[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[S. 1869 Reported in Senate (RS)]





                                                       Calendar No. 555

104th CONGRESS

  2d Session

                                S. 1869

                          [Report No. 104-346]

_______________________________________________________________________

                                 A BILL

    To make certain technical corrections in the Indian Health Care 
                Improvement Act, and for other purposes.

_______________________________________________________________________

                             July 31, 1996

                       Reported without amendment





                                                       Calendar No. 555
104th CONGRESS
  2d Session
                                S. 1869

                          [Report No. 104-346]

    To make certain technical corrections in the Indian Health Care 
                Improvement Act, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 13, 1996

 Mr. McCain (for himself, Mrs. Kassebaum, Mr. Murkowski, Mr. Stevens, 
and Mr. Simon) introduced the following bill; which was read twice and 
              referred to the Committee on Indian Affairs

                             July 31, 1996

               Reported by Mr. McCain, without amendment

_______________________________________________________________________

                                 A BILL


 
    To make certain technical corrections in the Indian Health Care 
                Improvement Act, and for other purposes.

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

SECTION 1. SHORT TITLE; REFERENCES.

    (a) Short Title.--This Act may be cited as the ``Indian Health Care 
Improvement Technical Corrections Act of 1996''.
    (b) References.--Whenever in this Act an amendment or repeal is 
expressed in terms of an amendment to or repeal of a section or other 
provision, the reference shall be considered to be made to a section or 
other provision of the Indian Health Care Improvement Act.

SEC. 2. TECHNICAL CORRECTIONS IN THE INDIAN HEALTH CARE IMPROVEMENT 
              ACT.

