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                                                       Calendar No. 375
109th Congress                                                   Report
                                 SENATE
 2d Session                                                     109-222

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



 
         INDIAN HEALTH CARE IMPROVEMENT ACT AMENDMENTS OF 2005

                                _______
                                

   March 16 (legislative day, March 15), 2006.--Ordered to be printed

                                _______
                                

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

                              R E P O R T

                         [To accompany S. 1057]

    The Senate Committee on Indian Affairs, to which was 
referred the bill (S. 1057), to amend the Indian Health Care 
Improvement Act to revise and extend that Act, having 
considered the same, reports favorably thereon with an 
amendment in the nature of a substitute and recommends that the 
bill, as amended, do pass.

                                Purpose

    The purpose of the Indian Health Care Improvement Act 
Amendments of 2005 (S. 1057) is to reauthorize the Act and 
improve the Indian health care delivery system. This 
legislation is intended to raise the health status of American 
Indians and Alaska Natives to the highest possible level in 
accordance with Healthy People 2010.\1\
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    \1\ Healthy People 2010 is the major health agenda for the Nation. 
``It is a statement of national health objectives designed to identify 
the most significant preventable threats to health and to establish 
national goals to reduce those threats.'' U.S. Department of Health and 
Human Services, www.healthypeople.gov (last reviewed November 8, 2005).
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    S. 1057 sets forth policies, programs and procedures 
designed to address health care deficiencies in native and 
urban Indian communities and streamline service delivery to 
those communities. In addition, S. 1057 addresses the health 
problems and associated socio-economic conditions in native 
communities by authorizing the Indian Health Service (IHS) and 
tribes to adopt current health industry ``best practices''.

                               Background

    Enacted in 1976, the Act established the first 
comprehensive framework for the delivery of health care 
services for native people, including various health programs, 
projects, and facilities. The Act was last reauthorized in 
1992.

                      The Reauthorization Process

    The work on the latest reauthorization began in 1999. Bills 
have been introduced since the 106th Congress \2\ to enact a 
series of improvements and updates to current law, most of 
which are contained in S. 1057.
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    \2\ S. 2526 (106th Congress), S. 212 (107th Congress), S. 556 
(108th Congress).
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                   NATIONAL STEERING COMMITTEE (NSC)

    In June, 1999, the Director of the IHS convened the NSC 
comprised of tribal leaders and representatives from Indian 
health organizations to facilitate the reauthorization. The NSC 
held a series of meetings in 1999 during which extensive 
discussions were held between the NSC and Department of Health 
and Human Services (DHHS) officials. The NSC also received 
technical assistance from the DHHS officials during these 
meetings.
    The NSC set out to craft a comprehensive legislative 
proposal that would reflect a consensus of the Indian tribes. 
With over 560 federally-recognized Indian tribes, each with 
unique histories, cultures, locations and needs, the NSC faced 
serious challenges. Despite the many differences, they 
coalesced around a draft document which formed the basis of the 
bills introduced, S. 2526 (106th Congress) and S. 212 (107th 
Congress). Neither bill was enacted, but S. 212 did receive 
significant attention from the Administration.
    By letter dated September 27, 2001, the Administration 
provided its views on S. 212 to the Committee. During 2002, 
tribal officials and Committee staff reconvened to address the 
Administration's concerns. The legislation was not passed by 
Congress that year, and S. 556 was introduced in the next 
Congress.
    During the 108th Congress, the Committee, the NSC and the 
Administration engaged in extensive negotiations over the 
reauthorization, but a final bill was not concluded before the 
108th Congress ended. Several recommendations developed during 
these negotiations were incorporated into S. 1057.

                 Overview of Indian Health Care History

    The history of the Federal responsibility for Indian health 
care is quite extensive and well-documented in numerous 
sources, including past Senate Reports on prior legislation. 
See e.g., Senate Report Nos. 94-133, 102-392 and 108-411. The 
underlying responsibility to provide health care did not 
originate with the Act; rather, the Act was passed after 
Congress recognized that a sea-change in administration was 
needed to ensure improvements were achieved in Indian health 
status and services.
    The administration of Indian health had initially been 
managed in a piecemeal approach, then ultimately coalesced 
within the IHS, an agency of the DHHS.\3\
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    \3\ The responsibility for Indian health first fell to the War 
Department in 1803, then to the Interior Department in 1849, before 
finally being transferred to the Department of Health, Education and 
Welfare (DHEW), the predecessor of the DHHS, in 1955. The Division of 
Indian Health within DHEW had initial responsibility for Indian health 
before eventually being renamed the Indian Health Service. See Task 
Force on Indian Health in the Final Report to the American Indian 
Policy Review Commission (Final Report) at 32.
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    Based on that history and in fulfillment of the special 
obligation to Indian people,\4\ Congress passed the Act to 
provide coordinated programs and meaningful direction in Indian 
health care administration.
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    \4\ Based on the U.S. Constitution, treaties, statutes and the 
historical, political and legal relationship with the Indian tribes, 
the United States has assumed responsibility for the provision of 
health care to Indian people. Those laws and relationships serve as the 
backdrop for the government-to-government relationship.
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                   THE PRE-IHCIA INDIAN HEALTH SYSTEM

    At the time of passage of the Act in 1976, the information 
on Indian health painted a stark portrait of existence in 
Indian communities. The Senate Report accompanying S. 522, the 
Indian Health Care Improvement Act, which was signed into law 
as Public Law No. 94-437, indicated that the ``vast majority of 
Indians still live in an environment characterized by 
inadequate and understaffed health facilities, improper or 
nonexistent waste disposal and water supply systems, and 
continuing dangers of deadly or disabling diseases.'' \5\
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    \5\ S. Rep. No. 94-133, at 36 (1976).
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    Health status. These conclusions were based upon the 
statistics at the time. For example, the ``incidence of 
tuberculosis for Indians and Alaska Natives [was] 7.3 times 
higher than the rate for all citizens of the United States. * * 
* [T]he suicide rate * * * [was] approximately twice as high as 
in the total U.S. population.'' \6\ Also troubling was the 
infant mortality rate for Indian babies which was significantly 
higher than the national average.\7\
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    \6\ Id.
    \7\ Id.
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    Health professionals. Compounding the low health status 
were the difficulties in recruiting and retaining qualified 
health professionals--Indian health professionals, in 
particular--to work in the Indian communities. The available 
information indicated that out of 500 doctors in the Indian 
Health Service, only 3 were Indian.\8\ Overall, ``in 1975, 
there were only 72 American Indian physicians.'' \9\ Likewise, 
only half of the number of pharmacists needed were employed in 
these Indian communities.\10\
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    \8\ Id., at 55.
    \9\ Headlands Indian Health Careers, Program History, available at 
http://www.headlands. ouhsc.edu/history.asp (Last reviewed December 14, 
2005).
    \10\ S. Rep. No. 94-133, at 42 (1976).
---------------------------------------------------------------------------
    Health facilities. The conditions and availability of 
health facilities did not fare any better. A significant number 
of the existing facilities were over twenty years old. Many 
others were ``old one-story, wooden buildings with inadequate 
electricity, ventilation, insulation and fire protection 
systems, and of such insufficient size as to jeopardize the 
health and safety of their occupants.'' \11\ The Joint 
Committee on Accreditation of Hospitals (JCAHO) found that 
``only 24 of the 51 existing IHS hospitals'' met accreditation 
standards and ``two-thirds [were] obsolete and that 22 need[ed] 
complete replacement.'' \12\
---------------------------------------------------------------------------
    \11\ S. Rep. No. 94-133, at 36-37 (1976).
    \12\ Id., at 37.
---------------------------------------------------------------------------
    Funding. The funding situation also revealed significant 
disparities. For example, ``[p]er capita expenditures for 
Indian health purposes [were] 25 percent below per capita 
expenditures for health care in the average American 
community.'' \13\
---------------------------------------------------------------------------
    \13\ Id.
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    Thus, the goals of the Act, by improving funding, direction 
in programs, and access to other programs such as Medicare and 
Medicaid, held great promise for the advancement of Indian 
health.

                      CURRENT INDIAN HEALTH SYSTEM

    Since 1976, significant improvements have been made in the 
programs and funding levels for Indian health through the Act 
and the amendments thereto. Yet, a comparison of historic 
statistics with current status indicators show that, while real 
progress has been made, significant disparities still persist.
    Indian health status. Indian mortality rates from 
tuberculosis were 400% greater than other U.S. populations.\14\ 
Despite a decrease of 64% over a period spanning 1972 to 1999, 
Indian infant mortality rates still remained 24% higher than 
other U.S. populations.\15\ Other Indian mortality rates far 
exceeded the mortality rates of other U.S. populations for 
causes including alcoholism (638%), diabetes mellitus (291%), 
unintentional injuries (215%), pneumonia and influenza (67%), 
gastrointestinal disease (38-40%) and heart disease (20%).
---------------------------------------------------------------------------
    \14\ U.S. Department of Health and Human Services, Indian Health 
Service, 2000-2001 Trends in Indian Health, at 7.
    \15\ U.S. Department of Health and Human Services, Indian Health 
Service, 2000-2001 Trends in Indian Health, at 49.
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    Even during the short period of 1997 to 2001, the overall 
``prevalence of diabetes increased by 33% in all major regions 
served by the Indian Health Service.'' The most alarming 
increase, however, occurred among the Indian youth ages 15-19, 
for whom diabetes increased by 106% from 1990-2002.\16\
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    \16\ U.S. Department of Health and Human Services, Indian Health 
Service, Fiscal Year 2006, Justification of Estimates for 
Appropriations Committees, at IHS-81.
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    Recent information on suicide indicates that these rates 
are also astonishing. In 2005, the Committee held two hearings 
on the issue of Indian youth suicide. A field hearing was held 
in Bismarck, N.D. on May 2, 2005, and an oversight hearing was 
held in Washington, D.C. on June 15, 2005.
    According to national data for 2002, suicide was the second 
leading cause of death for Indians of both sexes in the 15-34 
year age range, and the fourth leading cause of death for both 
sexes in the 10-14 year age range. On the reservations of the 
Northern Great Plains (States of North and South Dakota, Iowa, 
Minnesota and Nebraska), the rate of Indian youth suicide is up 
to 10 times higher than it is elsewhere in the country.
    Yet, in terms of services at several Indian health 
facilities, the demand for mental health care outstripped their 
capacity.\17\ In at least one facility, the mental health 
services would be cut by 20% in FY 2005 because funding had 
been depleted.\18\
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    \17\ United States Government Accountability Office, Report to the 
Committee on Indian Affairs, U.S. Senate, Indian Health Service: Health 
Care Services Are Not Always Available to Native Americans, GAO Report 
No. GAO-05-789, (August, 2005) at 18.
    \18\ GAO Report No. GAO-05-789, at 18.
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    Another alarming and growing problem arising in Indian 
communities is the use of methamphetamines. According to the 
National Survey on Drug Use and Health, the use rate during a 
2002-2004 survey period among Indians, aged 12 and older, is 
higher than nearly every other population.\19\
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    \19\ U.S. Department of Health and Human Services, Substance Abuse 
and Mental Health Services Administration, Office of Applied Studies, 
The NSDUH Report, September 16, 2005, http://oas.samhsa.gov/2k5/meth/
meth.htm, (Last reviewed on December 2, 2005).
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    Health facilities. According to the most recent data, 413 
facilities exist within the Indian health system with an 
average age of 30 years.\20\ Approximately 49 of those 
facilities are hospitals ranging in capacity from 4 to 156 
beds, but only 19 of the hospitals have operating rooms.\21\
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    \20\ U.S. Department of Health and Human Services, Indian Health 
Service, Fiscal Year 2006, Justification of Estimates for 
Appropriations Committees, at IHS-5.
    \21\ GAO Report No. GAO-05-789, at 9.
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    Besides hospitals, ``there were 231 health centers * * * 
offering primary care and some ancillary services such as 
pharmacy, laboratory and X-ray''.\22\ Also, the 133 health 
stations in the Indian health system provided primary 
services.\23\
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    \22\ Id.
    \23\ Id.
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    According to the IHS Health Facilities Construction 
Priority System, the estimated unfunded total cost to meet the 
need was nearly $1.5 billion as of FY 2005.\24\ In addition, 
the backlog for the maintenance and improvement needs of 
current facilities was estimated at $482,956,000.\25\ However, 
on the bright side, ``[f]ully 100 percent of IHS hospitals and 
health clinics met accreditation standards in FY 2004.'' \26\
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    \24\ U.S. Department of Health and Human Services, Indian Health 
Service, Health Care Facilities FY 2007 Planned Construction Budget 
(February 11, 2005).
    \25\ U.S. Department of Health and Human Services, Indian Health 
Service, Fiscal Year 2006, Justification of Estimates for 
Appropriations Committees, at IHF-4.
    \26\ Id., at IHS-5.
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    In addition, since the Indian Sanitation Facilities and 
Services Act, Public Law 86-121, codified at 42 U.S.C. 2004, 
was passed in 1959, ``over 265,000 Indian homes have been 
provided sanitation facilities'' which served to reduce ``[t]he 
gastroenteric and post-neonatal death rates among the Indian 
people * * * primarily because of the increased prevalence of 
safe drinking water supplies and sanitary waste disposal 
systems.'' \27\
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    \27\ U.S. Department of Health and Human Services, Indian Health 
Service. The Sanitation Facilities Construction Program of the Indian 
Health Service, Public Law 86-121, Annual Report for 2004, at 1.
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    The IHS noted that ``in 1955, more than 80% of American 
Indians and Alaska Natives were living in homes without 
essential sanitation facilities.'' \28\ The gastrointestinal 
death rate was ``15.4 per 100,000 population, * * * 4.3 times 
higher than that for all other races in the United States.'' 
\29\ But by 1995, that death rate was reduced to 1.7 per 
100,000, although it is still 38-40% higher than the rate for 
all races in the United States.\30\
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    \28\ Id., at 20.
    \29\ Id.
    \30\ Id.
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    In FY 2004, approximately $139 million was available for 
sanitation facilities construction, of which nearly $93 million 
came from Indian Health Service funds and more than $46.5 
million came from other Federal agencies and non-Federal 
sources.\31\ The Indian Health Service estimated that in FY 
2004 sanitation facilities were provided to a total of 24,928 
homes.\32\ However, the total estimated costs to address the 
sanitation deficiencies in existing homes was nearly $1.9 
billion, with nearly 150,000 Indian homes still needing 
sanitation facilities, 36,000 of which did not have potable 
water.\33\
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    \31\ U.S. Department of Health and Human Services, Indian Health 
Service. The sanitation Facilities Construction Program of the Indian 
Health Service, Public Law 86-121, Annual Report for 2004, at 5.
    \32\ Id.
    \33\ U.S. Department of Health and Human Services, Indian Health 
Service, Justification of Estimates for Appropriations Committees for 
Fiscal Year 2006, p. IHF-9 and U.S. Department of Health and Human 
Services, Indian Health Service, The Sanitation Facilities Construction 
Program of the Indian Health Service, Public Law 86-121, Annual Report 
for 2003.
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    Health professionals. The number of Indian health 
professionals has increased since the Act was signed into law. 
According to the latest Census information, there were over 
1,300 Indian physicians and surgeons and over 10,000 Indian 
registered nurses.\34\ These numbers suggest that the 
incentives in the Act have assisted in increasing these 
numbers.
---------------------------------------------------------------------------
    \34\ U.S. Census Bureau, American FactFinder, Census 2000 Summary 
File 4, Table PCT86. The numbers are for individuals reporting only the 
American Indian and Alaska Native race.
---------------------------------------------------------------------------
    However, vacancy rates for key health professionals 
indicate that a substantial need still exists for qualified 
health professionals in the Indian health system. The vacancy 
rates for health professions with the greatest shortfalls 
consist of Dentists (24%), Certified Registered Nurse 
Anesthetists (33%), Medical Imaging (including x-rays, 
ultrasounds, CT scans etc.) (20%), Nurses (14%) Pharmacists and 
Physicians (both 11%).\35\
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    \35\ Hearings on Interior, Environment and Related Agencies 
Appropriations for 2006 Before the U.S. House of Representatives, 
Committee on Appropriations, 109th Cong., 1st Sess., April 14, 2005, at 
278-279.
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    Types and level of services. The IHS and tribal and urban 
Indian health programs provide an array of basic medical, 
dental and vision services. For example, the personal health 
services including inpatient care, and routine and emergency 
ambulatory care; and medical support services including 
laboratory, pharmacy, nutrition, diagnostic imaging, medical 
records, physical therapy, etc.\36\
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    \36\ U.S. Department of Health and Human Services, Indian Health 
Service, Fiscal Year 2006, Justification of Estimates for 
Appropriations Committees, at IHS-3.
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    Even though basic services may be available, access to 
those services is not assured. In its study on the availability 
of health services to Indians, the Government Accountability 
Office (GAO) found that Indian patients often had to wait more 
than 30 days--in some cases 2 to 6 months--between setting the 
appointment for services and receiving the services, a time 
frame ``in excess of standards and goals identified in other 
federally operated health service delivery systems.'' \37\
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    \37\ GAO Report No. GAO-05-789, at 15.
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    Moreover, ``[t]he most frequent gaps were for services 
aimed at the diagnosis and treatment of medical conditions that 
caused discomfort, pain, or some degree of disability but that 
were not emergent or acutely urgent.'' \38\ For example, in 
some cases, adult Indian patients ``could wait as long as 120 
days to get approval for eyeglasses.'' \39\
---------------------------------------------------------------------------
    \38\ Id., at 19.
    \39\ Id.
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    According to one tribal official interviewed by the GAO, 
these situations create an environment in which Indian patients 
become demoralized and may wait until their condition becomes 
``an emergency that required a higher level of treatment.'' 
\40\ The GAO also noted that gaps in care were common.
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    \40\ Id., at 16.
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    The Committee is deeply concerned with the GAO's findings 
and its conclusions that the disturbing result of these gaps 
are ``diagnosis or treatment delays that exacerbate[ ] the 
severity of a patient's condition and create[ ] a need for more 
intensive treatment.'' \41\ The Committee is further concerned 
that these gaps are increasing health care costs and 
diminishing the potential for prevention efforts.
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    \41\ GAO Report No. GAO-05-789, at 21.
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    The Committee appreciates the Administration's efforts in 
promoting prevention as a key to reducing health care costs, 
but believes greater effort is needed to reduce gaps in health 
services to Indians. Improvements are needed in all areas of 
the Indian health care system to ameliorate problems and delays 
in service delivery. The improvements outlined in S. 1057 for 
programs and policies, the Bi-partisan Commission study on 
health service delivery, and other new provisions in S. 1057 
are designed to help address these problems.

                 The Indian Health Care Improvement Act

    In passing the Act, Congress set forth ambitious goals for 
improving the health of Indians, including encouraging their 
participation in ``the planning and management'' of health 
services. 25 U.S.C. 1601(b). The Act ``would provide the 
direction and financial resources to overcome the inadequacies 
in the existing Federal Indian health care program.'' Senate 
Report No. 94-133, at 13.
    These goals built upon the foundation laid in President 
Nixon's 1970 ``Special Message to the Congress on Indian 
Affairs''.\42\ In his Special Message, President Nixon declared 
that ``[t]he time ha[d] come to break decisively with the past 
and to create the conditions for a new era in which the Indian 
future is determined by Indians acts and Indian decisions.'' 
\43\
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    \42\ President's Special Message to Congress on Indian Affairs, 213 
Pub. Papers 564 (July 8, 1970).
    \43\ Id., at 565.
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    Breaking decisively with the past meant a radical change in 
health care delivery, beginning with the administration of the 
programs and policy-making. Placing administrative and 
decision-making authority in the hands of Indian tribes, rather 
than solely in the agency's hands, was a fundamental and 
logical approach in health care delivery. Such a modification 
took several years to overcome difficulties in achieving tribal 
participation in the administration of these programs.\44\
---------------------------------------------------------------------------
    \44\ See e.g., U.S. General Accounting Office, now, U.S. Government 
Accountability Office, Report to the Chairman, Select Committee on 
Indian Affairs, U.S. Senate, Indian Health Service, Contracting under 
the Indian Self-Determination Act, GAO Report No. GAO/HRD-86-99, 
September, 1986.
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    Today, nearly half of the IHS budget is administered 
through tribal contracts or compacts under the Indian Self-
Determination and Education Assistance Act of 1976 (ISDEAA), 
U.S.C. 450 et seq. This not only reflects Congressional policy 
of promoting tribal self-determination, but generates a higher 
level of cooperation between the Indian health providers.\45\
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    \45\ U.S. Department of Health and Human Services, Indian Health 
Service, Fiscal Year 2006, Justification of Estimates for 
Appropriations Committees.
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               GENERAL PRINCIPLES IN THE REAUTHORIZATION

    During the reauthorization process, a critical assessment 
of the Act was undertaken by the Committee and the Indian 
health community and several basic principles evolved. As a 
general matter, the history of Indian health and the interplay 
between the ISDEAA and the Act must be kept in mind when 
developing Indian health policy.
    Self-determination. Since self-determination was declared 
to be the new direction in Federal Indian policy, tribal 
participation has significantly contributed to improving 
services for Indian people.\46\ Meaningful participation by 
tribes in administering programs through contracting or 
compacting has been a principal means of implementing the self-
determination policy.
---------------------------------------------------------------------------
    \46\ See e.g., National Indian Health Board, Tribal Perspectives on 
Indian Self-Determination and Self-Governance in Health Care 
Management, 1998.
---------------------------------------------------------------------------
    However, simply administering a program designed and handed 
down by the agency does not accomplish the vision embodied in 
self-determination. Indian participation is critical in the 
development of the framework of these programs and services. 
Tribal self-determination involves tribes initiating programs, 
and the ideas, concepts and methodology of how those programs 
or services should be delivered to their own communities.
    Such involvement means appreciable engagement between the 
agency and Indian tribes. Numerous tools have successfully 
increased that involvement. For example, negotiated rulemaking 
has been found to be useful in several initiatives such as 
education, housing and self-governance.\47\
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    \47\ See e.g., No Child Left Behind Act, Pub. L. 107-110, 25 U.S.C. 
2001, et seq.; Native American Housing Assistance and Self-
Determination Act, Pub. L. 104-330, 25 U.S.C. 4116; Indian Self-
Determination and Education Assistance Act, Pub. L. 106-477, 25 U.S.C. 
458aa-16.
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    The Committee has received testimony from tribal 
participants in negotiated rulemaking that ``true understanding 
among Tribes and with IHS is achieved'' \48\ through that 
process. That true understanding is consistent with the 
Committee's desire to foster consensus-building and reduce 
obstacles that negatively impact service delivery.
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    \48\ The Indian Health Care Improvement Act Amendments of 2005: 
Hearings on S. 1057 Before the Senate Comm. on Indian Affairs and 
Senate Comm. on Health, Education, Labor and Pensions, 109th Cong., 1st 
Session, S. Hrg. 109-162 at 725 (July 14, 2005) (statement of Don 
Kashaveroff, President, Seldovia Village Tribe).
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    The Administration has expressed concerns about the time 
and resource constraints involved in negotiated rulemaking. The 
Committee strongly supports fiscal accountability, but believes 
that the long-term benefits of negotiated rulemaking exceed the 
short-term costs.
    The Committee believes that the Indian tribal and urban 
health providers--as first responders in the health system--
should be directly involved in developing health programs and 
the regulations that govern them. Tribal involvement in 
rulemaking not only leads to a more informed rule, but it 
fosters tribal support. Negotiated rulemaking can save costs to 
all parties in the long run. By building a higher level of 
consensus in the regulations, the IHS lowers the potential for 
legal challenges to the rules and associated litigation costs. 
The Committee favors consensus-building over litigation and 
encourages this long-term view.
    Besides negotiated rulemaking, the Committee has favored 
consultation with tribes as another tool to increase tribal 
participation, but has generally left the manner or method of 
consultation to the discretion of the Secretary.
    For example, the ISDEAA simply requires an annual 
consultation on the budget. However, the Secretary has in the 
past implemented a rigorous regional and national schedule for 
budget consultation.\49\
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    \49\ See e.g., http://www.hhs.gov/iga/tribal/
0506_budget_session_transcript.doc, (Last reviewed December 12, 2005), 
and http://www.hhs.gov/iga/tribal/9707.html, (Last reviewed December 9, 
2005), but see http://www.npaihb.org/legis/IHS%20Budget/
Budget_Intro_Page.htm, (Last reviewed December 9, 2005).
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    The Committee recognizes that the Administration has made 
efforts to involve Indian tribes in decision-making through the 
consultation policy issued by the DHHS.\50\ The Committee 
recognizes that the Department's policy has attempted to 
address a wide variety of matters affecting Indian communities. 
However, the Committee is concerned that the scope of the 
Department policy may not fully encompass all critical matters 
for which the Committee believes consultation should be used.
---------------------------------------------------------------------------
    \50\ U.S. Department of Health and Human Services, Department 
Tribal Consultation Policy, January, 2005, available at http://
www.hhs.gov/ofta/docs/FnlCnsltPlcywl.pdf. (Last reviewed December 15, 
2005).
---------------------------------------------------------------------------
    Such matters involve the development of program eligibility 
or criteria, or relate to specific tribes, Indian population 
groups (e.g., women) or to special tribal history, customs, or 
practices. Consequently, the Committee has provided for robust 
consultation in several key areas, leaving the manner of 
consultation to Secretarial discretion, and it remains 
committed to promoting tribal input by institutionalizing 
consultation.
    Flexibility. In addition, the Committee believes that less 
bureaucracy and more flexibility are needed to tailor programs 
or services to address local community health needs.\51\ The 
Committee is pleased that the Administration has joined in 
supporting flexibility, new approaches to health care, and 
expanding the range of options of health services.\52\
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    \51\ Flexibility also eliminates the need to identify each and 
every program that may be administered by IHS, the tribal or urban 
programs (e.g., the definition of ``health professions'' does not 
identify every profession that may be authorized). Many of the 
decisions or priorities are left to the Indian health providers to 
determine to implement as needed. The Committee is aware that the IHS, 
Indian tribes and urban programs engage in extensive budget 
consultations involving which programs and professions to implement, 
sometimes two years in advance of implementation.
    \52\ S. Hrg. 109-162 at 589 (statement of Dr. Grim, Director, U.S. 
Department of Health and Human Services, Indian Health Service).
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    However, in the course of negotiating this legislation, the 
Administration has indicated its preference to change mandatory 
programs to discretionary ones to meet budgetary constraints 
and to give the Secretary maximum flexibility.\53\ The 
Committee has accommodated these principles based on the 
understanding that Indian tribes would also be accorded the 
same flexibility under the Act and the ISDEAA.
---------------------------------------------------------------------------
    \53\ Id., at 596.
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    The Committee understands that, in the past, the Indian 
tribes had been foreclosed from implementing programs that the 
agency did not actually implement either under the Act or the 
Snyder Act, 25 U.S.C. 13. Simple program authorizations under 
the Act and the Snyder Act were deemed insufficient to allow 
the Indian tribes to administer the programs even under the 
redesign provisions of the ISDEAA.
    It is the Committee's intent, however, that simple 
authorizations are sufficient to enable tribes to implement 
programs, even if the Federal agency chooses not to, provided 
all other applicable provisions of the Act, the Snyder Act and 
the ISDEAA are met. The Committee believes that this 
interpretation is necessary to enable Indian tribes to meet the 
needs of their communities and required if the Secretary is to 
experience the flexibility desired.
    In the past, the Committee has been apprehensive about 
eliminating certain mandates such as those requiring studies. 
In reviewing the studies conducted and annual reporting 
information, it appears that quite a few studies mandated by 
the Act were not completed. These studies were intended to 
provide insight into the accomplishments and challenges in 
Indian health and assist the Committee in seeking new 
approaches to service delivery. The Committee is troubled that 
the health status of Indians reflects many of the same problems 
it did in 1976 and that several mandates in current law have 
been disregarded.
    Consequently, the Committee has included in S. 1057, a Bi-
partisan Commission to thoroughly review opportunities for 
improvement. During the 108th Congress, the bill to reauthorize 
the Act, S. 556, contained provisions wherein the Bi-partisan 
Commission would study the potential of funding Indian health 
as an entitlement. Based on the Administration's 
recommendations offered during the 108th Congress, the 
Committee modified the Commission's objectives in S. 1057.
    In addition, the Committee has included the Native American 
Health and Wellness Foundation provisions to promote the 
mission of IHS in improving Indian health. This Foundation is 
not a substitute for the federal obligation to Indian health, 
but is intended to complement the federal obligation in ways in 
which the United States has fallen short.
    Oversight and Reporting. While much discretion and 
flexibility is provided, the Committee must preserve the 
necessary mechanisms to fulfill its oversight function. The 
primary means is through active reporting requirements by the 
Secretary. Congress simply cannot leave unfettered the 
operations of these important programs without appropriate 
assurances that Indian people are being served consistent with 
Congressional intent and priorities. Moreover, Congress should 
be informed of how and when these programs meet--or fall short 
of meeting--the basic health needs of Indian people.

                             KEY PROVISIONS

    Several key improvements and provisions of S. 1057 are 
particularly noteworthy:
    Non-Eligibles. Congress has recognized that ``without a 
proper health status, the Indian people will be unable to fully 
avail themselves of the many economic, educational, and social 
programs already directed to them. * * *'' Senate Report No. 
94-133, at 23. Providing services to Indian people improves the 
health of Indians in a direct manner.
    However, protecting the health of Indians requires 
attention to issues other than direct services to Indians. In 
the 1800s, services such as vaccinations were provided to 
Indians located near forts to protect the health of 
soldiers.\54\ Now the tables are turned. Individuals not 
otherwise eligible for Indian health care may receive a limited 
scope of health services under the Act to protect the health of 
Indians.
---------------------------------------------------------------------------
    \54\ See American Indian Policy Review Commission, Task Force Six, 
Final Report to the Commission, Vol. 6.
---------------------------------------------------------------------------
    Serving non-eligibles for these purposes comports with the 
Administration's goals of promoting healthy ``Indian * * * 
communities'' and ``including new approaches to delivering 
care''.\55\ Serving non-eligibles has been a policy of the Act 
for many years and it reflects a logical and reasonable 
approach to protect Indian health.
---------------------------------------------------------------------------
    \55\ S. Hrg 109-162, at 589 (statement of Dr. Grim, Director, U.S. 
Department of Health and Human Services, Indian Health Service).
---------------------------------------------------------------------------
    For example, the Act provides that services may be provided 
to a non-eligible pregnant woman carrying an Indian's child. 25 
U.S.C. 1680c(c)(3) (Section 807(d)(3) of S. 1057). In addition, 
services may be provided to prevent the outbreak of 
communicable diseases such as tuberculosis. 25 U.S.C. 
1680c(c)(2) (Section 807(d)(2) of S. 1057).
    In including these ``non-eligible individuals'' in the 
service delivery, Congress has set forth considerations for the 
IHS and Indian tribes to address prior to providing the 
services--the ``two-part determination''. This two-part 
determination consists of determining 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. 25 U.S.C. 1680c(b)(1)(A).
    However, the Committee is aware that questions have arisen 
regarding how the two-part determination applies to Indian 
tribes with contracts or compacts under ISDEAA.
    Where services are directly provided by the IHS (direct 
services), the Indian tribe(s) served by the Service Unit and 
the IHS jointly make the two-part determination. 25 U.S.C. 
1680c(b)(1)(A). Section 807 of S. 1057 provides that, for 
programs administered by an Indian tribe pursuant to a contract 
or compact under the ISDEAA, the Indian tribe is authorized to 
provide services to non-eligibles, but ``shall take into 
account'' the two-part determination.
    Congress has made it clear that the determination shall be 
made in both instances: in the case of direct services it is 
made by both IHS and the Indian tribes and, in the case of 
ISDEAA contracts or compacts, by Indian tribes. Congress did 
not provide in the Act express substantive or procedural 
provisions governing how the determinations should be made, 
given the innumerable variances in circumstances for the Indian 
communities.
    However, Section 807 does provide some guidance on how the 
parties may determine whether there will be no diminution of 
services. For example, the non-eligibles receiving services 
``shall be liable for payment of such health services under a 
schedule of charges prescribed by the Secretary. * * *'' 25 
U.S.C. 1680c(b)(2)(A).
    In addition, health services may be provided to indigent 
non-eligibles if there is a reimbursement agreement with the 
State or local governments. These provisions, however, do not 
limit the ability of either the IHS or Indian tribes to include 
additional considerations in determining whether services would 
be decreased. Other budgetary factors, delays in services, 
appointment waiting times,\56\ etc. are all other 
considerations that may be appropriate, depending on the 
particular circumstances.
---------------------------------------------------------------------------
    \56\ See GAO Report No. GAO-05-789.
---------------------------------------------------------------------------
    Likewise, when assessing reasonable alternatives, the IHS 
and Indian tribes may be confronted by factors such as remote 
locations, distances to other health facilities and other 
unique difficulties, which render other health care 
alternatives unavailable. Questions surrounding what is 
available should be placed in the context of the following 
policy considerations. First, services under this Act are for 
the ultimate protection of Indian health. Second, the IHS and 
tribal health programs are the payors of last resort which 
means, in this situation, that all other avenues of obtaining 
health services should be exhausted prior to seeking assistance 
from either IHS or the tribal health programs.
    The Committee has been informed that some health providers 
may refuse to serve Medicaid beneficiaries, thus making any 
other health service alternative unavailable. If all entities 
have made good faith efforts to obtain services and all avenues 
have been exhausted, it appears that there may be an arguable 
case of unavailability.
    When making these determinations, Indian tribal leaders are 
placed in a difficult situation. On the one hand, the federal 
obligation for Indian health--which the Indian tribe is 
administering--is secured for the benefit of Indians. It may 
also be politically disastrous for tribal leaders to authorize 
services for non-eligibles, so the determinations are not made 
lightly by Indian tribal leaders. On the other hand, 
withholding services from these non-eligibles under the limited 
circumstances enumerated in this Act may serve to do harm to 
Indian people by not eliminating general health hazards.
    Evaluations were left in S. 1057 to the IHS and Indian 
tribes based on their individual circumstances and, if 
appropriate, could be developed more fully through negotiated 
rule-making or consultation.
    Third Party Reimbursements. Funding from sources other than 
IHS was identified as a factor which affected the availability 
of health care services for Indians.\57\ Those funding sources 
include third-party reimbursements from Medicaid and Medicare. 
In some cases, these reimbursements constitute up to 50% of the 
medical care budget for a particular Indian health program.\58\
---------------------------------------------------------------------------
    \57\ GAO Report No. GAO-05-789, at 4.
    \58\ Id., at 5.
---------------------------------------------------------------------------
    With more resources, the Indian health care system could 
provide more services and the Committee strongly encourages IHS 
and the Indian tribes to seek additional resources to 
supplement the appropriated sums provided annually.\59\ The GAO 
noted that ``[f]acilities with higher reimbursements had 
additional funds with which they could hire staff, purchase 
equipment and supplies, and renovate their buildings.'' \60\ In 
one case, 31 percent of a facility's clinical providers and 
other staff was funded by third party reimbursements.\61\
---------------------------------------------------------------------------
    \59\ S. 1057 adds amendments to the ISDEAA which authorize the 
Native American Health and Wellness Foundation to promote the mission 
of IHS through such means as receiving donations which supplement, not 
offset, appropriations. Offsetting in Indian health care programs is 
generally prohibited by law. See 25 USC Sec. 1641(a).
    \60\ GAO Report No. GAO-05-789, at 26.
    \61\ Id.
---------------------------------------------------------------------------
    S. 1057 provides for an increase in access to Medicaid by 
removing barriers through waivers of premiums and cost-sharing 
at Indian health facilities and by codifying agency regulations 
or practices which recognize the unique nature of and special 
circumstances applying to Indian property, particularly trust 
and restricted property.\62\ Likewise, S. 1057 provides other 
means of removing barriers to obtaining third-party 
reimbursements, such as the process for seeking waivers of 
sanctions, which promotes favorable state-tribal relations.
---------------------------------------------------------------------------
    \62\ As a general rule, these special types of property are not 
included in eligibility calculations for income taxes or federal 
benefits.
---------------------------------------------------------------------------
    Health Professions. Difficulties in recruiting and 
retaining qualified health professionals have long been 
recognized as a significant factor impairing Indians' access to 
health care services.\63\ Noting that many Indian communities 
are often in remote locations and lack adequate housing and 
educational and recreational opportunities for employees and 
their families,\64\ the GAO reported that some critical 
positions such as for pharmacists and dentists remained vacant 
for several years in some locations.\65\
---------------------------------------------------------------------------
    \63\ See also GAO Report No. GAO-05-789, at 4.
    \64\ Id.
    \65\ Id.
---------------------------------------------------------------------------
    The provisions in Title I address the health professional 
shortage in Indian communities. Congress specifically included 
these provisions in 1976 because the existing programs to 
improve manpower capabilities were woefully inadequate or 
completely unsuitable for Indian health providers and 
communities.\66\
---------------------------------------------------------------------------
    \66\ Senate Report No. 94-133, at 55-57.
---------------------------------------------------------------------------
    The programs existing in 1976 did ``not link the recipients 
[of scholarships] directly to the Indian Health Service,'' were 
``not designed to recruit and support Indians,'' and were too 
limited in the ``category of health professionals'' supported 
by these programs.\67\
---------------------------------------------------------------------------
    \67\ Id., at 55-56.
---------------------------------------------------------------------------
    Consequently, Congress developed a new approach and the IHS 
scholarship program was born. Fears of duplication were quickly 
disproven by the obvious need for and success of these programs 
in filling vacancies and returning Indian health professionals 
to the Indian communities. Today, the program has expanded to 
include a wide variety of health professions as determined by 
the priorities set by the IHS and the Indian tribes. The 
program also now includes, besides the scholarships, loan 
repayments, a tribal scholarship program, and bonus incentive 
payments.
    These programs specifically target the needs of the Indian 
health system. For example, the scholarship priorities are 
developed through a year-long consultation process wherein the 
IHS sends the program information and request for priority to 
each tribal leader and the tribal education and health 
programs. The comprehensive list is developed based on the IHS 
and tribal health professional projected needs, vacancies and 
available positions. By focusing on the specific needs of 
Indian communities, the Committee believes that this approach 
has significantly improved Indian health.
    Just as targeting the specific needs of the Indian health 
system became the hallmark of the health professional policy, a 
holistic approach also became a key policy component in 
increasing the number of Indian health professionals. The 
Committee strongly encourages the Secretary to evaluate all 
opportunities to improve the chances of success for Indian 
health professionals, including obtaining the licenses or 
certifications necessary for providing health care services. 
The Committee has been made aware of the need to increase the 
number of licensed health professionals in the Indian health 
system and included provisions in S. 1057 to address that need. 
S. 1057 provides for portability of current licenses for tribal 
health professionals consistent with other Federal health 
licensing provisions. In addition, S. 1057 authorizes programs 
to enhance and facilitate enrollment in and completion of 
courses of study in health professions.
    The Committee believes that the Title I programs should 
fully equip the individuals with the tools needed to transition 
into the health profession, including successfully completing 
all courses of study and passing the required licensing or 
board examinations. In addition, the Committee expects that the 
IHS would also ensure that scholarship recipients are provided 
every opportunity to fulfill their service obligations, 
including technical assistance in understanding their 
obligations.
    The remedial programs, scholarships, grants, externships, 
service obligations and advanced training established in Title 
I are all designed to provide seamless opportunities for 
successfully transitioning Indians into health professions. As 
part of the long-term view of Indian health professions, the 
Committee believes continuity is appropriate in administering 
the Title I programs.
    The incentives fostered by scholarships, loan repayments, 
and bonuses are multiplied when combined with professional 
development programs for health professionals which the 
Committee believes to be essential components of recruitment 
and retention programs in the Indian health system. S. 1057 
establishes several professional development programs in Title 
I such as opportunities for advanced training and research, 
tribal cultural orientation, training in the administration and 
planning of tribal health programs and tribal demonstration 
projects for innovative recruitment, placement and retention 
programs, which may include professional development programs.
    Such additional training for health professionals is 
particularly important in developing leadership and 
collaboration skills and ensuring that a culturally-competent 
workforce exists within the Indian health system. The Committee 
strongly encourages the Secretary and tribal and urban Indian 
health providers to develop innovative programs or take 
advantage of existing models for such professional development 
to increase and maintain the number of Indian health 
professionals in the Indian health system.
    In addition, the Committee took a long-term view of health 
professions in S. 1057. The most dire placement needs are in 
the direct care positions, such as doctors, nurses, and 
pharmacists. In the long-term, Indian health professionals are 
also needed in educational positions to bolster recruitment and 
improve the new Indian health professionals' chances of 
success.
    The Committee has been informed that an appreciable need 
exists at the tribal colleges and universities to increase the 
number of Indian instructors in the nursing programs.\68\ The 
Committee recognizes that Indian instructors often have 
personal knowledge of the health disparities in Indian 
communities and a deep commitment to serve these communities 
for the long-term. Indian educators increase the likelihood of 
success for Indian students and bring to the classroom the 
unique cultural competence required in the Indian health field.
---------------------------------------------------------------------------
    \68\ Joseph F. McDonald, Ed.D., President, Salish-Kootnai College, 
Letter to Chairman John McCain, U.S. Senate Committee on Indian 
Affairs, September 22, 2005.
---------------------------------------------------------------------------
    With that in mind, the Committee included provisions in 
Title I of S. 1057 wherein a scholarship recipient may fulfill 
his or her service obligation (required in exchange for the 
scholarship) by teaching in a tribal college or university 
nursing or other health related program, provided the Secretary 
determines that the health services to Indians will not be 
decreased. In addition, the Secretary may, prior to waiving any 
service obligation or repayment of a scholarship, consider 
placement of a scholarship recipient in a teaching capacity in 
a tribal college or university nursing or related health 
program. Other provisions for nursing grants were added to 
extend a preference in grant awards to tribal college and 
university nursing programs.
    Prior to including these provisions, the Committee 
considered the likelihood that inexperienced, new graduates 
might be placed in teaching positions. One tribal college 
President indicated that ``these are clinically seasoned, 
mature [Bachelor of Science-Nursing] prepared nurses returning 
to school for educational and career mobility.'' \69\ Teaching 
positions available for these individuals would include lab 
coordinators and clinical instructors. This tribal college 
President also indicated that ``new [Registered Nurse] 
graduates of associate or generic baccalaureate programs would 
not be qualified to teach. * * *'' \70\
---------------------------------------------------------------------------
    \69\ Joseph F. McDonald, Ed.D., President, Salish-Kootenai College, 
Letter to Honorable Don Young, U.S. House of Representatives, November 
1, 2005.
    \70\ Id.
---------------------------------------------------------------------------
    The Committee believes these positions should be filledby 
experienced faculty and expects that the Secretary and the tribal 
colleges or universities would be selective in placing these 
individuals to avoid compromising the quality of education and 
accreditation.
    The Committee strongly encourages the Secretary to examine 
the Title I programs with targeted, holistic, long-term 
approaches in mind and to develop more opportunities to 
increase the number of Indians in the health professions. The 
Committee believes that in the long-run, improving health 
educational opportunities at every level will also contribute 
to improving the health of Indian communities.
    Home Health Care. Current law authorized a feasibility 
study to be conducted on hospice care services. However, the 
IHS never conducted that study and now, thirteen years later, 
to conduct such a study would greatly delay what have already 
been demonstrated to be much needed services.
    The Committee has been informed that some Indian tribes and 
tribal organizations, through pilot projects, have provided 
this type of service or other services such as home-health care 
with great success. The Committee is concerned that not 
authorizing through the Indian health care system these 
services and other long-term or home health care services that 
have been an accepted part of the national health care system 
and Medicare since 1983 will prevent IHS and tribes from 
utilizing a proven, effective health delivery vehicle.
    Currently, home health care, long-term care and hospice 
care are not readily available to most Native communities. 
Indians must travel long distances only to be placed in 
facilities that are far from home, culturally unfamiliar, and 
not conducive to their well-being. Having culturally-
appropriate facilities close to Indian communities will not 
only promote the patient's well-being, but will enable family 
members to more easily visit the patient.
    Section 213 of S. 1057 authorizes the Secretary to fund 
other services which meet the policy objectives set forth in 
section 3 of the legislation. A partial list of such other 
services includes hospice care, assisted living, long-term 
health care, home- and community-based services, public health 
functions, and traditional health care practices.
    Concerns have been raised regarding the economic 
feasibility of facilities providing these types of services, if 
access is limited to just Indians. Therefore, subject to the 
``two-part determination'' under Section 807 of the bill, the 
IHS, Indian tribes, or tribal organizations may provide the 
types of care authorized in Section 213 to persons otherwise 
ineligible for the health care benefits of the IHS, provided 
that such persons furnish reimbursement of reasonable charges 
for such services. The inclusion of these individuals may be 
necessary in some circumstances to achieve the minimum patient 
base needed to make the venture economically feasible and to 
realize the cost efficiencies of providing these services.
    With regard to the services authorized by Section 213, the 
Department of Justice informally expressed concerns with a 
subset of the home- and community-based services, specifically 
``chore services''. These concerns primarily focus on potential 
liability for the Federal government that may arise under the 
Federal Tort Claims Act from: (1) services provided in a 
setting other than an IHS or tribal facility that are not 
directly associated with the medical condition being treated, 
(2) whether the providers will be adequately trained, and (3) 
family members' support being included as a standard service.
    To address these concerns the Committee struck the words 
``homemaker'' and ``chore services'' from the definitions in 
the substitute amendment adopted in Committee. The substitute 
amendment further clarified the ``Personal care services'' 
definition to specify that ancillary tasks, when performed, 
must be associated with support services related to activities 
of daily living. Last, the substitute amendment makes clear 
that home- and community-based services do not include services 
provided by an individual who is legally responsible for the 
provision of such services, such as a family member or legal 
guardian.
    Traditional Health Care. The 1928 Merriam Report \71\ 
generated several initiatives to improve health conditions for 
Native Americans. One reform was the active solicitation of 
traditional Indian healers to participate in federal health 
services to Indians--an abrupt change from the prior 
assimilationist policies promoted by the Federal Government.
---------------------------------------------------------------------------
    \71\ Merriam, Lewis (ed.), Institute for Government Research, The 
Problem of Indian Administration (1928) (commonly referred to as the 
``Merriam Report'').
---------------------------------------------------------------------------
    Several provisions in the Act reflected those reforms as 
well.\72\ In particular, the Community Health Representatives 
in the Act were required to ``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.'' 25 U.S.C. 1616(b)(6).
---------------------------------------------------------------------------
    \72\ Other federal agencies also appear to be consider the value of 
traditional healing in assisting Indian people recover from various 
maladies such as post-traumatic stress disorders. See e.g., 
www.helenair.com/articles/2005/11/30/montana/a06113005_01.txt, (Last 
reviewed November 30, 2005).
---------------------------------------------------------------------------
    The Committee is aware that Indian tribes have long sought 
to promote traditional healing in the framework of the Indian 
health system, but that concerns have been raised regarding 
inclusion of traditional healing in the IHCIA.
    One concern involves the possible legal liability to the 
Federal Government in connection with the traditional 
practices. Under the ISDEAA, Federal Tort Claim Act (FTCA) 
coverage applies when Indian tribes or tribal organizations 
administer programs or services pursuant to a contract or 
compact. If traditional health practices were services provided 
under an ISDEAA contract or compact, such practices would be 
covered by the FTCA.
    Other concerns have been raised regarding whether the 
Federal Government or courts should be scrutinizing tribal 
traditions in the defense against claims arising under the 
FTCA. To address these concerns, the Committee encourages the 
Secretary and Indian tribes to thoroughly examine the 
traditional healing provisions through the implementation plan 
under Section 803 of S. 1057, or through consultation, 
particularly on how the traditional practices and healers fit 
within the FTCA framework.
    Behavioral Health. S. 1057 has a strong focus on behavioral 
health. Title VII takes a comprehensive and integrative 
approach to behavioral health, providing both prevention and 
treatment programs for Indian children, youth, women and 
elders. The bill also emphasizes the interconnectedness of 
services related to alcohol and substance abuse, child welfare, 
suicide prevention and social services. Particular programs are 
authorized for Indian youth, Indian women, those affected by 
fetal alcohol disorder in Indian communities, and both the 
victims and perpetrators of child sexual abuse in Indian 
households.
    In addition to a comprehensive approach to addressing 
behavioral health services, the Committee recognizes and 
affirms the importance of providing care within the context of 
an individual's family, community and particular tribal 
culture, such as is used by the systems of care model.
    Indian Youth Suicide Prevention. The alarming suicide rates 
among Indian youth indicate a great need for improved, 
comprehensive behavioral health care services.
    The nation was shocked in March, 2005, when a troubled 16-
year old member of the Red Lake Band of Chippewa Indians in 
Minnesota shot and killed his grandfather, his grandfather's 
partner, five fellow high school students, a high school 
teacher and a security guard and seriously wounded several 
others at Red Lake High School on the reservation before 
killing himself. Several other young people subsequently took 
their own lives.
    The publicity around the nation's second-most deadly school 
shooting on the Red Lake reservation brought attention to the 
fact that in Indian Country, suicide is characterized by higher 
rates among a younger group than is experienced in the rest of 
the country. The suicide rate for Indian and Alaska Native 
youth, aged 15-24, is two and one-half times higher than the 
national average. Youth suicide ``clusters'' have also occurred 
on reservations in North and South Dakota, New Mexico and 
Arizona and in Nativecommunities in Alaska.
    In response to this tragedy, a number of resources were 
provided to the Red Lake reservation, including services by 
such Federal agencies as the IHS, SAMHSA and Office of Juvenile 
Justice and Delinquency Prevention, as well as by state and 
tribal agencies.
    The Committee held two hearings specifically on the issue 
of Indian youth suicide, one in Bismarck, North Dakota on May 
2, 2005, and the other in Washington, DC, on June 15, 2005, to 
discuss the kinds of resources and services being provided to 
Indian youth who have expressed suicidal thoughts or attempted 
suicide, and to explore what more might be done.
    Based on the information developed through hearings, the 
Committee added provisions to Title VII of S. 1057 which 
address youth suicide as part of the behavioral health program 
provisions. Other provisions added in Title I encourage more 
Indian people to enter into the psychology profession by 
increasing the number of grants for the program commonly 
referred to as In-Psych (Indians into the Psychology) from 3 to 
9 and by authorizing a specific level of funding.
    The provisions also add a significant cultural component to 
the suicide programs. They authorize the Secretary to award 
grants for telemental health demonstration projects to provide 
counseling to Indian youth and health providers, training for 
Indian community leaders, and the development of culturally-
relevant materials.
    The Committee is aware that suicide prevention for Indian 
youth is a long-term effort that must address many multi-
factorial causes. Questions such as whether the loss of 
cultural identity contributes to the youth suicide problem 
remain unanswered. Consequently, S. 1057 makes suicide a 
priority for the IHS research agenda, particularly the 
identification of various factors that either protect the 
tribal community or make that community at risk for suicides, 
and the role the loss of tribal identity plays in suicidal 
behavior.
    Urban Indians. Providing for urban Indian health has been a 
part of Federal policy for nearly 40 years. Congress began 
funding urban Indian clinics in 1967 when $321,000 was provided 
for an Indian clinic in Rapid City, South Dakota.\73\
---------------------------------------------------------------------------
    \73\ Senate Report No. 94-133, pg 136. In 1972, Congress added 
funding to the IHS appropriations for a pilot program in Minneapolis. 
Others followed in 1973 in Oklahoma City, Seattle and California (which 
covered nine urban Indian organizations).
---------------------------------------------------------------------------
    Congress specifically included urban Indian health programs 
as part of the Indian health care system in the Act in 1976, 
recognizing that the Federal obligation for health care 
extended to these individuals, to correct disparities in health 
levels for Indians living in urban areas first as pilot 
programs and then permanently in the Indian health care system. 
See Senate Report Nos. 94-133, 100-508 and 108-411.
    The policies and status of Indians and Indian tribes under 
Federal laws, treaties and judicial decisions provide ample 
support for continuing and improving programs for urban 
Indians. Under this varied history, the Federal government had 
dealt with Indian tribes in a variety of ways: some by treaty, 
others not by treaty. For some Indian tribes, the Federal 
Government had ignored completely. Some Indian tribes were 
legislatively blocked from some administrative programs, yet 
were allowed to exercise treaty rights. Some Indian tribes were 
``terminated'', yet later ``restored''.
    Courts have long held with great favor that Congress has 
the broad power to legislate for the benefit of Indians, even 
if located off the reservation, and to define who is an Indian, 
even if they may not be an enrolled member of a federally-
recognized Indian tribe, and for what purposes they may be 
provided services.\74\
---------------------------------------------------------------------------
    \74\ U.S. Const., Art. I Sec. 8, cl. 3. See also Cohen, Felix. 
Handbook of Federal Indian Law, at 23. 1982 ed.; U.S. v. Holliday, 70 
U.S. 407, 417 (1865) (the broad power also includes Congress' dealings 
with individual Indians). As the courts suggest, federal policy for 
Indians cannot be confined to reservation boundaries. (``The overriding 
duty of our Federal Government to deal fairly with Indians wherever 
located has been recognized by this Court on many occasions.'' Morton 
v. Ruiz, 415 U.S. 199 (1974) (citing Seminole Nation v. U.S., 316 U.S. 
286, 296 (1942); (``Patterns of cross or circular migration on and off 
the reservations make it misleading to suggest that reservations and 
urban Indians are two well-defined groups.'' U.S. v. Raszkiewicz, 169 
F.3d 459, 465 (7th Cir. 1999).
---------------------------------------------------------------------------
    For example, Congress has enacted laws which define Indians 
in different ways for different purposes. See e.g., Indian Arts 
and Crafts Act, Pub.L. 101-644, 25 USC 305; No Child Left 
Behind Act, Pub.L. 107-110, 25 USC 7491; and the American 
Indian Probate Reform Act of 2004, Pub.L. 108-374. Even the 
criminal statutes under Title 18 of the U.S. Code regarding 
crimes on Indian reservations do not define who is an Indian.
    In other cases, Congress did not define Indians, nor place 
geographical limitations on the service areas in which they may 
be served. The Snyder Act, 25 USC 13, authorizes permanent 
funding for health care for ``the Indians throughout the United 
States''. This statute does not confine the services to Indians 
who are members of current Federally-recognized tribes or to 
those living only on reservations. The Snyder Act has never 
been repealed nor otherwise limited in this respect.
    Under this Act, Congress has provided a more inclusive 
definition of urban Indian than mere membership in a federally-
recognized Indian tribe, including members of ``terminated'' 
tribes, that is, groups that once had a political government 
relationship with the United States.
    Termination was another failed Federal Indian policy 
designed to end the government-to-government relationship with 
Indian tribes and assimilate their members into the larger 
society. However in remedying the devastating effect of 
termination, Congress saw fit to continue the health services 
in the Act to those individuals. See Menominee Tribe v. U.S., 
391 U.S. 404 (1968). Likewise, by including members of state-
recognized tribes, Congress recognized that several Indian 
tribes had treaty relations with individual states before the 
Federal government was established, often referred to as 
``state-recognized tribes''.
    Congress did not in this Act recognize either the 
``terminated tribes'' or the state-recognized tribes on the 
same basis or for the same purposes as the federally-recognized 
tribes under this Act. However, the U.S. Supreme Court has 
found that extending Federal protection for limited purposes, 
such as in this Act, is within Congressional power.
    Further, in adopting S. 1057, the Committee is of the 
opinion that the Congress was on firm constitutional footing 
based on long-standing precedent. Indeed, the U.S. Supreme 
Court has held that ``it is not meant * * * that Congress may 
bring a community or body of people within the range of this 
power by arbitrarily calling them an Indian tribe, but only 
that in respect of distinctly Indian communities the questions, 
whether, to what extent and for what time they shall be 
recognized and dealt with as dependent tribes requiring the 
guardianship and protection of the United States are to be 
determined by Congress, and not by the courts.'' U.S. v. 
Sandoval, 231 U.S. 28, 46 (1913) (emphasis added). Accordingly, 
the Act extends health benefits to members of these groups 
(terminated tribes and state-recognized tribes) without 
extending Federal recognition to them for all purposes.
    In enacting this Act, the Committee has found ample 
justification for extending health services to the Indians who 
ended up in these urban areas because of several major 
developments:

          First, Indians were provided an opportunity to work 
        and share in the Nation's prosperity in industries 
        prior to and during World War II; second, thousands of 
        Indian men and women served in the Armed Forces away 
        from their reservation, traditional communities or 
        Alaska Native villages; third, formal government 
        relocation programs moved many Indian families from low 
        employment, rural areas to urban areas where 
        ``employment opportunities'' were considered more 
        readily available; and fourth, countless numbers of 
        Indians attempting to escape depressed conditions on 
        their reservations voluntarily relocated.\75\
---------------------------------------------------------------------------
    \75\ Senate Report 94-133, page 131.
---------------------------------------------------------------------------
      

    The comprehensive approach of this Act is needed to more 
fully implement the federal responsibility for Indian health 
care and, even more so today, to address health disparities 
facing the Indians that had moved from the reservations as a 
result of the relocation policies. Relocating Indians from 
reservations to urban areas is the Federal policy and program 
first begun in 1931.\76\ ``Relocation complemented other 
termination programs designed to promote rapid assimilation. 
Once relocated, Indians were cut off from the special federal 
services that had been available to them as reservation 
residents.'' \77\
---------------------------------------------------------------------------
    \76\ Felix Cohen, Handbook of Federal Indian Law (1982 ed.), at 
169.
    \77\ Id.
---------------------------------------------------------------------------
    Congress has previously recognized that the establishment 
of urban Indian health programs was necessary to rectify the 
errors of failed Federal Indian policies such as relocation. 
See Senate Report No. 94-133 at 138. The Committee further 
found that Title V ``represent[ed] a Federal policy commitment 
to provide the essential authorities and financial resources to 
permit urban Indian organizations to develop needed health 
services and to strengthen relationships with existing 
community health and medical care programs.'' Senate Report No. 
94-133 at 140.
    The justifications for that policy are still valid today. 
The most recent statistics indicate that urban Indians suffer 
health disparities as do Indians located on reservations. For 
example, the mortality rates are higher due to accidents (38% 
higher than other populations), chronic liver disease and 
cirrhosis (126% higher), diabetes (54% higher), alcoholism 
(178% higher), and sudden infant death syndrome (157% 
higher).\78\
---------------------------------------------------------------------------
    \78\ The Health Status of Urban American Indians and Alaska 
Natives, Urban Indian Health Institute, March 16, 2004, available at 
www.uihi.org (Last reviewed March 16, 2006).
---------------------------------------------------------------------------
    The Committee believes that continuation of services to 
urban Indians, recognized by S. 1057, makes sense from both 
policy and fiscal perspectives. The Committee has received 
testimony that these urban Indian health programs improve 
health services for Indians located in the urban centers in a 
highly cost-effective manner.
    In addition, the Committee has received testimony that 
without the urban Indian health programs, urban Indians would 
not seek care or could delay seeking proper medical attention 
until their health problems erupt into emergency situations or 
reach advanced stages when treatment is costlier and the rate 
of survival is much lower.
    By being located closer to the urban Indians than the 
tribal health programs on the reservations, urban Indian health 
programs reduce the number of emergency room visits by 
providing early disease prevention services.
    For example, the South Dakota Urban Indian Health Center 
operates 3 clinics and experiences over 17,500 patient 
encounters per year under the Title V program. This center 
provides such services as a foot care home visit program 
whereby Community Health Representatives conduct home visits to 
assess diabetic patients (or those at risk for diabetes). These 
home visits are a critical part of chronic disease management, 
particularly in avoiding amputations due to diabetes.
    The First Nations Community HealthSource in Albuquerque, 
New Mexico provides dental, primary, and behavioral health care 
for approximately 45,000 urban Indians and handles 
approximately 12,700 patient encounters per year under the 
Title V program.
    The Native Americans for Community Action in Flagstaff, 
Arizona provides immunizations, mental health and youth 
substance abuse prevention services among several other primary 
care services for urban Indians. The Committee has received 
testimony suggesting that the patients at this urban Indian 
health center would either have to travel 100 or more miles to 
visit an IHS clinic on the reservation or wait two or three 
weeks for an appointment at the local Community Health Center. 
Either alternative would impose significantly more burdens on 
the patient, and the testimony further suggests that most 
patients would simply avoid the care altogether.
    The Tucson Indian Center in Tucson, Arizona also provides 
important disease prevention services such as substance abuse 
prevention, wellness programs and immunizations. This Center 
provides services for over 2,500 patient encounters under the 
Title V programs.
    The health program operated by the Nevada Urban Indians, 
Inc. in Reno, Nevada provides, among other things, immunization 
and diabetes education programs and experienced over 9,000 
patient encounters in 2005. The Native American Rehabilitation 
Association of the Northwest, Inc. in Portland, Oregon 
experiences nearly 9,300 patient encounters per year, including 
1,040 for mental health care and 3,400 for alcohol and drug 
treatment. The N.A.T.I.V.E. Project in Spokane, Washington 
provides a community wellness program and community outreach 
services for diabetes screening and health education for a 
community of approximately 12,000 urban Indians.
    These programs, particularly the wellness, diabetes, and 
behavioral health programs are critical to preventing the 
development of diseases which may require long-term disease 
management such as for diabetes and alcohol or drug addictions. 
In addition, the outreach, screening and home-based care 
programs are a vital component in ensuring the patients receive 
early intervention and care rather than waiting until they need 
emergency services which cost far more than intervention 
services.
    Urban Indian health programs provide culturally-appropriate 
health care for Indians. The Committee has received testimony 
that Indians may avoid non-Indian (or ``mainstream'') health 
providers who are unfamiliar with or insensitive to Indian 
culture. The urban Indians have confidence in the urban Indian 
health programs and are more likely to seek care when the 
provider recognizes and respects culturally-appropriate care.
    Urban Indian health programs also address continuity of 
care for Indians migrating between the urban areas and 
reservations. Even though the disavowed policy of relocation no 
longer forces such migration, moving from the reservation to 
urban areas is not uncommon for these individuals, and neither 
is their return to the reservation. For example, the urban 
Indians may travel to the reservation for traditional 
ceremonies, tribal political (elections) or cultural events 
(e.g., pow-wows, festivals), clan or family events, and so on. 
On the other hand, Indians may move to the urban areas for job 
or educational opportunities--and carry with them the need for 
continuity of care. The Committee has received testimony that 
these programs recognize the migration and account for it in 
their patient care, particularly for quality follow-up care.
    The urban Indian health programs provide services for the 
uninsured Indians who might not be able to obtain care 
elsewhere. With poverty rates of urban Indians hovering at 25% 
(compared to 14% for the general population), and nearly half 
living below 200% of the Federal poverty level (compared to 30% 
for the general population) \79\, it is no surprise that many 
urban Indians are uninsured. The Committee has received 
testimony that in Boston, Massachusetts, 87% of the Boston 
Indian Center's clients have no health insurance and nearly two 
out of three urban Indians in Arizona have no insurance.
---------------------------------------------------------------------------
    \79\ The Health Status of Urban American Indians and Alaska 
Natives, Urban Indian Health Institute, March 16, 2004.
---------------------------------------------------------------------------
    The Committee believes that the urban Indian health 
programs are a crucial component in the overall Federal effort 
to reduce the health disparities for the urban Indians. Without 
such services by the Title V health programs, it is quite 
likely that the health disparities among the urban Indians will 
increase. This result would contradict the Congressional policy 
embodied in this Act and other statutes of increasing access to 
health care and of remedying health disparities resulting from 
the past failed Federal Indian policies.
    Dental health aides. Decades of inadequate access to dental 
care, along with other factors that contribute to the generally 
worse health condition of Indians as compared to the general 
population, have led to a true epidemic of dental disease in 
Indian communities and for Alaska Natives in particular.
    According to Oral Health in America: A Report of the 
Surgeon General, the incidence rates for periodontal disease 
among Indians is 2\1/2\ times that of the general public.\80\ 
In Alaska Native communities, it is not uncommon for the 
children to require extraction of all of their baby teeth due 
to pervasive caries. Nor is it uncommon for the nutritional 
status of Alaska Native elders to be compromised by their 
inability to consume healthy foods due to dental pain or 
missing teeth.
---------------------------------------------------------------------------
    \80\ U.S. Department of Health and Human Services, U.S. Public 
Health Service, National Institute of Dental and Craniofacial Research, 
National Institutes of Health, Oral Health in America: A Report of the 
Surgeon General (2000) at 77.
---------------------------------------------------------------------------
    This situation is exacerbated by a chronic shortage of 
dentists. Alaska Tribal health programs are currently 
experiencing a persistent 25 percent vacancy rate among 
dentists, with an annual 30 percent turnover rate.\81\ Even if 
the number of dentists in the IHS/tribal system were doubled, 
it would take 10 years to address the unmet need for dental 
services.\82\ A recent independent evaluation of the DHAT 
Program in Alaska reports that ``five full-time paid dentist 
positions in the Yukon-Kuskokwim Delta have remained vacant for 
six years despite a salary/benefits package starting at 
$177,000.'' \83\
---------------------------------------------------------------------------
    \81\ Indian Health, Hearing Before the Senate Comm. on Indian 
Affairs, 109th Cong., 1st Sess., S. Hrg. 109-26, at 168 (April 13, 
2005) (statement of Sally H. Smith, Chairman, National Indian Health 
Board).
    \82\ S. Hrg. 109-162, at 784 (statement of Dr. Mary Willard, Yukon-
Kuskokwim Health Corporation).
    \83\ Fiset, Louis. ``A Report on Quality Assessment of Primary Care 
Provided by Dental Therapists to Alaska Natives.'' August, 2005.
---------------------------------------------------------------------------
    At its joint hearing on S. 1057 on July 14, 2005, with the 
Senate Health, Education, Labor and Pensions Committee, the 
Committee examined issues surrounding the Dental Health Aide 
Therapist (DHAT) program currently operated under the Community 
Health Aide/Practitioner (CHAP) program in Alaska Native 
communities. The Committee received testimony regarding the 
crisis in oral health care in Alaska Native communities and how 
the DHAT program was a result of Alaska Native leaders and 
health providers searching for a means of addressing it. The 
Committee believes that the use of Alaska Natives trained 
through the DHAT program to serve as dental health aide 
therapists in Alaska is a necessary response to this access to 
care crisis.\84\
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    \84\ Because no U.S. dental school provides mid-level dental 
training, DHATs are trained at the University of Otago, New Zealand, 
under a two-year program. The Committee has been informed that the DHAT 
Program is operated with wide success in Canada and 40 other countries. 
See World Oral Health Country/Area Profile Programme, World Health 
Organization Collaborating Center.
---------------------------------------------------------------------------
    At the July 14 joint hearing, Dr. Willard, who serves as a 
dentist for the Yukon-Kuskokwim Health Corporation in Bethel, 
Alaska, testified before the Committee that the CHAP program 
has been used in Alaska for 30 years and that the dental health 
aides are part of the often-remote Native communities.\85\ She 
further testified that DHATs must meet the same dental 
standards and quality assessments that IHS uses for dentists, 
and that their skills are equal.
---------------------------------------------------------------------------
    \85\ S. Hrg. 109-162, at 363-363 (statement of Dr. Mary Willard, 
Yukon-Kuskokwim Health Corporation).
---------------------------------------------------------------------------
    The DHAT program in Alaska has been part of the CHAP 
program since 2002, and DHATs provide a wide range of oral 
health care promotion and disease prevention services. For the 
most part, the DHAT program is supported and applauded for its 
efforts in reducing the extraordinary dental crisis in Alaska 
Native communities. However, some activities have generated 
controversy because they require the performance of certain 
irreversible procedures, specifically, the treatment of dental 
caries, pulpotomies and extractions of teeth.
    Despite strong concerns expressed by the American Dental 
Association about the quality of care that would be provided by 
the DHATs, the Committee has received letters indicating strong 
support of the DHAT Program in Alaska from the State of 
Alaska's Department of Health and Human Services, the Alaska 
Native Health Board, the Alaska Native Tribal Health 
Consortium, the American Dental Hygienists' Association, and 
others.\86\
---------------------------------------------------------------------------
    \86\ See also Id., at 716 et seq. (statement of Don Kashaveroff, 
President, Seldovia Village Tribe).
---------------------------------------------------------------------------
    The Committee wants to ensure that Alaska Natives receive 
the best feasible care and appreciates the concerns for patient 
safety regarding the use of DHATs to perform surgical dental 
procedures (extractions, pulpotomies and diagnosis and 
treatment of caries). However, the difficult policy decisions 
lie in balancing perceived risks to patient safety against the 
alternative reality of their receiving no care at all.
    Consequently, the Committee has determined to limit the 
DHAT program to Alaska and require a study of the program. The 
study will be conducted by a panel of neutral experts, 
including clinicians with experience in providing care to 
remote populations and clinicians who can measure and evaluate 
oral and medical complications, community practitioners from 
Alaska, economists with experience in dental delivery, oral 
epidemiologists, and Alaskan Natives with experience in the 
health delivery system.
    In developing the study parameters, the Secretary must 
consult with appropriate professional organizations, among 
other parties. The Committee expects that the American Dental 
Association will be specifically included in that consultation 
given their concerns and expertise in these matters.
    Furthermore, the Committee believes that the study should 
compare the care provided by the DHATs with care provided by 
other dental delivery systems, such as the ``Integrated Dental 
Health Program for Alaska Native Populations'' model developed 
by Drs. Howard Bailit, Tryfon Beazoglou, Amid Ismail, and 
Thomas Kovaleski. During the term of this study, the Secretary 
should engage in appropriate oversight and take actions 
necessary to ensure that patient health and safety is not 
compromised.

                      Section-by-Section Analysis

    A significant portion of current law has been carried 
forward by S. 1057 and reorganized in the various titles 
according to subject matter. S. 1057 also adds several new 
provisions to current law which may (1) amend current law, such 
as turning a demonstration project into a permanent program, 
(2) simply clarify or make small additions, such as including 
tribal organizations in various sections, or (3) introduce 
brand new programs to the Indian health care system, such as 
hospice care.
    The following section-by-section analysis will, where 
relevant, identify whether current law has been changed 
followed by an explanation of the current law to be 
reauthorized by S. 1057. In addition, the codified section in 
current law will also be noted to provide ease of reference.
    Section 1. Short title. This Act may be cited as the 
``Indian Health Care Improvement Act Amendments of 2005''.
    Section 2(a). Indian Health Care Improvement Act Amended. 
This section begins the provisions of the Act ending with 
Section 816. The following section numbers of this analysis 
will reflect the section numbers of the Act.

Section 1. Short title; table of contents

    This Act may be cited as the ``Indian Health Care 
Improvement Act''. Section 1 also contains the table of 
contents.

Section 2. Findings

    This section maintains current law.
    Current law: Section 1601 of current law (25 U.S.C. 1601) 
sets out Congressional findings for the Act which indicate that 
the health levels of Indians are below that of the rest of the 
U.S. population and that the provision of health care is 
consonant with the Federal relationship and responsibility to 
Indian people.

Section 3. Declaration of national Indian health policy

    This section amends current law by (1) replacing the 
enumerated list of health level objectives with the goals 
contained in the Healthy People 2010 national health agenda; 
and (2) adding new language to (a) add trust to the 
responsibilities being fulfilled by the national policy, (b) 
allow Indians to set their priorities according to their needs, 
(c) increase the health profession degrees awarded to Indians 
so the levels of Indian health professionals in each Service 
Area is at least the level of the general population, (4) 
require consultation consistent with Indian self-determination, 
and (5) provide funding to Indian tribal programs and 
facilities consistent with levels of IHS programs and 
facilities.
    Current law: In Section 1602, Congress declares that the 
national policy, in fulfillment of special responsibilities and 
legal obligation to Indians, is to assure the highest possible 
health status for Indians and urban Indians and to provide all 
resources necessary to effect the policy. In addition, the 
policy is to meet an enumerated list of health status 
objectives for Indians such as reducing coronary heart disease 
to no more than 100 per 100,000. It is also the intent of 
Congress that the proportion of degrees awarded in the health 
professions to Indians be increased to 0.6 percent. The 
Secretary is also required to report on the progress made in 
each objective annually.

Section 4. Definitions

    This section (Section 1603 in current law) maintains 
current law and adds several new definitions to reflect current 
practices, significant updates and coordination in health 
services to Indians, as follows: accredited and accessible, 
Area Office, Assistant Secretary, behavioral health, community 
college, contract health service, Department, Indian health 
program, junior or community college, reservation, telehealth, 
telemedicine, Traditional Health Care Practices, tribal college 
or university, and Tribal Health Program.

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


Section 101. Purpose

    This section maintains current law and adds language 
indicating Congressional intent to maximize the number, and 
assure an optimum (not merely adequate) supply, of health 
professionals in the Indian health system.
    Current law: Under Section 1611, the purpose of Title I is 
to increase the number of Indian health professionals and to 
assure an adequate supply of health professionals to provide 
health services to Indians.

Section 102. Health professions recruitment program for Indians

    This section maintains current law.
    Current law: Section 1612 authorizes funding for 
recruitment programs, to include identifying Indians with 
potential for entering health professions, publicizing funding 
sources, and establishing programs to facilitate enrollment in 
applicable courses of study. This section also addresses 
funding applications and amount of funding to be provided, as 
well as outlining the eligibility for these programs.

Section 103. Health professions preparatory scholarship program for 
        Indians

    This section maintains current law and adds new provisions 
authorizing extensions of pregraduate scholarship award terms 
up to 2 years according to Secretarial regulations and 
authorizing regulations for determining part-time equivalents 
for the compensatory preprofessional scholarships.
    Current law. Section 1613 authorizes scholarships to 
Indians for compensatory preprofessional education as well as 
pregraduate education leading to a baccalaureate degree in a 
preparatory field for a health profession. The compensatory 
preprofessions scholarships are awarded for up to two years on 
a full or part-time basis and pregraduate scholarships are for 
up to four years (S. 1057 adds 2-year extensions). This section 
specifies certain conditions on these scholarships which 
include the types of costs that may be covered and prohibits 
denial of a scholarship based solely on scholastic achievement 
if the applicant has already been admitted or maintains good 
standing at an accredited institution or if the applicant is 
eligible for assistance under another Federal program.

Section 104. Indian Health Professions Scholarships

    This section maintains current law and adds new provisions 
that (1) require a year-for-year service obligation for 
scholarship recipients, (2) require Secretarial guidelines for 
fulfilling the service obligation in private practice, and (3) 
allow a recipient to fulfill the service obligation by teaching 
in a tribal college or university nursing program if health 
services to Indians are not diminished.
    Current law. Section 1613a authorizes scholarships, 
designated as Indian Health Scholarships, to Indians who are 
enrolled full or part time in accredited schools pursuing 
courses of study in the health professions. Scholarship 
recipients are then required to fulfill a service obligation by 
either working for an IHS, tribal or urban Indian health 
program or in private practice located in a health professional 
shortage area with the length not specified in statute. The 
section further sets forth how the funding for these 
scholarships is to be allocated and addresses all the 
requirements of the active duty service obligation incurred as 
a result of the scholarship, including breach of contract 
situations.

Section 105. American Indians Into Psychology Program

    This section maintains current law and adds new language 
which (1) sets the number of colleges or universities that may 
receive grants from at least 3 to 9 and (2) establishes a 
maximum grant amount of $300,000, for a total of $2.7 million 
for each of FY 2006 through 2015.
    Current law: Section 1621p authorizes grants to at least 3 
colleges and universities for developing and maintaining Indian 
psychology career recruitment programs, including one to 
develop and maintain the Quentin N. Burdick American Indians 
Into Psychology Program at the University of North Dakota. This 
section directs the Secretary to issue regulations for 
competitive funding and specifies conditions of the grants and 
active duty service requirements.

Section 106. Scholarship programs for Indian tribes

    This section maintains current law and adds new language 
which (1) amends the source of funds for the scholarship costs 
by allowing 20% to be from any source instead of only non-
federal sources, (2) requires that licensing and educational 
requirements for all health professions, instead of only 
thedoctor and nursing professions, be met, and (3) adds Title XXI of 
the Social Security Act to the non-discriminatory provisions.
    Current law: Section 1616m authorizes the Secretary to make 
funds available to Tribal Health Programs for the purpose of 
educating Indians to serve as health professionals in Indian 
communities. This section specifies the requirements for 
receiving such funds; the course of study; contract conditions; 
specific parameters for a breach of contract; the relationship 
of a scholarship under this section to the Social Security Act; 
and conditions of continuance of funding are all specified in 
this section. The recipient cannot discriminate against 
patients who receive assistance under Titles XVIII and XIX of 
the Social Security Act. The recipients shall be required to 
fulfill service obligations and use the scholarship for tuition 
and reasonable education or living expenses.

Section 107. Indian health service extern programs

    This section maintains current law and adds provisions (1) 
extending the extern program to tribal or urban Indian health 
providers (on a discretionary basis) or other DHHS agencies (as 
available) instead of only the IHS, (2) instead of entitling 
the externs to employment, gives them a preference for 
employment with the IHS, and allowing an extern program for 
high school programs.
    Current law: Section 1614 gives preference for employment 
in the Service (and as added by S. 1057, a Tribal Health 
Program, Urban Indian Organization or other agencies within the 
Department), to any recipient of a scholarship pursuant to 
section 1613a or 1616m. The section specifies that such 
employment does not count toward any active duty service 
obligation. It specifies the timing and length of employment 
and exempts the program from any competitive personnel system 
or agency personnel limitation.

Section 108. Continuing education allowances

    This section maintains current law, except for the deletion 
of the set-aside for postdoctoral training, and adds language 
which extends the continuing education allowances to tribal and 
urban Indian health providers, not just the IHS, and includes 
all health professionals.
    Current law: To encourage health professionals to join the 
IHS and continue working in rural or remote areas where 
significant numbers of Indians reside, Section 1615 permits the 
Secretary to provide allowances to health professionals 
employed by the IHS to enable them to take leave of their duty 
stations for a period of time each year for professional 
consultation and refresher training courses. Section 108 also 
authorizes a set-aside of not more than $1 million for 
postdoctoral training programs.

Section 109. Community Health Representative Program

    This section maintains current law and adds language which 
formally identifies the health paraprofessionals as Community 
Health Representatives (CHRs) and extends the use of CHRs to 
tribal and urban Indian health programs.
    Current law: Section 1616 authorizes the CHR Program for 
training and using Indians as CHRs. This section specifies the 
duties of the Service regarding this program, including 
providing supervision, an evaluation system and a high standard 
of training for CHRs to ensure that they provide quality health 
services to Indian communities served by this program. This 
program may also promote traditional health care practices 
consistent with IHS standards for health care.

Section 110. Indian Health Service Loan Repayment Program

    This section maintains current law and (1) eliminates the 
obsolete set asides during FY 1993-1995 for nursing and mental 
health professions, (2) establishes priorities among 
applications rather than requiring the priorities be subject to 
the list of positions established by the Secretary, and sets a 
21-day notice requirement instead of merely prompt notice.
    Current law: Section 1616a establishes the Indian Health 
Service Loan Repayment Program in order to ensure an adequate 
supply of trained health professionals needed to maintain 
accreditation and provide health care services to Indians. The 
section specifies eligibility for the program which includes 
individuals with a degree or license in a health profession, in 
graduate training or about to complete an approved course of 
study. The application information must clearly explain rights 
and obligations and be available very early so individuals can 
timely complete the applications. This section outlines how the 
priorities for program participants will be established. 
Recipient contracts are required which set forth the rights and 
obligations. This section establishes deadlines for decisions 
on applications (21 days under S. 1057). The loan repayment 
program includes payment of principal, interest and related 
expenses of school loans up to $35,000 for each year of 
obligated service and, in addition to this payment, may include 
an amount to cover tax liability incurred for this payment. 
This section also includes a waiver from any employment 
ceiling; recruitment programs; non-applicability of Section 215 
of the Public Health Service Act; assignment of individuals; 
breach of contract; waiver or suspension of obligation; and the 
requirement of an annual report to Congress.

Section 111. Scholarship and Loan Repayment Recovery Fund

    This section maintains current law and adds provisions 
expanding the source of funds for this Recovery Fund, in 
addition to appropriations, to include collections from 
contract breaches for the scholarships or loan repayment 
programs and interest. Tribal health programs may also use 
payments received to provide scholarships, in addition to the 
current uses of recruitment and employment of health care 
professionals. The Secretary of DHHS may now determine what 
amounts are not required to meet withdrawals for the Fund, 
rather than the Secretary of the Treasury.
    Current law: Section 1616a-1 establishes an Indian Health 
Scholarship and Loan Repayment Recovery Fund within the 
Treasury of the United States wherein funds collected for 
breaches of contractual obligations under the IHS or tribal 
scholarships or under loan repayment programs. The section 
specifies the use of these funds which includes employment or 
recruitment of health professionals, the investment of the 
funds, and the sale of obligations by the Secretary of the 
Treasury. The Secretary of the Treasury may also invest funds 
in this Fund which are not necessary to meet withdrawals for 
the uses specified in this Section.

Section 112. Recruitment activities

    This section maintains current law and adds language to 
allow reimbursement for health professionals seeking positions 
with tribal and urban Indian health programs, in addition to 
the IHS.
    Current law: Section 1616b permits the Secretary to 
reimburse certain travel expenses to health professionals 
seeking positions with the IHS. Potential candidates for 
contracts under section 110 and their spouses are all eligible 
for such reimbursement of travel. In addition, this section 
requires the Secretary to assign one individual in each Area 
Office to have full-time responsibility for recruitment 
activities.

Section 113. Indian Recruitment and Retention Program

    This section maintains current law and adds language which 
(1) sets a time limit of three years for demonstration projects 
funded under this section instead of an open-ended timeframe 
under current law and (2) clarifies that the Indian 
organizations eligible to compete are urban Indian 
organizations.
    Current law: Section 1616c requires the Secretary to fund 
innovative demonstration projects (under S. 1057 for up to 3 
years) to enable Indian tribes, tribal and Indian organizations 
to recruit, place, and retain health professionals to meet the 
staffing needs of Indian health programs. The section also 
specifies that any Indian tribe, tribal or Indian organization 
is eligible to apply for these funds and compete on the same 
basis as IHS programs which receive grants under this section.

Section 114. Advanced training and research

    This section maintains current law and adds language which 
limits the advanced training or research opportunities to 
health professionals who have worked for the IHS, tribal or 
urban Indian health programs for a substantial period of time, 
instead of merely being employed by one of these programs at 
the time of application.
    Current law: Section 1616d establishes a demonstration 
project to enable health professionals who are employed in an 
Indian Health Program or Urban Indian Organization at the time 
of application to pursue advanced training or research areas of 
study, where a need exists. The section also imposes a service 
obligation for the recipients and requires equal opportunity 
for participating in the program.

Section 115. Quentin N. Burdick American Indians into Nursing Program

    This section maintains current law and adds language which 
(1) includes advanced practice nurse programs in addition to 
nurse practitioners, (2) authorizes grants for midwife or 
nursing programs at tribal colleges and universities or, in 
their absence, other colleges and universities, instead of only 
at the other public or private institutions, (3) includes 
tribal colleges and universities in the preferences among grant 
applicants.
    Current law: Section 1616e authorizes the Quentin N. 
Burdick American Indians into Nursing Program for the purpose 
of increasing the number of nurses, nurse midwives, and nurse 
practitioners who deliver health care services to Indians. The 
section specifies potential grant recipients and requires that 
one of them be for the program at the University of North 
Dakota; how grants may be used; information which must be 
included in applications for the grant; preferences for grant 
recipients; establishment and maintenance of a program at the 
University of North Dakota; and an active duty service 
obligation.

Section 116. Tribal cultural orientation

    This section maintains current law and adds language which 
(1) ensures that employees in each Service Area obtain cultural 
orientation, rather than merely establishing a program for 
cultural orientation, (2) requires the program to include 
instruction on the relationship of the Indian tribes with the 
IHS, rather than simply a history of the IHS, and a description 
of the traditional health care practices of the Indian tribes 
in the Service Area and (3) requires consultation with affected 
tribal and urban Indian organizations.
    Current law: Section 1616f requires appropriate employees 
of the Service who serve particular Indian Tribes to receive 
instruction in the history and culture of the tribes they serve 
and in the history of the IHS. The section requires the 
Secretary to develop such a program in consultation with the 
affected Indian tribes, which shall, to the extent feasible, be 
implemented through tribal colleges or universities and include 
instruction in NativeAmerican studies.

Section 117. INMED Program

    This section maintains current law and adds language which 
(1) authorizes grants to an unspecified number of colleges or 
universities instead of the previous mandate of at least 3 
schools, (2) clarifies that the regulations govern the grants, 
including substantive provisions such as criteria and 
application requirements, rather than only the competitive 
award process, and (3) eliminates an old 1988 requirement of a 
report to Congress on the program and recommendations for 
changes.
    Current law: Section 1616g authorizes the Secretary to 
provide grants to at least 3 colleges and universities to 
maintain and expand the Indian health careers recruitment 
program (Indians Into Medicine Program). The Quentin N. Burdick 
Indian Health Programs at the University of North Dakota is to 
be one of the authorized grants. This section also specifies 
requirements for institutional applicants for these grants.

Section 118. Health training programs of community colleges

    This section maintains current law and adds language which 
(1) recognizes accredited and accessible community colleges as 
eligible recipients of grants, (2) requires the colleges to 
have a relationship with a hospital, rather than merely having 
access to a hospital, (3) requires Indian preference for 
program participants, (4) increases the ceiling amount of the 
grant from $100,000 to $250,000, and (5) establishes priority 
for tribally-controlled colleges in Service Areas where they 
exist if other requirements in the section are met.
    Current law: Section 1616h requires the Secretary to award 
grants to (under S. 1057, accredited, accessible) community 
colleges to assist in establishing health profession education 
leading to a degree or diploma for individuals who desire to 
practice such profession on or near a reservation or in a 
tribal clinic. The Secretary is also required to award grants 
to the colleges that already have these programs. The Secretary 
must provide technical assistance to encourage community 
colleges to establish and maintain such programs. Finally, any 
program receiving assistance under this section is required to 
provide advanced training for health professionals.

Section 119. Retention bonus

    This section maintains current law and adds language 
expanding the bonuses (1) to any health professional, rather 
than only doctors and nurses, so funding set-asides between 
these 2 professions have been deleted, (2) to health 
professionals employed by the tribal or urban health programs, 
rather than employed only by the Service, and eliminates the 
requirement that the retention bonus be paid at the beginning 
of the term of service.
    Current law: Section 1616j permits the Secretary to provide 
retention bonuses for health professions where recruitment or 
retention is difficult if the individual has completed 3 years 
of employment and any service obligation from federal 
scholarships or loan repayment programs. Rates for retention 
bonuses may cover multiple years, but not exceed an annual rate 
of $25,000. Refunds shall be required if the health 
professional does not complete the term of service under any 
retention agreement, unless the default is not the fault of the 
individual.

Section 120. Nursing residency program

    This section maintains current law and adds language which 
establishes this program for Indian nurses and includes 
advanced degrees or certifications in nursing or public health 
as eligible programs, besides a Master's degree as appropriate 
post-baccalaureate training.
    Current law: Section 1616k establishes a program to enable 
nurses working for an Indian Health Program or Urban Indian 
Organization to pursue advanced training. The participants are 
required to enter a service obligation. The program shall 
include a combination of education and work study leading to 
either an associate or bachelor's degree in nursing degrees or 
a Master's degree.

Section 121. Community health aide program

    This section maintains current law and adds provisions 
which (1) require the Secretary to establish a neutral panel, 
whose membership is also set forth in this section, to study 
the dental health aide therapist program in Alaska Native 
communities and to submit a report on the study to appropriate 
Congressional Committees and (2) authorizes the expansion of 
the Community Health Aide Program, except for the dental health 
aide therapist program, to Indian communities in the lower 48 
states.
    Current law: Section 1616e directs the Secretary to develop 
and operate a Community Health Aide Program in Alaska. 
Requirements are specified for the Alaska program including the 
(1) development of training and curriculum combining theory and 
practical experience, (2) instruction in acute care, health 
promotion, (3) establishment of a certification Board, and (4) 
development of systems for continuing education and 
supervision.

Section 122 Tribal health program administration

    This section maintains current law and adds language which 
specifies that the training shall be for Indian individuals.
    Current law: Section 1616n requires the Secretary to 
provide training in the administration and planning of Tribal 
Health Programs.

Section 123. Health professional chronic shortage demonstration 
        programs

    This section amends current law by changing a lone pilot 
program to address health professional shortages into a 
national demonstration project.
    Current law: Section 1616o authorizes the Secretary to make 
a grant to the School of Medicine at the University of South 
Dakota to fund a pilot program on an Indian reservation at one 
or more service units in South Dakota to address the chronic 
manpower shortages in the Aberdeen Area of the IHS. The pilot 
program shall incorporate a program advisory board composed of 
representatives from the tribes and Indian communities which 
are served by the program.

Section 124. National health service corps

    This section maintains current law and adds urban Indian 
health programs within the protections against removal of any 
member of the Corps working in the programs. The section also 
exempts National Health Service Corps scholars qualifying for 
the Commissioned Corps in the United States Public Health 
Service from full-time equivalent limitations when serving as a 
commissioned corps officer in a Tribal Health Program or an 
Urban Indian Organization.
    Current law: Section 1680b prohibits the Secretary from 
removing a member of this Corps from an Indian health program 
or withdrawing funding to support such member, unless the 
Secretary ensures that Indians will experience no reduction in 
services.

Section 125. Substance abuse counselor educational curricula 
        demonstration programs

    This section maintains current law and adds language 
including accredited and accessible qualifications for the 
community colleges eligible for these programs and extending 
the initial grant period from one year to three years and the 
renewal periods from one year to two years.
    Current law: Section 1665j allows the Secretary to enter 
into contracts with or make grants to colleges and universities 
(including tribal) to establish demonstration programs 
developing curricula for substance abuse counseling. Duration 
and renewal of the grant are both for periods of one year each. 
The section also states the criteria for review and approval of 
the applications, requires the Secretary to provide technical 
and other assistance to grant recipients, requires the 
Secretary to submit an annual report to the President for 
inclusion in the annual report to Congress and defines the term 
``educational curriculum'' and ``eligible community college''.

Section 126. Behavioral health training and community education 
        programs

    This section maintains current law and (1) adds tribal 
organizations and urban Indian organizations as participants in 
the program, (2) clarifies that the tribal and urban Indian 
organizations are part of the consultation process, (3) changes 
the focus from solely on mental health to behavioral health and 
(4) eliminates the requirement that the staff be assigned 
primarily to the IHS Service Units.
    Current law: Section 1621h(d) requires the Secretary, with 
the Secretary of the Interior and in consultation with 
representatives of the Indian Tribes, to conduct a study and 
compile a list of certain types of staff positions within the 
Bureau of Indian Affairs, the Service and Indian Tribes,which 
should include training in any aspect of mental illness, dysfunction, 
or self-destructive behavior. The Secretary is then required to provide 
training criteria appropriate for each type of position and ensure that 
this training is provided. On request of the appropriate Indian entity, 
the Secretary is required to develop and implement a program of 
community education on mental illness, as well as technical assistance 
to tribal entities to obtain and develop community education materials. 
Within 90 days of enactment of this Act, the Secretary is required to 
develop a plan to increase mental health services by at least 500 staff 
positions within 5 years, with at least 200 of such positions devoted 
to child, adolescent, and family services. Such staff would be assigned 
primarily to the IHS service unit levels.

Section 127. Authorization of appropriations

    Section 127 authorizes appropriations as are necessary to 
carry out this title for each fiscal year through 2015.

                       TITLE II--HEALTH SERVICES


Section 201. Indian Health Care Improvement Fund

    This section maintains current law and adds provisions 
clarifying that the Secretary may expend funds either directly 
or through contracts or compacts under the Indian Self-
Determination and Education Assistance Act, as well as 
provisions regarding the use of telemedicine and Traditional 
Health Care Practices.
    Current law: Section 1621 authorizes the use of funds, 
designated as the ``Indian Health Care Improvement Fund'', for 
the purposes of eliminating the deficiencies in health status 
and resources for tribes; eliminating backlogs and meeting the 
needs in health care services; eliminating the inequities in 
funding for direct care and contract health service programs; 
and augmenting the ability of the Indian Health Service to meet 
its various responsibilities. Funding authorized by this 
section may not be used to offset appropriated funds and must 
be used to improve the health status and reduce the resource 
deficiencies of tribes. This section also defines ``health 
status and resource deficiency'' and requires that Tribal 
Health Programs be equally eligible for funds as the IHS. A 
report is required to be submitted to Congress 3 years after 
enactment which addresses the current health status and 
resource deficiency for each Service Unit. Funds appropriated 
under this section are to be included in the base budget of the 
IHS for determining appropriations in subsequent years. 
Finally, nothing in this section is intended to diminish the 
primary responsibility of the IHS to eliminate backlogs in 
unmet health care, or to discourage additional efforts of IHS 
to achieve parity among Tribes.

Section 202. Catastrophic Health Emergency Fund

    This section maintains current law and adds language which 
requires the use of negotiated rulemaking for promulgation of 
regulations issued for this section.
    Current law: Section 1621a establishes the Catastrophic 
Health Emergency Fund (CHEF) to be administered by the 
Secretary through the central office of the Indian Health 
Service in order to meet the extraordinary medical costs 
associated with the treatment of victims of disasters or 
catastrophic illnesses. No part of the CHEF or the 
administration thereof is to be subject to contract or grant, 
nor shall these funds be apportioned on an Area Office, Service 
Unit, or other similar basis. The Secretary is required to 
promulgate regulations for the administration of these funds. 
This section prohibits funds appropriated to CHEF from being 
used to offset or limit other appropriations made to the Indian 
Health Service. It also requires that all reimbursements to 
which the Service is entitled from any source by reason of 
treatment rendered to any victim of a disaster or catastrophic 
illness the cost of which was paid from CHEF be deposited into 
CHEF.

Section 203. Health promotion and disease prevention services

    This section maintains current law, but moves the 
definition of health promotion and disease prevention to the 
definitions section and adds Congressional findings.
    Current law: Section 1621b directs the Secretary to provide 
health promotion and disease prevention services to Indians in 
order to meet the Act's health status objectives. An evaluation 
statement of the resources required to undertake these health 
promotion and disease prevention activities would be included 
in a required report to Congress.

Section 204. Diabetes prevention, treatment, and control

    This section maintains current law and (1) adds (a) tribal 
organizations as eligible participants in these programs, (b) 
effective ongoing monitoring of disease indicators, (c) the 
requirement that screening shall be to the extent medically 
indicated and with informed consent, (d) funding for dialysis 
programs, (e) consultation requirements; (2) changes the model 
diabetes projects into permanent programs to be continued along 
with any new programs developed with recurring funding; and (3) 
still allows employment of diabetes control officers, but if 
these positions and activities are administered by the Tribes 
or Tribal Organizations, then the funding and activities would 
not be divisible under the Indian Self-Determination and 
Education Assistance Act.
    Current law: Section 1621c requires the Secretary to 
determine the incidence of this disease and its complications 
among Indians and the measures needed to prevent, treat and 
control it. The Secretary is also required to screen Indians 
for diabetes and for conditions which indicate a high risk for 
diabetes. The Secretary is required to continue to fund model 
diabetes projects (and under S. 1057, dialysis programs). To 
the extent that funding is available, the Secretary is required 
to work with each Area Office to establish patient registries 
in Area Offices and ensure that data collected are disseminated 
to other Area Offices, subject to privacy laws. The Secretary 
is also allowed to maintain diabetes control officers in each 
Area.

Section 205. Shared services for long-term care

    This section amends current law by changing a demonstration 
project into a permanent program and adding new provisions 
which (1) authorize other services similar in nature to long-
term care and construction for facilities for the similar 
services and (2) encourage the use of existing underused 
facilities or allow the use of swing beds for long-term or 
similar care.
    Current law: Section 1680l allows the Secretary to enter 
contracts for 6 demonstration projects to deliver long-term 
care services to Indians which may also authorize sharing of 
staff, construction and proportionate allocation of funding 
between the tribes and IHS. Any nursing facility funded under 
this section must meet the requirements for such facilities 
under section 1919 of the Social Security Act. In addition, the 
Secretary is required to provide necessary technical and other 
assistance to enable applicants to comply with the provisions 
of this section.

Section 206. Health services research

    This section amends current law by (1) eliminating the 
specific set-aside of $200,000 for research and replacing it 
with general authority to fund research for Indian health 
programs, instead of only the IHS, (2) requiring the Secretary 
to coordinate, to the extent practical, the resources and 
activities for Indian health research needs, and (3) 
authorizing the funding for both clinical and nonclinical 
research.
    Current law: Section 1621g authorizes funding for research 
to further the performance of the health service 
responsibilities of the IHS. Indian tribes and tribal 
organizations contracting under the Indian Self-Determination 
and Education Assistance Act are to be given equal opportunity 
to compete for these research funds.

Section 207. Mammography and other cancer screening

    This section amends current law by authorizing other cancer 
screening, eliminating the minimum age requirement of 35 for 
Indian women and opening the mammography screening to all 
Indian women, at a frequency under appropriate national 
standards.
    Current law: Section 1621k requires the Secretary to 
provide for mammography for Indian women 35 years or older at a 
frequency determined by the Secretary in consultation with the 
National Cancer Institute and consistent with appropriate 
standards to ensure the safety and accuracy of the mammogram 
under the Social Security Act.

Section 208. Patient travel costs

    This section maintains current law and adds language which 
allows the use of appropriate and necessary qualified escorts 
and transportation by private vehicle where no other 
transportation is available, specially equipped vehicle, 
ambulance or by other means required when air or motor vehicle 
transport is not available.
    Current law: Section 1631l requires the Secretary to 
provide funds for the travel costs of patients, for emergency 
and non-emergency air transport where ground transport is not 
feasible, associated with receiving health care services.

Section 209. Epidemiology centers

    This section amends current law by (1) maintaining the 
centers in existence on the date of passage of this Act, but 
still requiring the establishment of centers in the remaining 
Areas without reducing funds for the existing centers, (2) 
allowing the funding for any new centers to be administered, 
but not divisible, by tribes and tribal organizations under the 
Indian Self-Determination and Education Assistance Act, but no 
longer by tribal consortia and (3) eliminating the requirements 
that the Secretary establish the data and formats for reporting 
and establish the system for monitoring progress toward the 
health objectives.
    Current law: Section 1621m requires the Secretary establish 
epidemiology centers in each Service Area. Newly established 
centers may be operated by Tribal Health Programs. The 
functions of these centers are delineated in this section. The 
Director of the Centers for Disease Control and Prevention is 
required to provide technical assistance to the centers and the 
Secretary is authorized to provide funding to Tribes and Tribal 
Organizations to conduct epidemiological studies of Indian 
communities.

Section 210. Comprehensive school health education programs

    This section maintains current law and adds language which 
(1) clarifies the types of purposes for which the funds may be 
used such as for both regular school and after school programs, 
for the benefit of Indian and urban Indian children, for oral 
health programs, for violence prevention and for other health 
issues as appropriate, (2) includes tribal organizations and 
urban Indian health organizations as eligible for funding, (3) 
consolidates the reporting requirements into the application 
criteria which is now subject to consultation between the 
Secretary and the Indian tribes, tribal organizations and urban 
Indian organizations.
    Current law: Section 1621n allows the Secretary to provide 
grants to Indian Tribes for the development of comprehensive 
school health education programs for children from pre-school 
through grade 12. The specific purposes for which funds may be 
used are delineated. Upon request, the Secretary is required to 
provide technical assistance in the development and 
dissemination of comprehensive health education plans, 
materials and information. The Secretary shall establish 
criteria for review and approval of applications for this 
funding. For Bureau of Indian Affairs funded schools, the 
Secretary of the Interior shall develop similar programs.

