105 
‘‘SEC. 206. HEALTH SERVICES RESEARCH. 
‘‘(a) IN GENERAL.—The Secretary, acting through the 
Service, shall make funding available for research to further 
the performance of the health service responsibilities of In-
dian Health Programs. 
‘‘(b) COORDINATION
OF RESOURCES
AND ACTIVI-
TIES.—The Secretary shall also, to the maximum extent 
practicable, coordinate departmental research resources and 
activities to address relevant Indian Health Program re-
search needs. 
‘‘(c) AVAILABILITY.—Tribal Health Programs shall be 
given an equal opportunity to compete for, and receive, re-
search funds under this section. 
‘‘(d) USE OF FUNDS.—This funding may be used for 
both clinical and nonclinical research. 
‘‘(e) EVALUATION
AND DISSEMINATION.—The Sec-
retary shall periodically— 
‘‘(1) evaluate the impact of research conducted 
under this section; and 
‘‘(2) disseminate to Tribal Health Programs in-
formation regarding that research as the Secretary 
determines to be appropriate. 
‘‘SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREEN-
ING. 
‘‘The Secretary, acting through the Service or Tribal 
Health Programs, shall provide for screening as follows: 
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‘‘(1) Screening mammography (as defined in sec-
tion 1861(jj) of the Social Security Act) for Indian 
women at a frequency appropriate to such women 
under accepted and appropriate national standards, 
and under such terms and conditions as are con-
sistent with standards established by the Secretary to 
ensure the safety and accuracy of screening mammog-
raphy under part B of title XVIII of such Act. 
‘‘(2) Other cancer screening that receives an A or 
B rating as recommended by the United States Pre-
ventive Services Task Force established under section 
915(a)(1) of the Public Health Service Act (42 U.S.C. 
299b–4(a)(1)). The Secretary shall ensure that screen-
ing provided for under this paragraph complies with 
the recommendations of the Task Force with respect 
to— 
‘‘(A) frequency; 
‘‘(B) the population to be served; 
‘‘(C) the procedure or technology to be used; 
‘‘(D) evidence of effectiveness; and 
‘‘(E) other matters that the Secretary deter-
mines appropriate. 
‘‘SEC. 208. PATIENT TRAVEL COSTS. 
‘‘(a) DEFINITION OF QUALIFIED ESCORT.—In this sec-
tion, the term ‘qualified escort’ means— 
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‘‘(1) an adult escort (including a parent, guard-
ian, or other family member) who is required because 
of the physical or mental condition, or age, of the ap-
plicable patient; 
‘‘(2) a health professional for the purpose of pro-
viding necessary medical care during travel by the 
applicable patient; or 
‘‘(3) other escorts, as the Secretary or applicable 
Indian Health Program determines to be appropriate. 
‘‘(b) PROVISION OF FUNDS.—The Secretary, acting 
through the Service and Tribal Health Programs, is author-
ized to provide funds for the following patient travel costs, 
including qualified escorts, associated with receiving health 
care services provided (either through direct or contract care 
or through a contract or compact under the Indian Self- 
Determination and Education Assistance Act (25 U.S.C. 
450 et seq.)) under this Act— 
‘‘(1) emergency air transportation and non- 
emergency air transportation where ground transpor-
tation is infeasible; 
‘‘(2) transportation by private vehicle (where no 
other means of transportation is available), specially 
equipped vehicle, and ambulance; and 
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‘‘(3) transportation by such other means as may 
be available and required when air or motor vehicle 
transportation is not available. 
‘‘SEC. 209. EPIDEMIOLOGY CENTERS. 
‘‘(a) ESTABLISHMENT OF CENTERS.—The Secretary 
shall establish an epidemiology center in each Service Area 
to carry out the functions described in subsection (b). Any 
new center established after the date of the enactment of 
the Indian Health Care Improvement Act Amendments of 
2007 may be operated under a grant authorized by sub-
section (d), but funding under such a grant shall not be 
divisible. 
‘‘(b) FUNCTIONS OF CENTERS.—In consultation with 
and upon the request of Indian Tribes, Tribal Organiza-
tions, and Urban Indian Organizations, each Service Area 
epidemiology center established under this subsection shall, 
with respect to such Service Area— 
‘‘(1) collect data relating to, and monitor 
progress made toward meeting, each of the health sta-
tus objectives of the Service, the Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations in 
the Service Area; 
‘‘(2) evaluate existing delivery systems, data sys-
tems, and other systems that impact the improvement 
of Indian health; 
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‘‘(3) assist Indian Tribes, Tribal Organizations, 
and Urban Indian Organizations in identifying their 
highest priority health status objectives and the serv-
ices needed to achieve such objectives, based on epide-
miological data; 
‘‘(4) make recommendations for the targeting of 
services needed by the populations served; 
‘‘(5) make recommendations to improve health 
care delivery systems for Indians and Urban Indians; 
‘‘(6) provide requested technical assistance to In-
dian Tribes, Tribal Organizations, and Urban Indian 
Organizations in the development of local health serv-
ice priorities and incidence and prevalence rates of 
disease and other illness in the community; and 
‘‘(7) provide disease surveillance and assist In-
dian Tribes, Tribal Organizations, and Urban Indian 
Organizations to promote public health. 
‘‘(c) TECHNICAL ASSISTANCE.—The Director of the 
Centers for Disease Control and Prevention shall provide 
technical assistance to the centers in carrying out the re-
quirements of this subsection. 
‘‘(d) GRANTS FOR STUDIES.— 
‘‘(1) IN
GENERAL.—The Secretary may make 
grants to Indian Tribes, Tribal Organizations, Urban 
Indian Organizations, and eligible intertribal con-
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110 
sortia to conduct epidemiological studies of Indian 
communities. 
‘‘(2) ELIGIBLE
INTERTRIBAL
CONSORTIA.—An 
intertribal consortium is eligible to receive a grant 
under this subsection if— 
‘‘(A) the intertribal consortium is incor-
porated for the primary purpose of improving 
Indian health; and 
‘‘(B) the intertribal consortium is represent-
ative of the Indian Tribes or urban Indian com-
munities in which the intertribal consortium is 
located. 
‘‘(3) APPLICATIONS.—An application for a grant 
under this subsection shall be submitted in such man-
ner and at such time as the Secretary shall prescribe. 
‘‘(4) REQUIREMENTS.—An applicant for a grant 
under this subsection shall— 
‘‘(A) demonstrate the technical, administra-
tive, and financial expertise necessary to carry 
out the functions described in paragraph (5); 
‘‘(B) consult and cooperate with providers 
of related health and social services in order to 
avoid duplication of existing services; and 
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‘‘(C) demonstrate cooperation from Indian 
tribes or Urban Indian Organizations in the 
area to be served. 
‘‘(5) USE OF FUNDS.—A grant awarded under 
paragraph (1) may be used— 
‘‘(A) to carry out the functions described in 
subsection (b); 
‘‘(B) to provide information to and consult 
with tribal leaders, urban Indian community 
leaders, and related health staff on health care 
and health service management issues; and 
‘‘(C) in collaboration with Indian Tribes, 
Tribal Organizations, and urban Indian com-
munities, to provide the Service with informa-
tion regarding ways to improve the health status 
of Indians. 
‘‘(e) ACCESS TO INFORMATION.—An epidemiology cen-
ter operated by a grantee pursuant to a grant awarded 
under subsection (d) shall be treated as a public health au-
thority for purposes of the Health Insurance Portability 
and Accountability Act of 1996 (Public Law 104–191; 110 
Stat. 2033), as such entities are defined in part 164.501 
of title 45, Code of Federal Regulations (or a successor regu-
lation). The Secretary shall grant such grantees access to 
and use of data, data sets, monitoring systems, delivery sys-
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tems, and other protected health information in the posses-
sion of the Secretary. 
