‘‘(i) it is not possible for the recipient to meet
that obligation or make that payment;
‘‘(ii) requiring that recipient to meet that obli-
gation or make that payment would result in ex-
treme hardship to the recipient; or
‘‘(iii) the enforcement of the requirement to
meet the obligation or make the payment would be
unconscionable.
‘‘(E) Notwithstanding any other provision of law, in
any case of extreme hardship or for other good cause
shown, the Secretary may waive, in whole or in part, the
right of the United States to recover funds made available
under this section.
‘‘(F) Notwithstanding any other provision of law,
with respect to a recipient of an Indian Health Scholar-
ship, no obligation for payment may be released by a dis-
charge in bankruptcy under title 11, United States Code,
unless that discharge is granted after the expiration of the
5-year period beginning on the initial date on which that
payment is due, and only if the bankruptcy court finds
that the nondischarge of the obligation would be uncon-
scionable.
‘‘(c) FUNDING FOR TRIBES FOR SCHOLARSHIP PRO-
GRAMS.—(1)(A) Subject to section 102, the Secretary
shall make funds available to Indian tribes and tribal or-
ganizations for the purpose of assisting such tribes and
tribal organizations in educating Indians to serve as health
professionals in Indian communities.
‘‘(B) Amounts available under subparagraph (A) for
any fiscal year shall not exceed 5 percent of the amounts
available for each fiscal year for Indian Health Scholar-
ships under this section.
‘‘(C) An application for funds under subparagraph
(A) shall be in such form and contain such agreements,
assurances, and information as consistent with this sec-
tion.
‘‘(2)(A) An Indian tribe or tribal organization receiv-
ing funds under paragraph (1) shall provide scholarships
to Indians in accordance with the requirements of this
subsection.
‘‘(B) With respect to costs of providing any scholar-
ship pursuant to subparagraph (A)—
‘‘(i) 80 percent of the costs of the scholarship
shall be paid from the funds pursuant to subsection
(c)(1) provided to the Indian tribe or tribal organi-
zation; and
‘‘(ii) 20 percent of such costs may be paid from
any other source of funds.
‘‘(3) An Indian tribe or tribal organization shall pro-
vide scholarships under subsection (c) only to Indians en-
rolled or accepted for enrollment in a course of study (ap-
proved by the Secretary) in one of the health professions
contemplated by this Act.
‘‘(4) In providing scholarships under paragraph (2),
the Secretary and the Indian tribe or tribal organization
shall enter into a written contract with each recipient of
such scholarship. Such contract shall—
‘‘(A) obligate such recipient to provide service
in an Indian health program (as defined in section
109(a)(2)(A)), in the same service area where the
Indian tribe or tribal organization providing the
scholarship is located, for—
‘‘(i) a number of years for which the schol-
arship is provided (or the part-time equivalent
thereof, as determined by the Secretary), or for
a period of 2 years, whichever period is greater;
or
‘‘(ii) such greater period of time as the re-
cipient and the Indian tribe or tribal organiza-
tion may agree;
‘‘(B) 
provide 
that 
the 
amount 
of 
the
scholarship—
‘‘(i) may only be expended for—
‘‘(I) tuition expenses, other reasonable
educational expenses, and reasonable living
expenses incurred in attendance at the
educational institution; and
‘‘(II) payment to the recipient of a
monthly stipend of not more than the
amount authorized by section 338(g)(1)(B)
of the Public Health Service Act (42
U.S.C. 254m(g)(1)(B), such amount to be
reduced pro rata (as determined by the
Secretary) based on the number of hours
such student is enrolled; and may not ex-
ceed, for any year of attendance for which
the scholarship is provided, the total
amount required for the year for the pur-
poses authorized in this clause; and
‘‘(ii) may not exceed, for any year of at-
tendance for which the scholarship is provided,
the total amount required for the year for the
purposes authorized in clause (i);
‘‘(C) require the recipient of such scholarship to
maintain an acceptable level of academic standing as
determined by the educational institution in accord-
ance with regulations issued pursuant to this Act;
and
‘‘(D) require the recipient of such scholarship
to meet the educational and licensure requirements
appropriate to each health profession.
‘‘(5)(A) An individual who has entered into a written
contract with the Secretary and an Indian tribe or tribal
organization under this paragraph and who—
‘‘(i) fails to maintain an acceptable level of aca-
demic standing in the educational institution in
which he is enrolled (such level determined by the
educational institution under regulations of the Sec-
retary);
‘‘(ii) is dismissed from such educational institu-
tion for disciplinary reasons;
‘‘(iii) voluntarily terminates the training in such
an educational institution for which he or she is pro-
vided a scholarship under such contract before the
completion of such training; or
‘‘(iv) fails to accept payment, or instructs the
educational institution in which he or she is enrolled
not to accept payment, in whole or in part, of a
scholarship under such contract, in lieu of any serv-
ice obligation arising under such contract,
shall be liable to the United States for the Federal share
of the amount which has been paid to him or her, or on
his or her behalf, under the contract.
‘‘(B) If for any reason not specified in subparagraph
(A), an individual breaches his or her written contract by
failing to either begin such individual’s service obligation
required under such contract or to complete such service
obligation, the United States shall be entitled to recover
from the individual an amount determined in accordance
with the formula specified in subsection (l) of section 110
in the manner provided for in such subsection.
‘‘(C) The Secretary may carry out this subsection on
the basis of information received from Indian tribes or
tribal organizations involved, or on the basis of informa-
tion collected through such other means as the Secretary
deems appropriate.
‘‘(6) The recipient of a scholarship under paragraph
(1) shall agree, in providing health care pursuant to the
requirements herein—
‘‘(A) not to discriminate against an individual
seeking care on the basis of the ability of the indi-
vidual to pay for such care or on the basis that pay-
ment for such care will be made pursuant to the
program established in title XVIII of the Social Se-
curity Act or pursuant to the programs established
in title XIX of such Act; and
‘‘(B) to accept assignment under section
1842(b)(3)(B)(ii) of the Social Security Act for all
services for which payment may be made under part
B of title XVIII of such Act, and to enter into an
appropriate agreement with the State agency that
administers the State plan for medical assistance
under title XIX of such Act to provide service to in-
dividuals entitled to medical assistance under the
plan.
‘‘(7) The Secretary shall make payments under this
paragraph to an Indian tribe or tribal organization for any
fiscal year subsequent to the first fiscal year of such pay-
ments unless the Secretary determines that, for the imme-
diately preceding fiscal year, the Indian tribe or tribal or-
ganization has not complied with the requirements of this
subsection.
‘‘SEC. 106. AMERICAN INDIANS INTO PSYCHOLOGY PRO-
GRAM.
‘‘(a) Notwithstanding section 102, the Secretary shall
provide funding grants to at least 3 colleges and univer-
sities for the purpose of developing and maintaining Amer-
ican Indian psychology career recruitment programs as a
means of encouraging Indians to enter the mental health
field. These programs shall be located at various locations
throughout the country to maximize their availability to
Indian students and new programs shall be established in
different locations from time to time.
