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                                                       Calendar No. 144
108th Congress                                                   Report
                                 SENATE
 1st Session                                                     108-76

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



 
ELEVATING THE POSITION OF DIRECTOR OF THE INDIAN HEALTH SERVICE WITHIN 
THE DEPARTMENT OF HEALTH AND HUMAN SERVICES TO ASSISTANT SECRETARY FOR 
                 INDIAN HEALTH, AND FOR OTHER PURPOSES

                                _______
                                

                 June 18, 2003.--Ordered to be printed

                                _______
                                

   Mr. Campbell, from the Committee on Indian Affairs, submitted the 
                               following

                              R E P O R T

                         [To accompany S. 558]

    The Committee on Indian Affairs, to which was referred the 
bill (S. 558) to elevate the position of Director of the Indian 
Health Service within the Department of Health and Human 
Services to Assistant Secretary for Indian Health, and for 
other purposes, having considered the same, reports favorably 
thereon without amendment and recommends that the bill do pass.

                                Purpose

    The purpose of S. 558 is to elevate the position of the 
Director of the Indian Health Service to the status of an 
Assistant Secretary within the Department of Health and Human 
Services. The bill establishes the Office of Assistant 
Secretary for Indian Health in order to further the unique 
government-to-government relationship between Indian tribes and 
the United States, facilitate advocacy for the development of 
Indian health policy, and promote consultation on matters 
related to Indian health.

                               Background

    In exchange for ceding millions of acres of land to which 
Indian tribes held aboriginal title, the United States entered 
into treties with the Indian tribes. Many of the treaties 
provided that health care services would be provided to the 
citizens of Indian tribes. Some have asserted that these 
contracts between the United States and Indian governments 
represent the ``first pre-paid health care plan'' in America.
    The Federal obligation to provide health care services to 
Indians also arises out of the special trust relationship 
between the United States and Indian tribes, which reflects the 
authority found in Article I, Section 8, clause 3 of the U.S. 
Constitution, and which has been given form and substance by 
numerous treaties, laws, Supreme Court decisions, and Executive 
Orders.
    The first Federal statute authorizing the appropriation of 
funds to carry out the United States' responsibilities was the 
Snyder Act of 1921 (25 U.S.C. 13). In 1976, the Indian Health 
Care Improvement Act (25 U.S.C. 1601 et seq.) (IHCIA) became 
law. The IHCIA was the first comprehensive statute specifically 
addressing the provision of health care to Indians and the 
Federal administration of health care.

               A. EVOLUTION OF THE INDIAN HEALTH SERVICE

    The Bureau of Indian Affairs within the U.S. Department of 
the Interior was initially charged with carrying out the United 
States responsibility for the provision of health care to 
Federally-recognized tribes and their members.
    In 1954, in response to a growing concern by the public 
health community that the Indian health care responsibility 
should be transferred to his authority, the Surgeon General, 
acting through the Public Health Service (PHS), established the 
Division of Indian Health (DIH) to administer the Indian health 
program.
    In 1968, the Division became the Indian Health Service 
(IHS) and operated as a sub-agency of other agencies within the 
Public Health Service including the Health Resources and 
Services Administration.
    In 1988, the Indian Health Service was established as a 
separate agency within the Public Health Service.
    On October 1, 1995, the Department of Health and Human 
Services (DHHS) reorganized its internal administrative 
structure and the Indian Health Service, along with the other 
agencies of the Public Health Service, became a separate 
operating division of the Department.
    Presently, the Director of the Indian Health Service is 
appointed by the President and is subject to Senate 
confirmation pursuant to 25 U.S.C. 1661(a). Under current law, 
the IHS Director reports to the DHHS Secretary through the 
Assistant Secretary for Health.
    Since the 1995 reorganization of the DHHS, all agencies, 
operating divisions, and programs within the Department, 
including those previously part of the Public Health Service 
and under the direction of the Assistant Secretary for Health, 
have been required to report directly to the Secretary. Under 
the DHHS restructuring, the position of Assistant Secretary for 
Health was combined with the position of Surgeon General and 
the Office of Public Health and Science (OPHS) was established. 
The Assistant Secretary for Health directs the OPHS, serves as 
the Secretary's senior advisor for public health and science, 
and provides leadership and coordination across the Department 
on public health and science issues.
    A key component to the IHS health care system is the Public 
Health Service's Commissioned Corps. The Corps was established 
by the Congress in 1889 as part of the Marine Hospital Service, 
which later became the Public Health Service. The original 
mission of the Corps was to provide medical care to sick and 
disabled navy and merchant seamen. While the Corps' duties were 
expanded during World Wars I and II, its original mission now 
serves as the basis for its9 continuing status as a uniformed 
service. The Surgeon General is statutorily responsible for 
supervising the activities of the Commissioned Corps. The Corps 
is also charged with providing technical and financial 
assistance to a variety of other federal agencies, state, and 
local public health departments.
    At the request of this Committee, the General Accounting 
Office (GAO) conducted a study of the role of the Corps in the 
Indian Health Service system. Corps officers have been assigned 
to Indian health agencies since 1926 and the Corps continues to 
provide many of the physicians, registered nurses, dentists, 
pharmacists, engineers, and sanitarians in Indian health 
facilities.
    As of August 1999, the Public Health Service employed 5,936 
Corps officers of which 2,204 or about 37 percent, are assigned 
to the Indian Health Service.
    S. 558, as introduced, closely resembles previous versions 
of legislation introduced in the last several Congresses, which 
resulted from discussions with tribal leaders and 
representatives of the DHHS.
    Like its legislative predecessors in previous sessions of 
the Congress, S. 558 seeks to honor the government-to-
government relationship between the United States and Indian 
tribes, to provide the necessary leadership within the 
Administration on Indian health issues, and to bring focus and 
national attention to the health care status of American 
Indians and Alaska Natives. The bill is intended to enhance the 
Federal capacity to respond to the ongoing health crisis in 
Indian country and the continuing frustrations of Indian 
patients that their needs and concerns are not adequately 
addressed under the current administrative policy and budgetary 
processes.

