IB 
Union Calendar No. 444 
110TH CONGRESS 
2D SESSION 
H. R. 1328 
[Report No. 110–564, Part I] 
To amend the Indian Health Care Improvement Act to revise and extend 
that Act. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 6, 2007 
Mr. PALLONE (for himself, Mr. RAHALL, Mr. YOUNG of Alaska, Mr. KILDEE, 
Mr. GEORGE
MILLER
of California, Mr. FALEOMAVAEGA, Mrs. 
CHRISTENSEN, Mr. GRIJALVA, Mr. BOREN, Mr. HINCHEY, Mr. KEN-
NEDY, Mr. KIND, Mr. INSLEE, Mr. BACA, Mr. UDALL of New Mexico, 
Mr. RENZI, Mr. WU, Mr. CONYERS, Mr. OBERSTAR, Mr. THOMPSON of 
California, Mr. WAXMAN, Mr. COLE of Oklahoma, Mr. BOSWELL, Ms. 
HERSETH, Mr. ENGEL, Mr. KAGEN, Ms. BORDALLO, Mrs. BONO, Mr. 
MORAN of Virginia, Mr. MCDERMOTT, Mr. HONDA, Mr. FILNER, Mr. 
MCKEON, and Ms. SOLIS) introduced the following bill; which was re-
ferred to the Committee on Natural Resources, and in addition to the 
Committees on Energy and Commerce and Ways and Means, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
APRIL 4, 2008 
Reported from the Committee on Natural Resources with an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
APRIL 4, 2008 
Referral to the Committees on Energy and Commerce and Ways and Means 
extended for a period ending not later than June 6, 2008 
JUNE 6, 2008 
Additional sponsors: Mr. UDALL of Colorado, Mr. ALLEN, Mr. WALDEN of Or-
egon, Mr. BERMAN, Ms. ZOE LOFGREN of California, Ms. LINDA T. 
SA´NCHEZ of California, Mr. LARSON of Connecticut, Mrs. CAPPS, Mrs. 
WILSON of New Mexico, Mr. MCCOTTER, Mr. MITCHELL, Mr. HINOJOSA, 
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Mr. MICHAUD, Mr. GORDON of Tennessee, Ms. DEGETTE, Ms. CARSON, 
Mr. CAPUANO, Mr. BLUMENAUER, Mr. MATHESON, Mr. PETERSON of 
Minnesota, Ms. BALDWIN, Mr. WALZ of Minnesota, Mr. PEARCE, Mr. 
MEEKS of New York, and Mr. SALAZAR 
JUNE 6, 2008 
Committees on Energy and Commerce and Ways and Means discharged; com-
mitted to the Committee of the Whole House on the State of the Union 
and ordered to be printed 
[For text of introduced bill, see copy of bill as introduced on March 6, 2007] 
A BILL 
To amend the Indian Health Care Improvement Act to revise 
and extend that Act. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the ‘‘In-
dian Health Care Improvement Act Amendments of 2007’’. 
(b) TABLE OF CONTENTS.—The table of contents of this 
Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—AMENDMENTS TO INDIAN LAWS 
Sec. 101. Indian Health Care Improvement Act amended. 
Sec. 102. Soboba sanitation facilities. 
Sec. 103. Native American Health and Wellness Foundation. 
TITLE II—IMPROVEMENT OF INDIAN HEALTH CARE PROVIDED 
UNDER THE SOCIAL SECURITY ACT 
Sec. 201. Expansion of payments under Medicare, Medicaid, and SCHIP for all 
covered services furnished by Indian Health Programs. 
Sec. 202. Increased outreach to Indians under Medicaid and SCHIP and im-
proved cooperation in the provision of items and services to In-
dians under Social Security Act health benefit programs. 
Sec. 203. Additional provisions to increase outreach to, and enrollment of, Indi-
ans in SCHIP and Medicaid. 
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Sec. 204. Premiums and cost sharing protections under Medicaid, eligibility de-
terminations under Medicaid and SCHIP, and protection of cer-
tain Indian property from Medicaid estate recovery. 
Sec. 205. Nondiscrimination in qualifications for payment for services under 
Federal health care programs. 
Sec. 206. Consultation on Medicaid, SCHIP, and other health care programs 
funded under the Social Security Act involving Indian Health 
Programs and Urban Indian Organizations. 