‘‘(b) The Secretary shall provide one of the grants
authorized under subsection (a) to develop and maintain
a program at the University of North Dakota to be known
as the ‘Quentin N. Burdick American Indians Into Psy-
chology Program’. Such program shall, to the maximum
extent feasible, coordinate with the Quentin N. Burdick
Indian Health Programs authorized under section 117(b),
the Quentin N. Burdick American Indians Into Nursing
Program authorized under section 115(e), and existing
university research and communications networks.
‘‘(c)(1) The Secretary shall issue regulations pursu-
ant to this Act for the competitive awarding of funds pro-
vided under this section.
‘‘(2) Applicants under this section shall agree to pro-
vide a program which, at a minimum—
‘‘(A) provides outreach and recruitment for
health professions to Indian communities including
elementary, secondary, and accredited and accessible
community colleges that will be served by the pro-
gram;
‘‘(B) incorporates a program advisory board
comprised of representatives from the tribes and
communities that will be served by the program;
‘‘(C) provides stipends to undergraduate and
graduate students to pursue a career in psychology;
‘‘(D) develops affiliation agreements with tribal
community colleges, the Service, university affiliated
programs, and other appropriate accredited and ac-
cessible entities to enhance the education of Indian
students;
‘‘(E) to the maximum extent feasible, uses ex-
isting university tutoring, counseling, and student
support services; and
‘‘(F) to the maximum extent feasible, employs
qualified Indians in the program.
‘‘(d) The active duty service obligation prescribed
under section 338C of the Public Health Service Act (42
U.S.C. 254m) shall be met by each graduate who receives
a stipend described in subsection (c)(2)(D) that is funded
under this section. Such obligation shall be met by
service—
‘‘(1) in the Indian Health Service;
‘‘(2) in a program conducted under a funding
agreement entered into under the Indian Self-Deter-
mination and Education Assistance Act;
‘‘(3) in a program assisted under title V of this
Act; or
‘‘(4) in the private practice of psychology if, as
determined by the Secretary, in accordance with
guidelines promulgated by the Secretary, such prac-
tice is situated in a physician or other health profes-
sional shortage area and addresses the health care
needs of a substantial number of Indians.
‘‘SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS.
‘‘(a) Any individual who receives a scholarship pursu-
ant to section 105 shall be given preference for employ-
ment in the Service, or may be employed by a program
of an Indian tribe, tribal organization, or urban Indian
organization, or other agencies of the Department as
available, during any nonacademic period of the year. Pe-
riods of employment pursuant to this subsection shall not
be counted in determining fulfillment of the service obliga-
tion incurred as a condition of the scholarship grant.
‘‘(b) Any individual enrolled in a course of study in
the health professions may be employed by the Service or
by an Indian tribe, tribal organization, or urban Indian
organization during any nonacademic period of the year.
Any such employment shall not exceed 120 days during
any calendar year.
‘‘(c) Any individual in a high school program author-
ized under section 103(a) may be employed by the Service
or by an Indian tribe, or tribal organization or urban In-
dian organization during any nonacademic period of the
year, not to exceed 120 days during a calendar year.
‘‘(d) Any employment pursuant to this section shall
be made without regard to any competitive personnel sys-
tem or agency personnel limitation and to a position which
will enable the individual so employed to receive practical
experience in the health profession in which he or she is
engaged in study. Any individual so employed shall receive
payment for his or her services comparable to the salary
he or she would receive if he or she were employed in the
competitive system. Any individual so employed shall not
be counted against any employment ceiling affecting the
Service or the Department.
‘‘SEC. 108. CONTINUING EDUCATION ALLOWANCES.
‘‘In order to encourage health professionals, including
for purposes of this section, community health representa-
tives and emergency medical technicians, to join or con-
tinue in the Service or program of an Indian tribe, tribal
organization, or urban Indian organization and to provide
their services in the rural and remote areas where a sig-
nificant portion of the Indian people reside, the Secretary,
subject to section 102, acting through the service area,
may provide allowances to health professionals employed
in the Service or program of an Indian tribe, tribal organi-
zation, or urban Indian organization to enable them for
a period of time each year prescribed by regulation of the
Secretary to take leave of their duty stations for profes-
sional consultation and refresher training courses.
‘‘SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PRO-
GRAM.
‘‘(a) Under the authority of the Act of November 2,
1921 (25 U.S.C. 13), popularly known as the Snyder Act,
the Secretary shall maintain a Community Health Rep-
resentative Program under which the Service, Indian
tribes, and tribal organizations—
‘‘(1) provide for the training of Indians as com-
munity health representatives; and
‘‘(2) use such community health representatives
in the provision of health care, health promotion,
and disease prevention services to Indian commu-
nities.
‘‘(b) The Secretary, acting through the Community
Health Representative Program of the Service, shall—
‘‘(1) provide a high standard of training for
community health representatives to ensure that the
community health representatives provide quality
health care, health promotion, and disease preven-
tion services to the Indian communities served by
such Program;
‘‘(2) in order to provide such training, develop
and maintain a curriculum that—
‘‘(A) combines education in the theory of
health care with supervised practical experience
in the provision of health care; and
‘‘(B) provides instruction and practical ex-
perience in health promotion and disease pre-
vention activities, with appropriate consider-
ation given to lifestyle factors that have an im-
pact on Indian health status, such as alco-
holism, family dysfunction, and poverty;
‘‘(3) maintain a system which identifies the
needs of community health representatives for con-
tinuing education in health care, health promotion,
and disease prevention and develop programs that
meet the needs for continuing education;
‘‘(4) maintain a system that provides close su-
pervision of Community Health Representatives;
‘‘(5) maintain a system under which the work
of the Community Health Representatives is re-
viewed and evaluated; and
‘‘(6) promote traditional health care practices
of the Indian tribes served consistent with the Serv-
ice standards for the provision of health care, health
promotion, and disease prevention.
‘‘SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT
PROGRAM.
‘‘(a)(1) Subject to section 102, the Secretary shall es-
tablish a program to be known as the Indian Health Serv-
ice Loan Repayment Program (hereinafter referred to as
the ‘Loan Repayment Program’) in order to ensure an
adequate supply of trained health professionals necessary
to maintain accreditation of, and provide health care serv-
ices to Indians through, Indian health programs.
‘‘(2) For the purposes of this section the term ‘State’
has the same meaning given such term in section 331(i)(4)
of the Public Health Service Act.
‘‘(b) To be eligible to participate in the Loan Repay-
ment Program, an individual must—
‘‘(1)(A) be enrolled—
‘‘(i) in a course of study or program in an
accredited institution, as determined by the
Secretary, within any State and be scheduled to
complete such course of study in the same year
such individual applies to participate in such
program; or
‘‘(ii) in an approved graduate training pro-
gram in a health profession; or
‘‘(B) have—
‘‘(i) a degree in a health profession; and
‘‘(ii) a license to practice a health profes-
sion;
‘‘(2)(A) be eligible for, or hold, an appointment
as a commissioned officer in the Regular or Reserve
Corps of the Public Health Service;
‘‘(B) be eligible for selection for civilian service
in the Regular or Reserve Corps of the Public
Health Service;
‘‘(C) meet the professional standards for civil
service employment in the Indian Health Service; or
‘‘(D) be employed in an Indian health program
without a service obligation; and
‘‘(3) submit to the Secretary an application for
a contract described in subsection (f).