‘‘SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION 
PROGRAMS. 
‘‘(a) FUNDING FOR DEVELOPMENT OF PROGRAMS.— 
In addition to carrying out any other program for health 
promotion or disease prevention, the Secretary, acting 
through the Service, is authorized to award grants to In-
dian Tribes, Tribal Organizations, and Urban Indian Or-
ganizations to develop comprehensive school health edu-
cation programs for children from pre-school through grade 
12 in schools for the benefit of Indian and Urban Indian 
children. 
‘‘(b) USE OF GRANT FUNDS.—A grant awarded under 
this section may be used for purposes which may include, 
but are not limited to, the following: 
‘‘(1) Developing health education materials both 
for regular school programs and afterschool programs. 
‘‘(2) Training teachers in comprehensive school 
health education materials. 
‘‘(3) Integrating school-based, community-based, 
and other public and private health promotion efforts. 
‘‘(4) Encouraging healthy, tobacco-free school en-
vironments. 
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‘‘(5) Coordinating school-based health programs 
with existing services and programs available in the 
community. 
‘‘(6) Developing school programs on nutrition 
education, personal health, oral health, and fitness. 
‘‘(7) Developing behavioral health wellness pro-
grams. 
‘‘(8) Developing chronic disease prevention pro-
grams. 
‘‘(9) Developing substance abuse prevention pro-
grams. 
‘‘(10) Developing injury prevention and safety 
education programs. 
‘‘(11) Developing activities for the prevention 
and control of communicable diseases. 
‘‘(12) Developing community and environmental 
health education programs that include traditional 
health care practitioners. 
‘‘(13) Violence prevention. 
‘‘(14) Such other health issues as are appro-
priate. 
‘‘(c) TECHNICAL ASSISTANCE.—Upon request, the Sec-
retary, acting through the Service, shall provide technical 
assistance to Indian Tribes, Tribal Organizations, and 
Urban Indian Organizations in the development of com-
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114 
prehensive health education plans and the dissemination of 
comprehensive health education materials and information 
on existing health programs and resources. 
‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF APPLI-
CATIONS.—The Secretary, acting through the Service, and 
in consultation with Indian Tribes, Tribal Organizations, 
and Urban Indian Organizations, shall establish criteria 
for the review and approval of applications for grants 
awarded under this section. 
‘‘(e) DEVELOPMENT OF PROGRAM FOR BIA-FUNDED 
SCHOOLS.— 
‘‘(1) IN GENERAL.—The Secretary of the Inte-
rior, acting through the Bureau of Indian Affairs and 
in cooperation with the Secretary, acting through the 
Service, and affected Indian Tribes and Tribal Orga-
nizations, shall develop a comprehensive school health 
education program for children from preschool 
through grade 12 in schools for which support is pro-
vided by the Bureau of Indian Affairs. 
‘‘(2) REQUIREMENTS
FOR
PROGRAMS.—Such 
programs shall include— 
‘‘(A) school programs on nutrition edu-
cation, personal health, oral health, and fitness; 
‘‘(B) behavioral health wellness programs; 
‘‘(C) chronic disease prevention programs; 
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‘‘(D) substance abuse prevention programs; 
‘‘(E) injury prevention and safety education 
programs; and 
‘‘(F) activities for the prevention and con-
trol of communicable diseases. 
‘‘(3) DUTIES
OF
THE
SECRETARY.—The Sec-
retary of the Interior shall— 
‘‘(A) provide training to teachers in com-
prehensive school health education materials; 
‘‘(B) ensure the integration and coordina-
tion of school-based programs with existing serv-
ices and health programs available in the com-
munity; and 
‘‘(C) encourage healthy, tobacco-free school 
environments. 
‘‘SEC. 211. INDIAN YOUTH PROGRAM. 
‘‘(a) PROGRAM AUTHORIZED.—The Secretary, acting 
through the Service, is authorized to establish and admin-
ister a program to provide grants to Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations for inno-
vative mental and physical disease prevention and health 
promotion and treatment programs for Indian and Urban 
Indian preadolescent and adolescent youths. 
‘‘(b) USE OF FUNDS.— 
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‘‘(1) ALLOWABLE USES.—Funds made available 
under this section may be used to— 
‘‘(A) develop prevention and treatment pro-
grams for Indian youth which promote mental 
and physical health and incorporate cultural 
values, community and family involvement, and 
traditional health care practitioners; and 
‘‘(B) develop and provide community train-
ing and education. 
‘‘(2) PROHIBITED USE.—Funds made available 
under this section may not be used to provide services 
described in section 707(c). 
‘‘(c) DUTIES
OF
THE SECRETARY.—The Secretary 
shall— 
‘‘(1) disseminate to Indian Tribes, Tribal Orga-
nizations, and Urban Indian Organizations informa-
tion regarding models for the delivery of comprehen-
sive health care services to Indian and Urban Indian 
adolescents; 
‘‘(2) encourage the implementation of such mod-
els; and 
‘‘(3) at the request of an Indian Tribe, Tribal 
Organization, or Urban Indian Organization, provide 
technical assistance in the implementation of such 
models. 
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‘‘(d) CRITERIA FOR REVIEW AND APPROVAL OF APPLI-
CATIONS.—The Secretary, in consultation with Indian 
Tribes, Tribal Organizations, and Urban Indian Organiza-
tions, shall establish criteria for the review and approval 
of applications or proposals under this section. 
‘‘SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF 
COMMUNICABLE AND INFECTIOUS DISEASES. 
‘‘(a) GRANTS AUTHORIZED.—The Secretary, acting 
through the Service, and after consultation with the Centers 
for Disease Control and Prevention, may make grants 
available to Indian Tribes, Tribal Organizations, and 
Urban Indian Organizations for the following: 
‘‘(1) Projects for the prevention, control, and 
elimination of communicable and infectious diseases, 
including tuberculosis, hepatitis, HIV, respiratory 
syncytial virus, hanta virus, sexually transmitted dis-
eases, and H. Pylori. 
‘‘(2) Public information and education programs 
for the prevention, control, and elimination of com-
municable and infectious diseases. 
‘‘(3) Education, training, and clinical skills im-
provement activities in the prevention, control, and 
elimination of communicable and infectious diseases 
for health professionals, including allied health profes-
sionals. 
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118 
‘‘(4) Demonstration projects for the screening, 
treatment, and prevention of hepatitis C virus (HCV). 
‘‘(b) APPLICATION REQUIRED.—The Secretary may 
provide funding under subsection (a) only if an application 
or proposal for funding is submitted to the Secretary. 
‘‘(c) COORDINATION WITH HEALTH AGENCIES.—In-
dian Tribes, Tribal Organizations, and Urban Indian Or-
ganizations receiving funding under this section are encour-
aged to coordinate their activities with the Centers for Dis-
ease Control and Prevention and State and local health 
agencies. 
‘‘(d) TECHNICAL ASSISTANCE; REPORT.—In carrying 
out this section, the Secretary— 
‘‘(1) may, at the request of an Indian Tribe, 
Tribal Organization, or Urban Indian Organization, 
provide technical assistance; and 
‘‘(2) shall prepare and submit a report to Con-
gress biennially on the use of funds under this section 
and on the progress made toward the prevention, con-
trol, and elimination of communicable and infectious 
diseases among Indians and Urban Indians. 
‘‘SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERV-
ICES. 
