDATION. 
(a) IN GENERAL.—The Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.) is 
amended by adding at the end the following: 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00334
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
335 
‘‘TITLE VIII—NATIVE AMERICAN 
HEALTH 
AND 
WELLNESS 
FOUNDATION 
‘‘SEC. 801. DEFINITIONS. 
‘‘In this title: 
‘‘(1) BOARD.—The term ‘Board’ means the 
Board of Directors of the Foundation. 
‘‘(2) 
COMMITTEE.—The 
term 
‘Committee’ 
means the Committee for the Establishment of Na-
tive American Health and Wellness Foundation es-
tablished under section 802(f). 
‘‘(3) FOUNDATION.—The term ‘Foundation’ 
means the Native American Health and Wellness 
Foundation established under section 802. 
‘‘(4) SECRETARY.—The term ‘Secretary’ means 
the Secretary of Health and Human Services. 
‘‘(5) SERVICE.—The term ‘Service’ means the 
Indian Health Service of the Department of Health 
and Human Services. 
‘‘SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS 
FOUNDATION. 
‘‘(a) ESTABLISHMENT.— 
‘‘(1) IN
GENERAL.—As soon as practicable 
after the date of enactment of this title, the Sec-
retary shall establish, under the laws of the District 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00335
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
336 
of Columbia and in accordance with this title, the 
Native American Health and Wellness Foundation. 
‘‘(2) FUNDING
DETERMINATIONS.—No funds, 
gift, property, or other item of value (including any 
interest accrued on such an item) acquired by the 
Foundation shall— 
‘‘(A) be taken into consideration for pur-
poses of determining Federal appropriations re-
lating to the provision of health care and serv-
ices to Indians; or 
‘‘(B) otherwise limit, diminish, or affect 
the Federal responsibility for the provision of 
health care and services to Indians. 
‘‘(b) PERPETUAL
EXISTENCE.—The Foundation 
shall have perpetual existence. 
‘‘(c) NATURE OF CORPORATION.—The Foundation— 
‘‘(1) shall be a charitable and nonprofit feder-
ally chartered corporation; and 
‘‘(2) shall not be an agency or instrumentality 
of the United States. 
‘‘(d) PLACE OF INCORPORATION AND DOMICILE.— 
The Foundation shall be incorporated and domiciled in the 
District of Columbia. 
‘‘(e) DUTIES.—The Foundation shall— 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00336
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
337 
‘‘(1) encourage, accept, and administer private 
gifts of real and personal property, and any income 
from or interest in such gifts, for the benefit of, or 
in support of, the mission of the Service; 
‘‘(2) undertake and conduct such other activi-
ties as will further the health and wellness activities 
and opportunities of Native Americans; and 
‘‘(3) participate with and assist Federal, State, 
and tribal governments, agencies, entities, and indi-
viduals in undertaking and conducting activities that 
will further the health and wellness activities and op-
portunities of Native Americans. 
‘‘(f) COMMITTEE FOR THE ESTABLISHMENT OF NA-
TIVE AMERICAN HEALTH
AND WELLNESS FOUNDA-
TION.— 
‘‘(1) IN GENERAL.—The Secretary shall estab-
lish the Committee for the Establishment of Native 
American Health and Wellness Foundation to assist 
the Secretary in establishing the Foundation. 
‘‘(2) DUTIES.—Not later than 180 days after 
the date of enactment of this section, the Committee 
shall— 
‘‘(A) carry out such activities as are nec-
essary to incorporate the Foundation under the 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00337
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
338 
laws of the District of Columbia, including act-
ing as incorporators of the Foundation; 
‘‘(B) ensure that the Foundation qualifies 
for and maintains the status required to carry 
out this section, until the Board is established; 
‘‘(C) establish the constitution and initial 
bylaws of the Foundation; 
‘‘(D) provide for the initial operation of 
the Foundation, including providing for tem-
porary or interim quarters, equipment, and 
staff; and 
‘‘(E) appoint the initial members of the 
Board in accordance with the constitution and 
initial bylaws of the Foundation. 
