209 
suicide identified by the Secretary under para-
graph (2)(A). 
‘‘(B) ELIGIBLE ENTITY.—The term ‘eligi-
ble entity’ means— 
‘‘(i) an Indian tribe; 
‘‘(ii) a tribal organization; 
‘‘(iii) any other tribally authorized en-
tity; and 
‘‘(iv) any partnership composed of 2 
or more entities described in clause (i), (ii), 
or (iii). 
‘‘(2) ESTABLISHMENT.—The Secretary, acting 
through the Administration, may establish and carry 
out a demonstration program under which the Sec-
retary shall— 
‘‘(A) identify a culturally compatible, 
school-based, life skills curriculum for the pre-
vention of Indian and Alaska Native adolescent 
suicide; 
‘‘(B) identify the Indian tribes that are at 
greatest risk for adolescent suicide; 
‘‘(C) invite those Indian tribes to partici-
pate in the demonstration program by— 
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‘‘(i) responding to a comprehensive 
program requirement request of the Sec-
retary; or 
‘‘(ii) submitting, through an eligible 
entity, an application in accordance with 
paragraph (4); and 
‘‘(D) provide grants to the Indian tribes 
identified under subparagraph (B) and eligible 
entities to implement the curriculum with re-
spect to Indian and Alaska Native youths 
who— 
‘‘(i) are between the ages of 10 and 
19; and 
‘‘(ii) attend school in a region that is 
at risk of high youth suicide rates, as de-
termined by the Administration. 
‘‘(3) REQUIREMENTS.— 
‘‘(A) TERM.—The term of a grant pro-
vided under the demonstration program under 
this section shall be not less than 4 years. 
‘‘(B) MAXIMUM NUMBER.—The Secretary 
may provide not more than 5 grants under the 
demonstration program under this section. 
‘‘(C) 
AMOUNT.—The 
grants 
provided 
under this section shall be of equal amounts. 
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‘‘(D) CERTAIN SCHOOLS.—In selecting eli-
gible entities to receive grants under this sec-
tion, the Secretary shall ensure that not less 
than 1 demonstration program shall be carried 
out at each of— 
‘‘(i) a school operated by the Bureau 
of Indian Education; 
‘‘(ii) a Tribal school; and 
‘‘(iii) a school receiving payments 
under section 8002 or 8003 of the Elemen-
tary and Secondary Education Act of 1965 
(20 U.S.C. 7702, 7703). 
‘‘(4) APPLICATIONS.—To be eligible to receive a 
grant under the demonstration program, an eligible 
entity shall submit to the Secretary an application, 
at such time, in such manner, and containing such 
information as the Secretary may require, includ-
ing— 
‘‘(A) an assurance that, in implementing 
the curriculum, the eligible entity will collabo-
rate with 1 or more local educational agencies, 
including elementary schools, middle schools, 
and high schools; 
‘‘(B) an assurance that the eligible entity 
will collaborate, for the purpose of curriculum 
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development, implementation, and training and 
technical assistance, with 1 or more— 
‘‘(i) nonprofit entities with dem-
onstrated expertise regarding the develop-
ment of culturally sensitive, school-based, 
youth suicide prevention and intervention 
programs; or 
‘‘(ii) institutions of higher education 
with demonstrated interest and knowledge 
regarding culturally sensitive, school-based, 
life skills youth suicide prevention and 
intervention programs; 
‘‘(C) an assurance that the curriculum will 
be carried out in an academic setting in con-
junction with at least 1 classroom teacher not 
less frequently than twice each school week for 
the duration of the academic year; 
‘‘(D) a description of the methods by 
which curriculum participants will be— 
‘‘(i) screened for mental health at-risk 
indicators; and 
‘‘(ii) if needed and on a case-by-case 
basis, referred to a mental health clinician 
for further assessment and treatment and 
with crisis response capability; and 
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‘‘(E) an assurance that supportive services 
will be provided to curriculum participants iden-
tified as high-risk participants, including refer-
ral, counseling, and follow-up services for— 
‘‘(i) drug or alcohol abuse; 
‘‘(ii) sexual or domestic abuse; and 
‘‘(iii) depression and other relevant 
mental health concerns. 
