until its cost of treating any victim of such cata-
strophic illness or disaster has reached a certain
threshold cost which the Secretary shall establish
at—
‘‘(A) the 1999 level of $19,000; and
‘‘(B) for any subsequent year, not less
than the threshold cost of the previous year in-
creased by the percentage increase in the med-
ical care expenditure category of the consumer
price index for all urban consumers (United
States city average) for the 12-month period
ending with December of the previous year; and
‘‘(3) establish a procedure for the reimburse-
ment of the portion of the costs incurred by—
‘‘(A) service units, Indian tribes or tribal
organizations, or facilities of the Service, or
‘‘(B) whenever otherwise authorized by the
Service, non-Service facilities or providers,
in rendering treatment that exceeds such threshold
cost;
‘‘(4) establish a procedure for payment from
CHEF in cases in which the exigencies of the med-
ical circumstances warrant treatment prior to the
authorization of such treatment by the Service; and
‘‘(5) establish a procedure that will ensure that
no payment shall be made from CHEF to any pro-
vider of treatment to the extent that such provider
is eligible to receive payment for the treatment from
any other Federal, State, local, or private source of
reimbursement for which the patient is eligible.
‘‘(c) Amounts appropriated to CHEF under this sec-
tion shall not be used to offset or limit appropriations
made to the Service under the authority of the Act of No-
vember 2, 1921 (25 U.S.C. 13), popularly known as the
Snyder Act, or any other law.
‘‘(d) There shall be deposited into CHEF all reim-
bursements to which the Service is entitled from any Fed-
eral, State, local, or private source (including third-party
insurance) by reason of treatment rendered to any victim
of a disaster or catastrophic illness the cost of which was
paid from CHEF.
‘‘SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION
SERVICES.
‘‘(a) The Congress finds that health promotion and
disease prevention activities will—
‘‘(1) improve the health and well-being of Indi-
ans, and
‘‘(2) reduce the expenses for health care of In-
dians.
‘‘(b) The Secretary, acting through the Service, and
through willing Indian tribes and tribal organizations,
shall provide health promotion and disease prevention
services to Indians so as to achieve the health status objec-
tives set forth in section 3(b).
‘‘(c) The Secretary, after obtaining input from the
affected Indian tribes and tribal organizations, shall sub-
mit to the President for inclusion in each statement which
is required to be submitted to the Congress under section
801 an evaluation of—
‘‘(1) the health promotion and disease preven-
tion needs of Indians;
‘‘(2) the health promotion and disease preven-
tion activities which would best meet such needs;
‘‘(3) the internal capacity of the Service to meet
such needs; and
‘‘(4) the resources which would be required to
enable the Service to undertake the health promotion
and disease prevention activities necessary to meet
such needs.
‘‘SEC. 204. DIABETES PREVENTION, TREATMENT, AND CON-
TROL.
‘‘(a) The Secretary, in consultation with the Indian
tribes and tribal organizations, shall determine—
‘‘(1) by tribe, tribal organization, and by Serv-
ice unit of the Service, the incidence of, and the
types of complications resulting from, diabetes
among Indians; and
‘‘(2) based on paragraph (1), the measures (in-
cluding patient education) each Service unit should
take to reduce the incidence of, and prevent, treat,
and control the complications resulting from, diabe-
tes among Indian tribes within that Service unit.
‘‘(b) The Secretary shall screen each Indian who re-
ceives services from the Service for diabetes and for condi-
tions which indicate a high risk that the individual will
become diabetic. Such screening may be done by a tribe
or tribal organization operating health care programs or
facilities with funds from the Service under the Indian
Self-Determination and Education Assistance Act.
‘‘(c) The Secretary shall continue to fund through fis-
cal year 2012 each model diabetes project in existence on
the date of the enactment of the Indian Health Amend-
ments of 2000 and any such other diabetes programs op-
erated by the Secretary or Indian tribes and tribal organi-
zations and any additional programs added to meet exist-
ing needs. Indian tribes and tribal organizations shall re-
ceive recurring funding for the diabetes programs which
they operate pursuant to this section.
‘‘(d) The Secretary shall provide funding through the
Service, Indian tribes, and tribal organizations to establish
dialysis programs, including funding to purchase dialysis
equipment and provide necessary staffing.
‘‘(e) The Secretary shall, to the extent funding is
available—
‘‘(1) in each Area Office of the Service, consult
with Indian tribes and tribal organizations regarding
programs for the prevention, treatment, and control
of diabetes;
‘‘(2) establish in each Area Office of the Service
a registry of patients with diabetes to track the inci-
dence of diabetes and the complications from diabe-
tes in that area; and
‘‘(3) ensure that data collected in each Area Of-
fice regarding diabetes and related complications
among Indians is disseminated to all other Area Of-
fices.
