Indian Health Amendments of 1992
PL 102-573 (S.2481), enacted 10/29/1992

106 STAT. 4526 
PUBLIC LAW 102-573—OCT. 29, 1992 
Public Law 102-573 
102d Congress 
An Act 
Oct. 29,1992 
To amend the Indian Health Care Improvement Act to authorize appropriations 
[S. 2481] 
for Indian health programs, and for other purposes. 
Be it enacted by the Senate and House of Representatives of 
Indian Health 
the United States of 
America in Congress assembled. 
Amendments of 
1992. 
SECTION 1. SHORT TITLE. 
25 use 1601 
note 
This Act may be cited as the "Indian Health Amendments 
of 1992". 
SEC. 2. AMENDMENTS TO INDIAN HEALTH CARE IMPROVEMENT ACT. 
Except as otherwise specifically provided, whenever in this 
Act a section or other provision is amended or repealed, such 
amendment or repeal shall be considered to be made to that section 
or other provision of the Indian Health Care Improvement Act 
(25 U.S.C. 1601 et seq.). 
SEC. 3. FINDINGS; POUCY; AND DEFINITIONS. 
(a) FINDINGS.—Section 2 of the Act (25 U.S.C. 1601) is 
amended— 
(1) in the matter preceding paragraph (a), by striking "finds 
that—" and inserting finds the following:"; 
(2) in paragraph (d), by striking out the second sentence; 
and 
(3) by striking out paragraphs (e), (f), and (g). 
(b) DECLARATION OF POLICY.—Section 3 of the Act (25 U.S.C. 
1602) is amended to read as follows: 
"DECLARATION OF HEALTH OBJECTIVES 
"SEC. 3. (a) The Congress hereby declares that it is the policy 
of this Nation, in fulfillment of its special responsibilities and 
legal obligation to the American Indian people, to assure the highest 
possible health status for Indians and urban Indians and to provide 
all resources necessary to effect that poUcy. 
"(b) It is the intent of the Congress that the Nation meet 
the following health status objectives with respect to Indians and 
urban Indians by the year 2000: 
"(1) Reduce coronary heart disease deaths to a level of 
no more than 100 per 100,000. 
"(2) Reduce the prevalence of overweight individuals to 
no more than 30 percent. 
"(3) Reduce the prevalence of anemia to less than 10 per-
cent among children aged 1 through 5. 
"(4) Reduce the level of cancer deaths to a rate of no 
more than 130 per 100,000. 
"(5) Reduce the level of limg cancer deaths to a rate of 
no more than 42 per 100,000. 
"(6) Reduce the level of chronic obstructive pulmonary dis-
ease related deaths to a rate of no more than 25 per 100,000. 
69-139 O - 92 (573) 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4527 
"(7) Reduce deaths among men caused by alcohol-related 
motor vehicle crashes to no more than 44.8 per 100,000. 
"(8) Reduce cirrhosis deaths to no more than 13 per 
100,000. 
"(9) Reduce drug-related deaths to no more than 3 per 
100,000. 
"(10) Reduce pregnancies among girls aged 17 and younger 
to no more than 50 per 1,000 adolescents. 
"(11) Reduce suicide among men to no more than 12.8 
per 100,000. 
"(12) Reduce by 15 percent the incidence of injurious suicide 
attempts among adolescents aged 14 through 17. 
"(13) Reduce to less than 10 percent the prevalence of 
mental disorders among children and adolescents. 
"(14) Reduce the incidence of child abuse or neglect to 
less than 25.2 per 1,000 children under age 18. 
"(15) Reduce physical abuse directed at women by male 
partners to no more than 27 per 1,000 couples. 
"(16) Increase years of healthy life to at least 65 years. 
"(17) Reduce deaths caused by unintentional injuries to 
no more than 66.1 per 100,000. 
"(18) Reduce deaths caused by motor vehicle crashes to 
no more than 39.2 per 100,000. 
"(19) Among children aged 6 months through 5 years, 
reduce the prevalence of blood lead levels exceeding 15 ug/dl 
and reduce to zero the prevalence of blood lead levels exceeding 
25 ug/dl. 
"(20) Reduce dental caries (cavities) so that the proportion 
of children with one or more caries (in permanent or primary 
teeth) is no more than 45 percent among children aged 6 
through 8 and no more than 60 percent among adolescents 
aged 15. 
"(21) Reduce untreated dental caries so that the proportion 
of children with untreated caries (in permanent or primary 
teeth) is no more than 20 percent among children aged 6 
through 8 and no more than 40 percent among adolescents 
aged 15. 
"(22) Reduce to no more than 20 percent the proportion 
of individuals aged 65 and older who have lost all of their 
natural teeth. 
"(23) Increase to at least 45 percent the proportion of 
individuals aged 35 to 44 who have never lost a permanent 
tooth due to dental caries or periodontal disease. 
"(24) Reduce destructive periodontal disease to a prevalence 
of no more than 15 percent among individuals aged 35 to 
44. 
"(25) Increase to at least 50 percent the proportion of 
children who have received protective sealants on the occlusal 
(chewing) surfaces of permanent molar teeth. 
"(26) Reduce the prevalence of gingivitis among individuals 
aged 35 to 44 to no more than 50 percent. 
"(27) Reduce the infant mortality rate to no more than 
8.5 per 1,000 live births. 
"(28) Reduce the fetal death rate (20 or more weeks of 
gestation) to no more than 4 per 1,000 live births plus feteil 
deaths. 
106 STAT. 4528 
PUBLIC LAW 102-573—OCT. 29, 1992 
"(29) Reduce the maternal mortality rate to no more than 
3.3 per 100,000 live births. 
"(30) Reduce the incidence of fetal alcohol s3midrome to 
no more than 2 per 1,000 live births. 
"(31) Reduce stroke deaths to no more than 20 per 100,000. 
"(32) Reverse the increase in end-stage renal disease 
(requiring maintenance dialysis or trsuisplantation) to attain 
an incidence of no more than 13 per 100,000. 
"(33) Reduce breast cancer deaths to no more than 20.6 
per 100,000 women. 
"(34) Reduce deaths from cancer of the uterine cervix to 
no more than 1.3 per 100,000 women. 
"(35) Reduce colorectal cancer deaths to no more than 
13.2 per 100,000. 
(36) Reduce to no more than 11 percent the proportion 
of individuals who experience a limitation in major activity 
due to chronic conditions. 
"(37) Reduce significant hearing impairment to a preva-
lence of no more than 82 per 1,000. 
"(38) Reduce significant visual impairment to a prevalence 
of no more than 30 per 1,000. 
"(39) Reduce (uabetes-related deaths to no more than 48 
per 100,000. 
"(40) Reduce diabetes to an incidence of no more than 
2.5 per 1,000 £Uid a prevalence of no more than 62 per 1,000. 
"(41) Reduce the most severe complications of diabetes 
as follows: 
"(A) End-stage renal disease, 1.9 per 1,000. 
"(B) Blindness, 1.4 per 1,000. 
"(C) Lower extremity amputation, 4.9 per 1,000. 
"(D) Perinatal mortality, 2 percent. 
"(E) Major congenital malformations, 4 percent. 
"(42) Confine annual incidence of diagnosed AIDS cases 
to no more than 1,000 cases. 
"(43) Confine the prevalence of HIV infection to no more 
than 100 per 100,000. 
"(44) Reduce gonorrhea to an incidence of no more than 
225 cases per 100,000. 
"(45) Reduce chlamydia trachomatis infections, as meas-
ured by a decrease in the incidence of nongonococcal urethritis 
to no more than 170 cases per 100,000. 
"(46) Reduce primary and secondary s3T)hiUs to an 
incidence of no more than 10 cases per 100,000. 
"(47) Reduce the incidence of pelvic inflammatory disease, 
as measured by a reduction in hospitalization for pelvic inflam-
matory disease to no more than 250 per 100,000 women aged 
15 through 44. 
"(48) Reduce viral hepatitis B infection to no more than 
40 per 100,000 cases. 
"(49) Reduce indigenous cases of vaccine-preventable dis-
eases as follows: 
"(A) Diphtheria among individuals aged 25 and 
younger, 0. 
"(B) Tetanus among individuals aged 25 and younger, 
0. 
"(C) Polio (wild-type virus), 0. 
"(D) Measles, 0. 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 45^9 
"(E) Rubella, 0. 
"(F) Congenital Rubella Syndrome, 0. 
"(G) Mumps, 500. 
"(H) Pertussis, 1,000. 
''(SO) Reduce epidemic-related pneumonia and influenza 
deaths among individu£ds aged 65 and older to no more than 
7.3 per 100,000. 
"(51) Reduce the number of new carriers of viral hepatitis 
B among Alaska Natives to no more than 1 case. 
"(52) Reduce tuberculosis to an incidence of no more than 
5 cases per 100,000. 
"(53) Reduce bacterial meningitis to no more than 8 cases 
per 100,000. 
"(54) Reduce infectious diarrhea by at least 25 percent 
among children. 
"(55) Reduce acute middle ear infections among children 
aged 4 and younger, as measured by days of restricted activity 
or school absenteeism, to no more than 105 days per 100 
children. 
"(56) Reduce cigarette smoking to a prevalence of no more 
than 20 percent. 
"(57) Reduce smokeless tobacco use by youth to a preva-
lence of no more than 10 percent. 
"(58) Increase to at least 65 percent the proportion of 
E
arents and caregivers who use feeding practices that prevent 
aby bottle tooth decay. 
"(59) Increase to at least 75 percent the proportion of 
mothers who breast feed their babies in the early postpartum 
period, and to at least 50 percent the proportion who continue 
breast feeding until their babies are 5 to 6 months old. 
"(60) Increase to at least 90 percent the proportion of 
pregnant women who receive prenatal care in the first trimester 
of pregnancy. 
"(61) Increase to at least 70 percent the proportion of 
individuals who have received, as a minimum within the appro-
priate interval, all of the screening and immunization services 
and at least one of the counseling services appropriate for 
their age and gender as recommended by the United States 
Preventive Services Task Force. 
"(c) It is the intent of the Congress that the Nation increase 
the proportion of all degrees in the health professions and allied 
and associated health profession fields awarded to Indians to 0.6 
percent. 
"(d) The Secretary shedl submit to the President, for inclusion Reports, 
in each report required to be transmitted to the Congress under 
section 801, a report on the progress made in each area of the 
Service toward meeting each of the objectives described in sub-
section (b).". 
(c) DEFINITIONS.—Section 4 of the Act (25 U.S.C. 1603) 
is 
amended by adding at the end the following new subsections: 
"(m) 'Service area' means the geographical area served by each 
area office. 
"(n) 'Health profession' means family medicine, internal medi-
cine, pediatrics, geriatric medicine, obstetrics and gynecology, 
podiatric medicine, nursing, public health nursing, dentistry, psy-
chiatry, osteopathy, optometry, pharmacy, psychology, public health, 
social work, marriage and family therapy, chiropractic medicine. 
106 STAT. 4530 
PUBLIC LAW 102-573—OCT. 29, 1992 
environmental health and engineering, and allied health profes-
sions. 
"(o) 'Substance abuse' includes inhalant abuse. 
"(p) 'FAE' means fetal alcohol effect. 
£ V «(q) 'FAS' means fetal alcohol syndrome.". 
TITLE I—INDIAN HEALTH 
PROFESSIONALS 
SEC. 101. PURPOSE. 
Section 101 of the Act (25 U.S.C. 1611) is amended to read 
as follows: 
,..;.-.:.:•, 
"PURPOSE 
..^^•:: 
"SEC. 101. The purpose of this title is to increase the number 
of Indians entering the health professions and to assure an adequate 
supply of health professionals to the Service, Indian tribes, tribal 
organizations, and urban Indian organizations involved in the provi-
sion of health care to Indian people.". 
SEC. 102. HEALTH PROFESSIONS. 
(a) RECRUITMENT PROGRAM.—Section 102(a) of the Act (25 
U.S.C. 1612(a)) is amended— 
(1) by amending paragraph (1) to read as follows: 
"(1) identifying Indians with a potential for education or 
training in the health professions and encouraging and assist-
ing them— 
"(A) to enroll in courses of study in such health profes-
sions; or 
"(B) if they are not qualified to enroll in any such 
courses of study, to undertake such postsecondary edu-
cation or training as may be required to qualify them 
for enrollment;"; 
(2) in paragraph (2)— 
(A) by striking out "school" both places it appears 
and inserting in lieu thereof the following: "course of study"; 
and 
(B) by striking out "clause (1)(A)" and inserting in 
lieu thereof the following: "paragraph (1)"; and 
(3) in paragraph (3)— 
(A) by striking out "Indians," and inserting in lieu 
thereof "Indians in,"; 
(B) by inserting a comma before "courses"; 
(C) by striking out", in any school"; and 
(D) by striking out "clause (1)(A)" and inserting in 
lieu thereof the following: "paragraph (1)". 
(b) PREPARATORY SCHOLARSHIP PROGRAM.—Section 103 of the 
Act (25 U.S.C. 1613) is amended— 
(1) by amending subsection (a)(2) to read as follows: 
"(2) have demonstrated the capability to successfully com-
plete courses of study in the health professions."; 
(2) in subsection (b)(1), by inserting before the period at 
the end the following: "on a full-time basis (or the part-time 
' 
equivalent thereof, as determined by the Secretary)"; 
(3) by amending subsection (b)(2) to read as follows: 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4531 
"(2) Pregraduate education of any grantee leading to a 
baccalaureate degree in £in approved course of study pre-
paratory to a field of study in a health profession, such scholar-
ship not to exceed 4 years (or the part-time equivalent thereof, 
as determined by the Secretary),"; 
(4) in subsection (c), by striking out "fiill time"; and 
(5) by amending subsection (e) to read as follows: 
**(e) The Secretary shall not deny scholarship assistance to 
an eligible applicant under this section solely by reason of such 
applicant's eligibiUty for assistance or benefits under any other 
Federal program.". 
(c) HEALTH PROFESSIONS SCHOLARSHIPS.—Section 104 of the 
Act (25 U.S.C. 1613a) is amended— 
(1) in subsection (a)— 
(A) by striking out "Indian communities" and inserting 
in lieu thereof the following: "Indians, Indian tribes, tribal 
organizations, and urban Indian organizations"; 
(B) by striking out "full time" and inserting in lieu 
thereof the following: "full or part time"; and 
(C) by striking out "of medicine" and all that follows 
through "social work" and inserting in lieu thereof the 
following: "and pursuing courses of study in the health 
professions"; 
(2) in subsection (b)— 
(A) in paragraph (2)— 
(i) by striking out "fiill time" and inserting in 
lieu thereof "full or part time"; and 
(ii) by striking out "health profession school" and 
inserting in lieu thereof "course of study"; 
(B) in paragraph (3)— 
(i) by striking "(3)" and inserting "(3)(A)"; 
(ii) by redesignating subparagraphs (A), (B), (C), 
and (D) as clauses (i), (ii), (iii), and (iv), respectively; 
and 
(iii) by inserting at the end the following new 
subparagraphs: 
"(B) A recipient of an Indian Health Scholarship may, at the 
election of the recipient, meet the active duty service obligation 
prescribed under section 338C of the Public Health Service Act 
(42 U.S.C. 254m) by service in a program specified in subparagraph 
(A) t h a t ^ 
"(i) is located on the reservation of the tribe in which 
the recipient is enrolled; or 
"(ii) serves the tribe in which the recipient is enrolled. 
"(C) Subject to subparagraph (B), the Secretary, in making 
assignments of Indian Health Scholarship recipients required to 
meet the active duty service obligation prescribed under section 
338C of the Pubhc Health Service Act (42 U.S.C. 254m), shall 
give priority to assigning individuals to service in those programs 
specified in subparagraph (A) that have a need for health profes-
sionals to provide health care services as a result of individuals 
having breached contracts entered into under this section."; and 
(C) by adding at the end the following new paragraph: 
"(4) In the case of an individual receiving a scholarship under 
this section who is enrolled part time in an approved course of 
study— 
106 STAT. 4532 
PUBLIC LAW 102-573—OCT. 29, 1992 
Establishment. 
25 use 1613a 
note. 
"(A) such scholarship shall be for a period of ye£irs not 
to exceed the part-time equivalent of 4 years, as determined 
by the Secretary; 
"(B) the period of obligated service specified in section 
338A(fKl)(B)(iv) of the PubUc Health Service Act (42 U.S.C. 
254m(fXl)(B)(iv)) shall be equal to the greater of— 
"(i) the part-time equivalent of one year for each year 
for which the individual was provided a scholarship (as 
determined by the Secretary); or 
**(ii) two years; and 
"(C) the amount of the monthly stipend specified in section 
338A(g)(l)(B) of the PubUc Health Service Act (42 U.S.C. 
254m(g)(l)(B)) shall be reduced pro rata (as determined by 
the Secretary) based on the number of hours such student 
is enrolled."; 
(3) by amending subsection (c) to read as follows: 
"(c) The Secretary shall, acting through the Service, establish 
a Placement Office to develop and implement a national poUcy 
for the placement, to available vacancies within the Service, of 
Indian Health Scholarship recipients required to meet the active 
duty service obligation prescribed under section 338C of the Pubhc 
Health Service Act (42 U.S.C. 254m) without regard to any competi-
tive personnel system, agency personnel Umitation, or Indian pref-
erence policy."; and 
(4) by striking out subsection (d). 
(d) EFFECTIVE DATE.—^The amendments made by subsection 
(c)(1)(C) and subsection (c)(2)(B) shall apply with respect to scholar-
ships granted under section 104 of the Indian Health Care Improve-
ment Act after the date of the enactment of this Act. 
(e) EXTERN PROGRAM.—Section 105 of the Act (25 U.S.C. 1614) 
is amended— 
(1) in subsection (a), by striking out "section 757 of the 
PubUc Health Service Act" and inserting in lieu thereof "section 
104"; and 
(2) in subsection (b), by striking out "school of medicine" 
and all that follows through "health professions" and inserting 
in Ueu thereof "course of study in the health professions". 
SEC. 103. BREACH OF CONTRACT PROVISIONS RELATING TO INDIAN 
HEALTH SCHOLARSHIPS. 
Section 104(b) of the Act (25 U.S.C. 1613a(b)) (as amended 
by section 102(c) of this Act) is amended by adding at the end 
the following new paragraph: 
"(5)(A) An individual who has, on or after the date of the 
enactment of this paragraph, entered into a written contract with 
the Secretary under this section and who— 
"(i) fails to m£dntain an acceptable level of academic stand-
ing in the educational institution in which he is enrolled (such 
level determined by the educational institution under regula-
tions of the Secretary), 
"(ii) is dismissed from such educational institution for dis-
ciplinaiy reasons, 
"(iii) voliuitarily terminates the training in such an edu-
cational institution for which he is provided a scholarship under 
such contract before the completion of such training, or 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4533 
"(iv) fails to accept pa)niient, or instructs the educational 
institution in which he is enrolled not to accept payment, 
in whole or in part, of a scholarship under such contract, 
in lieu of any service obligation arising under such contract, shall 
be liable to the United States for the amount which has been 
paid to him, or on his behalf, under the contract. 
"(B) If for any reason not specified in subparagraph (A) an 
individual breaches his written contract by failing either to begin 
such individual's service obligation under this section or to complete 
such service obligation, the United States shall be entitled to recover 
from the individual an amount determined in accordance with the 
formula specified in subsection (1) of section 108 in the manner 
provided for in such subsection.". 
SEC. 104. NURSING. 
(a) CONTINUING EDUCATION ALLOWANCES.—Section 106(a) of 
the Act (25 U.S.C. 1615(a)) is amended by inserting "nurses," afl«r 
"dentists,". 
(b) QUENTIN N. BURDICK AMERICAN INDIANS INTO NURSING 
PROGRAM.—Section 112 of the Act (25 U.S.C. 1616e) is amended— 
(1) by redesignating subsections (e) and (f) as subsections 
(f) and (g), respectively; and 
(2) by inserting after subsection (d) the following new sub-
section: 
"(e) The Secretary shall provide one of the grants authorized 
under subsection (a) to establish and maintain a program at the 
University of North Dakota to be known as the 'Quentin N. Burdick 
American Indians Into Nursing Program*. Such program shall, to 
the m£iximum extent feasible, coordinate with the Quentin N. Bur-
dick Indian Health Programs established under section 114(b) and 
the Quentin N. Burdick American Indians Into Psychology Program 
established under section 217(b).". 
(c) TRAINING FOR NURSE MIDWIVES, NURSE ANESTHETISTS, AND 
NURSE PRACTITIONERS.—Section 112(g) of the Act (25 U.S.C. 
1616e(g)) (as redesignated by subsection (b)(1) of this section) is 
amended to read as follows: 
"(g) Beginning with fiscal year 1993, of the amounts appro-
priated under the authority of this title for each fiscal year to 
be used to carry out this section, not less than $1,000,000 shall 
be used to provide grants under subsection (a) for the training 
of nurse midwives, nurse anesthetists, and nurse practitioners.". 
(d) RETENTION BONUS FOR NURSES.—Section 117 (25 U.S.C. 
1616J) of the Act is £unended— 
(1) by redesignating subsections (b) through (e) as sub-
sections (c) through (f), respectively; 
(2) by adding after subsection (a) the following new sub-
section (b): 
"(b) Beginning with fiscal year 1993, not less than 25 percent 
of the retention bonuses awarded each year imder subsection (a) 
shall be awarded to nurses."; and 
(3) by amending subsection (f) (as amended by paragraph 
(1)) to read as follows: 
"(f) The Secretary may pay a retention bonus to any physician 
or nurse employed by an organization providing health care services 
to Indians pursuant to a contract under the Indian Self-Determina-
tion Act if such physician or nurse is serving in a position which 
the Secretary determines is— 
Colleges and 
universities. 
Grants. 
106 STAT. 4534 
and 
PUBLIC LAW 102-573—OCT. 29, 1992 
"(1) a position for which recruitment or retention is difficult; 
"(2) necessary for providing health care services to 
Indians.". 
(e) RESIDENCY PROGRAM.—Title I of the Act is amended by 
adding at the end the following new section: 
"NURSING RESIDENCY PROGRAM 
25 use 1616k. 
«SEC. 118. (a) The Secretary, acting through the Service, shall 
establish a program to enable licensed practical nurses, licensed 
vocational nurses, and registered nurses who are working in an 
Indian health program (as defined in section 108(a)(2)(A)), and 
have done so for a period of not less than one year, to pursue 
advanced training. 
