[Senate Report 108-76]
[From the U.S. Government Publishing Office]
Calendar No. 144
108th Congress Report
SENATE
1st Session 108-76
======================================================================
ELEVATING THE POSITION OF DIRECTOR OF THE INDIAN HEALTH SERVICE WITHIN
THE DEPARTMENT OF HEALTH AND HUMAN SERVICES TO ASSISTANT SECRETARY FOR
INDIAN HEALTH, AND FOR OTHER PURPOSES
_______
June 18, 2003.--Ordered to be printed
_______
Mr. Campbell, from the Committee on Indian Affairs, submitted the
following
R E P O R T
[To accompany S. 558]
The Committee on Indian Affairs, to which was referred the
bill (S. 558) to elevate the position of Director of the Indian
Health Service within the Department of Health and Human
Services to Assistant Secretary for Indian Health, and for
other purposes, having considered the same, reports favorably
thereon without amendment and recommends that the bill do pass.
Purpose
The purpose of S. 558 is to elevate the position of the
Director of the Indian Health Service to the status of an
Assistant Secretary within the Department of Health and Human
Services. The bill establishes the Office of Assistant
Secretary for Indian Health in order to further the unique
government-to-government relationship between Indian tribes and
the United States, facilitate advocacy for the development of
Indian health policy, and promote consultation on matters
related to Indian health.
Background
In exchange for ceding millions of acres of land to which
Indian tribes held aboriginal title, the United States entered
into treties with the Indian tribes. Many of the treaties
provided that health care services would be provided to the
citizens of Indian tribes. Some have asserted that these
contracts between the United States and Indian governments
represent the ``first pre-paid health care plan'' in America.
The Federal obligation to provide health care services to
Indians also arises out of the special trust relationship
between the United States and Indian tribes, which reflects the
authority found in Article I, Section 8, clause 3 of the U.S.
Constitution, and which has been given form and substance by
numerous treaties, laws, Supreme Court decisions, and Executive
Orders.
The first Federal statute authorizing the appropriation of
funds to carry out the United States' responsibilities was the
Snyder Act of 1921 (25 U.S.C. 13). In 1976, the Indian Health
Care Improvement Act (25 U.S.C. 1601 et seq.) (IHCIA) became
law. The IHCIA was the first comprehensive statute specifically
addressing the provision of health care to Indians and the
Federal administration of health care.
A. EVOLUTION OF THE INDIAN HEALTH SERVICE
The Bureau of Indian Affairs within the U.S. Department of
the Interior was initially charged with carrying out the United
States responsibility for the provision of health care to
Federally-recognized tribes and their members.
In 1954, in response to a growing concern by the public
health community that the Indian health care responsibility
should be transferred to his authority, the Surgeon General,
acting through the Public Health Service (PHS), established the
Division of Indian Health (DIH) to administer the Indian health
program.
In 1968, the Division became the Indian Health Service
(IHS) and operated as a sub-agency of other agencies within the
Public Health Service including the Health Resources and
Services Administration.
In 1988, the Indian Health Service was established as a
separate agency within the Public Health Service.
On October 1, 1995, the Department of Health and Human
Services (DHHS) reorganized its internal administrative
structure and the Indian Health Service, along with the other
agencies of the Public Health Service, became a separate
operating division of the Department.
Presently, the Director of the Indian Health Service is
appointed by the President and is subject to Senate
confirmation pursuant to 25 U.S.C. 1661(a). Under current law,
the IHS Director reports to the DHHS Secretary through the
Assistant Secretary for Health.
Since the 1995 reorganization of the DHHS, all agencies,
operating divisions, and programs within the Department,
including those previously part of the Public Health Service
and under the direction of the Assistant Secretary for Health,
have been required to report directly to the Secretary. Under
the DHHS restructuring, the position of Assistant Secretary for
Health was combined with the position of Surgeon General and
the Office of Public Health and Science (OPHS) was established.
The Assistant Secretary for Health directs the OPHS, serves as
the Secretary's senior advisor for public health and science,
and provides leadership and coordination across the Department
on public health and science issues.
A key component to the IHS health care system is the Public
Health Service's Commissioned Corps. The Corps was established
by the Congress in 1889 as part of the Marine Hospital Service,
which later became the Public Health Service. The original
mission of the Corps was to provide medical care to sick and
disabled navy and merchant seamen. While the Corps' duties were
expanded during World Wars I and II, its original mission now
serves as the basis for its9 continuing status as a uniformed
service. The Surgeon General is statutorily responsible for
supervising the activities of the Commissioned Corps. The Corps
is also charged with providing technical and financial
assistance to a variety of other federal agencies, state, and
local public health departments.
