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






                                                       Calendar No. 802
108th CONGRESS
  2d Session
                                 S. 556

                          [Report No. 108-411]

 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, Mr. McCain, Mr. Johnson, Mrs. 
 Murray, Mr. Daschle, Mr. Bingaman, Mr. Dorgan, Ms. Murkowski, and Ms. 
   Cantwell) introduced the following bill; which was read twice and 
              referred to the Committee on Indian Affairs

                           November 16, 2004

              Reported by Mr. Campbell, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 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,

<DELETED>SECTION 1. SHORT TITLE; TABLE OF CONTENTS.</DELETED>

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

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

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

                     <DELETED>Subtitle A--Medicare

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

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

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

<DELETED>Sec. 231. Authorization of appropriations.
              <DELETED>TITLE III--MISCELLANEOUS PROVISIONS

<DELETED>Sec. 301. Repeals.
<DELETED>Sec. 302. Severability provisions.
<DELETED>Sec. 303. Effective date.

 <DELETED>TITLE I--REAUTHORIZATION AND REVISIONS OF THE INDIAN HEALTH 
                     CARE IMPROVEMENT ACT</DELETED>

<DELETED>SEC. 101. AMENDMENT TO THE INDIAN HEALTH CARE IMPROVEMENT 
              ACT.</DELETED>

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

<DELETED>``SECTION 1. SHORT TITLE; TABLE OF CONTENTS.</DELETED>

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

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

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

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

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

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

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

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

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

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

<DELETED>``SEC. 2. FINDINGS.</DELETED>

<DELETED>    ``Congress makes the following findings:</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 3. DECLARATION OF HEALTH OBJECTIVES.</DELETED>

<DELETED>    ``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--</DELETED>
        <DELETED>    ``(1) to assure the highest possible health status 
        for Indians and to provide all resources necessary to effect 
        that policy;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 4. DEFINITIONS.</DELETED>

<DELETED>    ``In this Act:</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) Assistant secretary.--The term `Assistant 
        Secretary' means the Assistant Secretary of the Indian Health 
        as established under section 601.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(5) Department.--The term `Department', unless 
        specifically provided otherwise, means the Department of Health 
        and Human Services.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(10) Indian.--The term `Indian' and `Indians' 
        shall have meanings given such terms for purposes of the Indian 
        Self-Determination and Education Assistance Act.</DELETED>
        <DELETED>    ``(11) Indian health program.--The term `Indian 
        health program' shall have the meaning given such term in 
        section 110(a)(2)(A).</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(14) Secretary.--The term `Secretary', unless 
        specifically provided otherwise, means the Secretary of Health 
        and Human Services.</DELETED>
        <DELETED>    ``(15) Service.--The term `Service' means the 
        Indian Health Service.</DELETED>
        <DELETED>    ``(16) Service area.--The term `service area' 
        means the geographical area served by each area 
        office.</DELETED>
        <DELETED>    ``(17) Service unit.--The term `service unit' 
        means--</DELETED>
                <DELETED>    ``(A) an administrative entity within the 
                Indian Health Service; or</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(20) Tribally controlled community college.--The 
        term `tribally controlled community college' shall have the 
        meaning given such term in section 126 (g)(2).</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(22) Urban indian.--The term `urban Indian' 
        means any individual who resides in an urban center and who--
        </DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(B) is an Eskimo or Aleut or other 
                Alaskan Native;</DELETED>
                <DELETED>    ``(C) is considered by the Secretary of 
                the Interior to be an Indian for any purpose; 
                or</DELETED>
                <DELETED>    ``(D) is determined to be an Indian under 
                regulations promulgated by the Secretary.</DELETED>
        <DELETED>    ``(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).</DELETED>

        <DELETED>``TITLE I--INDIAN HEALTH, HUMAN RESOURCES AND 
                         DEVELOPMENT</DELETED>

<DELETED>``SEC. 101. PURPOSE.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 102. GENERAL REQUIREMENTS.</DELETED>

<DELETED>    ``(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--
</DELETED>
        <DELETED>    ``(1) to be developed in consultation with Indian 
        tribes, tribal organizations and urban Indian 
        organizations;</DELETED>
        <DELETED>    ``(2) that takes into account the human resource 
        and development needs in each such service area; and</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 103. HEALTH PROFESSIONS RECRUITMENT PROGRAM FOR 
              INDIANS.</DELETED>

<DELETED>    ``(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--
</DELETED>
        <DELETED>    ``(1) identifying Indians with a potential for 
        education or training in the health professions and encouraging 
        and assisting them--</DELETED>
                <DELETED>    ``(A) to enroll in courses of study in 
                such health professions; or</DELETED>
                <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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).</DELETED>
<DELETED>    ``(b) Administrative Provisions.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) is an Eskimo or Aleut or other Alaska 
        Native;</DELETED>
        <DELETED>    ``(3) is considered by the Secretary of the 
        Interior to be an Indian for any purpose; or</DELETED>
        <DELETED>    ``(4) is determined to be an Indian under 
        regulations promulgated by the Secretary.</DELETED>

<DELETED>``SEC. 104. HEALTH PROFESSIONS PREPARATORY SCHOLARSHIP PROGRAM 
              FOR INDIANS.</DELETED>

<DELETED>    ``(a) In General.--The Secretary, acting through the 
Service, shall provide scholarships through the area offices to Indians 
who--</DELETED>
        <DELETED>    ``(1) have successfully completed their high 
        school education or high school equivalency; and</DELETED>
        <DELETED>    ``(2) have demonstrated the capability to 
        successfully complete courses of study in the health 
        professions.</DELETED>
<DELETED>    ``(b) Purpose.--Scholarships provided under this section 
shall be for the following purposes:</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Limitations.--Scholarship assistance to an eligible 
applicant under this section shall not be denied solely on the basis 
of--</DELETED>
        <DELETED>    ``(1) the applicant's scholastic achievement if 
        such applicant has been admitted to, or maintained good 
        standing at, an accredited institution; or</DELETED>
        <DELETED>    ``(2) the applicant's eligibility for assistance 
        or benefits under any other Federal program.</DELETED>

<DELETED>``SEC. 105. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.</DELETED>

<DELETED>    ``(a) Scholarships.--</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Eligibility.--</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(2) Service obligation.--</DELETED>
                <DELETED>    ``(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--
                </DELETED>
                        <DELETED>    ``(i) in the Indian Health 
                        Service;</DELETED>
                        <DELETED>    ``(ii) in a program conducted 
                        under a funding agreement entered into under 
                        the Indian Self-Determination and Education 
                        Assistance Act;</DELETED>
                        <DELETED>    ``(iii) in a program assisted 
                        under title V; or</DELETED>
                        <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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:</DELETED>
                        <DELETED>    ``(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.</DELETED>
                        <DELETED>    ``(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).</DELETED>
                        <DELETED>    ``(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).</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(B) the period of obligated service 
                described in paragraph (2)(A) shall be equal to the 
                greater of--</DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(ii) two years; and</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(4) Breach of contract.--</DELETED>
                <DELETED>    ``(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--
                </DELETED>
                        <DELETED>    ``(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);</DELETED>
                        <DELETED>    ``(ii) is dismissed from such 
                        educational institution for disciplinary 
                        reasons;</DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(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;</DELETED>
                <DELETED>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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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--</DELETED>
                        <DELETED>    ``(i) it is not possible for the 
                        recipient to meet that obligation or make that 
                        payment;</DELETED>
                        <DELETED>    ``(ii) requiring that recipient to 
                        meet that obligation or make that payment would 
                        result in extreme hardship to the recipient; 
                        or</DELETED>
                        <DELETED>    ``(iii) the enforcement of the 
                        requirement to meet the obligation or make the 
                        payment would be unconscionable.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Funding for Tribes for Scholarship Programs.--
</DELETED>
        <DELETED>    ``(1) Provision of funds.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Requirements.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(B) Matching requirement.--With respect 
                to the costs of providing any scholarship pursuant to 
                subparagraph (A)--</DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(ii) 20 percent of such costs 
                        shall be paid from any other source of 
                        funds.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(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--</DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(ii) such greater period of time 
                        as the recipient and the Indian tribe or tribal 
                        organization may agree;</DELETED>
                <DELETED>    ``(B) provide that the scholarship--
                </DELETED>
                        <DELETED>    ``(i) may only be expended for--
                        </DELETED>
                                <DELETED>    ``(I) tuition expenses, 
                                other reasonable educational expenses, 
                                and reasonable living expenses incurred 
                                in attendance at the educational 
                                institution; and</DELETED>
                                <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(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);</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(D) require the recipient of such 
                scholarship to meet the educational and licensure 
                requirements appropriate to the health profession 
                involved.</DELETED>
        <DELETED>    ``(5) Breach of contract.--</DELETED>
                <DELETED>    ``(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--</DELETED>
                        <DELETED>    ``(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);</DELETED>
                        <DELETED>    ``(ii) is dismissed from such 
                        education for disciplinary reasons;</DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(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;</DELETED>
                <DELETED>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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(6) Required agreements.--The recipient of a 
        scholarship under paragraph (1) shall agree, in providing 
        health care pursuant to the requirements of this subsection--
        </DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 106. AMERICAN INDIANS INTO PSYCHOLOGY 
              PROGRAM.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Requirements.--</DELETED>
        <DELETED>    ``(1) Regulations.--The Secretary shall promulgate 
        regulations pursuant to this Act for the competitive awarding 
        of funds under this section.</DELETED>
        <DELETED>    ``(2) Program.--Applicants for funds under this 
        section shall agree to provide a program which, at a minimum--
        </DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(B) incorporates a program advisory 
                board comprised of representatives from the tribes and 
                communities that will be served by the 
                program;</DELETED>
                <DELETED>    ``(C) provides summer enrichment programs 
                to expose Indian students to the various fields of 
                psychology through research, clinical, and experimental 
                activities;</DELETED>
                <DELETED>    ``(D) provides stipends to undergraduate 
                and graduate students to pursue a career in 
                psychology;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(F) utilizes, to the maximum extent 
                feasible, existing university tutoring, counseling and 
                student support services; and</DELETED>
                <DELETED>    ``(G) employs, to the maximum extent 
                feasible, qualified Indians in the program.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) in the Indian Health Service;</DELETED>
        <DELETED>    ``(2) in a program conducted under a funding 
        agreement contract entered into under the Indian Self-
        Determination and Education Assistance Act;</DELETED>
        <DELETED>    ``(3) in a program assisted under title V; 
        or</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 107. INDIAN HEALTH SERVICE EXTERN PROGRAMS.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 108. CONTINUING EDUCATION ALLOWANCES.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.</DELETED>

<DELETED>    ``(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--
</DELETED>
        <DELETED>    ``(1) provide for the training of Indians as 
        community health representatives; and</DELETED>
        <DELETED>    ``(2) use such community health representatives in 
        the provision of health care, health promotion, and disease 
        prevention services to Indian communities.</DELETED>
<DELETED>    ``(b) Activities.--The Secretary, acting through the 
Community Health Representative Program, shall--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) in order to provide such training, develop 
        and maintain a curriculum that--</DELETED>
                <DELETED>    ``(A) combines education in the theory of 
                health care with supervised practical experience in the 
                provision of health care; and</DELETED>
                <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(4) maintain a system that provides close 
        supervision of community health representatives;</DELETED>
        <DELETED>    ``(5) maintain a system under which the work of 
        community health representatives is reviewed and evaluated; 
        and</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 110. INDIAN HEALTH SERVICE LOAN REPAYMENT 
              PROGRAM.</DELETED>

<DELETED>    ``(a) Establishment.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Definitions.--In this section:</DELETED>
                <DELETED>    ``(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--</DELETED>
                        <DELETED>    ``(i) directly by the 
                        Service;</DELETED>
                        <DELETED>    ``(ii) by any Indian tribe or 
                        tribal or Indian organization pursuant to a 
                        funding agreement under--</DELETED>
                                <DELETED>    ``(I) the Indian Self-
                                Determination and Educational 
                                Assistance Act; or</DELETED>
                                <DELETED>    ``(II) section 23 of the 
                                Act of April 30, 1908 (25 U.S.C. 47) 
                                (commonly known as the `Buy-Indian 
                                Act'); or</DELETED>
                        <DELETED>    ``(iii) by an urban Indian 
                        organization pursuant to title V.</DELETED>
                <DELETED>    ``(B) State.--The term `State' has the 
                same meaning given such term in section 331(i)(4) of 
                the Public Health Service Act.</DELETED>
<DELETED>    ``(b) Eligibility.--To be eligible to participate in the 
Loan Repayment Program, an individual must--</DELETED>
        <DELETED>    ``(1)(A) be enrolled--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(ii) in an approved graduate training 
                program in a health profession; or</DELETED>
        <DELETED>    ``(B) have--</DELETED>
                <DELETED>    ``(i) a degree in a health profession; 
                and</DELETED>
                <DELETED>    ``(ii) a license to practice a health 
                profession in a State;</DELETED>
        <DELETED>    ``(2)(A) be eligible for, or hold, an appointment 
        as a commissioned officer in the Regular or Reserve Corps of 
        the Public Health Service;</DELETED>
        <DELETED>    ``(B) be eligible for selection for civilian 
        service in the Regular or Reserve Corps of the Public Health 
        Service;</DELETED>
        <DELETED>    ``(C) meet the professional standards for civil 
        service employment in the Indian Health Service; or</DELETED>
        <DELETED>    ``(D) be employed in an Indian health program 
        without a service obligation; and</DELETED>
        <DELETED>    ``(3) submit to the Secretary an application for a 
        contract described in subsection (f).</DELETED>
<DELETED>    ``(c) Forms.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Priority.--</DELETED>
        <DELETED>    ``(1) Annual determinations.--The Secretary, 
        acting through the Service and in accordance with subsection 
        (k), shall annually--</DELETED>
                <DELETED>    ``(A) identify the positions in each 
                Indian health program for which there is a need or a 
                vacancy; and</DELETED>
                <DELETED>    ``(B) rank those positions in order of 
                priority.</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) give first priority to applications 
                made by individual Indians; and</DELETED>
                <DELETED>    ``(B) after making determinations on all 
                applications submitted by individual Indians as 
                required under subparagraph (A), give priority to--
                </DELETED>
                        <DELETED>    ``(i) individuals recruited 
                        through the efforts an Indian tribe, tribal 
                        organization, or urban Indian organization; 
                        and</DELETED>
                        <DELETED>    ``(ii) other individuals based on 
                        the priority rankings under paragraph 
                        (1).</DELETED>
<DELETED>    ``(e) Contracts.--</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(B) the Secretary's disapproving an 
                individual's participation in such Program.</DELETED>
<DELETED>    ``(f) Written Contract.--The written contract referred to 
in this section between the Secretary and an individual shall contain--
</DELETED>
        <DELETED>    ``(1) an agreement under which--</DELETED>
                <DELETED>    ``(A) subject to paragraph (3), the 
                Secretary agrees--</DELETED>
                        <DELETED>    ``(i) to pay loans on behalf of 
                        the individual in accordance with the 
                        provisions of this section; and</DELETED>
                        <DELETED>    ``(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</DELETED>
                <DELETED>    ``(B) subject to paragraph (3), the 
                individual agrees--</DELETED>
                        <DELETED>    ``(i) to accept loan payments on 
                        behalf of the individual;</DELETED>
                        <DELETED>    ``(ii) in the case of an 
                        individual described in subsection (b)(1)--
                        </DELETED>
                                <DELETED>    ``(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</DELETED>
                                <DELETED>    ``(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);</DELETED>
                        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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);</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(5) such other statements of the rights and 
        liabilities of the Secretary and of the individual, not 
        inconsistent with this section.</DELETED>
<DELETED>    ``(g) Loan Repayments.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) tuition expenses;</DELETED>
                <DELETED>    ``(B) all other reasonable educational 
                expenses, including fees, books, and laboratory 
                expenses, incurred by the individual; and</DELETED>
                <DELETED>    ``(C) reasonable living expenses as 
                determined by the Secretary.</DELETED>
        <DELETED>    ``(2) Amount of payment.--</DELETED>
                <DELETED>    ``(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--</DELETED>
                        <DELETED>    ``(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;</DELETED>
                        <DELETED>    ``(ii) provides an incentive to 
                        serve in Indian health programs with the 
                        greatest shortages of health professionals; 
                        and</DELETED>
                        <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(k) Assignment of Individuals.--The Secretary, in 
assigning individuals to serve in Indian health programs pursuant to 
contracts entered into under this section, shall--</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(l) Breach of Contract.--</DELETED>
        <DELETED>    ``(1) In general.--An individual who has entered 
        into a written contract with the Secretary under this section 
        and who--</DELETED>
                <DELETED>    ``(A) is enrolled in the final year of a 
                course of study and who--</DELETED>
                        <DELETED>    ``(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);</DELETED>
                        <DELETED>    ``(ii) voluntarily terminates such 
                        enrollment; or</DELETED>
                        <DELETED>    ``(iii) is dismissed from such 
                        educational institution before completion of 
                        such course of study; or</DELETED>
                <DELETED>    ``(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),</DELETED>
        <DELETED>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.</DELETED>
        <DELETED>    ``(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:</DELETED>

                     <DELETED>A=3Z(t-s/t)</DELETED>

        <DELETED>in which--</DELETED>
                <DELETED>    ``(A) `A' is the amount the United States 
                is entitled to recover;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(C) `t' is the total number of months in 
                the individual's period of obligated service in 
                accordance with subsection (f); and</DELETED>
                <DELETED>    ``(D) `s' is the number of months of such 
                period served by such individual in accordance with 
                this section.</DELETED>
        <DELETED>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.</DELETED>
        <DELETED>    ``(3) Damages.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(B) Delinquencies.--If damages described 
                in subparagraph (A) are delinquent for 3 months, the 
                Secretary shall, for the purpose of recovering such 
                damages--</DELETED>
                        <DELETED>    ``(i) utilize collection agencies 
                        contracted with by the Administrator of the 
                        General Services Administration; or</DELETED>
                        <DELETED>    ``(ii) enter into contracts for 
                        the recovery of such damages with collection 
                        agencies selected by the Secretary.</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(m) Cancellation, Waiver or Release.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) the health professional positions maintained 
        by the Service or by tribal or Indian organizations for which 
        recruitment or retention is difficult;</DELETED>
        <DELETED>    ``(2) the number of Loan Repayment Program 
        applications filed with respect to each type of health 
        profession;</DELETED>
        <DELETED>    ``(3) the number of contracts described in 
        subsection (f) that are entered into with respect to each 
        health profession;</DELETED>
        <DELETED>    ``(4) the amount of loan payments made under this 
        section, in total and by health profession;</DELETED>
        <DELETED>    ``(5) the number of scholarship grants that are 
        provided under section 105 with respect to each health 
        profession;</DELETED>
        <DELETED>    ``(6) the amount of scholarship grants provided 
        under section 105, in total and by health profession;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 111. SCHOLARSHIP AND LOAN REPAYMENT RECOVERY 
              FUND.</DELETED>

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) such funds as may be appropriated to the 
        LRRF;</DELETED>
        <DELETED>    ``(3) such interest earned on amounts in the LRRF; 
        and</DELETED>
        <DELETED>    ``(4) such additional amounts as may be collected, 
        appropriated, or earned relative to the LRRF.</DELETED>
<DELETED> Amounts appropriated to the LRRF shall remain available until 
expended.</DELETED>
<DELETED>    ``(b) Use of LRRF.--</DELETED>
        <DELETED>    ``(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--
        </DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Investing of Fund.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Sale price.--Any obligation acquired by the 
        LRRF may be sold by the Secretary of the Treasury at the market 
        price.</DELETED>

