[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2440 Introduced in House (IH)]







108th CONGRESS
  1st Session
                                H. R. 2440

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 11, 2003

 Mr. Young of Alaska (for himself, Mr. Hayworth, Mr. Renzi, Mr. Cole, 
 Mr. Hunter, Mr. McKeon, Mr. Pallone, Mr. Rahall, Mr. George Miller of 
   California, Mr. Kildee, Mr. Dingell, Mr. Waxman, Mr. Rangel, Mr. 
Conyers, Mr. Oberstar, Mr. Grijalva, Ms. Millender-McDonald, Mr. Frost, 
 Mr. Kennedy of Rhode Island, Mr. Frank of Massachusetts, Mr. Filner, 
Mr. Honda, Mr. Carson of Oklahoma, Mr. Allen, Mr. Abercrombie, Ms. Lee, 
 Mrs. Napolitano, Mr. Faleomavaega, Ms. McCollum, Mr. Towns, Mr. Udall 
of New Mexico, Mr. Udall of Colorado, Mr. Kind, Mr. Lantos, Mr. Inslee, 
Mr. Stupak, Mr. Baca, Ms. Kilpatrick, Mrs. Christensen, Mr. Blumenauer, 
 and Ms. Norton) introduced the following bill; which was referred to 
the Committee on Resources, and in addition to the Committees on Energy 
   and Commerce, and Ways and Means, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


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

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Indian Health Care Improvement Act 
Amendments of 2003''.

SEC. 2. INDIAN HEALTH CARE IMPROVEMENT ACT AMENDED.

    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.
Sec. 2. Indian Health Care Improvement Act amended.
        ``Sec. 1. Short title; table of contents.
        ``Sec. 2. Findings.
        ``Sec. 3. Declaration of National Indian health policy.
        ``Sec. 4. Definitions.
       ``TITLE I--INDIAN HEALTH, HUMAN RESOURCES, AND DEVELOPMENT

        ``Sec. 101. Purpose.
        ``Sec. 102. Health Professions Recruitment Program for Indians.
        ``Sec. 103. Health Professions Preparatory Scholarship Program 
                            for Indians.
        ``Sec. 104. Indian health professions scholarships.
        ``Sec. 105. American Indians into psychology program.
        ``Sec. 106. Funding for tribes for scholarship programs.
        ``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. Indian recruitment and retention program.
        ``Sec. 114. Advanced training and research.
        ``Sec. 115. Quentin N. Burdick American Indians into nursing 
                            program.
        ``Sec. 116. Tribal cultural orientation.
        ``Sec. 117. Inmed program.
        ``Sec. 118. Health training programs of community colleges.
        ``Sec. 119. Retention bonus.
        ``Sec. 120. Nursing residency program.
        ``Sec. 121. Community Health Aide Program for Alaska.
        ``Sec. 122. Tribal health program administration.
        ``Sec. 123. Health professional chronic shortage demonstration 
                            programs.
        ``Sec. 124. Treatment of scholarships for certain purposes.
        ``Sec. 125. National Health Service Corps.
        ``Sec. 126. Substance abuse counselor educational curricula 
                            demonstration programs.
        ``Sec. 127. Mental health training and community education 
                            programs.
        ``Sec. 128. Designation of shortage areas.
        ``Sec. 129. 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 for long-term care.
        ``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. 216A. North Dakota as a contract health service delivery 
                            area.
        ``Sec. 216B. South Dakota as a contract health service delivery 
                            area.
        ``Sec. 217. California contract health services program.
        ``Sec. 218. California as a contract health service delivery 
                            area.
        ``Sec. 219. Contract health services for the Trenton Service 
                            Area.
        ``Sec. 220. Programs operated by Indian tribes and tribal 
                            organizations.
        ``Sec. 221. Licensing.
        ``Sec. 222. Notification of provision of 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. Sanitation facilities.
        ``Sec. 303. Preference to Indians and Indian firms.
        ``Sec. 304. Expenditure of nonservice funds for renovation.
        ``Sec. 305. Funding for the construction, expansion, and 
                            modernization of small ambulatory care 
                            facilities.
        ``Sec. 306. Indian Health Care Delivery Demonstration Project.
        ``Sec. 307. Land transfer.
        ``Sec. 308. Leases, contracts, and other agreements.
        ``Sec. 309. Loans, loan guarantees, and loan repayment.
        ``Sec. 310. Tribal leasing.
        ``Sec. 311. Indian Health Service/tribal facilities joint 
                            venture program.
        ``Sec. 312. Location of facilities.
        ``Sec. 313. Maintenance and improvement of health care 
                            facilities.
        ``Sec. 314. Tribal management of federally owned quarters.
        ``Sec. 315. Applicability of Buy American Act requirement.
        ``Sec. 316. Other funding for facilities.
        ``Sec. 317. Authorization of appropriations.
                 ``TITLE IV--ACCESS TO HEALTH SERVICES

        ``Sec. 401. Treatment of payments under Social Security Act 
                            health care programs.
        ``Sec. 402. Grants to and funding agreements with the Service, 
                            Indian tribes, tribal organizations, and 
                            urban Indian organizations.
        ``Sec. 403. Reimbursement from certain third parties of costs 
                            of health services.
        ``Sec. 404. Crediting of reimbursements.
        ``Sec. 405. Purchasing health care coverage.
        ``Sec. 406. Sharing arrangements with Federal agencies.
        ``Sec. 407. Payor of last resort.
        ``Sec. 408. Nondiscrimination in qualifications for 
                            reimbursement for services.
        ``Sec. 409. Consultation.
        ``Sec. 410. State children's health insurance program (SCHIP).
        ``Sec. 411. Social Security Act sanctions.
        ``Sec. 412. Cost sharing.
        ``Sec. 413. Treatment under medicaid managed care.
        ``Sec. 414. Navajo nation medicaid agency.
        ``Sec. 415. 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. Eligibility for services.
        ``Sec. 522. Authorization of appropriations.
                ``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

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

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

        ``Sec. 801. Reports.
        ``Sec. 802. Regulations.
        ``Sec. 803. Plan of implementation.
        ``Sec. 804. Availability of funds.
        ``Sec. 805. Limitation on use of funds appropriated to the 
                            Indian Health Service.
        ``Sec. 806. Eligibility of California Indians.
        ``Sec. 807. Health services for ineligible persons.
        ``Sec. 808. Reallocation of base resources.
        ``Sec. 809. Results of demonstration projects.
        ``Sec. 810. Provision of services in Montana.
        ``Sec. 811. Moratorium.
        ``Sec. 812. Tribal employment.
        ``Sec. 813. Prime vendor.
        ``Sec. 814. Severability provisions.
        ``Sec. 815. Establishment of National Bipartisan Commission on 
                            Indian Health Care Entitlement.
        ``Sec. 816. Appropriations; availability.
        ``Sec. 817. Confidentiality of medical quality assurance 
                            records: qualified immunity for 
                            participants.
        ``Sec. 818. Authorization of appropriations.
Sec. 3. Soboba sanitation facilities.
Sec. 4. Amendments to medicare program.
Sec. 5. Amendments to medicaid program and State Children's Health 
                            Insurance Program (SCHIP).

``SEC. 2. FINDINGS.

    ``Congress finds the following:
            ``(1) Federal delivery of health services and funding of 
        Indian and Urban Indian Health Programs to maintain and improve 
        the health of Indians are consonant with and required by the 
        Federal Government's historical and unique legal relationship 
        with Indians, as reflected in the Constitution, treaties, 
        Federal statutes and the course of dealings of the United 
        States with Indian Tribes and the United States' resulting 
        government-to-government relationship with Indian Tribes and 
        trust responsibilities and obligations to Indians.
            ``(2) From the time of European occupation and colonization 
        through the 20th century, policies and practices of the United 
        States caused and/or contributed to the severe health 
        conditions of Indians.
            ``(3) 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, Indian Tribes have secured a de 
        facto contract which entitles Indians to health care in 
        perpetuity, based on the moral, legal, and historic obligation 
        of the United States.
            ``(4) The population growth of Indians that began in the 
        later part of the 20th century increases the need for Federal 
        health care services.
            ``(5) A major national goal of the United States is to 
        provide the quantity and quality of health services which will 
        permit the health status of Indians regardless of where they 
        live to be raised to the highest possible level that is no less 
        than that of the general population and to provide for the 
        maximum participation of Indian Tribes, Tribal Organizations, 
        and Urban Indian Organizations in the planning, delivery and 
        management of those health 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 
        Indians remain alarmingly severe and the health status of 
        Indians is far below the health status of the general 
        population of the United States.
            ``(8) The disparity to be addressed is formidable. For 
        example, Indians suffer a death rate for diabetes mellitus that 
        is 318 percent higher than the all races rate for the United 
        States, a pneumonia and influenza death rate 52 percent 
        greater, a tuberculosis death rate that is 650 percent greater, 
        and a death rate from alcoholism that is 670 percent higher 
        than that of the all races United States rate.

``SEC. 3. DECLARATION OF NATIONAL INDIAN HEALTH POLICY.

    ``Congress hereby declares that it is the policy of this Nation, in 
fulfillment of its special trust responsibilities and legal obligations 
to Indians--
            ``(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 2010 or successor objectives;
            ``(3) to the greatest extent possible, to allow Indians to 
        set their own health care priorities and establish goals that 
        reflect their unmet needs;
            ``(4) to increase the proportion of all degrees in the 
        health professions and allied and associated health professions 
        awarded to Indians so that the proportion of Indian health 
        professionals in each Service Area is raised to at least the 
        level of that of the general population;
            ``(5) to require meaningful consultation with Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations to 
        implement this Act and the national policy of Indian self-
        determination; and
            ``(6) to provide funding for programs and facilities 
        operated by Indian Tribes and Tribal Organizations in amounts 
        that are not less than the amounts provided to programs and 
        facilities operated directly by the Service.

``SEC. 4. DEFINITIONS.

    ``For purposes of this Act:
            ``(1) The term `accredited and accessible' means on or near 
        a reservation and accredited by a national or regional 
        organization with accrediting authority.
            ``(2) The term `Area Office' means an administrative entity 
        including a program office, within the Service through which 
        services and funds are provided to the Service Units within a 
        defined geographic area.
            ``(3) The term `California Indians' shall mean those 
        Indians who are eligible for health services of the Service 
        pursuant to section 806.
            ``(4) The term `community college' means--
                    ``(A) a tribal college or university, or
                    ``(B) a junior or community college.
            ``(5) The term `contract health service' means health 
        services provided at the expense of the Service or a Tribal 
        Health Program by public or private medical providers or 
        hospitals, other than the Service Unit or the Tribal Health 
        Program at whose expense the services are provided.
            ``(6) The term `Department' means, unless otherwise 
        designated, the Department of Health and Human Services.
            ``(7) The term `Director' means the Director of the Indian 
        Health Service.
            ``(8) The term `disease prevention' means the reduction, 
        limitation, and prevention of disease and its complications and 
        reduction in the consequences of disease, including, but not 
        limited to--
                    ``(A) controlling--
                            ``(i) development of diabetes;
                            ``(ii) high blood pressure;
                            ``(iii) infectious agents;
                            ``(iv) injuries;
                            ``(v) occupational hazards and 
                        disabilities;
                            ``(vi) sexually transmittable diseases; and
                            ``(vii) toxic agents; and
                    ``(B) providing--
                            ``(i) fluoridation of water; and
                            ``(ii) immunizations.
            ``(9) The term `fund' or `funding' means the transfer of 
        moneys from the Department to any eligible entity or individual 
        under this Act by any legal means, including Funding 
        Agreements, contracts, memoranda of understanding, contracts 
        pursuant to section 23 of the Act of April 20, 1908 (25 U.S.C. 
        47; popularly known as the `Buy Indian Act'), or otherwise.
            ``(10) The term `Funding Agreement' means any agreement to 
        transfer funds for the planning, conduct, and administration of 
        programs, services, functions, and activities to Indian Tribes 
        and Tribal Organizations from the Secretary under the Indian 
        Self-Determination and Education Assistance Act.
            ``(11) The term `health profession' means allopathic 
        medicine, family medicine, internal medicine, pediatrics, 
        geriatric medicine, obstetrics and gynecology, podiatric 
        medicine, nursing, public health nursing, dentistry, 
        psychiatry, osteopathy, optometry, pharmacy, psychology, public 
        health, social work, marriage and family therapy, chiropractic 
        medicine, environmental health and engineering, allied health 
        professions, and any other health profession.
            ``(12) The term `health promotion' means--
                    ``(A) fostering social, economic, environmental, 
                and personal factors conducive to health, including 
                raising public awareness about health matters and 
                enabling the people to cope with health problems by 
                increasing their knowledge and providing them with 
                valid information;
                    ``(B) encouraging adequate and appropriate diet, 
                exercise, and sleep;
                    ``(C) promoting education and work in conformity 
                with physical and mental capacity;
                    ``(D) making available suitable housing, safe 
                water, and sanitary facilities;
                    ``(E) improving the physical, economic, cultural, 
                psychological, and social environment;
                    ``(F) promoting adequate opportunity for spiritual, 
                religious, and Traditional Health Care Practices; and
                    ``(G) providing adequate and appropriate programs, 
                including, but not limited to--
                            ``(i) abuse prevention (mental and 
                        physical);
                            ``(ii) community health;
                            ``(iii) community safety;
                            ``(iv) consumer health education;
                            ``(v) diet and nutrition;
                            ``(vi) immunization and other prevention of 
                        communicable diseases, including HIV/AIDS;
                            ``(vii) environmental health;
                            ``(viii) exercise and physical fitness;
                            ``(ix) avoidance of fetal alcohol 
                        disorders;
                            ``(x) first aid and CPR education;
                            ``(xi) human growth and development;
                            ``(xii) injury prevention and personal 
                        safety;
                            ``(xiii) mental health;
                            ``(xiv) personal health and wellness 
                        practices;
                            ``(xv) personal capacity building;
                            ``(xvi) prenatal, pregnancy, and infant 
                        care;
                            ``(xvii) psychological well-being;
                            ``(xviii) reproductive health and family 
                        planning;
                            ``(xix) safe and adequate water;
                            ``(xx) safe housing;
                            ``(xxi) safe work environments;
                            ``(xxii) stress control;
                            ``(xxiii) substance abuse;
                            ``(xxiv) sanitary facilities;
                            ``(xxv) tobacco use cessation and 
                        reduction;
                            ``(xxvi) violence prevention; and
                            ``(xxvii) such other activities identified 
                        by the Service, a Tribal Health Program, or an 
                        Urban Indian Organization, to promote 
                        achievement of any of the objectives described 
                        in section 3(2).
            ``(13) The term `Indian' shall have the meaning given that 
        term in the Indian Self-Determination and Education Assistance 
        Act.
            ``(14) The term `Indian Health Program' means the 
        following--
                    ``(A) any health program administered directly by 
                the Service;
                    ``(B) any Tribal Health Program; or
                    ``(C) any Indian Tribe or Tribal Organization to 
                which the Secretary provides funding pursuant to 
                section 23 of the Act of April 30, 1908 (25 U.S.C. 47), 
                popularly known as the `Buy Indian Act'.
            ``(15) The term `Indian Tribe' shall have the meaning given 
        that term in the Indian Self-Determination and Education 
        Assistance Act.
            ``(16) The term `junior or community college' has the 
        meaning given to such term by section 312(e) of the Higher 
        Education Act of 1965 (20 U.S.C. 1058(e)).
            ``(17) The term `reservation' means any federally 
        recognized Indian Tribe's reservation, Pueblo, or colony, 
        including former reservations in Oklahoma, Indian allotments, 
        and Alaska Native Regions established pursuant to the Alaska 
        Native Claims Settlement Act (25 U.S.C. 1601 et seq.).
            ``(18) The term `Secretary', unless otherwise designated, 
        means the Secretary of Health and Human Services.
            ``(19) The term `Service' means the Indian Health Service.
            ``(20) The term `Service Area' means the geographical area 
        served by each Area Office.
            ``(21) The term `Service Unit' means an administrative 
        entity of the Service, or a Tribal Health Program through which 
        services are provided, directly or by contract, to eligible 
        Indians within a defined geographic area.
            ``(22) The term `Traditional Health Care Practices' means 
        the application by Native healing practitioners of the Native 
        healing sciences (as opposed or in contradistinction to Western 
        healing sciences) which embody the influences or forces of 
        innate Tribal discovery, history, description, explanation and 
        knowledge of the states of wellness and illness and which call 
        upon these influences or forces, including physical, mental, 
        and spiritual forces in the promotion, restoration, 
        preservation, and maintenance of health, well-being, and life's 
        harmony.
            ``(23) The term `tribal college or university' shall have 
        the meaning given that term in section 316(b)(3) of the Higher 
        Education Act (20 U.S.C. 1059c(b)(3)).
            ``(24) The term `Tribal Health Program' means an Indian 
        Tribe or Tribal Organization that operates any health program, 
        service, function, activity, or facility funded, in whole or 
        part, by the Service through, or provided for in, a Funding 
        Agreement with the Service under the Indian Self-Determination 
        and Education Assistance Act.
            ``(25) The term `Tribal Organization' shall have the 
        meaning given that term in the Indian Self-Determination and 
        Education Assistance Act.
            ``(26) The term `Urban Center' means any community which 
        has a sufficient Urban Indian population with unmet health 
        needs to warrant assistance under title V, as determined by the 
        Secretary.
            ``(27) The term `Urban Indian' means any individual who 
        resides in an Urban Center and who meets 1 or more of the 
        following criteria:
                    ``(A) Irrespective of whether the individual lives 
                on or near a reservation, the individual is a member of 
                a tribe, band, or other organized group of Indians, 
                including those tribes, bands, or groups terminated 
                since 1940 and those tribes, bands, or groups that are 
                recognized by the States in which they reside, or who 
                is a descendant in the first or second degree of any 
                such member.
                    ``(B) The individual is an Eskimo, Aleut, or other 
                Alaskan Native.
                    ``(C) The individual is considered by the Secretary 
                of the Interior to be an Indian for any purpose.
                    ``(D) The individual is determined to be an Indian 
                under regulations promulgated by the Secretary.
            ``(28) The term `Urban Indian Organization' means a 
        nonprofit corporate body that (A) is situated in an Urban 
        Center; (B) is governed by an Urban Indian-controlled board of 
        directors; (C) provides for the participation of all interested 
        Indian groups and individuals; and (D) is capable of legally 
        cooperating with other public and private entities for the 
        purpose of performing the activities described in section 
        503(a).

       ``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 Indian Health Programs and Urban Indian 
Organizations involved in the provision of health services to Indians.

``SEC. 102. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR INDIANS.

    ``(a) In General.--The Secretary, acting through the Service, shall 
make funds available to public or nonprofit private health entities or 
Tribal Health Programs 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 Secretary 
        determines will enhance and facilitate the enrollment of 
        Indians in, and the subsequent pursuit and completion by them 
        of, courses of study referred to in paragraph (1).
    ``(b) Funding.--
            ``(1) Application.--Funds under this section shall require 
        that an application has been submitted to, and approved by, the 
        Secretary. Such application shall be in such form, submitted in 
        such manner, and contain such information, as the Secretary 
        shall by regulation prescribe pursuant to this Act. The 
        Secretary shall give a preference to applications submitted by 
        Tribal Health Programs or Urban Indian Organizations.
            ``(2) Amount of funds; payment.--The amount of funds 
        provided to entities under this section shall be determined by 
        the Secretary. Payments pursuant to this section may be made in 
        advance or by way of reimbursement, and at such intervals and 
        on such conditions as provided for in regulations issued 
        pursuant to this Act. To the extent not otherwise prohibited by 
        law, funding commitments shall be for 3 years, as provided in 
        regulations published pursuant to this Act.
    ``(c) Definition of Indian.--For purposes of this section and 
sections 103 and 104, the term `Indian' shall, in addition to the 
meaning given that term in section 4, also mean any individual who is 
an Urban Indian.

``SEC. 103. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP PROGRAM FOR 
              INDIANS.

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

``SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.

    ``(a) In General.--
            ``(1) Authority.--The Secretary, acting through the 
        Service, shall make scholarships to Indians who are enrolled 
        full or part time in accredited schools pursuing courses of 
        study in the health professions. Such scholarships shall be 
        designated Indian Health Scholarships and shall be made in 
        accordance with section 338A of the Public Health Services Act 
        (42 U.S.C. 2541), except as provided in subsection (b) of this 
        section.
            ``(2) Allocation by formula.--Except as provided in 
        paragraph (3), the funding authorized by this section shall be 
        allocated by Service Area by a formula developed in 
        consultation with Indian Tribes, Tribal Organizations, and 
        Urban Indian Organizations. Such formula shall consider the 
        human resource development needs in each Service Area.
            ``(3) Continuity of prior scholarships.--Paragraph (2) 
        shall not apply with respect to individual recipients of 
        scholarships provided under this section (as in effect 1 day 
        prior to the date of the enactment of the Indian Health Care 
        Improvement Act Amendments of 2003) until such time as the 
        individual completes the course of study that is supported 
        through such scholarship.
            ``(4) Certain delegation not allowed.--The administration 
        of this section shall be a responsibility of the Director and 
        shall not be delegated in a Funding Agreement.
    ``(b) Active Duty Service Obligation.--
            ``(1) Obligation met.--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 in one or more of the following:
                    ``(A) In an Indian Health Program.
                    ``(B) In a program assisted under title V.
                    ``(C) 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.
            ``(2) Obligation deferred.--At the request of any 
        individual who has entered into a contract referred to in 
        paragraph (1) and who receives a degree in medicine (including 
        osteopathic or allopathic medicine), dentistry, optometry, 
        podiatry, or pharmacy, the Secretary shall defer the active 
        duty service obligation of that individual under that contract, 
        in order that such individual may complete any internship, 
        residency, or other advanced clinical training that is required 
        for the practice of that health profession, for an appropriate 
        period (in years, as determined by the Secretary), subject to 
        the following conditions:
                    ``(A) No period of internship, residency, or other 
                advanced clinical training shall be counted as 
                satisfying any period of obligated service under this 
                subsection.
                    ``(B) The active duty service obligation of that 
                individual shall commence not later than 90 days after 
                the completion of that advanced clinical training (or 
                by a date specified by the Secretary).
                    ``(C) The active duty service obligation will be 
                served in the health profession of that individual in a 
                manner consistent with paragraph (1).
                    ``(D) A recipient of a scholarship under this 
                section may, at the election of the recipient, meet the 
                active duty service obligation described in paragraph 
                (1) by service in a program specified under that 
                paragraph that--
                            ``(i) is located on the reservation of the 
                        Indian Tribe in which the recipient is 
                        enrolled; or
                            ``(ii) serves the Indian Tribe in which the 
                        recipient is enrolled.
            ``(3) Priority when making assignments.--Subject to 
        paragraph (2), the Secretary, in making assignments of Indian 
        Health Scholarship recipients required to meet the active duty 
        service obligation described in paragraph (1), shall give 
        priority to assigning individuals to service in those programs 
        specified in paragraph (1) that have a need for health 
        professionals to provide health care services as a result of 
        individuals having breached contracts entered into under this 
        section.
    ``(c) Part-Time Students.--In the case of an individual receiving a 
scholarship under this section who is enrolled part time in an approved 
course of study--
            ``(1) such scholarship shall be for a period of years not 
        to exceed the part-time equivalent of 4 years, as determined by 
        the Area Office;
            ``(2) the period of obligated service described in 
        subsection (b)(1) shall be equal to the greater of--
                    ``(A) 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
                    ``(B) 2 years; and
            ``(3) 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.
    ``(d) Breach of Contract.--
            ``(1) Specified breaches.--An individual shall be liable to 
        the United States for the amount which has been paid to the 
        individual, or on behalf of the individual, under a contract 
        entered into with the Secretary under this section on or after 
        the date of the enactment of the Indian Health Care Improvement 
        Act Amendments of 2003 if that individual--
                    ``(A) fails to maintain an acceptable level of 
                academic standing in the educational institution in 
                which he or she is enrolled (such level determined by 
                the educational institution under regulations of the 
                Secretary);
                    ``(B) is dismissed from such educational 
                institution for disciplinary reasons;
                    ``(C) voluntarily terminates the training in such 
                an educational institution for which he or she is 
                provided a scholarship under such contract before the 
                completion of such training; or
                    ``(D) fails to accept payment, or instructs the 
                educational institution in which he or she is enrolled 
                not to accept payment, in whole or in part, of a 
                scholarship under such contract, in lieu of any service 
                obligation arising under such contract.
            ``(2) Other breaches.--If for any reason not specified in 
        paragraph (1) an individual breaches a written contract by 
        failing either to begin such individual's service obligation 
        required under such contract or to complete such service 
        obligation, the United States shall be entitled to recover from 
        the individual an amount determined in accordance with the 
        formula specified in subsection (l) of section 110 in the 
        manner provided for in such subsection.
            ``(3) Cancellation upon death of recipient.--Upon the death 
        of an individual who receives an Indian Health Scholarship, any 
        outstanding obligation of that individual for service or 
        payment that relates to that scholarship shall be canceled.
            ``(4) Waivers and suspensions.--The Secretary shall provide 
        for the partial or total waiver or suspension of any obligation 
        of service or payment of a recipient of an Indian Health 
        Scholarship if the Secretary, in consultation with the Area 
        Office, Indian Tribes, Tribal Organizations, and Urban Indian 
        Organizations, determines that--
                    ``(A) it is not possible for the recipient to meet 
                that obligation or make that payment;
                    ``(B) requiring that recipient to meet that 
                obligation or make that payment would result in extreme 
                hardship to the recipient; or
                    ``(C) the enforcement of the requirement to meet 
                the obligation or make the payment would be 
                unconscionable.
            ``(5) Extreme hardship.--Notwithstanding any other 
        provision of law, in any case of extreme hardship or for other 
        good cause shown, the Secretary may waive, in whole or in part, 
        the right of the United States to recover funds made available 
        under this section.
            ``(6) 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.

``SEC. 105. AMERICAN INDIANS INTO PSYCHOLOGY PROGRAM.

    ``(a) Grants Authorized.--The Secretary, acting through the 
Service, shall provide funding grants to at least 3 colleges and 
universities for the purpose of developing and maintaining Indian 
psychology career recruitment programs as a means of encouraging 
Indians to enter the mental health field. These programs shall be 
located at various locations throughout the country to maximize their 
availability to Indian students and new programs shall be established 
in different locations from time to time.
    ``(b) Quentin N. Burdick Program Grant.--The Secretary shall 
provide a grant authorized under subsection (a) to develop and maintain 
a program at the University of North Dakota to be known as the `Quentin 
N. Burdick American Indians Into Psychology Program'. Such program 
shall, to the maximum extent feasible, coordinate with the Quentin N. 
Burdick Indian Health Programs authorized under section 117(b), the 
Quentin N. Burdick American Indians Into Nursing Program authorized 
under section 115(e), and existing university research and 
communications networks.
    ``(c) Regulations.--The Secretary shall issue regulations pursuant 
to this Act for the competitive awarding of funds provided under this 
section.
    ``(d) Conditions of Grant.--Applicants under this section shall 
agree to provide a program which, at a minimum--
            ``(1) provides outreach and recruitment for health 
        professions to Indian communities including elementary, 
        secondary, and accredited and accessible community colleges 
        that will be served by the program;
            ``(2) incorporates a program advisory board comprised of 
        representatives from the tribes and communities that will be 
        served by the program;
            ``(3) provides summer enrichment programs to expose Indian 
        students to the various fields of psychology through research, 
        clinical, and experimental activities;
            ``(4) provides stipends to undergraduate and graduate 
        students to pursue a career in psychology;
            ``(5) develops affiliation agreements with tribal colleges 
        and universities, the Service, university affiliated programs, 
        and other appropriate accredited and accessible entities to 
        enhance the education of Indian students;
            ``(6) to the maximum extent feasible, uses existing 
        university tutoring, counseling, and student support services; 
        and
            ``(7) to the maximum extent feasible, employs qualified 
        Indians in the program.
    ``(e) Active Duty Service Requirement.--The active duty service 
obligation prescribed under section 338C of the Public Health Service 
Act (42 U.S.C. 254m) shall be met by each graduate who receives a 
stipend described in subsection (d)(4) that is funded under this 
section. Such obligation shall be met by service--
            ``(1) in an Indian Health Program;
            ``(2) in a program assisted under title V; or
            ``(3) in the private practice of psychology if, as 
        determined by the Secretary, in accordance with guidelines 
        promulgated by the Secretary, such practice is situated in a 
        physician or other health professional shortage area and 
        addresses the health care needs of a substantial number of 
        Indians.

``SEC. 106. FUNDING FOR TRIBES FOR SCHOLARSHIP PROGRAMS.

    ``(a) In General.--
            ``(1) Funding authorized.--The Secretary, acting through 
        the Service, shall make funds available to Tribal Health 
        Programs for the purpose of assisting such Tribal Health 
        Programs in educating Indians to serve as health professionals 
        in Indian communities.
            ``(2) Amount.--Amounts available under paragraph (1) for 
        any fiscal year shall not exceed 5 percent of the amounts 
        available for each fiscal year for Indian Health Scholarships 
        under section 104.
            ``(3) Application.--An application for funds under 
        paragraph (1) shall be in such form and contain such 
        agreements, assurances, and information as consistent with this 
        section.
    ``(b) Requirements.--
            ``(1) In general.--A Tribal Health Program receiving funds 
        under subsection (a) shall provide scholarships to Indians in 
        accordance with the requirements of this section.
            ``(2) Costs.--With respect to costs of providing any 
        scholarship pursuant to subsection (a)--
                    ``(A) 80 percent of the costs of the scholarship 
                shall be paid from the funds made available pursuant to 
                subsection (a)(1) provided to the Tribal Health 
                Program; and
                    ``(B) 20 percent of such costs may be paid from any 
                other source of funds.
    ``(c) Course of Study.--A Tribal Health Program shall provide 
scholarships under this section only to Indians enrolled or accepted 
for enrollment in a course of study (approved by the Secretary) in one 
of the health professions contemplated by this Act.
    ``(d) Contract.--In providing scholarships under subsection (b), 
the Secretary and the Tribal Health Program shall enter into a written 
contract with each recipient of such scholarship. Such contract shall--
            ``(1) obligate such recipient to provide service in an 
        Indian Health Program or Urban Indian Organization, in the same 
        Service Area where the Tribal Health Program providing the 
        scholarship is located, for--
                    ``(A) a number of years for which the scholarship 
                is provided (or the part-time equivalent thereof, as 
                determined by the Secretary), or for a period of 2 
                years, whichever period is greater; or
                    ``(B) such greater period of time as the recipient 
                and the Tribal Health Program may agree;
            ``(2) provide that the amount of the scholarship--
                    ``(A) may only be expended for--
                            ``(i) tuition expenses, other reasonable 
                        educational expenses, and reasonable 
living expenses incurred in attendance at the educational institution; 
and
                            ``(ii) payment to the recipient of a 
                        monthly stipend of not more than the amount 
                        authorized by section 338(g)(1)(B) of the 
                        Public Health Service Act (42 U.S.C. 
                        254m(g)(1)(B)), such amount to be reduced pro 
                        rata (as determined by the Secretary) based on 
                        the number of hours such student is enrolled; 
                        and may not exceed, for any year of attendance 
                        for which the scholarship is provided, the 
                        total amount required for the year for the 
                        purposes authorized in this clause; and
                    ``(B) may not exceed, for any year of attendance 
                for which the scholarship is provided, the total amount 
                required for the year for the purposes authorized in 
                subparagraph (A);
            ``(3) require the recipient of such scholarship to maintain 
        an acceptable level of academic standing as determined by the 
        educational institution in accordance with regulations issued 
        pursuant to this Act; and
            ``(4) require the recipient of such scholarship to meet the 
        educational and licensure requirements appropriate to each 
        health profession.
    ``(e) Breach of Contract.--
            ``(1) Specific breaches.--An individual who has entered 
        into a written contract with the Secretary and a Tribal Health 
        Program under subsection (d) shall be liable to the United 
        States for the Federal share of the amount which has been paid 
        to him or her, or on his or her behalf, under the contract if 
        that individual--
                    ``(A) fails to maintain an acceptable level of 
                academic standing in the educational institution in 
                which he or she is enrolled (such level as determined 
                by the educational institution under regulations of the 
                Secretary);
                    ``(B) is dismissed from such educational 
                institution for disciplinary reasons;
                    ``(C) voluntarily terminates the training in such 
                an educational institution for which he or she is 
                provided a scholarship under such contract before the 
                completion of such training; or
                    ``(D) fails to accept payment, or instructs the 
                educational institution in which he or she is enrolled 
                not to accept payment, in whole or in part, of a 
                scholarship under such contract, in lieu of any service 
                obligation arising under such contract.
            ``(2) Other breaches.--If for any reason not specified in 
        paragraph (1), an individual breaches a written contract by 
        failing to either begin such individual's service obligation 
        required under such contract or to complete such service 
        obligation, the United States shall be entitled to recover from 
        the individual an amount determined in accordance with the 
        formula specified in subsection (l) of section 110 in the 
        manner provided for in such subsection.
            ``(3) Cancellation upon death of recipient.--Upon the death 
        of an individual who receives an Indian Health Scholarship, any 
        outstanding obligation of that individual for service or 
        payment that relates to that scholarship shall be canceled.
            ``(4) Information.--The Secretary may carry out this 
        subsection on the basis of information received from Tribal 
        Health Programs involved or on the basis of information 
        collected through such other means as the Secretary deems 
        appropriate.
    ``(f) Relation to Social Security Act.--The recipient of a 
scholarship under this section shall agree, in providing health care 
pursuant to the requirements herein--
            ``(1) not to discriminate against an individual seeking 
        care on the basis of the ability of the individual to pay for 
        such care or on the basis that payment for such care will be 
        made pursuant to a program established in title XVIII of the 
        Social Security Act or pursuant to the programs established in 
        title XIX or title XXI of such Act; and
            ``(2) to accept assignment under section 1842(b)(3)(B)(ii) 
        of the Social Security Act for all services for which payment 
        may be made under part B of title XVIII of such Act, and to 
        enter into an appropriate agreement with the State agency that 
        administers the State plan for medical assistance under title 
        XIX, or the State child health plan under title XXI, of such 
        Act to provide service to individuals entitled to medical 
        assistance or child health assistance, respectively, under the 
        plan.
    ``(g) Continuance of Funding.--The Secretary shall make payments 
under this section to a Tribal Health Program for any fiscal year 
subsequent to the first fiscal year of such payments unless the 
Secretary determines that, for the immediately preceding fiscal year, 
the Tribal Health Program has not complied with the requirements of 
this section.