‘‘(c)(1) In disseminating application forms and con-
tract forms to individuals desiring to participate in the
Loan Repayment Program, the Secretary shall include
with such forms a fair summary of the rights and liabil-
ities of an individual whose application is approved (and
whose contract is accepted) by the Secretary, including in
the summary a clear explanation of the damages to which
the United States is entitled under subsection (l) in the
case of the individual’s breach of contract. The Secretary
shall provide such individuals with sufficient information
regarding the advantages and disadvantages of service as
a commissioned officer in the Regular or Reserve Corps
of the Public Health Service or a civilian employee of the
Indian Health Service to enable the individual to make
a decision on an informed basis.
‘‘(2) The application form, contract form, and all
other information furnished by the Secretary under this
section shall be written in a manner calculated to be un-
derstood by the average individual applying to participate
in the Loan Repayment Program.
‘‘(3) The Secretary shall make such application
forms, contract forms, and other information available to
individuals desiring to participate in the Loan Repayment
Program on a date sufficiently early to ensure that such
individuals have adequate time to carefully review and
evaluate such forms and information.
‘‘(d)(1) Consistent with section 102 and subsection
(k), the Secretary shall annually—
‘‘(A) identify the positions in each Indian
health program for which there is a need or a va-
cancy; and
‘‘(B) rank those positions in order of priority.
‘‘(2) Consistent with the priority determined under
paragraph (1), the Secretary, in determining which appli-
cations under the Loan Repayment Program to approve
(and which contracts to accept), shall give priority to ap-
plications made by—
‘‘(A) Indians; and
‘‘(B) individuals recruited through the efforts of
an Indian tribe, tribal organization, or urban Indian
organization.
‘‘(e)(1) An individual becomes a participant in the
Loan Repayment Program only upon the Secretary and
the individual entering into a written contract described
in subsection (f).
‘‘(2) The Secretary shall provide written notice to an
individual within 21 days on—
‘‘(A) the Secretary’s approving, under para-
graph (1), of the individual’s participation in the
Loan Repayment Program, including extensions re-
sulting in an aggregate period of obligated service in
excess of 4 years; or
‘‘(B) the Secretary’s disapproving an individ-
ual’s participation in such Program.
‘‘(f) The written contract referred to in this section
between the Secretary and an individual shall contain—
‘‘(1) an agreement under which—
‘‘(A) subject to paragraph (3), the Sec-
retary agrees—
‘‘(i) to pay loans on behalf of the indi-
vidual in accordance with the provisions of
this section; and
‘‘(ii) to accept (subject to the avail-
ability of appropriated funds for carrying
out this section) the individual into the
Service or place the individual with a tribe,
tribal organization, or urban Indian orga-
nization as provided in subparagraph
(B)(iii); and
‘‘(B) subject to paragraph (3), the indi-
vidual agrees—
‘‘(i) to accept loan payments on behalf
of the individual;
‘‘(ii) in the case of an individual de-
scribed in subsection (b)(1)—
‘‘(I) to maintain enrollment in a
course of study or training described
in subsection (b)(1)(A) until the indi-
vidual completes the course of study
or training, and
‘‘(II) while enrolled in such
course of study or training, to main-
tain an acceptable level of academic
standing (as determined under regula-
tions of the Secretary by the edu-
cational 
institution 
offering 
such
course of study or training); and
‘‘(iii) to serve for a time period (here-
inafter in this section referred to as the
‘period of obligated service’) equal to 2
years or such longer period as the indi-
vidual may agree to serve in the full-time
clinical practice of such individual’s profes-
sion in an Indian health program to which
the individual may be assigned by the Sec-
retary;
‘‘(2) a provision permitting the Secretary to ex-
tend for such longer additional periods, as the indi-
vidual may agree to, the period of obligated service
agreed to by the individual under paragraph
(1)(B)(iii);
‘‘(3) a provision that any financial obligation of
the United States arising out of a contract entered
into under this section and any obligation of the in-
dividual which is conditioned thereon is contingent
upon funds being appropriated for loan repayments
under this section;
‘‘(4) a statement of the damages to which the
United States is entitled under subsection (l) for the
individual’s breach of the contract; and
‘‘(5) such other statements of the rights and li-
abilities of the Secretary and of the individual, not
inconsistent with this section.
‘‘(g)(1) A loan repayment provided for an individual
under a written contract under the Loan Repayment Pro-
gram shall consist of payment, in accordance with para-
graph (2), on behalf of the individual of the principal, in-
terest, and related expenses on government and commer-
cial loans received by the individual regarding the under-
graduate or graduate education of the individual (or both),
which loans were made for—
‘‘(A) tuition expenses;
‘‘(B) all other reasonable educational expenses,
including fees, books, and laboratory expenses, in-
curred by the individual; and
‘‘(C) reasonable living expenses as determined
by the Secretary.
‘‘(2)(A) For each year of obligated service that an
individual contracts to serve under subsection (f) the Sec-
retary may pay up to $35,000 or an amount equal to the
amount specified in section 338B(g)(2)(A) of the Public
Health Service Act, whichever is more, on behalf of the
individual for loans described in paragraph (1). In making
a determination of the amount to pay for a year of such
service by an individual, the Secretary shall consider the
extent to which each such determination—
‘‘(i) affects the ability of the Secretary to maxi-
mize the number of contracts that can be provided
under the Loan Repayment Program from the
amounts appropriated for such contracts;
‘‘(ii) provides an incentive to serve in Indian
health programs with the greatest shortages of
health professionals; and
‘‘(iii) provides an incentive with respect to the
health professional involved remaining in an Indian
health program with such a health professional
shortage, and continuing to provide primary health
services, after the completion of the period of obli-
gated service under the Loan Repayment Program.
‘‘(B) Any arrangement made by the Secretary for the
making of loan repayments in accordance with this sub-
section shall provide that any repayments for a year of
obligated service shall be made no later than the end of
the fiscal year in which the individual completes such year
of service.
‘‘(3) The Secretary may enter into an agreement with
the holder of any loan for which payments are made under
the Loan Repayment Program to establish a schedule for
the making of such payments.
‘‘(h) Notwithstanding any other provision of law, in-
dividuals who have entered into written contracts with the
Secretary under this section, while undergoing academic
training, shall not be counted against any employment
ceiling affecting the Department.
‘‘(i) The Secretary shall conduct recruiting programs
for the Loan Repayment Program and other Service man-
power programs of the Service at educational institutions
training health professionals or specialists identified in
subsection (a).
‘‘(j) Section 214 of the Public Health Service Act (42
U.S.C. 215) shall not apply to individuals during their pe-
riod of obligated service under the Loan Repayment Pro-
gram.
‘‘(k) The Secretary, in assigning individuals to serve
in Indian health programs pursuant to contracts entered
into under this section, shall—
‘‘(1) ensure that the staffing needs of Indian
health programs administered by an Indian tribe or
tribal organization receive consideration on an equal
basis with programs that are administered directly
by the Service; and
‘‘(2) give priority to assigning individuals to In-
dian health programs that have a need for health
professionals to provide health care services as a re-
sult of individuals having breached contracts entered
into under this section.
