[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2526 Introduced in Senate (IS)]
106th CONGRESS
2d Session
S. 2526
To amend the Indian Health Care Improvement Act to revise and extend
such Act.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
May 9, 2000
Mr. Campbell (for himself and for Mr. Inouye) introduced the following
bill; which was read twice and referred to the Committee on Indian
Affairs
_______________________________________________________________________
A BILL
To amend the Indian Health Care Improvement Act to revise and extend
such Act.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Indian Health Care
Improvement Act Reauthorization of 2000''.
(b) Table of Contents.--The table of contents for this Act is as
follows:
Sec. 1. Short title.
TITLE I--REAUTHORIZATION AND REVISIONS OF THE INDIAN HEALTH CARE
IMPROVEMENT ACT
Sec. 101. Amendment to the Indian Health Care Improvement Act.
TITLE II--CONFORMING AMENDMENTS TO THE SOCIAL SECURITY ACT
Subtitle A--Medicare
Sec. 201. Limitations on charges.
Sec. 202. Indian health programs.
Sec. 203. Qualified Indian health program.
Subtitle B--Medicaid
Sec. 211. Payments to Federally-qualified health centers.
Sec. 212. State consultation with Indian health programs.
Sec. 213. Fmap for services provided by Indian health programs.
Sec. 214. Indian Health Service programs.
Subtitle C--State Children's Health Insurance Program
Sec. 221. Enhanced fmap for State children's health insurance program.
Sec. 222. Direct funding of State children's health insurance program.
``Sec. 2111. Direct funding of Indian health programs.
Subtitle D--Authorization of Appropriations
Sec. 231. Authorization of appropriations.
TITLE III--MISCELLANEOUS PROVISIONS
Sec. 301. Repeals.
Sec. 302. Severability provisions.
TITLE I--REAUTHORIZATION AND REVISIONS OF THE INDIAN HEALTH CARE
IMPROVEMENT ACT
SEC. 101. AMENDMENT TO THE INDIAN HEALTH CARE IMPROVEMENT ACT.
The Indian Health Care Improvement Act (25 U.S.C. 1601 et seq.) is
amended to read as follows:
``SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
``(a) Short Title.--This Act may be cited as the `Indian Health
Care Improvement Act'.
``(b) Table of Contents.--The table of contents for this Act is as
follows:
``Sec. 1. Short title; 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. Nursing programs; Quentin N. Burdick American
Indians into Nursing Program.
``Sec. 116. Tribal culture and history.
``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. Scholarships.
``Sec. 125. National Health Service Corps.
``Sec. 126. Substance abuse counselor education demonstration
project.
``Sec. 127. Mental health training and community education.
``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 demonstration
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. Soboba sanitation facilities.
``Sec. 305. Expenditure of nonservice funds for renovation.
``Sec. 306. Funding for the construction, expansion, and
modernization of small ambulatory care
facilities.
``Sec. 307. Indian health care delivery demonstration project.
``Sec. 308. Land transfer.
``Sec. 309. Leases.
``Sec. 310. Loans, loan guarantees and loan repayment.
``Sec. 311. Tribal leasing.
``Sec. 312. Indian Health Service/tribal facilities joint
venture program.
``Sec. 313. Location of facilities.
``Sec. 314. Maintenance and improvement of health care
facilities.
``Sec. 315. Tribal management of Federally-owned quarters.
``Sec. 316. Applicability of buy American requirement.
``Sec. 317. Other funding for facilities.
``Sec. 318. 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 or 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 Veteran's
Affairs, and other Federal agency health
facilities and services sharing.
``Sec. 410. Payor of last resort.
``Sec. 411. Right to recover from Federal health care programs.
``Sec. 412. Tuba city demonstration project.
``Sec. 413. Access to Federal insurance.
``Sec. 414. Consultation and rulemaking.
``Sec. 415. Limitations on charges.
``Sec. 416. Limitation on Secretary's waiver authority.
``Sec. 417. Waiver of medicare and medicaid sanctions.
``Sec. 418. Meaning of `remuneration' for purposes of safe
harbor provisions; antitrust immunity.
``Sec. 419. Co-insurance, co-payments, deductibles and
premiums.
``Sec. 420. Inclusion of income and resources for purposes of
medically needy medicaid eligibility.
``Sec. 421. Estate recovery provisions.
``Sec. 422. Medical child support.
``Sec. 423. Provisions relating to managed care.
``Sec. 424. Navajo Nation medicaid agency.
``Sec. 425. Indian advisory committees.
``Sec. 426. 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. Memorandum 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 assessment. --
``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 mental 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. National Bi-Partisan Commission on Indian Health
Care Entitlement.
``Sec. 815. Appropriations; availability.
``Sec. 816. Authorization of appropriations.
``SEC. 2. FINDINGS.
``Congress makes the following findings:
``(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 with the American Indian people, as reflected in
the Constitution, treaties, Federal laws, 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, the policies and practices of the
United States caused 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 that 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, a level that
is not 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 increase, and the health status of the Indians is
far below the health status of the general population of the
United States.
``(8) The disparity in health status that is to be
addresses is formidable. In death rates for example, Indian
people suffer a death rate for diabetes mellitus that is 249
percent higher than the death rate for all races in the United
States, a pneumonia and influenza death rate that is 71 percent
higher, a tuberculosis death rate that is 533 percent higher,
and a death rate from alcoholism that is 627 percent higher.
``SEC. 3. DECLARATION OF HEALTH OBJECTIVES.
``Congress hereby declares that it is the policy of the United
States, 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 any successor standards
thereto;
``(3) in order to raise the health status of Indian people
to at least the levels set forth in the goals contained within
the Healthy People 2000, or any successor standards thereto, to
permit Indian Tribes and tribal organizations 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, active consultation with
Indian Tribes, Indian organizations, and urban Indian
organizations to implement this Act and the national policy of
Indian self-determination; and
``(6) that funds for health care programs and facilities
operated by Tribes and tribal organizations be provided in
amounts that are not less than the funds that are provided to
programs and facilities operated directly by the Service.
``SEC. 4. DEFINITIONS.
``In this Act:
``(1) Accredited and accessible.--The term `accredited and
accessible', with respect to an entity, means a community
college or other appropriate entity that is on or near a
reservation and accredited by a national or regional
organization with accrediting authority.
``(2) Area office.--The term `area office' mean 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) Assistant secretary.--The term `Assistant Secretary'
means the Assistant Secretary of the Indian Health as
established under section 601.
``(4) Contract health service.--The term `contract health
service' means a health service that is provided at the expense
of the Service, Indian Tribe, or tribal organization by a
public or private medical provider or hospital, other than a
service funded under the Indian Self-Determination and
Education Assistance Act or under this Act.
``(5) Department.--The term `Department', unless
specifically provided otherwise, means the Department of Health
and Human Services.
``(6) Fund.--The terms `fund' or `funding' mean the
transfer of monies 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.
``(7) Funding agreement.--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 authority of the Indian Self-Determination
and Education Assistance Act.
``(8) Health profession.--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.
``(9) Health promotion; disease prevention.--The terms
`health promotion' and `disease prevention' shall have the
meanings given such terms in paragraphs (1) and (2) of section
203(c).
``(10) Indian.--The term `Indian' and `Indians' shall have
meanings given such terms for purposes of the Indian Self-
Determination and Education Assistance Act.
``(11) Indian health program.--The term `Indian health
program' shall have the meaning given such term in section
110(a)(2)(A).
``(12) Indian tribe.--The term `Indian tribe' shall have
the meaning given such term in section 4(e) of the Indian Self
Determination and Education Assistance Act.
``(13) Reservation.--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.
``(14) Secretary.--The term `Secretary', unless
specifically provided otherwise, means the Secretary of Health
and Human Services.
``(15) Service.--The term `Service' means the Indian Health
Service.
``(16) Service area.--The term `service area' means the
geographical area served by each area office.
``(17) Service unit.--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.
``(18) Traditional health care practices.--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.
``(19) Tribal organization.--The term `tribal organization'
shall have the meaning given such term in section 4(l) of the
Indian Self Determination and Education Assistance Act.
``(20) Tribally controlled community college.--The term
`tribally controlled community college' shall have the meaning
given such term in section 126 (g)(2).
``(21) Urban center.--The term `urban center' means any
community that has a sufficient urban Indian population with
unmet health needs to warrant assistance under title V, as
determined by the Secretary.
``(22) Urban indian.--The term `urban Indian' means any
individual who resides in an urban center and who--
``(A) regardless of whether such individual lives
on or near a reservation, is a member of a tribe, band
or other organized group of Indians, including those
tribes, bands or groups terminated since 1940;
``(B) is an Eskimo or Aleut or other Alaskan
Native;
``(C) is considered by the Secretary of the
Interior to be an Indian for any purpose; or
``(D) is determined to be an Indian under
regulations promulgated by the Secretary.
``(23) Urban indian organization.--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, and which is capable
of legally cooperating with other public and private entities
for the purpose of performing the activities described in
section 503(a).
``TITLE I--INDIAN HEALTH, HUMAN RESOURCES AND DEVELOPMENT
``SEC. 101. PURPOSE.
``The purpose of this title is to increase, to the maximum extent
feasible, the number of Indians entering the health professions and
providing health services, and to assure an optimum supply of health
professionals to the 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.--Unless specifically provided
otherwise, amounts appropriated for each fiscal year to carry out each
program authorized under this title shall be allocated by the Secretary
to the area office of each service area using a formula--
``(1) to be developed in consultation with Indian Tribes,
tribal organizations and urban Indian organizations; and
``(2) that takes into account the human resource and
development needs in each such service area.
``(b) Consultation.--Each area office receiving funds under this
title shall actively and continuously consult with representatives of
Indian tribes, tribal organizations, and urban Indian organizations to
prioritize the utilization of funds provided under this title within
the service area.
``(c) Reallocation.--Unless specifically prohibited, an area office
may reallocate funds provided to the office under this title among the
programs authorized by this title, except that scholarship and loan
repayment funds shall not be used for administrative functions or
expenses.
``(d) Limitation.--This section shall not apply with respect to
individual recipients of scholarships, loans or other funds provided
under this title (as this title existed 1 day prior to the date of
enactment of this Act) until such time as the individual completes the
course of study that is supported through the use of such funds.
``SEC. 103. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR INDIANS.
``(a) In General.--The Secretary, acting through the Service, shall
make funds available through the area office 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 qualify 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) Administrative Provisions.--
``(1) Application.--To be eligible to receive funds under
this section an entity described in subsection (a) shall submit
to the Secretary, through the appropriate area office, and have
approved, an application in such form, submitted in such
manner, and containing such information as the Secretary shall
by regulation prescribe.
``(2) Preference.--In awarding funds under this section,
the area office shall give a preference to applications
submitted by Indian tribes, tribal organizations, or urban
Indian organizations.
``(3) Amount.--The amount of funds to be provided to an
eligible entity under this section shall be determined by the
area office. Payments under 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 promulgated pursuant
to this Act.
``(4) Terms.--A funding commitment under this section
shall, to the extent not otherwise prohibited by law, be for a
term of 3 years, as provided for in regulations promulgated
pursuant to this Act.
``(c) Definition.--For purposes of this section and sections 104
and 105, the terms `Indian' and `Indians' shall, in addition to the
definition provided for in section 4, mean any individual who--
``(1) irrespective of whether such individual lives on or
near a reservation, is a member of a tribe, band, or other
organized group of Indians, including those Tribes, bands, or
groups terminated since 1940;
``(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) In General.--The Secretary, acting through the Service, shall
provide scholarships through the area offices to Indians who--
``(1) have successfully completed their high school
education or high school equivalency; and
``(2) have demonstrated the capability to successfully
complete courses of study in the health professions.
``(b) Purpose.--Scholarships provided under this section shall be
for the following purposes:
``(1) Compensatory preprofessional education of any
recipient. Such scholarship shall not exceed 2 years on a full-
time basis (or the part-time equivalent thereof, as determined
by the area office pursuant to regulations promulgated 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 (or the part-time equivalent thereof, as determined by
the area office pursuant to regulations promulgated under this Act)
except that an extension of up to 2 years may be approved by the
Secretary.
``(c) Use of Scholarship.--Scholarships made under this section may
be used to cover costs of tuition, books, transportation, board, and
other necessary related expenses of a recipient while attending school.
``(d) Limitations.--Scholarship assistance to an eligible applicant
under this section shall not be denied solely on the basis of--
``(1) the applicant's scholastic achievement if such
applicant has been admitted to, or maintained good standing at,
an accredited institution; or
``(2) the applicant's eligibility for assistance or
benefits under any other Federal program.
``SEC. 105. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.
``(a) Scholarships.--
``(1) In general.--In order to meet the needs of Indians,
Indian tribes, tribal organizations, and urban Indian
organizations for health professionals, the Secretary, acting
through the Service and in accordance with this section, shall
provide scholarships through the area offices 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, except as provided in subsection (b), be made in
accordance with section 338A of the Public Health Service Act
(42 U.S.C. 254l).
``(2) No delegation.--The Director of the Service shall
administer this section and shall not delegate any
administrative functions under a funding agreement pursuant to
the Indian Self-Determination and Education Assistance Act.
``(b) Eligibility.--
``(1) Enrollment.--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)(1).
``(2) Service obligation.--
``(A) Public health service act.--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; 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) Deferring active service.--At the request of
any Indian who has entered into a contract referred to
in subparagraph (A) and who receives a degree in
medicine (including osteopathic or allopathic
medicine), dentistry, optometry, podiatry, or pharmacy,
the Secretary shall defer the active duty service
obligation of that individual under that contract, in
order that such individual may complete any internship,
residency, or other advanced clinical training that is
required for the practice of that health profession,
for an appropriate period (in years, as determined by
the Secretary), subject to the following conditions:
``(i) No period of internship, residency,
or other advanced clinical training shall be
counted as satisfying any period of obligated
service that is required under this section.
``(ii) The active duty service obligation
of that individual shall commence not later
than 90 days after the completion of that
advanced clinical training (or by a date
specified by the Secretary).
``(iii) The active duty service obligation
will be served in the health profession of that
individual, in a manner consistent with clauses
(i) through (iv) of subparagraph (A).
``(C) New scholarship recipients.--A recipient of
an Indian Health Scholarship that is awarded after
December 31, 2001, shall meet the active duty service
obligation under such scholarship by providing service
within the service area from which the scholarship was
awarded. In placing the recipient for active duty the
area office shall give priority to the program that
funded the recipient, except that in cases of special
circumstances, a recipient may be placed in a different
service area pursuant to an agreement between the areas
or programs involved.
``(D) Priority in assignment.--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) Part-time enrollment.--In the case of an Indian
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 appropriate 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 1 year
for each year for which the individual was
provided a scholarship (as determined by the
area office); or
``(ii) two years; and
``(C) the amount of the monthly stipend specified
in section 338A(g)(1)(B) of the Public Health Service
Act (42 U.S.C. 254l(g)(1)(B)) shall be reduced pro rata
(as determined by the Secretary) based on the number of
hours such student is enrolled.
``(4) Breach of contract.--
``(A) In general.--An Indian who has, on or after
the date of the enactment of this paragraph, entered
into a written contract with the area office pursuant
to a scholarship under this section and who--
``(i) fails to maintain an acceptable level
of academic standing in the educational
institution in which he or she is enrolled
(such level determined by the educational
institution under regulations of the
Secretary);
``(ii) 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
amount which has been paid to him or her, or on his or
her behalf, under the contract.
``(B) Failure to perform service obligation.--If
for any reason not specified in subparagraph (A) an
individual breaches his or her 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 110 in the manner provided for in such
subsection.
``(C) Death.--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) Waiver.--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 appropriate area office, Indian tribe, tribal
organization, and urban Indian organization, 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) Hardship or good cause.--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) Bankruptcy.--Notwithstanding any other
provision of law, with respect to a recipient of an
Indian Health Scholarship, no obligation for payment
may be released by a discharge in bankruptcy under
title 11, United States Code, unless that discharge is
granted after the expiration of the 5-year period
beginning on the initial date on which that payment is
due, and only if the bankruptcy court finds that the
nondischarge of the obligation would be unconscionable.
``(c) Funding for Tribes for Scholarship Programs.--
``(1) Provision of funds.--
``(A) in general.--The Secretary shall make funds
available, through area offices, 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) Limitation.--The Secretary shall ensure that
amounts available for grants under subparagraph (A) for
any fiscal year shall not exceed an amount equal to 5
percent of the amount available for each fiscal year
for Indian Health Scholarships under this section.
``(C) Application.--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) Requirements.--
``(A) In general.--An Indian Tribe or tribal
organization receiving funds under paragraph (1) shall
agree to provide scholarships to Indians in accordance
with the requirements of this subsection.
``(B) Matching requirement.--With respect to the
costs of providing any scholarship pursuant to
subparagraph (A)--
``(i) 80 percent of the costs of the
scholarship shall be paid from the funds
provided under paragraph (1) to the Indian
Tribe or tribal organization; and
``(ii) 20 percent of such costs shall be
paid from any other source of funds.
``(3) Eligibility.--An Indian Tribe or tribal organization
shall provide scholarships under this subsection only to
Indians who are enrolled or accepted for enrollment in a course
of study (approved by the Secretary) in one of the health
professions described in this Act.
``(4) Contracts.--In providing scholarships under paragraph
(1), 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
110(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 equal to the number
of years for which the scholarship is provided
(or the part-time equivalent thereof, as
determined by the Secretary), or for a period
of 2 years, whichever period is greater; or
``(ii) such greater period of time as the
recipient and the Indian Tribe or tribal
organization may agree;
``(B) provide that 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 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 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 the health profession involved.
``(5) Breach of contract.--
``(A) In general.--An individual who has entered
into a written contract with the Secretary and an
Indian Tribe or tribal organization under this
subsection and who--
``(i) fails to maintain an acceptable level
of academic standing in the education
institution in which he or she is enrolled
(such level determined by the educational
institution under regulations of the
Secretary);
``(ii) is dismissed from such education for
disciplinary reasons;
``(iii) voluntarily terminates the training
in such an educational institution for which he
or she has been 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) Failure to perform service obligation.--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) Information.--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) Required agreements.--The recipient of a scholarship
under paragraph (1) shall agree, in providing health care
pursuant to the requirements of this subsection--
``(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) Payments.--The Secretary, through the area office,
shall make payments under this subsection to an Indian Tribe or
tribal organization for any fiscal year subsequent to the first
fiscal year of such payments unless the Secretary or area
office 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) In General.--Notwithstanding section 102, the Secretary shall
provide funds 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
colleges and universities throughout the country to maximize their
availability to Indian students and new programs shall be established
in different locations from time to time.
``(b) Quentin N. Burdick American Indians Into Psychology
Program.--The Secretary shall provide funds 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 American Indians Into Nursing
Program authorized under section 115, the Quentin N. Burdick Indians
into Health Program authorized under section 117, and existing
university research and communications networks.
``(c) Requirements.--
``(1) Regulations.--The Secretary shall promulgate
regulations pursuant to this Act for the competitive awarding
of funds under this section.
``(2) Program.--Applicants for funds 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 summer enrichment programs to expose
Indian students to the various fields of psychology
through research, clinical, and experimental
activities;
``(D) provides stipends to undergraduate and
graduate students to pursue a career in psychology;
``(E) develops affiliation agreements with tribal
community colleges, the Service, university affiliated
programs, and other appropriate accredited and
accessible entities to enhance the education of Indian
students;
``(F) utilizes, to the maximum extent feasible,
existing university tutoring, counseling and student
support services; and
``(G) employs, to the maximum extent feasible,
qualified Indians in the program.
``(d) Active Duty Obligation.--The active duty service obligation
prescribed under section 338C of the Public Health Service Act (42
U.S.C. 254m) shall be met by each graduate who receives a stipend
described in subsection (c)(2)(C) 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
contract entered into under the Indian Self-Determination and
Education Assistance Act;
``(3) in a program assisted under title V; 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) In General.--Any individual who receives a scholarship
pursuant to section 105 shall be entitled to employment in the Service,
or may be employed by a program of an Indian tribe, tribal
organization, or urban Indian organization, or other agency of the
Department as may be appropriate and available, during any nonacademic
period of the year. Periods of employment pursuant to this subsection
shall not be counted in determining the fulfillment of the service
obligation incurred as a condition of the scholarship.
``(b) Enrollees in Course of Study.--Any individual who is 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) High School Programs.--Any individual who is in a high school
program authorized under section 103(a) may be employed by the Service,
or by a 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.
``(d) Administrative Provisions.--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 in
any 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, acting through the area offices, may provide allowances to
health professionals employed in the Service or such a program to
enable such professionals to take leave of their duty stations for a
period of time each year (as prescribed by regulations of the
Secretary) for professional consultation and refresher training
courses.
``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.