Sec. 207. Exclusion waiver authority for affected Indian Health Programs and 
safe harbor transactions under the Social Security Act. 
Sec. 208. Rules applicable under Medicaid and SCHIP to managed care entities 
with respect to Indian enrollees and Indian health care pro-
viders and Indian managed care entities. 
Sec. 209. Annual report on Indians served by Social Security Act health benefit 
programs. 
SEC. 2. REPORT ON THIRD-PARTY PAYMENT COLLECTIONS. 
(a) STUDY.—The Secretary of Health and Human 
Services shall conduct a thorough study of the system of 
third-party payment collections for items and services fur-
nished through the Indian Health Service. 
(b) REPORT.—Not later than 6 months after the date 
of the enactment of this Act, the Secretary shall submit to 
each House of Congress a report on such study. Such report 
shall include such recommendations on how to improve such 
third-party payment collections as the Secretary determines 
appropriate. 
TITLE I—AMENDMENTS TO 
INDIAN LAWS 
SEC. 
101. 
INDIAN 
HEALTH 
CARE 
IMPROVEMENT 
ACT 
AMENDED. 
(a) IN GENERAL.—The Indian Health Care Improve-
ment Act (25 U.S.C. 1601 et seq.) is amended to read as 
follows: 
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‘‘SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
‘‘(a) SHORT TITLE.—This Act may be cited as the ‘In-
dian Health Care Improvement Act’. 
‘‘(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
‘‘Sec. 1. Short title; table of contents. 
‘‘Sec. 2. Findings. 
‘‘Sec. 3. Declaration of national Indian health policy. 
‘‘Sec. 4. Definitions. 
‘‘TITLE I—INDIAN HEALTH, HUMAN RESOURCES, AND 
DEVELOPMENT 
‘‘Sec. 101. Purpose. 
‘‘Sec. 102. Health professions recruitment program for Indians. 
‘‘Sec. 103. Health professions preparatory scholarship program for Indians. 
‘‘Sec. 104. Indian health professions scholarships. 
‘‘Sec. 105. American Indians Into Psychology Program. 
‘‘Sec. 106. Scholarship programs for Indian Tribes. 
‘‘Sec. 107. Indian Health Service extern programs. 
‘‘Sec. 108. Continuing education allowances. 
‘‘Sec. 109. Community Health Representative Program. 
‘‘Sec. 110. Indian Health Service Loan Repayment Program. 
‘‘Sec. 111. Scholarship and Loan Repayment Recovery Fund. 
‘‘Sec. 112. Recruitment activities. 
‘‘Sec. 113. Indian recruitment and retention program. 
‘‘Sec. 114. Advanced training and research. 
‘‘Sec. 115. Quentin N. Burdick American Indians Into Nursing Program. 
‘‘Sec. 116. Tribal cultural orientation. 
‘‘Sec. 117. INMED Program. 
‘‘Sec. 118. Health training programs of community colleges. 
‘‘Sec. 119. Retention bonus. 
‘‘Sec. 120. Nursing residency program. 
‘‘Sec. 121. Community Health Aide Program. 
‘‘Sec. 122. Tribal Health Program administration. 
‘‘Sec. 123. Health professional chronic shortage demonstration programs. 
‘‘Sec. 124. National Health Service Corps. 
‘‘Sec. 125. Substance abuse counselor educational curricula demonstration pro-
grams. 
‘‘Sec. 126. Behavioral health training and community education programs. 
‘‘Sec. 127. Authorization of appropriations. 
‘‘TITLE II—HEALTH SERVICES 
‘‘Sec. 201. Indian Health Care Improvement Fund. 
‘‘Sec. 202. Catastrophic Health Emergency Fund. 
‘‘Sec. 203. Health promotion and disease prevention services. 
‘‘Sec. 204. Diabetes prevention, treatment, and control. 
‘‘Sec. 205. Shared services for long-term care. 
‘‘Sec. 206. Health services research. 
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‘‘Sec. 207. Mammography and other cancer screening. 
‘‘Sec. 208. Patient travel costs. 
‘‘Sec. 209. Epidemiology centers. 
‘‘Sec. 210. Comprehensive school health education programs. 
‘‘Sec. 211. Indian youth program. 
‘‘Sec. 212. Prevention, control, and elimination of communicable and infectious 
diseases. 