‘‘(5) USE OF FUNDS.—An Indian tribe identi-
fied under paragraph (2)(B) or an eligible entity 
may use a grant provided under this subsection— 
‘‘(A) to develop and implement the cur-
riculum in a school-based setting; 
‘‘(B) to establish an advisory council— 
‘‘(i) to advise the Indian tribe or eligi-
ble entity regarding curriculum develop-
ment; and 
‘‘(ii) to provide support services iden-
tified as necessary by the community being 
served by the Indian tribe or eligible enti-
ty; 
‘‘(C) to appoint and train a school- and 
community-based cultural resource liaison, who 
will act as an intermediary among the Indian 
tribe or eligible entity, the applicable school ad-
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ministrators, and the advisory council estab-
lished by the Indian tribe or eligible entity; 
‘‘(D) to establish an on-site, school-based, 
M.A.- or Ph.D.-level mental health practitioner 
(employed by the Service, if practicable) to 
work with tribal educators and other personnel; 
‘‘(E) to provide for the training of peer 
counselors to assist in carrying out the cur-
riculum; 
‘‘(F) to procure technical and training sup-
port from nonprofit or State entities or institu-
tions of higher education identified by the com-
munity being served by the Indian tribe or eligi-
ble entity as the best suited to develop and im-
plement the curriculum; 
‘‘(G) to train teachers and school adminis-
trators to effectively carry out the curriculum; 
‘‘(H) to establish an effective referral pro-
cedure and network; 
‘‘(I) to identify and develop culturally com-
patible curriculum support measures; 
‘‘(J) to obtain educational materials and 
other resources from the Administration or 
other appropriate entities to ensure the success 
of the demonstration program; and 
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‘‘(K) to evaluate the effectiveness of the 
curriculum in preventing Indian and Alaska 
Native adolescent suicide. 
‘‘(c) EVALUATIONS.—Using such amounts made 
available pursuant to subsection (e) as the Secretary de-
termines to be appropriate, the Secretary shall conduct, 
directly or through a grant, contract, or cooperative agree-
ment with an entity that has experience regarding the de-
velopment and operation of successful culturally compat-
ible, school-based, life skills suicide prevention and inter-
vention programs or evaluations, an annual evaluation of 
the demonstration program under this section, including 
an evaluation of— 
‘‘(1) the effectiveness of the curriculum in pre-
venting Indian and Alaska Native adolescent suicide; 
‘‘(2) areas for program improvement; and 
‘‘(3) additional development of the goals and 
objectives of the demonstration program. 
‘‘(d) REPORT TO CONGRESS.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
not later than 180 days after the date of termination 
of the demonstration program, the Secretary shall 
submit to the Committee on Indian Affairs and the 
Committee on Health, Education, Labor, and Pen-
sions of the Senate and the Committee on Natural 
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Resources and the Committee on Education and 
Labor of the House of Representatives a final report 
that— 
‘‘(A) describes the results of the program 
of each Indian tribe or eligible entity under this 
section; 
‘‘(B) evaluates the effectiveness of the cur-
riculum in preventing Indian and Alaska Native 
adolescent suicide; 
‘‘(C) makes recommendations regarding— 
‘‘(i) the expansion of the demonstra-
tion program under this section to addi-
tional eligible entities; 
‘‘(ii) designating the demonstration 
program as a permanent program; and 
‘‘(iii) identifying and distributing the 
curriculum through the Suicide Prevention 
Resource Center of the Administration; 
and 
‘‘(D) incorporates any public comments re-
ceived under paragraph (2). 
‘‘(2) PUBLIC COMMENT.—The Secretary shall 
provide a notice of the report under paragraph (1) 
and an opportunity for public comment on the re-
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port for a period of not less than 90 days before 
submitting the report to Congress. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
$1,000,000 for each of fiscal years 2011 through 2014.’’. 
Subtitle H—Miscellaneous 
SEC. 191. CONFIDENTIALITY OF MEDICAL QUALITY ASSUR-
ANCE RECORDS; QUALIFIED IMMUNITY FOR 
PARTICIPANTS. 
Title VIII of the Indian Health Care Improvement 
Act (as amended by section 101(b)) is amended by insert-
ing after section 804 (25 U.S.C. 1674) the following: 
‘‘SEC. 805. CONFIDENTIALITY OF MEDICAL QUALITY ASSUR-
ANCE RECORDS; QUALIFIED IMMUNITY FOR 
PARTICIPANTS. 