"(b) Such program shall include a combination of education 
and work study in an Indian health program (as defined in section 
108(a)(2)(A)) leading to an associate or bachelor's degree (in the 
case of a Ucensed practical nurse or licensed vocational nurse) 
or a bachelor's degree (in the case of a registered nurse). 
"(c) An individual who participates in a program imder sub-
section (a), where the educational costs are paid by the Service, 
shall incur an obligation to serve in an Indian health program 
for a period of obligated service equsd to at least three times 
the period of time during which the individual participates in such 
program. In the event that the individual fails to complete such 
obligated service, the United States shall be entitled to recover 
from such individual an amount determined in accordance with 
the formula specified in subsection (1) of section 108 in the manner 
provided for in such subsection.". 
(0 GRANTS FOR THE PROVISION OF PRIMARY CARE SERVICES 
ON OR NEAR INDIAN COUNTRY.—Title I of the Indian Health Care 
Improvement Act (25 U.S.C. 1601 et seq.) is amended by adding 
immediately after section 112 the following new section: 
"NURSING SCHOOL CLINICS 
25 use I6l6e-l. 
"SEC. 112A. (a) GRANTS.—In addition to the authority of the 
Secretary under section 112(a)(1), the Secretary, acting through 
the Service, is authorized to provide grants to public or private 
schools of nursing for the purpose of establishing, developing, 
operating, and administering clinics to address the health care 
needs of Indians, and to provide primary health care services to 
Indians who reside on or within 50 miles of Indian country, as 
defined in section 1151 of title 18, United States Code. 
"(b) PURPOSES.—Grants provided under subsection (a) may be 
used to— 
"(1) establish clinics, to be run and staffed by the faculty 
and students of a grantee school, to provide primary care serv-
ices in areas in or within 50 miles of Indian country (as defined 
in section 1151 of title 18, United States Code); 
"(2) provide clinical training, program development, faculty 
enhancement, and student scholarships in a manner that would 
benefit such clinics; and 
"(3) carry out £uiy other activities determined appropriate 
by the Secretary. 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4535 
"(c) AMOUNT AND CONDITIONS.—The Secretary may award 
grants under this section in such amounts and subject to such 
conditions as the Secretary deems appropriate. 
"(d) DESIGN.—^The cUnics estabushed under this section shall 
be designed to provide nursing students with a structured cliniceQ 
experience that is similar in nature to that provided by residency 
training programs for physicians. 
"(e) REGULATIONS.—^The Secretary shall prescribe such regula-
tions as may be necessary to carry out the provisions of this section. 
"(f) AUTHORIZATION TO USE AMOUNTS.—Out of amounts appro-
priated to carry out this title for each of the fiscal years 1993 
through 2000 not more than $5,000,000 may be used to carry 
out tlus section.". 
SEC. 105. MAINTENANCE OF COMMUNITY HEALTH REPRESENTATIVE 
PROGRAM. 
Section 107(b) of the Act (25 U.S.C. 1616(b)) is amended— 
(1) in paragraph (2), in the material preceding subpara-
graph (A), by inserting "and maintain" after develop ; 
(2) in paragraph (2)(B), by adding at the end the following: 
"with appropriate consideration given to Hfestyle factors that 
have an impact on Indian health status, such as alcohoUsm, 
family dysfunction, and poverty,"; 
(3) in paragraphs (3) and (5), by striking out "develop" 
each place it appears and inserting in Ueu thereof "maintain"; 
and 
(4) in paragraph (4), by striking out "develop and". 
SEC. 106. CHANGES TO INDIAN HEALTH SERVICE LOAN REPAYMENT 
PROGRAM. 
(a) EuGiBiLTTY REQUIREMENTS.—Section 108 of the Act 
(25 
U.S.C. 1616a(b)) is amended— 
(1) in subsection (aXD, by striking out "physicians," and 
all that follows through "professionals and inserting in lieu 
thereof "health professionals"; and 
(2) in subsection (b)— 
(A) in paragraph (IXA)— 
(i) by amending clause (i) to read as follows: 
"(i) in a course of study or program in an accredited 
institution, as determined by the Secretary, within any 
State and be scheduled to complete such course of study 
in the same year such individual appHes to participate 
in such program; or"; and 
(ii) in clause (ii), by striking out "medicine" and 
all that foUows through "health profession" and insert-
ing in heu thereof the following: "a health profession"; 
(B) in paragraph (1)(B)— 
(i) by inserting "and" at the end of clause (i), 
by striking out clause (ii), and by redesignating clause 
(iii) as clause (ii); 
(ii) in clause (i), by striking out "medicine, osteop-
athy, dentistry, or other health profession" and insert-
ing in Ueu thereof the following: "a health profession"; 
and 
(iii) in clause (ii) (as redesignated by clause (i) 
of this subparagraph), by striking out "medicine, 
osteopathy, aentistry, or other healm profession" and 
59-194 O—93 
29:QL3(Pt. 5) 
106 STAT. 4536 
PUBLIC LAW 102-573—OCT. 29, 1992 
inserting in lieu thereof the following: "a health profes-
sion"; Eind 
(C) in paragraph (2), by inserting "sind" at the end 
of subparagraph (D), by striking out paragraphs (3) and 
(4), and by inserting after paragraph (2) the following: 
"(3) submit to the Secretary an application for a contract 
described in subsection if).". 
(b) PRIORITY.—Section 108(d) of the Act (25 U.S.C. 1616a(d)) 
is amended— 
(1) in paragraph (1), by striking out "The" and inserting 
"Consistent with paragraph (3), the"; and 
(2) by adding at the end the following new paragraph: 
"(3)(A) Subject to subparagraph (B), of the total amounts 
appropriated for each of the fiscal years 1993, 1994, and 1995 
for loan repayment contracts under this section, the Secretary 
shall provide that— 
"(i) not less than 25 percent be provided to applic£mts 
who are nurses, nurse practitioners, or nurse midwives; 
and 
"(ii) not less than 10 percent be provided to applicants 
who are mental health professionals (other than applic£ints 
described in clause (i)). 
"(B) The requirements specified in clause (i) or clause (ii) 
of subparagraph (A) shall not apply if the Secretary does not 
receive the number of applications from the individueds 
described in clause (i) or clause (ii), respectively, necessary 
to meet such requirements.". 
(c) BECOMING A PARTICIPANT.—Paragraph (1) of section 108(e) 
(25 U.S.C. 1616a(e)) is amended to read as follows: 
"(1) An individual becomes a participant in the Loan Repa3anent 
Program only upon the Secretary and the individual entering into 
a written contract described in subsection (f).". 
(d) EXTENSION OF OBLIGATED SERVICE.—Paragraph (2)(A) of 
section 108(e) (25 U.S.C. 1616a(e)) is amended by inserting before 
the semicolon the following: ", including extensions resulting in 
an aggregate period of obligated service in excess of 4 years". 
(e) CLARIFICATION REGARDING UNDERGRADUATE LOANS.—Para-
graph (1) of section 108(g) (25 U.S.C. 1616a(g)) is amended in 
the matter preceding subparagraph (A) by striking out "loans 
received by the individual for—" and inserting in lieu thereof "loans 
received by the individual regarding the undergraduate or graduate 
education of the individual (or both), which loans were made for—". 
if) PAYMENT.—Section 108(g)(2)(A) (25 U.S.C. 1616a(g)(2)(A)) 
is amended to read as follows: 
"(2)(A) For each year of obligated service that an individual 
contracts to serve under subsection (f) the Secretary may pay up 
to $35,000 (or an amount equal to the amount speeded in section 
338B(g)(2)(A) of the Public Health Service Act) on behalf of the 
individual for loans described in paragraph (1). In making a deter-
mination of the amount to pay for a year of such service by an 
individual, the Secretary shall consider the extent to which each 
such determination— 
"(i) affects the ability of the Secretary to maximize the 
number of contracts that can be provided under the Loan 
Repa3nnent Program from the amoimts appropriated for such 
contracts; 
note. 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4537 
"(ii) provides an incentive to serve in Indian health pro-
grams with the greatest shortages of health professionals; and 
"(iii) provides an incentive with respect to the health profes-
sional involved remaining in an Indian health program with 
such a health professiongd shortage, and continuing to provide 
primary health services, after the completion of the period 
of obligated service under the Loan Repayment Program.". 
(g) TAX LIABILITY.—(1) Paragraph (3) of section 108(g) (25 
U.S.C. 1616a(g)(3)) is amended to read as follows: 
"(3) For the purpose of providing reimbursements for tax liabil-
ity resulting from pa3nnients under paragraph (2) on behalf of an 
individual, the Secretary— 
"(A) in addition to such payments, may make payments 
to the individual in an amount not less th£ui 20 percent and 
not more than 39 percent of the total amount of loan repay-
ments made for the taxable year involved; and 
"(B) may make such additional payments as the Secretary 
determines to be appropriate with respect to such purpose.". 
(2) The amendment made by paragraph (1) shall apply only ^5 use I6l6a 
with respect to contracts under section 108 of the Indian Health 
Care Improvement Act entered into on or after the date of enact-
ment of this Act. 
(h) STAFFING NEEDS.—Section 108(k) (25 U.S.C. 1616a(k)) is 
amended to read as follows: 
"(k) The Secretary, in assigning individuals to serve in Indian 
health programs pursuant to contracts entered into under this 
section, sh^l— 
"(1) ensure that the staffing needs of Indian health pro-
grams administered by an Indian tribe or tribal or health 
organization receive consideration on an equal basis with pro-
grams that are administered directly by the Service; and 
"(2) give priority to assigning individuals to Indian health 
programs that have a need for health professionals to provide 
health care services as a result of individuals having breached 
contracts entered into imder this section.", 
(i) ANNUAL REPORT.—Subsection (n) of section 108 is amended 
to read as follows: 
"(n) The Secretary shall submit to the President, for inclusion 
in each report required to be submitted to the Congress luider 
section 801, a report concerning the previous fiscal year which 
sets forth— 
"(1) the health professional positions maintained by the 
Service or by tribal or Indian organizations for which recruit-
ment or retention is difficult; 
"(2) the number of Loan Repayment Program applications 
filed with respect to each type of health profession; 
"(3) the number of contracts described in subsection (f) 
that are entered into with respect to each health profession; 
"(4) the amount of loan payments made under this section, 
in total and by health profession; 
"(5) the number of scholarship grants that are provided 
under section 104 with respect to each health profession; 
"(6) the amount of scholarship grants provided under sec-
tion 104, in total and by health profession; 
"(7) the number of providers of health care that will be 
needed by Indian health programs, by location and profession, 
106 STAT. 4538 
PUBLIC LAW 102-573—OCT. 29, 1992 
during the three fiscal years beginning after the date the report 
is filed; and 
"(8) the measures the Secretary plans to take to fill the 
health professional positions maintained by the Service or by 
tribes or tribal or Indian organizations for which recruitment 
or retention is difficult.". 
SEC. 107. RECRUITMENT ACTIVITIES. 
Section 109 of the Act (25 U.S.C. 1616b) is amended— 
(1) by amending the heading to read as follows: 
"RECRUITMENT ACTIVITIES"; AND 
(2) by amending subsection (b) to read as follows: 
"(b) The Secretary, acting through the Service, shall assign 
one individual in each area office to be responsible on a fml-
time basis for recruitment activities.". 
SEC. 108. ADVANCED TRAINING AND RESEARCH. 
Section 111 of the Act (25 U.S.C. 1616d) is amended— 
(1) in subsection (b), by amending the last sentence to 
read as follows: "In such event, with respect to individuals 
entering the program after the date of the enactment of the 
Indian Health Amendments of 1992, the United States shall 
be entitled to recover from such individual an amount to be 
determined in accordance with the formula specified in sub-
section (1) of section 108 in the manner provided for in such 
subsection."; and 
(2) by striking out subsection (d). 
SEC. 109. INMED PROGRAM. 
Section 114(b) of the Act (25 U.S.C. 1616g(b)) is amended— 
(1) by inserting after "North Dakota," the following: "to 
be known as the 'Quentin N. Burdick Indian Health Pro-
grams',"; and 
(2) by adding at the end the following: "Such program 
shall, to the msiximum extent feasible, coordinate with the 
Quentin N. Burdick American Indians Into Psychology Program 
established under section 217(b) and the Quentin N. Burdick 
American Indians Into Nursing Program established under sec-
tion 112(e).". 
SEC. 
1
1
0
. 
SCHOLARSHIP 
AND 
LOAN 
REPAYMENT 
RECOVERY 
FUND. 
Title I of the Act is amended by inserting after section 108 
the following new section: 
"SCHOLARSHIP 
AND 
LOAN 
REPAYMENT 
RECOVERY 
FUND 
25 use I616a-1. 
"SEC. 108A. (a) There is established in the Treasury of the 
United States a fund to be known as the Indian Health Scholarship 
and Loan Repayment Recovery Fund (hereafter in this section 
referred to as the 'Fund'). The Fund shall consist of such amounts 
as may be appropriated to the Fund under subsection (b). Amounts 
appropriated for the Fund shall remain available until expended. 
"(b) For each fiscal year, there is authorized to be appropriated 
to the Fund an amount equal to the sum of— 
"(1) the amoiuit collected during the preceding fiscal year 
by the Federal Government pursuant to— 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4539 
"(A) the liability of individuals under subparagraph 
' (A) or (B) of section 104(b)(5) for the breach of contracts 
entered into under section 104; and 
"(B) the liability of individuals under section 108(1) 
for the breach of contracts entered into under section 108; 
and 
"(2) the aggregate amount of interest accruing during the 
preceding fiscal year on obligations held in the Fund pursuant 
to subsection (d) and the amount of proceeds from the sale 
or redemption of such obligations during such fiscal year. 
"(c)(1) Amounts in the Fund and available pursuant to appro-
priation Acts may be expended by the Secretary, acting through 
the Service, to make payments to an Indian tribe or tribal organiza-
tion administering a health care program pursuant to a contract 
entered into under the Indian Self-Determination Act— 
"(A) to which a scholarship recipient under section 104 
or a loan repayment program participant under section 108 
has been assigned to meet the obligated service requirements 
pursuant to sections; and 
"(B) that has a need for a health professional to provide 
health care services as a result of such recipient or participant 
having breached the contract entered into under section 104 
or section 108. 
"(2) An Indian tribe or tribal organization receiving pajnments 
pursuant to paragraph (1) may expend the payments to recruit 
and employ, directly or by contract, health professionals to provide 
health care services. 
"(d)(1) The Secretary of the Treasury shall invest such amounts Investments, 
of the Fund as such Secretary determines are not required to 
meet current withdrawals from the Fund. Such investments may 
be made only in interest-bearing obligations of the United States. 
For such purpose, such obligations may be acquired on original 
issue at the issue price, or by purchase of outstanding obligations 
at the market price. 
"(2) Any obligation acquired by the Fund may be sold by the 
Secretary of the Treasury at the market price.". 
SEC. 111. COMMUNITY HEALTH AIDE PROGRAM. 
Title I of the Act (as amended by section 104 of this Act) 
is amended by adding at the end the following new section: 
"COMMUNITY HEALTH AIDE PROGRAM FOR ALASKA 
"SEC. 119. (a) Under the authority of the Act of November 25USC1616/. 
2, 1921 (25 U.S.C. 13; popularly known as the Snyder Act), the 
Secretary shall maintain a Community Health Aide Program in 
Alaska under which the Service— 
"(1) provides for the training of Alaska Natives as health 
aides or community health practitioners; 
"(2) uses such aides or practitioners in the provision of 
health care, health promotion, and disease prevention services 
to Alaska Natives living in villages in rural Alaska; and 
"(3) provides for the establishment of teleconferencing 
capacity in health clinics located in or near such villages for 
use by community health aides or community health practition-
ers. 
"(b) The Secretary, acting through the Community Health Aide 
Program of the Service, shall— 
106 STAT. 4540 
PUBLIC LAW 102-573—OCT. 29, 1992 
"(1) using trainers accredited by the Program, provide a 
high standard of training to community health aides and com-
munity health practitioners to ensure that such aides and 
practitioners provide quality health care, health promotion, 
and disease prevention services to the villages served by the 
Program; 
"(2) in order to provide such training, develop a curriculiun 
t h a t ^ 
"(A) combines education in the theory of health care 
with supervised practical experience in the provision of 
health care; 
"(B) provides instruction and practical experience in 
the provision of acute care, emergency care, health pro-
motion, disease prevention, and the efficient and effective 
management of clinic pharmacies, supplies, equipment, and 
facilities; and 
"(C) promotes the achievement of the health status 
objectives specified in section 3(b); 
Establishment. 
"(3) establish and maintain a Community Health Aide Cer-
tification Board to certify as community health aides or commu-
nity health practitioners individuals who have successfully com-
pleted the training described in paragraph (1) or can dem-
onstrate equivalent experience; 
"(4) develop Euid maintain a system which identifies the 
needs of community health aides and community health 
practitioners for continuing education in the provision of health 
care, including the areas described in paragraph (2)(B), and 
develop programs that meet the needs for such continuing 
education; 
"(5) develop and maintain a system that provides close 
supervision of community health aides and community health 
practitioners; and 
"(6) develop a system under which the work of community 
health aides and community health practitioners is reviewed 
and evaluated to assure the provision of quality health care, 
health promotion, and disease prevention services.". 
SEC. 112. MATCHING GRANTS TO TRIBES. 
Title I of the Act (as amended by section 111 of this Act) 
is amended by adding at the end the following new section: 
"MATCHING GRANTS TO TRIBES FOR SCHOLARSHIP PROGRAMS 
25USC1616m. 
«SEC. 120. (a)(1) The Secretary shall make grants to Indian 
tribes and tribal organizations for the purpose of assisting such 
tribes and tribal organizations in educating Indians to serve as 
health professionals in Indian communities. 
"(2) Amounts available for grants under paragraph (1) for any 
fiscal year shall not exceed 5 percent of amounts available for 
such fiscal year for Indian Health Scholarships under section 104. 
"(3) An application for a grant under paragraph (1) shall be 
in such form and contain such agreements, assurances, and informa-
tion as the Secretary determines are necessary to carry out this 
section. 
"(b)(1) An Indian tribe or tribal organization receiving a grant 
under subsection (a) shall agree to provide scholarships to Indians 
pursuing education in the health professions in accordance with 
the requirements of this section. 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4541 
"(2) With respect to the costs of providing any scholarship 
pursuant to paragraph (1)— 
"(A) 80 percent of the costs of the scholarship shall be 
paid from the grant made under subsection (a) to the Indian 
tribe or tribal organization; and 
"(B) 20 percent of such costs shall be paid from non-Federal 
contributions by the Indian tribe or tribal organization through 
which the scholarship is provided. 
"(3) In determining the amount of non-Federal contributions 
that have been provided for purposes of subparagraph (B) of para-
graph (2), any amoiints provided by the Federal (Government to 
the Indian tribe or tribal organization involved or to any other 
entity shall not be included. 
"(4) Non-Federal contributions required by subparagraph (B) 
of paragraph (2) may be provided directly by the Indian tribe 
or tribal organization involved or through donations from pubUc 
and private entities. 
"(c) An Indian tribe or tribal org£inization shall provide scholar-
ships under subsection (b) only to Indians enrolled or accepted 
for enrollment in a course of study (approved by the Secretary) 
in one of the health professions described in section 104(a). 
"(d) In providing scholarships imder subsection (b), the Sec- Contracts, 
retary and the Indian tribe or tribal organization shall enter into 
a written contract with each recipient of such scholarship. Such 
contract shall— 
"(1) obligate such recipient to provide service in an Indian 
health program (as defined in section 108(a)(2)(A)), in the same 
service area where the Indian tribe or tribal organization pro-
viding the scholarship is located, for— 
"(A) a number of years equal to the number of years 
for which the scholarship is provided (or the part-time 
equivalent thereof, as determined by the Secretary), or 
for a period of 2 years, whichever period is greater; or 
"(B) such greater period of time as the recipient and 
the Indian tribe or tribal organization may agree; 
"(2) provide that the amount of such scholarship— 
"(A) may be expended only for— 
"(i) tuition expenses, other reasonable educational 
expenses, and reasonable living expenses incurred in 
attendance at the educational institution; and 
"(ii) payment to the recipient of a monthly stipend 
of not more than the amount authorized by section 
338A(g)(l)(B) of the Public Health Service Act (42 
U.S.C. 254m(g)(l)(B)), such amount to be reduced pro 
rata (as determined by the Secretary) based on the 
number of hours such student is enrolled; and 
"(B) may not exceed, for any year of attendance for 
which the scholarship is provided, the total amount 
required for the year for the purposes authorized in sub-
paragraph (A); 
"(3) require the recipient of such scholarship to maintain 
an acceptable level of academic standing (as determined by 
the educational institution in accordance with regulations 
issued by the Secretary); and 
"(4) require the recipient of such scholarship to meet the 
educational and licensure requirements necessary to be a physi-
106 STAT. 4542 
PUBLIC LAW 102-573—OCT. 29, 1992 
cian, certified nurse practitioner, certified nurse midwife, or 
physician assistant. 
"(e)(1) An individual who has entered into a written contract 
with the Secretary and an Indian tribe or tribal organization under 
subsection (d) and who— 
"(A) fails to maintain an acceptable level of academic stand-
ing in the educational institution in which he is enrolled (such 
level determined by the educational institution under regula-
tions of the Secretary), 
"(B) is dismissed from such educational institution for dis-
ciplinary reasons, 
"(C) voluntarily terminates the training in such an edu-
cational institution for which he is provided a scholarship under 
such contract before the completion of such training, or 
"(D) fails to accept payment, or instructs the educational 
institution in which he is enrolled not to accept payment, 
in whole or in part, of a scholarship under such contract, 
in lieu of any service obligation arising under such contract, shall 
be liable to the United States for the Federal share of the amount 
which has been paid to him, or on his behalf, under the contract. 
"(2) If for any reason not specified in paragraph (1), an individ-
ual breaches his written contract by failing either to begin such 
individual's service obligation required under such contract or to 
complete such service obligation, the United States shall be entitled 
to recover from the individual an amount determined in accordance 
with the formula specified in subsection (1) of section 108 in the 
manner provided for in such subsection. 
"(3) The Secretary may carry out this subsection on the basis 
of information submitted by the tribes or tribal organizations 
involved, or on the basis of information collected through such 
other means as the Secretary determines to be appropriate. 