At the request of this Committee, the General Accounting
Office (GAO) conducted a study of the role of the Corps in the
Indian Health Service system. Corps officers have been assigned
to Indian health agencies since 1926 and the Corps continues to
provide many of the physicians, registered nurses, dentists,
pharmacists, engineers, and sanitarians in Indian health
facilities.
As of August 1999, the Public Health Service employed 5,936
Corps officers of which 2,204 or about 37 percent, are assigned
to the Indian Health Service.
S. 558, as introduced, closely resembles previous versions
of legislation introduced in the last several Congresses, which
resulted from discussions with tribal leaders and
representatives of the DHHS.
Like its legislative predecessors in previous sessions of
the Congress, S. 558 seeks to honor the government-to-
government relationship between the United States and Indian
tribes, to provide the necessary leadership within the
Administration on Indian health issues, and to bring focus and
national attention to the health care status of American
Indians and Alaska Natives. The bill is intended to enhance the
Federal capacity to respond to the ongoing health crisis in
Indian country and the continuing frustrations of Indian
patients that their needs and concerns are not adequately
addressed under the current administrative policy and budgetary
processes.
B. INDIAN HEALTH CARE AND STATUS OF THE IHS
The IHS employs approximately 15,000 employees or about
one-quarter of all DHHS personnel. The IHS is a comprehensive
health care delivery system operating nationwide through a
variety of health care facilities. The IHS provides health care
services directly and through tribally contracted and operated
health care programs operated pursuant to the Indian Self
Determination and Education Assistance Act, 25 U.S.C. 450 et
seq.
Health services are also purchased from more than two
thousand private providers. As of 2002, the IHS system
consisted of 594 direct health care delivery facilities funded
through the IHS: 146 of these were directly operated by the IHS
and 448 were operated by tribes.
These facilities include, among others, 49 hospitals, 231
health care centers, 309 health stations, five school centers,
and 34 urban Indian programs. Each year the IHS provides health
care services to 559 Indian tribes in 35 states and in 2002
provided services to 1.6 million American Indians and Alaska
Natives. In 1998, IHS and tribal hospitals registered some
68,000 admissions and IHS and tribal direct health clinics
provided 7 million outpatient visits.
Previous efforts to address Indian health care needs and
concerns have not greatly affected the steady decline in
purchasing power of the IHS budget. The disparity between
Indian and non-Indian communities in Federal health care
expenditures continues to grow. IHS Health Expenditures for
Fiscal Year 1998 reflect a $1,507 per capita expenditure for
Indians, compared with a $3,383 per capita outlay for non-
Indians.
The Committee strongly believes that the
institutionalization of a senior policy official responsible
for Indian health within the DHHS is necessary to bring parity
to Indian health care needs.
S. 558 is intended to strengthen the Executive Order issued
on April 29, 1994, 59 F.R. 22951, which recognizes the
government-to-government relationship between the United States
and the tribes and the November 6, 2000, Executive Order No.
13175 directing executive agencies to consult with Indian
tribes prior to any Federal action that would affect the
tribes.
C. THE ROLE OF THE ASSISTANT SECRETARY FOR INDIAN HEALTH
On April 9, 2003, the Committee held a hearing to receive
testimony to discuss S. 558, among other legislation. At that
hearing, the National Indian Health Board, a national Indian
health policy advocacy organization, indicated its strong
support for the elevation of the Director of IHS to Assistant
Secretary for Indian Health. Additionally, the Committee has
received a significant volume of correspondence, uniformly
supporting the elevation of the Director of IHS to Assistant
Secretary for Indian Health.
The Administration has indicated its concerns with the
elevation of the IHS Director. Testifying before the Committee,
the DHHS witness noted that significant policymaking role given
to the IHS Director by the DHHSSecretary, and the
revitalization of the Intra-departmental Council for Native American
Affairs, on which the IHS Director serves as Vice-Chair.
The Committee is appreciative of the strong support for,
and emphasis placed on Native health issues by the current
Secretary. However, the Committee remains concerned that future
Secretaries may not place a similarly high priority on Native
health issues and, for that reason, elevation of the Director
to Assistant Secretary is important.
The Committee also recognizes the role of the Assistant
Secretary for Health (Surgeon General) in addressing the health
needs of all citizens of this country, including the American
Indian and Native Alaska populations. S. 558 does not alter the
important role the Assistant Secretary for Health (Surgeon
General) serves, particularly as principal adviser to the
Secretary of DHHS for public health matters affecting the
general population.
