[House Report 110-564]
[From the U.S. Government Publishing Office]
110th Congress Rept. 110-564
HOUSE OF REPRESENTATIVES
2d Session Part 1
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INDIAN HEALTH CARE IMPROVEMENT ACT AMENDMENTS OF 2007
_______
April 4, 2008.--Ordered to be printed
_______
Mr. Rahall, from the Committee on Natural Resources, submitted the
following
R E P O R T
[To accompany H.R. 1328]
[Including cost estimate of the Congressional Budget Office]
The Committee on Natural Resources, to whom was referred the
bill (H.R. 1328) to amend the Indian Health Care Improvement
Act to revise and extend that Act, having considered the same,
report favorably thereon with an amendment and recommend that
the bill as amended do pass.
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Indian Health Care
Improvement Act Amendments of 2007''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--AMENDMENTS TO INDIAN LAWS
Sec. 101. Indian Health Care Improvement Act amended.
Sec. 102. Soboba sanitation facilities.
Sec. 103. Native American Health and Wellness Foundation.
TITLE II--IMPROVEMENT OF INDIAN HEALTH CARE PROVIDED UNDER THE SOCIAL
SECURITY ACT
Sec. 201. Expansion of payments under Medicare, Medicaid, and SCHIP for
all covered services furnished by Indian Health Programs.
Sec. 202. Increased outreach to Indians under Medicaid and SCHIP and
improved cooperation in the provision of items and services to Indians
under Social Security Act health benefit programs.
Sec. 203. Additional provisions to increase outreach to, and enrollment
of, Indians in SCHIP and Medicaid.
Sec. 204. Premiums and cost sharing protections under Medicaid,
eligibility determinations under Medicaid and SCHIP, and protection of
certain Indian property from Medicaid estate recovery.
Sec. 205. Nondiscrimination in qualifications for payment for services
under Federal health care programs.
Sec. 206. Consultation on Medicaid, SCHIP, and other health care
programs funded under the Social Security Act involving Indian Health
Programs and Urban Indian Organizations.
Sec. 207. Exclusion waiver authority for affected Indian Health
Programs and safe harbor transactions under the Social Security Act.
Sec. 208. Rules applicable under Medicaid and SCHIP to managed care
entities with respect to Indian enrollees and Indian health care
providers and Indian managed care entities.
Sec. 209. Annual report on Indians served by Social Security Act health
benefit programs.
SEC. 2. REPORT ON THIRD-PARTY PAYMENT COLLECTIONS.
(a) Study.--The Secretary of Health and Human Services shall conduct
a thorough study of the system of third-party payment collections for
items and services furnished through the Indian Health Service.
(b) Report.--Not later than 6 months after the date of the enactment
of this Act, the Secretary shall submit to each House of Congress a
report on such study. Such report shall include such recommendations on
how to improve such third-party payment collections as the Secretary
determines appropriate.
TITLE I--AMENDMENTS TO INDIAN LAWS
SEC. 101. INDIAN HEALTH CARE IMPROVEMENT ACT AMENDED.
(a) In General.--The Indian Health Care Improvement Act (25 U.S.C.
1601 et seq.) is amended to read as follows:
``SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
``(a) Short Title.--This Act may be cited as the `Indian Health Care
Improvement Act'.
``(b) Table of Contents.--The table of contents for this Act is as
follows:
``Sec. 1. Short title; table of contents.
``Sec. 2. Findings.
``Sec. 3. Declaration of national Indian health policy.
``Sec. 4. Definitions.
``TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT
``Sec. 101. Purpose.
``Sec. 102. Health professions recruitment program for Indians.
``Sec. 103. Health professions preparatory scholarship program for
Indians.
``Sec. 104. Indian health professions scholarships.
``Sec. 105. American Indians Into Psychology Program.
``Sec. 106. Scholarship programs for Indian Tribes.
``Sec. 107. Indian Health Service extern programs.
``Sec. 108. Continuing education allowances.
``Sec. 109. Community Health Representative Program.
``Sec. 110. Indian Health Service Loan Repayment Program.
``Sec. 111. Scholarship and Loan Repayment Recovery Fund.
``Sec. 112. Recruitment activities.
``Sec. 113. Indian recruitment and retention program.
``Sec. 114. Advanced training and research.
``Sec. 115. Quentin N. Burdick American Indians Into Nursing Program.
``Sec. 116. Tribal cultural orientation.
``Sec. 117. INMED Program.
``Sec. 118. Health training programs of community colleges.
``Sec. 119. Retention bonus.
``Sec. 120. Nursing residency program.
``Sec. 121. Community Health Aide Program.
``Sec. 122. Tribal Health Program administration.
``Sec. 123. Health professional chronic shortage demonstration
programs.
``Sec. 124. National Health Service Corps.
``Sec. 125. Substance abuse counselor educational curricula
demonstration programs.
``Sec. 126. Behavioral health training and community education
programs.
``Sec. 127. Authorization of appropriations.
``TITLE II--HEALTH SERVICES
``Sec. 201. Indian Health Care Improvement Fund.
``Sec. 202. Catastrophic Health Emergency Fund.
``Sec. 203. Health promotion and disease prevention services.
``Sec. 204. Diabetes prevention, treatment, and control.
``Sec. 205. Shared services for long-term care.
``Sec. 206. Health services research.
``Sec. 207. Mammography and other cancer screening.
``Sec. 208. Patient travel costs.
``Sec. 209. Epidemiology centers.
``Sec. 210. Comprehensive school health education programs.
``Sec. 211. Indian youth program.
``Sec. 212. Prevention, control, and elimination of communicable and
infectious diseases.
``Sec. 213. Authority for provision of other services.
``Sec. 214. Indian women's health care.
``Sec. 215. Environmental and nuclear health hazards.
``Sec. 216. Arizona as a contract health service delivery area.
``Sec. 217. North Dakota and South Dakota as contract health service
delivery area.
``Sec. 218. California contract health services program.
``Sec. 219. California as a contract health service delivery area.
``Sec. 220. Contract health services for the Trenton Service Area.
``Sec. 221. Programs operated by Indian Tribes and Tribal
Organizations.
``Sec. 222. Licensing.
``Sec. 223. Notification of provision of emergency contract health
services.
``Sec. 224. Prompt action on payment of claims.
``Sec. 225. Liability for payment.
``Sec. 226. Office of Indian Men's Health.
``Sec. 227. Authorization of appropriations.
``TITLE III--FACILITIES
``Sec. 301. Consultation; construction and renovation of facilities;
reports.
``Sec. 302. Sanitation facilities.
``Sec. 303. Preference to Indians and Indian firms.
``Sec. 304. Expenditure of non-Service funds for renovation.
``Sec. 305. Funding for the construction, expansion, and modernization
of small ambulatory care facilities.
``Sec. 306. Indian health care delivery demonstration project.
``Sec. 307. Land transfer.
``Sec. 308. Leases, contracts, and other agreements.
``Sec. 309. Study on loans, loan guarantees, and loan repayment.
``Sec. 310. Tribal leasing.
``Sec. 311. Indian Health Service/tribal facilities joint venture
program.
``Sec. 312. Location of facilities.
``Sec. 313. Maintenance and improvement of health care facilities.
``Sec. 314. Tribal management of federally-owned quarters.
``Sec. 315. Applicability of Buy American Act requirement.
``Sec. 316. Other funding for facilities.
``Sec. 317. Authorization of appropriations.
``TITLE IV--ACCESS TO HEALTH SERVICES
``Sec. 401. Treatment of payments under Social Security Act health
benefits programs.
``Sec. 402. Grants to and contracts with the Service, Indian Tribes,
Tribal Organizations, and Urban Indian Organizations to facilitate
outreach, enrollment, and coverage of Indians under Social Security Act
health benefit programs and other health benefits programs.
``Sec. 403. Reimbursement from certain third parties of costs of health
services.
``Sec. 404. Crediting of reimbursements.
``Sec. 405. Purchasing health care coverage.
``Sec. 406. Sharing arrangements with Federal agencies.
``Sec. 407. Payor of last resort.
``Sec. 408. Nondiscrimination under Federal health care programs in
qualifications for reimbursement for services.
``Sec. 409. Consultation.
``Sec. 410. State Children's Health Insurance Program (SCHIP).
``Sec. 411. Exclusion waiver authority for affected Indian Health
Programs and safe harbor transactions under the Social Security Act.
``Sec. 412. Premium and cost sharing protections and eligibility
determinations under Medicaid and SCHIP and protection of certain
Indian property from Medicaid estate recovery.
``Sec. 413. Treatment under Medicaid and SCHIP managed care.
``Sec. 414. Navajo Nation Medicaid Agency feasibility study.
``Sec. 415. General exceptions.
``Sec. 416. Authorization of appropriations.
``TITLE V--HEALTH SERVICES FOR URBAN INDIANS
``Sec. 501. Purpose.
``Sec. 502. Contracts with, and grants to, Urban Indian Organizations.
``Sec. 503. Contracts and grants for the provision of health care and
referral services.
``Sec. 504. Contracts and grants for the determination of unmet health
care needs.
``Sec. 505. Evaluations; renewals.
``Sec. 506. Other contract and grant requirements.
``Sec. 507. Reports and records.
``Sec. 508. Limitation on contract authority.
``Sec. 509. Facilities.
``Sec. 510. Division of Urban Indian Health.
``Sec. 511. Grants for alcohol and substance abuse-related services.
``Sec. 512. Treatment of certain demonstration projects.
``Sec. 513. Urban NIAAA transferred programs.
``Sec. 514. Consultation with Urban Indian Organizations.
``Sec. 515. Urban youth treatment center demonstration.
``Sec. 516. Grants for diabetes prevention, treatment, and control.
``Sec. 517. Community health representatives.
``Sec. 518. Effective date.
``Sec. 519. Eligibility for services.
``Sec. 520. Authorization of appropriations.
``TITLE VI--ORGANIZATIONAL IMPROVEMENTS
``Sec. 601. Establishment of the Indian Health Service as an agency of
the Public Health Service.
``Sec. 602. Automated management information system.
``Sec. 603. Authorization of appropriations.
``TITLE VII--BEHAVIORAL HEALTH PROGRAMS
``Sec. 701. Behavioral health prevention and treatment services.
``Sec. 702. Memoranda of agreement with the Department of the Interior.
``Sec. 703. Comprehensive behavioral health prevention and treatment
program.
``Sec. 704. Mental health technician program.
``Sec. 705. Licensing requirement for mental health care workers.
``Sec. 706. Indian women treatment programs.
``Sec. 707. Indian youth program.
``Sec. 708. Indian youth telemental health demonstration project.
``Sec. 709. Inpatient and community-based mental health facilities
design, construction, and staffing.
``Sec. 710. Training and community education.
``Sec. 711. Behavioral health program.
``Sec. 712. Fetal alcohol disorder programs.
``Sec. 713. Child sexual abuse and prevention treatment programs.
``Sec. 714. Behavioral health research.
``Sec. 715. Definitions.
``Sec. 716. Authorization of appropriations.
``TITLE VIII--MISCELLANEOUS
``Sec. 801. Reports.
``Sec. 802. Regulations.
``Sec. 803. Plan of implementation.
``Sec. 804. Availability of funds.
``Sec. 805. Limitation on use of funds appropriated to Indian Health
Service.
``Sec. 806. Eligibility of California Indians.
``Sec. 807. Health services for ineligible persons.
``Sec. 808. Reallocation of base resources.
``Sec. 809. Results of demonstration projects.
``Sec. 810. Provision of services in Montana.
``Sec. 811. Moratorium.
``Sec. 812. Severability provisions.
``Sec. 813. Establishment of National Bipartisan Commission on Indian
Health Care.
``Sec. 814. Confidentiality of medical quality assurance records;
qualified immunity for participants.
``Sec. 815. Appropriations; availability.
``Sec. 816. Authorization of appropriations.
``SEC. 2. FINDINGS.
``Congress makes the following findings:
``(1) Federal health services to maintain and improve the
health of the Indians are consonant with and required by the
Federal Government's historical and unique legal relationship
with, and resulting responsibility to, the American Indian
people.
``(2) A major national goal of the United States is to
provide the quantity and quality of health services which will
permit the health status of Indians to be raised to the highest
possible level and to encourage the maximum participation of
Indians in the planning and management of those services.
``(3) Federal health services to Indians have resulted in a
reduction in the prevalence and incidence of preventable
illnesses among, and unnecessary and premature deaths of,
Indians.
``(4) Despite such services, the unmet health needs of the
American Indian people are severe and the health status of the
Indians is far below that of the general population of the
United States.
``SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.
``Congress declares that it is the policy of this Nation, in
fulfillment of its special trust responsibilities and legal obligations
to Indians--
``(1) to assure the highest possible health status for
Indians and Urban Indians and to provide all resources
necessary to effect that policy;
``(2) to raise the health status of Indians and Urban Indians
to at least the levels set forth in the goals contained within
the Healthy People 2010 or successor objectives;
``(3) to the greatest extent possible, to allow Indians to
set their own health care priorities and establish goals that
reflect their unmet needs;
``(4) to increase the proportion of all degrees in the health
professions and allied and associated health professions
awarded to Indians so that the proportion of Indian health
professionals in each Service Area is raised to at least the
level of that of the general population;
``(5) to require meaningful consultation with Indian Tribes,
Tribal Organizations, and Urban Indian Organizations to
implement this Act and the national policy of Indian self-
determination; and
``(6) to provide funding for programs and facilities operated
by Indian Tribes and Tribal Organizations in amounts that are
not less than the amounts provided to programs and facilities
operated directly by the Service.
``SEC. 4. DEFINITIONS.
``For purposes of this Act:
``(1) The term `accredited and accessible' means on or near a
reservation and accredited by a national or regional
organization with accrediting authority.
``(2) The term `Area Office' means an administrative entity,
including a program office, within the Service through which
services and funds are provided to the Service Units within a
defined geographic area.
``(3) The term `Assistant Secretary' means the Assistant
Secretary of Indian Health.
``(4)(A) The term `behavioral health' means the blending of
substance (alcohol, drugs, inhalants, and tobacco) abuse and
mental health prevention and treatment, for the purpose of
providing comprehensive services.
``(B) The term `behavioral health' includes the joint
development of substance abuse and mental health treatment
planning and coordinated case management using a
multidisciplinary approach.
``(5) The term `California Indians' means those Indians who
are eligible for health services of the Service pursuant to
section 806.
``(6) The term `community college' means--
``(A) a tribal college or university, or
``(B) a junior or community college.
``(7) The term `contract health service' means health
services provided at the expense of the Service or a Tribal
Health Program by public or private medical providers or
hospitals, other than the Service Unit or the Tribal Health
Program at whose expense the services are provided.
``(8) The term `Department' means, unless otherwise
designated, the Department of Health and Human Services.
``(9) The term `disease prevention' means the reduction,
limitation, and prevention of disease and its complications and
reduction in the consequences of disease, including--
``(A) controlling--
``(i) the development of diabetes;
``(ii) high blood pressure;
``(iii) infectious agents;
``(iv) injuries;
``(v) occupational hazards and disabilities;
``(vi) sexually transmittable diseases; and
``(vii) toxic agents; and
``(B) providing--
``(i) fluoridation of water; and
``(ii) immunizations.
``(10) The term `health profession' means allopathic
medicine, family medicine, internal medicine, pediatrics,
geriatric medicine, obstetrics and gynecology, podiatric
medicine, nursing, public health nursing, dentistry,
psychiatry, osteopathy, optometry, pharmacy, psychology, public
health, social work, marriage and family therapy, chiropractic
medicine, environmental health and engineering, allied health
professions, naturopathic medicine, and any other health
profession.
``(11) The term `health promotion' means--
``(A) fostering social, economic, environmental, and
personal factors conducive to health, including raising
public awareness about health matters and enabling the
people to cope with health problems by increasing their
knowledge and providing them with valid information;
``(B) encouraging adequate and appropriate diet,
exercise, and sleep;
``(C) promoting education and work in conformity with
physical and mental capacity;
``(D) making available safe water and sanitary
facilities;
``(E) improving the physical, economic, cultural,
psychological, and social environment;
``(F) promoting culturally competent care; and
``(G) providing adequate and appropriate programs,
which may include--
``(i) abuse prevention (mental and physical);
``(ii) community health;
``(iii) community safety;
``(iv) consumer health education;
``(v) diet and nutrition;
``(vi) immunization and other prevention of
communicable diseases, including HIV/AIDS;
``(vii) environmental health;
``(viii) exercise and physical fitness;
``(ix) avoidance of fetal alcohol disorders;
``(x) first aid and CPR education;
``(xi) human growth and development;
``(xii) injury prevention and personal
safety;
``(xiii) behavioral health;
``(xiv) monitoring of disease indicators
between health care provider visits, through
appropriate means, including Internet-based
health care management systems;
``(xv) personal health and wellness
practices;
``(xvi) personal capacity building;
``(xvii) prenatal, pregnancy, and infant
care;
``(xviii) psychological well-being;
``(xix) reproductive health and family
planning;
``(xx) safe and adequate water;
``(xxi) healthy work environments;
``(xxii) elimination, reduction, and
prevention of contaminants that create
unhealthy household conditions (including mold
and other allergens);
``(xxiii) stress control;
``(xxiv) substance abuse;
``(xxv) sanitary facilities;
``(xxvi) sudden infant death syndrome
prevention;
``(xxvii) tobacco use cessation and
reduction;
``(xxviii) violence prevention; and
``(xxix) such other activities identified by
the Service, a Tribal Health Program, or an
Urban Indian Organization, to promote
achievement of any of the objectives described
in section 3(2).
``(12) The term `Indian', unless otherwise designated, means
any person who is a member of an Indian Tribe or is eligible
for health services under section 806, except that, for the
purpose of sections 102 and 103, the term also means any
individual who--
``(A)(i) irrespective of whether the individual lives
on or near a reservation, is a member of a tribe, band,
or other organized group of Indians, including those
tribes, bands, or groups terminated since 1940 and
those recognized now or in the future by the State in
which they reside; or
``(ii) is a descendant, in the first or second
degree, of any such member;
``(B) is an Eskimo or Aleut or other Alaska Native;
``(C) is considered by the Secretary of the Interior
to be an Indian for any purpose; or
``(D) is determined to be an Indian under regulations
promulgated by the Secretary.
``(13) The term `Indian Health Program' means--
``(A) any health program administered directly by the
Service;
``(B) any Tribal Health Program; or
``(C) any Indian Tribe or Tribal Organization to
which the Secretary provides funding pursuant to
section 23 of the Act of June 25, 1910 (25 U.S.C. 47)
(commonly known as the `Buy Indian Act').
``(14) The term `Indian Tribe' has the meaning given the term
in the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.).
``(15) The term `junior or community college' has the meaning
given the term by section 312(e) of the Higher Education Act of
1965 (20 U.S.C. 1058(e)).
``(16) The term `reservation' means any federally recognized
Indian Tribe's reservation, Pueblo, or colony, including former
reservations in Oklahoma, Indian allotments, and Alaska Native
Regions established pursuant to the Alaska Native Claims
Settlement Act (43 U.S.C. 1601 et seq.).
``(17) The term `Secretary', unless otherwise designated,
means the Secretary of Health and Human Services.
``(18) The term `Service' means the Indian Health Service.
``(19) The term `Service Area' means the geographical area
served by each Area Office.
``(20) The term `Service Unit' means an administrative entity
of the Service, or a Tribal Health Program through which
services are provided, directly or by contract, to eligible
Indians within a defined geographic area.
``(21) The term `telehealth' has the meaning given the term
in section 330K(a) of the Public Health Service Act (42 U.S.C.
254c-16(a)).
``(22) The term `telemedicine' means a telecommunications
link to an end user through the use of eligible equipment that
electronically links health professionals or patients and
health professionals at separate sites in order to exchange
health care information in audio, video, graphic, or other
format for the purpose of providing improved health care
services.
``(23) The term `tribal college or university' has the
meaning given the term in section 316(b)(3) of the Higher
Education Act (20 U.S.C. 1059c(b)(3)).
``(24) The term `Tribal Health Program' means an Indian Tribe
or Tribal Organization that operates any health program,
service, function, activity, or facility funded, in whole or
part, by the Service through, or provided for in, a contract or
compact with the Service under the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.).
``(25) The term `Tribal Organization' has the meaning given
the term in the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.).
``(26) The term `Urban Center' means any community which has
a sufficient Urban Indian population with unmet health needs to
warrant assistance under title V of this Act, as determined by
the Secretary.
``(27) The term `Urban Indian' means any individual who
resides in an Urban Center and who meets 1 or more of the
following criteria:
``(A) Irrespective of whether the individual lives on
or near a reservation, the individual is a member of a
tribe, band, or other organized group of Indians,
including those tribes, bands, or groups terminated
since 1940 and those tribes, bands, or groups that are
recognized by the States in which they reside, or who
is a descendant in the first or second degree of any
such member.
``(B) The individual is an Eskimo, Aleut, or other
Alaska Native.
``(C) The individual is considered by the Secretary
of the Interior to be an Indian for any purpose.
``(D) The individual is determined to be an Indian
under regulations promulgated by the Secretary.
``(28) The term `Urban Indian Organization' means a nonprofit
corporate body that (A) is situated in an Urban Center; (B) is
governed by an Urban Indian-controlled board of directors; (C)
provides for the participation of all interested Indian groups
and individuals; and (D) is capable of legally cooperating with
other public and private entities for the purpose of performing
the activities described in section 503(a).
``TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT
``SEC. 101. PURPOSE.
``The purpose of this title is to increase, to the maximum extent
feasible, the number of Indians entering the health professions and
providing health services, and to assure an optimum supply of health
professionals to the Indian Health Programs and Urban Indian
Organizations involved in the provision of health services to Indians.
``SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR INDIANS.
``(a) In General.--The Secretary, acting through the Service, shall
make grants to public or nonprofit private health or educational
entities, Tribal Health Programs, or Urban Indian Organizations to
assist such entities in meeting the costs of--
``(1) identifying Indians with a potential for education or
training in the health professions and encouraging and
assisting them--
``(A) to enroll in courses of study in such health
professions; or
``(B) if they are not qualified to enroll in any such
courses of study, to undertake such postsecondary
education or training as may be required to qualify
them for enrollment;
``(2) publicizing existing sources of financial aid available
to Indians enrolled in any course of study referred to in
paragraph (1) or who are undertaking training necessary to
qualify them to enroll in any such course of study; or
``(3) establishing other programs which the Secretary
determines will enhance and facilitate the enrollment of
Indians in, and the subsequent pursuit and completion by them
of, courses of study referred to in paragraph (1).
``(b) Grants.--
``(1) Application.--The Secretary shall not make a grant
under this section unless an application has been submitted to,
and approved by, the Secretary. Such application shall be in
such form, submitted in such manner, and contain such
information, as the Secretary shall by regulation prescribe
pursuant to this Act. The Secretary shall give a preference to
applications submitted by Tribal Health Programs or Urban
Indian Organizations.
``(2) Amount of grants; payment.--The amount of a grant under
this section shall be determined by the Secretary. Payments
pursuant to this section may be made in advance or by way of
reimbursement, and at such intervals and on such conditions as
provided for in regulations issued pursuant to this Act. To the
extent not otherwise prohibited by law, grants shall be for 3
years, as provided in regulations issued pursuant to this Act.
``SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP PROGRAM FOR
INDIANS.
``(a) Scholarships Authorized.--The Secretary, acting through the
Service, shall provide scholarship grants to Indians who--
``(1) have successfully completed their high school education
or high school equivalency; and
``(2) have demonstrated the potential to successfully
complete courses of study in the health professions.
``(b) Purposes.--Scholarship grants provided pursuant to this section
shall be for the following purposes:
``(1) Compensatory preprofessional education of any
recipient, such scholarship not to exceed 2 years on a full-
time basis (or the part-time equivalent thereof, as determined
by the Secretary pursuant to regulations issued under this
Act).
``(2) Pregraduate education of any recipient leading to a
baccalaureate degree in an approved course of study preparatory
to a field of study in a health profession, such scholarship
not to exceed 4 years. An extension of up to 2 years (or the
part-time equivalent thereof, as determined by the Secretary
pursuant to regulations issued pursuant to this Act) may be
approved.
``(c) Other Conditions.--Scholarships under this section--
``(1) may cover costs of tuition, books, transportation,
board, and other necessary related expenses of a recipient
while attending school;
``(2) shall not be denied solely on the basis of the
applicant's scholastic achievement if such applicant has been
admitted to, or maintained good standing at, an accredited
institution; and
``(3) shall not be denied solely by reason of such
applicant's eligibility for assistance or benefits under any
other Federal program.
``SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.
``(a) In General.--
``(1) Authority.--The Secretary, acting through the Service,
shall make scholarship grants to Indians who are enrolled full
or part time in accredited schools pursuing courses of study in
the health professions. Such scholarships shall be designated
Indian Health Scholarships and shall be made in accordance with
section 338A of the Public Health Services Act (42 U.S.C.
254l), except as provided in subsection (b) of this section.
``(2) Determinations by secretary.--The Secretary, acting
through the Service, shall determine--
``(A) who shall receive scholarship grants under
subsection (a); and
``(B) the distribution of the scholarships among
health professions on the basis of the relative needs
of Indians for additional service in the health
professions.
``(3) Certain delegation not allowed.--The administration of
this section shall be a responsibility of the Assistant
Secretary and shall not be delegated in a contract or compact
under the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.).
``(b) Active Duty Service Obligation.--
``(1) Obligation met.--The active duty service obligation
under a written contract with the Secretary under this section
that an Indian has entered into shall, if that individual is a
recipient of an Indian Health Scholarship, be met in full-time
practice equal to 1 year for each school year for which the
participant receives a scholarship award under this part, or 2
years, whichever is greater, by service in 1 or more of the
following:
``(A) In an Indian Health Program.
``(B) In a program assisted under title V of this
Act.
``(C) In the private practice of the applicable
profession if, as determined by the Secretary, in
accordance with guidelines promulgated by the
Secretary, such practice is situated in a physician or
other health professional shortage area and addresses
the health care needs of a substantial number of
Indians.
``(D) In a teaching capacity in a tribal college or
university nursing program (or a related health
profession program) if, as determined by the Secretary,
the health service provided to Indians would not
decrease.
``(2) Obligation deferred.--At the request of any individual
who has entered into a contract referred to in paragraph (1)
and who receives a degree in medicine (including osteopathic or
allopathic medicine), dentistry, optometry, podiatry, or
pharmacy, the Secretary shall defer the active duty service
obligation of that individual under that contract, in order
that such individual may complete any internship, residency, or
other advanced clinical training that is required for the
practice of that health profession, for an appropriate period
(in years, as determined by the Secretary), subject to the
following conditions:
``(A) No period of internship, residency, or other
advanced clinical training shall be counted as
satisfying any period of obligated service under this
subsection.
``(B) The active duty service obligation of that
individual shall commence not later than 90 days after
the completion of that advanced clinical training (or
by a date specified by the Secretary).
``(C) The active duty service obligation will be
served in the health profession of that individual in a
manner consistent with paragraph (1).
``(D) A recipient of a scholarship under this section
may, at the election of the recipient, meet the active
duty service obligation described in paragraph (1) by
service in a program specified under that paragraph
that--
``(i) is located on the reservation of the
Indian Tribe in which the recipient is
enrolled; or
``(ii) serves the Indian Tribe in which the
recipient is enrolled.
``(3) Priority when making assignments.--Subject to paragraph
(2), the Secretary, in making assignments of Indian Health
Scholarship recipients required to meet the active duty service
obligation described in paragraph (1), shall give priority to
assigning individuals to service in those programs specified in
paragraph (1) that have a need for health professionals to
provide health care services as a result of individuals having
breached contracts entered into under this section.
``(c) Part-Time Students.--In the case of an individual receiving a
scholarship under this section who is enrolled part time in an approved
course of study--
``(1) such scholarship shall be for a period of years not to
exceed the part-time equivalent of 4 years, as determined by
the Secretary;
``(2) the period of obligated service described in subsection
(b)(1) shall be equal to the greater of--
``(A) the part-time equivalent of 1 year for each
year for which the individual was provided a
scholarship (as determined by the Secretary); or
``(B) 2 years; and
``(3) the amount of the monthly stipend specified in section
338A(g)(1)(B) of the Public Health Service Act (42 U.S.C.
254l(g)(1)(B)) shall be reduced pro rata (as determined by the
Secretary) based on the number of hours such student is
enrolled.
``(d) Breach of Contract.--
``(1) Specified breaches.--An individual shall be liable to
the United States for the amount which has been paid to the
individual, or on behalf of the individual, under a contract
entered into with the Secretary under this section on or after
the date of enactment of the Indian Health Care Improvement Act
Amendments of 2007 if that individual--
``(A) fails to maintain an acceptable level of
academic standing in the educational institution in
which he or she is enrolled (such level determined by
the educational institution under regulations of the
Secretary);
``(B) is dismissed from such educational institution
for disciplinary reasons;
``(C) voluntarily terminates the training in such an
educational institution for which he or she 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 or she 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.
``(2) Other breaches.--If for any reason not specified in
paragraph (1) an individual breaches a 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 (l) of section 110 in the
manner provided for in such subsection.
``(3) Cancellation upon death of recipient.--Upon the death
of an individual who receives an Indian Health Scholarship, any
outstanding obligation of that individual for service or
payment that relates to that scholarship shall be canceled.
``(4) Waivers and suspensions.--
``(A) In general.--The Secretary shall provide for
the partial or total waiver or suspension of any
obligation of service or payment of a recipient of an
Indian Health Scholarship if the Secretary determines
that--
``(i) it is not possible for the recipient to
meet that obligation or make that payment;
``(ii) requiring that recipient to meet that
obligation or make that payment would result in
extreme hardship to the recipient; or
``(iii) the enforcement of the requirement to
meet the obligation or make the payment would
be unconscionable.
``(B) Factors for consideration.--Before waiving or
suspending an obligation of service or payment under
subparagraph (A), the Secretary shall consult with the
affected Area Office, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations, and may
take into consideration whether the obligation may be
satisfied in a teaching capacity at a tribal college or
university nursing program under subsection (b)(1)(D).
``(5) Extreme hardship.--Notwithstanding any other provision
of law, in any case of extreme hardship or for other good cause
shown, the Secretary may waive, in whole or in part, the right
of the United States to recover funds made available under this
section.
``(6) Bankruptcy.--Notwithstanding any other provision of
law, with respect to a recipient of an Indian Health
Scholarship, no obligation for payment may be released by a
discharge in bankruptcy under title 11, United States Code,
unless that discharge is granted after the expiration of the 5-
year period beginning on the initial date on which that payment
is due, and only if the bankruptcy court finds that the
nondischarge of the obligation would be unconscionable.
``SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.
``(a) Grants Authorized.--The Secretary, acting through the Service,
shall make grants of not more than $300,000 to each of 9 colleges and
universities for the purpose of developing and maintaining Indian
psychology career recruitment programs as a means of encouraging
Indians to enter the behavioral health field. These programs shall be
located at various locations throughout the country to maximize their
availability to Indian students and new programs shall be established
in different locations from time to time.
``(b) Quentin N. Burdick Program Grant.--The Secretary shall provide
a grant authorized 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 maximum extent feasible, coordinate with the Quentin N.
Burdick Indian Health Programs authorized under section 117(b), the
Quentin N. Burdick American Indians Into Nursing Program authorized
under section 115(e), and existing university research and
communications networks.
``(c) Regulations.--The Secretary shall issue regulations pursuant to
this Act for the competitive awarding of grants provided under this
section.
``(d) Conditions of Grant.--Applicants under this section shall agree
to provide a program which, at a minimum--
``(1) provides outreach and recruitment for health
professions to Indian communities including elementary,
secondary, and accredited and accessible community colleges
that will be served by the program;
``(2) incorporates a program advisory board comprised of
representatives from the tribes and communities that will be
served by the program;
``(3) provides summer enrichment programs to expose Indian
students to the various fields of psychology through research,
clinical, and experimental activities;
``(4) provides stipends to undergraduate and graduate
students to pursue a career in psychology;
``(5) develops affiliation agreements with tribal colleges
and universities, the Service, university affiliated programs,
and other appropriate accredited and accessible entities to
enhance the education of Indian students;
``(6) to the maximum extent feasible, uses existing
university tutoring, counseling, and student support services;
and
``(7) to the maximum extent feasible, employs qualified
Indians in the program.
``(e) Active Duty Service Requirement.--The active duty service
obligation prescribed under section 338C of the Public Health Service
Act (42 U.S.C. 254m) shall be met by each graduate who receives a
stipend described in subsection (d)(4) that is funded under this
section. Such obligation shall be met by service--
``(1) in an Indian Health Program;
``(2) in a program assisted under title V of this Act; or
``(3) 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 physician or
other health professional shortage area and addresses the
health care needs of a substantial number of Indians.
``(f) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $2,700,000 for each of fiscal
years 2008 through 2017.
``SEC. 106. SCHOLARSHIP PROGRAMS FOR INDIAN TRIBES.
``(a) In General.--
``(1) Grants authorized.--The Secretary, acting through the
Service, shall make grants to Tribal Health Programs for the
purpose of providing scholarships for Indians to serve as
health professionals in Indian communities.
``(2) Amount.--Amounts available under paragraph (1) for any
fiscal year shall not exceed 5 percent of the amounts available
for each fiscal year for Indian Health Scholarships under
section 104.
``(3) Application.--An application for a grant under
paragraph (1) shall be in such form and contain such
agreements, assurances, and information as consistent with this
section.
``(b) Requirements.--
``(1) In general.--A Tribal Health Program receiving a grant
under subsection (a) shall provide scholarships to Indians in
accordance with the requirements of this section.
``(2) Costs.--With respect to costs of providing any
scholarship pursuant to subsection (a)--
``(A) 80 percent of the costs of the scholarship
shall be paid from the funds made available pursuant to
subsection (a)(1) provided to the Tribal Health
Program; and
``(B) 20 percent of such costs may be paid from any
other source of funds.
``(c) Course of Study.--A Tribal Health Program shall provide
scholarships under this section only to Indians enrolled or accepted
for enrollment in a course of study (approved by the Secretary) in 1 of
the health professions contemplated by this Act.
``(d) Contract.--
``(1) In general.--In providing scholarships under subsection
(b), the Secretary and the Tribal Health Program shall enter
into a written contract with each recipient of such
scholarship.
``(2) Requirements.--Such contract shall--
``(A) obligate such recipient to provide service in
an Indian Health Program or Urban Indian Organization,
in the same Service Area where the Tribal Health
Program providing the scholarship is located, for--
``(i) a 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
``(ii) such greater period of time as the
recipient and the Tribal Health Program may
agree;
``(B) provide that the amount of the scholarship--
``(i) may only be expended 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
338(g)(1)(B) of the Public Health
Service Act (42 U.S.C. 254m(g)(1)(B)),
with such amount to be reduced pro rata
(as determined by the Secretary) based
on the number of hours such student is
enrolled, and not to exceed, for any
year of attendance for which the
scholarship is provided, the total
amount required for the year for the
purposes authorized in this clause; and
``(ii) 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 clause (i);
``(C) 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 pursuant to this Act; and
``(D) require the recipient of such scholarship to
meet the educational and licensure requirements
appropriate to each health profession.
``(3) Service in other service areas.--The contract may allow
the recipient to serve in another Service Area, provided the
Tribal Health Program and Secretary approve and services are
not diminished to Indians in the Service Area where the Tribal
Health Program providing the scholarship is located.
``(e) Breach of Contract.--
``(1) Specific breaches.--An individual who has entered into
a written contract with the Secretary and a Tribal Health
Program under subsection (d) shall be liable to the United
States for the Federal share of the amount which has been paid
to him or her, or on his or her behalf, under the contract if
that individual--
``(A) fails to maintain an acceptable level of
academic standing in the educational institution in
which he or she is enrolled (such level as determined
by the educational institution under regulations of the
Secretary);
``(B) is dismissed from such educational institution
for disciplinary reasons;
``(C) voluntarily terminates the training in such an
educational institution for which he or she 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 or she 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.
``(2) Other breaches.--If for any reason not specified in
paragraph (1), an individual breaches a written contract by
failing to either 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 (l) of section 110 in the
manner provided for in such subsection.
``(3) Cancellation upon death of recipient.--Upon the death
of an individual who receives an Indian Health Scholarship, any
outstanding obligation of that individual for service or
payment that relates to that scholarship shall be canceled.
``(4) Information.--The Secretary may carry out this
subsection on the basis of information received from Tribal
Health Programs involved or on the basis of information
collected through such other means as the Secretary deems
appropriate.
``(f) Relation to Social Security Act.--The recipient of a
scholarship under this section shall agree, in providing health care
pursuant to the requirements herein--
``(1) not to discriminate against an individual seeking 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 a program established in title XVIII of the Social
Security Act or pursuant to the programs established in title
XIX or title XXI 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 XVIII 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, or the State child health plan under title XXI, of such
Act to provide service to individuals entitled to medical
assistance or child health assistance, respectively, under the
plan.
``(g) Continuance of Funding.--The Secretary shall make payments
under this section to a Tribal Health Program for any fiscal year
subsequent to the first fiscal year of such payments unless the
Secretary determines that, for the immediately preceding fiscal year,
the Tribal Health Program has not complied with the requirements of
this section.
``SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS.
``(a) Employment Preference.--Any individual who receives a
scholarship pursuant to section 104 or 106 shall be given preference
for employment in the Service, or may be employed by a Tribal Health
Program or an Urban Indian Organization, or other agencies of the
Department as available, during any nonacademic period of the year.
``(b) Not Counted Toward Active Duty Service Obligation.--Periods of
employment pursuant to this subsection shall not be counted in
determining fulfillment of the service obligation incurred as a
condition of the scholarship.
``(c) Timing; Length of Employment.--Any individual enrolled in a
program, including a high school program, authorized under section
102(a) may be employed by the Service or by a Tribal Health Program or
an Urban Indian Organization during any nonacademic period of the year.
Any such employment shall not exceed 120 days during any calendar year.
``(d) Nonapplicability of Competitive Personnel System.--Any
employment pursuant to this section shall be made without regard to any
competitive personnel system or agency personnel limitation and to a
position which will enable the individual so employed to receive
practical experience in the health profession in which he or she is
engaged in study. Any individual so employed shall receive payment for
his or her services comparable to the salary he or she would receive if
he or she were employed in the competitive system. Any individual so
employed shall not be counted against any employment ceiling affecting
the Service or the Department.
``SEC. 108. CONTINUING EDUCATION ALLOWANCES.
``In order to encourage scholarship and stipend recipients under
sections 104, 105, 106, and 115 and health professionals, including
community health representatives and emergency medical technicians, to
join or continue in an Indian Health Program and to provide their
services in the rural and remote areas where a significant portion of
Indians reside, the Secretary, acting through the Service, may--
``(1) provide programs or allowances to transition into an
Indian Health Program, including licensing, board or
certification examination assistance, and technical assistance
in fulfilling service obligations under sections 104, 105, 106,
and 115; and
``(2) provide programs or allowances to health professionals
employed in an Indian Health Program to enable them for a
period of time each year prescribed by regulation of the
Secretary to take leave of their duty stations for professional
consultation, management, leadership, and refresher training
courses.
``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.
``(a) In General.--Under the authority of the Act of November 2, 1921
(25 U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary,
acting through the Service, shall maintain a Community Health
Representative Program under which Indian Health Programs--
``(1) provide for the training of Indians as community health
representatives; and
``(2) use such community health representatives in the
provision of health care, health promotion, and disease
prevention services to Indian communities.
``(b) Duties.--The Community Health Representative Program of the
Service, shall--
``(1) provide a high standard of training for community
health representatives to ensure that the community health
representatives provide quality health care, health promotion,
and disease prevention services to the Indian communities
served by the Program;
``(2) in order to provide such training, develop and maintain
a curriculum that--
``(A) combines education in the theory of health care
with supervised practical experience in the provision
of health care; and
``(B) provides instruction and practical experience
in health promotion and disease prevention activities,
with appropriate consideration given to lifestyle
factors that have an impact on Indian health status,
such as alcoholism, family dysfunction, and poverty;
``(3) maintain a system which identifies the needs of
community health representatives for continuing education in
health care, health promotion, and disease prevention and
develop programs that meet the needs for continuing education;
``(4) maintain a system that provides close supervision of
Community Health Representatives;
``(5) maintain a system under which the work of Community
Health Representatives is reviewed and evaluated; and
``(6) promote traditional health care practices of the Indian
Tribes served consistent with the Service standards for the
provision of health care, health promotion, and disease
prevention.
``SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM.
``(a) Establishment.--The Secretary, acting through the Service,
shall establish and administer a program to be known as the Service
Loan Repayment Program (hereinafter referred to as the `Loan Repayment
Program') in order to ensure an adequate supply of trained health
professionals necessary to maintain accreditation of, and provide
health care services to Indians through, Indian Health Programs and
Urban Indian Organizations.
``(b) Eligible Individuals.--To be eligible to participate in the
Loan Repayment Program, an individual must--
``(1)(A) be enrolled--
``(i) in a course of study or program in an
accredited educational institution (as determined by
the Secretary under section 338B(b)(1)(c)(i) of the
Public Health Service Act (42 U.S.C. 254l-
1(b)(1)(c)(i))) and be scheduled to complete such
course of study in the same year such individual
applies to participate in such program; or
``(ii) in an approved graduate training program in a
health profession; or
``(B) have--
``(i) a degree in a health profession; and
``(ii) a license to practice a health profession;
``(2)(A) be eligible for, or hold, an appointment as a
commissioned officer in the Regular or Reserve Corps of the
Public Health Service;
``(B) be eligible for selection for civilian service in the
Regular or Reserve Corps of the Public Health Service;
``(C) meet the professional standards for civil service
employment in the Service; or
``(D) be employed in an Indian Health Program or Urban Indian
Organization without a service obligation; and
``(3) submit to the Secretary an application for a contract
described in subsection (e).
``(c) Application.--
``(1) Information to be included with forms.--In
disseminating application forms and contract forms to
individuals desiring to participate in the Loan Repayment
Program, the Secretary shall include with such forms a fair
summary of the rights and liabilities of an individual whose
application is approved (and whose contract is accepted) by the
Secretary, including in the summary a clear explanation of the
damages to which the United States is entitled under subsection
(l) in the case of the individual's breach of contract. The
Secretary shall provide such individuals with sufficient
information regarding the advantages and disadvantages of
service as a commissioned officer in the Regular or Reserve
Corps of the Public Health Service or a civilian employee of
the Service to enable the individual to make a decision on an
informed basis.
``(2) Clear language.--The application form, contract form,
and all other information furnished by the Secretary under this
section shall be written in a manner calculated to be
understood by the average individual applying to participate in
the Loan Repayment Program.
``(3) Timely availability of forms.--The Secretary shall make
such application forms, contract forms, and other information
available to individuals desiring to participate in the Loan
Repayment Program on a date sufficiently early to ensure that
such individuals have adequate time to carefully review and
evaluate such forms and information.
``(d) Priorities.--
``(1) List.--Consistent with subsection (k), the Secretary
shall annually--
``(A) identify the positions in each Indian Health
Program or Urban Indian Organization for which there is
a need or a vacancy; and
``(B) rank those positions in order of priority.
``(2) Approvals.--Notwithstanding the priority determined
under paragraph (1), the Secretary, in determining which
applications under the Loan Repayment Program to approve (and
which contracts to accept), shall--
``(A) give first priority to applications made by
individual Indians; and
``(B) after making determinations on all applications
submitted by individual Indians as required under
subparagraph (A), give priority to--
``(i) individuals recruited through the
efforts of an Indian Health Program or Urban
Indian Organization; and
``(ii) other individuals based on the
priority rankings under paragraph (1).
``(e) Recipient Contracts.--
``(1) Contract required.--An individual becomes a participant
in the Loan Repayment Program only upon the Secretary and the
individual entering into a written contract described in
paragraph (2).
``(2) Contents of contract.--The written contract referred to
in this section between the Secretary and an individual shall
contain--
``(A) an agreement under which--
``(i) subject to subparagraph (C), the
Secretary agrees--
``(I) to pay loans on behalf of the
individual in accordance with the
provisions of this section; and
``(II) to accept (subject to the
availability of appropriated funds for
carrying out this section) the
individual into the Service or place
the individual with a Tribal Health
Program or Urban Indian Organization as
provided in clause (ii)(III); and
``(ii) subject to subparagraph (C), the
individual agrees--
``(I) to accept loan payments on
behalf of the individual;
``(II) in the case of an individual
described in subsection (b)(1)--
``(aa) to maintain enrollment
in a course of study or
training described in
subsection (b)(1)(A) until the
individual completes the course
of study or training; and
``(bb) while enrolled in such
course of study or training, to
maintain an acceptable level of
academic standing (as
determined under regulations of
the Secretary by the
educational institution
offering such course of study
or training); and
``(III) to serve for a time period
(hereinafter in this section referred
to as the `period of obligated
service') equal to 2 years or such
longer period as the individual may
agree to serve in the full-time
clinical practice of such individual's
profession in an Indian Health Program
or Urban Indian Organization to which
the individual may be assigned by the
Secretary;
``(B) a provision permitting the Secretary to extend
for such longer additional periods, as the individual
may agree to, the period of obligated service agreed to
by the individual under subparagraph (A)(ii)(III);
``(C) a provision that any financial obligation of
the United States arising out of a contract entered
into under this section and any obligation of the
individual which is conditioned thereon is contingent
upon funds being appropriated for loan repayments under
this section;
``(D) a statement of the damages to which the United
States is entitled under subsection (l) for the
individual's breach of the contract; and
``(E) such other statements of the rights and
liabilities of the Secretary and of the individual, not
inconsistent with this section.
``(f) Deadline for Decision on Application.--The Secretary shall
provide written notice to an individual within 21 days on--
``(1) the Secretary's approving, under subsection (e)(1), of
the individual's participation in the Loan Repayment Program,
including extensions resulting in an aggregate period of
obligated service in excess of 4 years; or
``(2) the Secretary's disapproving an individual's
participation in such Program.
``(g) Payments.--
``(1) In general.--A loan repayment provided for an
individual under a written contract under the Loan Repayment
Program shall consist of payment, in accordance with paragraph
(2), on behalf of the individual of the principal, interest,
and related expenses on government and commercial loans
received by the individual regarding the undergraduate or
graduate education of the individual (or both), which loans
were made for--
``(A) tuition expenses;
``(B) all other reasonable educational expenses,
including fees, books, and laboratory expenses,
incurred by the individual; and
``(C) reasonable living expenses as determined by the
Secretary.
``(2) Amount.--For each year of obligated service that an
individual contracts to serve under subsection (e), the
Secretary may pay up to $35,000 or an amount equal to the
amount specified in section 338B(g)(2)(A) of the Public Health
Service Act, whichever is more, on behalf of the individual for
loans described in paragraph (1). In making a determination 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--
``(A) affects the ability of the Secretary to
maximize the number of contracts that can be provided
under the Loan Repayment Program from the amounts
appropriated for such contracts;
``(B) provides an incentive to serve in Indian Health
Programs and Urban Indian Organizations with the
greatest shortages of health professionals; and
``(C) provides an incentive with respect to the
health professional involved remaining in an Indian
Health Program or Urban Indian Organization with such a
health professional shortage, and continuing to provide
primary health services, after the completion of the
period of obligated service under the Loan Repayment
Program.
``(3) Timing.--Any arrangement made by the Secretary for the
making of loan repayments in accordance with this subsection
shall provide that any repayments for a year of obligated
service shall be made no later than the end of the fiscal year
in which the individual completes such year of service.
``(4) Reimbursements for tax liability.--For the purpose of
providing reimbursements for tax liability resulting from a
payment 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 equal to not less than
20 percent and not more than 39 percent of the total
amount of loan repayments 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.
``(5) Payment schedule.--The Secretary may enter into an
agreement with the holder of any loan for which payments are
made under the Loan Repayment Program to establish a schedule
for the making of such payments.
``(h) Employment Ceiling.--Notwithstanding any other provision of
law, individuals who have entered into written contracts with the
Secretary under this section shall not be counted against any
employment ceiling affecting the Department while those individuals are
undergoing academic training.
``(i) Recruitment.--The Secretary shall conduct recruiting programs
for the Loan Repayment Program and other manpower programs of the
Service at educational institutions training health professionals or
specialists identified in subsection (a).
``(j) Applicability of Law.--Section 214 of the Public Health Service
Act (42 U.S.C. 215) shall not apply to individuals during their period
of obligated service under the Loan Repayment Program.
``(k) Assignment of Individuals.--The Secretary, in assigning
individuals to serve in Indian Health Programs or Urban Indian
Organizations pursuant to contracts entered into under this section,
shall--
``(1) ensure that the staffing needs of Tribal Health
Programs and Urban Indian Organizations receive consideration
on an equal basis with programs that are administered directly
by the Service; and
``(2) give priority to assigning individuals to Indian Health
Programs and Urban Indian Organizations that have a need for
health professionals to provide health care services as a
result of individuals having breached contracts entered into
under this section.
``(l) Breach of Contract.--
``(1) Specific breaches.--An individual who has entered into
a written contract with the Secretary under this section and
has not received a waiver under subsection (m) shall be liable,
in lieu of any service obligation arising under such contract,
to the United States for the amount which has been paid on such
individual's behalf under the contract if that individual--
``(A) is enrolled in the final year of a course of
study and--
``(i) fails to maintain an acceptable level
of academic standing in the educational
institution in which he or she is enrolled
(such level determined by the educational
institution under regulations of the
Secretary);
``(ii) voluntarily terminates such
enrollment; or
``(iii) is dismissed from such educational
institution before completion of such course of
study; or
``(B) is enrolled in a graduate training program and
fails to complete such training program.
``(2) Other breaches; formula for amount owed.--If, for any
reason not specified in paragraph (1), an individual breaches
his or her written contract under this section by failing
either to begin, or complete, such individual's period of
obligated service in accordance with subsection (e)(2), the
United States shall be entitled to recover from such individual
an amount to be determined in accordance with the following
formula: A=3Z(t-s/t) in which--
``(A) `A' is the amount the United States is entitled
to recover;
``(B) `Z' is the sum of the amounts paid under this
section to, or on behalf of, the individual and the
interest on such amounts which would be payable if, at
the time the amounts were paid, they were loans bearing
interest at the maximum legal prevailing rate, as
determined by the Secretary of the Treasury;
``(C) `t' is the total number of months in the
individual's period of obligated service in accordance
with subsection (f); and
``(D) `s' is the number of months of such period
served by such individual in accordance with this
section.
``(3) Deductions in medicare payments.--Amounts not paid
within such period shall be subject to collection through
deductions in Medicare payments pursuant to section 1892 of the
Social Security Act.
``(4) Time period for repayment.--Any amount of damages which
the United States is entitled to recover under this subsection
shall be paid to the United States within the 1-year period
beginning on the date of the breach or such longer period
beginning on such date as shall be specified by the Secretary.
``(5) Recovery of delinquency.--
``(A) In general.--If damages described in paragraph
(4) are delinquent for 3 months, the Secretary shall,
for the purpose of recovering such damages--
``(i) use collection agencies contracted with
by the Administrator of General Services; or
``(ii) enter into contracts for the recovery
of such damages with collection agencies
selected by the Secretary.
``(B) Report.--Each contract for recovering damages
pursuant to this subsection shall provide that the
contractor will, not less than once each 6 months,
submit to the Secretary a status report on the success
of the contractor in collecting such damages. Section
3718 of title 31, United States Code, shall apply to
any such contract to the extent not inconsistent with
this subsection.
``(m) Waiver or Suspension of Obligation.--
``(1) In general.--The Secretary shall by regulation provide
for the partial or total waiver or suspension of any obligation
of service or payment by an individual under the Loan Repayment
Program whenever compliance by the individual is impossible or
would involve extreme hardship to the individual and if
enforcement of such obligation with respect to any individual
would be unconscionable.
``(2) Canceled upon death.--Any obligation of an individual
under the Loan Repayment Program for service or payment of
damages shall be canceled upon the death of the individual.
``(3) Hardship waiver.--The Secretary may waive, in whole or
in part, the rights of the United States to recover amounts
under this section in any case of extreme hardship or other
good cause shown, as determined by the Secretary.
``(4) Bankruptcy.--Any obligation of an individual under the
Loan Repayment Program for payment of damages may be released
by a discharge in bankruptcy under title 11 of the United
States Code only if such discharge is granted after the
expiration of the 5-year period beginning on the first date
that payment of such damages is required, and only if the
bankruptcy court finds that nondischarge of the obligation
would be unconscionable.
``(n) Report.--The Secretary shall submit to the President, for
inclusion in the report required to be submitted to Congress under
section 801, a report concerning the previous fiscal year which sets
forth by Service Area the following:
``(1) A list of the health professional positions maintained
by Indian Health Programs and Urban Indian Organizations for
which recruitment 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 (e)
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 scholarships that are provided under
sections 104 and 106 with respect to each health profession.
``(6) The amount of scholarship grants provided under section
104 and 106, in total and by health profession.
``(7) The number of providers of health care that will be
needed by Indian Health Programs and Urban Indian
Organizations, by location and profession, during the 3 fiscal
years beginning after the date the report is filed.
``(8) The measures the Secretary plans to take to fill the
health professional positions maintained by Indian Health
Programs or Urban Indian Organizations for which recruitment or
retention is difficult.
``SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND.
``(a) Establishment.--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 `LRRF'). The LRRF shall consist of such amounts as may be collected
from individuals under section 104(d), section 106(e), and section
110(l) for breach of contract, such funds as may be appropriated to the
LRRF, and interest earned on amounts in the LRRF. All amounts
collected, appropriated, or earned relative to the LRRF shall remain
available until expended.
``(b) Use of Funds.--
``(1) By secretary.--Amounts in the LRRF may be expended by
the Secretary, acting through the Service, to make payments to
an Indian Health Program--
``(A) to which a scholarship recipient under section
104 and 106 or a loan repayment program participant
under section 110 has been assigned to meet the
obligated service requirements pursuant to such
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, 106, or section 110.
``(2) By tribal health programs.--A Tribal Health Program
receiving payments pursuant to paragraph (1) may expend the
payments to provide scholarships or recruit and employ,
directly or by contract, health professionals to provide health
care services.
``(c) Investment of Funds.--The Secretary of the Treasury shall
invest such amounts of the LRRF as the Secretary of Health and Human
Services determines are not required to meet current withdrawals from
the LRRF. 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.
``(d) Sale of Obligations.--Any obligation acquired by the LRRF may
be sold by the Secretary of the Treasury at the market price.
``SEC. 112. RECRUITMENT ACTIVITIES.
``(a) Reimbursement for Travel.--The Secretary, acting through the
Service, may reimburse health professionals seeking positions with
Indian Health Programs or Urban Indian Organizations, including
individuals considering entering into a contract under section 110 and
their spouses, for actual and reasonable expenses incurred in traveling
to and from their places of residence to an area in which they may be
assigned for the purpose of evaluating such area with respect to such
assignment.
``(b) Recruitment Personnel.--The Secretary, acting through the
Service, shall assign 1 individual in each Area Office to be
responsible on a full-time basis for recruitment activities.
``SEC. 113. INDIAN RECRUITMENT AND RETENTION PROGRAM.
``(a) In General.--The Secretary, acting through the Service, shall
fund, on a competitive basis, innovative demonstration projects for a
period not to exceed 3 years to enable Tribal Health Programs and Urban
Indian Organizations to recruit, place, and retain health professionals
to meet their staffing needs.
``(b) Eligible Entities; Application.--Any Tribal Health Program or
Urban Indian Organization may submit an application for funding of a
project pursuant to this section.
``SEC. 114. ADVANCED TRAINING AND RESEARCH.
``(a) Demonstration Program.--The Secretary, acting through the
Service, shall establish a demonstration project to enable health
professionals who have worked in an Indian Health Program or Urban
Indian Organization for a substantial period of time to pursue advanced
training or research areas of study for which the Secretary determines
a need exists.
``(b) Service Obligation.--An individual who participates in a
program under subsection (a), where the educational costs are borne by
the Service, shall incur an obligation to serve in an Indian Health
Program or Urban Indian Organization for a period of obligated service
equal to at least 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 individual shall be liable to the
United States for the period of service remaining. In such event, with
respect to individuals entering the program after the date of enactment
of the Indian Health Care Improvement Act Amendments of 2007, the
United States shall be entitled to recover from such individual an
amount to be determined in accordance with the formula specified in
subsection (l) of section 110 in the manner provided for in such
subsection.
``(c) Equal Opportunity for Participation.--Health professionals from
Tribal Health Programs and Urban Indian Organizations shall be given an
equal opportunity to participate in the program under subsection (a).
``SEC. 115. QUENTIN N. BURDICK AMERICAN INDIANS INTO NURSING PROGRAM.
``(a) Grants Authorized.--For the purpose of increasing the number of
nurses, nurse midwives, and nurse practitioners who deliver health care
services to Indians, the Secretary, acting through the Service, shall
provide grants to the following:
``(1) Public or private schools of nursing.
``(2) Tribal colleges or universities.
``(3) Nurse midwife programs and advanced practice nurse
programs that are provided by any tribal college or university
accredited nursing program, or in the absence of such, any
other public or private institutions.
``(b) Use of Grants.--Grants provided under subsection (a) may be
used for 1 or more of the following:
``(1) To recruit individuals for programs which train
individuals to be nurses, nurse midwives, or advanced practice
nurses.
``(2) To provide scholarships to Indians enrolled in such
programs that may pay the tuition charged for such program and
other expenses incurred in connection with such program,
including books, fees, room and board, and stipends for living
expenses.
``(3) To provide a program that encourages nurses, nurse
midwives, and advanced practice nurses to provide, or continue
to provide, health care services to Indians.
``(4) To provide a program that increases the skills of, and
provides continuing education to, nurses, nurse midwives, and
advanced practice nurses.
``(5) To provide any program that is designed to achieve the
purpose described in subsection (a).
``(c) Applications.--Each application for a grant under subsection
(a) shall include such information as the Secretary may require to
establish the connection between the program of the applicant and a
health care facility that primarily serves Indians.
``(d) Preferences for Grant Recipients.--In providing grants under
subsection (a), the Secretary shall extend a preference to the
following:
``(1) Programs that provide a preference to Indians.
``(2) Programs that train nurse midwives or advanced practice
nurses.
``(3) Programs that are interdisciplinary.
``(4) Programs that are conducted in cooperation with a
program for gifted and talented Indian students.
``(5) Programs conducted by tribal colleges and universities.
``(e) Quentin N. Burdick Program Grant.--The Secretary shall provide
1 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 maximum extent feasible, coordinate with the
Quentin N. Burdick Indian Health Programs established under section
117(b) and the Quentin N. Burdick American Indians Into Psychology
Program established under section 105(b).
``(f) Active Duty Service Obligation.--The active duty service
obligation prescribed under section 338C of the Public Health Service
Act (42 U.S.C. 254m) shall be met by each individual who receives
training or assistance described in paragraph (1) or (2) of subsection
(b) that is funded by a grant provided under subsection (a). Such
obligation shall be met by service--
``(1) in the Service;
``(2) in a program of an Indian Tribe or Tribal Organization
conducted under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.) (including programs
under agreements with the Bureau of Indian Affairs);
``(3) in a program assisted under title V of this Act;
``(4) in the private practice of nursing if, as determined by
the Secretary, in accordance with guidelines promulgated by the
Secretary, such practice is situated in a physician or other
health shortage area and addresses the health care needs of a
substantial number of Indians; or
``(5) in a teaching capacity in a tribal college or
university nursing program (or a related health profession
program) if, as determined by the Secretary, health services
provided to Indians would not decrease.
``SEC. 116. TRIBAL CULTURAL ORIENTATION.
``(a) Cultural Education of Employees.--The Secretary, acting through
the Service, shall require that appropriate employees of the Service
who serve Indian Tribes in each Service Area receive educational
instruction in the history and culture of such Indian Tribes and their
relationship to the Service.
``(b) Program.--In carrying out subsection (a), the Secretary shall
establish a program which shall, to the extent feasible--
``(1) be developed in consultation with the affected Indian
Tribes, Tribal Organizations, and Urban Indian Organizations;
``(2) be carried out through tribal colleges or universities;
``(3) include instruction in American Indian studies; and
``(4) describe the use and place of traditional health care
practices of the Indian Tribes in the Service Area.
``SEC. 117. INMED PROGRAM.
``(a) Grants Authorized.--The Secretary, acting through the Service,
is authorized to provide grants to colleges and universities for the
purpose of maintaining and expanding the Indian health careers
recruitment program known as the `Indians Into Medicine Program'
(hereinafter in this section referred to as `INMED') as a means of
encouraging Indians to enter the health professions.
``(b) Quentin N. Burdick Grant.--The Secretary shall provide 1 of the
grants authorized under subsection (a) to maintain the INMED program at
the University of North Dakota, to be known as the `Quentin N. Burdick
Indian Health Programs', unless the Secretary makes a determination,
based upon program reviews, that the program is not meeting the
purposes of this section. Such program shall, to the maximum extent
feasible, coordinate with the Quentin N. Burdick American Indians Into
Psychology Program established under section 105(b) and the Quentin N.
Burdick American Indians Into Nursing Program established under section
115.
``(c) Regulations.--The Secretary, pursuant to this Act, shall
develop regulations to govern grants pursuant to this section.
``(d) Requirements.--Applicants for grants provided under this
section shall agree to provide a program which--
``(1) provides outreach and recruitment for health
professions to Indian communities including elementary and
secondary schools and community colleges located on
reservations which will be served by the program;
``(2) incorporates a program advisory board comprised of
representatives from the Indian Tribes and Indian communities
which will be served by the program;
``(3) provides summer preparatory programs for Indian
students who need enrichment in the subjects of math and
science in order to pursue training in the health professions;
``(4) provides tutoring, counseling, and support to students
who are enrolled in a health career program of study at the
respective college or university; and
``(5) to the maximum extent feasible, employs qualified
Indians in the program.
``SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY COLLEGES.
``(a) Grants to Establish Programs.--
``(1) In general.--The Secretary, acting through the Service,
shall award grants to accredited and accessible community
colleges for the purpose of assisting such community colleges
in the establishment of programs which provide education in a
health profession leading to a degree or diploma in a health
profession for individuals who desire to practice such
profession on or near a reservation or in an Indian Health
Program.
``(2) Amount of grants.--The amount of any grant awarded to a
community college under paragraph (1) for the first year in
which such a grant is provided to the community college shall
not exceed $250,000.
``(b) Grants for Maintenance and Recruiting.--
``(1) In general.--The Secretary, acting through the Service,
shall award grants to accredited and accessible community
colleges that have established a program described in
subsection (a)(1) for the purpose of maintaining the program
and recruiting students for the program.
``(2) Requirements.--Grants may only be made under this
section to a community college which--
``(A) is accredited;
``(B) has a relationship with a hospital facility,
Service facility, or hospital that could provide
training of nurses or health professionals;
``(C) has entered into an agreement with an
accredited college or university medical school, the
terms of which--
``(i) provide a program that enhances the
transition and recruitment of students into
advanced baccalaureate or graduate programs
that train health professionals; and
``(ii) stipulate certifications necessary to
approve internship and field placement
opportunities at Indian Health Programs;
``(D) has a qualified staff which has the appropriate
certifications;
``(E) is capable of obtaining State or regional
accreditation of the program described in subsection
(a)(1); and
``(F) agrees to provide for Indian preference for
applicants for programs under this section.
``(c) Technical Assistance.--The Secretary shall encourage community
colleges described in subsection (b)(2) to establish and maintain
programs described in subsection (a)(1) by--
``(1) entering into agreements with such colleges for the
provision of qualified personnel of the Service to teach
courses of study in such programs; and
``(2) providing technical assistance and support to such
colleges.
``(d) Advanced Training.--
``(1) Required.--Any program receiving assistance under this
section that is conducted with respect to a health profession
shall also offer courses of study which provide advanced
training for any health professional who--
``(A) has already received a degree or diploma in
such health profession; and
``(B) provides clinical services on or near a
reservation or for an Indian Health Program.
``(2) May be offered at alternate site.--Such courses of
study may be offered in conjunction with the college or
university with which the community college has entered into
the agreement required under subsection (b)(2)(C).
``(e) Priority.--Where the requirements of subsection (b) are met,
grant award priority shall be provided to tribal colleges and
universities in Service Areas where they exist.
``SEC. 119. RETENTION BONUS.
``(a) Bonus Authorized.--The Secretary may pay a retention bonus to
any health professional employed by, or assigned to, and serving in, an
Indian Health Program or Urban Indian Organization either as a civilian
employee or as a commissioned officer in the Regular or Reserve Corps
of the Public Health Service who--
``(1) is assigned to, and serving in, a position for which
recruitment or retention of personnel is difficult;
``(2) the Secretary determines is needed by Indian Health
Programs and Urban Indian Organizations;
``(3) has--
``(A) completed 2 years of employment with an Indian
Health Program or Urban Indian Organization; or
``(B) completed any service obligations incurred as a
requirement of--
``(i) any Federal scholarship program; or
``(ii) any Federal education loan repayment
program; and
``(4) enters into an agreement with an Indian Health Program
or Urban Indian Organization for continued employment for a
period of not less than 1 year.
``(b) Rates.--The Secretary may establish rates for the retention
bonus which shall provide for a higher annual rate for multiyear
agreements than for single year agreements referred to in subsection
(a)(4), but in no event shall the annual rate be more than $25,000 per
annum.
``(c) Default of Retention Agreement.--Any health professional
failing to complete the agreed upon term of service, except where such
failure is through no fault of the individual, shall be obligated to
refund to the Government the full amount of the retention bonus for the
period covered by the agreement, plus interest as determined by the
Secretary in accordance with section 110(l)(2)(B).
``(d) Other Retention Bonus.--The Secretary may pay a retention bonus
to any health professional employed by a Tribal Health Program if such
health professional is serving in a position which the Secretary
determines is--
``(1) a position for which recruitment or retention is
difficult; and
``(2) necessary for providing health care services to
Indians.
``SEC. 120. NURSING RESIDENCY PROGRAM.
``(a) Establishment of Program.--The Secretary, acting through the
Service, shall establish a program to enable Indians who are licensed
practical nurses, licensed vocational nurses, and registered nurses who
are working in an Indian Health Program or Urban Indian Organization,
and have done so for a period of not less than 1 year, to pursue
advanced training. Such program shall include a combination of
education and work study in an Indian Health Program or Urban Indian
Organization leading to an associate or bachelor's degree (in the case
of a licensed practical nurse or licensed vocational nurse), a
bachelor's degree (in the case of a registered nurse), or advanced
degrees or certifications in nursing and public health.
``(b) Service Obligation.--An individual who participates in a
program under subsection (a), where the educational costs are paid by
the Service, shall incur an obligation to serve in an Indian Health
Program or Urban Indian Organization for a period of obligated service
equal to 1 year for every year that nonprofessional employee (licensed
practical nurses, licensed vocational nurses, nursing assistants, and
various health care technicals), or 2 years for every year that
professional nurse (associate degree and bachelor-prepared registered
nurses), 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 (l) of section 110
in the manner provided for in such subsection.
``SEC. 121. COMMUNITY HEALTH AIDE PROGRAM.
``(a) General Purposes of Program.--Under the authority of the Act of
November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'),
the Secretary, acting through the Service, shall develop and operate 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
practitioners.
``(b) Specific Program Requirements.--The Secretary, acting through
the Community Health Aide Program of the Service, shall--
``(1) using trainers accredited by the Program, provide a
high standard of training to community health aides and
community 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 curriculum
that--
``(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
promotion, 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(2);
``(3) establish and maintain a Community Health Aide
Certification Board to certify as community health aides or
community health practitioners individuals who have
successfully completed the training described in paragraph (1)
or can demonstrate equivalent experience;
``(4) develop and 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;
``(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; and
``(7) ensure that pulpal therapy (not including pulpotomies
on deciduous teeth) or extraction of adult teeth can be
performed by a dental health aide therapist only after
consultation with a licensed dentist who determines that the
procedure is a medical emergency that cannot be resolved with
palliative treatment, and further that dental health aide
therapists are strictly prohibited from performing all other
oral or jaw surgeries, provided that uncomplicated extractions
shall not be considered oral surgery under this section.
``(c) Program Review.--
``(1) Neutral panel.--
``(A) Establishment.--The Secretary, acting through
the Service, shall establish a neutral panel to carry
out the study under paragraph (2).
``(B) Membership.--Members of the neutral panel shall
be appointed by the Secretary from among clinicians,
economists, community practitioners, oral
epidemiologists, and Alaska Natives.
``(2) Study.--
``(A) In general.--The neutral panel established
under paragraph (1) shall conduct a study of the dental
health aide therapist services provided by the
Community Health Aide Program under this section to
ensure that the quality of care provided through those
services is adequate and appropriate.
``(B) Parameters of study.--The Secretary, in
consultation with interested parties, including
professional dental organizations, shall develop the
parameters of the study.
``(C) Inclusions.--The study shall include a
determination by the neutral panel with respect to--
``(i) the ability of the dental health aide
therapist services under this section to
address the dental care needs of Alaska
Natives;
``(ii) the quality of care provided through
those services, including any training,
improvement, or additional oversight required
to improve the quality of care; and
``(iii) whether safer and less costly
alternatives to the dental health aide
therapist services exist.
``(D) Consultation.--In carrying out the study under
this paragraph, the neutral panel shall consult with
Alaska Tribal Organizations with respect to the
adequacy and accuracy of the study.
``(3) Report.--The neutral panel shall submit to the
Secretary, the Committee on Indian Affairs of the Senate, and
the Committee on Natural Resources of the House of
Representatives a report describing the results of the study
under paragraph (2), including a description of--
``(A) any determination of the neutral panel under
paragraph (2)(C); and
``(B) any comments received from an Alaska Tribal
Organization under paragraph (2)(D).
``(d) Nationalization of Program.--
``(1) In general.--Except as provided in paragraph (2), the
Secretary, acting through the Service, may establish a national
Community Health Aide Program in accordance with the program
under this section, as the Secretary determines to be
appropriate.
``(2) Exception.--The national Community Health Aide Program
under paragraph (1) shall not include dental health aide
therapist services.
``(3) Requirement.--In establishing a national program under
paragraph (1), the Secretary shall not reduce the amount of
funds provided for the Community Health Aide Program described
in subsections (a) and (b).
``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.
``The Secretary, acting through the Service, shall, by contract or
otherwise, provide training for Indians in the administration and
planning of Tribal Health Programs.
``SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION
PROGRAMS.
``(a) Demonstration Programs Authorized.--The Secretary, acting
through the Service, may fund demonstration programs for Tribal Health
Programs to address the chronic shortages of health professionals.
``(b) Purposes of Programs.--The purposes of demonstration programs
funded under subsection (a) shall be--
``(1) to provide direct clinical and practical experience at
a Service Unit to health profession students and residents from
medical schools;
``(2) to improve the quality of health care for Indians by
assuring access to qualified health care professionals; and
``(3) to provide academic and scholarly opportunities for
health professionals serving Indians by identifying all
academic and scholarly resources of the region.
``(c) Advisory Board.--The demonstration programs established
pursuant to subsection (a) shall incorporate a program advisory board
composed of representatives from the Indian Tribes and Indian
communities in the area which will be served by the program.
``SEC. 124. NATIONAL HEALTH SERVICE CORPS.
``(a) No Reduction in Services.--The Secretary shall not--
``(1) remove a member of the National Health Service Corps
from an Indian Health Program or Urban Indian Organization; or
``(2) withdraw funding used to support such member, unless
the Secretary, acting through the Service, has ensured that the
Indians receiving services from such member will experience no
reduction in services.
``(b) Exemption From Limitations.--National Health Service Corps
scholars qualifying for the Commissioned Corps in the Public Health
Service shall be exempt from the full-time equivalent limitations of
the National Health Service Corps and the Service when serving as a
commissioned corps officer in a Tribal Health Program or an Urban
Indian Organization.
``SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL CURRICULA
DEMONSTRATION PROGRAMS.
``(a) Contracts and Grants.--The Secretary, acting through the
Service, may enter into contracts with, or make grants to, accredited
tribal colleges and universities and eligible accredited and accessible
community colleges to establish demonstration programs to develop
educational curricula for substance abuse counseling.
``(b) Use of Funds.--Funds provided under this section shall be used
only for developing and providing educational curriculum for substance
abuse counseling (including paying salaries for instructors). Such
curricula may be provided through satellite campus programs.
``(c) Time Period of Assistance; Renewal.--A contract entered into or
a grant provided under this section shall be for a period of 3 years.
Such contract or grant may be renewed for an additional 2-year period
upon the approval of the Secretary.
``(d) Criteria for Review and Approval of Applications.--Not later
than 180 days after the date of enactment of the Indian Health Care
Improvement Act Amendments of 2007, the Secretary, after consultation
with Indian Tribes and administrators of tribal colleges and
universities and eligible accredited and accessible 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 criteria shall ensure that
demonstration programs established under this section promote the
development of the capacity of such entities to educate substance abuse
counselors.
``(e) Assistance.--The Secretary shall provide such technical and
other assistance as may be necessary to enable grant recipients to
comply with the provisions of this section.
``(f) Report.--Each fiscal year, the Secretary shall submit to the
President, for inclusion in the report which is required to be
submitted under section 801 for that fiscal year, a report on the
findings and conclusions derived from the demonstration programs
conducted under this section during that fiscal year.
``(g) Definition.--For the purposes of this section, the term
`educational curriculum' means 1 or more of the following:
``(1) Classroom education.
``(2) Clinical work experience.
``(3) Continuing education workshops.
``SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMUNITY EDUCATION
PROGRAMS.
``(a) Study; List.--The Secretary, acting through the Service, and
the Secretary of the Interior, in consultation with Indian Tribes and
Tribal Organizations, shall conduct a study and compile a list of the
types of staff positions specified in subsection (b) whose
qualifications include, or should include, training in the
identification, prevention, education, referral, or treatment of mental
illness, or dysfunctional and self destructive behavior.
``(b) Positions.--The positions referred to in subsection (a) are--
``(1) staff positions within the Bureau of Indian Affairs,
including existing positions, in the fields of--
``(A) elementary and secondary education;
``(B) social services and family and child welfare;
``(C) law enforcement and judicial services; and
``(D) alcohol and substance abuse;
``(2) staff positions within the Service; and
``(3) staff positions similar to those identified in
paragraphs (1) and (2) established and maintained by Indian
Tribes, Tribal Organizations (without regard to the funding
source), and Urban Indian Organizations.
``(c) Training Criteria.--
``(1) In general.--The appropriate Secretary shall provide
training criteria appropriate to each type of position
identified in subsection (b)(1) and (b)(2) and ensure that
appropriate training has been, or shall be provided to any
individual in any such position. With respect to any such
individual in a position identified pursuant to subsection
(b)(3), the respective Secretaries shall provide appropriate
training to, or provide funds to, an Indian Tribe, Tribal
Organization, or Urban Indian Organization for training of
appropriate individuals. In the case of positions funded under
a contract or compact under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.), the
appropriate Secretary shall ensure that such training costs are
included in the contract or compact, as the Secretary
determines necessary.
``(2) Position specific training criteria.--Position specific
training criteria shall be culturally relevant to Indians and
Indian Tribes and shall ensure that appropriate information
regarding traditional health care practices is provided.
``(d) Community Education on Mental Illness.--The Service shall
develop and implement, on request of an Indian Tribe, Tribal
Organization, or Urban Indian Organization, or assist the Indian Tribe,
Tribal Organization, or Urban Indian Organization to develop and
implement, a program of community education on mental illness. In
carrying out this subsection, the Service shall, upon request of an
Indian Tribe, Tribal Organization, or Urban Indian Organization,
provide technical assistance to the Indian Tribe, Tribal Organization,
or Urban Indian Organization to obtain and develop community
educational materials on the identification, prevention, referral, and
treatment of mental illness and dysfunctional and self-destructive
behavior.
``(e) Plan.--Not later than 90 days after the date of enactment of
the Indian Health Care Improvement Act Amendments of 2007, the
Secretary shall develop a plan under which the Service will increase
the health care staff providing behavioral health services by at least
500 positions within 5 years after the date of enactment of this
section, with at least 200 of such positions devoted to child,
adolescent, and family services. The plan developed under this
subsection shall be implemented under the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the `Snyder Act').
``SEC. 127. AUTHORIZATION OF APPROPRIATIONS.
``There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2017 to carry out
this title.
``TITLE II--HEALTH SERVICES
``SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.
``(a) Use of Funds.--The Secretary, acting through the Service, is
authorized to expend funds, directly or under the authority of the
Indian Self-Determination and Education Assistance Act (25 U.S.C. 450
et seq.), which are appropriated under the authority of this section,
for the purposes of--
``(1) eliminating the deficiencies in health status and
health resources of all Indian Tribes;
``(2) eliminating backlogs in the provision of health care
services to Indians;
``(3) meeting the health needs of Indians in an efficient and
equitable manner, including the use of telehealth and
telemedicine when appropriate;
``(4) eliminating inequities in funding for both direct care
and contract health service programs; and
``(5) augmenting the ability of the Service to meet the
following health service responsibilities with respect to those
Indian Tribes with the highest levels of health status
deficiencies and resource deficiencies:
``(A) Clinical care, including inpatient care,
outpatient care (including audiology, clinical eye, and
vision care), primary care, secondary and tertiary
care, and long-term care.
``(B) Preventive health, including mammography and
other cancer screening in accordance with section 207.
``(C) Dental care.
``(D) Mental health, including community mental
health services, inpatient mental health services,
dormitory mental health services, therapeutic and
residential treatment centers, and training of
traditional health care practitioners.
``(E) Emergency medical services.
``(F) Treatment and control of, and rehabilitative
care related to, alcoholism and drug abuse (including
fetal alcohol syndrome) among Indians.
``(G) Injury prevention programs, including data
collection and evaluation, demonstration projects,
training, and capacity building.
``(H) Home health care.
``(I) Community health representatives.
``(J) Maintenance and improvement.
``(b) No Offset or Limitation.--Any funds appropriated under the
authority of this section shall not be used to offset or limit any
other appropriations made to the Service under this Act or the Act of
November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'),
or any other provision of law.
``(c) Allocation; Use.--
``(1) In general.--Funds appropriated under the authority of
this section shall be allocated to Service Units, Indian
Tribes, or Tribal Organizations. The funds allocated to each
Indian Tribe, Tribal Organization, or Service Unit under this
paragraph shall be used by the Indian Tribe, Tribal
Organization, or Service Unit under this paragraph to improve
the health status and reduce the resource deficiency of each
Indian Tribe served by such Service Unit, Indian Tribe, or
Tribal Organization.
``(2) Apportionment of allocated funds.--The apportionment of
funds allocated to a Service Unit, Indian Tribe, or Tribal
Organization under paragraph (1) among the health service
responsibilities described in subsection (a)(5) shall be
determined by the Service in consultation with, and with the
active participation of, the affected Indian Tribes and Tribal
Organizations.
``(d) Provisions Relating to Health Status and Resource
Deficiencies.--For the purposes of this section, the following
definitions apply:
``(1) Definition.--The term `health status and resource
deficiency' means the extent to which--
``(A) the health status objectives set forth in
section 3(2) are not being achieved; and
``(B) the Indian Tribe or Tribal Organization 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.
``(2) Available resources.--The health resources available to
an Indian Tribe or Tribal Organization include health resources
provided by the Service as well as health resources used by the
Indian Tribe or Tribal Organization, including services and
financing systems provided by any Federal programs, private
insurance, and programs of State or local governments.
``(3) Process for review of determinations.--The Secretary
shall establish procedures which allow any Indian Tribe or
Tribal Organization to petition the Secretary for a review of
any determination of the extent of the health status and
resource deficiency of such Indian Tribe or Tribal
Organization.
``(e) Eligibility for Funds.--Tribal Health Programs shall be
eligible for funds appropriated under the authority of this section on
an equal basis with programs that are administered directly by the
Service.
``(f) Report.--By no later than the date that is 3 years after the
date of enactment of the Indian Health Care Improvement Act Amendments
of 2007, the Secretary shall submit to Congress the current health
status and resource deficiency report of the Service for each Service
Unit, including newly recognized or acknowledged Indian Tribes. Such
report shall set out--
``(1) the methodology then in use by the Service for
determining Tribal health status and resource deficiencies, as
well as the most recent application of that methodology;
``(2) the extent of the health status and resource deficiency
of each Indian Tribe served by the Service or a Tribal Health
Program;
``(3) the amount of funds necessary to eliminate the health
status and resource deficiencies of all Indian Tribes served by
the Service or a Tribal Health Program; and
``(4) an estimate of--
``(A) the amount of health service funds appropriated
under the authority of this Act, or any other Act,
including the amount of any funds transferred to the
Service for the preceding fiscal year which is
allocated to each Service Unit, Indian Tribe, or Tribal
Organization;
``(B) the number of Indians eligible for health
services in each Service Unit or Indian Tribe or Tribal
Organization; and
``(C) the number of Indians using the Service
resources made available to each Service Unit, Indian
Tribe or Tribal Organization, and, to the extent
available, information on the waiting lists and number
of Indians turned away for services due to lack of
resources.
``(g) Inclusion in Base Budget.--Funds appropriated under this
section for any fiscal year shall be included in the base budget of the
Service for the purpose of determining appropriations under this
section in subsequent fiscal years.
``(h) Clarification.--Nothing in this section is intended to diminish
the primary responsibility of the Service to eliminate existing
backlogs in unmet health care needs, nor are the provisions of this
section intended to discourage the Service from undertaking additional
efforts to achieve equity among Indian Tribes and Tribal Organizations.
``(i) Funding Designation.--Any funds appropriated under the
authority of this section shall be designated as the `Indian Health
Care Improvement Fund'.
``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.
``(a) Establishment.--There is established an Indian Catastrophic
Health Emergency Fund (hereafter in this section referred to as the
`CHEF') consisting of--
``(1) the amounts deposited under subsection (f); and
``(2) the amounts appropriated to CHEF under this section.
``(b) Administration.--CHEF shall be administered by the Secretary,
acting through the headquarters of the Service, solely for the purpose
of meeting the extraordinary medical costs associated with the
treatment of victims of disasters or catastrophic illnesses who are
within the responsibility of the Service.
``(c) Conditions on Use of Fund.--No part of CHEF or its
administration shall be subject to contract or grant under any law,
including the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.), nor shall CHEF funds be allocated,
apportioned, or delegated on an Area Office, Service Unit, or other
similar basis.
``(d) Regulations.--The Secretary shall promulgate regulations
consistent with the provisions of this section to--
``(1) establish a definition of disasters and catastrophic
illnesses for which the cost of the treatment provided under
contract would qualify for payment from CHEF;
``(2) provide that a Service Unit shall not be eligible for
reimbursement for the cost of treatment from CHEF until its
cost of treating any victim of such catastrophic illness or
disaster has reached a certain threshold cost which the
Secretary shall establish at--
``(A) the 2000 level of $19,000; and
``(B) for any subsequent year, not less than the
threshold 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;
``(3) establish a procedure for the reimbursement of the
portion of the costs that exceeds such threshold cost incurred
by--
``(A) Service Units; or
``(B) whenever otherwise authorized by the Service,
non-Service facilities or providers;
``(4) establish a procedure for payment from CHEF in cases in
which the exigencies of the medical circumstances warrant
treatment prior to the authorization of such treatment by the
Service; and
``(5) establish a procedure that will ensure that no payment
shall be made from CHEF to any provider of treatment to the
extent that such provider is eligible to receive payment for
the treatment from any other Federal, State, local, or private
source of reimbursement for which the patient is eligible.
``(e) No Offset or Limitation.--Amounts appropriated to CHEF under
this section shall not be used to offset or limit appropriations made
to the Service under the authority of the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the `Snyder Act'), or any other law.
``(f) Deposit of Reimbursement Funds.--There shall be deposited into
CHEF all reimbursements to which the Service is entitled from any
Federal, State, local, or private source (including third party
insurance) by reason of treatment rendered to any victim of a disaster
or catastrophic illness the cost of which was paid from CHEF.
``SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION SERVICES.
``(a) Findings.--Congress finds that health promotion and disease
prevention activities--
``(1) improve the health and well-being of Indians; and
``(2) reduce the expenses for health care of Indians.
``(b) Provision of Services.--The Secretary, acting through the
Service and Tribal Health Programs, shall provide health promotion and
disease prevention services to Indians to achieve the health status
objectives set forth in section 3(2).
``(c) Evaluation.--The Secretary, after obtaining input from the
affected Tribal Health Programs, shall submit to the President for
inclusion in the report which is required to be submitted to Congress
under section 801 an evaluation of--
``(1) the health promotion and disease prevention needs of
Indians;
``(2) the health promotion and disease prevention activities
which would best meet such needs;
``(3) the internal capacity of the Service and Tribal Health
Programs to meet such needs; and
``(4) the resources which would be required to enable the
Service and Tribal Health Programs to undertake the health
promotion and disease prevention activities necessary to meet
such needs.
``SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL.
``(a) Determinations Regarding Diabetes.--The Secretary, acting
through the Service, and in consultation with Indian Tribes and Tribal
Organizations, shall determine--
``(1) by Indian Tribe and by Service Unit, the incidence of,
and the types of complications resulting from, diabetes among
Indians; and
``(2) based on the determinations made pursuant to paragraph
(1), the measures (including patient education and effective
ongoing monitoring of disease indicators) each Service Unit
should take to reduce the incidence of, and prevent, treat, and
control the complications resulting from, diabetes among Indian
Tribes within that Service Unit.
``(b) Diabetes Screening.--To the extent medically indicated and with
informed consent, the Secretary shall screen each Indian who receives
services from the Service for diabetes and for conditions which
indicate a high risk that the individual will become diabetic and
establish a cost-effective approach to ensure ongoing monitoring of
disease indicators. Such screening and monitoring may be conducted by a
Tribal Health Program and may be conducted through appropriate
Internet-based health care management programs.
``(c) Diabetes Projects.--The Secretary shall continue to maintain
each model diabetes project in existence on the date of enactment of
the Indian Health Care Improvement Act Amendments of 2007, any such
other diabetes programs operated by the Service or Tribal Health
Programs, and any additional diabetes projects, such as the Medical
Vanguard program provided for in title IV of Public Law 108-87, as
implemented to serve Indian Tribes. Tribal Health Programs shall
receive recurring funding for the diabetes projects that they operate
pursuant to this section, both at the date of enactment of the Indian
Health Care Improvement Act Amendments of 2007 and for projects which
are added and funded thereafter.
``(d) Dialysis Programs.--The Secretary is authorized to provide,
through the Service, Indian Tribes, and Tribal Organizations, dialysis
programs, including the purchase of dialysis equipment and the
provision of necessary staffing.
``(e) Other Duties of the Secretary.--
``(1) In general.--The Secretary shall, to the extent funding
is available--
``(A) in each Area Office, consult with Indian Tribes
and Tribal Organizations regarding programs for the
prevention, treatment, and control of diabetes;
``(B) establish in each Area Office a registry of
patients with diabetes to track the incidence of
diabetes and the complications from diabetes in that
area; and
``(C) ensure that data collected in each Area Office
regarding diabetes and related complications among
Indians are disseminated to all other Area Offices,
subject to applicable patient privacy laws.
``(2) Diabetes control officers.--
``(A) In general.--The Secretary may establish and
maintain in each Area Office a position of diabetes
control officer to coordinate and manage any activity
of that Area Office relating to the prevention,
treatment, or control of diabetes to assist the
Secretary in carrying out a program under this section
or section 330C of the Public Health Service Act (42
U.S.C. 254c-3).
``(B) Certain activities.--Any activity carried out
by a diabetes control officer under subparagraph (A)
that is the subject of a contract or compact under the
Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.), and any funds made available
to carry out such an activity, shall not be divisible
for purposes of that Act.
``SEC. 205. SHARED SERVICES FOR LONG-TERM CARE.
``(a) Long-Term Care.--Notwithstanding any other provision of law,
the Secretary, acting through the Service, is authorized to provide
directly, or enter into contracts or compacts under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et seq.) with
Indian Tribes or Tribal Organizations for, the delivery of long-term
care (including health care services associated with long-term care)
provided in a facility to Indians. Such agreements shall provide for
the sharing of staff or other services between the Service or a Tribal
Health Program and a long-term care or related facility owned and
operated (directly or through a contract or compact under the Indian
Self-Determination and Education Assistance Act (25 U.S.C. 450 et
seq.)) by such Indian Tribe or Tribal Organization.
``(b) Contents of Agreements.--An agreement entered into pursuant to
subsection (a)--
``(1) may, at the request of the Indian Tribe or Tribal
Organization, delegate to such Indian Tribe or Tribal
Organization such 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 and
the Tribal Health Program be allocated proportionately between
the Service and the Indian Tribe or Tribal Organization; and
``(3) may authorize such Indian Tribe or Tribal Organization
to construct, renovate, or expand a long-term care or other
similar facility (including the construction of a facility
attached to a Service facility).
``(c) Minimum Requirement.--Any nursing facility provided for under
this section shall meet the requirements for nursing facilities under
section 1919 of the Social Security Act.
``(d) Other Assistance.--The Secretary shall provide such technical
and other assistance as may be necessary to enable applicants to comply
with the provisions of this section.
``(e) Use of Existing or Underused Facilities.--The Secretary shall
encourage the use of existing facilities that are underused or allow
the use of swing beds for long-term or similar care.
``SEC. 206. HEALTH SERVICES RESEARCH.
``(a) In General.--The Secretary, acting through the Service, shall
make funding available for research to further the performance of the
health service responsibilities of Indian Health Programs.
``(b) Coordination of Resources and Activities.--The Secretary shall
also, to the maximum extent practicable, coordinate departmental
research resources and activities to address relevant Indian Health
Program research needs.
``(c) Availability.--Tribal Health Programs shall be given an equal
opportunity to compete for, and receive, research funds under this
section.
``(d) Use of Funds.--This funding may be used for both clinical and
nonclinical research.
``(e) Evaluation and Dissemination.--The Secretary shall
periodically--
``(1) evaluate the impact of research conducted under this
section; and
``(2) disseminate to Tribal Health Programs information
regarding that research as the Secretary determines to be
appropriate.
``SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREENING.
``The Secretary, acting through the Service or Tribal Health
Programs, shall provide for screening as follows:
``(1) Screening mammography (as defined in section 1861(jj)
of the Social Security Act) for Indian women at a frequency
appropriate to such women under accepted and appropriate
national standards, and under such terms and conditions as are
consistent with standards established by the Secretary to
ensure the safety and accuracy of screening mammography under
part B of title XVIII of such Act.
``(2) Other cancer screening that receives an A or B rating
as recommended by the United States Preventive Services Task
Force established under section 915(a)(1) of the Public Health
Service Act (42 U.S.C. 299b-4(a)(1)). The Secretary shall
ensure that screening provided for under this paragraph
complies with the recommendations of the Task Force with
respect to--
``(A) frequency;
``(B) the population to be served;
``(C) the procedure or technology to be used;
``(D) evidence of effectiveness; and
``(E) other matters that the Secretary determines
appropriate.
``SEC. 208. PATIENT TRAVEL COSTS.
``(a) Definition of Qualified Escort.--In this section, the term
`qualified escort' means--
``(1) an adult escort (including a parent, guardian, or other
family member) who is required because of the physical or
mental condition, or age, of the applicable patient;
``(2) a health professional for the purpose of providing
necessary medical care during travel by the applicable patient;
or
``(3) other escorts, as the Secretary or applicable Indian
Health Program determines to be appropriate.
``(b) Provision of Funds.--The Secretary, acting through the Service
and Tribal Health Programs, is authorized to provide funds for the
following patient travel costs, including qualified escorts, associated
with receiving health care services provided (either through direct or
contract care or through a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et seq.))
under this Act--
``(1) emergency air transportation and non-emergency air
transportation where ground transportation is infeasible;
``(2) transportation by private vehicle (where no other means
of transportation is available), specially equipped vehicle,
and ambulance; and
``(3) transportation by such other means as may be available
and required when air or motor vehicle transportation is not
available.
``SEC. 209. EPIDEMIOLOGY CENTERS.
``(a) Establishment of Centers.--The Secretary shall establish an
epidemiology center in each Service Area to carry out the functions
described in subsection (b). Any new center established after the date
of the enactment of the Indian Health Care Improvement Act Amendments
of 2007 may be operated under a grant authorized by subsection (d), but
funding under such a grant shall not be divisible.
``(b) Functions of Centers.--In consultation with and upon the
request of Indian Tribes, Tribal Organizations, and Urban Indian
Organizations, each Service Area epidemiology center established under
this subsection shall, with respect to such Service Area--
``(1) collect data relating to, and monitor progress made
toward meeting, each of the health status objectives of the
Service, the Indian Tribes, Tribal Organizations, and Urban
Indian Organizations in the Service Area;
``(2) evaluate existing delivery systems, data systems, and
other systems that impact the improvement of Indian health;
``(3) assist Indian Tribes, Tribal Organizations, and Urban
Indian Organizations in identifying their highest priority
health status objectives and the services needed to achieve
such objectives, based on epidemiological data;
``(4) make recommendations for the targeting of services
needed by the populations served;
``(5) make recommendations to improve health care delivery
systems for Indians and Urban Indians;
``(6) provide requested technical assistance to Indian
Tribes, Tribal Organizations, 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; and
``(7) provide disease surveillance and assist Indian Tribes,
Tribal Organizations, and Urban Indian Organizations to promote
public health.
``(c) Technical Assistance.--The Director of the Centers for Disease
Control and Prevention shall provide technical assistance to the
centers in carrying out the requirements of this subsection.
``(d) Grants for Studies.--
``(1) In general.--The Secretary may make grants to Indian
Tribes, Tribal Organizations, Urban Indian Organizations, and
eligible intertribal consortia to conduct epidemiological
studies of Indian communities.
``(2) Eligible intertribal consortia.--An intertribal
consortium is eligible to receive a grant under this subsection
if--
``(A) the intertribal consortium is incorporated for
the primary purpose of improving Indian health; and
``(B) the intertribal consortium is representative of
the Indian Tribes or urban Indian communities in which
the intertribal consortium is located.
``(3) Applications.--An application for a grant under this
subsection shall be submitted in such manner and at such time
as the Secretary shall prescribe.
``(4) Requirements.--An applicant for a grant under this
subsection shall--
``(A) demonstrate the technical, administrative, and
financial 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 Indian tribes or
Urban Indian Organizations in the area to be served.
``(5) Use of funds.--A grant awarded under paragraph (1) may
be used--
``(A) to carry out the functions described in
subsection (b);
``(B) to provide information to and consult with
tribal leaders, urban Indian community leaders, and
related health staff on health care and health service
management issues; and
``(C) in collaboration with Indian Tribes, Tribal
Organizations, and urban Indian communities, to provide
the Service with information regarding ways to improve
the health status of Indians.
``(e) Access to Information.--An epidemiology center operated by a
grantee pursuant to a grant awarded under subsection (d) shall be
treated as a public health authority for purposes of the Health
Insurance Portability and Accountability Act of 1996 (Public Law 104-
191; 110 Stat. 2033), as such entities are defined in part 164.501 of
title 45, Code of Federal Regulations (or a successor regulation). The
Secretary shall grant such grantees access to and use of data, data
sets, monitoring systems, delivery systems, and other protected health
information in the possession of the Secretary.
``SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS.
``(a) Funding for Development of Programs.--In addition to carrying
out any other program for health promotion or disease prevention, the
Secretary, acting through the Service, is authorized to award grants to
Indian Tribes, Tribal Organizations, and Urban Indian Organizations to
develop comprehensive school health education programs for children
from pre-school through grade 12 in schools for the benefit of Indian
and Urban Indian children.
``(b) Use of Grant Funds.--A grant awarded under this section may be
used for purposes which may include, but are not limited to, the
following:
``(1) Developing health education materials both for regular
school programs and afterschool programs.
``(2) Training teachers in comprehensive school health
education materials.
``(3) Integrating school-based, community-based, and other
public and private health promotion efforts.
``(4) Encouraging healthy, tobacco-free school environments.
``(5) Coordinating school-based health programs with existing
services and programs available in the community.
``(6) Developing school programs on nutrition education,
personal health, oral health, and fitness.
``(7) Developing behavioral health wellness programs.
``(8) Developing chronic disease prevention programs.
``(9) Developing substance abuse prevention programs.
``(10) Developing injury prevention and safety education
programs.
``(11) Developing activities for the prevention and control
of communicable diseases.
``(12) Developing community and environmental health
education programs that include traditional health care
practitioners.
``(13) Violence prevention.
``(14) Such other health issues as are appropriate.
``(c) Technical Assistance.--Upon request, the Secretary, acting
through the Service, shall provide technical assistance to Indian
Tribes, Tribal Organizations, and Urban Indian Organizations in the
development of comprehensive health education plans and the
dissemination of comprehensive health education materials and
information on existing health programs and resources.
``(d) Criteria for Review and Approval of Applications.--The
Secretary, acting through the Service, and in consultation with Indian
Tribes, Tribal Organizations, and Urban Indian Organizations, shall
establish criteria for the review and approval of applications for
grants awarded under this section.
``(e) Development of Program for BIA-Funded Schools.--
``(1) In general.--The Secretary of the Interior, acting
through the Bureau of Indian Affairs and in cooperation with
the Secretary, acting through the Service, and affected Indian
Tribes and Tribal Organizations, shall develop a comprehensive
school health education program for children from preschool
through grade 12 in schools for which support is provided by
the Bureau of Indian Affairs.
``(2) Requirements for programs.--Such programs shall
include--
``(A) school programs on nutrition education,
personal health, oral health, and fitness;
``(B) behavioral health wellness programs;
``(C) chronic disease prevention programs;
``(D) substance abuse prevention programs;
``(E) injury prevention and safety education
programs; and
``(F) activities for the prevention and control of
communicable diseases.
``(3) Duties of the secretary.--The Secretary of the Interior
shall--
``(A) provide training to teachers in comprehensive
school health education materials;
``(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.
``SEC. 211. INDIAN YOUTH PROGRAM.
``(a) Program Authorized.--The Secretary, acting through the Service,
is authorized to establish and administer a program to provide grants
to Indian Tribes, Tribal Organizations, and Urban Indian Organizations
for innovative mental and physical disease prevention and health
promotion and treatment programs for Indian and Urban Indian
preadolescent and adolescent youths.
``(b) Use of Funds.--
``(1) Allowable uses.--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 incorporate cultural values, community and family
involvement, and traditional health care practitioners;
and
``(B) develop and provide community training and
education.
``(2) Prohibited use.--Funds made available under this
section may not be used to provide services described in
section 707(c).
``(c) Duties of the Secretary.--The Secretary shall--
``(1) disseminate to Indian Tribes, Tribal Organizations, and
Urban Indian Organizations 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, Tribal Organization,
or Urban Indian Organization, provide technical assistance in
the implementation of such models.
``(d) Criteria for Review and Approval of Applications.--The
Secretary, in consultation with Indian Tribes, Tribal Organizations,
and Urban Indian Organizations, shall establish criteria for the review
and approval of applications or proposals under this section.
``SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF COMMUNICABLE AND
INFECTIOUS DISEASES.
``(a) Grants Authorized.--The Secretary, acting through the Service,
and after consultation with the Centers for Disease Control and
Prevention, may make grants available to Indian Tribes, Tribal
Organizations, and Urban Indian Organizations for the following:
``(1) Projects for the prevention, control, and elimination
of communicable and infectious diseases, including
tuberculosis, hepatitis, HIV, respiratory syncytial virus,
hanta virus, sexually transmitted diseases, and H. Pylori.
``(2) Public information and education programs for the
prevention, control, and elimination of communicable and
infectious diseases.
``(3) Education, training, and clinical skills improvement
activities in the prevention, control, and elimination of
communicable and infectious diseases for health professionals,
including allied health professionals.
``(4) Demonstration projects for the screening, treatment,
and prevention of hepatitis C virus (HCV).
``(b) Application Required.--The Secretary may provide funding under
subsection (a) only if an application or proposal for funding is
submitted to the Secretary.
``(c) Coordination With Health Agencies.--Indian Tribes, Tribal
Organizations, and Urban Indian Organizations receiving funding under
this section are encouraged to coordinate their activities with the
Centers for Disease Control and Prevention and State and local health
agencies.
``(d) Technical Assistance; Report.--In carrying out this section,
the Secretary--
``(1) may, at the request of an Indian Tribe, Tribal
Organization, or Urban Indian Organization, provide technical
assistance; and
``(2) shall prepare and submit a report to Congress
biennially on the use of funds under this section and on the
progress made toward the prevention, control, and elimination
of communicable and infectious diseases among Indians and Urban
Indians.
``SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERVICES.
``(a) Funding Authorized.--The Secretary, acting through the Service,
Indian Tribes, and Tribal Organizations, may provide funding under this
Act to meet the objectives set forth in section 3 through health care-
related services and programs not otherwise described in this Act,
including--
``(1) hospice care;
``(2) assisted living;
``(3) long-term care; and
``(4) home- and community-based services.
``(b) Terms and Conditions.--
``(1) In general.--Any service provided under this section
shall be in accordance with such terms and conditions as are
consistent with accepted and appropriate standards relating to
the service, including any licensing term or condition under
this Act.
``(2) Standards.--
``(A) In general.--The Secretary may establish, by
regulation, the standards for a service provided under
this section, provided that such standards shall not be
more stringent than the standards required by the State
in which the service is provided.
``(B) Use of state standards.--If the Secretary does
not, by regulation, establish standards for a service
provided under this section, the standards required by
the State in which the service is or will be provided
shall apply to such service.
``(C) Indian tribes.--If a service under this section
is provided by an Indian Tribe or Tribal Organization
pursuant to the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.), the
verification by the Secretary that the service meets
any standards required by the State in which the
service is or will be provided shall be considered to
meet the terms and conditions required under this
subsection.
``(3) Eligibility.--The following individuals shall be
eligible to receive long-term care under this section:
``(A) Individuals who are unable to perform a certain
number of activities of daily living without
assistance.
``(B) Individuals with a mental impairment, such as
dementia, Alzheimer's disease, or another disabling
mental illness, who may be able to perform activities
of daily living under supervision.
``(C) Such other individuals as an applicable Indian
Health Program determines to be appropriate.
``(c) Definitions.--For the purposes of this section, the following
definitions shall apply:
``(1) The term `home- and community-based services' means 1
or more of the services specified in paragraphs (1) through (9)
of section 1929(a) of the Social Security Act (42 U.S.C.
1396t(a)) (whether provided by the Service or by an Indian
Tribe or Tribal Organization pursuant to the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.)) that are or will be provided in accordance with the
standards described in subsection (b).
``(2) The term `hospice care' means the items and services
specified in subparagraphs (A) through (H) of section
1861(dd)(1) of the Social Security Act (42 U.S.C.
1395x(dd)(1)), and such other services which an Indian Tribe or
Tribal Organization determines are necessary and appropriate to
provide in furtherance of this care.
``SEC. 214. INDIAN WOMEN'S HEALTH CARE.
``The Secretary, acting through the Service and Indian Tribes, Tribal
Organizations, and Urban Indian Organizations, shall monitor and
improve the quality of health care for Indian women of all ages through
the planning and delivery of programs administered by the Service, in
order to improve and enhance the treatment models of care for Indian
women.
``SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZARDS.
``(a) Studies and Monitoring.--The Secretary and the Service shall
conduct, in conjunction with other appropriate Federal agencies and in
consultation with concerned Indian Tribes and Tribal Organizations,
studies and ongoing monitoring programs to determine trends in the
health hazards to Indian miners and to Indians on or near reservations
and Indian communities as a result of environmental hazards which may
result in chronic or life threatening health problems, such as nuclear
resource development, petroleum contamination, and contamination of
water source and of the food chain. Such studies shall include--
``(1) an evaluation of the nature and extent of health
problems caused by environmental hazards currently exhibited
among Indians and the causes of such health problems;
``(2) an analysis of the potential effect of ongoing and
future environmental resource development on or near
reservations and Indian communities, including the cumulative
effect over time on health;
``(3) an evaluation of the types and nature of activities,
practices, and conditions causing or affecting such health
problems, including uranium mining and milling, uranium mine
tailing deposits, nuclear power plant operation and
construction, and nuclear waste disposal; oil and gas
production or transportation on or near reservations or Indian
communities; and other development that could affect the health
of Indians and their water supply and food chain;
``(4) a summary of any findings and recommendations provided
in Federal and State studies, reports, investigations, and
inspections during the 5 years prior to the date of enactment
of the Indian Health Care Improvement Act Amendments of 2007
that directly or indirectly relate to the activities,
practices, and conditions affecting the health or safety of
such Indians; and
``(5) the efforts that have been made by Federal and State
agencies and resource and economic development companies to
effectively carry out an education program for such Indians
regarding the health and safety hazards of such development.
``(b) Health Care Plans.--Upon completion of such studies, the
Secretary and the Service shall take into account the results of such
studies and develop health care plans to address the health problems
studied under subsection (a). The plans shall include--
``(1) methods for diagnosing and treating Indians currently
exhibiting such health problems;
``(2) preventive care and testing for Indians who may be
exposed to such health hazards, including the monitoring of the
health of individuals who have or may have been exposed to
excessive amounts of radiation or affected by other activities
that have had or could have a serious impact upon the health of
such individuals; and
``(3) a program of education for Indians who, by reason of
their work or geographic proximity to such nuclear or other
development activities, may experience health problems.
``(c) Submission of Report and Plan to Congress.--The Secretary and
the Service shall submit to Congress the study prepared under
subsection (a) no later than 18 months after the date of enactment of
the Indian Health Care Improvement Act Amendments of 2007. The health
care plan prepared under subsection (b) shall be submitted in a report
no later than 1 year after the study prepared under subsection (a) is
submitted to Congress. Such report shall include recommended activities
for the implementation of the plan, as well as an evaluation of any
activities previously undertaken by the Service to address such health
problems.
``(d) Intergovernmental Task Force.--
``(1) Establishment; members.--There is established an
Intergovernmental Task Force to be composed of the following
individuals (or their designees):
``(A) The Secretary of Energy.
``(B) The Secretary of the Environmental Protection
Agency.
``(C) The Director of the Bureau of Mines.
``(D) The Assistant Secretary for Occupational Safety
and Health.
``(E) The Secretary of the Interior.
``(F) The Secretary of Health and Human Services.
``(G) The Director of the Indian Health Service.
``(2) Duties.--The Task Force shall--
``(A) identify existing and potential operations
related to nuclear resource development or other
environmental hazards that affect or may affect the
health of Indians on or near a reservation or in an
Indian community; and
``(B) enter into activities to correct existing
health hazards and ensure that current and future
health problems resulting from nuclear resource or
other development activities are minimized or reduced.
``(3) Chairman; meetings.--The Secretary of Health and Human
Services shall be the Chairman of the Task Force. The Task
Force shall meet at least twice each year.
``(e) Health Services to Certain Employees.--In the case of any
Indian who--
``(1) as a result of employment in or near a uranium mine or
mill or near any other environmental hazard, suffers from a
work-related illness or condition;
``(2) is eligible to receive diagnosis and treatment services
from an Indian Health Program; and
``(3) by reason of such Indian's employment, is entitled to
medical care at the expense of such mine or mill operator or
entity responsible for the environmental hazard, the Indian
Health Program shall, at the request of such Indian, render
appropriate medical care to such Indian for such illness or
condition and may be reimbursed for any medical care so
rendered to which such Indian is entitled at the expense of
such operator or entity from such operator or entity. Nothing
in this subsection shall affect the rights of such Indian to
recover damages other than such amounts paid to the Indian
Health Program from the employer for providing medical care for
such illness or condition.
``SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.
``(a) In General.--For fiscal years beginning with the fiscal year
ending September 30, 1983, and ending with the fiscal year ending
September 30, 2016, the State of Arizona shall be designated as a
contract health service delivery area by the Service for the purpose of
providing contract health care services to members of federally
recognized Indian Tribes of Arizona.
``(b) Maintenance of Services.--The Service shall not curtail any
health care services provided to Indians residing on reservations in
the State of Arizona if such curtailment is due to the provision of
contract services in such State pursuant to the designation of such
State as a contract health service delivery area pursuant to subsection
(a).
``SEC. 217. NORTH DAKOTA AND SOUTH DAKOTA AS CONTRACT HEALTH SERVICE
DELIVERY AREA.
``(a) In General.--Beginning in fiscal year 2003, the States of North
Dakota and South Dakota shall be designated as a contract health
service delivery area by the Service for the purpose of providing
contract health care services to members of federally recognized Indian
Tribes of North Dakota and South Dakota.
``(b) Limitation.--The Service shall not curtail any health care
services provided to Indians residing on any reservation, or in any
county that has a common boundary with any reservation, in the State of
North Dakota or South Dakota if such curtailment is due to the
provision of contract services in such States pursuant to the
designation of such States as a contract health service delivery area
pursuant to subsection (a).
``SEC. 218. CALIFORNIA CONTRACT HEALTH SERVICES PROGRAM.
``(a) Funding Authorized.--The Secretary is authorized to fund a
program using the California Rural Indian Health Board (hereafter in
this section referred to as the `CRIHB') as a contract care
intermediary to improve the accessibility of health services to
California Indians.
``(b) Reimbursement Contract.--The Secretary shall enter into an
agreement with the CRIHB to reimburse the CRIHB for costs (including
reasonable administrative costs) incurred pursuant to this section, in
providing medical treatment under contract to California Indians
described in section 806(a) throughout the California contract health
services delivery area described in section 218 with respect to high
cost contract care cases.
``(c) Administrative Expenses.--Not more than 5 percent of the
amounts provided to the CRIHB under this section for any fiscal year
may be for reimbursement for administrative expenses incurred by the
CRIHB during such fiscal year.
``(d) Limitation on Payment.--No payment may be made for treatment
provided hereunder to the extent payment may be made for such treatment
under the Indian 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.
``(e) Advisory Board.--There is established an advisory board which
shall advise the CRIHB in carrying out this section. The advisory board
shall be composed of representatives, selected by the CRIHB, from not
less than 8 Tribal Health Programs serving California Indians covered
under this section at least \1/2\ of whom of whom are not affiliated
with the CRIHB.
``SEC. 219. CALIFORNIA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.
``The State of California, excluding the counties of Alameda, Contra
Costa, Los Angeles, Marin, Orange, Sacramento, San Francisco, San
Mateo, Santa Clara, Kern, Merced, Monterey, Napa, San Benito, San
Joaquin, San Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ventura,
shall be designated as a contract health service delivery area by the
Service for the purpose of providing contract health services to
California Indians. However, any of the counties listed herein may only
be included in the contract health services delivery area if funding is
specifically provided by the Service for such services in those
counties.
``SEC. 220. CONTRACT HEALTH SERVICES FOR THE TRENTON SERVICE AREA.
``(a) Authorization for Services.--The Secretary, acting through the
Service, is directed to provide contract health services to members of
the Turtle Mountain Band of Chippewa Indians that reside in the Trenton
Service Area of Divide, McKenzie, and Williams counties in the State of
North Dakota and the adjoining counties of Richland, Roosevelt, and
Sheridan in the State of Montana.
``(b) No Expansion of Eligibility.--Nothing in this section may be
construed as expanding the eligibility of members of the Turtle
Mountain Band of Chippewa Indians for health services provided by the
Service beyond the scope of eligibility for such health services that
applied on May 1, 1986.
``SEC. 221. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL
ORGANIZATIONS.
``The Service shall provide funds for health care programs and
facilities operated by Tribal Health Programs on the same basis as such
funds are provided to programs and facilities operated directly by the
Service.
``SEC. 222. LICENSING.
``Health care professionals employed by a Tribal Health Program
shall, if licensed in any State, be exempt from the licensing
requirements of the State in which the Tribal Health Program performs
the services described in its contract or compact under the Indian
Self-Determination and Education Assistance Act (25 U.S.C. 450 et
seq.).
``SEC. 223. NOTIFICATION OF PROVISION OF EMERGENCY CONTRACT HEALTH
SERVICES.
``With respect to an elderly Indian or an Indian with a disability
receiving emergency medical care or services from a non-Service
provider or in a non-Service facility under the authority of this Act,
the time limitation (as a condition of payment) for notifying the
Service of such treatment or admission shall be 30 days.
``SEC. 224. PROMPT ACTION ON PAYMENT OF CLAIMS.
``(a) Deadline for Response.--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) Effect of Untimely Response.--If the Service fails to respond
to a notification of a claim in accordance with subsection (a), the
Service shall accept as valid the claim submitted by the provider of a
contract care service.
``(c) Deadline for Payment of Valid Claim.--The Service shall pay a
valid contract care service claim within 30 days after the completion
of the claim.
``SEC. 225. LIABILITY FOR PAYMENT.
``(a) No Patient Liability.--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) Notification.--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
payment of any charges or costs associated with the provision of such
services not later than 5 business days after receipt of a notification
of a claim by a provider of contract care services.