"(f) The recipient of a scholarship under subsection (b) shall 
agree, in providing health care pursuant to the requirements of 
subsection (d)(1)— 
"(1) not to discriminate against an individual seeking such 
care on the basis of the ability of the individual to pay for 
such care or on the basis that payment for such care will 
be made pursuant to the program established in title XVIII 
of the Social Security Act or pursuant to the program estab-
lished in title XIX of such Act; and 
"(2) to accept assignment under section 1842(b)(3)(B)(ii) 
of the Social Security Act for all services for which payment 
may be made under part B of title XVTII of such Act, and 
to enter into an appropriate agreement with the State agency 
that administers the State plan for medical assistance under 
title XIX of such Act to provide service to individuals entitled 
to medical assistance under the plan. 
"(g) The Secretary may not make any pa3anents under sub-
section (a) to £m Indian tribe or tribal organization for any fiscal 
year subsequent to the first fiscal year of such pajonents unless 
the Secretary determines that, for the immediately preceding fiscal 
year, the Indian tribe or tribal organization has complied with 
requirements of this section.". 
SEC. 113. TRIBAL HEALTH PROGRAM ADMINISTRATION. 
Title I of the Act (as amended by section 112 of this/Act) 
is amended by adding at ttie end the following new section: 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4543 
"TRIBAL HEALTH PROGRAM ADMINISTRATION 
"SEC. 121. The Secretary shall, by contract or otherwise, provide 
^^^S??*^c c 
training for individuals in the administration and planning of tribal 
^^ ^°'^ I6l6n. 
health programs.". 
SEC. 114. TRIBALLY CONTROLLED VOCATIONAL INSTITUTIONS. 
(a) NURSING PROGRAM GRANTS.—Section 112(a)(2) of the Act 
(25 U.S.C. 1616e(a)(2)) is amended by inserting before the comma 
the following: "and tribally controlled postsecondary vocational 
institutions (as defined in section 390(2) of the Tribally Controlled 
Vocational Institutions Support Act of 1990 (20 U.S.C. 2397^2))". 
(b) 
TRIBAL 
CULTURE 
AND 
HISTORY 
PROGRAMS.—Section 
113(b)(1) of the Act (25 U.S.C. 1616f(b)(l) is amended by inserting 
before the comma "and tribally controlled postsecondary vocational 
institutions (as defined in section 390(2) of the Tribally Controlled 
Vocational Institutions Support Act of 1990 (20 U.S.C. 2397^2))". 
SEC. 116. CONTINUING EDUCATION ALLOWANCES. 
Section 106(b) of the Act (25 U.S.C. 1615(b)) is amended to 
read as follows: 
"(b) Of amounts appropriated under the authority of this title 
for each fiscal year to be used to carry out this section, not more 
than $1,000,000 may be used to establish postdoctoral training 
programs for health professionals.". 
SEC. 116. UNIVERSITY OF SOUTH DAKOTA MODEL HEALTH PROGRAM. 
Title I of the Act (as amended by section 113 of this Act) 
is amended by adding at the end the following new section: 
"UNIVERSITY OF SOUTH DAKOTA PILOT PROGRAM 
"SEC. 122. (a) The Secretary may make a grant to the School 
25 use i6l6o. 
of Medicine of the University of South Dakota (hereafter in this 
section referred to as TrSDoM') to establish a pilot program on 
an Indian reservation at one or more service units in South Dakota 
to address the chronic manpower shortage in the Aberdeen Area 
of the Service. 
"(b) The purposes of the program established pursuant to a 
grant provided under subsection (a) are— 
"(1) to provide direct clinical and practical experience at 
a service unit to medical students and residents from USDSM 
and other medical schools; 
"(2) to improve the quaUty of health care for Indians by 
assuring access to qualified health care professionals; and 
"(3) to provide academic and scholarly opportunities for 
physicians, physician assistants, nurse practitioners, nurses, 
and other allied health professionals serving Indian people 
by identifying and utilizing all academic and scholarly resources 
of the region. 
"(c) The pilot program established pursuant to a grant provided 
under subsection (a) shall— 
"(1) incorporate a program advisory board composed of 
representatives from the tribes and communities in the area 
which will be served by the program; and 
"(2) shall be designated as an extension of the USDSM 
campus and program participants shall be under the direct 
supervision and instruction of quaUfied medical staff serving 
at the service unit who shall be members of the USDSM faculty. 
106 STAT. 4544 
PUBLIC LAW 102-573—OCT. 29, 1992 
25 u s e 1616p. 
25 use 
25 use 
25 use 
25 use 
25 use 
25 use 
25 use 
25 use 
1612. 
1614. 
1616a. 
1616c. 
1616f. 
1616g. 
1616h. 
16161. 
"(d) The USDSM shall coordinate the program established pur-
suant to a grant provided under subsection (a) with other medical 
schools in the region, nursing schools, tribsd community colleges, 
and other health professional schools. 
"(e) The USDSM, in cooperation with the Service, shall develop 
additional professional opportunities for program participants on 
Indian reservations in order to improve the recruitment and reten-
tion of qualified health professionals in the Aberdeen Area of the 
Service. . 
SEC. 117. AUTHORIZATION OF APPROPRIATIONS. 
(a) AUTHORIZATION.—^Title I of the Act (as amended by section 
116 of this Act) is amended by adding at the end the following 
new section: 
"AUTHORIZATION OF APPROPRIATIONS 
"SEC. 123. There are authorized to be appropriated such sums 
as may be necessary for each fiscal year through fiscal year 2000 
to carry out this title.". 
(b) CONFORMING AMENDMENTS.—^Title I of the Act is amended— 
(1) in section 102, by striking out subsection (c); 
(2) in section 105, by striking out subsection (d); 
(3) in section 108, by striking out subsection (o); 
(4) in section 110, by striking out subsection (c); 
(5) in section 113, by striking out subsection (c); 
(6) in section 114, by striking out subsection (e); 
(7) in section 115, by striking out subsection (f); and 
(8) in section 116, by striking out subsection (e). 
TITLE II—HEALTH SERVICES 
SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND. 
(a) IN GENERAL.—Section 201 of the Act (25 U.S.C. 1621) is 
amended— 
(1) in subsection (a)— 
(A) in the material preceding paragraph (1), by striking 
out "subsection (h)" and inserting in lieu thereof "this sec-
tion"; 
(B) by amending paragraph (1) to read as follows: 
"(1) eliminating the deficiencies in health status and 
resources of all Indian tribes,"; and 
(C) in paragraph (4), in the material preceding sub-
paragraph (A)— 
(i) by inserting Eifter "responsibilities" the fol-
lowing: ", either through direct or contract care or 
through contracts entered into pursuant to the Indian 
Self-Determination Act,"; and 
(ii) by striking out "resources deficiency and 
' 
inserting in lieu thereof the following: "status £uid 
•
^ 
resource deficiencies"; 
(2) in subsection (b)— 
(A) in paragraph (1), by striking out "subsection (h)" 
and inserting in lieu thereof "this section"; 
(B) by striking out paragraph (2) and redesignating 
paragraph (3) as paragraph (2); and 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4545 
(C) in paragraph (2)(A) (as redesignated by subpara-
graph (B)>— 
(i) by striking out "subsection (h)" and inserting 
in lieu thereof "this section"; 
(ii) in the first sentence, by striking out "but such 
allocation" through "met"; 
(iii) in the second sentence— 
(I) by striking out "(in accordance with para-
graph (2))"; and 
(II) by striking out "raise the deficiency level" 
and inserting in lieu thereof the following: "reduce 
the health status and resource deficiency'; and 
(D) in paragraph (2)(B) (as redesignated by subpara-
graph (B)), by inserting after "consultation with" the fol-
lowing: ", and with the active participation of,"; 
(3) in subsection (c)— 
(A) by striking out paragraph (1) and redesignating 
paragraphs (2), (3), and (4) as paragraphs (1), (2), and 
(3), respectively; 
(B) by amending paragraph (1) (as redesignated by 
subparagraph (A) above) to read as follows: 
"(1) The term 'health status and resource deficiency means 
the extent to which— 
"(A) the health status objectives set forth in section 
3(b) are not being achieved; and 
"(B) the Indian tribe does not have available to it 
the health resources it needs, taking into account the actual 
cost of providing health care services given local geographic, 
climatic, rural, or other circumstances."; £ind 
(C) in paragraph (3) (as redesignated by subparagraph 
(A) above)— 
(i) by striking out "Under regulations, the" £uid 
inserting in lieu thereof "The"; and 
(ii) by striking out "health resources deficiency 
level" and inserting in lieu thereof "extent of the health 
status and resource deficiency"; 
(4) in subsection (d)(1), by striking out "subsection (h)" 
and inserting in lieu thereof "this section"; 
(5) in subsection (e)— 
(A) in the material preceding paragraph (1)— 
(i) by striking out "60 days" and inserting in lieu 
thereof "3 years"; 
(ii) by striking out "Indian Health Care Amend-
ments of 1988" and inserting in heu thereof "Indian 
Health Amendments of 1992"; and 
(iii) by striking out "health services priority sys-
tem" and inserting in lieu thereof "health status and 
resource deficiency'; 
(B) in paragraph (1), by striking out "health resources 
deficiencies" and inserting in lieu thereof "health status 
and resource deficiencies"; 
(C) in paragraph (2), by striking out "the level of health 
resources deficiency for" and inserting in lieu thereof the 
following: "the extent of the health status and resource 
deficiency of; 
(D) in paragraph (3), by striking "raise all" and all 
that follows through the semicolon and insert in lieu thereof 
106 STAT. 4546 
PUBLIC LAW 102-573—OCT. 29, 1992 
the following: "eliminate the health status and resource 
deficiencies of all Indian tribes served by the Service; and"; 
. 
and 
(E) by striking out paragraphs (4) and (5) and 
redesignating paragraph (6) as paragraph (4); and 
(6) in subsection (f), by striking out (0(1)" and all that 
follows through the paragraph designation for paragraph (2) 
and inserting in lieu thereof "(f)". 
25 use 1621 
(b) EFFECTIVE DATE.—^Except with respect to the amendments 
note. 
made by subsection (a)(5), the amendments made by subsection 
(a) shall take effect three years after the date of the enactment 
of this Act. The amendments made by subsection (a)(5) shall take 
effect upon the date of the enactment of this Act. 
(c) TECHNICAL AMENDMENT.^The heading for section 201 of 
the Act (25 U.S.C. 1621) is amended to read as follows: 
"INDIAN HEALTH CARE IMPROVEMENT FUND". 
SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND. 
(a) IN GENERAL.—Section 202 of the Act (25 U.S.C. 1621a) 
is amended— 
(1) in subsection (a)(1)(B), by striking out "under subsection 
(e)" and inserting in lieu thereof "to the Fund under this 
section"; 
(2) in subsection (b)(2), by striking out "shall estabUsh 
at not less than $10,000 or not more than $20,000;" and insert-
ing in Heu thereof the following: "shall establish at— 
"(A) for 1993, not less than $15,000 or not more than 
$25,000; and 
"(B) for any subsequent year, not less than the thresh-
old cost of the previous year increased by the percentage 
increase in the medical care expenditure category of the 
consumer price index for all urban consumers (United 
States city average) for the 12-month period ending with 
December of the previous year;"; and 
(3) in subsection (c), by striking out "Funds appropriated 
under subsection (e)" and inserting in lieu thereof "Amounts 
appropriated to the Fund under this section". 
25 use 1621a 
(b) EFFECTIVE DATE.—^The amendment made by subsection 
note. 
(a)(2) shall take effect January 1, 1993. 
SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION. 
Section 203 of the Act (25 U.S.C. 1621b) is amended— 
(1) in subsection (a), by inserting before the period at 
the end the following: "so as to achieve the health status 
objectives set forth in section 3(b)"; 
(2) in subsection (b), in the material preceding paragraph 
(1), by striking out "section 201(f)" and inserting in lieu thereof 
"section 801"; and 
(3) by striking out subsection (c). 
SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL. 
Section 204 of the Act (25 U.S.C. 162 Ic) is amended— 
(1) by amending subsection (c) to read as follows: 
"(c)(1) The Secretary shall continue to maintain through fiscal 
year 2000 each model diabetes project in existence on the date 
of the enactment of the Indian Health Amendments of 1992 and 
located— 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4547 
"(A) at the Claremore Indian Hospital in Oklahoma; 
"(B) at the Fort Totten Health Center in North Dakota; 
"(C) at the Sacaton Indian Hospital in Arizona; 
"(D) at the Winnebago Indian Hospital in Nebraska; 
"(E) at the Albuquerque Indian Hospital in New Mexico; 
"(F) at the Perry, Princeton, and Old Town Health Centers 
in Maine; 
"(G) at the Bellingham Health Center in Washington; 
"(H) at the Fort Berthold Reservation; 
"(I) at the Navajo Reservation; 
"(J) at the Papago Reservation; 
"(K) at the Zuni Reservation; or 
"(L) in the States of Alaska, California, Minnesota, Mon-
tana, Oregon, or Utah. 
"(2) The Secretary may establish new model diabetes projects 
under this section tsdcing into consideration applications received 
under this section from all service areas, except that the Secretary 
may not establish a greater number of such projects in one service 
area than in any other service area until there is an equal number 
of such projects established with respect to all service areas from 
which the Secretary receives qualified applications during the 
application period (as determined by the Secretary)."; and 
(2) in subsection (d)— 
(A) in paragraph (2), by striking out "and" after the 
semicolon; 
(B) in paragraph (3), by striking out the period and 
inserting in lieu thereof the following: "; and"; and 
(C) by adding at the end the following new paragraph: 
"(4) evaluate the effectiveness of services provided through 
model diabetes projects established under this section.". 
SEC. 
205. 
MENTAL 
HEALTH 
PREVENTION 
AND 
TREATMENT 
SERVICES. 
Section 209 of the Act (25 U.S.C. 1621h) is amended— 
(1) in subsection (j) (as redesignated by section 902(3)(B) Reports, 
of this Act), by striking out "submit to the Congress an annual 
report" and inserting in lieu thereof the following: "submit 
to the President, for inclusion in each report required to be 
transmitted to the Congress under section 801, a report"; and 
(2) by adding at the end the following new subsections: 
"(1) LICENSING REQUIREMENT FOR MENTAL HEALTH CARE WORK-
ERS.—^Any person employed as a psychologist, social worker, or 
marriage and family therapist for the purpose of providing mental 
health care services to Indians in a clinical setting under the 
authority of this Act or through a contract pursuant to the Indian 
Self-Determination Act shall— 
"(1) in the case of a person employed as a psychologist, 
be licensed as a clinical psychologist or working under the 
direct supervision of a licensed clinical psychologist; 
"(2) in the case of a person employed as a social worker, 
be licensed as a social worker or working under the direct 
supervision of a licensed social worker; or 
"(3) in the case of a person employed as a marriage and 
family therapist, be licensed as a marriage and family therapist 
or working under the direct supervision of a licensed marriage 
and family therapist. 
"(m) INTERMEDIATE ADOLESCENT MENTAL HEALTH SERVICES.— 
(1) The Secretary, acting through the Service, may make grants 
106 STAT. 4548 
PUBLIC LAW 102-573—OCT. 29, 1992 
to Indian tribes and tribal organizations to provide intermediate 
mental health services to Indian children and 
adolescents, 
including— 
"(A) inpatient and outpatient services; 
"(B) emergency care; 
"(C) suicide prevention and crisis intervention; and 
"(D) prevention and treatment of mental illness, and dys-
functional and self-destructive behavior, including child abuse 
and family violence. 
"(2) Funds provided under this subsection may be used— 
"(A) to construct or renovate an existing health facility 
to provide intermediate mental health services; 
"(B) to hire mental health professionals; 
"(C) to staff, operate, and maintain an intermediate mental 
health facility, group home, or youth shelter where intermediate 
mental health services are being provided; and 
"(D) to make renovations and hire appropriate staff to 
convert existing hospital beds into adolescent psychiatric units. 
"(3) Funds provided under this subsection may not be used 
for the purposes described in section 216(b)(1). 
"(4) An Indian tribe or tribal organization receiving a grant 
under this subsection shall ensure that intermediate adolescent 
mental health services are coordinated with other tribal. Service, 
and Bureau of Indian Affairs mental health, alcohol and substance 
abuse, and social services programs on the reservation of such 
tribe or tribal organization. 
"(5) The Secretary shall establish criteria for the review and 
approval of applications for grants made pursuant to this sub-
section. 
"(6) There are authorized to be appropriated to carry out this 
section $10,000,000 for fiscal year 1993 and such sums as may 
be necessary for each of the fiscal years 1994, 19P5, 1996, 1997, 
1998,1999, and 2000.". 
SEC. 206. NEW STUDIES AND DEMONSTRATION PROGRAM. 
(a) HOSPICE CARE.—Title II of the Act is amended by inserting 
after section 204 the following: 
"HOSPICE CARE FEASIBILITY STUDY 
25 use I62ld. 
"SEC. 205. (a) The Secretary, acting through the Service and 
in consultation with representatives of Indian tribes, tribal 
organizations, Indian Health Service personnel, and hospice provid-
ers, shall conduct a study— 
"(1) to assess the feasibility and desirability of furnishing 
hospice care to terminally ill Indians; and 
"(2) to determine the most efficient and effective means 
' 
of furnishing such care. 
"(b) Such study shall— 
"(1) assess the impact of Indian culture and beliefs concern-
ing death and dying on the provision of hospice care to Indians; 
"(2) estimate the number of Indians for whom hospice 
care may be appropriate and determine the geographic dis-
tribution of such individuals; 
"(3) determine the most appropriate means to facilitate 
the participation of Indian tribes and tribal organizations in 
providing hospice care; 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4549 
"(4) identify and evaluate various means for providing hos-
pice care, including— 
"(A) the provision of such care by the personnel of 
a Service hospital pursuant to a hospice program estab-
lished by the Secretary at such hospital; and 
"(B) the provision of such care by a community-based 
hospice program under contract to the Service; and 
"(5) identify and assess any difficulties in furnishing such 
care and the actions needed to resolve such difficulties. 
"(c) Not later than the date which is 12 months after the Reports, 
date of the enactment of this section, the Secretary shall transmit 
to the Congress a report containing-
"(1) a detailed description of the study conducted pursuant 
to this section; and 
"(2) a discussion of the findings and conclusions of such 
study. 
"(d) For the purposes of this section— 
"(1) the term 'terminally ill' means any Indian who has 
a medical prognosis (as certified by a physician) of a life expect-
ancy of six months or less; and 
"(2) the term 'hospice program' means any program which 
satisfies the requirements of section 1861(dd)(2) of the Socied 
Security Act (42 U.S.C. 1395x(dd)(2)); and 
"(3) the term 'hospice care' means the items and services 
specified 
in 
subparagraphs 
(A) through 
(H) of 
section 
1861(dd)(l) of the Social Security Act (42 U.S.C. 1395x(dd)(l)).". 
(b) MANAGED CARE.—Title II of the Act is amended by adding 
at the end the following new section: 
"MANAGED CARE FEASIBILITY STUDY 
"SEC. 210. (a) The Secretary, acting through the Service, shall 25 USC 16211. 
conduct a study to assess the feasibility of allowing an Indian 
tribe to purchase, directly or through the Service, managed care 
coverage for all members of the tribe from— 
"(1) a tribally owned and operated managed care plan; 
or 
"(2) a State licensed managed care plan. 
"(b) Not later than the date which is 12 months after the Reports, 
date of the enactment of this section, the Secretary shall transmit 
to the Congress a report containing— 
"(1) a detailed description of the study conducted pursuant 
to this section; and 
"(2) a discussion of the findings and conclusions of such 
study.". 
(c) CONTRACT CARE.—^Title II of the Act (as amended by sub-
section (b) of this Act) is amended by adding at the end the following 
new section: 
"CALIFORNIA CONTRACT HEALTH SERVICES DEMONSTRATION PROGRAM 
"SEC. 211. (a) The Secretary shall estabhsh a demonstration 
25USCl62lj. 
program to evaluate the use of a contract care intermediary to 
improve the accessibility of health services to Cahfomia Indians. 
"(b)(1) In establishing such program, the Secretary shall enter 
into an agreement with the California Rural Indian Health Board 
to reimburse the Board for costs (including reasonable administra-
tive costs) incurred, during the period of the demonstration pro-
106 STAT. 4550 
PUBLIC LAW 102-573—OCT. 29, 1992 
Establishment. 
Effective date. 
Termination 
date. 
Reports. 
gram, in providing medical treatment under contract to California 
Indians described in section 809(b) throughout the California con-
tract health services delivery area described in section 810 with 
respect to high-cost contract care cases. 
"(2) Not more than 5 percent of the amounts provided to the 
Board under this section for any fiscal year may be for reimburse-
ment for administrative expenses incurred by the Board during 
such fiscal year. 
"(3) No payment may be made for treatment provided under 
the demonstration program to the extent payment may be made 
for such treatment under the Catastrophic Health Emergency Fund 
described in section 202 or from amounts appropriated or otherwise 
made available to the California contract health service delivery 
area for a fiscal year. 
"(c) There is hereby established an advisory board which shall 
advise the California Rural Indian Health Board in carrying out 
the demonstration pursuant to this section. The advisory board 
shall be composed of representatives, selected by the California 
Rural IndiEin Health Board, from not less than 8 tribal health 
programs serving California Indians covered under such dem-
onstration, at least one half of whom are not affiliated with the 
California Rural Indian Health Board. 
"(d) The demonstration program described in this section shall 
begin on January 1, 1993, and shall terminate on September 30, 
1997. 
"(e) Not later than July 1, 1998, the California Rural Indian 
Health Board shall submit to the Secretary a report on the dem-
onstration program carried out under this section, including a state-
ment of its findings regarding the impact of using a contract care 
intermediary on— 
"(1) access to needed health services; 
"(2) waiting periods for receiving such services; and 
"(3) the efficient management of high-cost contract care 
cases. 
"(f) For the purposes of this section, the term 'high-cost contract 
care cases' means those cases in which the cost of the medical 
treatment provided to an individual— 
"(1) would otherwise be eligible for reimbursement from 
the Catastrophic Health Emergency Fund established under 
section 202, except that the cost of such treatment does not 
meet the threshold cost requirement established pursuant to 
section 202(b)(2); and 
"(2) exceeds $1,000. 
"(g) There are authorized to be appropriated for each of the 
fiscal years 1993, 1994, 1995, 1996, and 1997 such sums as may 
be necessary to carry out the purposes of this section.". 
SEC. 207. COVERAGE OF SCREENING MAMMOGRAPHY. 
(a) IN GENERAL.—^Title II of the Act (as amended by section 
206(c) of this Act) is amended by adding at the end the following 
new section: 
"COVERAGE OP SCREENING MAMMOGRAPHY 
25 use 1621k. 