Section 211. Indian Youth Program

    This section maintains current law and adds tribal 
organizations and urban Indian organizations as participants in 
the program and consultation and includes urban Indian youth as 
beneficiaries of program services.
    Current law: Section 1621o allows the Secretary to 
establish and administer programs for innovative mental and 
physical disease prevention and health promotion and treatment 
for Indian preadolescent and adolescent youths. Allowable and 
prohibited uses of the funds authorized by this section are 
delineated. The Secretary is required to disseminate 
information regarding models for delivery of comprehensive 
health care services to Indian youth; to encourage the 
implementation of these models; and to provide technical 
assistance upon request. The Secretary will establish criteria 
for review and approval of applications under this section.

Section 212. Prevention, control, and elimination of communicable and 
        infectious diseases.

    This section amends current law by expanding the 
communicable diseases from simply tuberculosis to other 
communicable and infectious diseases, by encouraging the Indian 
tribes to coordinate with the Centers for Disease Control, by 
eliminating superfluous provisions which reduce the grant 
amount for expenses incurred by the federal government or for 
supplies or equipment furnished to the grant recipient.
    Current law: Section 1621q authorizes the Secretary to fund 
projects specifically for the purpose of preventing, 
controlling and eliminating tuberculosis. Funding is also 
authorized for public information and education programs, and 
skills improvement activities. Funding under this section 
requires an application or proposal for funding. Entities which 
receive funding under this section must provide assurances they 
will coordinate their activities with the Centers for Disease 
Control and Prevention as well as State and local health 
agencies. Finally, in carrying out this section, the Secretary 
may provide technical assistance upon request and shall submit 
a report to Congress on the use of the funds and the progress 
made toward prevention, control, and elimination of 
tuberculosis among Indians.

Section 213. Authority for provision of other services

    This section amends current law by making permanent a 
demonstration project for home- and community-based care. The 
new provisions also (1) add special requirements for the home- 
and community-based care, (2) add several definitions, and (3) 
eliminate the exclusion of cash payments, room and board, 
construction and nursing facility services.
    Current law: Section 1680k authorizes the Secretary to 
establish not more than 24 demonstration projects for home- and 
community-based care, excluding cash payments, room and board, 
construction and nursing facility services, for functionally 
disabled Indians. Discretion is provided to the Indian Health 
Service, Indian Tribes, or Tribal Organizations to provide such 
care to persons otherwise ineligible for the health care 
benefits of the Indian Health Service (on a cost basis). The 
Secretary is required to submit to the President for inclusion 
in a report to Congress the findings of these projects. ``Home- 
and community-based services'' and ``functionally disabled'' 
are defined.

Section 214. Indian women's health care

    This section amends current law by eliminating the Office 
of Indian Women's Health and, instead, requiring the Secretary 
to monitor and improve the quality of Indian women's health 
through the various programs administered by IHS.
    Current law: Section 1621v establishes an Office of Indian 
women's health to oversee efforts of the IHS to monitor and 
improve health care for Indian women of all ages.

Section 215. Environmental and nuclear health hazards

    This section maintains current law and adds language which 
(1) requires ongoing monitoring of trends in health hazards to 
Indians and other environmental hazards to Indian communities, 
(2) provides additional considerations for the studies 
conducted under this section and (3) requires consultation with 
Indian tribes and tribal organizations in developing plans for 
addressing the health problems.
    Current law: Section 1677 requires the Secretary, in 
conjunction with other Federal agencies, to conduct studies to 
determine trends in the health hazards to Indian miners and 
other Indians as a result of nuclear resource development. Upon 
completion of such studies, the Secretary shall develop health 
plans to address the health problems studied. The Secretary is 
required to submit the study to Congress 18 months after the 
date of enactment and a report no later than 1 year after the 
study which includes recommendations for the implementation of 
the plan and evaluation activities. This section establishes an 
Intergovernmental Task Force to identify environmental hazards 
and to take corrective action. The Secretary is to chair this 
task force, which shall meet at least twice yearly. If an 
Indian, who is employed in or around any environmental hazard, 
suffers from a work-related condition, the Indian Health 
Program which treats him may be reimbursed by the Indian's 
employer.

Section 216. Arizona as a contract health service delivery area

    This section maintains current law and extends the date to 
2015, instead of 2000, for the designation as a contract health 
service delivery area.
    Current law: Under Section 1678, the State of Arizona is 
designated as a contract health service delivery area for the 
purpose of providing contract health care services to members 
of federally recognized Indian Tribes of Arizona effective 
fiscal years 1984 to 2000. The Indian Health Service will not 
curtail any services as a result of this provision.

Section 216A. North Dakota and South Dakota as a contract health 
        service delivery area

    This section is new.
    New provisions: The States of North Dakota and South Dakota 
are designated as one contract health service delivery area for 
the purpose of providing contract health care services to 
members of federally recognized Indian Tribes in North and 
South Dakota. The Indian Health Service will not curtail any 
services as a result of this provision.

Section 217. California Contract Health Services Program

    This section amends current law by turning the 
demonstration project for the California Indians into a 
permanent program.
    Current law: Section 1621j requires the Secretary to 
establish a demonstration project using the California Rural 
Indian Health Board (CRIHB) to serve as the contract care 
intermediary to improve the accessibility of health services to 
California Indians. The Secretary will reimburse CRIHB for 
costs incurred pursuant to this section. Not more than 5 
percent of the amounts provided under this section may be for 
administrative expenses. No payment may be made for treatment 
under this section to the extent payment may be made under the 
Indian Catastrophic Health Emergency Fund or from amounts 
appropriated or otherwise made available to the California 
contract health service delivery area. This section also 
establishes an Advisory Board, comprised of representatives 
from not less than 8 Tribal Health Programs serving California 
Indians covered under this section and at least one-half of 
whom are not affiliated with the CRIHB. The Advisory Board will 
advise the CRIHB in carrying out this section. The CRIHB is 
also required to report to the Secretary on the demonstration 
project findings.

Section 218. California as a contract health service delivery area

    This section maintains current law, but allows the excluded 
counties to become a part of the contract service delivery area 
if funding is specifically provided for those counties.
    Current law: Section 1680 designates the State of 
California, excluding certain specified counties, as a contract 
health service delivery area for providing contract health care 
services to California Indians.

Section 219. Contract health services for the Trenton service area

    This section maintains current law.
    Current law: Section 1680e directs the Secretary 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 North Dakota and the 
counties of Richland, Roosevelt, and Sheridan in Montana. This 
section does not expand 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 
these services that applied on May 1, 1986.

Section 220. Programs operated by Indian tribes and tribal 
        organizations

    This section maintains current law, but eliminates language 
which limits the particular use of funds for which the Indian 
tribes and tribal organizations can receive funding on the same 
basis as the IHS.
    Current law: Section 1680a requires the Indian Health 
Service to provide funds to Tribal Health Programs for health 
care programs and facilities to (1) maintain and repair 
clinics, (2) train employees, (3) provide cost-of-living 
expenses, and (4) provide for other expenses related to health 
services on the same basis as funds are provided to these 
programs operated directly by the Indian Health Service.

Section 221. Licensing

    This section is new.
    New provision: Section 221 requires that health care 
professionals employed by a Tribal Health Program shall, if 
licensed in any State, be exempt from the licensing 
requirements of the State in which the Tribal Health Program 
provides the services.

Section 222. Notification of provision of emergency contract health 
        services

    This section maintains current law.
    Current law: Section 1646 allows 30 days (as a condition of 
payment) for an elderly or disabled Indian to notify the 
Service of any emergency care or health services received from 
a non-Service provider or in a non-Service facility.

Section 223. Prompt action on payment of claims

    This section maintains current law, but changes the 
requirement of a completed claim to a valid claim.
    Current law: Section 1621s provides a deadline for the 
Service to respond to notification of a claim by a provider of 
a contract care service. The section also provides that if the 
Service fails to respond within the required time, the Service 
shall accept the claim as valid. The IHS shall pay a completed 
claim within 30 days after completion of the claim.

Section 224. Liability for payment

    This section maintains current law and adds language which 
limits the recourse against the patient if the claim has been 
deemed accepted under Section 223.
    Current law: Section 1621u provides that a patient who 
receives authorized contract health care services will not be 
held liable for any charges or costs associated with those 
authorized services. In addition, the Secretary is required to 
notify the provider of such services and the patient who 
receives them of the same, within a specified time.

Section 225. Office of Indian Men's Health

    This section is new.
    New provision: Section 225 directs the Secretary to 
establish the Office of Indian Men's Health, which shall be 
headed by a Director, to coordinate and promote the health 
status of Indian men. The Secretary is also required to submit 
a report to Congress within two years of enactment, describing 
any activity and finding of the Director.

Section 226. Authorization of appropriations

    This section maintains current law, but extends the 
authorization to 2015 and eliminates the references to specific 
sections which had a separate authorization period.
    Current law: Section 226 authorizes appropriations as 
necessary to carry out this title, for each fiscal year through 
2000, except for certain specific sections.

                         TITLE III--FACILITIES


Section 301. Consultation; construction and renovation of facilities; 
        reports

    This section maintains current law and adds language which 
(1) expands the accrediting bodies whose standards may be met 
for construction, (2) requires an evaluation of the impact of a 
proposed closure prior to closing, (3) requires the Secretary 
to establish a health care facility priority system developed 
through negotiated rule-making which prioritizes certain types 
of facilities such as outpatient, specialized care facilities, 
(4) adds specific requirements for the report to be submitted 
to Congress such as the types of facilities to be included, the 
method for evaluating the needs, the opportunity for nomination 
of facilities and consultation, (5) requires the Secretary to 
consult and cooperate with Indian tribes in finding innovative 
approaches to meet the facilities needs; and (6) requires a GAO 
study of the baseline facility needs and requires the Secretary 
to update this report every 5 years.
    Current law: Section 1631 requires consultation with Indian 
tribes prior to expending construction funds. In addition, it 
sets forth requirements to be met prior to closing any 
facility. This section also establishes and defines criteria 
for closure of health care facilities and sets forth reporting 
requirements.

Section 302. Sanitation Facilities

    This section maintains current law and adds language which 
(1) establishes priority funding for emergency repairs and 
operation or maintenance to avoid imminent health threats or to 
protect the investment in health benefits gained through the 
sanitation facilities, (2) prohibits the use of IHS funding for 
new homes constructed using Department of Housing and Urban 
Development funds, (3) allows the Secretary to accept funds 
from all federal sources and may place those funds in ISDEAA 
agreements for sanitation facilities construction, (4) 
authorizes the Secretary to allows certain funding to be used 
to fund tribal loans or matching or cost participation 
requirements to construct sanitation facilities, (5) requires 
the Secretary enter into interagency agreements for financial 
assistance, (6) requires standards for planning, design and 
construction of sanitation facilities to be developed through 
negotiated rule-making, (7) requires consultation with Indian 
tribes in developing the 10-year plan for sanitation 
facilities, (8) establishes an Indian tribe's primary 
responsibility for collecting user fees and the Secretary's 
responsibility in assisting tribes when the facility is 
threatened with imminent failure, (9) clarifies the information 
required to be in the annual report and, (10) sets forth the 
definitions of the different levels of deficiencies.
    Current law: Section 1632 provides the findings, certain 
duties for sanitation, authorized uses of sanitation funding 
and facilities, and reporting requirements, and establishes the 
deficiency levels for those facilities. This section requires 
training or technical assistance in the operation and 
maintenance of sanitation facilities. The Secretary is also 
required to submit a report to Congress on the status of 
sanitation facilities backlog and a 10-year plan for addressing 
it.

Section 303. Preference to Indians and Indian firms

    This section maintains current law and adds new language to 
clarify rates of pay requirements and other wage requirements 
similar to local rates as determined by the Indian tribes.
    Current law: Section 1633 authorizes the Secretary to use 
Indian preference for certain construction activities.

Section 304. Expenditure of nonservice funds for renovation

    This section maintains current law and adds language which 
(1) includes major expansion as an authorized use of funds, in 
addition to renovation and modernization, but requires the 
Indian Tribes or Tribal Organizations to provide certain 
information to the Secretary regarding staffing, equipment and 
other costs associated with the expansion, and (2) requires the 
methodology for determining priorities to be developed through 
negotiated rule-making with annual revisions developed through 
consultation.
    Current law: Section 1634 authorizes the Secretary to 
accept any expansion or renovation funded with non-Service 
funds in accordance with certain criteria. The Secretary is 
required to maintain a separate priority list for these 
facilities.

Section 305. Funding for the construction, expansion and modernization 
        of small ambulatory care facilities

    This section maintains current law and adds language which 
requires the funding to be used for the portion of costs which 
benefits the eligible population, but exempts from the specific 
eligibility requirements applicants whose principal health 
administration offices are located where there is no road 
system providing direct access to inpatient hospitals.
    Current law: Section 1636 establishes criteria for small 
ambulatory care facilities, including use of funds, grant 
application requirement priorities, and conditions for 
reversion of facilities.

Section 306. Indian health care delivery demonstration project

    This section maintains current law and adds language which 
(1) requires consultation, (2) permits the use of IHS funds to 
match other funds, and (3) authorizes regulations to be 
developed through negotiated rule-making.
    Current law: Section 1637 authorizes the Secretary to 
establish demonstration projects to test alternative health 
care delivery systems through the construction and renovation 
of hospitals, health centers, health stations and other 
facilities. Section 1637 establishes criteria for the projects 
such as the need for such facility, number of Indians to be 
served, the economic viability of the project, and the 
administrative and financial capability of Indian tribes or 
Tribal Organizations to administer the project. This section 
also requires technical assistance and use of the same criteria 
in evaluating tribal and IHS facilities.

Section 307. Land transfer

    This section amends current law by changing a specific 
authorization into a general authorization whereby Federal 
agencies may transfer, at nocost, land and improvements to the 
IHS for the provision of health care services, and the Secretary is 
authorized to accept the land.
    Current law: Section 1638 provides specific authorization 
for transferring 5 acres of land at the Chemawa Indian School 
to the IHS.

Section 308. Leases, contracts and other agreements

    This section maintains current law and adds tribal 
organizations as eligible lessors.
    Current law: Section 1674 authorizes the Secretary to enter 
into leases, contracts or other agreements with Indian Tribes 
for the delivery of health services at those facilities. The 
leases may also include provisions for construction, renovation 
and compensation.

Section 309. Study for loans, loan guarantees and loan repayment

    This section is new.
    New provisions: Section 309 authorizes a study, using 
consultation, to determine the feasibility of a loan or loan 
guarantee fund for Indian health care facilities construction. 
A number of study requirements are delineated such as the 
maximum principal amount and term of the loan that should be 
offered, amount attributable for planning, appropriate security 
for the loan, and legislative or regulatory changes needed.

Section 310. Tribal leasing

    This section is new.
    New provision: Section 310 authorizes a tribal health 
program to lease permanent structures without prior approval in 
appropriation Acts.

Section 311. Indian Health Service/Tribal Facilities Joint Venture 
        Program

    This section maintains current law and adds (1) tribal 
organizations to the eligible participants and those tribes 
that have begun, but not completed the process of acquisition 
or construction of a health care facility, (2) requires the 
criteria to be developed through negotiated rule-making, (3) 
requires negotiation for the continued operation of the 
facility at the end of the 10-year lease, (4) authorizes 
recovery in a proportional amount from the IHS if the IHS 
ceases to use the facility within the 10-year lease period, and 
(5) includes staff quarters in the definition of the health 
facilities under this section.
    Current law: Section 1680h(e) authorizes the Secretary to 
enter joint ventures with Indian Tribes, and provide staffing, 
equipment and supplies for the operation of the facility under 
a no-cost 10-year lease with the Indian Tribes in exchange for 
the tribal construction of the facility, in accordance with 
certain criteria.

Section 312. Location of facilities

    This section maintains current law and adds language which 
(1) allows an Indian owner to request that the IHS locate 
facilities on his or her lands within tribal jurisdiction, 
subject to the priority for location being given to the Indian 
tribe and (2) adds, as part of the Indian lands for 
consideration under this section, all lands in Alaska owned by 
any Alaska Native village, or regional corporation under the 
Alaska Native Claims Settlement Act, or land allotted to an 
Alaska Native.
    Current law: Section 1680n sets forth certain priorities in 
locating health care facilities on Indian lands to address 
unemployment conditions in the economically depressed Indian 
communities, if requested by the Indian tribe with jurisdiction 
over the Indian lands. Section 1680n also defines ``Indian 
lands''.

Section 313. Maintenance and improvement of health care facilities

    This section is new.
    New provisions: Section 313 requires reporting of backlogs 
in maintenance and improvements for facilities and authorizes 
the use of funds to construct a replacement facility if the 
costs of renovation would exceed a maximum threshold cost to be 
developed through negotiated rule-making.

Section 314. Tribal management of federally-owned quarters

    This section is new.
    New provisions: Section 314 authorizes Tribal Health 
Programs operating a health care facility and federally-owned 
quarters pursuant to a contract or compact under the Indian 
Self-Determination and Education Assistance Act to establish 
reasonable rental rates for the federally-owned quarters and 
directly collect the rent. These quarters shall remain eligible 
for improvement and repair funds as other federally-owned 
quarters. The Tribal Health Programs operating the quarters are 
required to provide at least 60 days notice before changing the 
rental rate.

Section 315. Applicability of Buy American Act requirement

    This section maintains current law, but exempts Indian 
tribes and tribal organizations from the requirements of the 
Buy American Act and eliminates a reporting requirement for 
purchases from FY 1993 to FY 1994.
    Current law: Section 1638b requires application of the Buy 
American Act for all procurement.

Section 316. Other funding for facilities

    This section is new.
    New provisions: Section 316 authorizes the Secretary to 
accept funding from other sources for the construction of 
health care facilities and to transfer such funds to Indian 
tribes. The Secretary may also enter into interagency 
agreements for the planning, design and construction of health 
care facilities.

Section 317. Authorization of appropriations

    This section maintains current law (found in Section 
1638a), but extends the authorization for appropriations 
through fiscal year 2015.

                  TITLE IV--ACCESS TO HEALTH SERVICES


Section 401. Treatment of payments under Social Security Act health 
        care programs

    This section maintains current law and adds (1) tribal 
organizations and urban Indian organizations, in addition to 
tribes and the IHS for whom reimbursements would not be 
considered in determining appropriations, and (2) expands the 
authorized uses of the reimbursements from improvements only to 
hospitals or skilled facilities to also include programs and 
the excess used to reduce health deficiencies, subject to 
consultation by the Indian tribes. However, this provision 
authorizing the Secretary to determine the uses shall not apply 
when the Indian tribes elect to receive reimbursements 
directly.
    Current law: Sections 1641 and 1642 require that any 
Medicare or Medicaid payments received by the IHS or Indian 
tribes shall not be considered in determining appropriations 
for health care services, and that Indians without Medicare or 
Medicaid are given equal consideration as those Indians are who 
are covered by these programs. Section 1645 established a 
program under which tribes could elect to directly bill and be 
reimbursed health care services provided under Medicare, 
Medicaid or other third parties. Specifications are made as to 
how funds collected from Medicare or Medicaid are to be used.

Section 402. Grants to and contracts with the service, Indian tribes, 
        tribal organizations, and urban Indian organizations

    This section maintains current law and adds provisions 
which outline the agreements between the Secretary and the 
tribes, tribal or urban Indian organizations to improve the 
enrollment of Indians in the Social Security Act programs.
    Current law: Section 402 requires the Secretary to make 
grants or enter into contracts with Tribes and Tribal 
Organizations to improve enrollment and participation in 
Medicare, Medicaid or SCHIP programs, such as paying premiums. 
In doing so, the Secretary shall place conditions as deemed 
necessary to effect the purpose of such funding. Additional 
agreements may be made in order to improve the receipt and 
processing of applications for enrollment of Indians under 
Social Security Act programs and to facilitate cooperation 
between States, the Service, Indian Tribes, Tribal 
Organizations, or Urban Indian Organizations.

Section 403. Reimbursement from certain third parties of costs of 
        health services

    This section maintains current law and adds language (1) to 
enable urban Indian organizations to seek recovery from third 
parties, (2) to require reasonable efforts be taken to provide 
notice to the patient either before or during the pendency of 
the action, (3) to limit the IHS right of recovery against a 
tribal self-insured plan absent written consent from the tribe, 
(4) to include awards of reasonable attorneys fees and costs of 
litigation, (5) to prohibit denial of reimbursement on the basis of a 
different format or form.
    Current law: Section 403 allows an Indian Tribe or Tribal 
Organization to recover payment from third parties for health 
services provided to the same extent that an individual, or any 
nongovernmental provider of health services, would be eligible 
to receive damages, reimbursement, or indemnification. This 
right of recovery is extended against any State under certain 
conditions. Certain State or local laws are deemed 
nonapplicable to prevent or hinder this right of recovery. This 
section has no effect on private rights of action. Enforcement 
measures for the right of recovery are all specified in this 
section.

Section 404. Crediting of reimbursements

    This section maintains current law and adds language which 
identifies which programs are included in the reimbursements.
    Current law: Section 404 authorizes the retention of the 
reimbursements received from third parties and specifies the 
use of those amounts collected. This section also disallows any 
offset or limitation of amount obligated to any Service Unit, 
Indian Tribe or Tribal or Urban Indian Organization because of 
the receipt of reimbursements under this section.

Section 405. Purchasing health care coverage

    This section is new.
    New provisions: Section 405 allows funding to be used for 
purchasing health insurance for Indians or to be used for a 
tribal self-insurance plan and eliminates the study previously 
required to determine the feasibility of allowing Indian tribes 
to purchase managed care coverage for their members and the 
report to Congress on the study.

Section 406. Sharing arrangements with Federal agencies

    This section amends current law by (1) authorizing the 
Secretary to enter agreements for sharing of medical facilities 
with the Departments of Veterans Affairs and Defense, instead 
of merely examining the feasibility of entering the agreements, 
(2) requiring consultation with Indian tribes prior to entering 
the agreements, (3) require reimbursement to the IHS, tribes, 
or tribal organizations by the VA where VA eligible 
beneficiaries receive care from the IHS, tribes or tribal 
organizations, (4) eliminating the specific cross-utilization 
of services in Utah only (expanding it generally), and (5) 
authorizing the Director of IHS to enter into interagency 
agreements to assist in achieving parity in services for 
Indians.
    Current law: Section 406 authorizes the Secretary to 
examine the feasibility of entering agreements to share medical 
facilities and services with the Departments of Veterans 
Affairs and Defense. The Secretary shall not take action which 
would impair priority access to or quality of care for Indians 
at IHS or priority of veterans to care by the Veterans' 
Administration.

Section 407. Payor of last resort

    This section is new.
    New provision: Section 407 codifies long-standing policy 
and specifies that Indian Health Programs and health care 
programs operated by Urban Indian Organizations shall be the 
payor of last resort for services provided to eligible persons.

Section 408. Nondiscrimination in qualifications for reimbursement for 
        services

    This section is new.
    New provision: Section 408 codifies regulations under Title 
42 of the Code of Federal Regulations and deems entities that 
are operated by the Service, an Indian Tribe, Tribal 
Organization, or Urban Indian Organization to be licensed or 
recognized under State or local law to furnish such services, 
for purposes of receiving payment or reimbursement from any 
federally funded health care program so long as these entities 
meet all applicable standards for licensure.

Section 409. Consultation

    This section is new.
    New provision: Section 409 codifies the Centers for 
Medicaid and Medicare Services charter which recognized the 
Tribal Technical Advisory Group established to assist the 
Secretary in identifying and addressing issues affecting 
Indians in health care programs under the Social Security Act. 
It also encourages a State to establish a process to seek 
advice on a regular basis from designees of Indian Health 
Programs and Urban Indian Organizations.

Section 410. State Children's Health Insurance Program (SCHIP)

    This section is new.
    New provision: Section 410 allows the Secretary to enter 
arrangements with individual States to allow SCHIP funds for 
Indians to be provided to Indian Health Programs for providing 
child health assistance to targeted low-income Indian children, 
consistent with the purposes of SCHIP.

Section 411. Social Security Act sanctions

    This section is new.
    New provision: Section 411 allows Indian Health Programs to 
request a waiver of a sanction imposed against a health care 
provider in the event the State does not act upon a tribal 
request to the State to seek the waiver. A safe harbor clause 
from anti-kickback sanctions is included in this section for 
referrals, transactions or exchanges between and among Indian 
Health Care Programs.

Section 412. Cost sharing

    This section is new.
    New provisions: Section 412 addresses coinsurance, 
copayments, and deductibles, and exempts Indians from such cost 
sharing. Section 412 provides an exemption from premium 
payments for Indians eligible for Medicaid and SCHIP programs. 
Section 412 also excludes certain trust, restricted, cultural 
or subsistence Indian property from the Medicaid eligibility 
determinations or Medicaid estate recovery.

Section 413. Treatment under Medicaid managed care

    This section is new.
    New provisions: Section 413 specifies actions to be taken 
for payment for services furnished to Indians in Medicaid 
managed care programs. This section also allows Medicaid 
managed care programs to be offered by Indian Health Programs 
and provides the requirements for these programs.

Section 414. Navajo Nation Medicaid Agency feasibility study

    This section is new.
    New provisions: Section 414 requires the Secretary to 
conduct a study to determine the feasibility of treating the 
Navajo Nation as a State for Medicaid purposes. Considerations 
for and a report of the results of the study are described in 
this section.

Section 415. Authorization of appropriations

    This section maintains current law and extends the 
authorization for appropriations to fiscal year 2015.
    Current law: Section 415 authorizes appropriations of 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


Section 501. Purpose

    This section maintains current law and adds language to 
maintain and make health services available, in addition to 
being accessible to urban Indians.
    Current law: Section 1651 sets forth the purpose of the 
title which is to establish programs in urban center to make 
health care accessible to urban Indians.

Section 502. Contracts with, and grants to, urban Indian organizations

    This section maintains current law.
    Current law: Section 1652 sets forth the authority of the 
Secretary to enter contracts with or make grants to Urban 
Indian Organizations including prescribing the criteria for 
selecting urban Indian organizations and making recommendations 
for improving health programs for urban Indians.

Section 503. Contracts and grants for the provision of health care and 
        referral services

    This section maintainscurrent law.
    Current law: Section 1653 sets forth the standards, 
criteria and uses of funds for contracts and grants for health 
care services. The grants require that the urban Indian 
organization estimate the service population, health care needs 
and status of the urban Indians, provide basic health education 
and make recommendations for improving health programs. The 
grants may be made to provide outreach, educational, outpatient 
behavioral health services, develop innovative service delivery 
models, health promotion and immunization services.

Section 504. Contracts and grants for the determination of unmet health 
        care needs

    This section maintains current law.
    Current law: Section 1654 authorizes the Secretary to enter 
into contracts under the Snyder Act, 25 U.S.C. 13, to urban 
Indian organizations who does not have a contract under section 
1654. Section 1654 sets forth the standards, criteria and uses 
of funds for contracts and grants to determine unmet health 
care needs of urban Indians.

Section 505. Evaluations; renewals

    This section maintains current law and adds a provision 
which would allow the Secretary to evaluate the urban Indian 
organization through acceptance of evidence of the 
organization's accreditation as an alternative to the onsite 
annual evaluation.
    Current law: Section 1655 authorizes the Secretary to 
develop evaluation and renewal standards for the various 
contracts and grants. The Secretary shall also evaluate the 
urban Indian programs through onsite annual evaluations.

Section 506. Other contract and grant requirements

    This section maintains current law and adds provisions 
which would allow lump sum payments unless the urban Indian 
organization is not capable of administering the payments in 
their entirety and allows the funding to be carried forward.
    Current law: Section 1656 sets forth other specific 
contract and grant requirements such as payment methods, 
procurement and amendments.

Section 507. Reports and records

    This section maintains current law and (1) adds language 
which extends the reporting period to semi-annual, rather than 
quarterly, (2) adds the requirement of a minimum set of data 
using uniform elements and that the audits may also be 
conducted by a certified public accounting firm and (3) deletes 
the requirement that IHS and the Department of Interior report 
to Congress by March 31, 1992, on the health status, unmet 
needs and welfare of urban Indian children.
    Current law: Section 1657 sets forth certain reporting and 
recordkeeping requirements for Urban Indian Organizations.

Section 508. Limitation on contract authority

    This section maintains current law and adds language which 
includes authority to award grants.
    Current law: Section 1658 limits contracts to the amount of 
appropriations.

Section 509. Facilities

    This section maintains current law and adds provisions 
which would allow for leasing, purchasing, renovating, 
constructing and expanding, in addition to repairing, 
facilities and authorizes a study for a revolving loan fund to 
construct facilities.
    Current law: Section 1659 sets forth the various 
requirements governing the funding for urban health care 
facilities and authorizes the Secretary to make funds available 
to contractors or grant recipients to make minor renovations to 
the urban health facilities to meet or maintain compliance with 
the requirements of the Joint Commission on Accrediting Health 
Care Organizations.

Section 510. Division of urban Indian health

    This section maintains current law, but changes the Branch 
of Urban Indian programs into an Office within the IHS.
    Current law: Section 1660 establishes a Branch of Urban 
Indian Health within the IHS.

Section 511. Grants for alcohol and substance abuse related services

    This section maintains current law.
    Current law: Section 1660a authorizes the Secretary to make 
grants for alcohol and substance abuse services to urban Indian 
organizations. Section 511 also establishes criteria for 
alcohol and substance abuse grants.

Section 512. Treatment of certain demonstration projects

    This section maintains provisions which makes permanent 
certain demonstration projects in Oklahoma and requires them to 
meet the requirements of Title V, but will be treated as 
service units, and the funding shall not be subject to the 
ISDEAA.

Section 513. Urban NIAAA transferred programs

    This section maintains current law, but changes the date of 
the transfer from September 30, 2001 to September 30, 2008.
    Current law: Section 1660c authorizes the Secretary to 
transfer to Urban Indian Organizations alcohol programs that 
had been previously transferred to the Secretary.

Section 514. Consultation with urban Indian organizations

    This section is new.
    New provision: Section 514 establishes consultation 
requirements with Urban Indian Organizations including a 
definition of consultation.

Section 515. Federal Tort Claim Act coverage

    This section is new.
    New provision: Section 515 authorizes Urban Indian 
Organizations to be deemed an executive agency for Federal Tort 
Claim Act coverage.

Section 516. Urban youth treatment center demonstration

    This section is new.
    New provision: Section 516 authorizes the Secretary to fund 
at least 2 Indian youth treatment centers in certain states 
where urban centers are located.

Section 517. Use of Federal Government facilities and sources of supply

    This section is new.
    New provisions: Section 517 authorizes the Urban Indian 
Organizations to receive donations of Federal excess property 
and, for purposes of 40 CFR 501, and deems them to be executive 
agencies for access to the Federal sources of supply.

Section 518. Grants for diabetes prevention, treatment and control

    This section is new.
    New provisions: Section 518 authorizes the Secretary to 
make grants for diabetes prevention, treatment and control. 
Section 518 sets forth requirements and criteria for diabetes 
grants, such as the size and location of the urban Indian 
population, the need and performance standards.

Section 519. Community health representatives

    This section is new.
    New provision: Section 519 authorizes the Secretary to 
contract with the urban Indian organizations to provide 
community health representatives.

Section 520. Effective date

    This section is new.
    New provision: Section 520 establishes that the effective 
date for the amendments made by this Act begins on the date of 
enactment regardless of whether the Secretary has issued 
regulations.

Section 521. Eligibility for services

    This section is new.
    New provision: Section 521 establishes that urban Indians 
are the ultimate beneficiaries of the services under this 
title.

Section 522. Authorization of appropriations

    This section maintains current law and extends the 
authorization to fiscal year 2015.
    Current law: Section 522 authorizes appropriations through 
fiscal year 2015.

                 TITLE VI--ORGANIZATIONAL IMPROVEMENTS


Section 601. Establishment of the Indian Health Service as an agency of 
        the Public Health Service

    This section amends current law by changing the position of 
the Director into an Assistant Secretary.
    Current law: Section 1661 establishes the Indian Health 
Service within the Public Health Service of the Department, and 
the position of Director of the Indian Health Service who shall 
be confirmed by the Senate with a term of four years. The 
Director shall administer the Indian Health Service and the 
Director's duties and responsibilities are outlined in this 
section, including managing funds, entering contracts, all 
functions relating to the management of hospitals and 
facilities.

Section 602. Automated management information system

    This section maintains current law and adds Secretarial 
authority to enter contracts or joint ventures to enhance 
information technology in Indian health programs.
    Current law: Section 1662 requires the Secretary to 
establish an automated management information system for the 
Service and each Tribal Health Program. It requires that 
patients have access to their own health records.

Section 603. Authorization of appropriations

    This section maintains current law and extends the 
authorization to fiscal year 2015.
    Current law: Section 1663 authorizes appropriated funds in 
sums that may be necessary to carry out this title, for each 
fiscal year through fiscal year 2000.

                 TITLE VII--BEHAVIORAL HEALTH PROGRAMS


Section 701. Behavioral health prevention and treatment services

    This section maintains current law and adds language which 
(1) authorizes the Secretary, Indian tribes, tribal 
organizations, and urban Indian organizations to develop 
programs which emphasize collaboration for behavioral health, 
(2) requires technical assistance to Indian tribes, tribal and 
urban Indian organizations, (3) requires a continuum of care 
for behavioral health to the extent feasible including acute 
hospitalization, detoxification, and emergency shelter.
    Current law: Section 1621h and Section 1665 state the 
purposes of the section; requires the Secretary to encourage 
the development of plans for delivery of Indian mental Health 
Services; directs the Secretary to provide comprehensive mental 
health care programs; facilitates the governing body of any 
Indian Tribe, Tribal Organization, or Urban Indian Organization 
to establish community mental health plans; requires the 
Secretary to coordinate mental health planning; and directs the 
Secretary to assess the need, availability and cost for 
inpatient mental health care for Indians.

Section 702. Memoranda of agreement with the Department of the Interior

    This section maintains current law and adds language which 
requires the Secretary to update existing Memoranda of 
Agreement and adds tribal organizations and to consult with 
Indian tribes, tribal and urban Indian organizations in 
developing the Memoranda which shall be published in the 
Federal Register.
    Current law: Section 1621h(b) requires the Secretary to 
develop and enter memoranda of agreement with the Secretary of 
the Interior to, among other things, make a comprehensive 
assessment, coordination, and annual review of all the 
behavioral health care needs and services available or 
unavailable to Indians. Specific provisions that are required 
in this memorandum are delineated.

Section 703. Comprehensive Behavioral Health Prevention and Treatment 
        Program

    This section amends current law by changing the alcohol and 
substance abuse focus to comprehensive behavioral health and 
adds more specific types of treatment such as residential and 
intensive outpatient treatment and by requiring consent of 
Indian tribes to be served before the Secretary enters 
contracts with private or other public health providers to 
provide the services under this section.
    Current law: Section 1665a requires the Secretary to 
provide a program of comprehensive behavioral health, 
prevention, treatment, and aftercare. The Secretary may provide 
these services through Contract Health Services.

Section 704. Mental Health Technician Program

    This section maintains current law and adds the use and 
promotion of traditional health care practices.
    Current law: Section 1621h(g) establishes a mental health 
technician program within the Service, requiring high-standard 
paraprofessional training in mental health care, supervision 
and evaluation of technicians.

Section 705. Licensing requirement for mental health care workers

    This section maintains current law.
    Current law: Section 1621h(l) requires that any person 
employed as a psychologist, social worker, or marriage and 
family therapist, be licensed to provide those services or be 
supervised by one who is licensed.

Section 706. Indian women treatment programs

    This section maintains current law and adds language which 
requires the implementation of this section to be consistent 
with section 701, recognizes the behavioral health focus and 
requires consultation with Indian tribes and tribal 
organizations in establishing criteria for applications.
    Current law: Section 1665b authorizes funding to develop 
and implement a program of prevention, intervention, treatment, 
and relapse prevention services for alcohol and substance 
abuse, specifically addressing the cultural, historical, 
social, and childcare needs of Indian women. How funds are to 
be used is specified in this section, including the development 
of community training, counseling and prevention models.

Section 707. Indian Youth Program

    This section maintains current law and adds language which 
(1) requires implementation of this section to be consistent 
with section 701, (2) recognizes the behavioral health focus, 
(3) includes programs developed at the local tribal level, (4) 
includes treatment networks in addition to treatment programs, 
(5) includes sober or transitional housing in the intermediate 
adolescent services, (6) requires community reintegration as 
part of the rehabilitation and aftercare services, (7) 
establishes a program to prevent and treat multi-drug abuse and 
(8) requires the Secretary to collect data for an Indian youth 
mental health report.
    Current law: Section 1665c requires the development and 
implementation of a program for detoxification and 
rehabilitation of Indian youth. It also establishes alcohol and 
substance abuse treatment centers or facilities for Indian 
youth. Additional provisions addressed in this section are: 
intermediate adolescent behavioral health services; use of 
Federally owned structures; rehabilitation and aftercare 
services; inclusion of family in youth treatment programs; and 
a study for the feasibility of multi-drug abuse programs.

Section 708. Indian Youth Telemental Health Demonstration Project

    This section is new.
    New provisions: This section authorizes the Secretary to 
carry out a four-year demonstration project under which five 
Tribes, Tribal Organizations or Urban Indian Organizations with 
telehealth capabilities could use telemental health services in 
youth suicide prevention and treatment. In awarding the grants, 
the Secretary would give priority to Tribes, Tribal 
Organizations or Urban Indian Organizations serving a 
particular tribal community where there is a demonstrated need 
to address Indian youth suicide or which is isolated and has 
limited access to mental health services; entering into 
collaborative partnership to provide the services; or operating 
a detention facility at which youth are detained. The 
demonstration project would permit the use of telemedicine for 
psychotherapy, psychiatric assessments and diagnostic 
interviews of Indian youth; the provision of clinical expertise 
and other medical advice to frontline health care providers 
working with Indian youth; training and related support for 
community leaders, family members and health and education 
workers who work with Indian youth; the development of 
culturally relevant educational materials on suicide prevention 
and intervention; and data collection and reporting.

Section 709. Inpatient and community-based mental health facilities 
        design, construction, and staffing

    This section amends current law by requiring the 
establishment in each Area at least one inpatient mental health 
facility and determining that California shall be considered 
two Areas.
    Current law: Section 1621h(i) states within one year after 
enactment, the Secretary shall make an assessment of the need 
for inpatient mental health care facilities, including the 
conversion of under utilized hospital beds into psychiatric 
units to meet the needs.

Section 710. Training and community education

    This section maintains current law and adds language which 
authorizes the Indian tribes and tribal organizations to 
develop training and community education programs, defines 
community based training, adds child sexual abuse to the types 
of training authorized and recognizes the behavioral health 
focus.
    Current law: Section 1621h(d) requires that the Secretary, 
in cooperation with the Secretary of the Interior, provide 
either directly or through funding, a program of community 
education in the area of behavioral health. Specifics of 
instruction are delineated. This section also requires the 
Secretary to develop and provide community-based training 
models.

Section 711. Behavioral Health Program

    This section maintains current law and adds the tribal 
organizations as eligible recipients for funding under this 
section.
    Current law: Section 1621h allows for the development of 
innovative community-based behavioral health programs; suggests 
criteria to be used for funding such programs; and requires 
that the same criteria as used in evaluating other funding 
proposals be used for programs under this section.

Section 712. Fetal alcohol disorder programs

    This section maintains current law and adds language (1) 
requiring these programs to be implemented consistent with 
section 701, (2)consolidating fetal alcohol syndrome and fetal 
alcohol effects into fetal alcohol disorders (FAD), (3) authorizing 
appropriate psychological services, the development of early childhood 
intervention projects, supportive services, (4) including the National 
Institute for Child Health and Human Development and the Centers for 
Disease Control and Prevention in the national task force on FAD.
    Current law: Section 1665g authorizes the Secretary to 
establish fetal alcohol syndrome and effects programs, to 
include the development and provision of services for the 
prevention, intervention, treatment, and aftercare for those 
affected by fetal alcohol disorders in Indian communities. In 
addition a Fetal Alcohol Task Force is established to advise 
the Secretary. Funding is to be made available for applied 
research projects which propose to elevate the understanding of 
methods to prevent, intervene, treat or provide rehabilitation 
and aftercare for Indians affected by this disorder. Urban 
Indians are included and 10% of the funding is set aside for 
urban programs.

Section 713. Child sexual abuse and prevention treatment programs

    This section amends current law by (1) turning two specific 
demonstration projects into permanent programs, (2) authorizing 
services for Indian child victims of sexual abuse and 
perpetrators of child sexual abuse who are members of an Indian 
household, and (3) including authorized uses of funds such as 
developing community education, identifying and providing 
treatment to victims, developing culturally-sensitive 
prevention models and diagnostic tools, providing treatment to 
the perpetrators.
    Current law: Section 1680i establishes demonstration 
projects for Child Sexual Abuse and Prevention Treatment 
Programs through the Hopi Tribe and Sioux Tribes of the Fort 
Peck Reservation. The Secretary may establish other 
demonstration projects, but must have an equal number of 
projects for the Areas.

Section 714. Behavioral health research

    This section maintains current law and adds language which 
emphasizes the focus on behavioral health instead of only 
mental health problems.
    Current law: Section 1621h provides for funding for 
research on the incidence and prevalence of behavioral health 
problems among Indians. Research priorities are specified such 
as the interrelationship of mental disorders with alcoholism, 
suicide, homicide, and the incidence of family violence.

Section 715. Definitions

    This section is new.
    New provisions: Section 715 provides definitions for the 
following terms used in this title: assessment; alcohol-related 
neurodevelopmental disorders or ARND; behavioral health 
aftercare; dual diagnosis; fetal alcohol disorders; fetal 
alcohol syndrome or FAS; partial FAS; rehabilitation; and 
substance abuse.

Section 716. Authorization of appropriations

    This section maintains current law and extends the 
authorization to fiscal year 2015 and eliminates the exceptions 
for sections that had specific terms of authorization.
    Current law: Section 1621w authorizes such sums as may be 
necessary to carry out this section, for each fiscal year 
through fiscal year 2000, except for section 703, 706, 708, 710 
and 711.

                       TITLE VIII--MISCELLANEOUS


Section 801. Reports

    This section maintains current law and adds provisions 
which either establish new reporting requirements or 
consolidates the information required in other sections in one 
organized list such as (1) requiring as part of the annual 
reports to Congress (a) comparisons of appropriations provided 
and required for parity in health services, (b) services 
provided under ISDEAA agreements, (c) information on the loan 
repayments, infectious diseases, environmental hazards, status 
of health care and sanitation facilities, sharing of services 
between the IHS and other federal agencies, and urban Indian 
programs.
    Current law: Section 1671 requires annual reports which 
outline the progress made in meeting health objectives, whether 
new national programs are needed, steps taken to consult with 
Indian tribes, separate statements for funding requested and 
obligated and other reporting requirements under this Act.

Section 802. Regulations

    This section is new.
    New provision: Section 802 sets forth the various 
requirements for regulations, including negotiated rule-making, 
for certain titles under this Act. Proposed regulations are 
required to be published in the Federal Register no later than 
270 days after enactment. This section authorizes a negotiated 
rule-making committee consisting of Indian tribes, tribal and 
urban Indian organizations.

Section 803. Plan of implementation

    This new section requires a plan of implementation of this 
Act to be submitted to Congress.

Section 804. Availability of funds

    This section maintains current law.
    Current law: Section 1675 authorizes funding to remain 
available until expended.

Section 805. Limitation on use of funds appropriated to the Indian 
        Health Service

    This section maintains current law.
    Current law: Section 1676 recognizes that any limitation 
contained in DHHS appropriations on the use of federal funds 
for abortions shall apply for that period with respect to use 
of IHS funds.

Section 806. Eligibility of California Indians

    This section maintains current law, but eliminates the 
Secretarial report developing data on the Indians located in 
California, health status and needs and other information.
    Current law: Section 1679 requires that until other federal 
law provides otherwise, Indians located in California shall be 
eligible for health services from under this Act, including 
members of federally-recognized tribes, descendants of Indians 
residing in California as of June 1, 1852, Indians holding 
trust interests in certain types of land, and Indians listed on 
the plans for asset distribution in California.

Section 807. Health services for ineligible persons

    This section maintains current law and adds language to 
include compacts, in addition to contracts, under the ISDEAA.
    Current law: Section 1680c authorizes services for certain 
ineligible persons under limited circumstances, including 
spouses or children of eligible Indians, non-Indian women 
carrying Indian babies, persons in need of emergency 
stabilization or prevention of communicable diseases, and 
outlines criteria for providing services such as requiring 
reimbursement and tribal approval.

Section 808. Reallocation of base services

    This section maintains current law.
    Current law: Section 1680g limits the reallocation of base 
funding upon certain requirements, such as reporting to 
Congress on the proposed changes and likely effects, the 
Secretary must fulfill.

Section 809. Results of demonstration projects

    This section maintains current law.
    Current law: Section 1680m requires that results of 
demonstration projects be made available to Indian tribes.

Section 810. Provision of services in Montana

    This section is new.
    Current law: Section 810 requires that services and 
benefits for Indians in Montana be provided consistent with the 
court decision McNabb v. Bowen, 829 F.2d 787 (9th Cir. 1987), 
but that this requirement shall not be construed as the sense 
of the Congress for Indians in any other state.

Section 811. Moratorium

    This section authorizes the Service to provide certain 
services according to eligibility criteria in effect on a 
certain date.

Section 812. Tribal employment

    This section is new.
    New provision: Section 812 recognizes the governmental 
purposes of health care by treating Indian tribes or tribal 
organizations not as an employer for certain purposes.

Section 813. Severability provisions

    This section retains remaining provisions if others are 
stricken by any court.

Section 814. Establishment of national bipartisan commission on Indian 
        health care

    This section is new.
    New provisions: Section 814 establishes a bi-partisan 
commission to study the delivery of health care services to 
Indians and sets forth (1) duties, such as holding hearings, 
consulting with Indian tribes, making recommendations and 
findings which have evaluated the needs, services available, 
costs and mechanisms for funding, (2) membership made up of 25 
members, 10 from Congress, 12 chosen by Congressional Members 
from each IHS Area and shall be members of federally-recognized 
tribes, 3 chosen by the Assistant Secretary for Indian Health, 
and (3) reporting requirements. This section (1) authorizes 
appointment of a Director and staff for the Commission, (2) 
establishes their compensation, and (3) authorizes details of 
federal employees, use of mails, technical assistance and 
administrative support services. This section authorizes $4 
million for the Commission.

Section 815. Appropriations; availability

    This section maintains current law subjects new spending 
authority to the availability of appropriations.

Section 816. Authorization of appropriations.

    This section maintains current law and extends the 
authorization to fiscal year 2015.
    Current law: Section 1680o authorizes appropriations 
through fiscal year 2000.

                       OTHER SECTIONS OF THE BILL

    Section 2(b). Indian Health Care Improvement Act amended.
    Section 2 of the bill is new.
    New provision: Section 2(b) also includes provisions 
amending other laws for the references to the ``Director of 
Indian Health Service'' which would be changed to ``Assistant 
Secretary for Indian Health''.
    Section 3. Soboba sanitation facilities. Section 3 of the 
bill retains current law.
    Current law: Section 3 authorizes sanitation facilities to 
the Soboba Band of Mission Indians, pursuant to the Act of 
December 17, 1970 (84 Stat. 1465).
    Section 4. Amendments to the Medicaid and State Children's 
Health Insurance Programs. Section 4 of the bill sets forth 
conforming amendments to the Social Security Act for Medicaid 
and State Children's Health Insurance Programs which authorize 
reimbursement to Indian Health Programs for medical assistance 
provided.
    Section 5. Native American Health and Wellness Foundation. 
Section 5 is new and sets forth amendments to the Indian Self-
Determination and Education Assistance Act to establish a 
Native American Health and Wellness Foundation in the following 
sections 801 to 803.

Section 801. Definitions

    This section sets forth definitions for the Foundation, the 
Foundation Board of Directors and establishment Committee.

Section 802. Native American Health and Wellness Foundation

    This section establishes the perpetual existence of the 
Foundation, the nature and duties of the Foundation and the 
place of incorporation. This section also authorizes the 
Secretary to establish an initial Committee to assist in 
establishing the Foundation. Section 802 establishes the 
authority of the Board of Directors, including their terms, the 
officers (including the extent of their liabilities) and the 
powers of the Foundation. This section also establishes limits 
on the administrative costs, audit requirements, and authorizes 
$500,000 for the fiscal years.

Section 803. Administrative services and support

    This section authorizes the Secretary to provide 
administrative support to the Foundation and initial operating 
funds on a reimbursement basis for up to five years.

                          Legislative History


                           LEGISLATIVE ACTION

    During the 109th Congress,\87\ Senator McCain introduced S. 
1057, the Indian Health Care Improvement Act Amendments of 
2005, on May 17, 2005, for himself and Senator Dorgan. The bill 
was referred to the Committee on Indian Affairs and reported 
favorably with amendments on October 27, 2005.
---------------------------------------------------------------------------
    \87\ Senate Report No. 108-411 provides a detailed chronology of 
the legislative activity that has occurred since the 106th Congress.
---------------------------------------------------------------------------
    On June 7, 2005, Senator Johnson was added as a cosponsor. 
On July 14, 2005, Senators Kennedy and Bingaman were added as 
cosponsors. On October 24, 2005, Senators Cantwell and Murray 
were added as cosponsors.

