Bill summaries are authored by CRS.

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Passed House amended (10/03/1992)

Indian Health Amendments of 1992 - Amends the Indian Health Care Improvement Act to state that it is the intent of the Congress that the Nation meet specified health status objectives with respect to Indians and urban Indians by the year 2000.

Directs the Secretary of Health and Human Services (Secretary) to report to the President, for transmission to the Congress, on the progress made in meeting each stated objective.

Title I: Indian Health Professionals - Directs the Secretary to make preparatory scholarship grants for: (1) up to two years on a full-time basis (or the part-time equivalent) to Indians who have demonstrated the capability to successfully complete courses of study in the health professions; and (2) up to four years (or the part-time equivalent) for pregraduate education of any grantee leading to a baccalaureate degree in an approved course of study preparatory to such health professions.

Prohibits the Secretary from denying scholarship assistance to an eligible applicant solely by reason of such applicant's eligibility for other Federal assistance.

Authorizes the Secretary to grant health professions scholarships to Indians who are enrolled full or part-time in appropriately accredited schools and pursuing courses of study in the health professions.

Permits an Indian Health Scholarship recipient to meet active duty requirements through service on his or her reservation or to his or her tribe.

Provides that the period for a part-time scholarship shall not exceed the part-time equivalent of four years.

Directs the Secretary, acting through the Indian Health Service (Service), to establish a Placement Office to develop a national policy for the placement within the Service of health professionals required to meet the active duty obligation prescribed under the Public Health Service Act without regard to any competitive personnel system, agency personnel limitation, or Indian preference policy.

Makes an individual liable to the United States for the amount paid to or on the individual's behalf under a written Indian health professions contract for specified breaches.

Entitles the United States to recover an amount determined by a specified formula from any individual who fails to begin or complete such service obligations.

Authorizes the Secretary, acting through the Service, to provide: (1) continuing education allowances to nurses employed by the Service; and (2) grants to establish and develop clinics operated by nurses, nurse midwives, or nurse practitioners to provide primary health care services to Indians. Allocates funds for the training of nurse practitioners.

Directs the Secretary to establish a program at the University of North Dakota to be known as the Quentin N. Burdick American Indians Into Nursing Program.

Requires that as of FY 1993 at least 25 percent of annual retention bonuses be awarded to nurses.

Requires the Secretary, acting through the Service, to establish a program to enable licensed practical nurses, licensed vocational nurses, and registered nurses working in an Indian health program for at least one year to pursue advanced training in a residency program.

Authorizes the Secretary, acting through the Service, to provide grants to nursing schools to establish primary health care clinics for Indians. Obligates grant funds.

Revises the Indian Health Service Loan Repayment Program with respect to: (1) eligibility and participation requirements; (2) extension of obligated service; (3) undergraduate loans; (4) repayment of loans; (5) tax liability reimbursements; and (6) the Secretary's annual report to the Congress.

Directs the Secretary, acting through the Service, to assign one individual in each area office to be responsible on a full-time basis for recruitment activities.

Requires the Secretary to provide a grant to a college or university to establish and maintain a program parallel to the Indians into Medicine Program (INMED) for the nursing and mental health professions.

Establishes in the Treasury the Indian Health Scholarship and Loan Repayment Recovery Fund.

Directs the Secretary, under authority of the Snyder Act, to: (1) maintain a Community Health Aide Program in Alaska; and (2) provide, in a specified manner, a high standard of training to community health aides to ensure that they provide quality health care, health promotion, and disease prevention services to the villages served by the Program.

Requires the Secretary, by contract or otherwise, to provide training for individuals in the administration and planning of tribal health programs.

Directs the Secretary to: (1) make matching grants to tribes and tribal organizations for health professional training scholarships; and (2) provide for training in tribal health program administration.

Makes tribally controlled vocational institutions eligible for: (1) nursing program grants; and (2) participation in tribal culture and history programs.

Authorizes the Secretary to make a grant to the School of Medicine of the University of South Dakota for a pilot program to address the health and medical manpower shortage in the Aberdeen Area of the Service.

Authorizes appropriations.

Title II: Health Services - Authorizes the Secretary to expend appropriated funds under this Act to eliminate the deficiencies in health status and resources of all Indian tribes.