It is the Committee's hope that a close collaboration
between the Assistant Secretary for Health and the Assistant
Secretary for Indian Health can serve as a model of interagency
cooperation and partnership and raise the health status of
American Indians and Alaska Natives.
S. 558 elevates the position of the IHS Director, but more
importantly, recognizes the unique government-to-government
relationship between Federally recognized Indian tribes and the
United States. The Assistant Secretary for Indian Health will
provide the necessary leadership and consultation to the
Secretary, the Assistant Secretary for Health, and others, on
the important health issues facing Indian people. S. 558 serves
to support the Federal policy of tribal self-determination and
ensures that Indian people are heard and their concerns are
brought to the table when important policy and budget decisions
are made on their behalf.
The establishment of an Assistant Secretary for Indian
Health will ensure that there is a senior official in current
and future administrations who is knowledgeable about the
United States' legal and moral obligations to Indian people,
the mission of the IHS, and who has the status to advocate
within the DHHS and the Office of Management and Budget for the
funding resources and policies that are necessary to
effectively and efficiently address the health care needs and
concerns of the Indian people.
S. 558 places this important and special leadership role
with the Assistant Secretary for Indian Health.
Legislative History
S. 558 was introduced on March 6, 2003, by Senator McCain
for himself, and for Senators Campbell, Domenici, Johnson,
Bingaman and Murray. The bill was referred to the Committee on
Indian Affairs. Senator Inouye was added as a cosponsor on
March 10, 2003, and Senator Conrad was added on April 1, 2003.
The bill was the subject of a hearing held by the Senate
Indian Affairs Committee on April 9, 2003, during which the
Committee received testimony from the DHHS, the NIHB, and
tribal leaders.
Section-by-Section Analysis
Section 1. Office of Assistant Secretary for Indian Health
Subsection (a) provides definitions for the terms
``Assistant Secretary'', ``Department'', ``Office'', and
``Secretary''.
Subsection (b) provides that the Office of Assistant
Secretary for Indian Health is established within the
Department and will be headed by the Assistant Secretary, who
is appointed by the President and confirmed by the United
States Senate. This subsection further provides for the current
incumbent Director of the IHS to serve as the Assistant
Secretary, at the pleasure of the President, after enactment.
The duties of the Assistant Secretary are to, consistent with
the unique government-to-government relationship between Indian
tribes and the United States, facilitate advocacy for the
development of Indian healthpolicy, and promote consultation on
matters related to Indian health.
Subsection (c) provides that the Assistant Secretary for
Indian Health shall report directly to the Secretary on all
policy and budget related matters affecting Indian health,
collaborate with the Assistant Secretary for Health on Indian
health matters, advise other Assistant Secretaries and others
within DHHS concerning matters of Indian health, perform the
functions of the Director of the Indian Health Service, and
other functions as designed by the Secretary of Health and
Human Services.
Subsection (d) provides technical changes to conform with
the Act. The elevation of the Director of Indian Health Service
to Assistant Secretary would increase the number of assistant
secretaries to seven. This subsection also abolishes the
position of the Director of Indian Health Service.
Subsection (e) amends section 601 of the Indian Health Care
Improvement Act, 25 U.S.C. 1661, by establishing the Indian
Health Service within the Public Health Service and further
outlines and clarifies the duties of the Assistant Secretary
for Indian Health.
Subsection (f) further amends the Indian Health Care
Improvement Act by deleting all provisions referring to ``the
Director'' or ``Director of Indian Health Service'' and
inserting in lieu thereof ``the Assistant Secretary for Indian
Health.'' This subsection also provides for conforming
amendments to other statutes to conform with this Act.
Subsection (g) provides that any references to the Director
of Indian Health Service in any other Federal laws, Executive
order, rule, regulation, or delegation of authority, or any
document will be deemed to refer to the Assistant Secretary for
Indian Health.
Committee Recommendation and Tabulation of Vote
On May 14, 2003, the Committee on Indian Affairs, in an
open business session, considered S. 558. The bill, without
amendment, was ordered favorably reported with a recommendation
that the bill do pass.
Cost and Budgetary Consideration
The cost estimate for S. 558 as calculated by the
Congressional Budget Office, is set forth below:
U.S. Congress,
Congressional Budget Office,
Washington, DC, May 22, 2003.
Hon. Ben Nighthorse Campbell,
Chairman, Committee on Indian Affairs,
U.S. Senate, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for S. 558, a bill to
elevate the position of Director of the Indian Health Service
within the Department of Health and Human Services to Assistant
Secretary for Indian Health, and for other purposes.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Eric Rollins.