              B. INDIAN HEALTH CARE AND STATUS OF THE IHS

    The IHS employs approximately 15,000 employees or about 
one-quarter of all DHHS personnel. The IHS is a comprehensive 
health care delivery system operating nationwide through a 
variety of health care facilities. The IHS provides health care 
services directly and through tribally contracted and operated 
health care programs operated pursuant to the Indian Self 
Determination and Education Assistance Act, 25 U.S.C. 450 et 
seq.
    Health services are also purchased from more than two 
thousand private providers. As of 2002, the IHS system 
consisted of 594 direct health care delivery facilities funded 
through the IHS: 146 of these were directly operated by the IHS 
and 448 were operated by tribes.
    These facilities include, among others, 49 hospitals, 231 
health care centers, 309 health stations, five school centers, 
and 34 urban Indian programs. Each year the IHS provides health 
care services to 559 Indian tribes in 35 states and in 2002 
provided services to 1.6 million American Indians and Alaska 
Natives. In 1998, IHS and tribal hospitals registered some 
68,000 admissions and IHS and tribal direct health clinics 
provided 7 million outpatient visits.
    Previous efforts to address Indian health care needs and 
concerns have not greatly affected the steady decline in 
purchasing power of the IHS budget. The disparity between 
Indian and non-Indian communities in Federal health care 
expenditures continues to grow. IHS Health Expenditures for 
Fiscal Year 1998 reflect a $1,507 per capita expenditure for 
Indians, compared with a $3,383 per capita outlay for non-
Indians.
    The Committee strongly believes that the 
institutionalization of a senior policy official responsible 
for Indian health within the DHHS is necessary to bring parity 
to Indian health care needs.
    S. 558 is intended to strengthen the Executive Order issued 
on April 29, 1994, 59 F.R. 22951, which recognizes the 
government-to-government relationship between the United States 
and the tribes and the November 6, 2000, Executive Order No. 
13175 directing executive agencies to consult with Indian 
tribes prior to any Federal action that would affect the 
tribes.

        C. THE ROLE OF THE ASSISTANT SECRETARY FOR INDIAN HEALTH

    On April 9, 2003, the Committee held a hearing to receive 
testimony to discuss S. 558, among other legislation. At that 
hearing, the National Indian Health Board, a national Indian 
health policy advocacy organization, indicated its strong 
support for the elevation of the Director of IHS to Assistant 
Secretary for Indian Health. Additionally, the Committee has 
received a significant volume of correspondence, uniformly 
supporting the elevation of the Director of IHS to Assistant 
Secretary for Indian Health.
    The Administration has indicated its concerns with the 
elevation of the IHS Director. Testifying before the Committee, 
the DHHS witness noted that significant policymaking role given 
to the IHS Director by the DHHSSecretary, and the 
revitalization of the Intra-departmental Council for Native American 
Affairs, on which the IHS Director serves as Vice-Chair.
    The Committee is appreciative of the strong support for, 
and emphasis placed on Native health issues by the current 
Secretary. However, the Committee remains concerned that future 
Secretaries may not place a similarly high priority on Native 
health issues and, for that reason, elevation of the Director 
to Assistant Secretary is important.
    The Committee also recognizes the role of the Assistant 
Secretary for Health (Surgeon General) in addressing the health 
needs of all citizens of this country, including the American 
Indian and Native Alaska populations. S. 558 does not alter the 
important role the Assistant Secretary for Health (Surgeon 
General) serves, particularly as principal adviser to the 
Secretary of DHHS for public health matters affecting the 
general population.
    It is the Committee's hope that a close collaboration 
between the Assistant Secretary for Health and the Assistant 
Secretary for Indian Health can serve as a model of interagency 
cooperation and partnership and raise the health status of 
American Indians and Alaska Natives.
    S. 558 elevates the position of the IHS Director, but more 
importantly, recognizes the unique government-to-government 
relationship between Federally recognized Indian tribes and the 
United States. The Assistant Secretary for Indian Health will 
provide the necessary leadership and consultation to the 
Secretary, the Assistant Secretary for Health, and others, on 
the important health issues facing Indian people. S. 558 serves 
to support the Federal policy of tribal self-determination and 
ensures that Indian people are heard and their concerns are 
brought to the table when important policy and budget decisions 
are made on their behalf.
    The establishment of an Assistant Secretary for Indian 
Health will ensure that there is a senior official in current 
and future administrations who is knowledgeable about the 
United States' legal and moral obligations to Indian people, 
the mission of the IHS, and who has the status to advocate 
within the DHHS and the Office of Management and Budget for the 
funding resources and policies that are necessary to 
effectively and efficiently address the health care needs and 
concerns of the Indian people.
    S. 558 places this important and special leadership role 
with the Assistant Secretary for Indian Health.

