[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 556 Introduced in Senate (IS)]







108th CONGRESS
  1st Session
                                 S. 556

 To amend the Indian Health Care Improvement Act to revise and extend 
                               that Act.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 6, 2003

 Mr. Campbell (for himself, Mr. Inouye, and Mr. McCain) introduced the 
 following bill; which was read twice and referred to the Committee on 
                             Indian Affairs

_______________________________________________________________________

                                 A BILL


 
 To amend the Indian Health Care Improvement Act to revise and extend 
                               that Act.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Indian Health Care 
Improvement Act Reauthorization of 2003''.
    (b) Table of Contents.--The table of contents for this Act is as 
follows:

Sec. 1. Short title.
   TITLE I--REAUTHORIZATION AND REVISIONS OF THE INDIAN HEALTH CARE 
                            IMPROVEMENT ACT

Sec. 101. Amendment to the Indian Health Care Improvement Act.
       TITLE II--CONFORMING AMENDMENTS TO THE SOCIAL SECURITY ACT

                          Subtitle A--Medicare

Sec. 201. Limitations on charges.
Sec. 202. Qualified Indian health program.
                          Subtitle B--Medicaid

Sec. 211. State consultation with Indian health programs.
Sec. 212. FMAP for services provided by Indian health programs.
Sec. 213. Indian Health Service programs.
         Subtitle C--State Children's Health Insurance Program

Sec. 221. Enhanced FMAP for State children's health insurance program.
Sec. 222. Direct funding of State children's health insurance program.
              Subtitle D--Authorization of Appropriations

Sec. 231. Authorization of appropriations.
                  TITLE III--MISCELLANEOUS PROVISIONS

Sec. 301. Repeals.
Sec. 302. Severability provisions.
Sec. 303. Effective date.

   TITLE I--REAUTHORIZATION AND REVISIONS OF THE INDIAN HEALTH CARE 
                            IMPROVEMENT ACT

SEC. 101. AMENDMENT TO THE INDIAN HEALTH CARE IMPROVEMENT ACT.

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

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

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

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

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

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

        ``Sec. 301. Consultation, construction and renovation of 
                            facilities; reports.
        ``Sec. 302. Safe water and sanitary waste disposal facilities.
        ``Sec. 303. Preference to Indians and Indian firms.
        ``Sec. 304. Soboba sanitation facilities.
        ``Sec. 305. Expenditure of nonservice funds for renovation.
        ``Sec. 306. Funding for the construction, expansion, and 
                            modernization of small ambulatory care 
                            facilities.
        ``Sec. 307. Indian health care delivery demonstration project.
        ``Sec. 308. Land transfer.
        ``Sec. 309. Leases.
        ``Sec. 310. Loans, loan guarantees and loan repayment.
        ``Sec. 311. Tribal leasing.
        ``Sec. 312. Indian Health Service/tribal facilities joint 
                            venture program.
        ``Sec. 313. Location of facilities.
        ``Sec. 314. Maintenance and improvement of health care 
                            facilities.
        ``Sec. 315. Tribal management of federally-owned quarters.
        ``Sec. 316. Applicability of buy American requirement.
        ``Sec. 317. Other funding for facilities.
        ``Sec. 318. Authorization of appropriations.
                 ``TITLE IV--ACCESS TO HEALTH SERVICES

        ``Sec. 401. Treatment of payments under medicare program.
        ``Sec. 402. Treatment of payments under medicaid program.
        ``Sec. 403. Report.
        ``Sec. 404. Grants to and funding agreements with the service, 
                            Indian tribes or tribal organizations, and 
                            urban Indian organizations.
        ``Sec. 405. Direct billing and reimbursement of medicare, 
                            medicaid, and other third party payors.
        ``Sec. 406. Reimbursement from certain third parties of costs 
                            of health services.
        ``Sec. 407. Crediting of reimbursements.
        ``Sec. 408. Purchasing health care coverage.
        ``Sec. 409. Indian Health Service, Department of Veteran's 
                            Affairs, and other Federal agency health 
                            facilities and services sharing.
        ``Sec. 410. Payor of last resort.
        ``Sec. 411. Right to recover from Federal health care programs.
        ``Sec. 412. Tuba City demonstration project.
        ``Sec. 413. Access to Federal insurance.
        ``Sec. 414. Consultation and rulemaking.
        ``Sec. 415. Limitations on charges.
        ``Sec. 416. Limitation on Secretary's waiver authority.
        ``Sec. 417. Waiver of medicare and medicaid sanctions.
        ``Sec. 418. Meaning of `remuneration' for purposes of safe 
                            harbor provisions; antitrust immunity.
        ``Sec. 419. Co-insurance, co-payments, deductibles and 
                            premiums.
        ``Sec. 420. Inclusion of income and resources for purposes of 
                            medically needy medicaid eligibility.
        ``Sec. 421. Estate recovery provisions.
        ``Sec. 422. Medical child support.
        ``Sec. 423. Provisions relating to managed care.
        ``Sec. 424. Navajo Nation medicaid agency.
        ``Sec. 425. Indian advisory committees.
        ``Sec. 426. Authorization of appropriations.
              ``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

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

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

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

        ``Sec. 801. Reports.
        ``Sec. 802. Regulations.
        ``Sec. 803. Plan of implementation.
        ``Sec. 804. Availability of funds.
        ``Sec. 805. Limitation on use of funds appropriated to the 
                            Indian Health Service.
        ``Sec. 806. Eligibility of California Indians.
        ``Sec. 807. Health services for ineligible persons.
        ``Sec. 808. Reallocation of base resources.
        ``Sec. 809. Results of demonstration projects.
        ``Sec. 810. Provision of services in Montana.
        ``Sec. 811. Moratorium.
        ``Sec. 812. Tribal employment.
        ``Sec. 813. Prime vendor.
        ``Sec. 814. National Bi-Partisan Commission on Indian Health 
                            Care Entitlement.
        ``Sec. 815. Appropriations; availability.
        ``Sec. 816. Authorization of appropriations.

``SEC. 2. FINDINGS.

    ``Congress makes the following findings:
            ``(1) Federal delivery of health services and funding of 
        tribal and urban Indian health programs to maintain and improve 
        the health of the Indians are consonant with and required by 
        the Federal Government's historical and unique legal 
        relationship with the American Indian people, as reflected in 
        the Constitution, treaties, Federal laws, and the course of 
        dealings of the United States with Indian tribes, and the 
        United States' resulting government to government and trust 
        responsibility and obligations to the American Indian people.
            ``(2) From the time of European occupation and colonization 
        through the 20th century, the policies and practices of the 
        United States caused or contributed to the severe health 
        conditions of Indians.
            ``(3) Indian tribes have, through the cession of over 
        400,000,000 acres of land to the United States in exchange for 
        promises, often reflected in treaties, of health care secured a 
        de facto contract that entitles Indians to health care in 
        perpetuity, based on the moral, legal, and historic obligation 
        of the United States.
            ``(4) The population growth of the Indian people that began 
        in the later part of the 20th century increases the need for 
        Federal health care services.
            ``(5) A major national goal of the United States is to 
        provide the quantity and quality of health services which will 
        permit the health status of Indians, regardless of where they 
        live, to be raised to the highest possible level, a level that 
        is not less than that of the general population, and to provide 
        for the maximum participation of Indian tribes, tribal 
        organizations, and urban Indian organizations in the planning, 
        delivery, and management of those services.
            ``(6) Federal health services to Indians have resulted in a 
        reduction in the prevalence and incidence of illnesses among, 
        and unnecessary and premature deaths of, Indians.
            ``(7) Despite such services, the unmet health needs of the 
        American Indian people remain alarmingly severe, and even 
        continue to increase, and the health status of the Indians is 
        far below the health status of the general population of the 
        United States.
            ``(8) The disparity in health status that is to be 
        addressed is formidable. In death rates for example, Indian 
        people suffer a death rate for diabetes mellitus that is 249 
        percent higher than the death rate for all races in the United 
        States, a pneumonia and influenza death rate that is 71 percent 
        higher, a tuberculosis death rate that is 533 percent higher, 
        and a death rate from alcoholism that is 627 percent higher.

``SEC. 3. DECLARATION OF HEALTH OBJECTIVES.

    ``Congress hereby declares that it is the policy of the United 
States, in fulfillment of its special trust responsibilities and legal 
obligations to the American Indian people--
            ``(1) to assure the highest possible health status for 
        Indians and to provide all resources necessary to effect that 
        policy;
            ``(2) to raise the health status of Indians by the year 
        2010 to at least the levels set forth in the goals contained 
        within the Healthy People 2010, or any successor standards 
        thereto;
            ``(3) in order to raise the health status of Indian people 
        to at least the levels set forth in the goals contained within 
        the Healthy People 2010, or any successor standards thereto, to 
        permit Indian tribes and tribal organizations to set their own 
        health care priorities and establish goals that reflect their 
        unmet needs;
            ``(4) to increase the proportion of all degrees in the 
        health professions and allied and associated health professions 
        awarded to Indians so that the proportion of Indian health 
        professionals in each geographic service area is raised to at 
        least the level of that of the general population;
            ``(5) to require meaningful, active consultation with 
        Indian tribes, Indian organizations, and urban Indian 
organizations to implement this Act and the national policy of Indian 
self-determination; and
            ``(6) that funds for health care programs and facilities 
        operated by tribes and tribal organizations be provided in 
        amounts that are not less than the funds that are provided to 
        programs and facilities operated directly by the Service.

``SEC. 4. DEFINITIONS.

    ``In this Act:
            ``(1) Accredited and accessible.--The term `accredited and 
        accessible', with respect to an entity, means a community 
        college or other appropriate entity that is on or near a 
        reservation and accredited by a national or regional 
        organization with accrediting authority.
            ``(2) Area office.--The term `area office' means an 
        administrative entity including a program office, within the 
        Indian Health Service through which services and funds are 
        provided to the service units within a defined geographic area.
            ``(3) Assistant secretary.--The term `Assistant Secretary' 
        means the Assistant Secretary of the Indian Health as 
        established under section 601.
            ``(4) Contract health service.--The term `contract health 
        service' means a health service that is provided at the expense 
of the Service, Indian tribe, or tribal organization by a public or 
private medical provider or hospital, other than a service funded under 
the Indian Self-Determination and Education Assistance Act or under 
this Act.
            ``(5) Department.--The term `Department', unless 
        specifically provided otherwise, means the Department of Health 
        and Human Services.
            ``(6) Fund.--The terms `fund' or `funding' mean the 
        transfer of monies from the Department to any eligible entity 
        or individual under this Act by any legal means, including 
        funding agreements, contracts, memoranda of understanding, Buy 
        Indian Act contracts, or otherwise.
            ``(7) Funding agreement.--The term `funding agreement' 
        means any agreement to transfer funds for the planning, 
        conduct, and administration of programs, functions, services 
        and activities to tribes and tribal organizations from the 
        Secretary under the authority of the Indian Self-Determination 
        and Education Assistance Act.
            ``(8) Health profession.--The term `health profession' 
        means allopathic medicine, family medicine, internal medicine, 
        pediatrics, geriatric medicine, obstetrics and gynecology, 
        podiatric medicine, nursing, public health nursing, dentistry, 
        psychiatry, osteopathy, optometry, pharmacy, psychology, public 
        health, social work, marriage and family therapy, chiropractic 
        medicine, environmental health and engineering, and allied 
        health professions, or any other health profession.
            ``(9) Health promotion; disease prevention.--The terms 
        `health promotion' and `disease prevention' shall have the 
        meanings given such terms in paragraphs (1) and (2) of section 
        203(c).
            ``(10) Indian.--The term `Indian' and `Indians' shall have 
        meanings given such terms for purposes of the Indian Self-
        Determination and Education Assistance Act.
            ``(11) Indian health program.--The term `Indian health 
        program' shall have the meaning given such term in section 
        110(a)(2)(A).
            ``(12) Indian tribe.--The term `Indian tribe' shall have 
        the meaning given such term in section 4(e) of the Indian Self 
        Determination and Education Assistance Act.
            ``(13) Reservation.--The term `reservation' means any 
        federally recognized Indian tribe's reservation, Pueblo or 
        colony, including former reservations in Oklahoma, Alaska 
        Native Regions established pursuant to the Alaska Native Claims 
        Settlement Act, and Indian allotments.
            ``(14) Secretary.--The term `Secretary', unless 
        specifically provided otherwise, means the Secretary of Health 
        and Human Services.
            ``(15) Service.--The term `Service' means the Indian Health 
        Service.
            ``(16) Service area.--The term `service area' means the 
        geographical area served by each area office.
            ``(17) Service unit.--The term `service unit' means--
                    ``(A) an administrative entity within the Indian 
                Health Service; or
                    ``(B) a tribe or tribal organization operating 
                health care programs or facilities with funds from the 
                Service under the Indian Self-Determination and 
                Education Assistance Act, through which services are 
                provided, directly or by contract, to the eligible 
                Indian population within a defined geographic area.
            ``(18) Traditional health care practices.--The term 
        `traditional health care practices' means the application by 
        Native healing practitioners of the Native healing sciences (as 
        opposed or in contradistinction to western healing sciences) 
        which embodies the influences or forces of innate tribal 
        discovery, history, description, explanation and knowledge of 
        the states of wellness and illness and which calls upon these 
        influences or forces, including physical, mental, and spiritual 
        forces in the promotion, restoration, preservation and 
        maintenance of health, well-being, and life's harmony.
            ``(19) Tribal organization.--The term `tribal organization' 
        shall have the meaning given such term in section 4(l) of the 
        Indian Self Determination and Education Assistance Act.
            ``(20) Tribally controlled community college.--The term 
        `tribally controlled community college' shall have the meaning 
        given such term in section 126 (g)(2).
            ``(21) Urban center.--The term `urban center' means any 
        community that has a sufficient urban Indian population with 
        unmet health needs to warrant assistance under title V, as 
        determined by the Secretary.
            ``(22) Urban indian.--The term `urban Indian' means any 
        individual who resides in an urban center and who--
                    ``(A) for purposes of title V and regardless of 
                whether such individual lives on or near a reservation, 
                is a member of a tribe, band or other organized group 
                of Indians, including those tribes, bands or groups 
                terminated since 1940 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) is an Eskimo or Aleut or other Alaskan 
                Native;
                    ``(C) is considered by the Secretary of the 
                Interior to be an Indian for any purpose; or
                    ``(D) is determined to be an Indian under 
                regulations promulgated by the Secretary.
            ``(23) Urban indian organization.--The term `urban Indian 
        organization' means a nonprofit corporate body situated in an 
        urban center, governed by an urban Indian controlled board of 
        directors, and providing for the participation of all 
        interested Indian groups and individuals, and which is capable 
        of legally cooperating with other public and private entities 
        for the purpose of performing the activities described in 
        section 503(a).

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

``SEC. 101. PURPOSE.

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

``SEC. 102. GENERAL REQUIREMENTS.

    ``(a) Service Area Priorities.--Unless specifically provided 
otherwise, amounts appropriated for each fiscal year to carry out each 
program authorized under this title shall be allocated by the Secretary 
to the area office of each service area using a formula--
            ``(1) to be developed in consultation with Indian tribes, 
        tribal organizations and urban Indian organizations;
            ``(2) that takes into account the human resource and 
        development needs in each such service area; and
            ``(3) that weighs the allocation of amounts appropriated in 
        favor of those service areas where the health status of Indians 
        within the area, as measured by life expectancy based upon the 
        most recent data available, is significantly lower than the 
        average health status for Indians in all service areas, except 
        that amounts allocated to each such area using such a weighted 
        allocation formula shall not be less than the amounts allocated 
        to each such area in the previous fiscal year.
    ``(b) Consultation.--Each area office receiving funds under this 
title shall actively and continuously consult with representatives of 
Indian tribes, tribal organizations, and urban Indian organizations to 
prioritize the utilization of funds provided under this title within 
the service area.
    ``(c) Reallocation.--Unless specifically prohibited, an area office 
may reallocate funds provided to the office under this title among the 
programs authorized by this title, except that scholarship and loan 
repayment funds shall not be used for administrative functions or 
expenses.
    ``(d) Limitation.--This section shall not apply with respect to 
individual recipients of scholarships, loans or other funds provided 
under this title (as this title existed 1 day prior to the date of 
enactment of this Act) until such time as the individual completes the 
course of study that is supported through the use of such funds.

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

    ``(a) In General.--The Secretary, acting through the Service, shall 
make funds available through the area office to public or nonprofit 
private health entities, or Indian tribes or tribal organizations to 
assist such entities in meeting the costs of--
            ``(1) identifying Indians with a potential for education or 
        training in the health professions and encouraging and 
        assisting them--
                    ``(A) to enroll in courses of study in such health 
                professions; or
                    ``(B) if they are not qualified to enroll in any 
                such courses of study, to undertake such postsecondary 
                education or training as may be required to qualify 
                them for enrollment;
            ``(2) publicizing existing sources of financial aid 
        available to Indians enrolled in any course of study referred 
        to in paragraph (1) or who are undertaking training necessary 
        to qualify them to enroll in any such course of study; or
            ``(3) establishing other programs which the area office 
        determines will enhance and facilitate the enrollment of 
        Indians in, and the subsequent pursuit and completion by them 
        of, courses of study referred to in paragraph (1).
    ``(b) Administrative Provisions.--
            ``(1) Application.--To be eligible to receive funds under 
        this section an entity described in subsection (a) shall submit 
        to the Secretary, through the appropriate area office, and have 
        approved, an application in such form, submitted in such 
        manner, and containing such information as the Secretary shall 
        by regulation prescribe.
            ``(2) Preference.--In awarding funds under this section, 
        the area office shall give a preference to applications 
        submitted by Indian tribes, tribal organizations, or urban 
        Indian organizations.
            ``(3) Amount.--The amount of funds to be provided to an 
        eligible entity under this section shall be determined by the 
        area office. Payments under this section may be made in advance 
        or by way of reimbursement, and at such intervals and on such 
        conditions as provided for in regulations promulgated pursuant 
        to this Act.
            ``(4) Terms.--A funding commitment under this section 
        shall, to the extent not otherwise prohibited by law, be for a 
        term of 3 years, as provided for in regulations promulgated 
        pursuant to this Act.
    ``(c) Definition.--For purposes of this section and sections 104 
and 105, the terms `Indian' and `Indians' shall, in addition to the 
definition provided for in section 4, mean any individual who--
            ``(1) irrespective of whether such individual lives on or 
        near a reservation, is a member of a tribe, band, or other 
        organized group of Indians, including those tribes, bands, or 
        groups terminated since 1940;
            ``(2) is an Eskimo or Aleut or other Alaska Native;
            ``(3) is considered by the Secretary of the Interior to be 
        an Indian for any purpose; or
            ``(4) is determined to be an Indian under regulations 
        promulgated by the Secretary.

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

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

``SEC. 105. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.

    ``(a) Scholarships.--
            ``(1) In general.--In order to meet the needs of Indians, 
        Indian tribes, tribal organizations, and urban Indian 
        organizations for health professionals, the Secretary, acting 
        through the Service and in accordance with this section, shall 
        provide scholarships through the area offices to Indians who 
        are enrolled full or part time in accredited schools and 
        pursuing courses of study in the health professions. Such 
        scholarships shall be designated Indian Health Scholarships and 
        shall, except as provided in subsection (b), be made in 
        accordance with section 338A of the Public Health Service Act 
        (42 U.S.C. 254l).
            ``(2) No delegation.--The Director of the Service shall 
        administer this section and shall not delegate any 
        administrative functions under a funding agreement pursuant to 
        the Indian Self-Determination and Education Assistance Act.
    ``(b) Eligibility.--
            ``(1) Enrollment.--An Indian shall be eligible for a 
        scholarship under subsection (a) in any year in which such 
individual is enrolled full or part time in a course of study referred 
to in subsection (a)(1).
            ``(2) Service obligation.--
                    ``(A) Public health service act.--The active duty 
                service obligation under a written contract with the 
                Secretary under section 338A of the Public Health 
                Service Act (42 U.S.C. 254l) that an Indian has entered 
                into under that section shall, if that individual is a 
                recipient of an Indian Health Scholarship, be met in 
                full-time practice on an equivalent year for year 
                obligation, by service--
                            ``(i) in the Indian Health Service;
                            ``(ii) in a program conducted under a 
                        funding agreement entered into under the Indian 
                        Self-Determination and Education Assistance 
                        Act;
                            ``(iii) in a program assisted under title 
                        V; or
                            ``(iv) in the private practice of the 
                        applicable profession if, as determined by the 
                        Secretary, in accordance with guidelines 
                        promulgated by the Secretary, such practice is 
                        situated in a physician or other health 
                        professional shortage area and addresses the 
                        health care needs of a substantial number of 
                        Indians.
                    ``(B) Deferring active service.--At the request of 
                any Indian who has entered into a contract referred to 
                in subparagraph (A) and who receives a degree in 
                medicine (including osteopathic or allopathic 
                medicine), dentistry, optometry, podiatry, or pharmacy, 
                the Secretary shall defer the active duty service 
                obligation of that individual under that contract, in 
                order that such individual may complete any internship, 
                residency, or other advanced clinical training that is 
                required for the practice of that health profession, 
                for an appropriate period (in years, as determined by 
                the Secretary), subject to the following conditions:
                            ``(i) No period of internship, residency, 
                        or other advanced clinical training shall be 
                        counted as satisfying any period of obligated 
                        service that is required under this section.
                            ``(ii) The active duty service obligation 
                        of that individual shall commence not later 
                        than 90 days after the completion of 
that advanced clinical training (or by a date specified by the 
Secretary).
                            ``(iii) The active duty service obligation 
                        will be served in the health profession of that 
                        individual, in a manner consistent with clauses 
                        (i) through (iv) of subparagraph (A).
                    ``(C) New scholarship recipients.--A recipient of 
                an Indian Health Scholarship that is awarded after 
                December 31, 2003, shall meet the active duty service 
                obligation under such scholarship by providing service 
                within the service area from which the scholarship was 
                awarded. In placing the recipient for active duty the 
                area office shall give priority to the program that 
                funded the recipient, except that in cases of special 
                circumstances, a recipient may be placed in a different 
                service area pursuant to an agreement between the areas 
                or programs involved.
                    ``(D) Priority in assignment.--Subject to 
                subparagraph (C), the area office, in making 
                assignments of Indian Health Scholarship recipients 
                required to meet the active duty service obligation 
                described in subparagraph (A), shall give priority to 
                assigning individuals to service in those programs 
                specified in subparagraph (A) that have a need for 
                health professionals to provide health care services as 
                a result of individuals having breached contracts 
                entered into under this section.
            ``(3) Part-time enrollment.--In the case of an Indian 
        receiving a scholarship under this section who is enrolled part 
        time in an approved course of study--
                    ``(A) such scholarship shall be for a period of 
                years not to exceed the part-time equivalent of 4 
                years, as determined by the appropriate area office;
                    ``(B) the period of obligated service described in 
                paragraph (2)(A) shall be equal to the greater of--
                            ``(i) the part-time equivalent of 1 year 
                        for each year for which the individual was 
                        provided a scholarship (as determined by the 
                        area office); or
                            ``(ii) two years; and
                    ``(C) the amount of the monthly stipend specified 
                in section 338A(g)(1)(B) of the Public Health Service 
                Act (42 U.S.C. 254l(g)(1)(B))  shall be reduced pro 
rata (as determined by the Secretary) based on the number of hours such 
student is enrolled.
            ``(4) Breach of contract.--
                    ``(A) In general.--An Indian who has, on or after 
                the date of the enactment of this paragraph, entered 
                into a written contract with the area office pursuant 
                to a scholarship under this section and who--
                            ``(i) fails to maintain an acceptable level 
                        of academic standing in the educational 
                        institution in which he or she is enrolled 
                        (such level determined by the educational 
                        institution under regulations of the 
                        Secretary);
                            ``(ii) is dismissed from such educational 
                        institution for disciplinary reasons;
                            ``(iii) voluntarily terminates the training 
                        in such an educational institution for which he 
                        or she is provided a scholarship under such 
                        contract before the completion of such 
                        training; or
                            ``(iv) fails to accept payment, or 
                        instructs the educational institution in which 
                        he or she is enrolled not to accept payment, in 
                        whole or in part, of a scholarship under such 
                        contract;
                in lieu of any service obligation arising under such 
                contract, shall be liable to the United States for the 
                amount which has been paid to him or her, or on his or 
                her behalf, under the contract.
                    ``(B) Failure to perform service obligation.--If 
                for any reason not specified in subparagraph (A) an 
                individual breaches his or her written contract by 
                failing either to begin such individual's service 
                obligation under this section or to complete such 
                service obligation, the United States shall be entitled 
                to recover from the individual an amount determined in 
                accordance with the formula specified in subsection (l) 
                of section 110 in the manner provided for in such 
                subsection.
                    ``(C) Death.--Upon the death of an individual who 
                receives an Indian Health Scholarship, any obligation 
                of that individual for service or payment that relates 
                to that scholarship shall be canceled.
                    ``(D) Waiver.--The Secretary shall provide for the 
                partial or total waiver or suspension of any obligation 
                of service or payment of a recipient of an Indian 
                Health Scholarship if the Secretary, in consultation 
                with the appropriate area office, Indian tribe, tribal 
                organization, and urban Indian organization, determines 
                that--
                            ``(i) it is not possible for the recipient 
                        to meet that obligation or make that payment;
                            ``(ii) requiring that recipient to meet 
                        that obligation or make that payment would 
                        result in extreme hardship to the recipient; or
                            ``(iii) the enforcement of the requirement 
                        to meet the obligation or make the payment 
                        would be unconscionable.
                    ``(E) Hardship or good cause.--Notwithstanding any 
                other provision of law, in any case of extreme hardship 
                or for other good cause shown, the Secretary may waive, 
                in whole or in part, the right of the United States to 
                recover funds made available under this section.
                    ``(F) Bankruptcy.--Notwithstanding any other 
                provision of law, with respect to a recipient of an 
                Indian Health Scholarship, no obligation for payment 
                may be released by a discharge in bankruptcy under 
                title 11, United States Code, unless that discharge is 
                granted after the expiration of the 5-year period 
                beginning on the initial date on which that payment is 
                due, and only if the bankruptcy court finds that the 
                nondischarge of the obligation would be unconscionable.
    ``(c) Funding for Tribes for Scholarship Programs.--
            ``(1) Provision of funds.--
                    ``(A) In general.--The Secretary shall make funds 
                available, through area offices, to Indian tribes and 
                tribal organizations for the purpose of assisting such 
                tribes and tribal organizations in educating Indians to 
                serve as health professionals in Indian communities.
                    ``(B) Limitation.--The Secretary shall ensure that 
                amounts available for grants under subparagraph (A) for 
                any fiscal year shall not exceed an amount equal to 5 
                percent of the amount available for each fiscal year 
                for Indian Health Scholarships under this section.
                    ``(C) Application.--An application for funds under 
                subparagraph (A) shall be in such form and contain such 
agreements, assurances and information as consistent with this section.
            ``(2) Requirements.--
                    ``(A) In general.--An Indian tribe or tribal 
                organization receiving funds under paragraph (1) shall 
                agree to provide scholarships to Indians in accordance 
                with the requirements of this subsection.
                    ``(B) Matching requirement.--With respect to the 
                costs of providing any scholarship pursuant to 
                subparagraph (A)--
                            ``(i) 80 percent of the costs of the 
                        scholarship shall be paid from the funds 
                        provided under paragraph (1) to the Indian 
                        tribe or tribal organization; and
                            ``(ii) 20 percent of such costs shall be 
                        paid from any other source of funds.
            ``(3) Eligibility.--An Indian tribe or tribal organization 
        shall provide scholarships under this subsection only to 
        Indians who are enrolled or accepted for enrollment in a course 
        of study (approved by the Secretary) in one of the health 
        professions described in this Act.
            ``(4) Contracts.--In providing scholarships under paragraph 
        (1), the Secretary and the Indian tribe or tribal organization 
        shall enter into a written contract with each recipient of such 
        scholarship. Such contract shall--
                    ``(A) obligate such recipient to provide service in 
                an Indian health program (as defined in section 
                110(a)(2)(A)) in the same service area where the Indian 
                tribe or tribal organization providing the scholarship 
                is located, for--
                            ``(i) a number of years equal to the number 
                        of years for which the scholarship is provided 
                        (or the part-time equivalent thereof, as 
                        determined by the Secretary), or for a period 
                        of 2 years, whichever period is greater; or
                            ``(ii) such greater period of time as the 
                        recipient and the Indian tribe or tribal 
                        organization may agree;
                    ``(B) provide that the scholarship--
                            ``(i) may only be expended for--
                                    ``(I) tuition expenses, other 
                                reasonable educational expenses, and 
                                reasonable living expenses incurred in 
                                attendance at the educational 
                                institution; and
                                    ``(II) payment to the recipient of 
                                a monthly stipend of not more than the 
                                amount authorized by section 
                                338(g)(1)(B) of the Public Health 
                                Service Act (42 U.S.C. 254m(g)(1)(B), 
                                such amount to be reduced pro rata (as 
                                determined by the Secretary) based on 
                                the number of hours such student is 
                                enrolled, and may not exceed, for any 
                                year of attendance which the 
                                scholarship is provided, the total 
                                amount required for the year for the 
                                purposes authorized in this clause; and
                            ``(ii) may not exceed, for any year of 
                        attendance which the scholarship is provided, 
                        the total amount required for the year for the 
                        purposes authorized in clause (i);
                    ``(C) require the recipient of such scholarship to 
                maintain an acceptable level of academic standing as 
                determined by the educational institution in accordance 
                with regulations issued pursuant to this Act; and
                    ``(D) require the recipient of such scholarship to 
                meet the educational and licensure requirements 
                appropriate to the health profession involved.
            ``(5) Breach of contract.--
                    ``(A) In general.--An individual who has entered 
                into a written contract with the Secretary and an 
                Indian tribe or tribal organization under this 
                subsection and who--
                            ``(i) fails to maintain an acceptable level 
                        of academic standing in the education 
                        institution in which he or she is enrolled 
                        (such level determined by the educational 
                        institution under regulations of the 
                        Secretary);
                            ``(ii) is dismissed from such education for 
                        disciplinary reasons;
                            ``(iii) voluntarily terminates the training 
                        in such an educational institution for which he 
                        or she has been provided a scholarship under 
                        such contract before the completion of such 
                        training; or
                            ``(iv) fails to accept payment, or 
                        instructs the educational institution in which 
                        he or she is enrolled not to accept payment, in 
                        whole or in part, of a scholarship under such 
                        contract, in lieu of any service obligation 
                        arising under such contract;
                shall be liable to the United States for the Federal 
                share of the amount which has been paid to him or her, 
                or on his or her behalf, under the contract.
                    ``(B) Failure to perform service obligation.--If 
                for any reason not specified in subparagraph (A), an 
                individual breaches his or her written contract by 
                failing to either begin such individual's service 
                obligation required under such contract or to complete 
                such service obligation, the United States shall be 
                entitled to recover from the individual an amount 
                determined in accordance with the formula specified in 
                subsection (l) of section 110 in the manner provided 
                for in such subsection.
                    ``(C) Information.--The Secretary may carry out 
                this subsection on the basis of information received 
                from Indian tribes or tribal organizations involved, or 
                on the basis of information collected through such 
                other means as the Secretary deems appropriate.
            ``(6) Required agreements.--The recipient of a scholarship 
        under paragraph (1) shall agree, in providing health care 
        pursuant to the requirements of this subsection--
                    ``(A) not to discriminate against an individual 
                seeking care on the basis of the ability of the 
                individual to pay for such care or on the basis that 
                payment for such care will be made pursuant to the 
                program established in title XVIII of the Social 
                Security Act or pursuant to the programs established in 
                title XIX of such Act; and
                    ``(B) to accept assignment under section 
                1842(b)(3)(B)(ii) of the Social Security Act for all 
                services for which payment may be made under part B of 
                title XVIII of such Act, and to enter into an 
                appropriate agreement with the State agency that 
                administers the State plan for medical assistance under 
                title XIX of such Act to provide service to individuals 
                entitled to medical assistance under the plan.
            ``(7) Payments.--The Secretary, through the area office, 
        shall make payments under this subsection to an Indian tribe or 
        tribal organization for any fiscal year subsequent to the first 
        fiscal year of  such payments unless the Secretary or area 
office determines that, for the immediately preceding fiscal year, the 
Indian tribe or tribal organization has not complied with the 
requirements of this subsection.