Changes the threshold cost established by the Secretary: (1) for FY 1993 to a minimum of $15,000 and a maximum of $25,000 (currently a minimum of $10,000 to a maximum of $20,000) before a service unit can be eligible for reimbursement from the Catastrophic Health Emergency Fund for the cost of treatment of an individual; and (2) for each succeeding year to the 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.

Directs the Secretary, acting through the Service, to provide health promotion and disease prevention services to Indians to achieve the health objectives set forth in this Act.

Repeals the requirement that the Secretary establish from one to four demonstration projects to discover the most effective and cost-efficient means of providing health promotion and disease prevention services to Indians.

Directs the Secretary to continue to maintain specified model diabetes projects in existence through FY 2000.

Authorizes the Secretary to establish new model diabetes projects. Prohibits the establishment of a greater number of them in one service area than in another until there is an equal number established with respect to all service areas.

Adds to the duties of the diabetes control officer employed in each area office of the Service the task of evaluating the effectiveness of services provided through model diabetes projects established under this Act.

Requires the Service to report annually to the President for transmission to the Congress, on the mental health status of Indians.

Requires any person employed as a psychologist, marriage and family therapist, or social worker providing clinical mental health care services to Indians to be licensed as such or working under the direct supervision of a licensed clinical psychologist, marriage and family therapist, or social worker.

Authorizes the Secretary, acting through the Service, to provide grants for intermediate mental health services to Indian children and adolescents. Authorizes appropriations.

Directs the Secretary to study and report to the Congress on the: (1) feasibility and desirability of furnishing hospice care to terminally ill Indians; (2) determination of the most efficient and effective means of furnishing such care; and (3) feasibility of allowing an Indian tribe to purchase, directly or through the Service, managed care coverage under certain circumstances. Authorizes appropriations.

Directs the Secretary to establish a contract health services demonstration program for California Indians. Provides for reimbursement of related costs for the California Rural Indian Health Board. Establishes a program advisory board. Terminates the program on September 30, 1997. Authorizes appropriations.

Directs the Secretary, acting through the Service, to: (1) provide for screening mammography of Indian and urban Indian women 35 years or older; and (2) provide funds for certain patient travel costs (authorizing appropriations).

Directs the Secretary to establish an epidemiology center in each service area.

Authorizes the Secretary, acting through the Service, to award grants to: (1) Indian tribes for comprehensive school health education programs; and (2) Indian tribes, tribal organizations, and urban Indian organizations for Indian youth programs. Directs the Secretary of the Interior, acting through the Bureau of Indian Affairs, to develop a comprehensive school health education program for Bureau schools. Authorizes appropriations.

Authorizes the Secretary to make grants to at least three colleges and universities (one of which shall be to the University of North Dakota to establish a Quentin N. Burdick American Indians into Psychology Program) to develop American Indian psychology career recruitment programs.

Authorizes the Secretary, acting through the Service, to make grants to tribes and tribal organizations to conduct a study of contract health services.

Establishes within the Service an Office of Indian Women's Health Care.

Authorizes appropriations for specified activities under this title.

Title III: Health Facilities - Requires the Secretary, when evaluating for the Congress the likely impact of the closure of an Indian Health Service hospital or one of its outpatient health care facilities, to specify: (1) the level of use of such hospital or facility by all eligible Indians; and (2) the distance between such hospital or facility and the nearest operating Service hospital.

Authorizes: (1) the Secretary to provide financial assistance to Indian tribes and communities for safe water and sanitary waste disposal facilities; and (2) the Secretary, acting through the Service, to provide grants to tribes and tribal organizations for construction and expansion of ambulatory care facilities.

Revises the priority for grant and contract awards under the Indian health care delivery demonstration project.

Authorizes the Bureau to transfer at no cost up to five acres of land at the Chemawa Indian School, Salem, Oregon, for the provision of health care services.

Authorizes appropriations for activities under this title.

Applies the requirements of the Buy American Act to all procurements with such funds. Prohibits contracts with persons falsely labeling products as Made in America.

Title IV: Access to Health Services - Prohibits any payments received by a hospital or skilled nursing facility of the Service for services provided to Indians eligible for Medicare benefits from being considered in determining appropriations for health care and services to Indians. Declares that the Secretary has no authority to provide services to an Indian beneficiary with coverage under Medicare in preference to an Indian beneficiary without such coverage.