‘‘(g) BOARD OF DIRECTORS.— 
‘‘(1) IN
GENERAL.—The Board of Directors 
shall be the governing body of the Foundation. 
‘‘(2) POWERS.—The Board may exercise, or 
provide for the exercise of, the powers of the Foun-
dation. 
‘‘(3) SELECTION.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), the number of members of the 
Board, the manner of selection of the members 
(including the filling of vacancies), and the 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00338
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
339 
terms of office of the members shall be as pro-
vided in the constitution and bylaws of the 
Foundation. 
‘‘(B) REQUIREMENTS.— 
‘‘(i) NUMBER
OF
MEMBERS.—The 
Board shall have at least 11 members, who 
shall have staggered terms. 
‘‘(ii) INITIAL VOTING MEMBERS.—The 
initial voting members of the Board— 
‘‘(I) shall be appointed by the 
Committee not later than 180 days 
after the date on which the Founda-
tion is established; and 
‘‘(II) shall have staggered terms. 
‘‘(iii) QUALIFICATION.—The members 
of the Board shall be United States citi-
zens who are knowledgeable or experienced 
in Native American health care and related 
matters. 
‘‘(C) COMPENSATION.—A member of the 
Board shall not receive compensation for service 
as a member, but shall be reimbursed for actual 
and necessary travel and subsistence expenses 
incurred in the performance of the duties of the 
Foundation. 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00339
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
340 
‘‘(h) OFFICERS.— 
‘‘(1) IN GENERAL.—The officers of the Founda-
tion shall be— 
‘‘(A) a secretary, elected from among the 
members of the Board; and 
‘‘(B) any other officers provided for in the 
constitution and bylaws of the Foundation. 
‘‘(2) CHIEF
OPERATING
OFFICER.—The sec-
retary of the Foundation may serve, at the direction 
of the Board, as the chief operating officer of the 
Foundation, or the Board may appoint a chief oper-
ating officer, who shall serve at the direction of the 
Board. 
‘‘(3) ELECTION.—The manner of election, term 
of office, and duties of the officers of the Founda-
tion shall be as provided in the constitution and by-
laws of the Foundation. 
‘‘(i) POWERS.—The Foundation— 
‘‘(1) shall adopt a constitution and bylaws for 
the management of the property of the Foundation 
and the regulation of the affairs of the Foundation; 
‘‘(2) may adopt and alter a corporate seal; 
‘‘(3) may enter into contracts; 
‘‘(4) may acquire (through a gift or otherwise), 
own, lease, encumber, and transfer real or personal 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00340
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
341 
property as necessary or convenient to carry out the 
purposes of the Foundation; 
‘‘(5) may sue and be sued; and 
‘‘(6) may perform any other act necessary and 
proper to carry out the purposes of the Foundation. 
‘‘(j) PRINCIPAL OFFICE.— 
‘‘(1) IN GENERAL.—The principal office of the 
Foundation shall be in the District of Columbia. 
‘‘(2) ACTIVITIES; OFFICES.—The activities of 
the Foundation may be conducted, and offices may 
be maintained, throughout the United States in ac-
cordance with the constitution and bylaws of the 
Foundation. 
‘‘(k) SERVICE OF PROCESS.—The Foundation shall 
comply with the law on service of process of each State 
in which the Foundation is incorporated and of each State 
in which the Foundation carries on activities. 
‘‘(l) LIABILITY
OF OFFICERS, EMPLOYEES, AND 
AGENTS.— 
‘‘(1) IN GENERAL.—The Foundation shall be 
liable for the acts of the officers, employees, and 
agents of the Foundation acting within the scope of 
their authority. 
‘‘(2) PERSONAL LIABILITY.—A member of the 
Board shall be personally liable only for gross neg-
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00341
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
342 
ligence in the performance of the duties of the mem-
ber. 