‘‘(a) DEFINITIONS.—In this section: 
‘‘(1) HEALTH
CARE
PROVIDER.—The term 
‘health care provider’ means any health care profes-
sional, including community health aides and practi-
tioners certified under section 119, who is— 
‘‘(A) granted clinical practice privileges or 
employed to provide health care services at— 
‘‘(i) an Indian health program; or 
‘‘(ii) a health program of an urban In-
dian organization; and 
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‘‘(B) licensed or certified to perform health 
care services by a governmental board or agen-
cy or professional health care society or organi-
zation. 
‘‘(2) MEDICAL
QUALITY
ASSURANCE
PRO-
GRAM.—The term ‘medical quality assurance pro-
gram’ means any activity carried out before, on, or 
after the date of enactment of the Indian Healthcare 
Improvement Act of 2011 by or for any Indian 
health program or urban Indian organization to as-
sess the quality of medical care, including activities 
conducted by or on behalf of individuals, Indian 
health program or urban Indian organization med-
ical or dental treatment review committees, or other 
review bodies responsible for quality assurance, cre-
dentials, infection control, patient safety, patient 
care assessment (including treatment procedures, 
blood, drugs, and therapeutics), medical records, 
health resources management review, and identifica-
tion and prevention of medical or dental incidents 
and risks. 
‘‘(3) MEDICAL QUALITY ASSURANCE RECORD.— 
The term ‘medical quality assurance record’ means 
the proceedings, records, minutes, and reports 
that— 
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‘‘(A) emanate from quality assurance pro-
gram activities described in paragraph (2); and 
‘‘(B) are produced or compiled by or for an 
Indian health program or urban Indian organi-
zation as part of a medical quality assurance 
program. 
‘‘(b) CONFIDENTIALITY OF RECORDS.—Medical qual-
ity assurance records created by or for any Indian health 
program or a health program of an urban Indian organiza-
tion as part of a medical quality assurance program are 
confidential and privileged. Such records may not be dis-
closed to any person or entity, except as provided in sub-
section (d). 
‘‘(c) PROHIBITION
ON DISCLOSURE
AND TESTI-
MONY.— 
‘‘(1) IN
GENERAL.—No part of any medical 
quality assurance record described in subsection (b) 
may be subject to discovery or admitted into evi-
dence in any judicial or administrative proceeding, 
except as provided in subsection (d). 
‘‘(2) TESTIMONY.—An individual who reviews 
or creates medical quality assurance records for any 
Indian health program or urban Indian organization 
who participates in any proceeding that reviews or 
creates such records may not be permitted or re-
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quired to testify in any judicial or administrative 
proceeding with respect to such records or with re-
spect to any finding, recommendation, evaluation, 
opinion, or action taken by such person or body in 
connection with such records except as provided in 
this section. 
‘‘(d) AUTHORIZED DISCLOSURE AND TESTIMONY.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), a 
medical quality assurance record described in sub-
section (b) may be disclosed, and an individual re-
ferred to in subsection (c) may give testimony in 
connection with such a record, only as follows: 
‘‘(A) To a Federal agency or private orga-
nization, if such medical quality assurance 
record or testimony is needed by such agency or 
organization to perform licensing or accredita-
tion functions related to any Indian health pro-
gram or to a health program of an urban In-
dian organization to perform monitoring, re-
quired by law, of such program or organization. 
‘‘(B) To an administrative or judicial pro-
ceeding commenced by a present or former In-
dian health program or urban Indian organiza-
tion provider concerning the termination, sus-
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222 
organization that created the records or for 
which the records were created. If that officer, 
employee, or contractor has a need for such 
record or testimony to perform official duties. 
‘‘(F) To a criminal or civil law enforce-
ment agency or instrumentality charged under 
applicable law with the protection of the public 
health or safety, if a qualified representative of 
such agency or instrumentality makes a written 
request that such record or testimony be pro-
vided for a purpose authorized by law. 
‘‘(G) In an administrative or judicial pro-
ceeding commenced by a criminal or civil law 
enforcement agency or instrumentality referred 
to in subparagraph (F), but only with respect 
to the subject of such proceeding. 