Sincerely,
Douglas Holtz-Eakin,
Director.
Enclosure.
Congressional Budget Office Cost Estimate
S. 558--A bill to elevate the position of Director of the Indian Health
Service within the Department of Health and Human Services to
Assistant Secretary for Indian Health, and for other purposes
CBO estimates that enacting this bill would have no
significant effect on the federal budget. S. 558 contains no
intergovernmental or private-sector mandates as defined in the
Unfunded Mandates Reform Act and would not affect the budgets
of state, local, or tribal governments.
S. 558 would establish the position of Assistant Secretary
for Indian Health in lieu of the current position of Director
of the Indian Health Service. The duties and responsibilities
of the office would not be changed significantly. The rate of
pay would increase from level V to level IV of the Executive
Schedule, an increase of $8,600. This change would not affect
the salary of the current Director of the Indian Health
Service, because his pay is governed by the pay structure of
the Public Health Service Commissioned Corps.
The CBO staff contact for this estimate is Eric Rollins.
This estimate was approved by Peter H. Fontaine, Deputy
Assistant Director for Budget Analysis.
Regulatory Impact Statement
Paragraph 11(b) of rule XXVI of the Standing Rules of the
Senate requires that each report accompanying a bill to
evaluate the regulatory paperwork impact that would be incurred
in carrying out the bill. The Committee believes that S. 558
will have minimal regulatory or paperwork impact.
Executive Communications
There have been no executive communications received
regarding this legislation.
Changes in Existing Law
In compliance with subsection 12 of rule XXVI of the
Standing Rules of the Senate, the Committee states that
enactment of S. 558 will result in the following changes in the
following statutes as noted below, with existing language which
is to be deleted in brackets and the new language which is to
be added in italic:
UNITED STATES CODE
TITLE 5.--GOVERNMENT ORGANIZATION AND EMPLOYEES
* * * * * * *
SEC. 5315. POSITIONS AT LEVEL IV.
Level IV of the Executive Schedule applies to the following
positions, for which the annual rate of basic pay shall be the
rate determined with respect to such level under chapter 11 of
title 2, as adjusted by section 5318 of this title: * * *
Assistant Secretaries of Health and Human Services [(6)]
(7). * * *
* * * * * * *
SEC. 5316. POSITIONS AT LEVEL V.
Level V of the Executive Schedule applies to the following
positions, for which the annual rate of basic pay shall be the
rate determined with respect to such level under 11 of title 2,
as adjusted by section 5318 of this title: * * *
[Director, Indian Health Service, Department of Health and
Human Services.] * * *
* * * * * * *
UNITED STATES CODE
TITLE 29.--LABOR
* * * * * * *
SEC. 5315. INTERAGENCY COMMITTEE.
(a) --
(1) In order to promote coordination and cooperation among
Federal departments and agencies conducting rehabilitation
research programs, including programs relating to assistive
technology research and research that incorporates the
principles of universal design, there is established within the
Federal Government an Interagency Committee on Disability
Research (hereinafter in this section referred to as the
``Committee''), chaired by the Director and comprised of such
members as the President may designate, including the following
(or their designees): the Director, the Commissioner of the
Rehabilitation Services Administration, the Assistant Secretary
for Special Education and Rehabilitative Services, the
Secretary of Education, the Secretary of Veterans Affairs, the
Director of the National Institutes of Health, the Director of
the National Institute of Mental Health, the Administrator of
the National Aeronautics and Space Administration, the
Secretary of Transportation, the Assistant Secretary of the
Interior for Indian Affairs, the Assistant Secretary for Indian
Health, and the Director of the National Science Foundation. *
* *
* * * * * * *
UNITED STATES CODE
TITLE 33.--NAVIGATION AND NAVIGABLE WATERS
* * * * * * *
SEC. 1377. INDIAN TRIBES. * * *
* * * * * * *
(B) Assessment of Sewage Treatment Needs; Report.--The
Administrator in cooperation with the [Director of the Indian
Health Service] Assistant Secretary for Indian Health, shall
assess the need for sewage treatment works to serve Indian
tribes, the degree to which such needs will be met through
funds allotted to States under section 205 of this Act and
priority lists under section 216 of this Act, and any obstacles
which prevent such needs from being met. Not later than one
year after the date of the enactment of this section, the
Administrator shall submit a report to Congress on the
assessment under this subsection, along with recommendations
specifying (1) how the Administrator intends to provide
assistance to Indian tribes to develop waste treatment
management plans and to construct treatment works under this
Act, and (2) methods by which the participation in and
administration of programs under this Act by Indian tribes can
be maximized. * * *
* * * * * * *
(e) Treatment as States.--The Administrator is authorized
to treat an Indian tribe as a State for purposes of title II
and sections 104, 106, 303, 305, 308, 309, 314, 319, 401, 402,
404, and 406 of this Act to the degree necessary to carry out
the objectives of this section, but only if-- * * *
(3) the Indian tribe is reasonably expected to be
capable, in the Administrator's judgment, of carrying
out the functions to be exercised in a manner
consistent with the terms and purposes of this Act and
of all applicable regulations.