‘‘(a) FUNDING AUTHORIZED.—The Secretary, acting 
through the Service, Indian Tribes, and Tribal Organiza-
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tions, may provide funding under this Act to meet the objec-
tives set forth in section 3 through health care-related serv-
ices and programs not otherwise described in this Act, in-
cluding— 
‘‘(1) hospice care; 
‘‘(2) assisted living; 
‘‘(3) long-term care; and 
‘‘(4) home- and community-based services. 
‘‘(b) TERMS AND CONDITIONS.— 
‘‘(1) IN GENERAL.—Any service provided under 
this section shall be in accordance with such terms 
and conditions as are consistent with accepted and 
appropriate standards relating to the service, includ-
ing any licensing term or condition under this Act. 
‘‘(2) STANDARDS.— 
‘‘(A) IN GENERAL.—The Secretary may es-
tablish, by regulation, the standards for a service 
provided under this section, provided that such 
standards shall not be more stringent than the 
standards required by the State in which the 
service is provided. 
‘‘(B) USE
OF
STATE
STANDARDS.—If the 
Secretary does not, by regulation, establish 
standards for a service provided under this sec-
tion, the standards required by the State in 
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120 
which the service is or will be provided shall 
apply to such service. 
‘‘(C) INDIAN TRIBES.—If a service under 
this section is provided by an Indian Tribe or 
Tribal Organization pursuant to the Indian 
Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.), the verification by 
the Secretary that the service meets any stand-
ards required by the State in which the service 
is or will be provided shall be considered to meet 
the terms and conditions required under this 
subsection. 
‘‘(3) ELIGIBILITY.—The following individuals 
shall be eligible to receive long-term care under this 
section: 
‘‘(A) Individuals who are unable to perform 
a certain number of activities of daily living 
without assistance. 
‘‘(B) Individuals with a mental impair-
ment, such as dementia, Alzheimer’s disease, or 
another disabling mental illness, who may be 
able to perform activities of daily living under 
supervision. 
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121 
‘‘(C) Such other individuals as an applica-
ble Indian Health Program determines to be ap-
propriate. 
‘‘(c) DEFINITIONS.—For the purposes of this section, 
the following definitions shall apply: 
‘‘(1) The term ‘home- and community-based serv-
ices’ means 1 or more of the services specified in 
paragraphs (1) through (9) of section 1929(a) of the 
Social Security Act (42 U.S.C. 1396t(a)) (whether 
provided by the Service or by an Indian Tribe or 
Tribal Organization pursuant to the Indian Self-De-
termination and Education Assistance Act (25 U.S.C. 
450 et seq.)) that are or will be provided in accord-
ance with the standards described in subsection (b). 
‘‘(2) The term ‘hospice care’ means the items and 
services specified in subparagraphs (A) through (H) 
of section 1861(dd)(1) of the Social Security Act (42 
U.S.C. 1395x(dd)(1)), and such other services which 
an Indian Tribe or Tribal Organization determines 
are necessary and appropriate to provide in further-
ance of this care. 
‘‘SEC. 214. INDIAN WOMEN’S HEALTH CARE. 
‘‘The Secretary, acting through the Service and Indian 
Tribes, Tribal Organizations, and Urban Indian Organiza-
tions, shall monitor and improve the quality of health care 
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122 
for Indian women of all ages through the planning and de-
livery of programs administered by the Service, in order 
to improve and enhance the treatment models of care for 
Indian women. 
‘‘SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZ-
ARDS. 
‘‘(a) STUDIES AND MONITORING.—The Secretary and 
the Service shall conduct, in conjunction with other appro-
priate Federal agencies and in consultation with concerned 
Indian Tribes and Tribal Organizations, studies and ongo-
ing monitoring programs to determine trends in the health 
hazards to Indian miners and to Indians on or near res-
ervations and Indian communities as a result of environ-
mental hazards which may result in chronic or life threat-
ening health problems, such as nuclear resource develop-
ment, petroleum contamination, and contamination of 
water source and of the food chain. Such studies shall in-
clude— 
‘‘(1) an evaluation of the nature and extent of 
health problems caused by environmental hazards cur-
rently exhibited among Indians and the causes of such 
health problems; 
‘‘(2) an analysis of the potential effect of ongoing 
and future environmental resource development on or 
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near reservations and Indian communities, including 
the cumulative effect over time on health; 
‘‘(3) an evaluation of the types and nature of ac-
tivities, practices, and conditions causing or affecting 
such health problems, including uranium mining and 
milling, uranium mine tailing deposits, nuclear 
power plant operation and construction, and nuclear 
waste disposal; oil and gas production or transpor-
tation on or near reservations or Indian commu-
nities; and other development that could affect the 
health of Indians and their water supply and food 
chain; 
‘‘(4) a summary of any findings and rec-
ommendations provided in Federal and State studies, 
reports, investigations, and inspections during the 5 
years prior to the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2007 
that directly or indirectly relate to the activities, 
practices, and conditions affecting the health or safety 
of such Indians; and 
‘‘(5) the efforts that have been made by Federal 
and State agencies and resource and economic devel-
opment companies to effectively carry out an edu-
cation program for such Indians regarding the health 
and safety hazards of such development. 
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‘‘(b) HEALTH CARE PLANS.—Upon completion of such 
studies, the Secretary and the Service shall take into ac-
count the results of such studies and develop health care 
plans to address the health problems studied under sub-
section (a). The plans shall include— 
‘‘(1) methods for diagnosing and treating Indi-
ans currently exhibiting such health problems; 
‘‘(2) preventive care and testing for Indians who 
may be exposed to such health hazards, including the 
monitoring of the health of individuals who have or 
may have been exposed to excessive amounts of radi-
ation or affected by other activities that have had or 
could have a serious impact upon the health of such 
individuals; and 
‘‘(3) a program of education for Indians who, by 
reason of their work or geographic proximity to such 
nuclear or other development activities, may experi-
ence health problems. 
‘‘(c) SUBMISSION OF REPORT AND PLAN TO CON-
GRESS.—The Secretary and the Service shall submit to 
Congress the study prepared under subsection (a) no later 
than 18 months after the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2007. The 
health care plan prepared under subsection (b) shall be sub-
mitted in a report no later than 1 year after the study pre-
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125 
pared under subsection (a) is submitted to Congress. Such 
report shall include recommended activities for the imple-
mentation of the plan, as well as an evaluation of any ac-
tivities previously undertaken by the Service to address such 
health problems. 
‘‘(d) INTERGOVERNMENTAL TASK FORCE.— 
‘‘(1) ESTABLISHMENT; MEMBERS.—There is es-
tablished an Intergovernmental Task Force to be com-
posed of the following individuals (or their designees): 
‘‘(A) The Secretary of Energy. 
‘‘(B) The Secretary of the Environmental 
Protection Agency. 
‘‘(C) The Director of the Bureau of Mines. 
‘‘(D) The Assistant Secretary for Occupa-
tional Safety and Health. 
‘‘(E) The Secretary of the Interior. 
‘‘(F) The Secretary of Health and Human 
Services. 
‘‘(G) The Director of the Indian Health 
Service. 
‘‘(2) DUTIES.—The Task Force shall— 
‘‘(A) identify existing and potential oper-
ations related to nuclear resource development or 
other environmental hazards that affect or may 
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affect the health of Indians on or near a reserva-
tion or in an Indian community; and 
‘‘(B) enter into activities to correct existing 
health hazards and ensure that current and fu-
ture health problems resulting from nuclear re-
source or other development activities are mini-
mized or reduced. 