``(a) In General.--Under the authority of the Act of November 2,
1921 (25 U.S.C. 13) (commonly known as the Snyder Act), the Secretary
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) Activities.--The Secretary, acting through the Community
Health Representative Program, 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
maintain programs that meet the needs for such continuing
education;
``(4) maintain a system that provides close supervision of
community health representatives;
``(5) maintain a system under which the work of community
health representatives is reviewed and evaluated; and
``(6) promote traditional health care practices of the
Indian tribes served consistent with the Service standards for
the provision of health care, health promotion, and disease
prevention.
``SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT PROGRAM.
``(a) Establishment.--
``(1) In general.--The Secretary, acting through the
Service, shall establish a program to be known as the Indian
Health Service Loan Repayment Program (referred to in this Act
as the `Loan Repayment Program') in order to assure an adequate
supply of trained health professionals necessary to maintain
accreditation of, and provide health care services to Indians
through, Indian health programs.
``(2) Definitions.--In this section:
``(A) Indian health program.--The term `Indian
health program' means any health program or facility
funded, in whole or part, by the Service for the
benefit of Indians and administered--
``(i) directly by the Service;
``(ii) by any Indian tribe or tribal or
Indian organization pursuant to a 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) (commonly
known as the `Buy-Indian Act'); or
``(iii) by an urban Indian organization
pursuant to title V.
``(B) State.--The term `State' has the same meaning
given such term in section 331(i)(4) of the Public
Health Service Act.
``(b) Eligibility.--To be eligible to participate in the Loan
Repayment Program, an individual must--
``(1)(A) be enrolled--
``(i) in a course of study or program in an
accredited institution, as determined by the Secretary,
within any State and be scheduled to complete such
course of study in the same year such individual
applies to participate in such program; or
``(ii) in an approved graduate training program in
a health profession; or
``(B) have--
``(i) a degree in a health profession; and
``(ii) a license to practice a health profession in
a State;
``(2)(A) be eligible for, or hold, an appointment as a
commissioned officer in the Regular or Reserve Corps of the
Public Health Service;
``(B) be eligible for selection for civilian service in the
Regular or Reserve Corps of the Public Health Service;
``(C) meet the professional standards for civil service
employment in the Indian Health Service; or
``(D) be employed in an Indian health program without a
service obligation; and
``(3) submit to the Secretary an application for a contract
described in subsection (f).
``(c) Forms.--
``(1) In general.--In disseminating application forms and
contract forms to individuals desiring to participate in the
Loan Repayment Program, the Secretary shall include with such
forms a fair summary of the rights and liabilities of an
individual whose application is approved (and whose contract is
accepted) by the Secretary, including in the summary a clear
explanation of the damages to which the United States is
entitled under subsection (l) in the case of the individual's
breach of the contract. The Secretary shall provide such
individuals with sufficient information regarding the
advantages and disadvantages of service as a commissioned
officer in the Regular or Reserve Corps of the Public Health
Service or a civilian employee of the Indian Health Service to
enable the individual to make a decision on an informed basis.
``(2) Forms to be understandable.--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) Availability.--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) Priority.--
``(1) Annual determinations.--The Secretary, acting through
the Service and in accordance with subsection (k), shall
annually--
``(A) identify the positions in each Indian health
program for which there is a need or a vacancy; and
``(B) rank those positions in order of priority.
``(2) Priority in approval.--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 an
Indian tribe, tribal organization, or urban Indian
organization.
``(e) Contracts.--
``(1) In general.--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) Notice.--Not later than 21 days after considering an
individual for participation in the Loan Repayment Program
under paragraph (1), the Secretary shall provide written notice
to the individual of--
``(A) the Secretary's approving 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) Written Contract.--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);
``(iii) to serve for a time period
(referred to in this section 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) Loan Repayments.--
``(1) In general.--A loan repayment provided for an
individual under a written contract under the Loan Repayment
Program shall consist of payment, in accordance with paragraph
(2), on behalf of the individual of the principal, interest,
and related expenses on government and commercial loans
received by the individual regarding the undergraduate or
graduate education of the individual (or both), which loans
were made for--
``(A) tuition expenses;
``(B) all other reasonable educational expenses,
including fees, books, and laboratory expenses,
incurred by the individual; and
``(C) reasonable living expenses as determined by
the Secretary.
``(2) Amount of payment.--
``(A) In general.--For each year of obligated
service that an individual contracts to serve under
subsection (f) the Secretary may pay up to $35,000 (or
an amount equal to the amount specified in section
338B(g)(2)(A) of the Public Health Service Act) on
behalf of the individual for loans described in
paragraph (1). In making a determination of the amount
to pay for a year of such service by an individual, the
Secretary shall consider the extent to which each such
determination--
``(i) affects the ability of the Secretary
to maximize the number of contracts that can be
provided under the Loan Repayment Program from
the amounts appropriated for such contracts;
``(ii) provides an incentive to serve in
Indian health programs with the greatest
shortages of health professionals; and
``(iii) provides an incentive with respect
to the health professional involved remaining
in an Indian health program with such a health
professional shortage, and continuing to
provide primary health services, after the
completion of the period of obligated service
under the Loan Repayment Program.
``(B) Time for payment.--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 not later than the end of the fiscal year in which
the individual completes such year of service.
``(3) Schedule for payments.--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) Counting of Individuals.--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) Recruiting Programs.--The Secretary shall conduct recruiting
programs for the Loan Repayment Program and other health professional
programs of the Service at educational institutions training health
professionals or specialists identified in subsection (a).
``(j) Nonapplication of Certain Provision.--Section 214 of the
Public Health Service Act (42 U.S.C. 215) shall not apply to
individuals during their period of obligated service under the Loan
Repayment Program.
``(k) Assignment of Individuals.--The Secretary, in assigning
individuals to serve in Indian health programs pursuant to contracts
entered into under this section, shall--
``(1) ensure that the staffing needs of Indian health
programs administered by an Indian tribe or tribal or health
organization receive consideration on an equal basis with
programs that are administered directly by the Service; and
``(2) give priority to assigning individuals to Indian
health programs that have a need for health professionals to
provide health care services as a result of individuals having
breached contracts entered into under this section.
``(l) Breach of Contract.--
``(1) In general.--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,
and who 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) Amount of recovery.--If, for any reason not specified
in paragraph (1), an individual breaches his written contract
under this section by failing either to begin, or complete,
such individual's period of obligated service in accordance
with subsection (f), the United States shall be entitled to
recover from such individual an amount to be determined in
accordance with the following formula:
A=3Z(t-s/t)
in which--
``(A) `A' is the amount the United States is
entitled to recover;
``(B) `Z' is the sum of the amounts paid under this
section to, or on behalf of, the individual and the
interest on such amounts which would be payable if, at
the time the amounts were paid, they were loans bearing
interest at the maximum legal prevailing rate, as
determined by the Treasurer of the United States;
``(C) `t' is the total number of months in the
individual's period of obligated service in accordance
with subsection (f); and
``(D) `s' is the number of months of such period
served by such individual in accordance with this
section.
Amounts not paid within such period shall be subject to
collection through deductions in Medicare payments pursuant to
section 1892 of the Social Security Act.
``(3) Damages.--
``(A) Time for payment.--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 of contract or such longer period beginning on
such date as shall be specified by the Secretary.
``(B) Delinquencies.--If damages described in
subparagraph (A) are delinquent for 3 months, the
Secretary shall, for the purpose of recovering such
damages--
``(i) utilize collection agencies
contracted with by the Administrator of the
General Services Administration; or
``(ii) enter into contracts for the
recovery of such damages with collection
agencies selected by the Secretary.
``(C) Contracts for recovery of damages.--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) Cancellation, Waiver or Release.--
``(1) Cancellation.--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) Waiver of service obligation.--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) Waiver of rights of united states.--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) Release.--Any obligation of an individual under the
Loan Repayment Program for payment of damages may be released
by a discharge in bankruptcy under title 11 of the United
States Code only if such discharge is granted after the
expiration of the 5-year period beginning on the first date
that payment of such damages is required, and only if the
bankruptcy court finds that nondischarge of the obligation
would be unconscionable.
``(n) Report.--The Secretary shall submit to the President, for
inclusion in each report required to be submitted to the Congress under
section 801, a report concerning the previous fiscal year which sets
forth--
``(1) the health professional positions maintained by the
Service or by tribal or Indian organizations for which
recruitment or retention is difficult;
``(2) the number of Loan Repayment Program applications
filed with respect to each type of health profession;
``(3) the number of contracts described in subsection (f)
that are entered into with respect to each health profession;
``(4) the amount of loan payments made under this section,
in total and by health profession;
``(5) the number of scholarship grants that are provided
under section 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, tribal organizations, or urban Indian organizations for
which recruitment or retention is difficult.
``SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY FUND.
``(a) Establishment.--Notwithstanding section 102, 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
(referred to in this section as the `LRRF'). The LRRF Fund shall
consist of--
``(1) such amounts as may be collected from individuals
under subparagraphs (A) and (B) of section 105(b)(4) and
section 110(l) for breach of contract;
``(2) such funds as may be appropriated to the LRRF;
``(3) such interest earned on amounts in the LRRF; and
``(4) such additional amounts as may be collected,
appropriated, or earned relative to the LRRF.
Amounts appropriated to the LRRF shall remain available until
expended.
``(b) Use of LRRF.--
``(1) In general.--Amounts in the LRRF may be expended by
the Secretary, subject to section 102, acting through the
Service, 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 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) Scholarships and recruiting.--An Indian tribe or
tribal organization receiving payments pursuant to paragraph
(1) may expend the payments to provide scholarships or to
recruit and employ, directly or by contract, health
professionals to provide health care services.
``(c) Investing of Fund.--
``(1) In general.--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) Sale price.--Any obligation acquired by the LRRF may
be sold by the Secretary of the Treasury at the market price.
``SEC. 112. RECRUITMENT ACTIVITIES.
``(a) Reimbursement of Expenses.--The Secretary may reimburse
health professionals seeking positions in 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) Assignment of Personnel.--The Secretary, acting through the
Service, shall assign one individual in each area office to be
responsible on a full-time basis for recruitment activities.
``SEC. 113. TRIBAL RECRUITMENT AND RETENTION PROGRAM.
``(a) Funding of Projects.--The Secretary, acting through the
Service, shall fund innovative 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) Eligibility.--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) Demonstration Project.--The Secretary, acting through the
Service, 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 in areas of study for which the Secretary
determines a need exists.
``(b) Service Obligation.--
``(1) In general.--An individual who participates in the
project 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 project.
``(2) Failure to complete service.--In the event that an
individual fails to complete a period of obligated service
under paragraph (1), the individual shall be liable to the
United States for the period of service remaining. In such
event, with respect to individuals entering the project after
the date of the enactment of this Act, 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) Opportunity To Participate.--Health professionals from Indian
tribes, tribal organizations, and urban Indian organizations under the
authority of the Indian Self-Determination and Education Assistance Act
shall be given an equal opportunity to participate in the program under
subsection (a).
``SEC. 115. NURSING PROGRAMS; QUENTIN N. BURDICK AMERICAN INDIANS INTO
NURSING PROGRAM.
``(a) Grants.--Notwithstanding section 102, the Secretary, acting
through the Service, shall provide funds 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, or in the absence of such, any other public or
private institution,
for the purpose of increasing the number of nurses, nurse midwives, and
nurse practitioners who deliver health care services to Indians.
``(b) Use of Grants.--Funds 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 be used to pay the tuition charged
for such program and for 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) Applications.--Each application for funds under subsection
(a) shall include such information as the Secretary may require to
establish the connection between the program of the applicant and a
health care facility that primarily serves Indians.
``(d) Preferences.--In providing funds 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) Quentin N. Burdick American Indians Into Nursing Program.--
The Secretary shall ensure that a portion of the funds authorized under
subsection (a) is made available 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
American Indians Into Psychology Program established under section
106(b) and the Quentin N. Burdick Indian Health Programs established
under section 117(b).
``(f) Service Obligation.--The active duty service obligation
prescribed under section 338C of the Public Health Service Act (42
U.S.C. 254m) shall be met by each individual who receives training or
assistance described in paragraph (1) or (2) of subsection (b) that is
funded under subsection (a). Such obligation shall be met by service--
``(1) in the Indian Health Service;
``(2) in a program conducted under a contract entered into
under the Indian Self-Determination and Education assistance
Act;
``(3) in a program assisted under title V; or
``(4) in the private practice of nursing if, as determined
by the Secretary, in accordance with guidelines promulgated by
the Secretary, such practice is situated in a physician or
other health professional shortage area and addresses the
health care needs of a substantial number of Indians.
``SEC. 116. TRIBAL CULTURE AND HISTORY.
``(a) In General.--The Secretary, acting through the Service, shall
require that appropriate employees of the Service who serve Indian
tribes in each service area receive educational instruction in the
history and culture of such tribes and their relationship to the
Service.
``(b) Requirements.--To the extent feasible, the educational
instruction to be provided under subsection (a) shall--
``(1) be provided in consultation with the affected tribal
governments, tribal organizations, and urban Indian
organizations;
``(2) be provided 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)); and
``(3) include instruction in Native American studies.
``SEC. 117. INMED PROGRAM.
``(a) Grants.--The Secretary may provide grants to 3 colleges and
universities for the purpose of maintaining and expanding the Native
American health careers recruitment program known as the `Indians into
Medicine Program' (referred to in this section as `INMED') as a means
of encouraging Indians to enter the health professions.
``(b) Quentin N. Burdick Indian Health Program.--The Secretary
shall provide 1 of the grants under subsection (a) to maintain the
INMED program at the University of North Dakota, to be known as the
`Quentin N. Burdick Indian Health Program', 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) Requirements.--
``(1) In general.--The Secretary shall develop regulations
to govern grants under to this section.
``(2) Program requirements.--Applicants for grants provided
under this section shall agree to provide a program that--
``(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) Establishment Grants.--
``(1) In general.--The Secretary, acting through the
Service, shall award grants to accredited and accessible
community colleges for the purpose of assisting such 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) Amount.--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) Continuation Grants.--
``(1) In general.--The Secretary, acting through the
Service, shall award grants to accredited and accessible
community colleges that have established a program described in
subsection (a)(1) for the purpose of maintaining the program
and recruiting students for the program.
``(2) Eligibility.--Grants may only be made under this
subsection to a community college that--
``(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 at 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) Service Personnel and Technical Assistance.--The Secretary
shall encourage community colleges described in subsection (b)(2) to
establish and maintain programs described in subsection (a)(1) by--
``(1) entering into agreements with such colleges for the
provision of qualified personnel of the Service to teach
courses of study in such programs, and
``(2) providing technical assistance and support to such
colleges.
``(d) Specified Courses of Study.--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) Priority.--Priority shall be provided under this section to
tribally controlled colleges in service areas that meet the
requirements of subsection (b).
``(f) Definitions.--In this section:
``(1) Community college.--The term `community college'
means--
``(A) a tribally controlled community college; or
``(B) a junior or community college.
``(2) Junior or community college.--The term `junior or
community college'' has the meaning given such term by section
312(e) of the Higher Education Act of 1965 (20 U.S.C. 1058(e)).
``(3) Tribally controlled college.--The term `tribally
controlled college' has the meaning given the term `tribally
controlled community college' by section 2(4) of the Tribally
Controlled Community College Assistance Act of 1978.
``SEC. 119. RETENTION BONUS.
``(a) In General.--The Secretary may pay a retention bonus to any
health professional employed by, or assigned to, and serving in, the
Service, an Indian tribe, a tribal organization, or an urban Indian
organization either as a civilian employee or as a commissioned officer
in the Regular or Reserve Corps of the Public Health Service who--
``(1) is assigned to, and serving in, a position for which
recruitment or retention of personnel is difficult;
``(2) the Secretary determines is needed by the Service,
tribe, tribal organization, or urban organization;
``(3) has--
``(A) completed 3 years of employment with the
Service; tribe, tribal organization, or urban
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, Indian
tribe, tribal organization, or urban Indian organization for
continued employment for a period of not less than 1 year.
``(b) Rates.--The Secretary may establish rates for the retention
bonus which shall provide for a higher annual rate for multiyear
agreements than for single year agreements referred to in subsection
(a)(4), but in no event shall the annual rate be more than $25,000 per
annum.
``(c) Failure To Complete Term of Service.--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) Funding Agreement.--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) Establishment.--The Secretary, acting through the Service,
shall establish a program to enable Indians who are licensed practical
nurses, licensed vocational nurses, and registered nurses who are
working in an Indian health program (as defined in section
110(a)(2)(A)), and have done so for a period of not less than 1 year,
to pursue advanced training.
``(b) Requirement.--The program established under subsection (a)
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 an advanced degrees in nursing and public
health.
``(c) Service Obligation.--An individual who participates in a
program under subsection (a), where the educational costs are paid by
the Service, shall incur an obligation to serve in an Indian health
program 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) In General.--Under the authority of the Act of November 2,
1921 (25 U.S.C. 13; commonly known as the Snyder Act), the Secretary
shall 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) Activities.--The Secretary, acting through the Community
Health Aide Program under subsection (a), 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
objective 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 who 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.
``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.
``Subject to Section 102, the Secretary, acting through the
Service, shall, through a 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) Pilot Programs.--The Secretary may, through area offices,
fund pilot programs for tribes and tribal organizations to address
chronic shortages of health professionals.
``(b) Purpose.--It is the purpose of the health professions
demonstration project under this section to--
``(1) provide direct clinical and practical experience in a
service area to health professions students and residents from
medical schools;
``(2) improve the quality of health care for Indians by
assuring access to qualified health care professionals; and
``(3) provide academic and scholarly opportunities for
health professionals serving Indian people by identifying and
utilizing all academic and scholarly resources of the region.
``(c) Advisory Board.--A pilot program established under subsection
(a) shall incorporate a program advisory board that shall be composed
of representatives from the tribes and communities in the service area
that will be served by the program.
``SEC. 124. SCHOLARSHIPS.
``Scholarships and loan reimbursements provided to individuals
pursuant to this title shall be treated as `qualified scholarships' for
purposes of section 117 of the Internal Revenue Code of 1986.
``SEC. 125. NATIONAL HEALTH SERVICE CORPS.
``(a) Limitations.--The Secretary shall not--
``(1) remove a member of the National Health Services Corps
from a health program operated by Indian Health Service or by a
tribe or tribal organization under a funding agreement with the
Service under the Indian Self-Determination and Education
Assistance Act, or by urban Indian organizations; or
``(2) withdraw the funding used to support such a member;
unless the Secretary, acting through the Service, tribes or tribal
organization, has ensured that the Indians receiving services from such
member will experience no reduction in services.
``(b) Designation of Service Areas as Health Professional Shortage
Areas.--All service areas served by programs operated by the Service or
by a tribe or tribal organization sunder the Indian Self-Determination
and Education Assistance Act, or by an urban Indian organization, shall
be designated under section 332 of the Public Health Service Act (42
U.S.C. 254e) as Health Professional Shortage Areas.
``(c) Full Time Equivalent.--National Health Service Corps scholars
that qualify for the commissioned corps in the Public Health Service
shall be exempt from the full time equivalent limitations of the
National Health Service Corps and the Service when such scholars serve
as commissioned corps officers in a health program operated by an
Indian tribe or tribal organization under the Indian Self-Determination
and Education Assistance Act or by an urban Indian organization.
``SEC. 126. SUBSTANCE ABUSE COUNSELOR EDUCATION DEMONSTRATION PROJECT.
``(a) Demonstration Projects.--The Secretary, acting through the
Service, may enter into contracts with, or make grants to, accredited
tribally controlled community colleges, tribally controlled
postsecondary vocational institutions, and eligible accredited and
accessible community colleges to establish demonstration projects to
develop educational curricula for substance abuse counseling.
``(b) Use of Funds.--Funds provided under this section shall be
used only for developing and providing educational curricula for
substance abuse counseling (including paying salaries for instructors).
Such curricula may be provided through satellite campus programs.
``(c) Term of Grant.--A contract entered into or a grant provided
under this section shall be for a period of 1 year. Such contract or
grant may be renewed for an additional 1 year period upon the approval
of the Secretary.
``(d) Review of Applications.--Not later than 180 days after the
date of the enactment of this Act, 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) Technical Assistance.--The Secretary shall provide such
technical and other assistance as may be necessary to enable grant
recipients to comply with the provisions of this section.
``(f) Report.--The Secretary shall submit to the President, for
inclusion in the report 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) Definitions.--In this section:
``(1) Educational curriculum.--The term `educational
curriculum' means 1 or more of the following:
``(A) Classroom education.
``(B) Clinical work experience.
``(C) Continuing education workshops.
``(2) Tribally controlled community college.--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)).
``(3) Tribally controlled postsecondary vocational
institution.--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.
``(a) Study and List.--
``(1) In general.--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, dysfunctional or self-destructive behavior.