<DELETED>``SEC. 112. RECRUITMENT ACTIVITIES.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 113. TRIBAL RECRUITMENT AND RETENTION 
              PROGRAM.</DELETED>

<DELETED>    ``(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)).</DELETED>
<DELETED>    ``(b) Eligibility.--Any Indian tribe, tribal organization, 
or urban Indian organization may submit an application for funding of a 
project pursuant to this section.</DELETED>

<DELETED>``SEC. 114. ADVANCED TRAINING AND RESEARCH.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Service Obligation.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>

<DELETED>``SEC. 115. NURSING PROGRAMS; QUENTIN N. BURDICK AMERICAN 
              INDIANS INTO NURSING PROGRAM.</DELETED>

<DELETED>    ``(a) Grants.--Notwithstanding section 102, the Secretary, 
acting through the Service, shall provide funds to--</DELETED>
        <DELETED>    ``(1) public or private schools of 
        nursing;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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,</DELETED>
<DELETED>for the purpose of increasing the number of nurses, nurse 
midwives, and nurse practitioners who deliver health care services to 
Indians.</DELETED>
<DELETED>    ``(b) Use of Grants.--Funds provided under subsection (a) 
may be used to--</DELETED>
        <DELETED>    ``(1) recruit individuals for programs which train 
        individuals to be nurses, nurse midwives, or advanced practice 
        nurses;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(3) provide a program that encourages nurses, 
        nurse midwives, and advanced practice nurses to provide, or 
        continue to provide, health care services to Indians;</DELETED>
        <DELETED>    ``(4) provide a program that increases the skills 
        of, and provides continuing education to, nurses, nurse 
        midwives, and advanced practice nurses; or</DELETED>
        <DELETED>    ``(5) provide any program that is designed to 
        achieve the purpose described in subsection (a).</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Preferences.--In providing funds under subsection 
(a), the Secretary shall extend a preference to--</DELETED>
        <DELETED>    ``(1) programs that provide a preference to 
        Indians;</DELETED>
        <DELETED>    ``(2) programs that train nurse midwives or 
        advanced practice nurses;</DELETED>
        <DELETED>    ``(3) programs that are interdisciplinary; 
        and</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) in the Indian Health Service;</DELETED>
        <DELETED>    ``(2) in a program conducted under a contract 
        entered into under the Indian Self-Determination and Education 
        Assistance Act;</DELETED>
        <DELETED>    ``(3) in a program assisted under title V; 
        or</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 116. TRIBAL CULTURE AND HISTORY.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Requirements.--To the extent feasible, the 
educational instruction to be provided under subsection (a) shall--
</DELETED>
        <DELETED>    ``(1) be provided in consultation with the 
        affected tribal governments, tribal organizations, and urban 
        Indian organizations;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(3) include instruction in Native American 
        studies.</DELETED>

<DELETED>``SEC. 117. INMED PROGRAM.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Requirements.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary shall develop 
        regulations to govern grants under to this section.</DELETED>
        <DELETED>    ``(2) Program requirements.--Applicants for grants 
        provided under this section shall agree to provide a program 
        that--</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(B) incorporates a program advisory 
                board comprised of representatives from the tribes and 
                communities which will be served by the 
                program;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(E) to the maximum extent feasible, 
                employs qualified Indians in the program.</DELETED>

<DELETED>``SEC. 118. HEALTH TRAINING PROGRAMS OF COMMUNITY 
              COLLEGES.</DELETED>

<DELETED>    ``(a) Establishment Grants.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Continuation Grants.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Eligibility.--Grants may only be made under 
        this subsection to a community college that--</DELETED>
                <DELETED>    ``(A) is accredited;</DELETED>
                <DELETED>    ``(B) has a relationship with a hospital 
                facility, Service facility, or hospital that could 
                provide training of nurses or health 
                professionals;</DELETED>
                <DELETED>    ``(C) has entered into an agreement with 
                an accredited college or university medical school, the 
                terms of which--</DELETED>
                        <DELETED>    ``(i) provide a program that 
                        enhances the transition and recruitment of 
                        students into advanced baccalaureate or 
                        graduate programs which train health 
                        professionals; and</DELETED>
                        <DELETED>    ``(ii) stipulate certifications 
                        necessary to approve internship and field 
                        placement opportunities at health programs of 
                        the Service or at tribal health 
                        programs;</DELETED>
                <DELETED>    ``(D) has a qualified staff which has the 
                appropriate certifications;</DELETED>
                <DELETED>    ``(E) is capable of obtaining State or 
                regional accreditation of the program described in 
                subsection (a)(1); and</DELETED>
                <DELETED>    ``(F) agrees to provide for Indian 
                preference for applicants for programs under this 
                section.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(2) providing technical assistance and support 
        to such colleges.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) has already received a degree or diploma in 
        such health profession; and</DELETED>
        <DELETED>    ``(2) provides clinical services on an Indian 
        reservation, at a Service facility, or at a tribal 
        clinic.</DELETED>
<DELETED>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).</DELETED>
<DELETED>    ``(e) Priority.--Priority shall be provided under this 
section to tribally controlled colleges in service areas that meet the 
requirements of subsection (b).</DELETED>
<DELETED>    ``(f) Definitions.--In this section:</DELETED>
        <DELETED>    ``(1) Community college.--The term `community 
        college' means--</DELETED>
                <DELETED>    ``(A) a tribally controlled community 
                college; or</DELETED>
                <DELETED>    ``(B) a junior or community 
                college.</DELETED>
        <DELETED>    ``(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)).</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 119. RETENTION BONUS.</DELETED>

<DELETED>    ``(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--
</DELETED>
        <DELETED>    ``(1) is assigned to, and serving in, a position 
        for which recruitment or retention of personnel is 
        difficult;</DELETED>
        <DELETED>    ``(2) the Secretary determines is needed by the 
        Service, tribe, tribal organization, or urban 
        organization;</DELETED>
        <DELETED>    ``(3) has--</DELETED>
                <DELETED>    ``(A) completed 3 years of employment with 
                the Service; tribe, tribal organization, or urban 
                organization; or</DELETED>
                <DELETED>    ``(B) completed any service obligations 
                incurred as a requirement of--</DELETED>
                        <DELETED>    ``(i) any Federal scholarship 
                        program; or</DELETED>
                        <DELETED>    ``(ii) any Federal education loan 
                        repayment program; and</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) a position for which recruitment or 
        retention is difficult; and</DELETED>
        <DELETED>    ``(2) necessary for providing health care services 
        to Indians.</DELETED>

<DELETED>``SEC. 120. NURSING RESIDENCY PROGRAM.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 121. COMMUNITY HEALTH AIDE PROGRAM FOR 
              ALASKA.</DELETED>

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) provides for the training of Alaska Natives 
        as health aides or community health practitioners;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Activities.--The Secretary, acting through the 
Community Health Aide Program under subsection (a), shall--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) in order to provide such training, develop a 
        curriculum that--</DELETED>
                <DELETED>    ``(A) combines education in the theory of 
                health care with supervised practical experience in the 
                provision of health care;</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(C) promotes the achievement of the 
                health status objective specified in section 
                3(b);</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(5) develop and maintain a system that provides 
        close supervision of community health aides and community 
        health practitioners; and</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 123. HEALTH PROFESSIONAL CHRONIC SHORTAGE DEMONSTRATION 
              PROJECT.</DELETED>

<DELETED>    ``(a) Pilot Programs.--The Secretary may, through area 
offices, fund pilot programs for tribes and tribal organizations to 
address chronic shortages of health professionals.</DELETED>
<DELETED>    ``(b) Purpose.--It is the purpose of the health 
professions demonstration project under this section to--</DELETED>
        <DELETED>    ``(1) provide direct clinical and practical 
        experience in a service area to health professions students and 
        residents from medical schools;</DELETED>
        <DELETED>    ``(2) improve the quality of health care for 
        Indians by assuring access to qualified health care 
        professionals; and</DELETED>
        <DELETED>    ``(3) provide academic and scholarly opportunities 
        for health professionals serving Indian people by identifying 
        and utilizing all academic and scholarly resources of the 
        region.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 124. SCHOLARSHIPS.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 125. NATIONAL HEALTH SERVICE CORPS.</DELETED>

<DELETED>    ``(a) Limitations.--The Secretary shall not--</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(2) withdraw the funding used to support such a 
        member;</DELETED>
<DELETED>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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 126. SUBSTANCE ABUSE COUNSELOR EDUCATION DEMONSTRATION 
              PROJECT.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(g) Definitions.--In this section:</DELETED>
        <DELETED>    ``(1) Educational curriculum.--The term 
        `educational curriculum' means 1 or more of the 
        following:</DELETED>
                <DELETED>    ``(A) Classroom education.</DELETED>
                <DELETED>    ``(B) Clinical work experience.</DELETED>
                <DELETED>    ``(C) Continuing education 
                workshops.</DELETED>
        <DELETED>    ``(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)).</DELETED>
        <DELETED>    ``(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)).</DELETED>

<DELETED>``SEC. 127. MENTAL HEALTH TRAINING AND COMMUNITY 
              EDUCATION.</DELETED>

<DELETED>    ``(a) Study and List.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Positions.--The positions referred to in 
        paragraph (1) are--</DELETED>
                <DELETED>    ``(A) staff positions within the Bureau of 
                Indian Affairs, including existing positions, in the 
                fields of--</DELETED>
                        <DELETED>    ``(i) elementary and secondary 
                        education;</DELETED>
                        <DELETED>    ``(ii) social services, family and 
                        child welfare;</DELETED>
                        <DELETED>    ``(iii) law enforcement and 
                        judicial services; and</DELETED>
                        <DELETED>    ``(iv) alcohol and substance 
                        abuse;</DELETED>
                <DELETED>    ``(B) staff positions within the Service; 
                and</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) Training criteria.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(5) Community education.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Staffing.--</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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').</DELETED>

<DELETED>``SEC. 128. AUTHORIZATION OF APPROPRIATIONS.</DELETED>

<DELETED>    ``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.</DELETED>

             <DELETED>``TITLE II--HEALTH SERVICES</DELETED>

<DELETED>``SEC. 201. INDIAN HEALTH CARE IMPROVEMENT FUND.</DELETED>

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) eliminating the deficiencies in the health 
        status and resources of all Indian tribes;</DELETED>
        <DELETED>    ``(2) eliminating backlogs in the provision of 
        health care services to Indians;</DELETED>
        <DELETED>    ``(3) meeting the health needs of Indians in an 
        efficient and equitable manner;</DELETED>
        <DELETED>    ``(4) eliminating inequities in funding for both 
        direct care and contract health service programs; and</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(B) preventive health, including 
                mammography and other cancer screening in accordance 
                with section 207;</DELETED>
                <DELETED>    ``(C) dental care;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(E) emergency medical 
                services;</DELETED>
                <DELETED>    ``(F) treatment and control of, and 
                rehabilitative care related to, alcoholism and drug 
                abuse (including fetal alcohol syndrome) among 
                Indians;</DELETED>
                <DELETED>    ``(G) accident prevention 
                programs;</DELETED>
                <DELETED>    ``(H) home health care;</DELETED>
                <DELETED>    ``(I) community health 
                representatives;</DELETED>
                <DELETED>    ``(J) maintenance and repair; 
                and</DELETED>
                <DELETED>    ``(K) traditional health care 
                practices.</DELETED>
<DELETED>    ``(b) Use of Funds.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Allocation.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Health Status and Resource Deficiency.--In this 
section:</DELETED>
        <DELETED>    ``(1) Definition.--The term `health status and 
        resource deficiency' means the extent to which--</DELETED>
                <DELETED>    ``(A) the health status objective set 
                forth in section 3(2) is not being achieved; 
                and</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--
</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) the extent of the health status and resource 
        deficiency of each Indian tribe served by the 
        Service;</DELETED>
        <DELETED>    ``(3) the amount of funds necessary to eliminate 
        the health status and resource deficiencies of all Indian 
        tribes served by the Service; and</DELETED>
        <DELETED>    ``(4) an estimate of--</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(B) the number of Indians eligible for 
                health services in each service unit or Indian tribe or 
                tribal organization; and</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(h) Designation.--Any funds appropriated under the 
authority of this section shall be designated as the `Indian Health 
Care Improvement Fund'.</DELETED>

<DELETED>``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.</DELETED>

<DELETED>    ``(a) Establishment.--</DELETED>
        <DELETED>    ``(1) In general.--There is hereby established an 
        Indian Catastrophic Health Emergency Fund (referred to in this 
        section as the `CHEF') consisting of--</DELETED>
                <DELETED>    ``(A) the amounts deposited under 
                subsection (d); and</DELETED>
                <DELETED>    ``(B) any amounts appropriated to the CHEF 
                under this Act.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Requirements.--The Secretary shall, through the 
negotiated rulemaking process under title VIII, promulgate regulations 
consistent with the provisions of this section--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) for 1999, not less than $19,000; 
                and</DELETED>
                <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(3) establish a procedure for the reimbursement 
        of the portion of the costs incurred by--</DELETED>
                <DELETED>    ``(A) service units, Indian tribes, or 
                tribal organizations, or facilities of the Service; 
                or</DELETED>
                <DELETED>    ``(B) non-Service facilities or providers 
                whenever otherwise authorized by the Service;</DELETED>
        <DELETED>in rendering treatment that exceeds threshold cost 
        described in paragraph (2);</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 203. HEALTH PROMOTION AND DISEASE PREVENTION 
              SERVICES.</DELETED>

<DELETED>    ``(a) Findings.--Congress finds that health promotion and 
disease prevention activities will--</DELETED>
        <DELETED>    ``(1) improve the health and well-being of 
        Indians; and</DELETED>
        <DELETED>    ``(2) reduce the expenses for health care of 
        Indians.</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(c) Disease Prevention and Health Promotion.--In this 
section:</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) controlling--</DELETED>
                        <DELETED>    ``(i) diabetes;</DELETED>
                        <DELETED>    ``(ii) high blood 
                        pressure;</DELETED>
                        <DELETED>    ``(iii) infectious 
                        agents;</DELETED>
                        <DELETED>    ``(iv) injuries;</DELETED>
                        <DELETED>    ``(v) occupational hazards and 
                        disabilities;</DELETED>
                        <DELETED>    ``(vi) sexually transmittable 
                        diseases; and</DELETED>
                        <DELETED>    ``(vii) toxic agents; 
                        and</DELETED>
                <DELETED>    ``(B) providing--</DELETED>
                        <DELETED>    ``(i) for the fluoridation of 
                        water; and</DELETED>
                        <DELETED>    ``(ii) immunizations.</DELETED>
        <DELETED>    ``(2) Health promotion.--The term `health 
        promotion' means fostering social, economic, environmental, and 
        personal factors conducive to health, including--</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(B) encouraging adequate and appropriate 
                diet, exercise, and sleep;</DELETED>
                <DELETED>    ``(C) promoting education and work in 
                conformity with physical and mental capacity;</DELETED>
                <DELETED>    ``(D) making available suitable housing, 
                safe water, and sanitary facilities;</DELETED>
                <DELETED>    ``(E) improving the physical economic, 
                cultural, psychological, and social 
                environment;</DELETED>
                <DELETED>    ``(F) promoting adequate opportunity for 
                spiritual, religious, and traditional practices; 
                and</DELETED>
                <DELETED>    ``(G) adequate and appropriate programs 
                including--</DELETED>
                        <DELETED>    ``(i) abuse prevention (mental and 
                        physical);</DELETED>
                        <DELETED>    ``(ii) community health;</DELETED>
                        <DELETED>    ``(iii) community 
                        safety;</DELETED>
                        <DELETED>    ``(iv) consumer health 
                        education;</DELETED>
                        <DELETED>    ``(v) diet and 
                        nutrition;</DELETED>
                        <DELETED>    ``(vi) disease prevention 
                        (communicable, immunizations, HIV/
                        AIDS);</DELETED>
                        <DELETED>    ``(vii) environmental 
                        health;</DELETED>
                        <DELETED>    ``(viii) exercise and physical 
                        fitness;</DELETED>
                        <DELETED>    ``(ix) fetal alcohol 
                        disorders;</DELETED>
                        <DELETED>    ``(x) first aid and CPR 
                        education;</DELETED>
                        <DELETED>    ``(xi) human growth and 
                        development;</DELETED>
                        <DELETED>    ``(xii) injury prevention and 
                        personal safety;</DELETED>
                        <DELETED>    ``(xiii) mental health (emotional, 
                        self-worth);</DELETED>
                        <DELETED>    ``(xiv) personal health and 
                        wellness practices;</DELETED>
                        <DELETED>    ``(xv) personal capacity 
                        building;</DELETED>
                        <DELETED>    ``(xvi) prenatal, pregnancy, and 
                        infant care;</DELETED>
                        <DELETED>    ``(xvii) psychological well 
                        being;</DELETED>
                        <DELETED>    ``(xiii) reproductive health 
                        (family planning);</DELETED>
                        <DELETED>    ``(xix) safe and adequate 
                        water;</DELETED>
                        <DELETED>    ``(xx) safe housing;</DELETED>
                        <DELETED>    ``(xxi) safe work 
                        environments;</DELETED>
                        <DELETED>    ``(xxii) stress control;</DELETED>
                        <DELETED>    ``(xxiii) substance 
                        abuse;</DELETED>
                        <DELETED>    ``(xxiv) sanitary 
                        facilities;</DELETED>
                        <DELETED>    ``(xxv) tobacco use cessation and 
                        reduction;</DELETED>
                        <DELETED>    ``(xxvi) violence prevention; 
                        and</DELETED>
                        <DELETED>    ``(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).</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) the health promotion and disease prevention 
        needs of Indians;</DELETED>
        <DELETED>    ``(2) the health promotion and disease prevention 
        activities which would best meet such needs;</DELETED>
        <DELETED>    ``(3) the internal capacity of the Service to meet 
        such needs; and</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 204. DIABETES PREVENTION, TREATMENT, AND 
              CONTROL.</DELETED>

<DELETED>    ``(a) Determination.--The Secretary, in consultation with 
Indian tribes and tribal organizations, shall determine--</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(e) Other Activities.--The Secretary shall, to the 
extent funding is available--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 205. SHARED SERVICES.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Requirements.--A funding agreement or other 
arrangement entered into pursuant to subsection (a)--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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).</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 206. HEALTH SERVICES RESEARCH.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 207. MAMMOGRAPHY AND OTHER CANCER SCREENING.</DELETED>

<DELETED>    ``The Secretary, through the Service or through Indian 
tribes or tribal organizations, shall provide for the following 
screening:</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Other cancer screening meeting national 
        standards.</DELETED>

<DELETED>``SEC. 208. PATIENT TRAVEL COSTS.</DELETED>

<DELETED>    ``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:</DELETED>
        <DELETED>    ``(1) Emergency air transportation and 
        nonemergency air transportation where ground transportation is 
        infeasible.</DELETED>
        <DELETED>    ``(2) Transportation by private vehicle, specially 
        equipped vehicle and ambulance.</DELETED>
        <DELETED>    ``(3) Transportation by such other means as may be 
        available and required when air or motor vehicle transportation 
        is not available.</DELETED>

