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108th Congress                                            Rept. 108-791
                        HOUSE OF REPRESENTATIVES
 2d Session                                                      Part 1

======================================================================



 
         INDIAN HEALTH CARE IMPROVEMENT ACT AMENDMENTS OF 2004

                                _______
                                

               November 19, 2004.--Ordered to be printed

                                _______
                                

  Mr. Pombo, from the Committee on Resources, submitted the following

                              R E P O R T

                        [To accompany H.R. 2440]

  The Committee on Resources, to whom was referred the bill 
(H.R. 2440) to improve the implementation of the Federal 
responsibility for the care and education of Indian people by 
improving the services and facilities of Federal health 
programs for Indians and encouraging maximum participation of 
Indians in such programs, and for other purposes, 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.

  This Act may be cited as the ``Indian Health Care Improvement Act 
Amendments of 2004''.

SEC. 2. 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.
Sec. 2. Indian Health Care Improvement Act amended.
        ``Sec. 1. Short title; table of contents.
        ``Sec. 2. Declaration of National Indian health policy.
        ``Sec. 3. 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. Funding for tribes for scholarship programs.
        ``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 for Alaska.
        ``Sec. 122. Tribal health program administration.
        ``Sec. 123. Health professional chronic shortage demonstration 
                        programs.
        ``Sec. 124. Treatment of scholarships for certain purposes.
        ``Sec. 125. National Health Service Corps.
        ``Sec. 126. Substance abuse counselor educational curricula 
                        demonstration programs.

                      ``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 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. 216A. North Dakota as a contract health service delivery 
                        area.
        ``Sec. 216B. South Dakota as a contract health service delivery 
                        area.
        ``Sec. 217. California contract health services program.
        ``Sec. 218. California as a contract health service delivery 
                        area.
        ``Sec. 219. Contract health services for the Trenton Service 
                        Area.
        ``Sec. 220. Programs operated by Indian Tribes and Tribal 
                        Organizations.
        ``Sec. 221. Licensing or certification.
        ``Sec. 222. Notification of provision of emergency contract 
                        health services.
        ``Sec. 223. Prompt action on payment of claims.
        ``Sec. 224. Liability for payment.
        ``Sec. 225. 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 nonservice 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 care programs.
        ``Sec. 402. Grants to and funding agreements with the Service, 
                        Indian Tribes, Tribal Organizations, and Urban 
                        Indian organizations.
        ``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 in qualifications for 
                        reimbursement for services.
        ``Sec. 409. Consultation.
        ``Sec. 410. State children's health insurance program (SCHIP).
        ``Sec. 411. Social Security Act sanctions.
        ``Sec. 412. Cost sharing.
        ``Sec. 413. Treatment under medicaid managed care.
        ``Sec. 414. Navajo nation medicaid agency feasibility study.
        ``Sec. 415. 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. Office 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. Federal Tort Claims Act coverage.
        ``Sec. 516. Urban youth treatment center demonstration.
        ``Sec. 517. Use of Federal property and supplies.
        ``Sec. 518. Grants for diabetes prevention, treatment, and 
                        control.
        ``Sec. 519. Community health representatives.
        ``Sec. 520. Regulations.
        ``Sec. 521. Eligibility for services.
        ``Sec. 522. 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. Inpatient and community-based mental health 
                        facilities design, construction, and staffing.
        ``Sec. 709. Training and community education.
        ``Sec. 710. Behavioral health program.
        ``Sec. 711. Fetal alcohol disorder funding.
        ``Sec. 712. Child sexual abuse and prevention treatment 
                        programs.
        ``Sec. 713. Behavioral health research.
        ``Sec. 714. Definitions.
        ``Sec. 715. 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 the 
                        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. Tribal employment.
        ``Sec. 813. Prime vendor.
        ``Sec. 814. Severability provisions.
        ``Sec. 815. Establishment of National Bipartisan Commission on 
                        Indian Health Care Entitlement.
        ``Sec. 816. Appropriations; availability.
        ``Sec. 817. Confidentiality of medical quality assurance 
                        records: qualified immunity for participants.
        ``Sec. 818. Authorization of appropriations.

``SEC. 2. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.

  ``Congress hereby 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 to provide all resources necessary to effect that 
        policy;
          ``(2) to raise the health status of Indians by the year 2010 
        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. 3. 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) The term `behavioral health' means the blending of 
        substance (alcohol, drugs, inhalants, and tobacco) abuse and 
        mental illness prevention and treatment, for the purpose of 
        providing comprehensive services. This definition can include 
        the joint development of substance abuse and mental illness 
        treatment planning and coordinated case management using a 
        multidisciplinary approach.
          ``(5) The term `California Indians' shall mean 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) 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 `fund' or `funding' means the transfer of 
        moneys from the Department to any eligible entity or individual 
        under this Act by any legal means, including Funding 
        Agreements, contracts, grants, memoranda of understanding, 
        contracts pursuant to section 23 of the Act of April 20, 1908 
        (25 U.S.C. 47; commonly known as the `Buy Indian Act'), or 
        otherwise. Any program administered as a grant program one day 
        before the date of enactment may continue to be administered as 
        a grant program. This definition does not otherwise modify 
        grant programs, except that upon request of the Indian Tribes 
        or Tribal Organizations, discretionary grants and all 
        categories of awarded nonrecurring funding shall be included in 
        the Funding Agreement. Discretionary grant funds shall be 
        governed by all the particular terms and conditions attached to 
        such funds, unless waived by the Secretary. All particular 
        terms and conditions attached to the discretionary grant funds 
        must be shown in the Funding Agreement. The use of such grant 
        funds shall be governed by the terms and conditions set forth 
        in the Funding Agreement and not the substantive provisions of 
        the Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 450 et seq.).
          ``(11) The term `Funding Agreement' means any agreement to 
        transfer funds for the planning, conduct, and administration of 
        programs, services, functions, and activities to Indian Tribes 
        and Tribal Organizations from the Secretary under the Indian 
        Self-Determination and Education Assistance Act (25 U.S.C. 450 
        et seq.).
          ``(12) The term `health profession' means allopathic 
        medicine, family medicine, internal medicine, pediatrics, 
        geriatric medicine, obstetrics and gynecology, podiatric 
        medicine, nursing, public health nursing, advanced practice 
        nursing, dentistry, psychiatry, osteopathy, optometry, 
        pharmacy, psychology, public health, social work, marriage and 
        family therapy, chiropractic medicine, environmental health and 
        engineering, allied health professions, and any other health 
        profession.
          ``(13) 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 suitable housing, safe water, 
                and sanitary facilities;
                  ``(E) improving the physical, economic, cultural, 
                psychological, and social environment;
                  ``(F) promoting adequate opportunity for spiritual, 
                religious, and Traditional Health Care Practices; and
                  ``(G) providing adequate and appropriate programs, 
                including, but not limited to--
                          ``(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) safe housing relative to eliminating, 
                        reducing, or preventing contaminants which 
                        create unhealthy housing conditions;
                          ``(xxii) safe work environments;
                          ``(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).
          ``(14) The term `Indian' 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 `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 April 30, 1908 (25 U.S.C. 47), 
                commonly known as the `Buy Indian Act'.
          ``(16) 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.).
          ``(17) 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)).
          ``(18) 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 (25 U.S.C. 1601 et seq.).
          ``(19) The term `Secretary', unless otherwise designated, 
        means the Secretary of Health and Human Services.
          ``(20) The term `Service' means the Indian Health Service.
          ``(21) The term `Service Area' means the geographical area 
        served by each Area Office.
          ``(22) 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.
          ``(23) 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)).
          ``(24) 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.
          ``(25) The term `Traditional Health Care Practices' means the 
        application by Native healing practitioners of the Native 
        healing sciences (as opposed or in contradistinction to Western 
        healing sciences) which embody the influences or forces of 
        innate Tribal discovery, history, description, explanation and 
        knowledge of the states of wellness and illness and which call 
        upon these influences or forces, including physical, mental, 
        and spiritual forces in the promotion, restoration, 
        preservation, and maintenance of health, well-being, and life's 
        harmony.
          ``(26) 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)).
          ``(27) 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 Funding 
        Agreement with the Service under the Indian Self-Determination 
        and Education Assistance Act (25 U.S.C. 450 et seq.).
          ``(28) 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.).
          ``(29) 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.
          ``(30) 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 
                Alaskan 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.
          ``(31) 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 funds available 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) Funding.--
          ``(1) Application.--Funds under this section shall require 
        that 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 funds; payment.--The amount of funds provided 
        to entities 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, funding commitments shall be for 3 years, as provided in 
        regulations issued pursuant to this Act.
  ``(c) Definition of Indian.--For purposes of this section and 
sections 103 and 104, the term `Indian' shall, in addition to the 
meaning given that term in section 4, also mean any individual who is 
an Urban Indian.

``SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP PROGRAM FOR 
                    INDIANS.

  ``(a) Scholarships Authorized.--The Secretary, acting through the 
Service, shall provide scholarships 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.--Scholarships 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 scholarships 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) Allocation by formula.--Except as provided in paragraph 
        (3), the funding authorized by this section shall be allocated 
        by Service Area by a formula developed in consultation with 
        Indian Tribes, Tribal Organizations, and Urban Indian 
        Organizations. Such formula shall consider the human resource 
        development needs in each Service Area.
          ``(3) Continuity of prior scholarships.--Paragraph (2) shall 
        not apply with respect to individual recipients of scholarships 
        provided under this section (as in effect 1 day prior to the 
        date of the enactment of the Indian Health Care Improvement Act 
        Amendments of 2004) until such time as the individual completes 
        the course of study that is supported through such scholarship.
          ``(4) Certain delegation not allowed.--The administration of 
        this section shall be a responsibility of the Assistant 
        Secretary and shall not be delegated in a Funding Agreement.
  ``(b) Active Duty Service Obligation.--
          ``(1) Obligation met.--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 
        Indian has entered into under that section shall, if that 
        individual is a recipient of an Indian Health Scholarship, be 
        met in full-time practice on an equivalent year-for-year 
        obligation, by service in one 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.
          ``(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--part-time equivalent of 4 years, as determined by the 
Area Office;
          ``(1) 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 Area Office); or
                  ``(B) 2 years; and
          ``(2) 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 the enactment of the Indian Health Care Improvement 
        Act Amendments of 2004 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.--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, in consultation with the Area 
        Office, Indian Tribes, Tribal Organizations, and Urban Indian 
        Organizations, determines that--
                  ``(A) it is not possible for the recipient to meet 
                that obligation or make that payment;
                  ``(B) requiring that recipient to meet that 
                obligation or make that payment would result in extreme 
                hardship to the recipient; or
                  ``(C) the enforcement of the requirement to meet the 
                obligation or make the payment would be unconscionable.
          ``(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 provide funding grants to at least 3 colleges and universities 
for the purpose of developing and maintaining Indian psychology career 
recruitment programs as a means of encouraging Indians to enter the 
mental 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 funds 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.

``SEC. 106. FUNDING FOR TRIBES FOR SCHOLARSHIP PROGRAMS.

  ``(a) In General.--
          ``(1) Funding authorized.--The Secretary, acting through the 
        Service, shall make funds available 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 funds 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 funds 
        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 one 
of the health professions contemplated by this Act.
  ``(d) Contract.--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. Such contract shall--
          ``(1) 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--
                  ``(A) 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
                  ``(B) such greater period of time as the recipient 
                and the Tribal Health Program may agree;
          ``(2) provide that the amount of the scholarship--
                  ``(A) 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)), such 
                        amount to be reduced pro rata (as determined by 
                        the Secretary) based on the number of hours 
                        such student is enrolled; and 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 this clause; 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 
        pursuant to this Act; and
          ``(4) require the recipient of such scholarship to meet the 
        educational and licensure requirements appropriate to each 
        health profession.
  ``(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 health professionals, including community 
health representatives and emergency medical technicians, to join or 
continue in an Indian Health Program or an Urban Indian Organization 
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 provide allowances to health professionals employed in 
an Indian Health Program or an Urban Indian Organization 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.

``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).
In the administration of this section, naturopathic medicine is 
included among the other health professions.
  ``(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) 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.
          ``(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 Service manpower programs 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 based on yields on appropriate marketable 
                Treasury securities;
                  ``(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 each 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, except for the appropriated funds, as 
the Secretary 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 unpaid 
student volunteers and 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 one 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 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 the 
enactment of the Indian Health Care Improvement Act Amendments of 2004, 
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 one 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 funding 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.
  ``(e) Quentin N. Burdick Program Grant.--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 
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 (including programs under agreements with the 
        Bureau of Indian Affairs);
          ``(3) in a program assisted under title V of this Act; or
          ``(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.

``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 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 
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 $100,000.
  ``(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 
                        which 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) Funding Priority.--Where the requirements of subsection (b) are 
met, funding 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 3 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 certification 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 the amount 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 110 in the manner provided for 
in such subsection.

``SEC. 121. COMMUNITY HEALTH AIDE PROGRAM FOR ALASKA.

  ``(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 no dental health aide is certified under 
        the program to perform treatment of dental caries, pulpotomies, 
        or extractions of teeth.
  ``(c) National Community Health Aide Program.--The Secretary, acting 
through the Service, shall develop and promulgate regulations to 
operate a national Community Health Aide Program consistent with the 
requirements of this section without reducing funds for the Community 
Health Aide Program for Alaska.

``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.

  ``The Secretary, acting through the Service, shall, by funding 
agreement 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. TREATMENT OF SCHOLARSHIPS FOR CERTAIN PURPOSES.

  ``Scholarships provided to individuals pursuant to this title shall 
be deemed `qualified Scholarships' for purposes of section 117 of the 
Internal Revenue Code of 1986.

``SEC. 125. 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, Indian Tribes, or 
Tribal Organizations, 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 United States 
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. 126. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL CURRICULA 
                    DEMONSTRATION PROGRAMS.

  ``(a) Grants and Contracts.--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 1 year. 
Such contract or grant may be renewed for an additional 1-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 the enactment of the Indian Health Care 
Improvement Act Amendments of 2004, 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. 127. 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 funding agreement, the appropriate Secretary shall ensure 
        that funds to cover the costs of such training costs are 
        included in the funding agreement.
          ``(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 the enactment 
of the Indian Health Care Improvement Act Amendments of 2004, 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 the 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').

                      ``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, 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, but not limited to, 
                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) Accident prevention programs.
                  ``(H) Home health care.
                  ``(I) Community health representatives.
                  ``(J) Maintenance and repair.
                  ``(K) Traditional Health Care Practices.
  ``(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 the enactment of the Indian Health Care Improvement Act 
Amendments of 2004, 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 hereby 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 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.
  ``(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, 
nor shall CHEF funds be allocated, apportioned, or delegated on an Area 
Office, Service Unit, or other similar basis.
  ``(d) Regulations.--The Secretary shall, through the negotiated 
rulemaking process under title VIII, 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 each 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 an Indian Tribe, Tribal Organization, 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, in 
consultation with Indian Tribes, Urban Indian Organizations, and 
appropriate health care providers, 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) Funding for Diabetes.--The Secretary shall continue to fund 
each model diabetes project in existence on the date of the enactment 
of the Indian Health Care Improvement Amendments Act of 2004, 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 2004 and for projects which 
are added and funded thereafter.
  ``(d) Funding for Dialysis Programs.--The Secretary shall provide 
funding through the Service, Indian Tribes, and Tribal Organizations to 
establish dialysis programs, including funding to purchase dialysis 
equipment and provide necessary staffing.
  ``(e) Other Duties of the Secretary.--The Secretary shall, to the 
extent funding is available--
          ``(1) in each Area Office, consult with Indian Tribes and 
        Tribal Organizations regarding programs for the prevention, 
        treatment, and control of diabetes;
          ``(2) 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
          ``(3) 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.