``(2) Positions.--The positions referred to in paragraph
(1) are--
``(A) staff positions within the Bureau of Indian
Affairs, including existing positions, in the fields
of--
``(i) elementary and secondary education;
``(ii) social services, 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 specified in
subsection (b) and established and maintained by Indian
tribes, tribal organizations, and urban Indian
organizations, including positions established pursuant
to funding agreements under the Indian Self-
determination and Education Assistance Act, and this
Act.
``(3) Training criteria.--
``(A) In general.--The appropriate Secretary shall
provide training criteria appropriate to each type of
position specified in subsection (b)(1) and ensure that
appropriate training has been or will be provided to
any individual in any such position.
``(B) Training.--With respect to any such
individual in a position specified pursuant to
subsection (b)(3), the respective Secretaries shall
provide appropriate training or provide funds to an
Indian tribe, tribal organization, or urban Indian
organization for the 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) Cultural relevancy.--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) Community education.--
``(A) Development.--The Service shall develop and
implement, or on request of an Indian tribe or tribal
organization, assist an Indian tribe or tribal
organization, in developing and implementing a program
of community education on mental illness.
``(B) Technical assistance.--In carrying out this
paragraph, the Service shall, upon the request of an
Indian tribe or tribal organization, provide technical
assistance to the Indian tribe or tribal organization
to obtain and develop community educational materials
on the identification, prevention, referral and
treatment of mental illness, dysfunctional and self-
destructive behavior.
``(b) Staffing.--
``(1) In general.--Not later than 90 days after the date of
enactment of the Act, the Director of the Service shall develop
a plan under which the Service will increase the number of
health care staff that are providing mental health services by
at least 500 positions within 5 years after such date of
enactment, 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) Implementation.--The plan developed under paragraph
(1) shall be implemented under the Act of November 2, 1921 (25
U.S.C. 13) (commonly know 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) In General.--The Secretary may expend funds, directly or
under the authority of the Indian Self-Determination and Education
Assistance Act, that are appropriated under the authority of this
section, for the purposes of--
``(1) eliminating the deficiencies in the 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 and
resource deficiencies:
``(A) clinical care, including 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; and
``(K) traditional health care practices.
``(b) Use of Funds.--
``(1) Limitation.--Any funds appropriated under the
authority of this section shall not be used to offset or limit
any other appropriations made to the Service under this Act,
the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as
the `Snyder Act'), or any other provision of law.
``(2) Allocation.--
``(A) In general.--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 to
improve the health status and reduce the resource
deficiency of each tribe served by such service unit,
tribe or tribal organization.
``(B) Apportionment.--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 this section
and such rules as may be established under title VIII.
``(c) Health Status and Resource Deficiency.--In this section:
``(1) Definition.--The term `health status and resource
deficiency' means the extent to which--
``(A) the health status objective set forth in
section 3(2) is 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) Resources.--The health resources available to an
Indian tribe or tribal organization shall 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) Review of determination.--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) Eligibility.--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) Report.--Not later than the date that is 3 years after the
date of enactment of this Act, the Secretary shall submit to the
Congress the current health status and resource deficiency report of
the Service for each Indian tribe or service unit, including newly
recognized or acknowledged tribes. Such report shall set out--
``(1) the methodology then in use by the Service for
determining tribal health status and resource deficiencies, as
well as the most recent application of that methodology;
``(2) the extent of the health status and resource
deficiency of each Indian tribe served by the Service;
``(3) the amount of funds necessary to eliminate the health
status and resource deficiencies of all Indian tribes served by
the Service; and
``(4) an estimate of--
``(A) the amount of health service funds
appropriated under the authority of this Act, or any
other Act, including the amount of any funds
transferred to the Service, for the preceding fiscal
year which is allocated to each service unit, Indian
tribe, or comparable entity;
``(B) the number of Indians eligible for health
services in each service unit or Indian tribe 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) Budgetary Rule.--Funds appropriated under the authority of
this section for any fiscal year shall be included in the base budget
of the Service for the purpose of determining appropriations under this
section in subsequent fiscal years.
``(g) Rule of Construction.--Nothing in this section shall be
construed to diminish the primary responsibility of the Service to
eliminate existing backlogs in unmet health care needs or to discourage
the Service from undertaking additional efforts to achieve equity among
Indian tribes and tribal organizations.
``(h) Designation.--Any funds appropriated under the authority of
this section shall be designated as the `Indian Health Care Improvement
Fund'.
``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.
``(a) Establishment.--
``(1) In general.--There is hereby established an Indian
Catastrophic Health Emergency Fund (referred to in this section
as the `CHEF') consisting of--
``(A) the amounts deposited under subsection (d);
and
``(B) any amounts appropriated to the CHEF under
this Act.
``(2) Administration.--The 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) Equitable allocation.--The CHEF shall be equitably
allocated, apportioned or delegated on a service unit or area
office basis, based upon a formula to be developed by the
Secretary in consultation with the Indian tribes and tribal
organizations through negotiated rulemaking under title VIII.
Such formula shall take into account the added needs of service
areas which are contract health service dependent.
``(4) Not subject to contract or grant.--No part of
the CHEF or its administration shall be subject to
contract or grant under any law, including the Indian
Self-Determination and Education Assistance Act.
``(5) Administration.--Amounts provided from the
CHEF shall be administered by the area offices based
upon priorities determined by the Indian tribes and
tribal organizations within each service area,
including a consideration of the needs of Indian tribes
and tribal organizations which are contract health
service-dependent.
``(b) Requirements.--The Secretary shall, through the negotiated
rulemaking process under title VIII, promulgate regulations consistent
with the provisions of this section--
``(1) establish a definition of disasters and catastrophic
illnesses for which the cost of treatment provided under
contract would qualify for payment from the CHEF;
``(2) provide that a service unit, Indian tribe, or tribal
organization shall not be eligible for reimbursement for the
cost of treatment from the CHEF until its cost of treatment for
any victim of such a catastrophic illness or disaster has
reached a certain threshold cost which the Secretary shall
establish at--
``(A) for 1999, not less than $19,000; and
``(B) for any subsequent year, not less than the
threshold cost of the previous year increased by the
percentage increase in the medical care expenditure
category of the consumer price index for all urban
consumers (United States city average) for the 12-month
period ending with December of the previous year;
``(3) establish a procedure for the reimbursement of the
portion of the costs incurred by--
``(A) service units, Indian tribes, or tribal
organizations, or facilities of the Service; or
``(B) non-Service facilities or providers whenever
otherwise authorized by the Service;
in rendering treatment that exceeds threshold cost described in
paragraph (2);
``(4) establish a procedure for payment from the 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 the 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) Limitation.--Amounts appropriated to the CHEF under this
section shall not be used to offset or limit appropriations made to the
Service under the authority of the Act of November 2, 1921 (25 U.S.C.
13) (commonly known as the Snyder Act) or any other law.
``(d) Deposits.--There shall be deposited into the 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 the CHEF.
``SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION SERVICES.
``(a) Findings.--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) Provision of Services.--The Secretary, acting through the
Service and through Indian tribes and tribal organizations, shall
provide health promotion and disease prevention services to Indians so
as to achieve the health status objective set forth in section 3(b).
``(c) Disease Prevention and Health Promotion.--In this section:
``(1) Disease prevention.--The term `disease prevention'
means the reduction, limitation, and prevention of disease and
its complications, and the reduction in the consequences of
such diseases, including--
``(A) controlling--
``(i) 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) for the fluoridation of water; and
``(ii) immunizations.
``(2) Health promotion.--The term `health promotion' means
fostering social, economic, environmental, and personal factors
conducive to health, including--
``(A) 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;
``(B) encouraging adequate and appropriate diet,
exercise, and sleep;
``(C) promoting education and work in conformity
with physical and mental capacity;
``(E) making available suitable housing, safe
water, and sanitary facilities;
``(F) improving the physical economic, cultural,
psychological, and social environment;
``(G) promoting adequate opportunity for spiritual,
religious, and traditional practices; and
``(H) adequate and appropriate programs including--
``(i) abuse prevention (mental and
physical);
``(iii) community health;
``(iv) community safety;
``(v) consumer health education;
``(vi) diet and nutrition;
``(vii) disease prevention (communicable,
immunizations, HIV/AIDS);
``(viii) environmental health;
``(ix) exercise and physical fitness;
``(x) fetal alcohol disorders;
``(xi) first aid and CPR education;
``(xii) human growth and development;
``(xiii) injury prevention and personal
safety;
``(xiv) mental health (emotional, self-
worth);
``(xv) personal health and wellness
practices;
``(xvi) personal capacity building;
``(xvii) prenatal, pregnancy, and infant
care;
``(xviii) psychological well being;
``(xix) reproductive health (family
planning);
``(xx) safe and adequate water;
``(xxi) safe housing;
``(xxii) safe work environments;
``(xxiii) stress control;
``(xxiv) substance abuse;
``(xxv) sanitary facilities;
``(xxvi) tobacco use cessation and
reduction;
``(xxvii) violence prevention; and
``(xxviii) such other activities identified
by the Service, an Indian tribe or tribal
organization, to promote the achievement of the
objective described in section 3(b).
``(d) Evaluation.--The Secretary, after obtaining input from
affected Indian tribes and tribal organizations, shall submit to the
President for inclusion in each statement which is required to be
submitted to Congress under section 801 an evaluation of--
``(1) the health promotion and disease prevention needs of
Indians;
``(2) the health promotion and disease prevention
activities which would best meet such needs;
``(3) the internal capacity of the Service 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) Determination.--The Secretary, in consultation with Indian
tribes and tribal organizations, shall determine--
``(1) by tribe, tribal organization, and service unit of
the Service, the prevalence 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
prevalence of, and prevent, treat, and control the
complications resulting from, diabetes among Indian tribes
within that service unit.
``(b) Screening.--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 an Indian 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) Continued Funding.--The Secretary shall continue to fund,
through fiscal year 2012, each effective model diabetes project in
existence on the date of the enactment of this Act and such other
diabetes programs operated by the Secretary or by Indian tribes and
tribal organizations and any additional programs added to meet existing
diabetes needs. Indian tribes and tribal organizations shall receive
recurring funding for the diabetes programs which they operate pursuant
to this section. Model diabetes projects shall consult, on a regular
basis, with tribes and tribal organizations in their regions regarding
diabetes needs and provide technical expertise as needed.
``(d) Dialysis Programs.--The Secretary shall provide funding
through the Service, Indian tribes and tribal organizations to
establish dialysis programs, including funds to purchase dialysis
equipment and provide necessary staffing.
``(e) Other Activities.--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 prevalence 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 tribes, tribal organizations, and all other
area offices.
``SEC. 205. SHARED SERVICES.
``(a) In General.--The Secretary, acting through the Service and
notwithstanding any other provision of law, 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
a funding agreement) by such Indian tribe or tribal organization.
``(b) Requirements.--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) 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.
``(d) Use of Existing Facilities.--The Secretary shall encourage
the use for long-term or similar care of existing facilities that are
under-utilized or allow the use of swing beds for such purposes.
``SEC. 206. HEALTH SERVICES RESEARCH.
``(a) Funding.--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 to address these research needs.
``(b) Allocation.--Funding under subsection (a) shall be allocated
equitably among the area offices. Each area office shall award such
funds competitively within that area.
``(c) Eligibility for Funds.--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.
``(d) Use.--Funds received under this section may be used for both
clinical and non-clinical research by Indian tribes and tribal
organizations and shall be distributed to the area offices. Such area
offices may make grants using such 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 the following screening:
``(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 assure 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, 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 and nonemergency air
transportation where ground transportation is infeasible.
``(2) Transportation by private vehicle, specially equipped
vehicle and ambulance.
``(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) Establishment.--
``(1) In general.--In addition to those centers operating 1
day prior to the date of enactment of this Act, (including
those centers for which funding is currently being provided
through funding agreements under the Indian Self-Determination
and Education Assistance Act), the Secretary shall, not later
than 180 days after such date of enactment, establish and fund
an epidemiology center in each service area which does not have
such a center to carry out the functions described in paragraph
(2). Any centers established under the preceding sentence may
be operated by Indian tribes or tribal organizations pursuant
to funding agreements under the Indian Self-Determination and
Education Assistance Act, but funding under such agreements may
not be divisible.
``(2) Functions.--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 shall--
``(A) collect data related to the health status
objective described in section 3(b), and monitor the
progress that the Service, Indian tribes, tribal
organizations, and urban Indian organizations have made
in meeting such health status objective;
``(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) Technical assistance.--The director of the Centers
for Disease Control and Prevention shall provide technical
assistance to the centers in carrying out the requirements of
this subsection.
``(b) Funding.--The Secretary may make funding available to Indian
tribes, tribal organizations, and eligible intertribal consortia or
urban Indian organizations to conduct epidemiological studies of Indian
communities.
``SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION PROGRAMS.
``(a) In General.--The Secretary, acting through the Service, shall
provide funding to Indian tribes, tribal organizations, and urban
Indian organizations to develop comprehensive school health education
programs for children from preschool through grade 12 in schools for
the benefit of Indian and urban Indian children.
``(b) Use of Funds.--Funds awarded under this section may be used
to--
``(1) develop and implement health education curricula both
for regular school programs and after school programs;
``(2) train teachers in comprehensive school health
education curricula;
``(3) integrate school-based, community-based, and other
public and private health promotion efforts;
``(4) encourage healthy, tobacco-free school environments;
``(5) coordinate school-based health programs with existing
services and programs available in the community;
``(6) develop school programs on nutrition education,
personal health, oral health, and fitness;
``(7) develop mental health wellness programs;
``(8) develop chronic disease prevention programs;
``(9) develop substance abuse prevention programs;
``(10) develop injury prevention and safety education
programs;
``(11) develop activities for the prevention and control of
communicable diseases;
``(12) develop community and environmental health education
programs that include traditional health care practitioners;
``(13) carry out violence prevention activities; and
``(14) carry out activities relating to such other health
issues as are appropriate.
``(c) Technical Assistance.--The Secretary shall, upon request,
provide technical assistance to Indian tribes, tribal organization and
urban Indian organizations in the development of comprehensive health
education plans, and the dissemination of comprehensive health
education materials and information on existing health programs and
resources.
``(d) Criteria.--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 under
this section.
``(e) Comprehensive School Health Education Program.--
``(1) Development.--The Secretary of the Interior, acting
through the Bureau of Indian Affairs and in cooperation with
the Secretary and affected Indian tribes and tribal
organizations, shall develop a comprehensive school health
education program for children from preschool through grade 12
for use in schools operated by the Bureau of Indian Affairs.
``(2) Requirements.--The program developed under paragraph
(1) 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) Training and coordination.--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) In General.--The Secretary, acting through the Service, 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) Use of Funds.--
``(1) in general.--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) Limitation.--Funds made available under this section
may not be used to provide services described in section
707(c).
``(c) Requirements.--The Secretary shall--
``(1) disseminate to Indian tribes, tribal organizations,
and urban Indian organizations information regarding models for
the delivery of comprehensive health care services to Indian
and urban Indian adolescents;
``(2) encourage the implementation of such models; and
``(3) at the request of an Indian tribe, tribal
organization, or urban Indian organization, provide technical
assistance in the implementation of such models.
``(d) Criteria.--The Secretary, in consultation with Indian tribes,
tribal organization, and urban Indian organizations, shall establish
criteria for the review and approval of applications under this
section.
``SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF COMMUNICABLE AND
INFECTIOUS DISEASES.
``(a) In General.--The Secretary, acting through the Service after
consultation with Indian tribes, tribal organizations, urban Indian
organizations, and the Centers for Disease Control and Prevention, may
make funding available to Indian tribes and tribal organizations for--
``(1) projects for the prevention, control, and elimination
of communicable and infectious diseases, including
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) Requirement of Application.--The Secretary may provide funds
under subsection (a) only if an application or proposal for such funds
is submitted.
``(c) Technical Assistance and Report.--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, biennially, a report to
Congress 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) In General.--The Secretary, acting through the Service,
Indian tribes, and tribal organizations, may provide funding under this
Act to meet the objective set forth in section 3 through health care
related services and programs not otherwise described in this Act. Such
services and programs shall include services and programs related 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) Availability of Services for Certain Individuals.--At the
discretion of the Service, Indian tribe, or tribal organization,
services hospice care, home health care (under section 201), home- and
community-based care, assisted living, and long term care may be
provided (on a cost basis) to individuals 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) Definitions.--In this section:
``(1) Home- and community-based services.--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.
``(2) Hospice care.--The term `hospice care' means the
items and services specified in subparagraphs (A) through (H)
of section 1861(dd)(1) of the Social Security Act (42 U.S.C.
1395x(dd)(1)), and such other services which an Indian tribe or
tribal organization determines are necessary and appropriate to
provide in furtherance of such care.
``(3) Public health functions.--The term `public health
functions' means public health related programs, functions, and
services including assessments, assurances, and policy
development that Indian tribes and tribal organizations are
authorized and encouraged, in those circumstances where it
meets their needs, to carry out by forming collaborative
relationships with all levels of local, State, and Federal
governments.
``SEC. 214. INDIAN WOMEN'S HEALTH CARE.
``The Secretary acting through the Service, 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) Study and Monitoring Programs.--The Secretary and the Service
shall, in conjunction with other appropriate Federal agencies and in
consultation with concerned Indian tribes and tribal organizations,
conduct a study and carry out ongoing monitoring programs to determine
the trends that exist in the health hazards posed to Indian miners and
to Indians on or near Indian reservations and in Indian communities as
a result of environmental hazards that may result in chronic or life-
threatening health problems. Such hazards include nuclear resource
development, petroleum contamination, and contamination of the water
source or of the food chain. Such study (and any reports with respect
to 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 of
such development over time on health;
``(3) an evaluation of the types and nature of activities,
practices, and conditions causing or affecting such health
problems including uranium mining and milling, uranium mine
tailing deposits, nuclear power plant operation and
construction, and nuclear waste disposal, 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 or recommendations provided
in Federal and State studies, reports, investigations, and
inspections during the 5 years prior to the date of the
enactment of this Act that directly or indirectly relate to the
activities, practices, and conditions affecting the health or
safety of such Indians; and
``(5) a description of 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) Development of Health Care Plans.--Upon the completion of the
study under subsection (a), the Secretary and the Service shall take
into account the results of such study and, in consultation with Indian
tribes and tribal organizations, develop a health care plan to address
the health problems that were the subject of such study. The plans
shall include--
``(1) methods for diagnosing and treating Indians currently
exhibiting such health problems;
``(2) preventive care and testing for Indians who may be
exposed to such health hazards, including the monitoring of the
health of individuals who have or may have been exposed to
excessive amounts of radiation, or affected by other activities
that have had or could have a serious impact upon the health of
such individuals; and
``(3) a program of education for Indians who, by reason of
their work or geographic proximity to such nuclear or other
development activities, may experience health problems.
``(c) Submission to Congress.--
``(1) General report.--Not later than 18 months after the
date of enactment of this Act, the Secretary and the Service
shall submit to Congress a report concerning the study
conducted under subsection (a).
``(2) Health care plan report.--Not later than 1 year after
the date on which the report under paragraph (1) is submitted
to Congress, the Secretary and the Service shall submit to
Congress the health care plan prepared under subsection (b).
Such plan 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 the
health problems involved.
``(d) Task Force.--
``(1) Established.--There is hereby established an
Intergovernmental Task Force (referred to in this section as
the `task force') that shall be composed of the following
individuals (or their designees):
``(A) The Secretary of Energy.
``(B) The Administrator of the Environmental
Protection Agency.
``(C) The Director of the Bureau of Mines.
``(D) The Assistant Secretary for Occupational
Safety and Health.
``(E) The Secretary of the Interior.
``(2) Duties.--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) Administrative provisions.--The Secretary shall serve
as the chairperson 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) Provision of Appropriate Medical Care.--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) In General.--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) Limitation.--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 DEMONSTRATION PROGRAM.
``(a) In General.--The Secretary may fund a program that utilizes
the California Rural Indian Health Board as a contract care
intermediary to improve the accessibility of health services to
California Indians.
``(b) Reimbursement of Board.--
``(1) Agreement.--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) Administration.--Not more than 5 percent of the
amounts provided to the Board under this section for any fiscal
year may be used for reimbursement for administrative expenses
incurred by the Board during such fiscal year.
``(3) Limitation.--No payment may be made for treatment
provided under this section to the extent that 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) Advisory Board.--There is hereby established an advisory
board that shall advise the California Rural Indian Health Board in
carrying out 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 this section, at least 50 percent 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, except that any of the counties described in
this section 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) In General.--The Secretary, acting through the Service, shall
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) Rule of Construction.--Nothing in this section shall 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
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) Requirement.--The Service shall respond to a notification of
a claim by a provider of a contract care service with either an
individual purchase order or a denial of the claim within 5 working
days after the receipt of such notification.