<DELETED>``SEC. 209. EPIDEMIOLOGY CENTERS.</DELETED>

<DELETED>    ``(a) Establishment.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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--
        </DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(B) evaluate existing delivery systems, 
                data systems, and other systems that impact the 
                improvement of Indian health;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(D) make recommendations for the 
                targeting of services needed by tribal, urban, and 
                other Indian communities;</DELETED>
                <DELETED>    ``(E) make recommendations to improve 
                health care delivery systems for Indians and urban 
                Indians;</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(G) provide disease surveillance and 
                assist Indian tribes, tribal organizations, and urban 
                Indian organizations to promote public 
                health.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 210. COMPREHENSIVE SCHOOL HEALTH EDUCATION 
              PROGRAMS.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Use of Funds.--Funds awarded under this section may 
be used to--</DELETED>
        <DELETED>    ``(1) develop and implement health education 
        curricula both for regular school programs and after school 
        programs;</DELETED>
        <DELETED>    ``(2) train teachers in comprehensive school 
        health education curricula;</DELETED>
        <DELETED>    ``(3) integrate school-based, community-based, and 
        other public and private health promotion efforts;</DELETED>
        <DELETED>    ``(4) encourage healthy, tobacco-free school 
        environments;</DELETED>
        <DELETED>    ``(5) coordinate school-based health programs with 
        existing services and programs available in the 
        community;</DELETED>
        <DELETED>    ``(6) develop school programs on nutrition 
        education, personal health, oral health, and fitness;</DELETED>
        <DELETED>    ``(7) develop mental health wellness 
        programs;</DELETED>
        <DELETED>    ``(8) develop chronic disease prevention 
        programs;</DELETED>
        <DELETED>    ``(9) develop substance abuse prevention 
        programs;</DELETED>
        <DELETED>    ``(10) develop injury prevention and safety 
        education programs;</DELETED>
        <DELETED>    ``(11) develop activities for the prevention and 
        control of communicable diseases;</DELETED>
        <DELETED>    ``(12) develop community and environmental health 
        education programs that include traditional health care 
        practitioners;</DELETED>
        <DELETED>    ``(13) carry out violence prevention activities; 
        and</DELETED>
        <DELETED>    ``(14) carry out activities relating to such other 
        health issues as are appropriate.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(e) Comprehensive School Health Education Program.--
</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Requirements.--The program developed under 
        paragraph (1) shall include--</DELETED>
                <DELETED>    ``(A) school programs on nutrition 
                education, personal health, oral health, and 
                fitness;</DELETED>
                <DELETED>    ``(B) mental health wellness 
                programs;</DELETED>
                <DELETED>    ``(C) chronic disease prevention 
                programs;</DELETED>
                <DELETED>    ``(D) substance abuse prevention 
                programs;</DELETED>
                <DELETED>    ``(E) injury prevention and safety 
                education programs; and</DELETED>
                <DELETED>    ``(F) activities for the prevention and 
                control of communicable diseases.</DELETED>
        <DELETED>    ``(3) Training and coordination.--The Secretary of 
        the Interior shall--</DELETED>
                <DELETED>    ``(A) provide training to teachers in 
                comprehensive school health education 
                curricula;</DELETED>
                <DELETED>    ``(B) ensure the integration and 
                coordination of school-based programs with 
existing services and health programs available in the community; 
and</DELETED>
                <DELETED>    ``(C) encourage healthy, tobacco-free 
                school environments.</DELETED>

<DELETED>``SEC. 211. INDIAN YOUTH PROGRAM.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Use of Funds.--</DELETED>
        <DELETED>    ``(1) In general.--Funds made available under this 
        section may be used to--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(B) develop and provide community 
                training and education.</DELETED>
        <DELETED>    ``(2) Limitation.--Funds made available under this 
        section may not be used to provide services described in 
        section 707(c).</DELETED>
<DELETED>    ``(c) Requirements.--The Secretary shall--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) encourage the implementation of such models; 
        and</DELETED>
        <DELETED>    ``(3) at the request of an Indian tribe, tribal 
        organization, or urban Indian organization, provide technical 
        assistance in the implementation of such models.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 212. PREVENTION, CONTROL, AND ELIMINATION OF 
              COMMUNICABLE AND INFECTIOUS DISEASES.</DELETED>

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) public information and education programs 
        for the prevention, control, and elimination of communicable 
        and infectious diseases;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Requirement of Application.--The Secretary may 
provide funds under subsection (a) only if an application or proposal 
for such funds is submitted.</DELETED>
<DELETED>    ``(c) Technical Assistance and Report.--In carrying out 
this section, the Secretary--</DELETED>
        <DELETED>    ``(1) may, at the request of an Indian tribe or 
        tribal organization, provide technical assistance; 
        and</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 213. AUTHORITY FOR PROVISION OF OTHER 
              SERVICES.</DELETED>

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) hospice care and assisted living;</DELETED>
        <DELETED>    ``(2) long-term health care;</DELETED>
        <DELETED>    ``(3) home- and community-based 
        services;</DELETED>
        <DELETED>    ``(4) public health functions; and</DELETED>
        <DELETED>    ``(5) traditional health care practices.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Definitions.--In this section:</DELETED>
        <DELETED>    ``(1) Home- and community-based services.--The 
        term `home- and community-based services' means 1 or more of 
        the following:</DELETED>
                <DELETED>    ``(A) Homemaker/home health aide 
                services.</DELETED>
                <DELETED>    ``(B) Chore services.</DELETED>
                <DELETED>    ``(C) Personal care services.</DELETED>
                <DELETED>    ``(D) Nursing care services provided 
                outside of a nursing facility by, or under the 
                supervision of, a registered nurse.</DELETED>
                <DELETED>    ``(E) Training for family 
                members.</DELETED>
                <DELETED>    ``(F) Adult day care.</DELETED>
                <DELETED>    ``(G) Such other home- and community-based 
                services as the Secretary or a tribe or tribal 
                organization may approve.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 214. INDIAN WOMEN'S HEALTH CARE.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 215. ENVIRONMENTAL AND NUCLEAR HEALTH 
              HAZARDS.</DELETED>

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) methods for diagnosing and treating Indians 
        currently exhibiting such health problems;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Submission to Congress.--</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Task Force.--</DELETED>
        <DELETED>    ``(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):</DELETED>
                <DELETED>    ``(A) The Secretary of Energy.</DELETED>
                <DELETED>    ``(B) The Administrator of the 
                Environmental Protection Agency.</DELETED>
                <DELETED>    ``(C) The Director of the Bureau of 
                Mines.</DELETED>
                <DELETED>    ``(D) The Assistant Secretary for 
                Occupational Safety and Health.</DELETED>
                <DELETED>    ``(E) The Secretary of the 
                Interior.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(e) Provision of Appropriate Medical Care.--In the case 
of any Indian who--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) is eligible to receive diagnosis and 
        treatment services from a Service facility; and</DELETED>
        <DELETED>    ``(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;</DELETED>
<DELETED>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.</DELETED>

<DELETED>``SEC. 216. ARIZONA AS A CONTRACT HEALTH SERVICE DELIVERY 
              AREA.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>

<DELETED>``SEC. 216A. NORTH DAKOTA AS A CONTRACT HEALTH SERVICE 
              DELIVERY AREA.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>

<DELETED>``SEC. 216B. SOUTH DAKOTA AS A CONTRACT HEALTH SERVICE 
              DELIVERY AREA.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>

<DELETED>``SEC. 217. CALIFORNIA CONTRACT HEALTH SERVICES DEMONSTRATION 
              PROGRAM.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Reimbursement of Board.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 218. CALIFORNIA AS A CONTRACT HEALTH SERVICE DELIVERY 
              AREA.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 219. CONTRACT HEALTH SERVICES FOR THE TRENTON SERVICE 
              AREA.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 220. PROGRAMS OPERATED BY INDIAN TRIBES AND TRIBAL 
              ORGANIZATIONS.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 221. LICENSING.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 222. AUTHORIZATION FOR EMERGENCY CONTRACT HEALTH 
              SERVICES.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 223. PROMPT ACTION ON PAYMENT OF CLAIMS.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Payment.--The Service shall pay a valid contract 
care service claim within 30 days after the completion of the 
claim.</DELETED>

<DELETED>``SEC. 224. LIABILITY FOR PAYMENT.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 225. AUTHORIZATION OF APPROPRIATIONS.</DELETED>

<DELETED>    ``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.</DELETED>

               <DELETED>``TITLE III--FACILITIES</DELETED>

<DELETED>``SEC. 301. CONSULTATION, CONSTRUCTION AND RENOVATION OF 
              FACILITIES; REPORTS.</DELETED>

<DELETED>    ``(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--
</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Closure of Facilities.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) the accessibility of alternative 
                health care resources for the population served by such 
                hospital or facility;</DELETED>
                <DELETED>    ``(B) the cost effectiveness of such 
                closure;</DELETED>
                <DELETED>    ``(C) the quality of health care to be 
                provided to the population served by such hospital or 
                facility after such closure;</DELETED>
                <DELETED>    ``(D) the availability of contract health 
                care funds to maintain existing levels of 
                service;</DELETED>
                <DELETED>    ``(E) the views of the Indian tribes 
                served by such hospital or facility concerning such 
                closure;</DELETED>
                <DELETED>    ``(F) the level of utilization of such 
                hospital or facility by all eligible Indians; 
                and</DELETED>
                <DELETED>    ``(G) the distance between such hospital 
                or facility and the nearest operating Service 
                hospital.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Priority System.--</DELETED>
        <DELETED>    ``(1) Establishment.--The Secretary shall 
        establish a health care facility priority system, that shall--
        </DELETED>
                <DELETED>    ``(A) be developed with Indian tribes and 
                tribal organizations through negotiated rulemaking 
                under section 802;</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(C) at a minimum, include the lists 
                required in paragraph (2)(B) and the methodology 
                required in paragraph (2)(E);</DELETED>
        <DELETED>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.</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) a description of the health care 
                facility priority system of the Service, as established 
                under paragraph (1);</DELETED>
                <DELETED>    ``(B) health care facility lists, 
                including--</DELETED>
                        <DELETED>    ``(i) the total health care 
                        facility planning, design, construction and 
                        renovation needs for Indians;</DELETED>
                        <DELETED>    ``(ii) the 10 top-priority 
                        inpatient care facilities;</DELETED>
                        <DELETED>    ``(iii) the 10 top-priority 
                        outpatient care facilities;</DELETED>
                        <DELETED>    ``(iv) the 10 top-priority 
                        specialized care facilities (such as long-term 
                        care and alcohol and drug abuse treatment); 
                        and</DELETED>
                        <DELETED>    ``(v) any staff quarters 
                        associated with such prioritized 
                        facilities;</DELETED>
                <DELETED>    ``(C) the justification for the order of 
                priority among facilities;</DELETED>
                <DELETED>    ``(D) the projected cost of the projects 
                involved; and</DELETED>
                <DELETED>    ``(E) the methodology adopted by the 
                Service in establishing priorities under its health 
                care facility priority system.</DELETED>
        <DELETED>    ``(3) Consultation.--In preparing each report 
        required under paragraph (2) (other than the initial report) 
        the Secretary shall annually--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Review of Need for Facilities.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 302. SAFE WATER AND SANITARY WASTE DISPOSAL 
              FACILITIES.</DELETED>

<DELETED>    ``(a) Findings.--Congress finds and declares that--
</DELETED>
        <DELETED>    ``(1) the provision of safe water supply 
        facilities and sanitary sewage and solid waste disposal 
        facilities is primarily a health consideration and 
        function;</DELETED>
        <DELETED>    ``(2) Indian people suffer an inordinately high 
        incidence of disease, injury, and illness directly attributable 
        to the absence or inadequacy of such facilities;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(4) many Indian homes and communities still lack 
        safe water supply facilities and sanitary sewage and solid 
        waste disposal facilities; and</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Provision of Facilities and Services.--</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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)--</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(B) ongoing technical assistance and 
                training in the management of utility organizations 
                which operate and maintain sanitation facilities; 
                and</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) Provisions relating to funding.--
        Notwithstanding any other provision of law--</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(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);</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) any funds appropriated pursuant to this 
        section; and</DELETED>
        <DELETED>    ``(2) any funds appropriated for the purpose of 
        providing water supply, sewage disposal, or solid waste 
        facilities;</DELETED>
<DELETED>on an equal basis with programs that are administered directly 
by the Service.</DELETED>
<DELETED>    ``(h) Report.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) the current Indian sanitation 
                facility priority system of the Service;</DELETED>
                <DELETED>    ``(B) the methodology for determining 
                sanitation deficiencies;</DELETED>
                <DELETED>    ``(C) the level of initial and final 
                sanitation deficiency for each type sanitation facility 
                for each project of each Indian tribe or community; 
and</DELETED>
                <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(A) A level I deficiency is a sanitation 
                facility serving an individual or community--</DELETED>
                        <DELETED>    ``(i) which complies with all 
                        applicable water supply, pollution control and 
                        solid waste disposal laws; and</DELETED>
                        <DELETED>    ``(ii) in which the deficiencies 
                        relate to routine replacement, repair, or 
                        maintenance needs.</DELETED>
                <DELETED>    ``(B) A level II deficiency is a 
                sanitation facility serving an individual or 
                community--</DELETED>
                        <DELETED>    ``(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;</DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(i) Definitions.--In this section:</DELETED>
        <DELETED>    ``(1) Facility.--The terms `facility' or 
        `facilities' shall have the same meaning as the terms `system' 
        or `systems' unless the context requires otherwise.</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 303. PREFERENCE TO INDIANS AND INDIAN FIRMS.</DELETED>

<DELETED>    ``(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--
</DELETED>
        <DELETED>    ``(1) ownership and control by Indians;</DELETED>
        <DELETED>    ``(2) equipment;</DELETED>
        <DELETED>    ``(3) bookkeeping and accounting 
        procedures;</DELETED>
        <DELETED>    ``(4) substantive knowledge of the project or 
        function to be contracted for;</DELETED>
        <DELETED>    ``(5) adequately trained personnel; or</DELETED>
        <DELETED>    ``(6) other necessary components of contract 
        performance.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 304. SOBOBA SANITATION FACILITIES.</DELETED>

<DELETED>    ``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).</DELETED>

<DELETED>``SEC. 305. EXPENDITURE OF NONSERVICE FUNDS FOR 
              RENOVATION.</DELETED>

<DELETED>    ``(a) Permissibility.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) any plans or designs for such 
                expansion, renovation or modernization; and</DELETED>
                <DELETED>    ``(B) any expansion, renovation or 
                modernization for which funds appropriated under any 
                Federal law were lawfully expended;</DELETED>
        <DELETED>but only if the requirements of subsection (b) are 
        met.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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).</DELETED>
<DELETED>    ``(b) Requirements.--The requirements of this subsection 
are met with respect to any expansion, renovation or modernization if--
</DELETED>
        <DELETED>    ``(1) the tribe or tribal organization--</DELETED>
                <DELETED>    ``(A) provides notice to the Secretary of 
                its intent to expand, renovate or modernize; 
                and</DELETED>
                <DELETED>    ``(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</DELETED>
        <DELETED>    ``(2) the expansion renovation or modernization--
        </DELETED>
                <DELETED>    ``(A) is approved by the appropriate area 
                director of the Service for Federal facilities; 
                and</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(a) Availability of Funding.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Use of Funds.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) located apart from a 
                hospital;</DELETED>
                <DELETED>    ``(B) not funded under section 301 or 
                section 307; and</DELETED>
                <DELETED>    ``(C) which, upon completion of such 
                construction, expansion, or modernization will--
                </DELETED>
                        <DELETED>    ``(i) have a total capacity 
                        appropriate to its projected service 
                        population;</DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Application and Priority.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) adequate financial support will be 
                available for the provision of services at such 
                facility;</DELETED>
                <DELETED>    ``(B) such facility will be available to 
                eligible Indians without regard to ability to pay or 
                source of payment; and</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Priority.--In awarding funds under this 
        section, the Secretary shall give priority to tribes and tribal 
        organizations that demonstrate--</DELETED>
                <DELETED>    ``(A) a need for increased ambulatory care 
                services; and</DELETED>
                <DELETED>    ``(B) insufficient capacity to deliver 
                such services.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 307. INDIAN HEALTH CARE DELIVERY DEMONSTRATION 
              PROJECT.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--
</DELETED>
        <DELETED>    ``(1) waive any leasing prohibition;</DELETED>
        <DELETED>    ``(2) permit carryover of funds appropriated for 
        the provision of health care services;</DELETED>
        <DELETED>    ``(3) permit the use of other available 
        funds;</DELETED>
        <DELETED>    ``(4) permit the use of funds or property donated 
        from any source for project purposes;</DELETED>
        <DELETED>    ``(5) provide for the reversion of donated real or 
        personal property to the donor; and</DELETED>
        <DELETED>    ``(6) permit the use of Service funds to match 
        other funds, including Federal funds.</DELETED>
<DELETED>    ``(c) Criteria.--</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(A) There is a need for a new facility 
                or program or the reorientation of an existing facility 
                or program.</DELETED>
                <DELETED>    ``(B) A significant number of Indians, 
                including those with low health status, will be served 
                by the project.</DELETED>
                <DELETED>    ``(C) The project has the potential to 
                address the health needs of Indians in an innovative 
                manner.</DELETED>
                <DELETED>    ``(D) The project has the potential to 
                deliver services in an efficient and effective 
                manner.</DELETED>
                <DELETED>    ``(E) The project is economically 
                viable.</DELETED>
                <DELETED>    ``(F) The Indian tribe or tribal 
                organization has the administrative and financial 
                capability to administer the project.</DELETED>
                <DELETED>    ``(G) The project is integrated with 
                providers of related health and social services and is 
                coordinated with, and avoids duplication of, existing 
                services.</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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):</DELETED>
                <DELETED>    ``(A) Cass Lake, Minnesota.</DELETED>
                <DELETED>    ``(B) Clinton, Oklahoma.</DELETED>
                <DELETED>    ``(C) Harlem, Montana.</DELETED>
                <DELETED>    ``(D) Mescalero, New Mexico.</DELETED>
                <DELETED>    ``(E) Owyhee, Nevada.</DELETED>
                <DELETED>    ``(F) Parker, Arizona.</DELETED>
                <DELETED>    ``(G) Schurz, Nevada.</DELETED>
                <DELETED>    ``(H) Winnebago, Nebraska.</DELETED>
                <DELETED>    ``(I) Ft. Yuma, California.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 308. LAND TRANSFER.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 309. LEASES.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) title to;</DELETED>
        <DELETED>    ``(2) a leasehold interest in; or</DELETED>
        <DELETED>    ``(3) a beneficial interest in (where title is 
        held by the United States in trust for the benefit of a 
        tribe);</DELETED>
<DELETED>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.</DELETED>

<DELETED>``SEC. 310. LOANS, LOAN GUARANTEES AND LOAN 
              REPAYMENT.</DELETED>

<DELETED>    ``(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).</DELETED>
<DELETED>    ``(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:</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(9) Service funds authorized under loans or loan 
        guarantees under this section may be used in matching other 
        Federal funds.</DELETED>
<DELETED>    ``(c) Funding.--</DELETED>
        <DELETED>    ``(1) In general.--The HCFLF shall consist of--
        </DELETED>
                <DELETED>    ``(A) such sums as may be initially 
                appropriated to the HCFLF and as may be subsequently 
                appropriated under paragraph (2);</DELETED>
                <DELETED>    ``(B) such amounts as may be collected 
                from borrowers; and</DELETED>
                <DELETED>    ``(C) all interest earned on amounts in 
                the HCFLF.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) Availability of funds.--Amounts 
        appropriated, collected or earned relative to the HCFLF shall 
        remain available until expended.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 311. TRIBAL LEASING.</DELETED>