" S E C 212. The Secretary, through the Service, shall provide 
for screening mammography (as defined in section 1861(ij) of the 
Social Security Act) for Indian and urban Indian women 35 years 
of age or older at a frequency, determined by the Secretary (in 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4551 
consultation with the Director of the National Cancer Institute), 
appropriate to such women, and under such terms and conditions 
as are consistent with standards established by the Secretary to 
assure the safety and accuracy of screening mammography under 
part B of title XVIII of the Social Security Act.". 
(b) CONFORMING AMENDMENT.—Section 201(a)(4)(B) of the Act 
(25 U.S.C. 1621(a)(4)(B)) is amended by striking the semicolon 
at the end and inserting the following: ", including screening mam-
mography in accordance with section 212;". 
SEC. 208. PATIENT TRAVEL COSTS. 
Title II of the Act (as amended by section 207 of this Act) 
is amended by adding at the end the following new section: 
"PATIENT TRAVEL COSTS 
"SEC. 213. (a) The Secretary, acting through the Service, shall 25 use 1621/. 
provide funds for the following patient travel costs associated with 
receiving health care services provided (either through direct or 
contract care or through contracts entered into pursu£uit to the 
Indian Self-Determination Act) under this Act— 
"(1) emergency air transportation; and 
"(2) nonemergency air transportation 
where 
ground 
transportation is infeasible. 
"(b) There are authorized to be appropriated to carry out this 
section $15,000,000 for fiscal year 1993 and such sums as may 
be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 
1998,1999, and 2000.". 
SEC. 209. THIRD PARTY REIMBURSEMENT. 
(a) RECOVERY BY INDIAN TRIBE.—Section 206 of the Act (25 
U.S.C. 1621e) is amended— 
(1) by inserting ", an Indian tribe, or a tribal organization" 
after "United States" each place it appears; 
(2) in subsection (a), by inserting ", an Indian tribe, or 
a tribal organization" after "Service"; 
(3) in subsection (a) and subsection (e)(1)(A), by inserting 
", an Indian tribe, or a tribal organization" aft«r "Secretary" 
each place it appears; and 
(4) in subsection (b), by striking ", or any political sub-
division of a State,". 
(b) SPECIAL RULE WITH RESPECT TO SELF-INSURANCE PLAN.— 
Section 206 of the Act (25 U.S.C. 1621e) is amended— 
(1) by striking "(a) The" and inserting the following: "(a) 
Except as provided in subsection (f), the"; and 
(2) by adding at the end the following new subsection: 
"(f) The United States shall not have a right of recovery under 
this section if the injury, illness, or disability for which health 
services were provided is covered under a self-insurance plan funded 
by an Indian tribe or tribal organization.". 
SEC. 210. EPIDEMIOLOGY CENTERS. 
Title II of the Act (as amended by section 208 of this Act) 
is amended by adding at the end the following new section: 
106 STAT. 4552 
PUBLIC LAW 102-573—OCT. 29, 1992 
"EPIDEMIOLOGY CENTERS 
l^teW^hment. 
«SEC. 214. (a)(1) The Secretary shall establish an epidemiology 
1621m. 
center in each Service area to carry out the functions described 
in paragraph (3). 
"(2) To assist such centers in canying out such functions, 
the Secretary shall perform the following: 
"(A) In consultation with the Centers for Disease Control 
and Indian tribes, develop sets of data (which to the extent 
practicable, shall be consistent with the uniform data sets 
used by the States with respect to the year 2000 health objec-
tives) for uniformly defining health status for purposes of the 
objectives specified in section 3(b). Such sets shall consist of 
one or more categories of information. The Secretary shall 
develop formats for the uniform collecting and reporting of 
information on such categories. 
"(B) Establish and maintain a system for monitoring the 
progress made toward meeting each of the health status objec-
tives described in section 3(b). 
"(3) In consultation with Indian tribes and urban Indian com-
munities, each area epidemiology center established under this 
subsection shall, with respect to such area— 
"(A) collect data relating to, and monitor progress made 
toward meeting, each of the health status objectives described 
in section 3(b) using the data sets and monitoring system 
developed by the Secretary pursuant to paragraph (2); 
"(B) evaluate existing delivery systems, data systems, and 
other systems that impact the improvement of Indian health; 
"(C) assist tribes and urban Indian communities in identify-
ing their highest priority health status objectives £ind the serv-
ices needed to achieve such objectives, based on epidemiological 
data; 
"(D) make recommendations for the targeting of services 
needed by tribal, urban, and other Indian communities; 
"(E) make recommendations to improve health care delivery 
systems for Indians and urban Indians; 
"(F) work cooperatively with tribal providers of health and 
social services in order to avoid duplication of existing services; 
and 
"(G) provide technical assistance to Indian tribes and urban 
Indian organizations in the development of local health service 
priorities and incidence and prevalence rates of disease and 
other illness in the community. 
"(4) Epidemiology centers established under this subsection 
shall be subject to the provisions of the Indian Self-Determination 
Act (25 U.S.C. 450f et seq.). 
"(5) The director of the Centers for Disease Control shall provide 
technical assistance to the centers in carrying out the requirements 
of this subsection. 
"(6) The Service shall assign one epidemiologist from each 
of its area offices to each area epidemiology center to provide 
such center with technical assistance necessary to carry out this 
subsection. 
"(b)(1) The Secretary may make grants to Indian tribes, tribal 
organizations, and eligible intertribal consortia or Indian organiza-
tions to conduct epidemiological studies of Indian communities. 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4553 
"(2) An intertribal consortia or Indian organization is eligible 
to receive a grant under this subsection if— 
"(A) it is incorporated for the primary purpose of improving 
Indian health; and 
"(B) it is representative of the tribes or urban Indian com-
munities in which it is located. 
"(3) An application for a grant under this subsection shall 
be submitted in such manner and at such time as the Secretary 
shall prescribe. 
"(4) Applicants for grants under this subsection shall— 
"(A) demonstrate the technical, administrative, and finan-
cial expertise necessary to carry out the functions described 
in paragraph (5); 
"(B) consult and cooperate with providers of related health 
and social services in order to avoid duplication of existing 
services; and 
"(C) demonstrate cooperation from Indiein tribes or urban 
Indian organizations in the area to be served. 
"(5) A grant awarded under paragraph (1) may be used to— 
"(A) carry out the functions described in subsection (a)(3); 
"(B) provide information to and consult with tribal leaders, 
urban Indian community leaders, and related health staff, on 
health care and health services management issues; and 
"(C) provide, in collaboration with tribes and urban Indian 
communities, the Service with information regarding ways to 
improve the health status of Indian people. 
"(6) There are authorized to be appropriated to carry out the 
purposes of this subsection not more than $12,000,000 for fiscal 
year 1993 and such sums as may be necessary for each of the 
fiscal years 1994, 1995,1996,1997,1998,1999, and 2000.". 
SEC. 211. COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS. 
Title II of the Act (as amended by section 210 of this Act) 
is amended by adding at the end the following new section: 
"COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS 
"SEC. 215. (a) The Secretary, acting through the Service and 
25 USC I62in. 
in consultation with the Secretary of the Interior, may award grants 
to Indian tribes to develop comprehensive school health education 
programs for children from preschool through grade 12 in schools 
located on Indian reservations. 
"(b) Grants awarded under this section may be used to— 
"(1) develop health education curricula; 
"(2) train teachers in comprehensive school health edu-
cation curricula; 
"(3) integrate school-based, community-based, and other 
public and private health promotion efforts; 
"(4) encourage healthy, tobacco-free school environments; 
"(5) coordinate school-based health programs with existing 
services and programs available in the commimity; 
"(6) develop school programs on nutrition education, per-
sonal health, and fitness; 
"(7) develop mental health wellness programs; 
"(8) develop chronic disease prevention programs; 
"(9) develop substance abuse prevention programs; 
"(10) develop accident prevention and safety education pro-
grams; 
106 STAT. 4554 
PUBLIC LAW 102-573—OCT. 29, 1992 
"(11) develop activities for the prevention and control of 
communicable diseases; and 
"(12) develop community and environmental health edu-
cation programs. 
"(c) The Secretary shall provide technical assistance to Indian 
tribes in the development of health education plans, and the dis-
semination of health education materials and information on exist-
ing health programs and resources. 
"(d) The Secretary shall establish criteria for the review and 
approval of applications for grants made pursuant to this section. 
Repoi^s- 
"(e) Recipients of grants under this section shall submit to 
the Secretary an annual report on activities undertaken with funds 
provided under this section. Such reports shall include a statement 
of— 
"(1) the number of preschools, elementary schools, and 
secondary schools served; 
"(2) the number of students served; 
"(3) any new curricula established with funds provided 
under this section; 
"(4) the number of teachers trained in the health curricula; 
and 
"(5) the involvement of parents, members of the community, 
and community health workers in programs established with 
funds provided under this section. 
"(f)(1) The Secretary of the Interior, acting through the Bureau 
of Indian Affairs and in cooperation with the Secretary, shall 
develop a comprehensive school health education program for chil-
dren from preschool through grade 12 in schools operated by the 
Bureau of Indian Affairs. 
"(2) Such program shall include— 
"(A) school programs on nutrition education, personal 
health, and fitness; 
"(B) mental health wellness programs; 
"(C) chronic disease prevention programs; 
"(D) substance abuse prevention programs; 
"(E) accident prevention and safety education programs; 
and 
"(F) activities for the prevention and control of commu-
nicable diseases. 
"(3) The Secretary of the Interior shall— 
"(A) provide training to teachers in comprehensive school 
health education curricula; 
"(B) ensure the integration and coordination of school-based 
programs with existing services and health programs available 
in the community; and 
"(C) encourage healthy, tobacco-free school environments. 
"(g) There are authorized to be appropriated to carry out this 
section $15,000,000 for fiscal year 1993 and such sums as may 
be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 
1998,1999, and 2000.". 
SEC. 212. INDIAN YOUTH GRANT PROGRAM. 
Title II of the Act (as amended by section 211 of this Act) 
is amended by adding at the end the following new section: 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4555 
"INDIAN YOUTH GRANT PROGRAM 
"SEC. 216. (a) The Secretary, acting through the Service, is 25USCl621o. 
authorized to make grants to Indian tribes, tribal organizations, 
and urban Indian organizations for innovative mentsd and physical 
disease prevention and health promotion and treatment programs 
for Indian preadolescent and adolescent youths. 
"(b)(1) Funds made available under this section may be used 
to— 
"(A) develop prevention and treatment programs for Indian 
youth which promote mental and physical health and incor-
porate cultural values, community and family involvement, and 
traditional healers; and 
"(B) develop and provide community training and edu-
cation. 
"(2) Funds made available under this section may not be used 
to provide services described in section 209(m). 
"(c) The Secretary shall— 
"(1) disseminate to Indian tribes information regarding 
models for the delivery of comprehensive health care services 
to Indian and urban Indian adolescents; 
"(2) encourage the implementation of such models; and 
"(3) at the request of an Indian tribe, provide technical 
assistance in the implementation of such models. 
"(d) The Secretary shall establish criteria for the review and 
approval of applications under this section. 
"(e) There are authorized to be appropriated to carry out this 
section $5,000,000 for fiscal year 1993 and such sums as may 
be necessary for each of the fiscal years 1994, 1995, 1996, 1997, 
1998,1999, and 2000.". 
SEC. 213. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM. 
Title II of the Act (as amended by section 212 of this Act) 
is amended by adding at the end the following new section: 
"AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM 
"SEC. 217. (a) The Secretary may provide grants to at least 
25 use I62lp. 
3 colleges and universities for the purpose of developing and 
maintaining American Indian psychology career recruitment pro-
grams as a means of encouraging Indians to enter the mental 
health field. 
"(b) The Secretary shall provide one of the grsuits authorized 
Grants, 
under subsection (a) to develop and maintain a program at the 
University of North Dakota to be known as the 'Quentin N. Burdick 
American Indians Into Psychology Program'. Such program shall, 
to the mELximum extent feasible, coordinate with the Quentin N. 
Burdick Indian Health Programs authorized under section 114(b), 
the Quentin N. Burdick American Indians Into Nursing Program 
authorized under section 112(e), and existing university research 
and communications networks. 
"(c)(1) The Secretary shall issue regulations for the competitive Regulations, 
awarding of the grants provided under mis section. 
"(2) Applicants for grants under this section shall agree to 
provide a program which, at a minimum— 
"(A) provides outreach and recruitment for health profes-
sions to Indian communities including elementary, secondary 
106 STAT. 4556 
PUBLIC LAW 102-573—OCT. 29, 1992 
and community colleges located on Indian reservations that 
will be served by the program; 
"(B) incorporates a program advisory board comprised of 
representatives from the tribes and communities that will be 
served by the program; 
"(C) provides summer enrichment programs to expose 
Indian students to the varied fields of psychology through 
research, clinical, and experientied activities; 
"(D) provides stipends to undergraduate and graduate stu-
dents to pursue a career in psychology; 
"(E) develops affiliation agreements with tribal community 
colleges, the Service, university affiliated programs, and other 
appropriate entities to enhance the education of Indian stu-
dents; 
"(F) to the maximum extent feasible, utilizes existing uni-
versity tutoring, counseling and student support services; and 
"(G) to the maximum extent feasible, employs qualified 
Indians in the program. 
"(d) The active duty service obligation prescribed under section 
338C of the PubHc Health Service Act (42 U.S.C. 254m) shall 
be met by each graduate student who receives a stipend described 
in subsection (c)(2)(D) that is funded by a grant provided under 
this section. Such obligation shall be met by service— 
"(1) in the Indian Health Service; 
"(2) in a program conducted under a contract entered into 
under the Indian Self-Determination Act; 
"(3) in a program assisted under title V of this Act; or 
"(4) in the private practice of psychology if, as determined 
by the Secretary, in accordance with guidelines promulgated 
by the Secretary, such practice is situated in a physicigm or 
other health professional shortage area and addresses the 
health care needs of a substantial number of Indians.". 
SEC. 214. PREVENTION, CONTROL, AND ELIMINATION OF TUBER-
CULOSIS. 
Title II of the Act (as amended by section 213 of this Act) 
is amended by adding at the end the following new section: 
"PREVENTION, CONTROL, AND ELIMINATION OF TUBERCULOSIS 
25 use I62lq. 
«SEC. 218. (a) The Secretary, acting through the Service after 
consultation with the Centers for Disease Control, may make grants 
to Indian tribes and tribal organizations for— 
"(1) projects for the prevention, control, and eUmination 
of tuberculosis; 
"(2) public information and education programs for the 
prevention, control, and elimination of tuberculosis; and 
"(3) education, training, and clinical skills improvement 
activities in the prevention, control, and elimination of tuber-
culosis for health professionals, including allied health profes-
sionals. 
"(b) The Secretary may make a grant under subsection (a) 
only if an application for the grant is submitted to the Secretary 
and the application is in such form, is made in such manner, 
and contains the assurances required by subsection (c) and such 
other agreements, assurances, and information as the Secretary 
may require. 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4557 
**(c) To be eligible for a grant under subsection (a), an applicant 
must provide assurances satisfactory to the Secretary that— 
"(1) the applicant will coordinate its activities for the pre-
vention, control, and elimination of tuberculosis with activities 
of the Centers for Disease Control, and State and local health 
agencies; and 
"(2) the applicant will submit to the Secretary an annual Reports, 
report on its activities for the prevention, control, and elimi-
nation of tuberculosis, 
"(d) In canying out this section, the Secretary— 
"(1) shall estabUsh criteria for the review and approval 
of appUcations for grants under subsection (a), including 
requirement of public health qualifications of applicants; 
"(2) shsdl, subject to available appropriations, make at least 
one grant under subsection (a) within each area office; 
(3) may, at the request of an Indian tribe or tribal 
organization, provide technical assistance; and 
"(4) shall prepare and submit a report to the Committee Reports, 
on Energy and Commerce and the Committee on Interior and 
Insular Affairs of the House and the Select Committee on 
Indian Affairs of the Senate not later than February 1, 1994, 
and biennially thereafter, on the use of funds under this section 
and on the progress made toward the prevention, control, and 
elimination of tuberculosis among Indisin tribes and tribal 
organizations. 
"(e) The Secretary may, at the request of a recipient of a 
grant under subsection (a), reduce the amount of such grant by— 
"(1) the fair market value of any suppUes or equipment 
furnished the grant recipient; and 
"(2) the amount of the pay, allowances, and travel expenses 
of any officer or employee of the Government when detailed 
to the grant recipient and the amount of any other costs 
incurred in connection with the detail of such officer or 
employee, 
when the furnishing of such supphes or equipment or the detail 
of such an officer or employee is for the convenience of and at 
the request of such grant recipient and for the purpose of carrying 
out a progreun with respect to which the grant under subsection 
(a) is made. The amount by which any such grant is so reduced 
shall be available for payment by the Secretary of the costs incurred 
in furnishing the supplies or equipment, or in detailing the person-
nel, on which the reduction of such grant is based, and such amount 
shall be deemed as part of the grsmt and shall be deemed to 
have been paid to the grant recipient.". 
SEC. 215. CONTRACT HEALTH SERVICES. 
Title II of the Act (as amended by section 214 of this Act) 
is amended by adding at the end the following new sections: 
CONTRACT HEALTH SERVICES PAYMENT STUDY 
" S E C 219. (a) The Secretary, acting through the Service and 
in consultation with representatives of Indian tribes and tribal 
organizations operating contract health care programs under the 
Indian Self-Determination Act (25 U.S.C. 450f et seq.) or under 
self-governance compacts. Service personnel, private contract health 
services providers, the Indian Health Service Fiscal Intermediary, 
and other appropriate experts, shall conduct a study— 
25 u s e 1621r. 
106 STAT. 4558 
PUBLIC LAW 102-573—OCT. 29, 1992 
"(1) to assess and identify administrative barriers that 
hinder the timely payment for services delivered by private 
contract health services providers to individual Indians by the 
Service and the Indian Health Service Fiscal Intermediary; 
"(2) to assess and identify the impact of such delayed 
payments upon the personal credit histories of individual 
Indians who have been treated by such providers; and 
"(3) to determine the most efficient and effective means 
of improving the Service's contract health services payment 
system and ensuring the development of appropriate consumer 
protection policies to protect individual Indians who receive 
authorized services from private contract health services provid-
ers from billing and collection practices, including the develop-
ment of materieds and programs explaining patients' rights 
and responsibilities, 
"(b) The study required by subsection (a) shall— 
"(1) assess the impact of the existing contract health serv-
ices regulations and policies upon the ability of the Service 
and the Indian Health Service Fiscal Intermediary to process, 
on a timely and efficient basis, the pa3anent of bills submitted 
by private contract health services providers; 
"(2) assess the financial and any other burdens imposed 
upon individual Indians and private contract health services 
providers by delayed payments; 
"(3) survey the policies and practices of collection agencies 
used by contract health services providers to collect payments 
for services rendered to individual Indians; 
"(4) identify appropriate changes in Federal poUcies, 
administrative procedures, and regulations, to eUminate the 
problems experienced by private contract health services provid-
ers and individual Indians as a result of delayed payments; 
and 
"(5) compare the Service's pa3anent processing require-
ments with private insurance claims processing requirements 
to evaluate the systemic diffierences or similarities employed 
by the Service and private insurers. 
R®P<"^- 
"(c) Not later than 12 months after the date of the enactment 
of this section, the Secretary shall transmit to the Congress a 
report that includes— 
"(1) a detailed description of the study conducted pursuant 
to this section; and 
"(2) a discussion of the findings and conclusions of such 
study. 
"PROMPT ACTION ON PAYMENT OF CLAIMS 
25USC16218. 
"SEC. 220. (a) The Service shall respond to a notification of 
a claim by a provider of a contract care service with either an 
individual purchase order or a denial of the claim within 5 working 
days after the receipt of such notification. 
"(b) If the Service fails to respond to a notification of a claim 
in accordance with subsection (a), the Service shall accept as vaUd 
the claim submitted by the provider of a contract care service. 
"(c) The Service shall pay a completed contract care service 
claim within 30 days after completion of the claim. 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4559 
DEMONSTRATION OF ELECTRONIC CLAIMS PROCESSING 
"SEC. 221. (a) Not later than June 15, 1993, the Secretary 
shall develop and implement, directly or by contract, 2 projects 
to demonstrate in a pilot setting the use of claims processing 
technology to improve the accuracy and timeliness of the billing 
for, and pajonent of, contract health services. 
"(b) The Secretary shall conduct one of the projects authorized 
in subsection (a) in the Service area served by the area office 
located in Phoenix, Arizona. 
"LIABILITY FOR PAYMENT 
"SEC. 222. (a) A patient who receives contract health care 
services that are authorized by the Service shall not be liable 
for the payment of any charges or costs associated with the provision 
of such services. 
"(b) The Secretary shall notify a contract care provider and 
any patient who receives contract health care services authorized 
by the Service that such patient is not liable for the pajonent 
of any charges or costs associated with the provision of such serv-
ices.". 
SEC. 216. OFFICE OF WOMEN'S INDIAN HEALTH CARE. 
Title II of the Act (as amended by section 215 of this Act) 
is amended by adding at the end the following new section: 
"OFFICE OF INDIAN WOMEN'S HEALTH CARE 
"SEC. 223. There is established within the Service an Office 
of Indian Women's Health Care to oversee efforts of the Service 
to monitor and improve the quality of health care for Indian women 
of all ages through the plsinning and deUvery of programs adminis-
tered by the Service, in order to improve and enhance the treatment 
models of care for Indian women.". 
SEC. 217. AUTHORIZATION OF APPROPRIATIONS. 
(a) AUTHORIZATION.—^Title II of the Act (as amended by section 
216 of this Act) is amended by adding at the end the following 
new section: 
25 u s e 1621t. 
Arizona. 
25 u s e 1621U. 
Establishment. 
25 use 1621v. 
"AUTHORIZATION OF APPROPRIATIONS 
"SEC. 224. Except as provided in sections 209(m), 211, 213, 
25USCl621w. 
214(b)(5), 215, and 216, there are authorized to be appropriated 
such sums as may be necessary for each fiscal year through fiscal 
year 2000 to carry out this title. . 
(b) 
CONFORMING 
AMENDMENTS.—Title 
II 
of 
the 
Act 
is 
amended— 
(1) in section 201(h), by striking out the first sentence 
25USC1621. 
and striking out "subsection" and inserting in lieu thereof "sec-
tion". 