                          LEGISLATIVE HEARINGS

    The Committee has held nine hearings since the 106th 
Congress on the reauthorization of the Act.
    During the 109th Congress, on July 14, 2005, the Committee 
held a joint hearing with the Senate Committee on Health, 
Education, Labor and Pensions to reauthorize the IHCIA. The 
hearing addressed the need for reauthorization and several key 
issues, including negotiated rulemaking, Federal Tort Claim Act 
coverage and the DHAT program. The witnesses included DHHS, 
members of the National Steering Committee, tribal leaders and 
health providers and the American Dental Association.

            Committee Recommendation and Tabulation of Votes

    In an open business session on October 27, 2005, the 
Committee considered a substitute amendment proposed by Senator 
McCain and other amendments offered by Senators Dorgan, Crapo, 
Coburn, and McCain. The Committee adopted the amendment offered 
by Senator McCain by unanimous consent.
    The Committee adopted by voice vote the amendments offered 
by Senators Dorgan and Crapo. The Committee, by roll call vote, 
rejected the amendment offered by Senator Coburn. Then, by a 
unanimous vote, the Committee ordered the substitute amendment, 
as amended, favorably reported to the full Senate with the 
recommendation that the bill do pass.

               Regulatory and Paperwork 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 and paperwork impact that would be 
incurred in carrying out the bill. The Committee has concluded 
that S. 1057 will not require the promulgation of regulations 
so the regulatory and paperwork impact should be minimal.

                        Executive Communications

    The Committee has not received any formal communication on 
S. 1057 from the Administration other than the written 
testimony from the Department of Health and Human Services 
submitted at the Joint Hearing on S. 1057 on July 14, 2005, 
which is attached hereto as an Exhibit.

  Statement of Dr. Charles W. Grim, Director, Indian Health Service, 
                Department of Health and Human Services

    Mr. Chairmen and Members of the Committees:
    I am honored to testify before you today on the important 
issue of reauthorization of the Indian Health Care Improvement 
Act (IHCIA). Accompanying me today are Robert McSwain, Deputy 
Directory, Craig Vanderwagen, M.D., Acting Chief Medical 
Officer, and Gary Hartz, Director, Office of Environmental 
Health and Engineering.
    This landmark legislation forms the backbone of the system 
through which Federal health programs serve American Indians/
Alaska Natives and encourages participation of eligible 
American Indians/Alaska Natives in these and other programs.
    The IHS has the responsibility for the delivery of health 
services to more than 1.8 million Federally-recognized American 
Indians/Alaska Natives through a system of IHS, tribal, and 
urban (I/T/U) health programs based on judicial decisions and 
statutes. The mission of the agency is to raise the physical, 
mental, social, and spiritual health of American Indians/Alaska 
Natives to the highest levels, in partnership with the 
population we serve. The agency goal is to assure that 
comprehensive, culturally acceptable personal and public health 
services are available and accessible to the service 
population. Our foundation is to uphold the Federal 
government's responsibility to promote healthy American Indian 
and Alaska Native people, communities, and cultures and to 
honor and protect the inherent sovereign rights of Tribes.
    Two major statutes are at the core of the Federal 
government's responsibility for meeting the health needs of 
American Indians/Alaska Natives: The Snyder Act of 1921, P.L. 
67-85, and the Indian Health Care Improvement Act (IHCIA), P.L. 
94-437, as amended. The Snyder Act authorized regular 
appropriations for ``the relief of distress and conservation of 
health'' of American Indians/Alaska Natives. The IHCIA was 
enacted ``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.'' Like the Snyder Act, the IHCIA provides the 
authority for the Federal government programs that deliver 
health services to Indian people, but it also provides 
additional guidance in several areas. The IHCIA contains 
specific language addressing the recruitment and retention of 
health professionals serving Indian communities; the provision 
of health services; the construction, replacement, and repair 
of health care facilities; access to health services; and, the 
provision of health services for urban Indian people.


                            DHHS ACTIVITIES


    Since enactment of the IHCIA in 1976, statutory authority 
has substantially expanded programs and activities to keep pace 
with changes in healthcare services and administration. Federal 
funding for the IHCIA has contributed billions of dollars to 
improve the health status of American Indians/Alaska Natives. 
And, much progress has been made, particularly in the areas of 
infant and maternal mortality.
    The Department under this Administration's leadership 
reactivated the Intradepartmental Council on Native American 
Affairs (ICNAA) to provide for a consistent HHS policy when 
working with the more than 560 Federally recognized Tribes. 
This Council gives the IHS Director a highly visible role 
within the Department on Indian policy, where he serves as vice 
chairperson of the Council.
    The Department has also recently completed work ushering 
through a revised HHS Tribal consultation policy and involving 
Tribal leaders in the process. This new policy further 
emphasizes the unique government-to-government relationship 
between Indian Tribes and the Federal government and assists in 
improving services to the Indian community through better 
communications. Consultation may take place at many different 
levels. To ensure the active participation of Tribes in the 
development of its budget request, an HHS-wide budget 
consultation session is held annually. This meeting provides 
Tribes with an opportunity to meet directly with leadership 
from all Department agencies and identify their priorities for 
upcoming program requests. Last year, Tribes identified 
inflation and population growth as their top budget priorities 
and IHS's FY 2006 budget request included an increase of $80 
million for these items. Both the House and the Senate have 
included these increases in FY 2006 appropriations action, and 
we appreciate their efforts in this regard.
    Through the Centers for Medicare & Medicaid Services (CMS), 
a Technical Tribal Advisory Group was established which 
provides Tribes with a vehicle for communicating concerns and 
comments to CMS on Medicare, Medicaid and SCHIP policies 
impacting their members. And, the IHS has been vigilant about 
improving outcomes of Indian children and families with 
diabetes by increasing education and physical activity programs 
aimed at preventing and addressing the needs of those 
susceptible to, or struggling with, this potentially disabling 
disease.
    It is clear the Department has not been a passive observer 
of the health needs of eligible American Indians/Alaska 
Natives. Yet, we recognize that health disparities among this 
population do exist and are among some of the highest in the 
Nation for certain diseases (e.g., alcoholism, tuberculosis, 
diabetes, and injuries), and that improvements in access to IHS 
and other Federal and private sector programs will result in 
improved health status for Indian people.
    The IHCIA was enacted to provide basic primary and 
preventive services in recognition of the Federal government's 
unique relationship with members of Federally recognized 
Tribes. Members of Federally recognized Tribes are also 
eligible for other Federal health programs (such as Medicare, 
Medicaid and SCHIP), on the same basis as other Americans, and 
many also receive health care through employer-sponsored or 
other healthcare coverage.
    It is within the context of current law and programs, that 
we turn our attention to S. 1057.


                                S. 1057


    We are here today to discuss reauthorization of the IHCIA, 
and its impact on programs and services provided for in current 
law. Improving access to healthcare for all eligible American 
Indians and Alaska Natives is critical to the Department and a 
priority for all of those involved in the administration of 
these important programs. We, therefore, commend your interest 
and will note positive provisions in S. 1057. However, we will 
also note concern on provisions which may negatively impact our 
ability to provide needed access to services by establishing 
program mandates and burdensome requirements that may divert 
resources from important services. We hope to work with you to 
address these issues.
    The Department brings a keen awareness of the health care 
needs of Indian country and is supportive of reauthorization of 
the IHCIA. We support provisions that increase the flexibility 
of the Department to work with Tribes, to increase the 
availability of health care, including new approaches to 
delivering care, and to expand the range of options of health 
services available to eligible American Indians and Alaska 
Natives. Accordingly, I commend Congress for including in S. 
1057 various changes that respond to concerns raised in 
previous proposals. Some of these changes go a long way toward 
improving the ability of the Secretary to effectively manage 
the program within current budgetary resources.
    Moreover, I would like to note our particular interest in 
other provisions of S. 1057.
    In the area of behavioral health, title VII of S. 1057 
provides for the needs of Indian women and youth and expands 
behavioral health services to include a much needed child 
sexual abuse and prevention treatment program. The Department 
supports this effort, but opposes language in Sections 704, 
706, 711(b) and 712 that requires the establishment or 
expansion of specific additional services. The Department 
should be given the flexibility to provide for all Behavioral 
Health Programs in a manner that supports the local control and 
priorities of Tribes, and to address their specific needs 
within IHS overall budgetary levels.


              PROVISIONS RELATED TO MEDICARE AND MEDICAID


    In general, we believe the provisions of the bill that 
relate to the Medicaid and State Children's Health Insurance 
(SCHIP) programs should be considered by the authorizing 
committees and in a framework consistent with the FY 2006 
Budget Resolution and the Reconciliation process. As part of 
the larger Resolution and Reconciliation process, a Medicaid 
Commission was established to examine many aspects of that 
program. The Commission is charged with advising the Secretary 
on ways to modernize the Medicaid program so that it can 
provide high-quality health care to its beneficiaries in a 
financially sustainable way. Tribes are represented on the 
Commission through Secretary Leavitt's recent appointment of 
the Chair of the Centers for Medicaid and Medicaid Services 
Tribal Technical Advisory Group.


                         REPORTING REQUIREMENTS


    S. 1057 includes new requirements for reporting to Congress 
within the President's Budget. The IHS and HHS will work with 
Congress to provide the most complete and relevant information 
on IHS programs, activities, and performance. However, we 
recommend striking language that provides additional 
specificity about what should be included in the President's 
budget request.


                 INDIAN HEALTH PROFESSIONS SCHOLARSHIPS


    Currently, the scholarship program regularly consults with 
the I/T/U's to determine the priorities. Each year, the program 
sends letters to all tribal chairmen, tribal health directors, 
urban program directors, IHS clinical directors, and IHS 
headquarters offices. Through this communication, scholarship 
program staff will update the relevant parties regarding the 
health professions for which awards were made in the current 
year and ask for their recommendations for the professions for 
which awards should be made in the coming year. Recommendations 
are aggregated and reviewed with the Office of Public Health 
and the Office of Management Support to determine which 
professions will be funded for the coming year.
    New section 104(a)(2) proposes to allocate the program 
funding by formula to the twelve IHS areas. If allocation by 
formula is authorized Indian, students will not be given an 
opportunity to apply for a scholarship if their area does not 
receive adequate allocation and if their profession is not 
considered a priority in their area; e.g., dental hygienist, 
physical therapist, medical technology. This would even impact 
a medical student who has identified general surgery or general 
psychiatry as a specialty. They will not receive the 
scholarship, because it is not a priority or there are no 
positions available for these disciplines/specialties.
    We are concerned that the large areas will receive the 
greatest amount of appropriated funds, leaving the smaller 
areas with amounts sufficient to fund only a small portion of 
their health professional needs. If an area chooses to allocate 
the funds among the tribes within the area, funds available to 
many will be insufficient to support even one student.
    We recommend retaining the provision in current law which 
would maintain the national focus of the scholarship program to 
more appropriately meet the health professions needs of Indian 
country.


                  DIABETES EVALUATION AND COORDINATION


    The bill has eliminated the current requirement for an 
evaluation of the 20 model diabetes programs for effectiveness 
and for each Area to employ at least one diabetes control 
officer, commonly now known as the Area Diabetes Consultant/
Coordinator, to coordinate and manage on a full-time basis 
activities within the Area Office for the prevention, 
treatment, and control of diabetes. Area Diabetes Consultants/
Coordinators are critical to the ability of the Service to 
provide support to the local Indian health programs as they 
implement the Special Diabetes for Indians Program formula and 
competitive grants programs. The evaluation provision for the 
model diabetes programs also is important to ensure that this 
program's effectiveness is assessed to make sure it maintains a 
productive role in the context of the implementation of the 
Special Diabetes for Indians Program at the local level. Both 
the National Diabetes Program and the Tribal Leaders Diabetes 
Committee (TLDC) have advocated for Area Diabetes Consultant/
Coordinators.
    We recommend that the requirement to employ at least one 
diabetes control officer in each of the 12 areas, as well as 
the requirement to evaluate the effectiveness of services 
provided through model diabetes projects established under this 
section, be retained.


                         HEALTH CARE FACILITIES


    Sanitation facilities construction is conducted in 38 
States with Federally recognized Tribes who take ownership of 
the facilities to operate and maintain them once completed. 
There are 49 hospitals, 247 health centers, 5 school health 
centers, over 2000 units of staff housing, and 309 health 
stations, satellite clinics, and Alaska village clinics 
supporting the delivery of health care to Indian people.


           HEALTH CARE FACILITIES NEEDS ASSESSMENT AND REPORT


    New section 301(d)91) authorizes Government Accountability 
Office (GAO) to complete a report, after consultation with 
Tribes, on the needs for health care facilities construction, 
including renovation and expansion needs. However, efforts are 
currently underway to develop a complete description of need 
similar to what would be required by the bill. The plan is to 
base our future facilities construction priority system 
methodology application on a more complete listing of tribal 
and Federal facilities needs for delivery of health care 
services funded through the IHS. We will continue to explore 
with the Tribes less resource intensive means for acquiring and 
updating the information that would be required in these 
reports.
    We recommend the deletion of the reference to the 
Government Accountability Office undertaking the report because 
it would be redundant of and a setback for IHS's current 
efforts to develop an improved facilities construction 
methodology. This would allow the IHS to complete its new 
priority construction methodology which will address the future 
federal and tribal health facility needs.


       RETROACTIVE FUNDING OF JOINT VENTURE CONSTRUCTION PROJECTS


    New section 311(a)(1) would permit a tribe that has ``begun 
or substantially completed'' the process of acquisition of a 
facility to participate in the Joint Venture Program, 
regardless of government involvement or lack thereof in the 
facility acquisition. An agreement implies that all parties 
have participated in the development of a plan and have arrived 
at some kind of consensus regarding the actions to be taken. By 
permitting a tribe that has ``begun or substantially 
completed'' the process of acquisition or construction, the 
proposed provisions could force IHS to commit the government to 
support already completed actions that have not included the 
government in the review and approval process. We are concerned 
that this language could put the government in the position of 
accepting space that is inefficient or ineffective to operate 
and recommend that it be deleted.


              SANITATION FACILITIES DEFICIENCY DEFINITIONS


    New section 302(h)(4) provides definitions of the 
sanitation deficiencies used to identify and prioritize water 
and sewer projects in Indian country, which are ambiguous. As 
proposed deficiency level III could be interpreted to mean all 
methods of service delivery (including methods where water and 
sewer service is provided by hauling rather than through piping 
systems directly into the home) are adequate to meet the level 
III requirements and only the operating condition, such as 
frequent service interruptions, makes that facility deficient. 
This description assumes that water haul delivery systems and 
piped systems provide a similar level of service. We believe it 
is important to distinguish between the two.
    In addition, the definition for deficiency level V and 
deficiency level IV, through phrased differently, have 
essentially the same meaning. Level IV should refer to an 
individual home or community lacking either water or wastewater 
facilities, whereas, level V should refer to an individual home 
or community lacking both water and wastewater facilities.
    We recommend retaining current law as more appropriate for 
distinguishing the various levels of deficiencies which 
determine the allocation of existing resources.


            THRESHOLD CRITERIA FOR SMALL AMBULATORY PROGRAM


    New Section 305(b)(1) amends current law to set two minimum 
thresholds--one for number of patient visits and another for 
the number of eligible Indians. In order to be eligible under 
the criteria of S. 1057, a facility must provide at least 150 
patient visits annually in a service area with no fewer than 
1500 eligible Indians. Aside from the fact that these are both 
minimum thresholds and so somewhat contradictory, the new makes 
implementation difficult. First, the IHS cannot validate 
patient visits unless the applicant participates in the 
Resource Patient Management System (RPNS). Since some tribes do 
not participate in the RPMS, it is difficult to ensure a fair 
evaluation of all applicants. Second, the term ``eligible 
Indians'' refers to the census population figures, which cannot 
be verified, since they are based on the individual's statement 
regarding ethnicity. In order to make the language clear and 
equitable, the provision should provide one minimum threshold 
that can be validated.


        NEW NEGOTIATED RULEMAKING AND CONSULTATION REQUIREMENTS


    We are concerned about the remaining requirements for 
negotiated rulemaking and increased requirements for 
consultation in the bill because of the high cost and staff 
time associated with this approach. We are committed to our on-
going consultation with Tribes and urban Indian organizations 
under current Executive Orders, as well as promulgating 
regulations where necessary to carry out IHCIA using the 
procedures required by Chapter V of title 6, United States Code 
(commonly known as the Administrative Procedures Act).
    We have other objections to S. 1057, including, for 
example: new requirements using ``shall'' instead of ``may'' in 
provisions that will create budget pressures on current program 
activity; expansion of the scope of Federal Torts Claim 
Coverage for service provided to otherwise ineligible non-
Indians; expansion of authorities for Urban Indian 
Organizations; elimination of the term ``grant'' and 
replacement with the term ``funding''; and new provisions that 
contemplate the Secretary exercising authority through the 
Service, Tribes and Tribal Organizations which is not tied to 
agreements entered into under the Indian Self-Determination and 
Education Assistance Act (ISDEAA). The Administration may also 
have additional views on this legislation.
    I reiterate our commitment to working with you to 
reauthorize of the Indian Health Care Improvement Act, and the 
strengthening of Indian health care programs. I hope to work 
with this Committee and other Committees of the Congress, the 
National Tribal Steering Committee, and other representatives 
of Indian country to develop a bill that all stakeholders in 
these important programs can support. Again, I appreciate the 
opportunity to appear before you today to discuss this 
important legislative proposal. I will be pleased to try to 
answer any questions that you may have. Thank you.

                             Cost Estimates

    The Committee has not yet received the final cost estimate 
from the Congressional Budget Office.

                        Changes in Existing Law

    In compliance with subsection 12 of rule XXVI of the 
Standing Rules of the Senate, the Committee states that the 
enactment of S. 1057 will result in the following changes in 
existing law (existing law proposed to be omitted enclosed in 
black brackets, new language to be added in italic, and 
existing law in which no change is proposed shown in roman):

                      UNITED STATES CODE ANNOTATED

                           TITLE 25. INDIANS

                     CHAPTER 18--INDIAN HEALTH CARE


                           GENERAL PROVISIONS

Sec.
1. Short title; table of contents
1601. [Congressional f]Findings.
1602. Declaration of National Indian health [objectives] policy.
1603. Definitions.



 [SUBCHAPTER] TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT 
                        [PROFESSIONAL PERSONNEL]



1611. [Congressional statement of p]Purpose.
1612. Health [p]Professions [r]Recruitment [p]Program for Indians.
1613. Health [p]Professions [p]Preparatory [s]Scholarship [p]Program for 
          Indians.
1613a. Indian health professions scholarships.
105. American Indians into Psychology program. 
106. Scholarship programs for Indian Tribes. 
1614. Indian health service extern programs.
1615. Continuing education allowances.
1616. Community Health Representative Program.
1616a. Indian Health Service Loan Repayment Program.
1616a-1. Scholarship and [L]loan [R]repayment [R]recovery [F]fund.
1616b. Recruitment activities.
1616c. [Tribal] Indian recruitment and retention program.
1616d. Advanced training and research.
1616e. Quentin N. Burdick American Indians into [N]nursing program.
[1616e-1. Nursing school clinics.]
1616f. Tribal cultural orientation [culture and history.]
1616g. INMED Program.
1616h. Health training programs of community colleges.
[1616i. Additional incentives for health professionals.]
1616j. Retention bonus.
1616k. Nursing residency program.
1616l. Community Health Aide Program.
[1616m. Matching grants to tribes for scholarship programs.]
1616n. Tribal health program administration.
123. Health professional chronic shortage demonstration programs.
124. National Health Service Corps.
125. Substance abuse counselor education curricula demonstration 
          programs.
126. Behavioral health training and community education programs.
[1616o. University of South Dakota pilot program.]
1616p. Authorization of appropriations.



                 [SUBCHAPTER] TITLE II--HEALTH SERVICES



1621. Indian Health Care Improvement Fund.
1621a. Catastrophic [h]Health [e]Emergency [f]Fund.
1621b. Health promotion and disease prevention services.
1621c. Diabetes prevention, treatment, and control.
205. Shared services for long-term care.
[1621d. Hospice care feasibility study.]
[1621e. Reimbursement from certain third parties of costs of health 
          services.]
[1621f. Crediting of reimbursements.]
1621g. Health services research.
207. Mammography and other cancer screening.
[1621h. Mental health prevention and treatment services.]
[1621i. Managed care feasibility study.]
[1621j. California contract health services demonstration program.]
[1621k. Coverage of screening mammography.]
1621l. Patient travel costs.
1621m. Epidemiology centers.
1621n. Comprehensive [school] health education programs.
1621o. Indian [y]Youth [grant] [p]Program.
[1621p. American Indians Into Psychology Program.]
1621q. Prevention, control, and elimination of [tuberculosis] 
          communicable and infectious diseases. 
213. Authority for provision of other services.
214. Indian women's health care.
215. Environmental and nuclear health hazards.
216. Arizona as a contract health service delivery area.
216A. North Dakota and South Dakota as a contract health service 
          delivery area.
217. California contract health services program.
218. California as a contract health service delivery area.
219. Contract health services for the Trenton Service Area.
220. Programs operated by Indian Tribes and Tribal Organizations.
221. Licensing.
222. Notification of provision of emergency contract health services.
223. Prompt action on payment of claims.
[1621r. Contract health services payment study.]
[1621s. Prompt action on payment of claims.]
[1621t. Demonstration of electronic claims processing.]
1621u. Liability for payment.
[1621v. Office of Indian Women's Health Care.]
225. Office of Indian Men's Health.
1621w. Authorization of appropriations.
[1621x. Limitation on use of funds.]
[1622. Transferred.]



               [SUBCHAPTER] TITLE III--[HEALTH] FACILITIES



1631. Consultation; [closure] construction and renovation of facilities; 
          reports.
1632. [Safe water and sanitary waste disposal] Sanitation facilities.
1633. Preference to Indians and Indian firms.
1634. Expenditure of [non-Service] nonservice funds for renovation.
[1635. Repealed.]
1636. [Grant program] Funding for the construction, expansion, and 
          modernization of small ambulatory care facilities.
1637. Indian [h]Health [c]Care [d]Delivery [d]Demonstration [p]Project.
1638. Land transfer.
308. Leases, contracts, and other agreements.
309. Study on loans, loan guarantees, and loan repayment.
310. Tribal leasing.
311. Indian Health Service/tribal facilities joint venture program.
312. Location of facilities.
313. Maintenance and improvement of health care facilities.
314. Tribal management of Federally owned quarters.
[1638a. Authorization of appropriations.]
1638b. Applicability of Buy American requirement.
316. Other funding for facilities.
317. Authorization of appropriations.
[1638c. Contracts for personal services in Indian Health Service 
          facilities.]
[1638d. Credit to appropriations of money collected for meals at Indian 
          Health Service facilities.]



         [SUBCHAPTER III-A] TITLE IV--ACCESS TO HEALTH SERVICES



1641. Treatment of payments under [medicare program] Social Security Act 
          health care programs. 
[1642. Treatment of payments under medicaid program.]
[1643. Amount and use of funds reimbursed through medicare and medicaid 
          available to Indian Health Service.]
1644. Grants to and contracts with the Service, Indian Tribes, [t]Tribal 
          [o]Organizations, and Urban Indian Organizations.
403. Reimbursement from certain third parties of costs of health 
          services.
404. Crediting of reimbursements.
405. Purchasing health care coverage.
406. Sharing arrangements with Federal agencies.
407. Payor of last resort.
408. Nondiscrimination in qualifications for reimbursement for services.
409. Consultation.
410. State children's health insurance program (SCHIP).
411. Social Security Act sanctions.
412. Cost sharing.
413. Treatment under medicaid managed care.
414. Navajo nation medicaid agency feasibility study.
[1645. Direct billing of Medicare, Medicaid, and other third party 
          payors.]
[1646. Authorization for emergency contract health services.]
1647. Authorization of appropriations.



       [SUBCHAPTER IV] TITLE V--HEALTH SERVICES FOR URBAN INDIANS



1651. Purpose.
1652. Contracts with, and grants to, [u]Urban Indian [o]Organizations.
1653. Contracts and grants for the provision of health care and referral 
          services.
1654. Contracts and grants for the determination of unmet health care 
          needs.
1655. Evaluations; renewals.
1656. Other contract and grant requirements.
1657. Reports and records.
1658. Limitation on contract authority.
1659. Facilities [renovation].
1660. Division of Urban Indian Health [Programs Branch].
1660a. Grants for alcohol and substance abuse-related services.
1660b. Treatment of certain demonstration projects.
1660c. Urban NIAAA transferred programs.
514. Consultation with Urban Indian Organizations.
515. Federal Tort Claim Act coverage.
516. Urban youth treatment center demonstration.
517. Use of Federal government facilities and sources of supply.
518. Grants for diabetes prevention, treatment, and control.
519. Community health representatives.
520. Effective date.
521. Eligibility for services.
1660d. Authorization of appropriations.



          [SUBCHAPTER V] TITLE VI--ORGANIZATIONAL IMPROVEMENTS



1661. Establishment of the Indian Health Service as an agency of the 
          Public Health Service.
1662. Automated management information system.
1663. Authorization of appropriations.



 [SUBCHAPTER V--A--SUBSTANCE ABUSE] TITLE VII_BEHAVIORAL HEALTH PROGRAMS



[1665. Indian Health Service responsibilities.]
[1665a. Indian Health Service program.]
701. Behavioral health prevention and treatment services.
702. Memoranda of agreement with the Department of the Interior.
703. Comprehensive behavioral health prevention and treatment program.
704. Mental health technician program.
705. Licensing requirement for mental health care workers.
1665b. Indian women treatment programs.
1665c. Indian [Health Service y]Youth [p]Program.
708. Indian youth telemental health demonstration project.
709. Inpatient and community-based mental health facilities design, 
          construction, and staffing.
1665d. Training and community education.
[1665e. Gallup alcohol and substance abuse treatment center.]
[1665f. Reports.]
711. Behavioral health program.
1665g. Fetal alcohol [syndrome and fetal alcohol effect grants] disorder 
          programs. 
[1665h. Pueblo substance abuse treatment project for San Juan Pueblo, 
          New Mexico.]
[1665i. Thunder Child Treatment Center.]
[1665j. Substance abuse counselor education demonstration project.]
[1665k. Gila River alcohol and substance abuse treatment facility.]
[1665l. Alaska Native drug and alcohol abuse demonstration project.]
713. Child sexual abuse and prevention treatment programs.
714. Behavioral health research.
715. Definitions.
1665m. Authorization of appropriations.



                [SUBCHAPTER VI] TITLE VIII--MISCELLANEOUS



1671. Reports.
1672. Regulations.
[1673. Repealed.]
[1674. Leases with Indian tribes.]
803. Plan of implementation.
1675. Availability of funds.
1676. Limitation on use of funds appropriated to the Indian Health 
          Service.
[1677. Nuclear resource development health hazards.]
[1678. Arizona as a contract health service delivery area.]
1679. Eligibility of California Indians.
[1680. California as a contract health service delivery area.]
[1680a. Contract health facilities.]
[1680b. National Health Service Corps.]
1680c. Health services for ineligible persons.
[1680d. Infant and maternal mortality; fetal alcohol syndrome.]
[1680e. Contract health services for the Trenton Service Area.]
[1680f. Indian Health Service and Department of Veterans Affairs health 
          facilities and services sharing.]
1680g. Reallocation of base resources.
[1680h. Demonstration projects for tribal management of health care 
          services.]
[1680i. Child sexual abuse treatment programs.]
[1680j. Tribal leasing.]
[1680k. Home- and community-based care demonstration project.]
[1680l. Shared services demonstration project.]
1680m. Results of demonstration projects.
810. Provision of services in Montana.
811. Moratorium.
812. Tribal employment.
813. Severability provisions.
814. Establishment of National Bipartisan Commission on Indian Health 
          Care.
815. Appropriations; availability.
[1680n. Priority for Indian reservations.]
1680o. Authorization of appropriations.
[1681. Omitted.]
[1682. Subrogation of claims by Indian Health Service.]
[1683. Indian Catastrophic Health Emergency Fund.]

                           GENERAL PROVISIONS


Sec. 1601. [Congressional f]Findings

    [The] Congress makes the following findings:
          [(a)] (1) Federal health services to maintain and 
        improve the health of the Indians are consonant with 
        and required by the Federal Government's historical and 
        unique legal relationship with, and resulting 
        responsibility to the American Indian people.
          [(b)] (2) A major national goal of the United States 
        is to provide the quantity and quality of health 
        services which will permit the health status of Indians 
        to be raised to the highest possible level and to 
        encourage the maximum participation of Indians in the 
        planning and management of those services.
          [(c)] (3) Federal health services to Indians have 
        resulted in a reduction in the prevalence and incidence 
        of preventable illnesses among, and unnecessary and 
        premature deaths of, Indians.
          [(d)] (4) Despite such services, the unmet health 
        needs of [the American] Indians [people] are severe and 
        the health status of the Indians is far below that of 
        the general population of the United States.

Sec. 1602. Declaration of [health objectives] National Indian Health 
                    Policy

    [(a) The] Congress [hereby] declares that it is the policy 
of this Nation, in fulfillment of its special trust 
responsibilities and legal obligations to [the American] 
Indians.--[people,]
          (1) 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 death 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 to 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 
        postSE 1)partum 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 1671 of this title, a report on the 
progress made in each area of the Service toward meeting each 
of the objectives described in subsection (b) of this section.]
          (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. 1603. Definitions

    For purposes of this [chapter] 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 health prevention and treatment, for 
        the purpose of providing comprehensive services. This 
        definition can include the joint development of 
        substance abuse and mental health treatment planning 
        and coordinated case management using a 
        multidisciplinary approach.
          (5) The term `California Indians' means those Indians 
        who are eligible for health services of the Service 
        pursuant to section 806.
          (6) The term `community college' means--
                  (A) a tribal college or university, or
                  (B) a junior or community college.
          (7) The term `contract health service' means health 
        services provided at the expense of the Service or a 
        Tribal Health Program by public or private medical 
        providers or hospitals, other than the Service Unit or 
        the Tribal Health Program at whose expense the services 
        are provided.
          (8) The term `Department' means, unless otherwise 
        designated, the Department of Health and Human 
        Services.
          (9) The term `disease prevention' means the 
        reduction, limitation, and prevention of disease and 
        its complications and reduction in the consequences of 
        disease, including--
                  (A) controlling--
                          (i) development of diabetes;
                          (ii) high blood pressure;
                          (iii) infectious agents;
                          (iv) injuries;
                          (v) occupational hazards and 
                        disabilities;
                          (vi) sexually transmittable diseases; 
                        and
                          (vii) toxic agents; and
                  (B) providing--
                          (i) fluoridation of water; and
                          (ii) immunizations.
          (10) The term `health profession' means allopathic 
        medicine, family medicine, internal medicine, 
        pediatrics, geriatric medicine, obstetrics and 
        gynecology, podiatric medicine, nursing, public health 
        nursing, dentistry, psychiatry, osteopathy, optometry, 
        pharmacy, psychology, public health, social work, 
        marriage and family therapy, chiropractic medicine, 
        environmental health and engineering, allied health 
        professions, and any other health profession.
          (11) The term `health promotion' means--
                  (A) fostering social, economic, 
                environmental, and personal factors conducive 
                to health, including raising public awareness 
                about health matters and enabling the people to 
                cope with health problems by increasing their 
                knowledge and providing them with valid 
                information;
                  (B) encouraging adequate and appropriate 
                diet, exercise, and sleep;
                  (C) promoting education and work in 
                conformity with physical and mental capacity;
                  (D) making available 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--
                          (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 relating to the 
                        elimination, reduction, and prevention 
                        of contaminants that 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).
          (12) The term `Indian', unless otherwise designated, 
        means any person who is a member of an Indian Tribe or 
        is eligible for health services under section 806, 
        except that, for the purpose of section 102 and 104, 
        the term also means any individual who--
                  (A)(i) irrespective of whether the individual 
                lives on or near a reservation, is a member of 
                a tribe, band, or other organized group of 
                Indians, including those tribes, bands, or 
                groups terminated since 1940 and those 
                recognized now or in the future by the State in 
                which they reside; or
                  (ii) is a descendant, in the first or second 
                degree, or any such member;
                  (B) is an Eskimo or Aleut or other Alaska 
                Native;
                  (C) is considered by the Secretary of the 
                Interior to be an Indian for any purpose; or
                  (D) is determined to be an Indian under 
                regulations promulgated by the Secretary.
          (13) The term `Indian Health Program' means--
                  (A) any health program administered directly 
                by the Service;
                  (B) any Tribal Health Program; or
                  (C) any Indian Tribe or Tribal Organization 
                to which the Secretary provides funding 
                pursuant to section 23 of the Act of June 25, 
                1910 (25 U.S.C. 47), (commonly known as the 
                `Buy Indian Act').
          (14) The term `Indian Tribe' has the meaning given 
        the term in the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.).
          (15) The term `junior or community college' has the 
        meaning given the term by section 312(e) of the Higher 
        Education Act of 1965 (20 U.S.C. 1058(e)).
          (16) The term `reservation' means any federally 
        recognized Indian Tribe's reservation, Pueblo, or 
        colony, including former reservations in Oklahoma, 
        Indian allotments, and Alaska Native Regions 
        established pursuant to the Alaska Native Claims 
        Settlement Act (25 U.S.C. 1601 et seq.).
    [(a)](17) The term [``]`Secretary['']' , unless otherwise 
designated, means the Secretary of Health and Human Services.
    [(b)](18) The term [``]`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) of this section, except 
that, for the purpose of sections 1612 and 1613 of this title, 
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) [43 U.S.C.A. Sec. 1601 et seq.], 
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.]
          (19) The term `Service Area' means the geographical 
        area served by each Area Office.
          (20) The term `Service Unit' means an administrative 
        entity of the Service, or a Tribal Health Program 
        through which services are provided, directly or by 
        contract, to eligible Indians within a defined 
        geographic area.
          (21) The term `telehealth' has the meaning given the 
        term in section 330K(a) of the Public Health Service 
        Act (42 U.S.C. 254c-16(a)).
          (22) The term `telemedicine' means a 
        telecommunications link to an end user through the use 
        of eligible equipment that electronically links health 
        professionals or patients and health professionals at 
        separate sites in order to exchange health care 
        information in audio, video, graphic, or other format 
        for the purpose of providing improved health care 
        services.
          (23) The term `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 in the 
        promotion, restoration, preservation, and maintenance 
        of health, well-being, and life's harmony.
          (24) 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)).
          (25) The term `Tribal Health Program' means an Indian 
        Tribe or Tribal Organization that operates any health 
        program, service, function, activity, or facility 
        funded, in whole or part, by the Service through, or 
        provided for in, a contract or compact with the Service 
        under the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.).
          (26) 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.).
          (27) 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.
          [(f) ``] (28) The term `Urban Indian['']' means any 
        individual who resides in an [u]Urban [c]Center [, as 
        defined in subsection (g) of this section,] and who 
        meets [one] 1 or more of the [four] following criteria: 
        [in subsection (c)(1) through (4) of this section.]
                  (A) Irrespective of whether the individual 
                lives on or near a reservation, the individual 
                is a member of a tribe, band, or other 
                organized group of Indians, including those 
                tribes, bands, or groups terminated since 1940 
                and those tribes, bands, or groups that are 
                recognized by the States in which they reside, 
                or who is a descendant in the first or second 
                degree of any such member.
                  (B) The individual is an Eskimo, Aleut, or 
                other Alaska Native.
                  (C) The individual is considered by the 
                Secretary of the Interior to be an Indian for 
                any purpose.
                  (D) The individual is determined to be an 
                Indian under regulations promulgated by the 
                Secretary.
          (29) 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).
    [(g) ``Urban center'' means any community which has a 
sufficient urban Indian population with unmet health needs to 
warrant assistance under subchapter IV of this chapter, 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 1653(a) of this title.]
    [(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 [25 U.S.C.A. 
        Sec. 450f et seq.],]
[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.]

 [SUBCHAPTER] TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT 
                        [PROFESSIONAL PERSONNEL]

Sec. 1611. [Congressional statement of p]Purpose

    The purpose of this [subchapter] 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 [adequate] optimum supply of health professionals to the 
Indian Health Programs [Service, Indian tribes, tribal 
organizations,] and [u]Urban Indian [o]Organizations involved 
in the provision of health care to Indians [people].

Sec. 1612. Health P[p]rofessions R[r]ecruitment P[p]rogram for Indians

    (a) [Grants for education and training] In General.--The 
Secretary, acting through the Service, shall make grants to 
public or nonprofit private health or educational entities, 
Tribal Health Programs, or Urban Indian Organizations [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 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) [of this subsection].
    (b) [Application for grant; submittal and approval; 
preference; payment] Funding._
          (1) Application._The Secretary shall not make a grant 
        under this section [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 pursuant to this Act. The 
        Secretary shall give a preference to applications 
        submitted by Tribal Health Programs or Urban Indian 
        Organizations [Indian tribes or tribal organizations].
          (2) Amount of grants; payment.--The amount of a [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.] provided 
        for in regulations issued pursuant to this Act. To the 
        extentnot otherwise prohibited by law, funding 
commitments shall be for 3 years, as provided in regulations issued 
pursuant to this Act.

Sec. 1613. Health P[p]rofessions P p]reparatory S s]cholarship 
                    P p]rogram for Indians

    (a) [Requirements] Scholarships Authorized.--The Secretary, 
acting through the Service, shall provide scholarship [make 
scholarship] grants to Indians who--
          (1) have successfully completed their high school 
        education or high school equivalency; and
          (2) have demonstrated the potential [capability] to 
        successfully complete courses of study in the health 
        professions.
    (b) Purposes.--[and duration of grants; preprofessional and 
pregraduate education] Scholarship grants provided [grants 
made] pursuant to this section shall be for the following 
purposes:
          (1) Compensatory preprofessional education of any 
        recipient [grantee], such scholarship not to exceed 
        [two] 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 [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)]. 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) [Covered expenses] Other Conditions.--Scholarships 
[grants made] under this section--
          (1) may cover costs of tuition, books, 
        transportation, board, and other necessary related 
        expenses of a recipient [grantee] 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.
    [(d) Basis for denial of assistance]
    [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) Eligibility for assistance under other Federal 
programs]
    [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.]

Sec. 1613a. Indian H[h]ealth P p]rofessions S s]cholarships

    (a) In General.-- [authority]
          (1) Authority.--[In order to provide health 
        professionals to Indians, Indian tribes, tribal 
        organizations, and urban Indian organizations, t]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 Services Act (42 
        U.S.C. 254l) [of Title 42], except as provided in 
        subsection (b) of this section.
          (2) Determinations by secretary.--The Secretary, 
        acting through the Service, shall determine--
                  (A) who shall receive scholarship grants 
                under subsection (a); and
                  (B) the distribution of the scholarships 
                among health professionals on the basis of the 
                relative needs of Indians for additional 
                service in the health professions.
          (3) Certain delegation not allowed.--The 
        administration of this section shall be a 
        responsibility of the Assistant Secretary and shall not 
        be delegated in a contract or compact under the Indian 
        Self-Determination and Education Assistance Act (25 
        U.S.C. 450 et seq.).
    (b) [Recipients; a]Active D[d]uty S[s]ervice 
O[o]bligation.--
          [(1) The Secretary, acting through the Service, shall 
        determine who shall receive scholarships under 
        subsection (a) of this section 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) of this section in any 
        year in which such individual is enrolled full or part 
        time in a course of study referred to in subsection (a) 
        of this section.]
           (1)[(3)(A)] Obligation met.--The [A]active duty 
        service obligation under a written contract with the 
        Secretary under this section [of Title 42] that an 
        [individual] 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 1 or more of the following:[--]
                  (A)[(i) i]In an [the] Indian Health Program. 
                [Service;]
                  [(ii) in a program conducted under a contract 
                entered into under the Indian Self-
                Determination Act [25 U.S.C.A. Sec. 450f et 
                seq.];]
                  (B)[(iii) i]In a program assisted under title 
                V [subchapter IV] of this Act. [chapter;]
                  (C)[(iv) i]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]
                  (D) In a teaching capacity in a tribal 
                college or university nursing program (or a 
                related health profession program) if, as 
                determined by the Secretary, the health service 
                provided to Indians would not decrease.
          (2)[(B)] Obligation deferred.--At the request of any 
        individual who has entered into a contract referred to 
        in paragraph (1) [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:
                  (A)[(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 
                subsection.
                  (B)[(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).
                  (C)[(iii)] The active duty service obligation 
                will be served in the health profession of that 
                individual[,] in a manner consistent with 
                paragraph (1) [clauses (i) through (v) of 
                subparagraph (A)].
                  (D)[(C)] A recipient of a[n Indian Health 
                S]scholarship under this section may, at the 
                election of the recipient, meet the active duty 
                service obligation described in paragraph (1) 
                [subparagraph (A)] by service in a program 
                specified under [in] that paragraph 
                [subparagraph] that--
                          (i) is located on the reservation of 
                        the Indian T[t]ribe in which the 
                        recipient is enrolled; or
                          (ii) serves the Indian T[t]ribe in 
                        which the recipient is enrolled.
          (3)[(D)] Priority when making assignments.--Subject 
        to paragraph (2) [subparagraph (C)], the Secretary, in 
        making assignments of Indian Health Scholarship 
        recipients required to meet the active duty service 
        obligation described in paragraph (1) [subparagraph 
        (A)], shall give priority to assigning individuals to 
        service in those programs specified in paragraph (1) 
        [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.
    (c)[(4)] Part-Time Students.--In the case of an individual 
receiving a scholarship under this section who is enrolled part 
time in an approved course of study--
          (1)[(A)] such scholarship shall be for a period of 
        years not to exceed the part-time equivalent of 4 
        years, as determined by the Area Office [Secretary];
          (2)[(B)] the period of obligated service described in 
        subsection (b)(1) [paragraph (3)(A)] shall be equal to 
        the greater of--
                  (A)[(i)] the part-time equivalent of 1[one] 
                year for each year for which the individual was 
                provided a scholarship (as determined by the 
                Area Office [Secretary]); or
                  (B)[(ii) two] 2 years; and
          (3)[(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)) [of Title 42] 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 2005 if that individual--
          [(5)(A) An individual who has, on or after October 
        29, 1992, entered into a written contract with the 
        Secretary under this section and who--]
                  (A)[(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)[,];
                  (B)[(ii)] is dismissed from such educational 
                institution for disciplinary reasons[,];
                  (C)[(iii)] 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)[(iv)] 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[, shall be liable 
                to the United States for the amount which has 
                been paid to him, on his behalf, under the 
                contract].
          (2)[(B)] Other breaches.--If for any reason not 
        specified in paragraph (1) [subparagraph (A)] an 
        individual breaches a [his] written contract by failing 
        either to begin such individual's service obligation 
        required under such contract [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 110 [1616a of 
        this title] in the manner provided for in such 
        subsection.
          (3)[(C)] Cancellation upon death of recipient.--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.
          (4)[(D)] Waivers and suspensions._
                  (A) In general.--The Secretary shall provide 
                for the partial or total waiver or suspension 
                of any obligation of service or payment of a 
                recipient of an Indian Health Scholarship if 
                the Secretary, in consultation with the 
                affected Area Office, Indian Tribes, Tribal 
                Organizations, and Urban Indian Organizations, 
                determines that--
                          (i) it is not possible for the 
                        recipient to meet that obligation or 
                        make that payment;
                          (ii) requiring that recipient to meet 
                        that obligation or make that payment 
                        would result in extreme hardship to the 
                        recipient; or
                          (iii) the enforcement of the 
                        requirement to meet the obligation or 
                        make the payment would be 
                        unconscionable.
                  (B) Factors for consideration.--Before 
                waiving or suspending an obligation of service 
                or payment under subparagraph (A), the 
                Secretary may take into consideration whether 
                the obligation may be satisfied in a teaching 
                capacity at a tribal college or university 
                nursing program under subsection (b)(1)(D).
          (5)[(E)] 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)[(F)] 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 
        [T]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) Placement Office]
    [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 254m of 
Title 42 without regard to any competitive personnel system, 
agency personnel limitation, or Indian preference policy.]

Sec. 105. American Indians into Psychology Program

    (a) Grants Authorized.--The Secretary, acting through the 
Service, shall make grants of not more than $300,000 to each of 
9 colleges and universities for the purpose of developing and 
maintaining Indian psychology career recruitment programs as a 
means of encouraging Indians to enter the behavioral health 
field. These programs shall be located at various locations 
throughout the country to maximize their availability to Indian 
students and new programs shall be established in different 
locations from time to time.
    (b) Quentin N. Burdick Program Grant.--The Secretary shall 
provide a grant authorized under subsection (a) to develop and 
maintain a program at the University of North Dakota to be 
known as the `Quentin N. Burdick American Indians Into 
Psychology Program'. Such program shall, to the maximum extent 
feasible, coordinate with the Quentin N. Burdick Indian Health 
Programs authorized under section 117(b), the Quentin N. 
Burdick American Indians Into Nursing Program authorized under 
section 115(e), and existing university research and 
communications networks.
    (c) Regulations.--The Secretary shall issue regulations 
pursuant to this Act for the competitive awarding of grants 
provided under this section.
    (d) Conditions of Grant.--Applicants under this section 
shall agree to provide a program which, at a minimum--
          (1) provides outreach and recruitment for the health 
        professions to Indian communities including elementary, 
        secondary, and accredited and accessible community 
        colleges that will be served by the program;
          (2) incorporates a program advisory board comprised 
        of representatives from the tribes and communities that 
        will be served by the program;
          (3) provides summer enrichment programs to expose 
        Indian students to the various fields of psychology 
        through research, clinical, and experimental 
        activities;
          (4) provides stipends to undergraduate and graduate 
        students to pursue a career in psychology;
          (5) develops affiliation agreements with tribal 
        colleges and universities, the Service, university 
        affiliated programs, and other appropriate accredited 
        and accessible entities to enhance the education of 
        Indian students;
          (6) to the maximum extent feasible, uses existing 
        university tutoring, counseling, and student support 
        services; and
          (7) to the maximum extent feasible, employs qualified 
        Indians in the program.
    (e) Active Duty Service Requirement.--The active duty 
service obligation prescribed under section 338C of the Public 
Health Service Act (42 U.S.C. 254m) shall be met by each 
graduate who receives a stipend described in subsection (d)(4) 
that is funded under this section. Such obligation shall be met 
by service--
          (1) in an Indian Health Program;
          (2) in a program assisted under title V of this Act; 
        or
          (3) in the private practice of psychology if, as 
        determined by the Secretary, in accordance with 
        guidelines promulgated by the Secretary, such practice 
        is situated in a physician or other health professional 
        shortage area and addresses the health care needs of a 
        substantial number of Indians.
    (f) Authorization of Appropriations.--There is authorized 
to be appropriated to carry out this section $2,700,000 for 
each of fiscal years 2006 through 2015.

Sec. 106. Scholarship programs for Indian tribes

    (a) In General.--
          (1) Grants authorized.--The Secretary, acting through 
        the Service, shall make grants 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 a grant under 
        paragraph (1) shall be in such form and contain such 
        agreements, assurances, and information as consistent 
        with this section.
    (b) Requirements.--
          (1) In general.--A Tribal Health Program receiving a 
        grant under subsection (a) shall provide scholarships 
        to Indians in accordance with the requirements of this 
        section.
          (2) Costs.--With respect to costs of providing any 
        scholarship pursuant to subsection (a)--
                  (A) 80 percent of the costs of the 
                scholarship shall be paid from the funds made 
                available pursuant to subsection (a)(1) 
                provided to the Tribal Health Program; and
                  (B) 20 percent of such costs may be paid from 
                any other source of funds.
    (c) Course of Study.--A Tribal Health Program shall provide 
scholarships under this section only to Indians enrolled or 
accepted for enrollment in a course of study (approved by the 
Secretary) in 1 of the health professions contemplated by this 
Act.
    (d) Contract.--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)), 
                        with such amount to be reduced pro rata 
                        (as determined by the Secretary) based 
                        on the number of hours such student is 
                        enrolled; and not to exceed, for any 
                        year of attendance for which the 
                        scholarship is provided, the total 
                        amount required for the year for the 
                        purposes authorized in this clause; and
                  (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 informationreceived 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. 1614. Indian H[h]ealth S[s]ervice E[e]xtern P[p]rograms

    (a) Employment Preference.--[of scholarship grantees during 
nonacademic periods] 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._
    [Any individual who receives a scholarship grant pursuant 
to section 1613a of this title 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].
    (c) Timing; Length of Employment._
    [(b) Employment of medical and other students during 
nonacademic periods]
    Any individual enrolled in a program, including a high 
school program, authorized under section 102(a) [course of 
study in the health professions] 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] [one hundred and twenty] days during any 
calendar year.
    (d) Nonapplicability of Competitive Personnel System._
    [(c) Employment without regard to competitive personnel 
system or agency personnel limitation; compensation]
    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].

Sec. 1615. Continuing E[e]ducation A[a]llowances

    [(a) Discretionary authority; scope of activities]
    In order to encourage health professionals, including 
community health representatives and emergency medical 
technicians, [physicians, dentists, nurses, and other health 
professionals] to join or continue in an Indian Health Program 
or an Urban Indian Organization [the Service] and to provide 
their services in the rural and remote areas where a 
significant portion of [the] Indians [people] reside[s], the 
Secretary, acting through the Service, may provide allowances 
to health professionals employed in an Indian Health Program or 
an Urban Indian Organization [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) Limitation]
    [Of amounts appropriated under the authority of this 
subchapter 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.]