‘‘(l)(1) An individual who has entered into a written
contract with the Secretary under this section and who—
(A) is enrolled in the final year of a course of
study and who—
‘‘(i) fails to maintain an acceptable level of
academic standing in the educational institution
in which he is enrolled (such level determined
by the educational institution under regulations
of the Secretary);
‘‘(ii) voluntarily terminates such enroll-
ment; or
‘‘(iii) is dismissed from such educational
institution before completion of such course of
study; or
‘‘(B) is enrolled in a graduate training pro-
gram, fails to complete such training program, and
does not receive a waiver from the Secretary under
subsection (b)(1)(B)(ii),
shall be liable, in lieu of any service obligation arising
under such contract, to the United States for the amount
which has been paid on such individual’s behalf under the
contract.
‘‘(2) If, for any reason not specified in paragraph (1),
an individual breaches his written contract under this sec-
tion by failing either to begin, or complete, such individ-
ual’s period of obligated service in accordance with sub-
section (f), the United States shall be entitled to recover
from such individual an amount to be determined in ac-
cordance with the following formula:
‘‘A=3Z(t-s/t)
in which—
‘‘(A) ‘A’ is the amount the United States is en-
titled to recover;
‘‘(B) ‘Z’ is the sum of the amounts paid under
this section to, or on behalf of, the individual and
the interest on such amounts which would be pay-
able if, at the time the amounts were paid, they were
loans bearing interest at the maximum legal pre-
vailing rate, as determined by the Secretary of the
Treasury;
‘‘(C) ‘t’ is the total number of months in the in-
dividual’s period of obligated service in accordance
with subsection (f); and
‘‘(D) ‘s’ is the number of months of such period
served by such individual in accordance with this
section.
Amounts not paid within such period shall be subject to
collection through deductions in medicare payments pur-
suant to section 1892 of the Social Security Act.
‘‘(3)(A) Any amount of damages which the United
States is entitled to recover under this subsection shall be
paid to the United States within the 1-year period begin-
ning on the date of the breach or such longer period begin-
ning on such date as shall be specified by the Secretary.
‘‘(B) If damages described in subparagraph (A) are
delinquent for 3 months, the Secretary shall, for the pur-
pose of recovering such damages—
‘‘(i) use collection agencies contracted with by
the Administrator of General Services; or
‘‘(ii) enter into contracts for the recovery of
such damages with collection agencies selected by
the Secretary.
‘‘(C) Each contract for recovering damages pursuant
to this subsection shall provide that the contractor will,
not less than once each 6 months, submit to the Secretary
a status report on the success of the contractor in col-
lecting such damages. Section 3718 of title 31, United
States Code, shall apply to any such contract to the extent
not inconsistent with this subsection.
‘‘(m)(1) Any obligation of an individual under the
Loan Repayment Program for service or payment of dam-
ages shall be canceled upon the death of the individual.
‘‘(2) The Secretary shall by regulation provide for the
partial or total waiver or suspension of any obligation of
service or payment by an individual under the Loan Re-
payment Program whenever compliance by the individual
is impossible or would involve extreme hardship to the in-
dividual and if enforcement of such obligation with respect
to any individual would be unconscionable.
‘‘(3) The Secretary may waive, in whole or in part,
the rights of the United States to recover amounts under
this section in any case of extreme hardship or other good
cause shown, as determined by the Secretary.
‘‘(4) Any obligation of an individual under the Loan
Repayment Program for payment of damages may be re-
leased by a discharge in bankruptcy under title 11 of the
United States Code only if such discharge is granted after
the expiration of the 5-year period beginning on the first
date that payment of such damages is required, and only
if the bankruptcy court finds that nondischarge of the ob-
ligation would be unconscionable.
‘‘(n) The Secretary shall submit to the President, for
inclusion in each report required to be submitted to the
Congress under section 801, a report concerning the pre-
vious fiscal year which sets forth by service area—
‘‘(1) the health professional positions main-
tained by the Service or by tribal or Indian organi-
zations for which recruitment or retention is dif-
ficult;
‘‘(2) the number of Loan Repayment Program
applications filed with respect to each type of health
profession;
‘‘(3) the number of contracts described in sub-
section (f) that are entered into with respect to each
health profession;
‘‘(4) the amount of loan payments made under
this section, in total and by health profession;
‘‘(5) the number of scholarships that are pro-
vided under section 105 with respect to each health
profession;
‘‘(6) the amount of scholarship grants provided
under section 105, in total and by health profession;
‘‘(7) the number of providers of health care
that will be needed by Indian health programs, by
location and profession, during the 3 fiscal years be-
ginning after the date the report is filed; and
‘‘(8) the measures the Secretary plans to take
to fill the health professional positions maintained
by the Service or by tribes or tribal organizations,
or urban Indian organization for which recruitment
or retention is difficult.
‘‘SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOV-
ERY FUND.
‘‘(a) Notwithstanding section 102 of this title, there
is established in the Treasury of the United States a fund
to be known as the Indian Health Scholarship and Loan
Repayment Recovery Fund (hereafter in this section re-
ferred to as the ‘LRRF’). The LRRF shall consist of such
amounts as may be collected from individuals under sec-
tions 105(b)(4)(A) and (B) and 110(1) for breach of con-
tract, such funds as may be appropriated to the LRRF,
and such interest earned on amounts in the LRRF, and
all amounts collected, appropriated, or earned relative to
the LRRF shall remain available until expended.
‘‘(b)(1) Amounts in the LRRF may be expended by
the Secretary, subject to the provisions of section 102, to
make payments to the Service or to an Indian tribe or
tribal organization administering a health care program
pursuant to a funding agreement entered into under the
Indian Self-Determination and Education Assistance
Act—
‘‘(A) to which a scholarship recipient under sec-
tion 105 or a loan repayment program participant
under section 110 has been assigned to meet the ob-
ligated service requirements pursuant to such sec-
tions; and
‘‘(B) that has a need for a health professional
to provide health care services as a result of such re-
cipient or participant having breached the contract
entered into under section 105 or section 110.
‘‘(2) An Indian tribe or tribal organization receiving
payments pursuant to paragraph (1) may expend the pay-
ments to provide scholarships or recruit and employ, di-
rectly or by contract, health professionals to provide health
care services.
‘‘(c)(1) The Secretary of the Treasury shall invest
such amounts of the LRRF as the Secretary determines
are not required to meet current withdrawals from the
LRRF. Such investments may be made only in interest-
bearing obligations of the United States. For such pur-
pose, such obligations may be acquired on original issue
at the issue price, or by purchase of outstanding obliga-
tions at the market price.
‘‘(2) Any obligation acquired by the LRRF may be
sold by the Secretary of the Treasury at the market price.
‘‘SEC. 112. RECRUITMENT ACTIVITIES.
‘‘(a) The Secretary may reimburse health profes-
sionals seeking positions with the Service, Indian tribes,
tribal organizations, or urban Indian organizations, in-
cluding unpaid student volunteers and individuals consid-
ering entering into a contract under section 110, and their
spouses, for actual and reasonable expenses incurred in
traveling to and from their places of residence to an area
in which they may be assigned for the purpose of evalu-
ating such area with respect to such assignment.
‘‘(b) The Secretary shall assign one individual in each
Area Office to be responsible on a full-time basis for re-
cruitment activities.