Requires payments to any Service facility made under the Medicaid program to be placed in a special fund to be held by the Secretary and used, in a specified manner, exclusively for making any improvements in the facilities of such Service to achieve compliance with the applicable conditions and requirements of the Social Security Act.

Prohibits payments received by such facility for services provided to Indians eligible for benefits under Medicaid from being considered in determining appropriations for the provision of health care and services to Indians.

Requires the Secretary to submit to the President, instead of the Congress, for submission with the budget, an accounting of the amount and use of funds reimbursed through Medicare and Medicaid made available to Indian Health Services.

Extends the demonstration program for direct billing of Medicare, Medicaid, and other third party payors.

Authorizes appropriations for activities under this title.

Title V: Health Services for Urban Indians - Authorizes grants to urban Indian organizations for health care services. (Currently the Secretary has contract authority only.)

Authorizes the Secretary to make grants to urban Indian organizations for alcohol and substance abuse related services.

States that the Oklahoma City Clinic demonstration project and the Tulsa Clinic demonstration project shall be treated as service units in the allocation of resources and shall not be subject to the terms of the Indian Self-Determination Act.

Directs the Secretary, within the Branch of Urban Health Programs of the Service, to 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.

Authorizes appropriations for activities under this title.

Title VI: Organizational Improvements - Requires the Secretary to carry out through the Service all scholarship and loan functions under this Act.

Requires the Director of the Service to be appointed by the President by and with the advice and consent of the Senate. (Currently the Director is appointed by the Secretary.) Authorizes a four-year term of service for the Director, who may serve more than one term.

Authorizes appropriations for activities under this title.

Title VII: Substance Abuse Programs - Redesignates Title VII of the Indian Health Care Improvement Act as Title VIII.

Expands the responsibilities of the Service with respect to the Memorandum of Agreement entered into under the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986.

Directs the Secretary, acting through the Service, to provide a program of comprehensive alcohol and substance abuse prevention and treatment to members of Indian tribes, including: (1) programs for pregnant and post-partum women and their children; and (2) grants to the Standing Rock Sioux Tribe for a model program.

Authorizes the Secretary, acting through the Service, to enter into contracts with public or private providers of alcohol and substance abuse treatment services to assist the Service in carrying out such programs.

Authorizes the Secretary to make grants to tribes and tribal organizations for alcohol and substance abuse treatment of Indian women. Authorizes appropriations. Obligates 20 percent of appropriations for grants to urban Indian organizations.

Directs the Secretary to: (1) develop a program for acute detoxification and treatment for Indian youth who are alcohol and substance abusers; and (2) operate a youth regional treatment center in each area under the jurisdiction of an area office. Considers the area offices of the Service in Tucson and Phoenix, Arizona, as one area office. Considers the one area office in California to be two area offices.

Authorizes the Secretary to make funds available to: (1) the Tanana Chiefs Conference, Incorporated, for a residential youth treatment facility in Fairbanks, Alaska; and (2) the Southeast Alaska Regional Health Corporation to operate a youth treatment facility without regard to certain contract agreement requirements.

Directs the Secretary, acting through the Service, to: (1) identify and use, where appropriate, federally-owned structures suitable as local residential or regional alcohol and substance abuse treatment centers for Indian youth; and (2) establish guidelines to determine their suitability for such purpose.

Directs the Secretary, in cooperation with the Secretary of the Interior, to develop within each Service unit community-based rehabilitation and follow-up services designed to integrate long-term treatment and to monitor and support Indian youth who are alcohol or substance abusers after their return home.

Provides for the inclusion of family members in such treatment programs or other appropriate services. Earmarks at least ten percent of funds appropriated to carry out such programs for outpatient care of adult family members related to the treatment of an Indian youth.

Directs the Secretary to study and report to the Congress on: (1) 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 (2) the interrelationship of such abuse with the incidence of mental illness among such youth.

Requires the Secretary, in cooperation with the Secretary of the Interior, to develop within each service unit, a program to provide training and community education in the areas of alcohol and substance abuse, including the development of community-based training models.

Requires the Secretary to make grants to the Navajo Nation to provide residential treatment for alcohol and substance abuse for the Tribe's adult and adolescent members and neighboring tribes.

