1807 
‘‘(1) the maximum principal amount of a loan 
or loan guarantee that should be offered to a recipi-
ent from the loan fund; 
‘‘(2) the percentage of eligible costs, not to ex-
ceed 100 percent, that may be covered by a loan or 
loan guarantee from the loan fund (including costs 
relating to planning, design, financing, site land de-
velopment, construction, rehabilitation, renovation, 
conversion, improvements, medical equipment and 
furnishings, and other facility-related costs and cap-
ital purchase (but excluding staffing)); 
‘‘(3) the cumulative total of the principal of di-
rect loans and loan guarantees, respectively, that 
may be outstanding at any 1 time; 
‘‘(4) the maximum term of a loan or loan guar-
antee that may be made for a facility from the loan 
fund; 
‘‘(5) the maximum percentage of funds from 
the loan fund that should be allocated for payment 
of costs associated with planning and applying for a 
loan or loan guarantee; 
‘‘(6) whether acceptance by the Secretary of an 
assignment of the revenue of an Indian Tribe or 
Tribal Organization as security for any direct loan 
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or loan guarantee from the loan fund would be ap-
propriate; 
‘‘(7) whether, in the planning and design of 
health facilities under this section, users eligible 
under section 806(c) may be included in any projec-
tion of patient population; 
‘‘(8) whether funds of the Service provided 
through loans or loan guarantees from the loan fund 
should be eligible for use in matching other Federal 
funds under other programs; 
‘‘(9) the appropriateness of, and best methods 
for, coordinating the loan fund with the health care 
priority system of the Service under section 301; and 
‘‘(10) any legislative or regulatory changes re-
quired to implement recommendations of the Sec-
retary based on results of the study. 
‘‘(c) REPORT.—Not later than September 30, 2010, 
the Secretary shall submit to the Committee on Indian Af-
fairs of the Senate and the Committee on Natural Re-
sources and the Committee on Energy and Commerce of 
the House of Representatives a report that describes— 
‘‘(1) the manner of consultation made as re-
quired by subsection (a); and 
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‘‘(2) the results of the study, including any rec-
ommendations of the Secretary based on results of 
the study. 
‘‘SEC. 310. TRIBAL LEASING. 
‘‘A Tribal Health Program may lease permanent 
structures for the purpose of providing health care services 
without obtaining advance approval in appropriation Acts. 
‘‘SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES 
JOINT VENTURE PROGRAM. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the Service, shall make arrangements with Indian Tribes 
and Tribal Organizations to establish joint venture dem-
onstration projects under which an Indian Tribe or Tribal 
Organization shall expend tribal, private, or other avail-
able funds, for the acquisition or construction of a health 
facility for a minimum of 10 years, under a no-cost lease, 
in exchange for agreement by the Service to provide the 
equipment, supplies, and staffing for the operation and 
maintenance of such a health facility. An Indian Tribe or 
Tribal Organization may use tribal funds, private sector, 
or other available resources, including loan guarantees, to 
fulfill its commitment under a joint venture entered into 
under this subsection. An Indian Tribe or Tribal Organi-
zation shall be eligible to establish a joint venture project 
if, when it submits a letter of intent, it— 
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‘‘(1) has begun but not completed the process 
of acquisition or construction of a health facility to 
be used in the joint venture project; 
‘‘(2) has not begun the process of acquisition or 
construction of a health facility for use in the joint 
venture project; or 
‘‘(3) in its application for a joint venture agree-
ment, agrees— 
‘‘(A) to construct a facility for the joint 
venture which complies with the size and space 
criteria established by the Service; or 
‘‘(B) if the facility it proposes for the joint 
venture is already in existence or under con-
struction, that only the portion of such facility 
which complies with the size and space criteria 
of the Service will be eligible for the joint ven-
ture agreement. 
‘‘(b) REQUIREMENTS.—The Secretary shall make 
such an arrangement with an Indian Tribe or Tribal Orga-
nization only if— 
‘‘(1) the Secretary first determines that the In-
dian Tribe or Tribal Organization has the adminis-
trative and financial capabilities necessary to com-
plete the timely acquisition or construction of the 
relevant health facility; and 
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‘‘(2) the Indian Tribe or Tribal Organization 
meets the need criteria determined using the criteria 
developed under the health care facility priority sys-
tem under section 301, unless the Secretary deter-
mines, pursuant to regulations, that other criteria 
will result in a more cost-effective and efficient 
method of facilitating and completing construction of 
health care facilities. 