``(c) No Recourse.--Following receipt of the notice provided under
subsection (b), or, if a claim has been deemed accepted under section
223(b), the provider shall have no further recourse against the patient
who received the services.
``SEC. 226. OFFICE OF INDIAN MEN'S HEALTH.
``(a) Establishment.--The Secretary may establish within the Service
an office to be known as the `Office of Indian Men's Health' (referred
to in this section as the `Office').
``(b) Director.--
``(1) In general.--The Office shall be headed by a director,
to be appointed by the Secretary.
``(2) Duties.--The director shall coordinate and promote the
status of the health of Indian men in the United States.
``(c) Report.--Not later than 2 years after the date of enactment of
the Indian Health Care Improvement Act Amendments of 2007, the
Secretary, acting through the director of the Office, shall submit to
Congress a report describing--
``(1) any activity carried out by the director as of the date
on which the report is prepared; and
``(2) any finding of the director with respect to the health
of Indian men.
``SEC. 227. AUTHORIZATION OF APPROPRIATIONS.
``There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2017 to carry out
this title.
``TITLE III--FACILITIES
``SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVATION OF FACILITIES;
REPORTS.
``(a) Prerequisites for Expenditure of Funds.--Prior to the
expenditure of, or the making of any binding commitment to expend, any
funds appropriated for the planning, design, construction, or
renovation of facilities pursuant to the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary, acting
through the Service, shall--
``(1) consult with any Indian Tribe that would be
significantly affected by such expenditure for the purpose of
determining and, whenever practicable, honoring tribal
preferences concerning size, location, type, and other
characteristics of any facility on which such expenditure is to
be made; and
``(2) ensure, whenever practicable and applicable, that such
facility meets the construction standards of any accrediting
body recognized by the Secretary for the purposes of the
Medicare, Medicaid, and SCHIP programs under titles XVIII, XIX,
and XXI of the Social Security Act by not later than 1 year
after the date on which the construction or renovation of such
facility is completed.
``(b) Closures.--
``(1) Evaluation required.--Notwithstanding any other
provision of law, no facility operated by the Service, or any
portion of such facility, may be closed if the Secretary has
not submitted to Congress, not less than 1 year and not more
than 2 years before the date of the proposed closure, an
evaluation, completed not more than 2 years before such
submission, of the impact of the proposed closure that
specifies, in addition to other considerations--
``(A) the accessibility of alternative health care
resources for the population served by such facility;
``(B) the cost-effectiveness of such closure;
``(C) the quality of health care to be provided to
the population served by such facility after such
closure;
``(D) the availability of contract health care funds
to maintain existing levels of service;
``(E) the views of the Indian Tribes served by such
facility concerning such closure;
``(F) the level of use of such facility by all
eligible Indians; and
``(G) the distance between such facility and the
nearest operating Service hospital.
``(2) Exception for certain temporary closures.--Paragraph
(1) shall not apply to any temporary closure of a facility or
any portion of a facility if such closure is necessary for
medical, environmental, or construction safety reasons.
``(c) Health Care Facility Priority System.--
``(1) In general.--
``(A) Priority system.--The Secretary, acting through
the Service, shall maintain a health care facility
priority system, which--
``(i) shall be developed in consultation with
Indian Tribes and Tribal Organizations;
``(ii) shall give Indian Tribes' needs the
highest priority;
``(iii)(I) may include the lists required in
paragraph (2)(B)(ii); and
``(II) shall include the methodology required
in paragraph (2)(B)(v); and
``(III) may include such other facilities,
and such renovation or expansion needs of any
health care facility, as the Service, Indian
Tribes, and Tribal Organizations may identify;
and
``(iv) shall provide an opportunity for the
nomination of planning, design, and
construction projects by the Service, Indian
Tribes, and Tribal Organizations for
consideration under the priority system at
least once every 3 years, or more frequently as
the Secretary determines to be appropriate.
``(B) Needs of facilities under isdeaa agreements.--
The Secretary shall ensure that the planning, design,
construction, renovation, and expansion needs of
Service and non-Service facilities operated under
contracts or compacts in accordance with the Indian
Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.) are fully and equitably integrated
into the health care facility priority system.
``(C) Criteria for evaluating needs.--For purposes of
this subsection, the Secretary, in evaluating the needs
of facilities operated under a contract or compact
under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.), shall use the
criteria used by the Secretary in evaluating the needs
of facilities operated directly by the Service.
``(D) Priority of certain projects protected.--The
priority of any project established under the
construction priority system in effect on the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2007 shall not be affected by any change
in the construction priority system taking place after
that date if the project--
``(i) was identified in the fiscal year 2008
Service budget justification as--
``(I) 1 of the 10 top-priority
inpatient projects;
``(II) 1 of the 10 top-priority
outpatient projects;
``(III) 1 of the 10 top-priority
staff quarters developments; or
``(IV) 1 of the 10 top-priority Youth
Regional Treatment Centers;
``(ii) had completed both Phase I and Phase
II of the construction priority system in
effect on the date of enactment of such Act; or
``(iii) is not included in clause (i) or (ii)
and is selected, as determined by the
Secretary--
``(I) on the initiative of the
Secretary; or
``(II) pursuant to a request of an
Indian Tribe or Tribal Organization.
``(2) Report; contents.--
``(A) Initial comprehensive report.--
``(i) Definitions.--In this subparagraph:
``(I) Facilities appropriation
advisory board.--The term `Facilities
Appropriation Advisory Board' means the
advisory board, comprised of 12 members
representing Indian tribes and 2
members representing the Service,
established at the discretion of the
Assistant Secretary--
``(aa) to provide advice and
recommendations for policies
and procedures of the programs
funded pursuant to facilities
appropriations; and
``(bb) to address other
facilities issues.
``(II) Facilities needs assessment
workgroup.--The term `Facilities Needs
Assessment Workgroup' means the
workgroup established at the discretion
of the Assistant Secretary--
``(aa) to review the health
care facilities construction
priority system; and
``(bb) to make
recommendations to the
Facilities Appropriation
Advisory Board for revising the
priority system.
``(ii) Initial report.--
``(I) In general.--Not later than 1
year after the date of enactment of the
Indian Health Care Improvement Act
Amendments of 2007, the Secretary shall
submit to the Committee on Indian
Affairs of the Senate and the Committee
on Natural Resources of the House of
Representatives a report that describes
the comprehensive, national, ranked
list of all health care facilities
needs for the Service, Indian Tribes,
and Tribal Organizations (including
inpatient health care facilities,
outpatient health care facilities,
specialized health care facilities
(such as for long-term care and alcohol
and drug abuse treatment), wellness
centers, staff quarters and hostels
associated with health care facilities,
and the renovation and expansion needs,
if any, of such facilities) developed
by the Service, Indian Tribes, and
Tribal Organizations for the Facilities
Needs Assessment Workgroup and the
Facilities Appropriation Advisory
Board.
``(II) Inclusions.--The initial
report shall include--
``(aa) the methodology and
criteria used by the Service in
determining the needs and
establishing the ranking of the
facilities needs; and
``(bb) such other information
as the Secretary determines to
be appropriate.
``(iii) Updates of report.--Beginning in
calendar year 2011, the Secretary shall--
``(I) update the report under clause
(ii) not less frequently that once
every 5 years; and
``(II) include the updated report in
the appropriate annual report under
subparagraph (B) for submission to
Congress under section 801.
``(B) Annual reports.--The Secretary shall submit to
the President, for inclusion in the report required to
be transmitted to Congress under section 801, a report
which sets forth the following:
``(i) A description of the health care
facility priority system of the Service
established under paragraph (1).
``(ii) Health care facilities lists, which
may include--
``(I) the 10 top-priority inpatient
health care facilities;
``(II) the 10 top-priority outpatient
health care facilities;
``(III) the 10 top-priority
specialized health care facilities
(such as long-term care and alcohol and
drug abuse treatment);
``(IV) the 10 top-priority staff
quarters developments associated with
health care facilities; and
``(V) the 10 top-priority hostels
associated with health care facilities.
``(iii) The justification for such order of
priority.
``(iv) The projected cost of such projects.
``(v) The methodology adopted by the Service
in establishing priorities under its health
care facility priority system.
``(3) Requirements for preparation of reports.--In preparing
the report required under paragraph (2), the Secretary shall--
``(A) consult with and obtain information on all
health care facilities needs from Indian Tribes, Tribal
Organizations, and Urban Indian Organizations; and
``(B) review the total unmet needs of all Indian
Tribes, Tribal Organizations, and Urban Indian
Organizations for health care facilities (including
hostels and staff quarters), including needs for
renovation and expansion of existing facilities.
``(d) Review of Methodology Used for Health Facilities Construction
Priority System.--
``(1) In general.--Not later than 1 year after the
establishment of the priority system under subsection
(c)(1)(A), the Comptroller General of the United States shall
prepare and finalize a report reviewing the methodologies
applied, and the processes followed, by the Service in making
each assessment of needs for the list under subsection
(c)(2)(A)(ii) and developing the priority system under
subsection (c)(1), including a review of--
``(A) the recommendations of the Facilities
Appropriation Advisory Board and the Facilities Needs
Assessment Workgroup (as those terms are defined in
subsection (c)(2)(A)(i)); and
``(B) the relevant criteria used in ranking or
prioritizing facilities other than hospitals or
clinics.
``(2) Submission to congress.--The Comptroller General of the
United States shall submit the report under paragraph (1) to--
``(A) the Committees on Indian Affairs and
Appropriations of the Senate;
``(B) the Committees on Natural Resources and
Appropriations of the House of Representatives; and
``(C) the Secretary.
``(e) Funding Condition.--All funds appropriated under the Act of
November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'),
for the planning, design, construction, or renovation of health
facilities for the benefit of 1 or more Indian Tribes shall be subject
to the provisions of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.).
``(f) Development of Innovative Approaches.--The Secretary shall
consult and cooperate with Indian Tribes, Tribal Organizations, and
Urban Indian Organizations in developing innovative approaches to
address all or part of the total unmet need for construction of health
facilities, including those provided for in other sections of this
title and other approaches.
``SEC. 302. SANITATION FACILITIES.
``(a) Findings.--Congress finds the following:
``(1) The provision of sanitation facilities is primarily a
health consideration and function.
``(2) Indian people suffer an inordinately high incidence of
disease, injury, and illness directly attributable to the
absence or inadequacy of sanitation facilities.
``(3) The long-term cost to the United States of treating and
curing such disease, injury, and illness is substantially
greater than the short-term cost of providing sanitation
facilities and other preventive health measures.
``(4) Many Indian homes and Indian communities still lack
sanitation facilities.
``(5) It is in the interest of the United States, and it is
the policy of the United States, that all Indian communities
and Indian homes, new and existing, be provided with sanitation
facilities.
``(b) Facilities and Services.--In furtherance of the findings made
in subsection (a), Congress reaffirms the primary responsibility and
authority of the Service to provide the necessary sanitation facilities
and services as provided in section 7 of the Act of August 5, 1954 (42
U.S.C. 2004a). Under such authority, the Secretary, acting through the
Service, is authorized to provide the following:
``(1) Financial and technical assistance to Indian Tribes,
Tribal Organizations, and Indian communities in the
establishment, training, and equipping of utility organizations
to operate and maintain sanitation facilities, including the
provision of existing plans, standard details, and
specifications available in the Department, to be used at the
option of the Indian Tribe, Tribal Organization, or Indian
community.
``(2) Ongoing technical assistance and training to Indian
Tribes, Tribal Organizations, and Indian communities in the
management of utility organizations which operate and maintain
sanitation facilities.
``(3) Priority funding for operation and maintenance
assistance for, and emergency repairs to, sanitation facilities
operated by an Indian Tribe, Tribal Organization or Indian
community when necessary to avoid an imminent health threat or
to protect the investment in sanitation facilities and the
investment in the health benefits gained through the provision
of sanitation facilities.
``(c) Funding.--Notwithstanding any other provision of law--
``(1) the Secretary of Housing and Urban Development is
authorized to transfer funds appropriated under the Native
American Housing Assistance and Self-Determination Act of 1996
(25 U.S.C. 4101 et seq.) to the Secretary of Health and Human
Services;
``(2) the Secretary of Health and Human Services is
authorized to accept and use such funds for the purpose of
providing sanitation facilities and services for Indians under
section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a);
``(3) unless specifically authorized when funds are
appropriated, the Secretary shall not use funds appropriated
under section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a),
to provide sanitation facilities to new homes constructed using
funds provided by the Department of Housing and Urban
Development;
``(4) the Secretary of Health and Human Services is
authorized to accept from any source, including Federal and
State agencies, funds for the purpose of providing sanitation
facilities and services and place these funds into contracts or
compacts under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.);
``(5) except as otherwise prohibited by this section, the
Secretary may use funds appropriated under the authority of
section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), to
fund up to 100 percent of the amount of an Indian Tribe's loan
obtained under any Federal program for new projects to
construct eligible sanitation facilities to serve Indian homes;
``(6) except as otherwise prohibited by this section, the
Secretary may use funds appropriated under the authority of
section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a) to
meet matching or cost participation requirements under other
Federal and non-Federal programs for new projects to construct
eligible sanitation facilities;
``(7) all Federal agencies are authorized to transfer to the
Secretary funds identified, granted, loaned, or appropriated
whereby the Department's applicable policies, rules, and
regulations shall apply in the implementation of such projects;
``(8) the Secretary of Health and Human Services shall enter
into interagency agreements with Federal and State agencies for
the purpose of providing financial assistance for sanitation
facilities and services under this Act;
``(9) the Secretary of Health and Human Services shall, by
regulation, establish standards applicable to the planning,
design, and construction of sanitation facilities funded under
this Act; and
``(10) the Secretary of Health and Human Services is
authorized to accept payments for goods and services furnished
by the Service from appropriate public authorities, nonprofit
organizations or agencies, or Indian Tribes, as contributions
by that authority, organization, agency, or tribe to agreements
made under section 7 of the Act of August 5, 1954 (42 U.S.C.
2004a), and such payments shall be credited to the same or
subsequent appropriation account as funds appropriated under
the authority of section 7 of the Act of August 5, 1954 (42
U.S.C. 2004a).
``(d) Certain Capabilities Not Prerequisite.--The financial and
technical capability of an Indian Tribe, Tribal Organization, or Indian
community to safely operate, manage, and maintain a sanitation facility
shall not be a prerequisite to the provision or construction of
sanitation facilities by the Secretary.
``(e) Financial Assistance.--The Secretary is authorized to provide
financial assistance to Indian Tribes, Tribal Organizations, and Indian
communities for operation, management, and maintenance of their
sanitation facilities.
``(f) Operation, Management, and Maintenance of Facilities.--The
Indian Tribe has the primary responsibility to establish, collect, and
use reasonable user fees, or otherwise set aside funding, for the
purpose of operating, managing, and maintaining sanitation facilities.
If a sanitation facility serving a community that is operated by an
Indian Tribe or Tribal Organization is threatened with imminent failure
and such operator lacks capacity to maintain the integrity or the
health benefits of the sanitation facility, then the Secretary is
authorized to assist the Indian Tribe, Tribal Organization, or Indian
community in the resolution of the problem on a short-term basis
through cooperation with the emergency coordinator or by providing
operation, management, and maintenance service.
``(g) ISDEAA Program Funded on Equal Basis.--Tribal Health Programs
shall be eligible (on an equal basis with programs that are
administered directly by the Service) for--
``(1) any funds appropriated pursuant to this section; and
``(2) any funds appropriated for the purpose of providing
sanitation facilities.
``(h) Report.--
``(1) Required; contents.--The Secretary, in consultation
with the Secretary of Housing and Urban Development, Indian
Tribes, Tribal Organizations, and tribally designated housing
entities (as defined in section 4 of the Native American
Housing Assistance and Self-Determination Act of 1996 (25
U.S.C. 4103)) shall submit to the President, for inclusion in
the report required to be transmitted to Congress under section
801, a report which sets forth--
``(A) the current Indian sanitation facility priority
system of the Service;
``(B) the methodology for determining sanitation
deficiencies and needs;
``(C) the criteria on which the deficiencies and
needs will be evaluated;
``(D) the level of initial and final sanitation
deficiency for each type of sanitation facility for
each project of each Indian Tribe or Indian community;
``(E) the amount and most effective use of funds,
derived from whatever source, necessary to accommodate
the sanitation facilities needs of new homes assisted
with funds under the Native American Housing Assistance
and Self-Determination Act (25 U.S.C. 4101 et seq.),
and to reduce the identified sanitation deficiency
levels of all Indian Tribes and Indian communities to
level I sanitation deficiency as defined in paragraph
(3)(A); and
``(F) a 10-year plan to provide sanitation facilities
to serve existing Indian homes and Indian communities
and new and renovated Indian homes.
``(2) Uniform methodology.--The methodology used by the
Secretary in determining, preparing cost estimates for, and
reporting sanitation deficiencies for purposes of paragraph (1)
shall be applied uniformly to all Indian Tribes and Indian
communities.
``(3) Sanitation deficiency levels.--For purposes of this
subsection, the sanitation deficiency levels for an individual,
Indian Tribe, or Indian community sanitation facility to serve
Indian homes are determined as follows:
``(A) A level I deficiency exists if a sanitation
facility serving an individual, Indian Tribe, or Indian
community--
``(i) complies with all applicable water
supply, pollution control, and solid waste
disposal laws; and
``(ii) deficiencies relate to routine
replacement, repair, or maintenance needs.
``(B) A level II deficiency exists if a sanitation
facility serving an individual, Indian Tribe, or Indian
community substantially or recently complied with all
applicable water supply, pollution control, and solid
waste laws and any deficiencies relate to--
``(i) small or minor capital improvements
needed to bring the facility back into
compliance;
``(ii) capital improvements that are
necessary to enlarge or improve the facilities
in order to meet the current needs for domestic
sanitation facilities; or
``(iii) the lack of equipment or training by
an Indian Tribe, Tribal Organization, or an
Indian community to properly operate and
maintain the sanitation facilities.
``(C) A level III deficiency exists if a sanitation
facility serving an individual, Indian Tribe or Indian
community meets 1 or more of the following conditions--
``(i) water or sewer service in the home is
provided by a haul system with holding tanks
and interior plumbing;
``(ii) major significant interruptions to
water supply or sewage disposal occur
frequently, requiring major capital
improvements to correct the deficiencies; or
``(iii) there is no access to or no approved
or permitted solid waste facility available.
``(D) A level IV deficiency exists--
``(i) if a sanitation facility for an
individual home, an Indian Tribe, or an Indian
community exists but--
``(I) lacks--
``(aa) a safe water supply
system; or
``(bb) a waste disposal
system;
``(II) contains no piped water or
sewer facilities; or
``(III) has become inoperable due to
a major component failure; or
``(ii) if only a washeteria or central
facility exists in the community.
``(E) A level V deficiency exists in the absence of a
sanitation facility, where individual homes do not have
access to safe drinking water or adequate wastewater
(including sewage) disposal.
``(i) Definitions.--For purposes of this section, the following terms
apply:
``(1) Indian community.--The term `Indian community' means a
geographic area, a significant proportion of whose inhabitants
are Indians and which is served by or capable of being served
by a facility described in this section.
``(2) Sanitation facilities.--The terms `sanitation facility'
and `sanitation facilities' mean safe and adequate water supply
systems, sanitary sewage disposal systems, and sanitary solid
waste systems (and all related equipment and support
infrastructure).
``SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS.
``(a) Buy Indian Act.--The Secretary, acting through the Service, may
use the negotiating authority of section 23 of the Act of June 25, 1910
(25 U.S.C. 47, commonly known as the `Buy Indian Act'), to give
preference to any Indian or any enterprise, partnership, corporation,
or other type of business organization owned and controlled by an
Indian or Indians including former or currently federally recognized
Indian Tribes in the State of New York (hereinafter referred to as an
`Indian firm') in the construction and renovation of Service facilities
pursuant to section 301 and in the construction of sanitation
facilities pursuant to section 302. Such preference may be accorded by
the Secretary unless the Secretary finds, pursuant to regulations, that
the project or function to be contracted for will not be satisfactory
or such project or function cannot be properly completed or maintained
under the proposed contract. The Secretary, in arriving at such a
finding, shall consider whether the Indian or Indian firm will be
deficient with respect to--
``(1) ownership and control by Indians;
``(2) equipment;
``(3) bookkeeping and accounting procedures;
``(4) substantive knowledge of the project or function to be
contracted for;
``(5) adequately trained personnel; or
``(6) other necessary components of contract performance.
``(b) Labor Standards.--For the purposes of implementing the
provisions of this title, contracts for the construction or renovation
of health care facilities, staff quarters, and sanitation facilities,
and related support infrastructure, funded in whole or in part with
funds made available pursuant to this title, shall contain a provision
requiring compliance with subchapter IV of chapter 31 of title 40,
United States Code (commonly known as the `Davis-Bacon Act').
``SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR RENOVATION.
``(a) In General.--Notwithstanding any other provision of law, if the
requirements of subsection (c) are met, the Secretary, acting through
the Service, is authorized to accept any major expansion, renovation,
or modernization by any Indian Tribe or Tribal Organization of any
Service facility or of any other Indian health facility operated
pursuant to a contract or compact under the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.), including--
``(1) any plans or designs for such expansion, renovation, or
modernization; and
``(2) any expansion, renovation, or modernization for which
funds appropriated under any Federal law were lawfully
expended.
``(b) Priority List.--
``(1) In general.--The Secretary shall maintain a separate
priority list to address the needs for increased operating
expenses, personnel, or equipment for such facilities. The
methodology for establishing priorities shall be developed
through regulations. The list of priority facilities will be
revised annually in consultation with Indian Tribes and Tribal
Organizations.
``(2) Report.--The Secretary shall submit to the President,
for inclusion in the report required to be transmitted to
Congress under section 801, the priority list maintained
pursuant to paragraph (1).
``(c) Requirements.--The requirements of this subsection are met with
respect to any expansion, renovation, or modernization if--
``(1) the Indian Tribe or Tribal Organization--
``(A) provides notice to the Secretary of its intent
to expand, 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 increased operating expenses, personnel,
or equipment; and
``(2) the expansion, renovation, or modernization--
``(A) is approved by the appropriate area director of
the Service for Federal facilities; and
``(B) is administered by the Indian Tribe or Tribal
Organization in accordance with any applicable
regulations prescribed by the Secretary with respect to
construction or renovation of Service facilities.
``(d) Additional Requirement for Expansion.--In addition to the
requirements under subsection (c), for any expansion, the Indian Tribe
or Tribal Organization shall provide to the Secretary additional
information pursuant to regulations, including additional staffing,
equipment, and other costs associated with the expansion.
``(e) Closure or Conversion of Facilities.--If any Service facility
which has been expanded, renovated, or modernized by an Indian Tribe or
Tribal Organization under this section ceases to be used as a Service
facility during the 20-year period beginning on the date such
expansion, renovation, or modernization is completed, such Indian Tribe
or Tribal Organization 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 expansion,
renovation, or modernization (less the total amount of any funds
provided specifically for such facility under any Federal program that
were expended for such expansion, renovation, or modernization) bore to
the value of such facility at the time of the completion of such
expansion, renovation, or modernization.
``SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND MODERNIZATION
OF SMALL AMBULATORY CARE FACILITIES.
``(a) Grants.--
``(1) In general.--The Secretary, acting through the Service,
shall make grants to Indian Tribes and Tribal Organizations for
the construction, expansion, or modernization of facilities for
the provision of ambulatory care services to eligible Indians
(and noneligible persons pursuant to subsections (b)(2) and
(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) Grant agreement required.--A grant under paragraph (1)
may only be made available to a Tribal Health Program 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 transferred to an
Indian Tribe or Tribal Organization).
``(b) Use of Grant Funds.--
``(1) Allowable uses.--A grant awarded under this section may
be used for the construction, expansion, or modernization
(including the planning and design of such construction,
expansion, or modernization) of an ambulatory care facility--
``(A) located apart from a hospital;
``(B) not funded under section 301 or section 306;
and
``(C) which, upon completion of such construction or
modernization will--
``(i) have a total capacity appropriate to
its projected service population;
``(ii) provide annually no fewer than 150
patient visits by eligible Indians and other
users who are eligible for services in such
facility in accordance with section 807(c)(2);
and
``(iii) provide ambulatory care in a Service
Area (specified in the contract or compact
under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et
seq.)) with a population of no fewer than 1,500
eligible Indians and other users who are
eligible for services in such facility in
accordance with section 807(c)(2).
``(2) Additional allowable use.--The Secretary may also
reserve a portion of the funding provided under this section
and use those reserved funds to reduce an outstanding debt
incurred by Indian Tribes or Tribal Organizations for the
construction, expansion, or modernization of an ambulatory care
facility that meets the requirements under paragraph (1). The
provisions of this section shall apply, except that such
applications for funding under this paragraph shall be
considered separately from applications for funding under
paragraph (1).
``(3) Use only for certain portion of costs.--A grant
provided under this section may be used only for the cost of
that portion of a construction, expansion, or modernization
project that benefits the Service population identified above
in subsection (b)(1)(C) (ii) and (iii). The requirements of
clauses (ii) and (iii) of paragraph (1)(C) shall not apply to
an Indian Tribe or Tribal Organization applying for a grant
under this section for a health care facility located or to be
constructed on an island or when such facility is not located
on a road system providing direct access to an inpatient
hospital where care is available to the Service population.
``(c) Grants.--
``(1) Application.--No grant may be made under this section
unless an application or proposal for the grant has been
approved by the Secretary in accordance with applicable
regulations and has set forth reasonable assurance by the
applicant that, at all times after the construction, expansion,
or modernization of a facility carried out using 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 without 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) Priority.--In awarding grants under this section, the
Secretary shall give priority to Indian Tribes and Tribal
Organizations that demonstrate--
``(A) a need for increased ambulatory care services;
and
``(B) insufficient capacity to deliver such services.
``(3) Peer review panels.--The Secretary may provide for the
establishment of peer review panels, as necessary, to review
and evaluate applications and proposals and to advise the
Secretary regarding such applications using the criteria
developed pursuant to subsection (a)(1).
``(d) Reversion of Facilities.--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 used for the purposes
of providing health care services to eligible Indians, all of the
right, title, and interest in and to such facility (or portion thereof)
shall transfer to the United States unless otherwise negotiated by the
Service and the Indian Tribe or Tribal Organization.
``(e) Funding Nonrecurring.--Funding provided under this section
shall be nonrecurring and shall not be available for inclusion in any
individual Indian Tribe's tribal share for an award under the Indian
Self-Determination and Education Assistance Act (25 U.S.C. 450 et seq.)
or for reallocation or redesign thereunder.
``SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECT.
``(a) Health Care Demonstration Projects.--The Secretary, acting
through the Service, is authorized to enter into contracts under the
Indian Self-Determination and Education Assistance Act (25 U.S.C. 450
et seq.) with Indian Tribes or Tribal Organizations for the purpose of
carrying out a health care delivery demonstration project to test
alternative means of delivering health care and services to Indians
through facilities.
``(b) Use of Funds.--The Secretary, in approving projects pursuant to
this section, may authorize such contracts for the construction and
renovation of hospitals, health centers, health stations, and other
facilities to deliver health care services and is authorized to--
``(1) waive any leasing prohibition;
``(2) permit carryover of funds appropriated for the
provision of health care services;
``(3) permit the use of other available funds;
``(4) permit the use of funds or property donated from any
source for project purposes;
``(5) provide for the reversion of donated real or personal
property to the donor; and
``(6) permit the use of Service funds to match other funds,
including Federal funds.
``(c) Regulations.--The Secretary shall develop and promulgate
regulations, not later than 1 year after the date of enactment of the
Indian Health Care Improvement Act Amendments of 2007, for the review
and approval of applications submitted under this section.
``(d) Criteria.--The Secretary may approve projects that meet the
following criteria:
``(1) There is a need for a new facility or program or the
reorientation of an existing facility or program.
``(2) A significant number of Indians, including those with
low health status, will be served by the project.
``(3) The project has the potential to deliver services in an
efficient and effective manner.
``(4) The project is economically viable.
``(5) The Indian Tribe or Tribal Organization has the
administrative and financial capability to administer the
project.
``(6) The project is integrated with providers of related
health and social services and is coordinated with, and avoids
duplication of, existing services.
``(e) Peer Review Panels.--The Secretary may provide for the
establishment of peer review panels, as necessary, to review and
evaluate applications using the criteria developed pursuant to
subsection (d).
``(f) Priority.--The Secretary shall give priority to applications
for demonstration projects in each of the following Service Units to
the extent that such applications are timely filed and meet the
criteria specified in subsection (d):
``(1) Cass Lake, Minnesota.
``(2) Mescalero, New Mexico.
``(3) Owyhee, Nevada.
``(4) Schurz, Nevada.
``(5) Ft. Yuma, California.
``(g) Technical Assistance.--The Secretary shall provide such
technical and other assistance as may be necessary to enable applicants
to comply with the provisions of this section.
``(h) Service to Ineligible Persons.--Subject to section 807, the
authority to provide services to persons otherwise ineligible for the
health care benefits of the Service and the authority to extend
hospital privileges in Service facilities to non-Service health
practitioners as provided in section 807 may be included, subject to
the terms of such section, in any demonstration project approved
pursuant to this section.
``(i) Equitable Treatment.--For purposes of subsection (d)(1), the
Secretary shall, in evaluating facilities operated under any contract
or compact under the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.), use the same criteria that the Secretary
uses in evaluating facilities operated directly by the Service.
``(j) Equitable Integration of Facilities.--The Secretary shall
ensure that the planning, design, construction, renovation, and
expansion needs of Service and non-Service facilities which are the
subject of a contract or compact under the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.) for health
services are fully and equitably integrated into the implementation of
the health care delivery demonstration projects under this section.
``SEC. 307. LAND TRANSFER.
``Notwithstanding any other provision of law, the Bureau of Indian
Affairs and all other agencies and departments of the United States are
authorized to transfer, at no cost, land and improvements to the
Service for the provision of health care services. The Secretary is
authorized to accept such land and improvements for such purposes.
``SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS.
``The Secretary, acting through the Service, may enter into leases,
contracts, and other agreements with Indian Tribes and Tribal
Organizations which hold (1) title to, (2) a leasehold interest in, or
(3) a beneficial interest in (when title is held by the United States
in trust for the benefit of an Indian Tribe) facilities used or to be
used for the administration and delivery of health services by an
Indian Health Program. Such leases, contracts, or agreements may
include provisions for construction or renovation and provide for
compensation to the Indian Tribe or Tribal Organization of rental and
other costs consistent with section 105(l) of the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450j(l)) and
regulations thereunder.
``SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND LOAN REPAYMENT.
``(a) In General.--The Secretary, in consultation with the Secretary
of the Treasury, Indian Tribes, and Tribal Organizations, shall carry
out a study to determine the feasibility of establishing a loan fund to
provide to Indian Tribes and Tribal Organizations direct loans or
guarantees for loans for the construction of health care facilities,
including--
``(1) inpatient facilities;
``(2) outpatient facilities;
``(3) staff quarters;
``(4) hostels; and
``(5) specialized care facilities, such as behavioral health
and elder care facilities.
``(b) Determinations.--In carrying out the study under subsection
(a), the Secretary shall determine--
``(1) the maximum principal amount of a loan or loan
guarantee that should be offered to a recipient from the loan
fund;
``(2) the percentage of eligible costs, not to exceed 100
percent, that may be covered by a loan or loan guarantee from
the loan fund (including costs relating to planning, design,
financing, site land development, construction, rehabilitation,
renovation, conversion, improvements, medical equipment and
furnishings, and other facility-related costs and capital
purchase (but excluding staffing));
``(3) the cumulative total of the principal of direct loans
and loan guarantees, respectively, that may be outstanding at
any 1 time;
``(4) the maximum term of a loan or loan guarantee that may
be made for a facility from the loan fund;
``(5) the maximum percentage of funds from the loan fund that
should be allocated for payment of costs associated with
planning and applying for a loan or loan guarantee;
``(6) whether acceptance by the Secretary of an assignment of
the revenue of an Indian Tribe or Tribal Organization as
security for any direct loan or loan guarantee from the loan
fund would be appropriate;
``(7) whether, in the planning and design of health
facilities under this section, users eligible under section
807(c) may be included in any projection of patient population;
``(8) whether funds of the Service provided through loans or
loan guarantees from the loan fund should be eligible for use
in matching other Federal funds under other programs;
``(9) the appropriateness of, and best methods for,
coordinating the loan fund with the health care priority system
of the Service under section 301; and
``(10) any legislative or regulatory changes required to
implement recommendations of the Secretary based on results of
the study.
``(c) Report.--Not later than September 30, 2009, the Secretary shall
submit to the Committee on Indian Affairs of the Senate and the
Committee on Natural Resources and the Committee on Energy and Commerce
of the House of Representatives a report that describes--
``(1) the manner of consultation made as required by
subsection (a); and
``(2) the results of the study, including any recommendations
of the Secretary based on results of the study.
``SEC. 310. TRIBAL LEASING.
``A Tribal Health Program may lease permanent structures for the
purpose of providing health care services without obtaining advance
approval in appropriation Acts.
``SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT VENTURE
PROGRAM.
``(a) In General.--The Secretary, acting through the Service, shall
make arrangements with Indian Tribes and Tribal Organizations to
establish joint venture demonstration projects under which an Indian
Tribe or Tribal Organization shall expend tribal, private, or other
available funds, for the acquisition or construction of a health
facility for a minimum of 10 years, under a no-cost lease, in exchange
for agreement by the Service to provide the equipment, supplies, and
staffing for the operation and maintenance of such a health facility.
An Indian Tribe or Tribal Organization may use tribal funds, private
sector, or other available resources, including loan guarantees, to
fulfill its commitment under a joint venture entered into under this
subsection. An Indian Tribe or Tribal Organization shall be eligible to
establish a joint venture project if, when it submits a letter of
intent, it--
``(1) has begun but not completed the process of acquisition
or construction of a health facility to be used in the joint
venture project; or
``(2) has not begun the process of acquisition or
construction of a health facility for use in the joint venture
project.
``(b) Requirements.--The Secretary shall make such an arrangement
with an Indian Tribe or Tribal Organization only if--
``(1) the Secretary first determines that the Indian Tribe or
Tribal Organization has the administrative and financial
capabilities necessary to complete the timely acquisition or
construction of the relevant health facility; and
``(2) the Indian Tribe or Tribal Organization meets the need
criteria determined using the criteria developed under the
health care facility priority system under section 301, unless
the Secretary determines, pursuant to regulations, that other
criteria will result in a more cost-effective and efficient
method of facilitating and completing construction of health
care facilities.
``(c) Continued Operation.--The Secretary shall negotiate an
agreement with the Indian Tribe or Tribal Organization regarding the
continued operation of the facility at the end of the initial 10 year
no-cost lease period.
``(d) Breach of Agreement.--An Indian Tribe or Tribal Organization
that has entered into a written agreement with the Secretary under this
section, 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 Indian Tribe or Tribal Organization, or paid to a third party on
the Indian Tribe's or Tribal Organization's behalf, under the
agreement. The Secretary has the right to recover tangible property
(including supplies) and equipment, less depreciation, 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, personnel, or staffing.
``(e) Recovery for Nonuse.--An Indian Tribe or Tribal Organization
that has entered into a written agreement with the Secretary under this
subsection shall be entitled to recover from the United States an
amount that is proportional to the value of such facility if, at any
time within the 10-year term of the agreement, the Service ceases to
use the facility or otherwise breaches the agreement.
``(f) Definition.--For the purposes of this section, the term `health
facility' or `health facilities' includes quarters needed to provide
housing for staff of the relevant Tribal Health Program.
``SEC. 312. LOCATION OF FACILITIES.
``(a) In General.--In all matters involving the reorganization or
development of Service facilities or in the establishment of related
employment projects to address unemployment conditions in economically
depressed areas, the Bureau of Indian Affairs and the Service shall
give priority to locating such facilities and projects on Indian lands,
or lands in Alaska owned by any Alaska Native village, or village or
regional corporation under the Alaska Native Claims Settlement Act (43
U.S.C. 1601 et seq.), or any land allotted to any Alaska Native, if
requested by the Indian owner and the Indian Tribe with jurisdiction
over such lands or other lands owned or leased by the Indian Tribe or
Tribal Organization. Top priority shall be given to Indian land owned
by 1 or more Indian Tribes.
``(b) Definition.--For purposes of this section, the term `Indian
lands' means--
``(1) all lands within the exterior boundaries of any
reservation; and
``(2) any lands title to 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.
``SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE FACILITIES.
``(a) Report.--The Secretary shall submit to the President, for
inclusion in the report required to be transmitted to Congress under
section 801, a report which identifies the backlog of maintenance and
repair work required at both Service and tribal health care facilities,
including new health care facilities expected to be in operation in the
next fiscal year. The report shall also identify the need for
renovation and expansion of existing facilities to support the growth
of health care programs.
``(b) Maintenance of Newly Constructed Space.--The Secretary, acting
through the Service, is authorized to expend maintenance and
improvement funds to support maintenance of newly constructed space
only if such space falls within the approved supportable space
allocation for the Indian Tribe or Tribal Organization. Supportable
space allocation shall be defined through the health care facility
priority system under section 301(c).
``(c) Replacement Facilities.--In addition to using maintenance and
improvement funds for renovation, modernization, and expansion of
facilities, an Indian Tribe or Tribal Organization may use maintenance
and improvement funds for construction of a replacement facility if the
costs of renovation of such facility would exceed a maximum renovation
cost threshold. The maximum renovation cost threshold shall be
determined through the negotiated rulemaking process provided for under
section 802.
``SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY-OWNED QUARTERS.
``(a) Rental Rates.--
``(1) Establishment.--Notwithstanding any other provision of
law, a Tribal Health Program which operates a hospital or other
health facility and the federally-owned quarters associated
therewith pursuant to a contract or compact under the Indian
Self-Determination and Education Assistance Act (25 U.S.C. 450
et seq.) shall have the authority to establish the rental rates
charged to the occupants of such quarters by providing notice
to the Secretary of its election to exercise such authority.
``(2) Objectives.--In establishing rental rates pursuant to
authority of this subsection, a Tribal Health Program shall
endeavor to achieve the following objectives:
``(A) To base such rental rates on the reasonable
value of the quarters to the occupants thereof.
``(B) To generate sufficient funds to prudently
provide for the operation and maintenance of the
quarters, and subject to the discretion of the Tribal
Health Program, to supply reserve funds for capital
repairs and replacement of the quarters.
``(3) Equitable funding.--Any quarters whose rental rates are
established by a Tribal Health Program pursuant to this
subsection shall remain eligible for quarters improvement and
repair funds to the same extent as all federally-owned quarters
used to house personnel in Services-supported programs.
``(4) Notice of rate change.--A Tribal Health Program which
exercises the authority provided under this subsection shall
provide occupants with no less than 60 days notice of any
change in rental rates.
``(b) Direct Collection of Rent.--
``(1) In general.--Notwithstanding any other provision of
law, and subject to paragraph (2), a Tribal Health Program
shall have the authority to collect rents directly from Federal
employees who occupy such quarters in accordance with the
following:
``(A) The Tribal Health Program shall notify the
Secretary and the subject Federal employees of its
election to exercise its authority to collect rents
directly from such Federal employees.
``(B) Upon receipt of a notice described in
subparagraph (A), the Federal employees shall pay rents
for occupancy of such quarters directly to the Tribal
Health Program and the Secretary shall have no further
authority to collect rents from such employees through
payroll deduction or otherwise.
``(C) Such rent payments shall be retained by the
Tribal Health Program and shall not be made payable to
or otherwise be deposited with the United States.
``(D) Such rent payments shall be deposited into a
separate account which shall be used by the Tribal
Health Program for the maintenance (including capital
repairs and replacement) and operation of the quarters
and facilities as the Tribal Health Program shall
determine.
``(2) Retrocession of authority.--If a Tribal Health Program
which has made an election under paragraph (1) requests
retrocession of its authority to directly collect rents from
Federal employees occupying federally-owned quarters, such
retrocession shall become effective on the earlier of--
``(A) the first day of the month that begins no less
than 180 days after the Tribal Health Program notifies
the Secretary of its desire to retrocede; or
``(B) such other date as may be mutually agreed by
the Secretary and the Tribal Health Program.
``(c) Rates in Alaska.--To the extent that a Tribal Health Program,
pursuant to authority granted in subsection (a), establishes rental
rates for federally-owned quarters provided to a Federal employee in
Alaska, such rents may be based on the cost of comparable private
rental housing in the nearest established community with a year-round
population of 1,500 or more individuals.
``SEC. 315. APPLICABILITY OF BUY AMERICAN ACT REQUIREMENT.
``(a) Applicability.--The Secretary shall ensure that the
requirements of the Buy American Act apply to all procurements made
with funds provided pursuant to section 317. Indian Tribes and Tribal
Organizations shall be exempt from these requirements.
``(b) Effect of Violation.--If it has been finally determined by a
court or Federal 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 section 317, pursuant to the debarment, suspension, and
ineligibility procedures described in sections 9.400 through 9.409 of
title 48, Code of Federal Regulations.
``(c) Definitions.--For purposes of this section, the term `Buy
American Act' means title III of the Act entitled `An Act making
appropriations 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.).
``SEC. 316. OTHER FUNDING FOR FACILITIES.
``(a) Authority To Accept Funds.--The Secretary is authorized to
accept from any source, including Federal and State agencies, funds
that are available for the construction of health care facilities and
use such funds to plan, design, and construct health care facilities
for Indians and to place such funds into a contract or compact under
the Indian Self-Determination and Education Assistance Act (25 U.S.C.
450 et seq.). Receipt of such funds shall have no effect on the
priorities established pursuant to section 301.
``(b) Interagency Agreements.--The Secretary is authorized to enter
into interagency agreements with other Federal agencies or State
agencies and other entities and to accept funds from such Federal or
State agencies or other sources to provide for the planning, design,
and construction of health care facilities to be administered by Indian
Health Programs in order to carry out the purposes of this Act and the
purposes for which the funds were appropriated or for which the funds
were otherwise provided.
``(c) Establishment of Standards.--The Secretary, through the
Service, shall establish standards by regulation for the planning,
design, and construction of health care facilities serving Indians
under this Act.
``SEC. 317. AUTHORIZATION OF APPROPRIATIONS.
``There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2017 to carry out
this title.
``TITLE IV--ACCESS TO HEALTH SERVICES
``SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT HEALTH
BENEFITS PROGRAMS.
``(a) Disregard of Medicare, Medicaid, and SCHIP Payments in
Determining Appropriations.--Any payments received by an Indian Health
Program or by an Urban Indian Organization under title XVIII, XIX, or
XXI of the Social Security Act for services provided to Indians
eligible for benefits under such respective titles shall not be
considered in determining appropriations for the provision of health
care and services to Indians.
``(b) Nonpreferential Treatment.--Nothing in this Act authorizes the
Secretary to provide services to an Indian with coverage under title
XVIII, XIX, or XXI of the Social Security Act in preference to an
Indian without such coverage.
``(c) Use of Funds.--
``(1) Special fund.--
``(A) 100 percent pass-through of payments due to
facilities.--Notwithstanding any other provision of
law, but subject to paragraph (2), payments to which a
facility of the Service is entitled by reason of a
provision of the Social Security Act shall be placed in
a special fund to be held by the Secretary. In making
payments from such fund, the Secretary shall ensure
that each Service Unit of the Service receives 100
percent of the amount to which the facilities of the
Service, for which such Service Unit makes collections,
are entitled by reason of a provision of the Social
Security Act.
``(B) Use of funds.--Amounts received by a facility
of the Service under subparagraph (A) shall first be
used (to such extent or in such amounts as are provided
in appropriation Acts) for the purpose of making any
improvements in the programs of the Service operated by
or through such facility which may be necessary to
achieve or maintain compliance with the applicable
conditions and requirements of titles XVIII and XIX of
the Social Security Act. Any amounts so received that
are in excess of the amount necessary to achieve or
maintain such conditions and requirements shall,
subject to consultation with the Indian Tribes being
served by the Service Unit, be used for reducing the
health resource deficiencies (as determined under
section 201(d)) of such Indian Tribes.
``(2) Direct payment option.--Paragraph (1) shall not apply
to a Tribal Health Program upon the election of such Program
under subsection (d) to receive payments directly. No payment
may be made out of the special fund described in such paragraph
with respect to reimbursement made for services provided by
such Program during the period of such election.
``(d) Direct Billing.--
``(1) In general.--Subject to complying with the requirements
of paragraph (2), a Tribal Health Program may elect to directly
bill for, and receive payment for, health care items and
services provided by such Program for which payment is made
under title XVIII or XIX of the Social Security Act or from any
other third party payor.
``(2) Direct reimbursement.--
``(A) Use of funds.--Each Tribal Health Program
making the election described in paragraph (1) with
respect to a program under a title of the Social
Security Act shall be reimbursed directly by that
program for items and services furnished without regard
to subsection (c)(1), but all amounts so reimbursed
shall be used by the Tribal Health Program for the
purpose of making any improvements in facilities of the
Tribal Health Program that may be necessary to achieve
or maintain compliance with the conditions and
requirements applicable generally to such items and
services under the program under such title and to
provide additional health care services, improvements
in health care facilities and Tribal Health Programs,
any health care related purpose, or otherwise to
achieve the objectives provided in section 3 of this
Act.
``(B) Audits.--The amounts paid to a Tribal Health
Program making the election described in paragraph (1)
with respect to a program under a title of the Social
Security Act shall be subject to all auditing
requirements applicable to the program under such
title, as well as all auditing requirements applicable
to programs administered by an Indian Health Program.
Nothing in the preceding sentence shall be construed as
limiting the application of auditing requirements
applicable to amounts paid under title XVIII, XIX, or
XXI of the Social Security Act.
``(C) Identification of source of payments.--Any
Tribal Health Program that receives reimbursements or
payments under title XVIII, XIX, or XXI of the Social
Security Act, shall provide to the Service a list of
each provider enrollment number (or other identifier)
under which such Program receives such reimbursements
or payments.
``(3) Examination and implementation of changes.--
``(A) In general.--The Secretary, acting through the
Service and with the assistance of the Administrator of
the Centers for Medicare & Medicaid Services, shall
examine on an ongoing basis and implement any
administrative changes that may be necessary to
facilitate direct billing and reimbursement under the
program established under this subsection, including
any agreements with States that may be necessary to
provide for direct billing under a program under a
title of the Social Security Act.
``(B) Coordination of information.--The Service shall
provide the Administrator of the Centers for Medicare &
Medicaid Services with copies of the lists submitted to
the Service under paragraph (2)(C), enrollment data
regarding patients served by the Service (and by Tribal
Health Programs, to the extent such data is available
to the Service), and such other information as the
Administrator may require for purposes of administering
title XVIII, XIX, or XXI of the Social Security Act.
``(4) Withdrawal from program.--A Tribal Health Program that
bills directly under the program established under this
subsection may withdraw from participation in the same manner
and under the same conditions that an Indian Tribe or Tribal
Organization may retrocede a contracted program to the
Secretary under the authority of the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.). All cost
accounting and billing authority under the program established
under this subsection shall be returned to the Secretary upon
the Secretary's acceptance of the withdrawal of participation
in this program.
``(5) Termination for failure to comply with requirements.--
The Secretary may terminate the participation of a Tribal
Health Program or in the direct billing program established
under this subsection if the Secretary determines that the
Program has failed to comply with the requirements of paragraph
(2). The Secretary shall provide a Tribal Health Program with
notice of a determination that the Program has failed to comply
with any such requirement and a reasonable opportunity to
correct such noncompliance prior to terminating the Program's
participation in the direct billing program established under
this subsection.
``(e) Related Provisions Under the Social Security Act.--For
provisions related to subsections (c) and (d), see sections 1880, 1911,
and 2107(e)(1)(D) of the Social Security Act.
``SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERVICE, INDIAN TRIBES,
TRIBAL ORGANIZATIONS, AND URBAN INDIAN
ORGANIZATIONS TO FACILITATE OUTREACH, ENROLLMENT,
AND COVERAGE OF INDIANS UNDER SOCIAL SECURITY ACT
HEALTH BENEFIT PROGRAMS AND OTHER HEALTH BENEFITS
PROGRAMS.
``(a) Indian Tribes and Tribal Organizations.--From funds
appropriated to carry out this title in accordance with section 416,
the Secretary, acting through the Service, shall make grants to or
enter into contracts with Indian Tribes and Tribal Organizations to
assist such Tribes and Tribal Organizations in establishing and
administering programs on or near reservations and trust lands to
assist individual Indians--
``(1) to enroll for benefits under a program established
under title XVIII, XIX, or XXI of the Social Security Act and
other health benefits programs; and
``(2) with respect to such programs for which the charging of
premiums and cost sharing is not prohibited under such
programs, to pay premiums or cost sharing for coverage for such
benefits, which may be based on financial need (as determined
by the Indian Tribe or Tribes or Tribal Organizations being
served based on a schedule of income levels developed or
implemented by such Tribe, Tribes, or Tribal Organizations).
``(b) Conditions.--The Secretary, acting through the Service, shall
place conditions as deemed necessary to effect the purpose of this
section in any grant or contract which the Secretary makes with any
Indian Tribe or Tribal Organization pursuant to this section. Such
conditions shall include requirements that the Indian Tribe or Tribal
Organization successfully undertake--
``(1) to determine the population of Indians eligible for the
benefits described in subsection (a);
``(2) to educate Indians with respect to the benefits
available under the respective programs;
``(3) to provide transportation for such individual Indians
to the appropriate offices for enrollment or applications for
such benefits; and
``(4) to develop and implement methods of improving the
participation of Indians in receiving benefits under such
programs.
``(c) Application to Urban Indian Organizations.--
``(1) In general.--The provisions of subsection (a) shall
apply with respect to grants and other funding to Urban Indian
Organizations with respect to populations served by such
organizations in the same manner they apply to grants and
contracts with Indian Tribes and Tribal Organizations with
respect to programs on or near reservations.
``(2) Requirements.--The Secretary shall include in the
grants or contracts made or provided under paragraph (1)
requirements that are--
``(A) consistent with the requirements imposed by the
Secretary under subsection (b);
``(B) appropriate to Urban Indian Organizations and
Urban Indians; and
``(C) necessary to effect the purposes of this
section.
``(d) Facilitating Cooperation.--The Secretary, acting through the
Centers for Medicare & Medicaid Services, shall take such steps as are
necessary to facilitate cooperation with, and agreements between,
States and the Service, Indian Tribes, Tribal Organizations, or Urban
Indian Organizations with respect to the provision of health care items
and services to Indians under the programs established under title
XVIII, XIX, or XXI of the Social Security Act.
``(e) Agreements Relating To Improving Enrollment of Indians Under
Social Security Act Health Benefits Programs.--For provisions relating
to agreements between the Secretary, acting through the Service, and
Indian Tribes, Tribal Organizations, and Urban Indian Organizations for
the collection, preparation, and submission of applications by Indians
for assistance under the Medicaid and State children's health insurance
programs established under titles XIX and XXI of the Social Security
Act, and benefits under the Medicare program established under title
XVIII of such Act, see subsections (a) and (b) of section 1139 of the
Social Security Act.
``(f) Definition of Premiums and Cost Sharing.--In this section:
``(1) Premium.--The term `premium' includes any enrollment
fee or similar charge.
``(2) Cost sharing.--The term `cost sharing' includes any
deduction, deductible, copayment, coinsurance, or similar
charge.
``SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF HEALTH
SERVICES.
``(a) Right of Recovery.--Except as provided in subsection (f), the
United States, an Indian Tribe, or Tribal Organization shall have the
right to recover from an insurance company, health maintenance
organization, employee benefit plan, third-party tortfeasor, or any
other responsible or liable third party (including a political
subdivision or local governmental entity of a State) the reasonable
charges billed by the Secretary, an Indian Tribe, or Tribal
Organization in providing health services through the Service, an
Indian Tribe, or Tribal Organization to any individual to the same
extent that such individual, or any nongovernmental provider of such
services, would be eligible to receive damages, reimbursement, or
indemnification for such charges or expenses if--
``(1) such services had been provided by a nongovernmental
provider; and
``(2) such individual had been required to pay such charges
or expenses and did pay such charges or expenses.
``(b) Limitations on Recoveries From States.--Subsection (a) shall
provide a right of recovery against any State, only if the injury,
illness, or disability for which health services were provided is
covered under--
``(1) workers' compensation laws; or
``(2) a no-fault automobile accident insurance plan or
program.
``(c) Nonapplication of Other Laws.--No law of any State, or of any
political subdivision of a State and no provision of any contract,
insurance or health maintenance organization policy, employee benefit
plan, self-insurance plan, managed care plan, or other health care plan
or program entered into or renewed after the date of the enactment of
the Indian Health Care Amendments of 1988, shall prevent or hinder the
right of recovery of the United States, an Indian Tribe, or Tribal
Organization under subsection (a).
``(d) No Effect on Private Rights of Action.--No action taken by the
United States, an Indian Tribe, or Tribal Organization to enforce the
right of recovery provided under this section shall operate to deny to
the injured person the recovery for that portion of the person's damage
not covered hereunder.
``(e) Enforcement.--
``(1) In general.--The United States, an Indian Tribe, or
Tribal Organization may enforce the right of recovery provided
under subsection (a) by--
``(A) intervening or joining in any civil action or
proceeding brought--
``(i) by the individual for whom health
services were provided by the Secretary, an
Indian Tribe, or Tribal Organization; or
``(ii) by any representative or heirs of such
individual, or
``(B) instituting a civil action, including a civil
action for injunctive relief and other relief and
including, with respect to a political subdivision or
local governmental entity of a State, such an action
against an official thereof.
``(2) Notice.--All reasonable efforts shall be made to
provide notice of action instituted under paragraph (1)(B) to
the individual to whom health services were provided, either
before or during the pendency of such action.
``(3) Recovery from tortfeasors.--
``(A) In general.--In any case in which an Indian
Tribe or Tribal Organization that is authorized or
required under a compact or contract issued pursuant to
the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.) to furnish or pay for
health services to a person who is injured or suffers a
disease on or after the date of enactment of the Indian
Health Care Improvement Act Amendments of 2007 under
circumstances that establish grounds for a claim of
liability against the tortfeasor with respect to the
injury or disease, the Indian Tribe or Tribal
Organization shall have a right to recover from the
tortfeasor (or an insurer of the tortfeasor) the
reasonable value of the health services so furnished,
paid for, or to be paid for, in accordance with the
Federal Medical Care Recovery Act (42 U.S.C. 2651 et
seq.), to the same extent and under the same
circumstances as the United States may recover under
that Act.
``(B) Treatment.--The right of an Indian Tribe or
Tribal Organization to recover under subparagraph (A)
shall be independent of the rights of the injured or
diseased person served by the Indian Tribe or Tribal
Organization.
``(f) Limitation.--Absent specific written authorization by the
governing body of an Indian Tribe for the period of such authorization
(which may not be for a period of more than 1 year and which may be
revoked at any time upon written notice by the governing body to the
Service), 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, Tribal Organization, or Urban Indian Organization.
Where such authorization is provided, the Service may receive and
expend such amounts for the provision of additional health services
consistent with such authorization.
``(g) Costs and Attorneys' Fees.--In any action brought to enforce
the provisions of this section, a prevailing plaintiff shall be awarded
its reasonable attorneys' fees and costs of litigation.
``(h) Nonapplication of Claims Filing Requirements.--An insurance
company, health maintenance organization, self-insurance plan, managed
care plan, or other health care plan or program (under the Social
Security Act or otherwise) may not deny a claim for benefits submitted
by the Service or by an Indian Tribe or Tribal Organization based on
the format in which the claim is submitted if such format complies with
the format required for submission of claims under title XVIII of the
Social Security Act or recognized under section 1175 of such Act.
``(i) Application to Urban Indian Organizations.--The previous
provisions of this section shall apply to Urban Indian Organizations
with respect to populations served by such Organizations in the same
manner they apply to Indian Tribes and Tribal Organizations with
respect to populations served by such Indian Tribes and Tribal
Organizations.
``(j) Statute of Limitations.--The provisions of section 2415 of
title 28, United States Code, shall apply to all actions commenced
under this section, and the references therein to the United States are
deemed to include Indian Tribes, Tribal Organizations, and Urban Indian
Organizations.
``(k) Savings.--Nothing in this section shall be construed to limit
any right of recovery available to the United States, an Indian Tribe,
or Tribal Organization under the provisions of any applicable, Federal,
State, or Tribal law, including medical lien laws.
``SEC. 404. CREDITING OF REIMBURSEMENTS.
``(a) Use of Amounts.--
``(1) Retention by program.--Except as provided in section
202(f) (relating to the Catastrophic Health Emergency Fund) and
section 807 (relating to health services for ineligible
persons), all reimbursements received or recovered under any of
the programs described in paragraph (2), including under
section 807, by reason of the provision of health services by
the Service, by an Indian Tribe or Tribal Organization, or by
an Urban Indian Organization, shall be credited to the Service,
such Indian Tribe or Tribal Organization, or such Urban Indian
Organization, respectively, and may be used as provided in
section 401. In the case of such a service provided by or
through a Service Unit, such amounts shall be credited to such
unit and used for such purposes.
``(2) Programs covered.--The programs referred to in
paragraph (1) are the following:
``(A) Titles XVIII, XIX, and XXI of the Social
Security Act.
``(B) This Act, including section 807.
``(C) Public Law 87-693.
``(D) Any other provision of law.
``(b) No Offset of Amounts.--The Service may not offset or limit any
amount obligated to any Service Unit or entity receiving funding from
the Service because of the receipt of reimbursements under subsection
(a).
``SEC. 405. PURCHASING HEALTH CARE COVERAGE.
``(a) In General.--Insofar as amounts are made available under law
(including a provision of the Social Security Act, the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et seq.), or
other law, other than under section 402) to Indian Tribes, Tribal
Organizations, and Urban Indian Organizations for health benefits for
Service beneficiaries, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations may use such amounts to purchase health benefits
coverage for such beneficiaries in any manner, including through--
``(1) a tribally owned and operated health care plan;
``(2) a State or locally authorized or licensed health care
plan;
``(3) a health insurance provider or managed care
organization; or
``(4) a self-insured plan.
The purchase of such coverage by an Indian Tribe, Tribal Organization,
or Urban Indian Organization may be based on the financial needs of
such beneficiaries (as determined by the Indian Tribe or Tribes being
served based on a schedule of income levels developed or implemented by
such Indian Tribe or Tribes).
``(b) Expenses for Self-Insured Plan.--In the case of a self-insured
plan under subsection (a)(4), the amounts may be used for expenses of
operating the plan, including administration and insurance to limit the
financial risks to the entity offering the plan.
``(c) Construction.--Nothing in this section shall be construed as
affecting the use of any amounts not referred to in subsection (a).
``SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.
``(a) Authority.--
``(1) In general.--The Secretary may enter into (or expand)
arrangements for the sharing of medical facilities and services
between the Service, Indian Tribes, and Tribal Organizations
and the Department of Veterans Affairs and the Department of
Defense.
``(2) Consultation by secretary required.--The Secretary may
not finalize any arrangement between the Service and a
Department described in paragraph (1) without first consulting
with the Indian Tribes which will be significantly affected by
the arrangement.
``(b) Limitations.--The Secretary shall not take any action under
this section or under subchapter IV of chapter 81 of title 38, United
States Code, which would impair--
``(1) the priority access of any Indian to health care
services provided through the Service and the eligibility of
any Indian to receive health services through the Service;
``(2) the quality of health care services provided to any
Indian through the Service;
``(3) the priority access of any veteran to health care
services provided by the Department of Veterans Affairs;
``(4) the quality of health care services provided by the
Department of Veterans Affairs or the Department of Defense; or
``(5) the eligibility of any Indian who is a veteran to
receive health services through the Department of Veterans
Affairs.
``(c) Reimbursement.--The Service, Indian Tribe, or Tribal
Organization shall be reimbursed by the Department of Veterans Affairs
or the Department of Defense (as the case may be) where services are
provided through the Service, an Indian Tribe, or a Tribal Organization
to beneficiaries eligible for services from either such Department,
notwithstanding any other provision of law.
``(d) Construction.--Nothing in this section may be construed as
creating any right of a non-Indian veteran to obtain health services
from the Service.
``SEC. 407. PAYOR OF LAST RESORT.
``Indian Health Programs and health care programs operated by Urban
Indian Organizations shall be the payor of last resort for services
provided to persons eligible for services from Indian Health Programs
and Urban Indian Organizations, notwithstanding any Federal, State, or
local law to the contrary.
``SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH CARE PROGRAMS IN
QUALIFICATIONS FOR REIMBURSEMENT FOR SERVICES.
``(a) Requirement To Satisfy Generally Applicable Participation
Requirements.--
``(1) In general.--A Federal health care program must accept
an entity that is operated by the Service, an Indian Tribe,
Tribal Organization, or Urban Indian Organization as a provider
eligible to receive payment under the program for health care
services furnished to an Indian on the same basis as any other
provider qualified to participate as a provider of health care
services under the program if the entity meets generally
applicable State or other requirements for participation as a
provider of health care services under the program.
``(2) Satisfaction of state or local licensure or recognition
requirements.--Any requirement for participation as a provider
of health care services under a Federal health care program
that an entity be licensed or recognized under the State or
local law where the entity is located to furnish health care
services shall be deemed to have been met in the case of an
entity operated by the Service, an Indian Tribe, Tribal
Organization, or Urban Indian Organization if the entity meets
all the applicable standards for such licensure or recognition,
regardless of whether the entity obtains a license or other
documentation under such State or local law. In accordance with
section 221, the absence of the licensure of a health care
professional employed by such an entity under the State or
local law where the entity is located shall not be taken into
account for purposes of determining whether the entity meets
such standards, if the professional is licensed in another
State.
``(b) Application of Exclusion From Participation in Federal Health
Care Programs.--
``(1) Excluded entities.--No entity operated by the Service,
an Indian Tribe, Tribal Organization, or Urban Indian
Organization that has been excluded from participation in any
Federal health care program or for which a license is under
suspension or has been revoked by the State where the entity is
located shall be eligible to receive payment or reimbursement
under any such program for health care services furnished to an
Indian.
``(2) Excluded individuals.--No individual who has been
excluded from participation in any Federal health care program
or whose State license is under suspension shall be eligible to
receive payment or reimbursement under any such program for
health care services furnished by that individual, directly or
through an entity that is otherwise eligible to receive payment
for health care services, to an Indian.
``(3) Federal health care program defined.--In this
subsection, the term, `Federal health care program' has the
meaning given that term in section 1128B(f) of the Social
Security Act (42 U.S.C. 1320a-7b(f)), except that, for purposes
of this subsection, such term shall include the health
insurance program under chapter 89 of title 5, United States
Code.
``(c) Related Provisions.--For provisions related to
nondiscrimination against providers operated by the Service, an Indian
Tribe, Tribal Organization, or Urban Indian Organization, see section
1139(c) of the Social Security Act (42 U.S.C. 1320b-9(c)).
``SEC. 409. CONSULTATION.
``For provisions related to consultation with representatives of
Indian Health Programs and Urban Indian Organizations with respect to
the health care programs established under titles XVIII, XIX, and XXI
of the Social Security Act, see section 1139(d) of the Social Security
Act (42 U.S.C. 1320b-9(d)).
``SEC. 410. STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP).
``For provisions relating to--
``(1) outreach to families of Indian children likely to be
eligible for child health assistance under the State children's
health insurance program established under title XXI of the
Social Security Act, see sections 2105(c)(2)(C) and 1139(a) of
such Act (42 U.S.C. 1397ee(c)(2), 1320b-9); and
``(2) ensuring that child health assistance is provided under
such program to targeted low-income children who are Indians
and that payments are made under such program to Indian Health
Programs and Urban Indian Organizations operating in the State
that provide such assistance, see sections 2102(b)(3)(D) and
2105(c)(6)(B) of such Act (42 U.S.C. 1397bb(b)(3)(D),
1397ee(c)(6)(B)).
``SEC. 411. EXCLUSION WAIVER AUTHORITY FOR AFFECTED INDIAN HEALTH
PROGRAMS AND SAFE HARBOR TRANSACTIONS UNDER THE
SOCIAL SECURITY ACT.
``For provisions relating to--
``(1) exclusion waiver authority for affected Indian Health
Programs under the Social Security Act, see section 1128(k) of
the Social Security Act (42 U.S.C. 1320a-7(k)); and
``(2) certain transactions involving Indian Health Programs
deemed to be in safe harbors under that Act, see section
1128B(b)(4) of the Social Security Act (42 U.S.C. 1320a-
7b(b)(4)).
``SEC. 412. PREMIUM AND COST SHARING PROTECTIONS AND ELIGIBILITY
DETERMINATIONS UNDER MEDICAID AND SCHIP AND
PROTECTION OF CERTAIN INDIAN PROPERTY FROM MEDICAID
ESTATE RECOVERY.
``For provisions relating to--
``(1) premiums or cost sharing protections for Indians
furnished items or services directly by Indian Health Programs
or through referral under the contract health service under the
Medicaid program established under title XIX of the Social
Security Act, see sections 1916(j) and 1916A(a)(1) of the
Social Security Act (42 U.S.C. 1396o(j), 1396o-1(a)(1));
``(2) rules regarding the treatment of certain property for
purposes of determining eligibility under such programs, see
sections 1902(e)(13) and 2107(e)(1)(B) of such Act (42 U.S.C.
1396a(e)(13), 1397gg(e)(1)(B)); and
``(3) the protection of certain property from estate recovery
provisions under the Medicaid program, see section
1917(b)(3)(B) of such Act (42 U.S.C. 1396p(b)(3)(B)).
``SEC. 413. TREATMENT UNDER MEDICAID AND SCHIP MANAGED CARE.
``For provisions relating to the treatment of Indians enrolled in a
managed care entity under the Medicaid program under title XIX of the
Social Security Act and Indian Health Programs and Urban Indian
Organizations that are providers of items or services to such Indian
enrollees, see sections 1932(h) and 2107(e)(1)(H) of the Social
Security Act (42 U.S.C. 1396u-2(h), 1397gg(e)(1)(H)).
``SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY.
``(a) Study.--The Secretary shall conduct a study to determine the
feasibility of treating the Navajo Nation as a State for the purposes
of title XIX of the Social Security Act, to provide services to Indians
living within the boundaries of the Navajo Nation through an entity
established having the same authority and performing the same functions
as single-State medicaid agencies responsible for the administration of
the State plan under title XIX of the Social Security Act.
``(b) Considerations.--In conducting the study, the Secretary shall
consider the feasibility of--
``(1) assigning and paying all expenditures for the provision
of services and related administration funds, under title XIX
of the Social Security Act, to Indians living within the
boundaries of the Navajo Nation that are currently paid to or
would otherwise be paid to the State of Arizona, New Mexico, or
Utah;
``(2) providing assistance to the Navajo Nation in the
development and implementation of such entity for the
administration, eligibility, payment, and delivery of medical
assistance under title XIX of the Social Security Act;
``(3) providing an appropriate level of matching funds for
Federal medical assistance with respect to amounts such entity
expends for medical assistance for services and related
administrative costs; and
``(4) authorizing the Secretary, at the option of the Navajo
Nation, to treat the Navajo Nation as a State for the purposes
of title XIX of the Social Security Act (relating to the State
children's health insurance program) under terms equivalent to
those described in paragraphs (2) through (4).
``(c) Report.--Not later then 3 years after the date of enactment of
the Indian Health Care Improvement Act Amendments of 2007, the
Secretary shall submit to the Committee on Indian Affairs and Committee
on Finance of the Senate and the Committee on Natural Resources and
Committee on Energy and Commerce of the House of Representatives a
report that includes--
``(1) the results of the study under this section;
``(2) a summary of any consultation that occurred between the
Secretary and the Navajo Nation, other Indian Tribes, the
States of Arizona, New Mexico, and Utah, counties which include
Navajo Lands, and other interested parties, in conducting this
study;
``(3) projected costs or savings associated with
establishment of such entity, and any estimated impact on
services provided as described in this section in relation to
probable costs or savings; and
``(4) legislative actions that would be required to authorize
the establishment of such entity if such entity is determined
by the Secretary to be feasible.
``SEC. 415. GENERAL EXCEPTIONS.
``The requirements of this title shall not apply to any excepted
benefits described in paragraph (1)(A) or (3) of section 2791(c) of the
Public Health Service Act (42 U.S.C. 300gg-91).
``SEC. 416. AUTHORIZATION OF APPROPRIATIONS.
``There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2017 to carry out
this title.
``TITLE V--HEALTH SERVICES FOR URBAN INDIANS
``SEC. 501. PURPOSE.
``The purpose of this title is to establish and maintain programs in
Urban Centers to make health services more accessible and available to
Urban Indians.
``SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN ORGANIZATIONS.
``Under authority of the Act of November 2, 1921 (25 U.S.C. 13)
(commonly known as the `Snyder Act'), the Secretary, acting through the
Service, shall enter into contracts with, or make grants to, Urban
Indian Organizations to assist such organizations in the establishment
and administration, within Urban Centers, of programs which meet the
requirements set forth in this title. Subject to section 506, the
Secretary, acting through the Service, shall include such conditions as
the Secretary considers necessary to effect the purpose of this title
in any contract into which the Secretary enters with, or in any grant
the Secretary makes to, any Urban Indian Organization pursuant to this
title.
``SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH CARE AND
REFERRAL SERVICES.
``(a) Requirements for Grants and Contracts.--Under authority of the
Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder
Act'), the Secretary, acting through the Service, shall enter into
contracts with, and make grants to, Urban Indian Organizations for the
provision of health care and referral services for Urban Indians. Any
such contract or grant shall include requirements that the Urban Indian
Organization successfully undertake to--
``(1) estimate the population of Urban Indians residing in
the Urban Center or centers that the organization proposes to
serve who are or could be recipients of health care or referral
services;
``(2) estimate the current health status of Urban Indians
residing in such Urban Center or centers;
``(3) estimate the current health care needs of Urban Indians
residing in such Urban Center or centers;
``(4) provide basic health education, including health
promotion and disease prevention education, to Urban Indians;
``(5) make recommendations to the Secretary and Federal,
State, local, and other resource agencies on methods of
improving health service programs to meet the needs of Urban
Indians; and
``(6) where necessary, provide, or enter into contracts for
the provision of, health care services for Urban Indians.
``(b) Criteria.--The Secretary, acting through the Service, shall, by
regulation, prescribe the criteria for selecting Urban Indian
Organizations to enter into contracts or receive grants under this
section. Such criteria shall, among other factors, include--
``(1) the extent of unmet health care needs of Urban Indians
in the Urban Center or centers involved;
``(2) the size of the Urban Indian population in the Urban
Center or centers involved;
``(3) the extent, if any, to which the activities set forth
in subsection (a) would duplicate any project funded under this
title, or under any current public health service project
funded in a manner other than pursuant to this title;
``(4) the capability of an Urban Indian Organization to
perform the activities set forth in subsection (a) and to enter
into a contract with the Secretary or to meet the requirements
for receiving a grant under this section;
``(5) the satisfactory performance and successful completion
by an Urban Indian Organization of other contracts with the
Secretary under this title;
``(6) the appropriateness and likely effectiveness of
conducting the activities set forth in subsection (a) in an
Urban Center or centers; and
``(7) the extent of existing or likely future participation
in the activities set forth in subsection (a) by appropriate
health and health-related Federal, State, local, and other
agencies.
``(c) Access to Health Promotion and Disease Prevention Programs.--
The Secretary, acting through the Service, shall facilitate access to
or provide health promotion and disease prevention services for Urban
Indians through grants made to Urban Indian Organizations administering
contracts entered into or receiving grants under subsection (a).
``(d) Immunization Services.--
``(1) Access or services provided.--The Secretary, acting
through the Service, shall facilitate access to, or provide,
immunization services for Urban Indians through grants made to
Urban Indian Organizations administering contracts entered into
or receiving grants under this section.
``(2) Definition.--For purposes of this subsection, the term
`immunization services' means services to provide without
charge immunizations against vaccine-preventable diseases.
``(e) Behavioral Health Services.--
``(1) Access or services provided.--The Secretary, acting
through the Service, shall facilitate access to, or provide,
behavioral health services for Urban Indians through grants
made to Urban Indian Organizations administering contracts
entered into or receiving grants under subsection (a).
``(2) Assessment required.--Except as provided by paragraph
(3)(A), a grant may not be made under this subsection to an
Urban Indian Organization until that organization has prepared,
and the Service has approved, an assessment of the following:
``(A) The behavioral health needs of the Urban Indian
population concerned.
``(B) The behavioral health services and other
related resources available to that population.
``(C) The barriers to obtaining those services and
resources.
``(D) The needs that are unmet by such services and
resources.
``(3) Purposes of grants.--Grants may be made under this
subsection for the following:
``(A) To prepare assessments required under paragraph
(2).
``(B) To provide outreach, educational, and referral
services to Urban Indians regarding the availability of
direct behavioral health services, to educate Urban
Indians about behavioral health issues and services,
and effect coordination with existing behavioral health
providers in order to improve services to Urban
Indians.
``(C) To provide outpatient behavioral health
services to Urban Indians, including the identification
and assessment of illness, therapeutic treatments, case
management, support groups, family treatment, and other
treatment.
``(D) To develop innovative behavioral health service
delivery models which incorporate Indian cultural
support systems and resources.
``(f) Prevention of Child Abuse.--
``(1) Access or services provided.--The Secretary, acting
through the Service, shall facilitate access to or provide
services for Urban Indians through grants to Urban Indian
Organizations administering contracts entered into or receiving
grants under subsection (a) to prevent and treat child abuse
(including sexual abuse) among Urban Indians.
``(2) Evaluation required.--Except as provided by paragraph
(3)(A), a grant may not be made under this subsection to an
Urban Indian Organization until that organization has prepared,
and the Service has approved, an assessment that documents the
prevalence of child abuse in the Urban Indian population
concerned and specifies the services and programs (which may
not duplicate existing services and programs) for which the
grant is requested.
``(3) Purposes of grants.--Grants may be made under this
subsection for the following:
``(A) To prepare assessments required under paragraph
(2).
``(B) For the development of prevention, training,
and education programs for Urban Indians, including
child education, parent education, provider training on
identification and intervention, education on reporting
requirements, prevention campaigns, and establishing
service networks of all those involved in Indian child
protection.
``(C) To provide direct outpatient treatment services
(including individual treatment, family treatment,
group therapy, and support groups) to Urban Indians who
are child victims of abuse (including sexual abuse) or
adult survivors of child sexual abuse, to the families
of such child victims, and to Urban Indian perpetrators
of child abuse (including sexual abuse).
``(4) Considerations when making grants.--In making grants to
carry out this subsection, the Secretary shall take into
consideration--
``(A) the support for the Urban Indian Organization
demonstrated by the child protection authorities in the
area, including committees or other services funded
under the Indian Child Welfare Act of 1978 (25 U.S.C.
1901 et seq.), if any;
``(B) the capability and expertise demonstrated by
the Urban Indian Organization to address the complex
problem of child sexual abuse in the community; and
``(C) the assessment required under paragraph (2).
``(g) Other Grants.--The Secretary, acting through the Service, may
enter into a contract with or make grants to an Urban Indian
Organization that provides or arranges for the provision of health care
services (through satellite facilities, provider networks, or
otherwise) to Urban Indians in more than 1 Urban Center.
``SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINATION OF UNMET HEALTH
CARE NEEDS.
``(a) Grants and Contracts Authorized.--Under authority of the Act of
November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'),
the Secretary, acting 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.
``(b) Purpose.--The purpose of a contract or grant made under this
section shall be the determination of the matters described in
subsection (c)(1) in order to assist the Secretary in assessing the
health status and health care needs of Urban Indians in the Urban
Center involved and determining whether the Secretary should enter into
a contract or make a grant under section 503 with respect to the Urban
Indian Organization which the Secretary has entered into a contract
with, or made a grant to, under this section.
``(c) Grant and Contract Requirements.--Any contract entered into, or
grant made, by the Secretary under this section shall include
requirements that--
``(1) the Urban Indian Organization successfully undertakes
to--
``(A) document the health care status and unmet
health care needs of Urban Indians in the Urban Center
involved; and
``(B) with respect to Urban Indians in the Urban
Center involved, determine the matters described in
paragraphs (2), (3), (4), and (7) of section 503(b);
and
``(2) the Urban Indian Organization complete performance of
the contract, or carry out the requirements of the grant,
within 1 year after the date on which the Secretary and such
organization enter into such contract, or within 1 year after
such organization receives such grant, whichever is applicable.
``(d) No Renewals.--The Secretary may not renew any contract entered
into or grant made under this section.
``SEC. 505. EVALUATIONS; RENEWALS.
``(a) Procedures for Evaluations.--The Secretary, acting through the
Service, shall develop procedures to evaluate compliance with grant
requirements and compliance with and performance of contracts entered
into by Urban Indian Organizations under this title. Such procedures
shall include provisions for carrying out the requirements of this
section.
``(b) Evaluations.--The Secretary, acting through the Service, shall
evaluate the compliance of each Urban Indian Organization which has
entered into a contract or received a grant under section 503 with the
terms of such contract or grant. For purposes of this evaluation, the
Secretary shall--
``(1) acting through the Service, conduct an annual onsite
evaluation of the organization; or
``(2) accept in lieu of such onsite evaluation evidence of
the organization's provisional or full accreditation by a
private independent entity recognized by the Secretary for
purposes of conducting quality reviews of providers
participating in the Medicare program under title XVIII of the
Social Security Act.
``(c) Noncompliance; Unsatisfactory Performance.--If, as a result of
the evaluations conducted under this section, the Secretary determines
that an Urban Indian Organization has not complied with the
requirements of a grant or complied with or satisfactorily performed a
contract under section 503, the Secretary shall, prior to renewing such
contract or grant, attempt to resolve with the organization the areas
of noncompliance or unsatisfactory performance and modify the contract
or grant to prevent future occurrences of noncompliance or
unsatisfactory performance. If the Secretary determines that the
noncompliance or unsatisfactory performance cannot be resolved and
prevented in the future, the Secretary shall not renew the contract or
grant with the organization and is authorized to enter into a contract
or make a grant under section 503 with another Urban Indian
Organization which is situated in the same Urban Center as the Urban
Indian Organization whose contract or grant is not renewed under this
section.
``(d) Considerations for Renewals.--In determining whether to renew a
contract or grant with an Urban Indian Organization under section 503
which has completed performance of a contract or grant under section
504, the Secretary shall review the records of the Urban Indian
Organization, the reports submitted under section 507, and shall
consider the results of the onsite evaluations or accreditations under
subsection (b).
``SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS.
``(a) Procurement.--Contracts with Urban Indian Organizations entered
into pursuant to this title shall be in accordance with all Federal
contracting laws and regulations relating to procurement except that in
the discretion of the Secretary, such contracts may be negotiated
without advertising and need not conform to the provisions of sections
1304 and 3131 through 3133 of title 40, United States Code.
``(b) Payments Under Contracts or Grants.--
``(1) In general.--Payments under any contracts or grants
pursuant to this title, notwithstanding any term or condition
of such contract or grant--
``(A) may be made in a single advance payment by the
Secretary to the Urban Indian Organization by no later
than the end of the first 30 days of the funding period
with respect to which the payments apply, unless the
Secretary determines through an evaluation under
section 505 that the organization is not capable of
administering such a single advance payment; and
``(B) if any portion thereof is unexpended by the
Urban Indian Organization during the funding period
with respect to which the payments initially apply,
shall be carried forward for expenditure with respect
to allowable or reimbursable costs incurred by the
organization during 1 or more subsequent funding
periods without additional justification or
documentation by the organization as a condition of
carrying forward the availability for expenditure of
such funds.
``(2) Semiannual and quarterly payments and reimbursements.--
If the Secretary determines under paragraph (1)(A) that an
Urban Indian Organization is not capable of administering an
entire single advance payment, on request of the Urban Indian
Organization, the payments may be made--
``(A) in semiannual or quarterly payments by not
later than 30 days after the date on which the funding
period with respect to which the payments apply begins;
or
``(B) by way of reimbursement.
``(c) Revision or Amendment of Contracts.--Notwithstanding any
provision of law to the contrary, the Secretary may, at the request and
consent of an Urban Indian Organization, revise or amend any contract
entered into by the Secretary with such organization under this title
as necessary to carry out the purposes of this title.
``(d) Fair and Uniform Services and Assistance.--Contracts with or
grants to Urban Indian Organizations and regulations adopted pursuant
to this title shall include provisions to assure the fair and uniform
provision to Urban Indians of services and assistance under such
contracts or grants by such organizations.
``SEC. 507. REPORTS AND RECORDS.
``(a) Reports.--
``(1) In general.--For each fiscal year during which an Urban
Indian Organization receives or expends funds pursuant to a
contract entered into or a grant received pursuant to this
title, such Urban Indian Organization shall submit to the
Secretary not more frequently than every 6 months, a report
that includes the following:
``(A) In the case of a contract or grant under
section 503, recommendations pursuant to section
503(a)(5).
``(B) Information on activities conducted by the
organization pursuant to the contract or grant.
``(C) An accounting of the amounts and purpose for
which Federal funds were expended.
``(D) A minimum set of data, using uniformly defined
elements, as specified by the Secretary after
consultation with Urban Indian Organizations.
``(2) Health status and services.--
``(A) In general.--Not later than 18 months after the
date of enactment of the Indian Health Care Improvement
Act Amendments of 2007, the Secretary, acting through
the Service, shall submit to Congress a report
evaluating--
``(i) the health status of Urban Indians;
``(ii) the services provided to Indians
pursuant to this title; and
``(iii) areas of unmet needs in the delivery
of health services to Urban Indians.
``(B) Consultation and contracts.--In preparing the
report under paragraph (1), the Secretary--
``(i) shall consult with Urban Indian
Organizations; and
``(ii) may enter into a contract with a
national organization representing Urban Indian
Organizations to conduct any aspect of the
report.
``(b) Audit.--The reports and records of the Urban Indian
Organization with respect to a contract or grant under this title shall
be subject to audit by the Secretary and the Comptroller General of the
United States.
``(c) Costs of Audits.--The Secretary shall allow as a cost of any
contract or grant entered into or awarded under section 502 or 503 the
cost of an annual independent financial audit conducted by--
``(1) a certified public accountant; or
``(2) a certified public accounting firm qualified to conduct
Federal compliance audits.
``SEC. 508. LIMITATION ON CONTRACT AUTHORITY.
``The authority of the Secretary to enter into contracts or to award
grants under this title shall be to the extent, and in an amount,
provided for in appropriation Acts.
``SEC. 509. FACILITIES.
``(a) Grants.--The Secretary, acting through the Service, may make
grants to contractors or grant recipients under this title for the
lease, purchase, renovation, construction, or expansion of facilities,
including leased facilities, in order to assist such contractors or
grant recipients in complying with applicable licensure or
certification requirements.
``(b) Loan Fund Study.--The Secretary, acting through the Service,
may carry out a study to determine the feasibility of establishing a
loan fund to provide to Urban Indian Organizations direct loans or
guarantees for loans for the construction of health care facilities in
a manner consistent with section 309, including by submitting a report
in accordance with subsection (c) of that section.
``SEC. 510. DIVISION OF URBAN INDIAN HEALTH.
``There is established within the Service a Division of Urban Indian
Health, which shall be responsible for--
``(1) carrying out the provisions of this title;
``(2) providing central oversight of the programs and
services authorized under this title; and
``(3) providing technical assistance to Urban Indian
Organizations.
``SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE-RELATED SERVICES.
``(a) Grants Authorized.--The Secretary, acting through the Service,
may make grants for the provision of health-related services in
prevention of, treatment of, rehabilitation of, or school- and
community-based education regarding, alcohol and substance abuse in
Urban Centers to those Urban Indian Organizations with which the
Secretary has entered into a contract under this title or under section
201.
``(b) Goals.--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
following:
``(1) The size of the Urban Indian population.
``(2) Capability of the organization to adequately perform
the activities required under the grant.
``(3) Satisfactory performance standards for the organization
in meeting the goals set forth in such grant. The standards
shall be negotiated and agreed to between the Secretary and the
grantee on a grant-by-grant basis.
``(4) Identification of the need for services.
``(d) Allocation of Grants.--The Secretary shall develop a
methodology for allocating grants made pursuant to this section based
on the criteria established pursuant to subsection (c).
``(e) Grants Subject to Criteria.--Any grant received by an Urban
Indian Organization under this Act for substance abuse prevention,
treatment, and rehabilitation shall be subject to the criteria set
forth in subsection (c).
``SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS.
``Notwithstanding any other provision of law, the Tulsa Clinic and
Oklahoma City Clinic demonstration projects shall--
``(1) be permanent programs within the Service's direct care
program;
``(2) continue to be treated as Service Units and Operating
Units in the allocation of resources and coordination of care;
and
``(3) continue to meet the requirements and definitions of an
Urban Indian Organization in this Act, and shall not be subject
to the provisions of the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.).
``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.
``(a) Grants and Contracts.--The Secretary, through the Division of
Urban Indian Health, shall make grants or enter into contracts with
Urban Indian Organizations, to take effect not later than September 30,
2010, 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) Use of Funds.--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) Eligibility.--Urban Indian Organizations that operate Indian
alcohol programs originally funded under the NIAAA and subsequently
transferred to the Service are eligible for grants or contracts under
this section.
``(d) Report.--The Secretary shall evaluate and report to Congress on
the activities of programs funded under this section not less than
every 5 years.
``SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZATIONS.
``(a) In General.--The Secretary shall ensure that the Service
consults, to the greatest extent practicable, with Urban Indian
Organizations.
``(b) Definition of Consultation.--For purposes of subsection (a),
consultation is the open and free exchange of information and opinions
which leads to mutual understanding and comprehension and which
emphasizes trust, respect, and shared responsibility.
``SEC. 515. URBAN YOUTH TREATMENT CENTER DEMONSTRATION.
``(a) Construction and Operation.--The Secretary, acting through the
Service, through grant or contract, is authorized to fund the
construction and operation of at least 2 residential treatment centers
in each State described in subsection (b) to demonstrate the provision
of alcohol and substance abuse treatment services to Urban Indian youth
in a culturally competent residential setting.
``(b) Definition of State.--A State described in this subsection is a
State in which--
``(1) there resides Urban Indian youth with need for alcohol
and substance abuse treatment services in a residential
setting; and
``(2) there is a significant shortage of culturally competent
residential treatment services for Urban Indian youth.
``SEC. 516. GRANTS FOR DIABETES PREVENTION, TREATMENT, AND CONTROL.
``(a) Grants Authorized.--The Secretary may make grants to those
Urban Indian Organizations that have entered into a contract or have
received a grant under this title for the provision of services for the
prevention and treatment of, and control of the complications resulting
from, diabetes among Urban Indians.
``(b) Goals.--Each grant made pursuant to subsection (a) shall set
forth the goals to be accomplished under the grant. The goals shall be
specific to each grant as agreed to between the Secretary and the
grantee.
``(c) Establishment of Criteria.--The Secretary shall establish
criteria for the grants made under subsection (a) relating to--
``(1) the size and location of the Urban Indian population to
be served;
``(2) the need for prevention of and treatment of, and
control of the complications resulting from, diabetes among the
Urban Indian population to be served;
``(3) performance standards for the organization in meeting
the goals set forth in such grant that are negotiated and
agreed to by the Secretary and the grantee;
``(4) the capability of the organization to adequately
perform the activities required under the grant; and
``(5) the willingness of the organization to collaborate with
the registry, if any, established by the Secretary under
section 204(e) in the Area Office of the Service in which the
organization is located.
``(d) Funds Subject to Criteria.--Any funds received by an Urban
Indian Organization under this Act for the prevention, treatment, and
control of diabetes among Urban Indians shall be subject to the
criteria developed by the Secretary under subsection (c).
``SEC. 517. COMMUNITY HEALTH REPRESENTATIVES.
``The Secretary, acting through the Service, may enter into contracts
with, and make grants to, Urban Indian Organizations for the employment
of Indians trained as health service providers through the Community
Health Representatives Program under section 109 in the provision of
health care, health promotion, and disease prevention services to Urban
Indians.
``SEC. 518. EFFECTIVE DATE.
``The amendments made by the Indian Health Care Improvement Act
Amendments of 2007 to this title shall take effect beginning on the
date of enactment of that Act, regardless of whether the Secretary has
promulgated regulations implementing such amendments.
``SEC. 519. ELIGIBILITY FOR SERVICES.
``Urban Indians shall be eligible for, and the ultimate beneficiaries
of, health care or referral services provided pursuant to this title.
``SEC. 520. AUTHORIZATION OF APPROPRIATIONS.
``There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2017 to carry out
this title.
``TITLE VI--ORGANIZATIONAL IMPROVEMENTS
``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, as are or may be hereafter
provided by Federal statute or treaties, there is established
within the Public Health Service of the Department the Indian
Health Service.
``(2) Assistant secretary of indian health.--The Service
shall be administered by an Assistant Secretary of Indian
Health, who shall be appointed by the President, by and with
the advice and consent of the Senate. The Assistant Secretary
shall report to the Secretary. Effective with respect to an
individual appointed by the President, by and with the advice
and consent of the Senate, after January 1, 2007, the term of
service of the Assistant Secretary shall be 4 years. An
Assistant Secretary may serve more than 1 term.
``(3) Incumbent.--The individual serving in the position of
Director of the Service on the day before the date of enactment
of the Indian Health Care Improvement Act Amendments of 2007
shall serve as Assistant Secretary.
``(4) Advocacy and consultation.--The position of Assistant
Secretary is established to, in a manner consistent with the
government-to-government relationship between the United States
and Indian Tribes--
``(A) facilitate advocacy for the development of
appropriate Indian health policy; and
``(B) promote consultation on matters relating to
Indian health.
``(b) Agency.--The Service shall be an agency within the Public
Health Service of the Department, and shall not be an office,
component, or unit of any other agency of the Department.
``(c) Duties.--The Assistant Secretary shall--
``(1) perform all functions that were, on the day before the
date of enactment of the Indian Health Care Improvement Act
Amendments of 2007, carried out by or under the direction of
the individual serving as Director of the Service on that day;
``(2) perform all functions of the Secretary relating to the
maintenance and operation of hospital and health facilities for
Indians and the planning for, and provision and utilization of,
health services for Indians;
``(3) administer all health programs under which health care
is provided to Indians based upon their status as Indians which
are administered by the Secretary, including programs under--
``(A) this Act;
``(B) the Act of November 2, 1921 (25 U.S.C. 13);
``(C) the Act of August 5, 1954 (42 U.S.C. 2001 et
seq.);
``(D) the Act of August 16, 1957 (42 U.S.C. 2005 et
seq.); and
``(E) the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.);
``(4) administer all scholarship and loan functions carried
out under title I;
``(5) report directly to the Secretary concerning all policy-
and budget-related matters affecting Indian health;
``(6) collaborate with the Assistant Secretary for Health
concerning appropriate matters of Indian health that affect the
agencies of the Public Health Service;
``(7) advise each Assistant Secretary of the Department
concerning matters of Indian health with respect to which that
Assistant Secretary has authority and responsibility;
``(8) advise the heads of other agencies and programs of the
Department concerning matters of Indian health with respect to
which those heads have authority and responsibility;
``(9) coordinate the activities of the Department concerning
matters of Indian health; and
``(10) perform such other functions as the Secretary may
designate.
``(d) Authority.--
``(1) In general.--The Secretary, acting through the
Assistant Secretary, shall have the authority--
``(A) except to the extent provided for in paragraph
(2), to appoint and compensate employees for the
Service in accordance with title 5, United States Code;
``(B) to enter into contracts for the procurement of
goods and services to carry out the functions of the
Service; and
``(C) to manage, expend, and obligate all funds
appropriated for the Service.
``(2) Personnel actions.--Notwithstanding any other provision
of law, the provisions of section 12 of the Act of June 18,
1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to all
personnel actions taken with respect to new positions created
within the Service as a result of its establishment under
subsection (a).
``(e) References.--Any reference to the Director of the Indian Health
Service in any other Federal law, Executive order, rule, regulation, or
delegation of authority, or in any document of or relating to the
Director of the Indian Health Service, shall be deemed to refer to the
Assistant Secretary.
``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.
``(a) Establishment.--
``(1) In general.--The Secretary shall establish an automated
management information system for the Service.
``(2) Requirements of system.--The information system
established under paragraph (1) shall include--
``(A) a financial management system;
``(B) a patient care information system for each area
served by the Service;
``(C) a privacy component that protects the privacy
of patient information held by, or on behalf of, the
Service;
``(D) a services-based cost accounting component that
provides estimates of the costs associated with the
provision of specific medical treatments or services in
each Area office of the Service;
``(E) an interface mechanism for patient billing and
accounts receivable system; and
``(F) a training component.
``(b) Provision of Systems to Tribes and Organizations.--The
Secretary shall provide each Tribal Health Program automated management
information systems which--
``(1) meet the management information needs of such Tribal
Health Program with respect to the treatment by the Tribal
Health Program of patients of the Service; and
``(2) meet the management information needs of the Service.
``(c) Access to Records.--Notwithstanding any other provision of law,
each patient shall have reasonable access to the medical or health
records of such patient which are held by, or on behalf of, the
Service.
``(d) Authority To Enhance Information Technology.--The Secretary,
acting through the Assistant Secretary, shall have the authority to
enter into contracts, agreements, or joint ventures with other Federal
agencies, States, private and nonprofit organizations, for the purpose
of enhancing information technology in Indian Health Programs and
facilities.
``SEC. 603. AUTHORIZATION OF APPROPRIATIONS.
``There is authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2017 to carry out
this title.
``TITLE VII--BEHAVIORAL HEALTH PROGRAMS
``SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREATMENT SERVICES.
``(a) Purposes.--The purposes of this section are as follows:
``(1) To authorize and direct the Secretary, acting through
the Service, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations, to develop a comprehensive behavioral
health prevention and treatment program which emphasizes
collaboration among alcohol and substance abuse, social
services, and mental health programs.
``(2) To provide information, direction, and guidance
relating to mental illness and dysfunction and self-destructive
behavior, including child abuse and family violence, to those
Federal, tribal, State, and local agencies responsible for
programs in Indian communities in areas of health care,
education, social services, child and family welfare, alcohol
and substance abuse, law enforcement, and judicial services.
``(3) To assist Indian Tribes to identify services and
resources available to address mental illness and dysfunctional
and self-destructive behavior.
``(4) To provide authority and opportunities for Indian
Tribes and Tribal Organizations to develop, implement, and
coordinate with community-based programs which include
identification, prevention, education, referral, and treatment
services, including through multidisciplinary resource teams.
``(5) To ensure that Indians, as citizens of the United
States and of the States in which they reside, have the same
access to behavioral health services to which all citizens have
access.
``(6) To modify or supplement existing programs and
authorities in the areas identified in paragraph (2).
``(b) Plans.--
``(1) Development.--The Secretary, acting through the
Service, Indian Tribes, Tribal Organizations, and Urban Indian
Organizations, shall encourage Indian Tribes and Tribal
Organizations to develop tribal plans, and Urban Indian
Organizations to develop local plans, and for all such groups
to participate in developing areawide plans for Indian
Behavioral Health Services. The plans shall include, to the
extent feasible, the following components:
``(A) An assessment of the scope of alcohol or other
substance abuse, mental illness, and dysfunctional and
self-destructive behavior, including suicide, child
abuse, and family violence, among Indians, including--
``(i) the number of Indians served who are
directly or indirectly affected by such illness
or behavior; or
``(ii) an estimate of the financial and human
cost attributable to such illness or behavior.
``(B) An assessment of the existing and additional
resources necessary for the prevention and treatment of
such illness and behavior, including an assessment of
the progress toward achieving the availability of the
full continuum of care described in subsection (c).
``(C) An estimate of the additional funding needed by
the Service, Indian Tribes, Tribal Organizations, and
Urban Indian Organizations to meet their
responsibilities under the plans.
``(2) National clearinghouse.--The Secretary, acting through
the Service, shall coordinate with existing national
clearinghouses and information centers to include at the
clearinghouses and centers plans and reports on the outcomes of
such plans developed by Indian Tribes, Tribal Organizations,
Urban Indian Organizations, and Service Areas relating to
behavioral health. The Secretary shall ensure access to these
plans and outcomes by any Indian Tribe, Tribal Organization,
Urban Indian Organization, or the Service.
``(3) Technical assistance.--The Secretary shall provide
technical assistance to Indian Tribes, Tribal Organizations,
and Urban Indian Organizations in preparation of plans under
this section and in developing standards of care that may be
used and adopted locally.
``(c) Programs.--The Secretary, acting through the Service, Indian
Tribes, and Tribal Organizations, shall provide, to the extent feasible
and if funding is available, programs including the following:
``(1) Comprehensive care.--A comprehensive continuum of
behavioral health care which provides--
``(A) community-based prevention, intervention,
outpatient, and behavioral health aftercare;
``(B) detoxification (social and medical);
``(C) acute hospitalization;
``(D) intensive outpatient/day treatment;
``(E) residential treatment;
``(F) transitional living for those needing a
temporary, stable living environment that is supportive
of treatment and recovery goals;
``(G) emergency shelter;
``(H) intensive case management; and
``(I) diagnostic services.
``(2) Child care.--Behavioral health services for Indians
from birth through age 17, including--
``(A) preschool and school age fetal alcohol disorder
services, including assessment and behavioral
intervention;
``(B) mental health and substance abuse services
(emotional, organic, alcohol, drug, inhalant, and
tobacco);
``(C) identification and treatment of co-occurring
disorders and comorbidity;
``(D) prevention of alcohol, drug, inhalant, and
tobacco use;
``(E) early intervention, treatment, and aftercare;
``(F) promotion of healthy approaches to risk and
safety issues; and
``(G) identification and treatment of neglect and
physical, mental, and sexual abuse.
``(3) Adult care.--Behavioral health services for Indians
from age 18 through 55, including--
``(A) early intervention, treatment, and aftercare;
``(B) mental health and substance abuse services
(emotional, alcohol, drug, inhalant, and tobacco),
including sex specific services;
``(C) identification and treatment of co-occurring
disorders (dual diagnosis) and comorbidity;
``(D) promotion of healthy approaches for risk-
related behavior;
``(E) treatment services for women at risk of giving
birth to a child with a fetal alcohol disorder; and
``(F) sex specific treatment for sexual assault and
domestic violence.
``(4) Family care.--Behavioral health services for families,
including--
``(A) early intervention, treatment, and aftercare
for affected families;
``(B) treatment for sexual assault and domestic
violence; and
``(C) promotion of healthy approaches relating to
parenting, domestic violence, and other abuse issues.
``(5) Elder care.--Behavioral health services for Indians 56
years of age and older, including--
``(A) early intervention, treatment, and aftercare;
``(B) mental health and substance abuse services
(emotional, alcohol, drug, inhalant, and tobacco),
including sex specific services;
``(C) identification and treatment of co-occurring
disorders (dual diagnosis) and comorbidity;
``(D) promotion of healthy approaches to managing
conditions related to aging;
``(E) sex specific treatment for sexual assault,
domestic violence, neglect, physical and mental abuse
and exploitation; and
``(F) identification and treatment of dementias
regardless of cause.
``(d) Community Behavioral Health Plan.--
``(1) Establishment.--The governing body of any Indian Tribe,
Tribal Organization, or Urban Indian Organization may adopt a
resolution for the establishment of a community behavioral
health plan providing for the identification and coordination
of available resources and programs to identify, prevent, or
treat substance abuse, mental illness, or dysfunctional and
self-destructive behavior, including child abuse and family
violence, among its members or its service population. This
plan should include behavioral health services, social
services, intensive outpatient services, and continuing
aftercare.
``(2) Technical assistance.--At the request of an Indian
Tribe, Tribal Organization, or Urban Indian Organization, the
Bureau of Indian Affairs and the Service shall cooperate with
and provide technical assistance to the Indian Tribe, Tribal
Organization, or Urban Indian Organization in the development
and implementation of such plan.
``(3) Funding.--The Secretary, acting through the Service,
may make funding available to Indian Tribes and Tribal
Organizations which adopt a resolution pursuant to paragraph
(1) to obtain technical assistance for the development of a
community behavioral health plan and to provide administrative
support in the implementation of such plan.
``(e) Coordination for Availability of Services.--The Secretary,
acting through the Service, Indian Tribes, Tribal Organizations, and
Urban Indian Organizations, shall coordinate behavioral health
planning, to the extent feasible, with other Federal agencies and with
State agencies, to encourage comprehensive behavioral health services
for Indians regardless of their place of residence.
``(f) Mental Health Care Need Assessment.--Not later than 1 year
after the date of enactment of the Indian Health Care Improvement Act
Amendments of 2007, the Secretary, acting through the Service, shall
make an assessment of the need for inpatient mental health care among
Indians and the availability and cost of inpatient mental health
facilities which can meet such need. In making such assessment, the
Secretary shall consider the possible conversion of existing, underused
Service hospital beds into psychiatric units to meet such need.
``SEC. 702. MEMORANDA OF AGREEMENT WITH THE DEPARTMENT OF THE INTERIOR.
``(a) Contents.--Not later than 12 months after the date of enactment
of the Indian Health Care Improvement Act Amendments of 2007, the
Secretary, acting through the Service, and the Secretary of the
Interior shall develop and enter into a memoranda of agreement, or
review and update any existing memoranda of agreement, as required by
section 4205 of the Indian Alcohol and Substance Abuse Prevention and
Treatment Act of 1986 (25 U.S.C. 2411) under which the Secretaries
address the following:
``(1) The scope and nature of mental illness and
dysfunctional and self-destructive behavior, including child
abuse and family violence, among Indians.
``(2) The existing Federal, tribal, State, local, and private
services, resources, and programs available to provide
behavioral health services for Indians.
``(3) The unmet need for additional services, resources, and
programs necessary to meet the needs identified pursuant to
paragraph (1).
``(4)(A) The right of Indians, as citizens of the United
States and of the States in which they reside, to have access
to behavioral health services to which all citizens have
access.
``(B) The right of Indians to participate in, and receive the
benefit of, such services.
``(C) The actions necessary to protect the exercise of such
right.
``(5) The responsibilities of the Bureau of Indian Affairs
and the Service, including mental illness identification,
prevention, education, referral, and treatment services
(including services through multidisciplinary resource teams),
at the central, area, and agency and Service Unit, Service
Area, and headquarters levels to address the problems
identified in paragraph (1).
``(6) A strategy for the comprehensive coordination of the
behavioral health services provided by the Bureau of Indian
Affairs and the Service to meet the problems identified
pursuant to paragraph (1), including--
``(A) the coordination of alcohol and substance abuse
programs of the Service, the Bureau of Indian Affairs,
and Indian Tribes and Tribal Organizations (developed
under the Indian Alcohol and Substance Abuse Prevention
and Treatment Act of 1986 (25 U.S.C. 2401 et seq.))
with behavioral health initiatives pursuant to this
Act, particularly with respect to the referral and
treatment of dually diagnosed individuals requiring
behavioral health and substance abuse treatment; and
``(B) ensuring that the Bureau of Indian Affairs and
Service programs and services (including
multidisciplinary resource teams) addressing child
abuse and family violence are coordinated with such
non-Federal programs and services.
``(7) Directing appropriate officials of the Bureau of Indian
Affairs and the Service, particularly at the agency and Service
Unit levels, to cooperate fully with tribal requests made
pursuant to community behavioral health plans adopted under
section 701(c) and section 4206 of the Indian Alcohol and
Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C.
2412).
``(8) Providing for an annual review of such agreement by the
Secretaries which shall be provided to Congress and Indian
Tribes and Tribal Organizations.
``(b) Specific Provisions Required.--The memoranda of agreement
updated or entered into pursuant to subsection (a) 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 Indians, including the number
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 and substance
abuse.
``(c) Publication.--Each memorandum of agreement entered into or
renewed (and amendments or modifications thereto) under subsection (a)
shall be published in the Federal Register. At the same time as
publication in the Federal Register, the Secretary shall provide a copy
of such memoranda, amendment, or modification to each Indian Tribe,
Tribal Organization, and Urban Indian Organization.
``SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND TREATMENT
PROGRAM.
``(a) Establishment.--
``(1) In general.--The Secretary, acting through the Service,
Indian Tribes, and Tribal Organizations, shall provide a
program of comprehensive behavioral health, prevention,
treatment, and aftercare, which shall include--
``(A) prevention, through educational intervention,
in Indian communities;
``(B) acute detoxification, psychiatric
hospitalization, residential, and intensive outpatient
treatment;
``(C) community-based rehabilitation and aftercare;
``(D) community education and involvement, including
extensive training of health care, educational, and
community-based personnel;
``(E) specialized residential treatment programs for
high-risk populations, including pregnant and
postpartum women and their children; and
``(F) diagnostic services.
``(2) Target populations.--The target population of such
programs shall be members of Indian Tribes. Efforts to train
and educate key members of the Indian community shall also
target employees of health, education, judicial, law
enforcement, legal, and social service programs.
``(b) Contract Health Services.--
``(1) In general.--The Secretary, acting through the Service,
Indian Tribes, and Tribal Organizations, may enter into
contracts with public or private providers of behavioral health
treatment services for the purpose of carrying out the program
required under subsection (a).
``(2) Provision of assistance.--In carrying out this
subsection, the Secretary shall provide assistance to Indian
Tribes and Tribal Organizations to develop criteria for the
certification of behavioral health service providers and
accreditation of service facilities which meet minimum
standards for such services and facilities.
``SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.
``(a) In General.--Under the authority of the Act of November 2, 1921
(25 U.S.C. 13) (commonly known as the `Snyder Act'), the Secretary
shall establish and maintain a mental health technician program within
the Service which--
``(1) provides for the training of Indians as mental health
technicians; and
``(2) employs such technicians in the provision of community-
based mental health care that includes identification,
prevention, education, referral, and treatment services.
``(b) Paraprofessional Training.--In carrying out subsection (a), the
Secretary, acting through the Service, Indian Tribes, and Tribal
Organizations, shall provide high-standard paraprofessional training in
mental health care necessary to provide quality care to the Indian
communities to be served. Such training shall be based upon a
curriculum developed or approved by the Secretary which combines
education in the theory of mental health care with supervised practical
experience in the provision of such care.
``(c) Supervision and Evaluation of Technicians.--The Secretary,
acting through the Service, Indian Tribes, and Tribal Organizations,
shall supervise and evaluate the mental health technicians in the
training program.
``(d) Traditional Health Care Practices.--The Secretary, acting
through the Service, shall ensure that the program established pursuant
to this subsection involves the use and promotion of the traditional
health care practices of the Indian Tribes to be served.
``SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE WORKERS.
``(a) In General.--Subject to the provisions of section 221, and
except as provided in subsection (b), any individual 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 this Act is required to be licensed as a
psychologist, social worker, or marriage and family therapist,
respectively.
``(b) Trainees.--An individual may be employed as a trainee in
psychology, social work, or marriage and family therapy to provide
mental health care services described in subsection (a) if such
individual--
``(1) works under the direct supervision of a licensed
psychologist, social worker, or marriage and family therapist,
respectively;
``(2) is enrolled in or has completed at least 2 years of
course work at a post-secondary, accredited education program
for psychology, social work, marriage and family therapy, or
counseling; and
``(3) meets such other training, supervision, and quality
review requirements as the Secretary may establish.
``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.
``(a) Grants.--The Secretary, consistent with section 701, may make
grants to Indian Tribes, Tribal Organizations, and Urban Indian
Organizations to develop and implement a comprehensive behavioral
health 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) Use of Grant Funds.--A grant made pursuant to this section may
be used to--
``(1) develop and provide community training, education, and
prevention programs for Indian women relating to behavioral
health issues, including fetal alcohol disorders;
``(2) identify and provide psychological services,
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 health care practices,
cultural values, and community and family involvement.
``(c) Criteria.--The Secretary, in consultation with Indian Tribes
and Tribal Organizations, shall establish criteria for the review and
approval of applications and proposals for funding under this section.
``(d) Earmark of Certain Funds.--Twenty percent of the funds
appropriated pursuant to this section shall be used to make grants to
Urban Indian Organizations.
``SEC. 707. INDIAN YOUTH PROGRAM.
``(a) Detoxification and Rehabilitation.--The Secretary, acting
through the Service, consistent with section 701, shall develop and
implement a program for acute detoxification and treatment for Indian
youths, including behavioral health services. The program shall include
regional treatment centers designed to include detoxification and
rehabilitation for both sexes on a referral basis and programs
developed and implemented by Indian Tribes or Tribal Organizations at
the local level under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.). Regional centers shall be
integrated with the intake and rehabilitation programs based in the
referring Indian community.
``(b) Alcohol and Substance Abuse Treatment Centers or Facilities.--
``(1) Establishment.--
``(A) In general.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, shall
construct, renovate, or, as necessary, purchase, and
appropriately staff and operate, at least 1 youth
regional treatment center or treatment network in each
area under the jurisdiction of an Area Office.
``(B) Area office in california.--For the purposes of
this subsection, the Area Office in California shall be
considered to be 2 Area Offices, 1 office whose
jurisdiction shall be considered to encompass the
northern area of the State of California, and 1 office
whose jurisdiction shall be considered to encompass the
remainder of the State of California for the purpose of
implementing California treatment networks.
``(2) Funding.--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) Location.--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 appropriate tribal resolution) by a
majority of the Indian Tribes to be served by such center.
``(4) Specific provision of funds.--
``(A) In general.--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--
``(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 without regard to the
proviso set forth in section 4(l) of the Indian
Self-Determination and Education Assistance Act
(25 U.S.C. 450b(l)).
``(B) Provision of services to eligible youths.--
Until additional residential youth treatment facilities
are established in Alaska pursuant to this section, the
facilities specified in subparagraph (A) shall make
every effort to provide services to all eligible Indian
youths residing in Alaska.
``(c) Intermediate Adolescent Behavioral Health Services.--
``(1) In general.--The Secretary, acting through the Service,
Indian Tribes, and Tribal Organizations, may provide
intermediate behavioral health services to Indian children and
adolescents, including--
``(A) pretreatment assistance;
``(B) inpatient, outpatient, and aftercare services;
``(C) emergency care;
``(D) suicide prevention and crisis intervention; and
``(E) prevention and treatment of mental illness and
dysfunctional and self-destructive behavior, including
child abuse and family violence.
``(2) Use of funds.--Funds provided under this subsection may
be used--
``(A) to construct or renovate an existing health
facility to provide intermediate behavioral health
services;
``(B) to hire behavioral health professionals;
``(C) to staff, operate, and maintain an intermediate
mental health facility, group home, sober housing,
transitional housing or similar facilities, or youth
shelter where intermediate behavioral health services
are being provided;
``(D) to make renovations and hire appropriate staff
to convert existing hospital beds into adolescent
psychiatric units; and
``(E) for intensive home- and community-based
services.
``(3) Criteria.--The Secretary, acting through the Service,
shall, in consultation with Indian Tribes and Tribal
Organizations, establish criteria for the review and approval
of applications or proposals for funding made available
pursuant to this subsection.
``(d) Federally-Owned Structures.--
``(1) In general.--The Secretary, in consultation with Indian
Tribes and Tribal Organizations, shall--
``(A) identify and use, where appropriate, federally-
owned structures suitable for local residential or
regional behavioral health treatment for Indian youths;
and
``(B) establish guidelines for determining the
suitability of any such federally-owned structure to be
used for local residential or regional behavioral
health treatment for Indian youths.
``(2) Terms and conditions for use of structure.--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 responsibility for the structure and any
Indian Tribe or Tribal Organization operating the program.
``(e) Rehabilitation and Aftercare Services.--
``(1) In general.--The Secretary, Indian Tribes, or Tribal
Organizations, in cooperation with the Secretary of the
Interior, shall develop and implement within each Service Unit,
community-based rehabilitation and follow-up services for
Indian youths who are having significant behavioral health
problems, and require long-term treatment, community
reintegration, and monitoring to support the Indian youths
after their return to their home community.
``(2) Administration.--Services under paragraph (1) shall be
provided by trained staff within the community who can assist
the Indian youths in their continuing development of self-
image, positive problem-solving skills, and nonalcohol or
substance abusing behaviors. Such staff may include alcohol and
substance abuse counselors, mental health professionals, and
other health professionals and paraprofessionals, including
community health representatives.
``(f) Inclusion of Family in Youth Treatment Program.--In providing
the treatment and other services to Indian youths authorized by this
section, the Secretary, acting through the Service, Indian Tribes, and
Tribal Organizations, shall provide for the inclusion of family members
of such youths in the treatment programs or other services as may be
appropriate. Not less than 10 percent of the funds appropriated for the
purposes of carrying out subsection (e) shall be used for outpatient
care of adult family members related to the treatment of an Indian
youth under that subsection.
