Native Behavioral Health Access Improvement Act of 2021
Bill: H.R.4251 | Sponsor: Rep. Pallone, Frank, Jr. (D-NJ)
Policy area: Native Americans

Summary:
Native Behavioral Health Access Improvement Act of 2021
This bill establishes a special tribal behavioral health grant program and expands the applicability of certain federal health care provisions to American Indians and Alaska Natives.
Specifically, the bill provides funds for and requires the Indian Health Service (IHS) to award grants to eligible entities (e.g., tribal health programs) for the prevention and treatment of mental health and substance use disorders.
The bill defines Indian for purposes of health insurance reform, exchanges, and subsidies to include individuals of Indian descent who are members of an Indian community served by the IHS and individuals considered by the Department of Health and Human Services to be Indian for purposes of eligibility for Indian health care services. Individuals included in the definition are eligible for special monthly enrollment periods on health insurance exchanges and elimination of cost sharing under individual health coverage for those whose income is not more than 300% of the poverty line. Under current law, only members of Indian tribes are eligible for these benefits.

To amend the Indian Health Care Improvement Act to authorize a special 
     behavioral health program for Indians, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Native Behavioral Health Access 
Improvement Act of 2021''.

SEC. 2. SPECIAL BEHAVIORAL HEALTH PROGRAM FOR INDIANS.

    (a) In General.--Subtitle A of title VII of the Indian Health Care 
Improvement Act (25 U.S.C. 1665 et seq.) is amended by adding at the 
end the following:

``SEC. 716. SPECIAL BEHAVIORAL HEALTH PROGRAM FOR INDIANS.

    ``(a) Definition of Eligible Entity.--In this section, the term 
`eligible entity' means--
            ``(1) any health program administered directly by the 
        Service;
            ``(2) a tribal health program; and
            ``(3) an Urban Indian health program operated by an Urban 
        Indian organization pursuant to a grant or contract with the 
        Service under title V.
    ``(b) Formula Grants.--
            ``(1) In general.--The Director of the Service (referred to 
        in this section as the `Director') shall award grants to 
        eligible entities, in amounts determined pursuant to the 
        formula described in paragraph (2), to be used by the eligible 
        entity to provide services for the prevention of, treatment of, 
        and recovery from mental health and substance use disorders.
            ``(2) Formula.--The Director, in consultation with Indian 
        tribes and Urban Indian organizations, shall develop a formula 
        to determine the amount of a grant under paragraph (1).
    ``(c) Technical Assistance and Program Evaluation.--
            ``(1) In general.--The Director shall--
                    ``(A) provide technical assistance to applicants 
                and grantees under this section; and
                    ``(B) collect and evaluate information on the 
                program carried out under this section.
            ``(2) Consultation.--The Director shall consult with 
        eligible entities under this section for purposes of developing 
        evaluation measures and data submission and reporting 
        requirements for purposes of the collection and evaluation of 
        information under paragraph (1)(B).
            ``(3) Data submission and reporting.--As a condition on 
        receipt of a grant under this section, an applicant shall agree 
        to submit data and reports consistent with the data submission 
        and reporting requirements developed under paragraph (2).
    ``(d) Funding.--To carry out this section, there is authorized to 
be appropriated, and there is appropriated, out of any money in the 
Treasury not otherwise appropriated, $200,000,000 for each of fiscal 
years 2022 through 2026.''.
    (b) Technical Amendment.--Section 4(26) of the Indian Health Care 
Improvement Act (25 U.S.C. 1603(26)) is amended by striking ``(25 
U.S.C. 450b)'' and inserting ``(25 U.S.C. 5304)''.

SEC. 3. INDIAN DEFINED IN PPACA.

    (a) Indian Defined in PPACA.--
            (1) In general.--Section 1304 of the Patient Protection and 
        Affordable Care Act (42 U.S.C. 18024) is amended by adding at 
        the end the following new subsection:
    ``(f) Indian.--
            ``(1) In general.--In this title, the term `Indian' means 
        any individual--
                    ``(A) described in paragraph (13) or (28) of 
                section 4 of the Indian Health Care Improvement Act (25 
                U.S.C. 1603);
                    ``(B) who is eligible for health services provided 
                by the Indian Health Service under section 809 of the 
                Indian Health Care Improvement Act (25 U.S.C. 1679);
                    ``(C) who is of Indian descent and belongs to the 
                Indian community served by the local facilities and 
                program of the Indian Health Service; or
                    ``(D) who is described in paragraph (2).
            ``(2) Included individuals.--For purposes of this title, 
        the following individuals shall be considered to be an 
        `Indian':
                    ``(A) A member of a Federally recognized Indian 
                tribe.
                    ``(B) A resident of an urban center who meets one 
                or more of the following four criteria:
                            ``(i) Membership in a Tribe, band, or other 
                        organized group of Indians, including those 
                        Tribes, bands, or groups terminated since 1940 
                        and those recognized by the State in which they 
                        reside, or being a descendant, in the first or 
                        second degree, of any such member.
                            ``(ii) Is an Eskimo or Aleut or other 
                        Alaska Native.
                            ``(iii) Is considered by the Secretary of 
                        the Interior to be an Indian for any purpose.
                            ``(iv) Is determined to be an Indian under 
                        regulations promulgated by the Secretary.
                    ``(C) An individual who is considered by the 
                Secretary of the Interior to be an Indian for any 
                purpose.
                    ``(D) An individual who is considered by the 
                Secretary to be an Indian for purposes of eligibility 
                for Indian health care services, including as a 
                California Indian, Eskimo, Aleut, or other Alaska 
                Native.''.
            (2) Conforming amendments.--
                    (A) Affordable choices health benefit plans.--
                Section 1311(c)(6)(D) of the Patient Protection and 
                Affordable Care Act (42 U.S.C. 18031(c)(6)(D)) is 
                amended by striking ``section 4 of the Indian Health 
                Care Improvement Act'' and inserting ``section 
                1304(f)''.
                    (B) Reduced cost-sharing for individuals enrolling 
                in qualified health plans.--Section 1402(d) of the 
                Patient Protection and Affordable Care Act (42 U.S.C. 
                18071(d)) is amended--
                            (i) in paragraph (1), in the matter 
                        preceding subparagraph (A), by striking 
                        ``section 4(d) of the Indian Self-Determination 
                        and Education Assistance Act (25 U.S.C. 
                        450b(d))'' and inserting ``section 1304(f)''; 
                        and
                            (ii) in paragraph (2), in the matter 
                        preceding subparagraph (A), by striking ``(as 
                        so defined)'' and inserting ``(as defined in 
                        section 1304(f))''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply with respect to plan years beginning on or after 
        January 1, 2023.
    (b) Technical Amendments.--Section 4 of the Indian Health Care 
Improvement Act (25 U.S.C. 1603) is amended--
            (1) in paragraph (13), by striking ``as defined in 
        subsection (d) hereof'' and inserting ``as defined in paragraph 
        (14)''; and
            (2) in paragraph (28)--
                    (A) by striking ``as defined in subsection (g) 
                hereof'' and inserting ``as defined in paragraph 
                (27)''; and
                    (B) by striking ``subsection (c)(1) through (4)'' 
                and inserting ``subparagraphs (A) through (D) of 
                paragraph (13)''.
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