‘‘(c) CONTINUED OPERATION.—The Secretary shall 
negotiate an agreement with the Indian Tribe or Tribal 
Organization regarding the continued operation of the fa-
cility at the end of the initial 10 year no-cost lease period. 
‘‘(d) BREACH OF AGREEMENT.—An Indian Tribe or 
Tribal Organization that has entered into a written agree-
ment with the Secretary under this section, and that 
breaches or terminates without cause such agreement, 
shall be liable to the United States for the amount that 
has been paid to the Indian Tribe or Tribal Organization, 
or paid to a third party on the Indian Tribe’s or Tribal 
Organization’s behalf, under the agreement. The Sec-
retary has the right to recover tangible property (including 
supplies) and equipment, less depreciation, and any funds 
expended for operations and maintenance under this sec-
tion. The preceding sentence does not apply to any funds 
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expended for the delivery of health care services, per-
sonnel, or staffing. 
‘‘(e) RECOVERY FOR NONUSE.—An Indian Tribe or 
Tribal Organization that has entered into a written agree-
ment with the Secretary under this subsection shall be en-
titled to recover from the United States an amount that 
is proportional to the value of such facility if, at any time 
within the 10-year term of the agreement, the Service 
ceases to use the facility or otherwise breaches the agree-
ment. 
‘‘(f) DEFINITION.—For the purposes of this section, 
the term ‘health facility’ or ‘health facilities’ includes 
quarters needed to provide housing for staff of the rel-
evant Tribal Health Program. 
‘‘SEC. 312. LOCATION OF FACILITIES. 
‘‘(a) IN GENERAL.—In all matters involving the reor-
ganization or development of Service facilities or in the 
establishment of related employment projects to address 
unemployment conditions in economically depressed areas, 
the Bureau of Indian Affairs and the Service shall give 
priority to locating such facilities and projects on Indian 
lands, or lands in Alaska owned by any Alaska Native vil-
lage, or village or regional corporation under the Alaska 
Native Claims Settlement Act (43 U.S.C. 1601 et seq.), 
or any land allotted to any Alaska Native, if requested 
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by the Indian owner and the Indian Tribe with jurisdiction 
over such lands or other lands owned or leased by the In-
dian Tribe or Tribal Organization. Top priority shall be 
given to Indian land owned by 1 or more Indian Tribes. 
‘‘(b) DEFINITION.—For purposes of this section, the 
term ‘Indian lands’ means— 
‘‘(1) all lands within the exterior boundaries of 
any reservation; and 
‘‘(2) any lands title to which is held in trust by 
the United States for the benefit of any Indian 
Tribe or individual Indian or held by any Indian 
Tribe or individual Indian subject to restriction by 
the United States against alienation. 
‘‘SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH 
CARE FACILITIES. 
‘‘(a) REPORT.—The Secretary shall submit to the 
President, for inclusion in the report required to be trans-
mitted to Congress under section 801, a report which iden-
tifies the backlog of maintenance and repair work required 
at both Service and tribal health care facilities, including 
new health care facilities expected to be in operation in 
the next fiscal year. The report shall also identify the need 
for renovation and expansion of existing facilities to sup-
port the growth of health care programs. 
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‘‘(b) MAINTENANCE
OF
NEWLY
CONSTRUCTED 
SPACE.—The Secretary, acting through the Service, is au-
thorized to expend maintenance and improvement funds 
to support maintenance of newly constructed space only 
if such space falls within the approved supportable space 
allocation for the Indian Tribe or Tribal Organization. 
Supportable space allocation shall be defined through the 
health care facility priority system under section 301(c). 
‘‘(c) REPLACEMENT FACILITIES.—In addition to 
using maintenance and improvement funds for renovation, 
modernization, and expansion of facilities, an Indian Tribe 
or Tribal Organization may use maintenance and improve-
ment funds for construction of a replacement facility if 
the costs of renovation of such facility would exceed a 
maximum renovation cost threshold. The Secretary shall 
consult with Indian Tribes and Tribal Organizations in de-
termining the maximum renovation cost threshold. 
‘‘SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY OWNED 
QUARTERS. 
