130 
‘‘(2) any finding of the Director with respect to 
the health of Indian men. 
‘‘SEC. 226. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There are authorized to be appropriated such sums 
as may be necessary for each fiscal year through fiscal 
year 2015 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 appro-
priated for the planning, design, construction, or renova-
tion of facilities 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 applica-
ble, that such facility meets the construction stand-
ards of any accrediting body recognized by the Sec-
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CCOLEMAN on PROD1PC71 with BILLS
131 
retary 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 date on which the construction or ren-
ovation of such facility is completed. 
‘‘(b) CLOSURES.— 
‘‘(1) 
EVALUATION
REQUIRED.—Notwith-
standing any other provision of law, no facility oper-
ated by the Service may be closed if the Secretary 
has not submitted to Congress at least 1 year prior 
to the date of the proposed closure an evaluation of 
the impact of the proposed closure which specifies, 
in addition 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; 
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CCOLEMAN on PROD1PC71 with BILLS
132 
‘‘(F) the level of use of such facility by all 
eligible Indians; and 
‘‘(G) the distance between such facility and 
the nearest operating Service hospital. 
‘‘(2) EXCEPTION
FOR
CERTAIN
TEMPORARY 
CLOSURES.—Paragraph (1) shall not apply to any 
temporary closure of a facility or any portion of a 
facility if such closure is necessary for medical, envi-
ronmental, or construction safety reasons. 
‘‘(c) HEALTH CARE FACILITY PRIORITY SYSTEM.— 
‘‘(1) IN GENERAL.— 
‘‘(A) ESTABLISHMENT.—The Secretary, 
acting through the Service, shall establish a 
health care facility priority system, which 
shall— 
‘‘(i) be developed with Indian Tribes 
and Tribal Organizations through nego-
tiated rulemaking under section 802; 
‘‘(ii) give Indian Tribes’ needs the 
highest priority; and 
‘‘(iii) at a minimum, include the lists 
required in paragraph (2)(B) and the 
methodology required in paragraph (2)(E). 
‘‘(B) PRIORITY
OF
CERTAIN
PROJECTS 
PROTECTED.—The priority of any project estab-
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CCOLEMAN on PROD1PC71 with BILLS
133 
lished under the construction priority system in 
effect on the date of the Indian Health Care 
Improvement Act Amendments of 2006 shall 
not be affected by any change in the construc-
tion priority system taking place thereafter if 
the project was identified as 1 of the 10 top- 
priority inpatient projects, 1 of the 10 top-pri-
ority outpatient projects, 1 of the 10 top-pri-
ority staff quarters developments, or 1 of the 
10 top-priority Youth Regional Treatment Cen-
ters in the fiscal year 2006 Indian Health Serv-
ice budget justification, or if the project had 
completed both Phase I and Phase II of the 
construction priority system in effect on the 
date of enactment of such Act. 
‘‘(2) REPORT; CONTENTS.—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: 
‘‘(A) A description of the health care facil-
ity priority system of the Service, established 
under paragraph (1). 
‘‘(B) Health care facilities lists, includ-
ing— 
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CCOLEMAN on PROD1PC71 with BILLS
134 
‘‘(i) the 10 top-priority inpatient 
health care facilities; 
‘‘(ii) the 10 top-priority outpatient 
health care facilities; 
‘‘(iii) the 10 top-priority specialized 
health care facilities (such as long-term 
care and alcohol and drug abuse treat-
ment); 
‘‘(iv) the 10 top-priority staff quarters 
developments associated with health care 
facilities; and 
‘‘(v) the 10 top-priority hostels associ-
ated with health care facilities. 
‘‘(C) The justification for such order of 
priority. 
‘‘(D) The projected cost of such projects. 
‘‘(E) 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 each report required under 
paragraph (2) (other than the initial report), the 
Secretary shall annually— 
‘‘(A) consult with and obtain information 
on all health care facilities needs from Indian 
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CCOLEMAN on PROD1PC71 with BILLS
135 
Tribes, Tribal Organizations, and Urban Indian 
Organizations; and 
‘‘(B) review the total unmet needs of all 
Indian Tribes, Tribal Organizations, and Urban 
Indian Organizations for health care facilities 
(including hostels and staff quarters), including 
needs for renovation and expansion of existing 
facilities. 
