[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3397 Introduced in House (IH)]







106th CONGRESS
  1st Session
                                H. R. 3397

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 16, 1999

Mr. George Miller of California (for himself, Mr. Young of Alaska, Mr. 
   Bonior, Mr. Waxman, Mr. Kildee, Mr. Kennedy of Rhode Island, Mr. 
Abercrombie, Mr. Hayworth, Mr. Inslee, Mr. Faleomavaega, Mr. Gallegly, 
 Mr. Smith of Washington, Mrs. Napolitano, Mr. Kind, Mrs. Christensen, 
 Mr. Blumenauer, Ms. Kilpatrick, Ms. Lee, Ms. Baldwin, Ms. Pelosi, Mr. 
Hinchey, Mr. Jefferson, Mr. Filner, Mr. Oberstar, Mr. Diaz-Balart, Ms. 
Stabenow, Mr. Nethercutt, and Mr. Martinez) (all by request) introduced 
 the following bill; which was referred to the Committee on Resources, 
  and in addition to the Committees on Commerce, Ways and Means, and 
 Government Reform, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


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

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Indian Health Care Improvement Act 
Amendments of 2000''.

SEC. 2. INDIAN HEALTH CARE IMPROVEMENT ACT AMENDED.

    The Indian Health Care Improvement Act (25 U.S.C. 1601 note) is 
amended to read as follows:

``SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    ``(a) Short Title.--This Act may be cited as the `Indian Health 
Care Improvement Act'.
    ``(b) Table of Contents.--The table of contents for this Act is as 
follows:

``Sec. 1. Short title; table of contents.
``Sec. 2. Findings.
``Sec. 3. Declaration of health objectives.
``Sec. 4. Definitions.
       ``TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT

``Sec. 101. Purpose.
``Sec. 102. General requirements.
``Sec. 103. Health professions recruitment program for Indians.
``Sec. 104. Health professions preparatory scholarship program for 
                            Indians.
``Sec. 105. Indian health professions scholarships.
``Sec. 106. American Indians into psychology program.
``Sec. 107. Indian health service extern programs.
``Sec. 108. Continuing education allowances.
``Sec. 109. Community health representative program.
``Sec. 110. Indian health service loan repayment program.
``Sec. 111. Scholarship and loan repayment recovery fund.
``Sec. 112. Recruitment activities.
``Sec. 113. Tribal recruitment and retention program.
``Sec. 114. Advanced training and research.
``Sec. 115. Quentin B. Burdick American Indians into Nursing Program.
``Sec. 116. Tribal cultural orientation.
``Sec. 117. INMED program.
``Sec. 118. Health training programs of community colleges.
``Sec. 119. Retention bonus.
``Sec. 120. Nursing residency program.
``Sec. 121. Community health aide program for Alaska.
``Sec. 122. Tribal health program administration.
``Sec. 123. Health professional chronic shortage demonstration project.
``Sec. 124. Treatment of scholarships for certain purposes.
``Sec. 125. National health service corps.
``Sec. 126. Substance abuse counselor education demonstration project.
``Sec. 127. Mental health training and community education programs.
``Sec. 128. Authorization of appropriations.
                      ``TITLE II--HEALTH SERVICES

``Sec. 201. Indian health care improvement fund.
``Sec. 202. Catastrophic health emergency fund.
``Sec. 203. Health promotion and disease prevention services.
``Sec. 204. Diabetes prevention, treatment, and control.
``Sec. 205. Shared services.
``Sec. 206. Health services research.
``Sec. 207. Mammography and other cancer screening.
``Sec. 208. Patient travel costs.
``Sec. 209. Epidemiology centers.
``Sec. 210. Comprehensive school health education programs.
``Sec. 211. Indian youth program.
``Sec. 212. Prevention, control, and elimination of communicable and 
                            infectious diseases.
``Sec. 213. Authority for provision of other services.
``Sec. 214. Indian women's health care.
``Sec. 215. Environmental and nuclear health hazards.
``Sec. 216. Arizona as a contract health service delivery area.
``Sec. 217. California contract health services program.
``Sec. 218. California as a contract health service delivery area.
``Sec. 219. Contract health services for the Trenton service area.
``Sec. 220. Programs operated by Indian tribes and tribal 
                            organizations.
``Sec. 221. Licensing.
``Sec. 222. Authorization for emergency contract health services.
``Sec. 223. Prompt action on payment of claims.
``Sec. 224. Liability for payment.
``Sec. 225. Authorization of appropriations.
                        ``TITLE III--FACILITIES

``Sec. 301. Consultation; construction and renovation of facilities; 
                            reports.
``Sec. 302. Safe water and sanitary waste disposal facilities.
``Sec. 303. Preference to Indians and Indian firms.
``Sec. 304. Expenditure of nonservice funds for renovation.
``Sec. 305. Funding for the construction, expansion, and modernization 
                            of small ambulatory care facilities.
``Sec. 306. Indian health care delivery demonstration project.
``Sec. 307. Land transfer.
``Sec. 308. Leases.
``Sec. 309. Loans, loan guarantees, and loan repayment.
``Sec. 310. Tribal leasing.
``Sec. 311. Indian health service/tribal facilities joint venture 
                            program.
``Sec. 312. Location of facilities.
``Sec. 313. Maintenance and improvement of health care facilities.
``Sec. 314. Tribal management of federally owned quarters.
``Sec. 315. Applicability of buy American requirement.
``Sec. 316. Other funding for facilities.
``Sec. 317. Authorization of appropriations.
                 ``TITLE IV--ACCESS TO HEALTH SERVICES

``Sec. 401. Treatment of payments under medicare program.
``Sec. 402. Treatment of payments under medicaid program.
``Sec. 403. Report.
``Sec. 404. Grants to and funding agreements with the service, Indian 
                            tribes, tribal organizations, and urban 
                            Indian organizations.
``Sec. 405. Direct billing and reimbursement of medicare, medicaid, and 
                            other third-party payors.
``Sec. 406. Reimbursement from certain third parties of costs of health 
                            services.
``Sec. 407. Crediting of reimbursements.
``Sec. 408. Purchasing health care coverage.
``Sec. 409. Indian health service, department of veterans affairs, and 
                            other Federal agency health facilities and 
                            services sharing.
``Sec. 410. Payor of last resort.
``Sec. 411. Payment or reimbursement for services.
``Sec. 412. Tuba city demonstration project.
``Sec. 413. Access to Federal insurance.
``Sec. 414. Consultation and rulemaking.
``Sec. 415. Limitation on secretary's waiver authority.
``Sec. 416. Children's health insurance program funds.
``Sec. 417. Waiver of medicare and medicaid sanctions.
``Sec. 418. Safe harbor.
``Sec. 419. Cost sharing.
``Sec. 420. Managed care.
``Sec. 421. Navajo nation medicaid agency.
``Sec. 422. Indian advisory committees.
``Sec. 423. Limitation on charges.
``Sec. 424. Authorization of appropriations.
              ``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

``Sec. 501. Purpose.
``Sec. 502. Contracts with, and grants to, urban Indian organizations.
``Sec. 503. Contracts and grants for the provision of health care and 
                            referral services.
``Sec. 504. Contracts and grants for the determination of unmet health 
                            care needs.
``Sec. 505. Evaluations; renewals.
``Sec. 506. Other contract and grant requirements.
``Sec. 507. Reports and records.
``Sec. 508. Limitation on contract authority.
``Sec. 509. Facilities.
``Sec. 510. Office of urban Indian health.
``Sec. 511. Grants for alcohol and substance abuse related services.
``Sec. 512. Treatment of certain demonstration projects.
``Sec. 513. Urban NIAAA transferred programs.
``Sec. 514. Consultation with urban Indian organizations.
``Sec. 515. Federal tort claims act coverage.
``Sec. 516. Urban youth treatment center demonstration.
``Sec. 517. Use of Federal government facilities and sources of supply.
``Sec. 518. Grants for diabetes prevention, treatment, and control.
``Sec. 519. Community health representatives.
``Sec. 520. Regulations.
``Sec. 521. Authorization of appropriations.
                ``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

``Sec. 601. Establishment of the Indian health service as an agency of 
                            the public health service.
``Sec. 602. Automated management information system.
``Sec. 603. Authorization of appropriations.
                ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

``Sec. 701. Behavioral health prevention and treatment services.
``Sec. 702. Memoranda of agreement with the department of the interior.
``Sec. 703. Comprehensive behavioral health prevention and treatment 
                            program.
``Sec. 704. Mental health technician program.
``Sec. 705. Licensing requirement for mental health care workers.
``Sec. 706. Indian women treatment programs.
``Sec. 707. Indian youth program.
``Sec. 708. Inpatient and community-based mental health facilities 
                            design, construction, and staffing.
``Sec. 709. Training and community education.
``Sec. 710. Behavioral health program.
``Sec. 711. Fetal alcohol disorder funding.
``Sec. 712. Child sexual abuse and prevention treatment programs.
``Sec. 713. Behavioral health research.
``Sec. 714. Definitions.
``Sec. 715. Authorization of appropriations.
                      ``TITLE VIII--MISCELLANEOUS

``Sec. 801. Reports.
``Sec. 802. Regulations.
``Sec. 803. Plan of implementation.
``Sec. 804. Availability of funds.
``Sec. 805. Limitation on use of funds appropriated to the Indian 
                            health service.
``Sec. 806. Eligibility of California Indians.
``Sec. 807. Health services for ineligible persons.
``Sec. 808. Reallocation of base resources.
``Sec. 809. Results of demonstration projects.
``Sec. 810. Provision of services in Montana.
``Sec. 811. Moratorium.
``Sec. 812. Tribal employment.
``Sec. 813. Prime vendor.
``Sec. 814. Severability provisions.
``Sec. 815. Establishment of national bipartisan commission on Indian 
                            health care entitlement.
``Sec. 816. Appropriations; availability.
``Sec. 817. Authorization of appropriations.

``SEC. 2. FINDINGS.

    ``The Congress finds the following:
            ``(1) Federal delivery of health services and funding of 
        tribal and urban Indian health programs to maintain and improve 
        the health of the Indians are consonant with and required by 
        the Federal Government's historical and unique legal 
        relationship, as reflected in the Constitution, treaties, 
        Federal statutes and the course of dealings of the United 
        States with Indian tribes and the United States resulting 
        Government to Government and trust responsibility and 
        obligations to the American Indian people.
            ``(2) From the time of European occupation and colonization 
        through the 20th century policies and practices of the United 
        States caused and/or contributed to the severe health 
        conditions of Indians.
            ``(3) Indian tribes, have, through the cession of over 
        400,000,000 acres of land, to the United States in exchange for 
        promises, often reflected in treaties, of health care secured a 
        de facto contract which entitles Indians to health care in 
        perpetuity, based on the moral legal and historic obligation of 
        the United States.
            ``(4) The population growth of the Indian people that began 
        in the later part of the 20th century increases the need for 
        Federal health care services.
            ``(5) 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 regardless of where they 
        live to be raised to the highest possible level that is no less 
        than that of the general population and to provide for the 
        maximum participation of Indian tribes, tribal organizations, 
        and urban Indian organizations in the planning, delivery and 
        management of those services.
            ``(6) Federal health services to Indians have resulted in a 
        reduction in the prevalence and incidence of illnesses among, 
        and unnecessary and premature deaths of, Indians.
            ``(7) Despite such services, the unmet health needs of the 
        American Indian people remain alarmingly severe, and even 
        continue to decline, and the health status of Indians is far 
        below the health status of the general population of the United 
        States.
            ``(8) The disparity to be addressed is formidable. In death 
        rates, for example, Indian people suffer a death rate for 
        diabetes mellitus that is 249 percent higher than the all races 
        rate for the United States, a pneumonia and influenza death 
        rate 71 percent greater, a tuberculosis death rate that is 533 
        percent greater, and a death rate from alcoholism that is 627 
        percent higher than that of the all races United States rate.

``SEC. 3. DECLARATION OF HEALTH OBJECTIVES.

    ``(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 Indian people--
            ``(1) to assure the highest possible health status for 
        Indians and to provide all resources necessary to effect that 
        policy;
            ``(2) to raise the health status of Indians by the year 
        2010 to at least the levels set forth in the goals contained 
        within the Healthy People 2000 or successor standards;
            ``(3) to the greatest extent possible, to allow Indian 
        people 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 geographic service area is raised to at 
        least the level of that of the general population;
            ``(5) to require meaningful consultation with Indian 
        tribes, Indian organizations, and urban Indian organizations to 
        implement this Act and the national policy of Indian self-
        determination; and
            ``(6) to provide for health care programs and facilities 
        operated by Tribes and tribal organizations in amounts that are 
        not less funds than are provided to programs and facilities 
        operated directly by the Service.

``SEC. 4. DEFINITIONS.

    ``For purposes of this Act:
            ``(1) The term `accredited and accessible' means a 
        community college or other appropriate entity 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 Indian Health Service 
        through which services and funds are provided to the service 
        units within a defined geographic area.
            ``(3) The term `contract health service' means health 
        services provided at the expense of the Service, Indian tribe 
        or tribal organization from public or private medical providers 
        or hospitals, other than those funded under the Indian Self-
        Determination and Education Assistance Act.
            ``(4) The term `Department' means, unless otherwise 
        designated, the Department of Health and Human Services.
            ``(5) The term `Director' means the Director of the Indian 
        Health Service.
            ``(6) The term `disease prevention' is the reduction, 
        limitation, and prevention of disease and its complications and 
        reduction in the consequences of such diseases including, but 
        not limited to--
                    ``(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.
            ``(7) The term `fund' or `funding' means the transfer of 
        moneys from the Department to any eligible entity or individual 
        under this Act by any legal means, including funding 
        agreements, contracts, memoranda of understanding, Buy Indian 
        Act contracts or otherwise.
            ``(8) The term `funding agreement' means any agreement to 
        transfer funds for the planning, conduct, and administration of 
        programs, functions, services and activities to Tribes and 
        tribal organizations from the Secretary under the Indian Self-
        Determination and Education Assistance Act.
            ``(9) 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, and allied 
        health professions, or any other health profession.
            ``(10) The `health promotion' means fostering social, 
        economic, environmental, and personal factors conducive to 
        health, including raising people's awareness about health 
        matters and enabling them to cope with health problems by 
        increasing their knowledge and providing them with valid 
        information; encouraging adequate and appropriate diet, 
        exercise, and enough sleep; promoting education and work in 
        conformity with physical and mental capacity; making available 
        suitable housing, safe water, and sanitary facilities; 
        improving the physical, economic, cultural, psychological, and 
        social environment; and promoting adequate opportunity for 
        spiritual, religious, and traditional practices; and adequate 
        and appropriate programs including, but not limited to--
                    ``(A) abuse prevention (mental and physical);
                    ``(B) community health;
                    ``(C) community safety;
                    ``(D) consumer health education;
                    ``(E) diet and nutrition;
                    ``(F) disease prevention (communicable, 
                immunizations, HIV/AIDS);
                    ``(G) environmental health;
                    ``(H) exercise and physical fitness;
                    ``(I) fetal alcohol disorders;
                    ``(J) first aid and CPR education;
                    ``(K) human growth and development;
                    ``(L) injury prevention and personal safety;
                    ``(M) mental health (emotional, self-worth);
                    ``(N) personal health and wellness practices;
                    ``(O) personal capacity building;
                    ``(P) prenatal, pregnancy, and infant care;
                    ``(Q) psychological well-being;
                    ``(R) reproductive health (family planning);
                    ``(S) safe and adequate water;
                    ``(T) safe housing;
                    ``(U) safe work environments;
                    ``(V) stress control;
                    ``(W) substance abuse;
                    ``(X) sanitary facilities;
                    ``(Y) tobacco use cessation and reduction;
                    ``(Z) violence prevention; and
                    ``(AA) such other activities identified by the 
                Indian Health Service, or an Indian tribe or tribal 
                organization, to promote achievement of any of the 
                objectives described in section 3(b).
            ``(11) The term `Indians' or `Indian' shall have the same 
        meaning as provided in the Indian Self-Determination and 
        Education Assistance Act.
            ``(12) 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 organization 
                pursuant to a funding agreement under--
                            ``(I) the Indian Self-Determination and 
                        Educational Assistance Act; or
                            ``(II) section 23 of the Act of April 30, 
                        1908 (25 U.S.C. 47), popularly known as the 
                        `Buy-Indian Act''; or
                    ``(iii) by an urban Indian organization pursuant to 
                title V of this Act.
            ``(13) The term `Indian tribe' shall have the same meaning 
        as provided in the Indian Self-Determination and Education 
        Assistance Act.
            ``(14) The term `reservation' means any federally 
        recognized Indian tribe's reservation, Pueblo or colony, 
        including former reservations in Oklahoma, Alaska Native 
        Regions established pursuant to the Alaska Native Claims 
        Settlement Act, and Indian allotments.
            ``(15) The term `Secretary', unless otherwise designated, 
        means the Secretary of Health and Human Services.
            ``(16) The term `Service' means the Indian Health Service.
            ``(17) The term `service area' means the geographical area 
        served by each Area Office.
            ``(18) The term `Service Unit' means--
                    ``(A) an administrative entity within the Indian 
                Health Service, or
                    ``(B) a Tribe or tribal organization operating 
                health care programs or facilities with funds from the 
                Service under the Indian Self-Determination and 
                Education Assistance Act, through which services are 
                provided, directly or by contract, to the eligible 
                Indian population within a defined geographic area.
            ``(19) 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 embodies the influences or forces of 
        innate tribal discovery, history, description, explanation and 
        knowledge of the states of wellness and illness and which calls 
        upon these influences or forces, including physical, mental, 
        and spiritual forces in the promotion, restoration, 
        preservation and maintenance of health, well-being, and life's 
        harmony.
            ``(20) The term `tribal organization' shall have the same 
        meaning as provided in the Indian Self-Determination and 
        Education Assistance Act.
            ``(21) The term `tribally controlled community college' has 
        the meaning given such term in section 2(a)(4) of the Tribally 
        Controlled Community College Assistance Act of 1978 (25 U.S.C. 
        1801(a)(4)) and the definition contained in the Indian Land 
        Grant Status Act (7 U.S.C. 301 note).
            ``(22) The term `urban center' means any community which 
        has a sufficient urban Indian population with unmet health 
        needs to warrant assistance under title V, as determined by the 
        Secretary.
            ``(23) The term `urban Indian' means any individual who 
        resides in an urban center and who meets one or more of the 
        following criteria:
                    ``(A) Irrespective of whether the individual lives 
                on or near a reservation, the individual is a member of 
                a Tribe, band, or other organized group of Indians, 
                including those Tribes, bands, or groups terminated 
                since 1940.
                    ``(B) The individual is an Eskimo or Aleut or other 
                Alaskan Native.
                    ``(C) The individual is considered by the Secretary 
                of the Interior to be an Indian for any purpose.
                    ``(D) The individual is determined to be an Indian 
                under regulations promulgated by the Secretary.
            ``(24) The term `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 participation of all interested Indian groups and 
        individuals, which body is capable of legally cooperating with 
        other public and private entities for the purpose of performing 
        the activities described in section 503(a).

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

``SEC. 101. PURPOSE.

    ``The purpose of this title is to increase to the maximum feasible 
extent the number of Indians entering the health professions and 
providing health services, and to assure an optimum supply of health 
professionals to the Service, Indian tribes, tribal organizations, and 
urban Indian organizations involved in the provision of health services 
to Indian people.

``SEC. 102. GENERAL REQUIREMENTS.

    ``(a) Service Area Priorities.--(1) Unless otherwise specified, the 
funding for each program authorized by this title shall be allocated by 
service area by formula developed in consultation with Indian tribes, 
tribal organizations, and urban Indian organizations. Such formula 
shall consider the human resource and development needs in each service 
area.
    ``(2) Each Area Office shall undertake active and continuing 
consultation with representatives of Indian tribes, tribal 
organizations, and urban Indian organizations to prioritize the use of 
funds authorized and provided under this title within the service area.
    ``(3) Unless otherwise prohibited, the Area Office is authorized to 
reallocate the funds available to it pursuant to this title among the 
programs authorized by this title, excepted that scholarship and loan 
repayment funds may not be used for administrative functions.
    ``(b) All individual recipients of scholarships, loans, or other 
funding authorized by this title that exist on September 30, 1976 shall 
be excluded from operation of this subsection through to the completion 
of the individual's course of study supported by funds appropriated to 
carry out this title.

``SEC. 103. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR INDIANS.

    ``(a) Subject to the requirements of section 102, the Secretary 
shall make funds available to public or nonprofit private health 
entities or Indian tribes or tribal organizations to assist such 
entities in meeting the costs of--
            ``(1) identifying Indians with a potential for education or 
        training in the health professions and encouraging and 
        assisting them--
                    ``(A) to enroll in courses of study in such health 
                professions; or
                    ``(B) if they are not qualified to enroll in any 
                such courses of study, to undertake such postsecondary 
                education or training as may be required to qualify 
                them for enrollment;
            ``(2) publicizing existing sources of financial aid 
        available to Indians enrolled in any course of study referred 
        to in paragraph (1) or who are undertaking training necessary 
        to quality them to enroll in any such course of study; or
            ``(3) establishing other programs which the Area Office 
        determines will enhance and facilitate the enrollment of 
        Indians in, and the subsequent pursuit and completion by them 
        of, courses of study referred to in paragraph (1).
    ``(b)(1) Funds under this section shall require that an application 
has been submitted to, and approved by, the Secretary through the Area 
Office. 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 Area Office shall give a 
preference to applications submitted by Indian tribes, tribal 
organizations, or urban Indian organizations.
    ``(2) The amount of funds provided to entities authorized under 
this section shall be determined by the Area Office. Payments pursuant 
to this section may be made in advance or by way of reimbursement, and 
at such intervals and on such conditions as provided for in regulations 
issued pursuant to this Act. To the extent not otherwise prohibited by 
law, funding commitments shall be for 3 years, as provided for in 
regulations published pursuant to this Act.
    ``(c) For purposes of this section and sections 104 and 105, the 
term `Indian' or `Indians' shall, in addition to the meaning contained 
in section 4, also mean any person 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;
            ``(2) is an Eskimo or Aleut or other Alaska Native;
            ``(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.

``SEC. 104. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP PROGRAM FOR 
              INDIANS.

    ``(a) Subject to the requirements of section 102, the Secretary 
shall provide scholarships to Indians who--
            ``(1) have successfully completed their high school 
        education or high school equivalency; and
            ``(2) have demonstrated the potential to successfully 
        complete courses of study in the health professions.
    ``(b) Scholarships provided pursuant to this section shall be for 
the following purposes:
            ``(1) Compensatory preprofessional education of any 
        recipient, such scholarship not to exceed 2 years on a full-
        time basis (or the part-time equivalent thereof, as determined 
        by the Area Office pursuant to regulations issued under this 
        Act).
            ``(2) Pregraduate education of any recipient leading to a 
        baccalaureate degree in an approved course of study preparatory 
        to a field of study in a health profession, such scholarship 
        not to exceed 4 years. An extension of up to 2-years (or the 
        part-time equivalent thereof, as determined by the Area Office 
        pursuant to regulations issued pursuant to this Act) may be 
        approved.
    ``(c) Scholarships under this section--
            ``(1) may cover costs of tuition, books, transportation, 
        board, and other necessary related expenses of a recipient 
        while attending school;
            ``(2) shall not be denied solely on the basis of the 
        applicant's scholastic achievement if such applicant has been 
        admitted to, or maintained good standing at, an accredited 
        institution; and
            ``(3) shall not be denied solely by reason of such 
        applicant's eligibility for assistance or benefits under any 
        other Federal program.

``SEC. 105. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.

    ``(a) In order to meet the need for health professionals serving 
Indians, Indian tribes, tribal organizations, and urban Indian 
organizations, subject to the requirements of section 102. The 
administration of this section shall be a responsibility of the 
Director and shall not be delegated in a funding agreement pursuant to 
the Indian Self-Determination and Education Assistance Act. The 
Secretary shall make scholarships to Indians who are enrolled full or 
part time in accredited schools and pursuing courses of study in the 
health professions. Such scholarships shall be designated Indian Health 
Scholarships and shall be made in accordance with section 338A of the 
Public Health Service Act (42 U.S.C. 254l), except as provided in 
subsection (b) of this section.
    ``(b)(1) An Indian shall be eligible for a scholarship under 
subsection (a) in any year in which such individual is enrolled full or 
part time in a course of study referred to in subsection (a).
    ``(2)(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 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--
            ``(i) in the Indian Health Service;
            ``(ii) in a program conducted under a funding agreement 
        entered into under the Indian Self-Determination and Education 
        Assistance Act;
            ``(iii) in a program assisted under title V of this Act; or
            ``(iv) in the private practice of the applicable profession 
        if, as determined by the Secretary, in accordance with 
        guidelines promulgated by the Secretary, such practice is 
        situated in a physician or other health professional shortage 
        area and addresses the health care needs of a substantial 
        number of Indians.
    ``(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, or in a field or 
        specialty where a need is determined to exist by the 
        appropriate service area, in a manner consistent with clauses 
        (i) through (iv) of subparagraph (A).
    ``(C) All new recipients of Indian Health Scholarships awarded 
after 2001 shall meet the active duty service obligation within the 
service area from which the scholarship was awarded. Priority shall be 
given to a program that funded the recipient. Under special 
circumstances, a recipient may be placed in a different service area by 
agreement between Areas or programs.
    ``(D) Subject to subparagraph (C), the Area Office, in making 
assignments of Indian Health Scholarship recipients required to meet 
the active duty service obligation described in subparagraph (A), shall 
give priority to assigning individuals to service in those programs 
specified in subparagraph (A) that have a need for health professionals 
to provide health care services as a result of individuals having 
breached contracts entered into under this section.
    ``(3) In the case of an individual receiving a scholarship under 
this section who is enrolled part time in an approved course of study--
            ``(A) such scholarship shall be for a period of years not 
        to exceed the part-time equivalent of 4 years, as determined by 
        the Area Office;
            ``(B) the period of obligated service described in 
        paragraph (2)(A) shall be equal to the greater of--
                    ``(i) the part-time equivalent of one year for each 
                year for which the individual was provided a 
                scholarship (as determined by the Area Office); or
                    ``(ii) 2 years; and
            ``(C) the amount of the monthly stipend specified in 
        section 338A(g)(1)(B) of the Public Health Service Act (42 
        U.S.C. 254l(g)(1)(B)) shall be reduced pro rata (as determined 
        by the Secretary) based on the number of hours such student is 
        enrolled.
    ``(4)(A) An individual who has, on or after the date of the 
enactment of this paragraph, entered into a written contract with the 
Secretary under this section and who--
            ``(i) fails to maintain an acceptable level of academic 
        standing in the educational institution in which he is enrolled 
        (such level determined by the educational institution under 
        regulations of the Secretary),
            ``(ii) is dismissed from such educational institution for 
        disciplinary reasons,
            ``(iii) voluntarily terminates the training in such an 
        educational institution for which he is provided a scholarship 
        under such contract before the completion of such training, or
            ``(iv) fails to accept payment, or instructs the 
        educational institution in which he is enrolled not to accept 
        payment, in whole or in part, of a scholarship under such 
        contract, in lieu of any service obligation arising under such 
        contract, shall be liable to the United States for the amount 
        which has been paid to him, or on his behalf, under the 
        contract.
    ``(B) If for any reason not specified in subparagraph (A) an 
individual breaches a written contract by failing either to begin such 
individual's service obligation under this section or to complete such 
service obligation, the United States shall be entitled to recover from 
the individual an amount determined in accordance with the formula 
specified in subsection (l) of section 108 in the manner provided for 
in such subsection.
    ``(C) Upon the death of an individual who receives an Indian Health 
Scholarship, any obligation of that individual for service or payment 
that relates to that scholarship shall be canceled.
    ``(D) The Secretary shall provide for the partial or total waiver 
or suspension of any obligation of service or payment of a recipient of 
an Indian Health Scholarship if the Secretary, in consultation with the 
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.
    ``(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) Funding for Tribes for Scholarship Programs.--(1)(A) Subject 
to section 102, the Secretary shall make funds available 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.
    ``(B) Amounts available under subparagraph (A) for any fiscal year 
shall not exceed 5 percent of the amounts available for each fiscal 
year for Indian Health Scholarships under this section.
    ``(C) An application for funds under subparagraph (A) shall be in 
such form and contain such agreements, assurances, and information as 
consistent with this section.
    ``(2)(A) An Indian tribe or tribal organization receiving funds 
under paragraph (1) shall provide scholarships to Indians in accordance 
with the requirements of this subsection.
    ``(B) With respect to costs of providing any scholarship pursuant 
to subparagraph (A)--
            ``(i) 80 percent of the costs of the scholarship shall be 
        paid from the funds pursuant to subsection (c)(1) provided to 
        the Indian tribe or tribal organization; and
            ``(ii) 20 percent of such costs may be paid from any other 
        source of funds.
    ``(3) An Indian tribe or tribal organization shall provide 
scholarships under subsection (c) only to Indians enrolled or accepted 
for enrollment in a course of study (approved by the Secretary) in one 
of the health professions contemplated by this Act.
    ``(4) In providing scholarships under paragraph (2), the Secretary 
and the Indian tribe or tribal organization shall enter into a written 
contract with each recipient of such scholarship. Such contract shall--
            ``(A) obligate such recipient to provide service in an 
        Indian health program (as defined in section 109(a)(2)(A)), in 
        the same service area where the Indian tribe or tribal 
        organization providing the scholarship is located, for--
                    ``(i) 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
                    ``(ii) such greater period of time as the recipient 
                and the Indian tribe or tribal organization may agree;
            ``(B) provide that the amount of the scholarship--
                    ``(i) may only be expended for--
                            ``(I) tuition expenses, other reasonable 
                        educational expenses, and reasonable living 
                        expenses incurred in attendance at the 
                        educational institution; and
                            ``(II) payment to the recipient of a 
                        monthly stipend of not more than the amount 
                        authorized by section 338(g)(1)(B) of the 
                        Public Health Service Act (42 U.S.C. 
                        254m(g)(1)(B), such amount to be reduced pro 
                        rata (as determined by the Secretary) based on 
                        the number of hours such student is enrolled; 
                        and may not exceed, for any year of attendance 
                        for which the scholarship is provided, the 
                        total amount required for the year for the 
                        purposes authorized in this clause; and
                    ``(ii) 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 
                clause (i);
            ``(C) 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
            ``(D) require the recipient of such scholarship to meet the 
        educational and licensure requirements appropriate to each 
        health profession.
    ``(5)(A) An individual who has entered into a written contract with 
the Secretary and an Indian tribe or tribal organization under this 
paragraph and who--
            ``(i) fails to maintain an acceptable level of academic 
        standing in the educational institution in which he is enrolled 
        (such level determined by the educational institution under 
        regulations of the Secretary);
            ``(ii) is dismissed from such educational institution for 
        disciplinary reasons;
            ``(iii) voluntarily terminates the training in such an 
        educational institution for which he or she is provided a 
        scholarship under such contract before the completion of such 
        training; or
            ``(iv) fails to accept payment, or instructs the 
        educational institution in which he 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 Federal share of the 
amount which has been paid to him or her, or on his or her behalf, 
under the contract.
    ``(B) If for any reason not specified in subparagraph (A), an 
individual breaches his or her 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.
    ``(C) The Secretary may carry out this subsection on the basis of 
information received from Indian tribes or tribal organizations 
involved, or on the basis of information collected through such other 
means as the Secretary deems appropriate.
    ``(6) The recipient of a scholarship under paragraph (1) shall 
agree, in providing health care pursuant to the requirements herein--
            ``(A) 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 the program established in title XVIII of the 
        Social Security Act or pursuant to the programs established in 
        title XIX of such Act; and
            ``(B) to accept assignment under section 1842(b)(3)(B)(ii) 
        of the Social Security Act for all services for which payment 
        may be made under part B of title XVIII of such Act, and to 
        enter into an appropriate agreement with the State agency that 
        administers the State plan for medical assistance under title 
        XIX of such Act to provide service to individuals entitled to 
        medical assistance under the plan.
    ``(7) The Secretary shall make payments under this paragraph 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 not complied with the requirements of this 
subsection.

``SEC. 106. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.