‘‘(a) RENTAL RATES.— 
‘‘(1) ESTABLISHMENT.—Notwithstanding any 
other provision of law, a Tribal Health Program 
which operates a hospital or other health facility and 
the federally owned quarters associated therewith 
pursuant to a contract or compact under the Indian 
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Self-Determination and Education Assistance Act 
(25 U.S.C. 450 et seq.) shall have the authority to 
establish the rental rates charged to the occupants 
of such quarters by providing notice to the Secretary 
of its election to exercise such authority. 
‘‘(2) OBJECTIVES.—In establishing rental rates 
pursuant to authority of this subsection, a Tribal 
Health Program shall endeavor to achieve the fol-
lowing objectives: 
‘‘(A) To base such rental rates on the rea-
sonable value of the quarters to the occupants 
thereof. 
‘‘(B) To generate sufficient funds to pru-
dently provide for the operation and mainte-
nance of the quarters, and subject to the discre-
tion of the Tribal Health Program, to supply 
reserve funds for capital repairs and replace-
ment of the quarters. 
‘‘(3) 
EQUITABLE
FUNDING.—Any 
quarters 
whose rental rates are established by a Tribal 
Health Program pursuant to this subsection shall 
remain eligible for quarters improvement and repair 
funds to the same extent as all federally owned 
quarters used to house personnel in Services-sup-
ported programs. 
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‘‘(4) NOTICE
OF
RATE
CHANGE.—A Tribal 
Health Program which exercises the authority pro-
vided under this subsection shall provide occupants 
with no less than 60 days notice of any change in 
rental rates. 
‘‘(b) DIRECT COLLECTION OF RENT.— 
‘‘(1) IN GENERAL.—Notwithstanding any other 
provision of law, and subject to paragraph (2), a 
Tribal Health Program shall have the authority to 
collect rents directly from Federal employees who oc-
cupy such quarters in accordance with the following: 
‘‘(A) The Tribal Health Program shall no-
tify the Secretary and the subject Federal em-
ployees of its election to exercise its authority 
to collect rents directly from such Federal em-
ployees. 
‘‘(B) Upon receipt of a notice described in 
subparagraph (A), the Federal employees shall 
pay rents for occupancy of such quarters di-
rectly to the Tribal Health Program and the 
Secretary shall have no further authority to col-
lect rents from such employees through payroll 
deduction or otherwise. 
‘‘(C) Such rent payments shall be retained 
by the Tribal Health Program and shall not be 
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made payable to or otherwise be deposited with 
the United States. 
‘‘(D) Such rent payments shall be depos-
ited into a separate account which shall be used 
by the Tribal Health Program for the mainte-
nance (including capital repairs and replace-
ment) and operation of the quarters and facili-
ties as the Tribal Health Program shall deter-
mine. 
‘‘(2) RETROCESSION
OF
AUTHORITY.—If a 
Tribal Health Program which has made an election 
under paragraph (1) requests retrocession of its au-
thority to directly collect rents from Federal employ-
ees occupying federally owned quarters, such ret-
rocession shall become effective on the earlier of— 
‘‘(A) the first day of the month that begins 
no less than 180 days after the Tribal Health 
Program notifies the Secretary of its desire to 
retrocede; or 
‘‘(B) such other date as may be mutually 
agreed by the Secretary and the Tribal Health 
Program. 
‘‘(c) RATES IN ALASKA.—To the extent that a Tribal 
Health Program, pursuant to authority granted in sub-
section (a), establishes rental rates for federally owned 
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quarters provided to a Federal employee in Alaska, such 
rents may be based on the cost of comparable private rent-
al housing in the nearest established community with a 
year-round population of 1,500 or more individuals. 
‘‘SEC. 315. APPLICABILITY OF BUY AMERICAN ACT RE-
QUIREMENT. 
‘‘(a) APPLICABILITY.—The Secretary shall ensure 
that the requirements of the Buy American Act apply to 
all procurements made with funds provided pursuant to 
section 317. Indian Tribes and Tribal Organizations shall 
be exempt from these requirements. 
‘‘(b) EFFECT OF VIOLATION.—If it has been finally 
determined by a court or Federal agency that any person 
intentionally affixed a label bearing a ‘Made in America’ 
inscription or any inscription with the same meaning, to 
any product sold in or shipped to the United States that 
is not made in the United States, such person shall be 
ineligible to receive any contract or subcontract made with 
funds provided pursuant to section 317, pursuant to the 
debarment, suspension, and ineligibility procedures de-
scribed in sections 9.400 through 9.409 of title 48, Code 
of Federal Regulations. 