    (a) Definition of Health Profession.--Section 4(n) (25 U.S.C. 
1603(n)) is amended--
            (1) by inserting ``allopathic medicine,'' before ``family 
        medicine''; and
            (2) by striking ``and allied health professions'' and 
        inserting ``an allied health profession, or any other health 
        profession''.
    (b) Indian Health Professions Scholarships.--Section 104(b) of the 
Indian Health Care Improvement Act (25 U.S.C. 1613a(b)) is amended--
            (1) in paragraph (3)--
                    (A) in subparagraph (A)--
                            (i) by striking the matter preceding clause 
                        (i) and inserting the following:
    ``(3)(A) The active duty service obligation under a written 
contract with the Secretary under section 338A of the Public Health 
Service Act (42 U.S.C. 254l) that an individual has entered into under 
that section shall, if that individual is a recipient of an Indian 
Health Scholarship, be met in full-time practice, by service--'';
                            (ii) by striking ``or'' at the end of 
                        clause (iii);
                            (iii) by striking the period at the end of 
                        clause (iv) and inserting ``; or''; and
                            (iv) by adding at the end the following new 
                        clause:
            ``(v) in an academic setting (including a program that 
        receives funding under section 102, 112, or 114, or any other 
        academic setting that the Secretary, acting through the 
        Service, determines to be appropriate for the purposes of this 
        clause) in which the major duties and responsibilities of the 
        recipient are the recruitment and training of Indian health 
        professionals in the discipline of that recipient in a manner 
        consistent with the purpose of this title, as specified in 
        section 101.'';
                    (B) by redesignating subparagraphs (B) and (C) as 
                subparagraphs (C) and (D), respectively;
                    (C) by inserting after subparagraph (A) the 
                following new subparagraph:
    ``(B) At the request of any individual who has entered into a 
contract referred to in subparagraph (A) and who receives a degree in 
medicine (including osteopathic or allopathic medicine), dentistry, 
optometry, podiatry, or pharmacy, the Secretary shall defer the active 
duty service obligation of that individual under that contract, in 
order that such individual may complete any internship, residency, or 
other advanced clinical training that is required for the practice of 
that health profession, for an appropriate period (in years, as 
determined by the Secretary), subject to the following conditions:
            ``(i) No period of internship, residency, or other advanced 
        clinical training shall be counted as satisfying any period of 
        obligated service that is required under this section.
            ``(ii) The active duty service obligation of that 
        individual shall commence not later than 90 days after the 
        completion of that advanced clinical training (or by a date 
        specified by the Secretary).
            ``(iii) The active duty service obligation will be served 
        in the health profession of that individual, in a manner 
        consistent with clauses (i) through (v) of subparagraph (A).'';
                    (D) in subparagraph (C), as so redesignated, by 
                striking ``prescribed under section 338C of the Public 
                Health Service Act (42 U.S.C. 254m) by service in a 
                program specified in subparagraph (A)'' and inserting 
                ``described in subparagraph (A) by service in a program 
                specified in that subparagraph''; and
                    (E) in subparagraph (D), as so redesignated--
                            (i) by striking ``Subject to subparagraph 
                        (B),'' and inserting ``Subject to subparagraph 
                        (C),''; and
                            (ii) by striking ``prescribed under section 
                        338C of the Public Health Service Act (42 
                        U.S.C. 254m)'' and inserting ``described in 
                        subparagraph (A)'';
            (2) in paragraph (4)--
                    (A) in subparagraph (B), by striking the matter 
                preceding clause (i) and inserting the following:
            ``(B) the period of obligated service described in 
        paragraph (3)(A) shall be equal to the greater of--''; and
                    (B) in subparagraph (C), by striking ``(42 U.S.C. 
                254m(g)(1)(B))'' and inserting ``(42 U.S.C. 
                254l(g)(1)(B))''; and
            (3) in paragraph (5), by adding at the end the following 
        new subparagraphs:
    ``(C) Upon the death of an individual who receives an Indian Health 
Scholarship, any obligation of that individual for service or payment 
that relates to that scholarship shall be canceled.
    ``(D) The Secretary shall provide for the partial or total waiver 
or suspension of any obligation of service or payment of a recipient of 
an Indian Health Scholarship if the Secretary determines that--
            ``(i) it is not possible for the recipient to meet that 
        obligation or make that payment;
            ``(ii) requiring that recipient to meet that obligation or 
        make that payment would result in extreme hardship to the 
        recipient; or
            ``(iii) the enforcement of the requirement to meet the 
        obligation or make the payment would be unconscionable.
    ``(E) Notwithstanding any other provision of law, in any case of 
extreme hardship or for other good cause shown, the Secretary may 
waive, in whole or in part, the right of the United States to recover 
funds made available under this section.
    ``(F) Notwithstanding any other provision of law, with respect to a 
recipient of an Indian Health Scholarship, no obligation for payment 
may be released by a discharge in bankruptcy under title 11, United 
States Code, unless that discharge is granted after the expiration of 
the 5-year period beginning on the initial date on which that payment 
is due, and only if the bankruptcy court finds that the nondischarge of 
the obligation would be unconscionable.''.
    (c) Reimbursement From Certain Third Parties of Costs of Health 
Services.--Section 206 (16 U.S.C. 1621e) is amended--
            (1) in subsection (a)--
                    (A) in the matter preceding paragraph (1)--
                            (i) by striking ``Except as provided'' and 
                        inserting ``(a) Right of Recovery.--Except as 
                        provided'';
                            (ii) by striking ``the reasonable expenses 
                        incurred'' and inserting ``the reasonable 
                        charges billed'';
                            (iii) by striking ``in providing'' and 
                        inserting ``for providing''; and
                            (iv) by striking ``for such expenses'' and 
                        inserting ``for such charges''; and
                    (B) in paragraph (2), by striking ``such expenses'' 
                each place it appears and inserting ``such charges'';
            (2) in subsection (b), by striking ``(b) Subsection (a)'' 
        and inserting ``(b) Recovery Against State With Workers' 
        Compensation Laws or No-Fault Automobile Accident Insurance 
        Program.--Subsection (a)'';
            (3) in subsection (c), by striking ``(c) No law'' and 
        inserting ``(c) Prohibition of State Law or Contract Provision 
        Impediment to Right of Recovery.--No law'';
            (4) in subsection (d), by striking ``(d) No action'' and 
        inserting ``(d) Right to Damages.--No action'';
            (5) in subsection (e)--
                    (A) in the matter preceding paragraph (1), by 
                striking ``(e) The United States'' and inserting ``(e) 
                Intervention or Separate Civil Action.--The United 
                States''; and
                    (B) by striking paragraph (2) and inserting the 
                following new paragraph:
            ``(2) while making all reasonable efforts to provide notice 
        of the action to the individual to whom health services are 
        provided prior to the filing of the action, instituting a civil 
        action.'';
            (6) in subsection (f), by striking ``(f) The United 
        States'' and inserting ``(f) Services Covered Under a Self-
        Insurance Plan.--The United States''; and
            (7) by adding at the end the following new subsections:
    ``(g) Costs of Action.--In any action brought to enforce this 
section, the court shall award any prevailing plaintiff costs, 
including attorneys' fees that were reasonably incurred in that action.
    ``(h) Right of Recovery for Failure To Provide Reasonable 
Assurances.--The United States, an Indian tribe, or a tribal 
organization shall have the right to recover damages against any 
fiduciary of an insurance company or employee benefit plan that is a 
provider referred to in subsection (a) who--
            ``(1) fails to provide reasonable assurances that such 
        insurance company or employee benefit plan has funds that are 
        sufficient to pay all benefits owed by that insurance company 
        or employee benefit plan in its capacity as such a provider; or
            ``(2) otherwise hinders or prevents recovery under 
        subsection (a), including hindering the pursuit of any claim 
        for a remedy that may be asserted by a beneficiary or 
        participant covered under subsection (a) under any other 
        applicable Federal or State law.''.
    (d) California Contract Health Services Demonstration Program.--
Section 211(g) (25 U.S.C. 1621j(g)) is amended by striking ``1993, 
1994, 1995, 1996, and 1997'' and inserting ``1996 through 2000''.
    (e) Medicare and Medicaid Demonstration Program.--Section 405(c) 
(25 U.S.C. 1645(c)) is amended--
            (1) in paragraph (1)(D), by striking ``prior to October 1, 
        1990'' and inserting ``on or before the date which is 1 year 
        after the date of submission of the plan''; and
            (2) in paragraph (2)--
                    (A) by striking ``, prior to October 1, 1989, 
                select no more than 4'' and inserting ``select no more 
                than 12''; and
                    (B) by striking ``September 30, 1996'' and 
                inserting ``September 30, 2000''.
    (f) Gallup Alcohol and Substance Abuse Treatment Center.--Section 
706(d) (25 U.S.C. 1665e(d)) is amended to read as follows:
    ``(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).''.
    (g) Substance Abuse Counselor Education Demonstration Program.--
Section 711(h) (25 U.S.C. 1665j(h)) is amended by striking ``1993, 
1994, 1995, 1996, and 1997'' and inserting ``1996 through 2000''.
    (h) Home and Community-Based Care Demonstration Program.--Section 
821(i) (25 U.S.C. 1680k(i)) is amended by striking ``1993, 1994, 1995, 
1996, and 1997'' and inserting ``1996 through 2000''.