``(g) Multidrug Abuse Program.--The Secretary, acting through the
Service, Indian Tribes, Tribal Organizations, and Urban Indian
Organizations, shall provide, consistent with section 701, programs and
services to prevent and treat the abuse of multiple forms of
substances, including alcohol, drugs, inhalants, and tobacco, among
Indian youths residing in Indian communities, on or near reservations,
and in urban areas and provide appropriate mental health services to
address the incidence of mental illness among such youths.
``(h) Indian Youth Mental Health.--The Secretary, acting through the
Service, shall collect data for the report under section 801 with
respect to--
``(1) the number of Indian youth who are being provided
mental health services through the Service and Tribal Health
Programs;
``(2) a description of, and costs associated with, the mental
health services provided for Indian youth through the Service
and Tribal Health Programs;
``(3) the number of youth referred to the Service or Tribal
Health Programs for mental health services;
``(4) the number of Indian youth provided residential
treatment for mental health and behavioral problems through the
Service and Tribal Health Programs, reported separately for on-
and off-reservation facilities; and
``(5) the costs of the services described in paragraph (4).
``SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT.
``(a) Purpose.--The purpose of this section is to authorize the
Secretary to carry out a demonstration project to test the use of
telemental health services in suicide prevention, intervention and
treatment of Indian youth, including through--
``(1) the use of psychotherapy, psychiatric assessments,
diagnostic interviews, therapies for mental health conditions
predisposing to suicide, and alcohol and substance abuse
treatment;
``(2) the provision of clinical expertise to, consultation
services with, and medical advice and training for frontline
health care providers working with Indian youth;
``(3) training and related support for community leaders,
family members and health and education workers who work with
Indian youth;
``(4) the development of culturally-relevant educational
materials on suicide; and
``(5) data collection and reporting.
``(b) Definitions.--For the purpose of this section, the following
definitions shall apply:
``(1) Demonstration project.--The term `demonstration
project' means the Indian youth telemental health demonstration
project authorized under subsection (c).
``(2) Telemental health.--The term `telemental health' means
the use of electronic information and telecommunications
technologies to support long distance mental health care,
patient and professional-related education, public health, and
health administration.
``(c) Authorization.--
``(1) In general.--The Secretary is authorized to award
grants under the demonstration project for the provision of
telemental health services to Indian youth who--
``(A) have expressed suicidal ideas;
``(B) have attempted suicide; or
``(C) have mental health conditions that increase or
could increase the risk of suicide.
``(2) Eligibility for grants.--Such grants shall be awarded
to Indian Tribes and Tribal Organizations that operate 1 or
more facilities--
``(A) located in Alaska and part of the Alaska
Federal Health Care Access Network;
``(B) reporting active clinical telehealth
capabilities; or
``(C) offering school-based telemental health
services relating to psychiatry to Indian youth.
``(3) Grant period.--The Secretary shall award grants under
this section for a period of up to 4 years.
``(4) Awarding of grants.--Not more than 5 grants shall be
provided under paragraph (1), with priority consideration given
to Indian Tribes and Tribal Organizations that--
``(A) serve a particular community or geographic area
where there is a demonstrated need to address Indian
youth suicide;
``(B) enter in to collaborative partnerships with
Indian Health Service or Tribal Health Programs or
facilities to provide services under this demonstration
project;
``(C) serve an isolated community or geographic area
which has limited or no access to behavioral health
services; or
``(D) operate a detention facility at which Indian
youth are detained.
``(d) Use of Funds.--
``(1) In general.--An Indian Tribe or Tribal Organization
shall use a grant received under subsection (c) for the
following purposes:
``(A) To provide telemental health services to Indian
youth, including the provision of--
``(i) psychotherapy;
``(ii) psychiatric assessments and diagnostic
interviews, therapies for mental health
conditions predisposing to suicide, and
treatment; and
``(iii) alcohol and substance abuse
treatment.
``(B) To provide clinician-interactive medical
advice, guidance and training, assistance in diagnosis
and interpretation, crisis counseling and intervention,
and related assistance to Service, tribal, or urban
clinicians and health services providers working with
youth being served under this demonstration project.
``(C) To assist, educate and train community leaders,
health education professionals and paraprofessionals,
tribal outreach workers, and family members who work
with the youth receiving telemental health services
under this demonstration project, including with
identification of suicidal tendencies, crisis
intervention and suicide prevention, emergency skill
development, and building and expanding networks among
these individuals and with State and local health
services providers.
``(D) To develop and distribute culturally
appropriate community educational materials on--
``(i) suicide prevention;
``(ii) suicide education;
``(iii) suicide screening;
``(iv) suicide intervention; and
``(v) ways to mobilize communities with
respect to the identification of risk factors
for suicide.
``(E) For data collection and reporting related to
Indian youth suicide prevention efforts.
``(2) Traditional health care practices.--In carrying out the
purposes described in paragraph (1), an Indian Tribe or Tribal
Organization may use and promote the traditional health care
practices of the Indian Tribes of the youth to be served.
``(e) Applications.--To be eligible to receive a grant under
subsection (c), an Indian Tribe or Tribal Organization shall prepare
and submit to the Secretary an application, at such time, in such
manner, and containing such information as the Secretary may require,
including--
``(1) a description of the project that the Indian Tribe or
Tribal Organization will carry out using the funds provided
under the grant;
``(2) a description of the manner in which the project funded
under the grant would--
``(A) meet the telemental health care needs of the
Indian youth population to be served by the project; or
``(B) improve the access of the Indian youth
population to be served to suicide prevention and
treatment services;
``(3) evidence of support for the project from the local
community to be served by the project;
``(4) a description of how the families and leadership of the
communities or populations to be served by the project would be
involved in the development and ongoing operations of the
project;
``(5) a plan to involve the tribal community of the youth who
are provided services by the project in planning and evaluating
the mental health care and suicide prevention efforts provided,
in order to ensure the integration of community, clinical,
environmental, and cultural components of the treatment; and
``(6) a plan for sustaining the project after Federal
assistance for the demonstration project has terminated.
``(f) Collaboration; Reporting to National Clearinghouse.--
``(1) Collaboration.--The Secretary, acting through the
Service, shall encourage Indian Tribes and Tribal Organizations
receiving grants under this section to collaborate to enable
comparisons about best practices across projects.
``(2) Reporting to national clearinghouse.--The Secretary,
acting through the Service, shall also encourage Indian Tribes
and Tribal Organizations receiving grants under this section to
submit relevant, declassified project information to the
national clearinghouse authorized under section 701(b)(2) in
order to better facilitate program performance and improve
suicide prevention, intervention, and treatment services.
``(g) Annual Report.--Each grant recipient shall submit to the
Secretary an annual report that--
``(1) describes the number of telemental health services
provided; and
``(2) includes any other information that the Secretary may
require.
``(h) Report to Congress.--Not later than 270 days after the
termination of the demonstration project, the Secretary shall submit to
the Committee on Indian Affairs of the Senate and the Committee on
Natural Resources and Committee on Energy and Commerce of the House of
Representatives a final report, based on the annual reports provided by
grant recipients under subsection (h), that--
``(1) describes the results of the projects funded by grants
awarded under this section, including any data available which
indicates the number of attempted suicides;
``(2) evaluates the impact of the telemental health services
funded by the grants in reducing the number of completed
suicides among Indian youth;
``(3) evaluates whether the demonstration project should be--
``(A) expanded to provide more than 5 grants; and
``(B) designated a permanent program; and
``(4) evaluates the benefits of expanding the demonstration
project to include Urban Indian Organizations.
``(i) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section $1,500,000 for each of fiscal
years 2008 through 2011.
``SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL HEALTH FACILITIES
DESIGN, CONSTRUCTION, AND STAFFING.
``Not later than 1 year after the date of enactment of the Indian
Health Care Improvement Act Amendments of 2007, the Secretary, acting
through the Service, Indian Tribes, and Tribal Organizations, may
provide, in each area of the Service, not less than 1 inpatient mental
health care facility, or the equivalent, for Indians with behavioral
health problems. For the purposes of this subsection, California shall
be considered to be 2 Area Offices, 1 office whose location shall be
considered to encompass the northern area of the State of California
and 1 office whose jurisdiction shall be considered to encompass the
remainder of the State of California. The Secretary shall consider the
possible conversion of existing, underused Service hospital beds into
psychiatric units to meet such need.
``SEC. 710. TRAINING AND COMMUNITY EDUCATION.
``(a) Program.--The Secretary, in cooperation with the Secretary of
the Interior, shall develop and implement or assist Indian Tribes and
Tribal Organizations to develop and implement, within each Service Unit
or tribal program, a program of community education and involvement
which shall be designed to provide concise and timely information to
the community leadership of each tribal community. Such program shall
include education about behavioral health issues to political leaders,
Tribal judges, law enforcement personnel, members of tribal health and
education boards, health care providers including traditional
practitioners, and other critical members of each tribal community.
Such program may also include community-based training to develop local
capacity and tribal community provider training for prevention,
intervention, treatment, and aftercare.
``(b) Instruction.--The Secretary, acting through the Service, shall,
either directly or through Indian Tribes and Tribal Organizations,
provide instruction in the area of behavioral health issues, including
instruction in crisis intervention and family relations in the context
of alcohol and substance abuse, child sexual abuse, youth alcohol and
substance abuse, and the causes and effects of fetal alcohol disorders
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 Affairs 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) Training Models.--In carrying out the education and training
programs required by this section, the Secretary, in consultation with
Indian Tribes, Tribal Organizations, Indian behavioral health experts,
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 behavioral health
problems faced by children of alcoholics;
``(2) the cultural, spiritual, and multigenerational aspects
of behavioral health problem prevention and recovery; and
``(3) community-based and multidisciplinary strategies for
preventing and treating behavioral health problems.
``SEC. 711. BEHAVIORAL HEALTH PROGRAM.
``(a) Innovative Programs.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, consistent with
section 701, may plan, develop, implement, and carry out programs to
deliver innovative community-based behavioral health services to
Indians.
``(b) Awards; Criteria.--The Secretary may award a grant for a
project under subsection (a) to an Indian Tribe or Tribal Organization
and may consider the following criteria:
``(1) The project will address significant unmet behavioral
health needs among Indians.
``(2) The project will serve a significant number of Indians.
``(3) The project has the potential to deliver services in an
efficient and effective manner.
``(4) The Indian Tribe or Tribal Organization has the
administrative and financial capability to administer the
project.
``(5) The project may deliver services in a manner consistent
with traditional health care practices.
``(6) The project is coordinated with, and avoids duplication
of, existing services.
``(c) Equitable Treatment.--For purposes of this subsection, the
Secretary shall, in evaluating project applications or proposals, use
the same criteria that the Secretary uses in evaluating any other
application or proposal for such funding.
``SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS.
``(a) Programs.--
``(1) Establishment.--The Secretary, consistent with section
701, acting through the Service, Indian Tribes, and Tribal
Organizations, is authorized to establish and operate fetal
alcohol disorder programs as provided in this section for the
purposes of meeting the health status objectives specified in
section 3.
``(2) Use of funds.--
``(A) In general.--Funding provided pursuant to this
section shall be used for the following:
``(i) To develop and provide for Indians
community and in-school training, education,
and prevention programs relating to fetal
alcohol disorders.
``(ii) To identify and provide behavioral
health treatment to high-risk Indian women and
high-risk women pregnant with an Indian's
child.
``(iii) To identify and provide appropriate
psychological services, educational and
vocational support, counseling, advocacy, and
information to fetal alcohol disorder affected
Indians and their families or caretakers.
``(iv) To develop and implement counseling
and support programs in schools for fetal
alcohol disorder affected Indian children.
``(v) To develop prevention and intervention
models which incorporate practitioners of
traditional health care practices, cultural
values, and community involvement.
``(vi) To develop, print, and disseminate
education and prevention materials on fetal
alcohol disorder.
``(vii) To develop and implement, in
consultation with Indian Tribes, Tribal
Organizations, and Urban Indian Organizations,
culturally sensitive assessment and diagnostic
tools including dysmorphology clinics and
multidisciplinary fetal alcohol disorder
clinics for use in Indian communities and Urban
Centers.
``(B) Additional uses.--In addition to any purpose
under subparagraph (A), funding provided pursuant to
this section may be used for 1 or more of the
following:
``(i) Early childhood intervention projects
from birth on to mitigate the effects of fetal
alcohol disorder among Indians.
``(ii) Community-based support services for
Indians and women pregnant with Indian
children.
``(iii) Community-based housing for adult
Indians with fetal alcohol disorder.
``(3) Criteria for applications.--The Secretary shall
establish criteria for the review and approval of applications
for funding under this section.
``(b) Services.--The Secretary, acting through the Service and Indian
Tribes, Tribal Organizations, and Urban Indian Organizations, shall--
``(1) develop and provide services for the prevention,
intervention, treatment, and aftercare for those affected by
fetal alcohol disorder in Indian communities; and
``(2) provide supportive services, including services to meet
the special educational, vocational, school-to-work transition,
and independent living needs of adolescent and adult Indians
with fetal alcohol disorder.
``(c) Task Force.--The Secretary shall establish a task force to be
known as the Fetal Alcohol Disorder Task Force to advise the Secretary
in carrying out subsection (b). Such task force shall be composed of
representatives from the following:
``(1) The National Institute on Drug Abuse.
``(2) The National Institute on Alcohol and Alcoholism.
``(3) The Office of Substance Abuse Prevention.
``(4) The National Institute of Mental Health.
``(5) The Service.
``(6) The Office of Minority Health of the Department of
Health and Human Services.
``(7) The Administration for Native Americans.
``(8) The National Institute of Child Health and Human
Development (NICHD).
``(9) The Centers for Disease Control and Prevention.
``(10) The Bureau of Indian Affairs.
``(11) Indian Tribes.
``(12) Tribal Organizations.
``(13) Urban Indian Organizations.
``(14) Indian fetal alcohol disorder experts.
``(d) Applied Research Projects.--The Secretary, acting through the
Substance Abuse and Mental Health Services Administration, shall make
grants to Indian Tribes, Tribal Organizations, and Urban Indian
Organizations for applied research projects which propose to elevate
the understanding of methods to prevent, intervene, treat, or provide
rehabilitation and behavioral health aftercare for Indians and Urban
Indians affected by fetal alcohol disorder.
``(e) Funding for Urban Indian Organizations.--Ten percent of the
funds appropriated pursuant to this section shall be used to make
grants to Urban Indian Organizations funded under title V.
``SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREATMENT PROGRAMS.
``(a) Establishment.--The Secretary, acting through the Service, and
the Secretary of the Interior, Indian Tribes, and Tribal Organizations,
shall establish, consistent with section 701, in every Service Area,
programs involving treatment for--
``(1) victims of sexual abuse who are Indian children or
children in an Indian household; and
``(2) perpetrators of child sexual abuse who are Indian or
members of an Indian household.
``(b) Use of Funds.--Funding provided pursuant to this section shall
be used for the following:
``(1) To develop and provide community education and
prevention programs related to sexual abuse of Indian children
or children in an Indian household.
``(2) To identify and provide behavioral health treatment to
victims of sexual abuse who are Indian children or children in
an Indian household, and to their family members who are
affected by sexual abuse.
``(3) To develop prevention and intervention models which
incorporate traditional health care practices, cultural values,
and community involvement.
``(4) To develop and implement culturally sensitive
assessment and diagnostic tools for use in Indian communities
and Urban Centers.
``(5) To identify and provide behavioral health treatment to
Indian perpetrators and perpetrators who are members of an
Indian household--
``(A) making efforts to begin offender and behavioral
health treatment while the perpetrator is incarcerated
or at the earliest possible date if the perpetrator is
not incarcerated; and
``(B) providing treatment after the perpetrator is
released, until it is determined that the perpetrator
is not a threat to children.
``(c) Coordination.--The programs established under subsection (a)
shall be carried out in coordination with programs and services
authorized under the Indian Child Protection and Family Violence
Prevention Act (25 U.S.C. 3201 et seq.).
``SEC. 714. BEHAVIORAL HEALTH RESEARCH.
``The Secretary, in consultation with appropriate Federal agencies,
shall make grants to, or enter into contracts with, Indian Tribes,
Tribal Organizations, and Urban Indian Organizations or enter into
contracts with, or make grants to appropriate institutions for, the
conduct of research on the incidence and prevalence of behavioral
health problems among Indians served by the Service, Indian Tribes, or
Tribal Organizations and among Indians in urban areas. Research
priorities under this section shall include--
``(1) the multifactorial causes of Indian youth suicide,
including--
``(A) protective and risk factors and scientific data
that identifies those factors; and
``(B) the effects of loss of cultural identity and
the development of scientific data on those effects;
``(2) the interrelationship and interdependence of behavioral
health problems with alcoholism and other substance abuse,
suicide, homicides, other injuries, and the incidence of family
violence; and
``(3) the development of models of prevention techniques.
The effect of the interrelationships and interdependencies referred to
in paragraph (2) on children, and the development of prevention
techniques under paragraph (3) applicable to children, shall be
emphasized.
``SEC. 715. DEFINITIONS.
``For the purpose of this title, the following definitions shall
apply:
``(1) Assessment.--The term `assessment' means the systematic
collection, analysis, and dissemination of information on
health status, health needs, and health problems.
``(2) Alcohol-related neurodevelopmental disorders or arnd.--
The term `alcohol-related neurodevelopmental disorders' or
`ARND' means, with a history of maternal alcohol consumption
during pregnancy, central nervous system involvement such as
developmental delay, intellectual deficit, or neurologic
abnormalities. Behaviorally, there can be problems with
irritability, and failure to thrive as infants. As children
become older there will likely be hyperactivity, attention
deficit, language dysfunction, and perceptual and judgment
problems.
``(3) Behavioral health aftercare.--The term `behavioral
health aftercare' includes those activities and resources used
to support recovery following inpatient, residential, intensive
substance abuse, or mental health outpatient or outpatient
treatment. The purpose is to help prevent or deal with relapse
by ensuring that by the time a client or patient is discharged
from a level of care, such as outpatient treatment, an
aftercare plan has been developed with the client. An aftercare
plan may use such resources as a community-based therapeutic
group, transitional living facilities, a 12-step sponsor, a
local 12-step or other related support group, and other
community-based providers.
``(4) Dual diagnosis.--The term `dual diagnosis' means
coexisting substance abuse and mental illness conditions or
diagnosis. Such clients are sometimes referred to as mentally
ill chemical abusers (MICAs).
``(5) Fetal alcohol disorders.--The term `fetal alcohol
disorders' means fetal alcohol syndrome, partial fetal alcohol
syndrome and alcohol related neurodevelopmental disorder
(ARND).
``(6) Fetal alcohol syndrome or fas.--The term `fetal alcohol
syndrome' or `FAS' means a syndrome in which, with a history of
maternal alcohol consumption during pregnancy, the following
criteria are met:
``(A) Central nervous system involvement such as
developmental delay, intellectual deficit,
microencephaly, or neurologic abnormalities.
``(B) Craniofacial abnormalities with at least 2 of
the following: microophthalmia, short palpebral
fissures, poorly developed philtrum, thin upper lip,
flat nasal bridge, and short upturned nose.
``(C) Prenatal or postnatal growth delay.
``(7) Partial fas.--The term `partial FAS' means, with a
history of maternal alcohol consumption during pregnancy,
having most of the criteria of FAS, though not meeting a
minimum of at least 2 of the following: microophthalmia, short
palpebral fissures, poorly developed philtrum, thin upper lip,
flat nasal bridge, and short upturned nose.
``(8) Rehabilitation.--The term `rehabilitation' means to
restore the ability or capacity to engage in usual and
customary life activities through education and therapy.
``(9) Substance abuse.--The term `substance abuse' includes
inhalant abuse.
``SEC. 716. AUTHORIZATION OF APPROPRIATIONS.
``There is authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2017 to carry out
the provisions of this title.
``TITLE VIII--MISCELLANEOUS
``SEC. 801. REPORTS.
``For each fiscal year following the date of enactment of the Indian
Health Care Improvement Act Amendments of 2007, the Secretary shall
transmit to Congress a report containing the following:
``(1) A report on the progress made in meeting the objectives
of this Act, including a review of programs established or
assisted pursuant to this Act and assessments and
recommendations 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, Tribal Organizations, and Urban Indian Organizations to
address such impact, including a report on proposed changes in
allocation of funding pursuant to section 808.
``(3) A report on the use of health services by Indians--
``(A) on a national and area or other relevant
geographical basis;
``(B) by gender and age;
``(C) by source of payment and type of service;
``(D) comparing such rates of use with rates of use
among comparable non-Indian populations; and
``(E) provided under contracts.
``(4) A report of contractors to the Secretary on Health Care
Educational Loan Repayments every 6 months required by section
110.
``(5) A general audit report of the Secretary on the Health
Care Educational Loan Repayment Program as required by section
110(n).
``(6) A report of the findings and conclusions of
demonstration programs on development of educational curricula
for substance abuse counseling as required in section 125(f).
``(7) A separate statement which specifies the amount of
funds requested to carry out the provisions of section 201.
``(8) A report of the evaluations of health promotion and
disease prevention as required in section 203(c).
``(9) A biennial report to Congress on infectious diseases as
required by section 212.
``(10) A report on environmental and nuclear health hazards
as required by section 215.
``(11) An annual report on the status of all health care
facilities needs as required by section 301(c)(2)(B) and
301(d).
``(12) Reports on safe water and sanitary waste disposal
facilities as required by section 302(h).
``(13) An annual report on the expenditure of non-Service
funds for renovation as required by sections 304(b)(2).
``(14) A report identifying the backlog of maintenance and
repair required at Service and tribal facilities required by
section 313(a).
``(15) A report providing an accounting of reimbursement
funds made available to the Secretary under titles XVIII, XIX,
and XXI of the Social Security Act.
``(16) A report on any arrangements for the sharing of
medical facilities or services, as authorized by section 406.
``(17) A report on evaluation and renewal of Urban Indian
programs under section 505.
``(18) A report on the evaluation of programs as required by
section 513(d).
``(19) A report on alcohol and substance abuse as required by
section 701(f).
``(20) A report on Indian youth mental health services as
required by section 707(h).
``(21) A report on the reallocation of base resources if
required by section 808.
``(22) Report regarding patient movement.--A report on the
movement of patients between Service Units, including--
``(A) a list of those Service Units that have a net
increase and those that have a net decrease of patients
due to patients assigned to one Service Unit
voluntarily choosing to receive service at another
Service Unit;
``(B) an analysis of the effect of patient movement
on the quality of services for those Service Units
experiencing an increase in the number of patients
served; and
``(C) what funding changes are necessary to maintain
a consistent quality of service at Service Units that
have an increase in the number of patients served.
``SEC. 802. REGULATIONS.
``(a) Deadlines.--
``(1) Procedures.--Not later than 90 days after the date of
enactment of the Indian Health Care Improvement Act Amendments
of 2007, the Secretary shall initiate procedures under
subchapter III of chapter 5 of title 5, United States Code, to
negotiate and promulgate such regulations or amendments thereto
that are necessary to carry out titles II (except section 202)
and VII, the sections of title III for which negotiated
rulemaking is specifically required, and section 807. Unless
otherwise required, the Secretary may promulgate regulations to
carry out titles I, III, IV, and V, and section 202, using the
procedures required by chapter V of title 5, United States Code
(commonly known as the `Administrative Procedure Act').
``(2) Proposed regulations.--Proposed regulations to
implement this Act shall be published in the Federal Register
by the Secretary no later than 2 years after the date of
enactment of the Indian Health Care Improvement Act Amendments
of 2007 and shall have no less than a 120-day comment period.
``(3) Final regulations.--The Secretary shall publish in the
Federal Register final regulations to implement this Act by not
later than 3 years after the date of enactment of the Indian
Health Care Improvement Act Amendments of 2007.
``(b) Committee.--A negotiated rulemaking committee established
pursuant to section 565 of title 5, United States Code, to carry out
this section shall have as its members only representatives of the
Federal Government and representatives of Indian Tribes, and Tribal
Organizations, a majority of whom shall be nominated by and be
representatives of Indian Tribes and Tribal Organizations from each
Service Area.
``(c) Adaptation of Procedures.--The Secretary shall adapt the
negotiated rulemaking procedures to the unique context of self-
governance and the government-to-government relationship between the
United States and Indian Tribes.
``(d) Lack of Regulations.--The lack of promulgated regulations shall
not limit the effect of this Act.
``(e) Inconsistent Regulations.--The provisions of this Act shall
supersede any conflicting provisions of law in effect on the day before
the date of enactment of the Indian Health Care Improvement Act
Amendments of 2007, and the Secretary is authorized to repeal any
regulation inconsistent with the provisions of this Act.
``SEC. 803. PLAN OF IMPLEMENTATION.
``Not later than 9 months after the date of enactment of the Indian
Health Care Improvement Act Amendments of 2007, the Secretary, in
consultation with Indian Tribes, Tribal Organizations, and Urban Indian
Organizations, shall submit to Congress a plan explaining the manner
and schedule, by title and section, by which the Secretary will
implement the provisions of this Act. This consultation may be
conducted jointly with the annual budget consultation pursuant to the
Indian Self-Determination and Education Assistance Act (25 U.S.C. 450
et seq).
``SEC. 804. AVAILABILITY OF FUNDS.
``The funds appropriated pursuant to this Act shall remain available
until expended.
``SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED TO INDIAN HEALTH
SERVICE.
``Any limitation on the use of funds contained in an Act providing
appropriations for the Department for a period with respect to the
performance of abortions shall apply for that period with respect to
the performance of abortions using funds contained in an Act providing
appropriations for the Service.
``SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.
``(a) In General.--The following California Indians shall be eligible
for health services provided by the Service:
``(1) Any member of a federally recognized Indian Tribe.
``(2) Any descendant of an Indian who was residing in
California on June 1, 1852, if such descendant--
``(A) is a member of the Indian community served by a
local program of the Service; and
``(B) is regarded as an Indian by the community in
which such descendant lives.
``(3) Any Indian who holds trust interests in public domain,
national forest, or reservation allotments in California.
``(4) Any Indian in California who is listed on the plans for
distribution of the assets of rancherias and reservations
located within the State of California under the Act of August
18, 1958 (72 Stat. 619), and any descendant of such an Indian.
``(b) Clarification.--Nothing in this section may be construed as
expanding the eligibility of California Indians for health services
provided by the Service beyond the scope of eligibility for such health
services that applied on May 1, 1986.
``SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS.
``(a) Children.--Any individual who--
``(1) has not attained 19 years of age;
``(2) is the natural or adopted child, stepchild, foster
child, legal ward, or orphan of an eligible Indian; and
``(3) is not otherwise eligible for health services provided
by the Service,
shall be eligible for all health services provided by the Service on
the same basis and subject to the same rules that apply to eligible
Indians until such individual attains 19 years of age. The existing and
potential health needs of all such individuals shall be taken into
consideration by the Service in determining the need for, or the
allocation of, the health resources of the Service. If such an
individual has been determined to be legally incompetent prior to
attaining 19 years of age, such individual shall remain eligible for
such services until 1 year after the date of a determination of
competency.
``(b) Spouses.--Any spouse of an eligible Indian who is not an
Indian, or who is of Indian descent but is not otherwise eligible for
the health services provided by the Service, shall be eligible for such
health services if all such spouses or spouses who are married to
members of each Indian Tribe being served are made eligible, as a
class, by an appropriate resolution of the governing body of the Indian
Tribe or Tribal Organization providing such services. The health needs
of persons made eligible under this paragraph shall not be taken into
consideration by the Service in determining the need for, or allocation
of, its health resources.
``(c) Provision of Services to Other Individuals.--
``(1) In general.--The Secretary is authorized to provide
health services under this subsection through health programs
operated directly by the Service to individuals who reside
within the Service Unit and who are not otherwise eligible for
such health services if--
``(A) the Indian Tribes served by such Service Unit
request such provision of health services to such
individuals; and
``(B) the Secretary and the served Indian Tribes have
jointly determined that--
``(i) the provision of such health services
will not result in a denial or diminution of
health services to eligible Indians; and
``(ii) there is no reasonable alternative
health facilities or services, within or
without the Service Unit, available to meet the
health needs of such individuals.
``(2) ISDEAA programs.--In the case of health programs and
facilities operated under a contract or compact entered into
under the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.), the governing body of the Indian
Tribe or Tribal Organization providing health services under
such contract or compact is authorized to determine whether
health services should be provided under such contract to
individuals who are not eligible for such health services under
any other subsection of this section or under any other
provision of law. In making such determinations, the governing
body of the Indian Tribe or Tribal Organization shall take into
account the considerations described in paragraph (1)(B).
``(3) Payment for services.--
``(A) In general.--Persons receiving health services
provided by the Service under this subsection shall be
liable for payment of such health services under a
schedule of charges prescribed by the Secretary which,
in the judgment of the Secretary, results in
reimbursement in an amount not less than the actual
cost of providing the health services. Notwithstanding
section 404 of this Act or any other provision of law,
amounts collected under this subsection, including
Medicare, Medicaid, or SCHIP reimbursements under
titles XVIII, XIX, and XXI of the Social Security Act,
shall be credited to the account of the program
providing the service and shall be used for the
purposes listed in section 401(d)(2) and amounts
collected under this subsection shall be available for
expenditure within such program.
``(B) Indigent people.--Health services may be
provided by the Secretary through the Service under
this subsection to an indigent individual who would not
be otherwise eligible for such health services but for
the provisions of paragraph (1) only if an agreement
has been entered into with a State or local government
under which the State or local government agrees to
reimburse the Service for the expenses incurred by the
Service in providing such health services to such
indigent individual.
``(4) Revocation of consent for services.--
``(A) Single tribe service area.--In the case of a
Service Area which serves only 1 Indian Tribe, the
authority of the Secretary to provide health services
under paragraph (1) shall terminate at the end of the
fiscal year succeeding the fiscal year in which the
governing body of the Indian Tribe revokes its
concurrence to the provision of such health services.
``(B) Multitribal service area.--In the case of a
multitribal Service Area, the authority of the
Secretary to provide health services under paragraph
(1) shall terminate at the end of the fiscal year
succeeding the fiscal year in which at least 51 percent
of the number of Indian Tribes in the Service Area
revoke their concurrence to the provisions of such
health services.
``(d) Other Services.--The Service may provide health services under
this subsection to individuals who are not eligible for health services
provided by the Service under any other provision of law in order to--
``(1) achieve stability in a medical emergency;
``(2) prevent the spread of a communicable disease or
otherwise deal with a public health hazard;
``(3) provide care to non-Indian women pregnant with an
eligible Indian's child for the duration of the pregnancy
through postpartum; or
``(4) provide care to immediate family members of an eligible
individual if such care is directly related to the treatment of
the eligible individual.
``(e) Hospital Privileges for Practitioners.--Hospital privileges in
health facilities operated and maintained by the Service or operated
under a contract or compact pursuant to the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.) may be extended to
non-Service health care practitioners who provide services to
individuals described in subsection (a), (b), (c), or (d). Such non-
Service health care practitioners may, as part of the privileging
process, be designated as employees of the Federal Government for
purposes of section 1346(b) and chapter 171 of title 28, United States
Code (relating to Federal tort claims) only with respect to acts or
omissions which occur in the course of providing services to eligible
individuals as a part of the conditions under which such hospital
privileges are extended.
``(f) Eligible Indian.--For purposes of this section, the term
`eligible Indian' means any Indian who is eligible for health services
provided by the Service without regard to the provisions of this
section.
``SEC. 808. REALLOCATION OF BASE RESOURCES.
``(a) Report Required.--Notwithstanding any other provision of law,
any allocation of Service funds for a fiscal year that reduces by 5
percent or more from the previous fiscal year the funding for any
recurring program, project, or activity of a Service Unit may be
implemented only after the Secretary has submitted to Congress, under
section 801, a report on the proposed change in allocation of funding,
including the reasons for the change and its likely effects.
``(b) Exception.--Subsection (a) shall not apply if the total amount
appropriated to the Service for a fiscal year is at least 5 percent
less than the amount appropriated to the Service for the previous
fiscal year.
``SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.
``The Secretary shall provide for the dissemination to Indian Tribes,
Tribal Organizations, and Urban Indian Organizations of the findings
and results of demonstration projects conducted under this Act.
``SEC. 810. PROVISION OF SERVICES IN MONTANA.
``(a) Consistent With Court Decision.--The Secretary, acting through
the Service, shall provide services and benefits for Indians in Montana
in a manner consistent with the decision of the United States Court of
Appeals for the Ninth Circuit in McNabb for McNabb v. Bowen, 829 F.2d
787 (9th Cir. 1987).
``(b) Clarification.--The provisions of subsection (a) shall not be
construed to be an expression of the sense of Congress on the
application of the decision described in subsection (a) with respect to
the provision of services or benefits for Indians living in any State
other than Montana.
``SEC. 811. MORATORIUM.
``During the period of the moratorium imposed on implementation of
the final rule published in the Federal Register on September 16, 1987,
by the Department of Health and Human Services, relating to eligibility
for the health care services of the Indian Health Service, the Indian
Health Service shall provide services pursuant to the criteria for
eligibility for such services that were in effect on September 15,
1987, subject to the provisions of sections 806 and 807, until the
Service has submitted to the Committees on Appropriations of the Senate
and the House of Representatives a budget request reflecting the
increased costs associated with the proposed final rule, and the
request has been included in an appropriations Act and enacted into
law.
``SEC. 812. SEVERABILITY PROVISIONS.
``If any provision of this Act, any amendment made by the Act, or the
application of such provision or amendment to any person or
circumstances is held to be invalid, the remainder of this Act, the
remaining amendments made by this Act, and the application of such
provisions to persons or circumstances other than those to which it is
held invalid, shall not be affected thereby.
``SEC. 813. ESTABLISHMENT OF NATIONAL BIPARTISAN COMMISSION ON INDIAN
HEALTH CARE.
``(a) Establishment.--There is established the National Bipartisan
Indian Health Care Commission (the `Commission').
``(b) Duties of Commission.--The duties of the Commission are the
following:
``(1) To establish a study committee composed of those
members of the Commission appointed by the Director of the
Service and at least 4 members of Congress from among the
members of the Commission, the duties of which shall be the
following:
``(A) To the extent necessary to carry out its
duties, collect and compile data necessary to
understand the extent of Indian needs with regard to
the provision of health services, regardless of the
location of Indians, including holding hearings and
soliciting the views of Indians, Indian Tribes, Tribal
Organizations, and Urban Indian Organizations, which
may include authorizing and making funds available for
feasibility studies of various models for providing and
funding health services for all Indian beneficiaries,
including those who live outside of a reservation,
temporarily or permanently.
``(B) To make legislative recommendations to the
Commission regarding the delivery of Federal health
care services to Indians. Such recommendations shall
include those related to issues of eligibility,
benefits, the range of service providers, the cost of
such services, financing such services, and the optimal
manner in which to provide such services.
``(C) To determine the effect of the enactment of
such recommendations on (i) the existing system of
delivery of health services for Indians, and (ii) the
sovereign status of Indian Tribes.
``(D) Not later than 12 months after the appointment
of all members of the Commission, to submit a written
report of its findings and recommendations to the full
Commission. The report shall include a statement of the
minority and majority position of the Committee and
shall be disseminated, at a minimum, to every Indian
Tribe, Tribal Organization, and Urban Indian
Organization for comment to the Commission.
``(E) To report regularly to the full Commission
regarding the findings and recommendations developed by
the study committee in the course of carrying out its
duties under this section.
``(2) To review and analyze the recommendations of the report
of the study committee.
``(3) To make legislative recommendations to Congress
regarding the delivery of Federal health care services to
Indians. Such recommendations shall include those related to
issues of eligibility, benefits, the range of service
providers, the cost of such services, financing such services,
and the optimal manner in which to provide such services.
``(4) Not later than 18 months following the date of
appointment of all members of the Commission, submit a written
report to Congress regarding the delivery of Federal health
care services to Indians. Such recommendations shall include
those related to issues of eligibility, benefits, the range of
service providers, the cost of such services, financing such
services, and the optimal manner in which to provide such
services.
``(c) Members.--
``(1) Appointment.--The Commission shall be composed of 25
members, appointed as follows:
``(A) Ten members of Congress, including 3 from the
House of Representatives and 2 from the Senate,
appointed by their respective majority leaders, and 3
from the House of Representatives and 2 from the
Senate, appointed by their respective minority leaders,
and who shall be members of the standing committees of
Congress that consider legislation affecting health
care to Indians.
``(B) Twelve persons chosen by the congressional
members of the Commission, 1 from each Service Area as
currently designated by the Director of the Service to
be chosen from among 3 nominees from each Service Area
put forward by the Indian Tribes within the area, with
due regard being given to the experience and expertise
of the nominees in the provision of health care to
Indians and to a reasonable representation on the
commission of members who are familiar with various
health care delivery modes and who represent Indian
Tribes of various size populations.
``(C) Three persons appointed by the Director who are
knowledgeable about the provision of health care to
Indians, at least 1 of whom shall be appointed from
among 3 nominees put forward by those programs whose
funds are provided in whole or in part by the Service
primarily or exclusively for the benefit of Urban
Indians.
``(D) All those persons chosen by the congressional
members of the Commission and by the Director shall be
members of federally recognized Indian Tribes.
``(2) Chair; vice chair.--The Chair and Vice Chair of the
Commission shall be selected by the congressional members of
the Commission.
``(3) Terms.--The terms of members of the Commission shall be
for the life of the Commission.
``(4) Deadline for appointments.--Congressional members of
the Commission shall be appointed not later than 180 days after
the date of enactment of the Indian Health Care Improvement Act
Amendments of 2007, and the remaining members of the Commission
shall be appointed not later than 60 days following the
appointment of the congressional members.
``(5) Vacancy.--A vacancy in the Commission shall be filled
in the manner in which the original appointment was made.
``(d) Compensation.--
``(1) Congressional members.--Each congressional member of
the Commission shall receive no additional pay, allowances, or
benefits by reason of their service on the Commission and shall
receive travel expenses and per diem in lieu of subsistence in
accordance with sections 5702 and 5703 of title 5, United
States Code.
``(2) Other members.--Remaining members of the Commission,
while serving on the business of the Commission (including
travel time), shall be entitled to receive compensation at the
per diem equivalent of the rate provided for level IV of the
Executive Schedule under section 5315 of title 5, United States
Code, and while so serving away from home and the member's
regular place of business, a member may be allowed travel
expenses, as authorized by the Chairman of the Commission. For
purpose of pay (other than pay of members of the Commission)
and employment benefits, rights, and privileges, all personnel
of the Commission shall be treated as if they were employees of
the United States Senate.
``(e) Meetings.--The Commission shall meet at the call of the Chair.
``(f) Quorum.--A quorum of the Commission shall consist of not less
than 15 members, provided that no less than 6 of the members of
Congress who are Commission members are present and no less than 9 of
the members who are Indians are present.
``(g) Executive Director; Staff; Facilities.--
``(1) Appointment; pay.--The Commission shall appoint an
executive director of the Commission. The executive director
shall be paid the rate of basic pay for level V of the
Executive Schedule.
``(2) Staff appointment.--With the approval of the
Commission, the executive director may appoint such personnel
as the executive director deems appropriate.
``(3) Staff pay.--The staff of the Commission shall be
appointed without regard to the provisions of title 5, United
States Code, governing appointments in the competitive service,
and shall be paid without regard to the provisions of chapter
51 and subchapter III of chapter 53 of such title (relating to
classification and General Schedule pay rates).
``(4) Temporary services.--With the approval of the
Commission, the executive director may procure temporary and
intermittent services under section 3109(b) of title 5, United
States Code.
``(5) Facilities.--The Administrator of General Services
shall locate suitable office space for the operation of the
Commission. The facilities shall serve as the headquarters of
the Commission and shall include all necessary equipment and
incidentals required for the proper functioning of the
Commission.
``(h) Hearings.--(1) For the purpose of carrying out its duties, the
Commission may hold such hearings and undertake such other activities
as the Commission determines to be necessary to carry out its duties,
provided that at least 6 regional hearings are held in different areas
of the United States in which large numbers of Indians are present.
Such hearings are to be held to solicit the views of Indians regarding
the delivery of health care services to them. To constitute a hearing
under this subsection, at least 5 members of the Commission, including
at least 1 member of Congress, must be present. Hearings held by the
study committee established in this section may count toward the number
of regional hearings required by this subsection.
``(2) Upon request of the Commission, the Comptroller General shall
conduct such studies or investigations as the Commission determines to
be necessary to carry out its duties.
``(3)(A) The Director of the Congressional Budget Office or the Chief
Actuary of the Centers for Medicare & Medicaid Services, or both, shall
provide to the Commission, upon the request of the Commission, such
cost estimates as the Commission determines to be necessary to carry
out its duties.
``(B) The Commission shall reimburse the Director of the
Congressional Budget Office for expenses relating to the employment in
the office of that Director of such additional staff as may be
necessary for the Director to comply with requests by the Commission
under subparagraph (A).
``(4) Upon the request of the Commission, the head of any Federal
agency is authorized to detail, without reimbursement, any of the
personnel of such agency to the Commission to assist the Commission in
carrying out its duties. Any such detail shall not interrupt or
otherwise affect the civil service status or privileges of the Federal
employee.
``(5) Upon the request of the Commission, the head of a Federal
agency shall provide such technical assistance to the Commission as the
Commission determines to be necessary to carry out its duties.
``(6) The Commission may use the United States mails in the same
manner and under the same conditions as Federal agencies and shall, for
purposes of the frank, be considered a commission of Congress as
described in section 3215 of title 39, United States Code.
``(7) The Commission may secure directly from any Federal agency
information necessary to enable it to carry out its duties, if the
information may be disclosed under section 552 of title 4, United
States Code. Upon request of the Chairman of the Commission, the head
of such agency shall furnish such information to the Commission.
``(8) Upon the request of the Commission, the Administrator of
General Services shall provide to the Commission on a reimbursable
basis such administrative support services as the Commission may
request.
``(9) For purposes of costs relating to printing and binding,
including the cost of personnel detailed from the Government Printing
Office, the Commission shall be deemed to be a committee of Congress.
``(i) Authorization of Appropriations.--There is authorized to be
appropriated $4,000,000 to carry out the provisions of this section,
which sum shall not be deducted from or affect any other appropriation
for health care for Indian persons.
``(j) Nonapplicability of FACA.--The Federal Advisory Committee Act
(5 U.S.C. App.) shall not apply to the Commission.
``SEC. 814. CONFIDENTIALITY OF MEDICAL QUALITY ASSURANCE RECORDS;
QUALIFIED IMMUNITY FOR PARTICIPANTS.
``(a) Confidentiality of Records.--Medical quality assurance records
created by or for any Indian Health Program or a health program of an
Urban Indian Organization as part of a medical quality assurance
program are confidential and privileged. Such records may not be
disclosed to any person or entity, except as provided in subsection
(c).
``(b) Prohibition on Disclosure and Testimony.--
``(1) In general.--No part of any medical quality assurance
record described in subsection (a) may be subject to discovery
or admitted into evidence in any judicial or administrative
proceeding, except as provided in subsection (c).
``(2) Testimony.--A person who reviews or creates medical
quality assurance records for any Indian Health Program or
Urban Indian Organization who participates in any proceeding
that reviews or creates such records may not be permitted or
required to testify in any judicial or administrative
proceeding with respect to such records or with respect to any
finding, recommendation, evaluation, opinion, or action taken
by such person or body in connection with such records except
as provided in this section.
``(c) Authorized Disclosure and Testimony.--
``(1) In general.--Subject to paragraph (2), a medical
quality assurance record described in subsection (a) may be
disclosed, and a person referred to in subsection (b) may give
testimony in connection with such a record, only as follows:
``(A) To a Federal executive agency or private
organization, if such medical quality assurance record
or testimony is needed by such agency or organization
to perform licensing or accreditation functions related
to any Indian Health Program or to a health program of
an Urban Indian Organization to perform monitoring,
required by law, of such program or organization.
``(B) To an administrative or judicial proceeding
commenced by a present or former Indian Health Program
or Urban Indian Organization provider concerning the
termination, suspension, or limitation of clinical
privileges of such health care provider.
``(C) To a governmental board or agency or to a
professional health care society or organization, if
such medical quality assurance record or testimony is
needed by such board, agency, society, or organization
to perform licensing, credentialing, or the monitoring
of professional standards with respect to any health
care provider who is or was an employee of any Indian
Health Program or Urban Indian Organization.
``(D) To a hospital, medical center, or other
institution that provides health care services, if such
medical quality assurance record or testimony is needed
by such institution to assess the professional
qualifications of any health care provider who is or
was an employee of any Indian Health Program or Urban
Indian Organization and who has applied for or been
granted authority or employment to provide health care
services in or on behalf of such program or
organization.
``(E) To an officer, employee, or contractor of the
Indian Health Program or Urban Indian Organization that
created the records or for which the records were
created. If that officer, employee, or contractor has a
need for such record or testimony to perform official
duties.
``(F) To a criminal or civil law enforcement agency
or instrumentality charged under applicable law with
the protection of the public health or safety, if a
qualified representative of such agency or
instrumentality makes a written request that such
record or testimony be provided for a purpose
authorized by law.
``(G) In an administrative or judicial proceeding
commenced by a criminal or civil law enforcement agency
or instrumentality referred to in subparagraph (F), but
only with respect to the subject of such proceeding.
``(2) Identity of participants.--With the exception of the
subject of a quality assurance action, the identity of any
person receiving health care services from any Indian Health
Program or Urban Indian Organization or the identity of any
other person associated with such program or organization for
purposes of a medical quality assurance program that is
disclosed in a medical quality assurance record described in
subsection (a) shall be deleted from that record or document
before any disclosure of such record is made outside such
program or organization. Such requirement does not apply to the
release of information pursuant to section 552a of title 5.
``(d) Disclosure for Certain Purposes.--
``(1) In general.--Nothing in this section shall be construed
as authorizing or requiring the withholding from any person or
entity aggregate statistical information regarding the results
of any Indian Health Program or Urban Indian Organizations's
medical quality assurance programs.
``(2) Withholding from congress.--Nothing in this section
shall be construed as authority to withhold any medical quality
assurance record from a committee of either House of Congress,
any joint committee of Congress, or the Government
Accountability Office if such record pertains to any matter
within their respective jurisdictions.
``(e) Prohibition on Disclosure of Record or Testimony.--A person or
entity having possession of or access to a record or testimony
described by this section may not disclose the contents of such record
or testimony in any manner or for any purpose except as provided in
this section.
``(f) Exemption From Freedom of Information Act.--Medical quality
assurance records described in subsection (a) may not be made available
to any person under section 552 of title 5.
``(g) Limitation on Civil Liability.--A person who participates in or
provides information to a person or body that reviews or creates
medical quality assurance records described in subsection (a) shall not
be civilly liable for such participation or for providing such
information if the participation or provision of information was in
good faith based on prevailing professional standards at the time the
medical quality assurance program activity took place.
``(h) Application to Information in Certain Other Records.--Nothing
in this section shall be construed as limiting access to the
information in a record created and maintained outside a medical
quality assurance program, including a patient's medical records, on
the grounds that the information was presented during meetings of a
review body that are part of a medical quality assurance program.
``(i) Regulations.--The Secretary, acting through the Service, shall
promulgate regulations pursuant to section 802.
``(j) Definitions.--In this section:
``(1) The term `health care provider' means any health care
professional, including community health aides and
practitioners certified under section 121, who are granted
clinical practice privileges or employed to provide health care
services in an Indian Health Program or health program of an
Urban Indian Organization, who is licensed or certified to
perform health care services by a governmental board or agency
or professional health care society or organization.
``(2) The term `medical quality assurance program' means any
activity carried out before, on, or after the date of enactment
of this Act by or for any Indian Health Program or Urban Indian
Organization to assess the quality of medical care, including
activities conducted by or on behalf of individuals, Indian
Health Program or Urban Indian Organization medical or dental
treatment review committees, or other review bodies responsible
for quality assurance, credentials, infection control, patient
safety, patient care assessment (including treatment
procedures, blood, drugs, and therapeutics), medical records,
health resources management review and identification and
prevention of medical or dental incidents and risks.
``(3) The term `medical quality assurance record' means the
proceedings, records, minutes, and reports that emanate from
quality assurance program activities described in paragraph (2)
and are produced or compiled by or for an Indian Health Program
or Urban Indian Organization as part of a medical quality
assurance program.
``SEC. 815. APPROPRIATIONS; AVAILABILITY.
``Any new spending authority (described in subparagraph (A) or (B) of
section 401(c)(2) of the Congressional Budget Act of 1974 (Public Law
93-344; 88 Stat. 317)) which is provided under this Act shall be
effective for any fiscal year only to such extent or in such amounts as
are provided in appropriation Acts.
``SEC. 816. AUTHORIZATION OF APPROPRIATIONS.
``There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2017 to carry out
this title.''.
(b) Rate of Pay.--
(1) Positions at level iv.--Section 5315 of title 5, United
States Code, is amended by striking ``Assistant Secretaries of
Health and Human Services (6)'' and inserting ``Assistant
Secretaries of Health and Human Services (7)''.
(2) Positions at level v.--Section 5316 of title 5, United
States Code, is amended by striking ``Director, Indian Health
Service, Department of Health and Human Services''.
(c) Amendments to Other Provisions of Law.--
(1) Section 3307(b)(1)(C) of the Children's Health Act of
2000 (25 U.S.C. 1671 note; Public Law 106-310) is amended by
striking ``Director of the Indian Health Service'' and
inserting ``Assistant Secretary for Indian Health''.
(2) The Indian Lands Open Dump Cleanup Act of 1994 is
amended--
(A) in section 3 (25 U.S.C. 3902)--
(i) by striking paragraph (2);
(ii) by redesignating paragraphs (1), (3),
(4), (5), and (6) as paragraphs (4), (5), (2),
(6), and (1), respectively, and moving those
paragraphs so as to appear in numerical order;
and
(iii) by inserting before paragraph (4) (as
redesignated by clause (ii)) the following:
``(3) Assistant secretary.--The term `Assistant Secretary'
means the Assistant Secretary for Indian Health.'';
(B) in section 5 (25 U.S.C. 3904), by striking the
section designation and heading and inserting the
following:
``SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR INDIAN HEALTH.'';
(C) in section 6(a) (25 U.S.C. 3905(a)), in the
subsection heading, by striking ``Director'' and
inserting ``Assistant Secretary'';
(D) in section 9(a) (25 U.S.C. 3908(a)), in the
subsection heading, by striking ``Director'' and
inserting ``Assistant Secretary''; and
(E) by striking ``Director'' each place it appears
and inserting ``Assistant Secretary''.
(3) Section 5504(d)(2) of the Augustus F. Hawkins-Robert T.
Stafford Elementary and Secondary School Improvement Amendments
of 1988 (25 U.S.C. 2001 note; Public Law 100-297) is amended by
striking ``Director of the Indian Health Service'' and
inserting ``Assistant Secretary for Indian Health''.
(4) Section 203(a)(1) of the Rehabilitation Act of 1973 (29
U.S.C. 763(a)(1)) is amended by striking ``Director of the
Indian Health Service'' and inserting ``Assistant Secretary for
Indian Health''.
(5) Subsections (b) and (e) of section 518 of the Federal
Water Pollution Control Act (33 U.S.C. 1377) are amended by
striking ``Director of the Indian Health Service'' each place
it appears and inserting ``Assistant Secretary for Indian
Health''.
(6) Section 317M(b) of the Public Health Service Act (42
U.S.C. 247b-14(b)) is amended--
(A) by striking ``Director of the Indian Health
Service'' each place it appears and inserting
``Assistant Secretary for Indian Health''; and
(B) in paragraph (2)(A), by striking ``the Directors
referred to in such paragraph'' and inserting ``the
Director of the Centers for Disease Control and
Prevention and the Assistant Secretary for Indian
Health''.
(7) Section 417C(b) of the Public Health Service Act (42
U.S.C. 285-9(b)) is amended by striking ``Director of the
Indian Health Service'' and inserting ``Assistant Secretary for
Indian Health''.
(8) Section 1452(i) of the Safe Drinking Water Act (42 U.S.C.
300j-12(i)) is amended by striking ``Director of the Indian
Health Service'' each place it appears and inserting
``Assistant Secretary for Indian Health''.
(9) Section 803B(d)(1) of the Native American Programs Act of
1974 (42 U.S.C. 2991b-2(d)(1)) is amended in the last sentence
by striking ``Director of the Indian Health Service'' and
inserting ``Assistant Secretary for Indian Health''.
(10) Section 203(b) of the Michigan Indian Land Claims
Settlement Act (Public Law 105-143; 111 Stat. 2666) is amended
by striking ``Director of the Indian Health Service'' and
inserting ``Assistant Secretary for Indian Health''.
SEC. 102. SOBOBA SANITATION FACILITIES.
The Act of December 17, 1970 (84 Stat. 1465), is amended by adding at
the end the following:
``Sec. 9. Nothing in this Act shall preclude the Soboba Band of
Mission Indians and the Soboba Indian Reservation from being provided
with sanitation facilities and services under the authority of section
7 of the Act of August 5, 1954 (68 Stat. 674), as amended by the Act of
July 31, 1959 (73 Stat. 267).''.
SEC. 103. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.
(a) In General.--The Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.) is amended by adding at the end
the following:
``TITLE VIII--NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION
``SEC. 801. DEFINITIONS.
``In this title:
``(1) Board.--The term `Board' means the Board of Directors
of the Foundation.
``(2) Committee.--The term `Committee' means the Committee
for the Establishment of Native American Health and Wellness
Foundation established under section 802(f).
``(3) Foundation.--The term `Foundation' means the Native
American Health and Wellness Foundation established under
section 802.
``(4) Secretary.--The term `Secretary' means the Secretary of
Health and Human Services.
``(5) Service.--The term `Service' means the Indian Health
Service of the Department of Health and Human Services.
``SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.
``(a) Establishment.--
``(1) In general.--As soon as practicable after the date of
enactment of this title, the Secretary shall establish, under
the laws of the District of Columbia and in accordance with
this title, the Native American Health and Wellness Foundation.
``(2) Funding determinations.--No funds, gift, property, or
other item of value (including any interest accrued on such an
item) acquired by the Foundation shall--
``(A) be taken into consideration for purposes of
determining Federal appropriations relating to the
provision of health care and services to Indians; or
``(B) otherwise limit, diminish, or affect the
Federal responsibility for the provision of health care
and services to Indians.
``(b) Perpetual Existence.--The Foundation shall have perpetual
existence.
``(c) Nature of Corporation.--The Foundation--
``(1) shall be a charitable and nonprofit federally chartered
corporation; and
``(2) shall not be an agency or instrumentality of the United
States.
``(d) Place of Incorporation and Domicile.--The Foundation shall be
incorporated and domiciled in the District of Columbia.
``(e) Duties.--The Foundation shall--
``(1) encourage, accept, and administer private gifts of real
and personal property, and any income from or interest in such
gifts, for the benefit of, or in support of, the mission of the
Service;
``(2) undertake and conduct such other activities as will
further the health and wellness activities and opportunities of
Native Americans; and
``(3) participate with and assist Federal, State, and tribal
governments, agencies, entities, and individuals in undertaking
and conducting activities that will further the health and
wellness activities and opportunities of Native Americans.
``(f) Committee for the Establishment of Native American Health and
Wellness Foundation.--
``(1) In general.--The Secretary shall establish the
Committee for the Establishment of Native American Health and
Wellness Foundation to assist the Secretary in establishing the
Foundation.
``(2) Duties.--Not later than 180 days after the date of
enactment of this section, the Committee shall--
``(A) carry out such activities as are necessary to
incorporate the Foundation under the laws of the
District of Columbia, including acting as incorporators
of the Foundation;
``(B) ensure that the Foundation qualifies for and
maintains the status required to carry out this
section, until the Board is established;
``(C) establish the constitution and initial bylaws
of the Foundation;
``(D) provide for the initial operation of the
Foundation, including providing for temporary or
interim quarters, equipment, and staff; and
``(E) appoint the initial members of the Board in
accordance with the constitution and initial bylaws of
the Foundation.
``(g) Board of Directors.--
``(1) In general.--The Board of Directors shall be the
governing body of the Foundation.
``(2) Powers.--The Board may exercise, or provide for the
exercise of, the powers of the Foundation.
``(3) Selection.--
``(A) In general.--Subject to subparagraph (B), the
number of members of the Board, the manner of selection
of the members (including the filling of vacancies),
and the terms of office of the members shall be as
provided in the constitution and bylaws of the
Foundation.
``(B) Requirements.--
``(i) Number of members.--The Board shall
have at least 11 members, who shall have
staggered terms.
``(ii) Initial voting members.--The initial
voting members of the Board--
``(I) shall be appointed by the
Committee not later than 180 days after
the date on which the Foundation is
established; and
``(II) shall have staggered terms.
``(iii) Qualification.--The members of the
Board shall be United States citizens who are
knowledgeable or experienced in Native American
health care and related matters.
``(C) Compensation.--A member of the Board shall not
receive compensation for service as a member, but shall
be reimbursed for actual and necessary travel and
subsistence expenses incurred in the performance of the
duties of the Foundation.
``(h) Officers.--
``(1) In general.--The officers of the Foundation shall be--
``(A) a secretary, elected from among the members of
the Board; and
``(B) any other officers provided for in the
constitution and bylaws of the Foundation.
``(2) Chief operating officer.--The secretary of the
Foundation may serve, at the direction of the Board, as the
chief operating officer of the Foundation, or the Board may
appoint a chief operating officer, who shall serve at the
direction of the Board.
``(3) Election.--The manner of election, term of office, and
duties of the officers of the Foundation shall be as provided
in the constitution and bylaws of the Foundation.
``(i) Powers.--The Foundation--
``(1) shall adopt a constitution and bylaws for the
management of the property of the Foundation and the regulation
of the affairs of the Foundation;
``(2) may adopt and alter a corporate seal;
``(3) may enter into contracts;
``(4) may acquire (through a gift or otherwise), own, lease,
encumber, and transfer real or personal property as necessary
or convenient to carry out the purposes of the Foundation;
``(5) may sue and be sued; and
``(6) may perform any other act necessary and proper to carry
out the purposes of the Foundation.
``(j) Principal Office.--
``(1) In general.--The principal office of the Foundation
shall be in the District of Columbia.
``(2) Activities; offices.--The activities of the Foundation
may be conducted, and offices may be maintained, throughout the
United States in accordance with the constitution and bylaws of
the Foundation.
``(k) Service of Process.--The Foundation shall comply with the law
on service of process of each State in which the Foundation is
incorporated and of each State in which the Foundation carries on
activities.
``(l) Liability of Officers, Employees, and Agents.--
``(1) In general.--The Foundation shall be liable for the
acts of the officers, employees, and agents of the Foundation
acting within the scope of their authority.
``(2) Personal liability.--A member of the Board shall be
personally liable only for gross negligence in the performance
of the duties of the member.
``(m) Restrictions.--
``(1) Limitation on spending.--Beginning with the fiscal year
following the first full fiscal year during which the
Foundation is in operation, the administrative costs of the
Foundation shall not exceed the percentage described in
paragraph (2) of the sum of--
``(A) the amounts transferred to the Foundation under
subsection (o) during the preceding fiscal year; and
``(B) donations received from private sources during
the preceding fiscal year.
``(2) Percentages.--The percentages referred to in paragraph
(1) are--
``(A) for the first fiscal year described in that
paragraph, 20 percent;
``(B) for the following fiscal year, 15 percent; and
``(C) for each fiscal year thereafter, 10 percent.
``(3) Appointment and hiring.--The appointment of officers
and employees of the Foundation shall be subject to the
availability of funds.
``(4) Status.--A member of the Board or officer, employee, or
agent of the Foundation shall not by reason of association with
the Foundation be considered to be an officer, employee, or
agent of the United States.
``(n) Audits.--The Foundation shall comply with section 10101 of
title 36, United States Code, as if the Foundation were a corporation
under part B of subtitle II of that title.
``(o) Funding.--
``(1) Authorization of appropriations.--There is authorized
to be appropriated to carry out subsection (e)(1) $500,000 for
each fiscal year, as adjusted to reflect changes in the
Consumer Price Index for all-urban consumers published by the
Department of Labor.
``(2) Transfer of donated funds.--The Secretary shall
transfer to the Foundation funds held by the Department of
Health and Human Services under the Act of August 5, 1954 (42
U.S.C. 2001 et seq.), if the transfer or use of the funds is
not prohibited by any term under which the funds were donated.
``SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT.
``(a) Provision of Support by Secretary.--Subject to subsection (b),
during the 5-year period beginning on the date on which the Foundation
is established, the Secretary--
``(1) may provide personnel, facilities, and other
administrative support services to the Foundation;
``(2) may provide funds for initial operating costs and to
reimburse the travel expenses of the members of the Board; and
``(3) shall require and accept reimbursements from the
Foundation for--
``(A) services provided under paragraph (1); and
``(B) funds provided under paragraph (2).
``(b) Reimbursement.--Reimbursements accepted under subsection
(a)(3)--
``(1) shall be deposited in the Treasury of the United States
to the credit of the applicable appropriations account; and
``(2) shall be chargeable for the cost of providing services
described in subsection (a)(1) and travel expenses described in
subsection (a)(2).
``(c) Continuation of Certain Services.--The Secretary may continue
to provide facilities and necessary support services to the Foundation
after the termination of the 5-year period specified in subsection (a)
if the facilities and services--
``(1) are available; and
``(2) are provided on reimbursable cost basis.''.
(b) Technical Amendments.--The Indian Self-Determination and
Education Assistance Act is amended--
(1) by redesignating the second title V (25 U.S.C. 458bbb et
seq.) as title VII;
(2) by redesignating sections 501, 502, and 503 (25 U.S.C.
458bbb, 458bbb-1, 458bbb-2) as sections 701, 702, and 703,
respectively; and
(3) in subsection (a)(2) of section 702 and paragraph (2) of
section 703 (as redesignated by paragraph (2)), by striking
``section 501'' and inserting ``section 701''.
TITLE II--IMPROVEMENT OF INDIAN HEALTH CARE PROVIDED UNDER THE SOCIAL
SECURITY ACT
SEC. 201. EXPANSION OF PAYMENTS UNDER MEDICARE, MEDICAID, AND SCHIP FOR
ALL COVERED SERVICES FURNISHED BY INDIAN HEALTH
PROGRAMS.
(a) Medicaid.--
(1) Expansion to all covered services.--Section 1911 of the
Social Security Act (42 U.S.C. 1396j) is amended--
(A) by amending the section designation and heading
to read as follows:
``SEC. 1911. INDIAN HEALTH PROGRAMS.''; AND
(B) by amending subsection (a) to read as follows:
``(a) Eligibility for Payment for Medical Assistance.--The Indian
Health Service and an Indian Tribe, Tribal Organization, or an Urban
Indian Organization shall be eligible for payment for medical
assistance provided under a State plan or under waiver authority with
respect to items and services furnished by the Indian Health Service,
Indian Tribe, Tribal Organization, or Urban Indian Organization if the
furnishing of such services meets all the conditions and requirements
which are applicable generally to the furnishing of items and services
under this title and under such plan or waiver authority.''.
(2) Compliance with conditions and requirements.--Subsection
(b) of such section is amended to read as follows:
``(b) Compliance With Conditions and Requirements.--A facility of the
Indian Health Service or an Indian Tribe, Tribal Organization, or an
Urban Indian Organization which is eligible for payment under
subsection (a) with respect to the furnishing of items and services,
but which does not meet all of the conditions and requirements of this
title and under a State plan or waiver authority which are applicable
generally to such facility, shall make such improvements as are
necessary to achieve or maintain compliance with such conditions and
requirements in accordance with a plan submitted to and accepted by the
Secretary for achieving or maintaining compliance with such conditions
and requirements, and shall be deemed to meet such conditions and
requirements (and to be eligible for payment under this title), without
regard to the extent of its actual compliance with such conditions and
requirements, during the first 12 months after the month in which such
plan is submitted.''.
(3) Revision of authority to enter into agreements.--
Subsection (c) of such section is amended to read as follows:
``(c) Authority To Enter Into Agreements.--The Secretary may enter
into an agreement with a State for the purpose of reimbursing the State
for medical assistance provided by the Indian Health Service, an Indian
Tribe, Tribal Organization, or an Urban Indian Organization (as so
defined), directly, through referral, or under contracts or other
arrangements between the Indian Health Service, an Indian Tribe, Tribal
Organization, or an Urban Indian Organization and another health care
provider to Indians who are eligible for medical assistance under the
State plan or under waiver authority.''.
(4) Cross-references to special fund for improvement of ihs
facilities; direct billing option; definitions.--Such section
is further amended by striking subsection (d) and adding at the
end the following new subsections:
``(d) Special Fund for Improvement of IHS Facilities.--For provisions
relating to the authority of the Secretary to place payments to which a
facility of the Indian Health Service is eligible for payment under
this title into a special fund established under section 401(c)(1) of
the Indian Health Care Improvement Act, and the requirement to use
amounts paid from such fund for making improvements in accordance with
subsection (b), see subparagraphs (A) and (B) of section 401(c)(1) of
such Act.
``(e) Direct Billing.--For provisions relating to the authority of a
Tribal Health Program or an Urban Indian Organization to elect to
directly bill for, and receive payment for, health care items and
services provided by such Program or Organization for which payment is
made under this title, see section 401(d) of the Indian Health Care
Improvement Act.
``(f) Definitions.--In this section, the terms `Indian Health
Program', `Indian Tribe', `Tribal Health Program', `Tribal
Organization', and `Urban Indian Organization' have the meanings given
those terms in section 4 of the Indian Health Care Improvement Act.''.
(b) Medicare.--
(1) Expansion to all covered services.--Section 1880 of such
Act (42 U.S.C. 1395qq) is amended--
(A) by amending the section designation and heading
to read as follows:
``SEC. 1880. INDIAN HEALTH PROGRAMS.''; AND
(B) by amending subsection (a) to read as follows:
``(a) Eligibility for Payments.--Subject to subsection (e), the
Indian Health Service and an Indian Tribe, Tribal Organization, or an
Urban Indian Organization shall be eligible for payments under this
title with respect to items and services furnished by the Indian Health
Service, Indian Tribe, Tribal Organization, or Urban Indian
Organization if the furnishing of such services meets all the
conditions and requirements which are applicable generally to the
furnishing of items and services under this title.''.
(2) Compliance with conditions and requirements.--Subsection
(b) of such section is amended to read as follows:
``(b) Compliance With Conditions and Requirements.--Subject to
subsection (e), a facility of the Indian Health Service or an Indian
Tribe, Tribal Organization, or an Urban Indian Organization which is
eligible for payment under subsection (a) with respect to the
furnishing of items and services, but which does not meet all of the
conditions and requirements of this title which are applicable
generally to such facility, shall make such improvements as are
necessary to achieve or maintain compliance with such conditions and
requirements in accordance with a plan submitted to and accepted by the
Secretary for achieving or maintaining compliance with such conditions
and requirements, and shall be deemed to meet such conditions and
requirements (and to be eligible for payment under this title), without
regard to the extent of its actual compliance with such conditions and
requirements, during the first 12 months after the month in which such
plan is submitted.''.
(3) Cross-references to special fund for improvement of ihs
facilities; direct billing option; definitions.--
(A) In general.--Such section is further amended by
striking subsections (c) and (d) and inserting the
following new subsections:
``(c) Special Fund for Improvement of IHS Facilities.--For provisions
relating to the authority of the Secretary to place payments to which a
facility of the Indian Health Service is eligible for payment under
this title into a special fund established under section 401(c)(1) of
the Indian Health Care Improvement Act, and the requirement to use
amounts paid from such fund for making improvements in accordance with
subsection (b), see subparagraphs (A) and (B) of section 401(c)(1) of
such Act.
``(d) Direct Billing.--For provisions relating to the authority of a
Tribal Health Program or an Urban Indian Organization to elect to
directly bill for, and receive payment for, health care items and
services provided by such Program or Organization for which payment is
made under this title, see section 401(d) of the Indian Health Care
Improvement Act.''.
(B) Conforming amendment.--Paragraph (3) of section
1880(e) of such Act (42 U.S.C. 1395qq(e)) is amended by
inserting ``and section 401(c)(1) of the Indian Health
Care Improvement Act'' after ``Subsection (c)''.
(4) Definitions.--Such section is further amended by amending
subsection (f) to read as follows:
``(f) Definitions.--In this section, the terms `Indian Health
Program', `Indian Tribe', `Service Unit', `Tribal Health Program',
`Tribal Organization', and `Urban Indian Organization' have the
meanings given those terms in section 4 of the Indian Health Care
Improvement Act.''.
(c) Application to SCHIP.--Section 2107(e)(1) of the Social Security
Act (42 U.S.C. 1397gg(e)(1)) is amended--
(1) by redesignating subparagraph (D) as subparagraph (E);
and
(2) by inserting after subparagraph (C), the following new
subparagraph:
``(D) Section 1911 (relating to Indian Health
Programs, other than subsection (d) of such
section).''.
SEC. 202. INCREASED OUTREACH TO INDIANS UNDER MEDICAID AND SCHIP AND
IMPROVED COOPERATION IN THE PROVISION OF ITEMS AND
SERVICES TO INDIANS UNDER SOCIAL SECURITY ACT
HEALTH BENEFIT PROGRAMS.
Section 1139 of the Social Security Act (42 U.S.C. 1320b-9) is
amended to read as follows:
``SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE FOR
INDIANS UNDER TITLES XVIII, XIX, AND XXI.
``(a) Agreements With States for Medicaid and SCHIP Outreach on or
Near Reservations To Increase the Enrollment of Indians in Those
Programs.--
``(1) In general.--In order to improve the access of Indians
residing on or near a reservation to obtain benefits under the
Medicaid and State children's health insurance programs
established under titles XIX and XXI, the Secretary shall
encourage the State to take steps to provide for enrollment on
or near the reservation. Such steps may include outreach
efforts such as the outstationing of eligibility workers,
entering into agreements with the Indian Health Service, Indian
Tribes, Tribal Organizations, and Urban Indian Organizations to
provide outreach, education regarding eligibility and benefits,
enrollment, and translation services when such services are
appropriate.
``(2) Construction.--Nothing in subparagraph (A) shall be
construed as affecting arrangements entered into between States
and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations for such Service,
Tribes, or Organizations to conduct administrative activities
under such titles.
``(b) Requirement To Facilitate Cooperation.--The Secretary, acting
through the Centers for Medicare & Medicaid Services, shall take such
steps as are necessary to facilitate cooperation with, and agreements
between, States and the Indian Health Service, Indian Tribes, Tribal
Organizations, or Urban Indian Organizations with respect to the
provision of health care items and services to Indians under the
programs established under title XVIII, XIX, or XXI.
``(c) Definition of Indian; Indian Tribe; Indian Health Program;
Tribal Organization; Urban Indian Organization.--In this section, the
terms `Indian', `Indian Tribe', `Indian Health Program', `Tribal
Organization', and `Urban Indian Organization' have the meanings given
those terms in section 4 of the Indian Health Care Improvement Act.''.
SEC. 203. ADDITIONAL PROVISIONS TO INCREASE OUTREACH TO, AND ENROLLMENT
OF, INDIANS IN SCHIP AND MEDICAID.
(a) Nonapplication of 10 Percent Limit on Outreach and Certain Other
Expenditures.--Section 2105(c)(2) of the Social Security Act (42 U.S.C.
1397ee(c)(2)) is amended by adding at the end the following new
subparagraph:
``(C) Nonapplication to expenditures for outreach to
increase the enrollment of indian children under this
title and title xix.--The limitation under subparagraph
(A) on expenditures for items described in subsection
(a)(1)(D) shall not apply in the case of expenditures
for outreach activities to families of Indian children
likely to be eligible for child health assistance under
the plan or medical assistance under the State plan
under title XIX (or under a waiver of such plan), to
inform such families of the availability of, and to
assist them in enrolling their children in, such plans,
including such activities conducted under grants,
contracts, or agreements entered into under section
1139(a).''.
(b) Assurance of Payments to Indian Health Care Providers for Child
Health Assistance.--Section 2102(b)(3)(D) of such Act (42 U.S.C.
1397bb(b)(3)(D)) is amended by striking ``(as defined in section 4(c)
of the Indian Health Care Improvement Act, 25 U.S.C. 1603(c))'' and
inserting ``, including how the State will ensure that payments are
made to Indian Health Programs and Urban Indian Organizations operating
in the State for the provision of such assistance''.
(c) Inclusion of Other Indian Financed Health Care Programs in
Exemption From Prohibition on Certain Payments.--Section 2105(c)(6)(B)
of such Act (42 U.S.C. 1397ee(c)(6)(B)) is amended by striking
``insurance program, other than an insurance program operated or
financed by the Indian Health Service'' and inserting ``program, other
than a health care program operated or financed by the Indian Health
Service or by an Indian Tribe, Tribal Organization, or Urban Indian
Organization''.
(d) Satisfaction of Medicaid Documentation Requirements.--
(1) In general.--Section 1903(x)(3)(B) of the Social Security
Act (42 U.S.C. 1396b(x)(3)(B)) is amended--
(A) by redesignating clause (v) as clause (vi); and
(B) by inserting after clause (iv), the following new
clause:
``(v)(I) Except as provided in subclause (II), a document
issued by a federally-recognized Indian tribe evidencing
membership or enrollment in, or affiliation with, such tribe.
``(II) With respect to those federally-recognized Indian
tribes located within States having an international border
whose membership includes individuals who are not citizens of
the United States, the Secretary shall, after consulting with
such tribes, issue regulations authorizing the presentation of
such other forms of documentation (including tribal
documentation, if appropriate) that the Secretary determines to
be satisfactory documentary evidence of citizenship or
nationality for purposes of satisfying the requirement of this
subsection.''.
(2) Transition rule.--During the period that begins on July
1, 2006, and ends on the effective date of final regulations
issued under subclause (II) of section 1903(x)(3)(B)(v) of the
Social Security Act (42 U.S.C. 1396b(x)(3)(B)(v)) (as added by
paragraph (1)), an individual who is a member of a federally-
recognized Indian tribe described in subclause (II) of that
section who presents a document described in subclause (I) of
such section that is issued by such Indian tribe, shall be
deemed to have presented satisfactory evidence of citizenship
or nationality for purposes of satisfying the requirement of
subsection (x) of section 1903 of such Act.
(e) Definitions.--Section 2110(c) of such Act (42 U.S.C. 1397jj(c))
is amended by adding at the end the following new paragraph:
``(9) Indian; indian health program; indian tribe; etc.--The
terms `Indian', `Indian Health Program', `Indian Tribe',
`Tribal Organization', and `Urban Indian Organization' have the
meanings given those terms in section 4 of the Indian Health
Care Improvement Act.''.
SEC. 204. PREMIUMS AND COST SHARING PROTECTIONS UNDER MEDICAID,
ELIGIBILITY DETERMINATIONS UNDER MEDICAID AND
SCHIP, AND PROTECTION OF CERTAIN INDIAN PROPERTY
FROM MEDICAID ESTATE RECOVERY.
(a) Premiums and Cost Sharing Protection Under Medicaid.--
(1) In general.--Section 1916 of the Social Security Act (42
U.S.C. 1396o) is amended--
(A) in subsection (a), in the matter preceding
paragraph (1), by striking ``and (i)'' and inserting
``, (i), and (j)''; and
(B) by adding at the end the following new
subsection:
``(j) No Premiums or Cost Sharing for Indians Furnished Items or
Services Directly by Indian Health Programs or Through Referral Under
the Contract Health Service.--
``(1) No cost sharing for items or services furnished to
indians through indian health programs.--
``(A) In general.--No enrollment fee, premium, or
similar charge, and no deduction, copayment, cost
sharing, or similar charge shall be imposed against an
Indian who is furnished an item or service directly by
the Indian Health Service, an Indian Tribe, Tribal
Organization, or Urban Indian Organization or through
referral under the contract health service for which
payment may be made under this title.
``(B) No reduction in amount of payment to indian
health providers.--Payment due under this title to the
Indian Health Service, an Indian Tribe, Tribal
Organization, or Urban Indian Organization, or a health
care provider through referral under the contract
health service for the furnishing of an item or service
to an Indian who is eligible for assistance under such
title, may not be reduced by the amount of any
enrollment fee, premium, or similar charge, or any
deduction, copayment, cost sharing, or similar charge
that would be due from the Indian but for the operation
of subparagraph (A).
``(2) Rule of construction.--Nothing in this subsection shall
be construed as restricting the application of any other
limitations on the imposition of premiums or cost sharing that
may apply to an individual receiving medical assistance under
this title who is an Indian.
``(3) Definitions.--In this subsection, the terms `contract
health service', `Indian', `Indian Tribe', `Tribal
Organization', and `Urban Indian Organization' have the
meanings given those terms in section 4 of the Indian Health
Care Improvement Act.''.
(2) Conforming amendment.--Section 1916A (a)(1) of such Act
(42 U.S.C. 1396o-1(a)(1)) is amended by striking ``section
1916(g)'' and inserting ``subsections (g), (i), or (j) of
section 1916''.
(b) Treatment of Certain Property for Medicaid and SCHIP
Eligibility.--
(1) Medicaid.--Section 1902(e) of the Social Security Act (42
U.S.C. 1396a) is amended by adding at the end the following new
paragraph:
``(13) Notwithstanding any other requirement of this title or any
other provision of Federal or State law, a State shall disregard the
following property for purposes of determining the eligibility of an
individual who is an Indian (as defined in section 4 of the Indian
Health Care Improvement Act) for medical assistance under this title:
``(A) Property, including real property and improvements,
that is held in trust, subject to Federal restrictions, or
otherwise under the supervision of the Secretary of the
Interior, located on a reservation, including any federally
recognized Indian Tribe's reservation, pueblo, or colony,
including former reservations in Oklahoma, Alaska Native
regions established by the Alaska Native Claims Settlement Act,
and Indian allotments on or near a reservation as designated
and approved by the Bureau of Indian Affairs of the Department
of the Interior.
``(B) For any federally recognized Tribe not described in
subparagraph (A), property located within the most recent
boundaries of a prior Federal reservation.
``(C) Ownership interests in rents, leases, royalties, or
usage rights related to natural resources (including extraction
of natural resources or harvesting of timber, other plants and
plant products, animals, fish, and shellfish) resulting from
the exercise of federally protected rights.
``(D) Ownership interests in or usage rights to items not
covered by subparagraphs (A) through (C) that have unique
religious, spiritual, traditional, or cultural significance or
rights that support subsistence or a traditional lifestyle
according to applicable tribal law or custom.''.
(2) Application to schip.--Section 2107(e)(1) of such Act (42
U.S.C. 1397gg(e)(1)), as amended by section 201(c), is
amended--
(A) by redesignating subparagraphs (B) through (E),
as subparagraphs (C) through (F), respectively; and
(B) by inserting after subparagraph (A), the
following new subparagraph:
``(B) Section 1902(e)(13) (relating to disregard of
certain property for purposes of making eligibility
determinations).''.
(c) Continuation of Current Law Protections of Certain Indian
Property From Medicaid Estate Recovery.--Section 1917(b)(3) of the
Social Security Act (42 U.S.C. 1396p(b)(3)) is amended--
(1) by inserting ``(A)'' after ``(3)''; and
(2) by adding at the end the following new subparagraph:
``(B) The standards specified by the Secretary under subparagraph (A)
shall require that the procedures established by the State agency under
subparagraph (A) exempt income, resources, and property that are exempt
from the application of this subsection as of April 1, 2003, under
manual instructions issued to carry out this subsection (as in effect
on such date) because of the Federal responsibility for Indian Tribes
and Alaska Native Villages. Nothing in this subparagraph shall be
construed as preventing the Secretary from providing additional estate
recovery exemptions under this title for Indians.''.
SEC. 205. NONDISCRIMINATION IN QUALIFICATIONS FOR PAYMENT FOR SERVICES
UNDER FEDERAL HEALTH CARE PROGRAMS.
Section 1139 of the Social Security Act (42 U.S.C. 1320b-9), as
amended by section 202, is amended by redesignating subsection (c) as
subsection (d), and inserting after subsection (b) the following new
subsection:
``(c) Nondiscrimination in Qualifications for Payment for Services
Under Federal Health Care Programs.--
``(1) Requirement to satisfy generally applicable
participation requirements.--
``(A) In general.--A Federal health care program must
accept an entity that is operated by the Indian Health
Service, an Indian Tribe, Tribal Organization, or Urban
Indian Organization as a provider eligible to receive
payment under the program for health care services
furnished to an Indian on the same basis as any other
provider qualified to participate as a provider of
health care services under the program if the entity
meets generally applicable State or other requirements
for participation as a provider of health care services
under the program.
``(B) Satisfaction of state or local licensure or
recognition requirements.--Any requirement for
participation as a provider of health care services
under a Federal health care program that an entity be
licensed or recognized under the State or local law
where the entity is located to furnish health care
services shall be deemed to have been met in the case
of an entity operated by the Indian Health Service, an
Indian Tribe, Tribal Organization, or Urban Indian
Organization if the entity meets all the applicable
standards for such licensure or recognition, regardless
of whether the entity obtains a license or other
documentation under such State or local law. In
accordance with section 221 of the Indian Health Care
Improvement Act, the absence of the licensure of a
health care professional employed by such an entity
under the State or local law where the entity is
located shall not be taken into account for purposes of
determining whether the entity meets such standards, if
the professional is licensed in another State.
``(2) Prohibition on federal payments to entities or
individuals excluded from participation in federal health care
programs or whose state licenses are under suspension or have
been revoked.--
``(A) Excluded entities.--No entity operated by the
Indian Health Service, an Indian Tribe, Tribal
Organization, or Urban Indian Organization that has
been excluded from participation in any Federal health
care program or for which a license is under suspension
or has been revoked by the State where the entity is
located shall be eligible to receive payment under any
such program for health care services furnished to an
Indian.
``(B) Excluded individuals.--No individual who has
been excluded from participation in any Federal health
care program or whose State license is under suspension
or has been revoked shall be eligible to receive
payment under any such program for health care services
furnished by that individual, directly or through an
entity that is otherwise eligible to receive payment
for health care services, to an Indian.
``(C) Federal health care program defined.--In this
subsection, the term, `Federal health care program' has
the meaning given that term in section 1128B(f), except
that, for purposes of this subsection, such term shall
include the health insurance program under chapter 89
of title 5, United States Code.''.
SEC. 206. CONSULTATION ON MEDICAID, SCHIP, AND OTHER HEALTH CARE
PROGRAMS FUNDED UNDER THE SOCIAL SECURITY ACT
INVOLVING INDIAN HEALTH PROGRAMS AND URBAN INDIAN
ORGANIZATIONS.
(a) In General.--Section 1139 of the Social Security Act (42 U.S.C.
1320b-9), as amended by sections 202 and 205, is amended by
redesignating subsection (d) as subsection (e), and inserting after
subsection (c) the following new subsection:
``(d) Consultation With Tribal Technical Advisory Group (TTAG).--The
Secretary shall maintain within the Centers for Medicaid & Medicare
Services (CMS) a Tribal Technical Advisory Group, established in
accordance with requirements of the charter dated September 30, 2003,
and in such group shall include a representative of the Urban Indian
Organizations and the Service. The representative of the Urban Indian
Organization shall be deemed to be an elected officer of a tribal
government for purposes of applying section 204(b) of the Unfunded
Mandates Reform Act of 1995 (2 U.S.C. 1534(b)).''.
(b) Solicitation of Advice Under Medicaid and SCHIP.--
(1) Medicaid state plan amendment.--Section 1902(a) of the
Social Security Act (42 U.S.C. 1396a(a)) is amended--
(A) in paragraph (69), by striking ``and'' at the
end;
(B) in paragraph (70)(B)(iv), by striking the period
at the end and inserting ``; and''; and
(C) by inserting after paragraph (70)(B)(iv), the
following new paragraph:
``(71) in the case of any State in which the Indian Health
Service operates or funds health care programs, or in which 1
or more Indian Health Programs or Urban Indian Organizations
(as such terms are defined in section 4 of the Indian Health
Care Improvement Act) provide health care in the State for
which medical assistance is available under such title, provide
for a process under which the State seeks advice on a regular,
ongoing basis from designees of such Indian Health Programs and
Urban Indian Organizations on matters relating to the
application of this title that are likely to have a direct
effect on such Indian Health Programs and Urban Indian
Organizations and that--
``(A) shall include solicitation of advice prior to
submission of any plan amendments, waiver requests, and
proposals for demonstration projects likely to have a
direct effect on Indians, Indian Health Programs, or
Urban Indian Organizations; and
``(B) may include appointment of an advisory
committee and of a designee of such Indian Health
Programs and Urban Indian Organizations to the medical
care advisory committee advising the State on its State
plan under this title.''.
(2) Application to schip.--Section 2107(e)(1) of such Act (42
U.S.C. 1397gg(e)(1)), as amended by section 204(b)(2), is
amended--
(A) by redesignating subparagraphs (B) through (F) as
subparagraphs (C) through (G), respectively; and
(B) by inserting after subparagraph (A), the
following new subparagraph:
``(B) Section 1902(a)(71) (relating to the option of
certain States to seek advice from designees of Indian
Health Programs and Urban Indian Organizations).''.
(c) Rule of Construction.--Nothing in the amendments made by this
section shall be construed as superseding existing advisory committees,
working groups, guidance, or other advisory procedures established by
the Secretary of Health and Human Services or by any State with respect
to the provision of health care to Indians.
SEC. 207. EXCLUSION WAIVER AUTHORITY FOR AFFECTED INDIAN HEALTH
PROGRAMS AND SAFE HARBOR TRANSACTIONS UNDER THE
SOCIAL SECURITY ACT.
(a) Exclusion Waiver Authority.--Section 1128 of the Social Security
Act (42 U.S.C. 1320a-7) is amended by adding at the end the following
new subsection:
``(k) Additional Exclusion Waiver Authority for Affected Indian
Health Programs.--In addition to the authority granted the Secretary
under subsections (c)(3)(B) and (d)(3)(B) to waive an exclusion under
subsection (a)(1), (a)(3), (a)(4), or (b), the Secretary may, in the
case of an Indian Health Program, waive such an exclusion upon the
request of the administrator of an affected Indian Health Program (as
defined in section 4 of the Indian Health Care Improvement Act) who
determines that the exclusion would impose a hardship on individuals
entitled to benefits under or enrolled in a Federal health care
program.''.
(b) Certain Transactions Involving Indian Health Care Programs Deemed
To Be in Safe Harbors.--Section 1128B(b) of the Social Security Act (42
U.S.C. 1320a-7b(b)) is amended by adding at the end the following new
paragraph:
``(4) Subject to such conditions as the Secretary may promulgate from
time to time as necessary to prevent fraud and abuse, for purposes of
paragraphs (1) and (2) and section 1128A(a), the following transfers
shall not be treated as remuneration:
``(A) Transfers between indian health programs, indian
tribes, tribal organizations, and urban indian organizations.--
Transfers of anything of value between or among an Indian
Health Program, Indian Tribe, Tribal Organization, or Urban
Indian Organization, that are made for the purpose of providing
necessary health care items and services to any patient served
by such Program, Tribe, or Organization and that consist of--
``(i) services in connection with the collection,
transport, analysis, or interpretation of diagnostic
specimens or test data;
``(ii) inventory or supplies;
``(iii) staff; or
``(iv) a waiver of all or part of premiums or cost
sharing.
``(B) Transfers between indian health programs, indian
tribes, tribal organizations, or urban indian organizations and
patients.--Transfers of anything of value between an Indian
Health Program, Indian Tribe, Tribal Organization, or Urban
Indian Organization and any patient served or eligible for
service from an Indian Health Program, Indian Tribe, Tribal
Organization, or Urban Indian Organization, including any
patient served or eligible for service pursuant to section 807
of the Indian Health Care Improvement Act, but only if such
transfers--
``(i) consist of expenditures related to providing
transportation for the patient for the provision of
necessary health care items or services, provided that
the provision of such transportation is not advertised,
nor an incentive of which the value is
disproportionately large in relationship to the value
of the health care item or service (with respect to the
value of the item or service itself or, for
preventative items or services, the future health care
costs reasonably expected to be avoided);
``(ii) consist of expenditures related to providing
housing to the patient (including a pregnant patient)
and immediate family members or an escort necessary to
assuring the timely provision of health care items and
services to the patient, provided that the provision of
such housing is not advertised nor an incentive of
which the value is disproportionately large in
relationship to the value of the health care item or
service (with respect to the value of the item or
service itself or, for preventative items or services,
the future health care costs reasonably expected to be
avoided); or
``(iii) are for the purpose of paying premiums or
cost sharing on behalf of such a patient, provided that
the making of such payment is not subject to conditions
other than conditions agreed to under a contract for
the delivery of contract health services.
``(C) Contract health services.--A transfer of anything of
value negotiated as part of a contract entered into between an
Indian Health Program, Indian Tribe, Tribal Organization, Urban
Indian Organization, or the Indian Health Service and a
contract care provider for the delivery of contract health
services authorized by the Indian Health Service, provided
that--
``(i) such a transfer is not tied to volume or value
of referrals or other business generated by the
parties; and
``(ii) any such transfer is limited to the fair
market value of the health care items or services
provided or, in the case of a transfer of items or
services related to preventative care, the value of the
future health care costs reasonably expected to be
avoided.
``(D) Other transfers.--Any other transfer of anything of
value involving an Indian Health Program, Indian Tribe, Tribal
Organization, or Urban Indian Organization, or a patient served
or eligible for service from an Indian Health Program, Indian
Tribe, Tribal Organization, or Urban Indian Organization, that
the Secretary, in consultation with the Attorney General,
determines is appropriate, taking into account the special
circumstances of such Indian Health Programs, Indian Tribes,
Tribal Organizations, and Urban Indian Organizations, and of
patients served by such Programs, Tribes, and Organizations.''.
SEC. 208. RULES APPLICABLE UNDER MEDICAID AND SCHIP TO MANAGED CARE
ENTITIES WITH RESPECT TO INDIAN ENROLLEES AND
INDIAN HEALTH CARE PROVIDERS AND INDIAN MANAGED
CARE ENTITIES.
(a) In General.--Section 1932 of the Social Security Act (42 U.S.C.
1396u-2) is amended by adding at the end the following new subsection:
``(h) Special Rules With Respect to Indian Enrollees, Indian Health
Care Providers, and Indian Managed Care Entities.--
``(1) Enrollee option to select an indian health care
provider as primary care provider.--In the case of a non-Indian
Medicaid managed care entity that--
``(A) has an Indian enrolled with the entity; and
``(B) has an Indian health care provider that is
participating as a primary care provider within the
network of the entity,
insofar as the Indian is otherwise eligible to receive services
from such Indian health care provider and the Indian health
care provider has the capacity to provide primary care services
to such Indian, the contract with the entity under section
1903(m) or under section 1905(t)(3) shall require, as a
condition of receiving payment under such contract, that the
Indian shall be allowed to choose such Indian health care
provider as the Indian's primary care provider under the
entity.
``(2) Assurance of payment to indian health care providers
for provision of covered services.--Each contract with a
managed care entity under section 1903(m) or under section
1905(t)(3) shall require any such entity that has a significant
percentage of Indian enrollees (as determined by the
Secretary), as a condition of receiving payment under such
contract to satisfy the following requirements:
``(A) Demonstration of participating indian health
care providers or application of alternative payment
arrangements.--Subject to subparagraph (E), to--
``(i) demonstrate that the number of Indian
health care providers that are participating
providers with respect to such entity are
sufficient to ensure timely access to covered
Medicaid managed care services for those
enrollees who are eligible to receive services
from such providers; or
``(ii) agree to pay Indian health care
providers who are not participating providers
with the entity for covered Medicaid managed
care services provided to those enrollees who
are eligible to receive services from such
providers at a rate equal to the rate
negotiated between such entity and the provider
involved or, if such a rate has not been
negotiated, at a rate that is not less than the
level and amount of payment which the entity
would make for the services if the services
were furnished by a participating provider
which is not an Indian health care provider.
``(B) Prompt payment.--To agree to make prompt
payment (in accordance with rules applicable to managed
care entities) to Indian health care providers that are
participating providers with respect to such entity or,
in the case of an entity to which subparagraph (A)(ii)
or (E) applies, that the entity is required to pay in
accordance with that subparagraph.
``(C) Satisfaction of claim requirement.--To deem any
requirement for the submission of a claim or other
documentation for services covered under subparagraph
(A) by the enrollee to be satisfied through the
submission of a claim or other documentation by an
Indian health care provider that is consistent with
section 403(h) of the Indian Health Care Improvement
Act.
``(D) Compliance with generally applicable
requirements.--
``(i) In general.--Subject to clause (ii), as
a condition of payment under subparagraph (A),
an Indian health care provider shall comply
with the generally applicable requirements of
this title, the State plan, and such entity
with respect to covered Medicaid managed care
services provided by the Indian health care
provider to the same extent that non-Indian
providers participating with the entity must
comply with such requirements.
``(ii) Limitations on compliance with managed
care entity generally applicable
requirements.--An Indian health care provider--
``(I) shall not be required to comply
with a generally applicable requirement
of a managed care entity described in
clause (i) as a condition of payment
under subparagraph (A) if such
compliance would conflict with any
other statutory or regulatory
requirements applicable to the Indian
health care provider; and
``(II) shall only need to comply with
those generally applicable requirements
of a managed care entity described in
clause (i) as a condition of payment
under subparagraph (A) that are
necessary for the entity's compliance
with the State plan, such as those
related to care management, quality
assurance, and utilization management.
``(E) Application of special payment requirements for
federally-qualified health centers and encounter rate
for services provided by certain indian health care
providers.--
``(i) Federally-qualified health centers.--
``(I) Managed care entity payment
requirement.--To agree to pay any
Indian health care provider that is a
federally-qualified health center but
not a participating provider with
respect to the entity, for the
provision of covered Medicaid managed
care services by such provider to an
Indian enrollee of the entity at a rate
equal to the amount of payment that the
entity would pay a federally-qualified
health center that is a participating
provider with respect to the entity but
is not an Indian health care provider
for such services.
``(II) Continued application of state
requirement to make supplemental
payment.--Nothing in subclause (I) or
subparagraph (A) or (B) shall be
construed as waiving the application of
section 1902(bb)(5) regarding the State
plan requirement to make any
supplemental payment due under such
section to a federally-qualified health
center for services furnished by such
center to an enrollee of a managed care
entity (regardless of whether the
federally-qualified health center is or
is not a participating provider with
the entity).
``(ii) Continued application of encounter
rate for services provided by certain indian
health care providers.--If the amount paid by a
managed care entity to an Indian health care
provider that is not a federally-qualified
health center and that has elected to receive
payment under this title as an Indian Health
Service provider under the July 11, 1996,
Memorandum of Agreement between the Health Care
Financing Administration (now the Centers for
Medicare & Medicaid Services) and the Indian
Health Service for services provided by such
provider to an Indian enrollee with the managed
care entity is less than the encounter rate
that applies to the provision of such services
under such memorandum, the State plan shall
provide for payment to the Indian health care
provider of the difference between the
applicable encounter rate under such memorandum
and the amount paid by the managed care entity
to the provider for such services.
``(F) Construction.--Nothing in this paragraph shall
be construed as waiving the application of section
1902(a)(30)(A) (relating to application of standards to
assure that payments are consistent with efficiency,
economy, and quality of care).
``(3) Offering of managed care through indian medicaid
managed care entities.--If--
``(A) a State elects to provide services through
Medicaid managed care entities under its Medicaid
managed care program; and
``(B) an Indian health care provider that is funded
in whole or in part by the Indian Health Service, or a
consortium composed of 1 or more Tribes, Tribal
Organizations, or Urban Indian Organizations, and which
also may include the Indian Health Service, has
established an Indian Medicaid managed care entity in
the State that meets generally applicable standards
required of such an entity under such Medicaid managed
care program,
the State shall offer to enter into an agreement with the
entity to serve as a Medicaid managed care entity with respect
to eligible Indians served by such entity under such program.
``(4) Special rules for indian managed care entities.--The
following are special rules regarding the application of a
Medicaid managed care program to Indian Medicaid managed care
entities:
``(A) Enrollment.--
``(i) Limitation to indians.--An Indian
Medicaid managed care entity may restrict
enrollment under such program to Indians and to
members of specific Tribes in the same manner
as Indian Health Programs may restrict the
delivery of services to such Indians and tribal
members.
``(ii) No less choice of plans.--Under such
program the State may not limit the choice of
an Indian among Medicaid managed care entities
only to Indian Medicaid managed care entities
or to be more restrictive than the choice of
managed care entities offered to individuals
who are not Indians.
``(iii) Default enrollment.--
``(I) In general.--If such program of
a State requires the enrollment of
Indians in a Medicaid managed care
entity in order to receive benefits,
the State, taking into consideration
the criteria specified in subsection
(a)(4)(D)(ii)(I), shall provide for the
enrollment of Indians described in
subclause (II) who are not otherwise
enrolled with such an entity in an
Indian Medicaid managed care entity
described in such clause.
``(II) Indian described.--An Indian
described in this subclause, with
respect to an Indian Medicaid managed
care entity, is an Indian who, based
upon the service area and capacity of
the entity, is eligible to be enrolled
with the entity consistent with
subparagraph (A).
``(iv) Exception to state lock-in.--A request
by an Indian who is enrolled under such program
with a non-Indian Medicaid managed care entity
to change enrollment with that entity to
enrollment with an Indian Medicaid managed care
entity shall be considered cause for granting
such request under procedures specified by the
Secretary.
``(B) Flexibility in application of solvency.--In
applying section 1903(m)(1) to an Indian Medicaid
managed care entity--
``(i) any reference to a `State' in
subparagraph (A)(ii) of that section shall be
deemed to be a reference to the `Secretary';
and
``(ii) the entity shall be deemed to be a
public entity described in subparagraph (C)(ii)
of that section.
``(C) Exceptions to advance directives.--The
Secretary may modify or waive the requirements of
section 1902(w) (relating to provision of written
materials on advance directives) insofar as the
Secretary finds that the requirements otherwise imposed
are not an appropriate or effective way of
communicating the information to Indians.
``(D) Flexibility in information and marketing.--
``(i) Materials.--The Secretary may modify
requirements under subsection (a)(5) to ensure
that information described in that subsection
is provided to enrollees and potential
enrollees of Indian Medicaid managed care
entities in a culturally appropriate and
understandable manner that clearly communicates
to such enrollees and potential enrollees their
rights, protections, and benefits.
``(ii) Distribution of marketing materials.--
The provisions of subsection (d)(2)(B)
requiring the distribution of marketing
materials to an entire service area shall be
deemed satisfied in the case of an Indian
Medicaid managed care entity that distributes
appropriate materials only to those Indians who
are potentially eligible to enroll with the
entity in the service area.
``(5) Malpractice insurance.--Insofar as, under a Medicaid
managed care program, a health care provider is required to
have medical malpractice insurance coverage as a condition of
contracting as a provider with a Medicaid managed care entity,
an Indian health care provider that is--
``(A) a federally-qualified health center that is
covered under the Federal Tort Claims Act (28 U.S.C.
1346(b), 2671 et seq.);
``(B) providing health care services pursuant to a
contract or compact under the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.)
that are covered under the Federal Tort Claims Act (28
U.S.C. 1346(b), 2671 et seq.); or
``(C) the Indian Health Service providing health care
services that are covered under the Federal Tort Claims
Act (28 U.S.C. 1346(b), 2671 et seq.);
are deemed to satisfy such requirement.
``(6) Definitions.--For purposes of this subsection:
``(A) Indian health care provider.--The term `Indian
health care provider' means an Indian Health Program or
an Urban Indian Organization.
``(B) Indian; indian health program; service; tribe;
tribal organization; urban indian organization.--The
terms `Indian', `Indian Health Program', `Service',
`Tribe', `tribal organization', `Urban Indian
Organization' have the meanings given such terms in
section 4 of the Indian Health Care Improvement Act.
``(C) Indian medicaid managed care entity.--The term
`Indian Medicaid managed care entity' means a managed
care entity that is controlled (within the meaning of
the last sentence of section 1903(m)(1)(C)) by the
Indian Health Service, a Tribe, Tribal Organization, or
Urban Indian Organization, or a consortium, which may
be composed of 1 or more Tribes, Tribal Organizations,
or Urban Indian Organizations, and which also may
include the Service.
``(D) Non-indian medicaid managed care entity.--The
term `non-Indian Medicaid managed care entity' means a
managed care entity that is not an Indian Medicaid
managed care entity.
``(E) Covered medicaid managed care services.--The
term `covered Medicaid managed care services' means,
with respect to an individual enrolled with a managed
care entity, items and services that are within the
scope of items and services for which benefits are
available with respect to the individual under the
contract between the entity and the State involved.
``(F) Medicaid managed care program.--The term
`Medicaid managed care program' means a program under
sections 1903(m) and 1932 and includes a managed care
program operating under a waiver under section 1915(b)
or 1115 or otherwise.''.
(b) Application to SCHIP.--Section 2107(e)(1) of such Act (42 U.S.C.
1397gg(1)), as amended by section 206(b)(2), is amended by adding at
the end the following new subparagraph:
``(H) Subsections (a)(2)(C) and (h) of section
1932.''.
SEC. 209. ANNUAL REPORT ON INDIANS SERVED BY SOCIAL SECURITY ACT HEALTH
BENEFIT PROGRAMS.
Section 1139 of the Social Security Act (42 U.S.C. 1320b-9), as
amended by the sections 202, 205, and 206, is amended by redesignating
subsection (e) as subsection (f), and inserting after subsection (d)
the following new subsection:
``(e) Annual Report on Indians Served by Health Benefit Programs
Funded Under This Act.--Beginning January 1, 2007, and annually
thereafter, the Secretary, acting through the Administrator of the
Centers for Medicare & Medicaid Services and the Director of the Indian
Health Service, shall submit a report to Congress regarding the
enrollment and health status of Indians receiving items or services
under health benefit programs funded under this Act during the
preceding year. Each such report shall include the following:
``(1) The total number of Indians enrolled in, or receiving
items or services under, such programs, disaggregated with
respect to each such program.
``(2) The number of Indians described in paragraph (1) that
also received health benefits under programs funded by the
Indian Health Service.
``(3) General information regarding the health status of the
Indians described in paragraph (1), disaggregated with respect
to specific diseases or conditions and presented in a manner
that is consistent with protections for privacy of individually
identifiable health information under section 264(c) of the
Health Insurance Portability and Accountability Act of 1996.
``(4) A detailed statement of the status of facilities of the
Indian Health Service or an Indian Tribe, Tribal Organization,
or an Urban Indian Organization with respect to such
facilities' compliance with the applicable conditions and
requirements of titles XVIII, XIX, and XXI, and, in the case of
title XIX or XXI, under a State plan under such title or under
waiver authority, and of the progress being made by such
facilities (under plans submitted under section 1880(b),
1911(b) or otherwise) toward the achievement and maintenance of
such compliance.
``(5) Such other information as the Secretary determines is
appropriate.''.
Purpose of the Bill
The purpose of H.R. 1328 is to amend the Indian Health Care
Improvement Act to revise and extend that Act.
Background and Need for Legislation
According to Indian Health Service (IHS) figures, the
mortality rates for Native Americans from tuberculosis and
alcoholism are more than six times the U.S. general population
rate and mortality rates from diabetes are nearly three times
as high as in the rest of the United States population.
American Indian and Alaska Native death rates for unintentional
injuries and motor vehicle crashes are two and one-half to
three times higher than the national rates. Suicide and
homicide rates are nearly twice as high in the Indian
population.
In addition, a new report from the Substance Abuse and
Mental Health Services Administration (SAMHSA)\1\ found that
American Indians and Alaska Natives continue to have higher
rates of substance use disorders than other racial groups
within the United States. Almost 11% percent of American
Indians and Alaska Natives reported having a past-year alcohol
use disorder compared with 7.6% of other racial groups, and 5%
of American Indians and Alaska Natives had a past-year illicit
drug use disorder compared with 2.9% of other racial groups.\2\
American Indians and Alaska Natives also had higher rates than
members of other racial groups for past-year marijuana use
(13.5% versus 10.6%), cocaine use (3.5% versus 2.4%), and
disorders involving hallucinogen use (2.7% versus 1.7%).\3\ IHS
reported that the number of patient services related to
amphetamine abuse went from about 3,000 contacts in 2000 to
over 7,000 contacts in 2005, an increase of almost 250% over 5
years.\4\ Modernizing and improving the health care system that
serves these communities is essential. This legislation does
that by upgrading and updating health care for Native
Americans.
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\1\National Survey on Drug Use and Health: Substance Use and
Substance Use Disorders Among American Indians and Alaska Natives,
Office of Applied Studies, Substance Abuse and Mental Health Services
Administration, January, 2007.
\2\Id.
\3\Id.
\4\Testimony of Robert McSwain, Deputy Director, Indian Health
Service to the Senate Committee on Indian Affairs, April 5, 2006 (109th
Congress).
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INDIAN HEALTH CARE IMPROVEMENT ACT--PUBLIC LAW 94-437
The Indian Health Care Improvement Act (IHCIA) is the
keystone federal law that directs the delivery of health
services to American Indian and Alaska Native people. The
Indian health care network--comprised of reservation and
traditional homeland-based hospitals, clinics, school health
centers; health stations in very remote areas; and urban Indian
health programs in major cities--is the primary source of
medical care for over 1.9 million American Indians and Alaska
Natives. IHS administers this comprehensive health care network
largely in partnership with Indian tribes, which have assumed
an increasingly greater role in operating health programs vital
to the well-being of their members.
First enacted in 1976, the IHCIA presented a more organized
and comprehensive approach to the delivery of medical care to
Indian people, many of whom live in isolated, sparsely-
populated and under-served areas of our country. Subsequent
reauthorizations--the IHCIA has been reauthorized three times
with substantial amendments, the last occurring in 1992--
amended the Act to reflect advancements in health care
delivery, enabled tribes to exercise greater responsibility
over programs, and targeted the high incidence of certain
diseases that have plagued the Native American population.
The National Steering Committee on the Reauthorization of
the IHCIA was established by tribal and health care
representatives in the summer of 1999 to review and reconcile
differences in recommendations from various areas of Indian
country. The Steering Committee then drafted legislation that
reflected the final recommendations and has remained involved
throughout the process.
URBAN INDIANS
For 40 years, the United States has provided health care to
Urban Indians. Although appropriations for specific urban
health care programs began in 1967, Congress formally
authorized urban Indian health programs in 1976.
In April 2004, the Supreme Court reaffirmed Congress'
plenary power to legislate over matters relating to Indians.\5\
The Court acknowledged that Congress' plenary authority
includes the power to recognize, terminate and restore the
tribal status of Indian tribes.\6\ While Congress cannot
arbitrarily call a community of people an Indian tribe,\7\ the
Supreme Court has acknowledged that ``in respect of distinctly
Indian communities, whether, to what extent and, for what time
they shall be recognized and dealt with as dependent tribes
requiring the guardianship and protection of the United States
is to be determined by Congress''\8\ Congress' plenary
authority over Indian tribes also includes the power to define
who is an Indian.\9\
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\5\United States v. Lara, 541 U.S. 193 (2004) (noting that the
power of Congress in Indian affairs derives not only from the Indian
Commerce Clause, U.S. Const., Art. I, Sec. 8, cl. 3, and the Treaty
Clause, Art II, Sec. 2, cl. 2, but rests also ``upon the Constitution's
adoption of preconstitutional powers necessarily inherent in any
Federal Government, namely powers that [the U.S. Supreme] Court has
described as `necessary concomitants of nationality.''')
\6\Id. See, also the court's observations in U.S. v. John, 437 U.S.
634 (1978): (stating ``[n]either the fact that the Choctaws in
Mississippi are merely a remnant of a larger group of Indians, long ago
removed from Mississippi, nor the fact that federal supervision over
them has not been continuous, destroys the federal power to deal with
them.'' Id., at 652-3.
\7\United States v. Sandoval, 231 U.S. 28, 46 (1913).
\8\Id.
\9\U.S. Const. Art. I, Sec. 8, cl. 3; Cohen, Felix, Handbook of
Federal Indian Law, at 23, 1982 ed.; United States v. Holliday, 70 U.S.
407, 417 (1865) (Congress' broad power includes dealings with
individual Indians).
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As noted, this is not the first time that Congress has
exercised its authority over individual urban Indians. The
Supreme Court has stated that ``[t]he overriding duty of our
federal government to deal fairly with Indians wherever located
has been recognized by this Court many times.''\10\ As early as
1921, Congress enacted the Snyder Act to authorize health care
funding for Indians throughout the United States.\11\ The
Snyder Act has never been held to be limited to Indians who are
members of federally recognized tribes or limited to
reservation Indians.\12\
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\10\Morton v. Ruiz, (415 U.S. 199, 236, (1974).
\11\25 U.S.C. Sec. 13 (emphasis added).
\12\See, e.g., Morton v. Ruiz, 415 U.S. 199 (1974) (upholding
general assistance benefits authorized under the Snyder Act for
individual Indians located off the reservation).
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Historically, the United States treated tribes
differently--entering into treaties with some tribes while
ignoring others. Various federal policies also impacted Indian
tribes differently. For instance, the former federal policy of
``termination'' was intended to assimilate individual Indians
by ending the government-to-government relationship with some
Indian tribes but not others. Terminating the political
relationship, however, did not result in the individual Indians
no longer being Indian. To the contrary, the Supreme Court has
upheld the exercise of treaty rights by individual Indians
despite the fact that Congress has terminated the federal
relationship.\13\ Consequently, Congress has recognized the
need to continue providing health care and certain other
federal services to such individuals.\14\
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\13\Menominee Tribe of Indians v. U.S., 391 U.S. 404 (1968).
\14\See, e.g., No Child Left Behind Act, Pub. L. 107-110.
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Another former federal policy--relocation\15\--is largely
responsible for Indians moving to urban locations. Depressed
reservation economies have also contributed to urban migration.
Even though urban Indians no longer reside on reservations,
they suffer from high rates of diseases and have health
statistics similar to reservation Indians.\16\ To address this
situation, Congress began providing health care services for
urban Indians in 1967.
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\15\Many Indians were relocated to urban areas as a result of
federal policy that began in 1931 as an attempt to assimilate Indians.
Although the initial purpose of the relocation programs was to end
Federal services, Congress has always indicated that health care
programs for Indians does not stop at reservation borders.
\16\For instance, the sudden infant death syndrome is 157% higher,
alcoholism is 178%, chronic liver disease and cirrhosis is 126% higher.
Without urban Indian health programs urban Indians are less likely to
seek medical attention causing higher costs later.
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The history and various policies of the United States also
resulted in some tribes entering into treaties with state
governments. Many of these tribes continue to have political
relationships with state governments.
In short, Congress' plenary authority over Indians is more
than broad enough to encompass the provisions of this Act.
Providing health care to urban Indians is consistent with
federal policy and with Congress' moral obligations to Indians.
TRADITIONAL HEALTH CARE PRACTICES
For centuries, the United States employed various policies,
such as assimilation and termination, to prevent Native
Americans from using traditional health care practices. In
furtherance of the current policy of self-governance, Congress
recognized the importance and continued practice of traditional
health care for Native Americans in the enactment of the Indian
Health Care Improvement Act in 1976. Current law continues to
recognize this importance and authorizes Federal funds to be
used for traditional health care purposes, thus ensuring that
health care for Native Americans is culturally appropriate.
In 1990, Congress extended the Federal Tort Claims Act
(FTCA) coverage to tribes and tribal organizations providing
health care services under a contract or compact pursuant to
the Indian Self-Determination and Education Assistance Act.
While some concern has been expressed about FTCA's
applicability to traditional health care practices, these
concerns are unfounded for several reasons.
First, a traditional healer is used when requested by an
individual under the care of an IHS facility. In most
instances, the traditional healer is not a Federal or tribal
employee nor even paid with Federal funds. In fact, the
traditional healer often does not accept any payment.
Second, under the FTCA, liability is determined ``in
accordance with the law of the place where the act or omission
occurred.''\17\ In order for a claim to proceed then, state or
tribal law must specify a standard of care for the traditional
healing act performed. If no such standard is defined, there is
no cause of action on which a claim for relief may be granted.
Without such cause of action, the United States cannot be held
liable under the FTCA.
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\17\28 U.S.C. Sec. Sec. 1346(b) & 2672.
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Finally, it should be noted that there is no record of a
FTCA claim arising from traditional health care practices ever
being filed.\18\
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\18\S. Hrg. 100-53 at 14 (March 8, 2007) (Statement of C. Frederick
Beckner III, Deputy Assistant Attorney General, Civil Division,
Department of Justice).
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H.R. 1328
This legislation's primary objective is to improve access
to quality medical care for American Indians and Alaska
Natives. Currently, over half of the IHS budget is distributed
directly to Indian tribes who provide health care delivery
services pursuant to Indian Self-Determination and Education
Assistance Act (ISDEAA) contracts or compacts. In many areas of
Indian country, IHS programs are the only source of available
health care.
The basic framework of the IHCIA has been retained in H.R.