Such treatment as a State may include the direct provision of
funds reserved under subsection (c) to the governing bodies of
Indian tribes, and the determination of priorities by Indian
tribes, where not determined by the Administrator in
cooperation with the [Director of the Indian Health Service]
Assistant Secretary for Indian Health. The Administrator, in
cooperation with the [Director of the Indian Health Service]
Assistant Secretary for Indian Health, is authorized to make
grants under title II of this Act in an amount not to exceed
100 percent of the cost of a project. Not later than 18 months
after the date of the enactment of this section, the
Administrator shall, in consultation with Indian tribes,
promulgate final regulations which specify how Indian tribes
shall be treated as States for purposes of this Act. The
Administrator shall, in promulgating such regulations, consult
affected States sharing common water bodies and provide a
mechanism for the resolution of any unreasonable consequences
that may arise as a result of differing water quality standards
that may be set by States and Indian tribes located on common
bodies of water. Such mechanism shall provide for explicit
consideration of relevant factors including, but not limited
to, the effects of differing water quality permit requirements
on upstream and downstream dischargers,economic impacts, and
present and historical uses and quality of the waters subject to such
standards. Such mechanism should provide for the avoidance of such
unreasonable consequences in a manner consistent with the objective of
this Act. * * *
* * * * * * *
UNITED STATES CODE
TITLE 42.--PUBLIC HEALTH AND WELFARE
* * * * * * *
SEC. 247B-14. ORAL HEALTH PROMOTION AND DISEASE PREVENTION. * * *
* * * * * * *
(b) Community Water Fluoridation.
(1) In general.--The Secretary, acting through the
Director of the Centers for Disease Control and
Prevention and in collaboration with the [Director of
the Indian Health Service] Assistant Secretary for
Indian Health, shall establish a demonstration project
that is designed to assist rural water systems in
successfully implementing the water fluoridation
guidelines of the Centers for Disease Control and
Prevention that are entitled ``Engineering and
Administrative Recommendations for Water Fluoridation,
1995'' (referred to in this subsection as the
``EARWF'').
(2) Requirements.
(A) Collaboration.--In collaborating under
paragraph (1), [the Directors] the Director of
the Centers for Disease Control and Prevention
and the Assistant Secretary for Indian Health
referred to in such paragraph shall ensure that
technical assistance and training are provided
to tribal programs located in each of the 12
areas of the Indian Health Service. The
[Director of the Indian Health Service]
Assistant Secretary for Indian Health shall
provide coordination and administrative support
to tribes under this section. * * *
* * * * * * *
SEC. 285A-9. GRANTS FOR EDUCATION, PREVENTION, AND EARLY DETECTION OF
RADIOGENIC CANCERS AND DISEASES. * * *
* * * * * * *
(b) In General.--The Secretary, acting through the
Administrator of the Health Resources and Services
Administration in consultation with the Director of the
National Institutes of Health and the [Director of the Indian
Health Service] Assistant Secretary for Indian Health, may make
competitive grants to any entity for the purpose of carrying
out programs to-- * * *
* * * * * * *
SEC. 300J-12. STATE REVOLVING LOAN FUNDS. * * *
* * * * * * *
(i) Indian Tribes. * * *
* * * * * * *
(2) Use of funds.--Funds reserved pursuant to
paragraph (1) shall be used to address the most
significant threats to public health associated with
public water systems that serve Indian Tribes, as
determined by the Administrator in consultation with
the [Director of the Indian Health Service] Assistant
Secretary for Indian Health and Indian Tribes. * * *
* * * * * * *
(4) Needs assessment.--The Administrator, in
consultation with the [Director of the Indian Health
Service] Assistant Secretary for Indian Health and
Indian Tribes, shall, in accordance with a schedule
that is consistent with the needs surveys conducted
pursuant to subsection (h), prepare surveys and assess
the needs of drinking water treatment facilities to
serve Indian Tribes, including an evaluation of the
public water systems that pose the most significant
threats to public health. * * *
* * * * * * *
SEC. 2991B-2. ESTABLISHMENT OF ADMINISTRATION FOR NATIVE AMERICANS. * *
*
* * * * * * *
(d) Intra-Departmental Council on Native American Affairs.