    ``(a) Notwithstanding section 102, the Secretary shall provide 
funding 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. 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) The Secretary shall provide one of the grants authorized 
under subsection (a) to develop and maintain a program at the 
University of North Dakota to be known as the `Quentin N. Burdick 
American Indians Into Psychology Program'. Such program shall, to the 
maximum extent feasible, coordinate with the Quentin N. Burdick Indian 
Health Programs authorized under section 117(b), the Quentin N. Burdick 
American Indians Into Nursing Program authorized under section 115(e), 
and existing university research and communications networks.
    ``(c)(1) The Secretary shall issue regulations pursuant to this Act 
for the competitive awarding of funds provided under this section.
    ``(2) Applicants 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 accredited and accessible community colleges 
        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 stipends to undergraduate and graduate 
        students to pursue a career in psychology;
            ``(D) develops affiliation agreements with tribal community 
        colleges, the Service, university affiliated programs, and 
        other appropriate accredited and accessible entities to enhance 
        the education of Indian students;
            ``(E) to the maximum extent feasible, uses existing 
        university tutoring, counseling, and student support services; 
        and
            ``(F) to the maximum extent feasible, employs qualified 
        Indians in the program.
    ``(d) The active duty service obligation prescribed under section 
338C of the Public Health Service Act (42 U.S.C. 254m) shall be met by 
each graduate who receives a stipend described in subsection (c)(2)(D) 
that is funded under this section. Such obligation shall be met by 
service--
            ``(1) in the Indian Health Service;
            ``(2) in a program conducted under a funding agreement 
        entered into under the Indian Self-Determination and Education 
        Assistance Act;
            ``(3) in a program assisted under title V of this Act; or
            ``(4) in the private practice of psychology if, as 
        determined by the Secretary, in accordance with guidelines 
        promulgated by the Secretary, such practice is situated in a 
        physician or other health professional shortage area and 
        addresses the health care needs of a substantial number of 
        Indians.

``SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS.

    ``(a) Any individual who receives a scholarship pursuant to section 
105 shall be given preference for employment in the Service, or may be 
employed by a program of an Indian tribe, tribal organization, or urban 
Indian organization, or other agencies of the Department as available, 
during any nonacademic period of the year. Periods of employment 
pursuant to this subsection shall not be counted in determining 
fulfillment of the service obligation incurred as a condition of the 
scholarship grant.
    ``(b) Any individual enrolled in a course of study in the health 
professions may be employed by the Service or by an Indian tribe, 
tribal organization, or urban Indian organization during any 
nonacademic period of the year. Any such employment shall not exceed 
120 days during any calendar year.
    ``(c) Any individual in a high school program authorized under 
section 103(a) may be employed by the Service or by an Indian tribe, or 
tribal organization or urban Indian organization during any nonacademic 
period of the year, not to exceed 120 days during a calendar year.
    ``(d) Any employment pursuant to this section shall be made without 
regard to any competitive personnel system or agency personnel 
limitation and to a position which will enable the individual so 
employed to receive practical experience in the health profession in 
which he or she is engaged in study. Any individual so employed shall 
receive payment for his or her services comparable to the salary he or 
she would receive if he or she were employed in the competitive system. 
Any individual so employed shall not be counted against any employment 
ceiling affecting the Service or the Department.

``SEC. 108. CONTINUING EDUCATION ALLOWANCES.

    ``In order to encourage health professionals, including for 
purposes of this section, community health representatives and 
emergency medical technicians, to join or continue in the Service or 
program of an Indian tribe, tribal organization, or urban Indian 
organization and to provide their services in the rural and remote 
areas where a significant portion of the Indian people reside, the 
Secretary, subject to section 102, acting through the service area, may 
provide allowances to health professionals employed in the Service or 
program of an Indian tribe, tribal organization, or urban Indian 
organization to enable them for a period of time each year prescribed 
by regulation of the Secretary to take leave of their duty stations for 
professional consultation and refresher training courses.

``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.

    ``(a) Under the authority of the Act of November 2, 1921 (25 U.S.C. 
13), popularly known as the Snyder Act, the Secretary shall maintain a 
Community Health Representative Program under which the Service, Indian 
tribes, and tribal organizations--
            ``(1) provide for the training of Indians as community 
        health representatives; and
            ``(2) use such community health representatives in the 
        provision of health care, health promotion, and disease 
        prevention services to Indian communities.
    ``(b) The Secretary, acting through the Community Health 
Representative Program of the Service, shall--
            ``(1) provide a high standard of training for community 
        health representatives to ensure that the community health 
        representatives provide quality health care, health promotion, 
        and disease prevention services to the Indian communities 
        served by such Program;
            ``(2) in order to provide such training, develop and 
        maintain a curriculum that--
                    ``(A) combines education in the theory of health 
                care with supervised practical experience in the 
                provision of health care; and
                    ``(B) provides instruction and practical experience 
                in health promotion and disease prevention activities, 
                with appropriate consideration given to lifestyle 
                factors that have an impact on Indian health status, 
                such as alcoholism, family dysfunction, and poverty;
            ``(3) maintain a system which identifies the needs of 
        community health representatives for continuing education in 
        health care, health promotion, and disease prevention and 
        develop programs that meet the needs for continuing education;
            ``(4) maintain a system that provides close supervision of 
        Community Health Representatives;
            ``(5) maintain a system under which the work of the 
        Community Health Representatives is reviewed and evaluated; and
            ``(6) promote traditional health care practices of the 
        Indian tribes served consistent with the Service standards for 
        the provision of health care, health promotion, and disease 
        prevention.

``SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM.

    ``(a)(1) Subject to section 102, the Secretary shall establish a 
program to be known as the Indian Health Service Loan Repayment Program 
(hereinafter referred to as the `Loan Repayment Program') in order to 
ensure an adequate supply of trained health professionals necessary to 
maintain accreditation of, and provide health care services to Indians 
through, Indian health programs.
    ``(2) For the purposes of this section the term `State' has the 
same meaning given such term in section 331(i)(4) of the Public Health 
Service Act.
    ``(b) To be eligible to participate in the Loan Repayment Program, 
an individual must--
            ``(1)(A) be enrolled--
                    ``(i) in a course of study or program in an 
                accredited institution, as determined by the Secretary, 
                within any State and be scheduled to complete such 
                course of study in the same year such individual 
                applies to participate in such program; or
                    ``(ii) in an approved graduate training program in 
                a health profession; or
            ``(B) have--
                    ``(i) a degree in a health profession; and
                    ``(ii) a license to practice a health profession;
            ``(2)(A) be eligible for, or hold, an appointment as a 
        commissioned officer in the Regular or Reserve Corps of the 
        Public Health Service;
            ``(B) be eligible for selection for civilian service in the 
        Regular or Reserve Corps of the Public Health Service;
            ``(C) meet the professional standards for civil service 
        employment in the Indian Health Service; or
            ``(D) be employed in an Indian health program without a 
        service obligation; and
            ``(3) submit to the Secretary an application for a contract 
        described in subsection (f).
    ``(c)(1) In disseminating application forms and contract forms to 
individuals desiring to participate in the Loan Repayment Program, the 
Secretary shall include with such forms a fair summary of the rights 
and liabilities of an individual whose application is approved (and 
whose contract is accepted) by the Secretary, including in the summary 
a clear explanation of the damages to which the United States is 
entitled under subsection (l) in the case of the individual's breach of 
contract. The Secretary shall provide such individuals with sufficient 
information regarding the advantages and disadvantages of service as a 
commissioned officer in the Regular or Reserve Corps of the Public 
Health Service or a civilian employee of the Indian Health Service to 
enable the individual to make a decision on an informed basis.
    ``(2) The application form, contract form, and all other 
information furnished by the Secretary under this section shall be 
written in a manner calculated to be understood by the average 
individual applying to participate in the Loan Repayment Program.
    ``(3) The Secretary shall make such application forms, contract 
forms, and other information available to individuals desiring to 
participate in the Loan Repayment Program on a date sufficiently early 
to ensure that such individuals have adequate time to carefully review 
and evaluate such forms and information.
    ``(d)(1) Consistent with section 102 and subsection (k), the 
Secretary shall annually--
            ``(A) identify the positions in each Indian health program 
        for which there is a need or a vacancy; and
            ``(B) rank those positions in order of priority.
    ``(2) Consistent with the priority determined under paragraph (1), 
the Secretary, in determining which applications under the Loan 
Repayment Program to approve (and which contracts to accept), shall 
give priority to applications made by--
            ``(A) Indians; and
            ``(B) individuals recruited through the efforts of an 
        Indian tribe, tribal organization, or urban Indian 
        organization.
    ``(e)(1) An individual becomes a participant in the Loan Repayment 
Program only upon the Secretary and the individual entering into a 
written contract described in subsection (f).
    ``(2) The Secretary shall provide written notice to an individual 
within 21 days on--
            ``(A) the Secretary's approving, under paragraph (1), of 
        the individual's participation in the Loan Repayment Program, 
        including extensions resulting in an aggregate period of 
        obligated service in excess of 4 years; or
            ``(B) the Secretary's disapproving an individual's 
        participation in such Program.
    ``(f) The written contract referred to in this section between the 
Secretary and an individual shall contain--
            ``(1) an agreement under which--
                    ``(A) subject to paragraph (3), the Secretary 
                agrees--
                            ``(i) to pay loans on behalf of the 
                        individual in accordance with the provisions of 
                        this section; and
                            ``(ii) to accept (subject to the 
                        availability of appropriated funds for carrying 
                        out this section) the individual into the 
                        Service or place the individual with a tribe, 
                        tribal organization, or urban Indian 
                        organization as provided in subparagraph 
                        (B)(iii); and
                    ``(B) subject to paragraph (3), the individual 
                agrees--
                            ``(i) to accept loan payments on behalf of 
                        the individual;
                            ``(ii) in the case of an individual 
                        described in subsection (b)(1)--
                                    ``(I) to maintain enrollment in a 
                                course of study or training described 
                                in subsection (b)(1)(A) until the 
                                individual completes the course of 
                                study or training, and
                                    ``(II) while enrolled in such 
                                course of study or training, to 
                                maintain an acceptable level of 
                                academic standing (as determined under 
                                regulations of the Secretary by the 
                                educational institution offering such 
                                course of study or training); and
                            ``(iii) to serve for a time period 
                        (hereinafter in this section referred to as the 
                        `period of obligated service') equal to 2 years 
                        or such longer period as the individual may 
                        agree to serve in the full-time clinical 
                        practice of such individual's profession in an 
                        Indian health program to which the individual 
                        may be assigned by the Secretary;
            ``(2) a provision permitting the Secretary to extend for 
        such longer additional periods, as the individual may agree to, 
        the period of obligated service agreed to by the individual 
        under paragraph (1)(B)(iii);
            ``(3) a provision that any financial obligation of the 
        United States arising out of a contract entered into under this 
        section and any obligation of the individual which is 
        conditioned thereon is contingent upon funds being appropriated 
        for loan repayments under this section;
            ``(4) a statement of the damages to which the United States 
        is entitled under subsection (l) for the individual's breach of 
        the contract; and
            ``(5) such other statements of the rights and liabilities 
        of the Secretary and of the individual, not inconsistent with 
        this section.
    ``(g)(1) A loan repayment provided for an individual under a 
written contract under the Loan Repayment Program shall consist of 
payment, in accordance with paragraph (2), on behalf of the individual 
of the principal, interest, and related expenses on government and 
commercial loans received by the individual regarding the undergraduate 
or graduate education of the individual (or both), which loans were 
made for--
            ``(A) tuition expenses;
            ``(B) all other reasonable educational expenses, including 
        fees, books, and laboratory expenses, incurred by the 
        individual; and
            ``(C) reasonable living expenses as determined by the 
        Secretary.
    ``(2)(A) For each year of obligated service that an individual 
contracts to serve under subsection (f) the Secretary may pay up to 
$35,000 or an amount equal to the amount specified in section 
338B(g)(2)(A) of the Public Health Service Act, whichever is more, on 
behalf of the individual for loans described in paragraph (1). In 
making a determination of the amount to pay for a year of such service 
by an individual, the Secretary shall consider the extent to which each 
such determination--
            ``(i) affects the ability of the Secretary to maximize the 
        number of contracts that can be provided under the Loan 
        Repayment Program from the amounts appropriated for such 
        contracts;
            ``(ii) provides an incentive to serve in Indian health 
        programs with the greatest shortages of health professionals; 
        and
            ``(iii) provides an incentive with respect to the health 
        professional involved remaining in an Indian health program 
        with such a health professional shortage, and continuing to 
        provide primary health services, after the completion of the 
        period of obligated service under the Loan Repayment Program.
    ``(B) Any arrangement made by the Secretary for the making of loan 
repayments in accordance with this subsection shall provide that any 
repayments for a year of obligated service shall be made no later than 
the end of the fiscal year in which the individual completes such year 
of service.
    ``(3) The Secretary may enter into an agreement with the holder of 
any loan for which payments are made under the Loan Repayment Program 
to establish a schedule for the making of such payments.
    ``(h) Notwithstanding any other provision of law, individuals who 
have entered into written contracts with the Secretary under this 
section, while undergoing academic training, shall not be counted 
against any employment ceiling affecting the Department.
    ``(i) The Secretary shall conduct recruiting programs for the Loan 
Repayment Program and other Service manpower programs of the Service at 
educational institutions training health professionals or specialists 
identified in subsection (a).
    ``(j) Section 214 of the Public Health Service Act (42 U.S.C. 215) 
shall not apply to individuals during their period of obligated service 
under the Loan Repayment Program.
    ``(k) The Secretary, in assigning individuals to serve in Indian 
health programs pursuant to contracts entered into under this section, 
shall--
            ``(1) ensure that the staffing needs of Indian health 
        programs administered by an Indian tribe or tribal organization 
        receive consideration on an equal basis with programs that are 
        administered directly by the Service; and
            ``(2) give priority to assigning individuals to Indian 
        health programs that have a need for health professionals to 
        provide health care services as a result of individuals having 
        breached contracts entered into under this section.
    ``(l)(1) An individual who has entered into a written contract with 
the Secretary under this section and who--
            (A) is enrolled in the final year of a course of study and 
        who--
                    ``(i) fails to maintain an acceptable level of 
                academic standing in the educational institution in 
                which he is enrolled (such level determined by the 
                educational institution under regulations of the 
                Secretary);
                    ``(ii) voluntarily terminates such enrollment; or
                    ``(iii) is dismissed from such educational 
                institution before completion of such course of study; 
                or
            ``(B) is enrolled in a graduate training program, fails to 
        complete such training program, and does not receive a waiver 
        from the Secretary under subsection (b)(1)(B)(ii),
shall be liable, in lieu of any service obligation arising under such 
contract, to the United States for the amount which has been paid on 
such individual's behalf under the contract.
    ``(2) If, for any reason not specified in paragraph (1), an 
individual breaches his written contract under this section by failing 
either to begin, or complete, such individual's period of obligated 
service in accordance with subsection (f), the United States shall be 
entitled to recover from such individual an amount to be determined in 
accordance with the following formula:


                             ``A=3Z(t-s/t)

in which--
            ``(A) `A' is the amount the United States is entitled to 
        recover;
            ``(B) `Z' is the sum of the amounts paid under this section 
        to, or on behalf of, the individual and the interest on such 
        amounts which would be payable if, at the time the amounts were 
        paid, they were loans bearing interest at the maximum legal 
        prevailing rate, as determined by the Secretary of the 
        Treasury;
            ``(C) `t' is the total number of months in the individual's 
        period of obligated service in accordance with subsection (f); 
        and
            ``(D) `s' is the number of months of such period served by 
        such individual in accordance with this section.
Amounts not paid within such period shall be subject to collection 
through deductions in medicare payments pursuant to section 1892 of the 
Social Security Act.
    ``(3)(A) Any amount of damages which the United States is entitled 
to recover under this subsection shall be paid to the United States 
within the 1-year period beginning on the date of the breach or such 
longer period beginning on such date as shall be specified by the 
Secretary.
    ``(B) If damages described in subparagraph (A) are delinquent for 3 
months, the Secretary shall, for the purpose of recovering such 
damages--
            ``(i) use collection agencies contracted with by the 
        Administrator of General Services; or
            ``(ii) enter into contracts for the recovery of such 
        damages with collection agencies selected by the Secretary.
    ``(C) Each contract for recovering damages pursuant to this 
subsection shall provide that the contractor will, not less than once 
each 6 months, submit to the Secretary a status report on the success 
of the contractor in collecting such damages. Section 3718 of title 31, 
United States Code, shall apply to any such contract to the extent not 
inconsistent with this subsection.
    ``(m)(1) Any obligation of an individual under the Loan Repayment 
Program for service or payment of damages shall be canceled upon the 
death of the individual.
    ``(2) The Secretary shall by regulation provide for the partial or 
total waiver or suspension of any obligation of service or payment by 
an individual under the Loan Repayment Program whenever compliance by 
the individual is impossible or would involve extreme hardship to the 
individual and if enforcement of such obligation with respect to any 
individual would be unconscionable.
    ``(3) The Secretary may waive, in whole or in part, the rights of 
the United States to recover amounts under this section in any case of 
extreme hardship or other good cause shown, as determined by the 
Secretary.
    ``(4) Any obligation of an individual under the Loan Repayment 
Program for payment of damages may be released by a discharge in 
bankruptcy under title 11 of the United States Code only if such 
discharge is granted after the expiration of the 5-year period 
beginning on the first date that payment of such damages is required, 
and only if the bankruptcy court finds that nondischarge of the 
obligation would be unconscionable.
    ``(n) The Secretary shall submit to the President, for inclusion in 
each report required to be submitted to the Congress under section 801, 
a report concerning the previous fiscal year which sets forth by 
service area--
            ``(1) the health professional positions maintained by the 
        Service or by tribal or Indian organizations for which 
        recruitment or retention is difficult;
            ``(2) the number of Loan Repayment Program applications 
        filed with respect to each type of health profession;
            ``(3) the number of contracts described in subsection (f) 
        that are entered into with respect to each health profession;
            ``(4) the amount of loan payments made under this section, 
        in total and by health profession;
            ``(5) the number of scholarships that are provided under 
        section 105 with respect to each health profession;
            ``(6) the amount of scholarship grants provided under 
        section 105, in total and by health profession;
            ``(7) the number of providers of health care that will be 
        needed by Indian health programs, by location and profession, 
        during the 3 fiscal years beginning after the date the report 
        is filed; and
            ``(8) the measures the Secretary plans to take to fill the 
        health professional positions maintained by the Service or by 
        tribes or tribal organizations, or urban Indian organization 
        for which recruitment or retention is difficult.

``SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND.

    ``(a) Notwithstanding section 102 of this title, there is 
established in the Treasury of the United States a fund to be known as 
the Indian Health Scholarship and Loan Repayment Recovery Fund 
(hereafter in this section referred to as the `LRRF'). The LRRF shall 
consist of such amounts as may be collected from individuals under 
sections 105(b)(4)(A) and (B) and 110(1) for breach of contract, such 
funds as may be appropriated to the LRRF, and such interest earned on 
amounts in the LRRF, and all amounts collected, appropriated, or earned 
relative to the LRRF shall remain available until expended.
    ``(b)(1) Amounts in the LRRF may be expended by the Secretary, 
subject to the provisions of section 102, to make payments to the 
Service or to an Indian tribe or tribal organization administering a 
health care program pursuant to a funding agreement entered into under 
the Indian Self-Determination and Education Assistance Act--
            ``(A) to which a scholarship recipient under section 105 or 
        a loan repayment program participant under section 110 has been 
        assigned to meet the obligated service requirements pursuant to 
        such sections; and
            ``(B) that has a need for a health professional to provide 
        health care services as a result of such recipient or 
        participant having breached the contract entered into under 
        section 105 or section 110.
    ``(2) 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)(1) The Secretary of the Treasury shall invest such amounts of 
the LRRF as the Secretary determines are not required to meet current 
withdrawals from the LRRF. Such investments may be made only in 
interest-bearing obligations of the United States. For such purpose, 
such obligations may be acquired on original issue at the issue price, 
or by purchase of outstanding obligations at the market price.
    ``(2) Any obligation acquired by the LRRF may be sold by the 
Secretary of the Treasury at the market price.

``SEC. 112. RECRUITMENT ACTIVITIES.

    ``(a) The Secretary may reimburse health professionals seeking 
positions with the Service, Indian tribes, tribal organizations, or 
urban Indian organizations, including unpaid student volunteers and 
individuals considering entering into a contract under section 110, and 
their spouses, for actual and reasonable expenses incurred in traveling 
to and from their places of residence to an area in which they may be 
assigned for the purpose of evaluating such area with respect to such 
assignment.
    ``(b) The Secretary shall assign one individual in each Area Office 
to be responsible on a full-time basis for recruitment activities.

``SEC. 113. TRIBAL RECRUITMENT AND RETENTION PROGRAM.

    ``(a) Subject to section 102, the Secretary shall fund innovative 
demonstration projects for a period not to exceed 3 years to enable 
Indian tribes, tribal organizations, and urban Indian organizations to 
recruit, place, and retain health professionals to meet the staffing 
needs of Indian health programs (as defined in section 110(a)(2)(A)).
    ``(b) Any Indian tribe, tribal organization, or urban Indian 
organization may submit an application for funding of a project 
pursuant to this section.

``SEC. 114. ADVANCED TRAINING AND RESEARCH.

    ``(a) The Secretary shall establish a demonstration project to 
enable health professionals who have worked in an Indian health program 
(as defined in section 110 for a substantial period of time to pursue 
advanced training or research areas of study for which the Secretary 
determines a need exists.
    ``(b) An individual who participates in a program under subsection 
(a), where the educational costs are borne by the Service, shall incur 
an obligation to serve in an Indian health program 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 2000, the United States shall be entitled 
to recover from such individual an amount to be determined in 
accordance with the formula specified in subsection (l) of section 110 
in the manner provided for in such subsection.
    ``(c) Health professionals from Indian tribes and tribal 
organizations under the authority of the Indian Self-Determination and 
Education Assistance Act, and urban Indian organizations shall be given 
an equal opportunity to participate in the program under subsection 
(a).

``SEC. 115. QUENTIN B. BURDICK AMERICAN INDIANS INTO NURSING PROGRAM.

    ``(a) Notwithstanding section 102, the Secretary shall provide 
grants to--
            ``(1) public or private schools of nursing,
            ``(2) tribally controlled community colleges and tribally 
        controlled postsecondary vocational institutions (as defined in 
        section 390(2) of the Tribally Controlled Vocational 
        Institutions Support Act of 1990 (20 U.S.C. 2397h(2)), and
            ``(3) nurse midwife programs, and advance practice nurse 
        programs, that are provided by any tribal college accredited 
        nursing program, in the absence of such, any other public or 
        private institutions,
for the purpose of increasing the number of nurses, nurse midwives, and 
nurse practitioners who deliver health care services to Indians.
    ``(b) Grants provided under subsection (a) may be used to--
            ``(1) recruit individuals for programs which train 
        individuals to be nurses, nurse midwives, or advanced practice 
        nurses,
            ``(2) provide scholarships to Indian 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 advanced practice nurses 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 
        advanced practice nurses, or
            ``(5) provide any program that is designed to achieve the 
        purpose described in subsection (a).
    ``(c) 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) In providing grants under subsection (a), the Secretary shall 
extend a preference to--
            ``(1) programs that provide a preference to Indians,
            ``(2) programs that train nurse midwives or advanced 
        practice nurses,
            ``(3) programs that are interdisciplinary, and
            ``(4) programs that are conducted in cooperation with a 
        center for gifted and talented Indian students established 
        under section 5324(a) of the Indian Education Act of 1988.
    ``(e) The Secretary shall provide one of the grants authorized 
under subsection (a) to establish and maintain a program at the 
University of North Dakota to be known as the `Quentin N. Burdick 
American Indians Into Nursing Program'. Such program shall, to the 
maximum extent feasible, coordinate with the Quentin N. Burdick Indian 
Health Programs established under section 117(b) and the Quentin N. 
Burdick American Indians Into Psychology Program established under 
section 106(b).
    ``(f) The active duty service obligation prescribed under section 
338C of the Public Health Service Act (42 U.S.C. 254m) shall be met by 
each individual who receives training or assistance described in 
paragraph (1) or (2) of subsection (b) that is funded by a grant 
provided under subsection (a). Such obligation shall be met by 
service--
            ``(A) in the Indian Health Service;
            ``(B) in a program conducted under a contract entered into 
        under the Indian Self-Determination Act;
            ``(C) in a program assisted under title V of this Act; or
            ``(D) in the private practice of nursing if, as determined 
        by the Secretary, in accordance with guidelines promulgated by 
        the Secretary, such practice is situated in a physician or 
        other health professional shortage area and addresses the 
        health care needs of a substantial number of Indians.

``SEC. 116. TRIBAL CULTURAL ORIENTATION.

    ``(a) The Secretary, pursuant to the requirements of section 102, 
shall require that appropriate employees of the Service who serve 
Indian tribes in each service area receive educational instruction in 
the history and culture of such Tribes and their relationship to the 
Service.
    ``(b) To the extent feasible, the program established under 
subsection (a) shall--
            ``(1) be developed in consultation with the affected tribal 
        governments, tribal organizations, and urban Indian 
        organizations,
            ``(2) be carried out through tribally controlled community 
        colleges (within the meaning of section 2(4) of the Tribally 
        Controlled Community College Assistance Act of 1978) and 
        tribally controlled postsecondary vocational institutions (as 
        defined in section 390(2) of the Tribally Controlled Vocational 
        Institutions Support Act of 1990 (20 U.S.C. 2397h(2)),
            ``(3) include instruction in American Indian studies, and
            ``(4) the use and place of traditional health care 
        practices in the tribe.

``SEC. 117. INMED PROGRAM.

    ``(a) The Secretary is authorized to provide grants to colleges and 
universities for the purpose of maintaining and expanding the Native 
American health careers recruitment program known as the `Indians into 
Medicine Program' (hereinafter in this section referred to as `INMED') 
as a means of encouraging Indians to enter the health professions.
    ``(b) The Secretary shall provide one of the grants authorized 
under subsection (a) to maintain the INMED program at the University of 
North Dakota, to be known as the `Quentin N. Burdick Indian Health 
Programs', unless the Secretary makes a determination, based upon 
program reviews, that the program is not meeting the purposes of this 
section. Such program shall, to the maximum extent feasible, coordinate 
with the Quentin N. Burdick American Indians Into Psychology Program 
established under section 106(b) and the Quentin N. Burdick American 
Indians Into Nursing Program established under section 115.
    ``(c)(1) The Secretary, pursuant to this Act, shall develop 
regulations to govern grants pursuant to this section.
    ``(2) Applicants for grants provided under this section shall agree 
to provide a program which--
            ``(A) provides outreach and recruitment for health 
        professions to Indian communities including elementary, 
        secondary, and community colleges located on Indian 
        reservations which will be served by the program,
            ``(B) incorporates a program advisory board comprised of 
        representatives from the tribes and communities which will be 
        served by the program,
            ``(C) provides summer preparatory programs for Indian 
        students who need enrichment in the subjects of math and 
        science in order to pursue training in the health professions,
            ``(D) provides tutoring, counseling, and support to 
        students who are enrolled in a health career program of study 
        at the respective college or university, and
            ``(E) to the maximum extent feasible, employs qualified 
        Indians in the program.

``SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY COLLEGES.

    ``(a)(1) Subject to the requirements of section 102, the Secretary 
shall award grants to accredited and accessible community colleges for 
the purpose of assisting such community colleges in the establishment 
of programs which provide education in a health profession leading to a 
degree or diploma in a health profession for individuals who desire to 
practice such profession on an Indian reservation, in the Service, or 
in a tribal health program.
    ``(2) The amount of any grant awarded to a community college under 
paragraph (1) for the first year in which such a grant is provided to 
the community college shall not exceed $100,000.
    ``(b)(1) The Secretary shall award grants to accredited and 
accessible community colleges that have established a program described 
in subsection (a)(1) for the purpose of maintaining the program and 
recruiting students for the program.
    ``(2) Grants may only be made under this section to a community 
college which--
            ``(A) is accredited,
            ``(B) has a relationship with a hospital facility, Service 
        facility, or hospital that could provide training of nurses or 
        health professionals,
            ``(C) has entered into an agreement with an accredited 
        college or university medical school, the terms of which--
                    ``(i) provide a program that enhances the 
                transition and recruitment of students into advanced 
                baccalaureate or graduate programs which train health 
                professionals, and
                    ``(ii) stipulate certifications necessary to 
                approve internship and field placement opportunities at 
                health programs of the Service or tribal health 
                programs,
            ``(D) has a qualified staff which has the appropriate 
        certifications,
            ``(E) is capable of obtaining State or regional 
        accreditation of the program described in subsection (a)(1), 
        and
            ``(F) agrees to provide for Indian preference for 
        applicants for programs under this section.
    ``(c) The Secretary shall encourage community colleges described in 
subsection (b)(2) to establish and maintain programs described in 
subsection (a)(1) by--
            ``(1) entering into agreements with such colleges for the 
        provision of qualified personnel of the Service to teach 
        courses of study in such programs, and
            ``(2) providing technical assistance and support to such 
        colleges.
    ``(d) Any program receiving assistance under this section that is 
conducted with respect to a health profession shall also offer courses 
of study which provide advanced training for any health professional 
who--
            ``(1) has already received a degree or diploma in such 
        health profession, and
            ``(2) provides clinical services on an Indian reservation, 
        at a Service facility, or at a tribal clinic.
Such courses of study may be offered in conjunction with the college or 
university with which the community college has entered into the 
agreement required under subsection (b)(2)(C).
    ``(e) For purposes of this section:
            ``(1) The term `community college' means--
                    ``(A) a tribally controlled college, or
                    ``(B) a junior or community college.
            ``(2) The term `tribally controlled college' has the 
        meaning given to `tribally controlled community college' by 
section 2(4) of the Tribally Controlled Community College Assistance 
Act of 1978.
            ``(3) The term `junior or community college' has the 
        meaning given to such term by section 312(e) of the Higher 
        Education Act of 1965 (20 U.S.C. 1058(e)).
            ``(4) Where the requirements of subsection (b) are met, 
        funding priority shall be provided to tribally controlled 
        colleges in service areas where they exist.

``SEC. 119. RETENTION BONUS.

    ``(a) The Secretary may pay a retention bonus to any health 
professional employed by, or assigned to, and serving in, the Service 
and Indian tribes, tribal organizations, or urban Indian organizations 
either as a civilian employee or as a commissioned officer in the 
Regular or Reserve Corps of the Public Health Service who--
            ``(1) is assigned to, and serving in, a position for which 
        recruitment or retention of personnel is difficult,
            ``(2) the Secretary determines is needed by the Service, 
        tribes, tribal organizations, and urban Indian organizations,
            ``(3) has--
                    ``(A) completed 3 years of employment with the 
                Service, or Indian tribe, or tribal organization, or 
                urban Indian organization, or
                    ``(B) completed any service obligations incurred as 
                a requirement of--
                            ``(i) any Federal scholarship program, or
                            ``(ii) any Federal education loan repayment 
                        program, and
            ``(4) enters into an agreement with the Service, or Indian 
        tribe, or tribal organization, or urban Indian organization for 
        continued employment for a period of not less than 1 year.
    ``(b) The Secretary may establish rates for the retention bonus 
which shall provide for a higher annual rate for multiyear agreements 
than for single year agreements referred to in subsection (a)(4), but 
in no event shall the annual rate be more than $25,000 per annum.
    ``(c) Any health professional failing to complete the agreed upon 
term of service, except where such failure is through no fault of the 
individual, shall be obligated to refund to the Government the full 
amount of the retention bonus for the period covered by the agreement, 
plus interest as determined by the Secretary in accordance with section 
110(l)(2)(B).
    ``(d) The Secretary may pay a retention bonus to any health 
professional employed by an organization providing health care services 
to Indians pursuant to a funding agreement under the Indian Self-
Determination and Education Assistance Act if such health professional 
is serving in a position which the Secretary determines is--
            ``(1) a position for which recruitment or retention is 
        difficult; and
            ``(2) necessary for providing health care services to 
        Indians.

``SEC. 120. NURSING RESIDENCY PROGRAM.