<DELETED>    ``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.</DELETED>

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

<DELETED>    ``(a) Authority.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Requirements.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary shall enter into 
        an arrangement under subsection (a)(1) with an Indian tribe or 
        tribal organization only if--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 313. LOCATION OF FACILITIES.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Definition.--In this section, the term `Indian 
lands' means--</DELETED>
        <DELETED>    ``(1) all lands within the exterior boundaries of 
        any Indian reservation;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 314. MAINTENANCE AND IMPROVEMENT OF HEALTH CARE 
              FACILITIES.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Maintenance of Newly Constructed Space.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Construction of Replacement Facilities.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 315. TRIBAL MANAGEMENT OF FEDERALLY-OWNED 
              QUARTERS.</DELETED>

<DELETED>    ``(a) Establishment of Rental Rates.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Objectives.--In establishing rental rates 
        under paragraph (1), an Indian tribe or tribal organization 
        shall attempt to achieve the following objectives:</DELETED>
                <DELETED>    ``(A) The rental rates should be based on 
                the reasonable value of the quarters to the occupants 
                thereof.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Collection of Rents.--</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(B) such other date as may be mutually 
                agreed upon by the Secretary and the Indian tribe or 
                tribal organization.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 316. APPLICABILITY OF BUY AMERICAN 
              REQUIREMENT.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.).</DELETED>

<DELETED>``SEC. 317. OTHER FUNDING FOR FACILITIES.</DELETED>

<DELETED>    ``Notwithstanding any other provision of law--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 318. AUTHORIZATION OF APPROPRIATIONS.</DELETED>

<DELETED>    ``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.</DELETED>

        <DELETED>``TITLE IV--ACCESS TO HEALTH SERVICES</DELETED>

<DELETED>``SEC. 401. TREATMENT OF PAYMENTS UNDER MEDICARE 
              PROGRAM.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Special Fund.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 402. TREATMENT OF PAYMENTS UNDER MEDICAID 
              PROGRAM.</DELETED>

<DELETED>    ``(a) Special Fund.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 403. REPORT.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) enroll under sections 1818, 1836, and 1837 
        of the Social Security Act;</DELETED>
        <DELETED>    ``(2) pay premiums for health insurance coverage; 
        and</DELETED>
        <DELETED>    ``(3) apply for medical assistance provided 
        pursuant to titles XIX and XXI of the Social Security 
        Act.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) assist individual Indians in becoming 
        familiar with and utilizing such benefits and 
        assistance;</DELETED>
        <DELETED>    ``(3) provide transportation to such individual 
        Indians to the appropriate offices for enrollment or 
        applications for such benefits and assistance;</DELETED>
        <DELETED>    ``(4) develop and implement--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Grants.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) enroll under sections 1818, 1836, 
                and 1837 of the Social Security Act;</DELETED>
                <DELETED>    ``(B) pay premiums on behalf of such 
                individuals for coverage under title XVIII of such Act; 
                and</DELETED>
                <DELETED>    ``(C) apply for medical assistance 
                provided under title XIX of such Act and for child 
                health assistance under title XXI of such 
                Act.</DELETED>
        <DELETED>    ``(2) Requirements.--The Secretary shall include 
        in the grants or contracts made or entered into under paragraph 
        (1) requirements that are--</DELETED>
                <DELETED>    ``(A) consistent with the conditions 
                imposed by the Secretary under subsection 
                (b);</DELETED>
                <DELETED>    ``(B) appropriate to urban Indian 
                organizations and urban Indians; and</DELETED>
                <DELETED>    ``(C) necessary to carry out the purposes 
                of this section.</DELETED>

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

<DELETED>    ``(a) Establishment of Direct Billing Program.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Direct Reimbursement.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) solely for improving the health 
                resources deficiency level of the Indian tribe; 
                and</DELETED>
                <DELETED>    ``(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.).</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Requirements for Participation.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) the Indian tribe, tribal 
                organization, or Alaska Native health organization 
                contracts or compacts for the operation of a facility 
                of the Service;</DELETED>
                <DELETED>    ``(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);</DELETED>
                <DELETED>    ``(C) the facility meets the requirements 
                that apply to programs operated directly by the 
                Service; and</DELETED>
                <DELETED>    ``(D) the facility--</DELETED>
                        <DELETED>    ``(i) is accredited by an 
                        accrediting body as eligible for reimbursement 
                        under the medicare or medicaid programs; 
                        or</DELETED>
                        <DELETED>    ``(ii) has submitted a plan, which 
                        has been approved by the Secretary, for 
                        achieving such accreditation.</DELETED>
        <DELETED>    ``(2) Approval.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Examination and Implementation of Changes.--
</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 406. REIMBURSEMENT FROM CERTAIN THIRD PARTIES OF COSTS 
              OF HEALTH SERVICES.</DELETED>

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) such services had been provided by a 
        nongovernmental provider; and</DELETED>
        <DELETED>    ``(2) such individual had been required to pay 
        such charges or expenses and did pay such expenses.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) workers' compensation laws; or</DELETED>
        <DELETED>    ``(2) a no-fault automobile accident insurance 
        plan or program.</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(f) Methods of Enforcement.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) intervening or joining in any civil 
                action or proceeding brought--</DELETED>
                        <DELETED>    ``(i) by the individual for whom 
                        health services were provided by the Secretary, 
                        an Indian tribe or tribal organization, or 
                        urban Indian organization; or</DELETED>
                        <DELETED>    ``(ii) by any representative or 
                        heirs of such individual; or</DELETED>
                <DELETED>    ``(B) instituting a civil 
                action.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(i) Right of Action Against Insurers and Employee 
Benefit Plans.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 407. CREDITING OF REIMBURSEMENTS.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>

<DELETED>``SEC. 408. PURCHASING HEALTH CARE COVERAGE.</DELETED>

<DELETED>    ``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--</DELETED>
        <DELETED>    ``(1) a tribally owned and operated managed care 
        plan;</DELETED>
        <DELETED>    ``(2) a State or locally-authorized or licensed 
        managed care plan; or</DELETED>
        <DELETED>    ``(3) a health insurance provider.</DELETED>

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

<DELETED>    ``(a) Examination of Feasibility of Arrangements.--
</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Submission of report.--Not later than 
        September 30, 2003, the Secretary shall submit the report 
        required under paragraph (1) to Congress.</DELETED>
        <DELETED>    ``(3) Consultation required.--The Secretary may 
        not finalize any arrangement described in paragraph (1) without 
        first consulting with the affected Indian tribes.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) the priority access of any Indian to health 
        care services provided through the Service;</DELETED>
        <DELETED>    ``(2) the quality of health care services provided 
        to any Indian through the Service;</DELETED>
        <DELETED>    ``(3) the priority access of any veteran to health 
        care services provided by the Veterans' 
        Administration;</DELETED>
        <DELETED>    ``(4) the quality of health care services provided 
        to any veteran by the Veteran's Administration;</DELETED>
        <DELETED>    ``(5) the eligibility of any Indian to receive 
        health services through the Service; or</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 410. PAYOR OF LAST RESORT.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 411. RIGHT TO RECOVER FROM FEDERAL HEALTH CARE 
              PROGRAMS.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 412. TUBA CITY DEMONSTRATION PROJECT.</DELETED>

<DELETED>    ``(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--
</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(2) purchase insurance to limit the financial 
        risks under the project.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 413. ACCESS TO FEDERAL INSURANCE.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 414. CONSULTATION AND RULEMAKING.</DELETED>

<DELETED>    ``(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--
</DELETED>
        <DELETED>    ``(1) identify the impact such policy or 
        regulation may have on the Service, Indian tribes or tribal 
        organizations, and urban Indian organizations;</DELETED>
        <DELETED>    ``(2) provide to the Service, Indian tribes or 
        tribal organizations, and urban Indian organizations the 
        information described in paragraph (1);</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 415. LIMITATIONS ON CHARGES.</DELETED>

<DELETED>    ``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--
</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 416. LIMITATION ON SECRETARY'S WAIVER 
              AUTHORITY.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 417. WAIVER OF MEDICARE AND MEDICAID 
              SANCTIONS.</DELETED>

<DELETED>    ``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.</DELETED>

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

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) any such Indian tribe or tribal organization 
        or urban Indian organization and the Service;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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;</DELETED>
<DELETED>provided the exchange arises from or relates to such health 
programs.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 419. CO-INSURANCE, CO-PAYMENTS, DEDUCTIBLES AND 
              PREMIUMS.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Exemption From Premiums.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 420. INCLUSION OF INCOME AND RESOURCES FOR PURPOSES OF 
              MEDICALLY NEEDY MEDICAID ELIGIBILITY.</DELETED>

<DELETED>  ``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.</DELETED>

<DELETED>``SEC. 421. ESTATE RECOVERY PROVISIONS.</DELETED>

<DELETED>    ``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:</DELETED>
        <DELETED>    ``(1) Income derived from rents, leases, or 
        royalties of property held in trust for individuals by the 
        Federal Government.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(4) Property that has unique religious or 
        cultural significance or that supports subsistence or 
        traditional life style according to applicable tribal law or 
        custom.</DELETED>

<DELETED>``SEC. 422. MEDICAL CHILD SUPPORT.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 423. PROVISIONS RELATING TO MANAGED CARE.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 424. NAVAJO NATION MEDICAID AGENCY.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 425. INDIAN ADVISORY COMMITTEES.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 426. AUTHORIZATION OF APPROPRIATIONS.</DELETED>

<DELETED>    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.''.</DELETED>

    <DELETED>``TITLE V--HEALTH SERVICES FOR URBAN INDIANS</DELETED>

<DELETED>``SEC. 501. PURPOSE.</DELETED>

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

<DELETED>``SEC. 502. CONTRACTS WITH, AND GRANTS TO, URBAN INDIAN 
              ORGANIZATIONS.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 503. CONTRACTS AND GRANTS FOR THE PROVISION OF HEALTH 
              CARE AND REFERRAL SERVICES.</DELETED>

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) estimate the current health status of urban 
        Indians residing in such urban center or centers;</DELETED>
        <DELETED>    ``(3) estimate the current health care needs of 
        urban Indians residing in such urban center or 
        centers;</DELETED>
        <DELETED>    ``(4) provide basic health education, including 
        health promotion and disease prevention education, to urban 
        Indians;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(6) where necessary, provide, or enter into 
        contracts for the provision of, health care services for urban 
        Indians.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) the extent of unmet health care needs of 
        urban Indians in the urban center or centers 
        involved;</DELETED>
        <DELETED>    ``(2) the size of the urban Indian population in 
        the urban center or centers involved;</DELETED>
        <DELETED>    ``(3) the extent, if any, to which the activities 
        set forth in subsection (a) would duplicate any project funded 
        under this title;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(5) the satisfactory performance and successful 
        completion by an urban Indian organization of other contracts 
        with the Secretary under this title;</DELETED>
        <DELETED>    ``(6) the appropriateness and likely effectiveness 
        of conducting the activities set forth in subsection (a) in an 
        urban center or centers; and</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(d) Immunization Services.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Definition.--In this section, the term 
        `immunization services' means services to provide without 
        charge immunizations against vaccine-preventable 
        diseases.</DELETED>
<DELETED>    ``(e) Mental Health Services.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) Use of funds.--Grants may be made under this 
        subsection--</DELETED>
                <DELETED>    ``(A) to prepare assessments required 
                under paragraph (2);</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(D) to develop innovative behavioral 
                health service delivery models which incorporate Indian 
                cultural support systems and resources.</DELETED>
<DELETED>    ``(f) Child Abuse.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) Use of funds.--Grants may be made under this 
        subsection--</DELETED>
                <DELETED>    ``(A) to prepare assessments required 
                under paragraph (2);</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(4) Considerations.--In making grants to carry 
        out this subsection, the Secretary shall take into 
        consideration--</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(B) the capability and expertise 
                demonstrated by the urban Indian organization to 
                address the complex problem of child sexual abuse in 
                the community; and</DELETED>
                <DELETED>    ``(C) the assessment required under 
                paragraph (2).</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 504. CONTRACTS AND GRANTS FOR THE DETERMINATION OF 
              UNMET HEALTH CARE NEEDS.</DELETED>

<DELETED>    ``(a) Authority.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Requirements.--Any contract entered into, or grant 
made, by the Secretary under this section shall include requirements 
that--</DELETED>
        <DELETED>    ``(1) the urban Indian organization successfully 
        undertake to--</DELETED>
                <DELETED>    ``(A) document the health care status and 
                unmet health care needs of urban Indians in the urban 
                center involved; and</DELETED>
                <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Limitation on Renewal.--The Secretary may not renew 
any contract entered into, or grant made, under this section.</DELETED>

<DELETED>``SEC. 505. EVALUATIONS; RENEWALS.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--
</DELETED>
        <DELETED>    ``(1) conduct, through the Service, an annual 
        onsite evaluation of the organization; or</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Noncompliance.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>

<DELETED>``SEC. 506. OTHER CONTRACT AND GRANT REQUIREMENTS.</DELETED>

<DELETED>    ``(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.).</DELETED>
<DELETED>    ``(b) Payments.--Payments under any contracts or grants 
pursuant to this title shall, notwithstanding any term or condition of 
such contract or grant--</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 507. REPORTS AND RECORDS.</DELETED>

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) in the case of a contract or grant under 
        section 503, information gathered pursuant to paragraph (5) of 
        subsection (a) of such section;</DELETED>
        <DELETED>    ``(2) information on activities conducted by the 
        organization pursuant to the contract or grant;</DELETED>
        <DELETED>    ``(3) an accounting of the amounts and purposes 
        for which Federal funds were expended; and</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--
</DELETED>
        <DELETED>    ``(1) a certified public accountant; or</DELETED>
        <DELETED>    ``(2) a certified public accounting firm qualified 
        to conduct Federal compliance audits.</DELETED>

<DELETED>``SEC. 508. LIMITATION ON CONTRACT AUTHORITY.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 509. FACILITIES.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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:</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) The loan or loan guarantee may have a term 
        of the shorter of the estimated useful life of the facility, or 
        25 years.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(5) The Secretary shall not collect application, 
        processing, or similar fees from urban Indian organizations 
        applying for loans or loan guarantees under this 
        subsection.</DELETED>
<DELETED>    ``(c) Urban Indian Health Care Facilities Revolving Loan 
Fund.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) such amounts as may be appropriated 
                to the URLF;</DELETED>
                <DELETED>    ``(B) amounts received from urban Indian 
                organizations in repayment of loans made to such 
                organizations under paragraph (2); and</DELETED>
                <DELETED>    ``(C) interest earned on amounts in the 
                URLF under paragraph (3).</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 510. OFFICE OF URBAN INDIAN HEALTH.</DELETED>

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

<DELETED>``SEC. 511. GRANTS FOR ALCOHOL AND SUBSTANCE ABUSE RELATED 
              SERVICES.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Criteria.--The Secretary shall establish criteria 
for the grants made under subsection (a), including criteria relating 
to the--</DELETED>
        <DELETED>    ``(1) size of the urban Indian 
        population;</DELETED>
        <DELETED>    ``(2) capability of the organization to adequately 
        perform the activities required under the grant;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(4) identification of need for 
        services.</DELETED>
<DELETED>The Secretary shall develop a methodology for allocating 
grants made pursuant to this section based on such criteria.</DELETED>
<DELETED>    ``(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).</DELETED>

<DELETED>``SEC. 512. TREATMENT OF CERTAIN DEMONSTRATION 
              PROJECTS.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>

<DELETED>``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 514. CONSULTATION WITH URBAN INDIAN 
              ORGANIZATIONS.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 515. FEDERAL TORT CLAIMS ACT COVERAGE.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 516. URBAN YOUTH TREATMENT CENTER 
              DEMONSTRATION.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) States.--A State described in this subsection is a 
State in which--</DELETED>
        <DELETED>    ``(1) there reside urban Indian youth with a need 
        for alcohol and substance abuse treatment services in a 
        residential setting; and</DELETED>
        <DELETED>    ``(2) there is a significant shortage of 
        culturally competent residential treatment services for urban 
        Indian youth.</DELETED>

<DELETED>``SEC. 517. USE OF FEDERAL GOVERNMENT FACILITIES AND SOURCES 
              OF SUPPLY.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 518. GRANTS FOR DIABETES PREVENTION, TREATMENT AND 
              CONTROL.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Criteria.--The Secretary shall establish criteria 
for the awarding of grants made under subsection (a) relating to--
</DELETED>
        <DELETED>    ``(1) the size and location of the urban Indian 
        population to be served;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(4) the capability of the urban Indian 
        organization to adequately perform the activities required 
        under the grant; and</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>

<DELETED>``SEC. 519. COMMUNITY HEALTH REPRESENTATIVES.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 520. REGULATIONS.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Promulgation.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary may promulgate 
        regulations to implement the provisions of this 
        title.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Adaption of Procedures.--The Secretary shall adapt 
the negotiated rulemaking procedures to the unique context of this 
Act.</DELETED>

<DELETED>``SEC. 521. AUTHORIZATION OF APPROPRIATIONS.</DELETED>

<DELETED>    ``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.</DELETED>

       <DELETED>``TITLE VI--ORGANIZATIONAL IMPROVEMENTS</DELETED>

<DELETED>``SEC. 601. ESTABLISHMENT OF THE INDIAN HEALTH SERVICE AS AN 
              AGENCY OF THE PUBLIC HEALTH SERVICE.</DELETED>

<DELETED>    ``(a) Establishment.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Functions and Duties.--The Secretary shall carry out 
through the Assistant Secretary of the Service--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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--
        </DELETED>
                <DELETED>    ``(A) this Act;</DELETED>
                <DELETED>    ``(B) the Act of November 2, 1921 (25 
                U.S.C. 13);</DELETED>
                <DELETED>    ``(C) the Act of August 5, 1954 (42 U.S.C. 
                2001, et seq.);</DELETED>
                <DELETED>    ``(D) the Act of August 16, 1957 (42 
                U.S.C. 2005 et seq.); and</DELETED>
                <DELETED>    ``(E) the Indian Self-Determination Act 
                (25 U.S.C. 450f, et seq.); and</DELETED>
        <DELETED>    ``(4) all scholarship and loan functions carried 
        out under title I.</DELETED>
<DELETED>    ``(d) Authority.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary, acting through 
        the Assistant Secretary, shall have the authority--</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(B) to enter into contracts for the 
                procurement of goods and services to carry out the 
                functions of the Service; and</DELETED>
                <DELETED>    ``(C) to manage, expend, and obligate all 
                funds appropriated for the Service.</DELETED>
        <DELETED>    ``(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).</DELETED>

<DELETED>``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.</DELETED>

<DELETED>    ``(a) Establishment.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Requirements of system.--The information 
        system established under paragraph (1) shall include--
        </DELETED>
                <DELETED>    ``(A) a financial management 
                system;</DELETED>
                <DELETED>    ``(B) a patient care information 
                system;</DELETED>
                <DELETED>    ``(C) a privacy component that protects 
                the privacy of patient information;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(E) an interface mechanism for patient 
                billing and accounts receivable system; and</DELETED>
                <DELETED>    ``(F) a training component.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(2) meet the management information needs of the 
        Service.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 603. AUTHORIZATION OF APPROPRIATIONS.</DELETED>