‘‘SEC. 205. SHARED SERVICES.
‘‘(a) The Secretary is authorized to enter into fund-
ing agreements or other arrangements with Indian tribes
or tribal organizations for the delivery of long-term care
and similar services to Indians. Such projects shall provide
for the sharing of staff or other services between a Service
or tribal facility and a long-term care or other similar fa-
cility owned and operated (directly or through funding
agreement) by such Indian tribe or tribal organization.
‘‘(b) A funding agreement or other arrangement en-
tered into pursuant to subsection (a)—
‘‘(1) may, at the request of the Indian tribe or
tribal organization, delegate to such tribe or tribal
organization such powers of supervision and control
over Service employees as the Secretary deems nec-
essary to carry out the purposes of this section;
‘‘(2) shall provide that expenses (including sala-
ries) relating to services that are shared between the
Service and the tribal facility be allocated propor-
tionately between the Service and the tribe or tribal
organization; and
‘‘(3) may authorize such tribe or tribal organi-
zation to construct, renovate, or expand a long-term
care or other similar facility (including the construc-
tion of a facility attached to a Service facility).
‘‘(c) The Secretary shall provide such technical and
other assistance as may be necessary to enable applicants
to comply with the provisions of this section.
‘‘(d) The Secretary shall encourage the use for long-
term or similar care of existing facilities that are
underused or allow the use of swing beds for such pur-
poses.
‘‘SEC. 206. HEALTH SERVICES RESEARCH.
‘‘The Secretary shall make funding available for re-
search to further the performance of the health service re-
sponsibilities of the Service, Indian tribes, and tribal orga-
nizations and shall coordinate the activities of other agen-
cies within the Department of Health and Human Services
to address these research needs. The funding shall be di-
vided equitably among the Area Offices and then each
Area Office shall award the funds competitively within
that Area. Indian tribes and tribal organizations receiving
funding from the Service under the authority of the Indian
Self-Determination and Education Assistance Act shall be
given an equal opportunity to compete for, and receive,
research funds under this section. This funding may be
used for both clinical and nonclinical research by Indian
tribes and tribal organizations and shall be distributed to
the Area Offices which may make grants from these funds
within each Area.
‘‘SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREEN-
ING.
‘‘The Secretary, through the Service or through In-
dian tribes or tribal organizations, shall provide for screen-
ing, as follows:
‘‘(1) Mammography (as defined in section
1861(jj) of the Social Security Act) for Indian
women at a frequency appropriate to such women
under national standards, and under such terms and
conditions as are consistent with standards estab-
lished by the Secretary to ensure the safety and ac-
curacy of screening mammography under part B of
title XVIII of the Social Security Act.
‘‘(2) Other cancer screening meeting national
standards.
‘‘SEC. 208. PATIENT TRAVEL COSTS.
‘‘The Secretary, acting through the Service and will-
ing Indian tribes and tribal organizations, shall provide
funds for the following patient travel costs, including ap-
propriate and necessary qualified escorts, associated with
receiving health care services provided (either through di-
rect or contract care or through funding agreements en-
tered into pursuant to the Indian Self-Determination and
Education Assistance Act) under this Act—
‘‘(1) 
emergency 
air 
transportation 
non-
emergency air transportation where ground trans-
portation is infeasible;
‘‘(2) transportation by private vehicle, specially
equipped vehicle and ambulance; and
‘‘(3) transportation by such other means as
may be available and required when air or motor ve-
hicle transportation is not available.
‘‘SEC. 209. EPIDEMIOLOGY CENTERS.
‘‘(a)(1) In addition to those centers already estab-
lished at the time of enactment of this Act (including those
for which funding is currently being provided in funding
agreements under the Indian Self-Determination and
Education Assistance Act), within 180 days of enactment
of the Indian Health Care Improvement Act Amendments
of 2000, the Secretary shall establish and fund an epide-
miology center in each service area which does not yet
have one to carry out the functions described in paragraph
(2). Any new centers so established may be operated by
Indian tribes or tribal organizations pursuant to funding
agreements under the Indian Self-Determination and
Education Assistance Act, but such funding may not be
divisible.
‘‘(2) In consultation with and upon the request of In-
dian tribes, tribal organizations, and urban Indian organi-
zations, each area epidemiology center established under
this subsection shall, with respect to such area carry out—
‘‘(A) collect data relating to, and monitor
progress made toward meeting, each of the health
status objectives of the Indian Health Service, the
Indian tribes, tribal organizations, and urban Indian
organizations in the Area;
‘‘(B) evaluate existing delivery systems, data
systems, and other systems that impact the improve-
ment of Indian health;
‘‘(C) assist Indian tribes, tribal organizations,
and urban Indian organizations in identifying their
highest priority health status objectives and the
services needed to achieve such objectives, based on
epidemiological data;
‘‘(D) make recommendations for the targeting
of services needed by tribal, urban, and other Indian
communities;
‘‘(E) make recommendations to improve health
care delivery systems for Indians and urban Indians;
‘‘(F) provide requested technical assistance to
Indian tribes and urban Indian organizations in the
development of local health service priorities and in-
cidence and prevalence rates of disease and other ill-
ness in the community; and
‘‘(G) provide disease surveillance and assist In-
dian tribes, tribal organizations, and urban Indian
organizations to promote public health.