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

    ``(a) Employment Preference.--Any individual who receives a 
scholarship pursuant to sections 104 or 106 shall be given preference 
for employment in the Service, or may be employed by a Tribal Health 
Program or an Urban Indian Organization, or other agencies of the 
Department as available, during any nonacademic period of the year.
    ``(b) Not Counted Toward Active Duty Service Obligation.--Periods 
of employment pursuant to this subsection shall not be counted in 
determining fulfillment of the service obligation incurred as a 
condition of the scholarship.
    ``(c) Timing; Length of Employment.--Any individual enrolled in a 
program, including a high school program, authorized under section 
102(a) may be employed by the Service or by a Tribal Health Program or 
an Urban Indian Organization during any nonacademic period of the year. 
Any such employment shall not exceed 120 days during any calendar year.
    ``(d) Nonapplicability of Competitive Personnel System.--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 community 
health representatives and emergency medical technicians, to join or 
continue in an Indian Health Program or an Urban Indian Organization 
and to provide their services in the rural and remote areas where a 
significant portion of Indians reside, the Secretary, acting through 
the Service Area, may provide allowances to health professionals 
employed in an Indian Health Program or an Urban Indian Organization to 
enable them for a period of time each year prescribed by regulation of 
the Secretary to take leave of their duty stations for professional 
consultation and refresher training courses.

``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.

    ``(a) In General.--Under the authority of the Act of November 2, 
1921 (25 U.S.C. 13; popularly known as the Snyder Act), the Secretary, 
acting through the Service, shall maintain a Community Health 
Representative Program under which Indian Health Programs--
            ``(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) Duties.--The Community Health Representative Program of the 
Service, shall--
            ``(1) provide a high standard of training for community 
        health representatives to ensure that the community health 
        representatives provide quality health care, health promotion, 
        and disease prevention services to the Indian communities 
        served by the Program;
            ``(2) in order to provide such training, develop and 
        maintain a curriculum that--
                    ``(A) combines education in the theory of health 
                care with supervised practical experience in the 
                provision of health care; and
                    ``(B) provides instruction and practical experience 
                in health promotion and disease prevention activities, 
                with appropriate consideration given to lifestyle 
                factors that have an impact on Indian health status, 
                such as alcoholism, family dysfunction, and poverty;
            ``(3) maintain a system which identifies the needs of 
        community health representatives for continuing education in 
        health care, health promotion, and disease prevention and 
        develop programs that meet the needs for continuing education;
            ``(4) maintain a system that provides close supervision of 
        Community Health Representatives;
            ``(5) maintain a system under which the work of 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.--The Secretary, acting through the Service, 
shall establish and administer a program to be known as the Service 
Loan Repayment Program (hereinafter referred to as the `Loan Repayment 
Program') in order to ensure an adequate supply of trained health 
professionals necessary to maintain accreditation of, and provide 
health care services to Indians through, Indian Health Programs and 
Urban Indian Organizations.
    ``(b) Eligible Individuals.--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 educational institution (as determined by 
                the Secretary under section 338B(b)(1)(c)(i) of the 
                Public Health Service Act (42 U.S.C. 254l-
                1(b)(1)(c)(i))) and be scheduled to complete such 
                course of study in the same year such individual 
                applies to participate in such program; or
                    ``(ii) in an approved graduate training program in 
                a health profession; or
            ``(B) have--
                    ``(i) a degree in a health profession; and
                    ``(ii) a license to practice a health profession;
            ``(2)(A) be eligible for, or hold, an appointment as a 
        commissioned officer in the Regular or Reserve Corps of the 
        Public Health Service;
            ``(B) be eligible for selection for civilian service in the 
        Regular or Reserve Corps of the Public Health Service;
            ``(C) meet the professional standards for civil service 
        employment in the Service; or
            ``(D) be employed in an Indian Health Program or Urban 
        Indian Organization without a service obligation; and
            ``(3) submit to the Secretary an application for a contract 
        described in subsection (e).
    ``(c) Application.--
            ``(1) Information to be included with forms.--In 
        disseminating application forms and contract forms to 
        individuals desiring to participate in the Loan Repayment 
        Program, the Secretary shall include with such forms a fair 
        summary of the rights and liabilities of an individual whose 
        application is approved (and whose contract is accepted) by the 
        Secretary, including in the summary a clear explanation of the 
        damages to which the United States is entitled under subsection 
        (l) in the case of the individual's breach of contract. The 
        Secretary shall provide such individuals with sufficient 
        information regarding the advantages and disadvantages of 
        service as a commissioned officer in the Regular or Reserve 
        Corps of the Public Health Service or a civilian employee of 
        the Service to enable the individual to make a decision on an 
        informed basis.
            ``(2) Clear language.--The application form, contract form, 
        and all other information furnished by the Secretary under this 
        section shall be written in a manner calculated to be 
        understood by the average individual applying to participate in 
        the Loan Repayment Program.
            ``(3) Timely availability of forms.--The Secretary shall 
        make such application forms, contract forms, and other 
        information available to individuals desiring to participate in 
        the Loan Repayment Program on a date sufficiently early to 
        ensure that such individuals have adequate time to carefully 
        review and evaluate such forms and information.
    ``(d) Priorities.--
            ``(1) List.--Consistent with subsection (k), the Secretary 
        shall annually--
                    ``(A) identify the positions in each Indian Health 
                Program or Urban Indian Organization for which there is 
                a need or a vacancy; and
                    ``(B) rank those positions in order of priority.
            ``(2) Approvals.--Notwithstanding the priority determined 
        under paragraph (1), the Secretary, in determining which 
        applications under the Loan Repayment Program to approve (and 
        which contracts to accept), shall--
                    ``(A) give first priority to applications made by 
                individual Indians; and
                    ``(B) after making determinations on all 
                applications submitted by individual Indians as 
                required under subparagraph (A), give priority to--
                            ``(i) individuals recruited through the 
                        efforts of a Tribal Health Program or Urban 
                        Indian Organization; and
                            ``(ii) other individuals based on the 
                        priority rankings under paragraph (1).
    ``(e) Recipient Contracts.--
            ``(1) Contract required.--An individual becomes a 
        participant in the Loan Repayment Program only upon the 
        Secretary and the individual entering into a written contract 
        described in paragraph (2).
            ``(2) Contents of contract.--The written contract referred 
        to in this section between the Secretary and an individual 
        shall contain--
                    ``(A) an agreement under which--
                            ``(i) subject to subparagraph (C), 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 Tribal Health 
                                Program or Urban Indian Organization as 
                                provided in clause (ii)(III); and
                            ``(ii) subject to subparagraph (C), 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)--
                                            ``(aa) 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
                                            ``(bb) while enrolled in 
                                        such course of study or 
                                        training, to maintain an 
                                        acceptable level of academic 
                                        standing (as determined under 
                                        regulations of the Secretary by 
                                        the educational institution 
                                        offering such course of study 
                                        or training); and
                                    ``(III) to serve for a time period 
                                (hereinafter in this section referred 
                                to as the `period of obligated 
                                service') equal to 2 years or such 
                                longer period as the individual may 
                                agree to serve in the full-time 
                                clinical practice of such individual's 
                                profession in an Indian Health Program 
                                or Urban Indian Organization to which 
                                the individual may be assigned by the 
                                Secretary;
                    ``(B) a provision permitting the Secretary to 
                extend for such longer additional periods, as the 
                individual may agree to, the period of obligated 
                service agreed to by the individual under subparagraph 
                (A)(ii)(III);
                    ``(C) a provision that any financial obligation of 
                the United States arising out of a contract entered 
                into under this section and any obligation of the 
                individual which is conditioned thereon is contingent 
                upon funds being appropriated for loan repayments under 
                this section;
                    ``(D) a statement of the damages to which the 
                United States is entitled under subsection (l) for the 
                individual's breach of the contract; and
                    ``(E) such other statements of the rights and 
                liabilities of the Secretary and of the individual, not 
                inconsistent with this section.
    ``(f) Deadline for Decision on Application.--The Secretary shall 
provide written notice to an individual within 21 days on--
            ``(1) the Secretary's approving, under subsection (e)(1), 
        of the individual's participation in the Loan Repayment 
        Program, including extensions resulting in an aggregate period 
        of obligated service in excess of 4 years; or
            ``(2) the Secretary's disapproving an individual's 
        participation in such Program.
    ``(g) Payments.--
            ``(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.--For each year of obligated service that an 
        individual contracts to serve under subsection (e), the 
        Secretary may pay up to $35,000 or an amount equal to the 
        amount specified in section 338B(g)(2)(A) of the Public Health 
        Service Act, whichever is more, on behalf of the individual for 
        loans described in paragraph (1). In making a determination of 
        the amount to pay for a year of such service by an individual, 
        the Secretary shall consider the extent to which each such 
        determination--
                    ``(A) affects the ability of the Secretary to 
                maximize the number of contracts that can be provided 
                under the Loan Repayment Program from the amounts 
                appropriated for such contracts;
                    ``(B) provides an incentive to serve in Indian 
                Health Programs and Urban Indian Organizations with the 
                greatest shortages of health professionals; and
                    ``(C) provides an incentive with respect to the 
                health professional involved remaining in an Indian 
                Health Program or Urban Indian Organization with such a 
                health professional shortage, and continuing to provide 
                primary health services, after the completion of the 
                period of obligated service under the Loan Repayment 
                Program.
            ``(3) Timing.--Any arrangement made by the Secretary for 
        the making of loan repayments in accordance with this 
        subsection shall provide that any repayments for a year of 
        obligated service shall be made no later than the end of the 
        fiscal year in which the individual completes such year of 
        service.
            ``(4) Payment schedule.--The Secretary may enter into an 
        agreement with the holder of any loan for which payments are 
        made under the Loan Repayment Program to establish a schedule 
        for the making of such payments.
    ``(h) Employment Ceiling.--Notwithstanding any other provision of 
law, individuals who have entered into written contracts with the 
Secretary under this section shall not be counted against any 
employment ceiling affecting the Department while those individuals are 
undergoing academic training.
    ``(i) Recruitment.--The Secretary shall conduct recruiting programs 
for the Loan Repayment Program and other Service manpower programs of 
the Service at educational institutions training health professionals 
or specialists identified in subsection (a).
    ``(j) Applicability of Law.--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 or Urban Indian 
Organizations pursuant to contracts entered into under this section, 
shall--
            ``(1) ensure that the staffing needs of Tribal Health 
        Programs and Urban Indian Organizations 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 and Urban Indian Organizations that have a need 
        for health professionals to provide health care services as a 
        result of individuals having breached contracts entered into 
        under this section.
    ``(l) Breach of Contract.--
            ``(1) Specific breaches.--An individual who has entered 
        into a written contract with the Secretary under this section 
        and has not received a waiver under subsection (m) shall be 
        liable, in lieu of any service obligation arising under such 
        contract, to the United States for the amount which has been 
        paid on such individual's behalf under the contract if that 
        individual--
                    ``(A) is enrolled in the final year of a course of 
                study and--
                            ``(i) fails to maintain an acceptable level 
                        of academic standing in the educational 
                        institution in which he or she is enrolled 
                        (such level determined by the educational 
                        institution under regulations of the 
                        Secretary);
                            ``(ii) voluntarily terminates such 
                        enrollment; or
                            ``(iii) is dismissed from such educational 
                        institution before completion of such course of 
                        study; or
                    ``(B) is enrolled in a graduate training program 
                and fails to complete such training program.
            ``(2) Other breaches; formula for amount owed.--If, for any 
        reason not specified in paragraph (1), an individual breaches 
        his or her written contract under this section by failing 
        either to begin, or complete, such individual's period of 
        obligated service in accordance with subsection (e)(2), the 
        United States shall be entitled to recover from such individual 
        an amount to be determined in accordance with the following 
        formula: A=3Z(t-s/t) in which--
                    ``(A) `A' is the amount the United States is 
                entitled to recover;
                    ``(B) `Z' is the sum of the amounts paid under this 
                section to, or on behalf of, the individual and the 
                interest on such amounts which would be payable if, at 
                the time the amounts were paid, they were loans bearing 
                interest at the maximum legal prevailing rate, as 
                determined by the Secretary of the Treasury;
                    ``(C) `t' is the total number of months in the 
                individual's period of obligated service in accordance 
                with subsection (f); and
                    ``(D) `s' is the number of months of such period 
                served by such individual in accordance with this 
                section.
            ``(3) Deductions in medicare payments.--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.
            ``(4) Time period for repayment.--Any amount of damages 
        which the United States is entitled to recover under this 
        subsection shall be paid to the United States within the 1-year 
        period beginning on the date of the breach or such longer 
        period beginning on such date as shall be specified by the 
        Secretary.
            ``(5) Recovery of delinquency.--
                    ``(A) In general.--If damages described in 
                paragraph (4) are delinquent for 3 months, the 
                Secretary shall, for the purpose of recovering such 
                damages--
                            ``(i) use collection agencies contracted 
                        with by the Administrator of General Services; 
                        or
                            ``(ii) enter into contracts for the 
                        recovery of such damages with collection 
                        agencies selected by the Secretary.
                    ``(B) Report.--Each contract for recovering damages 
                pursuant to this subsection shall provide that the 
                contractor will, not less than once each 6 months, 
                submit to the Secretary a status report on the success 
                of the contractor in collecting such damages. Section 
                3718 of title 31, United States Code, shall apply to 
                any such contract to the extent not inconsistent with 
                this subsection.
    ``(m) Waiver or Suspension of Obligation.--
            ``(1) In general.--The Secretary shall by regulation 
        provide for the partial or total waiver or suspension of any 
        obligation of service or payment by an individual under the 
        Loan Repayment Program whenever compliance by the individual is 
        impossible or would involve extreme hardship to the individual 
        and if enforcement of such obligation with respect to any 
        individual would be unconscionable.
            ``(2) Canceled upon death.--Any obligation of an individual 
        under the Loan Repayment Program for service or payment of 
        damages shall be canceled upon the death of the individual.
            ``(3) Hardship waiver.--The Secretary may waive, in whole 
        or in part, the rights of the United States to recover amounts 
        under this section in any case of extreme hardship or other 
        good cause shown, as determined by the Secretary.
            ``(4) Bankruptcy.--Any obligation of an individual under 
        the Loan Repayment Program for payment of damages may be 
        released by a discharge in bankruptcy under 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 Congress under 
section 801, a report concerning the previous fiscal year which sets 
forth by Service Area the following:
            ``(1) A list of the health professional positions 
        maintained by Indian Health Programs and Urban Indian 
        Organizations 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 (e) 
        that are entered into with respect to each health profession.
            ``(4) The amount of loan payments made under this section, 
        in total and by health profession.
            ``(5) The number of scholarships that are provided under 
        section 104 and 106 with respect to each health profession.
            ``(6) The amount of scholarship grants provided under 
        section 104 and 106, in total and by health profession.
            ``(7) The number of providers of health care that will be 
        needed by Indian Health Programs and Urban Indian 
        Organizations, by location and profession, during the 3 fiscal 
        years beginning after the date the report is filed.
            ``(8) The measures the Secretary plans to take to fill the 
        health professional positions maintained by Indian Health 
        Programs or Urban Indian Organizations for which recruitment or 
        retention is difficult.

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

    ``(a) Establishment.--There is established in the Treasury of the 
United States a fund to be known as the Indian Health Scholarship and 
Loan Repayment Recovery Fund (hereafter in this section referred to as 
the `LRRF'). The LRRF shall consist of such amounts as may be collected 
from individuals under section 104(d), section 106(e), and section 
110(l) for breach of contract, such funds as may be appropriated to the 
LRRF, and interest earned on amounts in the LRRF. All amounts 
collected, appropriated, or earned relative to the LRRF shall remain 
available until expended.
    ``(b) Use of Funds.--
            ``(1) By secretary.--Amounts in the LRRF may be expended by 
        the Secretary, acting through the Service, to make payments to 
        an Indian Health Program--
                    ``(A) to which a scholarship recipient under 
                section 104 and 106 or a loan repayment program 
                participant under section 110 has been assigned to meet 
                the obligated service requirements pursuant to such 
                sections; and
                    ``(B) that has a need for a health professional to 
                provide health care services as a result of such 
                recipient or participant having breached the contract 
                entered into under section 104, 106, or section 110.
            ``(2) By tribal health programs.--A Tribal Health Program 
        receiving payments pursuant to paragraph (1) may expend the 
        payments to provide scholarships or recruit and employ, 
        directly or by contract, health professionals to provide health 
        care services.
    ``(c) Investment of Funds.--The Secretary of the Treasury shall 
invest such amounts of the LRRF as the Secretary of Health and Human 
Services 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.
    ``(d) Sale of Obligations.--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 for Travel.--The Secretary, acting through the 
Service, may reimburse health professionals seeking positions with 
Indian Health Programs 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) Recruitment 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. INDIAN RECRUITMENT AND RETENTION PROGRAM.

    ``(a) In General.--The Secretary, acting through the Service, shall 
fund innovative demonstration projects for a period not to exceed 3 
years to enable Tribal Health Programs and Urban Indian Organizations 
to recruit, place, and retain health professionals to meet their 
staffing needs.
    ``(b) Eligible Entities; Application.--Any Tribal Health Program 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 Program.--The Secretary, acting through the 
Service, shall establish a demonstration project to enable health 
professionals who have worked in an Indian Health Program or Urban 
Indian Organization for a substantial period of time to pursue advanced 
training or research areas of study for which the Secretary determines 
a need exists.
    ``(b) Service Obligation.--An individual who participates in a 
program under subsection (a), where the educational costs are borne by 
the Service, shall incur an obligation to serve in an Indian Health 
Program or Urban Indian Organization for a period of obligated service 
equal to at least the period of time during which the individual 
participates in such program. In the event that the individual fails to 
complete such obligated service, the individual shall be liable to the 
United States for the period of service remaining. In such event, with 
respect to individuals entering the program after the date of the 
enactment of the Indian Health Care Improvement Act Amendments of 2003, 
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) Equal Opportunity for Participation.--Health professionals 
from Tribal Health Programs and Urban Indian Organizations shall be 
given an equal opportunity to participate in the program under 
subsection (a).

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

    ``(a) Grants Authorized.--For the purpose of increasing the number 
of nurses, nurse midwives, and nurse practitioners who deliver health 
care services to Indians, the Secretary, acting through the Service, 
shall provide grants to the following:
            ``(1) Public or private schools of nursing.
            ``(2) Tribal colleges or universities.
            ``(3) Nurse midwife programs and advanced practice nurse 
        programs that are provided by any tribal college or university 
        accredited nursing program, or in the absence of such, any 
        other public or private institutions.
    ``(b) Use of Grants.--Grants provided under subsection (a) may be 
used for one or more of the following:
            ``(1) To recruit individuals for programs which train 
        individuals to be nurses, nurse midwives, or advanced practice 
        nurses.
            ``(2) To provide scholarships to Indians enrolled in such 
        programs that may pay the tuition charged for such program and 
        other expenses incurred in connection with such program, 
        including books, fees, room and board, and stipends for living 
        expenses.
            ``(3) To provide a program that encourages nurses, nurse 
        midwives, and advanced practice nurses to provide, or continue 
        to provide, health care services to Indians.
            ``(4) To provide a program that increases the skills of, 
        and provides continuing education to, nurses, nurse midwives, 
        and advanced practice nurses.
            ``(5) To provide any program that is designed to achieve 
        the purpose described in subsection (a).
    ``(c) Applications.--Each application for funding under subsection 
(a) shall include such information as the Secretary may require to 
establish the connection between the program of the applicant and a 
health care facility that primarily serves Indians.
    ``(d) Preferences for Grant Recipients.--In providing grants under 
subsection (a), the Secretary shall extend a preference to the 
following:
            ``(1) Programs that provide a preference to Indians.
            ``(2) Programs that train nurse midwives or advanced 
        practice nurses.
            ``(3) Programs that are interdisciplinary.
            ``(4) Programs that are conducted in cooperation with a 
        program for gifted and talented Indian students.
    ``(e) Quentin N. Burdick Program Grant.--The Secretary shall 
provide one of the grants authorized under subsection (a) to establish 
and maintain a program at the University of North Dakota to be known as 
the `Quentin N. Burdick American Indians Into Nursing Program'. Such 
program shall, to the maximum extent feasible, coordinate with the 
Quentin N. Burdick Indian Health Programs established under section 
117(b) and the Quentin N. Burdick American Indians Into Psychology 
Program established under section 105(b).
    ``(f) Active Duty 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 by a grant provided under subsection (a). Such 
obligation shall be met by service--
            ``(1) in the Service;
            ``(2) in a program of an Indian Tribe or Tribal 
        Organization conducted under the Indian Self-Determination Act 
        (including programs under agreements with the Bureau of Indian 
        Affairs);
            ``(3) in a program assisted under title V of this Act; 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 shortage area and addresses the health care needs 
        of a substantial number of Indians.

``SEC. 116. TRIBAL CULTURAL ORIENTATION.

    ``(a) Cultural Education of Employees.--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 Indian 
Tribes and their relationship to the Service.
    ``(b) Program.--In carrying out subsection (a), the Secretary shall 
establish a program which shall, to the extent feasible--
            ``(1) be developed in consultation with the affected Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations;
            ``(2) be carried out through tribal colleges or 
        universities;
            ``(3) include instruction in American Indian studies; and
            ``(4) describe the use and place of Traditional Health Care 
        Practices of the Indian Tribes in the Service Area.

``SEC. 117. INMED PROGRAM.

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

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

    ``(a) Grants To Establish Programs.--
            ``(1) In general.--The Secretary, acting through the 
        Service, shall award grants to accredited and accessible 
        community colleges for the purpose of assisting such community 
        colleges in the establishment of programs which provide 
        education in a health profession leading to a degree or diploma 
        in a health profession for individuals who desire to practice 
        such profession on or near a reservation or in an Indian Health 
        Program.
            ``(2) Amount of grants.--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) Grants for Maintenance and Recruiting.--
            ``(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) Requirements.--Grants may only be made under this 
        section to a community college which--
                    ``(A) is accredited;
                    ``(B) has a relationship with a hospital facility, 
                Service facility, or hospital that could provide 
                training of nurses or health professionals;
                    ``(C) has entered into an agreement with an 
                accredited college or university medical school, the 
                terms of which--
                            ``(i) provide a program that enhances the 
                        transition and recruitment of students into 
                        advanced baccalaureate or graduate programs 
                        which train health professionals; and
                            ``(ii) stipulate certifications necessary 
                        to approve internship and field placement 
                        opportunities at Indian 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) 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) Advanced Training.--
            ``(1) Required.--Any program receiving assistance under 
        this section that is conducted with respect to a health 
        profession shall also offer courses of study which provide 
advanced training for any health professional who--
                    ``(A) has already received a degree or diploma in 
                such health profession; and
                    ``(B) provides clinical services on or near a 
                reservation or for an Indian Health Program.
            ``(2) May be offered at alternate site.--Such courses of 
        study may be offered in conjunction with the college or 
        university with which the community college has entered into 
        the agreement required under subsection (b)(2)(C).
    ``(e) Funding Priority.--Where the requirements of subsection (b) 
are met, funding priority shall be provided to tribal colleges and 
universities in Service Areas where they exist.

``SEC. 119. RETENTION BONUS.

    ``(a) Bonus Authorized.--The Secretary may pay a retention bonus to 
any health professional employed by, or assigned to, and serving in, an 
Indian Health Program or 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 Indian Health 
        Programs and Urban Indian Organizations;
            ``(3) has--
                    ``(A) completed 3 years of employment with an 
                Indian Health Program or Urban Indian Organization; or
                    ``(B) completed any service obligations incurred as 
                a requirement of--
                            ``(i) any Federal scholarship program; or
                            ``(ii) any Federal education loan repayment 
                        program; and
            ``(4) enters into an agreement with an Indian Health 
        Program 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) Default of Retention Agreement.--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) Other Retention Bonus.--The Secretary may pay a retention 
bonus to any health professional employed by a Tribal Health Program 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 of Program.--The Secretary, acting through the 
Service, shall establish a program to enable Indians who are licensed 
practical nurses, licensed vocational nurses, and registered nurses who 
are working in an Indian Health Program or Urban Indian Organization, 
and have done so for a period of not less than 1 year, to pursue 
advanced training. Such program shall include a combination of 
education and work study in an Indian Health Program or Urban Indian 
Organization leading to an associate or bachelor's degree (in the case 
of a licensed practical nurse or licensed vocational nurse), a 
bachelor's degree (in the case of a registered nurse), or advanced 
degrees in nursing and public health.
    ``(b) 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 or Urban Indian Organization 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) General Purposes of Program.--Under the authority of the Act 
of November 2, 1921 (25 U.S.C. 13; popularly known as the Snyder Act), 
the Secretary, acting through the Service, shall develop and operate a 
Community Health Aide Program in Alaska under which the Service--
            ``(1) provides for the training of Alaska Natives as health 
        aides or community health practitioners;
            ``(2) uses such aides or practitioners in the provision of 
        health care, health promotion, and disease prevention services 
        to Alaska Natives living in villages in rural Alaska; and
            ``(3) provides for the establishment of teleconferencing 
        capacity in health clinics located in or near such villages for 
        use by community health aides or community health 
        practitioners.
    ``(b) Specific Program Requirements.--The Secretary, acting through 
the Community Health Aide Program of the Service, shall--
            ``(1) using trainers accredited by the Program, provide a 
        high standard of training to community health aides and 
        community health practitioners to ensure that such aides and 
        practitioners provide quality health care, health promotion, 
        and disease prevention services to the villages served by the 
        Program;
            ``(2) in order to provide such training, develop a 
        curriculum that--
                    ``(A) combines education in the theory of health 
                care with supervised practical experience in the 
                provision of health care;
                    ``(B) provides instruction and practical experience 
                in the provision of acute care, emergency care, health 
                promotion, disease prevention, and the efficient and 
                effective management of clinic pharmacies, supplies, 
                equipment, and facilities; and
                    ``(C) promotes the achievement of the health status 
                objectives specified in section 3(2);
            ``(3) establish and maintain a Community Health Aide 
        Certification Board to certify as community health aides or 
        community health practitioners individuals who have 
        successfully completed the training described in paragraph (1) 
        or can demonstrate equivalent experience;
            ``(4) develop and maintain a system which identifies the 
        needs of community health aides and community health 
        practitioners for continuing education in the provision of 
        health care, including the areas described in paragraph (2)(B), 
        and develop programs that meet the needs for such continuing 
        education;
            ``(5) develop and maintain a system that provides close 
        supervision of community health aides and community health 
        practitioners; and
            ``(6) develop a system under which the work of community 
        health aides and community health practitioners is reviewed and 
        evaluated to assure the provision of quality health care, 
        health promotion, and disease prevention services.
    ``(c) National Community Health Aide Program.--The Secretary, 
acting through the Service, shall develop and operate a national 
Community Health Aide Program consistent with the requirements of this 
section without reducing funds for the Community Health Aide Program 
for Alaska.

``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.

    ``The Secretary, acting through the Service, shall, by funding 
agreement or otherwise, provide training for Indians in the 
administration and planning of Tribal Health Programs.

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

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

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

    ``Scholarships provided to individuals pursuant to this title shall 
be deemed `qualified Scholarships' for purposes of section 11 of the 
Internal Revenue Code of 1986.

``SEC. 125. NATIONAL HEALTH SERVICE CORPS.

    ``(a) No Reduction in Services.--The Secretary shall not--
            ``(1) remove a member of the National Health Service Corps 
        from an Indian Health Program or Urban Indian Organization; or
            ``(2) withdraw funding used to support such member, unless 
        the Secretary, acting through the Service, Indian Tribes, or 
        Tribal Organizations, has ensured that the Indians receiving 
        services from such member will experience no reduction in 
        services.
    ``(b) Exemption From Limitations.--National Health Service Corps 
scholars qualifying for the Commissioned Corps in the United States 
Public Health Service shall be exempt from the full-time equivalent 
limitations of the National Health Service Corps and the Service when 
serving as a commissioned corps officer in a Tribal Health Program or 
an Urban Indian Organization.

``SEC. 126. SUBSTANCE ABUSE COUNSELOR EDUCATIONAL CURRICULA 
              DEMONSTRATION PROGRAMS.

    ``(a) Grants and Contracts.--The Secretary, acting through the 
Service, may enter into contracts with, or make grants to, accredited 
tribal colleges and universities and eligible accredited and accessible 
community colleges to establish demonstration programs to develop 
educational curricula for substance abuse counseling.
    ``(b) Use of Funds.--Funds provided under this section shall be 
used only for developing and providing educational curriculum for 
substance abuse counseling (including paying salaries for instructors). 
Such curricula may be provided through satellite campus programs.
    ``(c) Time Period of Assistance; Renewal.--A contract entered into 
or a grant provided under this section shall be for a period of 1 year. 
Such contract or grant may be renewed for an additional 1-year period 
upon the approval of the Secretary.
    ``(d) Criteria for Review and Approval of Applications.--Not later 
than 180 days after the date of the enactment of the Indian Health Care 
Improvement Act Amendments of 2003, the Secretary, after consultation 
with Indian Tribes and administrators of tribal colleges and 
universities and eligible accredited and accessible community colleges, 
shall develop and issue criteria for the review and approval of 
applications for funding (including applications for renewals of 
funding) under this section. Such criteria shall ensure that 
demonstration programs established under this section promote the 
development of the capacity of such entities to educate substance abuse 
counselors.
    ``(e) Assistance.--The Secretary shall provide such technical and 
other assistance as may be necessary to enable grant recipients to 
comply with the provisions of this section.
    ``(f) Report.--Each fiscal year, the Secretary shall submit to the 
President, for inclusion in the report which is required to be 
submitted under section 801 for that fiscal year, a report on the 
findings and conclusions derived from the demonstration programs 
conducted under this section during that fiscal year.
    ``(g) Definition.--For the purposes of this section the term 
`educational curriculum' means 1 or more of the following--
            ``(1) classroom education;
            ``(2) clinical work experience; and
            ``(3) continuing education workshops.