(1) There is established in the Office of the
Secretary the Intra-Departmental Council on Native
American Affairs. The Commissioner shall be the
chairperson of such Council and shall advise the
Secretary on all matters affecting Native Americans
that involve the Department. The [Director of the
Indian Health Service] Assistant Secretary for Indian
Health shall serve as vice chairperson of the Council.
* * *
* * * * * * *
INDIAN HEALTH CARE IMPROVEMENT ACT
PUBLIC LAW 94-437
AN ACT To implement the Federal responsibility for the care and
education of the Indian people by improving the services and facilities
of Federal Indian health programs and encouraging maximum participation
of Indians in such programs, and for other purposes
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
* * * * * * *
[SEC. 601. ESTABLISHMENT OF INDIAN HEALTH SERVICE AS AN AGENCY OF
PUBLIC HEALTH SERVICE.
[(a) Establishment.--In order to more effectively and
efficiently carry out the responsibilities, authorities, and
functions of the United States to provide health care services
to Indians and Indian tribes, as are or may be on and after
November 23, 1988, provided by Federal statute or treaties,
there is established within the Public Health Service of the
Department of Health and Human Services the Indian Health
Service. The Indian Health Service shall be administered by a
Director, who shall be appointed by the President, by and with
the advice and consent of the Senate. The Director of the
Indian Health Service shall report to the Secretary through the
Assistant Secretary for Health of the Department of Health and
Human Services. 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. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN AGENCY OF
THE PUBLIC HEALTH SERVICE.
(a) Establishment.--
(1) In general.--In order to more effectively and
efficiently carry out the responsibilities,
authorities, and functions of the United States to
provide health care services to Indians and Indian
tribes, there is established within the Public Health
Service of the Department of Health and Human Services
the Indian Health Service.
(2) Administration.--The Indian Health Service shall
be administered by the Assistant Secretary for Indian
Health.
(3) Duties.--In carrying out paragraph (2), the
Assistant Secretary for Indian Health shall--
(A) report directly to the Secretary
concerning all policy- and budget-related
matters affecting Indian health;
(B) collaborate with the Assistant Secretary
for Health concerning appropriate matters of
Indian health that affect the agencies of the
Public Health Service;
(C) advise each Assistant Secretary of the
Department of Health and Human Services
concerning matters of Indian health with
respect to which that Assistant Secretary has
authority and responsibility;
(D) advise the heads of other agencies and
programs of the Department of Health and Human
Services concerning matters of Indian health
with respect to which those heads have
authority and responsibility;
(E) coordinate the activities of the
Department of Health and Human Services
concerning matters of Indian health; and
(F) perform such other function as the
Secretary may designate. * * *
* * * * * * *
(c) The Secretary shall carry out through the [Director of
the Indian Health Service] Assistant Secretary for Indian
Health--
(1) all functions which were, on the day before
November 23, 1988, carried out by or under the
direction of the individual serving as [Director of the
Indian Health Service] Assistant Secretary for Indian
Health. * * *
* * * * * * *
(d) Authority of Secretary.--
(1) The Secretary, acting through the [Director of
the Indian Health Service] Assistant Secretary for
Indian Health, shall have the authority--* * *
* * * * * * *
SEC. 816. INDIAN HEALTH SERVICE AND DEPARTMENT OF VETERANS AFFAIRS
HEALTH FACILITIES AND SERVICES SHARING. * * *
* * * * * * *
(c) Cross Utilization of Services.--
(1) Not later than December 23, 1988, the [Director
of the Indian Health Service] Assistant Secretary for
Indian Health and the Secretary of Veterans Affairs
shall implement an agreement under which-- * * *
* * * * * * *
CHILDREN'S HEALTH ACT OF 2000
PUBLIC LAW 106-310
AN ACT To amend the Public Health Service Act with respect to
children's health
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
* * * * * * *
SEC. 3307. ESTABLISHMENT OF COMMISSION. * * *
* * * * * * *
(b) Membership.--
(1) In general.--The Commission established under
subsection (a) shall consist of--
(A) the Secretary;
(B) 15 members who are experts in the health
care field and issues that the Commission is
established to examine; and
(C) the [Director of the Indian Health
Service] Assistant Secretary for Indian Health
and the Commissioner of Indian Affairs, who
shall be nonvoting members. * * *
* * * * * * *
INDIAN LANDS OPEN DUMP CLEANUP ACT OF 1994
PUBLIC LAW 103-399
AN ACT To clean up open dumps on Indian lands, and for other purposes
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
* * * * * * *
SEC. 3. DEFINITIONS.