‘‘(3) The Director of the Centers for Disease Control
and Prevention shall provide technical assistance to the
centers in carrying out the requirements of this sub-
section.
‘‘(b) The Secretary may make funding available to
Indian tribes, tribal organizations, and urban Indian orga-
nizations to conduct epidemiological studies of Indian
communities.
‘‘SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION
PROGRAMS.
‘‘(a) The Secretary shall provide funding to Indian
tribes, tribal organizations and urban Indian organizations
to develop comprehensive school health education pro-
grams for children from preschool through grade 12 in
schools for the benefit of Indian and urban Indian chil-
dren.
‘‘(b) Funding provided under this section may be
used for purposes which may include, but are not limited
to the following:
‘‘(1) Developing and implementing health edu-
cation curricula both for regular school programs
and after-school programs.
‘‘(2) Training teachers in comprehensive school
health education curricula.
‘‘(3) 
Integrating 
school-based, 
community-
based, and other public and private health promotion
efforts.
‘‘(4) Encouraging healthy, tobacco-free school
environments.
100
‘‘(5) Coordinating school-based health programs
with existing services and programs available in the
community.
‘‘(6) Developing school programs on nutrition
education, personal health, oral health, and fitness.
‘‘(7) Developing mental health wellness pro-
grams.
‘‘(8) Developing chronic disease prevention pro-
grams.
‘‘(9) Developing substance abuse prevention
programs.
‘‘(10) Developing injury prevention and safety
education programs.
‘‘(11) Developing activities for the prevention
and control of communicable diseases.
‘‘(12) Developing community and environmental
health education programs that include traditional
health care practitioners.
‘‘(13) Violence prevention.
‘‘(14) Such other health issues as are appro-
priate.
‘‘(c) Upon request, the Secretary shall provide tech-
nical assistance to Indian tribes, tribal organizations, and
urban Indian organizations in the development of com-
prehensive health education plans, and the dissemination
102
‘‘(A) provide training to teachers in comprehen-
sive school health education curricula;
‘‘(B) ensure the integration and coordination of
school-based programs with existing services and
health programs available in the community; and
‘‘(C) encourage healthy, tobacco-free school en-
vironments.
‘‘SEC. 211. INDIAN YOUTH PROGRAM.
‘‘(a) The Secretary is authorized to provide funding
to Indian tribes, tribal organizations, and urban Indian
organizations for innovative mental and physical disease
prevention and health promotion and treatment programs
for Indian and urban Indian preadolescent and adolescent
youths.
‘‘(b)(1) Funds made available under this section may
be used to—
‘‘(A) develop prevention and treatment pro-
grams for Indian youth which promote mental and
physical health and incorporate cultural values, com-
munity and family involvement, and traditional
health care practitioners; and
‘‘(B) develop and provide community training
and education.
‘‘(2) Funds made available under this section may
not be used to provide services described in section 707(c).
103
‘‘(c) The Secretary shall—
‘‘(1) disseminate to Indian tribes, tribal organi-
zations, and urban Indian organizations information
regarding models for the delivery of comprehensive
health care services to Indian and urban Indian ado-
lescents;
‘‘(2) encourage the implementation of such
models; and
‘‘(3) at the request of an Indian tribe, tribal or-
ganization, or urban Indian organization, provide
technical assistance in the implementation of such
models.
‘‘(d) The Secretary, in consultation with Indian
tribes, tribal organizations, and urban Indian organiza-
tions, shall establish criteria for the review and approval
of applications or proposals under this section.
‘‘SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF
COMMUNICABLE AND INFECTIOUS DISEASES.
‘‘(a) The Secretary, after consultation with Indian
tribes, tribal organizations, and urban Indian organiza-
tions, and the Centers for Disease Control and Prevention,
may make funding available to Indian tribes and tribal
organizations for—
‘‘(1) projects for the prevention, control, and
elimination of communicable and infectious diseases
104
including, but not limited to, tuberculosis, hepatitis,
HIV, respiratory syncitial virus, hanta virus, sexu-
ally transmitted diseases, and H. Pylori;
‘‘(2) public information and education programs
for the prevention, control, and elimination of com-
municable and infectious diseases; and
‘‘(3) education, training, and clinical skills im-
provement activities in the prevention, control, and
elimination of communicable and infectious diseases
for health professionals, including allied health pro-
fessionals.
