I 
111TH CONGRESS 
1ST SESSION H. R. 2708 
To amend the Indian Health Care Improvement Act to revise and extend 
that Act, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 4, 2009 
Mr. PALLONE (for himself, Mr. RAHALL, Mr. KILDEE, Mr. YOUNG of Alaska, 
Mr. GRIJALVA, Ms. BORDALLO, Mr. BOREN, Mr. INSLEE, Mr. BACA, Mr. 
HEINRICH, Mr. TEAGUE, Ms. MCCOLLUM, Ms. LINDA T. SA´NCHEZ of 
California, Mr. KAGEN, Mr. LUJA´N, Mr. SALAZAR, Mr. SCHAUER, and 
Mrs. BONO MACK) introduced the following bill; which was referred to 
the Committee on Natural Resources, and in addition to the Committees 
on Energy and Commerce and Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend the Indian Health Care Improvement Act to revise 
and extend that Act, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Indian Health Care Improvement Act Amendments of 
2009’’. 
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(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—AMENDMENTS TO INDIAN LAWS 
Sec. 101. Indian Health Care Improvement Act amended. 
Sec. 102. Soboba sanitation facilities. 
Sec. 103. Native American Health and Wellness Foundation. 
Sec. 104. GAO study and report on payments for contract health services. 
TITLE II—IMPROVEMENT OF INDIAN HEALTH CARE PROVIDED 
UNDER THE SOCIAL SECURITY ACT 
Sec. 201. Expansion of payments under Medicare, Medicaid, and SCHIP for all 
covered services furnished by Indian Health Programs. 
Sec. 202.
Increased outreach to Indians under Medicaid and SCHIP and im-
proved cooperation in the provision of items and services to In-
dians under Social Security Act health benefit programs. 
Sec. 203. Additional provisions to increase outreach to, and enrollment of, Indi-
ans in SCHIP and Medicaid. 
Sec. 204. Nondiscrimination in qualifications for payment for services under 
Federal health care programs. 
Sec. 205. Solicitation of proposals for safe harbors under the Social Security 
Act for facilities of Indian Health Programs and urban Indian 
organizations. 
Sec. 206. Annual report on Indians served by Social Security Act health benefit 
programs. 
Sec. 207. Development of recommendations to improve interstate coordination 
of Medicaid and SCHIP coverage of Indian children and other 
children who are outside of their State of residency because of 
educational or other needs. 
TITLE I—AMENDMENTS TO 
INDIAN LAWS 
SEC. 101. INDIAN HEALTH CARE IMPROVEMENT ACT 
AMENDED. 
(a) IN GENERAL.—The Indian Health Care Improve-
ment Act (25 U.S.C. 1601 et seq.) is amended to read 
as follows: 
‘‘SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
‘‘(a) SHORT TITLE.—This Act may be cited as the 
‘Indian Health Care Improvement Act’. 
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‘‘(b) TABLE OF CONTENTS.—The table of contents 
for this Act is as follows: 
‘‘Sec. 1. Short title; table of contents. 
‘‘Sec. 2. Findings. 
‘‘Sec. 3. Declaration of national Indian health policy. 
‘‘Sec. 4. Definitions. 
‘‘TITLE I—INDIAN HEALTH, HUMAN RESOURCES, AND 
DEVELOPMENT 
‘‘Sec. 101. Purpose. 
‘‘Sec. 102. Health professions recruitment program for Indians. 
‘‘Sec. 103. Health professions preparatory scholarship program for Indians. 
‘‘Sec. 104. Indian health professions scholarships. 
‘‘Sec. 105. American Indians Into Psychology Program. 
‘‘Sec. 106. Scholarship programs for Indian Tribes. 
‘‘Sec. 107. Indian Health Service extern programs. 
‘‘Sec. 108. Continuing education allowances. 
‘‘Sec. 109. Community Health Representative Program. 
‘‘Sec. 110. Indian Health Service Loan Repayment Program. 
‘‘Sec. 111. Scholarship and Loan Repayment Recovery Fund. 
‘‘Sec. 112. Recruitment activities. 
‘‘Sec. 113. Indian recruitment and retention program. 
‘‘Sec. 114. Advanced training and research. 
‘‘Sec. 115. Quentin N. Burdick American Indians Into Nursing Program. 
‘‘Sec. 116. Tribal cultural orientation. 
‘‘Sec. 117. INMED Program. 
‘‘Sec. 118. Health training programs of community colleges. 