``(b) Failure To Respond.--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) Payment.--The Service shall pay a valid contract care service
claim within 30 days after the completion of the claim.
``SEC. 224. LIABILITY FOR PAYMENT.
``(a) No Liability.--A patient who receives contract health care
services that are authorized by the Service shall not be liable for the
payment of any charges or costs associated with the provision of such
services.
``(b) Notification.--The Secretary shall notify a contract care
provider and any patient who receives contract health care services
authorized by the Service that such patient is not liable for the
payment of any charges or costs associated with the provision of such
services.
``(c) Limitation.--Following receipt of the notice provided under
subsection (b), or, if a claim has been deemed accepted under section
223(b), the provider shall have no further recourse against the patient
who received the services involved.
``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) Consultation.--Prior to the expenditure of, or the making of
any firm commitment to expend, any funds appropriated for the planning,
design, construction, or renovation of facilities pursuant to the Act
of November 2, 1921 (25 U.S.C. 13) (commonly known as the Snyder Act),
the Secretary, acting through the Service, shall--
``(1) consult with any Indian tribe that would be
significantly affected by such expenditure for the purpose of
determining and, whenever practicable, honoring tribal
preferences concerning size, location, type, and other
characteristics of any facility on which such expenditure is to
be made; and
``(2) ensure, whenever practicable, 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) Closure of Facilities.--
``(1) In general.--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 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 utilization of such hospital or
facility by all eligible Indians; and
``(G) the distance between such hospital or
facility and the nearest operating Service hospital.
``(2) Temporary closure.--Paragraph (1) shall not apply to
any temporary closure of a facility or of any portion of a
facility if such closure is necessary for medical,
environmental, or safety reasons.
``(c) Priority System.--
``(1) Establishment.--The Secretary shall establish a
health care facility priority system, that shall--
``(A) be developed with Indian tribes and tribal
organizations through negotiated rulemaking under
section 802;
``(B) give the needs of Indian tribes' the highest
priority; and
``(C) at a minimum, include the lists required in
paragraph (2)(B) and the methodology required in
paragraph (2)(E);
except that the priority of any project established under the
construction priority system in effect on the date of this Act
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 10 priority inpatient projects or
one of the top 10 outpatient projects in the Indian Health
Service budget justification for fiscal year 2000, or if the
project had completed both Phase I and Phase II of the
construction priority system in effect on the date of this Act.
``(2) Report.--The Secretary shall submit to the President,
for inclusion in each report required to be transmitted to the
Congress under section 801, a report that includes--
``(A) a description of the health care facility
priority system of the Service, as established under
paragraph (1);
``(B) health care facility lists, including--
``(i) the total health care facility
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); and
``(v) any staff quarters associated with
such prioritized facilities;
``(C) the justification for the order of priority
among facilities;
``(D) the projected cost of the projects involved;
and
``(E) the methodology adopted by the Service in
establishing priorities under its health care facility
priority system.
``(3) Consultation.--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) Criteria.--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) Equitable integration.--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) Report.--Beginning in 2001, the Secretary shall
annually submit to the President, for inclusion in the report
required to be transmitted to Congress under section 801 of
this Act, a report which sets forth the needs of the 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) Consultation.--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, and with urban
Indian organizations.
``(3) Criteria.--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) Equitable integration.--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) Annual nominations.--Each year the Secretary shall
provide an opportunity for the nomination of planning, design,
and construction projects by the Service and all Indian tribes
and tribal organizations for consideration under the health
care facility priority system.
``(e) Inclusion of Certain Programs.--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) Innovative Approaches.--The Secretary shall consult and
cooperate with Indian tribes, tribal organizations and urban Indian
organizations in developing innovative approaches to address all or
part of the total unmet need for construction of health facilities,
including those provided for in other sections of this title and other
approaches.
``SEC. 302. SAFE WATER AND SANITARY WASTE DISPOSAL FACILITIES.
``(a) Findings.--Congress 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 as soon as possible.
``(b) Provision of Facilities and Services.--
``(1) In general.--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) Assistance.--The Secretary, acting through the
Service, 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 the 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) Provisions relating to funding.--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
available 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,
between the Secretary and Indian tribes and tribal
organizations;
``(E) the Secretary may permit funds appropriated
under the authority of section 4 of the Act of August
5, 1954 (42 U.S.C. 2004) 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 permit funds appropriated
under the authority of section 4 of the Act of August
5, 1954 (42 U.S.C. 2004) 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 and thereafter the Department's
applicable policies, rules, regulations shall apply in
the implementation of such projects;
``(H) the Secretary of Health and Human Services
shall enter into inter-agency 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) 10-Year Funding Plan.--The Secretary, acting through the
Service and in consultation with Indian tribes and tribal
organizations, shall develop and implement 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 to new
and renovated Indian homes.
``(d) Capability of Tribe or Community.--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) Financial Assistance.--The Secretary may provide financial
assistance to Indian tribes, tribal organizations and communities for
the operation, management, and maintenance of their sanitation
facilities.
``(f) Responsibility for Fees for Operation and Maintenance.--The
Indian family, community or tribe involved shall have 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 benefit of the facility, the
Secretary may 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) Eligibility of Certain Tribes or Organizations.--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) Report.--
``(1) In general.--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 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 a level I sanitation
deficiency as described in paragraph (4)(A).
``(2) Consultation.--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 agreements 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) Methodology.--The methodology used by the Secretary
in determining, preparing cost estimates for and reporting
sanitation deficiencies for purposes of paragraph (1) shall be
applied uniformly to all Indian tribes and communities.
``(4) Sanitation deficiency levels.--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 and 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 and 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 are 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) Definitions.--In this section:
``(1) Facility.--The terms `facility' or `facilities' shall
have the same meaning as the terms `system' or `systems' unless
the context requires otherwise.
``(2) Indian community.--The term `Indian community' means
a geographic area, a significant proportion of whose
inhabitants are Indians and which is served by or capable of
being served by a facility described in this section.
``SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS.
``(a) In General.--The Secretary, acting through the Service, may
utilize the negotiating authority of the Act of June 25, 1910 (25
U.S.C. 47), to give preference to any Indian or any enterprise,
partnership, corporation, or other type of business organization owned
and controlled by an Indian or Indians including former or currently
federally recognized Indian tribes in the State of New York
(hereinafter referred to as an `Indian firm') in the construction and
renovation of Service facilities pursuant to section 301 and in the
construction of safe water and sanitary waste disposal facilities
pursuant to section 302. Such preference may be accorded by the
Secretary unless the Secretary finds, pursuant to rules and regulations
promulgated by the Secretary, that the project or function to be
contracted for will not be satisfactory or such project or function
cannot be properly completed or maintained under the proposed contract.
The Secretary, in arriving at such 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) Exemption From Davis-Bacon.--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 wages at rates that are not
less than the prevailing wage rates for similar construction in the
locality involved, as determined by the Indian tribe, Tribes, or tribal
organizations served by such facilities.
``SEC. 304. SOBOBA SANITATION FACILITIES.
``Nothing in the Act of December 17, 1970 (84 Stat. 1465) shall be
construed to 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. 305. EXPENDITURE OF NONSERVICE FUNDS FOR RENOVATION.
``(a) Permissibility.--
``(1) In general.--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) Priority list.--The Secretary shall maintain a
separate priority list to address the need for increased
operating expenses, personnel or equipment for such facilities
described in paragraph (1). 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) Report.--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) Requirements.--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) Right of Tribe in Case of Failure of Facility To Be Used as a
Service Facility.--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. 306. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND MODERNIZATION
OF SMALL AMBULATORY CARE FACILITIES.
``(a) Availability of Funding.--
``(1) In general.--The Secretary, acting through the
Service and in consultation with Indian tribes and tribal
organization, 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 for in
subsections (b)(2) and (c)(1)(C)). Funding 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) Requirement.--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) Use of Funds.--
``(1) In general.--Funds provided under this section may be
used only for the construction, expansion, or modernization
(including the planning and design of such construction,
expansion, or modernization) of an ambulatory care facility--
``(A) located apart from a hospital;
``(B) not funded under section 301 or section 307;
and
``(C) which, upon completion of such construction,
expansion, or modernization will--
``(i) have a total capacity appropriate to
its projected service population;
``(ii) provide annually not 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 not less 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) Limitation.--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 described in clauses (ii) and (iii) of paragraph
(1)(C). The requirements of such clauses (ii) and (iii)
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 where 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) Application and Priority.--
``(1) Application.--No funding may be made available under
this section unless an application 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) Priority.--In awarding funds under this section, the
Secretary shall give priority to tribes and tribal
organizations that demonstrate--
``A) a need for increased ambulatory care services;
and
``(B) insufficient capacity to deliver such
services.
``(d) Failure To Use Facility as Health Facility.--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 utilized 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) No Inclusion in Tribal Share.--Funding provided to Indian
tribes and tribal organizations under this section shall be non-
recurring 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. 307. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECT.
``(a) Health Care Delivery Demonstration Projects.--The Secretary,
acting through the Service and in consultation with Indian tribes and
tribal organizations, may 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 health facilities, including 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) In general.--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, 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 address the
health needs of Indians in an innovative manner.
``(D) The project has the potential to deliver
services in an efficient and effective manner.
``(E) The project is economically viable.
``(F) The Indian tribe or tribal organization has the
administrative and financial capability to administer the
project.
``(G) The project is integrated with providers of
related health and social services and is coordinated
with, and avoids duplication of, existing services.
``(2) Peer review panels.--The Secretary may provide for
the establishment of peer review panels, as necessary, to
review and evaluate applications and to advise the Secretary
regarding such applications using the criteria developed
pursuant to paragraph (1).
``(3) Priority.--The Secretary shall give priority to
applications for demonstration projects under this section in
each of the following service units to the extent that such
applications are filed in a timely manner and otherwise meet
the criteria specified in paragraph (1):
``(A) Cass Lake, Minnesota.
``(B) Clinton, Oklahoma.
``(C) Harlem, Montana.
``(D) Mescalero, New Mexico.
``(E) Owyhee, Nevada.
``(F) Parker, Arizona.
``(G) Schurz, Nevada.
``(H) Winnebago, Nebraska.
``(I) 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 care 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. 308. LAND TRANSFER.
``(a) General Authority for Transfers.--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.
``(b) Chemawa Indian School.--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.
``SEC. 309. LEASES.
``(a) In General.--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) Facilities for the Administration and Delivery of Health
Services.--The Secretary may enter into leases, contracts, and other
legal agreements with Indian tribes or tribal organizations which
hold--
``(1) title to;
``(2) a leasehold interest in; or
``(3) a beneficial interest in (where title is held by the
United States in trust for the benefit of a tribe);
facilities used for the administration and delivery of health services
by the Service or by programs operated by Indian tribes or tribal
organizations to compensate such Indian tribes or tribal organizations
for costs associated with the use of such facilities for such purposes,
and such leases shall be considered as operating leases for the
purposes of scoring under the Budget Enforcement Act, 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. 310. LOANS, LOAN GUARANTEES AND LOAN REPAYMENT.
``(a) Health Care Facilities Loan Fund.--There is established in
the Treasury of the United States a fund to be known as the `Health
Care Facilities Loan Fund' (referred to in this Act as the `HCFLF') to
provide to Indian Tribes and tribal organizations direct loans, or
guarantees for loans, for the construction of health care facilities
(including inpatient facilities, outpatient facilities, associated
staff quarters and specialized care facilities such as behavioral
health and elder care facilities).
``(b) Standards and Procedures.--The Secretary may promulgate
regulations, developed through rulemaking as provided for in section
802, to establish standards and procedures for governing loans and loan
guarantees under this section, subject to the following conditions:
``(1) The principal amount of a loan or loan guarantee may
cover up to 100 percent of eligible costs, including costs for
the 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 under
this section 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 less.
``(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 under this section may be used in matching other
Federal funds.
``(c) Funding.--
``(1) In general.--The HCFLF shall consist of--
``(A) such sums as may be initially appropriated to
the HCFLF and as may be subsequently appropriated under
paragraph (2);
``(B) such amounts as may be collected from
borrowers; and
``(C) all interest earned on amounts in the HCFLF.
``(2) Authorization of appropriations.--There is 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 on such amounts.
``(3) Availability of funds.--Amounts appropriated,
collected or earned relative to the HCFLF shall remain
available until expended.
``(d) Funding Agreements.--Amounts in the HCFLF and available
pursuant to appropriation Acts may be expended by the Secretary, acting
through the Service, 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) Investments.--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) Grants.--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. 311. TRIBAL LEASING.
``Indian Tribes and tribal organizations providing health care
services pursuant to a funding agreement contract 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. 312. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT VENTURE
PROGRAM.
``(a) Authority.--
``(1) In general.--The Secretary, acting through the
Service, shall make arrangements with Indian tribes and tribal
organizations to establish joint venture demonstration projects
under which an Indian tribe or tribal organization shall expend
tribal, private, or other available funds, for the acquisition
or construction of a health facility for a minimum of 10 years,
under a no-cost lease, in exchange for agreement by the Service
to provide the equipment, supplies, and staffing for the
operation and maintenance of such a health facility.
``(2) Use of resources.--A tribe or tribal organization may
utilize tribal funds, private sector, or other available
resources, including loan guarantees, to fulfill its commitment
under this subsection.
``(3) Eligibility of certain entities.--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) Requirements.--
``(1) In general.--The Secretary shall enter into an
arrangement under subsection (a)(1) 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 subsection (a)(1); and
``(B) the Indian tribe or tribal organization meets
the needs criteria that shall be developed through the
negotiated rulemaking process provided for under
section 802.
``(2) Continued operation of facility.--The Secretary shall
negotiate an agreement with the Indian tribe or tribal
organization regarding the continued operation of a facility
under this section at the end of the initial 10 year no-cost
lease period.
``(3) Breach or termination of agreement.--An Indian tribe
or tribal organization that has entered into a written
agreement with the Secretary under this section, and that
breaches or terminates without cause such agreement, shall be
liable to the United States for the amount that has been paid
to the 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 shall
not apply to any funds expended for the delivery of health care
services, or for personnel or staffing.
``(d) Recovery for Non-Use.--An Indian tribe or tribal organization
that has entered into a written agreement with the Secretary under this
section 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) Definition.--In this section, the terms `health facility' or
`health facilities' include staff quarters needed to provide housing
for the staff of the tribal health program.
``SEC. 313. LOCATION OF FACILITIES.
``(a) Priority.--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 so long as priority is given to
Indian land owned by an Indian tribe or tribes.
``(b) Definition.--In 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 any village or regional corporation under the
Alaska Native Claims Settlement Act, or any land allotted to
any Alaska Native.
``SEC. 314. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE FACILITIES.
``(a) Report.--The Secretary shall submit to the President, for
inclusion in the report required to be transmitted to Congress under
section 801, a report that 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 fiscal year after the
year for which the report is being prepared. The report shall identify
the need for renovation and expansion of existing facilities to support
the growth of health care programs.
``(b) Maintenance of Newly Constructed Space.--
``(1) In general.--The Secretary may expend maintenance and
improvement funds to support the maintenance of newly
constructed space only if such space falls within the approved
supportable space allocation for the Indian tribe or tribal
organization.
``(2) Definition.--For purposes of paragraph (1), the term
`supportable space allocation' shall be defined through the
negotiated rulemaking process provided for under section 802.
``(c) Construction of Replacement Facilities.--
``(1) In general.--In addition to using maintenance and
improvement funds for the maintenance of facilities under
subsection (b)(1), an Indian tribe or tribal organization may
use such funds for the construction of a replacement facility
if the costs of the renovation of such facility would exceed a
maximum renovation cost threshold.
``(2) Definition.--For purposes of paragraph (1), the term
`maximum renovation cost threshold' shall be defined through
the negotiated rulemaking process provided for under section
802.
``SEC. 315. TRIBAL MANAGEMENT OF FEDERALLY-OWNED QUARTERS.
``(a) Establishment of Rental Rates.--
``(1) In general.--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, may establish the rental rates charged to the occupants of
such quarters by providing notice to the Secretary of its
election to exercise such authority.
``(2) Objectives.--In establishing rental rates under
paragraph (1), an Indian tribe or tribal organization shall
attempt to achieve the following objectives:
``(A) The rental rates should be based on the
reasonable value of the quarters to the occupants
thereof.
``(B) The rental rates should 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) Eligibility for quarters improvement and repair.--Any
quarters whose rental rates are established by an Indian tribe
or tribal organization under this subsection shall continue to
be eligible for quarters improvement and repair funds to the
same extent as other Federally-owned quarters that are used to
house personnel in Service-supported programs.
``(4) Notice of change in rates.--An Indian tribe or tribal
organization that exercises the authority provided under this
subsection shall provide occupants with not less than 60 days
notice of any change in rental rates.
``(b) Collection of Rents.--
``(1) In general.--Notwithstanding any other provision of
law, and subject to paragraph (2), an Indian tribe or a tribal
organization that 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 Federal employees involved
of its election to exercise its authority to collect
rents directly from such Federal employees.
``(B) Upon the receipt of a notice described in
subparagraph (A), the Federal employees involved shall
pay rents for the 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 expenses)
and operation of the quarters and facilities as the
Indian tribe or tribal organization shall determine
appropriate.
``(2) Retrocession.--If an Indian tribe or tribal
organization which has made an election under paragraph (1)
requests retrocession of its authority to directly collect
rents from Federal employees occupying Federally-owned
quarters, such retrocession shall become effective on the
earlier of--
``(A) the first day of the month that begins not
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
upon by the Secretary and the Indian tribe or tribal
organization.
``(c) Rates.--To the extent that an Indian tribe or tribal
organization, pursuant to authority granted in subsection (a),
establishes rental rates for Federally-owned quarters provided to a
Federal employee in Alaska, such rents may be based on the cost of
comparable private rental housing in the nearest established community
with a year-round population of 1,500 or more individuals.-
``SEC. 316. APPLICABILITY OF BUY AMERICAN REQUIREMENT.
``(a) In General.--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, except
that Indian tribes and tribal organizations shall be exempt from such
requirements.
``(b) False or Misleading Labeling.--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 318,
pursuant to the debarment, suspension, and ineligibility procedures
described in sections 9.400 through 9.409 of title 48, Code of Federal
Regulations.
(c) Definition.--In 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. 317. OTHER FUNDING FOR FACILITIES.
``Notwithstanding any other provision of law--
``(1) the Secretary may 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, except that the receipt of
such funds shall not have an effect on the priorities
established pursuant to section 301;
``(2) the Secretary may enter into interagency agreements
with other Federal or State agencies and other entities and to
accept funds from such Federal or State agencies or other
entities 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 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, acting through the Service, shall
establish standards under regulations developed through
rulemaking under section 802, for the planning, design and
construction of health care facilities serving Indians under
this Act.
``SEC. 318. AUTHORIZATION OF APPROPRIATIONS.
``There is 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) In General.--Any payments received by the Service, 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) Equal Treatment.--Nothing in this Act authorizes the
Secretary to provide services to an Indian beneficiary with coverage
under title XVIII of the Social Security Act in preference to an Indian
beneficiary without such coverage.
``(c) Special Fund.--
``(1) Use of funds.--Notwithstanding any other provision of
this title or of title XVIII of the Social Security Act,
payments to which any 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.
``(2) Nonapplication in case of election for direct
billing.--Paragraph (1) shall not apply upon the election of an
Indian tribe or tribal organization under section 405 to
receive direct payments for services provided to Indians
eligible for benefits under title XVIII of the Social Security
Act.
``SEC. 402. TREATMENT OF PAYMENTS UNDER MEDICAID PROGRAM.
``(a) Special Fund.--
``(1) Use of funds.--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.
``(2) Nonapplication in case of election for direct
billing.--Paragraph (1) shall not apply upon the election of an
Indian tribe or tribal organization under section 405 to
receive direct payments for services provided to Indians
eligible for medical assistance under title XIX of the Social
Security Act.
``(b) Payments Disregarded for Appropriations.--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) Direct Billing.--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.
``SEC. 403. REPORT.
``(a) Inclusion in Annual Report.--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 under titles XVIII and XIX of the Social
Security Act.
``(b) Identification of Source of Payments.--If an Indian tribe or
tribal organization receives funding from the Service under the Indian
Self-Determination and Education Assistance Act or an urban Indian
organization receives funding from the Service under Title V of this
Act and receives reimbursements or payments under title XVIII, XIX, or
XXI of the Social Security Act, such Indian tribe or tribal
organization, or urban Indian organization, shall provide to the
Service a list of each provider enrollment number (or other identifier)
under which it receives such reimbursements or payments.
``SEC. 404. GRANTS TO AND FUNDING AGREEMENTS WITH THE SERVICE, INDIAN
TRIBES OR TRIBAL ORGANIZATIONS, AND URBAN INDIAN
ORGANIZATIONS.