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

    ``(a) Study; List.--The Secretary, acting through the Service, and 
the Secretary of the Interior, in consultation with Indian Tribes and 
Tribal Organizations, shall conduct a study and compile a list of the 
types of staff positions specified in subsection (b) whose 
qualifications include, or should include, training in the 
identification, prevention, education, referral, or treatment of mental 
illness, or dysfunctional and self destructive behavior.
    ``(b) Positions.--The positions referred to in subsection (a) are--
            ``(1) staff positions within the Bureau of Indian Affairs, 
        including existing positions, in the fields of--
                    ``(A) elementary and secondary education;
                    ``(B) social services and family and child welfare;
                    ``(C) law enforcement and judicial services; and
                    ``(D) alcohol and substance abuse;
            ``(2) staff positions within the Service; and
            ``(3) staff positions similar to those identified in 
        paragraphs (1) and (2) established and maintained by Indian 
        Tribes, Tribal Organizations, (without regard to the funding 
        source) and Urban Indian Organizations.
    ``(c) Training Criteria.--
            ``(1) In general.--The appropriate Secretary shall provide 
        training criteria appropriate to each type of position 
        identified in subsection (b)(1) and (b)(2) and ensure that 
        appropriate training has been, or shall be provided to any 
        individual in any such position. With respect to any such 
        individual in a position identified pursuant to subsection 
        (b)(3), the respective Secretaries shall provide appropriate 
        training to, or provide funds to, an Indian Tribe, Tribal 
        Organization, or Urban Indian Organization for training of 
        appropriate individuals. In the case of positions funded under 
        a funding agreement, the appropriate Secretary shall ensure 
        that funds to cover the costs of such training costs are 
        included in the funding agreement.
            ``(2) Position specific training criteria.--Position 
        specific training criteria shall be culturally relevant to 
        Indians and Indian Tribes and shall ensure that appropriate 
        information regarding Traditional Health Care Practices is 
        provided.
    ``(d) Community Education on Mental Illness.--The Service shall 
develop and implement, on request of an Indian Tribe or Tribal 
Organization, or assist the Indian Tribe or Tribal Organization to 
develop and implement a program of community education on mental 
illness. In carrying out this subsection, the Service shall, upon 
request of an Indian Tribe or Tribal Organization, provide technical 
assistance to the Indian Tribe or Tribal Organization to obtain and 
develop community educational materials on the identification, 
prevention, referral, and treatment of mental illness and dysfunctional 
and self-destructive behavior.
    ``(e) Plan.--Not later than 90 days after the date of the enactment 
of the Indian Health Care Improvement Act Amendments of 2003, the 
Secretary shall develop a plan under which the Service will increase 
the health care staff providing mental health services by at least 500 
positions within 5 years after the date of the enactment of this 
section, with at least 200 of such positions devoted to child, 
adolescent, and family services. The plan developed under this 
subsection shall be implemented under the Act of November 2, 1921 (25 
U.S.C. 13, popularly known as the Snyder Act).

``SEC. 128. DESIGNATION OF SHORTAGE AREAS.

    ``A Service Area served by an Indian Health Program or Urban Indian 
Organization shall be designated under the Public Health Services Act 
(42 U.S.C. 250 et seq.) as a shortage area immediately upon request of 
an Indian Health Program without further evaluation by the Secretary.

``SEC. 129. AUTHORIZATION OF APPROPRIATIONS.

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

                      ``TITLE II--HEALTH SERVICES

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

    ``(a) Use of Funds.--The Secretary, acting through the Service, is 
authorized to expend funds, directly or under the authority of the 
Indian Self-Determination and Education Assistance Act, which are 
appropriated under the authority of this section, for the purposes of--
            ``(1) eliminating the deficiencies in health status and 
        health resources of all Indian Tribes;
            ``(2) eliminating backlogs in the provision of health care 
        services to Indians;
            ``(3) meeting the health needs of Indians in an efficient 
        and equitable manner;
            ``(4) eliminating inequities in funding for both direct 
        care and contract health service programs; and
            ``(5) augmenting the ability of the Service to meet the 
        following health service responsibilities with respect to those 
        Indian Tribes with the highest levels of health status 
        deficiencies and resource deficiencies:
                    ``(A) Clinical care, including, but not limited to, 
                inpatient care, outpatient care (including audiology, 
                clinical eye, and vision care), primary care, secondary 
                and tertiary care, and long-term care.
                    ``(B) Preventive health, including mammography and 
                other cancer screening in accordance with section 207.
                    ``(C) Dental care.
                    ``(D) Mental health, including community mental 
                health services, inpatient mental health services, 
                dormitory mental health services, therapeutic and 
                residential treatment centers, and training of 
                traditional health care practitioners.
                    ``(E) Emergency medical services.
                    ``(F) Treatment and control of, and rehabilitative 
                care related to, alcoholism and drug abuse (including 
                fetal alcohol syndrome) among Indians.
                    ``(G) Accident prevention programs.
                    ``(H) Home health care.
                    ``(I) Community health representatives.
                    ``(J) Maintenance and repair.
                    ``(K) Traditional Health Care Practices.
    ``(b) No Offset or 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 or the Act of 
November 2, 1921 (25 U.S.C. 13, popularly known as the Snyder Act), or 
any other provision of law.
    ``(c) Allocation; Use.--
            ``(1) In general.--Funds appropriated under the authority 
        of this section shall be allocated to Service Units, Indian 
        Tribes, or Tribal Organizations. The funds allocated to each 
        Indian Tribe, Tribal Organization, or Service Unit under this 
        paragraph shall be used by the Indian Tribe, Tribal 
        Organization, or Service Unit under this paragraph to improve 
        the health status and reduce the resource deficiency of each 
        Indian Tribe served by such Service Unit, Indian Tribe, or 
        Tribal Organization.
            ``(2) Apportionment of allocated funds.--The apportionment 
        of funds allocated to a Service Unit, Indian Tribe, or Tribal 
        Organization under paragraph (1) among the health service 
        responsibilities described in subsection (a)(5) shall be 
        determined by the Service in consultation with, and with the 
        active participation of, the affected Indian Tribes and Tribal 
        Organizations.
    ``(d) Provisions Relating to Health Status and Resource 
Deficiencies.--For the purposes of this section, the following 
definitions apply:
            ``(1) Definition.--The term `health status and resource 
        deficiency' means the extent to which--
                    ``(A) the health status objectives set forth in 
                section 3(2) are not being achieved; and
                    ``(B) the Indian Tribe or Tribal Organization does 
                not have available to it the health resources it needs, 
                taking into account the actual cost of providing health 
                care services given local geographic, climatic, rural, 
                or other circumstances.
            ``(2) Available resources.--The health resources available 
        to an Indian Tribe or Tribal Organization include health 
        resources provided by the Service as well as health resources 
        used by the Indian Tribe or Tribal Organization, including 
        services and financing systems provided by any Federal 
        programs, private insurance, and programs of State or local 
        governments.
            ``(3) Process for review of determinations.--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 Indian Tribe or Tribal 
        Organization.
    ``(e) Eligibility for Funds.--Tribal Health Programs 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.
    ``(f) Report.--By no later than the date that is 3 years after the 
date of the enactment of the Indian Health Care Improvement Act 
Amendments of 2003, the Secretary shall submit to Congress the current 
health status and resource deficiency report of the Service for each 
Service Unit, including newly recognized or acknowledged Indian Tribes. 
Such report shall set out--
            ``(1) the methodology then in use by the Service for 
        determining Tribal health status and resource deficiencies, as 
        well as the most recent application of that methodology;
            ``(2) the extent of the health status and resource 
        deficiency of each Indian Tribe served by the Service or a 
        Tribal Health Program;
            ``(3) the amount of funds necessary to eliminate the health 
        status and resource deficiencies of all Indian Tribes served by 
        the Service or a Tribal Health Program; and
            ``(4) an estimate of--
                    ``(A) the amount of health service funds 
                appropriated under the authority of this Act, 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 Tribal Organization;
                    ``(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, 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.
    ``(g) Inclusion in Base Budget.--Funds appropriated under this 
section for any fiscal year shall be included in the base budget of the 
Service for the purpose of determining appropriations under this 
section in subsequent fiscal years.
    ``(h) Clarification.--Nothing in this section is intended to 
diminish the primary responsibility of the Service to eliminate 
existing backlogs in unmet health care needs, nor are the provisions of 
this section intended to discourage the Service from undertaking 
additional efforts to achieve equity among Indian Tribes and Tribal 
Organizations.
    ``(i) Funding 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.--There is hereby established an Indian 
Catastrophic Health Emergency Fund (hereafter in this section referred 
to as the `CHEF') consisting of--
            ``(1) the amounts deposited under subsection (f); and
            ``(2) the amounts appropriated to CHEF under this section.
    ``(b) Administration.--CHEF shall be administered by the Secretary, 
acting through the central office of the Service, solely for the 
purpose of meeting the extraordinary medical costs associated with the 
treatment of victims of disasters or catastrophic illnesses who are 
within the responsibility of the Service.
    ``(c) Conditions on Use of Fund.--No part of CHEF or its 
administration shall be subject to contract or grant under any law, 
including the Indian Self-Determination Act, nor shall CHEF funds be 
allocated, apportioned, or delegated on an Area Office, Service Unit, 
or other similar basis.
    ``(d) Regulations.--The Secretary shall, through the negotiated 
rulemaking process under title VIII, promulgate regulations consistent 
with the provisions of this section to--
            ``(1) establish a definition of disasters and catastrophic 
        illnesses for which the cost of the treatment provided under 
        contract would qualify for payment from CHEF;
            ``(2) provide that a Service Unit shall not be eligible for 
        reimbursement for the cost of treatment from CHEF until its 
        cost of treating any victim of such catastrophic illness or 
        disaster has reached a certain threshold cost which the 
        Secretary shall establish at--
                    ``(A) the 2000 level of $19,000; and
                    ``(B) for any subsequent year, not less than the 
                threshold cost of the previous year increased by the 
                percentage increase in the medical care expenditure 
                category of the consumer price index for all urban 
                consumers (United States city average) for the 12-month 
                period ending with December of the previous year; and
            ``(3) establish a procedure for the reimbursement of the 
        portion of the costs that exceeds such threshold cost incurred 
        by--
                    ``(A) Service Units; or
                    ``(B) whenever otherwise authorized by the Service, 
                non-Service facilities or providers;
            ``(4) establish a procedure for payment from CHEF in cases 
        in which the exigencies of the medical circumstances warrant 
        treatment prior to the authorization of such treatment by the 
        Service; and
            ``(5) establish a procedure that will ensure that no 
        payment shall be made from CHEF to any provider of treatment to 
        the extent that such provider is eligible to receive payment 
        for the treatment from any other Federal, State, local, or 
        private source of reimbursement for which the patient is 
        eligible.
    ``(e) No Offset or Limitation.--Amounts appropriated to CHEF under 
this section shall not be used to offset or limit appropriations made 
to the Service under the authority of the Act of November 2, 1921 (25 
U.S.C. 13, popularly known as the Snyder Act), or any other law.
    ``(f) Deposit of Reimbursement Funds.--There shall be deposited 
into CHEF all reimbursements to which the Service is entitled from any 
Federal, State, local, or private source (including third party 
insurance) by reason of treatment rendered to any victim of a disaster 
or catastrophic illness the cost of which was paid from CHEF.

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

    ``(a) Findings.--Congress finds that health promotion and disease 
prevention activities--
            ``(1) improve the health and well-being of Indians; and
            ``(2) reduce the expenses for health care of Indians.
    ``(b) Provision of Services.--The Secretary, acting through the 
Service and Tribal Health Programs, shall provide health promotion and 
disease prevention services to Indians to achieve the health status 
objectives set forth in section 3(2).
    ``(c) Evaluation.--The Secretary, after obtaining input from the 
affected Tribal Health Programs, shall submit to the President for 
inclusion in each report 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 and Tribal 
        Health Programs to meet such needs; and
            ``(4) the resources which would be required to enable the 
        Service and Tribal Health Programs to undertake the health 
        promotion and disease prevention activities necessary to meet 
        such needs.

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

    ``(a) Determinations Regarding Diabetes.--The Secretary, acting 
through the Service, and in consultation with Indian Tribes and Tribal 
Organizations, shall determine--
            ``(1) by an Indian Tribe, Tribal Organization, and by 
        Service Unit, the incidence of, and the types of complications 
        resulting from, diabetes among Indians; and
            ``(2) based on the determinations made pursuant to 
        paragraph (1), the measures (including patient education) each 
        Service Unit should take to reduce the incidence of, and 
        prevent, treat, and control the complications resulting from, 
        diabetes among Indian Tribes within that Service Unit.
    ``(b) Diabetes Screening.--To the extent medically indicated and 
with informed consent, the Secretary shall screen each Indian who 
receives services from the Service for diabetes and for conditions 
which indicate a high risk that the individual will become diabetic. 
Such screening may be done by a Tribal Health Program.
    ``(c) Funding for Diabetes.--The Secretary shall continue to fund 
each model diabetes project in existence on the date of the enactment 
of the Indian Health Amendments Care Improvement Act of 2003, any such 
other diabetes programs operated by the Service or Tribal Health 
Programs, and any additional diabetes projects. Tribal Health Programs 
shall receive recurring funding for the diabetes projects that they 
operate pursuant to this section, both at the date of enactment of the 
Indian Health Care Improvement Act Amendments of 2003 and for projects 
which are added and funded thereafter.
    ``(d) Funding for Dialysis Programs.--The Secretary shall provide 
funding through the Service, Indian Tribes, and Tribal Organizations to 
establish dialysis programs, including funding to purchase dialysis 
equipment and provide necessary staffing.
    ``(e) Other Duties of the Secretary.--The Secretary shall, to the 
extent funding is available--
            ``(1) in each Area Office, consult with Indian Tribes and 
        Tribal Organizations regarding programs for the prevention, 
        treatment, and control of diabetes;
            ``(2) establish in each Area Office a registry of patients 
        with diabetes to track the incidence of diabetes and the 
        complications from diabetes in that area; and
            ``(3) ensure that data collected in each Area Office 
        regarding diabetes and related complications among Indians is 
        disseminated to all other Area Offices.

``SEC. 205. SHARED SERVICES FOR LONG-TERM CARE.

    ``(a) Funding Agreements for Long-term Care.--Notwithstanding any 
other provisions of law, the Secretary, acting through the Service, 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 funding agreements or other 
arrangements shall provide for the sharing of staff or other services 
between the Service or a Tribal Health Program and a long-term care or 
other similar facility owned and operated (directly or through a 
Funding Agreement) by such Indian Tribe or Tribal Organization.
    ``(b) Contents of Funding Agreements.--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 Indian Tribe or Tribal 
        Organization such powers of supervision and control over 
        Service employees as the Secretary deems necessary to carry out 
        the purposes of this section;
            ``(2) shall provide that expenses (including salaries) 
        relating to services that are shared between the Service and 
        the Tribal Health Program be allocated proportionately between 
        the Service and the Indian Tribe or Tribal Organization; and
            ``(3) may authorize such Indian Tribe or Tribal 
        Organization to construct, renovate, or expand a long-term care 
        or other similar facility (including the construction of a 
        facility attached to a Service facility).
    ``(c) Minimum Requirement.--Any nursing facility provided for under 
this section shall meet the requirements for nursing facilities under 
section 1919 of the Social Security Act.
    ``(d) Other Assistance.--The Secretary shall provide such technical 
and other assistance as may be necessary to enable applicants to comply 
with the provisions of this section.
    ``(e) Use of Existing or Underused Facilities.--The Secretary shall 
encourage the use of existing facilities that are underused or allow 
the use of swing beds for long-term or similar care.

``SEC. 206. HEALTH SERVICES RESEARCH.

    ``The Secretary, acting through the Service, shall make funding 
available for research to further the performance of the health service 
responsibilities of Indian Health Programs and shall coordinate the 
activities of other agencies within the Department to address these 
research needs. The funding shall be divided equitably among the Area 
Offices. Then each Area Office shall award the funds competitively 
within that Area. The Secretary shall consult with Indian Tribes and 
Tribal Organizations in developing the methodology used to allocate 
these funds among Area Offices for competitive awards. Tribal Health 
Programs shall be given an equal opportunity to compete for, and 
receive, research funds under this section. This funding may be used 
for both clinical and nonclinical research.

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

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

``SEC. 208. PATIENT TRAVEL COSTS.

    ``The Secretary, acting through the Service and Tribal Health 
Programs, 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) under this Act--
            ``(1) emergency air transportation and non-emergency air 
        transportation where ground transportation is infeasible;
            ``(2) transportation by private vehicle, specially equipped 
        vehicle, and ambulance; and
            ``(3) transportation by such other means as may be 
        available and required when air or motor vehicle transportation 
        is not available.

``SEC. 209. EPIDEMIOLOGY CENTERS.

    ``(a) Additional Centers.--In addition to those epidemiology 
centers already established at the time of enactment of this Act, 
(including those for which funding is currently being provided in 
Funding Agreements), and without reducing the funding levels for such 
centers, not later than 180 days after the date of the enactment of the 
Indian Health Care Improvement Act Amendments of 2003, the Secretary, 
acting through the Service, shall establish and fund an epidemiology 
center in each Service Area which does not yet have one to carry out 
the functions described in subsection (b). Any new centers so 
established may be operated by Tribal Health Programs, but such funding 
shall not be divisible.
    ``(b) Functions of Centers.--In consultation with and upon the 
request of Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations, each Service Area epidemiology center established under 
this subsection shall, with respect to such Service Area--
            ``(1) collect data relating to, and monitor progress made 
        toward meeting, each of the health status objectives of the 
        Service, the Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations in the Service Area;
            ``(2) evaluate existing delivery systems, data systems, and 
        other systems that impact the improvement of Indian health;
            ``(3) assist Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations in identifying their highest priority 
        health status objectives and the services needed to achieve 
        such objectives, based on epidemiological data;
            ``(4) make recommendations for the targeting of services 
        needed by the populations served;
            ``(5) make recommendations to improve health care delivery 
        systems for Indians and Urban Indians;
            ``(6) provide requested technical assistance to Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations in 
        the development of local health service priorities and 
        incidence and prevalence rates of disease and other illness in 
        the community; and
            ``(7) provide disease surveillance and assist Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations to 
        promote public health.
    ``(c) Technical Assistance.--The Director of the Centers for 
Disease Control and Prevention shall provide technical assistance to 
the centers in carrying out the requirements of this subsection.
    ``(d) Funding for Studies.--The Secretary may make funding 
available to Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations to conduct epidemiological studies of Indian communities.

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

    ``(a) Funding for Development of Programs.--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 pre-school through 
grade 12 in schools for the benefit of Indian and Urban Indian 
children.
    ``(b) Use of Funds.--Funding provided under this section may be 
used for purposes which may include, but are not limited to, the 
following:
            ``(1) Developing and implementing health education 
        curricula both for regular school programs and afterschool 
        programs.
            ``(2) Training teachers in comprehensive school health 
        education curricula.
            ``(3) Integrating school-based, community-based, and other 
        public and private health promotion efforts.
            ``(4) Encouraging healthy, tobacco-free school 
        environments.
            ``(5) Coordinating school-based health programs with 
        existing services and programs available in the community.
            ``(6) Developing school programs on nutrition education, 
        personal health, oral health, and fitness.
            ``(7) Developing mental health wellness programs.
            ``(8) Developing chronic disease prevention programs.
            ``(9) Developing substance abuse prevention programs.
            ``(10) Developing injury prevention and safety education 
        programs.
            ``(11) Developing activities for the prevention and control 
        of communicable diseases.
            ``(12) Developing community and environmental health 
        education programs that include traditional health care 
        practitioners.
            ``(13) Violence prevention.
            ``(14) Such other health issues as are appropriate.
    ``(c) Technical Assistance.--Upon request, the Secretary, acting 
through the Service, shall provide technical assistance to Indian 
Tribes, Tribal Organizations, and Urban Indian Organizations in the 
development of comprehensive health education plans and the 
dissemination of comprehensive health education materials and 
information on existing health programs and resources.
    ``(d) Criteria for Review and Approval of Applications.--The 
Secretary, acting through the Service, and in consultation with Indian 
Tribes, Tribal Organizations, and Urban Indian Organizations, shall 
establish criteria for the review and approval of applications for 
funding provided pursuant to this section.
    ``(e) Development of Program for BIA Funded Schools.--
            ``(1) In general.--The Secretary of the Interior, acting 
        through the Bureau of Indian Affairs and in cooperation with 
        the Secretary, acting through the Service, and affected Indian 
        Tribes and Tribal Organizations, shall develop a comprehensive 
        school health education program for children from preschool 
        through grade 12 in schools for which support is provided by 
        the Bureau of Indian Affairs.
            ``(2) Requirements for programs.--Such programs shall 
        include the following--
                    ``(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) Duties of the secretary.--The Secretary of the 
        Interior shall--
                    ``(A) provide training to teachers in comprehensive 
                school health education curricula;
                    ``(B) ensure the integration and coordination of 
                school-based programs with existing services and health 
                programs available in the community; and
                    ``(C) encourage healthy, tobacco-free school 
                environments.

``SEC. 211. INDIAN YOUTH PROGRAM.

    ``(a) Program Authorized.--The Secretary, acting through the 
Service, is authorized to establish and administer a program to provide 
funding to Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations for innovative mental and physical disease prevention and 
health promotion and treatment programs for Indian and Urban Indian 
preadolescent and adolescent youths.
    ``(b) Use of Funds.--
            ``(1) Allowable uses.--Funds made available under this 
        section may be used to--
                    ``(A) develop prevention and treatment programs for 
                Indian youth which promote mental and physical health 
                and incorporate cultural values, community and family 
                involvement, and traditional health care practitioners; 
                and
                    ``(B) develop and provide community training and 
                education.
            ``(2) Prohibited use.--Funds made available under this 
        section may not be used to provide services described in 
        section 707(c).
    ``(c) Duties of the Secretary.--The Secretary shall--
            ``(1) disseminate to Indian Tribes, Tribal Organizations, 
        and Urban Indian Organizations information regarding models for 
        the delivery of comprehensive health care services to Indian 
        and Urban Indian adolescents;
            ``(2) encourage the implementation of such models; and
            ``(3) at the request of an Indian Tribe, Tribal 
        Organization, or Urban Indian Organization, provide technical 
        assistance in the implementation of such models.
    ``(d) Criteria for Review and Approval of Applications.--The 
Secretary, in consultation with Indian Tribes, Tribal Organization, and 
Urban Indian Organizations, shall establish criteria for the review and 
approval of applications or proposals under this section.

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

    ``(a) Funding Authorized.--The Secretary, acting through the 
Service, and after consultation with Indian Tribes, Tribal 
Organizations, Urban Indian Organizations, and the Centers for Disease 
Control and Prevention, may make funding available to Indian Tribes and 
Tribal Organizations for the following:
            ``(1) Projects for the prevention, control, and elimination 
        of communicable and infectious diseases including, but not 
        limited to, tuberculosis, hepatitis, HIV, respiratory syncitial 
        virus, hanta virus, sexually transmitted diseases, and H. 
        Pylori.
            ``(2) Public information and education programs for the 
        prevention, control, and elimination of communicable and 
        infectious diseases.
            ``(3) Education, training, and clinical skills improvement 
        activities in the prevention, control, and elimination of 
        communicable and infectious diseases for health professionals, 
        including allied health professionals.
            ``(4) Demonstration projects for the screening, treatment, 
        and prevention of hepatitis C virus (HCV).
    ``(b) Application Required.--The Secretary may provide funding 
under subsection (a) only if an application or proposal for funding is 
submitted to the Secretary.
    ``(c) Coordination With Health Agencies.--Indian Tribes and Tribal 
Organizations receiving funding under this section are encouraged to 
coordinate their activities with the Centers for Disease Control and 
Prevention and State and local health agencies.
    ``(d) Technical Assistance; 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 a report to Congress 
        biennially on the use of funds under this section and on the 
        progress made toward the prevention, control, and elimination 
        of communicable and infectious diseases among Indians and Urban 
        Indians.

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

    ``(a) Funding Authorized.--The Secretary, acting through the 
Service, Indian Tribes, and Tribal Organizations, may provide funding 
under this Act to meet the objectives set forth in section 3 through 
health care-related services and programs not otherwise described in 
this Act, which shall include, but not be limited to--
            ``(1) hospice care and assisted living;
            ``(2) long-term health care;
            ``(3) home- and community-based services;
            ``(4) public health functions; and
            ``(5) Traditional Health Care Practices.
    ``(b) Services to Otherwise Ineligible Persons.--At the discretion 
of the Service, Indian Tribes, or Tribal Organizations, services 
provided for hospice care, home health care, home- and community-based 
care, assisted living, and long-term care may be provided (subject to 
reimbursement of reasonable charges) to persons otherwise ineligible 
for the health care benefits of the Service. Any funds received under 
this subsection shall not be used to offset or limit the funding 
allocated to an Indian Tribe or Tribal Organization.
    ``(c) Definitions.--For the purposes of this section, the following 
definitions shall apply:
            ``(1) 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) Respite care.
                    ``(F) Training for family members.
                    ``(G) Adult day care.
                    ``(H) Such other home- and community-based services 
                as the Secretary, an Indian Tribe, or Tribal 
                Organization may approve.
            ``(2) The term `hospice care' means the items and services 
        specified in subparagraphs (A) through (H) of section 
        1861(dd)(1) of the Social Security Act (42 U.S.C. 
        1395x(dd)(1)), and such other services which an Indian Tribe or 
        Tribal Organization determines are necessary and appropriate to 
        provide in furtherance of this care.
            ``(3) The term `public health functions' means the 
        provision of public health-related programs, functions, and 
        services including, but not limited to, assessment, assurance, 
        and policy development which Indian Tribes and Tribal 
        Organizations are authorized and encouraged, in those 
        circumstances where it meets their needs, to do by forming 
        collaborative relationships with all levels of local, State, 
        and Federal Government.

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

    ``The Secretary, acting through the Service and 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) Studies and Monitoring.--The Secretary and the Service shall 
conduct, in conjunction with other appropriate Federal agencies and in 
consultation with concerned Indian Tribes and Tribal Organizations, 
studies and ongoing monitoring programs to determine trends in the 
health hazards to Indian miners and to Indians on or near reservations 
and Indian communities as a result of environmental hazards which may 
result in chronic or life threatening health problems, such as nuclear 
resource development, petroleum contamination, and contamination of 
water source and of the food chain. Such studies shall include--
            ``(1) an evaluation of the nature and extent of health 
        problems caused by environmental hazards currently exhibited 
        among Indians and the causes of such health problems;
            ``(2) an analysis of the potential effect of ongoing and 
        future environmental resource development on or near 
        reservations and Indian communities, including the cumulative 
        effect over time on health;
            ``(3) an evaluation of the types and nature of activities, 
        practices, and conditions causing or affecting such health 
        problems including, but not limited to, uranium mining and 
        milling, uranium mine tailing deposits, nuclear power plant 
        operation and construction, and nuclear waste disposal; oil and 
        gas production or transportation on or near reservations or 
        Indian communities; and other development that could affect the 
health of Indians and their water supply and food chain;
            ``(4) a summary of any findings and recommendations 
        provided in Federal and State studies, reports, investigations, 
        and inspections during the 5 years prior to the date of the 
        enactment of the Indian Health Care Improvement Act Amendments 
        of 2003 that directly or indirectly relate to the activities, 
        practices, and conditions affecting the health or safety of 
        such Indians; and
            ``(5) the efforts that have been made by Federal and State 
        agencies and resource and economic development companies to 
        effectively carry out an education program for such Indians 
        regarding the health and safety hazards of such development.
    ``(b) Health Care Plans.--Upon completion of such studies, the 
Secretary and the Service shall take into account the results of such 
studies and, in consultation with Indian Tribes and Tribal 
Organizations, develop health care plans to address the health problems 
studied under subsection (a). The plans shall include--
            ``(1) methods for diagnosing and treating Indians currently 
        exhibiting such health problems;
            ``(2) preventive care and testing for Indians who may be 
        exposed to such health hazards, including the monitoring of the 
        health of individuals who have or may have been exposed to 
        excessive amounts of radiation or affected by other activities 
        that have had or could have a serious impact upon the health of 
        such individuals; and
            ``(3) a program of education for Indians who, by reason of 
        their work or geographic proximity to such nuclear or other 
        development activities, may experience health problems.
    ``(c) Submission of Report and Plan to Congress.--The Secretary and 
the Service shall submit to Congress the study prepared under 
subsection (a) no later than 18 months after the date of the enactment 
of the Indian Health Care Improvement Act Amendments of 2003. The 
health care plan prepared under subsection (b) shall be submitted in a 
report no later than 1 year after the study prepared under subsection 
(a) is submitted to Congress. Such report shall include recommended 
activities for the implementation of the plan, as well as an evaluation 
of any activities previously undertaken by the Service to address such 
health problems.
    ``(d) Intergovernmental Task Force.--
            ``(1) Establishment; members.--There is established an 
        Intergovernmental Task Force to be composed of the following 
        individuals (or their designees):
                    ``(A) The Secretary of Energy.
                    ``(B) The Secretary of the Environmental Protection 
                Agency.
                    ``(C) The Director of the Bureau of Mines.
                    ``(D) The Assistant Secretary for Occupational 
                Safety and Health.
                    ``(E) The Secretary of the Interior.
                    ``(F) The Secretary of Health and Human Services.
                    ``(G) The Director of the Indian Health Service.
            ``(2) Duties.--The Task Force shall--
                    ``(A) identify existing and potential operations 
                related to nuclear resource development or other 
                environmental hazards that affect or may affect the 
                health of Indians on or near a reservation or in an 
                Indian community; and
                    ``(B) enter into activities to correct existing 
                health hazards and ensure that current and future 
                health problems resulting from nuclear resource or 
                other development activities are minimized or reduced.
            ``(3) Chairman; meetings.--The Secretary of Health and 
        Human Services shall be the Chairman of the Task Force. The 
        Task Force shall meet at least twice each year.
    ``(e) Health Services to Certain Employees.--In the case of any 
Indian who--
            ``(1) as a result of employment in or near a uranium mine 
        or mill or near any other environmental hazard, suffers from a 
        work-related illness or condition;
            ``(2) is eligible to receive diagnosis and treatment 
        services from an Indian Health Program; and
            ``(3) by reason of such Indian's employment, is entitled to 
        medical care at the expense of such mine or mill operator or 
        entity responsible for the environmental hazard, the Indian 
        Health Program shall, at the request of such Indian, render 
        appropriate medical care to such Indian for such illness or 
        condition and may be reimbursed for any medical care so 
        rendered to which such Indian is entitled at the expense of 
        such operator or entity from such operator or entity. Nothing 
        in this subsection shall affect the rights of such Indian to 
        recover damages other than such amounts paid to the Indian 
        Health Program from the employer for providing medical care for 
such illness or condition.

``SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.

    ``(a) In General.--For fiscal years beginning with the fiscal year 
ending September 30, 1983, and ending with the fiscal year ending 
September 30, 2015, the State of Arizona shall be designated as a 
contract health service delivery area by the Service for the purpose of 
providing contract health care services to members of federally 
recognized Indian Tribes of Arizona.
    ``(b) Maintenance of Services.--The Service shall not curtail any 
health care services provided to Indians residing on reservations in 
the State of Arizona if such curtailment is due to the provision of 
contract services in such State pursuant to the designation of such 
State as a contract health service delivery area pursuant to subsection 
(a).

``SEC. 216A. NORTH DAKOTA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.

    ``(a) In General.--For fiscal years beginning with the fiscal year 
ending September 30, 2003, and ending with the fiscal year ending 
September 30, 2015, the State of North Dakota shall be designated as a 
contract health service delivery area by the Service for the purpose of 
providing contract health care services to members of federally 
recognized Indian Tribes of North Dakota.
    ``(b) Limitation.--The Service shall not curtail any health care 
services provided to Indians residing on reservations in the State of 
North Dakota 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. 216B. SOUTH DAKOTA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.

    ``(a) In General.--For fiscal years beginning with the fiscal year 
ending September 30, 2003, and ending with the fiscal year ending on 
September 30, 2015, the State of South Dakota shall be designated as a 
contract health service delivery area by the Service for the purpose of 
providing contract health care services to members of federally 
recognized Indian Tribes of South Dakota.
    ``(b) Limitation.--The Service shall not curtail any health care 
services provided to Indians residing on reservations in the State of 
South Dakota if such curtailment is due to the provision of contract 
services in such State pursuant to the designation of such State as a 
contract health service delivery area pursuant to subsection (a).

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

    ``(a) Funding Authorized.--The Secretary is authorized to fund a 
program using the California Rural Indian Health Board (hereafter in 
this section referred to as the `CRIHB') as a contract care 
intermediary to improve the accessibility of health services to 
California Indians.
    ``(b) Reimbursement Contract.--The Secretary shall enter into an 
agreement with the CRIHB to reimburse the CRIHB for costs (including 
reasonable administrative costs) incurred pursuant to this section, in 
providing medical treatment under contract to California Indians 
described in section 806(a) throughout the California contract health 
services delivery area described in section 218 with respect to high 
cost contract care cases.
    ``(c) Administrative Expenses.--Not more than 5 percent of the 
amounts provided to the CRIHB under this section for any fiscal year 
may be for reimbursement for administrative expenses incurred by the 
CRIHB during such fiscal year.
    ``(d) Limitation on Payment.--No payment may be made for treatment 
provided hereunder to the extent payment may be made for such treatment 
under the Indian Catastrophic Health Emergency Fund described in 
section 202 or from amounts appropriated or otherwise made available to 
the California contract health service delivery area for a fiscal year.
    ``(e) Advisory Board.--There is hereby established an advisory 
board which shall advise the CRIHB in carrying out this section. The 
advisory board shall be composed of representatives, selected by the 
CRIHB, from not less than 8 Tribal Health Programs serving California 
Indians covered under this section at least one half of whom of whom 
are not affiliated with the CRIHB.

``SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE DELIVERY AREA.

    ``The State of California, excluding the counties of Alameda, 
Contra Costa, Los Angeles, Marin, Orange, Sacramento, San Francisco, 
San Mateo, Santa Clara, Kern, Merced, Monterey, Napa, San Benito, San 
Joaquin, San Luis Obispo, Santa Cruz, Solano, Stanislaus, and Ventura, 
shall be designated as a contract health service delivery area by the 
Service for the purpose of providing contract health services to 
California Indians. However, any of the counties listed herein may only 
be included in the contract health services delivery area if funding is 
specifically provided by the Service for such services in those 
counties.