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

    ``(a) In General.--Notwithstanding section 102, the Secretary shall 
provide funds to at least 3 colleges and universities for the purpose 
of developing and maintaining American Indian psychology career 
recruitment programs as a means of encouraging Indians to enter the 
mental health field. These programs shall be located at various 
colleges and universities throughout the country to maximize their 
availability to Indian students and new programs shall be established 
in different locations from time to time.
    ``(b) Quentin N. Burdick American Indians Into Psychology 
Program.--The Secretary shall provide funds under subsection (a) to 
develop and maintain a program at the University of North Dakota to be 
known as the `Quentin N. Burdick American Indians Into Psychology 
Program'. Such program shall, to the maximum extent feasible, 
coordinate with the Quentin N. Burdick American Indians Into Nursing 
Program authorized under section 115, the Quentin N. Burdick Indians 
into Health Program authorized under section 117, and existing 
university research and communications networks.
    ``(c) Requirements.--
            ``(1) Regulations.--The Secretary shall promulgate 
        regulations pursuant to this Act for the competitive awarding 
        of funds under this section.
            ``(2) Program.--Applicants for funds under this section 
        shall agree to provide a program which, at a minimum--
                    ``(A) provides outreach and recruitment for health 
                professions to Indian communities including elementary, 
                secondary and accredited and accessible community 
                colleges that will be served by the program;
                    ``(B) incorporates a program advisory board 
                comprised of representatives from the tribes and 
                communities that will be served by the program;
                    ``(C) provides summer enrichment programs to expose 
                Indian students to the various fields of psychology 
                through research, clinical, and experimental 
                activities;
                    ``(D) provides stipends to undergraduate and 
                graduate students to pursue a career in psychology;
                    ``(E) develops affiliation agreements with tribal 
                community colleges, the Service, university affiliated 
                programs, and other appropriate accredited and 
                accessible entities to enhance the education of Indian 
                students;
                    ``(F) utilizes, to the maximum extent feasible, 
                existing university tutoring, counseling and student 
                support services; and
                    ``(G) employs, to the maximum extent feasible, 
                qualified Indians in the program.
    ``(d) Active Duty Obligation.--The active duty service obligation 
prescribed under section 338C of the Public Health Service Act (42 
U.S.C. 254m) shall be met by each graduate who receives a stipend 
described in subsection (c)(2)(C) that is funded under this section. 
Such obligation shall be met by service--
            ``(1) in the Indian Health Service;
            ``(2) in a program conducted under a funding agreement 
        contract entered into under the Indian Self-Determination and 
        Education Assistance Act;
            ``(3) in a program assisted under title V; or
            ``(4) in the private practice of psychology if, as 
        determined by the Secretary, in accordance with guidelines 
        promulgated by the Secretary, such practice is situated in a 
        physician or other health professional shortage area and 
        addresses the health care needs of a substantial number of 
        Indians.

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

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

``SEC. 108. CONTINUING EDUCATION ALLOWANCES.

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

``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.

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

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

    ``(a) Establishment.--
            ``(1) In general.--The Secretary, acting through the 
        Service, shall establish a program to be known as the Indian 
        Health Service Loan Repayment Program (referred to in this Act 
        as the `Loan Repayment Program') in order to assure an adequate 
        supply of trained health professionals necessary to maintain 
        accreditation of, and provide health care services to Indians 
        through, Indian health programs.
            ``(2) Definitions.--In this section:
                    ``(A) Indian health program.--The term `Indian 
                health program' means any health program or facility 
                funded, in whole or part, by the Service for the 
                benefit of Indians and administered--
                            ``(i) directly by the Service;
                            ``(ii) by any Indian tribe or tribal or 
                        Indian organization pursuant to a funding 
                        agreement under--
                                    ``(I) the Indian Self-Determination 
                                and Educational Assistance Act; or
                                    ``(II) section 23 of the Act of 
                                April 30, 1908 (25 U.S.C. 47) (commonly 
                                known as the `Buy-Indian Act'); or
                            ``(iii) by an urban Indian organization 
                        pursuant to title V.
                    ``(B) State.--The term `State' has the same meaning 
                given such term in section 331(i)(4) of the Public 
                Health Service Act.
    ``(b) Eligibility.--To be eligible to participate in the Loan 
Repayment Program, an individual must--
            ``(1)(A) be enrolled--
                    ``(i) in a course of study or program in an 
                accredited institution, as determined by the Secretary, 
                within any State and be scheduled to complete such 
                course of study in the same year such individual 
                applies to participate in such program; or
                    ``(ii) in an approved graduate training program in 
                a health profession; or
            ``(B) have--
                    ``(i) a degree in a health profession; and
                    ``(ii) a license to practice a health profession in 
                a State;
            ``(2)(A) be eligible for, or hold, an appointment as a 
        commissioned officer in the Regular or Reserve Corps of the 
        Public Health Service;
            ``(B) be eligible for selection for civilian service in the 
        Regular or Reserve Corps of the Public Health Service;
            ``(C) meet the professional standards for civil service 
        employment in the Indian Health Service; or
            ``(D) be employed in an Indian health program without a 
        service obligation; and
            ``(3) submit to the Secretary an application for a contract 
        described in subsection (f).
    ``(c) Forms.--
            ``(1) In general.--In disseminating application forms and 
        contract forms to individuals desiring to participate in the 
        Loan Repayment Program, the Secretary shall include with such 
        forms a fair summary of the rights and liabilities of an 
        individual whose application is approved (and whose contract is 
        accepted) by the Secretary, including in the summary a clear 
        explanation of the damages to which the United States is 
        entitled under subsection (l) in the case of the individual's 
        breach of the contract. The Secretary shall provide such 
        individuals with sufficient information regarding the 
        advantages and disadvantages of service as a commissioned 
officer in the Regular or Reserve Corps of the Public Health Service or 
a civilian employee of the Indian Health Service to enable the 
individual to make a decision on an informed basis.
            ``(2) Forms to be understandable.--The application form, 
        contract form, and all other information furnished by the 
        Secretary under this section shall be written in a manner 
        calculated to be understood by the average individual applying 
        to participate in the Loan Repayment Program.
            ``(3) Availability.--The Secretary shall make such 
        application forms, contract forms, and other information 
        available to individuals desiring to participate in the Loan 
        Repayment Program on a date sufficiently early to ensure that 
        such individuals have adequate time to carefully review and 
        evaluate such forms and information.
    ``(d) Priority.--
            ``(1) Annual determinations.--The Secretary, acting through 
        the Service and in accordance with subsection (k), shall 
        annually--
                    ``(A) identify the positions in each Indian health 
                program for which there is a need or a vacancy; and
                    ``(B) rank those positions in order of priority.
            ``(2) Priority in approval.--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 an Indian tribe, tribal organization, 
                        or urban Indian organization; and
                            ``(ii) other individuals based on the 
                        priority rankings under paragraph (1).
    ``(e) Contracts.--
            ``(1) In general.--An individual becomes a participant in 
        the Loan Repayment Program only upon the Secretary and the 
        individual entering into a written contract described in 
        subsection (f).
            ``(2) Notice.--Not later than 21 days after considering an 
        individual for participation in the Loan Repayment Program 
        under paragraph (1), the Secretary shall provide written notice 
        to the individual of--
                    ``(A) the Secretary's approving of the individual's 
                participation in the Loan Repayment Program, including 
                extensions resulting in an aggregate period of 
                obligated service in excess of 4 years; or
                    ``(B) the Secretary's disapproving an individual's 
                participation in such Program.
    ``(f) Written Contract.--The written contract referred to in this 
section between the Secretary and an individual shall contain--
            ``(1) an agreement under which--
                    ``(A) subject to paragraph (3), the Secretary 
                agrees--
                            ``(i) to pay loans on behalf of the 
                        individual in accordance with the provisions of 
                        this section; and
                            ``(ii) to accept (subject to the 
                        availability of appropriated funds for carrying 
                        out this section) the individual into the 
                        Service or place the individual with a tribe, 
                        tribal organization, or urban Indian 
                        organization as provided in subparagraph 
                        (B)(iii); and
                    ``(B) subject to paragraph (3), the individual 
                agrees--
                            ``(i) to accept loan payments on behalf of 
                        the individual;
                            ``(ii) in the case of an individual 
                        described in subsection (b)(1)--
                                    ``(I) to maintain enrollment in a 
                                course of study or training described 
                                in subsection (b)(1)(A) until the 
                                individual completes the course of 
                                study or training; and
                                    ``(II) while enrolled in such 
                                course of study or training, to 
                                maintain an acceptable level of 
                                academic standing (as determined under 
                                regulations of the Secretary by the 
                                educational institution offering such 
                                course of study or training);
                            ``(iii) to serve for a time period 
                        (referred to in this section as the `period of 
                        obligated service') equal to 2 years or such 
                        longer period as the individual may agree to 
                        serve in the full-time clinical practice of  
such individual's profession in an Indian health program to which the 
individual may be assigned by the Secretary;
            ``(2) a provision permitting the Secretary to extend for 
        such longer additional periods, as the individual may agree to, 
        the period of obligated service agreed to by the individual 
        under paragraph (1)(B)(iii);
            ``(3) a provision that any financial obligation of the 
        United States arising out of a contract entered into under this 
        section and any obligation of the individual which is 
        conditioned thereon is contingent upon funds being appropriated 
        for loan repayments under this section;
            ``(4) a statement of the damages to which the United States 
        is entitled under subsection (l) for the individual's breach of 
        the contract; and
            ``(5) such other statements of the rights and liabilities 
        of the Secretary and of the individual, not inconsistent with 
        this section.
    ``(g) Loan Repayments.--
            ``(1) In general.--A loan repayment provided for an 
        individual under a written contract under the Loan Repayment 
        Program shall consist of payment, in accordance with paragraph 
        (2), on behalf of the individual of the principal, interest, 
and related expenses on government and commercial loans received by the 
individual regarding the undergraduate or graduate education of the 
individual (or both), which loans were made for--
                    ``(A) tuition expenses;
                    ``(B) all other reasonable educational expenses, 
                including fees, books, and laboratory expenses, 
                incurred by the individual; and
                    ``(C) reasonable living expenses as determined by 
                the Secretary.
            ``(2) Amount of payment.--
                    ``(A) In general.--For each year of obligated 
                service that an individual contracts to serve under 
                subsection (f) the Secretary may pay up to $35,000 (or 
                an amount equal to the amount specified in section 
                338B(g)(2)(A) of the Public Health Service Act) on 
                behalf of the individual for loans described in 
                paragraph (1). In making a determination of the amount 
                to pay for a year of such service by an individual, the 
                Secretary shall consider the extent to which each such 
                determination--
                            ``(i) affects the ability of the Secretary 
                        to maximize the number of contracts that can be 
                        provided under the Loan Repayment Program from 
                        the amounts appropriated for such contracts;
                            ``(ii) provides an incentive to serve in 
                        Indian health programs with the greatest 
                        shortages of health professionals; and
                            ``(iii) provides an incentive with respect 
                        to the health professional involved remaining 
                        in an Indian health program with such a health 
                        professional shortage, and continuing to 
                        provide primary health services, after the 
                        completion of the period of obligated service 
                        under the Loan Repayment Program.
                    ``(B) Time for payment.--Any arrangement made by 
                the Secretary for the making of loan repayments in 
                accordance with this subsection shall provide that any 
                repayments for a year of obligated service shall be 
                made not later than the end of the fiscal year in which 
                the individual completes such year of service.
            ``(3) Schedule for payments.--The Secretary may enter into 
        an agreement with the holder of any loan for which payments are 
        made under the Loan Repayment Program to establish a schedule 
        for the making of such payments.
    ``(h) Counting of Individuals.--Notwithstanding any other provision 
of law, individuals who have entered into written contracts with the 
Secretary under this section, while undergoing academic training, shall 
not be counted against any employment ceiling affecting the Department.
    ``(i) Recruiting Programs.--The Secretary shall conduct recruiting 
programs for the Loan Repayment Program and other health professional 
programs of the Service at educational institutions training health 
professionals or specialists identified in subsection (a).
    ``(j) Nonapplication of Certain Provision.--Section 214 of the 
Public Health Service Act (42 U.S.C. 215) shall not apply to 
individuals during their period of obligated service under the Loan 
Repayment Program.
    ``(k) Assignment of Individuals.--The Secretary, in assigning 
individuals to serve in Indian health programs pursuant to contracts 
entered into under this section, shall--
            ``(1) ensure that the staffing needs of Indian health 
        programs administered by an Indian tribe or tribal or health 
        organization receive consideration on an  equal basis with 
programs that are administered directly by the Service; and
            ``(2) give priority to assigning individuals to Indian 
        health programs that have a need for health professionals to 
        provide health care services as a result of individuals having 
        breached contracts entered into under this section.
    ``(l) Breach of Contract.--
            ``(1) In general.--An individual who has entered into a 
        written contract with the Secretary under this section and 
        who--
                    ``(A) is enrolled in the final year of a course of 
                study and who--
                            ``(i) fails to maintain an acceptable level 
                        of academic standing in the educational 
                        institution in which he is enrolled (such level 
                        determined by the educational institution under 
                        regulations of the Secretary);
                            ``(ii) voluntarily terminates such 
                        enrollment; or
                            ``(iii) is dismissed from such educational 
                        institution before completion of such course of 
                        study; or
                    ``(B) is enrolled in a graduate training program, 
                and who fails to complete such training program, and 
                does not receive a waiver from the Secretary under 
                subsection (b)(1)(B)(ii),
        shall be liable, in lieu of any service obligation arising 
        under such contract, to the United States for the amount which 
        has been paid on such individual's behalf under the contract.
            ``(2) Amount of recovery.--If, for any reason not specified 
        in paragraph (1), an individual breaches his written contract 
        under this section by failing either to begin, or complete, 
        such individual's period of obligated service in accordance 
        with subsection (f), the United States shall be entitled to 
        recover from such individual an amount to be determined in 
        accordance with the following formula:

                              A=3Z(t-s/t)

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

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

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

``SEC. 112. RECRUITMENT ACTIVITIES.

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

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

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

``SEC. 114. ADVANCED TRAINING AND RESEARCH.

    ``(a) Demonstration Project.--The Secretary, acting through the 
Service, shall establish a demonstration project to enable health 
professionals who have worked in an Indian health program (as defined 
in section 110) for a substantial period of time to pursue advanced 
training or research in areas of study for which the Secretary 
determines a need exists.
    ``(b) Service Obligation.--
            ``(1) In general.--An individual who participates in the 
        project under subsection (a), where the educational costs are 
        borne by the Service, shall incur an obligation to serve in an 
        Indian health program for a period of obligated service equal 
        to at  least the period of time during which the individual 
participates in such project.
            ``(2) Failure to complete service.--In the event that an 
        individual fails to complete a period of obligated service 
        under paragraph (1), the individual shall be liable to the 
        United States for the period of service remaining. In such 
        event, with respect to individuals entering the project after 
        the date of the enactment of this Act, the United States shall 
        be entitled to recover from such individual an amount to be 
        determined in accordance with the formula specified in 
        subsection (l) of section 110 in the manner provided for in 
        such subsection.
    ``(c) Opportunity To Participate.--Health professionals from Indian 
tribes, tribal organizations, and urban Indian organizations under the 
authority of the Indian Self-Determination and Education Assistance Act 
shall be given an equal opportunity to participate in the program under 
subsection (a).

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

    ``(a) Grants.--Notwithstanding section 102, the Secretary, acting 
through the Service, shall provide funds to--
            ``(1) public or private schools of nursing;
            ``(2) tribally controlled community colleges and tribally 
        controlled postsecondary vocational institutions (as defined in 
        section 390(2) of the Tribally Controlled Vocational 
        Institutions Support Act of 1990 (20 U.S.C. 2397h(2)); and
            ``(3) nurse midwife programs, and advance practice nurse 
        programs, that are provided by any tribal college accredited 
        nursing program, or in the absence of such, any other public or 
        private institution,
for the purpose of increasing the number of nurses, nurse midwives, and 
nurse practitioners who deliver health care services to Indians.
    ``(b) Use of Grants.--Funds provided under subsection (a) may be 
used to--
            ``(1) recruit individuals for programs which train 
        individuals to be nurses, nurse midwives, or advanced practice 
        nurses;
            ``(2) provide scholarships to Indian individuals enrolled 
        in such programs that may be used to pay the tuition charged 
        for such program and for other expenses incurred in connection 
        with such program, including books, fees, room and board, and 
        stipends for living expenses;
            ``(3) provide a program that encourages nurses, nurse 
        midwives, and advanced practice nurses to provide, or continue 
        to provide, health care services to Indians;
            ``(4) provide a program that increases the skills of, and 
        provides continuing education to, nurses, nurse midwives, and 
        advanced practice nurses; or
            ``(5) provide any program that is designed to achieve the 
        purpose described in subsection (a).
    ``(c) Applications.--Each application for funds under subsection 
(a) shall include such information as the Secretary may require to 
establish the connection between the program of the applicant and a 
health care facility that primarily serves Indians.
    ``(d) Preferences.--In providing funds under subsection (a), the 
Secretary shall extend a preference to--
            ``(1) programs that provide a preference to Indians;
            ``(2) programs that train nurse midwives or advanced 
        practice nurses;
            ``(3) programs that are interdisciplinary; and
            ``(4) programs that are conducted in cooperation with a 
        center for gifted and talented Indian students established 
        under section 5324(a) of the Indian Education Act of 1988.
    ``(e) Quentin N. Burdick American Indians Into Nursing Program.--
The Secretary shall ensure that a portion of the funds authorized under 
subsection (a) is made available to establish and maintain a program at 
the University of North Dakota to be known as the `Quentin N. Burdick 
American Indians Into Nursing Program'. Such program shall, to the 
maximum extent feasible, coordinate with the Quentin N. Burdick 
American Indians Into Psychology Program established under section 
106(b) and the Quentin N. Burdick Indian Health Programs established 
under section 117(b).
    ``(f) Service Obligation.--The active duty service obligation 
prescribed under section 338C of the Public Health Service Act (42 
U.S.C. 254m) shall be met by each individual who receives training or 
assistance described in paragraph (1) or (2) of subsection (b) that is 
funded under subsection (a). Such obligation shall be met by service--
            ``(1) in the Indian Health Service;
            ``(2) in a program conducted under a contract entered into 
        under the Indian Self-Determination and Education Assistance 
        Act;
            ``(3) in a program assisted under title V; or
            ``(4) in the private practice of nursing if, as determined 
        by the Secretary, in accordance with guidelines promulgated by 
        the Secretary, such practice is situated in a physician or 
        other health professional shortage area and addresses the 
        health care needs of a substantial number of Indians.

``SEC. 116. TRIBAL CULTURE AND HISTORY.

    ``(a) In General.--The Secretary, acting through the Service, shall 
require that appropriate employees of the Service who serve Indian 
tribes in each service area receive educational instruction in the 
history and culture of such tribes and their relationship to the 
Service.
    ``(b) Requirements.--To the extent feasible, the educational 
instruction to be provided under subsection (a) shall--
            ``(1) be provided in consultation with the affected tribal 
        governments, tribal organizations, and urban Indian 
        organizations;
            ``(2) be provided through tribally-controlled community 
        colleges (within the meaning of section 2(4) of the Tribally 
        Controlled Community College Assistance Act of 1978) and 
        tribally controlled postsecondary vocational institutions (as 
        defined in section 390(2) of the Tribally Controlled Vocational 
        Institutions Support Act of 1990 (20 U.S.C. 2397h(2)); and
            ``(3) include instruction in Native American studies.

``SEC. 117. INMED PROGRAM.

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

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

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

``SEC. 119. RETENTION BONUS.

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

``SEC. 120. NURSING RESIDENCY PROGRAM.

    ``(a) Establishment.--The Secretary, acting through the Service, 
shall establish a program to enable Indians who are licensed practical 
nurses, licensed vocational nurses, and registered nurses who are 
working in an Indian health program (as defined in section 
110(a)(2)(A)), and have done so for a period of not less than 1 year, 
to pursue advanced training.
    ``(b) Requirement.--The program established under subsection (a) 
shall include a combination of education and work study in an Indian 
health program (as defined in section 110(a)(2)(A)) leading to an 
associate or bachelor's degree (in the case of a licensed practical 
nurse or licensed vocational nurse) or a bachelor's degree (in the case 
of a registered nurse) or an advanced degree in nursing and public 
health.
    ``(c) Service Obligation.--An individual who participates in a 
program under subsection (a), where the educational costs are paid by 
the Service, shall incur an obligation to serve in an Indian health 
program for a period of obligated service equal to the amount of time 
during which the individual participates in such program. In the event 
that the individual fails to complete such obligated service, the 
United States shall be entitled to recover from such individual an 
amount determined in accordance with the formula specified in 
subsection (l) of section 110 in the manner provided for in such 
subsection.

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

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

``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.

    ``Subject to Section 102, the Secretary, acting through the 
Service, shall, through a funding agreement or otherwise, provide 
training for Indians in the administration and planning of tribal 
health programs.

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

    ``(a) Pilot Programs.--The Secretary may, through area offices, 
fund pilot programs for tribes and tribal organizations to address 
chronic shortages of health professionals.
    ``(b) Purpose.--It is the purpose of the health professions 
demonstration project under this section to--
            ``(1) provide direct clinical and practical experience in a 
        service area to health professions students and residents from 
        medical schools;
            ``(2) improve the quality of health care for Indians by 
        assuring access to qualified health care professionals; and
            ``(3) provide academic and scholarly opportunities for 
        health professionals serving Indian people by identifying and 
        utilizing all academic and scholarly resources of the region.
    ``(c) Advisory Board.--A pilot program established under subsection 
(a) shall incorporate a program advisory board that shall be composed 
of representatives from the tribes and communities in the service area 
that will be served by the program.

``SEC. 124. SCHOLARSHIPS.

    ``Scholarships and loan reimbursements provided to individuals 
pursuant to this title shall be treated as `qualified scholarships' for 
purposes of section 117 of the Internal Revenue Code of 1986.

``SEC. 125. NATIONAL HEALTH SERVICE CORPS.

    ``(a) Limitations.--The Secretary shall not--
            ``(1) remove a member of the National Health Services Corps 
        from a health program operated by Indian Health Service or by a 
        tribe or tribal organization under a funding agreement with the 
        Service under the Indian Self-Determination and Education 
        Assistance Act, or by urban Indian organizations; or
            ``(2) withdraw the funding used to support such a member;
unless the Secretary, acting through the Service, tribes or tribal 
organization, has ensured that the Indians receiving services from such 
member will experience no reduction in services.
    ``(b) Designation of Service Areas as Health Professional Shortage 
Areas.--All service areas served by programs operated by the Service or 
by a tribe or tribal organization under the Indian Self-Determination 
and Education Assistance Act, or by an urban Indian organization, shall 
be designated under section 332 of the Public Health Service Act (42 
U.S.C. 254e) as Health Professional Shortage Areas.
    ``(c) Full Time Equivalent.--National Health Service Corps scholars 
that qualify for the commissioned corps in the Public Health Service 
shall be exempt from the full time equivalent limitations of the 
National Health Service Corps and the Service when such scholars serve 
as commissioned corps officers in a health program operated by an 
Indian tribe or tribal organization under the Indian Self-Determination 
and Education Assistance Act or by an urban Indian organization.