‘‘Sec. 119. Retention bonus. 
‘‘Sec. 120. Nursing residency program. 
‘‘Sec. 121. Community Health Aide Program. 
‘‘Sec. 122. Tribal Health Program administration. 
‘‘Sec. 123. Health professional chronic shortage demonstration programs. 
‘‘Sec. 124. National Health Service Corps. 
‘‘Sec. 125. Substance abuse counselor educational curricula demonstration pro-
grams. 
‘‘Sec. 126. Behavioral health training and community education programs. 
‘‘Sec. 127. Exemption from payment of certain fees. 
‘‘Sec. 128. Authorization of appropriations. 
‘‘TITLE II—HEALTH SERVICES 
‘‘Sec. 201. Indian Health Care Improvement Fund. 
‘‘Sec. 202. Health promotion and disease prevention services. 
‘‘Sec. 203. Diabetes prevention, treatment, and control. 
‘‘Sec. 204. Shared services for long-term care. 
‘‘Sec. 205. Health services research. 
‘‘Sec. 206. Mammography and other cancer screening. 
‘‘Sec. 207. Patient travel costs. 
‘‘Sec. 208. Epidemiology centers. 
‘‘Sec. 209. Comprehensive school health education programs. 
‘‘Sec. 210. Indian youth program. 
‘‘Sec. 211. Prevention, control, and elimination of communicable and infectious 
diseases. 
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‘‘Sec. 212. Other authority for provision of services. 
‘‘Sec. 213. Indian women’s health care. 
‘‘Sec. 214. Environmental and nuclear health hazards. 
‘‘Sec. 215. Arizona as a contract health service delivery area. 
‘‘Sec. 216. North Dakota and South Dakota as contract health service delivery 
area. 
‘‘Sec. 217. California contract health services program. 
‘‘Sec. 218. California as a contract health service delivery area. 
‘‘Sec. 219. Contract health services for the Trenton Service Area. 
‘‘Sec. 220. Programs operated by Indian Tribes and tribal organizations. 
‘‘Sec. 221. Licensing. 
‘‘Sec. 222. Notification of provision of emergency contract health services. 
‘‘Sec. 223. Prompt action on payment of claims. 
‘‘Sec. 224. Liability for payment. 
‘‘Sec. 225. Office of Indian Men’s Health. 
‘‘Sec. 226. Authorization of appropriations. 
‘‘TITLE III—FACILITIES 
‘‘Sec. 301. Consultation; construction and renovation of facilities; reports. 
‘‘Sec. 302. Sanitation facilities. 
‘‘Sec. 303. Preference to Indians and Indian firms. 
‘‘Sec. 304. Expenditure of non-Service funds for renovation. 
‘‘Sec. 305. Funding for the construction, expansion, and modernization of small 
ambulatory care facilities. 
‘‘Sec. 306. Indian health care delivery demonstration project. 
‘‘Sec. 307. Land transfer. 
‘‘Sec. 308. Leases, contracts, and other agreements. 
‘‘Sec. 309. Study on loans, loan guarantees, and loan repayment. 
‘‘Sec. 310. Tribal leasing. 
‘‘Sec. 311. Indian Health Service/tribal facilities joint venture program. 
‘‘Sec. 312. Location of facilities. 
‘‘Sec. 313. Maintenance and improvement of health care facilities. 
‘‘Sec. 314. Tribal management of federally owned quarters. 
‘‘Sec. 315. Applicability of Buy American Act requirement. 
‘‘Sec. 316. Other funding for facilities. 
‘‘Sec. 317. Authorization of appropriations. 
‘‘TITLE IV—ACCESS TO HEALTH SERVICES 
‘‘Sec. 401. Treatment of payments under Social Security Act health benefits 
programs. 
‘‘Sec. 402. Grants to and contracts with the Service, Indian Tribes, Tribal Or-
ganizations, and urban Indian organizations to facilitate out-
reach, enrollment, and coverage of Indians under Social Secu-
rity Act health benefit programs. 
‘‘Sec. 403. Reimbursement from certain third parties of costs of health services. 
‘‘Sec. 404. Crediting of reimbursements. 
‘‘Sec. 405. Purchasing health care coverage. 
‘‘Sec. 406. Sharing arrangements with Federal agencies. 
‘‘Sec. 407. Eligible indian veteran services. 
‘‘Sec. 408. Payor of last resort. 
‘‘Sec. 409. Nondiscrimination under Federal health care programs in qualifica-
tions for reimbursement for services. 