``SEC. 219. CONTRACT HEALTH SERVICES FOR THE TRENTON SERVICE AREA.

    ``(a) Authorization for Services.--The Secretary, acting through 
the Service, is directed to provide contract health services to members 
of the Turtle Mountain Band of Chippewa Indians that reside in the 
Trenton Service Area of Divide, McKenzie, and Williams counties in the 
State of North Dakota and the adjoining counties of Richland, 
Roosevelt, and Sheridan in the State of Montana.
    ``(b) No Expansion of Eligibility.--Nothing in this section may be 
construed as expanding the eligibility of members of the Turtle 
Mountain Band of Chippewa Indians for health services provided by the 
Service beyond the scope of eligibility for such health services that 
applied on May 1, 1986.

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

    ``The Service shall provide funds for health care programs and 
facilities operated by Tribal Health Programs on the same basis as such 
funds are provided to programs and facilities operated directly by the 
Service.

``SEC. 221. LICENSING.

    ``Health care professionals employed by a Tribal Health Program 
shall, if licensed in any State, be exempt from the licensing 
requirements of the State in which the Tribal Health Program performs 
the services described in its Funding Agreement.

``SEC. 222. NOTIFICATION OF PROVISION OF EMERGENCY CONTRACT HEALTH 
              SERVICES.

    ``With respect to an elderly Indian or an Indian with a disability 
receiving emergency medical care or services from a non-Service 
provider or in a non-Service facility under the authority of this Act, 
the time limitation (as a condition of payment) for notifying the 
Service of such treatment or admission shall be 30 days.

``SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS.

    ``(a) Deadline for Response.--The Service shall respond to a 
notification of a claim by a provider of a contract care service with 
either an individual purchase order or a denial of the claim within 5 
working days after the receipt of such notification.
    ``(b) Effect of Untimely Response.--If the Service fails to respond 
to a notification of a claim in accordance with subsection (a), the 
Service shall accept as valid the claim submitted by the provider of a 
contract care service.
    ``(c) Deadline for Payment of Valid Claim.--The Service shall pay a 
valid contract care service claim within 30 days after the completion 
of the claim.

``SEC. 224. LIABILITY FOR PAYMENT.

    ``(a) No Patient Liability.--A patient who receives contract health 
care services that are authorized by the Service shall not be liable 
for the payment of any charges or costs associated with the provision 
of such services.
    ``(b) Notification.--The Secretary shall notify a contract care 
provider and any patient who receives contract health care services 
authorized by the Service that such patient is not liable for the 
payment of any charges or costs associated with the provision of such 
services not later than 5 business days after receipt of a notification 
of a claim by a provider of contract care services.
    ``(c) No Recourse.--Following receipt of the notice provided under 
subsection (b), or, if a claim has been deemed accepted under section 
223(b), the provider shall have no further recourse against the patient 
who received the services.

``SEC. 225. AUTHORIZATION OF APPROPRIATIONS.

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

                        ``TITLE III--FACILITIES

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

    ``(a) Prerequisites for Expenditure of Funds.--Prior to the 
expenditure of, or the making of any binding commitment to expend, any 
funds appropriated for the planning, design, construction, or 
renovation of facilities pursuant to the Act of November 2, 1921 (25 
U.S.C. 13; popularly known as the Snyder Act), the Secretary, 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 and applicable, that 
        such facility meets the construction standards of any 
        accrediting body recognized by the Secretary for the purposes 
        of the medicare, medicaid, and SCHIP programs under title 
        XVIII, XIX, and XXI of the Social Security Act by not later 
        than 1 year after the date on which the construction or 
        renovation of such facility is completed.
    ``(b) Closures.--
            ``(1) Evaluation required.--Notwithstanding any other 
        provision of law, no facility operated by the Service may be 
        closed if the Secretary has not submitted to Congress at least 
        1 year prior to the date of the proposed closure an evaluation 
        of the impact of the proposed closure which specifies, in 
        addition to other considerations the following:
                    ``(A) The accessibility of alternative health care 
                resources for the population served by such facility.
                    ``(B) The cost-effectiveness of such closure.
                    ``(C) The quality of health care to be provided to 
                the population served by such 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 
                facility concerning such closure.
                    ``(F) The level of use of such facility by all 
                eligible Indians.
                    ``(G) The distance between such facility and the 
                nearest operating Service hospital.
            ``(2) Exception for certain temporary closures.--Paragraph 
        (1) shall not apply to any temporary closure of a facility or 
        any portion of a facility if such closure is necessary for 
medical, environmental, or construction safety reasons.
    ``(c) Health Care Facility Priority System.--
            ``(1) In general.--
                    ``(A) Establishment.--The Secretary, acting through 
                the Service, shall establish a health care facility 
                priority system, which shall--
                            ``(i) be developed with Indian Tribes and 
                        Tribal Organizations through negotiated 
                        rulemaking under section 802;
                            ``(ii) give Indian Tribes' needs the 
                        highest priority; and
                            ``(iii) at a minimum, include the lists 
                        required in paragraph (2)(B) and the 
                        methodology required in paragraph (2)(E).
                    ``(B) Priority of certain projects protected.--The 
                priority of any project established under the 
                construction priority system in effect on the date of 
                the Indian Health Care Improvement Act Amendments of 
                2003 shall not be affected by any change in the 
                construction priority system taking place thereafter if 
                the project was identified as 1 of the 10 top-priority 
                inpatient projects, 1 of the 10 top-priority outpatient 
                projects, 1 of the 10 top-priority staff quarters 
                developments, or 1 of the 10 top-priority Youth 
                Regional Treatment Centers in the fiscal year 2004 
                Indian Health Service budget justification, or if the 
                project had completed both Phase I and Phase II of the 
                construction priority system in effect on the date of 
                the enactment of such Act.
            ``(2) Report; contents.--The Secretary shall submit to the 
        President, for inclusion in each report required to be 
        transmitted to Congress under section 801, a report which sets 
        forth the following:
                    ``(A) A description of the health care facility 
                priority system of the Service, established under 
                paragraph (1).
                    ``(B) Health care facilities lists, including but 
                not limited to--
                            ``(i) the total health care facilities 
                        planning, design, construction, and renovation 
                        needs for Indians, identified by national and 
                        Service Area priorities;
                            ``(ii) the 10 top-priority inpatient health 
                        care facilities;
                            ``(iii) the 10 top-priority outpatient 
                        health care facilities;
                            ``(iv) the 10 top-priority specialized 
                        health care facilities (such as long-term care 
                        and alcohol and drug abuse treatment);
                            ``(v) the 10 top-priority staff quarters 
                        developments associated with health care 
                        facilities; and
                            ``(vi) the 10 top-priority hostels 
                        associated with health care facilities.
                    ``(C) The justification for such order of priority.
                    ``(D) The projected cost of such projects.
                    ``(E) The methodology adopted by the Service in 
                establishing priorities under its health care facility 
                priority system.
            ``(3) Requirements for preparation of reports.--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, Tribal 
                Organizations, and Urban Indian Organizations; and
                    ``(B) review the total unmet needs of all Indian 
                Tribes and Tribal Organizations for health care 
                facilities (including hostels and staff quarters), 
                including needs for renovation and expansion of 
                existing facilities.
            ``(4) Criteria for evaluating needs.--For purposes of this 
        subsection, the Secretary shall, in evaluating the needs of 
        facilities operated under any Funding Agreement use the same 
        criteria that the Secretary uses in evaluating the needs of 
        facilities operated directly by the Service.
            ``(5) Needs of facilities under isdeaa agreements.--The 
        Secretary shall ensure that the planning, design, construction, 
        and renovation needs of Service and non-Service facilities 
        operated under 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) Initial report.--In the year 2005, the General 
        Accounting Office shall prepare and finalize a report which 
        sets forth the needs of the Service, Indian Tribes, Tribal 
        Organizations, and Urban Indian Organizations, for the 
        facilities listed under subsection (c)(2)(B), including the 
        needs for renovation and expansion of existing facilities. The 
        General Accounting Office shall submit the report to the 
appropriate authorizing and appropriations committees of the Congress 
and to the Secretary.
            ``(2) Beginning in the year 2006, the Secretary shall 
        annually update the report required under paragraph (1).
            ``(3) The Comptroller General and the Secretary shall 
        consult with Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations. In preparing the reports required by 
        paragraphs (1) and (2), the Secretary shall submit the report 
        to the President for inclusion in the report required to be 
        transmitted to the Congress under section 801.
            ``(4) For purposes of this subsection, the reports shall, 
        regarding the needs of facilities operated under any Funding 
        Agreement be based on the same criteria that the Secretary uses 
        in evaluating the needs of facilities operated directly by the 
        Service.
            ``(5) The planning, design, construction, and renovation 
        needs of facilities operated under Funding Agreements shall be 
        fully and equitably integrated into the development of the 
        health facility priority system.
            ``(6) Beginning in the year 2006 and each fiscal year 
        thereafter, the Secretary shall provide an opportunity for 
        nomination of planning, design, and construction projects by 
        the Service, Indian Tribes, and Tribal Organizations for 
        consideration under the health care facility priority system.
    ``(e) Funding Condition.--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 1 
or more Indian Tribes shall be subject to the provisions of the Indian 
Self-Determination and Education Assistance Act.
    ``(f) Development of Innovative Approaches.--The Secretary shall 
consult and cooperate with Indian Tribes, Tribal Organizations, and 
Urban Indian Organizations in developing innovative approaches to 
address all or part of the total unmet need for construction of health 
facilities, including those provided for in other sections of this 
title and other approaches.

``SEC. 302. SANITATION FACILITIES.

    ``(a) Findings.--Congress finds the following:
            ``(1) The provision of sanitation 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 sanitation 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 sanitation 
        facilities and other preventive health measures.
            ``(4) Many Indian homes and Indian communities still lack 
        sanitation facilities.
            ``(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 sanitation 
        facilities.
    ``(b) Facilities and Services.--In furtherance of the findings 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). Under such authority, the Secretary, acting through the 
Service, shall provide the following:
            ``(1) 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 sanitation facilities, including the 
        provision of existing plans, standard details, and 
        specifications available in the Department, to be used at the 
        option of the Indian Tribe, Tribal Organization, or Indian 
        community.
            ``(2) Ongoing technical assistance and training to Indian 
        Tribes, Tribal Organizations, and Indian communities in the 
        management of utility organizations which operate and maintain 
        sanitation facilities.
            ``(3) Priority funding for operation and maintenance 
        assistance for, and emergency repairs to, sanitation facilities 
        operated by an Indian Tribe, Tribal Organization or Indian 
        community 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.
    ``(c) Funding.--Notwithstanding any other provision of law--
            ``(1) 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;
            ``(2) 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);
            ``(3) unless specifically authorized otherwise when funds 
        are appropriated, the Secretary of Health and Human Services 
        shall use funds appropriated under section 7 of the Act of 
        August 5, 1954 (42 U.S.C. 2004a), to provide additional 
        priority of sanitation facilities assistance to eligible new 
        and existing Indian homes other than the following--
                    ``(A) new homes constructed using housing funds 
                provided by the Department of Housing and Urban 
                Development; and
                    ``(B) existing homes owned or managed by a tribally 
                designated housing entity (as that term is defined in 
                section 4(21) of the Native American Housing Assistance 
                and Self-Determination Act of 1996 (25 U.S.C. 4103(21)) 
                that were constructed using housing funds provided by 
                the Department of Housing and Urban Development;
            ``(4) the Secretary of Health and Human Services is 
        authorized to accept from any source, including Federal and 
        State agencies, funds for the purpose of providing sanitation 
        facilities and services and place these funds into Funding 
        Agreements;
            ``(5) funds appropriated under the authority of section 7 
        of the Act of August 5, 1954 (42 U.S.C. 2004a) may be used to 
        fund up to 100 percent of the amount of an Indian Tribe's loan 
        obtained under any Federal program for new projects to 
        construct eligible sanitation facilities to serve Indian homes;
            ``(6) funds appropriated under the authority of section 7 
        of the Act of August 5, 1954 (42 U.S.C. 2004a) may be used to 
        meet matching or cost participation requirements under other 
        Federal and non-Federal programs for new projects to construct 
        eligible sanitation facilities;
            ``(7) all Federal agencies are authorized to transfer to 
        the Secretary funds identified, granted, loaned, or 
        appropriated whereby the Department's applicable policies, 
        rules, and regulations shall apply in the implementation of 
        such projects;
            ``(8) the Secretary of Health and Human Services shall 
        enter into interagency agreements with Federal and State 
        agencies for the purpose of providing financial assistance for 
        sanitation facilities and services under this Act; and
            ``(9) the Secretary of Health and Human Services shall, by 
        regulation developed through rulemaking under section 802, 
        establish standards applicable to the planning, design, and 
        construction of sanitation facilities funded under this Act.
    ``(d) Funding Plan.--The Secretary, acting through the Service, and 
in consultation with Indian Tribes and Tribal Organizations, shall 
develop and begin implementation of a 10-year funding plan to provide 
sanitation facilities to serve existing Indian homes and Indian 
communities and new and renovated Indian homes.
    ``(e) Certain Capabilities Not Prerequisite.--The financial and 
technical capability of an Indian Tribe, Tribal Organization, or Indian 
community to safely operate, manage, and maintain a sanitation facility 
shall not be a prerequisite to the provision or construction of 
sanitation facilities by the Secretary.
    ``(f) Financial Assistance.--The Secretary is authorized to provide 
financial assistance to Indian Tribes, Tribal Organizations, and Indian 
communities for operation, management, and maintenance of their 
sanitation facilities.
    ``(g) Operation, Management, and Maintenance of Facilities.--The 
Indian Tribe, Tribal Organization, Indian family, or Indian community 
has the primary responsibility to establish, collect, and use 
reasonable user fees, or otherwise set aside funding, for the purpose 
of operating, managing, and maintaining sanitation facilities. If a 
sanitation facility serving a community that is operated by an Indian 
Tribe, Tribal Organization, or Indian community is threatened with 
imminent failure and such operator lacks capacity to maintain the 
integrity or the health benefits of the sanitation facility, then the 
Secretary is authorized to assist the Indian Tribe, Tribal 
Organization, or Indian community in the resolution of the problem on a 
short-term basis through cooperation with the emergency coordinator or 
by providing operation, management, and maintenance service.
    ``(h) ISDEAA Program Funded on Equal Basis.--Tribal Health Programs 
shall be eligible (on an equal basis with programs that are 
administered directly by the Service) for--
            ``(1) any funds appropriated pursuant to this section; and
            ``(2) any funds appropriated for the purpose of providing 
        sanitation facilities.
    ``(i) Report.--
            ``(1) Required; contents.--The Secretary shall submit to 
        the President, for inclusion in each report required to be 
        transmitted to Congress under section 801, a report which sets 
        forth--
                    ``(A) the current Indian sanitation facility 
                priority system of the Service;
                    ``(B) the methodology for determining sanitation 
                deficiencies;
                    ``(C) the level of initial and final sanitation 
                deficiency for each type of sanitation facility for 
                each project of each Indian Tribe or Indian community; 
                and
                    ``(D) the amount of funds necessary to reduce the 
                identified sanitation deficiency levels of all Indian 
                Tribes and Indian communities to level I sanitation 
                deficiency as defined in paragraph (4)(A).
            ``(2) Consultation.--In preparing each report required 
        under paragraph (1), the Secretary shall consult with Indian 
        Tribes and Tribal Organizations to determine the sanitation 
        facility needs of each Indian Tribe. The criteria on which the 
        needs will be evaluated shall be developed through negotiated 
        rulemaking pursuant to section 802.
            ``(3) Uniform methodology.--The methodology used by the 
        Secretary in determining, preparing cost estimates for, and 
        reporting sanitation deficiencies for purposes of paragraph (1) 
        shall be applied uniformly to all Indian Tribes and Indian 
        communities.
            ``(4) Sanitation deficiency levels.--For purposes of this 
        subsection, the sanitation deficiency levels for an individual, 
        Indian Tribe or Indian community sanitation facility to serve 
        Indian homes are determined as follows:
                    ``(A) A level I deficiency exists if a sanitation 
                facility serving an individual, Indian Tribe, or Indian 
                community--
                            ``(i) complies with all applicable water 
                        supply, pollution control, and solid waste 
                        disposal laws; and
                            ``(ii) deficiencies relate to routine 
                        replacement, repair, or maintenance needs.
                    ``(B) A level II deficiency exists if a sanitation 
                facility serving an individual, Indian Tribe, or Indian 
                community substantially or recently complied with all 
                applicable water supply, pollution control, and solid 
                waste laws and any deficiencies relate to--
                            ``(i) small or minor capital improvements 
                        needed to bring the facility back into 
                        compliance;
                            ``(ii) capital improvements that are 
                        necessary to enlarge or improve the facilities 
                        in order to meet the current needs for domestic 
                        sanitation facilities; or
                            ``(iii) the lack of equipment or training 
                        by an Indian Tribe, Tribal Organization, or an 
                        Indian community to properly operate and 
                        maintain the sanitation facilities.
                    ``(C) A level III deficiency exists if a sanitation 
                facility serving an individual, Indian Tribe or Indian 
                community meets one or more of the following 
                conditions--
                            ``(i) water or sewer service in the home is 
                        provided by a haul system with holding tanks 
                        and interior plumbing;
                            ``(ii) major significant interruptions to 
                        water supply or sewage disposal occur 
                        frequently, requiring major capital 
                        improvements to correct the deficiencies; or
                            ``(iii) there is no access to or no 
                        approved or permitted solid waste facility 
                        available.
                    ``(D) A level IV deficiency exists if--
                            ``(i) a sanitation facility of an 
                        individual, Indian Tribe, Tribal Organization, 
                        or Indian community has no piped water or sewer 
                        facilities in the home or the facility has 
                        become inoperable due to major component 
                        failure; or
                            ``(ii) where only a washeteria or central 
                        facility exists in the community.
                    ``(E) A level V deficiency exists in the absence of 
                a sanitation facility, where individual homes do not 
                have access to safe drinking water or adequate 
                wastewater (including sewage) disposal.
    ``(j) Definitions.--For purposes of this section, the following 
terms apply:
            ``(1) Indian community.--The term `Indian community' means 
        a geographic area, a significant proportion of whose 
        inhabitants are Indians and which is served by or capable of 
        being served by a facility described in this section.
            ``(2) Sanitation facilities.--The terms `sanitation 
        facility' and `sanitation facilities' mean safe and adequate 
        water supply systems, sanitary sewage disposal systems, and 
        sanitary solid waste systems (and all related equipment and 
        support infrastructure).

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

    ``(a) Buy Indian Act.--The Secretary, acting through the Service, 
may use the negotiating authority of section 23 of the Act of June 25, 
1910 (25 U.S.C. 47, commonly known as the `Buy Indian Act'), 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 sanitation 
facilities pursuant to section 302. Such preference may be accorded by 
the Secretary unless the Secretary finds, pursuant to regulations 
adopted pursuant to section 802, that the project or function to be 
contracted for will not be satisfactory or such project or function 
cannot be properly completed or maintained under the proposed contract. 
The Secretary, in arriving at such a finding, shall consider whether 
the Indian or Indian firm will be deficient with respect to--
            ``(1) ownership and control by Indians;
            ``(2) equipment;
            ``(3) bookkeeping and accounting procedures;
            ``(4) substantive knowledge of the project or function to 
        be contracted for;
            ``(5) adequately trained personnel; or
            ``(6) other necessary components of contract performance.
    ``(b) Labor Standards.--
            ``(1) In general.--For the purposes of implementing the 
        provisions of this title, contracts for the construction or 
        renovation of health care facilities, staff quarters, and 
        sanitation facilities, and related support infrastructure, 
        funded in whole or in part with funds made available pursuant 
        to this title, shall contain a provision requiring compliance 
        with the Act of March 3, 1931 (40 U.S.C. 276a--276a-5, known as 
        the Davis-Bacon Act), unless such construction or renovation--
                    ``(A) is performed by a contractor pursuant to a 
                contract with an Indian Tribe or Tribal Organization 
                with funds supplied through a contract, compact or 
                funding agreement authorized by the Indian Self-
                Determination and Education Assistance Act, or other 
                statutory authority; and
                    ``(B) is subject to prevailing wage rates for 
                similar construction or renovation in the locality as 
                determined by the Indian Tribes or Tribal Organizations 
to be served by the construction or renovation.
            ``(2) Exception.--This subsection shall not apply to 
        construction or renovation carried out by an Indian Tribe or 
        Tribal Organization with its own employees.

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

    ``(a) In General.--Notwithstanding any other provision of law, if 
the requirements of subsection (c) are met, the Secretary, acting 
through the Service, is authorized to accept any major expansion, 
renovation, or modernization by any Indian Tribe or Tribal Organization 
of any Service facility or of any other Indian health facility operated 
pursuant to a Funding Agreement, including--
            ``(1) any plans or designs for such expansion, renovation, 
        or modernization; and
            ``(2) any expansion, renovation, or modernization for which 
        funds appropriated under any Federal law were lawfully 
        expended.
    ``(b) Priority List.--
            ``(1) In general.--The Secretary shall maintain a separate 
        priority list to address the needs for increased operating 
        expenses, personnel, or equipment for such facilities. The 
        methodology for establishing priorities shall be developed 
        through negotiated rulemaking under section 802. The list of 
        priority facilities will be revised annually in consultation 
        with Indian Tribes and Tribal Organizations.
            ``(2) Report.--The Secretary shall submit to the President, 
        for inclusion in each report required to be transmitted to 
        Congress under section 801, the priority list maintained 
        pursuant to paragraph (1).
    ``(c) Requirements.--The requirements of this subsection are met 
with respect to any expansion, renovation, or modernization if--
            ``(1) the Indian 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.
    ``(d) Closure or Conversion of Facilities.--If any Service facility 
which has been expanded, renovated, or modernized by an Indian Tribe or 
Tribal Organization under this section ceases to be used as a Service 
facility during the 20-year period beginning on the date such 
expansion, renovation, or modernization is completed, such Indian Tribe 
or Tribal Organization shall be entitled to recover from the United 
States an amount which bears the same ratio to the value of such 
facility at the time of such cessation as the value of such expansion, 
renovation, or modernization (less the total amount of any funds 
provided specifically for such facility under any Federal program that 
were expended for such expansion, renovation, or modernization) bore to 
the value of such facility at the time of the completion of such 
expansion, renovation, or modernization.

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

    ``(a) Funding.--
            ``(1) In general.--The Secretary, acting through the 
        Service, in consultation with Indian Tribes and Tribal 
        Organizations, shall make funding available to Indian 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 
        pursuant to subsections (b)(2) and (c)(1)(C)). Funding made 
        under this section may cover up to 100 percent of the costs of 
        such construction, expansion, or modernization. For the 
        purposes of this section, the term `construction' includes the 
        replacement of an existing facility.
            ``(2) Funding agreement required.--Funding under paragraph 
        (1) may only be made available to a Tribal Health Program 
        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).
    ``(b) Use of Funds.--
            ``(1) Allowable uses.--Funding provided under this section 
        may be used only for debt reduction or the construction, 
        expansion, or modernization (including the planning and design 
        of such construction, expansion, or modernization) of an 
        ambulatory care facility--
                    ``(A) located apart from a hospital;
                    ``(B) not funded under section 301 or section 307; 
                and
                    ``(C) which, upon completion of such construction 
                or modernization will--
                            ``(i) have a total capacity appropriate to 
                        its projected service population;
                            ``(ii) provide annually no fewer than 500 
                        patient visits by eligible Indians and other 
                        users who are eligible for services in such 
                        facility in accordance with section 807(c)(2); 
                        and
                            ``(iii) provide ambulatory care in a 
                        Service Area (specified in the Funding 
                        Agreement) with a population of no fewer than 
                        1,500 eligible Indians and other users who are 
                        eligible for services in such facility in 
                        accordance with section 807(c)(2).
            ``(2) Use only for certain portion of costs.--Funding 
        provided under this section may be used only for the cost of 
        that portion of a construction, expansion, or modernization 
        project that benefits the Service population identified above 
        in subsection (b)(1)(C)(ii) and (iii). The requirements of 
        clauses (ii) and (iii) of paragraph (1)(C) shall not apply to 
        an Indian Tribe or Tribal Organization applying for funding 
        under this section whose principal office for health care 
        administration is located on an island or when such office is 
        not located on a road system providing direct access to an 
        inpatient hospital where care is available to the Service 
        population.
    ``(c) Funding.--
            ``(1) Application.--No funding may be made available under 
        this section unless an application or proposal for such funding 
        has been approved by the Secretary in accordance with 
        applicable regulations and has forth reasonable assurance by 
        the applicant that, at all times after the construction, 
        expansion, or modernization of a facility carried out pursuant 
        to funding received under this section--
                    ``(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 funding under this section, 
        the Secretary shall give priority to Indian Tribes and Tribal 
        Organizations that demonstrate--
                    ``(A) a need for increased ambulatory care 
                services; and
                    ``(B) insufficient capacity to deliver such 
                services.
            ``(3) Peer review panels.--The Secretary may provide for 
        the establishment of peer review panels, as necessary, to 
        review and evaluate applications and proposals and to advise 
        the Secretary regarding such applications using the criteria 
        developed during consultations pursuant to subsection (a)(1).
    ``(d) Reversion of Facilities.--If any facility (or portion 
thereof) with respect to which funds have been paid under this section, 
ceases, within 5 years after completion of the construction, expansion, 
or modernization carried out with such funds, to be used for the 
purposes of providing health care services to eligible Indians, all of 
the right, title, and interest in and to such facility (or portion 
thereof) shall transfer to the United States unless otherwise 
negotiated by the Service and the Indian Tribe or Tribal Organization.
    ``(e) Funding Nonrecurring.--Funding provided under this section 
shall be nonrecurring and shall not be available for inclusion in any 
individual Indian Tribe's tribal share for an award under the Indian 
Self-Determination and Education Assistance Act or for reallocation or 
redesign thereunder.

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

    ``(a) Health Care Demonstration Projects.--The Secretary, acting 
through the Service, and in consultation with Indian Tribes and Tribal 
Organizations, is authorized to enter into Funding Agreements with, or 
make grants or loan guarantees to, Indian Tribes or Tribal 
Organizations for the purpose of carrying out a health care delivery 
demonstration project to test alternative means of delivering health 
care and services to Indians through facilities, including but not 
limited to hospice, traditional Indian health, and child care 
facilities.
    ``(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) Regulations.--The Secretary shall develop and publish 
regulations, through rulemaking under section 802, for the review and 
approval of applications submitted under this section.
    ``(d) Criteria.--The Secretary may enter into a contract or Funding 
Agreement or award a grant under this section for projects which meet 
the following criteria:
            ``(1) There is a need for a new facility or program or the 
        reorientation of an existing facility or program.
            ``(2) A significant number of Indians, including those with 
        low health status, will be served by the project.
            ``(3) The project has the potential to deliver services in 
        an efficient and effective manner.
            ``(4) The project is economically viable.
            ``(5) The Indian Tribe or Tribal Organization has the 
        administrative and financial capability to administer the 
        project.
            ``(6) The project is integrated with providers of related 
        health and social services and is coordinated with, and avoids 
        duplication of, existing services.
    ``(e) Peer Review Panels.--The Secretary may provide for the 
establishment of peer review panels, as necessary, to review and 
evaluate applications using the criteria developed pursuant to 
subsection (d).
    ``(f) Priority.--The Secretary shall give priority to applications 
for demonstration projects in each of the following Service Units to 
the extent that such applications are timely filed and meet the 
criteria specified in subsection (d):
            ``(1) Cass Lake, Minnesota.
            ``(2) Clinton, Oklahoma.
            ``(3) Harlem, Montana.
            ``(4) Mescalero, New Mexico.
            ``(5) Owyhee, Nevada.
            ``(6) Parker, Arizona.
            ``(7) Schurz, Nevada.
            ``(8) Winnebago, Nebraska.
            ``(9) Ft. Yuma, California.
    ``(g) 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.
    ``(h) Service to Ineligible Persons.--The authority to provide 
services to persons otherwise ineligible for the health care benefits 
of the Service and the authority to extend hospital privileges in 
Service facilities to non-Service health practitioners as provided in 
section 807 may be included, subject to the terms of such section, in 
any demonstration project approved pursuant to this section.
    ``(i) Equitable Treatment.--For purposes of subsection (d)(1), the 
Secretary shall, in evaluating facilities operated under any Funding 
Agreement, use the same criteria that the Secretary uses in evaluating 
facilities operated directly by the Service.
    ``(j) 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 are fully and 
equitably integrated into the implementation of the health care 
delivery demonstration projects under this section.

``SEC. 307. LAND TRANSFER.

    ``(a) 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.
    ``(b) Federal Land to the Service.--Notwithstanding any other 
provision of law, the Bureau of Indian Affairs and all other agencies 
and departments of the United States are authorized to transfer, at no 
cost, land and improvements to the Service for the provision of health 
care services. The Secretary is authorized to accept such land and 
improvements for such purposes.

``SEC. 308. LEASES, CONTRACTS, AND OTHER AGREEMENTS.

    ``The Secretary, acting through the Service, may enter into leases, 
contracts, and other agreements with Indian Tribes and Tribal 
Organizations which hold (1) title to, (2) a leasehold interest in, or 
(3) a beneficial interest in (when title is held by the United States 
in trust for the benefit of an Indian Tribe) facilities used or to be 
used for the administration and delivery of health services by an 
Indian Health Program. Such leases, contracts, or agreements may 
include provisions for construction or renovation and provide for 
compensation to the Indian Tribe or Tribal Organization of rental and 
other costs consistent with section 105(l) of the Indian Self-
Determination Act and regulations thereunder. Notwithstanding any other 
provision of law, such leases, contracts, or other agreements shall be 
considered as operating leases for the purpose of scoring under the 
Budget Enforcement Act.

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

    ``(a) Establishment of Fund.--There is established in the Treasury 
of the United States a fund to be known as the Health Care Facilities 
Loan Fund (hereinafter referred to as the `HCFLF') to provide to Indian 
Tribes and Tribal Organizations direct loans, or guarantees for loans, 
for construction of health care facilities (including but not limited 
to inpatient facilities, outpatient facilities, staff quarters, 
hostels, and specialized care facilities such as behavioral health and 
elder care facilities).
    ``(b) Regulations; Standards and Procedures.--The Secretary, acting 
through the Service, is authorized to issue regulations, developed 
through rulemaking as set out in section 802, to provide standards and 
procedures for governing such loans and loan guarantees, subject to the 
following conditions:
            ``(1) The principal amount of a loan or loan guarantee may 
        cover 100 percent of eligible costs, including but not limited 
        to planning, design, financing, site land development, 
        construction, rehabilitation, renovation, conversion, 
        improvements, medical equipment and furnishings, other 
        facility-related costs and capital purchase (but excluding 
        staffing).
            ``(2) The cumulative total of the principal of direct loans 
        and loan guarantees, respectively, outstanding at any one time 
        shall not exceed such limitations as may be specified in 
        appropriation Acts.
            ``(3) In the discretion of the Secretary, the program may 
        be administered by the Service or the Health Resources and 
        Services Administration (which shall be specified by 
        regulation).
            ``(4) The Secretary may make or guarantee a loan with a 
        term of the useful estimated life of the facility, or 25 years, 
        whichever is shorter.
            ``(5) The Secretary may allocate up to 100 percent of the 
        funds available for loans or loan guarantees in any year for 
        the purpose of planning and applying for a loan or loan 
        guarantee.
            ``(6) The Secretary may accept an assignment of the revenue 
        of an Indian Tribe or Tribal Organization as security for any 
        direct loan or loan guarantee under this section.
            ``(7) In the planning and design of health facilities under 
        this section, users eligible under section 807(c) may be 
        included in any projection of patient population.
            ``(8) The Secretary shall not collect loan application, 
        processing, or other similar fees from Indian Tribes or Tribal 
        Organizations applying for direct loans or loan guarantees 
        under this section.
            ``(9) Service funds authorized under loans or loan 
        guarantees in this section shall be eligible for use in 
        matching other Federal funds.
    ``(c) Amount for HCFLF.--
            ``(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 to 
                the fund under paragraph (2);
                    ``(B) such amounts as may be collected from 
                borrowers; and
                    ``(C) all interest earned on amounts in the HCFLF.
            ``(2) Initial funds.--There are authorized to be 
        appropriated such sums as may be necessary to initiate the 
        HCFLF. For each fiscal year after the initial year in which 
        funds are appropriated to the HCFLF, there is authorized to be 
        appropriated an amount equal to the sum of the amount collected 
        by the HCFLF during the preceding fiscal year and all accrued 
        interest.
            ``(3) Available until expended.--All amounts appropriated, 
        collected, or earned relative to the HCFLF shall remain 
        available until expended.
            ``(4) 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.
    ``(d) Loans Under ISDEAA.--Amounts in the HCFLF and available 
pursuant to appropriation Acts may be expended by the Secretary to make 
loans under this section to a Tribal Health Program.
    ``(e) Grants To Repay Loans.--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, small ambulatory care, staff quarters, and 
specialized care facilities). Loans eligible for such repayment grants 
shall include loans that have been obtained under this section or 
otherwise.

