174 
made payable to or otherwise be deposited with 
the United States. 
‘‘(D) Such rent payments shall be depos-
ited into a separate account which shall be used 
by the Tribal Health Program for the mainte-
nance (including capital repairs and replace-
ment) and operation of the quarters and facili-
ties as the Tribal Health Program shall deter-
mine. 
‘‘(2) RETROCESSION
OF
AUTHORITY.—If a 
Tribal Health Program which has made an election 
under paragraph (1) requests retrocession of its au-
thority to directly collect rents from Federal employ-
ees occupying federally owned quarters, such ret-
rocession shall become effective on the earlier of— 
‘‘(A) the first day of the month that begins 
no less than 180 days after the Tribal Health 
Program notifies the Secretary of its desire to 
retrocede; or 
‘‘(B) such other date as may be mutually 
agreed by the Secretary and the Tribal Health 
Program. 
‘‘(c) RATES IN ALASKA.—To the extent that a Tribal 
Health Program, pursuant to authority granted in sub-
section (a), establishes rental rates for federally owned 
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quarters provided to a Federal employee in Alaska, such 
rents may be based on the cost of comparable private rent-
al housing in the nearest established community with a 
year-round population of 1,500 or more individuals. 
‘‘SEC. 315. APPLICABILITY OF BUY AMERICAN ACT RE-
QUIREMENT. 
‘‘(a) APPLICABILITY.—The Secretary shall ensure 
that the requirements of the Buy American Act apply to 
all procurements made with funds provided pursuant to 
section 317. Indian Tribes and Tribal Organizations shall 
be exempt from these requirements. 
‘‘(b) EFFECT OF VIOLATION.—If it has been finally 
determined by a court or Federal agency that any person 
intentionally affixed a label bearing a ‘Made in America’ 
inscription or any inscription with the same meaning, to 
any product sold in or shipped to the United States that 
is not made in the United States, such person shall be 
ineligible to receive any contract or subcontract made with 
funds provided pursuant to section 317, pursuant to the 
debarment, suspension, and ineligibility procedures de-
scribed in sections 9.400 through 9.409 of title 48, Code 
of Federal Regulations. 
‘‘(c) DEFINITIONS.—For purposes of this section, the 
term ‘Buy American Act’ means title III of the Act enti-
tled ‘An Act making appropriations for the Treasury and 
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Post Office Departments for the fiscal year ending June 
30, 1934, and for other purposes’, approved March 3, 
1933 (41 U.S.C. 10a et seq.). 
‘‘SEC. 316. OTHER FUNDING FOR FACILITIES. 
‘‘(a) AUTHORITY TO ACCEPT FUNDS.—The Sec-
retary is authorized to accept from any source, including 
Federal and State agencies, funds that are available for 
the construction of health care facilities and use such 
funds to plan, design, and construct health care facilities 
for Indians and to place such funds into a contract or com-
pact under the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.). Receipt of such 
funds shall have no effect on the priorities established pur-
suant to section 301. 
‘‘(b) INTERAGENCY AGREEMENTS.—The Secretary is 
authorized to enter into interagency agreements with 
other Federal agencies or State agencies and other entities 
and to accept funds from such Federal or State agencies 
or other sources to provide for the planning, design, and 
construction of health care facilities to be administered by 
Indian Health Programs in order to carry out the pur-
poses of this Act and the purposes for which the funds 
were appropriated or for which the funds were otherwise 
provided. 
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CCOLEMAN on PROD1PC71 with BILLS
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‘‘(c) TRANSFERRED FUNDS.—Any Federal agency to 
which funds for the construction of health care facilities 
are appropriated is authorized to transfer such funds to 
the Secretary for the construction of health care facilities 
to carry out the purposes of this Act as well as the pur-
poses for which such funds are appropriated to such other 
Federal agency. 
‘‘(d) ESTABLISHMENT
OF STANDARDS.—The Sec-
retary, through the Service, shall establish standards by 
regulation, developed by rulemaking under section 802, for 
the planning, design, and construction of health care fa-
cilities serving Indians under this Act. 
‘‘SEC. 317. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated such sums 
as may be necessary for each fiscal year through fiscal 
year 2015 to carry out this title. 
‘‘TITLE IV—ACCESS TO HEALTH 
SERVICES 
‘‘SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SE-
CURITY ACT HEALTH CARE PROGRAMS. 
‘‘(a) DISREGARD
OF MEDICARE, MEDICAID, AND 
SCHIP PAYMENTS IN DETERMINING APPROPRIATIONS.— 
Any payments received by an Indian Health Program or 
by an Urban Indian Organization made under title XVIII, 
XIX, or XXI of the Social Security Act for services pro-
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CCOLEMAN on PROD1PC71 with BILLS
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vided to Indians eligible for benefits under such respective 
titles shall not be considered in determining appropria-
tions for the provision of health care and services to Indi-
ans. 