‘‘(c) DEFINITIONS.—For purposes of this section, the 
term ‘Buy American Act’ means title III of the Act enti-
tled ‘An Act making appropriations for the Treasury and 
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Post Office Departments for the fiscal year ending June 
30, 1934, and for other purposes’, approved March 3, 
1933 (41 U.S.C. 10a et seq.). 
‘‘SEC. 316. OTHER FUNDING FOR FACILITIES. 
‘‘(a) AUTHORITY TO ACCEPT FUNDS.—The Sec-
retary is authorized to accept from any source, including 
Federal and State agencies, funds that are available for 
the construction of health care facilities and use such 
funds to plan, design, and construct health care facilities 
for Indians and to place such funds into a contract or com-
pact under the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.). Receipt of such 
funds shall have no effect on the priorities established pur-
suant to section 301. 
‘‘(b) INTERAGENCY AGREEMENTS.—The Secretary is 
authorized to enter into interagency agreements with 
other Federal agencies or State agencies and other entities 
and to accept funds from such Federal or State agencies 
or other sources to provide for the planning, design, and 
construction of health care facilities to be administered by 
Indian Health Programs in order to carry out the pur-
poses of this Act and the purposes for which the funds 
were appropriated or for which the funds were otherwise 
provided. 
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‘‘(c) TRANSFERRED FUNDS.—Any Federal agency to 
which funds for the construction of health care facilities 
are appropriated is authorized to transfer such funds to 
the Secretary for the construction of health care facilities 
to carry out the purposes of this Act as well as the pur-
poses for which such funds are appropriated to such other 
Federal agency. 
‘‘(d) ESTABLISHMENT
OF STANDARDS.—The Sec-
retary, through the Service, shall establish standards by 
regulation for the planning, design, and construction of 
health care facilities serving Indians under this Act. 
‘‘SEC. 317. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated such sums 
as may be necessary to carry out this title. 
‘‘TITLE IV—ACCESS TO HEALTH 
SERVICES 
‘‘SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SE-
CURITY ACT HEALTH BENEFITS PROGRAMS. 
‘‘(a) DISREGARD
OF MEDICARE, MEDICAID, AND 
SCHIP PAYMENTS IN DETERMINING APPROPRIATIONS.— 
Any payments received by an Indian Health Program or 
by an urban Indian organization under title XVIII, XIX, 
or XXI of the Social Security Act for services provided 
to Indians eligible for benefits under such respective titles 
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shall not be considered in determining appropriations for 
the provision of health care and services to Indians. 
‘‘(b) NONPREFERENTIAL TREATMENT.—Nothing in 
this Act authorizes the Secretary to provide services to an 
Indian with coverage under title XVIII, XIX, or XXI of 
the Social Security Act in preference to an Indian without 
such coverage. 
‘‘(c) USE OF FUNDS.— 
‘‘(1) SPECIAL FUND.— 
‘‘(A) 100 PERCENT
PASS-THROUGH
OF 
PAYMENTS
DUE
TO
FACILITIES.—Notwith-
standing any other provision of law, but subject 
to paragraph (2), payments to which a facility 
of the Service is entitled by reason of a provi-
sion of title XVIII or XIX of the Social Secu-
rity Act shall be placed in a special fund to be 
held by the Secretary. In making payments 
from such fund, the Secretary shall ensure that 
each Service Unit of the Service receives 100 
percent of the amount to which the facilities of 
the Service, for which such Service Unit makes 
collections, are entitled by reason of a provision 
of either such title. 
‘‘(B) USE OF FUNDS.—Amounts received 
by a facility of the Service under subparagraph 
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(A) by reason of a provision of title XVIII or 
XIX of the Social Security Act shall first be 
used (to such extent or in such amounts as are 
provided in appropriation Acts) for the purpose 
of making any improvements in the programs 
of the Service operated by or through such fa-
cility which may be necessary to achieve or 
maintain compliance with the applicable condi-
tions and requirements of such respective title. 
Any amounts so received that are in excess of 
the amount necessary to achieve or maintain 
such conditions and requirements shall, subject 
to consultation with the Indian Tribes being 
served by the Service Unit, be used for increas-
ing the facility’s capacity to provide, or improv-
ing the quality or accessibility of, services. 