``SEC. 205. SHARED SERVICES FOR LONG-TERM CARE.

  ``(a) Funding Agreements for Long-term Care.--Notwithstanding any 
other provisions of law, the Secretary, acting through the Service, is 
authorized to enter into Funding Agreements or other arrangements with 
Indian Tribes or Tribal Organizations for the delivery of long-term 
care and similar services to Indians. Such funding agreements or other 
arrangements shall provide for the sharing of staff or other services 
between the Service or a Tribal Health Program and a long-term care or 
other similar facility owned and operated (directly or through a 
Funding Agreement) by such Indian Tribe or Tribal Organization.
  ``(b) Contents of Funding Agreements.--A Funding Agreement or other 
arrangement 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.

  ``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 and shall coordinate the 
activities of other agencies within the Department to address these 
research needs. Tribal Health Programs shall be given an equal 
opportunity to compete for, and receive, research funds under this 
section. This funding may be used for both clinical and nonclinical 
research.

``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 national standards, such as 
        those of the National Cancer Institute for the National 
        Institutes for Health, 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 meeting national standards, such 
        as those of the National Cancer Institute.

``SEC. 208. PATIENT TRAVEL COSTS.

  ``The Secretary, acting through the Service and Tribal Health 
Programs, shall provide funds for the following patient travel costs, 
including appropriate and necessary qualified escorts, associated with 
receiving health care services provided (either through direct or 
contract care or through Funding Agreements) 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) Additional Centers.--In addition to those epidemiology centers 
already established at the time of enactment of this Act, (including 
those for which funding is currently being provided in Funding 
Agreements), and without reducing the funding levels for such centers, 
not later than 180 days after the date of the enactment of the Indian 
Health Care Improvement Act Amendments of 2004, the Secretary, acting 
through the Service, shall establish and fund an epidemiology center in 
each Service Area which does not yet have one to carry out the 
functions described in subsection (b). Any new centers so established 
may be operated by Tribal Health Programs, but such funding 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) Funding for Studies.--The Secretary may make funding available 
to Indian Tribes, Tribal Organizations, and Urban Indian Organizations 
to conduct epidemiological studies of Indian communities.

``SEC. 210. COMPREHENSIVE HEALTH EDUCATION PROGRAMS.

  ``(a) Funding for Development of Programs.--The Secretary, acting 
through the Service, shall provide funding 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 Funds.--Funding provided under this section may be used 
for purposes which may include, but are not limited to, the following:
          ``(1) Developing and implementing health education curricula 
        both for regular school programs and afterschool programs.
          ``(2) Training teachers in comprehensive school health 
        education curricula.
          ``(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 
funding provided pursuant to 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 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.

``SEC. 211. INDIAN YOUTH PROGRAM.

  ``(a) Program Authorized.--The Secretary, acting through the Service, 
is authorized to establish and administer a program to provide funding 
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) Funding Authorized.--The Secretary, acting through the Service, 
and after consultation with Indian Tribes, Tribal Organizations, Urban 
Indian Organizations, and the Centers for Disease Control and 
Prevention, may make funding 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, but not 
        limited to, tuberculosis, hepatitis, human immunodeficiency 
        virus, respiratory syncytial virus, hanta virus, sexually 
        transmitted diseases, and Helicobacter Pylori Infections.
          ``(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, 
which shall include, but not be limited to--
          ``(1) hospice care;
          ``(2) assisted living;
          ``(3) long-term health care;
          ``(4) home- and community-based services;
          ``(5) public health functions; and
          ``(6) Traditional Health Care Practices.
  ``(b) Services to Otherwise Ineligible Persons.--At the discretion of 
the Service, Indian Tribes, or Tribal Organizations, services provided 
for hospice care, home health care, home- and community-based care, 
assisted living, and long-term care may be provided (subject to 
reimbursement of reasonable charges) to persons otherwise ineligible 
for the health care benefits of the Service. Any funds received under 
this subsection shall not be used to offset or limit the funding 
allocated to an Indian Tribe or Tribal Organization.
  ``(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 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.
                  ``(G) Adult day care.
                  ``(H) Such other home- and community-based services 
                as the Secretary, an Indian Tribe, or Tribal 
                Organization may approve.
          ``(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.
          ``(3) The term `public health functions' means the provision 
        of public health-related programs, functions, and services 
        including, but not limited to, assessment, assurance, and 
        policy development which Indian Tribes and Tribal Organizations 
        are authorized and encouraged, in those circumstances where it 
        meets their needs, to do by forming collaborative relationships 
        with all levels of local, State, and Federal Government.

``SEC. 214. INDIAN WOMEN'S HEALTH CARE.

  ``The Secretary, acting through the Service and Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations, shall provide funding 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.

``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, but not limited to, 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 the 
        enactment of the Indian Health Care Improvement Act Amendments 
        of 2004 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, in consultation with Indian Tribes and Tribal 
Organizations, 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 the enactment 
of the Indian Health Care Improvement Act Amendments of 2004. 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, 2015, 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. 216A. NORTH DAKOTA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.

  ``(a) In General.--For fiscal years beginning with the fiscal year 
ending September 30, 2003, and ending with the fiscal year ending 
September 30, 2015, the State of North 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.
  ``(b) Limitation.--The Service shall not curtail any health care 
services provided to Indians residing on reservations in the State of 
North Dakota 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. 216B. SOUTH DAKOTA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.

  ``(a) In General.--For fiscal years beginning with the fiscal year 
ending September 30, 2003, and ending with the fiscal year ending on 
September 30, 2015, the State of 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 South Dakota.
  ``(b) Limitation.--The Service shall not curtail any health care 
services provided to Indians residing on reservations in the State of 
South Dakota 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. 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 hereby 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 one half of whom are not affiliated 
with the CRIHB.

``SEC. 218. 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. 219. 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. 220. 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. 221. LICENSING OR CERTIFICATION.

  ``Health care professionals employed by a Tribal Health Program 
shall, if licensed or certified in any State, be exempt from the 
licensing or certification requirements of the State in which the 
Tribal Health Program performs the services described in its Funding 
Agreement.

``SEC. 222. 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. 223. 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. 224. 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. 225. AUTHORIZATION OF APPROPRIATIONS.

  ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2015 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 may be 
        closed if the Secretary has not submitted to Congress at least 
        1 year prior to the date of the proposed closure an evaluation 
        of the impact of the proposed closure which 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) Establishment.--The Secretary, acting through 
                the Service, shall establish a health care facility 
                priority system, which shall--
                          ``(i) be developed with Indian Tribes and 
                        Tribal Organizations through negotiated 
                        rulemaking under section 802;
                          ``(ii) give Indian Tribes' needs the highest 
                        priority; and
                          ``(iii) at a minimum, include the lists 
                        required in paragraph (2)(B) and the 
                        methodology required in paragraph (2)(E).
                  ``(B) Priority of certain projects protected.--The 
                priority of any project established under the 
                construction priority system in effect on the date of 
                the Indian Health Care Improvement Act Amendments of 
                2004 shall not be affected by any change in the 
                construction priority system taking place thereafter if 
                the project was identified as 1 of the 10 top-priority 
                inpatient projects, 1 of the 10 top-priority outpatient 
                projects, 1 of the 10 top-priority staff quarters 
                developments, or 1 of the 10 top-priority Youth 
                Regional Treatment Centers in the fiscal year 2005 
                Indian Health Service budget justification, or if the 
                project had completed both Phase I and Phase II of the 
                construction priority system in effect on the date of 
                the enactment of such Act.
          ``(2) Report; contents.--The Secretary shall submit to the 
        President, for inclusion in each report required to be 
        transmitted to Congress under section 801, a report which sets 
        forth the following:
                  ``(A) A description of the health care facility 
                priority system of the Service, established under 
                paragraph (1).
                  ``(B) Health care facilities lists, including but not 
                limited to--
                          ``(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 patient hostels 
                        associated with health care facilities.
                  ``(C) The justification for such order of priority.
                  ``(D) The projected cost of such projects.
                  ``(E) The methodology adopted by the Service in 
                establishing priorities under its health care facility 
                priority system.
          ``(3) Requirements for preparation of reports.--In preparing 
        each report required under paragraph (2) (other than the 
        initial report), the Secretary shall annually--
                  ``(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.
          ``(4) Criteria for evaluating needs.--For purposes of this 
        subsection, the Secretary shall, in evaluating the needs of 
        facilities operated under any Funding Agreement use the same 
        criteria that the Secretary uses in evaluating the needs of 
        facilities operated directly by the Service.
          ``(5) Needs of facilities under isdeaa agreements.--The 
        Secretary shall ensure that the planning, design, construction, 
        and renovation needs of Service and non-Service facilities 
        operated under funding agreements 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.
  ``(d) Review of Need for Facilities.--
          ``(1) Initial report.--In the year 2005, the Government 
        Accountability Office shall prepare and finalize a report which 
        sets forth the needs of the Service, Indian Tribes, Tribal 
        Organizations, and Urban Indian Organizations, for the 
        facilities listed under subsection (c)(2)(B), including the 
        needs for renovation and expansion of existing facilities. The 
        Government Accountability Office shall submit the report to the 
        appropriate authorizing and appropriations committees of 
        Congress and to the Secretary.
          ``(2) Beginning in the year 2006, the Secretary shall update 
        the report required under paragraph (1) every 5 years.
          ``(3) The Comptroller General and the Secretary shall consult 
        with Indian Tribes, Tribal Organizations, and Urban Indian 
        Organizations. The Secretary shall submit the reports required 
        by paragraphs (1) and (2), to the President for inclusion in 
        the report required to be transmitted to Congress under section 
        801.
          ``(4) For purposes of this subsection, the reports shall, 
        regarding the needs of facilities operated under any Funding 
        Agreement, be based on the same criteria that the Secretary 
        uses in evaluating the needs of facilities operated directly by 
        the Service.
          ``(5) The planning, design, construction, and renovation 
        needs of facilities operated under Funding Agreements shall be 
        fully and equitably integrated into the development of the 
        health facility priority system.
          ``(6) Beginning in the year 2006 and each fiscal year 
        thereafter, the Secretary shall provide an opportunity for 
        nomination of planning, design, and construction projects by 
        the Service, Indian Tribes, and Tribal Organizations for 
        consideration under the health care facility priority system.
  ``(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 
        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 Funding 
        Agreements;
          ``(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; and
          ``(9) the Secretary of Health and Human Services shall, by 
        regulation developed through rulemaking under section 802, 
        establish standards applicable to the planning, design, and 
        construction of sanitation facilities funded under this Act.
  ``(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, Tribal Organization, or Indian community 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, Tribal Organization, 
or Indian community 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 
        each 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 level of initial and final sanitation 
                deficiency for each type of sanitation facility for 
                each project of each Indian Tribe or Indian community;
                  ``(D) 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, and to reduce the 
                identified sanitation deficiency levels of all Indian 
                Tribes and Indian communities to level I sanitation 
                deficiency as defined in paragraph (4)(A); and
                  ``(E) a 10-year plan to provide sanitation facilities 
                to serve existing Indian homes and Indian communities 
                and new and renovated Indian homes.
          ``(2) Criteria.--The criteria on which the deficiencies and 
        needs will be evaluated shall be developed through negotiated 
        rulemaking pursuant to section 802.
          ``(3) 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.
          ``(4) 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 one 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 if--
                          ``(i) a sanitation facility of an individual, 
                        Indian Tribe, Tribal Organization, or Indian 
                        community has no piped water or sewer 
                        facilities in the home or the facility has 
                        become inoperable due to major component 
                        failure; or
                          ``(ii) where 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.
  ``(j) 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 
adopted pursuant to section 802, 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.--
          ``(1) In general.--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'), unless such 
        construction or renovation--
                  ``(A) is performed by a contractor pursuant to a 
                contract with an Indian Tribe or Tribal Organization 
                with funds supplied through a contract, compact or 
                funding agreement authorized by the Indian Self-
                Determination and Education Assistance Act, or other 
                statutory authority; and
                  ``(B) is subject to prevailing wage rates for similar 
                construction or renovation in the locality as 
                determined by the Indian Tribes or Tribal Organizations 
                to be served by the construction or renovation.
          ``(2) Exception.--This subsection shall not apply to 
        construction or renovation carried out by an Indian Tribe or 
        Tribal Organization with its own employees.

``SEC. 304. EXPENDITURE OF NONSERVICE 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 Funding Agreement, 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 negotiated rulemaking under section 802. 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 each 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 in subsection (c), for any expansions, the Indian Tribe or 
Tribal Organization shall provide to the Secretary additional 
information developed through negotiated rulemaking under section 802, 
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) Funding.--
          ``(1) In general.--The Secretary, acting through the Service, 
        in consultation with Indian Tribes and Tribal Organizations, 
        shall make funding available 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)). Funding 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) Funding agreement required.--Funding 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 Funds.--
          ``(1) Allowable uses.--Funding provided 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 307; 
                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 
                        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 Funding Agreement) 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.--Funding 
        provided under this section may be used only for the cost of 
        that portion of a construction, expansion, or modernization 
        project or debt reduction that benefits the Service population 
        identified above in subsection (b)(1)(C) (ii) and (iii).
          ``(4) Applicability of requirements in the case of isolated 
        facilities.--The requirements of clauses (ii) and (iii) of 
        paragraph (1)(C) shall not apply to an Indian Tribe or Tribal 
        Organization applying for funding 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) Funding.--
          ``(1) Application.--No funding may be made available under 
        this section unless an application or proposal for such funding 
        has been approved by the Secretary in accordance with 
        applicable regulations and has provided reasonable assurance by 
        the applicant that, at all times after the construction, 
        expansion, or modernization of a facility carried out pursuant 
        to funding 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 funding 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 during consultations 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, 
within 5 years 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 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, and in consultation with Indian Tribes and Tribal 
Organizations, is authorized to enter into construction project 
agreements and construction 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, 
including but not limited to hospice, traditional Indian health, and 
child care facilities.
  ``(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 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 2004. If the Secretary 
has not promulgated regulations by that date, the Secretary shall 
develop and publish regulations, through rulemaking under section 802, 
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) Clinton, Oklahoma.
          ``(3) Harlem, Montana.
          ``(4) Mescalero, New Mexico.
          ``(5) Owyhee, Nevada.
          ``(6) Parker, Arizona.
          ``(7) Schurz, Nevada.
          ``(8) Winnebago, Nebraska.
          ``(9) 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.--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 Funding 
Agreement, 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 Funding Agreement 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 and regulations thereunder. 
Notwithstanding any other provision of law, such leases, contracts, or 
other agreements shall be considered as operating leases for the 
purpose of scoring under the Balanced Budget and Emergency Deficit 
Contol Act of 1985 (2 U.S.C. 901 et seq.)

``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, 2006, the Secretary shall 
submit to the Committee on Indian Affairs of the Senate and the 
Committee on 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, is 
authorized to negotiate and enter into 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 under this section 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 which shall be developed through the negotiated 
        rulemaking process provided for under section 802.
  ``(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 
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;
          ``(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; and
          ``(3) all lands in Alaska owned by any Alaska Native village, 
        or village or regional corporation under the Alaska Native 
        Claims Settlement Act, or any land allotted to any Alaska 
        Native.