1328, including provisions that target diseases for which
Indian Country reflects astonishingly high rates, such as
diabetes, tuberculosis, infant mortality, alcoholism,
accidents, homicide and substance abuse. H.R. 1328 would
reauthorize the IHCIA through 2017 and provide funding for the
recruitment and retention of Indian health professionals
through scholarships, extern programs, continuing education
programs, and retention bonuses. It would make permanent
current programs for diabetes, andestablish a Catastrophic
Health Emergency Fund administered for victims of disasters or
catastrophic illness. In addition, the bill would require the Secretary
to provide for mammography and other cancer screening consistent with
national standards.
Additionally, this legislation would authorize the
Secretary to establish an Indian youth program for the purpose
of providing innovative mental and physical disease prevention
programs. Funding would also be authorized for activities such
as assisted living, hospice care, long-term health care, home
and community-based services, and traditional healing
practices. H.R. 1328 would replace the current Urban Health
Programs Branch with a Division of Urban Health that would
continue to service urban Indian clinics.
The bill would require agreements be made with Indian
health care organizations to assist in enrolling qualified
Indians into Medicare, Medicaid, and State Children's Health
Insurance Program (SCHIP). It would further promote taking
steps to provide for Medicaid enrollment on Indian reservations
and seek input from Indian tribes on impacts encountered
through changes in State plans.
In addition, the bill would reorganize current substance
abuse programs under a new Behavioral Health program to combine
and integrate substance abuse, mental health, and social
service programs. It would elevate the current position of
Director of Indian Health Service to that of Assistant
Secretary. This initiative would provide the Assistant
Secretary with greater control over budget issues.
Finally, this legislation would place greater emphasis on
negotiated rulemaking with Indian tribes in order to provide
the service population with ongoing input into how the IHCIA
would be implemented.
LEGISLATIVE HISTORY
Similar legislation was introduced in the 106th (by Rep.
George Miller), 107th (by Rep. Rahall), 108th and 109th
Congresses (both by Rep. Don Young). The Committee reported
H.R. 2440 in the 108th Congress (House Report 108-791--Part I)
and H.R. 5312 the 109th Congress (House Report 109-661--Part
I). Also in the 109th Congress, the Senate companion bill (S.
1057) was reported by the Senate Committee on Indian Affairs on
March 16, 2006 (Senate Report 109-222).
Committee Action
H.R. 1328 was introduced on March 6, 2007 by Representative
Frank Pallone (D-NJ), along with thirty-four original
cosponsors, including both Chairman Rahall and Ranking Member
Don Young. The bill was referred to the Committee on Natural
Resources. On March 14, 2007, the Committee on Natural
Resources held a hearing on the bill. On April 25, 2007, the
Full Natural Resources Committee met to consider the bill.
Representative Abercrombie (D-HI) offered an en bloc
amendment to include ``Urban Indians'' in the goals of the
bill, correct typographical errors, reinsert provisions in
existing law that were inadvertently omitted, add naturopathic
medicine within the definition of ``health profession,'' and
make other clarifying changes. It was adopted by voice vote.
Rep. Pearce (R-NM) offered an amendment to distribute funds
based on actual population needs rather than historic funding
levels. It was withdrawn after discussion.
Rep. Pearce (R-NM) offered an amendment requiring the
Secretary of Health and Human Services to conduct a study of
the third-party payment collections system for items and
services furnished through the Indian Health Service and
requires the Secretary to submit such report to Congress within
6 months after date of enactment of the Act. It was adopted by
voice vote.
Rep. Boren (D-OK) offered an amendment to correct an
alleged criminal jurisdiction void at the Claremore Indian
Hospital. It was withdrawn by unanimous consent.
Rep. Inslee (D-WA) offered an amendment to create an Area
Distribution Fund formula to distribute health care
construction facilities funds. It was withdrawn after
discussion.
Rep. Pearce (R-NM) offered an amendment requiring a report
on the movement of patients between Service Units. It was
adopted by voice vote.
The bill, as amended, was then ordered favorably reported
to the House of Representatives by voice vote.
Section-by-Section Analysis
Section 1. Short title; Table of contents
Section 1 provides the short title of the bill as the
``Indian Health Care Improvement Act Amendments of 2007'' and
sets forth the Table of Contents.
Section 2. Report on third-party payment collections
Section 2 requires the Secretary of Health and Human
Services to conduct a study of the third-party payment
collections system for items and services furnished through the
Indian Health Service and requires the Secretary to submit such
report to Congress within 6 months after date of enactment of
the Act.
Title I--Amendments to Indian Laws
Section 101. Indian Health Care Improvement Act amended
Section 101 amends the Indian Health Care Improvement Act
to read as follows:
Section 1. Short title; Table of contents
Section 1 provides that this Act may be cited as the
``Indian Health Care Improvement Act'' and sets forth an
amended Table of Contents.
Section 2. Findings
Section 2 sets forth findings indicating that federal
health services are required by the historical and unique legal
relationship between the United States and Indians; that
improving the quantity and quality of health services for
Indians is a goal of the United States; that federal health
services to Indians have resulted in a reduction in the
prevalence and incidence of preventable illness and premature
deaths of Indians; and that despite such services, the health
status of Indians is still far below the general United States
population.
Section 3. Declaration of national Indian health policy
Section 3 sets forth a national policy of the United
States, in fulfillment of its trust responsibility and legal
obligations, to assure the highest possible health status of
Indians and Urban Indians; to raise the health status of
Indians and Urban Indians; to allow Indians to set their own
health care priorities; to increase the number of degrees in
health professions awarded to Indians; to require consultation
with tribes, tribal organizations and urban Indian
organizations; and to fund programs and facilities operated by
tribes and tribal organizations at the same level as Indian
Health Service (Service) programs and facilities are funded.
Section 4. Definitions
Section 4 defines terms used in this Act, including
definitions for the following new terms: ``accredited and
accessible,'' ``Assistant Secretary,'' ``behavioral health,''
``California Indians,'' ``community college,'' ``contract
health service,'' ``Department,'' ``disease prevention,''
``Indian Health Program,'' ``junior or community college,''
``reservation,'' ``telehealth,'' ``telemedicine,'' ``tribal
college or university,'' and ``Tribal Health Program.'' ``Urban
Indian'' includes members of federally-recognized Indian
tribes, members of State-recognized Indian tribes, members of
tribes whose relationship with the federal government has been
terminated, and individuals who are descendants in the first or
second degree of any such member. The Committee believes that
there is adequate authority and precedent for this definition,
especially since Congress has already done so for other
purposes.\19\
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\19\See e.g. Indian Arts and Crafts Act, Pub. L. 101-644.
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Title I--Indian Health, Human Resources, and Development
Section 101. Purpose
Section 101 provides that the purpose of this title is to
increase the number of Indians entering health professions and
providing health services as well as to assure a supply of
health professions to provide health services to Indians.
Section 102. Health professions recruitment program for Indians
Section 102 requires the Secretary to award grants to
specified entities to assist with various activities associated
with recruiting Indians for health professions. Terms
addressing the application process, amount of grants, and
payments are also set forth in this section.
Section 103. Health professions preparatory scholarship program for
Indians
Section 103 requires the Secretary to provide scholarships
to Indians for compensatory pre-professional education and pre-
graduate education. This section also specifies the uses of the
scholarships and prohibits denial based solely on the
applicant's scholastic achievement if the applicant has been
admitted to or maintained good standing at an accredited
institution or based solely on the applicant's eligibility for
other federal assistance or benefits.
Section 104. Indian health professions scholarships
Section 104 requires the Secretary to award Indian Health
Scholarships to Indians pursuing courses of study in the health
professions. The section specifies how the scholarships shall
be distributed, how the scholarship program shall be
administered, as well as active duty service requirements for
recipients. Terms covering breach of contract are specified as
are the right of recovery and the recovery terms used by the
United States in the event of a breach of contract. The
Secretary shall provide a partial or total waiver of the
obligation of service or the repayment in certain specified
conditions. A repayment obligation may not be discharged in
bankruptcy.
Section 105. American Indians into psychology program
Section 105 requires the Secretary to award competitive
grants of no more than $300,000 to nine colleges and
universities to develop and maintain Indian psychology career
recruitment programs. One of these grants shall be provided to
develop and maintain the Quentin N. Burdick American Indians
into Psychology Program at the University of North Dakota.
Grant conditions are also set forth. Each graduate who receives
a stipend from this program is required to meet the active duty
service requirement.
Section 106. Scholarship programs for Indian tribes
Section 106 requires the Secretary to make grants to Tribal
Health Programs for the purpose of providing scholarships for
Indians to serve as health professionals in Indian communities.
Grant amounts and requirements, contract terms, breach of
contract terms, the relationship of the scholarship to the
Social Security Act and continuance of funding terms are also
set forth.
Section 107. Indian Health Service extern programs
Section 107 grants an employment preference at the Indian
Health Service during the nonacademic period of the year for
Section 104 and Section 106 scholarship recipients. Scholarship
recipients may also be employed by a Tribal Health Program or
an Urban Indian Organization during the nonacademic period of
the year. Employment during this period does not count towards
the recipient's active duty service obligation and may not
exceed 120 days during any calendar year. The recipient shall
be compensated for his or her services and shall be employed in
a health profession in which he or she is studying. Such
employment shall not be counted against any employment ceiling
affecting the Service or the Department.
Section 108. Continuing education allowances
Section 108 authorizes the Secretary to provide programs or
allowances to participants under Section 104, 105, 106, and 115
in order to transition into an Indian Health Program or to take
leave, in accordance with regulations, for professional
consultation, management, leadership, and refresher training
courses.
Section 109. Community Health Representative Program
Section 109 directs the Secretary to maintain a Community
Health Representative Program to provide training to Indians as
community health representatives and to use community health
representatives in the provision of health care, health
promotion and disease prevention services to Indian
communities. Program requirements are also set forth.
Section 110. Indian Health Service Loan Repayment Program
Section 110 requires the Secretary to establish and
administer a Service Loan Repayment Program in which to pay an
individual's student loans in return for the individual
providing health care services to Indians. Eligibility,
application information, decision deadlines, priorities,
contract requirements, and loan payment terms are set forth.
Individuals with written contracts under this section shall not
count towards any employment ceiling affecting the Department.
The Secretary shall conduct recruiting programs and section 214
of the Public Health Service Act shall not apply to individuals
during their obligated service period. Terms governing
assignment of individuals, breach of contract, and waiver or
suspension of obligation are specified. The Secretary must
submit a report to Congress providing data on program
implementation on an annual basis.
Section 111. Scholarship and Loan Repayment Recovery Fund
Section 111 establishes an Indian Health Scholarship and
Loan Repayment Recovery Fund in the United States Treasury. The
Fund shall consist of amounts collected under sections 104(d),
106(e), and 110(l), any funds appropriated to the Fund, and
interest earned on amounts in the Fund. Amounts in the Fund may
be used to make payments to specified Indian Health Programs,
may only be invested in interest bearing obligations of the
United States, and such obligations may be sold by the
Secretary of the Treasury at market price.
Section 112. Recruitment activities
Section 112 allows the Secretary to reimburse health
professionals seeking positions with Indian Health Programs or
Urban Indian Organizations for certain travel expenses.
Individuals considering entering into a contract under section
110 and their spouses may also be reimbursed for such expenses.
One individual from each Area Office shall be assigned by the
Secretary to be responsible on a full-time basis for
recruitment activities.
Section 113. Indian recruitment and retention program
Section 113 requires the Secretary to fund, on a
competitive basis, innovative demonstration projects to enable
Tribal Health Programs and Urban Indian Organizations to
recruit, place, and retain health professionals to meet their
staffing needs.
Section 114. Advanced training and research
Section 114 requires the Secretary to establish a
demonstration project to enable health professionals who have
worked in an Indian Health Program or Urban Indian Organization
to pursue advanced training or research areas of study for
which there is a need. Participating individuals must perform
an active duty service obligation in an Indian Health Program
or Urban Indian Organization and shall be liable to the United
States for failure to complete such service obligation.
Section 115. Quentin N. Burdick American Indians Into Nursing Program
Section 115 requires the Secretary to provide grants to
public or private schools of nursing, tribal colleges or
universities, nurse midwife programs and advanced practice
nurse programs to increase the number of nurses, nurse
midwives, and nurse practitioners who deliver health care
services to Indians. Use of grants and grant recipient
priorities are specified. One grant shall be provided to the
Quentin N. Burdick American Indians Into Nursing Program at the
University of North Dakota. Individuals receiving training
pursuant to this section shall incur an active duty service
obligation.
Section 116. Tribal cultural orientation
Section 116 requires the Secretary to mandate that
employees of the Service serving Indian Tribes in each Service
Area receive educational instruction in the history and culture
of Indian Tribes and their relationship to the Service. Details
of the program are also set forth.
Section 117. Inmed Program
Section 117 authorizes the Secretary to provide grants to
colleges and universities to maintain and expand the Indian
health careers recruitment program known as the ``Indians Into
Medicine Program'' to encourage Indians to enter the health
professions. One grant shall be provided to the University of
North Dakota. The Secretary shall develop regulations governing
grants and applicants must meet specified criteria.
Section 118. Health training programs of community colleges
Section 118 requires the Secretary to award grants to
community colleges to assist such colleges in establishing or
maintaining programs leading to a degree or diploma in a health
profession for individuals who desire to practice such
profession on or near a reservation or in an Indian Health
Program. The Secretary shall enter into agreements with the
community colleges to provide qualified Service personnel to
teach in the colleges and to provide technical assistance and
support to such colleges. Any program receiving funding under
this section must offer advanced training for certain health
professionals. Tribal colleges and universities in the Service
Areas shall be given priority.
Section 119. Retention bonus
Section 119 authorizes the Secretary to pay a retention
bonus to certain health professionals employed by, or assigned
to, and serving in, an Indian Health Program or Urban Indian
Organization either as a civilian employee or as a commissioned
officer in the Regular or Reserve Corps of the Public Health
Service. The Secretary may establish retention bonus rates for
multiyear agreements. In the event of default, the retention
bonus plus interest must be repaid.
Section 120. Nursing residency program
Section 120 requires the Secretary to establish a program
to enable Indian nurses working in an Indian Health Program or
Urban Indian Organization to pursue advanced training. Program
participants are obligated to serve in an Indian Health Program
or Urban Indian Organization.
Section 121. Community Health Aide Program
Section 121 requires the Secretary to develop and operate a
Community Health Aide Program in Alaska. Specific program
requirements are set forth. A neutral panel, established by the
Secretary, shall conduct a study of the dental health aide
therapist services provided by the Community Health Aide
Program to ensure that the quality of care provided through
those services is adequate and appropriate. If the Secretary
determines it is appropriate, the Secretary may establish a
national Community Health Aide Program. The report shall be
submitted to the specified Congressional committees.
The Community Health Aide Program (CHAP), except for dental
health aide therapists' certification, may expand nationally.
The Dental Health Aide Therapist program will be limited to
Alaska only and the therapists' scope of practice will be
limited to the procedures as stated in the January 31, 2005,
Community Health Aide Program Certification Board's Standards
and Procedures. The Committee believes the importance of the
dental health aide program as part of a comprehensive oral
health care delivery system led by licensed dentists should not
be understated. This program provides an important extension of
the community health aide program because dental health aides
will work and live in the villages helping to establish disease
prevention and health education programs that can break the
dental disease cycle affecting many American Indians and Alaska
Natives. With the emphasis on prevention, the amount of new
active disease can be reduced and treatment of any new active
disease can be more easily managed.
The Committee crafted this language with input from other
concerned Members, after consideration of the endorsement of
the dental health aide therapist program by national Indian
organizations and public health organizations, and with the
assistance of the American Dental Association to ensure safety
and continued quality care in the larger CHAP program by
imposing certain limitations on the practice of dental health
aide therapists found in paragraph (b)(7). To help ensure the
continued quality of the dental health aides certified by the
Federal Community Health Aide Program Certification Board in
Alaska, the board should include at least one dentist from
outside the tribal community, who has actively practiced
dentistry and who has expertise in setting quality standards
for evaluating competence in education and practice. In
paragraph (b)(7), ``medical emergency'' is defined as an injury
or illness, including infection, that poses an immediate threat
to a person's well being, health or life. Also in paragraph
(b)(7), deciduous teeth are defined as primary teeth and adult
teeth are defined as permanent teeth. The amended provision
also provides for the Secretary to establish a neutral panel to
conduct a study of the dental health aide therapist services
and the services of other mid-level providers, such as the
Community Dental Health Coordinator, as developed by the
American Dental Association.
Section 122. Tribal Health Program administration
Section 122 requires the Secretary to provide training for
Indians in the administration and planning of Tribal Health
Programs.
Section 123. Health professional chronic shortage demonstration
programs
Section 123 authorizes the Secretary to fund demonstration
programs for Tribal Health Programs to address the chronic
shortages of health professionals. Demonstration programs must
be established for the purposes identified and must incorporate
a program advisory board composed of representatives from
Indian tribes and Indian communities in the area to be served.
Section 124. National Health Service Corps
Section 124 prohibits the Secretary from removing a member
of the National Health Service Corps from an Indian Health
Program or Urban Indian Organization or withdrawing funding
used to support such member unless the Secretary has ensured
that the Indians receiving services from such member will
experience no reduction in services. Certain National Health
Service Corps scholars are exempt from the full-time equivalent
limitations of the National Health Service Corps and the
Service when serving as a commissioned corps officer in a
Tribal Health Program or an Urban Indian Organization.
Section 125. Substance abuse counselor educational curricula
demonstration programs
Section 125 permits the Secretary to enter into three year
contracts with, or make three year grants to, tribal colleges
and universities and community colleges to establish
demonstration programs to develop educational curricula for
substance abuse counseling. The Secretary is required to
develop and issue criteria for the review and approval of
funding applications and must submit a report to the President
on the findings and conclusions from the demonstration
programs. Terms for use of funds, duration of grants and
renewal are set forth.
Section 126. Behavioral health training and community education
programs
Section 126 requires the Secretary, and the Secretary of
the Interior, to consult with Indian tribes and tribal
organizations in conducting a study and compiling a list of the
types of staff positions within the Indian Health Service,
Bureau of Indian Affairs and Indian tribes, Tribal
Organizations and Urban Indian Organizations whose
qualifications include, or should include, training in the
identification, prevention, education, referral, or treatment
of mental illness, or dysfunctional and self destructive
behavior. The appropriate Secretary is required to provide
training, or ensure that training is provided, appropriate to
the staff position. Upon request of an Indian Tribe, Tribal
Organization, or Urban Indian Organization, the Indian Health
Service is required to develop and implement, or assist in the
development and implementation of, a community education
program on mental illness. No later than 90 days after date of
enactment of this measure, the Secretary is required to develop
a plan to increase the health care staff providing behavioral
health services by at least 500 positions within five years.
Section 127. Authorization of appropriations
Section 127 authorizes such sums as may be necessary to
carry out Title I.
Title II--Health Services
Section 201. Indian health care improvement funds
Section 201 authorizes the Secretary to expend funds to
fulfill the purposes specified in this section, such as
eliminating the deficiencies in the health status and health
resources of all Indian tribes, meeting the health needs of
Indians, and training of traditional health care practitioners.
Funds appropriated under this section may not be used to offset
or limit any other appropriated funds. Funds appropriated
pursuant to this section shall be used to improve the health
status and reduce the resource deficiency of each Indian Tribe.
The term ``health status and resource deficiency'' is
definedfor purposes of this section and the health resources available
to an Indian Tribe or Tribal Organization is clarified. The Secretary
is also required to establish procedures for a review of any
determination of the extent of the health status and resource
deficiency of an Indian Tribe or Tribal Organization. The Secretary
must submit a report to Congress on the current health status and
resource deficiency of the Service for each Service Unit. Funds
appropriated pursuant to this section shall be designated as the
``Indian Health Care Improvement Fund.'' The funds shall be included in
the base budget of the Service.
While the Administration has raised concerns about
extending FTCA liability for services provided by traditional
health care practitioners, this provision, as well as many of
the other provisions, are existing law. The Committee believes
that the policy of self-governance should be furthered and that
there should be no regression from existing law. The Committee
also believes that the Administration's concern is unfounded
and that the federal government is adequately protected.
Section 202. Catastrophic Health Emergency Fund
Section 202 establishes an Indian Catastrophic Health
Emergency Fund to be administered by the Secretary solely for
the purpose of meeting the extraordinary medical costs
associated with the treatment of victims of disasters or
catastrophic illnesses who are within the Service's
responsibility. Neither these funds nor their administration
shall be subject to a contract or grant, nor shall such funds
be allocated, apportioned, or delegated to an Area Office,
Service Unit, or other similar basis. The Secretary is required
to promulgate regulations in accordance with this section.
Funds under this section may not be used to offset or limit
appropriations made under any other law. All reimbursements
from any other source by reason of treatment rendered to any
victim of a disaster or catastrophic illness shall be deposited
to this Fund.
Section 203. Health promotion and disease prevention services
Section 203 finds that health promotion and disease
prevention activities improve the health and well-being of
Indians and reduces health care expenses of Indians. The
Secretary is required to provide health promotion and disease
prevention services to Indians. After receiving input from the
affected Tribal Health Programs, the Secretary shall submit a
report to Congress on the health promotion and disease
prevention needs of Indians and the best activities to meet
such needs.
Section 204. Diabetes prevention, treatment, and control
Section 204 requires the Secretary, in consultation with
Indian Tribes and Tribal Organizations, to determine the
incidence of, and the type of complications resulting from
diabetes among Indians and the measures required to reduce the
incidence of diabetes. To the extent medically indicated and
with informed consent, the Secretary must screen each Indian
who receives diabetes services from the Service. The Secretary
shall also maintain any model diabetes project and other
specified projects in existence on the date of enactment of
this Act. The Secretary may provide dialysis programs. To the
extent funding is available, the Secretary shall undertake
other specified duties related to diabetes.
Section 205. Shared services for long-term care
Section 205 authorizes the Secretary to provide, either
directly or through grants or contracts, long-term care
services to Indians. Agreements between the Service and Tribal
Health Programs, Indian Tribes or Tribal Organizations must
provide for the sharing of staff or other services. Nursing
facilities must meet the requirements of Section 1919 of the
Social Security Act. The Secretary is required to provide
technical assistance to enable applicants to comply with the
provisions of this section and shall encourage the use of
existing underused facilities.
Section 206. Health services research
Section 206 requires the Secretary to fund research to
further the performance of the health service responsibilities
of Indian Health Programs. To the extent practicable, the
Secretary must coordinate departmental research resources and
activities to address relevant Indian Health Program research
needs. Tribal Health Programs shall have an equal opportunity
to compete for, and receive research funds under this section.
Use of funds are specified. The Secretary shall evaluate the
research and disseminate to the Tribal Health Programs
information regarding the research under this section.
Section 207. Mammography and other cancer screening
Section 207 requires the Secretary to provide mammography
and other cancer screening as recommended by the United States
Preventive Services Task Force.
Section 208. Patient travel costs
Section 208 defines the term ``qualified escort'' for
purposes of this section and authorizes the Secretary to fund
certain patient travel costs, including qualified escorts,
associated with receiving health care services.
Section 209. Epidemiology centers
Section 209 requires the Secretary to establish an
epidemiology center in each Service Area to carry out specified
functions. The Director of the Centers for Disease Control and
Prevention shall provide technical assistance to the centers.
Grants may be made by the Secretary to tribes, tribal
organizations, eligible intertribal consortia, and Urban Indian
Organizations to conduct epidemiological studies of Indian
communities. Epidemiology centers operated under such grants
shall be treated as public health authorities for purposes of
the Health Insurance Portability and Accountability Act of
1968. Eligible intertribal consortia is defined for purposes of
this section.
Section 210. Comprehensive school health education programs
Section 210 authorizes the Secretary to award grants to
Indian Tribes, Tribal Organizations, and Urban Indian
Organizations to develop comprehensive school health education
programs for children from pre-school through grade 12 in
schools for the benefit of Indian and Urban Indian children.
Upon request, the Secretary shall provide technical assistance
to a Tribe, Tribal Organization or Urban Indian Organization.
The Secretary shall also establish criteria for the review and
approval of grant applications under this section and shall
develop a comprehensive school health education program in
schools funded by the Bureau of Indian Affairs.
Section 211. Indian youth program
Section 211 authorizes the Secretary to establish and
administer a grant program to be awarded to Indian Tribes,
Tribal Organizations, and Urban Indian Organizations for
innovative mental and physical disease prevention and health
promotion and treatment programs for Indian and Urban Indian
preadolescent and adolescent youth. The allowable and
prohibited uses of the funds as well as the Secretary's duties
are set forth.
Section 212. Prevention, control, and elimination of communicable and
infectious diseases
Section 212 authorizes the Secretary to make grants
available to Indian Tribes, Tribal Organizations, and Urban
Indian Organizations for the prevention, control, and
elimination of communicable and infectious diseases, and other
specified related activities. Grant recipients are encouraged
to coordinate their activities with the Centers for Disease
Control and Prevention and State and local health agencies.
Upon request of an Indian Tribe, Tribal Organization, or Urban
Indian Organization, the Secretary may provide technical
assistance. The Secretary must prepare and submit a report to
Congress on the use of funds and the progress made toward
preventing, controlling, and eliminating communicable and
infectious diseases amongst Indians.
Section 213. Authority for provision of other services
Section 213 allows the Secretary to provide funding to meet
the Declaration of National Indian Health Policy objectives set
forth in Section 3 through health care-related services and
programs not otherwise described in this bill. Any service
provided shall meet the terms and conditions set forth. This
section also provides definitions for ``home- and community-
based services'' and ``hospice care'' for purposes of this
section.
Section 214. Indian women's health care
Section 214 requires the Secretary to monitor and improve
the quality of Indian women's health care through the planning
and delivery of programs.
Section 215. Environmental and nuclear health hazards
Section 215 requires the Secretary, along with other
federal agencies, to conduct studies and ongoing monitoring
programs to determine trends in the health hazards to Indian
miners and to other Indians as a result of environmental
hazards which may result in chronic or life threatening health
problems. Upon completion of such studies, the Secretary shall
develop health care plans to address the studied health
problems. The studies shall be submitted to Congress. An
Intergovernmental Task Force, composed of various federal
agencies, is established to identify existing and potential
operations related to nuclear resource development or other
environmental hazards that affect or may affect the health of
Indians and to undertake activities to correct existing health
hazards and ensure that current and future health problems are
minimized or reduced. The Indian Health Service shall provide
appropriate medical care to Indians who suffer from a work-
related illness as a result of employment in or near an
environmental hazard.
Section 216. Arizona as a contract health service delivery area
Section 216 designates the State of Arizona as a contract
health service delivery area through the fiscal year ending
September 30, 2016 for the purpose of providing contract health
care services to members of federally recognized Indian Tribes
of Arizona. The Service may not curtail any health care
services as a result of this provision.
Section 216A. North Dakota and South Dakota as contract health service
delivery area
Section 216A provides that beginning in fiscal year 2003,
the States of North Dakota and South Dakota are designated as a
contract health service delivery area for the purpose of
providing contract health care services to members of federally
recognized Indian Tribes of North Dakota and South Dakota.
Section 217. California contract health services program
Section 217 authorizes the Secretary to fund a program
using the California Rural Indian Health Board as a contract
care intermediary to improve the accessibility of health
services to California Indians. The Board shall be reimbursed
for costs incurred pursuant to this section, however, not more
than five percent of the reimbursed amounts may be used for
administrative expenses. Payment shall not be made for
treatment that may be paid for under the Indian Catastrophic
Health Emergency Fund. An advisory board, consisting of not
less than eight Tribal Health Programs serving California
Indians, shall advise the California Rural Indian Health Board.
Section 218. California as a contract health service delivery area
Section 218 designates the State of California, excluding
specified counties, as a contract health service delivery area
for the purpose of providing contract health care services to
California Indians. Excluded counties may only be included in
the contract health services delivery area if funding is
specifically provided by the Service for such services in those
counties.
Section 219. Contract health services for the Trenton Service Area
Section 219 directs the Secretary to provide contract
health care services to Turtle Mountain Band members residing
in specified counties of the Trenton Service Area. Nothing in
this section expands the eligibility of Band members for health
services beyond the scope of eligibility for such health
services that applied on May 1, 1986.
Section 220. Programs operated by Indian tribes and tribal
organizations
Section 220 requires the Indian Health Service to provide
funding to Tribal Health Programs on the same basis as funding
is provided to programs and facilities operated directly by the
Service.
Section 221. Licensing
Section 221 exempts Tribal Health Program health care
professionals from State licensing requirements for the State
in which the Tribal Health Program performs its services
pursuant to its contract or compact.
Section 222. Notification of provision of emergency contract health
services
Section 222 provides that elderly or disabled Indians
receiving emergency medical care or services from a non-Service
provider or in a non-Service facility shall have 30 days to
notify the Service of such treatment or admission.
Section 223. Prompt action on payment of claims
Section 223 establishes a time frame for the Service to
respond to a notification of a claim by a contract care service
provider. Failure to respond within the time established
requires the Service to accept the claim as valid. Payment on
valid contract care service claims shall be made within 30 days
after completion of the claim.
Section 224. Liability for payment
Section 224 exempts patients receiving authorized contract
health care services from liability for payment of such costs
associated with the provision of such services. The Secretary
shall notify the contract care provider and the patient that
the patient is not liable for payment. Upon receipt of a notice
that the claim is accepted or that the patient is not liable,
the provider shall have no further recourse against the
patient.
Section 225. Office of Indian Men's Health
Section 225 permits the Secretary to establish an Office of
Indian Men's Health within the Service. A Director, appointed
by the Secretary, shall head the Office and shall coordinate
and promote the health status of Indian men. Not later than two
years after enactment of this bill, the Secretary shall submit
a report to Congress describing the activities carried out by
the Director and any findings by the Director with respect to
the health of Indian men.
Section 226. Authorization of appropriations
Section 226 authorizes appropriations in such sums as
necessary for each fiscal year through fiscal year 2017.
Title III--Facilities
Section 301. Consultation; Construction and renovation of facilities;
Reports
Section 301 requires the Secretary to take certain actions
before expending or committing appropriated funds for
facilities planning, design, construction, or renovation.
Notwithstanding any other provision of law, the Secretary may
not close a facility if the Secretary has not submitted an
evaluation report to Congress that addresses the impact of the
proposed closure and other specified considerations. The
Secretary must maintain a health care priority system. Not
later than one year after establishing the priority system, the
Comptroller General of the United States shall prepare and
finalize a report reviewing the methodologies applied, and the
processes followed, by the Service in assessing the needs and
developing the priority system. All funds appropriated for the
planning, design, construction, or renovation of health care
facilities shall be subject to the provisions of the Indian
Self-Determination and Education Assistance Act. The Secretary
shall consult and cooperate with Indian Tribes, Tribal
Organizations, and Urban Indian Organizations in developing
innovative approaches to address all or part of the total unmet
need for construction of health facilities.
Section 302. Sanitation facilities
Section 302 sets forth findings relating to the need for
sanitation facilities and reaffirms that the Service has
primary responsibility and authority to provide necessary
sanitation facilities and services. Funding sources and terms
and conditions on the use of such funding are set forth. The
financial and technical capability of an Indian Tribe, Tribal
Organization, or Indian community to safely operate, manage,
and maintain a sanitation facility shall not be a prerequisite
to the provision or construction of sanitation facilities.
Financial assistance may be provided to tribes, tribal
organizations, and Indian communities for the operation,
management, and maintenance of their sanitation facility.
Reasonable user fees shall be established, collected, and used
as determined by the Tribe. Tribal Health Programs shall be
eligible for funding on an equal basis as programs administered
by the Service. A report, in accordance with this section,
shall be submitted by the Secretary as part of the reporting
requirements under section 801. The terms ``Indian community,''
``Sanitation facility,'' and ``Sanitation facilities'' are
defined for purposes of this section.
Section 303. Preference to Indians and Indian firms
Section 303 authorizes the Secretary to utilize the Buy
Indian Act, 25 U.S.C. Sec. 47, in the construction and
renovation of Service facilities pursuant to Section 301, and
in the construction of sanitation facilities pursuant to
Section 302. With regard to subchapter IV of chapter 31 of
title 40 of the Act commonly known as the ``Davis-Bacon Act,''
it is the intention of the Committee to maintain current law.
When Indian health facilities are constructed or renovated,
Davis-Bacon prevailing wage rates apply. However, pursuant to
current federal law and longstanding policy of the Department
of Labor, Indian Health Service, and Bureau of Indian Affairs,
when Indian tribes and tribal organization construct or
renovate federally-funded Indian health facilities using their
own employees, Davis-Bacon prevailing wage rates do not apply.
The intention of the Committee is to maintain the status quo of
current law and policy pursuant to the Davis-Bacon Act and the
Indian Self-Determination and Education Assistance Act in this
regard.
Section 304. Expenditure of non-service funds for renovation
Section 304 permits the Secretary, if specified
requirements are met, to accept any major expansion,
renovation, or modernization by any Indian Tribe or Tribal
Organization of any Service facility or of any other Indian
health facility operated pursuant to a contract or compact. A
separate priority list to address the increased operating
expenses of expanded, renovated or modernized facilities shall
be developed and maintained by the Secretary. The report shall
be transmitted to Congress under section 801.
Section 305. Funding for the construction, expansion, and modernization
of small ambulatory care facilities
Section 305 requires the Secretary to make grants to Indian
Tribes and Tribal Organizations for the construction,
expansion, and modernization of small ambulatory care
facilities. Funds may be used as specified in this section.
Grants must be approved by the Secretary in accordance with
regulations. If grant funds are used on a facility that later
is no longer used for the delivery of such health care
services, all right, title, and interest in and to the facility
shall transfer to the United States unless otherwise
negotiated. Grant funds are nonrecurring and may not be
included in an ISDEAA award.
Section 306. Indian Health Care delivery demonstration project
Section 306 authorizes the Secretary to enter into ISDEAA
contracts for the purpose of carrying out health care delivery
demonstration projects to test alternative means of delivering
health care and services to Indians. Funds may be used for the
construction and renovation of hospitals, health centers,
health stations, and other facilities to deliver health care
services. Regulations shall be developed for the review and
approval of applications. Projects meeting specified criteria
may be approved. Peer review panels may be used to review and
evaluate applications. The Secretary may provide technical and
other assistance to enable applicants to comply with this
section. Priority shall be given to demonstration projects in
the following Service Units: Cass Lake, Minnesota; Mescalero,
New Mexico; Owyhee, Nevada; Schurz, Nevada; and Fort Yuma,
California. The authority to provide services to otherwise
ineligible persons and to extend hospital privileges in Service
facilities to non-Service health practitioners may be included
in a demonstration project. Facilities operated under a
contract or compact shall be evaluated under the same criteria
that the Secretary uses in evaluating facilities operated
directly by the Service. Facilities subject to a contract or
compact shall be fully and equitably integrated into the
implementation of the health care delivery demonstration
projects.
Section 307. Land transfer
Section 307 authorizes the Bureau of Indian Affairs and all
federal agencies and departments to transfer, at no cost, land
and improvements to the Service for the provision of health
care services.
Section 308. Leases, contracts, and other agreements
Section 308 authorizes the Secretary to enter into leases,
contracts, and other agreements with Indian tribes and Tribal
Organizations for facilities used or to be used in the
administration and delivery of health services by an Indian
Health Program.
Section 309. Study on loans, loan guarantees, and loan repayment
Section 309 requires the Secretary to study feasibility of
establishing a loan fund to provide direct loans and loan
guarantees to Indian Tribes and Tribal Organizations for the
construction of health care facilities. The study must include
certain specified information and be submitted to Congress no
later than September 30, 2009.
Section 310. Tribal leasing
Section 310 authorizes a Tribal Health Program to lease
permanent structures for the purpose of providing health care
services without obtaining advance approval in appropriations
acts.
Section 311. Indian Health Service/Tribal Facilities Joint Venture
Program
Section 311 requires the Secretary to make arrangements
with Indian Tribes and Tribal Organizations to establish joint
venture demonstration projects, under which an Indian Tribe or
Tribal Organization must expend tribal, private, or other
available funds to acquire or construct a health facility for a
minimum of 10 years, under a no-cost lease. In exchange, the
Service would provide the equipment, supplies, and staffing for
the operation and maintenance of such health facility. The
Secretary is required to make such an arrangement in specified
instances and to continue the agreement at the end of the lease
period. The Indian Tribe or Tribal Organization shall be liable
to the United States for breach of the agreement and the Indian
Tribe or Tribal Organization may recover from the United States
if the Service breaches the agreement. The terms ``health
facility'' or ``health facilities'' are defined for purposes of
this section.
Section 312. Location of facilities
Section 312 requires the Bureau of Indian Affairs and the
Service to give priority to locating Service facilities and
projects on Indian lands or certain lands in Alaska. The term
``Indian lands'' is defined for purposes of this section.
Section 313. Maintenance and improvement of health care facilities
Section 313 requires the Secretary to submit to the
President, for inclusion in the report required to be
transmitted to Congress under section 801, a report on the
backlog of maintenance and repair work required at Service and
tribal health care facilities and the need for renovation and
expansion at existing facilities. The Secretary may provide
funds to support maintenance of newly constructed space. An
Indian Tribe or Tribal Organization may use maintenance and
improvement funds to construct a replacement facility if the
costs of renovation exceed a maximum renovation cost threshold.
Section 314. Tribal management of Federally-owned quarters
Section 314 authorizes a Tribal Health Program operating a
health facility and the federally-owned quarters associated
with it pursuant to a contract or compact to establish the
rental rates charged to the occupants of the such quarters. A
Tribal Health Program shall endeavor to achieve specified
objectives, and may collect rents directly from federal
employees occupying such quarters. Specific provisions govern
rental rates for federal employees in Alaska.
Section 315. Applicability of Buy American Act requirements
Section 315 requires the Secretary to comply with the Buy
American Act on all procurements made under section 317. Indian
Tribes and Tribal Organizations, however, are exempt from this
requirement. Any person who violates the Buy American Act shall
be subject to the penalties specified in this section.
Section 316. Other funding for facilities
Section 316 authorizes the Secretary to accept health care
facilities construction funds from any source and to use such
funds to plan, design, and construct health care facilities for
Indians. In addition, the Secretary may enter into interagency
agreements with other federal or state agencies, or other
entities and to accept funds to the planning, design, and
construction of health care facilities. Standards for the
planning, design, and construction of health care facilities
serving Indians shall be established by regulation.
Section 317. Authorization of appropriations
Section 317 authorizes such sums as may be necessary to be
appropriated through fiscal year 2017.
Title IV--Access to Health Services
Section 401. Treatment of payments under Social Security Act health
benefits programs
Section 401 provides that payments received by an Indian
Health Program or by an Urban Indian Organization under title
XVIII, XIX, and XXI of the Social Security Act for services
provided to Indians shall not be considered in determining
appropriations for the provision of health care and services to
Indians. Nothing in this Act authorizes the Secretary to
provide services to an Indian with coverage under title XVIII,
XIX, or XXI of the Social Security Act in preference to an
Indian without such coverage. Social Security payments to which
a Service facility is entitled shall be placed in a special
fund held by the Secretary and used as specified. A Tribal
Health Program may elect to directly bill for, and receive
Social Security payments for, health care items and services
provided. This section cross-references other provisions of the
Social Security Act.
Section 402. Grants to and contracts with the Service, Indian Tribes,
Tribal Organizations, and Urban Indian Organizations to
facilitate outreach, enrollment, and coverage of Indians under
Social Security Act health benefit programs and other health
benefits programs
Section 402 requires the Secretary to make grants to or
enter into contracts with Indian Tribes and Tribal
Organizations to assist such entities in establishing and
administering programs on or near reservations and trust lands
to assist individual Indians with activities specified in this
section. The Secretary shall place any necessary conditions and
requirements on the grants or contracts. Urban Indian
Organizations may also receive grants and other funding as
specified. The Secretary is directed to take such steps as are
necessary to facilitate cooperation with, and agreements
between, States and the Service, Indian tribes, tribal
organizations and Urban Indian Organizations. This section
cross-references to other provisions of the Social Security
Act. The terms ``Premium'' and ``Cost Sharing'' are defined for
purposes of this section.
Section 403. Reimbursement from certain third parties of costs of
health services
Section 403 provides the United States, an Indian Tribe, or
Tribal Organization with the right to recovery, in accordance
with this section, from an insurance company, health
maintenance organization, employee benefit plan, third-party
tortfeasor, or any other responsible or liable third party the
reasonable charges billed by the Secretary, an Indian Tribe, or
Tribal Organization for the provision of health services to any
individual to the same extent that such individual would be
eligible to receive damages, reimbursement or indemnification
for such charges or expenses.
With respect to the right of recovery against a State, this
section only applies if the injury, illness, or disability is
covered under workers' compensation laws or a no-fault
automobile accident insurance plan. No state law and no
contract provision, insurance policy, or other health care plan
or program entered into or renewed after the date of enactment
of this Act shall prevent or hinder the right of recovery under
this section. Any right of recovery exercised pursuant to this
section shall not deny the injured person the right of recovery
for that portion of the person's damages not covered under this
section. Provisions governing enforcement of the right of
recovery are provided.
Absent specific written authorization by a Tribal
government, the United States shall not have a right of
recovery under this section for an injury, illness, or
disability covered by a self-insurance plan funded by an Indian
Tribe, Tribal Organization, or Urban Indian Organization. A
prevailing plaintiff shall be awarded reasonable attorney's
fees and costs of litigation.
A claim for benefits from specified entities may not be
denied based on the format in which the claim is submitted.
This section also applies to Urban Indian Organizations.
Section 2415 of title 18, United States Code, applies to all
actions commenced under this section. Nothing in this section
shall be construed to limit any right of recovery available to
the United States, an Indian Tribe, or Tribal Organization
under the provisions of any applicable federal, state or tribal
law.
Section 404. Crediting of reimbursements
Section 404 provides that, except as provided in section
202(f) and section 807, all reimbursements received or
recovered under specified programs shall be credited to the
Service, Indian tribe, Tribal Organization or Urban Indian
Organization and used as provided in section 401. The Service
may not offset or limit any amount obligated to any Service
Unit or entity because of reimbursements under this section.
Section 405. Purchasing health care coverage
Section 405 authorizes Indian Tribes, Tribal Organizations,
and Urban Indian Organizations to use funds provided for health
benefits under any provision of law, other than those made
available under section 402, to purchase health benefits
coverages for beneficiaries. The amounts may also be used for
the expenses of operating a self-insured plan.
Section 406. Sharing arrangements with Federal agencies
Section 406 authorizes the Secretary to enter into or
expand arrangements for the sharing of medical facilities and
services between the Service, Indian Tribes, and Tribal
Organizations and the Department of Veterans Affairs and the
Department of Defense. The Secretary is prohibited from taking
certain actions that would: (1) Impair the priority access of
any Indian to health care services provided through the Service
and the eligibility of any Indian to receive health services
through the Service; (2) the quality of health care services
provided to any Indian through the Service; (3) the priority
access of any veteran to health care services provided by the
Department of Veterans Affairs; (4) the quality of health care
services provided by the Department of Veterans Affairs or the
Department of Defense; or (5) the eligibility of any Indian who
is a veteran to receive health services through the Department
of Veterans Affairs. The Department of Defense or the
Department of Veterans Affairs shall reimburse the Service,
Indian tribe, or Tribal Organization for services provided to
beneficiaries eligible for services from either Department.
Section 407. Payor of last resort
Section 407 mandates that, notwithstanding any federal,
state, or local law to the contrary, the Indian Health Programs
and health care programs operated by Urban Indian Organizations
are the payor of last resort for services provided to eligible
persons.
Section 408. Nondiscrimination under Federal health care programs in
qualifications for reimbursement for services
Section 408 requires a federal health care program to
accept an entity operated by the Service, an Indian Tribe,
Tribal Organization, or Urban Indian Organization as an
eligible provider for payment under the program for health care
services furnished to an Indian on the same basis as any other
provider qualified to participate as a health care services
provider under the program. A health care services entity
operated by the Service, an Indian Tribe, Tribal Organization,
or Urban Indian Organization shall be deemed to have met any
State or local licensure or recognition requirements for
purposes of participating as a health care services provider in
specified circumstances. Certain entities that have been
excluded from participating in a federal health care program
and certain entities and individuals who have had their license
suspended or revoked by a State may not receive payment or
reimbursement under the federal health care program. The term
``federal health care program'' is defined for purposes of this
section. This section cross-references certain provisions of
the Social Security Act.
Section 409. Consultation
Section 409 cross-references section 1139(d) of the Social
Security Act for provisions related to consultation with
representatives of Indian Health Programs and Urban Indian
Organizations with respect to the health care programs
established under Titles XVIII, XIX, and XXI of the Social
Security Act.
Section 410. State Children's Health Insurance Program (SCHIP)
Section 410 cross-references sections of the Social
Security Act related to outreach to families of Indian children
likely to be eligible for child health assistance under SCHIP
and related to ensuring that child health assistance is
provided under such program and that payments are made to
Indian Health Programs and Urban Indian Organizations.
Section 411. Exclusion waiver authority for affected Indian health
programs and safe harbor transactions under the Social Security
Act
Section 411 cross-references the Social Security Act for
provisions relating to exclusion waiver authority for affected
Indian Health Programs and relating to certain transactions
involving Indian Health Programs deemed to be in safe harbors.
Section 412. Premium and cost sharing protections and eligibility
determinations under Medicaid and SCHIP and protection of
certain Indian property from Medicaid estate recovery
Section 412 cross-references the Social Security Act for
provisions relating to premiums or cost sharing protections for
Indians furnished items or services directly by Indian Health
Programs or through referral under the contract health service
under the Medicaid program; relating rules regarding the
treatment of certain property for purposes of determining
eligibility; and relating to the protection of certain property
from estate recovery provisions under the Medicaid program.
Section 413. Treatment under Medicaid and SCHIP managed care
Section 413 cross-references the Social Security Act for
provisions relating to the treatment of Indians enrolled in a
managed care entity under the Medicaid program and Indian
Health Programs and Urban Indian Organizations that are
providers of items or services to such Indian enrollees.
Section 414. Navajo Nation Medicaid Agency feasibility study
Section 414 requires the Secretary to study the feasibility
of treating the Navajo Nation as a State for purposes of title
XIX of the Social Security Act. The study must include certain
considerations. A report of the feasibility study must be
provided to Congress.
Section 415. General exceptions
Section 415 provides that the requirements of this Title
shall not apply to any excepted benefits described in certain
paragraphs of the Public Health Service Act.
Section 416. Authorization of appropriations
Section 416 authorizes appropriations of such sums as may
be necessary for each fiscal year through fiscal year 2017.
Title--Health Services for Urban Indians
Section 501. Purpose
Section 501 states that the purpose of this title is to
establish and maintain programs in Urban Centers to make health
services more accessible and available to Urban Indians.
Section 502. Contracts with, and grants to, urban Indian organizations
Section 502 requires the Secretary to enter into contracts
with, or make grants to, Urban Indian Organizations to assist
in the establishment and administration of programs in Urban
Centers that meet the requirements specified in this Title.
Section 503. Contracts and grants for the provision of health care and
referral services
Section 503 requires the Secretary to enter into contracts
with, and make grants to, Urban Indian Organizations for the
provision of health care and referral services for Urban
Indians. Urban Indian Organizations will be selected using
criteria prescribed by regulations and that includes certain
specified factors. The Secretary shall facilitate access to or
provide health promotion, disease prevention services,
immunization services, behavioral health services, and child
abuse prevention and treatment programs for Urban Indians.
Other grants or contracts may be entered into between the
Secretary and Urban Indian Organizations to provide or arrange
for health care services to Urban Indians.
Section 504. Contracts and grants for the determination of unmet health
care needs
Section 504 authorizes the Secretary to enter into
contracts with, or make grants to, Urban Indian Organizations
for which there were no contracts or grants entered into under
section 503. The purpose of the grants or contracts shall be to
assist the Secretary in assessing the health status and health
care needs of Urban Indians. Any grant or contract entered into
shall include certain requirements. Grants and contracts under
this section may not be renewed.
Section 505. Evaluations; renewals
Section 505 requires the Secretary to develop procedures to
evaluate compliance with contract and grant requirements
entered into under this Title. Compliance evaluations shall be
conducted by the Secretary as set forth in this section. In the
event of noncompliance with the requirements, the Secretary
shall attempt to resolve with the organization any areas of
noncompliance or unsatisfactory performance. If the
noncompliance or unsatisfactory performance cannot be resolved
and prevented in the future, the Secretary shall not renew the
contract or grant with the organization.
Section 506. Other contract and grant requirements
Section 506 requires that contracts with Urban Indian
Organizations entered into pursuant to this title comply with
all federal contracting laws and regulations relating to
procurement except that in the discretion of the Secretary,
contracts may be negotiated without advertising and need not
conform to other specified provisions of law. The Secretary is
authorized to make contract or grant payments in a single
advance payment, in a semiannual or quarterly payment or by
reimbursement. Contract provisions may be amended by the
Secretary at the request of an Urban Indian Organization.
Contracts or grants must assure the fair and uniform provision
of services and assistance to Urban Indians.
Section 507. Reports and records
Section 507 requires each Urban Indian Organization to
submit to the Secretary a report containing specified
information for each fiscal year that funds are received. Not
later than 18 months after the date of enactment of this Act,
the Secretary shall submit a report to Congress regarding the
health status of, and services provided to, Urban Indians. The
contract and grant reports and records of Urban Indian
Organizations shall be subject to audit by the Secretary and
the Comptroller General of the United States. Annual
independent financial audits shall be an allowable cost of any
contract or grant under sections 502 and 503.
Section 508. Limitation on contract authority
Section 508 limits the Secretary's authority to enter into
contracts with or award grants to the extent, and in the
amount, provided for in appropriations acts.
Section 509. Facilities
Section 509 authorizes the Secretary to make grants to
contractors or grant recipients under this title for the lease,
purchase, renovation, construction or expansion of facilities
in order to assist contractors or grant recipients in complying
with applicable licensure or certification requirements. The
Secretary may conduct a study to determine the feasibility of
establishing a loan fund to provide direct loans or loan
guarantees to Urban Indian Organizations.
Section 510. Division of Urban Indian Health
Section 510 establishes the Division of Urban Indian Health
within the Service to carry out the provisions of this title,
provide central oversight of the programs and services
authorized under this title, and provide technical assistance
to Urban Indian Organizations.
Section. 511. Grants for alcohol and substance abuse related services
Section 511 authorizes the Secretary to make grants for the
provision of health-related services in prevention of,
treatment of, rehabilitation of, or school- and community-based
education regarding alcohol and substance abuse in urban
centers. Each grant shall have specific goals which must be set
forth in the grant. The Secretary shall establish the grant
criteria and develop a methodology for distributing grants.
Section 512. Treatment of certain demonstration projects
Section 512 provides that the Tulsa Clinic and Oklahoma
City Clinic demonstration projects shall be permanent programs,
continue to be treated as Service Units and Operating Units
with respect to resource allocation and coordination of care,
continue to meet the requirements and definitions of an Urban
Indian Organization, and shall not be subject to the ISDEAA.
Section 513. Urban NIAAA transferred programs
Section 513 requires the Secretary to make grants to, or
enter into contracts with, Urban Indian Organizations for the
administration of Urban Indian alcohol programs originally
established under the National Institute on Alcoholism and
Alcohol Abuse. Contracts and grants shall be used to provide
support for the continuation of alcohol prevention and
treatment services for Urban Indians. The Secretary must
evaluate and report to Congress on the activities of these
programs not less than every five years.
Section 514. Consultation with Urban Indian Organizations
Section 514 requires the Secretary to ensure that the
Service consults with Urban Indian Organizations.
``Consultation'' is defined for purposes of this section.
Section 515. Urban youth treatment center demonstration
Section 515 authorizes the Secretary to fund the
construction and operation of at least two residential
treatment centers in each State meeting specified criteria.
Section 516. Grants for diabetes prevention, treatment, and control
Section 516 permits the Secretary to make grants to certain
Urban Indian Organizations for the provision of services for
the prevention and treatment of, and control of the
complications resulting from, diabetes among Urban Indians.
Each grant must specify the goals to be accomplished under the
grant. The Secretary must establish criteria for the grants.
Any funds received by an Urban Indian Organization under this
Act for the prevention, treatment, and control of diabetes
shall be subject to these criteria.
Section 517. Community health representatives
This section authorizes the Secretary to enter into
contracts with, or award grants to, Urban Indian Organizations
to employ Indians trained as health service providers through
the Community Health Representatives Program.
Section 518. Effective date
This section mandates that the amendments made pursuant to
this title shall become effective on the date of enactment of
this Act regardless of whether the Secretary has promulgated
implementing regulations.
Section 519. Eligibility for services
This section mandates that Urban Indians are eligible for,
and the ultimate beneficiaries of, health care and referral
services provided pursuant to this title.
Section 520. Authorization of appropriations
This section authorizes appropriations of such sums as may
be necessary through fiscal year 2017.
Title VI--Organizational Improvements
Section 601. Establishment of the Indian Health Service as an Agency of
the Public Health Service
This section establishes the Indian Health Service within
the Public Health Service of the Department of Health and Human
Services. An Assistant Secretary of Indian Health shall be
appointed by the President, by and with the advice and consent
of the Senate, to administer the Service. The duties and
authorities of the Assistant Secretary are set forth. Any
reference to the Director of the Service in any other federal
law, Executive Order, rule, regulation, or delegation of
authority or in any document of or relating to the Director of
the Service, shall be deemed to refer to the Assistant
Secretary.
Section 602. Automated management information system
This section requires the Secretary to establish an
automated management information system for the Service that
meets specified requirements. Each Tribal Health Program must
be provided with an automated management information system
that meets the management information needs of each Program and
the Service. Each patient shall have reasonable access to his
or her medical or health records held by or on behalf of the
Service. The Secretary may enter into contracts, agreements, or
joint ventures to enhance information technology in Indian
Health Programs and facilities.
Section 603. Authorization of appropriations
This section authorizes appropriations of such sums as may
be necessary through fiscal year 2017.
Title VII--Behavioral Health Programs
Section 701. Behavioral health prevention and treatment services
This section sets forth a number of purposes, plans, and
programs for behavioral health prevention and treatment
services. The Secretary must encourage Indian Tribes, Tribal
Organizations, and Urban Indian Organizations to develop tribal
or local plans for Indian Behavioral Health Services. To the
extent feasible and if funding is available, the Secretary must
provide a comprehensive continuum of behavioral health care and
behavioral health services for Indians with services varying by
the age of the Indian. An Indian tribe, Tribal Organization, or
Urban Indian Organization may establish a community behavioral
health plan to identify and coordinate resources and programs.
The Secretary shall coordinate behavioral health planning with
state and federal agencies. Not later than one year after the
date of enactment of the bill, the Secretary shall assess the
need for inpatient mental health care among Indians and the
availability and cost of such inpatient mental health
facilities.
Section 702. Memoranda of agreement with the Department of the Interior
This section requires the Secretary and the Secretary of
the Interior to enter into a memoranda of agreement or to
update any existing memoranda of agreement required by the
Indian Alcohol and Substance Abuse Prevention and Treatment Act
of 1986 to address specified issues. The agreement must also
contain specified provisions. Each memoranda of agreement must
be published in the Federal Register.
Section 703. Comprehensive behavioral health prevention and treatment
program
This section requires the Secretary to provide
comprehensive behavioral health, prevention, treatment and
aftercare programs. Such programs may be provided pursuant to
contracts with public and private behavioral health treatment
programs.
Section 704. Mental health technician program
This section requires the Secretary to establish and
maintain a mental health technician program to train Indians as
mental health technicians and to employ such technicians in the
provision of community-based mental health care. High-standard
training in mental health care shall be provided to
paraprofessionals based on a curriculum developed or approved
by the Secretary. The Secretary shall supervise and evaluate
the mental health technicians in the training program and shall
ensure that the program uses and promotes traditional health
care practices of the Indian tribes being served.
Section 705. Licensing requirement for mental health care workers
This section requires any psychologist, social worker, or
marriage and family therapist providing mental health care
services to Indians in a clinical setting be licensed in the
respective field. In specified situations, a trainee in
psychology, social work, or marriage and family therapy may
provide mental health care services.
Section 706. Indian women treatment programs
This section allows the Secretary to make grants to Indian
tribes, Tribal Organizations, and Urban Indian Organizations to
develop and implement a comprehensive behavioral health
prevention, intervention, treatment, and relapse prevention
program that specifically addresses the cultural, historical,
social, and child care needs of Indian women. Terms governing
use of funds are specified. The Secretary shall establish
criteria for the review and approval of applications and
proposals for funding under this section. Twenty percent of the
funds appropriated under this section shall be for grants to
Urban Indian Organizations.
Section 707. Indian youth program
This section requires the Secretary to develop and
implement a program for acute detoxification and treatment for
Indian youths. The Secretary must construct, renovate, or, as
necessary, purchase and appropriately staff and operate at
least one youth regional treatment center or treatment network
in each area under the jurisdiction of an Area Office. The
Secretary may provide intermediate technical behavioral health
services to Indian children and adolescents. Federally-owned
structures suitable for local residential or regional
behavioral health treatment for Indian youths shall be
identified and used by the Secretary for such purposes.
Guidelines must be established by the Secretary for determining
the suitability of any such federally-owned structure for such
purposes.
The Secretary, Indian Tribes, or Tribal Organizations, in
cooperation with the Secretary of the Interior, shall develop
and implement in each Service Unit, community-based
rehabilitation and follow-up services for Indian youths who are
having significant behavioral problems and need long-term
treatment after their return to their home community. If
appropriate, family members shall be included in the treatment
programs provided to Indian youths. The Secretary shall provide
programs and services to prevent and treat substance abuse
among Indian youths. Data shall be collected by the Secretary
with respect to mental health services provided to Indian
youth.
Section 708. Indian youth telemental health demonstration project
This section sets forth the purpose of this section and
definitions specific to this section. The Secretary may award
grants through demonstration projects to provide telemental
health services to Indian youth. The use of funds and priority
for awarding funds and eligibility criteria are set forth. The
Secretary shall encourage grant recipients to collaborate to
enable comparisons about best practices across projects and to
submit relevant, declassified project information to the
national clearinghouse. Each grant recipient must submit an
annual report to the Secretary. At the termination of a
demonstration project, the Secretary must submit to Congress a
final report containing specified information. This section
authorizes $1,500,000 for each of fiscal years 2008 through
2011.
Section 709. Inpatient and community-based mental health facilities
design, construction, and staffing
This section authorizes the Secretary to provide in each
Service area, no less than one inpatient mental health care
facility, or the equivalent, for Indians with behavioral health
problems. The Secretary shall consider the possible conversion
of existing, underused Service hospital beds into psychiatric
units to meet such need.
Section 710. Training and community education
This section requires the Secretary to develop and
implement or assist Indian Tribes and Tribal Organizations to
develop and implement, with each Service Unit or tribal
program, a program of community education and behavioral health
issues. The Secretary must provide instruction in the area of
behavioral health issues to appropriate Bureau of Indian
Affairs and Indian Health Service employees and personnel in
schools or programs operated under any contract with either the
Bureau of Indian Affairs or the Service. In carrying out the
education and training programs, the Secretary must develop and
provide community-based training models.
Section 711. Behavioral health program
This section authorizes the Secretary to plan, develop,
implement, and carry out programs to deliver innovative
community-based behavioral health services to Indians. A grant
may be awarded by the Secretary to an Indian Tribe or Tribal
Organization to carry out the program. The Secretary may
consider specified criteria and shall use the same criteria in
evaluating the applications or proposals as used to evaluate
other applications or proposals for funding.
Section 712. Fetal alcohol disorder programs
This section authorizes the Secretary to establish and
operate fetal alcohol disorder programs. The Secretary must
develop and provide specified services. A Fetal Alcohol
Disorder Task Force, consisting of specified entities must be
established by the Secretary to advise the Secretary in
developing and providing specified services. The Secretary must
make grants to Indian Tribes, Tribal Organizations, and Urban
Indian Organizations for applied research projects, which
propose to elevate the understanding of methods to prevent,
intervene, treat, or provide rehabilitation and behavioral
health aftercare for Indians affected by fetal alcohol
disorder. Ten percent of the appropriated funds under this
section shall be used for grants to Urban Indian Organizations.
Section 713. Child sexual abuse and prevention treatment programs
This section requires the Secretary to establish treatment
programs for victims of sexual abuse who are Indian children or
children in an Indian household, and perpetrators of child
sexual abuse who are Indian or members of an Indian household.
Funding under this section shall be used for specified
purposes. Programs established under this section shall be
carried out in coordination with programs and services
authorized under the Indian Child Protection and Family
Violence Prevention Act.
Section 714. Behavioral health research
This section requires the Secretary to make grants to, or
enter into contracts with, Indian Tribes, Tribal Organizations,
Urban Indian Organizations, or appropriate institutions to
conduct research on the incidence and prevalence of behavioral
health problems among Indians. Research priorities are
specified.
Section 715. Definitions
This section sets forth definitions for purposes of this
title.
Section 716. Authorization of appropriations
This section authorizes such sums as may be necessary to
carry out this title.
Title VIII--Miscellaneous
Section 801. Reports
This section requires the Secretary to submit to Congress
21 different reports on specified topics for each fiscal year
following enactment of this measure.
Section 802. Regulations
This section requires the Secretary to initiate procedures
to negotiate and promulgate regulations or amendments to
regulations necessary to carry out specified titles of this
Act. A negotiated rulemaking committee to carry out this
section may only include representatives of the United States,
Indian Tribes, and Tribal Organizations, a majority of whom
shall be nominated by and be representatives of Indian Tribes
and Tribal Organizations from each Service Area. The negotiated
rulemaking procedures shall be adapted to the unique context of
self-governance and the government-to-government relationship
between the United States and Indian Tribes. The lack of
regulations shall not limit the effect of this Act. The
Secretary may repeal any inconsistent regulations. The
provisions of this Act shall supersede any conflicting
provisions of law in effect on the day before the date of
enactment of this Act.
The Committee understands the importance of negotiated
rulemaking for these titles and sections. Negotiated rulemaking
was authorized in 1990 and is now part of the Administrative
Procedures Act. Many federal agencies use negotiated rulemaking
and one agency has noted several advantages of using negotiated
rulemaking.\20\ Negotiated rulemaking will enable Tribal
leaders to provide advice and input in the development of
regulations throughout the process, which, under the general
regulations process, is limited. Given that the regulations
will impact the daily lives of tribal members directly, it is
important that Indian tribes have input in developing
regulations during the entire process. This will result in
regulations that are less costly, less burdensome, more
efficient to implement, and more likely to address tribal
concerns.
---------------------------------------------------------------------------
\20\http://www.epa.gov/brownfields/aai/negregfs.html (as of
December 18, 2007).
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Section 803. Plan of implementation
This section requires the Secretary to submit to Congress a
plan explaining the manner and schedule by which the Secretary
will implement this Act.
Section 804. Availability of funds
This section provides that funds made available pursuant to
this Act shall remain available until expended.
Section 805. Limitation on use of funds appropriated to Indian Health
Service
This section provides that any limitation on the use of
funds contained in an Appropriations bill for the Department
for a period with respect to the performance of abortions shall
apply for that period contained in the Appropriations bill for
the Service.
Section 806. Eligibility of California Indians
This section sets forth the eligibility criteria for
California Indians for health services provided by the Service.
Nothing in this section expands the eligibility of California
Indians for health services provided by the Service beyond the
scope of eligibility for such health services that applied on
May 1, 1986.
Section 807. Health services for ineligible persons
This section sets forth the eligibility criteria for health
services provided by the Service for individuals who would
otherwise be ineligible for such services. For purposes of this
section, the term ``eligible Indian'' means any Indian who is
eligible for health services provided by the Service without
regard to the provisions of this section.
Section 808. Reallocation of base resources
This section provides that any allocation of Service funds
for a fiscal year that reduces by five percent or more from the
previous fiscal year the funding for any recurring program,
project, or activity of a Service Unit may be implemented only
after the Secretary has submitted to Congress a report on the
proposed changes in allocation of funding. This provision does
not apply if the amount appropriated to the Service for a
fiscal year is at least five percent less than the amount
appropriated to the Service for the previous fiscal year.
Section 809. Results of demonstration projects
This section requires that the Secretary disseminate to
Indian Tribes, Tribal Organizations, and Urban Indian
Organizations the findings and results of demonstration
projects conducted under this Act.
Section 810. Provision of services in Montana
This section provides that the Secretary shall provide
services and benefits for Indians in Montana in a manner
consistent with the decision of the United States Court of
Appeals for the Ninth Circuit in a case titled McNabb for
McNabb v. Bowen, 829 F.2d 787 (9th Cir. 1987). Application of
this decision in Montana shall not be construed as expressing
Congress' intent to require the provision of services
consistent with that case in any other State.
Section 811. Moratorium
This section requires the Indian Health Service to provide
services during the period of the moratorium imposed on the
implementation of the final rule published in the Federal
Register on September 16, 1987 by the Department of Health and
Human Services pursuant to the eligibility criteria in effect
on September 15, 1987 until the Service has submitted to
Congress a budget request reflecting the increased costs
associated with the proposed final rule and the request is
included in an appropriations act.
Section 812. Severability provisions
This section provides that if any provision of this Act,
any amendment made by the Act, or the application of such
provision or amendment to any person or circumstances is held
to be invalid, the remainder of this Act shall remain and the
application of such provisions to persons or circumstances
other than those to which it is held invalid, shall not be
affected thereby.
Section 813. Establishment of National Bipartisan Commission on Indian
Health Care
This section establishes the National Bipartisan Indian
Health Care Commission. Composition, staffing, meeting and
hearing requirements, duties, and compensation of the
Commission are set forth. Appropriations are authorized to
carry out this section. The Federal Advisory Committee Act
shall not apply to the Commission.
Section 814. Confidentiality of medical quality assurance records;
Qualified immunity for participants
This section declares that the medical quality assurance
records created by or for any Indian Health Program or a health
program of an Urban Indian Organization as part of a medical
quality assurance program are confidential and privileged and
may not be disclosed to any person or entity, except as
provided in this section. The civil liability of a person who
releases such records in good faith is limited. The Secretary
must promulgate regulations. Definitions for purposes of this
section are set forth.
Section 815. Appropriations; availability
This section provides that any new spending authority,
which is provided under this Act shall be effective for any
fiscal year only to such extent or in such amounts as are
provided in appropriation Acts.
Section 816. Authorization of appropriations
This section authorizes such sums as may be necessary to be
appropriated for each fiscal year though fiscal year 2017 to
carry out this title. Conforming amendments are made to other
laws.
Section 102. Soboba sanitation facilities
This section amends the Act of December 17, 1970 to provide
that nothing in this Act precludes the Soboba Indian
Reservation from being provided with sanitation facilities and
services.
Section 103
This section amends the Indian Self-Determination and
Education Assistance Act to add a new Title VIII--Native
American Health and Wellness Foundation. This new Title VIII
provides definitions specific to that title and requires the
Secretary to establish a Native American Health and Wellness
Foundation. The organic structure of the Foundation is set
forth as are the powers and duties of the Foundation. A
Committee for the Establishment of Native American Health and
Wellness Foundation shall be established by the Secretary to
assist the Secretary in establishing the Foundation. The duties
of the Committee are set forth in this section. There are
authorized to be appropriated $500,000 for each fiscal year and
the Secretary is required to transfer to the Foundation funds
held by the Department of Health and Human Services under the
Act of August 5, 1954, if the transfer or use of the funds is
not prohibited by any term under which the funds were donated.
Title II--Improvement of Indian Health Care Provided Under the Social
Security Act
Title II amends specified provisions of the Social Security
Act.
Section 201. Expansion of payments under Medicare, Medicaid, and SCHIP
for all covered services furnished by Indian health programs
This section authorizes the Indian Health Service and an
Indian Tribe, Tribal Organization, or an Urban Indian
Organization to be reimbursed for Medicaid, if applicable
conditions and requirements are met. Indian Health Services,
tribes, and Tribal and Urban Indian Organizations, which do not
meet all applicable conditions and requirements, must make
necessary improvements to achieve or maintain compliance with
applicable conditions and requirements. The Secretary may enter
into an agreement with a State to reimburse a State for
Medicaid services provided by the Service, tribal or Urban
Indian Organizations. Medicare payments may be made to the
Service, Indian tribes, Tribal Organizations, or Urban Indian
Organizations, if applicable conditions and requirements are
met. If a Service, tribal, or urban Indian organization
facility does not meet applicable conditions and requirements,
such facility shall make necessary improvements to achieve or
maintain compliance. Definitions for terms used in this section
are provided. This section cross-references certain provisions
of the Social Security Act relating to a special fund and
direct billing for both Medicare and Medicaid by a Tribal
Health Program or an Urban Indian Organization.
Section 202. Increased outreach to Indians under Medicaid and SCHIP and
improved cooperation in the provision of items and services to
Indians under Social Security Act health benefit programs
This section requires the Secretary to encourage States to
enroll Indians in the Medicaid and SCHIP programs. The
Secretary is also required to take such steps as are necessary
to facilitate cooperation with, and agreements between, States
and the Service, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations with respect to the provision of health
care items and services. Definitions for terms used in this
section are provided.
Section 203. Additional provisions to increase outreach to, and
enrollments of, Indians in SCHIP and Medicaid
This section exempts outreach activities and enrollment
assistance to families of Indian children from the cap on SCHIP
payments.
Section 204. Premiums and cost sharing protections under Medicaid,
eligibility determinations under Medicaid and SCHIP, and
protection of certain Indian property from Medicaid estate
recovery
Section 204 prohibits enrollment fees, premiums, and cost-
sharing from being imposed on Indians served at Service,
tribal, or Urban Indian health programs or through the
referrals to contract health. It also prohibits the reduction
of the reimbursement of the Service, tribal, or Urban Indian
health program for the fees or cost-sharing. Certain Indian
property is exempted from Medicaid estate recovery.
Section 205. Nondiscrimination in qualifications for payment for
services under Federal health care programs
Section 205 permits the Service, an Indian Tribe, Tribal
Organization or Urban Indian Organization to be eligible on the
same basis as other qualified providers for reimbursement.
Payments may not be made to programs excluded from any other
federal health care program and if any state licenses were
suspended or revoked.
Section 206. Consultation on Medicaid, SCHIP, and other health care
programs funded under the Social Security Act involving Indian
health programs and urban Indian organizations
Section 206 maintains the Tribal Technical Advisory Group
within the Centers for Medicaid and Medicare Services to
provide the Centers with technical assistance and advice.
States must establish a process for consultation with tribal
and urban health programs on matters relating to Medicaid which
are likely to have a direct effect on Indians or Indian health
programs.
Section 207. Exclusion waiver authority for affected Indian health
programs and safe harbor transactions under the Social Security
Act
Section 207 authorizes the Secretary to waive an exclusion
under the Social Security Act for an Indian health program upon
the request of the Indian health program. Certain transactions
between the Indian health programs or patients may not be
considered remuneration under Section 1128B of the Social
Security Act.
Section 208. Rules applicable under Medicaid and SCHIP to managed care
entities with respect to Indian enrollees and Indian health
care providers and Indian managed care entities
Section 208 permits Indians, enrolled in a non-Indian
managed care entity with an Indian health program participating
in the network, to choose the Indian health program as the
primary care provider. Non-Indian managed care entities with
significant Indian enrollees must meet certain requirements.
The Indian health programs are required to comply with all
generally applicable Medicaid requirements to the extent the
requirements do not conflict with other federal statutes
applicable to the Indian health programs. Special rules are
applicable to Indian managed care entities. In regard to
Medicaid managed care program, if a health care provider is
required to have medical malpractice insurance as a condition
of contracting with a Medicaid managed care entity, an Indian
health care provider would be deemed to satisfy such a
requirement in specified instances.
Section 209. Annual Report on Indians served by Social Security Act
health benefit programs
Section 209 requires the Secretary to submit annual reports
to Congress regarding the enrollment and health status of
Indians receiving items or services under health benefit
programs funded under this Act.
Committee Oversight Findings and Recommendations
Regarding clause 2(b)(1) of rule X and clause 3(c)(1) of
rule XIII of the Rules of the House of Representatives, the
Committee on Natural Resources' oversight findings and
recommendations are reflected in the body of this report.
Constitutional Authority Statement
Article I, section 8, clause 3 of the Constitution of the
United States grants Congress the authority to enact this bill.
Compliance With House Rule XIII
1. Cost of Legislation. Clause 3(d)(2) of rule XIII of the
Rules of the House of Representatives requires an estimate and
a comparison by the Committee of the costs which would be
incurred in carrying out this bill. However, clause 3(d)(3)(B)
of that rule provides that this requirement does not apply when
the Committee has included in its report a timely submitted
cost estimate of the bill prepared by the Director of the
Congressional Budget Office under section 402 of the
Congressional Budget Act of 1974.
2. Congressional Budget Act. As required by clause 3(c)(2)
of rule XIII of the Rules of the House of Representatives and
section 308(a) of the Congressional Budget Act of 1974, this
bill contains several provisions, primarily related to the
Medicaid program, that would increase direct spending.
3. General Performance Goals and Objectives. As required by
clause 3(c)(4) of rule XIII, the general performance goal or
objective of this bill is to amend the Indian Health Care
Improvement Act to revise and extend that Act.
4. Congressional Budget Office Cost Estimate. Under clause
3(c)(3) of rule XIII of the Rules of the House of
Representatives and section 403 of the Congressional Budget Act
of 1974, the Committee has received the following cost estimate
for this bill from the Director of the Congressional Budget
Office:
H.R. 1328--Indian Health Care Improvement Act Amendments of 2007
Summary: H.R. 1328 would authorize the appropriation of
such sums as necessary through 2017 for activities under the
Indian Health Care Improvement Act, the primary authorizing
legislation for the Indian Health Service (IHS). The bill also
contains specific authorizations for a program to encourage
Indians to pursue careers related to behavioral health, a
demonstration project to provide suicide prevention services, a
commission on Indian health care, and administrative costs for
a new nonprofit corporation. Enacting the bill also would
affect direct spending, primarily through provisions affecting
the Medicaid program.
CBO estimates that implementing H.R. 1328 would cost $2.7
billion in 2008, about $16 billion over the 2008-2012 period,
and about $35 billion over the 2008-2017 period, assuming
appropriation of the necessary amounts. We also estimate that
enacting the bill would increase direct spending by $10 million
in 2008, $57 million over the 2008-2012 period, and $137
million over the 2008-2017 period.
H.R. 1328 would preempt state licensing laws in certain
cases, and this preemption would be an intergovernmental
mandate as defined in the Unfunded Mandates Reform Act (UMRA);
however, CBO estimates that the costs of that mandate would be
small and would not approach the threshold established in UMRA
($66 million in 2007, adjusted annually for inflation). The
bill also would place new requirements on Medicaid and the
State Children's Health Insurance Program (SCHIP) that would
result in additional spending of about $85 million over the
2008-2017 period. Those requirements, however, would not be
intergovernmental mandates as defined by UMRA. Other provisions
of the bill would benefit tribal governments by establishing
new or expanding existing programs for Indian health care. This
bill contains no private-sector mandates as defined in UMRA.
Estimated Cost to the Federal Government: The estimated
budgetary impact of H.R. 1328 is summarized in Table 1. The
costs of this legislation fall within budget function 550
(health).
TABLE 1.--ESTIMATED BUDGETARY EFFECTS OF H.R. 1328
------------------------------------------------------------------------
By fiscal year, in millions of
dollars--
---------------------------------------
2008 2009 2010 2011 2012
------------------------------------------------------------------------
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Estimated Authorization Level... 3,257 3,326 3,402 3,481 3,558
Estimated Outlays............... 2,682 3,141 3,310 3,449 3,534
CHANGES IN DIRECT SPENDING\1\
Estimated Budget Authority...... 9 10 12 12 13
Estimated Outlays............... 10 10 12 12 13
------------------------------------------------------------------------
\1\Direct spending changes through 2017 are shown in Table 3.
Basis of estimate: For the purpose of this estimate, CBO
assumes that H.R. 1328 will be enacted near the start of fiscal
year 2008 and that the necessary amounts will be appropriated
for each year.
Spending Subject to Appropriation
The estimated effects of H.R. 1328 on spending subject to
appropriation for the next five years are detailed in Table 2.
Implementing the legislation would result in discretionary
costs of about $16 billion over the 2008-2012 period. Because
the bill would authorize funding through 2017, such
discretionary cost would continue, with an estimated cost of
about $35 billion over the 2008-2017 period.
TABLE 2.--ESTIMATED EFFECTS OF H.R. 1328 ON DISCRETIONARY SPENDING
----------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------------
2007 2008 2009 2010 2011 2012
----------------------------------------------------------------------------------------------------------------
SPENDING SUBJECT TO APPROPRIATION
IHS Spending Under Current Law:\1\
Budget Authority............................................ 3,169 0 0 0 0 0
Estimated Outlays........................................... 3,203 553 164 72 12 2
Proposed Changes:
Existing Indian Health Service Activities:
Estimated Authorization Level........................... 0 3,247 3,320 3,396 3,475 3,554
Estimated Outlays....................................... 0 2,679 3,134 3,303 3,443 3,529
Recruitment Program for Behavioral Health Careers:
Authorization Level..................................... 0 3 3 3 3 3
Estimated Outlays....................................... 0 2 3 3 3 3
Mental Health Demonstration Project:
Authorization Level..................................... 0 2 2 2 2 0
Estimated Outlays....................................... 0 * 1 2 2 1
Commission on Indian Health Care:
Authorization Level..................................... 0 4 0 0 0 0
Estimated Outlays....................................... 0 1 2 1 0 0
Native American Health and Wellness Foundation:
Authorization Level..................................... 0 1 1 1 1 1
Estimated Outlays....................................... 0 * 1 1 1 1
Total Changes:
Estimated Authorization Level........................... 0 3257 3,326 3,402 3,481 3,558
Estimated Outlays....................................... 0 2,682 3,141 3,310 3,449 3,534
Spending Under S. 1200:
Estimated Authorization Level\1\............................ 3,169 3,257 3,326 3,402 3,481 3,558
Estimated Outlays........................................... 3,203 3,235 3,305 3,382 3,461 3,536
----------------------------------------------------------------------------------------------------------------
Note: * = less than $500,000.
\1\The 2007 level is the amount appropriated for that year for IHS.
Existing Indian Health Service Activities. H.R. 1328 would
authorize the appropriation of such sums as necessary for the
Indian Health Service through 2017. The agency's
responsibilities under the bill would be broadly similar to
those in current law. In 2007, the agency received an
appropriation of $3.2 billion. CBO's estimate of the authorized
level for IHS programs is the appropriated amount for 2007
adjusted for inflation in later years. (That level would grow
to nearly $4 billion by 2017.) The estimated outlays reflect
historical spending patterns for IHS activities.
Recruitment Program for Behavioral Health Careers. Section
105 of the bill would authorize the appropriation of $2.7
million annually through 2017 for grants to develop and
maintain programs that encourage Indians to pursue careers in a
field related to behavioral health. Assuming the appropriation
of the authorized amounts, CBO estimates that implementing this
provision would cost $2 million in 2008, $13 million over the
2008-2012 period, and $26 million over the 2008-2017 period.
Mental Health Demonstration Project. Section 708 would
authorize the appropriation of $1.5 million annually for fiscal
years 2008 through 2011 for grants to examine the feasibility
of using telecommunication technology to provide suicide
prevention services to Indians. Assuming the appropriation of
the authorized amounts, CBO estimates that implementing this
provision would cost less than $500,000 in 2008 and about $6
million over the 2008-2012 period.
Commission on Indian Health Care. Section 813 would
authorize the appropriation of $4 million for a commission that
would examine how the federal government provides health care
services to Indians. The members of the commission would have
to be appointed within eight months of the bill's enactment and
would be required to submit a final report to the Congress no
later than 18 months after that. Assuming the appropriation of
the authorized amount, CBO estimates that implementing this
provision would cost $1 million in 2008, $2 million in 2009,
and $1 million in 2010.
Native American Health and Wellness Foundation. H.R. 1328
would establish a charitable and nonprofit corporation called
the Native American Health and Wellness Foundation to assist
federal, state, tribal, and other entities in efforts to
further health and wellness activities and opportunities for
Indians. The bill would authorize the appropriation of $500,000
annually for the foundation's administrative expenses; this
amount would be adjusted in later years for inflation. Assuming
the appropriation of the authorized amounts, CBO estimates that
implementing this provision would cost less than $500,000 in
2008 and about $2 million over the 2008-2012 period.
Direct spending
H.R. 1328 contains several provisions, primarily related to
the Medicaid program, that would affect direct spending. The
bill's estimated effects on direct spending are shown in Table
3. Overall, CBO estimates that enacting the bill would increase
direct spending by $10 million in 2008 and $137 million over
the 2008-2017 period.
TABLE 3.--ESTIMATED EFFECTS OF H.R. 1328 ON DIRECT SPENDING
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-------------------------------------------------------------------------------------------
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2008-2012 2008-2017
--------------------------------------------------------------------------------------------------------------------------------------------------------
CHANGES IN DIRECT SPENDING
Exemption from Cost Sharing and Premiums:
Medicaid:
Estimated Budget Authority.......................... 6 6 7 7 8 9 9 9 10 11 34 82
Estimated Outlays................................... 6 6 7 7 8 9 9 9 10 11 34 82
SCHIP:
Budget Authority.................................... 0 0 0 0 0 0 0 0 0 0 0 0
Estimated Outlays................................... 1 * * * * -1 * * * * 2 *
Consultation with Indian Health Programs:
Estimated Budget Authority.............................. * * 1 1 1 1 1 1 1 1 3 7
Estimated Outlays....................................... * * 1 1 1 1 1 1 1 1 3 7
Medicaid Managed Care Provisions:
Estimated Budget Authority.............................. 3 3 4 4 4 5 5 5 6 6 18 45
Estimated Outlays....................................... 3 3 4 4 4 5 5 5 6 6 18 45
Scholarship and Loan Repayment Recovery Fund:
Estimated Budget Authority.............................. * * * * * * * * * * 2 4
Estimated Outlays....................................... * * * * * * * * * * 2 4
Total Changes:
Estimated Budget Authority.............................. 9 10 12 12 13 15 15 16 17 18 56 137
Estimated Outlays....................................... 10 10 12 12 13 14 15 16 17 18 57 137
--------------------------------------------------------------------------------------------------------------------------------------------------------
Notes: Components may not sum to totals because of rounding. SCHIP is the State Children's Health Insurance Program.
*= costs or savings of less than $500,000.
IHS-funded health programs are commonly divided into three
groups: Those operated directly by the Indian Health Service,
those operated by tribes and tribal organizations under self-
governance agreements, and those operated by urban Indian
organizations. For this estimate, they are referred to
collectively as Indian health programs.
Exemption from Cost Sharing and Premiums. Section 204 would
prohibit Medicaid and SCHIP programs from charging premiums or
other cost-sharing payments to Indians for services that are
provided directly or upon referral by Indian health programs.
The provision also would prohibit states from reducing payments
to providers for those services by the amount of cost sharing
that Indians otherwise would pay.
Medicaid. CBO anticipates that this provision's budgetary
effect would stem largely from eliminating cost sharing for
referral services. Current law already prohibits Indian health
programs from charging cost sharing to Indians who use their
services. In addition, Medicaid pays almost all facilities
operated by IHS and tribes based on an all-inclusive rate that
is not reduced to account for any cost sharing that Indians
would otherwise have to pay. Finally, very few states charge
premiums to their Medicaid enrollees.
Using Medicaid administrative data, CBO estimates that
about 280,000 Indians are Medicaid recipients who also use IHS,
and that federal Medicaid spending on affected services would
be about $225 per person annually in 2008. The amount of
affected spending would be relatively low because Medicaid
already prohibits cost sharing in many instances, such as long-
term care services, emergency services, and services for many
children and pregnant women. For the affected spending, CBO
assumes that cost-sharing payments by individuals equal 2
percent of total spending--Medicaid law limits the extent to
which states can impose cost sharing--and that eliminating cost
sharing would increase total spending by about 5 percent as
individuals consume more services. Overall, CBO estimates that
the provision would increase federal Medicaid spending by $6
million in 2008 and by $82 million over the 2008-2017 period.
State Children's Health Insurance Program. SCHIP
regulations already prohibit states from charging cost sharing
or premiums to Indian children enrolled in the program. As a
result, the provision's impact on SCHIP spending largely
reflects higher payments to Indian health programs and the use
of additional services by adult enrollees that a handful of
states cover in waiver programs. The provision's effects would
be limited in later years because total funding for the program
is capped. On balance, CBO estimates that the additional
spending would total less than $500,000 over the 2008-2017
period.
Consultation with Indian Health Programs. Section 206 would
encourage state Medicaid programs to consult regularly with
Indian health programs on outstanding Medicaid issues by
allowing states to receive federal matching funds for the cost
of those consultations. Those costs would be treated as an
administrative expense under Medicaid and divided equally
between the federal government and the states. CBO anticipates
that a small number of states would take advantage of this
provision, increasing federal Medicaid spending by less than
$500,000 in 2008 and by $7 million over the 2008-2017 period.
Medicaid Managed Care Provisions. Section 208 would make
several changes to improve the ability of Indian health
programs to receive payments for Indians who receive Medicaid
benefits through managed care arrangements. Those changes
include:
Managed care organizations (MCOs) would have to
pay Indian health programs at least the rates used for non-
preferred providers. States also would have the option of
making those payments directly to Indian health programs.
MCOs would have to accept claims submitted by
Indian health programs instead of requiring enrollees to submit
claims personally.
Some requirements that MCOs must now meet to
participate in Medicaid would be waived or modified for Indian
health programs that seek to operate as MCOs. (For example,
MCOs run by Indian health programs would be able to limit
enrollment to Indians only.)
States would be required to offer contracts to
Indian health programs seeking to operate their own MCOs.
Based on administrative data on Medicaid enrollment and
spending for Indians who receive benefits via managed care, CBO
estimates that those provisions would increase federal Medicaid
spending by $3 million in 2008 and $45 million over the 2008-
2017 period. We anticipate that the additional costs would be
relatively modest because some states already use similar rules
in their Medicaid managed care programs and Indian health
programs would have a limited interest in participating as
MCOs.
Scholarship and Loan Repayment Recovery Fund. H.R. 1328
would allow the Secretary of Health and Human Services to spend
amounts collected for breach of contract from recipients of
certain IHS scholarships. Under current law, those funds are
deposited in the Treasury and not spent. Because the
Secretary's ability to spend those funds would not be subject
to appropriation, the provision would increase direct spending.
Based on historical information from IHS, CBO estimates that
the provision would increase spending by less than $500,000 a
year, but would total about $4 million over the 2008-2017
period.
Estimated impact on state, local, and tribal governments:
Intergovernmental mandates
H.R. 1328 would preempt state licensing laws in cases where
a health care professional is licensed in one state but is
performing services in another state under a contract or
compact with a tribal health program. This preemption would be
an intergovernmental mandate as defined in the UMRA; however,
CBO estimates that the loss of any licensing fees resulting
from the mandate would be small and would not approach the
threshold established in UMRA ($66 million in 2007, adjusted
annually for inflation).
Other impacts
H.R. 1328 would reauthorize and expand grant and assistance
programs available to Indian tribes, tribal organizations, and
urban Indian organizations for a range of health care programs,
including prevention, treatment, and ongoing care. The bill
also would allow IHS and tribal entities to share facilities,
and it would authorize joint ventures between IHS and Indian
tribes or tribal organizations for the construction and
operation of health facilities. The bill would authorize
funding for a variety of health services including hospice
care, long-term care, public health services, and home and
community-based services.
The bill would prohibit states from charging cost sharing
or premiums in the Medicaid or SCHIP programs to Indians who
receive services or benefits through an Indian health program.
CBO estimates that the new requirements in the bill would
result in additional spending by states of about $85 million
over the 2008-2017 period. Those requirements, however, would
not be intergovernmental mandates as defined by UMRA because
Medicaid and SCHIP provide states with significant flexibility
to make programmatic adjustments to accommodate the changes.
Some tribal entities, particularly those operating managed care
systems, may realize some savings as a result of these
provisions.
Estimated impact on the private sector: This bill contains
no private-sector mandates as defined in UMRA.
Previous CBO estimate: On June 8, 2007, CBO issued an
estimate for H.R. 1328, the Indian Health Care Improvement Act
Amendments of 2007, as ordered reported by the Senate Committee
on Indian Affairs on May 10, 2007. There are only minor
differences between the two bills, and CBO's estimates for them
are identical.
Estimate prepared by: Federal Costs: Eric Rollins, Impact
on State, Local, and Tribal Governments: Leo Lex, Impact on the
Private Sector: Paige Shevlin.
Estimate approved by: Peter H. Fontaine, Deputy Assistant
Director for Budget Analysis.
Compliance With Public Law 104-4
This bill would preempt state licensing laws in certain
cases, which would be an intergovernmental mandate, however the
Congressional Budget Office estimates that the costs of this
mandate would be small and would not approach the threshold
established in the Unfunded Mandates Reform Act.
Earmark Statement
H.R. 1328 does not contain any congressional earmarks,
limited tax benefits, or limited tariff benefits as defined in
clause 9(d), 9(e) or 9(f) of rule XXI.
Preemption of State, Local or Tribal Law
This bill would preempt state licensing laws where a health
care professional is licensed in one state but is performing
services in another state under a contract or compact with a
tribal health program. This bill does not preempt local or
tribal law.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):
INDIAN HEALTH CARE IMPROVEMENT ACT
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, [That this
Act may be cited as the ``Indian Health Care Improvement Act''.
[findings
[Sec. 2. The Congress finds the following:
[(a) Federal health services to maintain and improve the
health of the Indians are consonant with and required by the
Federal Government's historical and unique legal relationship
with, and resulting responsibility to, the American Indian
people.
[(b) A major national goal of the United States is to provide
the quantity and quality of health services which will permit
the health status of Indians to be raised to the highest
possible level and to encourage the maximum participation of
Indians in the planning and management of those services.
[(c) Federal health services to Indians have resulted in a
reduction in the prevalence and incidence of preventable
illnesses among, and unnecessary and premature deaths of,
Indians.
[(d) Despite such services, the unmet health needs of the
American Indian people are severe and the health status of the
Indians is far below that of the general population of the
United States.
[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 policy.
[(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
percent 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 lung cancer deaths to a rate
of no more than 42 per 100,000.
[(6) Reduce the level of chronic obstructive
pulmonary disease related deaths to a rate of no more
than 25 per 100,000.
[(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
exceeding15ug/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 fetal deaths.
[(29) Reduce the maternal mortality rate to no more
than 3.3 per 100,000 live births.
[(30) Reduce the incidence of fetal alcohol syndrome
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 transplantation) 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
prevalence 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 diabetes-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 and 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
measured by a decrease in the incidence of
nongonococcal urethritis to no more than 170 cases per
100,000.
[(46) Reduce primary and secondary syphilis 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 inflammatory 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
diseases 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.
[(E) Rubella, 0.
[(F) Congenital Rubella Syndrome, 0.
[(G) Mumps, 500.
[(H) Pertussis, 1,000.
[(50) Reduce epidemic-related pneumonia and influenza
deaths among individuals 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
prevalence of no more than 10 percent.
[(58) Increase to at least 65 percent the proportion
of parents and caregivers who use feeding practices
that prevent baby 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 appropriate 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 shall submit to the President, for
inclusion 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 subsection (b).
[definitions
[Sec. 4. For purposes of this Act--
[(a) ``Secretary'', unless otherwise designated, means the
Secretary of Health and Human Services.
[(b) ``Service'' means the Indian Health Service.
[(c) ``Indians'' or ``Indian'', unless otherwise designated,
means any person who is a member of an Indian tribe, as defined
in subsection (d) hereof, except that, for the purpose of
sections 102 and 103, such terms shall mean any individual who
(1), irrespective of whether he or she lives on or near a
reservation, is a member of a tribe, band, or other organized
group of Indians, including those tribes, bands, or groups
terminated since 1940 and those recognized now or in the future
by the State in which they reside, or who is a descendant, in
the first or second degree, of any such member, or (2) is an
Eskimo or Aleut or other Alaska Native, or (3) is considered by
the Secretary of the Interior to be an Indian for any purpose,
or (4) is determined to be an Indian under regulations
promulgated by the Secretary.
[(d) ``Indian tribe'' means any Indian tribe, band, nation,
or other organized group or community, including any Alaska
Native village or group or regional or village corporation as
defined in or established pursuant to the Alaska Native Claims
Settlement Act (85 Stat. 688), which is recognized as eligible
for the special programs and services provided by the United
States to Indians because of their status as Indians.
[(e) ``Tribal organization'' means the elected governing body
of any Indian tribe or any legally established organization of
Indians which is controlled by one or more such bodies or by a
board of directors elected or selected by one or more such
bodies (or elected by the Indian population to be served by
such organization) and which includes the maximum participation
of Indians in all phases of its activities.
[(f) ``Urban Indian'' means any individual who resides in an
urban center, as defined in subsection (g) hereof, and who
meets one or more of the four criteria in subsection (c)(1)
through (4) of this section.
[(g) ``Urban center'' means any community which has a
sufficient urban Indian population with unmet health needs to
warrant assistance under title V, as determined by the
Secretary.
[(h) ``Urban Indian organization'' means a nonprofit
corporate body situated in an urban center, governed by an
urban Indian controlled board of directors and providing for
the maximum participation of all interested Indian groups and
individuals, which body is capable of legally cooperating with
other public and private entities for the purpose of performing
the activities described in section 503(a).
[(i) ``Area office'' means an administrative entity including
a program office, within the Indian Health Service through
which services and funds are provided to the service units
within a defined geographic area.
[(j) ``Service unit'' means--
[(1) an administrative entity within the Indian
Health Service, or
[(2) a tribe or tribal organization operating health
care programs or facilities with funds from the Service
under the Indian Self-Determination Act,
through which services are provided, directly or by contract,
to the eligible Indian population within a defined geographic
area.
[(k) ``Health promotion'' includes--
[(1) cessation of tobacco smoking,
[(2) reduction in the misuse of alcohol and drugs,
[(3) improvement of nutrition,
[(4) improvement in physical fitness,
[(5) family planning,
[(6) control of stress, and
[(7) pregnancy and infant care (including prevention
of fetal alcohol syndrome).
[(l) ``Disease prevention'' includes--
[(1) immunizations,
[(2) control of high blood pressure,
[(3) control of sexually transmittable diseases,
[(4) prevention and control of diabetes,
[(5) control of toxic agents,
[(6) occupational safety and health,
[(7) accident prevention,
[(8) fluoridation of water, and
[(9) control of infectious agents.
[(m) ``Service area'' means the geographical area served by
each area office.
[(n) ``Health profession'' means allopathic medicine, family
medicine, internal medicine, pediatrics, geriatric medicine,
obstetrics and gynecology, podiatric medicine, nursing, public
health nursing, dentistry, psychiatry, osteopathy, optometry,
pharmacy, psychology, public health, social work, marriage and
family therapy, chiropractic medicine, environmental health and
engineering, an allied health profession, or any other health
profession.
[(o) ``Substance abuse'' includes inhalant abuse.
[(p) ``FAE'' means fetal alcohol effect.
[(q) ``FAS'' means fetal alcohol syndrome.
TITLE I--INDIAN HEALTH MANPOWER
[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 provision of health care to
Indian people.
[health professions recruitment program for indians
[Sec. 102. (a) The Secretary, acting through the Service,
shall make grants to public or nonprofit private health, or
educational entities, or Indian tribes or tribal organizations
to assist such entities in meeting the costs of--
[(1) identifying Indians with a potential for
education or training in the health professions and
encouraging and assisting them--
[(A) to enroll in courses of study in such
health professions; or
[(B) if they are not qualified to enroll in
any such courses of study, to undertake such
postsecondary education or training as may be
required to qualify them for enrollment;
[(2) publicizing existing sources of financial aid
available to Indians enrolled in any course of study
referred to in paragraph (1) of this subsection or who
are undertaking training necessary to quality them to
enroll in any such course of study; or
[(3) establishing other programs which the Secretary
determines will enhance and facilitate the enrollment
of Indians in, and the subsequent pursuit and
completion by them of, courses of study referred to in
paragraph (1) of this subsection.
[(b)(1) No grant may be made under this section unless an
application therefor has been submitted to, and approved by,
the Secretary. Such application shall be in such form,
submitted in such manner, and contain such information, as the
Secretary shall by regulation prescribe. The Secretary shall
give a preference to applications submitted by Indian tribes or
tribal organizations.
[(2) The amount of any grant under this section shall be
determined by the Secretary. Payments pursuant to grants under
this section may be made in advance or by way of reimbursement,
and at such intervals and on such conditions as the Secretary
finds necessary.
[health professions preparatory scholarship program for indians
[Sec. 103. (a) The Secretary, acting through the Service,
shall make scholarship grants to Indians who--
[(1) have successfully completed their high school
education or high school equivalency; and
[(2) have demonstrated the capability to successfully
complete courses of study in the health professions.
[(b) Scholarship grants made pursuant to this section shall
be for the following purposes:
[(1) Compensatory preprofessional education of any
grantee, such scholarship not to exceed two years on a
full-time basis (or the part-time equivalent thereof,
as determined by the Secretary).
[(2) Pregraduate education of any grantee leading to
a baccalaureate degree in an approved course of study
preparatory to a field of study in a health profession,
such scholarship not to exceed 4 years (or the part-
time equivalent thereof, as determined by the
Secretary).
[(c) Scholarship grants made under this section may cover
costs of tuition, books, transportation, board, and other
necessary related expenses of a grantee while attending school.
[(d) The Secretary shall not deny scholarship assistance to
an eligible applicant under this section solely on the basis of
the applicant's scholastic achievement if such applicant has
been admitted to, or maintained good standing at, an accredited
institution.
[(e) The Secretary shall not deny scholarship assistance to
an eligible applicant under this section solely by reason of
such applicant's eligibility for assistance or benefits under
any other Federal program.
[indian health professions scholarships
[Sec. 104. (a) In order to provide health professionals to
Indians, Indian tribes, tribal organizations, and urban Indian
organizations, the Secretary, acting through the Service and in
accordance with this section, shall make scholarship grants to
Indians who are enrolled full or part time in appropriately
accredited schools and pursuing courses of study in the health
professions. Such scholarships shall be designated Indian
Health Scholarships and shall be made in accordance with
section 338A of the Public Health Service Act (42 U.S.C. 254l),
except as provided in subsection (b) of this section.
[(b)(1) The Secretary, acting through the Service, shall
determine who shall receive scholarships under subsection (a)
and shall determine the distribution of such scholarships among
such health professions on the basis of the relative needs of
Indians for additional service in such health professions.
[(2) An individual shall be eligible for a scholarship under
subsection (a) in any year in which such individual is enrolled
full or part time in a course of study referred to in
subsection (a).
[(3)(A) The active duty service obligation under a written
contract with the Secretary under section 338A of the Public
Health Service Act (42 U.S.C. 254l) that an individual has
entered into under that section shall, if that individual is a
recipient of an Indian Health Scholarship, be met in full-time
practice, by service--
[(i) in the Indian Health Service;
[(ii) in a program conducted under a contract entered
into under the Indian Self-Determination Act;
[(iii) in a program assisted under title V of this
Act;
[(iv) in the private practice of the applicable
profession if, as determined by the Secretary, in
accordance with guidelines promulgated by the
Secretary, such practice is situated in a physician or
other health professional shortage area and addresses
the health care needs of a substantial number of
Indians; or
[(B) At the request of any individual who has entered into a
contract referred to in subparagraph (A) and who receives a
degree in medicine (including osteopathic or allopathic
medicine), dentistry, optometry, podiatry, or pharmacy, the
Secretary shall defer the active duty service obligation of
that individual under that contract, in order that such
individual may complete any internship, residency, or other
advanced clinical training that is required for the practice of
that health profession, for an appropriate period (in years, as
determined by the Secretary), subject to the following
conditions:
[(i) No period of internship, residency, or other
advanced clinical training shall be counted as
satisfying any period of obligated service that is
required under this section.
[(ii) The active duty service obligation of that
individual shall commence not later than 90 days after
the completion of that advanced clinical training (or
by a date specified by the Secretary).
[(iii) The active duty service obligation will be
served in the health profession of that individual, in
a manner consistent with clauses (i) through (v) of
subparagraph (A).
[(C) A recipient of an Indian Health Scholarship may, at the
election of the recipient, meet the active duty service
obligation described in subparagraph (A) by service in a
program specified in that subparagraph that--
[(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.
[(D) Subject to subparagraph (C), the Secretary, in making
assignments of Indian Health Scholarship recipients required to
meet the active duty service obligation described in
subparagraph (A), shall give priority to assigning individuals
to service in those programs specified in subparagraph (A) that
have a need for health professionals to provide health care
services as a result of individuals having breached contracts
entered into under this section.
[(4) In the case of an individual receiving a scholarship
under this section who is enrolled part time in an approved
course of study--
[(A) such scholarship shall be for a period of years
not to exceed the part-time equivalent of 4 years, as
determined by the Secretary;
[(B) the period of obligated service described in
paragraph (3)(A) 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)(1)(B) of the Public Health Service Act
(42 U.S.C. 254l(g)(1)(B)) shall be reduced pro rata (as
determined by the Secretary) based on the number of
hours such student is enrolled.
[(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 maintain an acceptable level of
academic standing in the educational institution in
which he is enrolled (such level determined by the
educational institution under regulations of the
Secretary),
[(ii) is dismissed from such educational institution
for disciplinary reasons,
[(iii) voluntarily terminates the training in such an
educational institution for which he is provided a
scholarship under such contract before the completion
of such training, or
[(iv) 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 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 (l) of
section 108 in the manner provided for in such subsection.
[(C) Upon the death of an individual who receives an Indian
Health Scholarship, any obligation of that individual for
service or payment that relates to that scholarship shall be
canceled.
[(D) The Secretary shall provide for the partial or total
waiver or suspension of any obligation of service or payment of
a recipient of an Indian Health Scholarship if the Secretary
determines that--
[(i) it is not possible for the recipient to meet
that obligation or make that payment;
[(ii) requiring that recipient to meet that
obligation or make that payment would result in extreme
hardship to the recipient; or
[(iii) the enforcement of the requirement to meet the
obligation or make the payment would be unconscionable.
[(E) Notwithstanding any other provision of law, in any case
of extreme hardship or for other good cause shown, the
Secretary may waive, in whole or in part, the right of the
United States to recover funds made available under this
section.
[(F) Notwithstanding any other provision of law, with respect
to a recipient of an Indian Health Scholarship, no obligation
for payment may be released by a discharge in bankruptcy under
title 11, United States Code, unless that discharge is granted
after the expiration of the 5-year period beginning on the
initial date on which that payment is due, and only if the
bankruptcy court finds that the nondischarge of the obligation
would be unconscionable.
[(c) The Secretary shall, acting through the Service,
establish a Placement Office to develop and implement a
national policy 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 Public Health Service Act (42 U.S.C.
254m) without regard to any competitive personnel system,
agency personnel limitation, or Indian preference policy.
[indian health service extern programs
[Sec. 105. (a) Any individual who receives a scholarship
grant pursuant to section 104 shall be entitled to employment
in the service during any nonacademic period of the year.
Periods of employment pursuant to this subsection shall not be
counted in determining the fulfillment of the service
obligation incurred as a condition of the scholarship grant.
[(b) Any individual enrolled in a course of study in the
health professions may be employed by the Service during any
nonacademic period of the year. Any such employment shall not
exceed one hundred and twenty days during any calendar year.
[(c) Any employment pursuant to this section shall be made
without regard to any competitive personnel system or agency
personnel limitation and to a position which will enable the
individual so employed to receive practical experience in the
health profession in which he or she is engaged in study. Any
individual so employed shall receive payment for his or her
services comparable to the salary he or she would receive if he
or she were employed in the competitive system. Any individual
so employed shall not be counted against any employment ceiling
affecting the Service or the Department of Health and Human
Services.
[continuing education allowances
[Sec. 106. (a) In order to encourage physicians, dentists,
nurses, and other health professionals to join or continue in
the Service and to provide their services in the rural and
remote areas where a significant portion of the Indian people
resides, the Secretary, acting through the Service, may provide
allowances to health professionals employed in the Service to
enable them for a period of time each year prescribed by
regulation of the Secretary to take leave of their duty
stations for professional consultation and refresher training
courses.
[(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.
[community health representative program
[Sec. 107. (a) Under the authority of the Act of November 2,
1921 (25 U.S.C. 13), popularly known as the Snyder Act, the
Secretary shall maintain a Community Health Representative
Program under which the Service--
[(1) provides for the training of Indians as health
paraprofessionals, and
[(2) uses such paraprofessionals in the provision of
health care, health promotion, and disease prevention
services to Indian communities.
[(b) The Secretary, acting through the Community Health
Representative Program of the Service, shall--
[(1) provide a high standard of training for
paraprofessionals to Community Health Representatives
to ensure that the Community Health Representatives
provide quality health care, health promotion, and
disease prevention services to the Indian communities
served by such Program,
[(2) in order to provide such training, develop and
maintain a curriculum that--
[(A) combines education in the theory of
health care with supervised practical
experience in the provision of health care, and
[(B) provides instruction and practical
experience in health promotion and disease
prevention activities, with appropriate
consideration given to lifestyle factors that
have an impact on Indian health status, such as
alcoholism, family dysfunction, and poverty,
[(3) maintain a system which identifies the needs of
Community Health Representatives for continuing
education in health care, health promotion, and disease
prevention and maintain programs that meet the needs
for such continuing education,
[(4) maintain a system that provides close
supervision of Community Health Representatives,
[(5) maintain a system under which the work of
Community Health Representatives is reviewed and
evaluated, and
[(6) promote traditional health care practices of the
Indian tribes served consistent with the Service
standards for the provision of health care, health
promotion, and disease prevention.
[indian health service loan repayment program
[Sec. 108. (a)(1) The Secretary, acting through the Service,
shall establish a program to be known as the Indian Health
Service Loan Repayment Program (hereinafter referred to as the
``Loan Repayment Program'') in order to assure an adequate
supply of trained health professionals necessary to maintain
accreditation of, and provide health care services to Indians
through, Indian health programs.
[(2) For the purposes of this section--
[(A) the term ``Indian health program'' means any
health program or facility funded, in whole or part, by
the Service for the benefit of Indians and
administered--
[(i) directly by the Service;
[(ii) by any Indian tribe or tribal or Indian
organization pursuant to a contract under--
[(I) the Indian Self-Determination
Act, or
[(II) section 23 of the Act of April
30, 1908 (25 U.S.C. 47), popularly
known as the ``Buy-Indian'' Act; or
[(iii) by an urban Indian organization
pursuant to title V of this Act; and
[(B) the term ``State'' has the same meaning given
such term in section 331(i)(4) of the Public Health
Service Act.
[(b) To be eligible to participate in the Loan Repayment
Program, an individual must--
[(1)(A) be enrolled--
[(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 applies to participate in such
program; or
[(ii) in an approved graduate training
program in a health profession; or
[(B) have--
[(i) a degree in a health profession; and
[(ii) a license to practice a health
profession in a State;
[(2)(A) be eligible for, or hold, an appointment as a
commissioned officer in the Regular or Reserve Corps of
the Public Health Service;
[(B) be eligible for selection for civilian service
in the Regular or Reserve Corps of the Public Health
Service;
[(C) meet the professional standards for civil
service employment in the Indian Health Service; or
[(D) be employed in an Indian health program without
a service obligation; and
[(3) submit to the Secretary an application for a
contract described in subsection (f).
[(c)(1) In disseminating application forms and contract forms
to individuals desiring to participate in the Loan Repayment
Program, the Secretary shall include with such forms a fair
summary of the rights and liabilities of an individual whose
application is approved (and whose contract is accepted) by the
Secretary, including in the summary a clear explanation of the
damages to which the United States is entitled under subsection
(l) in the case of the individual's breach of the contract. The
Secretary shall provide such individuals with sufficient
information regarding the advantages and disadvantages of
service as a commissioned officer in the Regular or Reserve
Corps of the Public Health Service or a civilian employee of
the Indian Health Service to enable the individual to make a
decision on an informed basis.
[(2) The application form, contract form, and all other
information furnished by the Secretary under this section shall
be written in a manner calculated to be understood by the
average individual applying to participate in the Loan
Repayment Program.
[(3) The Secretary shall make such application forms,
contract forms, and other information available to individuals
desiring to participate in the Loan Repayment Program on a date
sufficiently early to ensure that such individuals have
adequate time to carefully review and evaluate such forms and
information.
[(d)(1) Consistent with paragraph (3), the Secretary, acting
through the Service and in accordance with subsection (k),
shall annually--
[(A) identify the positions in each Indian health
program for which there is a need or a vacancy, and
[(B) rank those positions in order of priority.
[(2) Consistent with the priority determined under paragraph
(1), the Secretary, in determining which applications under the
Loan Repayment Program to approve (and which contracts to
accept), shall give priority to applications made by--
[(A) Indians; and
[(B) individuals recruited through the efforts of
Indian tribes or tribal or Indian organizations.
[(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
applicants 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 applicants 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 individuals described in clause (i) or clause
(ii), respectively, necessary to meet such
requirements.
[(e)(1) An individual becomes a participant in the Loan
Repayment Program only upon the Secretary and the individual
entering into a written contract described in subsection (f).
[(2) The Secretary shall provide written notice to an
individual promptly on--
[(A) the Secretary's approving, under paragraph (1),
of the individual's participation in the Loan Repayment
Program, including extensions resulting in an aggregate
period of obligated service in excess of 4 years; or
[(B) the Secretary's disapproving an individual's
participation in such Program.
[(f) The written contract referred to in this section between
the Secretary and an individual shall contain--
[(1) an agreement under which--
[(A) subject to paragraph (3), the Secretary
agrees--
[(i) to pay loans on behalf of the
individual in accordance with the
provisions of this section, and
[(ii) to accept (subject to the
availability of appropriated funds for
carrying out this section) the
individual into the Service or place
the individual with a tribe or Indian
organization as provided in
subparagraph (B)(iii), and
[(B) subject to paragraph (3), the individual
agrees--
[(i) to accept loan payments on
behalf of the individual;
[(ii) in the case of an individual
described in subsection (b)(1)--
[(I) to maintain enrollment
in a course of study or
training described in
subsection (b)(1)(A) until the
individual completes the course
of study or training, and
[(II) while enrolled in such
course of study or training, to
maintain an acceptable level of
academic standing (as
determined under regulations of
the Secretary by the
educational institution
offering such course of study
or training);
[(iii) to serve for a time period
(hereinafter in this section referred
to as the ``period of obligated
service'') equal to 2 years or such
longer period as the individual may
agree to serve in the full-time
clinical practice of such individual's
profession in an Indian health program
to which the individual may be assigned
by the Secretary;
[(2) a provision permitting the Secretary to extend
for such longer additional periods, as the individual
may agree to, the period of obligated service agreed to
by the individual under paragraph (1)(B)(iii);
[(3) a provision that any financial obligation of the
United States arising out of a contract entered into
under this section and any obligation of the individual
which is conditioned thereon is contingent upon funds
being appropriated for loan repayments under this
section;
[(4) a statement of the damages to which the United
States is entitled under subsection (l) for the
individual's breach of the contract; and
[(5) such other statements of the rights and
liabilities of the Secretary and of the individual, not
inconsistent with this section.
[(g)(1) A loan repayment provided for an individual under a
written contract under the Loan Repayment Program shall consist
of payment, in accordance with paragraph (2), on behalf of the
individual of the principal, interest, and related expenses on
government and commercial loans received by the individual
regarding the undergraduate or graduate education of the
individual (or both), which loans were made for--
[(A) tuition expenses;
[(B) all other reasonable educational expenses,
including fees, books, and laboratory expenses,
incurred by the individual; and
[(C) reasonable living expenses as determined by the
Secretary.
[(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 specified 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 determination 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 Repayment Program from the amounts appropriated
for such contracts;
[(ii) provides an incentive to serve in Indian health
programs with the greatest shortages of health
professionals; and
[(iii) provides an incentive with respect to the
health professional involved remaining in an Indian
health program with such a health professional
shortage, and continuing to provide primary health
services, after the completion of the period of
obligated service under the Loan Repayment Program.
[(B) Any arrangement made by the Secretary for the making of
loan repayments in accordance with this subsection shall
provide that any repayments for a year of obligated service
shall be made no later than the end of the fiscal year in which
the individual completes such year of service.
[(3) For the purpose of providing reimbursements for tax
liability resulting from payments 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 than 20 percent
and not more than 39 percent of the total amount of
loan repayments 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.
[(4) The Secretary may enter into an agreement with the
holder of any loan for which payments are made under the Loan
Repayment Program to establish a schedule for the making of
such payments.
[(h) Notwithstanding any other provision of law, individuals
who have entered into written contracts with the Secretary
under this section, while undergoing academic training, shall
not be counted against any employment ceiling affecting the
Department of Health and Human Services.