<DELETED>    ``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.</DELETED>

       <DELETED>``TITLE VII--BEHAVIORAL HEALTH PROGRAMS</DELETED>

<DELETED>``SEC. 701. BEHAVIORAL HEALTH PREVENTION AND TREATMENT 
              SERVICES.</DELETED>

<DELETED>    ``(a) Purposes.--It is the purpose of this section to--
</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(3) assist Indian tribes to identify services 
        and resources available to address mental illness and 
        dysfunctional and self-destructive behavior;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(6) modify or supplement existing programs and 
        authorities in the areas identified in paragraph (2).</DELETED>
<DELETED>    ``(b) Behavioral Health Planning.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(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--</DELETED>
                        <DELETED>    ``(i) the number of Indians served 
                        who are directly or indirectly affected by such 
                        illness or behavior; and</DELETED>
                        <DELETED>    ``(ii) an estimate of the 
                        financial and human cost attributable to such 
                        illness or behavior;</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) a comprehensive continuum of behavioral 
        health care that provides for--</DELETED>
                <DELETED>    ``(A) community based prevention, 
                intervention, outpatient and behavioral health 
                aftercare;</DELETED>
                <DELETED>    ``(B) detoxification (social and 
                medical);</DELETED>
                <DELETED>    ``(C) acute hospitalization;</DELETED>
                <DELETED>    ``(D) intensive outpatient or day 
                treatment;</DELETED>
                <DELETED>    ``(E) residential treatment;</DELETED>
                <DELETED>    ``(F) transitional living for those 
                needing a temporary stable living environment that is 
                supportive of treatment or recovery goals;</DELETED>
                <DELETED>    ``(G) emergency shelter;</DELETED>
                <DELETED>    ``(H) intensive case management;</DELETED>
                <DELETED>    ``(I) traditional health care practices; 
                and</DELETED>
                <DELETED>    ``(J) diagnostic services, including the 
                utilization of neurological assessment technology; 
                and</DELETED>
        <DELETED>    ``(2) behavioral health services for particular 
        populations, including--</DELETED>
                <DELETED>    ``(A) for persons from birth through age 
                17, child behavioral health services, that include--
                </DELETED>
                        <DELETED>    ``(i) pre-school and school age 
                        fetal alcohol disorder services, including 
                        assessment and behavioral 
                        intervention);</DELETED>
                        <DELETED>    ``(ii) mental health or substance 
                        abuse services (emotional, organic, alcohol, 
                        drug, inhalant and tobacco);</DELETED>
                        <DELETED>    ``(iii) services for co-occurring 
                        disorders (multiple diagnosis);</DELETED>
                        <DELETED>    ``(iv) prevention services that 
                        are focused on individuals ages 5 years through 
                        10 years (alcohol, drug, inhalant and 
                        tobacco);</DELETED>
                        <DELETED>    ``(v) early intervention, 
                        treatment and aftercare services that are 
                        focused on individuals ages 11 years through 17 
                        years;</DELETED>
                        <DELETED>    ``(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);</DELETED>
                        <DELETED>    ``(vii) co-morbidity 
                        services;</DELETED>
                <DELETED>    ``(B) for persons ages 18 years through 55 
                years, adult behavioral health services that include--
                </DELETED>
                        <DELETED>    ``(i) early intervention, 
                        treatment and aftercare services;</DELETED>
                        <DELETED>    ``(ii) mental health and substance 
                        abuse services (emotional, alcohol, drug, 
                        inhalant and tobacco);</DELETED>
                        <DELETED>    ``(iii) services for co-occurring 
                        disorders (dual diagnosis) and co-
                        morbidity;</DELETED>
                        <DELETED>    ``(iv) healthy choices and life 
                        style services (related to parenting, partners, 
                        domestic violence, sexual abuse, suicide, 
                        obesity, and other risk related 
                        behavior);</DELETED>
                        <DELETED>    ``(v) female specific treatment 
                        services for--</DELETED>
                                <DELETED>    ``(I) women at risk of 
                                giving birth to a child with a fetal 
                                alcohol disorder;</DELETED>
                                <DELETED>    ``(II) substance abuse 
                                requiring gender specific 
                                services;</DELETED>
                                <DELETED>    ``(III) sexual assault and 
                                domestic violence; and</DELETED>
                                <DELETED>    ``(IV) healthy choices and 
                                life style (parenting, partners, 
                                obesity, suicide and other related 
                                behavioral risk); and</DELETED>
                        <DELETED>    ``(vi) male specific treatment 
                        services for--</DELETED>
                                <DELETED>    ``(I) substance abuse 
                                requiring gender specific 
                                services;</DELETED>
                                <DELETED>    ``(II) sexual assault and 
                                domestic violence; and</DELETED>
                                <DELETED>    ``(III) healthy choices 
                                and life style (parenting, partners, 
                                obesity, suicide and other risk related 
behavior);</DELETED>
                <DELETED>    ``(C) family behavioral health services, 
                including--</DELETED>
                        <DELETED>    ``(i) early intervention, 
                        treatment and aftercare for affected 
                        families;</DELETED>
                        <DELETED>    ``(ii) treatment for sexual 
                        assault and domestic violence; and</DELETED>
                        <DELETED>    ``(iii) healthy choices and life 
                        style (related to parenting, partners, domestic 
                        violence and other abuse issues);</DELETED>
                <DELETED>    ``(D) for persons age 56 years and older, 
                elder behavioral health services including--</DELETED>
                        <DELETED>    ``(i) early intervention, 
                        treatment and aftercare services that include--
                        </DELETED>
                                <DELETED>    ``(I) mental health and 
                                substance abuse services (emotional, 
                                alcohol, drug, inhalant and 
                                tobacco);</DELETED>
                                <DELETED>    ``(II) services for co-
                                occurring disorders (dual diagnosis) 
                                and co-morbidity; and</DELETED>
                                <DELETED>    ``(III) healthy choices 
                                and life style services (managing 
                                conditions related to aging);</DELETED>
                        <DELETED>    ``(ii) elder women specific 
                        services that include--</DELETED>
                                <DELETED>    ``(I) treatment for 
                                substance abuse requiring gender 
                                specific services and</DELETED>
                                <DELETED>    ``(II) treatment for 
                                sexual assault, domestic violence and 
                                neglect;</DELETED>
                        <DELETED>    ``(iii) elder men specific 
                        services that include--</DELETED>
                                <DELETED>    ``(I) treatment for 
                                substance abuse requiring gender 
                                specific services; and</DELETED>
                                <DELETED>    ``(II) treatment for 
                                sexual assault, domestic violence and 
                                neglect; and</DELETED>
                        <DELETED>    ``(iv) services for dementia 
                        regardless of cause.</DELETED>
<DELETED>    ``(d) Community Behavioral Health Plan.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 702. MEMORANDUM OF AGREEMENT WITH THE DEPARTMENT OF THE 
              INTERIOR.</DELETED>

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) the scope and nature of mental illness and 
        dysfunctional and self-destructive behavior, including child 
        abuse and family violence, among Indians;</DELETED>
        <DELETED>    ``(2) the existing Federal, tribal, State, local, 
        and private services, resources, and programs available to 
        provide mental health services for Indians;</DELETED>
        <DELETED>    ``(3) the unmet need for additional services, 
        resources, and programs necessary to meet the needs identified 
        pursuant to paragraph (1);</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(B) the right of Indians to participate in, and 
        receive the benefit of, such services; and</DELETED>
        <DELETED>    ``(C) the actions necessary to protect the 
        exercise of such right;</DELETED>
        <DELETED>    ``(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);</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) Indian tribes and tribal 
        organizations;</DELETED>
        <DELETED>    ``(2) Indian individuals;</DELETED>
        <DELETED>    ``(3) urban Indian organizations and other Indian 
        organizations;</DELETED>
        <DELETED>    ``(4) behavioral health service 
        providers.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 703. COMPREHENSIVE BEHAVIORAL HEALTH PREVENTION AND 
              TREATMENT PROGRAM.</DELETED>

<DELETED>    ``(a) Establishment.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) prevention, through educational 
                intervention, in Indian communities;</DELETED>
                <DELETED>    ``(B) acute detoxification or psychiatric 
                hospitalization and treatment (residential and 
                intensive outpatient);</DELETED>
                <DELETED>    ``(C) community-based rehabilitation and 
                aftercare;</DELETED>
                <DELETED>    ``(D) community education and involvement, 
                including extensive training of health care, 
                educational, and community-based personnel;</DELETED>
                <DELETED>    ``(E) specialized residential treatment 
                programs for high risk populations including pregnant 
                and post partum women and their children;</DELETED>
                <DELETED>    ``(F) diagnostic services utilizing, when 
                appropriate, neuropsychiatric assessments which include 
                the use of the most advances technology available; 
                and</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Contract Health Services.--</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.</DELETED>

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) provides for the training of Indians as 
        mental health technicians; and</DELETED>
        <DELETED>    ``(2) employs such technicians in the provision of 
        community-based mental health care that includes 
        identification, prevention, education, referral, and treatment 
        services.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Supervision and Evaluation.--The Secretary shall 
supervise and evaluate the mental health technicians in the training 
program under this section.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 705. LICENSING REQUIREMENT FOR MENTAL HEALTH CARE 
              WORKERS.</DELETED>

<DELETED>    ``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--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Use of Funds.--Funding provided pursuant to this 
section may be used to--</DELETED>
        <DELETED>    ``(1) develop and provide community training, 
        education, and prevention programs for Indian women relating to 
        behavioral health issues, including fetal alcohol 
        disorders;</DELETED>
        <DELETED>    ``(2) identify and provide psychological services, 
        counseling, advocacy, support, and relapse prevention to Indian 
        women and their families; and</DELETED>
        <DELETED>    ``(3) develop prevention and intervention models 
        for Indian women which incorporate traditional health care 
        practices, cultural values, and community and family 
        involvement.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 707. INDIAN YOUTH PROGRAM.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Alcohol and Substance Abuse Treatment Centers or 
Facilities.--</DELETED>
        <DELETED>    ``(1) Establishment.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(4) Specific provision of funds.--</DELETED>
                <DELETED>    ``(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--
                </DELETED>
                        <DELETED>    ``(i) the Tanana Chiefs 
                        Conference, Incorporated, for the purpose of 
                        leasing, constructing, renovating, operating 
                        and maintaining a residential youth treatment 
                        facility in Fairbanks, Alaska;</DELETED>
                        <DELETED>    ``(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));</DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Intermediate Adolescent Behavioral Health 
Services.--</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) pre-treatment assistance;</DELETED>
                <DELETED>    ``(B) inpatient, outpatient, and after-
                care services;</DELETED>
                <DELETED>    ``(C) emergency care;</DELETED>
                <DELETED>    ``(D) suicide prevention and crisis 
                intervention; and</DELETED>
                <DELETED>    ``(E) prevention and treatment of mental 
                illness, and dysfunctional and self-destructive 
                behavior, including child abuse and family 
                violence.</DELETED>
        <DELETED>    ``(2) Use of funds.--Funds provided under this 
        subsection may be used--</DELETED>
                <DELETED>    ``(A) to construct or renovate an existing 
                health facility to provide intermediate behavioral 
                health services;</DELETED>
                <DELETED>    ``(B) to hire behavioral health 
                professionals;</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(D) to make renovations and hire 
                appropriate staff to convert existing hospital beds 
                into adolescent psychiatric units; and</DELETED>
                <DELETED>    ``(E) to provide intensive home- and 
                community-based services, including collaborative 
                systems of care.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Federally Owned Structures.--</DELETED>
        <DELETED>    ``(1) In general.--The Secretary, acting through 
        the Service, shall, in consultation with Indian tribes and 
        tribal organizations--</DELETED>
                <DELETED>    ``(A) identify and use, where appropriate, 
                federally owned structures suitable for local 
                residential or regional behavioral health treatment for 
                Indian youth; and</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(e) Rehabilitation and Aftercare Services.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

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

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 709. TRAINING AND COMMUNITY EDUCATION.</DELETED>

<DELETED>    ``(a) Community Education.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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).</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) the elevated risk of alcohol and behavioral 
        health problems faced by children of alcoholics;</DELETED>
        <DELETED>    ``(2) the cultural, spiritual, and 
        multigenerational aspects of behavioral health problem 
        prevention and recovery; and</DELETED>
        <DELETED>    ``(3) community-based and multidisciplinary 
        strategies for preventing and treating behavioral health 
        problems.</DELETED>

<DELETED>``SEC. 710. BEHAVIORAL HEALTH PROGRAM.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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:</DELETED>
        <DELETED>    ``(1) Whether the project will address significant 
        unmet behavioral health needs among Indians.</DELETED>
        <DELETED>    ``(2) Whether the project will serve a significant 
        number of Indians.</DELETED>
        <DELETED>    ``(3) Whether the project has the potential to 
        deliver services in an efficient and effective 
        manner.</DELETED>
        <DELETED>    ``(4) Whether the tribe or tribal organization has 
        the administrative and financial capability to administer the 
        project.</DELETED>
        <DELETED>    ``(5) Whether the project will deliver services in 
        a manner consistent with traditional health care.</DELETED>
        <DELETED>    ``(6) Whether the project is coordinated with, and 
        avoids duplication of, existing services.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 711. FETAL ALCOHOL DISORDER FUNDING.</DELETED>

<DELETED>    ``(a) Establishment of Program.--</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(2) Use of funds.--Funding provided pursuant to 
        this section shall be used to--</DELETED>
                <DELETED>    ``(A) develop and provide community and 
                in-school training, education, and prevention programs 
                relating to fetal alcohol disorders;</DELETED>
                <DELETED>    ``(B) identify and provide behavioral 
                health treatment to high-risk women;</DELETED>
                <DELETED>    ``(C) identify and provide appropriate 
                educational and vocational support, counseling, 
                advocacy, and information to fetal alcohol disorder 
                affected persons and their families or 
                caretakers;</DELETED>
                <DELETED>    ``(D) develop and implement counseling and 
                support programs in schools for fetal alcohol disorder 
                affected children;</DELETED>
                <DELETED>    ``(E) develop prevention and intervention 
                models which incorporate traditional practitioners, 
                cultural and spiritual values and community 
                involvement;</DELETED>
                <DELETED>    ``(F) develop, print, and disseminate 
                education and prevention materials on fetal alcohol 
                disorders;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(H) develop early childhood intervention 
                projects from birth on to mitigate the effects of fetal 
                alcohol disorders; and</DELETED>
                <DELETED>    ``(I) develop and fund community-based 
                adult fetal alcohol disorder housing and support 
                services.</DELETED>
        <DELETED>    ``(3) Criteria.--The Secretary shall establish 
        criteria for the review and approval of applications for 
        funding under this section.</DELETED>
<DELETED>    ``(b) Provision of Services.--The Secretary, acting 
through the Service, Indian tribes, tribal organizations and urban 
Indian organizations, shall--</DELETED>
        <DELETED>    ``(1) develop and provide services for the 
        prevention, intervention, treatment, and aftercare for those 
        affected by fetal alcohol disorders in Indian communities; 
        and</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Task Force.--</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 712. CHILD SEXUAL ABUSE AND PREVENTION TREATMENT 
              PROGRAMS.</DELETED>

<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) victims of child sexual abuse; and</DELETED>
        <DELETED>    ``(2) perpetrators of child sexual 
        abuse.</DELETED>
<DELETED>    ``(b) Use of Funds.--Funds provided under this section 
shall be used to--</DELETED>
        <DELETED>    ``(1) develop and provide community education and 
        prevention programs related to child sexual abuse;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(3) develop prevention and intervention models 
        which incorporate traditional health care practitioners, 
        cultural and spiritual values, and community 
        involvement;</DELETED>
        <DELETED>    ``(4) develop and implement, though the tribal 
        consultation process, culturally sensitive assessment and 
        diagnostic tools for use in tribal and urban Indian 
        communities.</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 713. BEHAVIORAL MENTAL HEALTH RESEARCH.</DELETED>

<DELETED>    ``(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--
</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(2) the development of models of prevention 
        techniques.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 714. DEFINITIONS.</DELETED>

<DELETED>    ``In this title:</DELETED>
        <DELETED>    ``(1) Assessment.--The term `assessment' means the 
        systematic collection, analysis and dissemination of 
        information on health status, health needs and health 
        problems.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(4) Behavioral health aftercare.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(6) Fetal alcohol disorders.--The term `fetal 
        alcohol disorders' means fetal alcohol syndrome, partial fetal 
        alcohol syndrome, or alcohol related neural developmental 
        disorder.</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(A) Central nervous system involvement 
                such as developmental delay, intellectual deficit, 
                microencephaly, or neurologic abnormalities.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(C) Prenatal or postnatal growth 
                delay.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(9) Rehabilitation.--The term `rehabilitation' 
        means to restore the ability or capacity to engage in usual and 
        customary life activities through education and 
        therapy.</DELETED>
        <DELETED>    ``(10) Substance abuse.--The term `substance 
        abuse' includes inhalant abuse.</DELETED>

<DELETED>``SEC. 715. AUTHORIZATION OF APPROPRIATIONS.</DELETED>

<DELETED>    ``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.</DELETED>

             <DELETED>``TITLE VIII--MISCELLANEOUS</DELETED>

<DELETED>``SEC. 801. REPORTS.</DELETED>

<DELETED>    ``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--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(3) a report on the use of health services by 
        Indians--</DELETED>
                <DELETED>    ``(A) on a national and area or other 
                relevant geographical basis;</DELETED>
                <DELETED>    ``(B) by gender and age;</DELETED>
                <DELETED>    ``(C) by source of payment and type of 
                service;</DELETED>
                <DELETED>    ``(D) comparing such rates of use with 
                rates of use among comparable non-Indian populations; 
                and</DELETED>
                <DELETED>    ``(E) on the services provided under 
                funding agreements pursuant to the Indian Self-
                Determination and Education Assistance Act;</DELETED>
        <DELETED>    ``(4) a report of contractors concerning health 
        care educational loan repayments under section 110;</DELETED>
        <DELETED>    ``(5) a general audit report on the health care 
        educational loan repayment program as required under section 
        110(n);</DELETED>
        <DELETED>    ``(6) a separate statement that specifies the 
        amount of funds requested to carry out the provisions of 
        section 201;</DELETED>
        <DELETED>    ``(7) a report on infectious diseases as required 
        under section 212;</DELETED>
        <DELETED>    ``(8) a report on environmental and nuclear health 
        hazards as required under section 214;</DELETED>
        <DELETED>    ``(9) a report on the status of all health care 
        facilities needs as required under sections 301(c)(2) and 
        301(d);</DELETED>
        <DELETED>    ``(10) a report on safe water and sanitary waste 
        disposal facilities as required under section 
        302(h)(1);</DELETED>
        <DELETED>    ``(11) a report on the expenditure of non-service 
        funds for renovation as required under sections 305(a)(2) and 
        305(a)(3);</DELETED>
        <DELETED>    ``(12) a report identifying the backlog of 
        maintenance and repair required at Service and tribal 
        facilities as required under section 314(a);</DELETED>
        <DELETED>    ``(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);</DELETED>
        <DELETED>    ``(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);</DELETED>
        <DELETED>    ``(15) a report on the evaluation and renewal of 
        urban Indian programs as required under section 505;</DELETED>
        <DELETED>    ``(16) a report on the findings and conclusions 
        derived from the demonstration project as required under 
        section 512(a)(2);</DELETED>
        <DELETED>    ``(17) a report on the evaluation of programs as 
        required under section 513; and</DELETED>
        <DELETED>    ``(18) a report on alcohol and substance abuse as 
        required under section 701(f).</DELETED>