Directs the Navajo Nation to enter into a contract with a Gallup, New Mexico, area institution accredited by the Joint Commission of the Accreditation of Health Care Organizations to provide such comprehensive alcohol and drug treatment. Authorizes appropriations.

Authorizes the Secretary to make grants to tribes and tribal organizations for fetal alcohol syndrome (FAS) and fetal alcohol effect (FAE) programs. Directs the Secretary to: (1) establish an FAS/FAE Task Force; and (2) make grants through the Substance Abuse and Mental Health Services Administration to tribes, tribal organizations, and universities for applied FAS and FAE research projects. Authorizes appropriations. Obligates ten percent of appropriations for urban Indian organizations.

Directs the Secretary, acting through the Service, to: (1) make grants through FY 1995 to the 8 Northern Indian Pueblos Council, San Juan Pueblo, New Mexico, for substance abuse treatment services; and (2) make a grant to the Intertribal Addiction Recovery Organization, Inc. (Thunder Child Treatment Center), Sheridan, Wyoming, for the construction of a substance abuse treatment center (authorizing appropriations).

Authorizes the Secretary, acting through the Service, to enter into contracts with, or make grants to, tribally controlled or other eligible community colleges for demonstration projects to develop educational curricula for substance abuse counseling.

Authorizes appropriations.

Directs the Secretary, acting through the Service, to: (1) establish a regional youth alcohol and substance abuse prevention and treatment center in Sacaton, Arizona, on the Gila River Indian Reservation; and (2) make grants to the Alaska Native Health Board for a drug and alcohol abuse prevention demonstration program.

Amends the Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 to: (1) repeal current part 6 (Indian alcohol and substance abuse treatment and rehabilitation); (2) require Tribal Action Plans to be updated every two years; (3) extend authorization of appropriations for Tribal Action Plan technical assistance; (4) authorize grants and necessary appropriations for substance abuse education and prevention programs; (5) extend authorization of appropriations for a substance abuse newsletter; (6) extend authorization of appropriations for an Indian youth summer program; (7) extend authorization of appropriations for Indian youth emergency shelters and half-way houses; (8) authorize assistance to the Makah Indian Tribe of Washington for investigation and control of illegal narcotic traffic on the Makah Indian Reservation; (9) extend authorization of appropriations for similar narcotics investigation and control activities by the Tohono O'odham Tribe of Arizona and the St. Regis Band of Mohawk Indians of New York on their Reservations; (10) extend authorization of appropriations for the Department of the Interior's program of marijuana eradication and interdiction on Indian lands; (11) extend authorization of appropriations for the Bureau of Indian Affairs' program of law enforcement and judicial training; and (12) extend authorization of appropriations for juvenile detention centers.

Title VIII: Miscellaneous - Directs the President to include with submission of the budget certain reports and statements on meeting the objectives of this Act.

Extends to FY 2000 the time during which Arizona is designated as a contract health service delivery area.

Continues through FY 1995 the demonstration programs involving treatment for child sexual abuse that were conducted in FY 1991 through the Hopi Tribe and the Asiniboine and Sioux Tribes of Fort Peck Reservation.

Authorizes the Secretary and the Secretary of the Interior to establish such programs in any service area, except that the establishment of a greater number of them in one service area than in another is prohibited until there is an equal number established with respect to all service areas.

Extends the deadline for: (1) certain tribal health services management demonstration programs; and (2) an evaluation report by the Secretary.

Authorizes the Secretary, acting through the Service, to enter into contracts with, or make grants to, tribes or tribal organizations for home and community-based care demonstration projects for disabled Indians. Authorizes appropriations.

Authorizes the Secretary, acting through the Service, to enter into contracts with tribes or tribal organizations to establish up to six long-term care shared services demonstration projects.

Directs the Secretary to provide for the dissemination to Indian tribes of the results of demonstration projects under this Act.

Gives priority to Indian reservations in matters involving Service facilities or employment projects.

Authorizes appropriations.

Amends the Indian Self-Determination and Education Assistance Act to authorize appropriations for the purpose of providing one-year planning and negotiations grants to certain tribes under the tribal self-governance project.

Title IX: Technical Corrections - Makes technical corrections to the Indian Health Care Improvement Act.