Title: Native Health Access Improvement Act of 2019
Policy area: Native Americans

Summary:
Native Health Access Improvement Act of 2019
This bill establishes a grant program for Indian health facilities 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 Indian health facilities for the prevention and treatment of mental health and substance use disorders. The IHS must establish a technical assistance center for grantees.
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.
The bill also exempts Indians, as defined by the bill, from the tax penalty for not maintaining minimum essential health coverage.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4533 Introduced in House (IH)]

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116th CONGRESS
  1st Session
                                H. R. 4533

  To amend the Public Health Service Act to improve behavioral health 
   outcomes for American Indians and Alaskan Natives, and for other 
                               purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           September 26, 2019

 Mr. Pallone (for himself and Mr. Ruiz) introduced the following bill; 
  which was referred to the Committee on Energy and Commerce, and in 
 addition to the Committees on Ways and Means, and Natural Resources, 
for a period to be subsequently determined by the Speaker, in each case 
for consideration of such provisions as fall within the jurisdiction of 
                        the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend the Public Health Service Act to improve behavioral health 
   outcomes for American Indians and Alaskan Natives, 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 Health Access Improvement Act 
of 2019''.

SEC. 2. SPECIAL BEHAVIORAL HEALTH PROGRAM FOR INDIANS.

    Part A of title V of the Public Health Service Act (42 U.S.C. 290aa 
et seq.) is amended by adding at the end the following new section:

``SEC. 506B. SPECIAL BEHAVIORAL HEALTH PROGRAM FOR INDIANS.

    ``(a) In General.--The Director of the Indian Health Service, in 
coordination with the Assistant Secretary for Mental Health and 
Substance Use, shall award grants for providing services in accordance 
with subsection (b) for the prevention and treatment of mental health 
and substance use disorders.
    ``(b) Services Through Indian Health Facilities.--For purposes of 
subsection (a), services are provided in accordance with this 
subsection if the services are provided through any of the following 
entities:
            ``(1) The Indian Health Service.
            ``(2) An Indian health program operated by an Indian tribe 
        or tribal organization pursuant to a contract, grant, 
        cooperative agreement, or compact with the Indian Health 
        Service pursuant to the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 5301 et seq.).
            ``(3) An urban Indian health program operated by an urban 
        Indian organization pursuant to a grant or contract with the 
        Indian Health Service pursuant to title V of the Indian Health 
        Care Improvement Act (25 U.S.C. 1651 et seq.).
    ``(c) Reports.--Each grantee under this section shall submit 
reports at such time, in such manner, and containing such information 
as the Director of the Indian Health Service may require.
    ``(d) Technical Assistance Center.--
            ``(1) Establishment.--The Director of the Indian Health 
        Service, in coordination with the Assistant Secretary for 
        Mental Health and Substance Use, shall establish a technical 
        assistance center (directly or by contract or cooperative 
        agreement)--
                    ``(A) to provide technical assistance to grantees 
                under this section; and
                    ``(B) to collect and evaluate information on the 
                program carried out under this section.
            ``(2) Consultation.--The technical assistance center shall 
        consult with grantees under this section for purposes of 
        developing evaluation measures and data submission requirements 
        for purposes of the collection and evaluation of information 
        under paragraph (1)(B).
            ``(3) Data submission.--As a condition on receipt of a 
        grant under this section, an applicant shall agree to submit 
        data consistent with the data submission requirements developed 
        pursuant to paragraph (2).
    ``(e) Funding.--
            ``(1) In general.--For the purpose of making grants under 
        this section, there is authorized to be appropriated, and there 
        is appropriated, out of any money in the Treasury not otherwise 
        appropriated, $150,000,000 for each of fiscal years 2020 
        through 2024.
            ``(2) Technical assistance center.--Of the amount made 
        available to carry out this section for each of fiscal years 
        2020 through 2024, the Director of the Indian Health Service 
        shall allocate a percentage of such amount, to be determined by 
        the Director in consultation with Indian tribes, for the 
        technical assistance center under subsection (d).
    ``(f) Definitions.--In this section, the terms `Indian health 
program', `Indian tribe', `tribal organization', and `urban Indian 
organization' have the meanings given those terms in section 4 of the 
Indian Health Care Improvement Act (25 U.S.C. 1603).''.

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))''.
                    (C) Exemption from penalty for not maintaining 
                minimum essential coverage.--Section 5000A(e) of the 
                Internal Revenue Code of 1986 is amended by striking 
                paragraph (3) and inserting the following new 
                paragraph:
            ``(3) Indians.--Any applicable individual who is an Indian 
        (as defined in section 1304(f) of the Patient Protection and 
        Affordable Care Act).''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply with respect to plan years beginning on or after 
        January 1, 2021.
    (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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