‘‘SEC. 113. TRIBAL RECRUITMENT AND RETENTION PRO-
GRAM.
‘‘(a) Subject to section 102, the Secretary shall fund
innovative demonstration projects for a period not to ex-
ceed 3 years to enable Indian tribes, tribal organizations,
and urban Indian organizations to recruit, place, and re-
tain health professionals to meet the staffing needs of In-
dian health programs (as defined in section 110(a)(2)(A)).
‘‘(b) Any Indian tribe, tribal organization, or urban
Indian organization may submit an application for funding
of a project pursuant to this section.
‘‘SEC. 114. ADVANCED TRAINING AND RESEARCH.
‘‘(a) The Secretary shall establish a demonstration
project to enable health professionals who have worked in
an Indian health program (as defined in section 110 for
a substantial period of time to pursue advanced training
or research areas of study for which the Secretary deter-
mines a need exists.
‘‘(b) An individual who participates in a program
under subsection (a), where the educational costs are
borne by the Service, shall incur an obligation to serve
in an Indian health program for a period of obligated serv-
ice equal to at least the period of time during which the
individual participates in such program. In the event that
the individual fails to complete such obligated service, the
individual shall be liable to the United States for the pe-
riod of service remaining. In such event, with respect to
individuals entering the program after the date of the en-
actment of the Indian Health Care Improvement Act
Amendments of 2000, the United States shall be entitled
to recover from such individual an amount to be deter-
mined in accordance with the formula specified in sub-
section (l) of section 110 in the manner provided for in
such subsection.
‘‘(c) Health professionals from Indian tribes and trib-
al organizations under the authority of the Indian Self-
Determination and Education Assistance Act, and urban
Indian organizations shall be given an equal opportunity
to participate in the program under subsection (a).
‘‘SEC. 115. QUENTIN B. BURDICK AMERICAN INDIANS INTO
NURSING PROGRAM.
‘‘(a) Notwithstanding section 102, the Secretary shall
provide grants to—
‘‘(1) public or private schools of nursing,
‘‘(2) tribally controlled community colleges and
tribally controlled postsecondary vocational institu-
tions (as defined in section 390(2) of the Tribally
Controlled Vocational Institutions Support Act of
1990 (20 U.S.C. 2397h(2)), and
‘‘(3) nurse midwife programs, and advance
practice nurse programs, that are provided by any
tribal college accredited nursing program, in the ab-
sence of such, any other public or private institu-
tions,
for the purpose of increasing the number of nurses, nurse
midwives, and nurse practitioners who deliver health care
services to Indians.
‘‘(b) Grants provided under subsection (a) may be
used to—
‘‘(1) recruit individuals for programs which
train individuals to be nurses, nurse midwives, or
advanced practice nurses,
‘‘(2) provide scholarships to Indian individuals
enrolled in such programs that may pay the tuition
charged for such program and other expenses in-
curred in connection with such program, including
books, fees, room and board, and stipends for living
expenses,
‘‘(3) provide a program that encourages nurses,
nurse midwives, and advanced practice nurses to
provide, or continue to provide, health care services
to Indians,
‘‘(4) provide a program that increases the skills
of, and provides continuing education to, nurses,
nurse midwives, and advanced practice nurses, or
‘‘(5) provide any program that is designed to
achieve the purpose described in subsection (a).
‘‘(c) Each application for funding under subsection
(a) shall include such information as the Secretary may
require to establish the connection between the program
of the applicant and a health care facility that primarily
serves Indians.
‘‘(d) In providing grants under subsection (a), the
Secretary shall extend a preference to—
‘‘(1) programs that provide a preference to In-
dians,
‘‘(2) programs that train nurse midwives or ad-
vanced practice nurses,
‘‘(3) programs that are interdisciplinary, and
‘‘(4) programs that are conducted in coopera-
tion with a center for gifted and talented Indian stu-
dents established under section 5324(a) of the In-
dian Education Act of 1988.
‘‘(e) The Secretary shall provide one of the grants
authorized under subsection (a) to establish and maintain
a program at the University of North Dakota to be known
as the ‘Quentin N. Burdick American Indians Into Nurs-
ing Program’. Such program shall, to the maximum extent
feasible, coordinate with the Quentin N. Burdick Indian
Health Programs established under section 117(b) and the
Quentin N. Burdick American Indians Into Psychology
Program established under section 106(b).
‘‘(f) The active duty service obligation prescribed
under section 338C of the Public Health Service Act (42
U.S.C. 254m) shall be met by each individual who receives
training or assistance described in paragraph (1) or (2)
of subsection (b) that is funded by a grant provided under
subsection (a). Such obligation shall be met by service—
‘‘(A) in the Indian Health Service;
‘‘(B) in a program conducted under a contract
entered into under the Indian Self-Determination
Act;
‘‘(C) in a program assisted under title V of this
Act; or
‘‘(D) in the private practice of nursing if, as de-
termined by the Secretary, in accordance with guide-
lines promulgated by the Secretary, such practice is
situated in a physician or other health professional
shortage area and addresses the health care needs of
a substantial number of Indians.
‘‘SEC. 116. TRIBAL CULTURAL ORIENTATION.
‘‘(a) The Secretary, pursuant to the requirements of
section 102, shall require that appropriate employees of
the Service who serve Indian tribes in each service area
receive educational instruction in the history and culture
of such Tribes and their relationship to the Service.
‘‘(b) To the extent feasible, the program established
under subsection (a) shall—
‘‘(1) be developed in consultation with the af-
fected tribal governments, tribal organizations, and
urban Indian organizations,
‘‘(2) be carried out through tribally controlled
community colleges (within the meaning of section
2(4) of the Tribally Controlled Community College
Assistance Act of 1978) and tribally controlled post-
secondary vocational institutions (as defined in sec-
tion 390(2) of the Tribally Controlled Vocational In-
stitutions 
Support 
Act 
of 
1990 
(20 
U.S.C.
2397h(2)),
‘‘(3) include instruction in American Indian
studies, and
‘‘(4) the use and place of traditional health care
practices in the tribe.
‘‘SEC. 117. INMED PROGRAM.
‘‘(a) The Secretary is authorized to provide grants
to colleges and universities for the purpose of maintaining
and expanding the Native American health careers recruit-
ment program known as the ‘Indians into Medicine Pro-
gram’ (hereinafter in this section referred to as ‘INMED’)
as a means of encouraging Indians to enter the health pro-
fessions.
‘‘(b) The Secretary shall provide one of the grants
authorized under subsection (a) to maintain the INMED
program at the University of North Dakota, to be known
as the ‘Quentin N. Burdick Indian Health Programs’, un-
less the Secretary makes a determination, based upon pro-
gram reviews, that the program is not meeting the pur-
poses of this section. Such program shall, to the maximum
extent feasible, coordinate with the Quentin N. Burdick
American Indians Into Psychology Program established
under section 106(b) and the Quentin N. Burdick Amer-
ican Indians Into Nursing Program established under sec-
tion 115.
‘‘(c)(1) The Secretary, pursuant to this Act, shall de-
velop regulations to govern grants pursuant to this sec-
tion.