``SEC. 310. TRIBAL LEASING.

    ``A Tribal Health Program may lease permanent structures for the 
purpose of providing health care services without obtaining advance 
approval in appropriation Acts.

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

    ``(a) In General.--The Secretary, acting through the Service, shall 
make arrangements with Indian Tribes and Tribal Organizations to 
establish joint venture demonstration projects under which an Indian 
Tribe or Tribal Organization shall expend tribal, private, or other 
available funds, for the acquisition or construction of a health 
facility for a minimum of 10 years, under a no-cost lease, in exchange 
for agreement by the Service to provide the equipment, supplies, and 
staffing for the operation and maintenance of such a health facility. 
An Indian Tribe or Tribal Organization may use tribal funds, private 
sector, or other available resources, including loan guarantees, to 
fulfill its commitment under a joint venture entered into under this 
subsection. An Indian Tribe or Tribal Organization shall be eligible to 
establish a joint venture project if, when it submits a letter of 
intent, it--
            ``(1) has begun but not completed the process of 
        acquisition or construction of a health facility to be used in 
        the joint venture project; or
            ``(2) has not begun the process of acquisition or 
        construction of a health facility for use in the joint venture 
        project.
    ``(b) Requirements.--The Secretary shall make such an arrangement 
with an Indian Tribe or Tribal Organization only if--
            ``(1) the Secretary first determines that the Indian Tribe 
        or Tribal Organization has the administrative and financial 
        capabilities necessary to complete the timely acquisition or 
        construction of the relevant health facility; and
            ``(2) the Indian Tribe or Tribal Organization meets the 
        need criteria which shall be developed through the negotiated 
rulemaking process provided for under section 802.
    ``(c) Continued Operation.--The Secretary shall negotiate an 
agreement with the Indian Tribe or Tribal Organization regarding the 
continued operation of the facility at the end of the initial 10 year 
no-cost lease period.
    ``(d) Breach of Agreement.--An Indian Tribe or Tribal Organization 
that has entered into a written agreement with the Secretary under this 
section, and that breaches or terminates without cause such agreement, 
shall be liable to the United States for the amount that has been paid 
to the Indian Tribe or Tribal Organization, or paid to a third party on 
the Indian Tribe's or Tribal Organization's behalf, under the 
agreement. The Secretary has the right to recover tangible property 
(including supplies) and equipment, less depreciation, and any funds 
expended for operations and maintenance under this section. The 
preceding sentence does not apply to any funds expended for the 
delivery of health care services, personnel, or staffing.
    ``(e) Recovery for Nonuse.--An Indian Tribe or Tribal Organization 
that has entered into a written agreement with the Secretary under this 
subsection shall be entitled to recover from the United States an 
amount that is proportional to the value of such facility if, at any 
time within the 10-year term of the agreement, the Service ceases to 
use the facility or otherwise breaches the agreement.
    ``(f) Definition.--For the purposes of this section, the term 
`health facility' or `health facilities' includes quarters needed to 
provide housing for staff of the relevant Tribal Health Program.

``SEC. 312. LOCATION OF FACILITIES.

    ``(a) In General.--In all matters involving the reorganization or 
development of Service facilities or in the establishment of related 
employment projects to address unemployment conditions in economically 
depressed areas, the Bureau of Indian Affairs and the Service shall 
give priority to locating such facilities and projects on Indian lands 
if requested by the Indian owner and the Indian Tribe with jurisdiction 
over such lands or other lands owned or leased by the Indian Tribe or 
Tribal Organization. Top priority shall be given to Indian land owned 
by 1 or more Indian Tribes.
    ``(b) Definition.--For purposes of this section, the term `Indian 
lands' means--
            ``(1) all lands within the exterior boundaries of any 
        reservation;
            ``(2) any lands title to which is held in trust by the 
        United States for the benefit of any Indian Tribe or individual 
        Indian or held by any Indian Tribe or individual Indian subject 
        to restriction by the United States against alienation and over 
        which an Indian Tribe exercises governmental power; and
            ``(3) all lands in Alaska owned by any Alaska Native 
        village, or village or regional corporation under the Alaska 
        Native Claims Settlement Act, or any land allotted to any 
        Alaska Native.

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

    ``(a) Report.--The Secretary shall submit to the President, for 
inclusion in the report required to be transmitted to Congress under 
section 801, a report which identifies the backlog of maintenance and 
repair work required at both Service and tribal health care facilities, 
including new health care facilities expected to be in operation in the 
next fiscal year. The report shall also identify the need for 
renovation and expansion of existing facilities to support the growth 
of health care programs.
    ``(b) Maintenance of Newly Constructed Space.--The Secretary, 
acting through the Service, is authorized to expend maintenance and 
improvement funds to support maintenance of newly constructed space 
only if such space falls within the approved supportable space 
allocation for the Indian Tribe or Tribal Organization. Supportable 
space allocation shall be defined through the negotiated rulemaking 
process provided for under section 802.
    ``(c) Replacement Facilities.--In addition to using maintenance and 
improvement funds for renovation, modernization, and expansion of 
facilities, an Indian Tribe or Tribal Organization may use maintenance 
and improvement funds for construction of a replacement facility if the 
costs of renovation of such facility would exceed a maximum renovation 
cost threshold. The maximum renovation cost threshold shall be 
determined through the negotiated rulemaking process provided for under 
section 802.

``SEC. 314. TRIBAL MANAGEMENT OF FEDERALLY OWNED QUARTERS.

    ``(a) Rental Rates.--
            ``(1) Establishment.--Notwithstanding any other provision 
        of law, a Tribal Health Program which operates a hospital or 
        other health facility and the federally owned quarters 
        associated therewith pursuant to a Funding Agreement shall have 
        the authority to establish the rental rates charged to the 
        occupants of such quarters by providing notice to the Secretary 
        of its election to exercise such authority.
            ``(2) Objectives.--In establishing rental rates pursuant to 
        authority of this subsection, a Tribal Health Program shall 
        endeavor to achieve the following objectives:
                    ``(A) To base such rental rates on the reasonable 
                value of the quarters to the occupants thereof.
                    ``(B) To generate sufficient funds to prudently 
                provide for the operation and maintenance of the 
                quarters, and subject to the discretion of the Tribal 
                Health Program, to supply reserve funds for capital 
                repairs and replacement of the quarters.
            ``(3) Equitable funding.--Any quarters whose rental rates 
        are established by a Tribal Health Program pursuant to this 
        subsection shall remain eligible for quarters improvement and 
        repair funds to the same extent as all federally owned quarters 
        used to house personnel in Services-supported programs.
            ``(4) Notice of rate change.--A Tribal Health Program which 
        exercises the authority provided under this subsection shall 
        provide occupants with no less than 60 days notice of any 
        change in rental rates.
    ``(b) Direct Collection of Rent.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, and subject to paragraph (2), a Tribal Health Program 
        shall have the authority to collect rents directly from Federal 
        employees who occupy such quarters in accordance with the 
        following:
                    ``(A) The Tribal Health Program shall notify the 
                Secretary and the subject Federal employees of its 
                election to exercise its authority to collect rents 
                directly from such Federal employees.
                    ``(B) Upon receipt of a notice described in 
                subparagraph (A), the Federal employees shall pay rents 
                for occupancy of such quarters directly to the Tribal 
                Health Program and the Secretary shall have no further 
                authority to collect rents from such employees through 
                payroll deduction or otherwise.
                    ``(C) Such rent payments shall be retained by the 
                Tribal Health Program and shall not be made payable to 
                or otherwise be deposited with the United States.
                    ``(D) Such rent payments shall be deposited into a 
                separate account which shall be used by the Tribal 
                Health Program for the maintenance (including capital 
                repairs and replacement) and operation of the quarters 
                and facilities as the Tribal Health Program shall 
                determine.
            ``(2) Retrocession of authority.--If a Tribal Health 
        Program which has made an election under paragraph (1) requests 
        retrocession of its authority to directly collect rents from 
        Federal employees occupying federally owned quarters, such 
        retrocession shall become effective on the earlier of--
                    ``(A) the first day of the month that begins no 
                less than 180 days after the Tribal Health Program 
                notifies the Secretary of its desire to retrocede; or
                    ``(B) such other date as may be mutually agreed by 
                the Secretary and the Tribal Health Program.
    ``(c) Rates in Alaska.--To the extent that a Tribal Health Program, 
pursuant to authority granted in subsection (a), establishes rental 
rates for federally owned quarters provided to a Federal employee in 
Alaska, such rents may be based on the cost of comparable private 
rental housing in the nearest established community with a year-round 
population of 1,500 or more individuals.

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

    ``(a) Applicability.--The Secretary shall ensure that the 
requirements of the Buy American Act apply to all procurements made 
with funds provided pursuant to section 317. Indian Tribes and Tribal 
Organizations shall be exempt from these requirements.
    ``(b) Effect of Violation.--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 section 317, pursuant to the debarment, suspension, and 
ineligibility procedures described in sections 9.400 through 9.409 of 
title 48, Code of Federal Regulations.
    ``(c) Definitions.--For purposes of this section, the term `Buy 
American Act' means title III of the Act entitled `An Act making 
appropriations for the Treasury and Post Office Departments for the 
fiscal year ending June 30, 1934, and for other purposes', approved 
March 3, 1933 (41 U.S.C. 10a et seq.).

``SEC. 316. OTHER FUNDING FOR FACILITIES.

    ``(a) Authority To Accept Funds.--The Secretary is authorized to 
accept from any source, including Federal and State agencies, funds 
that are available for the construction of health care facilities and 
use such funds to plan, design, and construct health care facilities 
for Indians and to place such funds into Funding Agreements. Receipt of 
such funds shall have no effect on the priorities established pursuant 
to section 301.
    ``(b) Interagency Agreements.--The Secretary is authorized to enter 
into interagency agreements with other Federal agencies or State 
agencies and other entities and to accept funds from such Federal or 
State agencies or other sources to provide for the planning, design, 
and construction of health care facilities to be administered by Indian 
Health Programs in order to carry out the purposes of this Act and the 
purposes for which the funds were appropriated or for which the funds 
were otherwise provided.
    ``(c) Transferred Funds.--Any Federal agency to which funds for the 
construction of health care facilities are appropriated is authorized 
to transfer such funds to the Secretary for the construction of health 
care facilities to carry out the purposes of this Act as well as the 
purposes for which such funds are appropriated to such other Federal 
agency.
    ``(d) Establishment of Standards.--The Secretary, through the 
Service, shall establish standards by regulation, developed by 
rulemaking under section 802, for the planning, design, and 
construction of health care facilities serving Indians under this Act.

``SEC. 317. AUTHORIZATION OF APPROPRIATIONS.

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

                 ``TITLE IV--ACCESS TO HEALTH SERVICES

``SEC. 401. TREATMENT OF PAYMENTS UNDER SOCIAL SECURITY ACT HEALTH CARE 
              PROGRAMS.

    ``(a) Disregard of Medicare, Medicaid, and SCHIP Payments in 
Determining Appropriations.--Any payments received by an Indian Health 
Program or by an Urban Indian Organization made under title XVIII, XIX, 
or XXI of the Social Security Act for services provided to Indians 
eligible for benefits under such respective titles shall not be 
considered in determining appropriations for the provision of health 
care and services to Indians.
    ``(b) Nonpreferential Treatment.--Nothing in this Act authorizes 
the Secretary to provide services to an Indian with coverage under 
title XVIII, XIX, or XXI of the Social Security Act in preference to an 
Indian without such coverage.
    ``(c) Use of Funds.--
            ``(1) Special fund.--Notwithstanding any other provision of 
law, but subject to paragraph (2), payments to which a facility of the 
Service is entitled by reason of a provision of the Social Security 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 
programs of the Service which may be necessary to achieve or maintain 
compliance with the applicable conditions and requirements of titles 
XVIII, XIX, and XXI of the Social Security Act. Any amounts to be 
reimbursed that are in excess of the amount necessary to achieve or 
maintain such conditions and requirements shall, subject to the 
consultation with Indian Tribes being served by the Service Unit, be 
used for reducing the health resource deficiencies of the Indian 
Tribes. In making payments from such fund, the Secretary shall ensure 
that each Service Unit of the Service receives 100 percent of the 
amount to which the facilities of the Service, for which such Service 
Unit makes collections, are entitled by reason of a provision of the 
Social Security Act.
            ``(2) Direct payment option.--Paragraph (1) shall not apply 
        upon the election of a Tribal Health Program under subsection 
        (d) to receive payments directly. No payment may be made out of 
        the special fund described in such paragraph with respect to 
        reimbursement made for services provided during the period of 
        such election.
    ``(d) Direct Billing.--
            ``(1) In general.--A Tribal Health Program may directly 
        bill for, and receive payment for, health care items and 
        services provided by such Indian tribe or organization for 
        which payment is made under title XVIII, XIX, or XXI of the 
        Social Security Act or from any other third party payor.
            ``(2) Direct reimbursement.--
                    ``(A) Use of funds.--Each Tribal Health Program 
                exercising the option described in paragraph (1) with 
                respect to a program under a title of the Social 
                Security Act shall be reimbursed directly by that 
                program for items and services furnished without regard 
                to any other provision of law, but all amounts so 
                reimbursed shall be used by the Tribal Health Program 
                for the purpose of making any improvements in Tribal 
                facilities or Tribal Health Programs that may be 
                necessary to achieve or maintain compliance with the 
                conditions and requirements applicable generally to 
                such items and services under the program under such 
                title and to provide additional health care services, 
                improvements in health care facilities and Tribal 
                Health Programs, any health care-related purpose, or 
                otherwise to achieve the objectives provided in section 
                3 of this Act.
                    ``(B) Audits.--The amounts paid to an Indian Tribe 
                or Tribal Organization exercising the option described 
                in paragraph (1) with respect to a program under a 
                title of the Social Security Act shall be subject to 
                all auditing requirements applicable to programs 
                administered by an Indian Health Program.
            ``(3) Examination and implementation of changes.--The 
        Secretary, acting through the Service and with the assistance 
        of the Administrator of the Centers for Medicare & Medicaid 
        Services, shall examine on an ongoing basis and implement any 
        administrative changes that may be necessary to facilitate 
        direct billing and reimbursement under the program established 
        under this subsection, including any agreements with States 
        that may be necessary to provide for direct billing under a 
        program under a title of the Social Security Act.
            ``(4) Withdrawal from program.--A Tribal Health Program 
        that bills directly under the program established under this 
        subsection may withdraw from participation in the same manner 
        and under the same conditions that an Indian Tribe or Tribal 
        Organization may retrocede a contracted program to the 
        Secretary under the authority of the Indian Self-Determination 
        and Education Assistance Act (25 U.S.C. 450 et seq.). All cost 
        accounting and billing authority under the program established 
        under this subsection shall be returned to the Secretary upon 
        the Secretary's acceptance of the withdrawal of participation 
        in this program.

``SEC. 402. GRANTS TO AND FUNDING AGREEMENTS WITH THE SERVICE, INDIAN 
              TRIBES, TRIBAL ORGANIZATIONS, AND URBAN INDIAN 
              ORGANIZATIONS.

    ``(a) Indian Tribes and Tribal Organizations.--The Secretary, 
acting through the Service, shall make grants to or enter into Funding 
Agreements with Indian Tribes and Tribal Organizations to assist such 
Tribes and Tribal Organizations in establishing and administering 
programs on or near reservations and trust lands to assist individual 
Indians--
            ``(1) to enroll for benefits under title XVIII, XIX, or XXI 
        of the Social Security Act and other health benefits programs; 
        and
            ``(2) to pay premiums for coverage for such benefits, which 
        may be based on financial need (as determined by the Indian 
        Tribe or Tribes being served based on a schedule of income 
        levels developed or implemented by such Tribe or Tribes).
    ``(b) Conditions.--The Secretary, acting through the Service, shall 
place conditions as deemed necessary to effect the purpose of this 
section in any grant or Funding Agreement which the Secretary makes 
with any Indian Tribe or Tribal Organization pursuant to this section. 
Such conditions shall include requirements that the Indian Tribe or 
Tribal Organization successfully undertake--
            ``(1) to determine the population of Indians eligible for 
        the benefits described in subsection (a);
            ``(2) to educate Indians with respect to the benefits 
        available under the respective programs;
            ``(3) to provide transportation to such individual Indians 
        to the appropriate offices for enrollment or applications for 
        such benefits; and
            ``(4) to develop and implement methods of improving the 
        participation of Indians in receiving the benefits provided 
        under titles XVIII, XIX, and XXI of the Social Security Act.
    ``(c) Agreements Relating to Improving Enrollment of Indians Under 
Social Security Act Programs.--
            ``(1) Agreements with secretary to improve receipt and 
        processing of applications.--
                    ``(A) Authorization.--The Secretary, acting through 
                the Service, may enter into an agreement with an Indian 
                Tribe, Tribal Organization, or Urban Indian 
                Organization which provides for the receipt and 
                processing of applications by Indians for assistance 
                under titles XIX and XXI of the Social Security Act, 
                and benefits under title XVIII of such Act, by an 
                Indian Health Program or Urban Indian Organization.
                    ``(B) Reimbursement of costs.--Such agreements may 
                provide for reimbursement of costs of outreach, 
                education regarding eligibility and benefits, and 
                translation when such services are provided. The 
                reimbursement may, as appropriate, be added to the 
                applicable rate per encounter or be provided as a 
                separate fee-for-service payment to the Indian Tribe or 
                Tribal Organization.
                    ``(C) Processing clarified.--In this paragraph, the 
                term `processing' does not include a final 
                determination of eligibility.
            ``(2) Agreements with states for outreach on or near 
        reservation.--
                    ``(A) In general.--In order to improve the access 
                of Indians residing on or near a reservation to obtain 
                benefits under title XIX or XXI of the Social Security 
                Act, as a condition of continuing approval of a State 
                plan under such title, the State shall take steps as to 
                provide for enrollment on or near the reservation. Such 
                steps may include outreach efforts such as the 
                outstationing of eligibility workers, entering into 
                agreements with Indian Tribes and Tribal Organizations 
                to provide outreach, education regarding eligibility 
                and benefits, enrollment, and translation services when 
                such services are provided.
                    ``(B) Construction.--Nothing in subparagraph (A) 
                shall be construed as affecting arrangements entered 
                into between States and Indian Tribes and Tribal 
                Organizations for such Indian Tribes and Tribal 
                Organizations to conduct administrative activities 
                under such titles.
    ``(d) Facilitating Cooperation.--The Secretary, acting through the 
Centers for Medicare & Medicaid Services, shall take such steps as are 
necessary to facilitate cooperation with, and agreements between, 
States and the Service, Indian Tribes, Tribal Organizations, or Urban 
Indian Organizations.
    ``(e) Application to Urban Indian Organizations.--
            ``(1) In general.--The provisions of subsection (a) shall 
        apply with respect to grants and other funding to Urban Indian 
        Organizations with respect to populations served by such 
        organizations in the same manner they apply to grants and 
        Funding Agreements with Indian tribes and Tribal Organizations 
        with respect to programs on or near reservations.
            ``(2) Requirements.--The Secretary shall include in the 
        grants or Funding Agreements made or provided under paragraph 
        (1) requirements that are--
                    ``(A) consistent with the requirements imposed by 
                the Secretary under subsection (b);
                    ``(B) appropriate to Urban Indian Organizations and 
                Urban Indians; and
                    ``(C) necessary to effect the purposes of this 
                section.

``SEC. 403. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS OF HEALTH 
              SERVICES.

    ``(a) Right of Recovery.--Except as provided in subsection (f), the 
United States, an Indian Tribe, or Tribal Organization shall have the 
right to recover from an insurance company, health maintenance 
organization, employee benefit plan, third-party tortfeasor, or any 
other responsible or liable third party (including a political 
subdivision or local governmental entity of a State) the reasonable 
charges billed (or, if charges are not billed, the operational, 
administrative, and other expenses incurred) by the Secretary, an 
Indian Tribe, or Tribal Organization in providing health services, 
through the Service, an Indian Tribe, or Tribal Organization to any 
individual to the same extent that such individual, or any 
nongovernmental provider of such services, would be eligible to receive 
damages, reimbursement, or indemnification for such charges or expenses 
if--
            ``(1) such services had been provided by a nongovernmental 
        provider; and
            ``(2) such individual had been required to pay such charges 
        or expenses and did pay such charges or expenses.
    ``(b) Limitations on Recoveries From States.--Subsection (a) shall 
provide a right of recovery against any State, only if the injury, 
illness, or disability for which health services were provided is 
covered under--
            ``(1) workers' compensation laws; or
            ``(2) a no-fault automobile accident insurance plan or 
        program.
    ``(c) Nonapplication of Other Laws.--No law of any State, or of any 
political subdivision of a State and no provision of any contract, 
insurance or health maintenance organization policy, employee benefit 
plan, self-insurance plan, managed care plan, or other health care plan 
or program entered into or renewed after the date of the enactment of 
the Indian Health Care Amendments of 1988, shall prevent or hinder the 
right of recovery of the United States, an Indian Tribe, or Tribal 
Organization under subsection (a).
    ``(d) No Effect on Private Rights of Action.--No action taken by 
the United States, an Indian Tribe, or Tribal Organization to enforce 
the right of recovery provided under subsection (a) shall operate to 
deny to the injured person the recovery for that portion of the 
person's damage not covered hereunder.
    ``(e) Enforcement.--
            ``(1) In general.--The United States, an Indian Tribe, or 
        Tribal Organization may enforce the right of recovery provided 
        under subsection (a) by--
                    ``(A) intervening or joining in any civil action or 
                proceeding brought--
                            ``(i) by the individual for whom health 
                        services were provided by the Secretary, an 
                        Indian Tribe, or Tribal Organization; or
                            ``(ii) by any representative or heirs of 
                        such individual, or
                    ``(B) instituting a civil action, including a civil 
                action for injunctive relief and other relief and 
                including, with respect to a political subdivision or 
                local governmental entity of a State, such an action 
                against an official thereof.
            ``(2) Notice.--All reasonable efforts shall be made to 
        provide notice of action instituted under paragraph (1)(B) to 
        the individual to whom health services were provided, either 
        before or during the pendency of such action.
    ``(f) Limitation.--Absent specific written authorization by the 
governing body of an Indian Tribe for the period of such authorization 
(which may not be for a period of more than 1 year and which may be 
revoked at any time upon written notice by the governing body to the 
Service), the United States shall not have a right of recovery under 
this section if the injury, illness, or disability for which health 
services were provided is covered under a self-insurance plan funded by 
an Indian Tribe, Tribal Organization, or Urban Indian Organization. 
Where such authorization is provided, the Service may receive and 
expend such amounts for the provision of additional health services 
consistent with such authorization.
    ``(g) Costs and Attorneys' Fees.--In any action brought to enforce 
the provisions of this section, a prevailing plaintiff shall be awarded 
its reasonable attorneys' fees and costs of litigation.
    ``(h) Right of Action Against Insurers, HMOs, Employee Benefit 
Plans, Self-Insurance Plans, and Other Health Care Plans or Programs.--
Where an insurance company, health maintenance organization, employee 
benefit plan, self-insurance plan, managed care plan, or other health 
care plan or program 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, organization, 
plan, or program, the United States, Indian Tribe, or Tribal 
Organization shall have a right to assert and pursue all the claims and 
remedies against such company, organization, plan, or program and 
against the fiduciaries of such company, organization, plan, or program 
that the individual could assert or pursue under the terms of the 
contract, program, or plan or applicable Federal, State, or Tribal law.
    ``(i) Nonapplication of Claims Filing Requirements.--An insurance 
company, health maintenance organization, self-insurance plan, managed 
care plan, or other health care plan or program (under the Social 
Security Act or otherwise) may not deny a claim for benefits submitted 
by the Service or by an Indian Tribe or Tribal Organization based on 
the format in which the claim is submitted if such format complies with 
the format required for submission of claims under title XVIII of the 
Social Security Act or recognized under section 1175 of such Act.
    ``(j) Application to Urban Indian Organizations.--The previous 
provisions of this section shall apply to Urban Indian Organizations 
with respect to populations served by such Organizations in the same 
manner they apply to Indian Tribes and Tribal Organizations with 
respect to populations served by such Indian Tribes and Tribal 
Organizations.
    ``(k) Statute of Limitations.--The provisions of section 2415 of 
title 28, United States Code, shall apply to all actions commenced 
under this section, and the references therein to the United States are 
deemed to include Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations.
    ``(l) Savings.--Nothing in this section shall be construed to limit 
any right of recovery available to the United States, an Indian Tribe, 
or Tribal Organization under the provisions of any applicable, Federal, 
State, or Tribal law, including medical lien laws and the Federal 
Medical Care Recovery Act (42 U.S.C. 2651 et seq.).

``SEC. 404. CREDITING OF REIMBURSEMENTS.

    ``(a) Use of Amounts.--
            ``(1) Retention by program.--Except as provided in section 
        202(g) (relating to the Catastrophic Health Emergency Fund) and 
        section 807 (relating to health services for ineligible 
        persons), all reimbursements received or recovered under any of 
        the programs described in paragraph (2), including under 
        section 807, by reason of the provision of health services by 
        the Service, by an Indian Tribe or Tribal Organization, or by 
        an Urban Indian Organization, shall be credited to the Service, 
        such Indian Tribe or Tribal Organization, or such Urban Indian 
        Organization, respectively, and may be used as provided in 
        section 401. In the case of such a service provided by or 
        through a Service Unit, such amounts shall be credited to such 
        unit and used for such purposes.
            ``(2) Programs covered.--The programs referred to in 
        paragraph (1) are the following:
                    ``(A) Titles XVIII, XIX, and XXI of the Social 
                Security Act.
                    ``(B) This Act, including section 807.
                    ``(C) Public Law 87-693.
                    ``(D) Any other provision of law.
    ``(b) No Offset of Amounts.--The Service may not offset or limit 
any amount obligated to any Service Unit or entity receiving funding 
from the Service because of the receipt of reimbursements under 
subsection (a).

``SEC. 405. PURCHASING HEALTH CARE COVERAGE.

    ``(a) In General.--Insofar as amounts are made available under law 
(including a provision of the Social Security Act, the Indian Self-
Determination and Education Assistance Act, or other law, other than 
under section 402) to Indian Tribes, Tribal Organizations, and Urban 
Indian Organizations for health benefits for Service beneficiaries, 
Indian Tribes, Tribal Organizations, and Urban Indian Organizations may 
use such amounts to purchase health benefits coverage for such 
beneficiaries in any manner, including through--
            ``(1) a tribally owned and operated health care plan;
            ``(2) a State or locally authorized or licensed health care 
        plan;
            ``(3) a health insurance provider or managed care 
        organization; or
            ``(4) a self-insured plan.
The purchase of such coverage by an Indian Tribe, Tribal Organization, 
or Urban Indian Organization may be based on the financial needs of 
such beneficiaries (as determined by the Indian Tribe or Tribes being 
served based on a schedule of income levels developed or implemented by 
such Indian Tribe or Tribes).
    ``(b) Expenses for Self-Insured Plan.--In the case of a self-
insured plan under subsection (a)(4), the amounts may be used for 
expenses of operating the plan, including administration and insurance 
to limit the financial risks to the entity offering the plan.
    ``(c) Construction.--Nothing in this section shall be construed as 
affecting the use of any amounts not referred to in subsection (a).

``SEC. 406. SHARING ARRANGEMENTS WITH FEDERAL AGENCIES.

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

``SEC. 407. PAYOR OF LAST RESORT.

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

``SEC. 408. NONDISCRIMINATION IN QUALIFICATIONS FOR REIMBURSEMENT FOR 
              SERVICES.

    ``For purposes of determining the eligibility of an entity that is 
operated by the Service, an Indian Tribe, Tribal Organization, or Urban 
Indian Organization to receive payment or reimbursement from any 
federally funded health care program for health care services it 
furnishes to an Indian, any requirement that the entity be licensed or 
recognized under State or local law to furnish such services shall be 
deemed to have been met if the entity meets quality requirements for 
the furnishing of such services recognized by the Secretary.

``SEC. 409. CONSULTATION.

    ``(a) National Indian Technical Advisory Group (TAG).--
            ``(1) Establishment and membership.--The Secretary shall 
        establish a National Indian Technical Advisory Group (in this 
        subsection referred to as the `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 Secretary may 
appoint additional members upon the recommendation of the Advisory 
Group.
            ``(2) Duties.--
                    ``(A) Identification of issues.--The Advisory Group 
                shall assist the Secretary in identifying and 
                addressing issues regarding the health care programs 
                under the Social Security Act (including medicare, 
                medicaid, and SCHIP) that have implications for Indian 
                Health Programs or Urban Indian Organizations. The 
                Advisory Group shall provide advice to the Secretary 
                with respect to those issues and with respect to the 
                need for the Secretary to engage in consultation with 
                Indian Tribes, Tribal Organizations, and Urban Indian 
                Organizations.
                    ``(B) Construction.--Nothing in subparagraph (A) 
                shall be construed as affecting any requirement under 
                any applicable Executive order for the Secretary to 
                consult with Indian Tribes in cases of health care 
                policies that have implications for Indian Health 
                Programs or Urban Indian Organizations.
            ``(3) Funding.--The Secretary shall pay the expenses of the 
        Advisory Group using the general administrative funds of the 
        Centers for Medicare & Medicaid Services.
            ``(4) Nonapplication of federal advisory committee act.--
        The Federal Advisory Committee Act (5 U.S.C. App.) shall not 
        apply to the Advisory Group.
            ``(5) Meetings.--The Secretary shall convene meetings of 
        the Advisory Group no less frequently than quarterly.
    ``(b) Solicitation of Medicaid Advice.--
            ``(1) In general.--As a requirement for payment under title 
        XIX of the Social Security Act to a State in which the Service 
        operates or funds health care programs or in which 1 or more 
        Indian Health Programs or Urban Indian Organizations provide 
        health care in the State for which medical assistance is 
        available under such title, the State shall establish a process 
        under which the State seeks advice on a regular, ongoing basis 
        (at least on a quarterly basis) from designees of such Indian 
        Health Programs and Urban Indian Organizations on matters 
        relating to the application of such title to such Indian Health 
        Programs and Urban Indian Organizations.
            ``(2) Manner of advice.--Such process shall be in addition 
        to (and not in lieu of) any consultation otherwise required by 
        law and shall apply before the submittal of plan amendments, 
        waiver requests, and proposals for demonstration projects. Such 
        process may include appointment of an advisory committee and of 
        a designee of such Indian Health Programs and Urban Indian 
        Organizations to the medical care advisory committee advising 
        the State on its medicaid plan.
            ``(3) Payment of expenses.--Expenses in carrying out this 
        subsection shall be treated as reasonable administrative 
        expenses for which reimbursement may be made under section 
        1903(a) of the Social Security Act.
    ``(c) Construction.--Nothing in this section shall be construed as 
superseding existing advisory committees, working groups, or other 
advisory procedures established by the Secretary or by any State.

``SEC. 410. STATE CHILDREN'S HEALTH INSURANCE PROGRAM (SCHIP).

    ``(a) Authorization for Arrangements.--Notwithstanding any other 
provision of law, insofar as the State health plan of a State under 
title XXI of the Social Security Act may provide (whether through its 
medicaid plan under title XIX of such Act or otherwise) child or other 
health assistance to individuals who are otherwise served by the 
Service or by an Indian Tribe or Tribal Organization, the Secretary may 
enter into an arrangement with the State and with the Service or 1 or 
more Indian Tribes and Tribal Organizations in the State under which a 
portion of the funds otherwise made available to the State under such 
title with respect to such individuals is provided to the Service, 
Indian Tribe, or Tribal Organization, respectively, for the purpose of 
providing such assistance to such individuals consistent with the 
purposes of such title.
    ``(b) Entering Into Arrangements.--
            ``(1) In general.--Notwithstanding any other provision of 
        law, in the case of a State which has an unexpended allotment 
        amount described in paragraph (2) for a fiscal year, before 
        effecting any reallotment of such amount to other States, at 
        the request of the Service or 1 or more Indian Tribes or Tribal 
        Organizations that operate in the State with respect to 
        individuals who are served by such Service, Indian Tribes, or 
        Tribal Organizations, the Secretary shall enter into an 
        arrangement with the Service, Indian Tribes, or Tribal 
        Organizations under which the Indian child proportion (as 
        defined in paragraph (3)) for such Service, Indian Tribes, or 
Tribal Organizations of such unexpended allotment amount is made 
available to the Service or such Indian Tribes or Tribal Organizations 
for the purpose of providing child health or other assistance to 
individuals who are otherwise served by the Service or by such Indian 
Tribes or Tribal Organizations consistent with the purposes of title 
XXI of the Social Security Act. Insofar as amounts are made available 
under the preceding sentence, such amounts shall be treated (for 
purposes of title XXI of the Social Security Act) as if they had been 
expended during the period referred to in paragraph (2).
            ``(2) Unexpended allotment amount.--For purposes of this 
        subsection, the term `unexpended allotment amount' means, with 
        respect to an allotment to a State under section 2104 of the 
        Social Security Act for a fiscal year, the portion of such 
        allotment which was not expended by the State during the period 
        in which such allotment is available for expenditure by the 
        State and which would, but for this subsection, be realloted to 
        other States.
            ``(3) Indian child proportion.--For purposes of this 
        subsection, the term `Indian child proportion' means, with 
        respect to an unexpended allotment amount for a State and an 
        arrangement under paragraph (1) with the Service or Indian 
        Tribes or Tribal Organizations, the proportion of targeted low-
        income children in the State (as defined in section 2110(b) of 
        the Social Security Act) who are Indians who would be served 
        under an arrangement with the Service or such Indian Tribes or 
        Tribal Organizations under such paragraph, as estimated by the 
        Secretary of Health and Human Services based upon the best 
        available data before a portion of the unexpended allotment 
        amount is made available under this subsection.