Sec. 1616. Community Health Representative Program

    (a) In General.--Under the authority of the Act of November 
2, 1921 (25 U.S.C. 13) (commonly[, popularly] known as the 
(Snyder Act), the Secretary, acting through the Service, shall 
maintain a Community Health Representative Program under which 
Indian Health Programs [the Service]--
          (1) provide[s] for the training of Indians as 
        community health representatives; [health 
        paraprofessionals,] and
          (2) use[s] such community health representatives 
        [paraprofessionals] in the provision of health care, 
        health promotion, and disease prevention services to 
        Indian communities.
    (b) Duties.--The [Secretary, acting through the] Community 
Health Representative Program of the Service, shall--
          (1) provide a high standard of training for 
        [paraprofessionals to C]community [H]health 
        [R]representatives to ensure that the [C]community 
        [H]health [R]representatives provide quality health 
        care, health promotion, and disease prevention services 
        to the Indian communities served by [such] 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 
        [C]community [H]health [R]representatives for 
        continuing education in health care, health promotion, 
        and disease prevention, and develop [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 [t]Traditional [h]Health [c]Care 
        [p]Practices of the Indian [t]Tribes served consistent 
        with the Service standards for the provision of health 
        care, health promotion, and disease prevention.

Sec. 1616a. Indian Health Service Loan Repayment Program

    (a) Establishment.--
          [(1)] The Secretary, acting through the Service, 
        shall establish and administer a program to be known as 
        the [Indian Health] Service Loan Repayment Program 
        (hereinafter referred to as the ``Loan Repayment 
        Program'') in order to ensure [assure] an adequate 
        supply of trained health professionals necessary to 
        maintain accreditation of, and provide health care 
        services to Indians through, Indian [h]Health 
        [p]Programs and Urban Indian Organizations.
          [(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 [25 U.S.C.A. 
                                Sec. 450f et seq.], 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 subchapter IV 
                        of this chapter; and]
                  [(B) the term ``State'' has the same meaning 
                given such term in section 254d(i)(4) of Title 
                42.]
    (b) Eligible Individuals.--[Eligibility]
    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 under section 338B(b)(1)(c)(i) of the 
                Public Health Service Act (42 U.S.C. 254l-
                1(b)(1)(c)(i)) [, 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 [h]Health [p]Program or 
        Urban Indian Organization without a service obligation; 
        and
          (3) submit to the Secretary an application for a 
        contract described in subsection (e) [(f) of this 
        section].
    (c) Application [and contract forms].--
          (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) [of this section] 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) 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.--[Vacancies; priority]
          (1) List.--Consistent with subsection (k) [paragraph 
        (3)], the Secretary[, acting through the Service and in 
        accordance with subsection (k), of this section,] shall 
        annually--
                  (A) identify the positions in each Indian 
                [h]Health [p]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 [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--
                  (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 [tribes 
                        or tribal or Indian organizations.]
                          (ii) other individuals based on the 
                        priority rankings under paragraph (1).
          [(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) Recipient Contracts.--[Approval]
          (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) [subsection (f) of 
        this section].
          (2) Contents of Contract.--[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) Contract terms]
          The written contract referred to in this section 
        between the Secretary and an individual shall contain--
                  (A)[(1)] an agreement under which--
                          (i)[(A)] subject to subparagraph 
                        (C)[(3)], the Secretary agrees--
                                  (I)[(i)] to pay loans on 
                                behalf of the individual in 
                                accordance with the provisions 
                                of this section[,]; and
                                  (II)[(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 [tribe or 
                                Indian organization] as 
                                provided in clause (ii)(III); 
                                [subparagraph (B)(iii),] and
                          (ii)[(B)] subject to subparagraph 
                        (C)[(3)], the individual agrees--
                                  (I)[(i)] to accept loan 
                                payments on behalf of the 
                                individual;
                                  (II)[(ii)] in the case of an 
                                individual described in 
                                subsection (b)(1)--
                                          (aa)[(I)] to maintain 
                                        enrollment in a course 
                                        of study or training 
                                        described in subsection 
                                        (b)(1)(A) [of this 
                                        section] until the 
                                        individual completes 
                                        the course of study or 
                                        training[,]; and
                                          (bb)[(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); and
                                  (III)[(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 
                                [h]Health [p]Program or Urban 
                                Indian Organization to which 
                                the individual may be assigned 
                                by the Secretary;
                  (B)[(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 subparagraph (A)(ii)(III) [paragraph 
                (1)(B)(iii)];
                  (C)[(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;
                  (D)[(4)] a statement of the damages to which 
                the United States is entitled under subsection 
                (l) [of this section] for the individual's 
                breach of the contract; and
                  (E)[(5)] 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.--[Loan repayment purposes; maximum amount; 
tax liability reimbursement; schedule of 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)[(A)] Amount.--For each year of obligated service 
        that an individual contracts to serve under subsection 
        (e),[(f) of this section] 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, [254l-1(g)(2)(A) of Title 42)] 
        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)[(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;
                  (B)[(ii)] provides an incentive to serve in 
                Indian [h]Health [p]Programs and Urban Indian 
                Organizations with the greatest shortages of 
                health professionals; and
                  (C)[(iii)] provides an incentive with respect 
                to the health professional involved remaining 
                in an Indian [h]Health [p]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)[(B)]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)[(3)] Reimbursements for tax liability.--For the 
        purpose of providing reimbursements for tax liability 
        resulting from a payment under paragraph (2) on behalf 
        of an individual, the Secretary--
                  (A) in addition to such payments, may make 
                payments to the individual in an amount equal 
                to not less than 20 percent and not more than 
                39 percent of the total amount of loan 
                repayments made for the taxable year involved; 
                and
                  (B) may make such additional payments as the 
                Secretary determines to be appropriate with 
                respect to such purpose.
          (5)[(4)] 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.--[Effect on employment ceiling of 
Department of Health and Human Services] 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] while those individuals are undergoing academic 
training.
    (i) Recruitment.--[Recruiting programs] The Secretary shall 
conduct recruiting programs for the Loan Repayment Program and 
other [health professional programs of the] manpower programs 
of the Service at educational institutions training health 
professionals or specialists identified in subsection (a) [of 
this section].
    (j) Applicability of Law.--[Prohibition of assignment to 
other government departments] Section 214 of the Public Health 
Service Act (42 U.S.C. 215) [215 of Title 42] shall not apply 
to individuals during their period of obligated service under 
the Loan Repayment Program.
    (k) Assignment of Individuals.--[Staff needs of health 
programs administered by Indian tribes] The Secretary, in 
assigning individuals to serve in Indian [h]Health [p]Programs 
or Urban Indian Organizations pursuant to contracts entered 
into under this section, shall--
          (1) ensure that the staffing needs of Tribal [Indian 
        h]Health [p]Programs and Urban Indian Organizations 
        [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 
        [h]Health [p]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.--[Voluntary termination of study or 
dismissal from educational institution; collection of damages]
          (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 [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 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[, and does not receive a waiver from 
                the Secretary under subsection (b)(1)(B)(ii) of 
                this section,].
[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) 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) [(f) of this 
        section], 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) [of this section]; 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 [M]medicare payments pursuant to 
        section 1892 of the Social Security Act [1395ccc of 
        Title 42].
          (4)[(3)(A)] 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)[(B)] In general.--If damages described in 
                paragraph (4) [subparagraph (A)] are delinquent 
                for 3 months, the Secretary shall, for the 
                purpose of recovering such damages--
                          (i) use [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.
                  (B)[(C)] 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 [T]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.--[Cancellation or 
waiver of obligations; bankruptcy discharge]
          [(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.]
          (1)[(2)] 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 
        [T]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) [Annual r]Report.--The Secretary shall submit to the 
President, for inclusion in the [each] report required to be 
submitted to [the] Congress under section 801 [1671 of this 
title], 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 [the Service or by tribal or Indian 
        organizations] for which recruitment or retention is 
        difficult[;].
          (2) [t]The number of Loan Repayment Program 
        applications filed with respect to each type of health 
        profession[;].
          (3) [t]The number of contracts described in 
        subsection (e) [(f) of this section] that are entered 
        into with respect to each health profession[;].
          (4) [t]The amount of loan payments made under this 
        section, in total and by health profession[;].
          (5) [t]The number of scholarships [grants] that are 
        provided under sections 104 and 106 [1613a of this 
        title] with respect to each health profession[;].
          (6) [t]The amount of scholarships [grants] provided 
        under section 104 and 106 [1613a of this title], in 
        total and by health profession[;].
          (7) [t]The number of providers of health care that 
        will be needed by Indian [h]Health [p]Programs and 
        Urban Indian Organizations, by location and profession, 
        during the 3 [three] fiscal years beginning after the 
        date the report is filed[; and].
          (8) [t]The measures the Secretary plans to take to 
        fill the health professional positions maintained by 
        Indian Health Programs or Urban Indian Organizations 
        [the Service or by tribes or tribal or Indian 
        organizations] for which recruitment or retention is 
        difficult.

Sec. 1616a-1. Scholarship and Loan Repayment Recovery Fund

    (a) Establishment.--There is established in the Treasury of 
the United States a fund to be known as theIndian Health 
Scholarship and Loan Repayment Recovery Fund (hereinafter in this 
section referred to as the `LRRF' [``Fund'']). The LRRF [Fund] shall 
consist of such amounts as may be collected from individuals 
[appropriated to the Fund] 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 
[subsection (b) of this section]. All [A]amounts collected, 
appropriated, or earned relative to the LRRF [for the Fund] shall 
remain available until expended.
    [(b) Authorization of appropriations]
    [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 1613a(b)(5) 
                of this title for the breach of contracts 
                entered into under section 1613a of this title; 
                and]
                  [(B) the liability of individuals under 
                section 1616a(l) of this title for the breach 
                of contracts entered into under section 1616a 
                of this title; and]
          [(2) the aggregate amount of interest accruing during 
        the preceding fiscal year on obligations held in the 
        Fund pursuant to subsection (d) of this section and the 
        amount of proceeds from the sale or redemption of such 
        obligations during such fiscal year.]
    (b) [(c)] Use of Funds.--
          (1) By secretary.--Amounts in the LRRF [Fund and 
        available pursuant to appropriation Acts] may be 
        expended by the Secretary, acting through the Service, 
        to make payments to an Indian Health Program--[tribe or 
        tribal organization administering a health care program 
        pursuant to a contract entered into under the Indian 
        Self-Determination Act [25 U.S.C.A. Sec. 450f et 
        seq.]--]
                  (A) to which a scholarship recipient under 
                section 104 and 106 [1613a of this title] or a 
                loan repayment program participant under 
                section 110 [1616a of this title] 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 110. [1613a of this title or section 
                1616a of this title.]
          (2) By Tribal health programs.--A Tribal Health 
        Program [An Indian tribe or tribal organization] 
        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) [(d)] Investment of [excess f]Funds.--
          [(1)] The Secretary of the Treasury shall invest such 
        amounts of the LRRF, [Fund as such] as the Secretary of 
        Health and Human Services determines are not required 
        to meet current withdrawals from the LRRF [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.
    (d) Sale of Obligations.--[(2)] Any obligation acquired by 
the LRRF [Fund] may be sold by the Secretary of the Treasury at 
the market price.

Sec. 1616b. Recruitment A[a]ctivities

    (a) Reimbursement for Travel.--The Secretary, acting 
through the Service, may reimburse health professionals seeking 
positions with Indian Health Programs or Urban Indian 
Organizations [in the Service], including individuals 
considering entering into a contract under section 110 [1616a 
of this title], and their spouses, for actual and reasonable 
expenses incurred in traveling to and from their places of 
residence to an area in which they may be assigned for the 
purpose of evaluating such area with respect to such 
assignment.
    (b) Recruitment Personnel.--The Secretary, acting through 
the Service, shall assign 1 individual in each [a] Area [o] 
Office to be responsible on a full-time basis for recruitment 
activities.

Sec. 1616c. Indian [Tribal r]Recruitment and R[r]etention P[p]rogram

    (a) In General.--[Projects funded on competitive basis] The 
Secretary, acting through the Service, shall fund, on a 
competitive basis, innovative demonstration projects for a 
period not to exceed 3 years to enable Tribal Health Programs 
and Urban Indian Organizations to recruit, place, and retain 
health professionals to meet their staffing needs. [, on a 
competitive basis, projects to enable Indian tribes and tribal 
and Indian organization to recruit, place, and retain health 
professionals to meet the staffing needs of Indian health 
programs (as defined in section 1616a(a)(2) of this title).]
    (b) Eligible Entities; Application.--[Eligibility] [(1)] 
Any Tribal Health Program or Urban Indian Organization [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 [25 
U.S.C.A. Sec. 450f et seq.] shall be given an equal opportunity 
with programs that are administered directly by the Service to 
compete for, and receive, grants under subsection (a) of this 
section for such projects.]

Sec. 1616d. Advanced T[t]raining and R[r]esearch

    (a) Demonstration [Establishment of p]Program.--The 
Secretary, acting through the Service, shall establish a 
demonstration project [program] 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 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 organization, and urban Indian organizations, at the 
time of the submission of the applications.]
    (b) Service Obligation.--[Obligated service]An individual 
who participates in a program under subsection (a) [of this 
section], where the educational costs are borne by the Service, 
shall incur an obligation to serve in an Indian [h]Health 
[p]Program or Urban Indian Organization [(as defined in section 
1616a(a)(2) of this title)] 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 2005, [October 29, 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 110 [1616a of this title] in the 
manner provided for in such subsection.
    (c) Equal Opportunity for Participation.--[Eligibility] 
Health professionals from Tribal Health Programs and Urban 
Indian Organizations [Indian tribes and tribal and Indian 
organizations under the authority of the Indian Self-
Determination Act [25 U.S.C.A. Sec. 450f et seq.]] shall be 
given an equal opportunity to participate in the program under 
subsection (a) [of this section].

[Sec. 1616e. Nursing program]

    [(a) Grants]
    [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 2397h(2) of Title 
        20), 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) Purposes]
    [Grants provided under subsection (a) of this section 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) of this 
        section.]
    [(c) Application]
    [Each application for a grant under subsection (a) of this 
section 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) Preference]
    [In providing grants under subsection (a) of this section, 
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 2624(a) of this title.]

Sec. 115. [(e)] 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 1 of the grants authorized under subsection (a) [of 
this section] 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) [1616g(b) of this title] and the Quentin N. 
Burdick American Indians Into Psychology Program established 
under section 105(b) [1621p(b) of this title].
    (f) Active Duty Service O[o]bligation.--The active duty 
service obligation prescribed under section 338C of the Public 
Health Service Act (42 U.S.C. 254m) [of Title 42] shall be met 
by each individual who receives training or assistance 
described in paragraph (1) or (2) of subsection (b) [of this 
section] that is funded by a grant provided under subsection 
(a) [of this section]. Such obligation shall be met by 
service--
          (1)[(A)] in the [Indian Health] Service;
          (2)[(B)] in a program of an Indian Tribe or Tribal 
        Organization conducted under the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 
        450 et seq.) (including programs under agreements with 
        the Bureau of Indian Affairs) [a contract entered into 
        under the Indian Self-Determination Act [25 U.S.C.A. 
        Sec. 450f et seq.]];
          (3)[(C)] in a program assisted under title V 
        [subchapter IV] of this Act [chapter]; or
          (4)[(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.
          (5) in a teaching capacity in a tribal college or 
        university nursing program (or a related health 
        profession program) if, as determined by the Secretary, 
        health services provided to Indians would not decrease.
    [(g) Authorization of appropriations]
    [Beginning with fiscal year 1993, of the amounts 
appropriated under the authority of this subchapter 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) 
of this section for the training of nurse midwives, nurse 
anesthetists, and nurse practitioners.]

[Sec. 1616e-1. Nursing school clinics]

    [(a) Grants]
    [In addition to the authority of the Secretary under 
section 1616e(a)(1) of this title, 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.]
    [(b) Purposes]
    [Grants provided under subsection (a) of this section 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);]
          [(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 subchapter 
for each of the fiscal years 1993 through 2000 not more than 
$5,000,000 may be used to carry out this section.]

Sec. 1616f. Tribal Cultural Orientation  [culture and history]

    (a) Cultural Education of Employees.--[Program established] 
The Secretary, acting through the Service, shall require that 
[establish a program under which] appropriate employees of the 
Service who serve [particular] Indian [t]Tribes in each Service 
Area [shall] receive educational instruction in the history and 
culture of such Indian T[t]ribes and their relationship to [in 
the history of] the Service.
    (b) Program.--[Tribally-controlled community colleges] In 
carrying out subsection (a), the Secretary shall establish a 
program which shall, to the extent feasible--
    [To the extent feasible, the program established under 
subsection (a) of this section shall--]
          (1) be developed in consultation with the affected 
        Indian Tribes, Tribal Organizations, and Urban Indian 
        Organizations; [be carried out through tribally-
        controlled community colleges (within the meaning of 
        section 1801(4) of this title) and tribally controlled 
        postsecondary vocational institutions (as defined in 
        section 2397h(2) of Title 20),]
          (2) be carried out through tribal colleges or 
        universities; [be developed in consultation with the 
        affected tribal government, and]
          (3) include instruction in American Indian [Native 
        American] studies; and[.]
          (4) describe the use and place of Traditional Health 
        Care Practices of the Indian Tribes in the Service 
        Area.

Sec. 1616g. INMED Program

    (a) Grants Authorized._The Secretary, acting through the 
Service, is authorized to provide grants to [at least 3] 
colleges and universities for the purpose of maintaining and 
expanding the Indian [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) Quentin N. Burdick Grant.--[University of North Dakota] 
The Secretary shall provide one of the grants authorized under 
subsection (a) [of this section] 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) [1621p(b) of this title] and 
the Quentin N. Burdick American Indians Into Nursing Program 
established under section 115 [1616e of this title].
    (c) Regulations.--[; contents of recruitment program]
          [(1)] The Secretary, pursuant to this Act, shall 
        develop regulations to govern [for the competitive 
        awarding of the] grants pursuant to [provided under] 
        this section.
    (d) Requirements.--[(2)] Applicants for grants provided 
under this section shall agree to provide a program which--
          (1) [(A)] provides outreach and recruitment for 
        health professions to Indian communities, including 
        elementary[,] and secondary schools and community 
        colleges located on [Indian] reservations, which will 
        be served by the program[,];
          (2) [(B)] incorporates a program advisory board 
        comprised of representatives from the Indian tribes and 
        Indian communities which will be served by the 
        program[,];
          (3) [(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[,];
          (4) [(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
          (5) [(E)] to the maximum extent feasible, employs 
        qualified Indians in the program.
    [(d) Report to Congress]
    [By no later than the date that is 3 years after November 
23, 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.]

Sec. 1616h. Health [t]Training [p]Programs of [c]Community [c]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 [the] 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 [an Indian] 
        reservation or in an Indian Health Program [a tribal 
        clinic].
          (2) Amount of grants._T[t]he amount of any grant 
        awarded to a community college under paragraph (1) for 
        the first year in which such a grant is provided to the 
        community college shall not exceed $250,000.
    (b) Grants for Maintenance and Recruiting.--[Eligibility]
          (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) [of this 
        section] 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 [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 that train health 
                        professionals[,]; and
                          (ii) stipulate certifications 
                        necessary to approved internship and 
                        field placement opportunities at Indian 
                        Health Programs; [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) [of this section.]; and
                  (F) agrees to provide for Indian preference 
                for applicants for programs under this section.
    (c) [Agreements and t]Technical [a]Assistance.--The 
Secretary shall encourage community colleges described in 
subsection (b)(2) [of this section] to establish and maintain 
programs described in subsection (a)(1) [of this section] 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)[(1)] has already received a degree or 
                diploma in such health profession[,]; and
                  (B)[(2)] provides clinical services on or 
                near a [an Indian] reservation or for an Indian 
                Health Program[, at a Service facility, or at a 
                tribal clinic].
          (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) [of this section].
    (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.
    [(e) Definitions]
    [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 
        1801(4) of this title.]
          [(3) The term ``junior or community college'' has the 
        meaning given to such term by section 1058(e) of Title 
        20.]

[Sec. 1616i. Additional incentives for health professionals]

    [(a) Incentive special pay]
    [The Secretary may provide the incentive special pay 
authorized under section 302(b) of Title 37, 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) of this section for which recruitment 
or retention of personnel is difficult.]
    [(b) List of positions; bonus pay]
          [(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) Work schedules]
    [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, for health professionals employed by, or assigned 
to, the Service.]

Sec. 1616j. Retention bonus

    (a) Bonus Authorized.--[Eligibility]The Secretary may pay a 
retention bonus to any health professional [physician or nurse] 
employed by, or assigned to, and serving in, an Indian Health 
Program or Urban Indian Organization [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 
        1616i(b)(1) of this title] for which recruitment or 
        retention of personnel is difficult[,];
          (2) the Secretary determines is needed by Indian 
        Health Programs and Urban Indian Organizations; [the 
        Service,]
          (3) has--
                  (A) completed 3 years of employment with an 
                Indian Health Program or Urban Indian 
                Organization; [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 an Indian Health 
        Program or Urban Indian Organization [the Service] for 
        continued employment for a period of not less than 1 
        year.
    [(b) Minimum award percentage to nurses]
    [Beginning with fiscal year 1993, not less than 25 percent 
of the retention bonuses awarded each year under subsection (a) 
of the section shall be awarded to nurses.]
    (b)[(c)] Rates.--[; maximum rate]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) [of this 
section], but in no event shall the annual rate be more than 
$25,000 per annum.
    [(d) Time of payment]
    [The retention bonus for the entire period covered by the 
agreement described in subsection (a)(4) of this section shall 
be paid at the beginning of the agreed upon term of service.]
    [(e) Refund; interest]
    (c) Default of Retention Agreement._Any health professional 
[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 110(l)(2)(B) [1616a(l)(2)(B) of this 
title].
    (d) Other Retention Bonus._
    [(f) Physicians and nurses employed under indian self-
determination act]
    The Secretary may pay a retention bonus to any health 
professional [physician or nurse] employed by a Tribal Health 
Program [an organization providing health care services to 
Indians pursuant to a contract under the Indian Self-
Determination Act [25 U.S.C.A. Sec. 450f et. seq.]] if such 
health professional [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.

Sec. 1616k. 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 H[h]ealth 
P[p]rogram or Urban Indian Organization [(as defined in section 
1616a(a)(2)(A) of this title)], and have done so for a period 
of not less than 1 [one] year, to pursue advanced training.
    [(b) Program components]
    Such program shall include a combination of education and 
work study in an Indian H[h]ealth P[p]rogram or Urban Indian 
Organization [(as defined in section 1616a(a)(2)(A) of this 
title)] 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 advanced degrees or certification in nursing and 
public health [a Master's degree].
    (b)[(c)] Service O[o]bligation.--[of program participant] 
An individual who participates in a program under subsection 
(a) [of this section], where the educational costs are paid by 
the Service, shall incur an obligation to serve in an Indian 
H[h]ealth P[p]rogram or Urban Indian Organization for a period 
of obligated service equal to the amount of [at least three 
times the period of the] 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 [1616a of this title] in the 
manner provided for in such subsection.

Sec. 1616l. Community Health Aide Program

    (a) General Purposes [Maintenance] of Program.--Under the 
authority of the Act of November 2, 1921 (25 U.S.C. 13) 
(commonly known as the `Snyder Act') [section 13 of this 
title], the Secretary, acting through the Service, shall 
develop and operate [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) Specific Program Requirements.--[Training; curriculum; 
certification board]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) 
                [1602(b) of this title];
          (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.
    (c) Program Review.--
      (1) Neutral panel.--
                  (A) Establishment.--The Secretary, acting 
                through the Service, shall establish a neutral 
                panel to carry out the study under paragraph 
                (2).
                  (B) Membership.--Members of the neutral panel 
                shall be appointed by the Secretary from among 
                clinicians, economists, community 
                practitioners, oral epidemiologists, and Alaska 
                Natives.
      (2) study.--
                  (A) In general.--The neutral panel 
                established under paragraph (1) shall conduct a 
                study of the dental health aide therapist 
                services provided by the Community Health Aide 
                Program under this section to ensure that the 
                quality of care provided through thoseservices 
is adequate and appropriate.
                  (B) Parameters of study.--The Secretary, in 
                consultation with interested parties, including 
                professional dental organizations, shall 
                develop the parameters of the study.
                  (C) Inclusions.--The study shall include a 
                determination by the neutral panel with respect 
                to--
                          (i) the ability of the dental health 
                        aide services under this section to 
                        address the dental care needs of Alaska 
                        Natives;
                          (ii) the quality of care provided 
                        through those services, including any 
                        training, improvement, or additional 
                        oversight required to improve the 
                        quality of care; and
                          (iii) whether safer and less costly 
                        alternatives to the dental health aide 
                        therapist services exist.
                  (D) Consultation.--In carrying out the study 
                under this paragraph, the neutral panel shall 
                consult with Alaska Tribal Organizations with 
                respect to the adequacy and accuracy of the 
                study.
          (3) Report.--The neutral panel shall submit to the 
        Secretary, the Committee on Indian Affairs of the 
        Senate, and the Committee on Resources of the House of 
        Representatives a report describing the results of the 
        study under paragraph (2), including a description of--
                  (A) any determination of the neutral panel 
                under paragraph (2)(C); and
                  (B) any comments received from an Alaska 
                Tribal Organization under paragraph (2)(D).
    (d) Nationalization of Program.--
          (1) In general.--Except as provided in paragraph (2), 
        the Secretary, acting through the Service, may 
        establish a national Community Health Aide Program in 
        accordance with the program under this section, as the 
        Secretary determines to be appropriate.
          (2) Exception.--The national Community Health Aide 
        Program under paragraph (10) shall not include dental 
        health aide therapist services.
          (3) Requirement.--In establishing a national program 
        under paragraph (1), the Secretary shall not reduce the 
        amount of funds provided for the Community Health Aide 
        Program described in subsections (a) and (b).

[Sec. 1616m. Matching grants to tribes for scholarship programs]

    [(a) In general]
          [(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 1613a of this title.]
          [(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) Compliance with requirements]
          [(1) An Indian tribe or tribal organization receiving 
        a grant under subsection (a) of this section 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) of this section 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) Course of study in health professions]
    [An Indian tribe or tribal organization shall provide 
scholarships under subsection (b) of this section only to 
Indians enrolled or accepted for enrollment in the course of 
study (approved by the Secretary) in one of the health 
professions described in section 1613a(a) of this title.]
    [(d) Contract requirements]
    [In providing scholarships under subsection (b) of this 
section, 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 
        1616a(a)(2)(A) of this title), 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 
                        254l(g)(1)(B) of Title 42, 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) Breach of contract]
          [(1) an individual who has entered into a written 
        contract with the Secretary and an Indian tribe or 
        tribal organization under subsection (d) of this 
        section 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 1616a of this title 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 organization involved, or on the basis of 
        information collected through such other means as the 
        Secretary determines to be appropriate.]
    [(f) Nondiscriminatory practice]
    [The recipient of a scholarship under subsection (b) of 
this section shall agree, in providing health care pursuant to 
the requirements of subsection (d)(1) of this section--]
          [(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 [42 U.S.C.A. Sec. 1395 et. Seq.] or 
        pursuant to the program established in title XIX of 
        such Act [42 U.S.C.A. Sec. 1396 et. seq.]; and]
          [(2) to accept assignment under section 
        1842(b)(3)(B)(ii) of the Social Security Act [42 
        U.S.C.A. Sec. 1395u(b)(3)(B)(ii)] for all services for 
        which payment may be made under part B of title XVIII 
        of such Act 42 U.S.C.A. Sec. 1395j et. seq., 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 42 U.S.C.A. 
        Sec. 1396 et. seq. to provide service to individuals 
        entitled to medical assistance under the plan.]
    [(g) Payments for subsequent fiscal years]
    [The Secretary may not make any payments under subsection 
(a) of this section 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.]

Sec. 1616n. Tribal H[h]ealth P[p]rogram A[a]dministration

    The Secretary, acting through the Service, shall, by 
contract or otherwise, provide training for Indians 
[individuals] in the administration and planning of T[t]ribal 
H[h]ealth P[p]rograms

Sec. 123. Health Professional Chronic Shortage Demonstration Programs

    (a) Demonstration Programs Authorized.--The Secretary, 
acting through the Service, may fund demonstration programs for 
Tribal Health Programs to address the chronic shortages of 
health professionals.
    (b) Purposes of Programs.--The purposes of demonstration 
programs funded under subsection (a) shall be--
          (1) to provide direct clinical and practical 
        experience at a Service Unit to health profession 
        students and residents from medical schools;
          (2) to improve the quality of health care for Indians 
        by assuring access to qualified health care 
        professionals; and
          (3) to provide academic and scholarly opportunities 
        for health professionals serving Indians by identifying 
        all academic and scholarly resources of the region.
    (c) Advisory Board.--The demonstration programs established 
pursuant to subsection (a) shall incorporate a program advisory 
board composed of representatives from the Indian Tribes and 
Indian communities in the area which will be served by the 
program.

Sec. 124. National Health Service Corps

    (a) No Reduction in Services.--The Secretary shall not--
          (1) remove a member of the National Health Service 
        Corps from an Indian Health Program or Urban Indian 
        Organization; or
          (2) withdraw funding used to support such member, 
        unless the Secretary, acting through the Service, 
        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. 125. 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 3 years. Such contract or grant may be renewed for an 
additional 2-year period upon the approval of the Secretary.
    (d) Criteria for Review and Approval of Applications.--Not 
later than 180 days after the date of the enactment of the 
Indian Health Care Improvement Act Amendments of 2005, the 
Secretary, after consultation with Indian Tribes and 
administrators of tribal colleges and universities and eligible 
accredited and accessible community colleges, shall develop and 
issue criteria for the review and approval of applications for 
funding (including applications for renewals of funding) under 
this section. Such criteria shall ensure that demonstration 
programs established under this section promote the development 
of the capacity of such entities to educate substance abuse 
counselors.
    (e) Assistance.--The Secretary shall provide such technical 
and other assistance as may be necessary to enable grant 
recipients to comply with the provisions of this section.
    (f) Report.--Each fiscal year, the Secretary shall submit 
to the President, for inclusion in the report which is required 
to be submitted under section 801 for that fiscal year, a 
report on the findings and conclusions derived from the 
demonstration programs conducted under this section during that 
fiscal year.
    (g) Definition.--For the purposes of this section, the term 
`educational curriculum' means 1 or more of the following:
          (1) Classroom education.
          (2) Clinical work experience.
          (3) Continuing education workshops.

Sec. 126. Behavioral health training and community education programs

    (a) Study; List.--The Secretary, acting through the 
Service, and the Secretary of the Interior, in consultation 
with Indian Tribes and Tribal Organizations, shall conduct a 
study and compile a list of the types of staff positions 
specified in subsection (b) whose qualifications include, or 
should include, training in the identification, prevention, 
education, referral, or treatment of mental illness, or 
dysfunctional and self destructive behavior.
    (b) Positions.--The positions referred to in subsection (a) 
are--
          (1) staff positions within the Bureau of Indian 
        Affairs, including existing positions, in the fields 
        of--
                  (A) elementary and secondary education;
                  (B) social services and family and child 
                welfare;
                  (C) law enforcement and judicial services; 
                and
                  (D) alcohol and substance abuse;
          (2) staff positions within the Service; and
          (3) staff positions similar to those identified in 
        paragraphs (1) and (2) established and maintained by 
        Indian Tribes, Tribal Organizations, (without regard to 
        the funding source) and Urban Indian Organizations.
    (c) Training Criteria.--
          (1) In general.--The appropriate Secretary shall 
        provide training criteria appropriate to each type of 
        position identified in subsection (b)(1) and (b)(2) and 
        ensure that appropriate training has been, or shall be 
        provided to any individual in any such position. With 
        respect to any such individual in a position identified 
        pursuant to subsection (b)(3), the respective 
        Secretaries shall provide appropriate training to, or 
        provide funds to, an Indian Tribe, Tribal Organization, 
        or Urban Indian Organization for training of 
        appropriate individuals. In the case of positions 
        funded under a contract or compact under the Indian 
        Self-Determination and Education Assistance Act (25 
        U.S.C. 450 et seq.), the appropriate Secretary shall 
        ensure that such training costs are included in the 
        contract or compact, as the Secretary determines 
        necessary.
          (2) Position specific training criteria.--Position 
        specific training criteria shall be culturally relevant 
        to Indians and Indian Tribes and shall ensure that 
        appropriate information regarding Traditional Health 
        Care Practices is provided.
    (d) Community Education on Mental Illness.--The Service 
shall develop and implement, on request of an Indian Tribe, 
Tribal Organization, or Urban Indian Organization, or assist 
the Indian Tribe, Tribal Organization, or Urban Indian 
Organization to develop and implement, a program of community 
education on mental illness. In carrying out this subsection, 
the Service shall, upon request of an Indian Tribe, Tribal 
Organization, or Urban Indian Organization, provide technical 
assistance to the Indian Tribe, Tribal Organization, or Urban 
Indian Organization to obtain and develop community educational 
materials on the identification, prevention, referral, and 
treatment of mental illness and dysfunctional and self-
destructive behavior.
    (e) Plan.--Not later than 90 days after the date of the 
enactment of the Indian Health Care Improvement Act Amendments 
of 2005, 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').

[Sec. 1616o. University of South Dakota pilot program]

    [(a) Establishment]
    [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) Purposes]
    [The purposes of the program established pursuant to a 
grant provided under subsection (a) of this section are--]
          [(1) to provide direct clinical and practical 
        experience at the 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, nurse and other allied health 
        professionals serving Indian people by identifying and 
        utilizing all academic and scholarly resources of the 
        region.]
    [(c) Composition; designation]
    [The pilot program established pursuant to a grant provided 
under subsection (a) of this section 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) Coordination with other schools]
    [The USDSM shall coordinate the program established 
pursuant to a grant provided under subsection (a) of this 
section with other medical schools in the region, nursing 
schools, tribal community colleges, and other health 
professional schools.]
    [(e) Development of additional professional opportunities]
    [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.]

Sec. 1616p. Authorization of [a]Appropriations

    There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2015 [2000] 
to carry out this title [subchapter].

                 TITLE [SUBCHAPTER] II--HEALTH SERVICES

Sec. 1621. Indian Health Care Improvement Fund

    (a) Use of Funds._[Approved expenditures]
    The Secretary, acting through the Service, is authorized to 
expend funds, directly or under the authority of the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 
et seq.), which are appropriated under the authority of this 
section, [through the Service,] for the purposes of--
          (1) eliminating the deficiencies in health status and 
        health resources of all Indian [t]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; [and]
          (4) eliminating inequities in funding for both direct 
        care and contract health service programs; and
          (5) [(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 [25 U.S.C.A. Sec. 450f et seq.],] 
        with respect to those Indian [t]Tribes with the highest 
        levels of health status deficiencies and resource 
        deficiencies:
                  (A) [c]Clinical care, [(direct and indirect)] 
                including inpatient care, outpatient care 
                (including audiology, clinical eye and vision 
                care), primary care, secondary and tertiary 
                care, and long-term care.[;]
                  (B) [p]Preventive health, including 
                [screening] mammography and other cancer 
                screening in accordance with section 207. 
                [1621k of this title;]
                  (C) [d]Dental care. [(direct and indirect);]
                  (D) [m]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 
                [Indian] practitioners.[;]
                  (E) [e]Emergency medical services.[;]
                  (F) [t]Treatment and control of, and 
                rehabilitative care related to, alcoholism and 
                drug abuse (including fetal alcohol syndrome) 
                among Indians.[;]
                  (G) [a]Accident prevention programs.[;]
                  (H) [h]Home health care.[;]
                  (I) [c]Community health representatives.[; 
                and]
                  (J) [m]Maintenance and repair.
                  (K) Traditional Health Care Practices.
    (b) No Offset or Limitation.--[Effect on other 
appropriations; allocation to service units]
          [(1)] 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'), [section 13 of this title,] 
        or any other provision of law.
    (c) Allocation; Use.--[(2)(A)]
          (1) In general.--Funds appropriated under the 
        authority of this section shall [may] be allocated to 
        Service Units, Indian Tribes, or Tribal Organizations 
        [on a service unit basis]. The funds allocated to each 
        Indian Tribe, Tribal Organization, or S[s]ervice 
        U[u]nit under this [sub]paragraph shall be used by the 
        Indian Tribe, Tribal Organization, or S[s]ervice 
        U[u]nit under this paragraph to improve [reduce] the 
        health status and reduce the resource deficiency of 
        each Indian Tribe served by such S[s]ervice U[u]nit, 
        Indian Tribe, or Tribal Organization.
          (2) [(B)] Apportionment of allocated funds.--The 
        apportionment of funds allocated to a S[s]ervice 
        U[u]nit, Indian Tribe, or Tribal Organization under 
        [sub]paragraph (1) [(A)] among the health service 
        responsibilities described in subsection (a)(5) [(4) of 
        this section] shall be determined by the Service in 
        consultation with, and with the active participation 
        of, the affectedIndian Tribes and Tribal Organizations.
    (d) [(c)] Provisions Relating to Health Status and 
R[r]esource[s d]Deficienc y ies [levels]
    For 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)[1602(b) of this title] are not 
                being achieved; and
                  (B) the Indian [t]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 [t]Tribe or Tribal Organization 
        include health resources provided by the Service as 
        well as health resources used by the Indian [t]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 [t]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 T[t]ribe or Tribal Organization.
    (e) [(d)] Eligibility for Funds._[Programs administered by 
Indian tribe]
          [(1)] Tribal Health 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 [25 U.S.C.A. Sec. 450f et seq.], a 
        reasonable portion of such funds may be used for health 
        planning, training, technical assistance, and other 
        administrative support functions.]
    (f) [(e)] Report [to Congress].--
    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 2005 [October 29, 1992], the Secretary shall 
submit to [the] Congress the current health status and resource 
deficiency report of the Service for each [Indian tribe or 
s]Service [u]Unit, including newly recognized or acknowledged 
Indian T[t]ribes. Such report shall set out--
          (1) the methodology then in use by the Service for 
        determining [t]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 
                [chapter], or any other Act, including the 
                amount of any funds transferred to the 
                Service[,] for the preceding fiscal year which 
                is allocated to each S[s]ervice U[u]nit, Indian 
                [t]Tribe, or Tribal Organization [comparable 
                entity];
                  (B) the number of Indians eligible for health 
                services in each [s]Service [u]Unit or Indian 
                [t]Tribe or Tribal Organization; and
                  (C) the number of Indians using the Service 
                resources made available to each [s]Service 
                [u]Unit, [or] Indian [t]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) [(f)] Inclusion [Appropriated funds included] in 
[b]Base [b]Budget [of Service].--
    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.
    (h)[(g)] Clarification._[Continuation of Service 
responsibilities for backlogs and parity]
    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 [parity] among Indian[s t]Tribes and 
Tribal Organizations.
    (i)[(h)] Funding Designation.-- [Authorization of 
appropriations]
    Any funds appropriated under the authority of this section 
shall be designated as the [``]`Indian Health Care Improvement 
Fund'[''].

Sec. 1621a. Catastrophic [h]Health [e]Emergency [f]Fund.

    (a) Establishment.--[; administration; purpose]
    [(1)] There is established an Indian Catastrophic Health 
Emergency Fund (hereafter in this section referred to as the 
`CHEF' [``Fund'']) consisting of--
          (1)[(A)] the amounts deposited under subsection 
        (f)[(d) of this section,]; and
          (2)[(B)] the amounts appropriated to CHEF [the Fund] 
        under this section.
    (b) Administration.--[(2) The Fund] 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.
          [(3) The Fund shall not be allocated, apportioned, or 
        delegated on a service unit, area office, or any other 
        basis.]
      (c) Conditions on Use of Fund.--[(4)] No part of CHEF 
[the Fund] or its administration shall be subject to contract 
or grant under any law, including the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450 et seq.), [[25 
U.S.C.A. Sec. 450f et seq.].] nor shall CHEF funds be 
allocated, apportioned, or delegated on an Areaffice, Service 
Unit, or other similar basis.
    (d)[(b)] Regulations.--[; procedures for payment]
    The Secretary shall, through the negotiated rulemaking 
process under title VIII, promulgate [promulgation of] 
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 [the Fund];
          (2) provide that a [s]Service [u]Unit shall not be 
        eligible for reimbursement for the cost of treatment 
        from CHEF [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) the 2000 level of $19,000 [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 that exceeds such threshold 
        cost incurred by--
          (A) [s]Service [u]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 CHEF [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 CHEF [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.
    (e) No Offset or Limitation.--[(c) Effect on other 
appropriations]
    Amounts appropriated to CHEF [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) (commonly known as the `Snyder Act') [section 13 of 
this title], or any other law.
    (f)[(d)] Deposit of Reimbursement[s to] Funds.--
    There shall be deposited into CHEF [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 CHEF [the Fund].

Sec. 1621b. Health [p]Promotion and [d]Disease [p]Prevention 
                    [s]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.
    [(a) Authorization]
    (b) Provision of Services._
    The Secretary, acting through the Service and Tribal Health 
Programs, shall provide health promotion and disease prevention 
services to Indians [so as] to achieve the health status 
objectives set forth in section 3(2)[1602(b) of this title].
    (c)[(b)] Evaluation.--[statement for Presidential Budget]
    The Secretary, after obtaining input from the affected 
Tribal Health Programs, shall submit to the President for 
inclusion in the report [each statement] which is required to 
be submitted to [the] Congress under section 801[1671 of this 
title] 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. 1621c. Diabetes [p]Prevention, [t]Treatment, and [c]Control

    (a) Determinations Regarding Diabetes.--[Incidence and 
complications]
    The Secretary, acting through the Service, and in 
consultation with [the] Indian T[t]ribes and Tribal 
Organizations, shall determine--
          (1) by Indian T[t]ribe and by Service [u]Unit [of the 
        Service], 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 [u]Unit should take to reduce 
        the incidence of, and prevent, treat, and control the 
        complications resulting from, diabetes among Indian 
        T[t]ribes within that Service unit.
    (b) Diabetes Screening.--
    To the extent medically indicated and with informed 
consent, t[T]he 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 [done] by a Tribal Health Program and may be 
conducted through appropriate Internet-based health care 
management programs. [tribe or tribal organization operating 
health care programs or facilities with funds from the Service 
under the Indian Self-Determination Act [25 U.S.C.A. Sec. 450f 
et seq.].]
          (c) Funding for Diabetes.--The Secretary shall 
        continue to maintain each model diabetes project in 
        existence on the date of the enactment of the Indian 
        Health Care Improvement Act Amendments of 2005, 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 2005 and for projects which are added 
        and funded thereafter.
    [(c) Model diabetes projects]
          [(1) The Secretary shall continue to maintain through 
        fiscal year 2000 each model diabetes project in 
        existence October 29, 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) Funding for Dialysis Programs.--The Secretary is 
authorized to provide funding through the Service, Indian 
Tribes, and Tribal Organizations to establish dialysis 
programs, including funding to purchase dialysis equipment and 
provide necessary staffing.
    [(d) Control officer; registry of patients]
    [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) Other Duties of the Secretary.--
          (1) In general.--The Secretary shall, to the extent 
        funding is available--
                  (A) in each Area Office, consult with Indian 
                Tribes and Tribal Organizations regarding 
                programs for the prevention, treatment, and 
                control of diabetes;
                  (B) establish in each Area Office a registry 
                of patients with diabetes to track the 
                incidence of diabetes and the complications 
                from diabetes in that area; and
                  (C) ensure that data collected in each Area 
                Office regarding diabetes and related 
                complications among Indians are disseminated to 
                all other Area Offices, subject to applicable 
                patient privacy laws.
          (2) Diabetes control officers.--
                  (A) In general.--The Secretary may establish 
                and maintain in each Area Office a position of 
                diabetes control officer to coordinate and 
                manage any activity of that Area office 
                relating to the prevention, treatment, or 
                control of diabetes to assist the Secretary in 
                carrying out a program under this section or 
                section 330C of the Public Health Service Act 
                (42 U.S.C. 254c-3).
                  (B) Certain activities.--Any Activity carried 
                out by a diabetes control officer under 
                subparagraph (A) that is the subject of a 
                contract or compact under the Indian Self-
                Determination and Education Assistance Act (25 
                U.S.C. 450 et seq.), and any funds made 
                available to carry out such an activity, shall 
                not be divisible for purposes of that Act.
    [(e) Authorization of appropriations]
    [Funds appropriated under this section in any fiscal year 
shall be in addition to base resources appropriated to the 
Service for that year.]

Sec. 205. Shared services for long-term care

    (a) Long-Term Care.--Notwithstanding any other provision of 
law, the Secretary, acting through the Service, is authorized 
to provide directly, or enter into contracts or compacts under 
the Indian Self-Determination and Education Act (25 U.S.C. 450 
et seq.) with Indian Tribes or Tribal Organizations for, the 
delivery of long-term care and similar services to Indians. 
Such agreements shall provide for the sharing of staff or other 
services between the Service or a Tribal Health Program and a 
long-term care or other similar facility owned and operated 
(directly or through a contract or compact under the Indian 
Self-Determination and Education Act) (25 U.S.C. 450 et seq.)) 
by such Indian Tribe or Tribal Organization.
    (b) Contents of Agreements.--An 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. 1621d. Hospice care feasibility study]

    [(a) Duty of Secretary]
    [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) Functions of study]
    [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) Report to Congress]
    [Not later than the date which is 12 months after October 
29, 1992, 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) Definitions]
    [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 
        1395x(dd)(2) of Title 42; and]
          [(3) the term ``hospice care'' means the items and 
        services specified in subparagraphs (A) through (H) of 
        section 1395x(dd)(1) of Title 42.]

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. 
The Secretary shall also, to the maximum extent practicable, 
coordinate departmental research resources and activities to 
address relevant Indian Health Program 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. 1621e. Reimbursement from certain third parties of costs of 
                    health services]

    [(a) Right of recovery]
    [Except as provided in subsection (f) of this section, 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 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) Recovery against State with workers' compensation laws 
or no-fault automobile accident insurance program]
    [Subsection (a) of this section 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) Prohibition of State law or contract provision 
impeding right of recovery]
    [No law of any State, or of any political subdivision of a 
State, and no provision of any contract entered into or renewed 
after November 23, 1988, shall prevent or hinder the right of 
recovery of the United States, an Indian tribe, or a tribal 
organization under subsection (a) of this section.]
    [(d) Right to damages]
    [No action taken by the United States, an Indian tribe, or 
a tribal organization to enforce the right of recovery provided 
under subsection (a) of this section 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) Intervention or separate civil action]
    [The United States, an Indian tribe, or a tribal 
organization may enforce the right of recovery provided under 
subsection (a) of this section 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) Right of recovery for services when self-insurance 
plan provides coverage]
    [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.]

Sec. 207. Mammography and other cancer screening

    The Secretary, acting through the Service or Tribal Health 
Programs, shall provide for screening as follows:
          (1) Screening mammography (as defined in section 
        1861(jj) of the Social Security Act) for Indian women 
        at a frequency appropriate to such women under accepted 
        and appropriate national standards, and under such 
        terms and conditions as are consistent with standards 
        established by the Secretary to ensure the safety and 
        accuracy of screening mammography under part B of title 
        XVIII of such Act.
          (2) Other cancer screening meeting accepted and 
        appropriate national standards.

[Sec. 1621f. Crediting of reimbursements]

    [(a) Except as provided in section 1621a(d) of this title, 
subchapter III-A of this chapter, and section 1680c of this 
title, all reimbursements received or recovered, under 
authority of this chapter, 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 [25 U.S.C.A. Sec. 450f et seq.] 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 healthcare 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) of this section.]

Sec. 208. Patient travel costs

    The Secretary, acting through the Service and Tribal Health 
Programs, is authorized to 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 a contract or compact under the Indian Self-
Determination and Education Act (25 U.S.C. 450 et seq.)) under 
this Act--
          (1) emergency air transportation and non-emergency 
        air transportation where ground transportation is 
        infeasible;
          (2) transportation by private vehicle (where no other 
        means of transportation is available), specially 
        equipped vehicle, and ambulance; and
          (3) transportation by such other means as may be 
        available and required when air or motor vehicle 
        transportation is not available.

[Sec. 1621g. Health services research]

    [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 [25 U.S.C.A. 
Sec. 450f et seq.] shall be given an equal opportunity to 
compete for, and receive, research funds under this section.]

Sec. 209. Epidemiology centers

    (a) Additional Centers.--In addition to those epidemiology 
centers already established as of the date of enactment of this 
Act, 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 2005, the 
Secretary, acting through the Service, shall establish 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. 1621h. Mental health prevention and treatment services]

    [(a) National plan for Indian Mental Health Services]
          [(1) Not later than 120 days after November 28, 1990, 
        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 November 28, 1990, 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) [25 U.S.C.A. Sec. 2401 et seq.] with the 
                mental health initiatives pursuant to this 
                chapter, 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) of this 
        section; 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), of this 
        section, 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 [25 U.S.C.A. Sec. 450f et 
                seq.].]
          [(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 [25 
        U.S.C.A. Sec. 450f et seq.], 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) of this section 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) of this 
        section. 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 November 28, 1990, 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 November 28, 1990, 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 section 13 of this title.]
    [(f) Staff recruitment and retention]
          [(1) The Secretary shall provide for the recruitment 
        of the additional personnel required by subsection (f) 
        of this section 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 
                section 1616i and 1616j of this title) 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 1616a of this title) 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 subchapter I of this chapter.]
    [(g) Mental Health Technician program]
          [(1) Under the authority of section 13 of this title, 
        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 November 28, 1990, 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 1671 of this title, 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, andimplementing 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 [25 U.S.C.A. Sec. 450f et seq.], 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 
        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 chapter or through a contract 
pursuant to the Indian Self-Determination Act [25 U.S.C.A. 
Sec. 450f et. seq.] 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 1621o(b)(1) 
        of this title.]
          [(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 
        year 1993 and such sums as may be necessary for each of 
        the fiscal years 1994, 1995, 1996, 1997, 1998, 1999, 
        and 2000.]

Sec. 210. Comprehensive school health education programs

    (a) Funding for Development of Programs.--In addition to 
carrying out any other program for health promotion or disease 
prevention, the Secretary, acting through the Service, is 
authorized to award grants to Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations to develop 
comprehensive school health education programs for children 
from pre-school through grade 12 in schools for the benefit of 
Indian and Urban Indian children.
    (b) Use of Grant Funds.--A grant awarded under this section 
may be used for purposes which may include, but are not limited 
to, the following:
          (1) Developing 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. 1621i. Managed care feasibility study]

    [(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 
October 29, 1992, 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.]