‘‘(m) RESTRICTIONS.— 
‘‘(1) LIMITATION
ON
SPENDING.—Beginning 
with the fiscal year following the first full fiscal year 
during which the Foundation is in operation, the ad-
ministrative costs of the Foundation shall not exceed 
the percentage described in paragraph (2) of the 
sum of— 
‘‘(A) the amounts transferred to the Foun-
dation under subsection (o) during the pre-
ceding fiscal year; and 
‘‘(B) donations received from private 
sources during the preceding fiscal year. 
‘‘(2) PERCENTAGES.—The percentages referred 
to in paragraph (1) are— 
‘‘(A) for the first fiscal year described in 
that paragraph, 20 percent; 
‘‘(B) for the following fiscal year, 15 per-
cent; and 
‘‘(C) for each fiscal year thereafter, 10 
percent. 
‘‘(3) APPOINTMENT
AND
HIRING.—The ap-
pointment of officers and employees of the Founda-
tion shall be subject to the availability of funds. 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00342
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
343 
‘‘(4) STATUS.—A member of the Board or offi-
cer, employee, or agent of the Foundation shall not 
by reason of association with the Foundation be con-
sidered to be an officer, employee, or agent of the 
United States. 
‘‘(n) AUDITS.—The Foundation shall comply with 
section 10101 of title 36, United States Code, as if the 
Foundation were a corporation under part B of subtitle 
II of that title. 
‘‘(o) FUNDING.— 
‘‘(1) AUTHORIZATION
OF
APPROPRIATIONS.— 
There is authorized to be appropriated to carry out 
subsection (e)(1) $500,000 for each fiscal year, as 
adjusted to reflect changes in the Consumer Price 
Index for all-urban consumers published by the De-
partment of Labor. 
‘‘(2) TRANSFER
OF
DONATED
FUNDS.—The 
Secretary shall transfer to the Foundation funds 
held by the Department of Health and Human Serv-
ices under the Act of August 5, 1954 (42 U.S.C. 
2001 et seq.), if the transfer or use of the funds is 
not prohibited by any term under which the funds 
were donated. 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00343
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
345 
of the 5-year period specified in subsection (a) if the facili-
ties and services— 
‘‘(1) are available; and 
‘‘(2) are provided on reimbursable cost basis.’’. 
(b) TECHNICAL AMENDMENTS.—The Indian Self-De-
termination and Education Assistance Act is amended— 
(1) by redesignating title V (25 U.S.C. 458bbb 
et seq.) as title VII; 
(2) by redesignating sections 501, 502, and 503 
(25 U.S.C. 458bbb, 458bbb–1, 458bbb–2) as sec-
tions 701, 702, and 703, respectively; and 
(3) in subsection (a)(2) of section 702 and 
paragraph (2) of section 703 (as redesignated by 
paragraph (2)), by striking ‘‘section 501’’ and in-
serting ‘‘section 701’’. 
SEC. 104. GAO STUDY AND REPORT ON PAYMENTS FOR 
CONTRACT HEALTH SERVICES. 
(a) STUDY.— 
(1) IN GENERAL.—The Comptroller General of 
the United States (in this section referred to as the 
‘‘Comptroller General’’) shall conduct a study on the 
utilization of health care furnished by health care 
providers under the contract health services program 
funded by the Indian Health Service and operated 
by the Indian Health Service, an Indian Tribe, or a 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00345
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
346 
Tribal Organization (as those terms are defined in 
section 4 of the Indian Health Care Improvement 
Act). 
(2) ANALYSIS.—The study conducted under 
paragraph (1) shall include an analysis of— 
(A) the amounts reimbursed under the 
contract health services program described in 
paragraph (1) for health care furnished by enti-
ties, individual providers, and suppliers, includ-
ing a comparison of reimbursement for such 
health care through other public programs and 
in the private sector; 
(B) barriers to accessing care under such 
contract health services program, including, but 
not limited to, barriers relating to travel dis-
tances, cultural differences, and public and pri-
vate sector reluctance to furnish care to pa-
tients under such program; 
(C) the adequacy of existing Federal fund-
ing for health care under such contract health 
services program; and 
(D) any other items determined appro-
priate by the Comptroller General. 