(2) in section 202, by striking out subsection (e); 
25 USC 1621a. 
(3) in section 204(e), by striking out the first sentence 
25 use I62lc. 
and striking out "subsection (c)" and inserting in lieu thereof 
"this section"; and 
(4) in section 209 (as amended by section 902(3XB) of 
25USC162lh. 
this Act)— 
106 STAT. 4560 
PUBLIC LAW 102-573—OCT. 29, 1992 
(A) by striking out subsections (c)(5), (d)(6), (f)(4), and 
(g)(5); 
(B) in subsection (h)— 
(i) by striking out paragraph (2) and by striking 
out"(l)"; 
^ 
(ii) by redesignating subparagraphs (A) and (B) 
as paragraphs (1) and (2), respectively; 
(iii) by striking out "subparagraph (A)" and insert-
ing "paragraph (1)"; £uid 
(iv) by striking out "subparagraph (B)" and insert-
ing "paragraph (2)"; 
(C) in subsection (i), by striking out paragraph (2) 
and by striking out "(1)"; 
(D) in subsection (d)(3)(B), by striking out "this sub-
section" and inserting in Ueu thereof "this section"; and 
(E) in subsection (k)(6), by striking out the first sen-
tence and in the second sentence by striking 
out 
"subsection" and inserting in Ueu thereof "section". 
TITLE III—HEALTH FACILITIES 
SEC. 301. HEALTH FACIUTIES CLOSURE AND PRIORITIES. 
Section 301 of the Act (25 U.S.C. 1631) is amended— 
(1) in subsection (a)(2), by striking out "Hospitals" and 
inserting "Health Care Organizations"; 
(2) in subsection (b)(1)— 
(A) in the material preceding subparagraph (A), by 
striking out "other" before "outpatient"; 
(B) by striking out "and" at the end of subparagraph 
(D); 
X 
(C) by striking out the period at the end of subpara-
graph (E) and inserting in lieu thereof a semicolon; and 
(D) by adding at the end the following new sub-
paragraphs: 
"(F) the level of utilization of such hospital or facility 
by all eligible Indisuis; and 
"(G) the distance between such hospital or facility and 
the nearest operating Service hospital."; 
(3) by striking out subsection (c) and redesignating sub-
sections (d) and (e) as subsections (c) and (d), respectively; 
(4) in subsection (c)(1) (as redesignated by paragraph (2) 
of this subsection), by amending the material preceding sub-
paragraph (A) to read as follows: 
Reports- 
"(c)(1) The Secretary shall submit to the President, for inclusion 
in each report required to be transmitted to the Congress under 
section 801, a report which sets forth—"; and 
(5) by striking out paragraph (2) of subsection (c) (as 
redesignated by paragraph (2)) and redesignating paragraphs 
(3), (4), and (5) of such subsection as paragraphs (2), (3), £uid 
(4), respectively. 
SEC. 302. SAFE WATER AND SANITARY WASTE DISPOSAL FACIUTIES. 
Section 302 of the Act (25 U.S.C. 1632) is amended— 
(1) by amending subsection (e) to read as follows: 
"(e)(1) The Secretary is authorized to provide financial assist-
ance to Indian tribes and communities in an amount equal to 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4561 
the Federal share of the costs of operating, managing, and maintain-
ing the facihties provided under the plan described in subsection 
(c). 
"(2) For the purposes of paragraph (1), the term 'Federal share' 
means 80 percent of the costs described in paragraph (1). 
"(3) With respect to Indian tribes with fewer than 1,000 enrolled 
members, the non-Federal portion of the costs of operating, man-
aging, and msdntaining such facilities may be provided, in part, 
through cash donations or in kind property, fairly evaluated."; 
(2) in subsection (f)(1), by striking out "subsection (h)" 
and inserting in lieu thereof "this section"; and 
(3) in subsection (g)— 
(A) in paragraph (1), by striking out "The Secretary" Reports-
through "report and inserting in lieu thereof the following: 
"The Secretary shall submit to the President, for inclusion 
in each report required to be transmitted to the Congress 
under section 801, a report"; and 
(B) by striking out paragraph (2) and redesignating 
paragraphs (3), (4), (5), £uid (6) as paragraphs (2), (3), 
(4), and (5), respectively. 
SEC. 303. AMBULATORY CARE FACILrriES GRANT PROGRAM. 
Section 306 of the Act (25 U.S.C. 1636) is amended to read 
as follows: 
"GRANT PROGRAM FOR THE CONSTRUCTION, EXPANSION, AND 
MODERNIZATION OF SMALL AMBULATORY CARE FACILITIES 
"SEC. 306. (a)(1) The Secretary, acting through the Service, 
shall make grants to tribes and tribal organizations for the construc-
tion, expansion, or modernization of facilities for the provision of 
ambulatory care services to eligible Indians (and noneligible persons 
as provided in subsection (c)(1)(C)). A grant made under this section 
may cover up to 100 percent of the costs of such construction, 
expansion, or modernization. For the purposes of this section, the 
term 'construction' includes the replacement of an existing facility. 
"(2) A grant under paragraph (1) may only be made to a 
tribe or tribial organization operating an Indian health facility (other 
than a facility owned or constructed by the Service, including a 
facility originally owned or constructed by the Service and trans-
ferred to a tribe or tribal organization) pursuant to a contract 
entered into under the Indian Self-Determination Act. 
"(b)(1) A grant provided under this section may be used only 
for the construction, expansion, or modernization (including the 
planning and design of such construction, expansion, or mod-
ernization) of an ambulatoiy care facility— 
"(A) located apart from a hospital; 
"(B) not funded under section 301 or section 307; and 
"(C) which, upon completion of such construction, expan-
sion, or modernization will— 
"(i) have a total capacity appropriate to its projected 
service population; 
"(ii) serve no less than 500 eligible Indians annually; 
and 
"(iii) provide ambulatory care in a service area (speci-
fied in the contract entered into under the Indian Self-
Determination Act) with a population of not less than 2,000 
eligible Indians. 
106 STAT. 4562 
PUBLIC LAW 102-573—OCT. 29, 1992 
"(2) The requirements of clauses (ii) and (iii) of paragraph 
(1)(C) shall not apply to a tribe or tribal organization appl3dng 
for a grant under this section whose tribal government offices 
are located on an island. 
"(c)(1) No grant may be made under this section unless an 
application for such a grant has been submitted to and approved 
Regulations. 
by the Secretary. An application for a grant under this section 
shall be submitted in such form and manner as the Secretary 
shall by regulation prescribe and shall set forth reasonable assur-
ance by the applicant that, at all times after the construction, 
expansion, or modernization of a facility carried out pursuant to 
a grant received under this section— 
"(A) adequate financial support will be available for the 
provision of services at such facility; 
"(B) such facility will be available to eligible Indians with-
out regard to ability to pay or source of payment; and 
"(C) such facility will, as feasible without diminishing the 
quality or quantity of services provided to eligible Indians, 
serve noneligible persons on a cost basis. 
"(2) In awarding grants under this section, the Secretary shall 
give priority to tribes and tribal organizations that demonstrate— 
"(A) a need for increased ambulatory care services; and 
"(B) insufficient capacity to deliver such services. 
"(d) If any facility (or portion thereof) with respect to which 
funds have been paid under this section, ceases, at any time after 
completion of the construction, expansion, or modernization carried 
out with such funds, to be utilized for the purposes of providing 
ambulatory care services to eligible Indians, all of the right, title, 
and interest in and to such facility (or portion thereof) shall trtuisfer 
to the United States.". 
SEC. 304. INDIAN 
HEALTH 
CARE 
DELIVERY 
DEMONSTRATION 
PROJECT. 
(a) AWARDING OF GRANTS.—Section 307(c) of the Act (25 U.S.C. 
1637(c)(3)) is amended— 
(1) in paragraph (1)(A), by inserting "or program" imme-
diately after "facility" each place it appears; 
(2) in paragraph (3)(A)— 
(A) by striking "The" and inserting "On or before Sep-
tember 30, 1995, the"; and 
(B) by adding before the colon the following: "and for 
which a completed application has been received by the 
Secretar/'; and 
(3) by striking subparagraph (B) and inserting the fol-
lowing: 
"(B) The Secretary may also enter into contracts or award 
grants under this section taking into consideration applications 
received under this section from all service areas. The Secretary 
may not award a greater number of such contracts or grants in 
one service area than in any other service area until there is 
an equal number of such contracts or grants awarded with respect 
to all service areas from which the Secretary receives applications 
during the application period (as determined by the Secretary) 
which meet the criteria specified in paragraph (1).". 
(b) REPORTS.—Section 307(h) of the Act (25 U.S.C. 1637(h)) 
is amended to read as follows: 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4563 
"(hXD The Secretary shall submit to the President, for inclusion 
in the report which is required to be submitted to the Congress 
under section 801 for fiscal year 1997, an interim report on the 
findings and conclusions derived firom the demonstration projects 
established under this section, 
"(2) The Secretary shall submit to the President, for inclusion 
in the report which is required to be submitted to the Congress 
under section 801 for fiscal year 1999, a final report on the findings 
and conclusions derived from the demonstration projects established 
under this section, together with legislative recommendations.". 
SEC. 305. EXPENDITURE OF NONSERVICE FUNDS FOR RENOVATION. 
Section 305 of the Act (25 U.S.C. 1634) is amended to read 
as follows: 
"EXPENDITURE OF NONSERVICE FUNDS FOR RENOVATION 
"SEC. 305. (a)(1) Notwithstanding any other provision of law, 
the Secretary is authorized to accept any major renovation or mod-
ernization by £uiy Indian tribe of any Service facility, or of any 
other Indian health facility operated pursuant to a contract entered 
into under the Indian Self-Determination Act, including— 
"(A) any plans or designs for such renovation or mod-
ernization; and 
"(B) any renovation or modernization for which funds 
appropriated under any Federal law were lawfiilly expended, 
but only if the requirements of subsection (b) are met. 
"(2) The Secretary shall maintain a separate priority hst to 
address the needs of such facilities for personnel or equipment. 
"(3) The Secretary shall submit to the President, for inclusion Reports. 
in each report required to be transmitted to the Congress under 
section 801, the priority list maintained pursuant to paragraph 
(2). 
"(b) The requirements of this subsection are met with respect 
to any renovation or modernization if— 
"(1) the tribe or tribal organization— 
"(A) provides notice to the Secretary of its iijtent to 
renovate or modernize; and 
"(B) applies to the Secretary to be placed on a separate 
priority list to address the needs of such new facilities 
for personnel or equipment; and 
"(2) the renovation or modernization— 
"(A) is approved by the appropriate area director of 
the Service; and 
"(B) is administered by the tribe in accordance with 
the rules and regulations prescribed by the Secretary with 
respect to construction or renovation of Service facilities. 
"(c) If any Service facility which has been renovated or mod-
ernized by an Indian tribe under this section ceases to be used 
as a Service faciUty during the 20-year period beginning on the 
date such renovation or modernization is completed, such Indian 
tribe shall be entitled to recover from the United States an amount 
which bears the same ratio to the value of such facility at the 
time of such cessation as the value of such renovation or mod-
ernization (less the total amount of any funds provided specifically 
for such facility under any Federal program that were expended 
for such renovation or modernization) bore to the value of such 
106 STAT. 4564 
PUBLIC LAW 102-573—OCT. 29, 1992 
Oregon. 
25 u s e 1638. 
25 use 1638a. 
25 use 1632. 
25 u s e 1637. 
25 use 1638b. 
Reports. 
facility at the time of the completion of such renovation or mod-
ernization.". 
SEC. 306. LAND TRANSFER. 
Title III of the Act is amended by adding at the end the 
following new section: 
"LAND TRANSFER 
"SEC, 308. The Bureau of Indian Affairs is authorized to trans-
fer, at no cost, up to 5 acres of land at the Chemawa Indian 
School, Salem, Oregon, to the Service for the provision of health 
care services. The land authorized to be transferred by this section 
is that land adjacent to land under the jurisdiction of the Service 
and occupied by the Chemawa Indian Hemth Center.". 
SEC. 307. AUTHORIZATION OF APPROPRIATIONS. 
(a) AUTHORIZATION.—^Title III of the Act (as amended by section 
306 of this Act) is amended by adding at the end the following 
new section: 
"AUTHORIZATION OF APPROPRIATIONS 
"SEC. 309. There are authorized to be appropriated such sums 
as may be necessary for each fiscal year through fiscal year 2000 
to carry out this title.". 
(b) 
CONFORMING 
AMENDMENTS.—Title 
III 
of 
the 
Act 
is 
amended— 
(1) in section 302, by striking out subsection (h); and 
(2) in section 307, by striking out subsection (i). 
SEC. 308. BUY AMERICAN REQUIREMENT. 
Title III of the Act (as amended by section 307 of this Act) 
is amended by adding at the end the following new section: 
"APPLICABILITY OF BUY AMERICAN REQUIREMENT 
"SEC. 310. (a) The Secretary shall ensure that the requirements 
of the Buy American Act apply to all procurements made with 
fiinds provided pursuant to the authorization contained in section 
309. 
"(b) The Secretary shall submit to the Congress a report on 
the amoimt of procurements from foreign entities made in fiscal 
years 1993 and 1994 with funds provided pursuant to the authoriza-
tion contained in section 309. Such report shedl separately indicate 
the dollar value of items procured with such funds for which the 
Buy American Act was waived pursuant to the Trade Agreement 
Act of 1979 or £iny international agreement to which the United 
States is a party. 
"(c) If it has been finally determined by a court or Federsd 
agency that any person intentionally affixed a label bearing a 
*Made in America' inscription, or any inscription with the same 
meaning, to any product sold in or shipped to the United States 
that is not made in the United States, such person shall be ineligible 
to receive any contract or subcontract made with funds provided 
pursuant to the authorization contained in section 309, pursuant 
to the debarment, suspension, and inehgibihty procedures described 
in sections 9.400 through 9.409 of title 48, Code of Federal Regula-
tions. 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4565 
"(d) For purposes of this section, the term "Buy American 
Act" means title III of the Act entitled "An Act making appropria-
tions for the Treasury and Post Office Departments for the fiscal 
year ending June 30, 1934, and for other purposes", approved 
March 3,1933 (41 U.S.C. 10a et seq.).". 
TITLE IV—ACCESS TO HEALTH 
SERVICES 
SEC. 401. TREATMENT OF PAYMENTS TO INDIAN HEALTH SERVICE 
FACILITIES UNDER MEDICARE AND MEDICAID PROGRAMS. 
(a) MEDICARE PROGRAM.—Section 401 of the Act (42 U.S.C. 
1395qq note) is amended to read as follows: 
"TREATMENT OF PAYMENTS UNDER MEDICARE PROGRAM 
" S E C 401. (a) Any payments received by a hospital or skilled 
25 USC 1641. 
nursing facility of the Service (whether operated by the Service 
or by an Indian tribe or tribal organization pursuant to a contract 
under the Indian Self-Determination Act) for services provided to 
Indians eligible for benefits under title XVIII of the Social Security 
Act shall not be considered in determining appropriations for health 
care and services to Indians. 
"(b) Nothing in this Act authorizes the Secretary to provide 
services to an Indian beneficiary with coverage under title XVIII 
of the Social Security Act, as amended, in preference to an Indian 
beneficiary without such coverage.". 
(b) MEDICAID PROGRAM.—(1) Section 402 of the Act is amended 
to read as follows: 
"TREATMENT OF PAYMENTS UNDER MEDICAID PROGRAM 
" S E C 402. (a) Notwithstanding any other provision of law, 25 USC 1642. 
payments to which any facility of the Service (including a hospital, 
nursing facility, intermediate care facility for the mentally retarded, 
or any other type of facility which provides services for which 
pajmaent is available under title XIX of the Social Security Act) 
is entitled under a State plan by reason of section 1911 of such 
Act shall be placed in a special fund to be held by the Secretary 
and used by him (to such extent or in such amounts as are provided 
in appropriation Acts) exclusively for the purpose of making any 
improvements in the facilities of such Service which may be nec-
essary to achieve compliance with the applicable conditions and 
requirements of such title. In making payments from such fund, 
the Secretary shall ensure that each service unit of the Service 
receives at least 80 percent of the amounts to which the facilities 
of the Service, for which such service unit makes collections, are 
entitled by reason of section 1911 of the Social Security Act. 
"(b) Any pa3anents received by such facility for services provided 
to Indians eligible for benefits under title XIX of the Socisd Security 
Act shall not be considered in determining appropriations for the 
provision of health care and services to Indians.". 
(2) The increase (from 50 percent) in the percentage of the 
25 USC 1642 
payments from the fund to be made to each service imit of the ^°*^-
Service specified in the amendment made by paragraph (1) shall 
take effect beginning with pa3rments made on January 1, 1993. 
106 STAT. 4566 
PUBLIC LAW 102-573—OCT. 29, 1992 
SEC. 402. REPORT. 
25 use 1643. 
Section 403 of the Act (25 U.S.C. 1671 note) is amended by 
striking out "The Secretary" and all that follows through "section 
701" £ind inserting in Heu thereof the following: "The Secretary 
shall submit to the President, for inclusion in the report required 
to be transmitted to the Congress under section 801,". 
SEC. 403. APPLICATION ASSISTANCE. 
25 use 1644. 
Section 404 of the Act (25 U.S.C. 1622) is amended— 
(1) by amending subsection (b)(4) to read as follows: 
"(4) develop and implement— 
"(A) a schedule of income levels to determine the extent 
of pajntnents of premiums by such organizations for cov-
erage of needy individuals; and 
"(B) methods of improving the participation of Indians 
in receiving the benefits provided imder titles XVIII and 
XIX of the Social Security Act."; and 
(2) by amending subsection (c) to read as follows: 
"(c) The Secretary, acting through the Service, may enter into 
an agreement with an Indian tribe, tribal organization, or urban 
Indian organization which provides for the receipt and processing 
of applications for medical assistance under title XIX of the Social 
Security Act £uid benefits under title XVIII of the Social Security 
Act at a Service facility or a health care facility administered 
by such tribe or organization pursuant to a contract under the 
Indian Self-Determination Act.". 
SEC. 404. EXTENSION OF DEMONSTRATION PROGRAM. 
25 use 1645. 
Section 405 of the Act (42 U.S.C. 1395qq note) is amended— 
(1) in subsection (cX2), by striking "1995" and inserting 
"1996"; and 
(2) in subsection (e), by striking "1995" and inserting 
"1996". 
SEC. 405. AUTHORIZATION FOR EMERGENCY CONTRACT HEALTH 
SERVICES. 
Title IV of the Act is amended by adding at the end the 
following new section: 
"AUTHORIZATION FOR EMERGENCY CONTRACT HEALTH SERVICES 
25 use 1646. 
"SEC. 406. With respect to an elderly or disabled Indian receiv-
ing emergency medical care or services from a non-Service provider 
or in a non-Service facility under the authority of this Act, the 
time Umitation (as a condition of payment) for notifying the Service 
of such treatment or admission shall be 30 days.". 
SEC. 406. AUTHORIZATION OF APPROPRIATIONS. 
Title IV of the Act is amended by adding at the end the 
following new section: 
"AUTHORIZATION OF APPROPRIATIONS 
25 use 1647. 
"SEC. 407. There are authorized to be appropriated such sums 
as may be necessary for each fiscal year through fiscal year 2000 
to c£UTy out this title.". 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4567 
TITLE V—HEALTH SERVICES FOR 
URBAN INDIANS 
SEC. 501. GRANT AUTHORITY. 
(a) IN GENERAL.—Section 502 of the Act (25 U.S.C. 1652) is 
amended— 
(1) by striking "contracts with" and inserting the following: 
"contracts with, or make grants to,"; 
(2) by inserting after "enters into with" the following: 
", or in any grant the Secretary makes to,"; and 
(3) by amending the heading to read as follows: 
"CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN ORGANIZATIONS". 
(b) CONFORMING AMENDMENTS.—(1) Section 503 of the Act 
(25 
U.S.C. 1653) is amended— 
(A) in subsection (a), in the material preceding paragraph 
( 1 ) -
(i) by inserting ", or make grants to," after "contracts 
with"; and 
(ii) by inserting "or grant" after "such contract"; 
(B) in subsection (b)— 
(i) in the material preceding paragraph (1), by inserting 
"or receive grants" after "enter into contracts"; and 
(ii) in paragraph (5), by inserting "or to meet the 
requirements for receiving a grant" after "Secretary"; 
(C) in subsection (c)(1), by inserting before the period at 
the end the following: "or receiving grants under subsection 
(a)"; 
(D) in subsection (d)(1), by inserting before the period at 
the end the following: "or receiving grants under subsection 
(a)"; 
(E) in subsection (e)(1), by inserting before the period at 
the end the following: "or receiving grants under subsection 
(a)"; 
(F) in subsection (f), by inserting "or receiving grants under 
subsection (a)" after "this section"; and 
(G) by amending the heading to read as follows: 
"CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH CARE AND 
REFERRAL SERVICES". 
(2) Section 504 of the Act (25 U.S.C. 1654) is amended— 
(A) by striking "SEC. 504." and all that follows through 
the end of subsection (a) and inserting the following: 
"SEC. 504. (a) Under authority of the Act of November 2, 
1921 (25 U.S.C. 13), popularly known as the Snyder Act, the Sec-
retary, through the Service, may enter into contracts with, or make 
grants to, urban Indian organizations situated in urban centers 
for which contracts have not been entered into, or grants have 
not been made, under section 503. The purpose of a contract or 
grant made under this section shall be the determination of the 
matters described in subsection (b)(1) in order to assist the Sec-
retary in assessing the health status and heedth care needs of 
urban Indians in the urban center involved and determining 
whether the Secretary should enter into a contract or make a 
59-194 O—93 
30:QL3(Pt. 5) 
106 STAT. 4568 
PUBLIC LAW 102-573—OCT. 29, 1992 
grant under section 503 with respect to the urban Indian organiza-
tion which the Secretary has entered into a contract with, or made 
a grant to, under this section."; 
(B) in subsection (b)— 
(i) in the material preceding paragraph (1), by inserting 
", or grant made," after "contract entered into"; and 
(ii) in paragraph (2), by striking "within one year" 
and all that follows through the period at the end and 
inserting the following: ", or carry out the requirements 
of the grant, within one year after the date on which 
the Secretary and such organization enter into such con-
tract, or within one year after such organization receives 
such grant, whichever is applicable."; 
(0) in subsection (c), by inserting ", or grant made," after 
"entered into"; and 
(D) by amending the heading to read as follows: 
"CONTRACTS AND GRANTS FOR THE DETERMINATION OF UNMET 
HEALTH CARE NEEDS". 