‘‘(b) NONPREFERENTIAL TREATMENT.—Nothing in 
this Act authorizes the Secretary to provide services to an 
Indian with coverage under title XVIII, XIX, or XXI of 
the Social Security Act in preference to an Indian without 
such coverage. 
‘‘(c) USE OF FUNDS.— 
‘‘(1) SPECIAL
FUND.—Notwithstanding any 
other provision of law, but subject to paragraph (2), 
payments to which a facility of the Service is enti-
tled by reason of a provision of the Social Security 
Act shall be placed in a special fund to be held by 
the Secretary and first used (to such extent or in 
such amounts as are provided in appropriation Acts) 
for the purpose of making any improvements in the 
programs of the Service which may be necessary to 
achieve or maintain compliance with the applicable 
conditions and requirements of titles XVIII, XIX, 
and XXI of the Social Security Act. Any amounts to 
be reimbursed that are in excess of the amount nec-
essary to achieve or maintain such conditions and 
requirements shall, subject to the consultation with 
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CCOLEMAN on PROD1PC71 with BILLS
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Indian Tribes being served by the Service Unit, be 
used for reducing the health resource deficiencies of 
the Indian Tribes. In making payments from such 
fund, the Secretary shall ensure that each Service 
Unit of the Service receives 100 percent of the 
amount to which the facilities of the Service, for 
which such Service Unit makes collections, are enti-
tled by reason of a provision of the Social Security 
Act. 
‘‘(2) DIRECT
PAYMENT
OPTION.—Paragraph 
(1) shall not apply upon the election of a Tribal 
Health Program under subsection (d) to receive pay-
ments directly. No payment may be made out of the 
special fund described in such paragraph with re-
spect to reimbursement made for services provided 
during the period of such election. 
‘‘(d) DIRECT BILLING.— 
‘‘(1) IN GENERAL.—A Tribal Health Program 
may directly bill for, and receive payment for, health 
care items and services provided by such Indian 
Tribe or Tribal Organization for which payment is 
made under title XVIII, XIX, or XXI of the Social 
Security Act or from any other third party payor. 
‘‘(2) DIRECT REIMBURSEMENT.— 
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CCOLEMAN on PROD1PC71 with BILLS
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‘‘(A) USE OF FUNDS.—Each Tribal Health 
Program exercising the option described in 
paragraph (1) with respect to a program under 
a title of the Social Security Act shall be reim-
bursed directly by that program for items and 
services furnished without regard to section 
401(c), but all amounts so reimbursed shall be 
used by the Tribal Health Program for the pur-
pose of making any improvements in Tribal fa-
cilities or Tribal Health Programs that may be 
necessary to achieve or maintain compliance 
with the conditions and requirements applicable 
generally to such items and services under the 
program under such title and to provide addi-
tional health care services, improvements in 
health care facilities and Tribal Health Pro-
grams, any health care-related purpose, or oth-
erwise to achieve the objectives provided in sec-
tion 3 of this Act. 
‘‘(B) AUDITS.—The amounts paid to an 
Indian Tribe or Tribal Organization exercising 
the option described in paragraph (1) with re-
spect to a program under a title of the Social 
Security Act shall be subject to all auditing re-
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CCOLEMAN on PROD1PC71 with BILLS
181 
quirements applicable to programs administered 
by an Indian Health Program. 
‘‘(C) IDENTIFICATION OF SOURCE OF PAY-
MENTS.—If an Indian Tribe or Tribal Organi-
zation receives funding from the Service under 
the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.) or an 
Urban Indian Organization receives funding 
from the Service under title V of this Act and 
receives reimbursements or payments under 
title XVIII, XIX, or XXI of the Social Security 
Act, such Indian Tribe or Tribal Organization, 
or Urban Indian Organization, shall provide to 
the Service a list of each provider enrollment 
number (or other identifier) under which it re-
ceives such reimbursements or payments. 
‘‘(3) EXAMINATION AND IMPLEMENTATION OF 
CHANGES.—The Secretary, acting through the Serv-
ice and with the assistance of the Administrator of 
the Centers for Medicare & Medicaid Services, shall 
examine on an ongoing basis and implement any ad-
ministrative changes that may be necessary to facili-
tate direct billing and reimbursement under the pro-
gram established under this subsection, including 
any agreements with States that may be necessary 
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CCOLEMAN on PROD1PC71 with BILLS
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to provide for direct billing under a program under 
a title of the Social Security Act. 