‘‘Sec. 213. Authority for provision of other services. 
‘‘Sec. 214. Indian women’s health care. 
‘‘Sec. 215. Environmental and nuclear health hazards. 
‘‘Sec. 216. Arizona as a contract health service delivery area. 
‘‘Sec. 217. North Dakota and South Dakota as contract health service delivery 
area. 
‘‘Sec. 218. California contract health services program. 
‘‘Sec. 219. California as a contract health service delivery area. 
‘‘Sec. 220. Contract health services for the Trenton Service Area. 
‘‘Sec. 221. Programs operated by Indian Tribes and Tribal Organizations. 
‘‘Sec. 222. Licensing. 
‘‘Sec. 223. Notification of provision of emergency contract health services. 
‘‘Sec. 224. Prompt action on payment of claims. 
‘‘Sec. 225. Liability for payment. 
‘‘Sec. 226. Office of Indian Men’s Health. 
‘‘Sec. 227. Authorization of appropriations. 
‘‘TITLE III—FACILITIES 
‘‘Sec. 301. Consultation; construction and renovation of facilities; reports. 
‘‘Sec. 302. Sanitation facilities. 
‘‘Sec. 303. Preference to Indians and Indian firms. 
‘‘Sec. 304. Expenditure of non-Service funds for renovation. 
‘‘Sec. 305. Funding for the construction, expansion, and modernization of small 
ambulatory care facilities. 
‘‘Sec. 306. Indian health care delivery demonstration project. 
‘‘Sec. 307. Land transfer. 
‘‘Sec. 308. Leases, contracts, and other agreements. 
‘‘Sec. 309. Study on loans, loan guarantees, and loan repayment. 
‘‘Sec. 310. Tribal leasing. 
‘‘Sec. 311. Indian Health Service/tribal facilities joint venture program. 
‘‘Sec. 312. Location of facilities. 
‘‘Sec. 313. Maintenance and improvement of health care facilities. 
‘‘Sec. 314. Tribal management of federally-owned quarters. 
‘‘Sec. 315. Applicability of Buy American Act requirement. 
‘‘Sec. 316. Other funding for facilities. 
‘‘Sec. 317. Authorization of appropriations. 
‘‘TITLE IV—ACCESS TO HEALTH SERVICES 
‘‘Sec. 401. Treatment of payments under Social Security Act health benefits pro-
grams. 
‘‘Sec. 402. Grants to and contracts with the Service, Indian Tribes, Tribal Orga-
nizations, and Urban Indian Organizations to facilitate out-
reach, enrollment, and coverage of Indians under Social Security 
Act health benefit programs and other health benefits programs. 
‘‘Sec. 403. Reimbursement from certain third parties of costs of health services. 
‘‘Sec. 404. Crediting of reimbursements. 
‘‘Sec. 405. Purchasing health care coverage. 
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‘‘Sec. 406. Sharing arrangements with Federal agencies. 
‘‘Sec. 407. Payor of last resort. 
‘‘Sec. 408. Nondiscrimination under Federal health care programs in qualifica-
tions for reimbursement for services. 
‘‘Sec. 409. Consultation. 
‘‘Sec. 410. State Children’s Health Insurance Program (SCHIP). 
‘‘Sec. 411. Exclusion waiver authority for affected Indian Health Programs and 
safe harbor transactions under the Social Security Act. 
‘‘Sec. 412. Premium and cost sharing protections and eligibility determinations 
under Medicaid and SCHIP and protection of certain Indian 
property from Medicaid estate recovery. 
‘‘Sec. 413. Treatment under Medicaid and SCHIP managed care. 
‘‘Sec. 414. Navajo Nation Medicaid Agency feasibility study. 
‘‘Sec. 415. General exceptions. 
‘‘Sec. 416. Authorization of appropriations. 
‘‘TITLE V—HEALTH SERVICES FOR URBAN INDIANS 
‘‘Sec. 501. Purpose. 
‘‘Sec. 502. Contracts with, and grants to, Urban Indian Organizations. 
‘‘Sec. 503. Contracts and grants for the provision of health care and referral serv-
ices. 
‘‘Sec. 504. Contracts and grants for the determination of unmet health care needs. 
‘‘Sec. 505. Evaluations; renewals. 