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

    ``(a) Demonstration Projects.--The Secretary, acting through the 
Service, may enter into contracts with, or make grants to, accredited 
tribally controlled community colleges, tribally controlled 
postsecondary vocational institutions, and eligible accredited and 
accessible community colleges to establish demonstration projects to 
develop educational curricula for substance abuse counseling.
    ``(b) Use of Funds.--Funds provided under this section shall be 
used only for developing and providing educational curricula for 
substance abuse counseling (including paying salaries for instructors). 
Such curricula may be provided through satellite campus programs.
    ``(c) Term of Grant.--A contract entered into or a grant provided 
under this section shall be for a period of 1 year. Such contract or 
grant may be renewed for an additional 1 year period upon the approval 
of the Secretary.
    ``(d) Review of Applications.--Not later than 180 days after the 
date of the enactment of this Act, the Secretary, after consultation 
with Indian tribes and administrators of accredited tribally controlled 
community colleges, tribally controlled postsecondary vocational 
institutions, and eligible accredited and accessible community 
colleges, shall develop and issue criteria for the review and approval 
of applications for funding (including applications for renewals of 
funding) under this section. Such criteria shall ensure that 
demonstration projects established under this section promote the 
development of the capacity of such entities to educate substance abuse 
counselors.
    ``(e) Technical Assistance.--The Secretary shall provide such 
technical and other assistance as may be necessary to enable grant 
recipients to comply with the provisions of this section.
    ``(f) Report.--The Secretary shall submit to the President, for 
inclusion in the report required to be submitted under section 801 for 
fiscal year 1999, a report on the findings and conclusions derived from 
the demonstration projects conducted under this section.
    ``(g) Definitions.--In this section:
            ``(1) Educational curriculum.--The term `educational 
        curriculum' means 1 or more of the following:
                    ``(A) Classroom education.
                    ``(B) Clinical work experience.
                    ``(C) Continuing education workshops.
            ``(2) Tribally controlled community college.--The term 
        `tribally controlled community college' has the meaning given 
        such term in section 2(a)(4) of the Tribally Controlled 
        Community College Assistance Act of 1978 (25 U.S.C. 
        1801(a)(4)).
            ``(3) Tribally controlled postsecondary vocational 
        institution.--The term `tribally controlled postsecondary 
        vocational institution' has the meaning given such term in 
        section 390(2) of the Tribally Controlled Vocational 
        Institutions Support Act of 1990 (20 U.S.C. 2397h(2)).

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

    ``(a) Study and List.--
            ``(1) In general.--The Secretary and the Secretary of the 
        Interior in consultation with Indian tribes and tribal 
        organizations shall conduct a study and compile a list of the 
        types of staff positions specified in subsection (b) whose 
        qualifications include or should include, training in the 
        identification, prevention, education, referral or treatment of 
        mental illness, dysfunctional or self-destructive behavior.
            ``(2) Positions.--The positions referred to in paragraph 
        (1) are--
                    ``(A) staff positions within the Bureau of Indian 
                Affairs, including existing positions, in the fields 
                of--
                            ``(i) elementary and secondary education;
                            ``(ii) social services, family and child 
                        welfare;
                            ``(iii) law enforcement and judicial 
                        services; and
                            ``(iv) alcohol and substance abuse;
                    ``(B) staff positions within the Service; and
                    ``(C) staff positions similar to those specified in 
                subsection (b) and established and maintained by Indian 
                tribes, tribal organizations, and urban Indian 
                organizations, including positions established pursuant 
                to funding agreements under the Indian Self-
                determination and Education Assistance Act, and this 
                Act.
            ``(3) Training criteria.--
                    ``(A) In general.--The appropriate Secretary shall 
                provide training criteria appropriate to each type of 
                position specified in subsection (b)(1) and ensure that 
                appropriate training has been or will be provided to 
                any individual in any such position.
                    ``(B) Training.--With respect to any such 
                individual in a position specified pursuant to 
                subsection (b)(3), the respective Secretaries shall 
                provide appropriate training or provide funds to an 
                Indian tribe, tribal organization, or urban Indian 
                organization for the training of appropriate 
                individuals. In the case of a funding agreement, the 
                appropriate Secretary shall ensure that such training 
                costs are included in the funding agreement, if 
                necessary.
            ``(4) Cultural relevancy.--Position specific training 
        criteria shall be culturally relevant to Indians and Indian 
        tribes and shall ensure that appropriate information regarding 
        traditional health care practices is provided.
            ``(5) Community education.--
                    ``(A) Development.--The Service shall develop and 
                implement, or on request of an Indian tribe or tribal 
                organization, assist an Indian tribe or tribal 
                organization, in developing and implementing a program 
                of community education on mental illness.
                    ``(B) Technical assistance.--In carrying out this 
                paragraph, the Service shall, upon the request of an 
                Indian tribe or tribal organization, provide technical 
                assistance to the Indian tribe or tribal organization 
                to obtain and develop community educational materials 
                on the identification, prevention, referral and 
                treatment of mental illness, dysfunctional and self-
                destructive behavior.
    ``(b) Staffing.--
            ``(1) In general.--Not later than 90 days after the date of 
        enactment of the Act, the Director of the Service shall develop 
        a plan under which the Service will increase the number of 
        health care staff that are providing mental health services by 
        at least 500 positions within 5 years after such date of 
        enactment, with at least 200 of such positions devoted to 
        child, adolescent, and family services. The allocation of such 
        positions shall be subject to the provisions of section 102(a).
            ``(2) Implementation.--The plan developed under paragraph 
        (1) shall be implemented under the Act of November 2, 1921 (25 
        U.S.C. 13) (commonly know as the `Snyder Act').

``SEC. 128. AUTHORIZATION OF APPROPRIATIONS.

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

                      ``TITLE II--HEALTH SERVICES

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

    ``(a) In General.--The Secretary may expend funds, directly or 
under the authority of the Indian Self-Determination and Education 
Assistance Act, that are appropriated under the authority of this 
section, for the purposes of--
            ``(1) eliminating the deficiencies in the health status and 
        resources of all Indian tribes;
            ``(2) eliminating backlogs in the provision of health care 
        services to Indians;
            ``(3) meeting the health needs of Indians in an efficient 
        and equitable manner;
            ``(4) eliminating inequities in funding for both direct 
        care and contract health service programs; and
            ``(5) augmenting the ability of the Service to meet the 
        following health service responsibilities with respect to those 
        Indian tribes with the highest levels of health status and 
        resource deficiencies:
                    ``(A) clinical care, including inpatient care, 
                outpatient care (including audiology, clinical eye and 
                vision care), primary care, secondary and tertiary 
                care, and long term care;
                    ``(B) preventive health, including mammography and 
                other cancer screening in accordance with section 207;
                    ``(C) dental care;
                    ``(D) mental health, including community mental 
                health services, inpatient mental health services, 
                dormitory mental health services, therapeutic and 
                residential treatment centers, and training of 
                traditional health care practitioners;
                    ``(E) emergency medical services;
                    ``(F) treatment and control of, and rehabilitative 
                care related to, alcoholism and drug abuse (including 
                fetal alcohol syndrome) among Indians;
                    ``(G) accident prevention programs;
                    ``(H) home health care;
                    ``(I) community health representatives;
                    ``(J) maintenance and repair; and
                    ``(K) traditional health care practices.
    ``(b) Use of Funds.--
            ``(1) Limitation.--Any funds appropriated under the 
        authority of this section shall not be used to offset or limit 
        any other appropriations made to the Service under this Act, 
        the Act of November 2, 1921 (25 U.S.C. 13) (commonly known as 
        the `Snyder Act'), or any other provision of law.
            ``(2) Allocation.--
                    ``(A) In general.--Funds appropriated under the 
                authority of this section shall be allocated to service 
                units or Indian tribes or tribal organizations. The 
                funds allocated to each tribe, tribal organization, or 
                service unit under this subparagraph shall be used to 
                improve the health status and reduce the resource 
                deficiency of each tribe served by such service unit, 
                tribe or tribal organization. Such allocation shall 
                weigh the amounts appropriated in favor of those 
                service areas where the health status of Indians within 
                the area, as measured by life expectancy based upon the 
                most recent data available, is significantly lower than 
                the average health status for Indians for all service 
                areas, except that amounts allocated to each such area 
                using such a weighted allocation formula shall not be 
                less than the amounts allocated to each such area in 
                the previous fiscal year.
                    ``(B) Apportionment.--The apportionment of funds 
                allocated to a service unit, tribe or tribal 
                organization under subparagraph (A) among the health 
                service responsibilities described in subsection (a)(4) 
                shall be determined by the Service in consultation 
                with, and with the active participation of, the 
                affected Indian tribes in accordance with this section 
                and such rules as may be established under title VIII.
    ``(c) Health Status and Resource Deficiency.--In this section:
            ``(1) Definition.--The term `health status and resource 
        deficiency' means the extent to which--
                    ``(A) the health status objective set forth in 
                section 3(2) is not being achieved; and
                    ``(B) the Indian tribe or tribal organization does 
                not have available to it the health resources it needs, 
                taking into account the actual cost of providing health 
                care services given local geographic, climatic, rural, 
                or other circumstances.
            ``(2) Resources.--The health resources available to an 
        Indian tribe or tribal organization shall include health 
        resources provided by the Service as well as health resources 
        used by the Indian tribe or tribal organization, including 
        services and financing systems provided by any Federal 
        programs, private insurance, and programs of State or local 
        governments.
            ``(3) Review of determination.--The Secretary shall 
        establish procedures which allow any Indian tribe or tribal 
        organization to petition the Secretary for a review of any 
        determination of the extent of the health status and resource 
        deficiency of such tribe or tribal organization.
    ``(d) Eligibility.--Programs administered by any Indian tribe or 
tribal organization under the authority of the Indian Self-
Determination and Education Assistance Act shall be eligible for funds 
appropriated under the authority of this section on an equal basis with 
programs that are administered directly by the Service.
    ``(e) Report.--Not later than the date that is 3 years after the 
date of enactment of this Act, the Secretary shall submit to the 
Congress the current health status and resource deficiency report of 
the Service for each Indian tribe or service unit, including newly 
recognized or acknowledged tribes. Such report shall set out--
            ``(1) the methodology then in use by the Service for 
        determining tribal health status and resource deficiencies, as 
        well as the most recent application of that methodology;
            ``(2) the extent of the health status and resource 
        deficiency of each Indian tribe served by the Service;
            ``(3) the amount of funds necessary to eliminate the health 
        status and resource deficiencies of all Indian tribes served by 
        the Service; and
            ``(4) an estimate of--
                    ``(A) the amount of health service funds 
                appropriated under the authority of this Act, or any 
                other Act, including the amount of any funds 
                transferred to the Service, for the preceding fiscal 
                year which is allocated to each service unit, Indian 
                tribe, or comparable entity;
                    ``(B) the number of Indians eligible for health 
                services in each service unit or Indian tribe or tribal 
                organization; and
                    ``(C) the number of Indians using the Service 
                resources made available to each service unit or Indian 
                tribe or tribal organization, and, to the extent 
                available, information on the waiting lists and number 
                of Indians turned away for services due to lack of 
                resources.
    ``(f) Budgetary Rule.--Funds appropriated under the authority of 
this section for any fiscal year shall be included in the base budget 
of the Service for the purpose of determining appropriations under this 
section in subsequent fiscal years.
    ``(g) Rule of Construction.--Nothing in this section shall be 
construed to diminish the primary responsibility of the Service to 
eliminate existing backlogs in unmet health care needs or to discourage 
the Service from undertaking additional efforts to achieve equity among 
Indian tribes and tribal organizations.
    ``(h) Designation.--Any funds appropriated under the authority of 
this section shall be designated as the `Indian Health Care Improvement 
Fund'.

``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.

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

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

    ``(a) Findings.--Congress finds that health promotion and disease 
prevention activities will--
            ``(1) improve the health and well-being of Indians; and
            ``(2) reduce the expenses for health care of Indians.
    ``(b) Provision of Services.--The Secretary, acting through the 
Service and through Indian tribes and tribal organizations, shall 
provide health promotion and disease prevention services to Indians so 
as to achieve the health status objective set forth in section 3(b).
    ``(c) Disease Prevention and Health Promotion.--In this section:
            ``(1) Disease prevention.--The term `disease prevention' 
        means the reduction, limitation, and prevention of disease and 
        its complications, and the reduction in the consequences of 
        such diseases, including--
                    ``(A) controlling--
                            ``(i) diabetes;
                            ``(ii) high blood pressure;
                            ``(iii) infectious agents;
                            ``(iv) injuries;
                            ``(v) occupational hazards and 
                        disabilities;
                            ``(vi) sexually transmittable diseases; and
                            ``(vii) toxic agents; and
                    ``(B) providing--
                            ``(i) for the fluoridation of water; and
                            ``(ii) immunizations.
            ``(2) Health promotion.--The term `health promotion' means 
        fostering social, economic, environmental, and personal factors 
        conducive to health, including--
                    ``(A) raising people's awareness about health 
                matters and enabling them to cope with health problems 
                by increasing their knowledge and providing them with 
                valid information;
                    ``(B) encouraging adequate and appropriate diet, 
                exercise, and sleep;
                    ``(C) promoting education and work in conformity 
                with physical and mental capacity;
                    ``(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 practices; and
                    ``(G) adequate and appropriate programs including--
                            ``(i) abuse prevention (mental and 
                        physical);
                            ``(ii) community health;
                            ``(iii) community safety;
                            ``(iv) consumer health education;
                            ``(v) diet and nutrition;
                            ``(vi) disease prevention (communicable, 
                        immunizations, HIV/AIDS);
                            ``(vii) environmental health;
                            ``(viii) exercise and physical fitness;
                            ``(ix) fetal alcohol disorders;
                            ``(x) first aid and CPR education;
                            ``(xi) human growth and development;
                            ``(xii) injury prevention and personal 
                        safety;
                            ``(xiii) mental health (emotional, self-
                        worth);
                            ``(xiv) personal health and wellness 
                        practices;
                            ``(xv) personal capacity building;
                            ``(xvi) prenatal, pregnancy, and infant 
                        care;
                            ``(xvii) psychological well being;
                            ``(xiii) reproductive health (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, an Indian tribe or tribal 
                        organization, to promote the achievement of the 
                        objective described in section 3(b).
    ``(d) Evaluation.--The Secretary, after obtaining input from 
affected Indian tribes and tribal organizations, shall submit to the 
President for inclusion in each statement which is required to be 
submitted to Congress under section 801 an evaluation of--
            ``(1) the health promotion and disease prevention needs of 
        Indians;
            ``(2) the health promotion and disease prevention 
        activities which would best meet such needs;
            ``(3) the internal capacity of the Service to meet such 
        needs; and
            ``(4) the resources which would be required to enable the 
        Service to undertake the health promotion and disease 
        prevention activities necessary to meet such needs.

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

    ``(a) Determination.--The Secretary, in consultation with Indian 
tribes and tribal organizations, shall determine--
            ``(1) by tribe, tribal organization, and service unit of 
        the Service, the prevalence of, and the types of complications 
        resulting from, diabetes among Indians; and
            ``(2) based on paragraph (1), the measures (including 
        patient education) each service unit should take to reduce the 
        prevalence of, and prevent, treat, and control the 
        complications resulting from, diabetes among Indian tribes 
        within that service unit.
    ``(b) Screening.--The Secretary shall screen each Indian who 
receives services from the Service for diabetes and for conditions 
which indicate a high risk that the individual will become diabetic. 
Such screening may be done by an Indian tribe or tribal organization 
operating health care programs or facilities with funds from the 
Service under the Indian Self-Determination and Education Assistance 
Act.
    ``(c) Continued Funding.--The Secretary shall continue to fund, 
through fiscal year 2015, each effective model diabetes project in 
existence on the date of the enactment of this Act and such other 
diabetes programs operated by the Secretary or by Indian tribes and 
tribal organizations and any additional programs added to meet existing 
diabetes needs. Indian tribes and tribal organizations shall receive 
recurring funding for the diabetes programs which they operate pursuant 
to this section. Model diabetes projects shall consult, on a regular 
basis, with tribes and tribal organizations in their regions regarding 
diabetes needs and provide technical expertise as needed.
    ``(d) Dialysis Programs.--The Secretary shall provide funding 
through the Service, Indian tribes and tribal organizations to 
establish dialysis programs, including funds to purchase dialysis 
equipment and provide necessary staffing.
    ``(e) Other Activities.--The Secretary shall, to the extent funding 
is available--
            ``(1) in each area office of the Service, consult with 
        Indian tribes and tribal organizations regarding programs for 
        the prevention, treatment, and control of diabetes;
            ``(2) establish in each area office of the Service a 
        registry of patients with diabetes to track the prevalence of 
        diabetes and the complications from diabetes in that area; and
            ``(3) ensure that data collected in each area office 
        regarding diabetes and related complications among Indians is 
        disseminated to tribes, tribal organizations, and all other 
        area offices.

``SEC. 205. SHARED SERVICES.

    ``(a) In General.--The Secretary, acting through the Service and 
notwithstanding any other provision of law, is authorized to enter into 
funding agreements or other arrangements with Indian tribes or tribal 
organizations for the delivery of long-term care and similar services  
to Indians. Such projects shall provide for the sharing of staff or 
other services between a Service or tribal facility and a long-term 
care or other similar facility owned and operated (directly or through 
a funding agreement) by such Indian tribe or tribal organization.
    ``(b) Requirements.--A funding agreement or other arrangement 
entered into pursuant to subsection (a)--
            ``(1) may, at the request of the Indian tribe or tribal 
        organization, delegate to such tribe or tribal organization 
        such powers of supervision and control over Service employees 
        as the Secretary deems necessary to carry out the purposes of 
        this section;
            ``(2) shall provide that expenses (including salaries) 
        relating to services that are shared between the Service and 
        the tribal facility be allocated proportionately between the 
        Service and the tribe or tribal organization; and
            ``(3) may authorize such tribe or tribal organization to 
        construct, renovate, or expand a long-term care or other 
        similar facility (including the construction of a facility 
        attached to a Service facility).
    ``(c) Technical Assistance.--The Secretary shall provide such 
technical and other assistance as may be necessary to enable applicants 
to comply with the provisions of this section.
    ``(d) Use of Existing Facilities.--The Secretary shall encourage 
the use for long-term or similar care of existing facilities that are 
under-utilized or allow the use of swing beds for such purposes.

``SEC. 206. HEALTH SERVICES RESEARCH.

    ``(a) Funding.--The Secretary shall make funding available for 
research to further the performance of the health service 
responsibilities of the Service, Indian tribes, and tribal 
organizations and shall coordinate the activities of other Agencies 
within the Department to address these research needs.
    ``(b) Allocation.--Funding under subsection (a) shall be allocated 
equitably among the area offices. Each area office shall award such 
funds competitively within that area.
    ``(c) Eligibility for Funds.--Indian tribes and tribal 
organizations receiving funding from the Service under the authority of 
the Indian Self-Determination and Education Assistance Act shall be 
given an equal opportunity to compete for, and receive, research funds 
under this section.
    ``(d) Use.--Funds received under this section may be used for both 
clinical and non-clinical research by Indian tribes and tribal 
organizations and shall be distributed to the area offices. Such area 
offices may make grants using such funds within each area.

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

    ``The Secretary, through the Service or through Indian tribes or 
tribal organizations, shall provide for the following screening:
            ``(1) Mammography (as defined in section 1861(jj) of the 
        Social Security Act) for Indian women at a frequency 
        appropriate to such women under national standards, and under 
        such terms and conditions as are consistent with standards 
        established by the Secretary to assure the safety and accuracy 
        of screening mammography under part B of title XVIII of the 
        Social Security Act.
            ``(2) Other cancer screening meeting national standards.

``SEC. 208. PATIENT TRAVEL COSTS.

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

``SEC. 209. EPIDEMIOLOGY CENTERS.

    ``(a) Establishment.--
            ``(1) In general.--In addition to those centers operating 1 
        day prior to the date of enactment of this Act, (including 
        those centers for which funding is currently being provided 
        through funding agreements under the Indian Self-Determination 
        and Education Assistance Act), the Secretary shall, not later 
        than 180 days after such date of enactment, establish and fund 
        an epidemiology center in each service area which does not have 
        such a center to carry out the functions described in paragraph 
        (2). Any centers established under the preceding sentence may 
        be operated by Indian tribes or tribal organizations pursuant 
        to funding agreements under the Indian Self-Determination and 
Education Assistance Act, but funding under such agreements may not be 
divisible.
            ``(2) Functions.--In consultation with and upon the request 
        of Indian tribes, tribal organizations and urban Indian 
        organizations, each area epidemiology center established under 
        this subsection shall, with respect to such area shall--
                    ``(A) collect data related to the health status 
                objective described in section 3(b), and monitor the 
                progress that the Service, Indian tribes, tribal 
                organizations, and urban Indian organizations have made 
                in meeting such health status objective;
                    ``(B) evaluate existing delivery systems, data 
                systems, and other systems that impact the improvement 
                of Indian health;
                    ``(C) assist Indian tribes, tribal organizations, 
                and urban Indian organizations in identifying their 
                highest priority health status objectives and the 
                services needed to achieve such objectives, based on 
                epidemiological data;
                    ``(D) make recommendations for the targeting of 
                services needed by tribal, urban, and other Indian 
                communities;
                    ``(E) make recommendations to improve health care 
                delivery systems for Indians and urban Indians;
                    ``(F) provide requested technical assistance to 
                Indian tribes and urban Indian organizations in the 
                development of local health service priorities and 
                incidence and prevalence rates of disease and other 
                illness in the community; and
                    ``(G) provide disease surveillance and assist 
                Indian tribes, tribal organizations, and urban Indian 
                organizations to promote public health.
            ``(3) Technical assistance.--The director of the Centers 
        for Disease Control and Prevention shall provide technical 
        assistance to the centers in carrying out the requirements of 
        this subsection.
    ``(b) Funding.--The Secretary may make funding available to Indian 
tribes, tribal organizations, and eligible intertribal consortia or 
urban Indian organizations to conduct epidemiological studies of Indian 
communities.

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

    ``(a) In General.--The Secretary, acting through the Service, shall 
provide funding to Indian tribes, tribal organizations, and urban 
Indian organizations to develop comprehensive school health education 
programs for children from preschool through grade 12 in schools for 
the benefit of Indian and urban Indian children.
    ``(b) Use of Funds.--Funds awarded under this section may be used 
to--
            ``(1) develop and implement health education curricula both 
        for regular school programs and after school programs;
            ``(2) train teachers in comprehensive school health 
        education curricula;
            ``(3) integrate school-based, community-based, and other 
        public and private health promotion efforts;
            ``(4) encourage healthy, tobacco-free school environments;
            ``(5) coordinate school-based health programs with existing 
        services and programs available in the community;
            ``(6) develop school programs on nutrition education, 
        personal health, oral health, and fitness;
            ``(7) develop mental health wellness programs;
            ``(8) develop chronic disease prevention programs;
            ``(9) develop substance abuse prevention programs;
            ``(10) develop injury prevention and safety education 
        programs;
            ``(11) develop activities for the prevention and control of 
        communicable diseases;
            ``(12) develop community and environmental health education 
        programs that include traditional health care practitioners;
            ``(13) carry out violence prevention activities; and
            ``(14) carry out activities relating to such other health 
        issues as are appropriate.
    ``(c) Technical Assistance.--The Secretary shall, upon request, 
provide technical assistance to Indian tribes, tribal 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.--The Secretary, in consultation with Indian tribes, 
tribal organizations, and urban Indian organizations shall establish 
criteria for the review and approval of applications for funding under 
this section.
    ``(e) Comprehensive School Health Education Program.--
            ``(1) Development.--The Secretary of the Interior, acting 
        through the Bureau of Indian Affairs and in cooperation with 
        the Secretary and affected Indian tribes and tribal 
        organizations, shall develop a comprehensive school health 
        education program for children from preschool through grade 12 
        for use in schools operated by the Bureau of Indian Affairs.
            ``(2) Requirements.--The program developed under paragraph 
        (1) shall include--
                    ``(A) school programs on nutrition education, 
                personal health, oral health, and fitness;
                    ``(B) mental health wellness programs;
                    ``(C) chronic disease prevention programs;
                    ``(D) substance abuse prevention programs;
                    ``(E) injury prevention and safety education 
                programs; and
                    ``(F) activities for the prevention and control of 
                communicable diseases.
            ``(3) Training and coordination.--The Secretary of the 
        Interior shall--
                    ``(A) provide training to teachers in comprehensive 
                school health education curricula;
                    ``(B) ensure the integration and coordination of 
                school-based programs with existing services and health 
programs available in the community; and
                    ``(C) encourage healthy, tobacco-free school 
                environments.

``SEC. 211. INDIAN YOUTH PROGRAM.

    ``(a) In General.--The Secretary, acting through the Service, is 
authorized to provide funding to Indian tribes, tribal organizations, 
and urban Indian organizations for innovative mental and physical 
disease prevention and health promotion and treatment programs for 
Indian and urban Indian preadolescent and adolescent youths.
    ``(b) Use of Funds.--
            ``(1) In general.--Funds made available under this section 
        may be used to--
                    ``(A) develop prevention and treatment programs for 
                Indian youth which promote mental and physical health 
                and incorporate cultural values, community and family 
                involvement, and traditional health care practitioners; 
                and
                    ``(B) develop and provide community training and 
                education.
            ``(2) Limitation.--Funds made available under this section 
        may not be used to provide services described in section 
        707(c).
    ``(c) Requirements.--The Secretary shall--
            ``(1) disseminate to Indian tribes, tribal organizations, 
        and urban Indian organizations information regarding models for 
        the delivery of comprehensive health care services to Indian 
        and urban Indian adolescents;
            ``(2) encourage the implementation of such models; and
            ``(3) at the request of an Indian tribe, tribal 
        organization, or urban Indian organization, provide technical 
        assistance in the implementation of such models.
    ``(d) Criteria.--The Secretary, in consultation with Indian tribes, 
tribal organization, and urban Indian organizations, shall establish 
criteria for the review and approval of applications under this 
section.

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

    ``(a) In General.--The Secretary, acting through the Service after 
consultation with Indian tribes, tribal organizations, urban Indian 
organizations, and the Centers for Disease Control and Prevention, may 
make funding available to Indian tribes and tribal organizations for--
            ``(1) projects for the prevention, control, and elimination 
        of communicable and infectious diseases, including 
        tuberculosis, hepatitis, HIV, respiratory syncitial virus, 
        hanta virus, sexually transmitted diseases, and H. Pylori, 
        which projects may include screening, testing and treatment for 
        HCV and other infectious and communicable diseases;
            ``(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; and
            ``(4) a demonstration project that studies the 
        seroprevalence of the Hepatitis C virus among a random sample 
        of American Indian and Alaskan Native populations and 
        identifies prevalence rates among a variety of tribes and 
        geographic regions.
    ``(b) Requirement of Application.--The Secretary may provide funds 
under subsection (a) only if an application or proposal for such funds 
is submitted.
    ``(c) Technical Assistance and Report.--In carrying out this 
section, the Secretary--
            ``(1) may, at the request of an Indian tribe or tribal 
        organization, provide technical assistance; and
            ``(2) shall prepare and submit, biennially, a report to 
        Congress on the use of funds under this section and on the 
        progress made toward the prevention, control, and elimination 
        of communicable and infectious diseases among Indians and urban 
        Indians.