‘‘Sec. 410. Consultation. 
‘‘Sec. 411. State Children’s Health Insurance Program (SCHIP). 
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‘‘Sec. 412. Exclusion waiver authority for affected Indian Health Programs and 
safe harbor transactions under the Social Security Act. 
‘‘Sec. 413. Premium and cost sharing protections and eligibility determinations 
under Medicaid and SCHIP and protection of certain Indian 
property from Medicaid estate recovery. 
‘‘Sec. 414. Treatment under Medicaid and SCHIP managed care. 
‘‘Sec. 415. Navajo Nation Medicaid Agency feasibility study. 
‘‘Sec. 416. Exception for excepted benefits. 
‘‘Sec. 417. Authorization of appropriations. 
‘‘TITLE V—HEALTH SERVICES FOR URBAN INDIANS 
‘‘Sec. 501. Purpose. 
‘‘Sec. 502. Contracts with, and grants to, urban Indian organizations. 
‘‘Sec. 503. Contracts and grants for the provision of health care and referral 
services. 
‘‘Sec. 504. Use of Federal Government Facilities and Sources of Supply. 
‘‘Sec. 505. Contracts and grants for the determination of unmet health care 
needs. 
‘‘Sec. 506. Evaluations; renewals. 
‘‘Sec. 507. Other contract and grant requirements. 
‘‘Sec. 508. Reports and records. 
‘‘Sec. 509. Limitation on contract authority. 
‘‘Sec. 510. Facilities. 
‘‘Sec. 511. Division of Urban Indian Health. 
‘‘Sec. 512. Grants for alcohol and substance abuse-related services. 
‘‘Sec. 513. Treatment of certain demonstration projects. 
‘‘Sec. 514. Urban NIAAA transferred programs. 
‘‘Sec. 515. Conferring with urban Indian organizations. 
‘‘Sec. 516. Urban youth treatment center demonstration. 
‘‘Sec. 517. Grants for diabetes prevention, treatment, and control. 
‘‘Sec. 518. Community health representatives. 
‘‘Sec. 519. Effective date. 
‘‘Sec. 520. Eligibility for services. 
‘‘Sec. 521. Authorization of appropriations. 
‘‘Sec. 522. Health information technology. 
‘‘TITLE VI—ORGANIZATIONAL IMPROVEMENTS 
‘‘Sec. 601. Establishment of the Indian Health Service as an agency of the 
Public Health Service. 
‘‘Sec. 602. Automated management information system. 
‘‘Sec. 603. Authorization of appropriations. 
‘‘TITLE VII—BEHAVIORAL HEALTH PROGRAMS 
‘‘Sec. 701. Behavioral health prevention and treatment services. 
‘‘Sec. 702. Memoranda of agreement with the Department of the Interior. 
‘‘Sec. 703. Comprehensive behavioral health prevention and treatment program. 
‘‘Sec. 704. Mental health technician program. 
‘‘Sec. 705. Licensing requirement for mental health care workers. 
‘‘Sec. 706. Indian women treatment programs. 
‘‘Sec. 707. Indian youth program. 
‘‘Sec. 708. Indian youth telemental health demonstration project. 
‘‘Sec. 709. Inpatient and community-based mental health facilities design, con-
struction, and staffing. 
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‘‘Sec. 710. Training and community education. 
‘‘Sec. 711. Behavioral health program. 
‘‘Sec. 712. Fetal alcohol disorder programs. 
‘‘Sec. 713. Child sexual abuse and prevention treatment programs. 
‘‘Sec. 714. Domestic and sexual violence prevention and treatment. 
‘‘Sec. 715. Behavioral health research. 
‘‘Sec. 716. Definitions. 
‘‘Sec. 717. Authorization of appropriations. 
‘‘TITLE VIII—MISCELLANEOUS 
‘‘Sec. 801. Reports. 
‘‘Sec. 802. Regulations. 
‘‘Sec. 803. Plan of implementation. 
‘‘Sec. 804. Limitation on use of funds appropriated to Indian Health Service. 
‘‘Sec. 805. Eligibility of California Indians. 
‘‘Sec. 806. Health services for ineligible persons. 
‘‘Sec. 807. Treatment of certain services and benefits. 
‘‘Sec. 808. Reallocation of base resources. 
‘‘Sec. 809. Results of demonstration projects. 
‘‘Sec. 810. Provision of services in Montana. 