(b) REPORT.—Not later than 18 months after the 
date of enactment of this Act, the Comptroller General 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00346
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
347 
shall submit to Congress a report on the study conducted 
under subsection (a), together with recommendations re-
garding— 
(1) the appropriate level of Federal funding 
that should be established for health care under the 
contract health services program described in sub-
section (a)(1); and 
(2) how to most efficiently utilize such funding. 
(c) CONSULTATION.—In conducting the study under 
subsection (a) and preparing the report under subsection 
(b), the Comptroller General shall consult with the Indian 
Health Service, Indian Tribes, and Tribal Organizations. 
TITLE II—IMPROVEMENT OF IN-
DIAN 
HEALTH 
CARE 
PRO-
VIDED UNDER THE SOCIAL 
SECURITY ACT 
SEC. 201. EXPANSION OF PAYMENTS UNDER MEDICARE, 
MEDICAID, AND SCHIP FOR ALL COVERED 
SERVICES FURNISHED BY INDIAN HEALTH 
PROGRAMS. 
(a) MEDICAID.— 
(1) EXPANSION TO ALL COVERED SERVICES.— 
Section 1911 of the Social Security Act (42 U.S.C. 
1396j) is amended— 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00347
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
348 
(A) by amending the heading to read as 
follows: 
‘‘SEC. 1911. INDIAN HEALTH PROGRAMS.’’; 
and 
(B) by amending subsection (a) to read as 
follows: 
‘‘(a) ELIGIBILITY FOR PAYMENT FOR MEDICAL AS-
SISTANCE.—An Indian Health Program shall be eligible 
for payment for medical assistance provided under a State 
plan or under waiver authority with respect to items and 
services furnished by the Program if the furnishing of 
such services meets all the conditions and requirements 
which are applicable generally to the furnishing of items 
and services under this title and under such plan or waiver 
authority.’’. 
(2) REPEAL OF OBSOLETE PROVISION.—Sub-
section (b) of such section is repealed. 
(3) REVISION OF AUTHORITY TO ENTER INTO 
AGREEMENTS.—Subsection (c) of such section is 
amended to read as follows: 
‘‘(c) AUTHORITY TO ENTER INTO AGREEMENTS.— 
The Secretary may enter into an agreement with a State 
for the purpose of reimbursing the State for medical as-
sistance provided by the Indian Health Service, an Indian 
Tribe, Tribal Organization, or an Urban Indian Organiza-
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00348
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS
349 
tion (as so defined), directly, through referral, or under 
contracts or other arrangements between the Indian 
Health Service, an Indian Tribe, Tribal Organization, or 
an Urban Indian Organization and another health care 
provider to Indians who are eligible for medical assistance 
under the State plan or under waiver authority. This sub-
section shall not be construed to impair the entitlement 
of a State to reimbursement for such medical assistance 
under this title.’’. 
(4) CROSS-REFERENCES TO SPECIAL FUND FOR 
IMPROVEMENT OF IHS FACILITIES; DIRECT BILLING 
OPTION; 
DEFINITIONS.—Such section is further 
amended by striking subsection (d) and adding at 
the end the following new subsections: 
‘‘(c) SPECIAL FUND FOR IMPROVEMENT OF IHS FA-
CILITIES.—For provisions relating to the authority of the 
Secretary to place payments to which a facility of the In-
dian Health Service is eligible for payment under this title 
into a special fund established under section 401(c)(1) of 
the Indian Health Care Improvement Act, see subpara-
graphs (A) and (B) of section 401(c)(1) of such Act. 
‘‘(d) DIRECT BILLING.—For provisions relating to 
the authority of an Tribal Health Program to elect to di-
rectly bill for, and receive payment for, health care items 
and services provided by such Program for which payment 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00349
Fmt 6652
Sfmt 6201
E:\BILLS\H2708.IH
H2708
pwalker on PROD1PC71 with BILLS