                          Legislative History

    S. 558 was introduced on March 6, 2003, by Senator McCain 
for himself, and for Senators Campbell, Domenici, Johnson, 
Bingaman and Murray. The bill was referred to the Committee on 
Indian Affairs. Senator Inouye was added as a cosponsor on 
March 10, 2003, and Senator Conrad was added on April 1, 2003.
    The bill was the subject of a hearing held by the Senate 
Indian Affairs Committee on April 9, 2003, during which the 
Committee received testimony from the DHHS, the NIHB, and 
tribal leaders.

                      Section-by-Section Analysis


Section 1. Office of Assistant Secretary for Indian Health

    Subsection (a) provides definitions for the terms 
``Assistant Secretary'', ``Department'', ``Office'', and 
``Secretary''.
    Subsection (b) provides that the Office of Assistant 
Secretary for Indian Health is established within the 
Department and will be headed by the Assistant Secretary, who 
is appointed by the President and confirmed by the United 
States Senate. This subsection further provides for the current 
incumbent Director of the IHS to serve as the Assistant 
Secretary, at the pleasure of the President, after enactment. 
The duties of the Assistant Secretary are to, consistent with 
the unique government-to-government relationship between Indian 
tribes and the United States, facilitate advocacy for the 
development of Indian healthpolicy, and promote consultation on 
matters related to Indian health.
    Subsection (c) provides that the Assistant Secretary for 
Indian Health shall report directly to the Secretary on all 
policy and budget related matters affecting Indian health, 
collaborate with the Assistant Secretary for Health on Indian 
health matters, advise other Assistant Secretaries and others 
within DHHS concerning matters of Indian health, perform the 
functions of the Director of the Indian Health Service, and 
other functions as designed by the Secretary of Health and 
Human Services.
    Subsection (d) provides technical changes to conform with 
the Act. The elevation of the Director of Indian Health Service 
to Assistant Secretary would increase the number of assistant 
secretaries to seven. This subsection also abolishes the 
position of the Director of Indian Health Service.
    Subsection (e) amends section 601 of the Indian Health Care 
Improvement Act, 25 U.S.C. 1661, by establishing the Indian 
Health Service within the Public Health Service and further 
outlines and clarifies the duties of the Assistant Secretary 
for Indian Health.
    Subsection (f) further amends the Indian Health Care 
Improvement Act by deleting all provisions referring to ``the 
Director'' or ``Director of Indian Health Service'' and 
inserting in lieu thereof ``the Assistant Secretary for Indian 
Health.'' This subsection also provides for conforming 
amendments to other statutes to conform with this Act.
    Subsection (g) provides that any references to the Director 
of Indian Health Service in any other Federal laws, Executive 
order, rule, regulation, or delegation of authority, or any 
document will be deemed to refer to the Assistant Secretary for 
Indian Health.

            Committee Recommendation and Tabulation of Vote

    On May 14, 2003, the Committee on Indian Affairs, in an 
open business session, considered S. 558. The bill, without 
amendment, was ordered favorably reported with a recommendation 
that the bill do pass.

                    Cost and Budgetary Consideration

    The cost estimate for S. 558 as calculated by the 
Congressional Budget Office, is set forth below:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, May 22, 2003.
Hon. Ben Nighthorse Campbell,
Chairman, Committee on Indian Affairs,
U.S. Senate, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 558, a bill to 
elevate the position of Director of the Indian Health Service 
within the Department of Health and Human Services to Assistant 
Secretary for Indian Health, and for other purposes.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Eric Rollins.
            Sincerely,
                                       Douglas Holtz-Eakin,
                                                          Director.
    Enclosure.