‘‘(b) The Secretary may provide funding under sub-
section (a) only if an application or proposal for funding
is submitted to the Secretary.
‘‘(c) Indian tribes and tribal organizations receiving
funding under this section are encouraged to coordinate
their activities with the Centers for Disease Control and
Prevention and State and local health agencies.
‘‘(d) In carrying out this section, the Secretary—
‘‘(1) may, at the request of an Indian tribe or
tribal organization, provide technical assistance; and
‘‘(2) shall prepare and submit a report to the
Congress biennially on the use of funds under this
section and on the progress made toward the preven-
tion, control, and elimination of communicable and
105
infectious diseases among Indians and urban Indi-
ans.
‘‘SEC. 
213. 
AUTHORITY 
FOR 
PROVISION 
OF 
OTHER
SERVICES.
‘‘(a) The Secretary, acting through the Service and
willing tribes and tribal organizations, may provide fund-
ing under this Act to meet the objectives set forth in sec-
tion 3 of this Act through health care related services and
programs not otherwise described in this Act, which shall
include, but not be limited to—
‘‘(1) hospice care and assisted living;
‘‘(2) long-term health care;
‘‘(3) home- and community-based services;
‘‘(4) public health functions; and
‘‘(5) traditional health care practices.
‘‘(b) At the discretion of the Service, Indian tribes,
or tribal organizations, services provided for hospice care,
home health care (under section 201 of this Act), home-
and community-based care, assisted living, and long-term
care may be provided (on a cost basis) to persons other-
wise ineligible for the health care benefits of the Service.
Any funds received under this subsection shall not be used
to offset or limit the funding allocated to a tribe or tribal
organization.
106
‘‘(c) For the purposes of this section, the following
definitions shall apply:
‘‘(1) The term ‘hospice care’ means the items
and services specified in subparagraphs (A) through
(H) of section 1861(dd)(1) of the Social Security
Act (42 U.S.C. 1395x(dd)(1)), and such other serv-
ices which a tribe or tribal organization determines
are necessary and appropriate to provide in further-
ance of this care.
‘‘(2) The term ‘home- and community-based
services’ means 1 or more of the following:
‘‘(A) Homemaker/home health aide serv-
ices.
‘‘(B) Chore services.
‘‘(C) Personal care services.
‘‘(D) Nursing care services provided out-
side of a nursing facility by, or under the super-
vision of, a registered nurse.
‘‘(E) Training for family members.
‘‘(F) Adult day care.
‘‘(G) Such other home- and community-
based services as the Secretary or a tribe or
tribal organization may approve.
‘‘(3) The term ‘public health functions’ means
the provision of public health related programs,
107
functions, and services including, but not limited to,
assessment, assurance, and policy development which
Indian tribes and tribal organizations are authorized
and encouraged, in those circumstances where it
meets their needs, to do by forming collaborative re-
lationships with all levels of local, State, and Federal
Government.
‘‘SEC. 214. INDIAN WOMEN’S HEALTH CARE.
‘‘The Secretary, acting through the Service and will-
ing Indian tribes, tribal organizations, and urban Indian
organizations, shall provide funding to monitor and im-
prove the quality of health care for Indian women of all
ages through the planning and delivery of programs ad-
ministered by the Service, in order to improve and enhance
the treatment models of care for Indian women.
‘‘SEC. 
215. 
ENVIRONMENTAL 
AND 
NUCLEAR 
HEALTH
HAZARDS.
‘‘(a) The Secretary and the Service shall conduct, in
conjunction with other appropriate Federal agencies and
in consultation with concerned Indian tribes and tribal or-
ganizations, studies and ongoing monitoring programs to
determine trends in the health hazards to Indian miners
and to Indians on or near Indian reservations and in In-
dian communities as a result of environmental hazards
which may result in chronic or life-threatening health
108
problems, such as nuclear resource development, petro-
leum contamination, and contamination of water source
and of the food chain. Such study shall include—
‘‘(1) an evaluation of the nature and extent of
health problems caused by environmental hazards
currently exhibited among Indians and the causes of
such health problems;
‘‘(2) an analysis of the potential effect of ongo-
ing and future environmental resource development
on or near Indian reservations and communities in-
cluding the cumulative effect over time on health;
‘‘(3) an evaluation of the types and nature of
activities, practices, and conditions causing or affect-
ing such health problems including, but not limited
to, uranium mining and milling, uranium mine tail-
ing deposits, nuclear power plant operation and con-
struction, and nuclear waste disposal; oil and gas
production or transportation on or near Indian res-
ervations or communities; and other development
that could affect the health of Indians and their
water supply and food chain;
‘‘(4) a summary of any findings and rec-
ommendations provided in Federal and State stud-
ies, reports, investigations, and inspections during
the 5 years prior to the date of the enactment of