For the purposes of this Act, the following definitions
shall apply:
[(6)] (1) Alaska native entity.--The term ``Alaska
Native entity'' includes native corporations
established pursuant to the Alaska Native Claims
Settlement Act (43 U.S.C. 1600 et seq.) and any Alaska
Native village or municipal entity which owns Alaska
Native land.
[(2) Director.--The term ``Director'' means the
Director of the Indian Health Service.]
[(4)] (2) Alaska native land.--The term ``Alaska
Native land'' means (A) land conveyed or to be conveyed
pursuant to the Alaska Native Claims Settlement Act (43
U.S.C. 1600 et seq.), including any land reconveyed
under section 14(c)(3) of that Act (43 U.S.C.
1613(c)(3)), and (B) land conveyed pursuant to the Act
of November 2, 1966 (16 U.S.C. 1151 et seq.; commonly
known as the ``Fur Seal Act of 1966'').
(3) Assistant secretary.--The term ``Assistant
Secretary'' means the Assistant Secretary for Indian
Health.
[(1)] (4) Closure or close.--The term ``closure or
close'' means the termination of operations at open
dumps on Indian land or Alaska Native land and bringing
such dumps into compliance with applicable Federal
standards and regulations, or standards promulgated by
an Indian tribal government or Alaska Native entity, if
such standards are more stringent than the Federal
standards and regulations.
[(3)] (5) Indian land.--The term ``Indian land''
means--
(A) land within the limits of any Indian
reservation under the jurisdiction of the
United States Government, notwithstanding the
issuance of any patent, and including rights-
of-way running through the reservation;
(B) dependent Indian communities within the
borders of the United States whether within the
original orsubsequently acquired territory
thereof, and whether within or without the limits of a State; and
(C) Indian allotments, the Indian titles to
which have not been extinguished, including
rights-of-way running through such allotments.
[(5)] (6) Indian tribal government.--The term
``Indian tribal government'' means the governing body
of any Indian tribe, band, nation, pueblo, or other
organized group or community which is recognized as
eligible for the special programs and services provided
by the United States to Indians because of their status
as Indians. * * *
* * * * * * *
SEC. 4. INVENTORY OF OPEN DUMPS.
(a) Study and Inventory.--Not later than 12 months after
the date of enactment of this Act, the [Director] Assistant
Secretary shall conduct a study and inventory of open dumps on
Indian lands and Alaska Native lands. The inventory shall list
the geographic location of all open dumps, an evaluation of the
contents of each dump, and an assessment of the relative
severity of the threat to public health and the environment
posed by each dump. Such assessment shall be carried out
cooperatively with the Administrator of the Environmental
Protection Agency. The [Director] Assistant Secretary shall
obtain the concurrence of the Administrator in the
determination of relative severity made by any such assessment.
(b) Annual Reports.--Upon completion of the study and
inventory under subsection (a), the [Director] Assistant
Secretary shall report to the Congress, and update such report
annually--* * *
(c) 10-Year Plan.--The [Director] Assistant Secretary shall
develop and begin implementation of a 10-year plan to address
solid waste disposal needs on Indian lands and Alaska Native
lands. This 10-year plan shall identify-- * * *
* * * * * * *
[SEC. 5. AUTHORITY OF THE DIRECTOR OF THE INDIAN HEALTH SERVICE.] SEC.
5. AUTHORITY OF ASSISTANT SECRETARY FOR INDIAN
HEALTH.
(a) Reservation Inventory.--(1) Upon request by an Indian
tribal government or Alaska Native entity, the [Director]
Assistant Secretary shall-- * * *
(B) determine the relative severity of the
threat to public health and the environment
posed by each dump based on information
available to the Director and the Indian tribal
government or Alaska Native entity unless the
[Director] Assistant Secretary, in consultation
with the Indian tribal government or Alaska
Native entity, determines that additional
actions such as soil testing or water
monitoring would be appropriate in the
circumstances; * * *
(2) The inventory and evaluation authorized under
paragraph (1)(A) shall be carried out cooperatively
with the Administrator of the Environmental Protection
Agency. The [Director] Assistant Secretary shall obtain
the concurrence of the Administrator in the
determination of relative severity made under paragraph
(1)(B).
(b) Assistance.--Upon completion of the activities required
to be performed pursuant to subsection (a), the [Director]
Assistant Secretary shall, subject to subsection (c), provide
financial and technical assistance to the Indian tribal
government or Alaska Native entity to carry out the activities
necessary to--
(1) close such dumps; and
(2) provide for postclosure maintenance of such
dumps.
