298 
gage in usual and customary life activities through 
education and therapy. 
‘‘(9) SUBSTANCE ABUSE.—The term ‘substance 
abuse’ includes inhalant abuse. 
‘‘(10) SYSTEMS OF CARE.—The term ‘Systems 
of Care’ means a system for delivering services to 
children and their families that is child-centered, 
family-focused and family-driven, community-based, 
culturally competent, and responsive to the needs of 
the children and families being served. The System 
of Care values prevention and early identification, 
smooth transitions for children and families, child 
and family participation and advocacy, comprehen-
sive array of services, individualized service plan-
ning, services in the least restrictive environment, 
and integrated services with coordinated planning 
across the child-serving systems. 
‘‘SEC. 716. AUTHORIZATION OF APPROPRIATIONS. 
‘‘There is authorized to be appropriated such sums 
as may be necessary for each fiscal year through fiscal 
year 2015 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 
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of 2006, 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-
ity with the health services available to and the 
health status of the general population, including 
specific comparisons of appropriations provided and 
those required for such parity. 
‘‘(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 808. 
‘‘(3) A report on the use of health services by 
Indians— 
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‘‘(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. 
‘‘(5) A general audit report of the Secretary on 
the Health Care Educational Loan Repayment Pro-
gram as required by section 110(n). 
‘‘(6) A report of the findings and conclusions of 
demonstration programs on development of edu-
cational curricula for substance abuse counseling as 
required in section 125(f). 
‘‘(7) A separate statement which specifies the 
amount of funds requested to carry out the provi-
sions of section 201. 
‘‘(8) A report of the evaluations of health pro-
motion and disease prevention as required in section 
203(c). 
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‘‘(9) A biennial report to Congress on infectious 
diseases as required by section 212. 
‘‘(10) A report on environmental and nuclear 
health hazards as required by section 215. 
‘‘(11) An annual report on the status of all 
health care facilities needs as required by section 
301(c)(2) and 301(d). 
‘‘(12) Reports on safe water and sanitary waste 
disposal facilities as required by section 302(h). 
‘‘(13) An annual report on the expenditure of 
nonservice funds for renovation as required by sec-
tions 304(b)(2). 
‘‘(14) A report identifying the backlog of main-
tenance and repair required at Service and tribal fa-
cilities required by section 313(a). 
‘‘(15) A report providing an accounting of reim-
bursement funds made available to the Secretary 
under titles XVIII, XIX, and XXI of the Social Se-
curity Act. 
‘‘(16) A report on any arrangements for the 
sharing of medical facilities or services, as author-
ized by section 406. 
‘‘(17) A report on evaluation and renewal of 
Urban Indian programs under section 505. 
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‘‘(18) A report on the evaluation of programs 
as required by section 513(d). 
‘‘(19) A report on alcohol and substance abuse 
as required by section 701(f). 
‘‘(20) A report on Indian youth mental health 
services as required by section 707(h). 
‘‘SEC. 802. REGULATIONS. 
‘‘(a) DEADLINES.— 
‘‘(1) PROCEDURES.—Not later than 90 days 
after the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2006, the 
Secretary shall initiate procedures under subchapter 
III of chapter 5 of title 5, United States Code, to 
negotiate and promulgate such regulations or 
amendments thereto that are necessary to carry out 
titles I (except sections 105, 115, and 117), II, III, 
and VII. The Secretary may promulgate regulations 
to carry out sections 105, 115, 117, and titles IV 
and V, using the procedures required by chapter V 
of title 5, United States Code (commonly known as 
the ‘Administrative Procedure Act’). The Secretary 
shall issue no regulations to carry out titles VI and 
VIII. 
‘‘(2) PROPOSED REGULATIONS.—Proposed reg-
ulations to implement this Act shall be published in 
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CCOLEMAN on PROD1PC71 with BILLS
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the Federal Register by the Secretary no later than 
1 year after the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2006 
and shall have no less than a 120-day comment pe-
riod. 
‘‘(3) EXPIRATION OF AUTHORITY.—Except as 
otherwise provided herein, the authority to promul-
gate regulations under this Act shall expire 24 
months from the date of enactment of this Act. 
‘‘(b) COMMITTEE.—A negotiated rulemaking com-
mittee established pursuant to section 565 of title 5, 
United States Code, to carry out this section shall have 
as its members only representatives of the Federal Gov-
ernment and representatives of Indian Tribes and Tribal 
Organizations, a majority of whom shall be nominated by 
and be representatives of Indian Tribes, Tribal Organiza-
tions, and Urban Indian Organizations from each Service 
Area. The representative of the Urban Indian Organiza-
tion shall be deemed to be an elected officer of a tribal 
government for purposes of applying section 204(b) of the 
Unfunded Mandates Reform Act of 1995 (2 U.S.C. 
1534(b)). 
‘‘(c) ADAPTATION OF PROCEDURES.—The Secretary 
shall adapt the negotiated rulemaking procedures to the 
unique context of self-governance and the government-to- 
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government relationship between the United States and 
Indian Tribes. 
‘‘(d) LACK OF REGULATIONS.—The lack of promul-
gated regulations shall not limit the effect of this Act. 
‘‘(e) INCONSISTENT REGULATIONS.—The provisions 
of this Act shall supersede any conflicting provisions of 
law in effect on the day before the date of enactment of 
the Indian Health Care Improvement Act Amendments of 
2006, and the Secretary is authorized to repeal any regu-
lation inconsistent with the provisions of this Act. 
‘‘SEC. 803. PLAN OF IMPLEMENTATION. 