‘‘(2) IDENTITY
OF
PARTICIPANTS.—With the 
exception of the subject of a quality assurance ac-
tion, the identity of any person receiving health care 
services from any Indian health program or urban 
Indian organization or the identity of any other per-
son associated with such program or organization 
for purposes of a medical quality assurance program 
that is disclosed in a medical quality assurance 
record described in subsection (b) shall be deleted 
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from that record or document before any disclosure 
of such record is made outside such program or or-
ganization. 
‘‘(e) DISCLOSURE FOR CERTAIN PURPOSES.— 
‘‘(1) IN
GENERAL.—Nothing in this section 
shall be construed as authorizing or requiring the 
withholding from any person or entity aggregate sta-
tistical information regarding the results of any In-
dian health program or urban Indian organization’s 
medical quality assurance programs. 
‘‘(2) WITHHOLDING
FROM
CONGRESS.—Noth-
ing in this section shall be construed as authority to 
withhold any medical quality assurance record from 
a committee of either House of Congress, any joint 
committee of Congress, or the Government Account-
ability Office if such record pertains to any matter 
within their respective jurisdictions. 
‘‘(f) PROHIBITION ON DISCLOSURE OF RECORD OR 
TESTIMONY.—An individual or entity having possession of 
or access to a record or testimony described by this section 
may not disclose the contents of such record or testimony 
in any manner or for any purpose except as provided in 
this section. 
‘‘(g) EXEMPTION FROM FREEDOM OF INFORMATION 
ACT.—Medical quality assurance records described in sub-
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224 
section (b) may not be made available to any person under 
section 552 of title 5, United States Code. 
‘‘(h) LIMITATION
ON CIVIL LIABILITY.—An indi-
vidual who participates in or provides information to a 
person or body that reviews or creates medical quality as-
surance records described in subsection (b) shall not be 
civilly liable for such participation or for providing such 
information if the participation or provision of information 
was in good faith based on prevailing professional stand-
ards at the time the medical quality assurance program 
activity took place. 
‘‘(i) APPLICATION
TO INFORMATION
IN CERTAIN 
OTHER RECORDS.—Nothing in this section shall be con-
strued as limiting access to the information in a record 
created and maintained outside a medical quality assur-
ance program, including a patient’s medical records, on 
the grounds that the information was presented during 
meetings of a review body that are part of a medical qual-
ity assurance program. 
‘‘(j) REGULATIONS.—The Secretary, acting through 
the Service, shall promulgate regulations pursuant to sec-
tion 802. 
‘‘(k) CONTINUED PROTECTION.—Disclosure under 
subsection (d) does not permit redisclosure except to the 
extent such further disclosure is authorized under sub-
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section (d) or is otherwise authorized to be disclosed under 
this section. 
‘‘(l) INCONSISTENCIES.—To the extent that the pro-
tections under part C of title IX of the Public Health Serv-
ice Act (42 U.S.C. 229b–21 et seq.) (as amended by the 
Patient Safety and Quality Improvement Act of 2005 
(Public Law 109–41; 119 Stat. 424)) and this section are 
inconsistent, the provisions of whichever is more protective 
shall control. 
‘‘(m) RELATIONSHIP TO OTHER LAW.—This section 
shall continue in force and effect, except as otherwise spe-
cifically provided in any Federal law enacted after the date 
of enactment of the Indian Healthcare Improvement Act 
of 2011.’’. 
SEC. 192. LIMITATION ON USE OF FUNDS APPROPRAITED 
TO THE INDIAN HEALTH SERVICE. 
Section 806 of the Indian Health Care Improvement 
Act is amended— 
(1) by striking ‘‘Any limitation’’ and inserting 
the following: 
‘‘(a) HHS APPROPRIATIONS.—Any limitation’’; and 
(2) by adding at the end the following: 
‘‘(b) LIMITATIONS PURSUANT TO OTHER FEDERAL 
LAW.—Any limitation pursuant to other Federal laws on 
the use of Federal funds appropriated to the Service shall 
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apply with respect to the performance or coverage of abor-
tions.’’. 
SEC. 193. ARIZONA, NORTH DAKOTA, AND SOUTH DAKOTA 
AS CONTRACT HEALTH SERVICE DELIVERY 
AREAS; ELIGIBILITY OF CALIFORNIA INDI-
ANS. 