<DELETED>``SEC. 802. REGULATIONS.</DELETED>

<DELETED>    ``(a) Initiation of Rulemaking Procedures.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) Expiration of authority.--The authority to 
        promulgate regulations under this Act shall expire 18 months 
        from the date of enactment of this Act.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(d) Failure To Promulgate Regulations.--The lack of 
promulgated regulations shall not limit the effect of this 
Act.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 803. PLAN OF IMPLEMENTATION.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 804. AVAILABILITY OF FUNDS.</DELETED>

<DELETED>    ``Amounts appropriated under this Act shall remain 
available until expended.</DELETED>

<DELETED>``SEC. 805. LIMITATION ON USE OF FUNDS APPROPRIATED TO THE 
              INDIAN HEALTH SERVICE.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.</DELETED>

<DELETED>    ``(a) Eligibility.--</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(A) Any member of a federally recognized 
                Indian tribe.</DELETED>
                <DELETED>    ``(B) Any descendant of an Indian who was 
                residing in California on June 1, 1852, but only if 
                such descendant--</DELETED>
                        <DELETED>    ``(i) is a member of the Indian 
                        community served by a local program of the 
                        Service; and</DELETED>
                        <DELETED>    ``(ii) is regarded as an Indian by 
                        the community in which such descendant 
                        lives.</DELETED>
                <DELETED>    ``(C) Any Indian who holds trust interests 
                in public domain, national forest, or Indian 
                reservation allotments in California.</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 807. HEALTH SERVICES FOR INELIGIBLE PERSONS.</DELETED>

<DELETED>    ``(a) Ineligible Persons.--</DELETED>
        <DELETED>    ``(1) In general.--Any individual who--</DELETED>
                <DELETED>    ``(A) has not attained 19 years of 
                age;</DELETED>
                <DELETED>    ``(B) is the natural or adopted child, 
                step-child, foster-child, legal ward, or orphan of an 
                eligible Indian; and</DELETED>
                <DELETED>    ``(C) is not otherwise eligible for the 
                health services provided by the Service,</DELETED>
        <DELETED>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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Programs and Services.--</DELETED>
        <DELETED>    ``(1) Programs.--</DELETED>
                <DELETED>    ``(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--</DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(ii) the Secretary and the 
                        Indian tribe or tribes have jointly determined 
                        that--</DELETED>
                                <DELETED>    ``(I) the provision of 
                                such health services will not result in 
                                a denial or diminution of health 
                                services to eligible Indians; 
                                and</DELETED>
                                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(2) Liability for payment.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) Service areas.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) achieve stability in a medical 
        emergency;</DELETED>
        <DELETED>    ``(2) prevent the spread of a communicable disease 
        or otherwise deal with a public health hazard;</DELETED>
        <DELETED>    ``(3) provide care to non-Indian women pregnant 
        with an eligible Indian's child for the duration of the 
        pregnancy through post partum; or</DELETED>
        <DELETED>    ``(4) provide care to immediate family members of 
        an eligible person if such care is directly related to the 
        treatment of the eligible person.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 808. REALLOCATION OF BASE RESOURCES.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.</DELETED>

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

<DELETED>``SEC. 810. PROVISION OF SERVICES IN MONTANA.</DELETED>

<DELETED>    ``(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).</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 811. MORATORIUM.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 812. TRIBAL EMPLOYMENT.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 813. PRIME VENDOR.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 814. NATIONAL BI-PARTISAN COMMISSION ON INDIAN HEALTH 
              CARE ENTITLEMENT.</DELETED>

<DELETED>    ``(a) Establishment.--There is hereby established the 
National Bi-Partisan Indian Health Care Entitlement Commission 
(referred to in this Act as the `Commission').</DELETED>
<DELETED>    ``(b) Membership.--The Commission shall be composed of 25 
members, to be appointed as follows:</DELETED>
        <DELETED>    ``(1) Ten members of Congress, of which--
        </DELETED>
                <DELETED>    ``(A) three members shall be from the 
                House of Representatives and shall be appointed by the 
                majority leader;</DELETED>
                <DELETED>    ``(B) three members shall be from the 
                House of Representatives and shall be appointed by the 
                minority leader;</DELETED>
                <DELETED>    ``(C) two members shall be from the Senate 
                and shall be appointed by the majority leader; 
                and</DELETED>
                <DELETED>    ``(D) two members shall be from the Senate 
                and shall be appointed by the minority 
                leader;</DELETED>
        <DELETED>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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>All those persons appointed under paragraphs (2) and (3) shall 
be members of Federally recognized Indian tribes.</DELETED>
<DELETED>    ``(c) Terms.--</DELETED>
        <DELETED>    ``(1) In general.--Members of the Commission shall 
        serve for the life of the Commission.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) Vacancy.--A vacancy in the membership of the 
        Commission shall be filled in the manner in which the original 
        appointment was made.</DELETED>
<DELETED>    ``(d) Duties of the Commission.--The Commission shall 
carry out the following duties and functions:</DELETED>
        <DELETED>    ``(1) Review and analyze the recommendations of 
        the report of the study committee established under paragraph 
        (3) to the Commission.</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(C) determine the effect of the 
                enactment of such recommendations on the existing 
                system of the delivery of health services for 
                Indians;</DELETED>
                <DELETED>    ``(D) determine the effect of a health 
                services entitlement program for Indian persons on the 
                sovereign status of Indian tribes;</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(e) Administrative Provisions.--</DELETED>
        <DELETED>    ``(1) Compensation and expenses.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Meetings and quorum.--</DELETED>
                <DELETED>    ``(A) Meetings.--The Commission shall meet 
                at the call of the chairperson.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) Director and staff.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(B) Staff.--With the approval of the 
                Commission, the executive director may appoint such 
                personnel as the executive director deems 
                appropriate.</DELETED>
                <DELETED>    ``(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).</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(f) Powers.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) Cost estimates.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 815. APPROPRIATIONS; AVAILABILITY.</DELETED>

<DELETED>    ``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.</DELETED>

<DELETED>``SEC. 816. AUTHORIZATION OF APPROPRIATIONS.</DELETED>

<DELETED>    ``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.''.</DELETED>

    <DELETED>TITLE II--CONFORMING AMENDMENTS TO THE SOCIAL SECURITY 
                             ACT</DELETED>

                <DELETED>Subtitle A--Medicare</DELETED>

<DELETED>SEC. 201. LIMITATIONS ON CHARGES.</DELETED>

<DELETED>    Section 1866(a)(1) of the Social Security Act (42 U.S.C. 
1395cc(a)(1)) is amended--</DELETED>
        <DELETED>    (1) in subparagraph (R), by striking ``and'' at 
        the end;</DELETED>
        <DELETED>    (2) in subparagraph (S), by striking the period 
        and inserting ``, and''; and</DELETED>
        <DELETED>    (3) by adding at the end the following:</DELETED>
        <DELETED>    ``(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.''.</DELETED>

<DELETED>SEC. 202. QUALIFIED INDIAN HEALTH PROGRAM.</DELETED>

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

          <DELETED>``qualified indian health program</DELETED>

<DELETED>    ``Sec. 1880A. (a) Definition of Qualified Indian Health 
Program.--In this section:</DELETED>
        <DELETED>    ``(1) In general.--The term `qualified Indian 
        health program' means a health program operated by--</DELETED>
                <DELETED>    ``(A) the Indian Health Service;</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Determination of Payments.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Definition of full cost recovery.--
        </DELETED>
                <DELETED>    ``(A) In general.--Subject to subparagraph 
                (B), in this section, the term `full cost recovery' 
                means the sum of--</DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(ii) indirect costs which, in 
                        the case of a qualified Indian health program--
                        </DELETED>
                                <DELETED>    ``(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</DELETED>
                                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(4) Determination of all-inclusive encounter or 
        per diem amount.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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--
        </DELETED>
                <DELETED>    ``(A) a significant decrease in 
                discharges;</DELETED>
                <DELETED>    ``(B) costs for graduate medical education 
                programs;</DELETED>
                <DELETED>    ``(C) additional payment as a 
                disproportionate share hospital with a payment 
                adjustment factor of 10; and</DELETED>
                <DELETED>    ``(D) payment for outlier cases.</DELETED>
        <DELETED>    ``(6) Election of payment.--A qualified Indian 
        health program may elect to receive payment for services 
        provided under this section--</DELETED>
                <DELETED>    ``(A) on the full cost recovery basis 
                provided in paragraphs (1) through (5);</DELETED>
                <DELETED>    ``(B) on the basis of the inpatient or 
                outpatient encounter rates established for Indian 
                Health Service facilities and published annually in the 
                Federal Register;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(D) on the basis of any other rate or 
                methodology applicable to the Indian Health Service or 
                an Indian tribe or tribal organization; or</DELETED>
                <DELETED>    ``(E) on the basis of any rate or 
                methodology negotiated with the agency responsible for 
                making payment.</DELETED>
<DELETED>    ``(d) Election of Reimbursement for Other Services.--
</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Option to include additional services.--An 
        election under paragraph (1) may include, at the election of 
        the qualified Indian health program--</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(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);</DELETED>
                <DELETED>    ``(E) influenza and pneumococcal 
                immunizations;</DELETED>
                <DELETED>    ``(F) other immunizations for prevention 
                of communicable diseases when targeted; and</DELETED>
                <DELETED>    ``(G) the cost of transportation for 
                providers or patients necessary to facilitate access 
                for patients.''.</DELETED>

                <DELETED>Subtitle B--Medicaid</DELETED>

<DELETED>SEC. 211. STATE CONSULTATION WITH INDIAN HEALTH 
              PROGRAMS.</DELETED>

<DELETED>    Section 1902(a) of the Social Security Act (42 U.S.C. 
1396a(a)) is amended--</DELETED>
        <DELETED>    (1) in paragraph (64), by striking ``and'' at the 
        end:</DELETED>
        <DELETED>    (2) in paragraph (65), by striking the period and 
        inserting ``; and''; and</DELETED>
        <DELETED>    (3) by inserting after paragraph (65), the 
        following:</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(B) such consultation is carried out in 
                collaboration with the Indian Medicaid Advisory 
                Committee established under section 415(a)(3) of that 
                Act.''.</DELETED>

<DELETED>SEC. 212. FMAP FOR SERVICES PROVIDED BY INDIAN HEALTH 
              PROGRAMS.</DELETED>

<DELETED>    The third sentence of Section 1905(b) of the Social 
Security Act (42 U.S.C. 1396d(b)) is amended to read as 
follows:</DELETED>
<DELETED>``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.''.</DELETED>

<DELETED>SEC. 213. INDIAN HEALTH SERVICE PROGRAMS.</DELETED>

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

          <DELETED>``indian health service programs</DELETED>

<DELETED>    ``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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.''.</DELETED>

        <DELETED>Subtitle C--State Children's Health Insurance 
                           Program</DELETED>

<DELETED>SEC. 221. ENHANCED FMAP FOR STATE CHILDREN'S HEALTH INSURANCE 
              PROGRAM.</DELETED>

<DELETED>    (a) In General.--Section 2105(b) of the Social Security 
Act (42 U.S.C. 1397ee(b)) is amended--</DELETED>
        <DELETED>    (1) by striking ``For purposes'' and inserting the 
        following:</DELETED>
        <DELETED>    ``(1) In general.--Subject to paragraph (2), for 
        purposes''; and</DELETED>
        <DELETED>    (2) by adding at the end the following:</DELETED>
        <DELETED>    ``(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).''.</DELETED>
<DELETED>    (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,''.</DELETED>

<DELETED>SEC. 222. DIRECT FUNDING OF STATE CHILDREN'S HEALTH INSURANCE 
              PROGRAM.</DELETED>

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

<DELETED>``SEC. 2111. DIRECT FUNDING OF INDIAN HEALTH 
              PROGRAMS.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(2) under an agreement entered into under 
        subsection (a) between the entity and the 
        Secretary.''.</DELETED>

     <DELETED>Subtitle D--Authorization of Appropriations</DELETED>

<DELETED>SEC. 231. AUTHORIZATION OF APPROPRIATIONS.</DELETED>

<DELETED>    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.</DELETED>

         <DELETED>TITLE III--MISCELLANEOUS PROVISIONS</DELETED>

<DELETED>SEC. 301. REPEALS.</DELETED>

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

<DELETED>SEC. 302. SEVERABILITY PROVISIONS.</DELETED>

<DELETED>    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.</DELETED>

<DELETED>SEC. 303. EFFECTIVE DATE.</DELETED>

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Indian Health Care Improvement Act 
Amendments of 2004''.

SEC. 2. INDIAN HEALTH CARE IMPROVEMENT ACT AMENDED.

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

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

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

Sec. 1. Short title.
Sec. 2. Indian Health Care Improvement Act amended.
        ``Sec. 1. Short title; table of contents.
        ``Sec. 2. Findings.
        ``Sec. 3. Declaration of National Indian health policy.
        ``Sec. 4. Definitions.

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

        ``Sec. 101. Purpose.
        ``Sec. 102. Health Professions Recruitment Program for Indians.
        ``Sec. 103. Health Professions Preparatory Scholarship Program 
                            for Indians.
        ``Sec. 104. Indian health professions scholarships.
        ``Sec. 105. American Indians into psychology program.
        ``Sec. 106. Funding for tribes for scholarship programs.
        ``Sec. 107. Indian Health Service extern programs.
        ``Sec. 108. Continuing education allowances.
        ``Sec. 109. Community Health Representative Program.
        ``Sec. 110. Indian Health Service Loan Repayment Program.
        ``Sec. 111. Scholarship and loan repayment recovery fund.
        ``Sec. 112. Recruitment activities.
        ``Sec. 113. Indian recruitment and retention program.
        ``Sec. 114. Advanced training and research.
        ``Sec. 115. Quentin N. Burdick American Indians into nursing 
                            program.
        ``Sec. 116. Tribal cultural orientation.
        ``Sec. 117. Inmed program.
        ``Sec. 118. Health training programs of community colleges.
        ``Sec. 119. Retention bonus.
        ``Sec. 120. Nursing residency program.
        ``Sec. 121. Community Health Aide Program for Alaska.
        ``Sec. 122. Tribal health program administration.
        ``Sec. 123. Health professional chronic shortage demonstration 
                            programs.
        ``Sec. 124. Treatment of scholarships for certain purposes.
        ``Sec. 125. National Health Service Corps.
        ``Sec. 126. Substance abuse counselor educational curricula 
                            demonstration programs.
        ``Sec. 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 for long-term care.
        ``Sec. 206. Health services research.
        ``Sec. 207. Mammography and other cancer screening.
        ``Sec. 208. Patient travel costs.
        ``Sec. 209. Epidemiology centers.
        ``Sec. 210. Comprehensive health education programs.
        ``Sec. 211. Indian Youth Program.
        ``Sec. 212. Prevention, control, and elimination of 
                            communicable and infectious diseases.
        ``Sec. 213. Authority for provision of other services.
        ``Sec. 214. Indian women's health care.
        ``Sec. 215. Environmental and nuclear health hazards.
        ``Sec. 216. Arizona as a contract health service delivery area.
        ``Sec. 216A. North Dakota as a contract health service delivery 
                            area.
        ``Sec. 216B. South Dakota as a contract health service delivery 
                            area.
        ``Sec. 217. California contract health services program.
        ``Sec. 218. California as a contract health service delivery 
                            area.
        ``Sec. 219. Contract health services for the Trenton Service 
                            Area.
        ``Sec. 220. Programs operated by Indian Tribes and Tribal 
                            Organizations.
        ``Sec. 221. Licensing or certification.
        ``Sec. 222. Notification of provision of emergency contract 
                            health services.
        ``Sec. 223. Prompt action on payment of claims.
        ``Sec. 224. Liability for payment.
        ``Sec. 225. Authorization of appropriations.

                        ``TITLE III--FACILITIES

        ``Sec. 301. Consultation: construction and renovation of 
                            facilities; reports.
        ``Sec. 302. Sanitation facilities.
        ``Sec. 303. Preference to Indians and Indian firms.
        ``Sec. 304. Expenditure of nonservice funds for renovation.
        ``Sec. 305. Funding for the construction, expansion, and 
                            modernization of small ambulatory care 
                            facilities.
        ``Sec. 306. Indian Health Care Delivery Demonstration Project.
        ``Sec. 307. Land transfer.
        ``Sec. 308. Leases, contracts, and other agreements.
        ``Sec. 309. Study on loans, loan guarantees, and loan 
                            repayment.
        ``Sec. 310. Tribal leasing.
        ``Sec. 311. Indian Health Service/tribal facilities joint 
                            venture program.
        ``Sec. 312. Location of facilities.
        ``Sec. 313. Maintenance and improvement of health care 
                            facilities.
        ``Sec. 314. Tribal management of federally owned quarters.
        ``Sec. 315. Applicability of Buy American Act requirement.
        ``Sec. 316. Other funding for facilities.
        ``Sec. 317. Authorization of appropriations.

                 ``TITLE IV--ACCESS TO HEALTH SERVICES

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

              ``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

        ``Sec. 501. Purpose.
        ``Sec. 502. Contracts with, and grants to, Urban Indian 
                            Organizations.
        ``Sec. 503. Contracts and grants for the provision of health 
                            care and referral services.
        ``Sec. 504. Contracts and grants for the determination of unmet 
                            health care needs.
        ``Sec. 505. Evaluations; renewals.
        ``Sec. 506. Other contract and grant requirements.
        ``Sec. 507. Reports and records.
        ``Sec. 508. Limitation on contract authority.
        ``Sec. 509. Facilities.
        ``Sec. 510. Office of Urban Indian Health.
        ``Sec. 511. Grants for alcohol and substance abuse-related 
                            services.
        ``Sec. 512. Treatment of certain demonstration projects.
        ``Sec. 513. Urban NIAAA transferred programs.
        ``Sec. 514. Consultation with Urban Indian Organizations.
        ``Sec. 515. Federal Tort Claims Act coverage.
        ``Sec. 516. Urban youth treatment center demonstration.
        ``Sec. 517. Use of Federal property and supplies.
        ``Sec. 518. Grants for diabetes prevention, treatment, and 
                            control.
        ``Sec. 519. Community health representatives.
        ``Sec. 520. Regulations.
        ``Sec. 521. Eligibility for services.
        ``Sec. 522. Authorization of appropriations.

                ``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

        ``Sec. 601. Establishment of the Indian Health Service as an 
                            agency of the Public Health Service.
        ``Sec. 602. Automated management information system.
        ``Sec. 603. Authorization of appropriations.

                ``TITLE VII--BEHAVIORAL HEALTH PROGRAMS

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

                      ``TITLE VIII--MISCELLANEOUS

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

``SEC. 2. FINDINGS.