``(a) In General.--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 sections 1818, 1836, and 1837 of the
Social Security Act;
``(2) pay premiums for health insurance coverage; and
``(3) apply for medical assistance provided pursuant to
titles XIX and XXI of the Social Security Act.
``(b) Conditions.--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 or assistance under
titles XVIII, XIX, and XXI of the Social Security Act;
``(2) assist individual Indians in becoming familiar with
and utilizing such benefits and assistance;
``(3) provide transportation to such individual Indians to
the appropriate offices for enrollment or applications for such
benefits and assistance;
``(4) develop and implement--
``(A) a schedule of income levels to determine the
extent of payments of premiums by such organizations
for health insurance coverage of needy individuals; and
``(B) methods of improving the participation of
Indians in receiving the benefits and assistance
provided under titles XVIII, XIX, and XXI of the Social
Security Act.
``(c) Agreements for Receipt and Processing of Applications.--The
Secretary may enter into an agreement with an Indian tribe or tribal
organization, or an urban Indian organization, which provides for the
receipt and processing of applications for medical assistance under
title XIX of the Social Security Act, child health assistance under
title XXI of such Act and benefits under title XVIII of such Act by a
Service facility or a health care program administered by such Indian
tribe or 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, an Indian tribe or tribal organization, and
an urban Indian organization.
``(d) Grants.--
``(1) In general.--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 sections 1818, 1836, and 1837 of
the Social Security Act;
``(B) pay premiums on behalf of such individuals
for coverage under title XVIII of such Act; and
``(C) apply for medical assistance provided under
title XIX of such Act and for child health assistance
under title XXI of such Act.
``(2) Requirements.--The Secretary shall include in the
grants or contracts made or entered into under paragraph (1)
requirements that are--
``(A) consistent with the conditions imposed by the
Secretary under subsection (b);
``(B) appropriate to urban Indian organizations and
urban Indians; and
``(C) necessary to carry out the purposes of this
section.
``SEC. 405. DIRECT BILLING AND REIMBURSEMENT OF MEDICARE, MEDICAID, AND
OTHER THIRD PARTY PAYORS.
``(a) Direct Billing.--
``(1) In general.--An Indian tribe or tribal organization
may directly bill for, and receive payment for, health care
services provided by such tribe or organization for which
payment is made under title XVIII of the Social Security Act,
under a State plan for medical assistance approved under title
XIX of such Act, under a State child health plan approved under
title XXI of such Act, or from any other third party payor.
``(2) Application of 100 percent fmap.--The third sentence
of section 1905(b) of the Social Security Act and section
2101(c) of such Act shall apply for purposes of reimbursement
under the medicaid or State children's health insurance program
for health care services directly billed under the program
established under this section.
``(b) Direct Reimbursement.--
``(1) Use of Funds.--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 State children's health insurance
programs for services furnished, without regard to the
provisions of sections 1880(c) of the Social Security Act and
section 402(a) of this Act, 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 State 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) Audits.--The amounts paid to the health programs
exercising the option described in subsection (a) shall be
subject to all auditing requirements applicable to programs
administered directly by the Service and to facilities
participating in the medicare, medicaid, and State children's
health insurance programs.
``(3) No Payments from Special Funds.--Notwithstanding
section 401(c) or section 402(a), no payment may be made out of
the special fund described in section 401(c) or 402(a), for the
benefit of any health program exercising the option described
in subsection (a) of this section during the period of such
participation.
``(c) Examination and Implementation of Changes.--The Secretary,
acting through the Service, 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 State children's health insurance
program.
``(d) Withdrawal from Program.--A participant in the program
established under this section may withdraw from participation in the
same manner and under the same conditions that 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. 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.
``(e) Limitation.--Notwithstanding this section, absent specific
written authorization by the governing body of an Indian tribe for the
period of such authorization (which may not be for a period of more
than 1 year and which may be revoked at any time upon written notice by
the governing body to the Service), neither the United States through
the Service, nor an Indian tribe or tribal organization under a funding
agreement pursuant to the Indian Self-Determination and Education
Assistance Act, nor an urban Indian organization funded under title V,
shall have a right of recovery under this section if the injury,
illness, or disability for which health services were provided is
covered under a self-insurance plan funded by an Indian tribe or tribal
organization, or urban Indian organization. Where such tribal
authorization is provided, the Service may receive and expend such
funds for the provision of additional health services.
``SEC. 406. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF HEALTH
SERVICES.
``(a) Right of Recovery.--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 or an Indian tribe or tribal organization in providing
health services, through the Service or 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) Urban Indian Organizations.--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) Limitations on Recoveries From States.--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) Nonapplication of Other Laws.--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 or an Indian tribe or tribal organization
under subsection (a), or an urban Indian organization under subsection
(b).
``(e) No Effect on Private Rights of Action.--No action taken by
the United States or 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) Methods of Enforcement.--
``(1) In general.--The United States or 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--
``(A) intervening or joining in any civil action or
proceeding brought--
``(i) by the individual for whom health
services were provided by the Secretary, an
Indian tribe or tribal organization, or urban
Indian organization; or
``(ii) by any representative or heirs of
such individual; or
``(B) instituting a civil action.
``(2) Notice.--All reasonable efforts shall be made to
provide notice of an action instituted in accordance with
paragraph (1)(B) to the individual to whom health services were
provided, either before or during the pendency of such action.
``(g) Limitation.--Notwithstanding this section, absent specific
written authorization by the governing body of an Indian tribe for the
period of such authorization (which may not be for a period of more
than 1 year and which may be revoked at any time upon written notice by
the governing body to the Service), neither the United States through
the Service, nor an Indian tribe or tribal organization under a funding
agreement pursuant to the Indian Self-Determination and Education
Assistance Act, nor an urban Indian organization funded under title V,
shall have a right of recovery under this section if the injury,
illness, or disability for which health services were provided is
covered under a self-insurance plan funded by an Indian tribe or tribal
organization, or urban Indian organization. Where such tribal
authorization is provided, the Service may receive and expend such
funds for the provision of additional health services.
``(h) Costs and Attorneys' Fees.--In any action brought to enforce
the provisions of this section, a prevailing plaintiff shall be awarded
reasonable attorneys' fees and costs of litigation.
``(i) Right of Action Against Insurers and Employee Benefit
Plans.--
``(1) In general.--Where an insurance company or employee
benefit plan fails or refuses to pay the amount due under
subsection (a) for services provided to an individual who is a
beneficiary, participant, or insured of such company or plan,
the United States or an 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.
``(2) Urban indian organizations.--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.
``(j) Nonapplication of Claims Filing Requirements.--
Notwithstanding any other provision in law, the Service, an Indian
tribe or 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 NSF 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) Retention of Funds.--Except as provided in section 202(d),
this title, and section 807, all reimbursements received or recovered
under the authority of this Act, Public Law 87-693, 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) No Offset of Funds.--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.
``An Indian tribe or tribal organization, and an urban Indian
organization may utilize funding from the Secretary under this Act to
purchase managed care coverage for Service beneficiaries (including
insurance to limit the financial risks of managed care 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 VETERAN'S AFFAIRS, AND
OTHER FEDERAL AGENCY HEALTH FACILITIES AND SERVICES
SHARING.
``(a) Examination of Feasibility of Arrangements.--
``(1) In general.--The Secretary shall examine the
feasibility of entering into arrangements or expanding existing
arrangements for the sharing of medical facilities and services
between the 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 arrangements.
``(2) Submission of report.--Not later than September 30,
2000, the Secretary shall submit the report required under
paragraph (1) to Congress.
``(3) Consultation required.--The Secretary may not
finalize any arrangement described in paragraph (1) without
first consulting with the affected Indian tribes.
``(b) Limitations.--The Secretary shall not take any action under
this section or under subchapter IV of chapter 81 of title 38, United
States Code, which would impair--
``(1) the priority access of any Indian to health care
services provided through the Service;
``(2) the quality of health care services provided to any
Indian through the Service;
``(3) the priority access of any veteran to health care
services provided by the Veterans' Administration;
``(4) the quality of health care services provided to any
veteran by the Veteran's Administration;
``(5) the eligibility of any Indian to receive health
services through the Service; or
``(6) the eligibility of any Indian who is a veteran to
receive health services through the Veterans' Administration
provided, however, the Service or the Indian tribe or tribal
organization shall be reimbursed by the Veterans'
Administration where services are provided through the Service
or Indian tribes or tribal organizations to beneficiaries
eligible for services from the Veterans' Administration,
notwithstanding any other provision of law.
``(c) Agreements for Parity in Services.--The Service may 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 Service.
``SEC. 410. PAYOR OF LAST RESORT.
``The Service, and programs operated by Indian tribes or tribal
organizations, or urban Indian organizations shall be the payor of last
resort for services provided to individuals eligible for services from
the Service and such programs, notwithstanding any Federal, State or
local law to the contrary, unless such law explicitly provides
otherwise.
``SEC. 411. RIGHT TO RECOVER FROM FEDERAL HEALTH CARE PROGRAMS.
``Notwithstanding any other provision of law, the Service, Indian
tribes or tribal organizations, and urban Indian organizations
(notwithstanding limitations on who is eligible to receive services
from such entities) shall be entitled 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.
``(a) In General.--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 may--
``(1) enter into a demonstration project with the State of
Arizona under which the Service would provide certain specified
medicaid services to individuals dually eligible for services
from the Service and for medical assistance under title XIX of
the Social Security Act in return for payment on a capitated
basis from the State of Arizona; and
``(2) purchase insurance to limit the financial risks under
the project.
``(b) Extension of Project.--The demonstration project authorized
under subsection (a) 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 or tribal organization, or urban Indian organization,
under chapter 89 of title 5, United States Code, and chapter 87 of such
title if necessary employee deductions and agency contributions in
payment for the coverage, rights, and benefits for the period of
employment with such Indian tribe or tribal organization, or urban
Indian organization, are currently deposited in the applicable
Employee's Fund under such title.
``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 require the Administrator of that Administration to--
``(1) identify the impact such policy or regulation may
have on the Service, Indian tribes or tribal organizations, and
urban Indian organizations;
``(2) provide to the Service, Indian tribes or tribal
organizations, and urban Indian organizations the information
described in paragraph (1);
``(3) engage in consultation, consistent with the
requirements of Executive Order 13084 of May 14, 1998, with the
Service, Indian tribes or tribal organizations, and urban
Indian organizations prior to enacting any such policy or
regulation.
``(b) Rulemaking.--The Administrator of the Health Care Financing
Administration shall participate in the negotiated rulemaking provided
for under title VIII with regard to any regulations necessary to
implement the provisions of this title that relate to the Social
Security Act.
``SEC. 415. LIMITATIONS ON CHARGES.
``No provider of health services that is eligible to receive
payments or reimbursements under titles 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 Service, by an Indian tribe or tribal organization, or furnished to
an urban Indian eligible for health services purchased by an urban
Indian organization, in 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. 416. 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) of the Social Security
Act to any State plan under title XIX of the Social Security Act.
``SEC. 417. WAIVER OF MEDICARE AND MEDICAID SANCTIONS.
``Notwithstanding any other provision of law, the Service or an
Indian tribe or tribal organization or an urban Indian 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 such entity were directly responsible for administering the
State health care program.
``SEC. 418. MEANING OF `REMUNERATION' FOR PURPOSES OF SAFE HARBOR
PROVISIONS; ANTITRUST IMMUNITY.
``(a) Meaning of Remuneration.--Notwithstanding any other provision
of law, the term `remuneration' as used in sections 1128A and 1128B of
the Social Security Act shall not include any exchange of anything of
value between or among--
``(1) any Indian tribe or tribal organization or an urban
Indian organization that administers health programs under the
authority of the Indian Self-Determination and Education
Assistance Act;
``(2) any such Indian tribe or tribal organization or urban
Indian organization and the Service;
``(3) any such Indian tribe or tribal organization or urban
Indian organization and any patient served or eligible for
service under such programs, including patients served or
eligible for service pursuant to section 813 of this Act (as in
effect on the day before the date of enactment of the Indian
Health Care Improvement Act Reauthorization of 2000); or
``(4) any such Indian tribe or tribal organization or urban
Indian organization and any third party required by contract,
section 206 or 207 of this Act (as so in effect), 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 or urban Indian organization;
provided the exchange arises from or relates to such health programs.
``(b) Antitrust Immunity.--An Indian tribe or tribal organization
or an urban Indian organization that administers health programs under
the authority of the Indian Self-Determination and Education Assistance
Act or title V shall be deemed to be an agency of the United States and
immune from liability under the Acts commonly known as the Sherman Act,
the Clayton Act, the Robinson-Patman Anti-Discrimination Act, the
Federal Trade Commission Act, and any other Federal, State, or local
antitrust laws, with regard to any transaction, agreement, or conduct
that relates to such programs.
``SEC. 419. CO-INSURANCE, CO-PAYMENTS, DEDUCTIBLES AND PREMIUMS.
``(a) Exemption From Cost-Sharing Requirements.--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 under any other Federally funded health care programs, may be
charged a deductible, co-payment, or co-insurance for any service
provided by or through the Service, an Indian tribe or tribal
organization or urban Indian organization, nor may the payment or
reimbursement due to the Service or an Indian tribe or tribal
organization or urban Indian organization be reduced by the amount of
the deductible, co-payment, or co-insurance that would be due from the
Indian but for the operation of this section. For the purposes of this
section, the term `through' shall include services provided directly,
by referral, or under contracts or other arrangements between the
Service, an Indian tribe or tribal organization or an urban Indian
organization and another health provider.
``(b) Exemption From Premiums.--
``(1) Medicaid and state children's health insurance
program.--Notwithstanding any other provision of Federal or
State law, no Indian who is otherwise eligible for medical
assistance under title XIX of the Social Security Act or child
health assistance under title XXI of such Act may be charged a
premium as a condition of receiving such assistance under title
XIX of XXI of such Act.
``(2) Medicare enrollment premium penalties.--
Notwithstanding section 1839(b) of the Social Security Act or
any other provision of Federal or State law, no Indian who is
eligible for benefits under part B of title XVIII of the Social
Security Act, but for the payment of premiums, shall be charged
a penalty for enrolling in such part at a time later than the
Indian might otherwise have been first eligible to do so. The
preceding sentence applies whether an Indian pays for premiums
under such part directly or such premiums are paid by another
person or entity, including a State, the Service, an Indian
Tribe or tribal organization, or an urban Indian organization.
``SEC. 420. INCLUSION OF INCOME AND RESOURCES FOR PURPOSES OF MEDICALLY
NEEDY MEDICAID ELIGIBILITY.
``For the purpose of determining the eligibility under section
1902(a)(10)(A)(ii)(IV) of the Social Security Act of an Indian for
medical assistance under a State plan under title XIX of such Act, the
cost of providing services to an Indian in a health program of the
Service, an Indian Tribe or tribal organization, or an urban Indian
organization shall be deemed to have been an expenditure for health
care by the Indian.
``SEC. 421. ESTATE RECOVERY PROVISIONS.
``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 any other health care programs
funded in whole or part with Federal funds:
``(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 a 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, including public domain
allotments.
``(4) Property that has unique religious or cultural
significance or that supports subsistence or traditional life
style according to applicable tribal law or custom.
``SEC. 422. MEDICAL CHILD SUPPORT.
``Notwithstanding any other provision of law, a parent shall not be
responsible for reimbursing the Federal Government or a State for the
cost of medical services provided to a child by or through the Service,
an Indian tribe or tribal organization or an urban Indian organization.
For the purposes of this subsection, the term `through' includes
services provided directly, by referral, or under contracts or other
arrangements between the Service, an Indian Tribe or tribal
organization or an urban Indian organization and another health
provider.
``SEC. 423. PROVISIONS RELATING TO MANAGED CARE.
``(a) Recovery From Managed Care Plans.--Notwithstanding any other
provision in law, the Service, an Indian Tribe or tribal organization
or an urban Indian organization shall have a right of recovery under
section 408 from all private and public health plans or programs,
including the medicare, medicaid, and State children's health insurance
programs under titles XVIII, XIX, and XXI of the Social Security Act,
for the reasonable costs of delivering health services to Indians
entitled to receive services from the Service, an Indian Tribe or
tribal organization or an urban Indian organization.
``(b) Limitation.--No provision of law or regulation, or of any
contract, may be relied upon or interpreted to deny or reduce payments
otherwise due under subsection (a), except to the extent the Service,
an Indian tribe or tribal organization, or an urban Indian organization
has entered into an agreement with a managed care entity regarding
services to be provided to Indians or rates to be paid for such
services, provided that such an agreement may not be made a
prerequisite for such payments to be made.
``(c) Parity.--Payments due under subsection (a) from a managed
care entity may not be paid at a rate that is less than the rate paid
to a `preferred provider' by the entity or, in the event there is no
such rate, the usual and customary fee for equivalent services.
``(d) No Claim Requirement.--A managed care entity may not deny
payment under subsection (a) because an enrollee with the entity has
not submitted a claim.
``(e) Direct Billing.--Notwithstanding the preceding subsections of
this section, the Service, an Indian tribe or tribal organization, or
an urban Indian organization that provides a health service to an
Indian entitled to medical assistance under the State plan under title
XIX of the Social Security Act or enrolled in a child health plan under
title XXI of such Act shall have the right to be paid directly by the
State agency administering such plans notwithstanding any agreements
the State may have entered into with managed care organizations or
providers.
``(f) Requirement for Medicaid Managed Care Entities.--A managed
care entity (as defined in section 1932(a)(1)(B) of the Social Security
Act shall, as a condition of participation in the State plan under
title XIX of such Act, offer a contract to health programs administered
by the Service, an Indian tribe or tribal organization or an urban
Indian organization that provides health services in the geographic
area served by the managed care entity 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.
``(g) Prohibition.--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 entity participating
in a State plan under title XIX or XXI of the Social Security Act
unless the Indian had the option of enrolling in a managed care plan or
health program administered by the Service, an Indian tribe or tribal
organization, or an urban Indian organization.
``(h) 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 XXI
of the Social Security Act shall enter into such an agreement with the
Service, an Indian tribe or tribal organization or an urban Indian
organization under which such an entity may provide services to Indians
who may be eligible or required to enroll with a managed care
organization through enrollment in an Indian managed care organization
that provides services similar to those offered by other managed care
organizations in the State. The Secretary and the State are hereby
authorized to waive requirements regarding discrimination,
capitalization, and other matters that might otherwise prevent an
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 offers Indian
enrollees services of an equivalent quality to that required of other
managed care organizations.
``(i) Advertising.--A managed care organization entering into a
contract 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. 424. NAVAJO NATION MEDICAID AGENCY.
``(a) In General.--Notwithstanding any other provision of law, the
Secretary may treat the Navajo Nation as a State under title XIX of the
Social Security Act for purposes of providing medical assistance to
Indians living within the boundaries of the Navajo Nation.
``(b) Assignment and Payment.--Notwithstanding any other provision
of law, the Secretary may assign and pay all expenditures related to
the provision of services to Indians living within the boundaries of
the Navajo Nation under title XIX of the Social Security Act (including
administrative expenditures) that 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) Authority.--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 State
agency responsible for the administration of the State plan under title
XIX of the Social Security Act.
``(d) Technical Assistance.--The Secretary may directly assist the
Navajo Nation in the development and implementation of a Navajo Nation
Medicaid Agency for the administration, eligibility, payment, and
delivery of medical assistance under title XIX of the Social Security
Act (which shall, for purposes of reimbursement to such Nation, include
Western and traditional Navajo healing services) within the Navajo
Nation. Such assistance may include providing funds for demonstration
projects conducted with such Nation.
``(e) FMAP.--Notwithstanding section 1905(b) of the Social Security
Act, the Federal medical assistance percentage shall be 100 per cent
with respect to amounts the Navajo Nation Medicaid agency expends for
medical assistance and related administrative costs.
``(f) Waiver Authority.--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.
``(g) SCHIP.--At the option of the Navajo Nation, the Secretary may
treat the Navajo Nation as a State for purposes of title XXI of the
Social Security Act under terms equivalent to those described in the
preceding subsections of this section.
``SEC. 425. INDIAN ADVISORY COMMITTEES.
``(a) National Indian Technical Advisory Group.--The Administrator
of 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 Service. The scope of the activities of such group
shall be established under section 802 provided that 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
regarding any other health care program funded (in whole or part) by
the Health Care Financing Administration.
``(b) Indian Medicaid Advisory Committees.--The Administrator of
the Health Care Financing Administration shall establish and provide
funding for a Indian Medicaid Advisory Committee made up of designees
of the Service, Indian tribes and tribal organizations and urban Indian
organizations in each State in which the Service directly operates a
health program or in which there is one or more Indian tribe or tribal
organization or urban Indian organization.