(c) Conditions.--All assistance provided pursuant to
subsection (b) shall be made available on a site-specific basis
in accordance with priorities developed by the [Director]
Assistant Secretary. Priorities shall take into account the
relative severity of the threat to public health and the
environment posed by each open dump and the availability of
funds necessary for closure and postclosure maintenance.
SEC. 6. CONTRACT AUTHORITY.
(a) Authority of [Director] Assistant Secretary._To the
maximum extent feasible, the [Director] Assistant Secretary
shall carry out duties under this Act through contracts,
compacts, or memoranda of agreement with Indian tribal
governments or Alaska Native entities pursuant to the Indian
Self-Determination and Education Assistance Act (25 U.S.C. 450
et seq.), section 7 of the Act of August 5, 1954 (42 U.S.C.
2004a), or section 302 of the Indian Health Care Improvement
Act (25 U.S.C. 1632).
(b) Cooperative Agreements.--The [Director] Assistant
Secretary is authorized, for purposes of carrying out the
duties of the [Director] Assistant Secretary under this Act, to
contract with or enter into such cooperative agreements with
such other Federal agencies as is considered necessary to
provide cost-sharing for closure and postclosure activities, to
obtain necessary technical and financial assistance and
expertise, and for such other purposes as the [Director]
Assistant Secretary considers necessary.
SEC. 7. TRIBAL DEMONSTRATIONS PROJECT.
(a) In General.--The [Director] Assistant Secretary may
establish and carry out a program providing for demonstration
projects involving open dumps on Indian land or Alaska Native
land. It shall be the purpose of such projects to determine if
there are unique cost factors involved in the cleanup and
maintenance of open dumps on such land, and the extent to which
advanced closure planning is necessary. Under the program, the
[Director] Assistant Secretary is authorized to select no less
than three Indian tribal governments or Alaska Native entities
to a participate in such demonstration projects.
(b) Criteria.--Criteria established by the [Director]
Assistant Secretary for the selection and participation of an
Indian tribal government or Alaska Native entity in the
demonstration project shall provide that in order to be
eligible to participate, an Indian tribal government or Alaska
Native entity must-- * * *
* * * * * * *
SEC. 8. AUTHORIZATION OF APPROPRIATIONS.
* * * * * * *
(b) Coordination.--The activities required to be performed
by the [Director] Assistant Secretary under this Act shall be
coordinated with activities related to solid waste and
sanitation facilities funded pursuant to other authorizations.
SEC. 9. DISCLAIMERS.
(a) Authority of [Director] Assistant Secretary.--Nothing
in this Act shall be construed to alter, diminish, repeal, or
supersede any authority conferred on the [Director] Assistant
Secretary pursuant to section 302 of the Indian Health Care
Improvement Act (25 U.S.C. 1632), and section 7 of the Act of
August 5, 1954 (42 U.S.C. 2004a).
AUGUSTUS F. HAWKINS-ROBERT T. STAFFORD ELEMENTARY AND SECONDARY SCHOOL
IMPROVEMENT AMENDMENTS OF 1988
PUBLIC LAW 100-297
AN ACT To improve elementary and secondary education, and for other
purposes
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
* * * * * * *
SEC. 5504. ADMINISTRATIVE PROVISIONS. * * *
* * * * * * *
(d) Federal Agency Cooperation and Assistance.--* * *
(2) The Commissioner of the Administration for Native
Americans of the Department of Health and Human
Services and the [Director of the Indian Health
Service] Assistant Secretary for Indian Health of the
Department of Health and Human Services are authorized
to detail personnel to the Task Force, upon request, to
enable the Task Force to carry out its functions under
this part. * * *
* * * * * * *
MICHIGAN INDIAN LAND CLAIMS SETTLEMENT ACT
PUBLIC LAW 105-143
AN ACT To provide for the division, use, and distribution of judgment
funds of the Ottawa and Chippewa Indians of Michigan pursuant to
dockets numbered 18-E, 58, 364, and 18-R before the Indian Claims
Commission
Be it enacted by the Senate and House of Representatives of
the United States of American in Congress assembled,
* * * * * * *
SEC. 203. LIMITATION. * * *
* * * * * * *
(b) Consideration.--In any case in which the Secretary,
acting through the [Director of the Indian Health Service]
Assistant Secretary for Indian Health, is required to select
from more than 1 application for a contract or compact
described in subsection (a), in awarding the contract or
compact, the Secretary shall take into consideration-- * * *
* * * * * * *