    ``Congress finds the following:
            ``(1) Federal delivery of health services and funding of 
        Indian and Urban Indian Health Programs to maintain and improve 
        the health of Indians are consonant with and required by the 
        Federal Government's historical and unique legal relationship 
        with Indians, as reflected in the Constitution, treaties, 
        Federal statutes and the course of dealings of the United 
        States with Indian Tribes and the United States' resulting 
        government-to-government relationship with Indian Tribes and 
        trust responsibilities and obligations to Indians.
            ``(2) From the time of European occupation and colonization 
        through the 20th century, policies and practices of the United 
        States caused and/or contributed to the severe health 
        conditions of Indians.
            ``(3) Through the cession of over 400,000,000 acres of land 
        to the United States in exchange for promises, often reflected 
        in treaties, of health care, Indian Tribes have secured a de 
        facto contract which entitles Indians to health care in 
        perpetuity, based on the moral, legal, and historic obligation 
        of the United States.
            ``(4) The population growth of Indians that began in the 
        later part of the 20th century increases the need for Federal 
        health care services.
            ``(5) A major national goal of the United States is to 
        provide the quantity and quality of health services which will 
        permit the health status of Indians regardless of where they 
        live to be raised to the highest possible level that is no less 
        than that of the general population and to provide for the 
        maximum participation of Indian Tribes, Tribal Organizations, 
        and Urban Indian Organizations in the planning, delivery and 
        management of those health services.
            ``(6) Federal health services to Indians have resulted in a 
        reduction in the prevalence and incidence of illnesses among, 
        and unnecessary and premature deaths of, Indians.
            ``(7) Despite such services, the unmet health needs of 
        Indians remain alarmingly severe and the health status of 
        Indians is far below the health status of the general 
        population of the United States.
            ``(8) The disparity to be addressed is formidable. For 
        example, Indians suffer a death rate for diabetes mellitus that 
        is 318 percent higher than the all races rate for the United 
        States, a pneumonia and influenza death rate 52 percent 
        greater, a tuberculosis death rate that is 650 percent greater, 
        and a death rate from alcoholism that is 670 percent higher 
        than that of the all races United States rate.

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

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

``SEC. 4. DEFINITIONS.

    ``For purposes of this Act:
            ``(1) The term `accredited and accessible' means on or near 
        a reservation and accredited by a national or regional 
        organization with accrediting authority.
            ``(2) The term `Area Office' means an administrative entity 
        including a program office, within the Service through which 
        services and funds are provided to the Service Units within a 
        defined geographic area.
            ``(3) The term `Assistant Secretary' means the Assistant 
        Secretary of Indian Health.
            ``(4) The term `behavioral health' means the blending of 
        substance (alcohol, drugs, inhalants, and tobacco) abuse and 
        mental illness prevention and treatment, for the purpose of 
        providing comprehensive services. This definition can include 
        the joint development of substance abuse and mental illness 
        treatment planning and coordinated case management using a 
        multidisciplinary approach.
            ``(5) The term `California Indians' shall mean those 
        Indians who are eligible for health services of the Service 
        pursuant to section 806.
            ``(6) The term `community college' means--
                    ``(A) a tribal college or university, or
                    ``(B) a junior or community college.
            ``(7) The term `contract health service' means health 
        services provided at the expense of the Service or a Tribal 
        Health Program by public or private medical providers or 
        hospitals, other than the Service Unit or the Tribal Health 
        Program at whose expense the services are provided.
            ``(8) The term `Department' means, unless otherwise 
        designated, the Department of Health and Human Services.
            ``(9) The term `disease prevention' means the reduction, 
        limitation, and prevention of disease and its complications and 
        reduction in the consequences of disease, including--
                    ``(A) controlling--
                            ``(i) development of diabetes;
                            ``(ii) high blood pressure;
                            ``(iii) infectious agents;
                            ``(iv) injuries;
                            ``(v) occupational hazards and 
                        disabilities;
                            ``(vi) sexually transmittable diseases; and
                            ``(vii) toxic agents; and
                    ``(B) providing--
                            ``(i) fluoridation of water; and
                            ``(ii) immunizations.
            ``(10) The term `fund' or `funding' means the transfer of 
        moneys from the Department to any eligible entity or individual 
        under this Act by any legal means, including Funding 
        Agreements, contracts, grants, memoranda of understanding, 
        contracts pursuant to section 23 of the Act of April 20, 1908 
        (25 U.S.C. 47; commonly known as the `Buy Indian Act'), or 
        otherwise. Any program administered as a grant program one day 
        before the date of enactment may continue to be administered as 
        a grant program. This definition does not otherwise modify 
        grant programs, except that upon request of the Indian Tribes 
        or Tribal Organizations, discretionary grants and all 
        categories of awarded nonrecurring funding shall be included in 
        the Funding Agreement. Discretionary grant funds shall be 
        governed by all the particular terms and conditions attached to 
        such funds, unless waived by the Secretary. All particular 
        terms and conditions attached to the discretionary grant funds 
        must be shown in the Funding Agreement. The use of such grant 
        funds shall be governed by the terms and conditions set forth 
        in the Funding Agreement and not the substantive provisions of 
        the Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 450 et seq.).
            ``(11) The term `Funding Agreement' means any agreement to 
        transfer funds for the planning, conduct, and administration of 
        programs, services, functions, and activities to Indian Tribes 
        and Tribal Organizations from the Secretary under the Indian 
        Self-Determination and Education Assistance Act (25 U.S.C. 450 
        et seq.).
            ``(12) The term `health profession' means allopathic 
        medicine, family medicine, internal medicine, pediatrics, 
        geriatric medicine, obstetrics and gynecology, podiatric 
        medicine, nursing, public health nursing, advanced practice 
        nursing, dentistry, psychiatry, osteopathy, optometry, 
        pharmacy, psychology, public health, social work, marriage and 
        family therapy, chiropractic medicine, environmental health and 
        engineering, allied health professions, and any other health 
        profession.
            ``(13) The term `health promotion' means--
                    ``(A) fostering social, economic, environmental, 
                and personal factors conducive to health, including 
                raising public awareness about health matters and 
                enabling the people to cope with health problems by 
                increasing their knowledge and providing them with 
                valid information;
                    ``(B) encouraging adequate and appropriate diet, 
                exercise, and sleep;
                    ``(C) promoting education and work in conformity 
                with physical and mental capacity;
                    ``(D) making available suitable housing, safe 
                water, and sanitary facilities;
                    ``(E) improving the physical, economic, cultural, 
                psychological, and social environment;
                    ``(F) promoting adequate opportunity for spiritual, 
                religious, and Traditional Health Care Practices; and
                    ``(G) providing adequate and appropriate programs, 
                including, but not limited to--
                            ``(i) abuse prevention (mental and 
                        physical);
                            ``(ii) community health;
                            ``(iii) community safety;
                            ``(iv) consumer health education;
                            ``(v) diet and nutrition;
                            ``(vi) immunization and other prevention of 
                        communicable diseases, including HIV/AIDS;
                            ``(vii) environmental health;
                            ``(viii) exercise and physical fitness;
                            ``(ix) avoidance of fetal alcohol 
                        disorders;
                            ``(x) first aid and CPR education;
                            ``(xi) human growth and development;
                            ``(xii) injury prevention and personal 
                        safety;
                            ``(xiii) behavioral health;
                            ``(xiv) monitoring of disease indicators 
                        between health care provider visits, through 
                        appropriate means, including Internet-based 
                        health care management systems;
                            ``(xv) personal health and wellness 
                        practices;
                            ``(xvi) personal capacity building;
                            ``(xvii) prenatal, pregnancy, and infant 
                        care;
                            ``(xviii) psychological well-being;
                            ``(xix) reproductive health and family 
                        planning;
                            ``(xx) safe and adequate water;
                            ``(xxi) safe housing relative to 
                        eliminating, reducing, or preventing 
                        contaminants which create unhealthy housing 
                        conditions;
                            ``(xxii) safe work environments;
                            ``(xxiii) stress control;
                            ``(xxiv) substance abuse;
                            ``(xxv) sanitary facilities;
                            ``(xxvi) sudden infant death syndrome 
                        prevention;
                            ``(xxvii) tobacco use cessation and 
                        reduction;
                            ``(xxviii) violence prevention; and
                            ``(xxix) such other activities identified 
                        by the Service, a Tribal Health Program, or an 
                        Urban Indian Organization, to promote 
                        achievement of any of the objectives described 
                        in section 3(2).
            ``(14) The term `Indian' has the meaning given the term in 
        the Indian Self-Determination and Education Assistance Act (25 
        U.S.C. 450 et seq.).
            ``(15) The term `Indian Health Program' means--
                    ``(A) any health program administered directly by 
                the Service;
                    ``(B) any Tribal Health Program; or
                    ``(C) any Indian Tribe or Tribal Organization to 
                which the Secretary provides funding pursuant to 
                section 23 of the Act of April 30, 1908 (25 U.S.C. 47), 
                commonly known as the `Buy Indian Act'.
            ``(16) The term `Indian Tribe' has the meaning given the 
        term in the Indian Self-Determination and Education Assistance 
        Act (25 U.S.C. 450 et seq.).
            ``(17) The term `junior or community college' has the 
        meaning given the term by section 312(e) of the Higher 
        Education Act of 1965 (20 U.S.C. 1058(e)).
            ``(18) The term `reservation' means any federally 
        recognized Indian Tribe's reservation, Pueblo, or colony, 
        including former reservations in Oklahoma, Indian allotments, 
        and Alaska Native Regions established pursuant to the Alaska 
        Native Claims Settlement Act (25 U.S.C. 1601 et seq.).
            ``(19) The term `Secretary', unless otherwise designated, 
        means the Secretary of Health and Human Services.
            ``(20) The term `Service' means the Indian Health Service.
            ``(21) The term `Service Area' means the geographical area 
        served by each Area Office.
            ``(22) The term `Service Unit' means an administrative 
        entity of the Service, or a Tribal Health Program through which 
        services are provided, directly or by contract, to eligible 
        Indians within a defined geographic area.
            ``(23) The term `telehealth' has the meaning given the term 
        in section 330K(a) of the Public Health Service Act (42 U.S.C. 
        254c-16(a)).
            ``(24) The term `telemedicine' means a telecommunications 
        link to an end user through the use of eligible equipment that 
        electronically links health professionals or patients and 
        health professionals at separate sites in order to exchange 
        health care information in audio, video, graphic, or other 
        format for the purpose of providing improved health care 
        services.
            ``(25) The term `Traditional Health Care Practices' means 
        the application by Native healing practitioners of the Native 
        healing sciences (as opposed or in contradistinction to Western 
        healing sciences) which embody the influences or forces of 
        innate Tribal discovery, history, description, explanation and 
        knowledge of the states of wellness and illness and which call 
        upon these influences or forces, including physical, mental, 
        and spiritual forces in the promotion, restoration, 
        preservation, and maintenance of health, well-being, and life's 
        harmony.
            ``(26) The term `tribal college or university' has the 
        meaning given the term in section 316(b)(3) of the Higher 
        Education Act (20 U.S.C. 1059c(b)(3)).
            ``(27) The term `Tribal Health Program' means an Indian 
        Tribe or Tribal Organization that operates any health program, 
        service, function, activity, or facility funded, in whole or 
        part, by the Service through, or provided for in, a Funding 
        Agreement with the Service under the Indian Self-Determination 
        and Education Assistance Act (25 U.S.C. 450 et seq.).
            ``(28) The term `Tribal Organization' has the meaning given 
        the term in the Indian Self-Determination and Education 
        Assistance Act (25 U.S.C. 450 et seq.).
            ``(29) The term `Urban Center' means any community which 
        has a sufficient Urban Indian population with unmet health 
        needs to warrant assistance under title V of this Act, as 
        determined by the Secretary.
            ``(30) The term `Urban Indian' means any individual who 
        resides in an Urban Center and who meets 1 or more of the 
        following criteria:
                    ``(A) Irrespective of whether the individual lives 
                on or near a reservation, the individual is a member of 
                a tribe, band, or other organized group of Indians, 
                including those tribes, bands, or groups terminated 
                since 1940 and those tribes, bands, or groups that are 
                recognized by the States in which they reside, or who 
                is a descendant in the first or second degree of any 
                such member.
                    ``(B) The individual is an Eskimo, Aleut, or other 
                Alaskan Native.
                    ``(C) The individual is considered by the Secretary 
                of the Interior to be an Indian for any purpose.
                    ``(D) The individual is determined to be an Indian 
                under regulations promulgated by the Secretary.
            ``(31) The term `Urban Indian Organization' means a 
        nonprofit corporate body that (A) is situated in an Urban 
        Center; (B) is governed by an Urban Indian-controlled board of 
        directors; (C) provides for the participation of all interested 
        Indian groups and individuals; and (D) is capable of legally 
        cooperating with other public and private entities for the 
        purpose of performing the activities described in section 
        503(a).

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

``SEC. 101. PURPOSE.

    ``The purpose of this title is to increase, to the maximum extent 
feasible, the number of Indians entering the health professions and 
providing health services, and to assure an optimum supply of health 
professionals to the Indian Health Programs and Urban Indian 
Organizations involved in the provision of health services to Indians.

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

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

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

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

``SEC. 104. INDIAN HEALTH PROFESSIONS SCHOLARSHIPS.

    ``(a) In General.--
            ``(1) Authority.--The Secretary, acting through the 
        Service, shall make scholarships to Indians who are enrolled 
        full or part time in accredited schools pursuing courses of 
        study in the health professions. Such scholarships shall be 
        designated Indian Health Scholarships and shall be made in 
        accordance with section 338A of the Public Health Services Act 
        (42 U.S.C. 254l), except as provided in subsection (b) of this 
        section.
            ``(2) Allocation by formula.--Except as provided in 
        paragraph (3), the funding authorized by this section shall be 
        allocated by Service Area by a formula developed in 
        consultation with Indian Tribes, Tribal Organizations, and 
        Urban Indian Organizations. Such formula shall consider the 
        human resource development needs in each Service Area.
            ``(3) Continuity of prior scholarships.--Paragraph (2) 
        shall not apply with respect to individual recipients of 
        scholarships provided under this section (as in effect 1 day 
        prior to the date of the enactment of the Indian Health Care 
        Improvement Act Amendments of 2004) until such time as the 
        individual completes the course of study that is supported 
        through such scholarship.
            ``(4) Certain delegation not allowed.--The administration 
        of this section shall be a responsibility of the Assistant 
        Secretary and shall not be delegated in a Funding Agreement.
    ``(b) Active Duty Service Obligation.--
            ``(1) Obligation met.--The active duty service obligation 
        under a written contract with the Secretary under section 338A 
        of the Public Health Service Act (42 U.S.C. 254l) that an 
        Indian has entered into under that section shall, if that 
        individual is a recipient of an Indian Health Scholarship, be 
        met in full-time practice on an equivalent year-for-year 
        obligation, by service in one or more of the following:
                    ``(A) In an Indian Health Program.
                    ``(B) In a program assisted under title V of this 
                Act.
                    ``(C) In the private practice of the applicable 
                profession if, as determined by the Secretary, in 
                accordance with guidelines promulgated by the 
                Secretary, such practice is situated in a physician or 
                other health professional shortage area and addresses 
                the health care needs of a substantial number of 
                Indians.
            ``(2) Obligation deferred.--At the request of any 
        individual who has entered into a contract referred to in 
        paragraph (1) and who receives a degree in medicine (including 
        osteopathic or allopathic medicine), dentistry, optometry, 
        podiatry, or pharmacy, the Secretary shall defer the active 
        duty service obligation of that individual under that contract, 
        in order that such individual may complete any internship, 
        residency, or other advanced clinical training that is required 
        for the practice of that health profession, for an appropriate 
        period (in years, as determined by the Secretary), subject to 
        the following conditions:
                    ``(A) No period of internship, residency, or other 
                advanced clinical training shall be counted as 
                satisfying any period of obligated service under this 
                subsection.
                    ``(B) The active duty service obligation of that 
                individual shall commence not later than 90 days after 
                the completion of that advanced clinical training (or 
                by a date specified by the Secretary).
                    ``(C) The active duty service obligation will be 
                served in the health profession of that individual in a 
                manner consistent with paragraph (1).
                    ``(D) A recipient of a scholarship under this 
                section may, at the election of the recipient, meet the 
                active duty service obligation described in paragraph 
                (1) by service in a program specified under that 
                paragraph that--
                            ``(i) is located on the reservation of the 
                        Indian Tribe in which the recipient is 
                        enrolled; or
                            ``(ii) serves the Indian Tribe in which the 
                        recipient is enrolled.
            ``(3) Priority when making assignments.--Subject to 
        paragraph (2), the Secretary, in making assignments of Indian 
        Health Scholarship recipients required to meet the active duty 
        service obligation described in paragraph (1), shall give 
        priority to assigning individuals to service in those programs 
        specified in paragraph (1) that have a need for health 
        professionals to provide health care services as a result of 
        individuals having breached contracts entered into under this 
        section.
    ``(c) Part-Time Students.--In the case of an individual receiving a 
scholarship under this section who is enrolled part time in an approved 
course of study--part-time equivalent of 4 years, as determined by the 
Area Office;
            ``(2) the period of obligated service described in 
        subsection (b)(1) shall be equal to the greater of--
                    ``(A) the part-time equivalent of 1 year for each 
                year for which the individual was provided a 
                scholarship (as determined by the Area Office); or
                    ``(B) 2 years; and
            ``(3) the amount of the monthly stipend specified in 
        section 338A(g)(1)(B) of the Public Health Service Act (42 
        U.S.C. 254l(g)(1)(B)) shall be reduced pro rata (as determined 
        by the Secretary) based on the number of hours such student is 
        enrolled.
    ``(d) Breach of Contract.--
            ``(1) Specified breaches.--An individual shall be liable to 
        the United States for the amount which has been paid to the 
        individual, or on behalf of the individual, under a contract 
        entered into with the Secretary under this section on or after 
        the date of the enactment of the Indian Health Care Improvement 
        Act Amendments of 2004 if that individual--
                    ``(A) fails to maintain an acceptable level of 
                academic standing in the educational institution in 
                which he or she is enrolled (such level determined by 
                the educational institution under regulations of the 
                Secretary);
                    ``(B) is dismissed from such educational 
                institution for disciplinary reasons;
                    ``(C) voluntarily terminates the training in such 
                an educational institution for which he or she is 
                provided a scholarship under such contract before the 
                completion of such training; or
                    ``(D) fails to accept payment, or instructs the 
                educational institution in which he or she is enrolled 
                not to accept payment, in whole or in part, of a 
                scholarship under such contract, in lieu of any service 
                obligation arising under such contract.
            ``(2) Other breaches.--If for any reason not specified in 
        paragraph (1) an individual breaches a written contract by 
        failing either to begin such individual's service obligation 
        required under such contract or to complete such service 
        obligation, the United States shall be entitled to recover from 
        the individual an amount determined in accordance with the 
        formula specified in subsection (l) of section 110 in the 
        manner provided for in such subsection.
            ``(3) Cancellation upon death of recipient.--Upon the death 
        of an individual who receives an Indian Health Scholarship, any 
        outstanding obligation of that individual for service or 
        payment that relates to that scholarship shall be canceled.
            ``(4) Waivers and suspensions.--The Secretary shall provide 
        for the partial or total waiver or suspension of any obligation 
        of service or payment of a recipient of an Indian Health 
        Scholarship if the Secretary, in consultation with the Area 
        Office, Indian Tribes, Tribal Organizations, and Urban Indian 
        Organizations, determines that--
                    ``(A) it is not possible for the recipient to meet 
                that obligation or make that payment;
                    ``(B) requiring that recipient to meet that 
                obligation or make that payment would result in extreme 
                hardship to the recipient; or
                    ``(C) the enforcement of the requirement to meet 
                the obligation or make the payment would be 
                unconscionable.
            ``(5) Extreme hardship.--Notwithstanding any other 
        provision of law, in any case of extreme hardship or for other 
        good cause shown, the Secretary may waive, in whole or in part, 
        the right of the United States to recover funds made available 
        under this section.
            ``(6) Bankruptcy.--Notwithstanding any other provision of 
        law, with respect to a recipient of an Indian Health 
        Scholarship, no obligation for payment may be released by a 
        discharge in bankruptcy under title 11, United States Code, 
        unless that discharge is granted after the expiration of the 5-
        year period beginning on the initial date on which that payment 
        is due, and only if the bankruptcy court finds that the 
        nondischarge of the obligation would be unconscionable.