‘‘(2) Applicants for grants provided under this section
shall agree to provide a program which—
‘‘(A) provides outreach and recruitment for
health professions to Indian communities including
elementary, secondary, and community colleges lo-
cated on Indian reservations which will be served by
the program,
‘‘(B) incorporates a program advisory board
comprised of representatives from the tribes and
communities which will be served by the program,
‘‘(C) provides summer preparatory programs
for Indian students who need enrichment in the sub-
jects of math and science in order to pursue training
in the health professions,
‘‘(D) provides tutoring, counseling, and support
to students who are enrolled in a health career pro-
gram of study at the respective college or university,
and
‘‘(E) to the maximum extent feasible, employs
qualified Indians in the program.
‘‘SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY
COLLEGES.
‘‘(a)(1) Subject to the requirements of section 102,
the Secretary shall award grants to accredited and acces-
sible community colleges for the purpose of assisting such
community colleges in the establishment of programs
which provide education in a health profession leading to
a degree or diploma in a health profession for individuals
who desire to practice such profession on an Indian res-
ervation, in the Service, or in a tribal health program.
‘‘(2) The amount of any grant awarded to a commu-
nity college under paragraph (1) for the first year in which
such a grant is provided to the community college shall
not exceed $100,000.
‘‘(b)(1) The Secretary shall award grants to accred-
ited and accessible community colleges that have estab-
lished a program described in subsection (a)(1) for the
purpose of maintaining the program and recruiting stu-
dents for the program.
‘‘(2) Grants may only be made under this section to
a community college which—
‘‘(A) is accredited,
‘‘(B) has a relationship with a hospital facility,
Service facility, or hospital that could provide train-
ing of nurses or health professionals,
‘‘(C) has entered into an agreement with an ac-
credited college or university medical school, the
terms of which—
‘‘(i) provide a program that enhances the
transition and recruitment of students into ad-
vanced baccalaureate or graduate programs
which train health professionals, and
‘‘(ii) stipulate certifications necessary to
approve internship and field placement opportu-
nities at health programs of the Service or trib-
al health programs,
‘‘(D) has a qualified staff which has the appro-
priate certifications,
‘‘(E) is capable of obtaining State or regional
accreditation of the program described in subsection
(a)(1), and
‘‘(F) agrees to provide for Indian preference for
applicants for programs under this section.
‘‘(c) The Secretary shall encourage community col-
leges described in subsection (b)(2) to establish and main-
tain programs described in subsection (a)(1) by—
‘‘(1) entering into agreements with such col-
leges for the provision of qualified personnel of the
Service to teach courses of study in such programs,
and
‘‘(2) providing technical assistance and support
to such colleges.
‘‘(d) Any program receiving assistance under this sec-
tion that is conducted with respect to a health profession
shall also offer courses of study which provide advanced
training for any health professional who—
‘‘(1) has already received a degree or diploma
in such health profession, and
‘‘(2) provides clinical services on an Indian res-
ervation, at a Service facility, or at a tribal clinic.
Such courses of study may be offered in conjunction with
the college or university with which the community college
has entered into the agreement required under subsection
(b)(2)(C).
‘‘(e) For purposes of this section:
‘‘(1) The term ‘community college’ means—
‘‘(A) a tribally controlled college, or
‘‘(B) a junior or community college.
‘‘(2) The term ‘tribally controlled college’ has
the meaning given to ‘tribally controlled community
college’ by section 2(4) of the Tribally Controlled
Community College Assistance Act of 1978.
‘‘(3) The term ‘junior or community college’
has the meaning given to such term by section
312(e) of the Higher Education Act of 1965 (20
U.S.C. 1058(e)).
‘‘(4) Where the requirements of subsection (b)
are met, funding priority shall be provided to tribally
controlled colleges in service areas where they exist.
‘‘SEC. 119. RETENTION BONUS.
‘‘(a) The Secretary may pay a retention bonus to any
health professional employed by, or assigned to, and serv-
ing in, the Service and Indian tribes, tribal organizations,
or urban Indian organizations either as a civilian employee
or as a commissioned officer in the Regular or Reserve
Corps of the Public Health Service who—
‘‘(1) is assigned to, and serving in, a position
for which recruitment or retention of personnel is
difficult,
‘‘(2) the Secretary determines is needed by the
Service, tribes, tribal organizations, and urban In-
dian organizations,
‘‘(3) has—
‘‘(A) completed 3 years of employment
with the Service, or Indian tribe, or tribal orga-
nization, or urban Indian organization, 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 the Service,
or Indian tribe, or tribal organization, or urban In-
dian organization for continued employment for a
period of not less than 1 year.
‘‘(b) The Secretary may establish rates for the reten-
tion bonus which shall provide for a higher annual rate
for multiyear agreements than for single year agreements
referred to in subsection (a)(4), but in no event shall the
annual rate be more than $25,000 per annum.
‘‘(c) 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 Government the full amount of the retention
bonus for the period covered by the agreement, plus inter-
est as determined by the Secretary in accordance with sec-
tion 110(l)(2)(B).
‘‘(d) The Secretary may pay a retention bonus to any
health professional employed by an organization providing
health care services to Indians pursuant to a funding
agreement under the Indian Self-Determination and Edu-
cation Assistance Act 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) The Secretary 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 (as defined in section
110(a)(2)(A)), and have done so for a period of not less
than one year, to pursue advanced training.
‘‘(b) Such program shall include a combination of
education and work study in an Indian health program
(as defined in section 110(a)(2)(A)) leading to an asso-
ciate or bachelor’s degree (in the case of a licensed prac-
tical nurse or licensed vocational nurse) or a bachelor’s
degree (in the case of a registered nurse), or advanced
degrees in nursing and public health.
‘‘(c) An individual who participates in a program
under subsection (a), where the educational costs are paid
by the Service, shall incur an obligation to serve in an
Indian health program for a period of obligated service
equal to the amount of time during which the individual
participates in such program. In the event that the indi-
vidual 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 speci-
fied in subsection (l) of section 110 in the manner pro-
vided for in such subsection.
‘‘SEC. 121. COMMUNITY HEALTH AIDE PROGRAM FOR
ALASKA.
‘‘(a) Under the authority of the Act of November 2,
1921 (25 U.S.C. 13; popularly known as the Snyder Act),
the Secretary shall maintain a Community Health Aide
Program in Alaska under which the Service—
‘‘(1) provides for the training of Alaska Natives
as health aides or community health practitioners;
‘‘(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 tele-
conferencing capacity in health clinics located in or
near such villages for use by community health aides
or community health practitioners.
‘‘(b) The Secretary, acting through the Community
Health Aide Program 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
quality health care, health promotion, and disease
prevention services to the villages served by the Pro-
gram;
‘‘(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 preven-
tion, and the efficient and effective manage-
ment of clinic pharmacies, supplies, equipment,
and facilities; and
‘‘(C) promotes the achievement of the
health status objectives specified in section
3(b);
‘‘(3) establish and maintain a Community
Health Aide Certification Board to certify as com-
munity health aides or community health practi-
tioners individuals who have successfully completed
the training described in paragraph (1) or can dem-
onstrate 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 pro-
grams that meet the needs for such continuing edu-
cation;
‘‘(5) develop and maintain a system that pro-
vides close supervision of community health aides
and community health practitioners; and
‘‘(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.