``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 negotiated rulemaking 
process provided for under section 802.
  ``(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 Funding Agreement 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 transfer such funds to Indian Tribes or Tribal 
Organizations through construction project agreements or construction 
contracts 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) Transferred Funds.--Any Federal agency to which funds for the 
construction of health care facilities are appropriated is authorized 
to transfer such funds to the Secretary for the construction of health 
care facilities to carry out the purposes of this Act as well as the 
purposes for which such funds are appropriated to such other Federal 
agency.
  ``(d) Establishment of Standards.--The Secretary, through the 
Service, shall establish standards by regulation, developed by 
rulemaking under section 802, 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 2015 to carry out 
this title.

                 ``TITLE IV--ACCESS TO HEALTH SERVICES

``SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT HEALTH CARE 
                    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 made 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.--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 and first 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 which 
        may be necessary to achieve or maintain compliance with the 
        applicable conditions and requirements of titles XVIII, XIX, 
        and XXI of the Social Security Act. Any amounts to be 
        reimbursed that are in excess of the amount necessary to 
        achieve or maintain such conditions and requirements shall, 
        subject to the consultation with Indian Tribes being served by 
        the Service Unit, be used for reducing the health resource 
        deficiencies of the Indian Tribes. 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.
          ``(2) Direct payment option.--Paragraph (1) shall not apply 
        upon the election of a Tribal Health 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 during the period of 
        such election.
  ``(d) Direct Billing.--
          ``(1) In general.--A Tribal Health Program may directly bill 
        for, and receive payment for, health care items and services 
        provided by such Indian Tribe or Tribal organization for which 
        payment is made under title XVIII, XIX, or XXI of the Social 
        Security Act or from any other third party payor.
          ``(2) Direct reimbursement.--
                  ``(A) Use of funds.--Each Tribal Health Program 
                exercising the option 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 section 401(c), but all amounts so reimbursed shall 
                be used by the Tribal Health Program for the purpose of 
                making any improvements in Tribal facilities or Tribal 
                Health Programs 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 an Indian Tribe or 
                Tribal Organization exercising the option 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 programs 
                administered by an Indian Health Program.
                  ``(C) Identification of source of payments.--If an 
                Indian Tribe or Tribal Organization receives funding 
                from the Service under the Indian Self-Determination 
                and Education Assistance Act or an Urban Indian 
                Organization receives funding from the Service under 
                title V of this Act and receives reimbursements or 
                payments under title XVIII, XIX, or XXI of the Social 
                Security Act, such Indian Tribe or Tribal Organization, 
                or Urban Indian Organization, shall provide to the 
                Service a list of each provider enrollment number (or 
                other identifier) under which it receives such 
                reimbursements or payments.
          ``(3) Examination and implementation of changes.--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.
          ``(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.

``SEC. 402. GRANTS TO AND FUNDING AGREEMENTS WITH THE SERVICE, INDIAN 
                    TRIBES, TRIBAL ORGANIZATIONS, AND URBAN INDIAN 
                    ORGANIZATIONS.

  ``(a) Indian Tribes and Tribal Organizations.--The Secretary, acting 
through the Service, shall make grants to or enter into Funding 
Agreements 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 title XVIII, XIX, or XXI 
        of the Social Security Act and other health benefits programs; 
        and
          ``(2) to pay premiums for coverage for such benefits, which 
        may be based on financial need (as determined by the Indian 
        Tribe or Tribes being served based on a schedule of income 
        levels developed or implemented by such Tribe or Tribes).
  ``(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 Funding Agreement 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 the benefits provided 
        under titles XVIII, XIX, and XXI of the Social Security Act.
  ``(c) Agreements Relating to Improving Enrollment of Indians Under 
Social Security Act Programs.--
          ``(1) Agreements with secretary to improve receipt and 
        processing of applications.--
                  ``(A) Authorization.--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 by Indians for assistance 
                under titles XIX and XXI of the Social Security Act, 
                and benefits under title XVIII of such Act, by an 
                Indian Health Program or Urban Indian Organization.
                  ``(B) Reimbursement of costs.--Such agreements may 
                provide for reimbursement of costs of outreach, 
                education regarding eligibility and benefits, and 
                translation when such services are provided. The 
                reimbursement may, as appropriate, be added to the 
                applicable rate per encounter or be provided as a 
                separate fee-for-service payment to the Indian Tribe or 
                Tribal Organization.
                  ``(C) Processing clarified.--In this paragraph, the 
                term `processing' does not include a final 
                determination of eligibility.
          ``(2) Agreements with states for outreach on or near 
        reservation.--
                  ``(A) In general.--In order to improve the access of 
                Indians residing on or near a reservation to obtain 
                benefits under title XIX or XXI of the Social Security 
                Act, as a condition of continuing approval of a State 
                plan under such title, the State shall take steps as 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 Indian Tribes and Tribal Organizations 
                to provide outreach, education regarding eligibility 
                and benefits, enrollment, and translation services when 
                such services are provided.
                  ``(B) Construction.--Nothing in subparagraph (A) 
                shall be construed as affecting arrangements entered 
                into between States and Indian Tribes and Tribal 
                Organizations for such Indian Tribes and Tribal 
                Organizations to conduct administrative activities 
                under such titles.
  ``(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.
  ``(e) 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 
        Funding Agreements with Indian Tribes and Tribal Organizations 
        with respect to programs on or near reservations.
          ``(2) Requirements.--The Secretary shall include in the 
        grants or Funding Agreements 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.

``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 (or, if charges are not billed, the operational, 
administrative, and other expenses incurred) 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.
  ``(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) Right of Action Against Insurers, HMOs, Employee Benefit Plans, 
Self-Insurance Plans, and Other Health Care Plans or Programs.--Where 
an insurance company, health maintenance organization, employee benefit 
plan, self-insurance plan, managed care plan, or other health care plan 
or program fails or refuses to pay the amount due under subsection (a) 
for services provided to an individual who is a beneficiary, 
participant, or insured of such company, organization, plan, or 
program, the United States, Indian Tribe, or Tribal Organization shall 
have a right to assert and pursue all the claims and remedies against 
such company, organization, plan, or program and against the 
fiduciaries of such company, organization, plan, or program that the 
individual could assert or pursue under the terms of the contract, 
program, or plan or applicable Federal, State, or Tribal law.
  ``(i) 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.
  ``(j) 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.
  ``(k) 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.
  ``(l) 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 and the Federal 
Medical Care Recovery Act (42 U.S.C. 2651 et seq.).

``SEC. 404. CREDITING OF REIMBURSEMENTS.

  ``(a) Use of Amounts.--
          ``(1) Retention by program.--Except as provided in section 
        202(g) (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, 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 IN QUALIFICATIONS FOR REIMBURSEMENT FOR 
                    SERVICES.

  ``For purposes of determining the eligibility of an entity that is 
operated by the Service, an Indian Tribe, Tribal Organization, or Urban 
Indian Organization to receive payment or reimbursement from any 
federally funded health care program for health care services it 
furnishes to an Indian, any requirement that the entity be licensed or 
recognized under State or local law to furnish such services shall be 
deemed to have been met if the entity meets all the applicable 
standards for such licensure, but the entity need not obtain a license. 
In determining whether the entity meets such standards, the absence of 
licensure of any staff member of the entity may not be taken into 
account.

``SEC. 409. CONSULTATION.

  ``(a) National Indian Technical Advisory Group (TAG).--
          ``(1) Establishment and membership.--The Secretary shall 
        establish within the Centers for Medicare & Medicaid Services a 
        National Indian Technical Advisory Group (in this subsection 
        referred to as the `Advisory Group') which shall have no fewer 
        than 14 members including at least 1 member designated by the 
        Indian Tribes and Tribal Organizations in each Service Area, 1 
        Urban Indian Organization representative, and 1 member 
        representing the Service. The Secretary may appoint additional 
        members upon the recommendation of the Advisory Group.
          ``(2) Duties.--
                  ``(A) Identification of issues.--The Advisory Group 
                shall assist the Secretary in identifying and 
                addressing issues regarding the health care programs 
                under the Social Security Act (including medicare, 
                medicaid, and SCHIP) that have implications for Indian 
                Health Programs or Urban Indian Organizations. The 
                Advisory Group shall provide advice to the Secretary 
                with respect to those issues and with respect to the 
                need for the Secretary to engage in consultation with 
                Indian Tribes, Tribal Organizations, and Urban Indian 
                Organizations.
                  ``(B) Construction.--Nothing in subparagraph (A) 
                shall be construed as affecting any requirement under 
                any applicable Executive order for the Secretary to 
                consult with Indian Tribes in cases of health care 
                policies that have implications for Indian Health 
                Programs or Urban Indian Organizations.
          ``(3) Nonapplication of federal advisory committee act.--The 
        Federal Advisory Committee Act (5 U.S.C. App.) shall not apply 
        to the Advisory Group.
          ``(4) Meetings.--The Secretary is authorized to convene 
        meetings of the Advisory Group as often as needed to fulfill 
        the responsibilities under this section.
  ``(b) Solicitation of Medicaid Advice.--
          ``(1) In general.--As part of its plan for payment under 
        title XIX of the Social Security Act to a State in which the 
        Service operates or funds health care programs or in which 1 or 
        more Indian Health Programs or Urban Indian Organizations 
        provide health care in the State for which medical assistance 
        is available under such title, the State may establish 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 such title to and having a direct effect on such 
        Indian Health Programs and Urban Indian Organizations.
          ``(2) Manner of advice.--The process described in paragraph 
        (1) should include solicitation of advice prior to submission 
        of any plan amendments, waiver requests, and proposals for 
        demonstration projects. Such process 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 medicaid plan.
          ``(3) Payment of expenses.--Expenses in carrying out this 
        subsection shall be treated as reasonable administrative 
        expenses for which reimbursement may be made under section 
        1903(a) of the Social Security Act.
  ``(c) Construction.--Nothing in this section shall be construed as 
superseding existing advisory committees, working groups, or other 
advisory procedures established by the Secretary or by any State.

``SEC. 410. STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP).

  ``Notwithstanding any other provision of law, insofar as the State 
health plan of a State under title XXI of the Social Security Act may 
provide (whether through its medicaid plan under title XIX of such Act 
or otherwise) child health assistance to individuals who are otherwise 
served by the Service or by an Indian Tribe or Tribal Organization, the 
Secretary may enter into an arrangement with the State and with the 
Service or 1 or more Indian Tribes and Tribal Organizations in the 
State under which a portion of the funds otherwise made available to 
the State under such title with respect to such individuals is provided 
to the Service, Indian Tribe, or Tribal Organization, respectively, for 
the purpose of providing such assistance to such individuals consistent 
with the purposes of such title.

``SEC. 411. SOCIAL SECURITY ACT SANCTIONS.

  ``(a) Requests for Waiver of Sanctions.--For purposes of applying any 
authority under a provision of title XI, XVIII, XIX, or XXI of the 
Social Security Act to seek a waiver of a sanction imposed against a 
health care provider insofar as that provider provides services to 
individuals through an Indian Health Program, any requirement that a 
State request such a waiver shall be deemed to be met if such Indian 
Health Program requests such a waiver.
  ``(b) Safe Harbor for Transactions Between and Among Indian Health 
Care Programs.--For purposes of applying section 1128B(b) of the Social 
Security Act, the exchange of anything of value between or among the 
following shall not be treated as remuneration if the exchange arises 
from or relates to any of the following health programs:
          ``(1) An exchange between or among the following:
                  ``(A) Any Indian Health Program.
                  ``(B) Any Urban Indian Organization.
          ``(2) An exchange between an Indian Tribe, Tribal 
        Organization, or an Urban Indian Organization and any patient 
        served or eligible for service from an Indian Tribe, Tribal 
        Organization, or Urban Indian Organization, including patients 
        served or eligible for service pursuant to section 807, but 
        only if such exchange--
                  ``(A) is for the purpose of transporting the patient 
                for the provision of health care items or services;
                  ``(B) is for the purpose of providing housing to the 
                patient (including a pregnant patient) and immediate 
                family members or an escort incidental to assuring the 
                timely provision of health care items and services to 
                the patient;
                  ``(C) is for the purpose of paying premiums, 
                copayments, deductibles, or other cost-sharing on 
                behalf of patients; or
                  ``(D) consists of an item or service of small value 
                that is provided as a reasonable incentive to secure 
                timely and necessary preventive and other items and 
                services.
          ``(3) Other exchanges involving an Indian Health Program, an 
        Urban Indian Organization, or an Indian Tribe or Tribal 
        Organization that meet such standards as the Secretary of 
        Health and Human Services, in consultation with the Attorney 
        General, determines is appropriate, taking into account the 
        special circumstances of such Indian Health Programs, Urban 
        Indian Organizations, Indian Tribes, and Tribal Organizations 
        and of patients served by Indian Health Programs, Urban Indian 
        Organizations, Indian Tribes, and Tribal Organizations.

``SEC. 412. COST SHARING.

  ``(a) Coinsurance, Copayments, and Deductibles.--Notwithstanding any 
other provision of Federal or State law--
          ``(1) Protection for eligible indians under social security 
        act health programs.--No Indian who is furnished an item or 
        service for which payment may be made under title XIX or XXI of 
        the Social Security Act may be charged a deductible, copayment, 
        or coinsurance if the item or service is furnished by, or upon 
        referral made by, the Service, an Indian Tribe, Tribal 
        Organization, or Urban Indian Organization.
          ``(2) Protection for indians.--No Indian who is furnished an 
        item or service by the Service may be charged a deductible, 
        copayment, or coinsurance.
          ``(3) No reduction in amount of payment to indian health 
        providers.--The payment or reimbursement due to the Service, 
        Indian Tribe, Tribal Organization, or Urban Indian Organization 
        under title XIX or XXI of the Social Security Act may not be 
        reduced by the amount of the deductible, copayment, or 
        coinsurance that would be due from the Indian but for the 
        operation of this section.
  ``(b) Exemption From Medicaid and SCHIP Premiums.--Notwithstanding 
any other provision of Federal or State law, no Indian who is otherwise 
eligible for services under title XIX of the Social Security Act 
(relating to the medicaid program) or title XXI of such Act (relating 
to the State children's health insurance program) may be charged a 
premium as a condition of receiving benefits under the program under 
the respective title.
  ``(c) Limitation on Medical Child Support Recovery.--Notwithstanding 
any other provision of law, a parent (whether or not an Indian) of an 
Indian child shall not be responsible for reimbursing a State or the 
Federal Government under title XIX or XXI of the Social Security Act 
for the cost of medical services relating to the child (including 
childbirth and including, where such child is a minor parent, any child 
of such minor parent) under circumstances in which payment would have 
been made under the contract health services program of an Indian 
Health Program but for the child's (or, in the case of medical services 
relating to childbirth, mother's, or grandchild's, as the case may be) 
eligibility under title XIX or XXI of the Social Security Act.
  ``(d) Treatment of Certain Property for Medicaid Eligibility.--
Notwithstanding any other provision of Federal or State law, the 
following property may not be included when determining eligibility for 
services under title XIX of the Social Security Act:
          ``(1) Property, including interests in real property 
        currently or formerly held in trust by the Federal Government 
        which is protected under applicable Federal, State, or Tribal 
        law or custom from recourse and including public domain 
        allotments.
          ``(2) Property that has unique religious or cultural 
        significance or that supports subsistence or traditional 
        lifestyle according to applicable Tribal law or custom.
  ``(e) Continuation of Current Law Protections of Certain Indian 
Property From Medicaid Estate Recovery.--Income, resources, and 
property that are exempt from medicaid estate recovery under title XIX 
of the Social Security Act as of April 1, 2003, under manual 
instructions issued to carry out section 1917(b)(3) of such Act because 
of Federal responsibility for Indian Tribes and Alaska Native Villages 
shall remain so exempt. Nothing in this subsection shall be construed 
as preventing the Secretary from providing additional medicaid estate 
recovery exemptions for Indians.