‘‘(4) WITHDRAWAL FROM PROGRAM.—A Tribal 
Health Program that bills directly under the pro-
gram established under this subsection may with-
draw from participation in the same manner and 
under the same conditions that an Indian Tribe or 
Tribal Organization may retrocede a contracted pro-
gram to the Secretary under the authority of the In-
dian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.). All cost accounting and 
billing authority under the program established 
under this subsection shall be returned to the Sec-
retary upon the Secretary’s acceptance of the with-
drawal of participation in this program. 
‘‘SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERV-
ICE, 
INDIAN 
TRIBES, 
TRIBAL 
ORGANIZA-
TIONS, AND URBAN INDIAN ORGANIZATIONS. 
‘‘(a) INDIAN
TRIBES
AND
TRIBAL
ORGANIZA-
TIONS.—The Secretary, acting through the Service, shall 
make grants to or enter into contracts with Indian Tribes 
and Tribal Organizations to assist such Tribes and Tribal 
Organizations in establishing and administering programs 
on or near reservations and trust lands to assist individual 
Indians— 
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CCOLEMAN on PROD1PC71 with BILLS
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‘‘(1) to enroll for benefits under title XVIII, 
XIX, or XXI of the Social Security Act and other 
health benefits programs; and 
‘‘(2) to pay premiums for coverage for such 
benefits, which may be based on financial need (as 
determined by the Indian Tribe or Tribes being 
served based on a schedule of income levels devel-
oped or implemented by such Tribe or Tribes). 
‘‘(b) CONDITIONS.—The Secretary, acting through 
the Service, shall place conditions as deemed necessary to 
effect the purpose of this section in any grant or contract 
which the Secretary makes with any Indian Tribe or Trib-
al Organization pursuant to this section. Such conditions 
shall include requirements that the Indian Tribe or Tribal 
Organization successfully undertake— 
‘‘(1) to determine the population of Indians eli-
gible for the benefits described in subsection (a); 
‘‘(2) to educate Indians with respect to the ben-
efits available under the respective programs; 
‘‘(3) to provide transportation for such indi-
vidual Indians to the appropriate offices for enroll-
ment or applications for such benefits; and 
‘‘(4) to develop and implement methods of im-
proving the participation of Indians in receiving the 
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CCOLEMAN on PROD1PC71 with BILLS
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benefits provided under titles XVIII, XIX, and XXI 
of the Social Security Act. 
‘‘(c) AGREEMENTS RELATING TO IMPROVING EN-
ROLLMENT OF INDIANS UNDER SOCIAL SECURITY ACT 
PROGRAMS.— 
‘‘(1) AGREEMENTS
WITH
SECRETARY
TO
IM-
PROVE
RECEIPT
AND
PROCESSING
OF
APPLICA-
TIONS.— 
‘‘(A) 
AUTHORIZATION.—The 
Secretary, 
acting through the Service, may enter into an 
agreement with an Indian Tribe, Tribal Organi-
zation, or Urban Indian Organization which 
provides for the receipt and processing of appli-
cations by Indians for assistance under titles 
XIX and XXI of the Social Security Act, and 
benefits under title XVIII of such Act, by an 
Indian Health Program or Urban Indian Orga-
nization. 
‘‘(B) REIMBURSEMENT OF COSTS.—Such 
agreements may provide for reimbursement of 
costs of outreach, education regarding eligibility 
and benefits, and translation when such services 
are provided. The reimbursement may, as ap-
propriate, be added to the applicable rate per 
encounter or be provided as a separate fee-for- 
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CCOLEMAN on PROD1PC71 with BILLS
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service payment to the Indian Tribe or Tribal 
Organization. 
‘‘(C) PROCESSING
CLARIFIED.—In this 
paragraph, the term ‘processing’ does not in-
clude a final determination of eligibility. 
‘‘(2) AGREEMENTS
WITH
STATES
FOR
OUT-
REACH ON OR NEAR RESERVATION.— 
‘‘(A) IN GENERAL.—In order to improve 
the access of Indians residing on or near a res-
ervation to obtain benefits under title XIX or 
XXI of the Social Security Act, the Secretary 
shall encourage the State to take steps to pro-
vide for enrollment on or near the reservation. 
Such steps may include outreach efforts such as 
the outstationing of eligibility workers, entering 
into agreements with Indian Tribes and Tribal 
Organizations to provide outreach, education re-
garding eligibility and benefits, enrollment, and 
translation services when such services are pro-
vided. 
‘‘(B) CONSTRUCTION.—Nothing in sub-
paragraph (A) shall be construed as affecting 
arrangements entered into between States and 
Indian Tribes and Tribal Organizations for 
such Indian Tribes and Tribal Organizations to 
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CCOLEMAN on PROD1PC71 with BILLS
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conduct administrative activities under such ti-
tles. 