Title VIII of the Indian Health Care Improvement 
Act is amended— 
(1) by striking section 808 (25 U.S.C. 1678) 
and inserting the following: 
‘‘SEC. 808. ARIZONA AS CONTRACT HEALTH SERVICE DELIV-
ERY AREA. 
‘‘(a) IN GENERAL.—The State of Arizona 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 Indian tribes in the State of 
Arizona. 
‘‘(b) MAINTENANCE
OF
SERVICES.—The Service 
shall not curtail any health care services provided to Indi-
ans residing on reservations in the State of Arizona if the 
curtailment is due to the provision of contract services in 
that State pursuant to the designation of the State as a 
contract health service delivery area by subsection (a).’’; 
(2) by inserting after section 808 (25 U.S.C. 
1678) the following: 
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227 
‘‘SEC. 808A. NORTH DAKOTA AND SOUTH DAKOTA AS CON-
TRACT HEALTH SERVICE DELIVERY AREA. 
‘‘(a) IN GENERAL.—The States of North Dakota and 
South Dakota shall be designated as a contract health 
service delivery area by the Service for the purpose of pro-
viding contract health care services to members of Indian 
tribes in the States of North Dakota and South Dakota. 
‘‘(b) MAINTENANCE
OF
SERVICES.—The Service 
shall not curtail any health care services provided to Indi-
ans 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 the curtailment is due 
to the provision of contract services in those States pursu-
ant to the designation of the States as a contract health 
service delivery area by subsection (a).’’; and 
(3) by striking section 809 (25 U.S.C. 1679) 
and inserting the following: 
‘‘SEC. 809. 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— 
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‘‘(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 of California who is listed on 
the plans for distribution of the assets of rancherias 
and reservations located within the State of Cali-
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. 194. METHODS TO INCREASE ACCESS TO PROFES-
SIONALS OF CERTAIN CORPS. 
Section 812 of the Indian Health Care Improvement 
Act (25 U.S.C. 1680b) is amended to read as follows: 
‘‘SEC. 812. NATIONAL HEALTH SERVICE CORPS. 
‘‘(a) NO REDUCTION IN SERVICES.—The Secretary 
shall not remove a member of the National Health Service 
Corps from an Indian health program or urban Indian or-
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229 
ganization or withdraw funding used to support such a 
member, unless the Secretary, acting through the Service, 
has ensured that the Indians receiving services from the 
member will experience no reduction in services. 
‘‘(b) TREATMENT OF INDIAN HEALTH PROGRAMS.— 
At the request of an Indian health program, the services 
of a member of the National Health Service Corps as-
signed to the Indian health program may be limited to 
the individuals who are eligible for services from that In-
dian health program.’’. 
SEC. 195. HEALTH SERVICES FOR INELIGIBLE PERSONS. 
Section 813 of the Indian Health Care Improvement 
Act (25 U.S.C. 1680c) is amended to read as follows: 
‘‘SEC. 813. 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 
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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 
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 In-
dian tribe or tribal organization providing such services. 
The health needs of persons made eligible under this para-
graph shall not be taken into consideration by the Service 
in determining the need for, or allocation of, its health 
resources. 
‘‘(c) HEALTH
FACILITIES
PROVIDING
HEALTH 
SERVICES.— 
‘‘(1) IN GENERAL.—The Secretary is authorized 
to provide health services under this subsection 
through health facilities operated directly by the 
Service to individuals who reside within the Service 
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unit and who are not otherwise eligible for such 
health services if— 
‘‘(A) the Indian tribes served by such Serv-
ice unit requests such provision of health serv-
ices to such individuals, and 
‘‘(B) the Secretary and the served Indian 
tribes have jointly determined that the provision 
of such health services will not result in a de-
nial or diminution of health services to eligible 
Indians. 
‘‘(2) ISDEAA PROGRAMS.—In the case of 
health facilities operated under a contract or com-
pact entered into under the Indian Self-Determina-
tion and Education Assistance Act (25 U.S.C. 450 
et seq.), the governing body of the Indian tribe or 
tribal organization providing health services under 
such contract or compact is authorized to determine 
whether health services should be provided under 
such contract or compact to individuals who are not 
eligible for such health services under any other sub-
section of this section or under any other provision 
of law. In making such determinations, the gov-
erning body of the Indian tribe or tribal organization 
shall take into account the consideration described in 
paragraph (1)(B). Any services provided by the In-
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232 
dian tribe or tribal organization pursuant to a deter-
mination made under this subparagraph shall be 
deemed to be provided under the agreement entered 
into by the Indian tribe or tribal organization under 
the Indian Self-Determination and Education Assist-
ance Act. The provisions of section 314 of Public 
Law 101–512 (104 Stat. 1959), as amended by sec-
tion 308 of Public Law 103–138 (107 Stat. 1416), 
shall apply to any services provided by the Indian 
tribe or tribal organization pursuant to a determina-
tion made under this subparagraph. 