``SEC. 413. TREATMENT UNDER MEDICAID MANAGED CARE.

  ``(a) Payment for Services Furnished to Indians.--
          ``(1) In general.--Subject to paragraph (2), in the case of 
        an Indian who is enrolled with a managed care entity under 
        section 1932 of the Social Security Act (or otherwise under a 
        waiver under title XIX of such Act) and who receives services, 
        covered by a managed care entity, from an Indian Health Program 
        or an Urban Indian Organization, either--
                  ``(A) the entity shall make payment to the Indian 
                Health Program or Urban Indian Organization at a rate 
                established by the entity for such services that is not 
                less than the rate for preferred providers (or at such 
                other rate as may be negotiated between the entity and 
                such Indian Health Program or Urban Indian 
                Organization) and shall not require submittal of a 
                claim by the enrollee as a condition of payment to the 
                Indian Health Program or Urban Indian Organization; or
                  ``(B) the State shall provide for payment to the 
                Indian Health Program or Urban Indian Organization 
                under its State plan under title XIX of such Act at the 
                rate otherwise applicable and shall provide for an 
                appropriate adjustment of the capitation payment made 
                to the entity to take into account such payment.
          ``(2) Payment standards.--The payment provisions shall meet 
        the usual medicaid standards for economy, efficiency, and 
        access to quality care.
  ``(b) Offering of Managed Care.--If--
          ``(1) a State elects under its State plan under title XIX of 
        the Social Security Act to provide services through medicaid 
        managed care organizations or through primary care case 
        managers under section 1932 or under a waiver under such title; 
        and
          ``(2) the Indian Health Program or Urban Indian Organization 
        that is funded in whole or in part by the Service, or a 
        consortium thereof, has established a medicaid managed care 
        organization or a primary care case manager that meets quality 
        standards equivalent to those required of such an organization 
        or manager under such section or waiver,
the State shall enter into an agreement under such section with the 
Service, Indian Tribe, Tribal Organization, or Urban Indian 
Organization, or such consortium, to serve as a medicaid managed care 
organization or a primary care case manager, respectively with respect 
to Indians served by such entity. In carrying out this subsection, the 
Secretary and the State may waive requirements regarding enrollment, 
capitalization, and such other matters that might otherwise prevent the 
application of the previous sentence.

``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 Act Improvement Act Amendments of 2004, the Secretary 
shall submit to the Committee of Indian Affairs and Committee on 
Finance of the Senate and the Committee on Resources and Committee on 
Ways and Means on 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. AUTHORIZATION OF APPROPRIATIONS.

  ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2015 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, or 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 adopted pursuant to section 520 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;
          ``(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, in 
determining the capacity of an Urban Indian Organization to deliver 
quality patient care 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.--Payments under any 
contracts or grants pursuant to this title shall, notwithstanding any 
term or condition of such contract or grant--
          ``(1) be made in their entirety 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 payments in their entirety; and
          ``(2) 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.
  ``(c) Revision or Amendment of Contracts.--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) 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.--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:
          ``(1) In the case of a contract or grant under section 503, 
        recommendations pursuant to section 503(a)(5).
          ``(2) Information on activities conducted by the organization 
        pursuant to the contract or grant.
          ``(3) An accounting of the amounts and purpose for which 
        Federal funds were expended.
          ``(4) A minimum set of data, using uniformly defined 
        elements, that is specified by the Secretary in consultation, 
        consistent with section 514, with Urban Indian Organizations.
  ``(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) Loans.--The Secretary, acting through the Service or through 
the Health Resources and Services Administration, may provide to 
contractors or grant recipients under this title loans from the Urban 
Indian Health Care Facilities Revolving Loan Fund described in 
subsection (c), or guarantees for loans, for the construction, 
renovation, expansion, or purchase of health care facilities, subject 
to the following requirements:
          ``(1) The principal amount of a loan or loan guarantee may 
        cover 100 percent of the costs (other than staffing) relating 
        to the facility, including planning, design, financing, site 
        land development, construction, rehabilitation, renovation, 
        conversion, medical equipment, furnishings, and capital 
        purchase.
          ``(2) The total of the principal of loans and loan 
        guarantees, respectively, outstanding at any one time shall not 
        exceed such limitations as may be specified in appropriation 
        Acts.
          ``(3) The loan or loan guarantee may have a term of the 
        shorter of the estimated useful life of the facility or 25 
        years.
          ``(4) An Urban Indian Organization may assign, and the 
        Secretary may accept assignment of, the revenue of the Urban 
        Indian Organization as security for a loan or loan guarantee 
        under this subsection.
          ``(5) The Secretary shall not collect application, 
        processing, or similar fees from Urban Indian Organizations 
        applying for loans or loan guarantees under this subsection.
  ``(c) Fund.--
          ``(1) Establishment.--There is established in the Treasury of 
        the United States a fund to be known as the Urban Indian Health 
        Care Facilities Revolving Loan Fund (hereafter in this section 
        referred to as the `URLF'). The URLF shall consist of--
                  ``(A) such amounts as may be appropriated to the 
                URLF;
                  ``(B) amounts received from Urban Indian 
                Organizations in repayment of loans made to such 
                organizations under paragraph (2); and
                  ``(C) interest earned on amounts in the URLF under 
                paragraph (3).
          ``(2) Use of amount in fund.--Amounts in the URLF may be 
        expended by the Secretary, acting through the Service or the 
        Health Resources and Services Administration, to make loans 
        available to Urban Indian Organizations receiving grants or 
        contracts under this title for the purposes, and subject to the 
        requirements, described in subsection (b). Amounts appropriated 
        to the URLF, amounts received from Urban Indian Organizations 
        in repayment of loans, and interest on amounts in the URLF 
        shall remain available until expended.
          ``(3) Investment of amounts in fund.--The Secretary of the 
        Treasury shall invest such amounts of the URLF as such 
        Secretary determines are not required to meet current 
        withdrawals from the URLF. 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. Any obligation acquired by the URLF may be 
        sold by the Secretary of the Treasury at the market price.
          ``(4) Initial funds.--There are authorized to be appropriated 
        such sums as may be necessary to initiate the URLF. For each 
        fiscal year after the initial year in which funds are 
        appropriated to the URLF, there is authorized to be 
        appropriated an amount equal to the sum of the amount collected 
        by the URLF during the preceding fiscal year and all accrued 
        interest.

``SEC. 510. OFFICE OF URBAN INDIAN HEALTH.

  ``There is hereby established within the Service an Office 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 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).

``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 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.

``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.

  ``(a) Grants and Contracts.--The Secretary, through the Office of 
Urban Indian Health, shall make grants or enter into contracts with 
Urban Indian Organizations 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. Such grants and 
contracts shall become effective no later than September 30, 2007.
  ``(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. FEDERAL TORT CLAIM ACT COVERAGE.

  ``(a) In General.--With respect to claims resulting from the 
performance of functions during fiscal year 2004 and thereafter, or 
claims asserted after September 30, 2003, but resulting from the 
performance of functions prior to fiscal year 2004, under a contract, 
grant agreement, or any other agreement authorized under this title, an 
Urban Indian Organization is deemed hereafter to be part of the Service 
in the Department of Health and Human Services while carrying out any 
such contract or agreement and its employees are deemed employees of 
the Service while acting within the scope of their employment in 
carrying out the contract or agreement. After September 30, 2003, any 
civil action or proceeding involving such claims brought hereafter 
against any Urban Indian Organization or any employee of such Urban 
Indian Organization covered by this provision shall be deemed to be an 
action against the United States and will be defended by the Attorney 
General and be afforded the full protection and coverage of the Federal 
Tort Claims Act (28 U.S.C. 1346(b), 2671 et seq.).
  ``(b) Claims Resulting From Performance of Contract or Grant.--
Beginning with the fiscal year ending September 30, 2003, and 
thereafter, the Secretary shall request through annual appropriations 
funds sufficient to reimburse the Treasury for any claims paid in the 
prior fiscal year pursuant to the foregoing provisions.

``SEC. 516. 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. 517. USE OF FEDERAL PROPERTY AND SUPPLIES.

  ``(a) Authorization for Use.--The Secretary, acting through the 
Service, shall allow an Urban Indian Organization that has entered into 
a contract or received a grant pursuant to this title, in carrying out 
such contract or grant, to use existing facilities and all equipment 
therein or pertaining thereto and other real and personal property 
owned by the Federal Government within the Secretary's jurisdiction 
under such terms and conditions as may be agreed upon for their use and 
maintenance.
  ``(b) Donations.--Subject to subsection (d), the Secretary may donate 
to an Urban Indian Organization that has entered into a contract or 
received a grant pursuant to this title any personal or real property 
determined to be excess to the needs of the Service or the General 
Services Administration for purposes of carrying out the contract or 
grant.
  ``(c) Acquisition of Property for Donation.--The Secretary may 
acquire excess or surplus government personal or real property for 
donation (subject to subsection (d)), to an Urban Indian Organization 
that has entered into a contract or received a grant pursuant to this 
title if the Secretary determines that the property is appropriate for 
use by the Urban Indian Organization for a purpose for which a contract 
or grant is authorized under this title.
  ``(d) Priority.--In the event that the Secretary receives a request 
for donation of a specific item of personal or real property described 
in subsection (b) or (c) from both an Urban Indian Organization and 
from an Indian Tribe or Tribal Organization, the Secretary shall give 
priority to the request for donation of the Indian Tribe or Tribal 
Organization if the Secretary receives the request from the Indian 
Tribe or Tribal Organization before the date the Secretary transfers 
title to the property or, if earlier, the date the Secretary transfers 
the property physically to the Urban Indian Organization.
  ``(e) Urban Indian Organizations Deemed Executive Agency for Certain 
Purposes.--For purposes of section 501 of title 40, United States Code, 
(relating to Federal sources of supply, including lodging providers, 
airlines, and other transportation providers), an Urban Indian 
Organization that has entered into a contract or received a grant 
pursuant to this title shall be deemed an executive agency when 
carrying out such contract or grant, and the employees of the Urban 
Indian Organization shall be eligible to have access to such sources of 
supply on the same basis as employees of an executive agency have such 
access.

``SEC. 518. 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. 519. 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. 520. REGULATIONS.

  ``(a) Requirements for Regulations.--The Secretary may promulgate 
regulations to implement the provisions of this title in accordance 
with the following:
          ``(1) Proposed regulations to implement this Act shall be 
        published in the Federal Register by the Secretary no later 
        than 9 months after the date of the enactment of this Act and 
        shall have no less than a 4-month comment period.
          ``(2) The authority to promulgate regulations under this Act 
        shall expire 18 months from the date of the enactment of this 
        Act.
  ``(b) Effective Date of Title.--The amendments to this title made by 
the Indian Health Care Improvement Act Amendments of 2004 shall be 
effective on the date of the enactment of such amendments, regardless 
of whether the Secretary has promulgated regulations implementing such 
amendments have been promulgated.

``SEC. 521. ELIGIBILITY FOR SERVICES.

  ``Urban Indians shall be eligible and the ultimate beneficiaries for 
health care or referral services provided pursuant to this title.

``SEC. 522. AUTHORIZATION OF APPROPRIATIONS.

  ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2015 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, 2005, 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 Indian Health Service on the day before the 
        date of enactment of the Indian Health Care Improvement Act 
        Amendments of 2004 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 of Indian Health shall--
          ``(1) perform all functions that were, on the day before the 
        date of enactment of the Indian Health Care Improvement Act 
        Amendments of 2004, 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 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 2015 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 establish a national clearinghouse of 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;
                  ``(I) Traditional Health Care Practices; and
                  ``(J) 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 choices and lifestyle 
                (related to sexually transmitted diseases, domestic 
                violence, sexual abuse, suicide, teen pregnancy, 
                obesity, and other risk/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 gender specific services;
                  ``(C) identification and treatment of co-occurring 
                disorders (dual diagnosis) and comorbidity;
                  ``(D) promotion of gender specific healthy choices 
                and lifestyle (related to parenting, partners, domestic 
                violence, sexual abuse, suicide, obesity, and other 
                risk-related behavior);
                  ``(E) treatment services for women at risk of giving 
                birth to a child with a fetal alcohol disorder; and
                  ``(F) gender 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 choices and lifestyle 
                (related to parenting, partners, 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 gender specific services;
                  ``(C) identification and treatment of co-occurring 
                disorders (dual diagnosis) and comorbidity;
                  ``(D) promotion of healthy choices and lifestyle 
                (managing conditions related to aging);
                  ``(E) gender 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, withother 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 the enactment of the Indian Health Care Improvement 
Act Amendments of 2004, 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 the 
enactment of the Indian Health Care Improvement Act Amendments of 2004, 
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) 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) Consultation.--The Secretary, acting through the Service, and 
the Secretary of the Interior shall, in developing the memoranda of 
agreement under subsection (a), consult with and solicit the comments 
from--
          ``(1) Indian Tribes and Tribal Organizations;
          ``(2) Indians;
          ``(3) Urban Indian Organizations and other Indian 
        organizations; and
          ``(4) behavioral health service providers.
  ``(d) 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, including Traditional Health Care 
        Practices, 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 but not limited to 
                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.

  ``Subject to the provisions of section 221, 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 this Act or through a Funding Agreement shall be 
licensed as a clinical psychologist, social worker, or marriage and 
family therapist, respectively, or working under the direct supervision 
of a licensed clinical psychologist, social worker, or marriage and 
family therapist, respectively.

``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

  ``(a) Funding.--The Secretary, consistent with section 701, shall 
make funds available 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 spiritual, 
cultural, historical, social, and child care needs of Indian women, 
regardless of age.
  ``(b) Use of Funds.--Funds made available 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. 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, which may incorporate 
        Traditional Health Care Practices, 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, in consultation with 
                Indian Tribes and Tribal Organizations, 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, but not limited to, 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.

``SEC. 708. INPATIENT AND COMMUNITY-BASED MENTAL HEALTH FACILITIES 
                    DESIGN, CONSTRUCTION, AND STAFFING.

  ``Not later than 1 year after the date of the enactment of the Indian 
Health Care Improvement Act Amendments of 2004, 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. 709. TRAINING AND COMMUNITY EDUCATION.

  ``(a) Program.--The Secretary, in cooperation with the Secretary of 
the Interior, shall develop and implement or provide funding for 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. Community-based training (oriented toward local capacity 
development) shall also include tribal community provider training 
(designed for adult learners from the communities receiving services 
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. 710. 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) Funding; Criteria.--The Secretary may award such funding 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 applications or proposals for funding 
for projects to be operated under any Funding Agreement, use the same 
criteria that the Secretary uses in evaluating any other application or 
proposal for such funding.

``SEC. 711. FETAL ALCOHOL DISORDER FUNDING.