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

    ``(a) In General.--The Secretary, acting through the Service, 
Indian tribes, and tribal organizations, may provide funding under this 
Act to meet the objective set forth in section 3 through health care 
related services and programs not otherwise described in this Act. Such 
services and programs shall include services and programs related to--
            ``(1) hospice care and assisted living;
            ``(2) long-term health care;
            ``(3) home- and community-based services;
            ``(4) public health functions; and
            ``(5) traditional health care practices.
    ``(b) Availability of Services for Certain Individuals.--At the 
discretion of the Service, Indian tribe, or tribal organization, 
services hospice care, home health care (under section 201), home- and 
community-based care, assisted living, and long term care may be 
provided (on a cost basis) to individuals otherwise ineligible for the 
health care benefits of the Service. Any funds received under this 
subsection shall not be used to offset or limit the funding allocated 
to a tribe or tribal organization.
    ``(c) Definitions.--In this section:
            ``(1) Home- and community-based services.--The term `home- 
        and community-based services' means 1 or more of the following:
                    ``(A) Homemaker/home health aide services.
                    ``(B) Chore services.
                    ``(C) Personal care services.
                    ``(D) Nursing care services provided outside of a 
                nursing facility by, or under the supervision of, a 
                registered nurse.
                    ``(E) Training for family members.
                    ``(F) Adult day care.
                    ``(G) Such other home- and community-based services 
                as the Secretary or a tribe or tribal organization may 
                approve.
            ``(2) Hospice care.--The term `hospice care' means the 
        items and services specified in subparagraphs (A) through (H) 
        of section 1861(dd)(1) of the Social Security Act (42 U.S.C. 
        1395x(dd)(1)), and such other services which an Indian tribe 
or tribal organization determines are necessary and appropriate to 
provide in furtherance of such care.
            ``(3) Public health functions.--The term `public health 
        functions' means public health related programs, functions, and 
        services including assessments, assurances, and policy 
        development that Indian tribes and tribal organizations are 
        authorized and encouraged, in those circumstances where it 
        meets their needs, to carry out by forming collaborative 
        relationships with all levels of local, State, and Federal 
        governments.

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

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

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

    ``(a) Study and Monitoring Programs.--The Secretary and the Service 
shall, in conjunction with other appropriate Federal agencies and in 
consultation with concerned Indian tribes and tribal organizations, 
conduct a study and carry out ongoing monitoring programs to determine 
the trends that exist in the health hazards posed to Indian miners and 
to Indians on or near Indian reservations and in Indian communities as 
a result of environmental hazards that may result in chronic or life-
threatening health problems. Such hazards include nuclear resource 
development, petroleum contamination, and contamination of the water 
source or of the food chain. Such study (and any reports with respect 
to such study) shall include--
            ``(1) an evaluation of the nature and extent of health 
        problems caused by environmental hazards currently exhibited 
        among Indians and the causes of such health problems;
            ``(2) an analysis of the potential effect of ongoing and 
        future environmental resource development on or near Indian 
        reservations and communities including the cumulative effect of 
        such development over time on health;
            ``(3) an evaluation of the types and nature of activities, 
        practices, and conditions causing or affecting such health 
        problems including uranium mining and milling, uranium mine 
        tailing deposits, nuclear power plant operation and 
        construction, and nuclear waste disposal, oil and gas 
        production or transportation on or near Indian reservations or 
        communities, and other development that could affect the health 
        of Indians and their water supply and food chain;
            ``(4) a summary of any findings or recommendations provided 
        in Federal and State studies, reports, investigations, and 
        inspections during the 5 years prior to the date of the 
        enactment of this Act that directly or indirectly relate to the 
        activities, practices, and conditions affecting the health or 
        safety of such Indians; and
            ``(5) a description of the efforts that have been made by 
        Federal and State agencies and resource and economic 
        development companies to effectively carry out an education 
        program for such Indians regarding the health and safety 
        hazards of such development.
    ``(b) Development of Health Care Plans.--Upon the completion of the 
study under subsection (a), the Secretary and the Service shall take 
into account the results of such study and, in consultation with Indian 
tribes and tribal organizations, develop a health care plan to address 
the health problems that were the subject of such study. The plans 
shall include--
            ``(1) methods for diagnosing and treating Indians currently 
        exhibiting such health problems;
            ``(2) preventive care and testing for Indians who may be 
        exposed to such health hazards, including the monitoring of the 
        health of individuals who have or may have been exposed to 
        excessive amounts of radiation, or affected by other activities 
        that have had or could have a serious impact upon the health of 
        such individuals; and
            ``(3) a program of education for Indians who, by reason of 
        their work or geographic proximity to such nuclear or other 
        development activities, may experience health problems.
    ``(c) Submission to Congress.--
            ``(1) General report.--Not later than 18 months after the 
        date of enactment of this Act, the Secretary and the Service 
        shall submit to Congress a report concerning the study 
        conducted under subsection (a).
            ``(2) Health care plan report.--Not later than 1 year after 
        the date on which the report under paragraph (1) is submitted 
        to Congress, the Secretary and the Service shall submit to 
        Congress the health care plan prepared under subsection (b). 
        Such plan shall include recommended activities for the 
implementation of the plan, as well as an evaluation of any activities 
previously undertaken by the Service to address the health problems 
involved.
    ``(d) Task Force.--
            ``(1) Established.--There is hereby established an 
        Intergovernmental Task Force (referred to in this section as 
        the `task force') that shall be composed of the following 
        individuals (or their designees):
                    ``(A) The Secretary of Energy.
                    ``(B) The Administrator of the Environmental 
                Protection Agency.
                    ``(C) The Director of the Bureau of Mines.
                    ``(D) The Assistant Secretary for Occupational 
                Safety and Health.
                    ``(E) The Secretary of the Interior.
            ``(2) Duties.--The Task Force shall identify existing and 
        potential operations related to nuclear resource development or 
        other environmental hazards that affect or may affect the 
        health of Indians on or near an Indian reservation or in an 
        Indian community, and enter into activities to correct existing 
        health hazards and ensure that current and future health 
        problems resulting from nuclear resource or other development 
activities are minimized or reduced.
            ``(3) Administrative provisions.--The Secretary shall serve 
        as the chairperson of the Task Force. The Task Force shall meet 
        at least twice each year. Each member of the Task Force shall 
        furnish necessary assistance to the Task Force.
    ``(e) Provision of Appropriate Medical Care.--In the case of any 
Indian who--
            ``(1) as a result of employment in or near a uranium mine 
        or mill or near any other environmental hazard, suffers from a 
        work related illness or condition;
            ``(2) is eligible to receive diagnosis and treatment 
        services from a Service facility; and
            ``(3) by reason of such Indian's employment, is entitled to 
        medical care at the expense of such mine or mill operator or 
        entity responsible for the environmental hazard;
the Service shall, at the request of such Indian, render appropriate 
medical care to such Indian for such illness or condition and may 
recover the costs of any medical care so rendered to which such Indian 
is entitled at the expense of such operator or entity from such 
operator or entity. Nothing in this subsection shall affect the rights 
of such Indian to recover damages other than such costs paid to the 
Service from the employer for such illness or condition.

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

    ``(a) In General.--For fiscal years beginning with the fiscal year 
ending September 30, 1983, and ending with the fiscal year ending 
September 30, 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) Limitation.--The Service shall not curtail any health care 
services provided to Indians residing on Federal reservations in the 
State of Arizona if such curtailment is due to the provision of 
contract services in such State pursuant to the designation of such 
State as a contract health service delivery area pursuant to subsection 
(a).

``SEC. 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 Federal 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 
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 Federal 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 DEMONSTRATION PROGRAM.

    ``(a) In General.--The Secretary may fund a program that utilizes 
the California Rural Indian Health Board as a contract care 
intermediary to improve the accessibility of health services to 
California Indians.
    ``(b) Reimbursement of Board.--
            ``(1) Agreement.--The Secretary shall enter into an 
        agreement with the California Rural Indian Health Board to 
        reimburse the Board for costs (including reasonable 
        administrative costs) incurred pursuant to this section in 
        providing medical treatment under contract to California 
        Indians described in section 809(b) throughout the California 
        contract health services delivery area described in section 218 
        with respect to high-cost contract care cases.
            ``(2) Administration.--Not more than 5 percent of the 
        amounts provided to the Board under this section for any fiscal 
        year may be used for reimbursement for administrative expenses 
        incurred by the Board during such fiscal year.
            ``(3) Limitation.--No payment may be made for treatment 
        provided under this section to the extent that payment may be 
        made for such treatment under the Catastrophic Health Emergency 
        Fund described in section 202 or from amounts appropriated or 
        otherwise made available to the California contract health 
        service delivery area for a fiscal year.
    ``(c) Advisory Board.--There is hereby established an advisory 
board that shall advise the California Rural Indian Health Board in 
carrying out this section. The advisory board shall be composed of 
representatives, selected by the California Rural Indian Health Board, 
from not less than 8 tribal health programs serving California Indians 
covered under this section, at least 50 percent of whom are not 
affiliated with the California Rural Indian Health Board.

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

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

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

    ``(a) In General.--The Secretary, acting through the Service, shall 
provide contract health services to members of the Turtle Mountain Band 
of Chippewa Indians that reside in the Trenton Service Area of Divide, 
McKenzie, and Williams counties in the State of North Dakota and the 
adjoining counties of Richland, Roosevelt, and Sheridan in the State of 
Montana.
    ``(b) Rule of Construction.--Nothing in this section shall be 
construed as expanding the eligibility of members of the Turtle 
Mountain Band of Chippewa Indians for health services provided by the 
Service beyond the scope of eligibility for such health services that 
applied on May 1, 1986.

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

    ``The Service shall provide funds for health care programs and 
facilities operated by Indian tribes and tribal organizations under 
funding agreements with the Service entered into under the Indian Self-
Determination and Education Assistance Act on the same basis as such 
funds are provided to programs and facilities operated directly by the 
Service.

``SEC. 221. LICENSING.

    ``Health care professionals employed by Indian tribes and tribal 
organizations to carry out agreements under the Indian Self-
Determination and Education Assistance Act, shall, if licensed in any 
State, be exempt from the licensing requirements of the State in which 
the agreement is performed.

``SEC. 222. AUTHORIZATION FOR EMERGENCY CONTRACT HEALTH SERVICES.

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

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

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

``SEC. 224. LIABILITY FOR PAYMENT.

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

``SEC. 225. AUTHORIZATION OF APPROPRIATIONS.

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

                        ``TITLE III--FACILITIES

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

    ``(a) Consultation.--Prior to the expenditure of, or the making of 
any firm commitment to expend, any funds appropriated for the planning, 
design, construction, or renovation of facilities pursuant to the Act 
of November 2, 1921 (25 U.S.C. 13) (commonly known as the Snyder Act), 
the Secretary, acting through the Service, shall--
            ``(1) consult with any Indian tribe that would be 
        significantly affected by such expenditure for the purpose of 
        determining and, whenever practicable, honoring tribal 
        preferences concerning size, location, type, and other 
        characteristics of any facility on which such expenditure is to 
        be made; and
            ``(2) ensure, whenever practicable, that such facility 
        meets the construction standards of any nationally recognized 
        accrediting body by not later than 1 year after the date on 
        which the construction or renovation of such facility is 
        completed.
    ``(b) Closure of Facilities.--
            ``(1) In general.--Notwithstanding any provision of law 
        other than this subsection, no Service hospital or outpatient 
        health care facility or any inpatient service or special care 
        facility operated by the Service, may be closed if the 
        Secretary has not submitted to the Congress at least 1 year 
        prior to the date such proposed closure an evaluation of the 
        impact of such proposed closure which specifies, in addition to 
        other considerations--
                    ``(A) the accessibility of alternative health care 
                resources for the population served by such hospital or 
                facility;
                    ``(B) the cost effectiveness of such closure;
                    ``(C) the quality of health care to be provided to 
                the population served by such hospital or facility 
                after such closure;
                    ``(D) the availability of contract health care 
                funds to maintain existing levels of service;
                    ``(E) the views of the Indian tribes served by such 
                hospital or facility concerning such closure;
                    ``(F) the level of utilization of such hospital or 
                facility by all eligible Indians; and
                    ``(G) the distance between such hospital or 
                facility and the nearest operating Service hospital.
            ``(2) Temporary closure.--Paragraph (1) shall not apply to 
        any temporary closure of a facility or of any portion of a 
facility if such closure is necessary for medical, environmental, or 
safety reasons.
    ``(c) Priority System.--
            ``(1) Establishment.--The Secretary shall establish a 
        health care facility priority system, that shall--
                    ``(A) be developed with Indian tribes and tribal 
                organizations through negotiated rulemaking under 
                section 802;
                    ``(B) give the needs of Indian tribes the highest 
                priority, with additional priority being given to those 
                service areas where the health status of Indians within 
                the area, as measured by life expectancy based upon the 
                most recent data available, is significantly lower than 
                the average health status for Indians in all service 
                areas; and
                    ``(C) at a minimum, include the lists required in 
                paragraph (2)(B) and the methodology required in 
                paragraph (2)(E);
        except that the priority of any project established under the 
        construction priority system in effect on the date of this Act 
        shall not be affected by any change in the construction 
        priority system taking place thereafter if the project was 
        identified as one of the top 10 priority inpatient projects or 
        one of the top 10 outpatient projects in the Indian Health 
Service budget justification for fiscal year 2003, or if the project 
had completed both Phase I and Phase II of the construction priority 
system in effect on the date of this Act.
            ``(2) Report.--The Secretary shall submit to the President, 
        for inclusion in each report required to be transmitted to the 
        Congress under section 801, a report that includes--
                    ``(A) a description of the health care facility 
                priority system of the Service, as established under 
                paragraph (1);
                    ``(B) health care facility lists, including--
                            ``(i) the total health care facility 
                        planning, design, construction and renovation 
                        needs for Indians;
                            ``(ii) the 10 top-priority inpatient care 
                        facilities;
                            ``(iii) the 10 top-priority outpatient care 
                        facilities;
                            ``(iv) the 10 top-priority specialized care 
                        facilities (such as long-term care and alcohol 
                        and drug abuse treatment); and
                            ``(v) any staff quarters associated with 
                        such prioritized facilities;
                    ``(C) the justification for the order of priority 
                among facilities;
                    ``(D) the projected cost of the projects involved; 
                and
                    ``(E) the methodology adopted by the Service in 
                establishing priorities under its health care facility 
                priority system.
            ``(3) Consultation.--In preparing each report required 
        under paragraph (2) (other than the initial report) the 
        Secretary shall annually--
                    ``(A) consult with, and obtain information on all 
                health care facilities needs from, Indian tribes and 
                tribal organizations including those tribes or tribal 
                organizations operating health programs or facilities 
                under any funding agreement entered into with the 
                Service under the Indian Self-Determination and 
                Education Assistance Act; and
                    ``(B) review the total unmet needs of all tribes 
                and tribal organizations for health care facilities 
                (including staff quarters), including needs for 
                renovation and expansion of existing facilities.
            ``(4) Criteria.--For purposes of this subsection, the 
        Secretary shall, in evaluating the needs of facilities operated 
        under any funding agreement entered into with the Service under 
        the Indian Self-Determination and Education Assistance Act, use 
        the same criteria that the Secretary uses in evaluating the 
        needs of facilities operated directly by the Service.
            ``(5) Equitable integration.--The Secretary shall ensure 
        that the planning, design, construction, and renovation needs 
        of Service and non-Service facilities, operated under funding 
        agreements in accordance with the Indian Self-Determination and 
        Education Assistance Act are fully and equitably integrated 
        into the health care facility priority system.
    ``(d) Review of Need for Facilities.--
            ``(1) Report.--Beginning in 2004, the Secretary shall 
        annually submit to the President, for inclusion in the report 
        required to be transmitted to Congress under section 801 of 
        this Act, a report which sets forth the needs of the Service 
        and all Indian tribes and tribal organizations, including urban 
        Indian organizations, for inpatient, outpatient and specialized 
        care facilities, including the needs for renovation and 
        expansion of existing facilities.
            ``(2) Consultation.--In preparing each report required 
        under paragraph (1) (other than the initial report), the 
        Secretary shall consult with Indian tribes and tribal 
        organizations including those tribes or tribal organizations 
        operating health programs or facilities under any funding 
        agreement entered into with the Service under the Indian Self-
        Determination and Education Assistance Act, and with urban 
        Indian organizations.
            ``(3) Criteria.--For purposes of this subsection, the 
        Secretary shall, in evaluating the needs of facilities operated 
        under any funding agreement entered into with the Service under 
        the Indian Self-Determination and Education Assistance Act, use 
        the same criteria that the Secretary uses in evaluating the 
        needs of facilities operated directly by the Service.
            ``(4) Equitable integration.--The Secretary shall ensure 
        that the planning, design, construction, and renovation needs 
        of facilities operated under funding agreements, in accordance 
        with the Indian Self-Determination and Education Assistance 
        Act, are fully and equitably integrated into the development of 
        the health facility priority system.
            ``(5) Annual nominations.--Each year the Secretary shall 
        provide an opportunity for the nomination of planning, design, 
        and construction projects by the Service and all Indian tribes 
        and tribal organizations for consideration under the health 
        care facility priority system.
    ``(e) Inclusion of Certain Programs.--All funds appropriated under 
the Act of November 2, 1921 (25 U.S.C. 13), for the planning, design, 
construction, or renovation of health facilities for the benefit of an 
Indian tribe or tribes shall be subject to the provisions of section 
102 of the Indian Self-Determination and Education Assistance Act.
    ``(f) Innovative Approaches.--The Secretary shall consult and 
cooperate with Indian tribes, tribal organizations and urban Indian 
organizations in developing innovative approaches to address all or 
part of the total unmet need for construction of health facilities, 
including those provided for in other sections of this title and other 
approaches.

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

    ``(a) Findings.--Congress finds and declares that--
            ``(1) the provision of safe water supply facilities and 
        sanitary sewage and solid waste disposal facilities is 
        primarily a health consideration and function;
            ``(2) Indian people suffer an inordinately high incidence 
        of disease, injury, and illness directly attributable to the 
        absence or inadequacy of such facilities;
            ``(3) the long-term cost to the United States of treating 
        and curing such disease, injury, and illness is substantially 
        greater than the short-term cost of providing such facilities 
        and other preventive health measures;
            ``(4) many Indian homes and communities still lack safe 
        water supply facilities and sanitary sewage and solid waste 
        disposal facilities; and
            ``(5) it is in the interest of the United States, and it is 
        the policy of the United States, that all Indian communities 
        and Indian homes, new and existing, be provided with safe and 
        adequate water supply facilities and sanitary sewage waste 
        disposal facilities as soon as possible.
    ``(b) Provision of Facilities and Services.--
            ``(1) In general.--In furtherance of the findings and 
        declarations made in subsection (a), Congress reaffirms the 
        primary responsibility and authority of the Service to provide 
        the necessary sanitation facilities and services as provided in 
        section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a).
            ``(2) Assistance.--The Secretary, acting through the 
        Service, is authorized to provide under section 7 of the Act of 
        August 5, 1954 (42 U.S.C. 2004a)--
                    ``(A) financial and technical assistance to Indian 
                tribes, tribal organizations and Indian communities in 
                the establishment, training, and equipping of utility 
                organizations to operate and maintain Indian sanitation 
                facilities, including the provision of existing plans, 
                standard details, and specifications available in the 
                Department, to be used at the option of the tribe or 
                tribal organization;
                    ``(B) ongoing technical assistance and training in 
                the management of utility organizations which operate 
                and maintain sanitation facilities; and
                    ``(C) priority funding for the operation, and 
                maintenance assistance for, and emergency repairs to, 
                tribal sanitation facilities when necessary to avoid an 
                imminent health threat or to protect the investment in 
                sanitation facilities and the investment in the health 
                benefits gained through the provision of sanitation 
                facilities.
            ``(3) Provisions relating to funding.--Notwithstanding any 
        other provision of law--
                    ``(A) the Secretary of Housing and Urban 
                Development is authorized to transfer funds 
                appropriated under the Native American Housing 
                Assistance and Self-Determination Act of 1996 to the 
                Secretary of Health and Human Services;
                    ``(B) the Secretary of Health and Human Services is 
                authorized to accept and use such funds for the purpose 
                of providing sanitation facilities and services for 
                Indians under section 7 of the Act of August 5, 1954 
                (42 U.S.C. 2004a);
                    ``(C) unless specifically authorized when funds are 
                appropriated, the Secretary of Health and Human 
                Services shall not use funds appropriated under section 
                7 of the Act of August 5, 1954 (42 U.S.C. 2004a) to 
                provide sanitation facilities to new homes constructed 
                using funds provided by the Department of Housing and 
                Urban Development;
                    ``(D) the Secretary of Health and Human Services is 
                authorized to accept all Federal funds that are 
                available for the purpose of providing sanitation 
                facilities and related services and place those funds 
                into funding agreements, authorized under the Indian 
                Self-Determination and Education Assistance Act, 
                between the Secretary and Indian tribes and tribal 
                organizations;
                    ``(E) the Secretary may permit funds appropriated 
                under the authority of section 4 of the Act of August 
                5, 1954 (42 U.S.C. 2004) to be used to fund up to 100 
                percent of the amount of a tribe's loan obtained under 
                any Federal program for new projects to construct 
                eligible sanitation facilities to serve Indian homes;
                    ``(F) the Secretary may permit funds appropriated 
                under the authority of section 4 of the Act of August 
                5, 1954 (42 U.S.C. 2004) to be used to meet matching or 
                cost participation requirements under other Federal and 
                non-Federal programs for new projects to construct 
                eligible sanitation facilities;
                    ``(G) all Federal agencies are authorized to 
                transfer to the Secretary funds identified, granted, 
                loaned or appropriated and thereafter the Department's 
                applicable policies, rules, regulations shall apply in 
                the implementation of such projects;
                    ``(H) the Secretary of Health and Human Services 
                shall enter into inter-agency agreements with the 
                Bureau of Indian Affairs, the Department of Housing and 
                Urban Development, the Department of Agriculture, the 
                Environmental Protection Agency and other appropriate 
                Federal agencies, for the purpose of providing 
                financial assistance for safe water supply and sanitary 
                sewage disposal facilities under this Act; and
                    ``(I) the Secretary of Health and Human Services 
                shall, by regulation developed through rulemaking under 
                section 802, establish standards applicable to the 
                planning, design and construction of water supply and 
                sanitary sewage and solid waste disposal facilities 
                funded under this Act.
    ``(c) 10-Year Funding Plan.--The Secretary, acting through the 
Service and in consultation with Indian tribes and tribal 
organizations, shall develop and implement a 10-year funding plan to 
provide safe water supply and sanitary sewage and solid waste disposal 
facilities serving existing Indian homes and communities, and to new 
and renovated Indian homes.
    ``(d) Capability of Tribe or Community.--The financial and 
technical capability of an Indian tribe or community to safely operate 
and maintain a sanitation facility shall not be a prerequisite to the 
provision or construction of sanitation facilities by the Secretary.
    ``(e) Financial Assistance.--The Secretary may provide financial 
assistance to Indian tribes, tribal organizations and communities for 
the operation, management, and maintenance of their sanitation 
facilities.
    ``(f) Responsibility for Fees for Operation and Maintenance.--The 
Indian family, community or tribe involved shall have the primary 
responsibility to establish, collect, and use reasonable user fees, or 
otherwise set aside funding, for the purpose of operating and 
maintaining sanitation facilities. If a community facility is 
threatened with imminent failure and there is a lack of tribal capacity 
to maintain the integrity or the health benefit of the facility, the 
Secretary may assist the tribe in the resolution of the problem on a 
short term basis through cooperation with the emergency coordinator or 
by providing operation and maintenance service.
    ``(g) Eligibility of Certain Tribes or Organizations.--Programs 
administered by Indian tribes or tribal organizations under the 
authority of the Indian Self-Determination and Education Assistance Act 
shall be eligible for--
            ``(1) any funds appropriated pursuant to this section; and
            ``(2) any funds appropriated for the purpose of providing 
        water supply, sewage disposal, or solid waste facilities;
on an equal basis with programs that are administered directly by the 
Service.
    ``(h) Report.--
            ``(1) In general.--The Secretary shall submit to the 
        President, for inclusion in each report required to be 
        transmitted to the Congress under section 801, a report which 
        sets forth--
                    ``(A) the current Indian sanitation facility 
                priority system of the Service;
                    ``(B) the methodology for determining sanitation 
                deficiencies;
                    ``(C) the level of initial and final sanitation 
                deficiency for each type sanitation facility for each 
project of each Indian tribe or community; and
                    ``(D) the amount of funds necessary to reduce the 
                identified sanitation deficiency levels of all Indian 
                tribes and communities to a level I sanitation 
                deficiency as described in paragraph (4)(A).
            ``(2) Consultation.--In preparing each report required 
        under paragraph (1), the Secretary shall consult with Indian 
        tribes and tribal organizations (including those tribes or 
        tribal organizations operating health care programs or 
        facilities under any funding agreements entered into with the 
        Service under the Indian Self-Determination and Education 
        Assistance Act) to determine the sanitation needs of each tribe 
        and in developing the criteria on which the needs will be 
        evaluated through a process of negotiated rulemaking.
            ``(3) Methodology.--The methodology used by the Secretary 
        in determining, preparing cost estimates for and reporting 
        sanitation deficiencies for purposes of paragraph (1) shall be 
        applied uniformly to all Indian tribes and communities.
            ``(4) Sanitation deficiency levels.--For purposes of this 
        subsection, the sanitation deficiency levels for an individual 
        or community sanitation facility serving Indian homes are as 
        follows:
                    ``(A) A level I deficiency is a sanitation facility 
                serving an individual or community--
                            ``(i) which complies with all applicable 
                        water supply, pollution control and solid waste 
                        disposal laws; and
                            ``(ii) in which the deficiencies relate to 
                        routine replacement, repair, or maintenance 
                        needs.
                    ``(B) A level II deficiency is a sanitation 
                facility serving an individual or community--
                            ``(i) which substantially or recently 
                        complied with all applicable water supply, 
                        pollution control and solid waste laws, in 
                        which the deficiencies relate to small or minor 
                        capital improvements needed to bring the 
                        facility back into compliance;
                            ``(ii) in which the deficiencies relate to 
                        capital improvements that are necessary to 
                        enlarge or improve the facilities in order to 
                        meet the current needs for domestic sanitation 
                        facilities; or
                            ``(iii) in which the deficiencies relate to 
                        the lack of equipment or training by an Indian 
tribe or community to properly operate and maintain the sanitation 
facilities.
                    ``(C) A level III deficiency is an individual or 
                community facility with water or sewer service in the 
                home, piped services or a haul system with holding 
                tanks and interior plumbing, or where major significant 
                interruptions to water supply or sewage disposal occur 
                frequently, requiring major capital improvements to 
                correct the deficiencies. There is no access to or no 
                approved or permitted solid waste facility available.
                    ``(D) A level IV deficiency is an individual or 
                community facility where there are no piped water or 
                sewer facilities in the home or the facility has become 
                inoperable due to major component failure or where only 
                a washeteria or central facility exists.
                    ``(E) A level V deficiency is the absence of a 
                sanitation facility, where individual homes do not have 
                access to safe drinking water or adequate wastewater 
                disposal.
    ``(i) Definitions.--In this section:
            ``(1) Facility.--The terms `facility' or `facilities' shall 
        have the same meaning as the terms `system' or `systems' unless 
        the context requires otherwise.
            ``(2) Indian community.--The term `Indian community' means 
        a geographic area, a significant proportion of whose 
        inhabitants are Indians and which is served by or capable of 
        being served by a facility described in this section.

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

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

``SEC. 304. SOBOBA SANITATION FACILITIES.

    ``Nothing in the Act of December 17, 1970 (84 Stat. 1465) shall be 
construed to preclude the Soboba Band of Mission Indians and the Soboba 
Indian Reservation from being provided with sanitation facilities and 
services under the authority of section 7 of the Act of August 5, 1954 
(68 Stat. 674), as amended by the Act of July 31, 1959 (73 Stat. 267).

``SEC. 305. EXPENDITURE OF NONSERVICE FUNDS FOR RENOVATION.

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

``SEC. 306. FUNDING FOR THE CONSTRUCTION, EXPANSION, AND MODERNIZATION 
              OF SMALL AMBULATORY CARE FACILITIES.

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

``SEC. 307. INDIAN HEALTH CARE DELIVERY DEMONSTRATION PROJECT.