    ``(a) The Secretary shall establish a program to enable Indians who 
are licensed practical nurses, licensed vocational nurses, and 
registered nurses who are working in an Indian health program (as 
defined in section 110(a)(2)(A)), and have done so for a period of not 
less than one year, to pursue advanced training.
    ``(b) Such program shall include a combination of education and 
work study in an Indian health program (as defined in section 
110(a)(2)(A)) leading to an associate or bachelor's degree (in the case 
of a licensed practical nurse or licensed vocational nurse) or a 
bachelor's degree (in the case of a registered nurse), or advanced 
degrees in nursing and public health.
    ``(c) An individual who participates in a program under subsection 
(a), where the educational costs are paid by the Service, shall incur 
an obligation to serve in an Indian health program for a period of 
obligated service equal to the amount of time during which the 
individual participates in such program. In the event that the 
individual fails to complete such obligated service, the United States 
shall be entitled to recover from such individual an amount determined 
in accordance with the formula specified in subsection (l) of section 
110 in the manner provided for in such subsection.

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

    ``(a) Under the authority of the Act of November 2, 1921 (25 U.S.C. 
13; popularly known as the Snyder Act), the Secretary shall maintain a 
Community Health Aide Program in Alaska under which the Service--
            ``(1) provides for the training of Alaska Natives as health 
        aides or community health practitioners;
            ``(2) uses such aides or practitioners in the provision of 
        health care, health promotion, and disease prevention services 
        to Alaska Natives living in villages in rural Alaska; and
            ``(3) provides for the establishment of teleconferencing 
        capacity in health clinics located in or near such villages for 
        use by community health aides or community health 
        practitioners.
    ``(b) The Secretary, acting through the Community Health Aide 
Program of the Service, shall--
            ``(1) using trainers accredited by the Program, provide a 
        high standard of training to community health aides and 
        community health practitioners to ensure that such aides and 
        practitioners provide quality health care, health promotion, 
        and disease prevention services to the villages served by the 
        Program;
            ``(2) in order to provide such training, develop a 
        curriculum that--
                    ``(A) combines education in the theory of health 
                care with supervised practical experience in the 
                provision of health care;
                    ``(B) provides instruction and practical experience 
                in the provision of acute care, emergency care, health 
                promotion, disease prevention, and the efficient and 
                effective management of clinic pharmacies, supplies, 
                equipment, and facilities; and
                    ``(C) promotes the achievement of the health status 
                objectives specified in section 3(b);
            ``(3) establish and maintain a Community Health Aide 
        Certification Board to certify as community health aides or 
        community health practitioners individuals who have 
        successfully completed the training described in paragraph (1) 
        or can demonstrate equivalent experience;
            ``(4) develop and maintain a system which identifies the 
        needs of community health aides and community health 
        practitioners for continuing education in the provision of 
        health care, including the areas described in paragraph (2)(B), 
        and develop programs that meet the needs for such continuing 
        education;
            ``(5) develop and maintain a system that provides close 
        supervision of community health aides and community health 
        practitioners; and
            ``(6) develop a system under which the work of community 
        health aides and community health practitioners is reviewed and 
        evaluated to assure the provision of quality health care, 
        health promotion, and disease prevention services.
    ``(c) Subject to section 102, the Secretary shall develop and 
operate a National Community Health Aide Program based on the elements 
contained in this section.

``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.

    ``Subject to section 102, the Secretary shall, by funding agreement 
or otherwise, provide training for Indians in the administration and 
planning of tribal health programs.

``SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION PROJECT.

    ``(a) Subject to section 102, the Secretary may fund pilot programs 
for tribes and tribal organizations to address the chronic shortages of 
health professionals.
    ``(b) The purposes of the health profession demonstration program 
established herein are--
            ``(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 Indian people by identifying and 
        using all academic and scholarly resources of the region.
    ``(c) The demonstration programs established pursuant to subsection 
(a) shall incorporate a program advisory board composed of 
representatives from the tribes and communities in the area which will 
be served by the program.

``SEC. 124. TREATMENT OF SCHOLARSHIPS FOR CERTAIN PURPOSES.

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

``SEC. 125. NATIONAL HEALTH SERVICE CORPS.

    ``(a) The Secretary shall not--
            ``(1) remove a member of the National Health Service Corps 
        from a health program operated by the Indian Health Service or 
        by a tribe or tribal organization under funding agreement with 
        the Service under the Indian Self-Determination and Education 
        Assistance Act, or by urban Indian organizations, or
            ``(2) withdraw funding used to support such member,
unless the Secretary, acting through the Service, tribes, or tribal 
organizations, has ensured that the Indians receiving services from 
such member will experience no reduction in services.
    ``(b) All service areas served by programs operated by the Service 
or by tribes or tribal organizations under the Indian Self-
Determination and Education Assistance Act or by urban Indian 
organizations shall be designated under 42 U.S.C. 254c(a) as Health 
Professional Shortage areas.
    ``(c) 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 health program operated by an Indian tribe or tribal 
organization under the Indian Self-Determination and Education 
Assistance Act or by urban Indian organizations.

``SEC. 126. SUBSTANCE ABUSE COUNSELOR EDUCATION DEMONSTRATION PROJECT.

    ``(a) The Secretary may enter into contracts with, or make grants 
to, accredited tribally controlled community colleges, tribally 
controlled postsecondary vocational institutions, and eligible 
accredited and accessible community colleges to establish demonstration 
projects to develop educational curricula for substance abuse 
counseling.
    ``(b) Funds provided under this section shall be used only for 
developing and providing educational curriculum for substance abuse 
counseling (including paying salaries for instructors). Such curricula 
may be provided through satellite campus programs.
    ``(c) A contract entered into or a grant provided under this 
section shall be for a period of one year. Such contract or grant may 
be renewed for an additional one-year period upon the approval of the 
Secretary.
    ``(d) Not later than 180 days after the date of the enactment of 
this section, the Secretary, after consultation with Indian tribes and 
administrators of accredited tribally controlled community colleges, 
tribally controlled postsecondary vocational institutions, and eligible 
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 projects established 
under this section promote the development of the capacity of such 
entities to educate substance abuse counselors.
    ``(e) The Secretary shall provide such technical and other 
assistance as may be necessary to enable grant recipients to comply 
with the provisions of this section.
    ``(f) The Secretary shall submit to the President, for inclusion in 
the report which is required to be submitted under section 801 for 
fiscal year 1999, a report on the findings and conclusions derived from 
the demonstration projects conducted under this section.
    ``(g) For the purposes of this section, the following definitions 
apply:
            ``(1) The term `educational curriculum' means one or more 
        of the following:
                    ``(A) Classroom education.
                    ``(B) Clinical work experience.
                    ``(C) Continuing education workshops.
            ``(2) The term `tribally controlled postsecondary 
        vocational institution' has the meaning given such term in 
        section 390(2) of the Tribally Controlled Vocational 
        Institutions Support Act of 1990 (20 U.S.C. 2397h(2)).

``SEC. 127. MENTAL HEALTH TRAINING AND COMMUNITY EDUCATION PROGRAMS.

    ``(a)(1) The Secretary 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.
    ``(2) The positions referred to in subsection (a) 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 within the Service; and
            ``(C) staff positions similar to those identified in 
        subsection (b) established and maintained by Indian tribes, 
        tribal organizations, and urban Indian organizations, including 
        positions established pursuant to funding agreements pursuant 
        to the Indian Self-Determination and Education Assistance Act, 
        and this Act.
    ``(3) The appropriate Secretary shall provide training criteria 
appropriate to each type of position identified in subsection (b)(1) 
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 a 
funding agreement, the appropriate Secretary shall ensure that such 
training costs are included in the funding agreement, if necessary.
    ``(4) 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.
    ``(5) The Service shall develop and implement, or on request of an 
Indian tribe or tribal organization, assist an Indian tribe or tribal 
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 or tribal organization, 
provide technical assistance to an Indian tribe or tribal organization 
to obtain and develop community educational materials on the 
identification, technical assistance to the Indian tribe or tribal 
organization to obtain or develop materials on the identification, 
prevention, referral, and treatment of mental illness, dysfunctional, 
and self-destructive behavior.
    ``(b)(1) Within 90 days after the date of the enactment of the 
Indian Health Care Improvement Act Amendments of 2000, 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 5 years after the date of enactment of this section, with at 
least 200 of such positions devoted to child, adolescent, and family 
services. The allocation of such positions shall be subject to the 
provisions of section 102(a).
    ``(2) The plan developed under paragraph (1) shall be implemented 
under the Act of November 2, 1921 (25 U.S.C. 13), popularly known as 
the Snyder Act.

``SEC. 128. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2012 to carry out 
this title.

                      ``TITLE II--HEALTH SERVICES

``SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.

    ``(a) The Secretary is authorized to expend funds, directly or 
under the authority of the Indian Self-Determination and Education 
Assistance Act, which are appropriated under the authority of this 
section, for the purpose of--
            ``(1) eliminating the deficiencies in health status and 
        resources of all Indian tribes,
            ``(2) eliminating backlogs in the provision of health care 
        services to Indians,
            ``(3) meeting the health needs of Indians in an efficient 
        and equitable manner,
            ``(4) eliminating inequities in funding for both direct 
        care and contract health service programs, and
            ``(5) augmenting the ability of the Service to meet the 
        following health service responsibilities, with respect to 
        those Indian tribes with the highest levels of health status 
        deficiencies and resource deficiencies:
                    ``(A) Clinical care, including, but not limited to, 
                inpatient care, outpatient care (including audiology, 
                clinical eye and vision care), primary care, secondary 
                and tertiary care, and long-term care.
                    ``(B) Preventive health, including mammography and 
                other cancer screening in accordance with section 207.
                    ``(C) Dental care.
                    ``(D) Mental Health, including community mental 
                health services, inpatient mental health services, 
                dormitory mental health services, therapeutic and 
                residential treatment centers, and training of 
                traditional health care practitioners.
                    ``(E) Emergency medical services.
                    ``(F) Treatment and control of, and rehabilitative 
                care related to, alcoholism and drug abuse (including 
                fetal alcohol syndrome) among Indians.
                    ``(G) Accident prevention programs.
                    ``(H) Home health care.
                    ``(I) Community health representatives.
                    ``(J) Maintenance and repair.
                    ``(K) Traditional health care practices.
    ``(b)(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), popularly known as the Snyder Act, or any other provision of law.
    ``(2)(A) Funds appropriated under the authority of this section 
shall be allocated to service units or Indian tribes or tribal 
organizations. The funds allocated to each Tribe, tribal organization, 
or service unit under this subparagraph shall be used by the Tribe, 
tribal organization, or service unit under this subparagraph to improve 
the health status and reduce the resource deficiency of each Tribe 
served by such service unit, Tribe, or tribal organization.
    ``(B) The apportionment of funds allocated to a service unit, 
Tribe, or tribal organization under subparagraph (A) among the health 
service responsibilities described in subsection (a)(4) shall be 
determined by the Service in consultation with, and with the active 
participation of, the affected Indian tribes in accordance with the 
provisions of this section and such rulemaking as is permitted under 
title VIII of this Act.
    ``(c) For purposes of this section:
            ``(1) The term `health status and resource deficiency' 
        means the extent to which--
                    ``(A) the health status objectives set forth in 
                section 3(b) are not being achieved; and
                    ``(B) the Indian tribe 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) The health resources available to an Indian tribe or 
        tribal organization include health resources provided by the 
        Service as well as health resources used by the Indian tribe or 
        tribal organization, including services and financing systems 
        provided by any Federal programs, private insurance, and 
        programs of State or local governments.
            ``(3) The Secretary shall establish procedures which allow 
        any Indian tribe or tribal organization to petition the 
        Secretary for a review of any determination of the extent of 
        the health status and resource deficiency of such Tribe or 
        tribal organization.
    ``(d) Programs administered by any Indian tribe or tribal 
organization under the authority of the Indian Self-Determination and 
Education Assistance 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.
    ``(e) By no later than the date that is 3 years after the date of 
enactment of the Indian Health Care Improvement Act of 2000, the 
Secretary shall submit to the Congress the current health status and 
resource deficiency report of the Service for each Indian tribe or 
service unit, including newly recognized or acknowledged Indian tribes. 
Such report shall set out--
            ``(1) the methodology then in use by the Service for 
        determining tribal health status and resource deficiencies, as 
        well as the most recent application of that methodology;
            ``(2) the extent of the health status and resource 
        deficiency of each Indian tribe served by the Service;
            ``(3) the amount of funds necessary to eliminate the health 
        status and resource deficiencies of all Indian tribes served by 
        the Service; and
            ``(4) an estimate of--
                    ``(A) the amount of health service funds 
                appropriated under the authority of this Act, or any 
                other Act, including the amount of any funds 
                transferred to the Service, for the preceding fiscal 
                year which is allocated to each service unit, Indian 
                tribe, or comparable entity;
                    ``(B) the number of Indians eligible for health 
                services in each service unit or Indian tribe or tribal 
                organization; and
                    ``(C) the number of Indians using the Service 
                resources made available to each service unit or Indian 
                tribe or tribal organization, and, to the extent 
                available, information on the waiting lists and number 
                of Indians turned away for services due to lack of 
                resources.
    ``(f) Funds appropriated under this section for any fiscal year 
shall be included in the base budget of the Service for the purpose of 
determining appropriations under this section in subsequent fiscal 
years.
    ``(g) Nothing in this section is intended to diminish the primary 
responsibility of the Service to eliminate existing backlogs in unmet 
health care needs, nor are the provisions of this section intended to 
discourage the Service from undertaking additional efforts to achieve 
equity among Indian tribes and tribal organizations.
    ``(h) Any funds appropriated under the authority of this section 
shall be designated as the `Indian Health Care Improvement Fund'.

``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.

    ``(a)(1) There is hereby established an Indian Catastrophic Health 
Emergency Fund (hereafter in this section referred to as the `CHEF') 
consisting of--
            ``(A) the amounts deposited under subsection (d), and
            ``(B) the amounts appropriated under subsection (e) to CHEF 
        under this section.
    ``(2) CHEF shall be administered by the Secretary, 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) CHEF shall be equitably allocated, apportioned, or delegated 
on a service unit or Area Office basis, based upon a formula developed 
in consultation with the Indian tribes and tribal organizations through 
negotiated rulemaking under title VIII of this Act, which formula shall 
take into account the added needs of service areas which are contract 
health-service dependent.
    ``(4) No part of CHEF or its administration shall be subject to 
contract or grant under any law, including the Indian Self-
Determination Act, and shall be administered by the Area Offices based 
upon priorities determined by the Indian tribes and tribal 
organizations within each Area including consideration of the needs of 
Indian tribes and tribal organizations which are contract health 
service-dependent.
    ``(b) The Secretary shall, through the negotiated rulemaking 
process under title VIII of this Act, promulgate regulations consistent 
with the provisions of this section--
            ``(1) establish a definition of disasters and catastrophic 
        illnesses for which the cost of the treatment provided under 
        contract would qualify for payment from the Fund;
            ``(2) provide that a service unit, Indian tribe, or tribal 
        organization shall not be eligible for reimbursement for the 
        cost of treatment from CHEF until its cost of treating any 
        victim of such catastrophic illness or disaster has reached a 
        certain threshold cost which the Secretary shall establish at--
                    ``(A) the 1999 level of $19,000; and
                    ``(B) for any subsequent year, not less than the 
                threshold cost of the previous year increased by the 
                percentage increase in the medical care expenditure 
                category of the consumer price index for all urban 
                consumers (United States city average) for the 12-month 
                period ending with December of the previous year; and
            ``(3) establish a procedure for the reimbursement of the 
        portion of the costs incurred by--
                    ``(A) service units, Indian tribes or tribal 
                organizations, 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 in cases 
        in which the exigencies of the medical circumstances warrant 
        treatment prior to the authorization of such treatment by the 
        Service; and
            ``(5) establish a procedure that will ensure that no 
        payment shall be made from CHEF to any provider of treatment to 
        the extent that such provider is eligible to receive payment 
        for the treatment from any other Federal, State, local, or 
        private source of reimbursement for which the patient is 
        eligible.
    ``(c) Amounts appropriated to CHEF under this section shall not be 
used to offset or limit appropriations made to the Service under the 
authority of the Act of November 2, 1921 (25 U.S.C. 13), popularly 
known as the Snyder Act, or any other law.
    ``(d) There shall be deposited into CHEF all reimbursements to 
which the Service is entitled from any Federal, State, local, or 
private source (including third-party insurance) by reason of treatment 
rendered to any victim of a disaster or catastrophic illness the cost 
of which was paid from CHEF.

``SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION SERVICES.

    ``(a) The Congress finds that health promotion and disease 
prevention activities will--
            ``(1) improve the health and well-being of Indians, and
            ``(2) reduce the expenses for health care of Indians.
    ``(b) The Secretary, acting through the Service, and through 
willing Indian tribes and tribal organizations, shall provide health 
promotion and disease prevention services to Indians so as to achieve 
the health status objectives set forth in section 3(b).
    ``(c) The Secretary, after obtaining input from the affected Indian 
tribes and tribal organizations, shall submit to the President for 
inclusion in each statement which is required to be submitted to the 
Congress under section 801 an evaluation of--
            ``(1) the health promotion and disease prevention needs of 
        Indians;
            ``(2) the health promotion and disease prevention 
        activities which would best meet such needs;
            ``(3) the internal capacity of the Service to meet such 
        needs; and
            ``(4) the resources which would be required to enable the 
        Service to undertake the health promotion and disease 
        prevention activities necessary to meet such needs.

``SEC. 204. DIABETES PREVENTION, TREATMENT, AND CONTROL.

    ``(a) The Secretary, in consultation with the Indian tribes and 
tribal organizations, shall determine--
            ``(1) by tribe, tribal organization, and by Service unit of 
        the Service, the incidence of, and the types of complications 
        resulting from, diabetes among Indians; and
            ``(2) based on paragraph (1), the measures (including 
        patient education) each Service unit should take to reduce the 
        incidence of, and prevent, treat, and control the complications 
        resulting from, diabetes among Indian tribes within that 
        Service unit.
    ``(b) The Secretary shall screen each Indian who receives services 
from the Service for diabetes and for conditions which indicate a high 
risk that the individual will become diabetic. Such screening may be 
done by a tribe or tribal organization operating health care programs 
or facilities with funds from the Service under the Indian Self-
Determination and Education Assistance Act.
    ``(c) The Secretary shall continue to fund through fiscal year 2012 
each model diabetes project in existence on the date of the enactment 
of the Indian Health Amendments of 2000 and any such other diabetes 
programs operated by the Secretary or Indian tribes and tribal 
organizations and any additional programs added to meet existing needs. 
Indian tribes and tribal organizations shall receive recurring funding 
for the diabetes programs which they operate pursuant to this section.
    ``(d) The Secretary shall provide funding through the Service, 
Indian tribes, and tribal organizations to establish dialysis programs, 
including funding to purchase dialysis equipment and provide necessary 
staffing.
    ``(e) The Secretary shall, to the extent funding is available--
            ``(1) in each Area Office of the Service, consult with 
        Indian tribes and tribal organizations regarding programs 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; and
            ``(3) ensure that data collected in each Area Office 
        regarding diabetes and related complications among Indians is 
        disseminated to all other Area Offices.

``SEC. 205. SHARED SERVICES.

    ``(a) The Secretary is authorized to enter into funding agreements 
or other arrangements with Indian tribes or tribal organizations for 
the delivery of long-term care and similar services to Indians. Such 
projects shall provide for the sharing of staff or other services 
between a Service or tribal facility and a long-term care or other 
similar facility owned and operated (directly or through funding 
agreement) by such Indian tribe or tribal organization.
    ``(b) A funding agreement or other arrangement entered into 
pursuant to subsection (a)--
            ``(1) may, at the request of the Indian tribe or tribal 
        organization, delegate to such 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 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 long-term care or other 
        similar facility (including the construction of a facility 
        attached to a Service facility).
    ``(c) The Secretary shall provide such technical and other 
assistance as may be necessary to enable applicants to comply with the 
provisions of this section.
    ``(d) The Secretary shall encourage the use for long-term or 
similar care of existing facilities that are underused or allow the use 
of swing beds for such purposes.

``SEC. 206. HEALTH SERVICES RESEARCH.

    ``The Secretary shall make funding available for research to 
further the performance of the health service responsibilities of the 
Service, Indian tribes, and tribal organizations and shall coordinate 
the activities of other agencies within the Department of Health and 
Human Services to address these research needs. The funding shall be 
divided equitably among the Area Offices and then each Area Office 
shall award the funds competitively within that Area. Indian tribes and 
tribal organizations receiving funding from the Service under the 
authority of the Indian Self-Determination and Education Assistance Act 
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 by Indian tribes and tribal 
organizations and shall be distributed to the Area Offices which may 
make grants from these funds within each Area.

``SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREENING.

    ``The Secretary, through the Service or through Indian tribes or 
tribal organizations, shall provide for screening, as follows:
            ``(1) Mammography (as defined in section 1861(jj) of the 
        Social Security Act) for Indian women at a frequency 
        appropriate to such women under national standards, 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 the 
        Social Security Act.
            ``(2) Other cancer screening meeting national standards.

``SEC. 208. PATIENT TRAVEL COSTS.

    ``The Secretary, acting through the Service and willing Indian 
tribes and tribal organizations, shall provide funds for the following 
patient travel costs, including appropriate and necessary qualified 
escorts, associated with receiving health care services provided 
(either through direct or contract care or through funding agreements 
entered into pursuant to the Indian Self-Determination and Education 
Assistance Act) under this Act--
            ``(1) emergency air transportation nonemergency air 
        transportation where ground transportation is infeasible;
            ``(2) transportation by private vehicle, specially equipped 
        vehicle and ambulance; and
            ``(3) transportation by such other means as may be 
        available and required when air or motor vehicle transportation 
        is not available.

``SEC. 209. EPIDEMIOLOGY CENTERS.

    ``(a)(1) In addition to those centers already established at the 
time of enactment of this Act (including those for which funding is 
currently being provided in funding agreements under the Indian Self-
Determination and Education Assistance Act), within 180 days of 
enactment of the Indian Health Care Improvement Act Amendments of 2000, 
the Secretary shall establish and fund an epidemiology center in each 
service area which does not yet have one to carry out the functions 
described in paragraph (2). Any new centers so established may be 
operated by Indian tribes or tribal organizations pursuant to funding 
agreements under the Indian Self-Determination and Education Assistance 
Act, but such funding may not be divisible.
    ``(2) In consultation with and upon the request of Indian tribes, 
tribal organizations, and urban Indian organizations, each area 
epidemiology center established under this subsection shall, with 
respect to such area carry out--
            ``(A) collect data relating to, and monitor progress made 
        toward meeting, each of the health status objectives of the 
        Indian Health Service, the Indian tribes, tribal organizations, 
        and urban Indian organizations in the Area;
            ``(B) evaluate existing delivery systems, data systems, and 
        other systems that impact the improvement of Indian health;
            ``(C) 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;
            ``(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) provide requested 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; and
            ``(G) provide disease surveillance and assist Indian 
        tribes, tribal organizations, and urban Indian organizations to 
        promote public health.
    ``(3) 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.
    ``(b) The Secretary may make funding available to Indian tribes, 
tribal organizations, and urban Indian organizations to conduct 
epidemiological studies of Indian communities.

``SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS.

    ``(a) The Secretary shall provide funding to Indian tribes, tribal 
organizations and urban Indian organizations to develop comprehensive 
school health education programs for children from preschool through 
grade 12 in schools for the benefit of Indian and urban Indian 
children.
    ``(b) Funding provided under this section may be used for purposes 
which may include, but are not limited to the following:
            ``(1) Developing and implementing health education 
        curricula both for regular school programs and after-school 
        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 mental 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) Upon request, the Secretary 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) The Secretary, 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)(1) The Secretary of the Interior, acting through the Bureau 
of Indian Affairs and in cooperation with the Secretary and the 
affected Indian tribes and tribal organizations, 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 programs shall include--
            ``(A) school programs on nutrition education, personal 
        health, oral health, and fitness;
            ``(B) mental 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) The Secretary of the Interior shall--
            ``(A) provide training to teachers in comprehensive school 
        health education curricula;
            ``(B) ensure the integration and coordination of school-
        based programs with existing services and health programs 
        available in the community; and
            ``(C) encourage healthy, tobacco-free school environments.

``SEC. 211. INDIAN YOUTH PROGRAM.

    ``(a) The Secretary is authorized 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)(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 health care practitioners; 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 707(c).
    ``(c) 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) The Secretary, in consultation with Indian tribes, tribal 
organizations, and urban Indian organizations, shall establish criteria 
for the review and approval of applications or proposals under this 
section.

``SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF COMMUNICABLE AND 
              INFECTIOUS DISEASES.

    ``(a) The Secretary, after consultation with Indian tribes, tribal 
organizations, and urban Indian organizations, and the Centers for 
Disease Control and Prevention, may make funding available to Indian 
tribes and tribal organizations for--
            ``(1) projects for the prevention, control, and elimination 
        of communicable and infectious diseases including, but not 
limited to, tuberculosis, hepatitis, HIV, respiratory syncitial 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; and
            ``(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.
    ``(b) The Secretary may provide funding under subsection (a) only 
if an application or proposal for funding is submitted to the 
Secretary.
    ``(c) Indian tribes and tribal 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) In carrying out this section, the Secretary--
            ``(1) may, at the request of an Indian tribe or tribal 
        organization, provide technical assistance; and
            ``(2) shall prepare and submit a report to the Congress 
        biennially on the use of funds under this section and on the 
        progress made toward the prevention, control, and elimination 
        of communicable and infectious diseases among Indians and urban 
        Indians.

``SEC. 213. AUTHORITY FOR PROVISION OF OTHER SERVICES.

    ``(a) The Secretary, acting through the Service and willing tribes 
and tribal organizations, may provide funding under this Act to meet 
the objectives set forth in section 3 of this Act through health care 
related services and programs not otherwise described in this Act, 
which shall include, but not be limited to--
            ``(1) hospice care and assisted living;
            ``(2) long-term health care;
            ``(3) home- and community-based services;
            ``(4) public health functions; and
            ``(5) traditional health care practices.
    ``(b) At the discretion of the Service, Indian tribes, or tribal 
organizations, services provided for hospice care, home health care 
(under section 201 of this Act), home- and community-based care, 
assisted living, and long-term care may be provided (on a cost basis) 
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 a tribe or tribal 
organization.
    ``(c) For the purposes of this section, the following definitions 
shall apply:
            ``(1) 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 a tribe or tribal 
        organization determines are necessary and appropriate to 
        provide in furtherance of this care.
            ``(2) The term `home- and community-based services' means 1 
        or more of the following:
                    ``(A) Homemaker/home health aide services.
                    ``(B) Chore services.
                    ``(C) Personal care services.
                    ``(D) Nursing care services provided outside of a 
                nursing facility by, or under the supervision of, a 
                registered nurse.
                    ``(E) Training for family members.
                    ``(F) Adult day care.
                    ``(G) Such other home- and community-based services 
                as the Secretary or a tribe or tribal organization may 
                approve.
            ``(3) The term `public health functions' means the 
        provision of public health related programs, functions, and 
        services including, but not limited to, assessment, assurance, 
        and policy development which Indian tribes and tribal 
        organizations are authorized and encouraged, in those 
        circumstances where it meets their needs, to do by forming 
        collaborative relationships with all levels of local, State, 
        and Federal Government.

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

    ``The Secretary, acting through the Service and willing Indian 
tribes, tribal organizations, and urban Indian organizations, shall 
provide funding to monitor and improve the quality of health care for 
Indian women of all ages through the planning and delivery of programs 
administered by the Service, in order to improve and enhance the 
treatment models of care for Indian women.

``SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH HAZARDS.

    ``(a) 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 Indian reservations and in 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 study 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 Indian 
        reservations and communities including the cumulative effect 
        over time on health;
            ``(3) an evaluation of the types and nature of activities, 
        practices, and conditions causing or affecting such health 
        problems including, but not limited to, uranium mining and 
        milling, uranium mine tailing deposits, nuclear power plant 
        operation and construction, and nuclear waste disposal; oil and 
        gas production or transportation on or near Indian reservations 
        or 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 this section that directly or indirectly relate to 
        the activities, practices, and conditions affecting the health 
        or safety of such Indians; and
            ``(5) the efforts that have been made by Federal and State 
        agencies and 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) Upon completion of such study the Secretary and the Service 
shall take into account the results of such study 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) The Secretary and the Service shall submit to Congress the 
study prepared under subsection (a) no later than the date 18 months 
after the date of enactment of this section. The health care plan 
prepared under subsection (b) shall be submitted in a report no later 
than the date 1 year after the date that the study prepared under 
subsection (a) is submitted to Congress. Such report shall include 
recommended activities for the implementation of the plan, as well as 
an evaluation of any activities previously undertaken by the Service to 
address such health problems.
    ``(d)(1) There is established an Intergovernmental Task Force to be 
composed of the following individuals (or their designees): The 
Secretary of Energy, the Administrator of the Environmental Protection 
Agency, the Director of the Bureau of Mines, the Assistant Secretary 
for Occupational Safety and Health, and the Secretary of the Interior.
    ``(2) The Task Force shall identify existing and potential 
operations related to nuclear resource development or other 
environmental hazards 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 ensure that 
current and future health problems resulting from nuclear resource or 
other development activities are minimized or reduced.
    ``(3) The Secretary shall be Chairman of the Task Force. The Task 
Force shall meet at least twice each year. Each member of the Task 
Force shall furnish necessary assistance to the Task Force.
    ``(e) In the case of any Indian who--
            ``(1) as a result of employment in or near a uranium mine 
        or mill or near any other environmental hazard, 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 or 
        entity responsible for the environmental hazard,
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 or entity from such 
operator or entity. 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. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.

    ``(a) For fiscal years beginning with the fiscal year ending 
September 30, 1983, and ending with the fiscal year ending September 
30, 2012, the State of Arizona shall be designated as a contract health 
service delivery area by the Service for the purpose of providing 
contract health care services to members of federally recognized Indian 
tribes of Arizona.
    ``(b) The Service shall not curtail any health care services 
provided to Indians residing on Federal reservations in the State of 
Arizona if such curtailment is due to the provision of contract 
services in such State pursuant to the designation of such State as a 
contract health service delivery area pursuant to subsection (a).

``SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES PROGRAM.

    ``(a) The Secretary is authorized to fund a program using 
California Rural Indian Health Board as a contract care intermediary to 
improve the accessibility of health services to California Indians.
    ``(b)(1) 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 pursuant to this 
section, in providing medical treatment under contract to California 
Indians described in section 809(b) throughout the California contract 
health services delivery area described in section 218 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 hereunder to 
the extent payment may be made for such treatment under the 
Catastrophic Health Emergency Fund described in section 202 or from 
amounts appropriated or otherwise made available to the California 
contract health service delivery area for a fiscal year.
    ``(c) There is hereby established an advisory board which shall 
advise the California Rural Indian Health Board in carrying out the 
demonstration pursuant to this section. The advisory board shall be 
composed of representatives, selected by the California Rural Indian 
Health Board, from not less than 8 tribal health programs serving 
California Indians covered under such demonstration, at least one-half 
of whom are not affiliated with the California Rural Indian Health 
Board.

``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 
Indians in such State. However, any of the counties herein may 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) The Secretary is directed to provide contract health services 
to members of the Turtle Mountain Band of Chippewa Indians that reside 
in the Trenton Service Area of Divide, McKenzie, and Williams Counties 
in the State of North Dakota and the adjoining Counties of Richland, 
Roosevelt, and Sheridan in the State of Montana.
    ``(b) Nothing in this section may be construed as expanding the 
eligibility of members of the Turtle Mountain Band of Chippewa Indians 
for health services provided by the Service beyond the scope of 
eligibility for such health services that applied on May 1, 1986.

``SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL 
              ORGANIZATIONS.

    ``The Service shall provide funds for health care programs and 
facilities operated by Indian tribes and tribal organizations under 
funding agreements with the Service entered into under the Indian Self-
Determination and Education Assistance Act 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 Indian tribes and tribal 
organizations to carry out agreements under the Indian Self-
Determination and Education Assistance Act, shall, if licensed in any 
other State, be exempt from the licensing requirements of the State in 
which the agreement is performed.