‘‘(2) DIRECT
PAYMENT
OPTION.—Paragraph 
(1) shall not apply to a Tribal Health Program upon 
the election of such Program under subsection (d) to 
receive payments directly. No payment may be made 
out of the special fund described in such paragraph 
with respect to reimbursement made for services 
provided by such Program during the period of such 
election. 
‘‘(d) DIRECT BILLING.— 
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cial Security Act shall be subject to all auditing 
requirements applicable to the program under 
such title, as well as all auditing requirements 
applicable to programs administered by an In-
dian Health Program. Nothing in the preceding 
sentence shall be construed as limiting the ap-
plication of auditing requirements applicable to 
amounts paid under title XVIII, XIX, or XXI 
of the Social Security Act. 
‘‘(C) IDENTIFICATION OF SOURCE OF PAY-
MENTS.—Any Tribal Health Program that re-
ceives reimbursements or payments under title 
XVIII, XIX, or XXI of the Social Security Act 
shall provide to the Service a list of each pro-
vider enrollment number (or other identifier) 
under which such Program receives such reim-
bursements or payments. 
‘‘(3) EXAMINATION AND IMPLEMENTATION OF 
CHANGES.— 
‘‘(A) IN GENERAL.—The Secretary, acting 
through the Service and with the assistance of 
the Administrator of the Centers for Medicare 
& Medicaid Services, shall examine on an ongo-
ing basis and implement any administrative 
changes that may be necessary to facilitate di-
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rect billing and reimbursement under the pro-
gram established under this subsection, includ-
ing any agreements with States that may be 
necessary to provide for direct billing under a 
program under title XIX or XXI of the Social 
Security Act. 
‘‘(B) COORDINATION OF INFORMATION.— 
The Service shall provide the Administrator of 
the Centers for Medicare & Medicaid Services 
with copies of the lists submitted to the Service 
under paragraph (2)(C), enrollment data re-
garding patients served by the Service (and by 
Tribal Health Programs, to the extent such 
data is available to the Service), and such other 
information as the Administrator may require 
for purposes of administering title XVIII, XIX, 
or XXI of the Social Security Act. 
‘‘(4) WITHDRAWAL FROM PROGRAM.—A Tribal 
Health Program that bills directly under the pro-
gram established under this subsection may with-
draw from participation in the same manner and 
under the same conditions that an Indian Tribe or 
Tribal Organization may retrocede a contracted pro-
gram to the Secretary under the authority of the In-
dian Self-Determination and Education Assistance 
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Act (25 U.S.C. 450 et seq.). All cost accounting and 
billing authority under the program established 
under this subsection shall be returned to the Sec-
retary upon the Secretary’s acceptance of the with-
drawal of participation in this program. 
‘‘(5) TERMINATION FOR FAILURE TO COMPLY 
WITH REQUIREMENTS.—The Secretary may termi-
nate the participation of a Tribal Health Program or 
in the direct billing program established under this 
subsection if the Secretary determines that the Pro-
gram has failed to comply with the requirements of 
paragraph (2). The Secretary shall provide a Tribal 
Health Program with notice of a determination that 
the Program has failed to comply with any such re-
quirement and a reasonable opportunity to correct 
such noncompliance prior to terminating the Pro-
gram’s participation in the direct billing program es-
tablished under this subsection. 
‘‘(e) RELATED PROVISIONS UNDER THE SOCIAL SE-
CURITY ACT.—For provisions related to subsections (c) 
and (d), see sections 1880, 1911, and 2107(e)(1)(D) of 
the Social Security Act. 
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‘‘SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERV-
ICE, 
INDIAN 
TRIBES, 
TRIBAL 
ORGANIZA-
TIONS, AND URBAN INDIAN ORGANIZATIONS 
TO FACILITATE OUTREACH, ENROLLMENT, 
AND COVERAGE OF INDIANS UNDER SOCIAL 
SECURITY ACT HEALTH BENEFIT PROGRAMS. 
