1932 
system involvement such as developmental delay, in-
tellectual deficit, or neurologic abnormalities. Behav-
iorally, there can be problems with irritability, and 
failure to thrive as infants. As children become older 
there will likely be hyperactivity, attention deficit, 
language dysfunction, and perceptual and judgment 
problems. 
‘‘(3) BEHAVIORAL HEALTH AFTERCARE.—The 
term ‘behavioral health aftercare’ includes those ac-
tivities and resources used to support recovery fol-
lowing inpatient, residential, intensive substance 
abuse, or mental health outpatient or outpatient 
treatment. The purpose is to help prevent or deal 
with relapse by ensuring that by the time a client or 
patient is discharged from a level of care, such as 
outpatient treatment, an aftercare plan has been de-
veloped with the client. An aftercare plan may use 
such resources as a community-based therapeutic 
group, transitional living facilities, a 12-step spon-
sor, a local 12-step or other related support group, 
and other community-based providers. 
‘‘(4) DUAL DIAGNOSIS.—The term ‘dual diag-
nosis’ means coexisting substance abuse and mental 
illness conditions or diagnosis. Such clients are 
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sometimes referred to as mentally ill chemical abus-
ers (MICAs). 
‘‘(5) 
FETAL
ALCOHOL
SPECTRUM
DIS-
ORDERS.— 
‘‘(A) IN GENERAL.—The term ‘fetal alco-
hol spectrum disorders’ includes a range of ef-
fects that can occur in an individual whose 
mother drank alcohol during pregnancy, includ-
ing physical, mental, behavioral, and/or learning 
disabilities with possible lifelong implications. 
‘‘(B) INCLUSIONS.—The term ‘fetal alcohol 
spectrum disorders’ may include— 
‘‘(i) fetal alcohol syndrome (FAS); 
‘‘(ii) fetal alcohol effect (FAE); 
‘‘(iii) alcohol-related birth defects; and 
‘‘(iv) 
alcohol-related 
neurodevelopmental disorders (ARND). 
‘‘(6) FETAL
ALCOHOL
SYNDROME
OR
FAS.— 
The term ‘fetal alcohol syndrome’ or ‘FAS’ means 
any 1 of a spectrum of effects that may occur when 
a woman drinks alcohol during pregnancy, the diag-
nosis of which involves the confirmed presence of the 
following 3 criteria: 
‘‘(A) Craniofacial abnormalities. 
‘‘(B) Growth deficits. 
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‘‘(C) Central nervous system abnormalities. 
‘‘(7) REHABILITATION.—The term ‘rehabilita-
tion’ means medical and health care services that— 
‘‘(A) are recommended by a physician or 
licensed practitioner of the healing arts within 
the scope of their practice under applicable law; 
‘‘(B) are furnished in a facility, home, or 
other setting in accordance with applicable 
standards; and 
‘‘(C) have as their purpose any of the fol-
lowing: 
‘‘(i) The maximum attainment of 
physical, mental, and developmental func-
tioning. 
‘‘(ii) Averting deterioration in physical 
or mental functional status. 
‘‘(iii) The maintenance of physical or 
mental health functional status. 
‘‘(8) SUBSTANCE ABUSE.—The term ‘substance 
abuse’ includes inhalant abuse. 
‘‘(9) SYSTEMS OF CARE.—The term ‘Systems of 
Care’ means a system for delivering services to chil-
dren and their families that is child-centered, family- 
focused and family-driven, community-based, and 
culturally competent and responsive to the needs of 
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the children and families being served. The systems 
of care approach values prevention and early identi-
fication, smooth transitions for children and fami-
lies, child and family participation and advocacy, 
comprehensive array of services, individualized serv-
ice planning, services in the least restrictive environ-
ment, and integrated services with coordinated plan-
ning across the child-serving systems. 
‘‘SEC. 717. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There is authorized to be appropriated such sums 
as may be necessary to carry out the provisions of this 
title. 
‘‘TITLE VIII—MISCELLANEOUS 
‘‘SEC. 801. REPORTS. 
‘‘For each fiscal year following the date of enactment 
of the Indian Health Care Improvement Act Amendments 
of 2009, the Secretary shall transmit to Congress a report 
containing the following: 
‘‘(1) A report on the progress made in meeting 
the objectives of this Act, including a review of pro-
grams established or assisted pursuant to this Act 
and assessments and recommendations of additional 
programs or additional assistance necessary to, at a 
minimum, provide health services to Indians and en-
sure a health status for Indians, which are at a par-
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ity with the health services available to and the 
health status of the general population. 
‘‘(2) A report on whether, and to what extent, 
new national health care programs, benefits, initia-
tives, or financing systems have had an impact on 
the purposes of this Act and any steps that the Sec-
retary may have taken to consult with Indian Tribes, 
Tribal Organizations, and urban Indian organiza-
tions to address such impact, including a report on 
proposed changes in allocation of funding pursuant 
to section 807. 
‘‘(3) A report on the use of health services by 
Indians— 
‘‘(A) on a national and area or other rel-
evant geographical basis; 
‘‘(B) by gender and age; 
‘‘(C) by source of payment and type of 
service; 
‘‘(D) comparing such rates of use with 
rates of use among comparable non-Indian pop-
ulations; and 
‘‘(E) provided under contracts. 
‘‘(4) A report of contractors to the Secretary on 
Health Care Educational Loan Repayments every 6 
months required by section 110. 
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