‘‘Sec. 811. Moratorium. 
‘‘Sec. 812. Severability provisions. 
‘‘Sec. 813. Use of patient safety organizations. 
‘‘Sec. 814. Confidentiality of medical quality assurance records; qualified immu-
nity for participants. 
‘‘Sec. 815. Claremore Indian Hospital. 
‘‘Sec. 816. Sense of Congress regarding law enforcement and methamphetamine 
issues in Indian country. 
‘‘Sec. 817. Permitting implementation through contracts with Tribal Health 
Programs. 
‘‘Sec. 818. Authorization of appropriations; availability. 
‘‘SEC. 2. FINDINGS. 
‘‘Congress makes the following findings: 
‘‘(1) Federal health services to maintain and 
improve the health of the Indians are consonant 
with and required by the Federal Government’s his-
torical and unique legal relationship with, and re-
sulting responsibility to, the American Indian people. 
‘‘(2) A major national goal of the United States 
is to provide the resources, processes, and structure 
that will enable Indian tribes and tribal members to 
obtain the quantity and quality of health care serv-
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ices and opportunities that will eradicate the health 
dispartities between Indians the general population. 
‘‘(3) A major national goal of the United States 
is to provide the quantity and quality of health serv-
ices which will permit the health status of Indians 
to be raised to the highest possible level and to en-
courage the maximum participation of Indians in the 
planning and management of those services. 
‘‘(4) Federal health services to Indians have re-
sulted in a reduction in the prevalence and incidence 
of preventable illnesses among, and unnecessary and 
premature deaths of, Indians. 
‘‘(5) Despite such services, the unmet health 
needs of the American Indian people are severe and 
the health status of the Indians is far below that of 
the general population of the United States. 
‘‘SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POL-
ICY. 
‘‘Congress declares that it is the policy of this Nation, 
in fulfillment of its special trust responsibilities and legal 
obligations to Indians— 
‘‘(1) to assure the highest possible health status 
for Indians and to provide all resources necessary to 
effect that policy; 
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‘‘(2) to raise the health status of Indians to at 
least the levels set forth in the goals contained with-
in the Health People 2010 or successor objectives; 
‘‘(3) to the greatest extent possible, to allow In-
dians to set their own health care priorities and es-
tablish goals that reflect their unmet needs; 
‘‘(4) to increase the proportion of all degrees in 
the health professions and allied and associated 
health professions awarded to Indians so that the 
proportion of Indian health professionals in each 
Service Area is raised to at least the level of that of 
the general population; 
‘‘(5) to require meaningful consultation with In-
dian Tribes, Tribal Organizations, and urban Indian 
organizations to implement this Act and the national 
policy of Indian self-determination; and 
‘‘(6) to provide funding for programs and facili-
ties operated by Indian Tribes and Tribal Organiza-
tions in amounts that are not less than the amounts 
provided to programs and facilities operated directly 
by the Service. 
‘‘SEC. 4. DEFINITIONS. 
‘‘For purposes of this Act: 
‘‘(1) The term ‘accredited and accessible’ means 
on or near a reservation and accredited by a na-
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tional or regional organization with accrediting au-
thority. 
‘‘(2) The term ‘Area Office’ means an adminis-
trative entity, including a program office, within the 
Service through which services and funds are pro-
vided to the Service Units within a defined geo-
graphic area. 
‘‘(3) The term ‘Assistant Secretary’ means the 
Assistant Secretary of Indian Health. 
‘‘(4)(A) The term ‘behavioral health’ means the 
blending of substance (including alcohol, drugs, 
inhalants, and tobacco) abuse and mental health 
prevention and treatment, for the purpose of pro-
viding comprehensive services. 
‘‘(B) The term ‘behavioral health’ includes the 
joint development of substance abuse and mental 
health treatment planning and coordinated case 
management using a multidisciplinary approach. 
‘‘(5) The term ‘California Indians’ means those 
Indians who are eligible for health services of the 
Service pursuant to section 805. 
‘‘(6) The term ‘community college’ means— 
‘‘(A) a tribal college or university, or 
‘‘(B) a junior or community college. 
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‘‘(7) The term ‘contract health service’ means 
health services provided at the expense of the Serv-
ice or a Tribal Health Program by public or private 
medical providers or hospitals, other than the Serv-
ice Unit or the Tribal Health Program at whose ex-
pense the services are provided. 
‘‘(8) The term ‘Department’ means, unless oth-
erwise designated, the Department of Health and 
Human Services. 