  ``(a) Programs.--
          ``(1) Establishment.--The Secretary, consistent with section 
        701, acting through the Service, Indian Tribes, and Tribal 
        Organizations, shall 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.--Funding provided pursuant to this 
        section shall be used for the following:
                  ``(A) To develop and provide for Indians community 
                and in school training, education, and prevention 
                programs relating to fetal alcohol disorders.
                  ``(B) To identify and provide behavioral health 
                treatment to high-risk Indian women and high-risk women 
                pregnant with an Indian's child.
                  ``(C) 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.
                  ``(D) To develop and implement counseling and support 
                programs in schools for fetal alcohol disorder affected 
                Indian children.
                  ``(E) To develop prevention and intervention models 
                which incorporate practitioners of Traditional Health 
                Care Practices, cultural and spiritual values, and 
                community involvement.
                  ``(F) To develop, print, and disseminate education 
                and prevention materials on fetal alcohol disorder.
                  ``(G) To develop and implement, through the tribal 
                consultation process, culturally sensitive assessment 
                and diagnostic tools including dysmorphology clinics 
                and multidisciplinary fetal alcohol disorder clinics 
                for use in Indian communities and Urban Centers.
                  ``(H) To develop early childhood intervention 
                projects from birth on to mitigate the effects of fetal 
                alcohol disorder among Indians.
                  ``(I) To develop and fund community-based adult fetal 
                alcohol disorder housing and support services for 
                Indians and for women pregnant with an Indian's child.
          ``(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, directly or through an 
        Indian Tribe, Tribal Organization, or Urban Indian 
        Organization, 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 
funding available 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. 712. 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 and 
        spiritual values, and community involvement.
          ``(4) To develop and implement, through the tribal 
        consultation process, 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.

``SEC. 713. BEHAVIORAL HEALTH RESEARCH.

  ``The Secretary, in consultation with appropriate Federal agencies, 
shall provide funding to 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 interrelationship and interdependence of behavioral 
        health problems with alcoholism and other substance abuse, 
        suicide, homicides, other injuries, and the incidence of family 
        violence; and
          ``(2) the development of models of prevention techniques.
The effect of the interrelationships and interdependencies referred to 
in paragraph (1) on children, and the development of prevention 
techniques under paragraph (2) applicable to children, shall be 
emphasized.

``SEC. 714. 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 a central nervous system or behavioral disorder, 
        following a maternal history of alcohol consumption during 
        pregnancy, that may involve--
                  ``(A) physical manifestations such as development 
                delay, intellectual deficit, neurologic abnormalities, 
                or failure to thrive as infants; or
                  ``(B) behavioral manifestations such as irritability, 
                or for older children, hyperactivity, attention 
                deficit, language dysfunction, or perceptual or 
                judgment difficulties.
          ``(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 (mental health professionals, 
        traditional health care practitioners, community health aides, 
        community health representatives, mental health technicians, 
        ministers, etc.)
          ``(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. 715. AUTHORIZATION OF APPROPRIATIONS.

  ``There is authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2015 to carry out 
the provisions of this title.

                      ``TITLE VIII--MISCELLANEOUS

``SEC. 801. REPORTS.

  ``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 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, including specific comparisons of 
        appropriations provided and those required for such parity.
          ``(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 Funding Agreements.
          ``(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 126(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) 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 nonservice 
        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 between the Service, Indian 
        Tribes, and Tribal Organizations, and the Department of 
        Veterans Affairs and the Department of Defense, 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).

``SEC. 802. REGULATIONS.

  ``(a) Deadlines.--
          ``(1) Procedures.--Not later than 90 days after the date of 
        the enactment of the Indian Health Care Improvement Act 
        Amendments of 2004, 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 I, 
        II, III, and VII and section 817. The Secretary may promulgate 
        regulations to carry out sections 105, 115, 117, and titles IV 
        and V, using the procedures required by chapter V of title 5, 
        United States Code (commonly known as the `Administrative 
        Procedure Act'. The Secretary shall issue no regulations to 
        carry out titles VI and VIII, except as necessary to carry out 
        section 817.
          ``(2) Proposed regulations.--Proposed regulations to 
        implement this Act shall be published in the Federal Register 
        by the Secretary no later than 270 days after the date of the 
        enactment of the Indian Health Care Improvement Act Amendments 
        of 2004 and shall have no less than a 120-day comment period.
          ``(3) Expiration of authority.--The authority to promulgate 
        regulations under this Act shall expire 18 months from the date 
        of the enactment of this Act.
  ``(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, Tribal Organizations, and Urban 
Indian 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 the enactment of the Indian Health Care Improvement Act 
Amendments of 2004, and the Secretary is authorized to repeal any 
regulation inconsistent with the provisions of this Act.

``SEC. 803. PLAN OF IMPLEMENTATION.

  ``Not later than 8 months after the date of the enactment of the 
Indian Health Care Improvement Act Amendments of 2004, the Secretary in 
consultation with Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations, shall submit to Congress a plan explaining the manner 
and schedule (including a schedule of appropriation requests), by title 
and section, by which the Secretary will implement the provisions of 
this Act.

``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 THE 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 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 the Indian Tribe(s) 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 a Tribal Health 
        Program, the governing body of the Indian Tribe or Tribal 
        Organization providing health services under such Tribal Health 
        Program is authorized to determine whether health services 
        should be provided under its Funding Agreement to individuals 
        who are not otherwise eligible for such services. In making 
        such determination, the governing body shall take into account 
        the considerations described in clauses (i) and (ii) of 
        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 Funding Agreement 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 the President, 
for inclusion in the report required to be transmitted 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 Health Resources and Services Administration of the Public 
Health Service, 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 such time as new criteria governing 
eligibility for services are developed in accordance with section 802.

``SEC. 812. TRIBAL EMPLOYMENT.

  ``For purposes of section 2(2) of the Act of July 5, 1935 (49 Stat. 
450, chapter 372), an Indian Tribe or Tribal Organization carrying out 
a Funding Agreement shall not be considered an `employer'.

``SEC. 813. PRIME VENDOR.

  ``(a) Executive Agency Status.--For purposes of section 201(a) of the 
Federal Property and Administrative Services Act (40 U.S.C. 481(a)) 
(relating to Federal sources of supply, including lodging providers, 
airlines, and other transportation providers), a Tribal Health Program 
shall be deemed an executive agency when carrying out a contract, 
grant, cooperative agreement, or Funding Agreement with the Service and 
shall have access to the Federal Supply Schedule and any other Federal 
source of supply to which executive agencies have access.
  ``(b) IHS Status.--For purposes of section 4 of Public Law 102-585 
(38 U.S.C. 8126), a Tribal Health Program shall have the status of the 
Indian Health Service and shall have direct access to the Veterans 
Administration prime vendor provided for in section 4 of Public Law 
102-585.
  ``(c) Employee Status.--The employees of such Tribal Health Programs 
may order supplies under such respective programs on the same basis as 
employees of the Service.

``SEC. 814. 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. 815. ESTABLISHMENT OF NATIONAL BIPARTISAN COMMISSION ON INDIAN 
                    HEALTH CARE ENTITLEMENT.

  ``(a) Establishment.--There is hereby established the National 
Bipartisan Indian Health Care Entitlement 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 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 recommendations to the Commission for 
                legislation that will provide for the delivery of 
                health services for Indians as an entitlement, which 
                will address, among other things, issues of 
                eligibility, benefits to be provided, including 
                recommendations regarding from whom such health 
                services are to be provided and the cost, including 
                mechanisms for making funds available for the health 
                services to be provided.
                  ``(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 recommendations to Congress for providing 
        health services for Indians as an entitlement, giving due 
        regard to the effects of such a program on existing health care 
        delivery systems for Indians and the effect of such a program 
        on the sovereign status of Indian Tribes.
          ``(4) Not later than 18 months following the date of 
        appointment of all members of the Commission, submit a written 
        report to Congress containing a recommendation of policies and 
        legislation to implement a policy that would establish a health 
        care system for Indians based on delivery of health services as 
        an entitlement, together with a determination of the 
        implications of such an entitlement system on existing health 
        care delivery systems for Indians and on the sovereign status 
        of Indian Tribes.
  ``(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 membersof 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 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 90 days after 
        the date of the enactment of the Indian Health Care Improvement 
        Act Amendments of 2004, 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 the 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) FACA.--The Federal Advisory Committee Act (5 U.S.C. App.) shall 
not apply to the Commission.

``SEC. 816. APPROPRIATIONS; AVAILABILITY.

  ``Any new spending authority (described in subsection (c)(2)(A) or 
(B) of section 401 of the Congressional Budget Act of 1974) 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. 817. 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) 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) 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) 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) 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) 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) 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 of this title.
  ``(j) Definitions.--In this section:
          ``(1) 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 
        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.
          ``(2) The term `medical quality assurance record' means the 
        proceedings, records, minutes, and reports that emanate from 
        quality assurance program activities described in paragraph (1) 
        and are produced or compiled by or for an Indian Health Program 
        or Urban Indian Organization as part of a medical quality 
        assurance program.
          ``(3) 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.

``SEC. 818. AUTHORIZATION OF APPROPRIATIONS.

  ``In General.--There are authorized to be appropriated such sums as 
may be necessary for each fiscal year through fiscal year 2015 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) Three Affiliated Tribes Health Facility Compensation.--
          (1) Findings.--Congress finds that--
                  (A) in 1949, the United States assumed jurisdiction 
                over more than 150,000 prime acres on the Fort Berthold 
                Indian Reservation, North Dakota, for the construction 
                of the Garrison Dam and Reservoir;
                  (B) the reservoir flooded and destroyed vital 
                infrastructure on the reservation, including a hospital 
                of the Indian Health Service;
                  (C) the United States made a commitment to the Three 
                Affiliated Tribes of the Fort Berthold Indian 
                Reservation to replace the lost infrastructure;
                  (D) on May 10, 1985, the Secretary of the Interior 
                established the Garrison Unit Joint Tribal Advisory 
                Committee to examine the effects of the Garrison Dam 
                and Reservoir on the Fort Berthold Indian Reservation;
                  (E) the final report of the Committee issued on May 
                23, 1986, acknowledged the obligation of the Federal 
                Government to replace the infrastructure destroyed by 
                the Federal action;
                  (F) the Committee on Indian Affairs of the Senate--
                          (i) acknowledged the recommendations of the 
                        final report of the Committee in Senate Report 
                        No. 102-250; and
                          (ii) stated that every effort should be made 
                        by the Administration and Congress to provide 
                        additional Federal funding to replace the lost 
                        infrastructure; and
                  (G) on August 30, 2001, the Chairman of the Three 
                Affiliated Tribes testified before the Committee on 
                Indian Affairs of the Senate that the promise to 
                replace the lost infrastructure, particularly the 
                hospital, still had not been kept.
          (2) Rural health care facility, fort berthold indian 
        reservation, north dakota.--The Three Affiliated Tribes and 
        Standing Rock Sioux Tribe Equitable Compensation Act is 
        amended--
                  (A) in section 3504 (106 Stat. 4732), by adding at 
                the end the following:
  ``(c) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out this section.''; 
and
                  (B) by striking section 3511 (106 Stat. 4739) and 
                inserting the following:

``SEC. 3511. RURAL HEALTH CARE FACILITY, FORT BERTHOLD INDIAN 
                    RESERVATION, NORTH DAKOTA.

  ``There are authorized to be appropriated to the Secretary of Health 
and Human Services $20,000,000 for the construction of, and such sums 
as are necessary for other expenses relating to, a rural health care 
facility on the Fort Berthold Indian Reservation of the Three 
Affiliated Tribes, North Dakota.''.
  (d) 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 subclause (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 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. 3. SOBOBA SANITATION FACILITIES.

  The Act of December 17, 1970 (84 Stat. 1465), is amended by adding at 
the end the following new section:
  ``Sec. 10. 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. 4. AMENDMENTS TO THE MEDICAID AND STATE CHILDREN'S HEALTH 
                    INSURANCE PROGRAMS.

  (a) Expansion of Medicaid Payment for All Covered Services Furnished 
by Indian Health Programs.--
          (1) Expansion to all covered services.--Section 1911 of the 
        Social Security Act (42 U.S.C. 1396j) is amended--
                  (A) by amending the heading to read as follows:
                    ``indian health programs''; and
                  (B) by amending subsection (a) to read as follows:
  ``(a) Eligibility for Reimbursement for Medical Assistance.--The 
Indian Health Service and an Indian Tribe, Tribal Organization, or an 
urban Indian Organization (as such 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 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) Elimination of temporary deeming provision.--Such section 
        is amended by striking subsection (b).
          (3) Revision of authority to enter into agreements.--
        Subsection (c) of such section is redesignated as subsection 
        (b) and is amended to read as follows:
  ``(b) 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 Organizations, 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) Reference correction.--Subsection (d) of such section is 
        redesignated as subsection (c) and is amended--
                  (A) by striking ``For'' and inserting ``Direct 
                Billing.--For''; and
                  (B) by striking ``section 405'' and inserting 
                ``section 401(d)''.
  (b) SCHIP Treatment of Indian Tribes, Tribal Organizations, and Urban 
Indian Organizations.--Section 2105(c)(6)(B) of such Act (42 U.S.C. 
1397ee(c)(6)(B)) is amended by striking ``other than an insurance 
program operated or financed by the Indian Health Service,'' and 
inserting ``other than a health program operated or financed by the 
Indian Health Service or by an Indian Tribe, Tribal Organization, or 
Urban Indian Organization (as such terms are defined in section 4 of 
the Indian Health Care Improvement Act)''.

                          Purpose of the Bill

    The purpose of H.R. 2440 is to improve the implementation 
of the federal responsibility for the care and education of 
Indian people by improving the services and facilities of 
federal health programs for Indians and encouraging maximum 
participation of Indians in such programs, and other purposes.

                  Background and Need for Legislation

    The Indian Health Care Improvement Act (IHCIA) became 
Public Law 94-437 in the 94th Congress (September 30, 1976), 
and has been amended seven times since. IHCIA provides for 
health care delivery to over 2 million American Indians and 
Alaska Natives. Congress enacted a one-year reauthorization of 
appropriation through fiscal year (FY) 2001 but efforts at 
further extensions were interrupted due to 9/11/01 events. 
Appropriations for Indian health have continued through the 
Snyder Act, a permanent law authorizing expenditures of funds 
for a variety of Indian programs, including health. For FY 
2003, Congress appropriated $2.9 billion to help provide health 
care services to American Indians and Alaska Natives.
    Since 1998, the Indian Health Service (IHS) has coordinated 
an IHCIA reauthorization process by convening a roundtable to 
begin the discussion of the reauthorization and to give 
guidance to the consultation process which included all 
stakeholders. Coordinators from the 12 IHS areas formed 
workgroups. These meetings were to inform tribes about the 
reauthorization process, and provide opportunities to discuss 
and reach consensus on recommendations for IHCIA. Four regional 
consultation meetings were held to provide further 
opportunities for tribes to provide input, share 
recommendations from the 12 IHS areas, and build consensus 
among participants for a unified position.
    The IHS Director also convened a National Steering 
Committee (NSC) to be responsible for the final drafting of the 
report on the IHCIA recommendations. The NSC is composed of one 
elected and one alternate tribal representative from each of 
the 12 IHS areas, a representative from each of the National 
Indian Health Board, the National Council of Urban Indian 
Health, and the Self-Governance Advisory Committee. During the 
course of the four meetings, this group's responsibility 
evolved from compiling a final report of recommendations\1\ to 
the drafting of the actual IHCIA reauthorization bill language.
---------------------------------------------------------------------------
    \1\ The final report, entitled ``Speaking with One Voice,'' 
identified areas of consensus and differences.
---------------------------------------------------------------------------
    H.R. 2440 is the result of the NSC Committee meetings and 
further work by the Committee on Resources. Both the NSC and 
the Committee worked carefully to ensure that whenever 
possible, H.R. 2440 did not represent a regression from the 
authorities provided in current law. During consideration of 
the bill by the Resources Committee, Congressman Don Young 
offered an amendment in the nature of a substitute that removed 
from the introduced bill changes to the Medicare system. At 
this time, there was concern that consideration of any changes 
to the Medicare law soon after the enactment of the Medicare 
Modernization Act (Public Law 108-173) may be burdensome and 
impede the reauthorization of IHCIA.