``SEC. 411. SOCIAL SECURITY ACT SANCTIONS.

    ``(a) Requests for Waiver of Sanctions.--For purposes of applying 
any authority under a provision of title XI, XVIII, XIX, or XXI of the 
Social Security Act to seek a waiver of a sanction imposed against a 
health care provider insofar as that provider provides services to 
individuals through an Indian Health Program, any requirement that a 
State request such a waiver shall be deemed to be met if such Indian 
Health Program requests such a waiver.
    ``(b) Safe Harbor for Transactions Between and Among Indian Health 
Care Programs.--For purposes of applying section 1128B(b) of the Social 
Security Act, the exchange of anything of value between or among the 
following shall not be treated as remuneration if the exchange arises 
from or relates to any of the following health programs:
            ``(1) An exchange between or among the following:
                    ``(A) Any Indian Health Program.
                    ``(B) Any Urban Indian Organization.
            ``(2) An exchange between an Indian Tribe, Tribal 
        Organization, or an Urban Indian Organization and any patient 
        served or eligible for service from an Indian Tribe, Tribal 
        Organization, or Urban Indian Organization, including patients 
        served or eligible for service pursuant to section 807, but 
        only if such exchange--
                    ``(A) is for the purpose of transporting the 
                patient for the provision of health care items or 
                services;
                    ``(B) is for the purpose of providing housing to 
                the patient (including a pregnant patient) and 
                immediate family members or an escort incidental to 
                assuring the timely provision of health care items and 
                services to the patient;
                    ``(C) is for the purpose of paying premiums, 
                copayments, deductibles, or other cost-sharing on 
                behalf of patients; or
                    ``(D) consists of an item or service of small value 
                that is provided as a reasonable incentive to secure 
                timely and necessary preventive and other items and 
                services.
            ``(3) Such other exchanges involving an Indian Health 
        Program, an Urban Indian Organization, or an Indian Tribe or 
        Tribal Organization as meet such standards as the Secretary of 
        Health and Human Services, in consultation with the Attorney 
        General, determines is appropriate, taking into account the 
        special circumstances of such Indian Health Programs, Urban 
        Indian Organizations, Indian Tribes, and Tribal Organizations 
        and of patients served by Indian Health Programs, Urban Indian 
        Organizations, Indian Tribes, and Tribal Organizations.

``SEC. 412. COST SHARING.

    ``(a) Coinsurance, Copayments, and Deductibles.--Notwithstanding 
any other provision of Federal or State law--
            ``(1) Protection for eligible indians under social security 
        act health programs.--No Indian who is furnished an item or 
        service for which payment may be made under title XVIII, XIX, 
        or XXI of the Social Security Act may be charged a deductible, 
        copayment, or coinsurance if the item or service is furnished 
        by, or upon referral made by, the Service, an Indian Tribe, 
        Tribal Organization, or Urban Indian Organization.
            ``(2) Protection for indians.--No Indian who is furnished 
        an item or service by the Service may be charged a deductible, 
        copayment, or coinsurance.
            ``(3) No reduction in amount of payment to indian health 
        providers.--The payment or reimbursement due to the Service, 
        Indian Tribe, Tribal Organization, or Urban Indian Organization 
        under title XVIII, XIX, or XXI of the Social Security Act may 
        not be reduced by the amount of the deductible, copayment, or 
        coinsurance that would be due from the Indian but for the 
        operation of this section.
    ``(b) Exemption From Medicaid and SCHIP Premiums.--Notwithstanding 
any other provision of Federal or State law, no Indian who is otherwise 
eligible for services under title XIX of the Social Security Act 
(relating to the medicaid program) or title XXI of such Act (relating 
to the State children's health insurance program) may be charged a 
premium as a condition of receiving benefits under the program under 
the respective title.
    ``(c) Medically Needy Program Spend-Down.--For the purposes of 
determining the eligibility of an Indian for medical assistance under 
any medically needy option under a State's medicaid plan under title 
XIX of the Social Security Act, the cost of providing services to an 
Indian in a health program of the Service, an Indian Tribe, Tribal 
Organization, or Urban Indian Organization shall be deemed to have been 
an expenditure for health care by the Indian.
    ``(d) Limitation on Medical Child Support Recovery.--
Notwithstanding any other provision of law, a parent (whether or not an 
Indian) of an Indian child shall not be responsible for reimbursing a 
State or the Federal Government under title XIX or XXI of the Social 
Security Act for the cost of medical services relating to the child 
(including childbirth and including, where such child is a minor 
parent, any child of such minor parent) under circumstances in which 
payment would have been made under the contract health services program 
of an Indian Health Program but for the child's (or, in the case of 
medical services relating to childbirth, mother's, or grandchild's, as 
the case may be) eligibility under title XIX or XXI of the Social 
Security Act.
    ``(e) Treatment of Certain Property for Medicaid Eligibility.--
Notwithstanding any other provision of Federal or State law, the 
following property may not be included when determining eligibility for 
services under title XIX of the Social Security Act:
            ``(1) Property, including interests in real property 
        currently or formerly held in trust by the Federal Government 
        which is protected under applicable Federal, State, or Tribal 
        law or custom from recourse and including public domain 
        allotments.
            ``(2) Property that has unique religious or cultural 
        significance or that supports subsistence or traditional 
        lifestyle according to applicable Tribal law or custom.
    ``(f) Continuation of Current Law Protections of Certain Indian 
Property From Medicaid Estate Recovery.--Income, resources, and 
property that are exempt from medicaid estate recovery under title XIX 
of the Social Security Act as of April 1, 2003, under manual 
instructions issued to carry out section 1917(b)(3) of such Act because 
of Federal responsibility for Indian Tribes and Alaska Native Villages 
shall remain so exempt. Nothing in this subsection shall be construed 
as preventing the Secretary from providing additional medicaid estate 
recovery exemptions for Indians.

``SEC. 413. TREATMENT UNDER MEDICAID MANAGED CARE.

    ``(a) Payment for Services Furnished to Indians.--In the case of an 
Indian who is enrolled with a managed care entity under section 1932 of 
the Social Security Act (or otherwise under a waiver under title XIX of 
such Act) and who receives covered services from an Indian Health 
Program or an Urban Indian Organization, either--
            ``(1) the entity shall make payment to the Indian Health 
        Program or Urban Indian Organization at a rate established by 
        the entity for such services that is not less than the rate for 
        preferred providers (or at such other rate as may be negotiated 
        between the entity and such Indian Health Program or Urban 
        Indian Organization) and shall not require submittal of a claim 
        by the enrollee as a condition of payment to the Indian Health 
        Program or Urban Indian Organization; or
            ``(2) the State shall provide for payment to the Indian 
        Health Program or Urban Indian Organization under its State 
        plan under title XIX of such Act at the rate otherwise 
        applicable and shall provide for an appropriate adjustment of 
        the capitation payment made to the entity to take into account 
        such payment.
    ``(b) Offering of Managed Care.--If--
            ``(1) a State elects under its State plan under title XIX 
        of the Social Security Act to provide services through medicaid 
        managed care organizations or through primary care case 
        managers under section 1932 or under a waiver under such title; 
        and
            ``(2) the Indian Health Program or Urban Indian 
        Organization that is funded in whole or in part by the Service, 
        or a consortium thereof, has established a medicaid managed 
        care organization or a primary care case manager that meets 
        quality standards equivalent to those required of such an 
        organization or manager under such section or waiver,
the State shall enter into an agreement under such section with the 
Service, Indian Tribe, Tribal Organization, or Urban Indian 
Organization, or such consortium, to serve as a medicaid managed care 
organization or a primary care case manager, respectively with respect 
to Indians served by such entity. In carrying out this subsection, the 
Secretary and the State may waive requirements regarding enrollment, 
capitalization, and such other matters that might otherwise prevent the 
application of the previous sentence.

``SEC. 414. NAVAJO NATION MEDICAID AGENCY.

    ``(a) In General.--Notwithstanding any other provision of law, the 
Secretary is authorized to treat the Navajo Nation as a State for the 
purposes of title XIX of the Social Security Act, to provide services 
to Indians living within the boundaries of the Navajo Nation.
    ``(b) Assignment and Payment.--Notwithstanding any other provision 
of law, the Secretary may assign and pay all expenditures for the 
provision of services to Indians living within the boundaries of the 
Navajo Nation under title XIX of the Social Security Act and related 
administrative funds under such title, which are currently paid to or 
would otherwise be paid to the States of Arizona, New Mexico, and Utah, 
to an entity established by the Navajo Nation and approved by the 
Secretary, which shall be denominated the Navajo Nation Medicaid 
Agency.
    ``(c) 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 single 
State medicaid agencies 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.
    ``(e) FMAP.--Notwithstanding section 1905(b) of the Social Security 
Act, the Federal medical assistance percentage shall be 100 per centum 
with respect to amounts the Navajo Nation Medicaid Agency expends for 
medical assistance for services and for related administrative costs.
    ``(f) Demonstration Funding.--The Secretary is further authorized 
to assist the Navajo Nation by providing funding including 
demonstration grant funding for this project.
    ``(g) 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.
    ``(h) Optional Application to SCHIP.--In the option of the Navajo 
Nation, the Secretary is authorized to treat the Navajo Nation as a 
State for the purposes of title XXI of the Social Security Act 
(relating to the State children's health insurance program) under terms 
equivalent to those described in subsections (a) through (g).

``SEC. 415. AUTHORIZATION OF APPROPRIATIONS.

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

              ``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

``SEC. 501. PURPOSE.

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

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

    ``Under authority of the Act of November 2, 1921 (25 U.S.C. 13; 
popularly known as the Snyder Act), the Secretary, acting 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. Subject to section 506, the 
Secretary, acting through the Service, shall include such conditions as 
the Secretary considers necessary to effect the purpose of this title 
in any contract into which the Secretary enters 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) Requirements for Grants and Contracts.--Under authority of 
the Act of November 2, 1921 (25 U.S.C. 13; popularly 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) Access to Health Promotion and Disease Prevention Programs.--
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 or receiving grants under subsection (a).
    ``(d) Immunization Services.--
            ``(1) Access or services provided.--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.
            ``(2) Definition.--For purposes of this subsection, the 
        term `immunization services' means services to provide without 
        charge immunizations against vaccine-preventable diseases.
    ``(e) Mental Health Services.--
            ``(1) Access or services provided.--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 subsection (a).
            ``(2) Assessment required.--Except as provided by paragraph 
        (3)(A), 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 following:
                    ``(A) The mental health needs of the Urban Indian 
                population concerned.
                    ``(B) The mental health services and other related 
                resources available to that population.
                    ``(C) The barriers to obtaining those services and 
                resources.
                    ``(D) The needs that are unmet by such services and 
                resources.
            ``(3) Purposes of grants.--Grants may be made under this 
        subsection for the following:
                    ``(A) 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.
                    ``(D) To develop innovative behavioral health 
                service delivery models which incorporate Indian 
                cultural support systems and resources.
    ``(f) Prevention of Child Abuse.--
            ``(1) Access or services provided.--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 or receiving 
        grants under subsection (a) to prevent and treat child abuse 
        (including sexual abuse) among Urban Indians.
            ``(2) Evaluation required.--Except as provided by paragraph 
        (3)(A), 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) Purposes of grants.--Grants may be made under this 
        subsection for the following:
                    ``(A) To prepare assessments required under 
                paragraph (2).
                    ``(B) For the development of prevention, training, 
                and education programs for Urban Indians, 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.
                    ``(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 when making grants.--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) Other Grants.--The Secretary, acting through the Service, may 
enter into a contract with or make grants to an Urban Indian 
Organization that provides or arranges for the provision of health care 
services (through satellite facilities, provider networks, or 
otherwise) to Urban Indians in more than 1 Urban Center.

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

    ``(a) Grants and Contracts Authorized.--Under authority of the Act 
of November 2, 1921 (25 U.S.C. 13; popularly 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.
    ``(b) Purpose.--The purpose of a contract or grant made under this 
section shall be the determination of the matters described in 
subsection (c)(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.
    ``(c) Grant and Contract Requirements.--Any contract entered into, 
or grant made, by the Secretary under this section shall include 
requirements that--
            ``(1) the Urban Indian Organization successfully undertakes 
        to--
                    ``(A) document the health care status and unmet 
                health care needs of Urban Indians in the Urban Center 
                involved; and
                    ``(B) with respect to Urban Indians in the Urban 
                Center involved, determine the matters described in 
                paragraphs (2), (3), (4), and (7) of section 503(b); 
                and
            ``(2) the Urban Indian Organization complete performance of 
        the contract, or carry out the requirements of the grant, 
        within 1 year after the date on which the Secretary and such 
        organization enter into such contract, or within 1 year after 
        such organization receives such grant, whichever is applicable.
    ``(d) No Renewals.--The Secretary may not renew any contract 
entered into or grant made under this section.

``SEC. 505. EVALUATIONS; RENEWALS.

    ``(a) Procedures for Evaluations.--The Secretary, acting through 
the Service, shall develop procedures to evaluate compliance with grant 
requirements 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) Evaluations.--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 or grant. For purposes of this evaluation, 
in determining the capacity of an Urban Indian Organization to deliver 
quality patient care the Secretary shall, at the option of the 
organization--
            ``(1) acting through the Service, conduct an annual onsite 
        evaluation of the organization; or
            ``(2) accept in lieu of such onsite evaluation evidence of 
        the organization's provisional or full accreditation by a 
        private independent entity recognized by the Secretary for 
        purposes of conducting quality reviews of providers 
        participating in the Medicare program under title XVIII of the 
        Social Security Act.
    ``(c) Noncompliance; Unsatisfactory Performance.--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 the organization the areas 
of noncompliance or unsatisfactory performance and modify the contract 
or grant to prevent future occurrences of noncompliance or 
unsatisfactory performance. If the Secretary determines that the 
noncompliance or unsatisfactory performance cannot be resolved and 
prevented in the future, the Secretary shall not renew the contract or 
grant with the 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) Considerations for Renewals.--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 shall 
consider the results of the onsite evaluations or accreditations under 
subsection (b).

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

    ``(a) Procurement.--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 sections 1304, 3131, and 3133 of title 40, United States Code.
    ``(b) Payments Under Contracts or Grants.--Payments under any 
contracts or grants pursuant to this title shall, notwithstanding any 
term or condition of such contract or grant--
            ``(1) be made in their entirety by the Secretary to the 
        Urban Indian Organization by no later than the end of the first 
        30 days of the funding period with respect to which the 
        payments apply, unless the Secretary determines through an 
        evaluation under section 505 that the organization is not 
        capable of administering such payments in their entirety; and
            ``(2) if any portion thereof is unexpended by the Urban 
        Indian Organization during the funding period with respect to 
        which the payments initially apply, shall be carried forward 
        for expenditure with respect to allowable or reimbursable costs 
        incurred by the organization during 1 or more 
subsequent funding periods without additional justification or 
documentation by the organization as a condition of carrying forward 
the availability for expenditure of such funds.
    ``(c) Revision or Amendment of Contracts.--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 Services and Assistance.--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.

``SEC. 507. REPORTS AND RECORDS.

    ``(a) Reports.--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 Urban Indian 
Organization shall submit to the Secretary not more frequently than 
every 6 months, a report that includes the following:
            ``(1) In the case of a contract or grant under section 503, 
        recommendations pursuant to section 503(a)(5).
            ``(2) Information on activities conducted by the 
        organization pursuant to the contract or grant.
            ``(3) An accounting of the amounts and purpose for which 
        Federal funds were expended.
            ``(4) A minimum set of data, using uniformly defined 
        elements, that is specified by the Secretary in consultation, 
        consistent with section 514, with Urban Indian Organizations.
    ``(b) Audit.--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) Costs of Audits.--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, acting through the Service, 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.--The Secretary, acting through the Service or through 
the Health Resources and Services Administration, may provide to 
contractors or grant recipients under this title loans from the Urban 
Indian Health Care Facilities Revolving Loan Fund described in 
subsection (c), or guarantees for loans, for the construction, 
renovation, expansion, or purchase of health care facilities, subject 
to the following requirements:
            ``(1) The principal amount of a loan or loan guarantee may 
        cover 100 percent of the costs (other than staffing) relating 
        to the facility, including planning, design, financing, site 
        land development, construction, rehabilitation, renovation, 
        conversion, medical equipment, furnishings, and capital 
        purchase.
            ``(2) The total of the principal of loans and loan 
        guarantees, respectively, outstanding at any one time shall not 
        exceed such limitations as may be specified in appropriation 
        Acts.
            ``(3) The loan or loan guarantee may have a term of the 
        shorter of the estimated useful life of the facility or 25 
        years.
            ``(4) An Urban Indian Organization may assign, and the 
        Secretary may accept assignment of, the revenue of the Urban 
        Indian 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) 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 (hereafter in this 
        section referred to as the ``URLF''). 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 amount in fund.--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) Investment of amounts in fund.--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.
            ``(4) Initial funds.--There are authorized to be 
        appropriated such sums as may be necessary to initiate the 
        URLF. For each fiscal year after the initial year in which 
        funds are appropriated to the URLF, there is authorized to be 
        appropriated an amount equal to the sum of the amount collected 
        by the URLF during the preceding fiscal year and all accrued 
        interest.

``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 Authorized.--The Secretary, acting through the 
Service, may make grants for the provision of health-related services 
in prevention of, treatment of, rehabilitation of, or school- and 
community-based education regarding, alcohol and substance abuse in 
Urban Centers to those Urban Indian Organizations with which the 
Secretary has entered into a contract under this title or under section 
201.
    ``(b) Goals.--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 
following:
            ``(1) The 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. The 
        standards shall be negotiated and agreed to between the 
        Secretary and the grantee on a grant-by-grant basis.
            ``(4) Identification of the need for services.
    ``(d) Allocation of Grants.--The Secretary shall develop a 
methodology for allocating grants made pursuant to this section based 
on the criteria established pursuant to subsection (c).
    ``(e) Grants Subject to Criteria.--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.

    ``Notwithstanding any other provision of law, the Tulsa Clinic and 
Oklahoma City Clinic demonstration projects shall--
            ``(1) be permanent programs within the Service's direct 
        care program;
            ``(2) continue to be treated as Service Units in the 
        allocation of resources and coordination of care; and
            ``(3) shall be subject to the provisions of the Indian 
        Self-Determination and Education Assistance Act, except that 
        the programs shall not be divisible.

``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.

    ``(a) Grants and Contracts.--The Secretary, through the Office of 
Urban Indian Health, shall make grants or enter into contracts with 
Urban Indian Organizations for the administration of Urban Indian 
alcohol programs that were originally established under the National 
Institute on Alcoholism and Alcohol Abuse (hereafter in this section 
referred to as `NIAAA') and transferred to the Service. Such grants and 
contracts shall become effective no later than September 30, 2004.
    ``(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 the NIAAA and subsequently 
transferred to the Service are eligible for grants or contracts under 
this section.
    ``(d) Report.--The Secretary shall evaluate and report to Congress 
on the activities of programs funded under this section not less than 
every 5 years.

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

    ``(a) In General.--The Secretary shall ensure that the Service, the 
Centers for Medicare & Medicaid Services, and other operating divisions 
and staff divisions of the Department consult, to the greatest extent 
practicable, with Urban Indian Organizations 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) Definition of Consultation.--For purposes of subsection (a), 
consultation is the open and free exchange of information and opinion 
among Urban Indian Organizations and the operating and staff divisions 
of the Department which leads to mutual understanding and comprehension 
and which emphasizes trust, respect, and shared responsibility.

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

    ``(a) In General.--With respect to claims resulting from the 
performance of functions during fiscal year 2004 and thereafter, or 
claims asserted after September 30, 2003, but resulting from the 
performance of functions prior to fiscal year 2004, under a contract, 
grant agreement, or any other agreement authorized under this title, an 
Urban Indian Organization is deemed hereafter to be part of the Service 
in the Department of Health and Human Services while carrying out any 
such contract or agreement and its employees are deemed employees of 
the Service while acting within the scope of their employment in 
carrying out the contract or agreement. After September 30, 2003, any 
civil action or proceeding involving such claims brought hereafter 
against any Urban Indian Organization or any employee of such Urban 
Indian Organization covered by this provision shall be deemed to be an 
action against the United States and will be defended by the Attorney 
General and be afforded the full protection and coverage of the Federal 
Tort Claims Act (28 U.S.C. 1346(b), 2671 et seq.).
    ``(b) Claims Resulting From Performance of Contract or Grant.--
Beginning with the fiscal year ending September 30, 2003, and 
thereafter, the appropriate Secretary shall request through annual 
appropriations funds sufficient to reimburse the Treasury for any 
claims paid in the prior fiscal year pursuant to the foregoing 
provisions.
    ``(c) Effect on ISDEAA.--Nothing in this section shall in any way 
affect the provisions of section 102(d) of the Indian Self-
Determination and Education Assistance Act of 1975 (25 U.S.C. 450f(d)).

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

    ``(a) Construction and Operation.--The Secretary, acting through 
the Service, through grant or contract, shall 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) Definition of State.--A State described in this subsection is 
a State in which--
            ``(1) there resides Urban Indian youth with need for 
        alcohol and substance abuse treatment services in a residential 
        setting; and
            ``(2) there is a significant shortage of culturally 
        competent residential treatment services for Urban Indian 
        youth.

``SEC. 517. USE OF FEDERAL GOVERNMENT FACILITIES AND SOURCES OF SUPPLY.

    ``(a) Authorization for Use.--The Secretary, acting through the 
Service, shall allow an Urban Indian Organization that has entered into 
a contract or received a grant pursuant to this title, in carrying out 
such contract or grant, to use existing facilities and all equipment 
therein or pertaining thereto and other personal property owned by the 
Federal Government within the Secretary's jurisdiction under such terms 
and conditions as may be agreed upon for their use and maintenance.
    ``(b) Donations.--Subject to subsection (d), the Secretary may 
donate to an Urban Indian Organization that has entered into a contract 
or received a grant pursuant to this title any personal or real 
property determined to be excess to the needs of the Service or the 
General Services Administration for purposes of carrying out the 
contract or grant.
    ``(c) Acquisition of Property for Donation.--The Secretary may 
acquire excess or surplus government personal or real property for 
donation (subject to subsection (d)), to an Urban Indian Organization 
that has entered into a contract or received a grant pursuant to this 
title if the Secretary determines that the property is appropriate for 
use by the Urban Indian Organization for a purpose for which a contract 
or grant is authorized under this title.
    ``(d) Priority.--In the event that the Secretary receives a request 
for donation of a specific item of personal or real property described 
in subsection (b) or (c) from both an Urban Indian Organization and 
from an Indian Tribe or Tribal Organization, the Secretary shall give 
priority to the request for donation of the Indian Tribe or Tribal 
Organization if the Secretary receives the request from the Indian 
Tribe or Tribal Organization before the date the Secretary transfers 
title to the property or, if earlier, the date the Secretary transfers 
the property physically to the Urban Indian Organization.
    ``(e) Urban Indian Organizations Deemed Executive Agency for 
Certain Purposes.--For purposes of section 501 of title 40, United 
States Code, (relating to Federal sources of supply, including lodging 
providers, airlines, and other transportation providers), an Urban 
Indian Organization that has entered into a contract or received a 
grant pursuant to this title shall be deemed an executive agency when 
carrying out such contract or grant, 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) Grants Authorized.--The Secretary may make grants to those 
Urban Indian Organizations that have entered into a contract or have 
received a grant under this title for the provision of services for the 
prevention and treatment of, and control of the complications resulting 
from, diabetes among Urban Indians.
    ``(b) Goals.--Each grant made pursuant to subsection (a) shall set 
forth the goals to be accomplished under the grant. The goals shall be 
specific to each grant as agreed to between the Secretary and the 
grantee.
    ``(c) Establishment of Criteria.--The Secretary shall establish 
criteria for the grants made under subsection (a) relating to the 
following:
            ``(1) The size and location of the Urban Indian population 
        to be served.
            ``(2) The need for prevention of and treatment of, and 
        control of the complications resulting from, diabetes among the 
        Urban Indian population to be served.
            ``(3) Performance standards for the organization in meeting 
        the goals set forth in such grant that are negotiated and 
        agreed to by the Secretary and the grantee.
            ``(4) The capability of the organization to adequately 
        perform the activities required under the grant.
            ``(5) The willingness of the organization to collaborate 
        with the registry, if any, established by the Secretary under 
        section 204(e) in the Area Office of the Service in which the 
        organization is located.
    ``(d) Funds Subject to Criteria.--Any funds received by an Urban 
Indian Organization under this Act for the prevention, treatment, and 
control of diabetes among Urban Indians shall be subject to the 
criteria developed by the Secretary under subsection (c).

``SEC. 519. COMMUNITY HEALTH REPRESENTATIVES.

    ``The Secretary, acting through the Service, may enter into 
contracts with, and make grants to, Urban Indian Organizations for the 
employment of Indians trained as health service providers through the 
Community Health Representatives Program under section 109 in the 
provision of health care, health promotion, and disease prevention 
services to Urban Indians.

``SEC. 520. REGULATIONS.

    ``(a) Requirements for Regulations.--The Secretary may promulgate 
regulations to implement the provisions of this title in accordance 
with the following:
            ``(1) Proposed regulations to implement this Act shall be 
        published in the Federal Register by the Secretary no later 
        than 9 months after the date of the enactment of this Act and 
        shall have no less than a 4-month comment period.
            ``(2) The authority to promulgate regulations under this 
        Act shall expire 18 months from the date of the enactment of 
        this Act.
    ``(b) Effective Date of Title.--The amendments to this title made 
by the Indian Health Care Improvement Act Amendments of 2003 shall be 
effective on the date of the enactment of such amendments, regardless 
of whether the Secretary has promulgated regulations implementing such 
amendments have been promulgated.

``SEC. 521. ELIGIBILITY FOR SERVICES.

    ``Urban Indians shall be eligible for health care or referral 
services provided pursuant to this title.

``SEC. 522. AUTHORIZATION OF APPROPRIATIONS.

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

                ``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

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

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

``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.

    ``(a)(1) The Secretary shall establish an automated management 
information system for the Service.
    ``(2) The information system established under paragraph (1) shall 
include--
            ``(A) a financial management system;
            ``(B) a patient care information system for each area 
        served by the Service;
            ``(C) a privacy component that protects the privacy of 
        patient information held by, or on behalf of, the Service;
            ``(D) a services-based cost accounting component that 
        provides estimates of the costs associated with the provision 
        of specific medical treatments or services in each Area Office 
        of the Service;
            ``(E) an interface mechanism for patient billing and 
        accounts receivable system; and
            ``(F) a training component.
    ``(b) The Secretary shall provide each Tribal Health Program 
automated management information systems which--
            ``(1) meet the management information needs of such Tribal 
        Health Program with respect to the treatment by the Tribal 
        Health Program of patients of the Service; and
            ``(2) meet the management information needs of the Service.
    ``(c) Notwithstanding any other provision of law, each patient 
shall have reasonable access to the medical or health records of such 
patient which are held by, or on behalf of, the Service.
    ``(d) The Director shall have the authority to enter into 
contracts, agreements, or joint ventures with other Federal agencies, 
States, private and nonprofit organizations, for the purpose of 
enhancing information technology in Indian Health Programs and 
facilities.

``SEC. 603. AUTHORIZATION OF APPROPRIATIONS.

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

                ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

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

    ``(a) Purposes.--The purposes of this section are as follows:
            ``(1) To authorize and direct the Secretary, acting through 
        the Service, Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations, to develop a comprehensive behavioral 
        health prevention and treatment program which emphasizes 
        collaboration among alcohol and substance abuse, social 
        services, and mental health programs.
            ``(2) To provide information, direction, and guidance 
        relating to mental illness and dysfunction and self-destructive 
        behavior, including child abuse and family violence, to those 
        Federal, tribal, State, and local agencies responsible for 
        programs in Indian communities in areas of health care, 
        education, social services, child and family welfare, alcohol 
        and substance abuse, law enforcement, and judicial services.
            ``(3) To assist Indian Tribes to identify services and 
        resources available to address mental illness and dysfunctional 
        and self-destructive behavior.
            ``(4) To provide authority and opportunities for Indian 
        Tribes and Tribal Organizations to develop, implement, and 
        coordinate with community-based programs which include 
        identification, prevention, education, referral, and treatment 
        services, including through multidisciplinary resource teams.
            ``(5) To ensure that Indians, as citizens of the United 
        States and of the States in which they reside, have the same 
        access to behavioral health services to which all citizens have 
        access.
            ``(6) To modify or supplement existing programs and 
        authorities in the areas identified in paragraph (2).
    ``(b) Plans.--
            ``(1) Development.--The Secretary, acting through the 
        Service, Indian Tribes, Tribal Organizations, and Urban Indian 
        Organizations, shall encourage Indian Tribes and Tribal 
        Organizations to develop tribal plans, and Urban Indian 
        Organizations to develop local plans, and for all such groups 
        to participate in developing areawide plans for Indian 
        Behavioral Health Services. The plans shall include, to the 
        extent feasible, the following components:
                    ``(A) An assessment of the scope of alcohol or 
                other substance abuse, mental illness, and 
                dysfunctional and self-destructive behavior, including 
                suicide, child abuse, and family violence, among 
                Indians, including--
                            ``(i) the number of Indians served who are 
                        directly or indirectly affected by such illness 
                        or behavior; or
                            ``(ii) an estimate of the financial and 
                        human cost attributable to such illness or 
                        behavior.
                    ``(B) An assessment of the existing and additional 
                resources necessary for the prevention and treatment of 
                such illness and behavior, including an assessment of 
                the progress toward achieving the availability of the 
                full continuum of care described in subsection (c).
                    ``(C) An estimate of the additional funding needed 
                by the Service, Indian Tribes, Tribal Organizations, 
                and Urban Indian Organizations to meet their 
                responsibilities under the plans.
            ``(2) National clearinghouse.--The Secretary, acting 
        through the Service, shall establish a national clearinghouse 
        of plans and reports on the outcomes of such plans developed by 
        Indian Tribes, Tribal Organizations, Urban Indian 
        Organizations, and Service Areas relating to behavioral health. 
        The Secretary shall ensure access to these plans and outcomes 
        by any Indian Tribe, Tribal Organization, Urban Indian 
        Organization, or the Service.
            ``(3) Technical assistance.--The Secretary shall provide 
        technical assistance to Indian Tribes, Tribal Organizations, 
        and Urban Indian Organizations in preparation of plans under 
        this section and in developing standards of care that may be 
        used and adopted locally.
    ``(c) Programs.--The Secretary, acting through the Service, Indian 
Tribes, and Tribal Organizations, shall provide, to the extent feasible 
and if funding is available, programs including the following:
            ``(1) Comprehensive care.--A comprehensive continuum of 
        behavioral health care which provides--
                    ``(A) community-based prevention, intervention, 
                outpatient, and behavioral health aftercare;
                    ``(B) detoxification (social and medical);
                    ``(C) acute hospitalization;
                    ``(D) intensive outpatient/day treatment;
                    ``(E) residential treatment;
                    ``(F) transitional living for those needing a 
                temporary, stable living environment that is supportive 
                of treatment and recovery goals;
                    ``(G) emergency shelter;
                    ``(H) intensive case management; and
                    ``(I) Traditional Health Care Practices.
            ``(2) Child care.--Behavioral health services for Indians 
        from birth through age 17, including the following:
                    ``(A) Preschool and school age fetal alcohol 
                disorder services, including assessment and behavioral 
                intervention.
                    ``(B) Mental health and substance abuse services 
                (emotional, organic, alcohol, drug, inhalant, and 
                tobacco).
                    ``(C) Identification and treatment of co-occurring 
                disorders and comorbidity.
                    ``(D) Prevention of alcohol, drug, inhalant, and 
                tobacco use.
                    ``(E) Early intervention, treatment, and aftercare.
                    ``(F) Promotion of healthy choices and lifestyle 
                (related to sexually transmitted diseases, domestic 
                violence, sexual abuse, suicide, teen pregnancy, 
                obesity, and other risk/safety issues).
                    ``(G) Identification and treatment of neglect and 
                physical, mental, and sexual abuse.
            ``(3) Adult care.--Behavioral health services for Indians 
        from age 18 through 55, including the following:
                    ``(A) Early intervention, treatment, and aftercare.
                    ``(B) Mental health and substance abuse services 
                (emotional, alcohol, drug, inhalant, and tobacco), 
                including gender specific services.
                    ``(C) Identification and treatment of co-occurring 
                disorders (dual diagnosis) and comorbidity.
                    ``(D) Promotion of gender specific healthy choices 
                and lifestyle (related to parenting, partners, domestic 
                violence, sexual abuse, suicide, obesity, and other 
                risk-related behavior).
                    ``(E) Treatment services for women at risk of 
                giving birth to a child with a fetal alcohol disorder.
                    ``(F) Gender specific treatment for sexual assault 
                and domestic violence.
            ``(4) Family care.--Behavioral health services for 
        families, including the following:
                    ``(A) Early intervention, treatment, and aftercare 
                for affected families.
                    ``(B) Treatment for sexual assault and domestic 
                violence.
                    ``(C) Promotion of healthy choices and lifestyle 
                (related to parenting, partners, domestic violence, and 
                other abuse issues).
            ``(5) Elder care.--Behavioral health services for Indians 
        56 years of age and older, including the following:
                    ``(A) Early intervention, treatment, and aftercare.
                    ``(B) Mental health and substance abuse services 
                (emotional, alcohol, drug, inhalant, and tobacco), 
                including gender specific services.
                    ``(C) Identification and treatment of co-occurring 
                disorders (dual diagnosis) and comorbidity.
                    ``(D) Promotion of healthy choices and lifestyle 
                (managing conditions related to aging).
                    ``(E) Gender specific treatment for sexual assault, 
                domestic violence, neglect, physical and mental abuse 
                and exploitation.
                    ``(F) Identification and treatment of dementias 
                regardless of cause.
    ``(d) Community Behavioral Health Plan.--
            ``(1) Establishment.--The governing body of any Indian 
        Tribe, Tribal Organization, or Urban Indian Organization may 
        adopt a resolution for the establishment of a community 
        behavioral health plan providing for the identification and 
        coordination of available resources and programs to identify, 
        prevent, or treat substance abuse, mental illness, or 
        dysfunctional and self-destructive behavior, including child 
        abuse and family violence, among its members or its service 
        population. This plan should include behavioral health 
        services, social services, intensive outpatient services, and 
        continuing aftercare.
            ``(2) Technical assistance.--At the request of an Indian 
        Tribe, Tribal Organization, or Urban Indian Organization, the 
        Bureau of Indian Affairs and the Service shall cooperate with 
        and provide technical assistance to the Indian Tribe, Tribal 
        Organization, or Urban Indian Organization in the development 
        and implementation of such plan.
            ``(3) Funding.--The Secretary, acting through the Service, 
        may make funding available to Indian Tribes and Tribal 
        Organizations which adopt a resolution pursuant to paragraph 
        (1) to obtain technical assistance for the development of a 
        community behavioral health plan and to provide administrative 
        support in the implementation of such plan.
    ``(e) Coordination for Availability of Services.--The Secretary, 
acting through the Service, Indian Tribes, Tribal Organizations, and 
Urban Indian Organizations, shall coordinate behavioral health 
planning, to the extent feasible, with other Federal agencies and with 
State agencies, to encourage comprehensive behavioral health services 
for Indians regardless of their place of residence.
    ``(f) Mental Health Care Need Assessment.--Not later than 1 year 
after the date of the enactment of the Indian Health Care Improvement 
Act Amendments of 2003, the Secretary, acting through the Service, 
shall make an assessment of the need for inpatient mental health care 
among Indians and the availability and cost of inpatient mental health 
facilities which can meet such need. In making such assessment, the 
Secretary shall consider the possible conversion of existing, underused 
Service hospital beds into psychiatric units to meet such need.