    ``(a) Health Care Delivery Demonstration Projects.--The Secretary, 
acting through the Service and in consultation with Indian tribes and 
tribal organizations, may enter into funding agreements with, or make 
grants or loan guarantees to, Indian tribes or tribal organizations for 
the purpose of carrying out a health care delivery demonstration 
project to test alternative means of delivering health care and 
services through health facilities, including hospice, traditional 
Indian health and child care facilities, to Indians.
    ``(b) Use of Funds.--The Secretary, in approving projects pursuant 
to this section, may authorize funding for the construction and 
renovation of hospitals, health centers, health stations, and other 
facilities to deliver health care services and is authorized to--
            ``(1) waive any leasing prohibition;
            ``(2) permit carryover of funds appropriated for the 
        provision of health care services;
            ``(3) permit the use of other available funds;
            ``(4) permit the use of funds or property donated from any 
        source for project purposes;
            ``(5) provide for the reversion of donated real or personal 
        property to the donor; and
            ``(6) permit the use of Service funds to match other funds, 
        including Federal funds.
    ``(c) Criteria.--
            ``(1) In general.--The Secretary shall develop and publish 
        regulations through rulemaking under section 802 for the review 
        and approval of applications submitted under this section. The 
        Secretary may enter into a contract, funding agreement or award 
        a grant under this section for projects which meet the 
        following criteria:
                    ``(A) There is a need for a new facility or program 
                or the reorientation of an existing facility or 
                program.
                    ``(B) A significant number of Indians, including 
                those with low health status, will be served by the 
                project.
                    ``(C) The project has the potential to address the 
                health needs of Indians in an innovative manner.
                    ``(D) The project has the potential to deliver 
                services in an efficient and effective manner.
                    ``(E) The project is economically viable.
                    ``(F) The Indian tribe or tribal organization has 
                the administrative and financial capability to 
                administer the project.
                    ``(G) The project is integrated with providers of 
                related health and social services and is coordinated 
                with, and avoids duplication of, existing services.
            ``(2) Peer review panels.--The Secretary may provide for 
        the establishment of peer review panels, as necessary, to 
        review and evaluate applications and to advise the Secretary 
        regarding such applications using the criteria developed 
        pursuant to paragraph (1).
            ``(3) Priority.--The Secretary shall give priority to 
        applications for demonstration projects under this section in 
        each of the following service units to the extent that such 
        applications are filed in a timely manner and otherwise meet 
        the criteria specified in paragraph (1):
                    ``(A) Cass Lake, Minnesota.
                    ``(B) Clinton, Oklahoma.
                    ``(C) Harlem, Montana.
                    ``(D) Mescalero, New Mexico.
                    ``(E) Owyhee, Nevada.
                    ``(F) Parker, Arizona.
                    ``(G) Schurz, Nevada.
                    ``(H) Winnebago, Nebraska.
                    ``(I) Ft. Yuma, California.
    ``(d) Technical Assistance.--The Secretary shall provide such 
technical and other assistance as may be necessary to enable applicants 
to comply with the provisions of this section.
    ``(e) Service to Ineligible Persons.--The authority to provide 
services to persons otherwise ineligible for the health care benefits 
of the Service and the authority to extend hospital privileges in 
Service facilities to non-Service health care practitioners as provided 
in section 807 may be included, subject to the terms of such section, 
in any demonstration project approved pursuant to this section.
    ``(f) Equitable Treatment.--For purposes of subsection (c)(1)(A), 
the Secretary shall, in evaluating facilities operated under any 
funding agreement entered into with the Service under the Indian Self-
Determination and Education Assistance Act, use the same criteria that 
the Secretary uses in evaluating facilities operated directly by the 
Service.
    ``(g) Equitable Integration of Facilities.--The Secretary shall 
ensure that the planning, design, construction, renovation and 
expansion needs of Service and non-Service facilities which are the 
subject of a funding agreement for health services entered into with 
the Service under the Indian Self-Determination and Education 
Assistance Act, are fully and equitably integrated into the 
implementation of the health care delivery demonstration projects under 
this section.

``SEC. 308. LAND TRANSFER.

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

``SEC. 309. LEASES.

    ``(a) In General.--Notwithstanding any other provision of law, the 
Secretary is authorized, in carrying out the purposes of this Act, to 
enter into leases with Indian tribes and tribal organizations for 
periods not in excess of 20 years. Property leased by the Secretary 
from an Indian tribe or tribal organization may be reconstructed or 
renovated by the Secretary pursuant to an agreement with such Indian 
tribe or tribal organization.
    ``(b) Facilities for the Administration and Delivery of Health 
Services.--The Secretary may enter into leases, contracts, and other 
legal agreements with Indian tribes or tribal organizations which 
hold--
            ``(1) title to;
            ``(2) a leasehold interest in; or
            ``(3) a beneficial interest in (where title is held by the 
        United States in trust for the benefit of a tribe);
facilities used for the administration and delivery of health services 
by the Service or by programs operated by Indian tribes or tribal 
organizations to compensate such Indian tribes or tribal organizations 
for costs associated with the use of such facilities for such purposes, 
and such leases shall be considered as operating leases for the 
purposes of scoring under the Budget Enforcement Act, notwithstanding 
any other provision of law. Such costs include rent, depreciation based 
on the useful life of the building, principal and interest paid or 
accrued, operation and maintenance expenses, and other expenses 
determined by regulation to be allowable pursuant to regulations under 
section 105(l) of the Indian Self-Determination and Education 
Assistance Act.

``SEC. 310. LOANS, LOAN GUARANTEES AND LOAN REPAYMENT.

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

``SEC. 311. TRIBAL LEASING.

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

``SEC. 312. INDIAN HEALTH SERVICE/TRIBAL FACILITIES JOINT VENTURE 
              PROGRAM.

    ``(a) Authority.--
            ``(1) In general.--The Secretary, acting through the 
        Service, shall make arrangements with Indian tribes and tribal 
        organizations to establish joint venture demonstration projects 
        under which an Indian tribe or tribal organization shall expend 
        tribal, private, or other available funds, for the acquisition 
        or construction of a health facility for a minimum of 10 years, 
        under a no-cost lease, in exchange for agreement by the Service 
        to provide the equipment, supplies, and staffing for the 
        operation and maintenance of such a health facility.
            ``(2) Use of resources.--A tribe or tribal organization may 
        utilize tribal funds, private sector, or other available 
        resources, including loan guarantees, to fulfill its commitment 
        under this subsection.
            ``(3) Eligibility of certain entities.--A tribe that has 
        begun and substantially completed the  process of acquisition 
or construction of a health facility shall be eligible to establish a 
joint venture project with the Service using such health facility.
    ``(b) Requirements.--
            ``(1) In general.--The Secretary shall enter into an 
        arrangement under subsection (a)(1) with an Indian tribe or 
        tribal organization only if--
                    ``(A) the Secretary first determines that the 
                Indian tribe or tribal organization has the 
                administrative and financial capabilities necessary to 
                complete the timely acquisition or construction of the 
                health facility described in subsection (a)(1); and
                    ``(B) the Indian tribe or tribal organization meets 
                the needs criteria that shall be developed through the 
                negotiated rulemaking process provided for under 
                section 802.
            ``(2) Continued operation of facility.--The Secretary shall 
        negotiate an agreement with the Indian tribe or tribal 
        organization regarding the continued operation of a facility 
        under this section at the end of the initial 10 year no-cost 
        lease period.
            ``(3) Breach or termination of agreement.--An Indian tribe 
        or tribal organization that has entered into a written 
        agreement with the Secretary under this section, and that 
        breaches or terminates without cause such agreement, shall be 
        liable to the United States for the amount that has been paid 
        to the tribe or tribal organization, or paid to a third party 
        on the tribe's or tribal organization's behalf, under the 
        agreement. The Secretary has the right to recover tangible 
        property (including supplies), and equipment, less 
        depreciation, and any funds expended for operations and 
        maintenance under this section. The preceding sentence shall 
        not apply to any funds expended for the delivery of health care 
        services, or for personnel or staffing.
    ``(d) Recovery for Non-Use.--An Indian tribe or tribal organization 
that has entered into a written agreement with the Secretary under this 
section shall be entitled to recover from the United States an amount 
that is proportional to the value of such facility should at any time 
within 10 years the Service ceases to use the facility or otherwise 
breaches the agreement.
    ``(e) Definition.--In this section, the terms `health facility' or 
`health facilities' include staff quarters needed to provide housing 
for the staff of the tribal health program.

``SEC. 313. LOCATION OF FACILITIES.

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

``SEC. 314. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE FACILITIES.

    ``(a) Report.--The Secretary shall submit to the President, for 
inclusion in the report required to be transmitted to Congress under 
section 801, a report that identifies the backlog of maintenance and 
repair work required at both Service and tribal facilities, including 
new facilities expected to be in operation in the fiscal year after the 
year for which the report is being prepared. The report shall identify 
the need for renovation and expansion of existing facilities to support 
the growth of health care programs.
    ``(b) Maintenance of Newly Constructed Space.--
            ``(1) In general.--The Secretary may expend maintenance and 
        improvement funds to support the maintenance of newly 
        constructed space only if such space falls within the approved 
        supportable space allocation for the Indian tribe or tribal 
        organization.
            ``(2) Definition.--For purposes of paragraph (1), the term 
        `supportable space allocation' shall be defined through the 
        negotiated rulemaking process provided for under section 802.
    ``(c) Construction of Replacement Facilities.--
            ``(1) In general.--In addition to using maintenance and 
        improvement funds for the maintenance of facilities under 
subsection (b)(1), an Indian tribe or tribal organization may use such 
funds for the construction of a replacement facility if the costs of 
the renovation of such facility would exceed a maximum renovation cost 
threshold.
            ``(2) Definition.--For purposes of paragraph (1), the term 
        `maximum renovation cost threshold' shall be defined through 
        the negotiated rulemaking process provided for under section 
        802.

``SEC. 315. TRIBAL MANAGEMENT OF FEDERALLY-OWNED QUARTERS.

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

``SEC. 316. APPLICABILITY OF BUY AMERICAN REQUIREMENT.

    ``(a) In General.--The Secretary shall ensure that the requirements 
of the Buy American Act apply to all procurements made with funds 
provided pursuant to the authorization contained in section 318, except 
that Indian tribes and tribal organizations shall be exempt from such 
requirements.
    ``(b) False or Misleading Labeling.--If it has been finally 
determined by a court or Federal agency that any person intentionally 
affixed a label bearing a `Made in America' inscription, or any 
inscription with the same meaning, to any product sold in or shipped to 
the United States that is not made in the United States, such person 
shall be ineligible to receive any contract or subcontract made with 
funds provided pursuant to the authorization contained in section 318, 
pursuant to the debarment, suspension, and ineligibility procedures 
described in sections 9.400 through 9.409 of title 48, Code of Federal 
Regulations.
    ``(c) Definition.--In this section, the term `Buy American Act' 
means title III of the Act entitled `An Act making appropriations for 
the Treasury and Post Office Departments for the fiscal year ending 
June 30, 1934, and for other purposes', approved March 3, 1933 (41 
U.S.C. 10a et seq.).

``SEC. 317. OTHER FUNDING FOR FACILITIES.

    ``Notwithstanding any other provision of law--
            ``(1) the Secretary may accept from any source, including 
        Federal and State agencies, funds that are available for the 
        construction of health care facilities and use such funds to 
        plan, design and construct health care facilities for Indians 
        and to place such funds into funding agreements authorized 
        under the Indian Self-Determination and Education Assistance 
        Act (25 U.S.C. 450f et seq.) between the Secretary and an 
        Indian tribe or tribal organization, except that the receipt of 
        such funds shall not have an effect on the priorities 
        established pursuant to section 301;
            ``(2) the Secretary may enter into interagency agreements 
        with other Federal or State agencies and other entities and to 
        accept funds from such Federal or State agencies or other 
        entities to provide for the planning, design and construction 
        of health care facilities to be administered by the Service or 
        by Indian tribes or tribal organizations under the Indian Self-
        Determination and Education Assistance Act in order to carry 
out the purposes of this Act, together with the purposes for which such 
funds are appropriated to such other Federal or State agency or for 
which the funds were otherwise provided;
            ``(3) any Federal agency to which funds for the 
        construction of health care facilities are appropriated is 
        authorized to transfer such funds to the Secretary for the 
        construction of health care facilities to carry out the 
        purposes of this Act as well as the purposes for which such 
        funds are appropriated to such other Federal agency; and
            ``(4) the Secretary, acting through the Service, shall 
        establish standards under regulations developed through 
        rulemaking under section 802, for the planning, design and 
        construction of health care facilities serving Indians under 
        this Act.

``SEC. 318. AUTHORIZATION OF APPROPRIATIONS.

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

                 ``TITLE IV--ACCESS TO HEALTH SERVICES

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

    ``(a) In General.--Any payments received by the Service, by an 
Indian tribe or tribal organization pursuant to a funding agreement 
under the Indian Self-Determination and Education Assistance Act, or by 
an urban Indian organization pursuant to title V of this Act for 
services provided to Indians eligible for benefits under title XVIII of 
the Social Security Act shall not be considered in determining 
appropriations for health care and services to Indians.
    ``(b) Equal Treatment.--Nothing in this Act authorizes the 
Secretary to provide services to an Indian beneficiary with coverage 
under title XVIII of the Social Security Act in preference to an Indian 
beneficiary without such coverage.
    ``(c) Special Fund.--
            ``(1) Use of funds.--Notwithstanding any other provision of 
        this title or of title XVIII of the Social Security Act, 
        payments to which any facility of the Service is entitled by 
        reason of this section shall be placed in a special fund to be 
        held by the Secretary and first used (to such extent or in such 
        amounts as are provided in appropriation Acts) for the purpose 
        of making any improvements in the programs of the Service which 
        may be necessary to achieve or maintain compliance with the 
        applicable conditions and requirements of this title and of 
        title XVIII of the Social Security Act. Any funds to be 
        reimbursed which are in excess of the amount necessary to 
        achieve or maintain such conditions and requirements shall, 
        subject to the consultation with tribes being served by the 
        service unit, be used for reducing the health resource 
        deficiencies of the Indian tribes.
            ``(2) Nonapplication in case of election for direct 
        billing.--Paragraph (1) shall not apply upon the election of an 
        Indian tribe or tribal organization under section 405 to 
        receive direct payments for services provided to Indians 
        eligible for benefits under title XVIII of the Social Security 
        Act.

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

    ``(a) Special Fund.--
            ``(1) Use of funds.--Notwithstanding any other provision of 
        law, payments to which any facility of the Service (including a 
        hospital, nursing facility, intermediate care facility for the 
        mentally retarded, or any other type of facility which provides 
        services for which payment is available under title XIX of the 
        Social Security Act) is entitled under a State plan by reason 
        of section 1911 of such Act shall be placed in a special fund 
        to be held by the Secretary and first used (to such extent or 
        in such amounts as are provided in appropriation Acts) for the 
        purpose of making any improvements in the facilities of such 
        Service which may be necessary to achieve or maintain 
        compliance with the applicable conditions and requirements of 
        such title. Any payments which are in excess of the amount 
        necessary to achieve or maintain such conditions and 
        requirements shall, subject to the consultation with tribes 
        being served by the service unit, be used for reducing the 
        health resource deficiencies of the Indian tribes. In making 
        payments from such fund, the Secretary shall ensure that each 
        service unit of the Service receives 100 percent of the amounts 
        to which the facilities of the Service, for which such service 
        unit makes collections, are entitled by reason of section 1911 
        of the Social Security Act.
            ``(2) Nonapplication in case of election for direct 
        billing.--Paragraph (1) shall not apply upon the election of an 
        Indian tribe or tribal organization under section 405 to 
receive direct payments for services provided to Indians eligible for 
medical assistance under title XIX of the Social Security Act.
    ``(b) Payments Disregarded for Appropriations.--Any payments 
received under section 1911 of the Social Security Act for services 
provided to Indians eligible for benefits under title XIX of the Social 
Security Act shall not be considered in determining appropriations for 
the provision of health care and services to Indians.
    ``(c) Direct Billing.--For provisions relating to the authority of 
certain Indian tribes and tribal organizations to elect to directly 
bill for, and receive payment for, health care services provided by a 
hospital or clinic of such tribes or tribal organizations and for which 
payment may be made under this title, see section 405.

``SEC. 403. REPORT.

    ``(a) Inclusion in Annual Report.--The Secretary shall submit to 
the President, for inclusion in the report required to be transmitted 
to the Congress under section 801, an accounting on the amount and use 
of funds made available to the Service pursuant to this title as a 
result of reimbursements under titles XVIII and XIX of the Social 
Security Act.
    ``(b) Identification of Source of Payments.--If an Indian tribe or 
tribal organization receives funding from the Service under the Indian 
Self-Determination and Education Assistance Act or an urban Indian 
organization receives funding from the Service under title V of this 
Act and receives reimbursements or payments under title XVIII, XIX, or 
XXI of the Social Security Act, such Indian tribe or tribal 
organization, or urban Indian organization, shall provide to the 
Service a list of each provider enrollment number (or other identifier) 
under which it receives such reimbursements or payments.

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

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

``SEC. 405. DIRECT BILLING AND REIMBURSEMENT OF MEDICARE, MEDICAID, AND 
              OTHER THIRD PARTY PAYORS.

    ``(a) Establishment of Direct Billing Program.--
            ``(1) In general.--The Secretary shall establish a program 
        under which Indian tribes, tribal organizations, and Alaska 
        Native health organizations that contract or compact for the 
        operation of a hospital or clinic of the Service under the 
        Indian Self-Determination and Education Assistance Act may 
        elect to directly bill for, and receive payment for, health 
        care services provided by such hospital or clinic for which 
        payment is made under the medicare program established under 
        title XVIII of the Social Security Act (42 U.S.C. 1395 et 
        seq.), under the medicaid program established under title XIX 
        of the Social Security Act (42 U.S.C. 1396 et seq.), or from 
        any other third party payor.
            ``(2) Application of 100 percent fmap.--The third sentence 
        of section 1905(b) of the Social Security Act (42 U.S.C. 
1396d(b)) shall apply for purposes of reimbursement under title XIX of 
the Social Security Act for health care services directly billed under 
the program established under this section.
    ``(b) Direct Reimbursement.--
            ``(1) Use of funds.--Each hospital or clinic participating 
        in the program described in subsection (a) of this section 
        shall be reimbursed directly under titles XVIII and XIX of the 
        Social Security Act for services furnished, without regard to 
        the provisions of section 1880(c) of the Social Security Act 
        (42 U.S.C. 1395qq(c)) and sections 402(a) and 807(b)(2)(A), but 
        all funds so reimbursed shall first be used by the hospital or 
        clinic for the purpose of making any improvements in the 
        hospital or clinic that may be necessary to achieve or maintain 
        compliance with the conditions and requirements applicable 
        generally to facilities of such type under title XVIII or XIX 
        of the Social Security Act. Any funds so reimbursed which are 
        in excess of the amount necessary to achieve or maintain such 
        conditions shall be used--
                    ``(A) solely for improving the health resources 
                deficiency level of the Indian tribe; and
                    ``(B) in accordance with the regulations of the 
                Service applicable to funds provided by the Service 
                under any contract entered into under the Indian Self-
                Determination Act (25 U.S.C. 450f et seq.).
            ``(2) Audits.--The amounts paid to the hospitals and 
        clinics participating in the program established under this 
        section shall be subject to all auditing requirements 
        applicable to programs administered directly by the Service and 
        to facilities participating in the medicare and medicaid 
        programs under titles XVIII and XIX of the Social Security Act.
            ``(3) Secretarial oversight.--The Secretary shall monitor 
        the performance of hospitals and clinics participating in the 
        program established under this section, and shall require such 
        hospitals and clinics to submit reports on the program to the 
        Secretary on an annual basis.
            ``(4) No payments from special funds.--Notwithstanding 
        section 1880(c) of the Social Security Act (42 U.S.C. 
        1395qq(c)) or section 402(a), no payment may be made out of the 
        special funds described in such sections for the benefit of any 
        hospital or clinic during the period that the hospital or 
        clinic participates in the program established under this 
        section.
    ``(c) Requirements for Participation.--
            ``(1) Application.--Except as provided in paragraph (2)(B), 
        in order to be eligible for participation in the program 
        established under this section, an Indian tribe, tribal 
        organization, or Alaska Native health organization shall submit 
        an application to the Secretary that establishes to the 
        satisfaction of the Secretary that--
                    ``(A) the Indian tribe, tribal organization, or 
                Alaska Native health organization contracts or compacts 
                for the operation of a facility of the Service;
                    ``(B) the facility is eligible to participate in 
                the medicare or medicaid programs under section 1880 or 
                1911 of the Social Security Act (42 U.S.C. 1395qq; 
                1396j);
                    ``(C) the facility meets the requirements that 
                apply to programs operated directly by the Service; and
                    ``(D) the facility--
                            ``(i) is accredited by an accrediting body 
                        as eligible for reimbursement under the 
                        medicare or medicaid programs; or
                            ``(ii) has submitted a plan, which has been 
                        approved by the Secretary, for achieving such 
                        accreditation.
            ``(2) Approval.--
                    ``(A) In general.--The Secretary shall review and 
                approve a qualified application not later than 90 days 
                after the date the application is submitted to the 
                Secretary unless the Secretary determines that any of 
                the criteria set forth in paragraph (1) are not met.
                    ``(B) Grandfather of demonstration program 
                participants.--Any participant in the demonstration 
                program authorized under this section as in effect on 
                the day before the date of enactment of the Alaska 
                Native and American Indian Direct Reimbursement Act of 
                2000 shall be deemed approved for participation in the 
                program established under this section and shall not be 
                required to submit an application in order to 
                participate in the program.
                    ``(C) Duration.--An approval by the Secretary of a 
                qualified application under subparagraph (A), or a 
                deemed approval of a demonstration program under 
                subparagraph (B), shall continue in effect as long as 
                the approved applicant or the deemed approved 
demonstration program meets the requirements of this section.
    ``(d) Examination and Implementation of Changes.--
            ``(1) In general.--The Secretary, acting through the 
        Service, and with the assistance of the Administrator of the 
        Health Care Financing Administration, shall examine on an 
        ongoing basis and implement--
                    ``(A) any administrative changes that may be 
                necessary to facilitate direct billing and 
                reimbursement under the program established under this 
                section, including any agreements with States that may 
                be necessary to provide for direct billing under title 
                XIX of the Social Security Act; and
                    ``(B) any changes that may be necessary to enable 
                participants in the program established under this 
                section to provide to the Service medical records 
                information on patients served under the program that 
                is consistent with the medical records information 
                system of the Service.
            ``(2) Accounting information.--The accounting information 
        that a participant in the program established under this 
        section shall be required to report shall be the same as the 
        information required to be reported by participants in the 
        demonstration program authorized under this section as in 
        effect on the day before the date of enactment of the Alaska 
        Native and American Indian Direct Reimbursement Act of 2000. 
        The Secretary may from time to time, after consultation with 
        the program participants, change the accounting information 
        submission requirements.
    ``(e) Withdrawal From Program.--A participant in the program 
established under this section may withdraw from participation in the 
same manner and under the same conditions that a tribe or tribal 
organization may retrocede a contracted program to the Secretary under 
authority of the Indian Self-Determination Act (25 U.S.C. 450 et seq.). 
All cost accounting and billing authority under the program established 
under this section shall be returned to the Secretary upon the 
Secretary's acceptance of the withdrawal of participation in this 
program.

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

    ``(a) Right of Recovery.--Except as provided in subsection (g), the 
United States, an Indian tribe or tribal organization shall have the 
right to recover the reasonable charges billed or expenses incurred by 
the Secretary or an Indian tribe or tribal organization in providing 
health services, through the Service or an Indian tribe or tribal 
organization to any individual to the same extent that such individual, 
or any nongovernmental provider of such services, would be eligible to 
receive reimbursement or indemnification for such charges or expenses 
if--
            ``(1) such services had been provided by a nongovernmental 
        provider; and
            ``(2) such individual had been required to pay such charges 
        or expenses and did pay such expenses.
    ``(b) Urban Indian Organizations.--Except as provided in subsection 
(g), an urban Indian organization shall have the right to recover the 
reasonable charges billed or expenses incurred by the organization in 
providing health services to any individual to the same extent that 
such individual, or any other nongovernmental provider of such 
services, would be eligible to receive reimbursement or indemnification 
for such charges or expenses if such individual had been required to 
pay such charges or expenses and did pay such charges or expenses.
    ``(c) Limitations on Recoveries From States.--Subsections (a) and 
(b) shall provide a right of recovery against any State, only if the 
injury, illness, or disability for which health services were provided 
is covered under--
            ``(1) workers' compensation laws; or
            ``(2) a no-fault automobile accident insurance plan or 
        program.
    ``(d) Nonapplication of Other Laws.--No law of any State, or of any 
political subdivision of a State and no provision of any contract 
entered into or renewed after the date of enactment of the Indian 
Health Care Amendments of 1988, shall prevent or hinder the right of 
recovery of the United States or an Indian tribe or tribal organization 
under subsection (a), or an urban Indian organization under subsection 
(b).
    ``(e) No Effect on Private Rights of Action.--No action taken by 
the United States or an Indian tribe or tribal organization to enforce 
the right of recovery provided under subsection (a), or by an urban 
Indian organization to enforce the right of recovery provided under 
subsection (b), shall affect the right of any person to any damages 
(other than damages for the cost of health services provided by the 
Secretary through the Service).
    ``(f) Methods of Enforcement.--
            ``(1) In general.--The United States or an Indian tribe or 
        tribal organization may enforce the right of recovery provided 
        under subsection (a), and an urban Indian organization may 
        enforce the right of recovery provided under subsection (b), 
        by--
                    ``(A) intervening or joining in any civil action or 
                proceeding brought--
                            ``(i) by the individual for whom health 
                        services were provided by the Secretary, an 
                        Indian tribe or tribal organization, or urban 
                        Indian organization; or
                            ``(ii) by any representative or heirs of 
                        such individual; or
                    ``(B) instituting a civil action.
            ``(2) Notice.--All reasonable efforts shall be made to 
        provide notice of an action instituted in accordance with 
        paragraph (1)(B) to the individual to whom health services were 
        provided, either before or during the pendency of such action.
    ``(g) Limitation.--Notwithstanding this section, absent specific 
written authorization by the governing body of an Indian tribe for the 
period of such authorization (which may not be for a period of more 
than 1 year and which may be revoked at any time upon written notice by 
the governing body to the Service), neither the United States through 
the Service, nor an Indian tribe or tribal organization under a funding 
agreement pursuant to the Indian Self-Determination and Education 
Assistance Act, nor an urban Indian organization funded under title V, 
shall have a right of recovery under this section if the injury, 
illness, or disability for which health services were provided is 
covered under a self-insurance plan funded by an Indian tribe or tribal 
organization, or urban Indian organization. Where such tribal 
authorization is provided, the Service may receive and expend such 
funds for the provision of additional health services.
    ``(h) Costs and Attorneys' Fees.--In any action brought to enforce 
the provisions of this section, a prevailing plaintiff shall be awarded 
reasonable attorneys' fees and costs of litigation.
    ``(i) Right of Action Against Insurers and Employee Benefit 
Plans.--
            ``(1) In general.--Where an insurance company or employee 
        benefit plan fails or refuses to pay the amount due under 
        subsection (a) for services provided to an individual who is a 
        beneficiary, participant, or insured of such company or plan, 
        the United States or an Indian tribe or tribal organization 
        shall have a right to assert and pursue all the claims and 
        remedies against such company or plan, and against the 
        fiduciaries of such company or plan, that the individual could 
        assert or pursue under applicable Federal, State or tribal law.
            ``(2) Urban indian organizations.--Where an insurance 
        company or employee benefit plan fails or refuses to pay the 
        amounts due under subsection (b) for health services provided 
        to an individual who is a beneficiary, participant, or insured 
        of such company or plan, the urban Indian organization shall 
        have a right to assert and pursue all the claims and remedies 
        against such company or plan, and against the fiduciaries of 
        such company or plan, that the individual could assert or 
        pursue under applicable Federal or State law.
    ``(j) Nonapplication of Claims Filing Requirements.--
Notwithstanding any other provision in law, the Service, an Indian 
tribe or tribal organization, or an urban Indian organization shall 
have a right of recovery for any otherwise reimbursable claim filed on 
a current HCFA-1500 or UB-92 form, or the current NSF electronic 
format, or their successors. No health plan shall deny payment because 
a claim has not been submitted in a unique format that differs from 
such forms.