``SEC. 426. AUTHORIZATION OF APPROPRIATIONS.
There is authorized to be appropriated such sums as may be
necessary for each of fiscal years 2000 through 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 the authority of the Act of November 2, 1921 (25 U.S.C.
13)(commonly 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 section 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) Authority.--Under the authority of the Act of November 2,
1921 (25 U.S.C. 13) (commonly known as the Snyder Act), the Secretary,
acting through the Service, shall 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) Criteria.--The Secretary, acting through the Service, shall
by regulation adopted pursuant to section 520 prescribe the criteria
for selecting urban Indian organizations to enter into contracts or
receive grants under this section. Such criteria shall, among other
factors, include--
``(1) the extent of unmet health care needs of urban
Indians in the urban center or centers involved;
``(2) the size of the urban Indian population in the urban
center or centers involved;
``(3) the extent, if any, to which the activities set forth
in subsection (a) would duplicate any project funded under this
title;
``(4) the capability of an urban Indian organization to
perform the activities set forth in subsection (a) and to enter
into a contract with the Secretary or to meet the requirements
for receiving a grant under this section;
``(5) the satisfactory performance and successful
completion by an urban Indian organization of other contracts
with the Secretary under this title;
``(6) the appropriateness and likely effectiveness of
conducting the activities set forth in subsection (a) in an
urban center or centers; and
``(7) the extent of existing or likely future participation
in the activities set forth in subsection (a) by appropriate
health and health-related Federal, State, local, and other
agencies.
``(c) Health Promotion and Disease Prevention.--The Secretary,
acting through the Service, shall facilitate access to, or provide,
health promotion and disease prevention services for urban Indians
through grants made to urban Indian organizations administering
contracts entered into pursuant to this section or receiving grants
under subsection (a).
``(d) Immunization Services.--
``(1) In general.--The Secretary, acting through the
Service, shall facilitate access to, or provide, immunization
services for urban Indians through grants made to urban Indian
organizations administering contracts entered into, or
receiving grants, under this section.
``(3) Definition.--In this section, the term `immunization
services' means services to provide without charge
immunizations against vaccine-preventable diseases.
``(e) Mental Health Services.--
``(1) In general.--The Secretary, acting through the
Service, shall facilitate access to, or provide, mental health
services for urban Indians through grants made to urban Indian
organizations administering contracts entered into, or
receiving grants, under this section.
``(2) Assessment.--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) Use of funds.--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) Child Abuse.--
``(1) In general.--The Secretary, acting through the
Service, shall facilitate access to, or provide, services for
urban Indians through grants to urban Indian organizations
administering contracts entered into pursuant to this section
or receiving grants under subsection (a) to prevent and treat
child abuse (including sexual abuse) among urban Indians.
``(2) Assessment.--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) Use of funds.--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) Considerations.--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) Multiple Urban Centers.--The Secretary, acting through the
Service, may enter into a contract with, or make grants to, an urban
Indian organization that provides or arranges for the provision of
health care services (through satellite facilities, provider networks,
or otherwise) to urban Indians in more than one urban center.
``SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINATION OF UNMET HEALTH
CARE NEEDS.
``(a) Authority.--
``(1) In general.--Under authority of the Act of November
2, 1921 (25 U.S.C. 13) (commonly known as the Snyder Act), the
Secretary, acting through the Service, may enter into contracts
with, or make grants to, urban Indian organizations situated in
urban centers for which contracts have not been entered into,
or grants have not been made, under section 503.
``(2) Purpose.--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) Requirements.--Any contract entered into, or grant made, by
the Secretary under this section shall include requirements that--
``(1) the urban Indian organization successfully undertake
to--
``(A) document the health care status and unmet
health care needs of urban Indians in the urban center
involved; and
``(B) with respect to urban Indians in the urban
center involved, determine the matters described in
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) Limitation on Renewal.--The Secretary may not renew any
contract entered into, or grant made, under this section.
``SEC. 505. EVALUATIONS; RENEWALS.
``(a) Procedures.--The Secretary, acting through the Service, shall
develop procedures to evaluate compliance with grant requirements under
this title and compliance with, and performance of contracts entered
into by urban Indian organizations under this title. Such procedures
shall include provisions for carrying out the requirements of this
section.
``(b) Compliance with Terms.--The Secretary, acting through the
Service, shall evaluate the compliance of each urban Indian
organization which has entered into a contract or received a grant
under section 503 with the terms of such contract of grant. For
purposes of an evaluation under this subsection, the Secretary, in
determining the capacity of an urban Indian organization to deliver
quality patient care shall, at the option of the organization--
``(1) conduct, through the Service, an annual onsite
evaluation of the organization; or
``(2) accept, in lieu of an onsite evaluation, evidence of
the organization's provisional or full accreditation by a
private independent entity recognized by the Secretary for
purposes of conducting quality reviews of providers
participating in the medicare program under Title XVIII of the
Social Security Act.
``(c) Noncompliance.--
``(1) In general.--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.
``(2) Nonrenewal.--If the Secretary determines, under an
evaluation under this section, that 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) Determination of Renewal.--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 accreditation under subsection
(b).
``SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS.
``(a) Application of Federal Law.--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.--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 not 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, be carried forward for expenditure with respect to
allowable or reimbursable costs incurred by the organization
during 1 or more subsequent funding periods without additional
justification or documentation by the organization as a
condition of carrying forward the expenditure of such funds.
``(c) Revising or Amending Contract.--Notwithstanding any provision
of law to the contrary, the Secretary may, at the request or consent of
an urban Indian organization, revise or amend any contract entered into
by the Secretary with such organization under this title as necessary
to carry out the purposes of this title.
``(d) Fair and Uniform Provision of Services.--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) Eligibility of Urban Indians.--Urban Indians, as defined in
section 4(f), shall be eligible for health care or referral services
provided pursuant to this title.
``SEC. 507. REPORTS AND RECORDS.
``(a) Report.--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, a report 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 purposes for which
Federal funds were expended; and
``(4) a minimum set of data, using uniformly defined
elements, that is specified by the Secretary, after
consultations consistent with section 514, with urban Indian
organizations.
``(b) Audits.--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) Cost of Audit.--The Secretary shall allow as a cost of any
contract or grant entered into or awarded under section 502 or 503 the
cost of an annual independent financial audit conducted by--
``(1) a certified public accountant; or
``(2) a certified public accounting firm qualified to
conduct Federal compliance audits.
``SEC. 508. LIMITATION ON CONTRACT AUTHORITY.
``The authority of the Secretary to enter into contracts or to
award grants under this title shall be to the extent, and in an amount,
provided for in appropriation Acts.
``SEC. 509. FACILITIES.
``(a) Grants.--The Secretary may make grants to contractors or
grant recipients under this title for the lease, purchase, renovation,
construction, or expansion of facilities, including leased facilities,
in order to assist such contractors or grant recipients in complying
with applicable licensure or certification requirements.
``(b) Loans or Loan Guarantees.--The Secretary, acting through the
Service or through the Health Resources and Services Administration,
may provide loans to contractors or grant recipients under this title
from the Urban Indian Health Care Facilities Revolving Loan Fund
(referred to in this section 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 amount of the principal of loans and loan
guarantees, respectively, outstanding at any one time shall not
exceed such limitations as may be specified in appropriations
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) Urban Indian Health Care Facilities Revolving Loan Fund.--
``(1) Establishment.--There is established in the Treasury
of the United States a fund to be known as the Urban Indian
Health Care Facilities Revolving Loan Fund. The URLF shall
consist of--
``(A) such amounts as may be appropriated to the
URLF;
``(B) amounts received from urban Indian
organizations in repayment of loans made to such
organizations under paragraph (2); and
``(C) interest earned on amounts in the URLF under
paragraph (3).
``(2) Use of urlf.--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) Investments.--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) Grants.--The Secretary may make grants for the provision of
health-related services in prevention of, treatment of, rehabilitation
of, or school and community-based education in, alcohol and substance
abuse in urban centers to those urban Indian organizations with whom
the Secretary has entered into a contract under this title or under
section 201.
``(b) Goals of Grant.--Each grant made pursuant to subsection (a)
shall set forth the goals to be accomplished pursuant to the grant. The
goals shall be specific to each grant as agreed to between the
Secretary and the grantee.
``(c) Criteria.--The Secretary shall establish criteria for the
grants made under subsection (a), including criteria relating to the--
``(1) size of the urban Indian population;
``(2) 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) Treatment of Funds Received by Urban Indian Organizations.--
Any funds received by an urban Indian organization under this Act for
substance abuse prevention, treatment, and rehabilitation shall be
subject to the criteria set forth in subsection (c).
``SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION PROJECTS.
``(a) Oklahoma City Clinic.--
``(1) In general.--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 projects. The Secretary shall provide
assistance to such projects in the development of resources and
equipment and facility needs.
``(2) Report.--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) Tulsa Clinic.--Notwithstanding any other provision of law,
the Tulsa Clinic demonstration project shall become a permanent program
within the Service's direct care program and continue to be treated as
a service unit 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) Grants and Contracts.--The Secretary, acting through the
Office of Urban Indian Health of the Service, shall make grants or
enter into contracts, effective not 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 (referred to in this section
to as `NIAAA') and transferred to the Service.
``(b) Use of Funds.--Grants provided or contracts entered into
under this section shall be used to provide support for the
continuation of alcohol prevention and treatment services for urban
Indian populations and such other objectives as are agreed upon between
the Service and a recipient of a grant or contract under this section.
``(c) Eligibility.--Urban Indian organizations that operate Indian
alcohol programs originally funded under NIAAA and subsequently
transferred to the Service are eligible for grants or contracts under
this section.
``(d) Evaluation and Report.--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) In General.--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 maximum extent
practicable, with urban Indian organizations (as defined in section 4)
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) Requirement.--In subsection (a), the term `consultation'
means 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 (42
U.S.C. 233), 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 while carrying out any such
contract or grant and its employees (including those acting on behalf
of the organization as provided for 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, except
that 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) Construction and Operation.--The Secretary, acting through
the Service, shall, through grants or contracts, 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) States.--A State described in this subsection is a State in
which--
``(1) there reside urban Indian youth with a 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) In General.--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) Donation of Property.--Subject to subsection (d), the
Secretary may donate to an urban Indian organization that has entered
into a contract or received a grant pursuant to this title any personal
or real property determined to be excess to the needs of the Service or
the General Services Administration for purposes of carrying out the
contract or grant.
``(c) Acquisition of Property.--The Secretary may acquire excess or
surplus government personal or real property for donation, subject to
subsection (d), to an urban Indian organization that has entered into a
contract or received a grant pursuant to this title if the Secretary
determines that the property is appropriate for use by the urban Indian
organization for a purpose for which a contract or grant is authorized
under this title.
``(d) Priority.--In the event that the Secretary receives a request
for a specific item of personal or real property described in
subsections (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 to the Indian tribe or tribal organization
if the Secretary receives the request from the Indian tribe or tribal
organization before the date on which the Secretary transfers title to
the property or, if earlier, the date on which the Secretary transfers
the property physically, to the urban Indian organization.
``(e) Relation to Federal Sources of Supply.--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) Authority.--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) Goals.--Each grant made pursuant to subsection (a) shall set
forth the goals to be accomplished under the grant. The goals shall be
specific to each grant as agreed upon between the Secretary and the
grantee.
``(c) Criteria.--The Secretary shall establish criteria for the
awarding of grants made under subsection (a) relating to--
``(1) the size and location of the urban Indian population
to be served;
``(2) the need for the 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 urban Indian
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 urban Indian organization to
adequately perform the activities required under the grant; and
``(5) the willingness of the urban Indian 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) Application of Criteria.--Any funds received by an urban
Indian organization under this Act for the prevention, treatment, and
control of diabetes among urban Indians shall be subject to the
criteria developed by the Secretary under subsection (c).
``SEC. 519. COMMUNITY HEALTH REPRESENTATIVES.
``The Secretary, acting through the Service, may enter into
contracts with, and make grants to, urban Indian organizations for the
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) Effect of Title.--This title shall be effective on the date
of enactment of this Act regardless of whether the Secretary has
promulgated regulations implementing this title.
``(b) Promulgation.--
``(1) In general.--The Secretary may promulgate regulations
to implement the provisions of this title.
``(2) Publication.--Proposed regulations to implement this
title shall be published by the Secretary in the Federal
Register not later than 270 days after the date of enactment of
this Act and shall have a comment period of not less than 120
days.
``(3) Expiration of authority.--The authority to promulgate
regulations under this title shall expire on the date that is
18 months after the date of enactment of this Act.
``(c) Negotiated Rulemaking Committee.--A negotiated rulemaking
committee shall be established pursuant to section 565 of title 5,
United States Code, to carry out this section and shall, in addition to
Federal representatives, have as the majority of its members
representatives of urban Indian organizations from each service area.
``(d) Adaption of Procedures.--The Secretary shall adapt the
negotiated rulemaking procedures to the unique context of this Act.
``SEC. 521. AUTHORIZATION OF APPROPRIATIONS.
``There is 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) Establishment.--
``(1) In general.--In order to more effectively and
efficiently carry out the responsibilities, authorities, and
functions of the United States to provide health care services
to Indians and Indian tribes, as are or may be hereafter
provided by Federal statute or treaties, there is established
within the Public Health Service of the Department the Indian
Health Service.
``(2) Assistant secretary of indian health.--The Service
shall be administered by an Assistance Secretary of Indian
Health, who shall be appointed by the President, by and with
the advice and consent of the Senate. The Assistant Secretary
shall report to the Secretary. Effective with respect to an
individual appointed by the President, by and with the advice
and consent of the Senate, after January 1, 1993, the term of
service of the Assistant Secretary shall be 4 years. An
Assistant Secretary may serve more than 1 term.
``(b) Agency.--The Service shall be an agency within the Public
Health Service of the Department, and shall not be an office,
component, or unit of any other agency of the Department.
``(c) Functions and Duties.--The Secretary shall carry out through
the Assistant Secretary of the 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 Service on such day;
``(2) all functions of the Secretary relating to the
maintenance and operation of hospital and health facilities for
Indians and the planning for, and provision and utilization of,
health services for Indians;
``(3) all health programs under which health care is
provided to Indians based upon their status as Indians which
are administered by the Secretary, including programs under--
``(A) this Act;
``(B) the Act of November 2, 1921 (25 U.S.C. 13);
``(C) the Act of August 5, 1954 (42 U.S.C. 2001, et
seq.);
``(D) the Act of August 16, 1957 (42 U.S.C. 2005 et
seq.); and
``(E) the Indian Self-Determination Act (25 U.S.C.
450f, et seq.); and
``(4) all scholarship and loan functions carried out under
title I.
``(d) Authority.--
``(1) In general.--The Secretary, acting through the
Assistant Secretary, shall have the authority--
``(A) except to the extent provided for in
paragraph (2), to appoint and compensate employees for
the Service in accordance with title 5, United States
Code;
``(B) to enter into contracts for the procurement
of goods and services to carry out the functions of the
Service; and
``(C) to manage, expend, and obligate all funds
appropriated for the Service.
``(2) Personnel actions.--Notwithstanding any other
provision of law, the provisions of section 12 of the Act of
June 18, 1934 (48 Stat. 986; 25 U.S.C. 472), shall apply to all
personnel actions taken with respect to new positions created
within the Service as a result of its establishment under
subsection (a).
``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.
``(a) Establishment.--
``(1) In general.--The Secretary, in consultation with
tribes, tribal organizations, and urban Indian organizations,
shall establish an automated management information system for
the Service.
``(2) Requirements of system.--The information system
established under paragraph (1) shall include--
``(A) a financial management system;
``(B) a patient care information system;
``(C) a privacy component that protects the privacy
of patient information;
``(D) a services-based cost accounting component
that provides estimates of the costs associated with
the provision of specific medical treatments or
services in each area office of the Service;
``(E) an interface mechanism for patient billing
and accounts receivable system; and
``(F) a training component.
``(b) Provision of Systems to Tribes and Organizations.--The
Secretary shall provide each Indian tribe and tribal organization that
provides health services under a contract entered into with the Service
under the Indian Self-Determination Act automated management
information systems which--
``(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) Access to Records.--Notwithstanding any other provision of
law, each patient shall have reasonable access to the medical or health
records of such patient which are held by, or on behalf of, the
Service.
``(d) Authority To Enhance Information Technology.--The Secretary,
acting through the Assistant Secretary, shall have the authority to
enter into contracts, agreements or joint ventures with other Federal
agencies, States, private and nonprofit organizations, for the purpose
of enhancing information technology in Indian health programs and
facilities.
``SEC. 603. AUTHORIZATION OF APPROPRIATIONS.
``There is authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2012 to carry out
this title.
``TITLE VII--BEHAVIORAL HEALTH PROGRAMS
``SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREATMENT SERVICES.
``(a) Purposes.--It is the purpose of this section to--
``(1) authorize and direct the Secretary, acting through
the Service, Indian tribes, tribal organizations, and urban
Indian organizations to develop a comprehensive behavioral
health prevention and treatment program which emphasizes
collaboration among alcohol and substance abuse, social
services, and mental health programs;
``(2) 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 multi-
disciplinary 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) Behavioral Health Planning.--
``(1) Area-wide plans.--The Secretary, acting through the
Service, Indian tribes, tribal organizations, and urban Indian
organizations, shall encourage Indian tribes and tribal
organizations to develop tribal plans, encourage urban Indian
organizations to develop local plans, and encourage all such
groups to participate in developing area-wide plans for Indian
Behavioral Health Services. The plans shall, to the extent
feasible, include--
``(A) an assessment of the scope of the problem of
alcohol or other substance abuse, mental illness,
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); and
``(C) an estimate of the additional funding needed
by the Service, Indian tribes, tribal organizations and
urban Indian organizations to meet their
responsibilities under the plans.
``(2) National clearinghouse.--The Secretary shall
establish a national clearinghouse of plans and reports on the
outcomes of such plans developed under this section by Indian
tribes, tribal organizations and by areas relating to
behavioral health. The Secretary shall ensure access to such
plans and outcomes by any Indian tribe, tribal organization,
urban Indian organization or the Service.
``(3) Technical assistance.--The Secretary shall provide
technical assistance to Indian tribes, tribal organizations,
and urban Indian organizations in preparation of plans under
this section and in developing standards of care that may be
utilized and adopted locally.
``(c) Continuum of Care.--The Secretary, acting through the
Service, Indian tribes and tribal organizations, shall provide, to the
extent feasible and to the extent that funding is available, for the
implementation of programs including--
``(1) a comprehensive continuum of behavioral health care
that provides for--
``(A) community based prevention, intervention,
outpatient and behavioral health aftercare;
``(B) detoxification (social and medical);
``(C) acute hospitalization;
``(D) intensive outpatient or day treatment;
``(E) residential treatment;
``(F) transitional living for those needing a
temporary stable living environment that is supportive
of treatment or recovery goals;
``(G) emergency shelter;
``(H) intensive case management; and
``(I) traditional health care practices; and
``(2) behavioral health services for particular
populations, including--
``(A) for persons from birth through age 17, child
behavioral health services, that include--
``(i) pre-school and school age fetal
alcohol disorder services, including assessment
and behavioral intervention);
``(ii) mental health or substance abuse
services (emotional, organic, alcohol, drug,
inhalant and tobacco);
``(iii) services for co-occurring disorders
(multiple diagnosis);
``(iv) prevention services that are focused
on individuals ages 5 years through 10 years
(alcohol, drug, inhalant and tobacco);
``(v) early intervention, treatment and
aftercare services that are focused on
individuals ages 11 years through 17 years;
``(vi) healthy choices or life style
services (related to STD's, domestic violence,
sexual abuse, suicide, teen pregnancy, obesity,
and other risk or safety issues);
``(vii) co-morbidity services;
``(B) for persons ages 18 years through 55 years,
adult behavioral health services that include--
``(i) early intervention, treatment and
aftercare services;
``(ii) mental health and substance abuse
services (emotional, alcohol, drug, inhalant
and tobacco);
``(iii) services for co-occurring disorders
(dual diagnosis) and co-morbidity;
``(iv) healthy choices and life style
services (related to parenting, partners,
domestic violence, sexual abuse, suicide,
obesity, and other risk related behavior);
``(v) female specific treatment services
for--
``(I) women at risk of giving birth
to a child with a fetal alcohol
disorder;
``(II) substance abuse requiring
gender specific services;
``(III) sexual assault and domestic
violence; and
``(IV) healthy choices and life
style (parenting, partners, obesity,
suicide and other related behavioral
risk); and
``(vi) male specific treatment services
for--
``(I) substance abuse requiring
gender specific services;
``(II) sexual assault and domestic
violence; and
``(III) healthy choices and life
style (parenting, partners, obesity,
suicide and other risk related
behavior);
``(C) family behavioral health services,
including--
``(i) early intervention, treatment and
aftercare for affected families;
``(ii) treatment for sexual assault and
domestic violence; and
``(iii) healthy choices and life style
(related to parenting, partners, domestic
violence and other abuse issues);
``(D) for persons age 56 years and older, elder
behavioral health services including--
``(i) early intervention, treatment and
aftercare services that include--
``(I) mental health and substance
abuse services (emotional, alcohol,
drug, inhalant and tobacco);
``(II) services for co-occurring
disorders (dual diagnosis) and co-
morbidity; and
``(III) healthy choices and life
style services (managing conditions
related to aging);
``(ii) elder women specific services that
include--
``(I) treatment for substance abuse
requiring gender specific services and
``(II) treatment for sexual
assault, domestic violence and neglect;
``(iii) elder men specific services that
include--
``(I) treatment for substance abuse
requiring gender specific services; and
``(II) treatment for sexual
assault, domestic violence and neglect;
and
``(iv) services for dementia regardless of
cause.