‘‘(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 207 of this Act or any other provision 
of law, amounts collected under this subsection, 
including Medicare, Medicaid, or children’s 
health 
insurance 
program 
reimbursements 
under titles XVIII, XIX, and XXI of the Social 
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233 
Security Act (42 U.S.C. 1395 et seq.), shall be 
credited to the account of the program pro-
viding the service and shall be used for the pur-
poses listed in section 401(d)(2) and amounts 
collected under this subsection shall be available 
for expenditure 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 
such health services but for the provisions of 
paragraph (1) only if an agreement has been 
entered into with a State or local government 
under which the State or local government 
agrees to reimburse the Service for the expenses 
incurred by the Service in providing such health 
services to such indigent individual. 
‘‘(4) REVOCATION
OF
CONSENT
FOR
SERV-
ICES.— 
‘‘(A) SINGLE
TRIBE
SERVICE
AREA.—In 
the case of a Service Area which serves only 1 
Indian tribe, the authority of the Secretary to 
provide health services under paragraph (1) 
shall terminate at the end of the fiscal year suc-
ceeding the fiscal year in which the governing 
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234 
body of the Indian tribe revokes its concurrence 
to the provision of such health services. 
‘‘(B) MULTITRIBAL
SERVICE
AREA.—In 
the case of a multitribal Service Area, the au-
thority of the Secretary to provide health serv-
ices under paragraph (1) shall terminate at the 
end of the fiscal year succeeding the fiscal year 
in which at least 51 percent of the number of 
Indian tribes in the Service Area revoke their 
concurrence to the provisions of such health 
services. 
‘‘(d) OTHER SERVICES.—The Service may provide 
health services under this subsection to individuals who 
are not eligible for health services provided by the Service 
under any other provision of law in order to— 
‘‘(1) achieve stability in a medical emergency; 
‘‘(2) prevent the spread of a communicable dis-
ease or otherwise deal with a public health hazard; 
‘‘(3) provide care to non-Indian women preg-
nant with an eligible Indian’s child for the duration 
of the pregnancy through postpartum; or 
‘‘(4) provide care to immediate family members 
of an eligible individual if such care is directly re-
lated to the treatment of the eligible individual. 
‘‘(e) HOSPITAL PRIVILEGES FOR PRACTITIONERS.— 
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235 
‘‘(1) IN
GENERAL.—Hospital privileges in 
health facilities operated and maintained by the 
Service or operated under a contract or compact 
pursuant to the Indian Self-Determination and Edu-
cation Assistance Act (25 U.S.C. 450 et seq.) may 
be extended to non-Service health care practitioners 
who provide services to individuals described in sub-
section (a), (b), (c), or (d). Such non-Service health 
care practitioners may, as part of the privileging 
process, be designated as employees of the Federal 
Government for purposes of section 1346(b) and 
chapter 171 of title 28, United States Code (relating 
to Federal tort claims) only with respect to acts or 
omissions which occur in the course of providing 
services to eligible individuals as a part of the condi-
tions under which such hospital privileges are ex-
tended. 
‘‘(2) DEFINITION.—For purposes of this sub-
section, the term ‘non-Service health care practi-
tioner’ means a practitioner who is not— 
‘‘(A) an employee of the Service; or 
‘‘(B) an employee of an Indian tribe or 
tribal organization operating a contract or com-
pact under the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et 
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srobinson on DSK8KYBLC1PROD with BILLS
236 
seq.) or an individual who provides health care 
services pursuant to a personal services con-
tract with such Indian tribe or tribal organiza-
tion. 
‘‘(f) ELIGIBLE INDIAN.—For purposes of this sec-
tion, the term ‘eligible Indian’ means any Indian who is 
eligible for health services provided by the Service without 
regard to the provisions of this section.’’. 