[(i) The Secretary shall conduct recruiting programs for the
Loan Repayment Program and other health professional programs
of the Service at educational institutions training health
professionals or specialists identified in subsection (a).
[(j) Section 214 of the Public Health Service Act (42 U.S.C.
215) shall not apply to individuals during their period of
obligated service under the Loan Repayment Program.
[(k) The Secretary, in assigning individuals to serve in
Indian health programs pursuant to contracts entered into under
this section, shall--
[(1) ensure that the staffing needs of Indian health
programs administered by an Indian tribe or tribal or
health organization receive consideration on an equal
basis with programs 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 under this section.
[(l)(1) An individual who has entered into a written contract
with the Secretary under this section and who--
[(A) is enrolled in the final year of a course of
study and who--
[(i) fails to maintain an acceptable level of
academic standing in the educational
institution in which he is enrolled (such level
determined by the educational institution under
regulations of the Secretary);
[(ii) voluntarily terminates such enrollment;
or
[(iii) is dismissed from such educational
institution before completion of such course of
study; or
[(B) is enrolled in a graduate training program,
fails to complete such training program, and does not
receive a waiver from the Secretary under subsection
(b)(1)(B)(ii),
shall be liable, in lieu of any service obligation arising
under such contract, to the United States for the amount which
has been paid on such individual's behalf under the contract.
[(2) If, for any reason not specified in paragraph (1), an
individual breaches his written contract under this section by
failing either to begin, or complete, such individual's period
of obligated service in accordance with subsection (f), the
United States shall be entitled to recover from such individual
an amount to be determined in accordance with the following
formula:
[A=3Z(t-s/t)
in which--
[(A) ``A'' is the amount the United States is
entitled to recover;
[(B) ``Z'' is the sum of the amounts paid under this
section to, or on behalf of, the individual and the
interest on such amounts which would be payable if, at
the time the amounts were paid, they were loans bearing
interest at the maximum legal prevailing rate, as
determined by the Treasurer of the United States;
[(C) ``t'' is the total number of months in the
individual's period of obligated service in accordance
with subsection (f); and
[(D) ``s'' is the number of months of such period
served by such individual in accordance with this
section.
Amounts not paid within such period shall be subject to
collection through deductions in Medicare payments pursuant to
section 1892 of the Social Security Act.
[(3)(A) Any amount of damages which the United States is
entitled to recover under this subsection shall be paid to the
United States within the 1-year period beginning on the date of
the breach or such longer period beginning on such date as
shall be specified by the Secretary.
[(B) If damages described in subparagraph (A) are delinquent
for 3 months, the Secretary shall, for the purpose of
recovering such damages--
[(i) utilize collection agencies contracted with by
the Administrator of the General Services
Administration; or
[(ii) enter into contracts for the recovery of such
damages with collection agencies selected by the
Secretary.
[(C) Each contract for recovering damages pursuant to this
subsection shall provide that the contractor will, not less
than once each 6 months, submit to the Secretary a status
report on the success of the contractor in collecting such
damages. Section 3718 of title 31, United States Code, shall
apply to any such contract to the extent not inconsistent with
this subsection.
[(m)(1) Any obligation of an individual under the Loan
Repayment Program for service or payment of damages shall be
canceled upon the death of the individual.
[(2) The Secretary shall by regulation provide for the
partial or total waiver or suspension of any obligation of
service or payment by an individual under the Loan Repayment
Program whenever compliance by the individual is impossible or
would involve extreme hardship to the individual and if
enforcement of such obligation with respect to any individual
would be unconscionable.
[(3) The Secretary may waive, in whole or in part, the rights
of the United States to recover amounts under this section in
any case of extreme hardship or other good cause shown, as
determined by the Secretary.
[(4) Any obligation of an individual under the Loan Repayment
Program for payment of damages may be released by a discharge
in bankruptcy under title 11 of the United States Code only if
such discharge is granted after the expiration of the 5-year
period beginning on the first date that payment of such damages
is required, and only if the bankruptcy court finds that
nondischarge of the obligation would be unconscionable.
[(n) The Secretary shall submit to the President, for
inclusion in each report required to be submitted to the
Congress under 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 recruitment 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
section 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, 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.
[scholarship and loan repayment recovery fund
[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 amount collected during the preceding fiscal
year by the Federal Government pursuant to--
[(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(l) 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
appropriation Acts may be expended by the Secretary, acting
through the Service, to make payments to an Indian tribe or
tribal organization 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
payments 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 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.
[recruitment activities
[Sec. 109. (a) The Secretary may reimburse health
professionals seeking positions in the Service, including
individuals considering entering into a contract under section
108, and their spouses, for actual and reasonable expenses
incurred in traveling to and from their places of residence to
an area in which they may be assigned for the purpose of
evaluating such area with respect to such assignment.
[(b) The Secretary, acting through the Service, shall assign
one individual in each area office to be responsible on a full-
time basis for recruitment activities.
[tribal recruitment and retention program
[Sec. 110. (a) The Secretary, acting through the Service,
shall fund, on a competitive basis, projects to enable Indian
tribes and tribal and Indian organizations to recruit, place,
and retain health professionals to meet the staffing needs of
Indian health programs (as defined in section 108(a)(2)).
[(b)(1) Any Indian tribe or tribal or Indian organization may
submit an application for funding of a project pursuant to this
section.
[(2) Indian tribes and tribal and Indian organizations under
the authority of the Indian Self-Determination Act shall be
given an equal opportunity with programs that are administered
directly by the Service to compete for, and receive, grants
under subsection (a) for such projects.
[advanced training and research
[Sec. 111. (a) The Secretary, acting through the Service,
shall establish a program to enable health professionals to
pursue advanced training or research in areas of study for
which the Secretary determines a need exists. In selecting
participants for a program established under this subsection,
the Secretary, acting through the Service, shall give priority
to applicants who are employed by the Indian Health Service,
Indian tribes, tribal organizations, and urban Indian
organizations, at the time of the submission of the
applications.
[(b) An individual who participates in a program under
subsection (a), where the educational costs are borne by the
Service, shall incur an obligation to serve in an Indian health
program (as defined in section 108(a)(2)) for a period of
obligated service equal to at least 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 individual shall be liable to the United States for the
period of service remaining. 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 subsection (l) of section 108 in the manner
provided for in such subsection.
[(c) Health professionals from Indian tribes and tribal and
Indian organizations under the authority of the Indian Self-
Determination Act shall be given an equal opportunity to
participate in the program under subsection (a).
[nursing program
[Sec. 112. (a) The Secretary, acting through the Service,
shall provide grants to--
[(1) public or private schools of nursing,
[(2) tribally controlled community colleges 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. 2397h(2)), and
[(3) nurse midwife programs, and nurse practitioner
programs, that are provided by any public or private
institution,
for the purpose of increasing the number of nurses, nurse
midwives, and nurse practitioners who deliver health care
services to Indians.
[(b) Grants provided under subsection (a) may be used to--
[(1) recruit individuals for programs which train
individuals to be nurses, nurse midwives, or nurse
practitioners,
[(2) provide scholarships to individuals enrolled in
such programs that may pay the tuition charged for such
program and other expenses incurred in connection with
such program, including books, fees, room and board,
and stipends for living expenses,
[(3) provide a program that encourages nurses, nurse
midwives, and nurse practitioners to provide, or
continue to provide, health care services to Indians,
[(4) provide a program that increases the skills of,
and provides continuing education to, nurses, nurse
midwives, and nurse practitioners, or
[(5) provide any program that is designed to achieve
the purpose described in subsection (a).
[(c) Each application for a grant under subsection (a) shall
include such information as the Secretary may require to
establish the connection between the program of the applicant
and a health care facility that primarily serves Indians.
[(d) In providing grants under subsection (a), the Secretary
shall extend a preference to--
[(1) programs that provide a preference to Indians,
[(2) programs that train nurse midwives or nurse
practitioners,
[(3) programs that are interdisciplinary, and
[(4) programs that are conducted in cooperation with
a center for gifted and talented Indian students
established under section 5324(a) of the Indian
Education Act of 1988.
[(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 maximum extent feasible, coordinate with the
Quentin N. Burdick Indian Health Programs established under
section 114(b) and the Quentin N. Burdick American Indians Into
Psychology Program established under section 217(b).
[(f) The active duty service obligation prescribed under
section 338C of the Public Health Service Act (42 U.S.C. 254m)
shall be met by each individual who receives training or
assistance described in paragraph (1) or (2) of subsection (b)
that is funded by a grant provided under subsection (a). Such
obligation shall be met by service--
[(A) in the Indian Health Service;
[(B) in a program conducted under a contract entered
into under the Indian Self-Determination Act;
[(C) in a program assisted under title V of this Act;
or
[(D) in the private practice of nursing if, as
determined by the Secretary, in accordance with
guidelines promulgated by the Secretary, such practice
is situated in a physician or other health professional
shortage area and addresses the health care needs of a
substantial number of Indians.
[(g) Beginning with fiscal year 1993, of the amounts
appropriated 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.
[nursing school clinics
[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 services 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 any other activities determined
appropriate by the Secretary.
[(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 clinics established under this section
shall be designed to provide nursing students with a structured
clinical experience that is similar in nature to that provided
by residency training programs for physicians.
[(e) Regulations.--The Secretary shall prescribe such
regulations as may be necessary to carry out the provisions of
this section.
[(f) Authorization To Use Amounts.--Out of amounts
appropriated 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 this section.
[tribal culture and history
[Sec. 113. (a) The Secretary, acting through the Service,
shall establish a program under which appropriate employees of
the Service who serve particular Indian tribes shall receive
educational instruction in the history and culture of such
tribes and in the history of the Service.
[(b) To the extent feasible, the program established under
subsection (a) shall--
[(1) be carried out through tribally-controlled
community colleges (within the meaning of section 2(4)
of the Tribally Controlled Community College Assistance
Act of 1978) 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. 2397h(2)),
[(2) be developed in consultation with the affected
tribal government, and
[(3) include instruction in Native American studies.
[inmed program
[Sec. 114. (a) The Secretary is authorized to provide grants
to at least 3 colleges and universities for the purpose of
maintaining and expanding the Native American health careers
recruitment program known as the ``Indians into Medicine
Program'' (hereinafter in this section referred to as
``INMED'') as a means of encouraging Indians to enter the
health professions.
[(b) The Secretary shall provide one of the grants authorized
under subsection (a) to maintain the INMED program at the
University of North Dakota, to be known as the ``Quentin N.
Burdick Indian Health Programs'', unless the Secretary makes a
determination, based upon program reviews, that the program is
not meeting the purposes of this section. Such program shall,
to the maximum 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 section 112(e).
[(c)(1) The Secretary shall develop regulations for the
competitive awarding of the grants provided under this section.
[(2) Applicants for grants provided under this section shall
agree to provide a program which--
[(A) provides outreach and recruitment for health
professions to Indian communities including elementary,
secondary and community colleges located on Indian
reservations which will be served by the program,
[(B) incorporates a program advisory board comprised
of representatives from the tribes and communities
which will be served by the program,
[(C) provides summer preparatory programs for Indian
students who need enrichment in the subjects of math
and science in order to pursue training in the health
professions,
[(D) provides tutoring, counseling and support to
students who are enrolled in a health career program of
study at the respective college or university, and
[(E) to the maximum extent feasible, employs
qualified Indians in the program.
[(d) By no later than the date that is 3 years after the date
of enactment of the Indian Health Care Amendments of 1988, the
Secretary shall submit a report to the Congress on the program
established under this section including recommendations for
expansion or changes to the program.
[health training programs of community colleges
[Sec. 115. (a)(1) The Secretary, acting through the Service,
shall award grants to community colleges for the purpose of
assisting the community college in the establishment of
programs which provide education in a health profession leading
to a degree or diploma in a health profession for individuals
who desire to practice such profession on an Indian reservation
or in a tribal clinic.
[(2) The amount of any grant awarded to a community college
under paragraph (1) for the first year in which such a grant is
provided to the community college shall not exceed $100,000.
[(b)(1) The Secretary, acting through the Service, shall
award grants to community colleges that have established a
program described in subsection (a)(1) for the purpose of
maintaining the program and recruiting students for the
program.
[(2) Grants may only be made under this section to a
community college which--
[(A) is accredited,
[(B) has access to a hospital facility, Service
facility, or hospital that could provide training of
nurses or health professionals,
[(C) has entered into an agreement with an accredited
college or university medical school, the terms of
which--
[(i) provide a program that enhances the
transition and recruitment of students into
advanced baccalaureate or graduate programs
which train health professionals, and
[(ii) stipulate certifications necessary to
approve internship and field placement
opportunities at service unit facilities of the
Service or at tribal health facilities,
[(D) has a qualified staff which has the appropriate
certifications, and
[(E) is capable of obtaining State or regional
accreditation of the program described in subsection
(a)(1).
[(c) The Secretary shall encourage community colleges
described in subsection (b)(2) to establish and maintain
programs described in subsection (a)(1) by--
[(1) entering into agreements with such colleges for
the provision of qualified personnel of the Service to
teach courses of study in such programs, and
[(2) providing technical assistance and support to
such colleges.
[(d) Any program receiving assistance under this section that
is conducted with respect to a health profession shall also
offer courses of study which provide advanced training for any
health professional who--
[(1) has already received a degree or diploma in such
health profession, and
[(2) provides clinical services on an Indian
reservation, at a Service facility, or at a tribal
clinic.
Such courses of study may be offered in conjunction with the
college or university with which the community college has
entered into the agreement required under subsection (b)(2)(C).
[(e) For purposes of this section--
[(1) The term ``community college'' means--
[(A) a tribally controlled community college,
or
[(B) a junior or community college.
[(2) The term ``tribally controlled community
college'' has the meaning given to such term by section
2(4) of the Tribally Controlled Community College
Assistance Act of 1978.
[(3) The term ``junior or community college'' has the
meaning given to such term by section 312(e) of the
Higher Education Act of 1965 (20 U.S.C. 1058(e)).
[additional incentives for health professionals
[Sec. 116. (a) The Secretary may provide the incentive
special pay authorized under section 302(b) of title 37, United
States Code, to civilian medical officers of the Indian Health
Service who are assigned to, and serving in, positions included
in the list established under subsection (b)(1) for which
recruitment or retention of personnel is difficult.
[(b)(1) The Secretary shall establish and update on an annual
basis a list of positions of health care professionals employed
by, or assigned to, the Service for which recruitment or
retention is difficult.
[(2)(A) The Secretary may pay a bonus to any commissioned
officer or civil service employee, other than a commissioned
medical officer, dental officer, optometrist, and veterinarian,
who is employed in or assigned to, and serving in, a position
in the Service included in the list established by the
Secretary under paragraph (1).
[(B) The total amount of bonus payments made by the Secretary
under this paragraph to any employee during any 1-year period
shall not exceed $2,000.
[(c) The Secretary may establish programs to allow the use of
flexible work schedules, and compressed work schedules, in
accordance with the provisions of subchapter II of chapter 61
of title 5, United States Code, for health professionals
employed by, or assigned to, the Service.
[retention bonus
[Sec. 117. (a) The Secretary may pay a retention bonus to any
physician or nurse employed by, or assigned to, and serving in,
the Service either as a civilian employee or as a commissioned
officer in the Regular or Reserve Corps of the Public Health
Service who--
[(1) is assigned to, and serving in, a position
included in the list established under section
116(b)(1) for which recruitment or retention of
personnel is difficult,
[(2) the Secretary determines is needed by the
Service,
[(3) has--
[(A) completed 3 years of employment with the
Service, or
[(B) completed any service obligations
incurred as a requirement of--
[(i) any Federal scholarship program,
or
[(ii) any Federal education loan
repayment program, and
[(4) enters into an agreement with the Service for
continued employment for a period of not less than 1
year.
[(b) Beginning with fiscal year 1993, not less than 25
percent of the retention bonuses awarded each year under
subsection (a) shall be awarded to nurses.
[(c) The Secretary may establish rates for the retention
bonus which shall provide for a higher annual rate for
multiyear agreements than for single year agreements referred
to in subsection (a)(4), but in no event shall the annual rate
be more than $25,000 per annum.
[(d) The retention bonus for the entire period covered by the
agreement described in subsection (a)(4) shall be paid at the
beginning of the agreed upon term of service.
[(e) Any physician or nurse failing to complete the agreed
upon term of service, except where such failure is through no
fault of the individual, shall be obligated to refund to the
Government the full amount of the retention bonus for the
period covered by the agreement, plus interest as determined by
the Secretary in accordance with section 108(l)(2)(B).
[(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-Determination Act if such physician or nurse is serving in
a position which the Secretary determines is--
[(1) a position for which recruitment or retention is
difficult; and
[(2) necessary for providing health care services to
Indians.
[nursing residency program
[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 licensed practical nurse or licensed
vocational nurse) or a bachelor's degree (in the case of a
registered nurse) or a Master's degree.
[(c) An individual who participates in a program under
subsection (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 equal 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 (l) of section 108 in the manner provided for in
such subsection.
[community health aide program for alaska
[Sec. 119. (a) Under the authority of the Act of November 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 practitioners.
[(b) The Secretary, acting through the Community Health Aide
Program of the Service, shall--
[(1) using trainers accredited by the Program,
provide a high standard of training to community health
aides and community 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
curriculum that--
[(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 promotion, 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);
[(3) establish and maintain a Community Health Aide
Certification Board to certify as community health
aides or community health practitioners individuals who
have successfully completed the training described in
paragraph (1) or can demonstrate equivalent experience;
[(4) develop and 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.
[matching grants to tribes for scholarship programs
[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
information 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.
[(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
paragraph (2), any amounts 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
public and private entities.
[(c) An Indian tribe or tribal organization shall provide
scholarships 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 under subsection (b), the
Secretary 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 providing 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)(1)(B) of the Public Health
Service Act (42 U.S.C. 254m(g)(1)(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
subparagraph (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 physician, 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 standing in the educational institution in
which he is enrolled (such level determined by the
educational institution under regulations of the
Secretary),
[(B) is dismissed from such educational institution
for disciplinary reasons,
[(C) voluntarily terminates the training in such an
educational 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
individual 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 (l) 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 established 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 XVIII 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 payments under subsection
(a) to an Indian tribe or tribal organization for any fiscal
year subsequent to the first fiscal year of such payments
unless the Secretary determines that, for the immediately
preceding fiscal year, the Indian tribe or tribal organization
has complied with requirements of this section.
[tribal health program administration
[Sec. 121. The Secretary shall, by contract or otherwise,
provide training for individuals in the administration and
planning of tribal health programs.
[university of south dakota pilot program
[Sec. 122. (a) The Secretary may make a grant to the School
of Medicine of the University of South Dakota (hereafter in
this section referred to as ``USDSM'') 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 quality 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 qualified medical
staff serving at the service unit who shall be members
of the USDSM faculty.
[(d) The USDSM shall coordinate the program established
pursuant to a grant provided under subsection (a) with other
medical schools in the region, nursing schools, tribal
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 retention of qualified health professionals in
the Aberdeen Area of the Service.
[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.
[TITLE II--HEALTH SERVICES
[indian health care improvement fund
[Sec. 201. (a) The Secretary is authorized to expend funds
which are appropriated under the authority of this section,
through the Service, for the purposes of--
[(1) eliminating the deficiencies in health status
and resources of all Indian tribes,
[(2) eliminating backlogs in the provision of health
care services to Indians,
[(3) meeting the health needs of Indians in an
efficient and equitable manner, and
[(4) augmenting the ability of the Service to meet
the following health service responsibilities, either
through direct or contract care or through contracts
entered into pursuant to the Indian Self-Determination
Act, with respect to those Indian tribes with the
highest levels of health status and resource
deficiencies:
[(A) clinical care (direct and indirect)
including clinical eye and vision care;
[(B) preventive health;
[(C) dental care (direct and indirect);
[(D) mental health, including community
mental health services, inpatient mental health
services, dormitory mental health services,
therapeutic and residential treatment centers,
and training of traditional Indian
practitioners;
[(E) emergency medical services;
[(F) treatment and control of, and
rehabilitative care related to, alcoholism and
drug abuse (including fetal alcohol syndrome)
among Indians;
[(G) accident prevention programs;
[(H) home health care;
[(I) community health representatives; and
[(J) maintenance and repair.
[(b)(1) Any funds appropriated under the authority of this
section shall not be used to offset or limit any appropriations
made to the Service under the Act of November 2, 1921 (25
U.S.C. 13), popularly known as the Snyder Act, or any other
provision of law.
[(2)(A) Funds appropriated under the authority of this
section may be allocated on a service unit basis. The funds
allocated to each service unit under this subparagraph shall be
used by the service unit to reduce the health status and
resource deficiency of each tribe served by such service unit.
[(B) The apportionment of funds allocated to a service unit
under subparagraph (A) among the health service
responsibilities described in subsection (a)(4) shall be
determined by the Service in consultation with, and with the
active participation of, the affected Indian tribes.
[(c) For purposes of this section--
[(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.
[(2) The health resources available to an Indian
tribe include health resources provided by the Service
as well as health resources used by the Indian tribe,
including services and financing systems provided by
any Federal programs, private insurance, and programs
of State or local governments.
[(3) The Secretary shall establish procedures which
allow any Indian tribe to petition the Secretary for a
review of any determination of the extent of the health
status and resource deficiency of such tribe.
[(d)(1) Programs administered by any Indian tribe or tribal
organization under the authority of the Indian Self-
Determination Act shall be eligible for funds appropriated
under the authority of this section on an equal basis with
programs that are administered directly by the Service.
[(2) If any funds allocated to a tribe or service unit under
the authority of this section are used for a contract entered
into under the Indian Self-Determination Act, a reasonable
portion of such funds may be used for health planning,
training, technical assistance, and other administrative
support functions.
[(e) By no later than the date that is 3 years after the date
of enactment of the Indian Health Amendments of 1992, the
Secretary shall submit to the Congress the current health
status and resource deficiency report of the Service for each
Indian tribe or service unit, including newly recognized or
acknowledged tribes. Such report shall set out--
[(1) the methodology then in use by the Service for
determining tribal health status and resource
deficiencies, as well as the most recent application of
that methodology;
[(2) the extent of the health status and resource
deficiency of each Indian tribe served by the Service;
[(3) the amount of funds necessary to eliminate the
health status and resource deficiencies of all Indian
tribes served by the Service; and
[(4) an estimate of--
[(A) the amount of health service funds
appropriated under the authority of this Act,
or any other Act, including the amount of any
funds transferred to the Service, for the
preceding fiscal year which is allocated to
each service unit, Indian tribe, or comparable
entity;
[(B) the number of Indians eligible for
health services in each service unit or Indian
tribe; and
[(C) the number of Indians using the Service
resources made available to each service unit
or Indian tribe.
[(f) Funds appropriated under authority of this section for
any fiscal year shall be included in the base budget of the
Service for the purpose of determining appropriations under
this section in subsequent fiscal years.
[(g) Nothing in this section is intended to diminish the
primary responsibility of the Service to eliminate existing
backlogs in unmet health care needs, nor are the provisions of
this section intended to discourage the Service from
undertaking additional efforts to achieve parity among Indian
tribes.
[(h) Any funds appropriated under the authority of this
section shall be designated as the ``Indian Health Care
Improvement Fund''.
[catastrophic health emergency fund
[Sec. 202. (a)(1) There is hereby established an Indian
Catastrophic Health Emergency Fund (hereafter in this section
referred to as the ``Fund'') consisting of--
[(A) the amounts deposited under subsection (d), and
[(B) the amounts appropriated to the Fund under this
section.
[(2) The Fund shall be administered by the Secretary, acting
through the central office of the Service, solely for the
purpose of meeting the extraordinary medical costs associated
with the treatment of victims of disasters or catastrophic
illnesses who are within the responsibility of the Service.
[(3) The Fund shall not be allocated, apportioned, or
delegated on a service unit, area office, or any other basis.
[(4) No part of the Fund or its administration shall be
subject to contract or grant under any law, including the
Indian Self-Determination Act.
[(b) The Secretary shall, through the promulgation of
regulations consistent with the provisions of this section--
[(1) establish a definition of disasters and
catastrophic illnesses for which the cost of treatment
provided under contract would qualify for payment from
the Fund;
[(2) provide that a service unit shall not be
eligible for reimbursement for the cost of treatment
from the Fund until its cost of treating any victim of
such catastrophic illness or disaster has reached a
certain threshold cost which the Secretary 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 threshold 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;
[(3) establish a procedure for the reimbursement of
the portion of the costs incurred by--
[(A) service units or facilities of the
Service, or
[(B) whenever otherwise authorized by the
Service, non-Service facilities or providers,
in rendering treatment that exceeds such threshold
cost;
[(4) establish a procedure for payment from the Fund
in cases in which the exigencies of the medical
circumstances warrant treatment prior to the
authorization of such treatment by the Service; and
[(5) establish a procedure that will ensure that no
payment shall be made from the Fund to any provider of
treatment to the extent that such provider is eligible
to receive payment for the treatment from any other
Federal, State, local, or private source of
reimbursement for which the patient is eligible.
[(c) Amounts appropriated to the Fund under this section
shall not be used to offset or limit appropriations made to the
Service under authority of the Act of November 2, 1921 (25
U.S.C. 13), popularly known as the Snyder Act, or any other
law.
[(d) There shall be deposited into the Fund all
reimbursements to which the Service is entitled from any
Federal, State, local, or private source (including third party
insurance) by reason of treatment rendered to any victim of a
disaster or catastrophic illness the cost of which was paid
from the Fund.
[health promotion and disease prevention services
[Sec. 203. (a) The Secretary, acting through the Service,
shall provide health promotion and disease prevention services
to Indians so as to achieve the health status objectives set
forth in section 3(b).
[(b) The Secretary shall submit to the President for
inclusion in each statement which is required to be submitted
to the Congress under section 801 an evaluation of--
[(1) the health promotion and disease prevention
needs of Indians,
[(2) the health promotion and disease prevention
activities which would best meet such needs,
[(3) the internal capacity of the Service to meet
such needs, and
[(4) the resources which would be required to enable
the Service to undertake the health promotion and
disease prevention activities necessary to meet such
needs.
[diabetes prevention, treatment, and control
[Sec. 204. (a) The Secretary, in consultation with the
tribes, shall determine--
[(1) by tribe and by Service unit of the Service, the
incidence of, and the types of complications resulting
from, diabetes among Indians; and
[(2) based on paragraph (1), the measures (including
patient education) each Service unit should take to
reduce the incidence of, and prevent, treat, and
control the complications resulting from, diabetes
among tribes within that Service unit.
[(b) The Secretary shall screen each Indian who receives
services from the Service for diabetes and for conditions which
indicate a high risk that the individual will become diabetic.
Such screening may be done by a tribe or tribal organization
operating health care programs or facilities with funds from
the Service under the Indian Self-Determination Act.
[(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--
[(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,
Montana, Oregon, or Utah.
[(2) The Secretary may establish new model diabetes projects
under this section taking 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).
[(d) The Secretary shall--
[(1) employ in each area office of the Service at
least one diabetes control officer who shall coordinate
and manage on a full-time basis activities within that
area office for the prevention, treatment, and control
of diabetes;
[(2) establish in each area office of the Service a
registry of patients with diabetes to track the
incidence of diabetes and the complications from
diabetes in that area;
[(3) ensure that data collected in each area office
regarding diabetes and related complications among
Indians is disseminated to all other area offices; and
[(4) evaluate the effectiveness of services provided
through model diabetes projects established under this
section.
[(e) Funds appropriated under this section in any fiscal year
shall be in addition to base resources appropriated to the
Service for that year.
[hospice care feasibility study
[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
providers, 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
concerning 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
distribution of such individuals;
[(3) determine the most appropriate means to
facilitate the participation of Indian tribes and
tribal organizations in providing hospice care;
[(4) identify and evaluate various means for
providing hospice care, including--
[(A) the provision of such care by the
personnel of a Service hospital pursuant to a
hospice program established 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
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 expectancy 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 Social 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)(1) of the Social Security Act (42
U.S.C. 1395x(dd)(1)).
[reimbursement from certain third parties of costs of health services
[Sec. 206. (a) Except as provided in subsection (f), the
United States, an Indian tribe, or a tribal organization shall
have the right to recover the reasonable expenses incurred by
the Secretary, an Indian tribe, or a tribal organization in
providing health services, through the Service, an Indian
tribe, or a tribal organization, to any individual to the same
extent that such individual, or any nongovernmental provider of
such services, would be eligible to receive reimbursement or
indemnification for such expenses if--
[(1) such services had been provided by a
nongovernmental provider, and
[(2) such individual had been required to pay such
expenses and did pay such expenses.
[(b) Subsection (a) shall provide a right of recovery against
any State only if the injury, illness, or disability for which
health services were provided is covered under--
[(1) workers' compensation laws, or
[(2) a no-fault automobile accident insurance plan or
program.
[(c) No law of any State, or of any political subdivision of
a State, and no provision of any contract entered into or
renewed after the date of enactment of the Indian Health Care
Amendments of 1988, shall prevent or hinder the right of
recovery of the United States, an Indian tribe, or a tribal
organization under subsection (a).
[(d) No action taken by the United States, an Indian tribe,
or a tribal organization to enforce the right of recovery
provided under subsection (a) shall affect the right of any
person to any damages (other than damages for the cost of
health services provided by the Secretary through the Service).
[(e) The United States, an Indian tribe, or a tribal
organization may enforce the right of recovery provided under
subsection (a) by--
[(1) intervening or joining in any civil action or
proceeding brought--
[(A) by the individual for whom health
services were provided by the Secretary, an
Indian tribe, or a tribal organization, or
[(B) by any representative or heirs of such
individual, or
[(2) instituting a separate civil action, after
providing to such individual, or to the representative
or heirs of such individual, notice of the intention of
the United States, an Indian tribe, or a tribal
organization to institute a separate civil action.
[(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.
[crediting of reimbursements
[Sec. 207. (a) Except as provided in section 202(d), title
IV, and section 813 of this Act, all reimbursements received or
recovered, under authority of this Act, Public Law 87-693 (42
U.S.C. 2651, et seq.), or any other provision of law, by reason
of the provision of health services by the Service or by a
tribe or tribal organization under a contract pursuant to the
Indian Self-Determination Act shall be retained by the Service
or that tribe or tribal organization and shall be available for
the facilities, and to carry out the programs, of the Service
or that tribe or tribal organization to provide health care
services to Indians.
[(b) The Service may not offset or limit the amount of funds
obligated to any service unit or any entity under contract with
the Service because of the receipt of reimbursements under
subsection (a).
[health services research
[Sec. 208. Of the amounts appropriated for the Service in any
fiscal year, other than amounts made available for the Indian
Health Care Improvement Fund, not less than $200,000 shall be
available only for research to further the performance of the
health service responsibilities of the Service. Indian tribes
and tribal organizations contracting with the Service under the
authority of the Indian Self-Determination Act shall be given
an equal opportunity to compete for, and receive, research
funds under this section.
[mental health prevention and treatment services
[Sec. 209. (a) National Plan for Indian Mental Health
Services.--(1) Not later than 120 days after the date of
enactment of this section, the Secretary, acting through the
Service, shall develop and publish in the Federal Register a
final national plan for Indian Mental Health Services. The plan
shall include--
[(A) an assessment of the scope of the problem of
mental illness and dysfunctional and self-destructive
behavior, including child abuse and family violence,
among Indians, including--
[(i) the number of Indians served by the
Service who are directly or indirectly affected
by such illness or behavior, and
[(ii) an estimate of the financial and human
cost attributable to such illness or behavior;
[(B) an assessment of the existing and additional
resources necessary for the prevention and treatment of
such illness and behavior; and
[(C) an estimate of the additional funding needed by
the Service to meet its responsibilities under the
plan.
[(2) The Secretary shall submit a copy of the national plan
to the Congress.
[(b) Memorandum of Agreement.--Not later than 180 days after
the date of enactment of this section, the Secretary and the
Secretary of the Interior shall develop and enter into a
memorandum of agreement under which the Secretaries shall,
among other things--
[(1) determine and define the scope and nature of
mental illness and dysfunctional and self-destructive
behavior, including child abuse and family violence,
among Indians;
[(2) make an assessment of the existing Federal,
tribal, State, local, and private services, resources,
and programs available to provide mental health
services for Indians;
[(3) make an initial determination of the unmet need
for additional services, resources, and programs
necessary to meet the needs identified pursuant to
paragraph (1);
[(4)(A) ensure that Indians, as citizens of the
United States and of the States in which they reside,
have access to mental health services to which all
citizens have access;
[(B) determine the right of Indians to participate
in, and receive the benefit of, such services; and
[(C) take actions necessary to protect the exercise
of such right;
[(5) delineate the responsibilities of the Bureau of
Indian Affairs and the Service, including mental health
identification, prevention, education, referral, and
treatment services (including services through
multidisciplinary resource teams), at the central,
area, and agency and service unit levels to address the
problems identified in paragraph (1);
[(6) provide a strategy for the comprehensive
coordination of the mental health services provided by
the Bureau of Indian Affairs and the Service to meet
the needs identified pursuant to paragraph (1),
including--
[(A) the coordination of alcohol and
substance abuse programs of the Service, the
Bureau of Indian Affairs, and the various
tribes (developed under the Indian Alcohol and
Substance Abuse Prevention and Treatment Act of
1986) with the mental health initiatives
pursuant to this Act, particularly with respect
to the referral and treatment of dually-
diagnosed individuals requiring mental health
and substance abuse treatment; and
[(B) ensuring that Bureau of Indian Affairs
and Service programs and services (including
multidisciplinary resource teams) addressing
child abuse and family violence are coordinated
with such non-Federal programs and services;
[(7) direct appropriate officials of the Bureau of
Indian Affairs and the Service, particularly at the
agency and service unit levels, to cooperate fully with
tribal requests made pursuant to subsection (d); and
[(8) provide for an annual review of such agreement
by the two Secretaries.
[(c) Community Mental Health Plan.--(1) The governing body of
any Indian tribe may, at its discretion, adopt a resolution for
the establishment of a community mental health plan providing
for the identification and coordination of available resources
and programs to identify, prevent, or treat mental illness or
dysfunctional and self-destructive behavior, including child
abuse and family violence, among its members.
[(2) In furtherance of a plan established pursuant to
paragraph (1) and at the request of a tribe, the appropriate
agency, service unit, or other officials of the Bureau of
Indian Affairs and the Service shall cooperate with, and
provide technical assistance to, the tribe in the development
of such plan. Upon the establishment of such a plan and at the
request of the tribe, such officials, as directed by the
memorandum of agreement developed pursuant to subsection (c),
shall cooperate with the tribe in the implementation of such
plan.
[(3) Two or more Indian tribes may form a coalition for the
adoption of resolutions and the establishment and development
of a joint community mental health plan under this subsection.
[(4) The Secretary, acting through the Service, may make
grants to Indian tribes adopting a resolution pursuant to
paragraph (1) to obtain technical assistance for the
development of a community mental health plan and to provide
administrative support in the implementation of such plan.
[(d) Mental Health Training and Community Education
Programs.--(1) The Secretary and the Secretary of the Interior,
in consultation with representatives of Indian tribes, shall
conduct a study and compile a list, of the types of staff
positions specified in paragraph (2) whose qualifications
include, or should include, training in the identification,
prevention, education, referral, or treatment of mental illness
or dysfunctional and self-destructive behavior.
[(2) The positions referred to in paragraph (1) are--
[(A) staff positions within the Bureau of Indian
Affairs, including existing positions, in the fields
of--
[(i) elementary and secondary education;
[(ii) social services and family and child
welfare;
[(iii) law enforcement and judicial services;
and
[(iv) alcohol and substance abuse;
[(B) staff positions with the Service; and
[(C) staff positions similar to those identified in
subparagraphs (A) and (B) established and maintained by
Indian tribes, including positions established in
contracts entered into under the Indian Self-
Determination Act.
[(3)(A) The appropriate Secretary shall provide training
criteria appropriate to each type of position identified in
paragraph (2)(A) and ensure that appropriate training has been,
or will be, provided to any individual in any such position.
With respect to any such individual in a position identified
pursuant to paragraph (2)(C), the respective Secretaries shall
provide appropriate training to, or provide funds to an Indian
tribe for the training of, such individual. In the case of
positions funded under a contract entered into under the Indian
Self-Determination Act, the appropriate Secretary shall ensure
that such training costs are included in the contract, if
necessary.
[(B) Funds authorized to be appropriated pursuant to this
section may be used to provide training authorized by this
paragraph for community education programs described in
paragraph (5) if a plan adopted pursuant to subsection (d)
identifies individuals or employment categories, other than
those identified pursuant to paragraph (1), for which such
training or community education is deemed necessary or
desirable.
[(4) Position-specific training criteria described in
paragraph (3) shall be culturally relevant to Indians and
Indian tribes and shall ensure that appropriate information
regarding traditional Indian healing and treatment practices is
provided.
[(5) The Service shall develop and implement or, upon the
request of an Indian tribe, assist such tribe to develop and
implement, a program of community education on mental illness
and dysfunctional and self-destructive behavior for
individuals, as determined in a plan adopted pursuant to
subsection (d). In carrying out this paragraph, the Service
shall provide, upon the request of an Indian tribe, technical
assistance to the Indian tribe to obtain or develop community
education and training materials on the identification,
prevention, referral, and treatment of mental illness and
dysfunctional and self-destructive behavior.
[(e) Staffing.--(1) Within 90 days after the date of
enactment of this section, the Secretary shall develop a plan
under which the Service will increase the health care staff
providing mental health services by at least 500 positions
within five years after the date of enactment of this section,
with at least 200 of such positions devoted to child,
adolescent, and family services. Such additional staff shall be
primarily assigned to the service unit level for services which
shall include outpatient, emergency, aftercare and follow-up,
and prevention and education services.
[(2) The plan developed under paragraph (1) shall be
implemented under the Act of November 2, 1921 (25 U.S.C. 13)
popularly known as the ``Snyder Act''.
[(f) Staff Recruitment and Retention.--(1) The Secretary
shall provide for the recruitment of the additional personnel
required by subsection (f) and the retention of all Service
personnel providing mental health services. In carrying out
this subsection, the Secretary shall give priority to
practitioners providing mental health services to children and
adolescents with mental health problems.
[(2) In carrying out paragraph (1), the Secretary shall
develop a program providing for--
[(A) the payment of bonuses (which shall not be more
favorable than those provided for under sections 116
and 117) for service in hardship posts;
[(B) the repayment of loans (for which the provisions
of repayment contracts shall not be more favorable than
the repayment contracts under section 108) for health
professions education as a recruitment incentive; and
[(C) a system of postgraduate rotations as a
retention incentive.
[(3) This subsection shall be carried out in coordination
with the recruitment and retention programs under title I.
[(g) Mental Health Technician Program.--(1) Under the
authority of the Snyder Act of November 2, 1921 (25 U.S.C. 13),
the Secretary shall establish and maintain a Mental Health
Technician program within the Service which--
[(A) provides for the training of Indians as mental
health technicians; and
[(B) employs such technicians in the provision of
community-based mental health care that includes
identification, prevention, education, referral, and
treatment services.
[(2) In carrying out paragraph (1)(A), the Secretary shall
provide high standard paraprofessional training in mental
health care necessary to provide quality care to the Indian
communities to be served. Such training shall be based upon a
curriculum developed or approved by the Secretary which
combines education in the theory of mental health care with
supervised practical experience in the provision of such care.
[(3) The Secretary shall supervise and evaluate the mental
health technicians in the training program.
[(4) The Secretary shall ensure that the program established
pursuant to this subsection involves the utilization and
promotion of the traditional Indian health care and treatment
practices of the Indian tribes to be served.
[(h) Mental Health Research.--The Secretary, acting through
the Service and in consultation with the National Institute of
Mental Health, shall enter into contracts with, or make grants
to, appropriate institutions for the conduct of research on the
incidence and prevalence of mental disorders among Indians on
Indian reservations and in urban areas. Research priorities
under this subsection shall include--
[(1) the inter-relationship and inter-dependence of
mental disorders with alcoholism, suicide, homicides,
accidents, and the incidence of family violence, and
[(2) the development of models of prevention
techniques.
The effect of the inter-relationships and interdependencies
referred to in paragraph (1) on children, and the development
of prevention techniques under paragraph (2) applicable to
children, shall be emphasized.
[(i) Facilities Assessment.--Within one year after the date
of enactment of this section, the Secretary, acting through the
Service, shall make an assessment of the need for inpatient
mental health care among Indians and the availability and cost
of inpatient mental health facilities which can meet such need.
In making such assessment, the Secretary shall consider the
possible conversion of existing, under-utilized service
hospital beds into psychiatric units to meet such need.
[(j) Annual Report.--The Service shall develop methods for
analyzing and evaluating the overall status of mental health
programs and services for Indians and shall submit to the
President, for inclusion in each report required to be
transmitted to the Congress under section 801, a report on the
mental health status of Indians which shall describe the
progress being made to address mental health problems of Indian
communities.
[(k) Mental Health Demonstration Grant Program.--(1) The
Secretary, acting through the Service, is authorized to make
grants to Indian tribes and inter-tribal consortia to pay 75
percent of the cost of planning, developing, and implementing
programs to deliver innovative community-based mental health
services to Indians. The 25 percent tribal share of such cost
may be provided in cash or through the provision of property or
services.
[(2) The Secretary may award a grant for a project under
paragraph (1) to an Indian tribe or inter-tribal consortium
which meets the following criteria:
[(A) The project will address significant unmet
mental health needs among Indians.
[(B) The project will serve a significant number of
Indians.
[(C) The project has the potential to deliver
services in an efficient and effective manner.
[(D) The tribe or consortium has the administrative
and financial capability to administer the project.
[(E) The project will deliver services in a manner
consistent with traditional Indian healing and
treatment practices.
[(F) The project is coordinated with, and avoids
duplication of, existing services.
[(3) For purposes of this subsection, the Secretary shall, in
evaluating applications for grants for projects to be operated
under any contract entered into with the Service under the
Indian Self-Determination Act, use the same criteria that the
Secretary uses in evaluating any other application for such a
grant.
[(4) The Secretary may only award one grant under this
subsection with respect to a service area until the Secretary
has awarded grants for all service areas with respect to which
the Secretary receives applications during the application
period, as determined by the Secretary, which meet the criteria
specified in paragraph (2).
[(5) Not later than 180 days after the close of the term of
the last grant awarded pursuant to this subsection, the
Secretary shall submit to the Congress a report evaluating the
effectiveness of the innovative community-based projects
demonstrated pursuant to this subsection. Such report shall
include findings and recommendations, if any, relating to the
reorganization of the programs of the Service for delivery of
mental health services to Indians.
[(6) Grants made pursuant to this section may be expended
over a period of three years and no grant may exceed $1,000,000
for the fiscal years involved.
[(l) Licensing Requirement for Mental Health Care Workers.--
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 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
dysfunctional 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
subsection.
[(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, 1995, 1996,
1997, 1998, 1999, and 2000.
[managed care feasibility study
[Sec. 210. (a) The Secretary, acting through the Service,
shall 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
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.
[california contract health services demonstration program
[Sec. 211. (a) The Secretary shall establish a demonstration
program to evaluate the use of a contract care intermediary to
improve the accessibility of health services to California
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
administrative costs) incurred, during the period of the
demonstration program, in providing medical treatment under
contract to California Indians described in section 809(b)
throughout the California contract 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
reimbursement 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 Indian Health Board, from not less than
8 tribal health programs serving California Indians covered
under such demonstration, 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
demonstration program carried out under this section, including
a statement 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 1996 through 2000, such sums as may be necessary
to carry out the purposes of this section.
[coverage of screening mammography
[Sec. 212. The Secretary, through the Service, shall provide
for screening mammography (as defined in section 1861(jj) 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 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.
[patient travel costs
[Sec. 213. (a) The Secretary, acting through the Service,
shall 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 pursuant 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.
[epidemiology centers
[Sec. 214. (a)(1) The Secretary shall establish an
epidemiology center in each Service area to carry out the
functions described in paragraph (3).
[(2) To assist such centers in carrying 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 objectives) 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 objectives described in section 3(b).
[(3) In consultation with Indian tribes and urban Indian
communities, 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
identifying their highest priority health status
objectives and the services 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 organizations to conduct epidemiological studies of
Indian communities.
[(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 communities 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
financial 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 Indian 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.
[comprehensive school health education programs
[Sec. 215. (a) The Secretary, acting through the Service and
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
education 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
community;
[(6) develop school programs on nutrition education,
personal 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 programs;
[(11) develop activities for the prevention and
control of communicable diseases; and
[(12) develop community and environmental health
education programs.
[(c) The Secretary shall provide technical assistance to
Indian tribes in the development of health education plans, and
the dissemination of health education materials and information
on existing health programs and resources.
[(d) The Secretary shall establish criteria for the review
and approval of applications for grants made pursuant to this
section.
[(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 children 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
communicable 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.
[indian youth grant program
[Sec. 216. (a) The Secretary, acting through the Service, is
authorized to make grants to Indian tribes, tribal
organizations, and urban Indian organizations for innovative
mental 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 incorporate cultural values, community and family
involvement, and traditional healers; and
[(B) develop and provide community training and
education.
[(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.
[american indians into psychology program
[Sec. 217. (a) The Secretary may provide grants to at least 3
colleges and universities for the purpose of developing and
maintaining American Indian psychology career recruitment
programs as a means of encouraging Indians to enter the mental
health field.
[(b) The Secretary shall provide one of the grants authorized
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 maximum 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 awarding of the grants provided under this 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
professions to Indian communities including elementary,
secondary 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 experiential
activities;
[(D) provides stipends to undergraduate and graduate
students 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 students;
[(F) to the maximum extent feasible, utilizes
existing university 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 Public 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 physician or other health professional
shortage area and addresses the health care needs of a
substantial number of Indians.
[prevention, control, and elimination of tuberculosis
[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
elimination 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 tuberculosis for health professionals,
including allied health professionals.
[(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.
[(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 prevention, control, and elimination of
tuberculosis with activities of the Centers for Disease
Control\1\, and State and local health agencies; and
[(2) the applicant will submit to the Secretary an
annual report on its activities for the prevention,
control, and elimination of tuberculosis.
[(d) In carrying out this section, the Secretary--
[(1) shall establish criteria for the review and
approval of applications for grants under subsection
(a), including requirement of public health
qualifications of applicants;
[(2) shall, 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 on Energy and Commerce and the Committee on
Natural Resources of the House and the 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 Indian 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 supplies 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 supplies 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 program 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 personnel, on which the reduction of such
grant is based, and such amount shall be deemed as part of the
grant and shall be deemed to have been paid to the grant
recipient.
[contract health services payment study
[Sec. 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--
[(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 providers from billing
and collection practices, including the development of
materials and programs explaining patients' rights and
responsibilities.
[(b) The study required by subsection (a) shall--
[(1) assess the impact of the existing contract
health services 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 payment 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
policies, administrative procedures, and regulations,
to eliminate the problems experienced by private
contract health services providers and individual
Indians as a result of delayed payments; and
[(5) compare the Service's payment processing
requirements with private insurance claims processing
requirements to evaluate the systemic differences or
similarities employed by the Service and private
insurers.
[(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
[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 valid 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.
[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 payment 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 payment of any charges or costs associated with the
provision of such services.
[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 planning and delivery of programs
administered by the Service, in order to improve and enhance
the treatment models of care for Indian women.
[authorization of appropriations
[Sec. 224. Except as provided in sections 209(m), 211, 213,
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.
[limitation on use of funds
[Sec. 225. Amounts appropriated to carry out this title may
not be used in a manner inconsistent with the Assisted Suicide
Funding Restriction Act of 1997.
[TITLE III--HEALTH FACILITIES
[consultation; closure of facilities; reports
[Sec. 301. (a) Prior to the expenditure of, or the making of
any firm commitment to expend, any funds appropriated for the
planning, design, construction, or renovation of facilities
pursuant to the Act of November 2, 1921 (25 U.S.C. 13),
popularly known as the Snyder Act, the Secretary, acting
through the Service, shall--
[(1) consult with any Indian tribe that would be
significantly affected by such expenditure for the
purpose of determining and, whenever practicable,
honoring tribal preferences concerning size, location,
type, and other characteristics of any facility on
which such expenditure is to be made, and
[(2) ensure, whenever practicable, that such facility
meets the standards of the Joint Commission on
Accreditation of Health Care Organizations by not later
than 1 year after the date on which the construction or
renovation of such facility is completed.
[(b)(1) Notwithstanding any provision of law other than this
subsection, no Service hospital or outpatient health care
facility of the Service, or any portion of such a hospital or
facility, may be closed if the Secretary has not submitted to
the Congress at least 1 year prior to the date such hospital or
facility (or portion thereof) is proposed to be closed an
evaluation of the impact of such proposed closure which
specifies, in addition to other considerations--
[(A) the accessibility of alternative health care
resources for the population served by such hospital or
facility;
[(B) the cost effectiveness of such closure;
[(C) the quality of health care to be provided to the
population served by such hospital or facility after
such closure;
[(D) the availability of contract health care funds
to maintain existing levels of service;
[(E) the views of the Indian tribes served by such
hospital or facility concerning such closure;
[(F) the level of utilization of such hospital or
facility by all eligible Indians; and
[(G) the distance between such hospital or facility
and the nearest operating Service hospital.
[(2) Paragraph (1) shall not apply to any temporary closure
of a facility or of any portion of a facility if such closure
is necessary for medical, environmental, or safety reasons.
[(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--
[(A) the current health facility priority system of
the Service,
[(B) the planning, design, construction, and
renovation needs for the 10 top-priority inpatient care
facilities and the 10 top-priority ambulatory care
facilities (together with required staff quarters),
[(C) the justification for such order of priority,
[(D) the projected cost of such projects, and
[(E) the methodology adopted by the Service in
establishing priorities under its health facility
priority system.
[(2) In preparing each report required under paragraph (1)
(other than the initial report), the Secretary shall--
[(A) consult with Indian tribes and tribal
organizations including those tribes or tribal
organizations operating health programs or facilities
under any contract entered into with the Service under
the Indian Self-Determination Act, and
[(B) review the needs of such tribes and tribal
organizations for inpatient and outpatient facilities,
including their needs for renovation and expansion of
existing facilities.
[(3) For purposes of this subsection, the Secretary shall, in
evaluating the needs of facilities operated under any contract
entered into with the Service under the Indian Self-
Determination Act, use the same criteria that the Secretary
uses in evaluating the needs of facilities operated directly by
the Service.
[(4) The Secretary shall ensure that the planning, design,
construction, and renovation needs of Service and non-Service
facilities which are the subject of a contract for health
services entered into with the Service under the Indian Self-
Determination Act are fully and equitably integrated into the
development of the health facility priority system.
[(d) All funds appropriated under the Act of November 2, 1921
(25 U.S.C. 13), for the planning, design, construction, or
renovation of health facilities for the benefit of an Indian
tribe or tribes shall be subject to the provisions of section
102 of the Indian Self-Determination Act.
[safe water and sanitary waste disposal facilities
[Sec. 302. (a) The Congress hereby finds and declares that--
[(1) the provision of safe water supply systems and
sanitary sewage and solid waste disposal systems is
primarily a health consideration and function;
[(2) Indian people suffer an inordinately high
incidence of disease, injury, and illness directly
attributable to the absence or inadequacy of such
systems;
[(3) the long-term cost to the United States of
treating and curing such disease, injury, and illness
is substantially greater than the short-term cost of
providing such systems and other preventive health
measures;
[(4) many Indian homes and communities still lack
safe water supply systems and sanitary sewage and solid
waste disposal systems; and
[(5) it is in the interest of the United States, and
it is the policy of the United States, that all Indian
communities and Indian homes, new and existing, be
provided with safe and adequate water supply systems
and sanitary sewage waste disposal systems as soon as
possible.
[(b)(1) In furtherance of the findings and declarations made
in subsection (a), Congress reaffirms the primary
responsibility and authority of the Service to provide the
necessary sanitation facilities and services as provided in
section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a).
[(2) The Secretary, acting through the Service, is authorized
to provide under section 7 of the Act of August 5, 1954\1\ (42
U.S.C. 2004a)--
[(A) financial and technical assistance to Indian
tribes and communities in the establishment, training,
and equipping of utility organizations to operate and
maintain Indian sanitation facilities;
[(B) ongoing technical assistance and training in the
management of utility organizations which operate and
maintain sanitation facilities; and
[(C) operation and maintenance assistance for, and
emergency repairs to, tribal sanitation facilities when
necessary to avoid a health hazard or to protect the
Federal investment in sanitation facilities.
[(3) Notwithstanding any other provision of law--
[(A) the Secretary of Housing and Urban Affairs is
authorized to transfer funds appropriated under the
Housing and Community Development Act of 1974 (42
U.S.C. 5301, et seq.) to the Secretary of Health and
Human Services, and
[(B) the Secretary of Health and Human Services is
authorized to accept and use such funds for the purpose
of providing sanitation facilities and services for
Indians under section 7 of the Act of August 5, 1954
(42 U.S.C. 2004a).
[(c) Beginning in fiscal year 1990, the Secretary, acting
through the Service, shall develop and begin implementation of
a 10-year plan to provide safe water supply and sanitation
sewage and solid waste disposal facilities to existing Indian
homes and communities and to new and renovated Indian homes.
[(d) The financial and technical capability of an Indian
tribe or community to safely operate and maintain a sanitation
facility shall not be a prerequisite to the provision or
construction of sanitation facilities by the Secretary.
[(e)(1) The Secretary is authorized to provide financial
assistance to Indian tribes and communities in an amount equal
to the Federal share of the costs of operating, managing, and
maintaining the facilities 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, managing, and maintaining such facilities may be
provided, in part, through cash donations or in kind property,
fairly evaluated.
[(f) Programs administered by Indian tribes or tribal
organizations under the authority of the Indian Self-
Determination Act shall be eligible for--
[(1) any funds appropriated pursuant to this section,
and
[(2) any funds appropriated for the purpose of
providing water supply or sewage disposal services,
on an equal basis with programs that are administered directly
by the Service.
[(g)(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--
[(A) the current Indian sanitation facility priority
system of the Service;
[(B) the methodology for determining sanitation
deficiencies;
[(C) the level of sanitation deficiency for each
sanitation facilities project of each Indian tribe or
community;
[(D) the amount of funds necessary to raise all
Indian tribes and communities to a level I sanitation
deficiency; and
[(E) the amount of funds necessary to raise all
Indian tribes and communities to zero sanitation
deficiency.
[(2) In preparing each report required under paragraph (1)
(other than the initial report), the Secretary shall consult
with Indian tribes and tribal organizations (including those
tribes or tribal organizations operating health care programs
or facilities under any contract entered into with the Service
under the Indian Self-Determination Act) to determine the
sanitation needs of each tribe.
[(3) The methodology used by the Secretary in determining
sanitation deficiencies for purposes of paragraph (1) shall be
applied uniformly to all Indian tribes and communities.
[(4) For purposes of this subsection, the sanitation
deficiency levels for an Indian tribe or community are as
follows:
[(A) level I is an Indian tribe or community with a
sanitation system--
[(i) which complies with all applicable water
supply and pollution control laws, and
[(ii) in which the deficiencies relate to
routine replacement, repair, or maintenance
needs;
[(B) level II is an Indian tribe or community with a
sanitation system--
[(i) which complies with all applicable water
supply and pollution control laws, and
[(ii) in which the deficiencies relate to
capital improvements that are necessary to
improve the facilities in order to meet the
needs of such tribe or community for domestic
sanitation facilities;
[(C) level III is an Indian tribe or community with a
sanitation system which--
[(i) has an inadequate or partial water
supply and a sewage disposal facility that does
not comply with applicable water supply and
pollution control laws, or
[(ii) has no solid waste disposal facility;
[(D) level IV is an Indian tribe or community with a
sanitation system which lacks either a safe water
supply system or a sewage disposal system; and
[(E) level V is an Indian tribe or community that
lacks a safe water supply and a sewage disposal system.
[(5) For purposes of this subsection, any Indian tribe or
community that lacks the operation and maintenance capability
to enable its sanitation system to meet pollution control laws
may not be treated as having a level I or II sanitation
deficiency.
[preference to indians and indian firms
[Sec. 303. (a) The Secretary, acting through the Service, may
utilize the negotiating authority of the Act of June 25, 1910
(25 U.S.C. 47), to give preference to any Indian or any
enterprise, partnership, corporation, or other type of business
organization owned and controlled by an Indian or Indians
including former or currently federally recognized Indian
tribes in the State of New York (hereinafter referred to as an
``Indian firm'') in the construction and renovation of Service
facilities pursuant to section 301 and in the construction of
safe water and sanitary waste disposal facilities pursuant to
section 302. Such preference may be accorded by the Secretary
unless he finds, pursuant to rules and regulations promulgated
by him, that the project or function to be contracted for will
not be satisfactory or such project or function cannot be
properly completed or maintained under the proposed contract.
The Secretary, in arriving at his finding, shall consider
whether the Indian or Indian firm will be deficient with
respect to (1) ownership and control by Indians, (2) equipment,
(3) bookkeeping and accounting procedures, (4) substantive
knowledge of the project or function to be contracted for, (5)
adequately trained personnel, or (6) other necessary components
of contract performance.
[(b) For the purpose of implementing the provisions of this
title, the Secretary shall assure that the rates of pay for
personnel engaged in the construction or renovation of
facilities constructed or renovated in whole or in part by
funds made available pursuant to this title are not less than
the prevailing local wage rates for similar work as determined
in accordance with the Act of March 3, 1931 (40 U.S.C. 276a--
276a-5, known as the Davis-Bacon Act).
[soboba sanitation facilities
[Sec. 304. The Act of December 17, 1970 (84 Stat. 1465), is
hereby amended by adding the following new section 9 at the end
thereof:
[``Sec. 9. Nothing in this Act shall preclude the Soboba Band
of Mission Indians and the Soboba Indian Reservation from being
provided with sanitation facilities and services under the
authority of section 7 of the Act of August 5, 1954 (68 Stat
674), as amended by the Act of July 31, 1959 (73 Stat. 267).''.
[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
modernization by any 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
modernization; and
[(B) any renovation or modernization for which funds
appropriated under any Federal law were lawfully
expended,
but only if the requirements of subsection (b) are met.
[(2) The Secretary shall maintain a separate priority list to
address the needs of such facilities for personnel or
equipment.
[(3) The Secretary shall submit to the President, for
inclusion 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
intent 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
modernized by an Indian tribe under this section ceases to be
used as a Service facility 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 modernization (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 facility at the time
of the completion of such renovation or modernization.
[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
construction, 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 tribal 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 transferred 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
modernization) of an ambulatory 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,
expansion, 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 (specified in the contract entered into
under the Indian Self-Determination Act) with a
population of not less than 2,000 eligible
Indians.
[(2) The requirements of clauses (ii) and (iii) of paragraph
(1)(C) shall not apply to a tribe or tribal organization
applying 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
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
assurance 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 without 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 transfer to the United
States.
[indian health care delivery demonstration project
[Sec. 307. (a) Health Care Delivery Demonstration Projects.--
The Secretary, acting through the Service, is authorized to
enter into contracts with, or make grants to, Indian tribes or
tribal organizations for the purpose of carrying out a health
care delivery demonstration project to test alternative means
of delivering health care and services through health
facilities to Indians.
[(b) Use of Funds.--The Secretary, in approving projects
pursuant to this section, may authorize funding for the
construction and renovation of hospitals, health centers,
health stations, and other facilities to deliver health care
services and is authorized to--
[(1) waive any leasing prohibition;
[(2) permit carryover of funds appropriated for the
provision of health care services;
[(3) permit the use of non-Service Federal funds and
non-Federal funds;
[(4) permit the use of funds or property donated from
any source for project purposes; and
[(5) provide for the reversion of donated real or
personal property to the donor.
[(c) Criteria.--(1) Within 180 days after the date of
enactment of this section, the Secretary, after consultation
with Indian tribes and tribal organizations, shall develop and
publish in the Federal Register criteria for the review and
approval of applications submitted under this section. The
Secretary may enter into a contract or award a grant under this
section for projects which meet the following criteria:
[(A) There is a need for a new facility or program or
the reorientation of an existing facility or program.
[(B) A significant number of Indians, including those
with low health status, will be served by the project.
[(C) The project has the potential to address the
health needs of Indians in an innovative manner.
[(D) The project has the potential to deliver
services in an efficient and effective manner.
[(E) The project is economically viable.
[(F) The Indian tribe or tribal organization has the
administrative and financial capability to administer
the project.
[(G) The project is integrated with providers of
related health and social services and is coordinated
with, and avoids duplication of, existing services.
[(2) The Secretary may provide for the establishment of peer
review panels, as necessary, to review and evaluate
applications and to advise the Secretary regarding such
applications using the criteria developed pursuant to paragraph
(1).
[(3)(A) On or before September 30, 1995, the Secretary shall
enter into contracts or award grants under this section for a
demonstration project in each of the following service units
which meets the criteria specified in paragraph (1) and for
which a completed application has been received by the
Secretary:
[(i) Cass Lake, Minnesota.
[(ii) Clinton, Oklahoma.
[(iii) Harlem, Montana.
[(iv) Mescalero, New Mexico.
[(v) Owyhee, Nevada.
[(vi) Parker, Arizona.
[(vii) Schurz, Nevada.
[(viii) Winnebago, Nebraska.
[(ix) Ft. Yuma, California.
[(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).
[(d) Technical Assistance.--The Secretary shall provide such
technical and other assistance as may be necessary to enable
applicants to comply with the provisions of this section.
[(e) Service to Ineligible Persons.--The authority to provide
services to persons otherwise ineligible for the health care
benefits of the Service and the authority to extend hospital
privileges in service facilities to non-Service health care
practitioners as provided in section 813 may be included,
subject to the terms of such section, in any demonstration
project approved pursuant to this section.
[(f) Equitable Treatment.--For purposes of subsection
(c)(1)(A), the Secretary shall, in evaluating facilities
operated under any contract entered into with the Service under
the Indian Self-Determination Act, use the same criteria that
the Secretary uses in evaluating facilities operated directly
by the Service.
[(g) Equitable Integration of Facilities.--The Secretary
shall ensure that the planning, design, construction, and
renovation needs of Service and non-Service facilities which
are the subject of a contract for health services entered into
with the Service under the Indian Self-Determination Act, are
fully and equitably integrated into the implementation of the
health care delivery demonstration projects under this section.
[(h)(1) 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 from 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.
[land transfer
[Sec. 308. The Bureau of Indian Affairs is authorized to
transfer, 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
Health Center.
[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.
[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 funds provided pursuant to the authorization
contained in section 309.
[(b) The Secretary shall submit to the Congress a report on
the amount of procurements from foreign entities made in fiscal
years 1993 and 1994 with funds provided pursuant to the
authorization contained in section 309. Such report shall
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 any international
agreement to which the United States is a party.
[(c) If it has been finally determined by a court or Federal
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
ineligibility procedures described in sections 9.400 through
9.409 of title 48, Code of Federal Regulations.
[(d) For purposes of this section, the term ``Buy American
Act'' means title III of the Act entitled ``An Act making
appropriations 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
[treatment of payments under medicare program
[Sec. 401. (a) Any payments received by a hospital or skilled
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.
[treatment of payments under medicaid program
[Sec. 402. (a) Notwithstanding any other provision of law,
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 payment 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 necessary 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 payments received by such facility for services
provided to Indians eligible for benefits under title XIX of
the Social Security Act shall not be considered in determining
appropriations for the provision of health care and services to
Indians.
[report
[Sec. 403. The Secretary shall submit to the President, for
inclusion in the report required to be transmitted to the
Congress under section 801, an accounting on the amount and use
of funds made available to the Service pursuant to this title
as a result of reimbursements through title XVIII and XIX of
the Social Security Act, as amended.
[grants to and contracts with tribal organizations
[Sec. 404. (a) The Secretary, acting through the Service,
shall make grants to or enter into contracts with tribal
organizations to assist such organizations in establishing and
administering programs on or near Federal Indian reservations
and trust areas and in or near Alaska Native villages to assist
individual Indians to--
[(1) enroll under section 1818 of part A and sections
1836 and 1837 of part B of title XVIII of the Social
Security Act;
[(2) pay monthly premiums for coverage due to
financial need of such individual; and
[(3) apply for medical assistance provided pursuant
to title XIX of the Social Security Act.
[(b) The Secretary, acting through the Service, shall place
conditions as deemed necessary to effect the purpose of this
section in any contract or grant which the Secretary makes with
any tribal organization pursuant to this section. Such
conditions shall include, but are not limited to, requirements
that the organization successfully undertake to--
[(1) determine the population of Indians to be served
that are or could be recipients of benefits under
titles XVIII and XIX of the Social Security Act;
[(2) assist individual Indians in becoming familiar
with and utilizing such benefits;
[(3) provide transportation to such individual
Indians to the appropriate offices for enrollment or
application for medical assistance;
[(4) develop and implement--
[(A) a schedule of income levels to determine
the extent of payments of premiums by such
organizations for coverage of needy
individuals; and
[(B) methods of improving the participation
of Indians in receiving the benefits provided
under titles XVIII and XIX of the Social
Security Act.
[(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 and 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.
[demonstration program for direct billing of medicare, medicaid, and
other third party payorsi20 sec. 405.
[(a) Establishment of Direct Billing Program.--
[(1) In general.--The Secretary shall establish a
program under which Indian tribes, tribal
organizations, and Alaska Native health organizations
that contract or compact for the operation of a
hospital or clinic of the Service under the Indian
Self-Determination and Education Assistance Act may
elect to directly bill for, and receive payment for,
health care services provided by such hospital or
clinic for which payment is made under title XVIII of
the Social Security Act (42 U.S.C. 1395 et seq.) (in
this section referred to as the ``medicare program''),
under a State plan for medical assistance approved
under title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) (in this section referred to as the
``medicaid program''), or from any other third party
payor.
[(2) Application of 100 percent fmap.--The third
sentence of section 1905(b) of the Social Security Act
(42 U.S.C. 1396d(b)) shall apply for purposes of
reimbursement under the medicaid program for health
care services directly billed under the program
established under this section.
[(b) Direct Reimbursement.--
[(1) Use of funds.--Each hospital or clinic
participating in the program described in subsection
(a) of this section shall be reimbursed directly under
the medicare and medicaid programs for services
furnished, without regard to the provisions of section
1880(c) of the Social Security Act (42 U.S.C.
1395qq(c)) and sections 402(a) and 813(b)(2)(A), but
all funds so reimbursed shall first be used by the
hospital or clinic for the purpose of making any
improvements in the hospital or clinic that may be
necessary to achieve or maintain compliance with the
conditions and requirements applicable generally to
facilities of such type under the medicare or medicaid
programs. Any funds so reimbursed which are in excess
of the amount necessary to achieve or maintain such
conditions shall be used--
[(A) solely for improving the health
resources deficiency level of the Indian tribe;
and
[(B) in accordance with the regulations of
the Service applicable to funds provided by the
Service under any contract entered into under
the Indian Self-Determination Act (25 U.S.C.
450f et seq.).
[(2) Audits.--The amounts paid to the hospitals and
clinics participating in the program established under
this section shall be subject to all auditing
requirements applicable to programs administered
directly by the Service and to facilities participating
in the medicare and medicaid programs.
[(3) Secretarial oversight.--The Secretary shall
monitor the performance of hospitals and clinics
participating in the program established under this
section, and shall require such hospitals and clinics
to submit reports on the program to the Secretary on an
annual basis.
[(4) No payments from special funds.--Notwithstanding
section 1880(c) of the Social Security Act (42 U.S.C.
1395qq(c)) or section 402(a), no payment may be made
out of the special funds described in such sections for
the benefit of any hospital or clinic during the period
that the hospital or clinic participates in the program
established under this section.
[(c) Requirements for Participation.--
[(1) Application.--Except as provided in paragraph
(2)(B), in order to be eligible for participation in
the program established under this section, an Indian
tribe, tribal organization, or Alaska Native health
organization shall submit an application to the
Secretary that establishes to the satisfaction of the
Secretary that--
[(A) the Indian tribe, tribal organization,
or Alaska Native health organization contracts
or compacts for the operation of a facility of
the Service;
[(B) the facility is eligible to participate
in the medicare or medicaid programs under
section 1880 or 1911 of the Social Security Act
(42 U.S.C. 1395qq; 1396j);
[(C) the facility meets the requirements that
apply to programs operated directly by the
Service; and
[(D) the facility--
[(i) is accredited by an accrediting
body as eligible for reimbursement
under the medicare or medicaid
programs; or
[(ii) has submitted a plan, which has
been approved by the Secretary, for
achieving such accreditation.
[(2) Approval.--
[(A) In general.--The Secretary shall review
and approve a qualified application not later
than 90 days after the date the application is
submitted to the Secretary unless the Secretary
determines that any of the criteria set forth
in paragraph (1) are not met.
[(B) Grandfather of demonstration program
participants.--Any participant in the
demonstration program authorized under this
section as in effect on the day before the date
of enactment of the Alaska Native and American
Indian Direct Reimbursement Act of 1999 shall
be deemed approved for participation in the
program established under this section and
shall not be required to submit an application
in order to participate in the program.
[(C) Duration.--An approval by the Secretary
of a qualified application under subparagraph
(A), or a deemed approval of a demonstration
program under subparagraph (B), shall continue
in effect as long as the approved applicant or
the deemed approved demonstration program meets
the requirements of this section.
[(d) Examination and Implementation of Changes.--
[(1) In general.--The Secretary, acting through the
Service, and with the assistance of the Administrator
of the Centers for Medicare & Medicaid Services, shall
examine on an ongoing basis and implement--
[(A) any administrative changes that may be
necessary to facilitate direct billing and
reimbursement under the program established
under this section, including any agreements
with States that may be necessary to provide
for direct billing under the medicaid program;
and
[(B) any changes that may be necessary to
enable participants in the program established
under this section to provide to the Service
medical records information on patients served
under the program that is consistent with the
medical records information system of the
Service.
[(2) Accounting information.--The accounting
information that a participant in the program
established under this section shall be required to
report shall be the same as the information required to
be reported by participants in the demonstration
program authorized under this section as in effect on
the day before the date of enactment of the Alaska
Native and American Indian Direct Reimbursement Act of
1999. The Secretary may from time to time, after
consultation with the program participants, change the
accounting information submission requirements.
[(e) Withdrawal From Program.--A participant in the program
established under this section may withdraw from participation
in the same manner and under the same conditions that a tribe
or tribal organization may retrocede a contracted program to
the Secretary under authority of the Indian Self-Determination
Act (25 U.S.C. 450 et seq.). All cost accounting and billing
authority under the program established under this section
shall be returned to the Secretary upon the Secretary's
acceptance of the withdrawal of participation in this program.
[authorization for emergency contract health services
[Sec. 406. With respect to an elderly or disabled Indian
receiving emergency medical care or services from a non-Service
provider or in a non-Service facility under the authority of
this Act, the time limitation (as a condition of payment) for
notifying the Service of such treatment or admission shall be
30 days.
[authorization of appropriations
[Sec. 407. 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.
[TITLE V--HEALTH SERVICES FOR URBAN INDIANS
[purpose
[Sec. 501. The purpose of this title is to establish programs
in urban centers to make health services more accessible to
urban Indians.
[contracts with, and grants to, urban indian organizations
[Sec. 502. Under authority of the Act of November 2, 1921 (25
U.S.C. 13), popularly known as the Snyder Act, the Secretary,
through the Service, shall enter into contracts with, or make
grants to, urban Indian organizations to assist such
organizations in the establishment and administration, within
the urban centers in which such organizations are situated, of
programs which meet the requirements set forth in this title.
The Secretary, through the Service, shall include such
conditions as the Secretary considers necessary to effect the
purpose of this title in any contract which the Secretary
enters into with, or in any grant the Secretary makes to, any
urban Indian organization pursuant to this title.
[contracts and grants for the provision of health care and referral
services
[Sec. 503. (a) Under authority of the Act of November 2, 1921
(25 U.S.C. 13), popularly known as the Snyder Act, the
Secretary, through the Service, shall enter into contracts
with, or make grants to, urban Indian organizations for the
provision of health care and referral services for urban
Indians residing in the urban centers in which such
organizations are situated. Any such contract or grant shall
include requirements that the urban Indian organization
successfully undertake to--
[(1) estimate the population of urban Indians
residing in the urban center in which such organization
is situated who are or could be recipients of health
care or referral services;
[(2) estimate the current health status of urban
Indians residing in such urban center;
[(3) estimate the current health care needs of urban
Indians residing in such urban center;
[(4) identify all public and private health services
resources within such urban center which are or may be
available to urban Indians;
[(5) determine the use of public and health services
resources by the urban Indians residing in such urban
center;
[(6) assist such health services resources in
providing services to urban Indians;
[(7) assist urban Indians in becoming familiar with
and utilizing such health services resources;
[(8) provide basic health education, including health
promotion and disease prevention education, to urban
Indians;
[(9) establish and implement training programs to
accomplish the referral and education tasks set forth
in paragraphs (6) through (8) of this subsection;
[(10) identify gaps between unmet health needs of
urban Indians and the resources available to meet such
needs;
[(11) make recommendations to the Secretary and
Federal, State, local, and other resource agencies on
methods of improving health service programs to meet
the needs of urban Indians; and
[(12) where necessary, provide, or enter into
contracts for the provision of, health care services
for urban Indians.
[(b) The Secretary, through the Service, shall by regulation
prescribe the criteria for selecting urban Indian organizations
to enter into contracts or receive grants under this section.
Such criteria shall, among other factors, include--
[(1) the extent of unmet health care needs of urban
Indians in the urban center involved;
[(2) the size of the urban Indian population in the
urban center involved;
[(3) the accessibility to, and utilization of, health
care services (other than services provided under this
title) by urban Indians in the urban center involved;
[(4) the extent, if any, to which the activities set
forth in subsection (a) would duplicate--
[(A) any previous or current public or
private health services project in an urban
center that was or is funded in a manner other
than pursuant to this title; or
[(B) any project funded under this title;
[(5) the capability of an urban Indian organization
to perform the activities set forth in subsection (a)
and to enter into a contract with the Secretary or to
meet the requirements for receiving a grant under this
section;
[(6) the satisfactory performance and successful
completion by an urban Indian organization of other
contracts with the Secretary under this title;
[(7) the appropriateness and likely effectiveness of
conducting the activities set forth in subsection (a)
in an urban center; and
[(8) the extent of existing or likely future
participation in the activities set forth in subsection
(a) by appropriate health and health-related Federal,
State, local, and other agencies.
[(c) The Secretary, acting through the Service, shall
facilitate access to, or provide, health promotion and disease
prevention services for urban Indians through grants made to
urban Indian organizations administering contracts entered into
pursuant to this section or receiving grants under subsection
(a).
[(d)(1) The Secretary, acting through the Service, shall
facilitate access to, or provide, immunization services for
urban Indians through grants made to urban Indian organizations
administering contracts entered into pursuant to this section
or receiving grants under subsection (a).
[(2) In making any grant to carry out this subsection, the
Secretary shall take into consideration--
[(A) the size of the urban Indian population to be
served;
[(B) the immunization levels of the urban Indian
population, particularly the immunization levels of
infants, children, and the elderly;
[(C) the utilization by the urban Indians of
alternative resources from State and local governments
for no-cost or low-cost immunization services to the
general population; and
[(D) the capability of the urban Indian organization
to carry out services pursuant to this subsection.
[(3) For purposes of this subsection, the term ``immunization
services'' means services to provide without charge
immunizations against vaccine-preventable diseases.
[(e)(1) The Secretary, acting through the Service, shall
facilitate access to, or provide, mental health services for
urban Indians through grants made to urban Indian organizations
administering contracts entered into pursuant to this section
or receiving grants under subsection (a).
[(2) A grant may not be made under this subsection to an
urban Indian organization until that organization has prepared,
and the Service has approved, an assessment of the mental
health needs of the urban Indian population concerned, the
mental health services and other related resources available to
that population, the barriers to obtaining those services and
resources, and the needs that are unmet by such services and
resources.
[(3) Grants may be made under this subsection--
[(A) to prepare assessments required under paragraph
(2);
[(B) to provide outreach, educational, and referral
services to urban Indians regarding the availability of
direct mental health services, to educate urban Indians
about mental health issues and services, and effect
coordination with existing mental health providers in
order to improve services to urban Indians;
[(C) to provide outpatient mental health services to
urban Indians, including the identification and
assessment of illness, therapeutic treatments, case
management, support groups, family treatment, and other
treatment; and
[(D) to develop innovative mental health service
delivery models which incorporate Indian cultural
support systems and resources.
[(f)(1) The Secretary, acting through the Service, shall
facilitate access to, or provide, services for urban Indians
through grants to urban Indian organizations administering
contracts entered into pursuant to this section or receiving
grants under subsection (a) to prevent and treat child abuse
(including sexual abuse) among urban Indians.
[(2) A grant may not be made under this subsection to an
urban Indian organization until that organization has prepared,
and the Service has approved, an assessment that documents the
prevalence of child abuse in the urban Indian population
concerned and specifies the services and programs (which may
not duplicate existing services and programs) for which the
grant is requested.
[(3) Grants may be made under this subsection--
[(A) to prepare assessments required under paragraph
(2);
[(B) for the development of prevention, training, and
education programs for urban Indian populations,
including child education, parent education, provider
training on identification and intervention, education
on reporting requirements, prevention campaigns, and
establishing service networks of all those involved in
Indian child protection; and
[(C) to provide direct outpatient treatment services
(including individual treatment, family treatment,
group therapy, and support groups) to urban Indians who
are child victims of abuse (including sexual abuse) or
adult survivors of child sexual abuse, to the families
of such child victims, and to urban Indian perpetrators
of child abuse (including sexual abuse).
[(4) In making grants to carry out this subsection, the
Secretary shall take into consideration--
[(A) the support for the urban Indian organization
demonstrated by the child protection authorities in the
area, including committees or other services funded
under the Indian Child Welfare Act of 1978 (25 U.S.C.
1901 et seq.), if any;
[(B) the capability and expertise demonstrated by the
urban Indian organization to address the complex
problem of child sexual abuse in the community; and
[(C) the assessment required under paragraph (2).
[contracts and grants for the determination of unmet health care needs
[Sec. 504. (a) Under authority of the Act of November 2, 1921
(25 U.S.C. 13), popularly known as the Snyder Act, the
Secretary, 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 Secretary in assessing the health status
and health care needs of urban Indians in the urban center
involved and determining whether the Secretary should enter
into a contract or make a grant under section 503 with respect
to the urban Indian organization which the Secretary has
entered into a contract with, or made a grant to, under this
section.
[(b) Any contract entered into, or grant made, by the
Secretary under this section shall include requirements that--
[(1) the urban Indian organization successfully
undertake to--
[(A) document the health care status and
unmet health care needs of urban Indians in the
urban center involved; and
[(B) with respect to urban Indians in the
urban center involved, determine the matters
described in clauses (2), (3), (4), and (8) of
section 503(b); and
[(2) the urban Indian organization complete
performance of the contract, or carry out the
requirements of the grant, within one year after the
date on which the Secretary and such organization enter
into such contract, or within one year after such
organization receives such grant, whichever is
applicable.
[(c) The Secretary may not renew any contract entered into,
or grant made, under this section.
[evaluations; renewals
[Sec. 505. (a) The Secretary, through the Service, shall
develop procedures to evaluate compliance with grant
requirements under this title and compliance with, and
performance of contracts entered into by urban Indian
organizations under this title. Such procedures shall include
provisions for carrying out the requirements of this section.
[(b) The Secretary, through the Service, shall conduct an
annual onsite evaluation of each urban Indian organization
which has entered into a contract or received a grant under
section 503 for purposes of determining the compliance of such
organization with, and evaluating the performance of such
organization under, such contract or the terms of such grant.
[(c) If, as a result of the evaluations conducted under this
section, the Secretary determines that an urban Indian
organization has not complied with the requirements of a grant
or complied with or satisfactorily performed a contract under
section 503, the Secretary shall, prior to renewing such
contract or grant, attempt to resolve with such organization
the areas of noncompliance or unsatisfactory performance and
modify such contract or grant to prevent future occurrences of
such noncompliance or unsatisfactory performance. If the
Secretary determines that such noncompliance or unsatisfactory
performance cannot be resolved and prevented in the future, the
Secretary shall not renew such contract or grant with such
organization and is authorized to enter into a contract or make
a grant under section 503 with another urban Indian
organization which is situated in the same urban center as the
urban Indian organization whose contract or grant is not
renewed under this section.
[(d) In determining whether to renew a contract or grant with
an urban Indian organization under section 503 which has
completed performance of a contract or grant under section 504,
the Secretary shall review the records of the urban Indian
organization, the reports submitted under section 507, and, in
the case of a renewal of a contract or grant under section 503,
shall consider the results of the onsite evaluations conducted
under subsection (b).
[other contract and grant requirements
[Sec. 506. (a) Contracts with urban Indian organizations
entered into pursuant to this title shall be in accordance with
all Federal contracting laws and regulations except that, in
the discretion of the Secretary, such contracts may be
negotiated without advertising and need not conform to the
provisions of the Act of August 24, 1935 (40 U.S.C. 270a, et
seq.).
[(b) Payments under any contracts or grants pursuant to this
title may be made in advance or by way of reimbursement and in
such installments and on such conditions as the Secretary deems
necessary to carry out the purposes of this title.
[(c) Notwithstanding any provision of law to the contrary,
the Secretary may, at the request or consent of an urban Indian
organization, revise or amend any contract entered into by the
Secretary with such organization under this title as necessary
to carry out the purposes of this title.
[(d) In connection with any contract or grant entered into
pursuant to this title, the Secretary may permit an urban
Indian organization to utilize, in carrying out such contract
or grant, existing facilities owned by the Federal Government
within the Secretary's jurisdiction under such terms and
conditions as may be agreed upon for the use and maintenance of
such facilities.
[(e) Contracts with, or grants to, urban Indian organizations
and regulations adopted pursuant to this title shall include
provisions to assure the fair and uniform provision to urban
Indians of services and assistance under such contracts or
grants by such organizations.
[(f) Urban Indians, as defined in section 4(f) of this Act,
shall be eligible for health care or referral services provided
pursuant to this title.
[reports and records
[Sec. 507. (a) For each fiscal year during which an urban
Indian organization receives or expends funds pursuant to a
contract entered into, or a grant received, pursuant to this
title, such organization shall submit to the Secretary a
quarterly report including--
[(1) in the case of a contract or grant under section
503, information gathered pursuant to clauses (10) and
(11) of subsection (a) of such section;
[(2) information on activities conducted by the
organization pursuant to the contract or grant;
[(3) an accounting of the amounts and purposes for
which Federal funds were expended; and
[(4) such other information as the Secretary may
request.
[(b) The reports and records of the urban Indian organization
with respect to a contract or grant under this title shall be
subject to audit by the Secretary and the Comptroller General
of the United States.
[(c) The Secretary shall allow as a cost of any contract or
grant entered into under section 503 the cost of an annual
private audit conducted by a certified public accountant.
[(d)(1) The Secretary, acting through the Service, shall
submit a report to the Congress not later than March 31, 1992,
evaluating--
[(A) the health status of urban Indians;
[(B) the services provided to Indians through this
title;
[(C) areas of unmet needs in urban areas served under
this title; and
[(D) areas of unmet needs in urban areas not served
under this title.
[(2) In preparing the report under paragraph (1), the
Secretary shall consult with urban Indian health providers and
may contract with a national organization representing urban
Indian health concerns to conduct any aspect of the report.
[(3) The Secretary and the Secretary of the Interior shall--
[(A) assess the status of the welfare of urban Indian
children, including the volume of child protection
cases, the prevalence of child sexual abuse, and the
extent of urban Indian coordination with tribal
authorities with respect to child sexual abuse; and
[(B) submit a report on the assessment required under
subparagraph (A), together with recommended legislation
to improve Indian child protection in urban Indian
populations, to the Congress no later than March 31,
1992.
[limitation on contract authority
[Sec. 508. The authority of the Secretary to enter into
contracts under this title shall be to the extent, and in an
amount, provided for in appropriation Acts.
[facilities renovation
[Sec. 509. The Secretary may make funds available to
contractors or grant recipients under this title for minor
renovations to facilities, including leased facilities, to
assist such contractors or grant recipients in meeting or
maintaining the Joint Commission for Accreditation of Health
Care Organizations (JCAHO) standards.
[urban health programs branch
[Sec. 510. (a) Establishment.--There is hereby established
within the Service a Branch of Urban Health Programs which
shall be responsible for carrying out the provisions of this
title and for providing central oversight of the programs and
services authorized under this title.
[(b) Staff, Services, and Equipment.--The Secretary shall
appoint such employees to work in the branch, including a
program director, and shall provide such services and
equipment, as may be necessary for it to carry out its
responsibilities. The Secretary shall also analyze the need to
provide at least one urban health program analyst for each area
office of the Indian Health Service and shall submit his
findings to the Congress as a part of the Department's fiscal
year 1993 budget request.
[grants for alcohol and substance abuse related services
[Sec. 511. (a) Grants.--The Secretary may make grants for 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) Goals 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
organization under this Act for substance abuse prevention,
treatment, and rehabilitation shall be subject to the criteria
set forth in subsection (c).
[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).
[(c) In addition to the amounts made available under section
514 to carry out this section through fiscal year 2000, there
are authorized to be appropriated such sums as may be necessary
to carry out this section for each of fiscal years 2001 and
2002.
[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
transferred 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 Urban
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 5 years.
[authorization of appropriations
[Sec. 514. 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.
[TITLE VI--ORGANIZATIONAL IMPROVEMENTS
[establishment of the indian health service as an agency of the public
health service
[Sec. 601. (a) 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 hereafter 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.
[(b) The Indian Health Service shall be an agency within the
Public Health Service of the Department of Health and Human
Services, and shall not be an office, component, or unit of any
other agency of the Department.
[(c) The Secretary shall carry out through the Director of
the Indian Health Service--
[(1) all functions which were, on the day before the
date of enactment of the Indian Health Care Amendments
of 1988, carried out by or under the direction of the
individual serving as Director of the Indian Health
Service on such day;
[(2) all functions of the Secretary relating to the
maintenance and operation of hospital and health
facilities for Indians and the planning for, and
provision and utilization of, health services for
Indians;
[(3) all health programs under which health care is
provided to Indians based upon their status as Indians
which are administered by the Secretary, including (but
not limited to) programs under--
[(A) this Act;
[(B) the Act of November 2, 1921 (25 U.S.C.
13);
[(C) the Act of August 5, 1954 (42 U.S.C.
2001, et seq.);
[(D) the Act of August 16, 1957 (42 U.S.C.
2005 et seq.); and
[(E) the Indian Self-Determination Act (25
U.S.C. 450f, et seq.); and
[(4) all scholarship and loan functions carried out
under title I.
[(d)(1) The Secretary, acting through the Director of the
Indian Health Service, shall have the authority--
[(A) except to the extent provided in paragraph (2),
to appoint and compensate employees for the Service in
accordance with title 5, United States Code;
[(B) to enter into contracts for the procurement of
goods and services to carry out the functions of the
Service; and
[(C) to manage, expend, and obligate all funds
appropriated for the Service.
[(2) Notwithstanding any other law, the provisions of section
12 of the Act of June 18, 1934 (48 Stat. 986; 25 U.S.C. 472),
shall apply to all personnel actions taken with respect to new
positions created within the Service as a result of its
establishment under subsection (a).
[automated management information system
[Sec. 602. (a)(1) The Secretary shall establish an automated
management information system for the Service.
[(2) The information system established under paragraph (1)
shall include--
[(A) a financial management system,
[(B) a patient care information system for each area
served by the Service,
[(C) a privacy component that protects the privacy of
patient information held by, or on behalf of, the
Service, and
[(D) a services-based cost accounting component that
provides estimates of the costs associated with the
provision of specific medical treatments or services in
each area office of the Service.
[(b)(1) The Secretary shall provide each Indian tribe and
tribal organization that provides health services under a
contract entered into with the Service under the Indian Self-
Determination Act automated management information systems
which--
[(A) meet the management information needs of such
Indian tribe or tribal organization with respect to the
treatment by the Indian tribe or tribal organization of
patients of the Service, and
[(B) meet the management information needs of the
Service.
[(2) The Secretary shall reimburse each Indian tribe or
tribal organization for the part of the cost of the operation
of a system provided under paragraph (1) which is attributable
to the treatment by such Indian tribe or tribal organization of
patients of the Service.
[(3) The Secretary shall provide systems under paragraph (1)
to Indian tribes and tribal organizations providing health
services in California by no later than September 30, 1990.
[(c) Notwithstanding any other provision of law, each patient
shall have reasonable access to the medical or health records
of such patient which are held by, or on behalf of, the
Service.
[authorization of appropriations
[Sec. 603. 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.
[TITLE VII--SUBSTANCE ABUSE PROGRAMS
[indian health service responsibilities
[Sec. 701. The Memorandum of Agreement entered into pursuant
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 number 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 and substance abuse.
[indian health service program
[Sec. 702. (a) Comprehensive Prevention and Treatment
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 Treatment 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
Indian 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 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 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 fiscal 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
Secretary shall develop and implement a program for acute
detoxification 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
appropriately 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 northern 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
appropriate 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--
[(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 without regard to the proviso set
forth in section 4(l) of the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450b(l)).
[(B) Until additional residential youth treatment facilities
are established in Alaska pursuant to this section, the
facilities specified in subparagraph (A) shall make every
effort to provide services to all eligible 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
responsibility 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 services 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
inclusion 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
carrying out subsection (d) shall be used for outpatient care
of adult family members related to the treatment of an Indian
youth under 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 interrelationship of such abuse with the incidence of
mental illness among such youth.
[(2) The Secretary shall submit a report detailing the
findings of such study, together with recommendations based on
such findings, to the Congress no later than two years after
the date of the enactment of this section.
[training and community education
[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
education and involvement which shall be designed to provide
concise and timely information to the community 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
contract, provide instruction in the area of alcohol and
substance abuse, including instruction in crisis intervention
and family relations in the context of alcohol and substance
abuse, youth alcohol and substance abuse, and the causes and
effects of fetal alcohol syndrome 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 Affairs 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 carrying out the
education and training programs required by this section, the
Secretary, 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
[Sec. 706. (a) Grants for Residential Treatment.--The
Secretary 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
section 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 specialized services for women with
fetal alcohol syndrome children;
[(2) establish clinical assessment teams consisting
of a clinical psychologist, a part-time
addictionologist, a master's level assessment
counselor, and a certified medical records technician
which shall be responsible for conducting individual
assessments and matching Indian clients 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 intervention;
[(4) develop a relapse program for the purposes of
identifying 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
Accreditation 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, for each of fiscal years 1996 through 2000,
such sums as may be necessary to carry out subsection (b).
[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 directly or indirectly,
to alcohol or substance abuse. Such report shall include the
type of assistance provided and the disposition of these cases.
[(b) Referral of Data.--The data compiled under subsection
(a) shall be provided annually to the affected Indian tribe and
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 Prevention 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 comprehensive reports.
[fetal alcohol syndrome and fetal alcohol effect grants
[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
treatment to high-risk women;
[(C) identify and provide appropriate educational and
vocational support, counseling, advocacy, and
information to FAS and FAE affected persons and their
families or caretakers;
[(D) develop and implement counseling and support
programs 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
prevention 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 Indian
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,
intervention, 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
[(3) establish a national clearinghouse for
prevention and educational materials and other
information on FAS and FAE effect in Indian and Alaska
Native communities and ensure access to clearinghouse
materials by any Indian tribe or urban Indian
organization.
[(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
representatives from the National Institute on Drug Abuse, the
National Institute on Alcohol and Alcoholism, the Office of
Substance 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 Americans, the Bureau of Indian Affairs, Indian tribes,
tribal organizations, 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 in each report required to be transmitted to the
Congress under 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 born for all
births by reservation and urban-based sites.
[(C) The prevalence of FAS and FAE affected Indian
persons 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,
intervention, and appropriate vocational, educational
and other support services for FAS and FAE affected
individuals in Indian communities.
[(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.
[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 specializes 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 $2,000,000 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 substance 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 colleges, 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 criteria shall ensure that
demonstration projects established under this section promote
the development of the capacity of such entities to educate
substance abuse counselors.
[(e) The Secretary shall provide such technical and other
assistance 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 section.
[(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
accredited community college that--
[(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 Community 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
fiscal years 1996 through 2000, 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 established pursuant to this section shall be
known as the ``Regional Youth Alcohol and Substance Abuse
Prevention and 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 facility in
Fallon, Nevada.
[alaska native drug and alcohol abuse demonstration project
[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 community development programs in villages seeking
to organize to combat alcohol and drug use. Forty percent of
such grant funds shall be transferred to a qualified nonprofit
corporation providing alcohol recovery services in the village
of St. Mary's, Alaska, to enlarge and strengthen a family life
demonstration program of rehabilitation for families that have
been or are afflicted by alcoholism.
[(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 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
may be necessary for each fiscal year through fiscal year 2000
to carry out the provisions of this title.
[TITLE VIII--MISCELLANEOUS
[reports
[Sec. 801. The President shall, at the time the budget is
submitted under 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
established or assisted pursuant to this Act and an
assessment and recommendations 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;
[(3) a report on the use of health services by
Indians--
[(A) on a national and area or other relevant
geographical basis;
[(B) by gender and age;
[(C) by source of payment and type 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).
[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.
[leases with indian tribes
[Sec. 804. (a) Notwithstanding any other provision of law,
the Secretary is authorized, in carrying out the purposes of
this Act, to enter into leases with Indian tribes for periods
not in excess of twenty years. Property leased by the Secretary
from an Indian tribe may be reconstructed or renovated by the
Secretary pursuant to an agreement with such Indian tribe.
[(b) The Secretary may enter into leases, contracts, and
other legal agreements with Indian tribes or tribal
organizations which hold--
[(1) title to;
[(2) a leasehold interest in; or
[(3) a beneficial interest in (where title is held by
the United States in trust for the benefit of a tribe);
facilities used for the administration and delivery of health
services by the Service or by programs operated by Indian
tribes or tribal organizations to compensate such Indian tribes
or tribal organizations for costs associated with the use of
such facilities for such purposes. Such costs include rent,
depreciation based on the useful life of the building,
principal and interest paid or accrued, operation and
maintenance expenses, and other expenses determined by
regulation to be allowable.
[availability of funds
[Sec. 805. The funds appropriated pursuant to this Act shall
remain available until expended.
[limitation on use of funds appropriated to the indian health service
[Sec. 806. Any limitation on the use of funds contained in an
Act providing appropriations for the Department of Health and
Human Services for a period with respect to the performance of
abortions shall apply for that period with respect to the
performance of abortions using funds contained in an Act
providing appropriations for the Indian Health Service.
[nuclear resource development health hazards
[Sec. 807. (a) The Secretary and the Service shall conduct,
in conjunction with other appropriate Federal agencies and in
consultation with concerned Indian tribes and organizations, a
study of the health hazards to Indian communities as a result
of nuclear resource development. Such study shall include--
[(1) an evaluation of the nature and extent of
nuclear resource development related health problems
currently exhibited among Indians and the causes of
such health problems;
[(2) an analysis of the potential effect of ongoing
and future nuclear resource development on or near
Indian reservations and communities;
[(3) an evaluation of the types and nature of
activities, practices, and conditions causing or
affecting such health problems, including uranium
mining and milling, uranium mine tailing deposits,
nuclear powerplant operation and construction, and
nuclear waste disposal;
[(4) a summary of any findings and recommendations
provided in Federal and State studies, reports,
investigations, and inspections during the five years
prior to the date of the enactment of this section that
directly or indirectly relate to the activities,
practices, and conditions affecting the health or
safety of such Indians; and
[(5) the efforts that have been made by Federal and
State agencies and mining and milling companies to
effectively carry out an education program for such
Indians regarding the health and safety hazards of such
nuclear resource development.
[(b) Upon completion of such study the Secretary and the
Service shall take into account the results of such study and
develop a health care plan to address the health problems
studied under subsection (a). The plan shall include--
[(1) methods for diagnosing and treating Indians
currently exhibiting such health problems;
[(2) preventive care for Indians who may be exposed
to such health hazards, including the monitoring of the
health of individuals who have or may have been exposed
to excessive amounts of radiations, or affected by
other nuclear development activities that have had or
could have a serious impact upon the health of such
individuals; and
[(3) a program of education for Indians who, by
reason of their work or geographic proximity to such
nuclear development activities, may experience health
problems.
[(c) The Secretary and the Service shall submit to Congress
the study prepared under subsection (a) no later than the date
eighteen months after the date of enactment of this section.
The health care plan prepared under subsection (b) shall be
submitted in a report no later than the date one year after the
date that the study prepared under subsection (a) is submitted
to Congress. Such report shall include recommended activities
for the implementation of the plan, as well as an evaluation of
any activities previously undertaken by the service to address
such health problems.
[(d)(1) There is established an Intergovernmental Task Force
to be composed of the following individuals (or their
designees): the Secretary of Energy, the Administrator of the
Environmental Protection Agency, the Director of the Bureau of
Mines, the Assistant Secretary for Occupational Safety and
Health, and the Secretary of the Interior.
[(2) The Task Force shall identify existing and potential
operations related to nuclear resource development that affect
or may affect the health of Indians on or near an Indian
reservation or in an Indian community and enter into activities
to correct existing health hazards and insure that current and
future health problems resulting from nuclear resource
development activities are minimized or reduced.
[(3) The Secretary shall be Chairman of the Task Force. The
Task Force shall meet at least twice each year. Each member of
the Task Force shall furnish necessary assistance to the Task
Force.
[(e) In the case of any Indian who--
[(1) as a result of employment in or near a uranium
mine or mill, suffers from a work related illness or
condition;
[(2) is eligible to receive diagnosis and treatment
services from a service facility; and
[(3) by reason of such Indian's employment, is
entitled to medical care at the expense of such mine or
mill operator; the Service shall, at the request of
such Indian, render appropriate medical care to such
Indian for such illness or condition and may recover
the costs of any medical care so rendered to which such
Indian is entitled at the expense of such operator from
such operator. Nothing in this subsection shall affect
the rights of such Indian to recover damages other than
such costs paid to the Service from the employer for
such illness or condition.
[arizona as a contract health service delivery area
[Sec. 808. (a) For the fiscal years beginning with the fiscal
year ending September 30, 1982, and ending with the fiscal year
ending September 30, 2000, the State of Arizona shall be
designated as a contract health service delivery area by the
Service for the purpose of providing contract health care
services to members of federally recognized Indian tribes of
Arizona.
[(b) The Service shall not curtail any health care services
provided to Indians residing on Federal reservations in the
State of Arizona if such curtailment is due to the provision of
contract services in such State pursuant to the designation of
such State as a contract health service delivery area pursuant
to subsection (a).
[eligibility of california indians
[Sec. 809. (a)(1) In order to provide the Congress with
sufficient data to determine which Indians in the State of
California should be eligible for health services provided by
the Service, the Secretary shall, by no later than the date
that is 3 years after the date of enactment of the Indian
Health Care Amendments of 1988, prepare and submit to the
Congress a report which sets forth--
[(A) a determination by the Secretary of the number
of Indians described in subsection (b)(2), and the
number of Indians described in subsection (b)(3), who
are not members of an Indian tribe recognized by the
Federal Government,
[(B) the geographic location of such Indians,
[(C) the Indian tribes of which such Indians are
members,
[(D) an assessment of the current health status, and
health care needs, of such Indians, and
[(E) an assessment of the actual availability and
accessibility of alternative resources for the health
care of such Indians that such Indians would have to
rely on if the Service did not provide for the health
care of such Indians.
[(2) The report required under paragraph (1) shall be
prepared by the Secretary--
[(A) in consultation with the Secretary of the
Interior, and
[(B) with the assistance of the tribal health
programs providing services to the Indians described in
paragraph (2) or (3) of subsection (b) who are not
members of any Indian tribe recognized by the Federal
Government.
[(b) Until such time as any subsequent law may otherwise
provide, the following California Indians shall be eligible for
health services provided by the Service:
[(1) Any member of a federally recognized Indian
tribe.
[(2) Any descendant of an Indian who was residing in
California on June 1, 1852, but only if such
descendant--
[(A) is living in California,
[(B) is a member of the Indian community
served by a local program of the Service, and
[(C) is regarded as an Indian by the
community in which such descendant lives.
[(3) Any Indian who holds trust interests in public
domain, national forest, or Indian reservation
allotments in California.
[(4) Any Indian in California who is listed on the
plans for distribution of the assets of California
rancherias and reservations under the Act of August 18,
1958 (72 Stat. 619), and any descendant of such an
Indian.
[(c) Nothing in this section may be construed as expanding
the eligibility of California Indians for health services
provided by the Service beyond the scope of eligibility for
such health services that applied on May 1, 1986.
[california as a contract health service delivery area
[Sec. 810. The State of California, excluding the counties of
Alameda, Contra Costa, Los Angeles, Marin, Orange, Sacramento,
San Francisco, San Mateo, Santa Clara, Kern, Merced, Monterey,
Napa, San Benito, San Joaquin, San Luis Obispo, Santa Cruz,
Solano, Stanislaus, and Ventura shall be designated as a
contract health service delivery area by the Service for the
purpose of providing contract health services to Indians in
such State.
[contract health facilities
[Sec. 811. The Service shall provide funds for health care
programs and facilities operated by tribes and tribal
organizations under contracts with the Service entered into
under the Indian Self-Determination Act--
[(1) for the maintenance and repair of clinics owned
or leased by such tribes or tribal organizations,
[(2) for employee training,
[(3) for cost-of-living increases for employees, and
[(4) for any other expenses relating to the provision
of health services,
on the same basis as such funds are provided to programs and
facilities operated directly by the Service.
[national health service corps
[Sec. 812. The Secretary of Health and Human Services shall
not--
[(1) remove a member of the National Health Service
Corps from a health facility operated by the Indian
Health Service or by a tribe or tribal organization
under contract with the Indian Health Service under the
Indian Self-Determination Act, or
[(2) withdraw funding used to support such member,
unless the Secretary, acting through the Service, has ensured
that the Indians receiving services from such member will
experience no reduction in services.
[health services for ineligible persons
[Sec. 813. (a)(1) Any individual who--
[(A) has not attained 19 years of age,
[(B) is the natural or adopted child, step-child,
foster-child, legal ward, or orphan of an eligible
Indian, and
[(C) is not otherwise eligible for the health
services provided by the Service,
shall be eligible for all health services provided by the
Service on the same basis and subject to the same rules that
apply to eligible Indians until such individual attains 19
years of age. The existing and potential health needs of all
such individuals shall be taken into consideration by the
Service in determining the need for, or the allocation of, the
health resources of the Service. If such an individual has been
determined to be legally incompetent prior to attaining 19
years of age, such individual shall remain eligible for such
services until one year after the date such disability has been
removed.
[(2) Any spouse of an eligible Indian who is not an Indian,
or who is of Indian descent but not otherwise eligible for the
health services provided by the Service, shall be eligible for
such health services if all of such spouses are made eligible,
as a class, by an appropriate resolution of the governing body
of the Indian tribe of the eligible Indian. The health needs of
persons made eligible under this paragraph shall not be taken
into consideration by the Service in determining the need for,
or allocation of, its health resources.
[(b)(1)(A) The Secretary is authorized to provide health
services under this subsection through health facilities
operated directly by the Service to individuals who reside
within the service area of a service unit and who are not
eligible for such health services under any other subsection of
this section or under any other provision of law if--
[(i) the Indian tribe (or, in the case of a multi-
tribal service area, all the Indian tribes) served by
such service unit requests such provision of health
services to such individuals, and
[(ii) the Secretary and the Indian tribe or tribes
have jointly determined that--
[(I) the provision of such health services
will not result in a denial or diminution of
health services to eligible Indians, and
[(II) there is no reasonable alternative
health facility or services, within or without
the service area of such service unit,
available to meet the health needs of such
individuals.
[(B) In the case of health facilities operated under a
contract entered into under the Indian Self-Determination Act,
the governing body of the Indian tribe or tribal organization
providing health services under such contract is authorized to
determine whether health services should be provided under such
contract to individuals who are not eligible for such health
services under any other subsection of this section or under
any other provision of law. In making such determinations, the
governing body of the Indian tribe or tribal organization shall
take into account the considerations described in subparagraph
(A)(ii).
[(2)(A) Persons receiving health services provided by the
Service by reason of this subsection shall be liable for
payment of such health services under a schedule of charges
prescribed by the Secretary which, in the judgment of the
Secretary, results in reimbursement in an amount not less than
the actual cost of providing the health services.
Notwithstanding section 1880(c) of the Social Security Act,
section 402(a) of this Act, or any other provision of law,
amounts collected under this subsection, including medicare or
medicaid reimbursements under titles XVIII and XIX of the
Social Security Act, shall be credited to the account of the
facility providing the service and shall be used solely for the
provision of health services within that facility. Amounts
collected under this subsection shall be available for
expenditure within such facility for not to exceed one fiscal
year after the fiscal year in which collected.
[(B) Health services may be provided by the Secretary through
the Service under this subsection to an indigent person who
would not be eligible for such health services but for the
provisions of paragraph (1) only if an agreement has been
entered into with a State or local government under which the
State or local government agrees to reimburse the Service for
the expenses incurred by the Service in providing such health
services to such indigent person.
[(3)(A) In the case of a service area which serves only one
Indian tribe, the authority of the Secretary to provide health
services under paragraph (1)(A) shall terminate at the end of
the fiscal year succeeding the fiscal year in which the
governing body of the Indian tribe revokes its concurrence to
the provision of such health services.
[(B) In the case of a multi-tribal service area, the
authority of the Secretary to provide health services under
paragraph (1)(A) shall terminate at the end of the fiscal year
succeeding the fiscal year in which at least 51 percent of the
number of Indian tribes in the service area revoke their
concurrence to the provision of such health services.
[(c) The Service may provide health services under this
subsection to individuals who are not eligible for health
services provided by the Service under any other subsection of
this section or under any other provision of law in order to--
[(1) achieve stability in a medical emergency,
[(2) prevent the spread of a communicable disease or
otherwise deal with a public health hazard,
[(3) provide care to non-Indian women pregnant with
an eligible Indian's child for the duration of the
pregnancy through post partum, or
[(4) provide care to immediate family members of an
eligible person if such care is directly related to the
treatment of the eligible person.
[(d) Hospital privileges in health facilities operated and
maintained by the Service or operated under a contract entered
into under the Indian Self-Determination Act may be extended to
non-Service health care practitioners who provide services to
persons described in subsection (a) or (b). Such non-Service
health care practitioners may be regarded as employees of the
Federal Government for purposes of section 1346(b) and chapter
171 of title 28, United States Code (relating to Federal tort
claims) only with respect to acts or omissions which occur in
the course of providing services to eligible persons as a part
of the conditions under which such hospital privileges are
extended.
[(e) For purposes of this section, the term ``eligible
Indian'' means any Indian who is eligible for health services
provided by the Service without regard to the provisions of
this section.
[infant and maternal mortality; fetal alcohol syndrome
[Sec. 814. By no later than January 1, 1990, the Secretary
shall develop and begin implementation of a plan to achieve the
following objectives by January 1, 1994:
[(1) reduction of the rate of Indian infant mortality
in each area office of the Service to the lower of--
[(A) twelve deaths per one thousand live
births, or
[(B) the rate of infant mortality applicable
to the United States population as a whole;
[(2) reduction of the rate of maternal mortality in
each area office of the Service to the lower of--
[(A) five deaths per one hundred thousand
live births, or
[(B) the rate of maternal mortality
applicable to the United States population as a
whole; and
[(3) reduction of the rate of fetal alcohol syndrome
among Indians served by, or on behalf of, the Service
to one per one thousand live births.
[contract health services for the trenton service area
[Sec. 815. (a) The Secretary, acting through the Service, is
directed to provide contract health services to members of the
Turtle Mountain Band of Chippewa Indians that reside in the
Trenton Service Area of Divide, McKenzie, and Williams counties
in the State of North Dakota and the adjoining counties of
Richland, Roosevelt, and Sheridan in the State of Montana.
[(b) Nothing in this section may be construed as expanding
the eligibility of members of the Turtle Mountain Band of
Chippewa Indians for health services provided by the Service
beyond the scope of eligibility for such health services that
applied on May 1, 1986.
[indian health service and department of veterans affairs health
facilities and services sharing
[Sec. 816. (a) The Secretary shall examine the feasibility of
entering into an arrangement for the sharing of medical
facilities and services between the Indian Health Service and
the Department of Veterans Affairs and shall, in accordance
with subsection (b), prepare a report on the feasibility of
such an arrangement and submit such report to the Congress by
no later than September 30, 1990.
[(b) The Secretary shall not take any action under this
section or under subchapter IV of chapter 81 of title 38,
United States Code, which would impair--
[(1) the priority access of any Indian to health care
services provided through the Indian Health Service;
[(2) the quality of health care services provided to
any Indian through the Indian Health Service;
[(3) the priority access of any veteran to health
care services provided by the Department of Veterans
Affairs;
[(4) the quality of health care services provided to
any veteran by the Department of Veterans Affairs;
[(5) the eligibility of any Indian to receive health
services through the Indian Health Service; or
[(6) the eligibility of any Indian who is a veteran
to receive health services through the Department of
Veterans Affairs.
[(c)(1) Not later than December 23, 1988, the Director of the
Indian Health Service and the Secretary of Veterans Affairs
shall implement an agreement under which--
[(A) individuals in the vicinity of Roosevelt, Utah,
who are eligible for health care from the Department of
Veterans Affairs could obtain health care services at
the facilities of the Indian Health Service located at
Fort Duchesne, Utah; and
[(B) individuals eligible for health care from the
Indian Health Service at Fort Duchesne, Utah, could
obtain health care services at the Department of
Veterans Affairs medical center located in Salt Lake
City, Utah.
[(2) Not later than November 23, 1990, the Secretary and the
Secretary of Veterans Affairs shall jointly submit a report to
the Congress on the health care services provided as a result
of paragraph (1).
[(d) Nothing in this section may be construed as creating any
right of a veteran to obtain health services from the Indian
Health Service except as provided in an agreement under
subsection (c).
[reallocation of base resources
[Sec. 817. (a) Notwithstanding any other provision of law,
any allocation of Service funds for a fiscal year that reduces
by 5 percent or more from the previous fiscal year the funding
for any recurring program, project, or activity of a service
unit may be implemented only after the Secretary has submitted
to the President, for inclusion in the report required to be
transmitted to the Congress under section 801, a report on the
proposed change in allocation of funding, including the reasons
for the change and its likely effects.
[(b) Subsection (a) shall not apply if the total amount
appropriated to the Service for a fiscal year is less than the
amount appropriated to the Service for previous fiscal year.
[demonstration projects for tribal management of health care services
[Sec. 818. (a)(1) The Secretary, acting through the Service,
shall make grants to Indian tribes to establish demonstration
projects under which the Indian tribe will develop and test a
phased approach to assumption by the Indian tribe of the health
care delivery system of the Service for members of the Indian
tribe living on or near the reservations of the Indian tribe
through the use of Service, tribal, and private sector
resources.
[(2) A grant may be awarded to an Indian tribe under
paragraph (1) only if the Secretary determines that the Indian
tribe has the administrative and financial capabilities
necessary to conduct a demonstration project described in
paragraph (1).
[(b) During the period in which a demonstration project
established under subsection (a) is being conducted by an
Indian tribe, the Secretary shall award all health care
contracts, including community, behavioral, and preventive
health care contracts, to the Indian tribe in the form of a
single grant to which the regulations prescribed under part A
of title XIX of the Public Health Service Act (as modified as
necessary by any agreement entered into between the Secretary
and the Indian tribe to achieve the purposes of the
demonstration project established under subsection (a)) shall
apply.
[(c) The Secretary may waive such provisions of Federal
procurement law as are necessary to enable any Indian tribe to
develop and test administrative systems under the demonstration
project established under subsection (a), but only if such
waiver does not diminish or endanger the delivery of health
care services to Indians.
[(d)(1) The demonstration project established under
subsection (a) shall terminate on September 30, 1993, or, in
the case of a demonstration project for which a grant is made
after September 30, 1990, three years after the date on which
such grant is made.
[(2) By no later than September 30, 1996, the Secretary shall
evaluate the performance of each Indian tribe that has
participated in a demonstration project established under
subsection (a) and shall submit to the Congress a report on
such evaluations and demonstration projects.
[(e)(1) The Secretary, acting through the Service, shall make
arrangements with Indian tribes to establish joint venture
demonstration 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 maintenance of such a health facility. A
tribe may utilize tribal funds, private sector, or other
available resources, including loan guarantees, 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 tribe has the administrative and financial capabilities
necessary to complete the timely acquisition or construction of
the health facility 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 tangible property (including supplies), and
equipment, less depreciation, 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 staffing, shall be
recoverable.
[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 Hopi Tribe and the
Assiniboine 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 programs 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).
[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.