‘‘(d) FACILITATING COOPERATION.—The Secretary, 
acting through the Centers for Medicare & Medicaid Serv-
ices, shall take such steps as are necessary to facilitate 
cooperation with, and agreements between, States and the 
Service, Indian Tribes, Tribal Organizations, or Urban In-
dian Organizations. 
‘‘(e) APPLICATION
TO URBAN INDIAN ORGANIZA-
TIONS.— 
‘‘(1) IN
GENERAL.—The provisions of sub-
section (a) shall apply with respect to grants and 
other funding to Urban Indian Organizations with 
respect to populations served by such organizations 
in the same manner they apply to grants and con-
tracts with Indian Tribes and Tribal Organizations 
with respect to programs on or near reservations. 
‘‘(2) REQUIREMENTS.—The Secretary shall in-
clude in the grants or contracts made or provided 
under paragraph (1) requirements that are— 
‘‘(A) consistent with the requirements im-
posed by the Secretary under subsection (b); 
‘‘(B) appropriate to Urban Indian Organi-
zations and Urban Indians; and 
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CCOLEMAN on PROD1PC71 with BILLS
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‘‘(C) necessary to effect the purposes of 
this section. 
‘‘SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PAR-
TIES OF COSTS OF HEALTH SERVICES. 
‘‘(a) RIGHT OF RECOVERY.—Except as provided in 
subsection (f), the United States, an Indian Tribe, or 
Tribal Organization shall have the right to recover from 
an insurance company, health maintenance organization, 
employee benefit plan, third-party tortfeasor, or any other 
responsible or liable third party (including a political sub-
division or local governmental entity of a State) the rea-
sonable charges billed by the Secretary, an Indian Tribe, 
or Tribal Organization, in providing health services, 
through the Service, an Indian Tribe, or Tribal Organiza-
tion to any individual to the same extent that such indi-
vidual, or any nongovernmental provider of such services, 
would be eligible to receive damages, reimbursement, or 
indemnification for such charges or expenses if— 
‘‘(1) such services had been provided by a non-
governmental provider; and 
‘‘(2) such individual had been required to pay 
such charges or expenses and did pay such charges 
or expenses. 
‘‘(b) LIMITATIONS ON RECOVERIES FROM STATES.— 
Subsection (a) shall provide a right of recovery against 
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CCOLEMAN on PROD1PC71 with BILLS
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any State, only if the injury, illness, or disability for which 
health services were provided is covered under— 
‘‘(1) workers’ compensation laws; or 
‘‘(2) a no-fault automobile accident insurance 
plan or program. 
‘‘(c) NONAPPLICATION OF OTHER LAWS.—No law of 
any State, or of any political subdivision of a State and 
no provision of any contract, insurance or health mainte-
nance organization policy, employee benefit plan, self-in-
surance plan, managed care plan, or other health care plan 
or program entered into or renewed after the date of the 
enactment of the Indian Health Care Amendments of 
1988, shall prevent or hinder the right of recovery of the 
United States, an Indian Tribe, or Tribal Organization 
under subsection (a). 
‘‘(d) NO EFFECT ON PRIVATE RIGHTS OF ACTION.— 
No action taken by the United States, an Indian Tribe, 
or Tribal Organization to enforce the right of recovery 
provided under this section shall operate to deny to the 
injured person the recovery for that portion of the person’s 
damage not covered hereunder. 
‘‘(e) ENFORCEMENT.— 
‘‘(1) IN GENERAL.—The United States, an In-
dian Tribe, or Tribal Organization may enforce the 
right of recovery provided under subsection (a) by— 
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CCOLEMAN on PROD1PC71 with BILLS
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‘‘(A) intervening or joining in any civil ac-
tion or proceeding brought— 
‘‘(i) by the individual for whom health 
services were provided by the Secretary, an 
Indian Tribe, or Tribal Organization; or 
‘‘(ii) by any representative or heirs of 
such individual, or 
‘‘(B) instituting a civil action, including a 
civil action for injunctive relief and other relief, 
including an action under the Federal Medical 
Cost Recovery Act (42 U.S.C. 2651–2653), and 
including, with respect to a political subdivision 
or local governmental entity of a State, such an 
action against an official thereof. 
‘‘(2) NOTICE.—All reasonable efforts shall be 
made to provide notice of action instituted under 
paragraph (1)(B) to the individual to whom health 
services were provided, either before or during the 
pendency of such action. 
‘‘(f) LIMITATION.—Absent specific written authoriza-
tion by the governing body of an Indian Tribe for the pe-
riod of such authorization (which may not be for a period 
of more than 1 year and which may be revoked at any 
time upon written notice by the governing body to the 
Service), the United States shall not have a right of recov-
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