‘‘(a) INDIAN
TRIBES
AND
TRIBAL
ORGANIZA-
TIONS.—The Secretary, acting through the Service, shall 
make grants to or enter into contracts with Indian Tribes 
and Tribal Organizations to assist such Tribes and Tribal 
Organizations in establishing and administering programs 
on or near reservations, trust lands, and Alaska Native 
Villages, including programs to provide outreach and en-
rollment through video, electronic delivery methods, or 
telecommunication devices that allow real-time or time-de-
layed communication between individual Indians and the 
benefit program, to assist individual Indians— 
‘‘(1) to enroll for benefits under a program es-
tablished under title XVIII, XIX, or XXI of the So-
cial Security Act; and 
‘‘(2) with respect to such programs for which 
the charging of premiums and cost sharing is not 
prohibited under such programs, to pay premiums or 
cost sharing for coverage for such benefits, which 
may be based on financial need (as determined by 
the Indian Tribe or Tribes or Tribal Organizations 
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being served based on a schedule of income levels de-
veloped or implemented by such Tribe, Tribes, or 
Tribal Organizations). 
‘‘(b) CONDITIONS.—The Secretary, acting through 
the Service, shall place conditions as deemed necessary to 
effect the purpose of this section in any grant or contract 
which the Secretary makes with any Indian Tribe or Trib-
al Organization pursuant to this section. Such conditions 
shall include requirements that the Indian Tribe or Tribal 
Organization successfully undertake— 
‘‘(1) to determine the population of Indians eli-
gible for the benefits described in subsection (a); 
‘‘(2) to educate Indians with respect to the ben-
efits available under the respective programs; 
‘‘(3) to provide transportation for such indi-
vidual Indians to the appropriate offices for enroll-
ment or applications for such benefits; and 
‘‘(4) to develop and implement methods of im-
proving the participation of Indians in receiving ben-
efits under such programs. 
‘‘(c) APPLICATION
TO URBAN INDIAN ORGANIZA-
TIONS.— 
‘‘(1) IN
GENERAL.—The provisions of sub-
section (a) shall apply with respect to grants and 
other funding to urban Indian organizations with re-
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spect to populations served by such organizations in 
the same manner they apply to grants and contracts 
with Indian Tribes and Tribal Organizations with 
respect to programs on or near reservations. 
‘‘(2) REQUIREMENTS.—The Secretary shall in-
clude in the grants or contracts made or provided 
under paragraph (1) requirements that are— 
‘‘(A) consistent with the requirements im-
posed by the Secretary under subsection (b); 
‘‘(B) appropriate to urban Indian organi-
zations and urban Indians; and 
‘‘(C) necessary to effect the purposes of 
this section. 
‘‘(d) FACILITATING COOPERATION IN ENROLLMENT 
AND RETENTION.—The Secretary, acting through the 
Centers for Medicare & Medicaid Services, shall consult 
with States, the Service, Indian Tribes, Tribal Organiza-
tions, and urban Indian organizations to develop and dis-
seminate best practices with respect to facilitating agree-
ments between the States and Indian Tribes, Tribal Orga-
nizations, and urban Indian organizations relating to en-
rollment and retention of Indians in programs established 
under titles XVIII, XIX, and XXI of the Social Security 
Act. 
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‘‘(e) AGREEMENTS TO IMPROVE ENROLLMENT OF 
INDIANS UNDER SOCIAL SECURITY ACT HEALTH BENE-
FITS PROGRAMS.—For provisions relating to agreements 
between the Secretary and the Service, Indian Tribes, 
Tribal Organizations, and urban Indian organizations for 
the collection, preparation, and submission of applications 
by Indians for assistance under the Medicaid and chil-
dren’s health insurance programs established under titles 
XIX and XXI of the Social Security Act, and benefits 
under the Medicare program established under title XVIII 
of such Act, see subsections (a) and (b) of section 1139 
of the Social Security Act. 
‘‘(f) DEFINITIONS.—In this section: 
‘‘(1) PREMIUM.—The term ‘premium’ includes 
any enrollment fee or similar charge. 
‘‘(2) COST SHARING.—The term ‘cost sharing’ 
includes any deduction, deductible, copayment, coin-
surance, or similar charge. 
‘‘(3) BENEFITS.—The term ‘benefits’ means, 
with respect to— 
‘‘(A) title XVIII of the Social Security Act, 
benefits under such title; 
‘‘(B) title XIX of such Act, medical assist-
ance under such title; and 
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‘‘(C) title XXI of such Act, assistance 
under such title. 