SEC. 196. ANNUAL BUDGET SUBMISSION. 
Title VIII of the Indian Health Care Improvement 
Act (25 U.S.C. 1671 et seq.) is amended by adding at 
the end the following: 
‘‘SEC. 826. ANNUAL BUDGET SUBMISSION. 
‘‘Effective beginning with the submission of the an-
nual budget request to Congress for fiscal year 2011, the 
President shall include, in the amount requested and the 
budget justification, amounts that reflect any changes 
in— 
‘‘(1) the cost of health care services, as indexed 
for United States dollar inflation (as measured by 
the Consumer Price Index); and 
‘‘(2) the size of the population served by the 
Service.’’. 
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237 
SEC. 197. PRESCRIPTION DRUG MONITORING. 
Title VIII of the Indian Health Care Improvement 
Act (25 U.S.C. 1671 et seq.) (as amended by section 195) 
is amended by adding at the end the following: 
‘‘SEC. 827. PRESCRIPTION DRUG MONITORING. 
‘‘(a) MONITORING.— 
‘‘(1) ESTABLISHMENT.—The Secretary, in co-
ordination with the Secretary of the Interior and the 
Attorney General, shall establish a prescription drug 
monitoring program, to be carried out at health care 
facilities of the Service, tribal health care facilities, 
and urban Indian health care facilities. 
‘‘(2) REPORT.—Not later than 18 months after 
the date of enactment of the Indian Healthcare Im-
provement Act of 2011, the Secretary shall submit 
to the Committee on Indian Affairs of the Senate 
and the Committee on Natural Resources of the 
House of Representatives a report that describes— 
‘‘(A) the needs of the Service, tribal health 
care facilities, and urban Indian health care fa-
cilities with respect to the prescription drug 
monitoring program under paragraph (1); 
‘‘(B) the planned development of that pro-
gram, including any relevant statutory or ad-
ministrative limitations; and 
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238 
‘‘(C) the means by which the program 
could be carried out in coordination with any 
State prescription drug monitoring program. 
‘‘(b) ABUSE.— 
‘‘(1) IN GENERAL.—The Attorney General, in 
conjunction with the Secretary and the Secretary of 
the Interior, shall conduct— 
‘‘(A) an assessment of the capacity of, and 
support required by, relevant Federal and tribal 
agencies— 
‘‘(i) to carry out data collection and 
analysis regarding incidents of prescription 
drug abuse in Indian communities; and 
‘‘(ii) to exchange among those agen-
cies and Indian health programs informa-
tion relating to prescription drug abuse in 
Indian communities, including statutory 
and administrative requirements and limi-
tations relating to that abuse; and 
‘‘(B) training for Indian health care pro-
viders, tribal leaders, law enforcement officers, 
and school officials regarding awareness and 
prevention of prescription drug abuse and strat-
egies for improving agency responses to ad-
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srobinson on DSK8KYBLC1PROD with BILLS
239 
dressing prescription drug abuse in Indian com-
munities. 
‘‘(2) REPORT.—Not later than 18 months after 
the date of enactment of the Indian Healthcare Im-
provement Act of 2011, the Attorney General shall 
submit to the Committee on Indian Affairs of the 
Senate and the Committee on Natural Resources of 
the House of Representatives a report that de-
scribes— 
‘‘(A) the capacity of Federal and tribal 
agencies to carry out data collection and anal-
ysis and information exchanges as described in 
paragraph (1)(A); 
‘‘(B) the training conducted pursuant to 
paragraph (1)(B); 
‘‘(C) infrastructure enhancements required 
to carry out the activities described in para-
graph (1), if any; and 
‘‘(D) any statutory or administrative bar-
riers to carrying out those activities.’’. 
SEC. 198. TRIBAL HEALTH PROGRAM OPTION FOR COST 
SHARING. 
Title VIII of the Indian Health Care Improvement 
Act (25 U.S.C. 1671 et seq.) (as amended by section 196) 
is amended by adding at the end the following: 
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srobinson on DSK8KYBLC1PROD with BILLS
240 
‘‘SEC. 828. TRIBAL HEALTH PROGRAM OPTION FOR COST 
SHARING. 