``SEC. 222. AUTHORIZATION FOR 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) The Service shall respond to a notification of a claim by a 
provider of a contract care service with either an individual purchase 
order or a denial of the claim within 5 working days after the receipt 
of such notification.
    ``(b) If the Service fails to respond to a notification of a claim 
in accordance with subsection (a), the Service shall accept as valid 
the claim submitted by the provider of a contract care service.
    ``(c) The Service shall pay a valid contract care service claim 
within 30 days after completion of the claim.

``SEC. 224. 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.
    ``(c) Following receipt of the notice provided by subsection (a) of 
this section, or, if a claim has been deemed accepted under section 
223(b), the provider shall have no further recourse against the patient 
who received the services.

``SEC. 225. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2012 to carry out 
this title.

                        ``TITLE III--FACILITIES

``SEC. 301. CONSULTATION; CONSTRUCTION AND RENOVATION OF FACILITIES; 
              REPORTS.

    ``(a) Prior to the expenditure of, or the making of any binding 
commitment to expend, any funds appropriated for the planning, design, 
construction, or renovation of facilities pursuant to the Act of 
November 2, 1921 (25 U.S.C. 13), popularly known as the Snyder Act, the 
Secretary shall--
            ``(1) consult with any Indian tribe that would be 
        significantly affected by such expenditure for the purpose of 
        determining and, whenever practicable, honoring tribal 
        preferences concerning size, location, type, and other 
        characteristics of any facility on which such expenditure is to 
        be made, and
            ``(2) ensure, whenever practicable, that such facility 
        meets the construction standards of any nationally recognized 
        accrediting body by not later than 1 year after the date on 
        which the construction or renovation of such facility is 
        completed.
    ``(b)(1) Notwithstanding any provision of law other than this 
subsection, no Service hospital or outpatient health care facility or 
any inpatient service or special care facility operated by the Service 
may be closed if the Secretary has not submitted to the Congress at 
least 1 year prior to the date of such proposed closure an evaluation 
of the impact of such proposed closure which specifies, in addition to 
other considerations--
            ``(A) the accessibility of alternative health care 
        resources for the population served by such hospital or 
        facility;
            ``(B) the cost-effectiveness of such closure;
            ``(C) the quality of health care to be provided to the 
        population served by such hospital or facility after such 
        closure;
            ``(D) the availability of contract health care funds to 
        maintain existing levels of service;
            ``(E) the views of the Indian tribes served by such 
        hospital or facility concerning such closure;
            ``(F) the level of use of such hospital or facility by all 
        eligible Indians; and
            ``(G) the distance between such hospital or facility and 
        the nearest operating Service hospital.
    ``(2) Paragraph (1) shall not apply to any temporary closure of a 
facility or any portion of a facility if such closure is necessary for 
medical, environmental, or construction safety reasons.
    ``(c)(1)(A) The Secretary shall establish a health care facility 
priority system, which shall--
            ``(i) be developed with Indian tribes and tribal 
        organizations by 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) of this subsection.
    ``(B) 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 2000 shall not be affected by any 
change in the construction priority system taking place thereafter if 
the project was identified as one of the top ten priority inpatient 
projects or one of the top ten outpatient projects in the fiscal year 
2000 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) The Secretary shall submit to the President, for inclusion in 
each report required to be transmitted to the Congress under section 
801, a report which sets forth--
            ``(A) a description of the health care facility priority 
        system of the Service, established under paragraph (1) of this 
        subsection;
            ``(B) health care facilities lists, including but not 
        limited to--
                    ``(i) the total health care facilities planning, 
                design, construction, and renovation needs for Indians;
                    ``(ii) the 10 top-priority inpatient care 
                facilities;
                    ``(iii) the 10 top-priority outpatient care 
                facilities;
                    ``(iv) the 10 top-priority specialized care 
                facilities (such as long-term care and alcohol and drug 
                abuse treatment);
                    ``(v) any staff quarters associated with such 
                prioritized facilities;
            ``(C) the justification for such order of priority;
            ``(D) the projected cost of such projects; and
            ``(E) the methodology adopted by the Service in 
        establishing priorities under its health care facility priority 
        system.
    ``(3) In preparing each report required under paragraph (2) (other 
than the initial report), the Secretary shall annually--
            ``(A) consult with and obtain information on all health 
        care facilities needs from Indian tribes and tribal 
        organizations, including those tribes or tribal organizations 
        operating health programs or facilities under any funding 
        agreement entered into with the Service under the Indian Self-
        Determination and Education Assistance Act; and
            ``(B) review the total unmet needs of all tribes and tribal 
        organizations for health care facilities (including staff 
        quarters), including needs for renovation and expansion of 
        existing facilities.
    ``(4) For purposes of this subsection, the Secretary shall, in 
evaluating the needs of facilities operated under any funding agreement 
entered into with the Service under the Indian Self-Determination and 
Education Assistance Act, use the same criteria that the Secretary uses 
in evaluating the needs of facilities operated directly by the Service.
    ``(5) The Secretary shall ensure that the planning, design, 
construction, and renovation needs of Service and non-Service 
facilities, operated under funding agreements in accordance with the 
Indian Self-Determination and Education Assistance Act, are fully and 
equitably integrated into the health care facility priority system.
    ``(d) Review of Need for Facilities.--
            ``(1) Beginning in the year 2000, the Secretary shall 
        annually submit to the President, for inclusion in the report 
        required to be transmitted to the Congress under section 801 of 
        this Act, a report which sets forth the needs of the Indian 
        Health Service and all Indian tribes and tribal organizations, 
        including urban Indian organizations, for inpatient, 
        outpatient, and specialized care facilities, including the 
        needs for renovation and expansion of existing facilities.
            ``(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 programs or 
        facilities under any funding agreement entered into with the 
        Service under the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450f et seq.), and with urban Indian 
        organizations.
            ``(3) For purposes of this subsection, the Secretary shall, 
        in evaluating the needs of facilities operated under any 
        funding agreement entered into with the Service under the 
        Indian Self-Determination and Education Assistance Act, use the 
        same criteria that the Secretary uses in evaluating the needs 
        of facilities operated directly by the Service.
            ``(4) The Secretary shall ensure that the planning, design, 
        construction, and renovation needs of facilities operated under 
        funding agreements, in accordance with the Indian Self-
        Determination and Education Assistance Act, are fully and 
        equitably integrated into the development of the health 
        facility priority system.
            ``(5) Each fiscal year, the Secretary shall provide an 
        opportunity for nomination of planning, design, and 
        construction projects by the Indian Health Service and all 
        tribes and tribal organizations for consideration under the 
        health care facility priority system.
    ``(e) All funds appropriated under the Act of November 2, 1921 (25 
U.S.C. 13), for the planning, design, construction, or renovation of 
health facilities for the benefit of an Indian tribe or Tribes shall be 
subject to the provisions of section 102 of the Indian Self-
Determination and Education Assistance Act.
    ``(f) The Secretary shall consult and cooperate with Indian tribes, 
tribal organizations, and urban Indian organizations in developing 
innovative approaches to address all or part of the total unmet need 
for construction of health facilities, including those provided for in 
other sections of this title and other approaches.

``SEC. 302. SAFE WATER AND SANITARY WASTE DISPOSAL FACILITIES.

    ``(a) The Congress hereby finds and declares that--
            ``(1) the provision of safe water supply facilities and 
        sanitary sewage and solid waste disposal facilities is 
        primarily a health consideration and function;
            ``(2) Indian people suffer an inordinately high incidence 
        of disease, injury, and illness directly attributable to the 
        absence or inadequacy of such facilities;
            ``(3) the long-term cost to the United States of treating 
        and curing such disease, injury, and illness is substantially 
        greater than the short-term cost of providing such facilities 
        and other preventive health measures;
            ``(4) many Indian homes and communities still lack safe 
        water supply facilities and sanitary sewage and solid waste 
        disposal facilities; and
            ``(5) it is in the interest of the United States, and it is 
        the policy of the United States, that all Indian communities 
        and Indian homes, new and existing, be provided with safe and 
        adequate water supply facilities and sanitary sewage waste 
        disposal facilities.
    ``(b)(1) In furtherance of the findings and declarations made in 
subsection (a), Congress reaffirms the primary responsibility and 
authority of the Service to provide the necessary sanitation facilities 
and services as provided in section 7 of the Act of August 5, 1954 (42 
U.S.C. 2004a).
    ``(2) The Secretary is authorized to provide under section 7 of the 
Act of August 5, 1954 (42 U.S.C. 2004a)--
            ``(A) financial and technical assistance to Indian tribes, 
        tribal organizations, and Indian communities in the 
        establishment, training, and equipping of utility organizations 
        to operate and maintain 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 tribe or tribal organization;
            ``(B) ongoing technical assistance and training in the 
        management of utility organizations which operate and maintain 
        sanitation facilities; and
            ``(C) priority funding for operation and maintenance 
        assistance for, and emergency repairs to, tribal sanitation 
        facilities when necessary to avoid an imminent health threat or 
        to protect the investment in sanitation facilities and the 
        investment in the health benefits gained through the provision 
        of sanitation facilities.
    ``(3) Notwithstanding any other provision of law--
            ``(A) the Secretary of Housing and Urban Development is 
        authorized to transfer funds appropriated under the Native 
        American Housing Assistance and Self-Determination Act of 1996 
        to the Secretary of Health and Human Services,
            ``(B) the Secretary of Health and Human Services is 
        authorized to accept and use such funds for the purpose of 
        providing sanitation facilities and services for Indians under 
        section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a),
            ``(C) unless specifically authorized when funds are 
        appropriated, the Secretary of Health and Human Services 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,
            ``(D) the Secretary of Health and Human Services is 
        authorized to accept all Federal funds that are for the purpose 
        of providing sanitation facilities and related services and 
        place those funds into funding agreements, authorized under the 
        Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 450f et seq.), between the Secretary and Indian tribes 
        and tribal organizations,
            ``(E) the Secretary may allow funds appropriated under the 
        authority of section 7 of the Act of August 5, 1954 (42 U.S.C. 
        2004a), to be used to fund up to 100 percent of the amount of a 
        tribe's loan obtained under any Federal program for new 
        projects to construct eligible sanitation facilities to serve 
        Indian homes,
            ``(F) the Secretary may allow funds appropriated under the 
        authority of section 7 of the Act of August 5, 1954 (42 U.S.C. 
        2004a), to be used to meet matching or cost participation 
        requirements under other Federal and non-Federal programs for 
        new projects to construct eligible sanitation facilities,
            ``(G) 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,
            ``(H) The Secretary of Health and Human Services shall 
        enter into interagency agreements with the Bureau of Indian 
        Affairs, the Department of Housing and Urban Development, the 
        Department of Agriculture, the Environmental Protection Agency, 
        and other appropriate Federal agencies, for the purpose of 
        providing financial assistance for safe water supply and 
        sanitary sewage disposal facilities under this Act, and
            ``(I) 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 water supply and sanitary sewage and solid 
        waste disposal facilities funded under this Act.
    ``(c) The Secretary, in consultation with Indian tribes and tribal 
organizations, shall develop and begin implementation of a 10-year 
funding plan to provide safe water supply and sanitary sewage and solid 
waste disposal facilities serving existing Indian homes and communities 
and new and renovated Indian homes.
    ``(d) The financial and technical capability of an Indian tribe or 
community to safely operate and maintain a sanitation facility shall 
not be a prerequisite to the provision or construction of sanitation 
facilities by the Secretary.
    ``(e) The Secretary is authorized to provide financial assistance 
to Indian tribes, tribal organizations, and communities for operation, 
management, and maintenance of their sanitation facilities.
    ``(f) The Indian family, community, or Tribe has the primary 
responsibility to establish, collect, and use reasonable user fees, or 
otherwise set aside funding, for the purpose of operating and 
maintaining sanitation facilities. If a community facility is 
threatened with imminent failure and there is a lack of tribal capacity 
to maintain the integrity or the health benefits of the facility, then 
the Secretary is authorized to assist the Tribe in the resolution of 
the problem on a short-term basis through cooperation with the 
emergency coordinator or by providing operation and maintenance 
service.
    ``(g) Programs administered by Indian tribes or tribal 
organizations under the authority of the Indian Self-Determination and 
Education Assistance Act shall be eligible for--
            ``(1) any funds appropriated pursuant to this section, and
            ``(2) any funds appropriated for the purpose of providing 
        water supply, sewage disposal, or solid waste facilities,
on an equal basis with programs that are administered directly by the 
Service.
    ``(h)(1) The Secretary shall submit to the President, for inclusion 
in each report required to be transmitted to the Congress under section 
801, a report which sets forth--
            ``(A) the current Indian sanitation facility priority 
        system of the Service;
            ``(B) the methodology for determining sanitation 
        deficiencies;
            ``(C) the level of initial and final sanitation deficiency 
        for each type of sanitation facility for each project of each 
        Indian tribe or community; and
            ``(D) the amount of funds necessary to reduce the 
        identified sanitation deficiency levels of all Indian tribes 
        and communities to level I sanitation deficiency as defined in 
        subsection (h)(4)(A) of this section.
    ``(2) In preparing each report required under paragraph (1), the 
Secretary shall consult with Indian tribes and tribal organizations 
(including those tribes or tribal organizations operating health care 
programs or facilities under any funding agreement entered into with 
the Service under the Indian Self-Determination and Education 
Assistance Act) to determine the sanitation needs of each tribe and in 
developing the criteria on which the needs will be evaluated through a 
process of negotiated rulemaking.
    ``(3) The methodology used by the Secretary in determining, 
preparing cost estimates for and reporting sanitation deficiencies for 
purposes of paragraph (1) shall be applied uniformly to all Indian 
tribes and communities.
    ``(4) For purposes of this subsection, the sanitation deficiency 
levels for an individual or community sanitation facility serving 
Indian homes are as follows:
            ``(A) A level I deficiency is a sanitation facility serving 
        an individual or community--
                    ``(i) which complies with all applicable water 
                supply, 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 is a sanitation facility 
        serving an individual or community--
                    ``(i) which substantially or recently complied with 
                all applicable water supply, pollution control, and 
                solid waste laws, in which the deficiencies relate to 
                small or minor capital improvements needed to bring the 
                facility back into compliance;
                    ``(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 for 
                domestic sanitation facilities; or
                    ``(iii) in which the deficiencies relate to the 
                lack of equipment or training by an Indian tribe or 
                community to properly operate and maintain the 
                sanitation facilities.
            ``(C) A level III deficiency is an individual or community 
        facility with water or sewer service in the home, piped 
        services, or a haul system with holding tanks and interior 
        plumbing, or where major significant interruptions to water 
        supply or sewage disposal occur frequently, requiring major 
        capital improvements to correct the deficiencies. There is no 
        access to or no approved or permitted solid waste facility 
        available.
            ``(D) A level IV deficiency is an individual or community 
        facility where there is no piped water or sewer facilities in 
        the home or the facility has become inoperable due to major 
        component failure or where only a washeteria or central 
        facility exists.
            ``(E) A level V deficiency is the absence of a sanitation 
        facility, where individual homes do not have access to safe 
        drinking water or adequate wastewater disposal.
    ``(i) For purposes of this section--
            ``(1) the terms `facility' and `facilities' have the same 
        meanings as the terms `system' and `systems' unless the context 
        requires otherwise; and
            ``(2) 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.

``SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS.

    ``(a) The Secretary may use the negotiating authority of the Act of 
June 25, 1910 (25 U.S.C. 47), to give preference to any Indian or any 
enterprise, partnership, corporation, or other type of business 
organization owned and controlled by an Indian or Indians including 
former or currently federally recognized Indian tribes in the State of 
New York (hereinafter referred to as an `Indian firm') in the 
construction and renovation of Service facilities pursuant to section 
301 and in the construction of safe water and sanitary waste disposal 
facilities pursuant to section 302. Such preference may be accorded by 
the Secretary unless he finds, pursuant to rules and regulations 
promulgated by him, that the project or function to be contracted for 
will not be satisfactory or such project or function cannot be properly 
completed or maintained under the proposed contract. The Secretary, in 
arriving at his finding, shall consider whether the Indian or Indian 
firm will be deficient with respect to (1) ownership and control by 
Indians, (2) equipment, (3) bookkeeping and accounting procedures, (4) 
substantive knowledge of the project or function to be contracted for, 
(5) adequately trained personnel, or (6) other necessary components of 
contract performance.
    ``(b) For the purpose of implementing the provisions of this title, 
construction or renovation of facilities constructed or renovated in 
whole or in part by funds made available pursuant to this title are 
exempt from the Act of March 3, 1931 (40 U.S.C. 276a-276a-5, known as 
the Davis-Bacon Act.) For all health facilities, staff quarters, and 
sanitation facilities, construction and renovation subcontractors shall 
be paid wage rates not less than the prevailing wages on similar 
construction in the locality, as determined by the Indian tribe, 
Tribes, or tribal organizations served by such facilities.

``SEC. 304. EXPENDITURE OF NONSERVICE FUNDS FOR RENOVATION.

    ``(a)(1) Notwithstanding any other provision of law, the Secretary 
is authorized to accept any major expansion, renovation, or 
modernization by any Indian tribe of any Service facility, or of any 
other Indian health facility operated pursuant to a funding agreement 
entered into under the Indian Self-Determination and Education 
Assistance Act, including--
            ``(A) any plans or designs for such expansion, renovation, 
        or modernization; and
            ``(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) are met.
    ``(2) The Secretary shall maintain a separate priority list to 
address the needs for increased operating expenses, personnel, or 
equipment for such facilities. The methodology for establishing 
priorities shall be developed by negotiated rulemaking under section 
802. The list of priority facilities will be revised annually in 
consultation with Indian tribes and tribal organizations.
    ``(3) The Secretary shall submit to the President, for inclusion in 
each report required to be transmitted to the Congress under section 
801, the priority list maintained pursuant to paragraph (2).
    ``(b) The requirements of this subsection are met with respect to 
any expansion, renovation, or modernization if--
            ``(1) the tribe or tribal organization--
                    ``(A) provides notice to the Secretary of its 
                intent to expand, renovate, or modernize; and
                    ``(B) applies to the Secretary to be placed on a 
                separate priority list to address the needs of such new 
                facilities for increased operating expenses, personnel, 
                or equipment; and
            ``(2) the expansion, renovation, or modernization--
                    ``(A) is approved by the appropriate area director 
                of the Service for Federal facilities; and
                    ``(B) is administered by the Indian tribe or tribal 
                organization in accordance with any applicable 
                regulations prescribed by the Secretary with respect to 
                construction or renovation of Service facilities.
    ``(c) If any Service facility which has been expanded, renovated, 
or modernized by an Indian tribe under this section ceases to be used 
as a Service facility during the 20-year period beginning on the date 
such expansion, renovation, or modernization is completed, such Indian 
tribe shall be entitled to recover from the United States an amount 
which bears the same ratio to the value of such facility at the time of 
such cessation as the value of such expansion, renovation, or 
modernization (less the total amount of any funds provided specifically 
for such facility under any Federal program that were expended for such 
expansion, renovation, or modernization) bore to the value of such 
facility at the time of the completion of such expansion, renovation, 
or modernization.

``SEC. 305. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND MODERNIZATION 
              OF SMALL AMBULATORY CARE FACILITIES.

    ``(a)(1) The Secretary, in consultation with Indian tribes and 
tribal organizations, shall make funding available to Tribes and tribal 
organizations for the construction, expansion, or modernization of 
facilities for the provision of ambulatory care services to eligible 
Indians (and noneligible persons as provided in subsections (c)(1)(C) 
and (b)(2) of this section). Funding made under this section may cover 
up to 100 percent of the costs of such construction, expansion, or 
modernization. For the purposes of this section, the term 
`construction' includes the replacement of an existing facility.
    ``(2) Funding under paragraph (1) may only be made available to an 
Indian 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 an Indian tribe or tribal organization) pursuant to a funding 
agreement entered into under the Indian Self-Determination and 
Education Assistance Act.
    ``(b)(1) Funding provided under this section may be used only for 
the construction, expansion, or modernization (including the planning 
and design of such construction, expansion, or modernization) of an 
ambulatory care facility--
            ``(A) located apart from a hospital;
            ``(B) not funded under section 301 or section 307; and
            ``(C) which, upon completion of such construction or 
        modernization will--
                    ``(i) have a total capacity appropriate to its 
                projected service population;
                    ``(ii) provide annually no less than 500 patient 
                visits by eligible Indians and other users who are 
                eligible for services in such facility in accordance 
                with section 807(b)(1)(B); and
                    ``(iii) provide ambulatory care in a service area 
                (specified in the funding agreement entered into under 
                the Indian Self-Determination and Education Assistance 
                Act) with a population of no fewer than 1,500 eligible 
                Indians and other users who are eligible for services 
                in such facility in accordance with section 
                807(b)(1)(B).
    ``(2) Funding 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). The requirements of clauses (ii) 
and (iii) of paragraph (1)(C) shall not apply to a Tribe or tribal 
organization applying for funding under this section whose principal 
office for health care administration is located on an island or when 
such office is not located on a road system providing direct access to 
an inpatient hospital where care is available to the service 
population.
    ``(c)(1) No funding may be made available under this section unless 
an application or proposal for such funding has been submitted to and 
approved by the Secretary. An application or proposal for funding under 
this section shall be submitted in accordance with applicable 
regulations 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 funding received under this 
section--
            ``(A) adequate financial support will be available for the 
        provision of services at such facility;
            ``(B) such facility will be available to eligible Indians 
        without regard to ability to pay or source of payment; and
            ``(C) such facility will, as feasible without diminishing 
        the quality or quantity of services provided to eligible 
        Indians, serve noneligible persons on a cost basis.
    ``(2) In awarding funding under this section, the Secretary shall 
give priority to tribes and tribal organizations that demonstrate--
            ``(A) a need for increased ambulatory care services; and
            ``(B) insufficient capacity to deliver such services.
    ``(3) 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 pursuant to paragraph (1).
    ``(d) If any facility (or portion thereof) with respect to which 
funds have been paid under this section, ceases, within 5 years after 
completion of the construction, expansion, or modernization carried out 
with such funds, to be used for the purposes of providing health care 
services to eligible Indians, all of the right, title, and interest in 
and to such facility (or portion thereof) shall transfer to the United 
States unless otherwise negotiated by the Service and the Indian tribe 
or tribal organization.
    ``(e) Funding provided to Indian tribes and tribal organizations 
under this section shall be nonrecurring and shall not be available for 
inclusion in any individual Tribe's tribal share for an award under the 
Indian Self-Determination and Education Assistance Act or for 
reallocation or redesign thereunder.

``SEC. 306. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECT.

    ``(a) Health Care Demonstration Projects.--The Secretary, in 
consultation with Indian tribes and tribal organizations, is authorized 
to enter into funding agreements with, or make grants or loan 
guarantees to, Indian tribes or tribal organizations for the purpose of 
carrying out a health care delivery demonstration project to test 
alternative means of delivering health care and services through 
facilities, including but not limited to hospice, traditional Indian 
health, and child care facilities to Indians.
    ``(b) Use of Funds.--The Secretary, in approving projects pursuant 
to this section, may authorize funding for the construction and 
renovation of hospitals, health centers, health stations, and other 
facilities to deliver health care services and is authorized to--
            ``(1) waive any leasing prohibition;
            ``(2) permit carryover of funds appropriated for the 
        provision of health care services;
            ``(3) permit the use of other available funds;
            ``(4) permit the use of funds or property donated from any 
        source for project purposes;
            ``(5) provide for the reversion of donated real or personal 
        property to the donor; and
            ``(6) permit the use of Service funds to match other funds, 
        including Federal funds.
    ``(c) Criteria.--(1) The Secretary shall develop and publish 
regulations, through rulemaking under section 802, for the review and 
approval of applications submitted under this section. The Secretary 
may enter into a contract or funding agreement or award a grant under 
this section for projects which meet the following criteria:
            ``(A) There is a need for a new facility or program or the 
        reorientation of an existing facility or program.
            ``(B) A significant number of Indians, including those with 
        low health status, will be served by the project.
            ``(C) The project has the potential to deliver services in 
        an efficient and effective manner.
            ``(D) The project is economically viable.
            ``(E) The Indian tribe or tribal organization has the 
        administrative and financial capability to administer the 
        project.
            ``(F) The project is integrated with providers of related 
        health and social services and is coordinated with, and avoids 
        duplication of, existing services.
    ``(2) The Secretary may provide for the establishment of peer 
review panels, as necessary, to review and evaluate applications and 
using the criteria developed pursuant to paragraph (1).
    ``(3) The Secretary shall give priority to applications for 
demonstration projects in each of the following service units to the 
extent that such applications are timely filed and meet the criteria 
specified in paragraph (1):
            ``(i) Cass Lake, Minnesota.
            ``(ii) Clinton, Oklahoma.
            ``(iii) Harlem, Montana.
            ``(iv) Mescalero, New Mexico.
            ``(v) Owyhee, Nevada.
            ``(vi) Parker, Arizona.
            ``(vii) Schurz, Nevada.
            ``(viii) Winnebago, Nebraska.
            ``(ix) Ft. Yuma, California.
    ``(d) Technical Assistance.--The Secretary shall provide such 
technical and other assistance as may be necessary to enable applicants 
to comply with the provisions of this section.
    ``(e) Service to Ineligible Persons.--The authority to provide 
services to persons otherwise ineligible for the health care benefits 
of the Service and the authority to extend hospital privileges in 
Service facilities to non-Service health practitioners as provided in 
section 807 may be included, subject to the terms of such section, in 
any demonstration project approved pursuant to this section.
    ``(f) Equitable Treatment.--For purposes of subsection (c)(1)(A), 
the Secretary shall, in evaluating facilities operated under any 
funding agreement entered into with the Service under the Indian Self-
Determination and Education Assistance Act, use the same criteria that 
the Secretary uses in evaluating facilities operated directly by the 
Service.
    ``(g) Equitable Integration of Facilities.--The Secretary shall 
ensure that the planning, design, construction, renovation, and 
expansion needs of Service and non-Service facilities which are the 
subject of a funding agreement for health services entered into with 
the Service under the Indian Self-Determination and Education 
Assistance Act, are fully and equitably integrated into the 
implementation of the health care delivery demonstration projects under 
this section.

``SEC. 307. LAND TRANSFER.

    ``(a) The Bureau of Indian Affairs is authorized to transfer, at no 
cost, up to 5 acres of land at the Chemawa Indian School, Salem, 
Oregon, to the Service for the provision of health care services. The 
land authorized to be transferred by this section is that land adjacent 
to land under the jurisdiction of the Service and occupied by the 
Chemawa Indian Health Center.
    ``(b) Notwithstanding any other provision of law, the Bureau of 
Indian Affairs and all other agencies and departments of the United 
States are authorized to transfer, at no cost, land and improvements to 
the Service for the provision of health care services. The Secretary is 
authorized to accept such land and improvements for such purposes.

``SEC. 308. LEASES.

    ``(a) Notwithstanding any other provision of law, the Secretary is 
authorized, in carrying out the purposes of this Act, to enter into 
leases with Indian tribes and tribal organizations for periods not in 
excess of 20 years. Property leased by the Secretary from an Indian 
tribe or tribal organization may be reconstructed or renovated by the 
Secretary pursuant to an agreement with such Indian tribe or tribal 
organization.
    ``(b) The Secretary may enter into leases, contracts, and other 
legal agreements with Indian tribes or tribal organizations which hold 
title to--
            ``(1) a leasehold interest in; or
            ``(2) 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, and such leases shall be 
        considered as operating leases for the purposes of scoring 
        under the Budget Enforcement Act of 1990, notwithstanding any 
        other provision of law. 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 
        pursuant to regulations under section 105(l) of the Indian 
        Self-Determination and Education Assistance Act.

``SEC. 309. LOANS, LOAN GUARANTEES, AND LOAN REPAYMENT.

    ``(a) There is established in the Treasury of the United States a 
fund to be known as the Health Care Facilities Loan Fund (hereinafter 
referred to as the `HCFLF') to provide to Indian tribes and tribal 
organizations direct loans, or guarantees for loans, for construction 
of health care facilities (including but not limited to inpatient 
facilities, outpatient facilities, associated staff quarters and 
specialized care facilities such as behavioral health and elder care 
facilities).
    ``(b) The Secretary is authorized to issue regulations, developed 
through rulemaking as set out in section 802, to provide standards and 
procedures for governing such loans and loan guarantees, subject to the 
following conditions:
            ``(1) The principal amount of a loan or loan guarantee may 
        cover 100 percent of eligible costs, including but not limited 
        to planning, design, financing, site land development, 
        construction, rehabilitation, renovation, conversion, 
        improvements, medical equipment and furnishings, other 
        facility-related costs and capital purchase (but excluding 
        staffing).
            ``(2) The cumulative total of the principal of direct loans 
        and loan guarantees, respectively, outstanding at any one time 
        shall not exceed such limitations as may be specified in 
        appropriation Acts.
            ``(3) In the discretion of the Secretary, the program may 
        be administered by the Service or the Health Resources and 
        Services Administration (which shall be specified by 
        regulation).
            ``(4) The Secretary may make or guarantee a loan with a 
        term of the useful estimated life of the facility, or 25 years, 
        whichever is shorter.
            ``(5) The Secretary may allocate up to 100 percent of the 
        funds available for loans or loan guarantees in any year for 
        the purpose of planning and applying for a loan or loan 
        guarantee.
            ``(6) The Secretary may accept an assignment of the revenue 
        of an Indian tribe or tribal organization as security for any 
        direct loan or loan guarantee under this section.
            ``(7) In the planning and design of health facilities under 
        this section, users eligible under section 807(b) may be 
        included in any projection of patient population.
            ``(8) The Secretary shall not collect loan application, 
        processing, or other similar fees from Indian tribes or tribal 
        organizations applying for direct loans or loan guarantees 
        under this section.
            ``(9) Service funds authorized under loans or loan 
        guarantees in this section shall be eligible for use in 
        matching other Federal funds.
    ``(c)(1) The HCFLF shall consist of--
            ``(A) such sums as may be initially appropriated to the 
        HCFLF and as may be subsequently appropriated to the fund under 
        paragraph (2);
            ``(B) such amounts as may be collected from borrowers; and
            ``(C) all interest earned on amounts in the HCFLF.
    ``(2) There are authorized to be appropriated such sums as may be 
necessary to initiate the HCFLF. For each fiscal year after the initial 
year in which funds are appropriated to the HCFLF, there is authorized 
to be appropriated an amount equal to the sum of the amount collected 
by the HCFLF during the preceding fiscal year, and all accrued 
interest.
    ``(3) All amounts appropriated, collected, or earned relative to 
the HCFLF shall remain available until expended.
    ``(d) Amounts in the HCFLF and available pursuant to appropriation 
Acts may be expended by the Secretary to make loans under this section 
to an Indian tribe or tribal organization pursuant to a funding 
agreement entered into under the Indian Self-Determination and 
Education Assistance Act.
    ``(e) The Secretary of the Treasury shall invest such amounts of 
the HCFLF as such Secretary determines are not required to meet current 
withdrawals from the HCFLF. Such investments may be made only in 
interest-bearing obligations of the United States. For such purpose, 
such obligations may be acquired on original issue at the issue price, 
or by purchase of outstanding obligations at the market price. Any 
obligation acquired by the fund may be sold by the Secretary of the 
Treasury at the market price.
    ``(f) The Secretary is authorized to establish a program to provide 
grants to Indian tribes and tribal organizations for the purpose of 
repaying all or part of any loan obtained by an Indian tribe or tribal 
organization for construction and renovation of health care facilities 
(including inpatient facilities, outpatient facilities, associated 
staff quarters and specialized care facilities). Loans eligible for 
such repayment grants shall include loans that have been obtained under 
this section or otherwise.

``SEC. 310. TRIBAL LEASING.

    ``Indian tribes and tribal organizations providing health care 
services pursuant to a funding agreement entered into under the Indian 
Self-Determination and Education Assistance Act may lease permanent 
structures for the purpose of providing such health care services 
without obtaining advance approval in appropriation Acts.

``SEC. 311. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT VENTURE 
              PROGRAM.

