‘‘(3) has— 
‘‘(A) completed 2 years of employment with 
an Indian Health Program or Urban Indian Or-
ganization; or 
‘‘(B) completed any service obligations in-
curred as a requirement of— 
‘‘(i) any Federal scholarship program; 
or 
‘‘(ii) any Federal education loan re-
payment program; and 
‘‘(4) enters into an agreement with an Indian 
Health Program or Urban Indian Organization for 
continued employment for a period of not less than 1 
year. 
‘‘(b) RATES.—The Secretary may establish rates for 
the retention bonus which shall provide for a higher annual 
rate for multiyear agreements than for single year agree-
ments referred to in subsection (a)(4), but in no event shall 
the annual rate be more than $25,000 per annum. 
‘‘(c) DEFAULT
OF RETENTION AGREEMENT.—Any 
health professional failing to complete the agreed upon term 
of service, except where such failure is through no fault of 
the individual, shall be obligated to refund to the Govern-
ment the full amount of the retention bonus for the period 
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covered by the agreement, plus interest as determined by 
the Secretary in accordance with section 110(l)(2)(B). 
‘‘(d) OTHER RETENTION BONUS.—The Secretary may 
pay a retention bonus to any health professional employed 
by a Tribal Health Program if such health professional is 
serving in a position which the Secretary determines is— 
‘‘(1) a position for which recruitment or reten-
tion is difficult; and 
‘‘(2) necessary for providing health care services 
to Indians. 
‘‘SEC. 120. NURSING RESIDENCY PROGRAM. 
‘‘(a) ESTABLISHMENT OF PROGRAM.—The Secretary, 
acting through the Service, shall establish a program to en-
able Indians who are licensed practical nurses, licensed vo-
cational nurses, and registered nurses who are working in 
an Indian Health Program or Urban Indian Organization, 
and have done so for a period of not less than 1 year, to 
pursue advanced training. Such program shall include a 
combination of education and work study in an Indian 
Health Program or Urban Indian Organization leading to 
an associate or bachelor’s degree (in the case of a licensed 
practical nurse or licensed vocational nurse), a bachelor’s 
degree (in the case of a registered nurse), or advanced de-
grees or certifications in nursing and public health. 
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‘‘(b) SERVICE OBLIGATION.—An individual who par-
ticipates in a program under subsection (a), where the edu-
cational costs are paid by the Service, shall incur an obliga-
tion to serve in an Indian Health Program or Urban In-
dian Organization for a period of obligated service equal 
to 1 year for every year that nonprofessional employee (li-
censed practical nurses, licensed vocational nurses, nursing 
assistants, and various health care technicals), or 2 years 
for every year that professional nurse (associate degree and 
bachelor-prepared registered nurses), participates in such 
program. In the event that the individual fails to complete 
such obligated service, the United States shall be entitled 
to recover from such individual an amount determined in 
accordance with the formula specified in subsection (l) of 
section 110 in the manner provided for in such subsection. 
‘‘SEC. 121. COMMUNITY HEALTH AIDE PROGRAM. 
‘‘(a) GENERAL PURPOSES OF PROGRAM.—Under the 
authority of the Act of November 2, 1921 (25 U.S.C. 13) 
(commonly known as the ‘Snyder Act’), the Secretary, act-
ing through the Service, shall develop and operate a Com-
munity Health Aide Program in Alaska under which the 
Service— 
‘‘(1) provides for the training of Alaska Natives 
as health aides or community health practitioners; 
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‘‘(2) uses such aides or practitioners in the pro-
vision of health care, health promotion, and disease 
prevention services to Alaska Natives living in vil-
lages in rural Alaska; and 
‘‘(3) provides for the establishment of teleconfer-
encing capacity in health clinics located in or near 
such villages for use by community health aides or 
community health practitioners. 