(3) Section 505 of the Act (25 U.S.C. 1655) is amended— 
(A) in subsection (a), by inserting "compliance with grant 
requirements under this title and" before "complieuice with,"; 
(B) in subsection (b)— 
(i) by inserting "or received a grant" aft«r "entered 
j 
into a contract"; and 
(ii) by inserting before the period at the end the fol-
lowing: "or the terms of such grant"; 
(C) in subsection (c)— 
(i) by inserting "the requirements of a grant or com-
plied with" after "complied with"; 
(ii) by inserting or grant" after "such contract" each 
place it appears"; 
(iii) by inserting "or make a grant" after "enter into 
a contract"; and 
(iv) by inserting "or grant" after "whose contract"; 
(D) in subsection (d), by inserting "or grant" after "a con-
tract" each place it appears; and 
(E) by amending the heading to read as follows: 
"EVALUATIONS; RENEWALS". 
(4) Section 506 of the Act (25 U.S.C. 1656) is amended— 
(A) in subsection (b), by inserting "or grants" afl«r "any 
contracts"; 
(B) in subsection (d), by inserting "or grant" after "contract" 
each place it appears; 
(C) in subsection (e)— 
(i) by inserting ", or grants to," after "Contracts with"; 
and 
(ii) by inserting "or grants" after "such contracts"; and 
(D) by amending the heading to read as follows: 
"OTHER 
CONTRACT 
AND 
GRANT 
REQUIREMENTS". 
(5) Section 507 of the Act (25 U.S.C. 1657) is amended— 
(A) in subsection (a)— 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4569 
(i) in the material preceding paragraph (1), by inserting 
", or a grant received," after "entered into"; and 
(ii) in paragraphs (1) and (2), by inserting "or grant" 
after "contract" each place it appears; and 
(B) in subsections (b) and (c), by inserting "or grant" after 
"contract" each place it appears. 
(6) Section 509 of the Act (25 U.S.C. 1659) (as amended by 
section 902(5)(A) of this Act) is amended by inserting "or grant 
recipients" after "contractors" each place it appears. 
(7) Section 510(a) of the Act (25 U.S.C. 1660(a)) (as amended 
by section 902(5)(B) of this Act) is amended by inserting before 
the period at the end the following: "and for providing central 
oversight of the programs and services authorized under this title". 
SEC. 
502. 
ALCOHOL 
AND 
SUBSTANCE 
ABUSE. 
Title V of the Act is amended by inserting after section 510 
(as redesignated by section 902(5)(B) of this Act) the following 
new section: 
"GRANTS 
FOR 
ALCOHOL 
AND 
SUBSTANCE 
ABUSE 
RELATED 
SERVICES 
" S E C 511. (a) GRANTS.—The Secretary may make grants for 
25USCi660a. 
the provision of health-related services in prevention of, treatment 
of, rehabilitation of, or school and community-based education in, 
alcohol and substance abuse in urban centers to those urban Indian 
organizations with whom the Secretary has entered into a contract 
under this title or under section 201. 
"(b) (JOALS OF GRANT.—^Each grant made pursuant to subsection 
(a) shall set forth the goals to be accomplished pursuant to the 
grant. The goals shall be specific to each grant as agreed to between 
the Secretary and the grantee. 
"(c) CRITERIA.—^The Secretary shall establish criteria for the 
grants made under subsection (a), including criteria relating to 
the— 
"(1) size of the urban Indian population; 
"(2) accessibility to, and utilization of, other health 
resources available to such population; 
"(3) duplication of existing Service or other Federal grants 
or contracts; 
"(4) capability of the organization to adequately perform 
the activities required under the grant; 
"(5) satisfactory performance standards for the organization 
in meeting the goals set forth in such grant, which standards 
shall be negotiated and agreed to between the Secretary and 
the grantee on a grant-by-grant basis; and 
"(6) identification of need for services. 
"The Secretary shall develop a methodology for allocating grants 
made pursuant to this section based on such criteria. 
"(d) 
TREATMENT 
OF FUNDS 
RECEIVED 
BY URBAN 
INDIAN 
ORGANIZATIONS.—^Any funds received by an urban Indian organiza-
tion under this Act for substance abuse prevention, treatment, 
and rehabiUtation shall be subject to the criteria set forth in sub-
section (c).". 
SEC. 503. TREATMENT OF DEMONSTRATION PROJECTS. 
Title V of the Act (as amended by section 502 of this Act) 
is amended by adding at the end the following new section: 
106 STAT. 4570 
PUBLIC LAW 102-573—OCT. 29, 1992 
Oklahoma. 
25 u s e 1660b. 
Reports. 
Grants. 
Contracts. 
Alcohol and 
alcohol abuse. 
25 u s e 1660c. 
Reports. 
"TREATMENT OF CERTAIN DEMONSTRATION PROJECTS 
"SEC. 512. (a) Notwithstanding any other provision of law, 
the Oklahoma City Clinic demonstration project and the Tulsa 
Clinic demonstration project shall be treated as service units in 
the allocation of resources and coordination of care and shall not 
be subject to the provisions of the Indian Self-Determination Act 
for the term of such projects. The Secretary shall provide assistance 
to such projects in the development of resources and equipment 
and facility needs. 
"(b) The Secretary shall submit to the President, for inclusion 
in the report required to be submitted to the Congress under 
section 801 for fiscal year 1999, a report on the findings and 
conclusions derived from the demonstration projects specified in 
subsection (a).". 
SEC. 504. URBAN NIAAA TRANSFERRED PROGRAMS. 
Title V of the Act (as amended by section 503 of this Act) 
is amended by adding at the end the following new section: 
"URBAN 
NIAAA 
TRANSFERRED 
PROGRAMS 
"SEC. 513. (a) The Secretary shall, within the Branch of Urban 
Health Programs of the Service, make grants or enter into contracts 
for the administration of urban Indian alcohol programs that were 
originally established under the National Institute on Alcoholism 
and Alcohol Abuse (hereafter in this section referred to as 'NIAAA') 
and transferred to the Service. 
"(b) Grants provided or contracts entered into under this section 
shall be used to provide support for the continuation of alcohol 
prevention and treatment services for urban Indian populations 
and such other objectives as are agreed upon between the Service 
and a recipient of a grant or contract under this section. 
"(c) Urban Indian organizations that operate Indian alcohol 
programs originally funded under NIAAA and subsequently trans-
ferred to the Service are eligible for grants or contracts under 
this section. 
"(d) For the purpose of carrying out this section, the Secretary 
may combine NiAAA. alcohol funds with other substance abuse 
funds currently administered through the Branch of Urbsm Health 
Programs of the Service. 
"(e) The Secretary shall evaluate and report to the Congress 
on the activities of programs funded under this section at least 
every two years.". 
SEC. 505. AUTHORIZATION OF APPROPRIATIONS. 
(a) AUTHORIZATION.—^Title V of the Act (as amended by section 
504 of this Act) is amended by adding at the end the following 
new section: 
"AUTHORIZATION OF APPROPRIATIONS 
25 use I660d. 
"SEC. 514. There are authorized to be appropriated such simis 
as may be necessary for each fiscal year through fiscal year 2000 
to carry out this title.". 
(b) CONFORMING AMENDMENTS.—^Title V of the Act (25 U.S.C. 
1650 et seq.) is amended— 
25 use 1653. 
(1) in section 503— 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4571 
(A) in subsection (c), by striking out "(c)(1)" and insert-
ing "(c)" and by striking out psiragraph (2); 
(B) in subsection (d), by striking out paragraph (4); 
(C) in subsection (e), by striking out paragraph (4); 
and 
(D) in subsection (f), by striking out paragraph (5); 
and 
(2) in section 509 (as redesignated by section 902(5)(A) 
of this Act), by striking out the last sentence. 
25 USC 1659. 
TITLE VI—ORGANIZATIONAL 
IMPROVEMENTS 
SEC. 601. INDIAN HEALTH SERVICE. 
Section 601(c) of the Act (15 U.S.C. 1661(c)) is amended— 
(1) in paragraph (2), by striking out "and" after the semi-
colon; 
(2) in paragraph (3), by striking out the period at the 
end and inserting in lieu thereof "; and"; and 
(3) by adding at the end the following new paragraph: 
"(4) all scholarship and loan functions carried out under 
title I.". 
SEC. 602. DIRECTOR OF INDIAN HEALTH SERVICE. 
(a) CONFIRMATION BY SENATE.— 
(1) IN GENERAL.—Section 601(a) of the Act (25 U.S.C. 
1661(a)) is amended in the second sentence by striking "Sec-
retary" and inserting "President, by and with the advice and 
consent of the Senate". 
(2) EFFECTIVE DATE.—^The amendment made by paragraph 
25 use 1661 
(1) shall take effect January 1,1993. 
"°*^ 
(b) INTERIM APPOINTMENT.—The President may appoint an 
25 use I66i 
individual to serve as Interim Director of the Service from January 
"°*®' 
1, 1993, until such time as a Director is appointed and confirmed 
as provided in section 601(a) of the Indian Health Care Improve-
ment Act (25 U.S.C. 1601 et seq.) (as amended by subsection (a) 
, 
of this section). 
(c) TERM.—Section 601(a) of the Act (25 U.S.C. 1661(a)) is 
amended by adding at the end the following: "Effective with respect 
to an individual appointed by the President, by and with the advice 
and consent of the Senate, after January 1, 1993, the term of 
service of the Director shall be 4 years. A Director may serve 
more than 1 term.". 
SEC. 603. AUTHORIZATION OF APPROPRIATIONS. 
Title VI of the Act (25 U.S.C. 1661 et seq.) is amended by 
adding at the end the following new section: 
"AUTHORIZATION OF APPROPRIATIONS 
"SEC. 603. There are authorized to be appropriated such sums 
25 USC 1663. 
as may be necessary for each fiscal year through fiscal year 2000 
to carry out this title.". 
106 STAT. 4572 
PUBLIC LAW 102-573—OCT. 29, 1992 
TITLE VII—SUBSTANCE ABUSE 
PROGRAMS 
SEC. 701. REDESIGNATION OF EXISTING TITLE Vn. 
(a) TITLE HEADING.—Title VII of the Act (25 U.S.C. 1671 et 
seq.) is redesignated as title VIII and the title heading is amended 
to read as follows: 
TITLE VIII—MISCELLANEOUS" 
(b) REDESIGNATION OF SECTIONS.—Sections 701 through 720 
of the Act (25 U.S.C. 1671 et seq.) are hereby redesignated as 
sections 801 through 820, respectively. 
25 use i62if. 
(c) CONFORMING AMENDMENTS.—The Act is amended— 
(1) in section 207(a), by striking out "section 713" and 
inserting in lieu thereof "section 813"; 
25 use 1687. 
(2) in section 307(e), by striking out "section 713" and 
inserting in lieu thereof "section 813"; and 
25 use 1645. 
(3) in section 405(b)— 
(A) in paragraph (1), by striking out "sections 402(c) 
and 713(b)(2)(A)" and inserting in lieu thereof "sections 
402(a) and 813(b)(2)(A)"; and 
(B) in paragraph (4), by striking out "section 402(c)" 
each place it appears and inserting in lieu thereof "section 
402(a)". 
25 use 1671 
(d) REFERENCES.—^Any reference in a provision of law other 
than the Indian Health Care Improvement Act to sections redesig-
nated by subsection (b) shall be deemed to refer to the section 
as so redesignated. 
SEC. 702. SUBSTANCE ABUSE PROGRAMS. 
(a) IN GENERAL.—^The Act is amended by inserting after title 
VI the following new title: 
"TITLE VII—SUBSTANCE ABUSE PROGRAMS 
"INDIAN HEALTH SERVICE RESPONSIBILITIES 
25 use 1665. 
"SEC. 701. The Memorandum of Agreement entered into pursu-
ant to section 4205 of the Indian Alcohol and Substance Abuse 
Prevention and Treatment Act of 1986 (25 U.S.C. 2411) shall include 
specific provisions pursuant to which the Service shall assume 
responsibility for— 
"(1) the determination of the scope of the problem of alcohol 
and substance abuse among Indian people, including the num-
ber of Indians within the jurisdiction of the Service who are 
directly or indirectly affected by alcohol and substance abuse 
and the financial and human cost; 
"(2) an assessment of the existing and needed resources 
necessary for the prevention of alcohol and substance abuse 
and the treatment of Indians affected by alcohol and substance 
abuse; and 
"(3) an estimate of the funding necessary to adequately 
support a program of prevention of alcohol and substance abuse 
and treatment of Indians affected by alcohol £uid substance 
abuse. 
note. 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4573 
INDIAN HEALTH SERVICE PROGRAM 
"SEC. 702. (a) COMPREHENSIVE PREVENTION AND TREATMENT 25usci665a. 
PROGRAM.—(1) The Secretary, acting through the Service, shall 
provide a program of comprehensive alcohol and substance abuse 
prevention and treatment which shall include— 
"(A) prevention, through educational intervention, in Indian 
communities; 
"(B) acute detoxification and treatment; 
"(C) community-based rehabilitation; 
"(D) community education and involvement, including 
extensive training of health care, educational, and community-
based personnel; and 
"(E) residential treatment programs for pregnant and post 
partum women and their children. 
(2) The target population of such program shall be members 
of Indian tribes. Efforts to train and educate key members of 
the Indian community shall target employees of health, education, 
judicial, law enforcement, legal, and social service programs. 
"(b) CONTRACT HEALTH SERVICES.—(1) The Secretary, acting 
through the Service, may enter into contracts with public or private 
providers of alcohol and substance abuse treatment services for 
the purpose of assisting the Service in carrying out the program 
required under subsection (a). 
"(2) In carrying out this subsection, the Secretary shall provide 
assistance to Indian tribes to develop criteria for the certification 
of alcohol and substance abuse service providers and accreditation 
of service facilities which meet minimum standards for such services 
and facilities as may be determined pursuant to section 4205(a)(3) 
of the Indian Alcohol and Substance Abuse Prevention and Treat-
ment Act of 1986 (25 U.S.C. 2411(a)(3)). 
"(c) GRANTS FOR MODEL PROGRAM.—(1) The Secretary, acting 
through the Service shall make a grant to the Standing Rock 
Sioux Tribe to develop a community-based demonstration project 
to reduce drug and alcohol abuse on the Standing Rock Sioux 
Reservation and to rehabilitate Indian families afflicted by such 
abuse. 
"(2) Funds shall be used by the Tribe to— 
"(A) develop and coordinate community-based alcohol and 
substance abuse prevention and treatment services for Indian 
families; 
"(B) develop prevention and intervention models for Indiah 
families; 
"(C) conduct community education on alcohol and substance 
abuse; and 
"(D) coordinate with existing Federal, State, and tribal 
services on the reservation to develop a comprehensive alcohol 
and substance abuse program that assists in the rehabilitation 
of Indian families that have been or are afflicted by alcoholism. 
"(3) The Secretary shall submit to the President for inclusion 
Reports, 
in the report to be transmitted to the Congress under section 
801 for fiscal year 1995 an evaluation of the demonstration project 
established under paragraph (1). 
"INDIAN WOMEN TREATMENT PROGRAMS 
"SEC. 703. (a) The Secretary may make grants to Indian tribes 
and tribal organizations to develop and implement a comprehensive 
25 use 1665b. 
106 STAT. 4574 
PUBLIC LAW 102-573—OCT. 29, 1992 
25 u s e 1665c. 
Arizona. 
California. 
alcohol and substance abuse program of prevention, intervention, 
treatment, 
and 
relapse 
prevention 
services 
that 
specifically 
addresses the cultural, historical, social, and child care needs of 
Indian women, regardless of age. 
"(b) Grants made pursuant to this section may be used to— 
"(1) develop and provide community training, education, 
and prevention programs for Indian women relating to alcohol 
and substance abuse issues, including fetal alcohol syndrome 
and fetal alcohol effect; 
"(2) identify and provide appropriate counseling, advocacy, 
support, and relapse prevention to Indian women and their 
families; and 
"(3) develop prevention and intervention models for Indian 
women which incorporate traditional healers, cultural values, 
and community and family involvement. 
"(c) The Secretary shall establish criteria for the review and 
approval of applications for grants under this section. 
"(d)(1) There are authorized to be appropriated to carry out 
this section $10,000,000 for fiscal year 1993 and such sums as 
are necessary for each of the fisced years 1994, 1995, 1996, 1997, 
1998, 1999, and 2000. 
"(2) Twenty percent of the funds appropriated pursuant to 
this subsection shall be used to make grants to urban Indian 
organizations funded under title V. 
"INDIAN HEALTH SERVICE YOUTH PROGRAM 
"SEC. 704. (a) DETOXIFICATION AND REHABILITATION.—The Sec-
retary shall develop and implement a program for acute detoxifica-
tion and treatment for Indian youth who are alcohol and substance 
abusers. The program shall include regional treatment centers 
designed to include detoxification and rehabilitation for both sexes 
on a referral basis. These regional centers shall be integrated with 
the intake and rehabilitation programs based in the referring Indian 
community. 
"(b) 
TREATMENT CENTERS OR FACILITIES.—(1) The 
Secretary 
shall construct, renovate, or, as necessary, purchase, and appro-
priately staff and operate, a youth regional treatment center in 
each area under the jurisdiction of an area office. For the purposes 
of this subsection, the area offices of the Service in Tucson and 
Phoenix, Arizona, shall be considered one area office and the area 
office in California shall be considered to be two area offices, one 
office whose jurisdiction shall be considered to encompass the north-
ern area of the State of California, and one office whose jurisdiction 
shall be considered to encompass the remainder of the State of 
California. 
"(2) For the purpose of staffing and operating such centers 
or facilities, funding shall be pursuant to the Act of November 
2, 1921 (25 U.S.C. 13). 
"(3) A youth treatment center constructed or purchased under 
this subsection shall be constructed or purchased at a location 
within the area described in paragraph (1) agreed upon (by appro-
priate tribal resolution) by a majority of the tribes to be served 
by such center. 
"(4)(A) Notwithstanding any other provision of this title, the 
Secretary may, from amounts authorized to be appropriated for 
the purposes of carrying out this section, make funds available 
to— 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4575 
"(i) the Tanana Chiefs Conference, Incorporated, for the 
purpose of leasing, constructing, renovating, operating and 
maintaining a residential youth treatment facility in Fairbanks, 
Alaska; and 
"(ii) the Southeast Alaska Regional Health Corporation 
to staff and operate a residential youth treatment facility with-
out regard to the proviso set forth in section 4(1) of the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 
450b(l)). 
"(B) Until additional residential youth treatment facilities are Alaska. 
estabUshed in Alaska pursuant to this section, the facilities specified 
in subparagraph (A) shall make every effort to provide services 
to all eUgible Indian youth residing in such State. 
"(c) FEDERALLY OWNED STRUCTURES.— 
"(1) The Secretary, acting through the Service, shall, in 
consultation with Indian tribes— 
"(A) identify and use, where appropriate, federally 
owned structures suitable as local residential or regional 
alcohol and substance abuse treatment centers for Indian 
youth; and 
"(B) establish guidelines for determining the suitability 
of any such federally owned structure to be used as a 
local residential or regional alcohol and substance abuse 
treatment center for Indian youth. 
"(2) Any structure described in paragraph (1) may be used 
under such terms and conditions as may be agreed upon by 
the Secretary and the agency having responsibiUty for the 
structure. 
"(d) REHABILITATION AND AFTERCARE SERVICES.— 
"(1) The Secretary, in cooperation with the Secretary of 
the Interior, shall develop and implement within each Service 
service unit community-based rehabilitation and follow-up serv-
ices for Indian youth who are alcohol or substance abusers 
which are designed to integrate long-term treatment and to 
monitor and support the Indian youth after their return to 
their home community. 
"(2) Services under paragraph (1) shall be administered 
within each service unit by trained staff within the community 
who can assist the Indian youth in continuing development 
of self-image, positive problem-solving skills, and nonalcohol 
or substance abusing behaviors. Such staff shall include alcohol 
and substance abuse counselors, mental health professionals, 
and other health professionals and paraprofessionals, including 
community health representatives. 
"(e) INCLUSION OF FAMILY IN YOUTH TREATMENT PROGRAM.— 
In providing the treatment and other services to Indian youth 
authorized by this section, the Secretary shall provide for the inclu-
sion of family members of such youth in the treatment programs 
or other services as may be appropriate. Not less than 10 percent 
of the funds appropriated for the purposes of canying out subsection 
(d) shall be used for outpatient care of adult family members 
related to the treatment of an Indian youth luider that subsection. 
"(f) MULTIDRUG ABUSE STUDY.—(1) The Secretary shall conduct 
a study to determine the incidence and prevalence of the abuse 
of multiple forms of drugs, including alcohol, among Indian youth 
residing on Indian reservations and in urban areas and the inter-
106 STAT. 4576 
PUBLIC LAW 102-573—OCT. 29, 1992 
relationship of such abuse with the incidence of mental illness 
among such youth. 
Reports. 
"(2) The Secretary shall submit a report detailing the findings 
of such study, together with recommendations based on such find-
ings, to the Congress no later than two years afber the date of 
the enactment of this section. 
"TRAINING AND COMMUNITY EDUCATION 
25usci665d. 
"SEC. 705. (a) COMMUNITY EDUCATION.—The Secretary, in 
cooperation with the Secretary of the Interior, shall develop and 
implement within each service unit a program of community edu-
cation and involvement which shall be designed to provide concise 
and timely information to the commimity leadership of each tribal 
community. Such program shall include education in alcohol and 
substance abuse to political leaders, tribal judges, law enforcement 
personnel, members of tribal health and education boards, and 
other critical members of each tribal community. 
"(b) TRAINING.—^The Secretary shall, either directly or by con-
tract, provide instruction in the area of alcohol and substance 
abuse, including instruction in crisis intervention and family rela-
tions in the context of alcohol and substance abuse, youth alcohol 
and substance abuse, and the causes and effects of fetal sdcohol 
S3nidrome to appropriate employees of the Bureau of Indian Affairs 
and the Service, and to personnel in schools or programs operated 
under any contract with the Bureau of Indian Afmirs or the Service, 
including supervisors of emergency shelters and halfway houses 
described in section 4213 of the Indian Alcohol and Substance 
Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2433). 
"(c) COMMUNITY-BASED TRAINING MODELS.—In carrsdng out 
the 
education and training programs required by this section, the Sec-
retary, acting through the Service and in consultation with tribes 
and Indian alcohol and substance abuse prevention experts, shall 
develop and provide community-based training models. Such models 
shall address— 
"(1) the elevated risk of alcohol and substance abuse faced 
by children of alcoholics; 
"(2) the cultural and multigenerational aspects of alcohol 
and substance abuse prevention and recovery; and 
"(3) community-based and multidisciplinary strategies for 
preventing and treating alcohol and substance abuse. 