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

    ``(a) Contents.--Not later than 12 months after the date of the 
enactment of the Indian Health Care Improvement Act Amendments of 2003, 
the Secretary, acting through the Service, and the Secretary of the 
Interior shall develop and enter into a memoranda of agreement, or 
review and update any existing memoranda of agreement, as required by 
section 4205 of the Indian Alcohol and Substance Abuse Prevention and 
Treatment Act of 1986 (25 U.S.C. 2411) under which the Secretaries 
address the following:
            ``(1) The scope and nature of mental illness and 
        dysfunctional and self-destructive behavior, including child 
        abuse and family violence, among Indians.
            ``(2) The existing Federal, tribal, State, local, and 
        private services, resources, and programs available to provide 
        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.
            ``(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, Service 
        Area, and headquarters 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 problems identified pursuant to 
        paragraph (1), including--
                    ``(A) the coordination of alcohol and substance 
                abuse programs of the Service, the Bureau of Indian 
                Affairs, and Indian Tribes and Tribal Organizations 
                (developed under the Indian Alcohol and Substance Abuse 
                Prevention and Treatment Act of 1986) with mental 
                health initiatives pursuant to this Act, particularly 
                with respect to the referral and treatment of dually 
                diagnosed individuals requiring mental health and 
                substance abuse treatment; and
                    ``(B) ensuring that the Bureau of Indian Affairs 
                and Service programs and services (including 
                multidisciplinary resource teams) addressing child 
                abuse and family violence are coordinated with such 
                non-Federal programs and services.
            ``(7) Directing appropriate officials of the Bureau of 
        Indian Affairs and the Service, particularly at the agency and 
        Service Unit levels, to cooperate fully with tribal requests 
        made pursuant to community behavioral health plans adopted 
        under section 701(c) and section 4206 of the Indian Alcohol and 
        Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 
        2412).
            ``(8) Providing for an annual review of such agreement by 
        the Secretaries which shall be provided to Congress and Indian 
        Tribes and Tribal Organizations.
    ``(b) Specific Provisions Required.--The memoranda of agreement 
updated or entered into pursuant to subsection (a) shall include 
specific provisions pursuant to which the Service shall assume 
responsibility for--
            ``(1) the determination of the scope of the problem of 
        alcohol and substance abuse among Indians, including the number 
        of Indians within the jurisdiction of the Service who are 
        directly or indirectly affected by alcohol and substance abuse 
        and the financial and human cost;
            ``(2) an assessment of the existing and needed resources 
        necessary for the prevention of alcohol and substance abuse and 
        the treatment of Indians affected by alcohol and substance 
        abuse; and
            ``(3) an estimate of the funding necessary to adequately 
        support a program of prevention of alcohol and substance abuse 
        and treatment of Indians affected by alcohol and substance 
        abuse.
    ``(c) Consultation.--The Secretary, acting through the Service, and 
the Secretary of the Interior shall, in developing the memoranda of 
agreement under subsection (a), consult with and solicit the comments 
from--
            ``(1) Indian Tribes and Tribal Organizations;
            ``(2) Indians;
            ``(3) Urban Indian Organizations and other Indian 
        organizations; and
            ``(4) behavioral health service providers.
    ``(d) Publication.--Each memorandum of agreement entered into or 
renewed (and amendments or modifications thereto) under subsection (a) 
shall be published in the Federal Register. At the same time as 
publication in the Federal Register, the Secretary shall provide a copy 
of such memoranda, amendment, or modification to each Indian Tribe, 
Tribal Organization, and Urban Indian Organization.

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

    ``(a) Establishment.--
            ``(1) In general.--The Secretary, acting through the 
        Service, Indian Tribes, and Tribal Organizations, shall provide 
        a program of comprehensive behavioral health, prevention, 
treatment, and aftercare, including Traditional Health Care Practices, 
which shall include--
                    ``(A) prevention, through educational intervention, 
                in Indian communities;
                    ``(B) acute detoxification, psychiatric 
                hospitalization, and residential and intensive 
                outpatient treatment;
                    ``(C) community-based rehabilitation and aftercare;
                    ``(D) community education and involvement, 
                including extensive training of health care, 
                educational, and community-based personnel; and
                    ``(E) specialized residential treatment programs 
                for high-risk populations, including but not limited to 
                pregnant and postpartum women and their children.
            ``(2) Target populations.--The target population of such 
        program shall be members of Indian Tribes. Efforts to train and 
        educate key members of the Indian community shall target 
        employees of health, education, judicial, law enforcement, 
        legal, and social service programs.
    ``(b) Contract Health Services.--
            ``(1) In general.--The Secretary, acting through the 
        Service, Indian Tribes, and Tribal Organizations, may enter 
        into contracts with public or private providers of behavioral 
        health 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) Paraprofessional Training.--In carrying out subsection (a), 
the Secretary, acting through the Service, Indian Tribes, and Tribal 
Organizations, shall provide high-standard paraprofessional training in 
mental health care necessary to provide quality care to the Indian 
communities to be served. Such training shall be based upon a 
curriculum developed or approved by the Secretary which combines 
education in the theory of mental health care with supervised practical 
experience in the provision of such care.
    ``(c) Supervision and Evaluation of Technicians.--The Secretary, 
acting through the Service, Indian Tribes, and Tribal Organizations, 
shall supervise and evaluate the mental health technicians in the 
training program.
    ``(d) Traditional Health Care Practices.--The Secretary, acting 
through the Service, shall ensure that the program established pursuant 
to this subsection involves the use and promotion of the Traditional 
Health Care Practices of the Indian Tribes to be served.

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

    ``Subject to the provisions of section 221, any person employed as 
a psychologist, social worker, or marriage and family therapist for the 
purpose of providing mental health care services to Indians in a 
clinical setting under this Act or through a Funding Agreement shall, 
in the case of a person employed as a psychologist, social worker, or 
marriage and family therapist, be licensed as a clinical psychologist, 
social worker, or marriage and family therapist, respectively, or 
working under the direct supervision of a licensed clinical 
psychologist, social worker, or marriage and family therapist, 
respectively.

``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

    ``(a) Funding.--The Secretary, consistent with section 701, shall 
make funds available to Indian Tribes, Tribal Organizations, and Urban 
Indian Organizations to develop and implement a comprehensive 
behavioral health program of prevention, intervention, treatment, and 
relapse prevention services that specifically addresses the spiritual, 
cultural, historical, social, and child care needs of Indian women, 
regardless of age.
    ``(b) Use of Funds.--Funds made available pursuant to this section 
may be used to--
            ``(1) develop and provide community training, education, 
        and prevention programs for Indian women relating to behavioral 
        health issues, including fetal alcohol disorders;
            ``(2) identify and provide psychological services, 
        counseling, advocacy, support, and relapse prevention to Indian 
        women and their families; and
            ``(3) develop prevention and intervention models for Indian 
        women which incorporate Traditional Health Care Practices, 
        cultural values, and community and family involvement.
    ``(c) 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 funds 
appropriated pursuant to this section shall be used to make grants to 
Urban Indian Organizations.

``SEC. 707. INDIAN YOUTH PROGRAM.

    ``(a) Detoxification and Rehabilitation.--The Secretary, acting 
through the Service, consistent with section 701, shall develop and 
implement a program for acute detoxification and treatment for Indian 
youths, including behavioral health services. 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, and 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 the purposes 
                of this subsection, the Area Office in California shall 
                be considered to be 2 Area Offices, 1 office whose 
                jurisdiction shall be considered to encompass the 
                northern area of the State of California, and 1 office 
                whose jurisdiction shall be considered to encompass the 
                remainder of the State of California for the purpose of 
                implementing California treatment networks.
            ``(2) Funding.--For the purpose of staffing and operating 
        such centers or facilities, funding shall be pursuant to the 
        Act of November 2, 1921 (25 U.S.C. 13).
            ``(3) Location.--A youth treatment center constructed or 
        purchased under this subsection shall be constructed or 
        purchased at a location within the area described in paragraph 
        (1) agreed upon (by appropriate tribal resolution) by a 
        majority of the Indian 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; and
                            ``(ii) the Southeast Alaska Regional Health 
                        Corporation to staff and operate a residential 
                        youth treatment facility without regard to the 
                        proviso set forth in section 4(l) of the Indian 
                        Self-Determination and Education Assistance Act 
                        (25 U.S.C. 450b(l)).
                    ``(B) Provision of services to eligible youths.--
                Until additional residential youth treatment facilities 
                are established in Alaska pursuant to this section, the 
                facilities specified in subparagraph (A) shall make 
                every effort to provide services to all eligible Indian 
                youths residing in such State.
    ``(c) Intermediate Adolescent Behavioral Health Services.--
            ``(1) In general.--The Secretary, acting through the 
        Service, Indian Tribes, and Tribal Organizations, may provide 
        intermediate behavioral health services, which may incorporate 
        Traditional Health Care Practices, to Indian children and 
        adolescents, including--
                    ``(A) pretreatment assistance;
                    ``(B) inpatient, outpatient, and aftercare 
                services;
                    ``(C) emergency care;
                    ``(D) suicide prevention and crisis intervention; 
                and
                    ``(E) prevention and treatment of mental illness 
                and dysfunctional and self-destructive behavior, 
                including child abuse and family violence.
            ``(2) Use of funds.--Funds provided under this subsection 
        may be used--
                    ``(A) to construct or renovate an existing health 
                facility to provide intermediate behavioral health 
                services;
                    ``(B) to hire behavioral health professionals;
                    ``(C) to staff, operate, and maintain an 
                intermediate mental health facility, group home, sober 
                housing, transitional housing or similar facilities, or 
                youth shelter where intermediate behavioral health 
                services are being provided;
                    ``(D) to make renovations and hire appropriate 
                staff to convert existing hospital beds into adolescent 
                psychiatric units; and
                    ``(E) for intensive home- and community-based 
                services.
            ``(3) Criteria.--The Secretary, acting through the Service, 
        shall, in consultation with Indian Tribes and Tribal 
        Organizations, establish criteria for the review and approval 
        of applications or proposals for funding made available 
        pursuant to this subsection.
    ``(d) Federally Owned Structures.--
            ``(1) In general.--The Secretary, in consultation with 
        Indian Tribes and Tribal Organizations, shall--
                    ``(A) identify and use, where appropriate, 
                federally owned structures suitable for local 
                residential or regional behavioral health treatment for 
                Indian youths; and
                    ``(B) establish guidelines, in consultation with 
                Indian Tribes and Tribal Organizations, for determining 
                the suitability of any such federally owned structure 
                to be used for local residential or regional behavioral 
                health treatment for Indian youths.
            ``(2) Terms and conditions for use of structure.--Any 
        structure described in paragraph (1) may be used under such 
        terms and conditions as may be agreed upon by the Secretary and 
        the agency having responsibility for the structure and any 
        Indian Tribe or Tribal Organization operating the program.
    ``(e) Rehabilitation and Aftercare Services.--
            ``(1) In general.--The Secretary, Indian Tribes, or Tribal 
        Organizations, in cooperation with the Secretary of the 
        Interior, shall develop and implement within each Service Unit, 
        community-based rehabilitation and follow-up services for 
        Indian youths who are having significant behavioral health 
        problems, and require long-term treatment, community 
        reintegration, and monitoring to support the Indian youths 
        after their return to their home community.
            ``(2) Administration.--Services under paragraph (1) shall 
        be provided by trained staff within the community who can 
        assist the Indian youths in their continuing development of 
        self-image, positive problem-solving skills, and nonalcohol or 
        substance abusing behaviors. Such staff may 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 youths authorized by this 
section, the Secretary, acting through the Service, Indian Tribes, and 
Tribal Organizations, shall provide for the inclusion of family members 
of such youths in the treatment programs or other services as may be 
appropriate. Not less than 10 percent of the funds appropriated for the 
purposes of carrying out subsection (e) 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, but not limited to, alcohol, drugs, inhalants, 
and tobacco, among Indian youths residing in Indian communities, on or 
near reservations, and in urban areas and provide appropriate mental 
health services to address the incidence of mental illness among such 
youths.

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

    ``Not later than 1 year after the date of the enactment of the 
Indian Health Care Improvement Act Amendments of 2003, 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. For the purposes of this subsection, 
California shall be considered to be 2 Area Offices, 1 office whose 
location shall be considered to encompass the northern area of the 
State of California and 1 office whose jurisdiction shall be considered 
to encompass the remainder of the State of California. The Secretary 
shall consider the possible conversion of existing, underused Service 
hospital beds into psychiatric units to meet such need.

``SEC. 709. TRAINING AND COMMUNITY EDUCATION.

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

``SEC. 710. BEHAVIORAL HEALTH PROGRAM.

    ``(a) Innovative Programs.--The Secretary, acting through the 
Service, Indian Tribes, and Tribal Organizations, consistent with 
section 701, may plan, develop, implement, and carry out programs to 
deliver innovative community-based behavioral health services to 
Indians.
    ``(b) Funding; Criteria.--The Secretary may award such funding for 
a project under subsection (a) to an Indian Tribe or Tribal 
Organization and may consider the following criteria:
            ``(1) The project will address significant unmet behavioral 
        health needs among Indians.
            ``(2) The project will serve a significant number of 
        Indians.
            ``(3) The project has the potential to deliver services in 
        an efficient and effective manner.
            ``(4) The Indian Tribe or Tribal Organization has the 
        administrative and financial capability to administer the 
        project.
            ``(5) The project may deliver services in a manner 
        consistent with Traditional Health Care Practices.
            ``(6) The project is coordinated with, and avoids 
        duplication of, existing services.
    ``(c) Equitable Treatment.--For purposes of this subsection, the 
Secretary shall, in evaluating applications or proposals for funding 
for projects to be operated under any Funding Agreement, 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) Programs.--
            ``(1) Establishment.--The Secretary, consistent with 
        section 701, acting through Indian Tribes and Tribal 
        Organizations, shall establish and operate fetal alcohol 
        disorder programs as provided in this section for the purposes 
        of meeting the health status objectives specified in section 3.
            ``(2) Use of funds.--Funding provided pursuant to this 
        section shall be used for the following:
                    ``(A) To develop and provide for Indians community 
                and in school training, education, and prevention 
                programs relating to fetal alcohol disorders.
                    ``(B) To identify and provide behavioral health 
                treatment to high-risk Indian women and high-risk women 
                pregnant with an Indian's child.
                    ``(C) To identify and provide appropriate 
                psychological services, educational and vocational 
                support, counseling, advocacy, and information to fetal 
                alcohol disorder affected Indians and their families or 
                caretakers.
                    ``(D) To develop and implement counseling and 
                support programs in schools for fetal alcohol disorder 
                affected Indian children.
                    ``(E) To develop prevention and intervention models 
                which incorporate practitioners of Traditional Health 
                Care Practices, cultural and spiritual values, and 
                community involvement.
                    ``(F) To develop, print, and disseminate education 
                and prevention materials on fetal alcohol disorder.
                    ``(G) To 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 Indian communities and Urban Centers.
                    ``(H) To develop early childhood intervention 
                projects from birth on to mitigate the effects of fetal 
                alcohol disorder among Indians.
                    ``(I) To develop and fund community-based adult 
                fetal alcohol disorder housing and support services for 
                Indians and for women pregnant with an Indian's child.
            ``(3) Criteria for applications.--The Secretary shall 
        establish criteria for the review and approval of applications 
        for funding under this section.
    ``(b) Services.--The Secretary, acting through the Service and 
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 disorder 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 disorder.
    ``(c) Task Force.--The Secretary shall establish a task force to be 
known as the Fetal Alcohol Disorder Task Force to advise the Secretary 
in carrying out subsection (b). Such task force shall be composed of 
representatives from the following:
            ``(1) The National Institute on Drug Abuse.
            ``(2) The National Institute on Alcohol and Alcoholism.
            ``(3) The Office of Substance Abuse Prevention.
            ``(4) The National Institute of Mental Health.
            ``(5) The Service.
            ``(6) The Office of Minority Health of the Department of 
        Health and Human Services.
            ``(7) The Administration for Native Americans.
            ``(8) The National Institute of Child Health and Human 
        Development (NICHD).
            ``(9) The Centers for Disease Control and Prevention.
            ``(10) The Bureau of Indian Affairs.
            ``(11) Indian Tribes.
            ``(12) Tribal Organizations.
            ``(13) Urban Indian Organizations.
            ``(14) Indian fetal alcohol disorder experts.
    ``(d) Applied Research Projects.--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 disorder.
    ``(e) Funding for Urban Indian Organizations.--Ten percent of the 
funds appropriated pursuant to this section shall be used to make 
grants to Urban Indian Organizations funded under title V.

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

    ``(a) Establishment.--The Secretary, acting through the Service, 
and the Secretary of the Interior, Indian Tribes, and Tribal 
Organizations shall establish, consistent with section 701, in every 
Service Area, programs involving treatment for--
            ``(1) victims of sexual abuse who are Indian children or 
        children in an Indian household; and
            ``(2) perpetrators of child sexual abuse who are Indian or 
        members of an Indian household.
    ``(b) Use of Funds.--Funding provided pursuant to this section 
shall be used for the following:
            ``(1) To develop and provide community education and 
        prevention programs related to sexual abuse of Indian children 
        or children in an Indian household.
            ``(2) To identify and provide behavioral health treatment 
        to victims of sexual abuse who are Indian children or children 
        in an Indian household, and to their family members who are 
        affected by sexual abuse.
            ``(3) To develop prevention and intervention models which 
        incorporate Traditional Health Care Practices, cultural and 
        spiritual values, and community involvement.
            ``(4) To develop and implement, through the tribal 
        consultation process, culturally sensitive assessment and 
        diagnostic tools for use in Indian communities and Urban 
        Centers.
            ``(5) To identify and provide behavioral health treatment 
        to Indian perpetrators and perpetrators who are members of an 
        Indian household--
                    ``(A) making efforts to begin offender and 
                behavioral health treatment while the perpetrator is 
                incarcerated or at the earliest possible date if the 
                perpetrator is not incarcerated; and
                    ``(B) providing treatment after the perpetrator is 
                released, until it is determined that the perpetrator 
                is not a threat to children.

``SEC. 713. BEHAVIORAL HEALTH RESEARCH.

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

``SEC. 714. DEFINITIONS.

    ``For the purpose of this title, the following definitions shall 
apply:
            ``(1) Assessment.--The term `assessment' means the 
        systematic collection, analysis, and dissemination of 
        information on health status, health needs, and health 
        problems.
            ``(2) Alcohol-related neurodevelopmental disorders or 
        arnd.--The term `alcohol-related neurodevelopmental disorders' 
        or `ARND' means, with a history of maternal alcohol consumption 
        during pregnancy, central nervous system involvement such as 
        developmental delay, intellectual deficit, or neurologic 
        abnormalities. Behaviorally, there can be problems with 
        irritability, and failure to thrive as infants. As children 
        become older there will likely be hyperactivity, attention 
        deficit, language dysfunction, and perceptual and judgment 
        problems.
            ``(3) Behavioral health.--The term `behavioral health' 
        means the blending of substance (alcohol, drugs, inhalants, and 
        tobacco) abuse and mental health prevention and treatment, for 
        the purpose of providing comprehensive services. This can 
        include the joint development of substance abuse and mental 
        health treatment planning and coordinated case management using 
        a multidisciplinary approach.
            ``(4) Behavioral health aftercare.--The term `behavioral 
        health aftercare' includes those activities and resources used 
        to support recovery following inpatient, residential, intensive 
        substance abuse, or mental health outpatient or outpatient 
        treatment. The purpose is to help prevent or deal with relapse 
        by ensuring that by the time a client or patient is discharged 
        from a level of care, such as outpatient treatment, an 
        aftercare plan has been developed with the client. An aftercare 
        plan may use such resources a as community-based therapeutic 
        group, transitional living facilities, a 12-step sponsor, a 
        local 12-step or other related support group, and other 
        community-based providers (mental health professionals, 
        traditional health care practitioners, community health aides, 
        community health representatives, mental health technicians, 
        ministers, etc.)
            ``(5) Dual diagnosis.--The term `dual diagnosis' means 
        coexisting substance abuse and mental illness conditions or 
        diagnosis. Such clients are sometimes referred to as mentally 
        ill chemical abusers (MICAs).
            ``(6) Fetal alcohol disorders.--The term `fetal alcohol 
        disorders' means fetal alcohol syndrome, partial fetal alcohol 
        syndrome and alcohol related neurodevelopmental disorder 
        (ARND).
            ``(7) Fetal alcohol syndrome or fas.--The term `fetal 
        alcohol syndrome' or `FAS' means a syndrome in which, with a 
        history of maternal alcohol consumption during pregnancy, the 
        following criteria are met:
                    ``(A) Central nervous system involvement such as 
                developmental delay, intellectual deficit, 
                microencephaly, or neurologic abnormalities.
                    ``(B) Craniofacial abnormalities with at least 2 of 
                the following: microophthalmia, short palpebral 
                fissures, poorly developed philtrum, thin upper lip, 
                flat nasal bridge, and short upturned nose.
                    ``(C) Prenatal or postnatal growth delay.
            ``(8) Partial fas.--The term `partial FAS' means, with a 
        history of maternal alcohol consumption during pregnancy, 
        having most of the criteria of FAS, though not meeting a 
        minimum of at least 2 of the following: microophthalmia, short 
        palpebral fissures, poorly developed philtrum, thin upper lip, 
        flat nasal bridge, and short upturned nose.
            ``(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 2015 to carry out 
the provisions of this title.

                      ``TITLE VIII--MISCELLANEOUS

``SEC. 801. REPORTS.

    ``The President shall, at the time the budget is submitted under 
section 1105 of title 31, United States Code, for each fiscal year 
transmit to Congress a report containing the following:
            ``(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 assessments 
        and recommendations of additional programs or additional 
        assistance necessary to, at a minimum, provide health services 
        to Indians and ensure a health status for Indians, which are at 
        a parity with the health services available to and the health 
        status of the general population, including specific 
        comparisons of appropriations provided and those required for 
        such parity.
            ``(2) A report on whether, and to what extent, new national 
        health care programs, benefits, initiatives, or financing 
        systems have had an impact on the purposes of this Act and any 
        steps that the Secretary may have taken to consult with Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations to 
        address such impact, including a report on proposed changes in 
        allocation of funding pursuant to section 808.
            ``(3) A report on the use of health services by Indians--
                    ``(A) on a national and area or other relevant 
                geographical basis;
                    ``(B) by gender and age;
                    ``(C) by source of payment and type of service;
                    ``(D) comparing such rates of use with rates of use 
                among comparable non-Indian populations; and
                    ``(E) on the services provided under Funding 
                Agreements.
            ``(4) A report of contractors to the Secretary on Health 
        Care Educational Loan Repayments every 6 months required by 
        section 110.
            ``(5) A general audit report of the Secretary on the Health 
        Care Educational Loan Repayment Program as required by section 
        110(n).
            ``(6) A report of the findings and conclusions of 
        demonstration programs on development of educational curricula 
        for substance abuse counseling as required in section 126(f).
            ``(7) A separate statement which specifies the amount of 
        funds requested to carry out the provisions of section 201.
            ``(8) A report of the evaluations of health promotion and 
        disease prevention as required in section 203(c).
            ``(9) A biennial report to Congress on infectious diseases 
        as required by section 212.
            ``(10) A report on environmental and nuclear health hazards 
        as required by section 215.
            ``(11) An annual report on the status of all health care 
        facilities needs as required by section 301(c)(2) and 301(d).
            ``(12) Reports on safe water and sanitary waste disposal 
        facilities as required by section 302(i).
            ``(13) An annual report on the expenditure of nonservice 
        funds for renovation as required by sections 304(b)(2).
            ``(14) A report identifying the backlog of maintenance and 
        repair required at Service and tribal facilities required by 
        section 313(a).
            ``(15) A report providing an accounting of reimbursement 
        funds made available to the Secretary under titles XVIII, XIX, 
        and XXI of the Social Security Act.
            ``(16) A report on any arrangements for the sharing of 
        medical facilities or services between the Service, Indian 
        Tribes, and Tribal Organizations, and the Department of 
        Veterans Affairs and the Department of Defense, as authorized 
        by section 406.
            ``(17) A report on evaluation and renewal of Urban Indian 
        programs under section 505.
            ``(18) A report on the evaluation of programs as required 
        by section 513(d).
            ``(19) A report on alcohol and substance abuse as required 
        by section 701(f).

``SEC. 802. REGULATIONS.

    ``(a) Deadlines.--
            ``(1) Procedures.--Not later than 90 days after the date of 
        the enactment of the Indian Health Care Improvement Act 
        Amendments of 2003, the Secretary shall initiate procedures 
        under subchapter III of chapter 5 of title 5, United States 
        Code, to negotiate and promulgate such regulations or 
        amendments thereto that are necessary to carry out titles I, 
        II, III, IV, and VII and section 817. The Secretary may 
        promulgate regulations to carry out sections 105, 115, 117, and 
        title V, using the procedures required by the Administrative 
        Procedures Act. The Secretary shall issue no regulations to 
        carry out titles VI and VIII, except as necessary to carry out 
        section 817.
            ``(2) Proposed regulations.--Proposed regulations to 
        implement this Act shall be published in the Federal Register 
        by the Secretary no later than 270 days after the date of the 
        enactment of the Indian Health Care Improvement Act Amendments 
        of 2003 and shall have no less than a 120-day comment period.
            ``(3) Expiration of authority.--The authority to promulgate 
        regulations under this Act shall expire 18 months from the date 
        of the enactment of this Act.
    ``(b) Committee.--A negotiated rulemaking committee established 
pursuant to section 565 of title 5, United States Code, to carry out 
this section shall have as its members only representatives of the 
Federal Government and representatives of Indian Tribes and Tribal 
Organizations, a majority of whom shall be nominated by and be 
representatives of Indian Tribes, Tribal Organizations, and Urban 
Indian Organizations from each Service Area.
    ``(c) Adaptation of Procedures.--The Secretary shall adapt the 
negotiated rulemaking procedures to the unique context of self-
governance and the government-to-government relationship between the 
United States and Indian Tribes.
    ``(d) Lack of Regulations.--The lack of promulgated regulations 
shall not limit the effect of this Act.
    ``(e) Inconsistent Regulations.--The provisions of this Act shall 
supersede any conflicting provisions of law (including any conflicting 
regulations) in effect on the day before the date of the enactment of 
the Indian Health Care Improvement Act Amendments of 2003, and the 
Secretary is authorized to repeal any regulation inconsistent with the 
provisions of this Act.

``SEC. 803. PLAN OF IMPLEMENTATION.

    ``Not later than 8 months after the date of the enactment of the 
Indian Health Care Improvement Act Amendments of 2003, the Secretary in 
consultation with Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations, shall submit to Congress a plan explaining the manner 
and schedule (including a schedule of appropriation requests), by title 
and section, by which the Secretary will implement the provisions of 
this Act.

``SEC. 804. AVAILABILITY OF FUNDS.

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

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

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

``SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.

    ``(a) In General.--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, 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 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) Clarification.--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) Children.--Any individual who--
            ``(1) has not attained 19 years of age;
            ``(2) is the natural or adopted child, stepchild, foster 
        child, legal ward, or orphan of an eligible Indian; and
            ``(3) is not otherwise eligible for health services 
        provided by the Service,
shall be eligible for all health services provided by the Service on 
the same basis and subject to the same rules that apply to eligible 
Indians until such individual attains 19 years of age. The existing and 
potential health needs of all such individuals shall be taken into 
consideration by the Service in determining the need for, or the 
allocation of, the health resources of the Service. If such an 
individual has been determined to be legally incompetent prior to 
attaining 19 years of age, such individual shall remain eligible for 
such services until 1 year after the date of a determination of 
competency.
    ``(b) 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 such spouses or spouses who are married to 
members of the Indian Tribe(s) being served are made eligible, as a 
class, by an appropriate resolution of the governing body of the Indian 
Tribe or Tribal Organization providing such services. The health needs 
of persons made eligible under this paragraph shall not be taken into 
consideration by the Service in determining the need for, or allocation 
of, its health resources.
    ``(c) Provision of Services to Other Individuals.--
            ``(1) In general.--The Secretary is authorized to provide 
        health services under this subsection through health programs 
        operated directly by the Service to individuals who reside 
        within the Service Unit and who are not otherwise eligible for 
        such health services if--
                    ``(A) the Indian Tribes served by such Service Unit 
                request such provision of health services to such 
                individuals; and
                    ``(B) the Secretary and the served Indian 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 facilities or services, within or 
                        without the Service Unit, available to meet the 
                        health needs of such individuals.
            ``(2) ISDEAA programs.--In the case of a Tribal Health 
        Program, the governing body of the Indian Tribe or Tribal 
        Organization providing health services under such Tribal Health 
        Program is authorized to determine whether health services 
        should be provided under its Funding Agreement to individuals 
        who are not otherwise eligible for such services. In making 
        such determination, the governing body shall take into account 
        the considerations described in clauses (i) and (ii) of 
        paragraph (1)(B).
            ``(3) Payment for services.--
                    ``(A) In general.--Persons receiving health 
                services provided by the Service under 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 404 of this Act, or any other provision of 
                law, amounts collected under this subsection, including 
                medicare, medicaid, or SCHIP reimbursements under 
                titles XVIII, XIX, and XXI of the Social Security Act, 
                shall be credited to the account of the program 
                providing the service and shall be used for the 
                purposes listed in section 401(d)(2) and amounts 
                collected under this subsection shall be available for 
                expenditure within such program.
                    ``(B) Indigent people.--Health services may be 
                provided by the Secretary through the Service under 
                this subsection to an indigent individual who would not 
                be otherwise eligible for such health services but for 
                the provisions of paragraph (1) only if an agreement 
                has been entered into with a State or local government 
                under which the State or local government agrees to 
                reimburse the Service for the expenses incurred by the 
                Service in providing such health services to such 
                indigent individual.
            ``(4) Revocation of consent for services.--
                    ``(A) Single tribe service area.--In the case of a 
                Service Area which serves only 1 Indian Tribe, the 
                authority of the Secretary to provide health services 
                under paragraph (1) 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) Multitribal service area.--In the case of a 
                multitribal Service Area, the authority of the 
                Secretary to provide health services under paragraph 
                (1) shall terminate at the end of the fiscal year 
                succeeding the fiscal year in which at least 51 percent 
                of the number of Indian Tribes in the Service Area 
                revoke their concurrence to the provisions of such 
                health services.
    ``(d) Other 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 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 postpartum; or
            ``(4) provide care to immediate family members of an 
        eligible person if such care is directly related to the 
        treatment of the eligible individual.
    ``(e) Hospital Privileges for Practitioners.--Hospital privileges 
in health facilities operated and maintained by the Service or operated 
under a Funding Agreement may be extended to non-Service health care 
practitioners who provide services to individuals described in 
subsection (a), (b), (c), or (d). 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.
    ``(f) Eligible Indian.--For purposes of this section, the term 
`eligible Indian' means any Indian who is eligible for health services 
provided by the Service without regard to the provisions of this 
section.