[home- and community-based care demonstration project
[Sec. 821. (a) The Secretary, acting through the Service, is
authorized to enter into contracts with, or make grants to,
Indian tribes or tribal organizations providing health care
services pursuant 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) Funds 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 payments 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 applications 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 quality, culturally
appropriate home- and community-based services to functionally
disabled Indians;
[(d) The Secretary shall provide such technical and other
assistance as may be necessary to enable applicants 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 section may be provided (on a cost basis) to persons
otherwise ineligible for the health care benefits of the
Service.
[(f) The Secretary shall establish not more than 24
demonstration projects under this section. The Secretary may
not establish a greater number of demonstration projects under
this section in one service area than in any other service area
until there is an equal number of such demonstration projects
established 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 issued
pursuant to subsection (c).
[(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 section, together with legislative recommendations.
[(h) For the purposes of this section, the following
definitions shall apply:
[(1) The term ``home- and community-based services''
means one or more of the following:
[(A) Homemaker/home health 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 functionally 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
community-based services 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 1996 through 2000 such sums as may be necessary to
carry out this section. Such sums shall remain available until
expended.
[shared services demonstration project
[Sec. 822. (a) The Secretary, acting through the Service and
notwithstanding any other provision of law, 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 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 Service 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 shall 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 facility;
[(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 construction of a nursing facility.
[(d) Any nursing facility for which a contract is entered
into under 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
assistance as may be necessary to enable applicants to comply
with the provisions of this section.
[(f) The Secretary shall submit to the President, for
inclusion in each report required to be transmitted to the
Congress under section 801, a report on the findings and
conclusions derived from the demonstration projects conducted
under this 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.
[priority for indian reservations
[Sec. 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 establishment of related
employment projects to address unemployment conditions in
economically depressed areas, give priority to locating such
facilities and projects on Indian lands if requested by the
Indian tribe with jurisdiction over such lands.
[(b) For purposes of this section, the term ``Indian lands''
means--
[(1) all lands within the limits 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 Indian
tribe exercises governmental power.
[authorization of appropriations
[Sec. 825. Except as provided in section 821, 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.]
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Indian
Health Care Improvement Act''.
(b) Table of Contents.--The table of contents for this Act is
as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Findings.
Sec. 3. Declaration of national Indian health policy.
Sec. 4. Definitions.
TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT
Sec. 101. Purpose.
Sec. 102. Health professions recruitment program for Indians.
Sec. 103. Health professions preparatory scholarship program for
Indians.
Sec. 104. Indian health professions scholarships.
Sec. 105. American Indians Into Psychology Program.
Sec. 106. Scholarship programs for Indian Tribes.
Sec. 107. Indian Health Service extern programs.
Sec. 108. Continuing education allowances.
Sec. 109. Community Health Representative Program.
Sec. 110. Indian Health Service Loan Repayment Program.
Sec. 111. Scholarship and Loan Repayment Recovery Fund.
Sec. 112. Recruitment activities.
Sec. 113. Indian recruitment and retention program.
Sec. 114. Advanced training and research.
Sec. 115. Quentin N. Burdick American Indians Into Nursing Program.
Sec. 116. Tribal cultural orientation.
Sec. 117. INMED Program.
Sec. 118. Health training programs of community colleges.
Sec. 119. Retention bonus.
Sec. 120. Nursing residency program.
Sec. 121. Community Health Aide Program.
Sec. 122. Tribal Health Program administration.
Sec. 123. Health professional chronic shortage demonstration programs.
Sec. 124. National Health Service Corps.
Sec. 125. Substance abuse counselor educational curricula demonstration
programs.
Sec. 126. Behavioral health training and community education programs.
Sec. 127. Authorization of appropriations.
TITLE II--HEALTH SERVICES
Sec. 201. Indian Health Care Improvement Fund.
Sec. 202. Catastrophic Health Emergency Fund.
Sec. 203. Health promotion and disease prevention services.
Sec. 204. Diabetes prevention, treatment, and control.
Sec. 205. Shared services for long-term care.
Sec. 206. Health services research.
Sec. 207. Mammography and other cancer screening.
Sec. 208. Patient travel costs.
Sec. 209. Epidemiology centers.
Sec. 210. Comprehensive school health education programs.
Sec. 211. Indian youth program.
Sec. 212. Prevention, control, and elimination of communicable and
infectious diseases.
Sec. 213. Authority for provision of other services.
Sec. 214. Indian women's health care.
Sec. 215. Environmental and nuclear health hazards.
Sec. 216. Arizona as a contract health service delivery area.
Sec. 217. North Dakota and South Dakota as contract health service
delivery area.
Sec. 218. California contract health services program.
Sec. 219. California as a contract health service delivery area.
Sec. 220. Contract health services for the Trenton Service Area.
Sec. 221. Programs operated by Indian Tribes and Tribal Organizations.
Sec. 222. Licensing.
Sec. 223. Notification of provision of emergency contract health
services.
Sec. 224. Prompt action on payment of claims.
Sec. 225. Liability for payment.
Sec. 226. Office of Indian Men's Health.
Sec. 227. Authorization of appropriations.
TITLE III--FACILITIES
Sec. 301. Consultation; construction and renovation of facilities;
reports.
Sec. 302. Sanitation facilities.
Sec. 303. Preference to Indians and Indian firms.
Sec. 304. Expenditure of non-Service funds for renovation.
Sec. 305. Funding for the construction, expansion, and modernization of
small ambulatory care facilities.
Sec. 306. Indian health care delivery demonstration project.
Sec. 307. Land transfer.
Sec. 308. Leases, contracts, and other agreements.
Sec. 309. Study on loans, loan guarantees, and loan repayment.
Sec. 310. Tribal leasing.
Sec. 311. Indian Health Service/tribal facilities joint venture program.
Sec. 312. Location of facilities.
Sec. 313. Maintenance and improvement of health care facilities.
Sec. 314. Tribal management of federally-owned quarters.
Sec. 315. Applicability of Buy American Act requirement.
Sec. 316. Other funding for facilities.
Sec. 317. Authorization of appropriations.
TITLE IV--ACCESS TO HEALTH SERVICES
Sec. 401. Treatment of payments under Social Security Act health
benefits programs.
Sec. 402. Grants to and contracts with the Service, Indian Tribes,
Tribal Organizations, and Urban Indian Organizations to
facilitate outreach, enrollment, and coverage of Indians under
Social Security Act health benefit programs and other health
benefits programs.
Sec. 403. Reimbursement from certain third parties of costs of health
services.
Sec. 404. Crediting of reimbursements.
Sec. 405. Purchasing health care coverage.
Sec. 406. Sharing arrangements with Federal agencies.
Sec. 407. Payor of last resort.
Sec. 408. Nondiscrimination under Federal health care programs in
qualifications for reimbursement for services.
Sec. 409. Consultation.
Sec. 410. State Children's Health Insurance Program (SCHIP).
Sec. 411. Exclusion waiver authority for affected Indian Health Programs
and safe harbor transactions under the Social Security Act.
Sec. 412. Premium and cost sharing protections and eligibility
determinations under Medicaid and SCHIP and protection of
certain Indian property from Medicaid estate recovery.
Sec. 413. Treatment under Medicaid and SCHIP managed care.
Sec. 414. Navajo Nation Medicaid Agency feasibility study.
Sec. 415. General exceptions.
Sec. 416. Authorization of appropriations.
TITLE V--HEALTH SERVICES FOR URBAN INDIANS
Sec. 501. Purpose.
Sec. 502. Contracts with, and grants to, Urban Indian Organizations.
Sec. 503. Contracts and grants for the provision of health care and
referral services.
Sec. 504. Contracts and grants for the determination of unmet health
care needs.
Sec. 505. Evaluations; renewals.
Sec. 506. Other contract and grant requirements.
Sec. 507. Reports and records.
Sec. 508. Limitation on contract authority.
Sec. 509. Facilities.
Sec. 510. Division of Urban Indian Health.
Sec. 511. Grants for alcohol and substance abuse-related services.
Sec. 512. Treatment of certain demonstration projects.
Sec. 513. Urban NIAAA transferred programs.
Sec. 514. Consultation with Urban Indian Organizations.
Sec. 515. Urban youth treatment center demonstration.
Sec. 516. Grants for diabetes prevention, treatment, and control.
Sec. 517. Community health representatives.
Sec. 518. Effective date.
Sec. 519. Eligibility for services.
Sec. 520. Authorization of appropriations.
TITLE VI--ORGANIZATIONAL IMPROVEMENTS
Sec. 601. Establishment of the Indian Health Service as an agency of the
Public Health Service.
Sec. 602. Automated management information system.
Sec. 603. Authorization of appropriations.
TITLE VII--BEHAVIORAL HEALTH PROGRAMS
Sec. 701. Behavioral health prevention and treatment services.
Sec. 702. Memoranda of agreement with the Department of the Interior.
Sec. 703. Comprehensive behavioral health prevention and treatment
program.
Sec. 704. Mental health technician program.
Sec. 705. Licensing requirement for mental health care workers.
Sec. 706. Indian women treatment programs.
Sec. 707. Indian youth program.
Sec. 708. Indian youth telemental health demonstration project.
Sec. 709. Inpatient and community-based mental health facilities design,
construction, and staffing.
Sec. 710. Training and community education.
Sec. 711. Behavioral health program.
Sec. 712. Fetal alcohol disorder programs.
Sec. 713. Child sexual abuse and prevention treatment programs.
Sec. 714. Behavioral health research.
Sec. 715. Definitions.
Sec. 716. Authorization of appropriations.
TITLE VIII--MISCELLANEOUS
Sec. 801. Reports.
Sec. 802. Regulations.
Sec. 803. Plan of implementation.
Sec. 804. Availability of funds.
Sec. 805. Limitation on use of funds appropriated to Indian Health
Service.
Sec. 806. Eligibility of California Indians.
Sec. 807. Health services for ineligible persons.
Sec. 808. Reallocation of base resources.
Sec. 809. Results of demonstration projects.
Sec. 810. Provision of services in Montana.
Sec. 811. Moratorium.
Sec. 812. Severability provisions.
Sec. 813. Establishment of National Bipartisan Commission on Indian
Health Care.
Sec. 814. Confidentiality of medical quality assurance records;
qualified immunity for participants.
Sec. 815. Appropriations; availability.
Sec. 816. Authorization of appropriations.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) Federal health services to maintain and improve
the health of the Indians are consonant with and
required by the Federal Government's historical and
unique legal relationship with, and resulting
responsibility to, the American Indian people.
(2) A major national goal of the United States is to
provide the quantity and quality of health services
which will permit the health status of Indians to be
raised to the highest possible level and to encourage
the maximum participation of Indians in the planning
and management of those services.
(3) Federal health services to Indians have resulted
in a reduction in the prevalence and incidence of
preventable illnesses among, and unnecessary and
premature deaths of, Indians.
(4) Despite such services, the unmet health needs of
the American Indian people are severe and the health
status of the Indians is far below that of the general
population of the United States.
SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.
Congress declares that it is the policy of this Nation, in
fulfillment of its special trust responsibilities and legal
obligations to Indians--
(1) to assure the highest possible health status for
Indians and Urban Indians and to provide all resources
necessary to effect that policy;
(2) to raise the health status of Indians and Urban
Indians to at least the levels set forth in the goals
contained within the Healthy People 2010 or successor
objectives;
(3) to the greatest extent possible, to allow Indians
to set their own health care priorities and establish
goals that reflect their unmet needs;
(4) to increase the proportion of all degrees in the
health professions and allied and associated health
professions awarded to Indians so that the proportion
of Indian health professionals in each Service Area is
raised to at least the level of that of the general
population;
(5) to require meaningful consultation with Indian
Tribes, Tribal Organizations, and Urban Indian
Organizations to implement this Act and the national
policy of Indian self-determination; and
(6) to provide funding for programs and facilities
operated by Indian Tribes and Tribal Organizations in
amounts that are not less than the amounts provided to
programs and facilities operated directly by the
Service.
SEC. 4. DEFINITIONS.
For purposes of this Act:
(1) The term ``accredited and accessible'' means on
or near a reservation and accredited by a national or
regional organization with accrediting authority.
(2) The term ``Area Office'' means an administrative
entity, including a program office, within the Service
through which services and funds are provided to the
Service Units within a defined geographic area.
(3) The term ``Assistant Secretary'' means the
Assistant Secretary of Indian Health.
(4)(A) The term ``behavioral health'' means the
blending of substance (alcohol, drugs, inhalants, and
tobacco) abuse and mental health prevention and
treatment, for the purpose of providing comprehensive
services.
(B) The term ``behavioral health'' includes the joint
development of substance abuse and mental health
treatment planning and coordinated case management
using a multidisciplinary approach.
(5) The term ``California Indians'' means those
Indians who are eligible for health services of the
Service pursuant to section 806.
(6) The term ``community college'' means--
(A) a tribal college or university, or
(B) a junior or community college.
(7) The term ``contract health service'' means health
services provided at the expense of the Service or a
Tribal Health Program by public or private medical
providers or hospitals, other than the Service Unit or
the Tribal Health Program at whose expense the services
are provided.
(8) The term ``Department'' means, unless otherwise
designated, the Department of Health and Human
Services.
(9) The term ``disease prevention'' means the
reduction, limitation, and prevention of disease and
its complications and reduction in the consequences of
disease, including--
(A) controlling--
(i) the development of diabetes;
(ii) high blood pressure;
(iii) infectious agents;
(iv) injuries;
(v) occupational hazards and
disabilities;
(vi) sexually transmittable diseases;
and
(vii) toxic agents; and
(B) providing--
(i) fluoridation of water; and
(ii) immunizations.
(10) The term ``health profession'' means allopathic
medicine, family medicine, internal medicine,
pediatrics, geriatric medicine, obstetrics and
gynecology, podiatric medicine, nursing, public health
nursing, dentistry, psychiatry, osteopathy, optometry,
pharmacy, psychology, public health, social work,
marriage and family therapy, chiropractic medicine,
environmental health and engineering, allied health
professions, naturopathic medicine, and any other
health profession.
(11) The term ``health promotion'' means--
(A) fostering social, economic,
environmental, and personal factors conducive
to health, including raising public awareness
about health matters and enabling the people to
cope with health problems by increasing their
knowledge and providing them with valid
information;
(B) encouraging adequate and appropriate
diet, exercise, and sleep;
(C) promoting education and work in
conformity with physical and mental capacity;
(D) making available safe water and sanitary
facilities;
(E) improving the physical, economic,
cultural, psychological, and social
environment;
(F) promoting culturally competent care; and
(G) providing adequate and appropriate
programs, which may include--
(i) abuse prevention (mental and
physical);
(ii) community health;
(iii) community safety;
(iv) consumer health education;
(v) diet and nutrition;
(vi) immunization and other
prevention of communicable diseases,
including HIV/AIDS;
(vii) environmental health;
(viii) exercise and physical fitness;
(ix) avoidance of fetal alcohol
disorders;
(x) first aid and CPR education;
(xi) human growth and development;
(xii) injury prevention and personal
safety;
(xiii) behavioral health;
(xiv) monitoring of disease
indicators between health care provider
visits, through appropriate means,
including Internet-based health care
management systems;
(xv) personal health and wellness
practices;
(xvi) personal capacity building;
(xvii) prenatal, pregnancy, and
infant care;
(xviii) psychological well-being;
(xix) reproductive health and family
planning;
(xx) safe and adequate water;
(xxi) healthy work environments;
(xxii) elimination, reduction, and
prevention of contaminants that create
unhealthy household conditions
(including mold and other allergens);
(xxiii) stress control;
(xxiv) substance abuse;
(xxv) sanitary facilities;
(xxvi) sudden infant death syndrome
prevention;
(xxvii) tobacco use cessation and
reduction;
(xxviii) violence prevention; and
(xxix) such other activities
identified by the Service, a Tribal
Health Program, or an Urban Indian
Organization, to promote achievement of
any of the objectives described in
section 3(2).
(12) The term ``Indian'', unless otherwise
designated, means any person who is a member of an
Indian Tribe or is eligible for health services under
section 806, except that, for the purpose of sections
102 and 103, the term also means any individual who--
(A)(i) irrespective of whether the individual
lives on or near a reservation, is a member of
a tribe, band, or other organized group of
Indians, including those tribes, bands, or
groups terminated since 1940 and those
recognized now or in the future by the State in
which they reside; or
(ii) is a descendant, in the first or second
degree, of any such member;
(B) is an Eskimo or Aleut or other Alaska
Native;
(C) is considered by the Secretary of the
Interior to be an Indian for any purpose; or
(D) is determined to be an Indian under
regulations promulgated by the Secretary.
(13) The term ``Indian Health Program'' means--
(A) any health program administered directly
by the Service;
(B) any Tribal Health Program; or
(C) any Indian Tribe or Tribal Organization
to which the Secretary provides funding
pursuant to section 23 of the Act of June 25,
1910 (25 U.S.C. 47) (commonly known as the
``Buy Indian Act'').
(14) The term ``Indian Tribe'' has the meaning given
the term in the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.).
(15) The term ``junior or community college'' has the
meaning given the term by section 312(e) of the Higher
Education Act of 1965 (20 U.S.C. 1058(e)).
(16) The term ``reservation'' means any federally
recognized Indian Tribe's reservation, Pueblo, or
colony, including former reservations in Oklahoma,
Indian allotments, and Alaska Native Regions
established pursuant to the Alaska Native Claims
Settlement Act (43 U.S.C. 1601 et seq.).
(17) The term ``Secretary'', unless otherwise
designated, means the Secretary of Health and Human
Services.
(18) The term ``Service'' means the Indian Health
Service.
(19) The term ``Service Area'' means the geographical
area served by each Area Office.
(20) The term ``Service Unit'' means an
administrative entity of the Service, or a Tribal
Health Program through which services are provided,
directly or by contract, to eligible Indians within a
defined geographic area.
(21) The term ``telehealth'' has the meaning given
the term in section 330K(a) of the Public Health
Service Act (42 U.S.C. 254c-16(a)).
(22) The term ``telemedicine'' means a
telecommunications link to an end user through the use
of eligible equipment that electronically links health
professionals or patients and health professionals at
separate sites in order to exchange health care
information in audio, video, graphic, or other format
for the purpose of providing improved health care
services.
(23) The term ``tribal college or university'' has
the meaning given the term in section 316(b)(3) of the
Higher Education Act (20 U.S.C. 1059c(b)(3)).
(24) The term ``Tribal Health Program'' means an
Indian Tribe or Tribal Organization that operates any
health program, service, function, activity, or
facility funded, in whole or part, by the Service
through, or provided for in, a contract or compact with
the Service under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.).
(25) The term ``Tribal Organization'' has the meaning
given the term in the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.).
(26) The term ``Urban Center'' means any community
which has a sufficient Urban Indian population with
unmet health needs to warrant assistance under title V
of this Act, as determined by the Secretary.
(27) The term ``Urban Indian'' means any individual
who resides in an Urban Center and who meets 1 or more
of the following criteria:
(A) Irrespective of whether the individual
lives on or near a reservation, the individual
is a member of a tribe, band, or other
organized group of Indians, including those
tribes, bands, or groups terminated since 1940
and those tribes, bands, or groups that are
recognized by the States in which they reside,
or who is a descendant in the first or second
degree of any such member.
(B) The individual is an Eskimo, Aleut, or
other Alaska Native.
(C) The individual is considered by the
Secretary of the Interior to be an Indian for
any purpose.
(D) The individual is determined to be an
Indian under regulations promulgated by the
Secretary.
(28) The term ``Urban Indian Organization'' means a
nonprofit corporate body that (A) is situated in an
Urban Center; (B) is governed by an Urban Indian-
controlled board of directors; (C) provides for the
participation of all interested Indian groups and
individuals; and (D) is capable of legally cooperating
with other public and private entities for the purpose
of performing the activities described in section
503(a).
TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT
SEC. 101. PURPOSE.
The purpose of this title is to increase, to the maximum
extent feasible, the number of Indians entering the health
professions and providing health services, and to assure an
optimum supply of health professionals to the Indian Health
Programs and Urban Indian Organizations involved in the
provision of health services to Indians.
SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR INDIANS.
(a) In General.--The Secretary, acting through the Service,
shall make grants to public or nonprofit private health or
educational entities, Tribal Health Programs, or Urban Indian
Organizations to assist such entities in meeting the costs of--
(1) identifying Indians with a potential for
education or training in the health professions and
encouraging and assisting them--
(A) to enroll in courses of study in such
health professions; or
(B) if they are not qualified to enroll in
any such courses of study, to undertake such
postsecondary education or training as may be
required to qualify them for enrollment;
(2) publicizing existing sources of financial aid
available to Indians enrolled in any course of study
referred to in paragraph (1) or who are undertaking
training necessary to qualify them to enroll in any
such course of study; or
(3) establishing other programs which the Secretary
determines will enhance and facilitate the enrollment
of Indians in, and the subsequent pursuit and
completion by them of, courses of study referred to in
paragraph (1).
(b) Grants.--
(1) Application.--The Secretary shall not make a
grant under this section unless an application has been
submitted to, and approved by, the Secretary. Such
application shall be in such form, submitted in such
manner, and contain such information, as the Secretary
shall by regulation prescribe pursuant to this Act. The
Secretary shall give a preference to applications
submitted by Tribal Health Programs or Urban Indian
Organizations.
(2) Amount of grants; payment.--The amount of a grant
under this section shall be determined by the
Secretary. Payments pursuant to this section may be
made in advance or by way of reimbursement, and at such
intervals and on such conditions as provided for in
regulations issued pursuant to this Act. To the extent
not otherwise prohibited by law, grants shall be for 3
years, as provided in regulations issued pursuant to
this Act.
SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP PROGRAM FOR
INDIANS.
(a) Scholarships Authorized.--The Secretary, acting through
the Service, shall provide scholarship grants to Indians who--
(1) have successfully completed their high school
education or high school equivalency; and
(2) have demonstrated the potential to successfully
complete courses of study in the health professions.
(b) Purposes.--Scholarship grants provided pursuant to this
section shall be for the following purposes:
(1) Compensatory preprofessional education of any
recipient, such scholarship not to exceed 2 years on a
full-time basis (or the part-time equivalent thereof,
as determined by the Secretary pursuant to regulations
issued under this Act).
(2) Pregraduate education of any recipient leading to
a baccalaureate degree in an approved course of study
preparatory to a field of study in a health profession,
such scholarship not to exceed 4 years. An extension of
up to 2 years (or the part-time equivalent thereof, as
determined by the Secretary pursuant to regulations
issued pursuant to this Act) may be approved.
(c) Other Conditions.--Scholarships under this section--
(1) may cover costs of tuition, books,
transportation, board, and other necessary related
expenses of a recipient while attending school;
(2) shall not be denied solely on the basis of the
applicant's scholastic achievement if such applicant
has been admitted to, or maintained good standing at,
an accredited institution; and
(3) shall not be denied solely by reason of such
applicant's eligibility for assistance or benefits
under any other Federal program.
SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.
(a) In General.--
(1) Authority.--The Secretary, acting through the
Service, shall make scholarship grants to Indians who
are enrolled full or part time in accredited schools
pursuing courses of study in the health professions.
Such scholarships shall be designated Indian Health
Scholarships and shall be made in accordance with
section 338A of the Public Health Services Act (42
U.S.C. 254l), except as provided in subsection (b) of
this section.
(2) Determinations by secretary.--The Secretary,
acting through the Service, shall determine--
(A) who shall receive scholarship grants
under subsection (a); and
(B) the distribution of the scholarships
among health professions on the basis of the
relative needs of Indians for additional
service in the health professions.
(3) Certain delegation not allowed.--The
administration of this section shall be a
responsibility of the Assistant Secretary and shall not
be delegated in a contract or compact under the Indian
Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.).
(b) Active Duty Service Obligation.--
(1) Obligation met.--The active duty service
obligation under a written contract with the Secretary
under this section that an Indian has entered into
shall, if that individual is a recipient of an Indian
Health Scholarship, be met in full-time practice equal
to 1 year for each school year for which the
participant receives a scholarship award under this
part, or 2 years, whichever is greater, by service in 1
or more of the following:
(A) In an Indian Health Program.
(B) In a program assisted under title V of
this Act.
(C) In the private practice of the applicable
profession if, as determined by the Secretary,
in accordance with guidelines promulgated by
the Secretary, such practice is situated in a
physician or other health professional shortage
area and addresses the health care needs of a
substantial number of Indians.
(D) In a teaching capacity in a tribal
college or university nursing program (or a
related health profession program) if, as
determined by the Secretary, the health service
provided to Indians would not decrease.
(2) Obligation deferred.--At the request of any
individual who has entered into a contract referred to
in paragraph (1) and who receives a degree in medicine
(including osteopathic or allopathic medicine),
dentistry, optometry, podiatry, or pharmacy, the
Secretary shall defer the active duty service
obligation of that individual under that contract, in
order that such individual may complete any internship,
residency, or other advanced clinical training that is
required for the practice of that health profession,
for an appropriate period (in years, as determined by
the Secretary), subject to the following conditions:
(A) No period of internship, residency, or
other advanced clinical training shall be
counted as satisfying any period of obligated
service under this subsection.
(B) The active duty service obligation of
that individual shall commence not later than
90 days after the completion of that advanced
clinical training (or by a date specified by
the Secretary).
(C) The active duty service obligation will
be served in the health profession of that
individual in a manner consistent with
paragraph (1).
(D) A recipient of a scholarship under this
section may, at the election of the recipient,
meet the active duty service obligation
described in paragraph (1) by service in a
program specified under that paragraph that--
(i) is located on the reservation of
the Indian Tribe in which the recipient
is enrolled; or
(ii) serves the Indian Tribe in which
the recipient is enrolled.
(3) Priority when making assignments.--Subject to
paragraph (2), the Secretary, in making assignments of
Indian Health Scholarship recipients required to meet
the active duty service obligation described in
paragraph (1), shall give priority to assigning
individuals to service in those programs specified in
paragraph (1) that have a need for health professionals
to provide health care services as a result of
individuals having breached contracts entered into
under this section.
(c) Part-Time Students.--In the case of an individual
receiving a scholarship under this section who is enrolled part
time in an approved course of study--
(1) such scholarship shall be for a period of years
not to exceed the part-time equivalent of 4 years, as
determined by the Secretary;
(2) the period of obligated service described in
subsection (b)(1) shall be equal to the greater of--
(A) the part-time equivalent of 1 year for
each year for which the individual was provided
a scholarship (as determined by the Secretary);
or
(B) 2 years; and
(3) the amount of the monthly stipend specified in
section 338A(g)(1)(B) of the Public Health Service Act
(42 U.S.C. 254l(g)(1)(B)) shall be reduced pro rata (as
determined by the Secretary) based on the number of
hours such student is enrolled.
(d) Breach of Contract.--
(1) Specified breaches.--An individual shall be
liable to the United States for the amount which has
been paid to the individual, or on behalf of the
individual, under a contract entered into with the
Secretary under this section on or after the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2007 if that individual--
(A) fails to maintain an acceptable level of
academic standing in the educational
institution in which he or she is enrolled
(such level determined by the educational
institution under regulations of the
Secretary);
(B) is dismissed from such educational
institution for disciplinary reasons;
(C) voluntarily terminates the training in
such an educational institution for which he or
she 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 or she 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.
(2) Other breaches.--If for any reason not specified
in paragraph (1) an individual breaches a 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 (l) of section 110 in the
manner provided for in such subsection.
(3) Cancellation upon death of recipient.--Upon the
death of an individual who receives an Indian Health
Scholarship, any outstanding obligation of that
individual for service or payment that relates to that
scholarship shall be canceled.
(4) Waivers and suspensions.--
(A) In general.--The Secretary shall provide
for the partial or total waiver or suspension
of any obligation of service or payment of a
recipient of an Indian Health Scholarship if
the Secretary determines that--
(i) it is not possible for the
recipient to meet that obligation or
make that payment;
(ii) requiring that recipient to meet
that obligation or make that payment
would result in extreme hardship to the
recipient; or
(iii) the enforcement of the
requirement to meet the obligation or
make the payment would be
unconscionable.
(B) Factors for consideration.--Before
waiving or suspending an obligation of service
or payment under subparagraph (A), the
Secretary shall consult with the affected Area
Office, Indian Tribes, Tribal Organizations, or
Urban Indian Organizations, and may take into
consideration whether the obligation may be
satisfied in a teaching capacity at a tribal
college or university nursing program under
subsection (b)(1)(D).
(5) Extreme hardship.--Notwithstanding any other
provision of law, in any case of extreme hardship or
for other good cause shown, the Secretary may waive, in
whole or in part, the right of the United States to
recover funds made available under this section.
(6) Bankruptcy.--Notwithstanding any other provision
of law, with respect to a recipient of an Indian Health
Scholarship, no obligation for payment may be released
by a discharge in bankruptcy under title 11, United
States Code, unless that discharge is granted after the
expiration of the 5-year period beginning on the
initial date on which that payment is due, and only if
the bankruptcy court finds that the nondischarge of the
obligation would be unconscionable.
SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.
(a) Grants Authorized.--The Secretary, acting through the
Service, shall make grants of not more than $300,000 to each of
9 colleges and universities for the purpose of developing and
maintaining Indian psychology career recruitment programs as a
means of encouraging Indians to enter the behavioral health
field. These programs shall be located at various locations
throughout the country to maximize their availability to Indian
students and new programs shall be established in different
locations from time to time.
(b) Quentin N. Burdick Program Grant.--The Secretary shall
provide a grant authorized 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 maximum extent
feasible, coordinate with the Quentin N. Burdick Indian Health
Programs authorized under section 117(b), the Quentin N.
Burdick American Indians Into Nursing Program authorized under
section 115(e), and existing university research and
communications networks.
(c) Regulations.--The Secretary shall issue regulations
pursuant to this Act for the competitive awarding of grants
provided under this section.
(d) Conditions of Grant.--Applicants under this section shall
agree to provide a program which, at a minimum--
(1) provides outreach and recruitment for health
professions to Indian communities including elementary,
secondary, and accredited and accessible community
colleges that will be served by the program;
(2) incorporates a program advisory board comprised
of representatives from the tribes and communities that
will be served by the program;
(3) provides summer enrichment programs to expose
Indian students to the various fields of psychology
through research, clinical, and experimental
activities;
(4) provides stipends to undergraduate and graduate
students to pursue a career in psychology;
(5) develops affiliation agreements with tribal
colleges and universities, the Service, university
affiliated programs, and other appropriate accredited
and accessible entities to enhance the education of
Indian students;
(6) to the maximum extent feasible, uses existing
university tutoring, counseling, and student support
services; and
(7) to the maximum extent feasible, employs qualified
Indians in the program.
(e) Active Duty Service Requirement.--The active duty service
obligation prescribed under section 338C of the Public Health
Service Act (42 U.S.C. 254m) shall be met by each graduate who
receives a stipend described in subsection (d)(4) that is
funded under this section. Such obligation shall be met by
service--
(1) in an Indian Health Program;
(2) in a program assisted under title V of this Act;
or
(3) 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 physician or other health professional
shortage area and addresses the health care needs of a
substantial number of Indians.
(f) Authorization of Appropriations.--There is authorized to
be appropriated to carry out this section $2,700,000 for each
of fiscal years 2008 through 2017.
SEC. 106. SCHOLARSHIP PROGRAMS FOR INDIAN TRIBES.
(a) In General.--
(1) Grants authorized.--The Secretary, acting through
the Service, shall make grants to Tribal Health
Programs for the purpose of providing scholarships for
Indians to serve as health professionals in Indian
communities.
(2) Amount.--Amounts available under paragraph (1)
for any fiscal year shall not exceed 5 percent of the
amounts available for each fiscal year for Indian
Health Scholarships under section 104.
(3) Application.--An application for a grant under
paragraph (1) shall be in such form and contain such
agreements, assurances, and information as consistent
with this section.
(b) Requirements.--
(1) In general.--A Tribal Health Program receiving a
grant under subsection (a) shall provide scholarships
to Indians in accordance with the requirements of this
section.
(2) Costs.--With respect to costs of providing any
scholarship pursuant to subsection (a)--
(A) 80 percent of the costs of the
scholarship shall be paid from the funds made
available pursuant to subsection (a)(1)
provided to the Tribal Health Program; and
(B) 20 percent of such costs may be paid from
any other source of funds.
(c) Course of Study.--A Tribal Health Program shall provide
scholarships under this section only to Indians enrolled or
accepted for enrollment in a course of study (approved by the
Secretary) in 1 of the health professions contemplated by this
Act.
(d) Contract.--
(1) In general.--In providing scholarships under
subsection (b), the Secretary and the Tribal Health
Program shall enter into a written contract with each
recipient of such scholarship.
(2) Requirements.--Such contract shall--
(A) obligate such recipient to provide
service in an Indian Health Program or Urban
Indian Organization, in the same Service Area
where the Tribal Health Program providing the
scholarship is located, for--
(i) a 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
(ii) such greater period of time as
the recipient and the Tribal Health
Program may agree;
(B) provide that the amount of the
scholarship--
(i) may only be expended 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 338(g)(1)(B) of the
Public Health Service Act (42
U.S.C. 254m(g)(1)(B)), with
such amount to be reduced pro
rata (as determined by the
Secretary) based on the number
of hours such student is
enrolled, and not to exceed,
for any year of attendance for
which the scholarship is
provided, the total amount
required for the year for the
purposes authorized in this
clause; and
(ii) 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
clause (i);
(C) 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 pursuant to this Act; and
(D) require the recipient of such scholarship
to meet the educational and licensure
requirements appropriate to each health
profession.
(3) Service in other service areas.--The contract may
allow the recipient to serve in another Service Area,
provided the Tribal Health Program and Secretary
approve and services are not diminished to Indians in
the Service Area where the Tribal Health Program
providing the scholarship is located.
(e) Breach of Contract.--
(1) Specific breaches.--An individual who has entered
into a written contract with the Secretary and a Tribal
Health Program under subsection (d) shall be liable to
the United States for the Federal share of the amount
which has been paid to him or her, or on his or her
behalf, under the contract if that individual--
(A) fails to maintain an acceptable level of
academic standing in the educational
institution in which he or she is enrolled
(such level as determined by the educational
institution under regulations of the
Secretary);
(B) is dismissed from such educational
institution for disciplinary reasons;
(C) voluntarily terminates the training in
such an educational institution for which he or
she 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 or she 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.
(2) Other breaches.--If for any reason not specified
in paragraph (1), an individual breaches a written
contract by failing to either 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 (l) of section 110 in the
manner provided for in such subsection.
(3) Cancellation upon death of recipient.--Upon the
death of an individual who receives an Indian Health
Scholarship, any outstanding obligation of that
individual for service or payment that relates to that
scholarship shall be canceled.
(4) Information.--The Secretary may carry out this
subsection on the basis of information received from
Tribal Health Programs involved or on the basis of
information collected through such other means as the
Secretary deems appropriate.
(f) Relation to Social Security Act.--The recipient of a
scholarship under this section shall agree, in providing health
care pursuant to the requirements herein--
(1) not to discriminate against an individual seeking
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 a program established in
title XVIII of the Social Security Act or pursuant to
the programs established in title XIX or title XXI 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 XVIII 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, or the State child health plan under title
XXI, of such Act to provide service to individuals
entitled to medical assistance or child health
assistance, respectively, under the plan.
(g) Continuance of Funding.--The Secretary shall make
payments under this section to a Tribal Health Program for any
fiscal year subsequent to the first fiscal year of such
payments unless the Secretary determines that, for the
immediately preceding fiscal year, the Tribal Health Program
has not complied with the requirements of this section.
SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS.
(a) Employment Preference.--Any individual who receives a
scholarship pursuant to section 104 or 106 shall be given
preference for employment in the Service, or may be employed by
a Tribal Health Program or an Urban Indian Organization, or
other agencies of the Department as available, during any
nonacademic period of the year.
(b) Not Counted Toward Active Duty Service Obligation.--
Periods of employment pursuant to this subsection shall not be
counted in determining fulfillment of the service obligation
incurred as a condition of the scholarship.
(c) Timing; Length of Employment.--Any individual enrolled in
a program, including a high school program, authorized under
section 102(a) may be employed by the Service or by a Tribal
Health Program or an Urban Indian Organization during any
nonacademic period of the year. Any such employment shall not
exceed 120 days during any calendar year.
(d) Nonapplicability of Competitive Personnel System.--Any
employment pursuant to this section shall be made without
regard to any competitive personnel system or agency personnel
limitation and to a position which will enable the individual
so employed to receive practical experience in the health
profession in which he or she is engaged in study. Any
individual so employed shall receive payment for his or her
services comparable to the salary he or she would receive if he
or she were employed in the competitive system. Any individual
so employed shall not be counted against any employment ceiling
affecting the Service or the Department.
SEC. 108. CONTINUING EDUCATION ALLOWANCES.
In order to encourage scholarship and stipend recipients
under sections 104, 105, 106, and 115 and health professionals,
including community health representatives and emergency
medical technicians, to join or continue in an Indian Health
Program and to provide their services in the rural and remote
areas where a significant portion of Indians reside, the
Secretary, acting through the Service, may--
(1) provide programs or allowances to transition into
an Indian Health Program, including licensing, board or
certification examination assistance, and technical
assistance in fulfilling service obligations under
sections 104, 105, 106, and 115; and
(2) provide programs or allowances to health
professionals employed in an Indian Health Program to
enable them for a period of time each year prescribed
by regulation of the Secretary to take leave of their
duty stations for professional consultation,
management, leadership, and refresher training courses.
SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.
(a) In General.--Under the authority of the Act of November
2, 1921 (25 U.S.C. 13) (commonly known as the ``Snyder Act''),
the Secretary, acting through the Service, shall maintain a
Community Health Representative Program under which Indian
Health Programs--
(1) provide for the training of Indians as community
health representatives; and
(2) use such community health representatives in the
provision of health care, health promotion, and disease
prevention services to Indian communities.
(b) Duties.--The Community Health Representative Program of
the Service, shall--
(1) provide a high standard of training for community
health representatives to ensure that the community
health representatives provide quality health care,
health promotion, and disease prevention services to
the Indian communities served by the Program;
(2) in order to provide such training, develop and
maintain a curriculum that--
(A) combines education in the theory of
health care with supervised practical
experience in the provision of health care; and
(B) provides instruction and practical
experience in health promotion and disease
prevention activities, with appropriate
consideration given to lifestyle factors that
have an impact on Indian health status, such as
alcoholism, family dysfunction, and poverty;
(3) maintain a system which identifies the needs of
community health representatives for continuing
education in health care, health promotion, and disease
prevention and develop programs that meet the needs for
continuing education;
(4) maintain a system that provides close supervision
of Community Health Representatives;
(5) maintain a system under which the work of
Community Health Representatives is reviewed and
evaluated; and
(6) promote traditional health care practices of the
Indian Tribes served consistent with the Service
standards for the provision of health care, health
promotion, and disease prevention.
SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM.
(a) Establishment.--The Secretary, acting through the
Service, shall establish and administer a program to be known
as the Service Loan Repayment Program (hereinafter referred to
as the ``Loan Repayment Program'') in order to ensure an
adequate supply of trained health professionals necessary to
maintain accreditation of, and provide health care services to
Indians through, Indian Health Programs and Urban Indian
Organizations.
(b) Eligible Individuals.--To be eligible to participate in
the Loan Repayment Program, an individual must--
(1)(A) be enrolled--
(i) in a course of study or program in an
accredited educational institution (as
determined by the Secretary under section
338B(b)(1)(c)(i) of the Public Health Service
Act (42 U.S.C. 254l-1(b)(1)(c)(i))) and be
scheduled to complete such course of study in
the same year such individual applies to
participate in such program; or
(ii) in an approved graduate training program
in a health profession; or
(B) have--
(i) a degree in a health profession; and
(ii) a license to practice a health
profession;
(2)(A) be eligible for, or hold, an appointment as a
commissioned officer in the Regular or Reserve Corps of
the Public Health Service;
(B) be eligible for selection for civilian service in
the Regular or Reserve Corps of the Public Health
Service;
(C) meet the professional standards for civil service
employment in the Service; or
(D) be employed in an Indian Health Program or Urban
Indian Organization without a service obligation; and
(3) submit to the Secretary an application for a
contract described in subsection (e).
(c) Application.--
(1) Information to be included with forms.--In
disseminating application forms and contract forms to
individuals desiring to participate in the Loan
Repayment Program, the Secretary shall include with
such forms a fair summary of the rights and liabilities
of an individual whose application is approved (and
whose contract is accepted) by the Secretary, including
in the summary a clear explanation of the damages to
which the United States is entitled under subsection
(l) in the case of the individual's breach of contract.
The Secretary shall provide such individuals with
sufficient information regarding the advantages and
disadvantages of service as a commissioned officer in
the Regular or Reserve Corps of the Public Health
Service or a civilian employee of the Service to enable
the individual to make a decision on an informed basis.
(2) Clear language.--The application form, contract
form, and all other information furnished by the
Secretary under this section shall be written in a
manner calculated to be understood by the average
individual applying to participate in the Loan
Repayment Program.
(3) Timely availability of forms.--The Secretary
shall make such application forms, contract forms, and
other information available to individuals desiring to
participate in the Loan Repayment Program on a date
sufficiently early to ensure that such individuals have
adequate time to carefully review and evaluate such
forms and information.
(d) Priorities.--
(1) List.--Consistent with subsection (k), the
Secretary shall annually--
(A) identify the positions in each Indian
Health Program or Urban Indian Organization for
which there is a need or a vacancy; and
(B) rank those positions in order of
priority.
(2) Approvals.--Notwithstanding the priority
determined under paragraph (1), the Secretary, in
determining which applications under the Loan Repayment
Program to approve (and which contracts to accept),
shall--
(A) give first priority to applications made
by individual Indians; and
(B) after making determinations on all
applications submitted by individual Indians as
required under subparagraph (A), give priority
to--
(i) individuals recruited through the
efforts of an Indian Health Program or
Urban Indian Organization; and
(ii) other individuals based on the
priority rankings under paragraph (1).
(e) Recipient Contracts.--
(1) Contract required.--An individual becomes a
participant in the Loan Repayment Program only upon the
Secretary and the individual entering into a written
contract described in paragraph (2).
(2) Contents of contract.--The written contract
referred to in this section between the Secretary and
an individual shall contain--
(A) an agreement under which--
(i) subject to subparagraph (C), the
Secretary agrees--
(I) to pay loans on behalf of
the individual in accordance
with the provisions of this
section; and
(II) to accept (subject to
the availability of
appropriated funds for carrying
out this section) the
individual into the Service or
place the individual with a
Tribal Health Program or Urban
Indian Organization as provided
in clause (ii)(III); and
(ii) subject to subparagraph (C), the
individual agrees--
(I) to accept loan payments
on behalf of the individual;
(II) in the case of an
individual described in
subsection (b)(1)--
(aa) to maintain
enrollment in a course
of study or training
described in subsection
(b)(1)(A) until the
individual completes
the course of study or
training; and
(bb) while enrolled
in such course of study
or training, to
maintain an acceptable
level of academic
standing (as determined
under regulations of
the Secretary by the
educational institution
offering such course of
study or training); and
(III) to serve for a time
period (hereinafter in this
section referred to as the
``period of obligated
service'') equal to 2 years or
such longer period as the
individual may agree to serve
in the full-time clinical
practice of such individual's
profession in an Indian Health
Program or Urban Indian
Organization to which the
individual may be assigned by
the Secretary;
(B) a provision permitting the Secretary to
extend for such longer additional periods, as
the individual may agree to, the period of
obligated service agreed to by the individual
under subparagraph (A)(ii)(III);
(C) a provision that any financial obligation
of the United States arising out of a contract
entered into under this section and any
obligation of the individual which is
conditioned thereon is contingent upon funds
being appropriated for loan repayments under
this section;
(D) a statement of the damages to which the
United States is entitled under subsection (l)
for the individual's breach of the contract;
and
(E) such other statements of the rights and
liabilities of the Secretary and of the
individual, not inconsistent with this section.
(f) Deadline for Decision on Application.--The Secretary
shall provide written notice to an individual within 21 days
on--
(1) the Secretary's approving, under subsection
(e)(1), of the individual's participation in the Loan
Repayment Program, including extensions resulting in an
aggregate period of obligated service in excess of 4
years; or
(2) the Secretary's disapproving an individual's
participation in such Program.
(g) Payments.--
(1) In general.--A loan repayment provided for an
individual under a written contract under the Loan
Repayment Program shall consist of payment, in
accordance with paragraph (2), on behalf of the
individual of the principal, interest, and related
expenses on government and commercial loans received by
the individual regarding the undergraduate or graduate
education of the individual (or both), which loans were
made for--
(A) tuition expenses;
(B) all other reasonable educational
expenses, including fees, books, and laboratory
expenses, incurred by the individual; and
(C) reasonable living expenses as determined
by the Secretary.
(2) Amount.--For each year of obligated service that
an individual contracts to serve under subsection (e),
the Secretary may pay up to $35,000 or an amount equal
to the amount specified in section 338B(g)(2)(A) of the
Public Health Service Act, whichever is more, on behalf
of the individual for loans described in paragraph (1).
In making a determination 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--
(A) affects the ability of the Secretary to
maximize the number of contracts that can be
provided under the Loan Repayment Program from
the amounts appropriated for such contracts;
(B) provides an incentive to serve in Indian
Health Programs and Urban Indian Organizations
with the greatest shortages of health
professionals; and
(C) provides an incentive with respect to the
health professional involved remaining in an
Indian Health Program or Urban Indian
Organization with such a health professional
shortage, and continuing to provide primary
health services, after the completion of the
period of obligated service under the Loan
Repayment Program.
(3) Timing.--Any arrangement made by the Secretary
for the making of loan repayments in accordance with
this subsection shall provide that any repayments for a
year of obligated service shall be made no later than
the end of the fiscal year in which the individual
completes such year of service.
(4) Reimbursements for tax liability.--For the
purpose of providing reimbursements for tax liability
resulting from a payment 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 equal
to not less than 20 percent and not more than
39 percent of the total amount of loan
repayments 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.
(5) Payment schedule.--The Secretary may enter into
an agreement with the holder of any loan for which
payments are made under the Loan Repayment Program to
establish a schedule for the making of such payments.
(h) Employment Ceiling.--Notwithstanding any other provision
of law, individuals who have entered into written contracts
with the Secretary under this section shall not be counted
against any employment ceiling affecting the Department while
those individuals are undergoing academic training.
(i) Recruitment.--The Secretary shall conduct recruiting
programs for the Loan Repayment Program and other manpower
programs of the Service at educational institutions training
health professionals or specialists identified in subsection
(a).
(j) Applicability of Law.--Section 214 of the Public Health
Service Act (42 U.S.C. 215) shall not apply to individuals
during their period of obligated service under the Loan
Repayment Program.
(k) Assignment of Individuals.--The Secretary, in assigning
individuals to serve in Indian Health Programs or Urban Indian
Organizations pursuant to contracts entered into under this
section, shall--
(1) ensure that the staffing needs of Tribal Health
Programs and Urban Indian Organizations receive
consideration on an equal basis with programs that are
administered directly by the Service; and
(2) give priority to assigning individuals to Indian
Health Programs and Urban Indian Organizations that
have a need for health professionals to provide health
care services as a result of individuals having
breached contracts entered into under this section.
(l) Breach of Contract.--
(1) Specific breaches.--An individual who has entered
into a written contract with the Secretary under this
section and has not received a waiver under subsection
(m) shall be liable, in lieu of any service obligation
arising under such contract, to the United States for
the amount which has been paid on such individual's
behalf under the contract if that individual--
(A) is enrolled in the final year of a course
of study and--
(i) fails to maintain an acceptable
level of academic standing in the
educational institution in which he or
she is enrolled (such level determined
by the educational institution under
regulations of the Secretary);
(ii) voluntarily terminates such
enrollment; or
(iii) is dismissed from such
educational institution before
completion of such course of study; or
(B) is enrolled in a graduate training
program and fails to complete such training
program.
(2) Other breaches; formula for amount owed.--If, for
any reason not specified in paragraph (1), an
individual breaches his or her written contract under
this section by failing either to begin, or complete,
such individual's period of obligated service in
accordance with subsection (e)(2), the United States
shall be entitled to recover from such individual an
amount to be determined in accordance with the
following formula: A=3Z(t-s/t) in which--
(A) ``A'' is the amount the United States is
entitled to recover;
(B) ``Z'' is the sum of the amounts paid
under this section to, or on behalf of, the
individual and the interest on such amounts
which would be payable if, at the time the
amounts were paid, they were loans bearing
interest at the maximum legal prevailing rate,
as determined by the Secretary of the Treasury;
(C) ``t'' is the total number of months in
the individual's period of obligated service in
accordance with subsection (f); and
(D) ``s'' is the number of months of such
period served by such individual in accordance
with this section.
(3) Deductions in medicare payments.--Amounts not
paid within such period shall be subject to collection
through deductions in Medicare payments pursuant to
section 1892 of the Social Security Act.
(4) Time period for repayment.--Any amount of damages
which the United States is entitled to recover under
this subsection shall be paid to the United States
within the 1-year period beginning on the date of the
breach or such longer period beginning on such date as
shall be specified by the Secretary.
(5) Recovery of delinquency.--
(A) In general.--If damages described in
paragraph (4) are delinquent for 3 months, the
Secretary shall, for the purpose of recovering
such damages--
(i) use collection agencies
contracted with by the Administrator of
General Services; or
(ii) enter into contracts for the
recovery of such damages with
collection agencies selected by the
Secretary.
(B) Report.--Each contract for recovering
damages pursuant to this subsection shall
provide that the contractor will, not less than
once each 6 months, submit to the Secretary a
status report on the success of the contractor
in collecting such damages. Section 3718 of
title 31, United States Code, shall apply to
any such contract to the extent not
inconsistent with this subsection.
(m) Waiver or Suspension of Obligation.--
(1) In general.--The Secretary shall by regulation
provide for the partial or total waiver or suspension
of any obligation of service or payment by an
individual under the Loan Repayment Program whenever
compliance by the individual is impossible or would
involve extreme hardship to the individual and if
enforcement of such obligation with respect to any
individual would be unconscionable.
(2) Canceled upon death.--Any obligation of an
individual under the Loan Repayment Program for service
or payment of damages shall be canceled upon the death
of the individual.
(3) Hardship waiver.--The Secretary may waive, in
whole or in part, the rights of the United States to
recover amounts under this section in any case of
extreme hardship or other good cause shown, as
determined by the Secretary.
(4) Bankruptcy.--Any obligation of an individual
under the Loan Repayment Program for payment of damages
may be released by a discharge in bankruptcy under
title 11 of the United States Code only if such
discharge is granted after the expiration of the 5-year
period beginning on the first date that payment of such
damages is required, and only if the bankruptcy court
finds that nondischarge of the obligation would be
unconscionable.
(n) Report.--The Secretary shall submit to the President, for
inclusion in the report required to be submitted to Congress
under section 801, a report concerning the previous fiscal year
which sets forth by Service Area the following:
(1) A list of the health professional positions
maintained by Indian Health Programs and Urban Indian
Organizations for which recruitment 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
(e) 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 scholarships that are provided
under sections 104 and 106 with respect to each health
profession.
(6) The amount of scholarship grants provided under
section 104 and 106, in total and by health profession.
(7) The number of providers of health care that will
be needed by Indian Health Programs and Urban Indian
Organizations, by location and profession, during the 3
fiscal years beginning after the date the report is
filed.
(8) The measures the Secretary plans to take to fill
the health professional positions maintained by Indian
Health Programs or Urban Indian Organizations for which
recruitment or retention is difficult.
SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND.
(a) Establishment.--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 ``LRRF''). The LRRF shall consist of
such amounts as may be collected from individuals under section
104(d), section 106(e), and section 110(l) for breach of
contract, such funds as may be appropriated to the LRRF, and
interest earned on amounts in the LRRF. All amounts collected,
appropriated, or earned relative to the LRRF shall remain
available until expended.
(b) Use of Funds.--
(1) By secretary.--Amounts in the LRRF may be
expended by the Secretary, acting through the Service,
to make payments to an Indian Health Program--
(A) to which a scholarship recipient under
section 104 and 106 or a loan repayment program
participant under section 110 has been assigned
to meet the obligated service requirements
pursuant to such 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,
106, or section 110.
(2) By tribal health programs.--A Tribal Health
Program receiving payments pursuant to paragraph (1)
may expend the payments to provide scholarships or
recruit and employ, directly or by contract, health
professionals to provide health care services.
(c) Investment of Funds.--The Secretary of the Treasury shall
invest such amounts of the LRRF as the Secretary of Health and
Human Services determines are not required to meet current
withdrawals from the LRRF. 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.
(d) Sale of Obligations.--Any obligation acquired by the LRRF
may be sold by the Secretary of the Treasury at the market
price.
SEC. 112. RECRUITMENT ACTIVITIES.
(a) Reimbursement for Travel.--The Secretary, acting through
the Service, may reimburse health professionals seeking
positions with Indian Health Programs or Urban Indian
Organizations, including individuals considering entering into
a contract under section 110 and their spouses, for actual and
reasonable expenses incurred in traveling to and from their
places of residence to an area in which they may be assigned
for the purpose of evaluating such area with respect to such
assignment.
(b) Recruitment Personnel.--The Secretary, acting through the
Service, shall assign 1 individual in each Area Office to be
responsible on a full-time basis for recruitment activities.
SEC. 113. INDIAN RECRUITMENT AND RETENTION PROGRAM.
(a) In General.--The Secretary, acting through the Service,
shall fund, on a competitive basis, innovative demonstration
projects for a period not to exceed 3 years to enable Tribal
Health Programs and Urban Indian Organizations to recruit,
place, and retain health professionals to meet their staffing
needs.
(b) Eligible Entities; Application.--Any Tribal Health
Program or Urban Indian Organization may submit an application
for funding of a project pursuant to this section.
SEC. 114. ADVANCED TRAINING AND RESEARCH.
(a) Demonstration Program.--The Secretary, acting through the
Service, shall establish a demonstration project to enable
health professionals who have worked in an Indian Health
Program or Urban Indian Organization for a substantial period
of time to pursue advanced training or research areas of study
for which the Secretary determines a need exists.
(b) Service Obligation.--An individual who participates in a
program under subsection (a), where the educational costs are
borne by the Service, shall incur an obligation to serve in an
Indian Health Program or Urban Indian Organization for a period
of obligated service equal to at least 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 individual shall be liable to the United States
for the period of service remaining. In such event, with
respect to individuals entering the program after the date of
enactment of the Indian Health Care Improvement Act Amendments
of 2007, the United States shall be entitled to recover from
such individual an amount to be determined in accordance with
the formula specified in subsection (l) of section 110 in the
manner provided for in such subsection.
(c) Equal Opportunity for Participation.--Health
professionals from Tribal Health Programs and Urban Indian
Organizations shall be given an equal opportunity to
participate in the program under subsection (a).
SEC. 115. QUENTIN N. BURDICK AMERICAN INDIANS INTO NURSING PROGRAM.
(a) Grants Authorized.--For the purpose of increasing the
number of nurses, nurse midwives, and nurse practitioners who
deliver health care services to Indians, the Secretary, acting
through the Service, shall provide grants to the following:
(1) Public or private schools of nursing.
(2) Tribal colleges or universities.
(3) Nurse midwife programs and advanced practice
nurse programs that are provided by any tribal college
or university accredited nursing program, or in the
absence of such, any other public or private
institutions.
(b) Use of Grants.--Grants provided under subsection (a) may
be used for 1 or more of the following:
(1) To recruit individuals for programs which train
individuals to be nurses, nurse midwives, or advanced
practice nurses.
(2) To provide scholarships to Indians enrolled in
such programs that may pay the tuition charged for such
program and other expenses incurred in connection with
such program, including books, fees, room and board,
and stipends for living expenses.
(3) To provide a program that encourages nurses,
nurse midwives, and advanced practice nurses to
provide, or continue to provide, health care services
to Indians.
(4) To provide a program that increases the skills
of, and provides continuing education to, nurses, nurse
midwives, and advanced practice nurses.
(5) To provide any program that is designed to
achieve the purpose described in subsection (a).
(c) Applications.--Each application for a grant under
subsection (a) shall include such information as the Secretary
may require to establish the connection between the program of
the applicant and a health care facility that primarily serves
Indians.
(d) Preferences for Grant Recipients.--In providing grants
under subsection (a), the Secretary shall extend a preference
to the following:
(1) Programs that provide a preference to Indians.
(2) Programs that train nurse midwives or advanced
practice nurses.
(3) Programs that are interdisciplinary.
(4) Programs that are conducted in cooperation with a
program for gifted and talented Indian students.
(5) Programs conducted by tribal colleges and
universities.
(e) Quentin N. Burdick Program Grant.--The Secretary shall
provide 1 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 maximum
extent feasible, coordinate with the Quentin N. Burdick Indian
Health Programs established under section 117(b) and the
Quentin N. Burdick American Indians Into Psychology Program
established under section 105(b).
(f) Active Duty Service Obligation.--The active duty service
obligation prescribed under section 338C of the Public Health
Service Act (42 U.S.C. 254m) shall be met by each individual
who receives training or assistance described in paragraph (1)
or (2) of subsection (b) that is funded by a grant provided
under subsection (a). Such obligation shall be met by service--
(1) in the Service;
(2) in a program of an Indian Tribe or Tribal
Organization conducted under the Indian Self-
Determination and Education Assistance Act (25 U.S.C.
450 et seq.) (including programs under agreements with
the Bureau of Indian Affairs);
(3) in a program assisted under title V of this Act;
(4) in the private practice of nursing if, as
determined by the Secretary, in accordance with
guidelines promulgated by the Secretary, such practice
is situated in a physician or other health shortage
area and addresses the health care needs of a
substantial number of Indians; or
(5) in a teaching capacity in a tribal college or
university nursing program (or a related health
profession program) if, as determined by the Secretary,
health services provided to Indians would not decrease.
SEC. 116. TRIBAL CULTURAL ORIENTATION.
(a) Cultural Education of Employees.--The Secretary, acting
through the Service, shall require that appropriate employees
of the Service who serve Indian Tribes in each Service Area
receive educational instruction in the history and culture of
such Indian Tribes and their relationship to the Service.
(b) Program.--In carrying out subsection (a), the Secretary
shall establish a program which shall, to the extent feasible--
(1) be developed in consultation with the affected
Indian Tribes, Tribal Organizations, and Urban Indian
Organizations;
(2) be carried out through tribal colleges or
universities;
(3) include instruction in American Indian studies;
and
(4) describe the use and place of traditional health
care practices of the Indian Tribes in the Service
Area.
SEC. 117. INMED PROGRAM.
(a) Grants Authorized.--The Secretary, acting through the
Service, is authorized to provide grants to colleges and
universities for the purpose of maintaining and expanding the
Indian health careers recruitment program known as the
``Indians Into Medicine Program'' (hereinafter in this section
referred to as ``INMED'') as a means of encouraging Indians to
enter the health professions.
(b) Quentin N. Burdick Grant.--The Secretary shall provide 1
of the grants authorized under subsection (a) to maintain the
INMED program at the University of North Dakota, to be known as
the ``Quentin N. Burdick Indian Health Programs'', unless the
Secretary makes a determination, based upon program reviews,
that the program is not meeting the purposes of this section.
Such program shall, to the maximum extent feasible, coordinate
with the Quentin N. Burdick American Indians Into Psychology
Program established under section 105(b) and the Quentin N.
Burdick American Indians Into Nursing Program established under
section 115.
(c) Regulations.--The Secretary, pursuant to this Act, shall
develop regulations to govern grants pursuant to this section.
(d) Requirements.--Applicants for grants provided under this
section shall agree to provide a program which--
(1) provides outreach and recruitment for health
professions to Indian communities including elementary
and secondary schools and community colleges located on
reservations which will be served by the program;
(2) incorporates a program advisory board comprised
of representatives from the Indian Tribes and Indian
communities which will be served by the program;
(3) provides summer preparatory programs for Indian
students who need enrichment in the subjects of math
and science in order to pursue training in the health
professions;
(4) provides tutoring, counseling, and support to
students who are enrolled in a health career program of
study at the respective college or university; and
(5) to the maximum extent feasible, employs qualified
Indians in the program.
SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY COLLEGES.
(a) Grants to Establish Programs.--
(1) In general.--The Secretary, acting through the
Service, shall award grants to accredited and
accessible community colleges for the purpose of
assisting such community colleges in the establishment
of programs which provide education in a health
profession leading to a degree or diploma in a health
profession for individuals who desire to practice such
profession on or near a reservation or in an Indian
Health Program.
(2) Amount of grants.--The amount of any grant
awarded to a community college under paragraph (1) for
the first year in which such a grant is provided to the
community college shall not exceed $250,000.
(b) Grants for Maintenance and Recruiting.--
(1) In general.--The Secretary, acting through the
Service, shall award grants to accredited and
accessible community colleges that have established a
program described in subsection (a)(1) for the purpose
of maintaining the program and recruiting students for
the program.
(2) Requirements.--Grants may only be made under this
section to a community college which--
(A) is accredited;
(B) has a relationship with a hospital
facility, Service facility, or hospital that
could provide training of nurses or health
professionals;
(C) has entered into an agreement with an
accredited college or university medical
school, the terms of which--
(i) provide a program that enhances
the transition and recruitment of
students into advanced baccalaureate or
graduate programs that train health
professionals; and
(ii) stipulate certifications
necessary to approve internship and
field placement opportunities at Indian
Health Programs;
(D) has a qualified staff which has the
appropriate certifications;
(E) is capable of obtaining State or regional
accreditation of the program described in
subsection (a)(1); and
(F) agrees to provide for Indian preference
for applicants for programs under this section.
(c) Technical Assistance.--The Secretary shall encourage
community colleges described in subsection (b)(2) to establish
and maintain programs described in subsection (a)(1) by--
(1) entering into agreements with such colleges for
the provision of qualified personnel of the Service to
teach courses of study in such programs; and
(2) providing technical assistance and support to
such colleges.
(d) Advanced Training.--
(1) Required.--Any program receiving assistance under
this section that is conducted with respect to a health
profession shall also offer courses of study which
provide advanced training for any health professional
who--
(A) has already received a degree or diploma
in such health profession; and
(B) provides clinical services on or near a
reservation or for an Indian Health Program.
(2) May be offered at alternate site.--Such courses
of study may be offered in conjunction with the college
or university with which the community college has
entered into the agreement required under subsection
(b)(2)(C).
(e) Priority.--Where the requirements of subsection (b) are
met, grant award priority shall be provided to tribal colleges
and universities in Service Areas where they exist.
SEC. 119. RETENTION BONUS.
(a) Bonus Authorized.--The Secretary may pay a retention
bonus to any health professional employed by, or assigned to,
and serving in, an Indian Health Program or Urban Indian
Organization either as a civilian employee or as a commissioned
officer in the Regular or Reserve Corps of the Public Health
Service who--
(1) is assigned to, and serving in, a position for
which recruitment or retention of personnel is
difficult;
(2) the Secretary determines is needed by Indian
Health Programs and Urban Indian Organizations;
(3) has--
(A) completed 2 years of employment with an
Indian Health Program or Urban Indian
Organization; or
(B) completed any service obligations
incurred as a requirement of--
(i) any Federal scholarship program;
or
(ii) any Federal education loan
repayment program; and
(4) enters into an agreement with an Indian Health
Program or Urban Indian Organization for continued
employment for a period of not less than 1 year.
(b) Rates.--The Secretary may establish rates for the
retention bonus which shall provide for a higher annual rate
for multiyear agreements than for single year agreements
referred to in subsection (a)(4), but in no event shall the
annual rate be more than $25,000 per annum.
(c) Default of Retention Agreement.--Any health professional
failing to complete the agreed upon term of service, except
where such failure is through no fault of the individual, shall
be obligated to refund to the Government the full amount of the
retention bonus for the period covered by the agreement, plus
interest as determined by the Secretary in accordance with
section 110(l)(2)(B).
(d) Other Retention Bonus.--The Secretary may pay a retention
bonus to any health professional employed by a Tribal Health
Program if such health professional is serving in a position
which the Secretary determines is--
(1) a position for which recruitment or retention is
difficult; and
(2) necessary for providing health care services to
Indians.
SEC. 120. NURSING RESIDENCY PROGRAM.
(a) Establishment of Program.--The Secretary, acting through
the Service, shall establish a program to enable Indians who
are licensed practical nurses, licensed vocational nurses, and
registered nurses who are working in an Indian Health Program
or Urban Indian Organization, and have done so for a period of
not less than 1 year, to pursue advanced training. Such program
shall include a combination of education and work study in an
Indian Health Program or Urban Indian Organization leading to
an associate or bachelor's degree (in the case of a licensed
practical nurse or licensed vocational nurse), a bachelor's
degree (in the case of a registered nurse), or advanced degrees
or certifications in nursing and public health.
(b) Service Obligation.--An individual who participates in a
program under subsection (a), where the educational costs are
paid by the Service, shall incur an obligation to serve in an
Indian Health Program or Urban Indian Organization for a period
of obligated service equal to 1 year for every year that
nonprofessional employee (licensed practical nurses, licensed
vocational nurses, nursing assistants, and various health care
technicals), or 2 years for every year that professional nurse
(associate degree and bachelor-prepared registered nurses),
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 (l) of section 110 in the manner provided for in
such subsection.
SEC. 121. COMMUNITY HEALTH AIDE PROGRAM.
(a) General Purposes of Program.--Under the authority of the
Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the
``Snyder Act''), the Secretary, acting through the Service,
shall develop and operate 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 practitioners.
(b) Specific Program Requirements.--The Secretary, acting
through the Community Health Aide Program of the Service,
shall--
(1) using trainers accredited by the Program, provide
a high standard of training to community health aides
and community 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
curriculum that--
(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 promotion, 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(2);
(3) establish and maintain a Community Health Aide
Certification Board to certify as community health
aides or community health practitioners individuals who
have successfully completed the training described in
paragraph (1) or can demonstrate equivalent experience;
(4) develop and 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;
(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; and
(7) ensure that pulpal therapy (not including
pulpotomies on deciduous teeth) or extraction of adult
teeth can be performed by a dental health aide
therapist only after consultation with a licensed
dentist who determines that the procedure is a medical
emergency that cannot be resolved with palliative
treatment, and further that dental health aide
therapists are strictly prohibited from performing all
other oral or jaw surgeries, provided that
uncomplicated extractions shall not be considered oral
surgery under this section.
(c) Program Review.--
(1) Neutral panel.--
(A) Establishment.--The Secretary, acting
through the Service, shall establish a neutral
panel to carry out the study under paragraph
(2).
(B) Membership.--Members of the neutral panel
shall be appointed by the Secretary from among
clinicians, economists, community
practitioners, oral epidemiologists, and Alaska
Natives.
(2) Study.--
(A) In general.--The neutral panel
established under paragraph (1) shall conduct a
study of the dental health aide therapist
services provided by the Community Health Aide
Program under this section to ensure that the
quality of care provided through those services
is adequate and appropriate.
(B) Parameters of study.--The Secretary, in
consultation with interested parties, including
professional dental organizations, shall
develop the parameters of the study.
(C) Inclusions.--The study shall include a
determination by the neutral panel with respect
to--
(i) the ability of the dental health
aide therapist services under this
section to address the dental care
needs of Alaska Natives;
(ii) the quality of care provided
through those services, including any
training, improvement, or additional
oversight required to improve the
quality of care; and
(iii) whether safer and less costly
alternatives to the dental health aide
therapist services exist.
(D) Consultation.--In carrying out the study
under this paragraph, the neutral panel shall
consult with Alaska Tribal Organizations with
respect to the adequacy and accuracy of the
study.
(3) Report.--The neutral panel shall submit to the
Secretary, the Committee on Indian Affairs of the
Senate, and the Committee on Natural Resources of the
House of Representatives a report describing the
results of the study under paragraph (2), including a
description of--
(A) any determination of the neutral panel
under paragraph (2)(C); and
(B) any comments received from an Alaska
Tribal Organization under paragraph (2)(D).
(d) Nationalization of Program.--
(1) In general.--Except as provided in paragraph (2),
the Secretary, acting through the Service, may
establish a national Community Health Aide Program in
accordance with the program under this section, as the
Secretary determines to be appropriate.
(2) Exception.--The national Community Health Aide
Program under paragraph (1) shall not include dental
health aide therapist services.
(3) Requirement.--In establishing a national program
under paragraph (1), the Secretary shall not reduce the
amount of funds provided for the Community Health Aide
Program described in subsections (a) and (b).
SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.
The Secretary, acting through the Service, shall, by contract
or otherwise, provide training for Indians in the
administration and planning of Tribal Health Programs.
SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION PROGRAMS.
(a) Demonstration Programs Authorized.--The Secretary, acting
through the Service, may fund demonstration programs for Tribal
Health Programs to address the chronic shortages of health
professionals.
(b) Purposes of Programs.--The purposes of demonstration
programs funded under subsection (a) shall be--
(1) to provide direct clinical and practical
experience at a Service Unit to health profession
students and residents from medical schools;
(2) to improve the quality of health care for Indians
by assuring access to qualified health care
professionals; and
(3) to provide academic and scholarly opportunities
for health professionals serving Indians by identifying
all academic and scholarly resources of the region.
(c) Advisory Board.--The demonstration programs established
pursuant to subsection (a) shall incorporate a program advisory
board composed of representatives from the Indian Tribes and
Indian communities in the area which will be served by the
program.
SEC. 124. NATIONAL HEALTH SERVICE CORPS.
(a) No Reduction in Services.--The Secretary shall not--
(1) remove a member of the National Health Service
Corps from an Indian Health Program or Urban Indian
Organization; or
(2) withdraw funding used to support such member,
unless the Secretary, acting through the Service, has
ensured that the Indians receiving services from such
member will experience no reduction in services.
(b) Exemption From Limitations.--National Health Service
Corps scholars qualifying for the Commissioned Corps in the
Public Health Service shall be exempt from the full-time
equivalent limitations of the National Health Service Corps and
the Service when serving as a commissioned corps officer in a
Tribal Health Program or an Urban Indian Organization.
SEC. 125. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL CURRICULA DEMONSTRATION
PROGRAMS.
(a) Contracts and Grants.--The Secretary, acting through the
Service, may enter into contracts with, or make grants to,
accredited tribal colleges and universities and eligible
accredited and accessible community colleges to establish
demonstration programs to develop educational curricula for
substance abuse counseling.
(b) Use of Funds.--Funds provided under this section shall be
used only for developing and providing educational curriculum
for substance abuse counseling (including paying salaries for
instructors). Such curricula may be provided through satellite
campus programs.
(c) Time Period of Assistance; Renewal.--A contract entered
into or a grant provided under this section shall be for a
period of 3 years. Such contract or grant may be renewed for an
additional 2-year period upon the approval of the Secretary.
(d) Criteria for Review and Approval of Applications.--Not
later than 180 days after the date of enactment of the Indian
Health Care Improvement Act Amendments of 2007, the Secretary,
after consultation with Indian Tribes and administrators of
tribal colleges and universities and eligible accredited and
accessible 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 criteria shall ensure that demonstration programs
established under this section promote the development of the
capacity of such entities to educate substance abuse
counselors.
(e) Assistance.--The Secretary shall provide such technical
and other assistance as may be necessary to enable grant
recipients to comply with the provisions of this section.
(f) Report.--Each fiscal year, the Secretary shall submit to
the President, for inclusion in the report which is required to
be submitted under section 801 for that fiscal year, a report
on the findings and conclusions derived from the demonstration
programs conducted under this section during that fiscal year.
(g) Definition.--For the purposes of this section, the term
``educational curriculum'' means 1 or more of the following:
(1) Classroom education.
(2) Clinical work experience.
(3) Continuing education workshops.
SEC. 126. BEHAVIORAL HEALTH TRAINING AND COMMUNITY EDUCATION PROGRAMS.
(a) Study; List.--The Secretary, acting through the Service,
and the Secretary of the Interior, in consultation with Indian
Tribes and Tribal Organizations, shall conduct a study and
compile a list of the types of staff positions specified in
subsection (b) whose qualifications include, or should include,
training in the identification, prevention, education,
referral, or treatment of mental illness, or dysfunctional and
self destructive behavior.
(b) Positions.--The positions referred to in subsection (a)
are--
(1) staff positions within the Bureau of Indian
Affairs, including existing positions, in the fields
of--
(A) elementary and secondary education;
(B) social services and family and child
welfare;
(C) law enforcement and judicial services;
and
(D) alcohol and substance abuse;
(2) staff positions within the Service; and
(3) staff positions similar to those identified in
paragraphs (1) and (2) established and maintained by
Indian Tribes, Tribal Organizations (without regard to
the funding source), and Urban Indian Organizations.
(c) Training Criteria.--
(1) In general.--The appropriate Secretary shall
provide training criteria appropriate to each type of
position identified in subsection (b)(1) and (b)(2) and
ensure that appropriate training has been, or shall be
provided to any individual in any such position. With
respect to any such individual in a position identified
pursuant to subsection (b)(3), the respective
Secretaries shall provide appropriate training to, or
provide funds to, an Indian Tribe, Tribal Organization,
or Urban Indian Organization for training of
appropriate individuals. In the case of positions
funded under a contract or compact under the Indian
Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.), the appropriate Secretary shall
ensure that such training costs are included in the
contract or compact, as the Secretary determines
necessary.
(2) Position specific training criteria.--Position
specific training criteria shall be culturally relevant
to Indians and Indian Tribes and shall ensure that
appropriate information regarding traditional health
care practices is provided.
(d) Community Education on Mental Illness.--The Service shall
develop and implement, on request of an Indian Tribe, Tribal
Organization, or Urban Indian Organization, or assist the
Indian Tribe, Tribal Organization, or Urban Indian Organization
to develop and implement, a program of community education on
mental illness. In carrying out this subsection, the Service
shall, upon request of an Indian Tribe, Tribal Organization, or
Urban Indian Organization, provide technical assistance to the
Indian Tribe, Tribal Organization, or Urban Indian Organization
to obtain and develop community educational materials on the
identification, prevention, referral, and treatment of mental
illness and dysfunctional and self-destructive behavior.
(e) Plan.--Not later than 90 days after the date of enactment
of the Indian Health Care Improvement Act Amendments of 2007,
the Secretary shall develop a plan under which the Service will
increase the health care staff providing behavioral health
services by at least 500 positions within 5 years after the
date of enactment of this section, with at least 200 of such
positions devoted to child, adolescent, and family services.
The plan developed under this subsection shall be implemented
under the Act of November 2, 1921 (25 U.S.C. 13) (commonly
known as the ``Snyder Act'').
SEC. 127. AUTHORIZATION OF APPROPRIATIONS.
There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2017 to
carry out this title.
TITLE II--HEALTH SERVICES
SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.
(a) Use of Funds.--The Secretary, acting through the Service,
is authorized to expend funds, directly or under the authority
of the Indian Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.), which are appropriated under the
authority of this section, for the purposes of--
(1) eliminating the deficiencies in health status and
health resources of all Indian Tribes;
(2) eliminating backlogs in the provision of health
care services to Indians;
(3) meeting the health needs of Indians in an
efficient and equitable manner, including the use of
telehealth and telemedicine when appropriate;
(4) eliminating inequities in funding for both direct
care and contract health service programs; and
(5) augmenting the ability of the Service to meet the
following health service responsibilities with respect
to those Indian Tribes with the highest levels of
health status deficiencies and resource deficiencies:
(A) Clinical care, including inpatient care,
outpatient care (including audiology, clinical
eye, and vision care), primary care, secondary
and tertiary care, and long-term care.
(B) Preventive health, including mammography
and other cancer screening in accordance with
section 207.
(C) Dental care.
(D) Mental health, including community mental
health services, inpatient mental health
services, dormitory mental health services,
therapeutic and residential treatment centers,
and training of traditional health care
practitioners.
(E) Emergency medical services.
(F) Treatment and control of, and
rehabilitative care related to, alcoholism and
drug abuse (including fetal alcohol syndrome)
among Indians.
(G) Injury prevention programs, including
data collection and evaluation, demonstration
projects, training, and capacity building.
(H) Home health care.
(I) Community health representatives.
(J) Maintenance and improvement.
(b) No Offset or Limitation.--Any funds appropriated under
the authority of this section shall not be used to offset or
limit any other appropriations made to the Service under this
Act or the Act of November 2, 1921 (25 U.S.C. 13) (commonly
known as the ``Snyder Act''), or any other provision of law.
(c) Allocation; Use.--
(1) In general.--Funds appropriated under the
authority of this section shall be allocated to Service
Units, Indian Tribes, or Tribal Organizations. The
funds allocated to each Indian Tribe, Tribal
Organization, or Service Unit under this paragraph
shall be used by the Indian Tribe, Tribal Organization,
or Service Unit under this paragraph to improve the
health status and reduce the resource deficiency of
each Indian Tribe served by such Service Unit, Indian
Tribe, or Tribal Organization.
(2) Apportionment of allocated funds.--The
apportionment of funds allocated to a Service Unit,
Indian Tribe, or Tribal Organization under paragraph
(1) among the health service responsibilities described
in subsection (a)(5) shall be determined by the Service
in consultation with, and with the active participation
of, the affected Indian Tribes and Tribal
Organizations.
(d) Provisions Relating to Health Status and Resource
Deficiencies.--For the purposes of this section, the following
definitions apply:
(1) Definition.--The term ``health status and
resource deficiency'' means the extent to which--
(A) the health status objectives set forth in
section 3(2) are not being achieved; and
(B) the Indian Tribe or Tribal Organization
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.
(2) Available resources.--The health resources
available to an Indian Tribe or Tribal Organization
include health resources provided by the Service as
well as health resources used by the Indian Tribe or
Tribal Organization, including services and financing
systems provided by any Federal programs, private
insurance, and programs of State or local governments.
(3) Process for review of determinations.--The
Secretary shall establish procedures which allow any
Indian Tribe or Tribal Organization to petition the
Secretary for a review of any determination of the
extent of the health status and resource deficiency of
such Indian Tribe or Tribal Organization.
(e) Eligibility for Funds.--Tribal Health Programs shall be
eligible for funds appropriated under the authority of this
section on an equal basis with programs that are administered
directly by the Service.
(f) Report.--By no later than the date that is 3 years after
the date of enactment of the Indian Health Care Improvement Act
Amendments of 2007, the Secretary shall submit to Congress the
current health status and resource deficiency report of the
Service for each Service Unit, including newly recognized or
acknowledged Indian Tribes. Such report shall set out--
(1) the methodology then in use by the Service for
determining Tribal health status and resource
deficiencies, as well as the most recent application of
that methodology;
(2) the extent of the health status and resource
deficiency of each Indian Tribe served by the Service
or a Tribal Health Program;
(3) the amount of funds necessary to eliminate the
health status and resource deficiencies of all Indian
Tribes served by the Service or a Tribal Health
Program; and
(4) an estimate of--
(A) the amount of health service funds
appropriated under the authority of this Act,
or any other Act, including the amount of any
funds transferred to the Service for the
preceding fiscal year which is allocated to
each Service Unit, Indian Tribe, or Tribal
Organization;
(B) the number of Indians eligible for health
services in each Service Unit or Indian Tribe
or Tribal Organization; and
(C) the number of Indians using the Service
resources made available to each Service Unit,
Indian Tribe or Tribal Organization, and, to
the extent available, information on the
waiting lists and number of Indians turned away
for services due to lack of resources.
(g) Inclusion in Base Budget.--Funds appropriated under this
section for any fiscal year shall be included in the base
budget of the Service for the purpose of determining
appropriations under this section in subsequent fiscal years.
(h) Clarification.--Nothing in this section is intended to
diminish the primary responsibility of the Service to eliminate
existing backlogs in unmet health care needs, nor are the
provisions of this section intended to discourage the Service
from undertaking additional efforts to achieve equity among
Indian Tribes and Tribal Organizations.
(i) Funding Designation.--Any funds appropriated under the
authority of this section shall be designated as the ``Indian
Health Care Improvement Fund''.
SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.
(a) Establishment.--There is established an Indian
Catastrophic Health Emergency Fund (hereafter in this section
referred to as the ``CHEF'') consisting of--
(1) the amounts deposited under subsection (f); and
(2) the amounts appropriated to CHEF under this
section.
(b) Administration.--CHEF shall be administered by the
Secretary, acting through the headquarters of the Service,
solely for the purpose of meeting the extraordinary medical
costs associated with the treatment of victims of disasters or
catastrophic illnesses who are within the responsibility of the
Service.
(c) Conditions on Use of Fund.--No part of CHEF or its
administration shall be subject to contract or grant under any
law, including the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.), nor shall CHEF funds be
allocated, apportioned, or delegated on an Area Office, Service
Unit, or other similar basis.
(d) Regulations.--The Secretary shall promulgate regulations
consistent with the provisions of this section to--
(1) establish a definition of disasters and
catastrophic illnesses for which the cost of the
treatment provided under contract would qualify for
payment from CHEF;
(2) provide that a Service Unit shall not be eligible
for reimbursement for the cost of treatment from CHEF
until its cost of treating any victim of such
catastrophic illness or disaster has reached a certain
threshold cost which the Secretary shall establish at--
(A) the 2000 level of $19,000; and
(B) for any subsequent year, not less than
the threshold 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;
(3) establish a procedure for the reimbursement of
the portion of the costs that exceeds such threshold
cost incurred by--
(A) Service Units; or
(B) whenever otherwise authorized by the
Service, non-Service facilities or providers;
(4) establish a procedure for payment from CHEF in
cases in which the exigencies of the medical
circumstances warrant treatment prior to the
authorization of such treatment by the Service; and
(5) establish a procedure that will ensure that no
payment shall be made from CHEF to any provider of
treatment to the extent that such provider is eligible
to receive payment for the treatment from any other
Federal, State, local, or private source of
reimbursement for which the patient is eligible.
(e) No Offset or Limitation.--Amounts appropriated to CHEF
under this section shall not be used to offset or limit
appropriations made to the Service under the authority of the
Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the
``Snyder Act''), or any other law.
(f) Deposit of Reimbursement Funds.--There shall be deposited
into CHEF all reimbursements to which the Service is entitled
from any Federal, State, local, or private source (including
third party insurance) by reason of treatment rendered to any
victim of a disaster or catastrophic illness the cost of which
was paid from CHEF.
SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION SERVICES.
(a) Findings.--Congress finds that health promotion and
disease prevention activities--
(1) improve the health and well-being of Indians; and
(2) reduce the expenses for health care of Indians.
(b) Provision of Services.--The Secretary, acting through the
Service and Tribal Health Programs, shall provide health
promotion and disease prevention services to Indians to achieve
the health status objectives set forth in section 3(2).
(c) Evaluation.--The Secretary, after obtaining input from
the affected Tribal Health Programs, shall submit to the
President for inclusion in the report which is required to be
submitted to Congress under section 801 an evaluation of--
(1) the health promotion and disease prevention needs
of Indians;
(2) the health promotion and disease prevention
activities which would best meet such needs;
(3) the internal capacity of the Service and Tribal
Health Programs to meet such needs; and
(4) the resources which would be required to enable
the Service and Tribal Health Programs to undertake the
health promotion and disease prevention activities
necessary to meet such needs.
SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL.
(a) Determinations Regarding Diabetes.--The Secretary, acting
through the Service, and in consultation with Indian Tribes and
Tribal Organizations, shall determine--
(1) by Indian Tribe and by Service Unit, the
incidence of, and the types of complications resulting
from, diabetes among Indians; and
(2) based on the determinations made pursuant to
paragraph (1), the measures (including patient
education and effective ongoing monitoring of disease
indicators) each Service Unit should take to reduce the
incidence of, and prevent, treat, and control the
complications resulting from, diabetes among Indian
Tribes within that Service Unit.
(b) Diabetes Screening.--To the extent medically indicated
and with informed consent, the Secretary shall screen each
Indian who receives services from the Service for diabetes and
for conditions which indicate a high risk that the individual
will become diabetic and establish a cost-effective approach to
ensure ongoing monitoring of disease indicators. Such screening
and monitoring may be conducted by a Tribal Health Program and
may be conducted through appropriate Internet-based health care
management programs.
(c) Diabetes Projects.--The Secretary shall continue to
maintain each model diabetes project in existence on the date
of enactment of the Indian Health Care Improvement Act
Amendments of 2007, any such other diabetes programs operated
by the Service or Tribal Health Programs, and any additional
diabetes projects, such as the Medical Vanguard program
provided for in title IV of Public Law 108-87, as implemented
to serve Indian Tribes. Tribal Health Programs shall receive
recurring funding for the diabetes projects that they operate
pursuant to this section, both at the date of enactment of the
Indian Health Care Improvement Act Amendments of 2007 and for
projects which are added and funded thereafter.
(d) Dialysis Programs.--The Secretary is authorized to
provide, through the Service, Indian Tribes, and Tribal
Organizations, dialysis programs, including the purchase of
dialysis equipment and the provision of necessary staffing.
(e) Other Duties of the Secretary.--
(1) In general.--The Secretary shall, to the extent
funding is available--
(A) in each Area Office, consult with Indian
Tribes and Tribal Organizations regarding
programs for the prevention, treatment, and
control of diabetes;
(B) establish in each Area Office a registry
of patients with diabetes to track the
incidence of diabetes and the complications
from diabetes in that area; and
(C) ensure that data collected in each Area
Office regarding diabetes and related
complications among Indians are disseminated to
all other Area Offices, subject to applicable
patient privacy laws.
(2) Diabetes control officers.--
(A) In general.--The Secretary may establish
and maintain in each Area Office a position of
diabetes control officer to coordinate and
manage any activity of that Area Office
relating to the prevention, treatment, or
control of diabetes to assist the Secretary in
carrying out a program under this section or
section 330C of the Public Health Service Act
(42 U.S.C. 254c-3).
(B) Certain activities.--Any activity carried
out by a diabetes control officer under
subparagraph (A) that is the subject of a
contract or compact under the Indian Self-
Determination and Education Assistance Act (25
U.S.C. 450 et seq.), and any funds made
available to carry out such an activity, shall
not be divisible for purposes of that Act.
SEC. 205. SHARED SERVICES FOR LONG-TERM CARE.
(a) Long-Term Care.--Notwithstanding any other provision of
law, the Secretary, acting through the Service, is authorized
to provide directly, or enter into contracts or compacts under
the Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.) with Indian Tribes or Tribal Organizations
for, the delivery of long-term care (including health care
services associated with long-term care) provided in a facility
to Indians. Such agreements shall provide for the sharing of
staff or other services between the Service or a Tribal Health
Program and a long-term care or related facility owned and
operated (directly or through a contract or compact under the
Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.)) by such Indian Tribe or Tribal
Organization.
(b) Contents of Agreements.--An agreement entered into
pursuant to subsection (a)--
(1) may, at the request of the Indian Tribe or Tribal
Organization, delegate to such Indian Tribe or Tribal
Organization such 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 and the Tribal Health Program be allocated
proportionately between the Service and the Indian
Tribe or Tribal Organization; and
(3) may authorize such Indian Tribe or Tribal
Organization to construct, renovate, or expand a long-
term care or other similar facility (including the
construction of a facility attached to a Service
facility).
(c) Minimum Requirement.--Any nursing facility provided for
under this section shall meet the requirements for nursing
facilities under section 1919 of the Social Security Act.
(d) Other Assistance.--The Secretary shall provide such
technical and other assistance as may be necessary to enable
applicants to comply with the provisions of this section.
(e) Use of Existing or Underused Facilities.--The Secretary
shall encourage the use of existing facilities that are
underused or allow the use of swing beds for long-term or
similar care.
SEC. 206. HEALTH SERVICES RESEARCH.
(a) In General.--The Secretary, acting through the Service,
shall make funding available for research to further the
performance of the health service responsibilities of Indian
Health Programs.
(b) Coordination of Resources and Activities.--The Secretary
shall also, to the maximum extent practicable, coordinate
departmental research resources and activities to address
relevant Indian Health Program research needs.
(c) Availability.--Tribal Health Programs shall be given an
equal opportunity to compete for, and receive, research funds
under this section.
(d) Use of Funds.--This funding may be used for both clinical
and nonclinical research.
(e) Evaluation and Dissemination.--The Secretary shall
periodically--
(1) evaluate the impact of research conducted under
this section; and
(2) disseminate to Tribal Health Programs information
regarding that research as the Secretary determines to
be appropriate.
SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREENING.
The Secretary, acting through the Service or Tribal Health
Programs, shall provide for screening as follows:
(1) Screening mammography (as defined in section
1861(jj) of the Social Security Act) for Indian women
at a frequency appropriate to such women under accepted
and appropriate national standards, and under such
terms and conditions as are consistent with standards
established by the Secretary to ensure the safety and
accuracy of screening mammography under part B of title
XVIII of such Act.
(2) Other cancer screening that receives an A or B
rating as recommended by the United States Preventive
Services Task Force established under section 915(a)(1)
of the Public Health Service Act (42 U.S.C. 299b-
4(a)(1)). The Secretary shall ensure that screening
provided for under this paragraph complies with the
recommendations of the Task Force with respect to--
(A) frequency;
(B) the population to be served;
(C) the procedure or technology to be used;
(D) evidence of effectiveness; and
(E) other matters that the Secretary
determines appropriate.
SEC. 208. PATIENT TRAVEL COSTS.
(a) Definition of Qualified Escort.--In this section, the
term ``qualified escort'' means--
(1) an adult escort (including a parent, guardian, or
other family member) who is required because of the
physical or mental condition, or age, of the applicable
patient;
(2) a health professional for the purpose of
providing necessary medical care during travel by the
applicable patient; or
(3) other escorts, as the Secretary or applicable
Indian Health Program determines to be appropriate.
(b) Provision of Funds.--The Secretary, acting through the
Service and Tribal Health Programs, is authorized to provide
funds for the following patient travel costs, including
qualified escorts, associated with receiving health care
services provided (either through direct or contract care or
through a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.)) under this Act--
(1) emergency air transportation and non-emergency
air transportation where ground transportation is
infeasible;
(2) transportation by private vehicle (where no other
means of transportation is available), specially
equipped vehicle, and ambulance; and
(3) transportation by such other means as may be
available and required when air or motor vehicle
transportation is not available.
SEC. 209. EPIDEMIOLOGY CENTERS.
(a) Establishment of Centers.--The Secretary shall establish
an epidemiology center in each Service Area to carry out the
functions described in subsection (b). Any new center
established after the date of the enactment of the Indian
Health Care Improvement Act Amendments of 2007 may be operated
under a grant authorized by subsection (d), but funding under
such a grant shall not be divisible.
(b) Functions of Centers.--In consultation with and upon the
request of Indian Tribes, Tribal Organizations, and Urban
Indian Organizations, each Service Area epidemiology center
established under this subsection shall, with respect to such
Service Area--
(1) collect data relating to, and monitor progress
made toward meeting, each of the health status
objectives of the Service, the Indian Tribes, Tribal
Organizations, and Urban Indian Organizations in the
Service Area;
(2) evaluate existing delivery systems, data systems,
and other systems that impact the improvement of Indian
health;
(3) assist Indian Tribes, Tribal Organizations, and
Urban Indian Organizations in identifying their highest
priority health status objectives and the services
needed to achieve such objectives, based on
epidemiological data;
(4) make recommendations for the targeting of
services needed by the populations served;
(5) make recommendations to improve health care
delivery systems for Indians and Urban Indians;
(6) provide requested technical assistance to Indian
Tribes, Tribal Organizations, 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; and
(7) provide disease surveillance and assist Indian
Tribes, Tribal Organizations, and Urban Indian
Organizations to promote public health.
(c) Technical Assistance.--The Director of the Centers for
Disease Control and Prevention shall provide technical
assistance to the centers in carrying out the requirements of
this subsection.
(d) Grants for Studies.--
(1) In general.--The Secretary may make grants to
Indian Tribes, Tribal Organizations, Urban Indian
Organizations, and eligible intertribal consortia to
conduct epidemiological studies of Indian communities.
(2) Eligible intertribal consortia.--An intertribal
consortium is eligible to receive a grant under this
subsection if--
(A) the intertribal consortium is
incorporated for the primary purpose of
improving Indian health; and
(B) the intertribal consortium is
representative of the Indian Tribes or urban
Indian communities in which the intertribal
consortium is located.
(3) Applications.--An application for a grant under
this subsection shall be submitted in such manner and
at such time as the Secretary shall prescribe.
(4) Requirements.--An applicant for a grant under
this subsection shall--
(A) demonstrate the technical,
administrative, and financial 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 Indian
tribes or Urban Indian Organizations in the
area to be served.
(5) Use of funds.--A grant awarded under paragraph
(1) may be used--
(A) to carry out the functions described in
subsection (b);
(B) to provide information to and consult
with tribal leaders, urban Indian community
leaders, and related health staff on health
care and health service management issues; and
(C) in collaboration with Indian Tribes,
Tribal Organizations, and urban Indian
communities, to provide the Service with
information regarding ways to improve the
health status of Indians.
(e) Access to Information.--An epidemiology center operated
by a grantee pursuant to a grant awarded under subsection (d)
shall be treated as a public health authority for purposes of
the Health Insurance Portability and Accountability Act of 1996
(Public Law 104-191; 110 Stat. 2033), as such entities are
defined in part 164.501 of title 45, Code of Federal
Regulations (or a successor regulation). The Secretary shall
grant such grantees access to and use of data, data sets,
monitoring systems, delivery systems, and other protected
health information in the possession of the Secretary.
SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS.
(a) Funding for Development of Programs.--In addition to
carrying out any other program for health promotion or disease
prevention, the Secretary, acting through the Service, is
authorized to award grants to Indian Tribes, Tribal
Organizations, and Urban Indian Organizations to develop
comprehensive school health education programs for children
from pre-school through grade 12 in schools for the benefit of
Indian and Urban Indian children.
(b) Use of Grant Funds.--A grant awarded under this section
may be used for purposes which may include, but are not limited
to, the following:
(1) Developing health education materials both for
regular school programs and afterschool programs.
(2) Training teachers in comprehensive school health
education materials.
(3) Integrating school-based, community-based, and
other public and private health promotion efforts.
(4) Encouraging healthy, tobacco-free school
environments.
(5) Coordinating school-based health programs with
existing services and programs available in the
community.
(6) Developing school programs on nutrition
education, personal health, oral health, and fitness.
(7) Developing behavioral health wellness programs.
(8) Developing chronic disease prevention programs.
(9) Developing substance abuse prevention programs.
(10) Developing injury prevention and safety
education programs.
(11) Developing activities for the prevention and
control of communicable diseases.
(12) Developing community and environmental health
education programs that include traditional health care
practitioners.
(13) Violence prevention.
(14) Such other health issues as are appropriate.
(c) Technical Assistance.--Upon request, the Secretary,
acting through the Service, shall provide technical assistance
to Indian Tribes, Tribal Organizations, and Urban Indian
Organizations in the development of comprehensive health
education plans and the dissemination of comprehensive health
education materials and information on existing health programs
and resources.
(d) Criteria for Review and Approval of Applications.--The
Secretary, acting through the Service, and in consultation with
Indian Tribes, Tribal Organizations, and Urban Indian
Organizations, shall establish criteria for the review and
approval of applications for grants awarded under this section.
(e) Development of Program for BIA-Funded Schools.--
(1) In general.--The Secretary of the Interior,
acting through the Bureau of Indian Affairs and in
cooperation with the Secretary, acting through the
Service, and affected Indian Tribes and Tribal
Organizations, shall develop a comprehensive school
health education program for children from preschool
through grade 12 in schools for which support is
provided by the Bureau of Indian Affairs.
(2) Requirements for programs.--Such programs shall
include--
(A) school programs on nutrition education,
personal health, oral health, and fitness;
(B) behavioral health wellness programs;
(C) chronic disease prevention programs;
(D) substance abuse prevention programs;
(E) injury prevention and safety education
programs; and
(F) activities for the prevention and control
of communicable diseases.
(3) Duties of the secretary.--The Secretary of the
Interior shall--
(A) provide training to teachers in
comprehensive school health education
materials;
(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.
SEC. 211. INDIAN YOUTH PROGRAM.
(a) Program Authorized.--The Secretary, acting through the
Service, is authorized to establish and administer a program to
provide grants to Indian Tribes, Tribal Organizations, and
Urban Indian Organizations for innovative mental and physical
disease prevention and health promotion and treatment programs
for Indian and Urban Indian preadolescent and adolescent
youths.
(b) Use of Funds.--
(1) Allowable uses.--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 incorporate cultural
values, community and family involvement, and
traditional health care practitioners; and
(B) develop and provide community training
and education.
(2) Prohibited use.--Funds made available under this
section may not be used to provide services described
in section 707(c).
(c) Duties of the Secretary.--The Secretary shall--
(1) disseminate to Indian Tribes, Tribal
Organizations, and Urban Indian Organizations
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, Tribal
Organization, or Urban Indian Organization, provide
technical assistance in the implementation of such
models.
(d) Criteria for Review and Approval of Applications.--The
Secretary, in consultation with Indian Tribes, Tribal
Organizations, and Urban Indian Organizations, shall establish
criteria for the review and approval of applications or
proposals under this section.
SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF COMMUNICABLE AND
INFECTIOUS DISEASES.
(a) Grants Authorized.--The Secretary, acting through the
Service, and after consultation with the Centers for Disease
Control and Prevention, may make grants available to Indian
Tribes, Tribal Organizations, and Urban Indian Organizations
for the following:
(1) Projects for the prevention, control, and
elimination of communicable and infectious diseases,
including tuberculosis, hepatitis, HIV, respiratory
syncytial virus, hanta virus, sexually transmitted
diseases, and H. Pylori.
(2) Public information and education programs for the
prevention, control, and elimination of communicable
and infectious diseases.
(3) Education, training, and clinical skills
improvement activities in the prevention, control, and
elimination of communicable and infectious diseases for
health professionals, including allied health
professionals.
(4) Demonstration projects for the screening,
treatment, and prevention of hepatitis C virus (HCV).
(b) Application Required.--The Secretary may provide funding
under subsection (a) only if an application or proposal for
funding is submitted to the Secretary.
(c) Coordination With Health Agencies.--Indian Tribes, Tribal
Organizations, and Urban Indian Organizations receiving funding
under this section are encouraged to coordinate their
activities with the Centers for Disease Control and Prevention
and State and local health agencies.
(d) Technical Assistance; Report.--In carrying out this
section, the Secretary--
(1) may, at the request of an Indian Tribe, Tribal
Organization, or Urban Indian Organization, provide
technical assistance; and
(2) shall prepare and submit a report to Congress
biennially on the use of funds under this section and
on the progress made toward the prevention, control,
and elimination of communicable and infectious diseases
among Indians and Urban Indians.
SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERVICES.
(a) Funding Authorized.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, may provide
funding under this Act to meet the objectives set forth in
section 3 through health care-related services and programs not
otherwise described in this Act, including--
(1) hospice care;
(2) assisted living;
(3) long-term care; and
(4) home- and community-based services.
(b) Terms and Conditions.--
(1) In general.--Any service provided under this
section shall be in accordance with such terms and
conditions as are consistent with accepted and
appropriate standards relating to the service,
including any licensing term or condition under this
Act.
(2) Standards.--
(A) In general.--The Secretary may establish,
by regulation, the standards for a service
provided under this section, provided that such
standards shall not be more stringent than the
standards required by the State in which the
service is provided.
(B) Use of state standards.--If the Secretary
does not, by regulation, establish standards
for a service provided under this section, the
standards required by the State in which the
service is or will be provided shall apply to
such service.
(C) Indian tribes.--If a service under this
section is provided by an Indian Tribe or
Tribal Organization pursuant to the Indian
Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.), the verification by
the Secretary that the service meets any
standards required by the State in which the
service is or will be provided shall be
considered to meet the terms and conditions
required under this subsection.
(3) Eligibility.--The following individuals shall be
eligible to receive long-term care under this section:
(A) Individuals who are unable to perform a
certain number of activities of daily living
without assistance.
(B) Individuals with a mental impairment,
such as dementia, Alzheimer's disease, or
another disabling mental illness, who may be
able to perform activities of daily living
under supervision.
(C) Such other individuals as an applicable
Indian Health Program determines to be
appropriate.
(c) Definitions.--For the purposes of this section, the
following definitions shall apply:
(1) The term ``home- and community-based services''
means 1 or more of the services specified in paragraphs
(1) through (9) of section 1929(a) of the Social
Security Act (42 U.S.C. 1396t(a)) (whether provided by
the Service or by an Indian Tribe or Tribal
Organization pursuant to the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450 et seq.))
that are or will be provided in accordance with the
standards described in subsection (b).
(2) The term ``hospice care'' means the items and
services specified in subparagraphs (A) through (H) of
section 1861(dd)(1) of the Social Security Act (42
U.S.C. 1395x(dd)(1)), and such other services which an
Indian Tribe or Tribal Organization determines are
necessary and appropriate to provide in furtherance of
this care.
SEC. 214. INDIAN WOMEN'S HEALTH CARE.
The Secretary, acting through the Service and Indian Tribes,
Tribal Organizations, and Urban Indian Organizations, shall
monitor and improve the quality of health care for Indian women
of all ages through the planning and delivery of programs
administered by the Service, in order to improve and enhance
the treatment models of care for Indian women.
SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZARDS.
(a) Studies and Monitoring.--The Secretary and the Service
shall conduct, in conjunction with other appropriate Federal
agencies and in consultation with concerned Indian Tribes and
Tribal Organizations, studies and ongoing monitoring programs
to determine trends in the health hazards to Indian miners and
to Indians on or near reservations and Indian communities as a
result of environmental hazards which may result in chronic or
life threatening health problems, such as nuclear resource
development, petroleum contamination, and contamination of
water source and of the food chain. Such studies shall
include--
(1) an evaluation of the nature and extent of health
problems caused by environmental hazards currently
exhibited among Indians and the causes of such health
problems;
(2) an analysis of the potential effect of ongoing
and future environmental resource development on or
near reservations and Indian communities, including the
cumulative effect over time on health;
(3) an evaluation of the types and nature of
activities, practices, and conditions causing or
affecting such health problems, including uranium
mining and milling, uranium mine tailing deposits,
nuclear power plant operation and construction, and
nuclear waste disposal; oil and gas production or
transportation on or near reservations or Indian
communities; and other development that could affect
the health of Indians and their water supply and food
chain;
(4) a summary of any findings and recommendations
provided in Federal and State studies, reports,
investigations, and inspections during the 5 years
prior to the date of enactment of the Indian Health
Care Improvement Act Amendments of 2007 that directly
or indirectly relate to the activities, practices, and
conditions affecting the health or safety of such
Indians; and
(5) the efforts that have been made by Federal and
State agencies and resource and economic development
companies to effectively carry out an education program
for such Indians regarding the health and safety
hazards of such development.
(b) Health Care Plans.--Upon completion of such studies, the
Secretary and the Service shall take into account the results
of such studies and develop health care plans to address the
health problems studied under subsection (a). The plans shall
include--
(1) methods for diagnosing and treating Indians
currently exhibiting such health problems;
(2) preventive care and testing for Indians who may
be exposed to such health hazards, including the
monitoring of the health of individuals who have or may
have been exposed to excessive amounts of radiation or
affected by other activities that have had or could
have a serious impact upon the health of such
individuals; and
(3) a program of education for Indians who, by reason
of their work or geographic proximity to such nuclear
or other development activities, may experience health
problems.
(c) Submission of Report and Plan to Congress.--The Secretary
and the Service shall submit to Congress the study prepared
under subsection (a) no later than 18 months after the date of
enactment of the Indian Health Care Improvement Act Amendments
of 2007. The health care plan prepared under subsection (b)
shall be submitted in a report no later than 1 year after the
study prepared under subsection (a) is submitted to Congress.
Such report shall include recommended activities for the
implementation of the plan, as well as an evaluation of any
activities previously undertaken by the Service to address such
health problems.
(d) Intergovernmental Task Force.--
(1) Establishment; members.--There is established an
Intergovernmental Task Force to be composed of the
following individuals (or their designees):
(A) The Secretary of Energy.
(B) The Secretary of the Environmental
Protection Agency.
(C) The Director of the Bureau of Mines.
(D) The Assistant Secretary for Occupational
Safety and Health.
(E) The Secretary of the Interior.
(F) The Secretary of Health and Human
Services.
(G) The Director of the Indian Health
Service.
(2) Duties.--The Task Force shall--
(A) identify existing and potential
operations related to nuclear resource
development or other environmental hazards that
affect or may affect the health of Indians on
or near a reservation or in an Indian
community; and
(B) enter into activities to correct existing
health hazards and ensure that current and
future health problems resulting from nuclear
resource or other development activities are
minimized or reduced.
(3) Chairman; meetings.--The Secretary of Health and
Human Services shall be the Chairman of the Task Force.
The Task Force shall meet at least twice each year.
(e) Health Services to Certain Employees.--In the case of any
Indian who--
(1) as a result of employment in or near a uranium
mine or mill or near any other environmental hazard,
suffers from a work-related illness or condition;
(2) is eligible to receive diagnosis and treatment
services from an Indian Health Program; and
(3) by reason of such Indian's employment, is
entitled to medical care at the expense of such mine or
mill operator or entity responsible for the
environmental hazard, the Indian Health Program shall,
at the request of such Indian, render appropriate
medical care to such Indian for such illness or
condition and may be reimbursed for any medical care so
rendered to which such Indian is entitled at the
expense of such operator or entity from such operator
or entity. Nothing in this subsection shall affect the
rights of such Indian to recover damages other than
such amounts paid to the Indian Health Program from the
employer for providing medical care for such illness or
condition.
SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.
(a) In General.--For fiscal years beginning with the fiscal
year ending September 30, 1983, and ending with the fiscal year
ending September 30, 2016, the State of Arizona shall be
designated as a contract health service delivery area by the
Service for the purpose of providing contract health care
services to members of federally recognized Indian Tribes of
Arizona.
(b) Maintenance of Services.--The Service shall not curtail
any health care services provided to Indians residing on
reservations in the State of Arizona if such curtailment is due
to the provision of contract services in such State pursuant to
the designation of such State as a contract health service
delivery area pursuant to subsection (a).
SEC. 217. NORTH DAKOTA AND SOUTH DAKOTA AS CONTRACT HEALTH SERVICE
DELIVERY AREA.
(a) In General.--Beginning in fiscal year 2003, the States of
North Dakota and South Dakota shall be designated as a contract
health service delivery area by the Service for the purpose of
providing contract health care services to members of federally
recognized Indian Tribes of North Dakota and South Dakota.
(b) Limitation.--The Service shall not curtail any health
care services provided to Indians residing on any reservation,
or in any county that has a common boundary with any
reservation, in the State of North Dakota or South Dakota if
such curtailment is due to the provision of contract services
in such States pursuant to the designation of such States as a
contract health service delivery area pursuant to subsection
(a).
SEC. 218. CALIFORNIA CONTRACT HEALTH SERVICES PROGRAM.
(a) Funding Authorized.--The Secretary is authorized to fund
a program using the California Rural Indian Health Board
(hereafter in this section referred to as the ``CRIHB'') as a
contract care intermediary to improve the accessibility of
health services to California Indians.
(b) Reimbursement Contract.--The Secretary shall enter into
an agreement with the CRIHB to reimburse the CRIHB for costs
(including reasonable administrative costs) incurred pursuant
to this section, in providing medical treatment under contract
to California Indians described in section 806(a) throughout
the California contract health services delivery area described
in section 218 with respect to high cost contract care cases.
(c) Administrative Expenses.--Not more than 5 percent of the
amounts provided to the CRIHB under this section for any fiscal
year may be for reimbursement for administrative expenses
incurred by the CRIHB during such fiscal year.
(d) Limitation on Payment.--No payment may be made for
treatment provided hereunder to the extent payment may be made
for such treatment under the Indian 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.
(e) Advisory Board.--There is established an advisory board
which shall advise the CRIHB in carrying out this section. The
advisory board shall be composed of representatives, selected
by the CRIHB, from not less than 8 Tribal Health Programs
serving California Indians covered under this section at least
\1/2\ of whom of whom are not affiliated with the CRIHB.
SEC. 219. CALIFORNIA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.
The State of California, excluding the counties of Alameda,
Contra Costa, Los Angeles, Marin, Orange, Sacramento, San
Francisco, San Mateo, Santa Clara, Kern, Merced, Monterey,
Napa, San Benito, San Joaquin, San Luis Obispo, Santa Cruz,
Solano, Stanislaus, and Ventura, shall be designated as a
contract health service delivery area by the Service for the
purpose of providing contract health services to California
Indians. However, any of the counties listed herein may only be
included in the contract health services delivery area if
funding is specifically provided by the Service for such
services in those counties.
SEC. 220. CONTRACT HEALTH SERVICES FOR THE TRENTON SERVICE AREA.
(a) Authorization for Services.--The Secretary, acting
through the Service, is directed to provide contract health
services to members of the Turtle Mountain Band of Chippewa
Indians that reside in the Trenton Service Area of Divide,
McKenzie, and Williams counties in the State of North Dakota
and the adjoining counties of Richland, Roosevelt, and Sheridan
in the State of Montana.
(b) No Expansion of Eligibility.--Nothing in this section may
be construed as expanding the eligibility of members of the
Turtle Mountain Band of Chippewa Indians for health services
provided by the Service beyond the scope of eligibility for
such health services that applied on May 1, 1986.
SEC. 221. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL ORGANIZATIONS.
The Service shall provide funds for health care programs and
facilities operated by Tribal Health Programs on the same basis
as such funds are provided to programs and facilities operated
directly by the Service.
SEC. 222. LICENSING.
Health care professionals employed by a Tribal Health Program
shall, if licensed in any State, be exempt from the licensing
requirements of the State in which the Tribal Health Program
performs the services described in its contract or compact
under the Indian Self-Determination and Education Assistance
Act (25 U.S.C. 450 et seq.).
SEC. 223. NOTIFICATION OF PROVISION OF EMERGENCY CONTRACT HEALTH
SERVICES.
With respect to an elderly Indian or an Indian with a
disability receiving emergency medical care or services from a
non-Service provider or in a non-Service facility under the
authority of this Act, the time limitation (as a condition of
payment) for notifying the Service of such treatment or
admission shall be 30 days.
SEC. 224. PROMPT ACTION ON PAYMENT OF CLAIMS.
(a) Deadline for Response.--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) Effect of Untimely Response.--If the Service fails to
respond to a notification of a claim in accordance with
subsection (a), the Service shall accept as valid the claim
submitted by the provider of a contract care service.
(c) Deadline for Payment of Valid Claim.--The Service shall
pay a valid contract care service claim within 30 days after
the completion of the claim.
SEC. 225. LIABILITY FOR PAYMENT.
(a) No Patient Liability.--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) Notification.--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 payment of any charges or costs associated with
the provision of such services not later than 5 business days
after receipt of a notification of a claim by a provider of
contract care services.
(c) No Recourse.--Following receipt of the notice provided
under subsection (b), or, if a claim has been deemed accepted
under section 223(b), the provider shall have no further
recourse against the patient who received the services.
SEC. 226. OFFICE OF INDIAN MEN'S HEALTH.
(a) Establishment.--The Secretary may establish within the
Service an office to be known as the ``Office of Indian Men's
Health'' (referred to in this section as the ``Office'').
(b) Director.--
(1) In general.--The Office shall be headed by a
director, to be appointed by the Secretary.
(2) Duties.--The director shall coordinate and
promote the status of the health of Indian men in the
United States.
(c) Report.--Not later than 2 years after the date of
enactment of the Indian Health Care Improvement Act Amendments
of 2007, the Secretary, acting through the director of the
Office, shall submit to Congress a report describing--
(1) any activity carried out by the director as of
the date on which the report is prepared; and
(2) any finding of the director with respect to the
health of Indian men.
SEC. 227. AUTHORIZATION OF APPROPRIATIONS.
There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2017 to
carry out this title.
TITLE III--FACILITIES
SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVATION OF FACILITIES;
REPORTS.
(a) Prerequisites for Expenditure of Funds.--Prior to the
expenditure of, or the making of any binding commitment to
expend, any funds appropriated for the planning, design,
construction, or renovation of facilities pursuant to the Act
of November 2, 1921 (25 U.S.C. 13) (commonly known as the
``Snyder Act''), the Secretary, acting through the Service,
shall--
(1) consult with any Indian Tribe that would be
significantly affected by such expenditure for the
purpose of determining and, whenever practicable,
honoring tribal preferences concerning size, location,
type, and other characteristics of any facility on
which such expenditure is to be made; and
(2) ensure, whenever practicable and applicable, that
such facility meets the construction standards of any
accrediting body recognized by the Secretary for the
purposes of the Medicare, Medicaid, and SCHIP programs
under titles XVIII, XIX, and XXI of the Social Security
Act by not later than 1 year after the date on which
the construction or renovation of such facility is
completed.