‘‘Sec. 506. Other contract and grant requirements. 
‘‘Sec. 507. Reports and records. 
‘‘Sec. 508. Limitation on contract authority. 
‘‘Sec. 509. Facilities. 
‘‘Sec. 510. Division of Urban Indian Health. 
‘‘Sec. 511. Grants for alcohol and substance abuse-related services. 
‘‘Sec. 512. Treatment of certain demonstration projects. 
‘‘Sec. 513. Urban NIAAA transferred programs. 
‘‘Sec. 514. Consultation with Urban Indian Organizations. 
‘‘Sec. 515. Urban youth treatment center demonstration. 
‘‘Sec. 516. Grants for diabetes prevention, treatment, and control. 
‘‘Sec. 517. Community health representatives. 
‘‘Sec. 518. Effective date. 
‘‘Sec. 519. Eligibility for services. 
‘‘Sec. 520. Authorization of appropriations. 
‘‘TITLE VI—ORGANIZATIONAL IMPROVEMENTS 
‘‘Sec. 601. Establishment of the Indian Health Service as an agency of the Public 
Health Service. 
‘‘Sec. 602. Automated management information system. 
‘‘Sec. 603. Authorization of appropriations. 
‘‘TITLE VII—BEHAVIORAL HEALTH PROGRAMS 
‘‘Sec. 701. Behavioral health prevention and treatment services. 
‘‘Sec. 702. Memoranda of agreement with the Department of the Interior. 
‘‘Sec. 703. Comprehensive behavioral health prevention and treatment program. 
‘‘Sec. 704. Mental health technician program. 
‘‘Sec. 705. Licensing requirement for mental health care workers. 
‘‘Sec. 706. Indian women treatment programs. 
‘‘Sec. 707. Indian youth program. 
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‘‘Sec. 708. Indian youth telemental health demonstration project. 
‘‘Sec. 709. Inpatient and community-based mental health facilities design, con-
struction, and staffing. 
‘‘Sec. 710. Training and community education. 
‘‘Sec. 711. Behavioral health program. 
‘‘Sec. 712. Fetal alcohol disorder programs. 
‘‘Sec. 713. Child sexual abuse and prevention treatment programs. 
‘‘Sec. 714. Behavioral health research. 
‘‘Sec. 715. Definitions. 
‘‘Sec. 716. Authorization of appropriations. 
‘‘TITLE VIII—MISCELLANEOUS 
‘‘Sec. 801. Reports. 
‘‘Sec. 802. Regulations. 
‘‘Sec. 803. Plan of implementation. 
‘‘Sec. 804. Availability of funds. 
‘‘Sec. 805. Limitation on use of funds appropriated to Indian Health Service. 
‘‘Sec. 806. Eligibility of California Indians. 
‘‘Sec. 807. Health services for ineligible persons. 
‘‘Sec. 808. Reallocation of base resources. 
‘‘Sec. 809. Results of demonstration projects. 
‘‘Sec. 810. Provision of services in Montana. 
‘‘Sec. 811. Moratorium. 
‘‘Sec. 812. Severability provisions. 
‘‘Sec. 813. Establishment of National Bipartisan Commission on Indian Health 
Care. 
‘‘Sec. 814. Confidentiality of medical quality assurance records; qualified immu-
nity for participants. 
‘‘Sec. 815. Appropriations; availability. 
‘‘Sec. 816. Authorization of appropriations. 
‘‘SEC. 2. FINDINGS. 
‘‘Congress makes the following findings: 
‘‘(1) Federal health services to maintain and im-
prove the health of the Indians are consonant with 
and required by the Federal Government’s historical 
and unique legal relationship with, and resulting re-
sponsibility to, the American Indian people. 
‘‘(2) A major national goal of the United States 
is to provide the quantity and quality of health serv-
ices which will permit the health status of Indians to 
be raised to the highest possible level and to encourage 
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the maximum participation of Indians in the plan-
ning and management of those services. 
‘‘(3) Federal health services to Indians have re-
sulted in a reduction in the prevalence and incidence 
of preventable illnesses among, and unnecessary and 
premature deaths of, Indians. 
‘‘(4) Despite such services, the unmet health 
needs of the American Indian people are severe and 
the health status of the Indians is far below that of 
the general population of the United States. 
‘‘SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POL-
ICY. 