‘‘(9) The term ‘disease prevention’ means the 
reduction, limitation, and prevention of disease and 
its complications and reduction in the consequences 
of disease, including— 
‘‘(A) controlling— 
‘‘(i) the development of diabetes; 
‘‘(ii) high blood pressure; 
‘‘(iii) infectious agents; 
‘‘(iv) injuries; 
‘‘(v) occupational hazards and disabil-
ities; 
‘‘(vi) sexually transmittable diseases; 
and 
‘‘(vii) toxic agents; and 
‘‘(B) providing— 
‘‘(i) fluoridation of water; and 
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‘‘(ii) immunizations. 
‘‘(10) The term ‘health profession’ means 
allopathic medicine, family medicine, internal medi-
cine, pediatrics, geriatric medicine, obstetrics and 
gynecology, podiatric medicine, nursing, public 
health nursing, dentistry, psychiatry, osteopathy, op-
tometry, pharmacy, psychology, public health, social 
work, marriage and family therapy, chiropractic 
medicine, environmental health and engineering, al-
lied health professions, naturopathic medicine, and 
any other health profession. 
‘‘(11) The term ‘health promotion’ means— 
‘‘(A) fostering social, economic, environ-
mental, and personal factors conducive to 
health, including raising public awareness about 
health matters and enabling the people to cope 
with health problems by increasing their knowl-
edge and providing them with valid information; 
‘‘(B) encouraging adequate and appro-
priate diet, exercise, and sleep; 
‘‘(C) promoting education and work in con-
formity with physical and mental capacity; 
‘‘(D) making available safe water and sani-
tary facilities; 
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‘‘(E) improving the physical, economic, cul-
tural, psychological, and social environment; 
‘‘(F) promoting culturally competent care; 
and 
‘‘(G) providing adequate and appropriate 
programs, which may include— 
‘‘(i) abuse prevention (mental and 
physical); 
‘‘(ii) community health; 
‘‘(iii) community safety; 
‘‘(iv) consumer health education; 
‘‘(v) diet and nutrition; 
‘‘(vi) immunization and other preven-
tion of communicable diseases, including 
HIV/AIDS; 
‘‘(vii) environmental health; 
‘‘(viii) exercise and physical fitness; 
‘‘(ix) avoidance of fetal alcohol dis-
orders; 
‘‘(x) first aid and CPR education; 
‘‘(xi) human growth and development; 
‘‘(xii) injury prevention and personal 
safety; 
‘‘(xiii) behavioral health; 
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‘‘(xiv) monitoring of disease indicators 
between 
health 
care 
provider 
visits, 
through 
appropriate 
means, 
including 
Internet-based health care management 
systems; 
‘‘(xv) personal health and wellness 
practices; 
‘‘(xvi) personal capacity building; 
‘‘(xvii) prenatal, pregnancy, and in-
fant care; 
‘‘(xviii) psychological well-being; 
‘‘(xix) reproductive health and family 
planning; 
‘‘(xx) safe and adequate water; 
‘‘(xxi) healthy work environments; 
‘‘(xxii) elimination, reduction, and 
prevention of contaminants that create 
unhealthy household conditions (including 
mold and other allergens); 
‘‘(xxiii) stress control; 
‘‘(xxiv) substance abuse; 
‘‘(xxv) sanitary facilities; 
‘‘(xxvi) sudden infant death syndrome 
prevention; 
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‘‘(xxvii) tobacco use cessation and re-
duction; 
‘‘(xxviii) violence prevention; and 
‘‘(xxix) activities to promote achieve-
ment of any of the objectives described in 
section 3(2). 
‘‘(12) The term ‘Indian’, unless otherwise des-
ignated, means any person who is a member of an 
Indian Tribe or is eligible for health services under 
section 805, except that, for the purpose of sections 
102 and 103, the term also means any individual 
who— 
‘‘(A)(i) irrespective of whether the indi-
vidual lives on or near a reservation, is a mem-
ber of a tribe, band, or other organized group 
of Indians, including those tribes, bands, or 
groups terminated since 1940 and those recog-
nized now or in the future by the State in 
which they reside; or 
‘‘(ii) is a descendant, in the first or second 
degree, of any such member; 
‘‘(B) is an Eskimo or Aleut or other Alas-
ka Native; 
‘‘(C) is considered by the Secretary of the 
Interior to be an Indian for any purpose; or 
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‘‘(D) is determined to be an Indian under 
regulations promulgated by the Secretary. 