``(d) Community Behavioral Health Plan.--
``(1) In general.--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. Such
plan should include behavioral health services, social
services, intensive outpatient services, and continuing after
care.
``(2) Technical assistance.--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 a plan under
paragraph (1). 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) Funding.--The Secretary, acting through the Service,
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 behavioral health plan and to provide administrative
support in the implementation of such plan.
``(e) Coordinated Planning.--The Secretary, acting through the
Service, Indian tribes, tribal organizations, and urban Indian
organizations shall coordinate behavioral health planning, to the
extent feasible, with other Federal and State agencies, to ensure that
comprehensive behavioral health services are available to Indians
without regard to their place of residence.
``(f) Facilities Assessment.--Not later than 1 year after the date
of enactment of this Act, the Secretary, acting through the Service,
shall make an assessment of the need for inpatient mental health care
among Indians and the availability and cost of inpatient mental health
facilities which can meet such need. In making such assessment, the
Secretary shall consider the possible conversion of existing, under-
utilized service hospital beds into psychiatric units to meet such
need.
``SEC. 702. MEMORANDUM OF AGREEMENT WITH THE DEPARTMENT OF THE
INTERIOR.
``(a) In General.--Not later than 1 year after the date of
enactment of this Act, the Secretary and the Secretary of the Interior
shall develop and enter into a memorandum of agreement, or review and
update any existing memoranda of agreement as required under 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) the 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 Bureau of Indian Affairs and
Service programs and services (including
multidisciplinary resource teams) addressing child
abuse and family violence are coordinated with such
non-Federal programs and services;
``(7) direct appropriate officials of the Bureau of Indian
Affairs and the Service, particularly at the agency and service
unit levels, to cooperate fully with tribal requests made
pursuant to 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 and a report which shall be submitted to Congress
and made available to the Indian tribes.
``(b) Specific Provisions.--The memorandum 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) Consultation.--The Secretary and the Secretary of the
Interior shall, in developing the memorandum of agreement under
subsection (a), consult with and solicit the comments of--
``(1) Indian tribes and tribal organizations;
``(2) Indian individuals;
``(3) urban Indian organizations and other Indian
organizations;
``(4) behavioral health service providers.
``(d) Publication.--The memorandum of agreement under subsection
(a) shall be published in the Federal Register. At the same time as the
publication of such agreement in the Federal Register, the Secretary
shall provide a copy of such memorandum to each Indian tribe, tribal
organization, and urban Indian organization.
``SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND TREATMENT
PROGRAM.
``(a) Establishment.--
``(1) In general.--The Secretary, acting through the
Service, Indian tribes and tribal organizations consistent with
section 701, shall provide a program of comprehensive
behavioral health prevention and treatment and aftercare,
including traditional health care practices, which shall
include--
``(A) prevention, through educational intervention,
in Indian communities;
``(B) acute detoxification or 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 pregnant and post
partum women and their children.
``(2) Target populations.--The target population of the
program under paragraph (1) shall be members of Indian tribes.
Efforts to train and educate key members of the Indian
community shall target employees of health, education,
judicial, law enforcement, legal, and social service programs.
``(b) Contract Health Services.--
``(1) In general.--The Secretary, acting through the
Service (with the consent of the Indian tribe to be served),
Indian tribes and tribal organizations, may enter into
contracts with public or private providers of behavioral health
treatment services for the purpose of carrying out the program
required under subsection (a).
``(2) Provision of assistance.--In carrying out this
subsection, the Secretary shall provide assistance to Indian
tribes and tribal organizations to develop criteria for the
certification of behavioral health service providers and
accreditation of service facilities which meet minimum
standards for such services and facilities.
``SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.
``(a) In General.--Under the authority of the Act of November 2,
1921 (25 U.S.C. 13) (commonly known as the Snyder Act), the Secretary
shall establish and maintain a Mental Health Technician program within
the Service which--
``(1) provides for the training of Indians as mental health
technicians; and
``(2) employs such technicians in the provision of
community-based mental health care that includes
identification, prevention, education, referral, and treatment
services.
``(b) Training.--In carrying out subsection (a)(1), 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) Supervision and Evaluation.--The Secretary shall supervise
and evaluate the mental health technicians in the training program
under this section.
``(d) Traditional Care.--The Secretary shall ensure that the
program established pursuant to this section involves the utilization
and promotion of the traditional Indian health care and treatment
practices of the Indian tribes to be served.-
``SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE WORKERS.
``Subject to 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 to
provide health care services, be licensed as a clinical or
counseling psychologist, or working under the direct supervision of a
clinical or counseling 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) Funding.--The Secretary, consistent with section 701, shall
make funding available to Indian tribes, tribal organizations and urban
Indian organization to develop and implement a comprehensive behavioral
health program of prevention, intervention, treatment, and relapse
prevention services that specifically addresses the spiritual,
cultural, historical, social, and child care needs of Indian women,
regardless of age.
``(b) Use of Funds.--Funding provided pursuant to this section may
be used to--
``(1) develop and provide community training, education,
and prevention programs for Indian women relating to behavioral
health issues, including fetal alcohol disorders;
``(2) identify and provide psychological services,
counseling, advocacy, support, and relapse prevention to Indian
women and their families; and
``(3) develop prevention and intervention models for Indian
women which incorporate traditional health care practices,
cultural values, and community and family involvement.
``(c) Criteria.--The Secretary, in consultation with Indian tribes
and tribal organizations, shall establish criteria for the review and
approval of applications and proposals for funding under this section.
``(d) Earmark of Certain Funds.--Twenty percent of the amounts
appropriated to carry out this section shall be used to make grants to
urban Indian organizations funded under title V.
``SEC. 707. INDIAN YOUTH PROGRAM.
``(a) Detoxification and Rehabilitation.--The Secretary shall,
consistent with section 701, develop and implement a program for acute
detoxification and treatment for Indian youth that includes behavioral
health services. The program shall include regional treatment centers
designed to include detoxification and rehabilitation for both sexes on
a referral basis and programs developed and implemented by Indian
tribes or tribal organizations at the local level under the Indian
Self-Determination and Education Assistance Act. Regional centers shall
be integrated with the intake and rehabilitation programs based in the
referring Indian community.
``(b) Alcohol and Substance Abuse Treatment Centers or
Facilities.--
``(1) Establishment.--
``(A) In general.--The Secretary, acting through
the Service, Indian tribes, 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.
``(B) Area office in california.--For purposes of
this subsection, the area office in California shall be
considered to be 2 area offices, 1 office whose
jurisdiction shall be considered to encompass the
northern area of the State of California, and 1 office
whose jurisdiction shall be considered to encompass the
remainder of the State of California for the purpose of
implementing California treatment networks.
``(2) Funding.--For the purpose of staffing and operating
centers or facilities under this subsection, funding shall be
made available pursuant to the Act of November 2, 1921 (25
U.S.C. 13) (commonly known as the Snyder Act).
``(3) Location.--A youth treatment center constructed or
purchased under this subsection shall be constructed or
purchased at a location within the area described in paragraph
(1) that is agreed upon (by appropriate tribal resolution) by a
majority of the tribes to be served by such center.
``(4) Specific provision of funds.--
``(A) In general.--Notwithstanding any other
provision of this title, the Secretary may, from
amounts authorized to be appropriated for the purposes
of carrying out this section, make funds available to--
``(i) the Tanana Chiefs Conference,
Incorporated, for the purpose of leasing,
constructing, renovating, operating and
maintaining a residential youth treatment
facility in Fairbanks, Alaska;
``(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));
``(iii) the Southern Indian Health Council,
for the purpose of staffing, operating, and
maintaining a residential youth treatment
facility in San Diego County, California; and
``(iv) the Navajo Nation, for the staffing,
operation, and maintenance of the Four Corners
Regional Adolescent Treatment Center, a
residential youth treatment facility in New
Mexico.
``(B) Provision of services to eligible youth.--
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) Intermediate Adolescent Behavioral Health Services.--
``(1) In general.--The Secretary, acting through the
Service, Indian Tribes and tribal organizations, may provide
intermediate behavioral health services, which may incorporate
traditional health care practices, to Indian children and
adolescents, including--
``(A) pre-treatment 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) Use of funds.--Funds provided under this subsection
may be used--
``(A) to construct or renovate an existing health
facility to provide intermediate behavioral health
services;
``(B) to hire behavioral health professionals;
``(C) to staff, operate, and maintain an
intermediate mental health facility, group home, sober
housing, transitional housing or similar facilities, or
youth shelter where intermediate behavioral health
services are being provided; and
``(D) to make renovations and hire appropriate
staff to convert existing hospital beds into adolescent
psychiatric units; and
``(E) intensive home and community based services.
``(3) Criteria.--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) Federally Owned Structures.--
``(1) In general.--The Secretary, acting through the
Service, shall, in consultation with Indian tribes and tribal
organizations--
``(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) Terms and conditions for use of structure.--Any
structure described in paragraph (1) may be used under such
terms and conditions as may be agreed upon by the Secretary and
the agency having responsibility for the structure and any
Indian tribe or tribal organization operating the program.
``(e) Rehabilitation and Aftercare Services.--
``(1) In general.--The Secretary, an Indian tribe or tribal
organization, 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 have 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) Administration.--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) Inclusion of Family in Youth Treatment Program.--In providing
the treatment and other services to Indian youth authorized by this
section, the Secretary, an Indian tribe or tribal organization 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) Multidrug Abuse Program.--The Secretary, acting through the
Service, Indian tribes, tribal organizations and urban Indian
organizations, shall provide, consistent with section 701, programs and
services to prevent and treat the abuse of multiple forms of
substances, including 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 ASSESSMENT. --
``(a) In General.--Not later than 1 year after the date of
enactment of this section, the Secretary, acting through the Service,
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.
``(b) Treatment of California.--For purposes of this section,
California shall be considered to be 2 areas of the Service, 1 area
whose location shall be considered to encompass the northern area of
the State of California and 1 area whose jurisdiction shall be
considered to encompass the remainder of the State of California.
``(c) Conversion of Certain Hospital Beds.--The Secretary shall
consider the possible conversion of existing, under-utilized Service
hospital beds into psychiatric units to meet needs under this section.-
``SEC. 709. TRAINING AND COMMUNITY EDUCATION.
``(a) Community Education.--
``(1) In general.--The Secretary, in cooperation with the
Secretary of the Interior, shall develop and implement, or
provide funding to enable Indian tribes and tribal organization
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.
``(2) Education.--A program under paragraph (1) shall
include education concerning behavioral health for political
leaders, tribal judges, law enforcement personnel, members of
tribal health and education boards, and other critical members
of each tribal community.
``(3) Training.--Community-based training (oriented toward
local capacity development) under a program under paragraph (1)
shall include tribal community provider training (designed for
adult learners from the communities receiving services for
prevention, intervention, treatment and aftercare).
``(b) Training.--The Secretary shall, either directly or through
Indian tribes or tribal organization, 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) Community-Based Training Models.--In carrying out the
education and training programs required by this section, the
Secretary, acting through the Service and in consultation with 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) Programs for Innovative Services.--The Secretary, acting
through the Service, Indian Tribes or tribal organizations, consistent
with Section 701, may develop, implement, and carry out programs to
deliver innovative community-based behavioral health services to
Indians.
``(b) Criteria.--The Secretary may award funding for a project
under subsection (a) to an Indian tribe or tribal organization and may
consider the following criteria:
``(1) Whether the project will address significant unmet
behavioral health needs among Indians.
``(2) Whether the project will serve a significant number
of Indians.
``(3) Whether the project has the potential to deliver
services in an efficient and effective manner.
``(4) Whether the tribe or tribal organization has the
administrative and financial capability to administer the
project.
``(5) Whether the project will deliver services in a manner
consistent with traditional health care.
``(6) Whether the project is coordinated with, and avoids
duplication of, existing services.
``(c) Funding Agreements.--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 Act 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) Establishment of Program.--
``(1) In general.--The Secretary, consistent with Section
701, acting through Indian tribes, tribal organizations, and
urban Indian organizations, shall establish and operate fetal
alcohol disorders programs as provided for in this section for
the purposes of meeting the health status objective specified
in section 3(b).
``(2) Use of funds.--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 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) Criteria.--The Secretary shall establish criteria for
the review and approval of applications for funding under this
section.
``(b) Provision of Services.--The Secretary, acting through the
Service, 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 services to meet the special educational, vocational,
school-to-work transition, and independent living needs of
adolescent and adult Indians with fetal alcohol disorders.
``(c) Task Force.--
``(1) In general.--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).
``(2) Composition.--The task force under paragraph (1)
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 & Human Development, 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) Applied Research.--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) Urban Indian Organizations.--The Secretary shall ensure that
10 percent of the amounts appropriated to carry out this section shall
be used to make grants to urban Indian organizations funded under title
V.
``SEC. 712. CHILD SEXUAL ABUSE AND PREVENTION TREATMENT PROGRAMS.
``(a) Establishment.--The Secretary and the Secretary of the
Interior, acting through the Service, Indian tribes and tribal
organizations, shall establish, consistent with section 701, in each
service area, programs involving treatment for--
``(1) victims of child sexual abuse; and
``(2) perpetrators of child sexual abuse.
``(b) Use of Funds.--Funds provided under 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.
``(5) identify and provide behavioral health treatment to
perpetrators of child sexual abuse with efforts being 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 to provide treatment
after release to the community until it is determined that the
perpetrator is not a threat to children.
``SEC. 713. BEHAVIORAL MENTAL HEALTH RESEARCH.
``(a) In General.--The Secretary, acting through the Service and 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 inter-relationship and inter-dependance 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.
``(b) Special Emphasis.--The effect of the inter-relationships and
interdependencies referred to in subsection (a)(1) on children, and the
development of prevention techniques under subsection (a)(2) applicable
to children, shall be emphasized.
``SEC. 714. DEFINITIONS.
``In this title:
``(1) Assessment.--The term `assessment' means the
systematic collection, analysis and dissemination of
information on health status, health needs and health problems.
``(2) Alcohol related neurodevelop-mental disorders.--The
term `alcohol related neurodevelop-mental disorders' or `ARND'
with respect to an individual means the individual has a
history of maternal alcohol consumption during pregnancy,
central nervous system involvement such as developmental delay,
intellectual deficit, or neurologic abnormalities, that
behaviorally, there may be problems with irritability, and
failure to thrive as infants, and that as children become older
there will likely be hyperactivity, attention deficit, language
dysfunction and perceptual and judgment problems.
``(3) Behavioral health.--The term `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. Such term
includes the joint development of substance abuse and mental
health treatment planning and coordinated case management using
a multidisciplinary approach.
``(4) Behavioral health aftercare.--
``(A) In general.--The term `behavioral health
aftercare' includes those activities and resources used
to support recovery following inpatient, residential,
intensive substance abuse or mental health outpatient
or outpatient treatment, to help prevent or treat
relapse, including the development of an aftercare
plan.
``(B) Aftercare plan.--Prior to the time at which
an individual is discharged from a level of care, such
as outpatient treatment, an aftercare plan shall have
been developed for the individual. Such plan may use
such resources as community base therapeutic group
care, transitional living, a 12-step sponsor, a local
12-step or other related support group, or other
community based providers (such as mental health
professionals, traditional health care practitioners,
community health aides, community health
representatives, mental health technicians, or
ministers).
``(5) Dual diagnosis.--The term `dual diagnosis' means
coexisting substance abuse and mental illness conditions or
diagnosis. In individual with a dual diagnosis may be referred
to as a mentally ill chemical abuser.-
``(6) Fetal alcohol disorders.--The term `fetal alcohol
disorders' means fetal alcohol syndrome, partial fetal alcohol
syndrome, or alcohol related neural developmental disorder.
``(7) Fetal alcohol syndrome.--The term `fetal alcohol
syndrome' or `FAS' with respect to an individual means a
syndrome in which the individual has a history of maternal
alcohol consumption during pregnancy, and with respect to which
the following criteria should be met:
``(A) Central nervous system involvement such as
developmental delay, intellectual deficit,
microencephaly, or neurologic abnormalities.
``(B) Craniofacial abnormalities with at least 2 of
the following: 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.--The term `partial FAS' with respect to
an individual means 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: micro-
ophthalmia, short palpebral fissures, poorly developed
philtrum, thin upper lip, flat nasal bridge, short upturned
nose.
``(9) Rehabilitation.--The term `rehabilitation' means to
restore the ability or capacity to engage in usual and
customary life activities through education and therapy.-
``(10) Substance abuse.--The term `substance abuse'
includes inhalant abuse. --
``SEC. 715. AUTHORIZATION OF APPROPRIATIONS.
``There is authorized to be appropriated such sums as may be
necessary for each fiscal year through fiscal year 2012 to carry out
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 to address such impact, including a report on proposed
changes in the 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 concerning health care
educational loan repayments under section 110;
``(5) a general audit report on the health care educational
loan repayment program as required under section 110(n);
``(6) a separate statement that specifies the amount of
funds requested to carry out the provisions of section 201;
``(7) a report on infectious diseases as required under
section 212;
``(8) a report on environmental and nuclear health hazards
as required under section 214;
``(9) a report on the status of all health care facilities
needs as required under sections 301(c)(2) and 301(d);
``(10) a report on safe water and sanitary waste disposal
facilities as required under section 302(h)(1);
``(11) a report on the expenditure of non-service funds for
renovation as required under sections 305(a)(2) and 305(a)(3);
``(12) a report identifying the backlog of maintenance and
repair required at Service and tribal facilities as required
under 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 as required under section
403(a);
``(14) a report on services sharing of the Service, the
Department of Veteran's Affairs, and other Federal agency
health programs as required under section 412(c)(2);
``(15) a report on the evaluation and renewal of urban
Indian programs as required under section 505;
``(16) a report on the findings and conclusions derived
from the demonstration project as required under section
512(a)(2);
``(17) a report on the evaluation of programs as required
under section 513; and
``(18) a report on alcohol and substance abuse as required
under section 701(f).
``SEC. 802. REGULATIONS.
``(a) Initiation of Rulemaking Procedures.--
``(1) In general.--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 this Act.
``(2) Publication.--Proposed regulations to implement this
Act shall be published in the Federal Register by the Secretary
not later than 270 days after the date of enactment of this Act
and shall have not less than a 120 day comment period.
``(3) Expiration of authority.--The authority to promulgate
regulations under this Act shall expire 18 months from the date
of enactment of this Act.
``(b) Rulemaking 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) Adaption 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) Failure To Promulgate Regulations.--The lack of promulgated
regulations shall not limit the effect of this Act.
``(e) Supremacy of Provisions.--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 that is inconsistent
with the provisions of this Act.
``SEC. 803. PLAN OF IMPLEMENTATION.
``Not later than 240 days after the date of enactment of this Act,
the Secretary, in consultation with Indian tribes, tribal
organizations, and urban Indian organizations, shall prepare and submit
to Congress a plan that shall explain the manner and schedule
(including a schedule of appropriate requests), by title and section,
by which the Secretary will implement the provisions of this Act.
``SEC. 804. AVAILABILITY OF FUNDS.
``Amounts appropriated under this Act shall remain available until
expended.
``SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED TO THE INDIAN
HEALTH SERVICE.
``Any limitation on the use of funds contained in an Act providing
appropriations for the Department for a period with respect to the
performance of abortions shall apply for that period with respect to
the performance of abortions using funds contained in an Act providing
appropriations for the Service.
``SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.
``(a) Eligibility.--
``(1) In general.--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) Rule of Construction.--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) Ineligible Persons.--
``(1) In general.--Any individual who--
``(A) has not attained 19 years of age;
``(B) is the natural or adopted child, step-child,
foster-child, legal ward, or orphan of an eligible
Indian; and
``(C) is not otherwise eligible for the health
services provided by the Service,
shall be eligible for all health services provided by the
Service on the same basis and subject to the same rules that
apply to eligible Indians until such individual attains 19
years of age. The existing and potential health needs of all
such individuals shall be taken into consideration by the
Service in determining the need for, or the allocation of, the
health resources of the Service. If such an individual has been
determined to be legally incompetent prior to attaining 19
years of age, such individual shall remain eligible for such
services until one year after the date such disability has been
removed.