               Congressional Budget Office Cost Estimate


S. 558--A bill to elevate the position of Director of the Indian Health 
        Service within the Department of Health and Human Services to 
        Assistant Secretary for Indian Health, and for other purposes

    CBO estimates that enacting this bill would have no 
significant effect on the federal budget. S. 558 contains no 
intergovernmental or private-sector mandates as defined in the 
Unfunded Mandates Reform Act and would not affect the budgets 
of state, local, or tribal governments.
    S. 558 would establish the position of Assistant Secretary 
for Indian Health in lieu of the current position of Director 
of the Indian Health Service. The duties and responsibilities 
of the office would not be changed significantly. The rate of 
pay would increase from level V to level IV of the Executive 
Schedule, an increase of $8,600. This change would not affect 
the salary of the current Director of the Indian Health 
Service, because his pay is governed by the pay structure of 
the Public Health Service Commissioned Corps.
    The CBO staff contact for this estimate is Eric Rollins. 
This estimate was approved by Peter H. Fontaine, Deputy 
Assistant Director for Budget Analysis.

                      Regulatory Impact Statement

    Paragraph 11(b) of rule XXVI of the Standing Rules of the 
Senate requires that each report accompanying a bill to 
evaluate the regulatory paperwork impact that would be incurred 
in carrying out the bill. The Committee believes that S. 558 
will have minimal regulatory or paperwork impact.

                        Executive Communications

    There have been no executive communications received 
regarding this legislation.

                        Changes in Existing Law

    In compliance with subsection 12 of rule XXVI of the 
Standing Rules of the Senate, the Committee states that 
enactment of S. 558 will result in the following changes in the 
following statutes as noted below, with existing language which 
is to be deleted in brackets and the new language which is to 
be added in italic:

                           UNITED STATES CODE

TITLE 5.--GOVERNMENT ORGANIZATION AND EMPLOYEES

           *       *       *       *       *       *       *


SEC. 5315. POSITIONS AT LEVEL IV.

    Level IV of the Executive Schedule applies to the following 
positions, for which the annual rate of basic pay shall be the 
rate determined with respect to such level under chapter 11 of 
title 2, as adjusted by section 5318 of this title: * * *
    Assistant Secretaries of Health and Human Services [(6)] 
(7). * * *

           *       *       *       *       *       *       *


SEC. 5316. POSITIONS AT LEVEL V.

    Level V of the Executive Schedule applies to the following 
positions, for which the annual rate of basic pay shall be the 
rate determined with respect to such level under 11 of title 2, 
as adjusted by section 5318 of this title: * * *
    [Director, Indian Health Service, Department of Health and 
Human Services.] * * *

           *       *       *       *       *       *       *


                           UNITED STATES CODE

TITLE 29.--LABOR

           *       *       *       *       *       *       *


SEC. 5315. INTERAGENCY COMMITTEE.

    (a) --
    (1) In order to promote coordination and cooperation among 
Federal departments and agencies conducting rehabilitation 
research programs, including programs relating to assistive 
technology research and research that incorporates the 
principles of universal design, there is established within the 
Federal Government an Interagency Committee on Disability 
Research (hereinafter in this section referred to as the 
``Committee''), chaired by the Director and comprised of such 
members as the President may designate, including the following 
(or their designees): the Director, the Commissioner of the 
Rehabilitation Services Administration, the Assistant Secretary 
for Special Education and Rehabilitative Services, the 
Secretary of Education, the Secretary of Veterans Affairs, the 
Director of the National Institutes of Health, the Director of 
the National Institute of Mental Health, the Administrator of 
the National Aeronautics and Space Administration, the 
Secretary of Transportation, the Assistant Secretary of the 
Interior for Indian Affairs, the Assistant Secretary for Indian 
Health, and the Director of the National Science Foundation. * 
* *

           *       *       *       *       *       *       *


                           UNITED STATES CODE

TITLE 33.--NAVIGATION AND NAVIGABLE WATERS

           *       *       *       *       *       *       *


SEC. 1377. INDIAN TRIBES. * * *

           *       *       *       *       *       *       *


    (B) Assessment of Sewage Treatment Needs; Report.--The 
Administrator in cooperation with the [Director of the Indian 
Health Service] Assistant Secretary for Indian Health, shall 
assess the need for sewage treatment works to serve Indian 
tribes, the degree to which such needs will be met through 
funds allotted to States under section 205 of this Act and 
priority lists under section 216 of this Act, and any obstacles 
which prevent such needs from being met. Not later than one 
year after the date of the enactment of this section, the 
Administrator shall submit a report to Congress on the 
assessment under this subsection, along with recommendations 
specifying (1) how the Administrator intends to provide 
assistance to Indian tribes to develop waste treatment 
management plans and to construct treatment works under this 
Act, and (2) methods by which the participation in and 
administration of programs under this Act by Indian tribes can 
be maximized. * * *