"GALLUP ALCOHOL AND SUBSTANCE ABUSE TREATMENT CENTER 
25 use I665e. 
«SEC. 706. (a) GRANTS FOR RESIDENTIAL TREATMENT.—The Sec-
retary shall make grants to the Navajo Nation for the purpose 
of providing residential treatment for alcohol and substance abuse 
for adult and adolescent members of the Navajo Nation and 
neighboring tribes. 
"(b) PURPOSES OF GRANTS.—Grants made pursuant to this sec-
tion shall (to the extent appropriations are made available) be 
used to— 
"(1) provide at least 15 residential beds each year for adult 
long-term treatment, including beds for specialized services 
such as polydrug abusers, dual diagnosis, and speciahzed serv-
ices for women with fetal alcohol syndrome children; 
"(2) establish clinical assessment teams consisting of a 
clinical psychologist, a part-time addictionologist, a master's 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4577 
level assessment counselor, and a certified medical records 
technician which shall be responsible for conducting individual 
assessments and matching Indian chents with the appropriate 
available treatment; 
"(3) provide at least 12 beds for an adolescent shelterbed 
program in the city of Gallup, New Mexico, which shall serve 
as a satellite facility to the Acoma/Canoncito/Laguna Hospital 
and the adolescent center located in Shiprock, New Mexico, 
for emergency crisis services, assessment, and family interven-
tion; 
"(4) develop a relapse program for the purposes of identify-
ing sources of job training and job opportunity in the Gallup 
area and providing vocational training, job placement, and job 
retention services to recovering substance abusers; and 
"(5) provide continuing education and training of treatment 
staff in the areas of intensive outpatient services, development 
of family support systems, and case management in cooperation 
with regional colleges, community colleges, and universities. 
"(c) CONTRACT FOR RESIDENTIAL TREATMENT.—The Navajo 
Nation, in carrying out the purposes of this section, shall enter 
into a contract with an institution in the Gallup, New Mexico, 
area which is accredited by the Joint Commission of the Accredita-
tion of Health Care Organizations to provide comprehensive alcohol 
and drug treatment as authorized in subsection (b). 
"(d) AUTHORIZATION OF APPROPRIATIONS.—There are authorized 
to be appropriated— 
"(1) to carry out the purposes of subsection (b)(1)— 
"(A) $400,000 for fiscal year 1993; 
"(B) $400,000 for fiscal year 1994; and 
"(C) $500,000 for fiscal year 1995; 
"(2) to carry out the purposes of subsection (b)(2)— 
"(A) $100,000 for fiscal year 1993; 
"(B) $125,000 for fiscal year 1994; and 
"(C) $150,000 for fiscal year 1995; 
"(3) to carry out the purposes of subsection (b)(3)— 
"(A) $75,000 for fiscal year 1993; 
"(B) $85,000 for fiscal year 1994; and 
"(C) $100,000 for fiscal year 1995; 
"(4) to carry out the purposes of subsection (b)(4), $150,000 
for each of fiscal years 1993,1994, and 1995; and 
"(5) to carry out the purposes of subsection (bX5)— 
"(A) $75,000 for fiscal year 1993; 
"(B) $90,000 for fiscal year 1994; and 
"(C) $100,000 for fiscal year 1995. 
"REPORTS 
"SEC. 707. (a) COMPILATION OF DATA.—The Secretary, with 
respect to the administration of any health program by a service 
unit, directly or through contract, including a contract under the 
Indian Self-Determination Act, shall require the compilation of 
data relating to the number of cases or incidents in which any 
Service personnel or services were involved and which were related, 
either mrectly or indirectly, to alcohol or substance abuse. Such 
report shall include the type of assistance provided and the dis-
position of these cases. 
"(b) REFERRAL OF DATA.—^The data compiled under subsection 
(a) shall be provided annually to the affected Indian tribe and 
New Mexico. 
New Mexico. 
25 u s e 1665f. 
106 STAT. 4578 
PUBLIC LAW 102-573—OCT. 29, 1992 
Tribal Coordinating Committee to assist them in developing or 
modifying a Tribal Action Plan under section 4206 of the Indian 
Alcohol and Substance Abuse Prevention and Treatment Act of 
1986 (25 U.S.C. 2471 et seq.). 
"(c) COMPREHENSIVE REPORT.—Each service unit director shall 
be responsible for assembling the data compiled under this section 
and section 4214 of the Indian Alcohol and Substance Abuse Preven-
tion and Treatment Act of 1986 (25 U.S.C. 2434) into an annual 
tribal comprehensive report. Such report shall be provided to the 
affected tribe and to the Director of the Service who shall develop 
and publish a biennial national report based on such tribal com-
prehensive reports. 
"FETAL ALCOHOL SYNDROME AND FETAL ALCOHOL EFFECT GRANTS 
25USCi665g. 
"SEC. 708. (a)(1) The Secretary may make grants to Indian 
tribes and tribal organizations to establish fetal alcohol syndrome 
and fetal alcohol effect programs as provided in this section for 
the purposes of meeting the health status objectives specified in 
section 3(b). 
"(2) Grants made pursuant to this section shall be used to— 
"(A) develop and provide community and in-school training, 
education, and prevention programs relating to FAS and FAE; 
"(B) identify and provide alcohol and substance abuse treat-
ment to high-risk women; 
"(C) identify and provide appropriate educational and voca-
tional support, counseling, advocacy, and information to FAS 
and FAE affected persons and their families or caretakers; 
"(D) develop and implement counseling and support pro-
grams in schools for FAS and FAE affected children; 
"(E) develop prevention and intervention models which 
incorporate traditional healers, cultural values and community 
involvement; 
"(F) develop, print, and disseminate education and preven-
tion materials on FAS and FAE; and 
"(G) develop and implement, through the tribal consultation 
process, culturally sensitive assessment and diagnostic tools 
for use in tribal and urban Indism communities. 
"(3) The Secretary shall establish criteria for the review and 
approval of applications for grants under this section. 
"(b) The Secretary, acting through the Service, shall— 
"(1) develop an annual plan for the prevention, interven-
tion, treatment, and aftercare for those affected by FAS and 
FAE in Indian communities; 
"(2) conduct a study, directly or by contract with any 
organization, entity, or institution of higher education with 
significant knowledge of FAS and FAE and Indian communities, 
of the special educational, vocational, school-to-work transition, 
and independent living needs of adolescent and adult Indians 
and Alaska Natives with FAS or FAE; and 
Establishment. 
"(3) establish a national clearinghouse for prevention and 
educational materials and other information on FAS and FAE 
effect in Indian and Alaska Native conununities and ensure 
access to clearinghouse materials by any Indian tribe or urban 
Indian organization. 
Establishment. 
"(c) The Secretary shall establish a task force to be known 
as the FAS/FAE Task Force to advise the Secretary in carrying 
out subsection (b). Such task force shall be composed of rep-
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4579 
resentatives from the National Institute on Drug Abuse, the 
National Institute on Alcohol and Alcoholism, the Office of Sub-
stance Abuse Prevention, the National Institute of Mental Health, 
the Service, the Office of Minority Health of the Department of 
Health and Human Services, the Administration for Native Ameri-
cans, the Bureau of Indian Affairs, Indian tribes, tribal orgsiniza-
tions, urban Indian communities, and Indian FAS/FAE experts. 
"(d) The Secretary, acting through the Substance Abuse and 
Mental Health Services Administration, shall make grants to Indian 
tribes, tribal organizations, universities working with Indian tribes 
on cooperative projects, and urban Indian organizations for applied 
research projects which propose to elevate the understanding of 
methods to prevent, intervene, treat, or provide aftercare for Indians 
and urban Indians affected by FAS or FAE. 
"(e)(1) The Secretary shall submit to the President, for inclusion Reports, 
in each report required to be transmitted to the Congress imder 
section 801, a report on the status of FAS and FAE in the Indian 
population. Such report shall include, in addition to the information 
required under section (3)(d) with respect to the health status 
objective specified in section (3)(b)(27), the following: 
"(A) The progress of implementing a uniform assessment 
and diagnostic methodology in Service and tribally based service 
delivery systems. 
"(B) The incidence of FAS and FAE babies bom for all 
births by reservation £md urban-based sites. 
"(C) The prevalence of FAS and FAE affected Indian per-
sons in Indian communities, their primary means of support, 
and recommendations to improve the support system for these 
individuals and their families or caretakers. 
"(D) The level of support received from the entities specified 
in subsection (c) in the area of FAS and FAE. 
"(E) The number of inpatient and outpatient substance 
abuse treatment resources which are specifically designed to 
meet the unique needs of Indian women, and the volume of 
care provided to Indian women through these means. 
*(F) Recommendations regarding the prevention, interven-
tion, and appropriate vocational, educationsil and other support 
services for FAS and FAE affected individuals in Indian commu-
nities. 
"(2) The Secretary may contract the production of this report 
to a national organization specifically addressing FAS and FAE 
in Indian communities. 
"(f)(1) There are authorized to be appropriated to carry out 
this section $22,000,000 for fiscal year 1993 and such sums as 
may be necessary for each of the fiscal years 1994, 1995, 1996, 
1997,1998,1999, and 2000. 
"(2) Ten percent of the funds appropriated pursuant to this 
section shall be used to make grants to urban Indian organizations 
funded under title V. 
PUEBLO 
SUBSTANCE 
ABUSE 
TREATMENT 
PROJECT 
FOR 
SAN 
JUAN 
PUEBLO, 
NEW 
MEXICO 
"SEC. 709. The Secretary, acting through the Service, shall 
continue to make grants, through fiscal year 1995, to the 8 Northern 
Indian Pueblos Council, San Juan Pueblo, New Mexico, for the 
purpose of providing substance abuse treatment services to Indians 
in need of such services. 
Greints. 
25 use 1665h. 
106 STAT. 4580 
PUBLIC LAW 102-573—OCT. 29, 1992 
Grants. 
Wyoming. 
25 USCT665i. 
25 u s e 1665J. 
Contracts. 
Grants. 
Reports. 
"THUNDER CHILD TREATMENT CENTER 
"SEC. 710. (a) The Secretary, acting through the Service, shall 
make a grant to the Intertribal Addictions Recovery Organization, 
Inc. (commonly known as the Thunder Child Treatment Center) 
at Sheridan, Wyoming, for the completion of construction of a 
multiple approach substance abuse treatment center which special-
izes in the treatment of alcohol and drug abuse of Indians. 
"(b) For the purposes of carrying out subsection (a), there 
are authorized to be appropriated $2,()00,000 for fiscal years 1993 
and 1994. No funding shall be available for staffing or operation 
of this facility. None of the funding appropriated to carry out 
subsection (a) shall be used for administrative purposes. 
"SUBSTANCE ABUSE COUNSELOR EDUCATION DEMONSTRATION 
PROJECT 
"SEC. 711. (a) The Secretary, acting through the Service, may 
enter into contracts with, or make grants to, accredited tribally 
controlled community colleges, tribally controlled postsecondary 
vocational institutions, and eligible community colleges to establish 
demonstration projects to develop educational curricula for sub-
stance abuse counseling. 
"(b) Funds provided under this section shall be used only for 
developing and providing educational curricula for substance abuse 
counseling (including paying salaries for instructors). Such curricula 
may be provided through satellite campus programs. 
"(c) A contract entered into or a grant provided under this 
section shall be for a period of one year. Such contract or grant 
may be renewed for an additional one year period upon the approval 
of the Secretary. 
"(d) Not later than 180 days after the date of the enactment 
of this section, the Secretary, after consultation with Indian tribes 
and administrators of accredited tribally controlled community col-
leges, tribally controlled postsecondary vocational institutions, and 
eligible community colleges, shall develop and issue criteria for 
the review and approval of applications for funding (including 
applications for renewals of funding) under this section. Such cri-
teria shall ensure that demonstration projects established under 
this section promote the development of tne capacity of such entities 
to educate substance abuse counselors. 
"(e) The Secretary shall provide such technical and other assist-
ance as may be necessary to enable grant recipients to comply 
with the provisions of this section. 
"(f) The Secretary shall submit to the President, for inclusion 
in the report which is required to be submitted under section 
801 for fiscal year 1999, a report on the findings and conclusions 
derived from the demonstration projects conducted under this sec-
tion. 
"(g) For the purposes of this section, the following definitions 
apply: 
"(1) The term 'educational curriculum' means one or more 
of the following: 
"(A) Classroom education. 
"(B) Clinical work experience. 
"(C) Continuing education workshops. 
"(2) The term 'eligible community college' means an accred-
ited community college that— 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4581 
"(i) is located on or near an Indian reservation; 
"(ii) has entered into a cooperative agreement with 
the governing body of such Indian reservation to carry 
out a demonstration project under this section; and 
"(iii) has a student enrollment of not less than 
10 percent Indian. 
"(3) The term 'tribally controlled community college' has 
the meaning given such term in section 2(a)(4) of the Tribally 
Controlled Commimity College Assistance Act of 1978 (25 
U.S.C. 1801(a)(4)). 
"(4) The term 'tribally controlled postsecondary vocational 
institution' has the meaning given such term in section 390(2) 
of the Tribally Controlled Vocational Institutions Support Act 
of 1990 (20 U.S.C. 2397h(2)). 
"(h) There are authorized to be appropriated for each of the 
fiscal years 1993, 1994, 1995, 1996, and 1997, such sums as may 
be necessary to carry out the purposes of this section. Such sums 
shall remain available until expended. 
"GILA RIVER ALCOHOL AND SUBSTANCE ABUSE TREATMENT FACILITY 
"SEC. 712. (a) The Secretary, acting through the Service, shall 
establish a regional youth alcohol and substance abuse prevention 
and treatment center in Sacaton, Arizona, on the Gila River Indian 
Reservation. The center shall be established within facilities leased, 
with the consent of the Gila River Indian Community, by the 
Service from such Community. 
"(b) The center establisned pursuant to this section shall be 
known as the ^Regional Youth Alcohol £uid Substance Abuse Preven-
tion £uid Treatment Center*. 
"(c) The Secretary, acting through the Service, shall establish, 
as a unit of the regional center, a youth alcohol and substance 
abuse prevention and treatment facihty in Fallon, Nevada. 
"ALASKA NATIVE DRUG AND ALCOHOL ABUSE DEMONSTRATION 
PROJECT 
Establishment. 
Arizona. 
25 use 1665k. 
Establishment. 
Nevada. 
Grants. 
25 use 1665/. 
"SEC. 713. (a) The Secretary, acting through the Service, shall 
make grants to the Alaska Native Health Board for the conduct 
of a two-part community-based demonstration project to reduce 
drug and alcohol abuse in Alaska Native villages and to rehabilitate 
families afflicted by such abuse. Sixty percent of such grant funds 
shall be used by the Health Board to stimulate coordinated commu-
nity development programs in villages seeking to organize to combat 
alcohol and drug use. Forty percent of such grant fimds shall 
be transferred to a qusdified nonprofit corporation providing alcohol 
recovery services in the village of St. Mary's, Alaska, to enlarge 
and strengthen a famiily life demonstration program of rehabilita-
tion for famiUes that have been or are amicted by alcoholism. 
"(b) The Secretary shall submit to the President for inclusion Reports 
in the report required to be submitted to the Congress under 
section 801 for fiscal year 1995 an evaluation of the demonstration 
project established under subsection (a). 
AUTHORIZATION OF APPROPRIATIONS 
"SEC. 714. Except as provided in sections 703, 706, 708> 710, 
and 711, there are authorized to be appropriated sUch sums as 
25 use 1665m. 
106 STAT. 4582 
PUBLIC LAW 102-573—OCT. 29, 1992 
may be necessary for each fiscal year through fiscal year 2000 
to carry out the provisions of this title.". 
(b) REDESIGNATION AND REPEAL OF EXISTING PROVISIONS.— 
(1) REDESIGNATION.—^The Indian Alcohol and Substance 
Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2401 
25 use 2471, 
et seq.) is amended by redesignating section 4224 as section 
2414a. 
4208A. 
(2) REPEAL.—Part 6 of the Indian Alcohol and Substance 
Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 2471 
25 use 2472- 
et seq.), as amended by paragraph (1), is hereby repesded. 
2478. 
SEC. 703. INDIAN ALCOHOL AND SUBSTANCE ABUSE PREVENTION 
AND TREATMENT ACT OF 1986 AMENDMENTS. 
The Indian Alcohol and Substance Abuse Prevention and Treat-
ment Act of 1986 (25 U.S.C. 2401 et seq.) is amended— 
25 use 2412. 
(1) in section 4206— 
(A) in subsection (c)— 
(i) in paragraph (2)— 
(I) by striking "(2) the" and inserting "(B) the"; 
= 
(II) by striking "(3) the" and inserting "(C) 
the"; 
(III) by striking "(4) the" and inserting "(D) 
the"; 
(IV) in subparagraph (D) (as redesignated by 
subclause (III)), by striking "and" at the end; 
(V) in subparagraph (E), by striking the period 
at the end and inserting ", and"; and 
(VI) by adding at the end the following new 
subparagraph: 
"(F) an evaluation component to measure the success 
of efforts made."; and 
(ii) by adding at the end the following new para-
graph: 
"(3) All Tribal Action Plans shall be updated every 2 years."; 
and 
(B) in subsection (d), by amending paragraph (2) to 
read as follows: 
"(2) There are authorized to be appropriated for grants under 
this subsection not more than $2,000,000 for fiscal year 1993 and 
such sums as are necessary for each of the fiscal years 1994, 
1995, 1996, 1997, 1998, 1999, and 2000."; and 
(C) by adding at the end the following new subsection: 
"(f)(1) The Secretary of the Interior may make grants to Indian 
tribes adopting a resolution pursuant to subsection (a) to implement 
and develop community and in-school training, education, and pre-
vention programs on alcohol and substance abuse, fetal alcohol 
syndrome and fetal alcohol effect. 
"(2) Funds provided under this section may be used for, but 
are not limited to, the development and implementation of tribal 
programs for— 
"(A) youth employment; 
"(B) youth recreation; 
"(C) youth cultural activities; 
"(D) community awareness programs; and 
"(E) community training and education programs. 
"(3) There are authorized to be appropriated to carry out the 
provisions of this subsection $5,000,000 for fiscal year 1993 and 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4583 
such sums as are necessary for each of the fiscal years 1994, 
1995,1996,1997,1998,1999, and 2000."; 
(2) in section 4207(b), by amending paragraph (3) to read 25 USC 2413. 
as follows: 
"(3) The Assistant Secretary of the Interior for Indian 
Affairs shall appoint such employees to work in the Office 
of Alcohol and Substance Abuse, and shall provide such funding, 
services, and equipment as may be necessary to enable the 
Office of Alcohol and Substance Abuse to carry out its respon-
sibilities."; 
(3) in section 4210, by amending subsection (b) to read 25 USC 2416. 
as follows: 
"(b) AUTHORIZATION OF APPROPRIATIONS.—^There are authorized 
to be appropriated to carry out this section $500,000 for fiscal 
year 1993 and such sums as may be necessary for each of the 
fiscal years 1994, 1995, 1996,1997, 1998, 1999, and 2000."; 
(4) in section 4212(a), by striking out "1989, 1990, 1991, 25 USC 2432. 
and 1992" and inserting in Heu thereof "1993, 1994, 1995, 
1996, 1997, 1998, 1999, and 2000"; 
(5) in section 4213(e), by amending paragraphs (1) and 25 USC 2433. 
(2) to read as follows: 
"(1) For the planning and design, construction, and renovation 
of, or purchase or lease of land or facilities for, emergency shelters 
and half-way houses to provide emergency care for Indian youth, 
there are authorized to be appropriated $10,000,000 for fiscal year 
1993 and such sums as may be necessary for each of the fiscal 
years 1994, 1995, 1996,1997, 1998, 1999, and 2000. 
"(2) For the staffing and operation of emergency shelters and 
half-way houses, there are authorized to be appropriated $5,000,000 
for fiscal year 1993 and $7,000,000 for each of the fiscal years 
1994, 1995, 1996, 1997, 1998, 1999, and 2000."; 
(6) in section 4216(a)(1)— 
25 USC 2442. 
(A) in subpara]?raph (A), by striking "and" at the end; 
(B) in subparagraph (B), by striking the period at 
the end and inserting ", and"; and 
(C) by adding at the end the following new subpara-
graph: 
"(C) the Makah Indian Tribe of Washington for the inves- Washington, 
tigation and control of illegal narcotic traffic on the Makah 
Indian Reservation arising from its proximity to international 
waters."; 
(7) by amending section 4216(a)(3) to read as follows: 
"(3) For the purpose of providing the assistance required by 
this subsection, there are authorized to be appropriated— 
"(A) $500,000 under paragraph (1)(A) for fiscal year 1993 
and such sums as may be necessary for each of the fiscal 
years 1994,1995,1996,1997,1998,1999, and 2000, 
"(B) $500,000 under paragraph (1)(B) for fiscal year 1993 
and such sums as may be necessary for each of the fiscsd 
years 1994, 1995,1996, 1997, 1998, 1999, and 2000, and 
"(C) $500,000 under paragraph (1)(C) for fiscal year 1993 
and such sums as may be necessary for each of the fiscal 
years 1994,1995, 1996, 1997, 1998, 1999, and 2000."; 
(8) by amending section 4216(b) to read as follows: 
"(b)(1) MARIJUANA ERADICATION AND INTERDICTION.—The Sec-
retary of the Interior, in cooperation with appropriate Federal, 
tribal, and State and local law enforcement agencies, shall establish 
106 STAT. 4584 
PUBLIC LAW 102-573—OCT. 29, 1992 
and implement a program for the eradication of marijuana cul-
tivation, and interdiction, investigation, and control of illegal narcot-
ics trafficking within Indian coimtry as defined in section 1152 
of title 18, United States Code. The Secretary shall establish a 
priority for the use of funds appropriated under paragraph (2) 
for those Indian reservations where the scope of the problem is 
most critical, and such funds shall be available for contracting 
by Indian tribes pursuant to the Indian Self-Determination Act 
(25US.C.450fetseq.). 
"(2) For the purpose of establishing the program required by 
paragraph (1), there are authorized to be appropriated $2,000,000 
for fiscal year 1993 and such sums as may be necessary for each 
of the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, and 2000."; 
25 use 2451. 