(b) Closures.--
(1) Evaluation required.--Notwithstanding any other
provision of law, no facility operated by the Service,
or any portion of such facility, may be closed if the
Secretary has not submitted to Congress, not less than
1 year and not more than 2 years before the date of the
proposed closure, an evaluation, completed not more
than 2 years before such submission, of the impact of
the proposed closure that specifies, in addition to
other considerations--
(A) the accessibility of alternative health
care resources for the population served by
such facility;
(B) the cost-effectiveness of such closure;
(C) the quality of health care to be provided
to the population served by such facility after
such closure;
(D) the availability of contract health care
funds to maintain existing levels of service;
(E) the views of the Indian Tribes served by
such facility concerning such closure;
(F) the level of use of such facility by all
eligible Indians; and
(G) the distance between such facility and
the nearest operating Service hospital.
(2) Exception for certain temporary closures.--
Paragraph (1) shall not apply to any temporary closure
of a facility or any portion of a facility if such
closure is necessary for medical, environmental, or
construction safety reasons.
(c) Health Care Facility Priority System.--
(1) In general.--
(A) Priority system.--The Secretary, acting
through the Service, shall maintain a health
care facility priority system, which--
(i) shall be developed in
consultation with Indian Tribes and
Tribal Organizations;
(ii) shall give Indian Tribes' needs
the highest priority;
(iii)(I) may include the lists
required in paragraph (2)(B)(ii); and
(II) shall include the methodology
required in paragraph (2)(B)(v); and
(III) may include such other
facilities, and such renovation or
expansion needs of any health care
facility, as the Service, Indian
Tribes, and Tribal Organizations may
identify; and
(iv) shall provide an opportunity for
the nomination of planning, design, and
construction projects by the Service,
Indian Tribes, and Tribal Organizations
for consideration under the priority
system at least once every 3 years, or
more frequently as the Secretary
determines to be appropriate.
(B) Needs of facilities under isdeaa
agreements.--The Secretary shall ensure that
the planning, design, construction, renovation,
and expansion needs of Service and non-Service
facilities operated under contracts or compacts
in accordance with the Indian Self-
Determination and Education Assistance Act (25
U.S.C. 450 et seq.) are fully and equitably
integrated into the health care facility
priority system.
(C) Criteria for evaluating needs.--For
purposes of this subsection, the Secretary, in
evaluating the needs of facilities operated
under a contract or compact under the Indian
Self-Determination and Education Assistance Act
(25 U.S.C. 450 et seq.), shall use the criteria
used by the Secretary in evaluating the needs
of facilities operated directly by the Service.
(D) Priority of certain projects protected.--
The priority of any project established under
the construction priority system in effect on
the date of enactment of the Indian Health Care
Improvement Act Amendments of 2007 shall not be
affected by any change in the construction
priority system taking place after that date if
the project--
(i) was identified in the fiscal year
2008 Service budget justification as--
(I) 1 of the 10 top-priority
inpatient projects;
(II) 1 of the 10 top-priority
outpatient projects;
(III) 1 of the 10 top-
priority staff quarters
developments; or
(IV) 1 of the 10 top-priority
Youth Regional Treatment
Centers;
(ii) had completed both Phase I and
Phase II of the construction priority
system in effect on the date of
enactment of such Act; or
(iii) is not included in clause (i)
or (ii) and is selected, as determined
by the Secretary--
(I) on the initiative of the
Secretary; or
(II) pursuant to a request of
an Indian Tribe or Tribal
Organization.
(2) Report; contents.--
(A) Initial comprehensive report.--
(i) Definitions.--In this
subparagraph:
(I) Facilities appropriation
advisory board.--The term
``Facilities Appropriation
Advisory Board'' means the
advisory board, comprised of 12
members representing Indian
tribes and 2 members
representing the Service,
established at the discretion
of the Assistant Secretary--
(aa) to provide
advice and
recommendations for
policies and procedures
of the programs funded
pursuant to facilities
appropriations; and
(bb) to address other
facilities issues.
(II) Facilities needs
assessment workgroup.--The term
``Facilities Needs Assessment
Workgroup'' means the workgroup
established at the discretion
of the Assistant Secretary--
(aa) to review the
health care facilities
construction priority
system; and
(bb) to make
recommendations to the
Facilities
Appropriation Advisory
Board for revising the
priority system.
(ii) Initial report.--
(I) In general.--Not later
than 1 year after the date of
enactment of the Indian Health
Care Improvement Act Amendments
of 2007, the Secretary shall
submit to the Committee on
Indian Affairs of the Senate
and the Committee on Natural
Resources of the House of
Representatives a report that
describes the comprehensive,
national, ranked list of all
health care facilities needs
for the Service, Indian Tribes,
and Tribal Organizations
(including inpatient health
care facilities, outpatient
health care facilities,
specialized health care
facilities (such as for long-
term care and alcohol and drug
abuse treatment), wellness
centers, staff quarters and
hostels associated with health
care facilities, and the
renovation and expansion needs,
if any, of such facilities)
developed by the Service,
Indian Tribes, and Tribal
Organizations for the
Facilities Needs Assessment
Workgroup and the Facilities
Appropriation Advisory Board.
(II) Inclusions.--The initial
report shall include--
(aa) the methodology
and criteria used by
the Service in
determining the needs
and establishing the
ranking of the
facilities needs; and
(bb) such other
information as the
Secretary determines to
be appropriate.
(iii) Updates of report.--Beginning
in calendar year 2011, the Secretary
shall--
(I) update the report under
clause (ii) not less frequently
that once every 5 years; and
(II) include the updated
report in the appropriate
annual report under
subparagraph (B) for submission
to Congress under section 801.
(B) Annual reports.--The Secretary shall
submit to the President, for inclusion in the
report required to be transmitted to Congress
under section 801, a report which sets forth
the following:
(i) A description of the health care
facility priority system of the Service
established under paragraph (1).
(ii) Health care facilities lists,
which may include--
(I) the 10 top-priority
inpatient health care
facilities;
(II) the 10 top-priority
outpatient health care
facilities;
(III) the 10 top-priority
specialized health care
facilities (such as long-term
care and alcohol and drug abuse
treatment);
(IV) the 10 top-priority
staff quarters developments
associated with health care
facilities; and
(V) the 10 top-priority
hostels associated with health
care facilities.
(iii) The justification for such
order of priority.
(iv) The projected cost of such
projects.
(v) The methodology adopted by the
Service in establishing priorities
under its health care facility priority
system.
(3) Requirements for preparation of reports.--In
preparing the report required under paragraph (2), the
Secretary shall--
(A) consult with and obtain information on
all health care facilities needs from Indian
Tribes, Tribal Organizations, and Urban Indian
Organizations; and
(B) review the total unmet needs of all
Indian Tribes, Tribal Organizations, and Urban
Indian Organizations for health care facilities
(including hostels and staff quarters),
including needs for renovation and expansion of
existing facilities.
(d) Review of Methodology Used for Health Facilities
Construction Priority System.--
(1) In general.--Not later than 1 year after the
establishment of the priority system under subsection
(c)(1)(A), the Comptroller General of the United States
shall prepare and finalize a report reviewing the
methodologies applied, and the processes followed, by
the Service in making each assessment of needs for the
list under subsection (c)(2)(A)(ii) and developing the
priority system under subsection (c)(1), including a
review of--
(A) the recommendations of the Facilities
Appropriation Advisory Board and the Facilities
Needs Assessment Workgroup (as those terms are
defined in subsection (c)(2)(A)(i)); and
(B) the relevant criteria used in ranking or
prioritizing facilities other than hospitals or
clinics.
(2) Submission to congress.--The Comptroller General
of the United States shall submit the report under
paragraph (1) to--
(A) the Committees on Indian Affairs and
Appropriations of the Senate;
(B) the Committees on Natural Resources and
Appropriations of the House of Representatives;
and
(C) the Secretary.
(e) Funding Condition.--All funds appropriated under the Act
of November 2, 1921 (25 U.S.C. 13) (commonly known as the
``Snyder Act''), for the planning, design, construction, or
renovation of health facilities for the benefit of 1 or more
Indian Tribes shall be subject to the provisions of the Indian
Self-Determination and Education Assistance Act (25 U.S.C. 450
et seq.).
(f) Development of Innovative Approaches.--The Secretary
shall consult and cooperate with Indian Tribes, Tribal
Organizations, and Urban Indian Organizations in developing
innovative approaches to address all or part of the total unmet
need for construction of health facilities, including those
provided for in other sections of this title and other
approaches.
SEC. 302. SANITATION FACILITIES.
(a) Findings.--Congress finds the following:
(1) The provision of sanitation facilities is
primarily a health consideration and function.
(2) Indian people suffer an inordinately high
incidence of disease, injury, and illness directly
attributable to the absence or inadequacy of sanitation
facilities.
(3) The long-term cost to the United States of
treating and curing such disease, injury, and illness
is substantially greater than the short-term cost of
providing sanitation facilities and other preventive
health measures.
(4) Many Indian homes and Indian communities still
lack sanitation facilities.
(5) It is in the interest of the United States, and
it is the policy of the United States, that all Indian
communities and Indian homes, new and existing, be
provided with sanitation facilities.
(b) Facilities and Services.--In furtherance of the findings
made in subsection (a), Congress reaffirms the primary
responsibility and authority of the Service to provide the
necessary sanitation facilities and services as provided in
section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a). Under
such authority, the Secretary, acting through the Service, is
authorized to provide the following:
(1) Financial and technical assistance to Indian
Tribes, Tribal Organizations, and Indian communities in
the establishment, training, and equipping of utility
organizations to operate and maintain sanitation
facilities, including the provision of existing plans,
standard details, and specifications available in the
Department, to be used at the option of the Indian
Tribe, Tribal Organization, or Indian community.
(2) Ongoing technical assistance and training to
Indian Tribes, Tribal Organizations, and Indian
communities in the management of utility organizations
which operate and maintain sanitation facilities.
(3) Priority funding for operation and maintenance
assistance for, and emergency repairs to, sanitation
facilities operated by an Indian Tribe, Tribal
Organization or Indian community when necessary to
avoid an imminent health threat or to protect the
investment in sanitation facilities and the investment
in the health benefits gained through the provision of
sanitation facilities.
(c) Funding.--Notwithstanding any other provision of law--
(1) the Secretary of Housing and Urban Development is
authorized to transfer funds appropriated under the
Native American Housing Assistance and Self-
Determination Act of 1996 (25 U.S.C. 4101 et seq.) to
the Secretary of Health and Human Services;
(2) the Secretary of Health and Human Services is
authorized to accept and use such funds for the purpose
of providing sanitation facilities and services for
Indians under section 7 of the Act of August 5, 1954
(42 U.S.C. 2004a);
(3) unless specifically authorized when funds are
appropriated, the Secretary shall not use funds
appropriated under section 7 of the Act of August 5,
1954 (42 U.S.C. 2004a), to provide sanitation
facilities to new homes constructed using funds
provided by the Department of Housing and Urban
Development;
(4) the Secretary of Health and Human Services is
authorized to accept from any source, including Federal
and State agencies, funds for the purpose of providing
sanitation facilities and services and place these
funds into contracts or compacts under the Indian Self-
Determination and Education Assistance Act (25 U.S.C.
450 et seq.);
(5) except as otherwise prohibited by this section,
the Secretary may use funds appropriated under the
authority of section 7 of the Act of August 5, 1954 (42
U.S.C. 2004a), to fund up to 100 percent of the amount
of an Indian Tribe's loan obtained under any Federal
program for new projects to construct eligible
sanitation facilities to serve Indian homes;
(6) except as otherwise prohibited by this section,
the Secretary may use funds appropriated under the
authority of section 7 of the Act of August 5, 1954 (42
U.S.C. 2004a) to meet matching or cost participation
requirements under other Federal and non-Federal
programs for new projects to construct eligible
sanitation facilities;
(7) all Federal agencies are authorized to transfer
to the Secretary funds identified, granted, loaned, or
appropriated whereby the Department's applicable
policies, rules, and regulations shall apply in the
implementation of such projects;
(8) the Secretary of Health and Human Services shall
enter into interagency agreements with Federal and
State agencies for the purpose of providing financial
assistance for sanitation facilities and services under
this Act;
(9) the Secretary of Health and Human Services shall,
by regulation, establish standards applicable to the
planning, design, and construction of sanitation
facilities funded under this Act; and
(10) the Secretary of Health and Human Services is
authorized to accept payments for goods and services
furnished by the Service from appropriate public
authorities, nonprofit organizations or agencies, or
Indian Tribes, as contributions by that authority,
organization, agency, or tribe to agreements made under
section 7 of the Act of August 5, 1954 (42 U.S.C.
2004a), and such payments shall be credited to the same
or subsequent appropriation account as funds
appropriated under the authority of section 7 of the
Act of August 5, 1954 (42 U.S.C. 2004a).
(d) Certain Capabilities Not Prerequisite.--The financial and
technical capability of an Indian Tribe, Tribal Organization,
or Indian community to safely operate, manage, and maintain a
sanitation facility shall not be a prerequisite to the
provision or construction of sanitation facilities by the
Secretary.
(e) Financial Assistance.--The Secretary is authorized to
provide financial assistance to Indian Tribes, Tribal
Organizations, and Indian communities for operation,
management, and maintenance of their sanitation facilities.
(f) Operation, Management, and Maintenance of Facilities.--
The Indian Tribe has the primary responsibility to establish,
collect, and use reasonable user fees, or otherwise set aside
funding, for the purpose of operating, managing, and
maintaining sanitation facilities. If a sanitation facility
serving a community that is operated by an Indian Tribe or
Tribal Organization is threatened with imminent failure and
such operator lacks capacity to maintain the integrity or the
health benefits of the sanitation facility, then the Secretary
is authorized to assist the Indian Tribe, Tribal Organization,
or Indian community in the resolution of the problem on a
short-term basis through cooperation with the emergency
coordinator or by providing operation, management, and
maintenance service.
(g) ISDEAA Program Funded on Equal Basis.--Tribal Health
Programs shall be eligible (on an equal basis with programs
that are administered directly by the Service) for--
(1) any funds appropriated pursuant to this section;
and
(2) any funds appropriated for the purpose of
providing sanitation facilities.
(h) Report.--
(1) Required; contents.--The Secretary, in
consultation with the Secretary of Housing and Urban
Development, Indian Tribes, Tribal Organizations, and
tribally designated housing entities (as defined in
section 4 of the Native American Housing Assistance and
Self-Determination Act of 1996 (25 U.S.C. 4103)) shall
submit to the President, for inclusion in the report
required to be transmitted to Congress under section
801, a report which sets forth--
(A) the current Indian sanitation facility
priority system of the Service;
(B) the methodology for determining
sanitation deficiencies and needs;
(C) the criteria on which the deficiencies
and needs will be evaluated;
(D) the level of initial and final sanitation
deficiency for each type of sanitation facility
for each project of each Indian Tribe or Indian
community;
(E) the amount and most effective use of
funds, derived from whatever source, necessary
to accommodate the sanitation facilities needs
of new homes assisted with funds under the
Native American Housing Assistance and Self-
Determination Act (25 U.S.C. 4101 et seq.), and
to reduce the identified sanitation deficiency
levels of all Indian Tribes and Indian
communities to level I sanitation deficiency as
defined in paragraph (3)(A); and
(F) a 10-year plan to provide sanitation
facilities to serve existing Indian homes and
Indian communities and new and renovated Indian
homes.
(2) Uniform methodology.--The methodology used by the
Secretary in determining, preparing cost estimates for,
and reporting sanitation deficiencies for purposes of
paragraph (1) shall be applied uniformly to all Indian
Tribes and Indian communities.
(3) Sanitation deficiency levels.--For purposes of
this subsection, the sanitation deficiency levels for
an individual, Indian Tribe, or Indian community
sanitation facility to serve Indian homes are
determined as follows:
(A) A level I deficiency exists if a
sanitation facility serving an individual,
Indian Tribe, or Indian community--
(i) complies with all applicable
water supply, pollution control, and
solid waste disposal laws; and
(ii) deficiencies relate to routine
replacement, repair, or maintenance
needs.
(B) A level II deficiency exists if a
sanitation facility serving an individual,
Indian Tribe, or Indian community substantially
or recently complied with all applicable water
supply, pollution control, and solid waste laws
and any deficiencies relate to--
(i) small or minor capital
improvements needed to bring the
facility back into compliance;
(ii) capital improvements that are
necessary to enlarge or improve the
facilities in order to meet the current
needs for domestic sanitation
facilities; or
(iii) the lack of equipment or
training by an Indian Tribe, Tribal
Organization, or an Indian community to
properly operate and maintain the
sanitation facilities.
(C) A level III deficiency exists if a
sanitation facility serving an individual,
Indian Tribe or Indian community meets 1 or
more of the following conditions--
(i) water or sewer service in the
home is provided by a haul system with
holding tanks and interior plumbing;
(ii) major significant interruptions
to water supply or sewage disposal
occur frequently, requiring major
capital improvements to correct the
deficiencies; or
(iii) there is no access to or no
approved or permitted solid waste
facility available.
(D) A level IV deficiency exists--
(i) if a sanitation facility for an
individual home, an Indian Tribe, or an
Indian community exists but--
(I) lacks--
(aa) a safe water
supply system; or
(bb) a waste disposal
system;
(II) contains no piped water
or sewer facilities; or
(III) has become inoperable
due to a major component
failure; or
(ii) if only a washeteria or central
facility exists in the community.
(E) A level V deficiency exists in the
absence of a sanitation facility, where
individual homes do not have access to safe
drinking water or adequate wastewater
(including sewage) disposal.
(i) Definitions.--For purposes of this section, the following
terms apply:
(1) Indian community.--The term ``Indian community''
means a geographic area, a significant proportion of
whose inhabitants are Indians and which is served by or
capable of being served by a facility described in this
section.
(2) Sanitation facilities.--The terms ``sanitation
facility'' and ``sanitation facilities'' mean safe and
adequate water supply systems, sanitary sewage disposal
systems, and sanitary solid waste systems (and all
related equipment and support infrastructure).
SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS.
(a) Buy Indian Act.--The Secretary, acting through the
Service, may use the negotiating authority of section 23 of the
Act of June 25, 1910 (25 U.S.C. 47, commonly known as the ``Buy
Indian Act''), to give preference to any Indian or any
enterprise, partnership, corporation, or other type of business
organization owned and controlled by an Indian or Indians
including former or currently federally recognized Indian
Tribes in the State of New York (hereinafter referred to as an
``Indian firm'') in the construction and renovation of Service
facilities pursuant to section 301 and in the construction of
sanitation facilities pursuant to section 302. Such preference
may be accorded by the Secretary unless the Secretary finds,
pursuant to regulations, that the project or function to be
contracted for will not be satisfactory or such project or
function cannot be properly completed or maintained under the
proposed contract. The Secretary, in arriving at such a
finding, shall consider whether the Indian or Indian firm will
be deficient with respect to--
(1) ownership and control by Indians;
(2) equipment;
(3) bookkeeping and accounting procedures;
(4) substantive knowledge of the project or function
to be contracted for;
(5) adequately trained personnel; or
(6) other necessary components of contract
performance.
(b) Labor Standards.--For the purposes of implementing the
provisions of this title, contracts for the construction or
renovation of health care facilities, staff quarters, and
sanitation facilities, and related support infrastructure,
funded in whole or in part with funds made available pursuant
to this title, shall contain a provision requiring compliance
with subchapter IV of chapter 31 of title 40, United States
Code (commonly known as the ``Davis-Bacon Act'').
SEC. 304. EXPENDITURE OF NON-SERVICE FUNDS FOR RENOVATION.
(a) In General.--Notwithstanding any other provision of law,
if the requirements of subsection (c) are met, the Secretary,
acting through the Service, is authorized to accept any major
expansion, renovation, or modernization by any Indian Tribe or
Tribal Organization of any Service facility or of any other
Indian health facility operated pursuant to a contract or
compact under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.), including--
(1) any plans or designs for such expansion,
renovation, or modernization; and
(2) any expansion, renovation, or modernization for
which funds appropriated under any Federal law were
lawfully expended.
(b) Priority List.--
(1) In general.--The Secretary shall maintain a
separate priority list to address the needs for
increased operating expenses, personnel, or equipment
for such facilities. The methodology for establishing
priorities shall be developed through regulations. The
list of priority facilities will be revised annually in
consultation with Indian Tribes and Tribal
Organizations.
(2) Report.--The Secretary shall submit to the
President, for inclusion in the report required to be
transmitted to Congress under section 801, the priority
list maintained pursuant to paragraph (1).
(c) Requirements.--The requirements of this subsection are
met with respect to any expansion, renovation, or modernization
if--
(1) the Indian Tribe or Tribal Organization--
(A) provides notice to the Secretary of its
intent to expand, 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 increased operating
expenses, personnel, or equipment; and
(2) the expansion, renovation, or modernization--
(A) is approved by the appropriate area
director of the Service for Federal facilities;
and
(B) is administered by the Indian Tribe or
Tribal Organization in accordance with any
applicable regulations prescribed by the
Secretary with respect to construction or
renovation of Service facilities.
(d) Additional Requirement for Expansion.--In addition to the
requirements under subsection (c), for any expansion, the
Indian Tribe or Tribal Organization shall provide to the
Secretary additional information pursuant to regulations,
including additional staffing, equipment, and other costs
associated with the expansion.
(e) Closure or Conversion of Facilities.--If any Service
facility which has been expanded, renovated, or modernized by
an Indian Tribe or Tribal Organization under this section
ceases to be used as a Service facility during the 20-year
period beginning on the date such expansion, renovation, or
modernization is completed, such Indian Tribe or Tribal
Organization 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 expansion, renovation, or modernization (less the total
amount of any funds provided specifically for such facility
under any Federal program that were expended for such
expansion, renovation, or modernization) bore to the value of
such facility at the time of the completion of such expansion,
renovation, or modernization.
SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND MODERNIZATION OF
SMALL AMBULATORY CARE FACILITIES.
(a) Grants.--
(1) In general.--The Secretary, acting through the
Service, shall make grants to Indian Tribes and Tribal
Organizations for the construction, expansion, or
modernization of facilities for the provision of
ambulatory care services to eligible Indians (and
noneligible persons pursuant to subsections (b)(2) and
(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) Grant agreement required.--A grant under
paragraph (1) may only be made available to a Tribal
Health Program 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 transferred to an Indian
Tribe or Tribal Organization).
(b) Use of Grant Funds.--
(1) Allowable uses.--A grant awarded under this
section may be used for the construction, expansion, or
modernization (including the planning and design of
such construction, expansion, or modernization) of an
ambulatory care facility--
(A) located apart from a hospital;
(B) not funded under section 301 or section
306; and
(C) which, upon completion of such
construction or modernization will--
(i) have a total capacity appropriate
to its projected service population;
(ii) provide annually no fewer than
150 patient visits by eligible Indians
and other users who are eligible for
services in such facility in accordance
with section 807(c)(2); and
(iii) provide ambulatory care in a
Service Area (specified in the contract
or compact under the Indian Self-
Determination and Education Assistance
Act (25 U.S.C. 450 et seq.)) with a
population of no fewer than 1,500
eligible Indians and other users who
are eligible for services in such
facility in accordance with section
807(c)(2).
(2) Additional allowable use.--The Secretary may also
reserve a portion of the funding provided under this
section and use those reserved funds to reduce an
outstanding debt incurred by Indian Tribes or Tribal
Organizations for the construction, expansion, or
modernization of an ambulatory care facility that meets
the requirements under paragraph (1). The provisions of
this section shall apply, except that such applications
for funding under this paragraph shall be considered
separately from applications for funding under
paragraph (1).
(3) Use only for certain portion of costs.--A grant
provided under this section may be used only for the
cost of that portion of a construction, expansion, or
modernization project that benefits the Service
population identified above in subsection (b)(1)(C)
(ii) and (iii). The requirements of clauses (ii) and
(iii) of paragraph (1)(C) shall not apply to an Indian
Tribe or Tribal Organization applying for a grant under
this section for a health care facility located or to
be constructed on an island or when such facility is
not located on a road system providing direct access to
an inpatient hospital where care is available to the
Service population.
(c) Grants.--
(1) Application.--No grant may be made under this
section unless an application or proposal for the grant
has been approved by the Secretary in accordance with
applicable regulations and has set forth reasonable
assurance by the applicant that, at all times after the
construction, expansion, or modernization of a facility
carried out using 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 without 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) Priority.--In awarding grants under this section,
the Secretary shall give priority to Indian Tribes and
Tribal Organizations that demonstrate--
(A) a need for increased ambulatory care
services; and
(B) insufficient capacity to deliver such
services.
(3) Peer review panels.--The Secretary may provide
for the establishment of peer review panels, as
necessary, to review and evaluate applications and
proposals and to advise the Secretary regarding such
applications using the criteria developed pursuant to
subsection (a)(1).
(d) Reversion of Facilities.--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 used for the purposes of providing health care
services to eligible Indians, all of the right, title, and
interest in and to such facility (or portion thereof) shall
transfer to the United States unless otherwise negotiated by
the Service and the Indian Tribe or Tribal Organization.
(e) Funding Nonrecurring.--Funding provided under this
section shall be nonrecurring and shall not be available for
inclusion in any individual Indian Tribe's tribal share for an
award under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.) or for reallocation or
redesign thereunder.
SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECT.
(a) Health Care Demonstration Projects.--The Secretary,
acting through the Service, is authorized to enter into
contracts under the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.) with Indian Tribes or
Tribal Organizations for the purpose of carrying out a health
care delivery demonstration project to test alternative means
of delivering health care and services to Indians through
facilities.
(b) Use of Funds.--The Secretary, in approving projects
pursuant to this section, may authorize such contracts for the
construction and renovation of hospitals, health centers,
health stations, and other facilities to deliver health care
services and is authorized to--
(1) waive any leasing prohibition;
(2) permit carryover of funds appropriated for the
provision of health care services;
(3) permit the use of other available funds;
(4) permit the use of funds or property donated from
any source for project purposes;
(5) provide for the reversion of donated real or
personal property to the donor; and
(6) permit the use of Service funds to match other
funds, including Federal funds.
(c) Regulations.--The Secretary shall develop and promulgate
regulations, not later than 1 year after the date of enactment
of the Indian Health Care Improvement Act Amendments of 2007,
for the review and approval of applications submitted under
this section.
(d) Criteria.--The Secretary may approve projects that meet
the following criteria:
(1) There is a need for a new facility or program or
the reorientation of an existing facility or program.
(2) A significant number of Indians, including those
with low health status, will be served by the project.
(3) The project has the potential to deliver services
in an efficient and effective manner.
(4) The project is economically viable.
(5) The Indian Tribe or Tribal Organization has the
administrative and financial capability to administer
the project.
(6) The project is integrated with providers of
related health and social services and is coordinated
with, and avoids duplication of, existing services.
(e) Peer Review Panels.--The Secretary may provide for the
establishment of peer review panels, as necessary, to review
and evaluate applications using the criteria developed pursuant
to subsection (d).
(f) Priority.--The Secretary shall give priority to
applications for demonstration projects in each of the
following Service Units to the extent that such applications
are timely filed and meet the criteria specified in subsection
(d):
(1) Cass Lake, Minnesota.
(2) Mescalero, New Mexico.
(3) Owyhee, Nevada.
(4) Schurz, Nevada.
(5) Ft. Yuma, California.
(g) Technical Assistance.--The Secretary shall provide such
technical and other assistance as may be necessary to enable
applicants to comply with the provisions of this section.
(h) Service to Ineligible Persons.--Subject to section 807,
the authority to provide services to persons otherwise
ineligible for the health care benefits of the Service and the
authority to extend hospital privileges in Service facilities
to non-Service health practitioners as provided in section 807
may be included, subject to the terms of such section, in any
demonstration project approved pursuant to this section.
(i) Equitable Treatment.--For purposes of subsection (d)(1),
the Secretary shall, in evaluating facilities operated under
any contract or compact under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.), use the same
criteria that the Secretary uses in evaluating facilities
operated directly by the Service.
(j) Equitable Integration of Facilities.--The Secretary shall
ensure that the planning, design, construction, renovation, and
expansion needs of Service and non-Service facilities which are
the subject of a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.) for health services are fully and equitably integrated
into the implementation of the health care delivery
demonstration projects under this section.
SEC. 307. LAND TRANSFER.
Notwithstanding any other provision of law, the Bureau of
Indian Affairs and all other agencies and departments of the
United States are authorized to transfer, at no cost, land and
improvements to the Service for the provision of health care
services. The Secretary is authorized to accept such land and
improvements for such purposes.
SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS.
The Secretary, acting through the Service, may enter into
leases, contracts, and other agreements with Indian Tribes and
Tribal Organizations which hold (1) title to, (2) a leasehold
interest in, or (3) a beneficial interest in (when title is
held by the United States in trust for the benefit of an Indian
Tribe) facilities used or to be used for the administration and
delivery of health services by an Indian Health Program. Such
leases, contracts, or agreements may include provisions for
construction or renovation and provide for compensation to the
Indian Tribe or Tribal Organization of rental and other costs
consistent with section 105(l) of the Indian Self-Determination
and Education Assistance Act (25 U.S.C. 450j(l)) and
regulations thereunder.
SEC. 309. STUDY ON LOANS, LOAN GUARANTEES, AND LOAN REPAYMENT.
(a) In General.--The Secretary, in consultation with the
Secretary of the Treasury, Indian Tribes, and Tribal
Organizations, shall carry out a study to determine the
feasibility of establishing a loan fund to provide to Indian
Tribes and Tribal Organizations direct loans or guarantees for
loans for the construction of health care facilities,
including--
(1) inpatient facilities;
(2) outpatient facilities;
(3) staff quarters;
(4) hostels; and
(5) specialized care facilities, such as behavioral
health and elder care facilities.
(b) Determinations.--In carrying out the study under
subsection (a), the Secretary shall determine--
(1) the maximum principal amount of a loan or loan
guarantee that should be offered to a recipient from
the loan fund;
(2) the percentage of eligible costs, not to exceed
100 percent, that may be covered by a loan or loan
guarantee from the loan fund (including costs relating
to planning, design, financing, site land development,
construction, rehabilitation, renovation, conversion,
improvements, medical equipment and furnishings, and
other facility-related costs and capital purchase (but
excluding staffing));
(3) the cumulative total of the principal of direct
loans and loan guarantees, respectively, that may be
outstanding at any 1 time;
(4) the maximum term of a loan or loan guarantee that
may be made for a facility from the loan fund;
(5) the maximum percentage of funds from the loan
fund that should be allocated for payment of costs
associated with planning and applying for a loan or
loan guarantee;
(6) whether acceptance by the Secretary of an
assignment of the revenue of an Indian Tribe or Tribal
Organization as security for any direct loan or loan
guarantee from the loan fund would be appropriate;
(7) whether, in the planning and design of health
facilities under this section, users eligible under
section 807(c) may be included in any projection of
patient population;
(8) whether funds of the Service provided through
loans or loan guarantees from the loan fund should be
eligible for use in matching other Federal funds under
other programs;
(9) the appropriateness of, and best methods for,
coordinating the loan fund with the health care
priority system of the Service under section 301; and
(10) any legislative or regulatory changes required
to implement recommendations of the Secretary based on
results of the study.
(c) Report.--Not later than September 30, 2009, the Secretary
shall submit to the Committee on Indian Affairs of the Senate
and the Committee on Natural Resources and the Committee on
Energy and Commerce of the House of Representatives a report
that describes--
(1) the manner of consultation made as required by
subsection (a); and
(2) the results of the study, including any
recommendations of the Secretary based on results of
the study.
SEC. 310. TRIBAL LEASING.
A Tribal Health Program may lease permanent structures for
the purpose of providing health care services without obtaining
advance approval in appropriation Acts.
SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT VENTURE
PROGRAM.
(a) In General.--The Secretary, acting through the Service,
shall make arrangements with Indian Tribes and Tribal
Organizations to establish joint venture demonstration projects
under which an Indian Tribe or Tribal Organization shall expend
tribal, private, or other available funds, for the acquisition
or construction of a health facility for a minimum of 10 years,
under a no-cost lease, in exchange for agreement by the Service
to provide the equipment, supplies, and staffing for the
operation and maintenance of such a health facility. An Indian
Tribe or Tribal Organization may use tribal funds, private
sector, or other available resources, including loan
guarantees, to fulfill its commitment under a joint venture
entered into under this subsection. An Indian Tribe or Tribal
Organization shall be eligible to establish a joint venture
project if, when it submits a letter of intent, it--
(1) has begun but not completed the process of
acquisition or construction of a health facility to be
used in the joint venture project; or
(2) has not begun the process of acquisition or
construction of a health facility for use in the joint
venture project.
(b) Requirements.--The Secretary shall make such an
arrangement with an Indian Tribe or Tribal Organization only
if--
(1) the Secretary first determines that the Indian
Tribe or Tribal Organization has the administrative and
financial capabilities necessary to complete the timely
acquisition or construction of the relevant health
facility; and
(2) the Indian Tribe or Tribal Organization meets the
need criteria determined using the criteria developed
under the health care facility priority system under
section 301, unless the Secretary determines, pursuant
to regulations, that other criteria will result in a
more cost-effective and efficient method of
facilitating and completing construction of health care
facilities.
(c) Continued Operation.--The Secretary shall negotiate an
agreement with the Indian Tribe or Tribal Organization
regarding the continued operation of the facility at the end of
the initial 10 year no-cost lease period.
(d) Breach of Agreement.--An Indian Tribe or Tribal
Organization that has entered into a written agreement with the
Secretary under this section, 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 Indian Tribe or
Tribal Organization, or paid to a third party on the Indian
Tribe's or Tribal Organization's behalf, under the agreement.
The Secretary has the right to recover tangible property
(including supplies) and equipment, less depreciation, 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, personnel,
or staffing.
(e) Recovery for Nonuse.--An Indian Tribe or Tribal
Organization that has entered into a written agreement with the
Secretary under this subsection shall be entitled to recover
from the United States an amount that is proportional to the
value of such facility if, at any time within the 10-year term
of the agreement, the Service ceases to use the facility or
otherwise breaches the agreement.
(f) Definition.--For the purposes of this section, the term
``health facility'' or ``health facilities'' includes quarters
needed to provide housing for staff of the relevant Tribal
Health Program.
SEC. 312. LOCATION OF FACILITIES.
(a) In General.--In all matters involving the reorganization
or development of Service facilities or in the establishment of
related employment projects to address unemployment conditions
in economically depressed areas, the Bureau of Indian Affairs
and the Service shall give priority to locating such facilities
and projects on Indian lands, or lands in Alaska owned by any
Alaska Native village, or village or regional corporation under
the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et
seq.), or any land allotted to any Alaska Native, if requested
by the Indian owner and the Indian Tribe with jurisdiction over
such lands or other lands owned or leased by the Indian Tribe
or Tribal Organization. Top priority shall be given to Indian
land owned by 1 or more Indian Tribes.
(b) Definition.--For purposes of this section, the term
``Indian lands'' means--
(1) all lands within the exterior boundaries of any
reservation; and
(2) any lands title to 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.
SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE FACILITIES.
(a) Report.--The Secretary shall submit to the President, for
inclusion in the report required to be transmitted to Congress
under section 801, a report which identifies the backlog of
maintenance and repair work required at both Service and tribal
health care facilities, including new health care facilities
expected to be in operation in the next fiscal year. The report
shall also identify the need for renovation and expansion of
existing facilities to support the growth of health care
programs.
(b) Maintenance of Newly Constructed Space.--The Secretary,
acting through the Service, is authorized to expend maintenance
and improvement funds to support maintenance of newly
constructed space only if such space falls within the approved
supportable space allocation for the Indian Tribe or Tribal
Organization. Supportable space allocation shall be defined
through the health care facility priority system under section
301(c).
(c) Replacement Facilities.--In addition to using maintenance
and improvement funds for renovation, modernization, and
expansion of facilities, an Indian Tribe or Tribal Organization
may use maintenance and improvement funds for construction of a
replacement facility if the costs of renovation of such
facility would exceed a maximum renovation cost threshold. The
maximum renovation cost threshold shall be determined through
the negotiated rulemaking process provided for under section
802.
SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY-OWNED QUARTERS.
(a) Rental Rates.--
(1) Establishment.--Notwithstanding any other
provision of law, a Tribal Health Program which
operates a hospital or other health facility and the
federally-owned quarters associated therewith pursuant
to a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C.
450 et seq.) shall have the authority to establish the
rental rates charged to the occupants of such quarters
by providing notice to the Secretary of its election to
exercise such authority.
(2) Objectives.--In establishing rental rates
pursuant to authority of this subsection, a Tribal
Health Program shall endeavor to achieve the following
objectives:
(A) To base such rental rates on the
reasonable value of the quarters to the
occupants thereof.
(B) To generate sufficient funds to prudently
provide for the operation and maintenance of
the quarters, and subject to the discretion of
the Tribal Health Program, to supply reserve
funds for capital repairs and replacement of
the quarters.
(3) Equitable funding.--Any quarters whose rental
rates are established by a Tribal Health Program
pursuant to this subsection shall remain eligible for
quarters improvement and repair funds to the same
extent as all federally-owned quarters used to house
personnel in Services-supported programs.
(4) Notice of rate change.--A Tribal Health Program
which exercises the authority provided under this
subsection shall provide occupants with no less than 60
days notice of any change in rental rates.
(b) Direct Collection of Rent.--
(1) In general.--Notwithstanding any other provision
of law, and subject to paragraph (2), a Tribal Health
Program shall have the authority to collect rents
directly from Federal employees who occupy such
quarters in accordance with the following:
(A) The Tribal Health Program shall notify
the Secretary and the subject Federal employees
of its election to exercise its authority to
collect rents directly from such Federal
employees.
(B) Upon receipt of a notice described in
subparagraph (A), the Federal employees shall
pay rents for occupancy of such quarters
directly to the Tribal Health Program and the
Secretary shall have no further authority to
collect rents from such employees through
payroll deduction or otherwise.
(C) Such rent payments shall be retained by
the Tribal Health Program and shall not be made
payable to or otherwise be deposited with the
United States.
(D) Such rent payments shall be deposited
into a separate account which shall be used by
the Tribal Health Program for the maintenance
(including capital repairs and replacement) and
operation of the quarters and facilities as the
Tribal Health Program shall determine.
(2) Retrocession of authority.--If a Tribal Health
Program which has made an election under paragraph (1)
requests retrocession of its authority to directly
collect rents from Federal employees occupying
federally-owned quarters, such retrocession shall
become effective on the earlier of--
(A) the first day of the month that begins no
less than 180 days after the Tribal Health
Program notifies the Secretary of its desire to
retrocede; or
(B) such other date as may be mutually agreed
by the Secretary and the Tribal Health Program.
(c) Rates in Alaska.--To the extent that a Tribal Health
Program, pursuant to authority granted in subsection (a),
establishes rental rates for federally-owned quarters provided
to a Federal employee in Alaska, such rents may be based on the
cost of comparable private rental housing in the nearest
established community with a year-round population of 1,500 or
more individuals.
SEC. 315. APPLICABILITY OF BUY AMERICAN ACT REQUIREMENT.
(a) Applicability.--The Secretary shall ensure that the
requirements of the Buy American Act apply to all procurements
made with funds provided pursuant to section 317. Indian Tribes
and Tribal Organizations shall be exempt from these
requirements.
(b) Effect of Violation.--If it has been finally determined
by a court or Federal 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 section
317, pursuant to the debarment, suspension, and ineligibility
procedures described in sections 9.400 through 9.409 of title
48, Code of Federal Regulations.
(c) Definitions.--For purposes of this section, the term
``Buy American Act'' means title III of the Act entitled ``An
Act making appropriations 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.).
SEC. 316. OTHER FUNDING FOR FACILITIES.
(a) Authority To Accept Funds.--The Secretary is authorized
to accept from any source, including Federal and State
agencies, funds that are available for the construction of
health care facilities and use such funds to plan, design, and
construct health care facilities for Indians and to place such
funds into a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et
seq.). Receipt of such funds shall have no effect on the
priorities established pursuant to section 301.
(b) Interagency Agreements.--The Secretary is authorized to
enter into interagency agreements with other Federal agencies
or State agencies and other entities and to accept funds from
such Federal or State agencies or other sources to provide for
the planning, design, and construction of health care
facilities to be administered by Indian Health Programs in
order to carry out the purposes of this Act and the purposes
for which the funds were appropriated or for which the funds
were otherwise provided.
(c) Establishment of Standards.--The Secretary, through the
Service, shall establish standards by regulation for the
planning, design, and construction of health care facilities
serving Indians under this Act.
SEC. 317. AUTHORIZATION OF APPROPRIATIONS.
There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2017 to
carry out this title.
TITLE IV--ACCESS TO HEALTH SERVICES
SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT HEALTH
BENEFITS PROGRAMS.
(a) Disregard of Medicare, Medicaid, and SCHIP Payments in
Determining Appropriations.--Any payments received by an Indian
Health Program or by an Urban Indian Organization under title
XVIII, XIX, or XXI of the Social Security Act for services
provided to Indians eligible for benefits under such respective
titles shall not be considered in determining appropriations
for the provision of health care and services to Indians.
(b) Nonpreferential Treatment.--Nothing in this Act
authorizes the Secretary to provide services to an Indian with
coverage under title XVIII, XIX, or XXI of the Social Security
Act in preference to an Indian without such coverage.
(c) Use of Funds.--
(1) Special fund.--
(A) 100 percent pass-through of payments due
to facilities.--Notwithstanding any other
provision of law, but subject to paragraph (2),
payments to which a facility of the Service is
entitled by reason of a provision of the Social
Security Act shall be placed in a special fund
to be held by the Secretary. In making payments
from such fund, the Secretary shall ensure that
each Service Unit of the Service receives 100
percent of the amount to which the facilities
of the Service, for which such Service Unit
makes collections, are entitled by reason of a
provision of the Social Security Act.
(B) Use of funds.--Amounts received by a
facility of the Service under subparagraph (A)
shall first be used (to such extent or in such
amounts as are provided in appropriation Acts)
for the purpose of making any improvements in
the programs of the Service operated by or
through such facility which may be necessary to
achieve or maintain compliance with the
applicable conditions and requirements of
titles XVIII and XIX of the Social Security
Act. Any amounts so received that are in excess
of the amount necessary to achieve or maintain
such conditions and requirements shall, subject
to consultation with the Indian Tribes being
served by the Service Unit, be used for
reducing the health resource deficiencies (as
determined under section 201(d)) of such Indian
Tribes.
(2) Direct payment option.--Paragraph (1) shall not
apply to a Tribal Health Program upon the election of
such Program under subsection (d) to receive payments
directly. No payment may be made out of the special
fund described in such paragraph with respect to
reimbursement made for services provided by such
Program during the period of such election.
(d) Direct Billing.--
(1) In general.--Subject to complying with the
requirements of paragraph (2), a Tribal Health Program
may elect to directly bill for, and receive payment
for, health care items and services provided by such
Program for which payment is made under title XVIII or
XIX of the Social Security Act or from any other third
party payor.
(2) Direct reimbursement.--
(A) Use of funds.--Each Tribal Health Program
making the election described in paragraph (1)
with respect to a program under a title of the
Social Security Act shall be reimbursed
directly by that program for items and services
furnished without regard to subsection (c)(1),
but all amounts so reimbursed shall be used by
the Tribal Health Program for the purpose of
making any improvements in facilities of the
Tribal Health Program that may be necessary to
achieve or maintain compliance with the
conditions and requirements applicable
generally to such items and services under the
program under such title and to provide
additional health care services, improvements
in health care facilities and Tribal Health
Programs, any health care related purpose, or
otherwise to achieve the objectives provided in
section 3 of this Act.
(B) Audits.--The amounts paid to a Tribal
Health Program making the election described in
paragraph (1) with respect to a program under a
title of the Social Security Act shall be
subject to all auditing requirements applicable
to the program under such title, as well as all
auditing requirements applicable to programs
administered by an Indian Health Program.
Nothing in the preceding sentence shall be
construed as limiting the application of
auditing requirements applicable to amounts
paid under title XVIII, XIX, or XXI of the
Social Security Act.
(C) Identification of source of payments.--
Any Tribal Health Program that receives
reimbursements or payments under title XVIII,
XIX, or XXI of the Social Security Act, shall
provide to the Service a list of each provider
enrollment number (or other identifier) under
which such Program receives such reimbursements
or payments.
(3) Examination and implementation of changes.--
(A) In general.--The Secretary, acting
through the Service and with the assistance of
the Administrator of the Centers for Medicare &
Medicaid Services, shall examine on an ongoing
basis and implement any administrative changes
that may be necessary to facilitate direct
billing and reimbursement under the program
established under this subsection, including
any agreements with States that may be
necessary to provide for direct billing under a
program under a title of the Social Security
Act.
(B) Coordination of information.--The Service
shall provide the Administrator of the Centers
for Medicare & Medicaid Services with copies of
the lists submitted to the Service under
paragraph (2)(C), enrollment data regarding
patients served by the Service (and by Tribal
Health Programs, to the extent such data is
available to the Service), and such other
information as the Administrator may require
for purposes of administering title XVIII, XIX,
or XXI of the Social Security Act.
(4) Withdrawal from program.--A Tribal Health Program
that bills directly under the program established under
this subsection may withdraw from participation in the
same manner and under the same conditions that an
Indian Tribe or Tribal Organization may retrocede a
contracted program to the Secretary under the authority
of the Indian Self-Determination and Education
Assistance Act (25 U.S.C. 450 et seq.). All cost
accounting and billing authority under the program
established under this subsection shall be returned to
the Secretary upon the Secretary's acceptance of the
withdrawal of participation in this program.
(5) Termination for failure to comply with
requirements.--The Secretary may terminate the
participation of a Tribal Health Program or in the
direct billing program established under this
subsection if the Secretary determines that the Program
has failed to comply with the requirements of paragraph
(2). The Secretary shall provide a Tribal Health
Program with notice of a determination that the Program
has failed to comply with any such requirement and a
reasonable opportunity to correct such noncompliance
prior to terminating the Program's participation in the
direct billing program established under this
subsection.
(e) Related Provisions Under the Social Security Act.--For
provisions related to subsections (c) and (d), see sections
1880, 1911, and 2107(e)(1)(D) of the Social Security Act.
SEC. 402. GRANTS TO AND CONTRACTS WITH THE SERVICE, INDIAN TRIBES,
TRIBAL ORGANIZATIONS, AND URBAN INDIAN
ORGANIZATIONS TO FACILITATE OUTREACH, ENROLLMENT,
AND COVERAGE OF INDIANS UNDER SOCIAL SECURITY ACT
HEALTH BENEFIT PROGRAMS AND OTHER HEALTH BENEFITS
PROGRAMS.
(a) Indian Tribes and Tribal Organizations.--From funds
appropriated to carry out this title in accordance with section
416, the Secretary, acting through the Service, shall make
grants to or enter into contracts with Indian Tribes and Tribal
Organizations to assist such Tribes and Tribal Organizations in
establishing and administering programs on or near reservations
and trust lands to assist individual Indians--
(1) to enroll for benefits under a program
established under title XVIII, XIX, or XXI of the
Social Security Act and other health benefits programs;
and
(2) with respect to such programs for which the
charging of premiums and cost sharing is not prohibited
under such programs, to pay premiums or cost sharing
for coverage for such benefits, which may be based on
financial need (as determined by the Indian Tribe or
Tribes or Tribal Organizations being served based on a
schedule of income levels developed or implemented by
such Tribe, Tribes, or Tribal Organizations).
(b) Conditions.--The Secretary, acting through the Service,
shall place conditions as deemed necessary to effect the
purpose of this section in any grant or contract which the
Secretary makes with any Indian Tribe or Tribal Organization
pursuant to this section. Such conditions shall include
requirements that the Indian Tribe or Tribal Organization
successfully undertake--
(1) to determine the population of Indians eligible
for the benefits described in subsection (a);
(2) to educate Indians with respect to the benefits
available under the respective programs;
(3) to provide transportation for such individual
Indians to the appropriate offices for enrollment or
applications for such benefits; and
(4) to develop and implement methods of improving the
participation of Indians in receiving benefits under
such programs.
(c) Application to Urban Indian Organizations.--
(1) In general.--The provisions of subsection (a)
shall apply with respect to grants and other funding to
Urban Indian Organizations with respect to populations
served by such organizations in the same manner they
apply to grants and contracts with Indian Tribes and
Tribal Organizations with respect to programs on or
near reservations.
(2) Requirements.--The Secretary shall include in the
grants or contracts made or provided under paragraph
(1) requirements that are--
(A) consistent with the requirements imposed
by the Secretary under subsection (b);
(B) appropriate to Urban Indian Organizations
and Urban Indians; and
(C) necessary to effect the purposes of this
section.
(d) Facilitating Cooperation.--The Secretary, acting through
the Centers for Medicare & Medicaid Services, shall take such
steps as are necessary to facilitate cooperation with, and
agreements between, States and the Service, Indian Tribes,
Tribal Organizations, or Urban Indian Organizations with
respect to the provision of health care items and services to
Indians under the programs established under title XVIII, XIX,
or XXI of the Social Security Act.
(e) Agreements Relating To Improving Enrollment of Indians
Under Social Security Act Health Benefits Programs.--For
provisions relating to agreements between the Secretary, acting
through the Service, and Indian Tribes, Tribal Organizations,
and Urban Indian Organizations for the collection, preparation,
and submission of applications by Indians for assistance under
the Medicaid and State children's health insurance programs
established under titles XIX and XXI of the Social Security
Act, and benefits under the Medicare program established under
title XVIII of such Act, see subsections (a) and (b) of section
1139 of the Social Security Act.
(f) Definition of Premiums and Cost Sharing.--In this
section:
(1) Premium.--The term ``premium'' includes any
enrollment fee or similar charge.
(2) Cost sharing.--The term ``cost sharing'' includes
any deduction, deductible, copayment, coinsurance, or
similar charge.
SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF HEALTH
SERVICES.
(a) Right of Recovery.--Except as provided in subsection (f),
the United States, an Indian Tribe, or Tribal Organization
shall have the right to recover from an insurance company,
health maintenance organization, employee benefit plan, third-
party tortfeasor, or any other responsible or liable third
party (including a political subdivision or local governmental
entity of a State) the reasonable charges billed by the
Secretary, an Indian Tribe, or Tribal Organization in providing
health services through the Service, an Indian Tribe, or Tribal
Organization to any individual to the same extent that such
individual, or any nongovernmental provider of such services,
would be eligible to receive damages, reimbursement, or
indemnification for such charges or expenses if--
(1) such services had been provided by a
nongovernmental provider; and
(2) such individual had been required to pay such
charges or expenses and did pay such charges or
expenses.
(b) Limitations on Recoveries From States.--Subsection (a)
shall provide a right of recovery against any State, only if
the injury, illness, or disability for which health services
were provided is covered under--
(1) workers' compensation laws; or
(2) a no-fault automobile accident insurance plan or
program.
(c) Nonapplication of Other Laws.--No law of any State, or of
any political subdivision of a State and no provision of any
contract, insurance or health maintenance organization policy,
employee benefit plan, self-insurance plan, managed care plan,
or other health care plan or program entered into or renewed
after the date of the enactment of the Indian Health Care
Amendments of 1988, shall prevent or hinder the right of
recovery of the United States, an Indian Tribe, or Tribal
Organization under subsection (a).
(d) No Effect on Private Rights of Action.--No action taken
by the United States, an Indian Tribe, or Tribal Organization
to enforce the right of recovery provided under this section
shall operate to deny to the injured person the recovery for
that portion of the person's damage not covered hereunder.
(e) Enforcement.--
(1) In general.--The United States, an Indian Tribe,
or Tribal Organization may enforce the right of
recovery provided under subsection (a) by--
(A) intervening or joining in any civil
action or proceeding brought--
(i) by the individual for whom health
services were provided by the
Secretary, an Indian Tribe, or Tribal
Organization; or
(ii) by any representative or heirs
of such individual, or
(B) instituting a civil action, including a
civil action for injunctive relief and other
relief and including, with respect to a
political subdivision or local governmental
entity of a State, such an action against an
official thereof.
(2) Notice.--All reasonable efforts shall be made to
provide notice of action instituted under paragraph
(1)(B) to the individual to whom health services were
provided, either before or during the pendency of such
action.
(3) Recovery from tortfeasors.--
(A) In general.--In any case in which an
Indian Tribe or Tribal Organization that is
authorized or required under a compact or
contract issued pursuant to the Indian Self-
Determination and Education Assistance Act (25
U.S.C. 450 et seq.) to furnish or pay for
health services to a person who is injured or
suffers a disease on or after the date of
enactment of the Indian Health Care Improvement
Act Amendments of 2007 under circumstances that
establish grounds for a claim of liability
against the tortfeasor with respect to the
injury or disease, the Indian Tribe or Tribal
Organization shall have a right to recover from
the tortfeasor (or an insurer of the
tortfeasor) the reasonable value of the health
services so furnished, paid for, or to be paid
for, in accordance with the Federal Medical
Care Recovery Act (42 U.S.C. 2651 et seq.), to
the same extent and under the same
circumstances as the United States may recover
under that Act.
(B) Treatment.--The right of an Indian Tribe
or Tribal Organization to recover under
subparagraph (A) shall be independent of the
rights of the injured or diseased person served
by the Indian Tribe or Tribal Organization.
(f) Limitation.--Absent specific written authorization by the
governing body of an Indian Tribe for the period of such
authorization (which may not be for a period of more than 1
year and which may be revoked at any time upon written notice
by the governing body to the Service), 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, Tribal Organization, or Urban Indian Organization. Where
such authorization is provided, the Service may receive and
expend such amounts for the provision of additional health
services consistent with such authorization.
(g) Costs and Attorneys' Fees.--In any action brought to
enforce the provisions of this section, a prevailing plaintiff
shall be awarded its reasonable attorneys' fees and costs of
litigation.
(h) Nonapplication of Claims Filing Requirements.--An
insurance company, health maintenance organization, self-
insurance plan, managed care plan, or other health care plan or
program (under the Social Security Act or otherwise) may not
deny a claim for benefits submitted by the Service or by an
Indian Tribe or Tribal Organization based on the format in
which the claim is submitted if such format complies with the
format required for submission of claims under title XVIII of
the Social Security Act or recognized under section 1175 of
such Act.
(i) Application to Urban Indian Organizations.--The previous
provisions of this section shall apply to Urban Indian
Organizations with respect to populations served by such
Organizations in the same manner they apply to Indian Tribes
and Tribal Organizations with respect to populations served by
such Indian Tribes and Tribal Organizations.
(j) Statute of Limitations.--The provisions of section 2415
of title 28, United States Code, shall apply to all actions
commenced under this section, and the references therein to the
United States are deemed to include Indian Tribes, Tribal
Organizations, and Urban Indian Organizations.
(k) Savings.--Nothing in this section shall be construed to
limit any right of recovery available to the United States, an
Indian Tribe, or Tribal Organization under the provisions of
any applicable, Federal, State, or Tribal law, including
medical lien laws.
SEC. 404. CREDITING OF REIMBURSEMENTS.
(a) Use of Amounts.--
(1) Retention by program.--Except as provided in
section 202(f) (relating to the Catastrophic Health
Emergency Fund) and section 807 (relating to health
services for ineligible persons), all reimbursements
received or recovered under any of the programs
described in paragraph (2), including under section
807, by reason of the provision of health services by
the Service, by an Indian Tribe or Tribal Organization,
or by an Urban Indian Organization, shall be credited
to the Service, such Indian Tribe or Tribal
Organization, or such Urban Indian Organization,
respectively, and may be used as provided in section
401. In the case of such a service provided by or
through a Service Unit, such amounts shall be credited
to such unit and used for such purposes.
(2) Programs covered.--The programs referred to in
paragraph (1) are the following:
(A) Titles XVIII, XIX, and XXI of the Social
Security Act.
(B) This Act, including section 807.
(C) Public Law 87-693.
(D) Any other provision of law.
(b) No Offset of Amounts.--The Service may not offset or
limit any amount obligated to any Service Unit or entity
receiving funding from the Service because of the receipt of
reimbursements under subsection (a).
SEC. 405. PURCHASING HEALTH CARE COVERAGE.
(a) In General.--Insofar as amounts are made available under
law (including a provision of the Social Security Act, the
Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.), or other law, other than under section
402) to Indian Tribes, Tribal Organizations, and Urban Indian
Organizations for health benefits for Service beneficiaries,
Indian Tribes, Tribal Organizations, and Urban Indian
Organizations may use such amounts to purchase health benefits
coverage for such beneficiaries in any manner, including
through--
(1) a tribally owned and operated health care plan;
(2) a State or locally authorized or licensed health
care plan;
(3) a health insurance provider or managed care
organization; or
(4) a self-insured plan.
The purchase of such coverage by an Indian Tribe, Tribal
Organization, or Urban Indian Organization may be based on the
financial needs of such beneficiaries (as determined by the
Indian Tribe or Tribes being served based on a schedule of
income levels developed or implemented by such Indian Tribe or
Tribes).
(b) Expenses for Self-Insured Plan.--In the case of a self-
insured plan under subsection (a)(4), the amounts may be used
for expenses of operating the plan, including administration
and insurance to limit the financial risks to the entity
offering the plan.
(c) Construction.--Nothing in this section shall be construed
as affecting the use of any amounts not referred to in
subsection (a).
SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.
(a) Authority.--
(1) In general.--The Secretary may enter into (or
expand) arrangements for the sharing of medical
facilities and services between the Service, Indian
Tribes, and Tribal Organizations and the Department of
Veterans Affairs and the Department of Defense.
(2) Consultation by secretary required.--The
Secretary may not finalize any arrangement between the
Service and a Department described in paragraph (1)
without first consulting with the Indian Tribes which
will be significantly affected by the arrangement.
(b) Limitations.--The Secretary shall not take any action
under this section or under subchapter IV of chapter 81 of
title 38, United States Code, which would impair--
(1) the priority access of any Indian to health care
services provided through the Service and the
eligibility of any Indian to receive health services
through the Service;
(2) the quality of health care services provided to
any Indian through the Service;
(3) the priority access of any veteran to health care
services provided by the Department of Veterans
Affairs;
(4) the quality of health care services provided by
the Department of Veterans Affairs or the Department of
Defense; or
(5) the eligibility of any Indian who is a veteran to
receive health services through the Department of
Veterans Affairs.
(c) Reimbursement.--The Service, Indian Tribe, or Tribal
Organization shall be reimbursed by the Department of Veterans
Affairs or the Department of Defense (as the case may be) where
services are provided through the Service, an Indian Tribe, or
a Tribal Organization to beneficiaries eligible for services
from either such Department, notwithstanding any other
provision of law.
(d) Construction.--Nothing in this section may be construed
as creating any right of a non-Indian veteran to obtain health
services from the Service.
SEC. 407. PAYOR OF LAST RESORT.
Indian Health Programs and health care programs operated by
Urban Indian Organizations shall be the payor of last resort
for services provided to persons eligible for services from
Indian Health Programs and Urban Indian Organizations,
notwithstanding any Federal, State, or local law to the
contrary.
SEC. 408. NONDISCRIMINATION UNDER FEDERAL HEALTH CARE PROGRAMS IN
QUALIFICATIONS FOR REIMBURSEMENT FOR SERVICES.
(a) Requirement To Satisfy Generally Applicable Participation
Requirements.--
(1) In general.--A Federal health care program must
accept an entity that is operated by the Service, an
Indian Tribe, Tribal Organization, or Urban Indian
Organization as a provider eligible to receive payment
under the program for health care services furnished to
an Indian on the same basis as any other provider
qualified to participate as a provider of health care
services under the program if the entity meets
generally applicable State or other requirements for
participation as a provider of health care services
under the program.
(2) Satisfaction of state or local licensure or
recognition requirements.--Any requirement for
participation as a provider of health care services
under a Federal health care program that an entity be
licensed or recognized under the State or local law
where the entity is located to furnish health care
services shall be deemed to have been met in the case
of an entity operated by the Service, an Indian Tribe,
Tribal Organization, or Urban Indian Organization if
the entity meets all the applicable standards for such
licensure or recognition, regardless of whether the
entity obtains a license or other documentation under
such State or local law. In accordance with section
221, the absence of the licensure of a health care
professional employed by such an entity under the State
or local law where the entity is located shall not be
taken into account for purposes of determining whether
the entity meets such standards, if the professional is
licensed in another State.
(b) Application of Exclusion From Participation in Federal
Health Care Programs.--
(1) Excluded entities.--No entity operated by the
Service, an Indian Tribe, Tribal Organization, or Urban
Indian Organization that has been excluded from
participation in any Federal health care program or for
which a license is under suspension or has been revoked
by the State where the entity is located shall be
eligible to receive payment or reimbursement under any
such program for health care services furnished to an
Indian.
(2) Excluded individuals.--No individual who has been
excluded from participation in any Federal health care
program or whose State license is under suspension
shall be eligible to receive payment or reimbursement
under any such program for health care services
furnished by that individual, directly or through an
entity that is otherwise eligible to receive payment
for health care services, to an Indian.
(3) Federal health care program defined.--In this
subsection, the term, ``Federal health care program''
has the meaning given that term in section 1128B(f) of
the Social Security Act (42 U.S.C. 1320a-7b(f)), except
that, for purposes of this subsection, such term shall
include the health insurance program under chapter 89
of title 5, United States Code.
(c) Related Provisions.--For provisions related to
nondiscrimination against providers operated by the Service, an
Indian Tribe, Tribal Organization, or Urban Indian
Organization, see section 1139(c) of the Social Security Act
(42 U.S.C. 1320b-9(c)).
SEC. 409. CONSULTATION.
For provisions related to consultation with representatives
of Indian Health Programs and Urban Indian Organizations with
respect to the health care programs established under titles
XVIII, XIX, and XXI of the Social Security Act, see section
1139(d) of the Social Security Act (42 U.S.C. 1320b-9(d)).
SEC. 410. STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP).
For provisions relating to--
(1) outreach to families of Indian children likely to
be eligible for child health assistance under the State
children's health insurance program established under
title XXI of the Social Security Act, see sections
2105(c)(2)(C) and 1139(a) of such Act (42 U.S.C.
1397ee(c)(2), 1320b-9); and
(2) ensuring that child health assistance is provided
under such program to targeted low-income children who
are Indians and that payments are made under such
program to Indian Health Programs and Urban Indian
Organizations operating in the State that provide such
assistance, see sections 2102(b)(3)(D) and
2105(c)(6)(B) of such Act (42 U.S.C. 1397bb(b)(3)(D),
1397ee(c)(6)(B)).
SEC. 411. EXCLUSION WAIVER AUTHORITY FOR AFFECTED INDIAN HEALTH
PROGRAMS AND SAFE HARBOR TRANSACTIONS UNDER THE
SOCIAL SECURITY ACT.
For provisions relating to--
(1) exclusion waiver authority for affected Indian
Health Programs under the Social Security Act, see
section 1128(k) of the Social Security Act (42 U.S.C.
1320a-7(k)); and
(2) certain transactions involving Indian Health
Programs deemed to be in safe harbors under that Act,
see section 1128B(b)(4) of the Social Security Act (42
U.S.C. 1320a-7b(b)(4)).
SEC. 412. PREMIUM AND COST SHARING PROTECTIONS AND ELIGIBILITY
DETERMINATIONS UNDER MEDICAID AND SCHIP AND
PROTECTION OF CERTAIN INDIAN PROPERTY FROM MEDICAID
ESTATE RECOVERY.
For provisions relating to--
(1) premiums or cost sharing protections for Indians
furnished items or services directly by Indian Health
Programs or through referral under the contract health
service under the Medicaid program established under
title XIX of the Social Security Act, see sections
1916(j) and 1916A(a)(1) of the Social Security Act (42
U.S.C. 1396o(j), 1396o-1(a)(1));
(2) rules regarding the treatment of certain property
for purposes of determining eligibility under such
programs, see sections 1902(e)(13) and 2107(e)(1)(B) of
such Act (42 U.S.C. 1396a(e)(13), 1397gg(e)(1)(B)); and
(3) the protection of certain property from estate
recovery provisions under the Medicaid program, see
section 1917(b)(3)(B) of such Act (42 U.S.C.
1396p(b)(3)(B)).
SEC. 413. TREATMENT UNDER MEDICAID AND SCHIP MANAGED CARE.
For provisions relating to the treatment of Indians enrolled
in a managed care entity under the Medicaid program under title
XIX of the Social Security Act and Indian Health Programs and
Urban Indian Organizations that are providers of items or
services to such Indian enrollees, see sections 1932(h) and
2107(e)(1)(H) of the Social Security Act (42 U.S.C. 1396u-2(h),
1397gg(e)(1)(H)).
SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY.
(a) Study.--The Secretary shall conduct a study to determine
the feasibility of treating the Navajo Nation as a State for
the purposes of title XIX of the Social Security Act, to
provide services to Indians living within the boundaries of the
Navajo Nation through an entity established having the same
authority and performing the same functions as single-State
medicaid agencies responsible for the administration of the
State plan under title XIX of the Social Security Act.
(b) Considerations.--In conducting the study, the Secretary
shall consider the feasibility of--
(1) assigning and paying all expenditures for the
provision of services and related administration funds,
under title XIX of the Social Security Act, to Indians
living within the boundaries of the Navajo Nation that
are currently paid to or would otherwise be paid to the
State of Arizona, New Mexico, or Utah;
(2) providing assistance to the Navajo Nation in the
development and implementation of such entity for the
administration, eligibility, payment, and delivery of
medical assistance under title XIX of the Social
Security Act;
(3) providing an appropriate level of matching funds
for Federal medical assistance with respect to amounts
such entity expends for medical assistance for services
and related administrative costs; and
(4) authorizing the Secretary, at the option of the
Navajo Nation, to treat the Navajo Nation as a State
for the purposes of title XIX of the Social Security
Act (relating to the State children's health insurance
program) under terms equivalent to those described in
paragraphs (2) through (4).
(c) Report.--Not later then 3 years after the date of
enactment of the Indian Health Care Improvement Act Amendments
of 2007, the Secretary shall submit to the Committee on Indian
Affairs and Committee on Finance of the Senate and the
Committee on Natural Resources and Committee on Energy and
Commerce of the House of Representatives a report that
includes--
(1) the results of the study under this section;
(2) a summary of any consultation that occurred
between the Secretary and the Navajo Nation, other
Indian Tribes, the States of Arizona, New Mexico, and
Utah, counties which include Navajo Lands, and other
interested parties, in conducting this study;
(3) projected costs or savings associated with
establishment of such entity, and any estimated impact
on services provided as described in this section in
relation to probable costs or savings; and
(4) legislative actions that would be required to
authorize the establishment of such entity if such
entity is determined by the Secretary to be feasible.
SEC. 415. GENERAL EXCEPTIONS.
The requirements of this title shall not apply to any
excepted benefits described in paragraph (1)(A) or (3) of
section 2791(c) of the Public Health Service Act (42 U.S.C.
300gg-91).
SEC. 416. AUTHORIZATION OF APPROPRIATIONS.
There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2017 to
carry out this title.
TITLE V--HEALTH SERVICES FOR URBAN INDIANS
SEC. 501. PURPOSE.
The purpose of this title is to establish and maintain
programs in Urban Centers to make health services more
accessible and available to Urban Indians.
SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN ORGANIZATIONS.
Under authority of the Act of November 2, 1921 (25 U.S.C. 13)
(commonly known as the ``Snyder Act''), the Secretary, acting
through the Service, shall enter into contracts with, or make
grants to, Urban Indian Organizations to assist such
organizations in the establishment and administration, within
Urban Centers, of programs which meet the requirements set
forth in this title. Subject to section 506, the Secretary,
acting through the Service, shall include such conditions as
the Secretary considers necessary to effect the purpose of this
title in any contract into which the Secretary enters with, or
in any grant the Secretary makes to, any Urban Indian
Organization pursuant to this title.
SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH CARE AND
REFERRAL SERVICES.
(a) Requirements for Grants and Contracts.--Under authority
of the Act of November 2, 1921 (25 U.S.C. 13) (commonly known
as the ``Snyder Act''), the Secretary, acting through the
Service, shall enter into contracts with, and make grants to,
Urban Indian Organizations for the provision of health care and
referral services for Urban Indians. Any such contract or grant
shall include requirements that the Urban Indian Organization
successfully undertake to--
(1) estimate the population of Urban Indians residing
in the Urban Center or centers that the organization
proposes to serve who are or could be recipients of
health care or referral services;
(2) estimate the current health status of Urban
Indians residing in such Urban Center or centers;
(3) estimate the current health care needs of Urban
Indians residing in such Urban Center or centers;
(4) provide basic health education, including health
promotion and disease prevention education, to Urban
Indians;
(5) make recommendations to the Secretary and
Federal, State, local, and other resource agencies on
methods of improving health service programs to meet
the needs of Urban Indians; and
(6) where necessary, provide, or enter into contracts
for the provision of, health care services for Urban
Indians.
(b) Criteria.--The Secretary, acting through the Service,
shall, by regulation, prescribe the criteria for selecting
Urban Indian Organizations to enter into contracts or receive
grants under this section. Such criteria shall, among other
factors, include--
(1) the extent of unmet health care needs of Urban
Indians in the Urban Center or centers involved;
(2) the size of the Urban Indian population in the
Urban Center or centers involved;
(3) the extent, if any, to which the activities set
forth in subsection (a) would duplicate any project
funded under this title, or under any current public
health service project funded in a manner other than
pursuant to this title;
(4) the capability of an Urban Indian Organization to
perform the activities set forth in subsection (a) and
to enter into a contract with the Secretary or to meet
the requirements for receiving a grant under this
section;
(5) the satisfactory performance and successful
completion by an Urban Indian Organization of other
contracts with the Secretary under this title;
(6) the appropriateness and likely effectiveness of
conducting the activities set forth in subsection (a)
in an Urban Center or centers; and
(7) the extent of existing or likely future
participation in the activities set forth in subsection
(a) by appropriate health and health-related Federal,
State, local, and other agencies.
(c) Access to Health Promotion and Disease Prevention
Programs.--The Secretary, acting through the Service, shall
facilitate access to or provide health promotion and disease
prevention services for Urban Indians through grants made to
Urban Indian Organizations administering contracts entered into
or receiving grants under subsection (a).
(d) Immunization Services.--
(1) Access or services provided.--The Secretary,
acting through the Service, shall facilitate access to,
or provide, immunization services for Urban Indians
through grants made to Urban Indian Organizations
administering contracts entered into or receiving
grants under this section.
(2) Definition.--For purposes of this subsection, the
term ``immunization services'' means services to
provide without charge immunizations against vaccine-
preventable diseases.
(e) Behavioral Health Services.--
(1) Access or services provided.--The Secretary,
acting through the Service, shall facilitate access to,
or provide, behavioral health services for Urban
Indians through grants made to Urban Indian
Organizations administering contracts entered into or
receiving grants under subsection (a).
(2) Assessment required.--Except as provided by
paragraph (3)(A), a grant may not be made under this
subsection to an Urban Indian Organization until that
organization has prepared, and the Service has
approved, an assessment of the following:
(A) The behavioral health needs of the Urban
Indian population concerned.
(B) The behavioral health services and other
related resources available to that population.
(C) The barriers to obtaining those services
and resources.
(D) The needs that are unmet by such services
and resources.
(3) Purposes of grants.--Grants may be made under
this subsection for the following:
(A) To prepare assessments required under
paragraph (2).
(B) To provide outreach, educational, and
referral services to Urban Indians regarding
the availability of direct behavioral health
services, to educate Urban Indians about
behavioral health issues and services, and
effect coordination with existing behavioral
health providers in order to improve services
to Urban Indians.
(C) To provide outpatient behavioral health
services to Urban Indians, including the
identification and assessment of illness,
therapeutic treatments, case management,
support groups, family treatment, and other
treatment.
(D) To develop innovative behavioral health
service delivery models which incorporate
Indian cultural support systems and resources.
(f) Prevention of Child Abuse.--
(1) Access or services provided.--The Secretary,
acting through the Service, shall facilitate access to
or provide services for Urban Indians through grants to
Urban Indian Organizations administering contracts
entered into or receiving grants under subsection (a)
to prevent and treat child abuse (including sexual
abuse) among Urban Indians.
(2) Evaluation required.--Except as provided by
paragraph (3)(A), a grant may not be made under this
subsection to an Urban Indian Organization until that
organization has prepared, and the Service has
approved, an assessment that documents the prevalence
of child abuse in the Urban Indian population concerned
and specifies the services and programs (which may not
duplicate existing services and programs) for which the
grant is requested.
(3) Purposes of grants.--Grants may be made under
this subsection for the following:
(A) To prepare assessments required under
paragraph (2).
(B) For the development of prevention,
training, and education programs for Urban
Indians, including child education, parent
education, provider training on identification
and intervention, education on reporting
requirements, prevention campaigns, and
establishing service networks of all those
involved in Indian child protection.
(C) To provide direct outpatient treatment
services (including individual treatment,
family treatment, group therapy, and support
groups) to Urban Indians who are child victims
of abuse (including sexual abuse) or adult
survivors of child sexual abuse, to the
families of such child victims, and to Urban
Indian perpetrators of child abuse (including
sexual abuse).
(4) Considerations when making grants.--In making
grants to carry out this subsection, the Secretary
shall take into consideration--
(A) the support for the Urban Indian
Organization demonstrated by the child
protection authorities in the area, including
committees or other services funded under the
Indian Child Welfare Act of 1978 (25 U.S.C.
1901 et seq.), if any;
(B) the capability and expertise demonstrated
by the Urban Indian Organization to address the
complex problem of child sexual abuse in the
community; and
(C) the assessment required under paragraph
(2).
(g) Other Grants.--The Secretary, acting through the Service,
may enter into a contract with or make grants to an Urban
Indian Organization that provides or arranges for the provision
of health care services (through satellite facilities, provider
networks, or otherwise) to Urban Indians in more than 1 Urban
Center.
SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINATION OF UNMET HEALTH
CARE NEEDS.
(a) Grants and Contracts Authorized.--Under authority of the
Act of November 2, 1921 (25 U.S.C. 13) (commonly known as the
``Snyder Act''), the Secretary, acting 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.
(b) Purpose.--The purpose of a contract or grant made under
this section shall be the determination of the matters
described in subsection (c)(1) in order to assist the Secretary
in assessing the health status and health care needs of Urban
Indians in the Urban Center involved and determining whether
the Secretary should enter into a contract or make a grant
under section 503 with respect to the Urban Indian Organization
which the Secretary has entered into a contract with, or made a
grant to, under this section.
(c) Grant and Contract Requirements.--Any contract entered
into, or grant made, by the Secretary under this section shall
include requirements that--
(1) the Urban Indian Organization successfully
undertakes to--
(A) document the health care status and unmet
health care needs of Urban Indians in the Urban
Center involved; and
(B) with respect to Urban Indians in the
Urban Center involved, determine the matters
described in paragraphs (2), (3), (4), and (7)
of section 503(b); and
(2) the Urban Indian Organization complete
performance of the contract, or carry out the
requirements of the grant, within 1 year after the date
on which the Secretary and such organization enter into
such contract, or within 1 year after such organization
receives such grant, whichever is applicable.
(d) No Renewals.--The Secretary may not renew any contract
entered into or grant made under this section.
SEC. 505. EVALUATIONS; RENEWALS.
(a) Procedures for Evaluations.--The Secretary, acting
through the Service, shall develop procedures to evaluate
compliance with grant requirements and compliance with and
performance of contracts entered into by Urban Indian
Organizations under this title. Such procedures shall include
provisions for carrying out the requirements of this section.
(b) Evaluations.--The Secretary, acting through the Service,
shall evaluate the compliance of each Urban Indian Organization
which has entered into a contract or received a grant under
section 503 with the terms of such contract or grant. For
purposes of this evaluation, the Secretary shall--
(1) acting through the Service, conduct an annual
onsite evaluation of the organization; or
(2) accept in lieu of such onsite evaluation evidence
of the organization's provisional or full accreditation
by a private independent entity recognized by the
Secretary for purposes of conducting quality reviews of
providers participating in the Medicare program under
title XVIII of the Social Security Act.
(c) Noncompliance; Unsatisfactory Performance.--If, as a
result of the evaluations conducted under this section, the
Secretary determines that an Urban Indian Organization has not
complied with the requirements of a grant or complied with or
satisfactorily performed a contract under section 503, the
Secretary shall, prior to renewing such contract or grant,
attempt to resolve with the organization the areas of
noncompliance or unsatisfactory performance and modify the
contract or grant to prevent future occurrences of
noncompliance or unsatisfactory performance. If the Secretary
determines that the noncompliance or unsatisfactory performance
cannot be resolved and prevented in the future, the Secretary
shall not renew the contract or grant with the organization and
is authorized to enter into a contract or make a grant under
section 503 with another Urban Indian Organization which is
situated in the same Urban Center as the Urban Indian
Organization whose contract or grant is not renewed under this
section.
(d) Considerations for Renewals.--In determining whether to
renew a contract or grant with an Urban Indian Organization
under section 503 which has completed performance of a contract
or grant under section 504, the Secretary shall review the
records of the Urban Indian Organization, the reports submitted
under section 507, and shall consider the results of the onsite
evaluations or accreditations under subsection (b).
SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS.
(a) Procurement.--Contracts with Urban Indian Organizations
entered into pursuant to this title shall be in accordance with
all Federal contracting laws and regulations relating to
procurement except that in the discretion of the Secretary,
such contracts may be negotiated without advertising and need
not conform to the provisions of sections 1304 and 3131 through
3133 of title 40, United States Code.
(b) Payments Under Contracts or Grants.--
(1) In general.--Payments under any contracts or
grants pursuant to this title, notwithstanding any term
or condition of such contract or grant--
(A) may be made in a single advance payment
by the Secretary to the Urban Indian
Organization by no later than the end of the
first 30 days of the funding period with
respect to which the payments apply, unless the
Secretary determines through an evaluation
under section 505 that the organization is not
capable of administering such a single advance
payment; and
(B) if any portion thereof is unexpended by
the Urban Indian Organization during the
funding period with respect to which the
payments initially apply, shall be carried
forward for expenditure with respect to
allowable or reimbursable costs incurred by the
organization during 1 or more subsequent
funding periods without additional
justification or documentation by the
organization as a condition of carrying forward
the availability for expenditure of such funds.
(2) Semiannual and quarterly payments and
reimbursements.--If the Secretary determines under
paragraph (1)(A) that an Urban Indian Organization is
not capable of administering an entire single advance
payment, on request of the Urban Indian Organization,
the payments may be made--
(A) in semiannual or quarterly payments by
not later than 30 days after the date on which
the funding period with respect to which the
payments apply begins; or
(B) by way of reimbursement.
(c) Revision or Amendment of Contracts.--Notwithstanding any
provision of law to the contrary, the Secretary may, at the
request and consent of an Urban Indian Organization, revise or
amend any contract entered into by the Secretary with such
organization under this title as necessary to carry out the
purposes of this title.
(d) Fair and Uniform Services and Assistance.--Contracts with
or grants to Urban Indian Organizations and regulations adopted
pursuant to this title shall include provisions to assure the
fair and uniform provision to Urban Indians of services and
assistance under such contracts or grants by such
organizations.
SEC. 507. REPORTS AND RECORDS.
(a) Reports.--
(1) In general.--For each fiscal year during which an
Urban Indian Organization receives or expends funds
pursuant to a contract entered into or a grant received
pursuant to this title, such Urban Indian Organization
shall submit to the Secretary not more frequently than
every 6 months, a report that includes the following:
(A) In the case of a contract or grant under
section 503, recommendations pursuant to
section 503(a)(5).
(B) Information on activities conducted by
the organization pursuant to the contract or
grant.
(C) An accounting of the amounts and purpose
for which Federal funds were expended.
(D) A minimum set of data, using uniformly
defined elements, as specified by the Secretary
after consultation with Urban Indian
Organizations.
(2) Health status and services.--
(A) In general.--Not later than 18 months
after the date of enactment of the Indian
Health Care Improvement Act Amendments of 2007,
the Secretary, acting through the Service,
shall submit to Congress a report evaluating--
(i) the health status of Urban
Indians;
(ii) the services provided to Indians
pursuant to this title; and
(iii) areas of unmet needs in the
delivery of health services to Urban
Indians.
(B) Consultation and contracts.--In preparing
the report under paragraph (1), the Secretary--
(i) shall consult with Urban Indian
Organizations; and
(ii) may enter into a contract with a
national organization representing
Urban Indian Organizations to conduct
any aspect of the report.
(b) Audit.--The reports and records of the Urban Indian
Organization with respect to a contract or grant under this
title shall be subject to audit by the Secretary and the
Comptroller General of the United States.
(c) Costs of Audits.--The Secretary shall allow as a cost of
any contract or grant entered into or awarded under section 502
or 503 the cost of an annual independent financial audit
conducted by--
(1) a certified public accountant; or
(2) a certified public accounting firm qualified to
conduct Federal compliance audits.
SEC. 508. LIMITATION ON CONTRACT AUTHORITY.
The authority of the Secretary to enter into contracts or to
award grants under this title shall be to the extent, and in an
amount, provided for in appropriation Acts.
SEC. 509. FACILITIES.
(a) Grants.--The Secretary, acting through the Service, may
make grants to contractors or grant recipients under this title
for the lease, purchase, renovation, construction, or expansion
of facilities, including leased facilities, in order to assist
such contractors or grant recipients in complying with
applicable licensure or certification requirements.
(b) Loan Fund Study.--The Secretary, acting through the
Service, may carry out a study to determine the feasibility of
establishing a loan fund to provide to Urban Indian
Organizations direct loans or guarantees for loans for the
construction of health care facilities in a manner consistent
with section 309, including by submitting a report in
accordance with subsection (c) of that section.
SEC. 510. DIVISION OF URBAN INDIAN HEALTH.
There is established within the Service a Division of Urban
Indian Health, which shall be responsible for--
(1) carrying out the provisions of this title;
(2) providing central oversight of the programs and
services authorized under this title; and
(3) providing technical assistance to Urban Indian
Organizations.
SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE-RELATED SERVICES.
(a) Grants Authorized.--The Secretary, acting through the
Service, may make grants for the provision of health-related
services in prevention of, treatment of, rehabilitation of, or
school- and community-based education regarding, alcohol and
substance abuse in Urban Centers to those Urban Indian
Organizations with which the Secretary has entered into a
contract under this title or under section 201.
(b) Goals.--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 following:
(1) The size of the Urban Indian population.
(2) Capability of the organization to adequately
perform the activities required under the grant.
(3) Satisfactory performance standards for the
organization in meeting the goals set forth in such
grant. The standards shall be negotiated and agreed to
between the Secretary and the grantee on a grant-by-
grant basis.
(4) Identification of the need for services.
(d) Allocation of Grants.--The Secretary shall develop a
methodology for allocating grants made pursuant to this section
based on the criteria established pursuant to subsection (c).
(e) Grants Subject to Criteria.--Any grant received by an
Urban Indian Organization under this Act for substance abuse
prevention, treatment, and rehabilitation shall be subject to
the criteria set forth in subsection (c).
SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS.
Notwithstanding any other provision of law, the Tulsa Clinic
and Oklahoma City Clinic demonstration projects shall--
(1) be permanent programs within the Service's direct
care program;
(2) continue to be treated as Service Units and
Operating Units in the allocation of resources and
coordination of care; and
(3) continue to meet the requirements and definitions
of an Urban Indian Organization in this Act, and shall
not be subject to the provisions of the Indian Self-
Determination and Education Assistance Act (25 U.S.C.
450 et seq.).
SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.
(a) Grants and Contracts.--The Secretary, through the
Division of Urban Indian Health, shall make grants or enter
into contracts with Urban Indian Organizations, to take effect
not later than September 30, 2010, 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) Use of Funds.--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) Eligibility.--Urban Indian Organizations that operate
Indian alcohol programs originally funded under the NIAAA and
subsequently transferred to the Service are eligible for grants
or contracts under this section.
(d) Report.--The Secretary shall evaluate and report to
Congress on the activities of programs funded under this
section not less than every 5 years.
SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZATIONS.
(a) In General.--The Secretary shall ensure that the Service
consults, to the greatest extent practicable, with Urban Indian
Organizations.
(b) Definition of Consultation.--For purposes of subsection
(a), consultation is the open and free exchange of information
and opinions which leads to mutual understanding and
comprehension and which emphasizes trust, respect, and shared
responsibility.
SEC. 515. URBAN YOUTH TREATMENT CENTER DEMONSTRATION.
(a) Construction and Operation.--The Secretary, acting
through the Service, through grant or contract, is authorized
to fund the construction and operation of at least 2
residential treatment centers in each State described in
subsection (b) to demonstrate the provision of alcohol and
substance abuse treatment services to Urban Indian youth in a
culturally competent residential setting.
(b) Definition of State.--A State described in this
subsection is a State in which--
(1) there resides Urban Indian youth with need for
alcohol and substance abuse treatment services in a
residential setting; and
(2) there is a significant shortage of culturally
competent residential treatment services for Urban
Indian youth.
SEC. 516. GRANTS FOR DIABETES PREVENTION, TREATMENT, AND CONTROL.
(a) Grants Authorized.--The Secretary may make grants to
those Urban Indian Organizations that have entered into a
contract or have received a grant under this title for the
provision of services for the prevention and treatment of, and
control of the complications resulting from, diabetes among
Urban Indians.
(b) Goals.--Each grant made pursuant to subsection (a) shall
set forth the goals to be accomplished under the grant. The
goals shall be specific to each grant as agreed to between the
Secretary and the grantee.
(c) Establishment of Criteria.--The Secretary shall establish
criteria for the grants made under subsection (a) relating to--
(1) the size and location of the Urban Indian
population to be served;
(2) the need for prevention of and treatment of, and
control of the complications resulting from, diabetes
among the Urban Indian population to be served;
(3) performance standards for the organization in
meeting the goals set forth in such grant that are
negotiated and agreed to by the Secretary and the
grantee;
(4) the capability of the organization to adequately
perform the activities required under the grant; and
(5) the willingness of the organization to
collaborate with the registry, if any, established by
the Secretary under section 204(e) in the Area Office
of the Service in which the organization is located.
(d) Funds Subject to Criteria.--Any funds received by an
Urban Indian Organization under this Act for the prevention,
treatment, and control of diabetes among Urban Indians shall be
subject to the criteria developed by the Secretary under
subsection (c).
SEC. 517. COMMUNITY HEALTH REPRESENTATIVES.
The Secretary, acting through the Service, may enter into
contracts with, and make grants to, Urban Indian Organizations
for the employment of Indians trained as health service
providers through the Community Health Representatives Program
under section 109 in the provision of health care, health
promotion, and disease prevention services to Urban Indians.
SEC. 518. EFFECTIVE DATE.
The amendments made by the Indian Health Care Improvement Act
Amendments of 2007 to this title shall take effect beginning on
the date of enactment of that Act, regardless of whether the
Secretary has promulgated regulations implementing such
amendments.
SEC. 519. ELIGIBILITY FOR SERVICES.
Urban Indians shall be eligible for, and the ultimate
beneficiaries of, health care or referral services provided
pursuant to this title.
SEC. 520. AUTHORIZATION OF APPROPRIATIONS.
There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2017 to
carry out this title.
TITLE VI--ORGANIZATIONAL IMPROVEMENTS
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, as are or may be hereafter provided by Federal
statute or treaties, there is established within the
Public Health Service of the Department the Indian
Health Service.
(2) Assistant secretary of indian health.--The
Service shall be administered by an Assistant Secretary
of Indian Health, who shall be appointed by the
President, by and with the advice and consent of the
Senate. The Assistant Secretary shall report to the
Secretary. Effective with respect to an individual
appointed by the President, by and with the advice and
consent of the Senate, after January 1, 2007, the term
of service of the Assistant Secretary shall be 4 years.
An Assistant Secretary may serve more than 1 term.
(3) Incumbent.--The individual serving in the
position of Director of the Service on the day before
the date of enactment of the Indian Health Care
Improvement Act Amendments of 2007 shall serve as
Assistant Secretary.
(4) Advocacy and consultation.--The position of
Assistant Secretary is established to, in a manner
consistent with the government-to-government
relationship between the United States and Indian
Tribes--
(A) facilitate advocacy for the development
of appropriate Indian health policy; and
(B) promote consultation on matters relating
to Indian health.
(b) Agency.--The Service shall be an agency within the Public
Health Service of the Department, and shall not be an office,
component, or unit of any other agency of the Department.
(c) Duties.--The Assistant Secretary shall--
(1) perform all functions that were, on the day
before the date of enactment of the Indian Health Care
Improvement Act Amendments of 2007, carried out by or
under the direction of the individual serving as
Director of the Service on that day;
(2) perform all functions of the Secretary relating
to the maintenance and operation of hospital and health
facilities for Indians and the planning for, and
provision and utilization of, health services for
Indians;
(3) administer all health programs under which health
care is provided to Indians based upon their status as
Indians which are administered by the Secretary,
including programs under--
(A) this Act;
(B) the Act of November 2, 1921 (25 U.S.C.
13);
(C) the Act of August 5, 1954 (42 U.S.C. 2001
et seq.);
(D) the Act of August 16, 1957 (42 U.S.C.
2005 et seq.); and
(E) the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et
seq.);
(4) administer all scholarship and loan functions
carried out under title I;
(5) report directly to the Secretary concerning all
policy- and budget-related matters affecting Indian
health;
(6) collaborate with the Assistant Secretary for
Health concerning appropriate matters of Indian health
that affect the agencies of the Public Health Service;
(7) advise each Assistant Secretary of the Department
concerning matters of Indian health with respect to
which that Assistant Secretary has authority and
responsibility;
(8) advise the heads of other agencies and programs
of the Department concerning matters of Indian health
with respect to which those heads have authority and
responsibility;
(9) coordinate the activities of the Department
concerning matters of Indian health; and
(10) perform such other functions as the Secretary
may designate.
(d) Authority.--
(1) In general.--The Secretary, acting through the
Assistant Secretary, shall have the authority--
(A) except to the extent provided for in
paragraph (2), to appoint and compensate
employees for the Service in accordance with
title 5, United States Code;
(B) to enter into contracts for the
procurement of goods and services to carry out
the functions of the Service; and
(C) to manage, expend, and obligate all funds
appropriated for the Service.
(2) Personnel actions.--Notwithstanding any other
provision of law, the provisions of section 12 of the
Act of June 18, 1934 (48 Stat. 986; 25 U.S.C. 472),
shall apply to all personnel actions taken with respect
to new positions created within the Service as a result
of its establishment under subsection (a).
(e) References.--Any reference to the Director of the Indian
Health Service in any other Federal law, Executive order, rule,
regulation, or delegation of authority, or in any document of
or relating to the Director of the Indian Health Service, shall
be deemed to refer to the Assistant Secretary.
SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.
(a) Establishment.--
(1) In general.--The Secretary shall establish an
automated management information system for the
Service.
(2) Requirements of system.--The information system
established under paragraph (1) shall include--
(A) a financial management system;
(B) a patient care information system for
each area served by the Service;
(C) a privacy component that protects the
privacy of patient information held by, or on
behalf of, the Service;
(D) a services-based cost accounting
component that provides estimates of the costs
associated with the provision of specific
medical treatments or services in each Area
office of the Service;
(E) an interface mechanism for patient
billing and accounts receivable system; and
(F) a training component.
(b) Provision of Systems to Tribes and Organizations.--The
Secretary shall provide each Tribal Health Program automated
management information systems which--
(1) meet the management information needs of such
Tribal Health Program with respect to the treatment by
the Tribal Health Program of patients of the Service;
and
(2) meet the management information needs of the
Service.
(c) Access to Records.--Notwithstanding any other provision
of law, each patient shall have reasonable access to the
medical or health records of such patient which are held by, or
on behalf of, the Service.
(d) Authority To Enhance Information Technology.--The
Secretary, acting through the Assistant Secretary, shall have
the authority to enter into contracts, agreements, or joint
ventures with other Federal agencies, States, private and
nonprofit organizations, for the purpose of enhancing
information technology in Indian Health Programs and
facilities.
SEC. 603. AUTHORIZATION OF APPROPRIATIONS.
There is authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2017 to
carry out this title.
TITLE VII--BEHAVIORAL HEALTH PROGRAMS
SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREATMENT SERVICES.
(a) Purposes.--The purposes of this section are as follows:
(1) To authorize and direct the Secretary, acting
through the Service, Indian Tribes, Tribal
Organizations, and Urban Indian Organizations, to
develop a comprehensive behavioral health prevention
and treatment program which emphasizes collaboration
among alcohol and substance abuse, social services, and
mental health programs.
(2) To provide information, direction, and guidance
relating to mental illness and dysfunction and self-
destructive behavior, including child abuse and family
violence, to those Federal, tribal, State, and local
agencies responsible for programs in Indian communities
in areas of health care, education, social services,
child and family welfare, alcohol and substance abuse,
law enforcement, and judicial services.
(3) To assist Indian Tribes to identify services and
resources available to address mental illness and
dysfunctional and self-destructive behavior.
(4) To provide authority and opportunities for Indian
Tribes and Tribal Organizations to develop, implement,
and coordinate with community-based programs which
include identification, prevention, education,
referral, and treatment services, including through
multidisciplinary resource teams.
(5) To ensure that Indians, as citizens of the United
States and of the States in which they reside, have the
same access to behavioral health services to which all
citizens have access.
(6) To modify or supplement existing programs and
authorities in the areas identified in paragraph (2).
(b) Plans.--
(1) Development.--The Secretary, acting through the
Service, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations, shall encourage Indian Tribes and
Tribal Organizations to develop tribal plans, and Urban
Indian Organizations to develop local plans, and for
all such groups to participate in developing areawide
plans for Indian Behavioral Health Services. The plans
shall include, to the extent feasible, the following
components:
(A) An assessment of the scope of alcohol or
other substance abuse, mental illness, and
dysfunctional and self-destructive behavior,
including suicide, child abuse, and family
violence, among Indians, including--
(i) the number of Indians served who
are directly or indirectly affected by
such illness or behavior; or
(ii) an estimate of the financial and
human cost attributable to such illness
or behavior.
(B) An assessment of the existing and
additional resources necessary for the
prevention and treatment of such illness and
behavior, including an assessment of the
progress toward achieving the availability of
the full continuum of care described in
subsection (c).
(C) An estimate of the additional funding
needed by the Service, Indian Tribes, Tribal
Organizations, and Urban Indian Organizations
to meet their responsibilities under the plans.
(2) National clearinghouse.--The Secretary, acting
through the Service, shall coordinate with existing
national clearinghouses and information centers to
include at the clearinghouses and centers plans and
reports on the outcomes of such plans developed by
Indian Tribes, Tribal Organizations, Urban Indian
Organizations, and Service Areas relating to behavioral
health. The Secretary shall ensure access to these
plans and outcomes by any Indian Tribe, Tribal
Organization, Urban Indian Organization, or the
Service.
(3) Technical assistance.--The Secretary shall
provide technical assistance to Indian Tribes, Tribal
Organizations, and Urban Indian Organizations in
preparation of plans under this section and in
developing standards of care that may be used and
adopted locally.
(c) Programs.--The Secretary, acting through the Service,
Indian Tribes, and Tribal Organizations, shall provide, to the
extent feasible and if funding is available, programs including
the following:
(1) Comprehensive care.--A comprehensive continuum of
behavioral health care which provides--
(A) community-based prevention, intervention,
outpatient, and behavioral health aftercare;
(B) detoxification (social and medical);
(C) acute hospitalization;
(D) intensive outpatient/day treatment;
(E) residential treatment;
(F) transitional living for those needing a
temporary, stable living environment that is
supportive of treatment and recovery goals;
(G) emergency shelter;
(H) intensive case management; and
(I) diagnostic services.
(2) Child care.--Behavioral health services for
Indians from birth through age 17, including--
(A) preschool and school age fetal alcohol
disorder services, including assessment and
behavioral intervention;
(B) mental health and substance abuse
services (emotional, organic, alcohol, drug,
inhalant, and tobacco);
(C) identification and treatment of co-
occurring disorders and comorbidity;
(D) prevention of alcohol, drug, inhalant,
and tobacco use;
(E) early intervention, treatment, and
aftercare;
(F) promotion of healthy approaches to risk
and safety issues; and
(G) identification and treatment of neglect
and physical, mental, and sexual abuse.
(3) Adult care.--Behavioral health services for
Indians from age 18 through 55, including--
(A) early intervention, treatment, and
aftercare;
(B) mental health and substance abuse
services (emotional, alcohol, drug, inhalant,
and tobacco), including sex specific services;
(C) identification and treatment of co-
occurring disorders (dual diagnosis) and
comorbidity;
(D) promotion of healthy approaches for risk-
related behavior;
(E) treatment services for women at risk of
giving birth to a child with a fetal alcohol
disorder; and
(F) sex specific treatment for sexual assault
and domestic violence.
(4) Family care.--Behavioral health services for
families, including--
(A) early intervention, treatment, and
aftercare for affected families;
(B) treatment for sexual assault and domestic
violence; and
(C) promotion of healthy approaches relating
to parenting, domestic violence, and other
abuse issues.
(5) Elder care.--Behavioral health services for
Indians 56 years of age and older, including--
(A) early intervention, treatment, and
aftercare;
(B) mental health and substance abuse
services (emotional, alcohol, drug, inhalant,
and tobacco), including sex specific services;
(C) identification and treatment of co-
occurring disorders (dual diagnosis) and
comorbidity;
(D) promotion of healthy approaches to
managing conditions related to aging;
(E) sex specific treatment for sexual
assault, domestic violence, neglect, physical
and mental abuse and exploitation; and
(F) identification and treatment of dementias
regardless of cause.
(d) Community Behavioral Health Plan.--
(1) Establishment.--The governing body of any Indian
Tribe, Tribal Organization, or Urban Indian
Organization may adopt a resolution for the
establishment of a community behavioral health plan
providing for the identification and coordination of
available resources and programs to identify, prevent,
or treat substance abuse, mental illness, or
dysfunctional and self-destructive behavior, including
child abuse and family violence, among its members or
its service population. This plan should include
behavioral health services, social services, intensive
outpatient services, and continuing aftercare.
(2) Technical assistance.--At the request of an
Indian Tribe, Tribal Organization, or Urban Indian
Organization, the Bureau of Indian Affairs and the
Service shall cooperate with and provide technical
assistance to the Indian Tribe, Tribal Organization, or
Urban Indian Organization in the development and
implementation of such plan.
(3) Funding.--The Secretary, acting through the
Service, may make funding available to Indian Tribes
and Tribal Organizations which adopt a resolution
pursuant to paragraph (1) to obtain technical
assistance for the development of a community
behavioral health plan and to provide administrative
support in the implementation of such plan.
(e) Coordination for Availability of Services.--The
Secretary, acting through the Service, Indian Tribes, Tribal
Organizations, and Urban Indian Organizations, shall coordinate
behavioral health planning, to the extent feasible, with other
Federal agencies and with State agencies, to encourage
comprehensive behavioral health services for Indians regardless
of their place of residence.
(f) Mental Health Care Need Assessment.--Not later than 1
year after the date of enactment of the Indian Health Care
Improvement Act Amendments of 2007, the Secretary, acting
through the Service, shall make an assessment of the need for
inpatient mental health care among Indians and the availability
and cost of inpatient mental health facilities which can meet
such need. In making such assessment, the Secretary shall
consider the possible conversion of existing, underused Service
hospital beds into psychiatric units to meet such need.
SEC. 702. MEMORANDA OF AGREEMENT WITH THE DEPARTMENT OF THE INTERIOR.
(a) Contents.--Not later than 12 months after the date of
enactment of the Indian Health Care Improvement Act Amendments
of 2007, the Secretary, acting through the Service, and the
Secretary of the Interior shall develop and enter into a
memoranda of agreement, or review and update any existing
memoranda of agreement, as required by section 4205 of the
Indian Alcohol and Substance Abuse Prevention and Treatment Act
of 1986 (25 U.S.C. 2411) under which the Secretaries address
the following:
(1) The scope and nature of mental illness and
dysfunctional and self-destructive behavior, including
child abuse and family violence, among Indians.
(2) The existing Federal, tribal, State, local, and
private services, resources, and programs available to
provide behavioral health services for Indians.
(3) The unmet need for additional services,
resources, and programs necessary to meet the needs
identified pursuant to paragraph (1).
(4)(A) The right of Indians, as citizens of the
United States and of the States in which they reside,
to have access to behavioral health services to which
all citizens have access.
(B) The right of Indians to participate in, and
receive the benefit of, such services.
(C) The actions necessary to protect the exercise of
such right.
(5) The responsibilities of the Bureau of Indian
Affairs and the Service, including mental illness
identification, prevention, education, referral, and
treatment services (including services through
multidisciplinary resource teams), at the central,
area, and agency and Service Unit, Service Area, and
headquarters levels to address the problems identified
in paragraph (1).
(6) A strategy for the comprehensive coordination of
the behavioral health services provided by the Bureau
of Indian Affairs and the Service to meet the problems
identified pursuant to paragraph (1), including--
(A) the coordination of alcohol and substance
abuse programs of the Service, the Bureau of
Indian Affairs, and Indian Tribes and Tribal
Organizations (developed under the Indian
Alcohol and Substance Abuse Prevention and
Treatment Act of 1986 (25 U.S.C. 2401 et seq.))
with behavioral health initiatives pursuant to
this Act, particularly with respect to the
referral and treatment of dually diagnosed
individuals requiring behavioral health and
substance abuse treatment; and
(B) ensuring that the Bureau of Indian
Affairs and Service programs and services
(including multidisciplinary resource teams)
addressing child abuse and family violence are
coordinated with such non-Federal programs and
services.
(7) Directing appropriate officials of the Bureau of
Indian Affairs and the Service, particularly at the
agency and Service Unit levels, to cooperate fully with
tribal requests made pursuant to community behavioral
health plans adopted under section 701(c) and section
4206 of the Indian Alcohol and Substance Abuse
Prevention and Treatment Act of 1986 (25 U.S.C. 2412).
(8) Providing for an annual review of such agreement
by the Secretaries which shall be provided to Congress
and Indian Tribes and Tribal Organizations.
(b) Specific Provisions Required.--The memoranda of agreement
updated or entered into pursuant to subsection (a) 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 Indians, including
the number 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 and substance abuse.
(c) Publication.--Each memorandum of agreement entered into
or renewed (and amendments or modifications thereto) under
subsection (a) shall be published in the Federal Register. At
the same time as publication in the Federal Register, the
Secretary shall provide a copy of such memoranda, amendment, or
modification to each Indian Tribe, Tribal Organization, and
Urban Indian Organization.
SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND TREATMENT
PROGRAM.
(a) Establishment.--
(1) In general.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, shall
provide a program of comprehensive behavioral health,
prevention, treatment, and aftercare, which shall
include--
(A) prevention, through educational
intervention, in Indian communities;
(B) acute detoxification, psychiatric
hospitalization, residential, and intensive
outpatient treatment;
(C) community-based rehabilitation and
aftercare;
(D) community education and involvement,
including extensive training of health care,
educational, and community-based personnel;
(E) specialized residential treatment
programs for high-risk populations, including
pregnant and postpartum women and their
children; and
(F) diagnostic services.
(2) Target populations.--The target population of
such programs shall be members of Indian Tribes.
Efforts to train and educate key members of the Indian
community shall also target employees of health,
education, judicial, law enforcement, legal, and social
service programs.
(b) Contract Health Services.--
(1) In general.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, may
enter into contracts with public or private providers
of behavioral health treatment services for the purpose
of carrying out the program required under subsection
(a).
(2) Provision of assistance.--In carrying out this
subsection, the Secretary shall provide assistance to
Indian Tribes and Tribal Organizations to develop
criteria for the certification of behavioral health
service providers and accreditation of service
facilities which meet minimum standards for such
services and facilities.
SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.
(a) In General.--Under the authority of the Act of November
2, 1921 (25 U.S.C. 13) (commonly known as the ``Snyder Act''),
the Secretary shall establish and maintain a mental health
technician program within the Service which--
(1) provides for the training of Indians as mental
health technicians; and
(2) employs such technicians in the provision of
community-based mental health care that includes
identification, prevention, education, referral, and
treatment services.
(b) Paraprofessional Training.--In carrying out subsection
(a), the Secretary, acting through the Service, Indian Tribes,
and Tribal Organizations, shall provide high-standard
paraprofessional training in mental health care necessary to
provide quality care to the Indian communities to be served.
Such training shall be based upon a curriculum developed or
approved by the Secretary which combines education in the
theory of mental health care with supervised practical
experience in the provision of such care.
(c) Supervision and Evaluation of Technicians.--The
Secretary, acting through the Service, Indian Tribes, and
Tribal Organizations, shall supervise and evaluate the mental
health technicians in the training program.
(d) Traditional Health Care Practices.--The Secretary, acting
through the Service, shall ensure that the program established
pursuant to this subsection involves the use and promotion of
the traditional health care practices of the Indian Tribes to
be served.
SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE WORKERS.
(a) In General.--Subject to the provisions of section 221,
and except as provided in subsection (b), any individual
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 this Act
is required to be licensed as a psychologist, social worker, or
marriage and family therapist, respectively.
(b) Trainees.--An individual may be employed as a trainee in
psychology, social work, or marriage and family therapy to
provide mental health care services described in subsection (a)
if such individual--
(1) works under the direct supervision of a licensed
psychologist, social worker, or marriage and family
therapist, respectively;
(2) is enrolled in or has completed at least 2 years
of course work at a post-secondary, accredited
education program for psychology, social work, marriage
and family therapy, or counseling; and
(3) meets such other training, supervision, and
quality review requirements as the Secretary may
establish.
SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.
(a) Grants.--The Secretary, consistent with section 701, may
make grants to Indian Tribes, Tribal Organizations, and Urban
Indian Organizations to develop and implement a comprehensive
behavioral health 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) Use of Grant Funds.--A grant made pursuant to this
section may be used to--
(1) develop and provide community training,
education, and prevention programs for Indian women
relating to behavioral health issues, including fetal
alcohol disorders;
(2) identify and provide psychological services,
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 health care
practices, cultural values, and community and family
involvement.
(c) Criteria.--The Secretary, in consultation with Indian
Tribes and Tribal Organizations, shall establish criteria for
the review and approval of applications and proposals for
funding under this section.
(d) Earmark of Certain Funds.--Twenty percent of the funds
appropriated pursuant to this section shall be used to make
grants to Urban Indian Organizations.
SEC. 707. INDIAN YOUTH PROGRAM.
(a) Detoxification and Rehabilitation.--The Secretary, acting
through the Service, consistent with section 701, shall develop
and implement a program for acute detoxification and treatment
for Indian youths, including behavioral health services. The
program shall include regional treatment centers designed to
include detoxification and rehabilitation for both sexes on a
referral basis and programs developed and implemented by Indian
Tribes or Tribal Organizations at the local level under the
Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.). Regional centers shall be integrated with
the intake and rehabilitation programs based in the referring
Indian community.
(b) Alcohol and Substance Abuse Treatment Centers or
Facilities.--
(1) Establishment.--
(A) In general.--The Secretary, acting
through the Service, Indian Tribes, and Tribal
Organizations, shall construct, renovate, or,
as necessary, purchase, and appropriately staff
and operate, at least 1 youth regional
treatment center or treatment network in each
area under the jurisdiction of an Area Office.
(B) Area office in california.--For the
purposes of this subsection, the Area Office in
California shall be considered to be 2 Area
Offices, 1 office whose jurisdiction shall be
considered to encompass the northern area of
the State of California, and 1 office whose
jurisdiction shall be considered to encompass
the remainder of the State of California for
the purpose of implementing California
treatment networks.
(2) Funding.--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) Location.--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 appropriate tribal
resolution) by a majority of the Indian Tribes to be
served by such center.
(4) Specific provision of funds.--
(A) In general.--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--
(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
without regard to the proviso set forth
in section 4(l) of the Indian Self-
Determination and Education Assistance
Act (25 U.S.C. 450b(l)).
(B) Provision of services to eligible
youths.--Until additional residential youth
treatment facilities are established in Alaska
pursuant to this section, the facilities
specified in subparagraph (A) shall make every
effort to provide services to all eligible
Indian youths residing in Alaska.
(c) Intermediate Adolescent Behavioral Health Services.--
(1) In general.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, may
provide intermediate behavioral health services to
Indian children and adolescents, including--
(A) pretreatment assistance;
(B) inpatient, outpatient, and aftercare
services;
(C) emergency care;
(D) suicide prevention and crisis
intervention; and
(E) prevention and treatment of mental
illness and dysfunctional and self-destructive
behavior, including child abuse and family
violence.
(2) Use of funds.--Funds provided under this
subsection may be used--
(A) to construct or renovate an existing
health facility to provide intermediate
behavioral health services;
(B) to hire behavioral health professionals;
(C) to staff, operate, and maintain an
intermediate mental health facility, group
home, sober housing, transitional housing or
similar facilities, or youth shelter where
intermediate behavioral health services are
being provided;
(D) to make renovations and hire appropriate
staff to convert existing hospital beds into
adolescent psychiatric units; and
(E) for intensive home- and community-based
services.
(3) Criteria.--The Secretary, acting through the
Service, shall, in consultation with Indian Tribes and
Tribal Organizations, establish criteria for the review
and approval of applications or proposals for funding
made available pursuant to this subsection.
(d) Federally-Owned Structures.--
(1) In general.--The Secretary, in consultation with
Indian Tribes and Tribal Organizations, shall--
(A) identify and use, where appropriate,
federally-owned structures suitable for local
residential or regional behavioral health
treatment for Indian youths; and
(B) establish guidelines for determining the
suitability of any such federally-owned
structure to be used for local residential or
regional behavioral health treatment for Indian
youths.
(2) Terms and conditions for use of structure.--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 responsibility for the
structure and any Indian Tribe or Tribal Organization
operating the program.
(e) Rehabilitation and Aftercare Services.--
(1) In general.--The Secretary, Indian Tribes, or
Tribal Organizations, in cooperation with the Secretary
of the Interior, shall develop and implement within
each Service Unit, community-based rehabilitation and
follow-up services for Indian youths who are having
significant behavioral health problems, and require
long-term treatment, community reintegration, and
monitoring to support the Indian youths after their
return to their home community.
(2) Administration.--Services under paragraph (1)
shall be provided by trained staff within the community
who can assist the Indian youths in their continuing
development of self-image, positive problem-solving
skills, and nonalcohol or substance abusing behaviors.
Such staff may include alcohol and substance abuse
counselors, mental health professionals, and other
health professionals and paraprofessionals, including
community health representatives.
(f) Inclusion of Family in Youth Treatment Program.--In
providing the treatment and other services to Indian youths
authorized by this section, the Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, shall provide
for the inclusion of family members of such youths in the
treatment programs or other services as may be appropriate. Not
less than 10 percent of the funds appropriated for the purposes
of carrying out subsection (e) shall be used for outpatient
care of adult family members related to the treatment of an
Indian youth under that subsection.
(g) Multidrug Abuse Program.--The Secretary, acting through
the Service, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations, shall provide, consistent with section
701, programs and services to prevent and treat the abuse of
multiple forms of substances, including alcohol, drugs,
inhalants, and tobacco, among Indian youths residing in Indian
communities, on or near reservations, and in urban areas and
provide appropriate mental health services to address the
incidence of mental illness among such youths.
(h) Indian Youth Mental Health.--The Secretary, acting
through the Service, shall collect data for the report under
section 801 with respect to--
(1) the number of Indian youth who are being provided
mental health services through the Service and Tribal
Health Programs;
(2) a description of, and costs associated with, the
mental health services provided for Indian youth
through the Service and Tribal Health Programs;
(3) the number of youth referred to the Service or
Tribal Health Programs for mental health services;
(4) the number of Indian youth provided residential
treatment for mental health and behavioral problems
through the Service and Tribal Health Programs,
reported separately for on- and off-reservation
facilities; and
(5) the costs of the services described in paragraph
(4).
SEC. 708. INDIAN YOUTH TELEMENTAL HEALTH DEMONSTRATION PROJECT.
(a) Purpose.--The purpose of this section is to authorize the
Secretary to carry out a demonstration project to test the use
of telemental health services in suicide prevention,
intervention and treatment of Indian youth, including through--
(1) the use of psychotherapy, psychiatric
assessments, diagnostic interviews, therapies for
mental health conditions predisposing to suicide, and
alcohol and substance abuse treatment;
(2) the provision of clinical expertise to,
consultation services with, and medical advice and
training for frontline health care providers working
with Indian youth;
(3) training and related support for community
leaders, family members and health and education
workers who work with Indian youth;
(4) the development of culturally-relevant
educational materials on suicide; and
(5) data collection and reporting.
(b) Definitions.--For the purpose of this section, the
following definitions shall apply:
(1) Demonstration project.--The term ``demonstration
project'' means the Indian youth telemental health
demonstration project authorized under subsection (c).
(2) Telemental health.--The term ``telemental
health'' means the use of electronic information and
telecommunications technologies to support long
distance mental health care, patient and professional-
related education, public health, and health
administration.
(c) Authorization.--
(1) In general.--The Secretary is authorized to award
grants under the demonstration project for the
provision of telemental health services to Indian youth
who--
(A) have expressed suicidal ideas;
(B) have attempted suicide; or
(C) have mental health conditions that
increase or could increase the risk of suicide.