           *       *       *       *       *       *       *

    (e) Treatment as States.--The Administrator is authorized 
to treat an Indian tribe as a State for purposes of title II 
and sections 104, 106, 303, 305, 308, 309, 314, 319, 401, 402, 
404, and 406 of this Act to the degree necessary to carry out 
the objectives of this section, but only if-- * * *
          (3) the Indian tribe is reasonably expected to be 
        capable, in the Administrator's judgment, of carrying 
        out the functions to be exercised in a manner 
        consistent with the terms and purposes of this Act and 
        of all applicable regulations.
Such treatment as a State may include the direct provision of 
funds reserved under subsection (c) to the governing bodies of 
Indian tribes, and the determination of priorities by Indian 
tribes, where not determined by the Administrator in 
cooperation with the [Director of the Indian Health Service] 
Assistant Secretary for Indian Health. The Administrator, in 
cooperation with the [Director of the Indian Health Service] 
Assistant Secretary for Indian Health, is authorized to make 
grants under title II of this Act in an amount not to exceed 
100 percent of the cost of a project. Not later than 18 months 
after the date of the enactment of this section, the 
Administrator shall, in consultation with Indian tribes, 
promulgate final regulations which specify how Indian tribes 
shall be treated as States for purposes of this Act. The 
Administrator shall, in promulgating such regulations, consult 
affected States sharing common water bodies and provide a 
mechanism for the resolution of any unreasonable consequences 
that may arise as a result of differing water quality standards 
that may be set by States and Indian tribes located on common 
bodies of water. Such mechanism shall provide for explicit 
consideration of relevant factors including, but not limited 
to, the effects of differing water quality permit requirements 
on upstream and downstream dischargers,economic impacts, and 
present and historical uses and quality of the waters subject to such 
standards. Such mechanism should provide for the avoidance of such 
unreasonable consequences in a manner consistent with the objective of 
this Act. * * *

           *       *       *       *       *       *       *


                           UNITED STATES CODE

TITLE 42.--PUBLIC HEALTH AND WELFARE

           *       *       *       *       *       *       *


SEC. 247B-14. ORAL HEALTH PROMOTION AND DISEASE PREVENTION. * * *

           *       *       *       *       *       *       *


    (b) Community Water Fluoridation.
          (1) In general.--The Secretary, acting through the 
        Director of the Centers for Disease Control and 
        Prevention and in collaboration with the [Director of 
        the Indian Health Service] Assistant Secretary for 
        Indian Health, shall establish a demonstration project 
        that is designed to assist rural water systems in 
        successfully implementing the water fluoridation 
        guidelines of the Centers for Disease Control and 
        Prevention that are entitled ``Engineering and 
        Administrative Recommendations for Water Fluoridation, 
        1995'' (referred to in this subsection as the 
        ``EARWF'').
          (2) Requirements.
                  (A) Collaboration.--In collaborating under 
                paragraph (1), [the Directors] the Director of 
                the Centers for Disease Control and Prevention 
                and the Assistant Secretary for Indian Health 
                referred to in such paragraph shall ensure that 
                technical assistance and training are provided 
                to tribal programs located in each of the 12 
                areas of the Indian Health Service. The 
                [Director of the Indian Health Service] 
                Assistant Secretary for Indian Health shall 
                provide coordination and administrative support 
                to tribes under this section. * * *

           *       *       *       *       *       *       *


SEC. 285A-9. GRANTS FOR EDUCATION, PREVENTION, AND EARLY DETECTION OF 
                    RADIOGENIC CANCERS AND DISEASES. * * *

           *       *       *       *       *       *       *


    (b) In General.--The Secretary, acting through the 
Administrator of the Health Resources and Services 
Administration in consultation with the Director of the 
National Institutes of Health and the [Director of the Indian 
Health Service] Assistant Secretary for Indian Health, may make 
competitive grants to any entity for the purpose of carrying 
out programs to-- * * *

           *       *       *       *       *       *       *


SEC. 300J-12. STATE REVOLVING LOAN FUNDS. * * *

           *       *       *       *       *       *       *


    (i) Indian Tribes. * * *

           *       *       *       *       *       *       *

          (2) Use of funds.--Funds reserved pursuant to 
        paragraph (1) shall be used to address the most 
        significant threats to public health associated with 
        public water systems that serve Indian Tribes, as 
        determined by the Administrator in consultation with 
        the [Director of the Indian Health Service] Assistant 
        Secretary for Indian Health and Indian Tribes. * * *

           *       *       *       *       *       *       *

          (4) Needs assessment.--The Administrator, in 
        consultation with the [Director of the Indian Health 
        Service] Assistant Secretary for Indian Health and 
        Indian Tribes, shall, in accordance with a schedule 
        that is consistent with the needs surveys conducted 
        pursuant to subsection (h), prepare surveys and assess 
        the needs of drinking water treatment facilities to 
        serve Indian Tribes, including an evaluation of the 
        public water systems that pose the most significant 
        threats to public health. * * *

           *       *       *       *       *       *       *


SEC. 2991B-2. ESTABLISHMENT OF ADMINISTRATION FOR NATIVE AMERICANS. * * 
                    *

           *       *       *       *       *       *       *


    (d) Intra-Departmental Council on Native American Affairs.
          (1) There is established in the Office of the 
        Secretary the Intra-Departmental Council on Native 
        American Affairs. The Commissioner shall be the 
        chairperson of such Council and shall advise the 
        Secretary on all matters affecting Native Americans 
        that involve the Department. The [Director of the 
        Indian Health Service] Assistant Secretary for Indian 
        Health shall serve as vice chairperson of the Council. 
        * * *