‘‘Congress declares that it is the policy of this Nation, 
in fulfillment of its special trust responsibilities and legal 
obligations to Indians— 
‘‘(1) to assure the highest possible health status 
for Indians and Urban Indians and to provide all re-
sources necessary to effect that policy; 
‘‘(2) to raise the health status of Indians and 
Urban Indians to at least the levels set forth in the 
goals contained within the Healthy People 2010 or 
successor objectives; 
‘‘(3) to the greatest extent possible, to allow Indi-
ans to set their own health care priorities and estab-
lish goals that reflect their unmet needs; 
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‘‘(4) to increase the proportion of all degrees in 
the health professions and allied and associated health 
professions awarded to Indians so that the proportion 
of Indian health professionals in each Service Area is 
raised to at least the level of that of the general popu-
lation; 
‘‘(5) to require meaningful consultation with In-
dian Tribes, Tribal Organizations, and Urban Indian 
Organizations to implement this Act and the national 
policy of Indian self-determination; and 
‘‘(6) to provide funding for programs and facili-
ties operated by Indian Tribes and Tribal Organiza-
tions in amounts that are not less than the amounts 
provided to programs and facilities operated directly 
by the Service. 
‘‘SEC. 4. DEFINITIONS. 
‘‘For purposes of this Act: 
‘‘(1) The term ‘accredited and accessible’ means 
on or near a reservation and accredited by a national 
or regional organization with accrediting authority. 
‘‘(2) The term ‘Area Office’ means an adminis-
trative entity, including a program office, within the 
Service through which services and funds are pro-
vided to the Service Units within a defined geo-
graphic area. 
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‘‘(3) The term ‘Assistant Secretary’ means the 
Assistant Secretary of Indian Health. 
‘‘(4)(A) The term ‘behavioral health’ means the 
blending of substance (alcohol, drugs, inhalants, and 
tobacco) abuse and mental health prevention and 
treatment, for the purpose of providing comprehensive 
services. 
‘‘(B) The term ‘behavioral health’ includes the 
joint development of substance abuse and mental 
health treatment planning and coordinated case man-
agement using a multidisciplinary approach. 
‘‘(5) The term ‘California Indians’ means those 
Indians who are eligible for health services of the 
Service pursuant to section 806. 
‘‘(6) The term ‘community college’ means— 
‘‘(A) a tribal college or university, or 
‘‘(B) a junior or community college. 
‘‘(7) The term ‘contract health service’ means 
health services provided at the expense of the Service 
or a Tribal Health Program by public or private 
medical providers or hospitals, other than the Service 
Unit or the Tribal Health Program at whose expense 
the services are provided. 
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‘‘(8) The term ‘Department’ means, unless other-
wise designated, the Department of Health and 
Human Services. 
‘‘(9) The term ‘disease prevention’ means the re-
duction, limitation, and prevention of disease and its 
complications and reduction in the consequences of 
disease, including— 
‘‘(A) controlling— 
‘‘(i) the development of diabetes; 
‘‘(ii) high blood pressure; 
‘‘(iii) infectious agents; 
‘‘(iv) injuries; 
‘‘(v) occupational hazards and disabil-
ities; 
‘‘(vi) sexually transmittable diseases; 
and 
‘‘(vii) toxic agents; and 
‘‘(B) providing— 
‘‘(i) fluoridation of water; and 
‘‘(ii) immunizations. 
‘‘(10) The term ‘health profession’ means 
allopathic medicine, family medicine, internal medi-
cine, pediatrics, geriatric medicine, obstetrics and 
gynecology, podiatric medicine, nursing, public health 
nursing, dentistry, psychiatry, osteopathy, optometry, 
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pharmacy, psychology, public health, social work, 
marriage and family therapy, chiropractic medicine, 
environmental health and engineering, allied health 
professions, naturopathic medicine, and any other 
health profession. 