‘‘(c) Subject to section 102, the Secretary shall de-
velop and operate a National Community Health Aide
Program based on the elements contained in this section.
‘‘SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.
‘‘Subject to section 102, the Secretary shall, by fund-
ing agreement or otherwise, provide training for Indians
in the administration and planning of tribal health pro-
grams.
‘‘SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE
DEMONSTRATION PROJECT.
‘‘(a) Subject to section 102, the Secretary may fund
pilot programs for tribes and tribal organizations to ad-
dress the chronic shortages of health professionals.
‘‘(b) The purposes of the health profession dem-
onstration program established herein are—
‘‘(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
Indians by assuring access to qualified health care
professionals; and
‘‘(3) to provide academic and scholarly opportu-
nities for health professionals serving Indian people
by identifying and using all academic and scholarly
resources of the region.
‘‘(c) The demonstration programs established pursu-
ant to subsection (a) shall incorporate a program advisory
board composed of representatives from the tribes and
communities in the area which will be served by the pro-
gram.
‘‘SEC. 124. TREATMENT OF SCHOLARSHIPS FOR CERTAIN
PURPOSES.
‘‘Scholarships provided to individuals pursuant to
this title shall be deemed ‘qualified Scholarships’ for pur-
poses of section 117 of the Internal Revenue Code of
1986.
‘‘SEC. 125. NATIONAL HEALTH SERVICE CORPS.
‘‘(a) The Secretary shall not—
‘‘(1) remove a member of the National Health
Service Corps from a health program operated by
the Indian Health Service or by a tribe or tribal or-
ganization under funding agreement with the Service
under the Indian Self-Determination and Education
Assistance Act, or by urban Indian organizations, or
‘‘(2) withdraw funding used to support such
member,
unless the Secretary, acting through the Service, tribes,
or tribal organizations, has ensured that the Indians re-
ceiving services from such member will experience no re-
duction in services.
‘‘(b) All service areas served by programs operated
by the Service or by tribes or tribal organizations under
the Indian Self-Determination and Education Assistance
Act or by urban Indian organizations shall be designated
under 42 U.S.C. 254c(a) as Health Professional Shortage
areas.
‘‘(c) National Health Service Corps scholars quali-
fying for the Commissioned Corps in the United States
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 health program operated by an Indian
tribe or tribal organization under the Indian Self-Deter-
mination and Education Assistance Act or by urban In-
dian organizations.
‘‘SEC. 126. SUBSTANCE ABUSE COUNSELOR EDUCATION
DEMONSTRATION PROJECT.
‘‘(a) The Secretary may enter into contracts with, or
make grants to, accredited tribally controlled community
colleges, tribally controlled postsecondary vocational insti-
tutions, and eligible accredited and accessible community
colleges to establish demonstration projects to develop
educational curricula for substance abuse counseling.
‘‘(b) Funds provided under this section shall be used
only for developing and providing educational curriculum
for substance abuse counseling (including paying salaries
for instructors). Such curricula may be provided through
satellite campus programs.
‘‘(c) A contract entered into or a grant provided
under this section shall be for a period of one year. Such
contract or grant may be renewed for an additional one-
year period upon the approval of the Secretary.
‘‘(d) Not later than 180 days after the date of the
enactment of this section, the Secretary, after consultation
with Indian tribes and administrators of accredited trib-
ally controlled community colleges, tribally controlled post-
secondary vocational institutions, and eligible accredited
and accessible community colleges, shall develop and issue
criteria for the review and approval of applications for
funding (including applications for renewals of funding)
under this section. Such criteria shall ensure that dem-
onstration projects established under this section promote
the development of the capacity of such entities to educate
substance abuse counselors.
‘‘(e) The Secretary shall provide such technical and
other assistance as may be necessary to enable grant re-
cipients to comply with the provisions of this section.
‘‘(f) The Secretary shall submit to the President, for
inclusion in the report which is required to be submitted
under section 801 for fiscal year 1999, a report on the
findings and conclusions derived from the demonstration
projects conducted under this section.
‘‘(g) For the purposes of this section, the following
definitions apply:
‘‘(1) The term ‘educational curriculum’ means
one or more of the following:
‘‘(A) Classroom education.
‘‘(B) Clinical work experience.
‘‘(C) Continuing education workshops.
‘‘(2) The term ‘tribally controlled postsecondary
vocational institution’ has the meaning given such
term in section 390(2) of the Tribally Controlled Vo-
cational Institutions Support Act of 1990 (20 U.S.C.
2397h(2)).
‘‘SEC. 127. MENTAL HEALTH TRAINING AND COMMUNITY
EDUCATION PROGRAMS.
‘‘(a)(1) The Secretary and the Secretary of the Inte-
rior, in consultation with Indian tribes and tribal organi-
zations, shall conduct 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 dysfunctional and self-destructive be-
havior.
‘‘(2) The positions referred to in subsection (a) are—
‘‘(A) staff positions within the Bureau of In-
dian Affairs, including existing positions, in the
fields of—
‘‘(i) elementary and secondary education;
‘‘(ii) social services and family and child
welfare;
‘‘(iii) law enforcement and judicial services;
and
‘‘(iv) alcohol and substance abuse;
‘‘(B) staff positions within the Service; and
‘‘(C) staff positions similar to those identified
in subsection (b) established and maintained by In-
dian tribes, tribal organizations, and urban Indian
organizations, including positions established pursu-
ant to funding agreements pursuant to the Indian
Self-Determination and Education Assistance Act,
and this Act.
‘‘(3) The appropriate Secretary shall provide training
criteria appropriate to each type of position identified in
subsection (b)(1) 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 position
identified pursuant to subsection (b)(3), the respective
Secretaries shall provide appropriate training to, or pro-
vide funds to an Indian tribe, tribal organization, or urban
Indian organization for training of appropriate individ-
uals. In the case of a funding agreement, the appropriate
Secretary shall ensure that such training costs are in-
cluded in the funding agreement, if necessary.
‘‘(4) Position-specific training criteria shall be cul-
turally relevant to Indians and Indian tribes and shall en-
sure that appropriate information regarding traditional
health care practices is provided.
‘‘(5) The Service shall develop and implement, or on
request of an Indian tribe or tribal organization, assist
an Indian tribe or tribal organization, to develop and im-
plement, a program of community education on mental ill-
ness. In carrying out this subsection, the Service shall,
upon request of an Indian tribe or tribal organization, pro-
vide technical assistance to an Indian tribe or tribal orga-
nization to obtain and develop community educational ma-
terials on the identification, technical assistance to the In-
dian tribe or tribal organization to obtain or develop mate-
rials on the identification, prevention, referral, and treat-
ment of mental illness, dysfunctional, and self-destructive
behavior.
‘‘(b)(1) Within 90 days after the date of the enact-
ment of the Indian Health Care Improvement Act Amend-
ments of 2000, the Secretary shall develop a plan under
which the Service will increase the health care staff pro-
viding mental health services by at least 500 positions
within 5 years after the date of enactment of this section,
with at least 200 of such positions devoted to child, adoles-
cent, and family services. The allocation of such positions
shall be subject to the provisions of section 102(a).
‘‘(2) The plan developed under paragraph (1) shall
be implemented under the Act of November 2, 1921 (25
U.S.C. 13), popularly known as the Snyder Act.