‘‘(3) CHAIRMAN; MEETINGS.—The Secretary of 
Health and Human Services shall be the Chairman 
of the Task Force. The Task Force shall meet at least 
twice each year. 
‘‘(e) HEALTH SERVICES TO CERTAIN EMPLOYEES.— 
In the case of any Indian who— 
‘‘(1) as a result of employment in or near a ura-
nium mine or mill or near any other environmental 
hazard, suffers from a work-related illness or condi-
tion; 
‘‘(2) is eligible to receive diagnosis and treatment 
services from an Indian Health Program; and 
‘‘(3) by reason of such Indian’s employment, is 
entitled to medical care at the expense of such mine 
or mill operator or entity responsible for the environ-
mental hazard, the Indian Health Program shall, at 
the request of such Indian, render appropriate med-
ical care to such Indian for such illness or condition 
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and may be reimbursed for any medical care so ren-
dered to which such Indian is entitled at the expense 
of such operator or entity from such operator or enti-
ty. Nothing in this subsection shall affect the rights 
of such Indian to recover damages other than such 
amounts paid to the Indian Health Program from the 
employer for providing medical care for such illness 
or condition. 
‘‘SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DE-
LIVERY AREA. 
‘‘(a) IN GENERAL.—For fiscal years beginning with 
the fiscal year ending September 30, 1983, and ending with 
the fiscal year ending September 30, 2016, the State of Ari-
zona shall be designated as a contract health service delivery 
area by the Service for the purpose of providing contract 
health care services to members of federally recognized In-
dian Tribes of Arizona. 
‘‘(b) MAINTENANCE OF SERVICES.—The Service shall 
not curtail any health care services provided to Indians re-
siding on reservations in the State of Arizona if such cur-
tailment is due to the provision of contract services in such 
State pursuant to the designation of such State as a con-
tract health service delivery area pursuant to subsection (a). 
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‘‘SEC. 217. NORTH DAKOTA AND SOUTH DAKOTA AS CON-
TRACT HEALTH SERVICE DELIVERY AREA. 
‘‘(a) IN GENERAL.—Beginning in fiscal year 2003, the 
States of North Dakota and South Dakota shall be des-
ignated as a contract health service delivery area by the 
Service for the purpose of providing contract health care 
services to members of federally recognized Indian Tribes 
of North Dakota and South Dakota. 
‘‘(b) LIMITATION.—The Service shall not curtail any 
health care services provided to Indians residing on any 
reservation, or in any county that has a common boundary 
with any reservation, in the State of North Dakota or South 
Dakota if such curtailment is due to the provision of con-
tract services in such States pursuant to the designation 
of such States as a contract health service delivery area pur-
suant to subsection (a). 
‘‘SEC. 218. CALIFORNIA CONTRACT HEALTH SERVICES PRO-
GRAM. 
‘‘(a) FUNDING AUTHORIZED.—The Secretary is au-
thorized to fund a program using the California Rural In-
dian Health Board (hereafter in this section referred to as 
the ‘CRIHB’) as a contract care intermediary to improve 
the accessibility of health services to California Indians. 
‘‘(b) REIMBURSEMENT
CONTRACT.—The Secretary 
shall enter into an agreement with the CRIHB to reimburse 
the CRIHB for costs (including reasonable administrative 
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costs) incurred pursuant to this section, in providing med-
ical treatment under contract to California Indians de-
scribed in section 806(a) throughout the California contract 
health services delivery area described in section 218 with 
respect to high cost contract care cases. 
‘‘(c) ADMINISTRATIVE EXPENSES.—Not more than 5 
percent of the amounts provided to the CRIHB under this 
section for any fiscal year may be for reimbursement for 
administrative expenses incurred by the CRIHB during 
such fiscal year. 
‘‘(d) LIMITATION ON PAYMENT.—No payment may be 
made for treatment provided hereunder to the extent pay-
ment may be made for such treatment under the Indian 
Catastrophic Health Emergency Fund described in section 
202 or from amounts appropriated or otherwise made 
available to the California contract health service delivery 
area for a fiscal year. 
‘‘(e) ADVISORY BOARD.—There is established an advi-
sory board which shall advise the CRIHB in carrying out 
this section. The advisory board shall be composed of rep-
resentatives, selected by the CRIHB, from not less than 8 
Tribal Health Programs serving California Indians covered 
under this section at least 1⁄2 of whom of whom are not 
affiliated with the CRIHB. 
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‘‘SEC. 219. CALIFORNIA AS A CONTRACT HEALTH SERVICE 
DELIVERY AREA. 
‘‘The State of California, excluding the counties of Ala-
meda, Contra Costa, Los Angeles, Marin, Orange, Sac-
ramento, San Francisco, San Mateo, Santa Clara, Kern, 
Merced, Monterey, Napa, San Benito, San Joaquin, San 
Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ventura, 
shall be designated as a contract health service delivery area 
by the Service for the purpose of providing contract health 
services to California Indians. However, any of the counties 
listed herein may only be included in the contract health 
services delivery area if funding is specifically provided by 
the Service for such services in those counties. 
‘‘SEC. 220. CONTRACT HEALTH SERVICES FOR THE TREN-
TON SERVICE AREA. 
‘‘(a) AUTHORIZATION FOR SERVICES.—The Secretary, 
acting through the Service, is directed to provide contract 
health services to members of the Turtle Mountain Band 
of Chippewa Indians that reside in the Trenton Service 
Area of Divide, McKenzie, and Williams counties in the 
State of North Dakota and the adjoining counties of Rich-
land, Roosevelt, and Sheridan in the State of Montana. 
‘‘(b) NO EXPANSION OF ELIGIBILITY.—Nothing in this 
section may be construed as expanding the eligibility of 
members of the Turtle Mountain Band of Chippewa Indians 
for health services provided by the Service beyond the scope 
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131 
of eligibility for such health services that applied on May 
1, 1986. 
‘‘SEC. 221. PROGRAMS OPERATED BY INDIAN TRIBES AND 
TRIBAL ORGANIZATIONS. 
‘‘The Service shall provide funds for health care pro-
grams and facilities operated by Tribal Health Programs 
on the same basis as such funds are provided to programs 
and facilities operated directly by the Service. 
‘‘SEC. 222. LICENSING. 
‘‘Health care professionals employed by a Tribal 
Health Program shall, if licensed in any State, be exempt 
from the licensing requirements of the State in which the 
Tribal Health Program performs the services described in 
its contract or compact under the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C. 450 et seq.). 
‘‘SEC. 223. NOTIFICATION OF PROVISION OF EMERGENCY 
CONTRACT HEALTH SERVICES. 
‘‘With respect to an elderly Indian or an Indian with 
a disability receiving emergency medical care or services 
from a non-Service provider or in a non-Service facility 
under the authority of this Act, the time limitation (as a 
condition of payment) for notifying the Service of such 
treatment or admission shall be 30 days. 
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‘‘SEC. 224. PROMPT ACTION ON PAYMENT OF CLAIMS. 
‘‘(a) DEADLINE FOR RESPONSE.—The Service shall re-
spond to a notification of a claim by a provider of a con-
tract care service with either an individual purchase order 
or a denial of the claim within 5 working days after the 
receipt of such notification. 
‘‘(b) EFFECT OF UNTIMELY RESPONSE.—If the Service 
fails to respond to a notification of a claim in accordance 
with subsection (a), the Service shall accept as valid the 
claim submitted by the provider of a contract care service. 
‘‘(c) DEADLINE FOR PAYMENT OF VALID CLAIM.—The 
Service shall pay a valid contract care service claim within 
30 days after the completion of the claim. 