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. 1621j. California contract health services demonstration program]

    [(a) Establishment]
    [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) Agreement with California Rural Indian Health Board]
          [(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 1679(b) of this 
        title throughout the California contract health 
        services delivery area described in section 1680 of 
        this title 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 1621a of 
        this title or from amounts appropriated or otherwise 
        made available to the California contract health 
        service delivery area for a fiscal year.]
    [(c) Advisory board]
    [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) Commencement and termination dates]
    [The demonstration program described in this section shall 
begin on January 1, 1993, and shall terminate on September 30, 
1997.]
    [(e) Report]
    [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) ``High-cost contract care cases'' defined]
    [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 1621a of this title, except that the cost 
        of such treatment does not meet the threshold cost 
        requirement established pursuant to section 1621a(b)(2) 
        of this title; and]
          [(2) exceeds $1,000.]
    [(g) Authorization of appropriations]
    [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.]

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 tuberculosis, hepatitis, HIV, respiratory 
        syncytial virus, hanta virus, sexually transmitted 
        diseases, and H. Pylori.
          (2) Public information and education programs for the 
        prevention, control, and elimination of communicable 
        and infectious diseases.
          (3) Education, training, and clinical skills 
        improvement activities in the prevention, control, and 
        elimination of communicable and infectious diseases for 
        health professionals, including allied health 
        professionals.
          (4) Demonstration projects for the screening, 
        treatment, and prevention of hepatitis C virus (HCV).
    (b) Application Required.--The Secretary may provide 
funding under subsection (a) only if an application or proposal 
for funding is submitted to the Secretary.
    (c) Coordination with Health Agencies.--Indian Tribes, 
Tribal Organizations, and Urban Indian Organizations receiving 
funding under this section are encouraged to coordinate their 
activities with the Centers for Disease Control and Prevention 
and State and local health agencies.
    (d) Technical Assistance; Report.--In carrying out this 
section, the Secretary--
          (1) may, at the request of an Indian Tribe, Tribal 
        Organization, or Urban Indian Organization, provide 
        technical assistance; and
          (2) shall prepare and submit a report to Congress 
        biennially on the use of funds under this section and 
        on the progress made toward the prevention, control, 
        and elimination of communicable and infectious diseases 
        among Indians and Urban Indians.

[Sec. 1621k. Coverage of screening mammography]

    [The Secretary, through the Service, shall provide for 
screening mammography (as defined in section 1861(jj) of the 
Social Security Act [42 U.S.C.A. Sec. 1395x9JJ0]) 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 [42 U.S.C.A. Sec. 1395j et. seq.].]

Sec. 213. Authority for provision of other services

    (a) Funding Authorized.--The Secretary, acting through the 
Service, Indian Tribes, and Tribal Organizations, may provide 
funding under this Act to meet the objectives set forth in 
section 3 through health care-related services and programs not 
otherwise described in this Act, including--
          (1) hospice care;
          (2) assisted living;
          (3) long-term health care;
          (4) home- and community-based services, in accordance 
        with subsection (d); and
          (5) public health functions.
    (b) Services to Otherwise Ineligible Persons.--Subject to 
section 807, at the discretion of the Service, Indian Tribes, 
or Tribal Organizations, services provided for hospice care, 
home- and community-based care, assisted living, and long-term 
care may be provided (subject to reimbursement) 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 the Service or 
an Indian Tribe or Tribal Organization.
    (c) Terms and Conditions.--The Secretary shall require that 
any service provided under this section shall be in accordance 
with such terms and conditions as the Secretary determines to 
be consistent with accepted and appropriate standards relating 
to the service, including any licensing term or condition under 
this Act.
    (d) Definitions.--For the purposes of this section, the 
following definitions shall apply:
          (1)(A) The term `home- and community-based services' 
        means 1 or more of the following:
                  (i) Home health aide services.
                  (ii) Personal care services.
                  (iii) Nursing care services provided outside 
                of a nursing facility by, or under the 
                supervision of, a registered nurse.
                  (iv) Respite care.
                  (v) Training for family members.
                  (vi) Adult day care.
                  (vii) Such other home- and community-based 
                services as the Secretary, an Indian Tribe, or 
                a Tribal Organization may approve.
          (B) The term `home- and community-based services' 
        does not include a service provided by an individual 
        that is legally responsible for providing the service.
          (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)(A) The term `personal care services' means 
        services relating to assistance in carrying out 
        activities of daily living.
          (B) The term `personal care services' does not 
        include a service solely relating to assistance in 
        carrying out an ancillary activity, such as 
        housekeeping or household chores, as determined by the 
        Secretary.
          (4) The term `public health functions' means the 
        provision of public health-related programs, functions, 
        and services including 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. 1621l. Patient travel costs]

    [(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 [25 U.S.C.A. 
Sec. 450f et seq.]) under this chapter--]
          [(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.]

Sec. 214. Indian women's health care

    The Secretary, acting through the Service and Indian 
Tribes, Tribal Organizations, and Urban Indian Organizations, 
shall monitor and improve the quality of health care for Indian 
women of all ages through the planning and delivery of programs 
administered by the Service, in order to improve and enhance 
the treatment models of care for Indian women.

[Sec. 1621m. Epidemiology centers]

    [(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 
defininghealth status for purposes of the objectives specified in 
section 1602(b) of this title. 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 1602(b) of this 
        title.]
    [(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 1602(b) of this title 
        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 organization 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) of this section;]
          [(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 that $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.]

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) and evaluation of the types and nature of 
        activities, practices, and conditions causing or 
        affecting such health problems including uranium mining 
        and milling, uranium mining 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 2005 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 2005. The health care plan prepared under 
subsection (b) shall be submitted in a report no later than 1 
year after thestudy 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. 1621n. Comprehensive school health education programs]

    [(a) Award of grants]
    [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) Use of grants]
    [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) Assistance]
    [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) Criteria for review and approval of applications]
    [The Secretary shall establish criteria for the review and 
approval of applications for grants made pursuant to this 
section.]
    [(e) Report of recipient]
    [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) Program development]
          [(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) Authorization of appropriations]
    [There are authorized to be appropriated to carry out this 
section $15,000,000 for the fiscal year 1993 and such sums as 
may be necessary for each of the fiscal years 1994, 1995, 1996, 
1997, 1998, 1999, and 2000.]

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 and South Dakota as contract health service 
                    delivery area

    (a) In General.--Beginning in fiscal year 2003, the States 
of North Dakota and South Dakota shall be designated as a 
contract health service delivery area by the Service for the 
purpose of providing contract health care services to members 
of federally recognized Indian Tribes of North Dakota and South 
Dakota.
    (b) Limitation.--The Service shall not curtail any health 
care services provided to Indians residing on any reservation, 
or in any county that has a common boundary with any 
reservation, in the State of North Dakota or South Dakota if 
such curtailment is due to the provision of contract services 
in such States pursuant to the designation of such States as a 
contract health service delivery area pursuant to subsection 
(a).

[Sec. 1621o. Indian youth grant program]

    [(a) Grants]
    [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) Use of funds]
          [(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 
        1621h(m) of this title.]
    [(c) Models for delivery of comprehensive health care 
services]
    [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) Criteria for review and approval of applications]
    [The Secretary shall establish criteria for the review and 
approval of applications under this section.]
    [(e) Authorization of appropriations]
    [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.]

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 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. 1621p. American Indians Into Psychology Program]

    [(a) Grants]
    [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) Quentin N. Burdick American Indians Into Psychology 
Program]
    [The Secretary shall provide one of the grants authorized 
under subsection (a) of this section 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 1616g(b) of this title, the Quentin N. 
Burdick American Indians Into Nursing Program authorized under 
section 1616e(e) of this title, and existing university 
research and communications networks.]
    [(c) Issuance of regulations]
          [(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) Active duty service obligation]
    [The active duty service obligation prescribed under 
section 254m of Title 42 shall be met by each graduate student 
who receives a stipend described in subsection (c)(2)(D) of 
this section 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 [25 
        U.S.C.A. Sec. 450f et seq.],]
          [(3) in a program assisted under subchapter IV of 
        this chapter; 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.]

[Sec. 1621q. Prevention, control, and elimination of tuberculosis]

    [(a) Grants]
    [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) Application for grant]
    [The Secretary may make a grant under subsection (a) of 
this section 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) of this section and such other agreements, 
assurances, and information as the Secretary may require.]
    [(c) Eligibility for grant]
    [To be eligible for a grant under subsection (a) of this 
section, 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, 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) Duties of Secretary]
    [In carrying out this section, the Secretary--]
          [(1) shall establish criteria for the review and 
        approval of applications for grants under subsection 
        (a) of this section, including requirement of public 
        health qualifications of applicants;]
          [(2) shall, subject to available appropriations, make 
        at least one grant under subsection (a) of this section 
        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) Reduction of amount of grant]
    [The Secretary may, at the request of a recipient of a 
grant under subsection (a) of this section, 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) of this section 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.]

[Sec. 1621r. Contract health services payment study]

    [(a) Duty of Secretary]
    [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) Functions of study]
    [The study required by subsection (a) of this section 
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 
        requirement to evaluate the systemic differences or 
        similarities employed by the Service and private 
        insurers.]
    [(c) Report to Congress]
    [Not later than 12 months after October 29, 1992, 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.]

[Sec. 1621s. Prompt action on payment of claims]

    [(a) Time of 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) Failure to timely respond]
    [If the Service fails to respond to a notification of a 
claim in accordance with subsection (a) of this section, the 
Service shall accept as valid the claim submitted by the 
provider of a contract care service.]
    [(c) Time of payment]
    [The Service shall pay a completed contract care service 
claim within 30 days after completion of the claim.]

[Sec. 1621t. Demonstration of electronic claims processing]

    [(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) of this section in the Service 
area served by the area office located in Phoenix, Arizona.]

[Sec. 1621u. Liability for payment]

    [(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.]

[Sec. 1621v. Office of Indian Women's Health Care]

    [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.]

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

    Health care professionals employed by a Tribal Health 
Program shall, if licensed or certified in any State, be exempt 
from the licensing requirements of the State in which the 
Tribal Health Program performs the services described in its 
contract or compact under the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.).

Sec. 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 233(b), the provider shall have no further 
recourse against the patient who received the services.

Sec. 225. Office of Indian men's health

    (a) Establishment.--The Secretary shall establish within 
the Service an office to be known as the `Office of Indian 
Men's Health' (referred to in this section as the `Office').
    (b) Director.--
          (1) In general.--The Office shall be headed by a 
        Director, to be appointed by the Secretary.
          (2) Duties.--The Director shall coordinate and 
        promote the status of the health of Indian men in the 
        United States.
    (c) Report.--Not later than 2 years after the date of 
enactment of the Indian Health Care Improvement Act Amendments 
of 2005, the Secretary, acting through the Director of the 
Office, shall submit to Congress a report describing--
          (1) any activity carried out by the Director as of 
        the date on which the report is prepared; and
          (2) any finding of the Director with respect to the 
        health of Indian men.

Sec. 1621w. Authorization of appropriations

    [Except as provided in sections 1621h(m), 1621j, 1621l, 
1621m(b)(5), 1621n, and 1621o of this title, t] There are 
authorized to be appropriated such sums as may be necessary for 
each fiscal year through fiscal year 2015 [2000] to carry out 
this title [subchapter].

[Sec. 1621x. Limitation on use of funds]

    [Amounts appropriated to carry out this subchapter may not 
be used in a manner inconsistent with the Assisted Suicide 
Funding Restriction Act of 1997 [42 U.S.C.A. Sec. 14401 et 
seq.].

[Sec. 1622. Transferred]

              TITLE [SUBCHAPTER] III--[HEALTH] FACILITIES

Sec. 1631. Consultation; Construction and Renovation of Facilities; 
                    [closure of facilities; r]Reports

    (a) Prerequisites for Expenditure of Funds.--[Consultation; 
standards for accreditation]
    Prior to the expenditure of, or the making of any binding 
[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) 
(commonly known as the `Snyder Act') [section 13 of this title, 
popularly known as the Snyder Act], the Secretary, acting 
through the Service, shall--
          (1) consult with any Indian [t] 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 [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) Closures.--[; report on proposed closure]
          (1) Evaluation Required.--Notwithstanding any other 
        provision of law, no facility operated by the Service 
        [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 of the proposed closure 
        [such hospital or facility (or portion thereof) is 
        proposed to be closed] an evaluation of the impact of 
        the [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 [t] Tribes served 
                by such [hospital or] facility concerning such 
                closure;
                  (F) the level of use of such [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) Exception for certain temporary closures.--
        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 
        construction safety reasons.
    (c) Health Care Facility Priority System.--[Annual report 
on health 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 2005 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) [(1)] Report; contents.--The Secretary shall 
        submit to the President, for inclusion in [each] the 
        report required to be transmitted to [the] Congress 
        under section 801 [1671 of this title], a report which 
        sets forth the following:[--]
                  (A) A description of the [current] health 
                care facility priority system of the Service, 
                established under paragraph (1).
                  (B) Health care facilities lists, including--
                [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),]
                          (i) the 10 top-priority inpatient 
                        health care facilities;
                          (ii) the 10 top-priority outpatient 
                        health care facilities;
                          (iii) the 10 top-priority specialized 
                        health care facilities (such as long-
                        term care and alcohol and drug abuse 
                        treatment);
                          (iv) the 10 top-priority staff 
                        quarters developments associated with 
                        health care facilities; and
                          (v) the 10 top-priority hostels 
                        associated with health care facilities.
                  (C) [t]The justification for such order of 
                priority[,].
                  (D) [t]The projected cost of such projects.[, 
                and]
                  (E) [t]The methodology adopted by the Service 
                in establishing priorities under its health 
                facility priority system.
          (3)[(2)] Requirements for preparation of reports.--In 
        preparing each report required under paragraph (2) 
        [(1)] (other than the initial report), the Secretary 
        shall annually--
                  (A) consult with and obtain information on 
                all health care facilities needs from Indian 
                [t]Tribes, Tribal Organizations, and Urban 
                Indian Organizations; [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 [25 
                U.S.C.A. Sec. 450f et seq.],] and
                  (B) review the total unmet needs of all 
                Indian [such t]Tribes, Tribal Organizations, 
                and Urban Indian Organizations [and tribal 
                organizations] for health care [inpatient and 
                outpatient] facilities (including hostels and 
                staff quarters), including [their] needs for 
                renovation and expansion of existing 
                facilities.
          (4)[(3)] Criteria for evaluating needs.--For purposes 
        of this subsection, the Secretary shall, in evaluating 
        the needs of facilities operated under any contract or 
        compact [entered into with the Service] under the 
        Indian Self-Determination and Education Act (25 U.S.C. 
        450 et seq.) [25 U.S.C. Sec. 450f et seq],] use the 
        same criteria that the Secretary uses in evaluating the 
        needs of facilities operated directly by the Service.
          (5)[(4)] 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 
        contracts or compacts in accordance with the [which are 
        the subject of a contract for health services entered 
        into with the Service under the] Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 
        450 et seq.) [25 U.S.C. Sec. 450f et seq] are fully and 
        equitably integrated into [the development of] the 
        health care facility priority system.
    (d) Review of Need for Facilities
          (1) Initial report.--In the year 2006, 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) In preparing an updated report under paragraph 
        (2), the Secretary shall consult with Indian Tribes, 
        Tribal Organizations, and Urban Indian Organizations. 
        The Secretary shall submit the report under paragraph 
        (2) 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 contracts or compacts under the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 
        450 et seq.), 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 contracts 
        or compacts under the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450 et seq.) shall 
        be fully and equitably integrated into the development 
        of the health facility priority system.
          (6) Beginning in the year 2007 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.--[(d) Funds appropriated subject to 
section 450f of this title]
    All funds appropriated under the Act of November 2, 1921 
(25 U.S.C. 13) (commonly known as the `Snyder Act'), [section 
13 of this title,] for the planning, design, construction, or 
renovation of health facilities for the benefit of 1 or more 
[an] Indian [tribe or t]Tribes shall be subject to the 
provisions of [section 102 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. 1632. Sanitation [Safe water and sanitary waste disposal 
                    f]Facilities

    (a) [Congressional f]Findings.--
    [The] Congress [hereby] finds the following: [and declares 
that--]
          (1) [t]The provision of sanitation facilities [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 sanitation 
        facilities. [such systems;]
          (3) [t]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 [such systems] and 
        other preventive health measures[;].
          (4) [m]Many Indian homes and Indian communities still 
        lack sanitation facilities. [safe water supply systems 
        and sanitary sewage and solid waste disposal systems; 
        and]
          (5) [i]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. [safe and 
        adequate water supply systems and sanitary sewage waste 
        disposal systems as soon as possible.]
    (b) Facilities and Services._[Authority; assistance; 
transfer of funds]
    [(1)] In furtherance of the findings [and declarations] 
made in subsection (a) [of this section], 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.A. 
2004a) [2004a of Title 42]. Under such authority, [(2) T]the 
Secretary, acting through the Service, is authorized to provide 
the following: [under section 2004a of Title 42.]
          (1)[(A) f]Financial and technical assistance to 
        Indian [t]Tribes, Tribal Organizations, and Indian 
        communities in the establishment, training, and 
        equipping of utility organizations to operate and 
        maintain [Indian] 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)[(B) o]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.[; 
        and]
          (3)[(C)] Priority funding for operation and 
        maintenance assistance for, and emergency repairs to, 
        [tribal] sanitation facilities operated by an Indian 
        Tribe, Tribal Organization orIndian community when 
necessary to avoid an imminent [a] health threat [hazard] or to protect 
the [Federal] investment in sanitation facilities and the investment in 
the health benefits gained through the provision of sanitation 
facilities.
    (c) Funding.--[(3)] Notwithstanding any other provision of 
law--
          (1)[(A)] the Secretary of Housing and Urban 
        Development [Affairs] is authorized to transfer funds 
        appropriated under the Native American Housing 
        Assistance and Self-Determination [Community 
        Development] Act of 1996 [1974 (42 U.S.C. 5301 et 
        seq.)] to the Secretary of Health and Human Services;[, 
        and]
          (2)[(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); [2004a of Title 42.]
          (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 purposes of providing 
        sanitation facilities and services and place these 
        funds into contracts or compacts under the Indian Self-
        Determination and Education Act (25 U.S.C. 450 et 
        seq.);
          (5) except as otherwise prohibited by this section, 
        the Secretary may use funds appropriated under the 
        authority of section 7 of the Act of August 5, 1954 (42 
        U.S.C. 2004a) to fund up to 100 percent of the amount 
        of an Indian Tribe's loan obtained under any Federal 
        program for new projects to construct eligible 
        sanitation facilities to serve Indian homes;
          (6) except as otherwise prohibited by this section, 
        the Secretary may use funds appropriated under the 
        authority of section 7 of the Act of August 5, 1954 (42 
        U.S.C. 2004a) to meet matching or cost participation 
        requirements under other Federal and non-Federal 
        programs for new projects to construct eligible 
        sanitation facilities;
          (7) all Federal agencies are authorized to transfer 
        to the Secretary funds identified, granted, loaned, or 
        appropriated whereby the Department's applicable 
        policies, rules, and regulations shall apply in the 
        implementation of such projects;
          (8) the Secretary of Health and Human Services shall 
        enter into interagency agreements with Federal and 
        State agencies for the purpose of providing financial 
        assistance for sanitation facilities and services under 
        this Act; 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.
    [(c) 10-Year Plan]
    [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) Certain Capabilities Not Prerequisite._[Tribal 
capability]
    The financial and technical capability of an Indian 
[t]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 [Amount of a]Assistance.--
          [(1)] The Secretary is authorized to provide 
        financial assistance to Indian [t]Tribes, Tribal 
        Organizations and Indian communities for operation, 
        management, and maintenance of their sanitation 
        facilities. [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) of this section.]
          [(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) Operation, Management, and Maintenance of Facilities.--
The Indian Tribe has the primary responsibility to establish, 
collect, and use reasonable user fees, or otherwise set aside 
funding, for the purpose of operating, managing, and 
maintaining sanitation facilities. If a sanitation facility 
serving a community that is operated by an Indian Tribe or 
Tribal Organization is threatened with imminent failure and 
such operator lacks capacity to maintain the integrity or the 
health benefits of the sanitation facility, then the Secretary 
is authorized to assist the Indian Tribe, Tribal Organization, 
or Indian community in the resolution of the problem on a 
short-term basis through cooperation with the emergency 
coordinator or by providing operation, management, and 
maintenance service.
    (g) ISDEAA Program Funded on Equal Basis.--Tribal Health 
Programs shall be eligible (on an equal basis with programs 
that are administered directly by the Service) for--
          (1) any funds appropriated pursuant to this section; 
        and
          (2) any funds appropriated for the purpose of 
        providing sanitation facilities.
    [(f) Eligibility of programs administered by Indian tribes]
    [Programs administered by Indian tribes or tribal 
organizations under the authority of the Indian Self-
Determination Act [25 U.S.C.A. Sec. 450f et seq.] 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.]
    (h) Report.--[(g) Annual report; sanitation deficiency 
levels]
          (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] the 
        report required to be transmitted to [the] Congress 
        under section 801[1671 of this title], 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 
                [facilities] for each type of project of each 
                Indian [t]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 [raise] all 
                Indian [t]Tribes and Indian communities to [a] 
                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. [the amount of funds necessary to raise 
                all Indian tribes and communities to zero 
                sanitation deficiency.]
    (2) Criteria.--The criteria on which the deficiencies and 
needs will be evaluated shall be developed through negotiated 
rulemaking pursuant to section 802.
          [(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 [25 
        U.S.C.A. Sec. 450f et seq.]) to determine the 
        sanitation needs of each tribe.]
          (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 
        [t]Tribes and Indian communities.
          (4) Sanitation deficiency levels.--For purposes of 
        this subsection, the sanitation deficiency levels for 
        an individual, Indian [t]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 [is] an individual, 
                Indian [t]Tribe or Indian community [with a 
                sanitation system]--
                          (i) [which] complies with all 
                        applicable water supply, [and] 
                        pollution control, and solid waste 
                        disposal laws[,]; and
                          (ii) [in which the] deficiencies 
                        relate to routine replacement, repair, 
                        or maintenance needs[;].
                  (B) A level II deficiency exists if a 
                sanitation facility serving an individual, [is 
                an] Indian [t]Tribe, or Indian community 
                substantially or recently complied with all 
                applicable water supply, pollution control, and 
                solid waste laws and any deficiencies relate to 
                [with a sanitation system]--
                          (i) small or minor capital 
                        improvements needed to bring the 
                        facility back into compliance; [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 enlarge or improve the 
                        facilities in order to meet the current 
                        needs [of such tribe or community] 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, [is 
                an] Indian [t]Tribe or Indian community meets 
                one or more of the following conditions [with a 
                sanitation system which]--
                          (i) water or sewer service in the 
                        home is provided by a haul system with 
                        holding tanks and interior plumbing; 
                        [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) major significant interruptions 
                        to water supply or sewage disposal 
                        occur frequently, requiring major 
                        capital improvements to correct the 
                        deficiencies; or [has no solid waste 
                        disposal facility;]
                          (iii) there is no access to or no 
                        approved or permitted solid waste 
                        facility available.
                  (D) A level iv deficiency exists.--[(IV) is 
                an Indian tribe or community with a sanitary 
                system which lacks either a safe water supply 
                system or a sewage disposal system: and]
                          (i) if a sanitation facility of an 
                        individual home, an Indian Tribe, or an 
                        Indian community exists but--
                                  (I) lacks--
                                          (aa) a safe water 
                                        supply system; or
                                          (bb) a waste disposal 
                                        system;
                                  (II) contains no piped water 
                                or sewer facilities; or
                                  (III) has become inoperable 
                                due to a major component 
                                failure; or
                          (ii) if only a washeteria or central 
                        facility exists in the community.
                  (E) A level V deficiency exists in the 
                absence of a sanitation facility, where 
                individual homes do not have access to safe 
                drinking water or adequate wastewater 
                (including sewage) disposal. [(V) is an Indian 
                tribe or community that lacks a safe water 
                supply and a sewage disposal system.]
    (i) Definitions.--For purposes of this section, the 
following terms apply:
          (1) Indian community.--The term `Indian community' 
        means a geographic area, a significant proportion of 
        whose inhabitants are Indians and which is served by or 
        capable of being served by a facility described in this 
        section.
          (2) Sanitation facilities.--The terms `sanitation 
        facility' and `sanitation facilities' mean safe and 
        adequate water supply systems, sanitary sewage disposal 
        systems, and sanitary solid waste systems (and all 
        related equipment and support infrastructure).
          [(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.]

Sec. 1633. Preference to Indians and Indian firms

    (a) Buy Indian Act._[Discretionary authority; covered 
activities]
    The Secretary, acting through the Service, may use 
[utilize] the negotiating authority of section 23 [47] of the 
Act of June 25, 1910 (25 U.S.C. 47, commonly known as the `Buy 
Indian Act') [this title], 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 [t]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 [1631 
of this title] and in the construction of sanitation [safe 
water and sanitary waste disposal] facilities pursuant to 
section 302 [1632 of this title]. Such preference may be 
accorded by the Secretary unless the Secretary [he] finds, 
pursuant to [rules and] regulations [promulgated] adopted 
pursuant to section 802 [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 such a 
[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) Labor Standards._[Pay rates]
          (1) In general.--For the purpose of implementing the 
        provisions of this title [subchapter], 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--[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 subchapter are not less 
        than the prevailing local wage rates for similar work 
        as determined in accordance with sections 3141 to 3144, 
        3146, 3147 of Title 40.]
                  (A) is performed by a contractor pursuant to 
                a contract with an Indian Tribe or Tribal 
                Organization with funds supplied through a 
                contract or compact authorized by the Indian 
                Self-Determination and Education Assistance Act 
                (25 U.S.C. 450 et seq.), 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. 1634. Expenditure of [n]Non[-S]service [f]Funds for [r]Renovation

    (a) In General.--[Authority of Secretary] [(1)] 
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 [t]Tribe or Tribal 
Organization of any Service facility or of any other Indian 
health facility operated pursuant to a contract or compact 
[entered into] under the Indian Self-Determination Act and 
Education Assistance Act (25 U.S.C. 450 et seq.), [25 U.S.C.A. 
Sec. 450f et seq.] including--
          (1)[(A)] any plans or designs for such expansion, 
        renovation or modernization; and
          (2)[(B)] any expansion, renovation or modernization 
        for which funds appropriated under any Federal law were 
        lawfully expended. [, but only if the requirements of 
        subsection (b) of this section are met.]
    (b) Priority List._
          (1)[(2)] In general.--The Secretary shall maintain a 
        separate priority list to address the needs for 
        increased operating expenses, [of such facilities for] 
        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)[(3)] Report.--The Secretary shall submit to the 
        President, for inclusion in [each] the report required 
        to be transmitted to [the] Congress under section 801 
        [1671 of this section], the priority list maintained 
        pursuant to paragraph (1)[(2)].
    (c)[(b)] Requirements--The requirements of this subsection 
are met with respect to any expansion, renovation or 
modernization if--
          (1) the Indian T[t]ribe or [t]Tribal 
        [o]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 T[t]ribe or 
                Tribal Organization in accordance with any 
                applicable [the rules and] 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 expansion, 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._[(c) Recovery for 
non-use as Service facility]
    If any Service facility which has been expanded, renovated 
or modernized by an Indian [t]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 [t]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. 1635. Repealed. Pub. L. 100-713, Title III, Sec. 303(b), Nov. 23, 
                    1988, 102 Stat. 4817]

Sec. 1636. Funding [Grant program] for the [c]Construction, 
                    [e]Expansion, and [m]Modernization of [s]Small 
                    [a]Ambulatory [c]Care [f]Facilities

    (a) Funding._[Authorization]
          (1) In general.--The Secretary, acting through the 
        Service, shall make grants to Indian T[t]ribes and 
        [t]Tribal [o]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) [as provided in 
        subsection (c)(1)(C) of this section)]. A grant made 
        under this section may cover up to 100 percent of the 
        costs of such construction, expansion, or 
        modernization. For the purposes of this section, the 
        term [``]`construction'[''] includes the replacement of 
        an existing facility.
          (2) Grant agreement required._A grant under paragraph 
        (1) may only be available [made] to a Tribal Health 
        Program [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 Indian T[t]ribe or [t]Tribal 
        [o]Organization) [pursuant to a contract entered into 
        under the Indian Self-Determination Act [25 U.S.C.A. 
        Sec. 450f et seq.]].
    (b) Use of [g] Grant Funds
          (1) Allowable uses._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[1631] or 
                section 307[1637 of this title]; and
                  (C) which, upon completion of such 
                construction, expansion, or modernization 
                will--
                          (i) have a total capacity appropriate 
                        to its projected service population;
                          (ii) provide annually no fewer than 
                        150 patient visits by eligible Indians 
                        and other users who are eligible for 
                        services in such facility in accordance 
                        with section 807(c)(2) [serve no less 
                        than 500 eligible Indians annually]; 
                        and
                          (iii) provide ambulatory care in a 
                        [s]Service [a]Area (specified in the 
                        contract or compact [entered into] 
                        under the Indian Self-Determination and 
                        Education Assistance Act (25 U.S.C. 450 
                        et seq.)[25 U.S.C.A. Sec. 450f et 
                        seq.]]) with a population of no fewer 
                        than 1,500 [not less than 2,000] 
                        eligible Indians and other users who 
                        are eligible for services in such 
                        facility in accordance with section 
                        807(c)(2).
          (2) Additional allowable use.--The Secretary may also 
        reserve a portion of the funding provided under this 
        section and use those reserved funds to reduce an 
        outstanding debt incurred by Indian Tribes or Tribal 
        Organizations for the construction, expansion, or 
        modernization of an ambulatory care facility that meets 
        the requirements under paragraph (1). The provisions of 
        this section shall apply, except that such applications 
        for funding under this paragraph shall be considered 
        separately from applications for funding under 
        paragraph (1).
          (3) Use only for certain portion of costs.--A grant 
        provided under this section may be used only for the 
        cost of that portion of a construction, expansion, or 
        modernization project that benefits the Service 
        population identified above in subsection (b)(1)(C)(ii) 
        and (iii). [(2)] The requirements of clauses (ii) and 
        (iii) of paragraph (1)(C) shall not apply to an Indian 
        Tribe [a tribe] or [t]Tribal [o]Organization applying 
        for a grant under this section for a health care 
        facility [whose tribal government offices are] 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) [Application for g]Grants.--
          (1) Application._No grant may be made available under 
        this section unless an application or proposal for 
        [the] a grant has been [submitted to and] approved by 
        the Secretary in accordance with applicable regulations 
        and has forth 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--[. 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) Priority.--In awarding grants under this section, 
        the Secretary shall give priority to Indian T[t]ribes 
        and [t]Tribal [o]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._[Transfer of interest to 
United States upon cessation of facility] If any facility (or 
portion thereof) with respect to which funds have been paid 
under this section, ceases, within 5 years [at any time] after 
completion of the construction, expansion, or modernization 
carried out with such funds, to be used [utilized] for the 
purposes of providing health [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 unless otherwise negotiated by the Service and 
the Indian Tribe or Tribal Organization.
    (e) Funding Nonrecurring.--Funding provided under this 
section shall be nonrecurring and shall not be available for 
inclusion in any individual Indian Tribe's tribal share for an 
award under the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.) or for reallocation or 
redesign thereunder.

Sec. 1637. Indian [h]Health [c]Care [d]Delivery [d]Demonstration 
                    [p]Project

    (a) Health [c]Care [delivery d]Demonstration [p]Projects.--
The Secretary, acting through the Service, and in consultation 
with Indian Tribes and Tribal Organizations, is authorized to 
enter into construction agreements under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et 
seq.) with[, or make grants to,] Indian [t]Tribes or [t]Tribal 
[o]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 [f]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 [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[.]; and
          (6) permit the use of Service funds to match other 
        funds, including Federal funds.
    (c) Regulations._ Criteria]
          [(1) Within 180 days after November 28, 1990, t]The 
        Secretary[, after consultation with Indian tribes and 
        tribal organizations,] shall develop and promulgate 
        regulations not later than 1 year after the enactment 
        of the Indian Health Care Improvement Act Amendments of 
        2005. If the Secretary has not promulgated regulations 
        by that date, the Secretary shall develop and publish 
        regulations, through rulemaking under 802, [in the 
        Federal Register criteria] for the review and approval 
        of applications submitted under this section.
    (d) Criteria._The Secretary may approve [enter into a 
contract or award a grant under this section for] projects that 
[which] meet the following criteria:
          (1)[(A)] There is a need for a new facility or 
        program or the reorientation of an existing facility or 
        program.
          (2)[(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.]
          (3)[(D)] The project has the potential to deliver 
        services in an efficient and effective manner.
          (4)[(E)] The project is economically viable.
          (5)[(F)] The Indian [t]Tribe or [t]Tribal 
        [o]Organization has the administrative and financial 
        capability to administer the project.
          (6)[(G)] 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._[(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 subsection (d) [paragraph (1)].
    (f) Priority._The Secretary shall give priority to 
applications for demonstration projects [(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 [s]Service [u]Units to the extent that 
such applications are timely filed and meet the criteria 
specified in subsection (d): [which meets the criteria 
specified in paragraph (1) and for which a completed 
application has been received by the Secretary:]
          (1)[(i)] Cass Lake, Minnesota.
          (2)[(ii)] Clinton, Oklahoma.
          (3)[(iii)] Harlem, Montana.
          (4)[(iv)] Mescalero, New Mexico.
          (5)[(v)] Owyhee, Nevada.
          (6)[(vi)] Parker, Arizona.
          (7)[(vii)] Schurz, Nevada.
          (8)[(viii)] Winnebago, Nebraska.
          (9)[(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).]
    (g)[(d)] Technical [a]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)[(e)] Service to [i]Ineligible [p]Persons.--Subject to 
section 807, [T]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 
[s]Service facilities to non-Service health care practitioners 
as provided in section 807[1680c of this title] may be 
included, subject to the terms of such section, in any 
demonstration project approved pursuant to this section.
    (i)[(f)] Equitable [t]Treatment.--For purposes of 
subsection (d)(1)[(c)(1)(A) of this section], the Secretary 
shall, in evaluating facilities operated under any contract or 
compact entered into with the Service under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et 
seq.) [25 U.S.C.A. Sec. 450f et seq.], use the same criteria 
that the Secretary uses in evaluating facilities operated 
directly by the Service.
    (j)[(g)] Equitable [i]Integration of [f]Facilities.--The 
Secretary shall ensure that the planning, design, construction, 
[and] renovation, and expansion needs of Service and non-
Service facilities which are the subject of a contract or 
compact [entered into with the Service] under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et 
seq.) (25 U.S.C. 450 et seq.) [25 U.S.C.A. 450f et seq.],] for 
health services are fully and equitably integrated into the 
implementation of the health care delivery demonstration 
projects under this section.
    [(h) Report to Congress]
          [(1) The Secretary shall submit to the President, for 
        inclusion in the report which is required to be 
        submitted to the Congress under section 1671 of this 
        title 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 1671 of this 
        title 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.]

Sec. 1638. Land [t]Transfer

    Notwithstanding any other provision of law, [T]the Bureau 
of Indian Affairs and all other agencies and departments of the 
United States are [is] 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. [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.]

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 Organization which hold (1) title to, (2) a leasehold 
interest in, or (3) a beneficial interest in (when title is 
held by the United States in trust for the benefit of an Indian 
Tribe) facilities used or to be used for the administration and 
delivery of health services by an Indian Health Program. Such 
leases, contracts, or agreements may include provisions for 
construction or renovation and provide for compensation to the 
Indian Tribe or Tribal Organization of rental and other costs 
consistent with section 105(l) of the Indian Self-Determination 
and Education Assistance Act (25 U.S.C. 450j(l)) and 
regulations thereunder.

Sec. 309. Study on loans, loan guarantees, and loan repayment

    (a) In General.--The Secretary, in consultation with the 
Secretary of the Treasury, Indian Tribes, and Tribal 
Organizations, shall carry out a study to determine the 
feasibility of establishing a loan fund to provide to Indian 
Tribes and Tribal Organizations direct loans or guarantees for 
loans for the construction of health care facilities, 
including--
          (1) inpatient facilities;
          (2) outpatient facilities;
          (3) staff quarters;
          (4) hostels; and
          (5) specialized care facilities, such as behavioral 
        health and elder care facilities.
    (b) Determinations.--In carrying out the study under 
subsection (a), the Secretary shall determine--
          (1) the maximum principal amount of a loan or loan 
        guarantee that should be offered to a recipient from 
        the loan fund;
          (2) the percentage of eligible costs, not to exceed 
        100 percent, that may be covered by a loan or loan 
        guarantee from the loan fund (including costs relating 
        to planning, design, financing, site land development, 
        construction, rehabilitation, renovation, conversion, 
        improvements, medical equipment and furnishings, and 
        other facility-related costs and capital purchase (but 
        excluding staffing));
          (3) the cumulative total of the principal of direct 
        loans and loan guarantees, respectively, that may be 
        outstanding at any 1 time;
          (4) the maximum term of a loan or loan guarantee that 
        may be made for a facility from the loan fund;
          (5) the maximum percentage of funds from the loan 
        fund that should be allocated for payment of costs 
        associated with planning and applying for a loan or 
        loan guarantee;
          (6) whether acceptance by the Secretary of an 
        assignment of the revenue of an Indian Tribe or Tribal 
        Organization as security for any direct loan or loan 
        guarantee from the loan fund would be appropriate;
          (7) whether, in the planning and design of health 
        facilities under this section, users eligible under 
        section 807(c) may be included in any projection of 
        patient population;
          (8) whether funds of the Service provided through 
        loans or loan guarantees from the loan fund should be 
        eligible for use in matching other Federal funds under 
        other programs;
          (9) the appropriateness of, and best methods for, 
        coordinating the loan fund with the health care 
        priority system of the Service under section 301; and
          (10) any legislative or regulatory changes required 
        to implement recommendations of the Secretary based on 
        results of the study.
    (c) Report.--Not later than September 30, 2007, 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, 
shall make arrangements with Indian Tribes and Tribal 
Organizations to establish joint venture demonstration projects 
under which an Indian Tribe or Tribal Organization shall expend 
tribal, private, or other available funds, for the acquisition 
or construction of a health facility for a minimum of 10 years, 
under a no-cost lease, in exchange for agreement by the Service 
to provide the equipment, supplies, and staffing for the 
operation and maintenance of such a health facility. An Indian 
Tribe or Tribal Organization may use tribal funds, private 
sector, or other available resources, including loan 
guarantees, to fulfill its commitment under a joint venture 
entered into under this subsection. An Indian Tribe or Tribal 
Organization shall be eligible to establish a joint venture 
project if, when it submits a letter of intent, it--
          (1) has begun but not completed the process of 
        acquisition or construction of a health facility to be 
        used in the joint venture project; or
          (2) has not begun the process of acquisition or 
        construction of a health facility for use in the joint 
        venture project.
    (b) Requirements.--The Secretary shall make such an 
arrangement with an Indian Tribe or Tribal Organization only 
if--
          (1) the Secretary first determines that the Indian 
        Tribe or Tribal Organization has the administrative and 
        financial capabilities necessary to complete the timely 
        acquisition or construction of the relevant health 
        facility; and
          (2) the Indian Tribe or Tribal Organization meets the 
        need criteria 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, or lands 
owned by any Alaska Native village, or village or regional 
corporation under the Alaska Native Claims Settlement Act, or 
any lands allotted to any Alaska Native, if requested by the 
Indian owner and the Indian Tribe with jurisdiction over such 
lands or other lands owned or leased by the Indian Tribe or 
Tribal Organization. Top priority shall be given to Indian land 
owned by 1 or more Indian Tribes.
    (b) Definition.--For purposes of this section, the term 
`Indian lands' means--
          (1) all lands within the exterior boundaries of any 
        reservation;
          (2) any lands title to which is held in trust by the 
        United States for the benefit of any Indian Tribe or 
        individual Indian or held by any Indian Tribe or 
        individual Indian subject to restriction by the United 
        States against alienation.

Sec. 313. Maintenance and improvement of health care facilities

    (a) Report.--The Secretary shall submit to the President, 
for inclusion in the report required to be transmitted to 
Congress under section 801, a report which identifies the 
backlog of maintenance and repair work required at both Service 
and tribal health care facilities, including new health care 
facilities expected to be in operation in the next fiscal year. 
The report shall also identify the need for renovation and 
expansion of existing facilities to support the growth of 
health care programs.
    (b) Maintenance of Newly Constructed Space.--The Secretary, 
acting through the Service, is authorized to expend maintenance 
and improvement funds to support maintenance of newly 
constructed space only if such space falls within the approved 
supportable space allocation for the Indian Tribe or Tribal 
Organization. Supportable space allocation shall be defined 
through the 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 contract or compact under the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 
        450 et seq.) shall have the authority to establish the 
        rental rates charged to the occupants of such quarters 
        by providing notice to the Secretary of its election to 
        exercise such authority.
          (2) Objectives.--In establishing rental rates 
        pursuant to authority of this subsection, a Tribal 
        Health Program shall endeavor to achieve the following 
        objections:
                  (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. 1638a. Authorization of appropriations]

    [There are authorized to be appropriated such sums as may 
be necessary for each fiscal year through fiscal year 2000 to 
carry out this subchapter.]

Sec. 1638b. Applicability of Buy American Act R r]equirement

    (a) Applicability.--[Duty of Secretary]
    The Secretary shall ensure that the requirements of the Buy 
American Act [[41 U.S.C.A. Sec. 10a et seq.]] apply to all 
procurements made with funds provided pursuant to [the 
authorization contained in] section 317[1638a of this title]. 
Indian Tribes and Tribal Organizations shall be exempt from 
these requirements.
    [(b) Report to Congress]
    [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 1638a of this title. Such 
report shall separately indicate the dollar value of items 
procured with such funds for which the Buy American Act [41 
U.S.C.A. Sec. 10a et seq.] was waived pursuant to the Trade 
Agreement Act of 1979 [19 U.S.C.A. Sec. 2501 et seq.] or any 
international agreement to which the United States is a party.]
    (b)[(c)] Effect of Violation.--[Fraudulent use of Made-in-
America label] 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 317 [1638a of this title], 
pursuant to the debarment, suspension, and ineligibility 
procedures described in sections 9.400 through 9.409 of title 
48, Code of Federal Regulations.
    (c)[(d)] Definitions._[``Buy American Act'' defined] For 
purposes of this section, the term [``]`Buy American Act'[''] 
means title III of the Act entitled ``An Act making 
appropriations for the Treasury and Post Office Departments for 
the fiscal year ending June 30, 1934, and for other purposes'', 
approved March 3, 1933 (41 U.S.C. 10a et seq.).

Sec. 316. Other funding for facilities

    (a) Authority to Accept Funds.--The Secretary is authorized 
to accept from any source, including Federal and State 
agencies, funds that are available for the construction of 
health care facilities and use such funds to plan, design, and 
construct health care facilities for Indians and to place such 
funds into a contract or compact under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et 
seq.). Receipt of such funds shall have no effect on the 
priorities established pursuant to section 301.
    (b) Interagency Agreements.--The Secretary is authorized to 
enter into interagency agreements with other Federal agencies 
or State agencies and other entities and to accept funds from 
such Federal or State agencies or other sources to provide for 
the planning, design, and construction of health care 
facilities to be administered by Indian Health Programs in 
order to carry out the purposes of this Act and the purposes 
for which the funds were appropriated or for which the funds 
were otherwise provided.
    (c) 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.

[Sec. 1638c. Contracts for personal services in Indian Health Service 
                    facilities]

    [In fiscal year 1995 and thereafter--]
    [(a) In general]
    [The Secretary may enter into personal services contracts 
with entities, either individuals or organizations, for the 
provision of services in facilities owned, operated or 
constructed under the jurisdiction of the Indian Health 
Service.]
    [(b) Exemption from competitive contracting requirements]
    [The Secretary may exempt such a contract from competitive 
contracting requirements upon adequate notice of contracting 
opportunities to individuals and organizations residing in the 
geographic vicinity of the health facility.]
    [(c) Consideration of individuals and organizations]
    [Consideration of individuals and organizations shall be 
based solely on the qualifications established for the contract 
and the proposed contract price.]
    [(d) Liability]
    [Individuals providing health care services pursuant to 
these contracts are covered by the Federal Tort Claims Act.]

[Sec. 1638d. Credit to appropriations of money collected for meals at 
                    Indian Health Service facilities]

    [Money before, on, and after September 30, 1994, collected 
for meals served at Indian Health Service facilities will be 
credited to the appropriations from which the services were 
furnished and shall be credited to the appropriation when 
received.]

         TITLE IV [SUBCHAPTER III-A]--ACCESS TO HEALTH SERVICES

Sec. 1641. Treatment of [p]Payments [u]Under Social Security Act Health 
                    Care [medicare] P[p rograms

    (a) Disregard of Medicare, Medicaid, and SCHIP Payments in 
Determining Appropriations [Determination of 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 [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 [25 U.S.C.A.Sec. 450f 
et seq.])] for services provided to Indians eligible for 
benefits under such respective titles [Title XVIII of the 
Social Security Act [42 U.S.C.A. Sec. 1395 et seq.]] shall not 
be considered in determining appropriations for the provision 
of health care and services to Indians.
    (b) Nonpreferential Treatment._[Preferences] Nothing in 
this Act [chapter] authorizes the Secretary to provide services 
to an Indian [beneficiary] with coverage under title XVIII, 
XIX, or XXI of the Social Security Act [[42 U.S.C.A. Sec. 1395 
et seq.], as amended,] in preference to an Indian [beneficiary] 
without such coverage.

[Sec. 1642. Treatment of payments under medicaid program]

    (c)[(a)] Use of Funds._[Payments to special fund]
          (1) Special fund._Notwithstanding any other provision 
        of law, but subject to paragraph (2), payments to which 
        a[ny] 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 [42 U.S.C.A. 
        Sec. 1396 et seq.])] is entitled [under a State plan] 
        by reason of a provision of the Social Security Act 
        [section 1911 of such Act [42 U.S.C.A.Sec. 1396j]] 
        shall be placed in a special fund to be held by the 
        Secretary and first 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 programs [facilities] of the [such] 
        Service which may be necessary to achieve or maintain 
        compliance with the applicable conditions and 
        requirements of [such] 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 [s]Service [u]Unit of the Service 
        receives 100 [at least 80] percent of the amount[s] to 
        which the facilities of the Service, for which such 
        [s]Service [u]Unit makes collections, are entitled by 
        reason of a provision [section 1911] of the Social 
        Security Act [[42 U.S.C.A. Sec. 1396j]].
          (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 (25 
                U.S.C. 450 et seq.) 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.
    [(b) Determination of appropriations]
    [Any payments received by such facility for services 
provided to Indians eligible for benefits under title XIX of 
the Social Security Act [42 U.S.C.A. Sec. 1396 et seq.] shall 
not be considered in determining appropriations for the 
provision of health care and services to Indians.]

[Sec. 1643. Amount and use of funds reimbursed through medicare and 
                    medicaid available to Indian Health Service]

    [The Secretary shall submit to the President, for inclusion 
in the report required to be transmitted to the Congress under 
section 1671 of this title, an accounting on the amount and use 
of funds made available to the Service pursuant to this 
subchapter as a result of reimbursements through Titles XVIII 
and XIX of the Social Security Act [42 U.S.C.A. Sec. Sec. 1395 
et seq., 1396 et seq.], as amended.]

Sec. 1644. Grants to and C[c]ontracts with the Service, Indian Tribes, 
                    T [t]ribal [o]Organizations, and Urban Indian 
                    Organizations

    (a) Indian Tribes and Tribal Organizations._[Access to 
health services] The Secretary, acting through the Service, 
shall make grants to or enter into contracts with Indian Tribes 
and T [t]ribal O[o]rganizations to assist such Tribes and 
Tribal O[o]rganizations 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) to enroll for benefits under title XVIII, XIX, or 
        XXI [section 1818 of part A and sections 1836 and 1837 
        of part B of Title XVIII] of the Social Security Act 
        and other health benefits programs [42 U.S.C.A. 
        Sec. Sec. 1395i-2, 1395o, 1395p]; and
          (2) to pay [monthly] 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). [due to financial 
        need of such individual; and]
          [(3) apply for medical assistance provided pursuant 
        to Title XIX of the Social Security Act [42 U.S.C.A. 
        Sec. 1396 et seq.].]
    (b) [Terms and c]Conditions.--The Secretary, acting through 
the Service, shall place conditions as deemed necessary to 
effect the purpose of this section in any [contract or] grant 
or contract which the Secretary makes with any Indian Tribe or 
T[t]ribal O[o]rganization pursuant to this section. Such 
conditions shall include[, by are not limited to,] requirements 
that the Indian Tribe or Tribal O[o]rganization successfully 
undertake [to]--
          (1) to determine the population of Indians eligible 
        for the [to be served that are or could be recipients 
        of] benefits described in subsection (a) [under Titles 
        XVIII and XIX of the Social Security Act [42 U.S.C.A. 
        Sec. Sec. 1395 et seq., 1396 et seq.]];
          (2) to educate [assist individual] Indians with 
        respect to the benefits available under the respective 
        programs [in becoming familiar with and utilizing such 
        benefits];
          (3) to provide transportation for [to] such 
        individual Indians to the appropriate offices for 
        enrollment or applications for such benefits [medical 
        assistance]; and
          (4) to 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, and XXI of the 
                Social Security Act [[42 U.S.C.A. 
                Sec. Sec. 1395 et seq. And 1396 et seq.]].
    (c) Agreements Relating To Improving Enrollment of Indians 
Under Social Security Act Programs._[Application for medical 
assistance]
          (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 [t]Tribe, [t]Tribal 
                [o]Organization, or [u]Urban Indian 
                [o]Organization which provides for the receipt 
                and processing of applications by Indians for 
                [medical] assistance under titles XIX and XXI 
                of the Social Security Act, [[42 U.S.C.A. 
                Sec. 1396 et seq.]] and benefits under title 
                XVIII of such [the Social Security] Act, by an 
                Indian Health Program or Urban Indian 
                Organization. [[42 U.S.C.A. Sec. 1395 et seq.] 
                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 [25 U.S.C.A. Sec. 450f et 
                seq.].]
                  (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, the 
                Secretary shall encourage the State to take 
                steps to provide for enrollment on or near the 
                reservation. Such steps may include outreach 
                efforts such as the outstationing of 
                eligibility workers, entering into agreements 
                with 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 contracts with Indian Tribes and 
        Tribal Organizations with respect to programs on or 
        near reservations.
          (2) Requirements.--The Secretary shall include in the 
        grants or contracts made or provided under paragraph 
        (1) requirements that are--
                  (A) consistent with the requirements imposed 
                by the Secretary under subsection (b);
                  (B) appropriate to Urban Indian Organizations 
                and Urban Indians; and
                  (C) necessary to effect the purposes of this 
                section.

