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ities Education Act (20 U.S.C. 1400 et seq.): Provided 
further, That the accreditation emergency funds may be 
used, as needed, to carry out activities typically funded 
under the Indian Health Facilities account. 
CONTRACT SUPPORT COSTS 
For payments to tribes and tribal organizations for 
contract support costs associated with Indian Self-Deter-
mination and Education Assistance Act agreements with 
the Indian Health Service for fiscal year 2019, such sums 
as may be necessary: Provided, That notwithstanding any 
other provision of law, no amounts made available under 
this heading shall be available for transfer to another 
budget account. 
INDIAN HEALTH FACILITIES 
For construction, repair, maintenance, improvement, 
and equipment of health and related auxiliary facilities, 
including quarters for personnel; preparation of plans, 
specifications, and drawings; acquisition of sites, purchase 
and erection of modular buildings, and purchases of trail-
ers; and for provision of domestic and community sanita-
tion facilities for Indians, as authorized by section 7 of 
the Act of August 5, 1954 (42 U.S.C. 2004a), the Indian 
Self-Determination Act, and the Indian Health Care Im-
provement Act, and for expenses necessary to carry out 
such Acts and titles II and III of the Public Health Serv-
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ice Act with respect to environmental health and facilities 
support 
activities 
of 
the 
Indian 
Health 
Service, 
$877,504,000, to remain available until expended: Pro-
vided, That notwithstanding any other provision of law, 
funds appropriated for the planning, design, construction, 
renovation or expansion of health facilities for the benefit 
of an Indian tribe or tribes may be used to purchase land 
on which such facilities will be located: Provided further, 
That not to exceed $500,000 may be used by the Indian 
Health Service to purchase TRANSAM equipment from 
the Department of Defense for distribution to the Indian 
Health Service and tribal facilities: Provided further, That 
none of the funds appropriated to the Indian Health Serv-
ice may be used for sanitation facilities construction for 
new homes funded with grants by the housing programs 
of the United States Department of Housing and Urban 
Development: Provided further, That not to exceed 
$2,700,000 from this account and the ‘‘Indian Health 
Services’’ account may be used by the Indian Health Serv-
ice to obtain ambulances for the Indian Health Service 
and tribal facilities in conjunction with an existing inter-
agency agreement between the Indian Health Service and 
the General Services Administration: Provided further, 
That not to exceed $500,000 may be placed in a Demoli-
tion Fund, to remain available until expended, and be used 
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by the Indian Health Service for the demolition of Federal 
buildings. 
ADMINISTRATIVE PROVISIONS—INDIAN HEALTH SERVICE 
Appropriations provided in this Act to the Indian 
Health Service shall be available for services as authorized 
by 5 U.S.C. 3109 at rates not to exceed the per diem rate 
equivalent to the maximum rate payable for senior-level 
positions under 5 U.S.C. 5376; hire of passenger motor 
vehicles and aircraft; purchase of medical equipment; pur-
chase of reprints; purchase, renovation and erection of 
modular buildings and renovation of existing facilities; 
payments for telephone service in private residences in the 
field, when authorized under regulations approved by the 
Secretary of Health and Human Services; uniforms or al-
lowances therefor as authorized by 5 U.S.C. 5901–5902; 
and for expenses of attendance at meetings that relate to 
the functions or activities of the Indian Health Service: 
Provided, That in accordance with the provisions of the 
Indian Health Care Improvement Act, non-Indian patients 
may be extended health care at all tribally administered 
or Indian Health Service facilities, subject to charges, and 
the proceeds along with funds recovered under the Federal 
Medical Care Recovery Act (42 U.S.C. 2651–2653) shall 
be credited to the account of the facility providing the 
service and shall be available without fiscal year limitation: 
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Provided further, That notwithstanding any other law or 
regulation, funds transferred from the Department of 
Housing and Urban Development to the Indian Health 
Service shall be administered under Public Law 86–121, 
the Indian Sanitation Facilities Act and Public Law 93– 
638: Provided further, That funds appropriated to the In-
dian Health Service in this Act, except those used for ad-
ministrative and program direction purposes, shall not be 
subject to limitations directed at curtailing Federal travel 
and transportation: Provided further, That none of the 
funds made available to the Indian Health Service in this 
Act shall be used for any assessments or charges by the 
Department of Health and Human Services unless identi-
fied in the budget justification and provided in this Act, 
or approved by the House and Senate Committees on Ap-
propriations through the reprogramming process: Pro-
vided further, That notwithstanding any other provision 
of law, funds previously or herein made available to a tribe 
or tribal organization through a contract, grant, or agree-
ment authorized by title I or title V of the Indian Self- 
Determination and Education Assistance Act of 1975 (25 
U.S.C. 5321 et seq. (title I), 5381 et seq. (title V)), may 
be deobligated and reobligated to a self-determination con-
tract under title I, or a self-governance agreement under 
title V of such Act and thereafter shall remain available 
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to the tribe or tribal organization without fiscal year limi-
tation: Provided further, That none of the funds made 
available to the Indian Health Service in this Act shall 
be used to implement the final rule published in the Fed-
eral Register on September 16, 1987, by the Department 
of Health and Human Services, relating to the eligibility 
for the health care services of the Indian Health Service 
until the Indian Health Service has submitted a budget 
request reflecting the increased costs associated with the 
proposed final rule, and such request has been included 
in an appropriations Act and enacted into law: Provided 
further, That with respect to functions transferred by the 
Indian Health Service to tribes or tribal organizations, the 
Indian Health Service is authorized to provide goods and 
services to those entities on a reimbursable basis, includ-
ing payments in advance with subsequent adjustment, and 
the reimbursements received therefrom, along with the 
funds received from those entities pursuant to the Indian 
Self-Determination Act, may be credited to the same or 
subsequent appropriation account from which the funds 
were originally derived, with such amounts to remain 
available until expended: Provided further, That reim-
bursements for training, technical assistance, or services 
provided by the Indian Health Service will contain total 
costs, including direct, administrative, and overhead costs 
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