‘‘(11) The term ‘health promotion’ means— 
‘‘(A) fostering social, economic, environ-
mental, and personal factors conducive to health, 
including raising public awareness about health 
matters and enabling the people to cope with 
health problems by increasing their knowledge 
and providing them with valid information; 
‘‘(B) encouraging adequate and appropriate 
diet, exercise, and sleep; 
‘‘(C) promoting education and work in con-
formity with physical and mental capacity; 
‘‘(D) making available safe water and sani-
tary facilities; 
‘‘(E) improving the physical, economic, cul-
tural, psychological, and social environment; 
‘‘(F) promoting culturally competent care; 
and 
‘‘(G) providing adequate and appropriate 
programs, which may include— 
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‘‘(i) abuse prevention (mental and 
physical); 
‘‘(ii) community health; 
‘‘(iii) community safety; 
‘‘(iv) consumer health education; 
‘‘(v) diet and nutrition; 
‘‘(vi) immunization and other preven-
tion of communicable diseases, including 
HIV/AIDS; 
‘‘(vii) environmental health; 
‘‘(viii) exercise and physical fitness; 
‘‘(ix) avoidance of fetal alcohol dis-
orders; 
‘‘(x) first aid and CPR education; 
‘‘(xi) human growth and development; 
‘‘(xii) injury prevention and personal 
safety; 
‘‘(xiii) behavioral health; 
‘‘(xiv) monitoring of disease indicators 
between health care provider visits, through 
appropriate means, including Internet- 
based health care management systems; 
‘‘(xv) personal health and wellness 
practices; 
‘‘(xvi) personal capacity building; 
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‘‘(xvii) prenatal, pregnancy, and in-
fant care; 
‘‘(xviii) psychological well-being; 
‘‘(xix) reproductive health and family 
planning; 
‘‘(xx) safe and adequate water; 
‘‘(xxi) healthy work environments; 
‘‘(xxii) elimination, reduction, and 
prevention of contaminants that create 
unhealthy household conditions (including 
mold and other allergens); 
‘‘(xxiii) stress control; 
‘‘(xxiv) substance abuse; 
‘‘(xxv) sanitary facilities; 
‘‘(xxvi) sudden infant death syndrome 
prevention; 
‘‘(xxvii) tobacco use cessation and re-
duction; 
‘‘(xxviii) violence prevention; and 
‘‘(xxix) such other activities identified 
by the Service, a Tribal Health Program, or 
an Urban Indian Organization, to promote 
achievement of any of the objectives de-
scribed in section 3(2). 
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‘‘(12) The term ‘Indian’, unless otherwise des-
ignated, means any person who is a member of an In-
dian Tribe or is eligible for health services under sec-
tion 806, except that, for the purpose of sections 102 
and 103, the term also means any individual who— 
‘‘(A)(i) irrespective of whether the indi-
vidual lives on or near a reservation, is a mem-
ber of a tribe, band, or other organized group of 
Indians, including those tribes, bands, or groups 
terminated since 1940 and those recognized now 
or in the future by the State in which they re-
side; or 
‘‘(ii) is a descendant, in the first or second 
degree, of any such member; 
‘‘(B) is an Eskimo or Aleut or other Alaska 
Native; 
‘‘(C) is considered by the Secretary of the 
Interior to be an Indian for any purpose; or 
‘‘(D) is determined to be an Indian under 
regulations promulgated by the Secretary. 
‘‘(13) The term ‘Indian Health Program’ 
means— 
‘‘(A) any health program administered di-
rectly by the Service; 
‘‘(B) any Tribal Health Program; or 
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‘‘(C) any Indian Tribe or Tribal Organiza-
tion to which the Secretary provides funding 
pursuant to section 23 of the Act of June 25, 
1910 (25 U.S.C. 47) (commonly known as the 
‘Buy Indian Act’). 
‘‘(14) The term ‘Indian Tribe’ has the meaning 
given the term in the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.). 
‘‘(15) The term ‘junior or community college’ has 
the meaning given the term by section 312(e) of the 
Higher Education Act of 1965 (20 U.S.C. 1058(e)). 
‘‘(16) The term ‘reservation’ means any federally 
recognized Indian Tribe’s reservation, Pueblo, or col-
ony, including former reservations in Oklahoma, In-
dian allotments, and Alaska Native Regions estab-
lished pursuant to the Alaska Native Claims Settle-
ment Act (43 U.S.C. 1601 et seq.). 
‘‘(17) The term ‘Secretary’, unless otherwise des-
ignated, means the Secretary of Health and Human 
Services. 
‘‘(18) The term ‘Service’ means the Indian 
Health Service. 
‘‘(19) The term ‘Service Area’ means the geo-
graphical area served by each Area Office. 
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