           *       *       *       *       *       *       *


                   INDIAN HEALTH CARE IMPROVEMENT ACT

                           PUBLIC LAW 94-437

    AN ACT To implement the Federal responsibility for the care and 
education of the Indian people by improving the services and facilities 
of Federal Indian health programs and encouraging maximum participation 
          of Indians in such programs, and for other purposes

    Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled,

           *       *       *       *       *       *       *


[SEC. 601. ESTABLISHMENT OF INDIAN HEALTH SERVICE AS AN AGENCY OF 
                    PUBLIC HEALTH SERVICE.

    [(a) Establishment.--In order to more effectively and 
efficiently carry out the responsibilities, authorities, and 
functions of the United States to provide health care services 
to Indians and Indian tribes, as are or may be on and after 
November 23, 1988, provided by Federal statute or treaties, 
there is established within the Public Health Service of the 
Department of Health and Human Services the Indian Health 
Service. The Indian Health Service shall be administered by a 
Director, who shall be appointed by the President, by and with 
the advice and consent of the Senate. The Director of the 
Indian Health Service shall report to the Secretary through the 
Assistant Secretary for Health of the Department of Health and 
Human Services. Effective with respect to an individual 
appointed by the President, by and with the advice and consent 
of the Senate, after January 1, 1993, the term of service of 
the Director shall be 4 years. A Director may serve more than 1 
term.]

SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN AGENCY OF 
                    THE PUBLIC HEALTH SERVICE.

    (a) Establishment.--
          (1) In general.--In order to more effectively and 
        efficiently carry out the responsibilities, 
        authorities, and functions of the United States to 
        provide health care services to Indians and Indian 
        tribes, there is established within the Public Health 
        Service of the Department of Health and Human Services 
        the Indian Health Service.
          (2) Administration.--The Indian Health Service shall 
        be administered by the Assistant Secretary for Indian 
        Health.
          (3) Duties.--In carrying out paragraph (2), the 
        Assistant Secretary for Indian Health shall--
                  (A) report directly to the Secretary 
                concerning all policy- and budget-related 
                matters affecting Indian health;
                  (B) collaborate with the Assistant Secretary 
                for Health concerning appropriate matters of 
                Indian health that affect the agencies of the 
                Public Health Service;
                  (C) advise each Assistant Secretary of the 
                Department of Health and Human Services 
                concerning matters of Indian health with 
                respect to which that Assistant Secretary has 
                authority and responsibility;
                  (D) advise the heads of other agencies and 
                programs of the Department of Health and Human 
                Services concerning matters of Indian health 
                with respect to which those heads have 
                authority and responsibility;
                  (E) coordinate the activities of the 
                Department of Health and Human Services 
                concerning matters of Indian health; and
                  (F) perform such other function as the 
                Secretary may designate. * * *

           *       *       *       *       *       *       *

    (c) The Secretary shall carry out through the [Director of 
the Indian Health Service] Assistant Secretary for Indian 
Health--
          (1) all functions which were, on the day before 
        November 23, 1988, carried out by or under the 
        direction of the individual serving as [Director of the 
        Indian Health Service] Assistant Secretary for Indian 
        Health. * * *

           *       *       *       *       *       *       *

    (d) Authority of Secretary.--
          (1) The Secretary, acting through the [Director of 
        the Indian Health Service] Assistant Secretary for 
        Indian Health, shall have the authority--* * *

           *       *       *       *       *       *       *


SEC. 816. INDIAN HEALTH SERVICE AND DEPARTMENT OF VETERANS AFFAIRS 
                    HEALTH FACILITIES AND SERVICES SHARING. * * *

           *       *       *       *       *       *       *


    (c) Cross Utilization of Services.--
          (1) Not later than December 23, 1988, the [Director 
        of the Indian Health Service] Assistant Secretary for 
        Indian Health and the Secretary of Veterans Affairs 
        shall implement an agreement under which-- * * *

           *       *       *       *       *       *       *


                     CHILDREN'S HEALTH ACT OF 2000

                           PUBLIC LAW 106-310

     AN ACT To amend the Public Health Service Act with respect to 
                           children's health

    Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled,

           *       *       *       *       *       *       *


SEC. 3307. ESTABLISHMENT OF COMMISSION. * * *

           *       *       *       *       *       *       *


    (b) Membership.--
          (1) In general.--The Commission established under 
        subsection (a) shall consist of--
                  (A) the Secretary;
                  (B) 15 members who are experts in the health 
                care field and issues that the Commission is 
                established to examine; and
                  (C) the [Director of the Indian Health 
                Service] Assistant Secretary for Indian Health 
                and the Commissioner of Indian Affairs, who 
                shall be nonvoting members. * * *

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               INDIAN LANDS OPEN DUMP CLEANUP ACT OF 1994

                           PUBLIC LAW 103-399

 AN ACT To clean up open dumps on Indian lands, and for other purposes

    Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled,

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SEC. 3. DEFINITIONS.