[Sec. 1645. Direct billing of Medicare, Medicaid, and other third party 
                    payors]

    [(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 (25 U.S.C. 450 et 
seq.) 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 1396d(b) of Title 42 shall 
apply for purposes of reimbursement under the medicaid program 
for health care services directly billed under the program 
established under this section.]
    [(b) Direct reimbursement]
          [(1) Use of funds]
    [Each hospital or clinic participating in the program 
described in subsection (a) of this section shall be reimbursed 
directly under the medicare and medicaid programs for services 
furnished, without regard to the provisions of section 1880(c) 
of the Social Security Act (42 U.S.C. 1395qq(c)) and sections 
1642(a) and 1680c(b)(2)(A) of this title, 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.A. Sec. 1395qq(c)) or section 1642(a) of this title, 
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 1395qq or 1396j of Title 42;]
                  [(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 that 
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 November 1, 2000, 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 bill 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 
November 1, 2000. 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.A. 
Sec. 450f 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.]

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 as determined by the 
Secretary, and billed by the Secretary, an Indian Tribe, or 
Tribal Organization in providing health services, through the 
Service, an Indian Tribe, or Tribal Organization to any 
individual to the same extent that such individual, or any 
nongovernmental provider of such services, would be eligible to 
receive damages, reimbursement, or indemnification for such 
charges or expenses if--
          (1) such services had been provided by a 
        nongovernmental provider; and
          (2) such individual had been required to pay such 
        charges or expenses and did pay such charges or 
        expenses.
    (b) Limitations on Recoveries From States.--Subsection (a) 
shall provide a right of recovery against any State, only if 
the injury, illness, or disability for which health services 
were provided is covered under--
          (1) workers' compensation laws; or
          (2) a no-fault automobile accident insurance plan or 
        program.
    (c) Nonapplication of Other Laws.--No law of any State, or 
of any political subdivision of a State and no provision of any 
contract, insurance or health maintenance organization policy, 
employee benefit plan, self-insurance plan, managed care plan, 
or other health care plan or program entered into or renewed 
after the date of the enactment of the Indian Health Care 
Amendments of 1988, shall prevent or hinder the right of 
recovery of the United States, an Indian Tribe, or Tribal 
Organization under subsection (a).
    (d) No Effect on Private Rights of Action.--No action taken 
by the United States, an Indian Tribe, or Tribal Organization 
to enforce the right of recovery provided under this section 
shall operate to deny to the injured person the recovery for 
that portion of the person's damage not covered hereunder.
    (e) Enforcement.--
        (1) In general.--The United States, an Indian Tribe, or 
        Tribal Organization may enforce the right of recovery 
        provided under subsection (a) by--
                  (A) intervening or joining in any civil 
                action or proceeding brought--
                          (i) by the individual for whom health 
                        services were provided by the 
                        Secretary, an Indian Tribe, or Tribal 
                        Organization; or
                          (ii) by any representative or heirs 
                        of such individual, or
                  (B) instituting a civil action, including a 
                civil action for injunctive relief and other 
                relief and including, with respect to a 
                political subdivision or local governmental 
                entity of a State, such an action against an 
                official thereof.
          (2) Notice.--All reasonable efforts shall be made to 
        provide notice of action instituted under paragraph 
        (1)(B) to the individual to whom health services were 
        provided, either before or during the pendency of such 
        action.
    (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 
suchauthorization is provided, the Service may receive and 
expend such amounts for the provision of additional health services 
consistent with such authorization.
    (g) Costs and Attorneys' Fees.--In any action brought to 
enforce the provisions of this section, a prevailing plaintiff 
shall be awarded its reasonable attorneys' fees and costs of 
litigation.
    (h) Nonapplication of Claims Filing Requirements.--An 
insurance company, health maintenance organization, self-
insurance plan, managed care plan, or other health care plan or 
program (under the Social Security Act or otherwise) may not 
deny a claim for benefits submitted by the Service or by an 
Indian Tribe or Tribal Organization based on the format in 
which the claim is submitted if such format complies with the 
format required for submission of claims under title XVIII of 
the Social Security Act or recognized under section 1175 of 
such Act.
    (i) Application to Urban Indian Organizations.--The 
previous provisions of this section shall apply to Urban Indian 
Organizations with respect to populations served by such 
Organizations in the same manner they apply to Indian Tribes 
and Tribal Organizations with respect to populations served by 
such Indian Tribes and Tribal Organizations.
    (j) Statute of Limitations.--The provisions of section 2415 
of title 28, United States Code, shall apply to all actions 
commenced under this section, and the references therein to the 
United States are deemed to include Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations.
    (k) Savings.--Nothing in this section shall be construed to 
limit any right of recovery available to the United States, an 
Indian Tribe, or Tribal Organization under the provisions of 
any applicable, Federal, State, or Tribal law, including 
medical lien laws 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 (25 
U.S.C. 450 et seq.), or other law, other than under section 
402) to Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations for health benefits for Service beneficiaries, 
Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations may use such amounts to purchase health benefits 
coverage for such beneficiaries in any manner, including 
through--
          (1) a tribally owned and operated health care plan;
          (2) a State or locally authorized or licensed health 
        care plan;
          (3) a health insurance provider or managed care 
        organization; or
          (4) a self-insured plan.
The purchase of such coverage by an Indian Tribe, Tribal 
Organization, or Urban Indian Organization may be based on the 
financial needs of such beneficiaries (as determined by the 
Indian Tribe or Tribes being served based on a schedule of 
income levels developed or implemented by such Indian Tribe or 
Tribes).
    (b) Expenses for Self-Insured Plan.--In the case of a self-
insured plan under subsection (a)(4), the amounts may be used 
for expenses of operating the plan, including administration 
and insurance to limit the financial risks to the entity 
offering the plan.
    (c) Construction.--Nothing in this section shall be 
construed as affecting the use of any amounts not referred to 
in subsection (a).

Sec. 406. Sharing arrangements with Federal agencies

    (a) Authority.--
          (1) In general.--The Secretary may enter into (or 
        expand) arrangements for the sharing of medical 
        facilities and services between the Service, Indian 
        Tribes, and Tribal Organizations and the Department of 
        Veterans Affairs and the Department of Defense.
          (2) Consultation by secretary required.--The 
        Secretary may not finalize any arrangement between the 
        Service and a Department described in paragraph (1) 
        without first consulting with the Indian Tribes which 
        will be significantly affected by the arrangement.
    (b) Limitations.--The Secretary shall not take any action 
under this section or under subchapter IV of chapter 81 of 
title 38, United States Code, which would impair--
          (1) the priority access of any Indian to health care 
        services provided through the Service and the 
        eligibility of any Indian to receive health services 
        through the Service;
          (2) the quality of health care services provided to 
        any Indian through the Service;
          (3) the priority access of any veteran to health care 
        services provided by the Department of Veterans 
        Affairs;
          (4) the quality of health care services provided by 
        the Department of Veterans Affairs or the Department of 
        Defense; or
          (5) the eligibility of any Indian who is a veteran to 
        receive health services through the Department of 
        Veterans Affairs.
    (c) Reimbursement.--The Service, Indian Tribe, or Tribal 
Organization shall be reimbursed by the Department of Veterans 
Affairs or the Department of Defense (as the case may be) where 
services are provided through the Service, an Indian Tribe, or 
a Tribal Organization to beneficiaries eligible for services 
from either such Department, notwithstanding any other 
provision of law.
    (d) Construction.--Nothing in this section may be construed 
as creating any right of a non-Indian veteran to obtain health 
services from the Service.

Sec. 407. Payor of last resort

    Indian Health Programs and health care programs operated by 
Urban Indian Organizations shall be the payor of last resort 
for services provided to persons eligible for services from 
Indian Health Programs and Urban Indian Organizations, 
notwithstanding any Federal, State, or local law to the 
contrary.

Sec. 408. Nondiscrimination 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, such 
program must provide that such entity, meeting generally 
applicable State or other requirements applicable for 
participation, must be accepted as a provider on the same basis 
as any other qualified provider, except that 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 or other 
documentation. 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) Tribal Indian Technical Advisory Group (TTAG).--The 
Secretary shall maintain within the Centers for Medicare & 
Medicaid Services (CMS) a Tribal Indian Technical Advisory 
Group, established in accordance with requirements of the 
charter dated September 30, 2003, and in such group shall 
include a representative of the Urban Indian Organizations and 
the Service. The representative of the Urban Indian 
Organization shall be deemed to be an elected officer of a 
tribal government for purposes of applying section 204(b) of 
the Unfunded Mandates Reform Act of 1995 (2 U.S.C. 1534(b)).
    (b) Solicitation of Medicaid Advice.--
          (1) In general.--As part of its plan for payment 
        under title XIX of the Social Security Act, 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, 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 likely to have 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 
        likely to have a direct effect on Indians, Indian 
        Health Programs, or Urban Indian Organizations. 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.--The reasonable expenses of 
        carrying out this subsection shall be eligible for 
        reimbursement 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)

    (a) Optional Use of Funds for Indian Health Payments.--
Subject to the succeeding provisions of this section, a State 
may provide under its State child health plan under title XXI 
of the Social Security Act (regardless of whether such plan is 
implemented under such title, title XIX of such Act, or both) 
for payments under this section to Indian Health Programs and 
Urban Indian Organizations operating in the State. Such payment 
shall be treated under title XXI of the Social Security Act as 
expenditures described in section 2105(a)(1)(A) of such Act.
    (b) Use of Funds.--Payments under this section may be used 
only for expenditures described in clauses (i) through (iii) of 
section 2105 (a)(1)(D) of the Social Security Act for targeted 
low-income children or other low-income children (as defined in 
2110 of such Act) who are--
          (1) Indians; or
          (2) otherwise eligible for health services from the 
        Indian Health Program involved.
    (c) Special Restrictions.--The following conditions apply 
to a State electing to provide payments under this section:
          (1) No limitation on other schip participation of, or 
        provider payments to, indian health programs.--The 
        State may not exclude or limit participation of 
        otherwise eligible Indian Health Programs in its State 
        child health program under title XXI of the Social 
        Security Act or its medicaid program under title XIX of 
        such Act or pay such Programs less then they otherwise 
        would as participating providers on the basis that 
        payments are made to such Programs under this section.
          (2) No limitation on other schip eligibility of 
        indians.--The State may not exclude or limit 
        participation of otherwise eligible Indian children in 
        such State child health or medicaid program on the 
        basis that payments are made for assistance for such 
        children under this section.
          (3) Limitation on acceptance of contributions.--
                  (A) In general.--The State may not accept 
                contributions or condition making of payments 
                under this section upon contribution of funds 
                from an Indian Health Program to meet the 
                State's non-Federal matching fund requirements 
                under titles XIX and XXI of the Social Security 
                Act.
                  (B) Contribution defined.--For purposes of 
                subparagraph (A), the term `contribution' 
                includes any tax, donation, fee, or other 
                payment made, whether made voluntarily or 
                involuntarily.
    (d) Application of Separate 10 Percent Limitation.--Payment 
may be made under section 2105(a) of the Social Security Act to 
a State for a fiscal year for payments under this section up to 
an amount equal to 10 percent of the total amount available 
under title XXI of such Act (including allotments and 
reallotments available from previous fiscal years) to the State 
with respect to the fiscal year.
    (e) General Terms.--A payment under this section shall only 
be made upon application to the State from the Indian Health 
Program involved and under such terms and conditions, and in a 
form and manner, as the Secretary determines appropriate.

Sec. 411. Social Security Act sanctions

    (a) Requests for Waiver of Sanctions.--
          (1) In general.--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, the Indian Health 
        Program shall request the State to seek such waiver, 
        and if such State has not sought the waiver within 60 
        days of the Indian Health Program request, the Indian 
        Health Program itself may petition the Secretary for 
        such waiver.
          (2) Procedure.--In seeking a waiver under paragraph 
        (1), the Indian Health Program much provide notice an a 
        copy of the request, including the reasons for the 
        waiver sought, to the State. The Secretary may consider 
        the State's views in the determination of the waiver 
        request, but may not withhold or delay a determination 
        based on the lack of the State's views.
    (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.
          (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) 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 real property and 
        improvements, located on the reservation, including any 
        federally recognized Indian Tribe's reservation, 
        Pueblo, or Colony, including former reservations in 
        Oklahoma, Alaska Native regions established by the 
        Alaska Native Claims Settlement Act and Indian 
        allotments on or near the reservation as designated and 
        approved by the Bureau of Indian Affairs of the 
        Department of the Interior.
          (2) For any federally recognized Tribe not described 
        in paragraph (1), property located within the most 
        recent boundaries of a prior Federal reservation.
          (3) Ownership interests in rents, leases, royalties, 
        or usage rights related to natural resources (including 
        extraction of natural resources or harvesting of 
        timber, or other plants and plant products, animals, 
        fish, and shellfish) resulting from the exercise of 
        federally protected rights.
          (4) Ownership interests in or usage rights to items 
        not covered by paragraphs (1) through (3) that have 
        unique religious, spiritual, traditional, or cultural 
        significance or rights that support subsistence or a 
        traditional life style according to applicable tribal 
        law and custom.
    (d) 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) Provision of Services, to Enrollees With Non-Indian 
Medicaid Managed Care Entities, by Indian Health Programs and 
Urban Indian Organizations.--
          (1) Payment rules.--
                  (A) In general.--Subject to subparagraph (B), 
                in the case of an Indian who is enrolled with a 
                non-Indian medicaid managed care entity (as 
                defined in subsection (c)) and who receives 
                covered medicaid managed care services from an 
                Indian Health Program or an Urban Indian 
                Organization, whether or not it is a 
                participating provider with respect to such 
                entity, the following rules apply:
                          (i) Direct payment.--The entity shall 
                        make prompt payment (in accordance with 
                        rules applicable to medicaid managed 
                        care entities under title XIX of the 
                        Social Security Act) to the Indian 
                        Health Program or Urban Indian 
                        Organization at a rate established by 
                        the entity for such services that is 
                        equal to the rate negotiated between 
                        such entity and the Program or 
                        Organization involved or, if such a 
                        rate has not been negotiated, a rate 
                        that is not less than the level and 
                        amount of payment which the entity 
                        would make for the services if the 
                        services were furnished by a provider 
                        which is not a Program or Organization.
                          (ii) Payment through state.--If there 
                        is no arrangement for direct payment 
                        under clause (i) or if the State 
                        provides for this clause to apply in 
                        lieu of clause (i), the State shall 
                        provide for payment to the Indian 
                        Health Program or Urban Indian 
                        Organization under its State program 
                        under title XIX of such Act at the rate 
                        that would be otherwise applicable for 
                        such services under such program and 
                        shall provide for an appropriate 
                        adjustment of the capitation payment 
                        made to the entity to take into account 
                        such payment.
                  (B) Compliance with generally applicable 
                requirements.--
                          (i) In general.--Except as otherwise 
                        provided, as a condition of payment 
                        under subparagraph (A), the Indian 
                        Health Program or Urban Indian 
                        Organization shall comply with the 
                        generally applicable requirements of 
                        title XIX of the Social Security Act 
                        with respect to covered services.
                          (ii) Satisfaction of claim 
                        requirement.--Any requirement for the 
                        submission of a claim or other 
                        documentation for services covered 
                        under subparagraph (A) by the enrollee 
                        is deemed to be satisfied through the 
                        submission of a claim or other 
                        documentation by the Indian Health 
                        Program or Urban Indian Organization 
                        consistent with section 403(h).
                  (C) Construction.--Nothing in this subsection 
                shall be construed as waiving the application 
                of section 1902(a)(30)(A) of the Social 
                Security Act (relating to application of 
                standards to assure that payments are 
                consistent with efficiency, economy, and 
                quality of care).
          (2) Enrollee option to select an indian health 
        program or urban indian organization as primary care 
        provider.--In the case of a non-Indian medicaid managed 
        care entity that--
                  (A) has an Indian enrolled with the entity; 
                and
                  (B) has an Indian Health Program or Urban 
                Indian Organization that is participating as a 
                primary care provider within the network of the 
                entity, insofar as the Indian is otherwise 
                eligible to receive services from such Program 
                or Organization and the Program or Organization 
                has the capacity to provide primary care 
                services to such Indian, the Indian shall be 
                allowed to choose such Program or Organization 
                as the Indian's primary care provider under the 
                entity.
    (b) Offering of Managed Care Through Indian Medicaid 
Managed Care Entities.--if--
          (1) a State elects to provide services through 
        medicaid managed care entities under its medicaid 
        managed care program; and
          (2) an Indian Health Program or Urban Indian 
        Organization that is funded in whole or in part by the 
        Service, or a consortium thereof, has established an 
        Indian medicaid managed care entity in the State that 
        meets generally applicable standards required of such 
        an entity under such medicaid managed care program, the 
        State shall offer to enter into an agreement with the 
        entity to serve as a medicaid managed care entity with 
        respect to eligible Indians served by such entity under 
        such program.
    (c) Special Rules for Indian Managed Care Entities.--The 
following are special rules regarding the application of a 
medicaid managed care program to Indian medicaid managed care 
entities:
          (1) Enrollment.--
                  (A) Limitation to indians.--An Indian 
                medicaid managed care entity may restrict 
                enrollment under such program to Indians and to 
                members of specific Tribes in the same manner 
                as Indian Health Programs may restrict the 
                delivery of services to such Indians and tribal 
                members.
                  (B) No less choice of plans.--Under such 
                program the State may not limit the choice of 
                an Indian among medicaid managed care entities 
                only to Indian medicaid managed care entities 
                or to be more restrictive than the choice of 
                managed care entities offered to individual who 
                are not Indians.
                  (C) Default enrollment.--
                          (i) In general.--If such program of a 
                        State required the enrollment of 
                        Indians in a medicaid managed care 
                        entity in order to receive benefits, 
                        the State shall provide for the 
                        enrollment of Indians described in 
                        clause (ii) who are not otherwise 
                        enrolled with such an entity in an 
                        Indian medicaid managed care entity 
                        described in such clause.
                          (ii) Indian described.--An Indian 
                        described in this clause, with respect 
                        to an Indian medicaid managed care 
                        entity, is an Indian who, based upon 
                        the service area and capacity of the 
                        entity, is eligible to be enrolled with 
                        the entity consistent with subparagraph 
                        (A).
                  (D) Exception to state lock-in.--A request by 
                an Indian who is enrolled under such program 
                with a non-Indian medicaid managed care entity 
                to change enrollment with that entity to 
                enrollment with an Indian medicaid managed care 
                entity shall be considered cause for granting 
                such request under procedures specified by the 
                Secretary.
          (2) Flexibility in application of solvency.--In 
        applying section 1903(m)(1) of the Social Security Act 
        to an Indian medicaid managed care entity--
                  (A) any reference to a 'State' in 
                subparagraph (A)(ii) of that section shall be 
                deemed to be a reference to the 'Secretary'; 
                and
                  (B) the entity shall be deemed to be a public 
                entity described in subparagraph (C)(ii) of 
                that section.
          (3) Exceptions to advance directives.--The Secretary 
        may modify or waive the requirement of section 1902(w) 
        of the Social Security Act (relating to provision of 
        written materials of advance directives) insofar as the 
        Secretary finds that the requirements otherwise imposed 
        are not an appropriate or effective way of 
        communicating the information to Indians.
          (4) Flexibility in information and marketing.--
                  (A) Materials.--The Secretary may modify 
                requirements under section 1932(a)(5) of the 
                Social Security Act in a manner that improves 
                the materials to take into account the special 
                circumstances of such entities and their 
                enrollees while maintaining and clearly 
                communicating to potential enrollees their 
                rights, protections, and benefits.
                  (B) Distribution of marketing materials.--The 
                provisions of section 1931(d)(2)(B) of the 
                Social Security Act requiring the distribution 
                of marketing materials to an entire service 
                areashall be deemed satisfied in the case of an 
Indian medicaid managed care entity that distributes appropriate 
materials only to those Indians who are potentially eligible to enroll 
with the entity in the service area.
    (d) Malpractice Insurance.--Insofar as, under a medicaid 
managed care program, a health care provider is required to 
have a medical malpractice insurance coverage as a condition of 
contracting as a provider with a medicaid managed care entity, 
an Indian Health Program, or an Urban Indian Organization that 
is a Federally-qualified health center under title XIX of the 
Social Security Act, that is covered under the Federal Tort 
Claims Act 28 U.S.C. 1346(b), 2671 et seq.) is deemed to 
satisfy such requirement.
    (e) Definitions.--For purposes of this section:
          (1) Medicaid managed care entity.--The term `medicaid 
        managed care entity' means a managed care entity 
        (whether a managed care organization or a primary care 
        case manager) under title XIX of the Social Security 
        Act, whether pursuant to section 1903(m) or section 
        1932 of such Act, a waiver under section 1115 or 
        1915(b) of such Act, or otherwise.
          (2) Indian medicaid managed care entity.--The term 
        `Indian medicaid managed care entity' means a managed 
        care entity that is controlled (within the meaning of 
        the last sentence of section 1903(m)(1)(C) of the 
        Social Security Act) by the Indian Health Service, a 
        Tribe, Tribal Organization, or Urban Indian 
        Organization (as such terms are defined in section 4), 
        or a consortium, which may be composed of 1 or more 
        Tribes, Tribal Organizations, or Urban Indian 
        Organizations, and which also may include the Service.
          (3) Non-indian medicaid managed care entity.--The 
        term `non-Indian medicaid managed care entity' means a 
        medicaid managed care entity that is not an Indian 
        medicaid managed care entity.
          (4) Covered medicaid managed care services.--The term 
        `covered medicaid managed care services' means, with 
        respect to an individual enrolled with a medicaid 
        managed care entity, items and services that are within 
        the scope of items and services for which benefits are 
        available with respect to the individual under the 
        contract between the entity and the State involved.
          (5) Medicaid managed care program.--The term 
        `medicaid managed care program' means a program under 
        sections 1903(m) and 1932 of the Social Security Act 
        and includes a managed care program operating under a 
        waiver under section 1915(b) or 1115 of such Act or 
        otherwise.

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 2005, the Secretary shall submit to the Committee on Indian 
Affairs and Committee on Finance of the Senate and the 
Committee on Resources and Committee on Energy and Commerce of 
the House of Representatives a report that includes--
          (1) the results of the study under this section;
          (2) a summary of any consultation that occurred 
        between the Secretary and the Navajo Nation, other 
        Indian Tribes, the States of Arizona, New Mexico, and 
        Utah, counties which include Navajo Lands, and other 
        interested parties, in conducting this study;
          (3) projected costs or savings associated with 
        establishment of such entity, and any estimated impact 
        on services provided as described in this section in 
        relation to probable costs or savings; and
          (4) legislative actions that would be required to 
        authorize the establishment of such entity if such 
        entity is determined by the Secretary to be feasible.

[Sec. 1646. Authorization for emergency contract health services]

    [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 
chapter, the time limitation (as a condition of payment) for 
notifying the Service of suchtreatment or admission shall be 30 
days.]

Sec. 1647. Authorization of [a]Appropriations

    There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2015 [2000] 
to carry out this title [subchapter].

       TITLE V [SUBCHAPTER IV]--HEALTH SERVICES FOR URBAN INDIANS

Sec. 1651. Purpose

    The purpose of this title [subchapter] is to establish and 
maintain programs in [u]Urban [c]Centers to make health 
services more accessible and available to [u]Urban Indians.

Sec. 1652. Contracts [w]With, and [g]Grants to, [u]Urban Indian 
                    [o]Organizations

    Under authority of the Act of November 2, 1921 (25 U.S.C. 
13), (commonly [popularly] known as the `Snyder Act'), the 
Secretary, acting through the Service, shall enter into 
contracts with, or make grants to, [u]Urban Indian 
[o]Organizations to assist such organizations in the 
establishment and administration, within [the u]Urban 
[c]Centers [in which such organizations are situated], of 
programs which meet the requirements set forth in this title 
[subchapter]. Subject to section 506, t[T]he Secretary, acting 
through the Service, shall include such conditions as the 
Secretary considers necessary to effect the purpose of this 
title [subchapter] in any contract into which the Secretary 
enters [into] with, or in any grant the Secretary makes to, any 
U[u]rban Indian O[o]rganization pursuant to this title 
[subchapter].

Sec. 1653. Contracts and G[g]rants for the P[p]rovision of H[h]ealth 
                    C[c]are and R[r]eferral S[s]ervices

    (a) Requirements for Grants and Contracts.--Under authority 
of the Act of November 2, 1921 (25 U.S.C. 13)[, popularly] 
(commonly known as the `Snyder Act'), the Secretary, acting 
through the Service, shall enter into contracts with, and make 
grants to, [u]Urban Indian [o]Organizations for the provision 
of health care and referral services for [u]Urban Indians 
[residing in the urban centers in which such organizations are 
situated]. Any such contract or grant shall include 
requirements that the [u]Urban Indian [o]Organization 
successfully undertake to--
          (1) estimate the population of [u]Urban Indians 
        residing in the [u]Urban [c]Center or centers that the 
        organization proposes to serve [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 [u]Urban 
        Indians residing in such [u]Urban [c]Center or centers;
          (3) estimate the current health care needs of 
        [u]Urban Indians residing in such [u]Urban [c]Center or 
        centers;
          (4) provide basic health education, including health 
        promotion and disease prevention education, to Urban 
        Indians [identify all public and private health 
        services resources within such urban center which are 
        or may be available 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 [determine the use of public 
        and private health services resources by the urban 
        Indians residing in such urban center]; and
          (6) where necessary, provide, or enter into contracts 
        for the provision of, health care services for Urban 
        Indians. [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) Criteria [for selection of organizations to enter 
        into contracts or receive grants].--The Secretary, 
        acting through the Service, shall, by regulation, 
        prescribe the criteria for selecting [u]Urban Indian 
        [o]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 [u]Urban 
        Indians in the [u]Urban [c]Center or centers involved;
          (2) the size of the [u]Urban Indian population in the 
        [u]Urban [c]Center or centers involved;
          [(3) the accessibility to, and utilization of, health 
        care services (other than services provided under this 
        subchapter) by urban Indians in the urban center 
        involved;]
          (3)[(4)] the extent, if any, to which the activities 
        set forth in subsection (a) [of this section] would 
        duplicate any project funded under this title;[--]
                  [(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 subchapter; or]
                  [(B) any project funded under this 
                subchapter;]
          (4)[(5)] the capability of an [u]Urban Indian 
        [o]Organization to perform the activities set forth in 
        subsection (a) [of this section] and to enter into a 
        contract with the Secretary or to meet the requirements 
        for receiving a grant under this section;
          (5)[(6)] the satisfactory performance and successful 
        completion by an [u]Urban Indian [o]Organization of 
        other contracts with the Secretary under this title 
        [subchapter];
          (6)[(7)] the appropriateness and likely effectiveness 
        of conducting the activities set forth in subsection 
        (a) [of this section] in an [u]Urban [c]Center or 
        centers; and
          (7)[(8)] the extent of existing or likely future 
        participation in the activities set forth in subsection 
        (a) [of this section] by appropriate health and health-
        related Federal, State, local, and other agencies.
    (c) Access to Health Promotion and Disease Prevention 
Programs.--[Grants for health promotion and disease prevention 
services] The Secretary, acting through the Service, shall 
facilitate access to[,] or provide[,] health promotion and 
disease prevention services for [u]Urban Indians through grants 
made to [u]Urban Indian [o]Organizations administering 
contracts entered into [pursuant to this section] or receiving 
grants under subsection (a) [of this section].
    (d) [Grants for i]Immunization [s]Services
          (1) Access or services provided.--The Secretary, 
        acting through the Service, shall facilitate access to, 
        or provide, immunization services for [u]Urban Indians 
        through grants made to [u]Urban Indian [o]Organizations 
        administering contracts entered into [pursuant to this 
        section] or receiving grants under [subsection (a) of] 
        this section.
          (2) Definition.--For purposes of this subsection, the 
        term `immunization services' means services to provide 
        without charge immunizations against vaccine-
        preventable diseases.
          [(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) Behavioral [Grants for provision of mental h]Health 
[s]Services.--
          (1) Access or services provided.--The Secretary, 
        acting through the Service, shall facilitate access to, 
        or provide, behavioral [mental] health services for 
        [u]Urban Indians through grants made to [u]Urban Indian 
        [o]Organizations administering contracts entered into 
        [pursuant to this section] or receiving grants under 
        subsection (a) [of this section].
          (2) Assessment required.--Except as provided by 
        paragraph (3)(A), a [A] grant may not be made under 
        this subsection to an [u]Urban Indian [o]Organization 
        until that organization has prepared, and the Service 
        has approved, an assessment of the following: [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.]
                  (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) [t]To prepare assessments required under 
                paragraph (2)[;].
                  (B) [t]To provide outreach, educational, and 
                referral services to [u]Urban Indians regarding 
                the availability of direct behavioral [mental] 
                health services, to educate [u]Urban Indians 
                about behavioral [mental] health issues and 
                services, and effect coordination with existing 
                behavioral [mental] health providers in order 
                to improve services to [u]Urban Indians[;].
                  (C) [t]To provide outpatient behavioral 
                [mental] health services to [u]Urban Indians, 
                including the identification and assessment of 
                illness, therapeutic treatments, case 
                management, support groups, family treatment, 
                and other treatment.[; and]
                  (D) [t]To develop innovative behavioral 
                [mental] health service delivery models which 
                incorporate Indian cultural support systems and 
                resources.
    (f) [Grants for p]Prevention [and treatment] of [c]Child 
[a]Abuse
          (1) Access or services provided.--The Secretary, 
        acting through the Service, shall facilitate access 
        to[,] or provide[,] services for [u]Urban Indians 
        through grants to [u]Urban Indian [o]Organizations 
        administering contracts entered into [pursuant to this 
        section] or receiving grants under subsection (a) [of 
        this section] to prevent and treat child abuse 
        (including sexual abuse) among [u]Urban Indians.
          (2) Evaluation required.--Except as provided by 
        paragraph (3)(A), a [A] grant may not be made under 
        this subsection to an [u]Urban Indian [o]Organization 
        until that organization has prepared, and the Service 
        has approved, an assessment that documents the 
        prevalence of child abuse in the [u]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) [t]To prepare assessments required under 
                paragraph (2)[;].
                  (B) [f]For the development of prevention, 
                training, and education programs for [u]Urban 
                Indians [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) [t]To provide direct outpatient treatment 
                services (including individual treatment, 
                family treatment, group therapy, and support 
                groups) to [u]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 [u]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 [u]Urban Indian 
                [o]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 [u]Urban Indian [o]Organization to 
                address the complex problem of child sexual 
                abuse in the community; and (C) the assessment 
                required under paragraph (2).
                  (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. 1654. Contracts and [g]Grants for the [d]Determination of [u]Unmet 
                    [h]Health [c]Care [n]Needs

    (a) Grants and Contracts Authorized.--[Authority] Under 
authority of the Act of November 2, 1921 (25 U.S.C. 13)[, 
popularly] (commonly known as the `Snyder Act'), the Secretary, 
acting through the Service, may enter into contracts with[,] or 
make grants to[, u]Urban Indian [o]Organizations situated in 
[u]Urban [c]Centers for which contracts have not been entered 
into[,] or grants have not been made[,] under section 503 [1653 
of this title].
    (b) Purpose._The purpose of a contract or grant made under 
this section shall be the determination of the matters 
described in subsection (c)[(b)](1) [of this section] in order 
to assist the Secretary in assessing the health status and 
health care needs of [u]Urban Indians in the [u]Urban [c]Center 
involved and determining whether the Secretary should enter 
into a contract or make a grant under section 503[1653 of this 
title] with respect to the [u]Urban Indian [o]Organization 
which the Secretary has entered into a contract with, or made a 
grant to, under this section.
    (c)[(b)] Grant and Contract Requirements.--Any contract 
entered into, or grant made, by the Secretary under this 
section shall include requirements that--
          (1) the [u]Urban Indian [o]Organization successfully 
        undertakes to--
                  (A) document the health care status and unmet 
                health care needs of [u]Urban Indians in the 
                [u]Urban [c]Center involved; and
                  (B) with respect to [u]Urban Indians in the 
                [u]Urban [c]Center involved, determine the 
                matters described in paragraphs [clauses] (2), 
                (3), (4), and (7)[(8)] of section 
                503(b)[1653(b) of this title]; and
          (2) the [u]Urban Indian [o]Organization complete 
        performance of the contract, or carry out the 
        requirements of the grant, within 1[one] year after the 
        date on which the Secretary and such organization enter 
        into such contract, or within 1[one] year after such 
        organization receives such grant, whichever is 
        applicable.
    (d)[(c)] No Renewals.--The Secretary may not renew any 
contract entered into [,] or grant made [,] under this section.

Sec. 1655. Evaluations; [r]Renewals

    (a) Procedures for Evaluations.--[Contract compliance and 
performance] The Secretary, acting through the Service, shall 
develop procedures to evaluate compliance with grant 
requirements [under this subchapter] and compliance with[,] and 
performance of contracts entered into by [u]Urban Indian 
[o]Organizations under this title [subchapter]. Such procedures 
shall include provisions for carrying out the requirements of 
this section.
    (b) [Annual onsite e]Evaluations.--The Secretary, acting 
through the Service, shall evaluate the compliance [conduct an 
annual onsite evaluation] of each [u]Urban Indian 
[o]Organization which has entered into a contract or received a 
grant under section 503 with the terms of [1653 of this title 
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 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; [or u]Unsatisfactory [p]Performance.-- 
If, as a result of the evaluations conducted under this 
section, the Secretary determines that an [u]Urban Indian 
[o]Organization has not complied with the requirements of a 
grant or complied with or satisfactorily performed a contract 
under section 503 [1653 of this title], the Secretary shall, 
prior to renewing such contract or grant, attempt to resolve 
with the [such] organization the areas of noncompliance or 
unsatisfactory performance and modify the [such] contract or 
grant to prevent future occurrences of [such] noncompliance or 
unsatisfactory performance. If the Secretary determines that 
the [such] noncompliance or unsatisfactory performance cannot 
be resolved and prevented in the future, the Secretary shall 
not renew the [such] contract or grant with the [such] 
organization and is authorized to enter into a contract or make 
a grant under section 503 [1653 of this title] with another 
[u]Urban Indian [o]Organization which is situated in the same 
[u]Urban [c]Center as the [u]Urban Indian [o]Organization whose 
contract or grant is not renewed under this section.
    (d) Considerations for  Contract and grant r]Renewals.-- In 
determining whether to renew a contract or grant with an 
[u]Urban Indian [o]Organization under section 503 [1653 of this 
title] which has completed performance of a contract or grant 
under section 504 [1654 of this title], the Secretary shall 
review the records of the [u]Urban Indian [o]Organization, the 
reports submitted under section 507 [1657 of this title, and, 
in the case of a renewal of a contract or grant under section 
1653 of this title], and shall consider the results of the 
onsite evaluations or accreditations [conducted] under 
subsection (b) [of this section].

Sec. 1656. Other [c]Contract and [g]Grant [r]Requirements

    (a) Procurement._ Federal regulations; exceptions] 
Contracts with [u]Urban Indian [o]Organizations entered into 
pursuant to this title [subchapter] 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 
[3131 to] 3133 of [T]title 40, United States Code.
    (b) Payment 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--[subchapter 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 subchapter.]
          (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 [a]Amendment of Contracts._Notwithstanding 
any provision of law to the contrary, the Secretary may, at the 
request and consent of an [u]Urban Indian [o]Organization, 
revise or amend any contract entered into by the Secretary with 
such organization under this title [subchapter] as necessary to 
carry out thepurposes of this title [subchapter].
    [(d) Existing Government facilities]
    [In connection with any contract or grant entered into 
pursuant to this subchapter, 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.]
    (d) Fair and  (e)] Uniform [provision of s]Services and 
[a]Assistance.--Contracts with[,] or grants to[, u]Urban Indian 
[o]Organizations and regulations adopted pursuant to this title 
[subchapter] shall include provisions to assure the fair and 
uniform provision to [u]Urban Indians of services and 
assistance under such contracts or grants by such 
organizations.
    [(f) Eligibility for health care or referral services]
    [Urban Indians, as defined in section 1603(f) of this 
title, shall be eligible for health care or referral services 
provided pursuant to this subchapter.]

Sec. 1657. Reports and [r]Records

    (a) [Quarterly r]Reports.--For each fiscal year during 
which an [u]Urban Indian [o]Organization receives or expends 
funds pursuant to a contract entered into[,] or a grant 
received[,] pursuant to this title [subchapter], such Urban 
Indian O[o]rganization shall submit to the Secretary not more 
frequently than every 6 months, a [quarterly] report that 
includes the following: [including--]
          (1) [i]In the case of a contract or grant under 
        section 503, recommendations pursuant to section 
        503(a)(5). [1653 of this title, information gathered 
        pursuant to clauses (10) and (11) of this subsection 
        (a) of such section;]
          (2) [i]Information on activities conducted by the 
        organization pursuant to the contract or grant[;].
          (3) [a]An accounting of the amounts and purpose[s] 
        for which Federal funds were expended.[; and]
          (4) A minimum set of data, using uniformly defined 
        elements, as specified by the Secretary after 
        consultation with Urban Indian Organizations. [such 
        other information as the Secretary may request.]
    (b) Audit [by Secretary and Comptroller General].--
    The reports and records of the [u]Urban Indian 
[o]Organization with respect to a contract or grant under this 
title [subchapter] shall be subject to audit by the Secretary 
and the Comptroller General of the United States.
    (c) Cost of [annual private a]Audits.--The Secretary shall 
allow as a cost of any contract or grant entered into or 
awarded under section 502 or 503 [1653 of this title] the cost 
of an annual independent financial [private] audit conducted 
by--
          (1) a certified public accountant[.]; or
          (2) a certified public accounting firm qualified to 
        conduct Federal compliance audits.
    [(d) Health status, services, and areas of unmet needs; 
child welfare]
          [(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 subchapter;]
                  [(C) areas of unmet needs in urban areas 
                served under this subchapter; and]
                  [(D) areas of unmet needs in urban areas not 
                served under this subchapter.]
          [(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.]

Sec. 1658. Limitation on [c]Contract [a]Authority

    The authority of the Secretary to enter into contracts or 
to award grants under this title [subchapter] shall be to the 
extent, and in an amount, provided for in appropriation Acts.

Sec. 1659. Facilities [renovation]

    (a) Grants.--The Secretary, acting through the Service, may 
make grants [funds available] to contractors or grant 
recipients under this title [subchapter] for the lease, 
purchase, renovation, construction, or expansion of [minor 
renovations to] facilities, including leased facilities, in 
order to assist such contractors or grant recipients in 
complying with applicable licensure or certification 
requirements [meeting or maintaining the Joint Commission for 
Accreditation of Health Care Organizations (JCAHO) standards].
    (b) Loan Fund Study.--The Secretary, acting through the 
Services, may carry out a study to determine the feasibility of 
establishing a loan fund to provide to Urban Indian 
Organizations direct loans or guarantees for loans for the 
construction of health care facilities in a manner consistent 
with Section 309.

Sec. 1660. Division of Urban Indian Health [Programs Branch]

    [(a) Establishment]
    There is established within the Service a Division [a 
Branch] of Urban Indian Health, [Programs] which shall be 
responsible for--
          (1) carrying out the provisions of this title; 
        [subchapter and for]
          (2) providing central oversight of the programs and 
        services authorized under this title; and [subchapter.]
          (3) providing technical assistance to Urban Indian 
        Organizations.
    [(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.]

Sec. 1660a. Grants for [a]Alcohol and [s]Substance [a]Abuse  r Related 
                    [s]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 [in], alcohol 
and substance abuse in [u]Urban [c]Centers to those [u]Urban 
Indian [o]Organizations with which [whom] the Secretary has 
entered into a contract under this title [subchapter] or under 
section 201[1621 of this title].
    (b) Goals [of grant].--Each grant made pursuant to 
subsection (a) [of this section] 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) [of this section], 
including criteria relating to the following:[--]
          (1) The size of the [u]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;]
          (2) [(4) c]Capability of the organization to 
        adequately perform the activities required under the 
        grant[;].
          (3)[(5) s]Satisfactory performance standards for the 
        organization in meeting the goals set forth in such 
        grant.[, which] The standards shall be negotiated and 
        agreed to between the Secretary and the grantee on a 
        grant-by-grant basis.[; and]
          (4)[(6) i]Identification of need for services.
    (d) Allocation of Grants.--The Secretary shall develop a 
methodology for allocating grants made pursuant to this section 
based on the [such] criteria established pursuant to subsection 
(c).
    (e)[(d)] Grants Subject to Criteria.--[Treatment of funds 
received by urban Indian organizations] Any funds received by 
an [u]Urban Indian [o]Organization under this Act [chapter] for 
substance abuse prevention, treatment, and rehabilitation shall 
be subject to the criteria set forth in subsection (c) [of this 
section].

Sec. 1660b. Treatment of [c]Certain [d]Demonstration [p]Projects

    [(a)] Notwithstanding any other provision of law, the Tulsa 
Clinic and Oklahoma City Clinic demonstration projects shall--
[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 [25 U.S.C.A. Sec. 450f et seq.] 
for the term of such projects. The Secretary shall provide 
assistance to such projects in the development of resources and 
equipment and facility needs.]
          (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 (25 U.S.C. 
        450 et seq.).
    [(b) The Secretary shall submit to the President, for 
inclusion in the report required to be submitted to the 
Congress under section 1671 of this title for fiscal year 1999, 
a report on the findings and conclusions derived from the 
demonstration projects specified in subsection (a) of this 
section.]
    [(c) In addition to the amounts made available under 
section 1660d of this title 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.]

Sec. 1660c. Urban NIAAA [t]Transferred [p]Programs

    (a) Grants and Contracts.--[Duty of Secretary] The 
Secretary, through the Division [shall, within the Branch] of 
Urban Indian Health, shall [Programs of the Service,] make 
grants or enter into contracts with Urban Indian Organizations, 
to take effect not later than September 30, 2008, for the 
administration of [u]Urban Indian alcohol programs that were 
originally established under the National Institute on 
Alcoholism and Alcohol Abuse (hereafter in this section 
referred to as [``] `NIAAA' ['']) and transferred to the 
Service.
    (b) Use of Funds.--[grants] 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 [u]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.--[for grants] Urban Indian 
[o]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) Combination of funds]
    [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 
UrbanHealth Programs of the Service.]
    (d)[(e) Evaluation and r]Report.--[to Congress] The 
Secretary shall evaluate and report to [the] Congress on the 
activities of programs funded under this section not less than 
[at least] 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 2005 and 
thereafter, or claims asserted after September 30, 2004, but 
resulting from the performance of functions prior to fiscal 
year 2005, 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.). 
Future coverage under that Act shall be contingent on 
cooperation of the Urban Indian Organization with the Attorney 
General in prosecuting past claims.
    (b) Claims Resulting From Performance of Contract or 
Grant.--Beginning for fiscal year 2005 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 Government Facilities and Sources of Supply

    (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 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.

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 ofservices 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. Effective Date

    The amendments made by the Indian Health Care Improvement 
Act Amendments of 2005 to this title shall take effect 
beginning on the date of enactment of that Act, regardless of 
whether the Secretary has promulgated regulations implementing 
such amendments.

Sec. 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. 1660d. Authorization of [a]Appropriations

    There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2015 [2000] 
to carry out this title [subchapter].

          TITLE VI [SUBCHAPTER V]--ORGANIZATIONAL IMPROVEMENTS

Sec. 1661. Establishment of the Indian Health Service as an A  a gency 
                    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 
        [t]Tribes, as are or may be hereafter [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.
          (2) Assistant secretary of indian health.--The 
        [Indian Health] Service shall be administered by an 
        Assistant Secretary of Indian Health [a Director], who 
        shall be appointed by the President, by and with the 
        advice and consent of the Senate. The Assistant 
        Secretary [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, 
        2005[1993], the term of service of the Assistant 
        Secretary [Director] shall be 4 years. An Assistant 
        Secretary [A Director] may serve more that 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 2005 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.--[status] 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) Duties.--The Assistant Secretary [shall carry out 
through the Director] of [the] Indian Health [Service] shall--
          (1) perform all functions that [which] were, on the 
        day before the date of enactment of the Indian Health 
        Care Improvement Act Amendments of 2005, [November 23, 
        1988,] carried out by or under the direction of the 
        individual serving as Director of the Indian Health 
        Service on that [such] 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 [(but not limited to)] programs under--
                  (A) this Act [chapter];
                  (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[f] et 
                seq.); [and]
          (4) administer all scholarship and loan functions 
        carried out under title [subchapter] I [of this 
        chapter.];
          (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.--[of Secretary]
          (1) In general.--The Secretary, acting through the 
        Assistant Secretary [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 
                [T]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 
        provisions of law, the provisions of section 12 [472] 
        of the Act of June 18, 1934 (48 Stat. 986; 25 U.S.C. 
        472) [this title], 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) [of this section].
    (e) References.--Any reference to the Director of the 
Indian Health Service in any other Federal law, Executive 
order, rule, regulation, or delegation of authority, or in any 
document of or relating to the Director of the Indian Health 
Service, shall be deemed to refer to the Assistant Secretary.

Sec. 1662. Automated [m]Management [i]Information [s]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 [s]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 [a]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 [Indian t]Tribes and 
[o]Organizations.--[; reimbursement] [(1)] The Secretary shall 
provide each Tribal Health Program [Indian tribe and tribal 
organization] that provides health services under a contract 
entered into with the Service under the Indian Self-
Determination Act [25 U.S.C.A. Sec. 450f et seq.]] automated 
management information systems which--
          (1)[(A)] meet the management information needs of 
        such Tribal Health Program [Indian tribe or tribal 
        organization] with respect to the treatment by the 
        Tribal Health Program [Indian tribe or tribal 
        organization] of patients of the Service[,]; and
          (2)[(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) 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  SUBCHAPTER V--A--SUBSTANCE ABUSE  
                                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 behavior 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 
                progresstoward 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 approaches to risk 
                and safety issues; and
                  (G) identification and treatment of neglect 
                and physical, mental, and sexual abuse.
          (3) Adult care.--Behavioral health services for 
        Indians from age 18 through 55, including--
                  (A) early intervention, treatment, and 
                aftercare;
                  (B) mental health and substance abuse 
                services (emotional, alcohol, drug, inhalant, 
                and tobacco), including sex specific services;
                  (C) identification and treatment of co-
                occurring disorders (dual diagnosis) and 
                comorbidity;
                  (D) promotion of healthy approached to risk-
                related behaviors;
                  (E) treatment services for women at risk of 
                giving birth to a child with a fetal alcohol 
                disorder; and
                  (F) sex specific treatment for sexual assault 
                and domestic violence.
          (4) Family care.--Behavioral health services for 
        families, including--
                  (A) early intervention, treatment, and 
                aftercare for affected families;
                  (B) treatment for sexual assault and domestic 
                violence; and
                  (C) promotion of healthy approaches relating 
                to parenting, domestic violence, and other 
                abuse issues.
          (5) Elder care.--Behavioral health services for 
        Indians 56 years of age and older, including--
                  (A) early intervention, treatment, and 
                aftercare;
                  (B) mental health and substance abuse 
                services (emotional, alcohol, drug, inhalant, 
                and tobacco), including sex specific services;
                  (C) identification and treatment of co-
                occurring disorders (dual diagnosis) and 
                comorbidity;
                  (D) promotion of healthy approaches to 
                managing conditions related to aging;
                  (E) sex specific treatment for sexual 
                assault, domestic violence, neglect, physical 
                and mental abuse and exploitation; and
                  (F) identification and treatment of dementias 
                regardless of cause.
    (d) Community Behavioral Health Plan.--
          (1) Establishment.--The governing body of any Indian 
        Tribe, Tribal Organization, or Urban Indian 
        Organization may adopt a resolution for the 
        establishment of a community behavioral health plan 
        providing for the identification and coordination of 
        available resources and programs to identify, prevent, 
        or treat substance abuse, mental illness, or 
        dysfunctional and self-destructive behavior, including 
        child abuse and family violence, among its members or 
        its service population. This plan should include 
        behavioral health services, social services, intensive 
        outpatient services, and continuing aftercare.
          (2) Technical assistance.--At the request of an 
        Indian Tribe, Tribal Organization, or Urban Indian 
        Organization, the Bureau of Indian Affairs and the 
        Service shall cooperate with and provide technical 
        assistance to the Indian Tribe, Tribal Organization, or 
        Urban Indian Organization in the development and 
        implementation of such plan.
          (3) Funding.--The Secretary, acting through the 
        Service, may make funding available to Indian Tribes 
        and Tribal Organizations which adopt a resolution 
        pursuant to paragraph (1) to obtain technical 
        assistance for the development of a community 
        behavioral health plan and to provide administrative 
        support in the implementation of such plan.
    (e) Coordination for Availability of Services.--The 
Secretary, acting through the Service, Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations, shall coordinate 
behavioral health planning, to the extent feasible, with other 
Federal agencies and with State agencies, to encourage 
comprehensive behavioral health services for Indians regardless 
of their place of residence.
    (f) Mental Health Care Need Assessment.--Not later than 1 
year after the date of the enactment of the Indian Health Care 
Improvement Act Amendments of 2005, 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

[Sec. 1665. Indian Health Service responsibilities]

    (a) Contents.--Not later than 12 months after the date of 
the enactment of the Indian Health Care Improvement Act 
Amendments of 2005, 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 
ofdually 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 [Memorandum] 
memoranda of [A]agreement updated or entered into pursuant to 
subsection (a) [section 2411 of this title] shall include 
specific provisions pursuant to which the Service shall assue 
responsibility for--
          (1) the determination of the scope of the problem of 
        alcohol and substance abuse among Indians [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.
    (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 thereof) 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. 1665a. Indian Health Service program]

Sec. 703. [(a)] Comprehensive Behavioral Health [p] Prevention and 
                    [t]Treatment [p]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, 
        [alcohol and substance abuse] prevention, [and] 
        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 [and] treatment;
                  (C) community-based rehabilitation and 
                aftercare;
                  (D) community education and involvement, 
                including extensive training of health care, 
                educational, and community-based personnel; 
                [and]
                  (E) specialized residential treatment 
                programs for high-risk populations, including 
                pregnant and postpartum [post partum] women and 
                their children[.]; and
                  (F) diagnostic services.
          (2) Target populations.--The target population of 
        such programs shall be members of Indian [t]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 [h]Health [s]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 [alcohol and substance abuse] 
        treatment services for the purpose of [assisting the 
        Service in] carrying out the program required under 
        subsection (a) [of this section].
          (2) Provision of assistance.--In carrying out this 
        subsection, the Secretary shall provide assistance to 
        Indian [t]Tribes and Tribal Organizations to develop 
        criteria for the certification of behavioral health 
        [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 2411(a)(3) of this 
        title].