    ``(a) The Secretary 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. A Tribe or tribal organization may use tribal funds, 
private sector, or other available resources, including loan 
guarantees, to fulfill its commitment under this subsection. A Tribe 
that has begun and substantially completed the process of acquisition 
or construction of a health facility shall be eligible to establish a 
joint venture project with the Service using such health facility.
    ``(b)(1) The Secretary shall make such an arrangement with an 
Indian tribe or tribal organization only if--
            ``(A) 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 health facility described in paragraph (1), 
        and
            ``(B) the Indian tribe or tribal organization meets the 
        need criteria which shall be developed through the negotiated 
        rulemaking process provided for under section 802.
    ``(2) 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.
    ``(c) 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 
tribal organization, or paid to a third party on the 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, or for personnel or 
staffing.
    ``(d) 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 should at any 
time within 10 years the Service ceases to use the facility or 
otherwise breaches the agreement.
    ``(e) Wherever `health facility' or `health facilities' is used in 
this section, they may include quarters needed to provide housing for 
staff of the tribal health program.

``SEC. 312. LOCATION OF FACILITIES.

    ``(a) 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 owner and the Indian tribe with jurisdiction 
over such lands or other lands owned or leased by the Indian tribe or 
tribal organization, provided that priority shall be given to Indian 
land owned by an Indian tribe or Tribes.
    ``(b) For purposes of this section, the term `Indian lands' means--
            ``(1) all lands within the exterior boundaries of any 
        Indian reservation;
            ``(2) any lands title to which is held in trust by the 
        United States for the benefit of any Indian tribe or individual 
        Indian, or held by any Indian tribe or individual Indian 
        subject to restriction by the United States against alienation 
        and over which an Indian tribe exercises governmental power; 
        and
            ``(3) all lands in Alaska owned by any Alaska Native 
        village, or village or regional corporation under the Alaska 
        Native Claims Settlement Act, or any land allotted to any 
        Alaska Native.

``SEC. 313. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE FACILITIES.

    ``(a) The Secretary shall submit to the President, for inclusion in 
the report required to be transmitted to the Congress under section 
801, a report which identifies the backlog of maintenance and repair 
work required at both Service and tribal facilities, including new 
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) The Secretary 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 Tribe or tribal organization. `Supportable space 
allocation' shall be defined through the negotiated rulemaking process 
provided for under section 802.
    ``(c) 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)(1) Notwithstanding any other provision of law, an Indian 
tribe or tribal organization which operates a hospital or other health 
facility and the federally owned quarters associated therewith pursuant 
to a funding agreement under the Indian Self-Determination and 
Education Assistance Act 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) In establishing rental rates pursuant to authority of this 
subsection, an Indian tribe or tribal organization shall endeavor to 
achieve the following objectives:
            ``(A) To base such rental rates on the reasonable value of 
        the quarters to the occupants thereof.
            ``(B) To generate sufficient funds to prudently provide for 
        the operation and maintenance of the quarters, and, subject to 
        the discretion of the Indian tribe or tribal organization, to 
        supply reserve funds for capital repairs and replacement of the 
        quarters.
    ``(3) Any quarters whose rental rates are established by an Indian 
tribe or tribal organization pursuant to authority of 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 
Indian Health Services-supported programs;
    ``(4) An Indian tribe or tribal organization 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)(1) Notwithstanding any other provision of law, and subject to 
paragraph (2) hereof, an Indian tribe or a tribal organization which 
operates federally owned quarters pursuant to a funding agreement under 
the Indian Self-Determination and Education Assistance Act shall have 
the authority to collect rents directly from Federal employees who 
occupy such quarters in accordance with the following:
            ``(A) The Indian tribe or tribal organization 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 Indian tribe or tribal 
        organization 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 Indian 
        tribe or tribal organization 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 Indian tribe or tribal 
        organization for the maintenance (including capital repairs and 
        replacement) and operation of the quarters and facilities as 
        the Indian tribe or tribal organization shall determine.
    ``(2) If an Indian tribe or tribal organization which has made an 
election under paragraph (1) hereof 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 Indian tribe or tribal organization notifies 
        the Secretary of its desire to retrocede; or
            ``(B) such other date as may be mutually agreed by the 
        Secretary and the Indian tribe or tribal organization.
    ``(c) To the extent that an Indian tribe or tribal organization, 
pursuant to authority granted in subsection (a) hereof, establishes 
rental rates for federally owned quarters provided to a Federal 
employee in Alaska, such rents may be based on the cost of comparable 
private rental housing in the nearest established community with a 
year-round population of 1,500 or more individuals.

``SEC. 315. APPLICABILITY OF BUY AMERICAN REQUIREMENT.

    ``(a) The Secretary shall ensure that the requirements of the Buy 
American Act apply to all procurements made with funds provided 
pursuant to the authorization contained in section 318, provided that 
Indian tribes and tribal organizations shall be exempt from these 
requirements.
    ``(b) If it has been finally determined by a court or Federal 
agency that any person intentionally affixed a label bearing a `Made in 
America' inscription, or any inscription with the same meaning, to any 
product sold in or shipped to the United States that is not made in the 
United States, such person shall be ineligible to receive any contract 
or subcontract made with funds provided pursuant to the authorization 
contained in section 309, pursuant to the debarment, suspension, and 
ineligibility procedures described in sections 9.400 through 9.409 of 
title 48, Code of Federal Regulations.
    ``(c) 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.

    ``Notwithstanding any other provision of law--
            ``(1) 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 funding 
        agreements authorized under the Indian Self-Determination and 
        Education Assistance Act (25 U.S.C. 450f et seq.) between the 
        Secretary and an Indian tribe or tribal organization, provided 
        that receipt of such funds shall have not an effect on the 
        priorities established pursuant to section 301;
            ``(2) 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 the Service or by Indian tribes or tribal organizations 
        under the Indian Self-Determination and Education Assistance 
        Act in order to carry out the purposes of this Act, together 
        with the purposes for which such funds are appropriated to such 
        other Federal department or State agency or for which the funds 
        were otherwise provided;
            ``(3) 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; and
            ``(4) 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 2012 to carry out 
this title.

                 ``TITLE IV--ACCESS TO HEALTH SERVICES

``SEC. 401. TREATMENT OF PAYMENTS UNDER MEDICARE PROGRAM.

    ``(a) Any payments received by the Service or by an Indian tribe or 
tribal organization pursuant to a funding agreement under the Indian 
Self-Determination and Education Assistance Act or by an urban Indian 
organization pursuant to title V of this Act for services provided to 
Indians eligible for benefits under title XVIII of the Social Security 
Act shall not be considered in determining appropriations for health 
care and services to Indians.
    ``(b) Nothing in this Act authorizes the Secretary to provide 
services to an Indian beneficiary with coverage under title XVIII of 
the Social Security Act, as amended, in preference to an Indian 
beneficiary without such coverage.
    ``(c) Notwithstanding any other provision of this title or of title 
XVIII of the Social Security Act, payments to which facility of the 
Service is entitled by reason of this section shall be placed in a 
special fund to be held by the Secretary and first used (to such extent 
or in such amounts as are provided in appropriation Acts) for the 
purpose of making any improvements in the programs of the Service which 
may be necessary to achieve or maintain compliance with the applicable 
conditions and requirements of this title and of title XVIII of the 
Social Security Act. Any funds to be reimbursed which are in excess of 
the amount necessary to achieve or maintain such conditions and 
requirements shall, subject to the consultation with Tribes being 
served by the service unit, be used for reducing the health resource 
deficiencies of the Indian tribes. This paragraph shall not apply upon 
the election of an Indian tribe or tribal organization under section 
405 of the Indian Health Care Improvement Act to receive payments 
directly.

``SEC. 402. TREATMENT OF PAYMENTS UNDER MEDICAID PROGRAM.

    ``(a) Notwithstanding any other provision of law, payments to which 
any facility of the Service (including a hospital, nursing facility, 
intermediate care facility for the mentally retarded, or any other type 
of facility which provides services for which payment is available 
under title XIX of the Social Security Act) is entitled under a State 
plan by reason of section 1911 of such Act shall be placed in a special 
fund to be held by the Secretary and first used (to such extent or in 
such amounts as are provided in appropriation Acts) for the purpose of 
making any improvements in the facilities of such Service which may be 
necessary to achieve or maintain compliance with the applicable 
conditions and requirements of such title. Any payments which are in 
excess of the amount necessary to achieve or maintain such conditions 
and requirements shall, subject to the consultation with Tribes being 
served by the service unit, be used for reducing the health resource 
deficiencies of the Indian tribes. In making payments from such fund, 
the Secretary shall ensure that each service unit of the Service 
receives 100 percent of the amounts to which the facilities of the 
Service, for which such service unit makes collections, are entitled by 
reason of section 1911 of the Social Security Act. This subsection 
shall not apply to Indian tribes and tribal organizations that elect 
under section 405 to receive payments directly.
    ``(b) Any payments received under section 1911 of the Social 
Security Act for services provided to Indians eligible for benefits 
under title XIX of the Social Security Act shall not be considered in 
determining appropriations for the provision of health care and 
services to Indians.
    ``(c) For provisions relating to the authority of certain Indian 
tribes and tribal organizations to elect to directly bill for, and 
receive payment for, health care services provided by a hospital or 
clinic of such Tribes or tribal organizations and for which payment may 
be made under this title, see section 405 of the Indian Health Care 
Improvement Act.

``SEC. 403. REPORT.

    ``(a) The Secretary shall submit to the President, for inclusion in 
the report required to be transmitted to the Congress under section 
801, an accounting on the amount and use of funds made available to the 
Service pursuant to this title as a result of reimbursements through 
titles XVIII and XIX of the Social Security Act, as amended.
    ``(b) If an Indian tribe or tribal organization receives funding 
from the Service under the Indian Self-Determination and Education 
Assistance Act or an urban Indian organization receives funding from 
the Indian Health Service under title V of the Indian Health Care 
Improvement Act receives reimbursements or payments under title XVIII 
(medicare), title XIX (medicaid), or title XXI (children's health 
insurance program) of the Social Security Act, such Indian tribe, 
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 payments.

``SEC. 404. GRANTS TO AND FUNDING AGREEMENTS WITH THE SERVICE, INDIAN 
              TRIBES, TRIBAL ORGANIZATIONS, AND URBAN INDIAN 
              ORGANIZATIONS.

    ``(a) The Secretary shall make grants to or enter into funding 
agreements with Indian tribes and tribal organizations to assist such 
organizations in establishing and administering programs on or near 
Federal Indian reservations and trust areas and in or near Alaska 
Native villages to assist individual Indians to--
            ``(1) enroll under section 1818 of part A and sections 1836 
        and 1837 of part B of title XVIII of the Social Security Act;
            ``(2) pay premiums for coverage; and
            ``(3) apply for medical assistance provided pursuant to 
        title XIX (medicaid) and XXI (children's health insurance 
        program) of the Social Security Act.
    ``(b) The Secretary shall place conditions as deemed necessary to 
effect the purpose of this section in any funding agreement or grant 
which the Secretary makes with any Indian tribe or tribal organization 
pursuant to this section. Such conditions shall include, but are not 
limited to, requirements that the organization successfully undertake 
to--
            ``(1) determine the population of Indians to be served that 
        are or could be recipients of benefits under titles XVIII, XIX, 
        and XXI of the Social Security Act;
            ``(2) assist individual Indians in becoming familiar with 
        and using such benefits;
            ``(3) provide transportation to such individual Indians to 
        the appropriate offices for enrollment or applications for 
        medical assistance; and
            ``(4) develop and implement--
                    ``(A) a schedule of income levels to determine the 
                extent of payments of premiums by such organizations 
                for coverage of needy individuals; and
                    ``(B) methods of improving the participation of 
                Indians in receiving the benefits provided under titles 
                XVIII, XIX, and XXI of the Social Security Act.
    ``(c) The Secretary may enter into an agreement with an Indian 
tribe, tribal organization, or urban Indian organization which provides 
for the receipt and processing of applications for medical assistance 
under title XIX of the Social Security Act and benefits under titles 
XVIII and XXI of the Social Security Act by a Service facility or a 
health care program administered by such Indian tribe, tribal 
organization, or urban Indian organization pursuant to a funding 
agreement under the Indian Self-Determination and Education Assistance 
Act or a grant or contract entered into with an urban Indian 
organization under title V of this Act. Notwithstanding any other 
provision of law, such agreements shall provide for reimbursement of 
the cost of outreach, education regarding eligibility and benefits, and 
translation when such services are provided. The reimbursement may be 
included in an encounter rate or be made on a fee for service basis as 
appropriate for the provider. When necessary to carry out the terms of 
this section, the Secretary, acting through the Health Care Financing 
Administration or the Service, may enter into agreements with a State 
(or political subdivision thereof) to facilitate cooperation between 
the State and the Service, Indian tribe, or tribal organization.
    ``(d)(1) The Secretary shall make grants or enter into contracts 
with urban Indian organizations to assist such organizations in 
establishing and administering programs to assist individual urban 
Indians to--
            ``(A) enroll under section 1818 of part A and sections 1836 
        and 1837 of part B of title XVIII (medicare) of the Social 
        Security Act;
            ``(B) pay premiums on behalf of such individuals for 
        coverage under title XVIII of the Social Security Act; and
            ``(C) apply for medical assistance provided under title XIX 
        (medicaid) of the Social Security Act and for child health 
        assistance under title XXI (child health insurance program) of 
        the Social Security Act.
    ``(2) The Secretary shall include in the grants or contracts made 
or entered into 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. 405. DIRECT BILLING AND REIMBURSEMENT OF MEDICARE, MEDICAID, AND 
              OTHER THIRD-PARTY PAYORS.

    ``(a)(1) An Indian tribe or tribal organization may directly bill 
for, and receive payment for, health care services provided by such 
health program for which payment is made under title XVIII of the 
Social Security Act (42 U.S.C. 1395 et seq.) (medicare), under a State 
plan for medical assistance approved under title XIX of the Social 
Security Act (42 U.S.C. 1396 et seq.) (medicaid), under a State's 
children's health insurance plan approved under title XXI of the Social 
Security Act (42 U.S.C. 1397aa et seq.) or from any other third-party 
payor.
    ``(2) The third sentence of section 1905(b) of the Social Security 
Act (42 U.S.C. 1396d(b)) and the second sentence of section 2101(c) of 
the Social Security Act (42 U.S.C. 1397aa(c)) shall apply for purposes 
of reimbursement under the medicaid or children's health insurance 
program for health care services directly billed under the program 
established under this section.
    ``(b)(1) Each Indian tribe or tribal organization exercising the 
option described in subsection (a) of this section shall be reimbursed 
directly under the medicare, medicaid, and children's health insurance 
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 
section 402(a) of this title, but all funds so reimbursed shall first 
be used by the health program for the purpose of making any 
improvements in the facility or health programs that may be necessary 
to achieve or maintain compliance with the conditions and requirements 
applicable generally to such health services under the medicare, 
medicaid, or children's health insurance program. Any funds so 
reimbursed which are in excess of the amount necessary to achieve or 
maintain such conditions or requirements shall be used to provide 
additional health services, improvements in its health care facilities, 
or otherwise to achieve the health objectives provided for under 
section 3 of this Act.
    ``(2) The amounts paid to the health programs exercising the option 
described in subsection (a) of this section shall be subject to all 
auditing requirements applicable to programs administered directly by 
the Service and to facilities participating in the medicare, medicaid, 
and children's health insurance programs.
    ``(3) Notwithstanding section 1880(c) of the Social Security Act 
(42 U.S.C. 1395qq(c)) or section 402(a) of this title, no payment may 
be made out of the special fund described in section 1880(c) of the 
Social Security Act (42 U.S.C. 1395qq(c)), or section 402(a) of this 
title, for the benefit of any health program exercising the option 
described in subsection (a) of this section during the period of such 
participation.
    ``(c) The Secretary, and with the assistance of the Administrator 
of the Health Care Financing Administration, 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 section, including any agreements with 
States that may be necessary to provide for direct billing under the 
medicaid or children's health insurance program.
    ``(d) A participant in the program established under this section 
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 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 section shall be returned to the Secretary upon the 
Secretary's acceptance of the withdrawal of participation in this 
program.

``SEC. 406. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF HEALTH 
              SERVICES.

    ``(a) Except as provided in subsection (g), the United States, an 
Indian tribe, or tribal organization shall have the right to recover 
the reasonable charges billed or expenses incurred by the Secretary, an 
Indian tribe, or tribal organization in providing health services, 
through the Service, an Indian tribe, or tribal organization to any 
individual to the same extent that such individual, or any 
nongovernmental provider of such services, would be eligible to receive 
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 expenses.
    ``(b) Except as provided in subsection (g), an urban Indian 
organization shall have the right to recover the reasonable charges 
billed or expenses incurred by the organization in providing health 
services to any individual to the same extent that such individual, or 
any other nongovernmental provider of such services, would be eligible 
to receive reimbursement or indemnification for such charges or 
expenses if such individual had been required to pay such charges or 
expenses and did pay such charges or expenses.
    ``(c) Subsections (a) and (b) 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.
    ``(d) No law of any State, or of any political subdivision of a 
State and no provision of any contract entered into or renewed after 
the date of enactment of the Indian Health Care Amendments of 1988, 
shall prevent or hinder the right of recovery of the United States, an 
Indian tribe, or tribal organization under subsection (a) or an urban 
Indian organization under subsection (b).
    ``(e) No action taken by the United States, an Indian tribe, or 
tribal organization to enforce the right of recovery provided under 
subsection (a), or by an urban Indian organization to enforce the right 
of recovery provided under subsection (b), 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).
    ``(f) The United States, an Indian tribe, or tribal organization 
may enforce the right of recovery provided under subsection (a), and an 
urban Indian organization may enforce the right of recovery provided 
under subsection (b), 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, tribal 
                organization, or urban Indian organization; or
                    ``(B) by any representative or heirs of such 
                individual, or
            ``(2) instituting a civil action.
All reasonable efforts shall be made to provide notice of such action 
to the individual to whom health services were provided, either before 
or during the pendency of such action.
    ``(g) 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 one 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. However, 
where such tribal authorization is provided, the Service may receive 
and expend such funds for the provision of additional health services.
    ``(h) 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.
    ``(i) Where an insurance company or employee benefit plan fails or 
refuses to pay the amount due under subsection (a) of this section for 
services provided to an individual who is a beneficiary, participant, 
or insured of such company or plan, the United States, Indian tribe, or 
tribal organization shall have a right to assert and pursue all the 
claims and remedies against such company or plan, and against the 
fiduciaries of such company or plan, that the individual could assert 
or pursue under applicable Federal, State, or tribal law.
    ``(j) Where an insurance company or employee benefit plan fails or 
refuses to pay the amounts due under subsection (b) for health services 
provided to an individual who is a beneficiary, participant, or insured 
of such company or plan, the urban Indian organization shall have a 
right to assert and pursue all the claims and remedies against such 
company or plan, and against the fiduciaries of such company or plan, 
that the individual could assert or pursue under applicable Federal or 
State law.
    ``(k) Notwithstanding any other provision in law, the Service, an 
Indian tribe, tribal organization, or an urban Indian organization 
shall have a right of recovery for any otherwise reimbursable claim 
filed on a current HCFA-1500 or UB-92 form, or the current electronic 
format, or their successors. No health plan shall deny payment because 
a claim has not been submitted in a unique format that differs from 
such forms.

``SEC. 407. CREDITING OF REIMBURSEMENTS.

    ``(a) Except as provided in section 202(d), this title, and section 
807, all reimbursements received or recovered, under authority of this 
Act, Public Law 87-693 (42 U.S.C. 2651 et seq.), or any other provision 
of law, by reason of the provision of health services by the Service or 
by an Indian tribe or tribal organization under a funding agreement 
pursuant to the Indian Self-Determination and Education Assistance Act 
or by an urban Indian organization funded under title V shall be 
retained by the Service or that Tribe or tribal organization and shall 
be available for the facilities, and to carry out the programs, of the 
Service or that Tribe or tribal organization to provide health care 
services to Indians.
    ``(b) The Service may not offset or limit the amount of funds 
obligated to any service unit or entity receiving funding from the 
Service because of the receipt of reimbursements under subsection (a).

``SEC. 408. PURCHASING HEALTH CARE COVERAGE.

    ``Tribes, tribal organizations, and urban Indian organizations are 
authorized to use funding from the Secretary under this Act to purchase 
managed care coverage for Indian Health Services beneficiaries 
(including authority to purchase insurance to limit the financial risks 
of such entities) from--
            ``(1) a tribally owned and operated managed care plan;
            ``(2) a State or locally authorized or licensed managed 
        care plan; or
            ``(3) a health insurance provider.

``SEC. 409. INDIAN HEALTH SERVICE, DEPARTMENT OF VETERANS AFFAIRS, AND 
              OTHER FEDERAL AGENCY HEALTH FACILITIES AND SERVICES 
              SHARING.

    ``(a) The Secretary shall examine the feasibility of entering into 
arrangements or expanding existing arrangements for the sharing of 
medical facilities and services between the Indian Health Service and 
the Veterans Administration, and other appropriate Federal agencies, 
including those within the Department, and shall, in accordance with 
subsection (b), prepare a report on the feasibility of such an 
arrangement and submit such report to the Congress by no later than 
September 30, 2000, provided that the Secretary may not finalize any 
such agreement without first consulting with the affected Indian 
tribes.
    ``(b) The Secretary shall not take any action under this section or 
under subchapter IV of chapter 81 of title 38, United States Code, 
which would impair--
            ``(1) the priority access of any Indian to health care 
        services provided through the Indian Health Service;
            ``(2) the quality of health care services provided to any 
        Indian through the Indian Health Service;
            ``(3) the priority access of any veteran to health care 
        services provided by the Veterans Administration;
            ``(4) the quality of health care services provided to any 
        veteran by the Veterans Administration;
            ``(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 Veterans Administration 
        (provided that the Service, the Indian tribe or tribal 
        organization shall be reimbursed by the Veterans Administration 
        where services are provided through the Service, Indian tribes 
        or tribal organizations to beneficiaries eligible for services 
        from the Veterans Administration, notwithstanding any other 
        provision of law).
    ``(c) The Director is authorized to enter into agreements with 
other Federal agencies to assist in achieving parity in services for 
Indians. Nothing in this section may be construed as creating any right 
of a veteran to obtain health services from the Indian Health Service.

``SEC. 410. PAYOR OF LAST RESORT.

    ``The Indian Health Service, and programs operated by Tribes, 
tribal organizations, or urban Indian organizations shall be the payor 
of last resort for services provided to persons eligible for services 
from these programs, notwithstanding any Federal, State, or local law 
to the contrary, unless such law explicitly provides otherwise.

``SEC. 411. PAYMENT OR REIMBURSEMENT FOR SERVICES.

    ``Notwithstanding any other provision of law, the Indian Health 
Service, Indian Tribes, tribal organizations, and urban Indian 
organizations (notwithstanding limitations on who is eligible to 
receive services from such entity) shall be eligible to receive payment 
or reimbursement for services provided by such entities from any 
federally funded health care program, unless there is an 
explicit prohibition on such payments in the applicable authorizing 
statute.

``SEC. 412. TUBA CITY DEMONSTRATION PROJECT.

    ``Notwithstanding any other provision of law, including the Anti-
Deficiency Act, provided the Indian tribes to be served approve, the 
Service in the Tuba City Service Unit is authorized to enter into a 
demonstration project with the State of Arizona under which the Service 
would provide certain specified medicaid services to Indian Health 
Services/medicaid eligibles in return for payment on a capitated basis 
from the State of Arizona and is authorized to purchase insurance to 
limit its financial risks under this project. This project may be 
extended to other service units in Arizona, subject to the approval of 
the Indian tribes to be served in such service units, the Service, and 
the State of Arizona.

``SEC. 413. ACCESS TO FEDERAL INSURANCE.

    ``Notwithstanding the provisions of title 5, United States Code, 
executive order, or administrative regulation, an Indian tribe or 
tribal organization carrying out programs under the Indian Self-
Determination and Education Assistance Act or an urban Indian 
organization carrying out programs under title V of this Act shall be 
entitled to purchase coverage, rights, and benefits for the employees 
of such Indian tribe, tribal organization, or urban Indian organization 
under chapter 89 of title 5, United States Code, (relating to health 
insurance) and chapter 87 of title 5, United States Code, (relating to 
life insurance) if necessary employee deductions and agency 
contributions in payment for the coverage, rights, and benefits for the 
period of employment with such Indian tribe, tribal organization, or 
urban Indian organization are currently deposited in the applicable 
Employee's Fund under title 5, United States Code.

``SEC. 414. CONSULTATION AND RULEMAKING.

    ``(a) Consultation.--Prior to the adoption of any policy or 
regulation by the Health Care Financing Administration, the Secretary 
shall--
            ``(1) identify the impact such policy or regulation may 
        have on the Service, Indian tribes, tribal organizations, and 
        urban Indian organizations;
            ``(2) provide to the Service, Indian tribes, tribal 
        organizations, and urban Indian organizations the information 
        described in paragraph (1); and
            ``(3) engage in consultation with the Service, Indian 
        tribes, tribal organizations, and urban Indian organizations 
        prior to enacting any such policy or regulation. Such 
        consultation shall be consistent with the requirements of 
        Executive Order 13084 of May 14, 1998.
    ``(b) Rulemaking.--The Health Care Financing Administration shall 
participate in the negotiated rulemaking provided for under title VIII 
of this Act with regard to any regulations necessary to implement the 
provisions of this title that relate to the Social Security Act.''.

``SEC. 415. LIMITATION ON SECRETARY'S WAIVER AUTHORITY.

    ``Notwithstanding any other provision of law, the Secretary may not 
waive the application of section 1902(a)(13)(D) to any State Plan under 
title XIX of the Social Security Act.

``SEC. 416. CHILDREN'S HEALTH INSURANCE PROGRAM FUNDS.

    ``(a) Direct Funding.--The Secretary is authorized to enter into 
agreements directly with the Indian Health Service and Indian tribes 
and tribal organizations under which such entities will provide 
children's health insurance program-like services to Indians who reside 
in a service area on or near an Indian reservation. Such agreements may 
provide for funding under a block grant or such other mechanism as is 
agreed upon by the Secretary and the Indian Health Service, Indian 
tribe, or tribal organization. Such agreements may not be made 
contingent on the approval of the State in which the Indians to be 
served reside.
    ``(b) Transfer.--Notwithstanding any other provision of law, a 
State may transfer funds to which it is, or would otherwise be, 
entitled under title XXI of the Social Security Act to the Indian 
Health Service, Indian tribes, and tribal organizations to be 
administered to achieve the purposes and objectives of such title under 
agreements between the State and recipient entity or under an agreement 
directly between the recipient entity and the Health Care Financing 
Administration.

``SEC. 417. WAIVER OF MEDICARE AND MEDICAID SANCTIONS.

    ``Notwithstanding any other provision of law, the Indian Health 
Service or an Indian tribe or tribal organization operating a health 
program under the Indian Self-Determination and Education Assistance 
Act shall be entitled to seek a waiver of sanctions imposed under title 
XVIII, XIX, or XXI of the Social Security Act as if it were directly 
responsible for administering the State health care program.

``SEC. 418. SAFE HARBOR.

    ``(a) The term `remuneration' as used in sections 1128A and 1128B 
of the Social Security Act (42 U.S.C. 1320a-7a and 1320a-7b) shall not 
include any exchange of anything of value between or among--
            ``(1) any Indian tribe or tribal organization that 
        administers health programs under the authority of the Indian 
        Self-Determination and Education Assistance Act (25 U.S.C. 450 
        et seq.);
            ``(2) any such Indian tribe or tribal organization and the 
        Indian Health Service;
            ``(3) any such Indian tribe or tribal organization and any 
        patient served or eligible for service under such programs, 
        including patients served or eligible for service pursuant to 
        section 813 of Public Law 94-437 (25 U.S.C. 1680c); or
            ``(4) any such Indian tribe or tribal organization and any 
        third party required by contract, section 206 or 207 of Public 
        Law 94-437 (42 U.S.C. 1621e or 1621f), or other applicable law, 
        to pay or reimburse the reasonable health care costs incurred 
        by the United States or any such Indian tribe or tribal 
        organization;
if the exchange arises from or relates to such health programs.
    ``(b) An Indian tribe, tribal organization, or urban Indian 
organization that administers health programs under the authority of 
the Indian Self-Determination and Education Assistance Act (25 U.S.C. 
450 et seq.) or title V of the Indian Health Care Improvement Act shall 
be deemed to be an agency of the United States and immune from 
liability under the Sherman Act (15 U.S.C. 1 et seq.), the Clayton Act 
(15 U.S.C. 12 et seq.), the Robinson-Patman Act, the Federal Trade 
Commission Act (15 U.S.C. 41 et seq.), and any other Federal, State, or 
local antitrust laws, with regard to any transaction, agreement, or 
conduct that relates to such programs.

``SEC. 419. COST SHARING.

    ``(a) Coinsurance, Copayments, and Deductibles.--Notwithstanding 
any other provision of Federal or State law, no Indian who is eligible 
for services under title XVIII, XIX, or XXI of the Social Security Act, 
or any other federally funded health programs may be charged a 
deductible, copayment, or coinsurance for any service provided by or 
through the Indian Health Service, an Indian tribe, tribal 
organization, or urban Indian organization, nor may the payment or 
reimbursement due to the Indian Health Service or an Indian tribe, 
tribal organization, or urban Indian organization 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. For the purposes 
of this section, `through' shall include services provided directly, by 
referral, or under contracts or other arrangements between the 
Indian Health Service, Indian tribe, tribal organization, or urban 
Indian organization and another health provider.
    ``(b) Premiums.--
            ``(1) Medicaid and child health insurance program.--
        Notwithstanding any other provision of Federal or State law, no 
        Indian who is otherwise eligible for services under title XIX 
        (medicaid) or title XXI (children's health insurance program) 
        of the Social Security Act may be charged a premium as a 
        condition of receiving benefits from the program.
            ``(2) Medicare enrollment premium penalties.--
        Notwithstanding any other provision of Federal or State law, no 
        Indian (as that term is defined in section 4 of the Indian 
        Health Care Improvement Act) who is eligible for Medicare, but 
        for the payment of premiums, shall be charged a penalty for 
        enrolling in Medicare at a time later than the person might 
        otherwise have been eligible. This prohibition applies whether 
        the Indian pays for the premiums directly or the premiums are 
        paid by another person or entity, including a State, the Indian 
        Health Service, an Indian tribe, tribal organization, or an 
        urban Indian organization.
    ``(c) Medically Needy Program Spend-Down.--For the purposes of any 
medically needy option under a State's Medicaid plan under title XIX of 
the Social Security Act, the cost of providing services to an Indian in 
a health program of the Indian Health Service, an Indian tribe, tribal 
organization, or urban Indian organization shall be deemed to have been 
an expenditure for health care by the person applying for Medicaid.
    ``(d) Estate Recovery.--Notwithstanding any other provision of 
Federal or State law, the following property may not be included when 
determining eligibility for services or implementing estate recovery 
rights under title XVIII, XIX, or XXI of the Social Security Act, or 
other health care programs funded in whole or part with Federal 
moneys--
            ``(1) income derived from rents, leases, or royalties of 
        property held in trust for individuals by the Federal 
        Government;
            ``(2) income derived from rents, leases, royalties, or 
        natural resources (including timber and fishing activities) 
        resulting from the exercise of federally protected rights, 
        whether collected by an individual or tribal group, and 
        distributed to individuals;
            ``(3) property, including interests in real property 
        currently or formerly held in trust by the Federal Government 
        which is protected under applicable Federal, State or tribal 
        law or custom from recourse and including public domain 
        allotments; and
            ``(4) property that has unique religious or cultural 
        significance or that supports subsistence or traditional 
        lifestyle according to applicable tribal law or custom.
    ``(e) Medical Child Support Recovery.--Notwithstanding any other 
provision of law, a parent shall not be responsible for reimbursing a 
State or the Federal Government for the cost of medical services 
provided to a child by or through the Indian Health Service, an Indian 
tribe, tribal organization, or urban Indian organization. For the 
purposes of this subsection, `through' shall include services provided 
directly, by referral, or under contracts or other arrangements between 
the Indian Health Service, Indian tribe, tribal organization or urban 
Indian organization and another health provider.

``SEC. 420. MANAGED CARE.