‘‘SEC. 128. AUTHORIZATION OF APPROPRIATIONS.
‘‘There are authorized to be appropriated such sums
as may be necessary for each fiscal year through fiscal
year 2012 to carry out this title.
‘‘TITLE II—HEALTH SERVICES
‘‘SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.
‘‘(a) The Secretary is authorized to expend funds, di-
rectly or under the authority of the Indian Self-Deter-
mination and Education Assistance Act, which are appro-
priated under the authority of this section, for the purpose
of—
‘‘(1) eliminating the deficiencies in health sta-
tus and 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,
‘‘(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 defi-
ciencies:
‘‘(A) Clinical care, including, but not lim-
ited to, inpatient care, outpatient care (includ-
ing audiology, clinical eye and vision care), pri-
mary care, secondary and tertiary care, and
long-term care.
‘‘(B) Preventive health, including mam-
mography and other cancer screening in accord-
ance with section 207.
‘‘(C) Dental care.
‘‘(D) Mental Health, including community
mental health services, inpatient mental health
services, dormitory mental health services,
therapeutic and residential treatment centers,
and training of traditional health care practi-
tioners.
‘‘(E) Emergency medical services.
‘‘(F) Treatment and control of, and reha-
bilitative care related to, alcoholism and drug
abuse (including fetal alcohol syndrome) among
Indians.
‘‘(G) Accident prevention programs.
‘‘(H) Home health care.
‘‘(I) Community health representatives.
‘‘(J) Maintenance and repair.
‘‘(K) Traditional health care practices.
‘‘(b)(1) Any funds appropriated under the authority
of this section shall not be used to offset or limit any other
appropriations made to the Service under this Act or the
Act of November 2, 1921 (25 U.S.C. 13), popularly known
as the Snyder Act, or any other provision of law.
‘‘(2)(A) Funds appropriated under the authority of
this section shall be allocated to service units or Indian
tribes or tribal organizations. The funds allocated to each
Tribe, tribal organization, or service unit under this sub-
paragraph shall be used by the Tribe, tribal organization,
or service unit under this subparagraph to improve the
health status and reduce the resource deficiency of each
Tribe served by such service unit, Tribe, or tribal organi-
zation.
‘‘(B) The apportionment of funds allocated to a serv-
ice unit, Tribe, or tribal organization under subparagraph
(A) among the health service responsibilities described in
subsection (a)(4) shall be determined by the Service in
consultation with, and with the active participation of, the
affected Indian tribes in accordance with the provisions
of this section and such rulemaking as is permitted under
title VIII of this Act.
‘‘(c) For purposes of this section:
‘‘(1) The term ‘health status and resource defi-
ciency’ means the extent to which—
‘‘(A) the health status objectives set forth
in section 3(b) are not being achieved; and
‘‘(B) the Indian tribe or tribal organization
does not have available to it the health re-
sources it needs, taking into account the actual
cost of providing health care services given local
geographic, climatic, rural, or other cir-
cumstances.
‘‘(2) The health resources available to an In-
dian tribe or tribal organization include health re-
sources provided by the Service as well as health re-
sources used by the Indian tribe or tribal organiza-
tion, including services and financing systems pro-
vided by any Federal programs, private insurance,
and programs of State or local governments.
‘‘(3) The Secretary shall establish procedures
which allow any Indian tribe or tribal organization
to petition the Secretary for a review of any deter-
mination of the extent of the health status and re-
source deficiency of such Tribe or tribal organiza-
tion.
‘‘(d) Programs administered by any Indian tribe or
tribal organization under the authority of the Indian Self-
Determination and Education Assistance Act shall be eli-
gible for funds appropriated under the authority of this
section on an equal basis with programs that are adminis-
tered directly by the Service.
‘‘(e) By no later than the date that is 3 years after
the date of enactment of the Indian Health Care Improve-
ment Act of 2000, the Secretary shall submit to the Con-
gress the current health status and resource deficiency re-
port of the Service for each Indian tribe or service unit,
including newly recognized or acknowledged Indian tribes.
Such report shall set out—
‘‘(1) the methodology then in use by the Service
for determining tribal health status and resource de-
ficiencies, as well as the most recent application of
that methodology;
‘‘(2) the extent of the health status and re-
source deficiency of each Indian tribe served by the
Service;
‘‘(3) the amount of funds necessary to eliminate
the health status and resource deficiencies of all In-
dian tribes served by the Service; and
‘‘(4) an estimate of—
‘‘(A) the amount of health service funds
appropriated under the authority of this Act, or
any other Act, including the amount of any
funds transferred to the Service, for the pre-
ceding fiscal year which is allocated to each
service unit, Indian tribe, or comparable entity;
‘‘(B) the number of Indians eligible for
health services in each service unit or Indian
tribe or tribal organization; and
‘‘(C) the number of Indians using the
Service resources made available to each service
unit or Indian tribe or tribal organization, and,
to the extent available, information on the wait-
ing lists and number of Indians turned away for
services due to lack of resources.
‘‘(f) Funds appropriated under this section for any
fiscal year shall be included in the base budget of the Serv-
ice for the purpose of determining appropriations under
this section in subsequent fiscal years.
‘‘(g) Nothing in this section is intended to diminish
the primary responsibility of the Service to eliminate exist-
ing backlogs in unmet health care needs, nor are the provi-
sions of this section intended to discourage the Service
from undertaking additional efforts to achieve equity
among Indian tribes and tribal organizations.
‘‘(h) Any funds appropriated under the authority of
this section shall be designated as the ‘Indian Health Care
Improvement Fund’.
‘‘SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.
‘‘(a)(1) There is hereby established an Indian Cata-
strophic Health Emergency Fund (hereafter in this sec-
tion referred to as the ‘CHEF’) consisting of—
‘‘(A) the amounts deposited under subsection
(d), and
‘‘(B) the amounts appropriated under sub-
section (e) to CHEF under this section.
‘‘(2) CHEF shall be administered by the Secretary,
solely for the purpose of meeting the extraordinary med-
ical costs associated with the treatment of victims of disas-
ters or catastrophic illnesses who are within the responsi-
bility of the Service.
‘‘(3) CHEF shall be equitably allocated, apportioned,
or delegated on a service unit or Area Office basis, based
upon a formula developed in consultation with the Indian
tribes and tribal organizations through negotiated rule-
making under title VIII of this Act, which formula shall
take into account the added needs of service areas which
are contract health-service dependent.
‘‘(4) No part of CHEF or its administration shall be
subject to contract or grant under any law, including the
Indian Self-Determination Act, and shall be administered
by the Area Offices based upon priorities determined by
the Indian tribes and tribal organizations within each Area
including consideration of the needs of Indian tribes and
tribal organizations which are contract health service-de-
pendent.
‘‘(b) The Secretary shall, through the negotiated rule-
making process under title VIII of this Act, promulgate
regulations consistent with the provisions of this section—
‘‘(1) establish a definition of disasters and cata-
strophic illnesses for which the cost of the treatment
provided under contract would qualify for payment
from the Fund;
‘‘(2) provide that a service unit, Indian tribe, or
tribal organization shall not be eligible for reim-
bursement for the cost of treatment from CHEF