    For the purposes of this Act, the following definitions 
shall apply:
          [(6)] (1) Alaska native entity.--The term ``Alaska 
        Native entity'' includes native corporations 
        established pursuant to the Alaska Native Claims 
        Settlement Act (43 U.S.C. 1600 et seq.) and any Alaska 
        Native village or municipal entity which owns Alaska 
        Native land.
          [(2) Director.--The term ``Director'' means the 
        Director of the Indian Health Service.]
          [(4)] (2) Alaska native land.--The term ``Alaska 
        Native land'' means (A) land conveyed or to be conveyed 
        pursuant to the Alaska Native Claims Settlement Act (43 
        U.S.C. 1600 et seq.), including any land reconveyed 
        under section 14(c)(3) of that Act (43 U.S.C. 
        1613(c)(3)), and (B) land conveyed pursuant to the Act 
        of November 2, 1966 (16 U.S.C. 1151 et seq.; commonly 
        known as the ``Fur Seal Act of 1966'').
          (3) Assistant secretary.--The term ``Assistant 
        Secretary'' means the Assistant Secretary for Indian 
        Health.
          [(1)] (4) Closure or close.--The term ``closure or 
        close'' means the termination of operations at open 
        dumps on Indian land or Alaska Native land and bringing 
        such dumps into compliance with applicable Federal 
        standards and regulations, or standards promulgated by 
        an Indian tribal government or Alaska Native entity, if 
        such standards are more stringent than the Federal 
        standards and regulations.
          [(3)] (5) Indian land.--The term ``Indian land'' 
        means--
                  (A) land within the limits of any Indian 
                reservation under the jurisdiction of the 
                United States Government, notwithstanding the 
                issuance of any patent, and including rights-
                of-way running through the reservation;
                  (B) dependent Indian communities within the 
                borders of the United States whether within the 
                original orsubsequently acquired territory 
thereof, and whether within or without the limits of a State; and
                  (C) Indian allotments, the Indian titles to 
                which have not been extinguished, including 
                rights-of-way running through such allotments.
          [(5)] (6) Indian tribal government.--The term 
        ``Indian tribal government'' means the governing body 
        of any Indian tribe, band, nation, pueblo, or other 
        organized group or community which is recognized as 
        eligible for the special programs and services provided 
        by the United States to Indians because of their status 
        as Indians. * * *

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SEC. 4. INVENTORY OF OPEN DUMPS.

    (a) Study and Inventory.--Not later than 12 months after 
the date of enactment of this Act, the [Director] Assistant 
Secretary shall conduct a study and inventory of open dumps on 
Indian lands and Alaska Native lands. The inventory shall list 
the geographic location of all open dumps, an evaluation of the 
contents of each dump, and an assessment of the relative 
severity of the threat to public health and the environment 
posed by each dump. Such assessment shall be carried out 
cooperatively with the Administrator of the Environmental 
Protection Agency. The [Director] Assistant Secretary shall 
obtain the concurrence of the Administrator in the 
determination of relative severity made by any such assessment.
    (b) Annual Reports.--Upon completion of the study and 
inventory under subsection (a), the [Director] Assistant 
Secretary shall report to the Congress, and update such report 
annually--* * *
    (c) 10-Year Plan.--The [Director] Assistant Secretary shall 
develop and begin implementation of a 10-year plan to address 
solid waste disposal needs on Indian lands and Alaska Native 
lands. This 10-year plan shall identify-- * * *

           *       *       *       *       *       *       *


[SEC. 5. AUTHORITY OF THE DIRECTOR OF THE INDIAN HEALTH SERVICE.] SEC. 
                    5. AUTHORITY OF ASSISTANT SECRETARY FOR INDIAN 
                    HEALTH.

    (a) Reservation Inventory.--(1) Upon request by an Indian 
tribal government or Alaska Native entity, the [Director] 
Assistant Secretary shall-- * * *
                  (B) determine the relative severity of the 
                threat to public health and the environment 
                posed by each dump based on information 
                available to the Director and the Indian tribal 
                government or Alaska Native entity unless the 
                [Director] Assistant Secretary, in consultation 
                with the Indian tribal government or Alaska 
                Native entity, determines that additional 
                actions such as soil testing or water 
                monitoring would be appropriate in the 
                circumstances; * * *
          (2) The inventory and evaluation authorized under 
        paragraph (1)(A) shall be carried out cooperatively 
        with the Administrator of the Environmental Protection 
        Agency. The [Director] Assistant Secretary shall obtain 
        the concurrence of the Administrator in the 
        determination of relative severity made under paragraph 
        (1)(B).
    (b) Assistance.--Upon completion of the activities required 
to be performed pursuant to subsection (a), the [Director] 
Assistant Secretary shall, subject to subsection (c), provide 
financial and technical assistance to the Indian tribal 
government or Alaska Native entity to carry out the activities 
necessary to--
          (1) close such dumps; and
          (2) provide for postclosure maintenance of such 
        dumps.
    (c) Conditions.--All assistance provided pursuant to 
subsection (b) shall be made available on a site-specific basis 
in accordance with priorities developed by the [Director] 
Assistant Secretary. Priorities shall take into account the 
relative severity of the threat to public health and the 
environment posed by each open dump and the availability of 
funds necessary for closure and postclosure maintenance.