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.
    [(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 1671 of this title for fiscal 
        year 1995 an evaluation of the demonstration project 
        established under paragraph (1).]

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 
is required to 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. 1665b. Indian [w]Women [t]Treatment [p]Programs

    (a) Grants.--The Secretary, consistent with section 701, 
may make grants to Indian [t]Tribes, [and t]Tribal 
[o]Organizations, and Urban Indian Organizations to develop and 
implement a comprehensive behavioral health [alcohol and 
substance abuse] 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 Grant[s] Funds._A grant made pursuant to this 
section may be used to--
          (1) develop and provide community training, 
        education, and prevention programs for Indian women 
        relating to behavioral health [alcohol and substance 
        abuse] issues, including fetal alcohol disorders 
        [syndrome and fetal alcohol effect];
          (2) identify and provide psychological services, 
        [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 [t]Traditional Health 
        Care Practices [healers], cultural values, and 
        community and family involvement.
    (c) Criteria.--[for review and approval of grant 
applications]The Secretary, in consultation with Indian Tribes 
and Tribal Organizations, shall establish criteria for the 
review and approval of applications and proposals for funding 
[grants] 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.
    [(d) Authorization of appropriations]
          [(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 
        subchapter IV of this chapter.]

Sec. 1665c. Indian [Health Service y]Youth [p]Program

    (a) Detoxification and [r]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 [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 and programs developed and implemented by Indian Tribes 
or Tribal Organizations at the local level under the Indian 
Self-Determination and Education Assistance Act (25 U.S.C. 450 
et seq.). [These r]Regional centers shall be integrated with 
the intake and rehabilitation programs based in the referring 
Indian community.
    (b) Alcohol and Substance Abuse Treatment [c]Centers or 
[f]Facilities
          (1) Establishment._
                  [(1)](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[a] youth regional 
                treatment center or treatment network in each 
                area under the jurisdiction of an [a]Area 
                [o]Office.
                  (B) Area office in California.--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 
                a]Area [o]Office in California shall be 
                considered to be 2 [two a]Area [o]Offices, 
                1[one] office whose jurisdiction shall be 
                considered to encompass the northern area of 
                the State of California, and 1[one] 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 T[t]ribes to be 
        served by such center.
          (4) Specific Provision of Funds._
                  (A) In general.--Notwithstanding any other 
                provision of this title [subchapter], 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[50b](l) of the Indian 
                        Self-Determination and Education 
                        Assistance Act (25 U.S.C. 450b(l)) 
                        [this title].
                  (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 [such State].
    (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)[(c)] Federally [o]Owned [s]Structures.--
          (1) In general.--The Secretary, [acting through the 
        Service, shall,] in consultation with Indian [t]Tribes 
        and Tribal Organizations, shall--
                  (A) identify and use, where appropriate, 
                federally owned structures suitable for [as] 
                local residential or regional behavioral health 
                [alcohol and substance abuse] treatment 
                [centers] 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 [as a] 
                local residential or regional behavioral health 
                [alcohol and substance abuse] treatment 
                [center] 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)[(d)] Rehabilitation and [a]Aftercare [s]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 [service u]Unit, community-based 
        rehabilitation and follow-up services for Indian youths 
        who are having significant behavioral health problems 
        and require [alcohol or substance abusers which are 
        designed to integrate] long-term treatment, community 
        reintegration, and monitoring to [monitor and] support 
        the Indian youths after their return to their home 
        community.
          (2) Administration.--Services under paragraph (1) 
        shall be provided [administered within each service 
        unit] 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 [shall] include alcohol and substance 
        abuse counselors, mental health professionals, and 
        other health professionals and paraprofessionals, 
        including community health representatives.
    (f)[(e)] Inclusion of [f]Family in [y]Youth [t]Treatment 
[p]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)[(d) of this 
section] shall be used for outpatient care of adult family 
members related to the treatment of an Indian youth under that 
subsection.
    (g)[(f)] Multidrug [a]Abuse Program.--[study]
          [(1)] 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 
        [conduct a study to determine the incidence and 
        prevalence of] the abuse of multiple forms of 
        substances [drugs], including alcohol, drugs, 
        inhalants, and tobacco, among Indian youths residing in 
        Indian communities, on or near [Indian] reservations, 
        and in urban areas and provide appropriate mental 
        health services to address [the interrelationship of 
        such abuse with] the incidence of mental illness among 
        such youths.
          [(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 October 29, 1992.]
    (h) Indian Youth Mental Health.--The Secretary, acting 
through the Service, shall collect data from the report under 
section 801 with respect to--
          (1) the number of Indian youth who are being provided 
        mental health services through the Service and Tribal 
        Health Programs;
          (2) a description of, and costs associated with, the 
        mental health services provided for Indian youth 
        through the Service and Tribal Health Programs;
          (3) the number of youth referred to the Service or 
        Tribal Health Programs for mental health services;
          (4) the number of Indian youth provided residential 
        treatment for mental health and behavioral problems 
        through the Service and Tribal Health Programs, 
        reported separately for on-and off-reservation 
        facilities; and
          (5) the cost of the services described in paragraph 
        (4).

Sec. 708. Indian Youth Telemental Health Demonstration Project

    (a) Purpose.--The purpose of this section is to authorize 
the Secretary to carry out a demonstration project to test the 
use of telemental health services in suicide prevention, 
intervention and treatment of Indian youth, including through--
          (1) the use of psychotherapy, psychiatric 
        assessments, diagnostic interviews, therapies for 
        mental health conditions predisposing to suicide, and 
        alcohol and substance abuse treatment;
          (2) the provision of clinical expertise to, 
        consultation services with, and medical advice and 
        training for frontline health care providers working 
        with Indian youth;
          (3) training and related support for community 
        leaders, family members and health and education 
        workers who work with Indian youth;
          (4) the development of culturally-relevant 
        educational materials on suicide; and
          (5) data collection and reporting.
    (b) Definitions.--For the purpose of this section, the 
following definitions shall apply:
          (1) Demonstration project.--The term `demonstration 
        project' means the Indian youth telemental health 
        demonstration project authorized under subsection (c).
          (2) Telemental health.--The term `telemental health' 
        means the use of electronic information and 
        telecommunications technologies to support long 
        distance mental health care, patient and professional-
        related education, public health, and health 
        administration.
    (c) Authorization.--
          (1) In general.--The Secretary is authorized to award 
        grants under the demonstration project for the 
        provision of telemental health services to Indian youth 
        who--
                  (A) have expressed suicidal ideas;
                  (B) have attempted suicide; or
                  (C) have mental health conditions that 
                increase or could increase the risk of suicide.
          (2) Eligibility for grants.--Such grants shall be 
        awarded to Indian Tribes, Tribal Organizations, and 
        Urban Indian Organizations that operate 1 or more 
        facilities--
                  (A) located in Alaska and part of the Alaska 
                Federal Health Care Access Network;
                  (B) reporting active clinical telehealth 
                capabilities; or
                  (C) offering school-based telemental health 
                services relating to psychiatry to Indian 
                youth.
          (3) Grant period.--The Secretary shall award grants 
        under this section for a period of up to 4 years.
          (4) Awarding of grants.--Not more than 5 grants shall 
        be provided under paragraph (1), with priority 
        consideration given to Indian Tribes, Tribal 
        Organizations, and Urban Indian Organizations that--
                  (A) serve a particular community or 
                geographic area where there is a demonstrated 
                need to address Indian youth suicide;
                  (B) enter into collaborative partnerships 
                with Indian Health Service or other Tribal 
                Health Programs or facilities to provide 
                services under this demonstration project;
                  (C) serve an isolated community or geographic 
                area which has limited or no access to 
                behavioral health services; or
                  (D) operate a detention facility at which 
                youth are detained.
    (d) Use of Funds.--An Indian Tribe, Tribal Organization, or 
Urban Indian Organization shall use a grant received under 
subsection (c) for the following purposes:
          (1) To provide telemental health services to Indian 
        youth, including the provision of--
                  (A) psychotherapy;
                  (B) psychiatric assessments and diagnostic 
                interviews, therapies for mental health 
                conditions predisposing to suicide, and 
                treatment; and
                  (C) alcohol and substance abuse treatment.
          (2) To provide clinician-interactive medical advice, 
        guidance and training, assistance in diagnosis and 
        interpretation, crisis counseling and intervention, and 
        related assistance to Service, tribal, or urban 
        clinicians and health services providers working with 
        youth being served under this demonstration project.
          (3) To assist, educate and train community leaders, 
        health education professionals and paraprofessionals, 
        tribal outreach workers, and family members who work 
        with the youth receiving telemental health services 
        under this demonstration project, including with 
        identification of suicidal tendencies, crisis 
        intervention and suicide prevention, emergency skill 
        development, and building and expanding networks among 
        these individuals and with State and local health 
        services providers.
          (4) To develop and distribute culturally appropriate 
        community educational materials on--
                  (A) suicide prevention;
                  (B) suicide education;
                  (C) suicide screening;
                  (D) suicide intervention; and
                  (E) ways to mobilize communities with respect 
                to the identification of risk factors for 
                suicide.
          (5) For data collection and reporting related to 
        Indian youth suicide prevention efforts.
    (e) Applications.--To be eligible to receive a grant under 
subsection (c), an Indian Tribe, Tribal Organization, or Urban 
Indian Organization shall prepare and submit to the Secretary 
an application, at such time, in such manner, and containing 
such information as the Secretary may require, including--
          (1) a description of the project that the Indian 
        Tribe, Tribal Organization, or Urban Indian 
        Organization will carry out using the funds provided 
        under the grant;
          (2) a description of the manner in which the project 
        funded under the grant would--
                  (A) meet the telemental health care needs of 
                the Indian youth population to be served by the 
                project; or
                  (B) improve the access of the Indian youth 
                population to be served to suicide prevention 
                and treatment services;
          (3) evidence of support for the project from the 
        local community to be served by the project;
          (4) a description of how the families and leadership 
        of the communities or populations to be served by the 
        project would be involved in the development and 
        ongoing operations of the project;
          (5) a plan to involve the tribal community of the 
        youth who are provided services by the project in 
        planning and evaluating the mental health care and 
        suicide prevention efforts provided, in order to ensure 
        the integration of community, clinical, environmental, 
        and cultural components of the treatment; and
          (6) a plan for sustaining the project after Federal 
        assistance for the demonstration project has 
        terminated.
    (f) Traditional Health Care Practices.--The Secretary, 
acting through the Service, shall ensure that the demonstration 
project established pursuant to this section involves the use 
and promotion of the Traditional Health Care Practices of the 
Indian Tribes of the youth to be served.
    (g) Collaboration; Reporting to National Clearinghouse.--
          (1) Collaboration.--The Secretary, acting through the 
        Service, shall encourage Indian Tribes, Tribal 
        Organizations, and Urban Indian Organizations receiving 
        grants under this section to collaborate to enable 
        comparisons about best practices across projects.
          (2) Reporting to national clearinghouse.--The 
        Secretary, acting through the Service, shall also 
        encourage Indian Tribes, Tribal Organizations, and 
        Urban Indian Organizations receiving grants under this 
        section to submit relevant, declassified project 
        information to the national clearinghouse authorized 
        under section 701(b)(2) in order to better facilitate 
        program performance and improve suicide prevention, 
        intervention, and treatment services.
    (h) Annual Report.--Each grant recipient shall submit to 
the Secretary an annual report that--
          (1) describes the number of telemental health 
        services provided; and
          (2) includes any other information that the Secretary 
        may require.
    (i) Report to Congress.--Not later than 270 days after the 
termination of the demonstration project, the Secretary shall 
submit to the Committee on Indian Affairs of the Senate and the 
Committee on Resources and Committee on Energy and Commerce of 
the House of Representatives a final report, based on the 
annual reports provided by grant recipients under subsection 
(h), that--
          (1) describes the results of the projects funded by 
        grants awarded under this section, including any data 
        available which indicates the number of attempted 
        suicides; and
          (2) evaluates the impact of the telemental health 
        services funded by the grants in reducing the number of 
        completed suicides among Indian youth.
    (j) Authorization of Appropriations.--There is authorized 
to be appropriated to carry out this section $1,500,000 for 
each of fiscal years 2006 through 2009.''

Sec. 709. Inpatient and Community-Based Mental Health Facilities 
                    Design, Construction, and Staffing

    Not later than 1 year after the date of enactment of the 
Indian Health Care Improvement Act Amendments of 2005, 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 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. 1665d. Training and [c]Community [e]Education

    (a) Program._[Community education] 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 [s]Service 
[u]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 [in alcohol and substance abuse] to 
political leaders, [t]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._[Training] The Secretary, acting through 
the Service, shall, either directly or through Indian Tribes 
and Tribal Organizations [by contract], provide instruction in 
the area of behavioral health issues [alcohol and substance 
abuse], 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 [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) 
[2433 of this title].
    (c) Training [Community-based training m]Models.-- In 
carrying out the education and training programs required by 
this section, the Secretary, [acting through the Service and] 
in consultation with Indian T[t]ribes, 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 [substance abuse] faced by children of 
        alcoholics;
          (2) the cultural, spiritual, and multigenerational 
        aspects of behavioral health problem [alcohol and 
        substance abuse] prevention and recovery; and
          (3) community-based and multidisciplinary strategies 
        for preventing and treatingbehavioral health problems 
[alcohol and substance abuse].

Sec. 711. Behavioral Health Program

    (a) Innovative Programs.--The Secretary, acting through the 
Service, Indian Tribes, and Tribal Organizations, consistent 
with section 701, may plan, develop, implement, and carry out 
programs to deliver innovative community-based behavioral 
health services to Indians.
    (b) 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 project applications or 
proposals, use the same criteria that the Secretary uses in 
evaluating any other application or proposal for such funding.

[Sec. 1665e. Gallup alcohol and substance abuse treatment center]

    [(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) of this section.]
    [(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) of this section.]

[Sec. 1665f. Reports]

    [(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 
[25 U.S.C.A. Sec. 450f et seq.], 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) of this section 
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 2412 of this 
title.]
    [(c) Comprehensive report]
    [Each service unit director shall be responsible for 
assembling the data compiled under this section and section 
2434 of this title 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.]

Sec. 1665g. Fetal [a]Alcohol Disorder Programs._ [syndrome and fetal 
                    alcohol effect grants]

    (a) Programs._[Award; use; review criteria]
          (1) Establishment.--The Secretary, consistent with 
        section 701, acting through the Service, Indian Tribes, 
        and Tribal Organizations, is authorized to establish 
        and operate fetal alcohol disorder [syndrome and fetal 
        alcohol effect] programs as provided in this section 
        for the purposes of meeting the health status 
        objectives specified in section 3[1602(b) of this 
        title].
          (2) Use of funds._Funding provided [Grants made] 
        pursuant to this section shall be used for the 
        following:[ to--]
                  (A) To develop and provide for Indians 
                community and in[-]school training, education, 
                and prevention programs relating to fetal 
                alcohol disorders. [FAS and FAE;]
                  (B) To identify and provide behavioral health 
                [alcohol and substance abuse] 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 [FAS and 
                FAE] affected Indians [persons] and their 
                families or caretakers[;].
                  (D) To develop and implement counseling and 
                support programs in schools for fetal alcohol 
                disorder [FAS and FAE] affected Indian 
                children[;].
                  (E) To develop prevention and intervention 
                models which incorporate practitioners of 
                T[t]raditional Health Care Practices [healers], 
                cultural and spiritual values, and community 
                involvement[;].
                  (F) To develop, print, and disseminate 
                education and prevention materials on fetal 
                alcohol disorder. [FAS and FAE; and]
                  (G) To develop and implement, through the 
                tribal consultation with Indian Tribes, Tribal 
                Organizations, and Urban Indian Organizations, 
                culturally sensitive assessment and diagnostic 
                tools including dysmorphology clinics and 
                multidisciplinary fetal alcohol and disorder 
                clinics for use in [tribal and urban] 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--
                          (i) community-based support service 
                        for Indians and for women pregnant with 
                        Indian children; and
                          (ii) to the extent funding is 
                        available, community-based housing for 
                        adult Indians with fetal alcohol 
                        disorder.
          (3) Criteria for applications.--The Secretary shall 
        establish criteria for the review and approval of 
        applications for funding [grants] under this section.
    (b) Services.--[Plan; study; national clearinghouse] The 
Secretary, acting through the Service and Indian Tribes, Tribal 
Organizations, and Urban Indian Organizations, shall--
          (1) develop and provide services [an annual plan] for 
        the prevention, intervention, treatment, and aftercare 
        for those affected by fetal alcohol disorder [FAS and 
        FAE] in Indian communities; and
          (2) provide supportive services, directly or through 
        an Indian Tribe, Tribal Organization, or Urban Indian 
        Organization, including services to meet [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 with fetal alcohol 
        disorder. [and Alaska Natives with FAS or FAE; and]
          [(3) establish a national clearinghouse for 
        prevention and educational materials and other 
        information of 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) Task [f]Force.--The Secretary shall establish a task 
force to be known as the Fetal Alcohol Disorder [FAS/FAE] Task 
Force to advise the Secretary in carrying out subsection (b) 
[of this section]. Such task force shall be composed of 
representatives from the following:
          (1) The National Institute on Drug Abuse.[,]
          (2) T[t]he National Institute on Alcohol and 
        Alcoholism.[,]
          (3) T[t]he Office of Substance Abuse Prevention.[,]
          (4) T[t]he National Institute of Mental Health.[,]
          (5) T[t]he Service.[,]
          (6) T[t]he Office of Minority Health of the 
        Department of Health and Human Services.[,]
          (7) T[t]he Administration for Native Americans.[,]
          (8) The National Institute of Child Health and Human 
        Development (NICHD).
          (9) The Centers for Disease Control and Prevention.
          (10) T[t]he Bureau of Indian Affairs.[,]
          (11) Indian T[t]ribes.[,]
          (12) T[t]ribal O[o]rganizations.[,]
          (13) U[u]rban Indian Organizations. [communities, 
        and]
          (14) Indian fetal alcohol disorder [FAS/FAE] experts.
    (d) [Cooperative projects;] Applied R[r]esearch 
P[p]rojects.--The Secretary, acting through the Substance Abuse 
and Mental Health Services Administration, shall make grants to 
Indian T[t]ribes, T[t]ribal O[o]rganizations, and Urban Indian 
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 rehabilitation and behavioral health aftercare for 
Indians and U[u]rban Indians affected by fetal alcohol disorder 
[FAS or FAE].
    [(e) Report]
          [(1) The Secretary shall submit to the President, for 
        inclusion in each report required to be transmitted to 
        the Congress under section 1671 of this title, 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 1602(d) of this 
        title with respect to the health status objective 
        specified in section 1602(b)(27) of this title, 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) of this 
                section 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) Authorization of appropriations]
          [(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.]
    (e) Funding for Urban Indian Organizations.--[(2)] Ten 
percent of the funds appropriated pursuant to this section 
shall be used to make grants to U[u]rban Indian 
O[o]rganizations funded under title V [subchapter IV of this 
chapter].

[Sec. 1665h. Pueblo substance abuse treatment project for San Juan 
                    Pueblo, New Mexico]

    [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.]

[Sec. 1665i. Thunder Child Treatment Center]

    [(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) of 
this section, 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) of this 
section shall be used for administrative purposes.]

[Sec. 1665j. Substance abuse counselor education demonstration project]

    [(a) Contracts and grants]
    [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) Use of funds]
    [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) Effective period of contract or grant; renewal]
    [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) Criteria for review and approval of applications]
    [Not later than 180 days after October 29, 1992, 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 education 
substance abuse counselors.]
    [(e) Assistance to recipients]
    [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]
    [The Secretary shall submit to the President, for inclusion 
in the report which is required to be submitted under section 
1671 of this title for fiscal year 1999, a report on the 
findings and conclusions derived from the demonstration 
projects conducted under this section.]

Sec. 713. Child Sexual Abuse and Prevention Treatment Programs

    (a) Establishment.--The Secretary, acting through the 
Service, and the Secretary of the Interior, Indian Tribes, and 
Tribal Organizations shall establish, consistent with section 
701, in every Service Area, programs involving treatment for--
          (1) victims of sexual abuse who are Indian children 
        or children in an Indian household; and
          (2) perpetrators of child sexual abuse who are Indian 
        or members of an Indian household.
    (b) Use of Funds.--Funding provided pursuant to this 
section shall be used for the following:
          (1) To develop and provide community education and 
        prevention programs related to sexual abuse of Indian 
        children or children in an Indian household.
          (2) To identify and provide behavioral health 
        treatment to victims of sexual abuse who are Indian 
        children or children in an Indian household, and to 
        their family members who are affected by sexual abuse.
          (3) To develop prevention and intervention models 
        which incorporate Traditional Health Care Practices, 
        cultural and spiritual values, and community 
        involvement.
          (4) To develop and implement, in consultation with 
        Indian Tribes, Tribal Organizations, and Urban Indian 
        Organizations, cultural 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. 714. Behavioral Health Research

    The Secretary, in consultation with appropriate Federal 
agencies, shall provide grants to, or enter into contracts 
with, Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations or make grants to appropriate institutions for, 
the conduct of research on the incidence and prevalence of 
behavioral health problems among Indians served by the Service, 
Indian Tribes, or Tribal Organizations and among Indians in 
urban areas. Research priorities under this section shall 
include--
          (1) the multifactorial causes of Indian youth 
        suicide, including--
                  (A) protective and risk factors and 
                scientific data that identifies those factors; 
                and
                  (B) the effects of loss of cultural identity 
                and the development of scientific data on those 
                effects;
          (2) the interrelationship and interdependence of 
        behavioral health problems with alcoholism and other 
        substance abuse, suicide, homicides, other injuries, 
        and the incidence of family violence; and
          (3) the development of models of prevention 
        techniques.
The effect of the interrelationships and interdependencies 
referred to in paragraph (2) on children, and the development 
of prevention techniques under paragraph (3) applicable to 
children, shall be emphasized.

Sec. 715. [(g)] Definitions

    For the purposes of this title [section], 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. [The term ``educational curriculum'' means 
        one or more of the following:]
                  [(A) Classroom education.]
                  [(B) Clinical work experience.]
                  [(C) Continuing education workshops.]
          (2) Alcohol-related neurodevelopmental disorders or 
        arnd.--The term `alcohol-related neurodevelopmental 
        disorders' or `ARND' means, with a history of maternal 
        alcohol consumption during pregnancy, central nervous 
        system involvement such as developmental delay, 
        intellectual, deficit, or neurologic abnormalities. 
        Behaviorally, there can be problems with irritability, 
        and failure to thrive as infants. As children become 
        older there will likely be hyperactivity, attention 
        deficit, language dysfunction, and perceptual and 
        judgment problems.
          (3) Behavioral health aftercare.--The term 
        `behavioral health aftercare' includes those activities 
        and resources used to support recovery following 
        inpatient, residential, intensive substance abuse, or 
        mental health outpatient or outpatient treatment. The 
        purpose is to help prevent or deal with relapse by 
        ensuring that by the time a client or patient is 
        discharged from a level of care, such as outpatient 
        treatment, an aftercare plan has been developed with 
        the client. An aftercare plan may use such resources as 
        a community-based therapeutic group, transitional 
        living facilities, a 12-step sponsor, a local 12-step 
        or other related support group, and other community-
        based providers (mental health professionals, 
        traditional health care practitioners, community health 
        aides, community health representatives, mental health 
        technicians, ministers, etc.)
          [(3) The term ``tribally controlled community 
        college'' has the meaning given such term in section 
        1801(a)(4) of this title.]
          (4) Dual diagnosis.--The term `dual diagnosis' means 
        coexisting substance abuse andmental illness conditions 
or diagnosis. Such clients are sometimes referred to as mentally ill 
chemical abusers (MICAs).
          [(4) The term ``tribally controlled postsecondary 
        vocational institution'' has the meaning given such 
        term in section 2397h(2) of Title 20.]
          (5) Fetal alcohol disorders.--The term `fetal alcohol 
        disorders' means fetal alcohol syndrome, partial fetal 
        alcohol syndrome and alcohol related neurodevelopmental 
        disorder (ARND).
          (6) Fetal alcohol syndrome or fas.--The term `fetal 
        alcohol syndrome' or `FAS' means a syndrome in which, 
        with a history of maternal alcohol consumption during 
        pregnancy, the following criteria are met:
                  (A) Central nervous system involvement such 
                as developmental delay, intellectual deficit, 
                microencephaly, or neurologic abnormalities.
                  (B) Craniofacial abnormalities with at least 
                2 of the following: microophthalmia, short 
                palpebral fissures, poorly developed philtrum, 
                thin upper lip, flat nasal bridge, and short 
                upturned nose.
                  (C) Prenatal or postnatal growth delay.
          (7) Partial fas.--The term `partial FAS' means, with 
        a history of maternal alcohol consumption during 
        pregnancy, having most of the criteria of FAS, though 
        not meeting a minimum of at least 2 of the following: 
        microophthalmia, short palpebral fissures, poorly 
        developed philtrum, thin upper lip, flat nasal bridge, 
        and short upturned nose.
          (8) Rehabilitation.--The term `rehabilitation' means 
        to restore the ability or capacity to engage in usual 
        and customary life activities through education and 
        therapy.
          (9) Substance abuse.--The term `substance abuse' 
        includes inhalant abuse.

Sec. 716. [(h)] Authorization of A[a]ppropriations

    There is [are] authorized to be appropriated [for each of 
fiscal years 1996 through 2000,] such sums as may be necessary 
for each fiscal year through fiscal year 2015 to carry out the 
provisions [purposes] of this title [section]. [Such sums shall 
remain available until expended.]

[Sec. 1665k. Gila River alcohol and substance abuse treatment facility]

    [(a) Regional center]
    [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) Name of regional center]
    [The center established pursuant to this section shall be 
known as the ``Regional Youth Alcohol and Substance Abuse 
Prevention and Treatment Center''.]
    [(c) Unit of regional center]
    [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.]

[Sec. 1665l. Alaska Native drug and alcohol abuse demonstration 
                    project]

    [(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 1671 of this title for fiscal year 1995 
an evaluation of the demonstration project established under 
subsection (a) of this section.]

[Sec. 1665m. Authorization of appropriations]

    [Except as provided in sections 1665b, 1665e, 1665g, 1665i, 
and 1665j of this title, 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 
subchapter.]

               TITLE VIII [SUBCHAPTER VI]--MISCELLANEOUS

Sec. 1671. Reports

    For each fiscal year following the date of enactment of the 
Indian Health Care Improvement Act Amendments of 2005, the 
Secretary shall transmit to Congress a report containing the 
following:
    [The President shall, at the time the budget is submitted 
under section 1105 of Title 31, for each fiscal year transmit 
to the Congress a report containing--]
          (1) A[a] report on the progress made in meeting the 
        objectives of this Act [chapter], including a review of 
        programs established or assisted pursuant to this Act 
        [chapter] and [an] 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[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 [chapter] and any steps that the Secretary 
        may have taken to consult with Indian [t]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[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[.]; 
                and
                  (E) provided under contracts.
          (4) A report of contractors to the Secretary on 
        Health Care Educational Loan Repayments every 6 months 
        required by section 110.
          (5) A general audit report of the Secretary on the 
        Health Care Educational Loan Repayment Program as 
        required by section 110(n).
          (6) A report of the findings and conclusions of 
        demonstration programs on development of educational 
        curricula for substance abuse counseling as required in 
        section 125(f).
          (7)[(4) a]A separate statement which specifies the 
        amount of funds requested to carry out the provisions 
        of section 201. [1621 of this title;]
          (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 as authorized by section 
        406.
          (17) A report on evaluation and renewal of Urban 
        Indian programs under section 505.
          (18) A report on the evaluation of programs as 
        required by section 513(d).
          (19) A report on alcohol and substance abuse as 
        required by section 701(f).
          (20) A report on Indian youth mental health services 
        are required by section 707(h).
          [(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 1680d of this title, relating to infant and 
        maternal mortality and fetal alcohol syndrome;]
          [(6) the reports required by the sections 1602(d), 
        1616a(n), 1621b(b), 1621h(j), 1631(c), 1632(g), 
        1634(a)(3), 1643, 1665g(e), and 1680g(a), and 1680l(f) 
        of this title;]
          [(7) for fiscal year 1995, the report required by 
        sections 1665a(c)(3) and 1665l(b) of this title;]
          [(8) for fiscal year 1997, the interim report 
        required by section 1637(h)(1) of this title; and]
          [(9) for fiscal year 1999, the reports required by 
        sections 1637(h)(2), 1660b(b), 1665j(f), and 1680k(g) 
        of this title.]

Sec. 1672. Regulations

    (a) Deadlines.--
          (1) Procedures.--Not later than 90 days after the 
        date of the enactment of the IndianHealth Care 
Improvement Act Amendments of 2005, 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 (except section 105, 
115 and 117), II, III, and VII. 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.
          (2) Proposed regulations.--Proposed regulations to 
        implement this Act shall be published in the Federal 
        Register by the Secretary no later than 1 year after 
        the date of the enactment of the Indian Health Care 
        Improvement Act Amendments of 2005 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 24 
        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 State 
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. The representative of the Urban Indian 
Organizations shall be deemed to be an elected officer of a 
tribal government for purposes fo applying section 204(b) of 
the Unfunded Mandates Reform Act of 1995 (2 U.S.C. 1534(b).
    (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 2005, and the Secretary is 
authorized to repeal any regulation inconsistent with the 
provisions of this Act.
    [Prior to any revision of or amendment to rules or 
regulations promulgated pursuant to this chapter, 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.]

[Sec. 1673. Repealed.]

[Sec. 1674. Leases with Indian tribes]

    [(a) Notwithstanding any other provision of law, the 
Secretary is authorized, in carrying out the purposes of this 
chapter, 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.]

Sec. 803. Plan of Implementation.

    Not later than 9 months after the date of the enactment of 
the Indian Health Care Improvement Act Amendments of 2005, 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. 1675. Availability of F f]unds

    The funds appropriated pursuant to this Act [chapter] shall 
remain available until expended.

Sec. 1676. Limitation on U u]se of F f]unds A a]ppropriated to the 
                    Indian Health Service

    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.

[Sec. 1677. Nuclear resource development health hazards]

    [(a) Study]
    [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 miners and Indians on or 
near Indian reservations and in 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 power plant 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 December 17, 1980, 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) Health care plan; development]
    [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) of this section. 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 radiation, 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) Reports to Congress]
    [The Secretary and the Service shall submit to Congress the 
study prepared under subsection (a) of this section no later 
than the date eighteen months after December 17, 1980. The 
health care plan prepared under subsection (b) of this section 
shall be submitted in a report no later than the date one year 
after the date that the study prepared under subsection (a) of 
this section 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; establishment and 
functions]
          [(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 United States 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) Medical care]
    [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.]

[Sec. 1678. Arizona as a contract health service delivery area]

    [(a) Designation]
    [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 designatedas 
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) Curtailment of health services prohibited]
    [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) of this section.]

Sec. 1679. Eligibility of California Indians

    (a) In General._[Report to Congress] The following 
California Indians shall be eligible for health services 
provided by the Service:
        [(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 November 23, 
        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) of this section, and the number of 
                Indians described in subsection (b)(3) of this 
                section, 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) of this section who are not members of any 
                Indian tribe recognized by the Federal 
                Government.]
    [(b) Eligible Indians]
    [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 
        T[t]ribe.
          (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,]
                  (A)[(B)] is a member of the Indian community 
                served by a local program of the Service[,]; 
                and
                  (B)[(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 located within the State of 
        California under the Act of August 18, 1958 (72 Stat. 
        619), and any descendant of such an Indian.
    (b)[(c)] Clarification.--[Scope of eligibility] 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. 1680. 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, Sant 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.]

[Sec. 1680a. Contract health facilities]

    [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 [25 U.S.C.A. Sec. 450f et seq.]--]
          [(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.]

[Sec. 1680b. National Health Service Corps]

    [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 [25 U.S.C.A. Sec. 450f et 
        seq.], 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.]

Sec. 1680c. Health S[s]ervices for I[i]neligible P[p]ersons

    (a) Children.--[Individuals not otherwise eligible]
          [(1)] Any individual who--
          (1)[(A)] has not attained 19 years of age[,];
          (2)[(B)] is the natural or adopted child, step[-
        ]child,
        foster[-]child, legal ward, or orphan of an eligible 
        Indian[,]; and
          (3)[(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 1[one] year after the date of a determination of 
competency [such disability has been removed].
    (b) Spouses.--[(2)] Any spouse of an eligible Indian who is 
not an Indian, or who is of Indian descent but is not otherwise 
eligible for the health services provided by the Service, shall 
be eligible for such health services if all of such spouses or 
spouses who are married to membersof each Indian Tribe 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 [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.
    (c)[(b)] Provision of Services to Other Individuals._
[Health facilities providing health service]
          (1)[(A)] In general.--The Secretary is authorized to 
        provide health services under this subsection through 
        health programs [facilities] operated directly by the 
        Service to individuals who reside within the [service 
        area of a s]Service [u]Unit and who are not otherwise 
        eligible for such health services [under any other 
        subsection of this section or under any other provision 
        of law] if--
                  (A)[(i)] the Indian T[t]ribes [(or, in the 
                case of a multi-tribal service are, all the 
                Indian tribes)] served by such [s]Service 
                [u]Unit request[s] such provision of health 
                services to such individuals[,]; and
                  (B)[(ii)] the Secretary and the served Indian 
                [tribe or t]Tribes have jointly determined 
                that--
                          (i)[(I)] the provision of such health 
                        services will not result in a denial or 
                        diminution of health services to 
                        eligible Indians[,]; and
                          (ii)[(II)] there is no reasonable 
                        alternative health facilit[y]ies or 
                        services, within or without the 
                        [service area of such s]Service 
                        [u]Unit, available to meet the health 
                        needs of such individuals.
          (2)[(B)] ISDEAA programs.--In the case of health 
        programs and facilities operated under a contract or 
        compact entered into under the Indian Self-
        Determination and Education Assistance Act (25 U.S.C. 
        450 et seq.), [[25 U.S.C.A. Sec. 450f et seq.],] the 
        governing body of the Indian [t]Tribe or T[t]ribal 
        O[o]rganization providing health services under such 
        contract or compact is authorized to determine whether 
        health services should be provided under such contract 
        or compact to individuals who are not otherwise 
        eligible for such [health] services under any other 
        subsection of this section or under any other provision 
        of law. In making such determination[s], the governing 
        body of the Indian [t]Tribe or [t]Tribal 
        [o]Organization shall take into account the 
        considerations described in clauses (i) and (ii) of 
        paragraph (1)(B) [subparagraph (A)(ii)].
          (3)[(2)] Payment for services._
                  (A) In general.--Persons receiving health 
                services provided by the Service under [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 404[1880(c)] 
                of this [the Social Security] Act [[42 U.S.C.A. 
                Sec. 1395qq(c)], section 1642(a) of this 
                title,] or any other provision of law, amounts 
                collected under this subsection, including 
                medicare, [or] medicaid or SCHIP reimbursements 
                under titles XVIII, [and] XIX, and XXI of the 
                Social Security Act [[42 U.S.C.A. 
                Sec. Sec. 1395 et seq., 1396 et seq.]], shall 
                be credited to the account of the program 
                [facility] providing the service and shall be 
                used [solely] for the purposes listed in 
                section 401(d)(2) and [provision of health 
                services within that facility. A]amounts 
                collected under this subsection shall be 
                available for expenditure within such program 
                [facility for not to exceed one fiscal year 
                after the fiscal year in which collected].
                  (B) Indigent people.--Health services may be 
                provided by the Secretary through the Service 
                under this subsection to an indigent individual 
                [person] 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 [person].
          (4)[(3)] Revocation of consent for services._
                  (A) Single tribe service area.--In the case 
                of a S[s]ervice A[a]rea which serves only 
                1[one] Indian T[t]ribe, 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 
                T[t]ribe revokes its concurrence to the 
                provision of such health services.
                  (B) Multitribal service area.--In the case of 
                a 
                multi[-]tribal S[s]ervice A[a]rea, 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 T[t]ribes in 
                the S[s]ervice A[a]rea revoke their concurrence 
                to the provision of such health services.
    (d)[(c)] Other Services.--[Purposes served in providing 
health services to otherwise ineligible individuals] 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 individual [person] if suchcare is directly 
related to the treatment of the eligible individual [person].
    (e)[(d) Extension of h]Hospital [p]Privileges for [to non-
Service health care p]Practitioners.--Hospital privileges in 
health facilities operated and maintained by the Service or 
operated under a contract or compact [entered into under] 
pursuant to the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.) [[25 U.S.C.A. Sec. 450f 
et seq.]] may be extended to non-Service health care 
practitioners who provide services to individuals [persons] 
described in subsection (a), [or] (b), (c), or (d) [of this 
section]. Such non-Service health care practitioners may, as 
part of the privileging process, be designated [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 individuals [persons] as a part of the conditions 
under which such hospital privileges are extended.
    (f)[(e) ``]Eligible Indian['' ``defined].--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. 1680d. Infant and maternal mortality; fetal alcohol syndrome]

    [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 births.]

[Sec. 1680e. Contract health services for the Trenton Service Area]

    [(a) Service to Turtle Mountain Band]
    [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) Band member eligibility not expanded]
    [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. 1680f. Indian Health Service and Department of Veterans Affairs 
                    health facilities and services sharing]

    [(a) Feasibility study and report]
    [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) of this section, 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) Nonimpairment of service quality, eligibility, or 
priority of access]
    [The Secretary shall not take any action under this section 
or under subchapter IV of chapter 81 of Title 38 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) Cross utilization of services]
          [(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 George E. Wahlen 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) Right to health services]
    [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) of this section.]

Sec. 1680g. Reallocation of B[b]aseR[r]esources

    (a) Report Required.--[to Congress] 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 S[s]ervice U[u]nit 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[1671 of this title], a report on the proposed 
change in allocation of funding, including the reasons for the 
change and its likely effects.
    (b) Exception.--[Appropriated amounts] Subsection (a) [of 
this section] 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. 1680h. Demonstration projects for tribal management of health 
                    care services]

    [(a) Establishment; grants]
          [(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) Health care contracts]
    [During the period in which a demonstration project 
established under subsection (a) of this section 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 [42 
U.S.C.A. Sec. 300w et seq.] (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) of this section) shall apply.]
    [(c) Waiver of procurement laws]
    [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) of this section, but 
only if such waiver does not diminish or endanger the delivery 
of health care services to Indians.]
    [(d) Termination; evaluation and report]
          [(1) The demonstration project established under 
        subsection (a) of this section 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) of this section and 
        shall submit to the Congress a report on such 
        evaluations and demonstration projects.]
    [(e) Joint venture demonstration projects]
          [(1) The Secretary, acting through the Service, shall 
        make arrangements with Indian tribes to establish joint 
        venture demonstrative 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.]

[Sec. 1680i. Child sexual abuse treatment programs]

    [(a) Continuation of existing demonstration programs]
    [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) Establishment of new demonstration programs]
    [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).]

[Sec. 1680j. Tribal leasing]

    [Indian tribes providing health care services pursuant to a 
contract entered into under the Indian Self-Determination Act 
[25 U.S.C.A. Sec. 450f et seq.] may lease permanent structures 
for the purpose of providing such health care services without 
obtaining advance approval in appropriation Acts.]

[Sec. 1680k. Home- and community-based care demonstration project]

    [(a) Authority of Secretary]
    [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 [25 U.S.C.A. Sec. 450f et seq.], to establish demonstration 
projects for the delivery of home- and community-based services 
to functionally disabled Indians.]
    [(b) Use of funds]
          [(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 by 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) Criteria for approval of applications]
    [Not later than 180 days after October 29, 1992, 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) Assistance to applicants]
    [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) Services to ineligible persons]
    [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) Maximum number of demonstration projects]
    [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) of this section.]
    [(g) Report]
    [The Secretary shall submit to the President, for inclusion 
in the report which is required to be submitted under section 
1671 of this title 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) Definitions]
    [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) Authorization of appropriations]
    [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.]

[Sec. 1680l. Shared services demonstration project]

    [(a) Authority of Secretary]
    [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) Contract requirements]
    [A contract entered into pursuant to subsection (a) of this 
section--]
          [(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) Eligibility]
    [To be eligible for a contract under this section, a tribe 
or tribal organization, shall, as of October 29, 1992--]
          [(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) Nursing facilities]
    [Any nursing facility for which a contract is entered into 
under this section shall meet the requirements for nursing 
facilities under section 1396r or Title 42.]
    [(e) Assistance to applicants]
    [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) Report]
    [The Secretary shall submit to the President, for inclusion 
in each report required to be transmitted to the Congress under 
section 1671 of this title, a report on the findings and 
conclusions derived from the demonstration projects conducted 
under this section.]

Sec. 1680m. Results of [d]Demonstration [p]Projects

    The Secretary shall provide for the dissemination to Indian 
T[t]ribes, Tribal Organizations, and Urban Indian Organizations 
of the findings and results of demonstration projects conducted 
under this Act [chapter].

[Sec. 1680n. Priority for Indian reservations]

    [(a) Facilities and projects]
    [Beginning on October 29, 1992, 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) ``Indian lands'' defined]
    [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.]

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. 1680o. Authorization of appropriations]

    [Except as provided in section 1680k of this title, there 
are authorized to be appropriated such sums as may be necessary 
for each fiscal year through fiscal year 2000 to carry out this 
subchapter.]

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. 1681. Omitted]

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 contract or compact pursuant to the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et 
seq.) shall not be considered an `employer'.

[Sec. 1682. Subrogation of claims by Indian Health Service]

    [On and after October 18, 1986, the Indian Health Service 
may seek subrogation of claims including but not limited to 
auto accident claims, including no-fault claims, personal 
injury, disease, or disability claims, and worker's 
compensation claims, the proceeds of which shall be credited to 
the funds established by sections 401 and 402 of the Indian 
Health Care Improvement Act.]

[Sec. 1683. Indian Catastrophic Health Emergency Fund]

    [$10,000,000 shall remain available until expended, for the 
establishment of an Indian Catastrophic Health Emergency Fund 
(hereinafter referred to as the ``Fund''). On and after October 
18, 1986, the Fund is to cover the Indian Health Service 
portion of the medical expenses of catastrophic illness falling 
within the responsibility of the Service and shall be 
administered by the Secretary of Health and Human Services, 
acting through the central office of the Indian Health Service. 
No part of the Fund or its administration shall be subject to 
contract or grant under the Indian Self-Determination and 
Education Assistance Act (Public Law 93-638) [25 U.S.C.A. 
Sec. 450 et seq.]. There shall be deposited into the Fund all 
amounts recovered under the authority of the Federal Medical 
Care Recovery Act (42 U.S.C. 2651 et seq.), which shall become 
available for obligation upon receipt and which shall remain 
available for obligation until expended. The Fund shall not be 
used to pay for health services provided to eligible Indians to 
the extent that alternate Federal, State, local, or private 
insurance resources for payment: (1) are available and 
accessible to the beneficiary; or (2) would be available and 
accessible if the beneficiary were to apply for them; or (3) 
would be available and accessible to other citizens similarly 
situated under Federal, State, or local law or regulation or 
private insurance program notwithstanding Indian Health Service 
eligibility or residency on or off a Federal Indian 
reservation.]

Sec. 813. 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. 814. Establishment of National Bipartisan Commission on Indian 
                    Health Care

    (a) Establishment.--There is established the National 
Bipartisan Indian Health Care Commission (the `Commission').
    (b) Duties of Commission.--The duties of the Commission are 
the following:
          (1) To establish a study committee composed of those 
        members of the Commission appointed by the Director and 
        at least 4 members of Congress from among the members 
        of the Commission, the duties of which shall be the 
        following:
                  (A) To the extent necessary to carry out its 
                duties, collect and compile data necessary to 
                understand the extent of Indian needs with 
                regard to the provision of health services, 
                regardless of the location of Indians, 
                including holding hearings and soliciting the 
                views of Indians, Indian Tribes, Tribal 
                Organizations, and Urban Indian Organizations, 
                which may include authorizing and making funds 
                available for feasibility studies of various 
                models for providing and funding health 
                services for all Indian beneficiaries, 
                including those who live outside of a 
                reservation, temporarily or permanently.
                  (B) To make legislative recommendations to 
                the Commission regarding the delivery of 
                Federal health services to Indians. Such 
                recommendations shall include those related to 
                issues of eligibility, benefits, the range of 
                service providers, the cost of such services, 
                financing such services, and the optimal manner 
                in which to provide such services.
                  (C) To determine the effect of the enactment 
                of such recommendations on (i) the existing 
                system of delivery of health services for 
                Indians, and (ii) the sovereign status of 
                Indian Tribes.
                  (D) Not later than 12 months after the 
                appointment of all members of the Commission, 
                to submit a written report of its findings and 
                recommendations to the full Commission. The 
                report shall include a statement of the 
                minority and majority position of the Committee 
                and shall be disseminated, at a minimum, to 
                every Indian Tribe, Tribal Organization, and 
                Urban Indian Organization for comment to the 
                Commission.
                  (E) To report regularly to the full 
                Commission regarding the findings and 
                recommendations developed by the study 
                committee in the course of carrying out its 
                duties under this section.
          (2) To review and analyze the recommendations of the 
        report of the study committee.
          (3) To make legislative recommendations to Congress 
        regarding the delivery of health care services to 
        Indians. Such recommendation shall include those 
        related to issues of eligibility, benefits, the range 
        of service providers, the cost of such services, 
        financing such services, and the optimal manner in 
        which to provide such services.
          (4) Not later than 18 months following the date of 
        appointment of all members of the Commission, submit a 
        written report to Congress regarding the delivery of 
        Federal health care services to Indians. Such 
        recommendation shall include those related to issues of 
        eligibility, benefits, the range of service providers, 
        the cost of such services, financing such services, and 
        the optimal manner in which to provide such services.
    (c) Members.--
          (1) Appointment.--The Commission shall be composed of 
        25 members, appointed as follows:
                  (A) Ten members of Congress, including 3 from 
                the House of Representatives and 2 from the 
                Senate, appointed by their respective majority 
                leaders, and 3 from the House of 
                Representatives and 2 from the Senate, 
                appointed by their respective minority leaders, 
                and who shall be members of the standing 
                committees of Congress that consider 
                legislation affecting health care to Indians.
                  (B) Twelve persons chosen by the 
                congressional members of the Commission, 1 from 
                each Service Area as currently designated by 
                the Director to be chosen from among 3 nominees 
                from each Service Area put forward by the 
                Indian Tribes within the area, with due regard 
                being given to the experience and expertise of 
                the nominees in the provision of health care to 
                Indians and to a reasonable representation on 
                the commission of members who are familiar with 
                various health care delivery modes and who 
                represent Indian Tribes of various size 
                populations.
                  (C) Three persons appointed by the Director 
                who are knowledgeable about the provision of 
                health care to Indians, at least 1 of whom 
                shall be appointed from among 3 nominees put 
                forward by those programs whose funds are 
                provided in whole or in part by the Service 
                primarily or exclusively for the benefit of 
                Urban Indians.
                  (D) All those persons chosen by the 
                congressional members of the Commission and by 
                the Director shall be members of federally 
                recognized Indian Tribes.
          (2) Chair; vice chair.--The Chair and Vice Chair of 
        the Commission shall be selected by the congressional 
        members of the Commission.
          (3) Terms.--The terms of members of the Commission 
        shall be for the life of the Commission.
          (4) Deadline for appointments.--Congressional members 
        of the Commission shall be appointed not later than 180 
        days after the date of the enactment of the Indian 
        Health Care Improvement Act Amendments of 2005, 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 appropriations 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. 815. 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. 816. Authorization of Appropriations

    (a) 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) 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. 9. Nothing in this Act shall preclude the Soboba 
Band of Mission Indians and the Soboba Indian Reservation from 
being provided with sanitation facilities and services under 
the authority of section 7 of the Act of August 5, 1954 (68 
Stat. 674), as amended by the Act of July 31, 1959 (73 Stat. 
267).''.

SEC. 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:

``SEC. 1911. 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