``SEC. 407. CREDITING OF REIMBURSEMENTS.

    ``(a) Retention of Funds.--Except as provided in section 202(d), 
this title, and section 807, all reimbursements received or recovered 
under the authority of this Act, Public Law 87-693, or any other 
provision of law, by reason of the provision of health services by the 
Service or by an Indian tribe or tribal organization under a funding 
agreement pursuant to the Indian Self-Determination and Education 
Assistance Act, or by an urban Indian organization funded under title 
V, shall be retained by the Service or that tribe or tribal 
organization and shall be available for the facilities, and to carry 
out the programs, of the Service or that tribe or tribal organization 
to provide health care services to Indians.
    ``(b) No Offset of Funds.--The Service may not offset or limit the 
amount of funds obligated to any service unit or entity receiving 
funding from the Service because of the receipt of reimbursements under 
subsection (a).

``SEC. 408. PURCHASING HEALTH CARE COVERAGE.

    ``An Indian tribe or tribal organization, and an urban Indian 
organization may utilize funding from the Secretary under this Act to 
purchase managed care coverage for Service beneficiaries (including 
insurance to limit the financial risks of managed care entities) from--
            ``(1) a tribally owned and operated managed care plan;
            ``(2) a State or locally-authorized or licensed managed 
        care plan; or
            ``(3) a health insurance provider.

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

    ``(a) Examination of Feasibility of Arrangements.--
            ``(1) In general.--The Secretary shall examine the 
        feasibility of entering into arrangements or expanding existing 
        arrangements for the sharing of medical facilities and services 
        between the Service and the Veterans' Administration, and other 
        appropriate Federal agencies, including those within the 
        Department, and shall, in accordance with subsection (b), 
        prepare a report on the feasibility of such arrangements.
            ``(2) Submission of report.--Not later than September 30, 
        2003, the Secretary shall submit the report required under 
        paragraph (1) to Congress.
            ``(3) Consultation required.--The Secretary may not 
        finalize any arrangement described in paragraph (1) without 
        first consulting with the affected Indian tribes.
    ``(b) Limitations.--The Secretary shall not take any action under 
this section or under subchapter IV of chapter 81 of title 38, United 
States Code, which would impair--
            ``(1) the priority access of any Indian to health care 
        services provided through the Service;
            ``(2) the quality of health care services provided to any 
        Indian through the Service;
            ``(3) the priority access of any veteran to health care 
        services provided by the Veterans' Administration;
            ``(4) the quality of health care services provided to any 
        veteran by the Veteran's Administration;
            ``(5) the eligibility of any Indian to receive health 
        services through the Service; or
            ``(6) the eligibility of any Indian who is a veteran to 
        receive health services through the Veterans' Administration 
        provided, however, the Service or the Indian tribe or tribal 
        organization shall be reimbursed by the Veterans' 
        Administration where services are provided through the Service 
        or Indian tribes or tribal organizations to beneficiaries 
        eligible for services from the Veterans' Administration, 
        notwithstanding any other provision of law.
    ``(c) Agreements for Parity in Services.--The Service may enter 
into agreements with other Federal agencies to assist in achieving 
parity in services for Indians. Nothing in this section may be 
construed as creating any right of a veteran to obtain health services 
from the Service.

``SEC. 410. PAYOR OF LAST RESORT.

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

``SEC. 411. RIGHT TO RECOVER FROM FEDERAL HEALTH CARE PROGRAMS.

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

``SEC. 412. TUBA CITY DEMONSTRATION PROJECT.

    ``(a) In General.--Notwithstanding any other provision of law, 
including the Anti-Deficiency Act, provided the Indian tribes to be 
served approve, the Service in the Tuba City Service Unit may--
            ``(1) enter into a demonstration project with the State of 
        Arizona under which the Service would provide certain specified 
        medicaid services to individuals dually eligible for services 
        from the Service and for medical assistance under title XIX of 
        the Social Security Act in return for payment on a capitated 
        basis from the State of Arizona; and
            ``(2) purchase insurance to limit the financial risks under 
        the project.
    ``(b) Extension of Project.--The demonstration project authorized 
under subsection (a) may be extended to other service units in Arizona, 
subject to the approval of the Indian tribes to be served in such 
service units, the Service, and the State of Arizona.

``SEC. 413. ACCESS TO FEDERAL INSURANCE.

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

``SEC. 414. CONSULTATION AND RULEMAKING.

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

``SEC. 415. LIMITATIONS ON CHARGES.

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

``SEC. 416. LIMITATION ON SECRETARY'S WAIVER AUTHORITY.

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

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

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

``SEC. 418. MEANING OF `REMUNERATION' FOR PURPOSES OF SAFE HARBOR 
              PROVISIONS; ANTITRUST IMMUNITY.

    ``(a) Meaning of Remuneration.--Notwithstanding any other provision 
of law, the term `remuneration' as used in sections 1128A and 1128B of 
the Social Security Act shall not include any exchange of anything of 
value between or among--
            ``(1) any Indian tribe or tribal organization or an urban 
        Indian organization that administers health programs under the 
authority of the Indian Self-Determination and Education Assistance 
Act;
            ``(2) any such Indian tribe or tribal organization or urban 
        Indian organization and the Service;
            ``(3) any such Indian tribe or tribal organization or urban 
        Indian organization and any patient served or eligible for 
        service under such programs, including patients served or 
        eligible for service pursuant to section 813 of this Act (as in 
        effect on the day before the date of enactment of the Indian 
        Health Care Improvement Act Reauthorization of 2003); or
            ``(4) any such Indian tribe or tribal organization or urban 
        Indian organization and any third party required by contract, 
        section 206 or 207 of this Act (as so in effect), or other 
        applicable law, to pay or reimburse the reasonable health care 
        costs incurred by the United States or any such Indian tribe or 
        tribal organization or urban Indian organization;
provided the exchange arises from or relates to such health programs.
    ``(b) Antitrust Immunity.--An Indian tribe or tribal organization 
or an urban Indian organization that administers health programs under 
the authority of the Indian Self-Determination and Education Assistance 
Act or title V shall be deemed to be an agency of the United States and 
immune from liability under the Acts commonly known as the Sherman Act, 
the Clayton Act, the Robinson-Patman Anti-Discrimination Act, the 
Federal Trade Commission Act, and any other Federal, State, or local 
antitrust laws, with regard to any transaction, agreement, or conduct 
that relates to such programs.

``SEC. 419. CO-INSURANCE, CO-PAYMENTS, DEDUCTIBLES AND PREMIUMS.

    ``(a) Exemption From Cost-Sharing Requirements.--Notwithstanding 
any other provision of Federal or State law, no Indian who is eligible 
for services under title XVIII, XIX, or XXI of the Social Security Act, 
or under any other Federally funded health care programs, may be 
charged a deductible, co-payment, or co-insurance for any service 
provided by or through the Service, an Indian tribe or tribal 
organization or urban Indian organization, nor may the payment or 
reimbursement due to the Service or an Indian tribe or tribal 
organization or urban Indian organization be reduced by the amount of 
the deductible, co-payment, or co-insurance that would be due from the 
Indian but for the operation of this section. For the purposes of this 
section, the term `through' shall include services provided directly, 
by referral, or under contracts or other arrangements between the 
Service, an Indian tribe or tribal organization or an urban Indian 
organization and another health provider.
    ``(b) Exemption From Premiums.--
            ``(1) Medicaid and state children's health insurance 
        program.--Notwithstanding any other provision of Federal or 
        State law, no Indian who is otherwise eligible for medical 
        assistance under title XIX of the Social Security Act or child 
        health assistance under title XXI of such Act may be charged a 
        premium as a condition of receiving such assistance under title 
        XIX or XXI of such Act.
            ``(2) Medicare enrollment premium penalties.--
        Notwithstanding section 1839(b) of the Social Security Act or 
        any other provision of Federal or State law, no Indian who is 
        eligible for benefits under part B of title XVIII of the Social 
        Security Act, but for the payment of premiums, shall be charged 
        a penalty for enrolling in such part at a time later than the 
        Indian might otherwise have been first eligible to do so. The 
        preceding sentence applies whether an Indian pays for premiums 
        under such part directly or such premiums are paid by another 
        person or entity, including a State, the Service, an Indian 
        tribe or tribal organization, or an urban Indian organization.

``SEC. 420. INCLUSION OF INCOME AND RESOURCES FOR PURPOSES OF MEDICALLY 
              NEEDY MEDICAID ELIGIBILITY.

  ``For the purpose of determining the eligibility under section 
1902(a)(10)(A)(ii)(IV) of the Social Security Act of an Indian for 
medical assistance under a State plan under title XIX of such Act, the 
cost of providing services to an Indian in a health program of the 
Service, an Indian tribe or tribal organization, or an urban Indian 
organization shall be deemed to have been an expenditure for health 
care by the Indian.

``SEC. 421. ESTATE RECOVERY PROVISIONS.

    ``Notwithstanding any other provision of Federal or State law, the 
following property may not be included when determining eligibility for 
services or implementing estate recovery rights under title XVIII, XIX, 
or XXI of the Social Security Act, or any other health care programs 
funded in whole or part with Federal funds:
            ``(1) Income derived from rents, leases, or royalties of 
        property held in trust for individuals by the Federal 
        Government.
            ``(2) Income derived from rents, leases, royalties, or 
        natural resources (including timber and fishing activities) 
        resulting from the exercise of federally protected rights, 
        whether collected by an individual or a tribal group and 
        distributed to individuals.
            ``(3) Property, including interests in real property 
        currently or formerly held in trust by the Federal Government 
        which is protected under applicable Federal, State or tribal 
        law or custom from recourse, including public domain 
        allotments.
            ``(4) Property that has unique religious or cultural 
        significance or that supports subsistence or traditional life 
        style according to applicable tribal law or custom.

``SEC. 422. MEDICAL CHILD SUPPORT.

    ``Notwithstanding any other provision of law, a parent shall not be 
responsible for reimbursing the Federal Government or a State for the 
cost of medical services provided to a child by or through the Service, 
an Indian tribe or tribal organization or an urban Indian organization. 
For the purposes of this subsection, the term `through' includes 
services provided directly, by referral, or under contracts or other 
arrangements between the Service, an Indian tribe or tribal 
organization or an urban Indian organization and another health 
provider.

``SEC. 423. PROVISIONS RELATING TO MANAGED CARE.

    ``(a) Recovery From Managed Care Plans.--Notwithstanding any other 
provision in law, the Service, an Indian tribe or tribal organization 
or an urban Indian organization shall have a right of recovery under 
section 408 from all private and public health plans or programs, 
including the medicare, medicaid, and State children's health insurance 
programs under titles XVIII, XIX, and XXI of the Social Security Act, 
for the reasonable costs of delivering health services to Indians 
entitled to receive services from the Service, an Indian tribe or 
tribal organization or an urban Indian organization.
    ``(b) Limitation.--No provision of law or regulation, or of any 
contract, may be relied upon or interpreted to deny or reduce payments 
otherwise due under subsection (a), except to the extent the Service, 
an Indian tribe or tribal organization, or an urban Indian organization 
has entered into an agreement with a managed care entity regarding 
services to be provided to Indians or rates to be paid for such 
services, provided that such an agreement may not be made a 
prerequisite for such payments to be made.
    ``(c) Parity.--Payments due under subsection (a) from a managed 
care entity may not be paid at a rate that is less than the rate paid 
to a `preferred provider' by the entity or, in the event there is no 
such rate, the usual and customary fee for equivalent services.
    ``(d) No Claim Requirement.--A managed care entity may not deny 
payment under subsection (a) because an enrollee with the entity has 
not submitted a claim.
    ``(e) Direct Billing.--Notwithstanding the preceding subsections of 
this section, the Service, an Indian tribe or tribal organization, or 
an urban Indian organization that provides a health service to an 
Indian entitled to medical assistance under the State plan under title 
XIX of the Social Security Act or enrolled in a child health plan under 
title XXI of such Act shall have the right to be paid directly by the 
State agency administering such plans notwithstanding any agreements 
the State may have entered into with managed care organizations or 
providers.
    ``(f) Requirement for Medicaid Managed Care Entities.--A managed 
care entity (as defined in section 1932(a)(1)(B) of the Social Security 
Act shall, as a condition of participation in the State plan under 
title XIX of such Act, offer a contract to health programs administered 
by the Service, an Indian tribe or tribal organization or an urban 
Indian organization that provides health services in the geographic 
area served by the managed care entity and such contract (or other 
provider participation agreement) shall contain terms and conditions of 
participation  and payment no more restrictive or onerous than those 
provided for in this section.
    ``(g) Prohibition.--Notwithstanding any other provision of law or 
any waiver granted by the Secretary no Indian may be assigned 
automatically or by default under any managed care entity participating 
in a State plan under title XIX or XXI of the Social Security Act 
unless the Indian had the option of enrolling in a managed care plan or 
health program administered by the Service, an Indian tribe or tribal 
organization, or an urban Indian organization.
    ``(h) Indian Managed Care Plans.--Notwithstanding any other 
provision of law, any State entering into agreements with one or more 
managed care organizations to provide services under title XIX or XXI 
of the Social Security Act shall enter into such an agreement with the 
Service, an Indian tribe or tribal organization or an urban Indian 
organization under which such an entity may provide services to Indians 
who may be eligible or required to enroll with a managed care 
organization through enrollment in an Indian managed care organization 
that provides services similar to those offered by other managed care 
organizations in the State. The Secretary and the State are hereby 
authorized to waive requirements regarding discrimination, 
capitalization, and other matters that might otherwise prevent an 
Indian managed care organization or health program from meeting Federal 
or State standards applicable to such organizations, provided such 
Indian managed care organization or health program offers Indian 
enrollees services of an equivalent quality to that required of other 
managed care organizations.
    ``(i) Advertising.--A managed care organization entering into a 
contract to provide services to Indians on or near an Indian 
reservation shall provide a certificate of coverage or similar type of 
document that is written in the Indian language of the majority of the 
Indian population residing on such reservation.

``SEC. 424. NAVAJO NATION MEDICAID AGENCY.

    ``(a) In General.--Notwithstanding any other provision of law, the 
Secretary may treat the Navajo Nation as a State under title XIX of the 
Social Security Act for purposes of providing medical assistance to 
Indians living within the boundaries of the Navajo Nation.
    ``(b) Assignment and Payment.--Notwithstanding any other provision 
of law, the Secretary may assign and pay all expenditures related to 
the provision of services to Indians living within the boundaries of 
the Navajo Nation under title XIX of the Social Security Act (including 
administrative expenditures) that are currently paid to or would 
otherwise be paid to the States of Arizona, New Mexico, and Utah, to an 
entity established by the Navajo Nation and approved by the Secretary, 
which shall be denominated the Navajo Nation Medicaid Agency.
    ``(c) Authority.--The Navajo Nation Medicaid Agency shall serve 
Indians living within the boundaries of the Navajo Nation and shall 
have the same authority and perform the same functions as other State 
agency responsible for the administration of the State plan under title 
XIX of the Social Security Act.
    ``(d) Technical Assistance.--The Secretary may directly assist the 
Navajo Nation in the development and implementation of a Navajo Nation 
Medicaid Agency for the administration, eligibility, payment, and 
delivery of medical assistance under title XIX of the Social Security 
Act (which shall, for purposes of reimbursement to such Nation, include 
Western and traditional Navajo healing services) within the Navajo 
Nation. Such assistance may include providing funds for demonstration 
projects conducted with such Nation.
    ``(e) FMAP.--Notwithstanding section 1905(b) of the Social Security 
Act, the Federal medical assistance percentage shall be 100 per cent 
with respect to amounts the Navajo Nation Medicaid agency expends for 
medical assistance and related administrative costs.
    ``(f) Waiver Authority.--The Secretary shall have the authority to 
waive applicable provisions of title XIX of the Social Security Act to 
establish, develop and implement the Navajo Nation Medicaid Agency.
    ``(g) SCHIP.--At the option of the Navajo Nation, the Secretary may 
treat the Navajo Nation as a State for purposes of title XXI of the 
Social Security Act under terms equivalent to those described in the 
preceding subsections of this section.

``SEC. 425. INDIAN ADVISORY COMMITTEES.

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

``SEC. 426. AUTHORIZATION OF APPROPRIATIONS.

    There is authorized to be appropriated such sums as may be 
necessary for each of fiscal years 2004 through 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 the authority of the Act of November 2, 1921 (25 U.S.C. 13) 
(commonly known as the Snyder Act), the Secretary, through the Service, 
shall enter into contracts with, or make grants to, urban Indian 
organizations to assist such organizations in the establishment and 
administration, within urban centers, of programs which meet the 
requirements set forth in this title. The Secretary, through the 
Service, subject to section 506, shall include such conditions as the 
Secretary considers necessary to effect the purpose of this title in 
any contract which the Secretary enters into with, or in any grant the 
Secretary makes to, any urban Indian organization pursuant to this 
title.

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

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

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

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

``SEC. 505. EVALUATIONS; RENEWALS.

    ``(a) Procedures.--The Secretary, acting through the Service, shall 
develop procedures to evaluate compliance with grant requirements under 
this title and compliance with, and performance of contracts entered 
into by urban Indian organizations under this title. Such procedures 
shall include provisions for carrying out the requirements of this 
section.
    ``(b) Compliance With Terms.--The Secretary, acting through the 
Service, shall evaluate the compliance of each urban Indian 
organization which has entered into a contract or received a grant 
under section 503 with the terms of such contract or grant. For 
purposes of an evaluation under this subsection, the Secretary, in 
determining the capacity of an urban Indian organization to deliver 
quality patient care shall, at the option of the organization--
            ``(1) conduct, through the Service, an annual onsite 
        evaluation of the organization; or
            ``(2) accept, in lieu of an onsite evaluation, evidence of 
        the organization's provisional or full accreditation by a 
        private independent entity recognized by the Secretary for 
        purposes of conducting quality reviews of providers 
        participating in the medicare program under Title XVIII of the 
        Social Security Act.
    ``(c) Noncompliance.--
            ``(1) In general.--If, as a result of the evaluations 
        conducted under this section, the Secretary determines that an 
        urban Indian organization has not complied with the 
        requirements of a grant or complied with or satisfactorily 
        performed a contract under section 503, the Secretary shall, 
        prior to renewing such contract or grant, attempt to resolve 
        with such organization the areas of noncompliance or 
        unsatisfactory performance and modify such contract or grant to 
        prevent future occurrences of such noncompliance or 
        unsatisfactory performance.
            ``(2) Nonrenewal.--If the Secretary determines, under an 
        evaluation under this section, that noncompliance or 
        unsatisfactory performance cannot be resolved and prevented in 
        the future, the Secretary shall not renew such contract or 
        grant with such organization and is authorized to enter into a 
        contract or make a grant under section 503 with another urban 
        Indian organization which is situated in the same urban center 
        as the urban Indian organization whose contract or grant is not 
        renewed under this section.
    ``(d) Determination of Renewal.--In determining whether to renew a 
contract or grant with an urban Indian organization under section 503 
which has completed performance of a contract or grant under section 
504, the Secretary shall review the records of the urban Indian 
organization, the reports submitted under section 507, and, in the case 
of a renewal of a contract or grant under section 503, shall consider 
the results of the onsite evaluations or accreditation under subsection 
(b).

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

    ``(a) Application of Federal Law.--Contracts with urban Indian 
organizations entered into pursuant to this title shall be in 
accordance with all Federal contracting laws and regulations relating 
to procurement except that, in the discretion of the Secretary, such 
contracts may be negotiated without advertising and need not conform to 
the provisions of the Act of August 24, 1935 (40 U.S.C. 270a, et seq.).
    ``(b) Payments.--Payments under any contracts or grants pursuant to 
this title shall, notwithstanding any term or condition of such 
contract or grant--
            ``(1) be made in their entirety by the Secretary to the 
        urban Indian organization by not later than the end of the 
        first 30 days of the funding period with respect to which the 
        payments apply, unless the Secretary determines through an 
        evaluation under section 505 that the organization is not 
        capable of administering such payments in their entirety; and
            ``(2) if unexpended by the urban Indian organization during 
        the funding period with respect to which the payments initially 
        apply, be carried forward for expenditure with respect to 
        allowable or reimbursable costs incurred by the organization 
        during 1 or more subsequent funding periods without additional 
        justification or documentation by the organization as a 
        condition of carrying forward the expenditure of such funds.
    ``(c) Revising or Amending Contract.--Notwithstanding any provision 
of law to the contrary, the Secretary may, at the request or consent of 
an urban Indian organization, revise or amend any contract entered into 
by the Secretary with such organization under this title as necessary 
to carry out the purposes of this title.
    ``(d) Fair and Uniform Provision of Services.--Contracts with, or 
grants to, urban Indian organizations and regulations adopted pursuant 
to this title shall  include provisions to assure the fair and uniform 
provision to urban Indians of services and assistance under such 
contracts or grants by such organizations.
    ``(e) Eligibility of Urban Indians.--Urban Indians, as defined in 
section 4(f), shall be eligible for health care or referral services 
provided pursuant to this title.

``SEC. 507. REPORTS AND RECORDS.

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

``SEC. 508. LIMITATION ON CONTRACT AUTHORITY.

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

``SEC. 509. FACILITIES.

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

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

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

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

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

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

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

``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.

    ``(a) Grants and Contracts.--The Secretary, acting through the 
Office of Urban Indian Health of the Service, shall make grants or 
enter into contracts, effective not later than September 30, 2004, with 
urban Indian organizations for the administration of urban Indian 
alcohol programs that were originally established under the National 
Institute on Alcoholism and Alcohol Abuse (referred to in this section 
to as `NIAAA') and transferred to the Service.
    ``(b) Use of Funds.--Grants provided or contracts entered into 
under this section shall be used to provide support for the 
continuation of alcohol prevention and treatment services for urban 
Indian populations and such other objectives as are agreed upon between 
the Service and a recipient of a grant or contract under this section.
    ``(c) Eligibility.--Urban Indian organizations that operate Indian 
alcohol programs originally funded under NIAAA and subsequently 
transferred to the Service are eligible for grants or contracts under 
this section.
    ``(d) Evaluation and Report.--The Secretary shall evaluate and 
report to the Congress on the activities of programs funded under this 
section at least every 5 years.

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

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

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

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

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

    ``(a) Construction and Operation.--The Secretary, acting through 
the Service, shall, through grants or contracts, make payment for the 
construction and operation of at least 2 residential treatment centers 
in each State described in subsection (b) to demonstrate the provision 
of alcohol and substance abuse treatment services to urban Indian youth 
in a culturally competent residential setting.
    ``(b) States.--A State described in this subsection is a State in 
which--
            ``(1) there reside urban Indian youth with a need for 
        alcohol and substance abuse treatment services in a residential 
        setting; and
            ``(2) there is a significant shortage of culturally 
        competent residential treatment services for urban Indian 
        youth.

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

    ``(a) In General.--The Secretary shall permit an urban Indian 
organization that has entered into a contract or received a grant 
pursuant to this title, in carrying out such contract or grant, to use 
existing facilities and all equipment therein or pertaining thereto and 
other personal property owned by the Federal Government within the 
Secretary's jurisdiction under such terms and conditions as may be 
agreed upon for their use and maintenance.
    ``(b) Donation of Property.--Subject to subsection (d), the 
Secretary may donate to an urban Indian organization that has entered 
into a contract or received a grant pursuant to this title any personal 
or real property determined to be excess to the needs of the Service or 
the General Services Administration for purposes of carrying out the 
contract or grant.
    ``(c) Acquisition of Property.--The Secretary may acquire excess or 
surplus government personal or real property for donation, subject to 
subsection (d), to an urban Indian organization that has entered into a 
contract or received a grant pursuant to this title if the Secretary 
determines that the property is appropriate for use by the urban Indian 
organization for a purpose for which a contract or grant is authorized 
under this title.
    ``(d) Priority.--In the event that the Secretary receives a request 
for a specific item of personal or real property described in 
subsections (b) or (c) from an urban Indian organization and from an 
Indian tribe or tribal organization, the Secretary shall give priority 
to the request for donation to the Indian tribe or tribal organization 
if the Secretary receives the request from the Indian tribe or tribal 
organization before the date on which the Secretary transfers title to 
the property or, if earlier, the date on which the Secretary transfers 
the property physically, to the urban Indian organization.
    ``(e) Relation to Federal Sources of Supply.--For purposes of 
section 201(a) of the Federal Property and Administrative Services Act 
of 1949 (40 U.S.C. 481(a)) (relating to Federal sources of supply, 
including lodging providers, airlines, and other transportation 
providers), an urban Indian organization that has entered into a 
contract or received a grant pursuant to this title shall be deemed an 
executive agency when carrying out such contract or grant, and the 
employees of the urban Indian organization shall be eligible to have 
access to such sources of supply on the same basis as employees of an 
executive agency have such access.

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

    ``(a) Authority.--The Secretary may make grants to those urban 
Indian organizations that have entered into a contract or have received 
a grant under this title for the provision of services for the 
prevention, treatment, and control of the complications resulting from, 
diabetes among urban Indians.
    ``(b) Goals.--Each grant made pursuant to subsection (a) shall set 
forth the goals to be accomplished under the grant. The goals shall be 
specific to each grant as agreed upon between the Secretary and the 
grantee.
    ``(c) Criteria.--The Secretary shall establish criteria for the 
awarding of grants made under subsection (a) relating to--
            ``(1) the size and location of the urban Indian population 
        to be served;
            ``(2) the need for the prevention of, treatment of, and 
        control of the complications resulting from diabetes among the 
        urban Indian population to be served;
            ``(3) performance standards for the urban Indian 
        organization in meeting the goals set forth in such grant that 
        are negotiated and agreed to by the Secretary and the grantee;
            ``(4) the capability of the urban Indian organization to 
        adequately perform the activities required under the grant; and
            ``(5) the willingness of the urban Indian organization to 
        collaborate with the registry, if any, established by the 
        Secretary under section 204(e) in the area office of the 
        Service in which the organization is located.
    ``(d) Application of Criteria.--Any funds received by an urban 
Indian organization under this Act for the prevention, treatment, and 
control of diabetes among urban Indians shall be subject to the 
criteria developed by the Secretary under subsection (c).

``SEC. 519. COMMUNITY HEALTH REPRESENTATIVES.

    ``The Secretary, acting through the Service, may enter into 
contracts with, and make grants to, urban Indian organizations for the 
use of Indians trained as health service providers through the 
Community Health Representatives Program under section 107(b) in the 
provision of health care, health promotion, and disease prevention 
services to urban Indians.

``SEC. 520. REGULATIONS.

    ``(a) Effect of Title.--This title shall be effective on the date 
of enactment of this Act regardless of whether the Secretary has 
promulgated regulations implementing this title.
    ``(b) Promulgation.--
            ``(1) In general.--The Secretary may promulgate regulations 
        to implement the provisions of this title.
            ``(2) Publication.--Proposed regulations to implement this 
        title shall be published by the Secretary in the Federal 
        Register not later than 270 days after the date of enactment of 
        this Act and shall have a comment period of not less than 120 
        days.
            ``(3) Expiration of authority.--The authority to promulgate 
        regulations under this title shall expire on the date that is 
        18 months after the date of enactment of this Act.
    ``(c) Negotiated Rulemaking Committee.--A negotiated rulemaking 
committee shall be established pursuant to section 565 of title 5, 
United States Code, to carry out this section and shall, in addition to 
Federal representatives, have as the majority of its members 
representatives of urban Indian organizations from each service area.
    ``(d) Adaption of Procedures.--The Secretary shall adapt the 
negotiated rulemaking procedures to the unique context of this Act.