‘‘SEC. 225. LIABILITY FOR PAYMENT. 
‘‘(a) NO PATIENT LIABILITY.—A patient who receives 
contract health care services that are authorized by the 
Service shall not be liable for the payment of any charges 
or costs associated with the provision of such services. 
‘‘(b) NOTIFICATION.—The Secretary shall notify a con-
tract care provider and any patient who receives contract 
health care services authorized by the Service that such pa-
tient is not liable for the payment of any charges or costs 
associated with the provision of such services not later than 
5 business days after receipt of a notification of a claim 
by a provider of contract care services. 
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‘‘(c) NO RECOURSE.—Following receipt of the notice 
provided under subsection (b), or, if a claim has been 
deemed accepted under section 223(b), the provider shall 
have no further recourse against the patient who received 
the services. 
‘‘SEC. 226. OFFICE OF INDIAN MEN’S HEALTH. 
‘‘(a) ESTABLISHMENT.—The Secretary may establish 
within the Service an office to be known as the ‘Office of 
Indian Men’s Health’ (referred to in this section as the ‘Of-
fice’). 
‘‘(b) DIRECTOR.— 
‘‘(1) IN GENERAL.—The Office shall be headed by 
a director, to be appointed by the Secretary. 
‘‘(2) DUTIES.—The director shall coordinate and 
promote the status of the health of Indian men in the 
United States. 
‘‘(c) REPORT.—Not later than 2 years after the date 
of enactment of the Indian Health Care Improvement Act 
Amendments of 2007, the Secretary, acting through the di-
rector of the Office, shall submit to Congress a report de-
scribing— 
‘‘(1) any activity carried out by the director as 
of the date on which the report is prepared; and 
‘‘(2) any finding of the director with respect to 
the health of Indian men. 
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‘‘SEC. 227. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated such sums 
as may be necessary for each fiscal year through fiscal year 
2017 to carry out this title. 
‘‘TITLE III—FACILITIES 
‘‘SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVA-
TION OF FACILITIES; REPORTS. 
‘‘(a) 
PREREQUISITES
FOR
EXPENDITURE
OF 
FUNDS.—Prior to the expenditure of, or the making of any 
binding commitment to expend, any funds appropriated for 
the planning, design, construction, or renovation of facili-
ties pursuant to the Act of November 2, 1921 (25 U.S.C. 
13) (commonly known as the ‘Snyder Act’), the Secretary, 
acting through the Service, shall— 
‘‘(1) consult with any Indian Tribe that would 
be significantly affected by such expenditure for the 
purpose of determining and, whenever practicable, 
honoring tribal preferences concerning size, location, 
type, and other characteristics of any facility on 
which such expenditure is to be made; and 
‘‘(2) ensure, whenever practicable and applicable, 
that such facility meets the construction standards of 
any accrediting body recognized by the Secretary for 
the purposes of the Medicare, Medicaid, and SCHIP 
programs under titles XVIII, XIX, and XXI of the 
Social Security Act by not later than 1 year after the 
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date on which the construction or renovation of such 
facility is completed. 
‘‘(b) CLOSURES.— 
‘‘(1) EVALUATION REQUIRED.—Notwithstanding 
any other provision of law, no facility operated by the 
Service, or any portion of such facility, may be closed 
if the Secretary has not submitted to Congress, not 
less than 1 year and not more than 2 years before the 
date of the proposed closure, an evaluation, completed 
not more than 2 years before such submission, of the 
impact of the proposed closure that specifies, in addi-
tion to other considerations— 
‘‘(A) the accessibility of alternative health 
care resources for the population served by such 
facility; 
‘‘(B) the cost-effectiveness of such closure; 
‘‘(C) the quality of health care to be pro-
vided to the population served by such facility 
after such closure; 
‘‘(D) the availability of contract health care 
funds to maintain existing levels of service; 
‘‘(E) the views of the Indian Tribes served 
by such facility concerning such closure; 
‘‘(F) the level of use of such facility by all 
eligible Indians; and 
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‘‘(G) the distance between such facility and 
the nearest operating Service hospital. 
‘‘(2) EXCEPTION FOR CERTAIN TEMPORARY CLO-
SURES.—Paragraph (1) shall not apply to any tem-
porary closure of a facility or any portion of a facil-
ity if such closure is necessary for medical, environ-
mental, or construction safety reasons. 
‘‘(c) HEALTH CARE FACILITY PRIORITY SYSTEM.— 
‘‘(1) IN GENERAL.— 
‘‘(A) PRIORITY
SYSTEM.—The Secretary, 
acting through the Service, shall maintain a 
health care facility priority system, which— 
‘‘(i) shall be developed in consultation 
with Indian Tribes and Tribal Organiza-
tions; 
‘‘(ii) shall give Indian Tribes’ needs 
the highest priority; 
‘‘(iii)(I) may include the lists required 
in paragraph (2)(B)(ii); and 
‘‘(II) shall include the methodology re-
quired in paragraph (2)(B)(v); and 
‘‘(III) may include such other facili-
ties, and such renovation or expansion 
needs of any health care facility, as the 
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Service, Indian Tribes, and Tribal Organi-
zations may identify; and 
‘‘(iv) shall provide an opportunity for 
the nomination of planning, design, and 
construction projects by the Service, Indian 
Tribes, and Tribal Organizations for con-
sideration under the priority system at least 
once every 3 years, or more frequently as 
the Secretary determines to be appropriate. 
‘‘(B) NEEDS OF FACILITIES UNDER ISDEAA 
AGREEMENTS.—The Secretary shall ensure that 
the planning, design, construction, renovation, 
and expansion needs of Service and non-Service 
facilities operated under contracts or compacts 
in accordance with the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C. 
450 et seq.) are fully and equitably integrated 
into the health care facility priority system. 
‘‘(C) CRITERIA FOR EVALUATING NEEDS.— 
For purposes of this subsection, the Secretary, in 
evaluating the needs of facilities operated under 
a contract or compact under the Indian Self-De-
termination and Education Assistance Act (25 
U.S.C. 450 et seq.), shall use the criteria used by 
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138 
the Secretary in evaluating the needs of facilities 
operated directly by the Service. 
‘‘(D) PRIORITY OF CERTAIN PROJECTS PRO-
TECTED.—The priority of any project established 
under the construction priority system in effect 
on the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2007 
shall not be affected by any change in the con-
struction priority system taking place after that 
date if the project— 
‘‘(i) was identified in the fiscal year 
2008 Service budget justification as— 
‘‘(I) 1 of the 10 top-priority inpa-
tient projects; 
‘‘(II) 1 of the 10 top-priority out-
patient projects; 
‘‘(III) 1 of the 10 top-priority 
staff quarters developments; or 
‘‘(IV) 1 of the 10 top-priority 
Youth Regional Treatment Centers; 
‘‘(ii) had completed both Phase I and 
Phase II of the construction priority system 
in effect on the date of enactment of such 
Act; or 
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139 
‘‘(iii) is not included in clause (i) or 
(ii) and is selected, as determined by the 
Secretary— 
‘‘(I) on the initiative of the Sec-
retary; or 
‘‘(II) pursuant to a request of an 
Indian Tribe or Tribal Organization. 
‘‘(2) REPORT; CONTENTS.— 
‘‘(A) INITIAL COMPREHENSIVE REPORT.— 
‘‘(i) DEFINITIONS.—In this subpara-
graph: 
‘‘(I) FACILITIES
APPROPRIATION 
ADVISORY
BOARD.—The term ‘Facili-
ties Appropriation Advisory Board’ 
means the advisory board, comprised of 
12 members representing Indian tribes 
and 2 members representing the Serv-
ice, established at the discretion of the 
Assistant Secretary— 
‘‘(aa) to provide advice and 
recommendations for policies and 
procedures of the programs funded 
pursuant to facilities appropria-
tions; and 
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140 
‘‘(bb) to address other facili-
ties issues. 