``(2) Spouses.--Any spouse of an eligible Indian who is not
an Indian, or who is of Indian descent but not otherwise
eligible for the health services provided by the Service, shall
be eligible for such health services if all of such spouses or
spouses who are married to members of the Indian tribe 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) Programs and Services.--
``(1) Programs.--
``(A) In general.--The Secretary may 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 or services,
within or without the service area of
such service unit, available to meet
the health needs of such individuals.
``(B) Funding agreements.--In the case of health
programs operated under a funding agreement entered
into under the Indian Self-Determination and
Educational Assistance Act, the governing body of the
Indian tribe or tribal organization providing health
services under such funding agreement 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 of this section or under any other provision
of law. In making such determinations, the governing
body of the Indian tribe or tribal organization shall
take into account the considerations described in
subparagraph (A)(ii).
``(2) Liability for payment.--
``(A) In general.--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 for not to exceed 1
fiscal year after the fiscal year in which collected.
``(B) Services for indigent persons.--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) Service areas.--
``(A) Service to only one tribe.--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) Multi-tribal areas.--In the case of a multi-
tribal service area, the authority of the Secretary to
provide health services under paragraph (1)(A) shall
terminate at the end of the fiscal year succeeding the
fiscal year in which at least 51 percent of the number
of Indian tribes in the service area revoke their
concurrence to the provision of such health services.
``(c) Purpose for Providing Services.--The Service may provide
health services under this subsection to individuals who are not
eligible for health services provided by the Service under any other
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.--Hospital privileges in health
facilities operated and maintained by the Service or operated under a
contract entered into under the Indian Self-Determination 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) Definition.--In 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) Requirement of Report.--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) Nonapplication of Section.--Subsection (a) shall not apply if
the total amount appropriated to the Service for a fiscal year is less
than the amount appropriated to the Service for previous fiscal year.
``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) In General.--The Secretary, acting through the Service, shall
provide services and benefits for Indians in Montana in a manner
consistent with the decision of the United States Court of Appeals for
the Ninth Circuit in McNabb for McNabb v. Bowen, 829 F.2d 787 (9th Cr.
1987).
``(b) Rule of Construction.--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, relating to eligibility for the health care services of
the Service, the Service shall provide services pursuant to the
criteria for eligibility for such services that were in effect on
September 15, 1987, subject to the provisions of sections 806 and 807
until such time as new criteria governing eligibility for services are
developed in accordance with section 802.
``SEC. 812. TRIBAL EMPLOYMENT.
``For purposes of section 2(2) of the Act of July 5, 1935 (49 Stat.
450, Chapter 372), an Indian tribe or tribal organization carrying out
a funding agreement under the 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)
Indian tribes and tribal organizations carrying out a grant,
cooperative agreement, or 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 Service in
the and, as such, may act as an ordering agent of the Service and the
employees of the tribe or tribal organization may order supplies on
behalf thereof on the same basis as employees of the Service.
``SEC. 814. NATIONAL BI-PARTISAN COMMISSION ON INDIAN HEALTH CARE
ENTITLEMENT.
``(a) Establishment.--There is hereby established the National Bi-
Partisan Indian Health Care Entitlement Commission (referred to in this
Act as the `Commission').
``(b) Membership.--The Commission shall be composed of 25 members,
to be appointed as follows:
``(1) Ten members of Congress, of which--
``(A) three members shall be from the House of
Representatives and shall be appointed by the majority
leader;
``(B) three members shall be from the House of
Representatives and shall be appointed by the minority
leader;
``(C) two members shall be from the Senate and
shall be appointed by the majority leader; and
``(D) two members shall be from the Senate and
shall be appointed by the minority leader;
who shall each be members of the committees of Congress that
consider legislation affecting the provision of health care to
Indians and who shall elect the chairperson and vice-
chairperson of the Commission.
``(2) Twelve individuals to be appointed by the members of
the Commission appointed under paragraph (1), of which at least
1 shall be from each service area as currently designated by
the Director of the Service, to be chosen from among 3 nominees
from each such area as selected by the Indian tribes within the
area, with due regard being given to the experience and
expertise of the nominees in the provision of health care to
Indians and 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.
``(3) Three individuals shall be appointed by the Director
of the Service from among individual who are knowledgeable
about the provision of health care to Indians, at least 1 of
whom shall be appointed from among 3 nominees from each program
that is funded in whole or in part by the Service primarily or
exclusively for the benefit of urban Indians.
All those persons appointed under paragraphs (2) and (3) shall be
members of Federally recognized Indian Tribes.
``(c) Terms.--
``(1) In general.--Members of the Commission shall serve
for the life of the Commission.
``(2) Appointment of members.--Members of the Commission
shall be appointed under subsection (b)(1) not later than 90
days after the date of enactment of this Act, and the remaining
members of the Commission shall be appointed not later than 60
days after the date on which the members are appointed under
such subsection.
``(3) Vacancy.--A vacancy in the membership of the
Commission shall be filled in the manner in which the original
appointment was made.
``(d) Duties of the Commission.--The Commission shall carry out the
following duties and functions:
``(1) Review and analyze the recommendations of the report
of the study committee established under paragraph (3) to the
Commission.
``(2) Make recommendations to Congress for providing health
services for Indian persons as an entitlement, giving due
regard to the effects of such a programs on existing health
care delivery systems for Indian persons and the effect of such
programs on the sovereign status of Indian Tribes;
``(3) Establish a study committee to be composed of those
members of the Commission appointed by the Director of the
Service and at least 4 additional 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
shall, at a minimum, address issues of eligibility,
benefits to be provided, including recommendations
regarding from whom such health services are to be
provide,d 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 the 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, make a
written report of its findings and recommendations to
the 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 each
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 committee in the course of carrying out its duties
under this section.
``(4) Not later than 18 months after 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 the 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.
``(e) Administrative Provisions.--
``(1) Compensation and expenses.--
``(A) Congressional members.--Each member of the
Commission appointed under subsection (b)(1) 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.
``(B) Other members.--The members of the Commission
appointed under paragraphs (2) and (3) of subsection
(b), 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, be allowed travel expenses, as
authorized by the chairperson of the Commission. For
purposes 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.
``(2) Meetings and quorum.--
``(A) Meetings.--The Commission shall meet at the
call of the chairperson.
``(B) Quorum.--A quorum of the Commission shall
consist of not less than 15 members, of which not less
than 6 of such members shall be appointees under
subsection (b)(1) and not less than 9 of such members
shall be Indians.
``(3) Director and staff.--
``(A) Executive director.--The members of the
Commission shall appoint an executive director of the
Commission. The executive director shall be paid the
rate of basic pay equal to that for level V of the
Executive Schedule.
``(B) Staff.--With the approval of the Commission,
the executive director may appoint such personnel as
the executive director deems appropriate.
``(C) Applicability of civil service laws.--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).
``(D) Experts and consultants.--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.
``(E) Facilities.--The Administrator of the General
Services Administration 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.
``(f) Powers.--
``(1) Hearings and other activities.--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, except that
at least 6 regional hearings shall be held in different areas
of the United States in which large numbers of Indians are
present. Such hearings shall be held to solicit the views of
Indians regarding the delivery of health care services to them.
To constitute a hearing under this paragraph, at least 5
members of the Commission, including at least 1 member of
Congress, must be present. Hearings held by the study committee
established under this section may be counted towards the
number of regional hearings required by this paragraph.
``(2) Studies by gao.--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) Cost estimates.--
``(A) In general.--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) Reimbursements.--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) Detail of federal employees.--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) Technical assistance.--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) Use of mails.--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) Obtaining information.--The Commission may secure
directly from the 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 chairperson of the Commission, the head of
such agency shall furnish such information to the Commission.
``(8) Support services.--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) Printing.--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.
``(g) Authorization of Appropriations.--There is authorized to be
appropriated $4,000,000 to carry out this section. The amount
appropriated under this subsection shall not be deducted from or affect
any other appropriation for health care for Indian persons.
``SEC. 815. APPROPRIATIONS; AVAILABILITY.
``Any new spending authority (described in subsection (c)(2)(A) or
(B) of section 401 of the Congressional Budget Act of 1974) which is
provided under this Act shall be effective for any fiscal year only to
such extent or in such amounts as are provided in appropriation Acts.
``SEC. 816. AUTHORIZATION OF APPROPRIATIONS.
``There is 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--CONFORMING AMENDMENTS TO THE SOCIAL SECURITY ACT
Subtitle A--Medicare
SEC. 201. LIMITATIONS ON CHARGES.
Section 1866(a)(1) of the Social Security Act (42 U.S.C.
1395cc(a)(1)) is amended--
(1) in subparagraph (R), by adding a semicolon at the end;
(2) in subparagraph (S), by striking the period and
inserting ``; and''; and
(3) by adding at the end the following:
``(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.''.
SEC. 202. INDIAN HEALTH PROGRAMS.
Section 1880 of the Social Security Act (42 U.S.C. 1395qq) is
amended to read as follows:
``indian health programs
``Sec. 1880. (a) Eligibility for Payments.--The Indian Health
Service (referred to in this section as the `Service') and an Indian
tribe or tribal organization, or an urban Indian 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 the Service, Indian
tribe or tribal organization, or urban Indian organization meets the
conditions and requirements for such payments which are applicable
generally to the service or provider type for which the Service, Indian
tribe or tribal organization, or urban Indian organization seeks
payment under this title and for services and provider types provided
by a qualified Indian health program under section 1880A.
``(b) Period for Billing.--Notwithstanding subsection (a), if the
Service, an Indian tribe or tribal organization, or urban Indian
organization, does not meet all of the conditions and requirements of
this title which are applicable generally to the service or provider
type for which payment is sought, but submits to the Secretary within 6
months after the date on which such reimbursement is first sought an
acceptable plan for achieving compliance with such conditions and
requirements, the Service, an Indian tribe or tribal organization, or
urban Indian organization shall be deemed to meet such conditions and
requirements (and to be eligible for reimbursement under this title),
without regard to the extent of actual compliance with such conditions
and requirements during the first 12 months after the month in which
such plan is submitted.
``(c) Direct Billing.--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) Community Health Aides.--The Service or 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 shall be paid for such services on
the same basis that such services are reimbursed under State plans
approved under title XIX.
``(e) Treatment of Certain Programs.--Notwithstanding any other
provision of law, a health program operated by the Service or an Indian
tribe or tribal organization, which collaborates with a hospital
operated by the 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 for under
this as if the health program 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.
``(f) Payment for Certain Nursing Services.--The Service or 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 under this title
for other primary care providers.
``(g) Alternative Methods of Reimbursement.--Notwithstanding any
other provision of law, the Secretary may identify and implement
alternative methods of reimbursing Indian health programs for services
reimbursable under this title that are provided to Indians, so long as
such methods--
``(1) allow an Indian tribe or tribal organization or urban
Indian organization to opt to receive reimbursement under
reimbursement methodologies applicable to other providers of
similar services; and
``(2) provide that the amount of reimbursement resulting
under any such methodology shall not be less than 100 percent
of the reasonable cost of the service to which the methodology
applies under section 1861(v).''.
SEC. 203. QUALIFIED INDIAN HEALTH PROGRAM.
Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is
amended by inserting after section 1880 the following:
``qualified indian health program
``Sec. 1880A. (a) Definition of Qualified Indian Health Program.--
In this section:
``(1) In general.--The term `qualified Indian health
program' means a health program operated by--
``(A) the Indian Health Service;
``(B) an Indian tribe or tribal organization or an
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 so defined)
and which is funded in whole or in part under title V
of the Indian Health Care Improvement Act.
``(2) Included programs and entities.--Such term may
include 1 or more hospital, nursing home, home health program,
clinic, ambulance service or other health program that provides
a service for which payments may be made under this title and
which is covered in the cost report submitted under this title
or title XIX for the qualified Indian health program.
``(b) Eligibility for Payments.--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 the program meets
all the conditions and requirements set forth in this section.
``(c) Determination of Payments.--
``(1) In general.--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) Definition of full cost recovery.--
``(A) In general.--Subject to subparagraph (B), in
this section, the term `full cost recovery' means the
sum of--
``(i) 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; and
``(ii) indirect costs which, in the case of
a qualified Indian health program--
``(I) 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, shall be not
less than an amount determined on the
basis of the indirect cost rate; or
``(II) 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.
``(B) Limitation.--Notwithstanding any other
provision of law, the amount determined to be payable
as full cost recovery may not be reduced for co-
insurance, co-payments, or deductibles when the service
was provided to an Indian entitled under Federal law to
receive the 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) Outstationing costs.--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 the programs established under this title,
title XIX, and XXI.
``(4) Determination of all-inclusive encounter or per diem
amount.--
``(A) In general.--Costs identified for services
addressed in a cost report submitted by a qualified
Indian health program shall be used to determine an
all-inclusive encounter or per diem payment amount for
such services.
``(B) No single report requirement.--Not all health
programs provided or administered by the Indian Health
Service, an Indian tribe or tribal organization, or an
urban Indian organization need be combined into a
single cost report.
``(C) Payment for items not covered by a cost
report.--A full cost recovery payment for services not
covered by a cost report shall be made on a fee-for-
service, encounter, or per diem basis.
``(5) Optional determination.--The full cost recovery rate
provided for in paragraphs (1) through (3) may be determined,
at the election of the qualified Indian health program, by the
Health Care Financing Administration or by the State agency
responsible for administering the State plan under title XIX
and shall be valid for reimbursements made under this title,
title XIX, and title XXI. The costs described in paragraph
(2)(A) 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) Election of payment.--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
paragraphs (1) through (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 the amounts
determined under paragraph (c)(2)(B) shall be added to
any such amount;
``(D) on the basis of any other rate or methodology
applicable to the Indian Health Service or 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) Election of Reimbursement for Other Services.--
``(1) In general.--A qualified Indian health program may
elect to be reimbursed for any service the Indian Health
Service, an Indian tribe or tribal organization or an urban
Indian organization may be reimbursed for under section 1880
and section 1911.
``(2) Option to include additional services.--An election
under paragraph (1) may include, at the election of the
qualified Indian health program--
``(A) 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;
``(B) screening, diagnostic, and therapeutic
outpatient services including 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;
``(C) 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;
``(D) with respect to services for children, all
services specified as part of the State plan under
title XIX, the State child health plan under title XXI,
and early and periodic screening, diagnostic, and
treatment services as described in section 1905(r);
``(E) influenza and pneumococcal immunizations;
``(F) other immunizations for prevention of
communicable diseases when targeted; and
``(G) the cost of transportation for providers or
patients necessary to facilitate access for
patients.''.
Subtitle B--Medicaid
SEC. 211. PAYMENTS TO FEDERALLY-QUALIFIED HEALTH CENTERS.
Section 1902(a)(13) of the Social Security Act (42 U.S.C.
1396a(a)(13)) is amended--
(1) in subparagraph (B), by striking ``and'' at the end;
(2) in subparagraph (C), by adding ``and'' at the end; and
(3) by adding at the end the following:
``(D)(i) for payment for services described in
section 1905(a)(2)(C) under the plan furnished by an
Indian tribe or tribal organization or an 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), and
``(ii) in the case of such services furnished
pursuant to a contract between a Federally-qualified
health center and a medicaid managed care organization
under section 1903(m), for payment to the Federally-
qualified health 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.''.
SEC. 212. STATE CONSULTATION WITH INDIAN HEALTH PROGRAMS.
Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is
amended--
(1) in paragraph (65), by striking the period; and
(2) by inserting after (65), the following:
``(66) if the Indian Health Service operates or funds
health programs in the State or if there are Indian tribes or
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 State plan under this title, so long as--
``(A) the term `meaningful consultation' is defined
through the negotiated rulemaking process provided for
under section 802 of the Indian Health Care Improvement
Act; and
``(B) such consultation is carried out in
collaboration with the Indian Medicaid Advisory
Committee established under section 415(a)(3) of that
Act.''.
SEC. 213. FMAP FOR SERVICES PROVIDED BY INDIAN HEALTH PROGRAMS.
The third sentence of Section 1905(b) of the Social Security Act
(42 U.S.C. 1396d(b)) is amended to read as follows:
``Notwithstanding the first sentence of this section, the Federal
medical assistance percentage shall be 100 per cent with respect to
amounts expended as medical assistance for services which are received
through the Indian Health Service, an Indian tribe or tribal
organization, or an urban Indian organization (as defined in section 4
of the Indian Health Care Improvement Act) under section 1911, whether
directly, by referral, or under contracts or other arrangements between
the Indian Health Service, Indian tribe or tribal organization, or
urban Indian organization and another health provider.''.
SEC. 214. INDIAN HEALTH SERVICE PROGRAMS.
Section 1911 of the Social Security Act (42 U.S.C. 1396j) is
amended to read as follows:
``indian health service programs
``Sec. 1911. (a) In General.--The Indian Health Service and an
Indian tribe or tribal organization or an 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 such
Service, Indian tribe or tribal organization, or urban Indian
organization 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) Period for Billing.--Notwithstanding subsection (a), if the
Indian Health Service, an Indian tribe or tribal organization, or an
urban Indian 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 such reimbursement is first sought an acceptable plan for
achieving compliance with such conditions and requirements, the
Service, an Indian tribe or tribal organization, or urban Indian
organization shall be deemed to meet such conditions and requirements
(and to be eligible for reimbursement under this title), without regard
to the extent of actual compliance with such conditions and
requirements during the first 12 months after the month in which such
plan is submitted.
``(c) Authority To Enter Into Agreements.--The Secretary may 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 or tribal organizations and urban Indian
organizations, directly, through referral, or under contracts or other
arrangements between the Indian Health Service, an Indian tribe or
tribal organization, or an urban Indian organization and another health
care provider to Indians who are eligible for medical assistance under
the State plan.
Subtitle C--State Children's Health Insurance Program
SEC. 221. ENHANCED FMAP FOR STATE CHILDREN'S HEALTH INSURANCE PROGRAM.
(a) In General.--Section 2105(b) of the Social Security Act (42
U.S.C. 1397ee(b)) is amended--
(1) by striking ``For purposes'' and inserting the
following:
``(1) In general.--Subject to paragraph (2), for
purposes''; and
(2) by adding at the end the following:
``(2) Services provided by indian programs.--Without regard
to which option a State chooses under section 2101(a), the
`enhanced FMAP' for a State for a fiscal year shall be 100 per
cent with respect to expenditures for child health assistance
for services provided through a health program operated by the
Indian Health Service, an Indian tribe or tribal organization,
or an urban Indian organization (as such terms are defined in
section 4 of the Indian Health Care Improvement Act).''.
(b) Conforming Amendment.--Section 2105(c)(6)(B) of such Act (42
U.S.C. 1397ee(c)(6)(B)) is amended by inserting ``an Indian tribe or
tribal organization, or an urban Indian organization (as such terms are
defined in section 4 of the Indian Health Care Improvement Act)'' after
``Service''.
SEC. 222. DIRECT FUNDING OF STATE CHILDREN'S HEALTH INSURANCE PROGRAM.
Title XXI of Social Security Act (42 U.S.C. 1397aa et seq.) is
amended by adding at the end the following:
``SEC. 2111. DIRECT FUNDING OF INDIAN HEALTH PROGRAMS.
``(a) In General.--The Secretary may enter into agreements directly
with the Indian Health Service, an Indian tribe or tribal organization,
or an urban Indian organization (as such terms are defined in section 4
of the Indian Health Care Improvement Act) for such entities to provide
child health assistance 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, or urban Indian organization. Such agreements may not be
made contingent on the approval of the State in which the Indians to be
served reside.
``(b) Transfer of Funds.--Notwithstanding any other provision of
law, a State may transfer funds to which it is, or would otherwise be,
entitled to under this title to the Indian Health Service, an Indian
tribe or tribal organization or an urban Indian organization--
``(1) to be administered by such entity to achieve the
purposes and objectives of this title under an agreement
between the State and the entity; or
``(2) under an agreement entered into under subsection (a)
between the entity and the Secretary.''.
Subtitle D--Authorization of Appropriations
SEC. 231. AUTHORIZATION OF APPROPRIATIONS.
There is authorized to be appropriated such sums as may be
necessary for each of fiscal years 2000 through 2012 to carry out this
title and the amendments by this title.
TITLE III--MISCELLANEOUS PROVISIONS
SEC. 301. REPEALS.
The following are repealed:
(1) Section 506 of Public Law 101-630 (25 U.S.C. 1653 note)
is repealed.
(2) Section 712 of the Indian Health Care Amendments of
1988 is repealed.
SEC. 302. 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.
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