    ``(a) Recovery From Managed Care Plans.--(1) Notwithstanding any 
other provision in law, the Indian Health Service, an Indian tribe, 
tribal organization, or urban Indian organization shall have a right of 
recovery under section 408 of this title from all private and public 
health plans, including medicare, medicaid, children's health 
insurance, and privately managed care plans for the reasonable costs of 
delivering health services to Indians entitled to receive services from 
the Service, an Indian tribe, tribal organization, or urban Indian 
organization.
    ``(2) No provision of a contract, regulation or statute may be 
relied upon or interpreted to deny or reduce payments otherwise due 
under this section, except to the extent the Service, Indian tribe, 
tribal organization, or urban Indian organization has entered into an 
agreement with the managed care plan regarding services to be provided 
or rates to be paid, provided that such an agreement may not be made a 
prerequisite for such payments to be made.
    ``(3) Payments due under this section may not be less than those 
paid to a `preferred provider' under the managed care plan or, in the 
event there is no such rate, the usual and customary fee for equivalent 
services.
    ``(4) A managed care plan may not deny payment under this section 
because the insured or covered beneficiary of the plan has not 
submitted a claim.
    ``(5) Notwithstanding paragraphs (1) through (4) of this section, 
the Indian Health Service, an Indian tribe, tribal organization, or 
urban Indian organization that provides a health service to an Indian 
entitled under title XIX (medicaid) or enrolled under title XXI 
(children's health insurance program) of the Social Security Act to 
receive such services shall have the right to be paid directly by the 
State's Medicaid or children's health insurance program notwithstanding 
any agreements the State may have entered into with managed care 
organizations or providers.
    ``(6) A managed care organization that is enrolled in a State 
Medicaid program must as a condition of such enrollment offer a 
contract to health programs administered by the Indian Health Service, 
an Indian tribe, tribal organization, or urban Indian organization that 
provides health services in the geographic area served by the managed 
care organization and such contract (or other provider participation 
agreement) shall contain terms and conditions of participation and 
payment no more restrictive or onerous than those provided for in this 
section.
    ``(b) Prohibit Auto- and Default Assignment.--Notwithstanding any 
other provision of law or any waiver granted by the Secretary, no 
Indian may be assigned automatically or by default under any managed 
care plan paid under title XIX (medicaid) or title XXI (children's 
health insurance program) of the Social Security Act unless the person 
had the option of enrolling in a managed care plan or health program 
administered by the Service, an Indian tribe, tribal organization, or 
urban Indian organization in which case an Indian may be assigned only 
to such a managed care plan or health program.
    ``(c) Indian Managed Care Plans.--Notwithstanding any other 
provision of law, any State entering into agreements with one or more 
managed care organizations to provide services under title XIX or title 
XXI of the Social Security Act must enter into such an agreement with 
the Service, an Indian tribe, tribal organization, or urban Indian 
organization that can provide services to Indians who may be eligible 
or required to enroll in such a managed care plan similar to those to 
be offered by other managed care organizations. The Secretary and the 
State are hereby authorized to waive requirements regarding 
discrimination, capitalization, and other matters that might otherwise 
prevent the Indian managed care organization or health program from 
meeting Federal or State standards applicable to such organizations, 
provided such Indian managed care organization or health program must 
be able to offer its Indian enrollees services of an equivalent quality 
to that required of other managed care organizations.
    ``(d) Advertising.--A managed care organization entering into 
contracts to provide services to Indians on or near an Indian 
reservation shall provide a certificate of coverage or similar type of 
document that is written in the Indian language of the majority of the 
Indian population residing on such reservation.

``SEC. 421. NAVAJO NATION MEDICAID AGENCY.

    ``(a) Notwithstanding any other provision of law, the Secretary is 
authorized to treat 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.
    ``(b) Notwithstanding any other provision of law, the Secretary 
shall have the authority to assign and pay all funds for the provision 
of services to Indians living within the boundaries of the Navajo 
Nation under title XIX of the Social Security Act and related 
administrative funds under title XIX (medicaid) of the Social Security 
Act, which are currently paid to or would otherwise be paid to the 
States of Arizona, New Mexico, and Utah, to an entity established by 
the Navajo Nation and approved by the Secretary, which shall be 
denominated the Navajo Nation Medicaid Agency.
    ``(c) The Navajo Nation Medicaid Agency shall serve Indians living 
within the boundaries of the Navajo Nation and shall have the same 
authority and perform the same functions as other single State medicaid 
agencies.
    ``(d) The Secretary is authorized to directly assist the Navajo 
Nation in the development and implementation of a Navajo Nation 
Medicaid Agency for the administration, eligibility, payment, and 
delivery of Medicaid eligible services, including western and 
traditional Navajo healing services, within the Navajo Nation.
    ``(e) Notwithstanding section 1905(b) of the Social Security Act, 
the Federal medical assistance percentage shall be 100 per centum with 
respect to amounts the Navajo Nation Medicaid Agency expends for 
medical assistance for services and for related administrative costs.
    ``(f) The Secretary is further authorized to assist the Navajo 
Nation by providing funding including demonstration grant funding for 
this project.
    ``(g) The Secretary shall have the authority to waive applicable 
provisions of title XIX of the Social Security Act to establish, 
develop, and implement the Navajo Nation Medicaid Agency.
    ``(h) In the option of the Navajo Nation, the Secretary is 
authorized to treat the Navajo Nation as a State for the purposes of 
title XXI (children's health insurance program) under terms equivalent 
to those described in subsections (a) through (g) of this section.

``SEC. 422. INDIAN ADVISORY COMMITTEES.

    ``(a) National Indian Technical Advisory Group.--The Health Care 
Financing Administration shall establish and fund the expenses of a 
National Indian Technical Advisory Group which shall have no fewer than 
14 members including at least 1 member designated by the Indian tribes 
and tribal organizations in each service area, 1 urban Indian 
organization representative, and 1 member representing the Indian 
Health Service. The scope of the activities of such group shall be 
established under section 802. Such scope shall include providing 
comment on and advice regarding the programs funded under titles XVIII, 
XIX, and XXI of the Social Security Act or any other health care 
program funded (in whole or part) by the Health Care Financing 
Administration.
    ``(b) Indian Medicaid Advisory Committees.--The Health Care 
Financing Administration shall establish and provide funding for an 
Indian Medicaid Advisory Committee made up of designees of the Indian 
Health Service, Indian tribes, tribal organizations, and urban Indian 
organizations in each State in which the Indian Health Service directly 
operates a health program or in which there is 1 or more Indian tribe, 
tribal organization, or urban Indian organization.

``SEC. 423. LIMITATIONS ON CHARGES.

    ``No provider of health services that is eligible to receive 
payments or reimbursements from under title XVIII, XIX, or XXI of the 
Social Security Act or from any federally funded (whether in whole or 
part) health care program may seek to recover payment for services--
            ``(1) that are covered under and furnished to an individual 
        eligible for the contract health services program operated by 
        the Indian Health Service, by an Indian tribe or tribal 
        organization or furnished to an urban Indian eligible for 
        health services purchased by an urban Indian organization (as 
        those terms are defined in section 4 of the Indian Health Care 
        Improvement Act), an amount in excess of the lowest amount paid 
        by any other payor for comparable services; or
            ``(2) for examinations or other diagnostic procedures that 
        are not medically necessary if such procedures have already 
        been performed by the referring Indian health program and 
        reported to the provider.

``SEC. 424. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2012 to carry out 
this title.

              ``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

``SEC. 501. PURPOSE.

    ``The purpose of this title is to establish programs in urban 
centers to make health services more accessible and available to urban 
Indians.

``SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN ORGANIZATIONS.

    ``Under authority of the Act of November 2, 1921 (25 U.S.C. 13), 
popularly known as the Snyder Act, the Secretary, through the Service, 
shall enter into contracts with, or make grants to, urban Indian 
organizations to assist such organizations in the establishment and 
administration, within urban centers, of programs which meet the 
requirements set forth in this title. The Secretary, through the 
Service, subject to subsection 506, shall include such conditions as 
the Secretary considers necessary to effect the purpose of this title 
in any contract which the Secretary enters into with, or in any grant 
the Secretary makes to, any urban Indian organization pursuant to this 
title.

``SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH CARE AND 
              REFERRAL SERVICES.

    ``(a) Under authority of the Act of November 2, 1921 (25 U.S.C. 
13), popularly known as the Snyder Act, the Secretary, through the 
Service, shall enter into contracts with, and make grants to, urban 
Indian organizations for the provision of health care and referral 
services for urban Indians. Any such contract or grant shall include 
requirements that the urban Indian organization successfully undertake 
to--
            ``(1) estimate the population of urban Indians residing in 
        the urban center or centers that the organization proposes to 
        serve who are or could be recipients of health care or referral 
        services;
            ``(2) estimate the current health status of urban Indians 
        residing in such urban center or centers;
            ``(3) estimate the current health care needs of urban 
        Indians residing in such urban center or centers;
            ``(4) provide basic health education, including health 
        promotion and disease prevention education, to urban Indians;
            ``(5) make recommendations to the Secretary and Federal, 
        State, local, and other resource agencies on methods of 
        improving health service programs to meet the needs of urban 
        Indians; and
            ``(6) where necessary, provide, or enter into contracts for 
        the provision of, health care services for urban Indians.
    ``(b) The Secretary, through the Service, shall by regulation 
adopted pursuant to section 520 prescribe the criteria for selecting 
urban Indian organizations to enter into contracts or receive grants 
under this section. Such criteria shall, among other factors, include--
            ``(1) the extent of unmet health care needs of urban 
        Indians in the urban center or centers involved;
            ``(2) the size of the urban Indian population in the urban 
        center or centers involved;
            ``(3) the extent, if any, to which the activities set forth 
        in subsection (a) would duplicate any project funded under this 
        title;
            ``(4) the capability of an urban Indian organization to 
        perform the activities set forth in subsection (a) and to enter 
        into a contract with the Secretary or to meet the requirements 
        for receiving a grant under this section;
            ``(5) the satisfactory performance and successful 
        completion by an urban Indian organization of other contracts 
        with the Secretary under this title;
            ``(6) the appropriateness and likely effectiveness of 
        conducting the activities set forth in subsection (a) in an 
        urban center or centers; and
            ``(7) the extent of existing or likely future participation 
        in the activities set forth in subsection (a) by appropriate 
        health and health-related Federal, State, local, and other 
        agencies.
    ``(c) The Secretary shall facilitate access to, or provide, health 
promotion and disease prevention services for urban Indians through 
grants made to urban Indian organizations administering contracts 
entered into pursuant to this section or receiving grants under 
subsection (a).
    ``(d)(1) The Secretary shall facilitate access to, or provide, 
immunization services for urban Indians through grants made to urban 
Indian organizations administering contracts entered into or receiving 
grants under this section.
    ``(2) For purposes of this subsection, the term `immunization 
services' means services to provide without charge immunizations 
against vaccine-preventable diseases.
    ``(e)(1) The Secretary shall facilitate access to, or provide, 
mental health services for urban Indians through grants made to urban 
Indian organizations administering contracts entered into pursuant to 
this section or receiving grants under subsection (a).
    ``(2) A grant may not be made under this subsection to an urban 
Indian organization until that organization has prepared, and the 
Service has approved, an assessment of the mental health needs of the 
urban Indian population concerned, the mental health services, and 
other related resources available to that population, the barriers to 
obtaining those services and resources, and the needs that are unmet by 
such services and resources.
    ``(3) Grants may be made under this subsection--
            ``(A) to prepare assessments required under paragraph (2);
            ``(B) to provide outreach, educational, and referral 
        services to urban Indians regarding the availability of direct 
        behavioral health services, to educate urban Indians about 
        behavioral health issues and services, and effect coordination 
        with existing behavioral health providers in order to improve 
        services to urban Indians;
            ``(C) to provide outpatient behavioral health services to 
        urban Indians, including the identification and assessment of 
        illness, therapeutic treatments, case management, support 
        groups, family treatment, and other treatment; and
            ``(D) to develop innovative behavioral health service 
        delivery models which incorporate Indian cultural support 
        systems and resources.
    ``(f)(1) The Secretary shall facilitate access to, or provide, 
services for urban Indians through grants to urban Indian organizations 
administering contracts entered into pursuant to this section or 
receiving grants under subsection (a) to prevent and treat child abuse 
(including sexual abuse) among urban Indians.
    ``(2) A grant may not be made under this subsection to an urban 
Indian organization until that organization has prepared, and the 
Service has approved, an assessment that documents the prevalence of 
child abuse in the urban Indian population concerned and specifies the 
services and programs (which may not duplicate existing services and 
programs) for which the grant is requested.
    ``(3) Grants may be made under this subsection--
            ``(A) to prepare assessments required under paragraph (2);
            ``(B) for the development of prevention, training, and 
        education programs for urban Indian populations, including 
        child education, parent education, provider training on 
        identification and intervention, education on reporting 
        requirements, prevention campaigns, and establishing service 
        networks of all those involved in Indian child protection; and
            ``(C) to provide direct outpatient treatment services 
        (including individual treatment, family treatment, group 
        therapy, and support groups) to urban Indians who are child 
        victims of abuse (including sexual abuse) or adult survivors of 
        child sexual abuse, to the families of such child victims, and 
        to urban Indian perpetrators of child abuse (including sexual 
        abuse).
    ``(4) In making grants to carry out this subsection, the Secretary 
shall take into consideration--
            ``(A) the support for the urban Indian organization 
        demonstrated by the child protection authorities in the area, 
        including committees or other services funded under the Indian 
        Child Welfare Act of 1978 (25 U.S.C. 1901 et seq.), if any;
            ``(B) the capability and expertise demonstrated by the 
        urban Indian organization to address the complex problem of 
        child sexual abuse in the community; and
            ``(C) the assessment required under paragraph (2).
    ``(g) The Secretary, through the Service, may enter into a contract 
with, or make grants to, an urban Indian organization that provides or 
arranges for the provision of health care services (through satellite 
facilities, provider networks, or otherwise) to urban Indians in more 
than 1 urban center.

``SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINATION OF UNMET HEALTH 
              CARE NEEDS.

    ``(a) Under authority of the Act of November 2, 1921 (25 U.S.C. 
13), popularly known as the Snyder Act, the Secretary, through the 
Service, may enter into contracts with, or make grants to, urban Indian 
organizations situated in urban centers for which contracts have not 
been entered into, or grants have not been made, under section 503. The 
purpose of a contract or grant made under this section shall be the 
determination of the matters described in subsection (b)(1) in order to 
assist the Secretary in assessing the health status and health care 
needs of urban Indians in the urban center involved and determining 
whether the Secretary should enter into a contract or make a grant 
under section 503 with respect to the urban Indian organization which 
the Secretary has entered into a contract with, or made a grant to, 
under this section.
    ``(b) Any contract entered into, or grant made, by the Secretary 
under this section shall include requirements that--
            ``(1) the urban Indian organization successfully undertakes 
        to--
                    ``(A) document the health care status and unmet 
                health care needs of urban Indians in the urban center 
                involved; and
                    ``(B) with respect to urban Indians in the urban 
                center involved, determine the matters described in 
                paragraphs (2), (3), (4), and (7) of section 503(b); 
                and
            ``(2) the urban Indian organization complete performance of 
        the contract, or carry out the requirements of the grant, 
        within 1 year after the date on which the Secretary and such 
        organization enter into such contract, or within 1 year after 
        such organization receives such grant, whichever is applicable.
    ``(c) The Secretary may not renew any contract entered into, or 
grant made, under this section.

``SEC. 505. EVALUATIONS; RENEWALS.

    ``(a) The Secretary shall develop procedures to evaluate compliance 
with grant requirements under this title and compliance with, and 
performance of contracts entered into by urban Indian organizations 
under this title. Such procedures shall include provisions for carrying 
out the requirements of this section.
    ``(b) The Secretary shall evaluate the compliance of each urban 
Indian organization which has entered into a contract or received a 
grant under section 503 with the terms of such contract or grant. For 
purposes of this evaluation, the Secretary, in determining the capacity 
of an urban Indian organization to deliver quality patient care shall, 
at the option of the organization--
            ``(1) 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 or providers 
        participating in the Medicare program under title XVIII of the 
        Social Security Act.
    ``(c) If, as a result of the evaluations conducted under this 
section, the Secretary determines that an urban Indian organization has 
not complied with the requirements of a grant or complied with or 
satisfactorily performed a contract under section 503, the Secretary 
shall, prior to renewing such contract or grant, attempt to resolve 
with such organization the areas of noncompliance or unsatisfactory 
performance and modify such contract or grant to prevent future 
occurrences of such noncompliance or unsatisfactory performance. If the 
Secretary determines that such noncompliance or unsatisfactory 
performance cannot be resolved and prevented in the future, the 
Secretary shall not renew such contract or grant with such organization 
and is authorized to enter into a contract or make a grant under 
section 503 with another urban Indian organization which is situated in 
the same urban center as the urban Indian organization whose contract 
or grant is not renewed under this section.
    ``(d) In determining whether to renew a contract or grant with an 
urban Indian organization under section 503 which has completed 
performance of a contract or grant under section 504, the Secretary 
shall review the records of the urban Indian organization, the reports 
submitted under section 507, and, in the case of a renewal of a 
contract or grant under section 503, shall consider the results of the 
onsite evaluations or accreditations under subsection (b).

``SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS.

    ``(a) Contracts with urban Indian organizations entered into 
pursuant to this title shall be in accordance with all Federal 
contracting laws and regulations relating to procurement except that in 
the discretion of the Secretary, such contracts may be negotiated 
without advertising and need not conform to the provisions of the Act 
of August 24, 1935 (40 U.S.C. 270a et seq.).
    ``(b) Payments under any contracts or grants pursuant to this title 
shall, notwithstanding any term or condition of such contract or 
grant--
            ``(1) be made in their entirety by the Secretary to the 
        urban Indian organization by no later than the end of the first 
        30 days of the funding period with respect to which the 
        payments apply, unless the Secretary determines through an 
        evaluation under section 505 that the organization is not 
        capable of administering such payments in their entirety; and
            ``(2) if 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 one or more subsequent funding periods without 
        additional justification or documentation by the organization 
        as a condition of carrying forward the expenditure of such 
        funds.
    ``(c) Notwithstanding any provision of law to the contrary, the 
Secretary may, at the request or consent of an urban Indian 
organization, revise or amend any contract entered into by the 
Secretary with such organization under this title as necessary to carry 
out the purposes of this title.
    ``(d) Contracts with or grants to urban Indian organizations and 
regulations adopted pursuant to this title shall include provisions to 
assure the fair and uniform provision to urban Indians of services and 
assistance under such contracts or grants by such organizations.
    ``(e) Urban Indians, as defined under section 4(t) of this Act, 
shall be eligible for health care or referral services provided 
pursuant to this title.

``SEC. 507. REPORTS AND RECORDS.

    ``(a) For each fiscal year during which an urban Indian 
organization receives or expends funds pursuant to a contract entered 
into, or a grant received, pursuant to this title, such organization 
shall submit to the Secretary on a basis no more frequent than every 6 
months, including--
            ``(1) in the case of a contract or grant under section 503, 
        information gathered pursuant to paragraph (5) of subsection 
        (a) of such section;
            ``(2) information on activities conducted by the 
        organization pursuant to the contract or grant;
            ``(3) an accounting of the amounts and purpose for which 
        Federal funds were expended; and
            ``(4) a minimum set of data, using uniformly defined 
        elements, that is specified by the Secretary in consultation 
        consistent with section 514, with urban Indian organizations.
    ``(b) The reports and records of the urban Indian organization with 
respect to a contract or grant under this title shall be subject to 
audit by the Secretary and the Comptroller General of the United 
States.
    ``(c) The Secretary shall allow as a cost of any contract or grant 
entered into or awarded under section 502 or 503 the cost of an annual 
independent financial audit conducted by--
            ``(1) a certified public accountant; or
            ``(2) a certified public accounting firm qualified to 
        conduct Federal compliance audits.

``SEC. 508. LIMITATION ON CONTRACT AUTHORITY.

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

``SEC. 509. FACILITIES.

    ``(a) The Secretary may make grants to contractors or grant 
recipients under this title for the lease, purchase, renovation, 
construction, or expansion of facilities, including leased facilities, 
in order to assist such contractors or grant recipients in complying 
with applicable licensure or certification requirements.
    ``(b) The Secretary, acting through the Service or through the 
Health Resources and Services Administration, may provide to 
contractors or grant recipients under this title loans from the Urban 
Indian Health Care Facilities Revolving Loan Fund (hereinafter in this 
section referred to as the `URLF') described in subsection (c), or 
guarantees for loans, for the construction, renovation, expansion, or 
purchase of health care facilities, subject to the following 
requirements:
            ``(1) The principal amount of a loan or loan guarantee may 
        cover 100 percent of the costs (other than staffing) relating 
        to the facility, including planning, design, financing, site 
        land development, construction, rehabilitation, renovation, 
        conversion, medical equipment, furnishings, and capital 
        purchase.
            ``(2) The total of the principal of loans and loan 
        guarantees, respectively, outstanding at any one time shall not 
        exceed such limitations as may be specified in appropriation 
        Acts.
            ``(3) The loan or loan guarantee may have a term of the 
        shorter of the estimated useful life of the facility, or 25 
        years.
            ``(4) An urban Indian organization may assign, and the 
        Secretary may accept assignment of, the revenue of the 
        organization as security for a loan or loan guarantee under 
        this subsection.
            ``(5) The Secretary shall not collect application, 
        processing, or similar fees from urban Indian organizations 
        applying for loans or loan guarantees under this subsection.
    ``(c)(1) There is established in the Treasury of the United States 
a fund to be known as the Urban Indian Health Care Facilities Revolving 
Loan Fund. The URLF shall consist of--
            ``(A) such amounts as may be appropriated to the URLF;
            ``(B) amounts received from urban Indian organizations in 
        repayment of loans made to such organizations under paragraph 
        (2); and
            ``(C) interest earned on amounts in the URLF under 
        paragraph (3).
    ``(2) Amounts in the URLF may be expended by the Secretary, acting 
through the Service or the Health Resources and Services 
Administration, to make loans available to urban Indian organizations 
receiving grants or contracts under this title for the purposes, and 
subject to the requirements, described in subsection (b). Amounts 
appropriated to the URLF, amounts received from urban Indian 
organizations in repayment of loans, and interest on amounts in the 
URLF shall remain available until expended.
    ``(3) The Secretary of the Treasury shall invest such amounts of 
the URLF as such Secretary determines are not required to meet current 
withdrawals from the URLF. Such investments may be made only in 
interest-bearing obligations of the United States. For such purpose, 
such obligations may be acquired on original issue at the issue price, 
or by purchase of outstanding obligations at the market price. Any 
obligation acquired by the URLF may be sold by the Secretary of the 
Treasury at the market price.

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

    ``There is hereby established within the Service an Office of Urban 
Indian Health, which shall be responsible for--
            ``(1) carrying out the provisions of this title;
            ``(2) providing central oversight of the programs and 
        services authorized under this title; and
            ``(3) providing technical assistance to urban Indian 
        organizations.

``SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE RELATED SERVICES.

    ``(a) The Secretary may make grants for the provision of health-
related services in prevention of, treatment of, rehabilitation of, or 
school and community-based education in, alcohol and substance abuse in 
urban centers to those urban Indian organizations with which the 
Secretary has entered into a contract under this title or under section 
201.
    ``(b) Each grant made pursuant to subsection (a) shall set forth 
the goals to be accomplished pursuant to the grant. The goals shall be 
specific to each grant as agreed to between the Secretary and the 
grantee.
    ``(c) The Secretary shall establish criteria for the grants made 
under subsection (a), including criteria relating to the--
            ``(1) size of the urban Indian population;
            ``(2) capability of the organization to adequately perform 
        the activities required under the grant;
            ``(3) satisfactory performance standards for the 
        organization in meeting the goals set forth in such grant, 
        which standards shall be negotiated and agreed to between the 
        Secretary and the grantee on a grant-by-grant basis; and
            ``(4) identification of need for services.
The Secretary shall develop a methodology for allocating grants made 
pursuant to this section based on such criteria.
    ``(d) Any funds received by an urban Indian organization under this 
Act for substance abuse prevention, treatment, and rehabilitation shall 
be subject to the criteria set forth in subsection (c).

``SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS.

    ``(a)(1) Notwithstanding any other provision of law, the Oklahoma 
City Clinic demonstration project shall be treated as a service unit in 
the allocation of resources and coordination of care and shall not be 
subject to the provisions of the Indian Self-Determination and 
Education Assistance Act for the term of such project. The Secretary 
shall provide assistance to such project in the development of 
resources and equipment and facility needs.
    ``(2) The Secretary shall submit to the President, for inclusion in 
the report required to be submitted to the Congress under section 801 
for fiscal year 1999, a report on the findings and conclusions derived 
from the demonstration project specified in paragraph (1).
    ``(b) Notwithstanding any other provision of law, the Tulsa Clinic 
demonstration project shall become permanent programs within the 
Service's direct care program and continue to be treated as service 
units in the allocation of resources and coordination of care, and 
shall continue to meet the requirements and definitions of an urban 
Indian organization in this title, and as such will not be subject to 
the provisions of the Indian Self-Determination and Education 
Assistance Act.

``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.

    ``(a) The Secretary shall, through the Office of Urban Indian 
Health of the Service, make grants or enter into contracts effective no 
later than September 30, 2001, with urban Indian organizations for the 
administration of urban Indian alcohol programs that were originally 
established under the National Institute on Alcoholism and Alcohol 
Abuse (hereafter in this section referred to as `NIAAA') and 
transferred to the Service.
    ``(b) Grants provided or contracts entered into under this section 
shall be used to provide support for the continuation of alcohol 
prevention and treatment services for urban Indian populations and such 
other objectives as are agreed upon between the Service and a recipient 
of a grant or contract under this section.
    ``(c) Urban Indian organizations that operate Indian alcohol 
programs originally funded under the NIAAA and subsequently transferred 
to the Service are eligible for grants or contracts under this section.
    ``(d) The Secretary shall evaluate and report to the Congress on 
the activities of programs funded under this section at least every 5 
years.

``SEC. 514. CONSULTATION WITH URBAN INDIAN ORGANIZATIONS.

    ``(a) The Secretary shall ensure that the Service, the Health Care 
Financing Administration, and other operating divisions and staff 
divisions of the Department consult, to the greatest extent 
practicable, with urban Indian organizations (as defined in section 
4(w)) prior to taking any action, or approving Federal financial 
assistance for any action of a State, that may affect urban Indians or 
urban Indian organizations.
    ``(b) For purposes of subsection (a), consultation is the open and 
free exchange of information and opinion among urban Indian 
organizations and the operating and staff divisions of the Department 
which leads to mutual understanding and comprehension and which 
emphasizes trust, respect, and shared responsibility.

``SEC. 515. FEDERAL TORT CLAIMS ACT COVERAGE.

    ``For purposes of section 224 of the Public Health Service Act of 
July 1, 1944 (42 U.S.C. 233(a)) with respect to claims by any person, 
initially filed on or after October 1, 1999, whether or not such person 
is an Indian or Alaska Native or is served on a fee basis or under 
other circumstances as permitted by Federal law or regulations, for 
personal injury, including death, resulting from the performance prior 
to, including, or after October 1, 1999, of medical, surgical, dental, 
or related functions, including the conduct of clinical studies or 
investigations, or for purposes of section 2679 of title 28, United 
States Code, with respect to claims by any such person, on or after 
October 1, 1999, for personal injury, including death, resulting from 
the operation of an emergency motor vehicle, an urban Indian 
organization that has entered into a contract or received a grant 
pursuant to this title is deemed to be part of the Public Health 
Service in the Department of Health and Human Services while carrying 
out any such contract or grant and its employees (including those 
acting on behalf of the organization as provided in section 2671 of 
title 28, United States Code, and including an individual who provides 
health care services pursuant to a personal services contract with an 
urban Indian organization for the provision of services in any facility 
owned, operated, or constructed under the jurisdiction of the Indian 
Health Service) are deemed employees of the Service while acting within 
the scope of their employment in carrying out the contract or grant. 
Such employees shall be deemed to be acting within the scope of their 
employment in carrying out the contract or grant when they are 
required, by reason of their employment, to perform medical, surgical, 
dental, or related functions at a facility other than a facility 
operated by the urban Indian organization pursuant to such contract or 
grant, but only if such employees are not compensated for the 
performance of such functions by a person or entity other than the 
urban Indian organization.

``SEC. 516. URBAN YOUTH TREATMENT CENTER DEMONSTRATION.

    ``(a) The Secretary shall, through grant or contract, make payment 
for 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) A State described in this subsection is a State in which--
            ``(1) there reside 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) The Secretary shall permit 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) 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 Indian Health Service or the General 
Services Administration for purposes of carrying out the contract or 
grant.
    ``(c) 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) In the event that the Secretary receives a request for a 
specific item of personal or real property described in subsection (b) 
or (c) from 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) For purposes of section 201(a) of the Federal Property and 
Administrative Services Act of 1949 (40 U.S.C. 481(a)) (relating to 
Federal sources of supply, including lodging providers, airlines, and 
other transportation providers), an urban Indian organization that has 
entered into a contract or received a grant pursuant to this title 
shall be deemed an executive agency when carrying out such contract or 
grant, and the employees of the urban Indian organization shall be 
eligible to have access to such sources of supply on the same basis as 
employees of an executive agency have such access.

``SEC. 518. GRANTS FOR DIABETES PREVENTION, TREATMENT, AND CONTROL.

    ``(a) The Secretary may make grants to those urban Indian 
organizations that have entered into a contract or have received a 
grant under this title for the provision of services for the 
prevention, treatment, and control of the complications resulting from, 
diabetes among urban Indians.
    ``(b) 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) 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, 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) 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, through the Service, may enter into contracts 
with, and make grants to, urban Indian organizations for the use of 
Indians trained as health service providers through the Community 
Health Representatives Program under section 107(b) in the provision of 
health care, health promotion, and disease prevention services to urban 
Indians.

``SEC. 520. REGULATIONS.

    ``(a) The amendments to this title made by the Indian Health Care 
Improvement Act Amendments of 2000 shall be effective on the date of 
enactment of such amendments, regardless of whether the Secretary has 
promulgated regulations implementing such amendments have been 
promulgated.
    ``(b) The Secretary may promulgate regulations to implement the 
provisions of this title.
            ``(1) Proposed regulations to implement this Act shall be 
        published in the Federal Register by the Secretary no later 
        than 270 days after the date of enactment of this Act and shall 
        have no less than a 120-day comment period.
            ``(2) The authority to promulgate regulations under this 
        Act shall expire 18 months from the date of enactment of this 
        Act.
    ``(c) The negotiated rulemaking committee described in this section 
shall be established pursuant to section 565 of title 5, United States 
Code, and shall have as the majority of its members representatives of 
urban Indian organizations from each service area in addition to 
Federal representatives.
    ``(d) The Secretary shall adapt the negotiated rulemaking 
procedures to the unique context of this Act.

``SEC. 521. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2012 to carry out 
this title.