‘‘(II) FACILITIES NEEDS ASSESS-
MENT WORKGROUP.—The term ‘Facili-
ties 
Needs 
Assessment 
Workgroup’ 
means the workgroup established at the 
discretion of the Assistant Secretary— 
‘‘(aa) to review the health 
care facilities construction pri-
ority system; and 
‘‘(bb) to make recommenda-
tions to the Facilities Appropria-
tion Advisory Board for revising 
the priority system. 
‘‘(ii) INITIAL REPORT.— 
‘‘(I) IN GENERAL.—Not later than 
1 year after the date of enactment of 
the Indian Health Care Improvement 
Act Amendments of 2007, the Secretary 
shall submit to the Committee on In-
dian Affairs of the Senate and the 
Committee on Natural Resources of the 
House of Representatives a report that 
describes the comprehensive, national, 
ranked list of all health care facilities 
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141 
needs for the Service, Indian Tribes, 
and Tribal Organizations (including 
inpatient health care facilities, out-
patient health care facilities, special-
ized health care facilities (such as for 
long-term care and alcohol and drug 
abuse treatment), wellness centers, staff 
quarters and hostels associated with 
health care facilities, and the renova-
tion and expansion needs, if any, of 
such facilities) developed by the Serv-
ice, Indian Tribes, and Tribal Organi-
zations for the Facilities Needs Assess-
ment Workgroup and the Facilities Ap-
propriation Advisory Board. 
‘‘(II) INCLUSIONS.—The initial 
report shall include— 
‘‘(aa) the methodology and 
criteria used by the Service in de-
termining the needs and estab-
lishing the ranking of the facili-
ties needs; and 
‘‘(bb) such other information 
as the Secretary determines to be 
appropriate. 
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‘‘(iii) UPDATES
OF
REPORT.—Begin-
ning in calendar year 2011, the Secretary 
shall— 
‘‘(I) update the report under 
clause (ii) not less frequently that once 
every 5 years; and 
‘‘(II) include the updated report 
in the appropriate annual report 
under subparagraph (B) for submis-
sion to Congress under section 801. 
‘‘(B) ANNUAL
REPORTS.—The Secretary 
shall submit to the President, for inclusion in the 
report required to be transmitted to Congress 
under section 801, a report which sets forth the 
following: 
‘‘(i) A description of the health care fa-
cility priority system of the Service estab-
lished under paragraph (1). 
‘‘(ii) Health care facilities lists, which 
may include— 
‘‘(I) the 10 top-priority inpatient 
health care facilities; 
‘‘(II) the 10 top-priority out-
patient health care facilities; 
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‘‘(III) the 10 top-priority special-
ized health care facilities (such as long- 
term care and alcohol and drug abuse 
treatment); 
‘‘(IV) the 10 top-priority staff 
quarters developments associated with 
health care facilities; and 
‘‘(V) the 10 top-priority hostels 
associated with health care facilities. 
‘‘(iii) The justification for such order 
of priority. 
‘‘(iv) The projected cost of such 
projects. 
‘‘(v) The methodology adopted by the 
Service in establishing priorities under its 
health care facility priority system. 
‘‘(3) REQUIREMENTS FOR PREPARATION OF RE-
PORTS.—In preparing the report required under 
paragraph (2), the Secretary shall— 
‘‘(A) consult with and obtain information 
on all health care facilities needs from Indian 
Tribes, Tribal Organizations, and Urban Indian 
Organizations; and 
‘‘(B) review the total unmet needs of all In-
dian Tribes, Tribal Organizations, and Urban 
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144 
Indian Organizations for health care facilities 
(including hostels and staff quarters), including 
needs for renovation and expansion of existing 
facilities. 
‘‘(d) REVIEW OF METHODOLOGY USED FOR HEALTH 
FACILITIES CONSTRUCTION PRIORITY SYSTEM.— 
‘‘(1) IN GENERAL.—Not later than 1 year after 
the establishment of the priority system under sub-
section (c)(1)(A), the Comptroller General of the 
United States shall prepare and finalize a report re-
viewing the methodologies applied, and the processes 
followed, by the Service in making each assessment of 
needs for the list under subsection (c)(2)(A)(ii) and 
developing the priority system under subsection 
(c)(1), including a review of— 
‘‘(A) the recommendations of the Facilities 
Appropriation Advisory Board and the Facili-
ties Needs Assessment Workgroup (as those terms 
are defined in subsection (c)(2)(A)(i)); and 
‘‘(B) the relevant criteria used in ranking 
or prioritizing facilities other than hospitals or 
clinics. 
‘‘(2) SUBMISSION
TO
CONGRESS.—The Comp-
troller General of the United States shall submit the 
report under paragraph (1) to— 
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‘‘(A) the Committees on Indian Affairs and 
Appropriations of the Senate; 
‘‘(B) the Committees on Natural Resources 
and Appropriations of the House of Representa-
tives; and 
‘‘(C) the Secretary. 
‘‘(e) FUNDING CONDITION.—All funds appropriated 
under the Act of November 2, 1921 (25 U.S.C. 13) (com-
monly known as the ‘Snyder Act’), for the planning, design, 
construction, or renovation of health facilities for the benefit 
of 1 or more Indian Tribes shall be subject to the provisions 
of the Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.). 
‘‘(f) DEVELOPMENT OF INNOVATIVE APPROACHES.— 
The Secretary shall consult and cooperate with Indian 
Tribes, Tribal Organizations, and Urban Indian Organiza-
tions in developing innovative approaches to address all or 
part of the total unmet need for construction of health facili-
ties, including those provided for in other sections of this 
title and other approaches. 
‘‘SEC. 302. SANITATION FACILITIES. 
‘‘(a) FINDINGS.—Congress finds the following: 
‘‘(1) The provision of sanitation facilities is pri-
marily a health consideration and function. 
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‘‘(2) Indian people suffer an inordinately high 
incidence of disease, injury, and illness directly at-
tributable to the absence or inadequacy of sanitation 
facilities. 
‘‘(3) The long-term cost to the United States of 
treating and curing such disease, injury, and illness 
is substantially greater than the short-term cost of 
providing sanitation facilities and other preventive 
health measures. 
‘‘(4) Many Indian homes and Indian commu-
nities still lack sanitation facilities. 
‘‘(5) It is in the interest of the United States, 
and it is the policy of the United States, that all In-
dian communities and Indian homes, new and exist-
ing, be provided with sanitation facilities. 
‘‘(b) FACILITIES AND SERVICES.—In furtherance of the 
findings made in subsection (a), Congress reaffirms the pri-
mary responsibility and authority of the Service to provide 
the necessary sanitation facilities and services as provided 
in section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a). 
Under such authority, the Secretary, acting through the 
Service, is authorized to provide the following: 
‘‘(1) Financial and technical assistance to In-
dian Tribes, Tribal Organizations, and Indian com-
munities in the establishment, training, and equip-
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ping of utility organizations to operate and maintain 
sanitation facilities, including the provision of exist-
ing plans, standard details, and specifications avail-
able in the Department, to be used at the option of 
the Indian Tribe, Tribal Organization, or Indian 
community. 
‘‘(2) Ongoing technical assistance and training 
to Indian Tribes, Tribal Organizations, and Indian 
communities in the management of utility organiza-
tions which operate and maintain sanitation facili-
ties. 