``SEC. 521. AUTHORIZATION OF APPROPRIATIONS.

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

``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.

    ``(a) Establishment.--
            ``(1) In general.--The Secretary, in consultation with 
        tribes, tribal organizations, and urban Indian organizations, 
        shall establish an automated management information system for 
        the Service.
            ``(2) Requirements of system.--The information system 
        established under paragraph (1) shall include--
                    ``(A) a financial management system;
                    ``(B) a patient care information system;
                    ``(C) a privacy component that protects the privacy 
                of patient information;
                    ``(D) a services-based cost accounting component 
                that provides estimates of the costs associated with 
                the provision of specific medical treatments or 
                services in each area office of the Service;
                    ``(E) an interface mechanism for patient billing 
                and accounts receivable system; and
                    ``(F) a training component.
    ``(b) Provision of Systems to Tribes and Organizations.--The 
Secretary shall provide each Indian tribe and tribal organization that 
provides health services under a contract entered into with the Service 
under the Indian Self-Determination Act automated management 
information systems which--
            ``(1) meet the management information needs of such Indian 
        tribe or tribal organization with respect to the treatment by 
        the Indian tribe or tribal organization of patients of the 
        Service; and
            ``(2) meet the management information needs of the Service.
    ``(c) Access to Records.--Notwithstanding any other provision of 
law, each patient shall have reasonable access to the medical or health 
records of such patient which are held by, or on behalf of, the 
Service.
    ``(d) Authority To Enhance Information Technology.--The Secretary, 
acting through the Assistant Secretary, shall have the authority to 
enter into contracts, agreements or joint ventures with other Federal 
agencies, States, private and nonprofit organizations, for the purpose 
of enhancing information technology in Indian health programs and 
facilities.

``SEC. 603. AUTHORIZATION OF APPROPRIATIONS.

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

                ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

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

    ``(a) Purposes.--It is the purpose of this section to--
            ``(1) authorize and direct the Secretary, acting through 
        the Service, Indian tribes, tribal organizations, and urban 
        Indian organizations to develop a comprehensive behavioral 
        health prevention and treatment program which emphasizes 
        collaboration among alcohol and substance abuse, social 
        services, and mental health programs;
            ``(2) provide information, direction and guidance relating 
        to mental illness and dysfunction and self-destructive 
        behavior, including child abuse and family violence, to those 
        Federal, tribal, State and local agencies responsible for 
        programs in Indian communities in areas of health care, 
        education, social services, child and family welfare, alcohol 
        and substance abuse, law enforcement and judicial services;
            ``(3) assist Indian tribes to identify services and 
        resources available to address mental illness and dysfunctional 
        and self-destructive behavior;
            ``(4) provide authority and opportunities for Indian tribes 
        to develop and implement, and coordinate with, community-based 
        programs which include identification, prevention, education, 
        referral, and treatment services, including through multi-
        disciplinary resource teams;
            ``(5) ensure that Indians, as citizens of the United States 
        and of the States in which they reside, have the same access to 
        behavioral health services to which all citizens have access; 
        and
            ``(6) modify or supplement existing programs and 
        authorities in the areas identified in paragraph (2).
    ``(b) Behavioral Health Planning.--
            ``(1) Area-wide plans.--The Secretary, acting through the 
        Service, Indian tribes, tribal organizations, and urban Indian 
        organizations, shall encourage Indian tribes and tribal 
        organizations to develop tribal plans, encourage urban Indian 
        organizations to develop local plans, and encourage all such 
        groups to participate in developing area-wide plans for Indian 
        Behavioral Health Services. The plans shall, to the extent 
        feasible, include--
                    ``(A) an assessment of the scope of the problem of 
                alcohol or other substance abuse, mental illness, 
                dysfunctional and self-destructive behavior, including 
                suicide, child abuse and family violence, among 
                Indians, including--
                            ``(i) the number of Indians served who are 
                        directly or indirectly affected by such illness 
                        or behavior; and
                            ``(ii) an estimate of the financial and 
                        human cost attributable to such illness or 
                        behavior;
                    ``(B) an assessment of the existing and additional 
                resources necessary for the prevention and treatment of 
                such illness and behavior, including an assessment of 
                the progress toward achieving the availability of the 
                full continuum of care described in subsection (c); and
                    ``(C) an estimate of the additional funding needed 
                by the Service, Indian tribes, tribal organizations and 
                urban Indian organizations to meet their 
                responsibilities under the plans.
            ``(2) National clearinghouse.--The Secretary shall 
        establish a national clearinghouse of plans and reports on the 
        outcomes of such plans developed under this section by Indian 
        tribes, tribal organizations and by areas relating to 
        behavioral health. The Secretary shall ensure access to such 
        plans and outcomes by any Indian tribe, tribal organization, 
        urban Indian organization or the Service.
            ``(3) Technical assistance.--The Secretary shall provide 
        technical assistance to Indian tribes, tribal organizations, 
        and urban Indian organizations in preparation of plans under 
        this section and in developing standards of care that may be 
        utilized and adopted locally.
    ``(c) Continuum of Care.--The Secretary, acting through the 
Service, Indian tribes and tribal organizations, shall provide, to the 
extent feasible and to the extent that funding is available, for the 
implementation of programs including--
            ``(1) a comprehensive continuum of behavioral health care 
        that provides for--
                    ``(A) community based prevention, intervention, 
                outpatient and behavioral health aftercare;
                    ``(B) detoxification (social and medical);
                    ``(C) acute hospitalization;
                    ``(D) intensive outpatient or day treatment;
                    ``(E) residential treatment;
                    ``(F) transitional living for those needing a 
                temporary stable living environment that is supportive 
                of treatment or recovery goals;
                    ``(G) emergency shelter;
                    ``(H) intensive case management;
                    ``(I) traditional health care practices; and
                    ``(J) diagnostic services, including the 
                utilization of neurological assessment technology; and
            ``(2) behavioral health services for particular 
        populations, including--
                    ``(A) for persons from birth through age 17, child 
                behavioral health services, that include--
                            ``(i) pre-school and school age fetal 
                        alcohol disorder services, including assessment 
                        and behavioral intervention);
                            ``(ii) mental health or substance abuse 
                        services (emotional, organic, alcohol, drug, 
                        inhalant and tobacco);
                            ``(iii) services for co-occurring disorders 
                        (multiple diagnosis);
                            ``(iv) prevention services that are focused 
                        on individuals ages 5 years through 10 years 
                        (alcohol, drug, inhalant and tobacco);
                            ``(v) early intervention, treatment and 
                        aftercare services that are focused on 
                        individuals ages 11 years through 17 years;
                            ``(vi) healthy choices or life style 
                        services (related to STD's, domestic violence, 
                        sexual abuse, suicide, teen pregnancy, obesity, 
                        and other risk or safety issues);
                            ``(vii) co-morbidity services;
                    ``(B) for persons ages 18 years through 55 years, 
                adult behavioral health services that include--
                            ``(i) early intervention, treatment and 
                        aftercare services;
                            ``(ii) mental health and substance abuse 
                        services (emotional, alcohol, drug, inhalant 
                        and tobacco);
                            ``(iii) services for co-occurring disorders 
                        (dual diagnosis) and co-morbidity;
                            ``(iv) healthy choices and life style 
                        services (related to parenting, partners, 
                        domestic violence, sexual abuse, suicide, 
                        obesity, and other risk related behavior);
                            ``(v) female specific treatment services 
                        for--
                                    ``(I) women at risk of giving birth 
                                to a child with a fetal alcohol 
                                disorder;
                                    ``(II) substance abuse requiring 
                                gender specific services;
                                    ``(III) sexual assault and domestic 
                                violence; and
                                    ``(IV) healthy choices and life 
                                style (parenting, partners, obesity, 
                                suicide and other related behavioral 
                                risk); and
                            ``(vi) male specific treatment services 
                        for--
                                    ``(I) substance abuse requiring 
                                gender specific services;
                                    ``(II) sexual assault and domestic 
                                violence; and
                                    ``(III) healthy choices and life 
                                style (parenting, partners, 
obesity, suicide and other risk related behavior);
                    ``(C) family behavioral health services, 
                including--
                            ``(i) early intervention, treatment and 
                        aftercare for affected families;
                            ``(ii) treatment for sexual assault and 
                        domestic violence; and
                            ``(iii) healthy choices and life style 
                        (related to parenting, partners, domestic 
                        violence and other abuse issues);
                    ``(D) for persons age 56 years and older, elder 
                behavioral health services including--
                            ``(i) early intervention, treatment and 
                        aftercare services that include--
                                    ``(I) mental health and substance 
                                abuse services (emotional, alcohol, 
                                drug, inhalant and tobacco);
                                    ``(II) services for co-occurring 
                                disorders (dual diagnosis) and co-
                                morbidity; and
                                    ``(III) healthy choices and life 
                                style services (managing conditions 
                                related to aging);
                            ``(ii) elder women specific services that 
                        include--
                                    ``(I) treatment for substance abuse 
                                requiring gender specific services and
                                    ``(II) treatment for sexual 
                                assault, domestic violence and neglect;
                            ``(iii) elder men specific services that 
                        include--
                                    ``(I) treatment for substance abuse 
                                requiring gender specific services; and
                                    ``(II) treatment for sexual 
                                assault, domestic violence and neglect; 
                                and
                            ``(iv) services for dementia regardless of 
                        cause.
    ``(d) Community Behavioral Health Plan.--
            ``(1) In general.--The governing body of any Indian tribe 
        or tribal organization or urban Indian organization may, at its 
        discretion, adopt a resolution for the establishment of a 
        community behavioral health plan providing for the 
        identification and coordination of available resources and 
        programs to identify, prevent, or treat alcohol and other 
        substance abuse, mental illness or dysfunctional and self-
        destructive behavior, including child abuse and family 
        violence, among its members or its service population. Such 
        plan should include behavioral health services, social 
        services, intensive outpatient services, and continuing after 
        care.
            ``(2) Technical assistance.--In furtherance of a plan 
        established pursuant to paragraph (1) and at the request of a 
        tribe, the appropriate agency, service unit, or other officials 
        of the Bureau of Indian Affairs and the Service shall cooperate 
        with, and provide technical assistance to, the Indian tribe or 
        tribal organization in the development of a plan under 
        paragraph (1). Upon the establishment of such a plan and at the 
        request of the Indian tribe or tribal organization, such 
        officials shall cooperate with the Indian tribe or tribal 
        organization in the implementation of such plan.
            ``(3) Funding.--The Secretary, acting through the Service, 
        may make funding available to Indian tribes and tribal 
        organizations adopting a resolution pursuant to paragraph (1) 
        to obtain technical assistance for the development of a 
        community behavioral health plan and to provide administrative 
        support in the implementation of such plan.
    ``(e) Coordinated Planning.--The Secretary, acting through the 
Service, Indian tribes, tribal organizations, and urban Indian 
organizations shall coordinate behavioral health planning, to the 
extent feasible, with other Federal and State agencies, to ensure that 
comprehensive behavioral health services are available to Indians 
without regard to their place of residence.
    ``(f) Facilities Assessment.--Not later than 1 year after the date 
of enactment of this Act, the Secretary, acting through the Service, 
shall make an assessment of the need for inpatient mental health care 
among Indians and the availability and cost of inpatient mental health 
facilities which can meet such need. In making such assessment, the 
Secretary shall consider the possible conversion of existing, under-
utilized service hospital beds into psychiatric units to meet such 
need.

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

    ``(a) In General.--Not later than 1 year after the date of 
enactment of this Act, the Secretary and the Secretary of the Interior 
shall develop and enter into a memorandum of agreement, or review and 
update any existing memoranda of agreement as required under section 
4205 of the Indian Alcohol and Substance Abuse Prevention  and 
Treatment Act of 1986 (25 U.S.C. 2411), and under which the Secretaries 
address--
            ``(1) the scope and nature of mental illness and 
        dysfunctional and self-destructive behavior, including child 
        abuse and family violence, among Indians;
            ``(2) the existing Federal, tribal, State, local, and 
        private services, resources, and programs available to provide 
        mental health services for Indians;
            ``(3) the unmet need for additional services, resources, 
        and programs necessary to meet the needs identified pursuant to 
        paragraph (1);
            ``(4)(A) the right of Indians, as citizens of the United 
        States and of the States in which they reside, to have access 
        to mental health services to which all citizens have access;
            ``(B) the right of Indians to participate in, and receive 
        the benefit of, such services; and
            ``(C) the actions necessary to protect the exercise of such 
        right;
            ``(5) the responsibilities of the Bureau of Indian Affairs 
        and the Service, including mental health identification, 
        prevention, education, referral, and treatment services 
        (including services through multidisciplinary resource teams), 
        at the central, area, and agency and service unit levels to 
        address the problems identified in paragraph (1);
            ``(6) a strategy for the comprehensive coordination of the 
        mental health services provided by the Bureau of Indian Affairs 
        and the Service to meet the needs identified pursuant to 
        paragraph (1), including--
                    ``(A) the coordination of alcohol and substance 
                abuse programs of the Service, the Bureau of Indian 
                Affairs, and the various Indian tribes (developed under 
                the Indian Alcohol and Substance Abuse Prevention and 
                Treatment Act of 1986) with the mental health 
                initiatives pursuant to this Act, particularly with 
                respect to the referral and treatment of dually-
                diagnosed individuals requiring mental health and 
                substance abuse treatment; and
                    ``(B) ensuring that Bureau of Indian Affairs and 
                Service programs and services (including 
                multidisciplinary resource teams) addressing child 
                abuse and family violence are coordinated with such 
                non-Federal programs and services;
            ``(7) direct appropriate officials of the Bureau of Indian 
        Affairs and the Service, particularly at the agency and service 
unit levels, to cooperate fully with tribal requests made pursuant to 
community behavioral health plans adopted under section 701(c) and 
section 4206 of the Indian Alcohol and Substance Abuse Prevention and 
Treatment Act of 1986 (25 U.S.C. 2412); and
            ``(8) provide for an annual review of such agreement by the 
        2 Secretaries and a report which shall be submitted to Congress 
        and made available to the Indian tribes.
    ``(b) Specific Provisions.--The memorandum of agreement updated or 
entered into pursuant to subsection (a) shall include specific 
provisions pursuant to which the Service shall assume responsibility 
for--
            ``(1) the determination of the scope of the problem of 
        alcohol and substance abuse among Indian people, including the 
        number of Indians within the jurisdiction of the Service who 
        are directly or indirectly affected by alcohol and substance 
        abuse and the financial and human cost;
            ``(2) an assessment of the existing and needed resources 
        necessary for the prevention of alcohol and substance abuse and 
        the treatment of Indians affected by alcohol and substance 
        abuse; and
            ``(3) an estimate of the funding necessary to adequately 
        support a program of prevention of alcohol and substance abuse 
        and treatment of Indians affected by alcohol and substance 
        abuse.
    ``(c) Consultation.--The Secretary and the Secretary of the 
Interior shall, in developing the memorandum of agreement under 
subsection (a), consult with and solicit the comments of--
            ``(1) Indian tribes and tribal organizations;
            ``(2) Indian individuals;
            ``(3) urban Indian organizations and other Indian 
        organizations;
            ``(4) behavioral health service providers.
    ``(d) Publication.--The memorandum of agreement under subsection 
(a) shall be published in the Federal Register. At the same time as the 
publication of such agreement in the Federal Register, the Secretary 
shall provide a copy of such memorandum to each Indian tribe, tribal 
organization, and urban Indian organization.

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

    ``(a) Establishment.--
            ``(1) In general.--The Secretary, acting through the 
        Service, Indian tribes and tribal organizations consistent with 
        section 701, shall provide a program of comprehensive 
behavioral health prevention and treatment and aftercare, including 
systems of care and traditional health care practices, which shall 
include--
                    ``(A) prevention, through educational intervention, 
                in Indian communities;
                    ``(B) acute detoxification or psychiatric 
                hospitalization and treatment (residential and 
                intensive outpatient);
                    ``(C) community-based rehabilitation and aftercare;
                    ``(D) community education and involvement, 
                including extensive training of health care, 
                educational, and community-based personnel;
                    ``(E) specialized residential treatment programs 
                for high risk populations including pregnant and post 
                partum women and their children;
                    ``(F) diagnostic services utilizing, when 
                appropriate, neuropsychiatric assessments which include 
                the use of the most advances technology available; and
                    ``(G) a telepsychiatry program that uses experts in 
                the field of pediatric psychiatry, and that 
                incorporates assessment, diagnosis and treatment for 
                children, including those children with concurrent 
                neurological disorders.
            ``(2) Target populations.--The target population of the 
        program under paragraph (1) shall be members of Indian tribes. 
        Efforts to train and educate key members of the Indian 
        community shall target employees of health, education, 
        judicial, law enforcement, legal, and social service programs.
    ``(b) Contract Health Services.--
            ``(1) In general.--The Secretary, acting through the 
        Service (with the consent of the Indian tribe to be served), 
        Indian tribes and tribal organizations, may enter into 
        contracts with public or private providers of behavioral health 
        treatment services for the purpose of carrying out the program 
        required under subsection (a).
            ``(2) Provision of assistance.--In carrying out this 
        subsection, the Secretary shall provide assistance to Indian 
        tribes and tribal organizations to develop criteria for the 
        certification of behavioral health service providers and 
        accreditation of service facilities which meet minimum 
        standards for such services and facilities.

``SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.

    ``(a) In General.--Under the authority of the Act of November 2, 
1921 (25 U.S.C. 13) (commonly known as the Snyder Act), the Secretary 
shall establish and maintain a Mental Health Technician program within 
the Service which--
            ``(1) provides for the training of Indians as mental health 
        technicians; and
            ``(2) employs such technicians in the provision of 
        community-based mental health care that includes 
        identification, prevention, education, referral, and treatment 
        services.
    ``(b) Training.--In carrying out subsection (a)(1), the Secretary 
shall provide high standard paraprofessional training in mental health 
care necessary to provide quality care to the Indian communities to be 
served. Such training shall be based upon a curriculum developed or 
approved by the Secretary which combines education in the theory of 
mental health care with supervised practical experience in the 
provision of such care.
    ``(c) Supervision and Evaluation.--The Secretary shall supervise 
and evaluate the mental health technicians in the training program 
under this section.
    ``(d) Traditional Care.--The Secretary shall ensure that the 
program established pursuant to this section involves the utilization 
and promotion of the traditional Indian health care and treatment 
practices of the Indian tribes to be served.

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

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

``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

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

``SEC. 707. INDIAN YOUTH PROGRAM.

    ``(a) Detoxification and Rehabilitation.--The Secretary shall, 
consistent with section 701, develop and implement a program for acute 
detoxification and treatment for Indian youth that includes behavioral 
health services. The program shall include regional treatment centers 
designed to include detoxification and rehabilitation for both sexes on 
a referral basis and programs developed and implemented by Indian 
tribes or tribal organizations at the local level under the Indian 
Self-Determination and Education Assistance Act. Regional centers shall 
be integrated with the intake and rehabilitation programs based in the 
referring Indian community.
    ``(b) Alcohol and Substance Abuse Treatment Centers or 
Facilities.--
            ``(1) Establishment.--
                    ``(A) In general.--The Secretary, acting through 
                the Service, Indian tribes, or tribal organizations, 
                shall construct, renovate, or, as necessary, purchase, 
                and appropriately staff and operate, at least 1 youth 
                regional treatment center or treatment network in each 
                area under the jurisdiction of an area office.
                    ``(B) Area office in california.--For purposes of 
                this subsection, the area office in California shall be 
                considered to be 2 area offices, 1 office whose 
                jurisdiction shall be considered to encompass the 
                northern area of the State of California, and 1 office 
                whose jurisdiction shall be considered to encompass the 
                remainder of the State of California for the purpose of 
                implementing California treatment networks.
            ``(2) Funding.--For the purpose of staffing and operating 
        centers or facilities under this subsection, funding shall be 
        made available pursuant to the Act of November 2, 1921 (25 
        U.S.C. 13) (commonly known as the Snyder Act).
            ``(3) Location.--A youth treatment center constructed or 
        purchased under this subsection shall be constructed or 
        purchased at a location within the area described in paragraph 
        (1) that is agreed upon (by appropriate tribal resolution) by a 
        majority of the tribes to be served by such center.
            ``(4) Specific provision of funds.--
                    ``(A) In general.--Notwithstanding any other 
                provision of this title, the Secretary may, from 
                amounts authorized to be appropriated for the purposes 
                of carrying out this section, make funds available to--
                            ``(i) the Tanana Chiefs Conference, 
                        Incorporated, for the purpose of leasing, 
                        constructing, renovating, operating and 
                        maintaining a residential youth treatment 
                        facility in Fairbanks, Alaska;
                            ``(ii) the Southeast Alaska Regional Health 
                        Corporation to staff and operate a residential 
                        youth treatment facility without regard to the 
                        proviso set forth in section 4(l) of the Indian 
                        Self-Determination and Education Assistance Act 
                        (25 U.S.C. 450b(l));
                            ``(iii) the Southern Indian Health Council, 
                        for the purpose of staffing, operating, and 
                        maintaining a residential youth treatment 
                        facility in San Diego County, California; and
                            ``(iv) the Navajo Nation, for the staffing, 
                        operation, and maintenance of the Four Corners 
                        Regional Adolescent Treatment Center, a 
                        residential youth treatment facility in New 
                        Mexico.
                    ``(B) Provision of services to eligible youth.--
                Until additional residential youth treatment facilities 
                are established in Alaska pursuant to this section, the 
                facilities specified in subparagraph (A) shall make 
                every effort to provide services to all eligible Indian 
                youth residing in such State.
    ``(c) Intermediate Adolescent Behavioral Health Services.--
            ``(1) In general.--The Secretary, acting through the 
        Service, Indian tribes and tribal organizations, may provide 
        intermediate behavioral health services, which may incorporate 
        traditional health care practices, to Indian children and 
        adolescents, including--
                    ``(A) pre-treatment assistance;
                    ``(B) inpatient, outpatient, and after-care 
                services;
                    ``(C) emergency care;
                    ``(D) suicide prevention and crisis intervention; 
                and
                    ``(E) prevention and treatment of mental illness, 
                and dysfunctional and self-destructive behavior, 
                including child abuse and family violence.
            ``(2) Use of funds.--Funds provided under this subsection 
        may be used--
                    ``(A) to construct or renovate an existing health 
                facility to provide intermediate behavioral health 
                services;
                    ``(B) to hire behavioral health professionals;
                    ``(C) to staff, operate, and maintain an 
                intermediate mental health facility, group home, sober 
                housing, transitional housing or similar facilities, or 
                youth shelter where intermediate behavioral health 
                services are being provided; and
                    ``(D) to make renovations and hire appropriate 
                staff to convert existing hospital beds into adolescent 
                psychiatric units; and
                    ``(E) to provide intensive home- and community-
                based services, including collaborative systems of 
                care.
            ``(3) Criteria.--The Secretary shall, in consultation with 
        Indian tribes and tribal organizations, establish criteria for 
        the review and approval of  applications or proposals for 
funding made available pursuant to this subsection.
    ``(d) Federally Owned Structures.--
            ``(1) In general.--The Secretary, acting through the 
        Service, shall, in consultation with Indian tribes and tribal 
        organizations--
                    ``(A) identify and use, where appropriate, 
                federally owned structures suitable for local 
                residential or regional behavioral health treatment for 
                Indian youth; and
                    ``(B) establish guidelines, in consultation with 
                Indian tribes and tribal organizations, for determining 
                the suitability of any such Federally owned structure 
                to be used for local residential or regional behavioral 
                health treatment for Indian youth.
            ``(2) Terms and conditions for use of structure.--Any 
        structure described in paragraph (1) may be used under such 
        terms and conditions as may be agreed upon by the Secretary and 
        the agency having responsibility for the structure and any 
        Indian tribe or tribal organization operating the program.
    ``(e) Rehabilitation and Aftercare Services.--
            ``(1) In general.--The Secretary, an Indian tribe or tribal 
        organization, in cooperation with the Secretary of the 
        Interior, shall develop and implement within each service unit, 
        community-based rehabilitation and follow-up services for 
        Indian youth who have significant behavioral health problems, 
        and require long-term treatment, community reintegration, and 
        monitoring to support the Indian youth after their return to 
        their home community.
            ``(2) Administration.--Services under paragraph (1) shall 
        be administered within each service unit or tribal program by 
        trained staff within the community who can assist the Indian 
        youth in continuing development of self-image, positive 
        problem-solving skills, and nonalcohol or substance abusing 
        behaviors. Such staff may include alcohol and substance abuse 
        counselors, mental health professionals, and other health 
        professionals and paraprofessionals, including community health 
        representatives.
    ``(f) Inclusion of Family in Youth Treatment Program.--In providing 
the treatment and other services to Indian youth authorized by this 
section, the Secretary, an Indian tribe or tribal organization shall 
provide for the inclusion of family members of such youth in the 
treatment programs or other services as may be appropriate. Not less 
than 10 percent of the funds appropriated for the purposes of carrying 
out subsection (e) shall be used for outpatient care of adult family 
members related to the treatment of an Indian youth under that 
subsection.
    ``(g) Multidrug Abuse Program.--The Secretary, acting through the 
Service, Indian tribes, tribal organizations and urban Indian 
organizations, shall provide, consistent with section 701, programs and 
services to prevent and treat the abuse of multiple forms of 
substances, including alcohol, drugs, inhalants, and tobacco, among 
Indian youth residing in Indian communities, on Indian reservations, 
and in urban areas and provide appropriate mental health services to 
address the incidence of mental illness among such youth.

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

    ``(a) In General.--Not later than 1 year after the date of 
enactment of this section, the Secretary, acting through the Service, 
Indian tribes and tribal organizations, shall provide, in each area of 
the Service, not less than 1 inpatient mental health care facility, or 
the equivalent, for Indians with behavioral health problems.
    ``(b) Treatment of California.--For purposes of this section, 
California shall be considered to be 2 areas of the Service, 1 area 
whose location shall be considered to encompass the northern area of 
the State of California and 1 area whose jurisdiction shall be 
considered to encompass the remainder of the State of California.
    ``(c) Conversion of Certain Hospital Beds.--The Secretary shall 
consider the possible conversion of existing, under-utilized Service 
hospital beds into psychiatric units to meet needs under this section.

``SEC. 709. TRAINING AND COMMUNITY EDUCATION.

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

``SEC. 710. BEHAVIORAL HEALTH PROGRAM.

    ``(a) Programs for Innovative Services.--The Secretary, acting 
through the Service, Indian tribes or tribal organizations, consistent 
with Section 701, may develop, implement, and carry out programs to 
deliver innovative community-based behavioral health services to 
Indians.
    ``(b) Criteria.--The Secretary may award funding for a project 
under subsection (a) to an Indian tribe or tribal organization and may 
consider the following criteria:
            ``(1) Whether the project will address significant unmet 
        behavioral health needs among Indians.
            ``(2) Whether the project will serve a significant number 
        of Indians.
            ``(3) Whether the project has the potential to deliver 
        services in an efficient and effective manner.
            ``(4) Whether the tribe or tribal organization has the 
        administrative and financial capability to administer the 
        project.
            ``(5) Whether the project will deliver services in a manner 
        consistent with traditional health care.
            ``(6) Whether the project is coordinated with, and avoids 
        duplication of, existing services.
    ``(c) Funding Agreements.--For purposes of this subsection, the 
Secretary shall, in evaluating applications or proposals for funding 
for projects to be operated under any funding agreement entered into 
with the Service under the Indian Self-Determination Act and Education 
Assistance Act, use the same criteria that the Secretary uses in 
evaluating any other application or proposal for such funding.

``SEC. 711. FETAL ALCOHOL DISORDER FUNDING.