                ``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

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

    ``(a) In order to more effectively and efficiently carry out the 
responsibilities, authorities, and functions of the United States to 
provide health care services to Indians and Indian tribes, as are or 
may be hereafter provided by Federal statute or treaties, there is 
established within the Public Health Service of the Department of 
Health and Human Services the Indian Health Service. The Indian Health 
Service shall be administered by a Director, who shall be appointed by 
the President, by and with the advice and consent of the Senate. The 
Director of the Indian Health Service shall report to the Secretary 
through the Assistant Secretary for Health of the Department of Health 
and Human Services. Effective with respect to an individual appointed 
by the President, by and with the advice and consent of the Senate, 
after January 1, 1993, the term of service of the Director shall be 4 
years. A Director may serve more than 1 term.
    ``(b) The Indian Health Service shall be an agency within the 
Public Health Service of the Department of Health and Human Services, 
and shall not be an office, component, or unit of any other agency of 
the Department.
    ``(c) The Secretary shall carry out through the Director of the 
Indian Health Service--
            ``(1) all functions which were, on the day before the date 
        of enactment of the Indian Health Care Amendments of 1988, 
        carried out by or under the direction of the individual serving 
        as Director of the Indian Health Service on such day;
            ``(2) all functions of the Secretary relating to the 
        maintenance and operation of hospital and health facilities for 
        Indians and the planning for, and provision and use of, health 
        services for Indians;
            ``(3) all health programs under which health care is 
        provided to Indians based upon their status as Indians which 
        are administered by the Secretary, including but not limited to 
        programs under--
                    ``(A) this Act;
                    ``(B) the Act of November 2, 1921 (25 U.S.C. 13);
                    ``(C) the Act of August 5, 1954 (42 U.S.C. 2001 et 
                seq.);
                    ``(D) the Act of August 16, 1957 (42 U.S.C. 2005 et 
                seq.); and
                    ``(E) the Indian Self-Determination and Education 
                Assistance Act (25 U.S.C. 450f et seq.); and
            ``(4) all scholarship and loan functions carried out under 
        title I.
    ``(d)(1) The Director shall have the authority--
            ``(A) except to the extent provided in paragraph (2), to 
        appoint and compensate employees for the Service in accordance 
        with title 5, United States Code;
            ``(B) to enter into contracts for the procurement of goods 
        and services to carry out the functions of the Service; and
            ``(C) to manage, expend, and obligate all funds 
        appropriated for the Service.
    ``(2) Notwithstanding any other law, the provisions of section 12 
of the Act of June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), shall apply 
to all personnel actions taken with respect to new positions created 
within the Service as a result of its establishment under subsection 
(a).
    ``(e) All personnel, records, equipment, facilities, and interests 
in property that are administered by the Indian Health Service shall be 
the transferred to the Indian Health Service established by the 
amendment made by subsection (a) of this section. All transfers must be 
accomplished within 9 months of the date of enactment of this section. 
The Secretary is authorize to waive the Indian preference laws on a 
case-by-case basis for temporary transfers involved in implementing 
this section during such 9-month period.
    ``(f)(1) Except as provided in paragraph (2), section 601 of the 
Indian Health Care Improvement Act shall take effect 9 months from the 
date of the enactment of this section.
    ``(2) Notwithstanding subsections (e) and (f)(1), any action which 
carries out such section 601 that is taken by the Secretary before the 
effective date of such section 601 shall be effective beginning on the 
date such action was taken.

``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.

    ``(a)(1) The Secretary shall establish an automated management 
information system for the Service.
    ``(2) The information system established under paragraph (1) shall 
include--
            ``(A) a financial management system;
            ``(B) a patient care information system for each area 
        served by the Service;
            ``(C) a privacy component that protects the privacy of 
        patient information held by, or on behalf of, the Service;
            ``(D) a services-based cost accounting component that 
        provides estimates of the costs associated with the provision 
        of specific medical treatments or services in each Area Office 
        of the Service;
            ``(E) an interface mechanism for patient billing and 
        accounts receivable system; and
            ``(F) a training component.
    ``(b) The Secretary shall provide each Indian tribe and tribal 
organization that provides health services under a contract entered 
into with the Service under the Indian Self-Determination and Education 
Assistance Act automated management information systems which--
            ``(1) meet the management information needs of such Indian 
        tribe or tribal organization with respect to the treatment by 
        the Indian tribe or tribal organization of patients of the 
        Service; and
            ``(2) meet the management information needs of the Service.
    ``(c) Notwithstanding any other provision of law, each patient 
shall have reasonable access to the medical or health records of such 
patient which are held by, or on behalf of, the Service.
    ``(d) The Director 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 are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2012 to carry out 
this title.

                ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

``SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREATMENT SERVICES.

    ``(a) The purposes of this section are to--
            ``(1) authorize and direct the Secretary, acting through 
        the Indian Health Service, and willing Indian tribes, tribal 
        organizations, and urban Indian organizations, to develop a 
        comprehensive behavioral health prevention and treatment 
        program which emphasizes collaboration among alcohol and 
        substance abuse, social services, and mental health programs;
            ``(2) 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) assist Indian tribes to identify services and 
        resources available to address mental illness and dysfunctional 
        and self-destructive behavior;
            ``(4) provide authority and opportunities for Indian tribes 
        to develop and implement, and coordinate with, community-based 
        programs which include identification, prevention, education, 
        referral, and treatment services, including through 
        multidisciplinary resource teams;
            ``(5) 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; 
        and
            ``(6) modify or supplement existing programs and 
        authorities in the areas identified in paragraph (2).
    ``(b)(1) The Secretary, acting through the Service, and willing 
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 area-wide plans 
for Indian Behavioral Health Services. The plans shall include, to the 
extent feasible, the following components:
            ``(A) An assessment of the scope of the problem 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, 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, including an assessment of the progress 
        toward achieving the availability of the full continuum of care 
        described in subsection (c).
            ``(C) An estimate of the additional funding needed by the 
        Service, Indian tribes, tribal organizations, and urban Indian 
        organizations to meet their responsibilities under the plans.
    ``(2) The Secretary shall establish a national clearinghouse of 
plans and reports on the outcomes of such plans developed by Indian 
tribes, tribal organizations, and by Areas relating to Behavioral 
Health. The Secretary shall ensure access to these plans and outcomes 
by any Indian tribe, tribal organization, urban organization, or the 
Service.
    ``(3) The Secretary shall provide technical assistance to Indian 
tribes, tribal organizations, and urban Indian organizations in 
preparation of their plans and in developing standards of care that may 
be used and adopted locally.
    ``(c) The Secretary, acting through the Service and willing Indian 
tribes and tribal organizations, shall provide, to the extent feasible 
and funding is available, programs including, but not limited to, the 
following:
            ``(1) 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/recovery goals;
                    ``(G) emergency shelter;
                    ``(H) intensive case management; and
                    ``(I) traditional health care practices.
            ``(2) Behavioral health services by the following services 
        and populations:
                    ``(A) Child Behavioral Health Services for persons 
                from birth through age 17, including--
                            ``(i) preschool and school age fetal 
                        alcohol disorder services, including assessment 
                        and behavioral intervention;
                            ``(ii) mental health/substance abuse 
                        services (emotional, organic, alcohol, drug, 
                        inhalant and, tobacco);
                            ``(iii) co-occurring disorders (multiple 
                        diagnosis);
                            ``(iv) prevention focused on ages 5 through 
                        10 (alcohol, drug, inhalant, and tobacco);
                            ``(v) early intervention, treatment and 
                        aftercare focused on ages 11-17;
                            ``(vi) healthy choices/lifestyle (related 
                        to sexually transmitted diseases, domestic 
                        violence, sexual abuse; suicide, teen 
                        pregnancy, obesity, and other risk/safety 
                        issues); and
                            ``(vii) co-morbidity.
                    ``(B) Adult Behavioral Health Services (ages 18 
                through 55):
                            ``(i) Early intervention, treatment, and 
                        aftercare.
                            ``(ii) Mental health/substance abuse 
                        services (emotional, alcohol, drug, inhalant 
                        and tobacco).
                            ``(iii) Co-occurring disorders (dual 
                        diagnosis) and co-morbidity.
                            ``(iv) Healthy choices/lifestyle (related 
                        to parenting, partners, domestic violence, 
                        sexual abuse, suicide, obesity, and other risk-
                        related behavior).
                            ``(v)(I) Treatment services for women at 
                        risk of giving birth to a child with a fetal 
                        alcohol disorder.
                            ``(II) Treatment for substance abuse 
                        requiring gender-specific services.
                            ``(III) Treatment for sexual assault and 
                        domestic violence.
                            ``(IV) Healthy choices/lifestyle 
                        (parenting, partners, obesity, suicide, and 
                        other related behavioral risk).
                            ``(vi) Men-specific:
                                    ``(I) Treatment for substance abuse 
                                requiring gender-specific services.
                                    ``(II) Treatment for sexual assault 
                                and domestic violence.
                                    ``(III) Healthy choices/lifestyle 
                                (parenting, partners, obesity, suicide, 
                                and other risk-related behavior).
                    ``(C) Family Behavioral Health Services:
                            ``(i) Early intervention, treatment, and 
                        aftercare for affected families.
                            ``(ii) Treatment for sexual assault and 
                        domestic violence.
                            ``(iii) Healthy choices/lifestyle (related 
                        to parenting, partners, domestic violence, and 
                        other abuse issues).
                    ``(D) Elder Behavioral Health Services (age 56 and 
                above):
                            ``(i) Early intervention, treatment, and 
                        aftercare.
                                    ``(I) Mental health/substance abuse 
                                services (emotional, alcohol, drug, 
                                inhalant, and tobacco).
                                    ``(II) Co-occurring disorders (dual 
                                diagnosis) and co-morbidity.
                                    ``(III) Healthy choices/lifestyle 
                                (managing conditions related to aging).
                            ``(ii) Elder women-specific:
                                    ``(I) Treatment for substance abuse 
                                requiring gender-specific services.
                                    ``(II) Treatment for sexual 
                                assault, domestic violence, and 
                                neglect.
                            ``(iii) Elder men-specific:
                                    ``(I) Treatment for substance abuse 
                                requiring gender-specific services.
                                    ``(II) Treatment for sexual 
                                assault, domestic violence, and 
                                neglect.
                            ``(iv) Dimentias regardless of cause.
    ``(d)(1) The governing body of any Indian tribe, or tribal 
organization, or urban Indian organization may, at its discretion, 
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 alcohol 
and other 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, but 
not be limited to, behavioral health services, social services, 
intensive outpatient services, and continuing after care.
    ``(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 
Indian tribe or tribal organization in the development of such plan. 
Upon the establishment of such a plan and at the request of the Indian 
tribe or tribal organization, such officials shall cooperate with the 
Indian tribe or tribal organization in the implementation of such plan.
    ``(3) The Secretary may make funding available to Indian tribes and 
tribal organizations 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.
    ``(e) The Secretary, acting through the Service and willing 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 are available to Indians 
without regard to their place of residence.
    ``(f) Within 1 year after the date of the enactment of the Indian 
Health Care Improvement Act Amendments of 2000, the Secretary shall 
make an assessment of the need for inpatient mental health care among 
Indians and the availability and cost of inpatient mental health 
facilities which can meet such need. In making such assessment, the 
Secretary shall consider the possible conversion of existing, underused 
service hospital beds into psychiatric units to meet such need.

``SEC. 702. MEMORANDA OF AGREEMENT WITH THE DEPARTMENT OF THE INTERIOR.

    ``(a) Not later than 12 months after the date of the enactment of 
the Indian Health Care Improvement Act Amendments of 2000, the 
Secretary and the Secretary of the Interior shall develop and enter 
into 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) and under which the Secretaries address--
            ``(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 
        mental 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 mental health services to which all citizens have access;
            ``(B) 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) 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) 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 Indian tribes (developed under 
                the Indian Alcohol and Substance Abuse Prevention and 
                Treatment Act of 1986) with the mental health 
                initiatives pursuant to this Act, particularly with 
                respect to the referral and treatment of dually 
                diagnosed individuals requiring mental health and 
                substance abuse treatment; and
                    ``(B) ensuring that the Bureau of Indian Affairs 
                and Service programs and services (including multi-
                disciplinary 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 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); and
            ``(8) provide for an annual review of such agreement by the 
        2 Secretaries which shall be provided to Congress and the 
        Indian tribes.
    ``(b) The memoranda of agreement updated or entered into pursuant 
to subsection (a) shall include specific provisions pursuant to which 
the Service shall assume responsibility for--
            ``(1) the determination of the scope of the problem of 
        alcohol and substance abuse among Indian people, including the 
        number of Indians within the jurisdiction of the Service who 
        are directly or indirectly affected by alcohol and substance 
        abuse and the financial and human cost;
            ``(2) an assessment of the existing and needed resources 
        necessary for the prevention of alcohol and substance abuse and 
        the treatment of Indians affected by alcohol and substance 
        abuse; and
            ``(3) an estimate of the funding necessary to adequately 
        support a program of prevention of alcohol and substance abuse 
        and treatment of Indians affected by alcohol and substance 
        abuse.
    ``(c) The Secretary and the Secretary of the Interior shall, in 
developing the memoranda of agreement under subsection (a) of this 
section, consult with and solicit the comments of--
            ``(1) Indian tribes and tribal organizations;
            ``(2) Indian individuals;
            ``(3) urban Indian organizations and other Indian 
        organizations; and
            ``(4) behavioral health service providers.
    ``(d) The memoranda of agreement under subsection (a) of this 
section 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 to each Indian tribe, tribal organization, and urban 
Indian organization.

``SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND TREATMENT 
              PROGRAM.

    ``(a)(1) The Secretary, acting through the Service and willing 
Indian tribes, and tribal organizations, consistent with section 701, 
shall provide a program of comprehensive behavioral health, prevention, 
treatment, and aftercare, including traditional health care practices, 
which shall include--
            ``(A) prevention, through educational intervention, in 
        Indian communities;
            ``(B) acute detoxification and psychiatric hospitalization 
        and treatment (residential and intensive outpatient);
            ``(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 but not limited to pregnant and 
        post partum women and their children.
    ``(2) The target population of such program shall be members of 
Indian tribes. Efforts to train and educate key members of the Indian 
community shall target employees of health, education, judicial, law 
enforcement, legal, and social service programs.
    ``(b)(1) The Secretary, acting through the Service and willing 
Indian tribes and tribal organizations, may, enter into contracts with 
public or private providers of behavioral health treatment services for 
the purpose of carrying out the program required under subsection (a).
    ``(2) In carrying out this subsection, the Secretary shall provide 
assistance to Indian tribes and tribal organizations to develop 
criteria for the certification of behavioral health service providers 
and accreditation of service facilities which meet minimum standards 
for such services and facilities.

``SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.

    ``(a) Under the authority of the Snyder Act of November 2, 1921 (25 
U.S.C. 13), the Secretary shall establish and maintain a mental health 
technician program within the Service which--
            ``(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) In carrying out subsection (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.
    ``(c) The Secretary shall supervise and evaluate the mental health 
technicians in the training program.
    ``(d) The Secretary shall ensure that the program established 
pursuant to this subsection involves the use and promotion of the 
traditional health care practices of the Indian tribes to be served.

``SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE WORKERS.

    ``Subject to the provisions of section 220, any person employed as 
a psychologist, social worker, or marriage and family therapist for the 
purpose of providing mental health care services to Indians in a 
clinical setting under the authority of this Act or through a funding 
agreement pursuant to the Indian Self-Determination and Education 
Assistance Act shall--
            ``(1) in the case of a person employed as a psychologist, 
        be licensed as a clinical psychologist or working under the 
        direct supervision of a licensed clinical psychologist;
            ``(2) in the case of a person employed as a social worker, 
        be licensed as a social worker or working under the direct 
        supervision of a licensed social worker; or
            ``(3) in the case of a person employed as a marriage and 
        family therapist, be licensed as a marriage and family 
        therapist or working under the direct supervision of a licensed 
        marriage and family therapist.

``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

    ``(a) The Secretary, consistent with section 701, shall make 
funding available to Indian tribes, tribal organizations, and urban 
Indian organizations to develop and implement a comprehensive 
behavioral health program of prevention, intervention, treatment, and 
relapse prevention services that specifically addresses the spiritual, 
cultural, historical, social, and child care needs of Indian women, 
regardless of age.
    ``(b) Funding made available pursuant to this section may be used 
to--
            ``(1) develop and provide community training, education, 
        and prevention programs for Indian women relating to behavioral 
        health issues, including fetal alcohol disorders;
            ``(2) identify and provide psychological services, 
        counseling, advocacy, support, and relapse prevention to Indian 
        women and their families; and
            ``(3) develop prevention and intervention models for Indian 
        women which incorporate traditional health care practices, 
        cultural values, and community and family involvement.
    ``(c) The Secretary, in consultation with Indian tribes and tribal 
organizations, shall establish criteria for the review and approval of 
applications and proposals for funding under this section.
    ``(d) Twenty percent of the funds appropriated pursuant to this 
section shall be used to make grants to urban Indian organizations 
funded under title V.

``SEC. 707. INDIAN YOUTH PROGRAM.

    ``(a) The Secretary, consistent with section 701, shall develop and 
implement a program for acute detoxification and treatment for Indian 
youth, including behavioral health services. The program shall include 
regional treatment centers designed to include detoxification and 
rehabilitation for both sexes on a referral basis and programs 
developed and implemented by Indian tribes or tribal organizations at 
the local level under the Indian Self-Determination and Education 
Assistance Act. Regional centers shall be integrated with the intake 
and rehabilitation programs based in the referring Indian community.
    ``(b)(1) The Secretary, acting through the Service or willing 
Indian tribes, or tribal organizations, shall construct, renovate, or, 
as necessary, purchase, and appropriately staff and operate, at least 1 
youth regional treatment center or treatment network in each area under 
the jurisdiction of an Area Office. For the purposes of this 
subsection, the Area Office in California shall be considered to be 2 
Area Offices, 1 office whose jurisdiction shall be considered to 
encompass the northern area of the State of California, and 1 office 
whose jurisdiction shall be considered to encompass the remainder of 
the State of California for the purpose of implementing California 
treatment networks.
    ``(2) For the purpose of staffing and operating such centers or 
facilities, funding shall be pursuant to the Act of November 2, 1921 
(25 U.S.C. 13).
    ``(3) A youth treatment center constructed or purchased under this 
subsection shall be constructed or purchased at a location within the 
area described in paragraph (1) agreed upon (by appropriate tribal 
resolution) by a majority of the Indian tribes to be served by such 
center.
    ``(4)(A) Notwithstanding any other provision of this title, the 
Secretary may, from amounts authorized to be appropriated for the 
purposes of carrying out this section, make funds available to--
            ``(i) the Tanana Chiefs Conference, Incorporated, for the 
        purpose of leasing, constructing, renovating, operating, and 
        maintaining a residential youth treatment facility in 
        Fairbanks, Alaska; and
            ``(ii) the Southeast Alaska Regional Health Corporation to 
        staff and operate a residential youth treatment facility 
        without regard to the proviso set forth in section 4(l) of the 
        Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 450b(l)).
    ``(B) Until additional residential youth treatment facilities are 
established in Alaska pursuant to this section, the facilities 
specified in subparagraph (A) shall make every effort to provide 
services to all eligible Indian youth residing in such State.
    ``(c)(1) The Secretary, acting through the Service and willing 
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 after-care 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) 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) The Secretary 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)(1) The Secretary, in consultation with Indian tribes and 
tribal organizations, shall--
            ``(A) identify and use, where appropriate, federally owned 
        structures suitable for local residential or regional 
        behavioral health treatment for Indian youth; and
            ``(B) establish guidelines, in consultation with Indian 
        tribes and tribal organizations, for determining the 
        suitability of any such federally owned structure to be used 
        for local residential or regional behavioral health treatment 
        for Indian youth.
    ``(2) Any structure described in paragraph (1) may be used under 
such terms and conditions as may be agreed upon by the Secretary and 
the agency having responsibility for the structure and any Tribe or 
tribal organization operating the program.
    ``(e)(1) The Secretary, Indian tribes or tribal organizations, in 
cooperation with the Secretary of the Interior, shall develop and 
implement within each service unit, community-based rehabilitation and 
follow-up services for Indian youth who are having significant 
behavioral health problems, and require long-term treatment, community 
reintegration, and monitoring to support the Indian youth after their 
return to their home community.
    ``(2) Services under paragraph (1) shall be administered within 
each service unit or tribal program by trained staff within the 
community who can assist the Indian youth in continuing development of 
self-image, positive problem-solving skills, and nonalcohol or 
substance abusing behaviors. Such staff may include alcohol and 
substance abuse counselors, mental health professionals, and other 
health professionals and paraprofessionals, including community health 
representatives.
    ``(f) In providing the treatment and other services to Indian youth 
authorized by this section, the Secretary, Indian tribes, and tribal 
organizations shall provide for the inclusion of family members of such 
youth in the treatment programs or other services as may be 
appropriate. Not less than 10 percent of the funds appropriated for the 
purposes of carrying out subsection (e) shall be used for outpatient 
care of adult family members related to the treatment of an Indian 
youth under that subsection.
    ``(g) The Secretary, acting through the Service and willing Indian 
tribes, tribal organizations, and urban Indian organizations, shall 
provide, consistent with section 701, programs and services to prevent 
and treat the abuse of multiple forms of substances, including, but not 
limited to, alcohol, drugs, inhalants, and tobacco, among Indian youth 
residing in Indian communities, on Indian reservations, and in urban 
areas and provide appropriate mental health services to address the 
incidence of mental illness among such youth.

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

    ``Within 1 year after the date of enactment of the Indian Health 
Care Improvement Act Amendments of 2000, the Secretary, acting through 
the Service and willing Indian tribes and tribal organizations, shall 
provide, in each area of the Service, not less than 1 inpatient mental 
health care facility, or the equivalent, for Indians with behavioral 
health problems. For the purposes of this subsection, California shall 
be considered to be 2 Area Offices, 1 office whose location shall be 
considered to encompass the northern area of the State of California 
and 1 office whose jurisdiction shall be considered to encompass the 
remainder of the State of California. The Secretary shall consider the 
possible conversion of existing, underused service hospital beds into 
psychiatric units to meet such need.

``SEC. 709. TRAINING AND COMMUNITY EDUCATION.

    ``(a) The Secretary, in cooperation with the Secretary of the 
Interior, shall develop and implement or provide funding for Indian 
tribes and tribal organizations to develop and implement within each 
service unit or tribal program a program of community education and 
involvement which shall be designed to provide concise and timely 
information to the community leadership of each tribal community. Such 
program shall include education about behavioral health issues to 
political leaders, tribal judges, law enforcement personnel, members of 
tribal health and education boards, health care providers including 
traditional practitioners, and other critical members of each tribal 
community. Community-based training (oriented toward local capacity 
development) shall also include tribal community provider training 
(designed for adult learners from the communities receiving services 
for prevention, intervention, treatment and aftercare).
    ``(b) The Secretary shall, either directly or through Indian tribes 
and tribal organizations, provide instruction in the area of behavioral 
health issues, including instruction in crisis intervention and family 
relations in the context of alcohol and substance abuse, child sexual 
abuse, youth alcohol and substance abuse, and the causes and effects of 
fetal alcohol disorders to appropriate employees of the Bureau of 
Indian Affairs and the Service, and to personnel in schools or programs 
operated under any contract with the Bureau of Indian Affairs or the 
Service, including supervisors of emergency shelters and halfway houses 
described in section 4213 of the Indian Alcohol and Substance Abuse 
Prevention and Treatment Act of 1986 (25 U.S.C. 2433).
    ``(c) In carrying out the education and training programs required 
by this section, the Secretary, in consultation with Indian tribes, 
tribal organizations, Indian behavioral health experts, and Indian 
alcohol and substance abuse prevention experts, shall develop and 
provide community-based training models. Such models shall address--
            ``(1) the elevated risk of alcohol and behavioral health 
        problems faced by children of alcoholics;
            ``(2) the cultural, spiritual and multigenerational aspects 
        of behavioral health problem prevention and recovery; and
            ``(3) community-based and multidisciplinary strategies for 
        preventing and treating behavioral health problems.

``SEC. 710. BEHAVIORAL HEALTH PROGRAM.

    ``(a) The Secretary, acting through the Service or willing Indian 
tribes or 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) 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 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) For purposes of this subsection, the Secretary shall, in 
evaluating applications or proposals for funding for projects to be 
operated under any funding agreement entered into with the Service 
under the Indian Self-Determination and Education Assistance Act, use 
the same criteria that the Secretary uses in evaluating any other 
application or proposal for such funding.

``SEC. 711. FETAL ALCOHOL DISORDER FUNDING.

    ``(a)(1) The Secretary, consistent with section 701, acting through 
willing Indian tribes, tribal organizations, and urban Indian 
organizations, shall establish and operate fetal alcohol disorders 
programs as provided in this section for the purposes of meeting the 
health status objectives specified in section 3(b).
    ``(2) Funding provided pursuant to this section shall be used to--
            ``(A) develop and provide community and in-school training, 
        education, and prevention programs relating to fetal alcohol 
        disorders;
            ``(B) identify and provide behavioral health treatment to 
        high-risk women;
            ``(C) identify and provide appropriate psychological 
        services, educational and vocational support, counseling, 
        advocacy, and information to fetal alcohol disorder affected 
        persons and their families or caretakers;
            ``(D) develop and implement counseling and support programs 
        in schools for fetal alcohol disorder affected children;
            ``(E) develop prevention and intervention models which 
        incorporate traditional practitioners, cultural and spiritual 
        values, and community involvement;
            ``(F) develop, print, and disseminate education and 
        prevention materials on fetal alcohol disorders;
            ``(G) develop and implement, through the tribal 
        consultation process, culturally sensitive assessment and 
        diagnostic tools including dysmorphology clinics and 
        multidisciplinary fetal alcohol disorder clinics for use in 
        tribal and urban Indian communities;
            ``(H) develop early childhood intervention projects from 
        birth on to mitigate the effects of fetal alcohol disorders; 
        and
            ``(I) develop and fund community-based adult fetal alcohol 
        disorder housing and support services.
    ``(3) The Secretary shall establish criteria for the review and 
approval of applications for funding under this section.
    ``(b) The Secretary, acting through the Service and willing Indian 
tribes, tribal organizations, and urban Indian organizations, shall--
            ``(1) develop and provide services for the prevention, 
        intervention, treatment, and aftercare for those affected by 
        fetal alcohol disorders in Indian communities; and
            ``(2) provide supportive services, directly or through an 
        Indian tribe, tribal organization, or urban Indian 
        organization, including, which services shall include but not 
        be limited to, meeting the special educational, vocational, 
        school-to-work transition, and independent living needs of 
        adolescent and adult Indians with fetal alcohol disorders.
    ``(c) The Secretary shall establish a task force to be known as the 
Fetal Alcohol Disorders Task Force to advise the Secretary in carrying 
out subsection (b). Such task force shall be composed of 
representatives from the National Institute on Drug Abuse, the National 
Institute on Alcohol and Alcoholism, the Office of Substance Abuse 
Prevention, the National Institute of Mental Health, the Service, the 
Office of Minority Health of the Department of Health and Human 
Services, the Administration for Native Americans, the National 
Institute of Child Health and Human Development (NICHD), the Centers 
for Disease Control and Prevention, the Bureau of Indian Affairs, 
Indian tribes, tribal organizations, urban Indian communities, and 
Indian fetal alcohol disorders experts.
    ``(d) The Secretary, acting through the Substance Abuse and Mental 
Health Services Administration, shall make funding available to Indian 
tribes, tribal organizations, and urban Indian organizations for 
applied research projects which propose to elevate the understanding of 
methods to prevent, intervene, treat, or provide rehabilitation and 
behavioral health aftercare for Indians and urban Indians affected by 
fetal alcohol disorders.
    ``(e) Ten percent of the funds appropriated pursuant to this 
section shall be used to make grants to urban Indian organizations 
funded under title V.

``SEC. 712. CHILD SEXUAL ABUSE AND PREVENTION TREATMENT PROGRAMS.

    ``(a) The Secretary and the Secretary of the Interior, acting 
through the Service and willing Indian tribes and tribal organizations, 
shall establish, consistent with section 701, in every service area, 
programs involving treatment for--
            ``(1) victims of child sexual abuse; and
            ``(2) perpetrators of child sexual abuse.
    ``(b) Funding provided pursuant to this section shall be used to--
            ``(1) develop and provide community education and 
        prevention programs related to child sexual abuse;
            ``(2) identify and provide behavioral health treatment to 
        children who are victims of sexual abuse and to their families 
        who are affected by sexual abuse;
            ``(3) develop prevention and intervention models which 
        incorporate traditional health care practitioners, cultural and 
        spiritual values, and community involvement;
            ``(4) develop and implement, though the tribal consultation 
        process, culturally sensitive assessment and diagnostic tools 
        for use in tribal and urban Indian communities; and
            ``(5) identify and provide behavioral health treatment to 
        perpetrators--
                    ``(A) efforts will be made 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) treatment should be provided after release to 
                the community, until it is determined that the 
                perpetrator is not a threat to children.

``SEC. 713. BEHAVIORAL HEALTH RESEARCH.

    ``The Secretary, in consultation with appropriate Federal agencies, 
shall provide funding to Indian tribes, tribal organizations, and urban 
Indian organizations or, enter into contracts with, or make grants to 
appropriate institutions for the conduct of research on the incidence 
and prevalence of behavioral health problems among Indians served by 
the Service, Indian tribes, or tribal organizations and among Indians 
in urban areas. Research priorities under this section shall include--
            ``(1) the interrelationship and interdependence of 
        behavioral health problems with alcoholism and other substance 
        abuse, suicide, homicides, other injuries, and the incidence of 
        family violence; and
            ``(2) the development of models of prevention techniques.
The effect of the interrelationships and interdependencies referred to 
in paragraph (1) on children, and the development of prevention 
techniques under paragraph (2) applicable to children, shall be 
emphasized.

``SEC. 714. DEFINITIONS.

    ``For the purpose of this title, the following definitions shall 
apply:
            ``(1) `Assessment' means the systematic collection, 
        analysis, and dissemination of information on health status, 
        health needs, and health problems.
            ``(2) `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' means the blending of substances 
        (alcohol, drugs, inhalants, and tobacco) abuse and mental 
        health prevention and treatment, for the purpose of providing 
        comprehensive services. This can include the joint development 
        of substance abuse and mental health treatment planning and 
        coordinated case management using a multidisciplinary approach.
            ``(4) `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 
        community-based therapeutic group, transitional living, 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.)
            ``(5) `Dual diagnosis' means coexisting substance abuse and 
        mental illness conditions or diagnosis. Patients/clients are 
        sometimes referred to as mentally ill chemical abusers (MICAs).
            ``(6) `Fetal alcohol disorders' means fetal alcohol 
        syndrome, partial fetal alcohol syndrome and alcohol related 
        neural developmental disorder (ARNDD).
            ``(7) `Fetal alcohol syndrome' or `FAS' means a syndrome in 
        which with a history of maternal alcohol consumption during 
        pregnancy, the following criteria should be met:
                    ``(A) Central nervous system involvement such as 
                developmental delay, intellectual deficit, 
                microcephaly, or neurologic abnormalities.
                    ``(B) Craniofacial abnormalities with at least 2 of 
                the following: microphthalmia, short palpebral 
                fissures, poorly developed philtrum, thin upper lip, 
                flat nasal bridge, and short upturned nose.
                    ``(C) Prenatal or postnatal growth delay.
            ``(8) `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, 
        short upturned nose.
            ``(9) `Rehabilitation' means to restore the ability or 
        capacity to engage in usual and customary life activities 
        through education and therapy.
            ``(10) `Substance abuse' includes inhalant abuse.

``SEC. 715. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2012 to carry out 
the provisions of this title.

                      ``TITLE VIII--MISCELLANEOUS

``SEC. 801. REPORTS.

    ``The President shall, at the time the budget is submitted under 
section 1105 of title 31, United States Code, for each fiscal year 
transmit to the Congress a report containing--
            ``(1) a report on the progress made in meeting the 
        objectives of this Act, including a review of programs 
        established or assisted pursuant to this Act and an assessment 
        and recommendations of additional programs or additional 
        assistance necessary to, at a minimum, provide health services 
        to Indians, and ensure a health status for Indians, which are 
        at a parity with the health services available to and the 
        health status of, the general population including specific 
        comparisons of appropriations provided and those required for 
        such parity;
            ``(2) a report on whether, and to what extent, new national 
        health care programs, benefits, initiatives, or financing 
        systems have had an impact on the purposes of this Act and any 
        steps that the Secretary may have taken to consult with Indian 
        tribes, tribal organizations, and urban Indian organizations to 
        address such impact, including a report on proposed changes in 
        allocation of funding pursuant to section 808;
            ``(3) a report on the use of health services by Indians--
                    ``(A) on a national and area or other relevant 
                geographical basis;
                    ``(B) by gender and age;
                    ``(C) by source of payment and type of service;
                    ``(D) comparing such rates of use with rates of use 
                among comparable non-Indian populations; and
                    ``(E) on the services provided under funding 
                agreements pursuant to the Indian Self-Determination 
                and Education Assistance Act;
            ``(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 separate statement which specifies the amount of 
        funds requested to carry out the provisions of section 201;
            ``(7) a biennial report to Congress on infectious diseases 
        as required by section 212;
            ``(8) a report on environmental and nuclear health hazards 
        as required by section 214;
            ``(9) an annual report on the status of all health care 
        facilities needs as required by section 301(c)(2) and 301(d);
            ``(10) reports on safe water and sanitary waste disposal 
        facilities as required by section 302(h)(1);
            ``(11) an annual report on the expenditure of nonservice 
        funds for renovation as required by sections 305(a)(2) and 
        305(a)(3);
            ``(12) a report identifying the backlog of maintenance and 
        repair required at Service and tribal facilities required by 
        section 314(a);
            ``(13) a report providing an accounting of reimbursement 
        funds made available to the Secretary under titles XVIII and 
        XIX of the Social Security Act required by section 403(a);
            ``(14) a report on services sharing of Indian Health 
        Service, Veterans Affairs, and other Federal agency health 
programs as required by section 412(c)(2);
            ``(15) a report on evaluation and renewal of urban Indian 
        programs as required by section 505;
            ``(16) a report on the findings and conclusions derived 
        from the demonstration project as required by section 
        512(a)(2);
            ``(17) a report on the evaluation of programs as required 
        by section 513; and
            ``(18) a report on alcohol and substance abuse as required 
        by section 701(f).