‘‘SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PAR-
TIES OF COSTS OF HEALTH SERVICES. 
‘‘(a) RIGHT OF RECOVERY.—Except as provided in 
subsection (f), the United States, an Indian Tribe, or 
Tribal Organization shall have the right to recover from 
an insurance company, health maintenance organization, 
employee benefit plan, third-party tortfeasor, or any other 
responsible or liable third party (including a political sub-
division or local governmental entity of a State) the rea-
sonable charges incurred by the Secretary, an Indian 
Tribe, or Tribal Organization, or, if higher, the highest 
amount the third party would pay for care and services 
furnished by providers other than governmental entities, 
in providing health services through the Service, an Indian 
Tribe, or Tribal Organization to any individual to the 
same extent that such individual, or any nongovernmental 
provider of such services, would be eligible to receive dam-
ages, reimbursement, or indemnification for such charges 
if— 
‘‘(1) such services had been provided by a non-
governmental provider; and 
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‘‘(2) such individual had been required to pay 
such charges or expenses and did pay such charges 
or expenses. 
‘‘(b) LIMITATIONS ON RECOVERIES FROM STATES.— 
Subsection (a) shall provide a right of recovery against 
any State, only if the injury, illness, or disability for which 
health services were provided is covered under— 
‘‘(1) workers’ compensation laws; or 
‘‘(2) a no-fault automobile accident insurance 
plan or program. 
‘‘(c) NONAPPLICATION OF OTHER LAWS.—No law of 
any State, or of any political subdivision of a State and 
no provision of any contract, insurance or health mainte-
nance organization policy, employee benefit plan, self-in-
surance plan, managed care plan, or other health care plan 
or program entered into or renewed after the date of the 
enactment of the Indian Health Care Amendments of 
1988, shall prevent or hinder the right of recovery of the 
United States, an Indian Tribe, or Tribal Organization 
under subsection (a). 
‘‘(d) NO EFFECT ON PRIVATE RIGHTS OF ACTION.— 
No action taken by the United States, an Indian Tribe, 
or Tribal Organization to enforce the right of recovery 
provided under this section shall operate to deny to the 
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injured person the recovery for that portion of the person’s 
damage not covered hereunder. 
‘‘(e) ENFORCEMENT.— 
‘‘(1) IN GENERAL.—The United States, an In-
dian Tribe, or Tribal Organization may enforce the 
right of recovery provided under subsection (a) by— 
‘‘(A) intervening or joining in any civil ac-
tion or proceeding brought— 
‘‘(i) by the individual for whom health 
services were provided by the Secretary, an 
Indian Tribe, or Tribal Organization; or 
‘‘(ii) by any representative or heirs of 
such individual, or 
‘‘(B) instituting a civil action, including a 
civil action for injunctive relief and other relief 
and including, with respect to a political sub-
division or local governmental entity of a State, 
such an action against an official thereof. 
‘‘(2) NOTICE.—All reasonable efforts shall be 
made to provide notice of action instituted under 
paragraph (1)(B) to the individual to whom health 
services were provided, either before or during the 
pendency of such action. 
‘‘(3) RECOVERY FROM TORTFEASORS.— 
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‘‘(4) the quality of health care services provided 
by the Department of Veterans Affairs or the De-
partment of Defense; or 
‘‘(5) the eligibility of any Indian who is a vet-
eran to receive health services through the Depart-
ment of Veterans Affairs. 
‘‘(c) REIMBURSEMENT.—The Service, Indian Tribe, 
or Tribal Organization shall be reimbursed by the Depart-
ment of Veterans Affairs or the Department of Defense 
(as the case may be) where services are provided through 
the Service, an Indian Tribe, or a Tribal Organization to 
beneficiaries eligible for services from either such Depart-
ment, notwithstanding any other provision of law. 
‘‘(d) CONSTRUCTION.—Nothing in this section may 
be construed as creating any right of a non-Indian veteran 
to obtain health services from the Service. 
‘‘SEC. 407. ELIGIBLE INDIAN VETERAN SERVICES. 
‘‘(a) FINDINGS; PURPOSE.— 
‘‘(1) FINDINGS.—Congress finds that— 
‘‘(A) collaborations between the Secretary 
and the Secretary of Veterans Affairs regarding 
the treatment of Indian veterans at facilities of 
the Service should be encouraged to the max-
imum extent practicable; and 
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