(9) in section 4218, by amending subsection (b) to read 
as follows: 
"(b) AUTHORIZATION.—^For the purposes of providing the train-
ing required by subsection (a), there are authorized to be appro-
Eriated $2,000,000 for fiscal year 1993 and such sums as may 
e necessary for each of the fiscal years 1994, 1995, 1996, 1997, 
1998,1999 and 2000."; and 
25 use 2453. 
(10) in section 4220(b), by amending paragraphs (1) and 
(2) to read as follows: 
"(1) For the purpose of constructing or renovating juvenile 
detention centers as provided in subsection (a), there are 
authorized to be appropriated $10,000,000 for fiscal year 1993 
and such sums as may be necessary for each of the fiscal 
years 1994,1995,1996,1997,1998,1999, and 2000. 
"(2) For the purpose of staffing and operating juvenile 
detention centers, there are authorized to be appropriated 
$7,000,000 for fiscal year 1993 and such sums as may be 
necessary for each of the fiscal years 1994, 1995, 1996, 1997, 
, . 
1998,1999, and 2000.". 
TITLE VIII-^VnSCELLANEOUS 
SEC. 801. REPORTS. 
Section 801 of the Act (25 U.S.C. 1671) (as redesignated by 
section 701(b) of this Act) is amended to read as follows: 
" R E P O R T S 
::• . •••'-i.y^\-^'-^ ^ 
"SEO. 801. The President shall, at the time the budget is submit-
ted imder section 1105 of title 31, United States Code, for each 
fiscal year transmit to the Congress a report containing— 
"(1) a report on the progress made in meeting the objectives 
of this Act, including a review of programs estabUshed or 
assisted pursuant to this Act and an assessment and rec-
ommendations of additional programs or additional assistance 
necessary to, at a minimum, provide health services to Indians, 
and ensure a health status for Indians, which are at a parity 
with the health services available to and the health status 
of, the general population; 
"(2) a report on whether, and to what extent, new national 
health care programs, benefits, initiatives, or financing systems 
have had an impact on the purposes of this Act and any 
steps that the Secretary may have taken to consult with Indian 
tribes to address such impact; 
; ,. 
PUBLIC LAW 102-573—OCT. 29,1992 
106 STAT. 4585 
"(3) a report on the use of health services by Indians— 
"(A) on a national and area or other relevant geo-
graphical basis; 
"(B) by gender and age; 
"(C) by source of pajnnent and t3rpe of service; and 
"(D) comparing such rates of use with rates of use 
among comparable non-Indian populations. 
"(4) a separate statement which specifies the amount of 
funds requested to carry out the provisions of section 201; 
"(5) a separate statement of the total amount obligated 
or expended in the most recently completed fiscal year to 
achieve each of the objectives described in section 814, relating 
to infant and maternal mortality and fetal alcohol syndrome; 
"(6) the reports required by sections 3(d), 108(n), 203(b), 
209(j), 301(c), 302(g), 305(a)(3), 403, 708(e), and 817(a), and 
822(f); 
"(7) for fiscal year 1995, the report required by sections 
702(c)(3) and 713(b); 
"(8) for fiscal year 1997, the interim report required by 
section 307(h)(1); and 
"(9) for fiscal year 1999, the reports required by sections 
307(h)(2), 512(b), 711(f), and 821(g).''. 
SEC. 802. REGULATIONS. 
Section 802 of the Act (25 U.S.C. 1672) (as redesignated by 
section 701(b) of this Act) is amended to read as follows: 
Federal 
Register, 
publication. 
"REGULATIONS 
"SEC. 802. Prior to any revision of or amendment to rules 
or regulations promulgated pursuant to this Act, the Secretary 
shall consult with Indian tribes and appropriate national or regional 
Indian organizations and shall publish any proposed revision or 
amendment in the Federal Register not less than sixty days prior 
to the effective date of such revision or amendment in order to 
provide adequate notice to, and receive comments from, other 
interested parties.". 
SEC. 8
0
3
. EXTENSION 
OF 
TREATMENT OF 
ARIZONA 
AS 
A CONTRACT 
HEALTH 
SERVICE 
DELIVERY 
AREA. 
Section 808 of the Act (25 U.S.C. 1678) (as redesignated by 
section 701(b) of this Act) is amended by striking out "1991" and 
inserting in lieu thereof "2000". 
SEC. 804. INFANT AND MATERNAL MORTALITY; FETAL ALCOHOL SYN-
DROME. 
Section 814 of the Act (25 U.S.C. 1680d) (as redesignated by 
section 701(b) of this Act) is amended— 
(1) by striking out "(a)"; and 
(2) by striking out subsection (b). 
SEC. 
8
0
5
. 
REALLOCATION 
OF 
BASE 
RESOURCES. 
Section 817(a) of the Act (25 U.S.C. 1680(g)) (as redesignated 
25 USC 1680g. 
by section 701(b) of this Act) is amended by striking out "Secretary 
has submitted to the Congress" and inserting in lieu thereof the 
following: "Secretary has submitted to the President, for inclusion 
in the report required to be transmitted to the Congress under 
section 801,". 
106 STAT. 4586 
PUBLIC LAW 102-573—OCT. 29, 1992 
SEC. 806. CHILD SEXUAL ABUSE TKEATMENT PROGRAMS. 
Section 819 of the Act (25 U.S.C. 16801) (as redesignated by 
section 701(b) of this Act) is amended to read as follows: 
"CHILD SEXUAL ABUSE TREATMENT PROGRAMS 
"SEC. 819, (a) The Secretary and the Secretary of the Interior 
shall, for each fiscal year through fiscal year 1995, continue the 
demonstration programs involving treatment for child sexual abuse 
provided through the Hopl Tribe and the Asslniboine and Sioux 
Tribes of the Fort Peck Reservation. 
"(b) Beginning October 1, 1995, the Secretary and the Secretary 
of the Interior may establish, in any service area, demonstration 
programs involving treatment for child sexual abuse, except that 
the Secretaries may not establish a greater number of such pro-
grams in one service area than in any other service area until 
there is an equal number of such programs established with respect 
to all service areas from which the Secretary receives qualified 
applications during the application period (as determined by the 
Secretary).". 
SEC. 807. TRIBAL LEASING. 
Section 820 of the Act (25 U.S.C. 1680j) (as redesignated by 
section 701(b) of this Act) is amended to read as follows: 
* 
"TRIBAL LEASING 
"SEC 820. Indian tribes providing health care services pursuant 
to a contract entered into under the Indian Self-Determination 
Act may lease permanent structures for the purpose of providing 
such health care services without obtaining advance approval in 
appropriation Acts.". 
SEC. 
808. EXTENSION OF TERMINATION DATE OF CERTAIN DEM-
ONSTRATION 
PROJECTS; 
JOINT 
VENTURE 
PROJECTS. 
Section 818 of the Act (25 U.S.C. 1680h) (as redesignated 
by section 701(b) of this Act) is amended— 
(1) in subsection (d)— 
(A) in paragraph (1), by inserting before the period 
at the end the following: ", or, in the case of a dem-
onstration project for which a grant is made after Septem-
ber 30, 1990, three years after the date on which such 
grant is made"; and 
(B) in paragraph (2), by striking "1994" and inserting 
"1996"; and 
(2) by amending subsection (e) to read as follows: 
Contracts. 
"(e)(1) The Secretary, acting through the Service, shall make 
arrangements with Indian tribes to establish joint venture dem-
onstration projects under which an Indian tribe shall expend tribal, 
private, or other available nontribal funds, for the acquisition or 
construction of a health facility for a minimum of 20 years, under 
a no-cost lease, in exchange for agreement by the Service to provide 
the equipment, supplies, and staffing for the operation and mainte-
nance of such a health facility. A tribe may utilize tribal funds, 
private sector, or other available resources, including loan guaran-
tees, to fulfill its commitment under this subsection. 
"(2) The Secretary shall make such an arrangement with an 
Indian tribe only if the Secretary first determines that the Indian 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4587 
tribe has the administrative and financial capabiUties necessary 
to complete the timely acquisition or construction of the health 
faciUty described in paragraph (1). 
"(3) An Indian tribe or tribal organization that has entered 
into a written agreement with the Secretary under this subsection, 
and that breaches or terminates without cause such agreement, 
shall be liable to the United States for the amount that has been 
paid to the tribe, or paid to a third party on the tribe's behalf, 
under the agreement. The Secretary has the right to recover tan-
gible property (including suppUes), and equipment, less deprecia-
tion, and any funds expended for operations and maintenance under 
this section. The preceding sentence does not apply to any funds 
expended for the delivery of health care services, or for personnel 
or stgiffing, shall be recoverable.". 
SEC. 809. HOME AND COMMUNITY BASED CARE DEMONSTRATION 
PROJECT. 
Title VIII of the Act (as redesignated by subsections (a) £ind 
(b) of section 701 of this Act) is amended by adding at the end 
the following new section: 
"HOME- AND COMMUNITY-BASED CARE DEMONSTRATION PROJECT 
" S E C 821. (a) The Secretary, acting through the Service, is 25 USC 1680k. 
authorized to enter into contracts with, or make grants to, Indian 
tribes or tribal organizations providing health care services pursu-
ant to a contract entered into under the Indian Self-Determination 
Act, to establish demonstration projects for the delivery of home-
and community-based services to functionally disabled Indians. 
"(b)(1) Fluids provided for a demonstration project under this 
section shall be used only for the delivery of home- and community-
based services (including transportation services) to functionally 
disabled Indians. 
"(2) Such funds may not be used— 
"(A) to make cash pajonents to functionally disabled 
Indians; 
"(B) to provide room and board for functionally disabled 
Indians; 
"(C) for the construction or renovation of facilities or the 
purchase of medical equipment; or 
"(D) for the provision of nursing facility services. 
"(c) Not later than 180 days after the date of the enactment 
of this section, the Secretary, after consultation with Indian tribes 
and tribal organizations, shall develop and issue criteria for the 
approval of apphcations submitted under this section. Such criteria 
shall ensure that demonstration projects established under this 
section promote the development of the capacity of tribes and tribal 
organizations to deliver, or arrange for the delivery of, high quaUty, 
culturally appropriate home- and community-based services to func-
tionally disabled Indians; 
"(d) The Secretary shall provide such technical and other assist-
ance as may be necessary to enable appUcants to comply with 
the provisions of this section. 
"(e) At the discretion of the tribe or tribal organization, services 
provided under a demonstration project established under this sec-
tion may be provided (on a cost basis) to persons otherwise ineUgible 
for the healtn care benefits of the Service. 
106 STAT. 4588 
PUBLIC LAW 102-573—(X?r. 29, 1992 
"(f) The Secretary shall establish not more than 24 dem-
onstration projects under this section. The Secretary may not estab-
lish a greater number of demonstration projects under this section 
in one service area than in any other sendee area until there 
is an equal number of such demonstration projects established 
with respect to all service areas from which the Secretary receives 
appUcations during the application period (as determined by the 
Secretary) which meet the criteria issued pursuant to subsection 
(0. 
Reports. 
"(g) The Secretary shall submit to the President, for inclusion 
in the report which is required to be submitted under section 
801 for fiscal year 1999, a report on the findings and conclusions 
derived from the demonstration projects conducted under this sec-
tion, together with legislative recommendations. 
"(h) For the purposes of this section, the following definitions 
shall apply: 
"(1) The term Tiome- and commimity-based services' means 
one or more of the following: 
"(A) Homemaker/home heedth aide services. 
"(B) Chore services. 
"(C) Personal care services. 
"(D) Nursing care services provided outside of a nursing 
facility by, or under the supervision of, a registered nurse. 
"(E) Respite care. 
"(F) Training for family members in managing a func-
tionally disabled individual. 
"(G) Adult day care. 
"(H) Such other home- and community-based services 
as the Secretary may approve. 
"(2) The term 'functionally disabled' means an individual 
who is determined to require home- and commiuiity-based serv-
ices based on an assessment that uses criteria (including, at 
the discretion of the tribe or tribal organization, activities of 
daily living) developed by the tribe or tribal organization, 
"(i) There are authorized to be appropriated for each of the 
fiscal years 1993, 1994, 1995, 1996, and 1997 such siuns as may 
be necessary to carry out this section. Such sums shall remain 
available until expended.". 
SEC. 810. SHARED SERVICES DEMONSTRATION PROJECTS. 
Title VIII of the Act (as redesignated by subsections (a) and 
(b) of section 701 and amended by section 809 of this Act) is 
amended by adding at the end the following new section: 
"SHARED SERVICES DEMONSTRATION PROJECT 
25 use 1680/. 
"SEC. 822. (a) The Secretary, acting through the Service and 
notwithstanding any other provision of Taw, is authorized to enter 
into contracts with Indian tribes or tribal organizations to establish 
not more than 6 shared services demonstration projects for the 
delivery of long-term care to Indians. Such projects shall provide 
for the sharing of staff or other services between a Service facility 
and a nursing facility owned and operated (directly or by contract) 
by such Indian tribe or tribal organization. 
"(b) A contract entered into pursuant to subsection (a)— 
"(1) may, at the request of the Indian tribe or tribal 
organization, delegate to such tribe or tribal organization such 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4589 
powers of supervision and control over Service employees as 
the Secretary deems necessary to carry out the purposes of 
this section; 
"(2) shall provide that expenses (including salaries) relating 
to services that are shared between the Service facility and 
the tribal facility be allocated proportionately between the Serv-
ice and the tribe or tribal organization; and 
"(3) may authorize such tribe or tribal organization to 
construct, renovate, or expand a nursing facility (including 
the construction of a facility attached to a Service facility), 
except that no funds appropriated for the Service shsdl be 
obligated or expended for such purpose. 
"(c) To be eligible for a contract under this section, a tribe 
or tribal organization, shall, as of the date of the enactment of 
this Act— 
"(1) own and operate (directly or by contract) a nursing 
facihty; 
"(2) have entered into an agreement with a consultant 
to develop a plan for meeting the long-term needs of the tribe 
or tribal organization; or 
"(3) have adopted a tribal resolution providing for the con-
struction of a nursing facihty. 
"(d) Any nursing facility for which a contract is entered into 
luider this section shall meet the requirements for nursing facilities 
under section 1919 of the Social Security Act. 
"(e) The Secretary shall provide such technical and other assist-
ance as may be necessary to enable apphcants to comply with 
the provisions of this section. 
"(f) The Secretary shall submit to the President, for inclusion 
in each report required to be trginsmitted to the Congress under 
section 801, a report on the findings and conclusions derived from 
the demonstration projects conducted under this section.". 
SEC. 811. RESULTS OF DEMONSTRATION PROJECTS. 
Title VIII of the Act (as redesignated by subsections (a) and 
(b) of section 701 and amended by section 810 of this Act) is 
amended by adding at the end the following new section: 
"RESULTS OF DEMONSTRATION PROJECTS 
"SEC. 823. The Secretary shall provide for the dissemination 
to Indian tribes of the findings and results of demonstration projects 
conducted under this Act.". 
SEC. 812. PRIORITY FOR INDIAN RESERVATIONS. 
Title VIII of the Act (as redesignated by subsections (a) and 
(b) of section 701 and amended by section 811 of this Act) is 
amended by adding at the end the following new section: 
"PRIORITY FOR INDIAN RESERVATIONS 
" S E C 824. (a) Beginning on the date of the enactment of this 
section, the Bureau of Indian Affairs and the Service shall, in 
all matters involving the reorganization or development of Service 
facilities, or in the estabUshment of related empi03anent projects 
to address unemployment conditions in economically depressed 
areas, give priority to locating such facihties and projects on Indian 
lands 3" requested by the Indian tribe with jurisdiction over such 
lands. 
Reports. 
25 use 1680m. 
25 use 1680n. 
106 STAT. 4590 
PUBLIC LAW 102-573—(Xrr. 29, 1992 
25 u s e I68O0. 
25 u s e 450f 
note. 
25 use 450f 
note. 
25 u s e 450f 
note. 
"(b) For purposes of this section, the term "Indian lands" 
means— 
"(1) all lands within the Umits of any Indian reservation; 
and 
"(2) any lands title which is held in trust by the United 
States for the benefit of any Indian tribe or individual Indian, 
or held by any Indian tribe or individual Indian subject to 
restriction by the United States against alienation and over 
which an IncUan tribe exercises governmental power.". 
SEC. 813. AUTHORIZATION OF APPROPRIATIONS. 
(a) AUTHORIZATION.—Title VIII of the Act (as redesignated by 
subsections (a) and (b) of section 701 and amended by section 
812 of this Act) is amended by adding at the end the following 
new section: 
"AUTHORIZATION OF APPROPRIATIONS 
"SEC. 825. Except as provided in section 821, there are author-
ized to be appropriated such sums as may be necessary for each 
fiscal year through fiscal year 2000 to carry out this title.". 
(b) CONFORMING AMENDMENTS.—Section 807 of the Act 
(25 
U.S.C. 1677) (as redesignated by subsections (a) and (b) of section 
701 of this Act) is amended by striking out subsection (f). 
SEC. 814. TRIBAL SELF-GOVERNANCE PROJECT. 
The Indian Self-Determination and Education Assistemce Act 
(25 U.S.C. 450f note) is amended— 
(1) in section 301, by inserting after "Interior" the following: 
"and the Secretary of Health and Human Services (hereafter 
in this title referred to as the 'Secretaries') each"; 
(2) in sections 302, 303, 304, and 305, by striking "Sec-
retary" each place it appears and inserting in Heu thereof 
"Secretaries"; 
(3) in section 303(a)(1), by inserting after "Interior" the 
following: "and the Indian Health Service of the Department 
of Health and Human Services"; and 
(4) by adding after section 309 the following new section: 
"SEC. 310. For the purposes of providing one year planning 
and negotiations grants to the Indisin tribes identified by section 
302, with respect to the programs, activities, functions, or services 
of the Indian Health Service, there are authorized to be appro-
priated such sums as may be necessary to carry out such purposes. 
Upon completion of an authorized planning activity or a comparable 
planning activity by a tribe, the Secretary is authorized to negotiate 
and implement a Compact of Self-Governance and Annual Funding 
Agreement with such tribe.". 
TITLE IX—TECHNICAL CORRECTIONS 
SEC. 901. REPEAL OF EXPIRED REPORTING REQUIREMENTS. 
The Act is amended— 
25 use 16161. 
(1) in section 116, by striking out subsection (d); 
25 use 1621c. 
(2) in section 204(a)— 
(A) by striking out paragraph (2); 
(B) by striking out "(aXD" and inserting in lieu thereof 
"(a)"; 
PUBLIC LAW 102-573—OCT. 29, 1992 
106 STAT. 4591 
(C) by redesignating subparagraphs (A) and (B) as 
paragraphs (1) and (2), respectively; and 
(D) in paragraph (2) (as redesignated by subparagraph 
(O), by striking out "subparagraph (A)" and inserting in 
lieu thereof "paragraph (1)"; 
(3) in section 602, by striking out subsection (a)(3); and 
(4) by striking out section 803 (as redesignated by section 
701(b) of this Act). 
SEC. 
902. 
OTHER 
TECHNICAL 
CORRECTIONS. 
The Act is amended— 
(1) in section 4(c), by striking out "sections 102, 103, and 
201(c)(5)," and inserting in lieu thereof the following: "sections 
102 and 103,"; 
(2) in title I— 
(A) in section 102(b)(1), by striking ": Provided, That 
the" and inserting in lieu thereof". The"; 
(B) in section 105(c), by striking out "Department of 
Health, Education, and Welfare" and inserting in lieu 
thereof "Department of Health and Human Services"; 
(C) in section 108(d)(1)(A), by striking out "Indian 
Health" and inserting in lieu thereof "Indian health"; and 
(D) in section 108(i), by striking out "Service manpower 
programs" and inserting in lieu thereof "health professional 
programs of the Service". 
(3) in title II— 
(A) by striking out "SEC. 209. MENTAL HEALTH 
PREVENTION AND TREATMENT SERVICES." and 
inserting in lieu thereof the following: 
25 use 1662. 
25 u s e 1673. 
25 u s e 1603. 
25 u s e 1612. 
25 u s e 1614. 
25 use 1616a. 
25 use 1621h. 
"MENTAL HEALTH PREVENTION AND TREATMENT SERVICES 
"SEC. 209."; and 
(B) in section 209, by redesignating subsections (c) 
through (1) as subsections (b) through (k), respectively; 
(4) in title III— 
(A) by striking out "SEC. 307. INDIAN HEALTH 25USei637. 
CARE DELIVERY DEMONSTRATION PROJECT." and 
inserting in lieu thereof the following: 
"INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECT 
"SEC. 307."; and 
(B) in section 301(d) (as redesignated by section 301(2) 25 USC 1631. 
of this Act), by striking out "sections 102 and 103(b)" and 
inserting in lieu thereof "section 102"; 
(5) in title V— 
(A) by striking out "SEC. 409. FACILITIES REN- 25 USC 1659. 
OVATION." and inserting in lieu thereof the following: 
FACILITIES RENOVATION 
"SEC 509 "• and 
(B) by striking out "SEC. 511. URBAN HEALTH 25 USC 1660. 
PROGRAMS BRANCH." and inserting in lieu thereof 
the following: 
106 STAT. 4592 
25 u s e 1661. 
25 u s e 1680c. 
25 u s e 1680f. 
PUBLIC LAW 102-573—OCT. 29, 1992 
"URBAN HEALTH PROGRAMS BRANCH 
"SEC. 510."* 
(6) in section 601(c)(3)(D), by striking out "(25 U.S.C. 2005, 
et seq.)" and inserting in lieu thereof "(42 U.S.C. 2005 et 
seq.)"; 
(7) in section 601(d)(1)(C), by striking out "appropriate" 
and inserting in lieu thereof "appropriated"; 
(8) in section 813(b)(2)(A) (as redesignated by section 701(b) 
of this Act), by striking out "section 402(c)" and inseriiing in 
lieu thereof "section 402(a)"; and 
(9) by amending the heading for section 816 (as redesig-
nated by section 701(b)) to read as follows: 
"INDIAN HEALTH SERVICE AND DEPARTMENT OF VETERANS AFFAIRS 
HEALTH FACILITIES AND SERVICES SHARING". 
Approved October 29, 1992. 
LEGISLATIVE HISTORY—S. 2481: 
SENATE REPORTS: No. 102-392 (Comm. on Indian Affairs). 
CONGRESSIONAL RECORD, Vol. 138 (1992): 
Sept. 18, considered and passed Senate. 
Oct. 2, 3, considered and passed House, amended. 
Oct. 7, Senate concurred in House amendment. 
WEEKLY COMPILATION OF PRESIDENTIAL DOCUMENTS, Vol. 28 (1992): 
Oct. 29, Presidential statement.