‘‘Not later than 9 months after the date of enactment 
of the Indian Health Care Improvement Act Amendments 
of 2006, the Secretary in consultation with Indian Tribes, 
Tribal Organizations, and Urban Indian Organizations, 
shall submit to Congress a plan explaining the manner and 
schedule (including a schedule of appropriation requests), 
by title and section, by which the Secretary will implement 
the provisions of this Act. 
‘‘SEC. 804. AVAILABILITY OF FUNDS. 
‘‘The funds appropriated pursuant to this Act shall 
remain available until expended. 
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CCOLEMAN on PROD1PC71 with BILLS
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‘‘SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED 
TO THE INDIAN HEALTH SERVICE. 
‘‘Any limitation on the use of funds contained in an 
Act providing appropriations for the Department for a pe-
riod with respect to the performance of abortions shall 
apply for that period with respect to the performance of 
abortions using funds contained in an Act providing ap-
propriations for the Service. 
‘‘SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS. 
‘‘(a) IN GENERAL.—The following California Indians 
shall be eligible for health services provided by the Service: 
‘‘(1) Any member of a federally recognized In-
dian Tribe. 
‘‘(2) Any descendant of an Indian who was re-
siding in California on June 1, 1852, if such de-
scendant— 
‘‘(A) is a member of the Indian community 
served by a local program of the Service; and 
‘‘(B) is regarded as an Indian by the com-
munity in which such descendant lives. 
‘‘(3) Any Indian who holds trust interests in 
public domain, national forest, or reservation allot-
ments in California. 
‘‘(4) Any Indian in California who is listed on 
the plans for distribution of the assets of rancherias 
and reservations located within the State of Cali-
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fornia under the Act of August 18, 1958 (72 Stat. 
619), and any descendant of such an Indian. 
‘‘(b) CLARIFICATION.—Nothing in this section may 
be construed as expanding the eligibility of California Indi-
ans for health services provided by the Service beyond the 
scope of eligibility for such health services that applied on 
May 1, 1986. 
‘‘SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS. 
‘‘(a) CHILDREN.—Any individual who— 
‘‘(1) has not attained 19 years of age; 
‘‘(2) is the natural or adopted child, stepchild, 
foster child, legal ward, or orphan of an eligible In-
dian; and 
‘‘(3) is not otherwise eligible for health services 
provided by the Service, 
shall be eligible for all health services provided by the 
Service on the same basis and subject to the same rules 
that apply to eligible Indians until such individual attains 
19 years of age. The existing and potential health needs 
of all such individuals shall be taken into consideration 
by the Service in determining the need for, or the alloca-
tion of, the health resources of the Service. If such an indi-
vidual has been determined to be legally incompetent prior 
to attaining 19 years of age, such individual shall remain 
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eligible for such services until 1 year after the date of a 
determination of competency. 
‘‘(b) SPOUSES.—Any spouse of an eligible Indian who 
is not an Indian, or who is of Indian descent but is not 
otherwise eligible for the health services provided by the 
Service, shall be eligible for such health services if all such 
spouses or spouses who are married to members of each 
Indian Tribe being served are made eligible, as a class, 
by an appropriate resolution of the governing body of the 
Indian Tribe or Tribal Organization providing such serv-
ices. The health needs of persons made eligible under this 
paragraph shall not be taken into consideration by the 
Service in determining the need for, or allocation of, its 
health resources. 
‘‘(c) PROVISION OF SERVICES TO OTHER INDIVID-
UALS.— 
‘‘(1) IN GENERAL.—The Secretary is authorized 
to provide health services under this subsection 
through health programs operated directly by the 
Service to individuals who reside within the Service 
Unit and who are not otherwise eligible for such 
health services if— 
‘‘(A) the Indian Tribes served by such 
Service Unit request such provision of health 
services to such individuals; and 
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CCOLEMAN on PROD1PC71 with BILLS
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‘‘(B) the Secretary and the served Indian 
Tribes have jointly determined that— 
‘‘(i) the provision of such health serv-
ices will not result in a denial or diminu-
tion of health services to eligible Indians; 
and 
‘‘(ii) there is no reasonable alternative 
health facilities or services, within or with-
out the Service Unit, available to meet the 
health needs of such individuals. 
‘‘(2) ISDEAA PROGRAMS.—In the case of 
health programs and facilities operated under a con-
tract or compact entered into under the Indian Self- 
Determination and Education Assistance Act (25 
U.S.C. 450 et seq.), the governing body of the In-
dian Tribe or Tribal Organization providing health 
services under such contract or compact is author-
ized to determine whether health services should be 
provided under such contract or compact to individ-
uals who are not otherwise eligible for such services 
under any other subsection of this section or under 
any other provision of law. In making such deter-
mination, the governing body of the Indian Tribe or 
Tribal Organization shall take into account the con-
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CCOLEMAN on PROD1PC71 with BILLS
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siderations described in clauses (i) and (ii) of para-
graph (1)(B). 
‘‘(3) PAYMENT FOR SERVICES.— 
‘‘(A) IN
GENERAL.—Persons receiving 
health services provided by the Service under 
this subsection shall be liable for payment of 
such health services under a schedule of charges 
prescribed by the Secretary which, in the judg-
ment of the Secretary, results in reimbursement 
in an amount not less than the actual cost of 
providing the health services. Notwithstanding 
section 404 of this Act or any other provision 
of law, amounts collected under this subsection, 
including medicare, medicaid, or SCHIP reim-
bursements under titles XVIII, XIX, and XXI 
of the Social Security Act, shall be credited to 
the account of the program providing the serv-
ice and shall be used for the purposes listed in 
section 401(d)(2) and amounts collected under 
this subsection shall be available for expendi-
ture within such program. 
‘‘(B) INDIGENT PEOPLE.—Health services 
may be provided by the Secretary through the 
Service under this subsection to an indigent in-
dividual who would not be otherwise eligible for 
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