                            Committee Action

    H.R. 2440 was introduced on June 11, 2003, by Congressman 
Don Young (AK). The bill was referred primarily to the 
Committee on Resources, and additionally to the Committee on 
Energy and Commerce, and the Committee on Ways and Means. On 
July 16, 2003, a joint hearing was held by the Committee on 
Resources and the Senate Committee on Indian Affairs. On 
October 1, 2003, the Committee on Resources held a second 
hearing on the bill. On September 22, 2004, the Full Resources 
Committee met to consider the bill. Congressman Don Young 
offered an amendment in the nature of a substitute to make 
numerous changes to the bill, including the removal of various 
Medicare and Medicaid sections, as well as provide clarifying 
language throughout the bill. It was adopted by unanimous 
consent. The bill, as amended, was then ordered favorably 
reported to the House of Representatives by unanimous consent.

                      Section-by-Section Analysis


Section 1. Short Title

    This section provides a short title for the bill, the 
``Indian Health Care Improvement Act Amendments of 2004.''

Section 2. Indian Health Care Improvement Act Amended

    This section replaces the existing Indian Health Care 
Improvement Act (25 U.S.C. 1601 et seq.) with new text, as 
further described below.
Section 2. Declaration of National Indian Health Care Policy
    A new section 2 of IHCIA declares that it is the policy of 
the United States that the health status of American Indians 
and Alaska Natives should be raised by 2010 to the same level 
as is set for other Americans, instead of following the lower 
thresholds seen in the past. It also establishes a policy 
regarding the importance of ``meaningful consultations'' with 
Indian tribes, tribal health organizations and urban Indian 
organizations.
Section 3. Definitions.
    A new IHCIA section 3 modernizes the definitions used in 
the IHCIA and makes them consistent with the Indian Self-
Determination and Education Assistance Act. Definitions of 
``health promotion'' and ``disease prevention'' are expanded to 
encompass the full scope of these activities as recommended by 
the World Health Organization.


        TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT


Section 101. Purpose
    A new section 101 states the interest in this new Title I 
of assisting Indians in getting them more involved in the 
health care arena, both as health professionals and providing 
health services. The new IHCIA sections 102, 103, 104, 108, 
109, 111, 112, 113, 114, 117, 118, 122, 203, 204, 206, 211, 
216, 217, 219, and 706 continue existing program already in 
current law.
Section 105. American Indians Into Psychology Program
    A new IHCIA section 105 authorizes grants for developing 
and maintaining Indian psychology career recruitment programs 
as a means of encouraging Indians to enter the mental health 
field.
Section 106. Funding for Tribes for Scholarship Programs
    A new IHCIA section 106 makes more flexible the sources of 
funds a tribe may use for matching scholarship funds.
Section 107. Indian Health Service Extern Programs
    The new IHCIA section 107 authorizes IHS and tribes to 
employ high school students involved in high school programs 
designed to encourage them to pursue a health career.
Section 110. Indian Health Service Loan Repayment Program
    The new section 110 provides that the IHS Loan Repayment 
Program Fund shall be a revolving fund including not only 
appropriated funds, but also payments, interest paid, and 
interest earned.
Section 115. Quentin N. Burdick American Indians Into Nursing Program
    New section 115 renames a current program after Quentin N. 
Burdick.
Section 116. Tribal Cultural Orientation
    New IHCIA section 116 continues an existing program with a 
focus on educating appropriate employees in the history and 
culture of Indian Tribes with whom they work.
Section 119. Retention Bonus
    The new IHCIA section 119 authorizes retention bonuses to 
any health professional working in the Indian health system, 
not just doctors and nurses.
Section 120. Nursing Residency Program
    The new section 120 of IHCIA expands an existing program to 
include advanced degrees in nursing and public health.
Section 121. Community Health Aide Program for Alaska
    The new section 121, subject to the availability of new 
funding, authorizes IHS to develop this existing program 
nationally. The Committee considered various options prior to 
amending this section. The reported text will continue to allow 
the Community Health Aide Program (CHAP) to expand nationally. 
The Committee believes the importance of the dental health aide 
program 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.
    The best solution to dental disease is the prevention of 
disease and the dental health aides, including dental 
hygienists, will be the front-line workers in these preventive 
measures. 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 the 
language with input from other concerned Members to ensure 
safety and continued quality care in the larger CHAP program, 
while understanding that dental health aide therapists are not 
permitted to provide procedures that could result in 
irreversible damage.
    Dental health aides are an important component to the 
health care system for Alaska Natives. Due to the extensive 
oral health care needs of the numerous villages across the 
State of Alaska, the best way to develop and implement 
successful long-term quality dental programs in Alaska is to 
increase access to oral health care. Therefore, the Committee 
welcomes the commitment of the Alaska Dental Society, with the 
full support of the American Dental Association, to work in 
collaboration with Alaska Native people and Native Corporations 
to increase the number of dentists to help fill the unmet need 
for dental services for Alaska Natives on an ongoing basis, in 
such a way that provides continuity of care. Further, the 
Committee encourages the Alaska Dental Society and the American 
Dental Association to work in conjunction to develop a 
volunteer program at no cost to the IHS to bring dentists to 
rural Alaska to help meet the crisis in dental care in the 
State.
Section 123. Health Professional Chronic Shortage Demonstration 
        Programs
    New IHCIA section 123 expands authority to fund 
demonstration projects for clinical education and quality 
improvement programs. This will improve quality of care for 
tribes while giving health professionals new opportunities in 
Indian country.
Section 124. Treatment of Scholarships for Certain Purposes
    The new IHCIA section 124 makes scholarships provided under 
Title I of IHCIA tax exempt under section 117 of the Internal 
Revenue Code of 1986.
Section 125. National Health Service Corps
    The new IHCIA section 125 ensures services will continue 
for a member of the National Health Service Corps from an 
Indian Health Program or Urban Indian Organization.
Section 126. Substance Abuse Counselor Education Curricula 
        Demonstration Programs
    The new IHCIA section 126 establishes the option of 
entering into grants or contracts with colleges and 
universities so that they can develop curricula for substance 
abuse counseling.
Section 127. Behavioral Health Training and Community Education 
        Programs
    The new section 127 provides for a study to examine what 
positions within the Bureau of Indian Affairs should have 
training that helps in treating dysfunctional or self-
destructive behavior.


                       TITLE II--HEALTH SERVICES


Section 201. Indian Health Care Improvement Fund
    The new IHCIA section 201 authorizes funds to be 
distributed under the Indian Self-Determination Act. It adds to 
the authorized purposes for expending funds, eliminating 
inequities in funding for both direct care and contract health 
service programs. Provides for allocation of funds to be 
decided through tribal consultation. Provides for consideration 
of the number of Indians on a waiting list and/or turned away 
due to a lack of services.
Section 202. Catastrophic Health Emergency Fund
    The new IHCIA section 202 retains current law by 
maintaining this fund as a national risk pool, rather than 
allocating to all areas.
Section 205. Shared Services for Long-Term Care
    The new IHCIA section 205 authorizes funding agreements or 
other arrangements with Indian tribes for the delivery of long-
term care or similar services to Indians.
Section 207. Mammography and Other Cancer Screening
    The new IHCIA section 207 expands screening from 
mammography to include other screening as appropriate based on 
national standing such as those of the National Cancer 
Institute.
Section 208. Patient Travel Costs
    The new section 208 expands coverage to include not only 
patients, but ``appropriate and qualified escorts'' and 
transportation by any means when conventional emergency 
transport is not available or feasible.
Section 209. Epidemiology Centers
    The new section 209, subject to the availability of funds, 
provides for an epidemiology center in each IHS Service Area. 
It also allows centers to be operated under the Indian Self-
Determination Act, but provides that the funding is not 
divisible.
Section 210. Comprehensive Health Education Programs
    The new section 210 expands programs so that they may be 
carried out by tribal organizations and urban Indian 
organizations for the benefit of all Indian children, not just 
those living on reservations. It provides for after school 
programs and requires consultation in establishing criteria for 
funding such programs.
Section 212. Prevention, Control, and Elimination of Communicable and 
        Infectious Diseases
    The new IHCIA section 212 expands an existing program to 
prevent, control and eliminate tuberculosis to all communicable 
and infectious diseases.
Section 213. Authority for Provision of Other Services
    The new section 213 authorizes a full range of health 
services, including home and community based services, respite, 
long term care; rather than relying only on demonstration 
projects.
Section 214. Indian Women's Health Care
    The new IHCIA section 214 states that the Secretary shall 
provide funding to monitor and improve the quality of health 
care for Indian women of all ages.
Section 215. Environmental and Nuclear Health Hazards
    The new IHCIA section 215 expands the authority for studies 
and remediation from only nuclear hazards to other 
environmental conditions that may result in chronic or life-
threatening health problems.
Section 216A. North Dakota as a Contract Health Service Delivery Area
    The new IHCIA section 216A creates a health contract 
service delivery area in North Dakota subject to the 
availability of funds.
Section 216B. South Dakota as a Contract Health Service Delivery Area
    The new IHCIA section 216B creates a health contract 
service delivery area in South Dakota subject to the 
availability of funds.
Section 218. California as a Contract Health Service Delivery Area
    The new IHCIA section 218 delineates which counties in 
California will not be designated as a delivery area for the 
purpose of providing contract health services to the Indians 
there.
Section 220. Programs Operated by Indian Tribes and Tribal 
        Organizations
    The new IHCIA section 220 allows Tribal Health Programs to 
be put on equal footing with IHS programs as they pertain to 
funds for health care services and facilities.
Section 221. Licensing or Certification
    The new IHCIA section 221 extends the right enjoyed by IHS 
to exempt from licensing requirements in the state which the 
Indian health program is carried out, so long as the provider 
is licensed in at least one other state.
Section 222. Notification of Provision of Emergency Contract Health 
        Services
    The new section 222 provides as 30 days the time limitation 
for notifying the IHS of an Indian receiving emergency medical 
care.
Section 223. Prompt Action on Payment of Claims
    The new IHCIA section 223 sets times for payment of claims 
in line with the Prompt Payment Act (Public Law 97-177).
Section 224. Liability for Payment
    The new section 224 states that patients who receive 
contract health care services are not liable for the payment 
for the provision of those services.
Section 225. Authorization of Appropriations
    The new section 225 provides an authorization of an 
appropriation of ``such sums as may be necessary'' for Title II 
of IHCIA.


                         TITLE III--FACILITIES


Section 301. Consultation; Construction and Renovation of Facilities; 
        Reports
    New IHCIA section 301 makes a list through negotiated 
rulemaking, and allows for the grandfathering of the top 10 
facilities in each priority category. It also provides for an 
initial report by the General Accounting Office of all IHS and 
tribal health facility construction, expansion and improvement 
needs with updates to be done by the Secretary every five 
years, so that the full unmet need can be known and tracked.
Section 302. Sanitation Facilities
    The new IHCIA section 302 updates terminology so that it is 
simpler and more accurate. It provides for newly constructed 
homes to be assisted by the program under certain conditions 
and provides authority for use of funds from a wider range of 
funding sources. The section further provides for planning, 
design and construction standards to be set through negotiated 
rulemaking, requires local responsibility for operating and 
maintaining systems, and modernizes the determination of 
deficiencies in sanitation systems.
Section 303. Preference to Indians and Indian Firms
    Section 303 continues an existing program with the addition 
of a new ``Section 303 (``Labor Standards'').'' This new 
section provides authority to rely on local wage standards, as 
determined by the tribe or tribal organizations, for tribal 
health facility and sanitation facility construction.
Section 304. Expenditure of Nonservice Funds for Renovation
    New IHCIA section 304 expands authority to expansion, in 
addition to renovation and modernization, and provides that the 
criteria for this separate priority list shall be developed 
through negotiated rulemaking.
Section 305. Funding for the Construction, Expansion, and Modernization 
        of Small Ambulatory Care Facilities
    New section 305 modifies the standards for access to this 
program and provides for peer review panels to consider 
rulemaking.
Section 306. Indian Health Care Delivery Demonstration Project
    New IHCIA section 306 specifically expands the types of 
facilities that may be funded to include hospice and child care 
facilities. It authorizes IHS funds to be used as matching 
dollars for other funds, including other federal funds, and 
provides that the criteria for funding shall be developed 
through negotiated rulemaking.
Section 307. Land Transfer
    New section 307 authorizes land transfers to IHS from all 
federal agencies for the provision of health care services.
Section 308. Leases, Contracts, and Other Agreements
    New IHCIA section 308 provides that leases by IHS of tribal 
facilities shall be treated as operating leases for the 
purposes of scoring under the Budget Enforcement Act. This 
section will encourage tribal health programs to finance their 
own new construction leases.
Section 309. Study on Loans, Loan Guarantees, and Loan Repayment
    New section 309 has changed from the introduced version of 
the legislation in large part due to objections from the 
Department of Health and Human Services. The Committee has had 
success in the expansion of loan guarantee programs in other 
arenas of Indian policy, and was interested in continuing this 
pursuit in conjunction with providing expanded capital access 
opportunities for tribes and their health care delivery 
pursuits. The reported language directs the Secretary, in 
consultation with the Secretary of the Treasury, Indian tribes, 
and tribal organizations, to conduct 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. It also 
directs the Secretary to provide a report no later than 
September 30, 2006, on the manner of consultation made as 
required and the results of the study, including any 
recommendations of the Secretary based on the results of the 
study.
Section 310. Tribal Leasing
    New IHCIA section 310 authorizes tribal health program 
funded under the Indian Self-Determination Act to lease health 
facilities without advance approval in appropriations acts.
Section 311. Indian Health Service/Tribal Facilities Joint Venture 
        Program
    Section 311 authorizes the Secretary to negotiate with 
tribes or tribal organizations to establish joint venture 
construction projects to provide another flexible means by 
which tribal health programs may contribute to meeting their 
own facilities construction needs without forgoing recurring 
funds for operations.
Section 312. Location of Facilities
    New IHCIA section 312 expands the lands upon which IHS 
facilities may be constructed for health care or to address 
unemployment conditions.
Section 313. Maintenance and Improvement of Health Care Facilities
    New section 313 requires a report to Congress about the 
backlog in maintenance and repair work of IHS and tribal health 
facilities. The section also provides for the allocation of 
funds to be decided upon in negotiated rulemaking.
Section 314. Tribal Management of Federally Owned Quarters
    New IHCIA section 314 provides that tribal health programs 
operating under the Indian Self-Determination Act may manage 
federally owned quarters including setting rents and directly 
collecting rents, even from federal employees.
Section 315. Applicability of Buy American Act Requirement
    New IHCIA section 315 exempts tribes and tribal 
organizations from the requirements of the Buy American Act.
Section 316. Other Funding for Facilities
    IHCIA section 316 generally authorizes the Secretary at the 
Department of Health and Human Services to accept funds from 
any source and use that money for the planning, design or 
construction of health care facilities. These funds can also be 
transferred to Indian tribes or tribal organizations through 
agreements or contracts established under the Indian Self-
Determination Act.
Section 317. Authorization of Appropriations
    New section 317 provides an authorization of appropriations 
for ``such sums'' for Title III of the IHCIA.