``SEC. 802. REGULATIONS.

    ``(a)(1) Not later than 90 days after the date of enactment of this 
Act, 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 
the Indian Health Care Improvement Act, as amended.
    ``(2) Proposed regulations to implement this Act shall be published 
in the Federal Register by the Secretary no later than 270 days after 
the date of enactment of this Act and shall have no less than a 120-day 
comment period.
    ``(3) The authority to promulgate regulations under this Act shall 
expire 18 months from the date of enactment of this Act.
    ``(b) Committee.--A negotiated rulemaking committee established 
pursuant to section 565 of title 5, United States Code, to carry out 
this section shall have as its members only representatives of the 
Federal Government and representatives of Indian tribes, and tribal 
organizations, a majority of whom shall be nominated by and be 
representatives of Indian tribes, tribal organizations, and urban 
Indian organizations from each service area.
    ``(c) Adaptation of Procedures.--The Secretary shall adapt the 
negotiated rulemaking procedures to the unique context of self-
governance and the government-to-government relationship between the 
United States and Indian tribes.
    ``(d) The lack of promulgated regulations shall not limit the 
effect of this Act.
    ``(e) The provisions of this Act shall supersede any conflicting 
provisions of law (including any conflicting regulations) in effect on 
the day before the date of enactment of the Indian Self-Determination 
Contract Reform Act of 1994, and the Secretary is authorized to repeal 
any regulation inconsistent with the provisions of this Act.

``SEC. 803. PLAN OF IMPLEMENTATION.

    ``Within 240 days after the date of the enactment of the Indian 
Health Care Improvement Act Amendments of 2000, a plan will be prepared 
by the Secretary in consultation with Indian tribes, tribal 
organizations, and urban Indian organizations, and will be submitted to 
the Congress. The plan will explain the manner and schedule (including 
a schedule of appropriation requests), by title and section, by which 
the Secretary will implement the provisions of this Act.

``SEC. 804. AVAILABILITY OF FUNDS.

    ``The funds appropriated pursuant to this Act shall remain 
available until expended.

``SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED TO THE INDIAN 
              HEALTH SERVICE.

    ``Any limitation on the use of funds contained in an Act providing 
appropriations for the Department for a period with respect to the 
performance of abortions shall apply for that period with respect to 
the performance of abortions using funds contained in an Act providing 
appropriations for the Indian Health Service.

``SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.

    ``(a) Until such time as any subsequent law may otherwise provide, 
the following California Indians shall be eligible for health services 
provided by the Service:
            ``(1) Any member of a federally recognized Indian tribe.
            ``(2) Any descendant of an Indian who was residing in 
        California on June 1, 1852, but only if such descendant--
                    ``(A) is a member of the Indian community served by 
                a local program of the Service; and
                    ``(B) is regarded as an Indian by the community in 
                which such descendant lives.
            ``(3) Any Indian who holds trust interests in public 
        domain, national forest, or Indian reservation allotments in 
        California.
            ``(4) Any Indian in California who is listed on the plans 
        for distribution of the assets of California rancherias and 
        reservations under the Act of August 18, 1958 (72 Stat. 619), 
        and any descendant of such an Indian.
    ``(b) Nothing in this section may be construed as expanding the 
eligibility of California Indians for health services provided by the 
Service beyond the scope of eligibility for such health services that 
applied on May 1, 1986.

``SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS.

    ``(a)(1) Any individual who--
            ``(A) has not attained 19 years of age;
            ``(B) is the natural or adopted child, step-child, foster-
        child, legal ward, or orphan of an eligible Indian; and
            ``(C) is not otherwise eligible for health services 
        provided by the Service,
shall be eligible for all health services provided by the Service on 
the same basis and subject to the same rules that apply to eligible 
Indians until such individual attains 19 years of age. The existing and 
potential health needs of all such individuals shall be taken into 
consideration by the Service in determining the need for, or the 
allocation of, the health resources of the service. If such an 
individual has been determined to be legally incompetent prior to 
attaining 19 years of age, such individual shall remain eligible for 
such services until 1 year after the date of a determination of 
competency.
    ``(2) Any spouse of an eligible Indian who is not an Indian, or who 
is of Indian descent but not otherwise eligible for the health services 
provided by the Service, shall be eligible for such health services if 
all such spouses or spouses who are married to members of the Indian 
tribe(s) being served are made eligible, as a class, by an appropriate 
resolution of the governing body of the Indian tribe or tribal 
organization providing such services. The health needs of persons made 
eligible under this paragraph shall not be taken into consideration by 
the Service in determining the need for, or allocation of, its health 
resources.
    ``(b)(1)(A) The Secretary is authorized to provide health services 
under this subsection through health programs operated directly by the 
Service to individuals who reside within the service area of a service 
unit and who are not eligible for such health services under any other 
subsection of this section or under any other provision of law if--
            ``(i) the Indian tribe (or, in the case of a multi-tribal 
        service area, all the Indian tribes) served by such service 
        unit requests such provision of health services to such 
        individuals; and
            ``(ii) the Secretary and the Indian tribe or tribes have 
        jointly determined that--
                    ``(I) the provision of such health services will 
                not result in a denial or diminution of health services 
                to eligible Indians; and
                    ``(II) there is no reasonable alternative health 
                program, within or without the service area of such 
                service unit, available to meet the health needs of 
                such individuals.
    ``(B) In the case of health programs operated under a contract 
entered into under the Indian Self-Determination and Education 
Assistance Act, the governing body of the Indian tribe or tribal 
organization providing health services under such contract is 
authorized to determine whether health services should be provided 
under such funding agreement to individuals who are not eligible for 
such health services under any other subsection in this section or 
under any other provision of law. In making such determinations, the 
governing body of the Indian tribe or tribal organization shall take 
into account the considerations described in subparagraph (A)(ii).
    ``(2)(A) Persons receiving health services provided by the Service 
by reason of this subsection shall be liable for payment of such health 
services under a schedule of charges prescribed by the Secretary which, 
in the judgment of the Secretary, results in reimbursement in an amount 
not less than the actual cost of providing the health services. 
Notwithstanding section 1880(c) of the Social Security Act, section 
402(a) of this Act, or any other provision of law, amounts collected 
under this subsection, including medicare or medicaid reimbursements 
under titles XVIII and XIX of the Social Security Act, shall be 
credited to the account of the program providing the service and shall 
be used solely for the provision of health services within that 
program. Amounts collected under this subsection shall be available for 
expenditure within such program.
    ``(B) Health services may be provided by the Secretary through the 
Service under this subsection to an indigent person who would not be 
eligible for such health services but for the provisions of paragraph 
(1) only if an agreement has been entered into with a State or local 
government under which the State or local government agrees to 
reimburse the Service for the expenses incurred by the Service in 
providing such health services to such indigent person.
    ``(3)(A) In the case of a service area which serves only one Indian 
tribe, the authority of the Secretary to provide health services under 
paragraph (1)(A) shall terminate at the end of the fiscal year 
succeeding the fiscal year in which the governing body of the Indian 
tribe revokes its concurrence to the provision of such health services.
    ``(B) In the case of a multi-tribal service area, the authority of 
the Secretary to provide health services under paragraph (1)(A) shall 
terminate at the end of the fiscal year succeeding the fiscal year in 
which at least 51 percent of the number of Indian tribes in the service 
area revoke their concurrence to the provisions of such health 
services.
    ``(c) The Service may provide health services under this subsection 
to individuals who are not eligible for health services provided by the 
Service under any other subsection of this section or under any other 
provision of law in order to--
            ``(1) achieve stability in a medical emergency;
            ``(2) prevent the spread of a communicable disease or 
        otherwise deal with a public health hazard;
            ``(3) provide care to non-Indian women pregnant with an 
        eligible Indian's child for the duration of the pregnancy 
        through post partum; or
            ``(4) provide care to immediate family members of an 
        eligible person if such care is directly related to the 
        treatment of the eligible person.
    ``(d) Hospital privileges in health facilities operated and 
maintained by the Service or operated under a contract entered into 
under the Indian Self-Determination and Education Assistance Act may be 
extended to non-Service health care practitioners who provide services 
to persons described in subsection (a) or (b). Such non-Service health 
care practitioners may be regarded as employees of the Federal 
Government for purposes of section 1346(b) and chapter 171 of title 28, 
United States Code (relating to Federal tort claims) only with respect 
to acts or omissions which occur in the course of providing services to 
eligible persons as a part of the conditions under which such hospital 
privileges are extended.
    ``(e) For purposes of this section, the term `eligible Indian' 
means any Indian who is eligible for health services provided by the 
Service without regard to the provisions of this section.

``SEC. 808. REALLOCATION OF BASE RESOURCES.

    ``(a) Notwithstanding any other provision of law, any allocation of 
Service funds for a fiscal year that reduces by 5 percent or more from 
the previous fiscal year the funding for any recurring program, 
project, or activity of a service unit may be implemented only after 
the Secretary has submitted to the President, for inclusion in the 
report required to be transmitted to the Congress under section 801, a 
report on the proposed change in allocation of funding, including the 
reasons for the change and its likely effects.
    ``(b) Subsection (a) shall not apply if the total amount 
appropriated to the Service for a fiscal year is less than the amount 
appropriated to the Service for the previous fiscal year.

``SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.

    ``The Secretary shall provide for the dissemination to Indian 
tribes of the findings and results of demonstration projects conducted 
under this Act.

``SEC. 810. PROVISION OF SERVICES IN MONTANA.

    ``(a) The Secretary 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) The provisions of subsection (a) shall not be construed to be 
an expression of the sense of the Congress on the application of the 
decision described in subsection (a) with respect to the provision of 
services or benefits for Indians living in any State other than 
Montana.

``SEC. 811. MORATORIUM.

    ``During the period of the moratorium imposed by Public Law 100-446 
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 of the Indian 
Health Care Improvement Act, as amended by this Act until such time as 
new criteria governing eligibility for services are developed in 
accordance with section 802 of this Act.

``SEC. 812. TRIBAL EMPLOYMENT.

    ``For purposes of section 2(2) of the Act of July 5, 1935, as 
amended (49 Stat. 450, chapter 372), an Indian tribe or tribal 
organization carrying out a funding agreement under the Indian Self-
Determination and Education Assistance Act shall not be considered an 
`employer'.

``SEC. 813. PRIME VENDOR.

    ``For purposes of section 4 of Public Law 102-585 (38 U.S.C. 812) 
tribes and tribal organizations carrying out a grant, cooperative 
agreement of funding agreement under the Indian Self-Determination and 
Education Assistance Act (25 U.S.C. 450 et seq.) shall be deemed to be 
an executive agency and part of the Indian Health Service in the 
Department of Health and Human Services and, as such, may act as an 
ordering agent of the Indian Health Service and the employees of the 
tribe or tribal organization may order supplies on behalf thereof on 
the same basis as employees of the Indian Health Service.

``SEC. 814. SEVERABILITY PROVISIONS.

    ``If any provision of this Act, any amendment made by the Act, or 
the application of such provision or amendment to any person or 
circumstances is held to be invalid, the remainder of this Act, the 
remaining amendments made by this Act, and the application of such 
provisions to persons or circumstances other than those to which it is 
held invalid, shall not be affected thereby.

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

    ``(a) There is hereby established the National Bipartisan Indian 
Health Care Entitlement Commission (the `Commission').
    ``(b) Duties of Commission.--The Commission shall--
            ``(1) review and analyze the recommendations of the report 
        of the Study Committee, as established below, to the 
        Commission;
            ``(2) make recommendations to the Congress for providing 
        health services for Indian persons as an entitlement, giving 
        due regard to the effects of such a program on existing health 
        care delivery systems for Indian persons and the effect of such 
        a program on the sovereign status of Indian tribes;
            ``(3) establish a Study Committee composed of those members 
        of the Commission appointed by the Director of the Indian 
        Health Service and at least 4 members of Congress from among 
        the members of the Commission which shall--
                    ``(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, and 
                which may include authorizing and funding 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) make recommendations to the Commission for 
                legislation that will provide for the delivery of 
                health services for Indians as an entitlement, which 
                will address, among other things, issues of 
                eligibility, benefits to be provided, including 
                recommendations regarding from whom such health 
                services are to be provided and the cost, including 
                mechanisms for funding of the health services to be 
                provided;
                    ``(C) determine the effect of the enactment of such 
                recommendations on the existing system of delivery of 
                health services for Indians;
                    ``(D) determine the effect of a health services 
                entitlement program for Indian persons on the sovereign 
                status of Indian tribes;
                    ``(E) not later than 12 months after the 
                appointment of all members of the Commission, shall 
                make a written report of its findings and 
                recommendations to the full Commission, which report 
                shall include a statement of the minority and majority 
                position of the Committee and which shall be 
                disseminated, at a minimum, to every federally 
                recognized Indian tribe, tribal organization, and urban 
                Indian organization for comment to the Commission; and
                    ``(F) 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.
            ``(4) By not later than 18 months following the date of 
        appointment of all members of the Commission, submit a written 
        report to Congress containing a recommendation of policies and 
        legislation to implement a policy that would establish a health 
        care system for Indians based on delivery of health services as 
        an entitlement, together with a determination of the 
        implications of such an entitlement system on existing health 
        care delivery systems for Indians and on the sovereign status 
        of Indian tribes.
    ``(c)(1) The Commission shall be composed of 25 members, selected 
by as follows:
            ``(A) 10 members of Congress, including 3 from the United 
        States House of Representatives and 2 from the United States 
        Senate, appointed by their respective majority leaders, and 3 
        from the United States House of Representatives and 2 from the 
        United States 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) 12 persons chosen by the Congressional members of the 
        Commission, 1 from each Indian health care service area as 
        currently designated by the Director of the Indian Health 
        Service, to be chosen from among 3 nominees from each area put 
        forward by the 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 with due regard being 
        given to a reasonable representation on the commission of 
        members who are familiar with various health care delivery 
        modes and who represent Tribes of various size populations.
            ``(C) 3 persons appointed by the Director of the Indian 
        Health Service who are knowledgeable about the provision of 
        health care to Indians, at least one of whom shall be appointed 
        from among 3 nominees put forward by those programs whose 
        funding is provided in whole or in part by the Indian Health 
        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 President shall be members of 
        federally recognized Indian tribes.
            ``(E) The Chairman and Vice Chairman of the Commission 
        shall be selected by the Congressional members of the 
        Commission.
    ``(d)(1) The terms of members of the Commission shall be for the 
life of the Commission.
    ``(2) Congressional members of the Commission shall be appointed 
not later than 90 days after the approval of this Act, and the 
remaining members of the Commission shall be appointed not later than 
60 days following the appointment of the Congressional members.
    ``(3) A vacancy in the Commission shall be filled in the manner in 
which the original appointment was made.
    ``(e)(1) 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) 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.
    ``(f)(1) The Commission shall meet at the call of the Chairman.
    ``(2) 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)(1)(A) The Commission shall appoint an executive director of 
the Commission.
    ``(B) The executive director shall be paid the rate of basic pay 
for level V of the Executive Schedule.
    ``(2) With the approval of the Commission, the executive director 
may appoint such personnel as the executive director deems appropriate.
    ``(3) 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) 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) 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)(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 towards 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 Health Care Financing Administration, 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 the 
Congress.
    ``(i) There are authorized to be appropriated $4,000,000 to carry 
out the provisions of this section, which sum shall not be deducted 
from or affect any other appropriation for health care for Indian 
persons.

``SEC. 816. APPROPRIATIONS; AVAILABILITY.

    ``Any new spending authority (described in subsection (c)(2)(A) or 
(B) of section 401 of the Congressional Budget Act of 1974) which is 
provided under this Act shall be effective for any fiscal year only to 
such extent or in such amounts as are provided in appropriation Acts.

``SEC. 817. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2012 to carry out 
this title.''.

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. SOCIAL SECURITY ACT AMENDMENTS.

    (a) Section 1866(a)(1) of the Social Security Act (42 U.S.C. 
1395cc(a)(1)) is amended by adding at the end the following new 
subparagraph:
                    ``(T) in the case of hospitals and critical access 
                hospitals which provide inpatient hospital services for 
                which payment may be made under this title, to accept 
                as payment in full for services that are covered under 
                and furnished to an individual eligible for the 
                contract health services program operated by the Indian 
                Health Service, by an Indian tribe or tribal 
                organization or furnished to an urban Indian eligible 
                for health services purchased by an urban Indian 
                organization (as those terms are defined in section 4 
                of the Indian Health Care Improvement Act), in 
                accordance with such admission practices, and such 
                payment methodology and amounts, as are prescribed 
                under regulations issued by the Secretary in 
implementation of such section.''.
    (b) Section 1880 of the Social Security Act is amended to read as 
follows:

``SEC. 1880. INDIAN HEALTH PROGRAMS.

    ``(a) The Indian Health Service and an Indian tribe or tribal 
organization (as those terms are defined in section 4 of the Indian 
Health Care Improvement Act), shall be eligible for payments under this 
title, notwithstanding sections 1814(c) and 1835(d), if and for so long 
as it meets the conditions and requirements for such payments which are 
applicable generally to the service or provider type for which it seeks 
payment under this title and for services and provider types provided 
by a qualified Indian health program under section 1880A.
    ``(b) Notwithstanding subsection (a), if the Indian Health Service 
or an Indian tribe, tribal organization, or urban Indian organization, 
does not meet all of the conditions and requirements of this title 
which are applicable generally to such service or provider type submits 
to the Secretary within 6 months after the date on which it first 
sought reimbursement for the service or provider type an acceptable 
plan for achieving compliance with such conditions and requirements, it 
shall be deemed to meet such conditions and requirements (and to be 
eligible for reimbursement under this title), without regard to the 
extent of its actual compliance with such conditions and requirements, 
during the first 12 months after the month in which such plan is 
submitted.
    ``(c) For provisions relating to the authority of certain Indian 
tribes and tribal organizations to elect to directly bill for, and 
receive payment for, health care services provided by a hospital or 
clinic of such Tribes or tribal organizations and for which payment may 
be made under this title, see section 405 of the Indian Health Care 
Improvement Act.
    ``(d) The Indian Health Service, an Indian tribe, or tribal 
organization providing a service otherwise eligible for payment under 
this section through the use of a community health aide or practitioner 
certified under the provisions of section 121 of the Indian Health Care 
Improvement Act (25 U.S.C. 1616l) shall be paid for such services on 
the same basis that such services are reimbursed under State Plans 
approved under title XIX of the Social Security Act.
    ``(e) Notwithstanding any other provision of law, a health program 
operated by the Indian Health Service, an Indian tribe, or tribal 
organization, which collaborates with a hospital operated by the Indian 
Health Service or an Indian tribe or tribal organization, shall, at the 
option of the Indian tribe or tribal organization, be paid for services 
for which it would otherwise be eligible under this section as if it 
were an outpatient department of the hospital. In situations where the 
health program is on a separate campus from the hospital, billing as an 
outpatient department of the hospital shall not subject such a health 
program to the requirements of section 1867 (42 U.S.C. 1395dd) (the 
Emergency Medical Treatment and Active Labor Act).
    ``(f) The Indian Health Service, an Indian tribe, or tribal 
organization providing visiting nurse services in a Home Health Agency 
Shortage Area shall be paid for such services on the same basis that 
such services are reimbursed for other primary care providers.
    ``(g) Notwithstanding any other provision of law, the Secretary 
shall have broad authority to identify and implement alternative 
methods of reimbursing Indian health programs for Medicare services 
provided to Indians. The Indian tribe, tribal organization, or urban 
Indian organization may opt to receive reimbursement under 
reimbursement methodologies applicable to other providers of similar 
services, provided that the amount of reimbursement resulting under 
such alternative methodology shall not be less than 100 percent of the 
reasonable cost of the service to which the methodology applies under 
section 1861(v).''.
    (c) Title XVIII of the Social Security Act is amended by adding 
after section 1880A the following new section:

``SEC. 1880B. QUALIFIED INDIAN HEALTH PROGRAM.

    ``(a) A qualified Indian health program shall be eligible for 
payments under this title, notwithstanding sections 1814(c) and 
1835(d), if and for so long as it meets all the conditions and 
requirements set forth in this section.
    ``(b)(1) The term `qualified Indian health program' means a health 
program operated by--
            ``(A) the Indian Health Service;
            ``(B) an Indian tribe, tribal organization, or urban Indian 
        organization (as those terms are defined in section 4 of the 
        Indian Health Care Improvement Act) and which is funded in 
        whole or part by the Indian Health Service under the Indian 
        Self-Determination and Education Assistance Act; and
            ``(C) an urban Indian organization (as that term is defined 
        in section 4 of the Indian Health Care Improvement Act) and 
        which is funded in whole or part under title V of the Indian 
        Health Care Improvement Act.
    ``(2) A qualified Indian health program may include one or more 
hospitals, nursing homes, home health programs, clinics, ambulance 
services, or other health programs providing a service for which 
payments may be made under this title and which is covered in the 
Medicare or Medicaid cost report for such qualified Indian health 
program.
    ``(c)(1) Notwithstanding any other provision in the law, a 
qualified Indian health program shall be entitled to receive payment 
based on an all-inclusive rate which shall be calculated to provide 
full cost recovery for the cost of furnishing services provided under 
this section.
    ``(2) The term `full cost recovery' shall mean--
            ``(A) the direct costs, which are reasonable, adequate, and 
        related to the cost of furnishing such services, taking into 
        account the unique nature, location, and service population of 
        the qualified Indian health program, and which shall include 
        direct program, administrative, and overhead costs, without 
        regard to the customary or other charge or any fee schedule 
        that would otherwise be applicable, plus
            ``(B) indirect costs which for a qualified Indian health 
        program operated by--
                    ``(i) an Indian tribe or tribal organization for 
                which an indirect cost rate (as that term is defined in 
                section 4(g) of the Indian Self-Determination and 
                Education Assistance Act) has been established or an 
                urban Indian organization for which an indirect cost 
                rate has otherwise been established shall be not less 
                than an amount determined on the basis of the indirect 
                cost rate; or
                    ``(ii) the Indian Health Service, an Indian tribe, 
                tribal organization, or urban Indian organization for 
                which no such rate has been established shall be not 
                less than the administrative costs specifically 
                associated with the delivery of the services being 
                provided.
            ``(C) Notwithstanding any other provision of law, the 
        amount determined to be payable as full cost recovery may not 
        be reduced for coinsurance, copayments or deductibles when the 
        service was provided to an Indian entitled under Federal law to 
        receive service from the Indian Health Service, an Indian 
        tribe, or tribal organization, or an urban Indian organization 
        or because of any limitations on payment provided for in any 
        managed care plan.
    ``(3) In addition to full cost recovery, a qualified Indian health 
program shall be entitled to reasonable outstationing costs, which 
shall include all administrative costs associated with outreach and 
acceptance of eligibility applications for any Federal or State health 
program including, but not limited to medicare, medicaid, and the 
Children's Health Insurance Program.
    ``(4) Costs identified for services addressed in a cost report 
submitted by the qualified Indian health program shall be used to 
determine an all-inclusive encounter or per diem payment amount for 
such services. Not all health programs provided or administered by the 
Indian Health Service, an Indian tribe or tribal organization, or an 
urban Indian organization must be combined into a single cost report. A 
full cost recovery payment for services not covered by such cost report 
shall be made on a fee-for-service, encounter, or per diem basis.
    ``(5) The full cost recovery rate provided for in paragraphs (1) 
through (3) of this subsection may be determined, at the election of 
the qualified Indian health program, by the Health Care Financing 
Administration or by a State Medicaid agency and shall be valid for 
reimbursement made under title XVIII (medicare), title XIX (medicaid), 
and title XXI (children's health insurance program) purposes. The costs 
described in subparagraph (A) of paragraph (2) shall be calculated 
under whatever methodology yields the greatest aggregate payment for 
the cost reporting period, provided that such methodology shall be 
adjusted to include adjustments to such payment to take into account 
for those qualified Indian health programs that include hospitals--
            ``(A) a significant decrease in discharges;
            ``(B) costs for graduate medical education programs;
            ``(C) additional payment as a disproportionate share 
        hospital with a payment adjustment factor of 10; and
            ``(D) payment for outlier cases.
    ``(6) A qualified Indian health program may elect to receive 
payment for services provided under this section--
            ``(A) on the full cost recovery basis provided in 
        subsection (c)(1)-(5)
            ``(B) on the basis of the inpatient or outpatient encounter 
        rates established for Indian Health Service facilities and 
        published annually in the Federal Register;
            ``(C) on the same basis as other providers are reimbursed 
        under this title, provided that to this amount shall be added 
        the amounts determined under subparagraph (B) of subsection 
        (c)(2);
            ``(D) on the basis of any other rate or methodology 
        applicable to the Service, an Indian tribe, or tribal 
        organization; or
            ``(E) on the basis of any rate or methodology negotiated 
        with the agency responsible for making payment.
    ``(d) A qualified Indian health program may under this section 
provide and be reimbursed for any service the Indian Health Service, an 
Indian tribe, or tribal organization or an urban Indian organization 
may be reimbursed under section 1880 for the medicare program and 
section 1911 for the Medicaid program, provided that in either event 
such services may also include, at the election of the qualified Indian 
health program--
            ``(1) any service when furnished by an employee of the 
        qualified Indian health program who is licensed or certified to 
        perform such a service to the same extent that such service 
        would be reimbursable if performed by a physician and any 
        service or supplies furnished as incident to a physician's 
        service as would otherwise be covered if furnished by a 
        physician or as an incident to a physician's service;
            ``(2) screening, diagnostic, and therapeutic outpatient 
        services including, but not limited to, part-time or 
        intermittent screening, diagnostic and therapeutic skilled 
        nursing care and related medical supplies (other than drugs and 
        biologicals), furnished by an employee of the qualified Indian 
        health program who is licensed or certified to perform such a 
        service for an individual in the individual's home or in a 
        community health setting under a written plan of treatment 
        established and periodically reviewed by a physician, when 
        furnished to an individual as an outpatient of a qualified 
        Indian health program;
            ``(3) preventive primary health services as described under 
        sections 329, 330, and 340 of the Public Health Service Act, 
        when provided by an employee of the qualified Indian health 
        program who is licensed or certified to perform such a service, 
        regardless of the location in which the service is provided;
            ``(4) for children, all services specified as part of the 
        State medicaid plan, Children's Health Insurance Program, and 
        EPSDT;
            ``(5) influenza and pneumococcal immunizations;
            ``(6) other immunizations for prevention of communicable 
        diseases when targeted; and
            ``(7) the cost of transportation for providers or patients 
        necessary to facilitate access for patients.''.
    (d) Section 1902(a)(13) of the Social Security Act is amended by 
adding at the end the following:
                    ``(D)(i) for payment for services described in 
                subparagraph (C) of section 1905(a)(2) under the plan 
                furnished by an Indian tribe, tribal organization, or 
                urban Indian organization (as defined in section 4 of 
                the Indian Health Care Improvement Act) of 100 percent 
                of costs which are reasonable and related to the cost 
                of furnishing such services or based on other tests of 
                reasonableness as the Secretary prescribes in 
                regulations under section 1833(a)(3), or, in the case 
                of services to which those regulations do not apply, 
                the same methodology used under section 1833(a)(3).
                    ``(ii) in carrying out clause (i) in the case of 
                services furnished by a federally qualified health 
                center that is operated by an Indian tribe, tribal 
                organization or urban Indian organization (as defined 
                in section 4 of the Indian Health Care Improvement Act) 
                pursuant to a contract between the center and an 
                organization under section 1903(m), for payment to the 
                center at least quarterly by the State of a 
                supplemental payment equal to the amount (if any) by 
                which the amount determined under clause (i) exceeds 
                the amount of the payments provided under such 
                contract.''.
    (e) Section 1902(a) of the Social Security Act is amended by adding 
at the end the following:
            ``(66) if the Indian Health Service operates or funds 
        health programs in the State or if there are Indian tribes, 
        tribal organizations or urban Indian organizations (as those 
        terms are defined in section 4 of the Indian Health Care 
        Improvement Act) present in the State, provide for meaningful 
        consultation with such entities prior to the submission of, and 
        as a precondition of approval of, any proposed amendment, 
        waiver, demonstration project, or other request that would have 
        the effect of changing any aspect of the State's administration 
        of the Medicaid program, provided that `meaningful 
        consultation' shall be defined through the negotiated 
        rulemaking provided for under section 802 of the Indian Health 
        Care Improvement Act, provided that such consultation must be 
        carried out in collaboration with the Indian Medicaid Advisory 
        Committee established under section 415(a)(3) of the Indian 
        Health Care Improvement Act.''.
    (f) The last sentence of section 1905(b) of the Social Security Act 
is amended to read as follows: ``Notwithstanding the first sentence of 
this section, the Federal medical assistance percentage shall be 100 
percent with respect to amounts expended as medical assistance for 
services which are received through the Indian Health Service or an 
Indian tribe, tribal organization, or urban Indian organization (as 
defined in section 4 of the Indian Health Care Improvement Act) under 
section 1911 of the Social Security Act. `Through' in this subsection 
shall include services provided directly, by referral, or under 
contracts or other arrangements between the Indian Health Service, 
Indian tribe, tribal organization, or urban Indian organization and 
another health provider.''.
    (g) Section 1911 of the Social Security Act is amended to read as 
follows:

``SEC. 1911. INDIAN HEALTH SERVICE PROGRAMS.

    ``(a) The Indian Health Service and an Indian tribe, tribal 
organization, or urban Indian organization (as those 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 if and for so long as it provides services or provider types 
of a type otherwise covered under the State plan and meets the 
conditions and requirements which are applicable generally to the 
service for which it seeks reimbursement under this title and for 
services provided by a qualified Indian health program under section 
1880A.
    ``(b) Notwithstanding subsection (a), if the Indian Health Service, 
an Indian tribe, or tribal organization, which provides services of a 
type otherwise covered under the State plan, does not meet all of the 
conditions and requirements of this title which are applicable 
generally to such services submits to the Secretary within 6 months 
after the date on which it first sought reimbursement for the service 
an acceptable plan for achieving compliance with such conditions and 
requirements, it shall be deemed to meet such conditions and 
requirements (and to be eligible for reimbursement under this title), 
without regard to the extent of its actual compliance with such 
conditions and requirements, during the first 12 months after the month 
in which such plan is submitted.
    ``(c) The Secretary is authorized to enter into agreements with the 
State agency for the purpose of reimbursing such agency for health care 
and services provided by the Indian Health Service, Indian tribes, 
tribal organizations, and urban Indian organizations, directly, through 
referral, or under contracts or other arrangements between the Indian 
Health Service, Indian tribe, tribal organization, or urban Indian 
organization and another health provider to Indians who are eligible 
for medical assistance under the State plan.''.
    (h) Section 2101(c) of the Social Security Act is amended by adding 
at the end the following: ``Without regard to which option a State 
chooses under section 2101(a), the Federal medical assistance 
percentage shall be 100 per centum with respect to amounts expended as 
medical assistance for services which are provided through a health 
program operated by the Indian Health Service, an Indian tribe, or 
tribal organization (as those terms are defined in section 4 of the 
Indian Health Care Improvement Act).''.

SEC. 5. REPEAL OF FACILITIES SURVEY AND REPORTING REQUIREMENT.

    Subsections (a) and (b) of section 506 of P.L. 101-630 are 
repealed.
                                 <all>