``SEC. 808. REALLOCATION OF BASE RESOURCES.

    ``(a) Report Required.--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 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) Exception.--Subsection (a) shall not apply if the total 
amount appropriated to the Service for a fiscal year is at least 5 
percent less than the amount appropriated to the Service for the 
previous fiscal year.

``SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.

    ``The Secretary shall provide for the dissemination to Indian 
Tribes, Tribal Organizations, and Urban Indian Organizations of the 
findings and results of demonstration projects conducted under this 
Act.

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

    ``(a) Consistent With Court Decision.--The Secretary, acting 
through the Service, shall provide services and benefits for Indians in 
Montana in a manner consistent with the decision of the United States 
Court of Appeals for the Ninth Circuit in McNabb for McNabb v. Bowen, 
829 F.2d 787 (9th Cir. 1987).
    ``(b) Clarification.--The provisions of subsection (a) shall not be 
construed to be an expression of the sense of Congress on the 
application of the decision described in subsection (a) with respect to 
the provision of services or benefits for Indians living in any State 
other than Montana.

``SEC. 811. MORATORIUM.

    ``During the period of the moratorium imposed on implementation of 
the final rule published in the Federal Register on September 16, 1987, 
by the Health Resources and Services Administration of the Public 
Health Service, relating to eligibility for the health care services of 
the Indian Health Service, the Indian Health Service shall provide 
services pursuant to the criteria for eligibility for such services 
that were in effect on September 15, 1987, subject to the provisions of 
sections 806 and 807 until such time as new criteria governing 
eligibility for services are developed in accordance with section 802.

``SEC. 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 shall not be considered an `employer'.

``SEC. 813. PRIME VENDOR.

    ``(a) Executive Agency Status.--For purposes of section 201(a) of 
the Federal Property and Administrative Services Act (40 U.S.C. 481(a)) 
(relating to Federal sources of supply, including lodging providers, 
airlines, and other transportation providers), a Tribal Health Program 
shall be deemed an executive agency when carrying out a contract, 
grant, cooperative agreement, or Funding Agreement with the Service and 
shall have access to the Federal Supply Schedule and any other Federal 
source of supply to which executive agencies have access.
    ``(b) HHS Status.--For purposes of section 4 of Public Law 102-585 
(38 U.S.C. 8126), a Tribal Health Program shall have the status of the 
Indian Health Service and shall have direct access to the Veterans 
Administration prime vendor provided for in section 4 of Public Law 
102-585.
    ``(c) Employee Status.--The employees of such Tribal Health 
Programs may order supplies under such respective programs on the same 
basis as employees of the Service.

``SEC. 814. SEVERABILITY PROVISIONS.

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

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

    ``(a) Establishment.--There is hereby established the National 
Bipartisan Indian Health Care Entitlement Commission (the 
`Commission').
    ``(b) Duties of Commission.--The duties of the Commission are the 
following:
            ``(1) To establish a study committee composed of those 
        members of the Commission appointed by the Director and at 
        least 4 members of Congress from among the members of the 
        Commission, the duties of which shall be the following:
                    ``(A) To the extent necessary to carry out its 
                duties, collect and compile data necessary to 
                understand the extent of Indian needs with regard to 
                the provision of health services, regardless of the 
                location of Indians, including holding hearings and 
                soliciting the views of Indians, Indian Tribes, Tribal 
                Organizations, and Urban Indian Organizations, which 
                may include authorizing and making funds available for 
                feasibility studies of various models for providing and 
                funding health services for all Indian beneficiaries, 
                including those who live outside of a reservation, 
                temporarily or permanently.
                    ``(B) To make recommendations to the Commission for 
                legislation that will provide for the delivery of 
                health services for Indians as an entitlement, which 
                will address, among other things, issues of 
                eligibility, benefits to be provided, including 
                recommendations regarding from whom such health 
                services are to be provided and the cost, including 
                mechanisms for making funds available for the health 
                services to be provided.
                    ``(C) To determine the effect of the enactment of 
                such recommendations on (i) the existing system of 
                delivery of health services for Indians, and (ii) the 
                sovereign status of Indian Tribes.
                    ``(D) Not later than 12 months after the 
                appointment of all members of the Commission, to submit 
                a written report of its findings and recommendations to 
                the full Commission. The report shall include a 
                statement of the minority and majority position of the 
                Committee and shall be disseminated, at a minimum, to 
                every Indian Tribe, Tribal Organization, and Urban 
                Indian Organization for comment to the Commission.
                    ``(E) To report regularly to the full Commission 
                regarding the findings and recommendations developed by 
                the study committee in the course of carrying out its 
                duties under this section.
            ``(2) To review and analyze the recommendations of the 
        report of the study committee.
            ``(3) To make recommendations to Congress for providing 
        health services for Indians as an entitlement, giving due 
        regard to the effects of such a program on existing health care 
        delivery systems for Indians and the effect of such a program 
        on the sovereign status of Indian Tribes.
            ``(4) Not later than 18 months following the date of 
        appointment of all members of the Commission, submit a written 
        report to Congress containing a recommendation of policies and 
        legislation to implement a policy that would establish a health 
        care system for Indians based on delivery of health services as 
        an entitlement, together with a determination of the 
        implications of such an entitlement system on existing health 
        care delivery systems for Indians and on the sovereign status 
        of Indian Tribes.
    ``(c) Members.--
            ``(1) Appointment.--The Commission shall be composed of 25 
        members, appointed as follows:
                    ``(A) Ten members of Congress, including 3 from the 
                United States House of Representatives and 2 from the 
                United States Senate, appointed by their respective 
                majority leaders, and 3 from the United States House of 
                Representatives and 2 from the United States Senate, 
                appointed by their respective minority leaders, and who 
                shall be members of the standing committees of Congress 
                that consider legislation affecting health care to 
                Indians.
                    ``(B) Twelve persons chosen by the Congressional 
                members of the Commission, 1 from each Service Area as 
                currently designated by the Director to be chosen from 
                among 3 nominees from each Service Area put forward by 
                the Indian Tribes within the area, with due regard 
                being given to the experience and expertise of the 
                nominees in the provision of health care to Indians and 
                to a reasonable representation on the commission of 
                members who are familiar with various health care 
                delivery modes and who represent Indian Tribes of 
                various size populations.
                    ``(C) Three persons appointed by the Director who 
                are knowledgeable about the provision of health care to 
                Indians, at least one of whom shall be appointed from 
                among 3 nominees put forward by those programs whose 
                funds are provided in whole or in part by the Service 
                primarily or exclusively for the benefit of Urban 
                Indians.
                    ``(D) All those persons chosen by the Congressional 
                members of the Commission and by the Director shall be 
                members of federally recognized Indian Tribes.
            ``(2) Chair; vice chair.--The Chair and Vice Chair of the 
        Commission shall be selected by the Congressional members of 
        the Commission.
            ``(3) Terms.--The terms of members of the Commission shall 
        be for the life of the Commission.
            ``(4) Deadline for appointments.--Congressional members of 
        the Commission shall be appointed not later than 90 days after 
        the date of the enactment of the Indian Health Care Improvement 
        Act Amendments of 2003, and the remaining members of the 
        Commission shall be appointed not later than 60 days following 
        the appointment of the Congressional members.
            ``(5) Vacancy.--A vacancy in the Commission shall be filled 
        in the manner in which the original appointment was made.
    ``(d) Compensation.--
            ``(1) Congressional members.--Each Congressional member of 
        the Commission shall receive no additional pay, allowances, or 
        benefits by reason of their service on the Commission and shall 
        receive travel expenses and per diem in lieu of subsistence in 
        accordance with sections 5702 and 5703 of title 5, United 
        States Code.
            ``(2) Other members.--Remaining members of the Commission, 
        while serving on the business of the Commission (including 
        travel time), shall be entitled to receive compensation at the 
        per diem equivalent of the rate provided for level IV of the 
        Executive Schedule under section 5315 of title 5, United States 
        Code, and while so serving away from home and the member's 
        regular place of business, a member may be allowed travel 
        expenses, as authorized by the Chairman of the Commission. For 
        purpose of pay (other than pay of members of the Commission) 
        and employment benefits, rights, and privileges, all personnel 
        of the Commission shall be treated as if they were employees of 
        the United States Senate.
    ``(e) Meetings.--The Commission shall meet at the call of the 
Chair.
    ``(f) Quorum.--A quorum of the Commission shall consist of not less 
than 15 members, provided that no less than 6 of the members of 
Congress who are Commission members are present and no less than 9 of 
the members who are Indians are present.
    ``(g) Executive Director; Staff; Facilities.--
            ``(1) Appointment; pay.--The Commission shall appoint an 
        executive director of the Commission. The executive director 
        shall be paid the rate of basic pay for level V of the 
        Executive Schedule.
            ``(2) Staff appointment.--With the approval of the 
        Commission, the executive director may appoint such personnel 
        as the executive director deems appropriate.
            ``(3) Staff pay.--The staff of the Commission shall be 
        appointed without regard to the provisions of title 5, United 
        States Code, governing appointments in the competitive service, 
        and shall be paid without regard to the provisions of chapter 
        51 and subchapter III of chapter 53 of such title (relating to 
        classification and General Schedule pay rates).
            ``(4) Temporary services.--With the approval of the 
        Commission, the executive director may procure temporary and 
        intermittent services under section 3109(b) of title 5, United 
        States Code.
            ``(5) Facilities.--The Administrator of General Services 
        shall locate suitable office space for the operation of the 
        Commission. The facilities shall serve as the headquarters of 
        the Commission and shall include all necessary equipment and 
        incidentals required for the proper functioning of the 
        Commission.
    ``(h) Hearings.--(1) For the purpose of carrying out its duties, 
the Commission may hold such hearings and undertake such other 
activities as the Commission determines to be necessary to carry out 
its duties, provided that at least 6 regional hearings are held in 
different areas of the United States in which large numbers of Indians 
are present. Such hearings are to be held to solicit the views of 
Indians regarding the delivery of health care services to them. To 
constitute a hearing under this subsection, at least 5 members of the 
Commission, including at least 1 member of Congress, must be present. 
Hearings held by the study committee established in this section may 
count towards the number of regional hearings required by this 
subsection.
    ``(2) Upon request of the Commission, the Comptroller General shall 
conduct such studies or investigations as the Commission determines to 
be necessary to carry out its duties.
    ``(3)(A) The Director of the Congressional Budget Office or the 
Chief Actuary of the Centers for Medicare and Medicaid Services, or 
both, shall provide to the Commission, upon the request of the 
Commission, such cost estimates as the Commission determines to be 
necessary to carry out its duties.
    ``(B) The Commission shall reimburse the Director of the 
Congressional Budget Office for expenses relating to the employment in 
the office of the Director of such additional staff as may be necessary 
for the Director to comply with requests by the Commission under 
subparagraph (A).
    ``(4) Upon the request of the Commission, the head of any Federal 
agency is authorized to detail, without reimbursement, any of the 
personnel of such agency to the Commission to assist the Commission in 
carrying out its duties. Any such detail shall not interrupt or 
otherwise affect the civil service status or privileges of the Federal 
employee.
    ``(5) Upon the request of the Commission, the head of a Federal 
agency shall provide such technical assistance to the Commission as the 
Commission determines to be necessary to carry out its duties.
    ``(6) The Commission may use the United States mails in the same 
manner and under the same conditions as Federal agencies and shall, for 
purposes of the frank, be considered a commission of Congress as 
described in section 3215 of title 39, United States Code.
    ``(7) The Commission may secure directly from any Federal agency 
information necessary to enable it to carry out its duties, if the 
information may be disclosed under section 552 of title 4, United 
States Code. Upon request of the Chairman of the Commission, the head 
of such agency shall furnish such information to the Commission.
    ``(8) Upon the request of the Commission, the Administrator of 
General Services shall provide to the Commission on a reimbursable 
basis such administrative support services as the Commission may 
request.
    ``(9) For purposes of costs relating to printing and binding, 
including the cost of personnel detailed from the Government Printing 
Office, the Commission shall be deemed to be a committee of Congress.
    ``(i) Authorization of Appropriations.--There is authorized to be 
appropriated $4,000,000 to carry out the provisions of this section, 
which sum shall not be deducted from or affect any other appropriation 
for health care for Indian persons.
    ``(j) FACA.--The Federal Advisory Committee Act (5 U.S.C. App.) 
shall not apply to the Commission.

``SEC. 816. APPROPRIATIONS; AVAILABILITY.

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

``SEC. 817. CONFIDENTIALITY OF MEDICAL QUALITY ASSURANCE RECORDS: 
              QUALIFIED IMMUNITY FOR PARTICIPANTS.

    ``(a) Confidentiality of Records.--Medical quality assurance 
records created by or for any Indian Health Program or a health program 
of an Urban Indian Organization as part of a medical quality assurance 
program are confidential and privileged. Such records may not be 
disclosed to any person or entity, except as provided in subsection 
(c).
    ``(b) Prohibition on Disclosure and Testimony.--
            ``(1) No part of any medical quality assurance record 
        described in subsection (a) may be subject to discovery or 
        admitted into evidence in any judicial or administrative 
        proceeding, except as provided in subsection (c).
            ``(2) A person who reviews or creates medical quality 
        assurance records for any Indian health program or who 
        participates in any proceeding that reviews or creates such 
        records may not be permitted or required to testify in any 
        judicial or administrative proceeding with respect to such 
        records or with respect to any finding, recommendation, 
evaluation, opinion, or action taken by such person or body in 
connection with such records except as provided in this section.
    ``(c) Authorized Disclosure and Testimony.--
            ``(1) Subject to paragraph (2), a medical quality assurance 
        record described in subsection (a) may be disclosed, and a 
        person referred to in subsection (b) may give testimony in 
        connection with such a record, only as follows:
                    ``(A) To a Federal executive agency or private 
                organization, if such medical quality assurance record 
                or testimony is needed by such agency or organization 
                to perform licensing or accreditation functions related 
                to any Indian Health Program or to a health program of 
                an Urban Indian Organization to perform monitoring, 
                required by law, of such program or organization.
                    ``(B) To an administrative or judicial proceeding 
                commenced by a present or former Indian Health Program 
                or Urban Indian Organization provider concerning the 
                termination, suspension, or limitation of clinical 
                privileges of such health care provider.
                    ``(C) To a governmental board or agency or to a 
                professional health care society or organization, if 
                such medical quality assurance record or testimony is 
                needed by such board, agency, society, or organization 
                to perform licensing, credentialing, or the monitoring 
                of professional standards with respect to any health 
                care provider who is or was an employee of any Indian 
                Health Program or Urban Indian Organization.
                    ``(D) To a hospital, medical center, or other 
                institution that provides health care services, if such 
                medical quality assurance record or testimony is needed 
                by such institution to assess the professional 
                qualifications of any health care provider who is or 
                was an employee of any Indian Health Program or Urban 
                Indian Organization and who has applied for or been 
                granted authority or employment to provide health care 
                services in or on behalf of such program or 
                organization.
                    ``(E) To an officer, employee, or contractor of any 
                Indian Health Program or Urban Indian Organization who 
                has a need for such record or testimony to perform 
                official duties.
                    ``(F) To a criminal or civil law enforcement agency 
                or instrumentality charged under applicable law with 
                the protection of the public health or safety, if a 
                qualified representative of such agency or 
                instrumentality makes a written request that such 
                record or testimony be provided for a purpose 
                authorized by law.
                    ``(G) In an administrative or judicial proceeding 
                commenced by a criminal or civil law enforcement agency 
                or instrumentality referred to in subparagraph (F), but 
                only with respect to the subject of such proceeding.
            ``(2) With the exception of the subject of a quality 
        assurance action, the identity of any person receiving health 
        care services from any Indian Health Program or Urban Indian 
        Organization or the identity of any other person associated 
        with such program or organization for purposes of a medical 
        quality assurance program that is disclosed in a medical 
        quality assurance record described in subsection (a) shall be 
        deleted from that record or document before any disclosure of 
        such record is made outside such program or organization. Such 
        requirement does not apply to the release of information 
        pursuant to section 552a of title 5.
    ``(d) Disclosure for Certain Purposes.--
            ``(1) Nothing in this section shall be construed as 
        authorizing or requiring the withholding from any person or 
        entity aggregate statistical information regarding the results 
        of any Indian Health Program or Urban Indian Organizations's 
        medical quality assurance programs.
            ``(2) Nothing in this section shall be construed as 
        authority to withhold any medical quality assurance record from 
        a committee of either House of Congress, any joint committee of 
        Congress, or the General Accounting Office if such record 
        pertains to any matter within their respective jurisdictions.
    ``(e) Prohibition on Disclosure of Record or Testimony.--A person 
or entity having possession of or access to a record or testimony 
described by this section may not disclose the contents of such record 
or testimony in any manner or for any purpose except as provided in 
this section.
    ``(f) Exemption From Freedom of Information Act.--Medical quality 
assurance records described in subsection (a) may not be made available 
to any person under section 552 of title 5.
    ``(g) Limitation on Civil Liability.--A person who participates in 
or provides information to a person or body that reviews or creates 
medical quality assurance records described in subsection (a) shall not 
be civilly liable for such participation or for providing such 
information if the participation or provision of information was in 
good faith based on prevailing professional standards at the time the 
medical quality assurance program activity took place.
    ``(h) Application to Information in Certain Other Records.--Nothing 
in this section shall be construed as limiting access to the 
information in a record created and maintained outside a medical 
quality assurance program, including a patient's medical records, on 
the grounds that the information was presented during meetings of a 
review body that are part of a medical quality assurance program.
    ``(i) Regulations.--The Secretary, acting through the Service, 
shall promulgate regulations pursuant to section 802 of this title.
    ``(j) Definitions.--In this section:
            ``(1) The term `medical quality assurance program' means 
        any activity carried out before, on, or after the date of 
        enactment of this Act by or for any Indian Health Program or 
        Urban Indian Organization to assess the quality of medical 
        care, including activities conducted by individuals, military 
medical or dental treatment facility committees, or other review bodies 
responsible for quality assurance, credentials, infection control, 
patient care assessment (including treatment procedures, blood, drugs, 
and therapeutics), medical records, health resources management review 
and identification and prevention of medical or dental incidents and 
risks.
            ``(2) The term `medical quality assurance record' means the 
        proceedings, records, minutes, and reports that emanate from 
        quality assurance program activities described in paragraph (1) 
        and are produced or compiled by an Indian Health Program or 
        Urban Indian Organization as part of a medical quality 
        assurance program.
            ``(3) The term `health care provider' means any health care 
        professional, including community health aides and 
        practitioners certified under section 121, who are granted 
        clinical practice privileges or employed to provide health care 
        services in an Indian Health Program or health program of an 
        Urban Indian Organization, who is licensed or certified to 
        perform health care services by a governmental board or agency 
        or professional health care society or organization.

``SEC. 818. AUTHORIZATION OF APPROPRIATIONS.

    ``There are authorized to be appropriated such sums as may be 
necessary for each fiscal year through fiscal year 2015 to carry out 
this title.''.

SEC. 3. SOBOBA SANITATION FACILITIES.

    The Act of December 17, 1970 (84 Stat. 1465), is amended by adding 
at the end the following new section:
    ``Sec. 9. Nothing in this Act shall preclude the Soboba Band of 
Mission Indians and the Soboba Indian Reservation from being provided 
with sanitation facilities and services under the authority of section 
7 of the Act of August 5, 1954 (68 Stat. 674), as amended by the Act of 
July 31, 1959 (73 Stat. 267).''.

SEC. 4. AMENDMENTS TO MEDICARE PROGRAM.

    (a) Expansion of Medicare Payment for All Covered Services 
Furnished by Indian Health Programs.--
            (1) Expansion to all covered services.--Section 1880 of the 
        Social Security Act (42 U.S.C. 1395qq) is amended--
                    (A) by amending the heading to read as follows:

                      ``indian health programs'';

                    (B) by amending subsection (a) to read as follows:
    ``(a) An Indian Health Program (as that term is 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), with respect to covered items and services it furnishes if 
(subject to section 408 of such Act) it meets the conditions and 
requirements for such payments which apply to the furnishing of such 
items and services under this title.''; and
                    (C) by striking subsection (e).
            (2) Elimination of temporary deeming provision, separate 
        fund requirement, and duplicative annual report.--Such section 
        is amended by striking subsections (b) through (d).
            (3) Reference correction.--Subsection (f) of such section 
        is redesignated as subsection (b) and is amended by striking 
        ``section 405'' and inserting ``section 401(d)''.
    (b) Limitation on Charges for Hospital Contract Health Services 
Provided to Indians by Medicare Participating Hospitals.--
            (1) In general.--Section 1866(a)(1) of the Social Security 
        Act (42 U.S.C. 1395cc(a)(1)) is amended--
                    (A) in subparagraph (R), by striking ``and'' at the 
                end;
                    (B) in subparagraph (S), by striking the period and 
                inserting ``, and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(T) in the case of hospitals and critical access 
                hospitals which furnish services for which payment may 
                be made under this title to be a participating 
                provider--
                            ``(i) under the contract health services 
                        program operated by an Indian Health Program 
                        (as those terms are defined in section 4 of the 
                        Indian Health Care Improvement Act), with 
                        respect to items and services that are covered 
                        under and furnished to an individual eligible 
                        for such program; and
                            ``(ii) under a program funded by the Indian 
                        Health Service and operated by an Urban Indian 
                        Organization with respect to the purchase of 
                        items and services for an eligible Urban Indian 
                        (as those terms are defined in section 4 of the 
                        Indian Health Care Improvement Act (25 U.S.C. 
                        1603);
                in accordance with regulations promulgated by the 
                Secretary regarding admission practices, payment 
                methodology, and rates of payment (including the 
                acceptance of not more than such payment rate as 
                payment in full for such items and services).''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall apply as of a date specified by the Secretary of Health 
        and Human Services (but in no case later than 6 months after 
        the date of the enactment of this Act) to medicare 
        participation agreements in effect (or entered into) on or 
        after such date.
    (c) Medicare Coverage of Services of Community Health Aides or 
Practitioners.--
            (1) In general.--Section 1861 of such Act (42 U.S.C. 1395x) 
        is amended--
                    (A) in subsection (s)(2)(K)--
                            (i) in clause (ii), by adding ``and'' at 
                        the end; and
                            (ii) by adding at the end the following new 
                        clause:
            ``(iii) services which would be physicians' services if 
        furnished by a physician (as defined in subsection (r)(1)) and 
        which are performed by a community health aide or practitioner 
        which the aide or practitioner is legally authorized to 
        perform, and such services and supplies furnished as incident 
to such services as would be covered under subparagraph (A) if 
furnished incident to a physician's professional service but only if no 
other provider charges or is paid any amounts with respect to the 
professional fee for furnishing of such services (and, in the case of a 
telehealth service described in section 1834(m), treating services at 
the originating site and the distant site as separate services);''; and
                    (B) by adding at the end the following new 
                subsection:

               ``Community Health Aides or Practitioners

    ``(ww) The term `community health aides or practitioner' means such 
an aide or practitioner who has been certified under the provisions of 
section 121 of the Indian Health Care Improvement Act and who only 
provides services as an employee of the Indian Health Service, an 
Indian Tribe, or Tribal Organization.''.
            (2) Payment.--
                    (A) Payment rate.--Section 1833(a)(1)(O) of such 
                Act (42 U.S.C. 1395l(a)(1)(O)) is amended--
                            (i) by striking ``or'' before ``(ii)''; and
                            (ii) by adding at the end the following: 
                        ``or (iii) in the case of services of a 
                        community health aide or practitioner, the 
                        lesser of the actual charge or 80 percent of 
                        the fee schedule amount provided under section 
                        1848,''.
                    (B) Limitation on balance billing.--Section 
                1842(b)(18)(C) of such Act (42 U.S.C. 1395u(b)(18)(C)) 
                is amended by adding at the end the following new 
                clause:
            ``(vii) A community health aide or practitioner.''.
            (3) Effective date.--The amendments made by this subsection 
        shall apply to services furnished on or after January 1, 2004.
    (d) Continuation of Special Treatment for Collaborative 
Arrangements Between Indian Health Programs and Hospital Outpatient 
Departments.--Section 1833(t)(13) of the Social Security Act (42 U.S.C. 
1395l(t)(13)) is amended by adding at the end the following new 
subparagraph:
                    ``(B) Extension of treatment of certain 
                collaborative arrangements.--With respect to the 
                treatment under this subsection of collaborative 
                arrangements between a health program operated by the 
                Indian Health Service, an Indian Tribe, or Tribal 
                Organization and a hospital operated by such Service or 
                such an Indian Tribe or Tribal Organization, the 
                Secretary shall reinstate treatment (as in effect on 
                January 1, 2000) and extend it to such collaborative 
                arrangements regardless of when they were entered 
                into.''.
    (e) Coverage of Visiting Nurse Services of Tribal Clinics.--
            (1) In general.--Section 1861(aa)(1) of the Social Security 
        Act (42 U.S.C. 1395x(aa)(1)) is amended by adding at the end 
        the following:
``For purposes of applying subparagraph (C) (relating to visiting nurse 
services), an ambulatory care clinic or other outpatient program of the 
Indian Health Service or of an Indian Tribe or a Tribal Organization 
(as such terms are defined in section 4 of the Indian Health Care 
Improvement Act) shall be treated as if it were a rural health clinic 
located in an area described in such subparagraph, and nursing care and 
supplies described in such subparagraph and furnished to an individual 
as an outpatient of such a tribal clinic or program shall be 
reimbursable under this title using the methodology specified in 
section 4(f) of the Indian Health Care Improvement Act Amendments of 
2003, and, for purposes of this sentence, any reference in such 
subparagraph (C) to a licensed practical nurse is also deemed to 
include a reference to a home health aide.''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply services furnished on or after January 1, 2004.
    (f) Medicare Payment for Outpatient Clinics.--
            (1) In general.--Notwithstanding any other provision of 
        law, for purposes of determining the rate of reimbursement 
        under title XVIII of the Social Security Act, any outpatient or 
        ambulatory care clinic (whether freestanding or provider-based) 
        operated by the Indian Health Service, by an Indian Tribe, or 
        by a Tribal Organization (as such terms are defined for 
        purposes of the Indian Health Care Improvement Act) shall, upon 
        the election of such clinic, be reimbursed on the same basis as 
        if such clinic were a hospital outpatient department of the 
        Indian Health Service.
            (2) Effective date.--Paragraph (1) shall apply to payment 
        for services furnished on or after January 1, 2004.
    (g) Review of Medicare and Medicaid Payment Systems.--
            (1) Study.--
                    (A) In general.--The Secretary of Health and Human 
                Services shall conduct a review of the extent to which 
                the payment methodologies applicable under titles XVIII 
                and XIX of the Social Security Act (including under 
                section 1880 of such Act, as amended by this section, 
                section 1911 of such Act, as amended by section 5(a), 
                and including payment methodologies in effect at the 
                time the review is undertaken and payment methodologies 
                effected under this section or section 5) take into 
                account the unique or special circumstances of the 
                provision of covered services to Indians by the Indian 
                Health Service, Indian Tribes, Tribal Organizations, 
                and Urban Indian Organizations (as such terms are 
                defined in section 4 of the Indian Health Care 
                Improvement Act).
                    (B) Matters considered.--In particular, the 
                Secretary shall review the sufficiency of the payment 
                amounts under such methodologies in assuring access to 
                care and payment rates consistent with the payment 
                rates for most favored providers.
                    (C) Consultation.--In conducting the study, the 
                Secretary shall consult with the Indian Health Service, 
                Indian Tribes, Tribal Organizations, and Urban Indian 
                Organizations.
            (2) Report.--Not later than 2 years after the date of 
        implementation of the amendments made by subsection (a) (or, if 
        later, the date of implementation of the amendments made by 
        section 5(a)), the Secretary shall submit to Congress a report 
        on the review under paragraph (1). Such report shall include 
        recommendations for such adjustments to such payment 
        methodologies as may be necessary to assure that payment 
        amounts under the medicare and medicaid programs to such 
        Service, Indian Tribes, Tribal Organizations, and Urban Indian 
        Organizations are sufficient to provide access to quality care.
            (3) Retention of current payment methodology.--
        Notwithstanding any other provision of law, the Secretary shall 
        retain the all-inclusive payment methodology for encounter 
        rates for the Indian Health Service, Indian Tribes, and Tribal 
        Organizations under titles XVIII and XIX of the Social Security 
        Act unless the use of such methodology is expressly prohibited 
        or otherwise superceded by Act of Congress.

SEC. 5. AMENDMENTS TO MEDICAID PROGRAM AND STATE CHILDREN'S HEALTH 
              INSURANCE PROGRAM (SCHIP).

    (a) Expansion of Medicaid Payment for All Covered Services 
Furnished by Indian Health Programs.--
            (1) Expansion to all covered services.--Section 1911 of the 
        Social Security Act (42 U.S.C. 1396j) is amended--
                    (A) by amending the heading to read as follows:

                    ``indian health programs''; and

                    (B) by amending subsection (a) to read as follows:
    ``(a) The Indian Health Service and an Indian Tribe or Tribal 
Organization (as those terms are defined in section 4 of the Indian 
Health Care Improvement Act) shall be eligible for reimbursement for 
medical assistance provided under a State plan with respect to covered 
items and services it furnishes if it meets all the conditions and 
requirements which are applicable generally to the furnishing of such 
items and services under this title.''.
            (2) Elimination of temporary deeming provision--Such 
        section is amended by striking subsection (b).
            (3) Revision of authority to enter into agreements.--
        Subsection (c) of such section is redesignated as subsection 
        (b) and is amended to read as follows:
    ``(b) 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, Tribal 
Organizations, or Urban Indian Organizations (as such terms are defined 
in section 4 of the Indian Health Care Improvement Act), 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.''.
            (4) Reference correction.--Subsection (d) of such section 
        is redesignated as subsection (c) and is amended by striking 
        ``section 405'' and inserting ``section 401(d)''.
    (b) Seeking Advice From Indian Health Programs.--Section 1902(a) of 
the Social Security Act (42 U.S.C. 1396a(a)) is amended--
            (1) in paragraph (64), by striking ``and'' at the end;
            (2) in paragraph (65), by striking the period and inserting 
        ``; and''; and
            (3) by inserting after paragraph (65), the following new 
        paragraph:
            ``(66) if the Indian Health Service operates or funds 
        health programs in the State or if there are Indian Tribes, 
        Tribal Organizations, or Urban Indian Organizations (as those 
        terms are defined in section 4 of the Indian Health Care 
        Improvement Act) providing health care in the State for which 
        medical assistance is available, provide for the establishment 
        and maintenance of the advisory process described in section 
        409(b) of such Act.''.
    (c) SCHIP Treatment of Indian Tribes, Tribal Organizations, and 
Urban Indian Organizations.--Section 2105(c)(6)(B) of such Act (42 
U.S.C. 1397ee(c)(6)(B)) is amended by inserting ``or by an Indian 
Tribe, Tribal Organization, or Urban Indian Organization (as such terms 
are defined in section 4 of the Indian Health Care Improvement Act)'' 
after ``Service''.
                                 <all>