                  TITLE IV--ACCESS TO HEALTH SERVICES


Section 401. Treatment of Payments Under Social Security Act Health 
        Care Programs
    New section 401 consolidates multiple sections regarding 
Medicare and Medicaid into a single simplified provision. It 
provides that all receipts are returned to the Service Unit 
from which they were generated. The section also streamlines 
the right of tribal health programs to bill and collect 
directly.
Section 402. Grants to and Funding Agreements With the Service, Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations
    New section 402 makes grants available to the IHS, Indian 
tribes, tribal organizations and urban tribal organizations for 
establishing and administering programs that will assist 
individual Indians in enrolling in health benefits programs, 
including those within the Social Security Act.
Section 403. Reimbursement From Certain Third Parties of Costs of 
        Health Services
    New IHCIA section 403 clarifies existing law regarding the 
amount that third parties must pay, including urban Indian 
health organizations. It also provides limited authority to IHS 
to recover from tribes that have plans with members who are 
self-insured. The section eliminates burdensome claims 
processing requirements and provides for a specific statute of 
limitations on ths same basis as it applies to claims by the 
IHS.
Section 404. Crediting of Reimbursements
    New IHCIA section 404 clarifies that all reimbursements to 
Indian tribes, tribal organizations or urban Indian 
organizations are able to be used and returned to the Service 
Units as authorized under new IHCIA section 401.
Section 405. Purchasing Health Care Coverage
    New section 405 eliminates references to a study regarding 
tribal purchase of health care coverage and substitutes general 
authority.
Section 406. Sharing Arrangements With Federal Agencies
    New IHCIA section 406 authorizes the Secretary to create or 
expand current arrangements for the sharing of medical 
facilities between the IHS, Indian tribes, and tribal 
organizations with the Department of Veterans Affairs and the 
Department of Defense.
Section 407. Payor of Last Resort
    New section 407 provides that the IHS and tribal health 
programs are the payor of last resort notwithstanding any other 
federal, state, or local law to the contrary.
Section 408. Nondiscrimination in Qualifications for Reimbursement for 
        Services
    New section 408 states that IHS and tribal health programs 
are exempt from state and local licensing and other 
requirements so long as the program meets the quality standards 
recognized by the Secretary for furnishing such services.
Section 409. Consultation
    This new section provides for the formation by the 
Secretary of a Tribal Technical Advisory Group regarding 
Medicare, Medicaid, and State Children's Health Insurance 
Program. It also requires States in which there are Indian 
health programs to consult with those programs and on a regular 
basis.
Section 410. State Children's Health Insurance Program (SCHIP)
    New IHCIA section 410 authorizes the State health plans of 
States to be opened up to one or more Indian tribes and tribal 
organizations in the State for purposes of providing care 
consistent with the program.
Section 411. Social Security Act Sanctions
    New section 411 extends the rights that States have to seek 
a waiver to tribal health programs. It also authorizes certain 
safe harbors for transactions among IHS, tribal health 
programs, and urban Indian organizations, and for purposes of 
providing necessary transportation, housing, and paying certain 
costs of their patients.
Section 412. Cost Sharing
    New section 412 eliminates cost sharing requirements for 
patients served in, or upon a referral from, the IHS or urban 
Indian organization health program, and provides the at the 
provider will not have its reimbursement reduced by the value 
of the otherwise applicable co-pay or deductible. The section 
further exempts Indians from the cost of premiums under the 
Medicaid and SCHIP programs. The section also protects certain 
trust properties and property of unique religious or cultural 
significance or that is necessary to support subsistence or 
traditional lifestyle from estate recovery rules.
Section 413. Treatment Under Medicaid Managed Care
    New IHCIA section 413 requires managed care providers to 
reimburse the IHS and tribal health care programs for care 
provided to their beneficiaries.
Section 414. Navajo Nation Medicaid Agency Feasibility Study
    New IHCIA section 414 directs the Secretary to conduct a 
study on the feasibility of treating the Navajo Nation as a 
State for the purposes of the Medicaid program.
Section 415. Authorization of Appropriations
    This section provides an authorization of appropriations of 
``such sums'' Title IV of IHCIA.


               TITLE V--HEALTH SERVICES FOR URBAN INDIANS


Section 501. Purpose
    New IHCIA section 501 states the purpose of the Title as it 
relates to treating urban Indians.
Section 502. Contracts With, and Grants to, Urban Indian Organizations
    New IHCIA section 502 provides general authority to the 
Secretary to enter into contracts with urban Indian 
organizations.
Section 503. Contracts and Grants for the Provision of Health Care and 
        Referral Services
    New section 503 streamlines the material required in an 
application for funding. Authorizes an Urban Indian 
organization to receive funding to provide services to Urban 
Indians in more than one location.
Section 504. Contracts and Grants for the Determination of Unmet Health 
        Care Needs
    New section 504 authorizes a discretionary program under 
which funds may be made available to determine the unmet need 
for health services for urban Indians living in communities not 
served by an urban Indian organization.
Section 505. Evaluations; Renewals
    New IHCIA section 505 provides authority for the urban 
Indian organization to substitute for IHS surveys accreditation 
by an entity recognized by the Secretary and for the purposes 
of conducting quality reviews of providers under Medicare.
Section 506. Other Contract and Grant Requirements
    New section 506 provides for lump sum payments and carry 
forward of unexpended funds.
Section 507. Reports and Records
    New IHCIA section 507 requires reports, records and audits 
once every six months instead of quarterly and for reporting of 
a minimum set of data to be established through negotiated 
rulemaking.
Section 508. Limitation on Contract Authority
    New IHCIA section 508 allows the Secretary to enter into 
contracts and award grants only up to the amounts that are 
provided in federal appropriations Acts.
Section 509. Facilities
    New IHCIA section 509 expands the means by which an urban 
Indian organization may acquire or improve facilities funded 
under this section. It also provides for a revolving loan fund 
for construction, renovation, expansion, and purchase of health 
care facilities like that authorized for tribal health programs 
under Title II.
Section 510. Office of Urban Indian Health
    Section 510 establishes this office at the IHS to provide 
technical assistance and other oversight matters.
Section 511. Grants for Alcohol and Substance Abuse-Related Services
    New section 511 authorizes grants for prevention, 
treatment, and rehabilitation as it relates to alcohol and 
substance abuse.
Section 512. Treatment of Certain Demonstration Projects
    New IHCIA section 512 changes the Tulsa Clinic and Oklahoma 
City demonstration projects into permanent programs within the 
IHS's direct care program. This is a departure from the 
introduced version of the legislation that now conforms with 
the Senate reported version of this legislation.
Section 513. Urban NIAAA Transferred Programs
    New IHCIA section 513 authorizes grants or contracts for 
use in association with the National Institute on Alcoholism 
and Alcohol Abuse.
Section 514. Consultation With Urban Indian Organizations
    New section 514 requires consultation with urban Indian 
organizations by the Centers for Medicare and Medicaid Services 
and other relevant agencies of the Department of Health and 
Human Services.
Section 515. Federal Tort Claim Act Coverage
    Section 515 extends this coverage on the same basis that 
tribal health programs have coverage.
Section 516. Urban Youth Treatment Center Demonstration
    New section 516 establishes authority for the construction 
and operation of urban youth residential centers.
Section 517. Use of Federal Property and Supplies
    New IHCIA section 517 authorizes urban Indian programs to 
participate in access to federal facilities and personal 
property and federal sources of supply.
Section 518. Grants for Diabetes Prevention, Treatment, and Control
    New section 518 authorizes grants to urban Indian 
organizations for diabetes prevention, treatment and control.
Section 519. Community Health Representatives
    New IHCIA provides that urban Indian organizations to 
receive grants to carry out a community health representative 
program.
Section 520. Regulations
    This section authorizes negotiated rulemaking and 
establishes deadlines.
Section 521. Eligibility for Services
    New IHCIA section 521 establishes the eligibility of urban 
Indians to the programs provided under this Title.
Section 522. Authorization of Appropriations
    New IHCIA section 522 authorizations appropriations of 
``such sums as may be necessary'' to carry out Title V of 
IHCIA.


                 TITLE VI--ORGANIZATIONAL IMPROVEMENTS


Section 601. Establishment of the Indian Health Service as an Agency of 
        the Public Health Service
    New IHCIA section 601 continues the IHS as an agency of the 
Public Health Service headed up by a Director. Further, the 
section provides for the elevation of the Director to Assistant 
Secretary. This concept is similar to legislation introduced in 
the 108th Congress by Congressman George Nethercutt as H.R. 
151.
Section 602. Automated Account Management Information System
    New IHCIA section 602 adds a requirement that the system 
accommodate patient billing and accounts receivable and a 
training component. It also authorizes various kinds of 
collaboration to enhance information technology in Indian 
health programs and facilities.
Section 603. Authorization of Appropriations
    New IHCIA section 603 authorizations appropriations of 
``such sums as may be necessary'' to carry out Title VI of 
IHCIA.


                 TITLE VII--BEHAVIORAL HEALTH PROGRAMS


Section 701. Behavioral Health Prevention and Treatment Services
    New IHCIA section 701 eliminates, as ineffective and too 
costly, a national plan and substitutes encouragement for local 
tribal and area planning. It establishes a clearinghouse for 
dissemination of such plans and their outcomes to other tribes 
and areas. The section also requires coordination of such 
planning with federal and State agencies to encourage 
comprehensive services be made available to Indians.
Section 702. Memoranda of Agreement With the Department of the Interior
    Section 702 requires review and update of the Memoranda of 
Agreement (MOA) required under the Indian Alcohol and Substance 
Abuse Prevention and Treatment Act of 1996. It also provides 
for tribal consultation during the review and publication of 
the MOA in the Federal Register.
Section 703. Comprehensive Behavioral Health Prevention and Treatment 
        Program
    New IHCIA section 703 provides for a program for prevention 
and treatment of behavioral health problems and defines a 
target population for care.
Section 704. Mental Health Technician Program
    New IHCIA section 704 authorizes a program for training and 
employing community-based mental health technicians.
Section 705. Licensing Requirement for Mental Health Care Workers
    New IHCIA section 705 states that various specialties 
including clinical psychologists and marriage family therapists 
should be properly licensed in these fields of care.
Section 707. Indian Youth Program
    New IHCIA section 707 authorizes funding for staffing and 
facilities in various forms of substance abuse treatment 
centers and detoxification programs. It makes specific mention 
of Alaska facilities that are eligible.
Section 708. Inpatient and Community-Based Mental Health Facilities 
        Design, Construction, and Staffing
    New section 708 provides that no later than one year after 
the enactment of this legislation, the Secretary may provide an 
inpatient mental health care facility to Indians with 
behavioral health problems.
Section 709. Training and Community Education
    New IHCIA section 709 provides for development of community 
education programs that include local leaders from law 
enforcement and tribal health board members.
Section 710. Behavioral Health Program
    New IHCIA section 710 generally authorizes the Secretary to 
plan, develop, and implement community-based behavioral health 
services programs.
Section 711. Fetal Alcohol Disorder Funding
    New IHCIA section 711 brings this section up-to-date with 
current understanding of this condition. It authorizes new 
interventions while eliminating the requirements for a study 
and clearinghouse.
Section 712. Child Sexual Abuse and Prevention Treatment Programs
    New IHCIA section 712 eliminates the demonstration project 
and generally authorizes child sexual abuse prevention and 
treatment programs.
Section 713. Behavioral Health Research
    New IHCIA section 713 provides prioritized areas for which 
funding is available for conducting research on the prevalence 
of behavioral health problems among those served by the various 
Indian health programs.
Section 714. Definitions
    New IHCIA section 714 defines the terms used within Title 
VII.
Section 715. Authorization of Appropriations
    New IHCIA section 715 authorizations appropriations of 
``such sums as may be necessary'' to carry out Title VII of 
IHCIA.


                       TITLE VIII--MISCELLANEOUS


Section 801. Reports
    This section consolidates all of the reports described 
throughout the Act.
Section 802. Regulations
    New IHCIA section 802 provides for negotiated rulemaking 
for carrying out Titles I, II, III, and VII and section 817 of 
IHCIA. It also provides for administrative rulemaking regarding 
sections 105, 115, 117, and Titles IV and V of IHCIA.
Section 803. Plan of Implementation
    New IHCIA section 803 lays out a time table of not more 
than eight months after enactment of the bill for tribes to 
submit their requests for implementation of the provisions of 
the IHCIA, as well as appropriations requests per 
authorizations in various titles.
Section 804. Availability of Funds
    New IHCIA section 804 states that funds are available until 
expended.
Section 805. Limitation on Use of Funds Appropriated to the Indian 
        Health Service
    New IHCIA section 805 puts funding limitations in line with 
other Health and Human Services departmental priorities.
Section 806. Eligibility of California Indians
    New section 806 eliminates an outdated study provision.
Section 807. Health Services for Ineligible Persons
    New IHCIA section 807 specifies ages and family ties that 
create eligibility criteria for the health services provided by 
the IHS.
Section 808. Reallocation of Base Resources
    New IHCIA section 808 stipulates that planned reductions of 
five percent or more in any recurring program must be 
accompanied by a report by the Secretary to the President, 
which includes the reasoning for the change and its potential 
effects.
Section 809. Results of Demonstration Projects
    New IHCIA section 809 clarifies that projects authorized 
under the IHCIA are to be disseminated by the Secretary to 
Indian tribes, tribal organizations, and urban Indian 
organizations.
Section 810. Provision of Services in Montana
    New section 810 aligns the application of IHS programs 
consistent with the decision of the United States Court of 
Appeals for the Ninth Circuit in McNabb for McNabb v. Bowen.
Section 811. Moratorium
    New section 811 eliminates a study regarding eligibility.
Section 812. Tribal Employment
    New IHCIA section 812 limits the application of 
circumstances in which tribes and tribal organizations carrying 
out agreements under the Indian Self-Determination Act are 
considered ``employers'' for the purposes of other federal 
laws.
Section 813. Prime Vendor
    New section 813 of IHCIA clarifies access to federal supply 
sources.
Section 814. Severability Provisions
    New section 814 states that if one section is deemed 
invalid, it holds harmless the rest of the sections of the 
IHCIA, as amended.
Section 815. Establishment of National Bipartisan Commission on Indian 
        Health Care Entitlement
    New section 815 establishes a commission to study Indian 
health care entitlement accompanied by a report to Congress 
within 18 months after appointment. The Committee has concerns 
over the effect of a report stating the need for a large, 
costly entitlement program as detailed in this section.
Section 816. Appropriations; Availability
    New IHCIA section 816 details that new spending authorities 
in the legislation are effective only as they relate to federal 
appropriations measures.
Section 817. Confidentiality of Medical Quality Assurance Records: 
        Qualified Immunity for Participants
    New section 817 provides for peer review within IHS, tribal 
and urban Indian health programs and immunity from civil 
liability for participating.
Section 818. Authorization of Appropriations
    This section provides an authorization of appropriations 
for ``such sums as may be necessary'' for Title VIII of IHCIA. 
It also authorizes $20 million construction of a health care 
facility and such sums as are necessary for the expenses 
related to this facility on the Fort Berthold Reservation of 
the Three Affiliated Tribes. The section also makes technical 
corrections relating to the changes made regarding the 
introduction of an Assistant Secretary for Indian Health. 
Language is this section is reflective of S. 1146, a bill to 
implement the recommendations of the Garrison Unit Joint Tribal 
Advisory Committee by providing authorization for the 
construction of a rural health care facility on the Fort 
Berthold Indian Reservation, North Dakota, which at the time 
that H.R. 2440 was ordered reported, was not yet public law.

Section 3. Soboba Sanitation Facilities

    Section 3 of the bill states that nothing precludes the 
previous funding eligibility for sanitation programs on the 
Soboba Indian Reservation.