‘‘(3) Priority funding for operation and mainte-
nance assistance for, and emergency repairs to, sani-
tation facilities operated by an Indian Tribe, Tribal 
Organization or Indian community when necessary 
to avoid an imminent health threat or to protect the 
investment in sanitation facilities and the investment 
in the health benefits gained through the provision of 
sanitation facilities. 
‘‘(c) FUNDING.—Notwithstanding any other provision 
of law— 
‘‘(1) the Secretary of Housing and Urban Devel-
opment is authorized to transfer funds appropriated 
under the Native American Housing Assistance and 
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148 
Self-Determination Act of 1996 (25 U.S.C. 4101 et 
seq.) to the Secretary of Health and Human Services; 
‘‘(2) the Secretary of Health and Human Serv-
ices is authorized to accept and use such funds for the 
purpose of providing sanitation facilities and services 
for Indians under section 7 of the Act of August 5, 
1954 (42 U.S.C. 2004a); 
‘‘(3) unless specifically authorized when funds 
are appropriated, the Secretary shall not use funds 
appropriated under section 7 of the Act of August 5, 
1954 (42 U.S.C. 2004a), to provide sanitation facili-
ties to new homes constructed using funds provided by 
the Department of Housing and Urban Development; 
‘‘(4) the Secretary of Health and Human Serv-
ices is authorized to accept from any source, includ-
ing Federal and State agencies, funds for the purpose 
of providing sanitation facilities and services and 
place these funds into contracts or compacts under the 
Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.); 
‘‘(5) except as otherwise prohibited by this sec-
tion, the Secretary may use funds appropriated under 
the authority of section 7 of the Act of August 5, 1954 
(42 U.S.C. 2004a), to fund up to 100 percent of the 
amount of an Indian Tribe’s loan obtained under any 
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149 
Federal program for new projects to construct eligible 
sanitation facilities to serve Indian homes; 
‘‘(6) except as otherwise prohibited by this sec-
tion, the Secretary may use funds appropriated under 
the authority of section 7 of the Act of August 5, 1954 
(42 U.S.C. 2004a) to meet matching or cost partici-
pation requirements under other Federal and non- 
Federal programs for new projects to construct eligible 
sanitation facilities; 
‘‘(7) all Federal agencies are authorized to trans-
fer to the Secretary funds identified, granted, loaned, 
or appropriated whereby the Department’s applicable 
policies, rules, and regulations shall apply in the im-
plementation of such projects; 
‘‘(8) the Secretary of Health and Human Serv-
ices shall enter into interagency agreements with Fed-
eral and State agencies for the purpose of providing 
financial assistance for sanitation facilities and serv-
ices under this Act; 
‘‘(9) the Secretary of Health and Human Serv-
ices shall, by regulation, establish standards applica-
ble to the planning, design, and construction of sani-
tation facilities funded under this Act; and 
‘‘(10) the Secretary of Health and Human Serv-
ices is authorized to accept payments for goods and 
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150 
services furnished by the Service from appropriate 
public authorities, nonprofit organizations or agen-
cies, or Indian Tribes, as contributions by that au-
thority, organization, agency, or tribe to agreements 
made under section 7 of the Act of August 5, 1954 (42 
U.S.C. 2004a), and such payments shall be credited 
to the same or subsequent appropriation account as 
funds appropriated under the authority of section 7 
of the Act of August 5, 1954 (42 U.S.C. 2004a). 
‘‘(d) CERTAIN CAPABILITIES NOT PREREQUISITE.— 
The financial and technical capability of an Indian Tribe, 
Tribal Organization, or Indian community to safely oper-
ate, manage, and maintain a sanitation facility shall not 
be a prerequisite to the provision or construction of sanita-
tion facilities by the Secretary. 
‘‘(e) FINANCIAL ASSISTANCE.—The Secretary is au-
thorized to provide financial assistance to Indian Tribes, 
Tribal Organizations, and Indian communities for oper-
ation, management, and maintenance of their sanitation 
facilities. 
‘‘(f) OPERATION, MANAGEMENT, AND MAINTENANCE OF 
FACILITIES.—The Indian Tribe has the primary responsi-
bility to establish, collect, and use reasonable user fees, or 
otherwise set aside funding, for the purpose of operating, 
managing, and maintaining sanitation facilities. If a sani-
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151 
tation facility serving a community that is operated by an 
Indian Tribe or Tribal Organization is threatened with im-
minent failure and such operator lacks capacity to main-
tain the integrity or the health benefits of the sanitation 
facility, then the Secretary is authorized to assist the In-
dian Tribe, Tribal Organization, or Indian community in 
the resolution of the problem on a short-term basis through 
cooperation with the emergency coordinator or by providing 
operation, management, and maintenance service. 
‘‘(g) ISDEAA PROGRAM FUNDED ON EQUAL BASIS.— 
Tribal Health Programs shall be eligible (on an equal basis 
with programs that are administered directly by the Serv-
ice) for— 
‘‘(1) any funds appropriated pursuant to this 
section; and 
‘‘(2) any funds appropriated for the purpose of 
providing sanitation facilities. 
‘‘(h) REPORT.— 
‘‘(1) REQUIRED; CONTENTS.—The Secretary, in 
consultation with the Secretary of Housing and 
Urban Development, Indian Tribes, Tribal Organiza-
tions, and tribally designated housing entities (as de-
fined in section 4 of the Native American Housing 
Assistance and Self-Determination Act of 1996 (25 
U.S.C. 4103)) shall submit to the President, for inclu-
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152 
sion in the report required to be transmitted to Con-
gress under section 801, a report which sets forth— 
‘‘(A) the current Indian sanitation facility 
priority system of the Service; 
‘‘(B) the methodology for determining sani-
tation deficiencies and needs; 
‘‘(C) the criteria on which the deficiencies 
and needs will be evaluated; 
‘‘(D) the level of initial and final sanitation 
deficiency for each type of sanitation facility for 
each project of each Indian Tribe or Indian com-
munity; 
‘‘(E) the amount and most effective use of 
funds, derived from whatever source, necessary to 
accommodate the sanitation facilities needs of 
new homes assisted with funds under the Native 
American Housing Assistance and Self-Deter-
mination Act (25 U.S.C. 4101 et seq.), and to re-
duce the identified sanitation deficiency levels of 
all Indian Tribes and Indian communities to 
level I sanitation deficiency as defined in para-
graph (3)(A); and 
‘‘(F) a 10-year plan to provide sanitation 
facilities to serve existing Indian homes and In-
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153 
dian communities and new and renovated In-
dian homes. 
‘‘(2) UNIFORM
METHODOLOGY.—The method-
ology used by the Secretary in determining, pre-
paring cost estimates for, and reporting sanitation 
deficiencies for purposes of paragraph (1) shall be ap-
plied uniformly to all Indian Tribes and Indian com-
munities. 
‘‘(3) SANITATION
DEFICIENCY
LEVELS.—For 
purposes of this subsection, the sanitation deficiency 
levels for an individual, Indian Tribe, or Indian com-
munity sanitation facility to serve Indian homes are 
determined as follows: 
‘‘(A) A level I deficiency exists if a sanita-
tion facility serving an individual, Indian 
Tribe, or Indian community— 
‘‘(i) complies with all applicable water 
supply, pollution control, and solid waste 
disposal laws; and 
‘‘(ii) deficiencies relate to routine re-
placement, repair, or maintenance needs. 