‘‘(b) SPECIFIC PROGRAM REQUIREMENTS.—The Sec-
retary, acting through the Community Health Aide Pro-
gram of the Service, shall— 
‘‘(1) using trainers accredited by the Program, 
provide a high standard of training to community 
health aides and community health practitioners to 
ensure that such aides and practitioners provide qual-
ity health care, health promotion, and disease preven-
tion services to the villages served by the Program; 
‘‘(2) in order to provide such training, develop 
a curriculum that— 
‘‘(A) combines education in the theory of 
health care with supervised practical experience 
in the provision of health care; 
‘‘(B) provides instruction and practical ex-
perience in the provision of acute care, emer-
gency care, health promotion, disease prevention, 
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and the efficient and effective management of 
clinic pharmacies, supplies, equipment, and fa-
cilities; and 
‘‘(C) promotes the achievement of the health 
status objectives specified in section 3(2); 
‘‘(3) establish and maintain a Community 
Health Aide Certification Board to certify as commu-
nity health aides or community health practitioners 
individuals who have successfully completed the train-
ing described in paragraph (1) or can demonstrate 
equivalent experience; 
‘‘(4) develop and maintain a system which iden-
tifies the needs of community health aides and com-
munity health practitioners for continuing education 
in the provision of health care, including the areas 
described in paragraph (2)(B), and develop programs 
that meet the needs for such continuing education; 
‘‘(5) develop and maintain a system that pro-
vides close supervision of community health aides and 
community health practitioners; 
‘‘(6) develop a system under which the work of 
community health aides and community health prac-
titioners is reviewed and evaluated to assure the pro-
vision of quality health care, health promotion, and 
disease prevention services; and 
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‘‘(7) ensure that pulpal therapy (not including 
pulpotomies on deciduous teeth) or extraction of adult 
teeth can be performed by a dental health aide thera-
pist only after consultation with a licensed dentist 
who determines that the procedure is a medical emer-
gency that cannot be resolved with palliative treat-
ment, and further that dental health aide therapists 
are strictly prohibited from performing all other oral 
or jaw surgeries, provided that uncomplicated extrac-
tions shall not be considered oral surgery under this 
section. 
‘‘(c) PROGRAM REVIEW.— 
‘‘(1) NEUTRAL PANEL.— 
‘‘(A) ESTABLISHMENT.—The Secretary, act-
ing through the Service, shall establish a neutral 
panel to carry out the study under paragraph 
(2). 
‘‘(B) MEMBERSHIP.—Members of the neu-
tral panel shall be appointed by the Secretary 
from among clinicians, economists, community 
practitioners, oral epidemiologists, and Alaska 
Natives. 
‘‘(2) STUDY.— 
‘‘(A) IN GENERAL.—The neutral panel es-
tablished under paragraph (1) shall conduct a 
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study of the dental health aide therapist services 
provided by the Community Health Aide Pro-
gram under this section to ensure that the qual-
ity of care provided through those services is ade-
quate and appropriate. 
‘‘(B) PARAMETERS
OF
STUDY.—The Sec-
retary, in consultation with interested parties, 
including professional dental organizations, shall 
develop the parameters of the study. 
‘‘(C) INCLUSIONS.—The study shall include 
a determination by the neutral panel with re-
spect to— 
‘‘(i) the ability of the dental health 
aide therapist services under this section to 
address the dental care needs of Alaska Na-
tives; 
‘‘(ii) the quality of care provided 
through those services, including any train-
ing, improvement, or additional oversight 
required to improve the quality of care; and 
‘‘(iii) whether safer and less costly al-
ternatives to the dental health aide therapist 
services exist. 
‘‘(D) CONSULTATION.—In carrying out the 
study under this paragraph, the neutral panel 
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shall consult with Alaska Tribal Organizations 
with respect to the adequacy and accuracy of the 
study. 
‘‘(3) REPORT.—The neutral panel shall submit 
to the Secretary, the Committee on Indian Affairs of 
the Senate, and the Committee on Natural Resources 
of the House of Representatives a report describing 
the results of the study under paragraph (2), includ-
ing a description of— 
‘‘(A) any determination of the neutral panel 
under paragraph (2)(C); and 
‘‘(B) any comments received from an Alaska 
Tribal Organization under paragraph (2)(D). 
‘‘(d) NATIONALIZATION OF PROGRAM.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graph (2), the Secretary, acting through the Service, 
may establish a national Community Health Aide 
Program in accordance with the program under this 
section, as the Secretary determines to be appropriate. 
‘‘(2) EXCEPTION.—The national Community 
Health Aide Program under paragraph (1) shall not 
include dental health aide therapist services. 
‘‘(3) REQUIREMENT.—In establishing a national 
program under paragraph (1), the Secretary shall not 
reduce the amount of funds provided for the Commu-
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nity Health Aide Program described in subsections 
(a) and (b). 
‘‘SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION. 
‘‘The Secretary, acting through the Service, shall, by 
contract or otherwise, provide training for Indians in the 
administration and planning of Tribal Health Programs. 
‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE 
DEMONSTRATION PROGRAMS. 
‘‘(a) DEMONSTRATION PROGRAMS AUTHORIZED.—The 
Secretary, acting through the Service, may fund demonstra-
tion programs for Tribal Health Programs to address the 
chronic shortages of health professionals. 
‘‘(b) PURPOSES OF PROGRAMS.—The purposes of dem-
onstration programs funded under subsection (a) shall be— 
‘‘(1) to provide direct clinical and practical ex-
perience at a Service Unit to health profession stu-
dents and residents from medical schools; 
‘‘(2) to improve the quality of health care for In-
dians by assuring access to qualified health care pro-
fessionals; and 
‘‘(3) to provide academic and scholarly opportu-
nities for health professionals serving Indians by 
identifying all academic and scholarly resources of 
the region. 
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‘‘(c) ADVISORY BOARD.—The demonstration programs 
established pursuant to subsection (a) shall incorporate a 
program advisory board composed of representatives from 
the Indian Tribes and Indian communities in the area 
which will be served by the program. 
‘‘SEC. 124. NATIONAL HEALTH SERVICE CORPS. 
‘‘(a) NO REDUCTION IN SERVICES.—The Secretary 
shall not— 
‘‘(1) remove a member of the National Health 
Service Corps from an Indian Health Program or 
Urban Indian Organization; or 
‘‘(2) withdraw funding used to support such 
member, unless the Secretary, acting through the 
Service, has ensured that the Indians receiving serv-
ices from such member will experience no reduction in 
services. 
‘‘(b) 
EXEMPTION
FROM
LIMITATIONS.—National 
Health Service Corps scholars qualifying for the Commis-
sioned Corps in the Public Health Service shall be exempt 
from the full-time equivalent limitations of the National 
Health Service Corps and the Service when serving as a 
commissioned corps officer in a Tribal Health Program or 
an Urban Indian Organization. 
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‘‘SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL 
CURRICULA DEMONSTRATION PROGRAMS. 
‘‘(a) CONTRACTS AND GRANTS.—The Secretary, acting 
through the Service, may enter into contracts with, or make 
grants to, accredited tribal colleges and universities and eli-
gible accredited and accessible community colleges to estab-
lish demonstration programs to develop educational cur-
ricula for substance abuse counseling. 
‘‘(b) USE OF FUNDS.—Funds provided under this sec-
tion shall be used only for developing and providing edu-
cational curriculum for substance abuse counseling (includ-
ing paying salaries for instructors). Such curricula may 
be provided through satellite campus programs. 
‘‘(c) TIME PERIOD
OF ASSISTANCE; RENEWAL.—A 
contract entered into or a grant provided under this section 
shall be for a period of 3 years. Such contract or grant may 
be renewed for an additional 2-year period upon the ap-
proval of the Secretary. 
‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF APPLI-
CATIONS.—Not later than 180 days after the date of enact-
ment of the Indian Health Care Improvement Act Amend-
ments of 2007, the Secretary, after consultation with Indian 
Tribes and administrators of tribal colleges and universities 
and eligible accredited and accessible community colleges, 
shall develop and issue criteria for the review and approval 
of applications for funding (including applications for re-
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newals of funding) under this section. Such criteria shall 
ensure that demonstration programs established under this 
section promote the development of the capacity of such en-
tities to educate substance abuse counselors. 
‘‘(e) ASSISTANCE.—The Secretary shall provide such 
technical and other assistance as may be necessary to enable 
grant recipients to comply with the provisions of this sec-
tion. 
‘‘(f) REPORT.—Each fiscal year, the Secretary shall 
submit to the President, for inclusion in the report which 
is required to be submitted under section 801 for that fiscal 
year, a report on the findings and conclusions derived from 
the demonstration programs conducted under this section 
during that fiscal year. 
‘‘(g) DEFINITION.—For the purposes of this section, the 
term ‘educational curriculum’ means 1 or more of the fol-
lowing: 
‘‘(1) Classroom education. 
‘‘(2) Clinical work experience. 
‘‘(3) Continuing education workshops. 
‘‘SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMU-
NITY EDUCATION PROGRAMS. 