    ``(a) Establishment of Program.--
            ``(1) In general.--The Secretary, consistent with Section 
        701, acting through Indian tribes, tribal organizations, and 
        urban Indian organizations, shall establish and operate fetal 
        alcohol disorders programs as provided for in this section for 
        the purposes of meeting the health status objective specified 
        in section 3(b).
            ``(2) Use of funds.--Funding provided pursuant to this 
        section shall be used to--
                    ``(A) develop and provide community and in-school 
                training, education, and prevention programs relating 
                to fetal alcohol disorders;
                    ``(B) identify and provide behavioral health 
                treatment to high-risk women;
                    ``(C) identify and provide appropriate educational 
                and vocational support, counseling, advocacy, and 
                information to fetal alcohol disorder affected persons 
                and their families or caretakers;
                    ``(D) develop and implement counseling and support 
                programs in schools for fetal alcohol disorder affected 
                children;
                    ``(E) develop prevention and intervention models 
                which incorporate traditional practitioners, cultural 
                and spiritual values and community involvement;
                    ``(F) develop, print, and disseminate education and 
                prevention materials on fetal alcohol disorders;
                    ``(G) develop and implement, through the tribal 
                consultation process, culturally sensitive assessment 
                and diagnostic tools including dysmorphology clinics 
                and multidisciplinary fetal alcohol disorder clinics 
                for use in tribal and urban Indian communities;
                    ``(H) develop early childhood intervention projects 
                from birth on to mitigate the effects of fetal alcohol 
                disorders; and
                    ``(I) develop and fund community-based adult fetal 
                alcohol disorder housing and support services.
            ``(3) Criteria.--The Secretary shall establish criteria for 
        the review and approval of applications for funding under this 
        section.
    ``(b) Provision of Services.--The Secretary, acting through the 
Service, Indian tribes, tribal organizations and urban Indian 
organizations, shall--
            ``(1) develop and provide services for the prevention, 
        intervention, treatment, and aftercare for those affected by 
        fetal alcohol disorders in Indian communities; and
            ``(2) provide supportive services, directly or through an 
        Indian tribe, tribal organization or urban Indian organization, 
        including services to meet the special educational, vocational, 
        school-to-work transition, and independent living needs of 
        adolescent and adult Indians with fetal alcohol disorders.
    ``(c) Task Force.--
            ``(1) In general.--The Secretary shall establish a task 
        force to be known as the Fetal Alcohol Disorders Task Force to 
        advise the Secretary in carrying out subsection (b).
            ``(2) Composition.--The task force under paragraph (1) 
        shall be composed of representatives from the National 
        Institute on Drug Abuse, the National Institute on Alcohol and 
        Alcoholism, the Office of Substance Abuse Prevention, the 
        National Institute of Mental Health, the Service, the Office of 
        Minority Health of the Department of Health and Human Services, 
        the Administration for Native Americans, the National Institute 
        of Child Health & Human Development, the Centers for Disease 
        Control and Prevention, the Bureau of Indian Affairs, Indian 
        tribes, tribal organizations, urban Indian communities, and 
        Indian fetal alcohol disorders experts.
    ``(d) Applied Research.--The Secretary, acting through the 
Substance Abuse and Mental Health Services Administration, shall make 
funding available to Indian tribes, tribal organizations and urban 
Indian organizations for applied research projects which propose to 
elevate the understanding of methods to prevent, intervene, treat, or 
provide rehabilitation and behavioral health aftercare for Indians and 
urban Indians affected by fetal alcohol disorders.
    ``(e) Urban Indian Organizations.--The Secretary shall ensure that 
10 percent of the amounts appropriated to carry out this section shall 
be used to make grants to urban Indian organizations funded under title 
V.

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

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

``SEC. 713. BEHAVIORAL MENTAL HEALTH RESEARCH.

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

``SEC. 714. DEFINITIONS.

    ``In this title:
            ``(1) Assessment.--The term `assessment' means the 
        systematic collection, analysis and dissemination of 
        information on health status, health needs and health problems.
            ``(2) Alcohol related neurodevelopmental disorders.--The 
        term `alcohol related neurodevelopmental disorders' or `ARND' 
        with respect to an individual means the individual has a 
        history of maternal alcohol consumption during pregnancy, 
        central nervous system involvement such as developmental delay, 
        intellectual deficit, or neurologic abnormalities, that 
        behaviorally, there may be problems with irritability, and 
        failure to thrive as infants, and that as children become older 
        there will likely be hyperactivity, attention deficit, language 
        dysfunction and perceptual and judgment problems.
            ``(3) Behavioral health.--The term `behavioral health' 
        means the blending of substances (alcohol, drugs, inhalants and 
        tobacco) abuse and mental health prevention and treatment, for 
        the purpose of providing comprehensive services. Such term 
        includes the joint development of substance abuse and mental 
        health treatment planning and coordinated case management using 
        a multidisciplinary approach.
            ``(4) Behavioral health aftercare.--
                    ``(A) In general.--The term `behavioral health 
                aftercare' includes those activities and resources used 
                to support recovery following inpatient, residential, 
                intensive substance abuse or mental health outpatient 
                or outpatient treatment, to help prevent or treat 
                relapse, including the development of an aftercare 
                plan.
                    ``(B) Aftercare plan.--Prior to the time at which 
                an individual is discharged from a level of care, such 
                as outpatient treatment, an aftercare plan shall have 
                been developed for the individual. Such plan may use 
                such resources as community base therapeutic group 
                care, transitional living, a 12-step sponsor, a local 
                12-step or other related support group, or other 
                community based providers (such as mental health 
                professionals, traditional health care practitioners, 
                community health aides, community health 
                representatives, mental health technicians, or 
                ministers).
            ``(5) Dual diagnosis.--The term `dual diagnosis' means 
        coexisting substance abuse and mental illness conditions or 
        diagnosis. In individual with a dual diagnosis may be referred 
        to as a mentally ill chemical abuser.
            ``(6) Fetal alcohol disorders.--The term `fetal alcohol 
        disorders' means fetal alcohol syndrome, partial fetal alcohol 
        syndrome, or alcohol related neural developmental disorder.
            ``(7) Fetal alcohol syndrome.--The term `fetal alcohol 
        syndrome' or `FAS' with respect to an individual means a 
        syndrome in which the individual has a history of maternal 
        alcohol consumption during pregnancy, and with respect to which 
        the following criteria should be met:
                    ``(A) Central nervous system involvement such as 
                developmental delay, intellectual deficit, 
                microencephaly, or neurologic abnormalities.
                    ``(B) Craniofacial abnormalities with at least 2 of 
                the following: microphthalmia, short palpebral 
                fissures, poorly developed philtrum, thin upper lip, 
                flat nasal bridge, and short upturned nose.
                    ``(C) Prenatal or postnatal growth delay.
            ``(8) Partial fas.--The term `partial FAS' with respect to 
        an individual means a history of maternal alcohol consumption 
        during pregnancy having most of the criteria of FAS, though not 
        meeting a minimum of at least 2 of the following: micro-
        ophthalmia, short palpebral fissures, poorly developed 
        philtrum, thin upper lip, flat nasal bridge, short upturned 
        nose.
            ``(9) Rehabilitation.--The term `rehabilitation' means to 
        restore the ability or capacity to engage in usual and 
        customary life activities through education and therapy.
            ``(10) Substance abuse.--The term `substance abuse' 
        includes inhalant abuse.

``SEC. 715. AUTHORIZATION OF APPROPRIATIONS.

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

                      ``TITLE VIII--MISCELLANEOUS

``SEC. 801. REPORTS.

    ``The President shall, at the time the budget is submitted under 
section 1105 of title 31, United States Code, for each fiscal year 
transmit to the Congress a report containing--
            ``(1) a report on the progress made in meeting the 
        objectives of this Act, including a review of programs 
        established or assisted pursuant to this Act and an assessment 
        and recommendations of additional programs or additional 
        assistance necessary to, at a minimum, provide health services 
        to Indians, and ensure a health status for Indians, which are 
        at a parity with the health services available to and the 
        health status of, the general population, including specific 
        comparisons of appropriations provided and those required for 
        such parity;
            ``(2) a report on whether, and to what extent, new national 
        health care programs, benefits, initiatives, or financing 
        systems have had an impact on the purposes of this Act and any 
        steps that the Secretary may have taken to consult with Indian 
        tribes to address such impact, including a report on proposed 
        changes in the allocation of funding pursuant to section 808;
            ``(3) a report on the use of health services by Indians--
                    ``(A) on a national and area or other relevant 
                geographical basis;
                    ``(B) by gender and age;
                    ``(C) by source of payment and type of service;
                    ``(D) comparing such rates of use with rates of use 
                among comparable non-Indian populations; and
                    ``(E) on the services provided under funding 
                agreements pursuant to the Indian Self-Determination 
                and Education Assistance Act;
            ``(4) a report of contractors concerning health care 
        educational loan repayments under section 110;
            ``(5) a general audit report on the health care educational 
        loan repayment program as required under section 110(n);
            ``(6) a separate statement that specifies the amount of 
        funds requested to carry out the provisions of section 201;
            ``(7) a report on infectious diseases as required under 
        section 212;
            ``(8) a report on environmental and nuclear health hazards 
        as required under section 214;
            ``(9) a report on the status of all health care facilities 
        needs as required under sections 301(c)(2) and 301(d);
            ``(10) a report on safe water and sanitary waste disposal 
        facilities as required under section 302(h)(1);
            ``(11) a report on the expenditure of non-service funds for 
        renovation as required under sections 305(a)(2) and 305(a)(3);
            ``(12) a report identifying the backlog of maintenance and 
        repair required at Service and tribal facilities as required 
        under section 314(a);
            ``(13) a report providing an accounting of reimbursement 
        funds made available to the Secretary under titles XVIII and 
        XIX of the Social Security Act as required under section 
        403(a);
            ``(14) a report on services sharing of the Service, the 
        Department of Veteran's Affairs, and other Federal agency 
        health programs as required under section 412(c)(2);
            ``(15) a report on the evaluation and renewal of urban 
        Indian programs as required under section 505;
            ``(16) a report on the findings and conclusions derived 
        from the demonstration project as required under section 
        512(a)(2);
            ``(17) a report on the evaluation of programs as required 
        under section 513; and
            ``(18) a report on alcohol and substance abuse as required 
        under section 701(f).

``SEC. 802. REGULATIONS.

    ``(a) Initiation of Rulemaking Procedures.--
            ``(1) In general.--Not later than 90 days after the date of 
        enactment of this Act, the Secretary shall initiate procedures 
        under subchapter III of chapter 5 of title 5, United States 
        Code, to negotiate and promulgate such regulations or 
        amendments thereto that are necessary to carry out this Act.
            ``(2) Publication.--Proposed regulations to implement this 
        Act shall be published in the Federal Register by the Secretary 
        not later than 270 days after the date of enactment of this Act 
        and shall have not less than a 120 day comment period.
            ``(3) Expiration of authority.--The authority to promulgate 
        regulations under this Act shall expire 18 months from the date 
        of enactment of this Act.
    ``(b) Rulemaking Committee.--A negotiated rulemaking committee 
established pursuant to section 565 of title 5, United States Code, to 
carry out this section shall have as its members only representatives 
of the Federal Government and representatives of Indian tribes, and 
tribal organizations, a majority of whom shall be nominated by and be 
representatives of Indian tribes, tribal organizations, and urban 
Indian organizations from each service area.
    ``(c) Adaption of Procedures.--The Secretary shall adapt the 
negotiated rulemaking procedures to the unique context of self-
governance and the government-to-government relationship between the 
United States and Indian tribes.
    ``(d) Failure To Promulgate Regulations.--The lack of promulgated 
regulations shall not limit the effect of this Act.
    ``(e) Supremacy of Provisions.--The provisions of this Act shall 
supersede any conflicting provisions of law (including any conflicting 
regulations) in effect on the day before the date of enactment of the 
Indian Self-Determination Contract Reform Act of 1994, and the 
Secretary is authorized to repeal any regulation that is inconsistent 
with the provisions of this Act.

``SEC. 803. PLAN OF IMPLEMENTATION.

    ``Not later than 240 days after the date of enactment of this Act, 
the Secretary, in consultation with Indian tribes, tribal 
organizations, and urban Indian organizations, shall prepare and submit 
to Congress a plan that shall explain the manner and schedule 
(including a schedule of appropriate requests), by title and section, 
by which the Secretary will implement the provisions of this Act.

``SEC. 804. AVAILABILITY OF FUNDS.

    ``Amounts appropriated under this Act shall remain available until 
expended.

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

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

``SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.

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

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

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

``SEC. 808. REALLOCATION OF BASE RESOURCES.

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

``SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.

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

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

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

``SEC. 811. MORATORIUM.

    ``During the period of the moratorium imposed by Public Law 100-446 
on implementation of the final rule published in the Federal Register 
on September 16, 1987, by the Health Resources and Services 
Administration, relating to eligibility for the health care services of 
the Service, the Service shall provide services pursuant to the 
criteria for eligibility for such services that were in effect on 
September 15, 1987, subject to the provisions of sections 806 and 807 
until such time as new criteria governing eligibility for services are 
developed in accordance with section 802.

``SEC. 812. TRIBAL EMPLOYMENT.

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

``SEC. 813. PRIME VENDOR.

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

``SEC. 814. NATIONAL BI-PARTISAN COMMISSION ON INDIAN HEALTH CARE 
              ENTITLEMENT.

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

``SEC. 815. APPROPRIATIONS; AVAILABILITY.

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

``SEC. 816. AUTHORIZATION OF APPROPRIATIONS.

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

       TITLE II--CONFORMING AMENDMENTS TO THE SOCIAL SECURITY ACT

                          Subtitle A--Medicare

SEC. 201. LIMITATIONS ON CHARGES.

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

SEC. 202. QUALIFIED INDIAN HEALTH PROGRAM.

    Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by inserting after section 1880 the following:

                   ``qualified indian health program

    ``Sec. 1880A. (a) Definition of Qualified Indian Health Program.--
In this section:
            ``(1) In general.--The term `qualified Indian health 
        program' means a health program operated by--
                    ``(A) the Indian Health Service;
                    ``(B) an Indian tribe or tribal organization or an 
                urban Indian organization (as those terms are defined 
                in section 4 of the Indian Health Care Improvement Act) 
                and which is funded in whole or part by the Indian 
                Health Service under the Indian Self Determination and 
                Education Assistance Act; or
                    ``(C) an urban Indian organization (as so defined) 
                and which is funded in whole or in part under title V 
                of the Indian Health Care Improvement Act.
            ``(2) Included programs and entities.--Such term may 
        include 1 or more hospital, nursing home, home health program, 
        clinic, ambulance service or other health program that provides 
        a service for which payments may be made under this title and 
        which is covered in the cost report submitted under this title 
        or title XIX for the qualified Indian health program.
    ``(b) Eligibility for Payments.--A qualified Indian health program 
shall be eligible for payments under this title, notwithstanding 
sections 1814(c) and 1835(d), if and for so long as the program meets 
all the conditions and requirements set forth in this section.
    ``(c) Determination of Payments.--
            ``(1) In general.--Notwithstanding any other provision in 
        the law, a qualified Indian health program shall be entitled to 
        receive payment based on an all-inclusive rate which shall be 
        calculated to provide full cost recovery for the cost of 
        furnishing services provided under this section.
            ``(2) Definition of full cost recovery.--
                    ``(A) In general.--Subject to subparagraph (B), in 
                this section, the term `full cost recovery' means the 
                sum of--
                            ``(i) the direct costs, which are 
                        reasonable, adequate and related to the cost of 
                        furnishing such services, taking into account 
                        the unique nature, location, and service 
                        population of the qualified Indian health 
                        program, and which shall include direct 
                        program, administrative, and overhead costs, 
                        without regard to the customary or other charge 
                        or any fee schedule that would otherwise be 
                        applicable; and
                            ``(ii) indirect costs which, in the case of 
                        a qualified Indian health program--
                                    ``(I) for which an indirect cost 
                                rate (as that term is defined in 
                                section 4(g) of the Indian Self-
                                Determination and Education Assistance 
                                Act) has been established, shall be not 
                                less than an amount determined on the 
                                basis of the indirect cost rate; or
                                    ``(II) for which no such rate has 
                                been established, shall be not less 
                                than the administrative costs 
                                specifically associated with the 
                                delivery of the services being 
                                provided.
                    ``(B) Limitation.--Notwithstanding any other 
                provision of law, the amount determined to be payable 
                as full cost recovery may not be reduced for co-
                insurance, co-payments, or deductibles when the service 
                was provided to an Indian entitled under Federal law to 
                receive the service from the Indian Health Service, an 
                Indian tribe or tribal organization, or an urban Indian 
                organization or because of any limitations on payment 
                provided for in any managed care plan.
            ``(3) Outstationing costs.--In addition to full cost 
        recovery, a qualified Indian health program shall be entitled 
        to reasonable outstationing costs, which shall include all 
        administrative costs associated with outreach and acceptance of 
        eligibility applications for any Federal or State health 
        program including the programs established under this title, 
        title XIX, and XXI.
            ``(4) Determination of all-inclusive encounter or per diem 
        amount.--
                    ``(A) In general.--Costs identified for services 
                addressed in a cost report submitted by a qualified 
                Indian health program shall be used to determine an 
                all-inclusive encounter or per diem payment amount for 
                such services.
                    ``(B) No single report requirement.--Not all 
                qualified Indian health programs provided or 
                administered by the Indian Health Service, an Indian 
                tribe or tribal organization, or an urban Indian 
                organization need be combined into a single cost 
                report.
                    ``(C) Payment for items not covered by a cost 
                report.--A full cost recovery payment for services not 
                covered by a cost report shall be made on a fee-for-
                service, encounter, or per diem basis.
            ``(5) Optional determination.--The full cost recovery rate 
        provided for in paragraphs (1) through (3) may be determined, 
        at the election of the qualified Indian health program, by the 
        Health Care Financing Administration or by the State agency 
        responsible for administering the State plan under title XIX 
        and shall be valid for reimbursements made under this title, 
        title XIX, and title XXI. The costs described in paragraph 
        (2)(A) shall be calculated under whatever methodology yields 
        the greatest aggregate payment for the cost reporting period, 
        provided that such methodology shall be adjusted to include 
        adjustments to such payment to take into account for those 
        qualified Indian health programs that include hospitals--
                    ``(A) a significant decrease in discharges;
                    ``(B) costs for graduate medical education 
                programs;
                    ``(C) additional payment as a disproportionate 
                share hospital with a payment adjustment factor of 10; 
                and
                    ``(D) payment for outlier cases.
            ``(6) Election of payment.--A qualified Indian health 
        program may elect to receive payment for services provided 
        under this section--
                    ``(A) on the full cost recovery basis provided in 
                paragraphs (1) through (5);
                    ``(B) on the basis of the inpatient or outpatient 
                encounter rates established for Indian Health Service 
                facilities and published annually in the Federal 
                Register;
                    ``(C) on the same basis as other providers are 
                reimbursed under this title, provided that the amounts 
                determined under paragraph (c)(2)(B) shall be added to 
                any such amount;
                    ``(D) on the basis of any other rate or methodology 
                applicable to the Indian Health Service or an Indian 
                tribe or tribal organization; or
                    ``(E) on the basis of any rate or methodology 
                negotiated with the agency responsible for making 
                payment.
    ``(d) Election of Reimbursement for Other Services.--
            ``(1) In general.--A qualified Indian health program may 
        elect to be reimbursed for any service the Indian Health 
        Service, an Indian tribe or tribal organization, or an urban 
        Indian organization may be reimbursed for under section 1880 
        and section 1911.
            ``(2) Option to include additional services.--An election 
        under paragraph (1) may include, at the election of the 
        qualified Indian health program--
                    ``(A) any service when furnished by an employee of 
                the qualified Indian health program who is licensed or 
                certified to perform such a service to the same extent 
                that such service would be reimbursable if performed by 
                a physician and any service or supplies furnished as 
                incident to a physician's service as would otherwise be 
                covered if furnished by a physician or as an incident 
                to a physician's service;
                    ``(B) screening, diagnostic, and therapeutic 
                outpatient services including part-time or intermittent 
                screening, diagnostic, and therapeutic skilled nursing 
                care and related medical supplies (other than drugs and 
                biologicals), furnished by an employee of the qualified 
                Indian health program who is licensed or certified to 
                perform such a service for an individual in the 
                individual's home or in a community health setting 
                under a written plan of treatment established and 
                periodically reviewed by a physician, when furnished to 
                an individual as an outpatient of a qualified Indian 
                health program;
                    ``(C) preventive primary health services as 
                described under section 330 of the Public Health 
                Service Act, when provided by an employee of the 
                qualified Indian health program who is licensed or 
                certified to perform such a service, regardless of the 
                location in which the service is provided;
                    ``(D) with respect to services for children, all 
                services specified as part of the State plan under 
                title XIX, the State child health plan under title XXI, 
                and early and periodic screening, diagnostic, and 
                treatment services as described in section 1905(r);
                    ``(E) influenza and pneumococcal immunizations;
                    ``(F) other immunizations for prevention of 
                communicable diseases when targeted; and
                    ``(G) the cost of transportation for providers or 
                patients necessary to facilitate access for 
                patients.''.

                          Subtitle B--Medicaid

SEC. 211. STATE CONSULTATION WITH INDIAN HEALTH PROGRAMS.

    Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is 
amended--
            (1) in paragraph (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:
            ``(66) if the Indian Health Service operates or funds 
        health programs in the State or if there are Indian tribes or 
        tribal organizations or urban Indian organizations (as those 
        terms are defined in Section 4 of the Indian Health Care 
        Improvement Act) present in the State, provide for meaningful 
        consultation with such entities prior to the submission of, and 
        as a precondition of approval of, any proposed amendment, 
        waiver, demonstration project, or other request that would have 
        the effect of changing any aspect of the State's administration 
        of the State plan under this title, so long as--
                    ``(A) the term `meaningful consultation' is defined 
                through the negotiated rulemaking  process provided for 
under section 802 of the Indian Health Care Improvement Act; and
                    ``(B) such consultation is carried out in 
                collaboration with the Indian Medicaid Advisory 
                Committee established under section 415(a)(3) of that 
                Act.''.

SEC. 212. FMAP FOR SERVICES PROVIDED BY INDIAN HEALTH PROGRAMS.

    The third sentence of Section 1905(b) of the Social Security Act 
(42 U.S.C. 1396d(b)) is amended to read as follows:
``Notwithstanding the first sentence of this section, the Federal 
medical assistance percentage shall be 100 per cent with respect to 
amounts expended as medical assistance for services which are received 
through the Indian Health Service, an Indian tribe or tribal 
organization, or an urban Indian organization (as defined in section 4 
of the Indian Health Care Improvement Act) under section 1911, whether 
directly, by referral, or under contracts or other arrangements between 
the Indian Health Service, Indian tribe or tribal organization, or 
urban Indian organization and another health provider.''.

SEC. 213. INDIAN HEALTH SERVICE PROGRAMS.

    Section 1911 of the Social Security Act (42 U.S.C. 1396j) is 
amended to read as follows:

                    ``indian health service programs

    ``Sec. 1911. (a) In General.--The Indian Health Service, an Indian 
tribe or tribal organization, or an urban Indian organization (as those 
terms are defined in section 4 of the Indian Health Care Improvement 
Act), shall be eligible for reimbursement for medical assistance 
provided under a State plan by such entities if and for so long as the 
Service, Indian tribe or tribal organization, or urban Indian 
organization provides services or provider types of a type otherwise 
covered under the State plan and meets the conditions and requirements 
which are applicable generally to the service for which it seeks 
reimbursement under this title and for services provided by a qualified 
Indian health program under section 1880A.
    ``(b) Period for Billing.--Notwithstanding subsection (a), if the 
Indian Health Service, an Indian tribe or tribal organization, or an 
urban Indian organization which provides services of a type otherwise 
covered under the State plan does not meet all of the conditions and 
requirements of this title which are applicable generally to such 
services submits to the Secretary within 6 months after the date on 
which such reimbursement is first sought an acceptable plan for 
achieving compliance with such conditions and requirements, the 
Service, an Indian tribe or tribal organization, or urban Indian 
organization shall be deemed to meet such conditions and requirements 
(and to be eligible for reimbursement under this title), without regard 
to the extent of actual compliance with such conditions and 
requirements during the first 12 months after the month in which such 
plan is submitted.
    ``(c) Authority To Enter Into Agreements.--The Secretary may enter 
into agreements with the State agency for the purpose of reimbursing 
such agency for health care and services provided by the Indian Health 
Service, Indian tribes or tribal organizations, or urban Indian 
organizations, directly, through referral, or under contracts or other 
arrangements between the Indian Health Service, an Indian tribe or 
tribal organization, or an urban Indian organization and another health 
care provider to Indians who are eligible for medical assistance under 
the State plan.''.

         Subtitle C--State Children's Health Insurance Program

SEC. 221. ENHANCED FMAP FOR STATE CHILDREN'S HEALTH INSURANCE PROGRAM.

    (a) In General.--Section 2105(b) of the Social Security Act (42 
U.S.C. 1397ee(b)) is amended--
            (1) by striking ``For purposes'' and inserting the 
        following:
            ``(1) In general.--Subject to paragraph (2), for 
        purposes''; and
            (2) by adding at the end the following:
            ``(2) Services provided by indian programs.--Without regard 
        to which option a State chooses under section 2101(a), the 
        `enhanced FMAP' for a State for a fiscal year shall be 100 per 
        cent with respect to expenditures for child health assistance 
        for services provided through a health program operated by the 
        Indian Health Service, an Indian tribe or tribal organization, 
        or an urban Indian organization (as such terms are defined in 
        section 4 of the Indian Health Care Improvement Act).''.
    (b) Conforming Amendment.--Section 2105(c)(6)(B) of such Act (42 
U.S.C. 1397ee(c)(6)(B)) is amended by inserting ``an Indian tribe or 
tribal organization, or an urban Indian organization (as such terms are 
defined in section 4 of the Indian Health Care Improvement Act),'' 
after ``Service,''.

SEC. 222. DIRECT FUNDING OF STATE CHILDREN'S HEALTH INSURANCE PROGRAM.

    Title XXI of Social Security Act (42 U.S.C. 1397aa et seq.) is 
amended by adding at the end the following:

``SEC. 2111. DIRECT FUNDING OF INDIAN HEALTH PROGRAMS.

    ``(a) In General.--The Secretary may enter into agreements directly 
with the Indian Health Service, an Indian tribe or tribal organization, 
or an urban Indian organization (as such terms are defined in section 4 
of the Indian Health Care Improvement Act) for such entities to provide 
child health assistance to Indians who reside in a service area on or 
near an Indian reservation. Such agreements may provide for funding 
under a block grant or such other mechanism as is agreed upon by the 
Secretary and the Indian Health Service, Indian tribe or tribal 
organization, or urban Indian organization. Such agreements may not be 
made contingent on the approval of the State in which the Indians to be 
served reside.
    ``(b) Transfer of Funds.--Notwithstanding any other provision of 
law, a State may transfer funds to which it is, or would otherwise be, 
entitled to under this title to the Indian Health Service, an Indian 
tribe or tribal organization or an urban Indian organization--
            ``(1) to be administered by such entity to achieve the 
        purposes and objectives of this title under an agreement 
        between the State and the entity; or
            ``(2) under an agreement entered into under subsection (a) 
        between the entity and the Secretary.''.

              Subtitle D--Authorization of Appropriations

SEC. 231. AUTHORIZATION OF APPROPRIATIONS.

    There is authorized to be appropriated such sums as may be 
necessary for each of fiscal years 2004 through 2015 to carry out this 
title and the amendments by this title.

                  TITLE III--MISCELLANEOUS PROVISIONS

SEC. 301. REPEALS.

    The following are repealed:
            (1) Section 506 of Public Law 101-630 (25 U.S.C. 1653 note) 
        is repealed.
            (2) Section 712 of the Indian Health Care Amendments of 
        1988 is repealed.

SEC. 302. SEVERABILITY PROVISIONS.

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

SEC. 303. EFFECTIVE DATE.

    This Act and the amendments made by this Act take effect on October 
1, 2003.
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