SEC. 6. CONTRACT AUTHORITY.

    (a) Authority of [Director] Assistant Secretary._To the 
maximum extent feasible, the [Director] Assistant Secretary 
shall carry out duties under this Act through contracts, 
compacts, or memoranda of agreement with Indian tribal 
governments or Alaska Native entities pursuant to the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 
et seq.), section 7 of the Act of August 5, 1954 (42 U.S.C. 
2004a), or section 302 of the Indian Health Care Improvement 
Act (25 U.S.C. 1632).
    (b) Cooperative Agreements.--The [Director] Assistant 
Secretary is authorized, for purposes of carrying out the 
duties of the [Director] Assistant Secretary under this Act, to 
contract with or enter into such cooperative agreements with 
such other Federal agencies as is considered necessary to 
provide cost-sharing for closure and postclosure activities, to 
obtain necessary technical and financial assistance and 
expertise, and for such other purposes as the [Director] 
Assistant Secretary considers necessary.

SEC. 7. TRIBAL DEMONSTRATIONS PROJECT.

    (a) In General.--The [Director] Assistant Secretary may 
establish and carry out a program providing for demonstration 
projects involving open dumps on Indian land or Alaska Native 
land. It shall be the purpose of such projects to determine if 
there are unique cost factors involved in the cleanup and 
maintenance of open dumps on such land, and the extent to which 
advanced closure planning is necessary. Under the program, the 
[Director] Assistant Secretary is authorized to select no less 
than three Indian tribal governments or Alaska Native entities 
to a participate in such demonstration projects.
    (b) Criteria.--Criteria established by the [Director] 
Assistant Secretary for the selection and participation of an 
Indian tribal government or Alaska Native entity in the 
demonstration project shall provide that in order to be 
eligible to participate, an Indian tribal government or Alaska 
Native entity must-- * * *

           *       *       *       *       *       *       *


SEC. 8. AUTHORIZATION OF APPROPRIATIONS.

           *       *       *       *       *       *       *


    (b) Coordination.--The activities required to be performed 
by the [Director] Assistant Secretary under this Act shall be 
coordinated with activities related to solid waste and 
sanitation facilities funded pursuant to other authorizations.

SEC. 9. DISCLAIMERS.

    (a) Authority of [Director] Assistant Secretary.--Nothing 
in this Act shall be construed to alter, diminish, repeal, or 
supersede any authority conferred on the [Director] Assistant 
Secretary pursuant to section 302 of the Indian Health Care 
Improvement Act (25 U.S.C. 1632), and section 7 of the Act of 
August 5, 1954 (42 U.S.C. 2004a).

AUGUSTUS F. HAWKINS-ROBERT T. STAFFORD ELEMENTARY AND SECONDARY SCHOOL 
                     IMPROVEMENT AMENDMENTS OF 1988

                           PUBLIC LAW 100-297

  AN ACT To improve elementary and secondary education, and for other 
                                purposes

    Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled,

           *       *       *       *       *       *       *


SEC. 5504. ADMINISTRATIVE PROVISIONS. * * *

           *       *       *       *       *       *       *


    (d) Federal Agency Cooperation and Assistance.--* * *
          (2) The Commissioner of the Administration for Native 
        Americans of the Department of Health and Human 
        Services and the [Director of the Indian Health 
        Service] Assistant Secretary for Indian Health of the 
        Department of Health and Human Services are authorized 
        to detail personnel to the Task Force, upon request, to 
        enable the Task Force to carry out its functions under 
        this part. * * *

           *       *       *       *       *       *       *


               MICHIGAN INDIAN LAND CLAIMS SETTLEMENT ACT

                           PUBLIC LAW 105-143

 AN ACT To provide for the division, use, and distribution of judgment 
   funds of the Ottawa and Chippewa Indians of Michigan pursuant to 
   dockets numbered 18-E, 58, 364, and 18-R before the Indian Claims 
                               Commission

    Be it enacted by the Senate and House of Representatives of 
the United States of American in Congress assembled,

           *       *       *       *       *       *       *


SEC. 203. LIMITATION. * * *

           *       *       *       *       *       *       *


    (b) Consideration.--In any case in which the Secretary, 
acting through the [Director of the Indian Health Service] 
Assistant Secretary for Indian Health, is required to select 
from more than 1 application for a contract or compact 
described in subsection (a), in awarding the contract or 
compact, the Secretary shall take into consideration-- * * *

           *       *       *       *       *       *       *