‘‘(a) IN GENERAL.—Nothing in this Act limits the 
ability of a tribal health program operating any health 
program, service, function, activity, or facility funded, in 
whole or part, by the Service through, or provided for in, 
a compact with the Service pursuant to title V of the In-
dian Self-Determination and Education Assistance Act 
(25 U.S.C. 458aaa et seq.) to charge an Indian for serv-
ices provided by the tribal health program. 
‘‘(b) SERVICE.—Nothing in this Act authorizes the 
Service— 
‘‘(1) to charge an Indian for services; or 
‘‘(2) to require any tribal health program to 
charge an Indian for services.’’. 
SEC. 199. DISEASE AND INJURY PREVENTION REPORT. 
Title VIII of the Indian Health Care Improvement 
Act (25 U.S.C. 1671 et seq.) (as amended by section 197) 
is amended by adding at the end the following: 
‘‘SEC. 829. DISEASE AND INJURY PREVENTION REPORT. 
‘‘Not later than 18 months after the date of enact-
ment of the Indian Healthcare Improvement Act of 2011, 
the Secretary shall submit to the Committee on Indian Af-
fairs of the Senate and the Committees on Natural Re-
sources and Energy and Commerce of the House of Rep-
resentatives describing— 
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srobinson on DSK8KYBLC1PROD with BILLS
241 
‘‘(1) all disease and injury prevention activities 
conducted by the Service, independently or in con-
junction with other Federal departments and agen-
cies and Indian tribes; and 
‘‘(2) the effectiveness of those activities, includ-
ing the reductions of injury or disease conditions 
achieved by the activities.’’. 
SEC. 200. OTHER GAO REPORTS. 
Title VIII of the Indian Health Care Improvement 
Act (25 U.S.C. 1671 et seq.) (as amended by section 198) 
is amended by adding at the end the following: 
‘‘SEC. 830. OTHER GAO REPORTS. 
‘‘(a) COORDINATION OF SERVICES.— 
‘‘(1) STUDY
AND
EVALUATION.—The Comp-
troller General of the United States shall conduct a 
study, and evaluate the effectiveness, of coordination 
of health care services provided to Indians— 
‘‘(A) through Medicare, Medicaid, or 
SCHIP; 
‘‘(B) by the Service; or 
‘‘(C) using funds provided by— 
‘‘(i) State or local governments; or 
‘‘(ii) Indian tribes. 
‘‘(2) REPORT.—Not later than 18 months after 
the date of enactment of the Indian Healthcare Im-
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242 
provement Act of 2011, the Comptroller General 
shall submit to Congress a report— 
‘‘(A) describing the results of the evalua-
tion under paragraph (1); and 
‘‘(B) containing recommendations of the 
Comptroller General regarding measures to 
support and increase coordination of the provi-
sion of health care services to Indians as de-
scribed in paragraph (1). 
‘‘(b) PAYMENTS
FOR CONTRACT HEALTH SERV-
ICES.— 
‘‘(1) IN GENERAL.—The Comptroller General 
shall conduct a study on the use of health care fur-
nished by health care providers under the contract 
health services program funded by the Service and 
operated by the Service, an Indian tribe, or a tribal 
organization. 
‘‘(2) ANALYSIS.—The study conducted under 
paragraph (1) shall include an analysis of— 
‘‘(A) the amounts reimbursed under the 
contract health services program described in 
paragraph (1) for health care furnished by enti-
ties, individual providers, and suppliers, includ-
ing a comparison of reimbursement for that 
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srobinson on DSK8KYBLC1PROD with BILLS
243 
health care through other public programs and 
in the private sector; 
‘‘(B) barriers to accessing care under such 
contract health services program, including bar-
riers relating to travel distances, cultural dif-
ferences, and public and private sector reluc-
tance to furnish care to patients under the pro-
gram; 
‘‘(C) the adequacy of existing Federal 
funding for health care under the contract 
health services program; 
‘‘(D) the administration of the contract 
health service program, including the distribu-
tion of funds to Indian health programs pursu-
ant to the program; and 
‘‘(E) any other items determined appro-
priate by the Comptroller General. 
‘‘(3) REPORT.—Not later than 18 months after 
the date of enactment of the Indian Healthcare Im-
provement Act of 2011, the Comptroller General 
shall submit to Congress a report on the study con-
ducted under paragraph (1), together with rec-
ommendations regarding— 
‘‘(A) the appropriate level of Federal fund-
ing that should be established for health care 
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