‘‘(B) A level II deficiency exists if a sanita-
tion facility serving an individual, Indian 
Tribe, or Indian community substantially or re-
cently complied with all applicable water sup-
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ply, pollution control, and solid waste laws and 
any deficiencies relate to— 
‘‘(i) small or minor capital improve-
ments needed to bring the facility back into 
compliance; 
‘‘(ii) capital improvements that are 
necessary to enlarge or improve the facili-
ties in order to meet the current needs for 
domestic sanitation facilities; or 
‘‘(iii) the lack of equipment or training 
by an Indian Tribe, Tribal Organization, 
or an Indian community to properly oper-
ate and maintain the sanitation facilities. 
‘‘(C) A level III deficiency exists if a sani-
tation facility serving an individual, Indian 
Tribe or Indian community meets 1 or more of 
the following conditions— 
‘‘(i) water or sewer service in the home 
is provided by a haul system with holding 
tanks and interior plumbing; 
‘‘(ii) major significant interruptions to 
water supply or sewage disposal occur fre-
quently, requiring major capital improve-
ments to correct the deficiencies; or 
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155 
‘‘(iii) there is no access to or no ap-
proved or permitted solid waste facility 
available. 
‘‘(D) A level IV deficiency exists— 
‘‘(i) if a sanitation facility for an in-
dividual home, an Indian Tribe, or an In-
dian community exists but— 
‘‘(I) lacks— 
‘‘(aa) a safe water supply 
system; or 
‘‘(bb) a waste disposal sys-
tem; 
‘‘(II) contains no piped water or 
sewer facilities; or 
‘‘(III) has become inoperable due 
to a major component failure; or 
‘‘(ii) if only a washeteria or central fa-
cility exists in the community. 
‘‘(E) A level V deficiency exists in the ab-
sence of a sanitation facility, where individual 
homes do not have access to safe drinking water 
or adequate wastewater (including sewage) dis-
posal. 
‘‘(i) DEFINITIONS.—For purposes of this section, the 
following terms apply: 
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‘‘(1) INDIAN
COMMUNITY.—The term ‘Indian 
community’ means a geographic area, a significant 
proportion of whose inhabitants are Indians and 
which is served by or capable of being served by a fa-
cility described in this section. 
‘‘(2) SANITATION FACILITIES.—The terms ‘sani-
tation facility’ and ‘sanitation facilities’ mean safe 
and adequate water supply systems, sanitary sewage 
disposal systems, and sanitary solid waste systems 
(and all related equipment and support infrastruc-
ture). 
‘‘SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS. 
‘‘(a) BUY INDIAN ACT.—The Secretary, acting through 
the Service, may use the negotiating authority of section 
23 of the Act of June 25, 1910 (25 U.S.C. 47, commonly 
known as the ‘Buy Indian Act’), to give preference to any 
Indian or any enterprise, partnership, corporation, or other 
type of business organization owned and controlled by an 
Indian or Indians including former or currently federally 
recognized Indian Tribes in the State of New York (herein-
after referred to as an ‘Indian firm’) in the construction 
and renovation of Service facilities pursuant to section 301 
and in the construction of sanitation facilities pursuant to 
section 302. Such preference may be accorded by the Sec-
retary unless the Secretary finds, pursuant to regulations, 
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that the project or function to be contracted for will not 
be satisfactory or such project or function cannot be prop-
erly completed or maintained under the proposed contract. 
The Secretary, in arriving at such a finding, shall consider 
whether the Indian or Indian firm will be deficient with 
respect to— 
‘‘(1) ownership and control by Indians; 
‘‘(2) equipment; 
‘‘(3) bookkeeping and accounting procedures; 
‘‘(4) substantive knowledge of the project or func-
tion to be contracted for; 
‘‘(5) adequately trained personnel; or 
‘‘(6) other necessary components of contract per-
formance. 
‘‘(b) LABOR STANDARDS.—For the purposes of imple-
menting the provisions of this title, contracts for the con-
struction or renovation of health care facilities, staff quar-
ters, and sanitation facilities, and related support infra-
structure, funded in whole or in part with funds made 
available pursuant to this title, shall contain a provision 
requiring compliance with subchapter IV of chapter 31 of 
title 40, United States Code (commonly known as the 
‘Davis-Bacon Act’). 
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158 
‘‘SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR 
RENOVATION. 
‘‘(a) IN GENERAL.—Notwithstanding any other provi-
sion of law, if the requirements of subsection (c) are met, 
the Secretary, acting through the Service, is authorized to 
accept any major expansion, renovation, or modernization 
by any Indian Tribe or Tribal Organization of any Service 
facility or of any other Indian health facility operated pur-
suant to a contract or compact under the Indian Self-Deter-
mination and Education Assistance Act (25 U.S.C. 450 et 
seq.), including— 
‘‘(1) any plans or designs for such expansion, 
renovation, or modernization; and 
‘‘(2) any expansion, renovation, or moderniza-
tion for which funds appropriated under any Federal 
law were lawfully expended. 
‘‘(b) PRIORITY LIST.— 
‘‘(1) IN GENERAL.—The Secretary shall main-
tain a separate priority list to address the needs for 
increased operating expenses, personnel, or equipment 
for such facilities. The methodology for establishing 
priorities shall be developed through regulations. The 
list of priority facilities will be revised annually in 
consultation with Indian Tribes and Tribal Organi-
zations. 
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159 
‘‘(2) REPORT.—The Secretary shall submit to the 
President, for inclusion in the report required to be 
transmitted to Congress under section 801, the pri-
ority list maintained pursuant to paragraph (1). 
‘‘(c) REQUIREMENTS.—The requirements of this sub-
section are met with respect to any expansion, renovation, 
or modernization if— 
‘‘(1) the Indian Tribe or Tribal Organization— 
‘‘(A) provides notice to the Secretary of its 
intent to expand, renovate, or modernize; and 
‘‘(B) applies to the Secretary to be placed 
on a separate priority list to address the needs 
of such new facilities for increased operating ex-
penses, personnel, or equipment; and 
‘‘(2) the expansion, renovation, or moderniza-
tion— 
‘‘(A) is approved by the appropriate area 
director of the Service for Federal facilities; and 
‘‘(B) is administered by the Indian Tribe or 
Tribal Organization in accordance with any ap-
plicable regulations prescribed by the Secretary 
with respect to construction or renovation of 
Service facilities. 
‘‘(d) ADDITIONAL REQUIREMENT FOR EXPANSION.— 
In addition to the requirements under subsection (c), for 
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260 
‘‘(b) ALCOHOL AND SUBSTANCE ABUSE TREATMENT 
CENTERS OR FACILITIES.— 
‘‘(1) ESTABLISHMENT.— 
‘‘(A) IN GENERAL.—The Secretary, acting 
through the Service, Indian Tribes, and Tribal 
Organizations, shall construct, renovate, or, as 
necessary, purchase, and appropriately staff and 
operate, at least 1 youth regional treatment cen-
ter or treatment network in each area under the 
jurisdiction of an Area Office. 
‘‘(B) AREA
OFFICE
IN
CALIFORNIA.—For 
the purposes of this subsection, the Area Office in 
California shall be considered to be 2 Area Of-
fices, 1 office whose jurisdiction shall be consid-
ered to encompass the northern area of the State 
of California, and 1 office whose jurisdiction 
shall be considered to encompass the remainder 
of the State of California for the purpose of im-
plementing California treatment networks. 
‘‘(2) FUNDING.—For the purpose of staffing and 
operating such centers or facilities, funding shall be 
pursuant to the Act of November 2, 1921 (25 U.S.C. 
13). 
‘‘(3) LOCATION.—A youth treatment center con-
structed or purchased under this subsection shall be 
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