‘‘(4) CRITERIA FOR EVALUATING NEEDS.—For 
purposes of this subsection, the Secretary shall, in 
evaluating the needs of facilities operated under any 
contract or compact under the Indian Self-Deter-
mination and Education Assistance Act (25 U.S.C. 
450 et seq.) use the same criteria that the Secretary 
uses in evaluating the needs of facilities operated di-
rectly by the Service. 
‘‘(5) NEEDS
OF
FACILITIES
UNDER
ISDEAA 
AGREEMENTS.—The Secretary shall ensure that the 
planning, design, construction, and renovation needs 
of Service and non-Service facilities operated under 
contracts or compacts in accordance with the Indian 
Self-Determination and Education Assistance Act 
(25 U.S.C. 450 et seq.) are fully and equitably inte-
grated into the health care facility priority system. 
‘‘(d) REVIEW OF NEED FOR FACILITIES.— 
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CCOLEMAN on PROD1PC71 with BILLS
136 
‘‘(1) INITIAL REPORT.—In the year 2006, the 
Government Accountability Office shall prepare and 
finalize a report which sets forth the needs of the 
Service, Indian Tribes, Tribal Organizations, and 
Urban Indian Organizations, for the types of facili-
ties listed under subsection (c)(2)(B), including the 
needs for renovation and expansion of existing facili-
ties. The Government Accountability Office shall 
submit the report to the appropriate authorizing and 
appropriations committees of Congress and to the 
Secretary. 
‘‘(2) Beginning in the year 2006, the Secretary 
shall update the report required under paragraph 
(1) every 5 years. 
‘‘(3) In preparing an updated report under 
paragraph (2), the Secretary shall consult with In-
dian Tribes, Tribal Organizations, and Urban Indian 
Organizations. The Secretary shall submit the report 
under paragraph (2) for inclusion in the report re-
quired to be transmitted to Congress under section 
801. 
‘‘(4) For purposes of this subsection, the re-
ports shall, regarding the needs of facilities operated 
under any contract or compact under the Indian 
Self-Determination and Education Assistance Act 
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CCOLEMAN on PROD1PC71 with BILLS
137 
(25 U.S.C. 450 et seq.), be based on the same cri-
teria that the Secretary uses in evaluating the needs 
of facilities operated directly by the Service. 
‘‘(5) The planning, design, construction, and 
renovation needs of facilities operated under con-
tracts or compacts under the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C. 450 
et seq.) shall be fully and equitably integrated into 
the development of the health facility priority sys-
tem. 
‘‘(6) Beginning in 2007 and each fiscal year 
thereafter, the Secretary shall provide an oppor-
tunity for nomination of planning, design, and con-
struction projects by the Service, Indian Tribes, 
Tribal Organizations, and Urban Indian Organiza-
tions for consideration under the health care facility 
priority system. 
‘‘(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, de-
sign, 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 Edu-
cation Assistance Act (25 U.S.C. 450 et seq.). 
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CCOLEMAN on PROD1PC71 with BILLS
138 
‘‘(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 
facilities, 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. 
‘‘(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-
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CCOLEMAN on PROD1PC71 with BILLS
139 
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 primary 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, act-
ing through the Service, is authorized to provide the fol-
lowing: 
‘‘(1) Financial and technical assistance to In-
dian Tribes, Tribal Organizations, and Indian com-
munities in the establishment, training, and equip-
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. 
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CCOLEMAN on PROD1PC71 with BILLS
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‘‘(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 provi-
sion of law— 
‘‘(1) the Secretary of Housing and Urban De-
velopment is authorized to transfer funds appro-
priated under the Native American Housing Assist-
ance and Self-Determination Act of 1996 to the Sec-
retary 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 fa-
cilities to new homes constructed using funds pro-
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CCOLEMAN on PROD1PC71 with BILLS
141 
vided by the Department of Housing and Urban De-
velopment; 
‘‘(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 pur-
pose 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 Au-
gust 5, 1954 (42 U.S.C. 2004a) to fund up to 100 
percent of the amount of an Indian Tribe’s loan ob-
tained under any Federal program for new projects 
to construct eligible sanitation facilities to serve In-
dian 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 Au-
gust 5, 1954 (42 U.S.C. 2004a) to meet matching 
or cost participation requirements under other Fed-
eral and non-Federal programs for new projects to 
construct eligible sanitation facilities; 
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