‘‘(13) The term ‘Indian Health Program’ 
means— 
‘‘(A) any health program administered di-
rectly by the Service; 
‘‘(B) any Tribal Health Program; or 
‘‘(C) any Indian Tribe or Tribal Organiza-
tion to which the Secretary provides funding 
pursuant to section 23 of the Act of June 25, 
1910 (25 U.S.C. 47) (commonly known as the 
‘Buy Indian Act’). 
‘‘(14) The term ‘Indian Tribe’ has the meaning 
given the term in the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.). 
‘‘(15) The term ‘junior or community college’ 
has the meaning given the term by section 312(f) of 
the Higher Education Act of 1965 (20 U.S.C. 
1058(f)). 
‘‘(16) The term ‘reservation’ means any feder-
ally recognized Indian Tribe’s reservation, Pueblo, or 
colony, including former reservations in Oklahoma, 
Indian allotments, and Alaska Native Regions estab-
lished pursuant to the Alaska Native Claims Settle-
ment Act (43 U.S.C. 1601 et seq.). 
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‘‘(17) The term ‘Secretary’, unless otherwise 
designated, means the Secretary of Health and 
Human Services. 
‘‘(18) The term ‘Service’ means the Indian 
Health Service. 
‘‘(19) The term ‘Service Area’ means the geo-
graphical area served by each Area Office. 
‘‘(20) The term ‘Service Unit’ means an admin-
istrative entity of the Service, or a Tribal Health 
Program through which services are provided, di-
rectly or by contract, to eligible Indians within a de-
fined geographic area. 
‘‘(21) The term ‘telehealth’ has the meaning 
given the term in section 330K(a) of the Public 
Health Service Act (42 U.S.C. 254c–16(a)). 
‘‘(22) The term ‘telemedicine’ means a tele-
communications link to an end user through the use 
of eligible equipment that electronically links health 
professionals or patients and health professionals at 
separate sites in order to exchange health care infor-
mation in audio, video, graphic, or other format for 
the purpose of providing improved health care serv-
ices. 
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‘‘(23) The term ‘tribal college or university’ has 
the meaning given the term in section 316(b)(3) of 
the Higher Education Act (20 U.S.C. 1059c(b)(3)). 
‘‘(24) The term ‘Tribal Health Program’ means 
an Indian Tribe or Tribal Organization that oper-
ates any health program, service, function, activity, 
or facility funded, in whole or part, by the Service 
through, or provided for in, a contract or compact 
with the Service under the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C. 450 
et seq.). 
‘‘(25) The term ‘Tribal Organization’ has the 
meaning given the term in the Indian Self-Deter-
mination and Education Assistance Act (25 U.S.C. 
450 et seq.). 
‘‘(26) The term ‘Urban Center’ means any com-
munity which has a sufficient Urban Indian popu-
lation with unmet health needs to warrant assistance 
under title V of this Act, as determined by the Sec-
retary. 
‘‘(27) The term ‘Urban Indian’ means any indi-
vidual who resides in an Urban Center and who 
meets 1 or more of the following criteria: 
‘‘(A) Irrespective of whether the individual 
lives on or near a reservation, the individual is 
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tain such agreements, assurances, and information 
as consistent with this section. 
‘‘(b) REQUIREMENTS.— 
‘‘(1) IN GENERAL.—A Tribal Health Program 
receiving a grant under subsection (a) shall provide 
scholarships to Indians in accordance with the re-
quirements of this section. 
‘‘(2) COSTS.—With respect to costs of providing 
any scholarship pursuant to subsection (a)— 
‘‘(A) 80 percent of the costs of the scholar-
ship shall be paid from the funds made avail-
able pursuant to subsection (a)(1) provided to 
the Tribal Health Program; and 
‘‘(B) 20 percent of such costs may be paid 
from any other source of funds. 
‘‘(c) COURSE OF STUDY.—A Tribal Health Program 
shall provide scholarships under this section only to Indi-
ans enrolled or accepted for enrollment in a course of 
study (approved by the Secretary) in 1 of the health pro-
fessions contemplated by this Act. 
‘‘(d) CONTRACT.— 
‘‘(1) IN GENERAL.—In providing scholarships 
under subsection (b), the Secretary and the Tribal 
Health Program shall enter into a written contract 
with each recipient of such scholarship. 
VerDate Nov 24 2008 
23:28 Jun 06, 2009
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