(2) Eligibility for grants.--Such grants shall be
awarded to Indian Tribes and Tribal Organizations that
operate 1 or more facilities--
(A) located in Alaska and part of the Alaska
Federal Health Care Access Network;
(B) reporting active clinical telehealth
capabilities; or
(C) offering school-based telemental health
services relating to psychiatry to Indian
youth.
(3) Grant period.--The Secretary shall award grants
under this section for a period of up to 4 years.
(4) Awarding of grants.--Not more than 5 grants shall
be provided under paragraph (1), with priority
consideration given to Indian Tribes and Tribal
Organizations that--
(A) serve a particular community or
geographic area where there is a demonstrated
need to address Indian youth suicide;
(B) enter in to collaborative partnerships
with Indian Health Service or Tribal Health
Programs or facilities to provide services
under this demonstration project;
(C) serve an isolated community or geographic
area which has limited or no access to
behavioral health services; or
(D) operate a detention facility at which
Indian youth are detained.
(d) Use of Funds.--
(1) In general.--An Indian Tribe or Tribal
Organization shall use a grant received under
subsection (c) for the following purposes:
(A) To provide telemental health services to
Indian youth, including the provision of--
(i) psychotherapy;
(ii) psychiatric assessments and
diagnostic interviews, therapies for
mental health conditions predisposing
to suicide, and treatment; and
(iii) alcohol and substance abuse
treatment.
(B) To provide clinician-interactive medical
advice, guidance and training, assistance in
diagnosis and interpretation, crisis counseling
and intervention, and related assistance to
Service, tribal, or urban clinicians and health
services providers working with youth being
served under this demonstration project.
(C) To assist, educate and train community
leaders, health education professionals and
paraprofessionals, tribal outreach workers, and
family members who work with the youth
receiving telemental health services under this
demonstration project, including with
identification of suicidal tendencies, crisis
intervention and suicide prevention, emergency
skill development, and building and expanding
networks among these individuals and with State
and local health services providers.
(D) To develop and distribute culturally
appropriate community educational materials
on--
(i) suicide prevention;
(ii) suicide education;
(iii) suicide screening;
(iv) suicide intervention; and
(v) ways to mobilize communities with
respect to the identification of risk
factors for suicide.
(E) For data collection and reporting related
to Indian youth suicide prevention efforts.
(2) Traditional health care practices.--In carrying
out the purposes described in paragraph (1), an Indian
Tribe or Tribal Organization may use and promote the
traditional health care practices of the Indian Tribes
of the youth to be served.
(e) Applications.--To be eligible to receive a grant under
subsection (c), an Indian Tribe or Tribal Organization shall
prepare and submit to the Secretary an application, at such
time, in such manner, and containing such information as the
Secretary may require, including--
(1) a description of the project that the Indian
Tribe or Tribal Organization will carry out using the
funds provided under the grant;
(2) a description of the manner in which the project
funded under the grant would--
(A) meet the telemental health care needs of
the Indian youth population to be served by the
project; or
(B) improve the access of the Indian youth
population to be served to suicide prevention
and treatment services;
(3) evidence of support for the project from the
local community to be served by the project;
(4) a description of how the families and leadership
of the communities or populations to be served by the
project would be involved in the development and
ongoing operations of the project;
(5) a plan to involve the tribal community of the
youth who are provided services by the project in
planning and evaluating the mental health care and
suicide prevention efforts provided, in order to ensure
the integration of community, clinical, environmental,
and cultural components of the treatment; and
(6) a plan for sustaining the project after Federal
assistance for the demonstration project has
terminated.
(f) Collaboration; Reporting to National Clearinghouse.--
(1) Collaboration.--The Secretary, acting through the
Service, shall encourage Indian Tribes and Tribal
Organizations receiving grants under this section to
collaborate to enable comparisons about best practices
across projects.
(2) Reporting to national clearinghouse.--The
Secretary, acting through the Service, shall also
encourage Indian Tribes and Tribal Organizations
receiving grants under this section to submit relevant,
declassified project information to the national
clearinghouse authorized under section 701(b)(2) in
order to better facilitate program performance and
improve suicide prevention, intervention, and treatment
services.
(g) Annual Report.--Each grant recipient shall submit to the
Secretary an annual report that--
(1) describes the number of telemental health
services provided; and
(2) includes any other information that the Secretary
may require.
(h) Report to Congress.--Not later than 270 days after the
termination of the demonstration project, the Secretary shall
submit to the Committee on Indian Affairs of the Senate and the
Committee on Natural Resources and Committee on Energy and
Commerce of the House of Representatives a final report, based
on the annual reports provided by grant recipients under
subsection (h), that--
(1) describes the results of the projects funded by
grants awarded under this section, including any data
available which indicates the number of attempted
suicides;
(2) evaluates the impact of the telemental health
services funded by the grants in reducing the number of
completed suicides among Indian youth;
(3) evaluates whether the demonstration project
should be--
(A) expanded to provide more than 5 grants;
and
(B) designated a permanent program; and
(4) evaluates the benefits of expanding the
demonstration project to include Urban Indian
Organizations.
(i) Authorization of Appropriations.--There is authorized to
be appropriated to carry out this section $1,500,000 for each
of fiscal years 2008 through 2011.
SEC. 709. INPATIENT AND COMMUNITY-BASED MENTAL HEALTH FACILITIES
DESIGN, CONSTRUCTION, AND STAFFING.
Not later than 1 year after the date of enactment of the
Indian Health Care Improvement Act Amendments of 2007, the
Secretary, acting through the Service, Indian Tribes, and
Tribal Organizations, may provide, in each area of the Service,
not less than 1 inpatient mental health care facility, or the
equivalent, for Indians with behavioral health problems. For
the purposes of this subsection, California shall be considered
to be 2 Area Offices, 1 office whose location shall be
considered to encompass the northern area of the State of
California and 1 office whose jurisdiction shall be considered
to encompass the remainder of the State of California. The
Secretary shall consider the possible conversion of existing,
underused Service hospital beds into psychiatric units to meet
such need.
SEC. 710. TRAINING AND COMMUNITY EDUCATION.
(a) Program.--The Secretary, in cooperation with the
Secretary of the Interior, shall develop and implement or
assist Indian Tribes and Tribal Organizations to develop and
implement, within each Service Unit or tribal program, a
program of community education and involvement which shall be
designed to provide concise and timely information to the
community leadership of each tribal community. Such program
shall include education about behavioral health issues to
political leaders, Tribal judges, law enforcement personnel,
members of tribal health and education boards, health care
providers including traditional practitioners, and other
critical members of each tribal community. Such program may
also include community-based training to develop local capacity
and tribal community provider training for prevention,
intervention, treatment, and aftercare.
(b) Instruction.--The Secretary, acting through the Service,
shall, either directly or through Indian Tribes and Tribal
Organizations, provide instruction in the area of behavioral
health issues, including instruction in crisis intervention and
family relations in the context of alcohol and substance abuse,
child sexual abuse, youth alcohol and substance abuse, and the
causes and effects of fetal alcohol disorders 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 Affairs 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) Training Models.--In carrying out the education and
training programs required by this section, the Secretary, in
consultation with Indian Tribes, Tribal Organizations, Indian
behavioral health experts, 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 behavioral
health problems faced by children of alcoholics;
(2) the cultural, spiritual, and multigenerational
aspects of behavioral health problem prevention and
recovery; and
(3) community-based and multidisciplinary strategies
for preventing and treating behavioral health problems.
SEC. 711. BEHAVIORAL HEALTH PROGRAM.
(a) Innovative Programs.--The Secretary, acting through the
Service, Indian Tribes, and Tribal Organizations, consistent
with section 701, may plan, develop, implement, and carry out
programs to deliver innovative community-based behavioral
health services to Indians.
(b) Awards; Criteria.--The Secretary may award a grant for a
project under subsection (a) to an Indian Tribe or Tribal
Organization and may consider the following criteria:
(1) The project will address significant unmet
behavioral health needs among Indians.
(2) The project will serve a significant number of
Indians.
(3) The project has the potential to deliver services
in an efficient and effective manner.
(4) The Indian Tribe or Tribal Organization has the
administrative and financial capability to administer
the project.
(5) The project may deliver services in a manner
consistent with traditional health care practices.
(6) The project is coordinated with, and avoids
duplication of, existing services.
(c) Equitable Treatment.--For purposes of this subsection,
the Secretary shall, in evaluating project applications or
proposals, use the same criteria that the Secretary uses in
evaluating any other application or proposal for such funding.
SEC. 712. FETAL ALCOHOL DISORDER PROGRAMS.
(a) Programs.--
(1) Establishment.--The Secretary, consistent with
section 701, acting through the Service, Indian Tribes,
and Tribal Organizations, is authorized to establish
and operate fetal alcohol disorder programs as provided
in this section for the purposes of meeting the health
status objectives specified in section 3.
(2) Use of funds.--
(A) In general.--Funding provided pursuant to
this section shall be used for the following:
(i) To develop and provide for
Indians community and in-school
training, education, and prevention
programs relating to fetal alcohol
disorders.
(ii) To identify and provide
behavioral health treatment to high-
risk Indian women and high-risk women
pregnant with an Indian's child.
(iii) To identify and provide
appropriate psychological services,
educational and vocational support,
counseling, advocacy, and information
to fetal alcohol disorder affected
Indians and their families or
caretakers.
(iv) To develop and implement
counseling and support programs in
schools for fetal alcohol disorder
affected Indian children.
(v) To develop prevention and
intervention models which incorporate
practitioners of traditional health
care practices, cultural values, and
community involvement.
(vi) To develop, print, and
disseminate education and prevention
materials on fetal alcohol disorder.
(vii) To develop and implement, in
consultation with Indian Tribes, Tribal
Organizations, and Urban Indian
Organizations, culturally sensitive
assessment and diagnostic tools
including dysmorphology clinics and
multidisciplinary fetal alcohol
disorder clinics for use in Indian
communities and Urban Centers.
(B) Additional uses.--In addition to any
purpose under subparagraph (A), funding
provided pursuant to this section may be used
for 1 or more of the following:
(i) Early childhood intervention
projects from birth on to mitigate the
effects of fetal alcohol disorder among
Indians.
(ii) Community-based support services
for Indians and women pregnant with
Indian children.
(iii) Community-based housing for
adult Indians with fetal alcohol
disorder.
(3) Criteria for applications.--The Secretary shall
establish criteria for the review and approval of
applications for funding under this section.
(b) Services.--The Secretary, acting through the Service and
Indian Tribes, Tribal Organizations, and Urban Indian
Organizations, shall--
(1) develop and provide services for the prevention,
intervention, treatment, and aftercare for those
affected by fetal alcohol disorder in Indian
communities; and
(2) provide supportive services, including services
to meet the special educational, vocational, school-to-
work transition, and independent living needs of
adolescent and adult Indians with fetal alcohol
disorder.
(c) Task Force.--The Secretary shall establish a task force
to be known as the Fetal Alcohol Disorder Task Force to advise
the Secretary in carrying out subsection (b). Such task force
shall be composed of representatives from the following:
(1) The National Institute on Drug Abuse.
(2) The National Institute on Alcohol and Alcoholism.
(3) The Office of Substance Abuse Prevention.
(4) The National Institute of Mental Health.
(5) The Service.
(6) The Office of Minority Health of the Department
of Health and Human Services.
(7) The Administration for Native Americans.
(8) The National Institute of Child Health and Human
Development (NICHD).
(9) The Centers for Disease Control and Prevention.
(10) The Bureau of Indian Affairs.
(11) Indian Tribes.
(12) Tribal Organizations.
(13) Urban Indian Organizations.
(14) Indian fetal alcohol disorder experts.
(d) Applied Research Projects.--The Secretary, acting through
the Substance Abuse and Mental Health Services Administration,
shall make grants to Indian Tribes, Tribal Organizations, and
Urban Indian Organizations for applied research projects which
propose to elevate the understanding of methods to prevent,
intervene, treat, or provide rehabilitation and behavioral
health aftercare for Indians and Urban Indians affected by
fetal alcohol disorder.
(e) Funding for Urban Indian Organizations.--Ten percent of
the funds appropriated pursuant to this section shall be used
to make grants to Urban Indian Organizations funded under title
V.
SEC. 713. CHILD SEXUAL ABUSE AND PREVENTION TREATMENT PROGRAMS.
(a) Establishment.--The Secretary, acting through the
Service, and the Secretary of the Interior, Indian Tribes, and
Tribal Organizations, shall establish, consistent with section
701, in every Service Area, programs involving treatment for--
(1) victims of sexual abuse who are Indian children
or children in an Indian household; and
(2) perpetrators of child sexual abuse who are Indian
or members of an Indian household.
(b) Use of Funds.--Funding provided pursuant to this section
shall be used for the following:
(1) To develop and provide community education and
prevention programs related to sexual abuse of Indian
children or children in an Indian household.
(2) To identify and provide behavioral health
treatment to victims of sexual abuse who are Indian
children or children in an Indian household, and to
their family members who are affected by sexual abuse.
(3) To develop prevention and intervention models
which incorporate traditional health care practices,
cultural values, and community involvement.
(4) To develop and implement culturally sensitive
assessment and diagnostic tools for use in Indian
communities and Urban Centers.
(5) To identify and provide behavioral health
treatment to Indian perpetrators and perpetrators who
are members of an Indian household--
(A) making efforts to begin offender and
behavioral health treatment while the
perpetrator is incarcerated or at the earliest
possible date if the perpetrator is not
incarcerated; and
(B) providing treatment after the perpetrator
is released, until it is determined that the
perpetrator is not a threat to children.
(c) Coordination.--The programs established under subsection
(a) shall be carried out in coordination with programs and
services authorized under the Indian Child Protection and
Family Violence Prevention Act (25 U.S.C. 3201 et seq.).
SEC. 714. BEHAVIORAL HEALTH RESEARCH.
The Secretary, in consultation with appropriate Federal
agencies, shall make grants to, or enter into contracts with,
Indian Tribes, Tribal Organizations, and Urban Indian
Organizations or enter into contracts with, or make grants to
appropriate institutions for, the conduct of research on the
incidence and prevalence of behavioral health problems among
Indians served by the Service, Indian Tribes, or Tribal
Organizations and among Indians in urban areas. Research
priorities under this section shall include--
(1) the multifactorial causes of Indian youth
suicide, including--
(A) protective and risk factors and
scientific data that identifies those factors;
and
(B) the effects of loss of cultural identity
and the development of scientific data on those
effects;
(2) the interrelationship and interdependence of
behavioral health problems with alcoholism and other
substance abuse, suicide, homicides, other injuries,
and the incidence of family violence; and
(3) the development of models of prevention
techniques.
The effect of the interrelationships and interdependencies
referred to in paragraph (2) on children, and the development
of prevention techniques under paragraph (3) applicable to
children, shall be emphasized.
SEC. 715. DEFINITIONS.
For the purpose of this title, the following definitions
shall apply:
(1) Assessment.--The term ``assessment'' means the
systematic collection, analysis, and dissemination of
information on health status, health needs, and health
problems.
(2) Alcohol-related neurodevelopmental disorders or
arnd.--The term ``alcohol-related neurodevelopmental
disorders'' or ``ARND'' means, with a history of
maternal alcohol consumption during pregnancy, central
nervous system involvement such as developmental delay,
intellectual deficit, or neurologic abnormalities.
Behaviorally, there can be problems with irritability,
and failure to thrive as infants. As children become
older there will likely be hyperactivity, attention
deficit, language dysfunction, and perceptual and
judgment problems.
(3) Behavioral health aftercare.--The term
``behavioral health aftercare'' includes those
activities and resources used to support recovery
following inpatient, residential, intensive substance
abuse, or mental health outpatient or outpatient
treatment. The purpose is to help prevent or deal with
relapse by ensuring that by the time a client or
patient is discharged from a level of care, such as
outpatient treatment, an aftercare plan has been
developed with the client. An aftercare plan may use
such resources as a community-based therapeutic group,
transitional living facilities, a 12-step sponsor, a
local 12-step or other related support group, and other
community-based providers.
(4) Dual diagnosis.--The term ``dual diagnosis''
means coexisting substance abuse and mental illness
conditions or diagnosis. Such clients are sometimes
referred to as mentally ill chemical abusers (MICAs).
(5) Fetal alcohol disorders.--The term ``fetal
alcohol disorders'' means fetal alcohol syndrome,
partial fetal alcohol syndrome and alcohol related
neurodevelopmental disorder (ARND).
(6) Fetal alcohol syndrome or fas.--The term ``fetal
alcohol syndrome'' or ``FAS'' means a syndrome in
which, with a history of maternal alcohol consumption
during pregnancy, the following criteria are met:
(A) Central nervous system involvement such
as developmental delay, intellectual deficit,
microencephaly, or neurologic abnormalities.
(B) Craniofacial abnormalities with at least
2 of the following: microophthalmia, short
palpebral fissures, poorly developed philtrum,
thin upper lip, flat nasal bridge, and short
upturned nose.
(C) Prenatal or postnatal growth delay.
(7) Partial fas.--The term ``partial FAS'' means,
with a history of maternal alcohol consumption during
pregnancy, having most of the criteria of FAS, though
not meeting a minimum of at least 2 of the following:
microophthalmia, short palpebral fissures, poorly
developed philtrum, thin upper lip, flat nasal bridge,
and short upturned nose.
(8) Rehabilitation.--The term ``rehabilitation''
means to restore the ability or capacity to engage in
usual and customary life activities through education
and therapy.
(9) Substance abuse.--The term ``substance abuse''
includes inhalant abuse.
SEC. 716. AUTHORIZATION OF APPROPRIATIONS.
There is authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2017 to
carry out the provisions of this title.
TITLE VIII--MISCELLANEOUS
SEC. 801. REPORTS.
For each fiscal year following the date of enactment of the
Indian Health Care Improvement Act Amendments of 2007, the
Secretary shall transmit to Congress a report containing the
following:
(1) A report on the progress made in meeting the
objectives of this Act, including a review of programs
established or assisted pursuant to this Act and
assessments and recommendations 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, Tribal
Organizations, and Urban Indian Organizations to
address such impact, including a report on proposed
changes in allocation of funding pursuant to section
808.
(3) A report on the use of health services by
Indians--
(A) on a national and area or other relevant
geographical basis;
(B) by gender and age;
(C) by source of payment and type of service;
(D) comparing such rates of use with rates of
use among comparable non-Indian populations;
and
(E) provided under contracts.
(4) A report of contractors to the Secretary on
Health Care Educational Loan Repayments every 6 months
required by section 110.
(5) A general audit report of the Secretary on the
Health Care Educational Loan Repayment Program as
required by section 110(n).
(6) A report of the findings and conclusions of
demonstration programs on development of educational
curricula for substance abuse counseling as required in
section 125(f).
(7) A separate statement which specifies the amount
of funds requested to carry out the provisions of
section 201.
(8) A report of the evaluations of health promotion
and disease prevention as required in section 203(c).
(9) A biennial report to Congress on infectious
diseases as required by section 212.
(10) A report on environmental and nuclear health
hazards as required by section 215.
(11) An annual report on the status of all health
care facilities needs as required by section
301(c)(2)(B) and 301(d).
(12) Reports on safe water and sanitary waste
disposal facilities as required by section 302(h).
(13) An annual report on the expenditure of non-
Service funds for renovation as required by sections
304(b)(2).
(14) A report identifying the backlog of maintenance
and repair required at Service and tribal facilities
required by section 313(a).
(15) A report providing an accounting of
reimbursement funds made available to the Secretary
under titles XVIII, XIX, and XXI of the Social Security
Act.
(16) A report on any arrangements for the sharing of
medical facilities or services, as authorized by
section 406.
(17) A report on evaluation and renewal of Urban
Indian programs under section 505.
(18) A report on the evaluation of programs as
required by section 513(d).
(19) A report on alcohol and substance abuse as
required by section 701(f).
(20) A report on Indian youth mental health services
as required by section 707(h).
(21) A report on the reallocation of base resources
if required by section 808.
(22) Report regarding patient movement.--A report on
the movement of patients between Service Units,
including--
(A) a list of those Service Units that have a
net increase and those that have a net decrease
of patients due to patients assigned to one
Service Unit voluntarily choosing to receive
service at another Service Unit;
(B) an analysis of the effect of patient
movement on the quality of services for those
Service Units experiencing an increase in the
number of patients served; and
(C) what funding changes are necessary to
maintain a consistent quality of service at
Service Units that have an increase in the
number of patients served.
SEC. 802. REGULATIONS.
(a) Deadlines.--
(1) Procedures.--Not later than 90 days after the
date of enactment of the Indian Health Care Improvement
Act Amendments of 2007, the Secretary shall initiate
procedures under subchapter III of chapter 5 of title
5, United States Code, to negotiate and promulgate such
regulations or amendments thereto that are necessary to
carry out titles II (except section 202) and VII, the
sections of title III for which negotiated rulemaking
is specifically required, and section 807. Unless
otherwise required, the Secretary may promulgate
regulations to carry out titles I, III, IV, and V, and
section 202, using the procedures required by chapter V
of title 5, United States Code (commonly known as the
``Administrative Procedure Act'').
(2) Proposed regulations.--Proposed regulations to
implement this Act shall be published in the Federal
Register by the Secretary no later than 2 years after
the date of enactment of the Indian Health Care
Improvement Act Amendments of 2007 and shall have no
less than a 120-day comment period.
(3) Final regulations.--The Secretary shall publish
in the Federal Register final regulations to implement
this Act by not later than 3 years after the date of
enactment of the Indian Health Care Improvement Act
Amendments of 2007.
(b) Committee.--A negotiated rulemaking committee established
pursuant to section 565 of title 5, United States Code, to
carry out this section shall have as its members only
representatives of the Federal Government and representatives
of Indian Tribes, and Tribal Organizations, a majority of whom
shall be nominated by and be representatives of Indian Tribes
and Tribal Organizations from each Service Area.
(c) Adaptation of Procedures.--The Secretary shall adapt the
negotiated rulemaking procedures to the unique context of self-
governance and the government-to-government relationship
between the United States and Indian Tribes.
(d) Lack of Regulations.--The lack of promulgated regulations
shall not limit the effect of this Act.
(e) Inconsistent Regulations.--The provisions of this Act
shall supersede any conflicting provisions of law in effect on
the day before the date of enactment of the Indian Health Care
Improvement Act Amendments of 2007, and the Secretary is
authorized to repeal any regulation inconsistent with the
provisions of this Act.
SEC. 803. PLAN OF IMPLEMENTATION.
Not later than 9 months after the date of enactment of the
Indian Health Care Improvement Act Amendments of 2007, the
Secretary, in consultation with Indian Tribes, Tribal
Organizations, and Urban Indian Organizations, shall submit to
Congress a plan explaining the manner and schedule, by title
and section, by which the Secretary will implement the
provisions of this Act. This consultation may be conducted
jointly with the annual budget consultation pursuant to the
Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq).
SEC. 804. AVAILABILITY OF FUNDS.
The funds appropriated pursuant to this Act shall remain
available until expended.
SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED TO INDIAN HEALTH
SERVICE.
Any limitation on the use of funds contained in an Act
providing appropriations for the Department for a period with
respect to the performance of abortions shall apply for that
period with respect to the performance of abortions using funds
contained in an Act providing appropriations for the Service.
SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.
(a) In General.--The following California Indians shall be
eligible for health services provided by the Service:
(1) Any member of a federally recognized Indian
Tribe.
(2) Any descendant of an Indian who was residing in
California on June 1, 1852, if such descendant--
(A) is a member of the Indian community
served by a local program of the Service; and
(B) is regarded as an Indian by the community
in which such descendant lives.
(3) Any Indian who holds trust interests in public
domain, national forest, or reservation allotments in
California.
(4) Any Indian in California who is listed on the
plans for distribution of the assets of rancherias and
reservations located within the State of California
under the Act of August 18, 1958 (72 Stat. 619), and
any descendant of such an Indian.
(b) Clarification.--Nothing in this section may be construed
as expanding the eligibility of California Indians for health
services provided by the Service beyond the scope of
eligibility for such health services that applied on May 1,
1986.
SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS.
(a) Children.--Any individual who--
(1) has not attained 19 years of age;
(2) is the natural or adopted child, stepchild,
foster child, legal ward, or orphan of an eligible
Indian; and
(3) is not otherwise eligible for health services
provided by the Service,
shall be eligible for all health services provided by the
Service on the same basis and subject to the same rules that
apply to eligible Indians until such individual attains 19
years of age. The existing and potential health needs of all
such individuals shall be taken into consideration by the
Service in determining the need for, or the allocation of, the
health resources of the Service. If such an individual has been
determined to be legally incompetent prior to attaining 19
years of age, such individual shall remain eligible for such
services until 1 year after the date of a determination of
competency.
(b) Spouses.--Any spouse of an eligible Indian who is not an
Indian, or who is of Indian descent but is not otherwise
eligible for the health services provided by the Service, shall
be eligible for such health services if all such spouses or
spouses who are married to members of each Indian Tribe being
served are made eligible, as a class, by an appropriate
resolution of the governing body of the Indian Tribe or Tribal
Organization providing such services. The health needs of
persons made eligible under this paragraph shall not be taken
into consideration by the Service in determining the need for,
or allocation of, its health resources.
(c) Provision of Services to Other Individuals.--
(1) In general.--The Secretary is authorized to
provide health services under this subsection through
health programs operated directly by the Service to
individuals who reside within the Service Unit and who
are not otherwise eligible for such health services
if--
(A) the Indian Tribes served by such Service
Unit request such provision of health services
to such individuals; and
(B) the Secretary and the served Indian
Tribes have jointly determined that--
(i) the provision of such health
services will not result in a denial or
diminution of health services to
eligible Indians; and
(ii) there is no reasonable
alternative health facilities or
services, within or without the Service
Unit, available to meet the health
needs of such individuals.
(2) ISDEAA programs.--In the case of health programs
and facilities operated under a contract or compact
entered into under the Indian Self-Determination and
Education Assistance Act (25 U.S.C. 450 et seq.), the
governing body of the Indian Tribe or Tribal
Organization providing health services under such
contract or compact is authorized to determine whether
health services should be provided under such contract
to individuals who are not eligible for such health
services under any other subsection of this section or
under any other provision of law. In making such
determinations, the governing body of the Indian Tribe
or Tribal Organization shall take into account the
considerations described in paragraph (1)(B).
(3) Payment for services.--
(A) In general.--Persons receiving health
services provided by the Service under this
subsection shall be liable for payment of such
health services under a schedule of charges
prescribed by the Secretary which, in the
judgment of the Secretary, results in
reimbursement in an amount not less than the
actual cost of providing the health services.
Notwithstanding section 404 of this Act or any
other provision of law, amounts collected under
this subsection, including Medicare, Medicaid,
or SCHIP reimbursements under titles XVIII,
XIX, and XXI of the Social Security Act, shall
be credited to the account of the program
providing the service and shall be used for the
purposes listed in section 401(d)(2) and
amounts collected under this subsection shall
be available for expenditure within such
program.
(B) Indigent people.--Health services may be
provided by the Secretary through the Service
under this subsection to an indigent individual
who would not be otherwise eligible for such
health services but for the provisions of
paragraph (1) only if an agreement has been
entered into with a State or local government
under which the State or local government
agrees to reimburse the Service for the
expenses incurred by the Service in providing
such health services to such indigent
individual.
(4) Revocation of consent for services.--
(A) Single tribe service area.--In the case
of a Service Area which serves only 1 Indian
Tribe, the authority of the Secretary to
provide health services under paragraph (1)
shall terminate at the end of the fiscal year
succeeding the fiscal year in which the
governing body of the Indian Tribe revokes its
concurrence to the provision of such health
services.
(B) Multitribal service area.--In the case of
a multitribal Service Area, the authority of
the Secretary to provide health services under
paragraph (1) shall terminate at the end of the
fiscal year succeeding the fiscal year in which
at least 51 percent of the number of Indian
Tribes in the Service Area revoke their
concurrence to the provisions of such health
services.
(d) Other Services.--The Service may provide health services
under this subsection to individuals who are not eligible for
health services provided by the Service under any other
provision of law in order to--
(1) achieve stability in a medical emergency;
(2) prevent the spread of a communicable disease or
otherwise deal with a public health hazard;
(3) provide care to non-Indian women pregnant with an
eligible Indian's child for the duration of the
pregnancy through postpartum; or
(4) provide care to immediate family members of an
eligible individual if such care is directly related to
the treatment of the eligible individual.
(e) Hospital Privileges for Practitioners.--Hospital
privileges in health facilities operated and maintained by the
Service or operated under a contract or compact pursuant to the
Indian Self-Determination and Education Assistance Act (25
U.S.C. 450 et seq.) may be extended to non-Service health care
practitioners who provide services to individuals described in
subsection (a), (b), (c), or (d). Such non-Service health care
practitioners may, as part of the privileging process, be
designated as employees of the Federal Government for purposes
of section 1346(b) and chapter 171 of title 28, United States
Code (relating to Federal tort claims) only with respect to
acts or omissions which occur in the course of providing
services to eligible individuals as a part of the conditions
under which such hospital privileges are extended.
(f) Eligible Indian.--For purposes of this section, the term
``eligible Indian'' means any Indian who is eligible for health
services provided by the Service without regard to the
provisions of this section.
SEC. 808. REALLOCATION OF BASE RESOURCES.
(a) Report Required.--Notwithstanding any other provision of
law, any allocation of Service funds for a fiscal year that
reduces by 5 percent or more from the previous fiscal year the
funding for any recurring program, project, or activity of a
Service Unit may be implemented only after the Secretary has
submitted to Congress, under section 801, a report on the
proposed change in allocation of funding, including the reasons
for the change and its likely effects.
(b) Exception.--Subsection (a) shall not apply if the total
amount appropriated to the Service for a fiscal year is at
least 5 percent less than the amount appropriated to the
Service for the previous fiscal year.
SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.
The Secretary shall provide for the dissemination to Indian
Tribes, Tribal Organizations, and Urban Indian Organizations of
the findings and results of demonstration projects conducted
under this Act.
SEC. 810. PROVISION OF SERVICES IN MONTANA.
(a) Consistent With Court Decision.--The Secretary, acting
through the Service, shall provide services and benefits for
Indians in Montana in a manner consistent with the decision of
the United States Court of Appeals for the Ninth Circuit in
McNabb for McNabb v. Bowen, 829 F.2d 787 (9th Cir. 1987).
(b) Clarification.--The provisions of subsection (a) shall
not be construed to be an expression of the sense of Congress
on the application of the decision described in subsection (a)
with respect to the provision of services or benefits for
Indians living in any State other than Montana.
SEC. 811. MORATORIUM.
During the period of the moratorium imposed on implementation
of the final rule published in the Federal Register on
September 16, 1987, by the Department of Health and Human
Services, relating to eligibility for the health care services
of the Indian Health Service, the Indian Health Service shall
provide services pursuant to the criteria for eligibility for
such services that were in effect on September 15, 1987,
subject to the provisions of sections 806 and 807, until the
Service has submitted to the Committees on Appropriations of
the Senate and the House of Representatives a budget request
reflecting the increased costs associated with the proposed
final rule, and the request has been included in an
appropriations Act and enacted into law.
SEC. 812. SEVERABILITY PROVISIONS.
If any provision of this Act, any amendment made by the Act,
or the application of such provision or amendment to any person
or circumstances is held to be invalid, the remainder of this
Act, the remaining amendments made by this Act, and the
application of such provisions to persons or circumstances
other than those to which it is held invalid, shall not be
affected thereby.
SEC. 813. ESTABLISHMENT OF NATIONAL BIPARTISAN COMMISSION ON INDIAN
HEALTH CARE.
(a) Establishment.--There is established the National
Bipartisan Indian Health Care Commission (the ``Commission'').
(b) Duties of Commission.--The duties of the Commission are
the following:
(1) To establish a study committee composed of those
members of the Commission appointed by the Director of
the Service and at least 4 members of Congress from
among the members of the Commission, the duties of
which shall be the following:
(A) To the extent necessary to carry out its
duties, collect and compile data necessary to
understand the extent of Indian needs with
regard to the provision of health services,
regardless of the location of Indians,
including holding hearings and soliciting the
views of Indians, Indian Tribes, Tribal
Organizations, and Urban Indian Organizations,
which may include authorizing and making funds
available for feasibility studies of various
models for providing and funding health
services for all Indian beneficiaries,
including those who live outside of a
reservation, temporarily or permanently.
(B) To make legislative recommendations to
the Commission regarding the delivery of
Federal health care services to Indians. Such
recommendations shall include those related to
issues of eligibility, benefits, the range of
service providers, the cost of such services,
financing such services, and the optimal manner
in which to provide such services.
(C) To determine the effect of the enactment
of such recommendations on (i) the existing
system of delivery of health services for
Indians, and (ii) the sovereign status of
Indian Tribes.
(D) Not later than 12 months after the
appointment of all members of the Commission,
to submit a written report of its findings and
recommendations to the full Commission. The
report shall include a statement of the
minority and majority position of the Committee
and shall be disseminated, at a minimum, to
every Indian Tribe, Tribal Organization, and
Urban Indian Organization for comment to the
Commission.
(E) To report regularly to the full
Commission regarding the findings and
recommendations developed by the study
committee in the course of carrying out its
duties under this section.
(2) To review and analyze the recommendations of the
report of the study committee.
(3) To make legislative recommendations to Congress
regarding the delivery of Federal health care services
to Indians. Such recommendations shall include those
related to issues of eligibility, benefits, the range
of service providers, the cost of such services,
financing such services, and the optimal manner in
which to provide such services.
(4) Not later than 18 months following the date of
appointment of all members of the Commission, submit a
written report to Congress regarding the delivery of
Federal health care services to Indians. Such
recommendations shall include those related to issues
of eligibility, benefits, the range of service
providers, the cost of such services, financing such
services, and the optimal manner in which to provide
such services.
(c) Members.--
(1) Appointment.--The Commission shall be composed of
25 members, appointed as follows:
(A) Ten members of Congress, including 3 from
the House of Representatives and 2 from the
Senate, appointed by their respective majority
leaders, and 3 from the House of
Representatives and 2 from the Senate,
appointed by their respective minority leaders,
and who shall be members of the standing
committees of Congress that consider
legislation affecting health care to Indians.
(B) Twelve persons chosen by the
congressional members of the Commission, 1 from
each Service Area as currently designated by
the Director of the Service to be chosen from
among 3 nominees from each Service Area put
forward by the Indian Tribes within the area,
with due regard being given to the experience
and expertise of the nominees in the provision
of health care to Indians and to a reasonable
representation on the commission of members who
are familiar with various health care delivery
modes and who represent Indian Tribes of
various size populations.
(C) Three persons appointed by the Director
who are knowledgeable about the provision of
health care to Indians, at least 1 of whom
shall be appointed from among 3 nominees put
forward by those programs whose funds are
provided in whole or in part by the Service
primarily or exclusively for the benefit of
Urban Indians.
(D) All those persons chosen by the
congressional members of the Commission and by
the Director shall be members of federally
recognized Indian Tribes.
(2) Chair; vice chair.--The Chair and Vice Chair of
the Commission shall be selected by the congressional
members of the Commission.
(3) Terms.--The terms of members of the Commission
shall be for the life of the Commission.
(4) Deadline for appointments.--Congressional members
of the Commission shall be appointed not later than 180
days after the date of enactment of the Indian Health
Care Improvement Act Amendments of 2007, and the
remaining members of the Commission shall be appointed
not later than 60 days following the appointment of the
congressional members.
(5) Vacancy.--A vacancy in the Commission shall be
filled in the manner in which the original appointment
was made.
(d) Compensation.--
(1) Congressional members.--Each congressional member
of the Commission shall receive no additional pay,
allowances, or benefits by reason of their service on
the Commission and shall receive travel expenses and
per diem in lieu of subsistence in accordance with
sections 5702 and 5703 of title 5, United States Code.
(2) Other members.--Remaining members of the
Commission, while serving on the business of the
Commission (including travel time), shall be entitled
to receive compensation at the per diem equivalent of
the rate provided for level IV of the Executive
Schedule under section 5315 of title 5, United States
Code, and while so serving away from home and the
member's regular place of business, a member may be
allowed travel expenses, as authorized by the Chairman
of the Commission. For purpose of pay (other than pay
of members of the Commission) and employment benefits,
rights, and privileges, all personnel of the Commission
shall be treated as if they were employees of the
United States Senate.
(e) Meetings.--The Commission shall meet at the call of the
Chair.
(f) Quorum.--A quorum of the Commission shall consist of not
less than 15 members, provided that no less than 6 of the
members of Congress who are Commission members are present and
no less than 9 of the members who are Indians are present.
(g) Executive Director; Staff; Facilities.--
(1) Appointment; pay.--The Commission shall appoint
an executive director of the Commission. The executive
director shall be paid the rate of basic pay for level
V of the Executive Schedule.
(2) Staff appointment.--With the approval of the
Commission, the executive director may appoint such
personnel as the executive director deems appropriate.
(3) Staff pay.--The staff of the Commission shall be
appointed without regard to the provisions of title 5,
United States Code, governing appointments in the
competitive service, and shall be paid without regard
to the provisions of chapter 51 and subchapter III of
chapter 53 of such title (relating to classification
and General Schedule pay rates).
(4) Temporary services.--With the approval of the
Commission, the executive director may procure
temporary and intermittent services under section
3109(b) of title 5, United States Code.
(5) Facilities.--The Administrator of General
Services shall locate suitable office space for the
operation of the Commission. The facilities shall serve
as the headquarters of the Commission and shall include
all necessary equipment and incidentals required for
the proper functioning of the Commission.
(h) Hearings.--(1) For the purpose of carrying out its
duties, the Commission may hold such hearings and undertake
such other activities as the Commission determines to be
necessary to carry out its duties, provided that at least 6
regional hearings are held in different areas of the United
States in which large numbers of Indians are present. Such
hearings are to be held to solicit the views of Indians
regarding the delivery of health care services to them. To
constitute a hearing under this subsection, at least 5 members
of the Commission, including at least 1 member of Congress,
must be present. Hearings held by the study committee
established in this section may count toward the number of
regional hearings required by this subsection.
(2) Upon request of the Commission, the Comptroller General
shall conduct such studies or investigations as the Commission
determines to be necessary to carry out its duties.
(3)(A) The Director of the Congressional Budget Office or the
Chief Actuary of the Centers for Medicare & Medicaid Services,
or both, shall provide to the Commission, upon the request of
the Commission, such cost estimates as the Commission
determines to be necessary to carry out its duties.
(B) The Commission shall reimburse the Director of the
Congressional Budget Office for expenses relating to the
employment in the office of that Director of such additional
staff as may be necessary for the Director to comply with
requests by the Commission under subparagraph (A).
(4) Upon the request of the Commission, the head of any
Federal agency is authorized to detail, without reimbursement,
any of the personnel of such agency to the Commission to assist
the Commission in carrying out its duties. Any such detail
shall not interrupt or otherwise affect the civil service
status or privileges of the Federal employee.
(5) Upon the request of the Commission, the head of a Federal
agency shall provide such technical assistance to the
Commission as the Commission determines to be necessary to
carry out its duties.
(6) The Commission may use the United States mails in the
same manner and under the same conditions as Federal agencies
and shall, for purposes of the frank, be considered a
commission of Congress as described in section 3215 of title
39, United States Code.
(7) The Commission may secure directly from any Federal
agency information necessary to enable it to carry out its
duties, if the information may be disclosed under section 552
of title 4, United States Code. Upon request of the Chairman of
the Commission, the head of such agency shall furnish such
information to the Commission.
(8) Upon the request of the Commission, the Administrator of
General Services shall provide to the Commission on a
reimbursable basis such administrative support services as the
Commission may request.
(9) For purposes of costs relating to printing and binding,
including the cost of personnel detailed from the Government
Printing Office, the Commission shall be deemed to be a
committee of Congress.
(i) Authorization of Appropriations.--There is authorized to
be appropriated $4,000,000 to carry out the provisions of this
section, which sum shall not be deducted from or affect any
other appropriation for health care for Indian persons.
(j) Nonapplicability of FACA.--The Federal Advisory Committee
Act (5 U.S.C. App.) shall not apply to the Commission.
SEC. 814. CONFIDENTIALITY OF MEDICAL QUALITY ASSURANCE RECORDS;
QUALIFIED IMMUNITY FOR PARTICIPANTS.
(a) Confidentiality of Records.--Medical quality assurance
records created by or for any Indian Health Program or a health
program of an Urban Indian Organization as part of a medical
quality assurance program are confidential and privileged. Such
records may not be disclosed to any person or entity, except as
provided in subsection (c).
(b) Prohibition on Disclosure and Testimony.--
(1) In general.--No part of any medical quality
assurance record described in subsection (a) may be
subject to discovery or admitted into evidence in any
judicial or administrative proceeding, except as
provided in subsection (c).
(2) Testimony.--A person who reviews or creates
medical quality assurance records for any Indian Health
Program or Urban Indian Organization who participates
in any proceeding that reviews or creates such records
may not be permitted or required to testify in any
judicial or administrative proceeding with respect to
such records or with respect to any finding,
recommendation, evaluation, opinion, or action taken by
such person or body in connection with such records
except as provided in this section.
(c) Authorized Disclosure and Testimony.--
(1) In general.--Subject to paragraph (2), a medical
quality assurance record described in subsection (a)
may be disclosed, and a person referred to in
subsection (b) may give testimony in connection with
such a record, only as follows:
(A) To a Federal executive agency or private
organization, if such medical quality assurance
record or testimony is needed by such agency or
organization to perform licensing or
accreditation functions related to any Indian
Health Program or to a health program of an
Urban Indian Organization to perform
monitoring, required by law, of such program or
organization.
(B) To an administrative or judicial
proceeding commenced by a present or former
Indian Health Program or Urban Indian
Organization provider concerning the
termination, suspension, or limitation of
clinical privileges of such health care
provider.
(C) To a governmental board or agency or to a
professional health care society or
organization, if such medical quality assurance
record or testimony is needed by such board,
agency, society, or organization to perform
licensing, credentialing, or the monitoring of
professional standards with respect to any
health care provider who is or was an employee
of any Indian Health Program or Urban Indian
Organization.
(D) To a hospital, medical center, or other
institution that provides health care services,
if such medical quality assurance record or
testimony is needed by such institution to
assess the professional qualifications of any
health care provider who is or was an employee
of any Indian Health Program or Urban Indian
Organization and who has applied for or been
granted authority or employment to provide
health care services in or on behalf of such
program or organization.
(E) To an officer, employee, or contractor of
the Indian Health Program or Urban Indian
Organization that created the records or for
which the records were created. If that
officer, employee, or contractor has a need for
such record or testimony to perform official
duties.
(F) To a criminal or civil law enforcement
agency or instrumentality charged under
applicable law with the protection of the
public health or safety, if a qualified
representative of such agency or
instrumentality makes a written request that
such record or testimony be provided for a
purpose authorized by law.
(G) In an administrative or judicial
proceeding commenced by a criminal or civil law
enforcement agency or instrumentality referred
to in subparagraph (F), but only with respect
to the subject of such proceeding.
(2) Identity of participants.--With the exception of
the subject of a quality assurance action, the identity
of any person receiving health care services from any
Indian Health Program or Urban Indian Organization or
the identity of any other person associated with such
program or organization for purposes of a medical
quality assurance program that is disclosed in a
medical quality assurance record described in
subsection (a) shall be deleted from that record or
document before any disclosure of such record is made
outside such program or organization. Such requirement
does not apply to the release of information pursuant
to section 552a of title 5.
(d) Disclosure for Certain Purposes.--
(1) In general.--Nothing in this section shall be
construed as authorizing or requiring the withholding
from any person or entity aggregate statistical
information regarding the results of any Indian Health
Program or Urban Indian Organizations's medical quality
assurance programs.
(2) Withholding from congress.--Nothing in this
section shall be construed as authority to withhold any
medical quality assurance record from a committee of
either House of Congress, any joint committee of
Congress, or the Government Accountability Office if
such record pertains to any matter within their
respective jurisdictions.
(e) Prohibition on Disclosure of Record or Testimony.--A
person or entity having possession of or access to a record or
testimony described by this section may not disclose the
contents of such record or testimony in any manner or for any
purpose except as provided in this section.
(f) Exemption From Freedom of Information Act.--Medical
quality assurance records described in subsection (a) may not
be made available to any person under section 552 of title 5.
(g) Limitation on Civil Liability.--A person who participates
in or provides information to a person or body that reviews or
creates medical quality assurance records described in
subsection (a) shall not be civilly liable for such
participation or for providing such information if the
participation or provision of information was in good faith
based on prevailing professional standards at the time the
medical quality assurance program activity took place.
(h) Application to Information in Certain Other Records.--
Nothing in this section shall be construed as limiting access
to the information in a record created and maintained outside a
medical quality assurance program, including a patient's
medical records, on the grounds that the information was
presented during meetings of a review body that are part of a
medical quality assurance program.
(i) Regulations.--The Secretary, acting through the Service,
shall promulgate regulations pursuant to section 802.
(j) Definitions.--In this section:
(1) The term ``health care provider'' means any
health care professional, including community health
aides and practitioners certified under section 121,
who are granted clinical practice privileges or
employed to provide health care services in an Indian
Health Program or health program of an Urban Indian
Organization, who is licensed or certified to perform
health care services by a governmental board or agency
or professional health care society or organization.
(2) The term ``medical quality assurance program''
means any activity carried out before, on, or after the
date of enactment of this Act by or for any Indian
Health Program or Urban Indian Organization to assess
the quality of medical care, including activities
conducted by or on behalf of individuals, Indian Health
Program or Urban Indian Organization medical or dental
treatment review committees, or other review bodies
responsible for quality assurance, credentials,
infection control, patient safety, patient care
assessment (including treatment procedures, blood,
drugs, and therapeutics), medical records, health
resources management review and identification and
prevention of medical or dental incidents and risks.
(3) The term ``medical quality assurance record''
means the proceedings, records, minutes, and reports
that emanate from quality assurance program activities
described in paragraph (2) and are produced or compiled
by or for an Indian Health Program or Urban Indian
Organization as part of a medical quality assurance
program.
SEC. 815. APPROPRIATIONS; AVAILABILITY.
Any new spending authority (described in subparagraph (A) or
(B) of section 401(c)(2) of the Congressional Budget Act of
1974 (Public Law 93-344; 88 Stat. 317)) which is provided under
this Act shall be effective for any fiscal year only to such
extent or in such amounts as are provided in appropriation
Acts.
SEC. 816. AUTHORIZATION OF APPROPRIATIONS.
There are authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2017 to
carry out this title.
* * * * * * *
---------- -
TITLE 5, UNITED STATES CODE
-
* * * * * * *
PART III--EMPLOYEES
* * * * * * *
SUBPART D--PAY AND ALLOWANCES
* * * * * * *
CHAPTER 53--PAY RATES AND SYSTEMS
* * * * * * *
SUBCHAPTER II--EXECUTIVE SCHEDULE PAY RATES
* * * * * * *
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:
Deputy Administrator of General Services.
* * * * * * *
[Assistant Secretaries of Health and Human Services
(6)] Assistant Secretaries of Health and Human Services
(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 chapter 11 of
title 2, as adjusted by section 5318 of this title:
Administrator, Bonneville Power Administration,
Department of the Interior.
* * * * * * *
[Director, Indian Health Service, Department of
Health and Human Services.]
* * * * * * *
----------
CHILDREN'S HEALTH ACT OF 2000
SEC. 3307. ESTABLISHMENT OF COMMISSION.
(a) * * *
(b) Membership.--
(1) In general.--The Commission established under
subsection (a) shall consist of--
(A) * * *
(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
* * * * * * *
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 or subsequently 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--
(1) the current priority of Indian and Alaska Native
solid waste deficiencies,
(2) the methodology of determining the priority
listing,
(3) the level of funding needed to effectively close
or bring into compliance all open dumps on Indian lands
or Alaska Native lands, and
(4) the progress made in addressing Indian and Alaska
Native solid waste deficiencies.
(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--
(1) * * *
* * * * * * *
[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--
(A) * * *
(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]
Assistant Secretary 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;
and
* * * * * * *
(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) * * *
* * * * * * *
(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 on specific Indian lands or
Alaska Native lands shall be developed in consultation with the
Indian tribal government or Alaska Native entity. The
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 DEMONSTRATION 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 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--
(1) * * *
* * * * * * *
SEC. 8. AUTHORIZATION OF APPROPRIATIONS.
(a) * * *
(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).
* * * * * * *
----------
SECTION 5504 OF THE AUGUSTUS F. HAWKINS-ROBERT T. STAFFORD ELEMENTARY
AND SECONDARY SCHOOL IMPROVEMENT AMENDMENTS OF 1988
SEC. 5504. ADMINISTRATIVE PROVISIONS.
(a) * * *
* * * * * * *
(d) Federal Agency Cooperation and Assistance.--
(1) * * *
(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.
* * * * * * *
---------- -
REHABILITATION ACT OF 1973
* * * * * * *
TITLE II--RESEARCH AND TRAINING
* * * * * * *
INTERAGENCY COMMITTEE
Sec. 203. (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 [Director of the Indian Health
Service] Assistant Secretary for Indian Health, and the
Director of the National Science Foundation.
* * * * * * *
---------- -
SECTION 518 OF THE FEDERAL WATER POLLUTION CONTROL ACT
SEC. 518. INDIAN TRIBES.
(a) * * *
(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--
(1) * * *
* * * * * * *
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.
* * * * * * *
----------
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE
* * * * * * *
Part B--Federal-State Cooperation
* * * * * * *
ORAL HEALTH PROMOTION AND DISEASE PREVENTION
Sec. 317M. (a) * * *
(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 referred to in
such paragraph] the Director of the Centers for
Disease Control and Prevention and the
Assistant Secretary for Indian Health 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.
* * * * * * *
TITLE IV--NATIONAL RESEARCH INSTITUTES
* * * * * * *
Part C--Specific Provisions Respecting National Research Institutes
Subpart 1--National Cancer Institute
* * * * * * *
SEC. 417C. GRANTS FOR EDUCATION, PREVENTION, AND EARLY DETECTION OF
RADIOGENIC CANCERS AND DISEASES.
(a) * * *
(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--
(1) * * *
* * * * * * *
---------- -
SAFE DRINKING WATER ACT
-TITLE XIV--SAFETY OF PUBLIC WATER SYSTEMS
* * * * * * *
Part E--General Provisions
* * * * * * *
STATE REVOLVING LOAN FUNDS
Sec. 1452. (a) * * *
* * * * * * *
(i) Indian Tribes.--
(1) * * *
(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.
* * * * * * *
---------- -
NATIVE AMERICAN PROGRAMS ACT OF 1974
* * * * * * *
TITLE VIII--NATIVE AMERICAN PROGRAMS
* * * * * * *
ESTABLISHMENT OF ADMINISTRATION FOR NATIVE AMERICANS
Sec. 803B. (a) * * *
* * * * * * *
(d)(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.
* * * * * * *
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SECTION 203 OF THE MICHIGAN INDIAN LAND CLAIMS SETTLEMENT ACT
SEC. 203. LIMITATION.
(a) * * *
(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--
(1) * * *
* * * * * * *
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ACT OF DECEMBER 17, 1970
(Public Law 91-557)
AN ACT To authorize the Secretary of the Interior to approve an
agreement entered into by the Soboba Band of Mission Indians releasing
a claim against the Metropolitan Water District of Southern California
and Eastern Municipal Water District, California, and to provide for
construction of a water distribution system and a water supply for the
Soboba Indian Reservation; and to authorize long-term leases of land on
the reservation.
* * * * * * *
Sec. 9. Nothing in this Act shall preclude the Soboba Band
of Mission Indians and the Soboba Indian Reservation from being
provided with sanitation facilities and services under the
authority of section 7 of the Act of August 5, 1954 (68 Stat.
674), as amended by the Act of July 31, 1959 (73 Stat. 267).
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INDIAN SELF-DETERMINATION AND EDUCATION ASSISTANCE ACT
* * * * * * *
TITLE [V] VII--AMERICAN INDIAN EDUCATION FOUNDATION
SEC. [501.] 701. AMERICAN INDIAN EDUCATION FOUNDATION.
(a) * * *
* * * * * * *
SEC. [502.] 702. ADMINISTRATIVE SERVICES AND SUPPORT.
(a) Provision of Support by Secretary.--Subject to subsection
(b), during the 5-year period beginning on the date that the
Foundation is established, the Secretary--
(1) * * *
(2) may provide funds to reimburse the travel
expenses of the members of the Board under [section
501] section 701; and
* * * * * * *
SEC. [503.] 703. DEFINITIONS.
For the purposes of this title--
(1) the term ``Bureau funded school'' has the meaning
given that term in title XI of the Education Amendments
of 1978;
(2) the term ``Foundation'' means the Foundation
established by the Secretary pursuant to [section 501]
section 701; and
* * * * * * *
TITLE VIII--NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION
SEC. 801. DEFINITIONS.
In this title:
(1) Board.--The term ``Board'' means the Board of
Directors of the Foundation.
(2) Committee.--The term ``Committee'' means the
Committee for the Establishment of Native American
Health and Wellness Foundation established under
section 802(f).
(3) Foundation.--The term ``Foundation'' means the
Native American Health and Wellness Foundation
established under section 802.
(4) Secretary.--The term ``Secretary'' means the
Secretary of Health and Human Services.
(5) Service.--The term ``Service'' means the Indian
Health Service of the Department of Health and Human
Services.
SEC. 802. NATIVE AMERICAN HEALTH AND WELLNESS FOUNDATION.
(a) Establishment.--
(1) In general.--As soon as practicable after the
date of enactment of this title, the Secretary shall
establish, under the laws of the District of Columbia
and in accordance with this title, the Native American
Health and Wellness Foundation.
(2) Funding determinations.--No funds, gift,
property, or other item of value (including any
interest accrued on such an item) acquired by the
Foundation shall--
(A) be taken into consideration for purposes
of determining Federal appropriations relating
to the provision of health care and services to
Indians; or
(B) otherwise limit, diminish, or affect the
Federal responsibility for the provision of
health care and services to Indians.
(b) Perpetual Existence.--The Foundation shall have perpetual
existence.
(c) Nature of Corporation.--The Foundation--
(1) shall be a charitable and nonprofit federally
chartered corporation; and
(2) shall not be an agency or instrumentality of the
United States.
(d) Place of Incorporation and Domicile.--The Foundation
shall be incorporated and domiciled in the District of
Columbia.
(e) Duties.--The Foundation shall--
(1) encourage, accept, and administer private gifts
of real and personal property, and any income from or
interest in such gifts, for the benefit of, or in
support of, the mission of the Service;
(2) undertake and conduct such other activities as
will further the health and wellness activities and
opportunities of Native Americans; and
(3) participate with and assist Federal, State, and
tribal governments, agencies, entities, and individuals
in undertaking and conducting activities that will
further the health and wellness activities and
opportunities of Native Americans.
(f) Committee for the Establishment of Native American Health
and Wellness Foundation.--
(1) In general.--The Secretary shall establish the
Committee for the Establishment of Native American
Health and Wellness Foundation to assist the Secretary
in establishing the Foundation.
(2) Duties.--Not later than 180 days after the date
of enactment of this section, the Committee shall--
(A) carry out such activities as are
necessary to incorporate the Foundation under
the laws of the District of Columbia, including
acting as incorporators of the Foundation;
(B) ensure that the Foundation qualifies for
and maintains the status required to carry out
this section, until the Board is established;
(C) establish the constitution and initial
bylaws of the Foundation;
(D) provide for the initial operation of the
Foundation, including providing for temporary
or interim quarters, equipment, and staff; and
(E) appoint the initial members of the Board
in accordance with the constitution and initial
bylaws of the Foundation.
(g) Board of Directors.--
(1) In general.--The Board of Directors shall be the
governing body of the Foundation.
(2) Powers.--The Board may exercise, or provide for
the exercise of, the powers of the Foundation.
(3) Selection.--
(A) In general.--Subject to subparagraph (B),
the number of members of the Board, the manner
of selection of the members (including the
filling of vacancies), and the terms of office
of the members shall be as provided in the
constitution and bylaws of the Foundation.
(B) Requirements.--
(i) Number of members.--The Board
shall have at least 11 members, who
shall have staggered terms.
(ii) Initial voting members.--The
initial voting members of the Board--
(I) shall be appointed by the
Committee not later than 180
days after the date on which
the Foundation is established;
and
(II) shall have staggered
terms.
(iii) Qualification.--The members of
the Board shall be United States
citizens who are knowledgeable or
experienced in Native American health
care and related matters.
(C) Compensation.--A member of the Board
shall not receive compensation for service as a
member, but shall be reimbursed for actual and
necessary travel and subsistence expenses
incurred in the performance of the duties of
the Foundation.
(h) Officers.--
(1) In general.--The officers of the Foundation shall
be--
(A) a secretary, elected from among the
members of the Board; and
(B) any other officers provided for in the
constitution and bylaws of the Foundation.
(2) Chief operating officer.--The secretary of the
Foundation may serve, at the direction of the Board, as
the chief operating officer of the Foundation, or the
Board may appoint a chief operating officer, who shall
serve at the direction of the Board.
(3) Election.--The manner of election, term of
office, and duties of the officers of the Foundation
shall be as provided in the constitution and bylaws of
the Foundation.
(i) Powers.--The Foundation--
(1) shall adopt a constitution and bylaws for the
management of the property of the Foundation and the
regulation of the affairs of the Foundation;
(2) may adopt and alter a corporate seal;
(3) may enter into contracts;
(4) may acquire (through a gift or otherwise), own,
lease, encumber, and transfer real or personal property
as necessary or convenient to carry out the purposes of
the Foundation;
(5) may sue and be sued; and
(6) may perform any other act necessary and proper to
carry out the purposes of the Foundation.
(j) Principal Office.--
(1) In general.--The principal office of the
Foundation shall be in the District of Columbia.
(2) Activities; offices.--The activities of the
Foundation may be conducted, and offices may be
maintained, throughout the United States in accordance
with the constitution and bylaws of the Foundation.
(k) Service of Process.--The Foundation shall comply with the
law on service of process of each State in which the Foundation
is incorporated and of each State in which the Foundation
carries on activities.
(l) Liability of Officers, Employees, and Agents.--
(1) In general.--The Foundation shall be liable for
the acts of the officers, employees, and agents of the
Foundation acting within the scope of their authority.
(2) Personal liability.--A member of the Board shall
be personally liable only for gross negligence in the
performance of the duties of the member.
(m) Restrictions.--
(1) Limitation on spending.--Beginning with the
fiscal year following the first full fiscal year during
which the Foundation is in operation, the
administrative costs of the Foundation shall not exceed
the percentage described in paragraph (2) of the sum
of--
(A) the amounts transferred to the Foundation
under subsection (o) during the preceding
fiscal year; and
(B) donations received from private sources
during the preceding fiscal year.
(2) Percentages.--The percentages referred to in
paragraph (1) are--
(A) for the first fiscal year described in
that paragraph, 20 percent;
(B) for the following fiscal year, 15
percent; and
(C) for each fiscal year thereafter, 10
percent.
(3) Appointment and hiring.--The appointment of
officers and employees of the Foundation shall be
subject to the availability of funds.
(4) Status.--A member of the Board or officer,
employee, or agent of the Foundation shall not by
reason of association with the Foundation be considered
to be an officer, employee, or agent of the United
States.
(n) Audits.--The Foundation shall comply with section 10101
of title 36, United States Code, as if the Foundation were a
corporation under part B of subtitle II of that title.
(o) Funding.--
(1) Authorization of appropriations.--There is
authorized to be appropriated to carry out subsection
(e)(1) $500,000 for each fiscal year, as adjusted to
reflect changes in the Consumer Price Index for all-
urban consumers published by the Department of Labor.
(2) Transfer of donated funds.--The Secretary shall
transfer to the Foundation funds held by the Department
of Health and Human Services under the Act of August 5,
1954 (42 U.S.C. 2001 et seq.), if the transfer or use
of the funds is not prohibited by any term under which
the funds were donated.
SEC. 803. ADMINISTRATIVE SERVICES AND SUPPORT.
(a) Provision of Support by Secretary.--Subject to subsection
(b), during the 5-year period beginning on the date on which
the Foundation is established, the Secretary--
(1) may provide personnel, facilities, and other
administrative support services to the Foundation;
(2) may provide funds for initial operating costs and
to reimburse the travel expenses of the members of the
Board; and
(3) shall require and accept reimbursements from the
Foundation for--
(A) services provided under paragraph (1);
and
(B) funds provided under paragraph (2).
(b) Reimbursement.--Reimbursements accepted under subsection
(a)(3)--
(1) shall be deposited in the Treasury of the United
States to the credit of the applicable appropriations
account; and
(2) shall be chargeable for the cost of providing
services described in subsection (a)(1) and travel
expenses described in subsection (a)(2).
(c) Continuation of Certain Services.--The Secretary may
continue to provide facilities and necessary support services
to the Foundation after the termination of the 5-year period
specified in subsection (a) if the facilities and services--
(1) are available; and
(2) are provided on reimbursable cost basis.
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SOCIAL SECURITY ACT
* * * * * * *
TITLE XI--GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE
SIMPLIFICATION
Part A--General Provisions
* * * * * * *
EXCLUSION OF CERTAIN INDIVIDUALS AND ENTITIES FROM PARTICIPATION IN
MEDICARE AND STATE HEALTH CARE PROGRAMS
Sec. 1128. (a) * * *
* * * * * * *
(k) Additional Exclusion waiver authority for affected Indian
Health Programs.--In addition to the authority granted the
Secretary under subsections (c)(3)(B) and (d)(3)(B) to waive an
exclusion under subsection (a)(1), (a)(3), (a)(4), or (b), the
Secretary may, in the case of an Indian Health Program, waive
such an exclusion upon the request of the administrator of an
affected Indian Health Program (as defined in section 4 of the
Indian Health Care Improvement Act) who determines that the
exclusion would impose a hardship on individuals entitled to
benefits under or enrolled in a Federal health care program.
* * * * * * *
CRIMINAL PENALTIES FOR ACTS INVOLVING FEDERAL HEALTH CARE PROGRAMS
Sec. 1128B. (a) * * *
(b)(1) * * *
* * * * * * *
(4) Subject to such conditions as the Secretary may
promulgate from time to time as necessary to prevent fraud and
abuse, for purposes of paragraphs (1) and (2) and section
1128A(a), the following transfers shall not be treated as
remuneration:
(A) Transfers between indian health programs, indian
tribes, tribal organizations, and urban indian
organizations.--Transfers of anything of value between
or among an Indian Health Program, Indian Tribe, Tribal
Organization, or Urban Indian Organization, that are
made for the purpose of providing necessary health care
items and services to any patient served by such
Program, Tribe, or Organization and that consist of--
(i) services in connection with the
collection, transport, analysis, or
interpretation of diagnostic specimens or test
data;
(ii) inventory or supplies;
(iii) staff; or
(iv) a waiver of all or part of premiums or
cost sharing.
(B) Transfers between indian health programs, indian
tribes, tribal organizations, or urban indian
organizations and patients.--Transfers of anything of
value between an Indian Health Program, Indian Tribe,
Tribal Organization, or Urban Indian Organization and
any patient served or eligible for service from an
Indian Health Program, Indian Tribe, Tribal
Organization, or Urban Indian Organization, including
any patient served or eligible for service pursuant to
section 807 of the Indian Health Care Improvement Act,
but only if such transfers--
(i) consist of expenditures related to
providing transportation for the patient for
the provision of necessary health care items or
services, provided that the provision of such
transportation is not advertised, nor an
incentive of which the value is
disproportionately large in relationship to the
value of the health care item or service (with
respect to the value of the item or service
itself or, for preventative items or services,
the future health care costs reasonably
expected to be avoided);
(ii) consist of expenditures related to
providing housing to the patient (including a
pregnant patient) and immediate family members
or an escort necessary to assuring the timely
provision of health care items and services to
the patient, provided that the provision of
such housing is not advertised nor an incentive
of which the value is disproportionately large
in relationship to the value of the health care
item or service (with respect to the value of
the item or service itself or, for preventative
items or services, the future health care costs
reasonably expected to be avoided); or
(iii) are for the purpose of paying premiums
or cost sharing on behalf of such a patient,
provided that the making of such payment is not
subject to conditions other than conditions
agreed to under a contract for the delivery of
contract health services.
(C) Contract health services.--A transfer of anything
of value negotiated as part of a contract entered into
between an Indian Health Program, Indian Tribe, Tribal
Organization, Urban Indian Organization, or the Indian
Health Service and a contract care provider for the
delivery of contract health services authorized by the
Indian Health Service, provided that--
(i) such a transfer is not tied to volume or
value of referrals or other business generated
by the parties; and
(ii) any such transfer is limited to the fair
market value of the health care items or
services provided or, in the case of a transfer
of items or services related to preventative
care, the value of the future health care costs
reasonably expected to be avoided.
(D) Other transfers.--Any other transfer of anything
of value involving an Indian Health Program, Indian
Tribe, Tribal Organization, or Urban Indian
Organization, or a patient served or eligible for
service from an Indian Health Program, Indian Tribe,
Tribal Organization, or Urban Indian Organization, that
the Secretary, in consultation with the Attorney
General, determines is appropriate, taking into account
the special circumstances of such Indian Health
Programs, Indian Tribes, Tribal Organizations, and
Urban Indian Organizations, and of patients served by
such Programs, Tribes, and Organizations.
* * * * * * *
[NATIONAL COMMISSION ON CHILDREN
[Sec. 1139.
[(a)(1) There is hereby established a commission to be known
as the National Commission on Children (in this section
referred to as the ``Commission'').
[(b)(1) The Commission shall consist of--
[(A) 12 members to be appointed by the President,
[(B) 12 members to be appointed by the Speaker of the
House of Representatives, and
[(C) 12 members to be appointed by the President pro
tempore of the Senate.
[(2) The President, the Speaker, and the President pro
tempore shall each appoint as members of the Commission--
[(A) 4 individuals who--
[(i) are representatives of organizations
providing services to children,
[(ii) are involved in activities on behalf of
children, or
[(iii) have engaged in academic research with
respect to the problems and needs of children,
[(B) 4 individuals who are elected or appointed
public officials (at the Federal, State, or local
level) involved in issues and programs relating to
children, and
[(C) 4 individuals who are parents or representatives
of parents or parents' organizations.
[(3) The appointments made pursuant to subparagraphs (B) and
(C) of paragraph (1) shall be made in consultation with the
chairmen of committees of the House of Representatives and the
Senate, respectively, having jurisdiction over relevant Federal
programs.
[(c)(1) It shall be the duty and function of the Commission
to serve as a forum on behalf of the children of the Nation and
to conduct the studies and issue the report required by
subsection (d).
[(2) The Commission (and any committees that it may form)
shall conduct public hearings in different geographic areas of
the country, both urban and rural, in order to receive the
views of a broad spectrum of the public on the status of the
Nation's children and on ways to safeguard and enhance the
physical, mental, and emotional well-being of all of the
children of the Nation, including those with physical or mental
disabilities, and others whose circumstances deny them a full
share of the opportunities that parents of the Nation may
rightfully expect for their children.
[(3) The Commission shall receive testimony from individuals,
and from representatives of public and private organizations
and institutions with an interest in the welfare of children,
including educators, health care professionals, religious
leaders, providers of social services, representatives of
organizations with children as members, elected and appointed
public officials, and from parents and children speaking in
their own behalf.
[(d) The Commission shall submit to the President, and to the
Committees on Finance and Labor and Human Resources of the
Senate and the Committees on Ways and Means, Education and
Labor, and Energy and Commerce of the House of Representatives,
an interim report no later than March 31, 1990, and a final
report no later than March 31, 1991, setting forth
recommendations with respect to the following subjects:
[(1) Questions relating to the health of children
that the Commission shall address include--
[(A) how to reduce infant mortality,
[(B) how to reduce the number of low-birth-
weight babies,
[(C) how to reduce the number of children
with chronic illnesses and disabilities,
[(D) how to improve the nutrition of
children,
[(E) how to promote the physical fitness of
children,
[(F) how to ensure that pregnant women
receive adequate prenatal care,
[(G) how to ensure that all children have
access to both preventive and acute care health
services, and
[(H) how to improve the quality and
availability of health care for children.
[(2) Questions relating to social and support
services for children and their parents that the
Commission shall address include--
[(A) how to prevent and treat child neglect
and abuse,
[(B) how to provide help to parents who seek
assistance in meeting the problems of their
children,
[(C) how to provide counseling services for
children,
[(D) how to strengthen the family unit,
[(E) how children can be assured of adequate
care while their parents are working or
participating in education or training
programs,
[(F) how to improve foster care and adoption
services,
[(G) how to reduce drug and alcohol abuse by
children and youths, and
[(H) how to reduce the incidence of teenage
pregnancy.
[(3) Questions relating to education that the
Commission shall address include--
[(A) how to encourage academic excellence for
all children at all levels of education,
[(B) how to use preschool experiences to
enhance educational achievement,
[(C) how to improve the qualifications of
teachers,
[(D) how schools can better prepare the
Nation's youth to compete in the labor market,
[(E) how parents and schools can work
together to help children achieve success at
each step of the academic ladder,
[(F) how to encourage teenagers to complete
high school and remain in school to fulfill
their academic potential,
[(G) how to address the problems of drug and
alcohol abuse by young people,
[(H) how schools might lend support to
efforts aimed at reducing the incidence of
teenage pregnancy, and
[(I) how schools might better meet the
special needs of children who have physical or
mental handicaps.
[(4) Questions relating to income security that the
Commission shall address include--
[(A) how to reduce poverty among children,
[(B) how to ensure that parents support their
children to the fullest extent possible through
improved child support collection services,
including services on behalf of children whose
parents are unmarried, and
[(C) how to ensure that cash assistance to
needy children is adequate.
[(5) Questions relating to tax policy that the
Commission shall address include--
[(A) how to assure the equitable tax
treatment of families with children,
[(B) the effect of existing tax provisions,
including the dependent care tax credit, the
earned income tax credit, and the targeted jobs
tax credit, on children living in poverty,
[(C) whether the dependent care tax credit
should be refundable and the effect of such a
policy,
[(D) whether the earned income tax credit
should be adjusted for family size and the
effect of such a policy, and
[(E) whether there are other tax-related
policies which would reduce poverty among
children.
[(6) In addition to addressing the questions
specified in paragraphs (1) through (5), the Commission
shall--
[(A) seek to identify ways in which public
and private organizations and institutions can
work together at the community level to
identify deficiencies in existing services for
families and children and to develop
recommendations to ensure that the needs of
families and children are met, using all
available resources, in a coordinated and
comprehensive manner, and
[(B) assess the existing capacities of
agencies to collect and analyze data on the
status of children and on relevant programs,
identify gaps in the data collection system,
and recommend ways to improve the collection of
data and the coordination among agencies in the
collection and utilization of data.
The reports required by this subsection shall be based upon the
testimony received in the hearings conducted pursuant to
subsection (c), and upon other data and findings developed by
the Commission.
[(e)(1)(A) Members of the Commission shall first be appointed
not later than 60 days after the date of the enactment of this
section, for terms ending on March 31, 1991.
[(B) A vacancy in the Commission shall not affect its powers,
but shall be filled in the same manner as the vacant position
was first filled.
[(2) The Commission shall elect one of its members to serve
as Chairman of the Commission. The Chairman shall be a
nonvoting member of the Commission.
[(3) A majority of the members of the Commission shall
constitute a quorum for the transaction of business.
[(4)(A) The Commission shall meet at the call of the
Chairman, or at the call of a majority of the members of the
Commission.
[(B) The Commission shall meet not less than 4 times during
the period beginning with the date of the enactment of this
section and ending with September 30, 1990.
[(5) Decisions of the Commission shall be according to the
vote of a simple majority of those present and voting at a
properly called meeting.
[(6) Members of the Commission shall serve without
compensation, but shall be reimbursed for travel, subsistence,
and other necessary expenses incurred in the performance of
their duties as members of the Commission.
[(f)(1) The Commission shall appoint an Executive Director of
the Commission. In addition to the Executive Director, the
Commission may appoint and fix the compensation of such
personnel as it deems advisable. Such appointments and
compensation may be made without regard to title 5, United
States Code, that govern appointments in the competitive
services, and the provisions of chapter 51 and subchapter III
of chapter 53 of such title that relate to classifications and
the General Schedule pay rates.
[(2) The Commission may procure such temporary and
intermittent services of consultants under section 3109(b) of
title 5, United States Code, as the Commission determines to be
necessary to carry out the duties of the Commission.
[(g) In carrying out its duties, the Commission, or any duly
organized committee thereof, is authorized to hold such
hearings, sit and act at such times and places, and take such
testimony, with respect to matters for which it has a
responsibility under this section, as the Commission or
committee may deem advisable.
[(h)(1) The Commission may secure directly from any
department or agency of the United States such data and
information as may be necessary to carry out its
responsibilities.
[(2) Upon request of the Commission, any such department or
agency shall furnish any such data or information.
[(i) The General Services Administration shall provide to the
Commission, on a reimbursable basis, such administrative
support services as the Commission may request.
[(j) There are authorized to be appropriated through fiscal
year 1991, such sums as may be necessary to carry out this
section for each of fiscal years 1989 and 1990.
[(k)(1) The Commission is authorized to accept donations of
money, property, or personal services. Funds received from
donations shall be deposited in the Treasury in a separate fund
created for this purpose. Funds appropriated for the Commission
and donated funds may be expended for such purposes as official
reception and representation expenses, public surveys, public
service announcements, preparation of special papers, analyses,
and documentaries, and for such other purposes as determined by
the Commission to be in furtherance of its mission to review
national issues affecting children.
[(2) For purposes of Federal income, estate, and gift
taxation, money and other property accepted under paragraph (1)
of this subsection shall be considered as a gift or bequest to
or for the use of the United States.
[(3) Expenditure of appropriated and donated funds shall be
subject to such rules and regulations as may be adopted by the
Commission and shall not be subject to Federal procurement
requirements.
[(l) The Commission is authorized to conduct such public
surveys as it deems necessary in support of its review of
national issues affecting children and, in conducting such
surveys, the Commission shall not be deemed to be an ``agency''
for the purpose of section 3502 of title 44, United States
Code.]
SEC. 1139. IMPROVED ACCESS TO, AND DELIVERY OF, HEALTH CARE FOR INDIANS
UNDER TITLES XVIII, XIX, AND XXI.
(a) Agreements with States for Medicaid and Schip Outreach on
or Near Reservations To Increase the Enrollment of Indians in
Those Programs.--
(1) In general.--In order to improve the access of
Indians residing on or near a reservation to obtain
benefits under the Medicaid and State children's health
insurance programs established under titles XIX and
XXI, the Secretary shall encourage the State to take
steps to provide for enrollment on or near the
reservation. Such steps may include outreach efforts
such as the outstationing of eligibility workers,
entering into agreements with the Indian Health
Service, Indian Tribes, Tribal Organizations, and Urban
Indian Organizations to provide outreach, education
regarding eligibility and benefits, enrollment, and
translation services when such services are
appropriate.
(2) Construction.--Nothing in subparagraph (A) shall
be construed as affecting arrangements entered into
between States and the Indian Health Service, Indian
Tribes, Tribal Organizations, or Urban Indian
Organizations for such Service, Tribes, or
Organizations to conduct administrative activities
under such titles.
(b) Requirement To Facilitate Cooperation.--The Secretary,
acting through the Centers for Medicare & Medicaid Services,
shall take such steps as are necessary to facilitate
cooperation with, and agreements between, States and the Indian
Health Service, Indian Tribes, Tribal Organizations, or Urban
Indian Organizations with respect to the provision of health
care items and services to Indians under the programs
established under title XVIII, XIX, or XXI.
(c) Nondiscrimination in Qualifications for Payment for
Services under Federal Health Care Programs.--
(1) Requirement to satisfy generally applicable
participation requirements.--
(A) In general.--A Federal health care
program must accept an entity that is operated
by the Indian Health Service, an Indian Tribe,
Tribal Organization, or Urban Indian
Organization as a provider eligible to receive
payment under the program for health care
services furnished to an Indian on the same
basis as any other provider qualified to
participate as a provider of health care
services under the program if the entity meets
generally applicable State or other
requirements for participation as a provider of
health care services under the program.
(B) Satisfaction of state or local licensure
or recognition requirements.--Any requirement
for participation as a provider of health care
services under a Federal health care program
that an entity be licensed or recognized under
the State or local law where the entity is
located to furnish health care services shall
be deemed to have been met in the case of an
entity operated by the Indian Health Service,
an Indian Tribe, Tribal Organization, or Urban
Indian Organization if the entity meets all the
applicable standards for such licensure or
recognition, regardless of whether the entity
obtains a license or other documentation under
such State or local law. In accordance with
section 221 of the Indian Health Care
Improvement Act, the absence of the licensure
of a health care professional employed by such
an entity under the State or local law where
the entity is located shall not be taken into
account for purposes of determining whether the
entity meets such standards, if the
professional is licensed in another State.
(2) Prohibition on federal payments to entities or
individuals excluded from participation in federal
health care programs or whose State licenses are under
suspension or have been revoked.--
(A) Excluded entities.--No entity operated by
the Indian Health Service, an Indian Tribe,
Tribal Organization, or Urban Indian
Organization that has been excluded from
participation in any Federal health care
program or for which a license is under
suspension or has been revoked by the State
where the entity is located shall be eligible
to receive payment under any such program for
health care services furnished to an Indian.
(B) Excluded individuals.--No individual who
has been excluded from participation in any
Federal health care program or whose State
license is under suspension or has been revoked
shall be eligible to receive payment under any
such program for health care services furnished
by that individual, directly or through an
entity that is otherwise eligible to receive
payment for health care services, to an Indian.
(C) Federal health care program defined.--In
this subsection, the term, ``Federal health
care program'' has the meaning given that term
in section 1128B(f), except that, for purposes
of this subsection, such term shall include the
health insurance program under chapter 89 of
title 5, United States Code.
(d) Consultation With Tribal Technical Advisory Group
(Ttag).--The Secretary shall maintain within the Centers for
Medicaid & Medicare Services (CMS) a Tribal Technical Advisory
Group, established in accordance with requirements of the
charter dated September 30, 2003, and in such group shall
include a representative of the Urban Indian Organizations and
the Service. The representative of the Urban Indian
Organization shall be deemed to be an elected officer of a
tribal government for purposes of applying section 204(b) of
the Unfunded Mandates Reform Act of 1995 (2 U.S.C. 1534(b)).
(e) Annual Report on Indians Served by Health Benefit
Programs Funded Under This Act.--Beginning January 1, 2007, and
annually thereafter, the Secretary, acting through the
Administrator of the Centers for Medicare & Medicaid Services
and the Director of the Indian Health Service, shall submit a
report to Congress regarding the enrollment and health status
of Indians receiving items or services under health benefit
programs funded under this Act during the preceding year. Each
such report shall include the following:
(1) The total number of Indians enrolled in, or
receiving items or services under, such programs,
disaggregated with respect to each such program.
(2) The number of Indians described in paragraph (1)
that also received health benefits under programs
funded by the Indian Health Service.
(3) General information regarding the health status
of the Indians described in paragraph (1),
disaggregated with respect to specific diseases or
conditions and presented in a manner that is consistent
with protections for privacy of individually
identifiable health information under section 264(c) of
the Health Insurance Portability and Accountability Act
of 1996.
(4) A detailed statement of the status of facilities
of the Indian Health Service or an Indian Tribe, Tribal
Organization, or an Urban Indian Organization with
respect to such facilities' compliance with the
applicable conditions and requirements of titles XVIII,
XIX, and XXI, and, in the case of title XIX or XXI,
under a State plan under such title or under waiver
authority, and of the progress being made by such
facilities (under plans submitted under section
1880(b), 1911(b) or otherwise) toward the achievement
and maintenance of such compliance.
(5) Such other information as the Secretary
determines is appropriate.
(f) Definition of Indian; Indian Tribe; Indian Health
Program; Tribal Organization; Urban Indian Organization.--In
this section, the terms ``Indian'', ``Indian Tribe'', ``Indian
Health Program'', ``Tribal Organization'', and ``Urban Indian
Organization'' have the meanings given those terms in section 4
of the Indian Health Care Improvement Act.
* * * * * * *
TITLE XVIII--HEALTH INSURANCE FOR THE AGED AND DISABLED
* * * * * * *
Part E--Miscellaneous Provisions
* * * * * * *
[INDIAN HEALTH SERVICE FACILITIES
[Sec. 1880.
[(a) A hospital or skilled nursing facility of the Indian
Health Service, whether operated by such Service or by an
Indian tribe or tribal organization (as those terms are defined
in section 4 of the Indian Health Care Improvement Act), shall
be eligible for payments under this title, notwithstanding
sections 1814(c) and 1835(d), if and for so long as it meets
all of the conditions and requirements for such payments which
are applicable generally to hospitals or skilled nursing
facilities (as the case may be) under this title.
[(b) Notwithstanding subsection (a), a hospital or skilled
nursing facility of the Indian Health Service which does not
meet all of the conditions and requirements of this title which
are applicable generally to hospitals or skilled nursing
facilities (as the case may be), but which submits to the
Secretary within six months after the date of the enactment of
this section an acceptable plan for achieving compliance with
such conditions and requirements, shall be deemed to meet such
conditions and requirements (and to be eligible for payments
under this title), without regard to the extent of its actual
compliance with such conditions and requirements, during the
first 12 months after the month in which such plan is
submitted.
[(c) Notwithstanding any other provision of this title,
payments to which any hospital or skilled nursing facility of
the Indian Health Service is entitled by reason of this section
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 hospitals and skilled nursing
facilities of such Service which may be necessary to achieve
compliance with the applicable conditions and requirements of
this title. The preceding sentence shall cease to apply when
the Secretary determines and certifies that substantially all
of the hospitals and skilled nursing facilities of such Service
in the United States are in compliance with such conditions and
requirements.
[(d) The annual report of the Secretary which is required by
section 701 of the Indian Health Care Improvement Act shall
include (along with the matters specified in section 403 of
such Act) a detailed statement of the status of the hospitals
and skilled nursing facilities of the Service in terms of their
compliance with the applicable conditions and requirements of
this title and of the progress being made by such hospitals and
facilities (under plans submitted under subsection (b) and
otherwise) toward the achievement of such compliance.]
SEC. 1880. INDIAN HEALTH PROGRAMS.
(a) Eligibility for Payments.--Subject to subsection (e), the
Indian Health Service and an Indian Tribe, Tribal Organization,
or an Urban Indian Organization shall be eligible for payments
under this title with respect to items and services furnished
by the Indian Health Service, Indian Tribe, Tribal
Organization, or Urban Indian Organization if the furnishing of
such services meets all the conditions and requirements which
are applicable generally to the furnishing of items and
services under this title.
(b) Compliance With Conditions and Requirements.--Subject to
subsection (e), a facility of the Indian Health Service or an
Indian Tribe, Tribal Organization, or an Urban Indian
Organization which is eligible for payment under subsection (a)
with respect to the furnishing of items and services, but which
does not meet all of the conditions and requirements of this
title which are applicable generally to such facility, shall
make such improvements as are necessary to achieve or maintain
compliance with such conditions and requirements in accordance
with a plan submitted to and accepted by the Secretary for
achieving or maintaining compliance with such conditions and
requirements, and shall be deemed to meet such conditions and
requirements (and to be eligible for payment under this title),
without regard to the extent of its actual compliance with such
conditions and requirements, during the first 12 months after
the month in which such plan is submitted.
(c) Special Fund for Improvement of IHS Facilities.--For
provisions relating to the authority of the Secretary to place
payments to which a facility of the Indian Health Service is
eligible for payment under this title into a special fund
established under section 401(c)(1) of the Indian Health Care
Improvement Act, and the requirement to use amounts paid from
such fund for making improvements in accordance with subsection
(b), see subparagraphs (A) and (B) of section 401(c)(1) of such
Act.
(d) Direct Billing.--For provisions relating to the authority
of a Tribal Health Program or an Urban Indian Organization to
elect to directly bill for, and receive payment for, health
care items and services provided by such Program or
Organization for which payment is made under this title, see
section 401(d) of the Indian Health Care Improvement Act.
(e)(1) * * *
* * * * * * *
(3) Subsection (c) and section 401(c)(1) of the Indian Health
Care Improvement Act shall not apply to payments made under
this subsection.
[(f) For provisions relating to the authority of certain
Indian tribes, tribal organizations, and Alaska Native health
organizations to elect to directly bill for, and receive
payment for, health care services provided by a hospital or
clinic of such tribes or organizations and for which payment
may be made under this title, see section 405 of the Indian
Health Care Improvement Act (25 U.S.C. 1645).]
(f) Definitions.--In this section, the terms ``Indian Health
Program'', ``Indian Tribe'', ``Service Unit'', ``Tribal Health
Program'', ``Tribal Organization'', and ``Urban Indian
Organization'' have the meanings given those terms in section 4
of the Indian Health Care Improvement Act.
* * * * * * *
TITLE XIX--GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS
* * * * * * *
STATE PLANS FOR MEDICAL ASSISTANCE
Sec. 1902. (a) A State plan for medical assistance must--
(1) * * *
* * * * * * *
(69) provide that the State must comply with any
requirements determined by the Secretary to be
necessary for carrying out the Medicaid Integrity
Program established under section 1936; [and]
(70) at the option of the State and notwithstanding
paragraphs (1), (10)(B), and (23), provide for the
establishment of a non-emergency medical transportation
brokerage program in order to more cost-effectively
provide transportation for individuals eligible for
medical assistance under the State plan who need access
to medical care or services and have no other means of
transportation which--
(A) * * *
(B) may be conducted under contract with a
broker who--
(i) * * *
* * * * * * *
(iv) complies with such requirements
related to prohibitions on referrals
and conflict of interest as the
Secretary shall establish (based on the
prohibitions on physician referrals
under section 1877 and such other
prohibitions and requirements as the
Secretary determines to be
appropriate)[.]; and
(71) in the case of any State in which the Indian
Health Service operates or funds health care programs,
or in which 1 or more Indian Health Programs or Urban
Indian Organizations (as such terms are defined in
section 4 of the Indian Health Care Improvement Act)
provide health care in the State for which medical
assistance is available under such title, provide for a
process under which the State seeks advice on a
regular, ongoing basis from designees of such Indian
Health Programs and Urban Indian Organizations on
matters relating to the application of this title that
are likely to have a direct effect on such Indian
Health Programs and Urban Indian Organizations and
that--
(A) shall include solicitation of advice
prior to submission of any plan amendments,
waiver requests, and proposals for
demonstration projects likely to have a direct
effect on Indians, Indian Health Programs, or
Urban Indian Organizations; and
(B) may include appointment of an advisory
committee and of a designee of such Indian
Health Programs and Urban Indian Organizations
to the medical care advisory committee advising
the State on its State plan under this title.
Notwithstanding paragraph (5), if on January 1, 1965, and on
the date on which a State submits its plan for approval under
this title, the State agency which administered or supervised
the administration of the plan of such State approved under
title X (or title XVI, insofar as it relates to the blind) was
different from the State agency which administered or
supervised the administration of the State plan approved under
title I (or title XVI, insofar as it relates to the aged), the
State agency which administered or supervised the
administration of such plan approved under title X (or title
XVI, insofar as it relates to the blind) may be designated to
administer or supervise the administration of the portion of
the State plan for medical assistance which relates to blind
individuals and a different State agency may be established or
designated to administer or supervise the administration of the
rest of the State plan for medical assistance; and in such case
the part of the plan which each such agency administers, or the
administration of which each such agency supervises, shall be
regarded as a separate plan for purposes of this title (except
for purposes of paragraph (10)). The provisions of paragraphs
(9)(A), (31), and (33) and of section 1903(i)(4) shall not
apply to a religious nonmedical health care institution (as
defined in section 1861(ss)(1)).
* * * * * * *
(e)(1) * * *
* * * * * * *
(13) Notwithstanding any other requirement of this title or
any other provision of Federal or State law, a State shall
disregard the following property for purposes of determining
the eligibility of an individual who is an Indian (as defined
in section 4 of the Indian Health Care Improvement Act) for
medical assistance under this title:
(A) Property, including real property and
improvements, that is held in trust, subject to Federal
restrictions, or otherwise under the supervision of the
Secretary of the Interior, located on a reservation,
including any federally recognized Indian Tribe's
reservation, pueblo, or colony, including former
reservations in Oklahoma, Alaska Native regions
established by the Alaska Native Claims Settlement Act,
and Indian allotments on or near a reservation as
designated and approved by the Bureau of Indian Affairs
of the Department of the Interior.
(B) For any federally recognized Tribe not described
in subparagraph (A), property located within the most
recent boundaries of a prior Federal reservation.
(C) Ownership interests in rents, leases, royalties,
or usage rights related to natural resources (including
extraction of natural resources or harvesting of
timber, other plants and plant products, animals, fish,
and shellfish) resulting from the exercise of federally
protected rights.
(D) Ownership interests in or usage rights to items
not covered by subparagraphs (A) through (C) that have
unique religious, spiritual, traditional, or cultural
significance or rights that support subsistence or a
traditional lifestyle according to applicable tribal
law or custom.
* * * * * * *
PAYMENT TO STATES
Sec. 1903. (a) * * *
* * * * * * *
(x)(1) * * *
* * * * * * *
(3)(A) * * *
(B) The following are documents described in this
subparagraph:
(i) * * *
* * * * * * *
(v)(I) Except as provided in subclause (II), a
document issued by a federally-recognized Indian tribe
evidencing membership or enrollment in, or affiliation
with, such tribe.
(II) With respect to those federally-recognized
Indian tribes located within States having an
international border whose membership includes
individuals who are not citizens of the United States,
the Secretary shall, after consulting with such tribes,
issue regulations authorizing the presentation of such
other forms of documentation (including tribal
documentation, if appropriate) that the Secretary
determines to be satisfactory documentary evidence of
citizenship or nationality for purposes of satisfying
the requirement of this subsection.
[(v)] (vi) Such other document as the Secretary may
specify, by regulation, that provides proof of United
States citizenship or nationality and that provides a
reliable means of documentation of personal identity.
* * * * * * *
[INDIAN HEALTH SERVICE FACILITIES
[Sec. 1911.
[(a) A facility of the Indian Health Service (including a
hospital, nursing facility, or any other type of facility which
provides services of a type otherwise covered under the State
plan), whether operated by such Service or by an Indian tribe
or tribal organization (as those terms are defined in section 4
of the Indian Health Care Improvement Act), shall be eligible
for reimbursement for medical assistance provided under a State
plan if and for so long as it meets all of the conditions and
requirements which are applicable generally to such facilities
under this title.
[(b) Notwithstanding subsection (a), a facility of the Indian
Health Service (including a hospital, nursing facility, or any
other type of facility which provides services of a type
otherwise covered under the State plan) which does not meet all
of the conditions and requirements of this title which are
applicable generally to such facility, but which submits to the
Secretary within six months after the date of the enactment of
this section an acceptable plan for achieving compliance with
such conditions and requirements, shall be deemed to meet such
conditions and requirements (and to be eligible for
reimbursement under this title), without regard to the extent
of its actual compliance with such conditions and requirements,
during the first twelve months after the month in which such
plan is submitted.
[(c) The Secretary is authorized to enter into agreements
with the State agency for the purpose of reimbursing such
agency for health care and services provided in Indian Health
Service facilities to Indians who are eligible for medical
assistance under the State plan.
[(d) For provisions relating to the authority of certain
Indian tribes, tribal organizations, and Alaska Native health
organizations to elect to directly bill for, and receive
payment for, health care services provided by a hospital or
clinic of such tribes or organizations and for which payment
may be made under this title, see section 405 of the Indian
Health Care Improvement Act (25 U.S.C. 1645).]
SEC. 1911. INDIAN HEALTH PROGRAMS.
(a) Eligibility for Payment for Medical Assistance.--The
Indian Health Service and an Indian Tribe, Tribal Organization,
or an Urban Indian Organization shall be eligible for payment
for medical assistance provided under a State plan or under
waiver authority with respect to items and services furnished
by the Indian Health Service, Indian Tribe, Tribal
Organization, or Urban Indian Organization if the furnishing of
such services meets all the conditions and requirements which
are applicable generally to the furnishing of items and
services under this title and under such plan or waiver
authority.
(b) Compliance With Conditions and Requirements.--A facility
of the Indian Health Service or an Indian Tribe, Tribal
Organization, or an Urban Indian Organization which is eligible
for payment under subsection (a) with respect to the furnishing
of items and services, but which does not meet all of the
conditions and requirements of this title and under a State
plan or waiver authority which are applicable generally to such
facility, shall make such improvements as are necessary to
achieve or maintain compliance with such conditions and
requirements in accordance with a plan submitted to and
accepted by the Secretary for achieving or maintaining
compliance with such conditions and requirements, and shall be
deemed to meet such conditions and requirements (and to be
eligible for payment under this title), without regard to the
extent of its actual compliance with such conditions and
requirements, during the first 12 months after the month in
which such plan is submitted.
(c) Authority To Enter Into Agreements.--The Secretary may
enter into an agreement with a State for the purpose of
reimbursing the State for medical assistance provided by the
Indian Health Service, an Indian Tribe, Tribal Organization, or
an Urban Indian Organization (as so defined), directly, through
referral, or under contracts or other arrangements between the
Indian Health Service, an Indian Tribe, Tribal Organization, or
an Urban Indian Organization and another health care provider
to Indians who are eligible for medical assistance under the
State plan or under waiver authority.
(d) Special Fund for Improvement of IHS Facilities.--For
provisions relating to the authority of the Secretary to place
payments to which a facility of the Indian Health Service is
eligible for payment under this title into a special fund
established under section 401(c)(1) of the Indian Health Care
Improvement Act, and the requirement to use amounts paid from
such fund for making improvements in accordance with subsection
(b), see subparagraphs (A) and (B) of section 401(c)(1) of such
Act.
(e) Direct Billing.--For provisions relating to the authority
of a Tribal Health Program or an Urban Indian Organization to
elect to directly bill for, and receive payment for, health
care items and services provided by such Program or
Organization for which payment is made under this title, see
section 401(d) of the Indian Health Care Improvement Act.
(f) Definitions.--In this section, the terms ``Indian Health
Program'', ``Indian Tribe'', ``Tribal Health Program'',
``Tribal Organization'', and ``Urban Indian Organization'' have
the meanings given those terms in section 4 of the Indian
Health Care Improvement Act.
* * * * * * *
USE OF ENROLLMENT FEES, PREMIUMS, DEDUCTIONS, COST SHARING, AND SIMILAR
CHARGES
Sec. 1916. (a) Subject to subsections (g) [and (i)], (i), and
(j), the State plan shall provide that in the case of
individuals described in subparagraph (A) or (E)(i) of section
1902(a)(10) who are eligible under the plan--
(1) * * *
* * * * * * *
-
(j) No Premiums or Cost Sharing for Indians Furnished Items
or Services Directly by Indian Health Programs or through
Referral under the Contract Health Service.--
(1) No cost sharing for items or services furnished
to indians through indian health programs.--
(A) In general.--No enrollment fee, premium,
or similar charge, and no deduction, copayment,
cost sharing, or similar charge shall be
imposed against an Indian who is furnished an
item or service directly by the Indian Health
Service, an Indian Tribe, Tribal Organization,
or Urban Indian Organization or through
referral under the contract health service for
which payment may be made under this title.
(B) No reduction in amount of payment to
Indian health providers.--Payment due under
this title to the Indian Health Service, an
Indian Tribe, Tribal Organization, or Urban
Indian Organization, or a health care provider
through referral under the contract health
service for the furnishing of an item or
service to an Indian who is eligible for
assistance under such title, may not be reduced
by the amount of any enrollment fee, premium,
or similar charge, or any deduction, copayment,
cost sharing, or similar charge that would be
due from the Indian but for the operation of
subparagraph (A).
(2) Rule of construction.--Nothing in this subsection
shall be construed as restricting the application of
any other limitations on the imposition of premiums or
cost sharing that may apply to an individual receiving
medical assistance under this title who is an Indian.
(3) Definitions.--In this subsection, the terms
``contract health service'', ``Indian'', ``Indian
Tribe'', ``Tribal Organization'', and ``Urban Indian
Organization'' have the meanings given those terms in
section 4 of the Indian Health Care Improvement Act.
STATE OPTION FOR ALTERNATIVE PREMIUMS AND COST SHARING
Sec. 1916A.
(a) State Flexibility.--
(1) In general.--Notwithstanding sections 1916 and
1902(a)(10)(B), but subject to paragraph (2), a State,
at its option and through a State plan amendment, may
impose premiums and cost sharing for any group of
individuals (as specified by the State) and for any
type of services (other than drugs for which cost
sharing may be imposed under subsection (c) and non-
emergency services furnished in a hospital emergency
department for which cost sharing may be imposed under
subsection (e)), and may vary such premiums and cost
sharing among such groups or types, consistent with the
limitations established under this section. Nothing in
this section shall be construed as superseding (or
preventing the application of) [section 1916(g)]
subsections (g), (i), or (j) of section 1916.
* * * * * * *
LIENS, ADJUSTMENTS AND RECOVERIES, AND TRANSFERS OF ASSETS
Sec. 1917. (a) * * *
(b)(1) * * *
* * * * * * *
(3)(A) The State agency shall establish procedures (in
accordance with standards specified by the Secretary) under
which the agency shall waive the application of this subsection
(other than paragraph (1)(C)) if such application would work an
undue hardship as determined on the basis of criteria
established by the Secretary.
(B) The standards specified by the Secretary under
subparagraph (A) shall require that the procedures established
by the State agency under subparagraph (A) exempt income,
resources, and property that are exempt from the application of
this subsection as of April 1, 2003, under manual instructions
issued to carry out this subsection (as in effect on such date)
because of the Federal responsibility for Indian Tribes and
Alaska Native Villages. Nothing in this subparagraph shall be
construed as preventing the Secretary from providing additional
estate recovery exemptions under this title for Indians.
* * * * * * *
PROVISIONS RELATING TO MANAGED CARE
Sec. 1932. (a) * * *
* * * * * * *
(h) Special Rules With Respect to Indian Enrollees, Indian
Health Care Providers, and Indian Managed Care Entities.--
(1) Enrollee option to select an indian health care
provider as primary care provider.--In the case of a
non-Indian Medicaid managed care entity that--
(A) has an Indian enrolled with the entity;
and
(B) has an Indian health care provider that
is participating as a primary care provider
within the network of the entity,
insofar as the Indian is otherwise eligible to receive
services from such Indian health care provider and the
Indian health care provider has the capacity to provide
primary care services to such Indian, the contract with
the entity under section 1903(m) or under section
1905(t)(3) shall require, as a condition of receiving
payment under such contract, that the Indian shall be
allowed to choose such Indian health care provider as
the Indian's primary care provider under the entity.
(2) Assurance of payment to indian health care
providers for provision of covered services.--Each
contract with a managed care entity under section
1903(m) or under section 1905(t)(3) shall require any
such entity that has a significant percentage of Indian
enrollees (as determined by the Secretary), as a
condition of receiving payment under such contract to
satisfy the following requirements:
(A) Demonstration of participating indian
health care providers or application of
alternative payment arrangements.--Subject to
subparagraph (E), to--
(i) demonstrate that the number of
Indian health care providers that are
participating providers with respect to
such entity are sufficient to ensure
timely access to covered Medicaid
managed care services for those
enrollees who are eligible to receive
services from such providers; or
(ii) agree to pay Indian health care
providers who are not participating
providers with the entity for covered
Medicaid managed care services provided
to those enrollees who are eligible to
receive services from such providers at
a rate equal to the rate negotiated
between such entity and the provider
involved or, if such a rate has not
been negotiated, at a rate that is not
less than the level and amount of
payment which the entity would make for
the services if the services were
furnished by a participating provider
which is not an Indian health care
provider.
(B) Prompt payment.--To agree to make prompt
payment (in accordance with rules applicable to
managed care entities) to Indian health care
providers that are participating providers with
respect to such entity or, in the case of an
entity to which subparagraph (A)(ii) or (E)
applies, that the entity is required to pay in
accordance with that subparagraph.
(C) Satisfaction of claim requirement.--To
deem any requirement for the submission of a
claim or other documentation for services
covered under subparagraph (A) by the enrollee
to be satisfied through the submission of a
claim or other documentation by an Indian
health care provider that is consistent with
section 403(h) of the Indian Health Care
Improvement Act.
(D) Compliance with generally applicable
requirements.--
(i) In general.--Subject to clause
(ii), as a condition of payment under
subparagraph (A), an Indian health care
provider shall comply with the
generally applicable requirements of
this title, the State plan, and such
entity with respect to covered Medicaid
managed care services provided by the
Indian health care provider to the same
extent that non-Indian providers
participating with the entity must
comply with such requirements.
(ii) Limitations on compliance with
managed care entity generally
applicable requirements.--An Indian
health care provider--
(I) shall not be required to
comply with a generally
applicable requirement of a
managed care entity described
in clause (i) as a condition of
payment under subparagraph (A)
if such compliance would
conflict with any other
statutory or regulatory
requirements applicable to the
Indian health care provider;
and
(II) shall only need to
comply with those generally
applicable requirements of a
managed care entity described
in clause (i) as a condition of
payment under subparagraph (A)
that are necessary for the
entity's compliance with the
State plan, such as those
related to care management,
quality assurance, and
utilization management.
(E) Application of special payment
requirements for federally-qualified health
centers and encounter rate for services
provided by certain indian health care
providers.--
(i) Federally-qualified health
centers.--
(I) Managed care entity
payment requirement.--To agree
to pay any Indian health care
provider that is a federally-
qualified health center but not
a participating provider with
respect to the entity, for the
provision of covered Medicaid
managed care services by such
provider to an Indian enrollee
of the entity at a rate equal
to the amount of payment that
the entity would pay a
federally-qualified health
center that is a participating
provider with respect to the
entity but is not an Indian
health care provider for such
services.
(II) Continued application of
state requirement to make
supplemental payment.--Nothing
in subclause (I) or
subparagraph (A) or (B) shall
be construed as waiving the
application of section
1902(bb)(5) regarding the State
plan requirement to make any
supplemental payment due under
such section to a federally-
qualified health center for
services furnished by such
center to an enrollee of a
managed care entity (regardless
of whether the federally-
qualified health center is or
is not a participating provider
with the entity).
(ii) Continued application of
encounter rate for services provided by
certain indian health care providers.--
If the amount paid by a managed care
entity to an Indian health care
provider that is not a federally-
qualified health center and that has
elected to receive payment under this
title as an Indian Health Service
provider under the July 11, 1996,
Memorandum of Agreement between the
Health Care Financing Administration
(now the Centers for Medicare &
Medicaid Services) and the Indian
Health Service for services provided by
such provider to an Indian enrollee
with the managed care entity is less
than the encounter rate that applies to
the provision of such services under
such memorandum, the State plan shall
provide for payment to the Indian
health care provider of the difference
between the applicable encounter rate
under such memorandum and the amount
paid by the managed care entity to the
provider for such services.
(F) Construction.--Nothing in this paragraph
shall be construed as waiving the application
of section 1902(a)(30)(A) (relating to
application of standards to assure that
payments are consistent with efficiency,
economy, and quality of care).
(3) Offering of managed care through indian medicaid
managed care entities.--If--
(A) a State elects to provide services
through Medicaid managed care entities under
its Medicaid managed care program; and
(B) an Indian health care provider that is
funded in whole or in part by the Indian Health
Service, or a consortium composed of 1 or more
Tribes, Tribal Organizations, or Urban Indian
Organizations, and which also may include the
Indian Health Service, has established an
Indian Medicaid managed care entity in the
State that meets generally applicable standards
required of such an entity under such Medicaid
managed care program,
the State shall offer to enter into an agreement with
the entity to serve as a Medicaid managed care entity
with respect to eligible Indians served by such entity
under such program.
(4) Special rules for indian managed care entities.--
The following are special rules regarding the
application of a Medicaid managed care program to
Indian Medicaid managed care entities:
(A) Enrollment.--
(i) Limitation to indians.--An Indian
Medicaid managed care entity may
restrict enrollment under such program
to Indians and to members of specific
Tribes in the same manner as Indian
Health Programs may restrict the
delivery of services to such Indians
and tribal members.
(ii) No less choice of plans.--Under
such program the State may not limit
the choice of an Indian among Medicaid
managed care entities only to Indian
Medicaid managed care entities or to be
more restrictive than the choice of
managed care entities offered to
individuals who are not Indians.
(iii) Default enrollment.--
(I) In general.--If such
program of a State requires the
enrollment of Indians in a
Medicaid managed care entity in
order to receive benefits, the
State, taking into
consideration the criteria
specified in subsection
(a)(4)(D)(ii)(I), shall provide
for the enrollment of Indians
described in subclause (II) who
are not otherwise enrolled with
such an entity in an Indian
Medicaid managed care entity
described in such clause.
(II) Indian described.--An
Indian described in this
subclause, with respect to an
Indian Medicaid managed care
entity, is an Indian who, based
upon the service area and
capacity of the entity, is
eligible to be enrolled with
the entity consistent with
subparagraph (A).
(iv) Exception to state lock-in.--A
request by an Indian who is enrolled
under such program with a non-Indian
Medicaid managed care entity to change
enrollment with that entity to
enrollment with an Indian Medicaid
managed care entity shall be considered
cause for granting such request under
procedures specified by the Secretary.
(B) Flexibility in application of solvency.--
In applying section 1903(m)(1) to an Indian
Medicaid managed care entity--
(i) any reference to a ``State'' in
subparagraph (A)(ii) of that section
shall be deemed to be a reference to
the ``Secretary''; and
(ii) the entity shall be deemed to be
a public entity described in
subparagraph (C)(ii) of that section.
(C) Exceptions to advance directives.--The
Secretary may modify or waive the requirements
of section 1902(w) (relating to provision of
written materials on advance directives)
insofar as the Secretary finds that the
requirements otherwise imposed are not an
appropriate or effective way of communicating
the information to Indians.
(D) Flexibility in information and
marketing.--
(i) Materials.--The Secretary may
modify requirements under subsection
(a)(5) to ensure that information
described in that subsection is
provided to enrollees and potential
enrollees of Indian Medicaid managed
care entities in a culturally
appropriate and understandable manner
that clearly communicates to such
enrollees and potential enrollees their
rights, protections, and benefits.
(ii) Distribution of marketing
materials.--The provisions of
subsection (d)(2)(B) requiring the
distribution of marketing materials to
an entire service area shall be deemed
satisfied in the case of an Indian
Medicaid managed care entity that
distributes appropriate materials only
to those Indians who are potentially
eligible to enroll with the entity in
the service area.
(5) Malpractice insurance.--Insofar as, under a
Medicaid managed care program, a health care provider
is required to have medical malpractice insurance
coverage as a condition of contracting as a provider
with a Medicaid managed care entity, an Indian health
care provider that is--
(A) a federally-qualified health center that
is covered under the Federal Tort Claims Act
(28 U.S.C. 1346(b), 2671 et seq.);
(B) providing health care services pursuant
to a contract or compact under the Indian Self-
Determination and Education Assistance Act (25
U.S.C. 450 et seq.) that are covered under the
Federal Tort Claims Act (28 U.S.C. 1346(b),
2671 et seq.); or
(C) the Indian Health Service providing
health care services that are covered under the
Federal Tort Claims Act (28 U.S.C. 1346(b),
2671 et seq.);
are deemed to satisfy such requirement.
(6) Definitions.--For purposes of this subsection:
(A) Indian health care provider.--The term
``Indian health care provider'' means an Indian
Health Program or an Urban Indian Organization.
(B) Indian; indian health program; service;
tribe; tribal organization; urban indian
organization.--The terms ``Indian'', ``Indian
Health Program'', ``Service'', ``Tribe'',
``tribal organization'', ``Urban Indian
Organization'' have the meanings given such
terms in section 4 of the Indian Health Care
Improvement Act.
(C) Indian medicaid managed care entity.--The
term ``Indian Medicaid managed care entity''
means a managed care entity that is controlled
(within the meaning of the last sentence of
section 1903(m)(1)(C)) by the Indian Health
Service, a Tribe, Tribal Organization, or Urban
Indian Organization, or a consortium, which may
be composed of 1 or more Tribes, Tribal
Organizations, or Urban Indian Organizations,
and which also may include the Service.
(D) Non-indian medicaid managed care
entity.--The term ``non-Indian Medicaid managed
care entity'' means a managed care entity that
is not an Indian Medicaid managed care entity.
(E) Covered medicaid managed care services.--
The term ``covered Medicaid managed care
services'' means, with respect to an individual
enrolled with a managed care entity, items and
services that are within the scope of items and
services for which benefits are available with
respect to the individual under the contract
between the entity and the State involved.
(F) Medicaid managed care program.--The term
``Medicaid managed care program'' means a
program under sections 1903(m) and 1932 and
includes a managed care program operating under
a waiver under section 1915(b) or 1115 or
otherwise.
* * * * * * *
TITLE XXI--STATE CHILDREN'S HEALTH INSURANCE PROGRAM
* * * * * * *
SEC. 2102. GENERAL CONTENTS OF STATE CHILD HEALTH PLAN; ELIGIBILITY;
OUTREACH.
(a) * * *
(b) General Description of Eligibility Standards and
Methodology.--
(1) * * *
* * * * * * *
(3) Eligibility screening; coordination with other
health coverage programs.--The plan shall include a
description of procedures to be used to ensure--
(A) * * *
* * * * * * *
(D) the provision of child health assistance
to targeted low-income children in the State
who are Indians [(as defined in section 4(c) of
the Indian Health Care Improvement Act, 25
U.S.C. 1603(c))], including how the State will
ensure that payments are made to Indian Health
Programs and Urban Indian Organizations
operating in the State for the provision of
such assistance; and
* * * * * * *
SEC. 2105. PAYMENTS TO STATES.
(a) * * *
* * * * * * *
(c) Limitation on Certain Payments for Certain
Expenditures.--
(1) * * *
(2) Limitation on expenditures not used for medicaid
or health insurance assistance.--
(A) * * *
* * * * * * *
(C) Nonapplication to expenditures for
outreach to increase the enrollment of indian
children under this title and title xix.--The
limitation under subparagraph (A) on
expenditures for items described in subsection
(a)(1)(D) shall not apply in the case of
expenditures for outreach activities to
families of Indian children likely to be
eligible for child health assistance under the
plan or medical assistance under the State plan
under title XIX (or under a waiver of such
plan), to inform such families of the
availability of, and to assist them in
enrolling their children in, such plans,
including such activities conducted under
grants, contracts, or agreements entered into
under section 1139(a).
* * * * * * *
(6) Prevention of duplicative payments.--
(A) * * *
(B) Other federal governmental programs.--
Except as provided in subparagraph (A) or (B)
of subsection (a)(1) or any other provision of
law, no payment shall be made to a State under
this section for expenditures for child health
assistance provided for a targeted low-income
child under its plan to the extent that payment
has been made or can reasonably be expected to
be made promptly (as determined in accordance
with regulations) under any other federally
operated or financed health care [insurance
program, other than an insurance program
operated or financed by the Indian Health
Service] program, other than a health care
program operated or financed by the Indian
Health Service or by an Indian Tribe, Tribal
Organization, or Urban Indian Organization, as
identified by the Secretary. For purposes of
this paragraph, rules similar to the rules for
overpayments under section 1903(d)(2) shall
apply.
* * * * * * *
SEC. 2107. STRATEGIC OBJECTIVES AND PERFORMANCE GOALS; PLAN
ADMINISTRATION.
(a) * * *
* * * * * * *
(e) Application of Certain General Provisions.--The following
sections of this Act shall apply to States under this title in
the same manner as they apply to a State under title XIX:
(1) Title xix provisions.--
(A) * * *
(B) Section 1902(a)(71) (relating to the
option of certain States to seek advice from
designees of Indian Health Programs and Urban
Indian Organizations).
(C) Section 1902(e)(13) (relating to
disregard of certain property for purposes of
making eligibility determinations).
[(B)] (D) Paragraphs (2), (16), and (17) of
section 1903(i) (relating to limitations on
payment).
[(C)] (E) Section 1903(w) (relating to
limitations on provider taxes and donations).
(F) Section 1911 (relating to Indian Health
Programs, other than subsection (d) of such
section).
[(D)] (G) Section 1920A (relating to
presumptive eligibility for children).
(H) Subsections (a)(2)(C) and (h) of section
1932.
* * * * * * *
SEC. 2110. DEFINITIONS.
(a) * * *
* * * * * * *
(c) Additional Definitions.--For purposes of this title:
(1) * * *
* * * * * * *
(9) Indian; indian health program; indian tribe;
etc.--The terms ``Indian'', ``Indian Health Program'',
``Indian Tribe'', ``Tribal Organization'', and ``Urban
Indian Organization'' have the meanings given those
terms in section 4 of the Indian Health Care
Improvement Act.
* * * * * * *