Section 4. Amendments to the Medicaid and State Children's Health 
        Insurance Programs

    Section 4 of the bill provides for Indian health programs 
to be reimbursed for all Medicaid and SCHIP services they 
provide. It also authorizes the Secretary to enter into 
agreements with States regarding reimbursement to the State for 
services provided by the IHS, tribal health programs and urban 
Indian organizations. This section also requires States to 
consult with Indian health programs.
    The Committee would also like to note that the introduced 
version of this legislation included a section regarding the 
review of Medicare and Medicaid Payment system. At the request 
of the Department of Health and Human Services, the Committee 
omitted a provision requiring the Secretary of Health and Human 
Services to examine the extent to which Medicare and Medicaid 
payment methodologies take into account the unique and special 
circumstances of the provision of covered services by health 
programs operated by the relevant Service and tribal entities. 
The Department indicated to the Committee that it has 
sufficient authority under existing law to undertake this 
payment methodology review. That said, the Committee is hopeful 
the Secretary will perform such a review pursuant to existing 
authority. The review should include the current payment 
methodologies applicable to the Indian health system. The 
objectives of the review should be to determine the sufficiency 
of payments to the providers in the Indian health system under 
various payment methodologies both in terms of assuring access 
to care and payment at rates consistent with those for most 
favored providers. Moving forward, the Committee looks forward 
to the recommendations made by the Department of Health and 
Human Services to Congress.
    While this study is being performed and during the time 
Congress reviews the Secretary's recommendations for potential 
legislative action, the Committee expects the Department to 
maintain in place the current payment methodology for Indian 
health programs.

            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 Resources' oversight findings and recommendations 
are reflected in the body of this report.

                  Federal Advisory Committee Statement

    The functions of the proposed advisory committees 
authorized in the bill are not currently being nor could they 
be performed by one or more agencies, an advisory committee 
already in existence or by enlarging the mandate of an existing 
advisory committee.

                   Constitutional Authority Statement

    Article I, section 8 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. The Committee estimates 
that enactment of this bill will provide a savings to the 
federal government over the current Indian health care program.
    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 does not contain any new budget authority, credit 
authority, or an increase or decrease in revenues or tax 
expenditures.
    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 improve the implementation of the 
federal responsibility for the care and education of Indian 
people by improving the services and facilities of federal 
health programs for Indians and encouraging maximum 
participation of Indians in such programs, and other purposes.
    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 requested but not received a cost 
estimate for this bill from the Director of the Congressional 
Budget Office.

                    Compliance With Public Law 104-4

    This bill contains no unfunded mandates.

                Preemption of State, Local or Tribal Law

    This bill is not intended to preempt any State, 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 exceeding 15 
        ug/dl and reduce to zero the prevalence of blood lead 
        levels exceeding 25 ug/dl.
          [(20) Reduce dental caries (cavities) so that the 
        proportion of children with one or more caries (in 
        permanent or primary teeth) is no more than 45 percent 
        among children aged 6 through 8 and no more than 60 
        percent among adolescents aged 15.
          [(21) Reduce untreated dental caries so that the 
        proportion of children with untreated caries (in 
        permanent or primary teeth) is no more than 20 percent 
        among children aged 6 through 8 and no more than 40 
        percent among adolescents aged 15.
          [(22) Reduce to no more than 20 percent the 
        proportion of individuals aged 65 and older who have 
        lost all of their natural teeth.
          [(23) Increase to at least 45 percent the proportion 
        of individuals aged 35 to 44 who have never lost a 
        permanent tooth due to dental caries or periodontal 
        disease.
          [(24) Reduce destructive periodontal disease to a 
        prevalence of no more than 15 percent among individuals 
        aged 35 to 44.
          [(25) Increase to at least 50 percent the proportion 
        of children who have received protective sealants on 
        the occlusal (chewing) surfaces of permanent molar 
        teeth.
          [(26) Reduce the prevalence of gingivitis among 
        individuals aged 35 to 44 to no more than 50 percent.
          [(27) Reduce the infant mortality rate to no more 
        than 8.5 per 1,000 live births.
          [(28) Reduce the fetal death rate (20 or more weeks 
        of gestation) to no more than 4 per 1,000 live births 
        plus 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 UnitedStates, 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 PAYORS

  [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 themedicaid 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.
Sec. 2. Indian Health Care Improvement Act amended.
    Sec. 1. Short title; table of contents.
    Sec. 2. Declaration of National Indian health policy.
    Sec. 3. 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. Funding for tribes for scholarship programs.
    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 for Alaska.
    Sec. 122. Tribal health program administration.
    Sec. 123. Health professional chronic shortage demonstration 
              programs.
    Sec. 124. Treatment of scholarships for certain purposes.
    Sec. 125. National Health Service Corps.
    Sec. 126. Substance abuse counselor educational curricula 
              demonstration programs.

                        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 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. 216A. North Dakota as a contract health service delivery area.
    Sec. 216B. South Dakota as a contract health service delivery area.
    Sec. 217. California contract health services program.
    Sec. 218. California as a contract health service delivery area.
    Sec. 219. Contract health services for the Trenton Service Area.
    Sec. 220. Programs operated by Indian Tribes and Tribal 
              Organizations.
    Sec. 221. Licensing or certification.
    Sec. 222. Notification of provision of emergency contract health 
              services.
    Sec. 223. Prompt action on payment of claims.
    Sec. 224. Liability for payment.
    Sec. 225. 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 nonservice 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 
              care programs.
    Sec. 402. Grants to and funding agreements with the Service, Indian 
              Tribes, Tribal Organizations, and Urban Indian 
              organizations.
    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 in qualifications for reimbursement for 
              services.
    Sec. 409. Consultation.
    Sec. 410. State children's health insurance program (SCHIP).
    Sec. 411. Social Security Act sanctions.
    Sec. 412. Cost sharing.
    Sec. 413. Treatment under medicaid managed care.
    Sec. 414. Navajo nation medicaid agency feasibility study.
    Sec. 415. 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. Office 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. Federal Tort Claims Act coverage.
    Sec. 516. Urban youth treatment center demonstration.
    Sec. 517. Use of Federal property and supplies.
    Sec. 518. Grants for diabetes prevention, treatment, and control.
    Sec. 519. Community health representatives.
    Sec. 520. Regulations.
    Sec. 521. Eligibility for services.
    Sec. 522. 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. Inpatient and community-based mental health facilities 
              design, construction, and staffing.
    Sec. 709. Training and community education.
    Sec. 710. Behavioral health program.
    Sec. 711. Fetal alcohol disorder funding.
    Sec. 712. Child sexual abuse and prevention treatment programs.
    Sec. 713. Behavioral health research.
    Sec. 714. Definitions.
    Sec. 715. 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 the 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. Tribal employment.
    Sec. 813. Prime vendor.
    Sec. 814. Severability provisions.
    Sec. 815. Establishment of National Bipartisan Commission on Indian 
              Health Care Entitlement.
    Sec. 816. Appropriations; availability.
    Sec. 817. Confidentiality of medical quality assurance records: 
              qualified immunity for participants.
    Sec. 818. Authorization of appropriations.

SEC. 2. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.

  Congress hereby 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 to provide all resources necessary to 
        effect that policy;
          (2) to raise the health status of Indians by the year 
        2010 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. 3. 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) The term ``behavioral health'' means the blending 
        of substance (alcohol, drugs, inhalants, and tobacco) 
        abuse and mental illness prevention and treatment, for 
        the purpose of providing comprehensive services. This 
        definition can include the joint development of 
        substance abuse and mental illness treatment planning 
        and coordinated case management using a 
        multidisciplinary approach.
          (5) The term ``California Indians'' shall mean 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) 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 ``fund'' or ``funding'' means the 
        transfer of moneys from the Department to any eligible 
        entity or individual under this Act by any legal means, 
        including Funding Agreements, contracts, grants, 
        memoranda of understanding, contracts pursuant to 
        section 23 of the Act of April 20, 1908 (25 U.S.C. 47; 
        commonly known as the ``Buy Indian Act''), or 
        otherwise. Any program administered as a grant program 
        one day before the date of enactment may continue to be 
        administered as a grant program. This definition does 
        not otherwise modify grant programs, except that upon 
        request of the Indian Tribes or Tribal Organizations, 
        discretionary grants and all categories of awarded 
        nonrecurring funding shall be included in the Funding 
        Agreement. Discretionary grant funds shall be governed 
        by all the particular terms and conditions attached to 
        such funds, unless waived by the Secretary. All 
        particular terms and conditions attached to the 
        discretionary grant funds must be shown in the Funding 
        Agreement. The use of such grant funds shall be 
        governed by the terms and conditions set forth in the 
        Funding Agreement and not the substantive provisions of 
        the Indian Self-Determination and Education Assistance 
        Act (25 U.S.C. 450 et seq.).
          (11) The term ``Funding Agreement'' means any 
        agreement to transfer funds for the planning, conduct, 
        and administration of programs, services, functions, 
        and activities to Indian Tribes and Tribal 
        Organizations from the Secretary under the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 
        450 et seq.).
          (12) The term ``health profession'' means allopathic 
        medicine, family medicine, internal medicine, 
        pediatrics, geriatric medicine, obstetrics and 
        gynecology, podiatric medicine, nursing, public health 
        nursing, advanced practice nursing, dentistry, 
        psychiatry, osteopathy, optometry, pharmacy, 
        psychology, public health, social work, marriage and 
        family therapy, chiropractic medicine, environmental 
        health and engineering, allied health professions, and 
        any other health profession.
          (13) 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 suitable housing, safe 
                water, and sanitary facilities;
                  (E) improving the physical, economic, 
                cultural, psychological, and social 
                environment;
                  (F) promoting adequate opportunity for 
                spiritual, religious, and Traditional Health 
                Care Practices; and
                  (G) providing adequate and appropriate 
                programs, including, but not limited to--
                          (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) safe housing relative to 
                        eliminating, reducing, or preventing 
                        contaminants which create unhealthy 
                        housing conditions;
                          (xxii) safe work environments;
                          (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).
          (14) The term ``Indian'' 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 ``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 April 30, 
                1908 (25 U.S.C. 47), commonly known as the 
                ``Buy Indian Act''.
          (16) 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.).
          (17) 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)).
          (18) 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 (25 U.S.C. 1601 et seq.).
          (19) The term ``Secretary'', unless otherwise 
        designated, means the Secretary of Health and Human 
        Services.
          (20) The term ``Service'' means the Indian Health 
        Service.
          (21) The term ``Service Area'' means the geographical 
        area served by each Area Office.
          (22) 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.
          (23) 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)).
          (24) 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.
          (25) The term ``Traditional Health Care Practices'' 
        means the application by Native healing practitioners 
        of the Native healing sciences (as opposed or in 
        contradistinction to Western healing sciences) which 
        embody the influences or forces of innate Tribal 
        discovery, history, description, explanation and 
        knowledge of the states of wellness and illness and 
        which call upon these influences or forces, including 
        physical, mental, and spiritual forces in the 
        promotion, restoration, preservation, and maintenance 
        of health, well-being, and life's harmony.
          (26) 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)).
          (27) 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 Funding Agreement with 
        the Service under the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450 et seq.).
          (28) 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.).
          (29) 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.
          (30) 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 Alaskan 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.
          (31) 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 funds available 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) Funding.--
          (1) Application.--Funds under this section shall 
        require that 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 funds; payment.--The amount of funds 
        provided to entities 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, funding commitments shall be for 3 
        years, as provided in regulations issued pursuant to 
        this Act.
  (c) Definition of Indian.--For purposes of this section and 
sections 103 and 104, the term ``Indian'' shall, in addition to 
the meaning given that term in section 4, also mean any 
individual who is an Urban Indian.

SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP PROGRAM FOR 
                    INDIANS.

  (a) Scholarships Authorized.--The Secretary, acting through 
the Service, shall provide scholarships 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.--Scholarships 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 scholarships 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) Allocation by formula.--Except as provided in 
        paragraph (3), the funding authorized by this section 
        shall be allocated by Service Area by a formula 
        developed in consultation with Indian Tribes, Tribal 
        Organizations, and Urban Indian Organizations. Such 
        formula shall consider the human resource development 
        needs in each Service Area.
          (3) Continuity of prior scholarships.--Paragraph (2) 
        shall not apply with respect to individual recipients 
        of scholarships provided under this section (as in 
        effect 1 day prior to the date of the enactment of the 
        Indian Health Care Improvement Act Amendments of 2004) 
        until such time as the individual completes the course 
        of study that is supported through such scholarship.
          (4) Certain delegation not allowed.--The 
        administration of this section shall be a 
        responsibility of the Assistant Secretary and shall not 
        be delegated in a Funding Agreement.
  (b) Active Duty Service Obligation.--
          (1) Obligation met.--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 Indian has entered into under that 
        section shall, if that individual is a recipient of an 
        Indian Health Scholarship, be met in full-time practice 
        on an equivalent year-for-year obligation, by service 
        in one 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.
          (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--part-time equivalent of 4 
years, as determined by the Area Office;
          (1) 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 Area 
                Office); or
                  (B) 2 years; and
          (2) 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 
        the enactment of the Indian Health Care Improvement Act 
        Amendments of 2004 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.--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, in 
        consultation with the Area Office, Indian Tribes, 
        Tribal Organizations, and Urban Indian Organizations, 
        determines that--
                  (A) it is not possible for the recipient to 
                meet that obligation or make that payment;
                  (B) requiring that recipient to meet that 
                obligation or make that payment would result in 
                extreme hardship to the recipient; or
                  (C) the enforcement of the requirement to 
                meet the obligation or make the payment would 
                be unconscionable.
          (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 provide funding grants to at least 3 colleges 
and universities for the purpose of developing and maintaining 
Indian psychology career recruitment programs as a means of 
encouraging Indians to enter the mental 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 funds 
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.

SEC. 106. FUNDING FOR TRIBES FOR SCHOLARSHIP PROGRAMS.

  (a) In General.--
          (1) Funding authorized.--The Secretary, acting 
        through the Service, shall make funds available 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 funds 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 
        funds 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 one of the health professions contemplated by 
this Act.
  (d) Contract.--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. Such contract shall--
          (1) 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--
                  (A) 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
                  (B) such greater period of time as the 
                recipient and the Tribal Health Program may 
                agree;
          (2) provide that the amount of the scholarship--
                  (A) 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)), 
                        such amount to be reduced pro rata (as 
                        determined by the Secretary) based on 
                        the number of hours such student is 
                        enrolled; and 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 this clause; 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 pursuant to this Act; and
          (4) require the recipient of such scholarship to meet 
        the educational and licensure requirements appropriate 
        to each health profession.
  (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 health professionals, including 
community health representatives and emergency medical 
technicians, to join or continue in an Indian Health Program or 
an Urban Indian Organization 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 
provide allowances to health professionals employed in an 
Indian Health Program or an Urban Indian Organization 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.

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).
In the administration of this section, naturopathic medicine is 
included among the other health professions.
  (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) 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.
          (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 Service 
manpower programs 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 based on yields on appropriate 
                marketable Treasury securities;
                  (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 each 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, except for the appropriated 
funds, as the Secretary 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 unpaid student volunteers and 
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 one 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 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 
the enactment of the Indian Health Care Improvement Act 
Amendments of 2004, 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 one 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 funding 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.
  (e) Quentin N. Burdick Program Grant.--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 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 (including 
        programs under agreements with the Bureau of Indian 
        Affairs);
          (3) in a program assisted under title V of this Act; 
        or
          (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.

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 
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 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 $100,000.
  (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 which 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) Funding Priority.--Where the requirements of subsection 
(b) are met, funding 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 3 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