‘‘(a) STUDY; LIST.—The Secretary, acting through the 
Service, and the Secretary of the Interior, in consultation 
with Indian Tribes and Tribal Organizations, shall conduct 
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a study and compile a list of the types of staff positions 
specified in subsection (b) whose qualifications include, or 
should include, training in the identification, prevention, 
education, referral, or treatment of mental illness, or dys-
functional and self destructive behavior. 
‘‘(b) POSITIONS.—The positions referred to in sub-
section (a) are— 
‘‘(1) staff positions within the Bureau of Indian 
Affairs, including existing positions, in the fields of— 
‘‘(A) elementary and secondary education; 
‘‘(B) social services and family and child 
welfare; 
‘‘(C) law enforcement and judicial services; 
and 
‘‘(D) alcohol and substance abuse; 
‘‘(2) staff positions within the Service; and 
‘‘(3) staff positions similar to those identified in 
paragraphs (1) and (2) established and maintained 
by Indian Tribes, Tribal Organizations (without re-
gard to the funding source), and Urban Indian Orga-
nizations. 
‘‘(c) TRAINING CRITERIA.— 
‘‘(1) IN GENERAL.—The appropriate Secretary 
shall provide training criteria appropriate to each 
type of position identified in subsection (b)(1) and 
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(b)(2) and ensure that appropriate training has been, 
or shall be provided to any individual in any such 
position. With respect to any such individual in a po-
sition identified pursuant to subsection (b)(3), the re-
spective Secretaries shall provide appropriate train-
ing to, or provide funds to, an Indian Tribe, Tribal 
Organization, or Urban Indian Organization for 
training of appropriate individuals. In the case of po-
sitions funded under a contract or compact under the 
Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.), the appropriate Secretary 
shall ensure that such training costs are included in 
the contract or compact, as the Secretary determines 
necessary. 
‘‘(2) POSITION SPECIFIC TRAINING CRITERIA.— 
Position specific training criteria shall be culturally 
relevant to Indians and Indian Tribes and shall en-
sure that appropriate information regarding tradi-
tional health care practices is provided. 
‘‘(d) COMMUNITY EDUCATION ON MENTAL ILLNESS.— 
The Service shall develop and implement, on request of an 
Indian Tribe, Tribal Organization, or Urban Indian Orga-
nization, or assist the Indian Tribe, Tribal Organization, 
or Urban Indian Organization to develop and implement, 
a program of community education on mental illness. In 
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carrying out this subsection, the Service shall, upon request 
of an Indian Tribe, Tribal Organization, or Urban Indian 
Organization, provide technical assistance to the Indian 
Tribe, Tribal Organization, or Urban Indian Organization 
to obtain and develop community educational materials on 
the identification, prevention, referral, and treatment of 
mental illness and dysfunctional and self-destructive behav-
ior. 
‘‘(e) PLAN.—Not later than 90 days after the date of 
enactment of the Indian Health Care Improvement Act 
Amendments of 2007, the Secretary shall develop a plan 
under which the Service will increase the health care staff 
providing behavioral health services by at least 500 posi-
tions within 5 years after the date of enactment of this sec-
tion, with at least 200 of such positions devoted to child, 
adolescent, and family services. The plan developed under 
this subsection shall be implemented under the Act of No-
vember 2, 1921 (25 U.S.C. 13) (commonly known as the 
‘Snyder Act’). 
‘‘SEC. 127. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated such sums 
as may be necessary for each fiscal year through fiscal year 
2017 to carry out this title. 
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‘‘TITLE II—HEALTH SERVICES 
‘‘SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. 
‘‘(a) USE OF FUNDS.—The Secretary, acting through 
the Service, is authorized to expend funds, directly or under 
the authority of the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.), which are 
appropriated under the authority of this section, for the 
purposes of— 
‘‘(1) eliminating the deficiencies in health status 
and health resources of all Indian Tribes; 
‘‘(2) eliminating backlogs in the provision of 
health care services to Indians; 
‘‘(3) meeting the health needs of Indians in an 
efficient and equitable manner, including the use of 
telehealth and telemedicine when appropriate; 
‘‘(4) eliminating inequities in funding for both 
direct care and contract health service programs; and 
‘‘(5) augmenting the ability of the Service to 
meet the following health service responsibilities with 
respect to those Indian Tribes with the highest levels 
of health status deficiencies and resource deficiencies: 
‘‘(A) Clinical care, including inpatient 
care, outpatient care (including audiology, clin-
ical eye, and vision care), primary care, sec-
ondary and tertiary care, and long-term care. 
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