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

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

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

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

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

    ``(a) Employment Preference.--Any individual who receives a 
scholarship pursuant to section 104 or 106 shall be given preference 
for employment in the Service, or may be employed by a Tribal Health 
Program or an Urban Indian Organization, or other agencies of the 
Department as available, during any nonacademic period of the year.
    ``(b) Not Counted Toward Active Duty Service Obligation.--Periods 
of employment pursuant to this subsection shall not be counted in 
determining fulfillment of the service obligation incurred as a 
condition of the scholarship.
    ``(c) Timing; Length of Employment.--Any individual enrolled in a 
program, including a high school program, authorized under section 
102(a) may be employed by the Service or by a Tribal Health Program or 
an Urban Indian Organization during any nonacademic period of the year. 
Any such employment shall not exceed 120 days during any calendar year.
    ``(d) Nonapplicability of Competitive Personnel System.--Any 
employment pursuant to this section shall be made without regard to any 
competitive personnel system or agency personnel limitation and to a 
position which will enable the individual so employed to receive 
practical experience in the health profession in which he or she is 
engaged in study. Any individual so employed shall receive payment for 
his or her services comparable to the salary he or she would receive if 
he or she were employed in the competitive system. Any individual so 
employed shall not be counted against any employment ceiling affecting 
the Service or the Department.

``SEC. 108. CONTINUING EDUCATION ALLOWANCES.

    ``In order to encourage health professionals, including community 
health representatives and emergency medical technicians, to join or 
continue in an Indian Health Program or an Urban Indian Organization 
and to provide their services in the rural and remote areas where a 
significant portion of Indians reside, the Secretary, acting through 
the Service, may provide allowances to health professionals employed in 
an Indian Health Program or an Urban Indian Organization to enable them 
for a period of time each year prescribed by regulation of the 
Secretary to take leave of their duty stations for professional 
consultation and refresher training courses.

``SEC. 109. COMMUNITY HEALTH REPRESENTATIVE PROGRAM.

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

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

    ``(a) Establishment.--The Secretary, acting through the Service, 
shall establish and administer a program to be known as the Service 
Loan Repayment Program (hereinafter referred to as the `Loan Repayment 
Program') in order to ensure an adequate supply of trained health 
professionals necessary to maintain accreditation of, and provide 
health care services to Indians through, Indian Health Programs and 
Urban Indian Organizations.
    ``(b) Eligible Individuals.--To be eligible to participate in the 
Loan Repayment Program, an individual must--
            ``(1)(A) be enrolled--
                    ``(i) in a course of study or program in an 
                accredited educational institution (as determined by 
                the Secretary under section 338B(b)(1)(c)(i) of the 
                Public Health Service Act (42 U.S.C. 254l-
                1(b)(1)(c)(i))) and be scheduled to complete such 
                course of study in the same year such individual 
                applies to participate in such program; or
                    ``(ii) in an approved graduate training program in 
                a health profession; or
            ``(B) have--
                    ``(i) a degree in a health profession; and
                    ``(ii) a license to practice a health profession;
            ``(2)(A) be eligible for, or hold, an appointment as a 
        commissioned officer in the Regular or Reserve Corps of the 
        Public Health Service;
            ``(B) be eligible for selection for civilian service in the 
        Regular or Reserve Corps of the Public Health Service;
            ``(C) meet the professional standards for civil service 
        employment in the Service; or
            ``(D) be employed in an Indian Health Program or Urban 
        Indian Organization without a service obligation; and
            ``(3) submit to the Secretary an application for a contract 
        described in subsection (e).
    ``(c) Application.--
            ``(1) Information to be included with forms.--In 
        disseminating application forms and contract forms to 
        individuals desiring to participate in the Loan Repayment 
        Program, the Secretary shall include with such forms a fair 
        summary of the rights and liabilities of an individual whose 
        application is approved (and whose contract is accepted) by the 
        Secretary, including in the summary a clear explanation of the 
        damages to which the United States is entitled under subsection 
        (l) in the case of the individual's breach of contract. The 
        Secretary shall provide such individuals with sufficient 
        information regarding the advantages and disadvantages of 
        service as a commissioned officer in the Regular or Reserve 
        Corps of the Public Health Service or a civilian employee of 
        the Service to enable the individual to make a decision on an 
        informed basis.
            ``(2) Clear language.--The application form, contract form, 
        and all other information furnished by the Secretary under this 
        section shall be written in a manner calculated to be 
        understood by the average individual applying to participate in 
        the Loan Repayment Program.
            ``(3) Timely availability of forms.--The Secretary shall 
        make such application forms, contract forms, and other 
        information available to individuals desiring to participate in 
        the Loan Repayment Program on a date sufficiently early to 
        ensure that such individuals have adequate time to carefully 
        review and evaluate such forms and information.
    ``(d) Priorities.--
            ``(1) List.--Consistent with subsection (k), the Secretary 
        shall annually--
                    ``(A) identify the positions in each Indian Health 
                Program or Urban Indian Organization for which there is 
                a need or a vacancy; and
                    ``(B) rank those positions in order of priority.
            ``(2) Approvals.--Notwithstanding the priority determined 
        under paragraph (1), the Secretary, in determining which 
        applications under the Loan Repayment Program to approve (and 
        which contracts to accept), shall--
                    ``(A) give first priority to applications made by 
                individual Indians; and
                    ``(B) after making determinations on all 
                applications submitted by individual Indians as 
                required under subparagraph (A), give priority to--
                            ``(i) individuals recruited through the 
                        efforts of an Indian Health Program or Urban 
                        Indian Organization; and
                            ``(ii) other individuals based on the 
                        priority rankings under paragraph (1).
    ``(e) Recipient Contracts.--
            ``(1) Contract required.--An individual becomes a 
        participant in the Loan Repayment Program only upon the 
        Secretary and the individual entering into a written contract 
        described in paragraph (2).
            ``(2) Contents of contract.--The written contract referred 
        to in this section between the Secretary and an individual 
        shall contain--
                    ``(A) an agreement under which--
                            ``(i) subject to subparagraph (C), the 
                        Secretary agrees--
                                    ``(I) to pay loans on behalf of the 
                                individual in accordance with the 
                                provisions of this section; and
                                    ``(II) to accept (subject to the 
                                availability of appropriated funds for 
                                carrying out this section) the 
                                individual into the Service or place 
                                the individual with a Tribal Health 
                                Program or Urban Indian Organization as 
                                provided in clause (ii)(III); and
                            ``(ii) subject to subparagraph (C), the 
                        individual agrees--
                                    ``(I) to accept loan payments on 
                                behalf of the individual;
                                    ``(II) in the case of an individual 
                                described in subsection (b)(1)--
                                            ``(aa) to maintain 
                                        enrollment in a course of study 
                                        or training described in 
                                        subsection (b)(1)(A) until the 
                                        individual completes the course 
                                        of study or training; and
                                            ``(bb) while enrolled in 
                                        such course of study or 
                                        training, to maintain an 
                                        acceptable level of academic 
                                        standing (as determined under 
                                        regulations of the Secretary by 
                                        the educational institution 
                                        offering such course of study 
                                        or training); and
                                    ``(III) to serve for a time period 
                                (hereinafter in this section referred 
                                to as the `period of obligated 
                                service') equal to 2 years or such 
                                longer period as the individual may 
                                agree to serve in the full-time 
                                clinical practice of such individual's 
                                profession in an Indian Health Program 
                                or Urban Indian Organization to which 
                                the individual may be assigned by the 
                                Secretary;
                    ``(B) a provision permitting the Secretary to 
                extend for such longer additional periods, as the 
                individual may agree to, the period of obligated 
                service agreed to by the individual under subparagraph 
                (A)(ii)(III);
                    ``(C) a provision that any financial obligation of 
                the United States arising out of a contract entered 
                into under this section and any obligation of the 
                individual which is conditioned thereon is contingent 
                upon funds being appropriated for loan repayments under 
                this section;
                    ``(D) a statement of the damages to which the 
                United States is entitled under subsection (l) for the 
                individual's breach of the contract; and
                    ``(E) such other statements of the rights and 
                liabilities of the Secretary and of the individual, not 
                inconsistent with this section.
    ``(f) Deadline for Decision on Application.--The Secretary shall 
provide written notice to an individual within 21 days on--
            ``(1) the Secretary's approving, under subsection (e)(1), 
        of the individual's participation in the Loan Repayment 
        Program, including extensions resulting in an aggregate period 
        of obligated service in excess of 4 years; or
            ``(2) the Secretary's disapproving an individual's 
        participation in such Program.
    ``(g) Payments.--
            ``(1) In general.--A loan repayment provided for an 
        individual under a written contract under the Loan Repayment 
        Program shall consist of payment, in accordance with paragraph 
        (2), on behalf of the individual of the principal, interest, 
        and related expenses on government and commercial loans 
        received by the individual regarding the undergraduate or 
        graduate education of the individual (or both), which loans 
        were made for--
                    ``(A) tuition expenses;
                    ``(B) all other reasonable educational expenses, 
                including fees, books, and laboratory expenses, 
                incurred by the individual; and
                    ``(C) reasonable living expenses as determined by 
                the Secretary.
            ``(2) Amount.--For each year of obligated service that an 
        individual contracts to serve under subsection (e), the 
        Secretary may pay up to $35,000 or an amount equal to the 
        amount specified in section 338B(g)(2)(A) of the Public Health 
        Service Act, whichever is more, on behalf of the individual for 
        loans described in paragraph (1). In making a determination of 
        the amount to pay for a year of such service by an individual, 
        the Secretary shall consider the extent to which each such 
        determination--
                    ``(A) affects the ability of the Secretary to 
                maximize the number of contracts that can be provided 
                under the Loan Repayment Program from the amounts 
                appropriated for such contracts;
                    ``(B) provides an incentive to serve in Indian 
                Health Programs and Urban Indian Organizations with the 
                greatest shortages of health professionals; and
                    ``(C) provides an incentive with respect to the 
                health professional involved remaining in an Indian 
                Health Program or Urban Indian Organization with such a 
                health professional shortage, and continuing to provide 
                primary health services, after the completion of the 
                period of obligated service under the Loan Repayment 
                Program.
            ``(3) Timing.--Any arrangement made by the Secretary for 
        the making of loan repayments in accordance with this 
        subsection shall provide that any repayments for a year of 
        obligated service shall be made no later than the end of the 
        fiscal year in which the individual completes such year of 
        service.
            ``(4) For the purpose of providing reimbursements for tax 
        liability resulting from payments under paragraph (2) on behalf 
        of an individual, the Secretary--
                    ``(A) in addition to such payments, may make 
                payments to the individual in an amount not less than 
                20 percent and not more than 39 percent of the total 
                amount of loan repayments made for the taxable year 
                involved; and
                    ``(B) may make such additional payments as the 
                Secretary determines to be appropriate with respect to 
                such purpose.
            ``(5) Payment schedule.--The Secretary may enter into an 
        agreement with the holder of any loan for which payments are 
        made under the Loan Repayment Program to establish a schedule 
        for the making of such payments.
    ``(h) Employment Ceiling.--Notwithstanding any other provision of 
law, individuals who have entered into written contracts with the 
Secretary under this section shall not be counted against any 
employment ceiling affecting the Department while those individuals are 
undergoing academic training.
    ``(i) Recruitment.--The Secretary shall conduct recruiting programs 
for the Loan Repayment Program and other Service manpower programs at 
educational institutions training health professionals or specialists 
identified in subsection (a).
    ``(j) Applicability of Law.--Section 214 of the Public Health 
Service Act (42 U.S.C. 215) shall not apply to individuals during their 
period of obligated service under the Loan Repayment Program.
    ``(k) Assignment of Individuals.--The Secretary, in assigning 
individuals to serve in Indian Health Programs or Urban Indian 
Organizations pursuant to contracts entered into under this section, 
shall--
            ``(1) ensure that the staffing needs of Tribal Health 
        Programs and Urban Indian Organizations receive consideration 
        on an equal basis with programs that are administered directly 
        by the Service; and
            ``(2) give priority to assigning individuals to Indian 
        Health Programs and Urban Indian Organizations that have a need 
        for health professionals to provide health care services as a 
        result of individuals having breached contracts entered into 
        under this section.
    ``(l) Breach of Contract.--
            ``(1) Specific breaches.--An individual who has entered 
        into a written contract with the Secretary under this section 
        and has not received a waiver under subsection (m) shall be 
        liable, in lieu of any service obligation arising under such 
        contract, to the United States for the amount which has been 
        paid on such individual's behalf under the contract if that 
        individual--
                    ``(A) is enrolled in the final year of a course of 
                study and--
                            ``(i) fails to maintain an acceptable level 
                        of academic standing in the educational 
                        institution in which he or she is enrolled 
                        (such level determined by the educational 
                        institution under regulations of the 
                        Secretary);
                            ``(ii) voluntarily terminates such 
                        enrollment; or
                            ``(iii) is dismissed from such educational 
                        institution before completion of such course of 
                        study; or
                    ``(B) is enrolled in a graduate training program 
                and fails to complete such training program.
            ``(2) Other breaches; formula for amount owed.--If, for any 
        reason not specified in paragraph (1), an individual breaches 
        his or her written contract under this section by failing 
        either to begin, or complete, such individual's period of 
        obligated service in accordance with subsection (e)(2), the 
        United States shall be entitled to recover from such individual 
        an amount to be determined in accordance with the following 
        formula: A=3Z(t-s/t) in which--
                    ``(A) `A' is the amount the United States is 
                entitled to recover;
                    ``(B) `Z' is the sum of the amounts paid under this 
                section to, or on behalf of, the individual and the 
                interest on such amounts which would be payable if, at 
                the time the amounts were paid, they were loans bearing 
                interest based on yields on appropriate marketable 
                Treasury securities;
                    ``(C) `t' is the total number of months in the 
                individual's period of obligated service in accordance 
                with subsection (f); and
                    ``(D) `s' is the number of months of such period 
                served by such individual in accordance with this 
                section.
            ``(3) Deductions in medicare payments.--Amounts not paid 
        within such period shall be subject to collection through 
        deductions in medicare payments pursuant to section 1892 of the 
        Social Security Act.
            ``(4) Time period for repayment.--Any amount of damages 
        which the United States is entitled to recover under this 
        subsection shall be paid to the United States within the 1-year 
        period beginning on the date of the breach or such longer 
        period beginning on such date as shall be specified by the 
        Secretary.
            ``(5) Recovery of delinquency.--
                    ``(A) In general.--If damages described in 
                paragraph (4) are delinquent for 3 months, the 
                Secretary shall, for the purpose of recovering such 
                damages--
                            ``(i) use collection agencies contracted 
                        with by the Administrator of General Services; 
                        or
                            ``(ii) enter into contracts for the 
                        recovery of such damages with collection 
                        agencies selected by the Secretary.
                    ``(B) Report.--Each contract for recovering damages 
                pursuant to this subsection shall provide that the 
                contractor will, not less than once each 6 months, 
                submit to the Secretary a status report on the success 
                of the contractor in collecting such damages. Section 
                3718 of title 31, United States Code, shall apply to 
                any such contract to the extent not inconsistent with 
                this subsection.
    ``(m) Waiver or Suspension of Obligation.--
            ``(1) In general.--The Secretary shall by regulation 
        provide for the partial or total waiver or suspension of any 
        obligation of service or payment by an individual under the 
        Loan Repayment Program whenever compliance by the individual is 
        impossible or would involve extreme hardship to the individual 
        and if enforcement of such obligation with respect to any 
        individual would be unconscionable.
            ``(2) Canceled upon death.--Any obligation of an individual 
        under the Loan Repayment Program for service or payment of 
        damages shall be canceled upon the death of the individual.
            ``(3) Hardship waiver.--The Secretary may waive, in whole 
        or in part, the rights of the United States to recover amounts 
        under this section in any case of extreme hardship or other 
        good cause shown, as determined by the Secretary.
            ``(4) Bankruptcy.--Any obligation of an individual under 
        the Loan Repayment Program for payment of damages may be 
        released by a discharge in bankruptcy under title 11 of the 
        United States Code only if such discharge is granted after the 
        expiration of the 5-year period beginning on the first date 
        that payment of such damages is required, and only if the 
        bankruptcy court finds that nondischarge of the obligation 
        would be unconscionable.
    ``(n) Report.--The Secretary shall submit to the President, for 
inclusion in each report required to be submitted to Congress under 
section 801, a report concerning the previous fiscal year which sets 
forth by Service Area the following:
            ``(1) A list of the health professional positions 
        maintained by Indian Health Programs and Urban Indian 
        Organizations for which recruitment or retention is difficult.
            ``(2) The number of Loan Repayment Program applications 
        filed with respect to each type of health profession.
            ``(3) The number of contracts described in subsection (e) 
        that are entered into with respect to each health profession.
            ``(4) The amount of loan payments made under this section, 
        in total and by health profession.
            ``(5) The number of scholarships that are provided under 
        sections 104 and 106 with respect to each health profession.
            ``(6) The amount of scholarship grants provided under 
        section 104 and 106, in total and by health profession.
            ``(7) The number of providers of health care that will be 
        needed by Indian Health Programs and Urban Indian 
        Organizations, by location and profession, during the 3 fiscal 
        years beginning after the date the report is filed.
            ``(8) The measures the Secretary plans to take to fill the 
        health professional positions maintained by Indian Health 
        Programs or Urban Indian Organizations for which recruitment or 
        retention is difficult.

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

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

``SEC. 112. RECRUITMENT ACTIVITIES.

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

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

    ``(a) In General.--The Secretary, acting through the Service, shall 
fund innovative demonstration projects for a period not to exceed 3 
years to enable Tribal Health Programs and Urban Indian Organizations 
to recruit, place, and retain health professionals to meet their 
staffing needs.
    ``(b) Eligible Entities; Application.--Any Tribal Health Program or 
Urban Indian Organization may submit an application for funding of a 
project pursuant to this section.

``SEC. 114. ADVANCED TRAINING AND RESEARCH.

    ``(a) Demonstration Program.--The Secretary, acting through the 
Service, shall establish a demonstration project to enable health 
professionals who have worked in an Indian Health Program or Urban 
Indian Organization for a substantial period of time to pursue advanced 
training or research areas of study for which the Secretary determines 
a need exists.
    ``(b) Service Obligation.--An individual who participates in a 
program under subsection (a), where the educational costs are borne by 
the Service, shall incur an obligation to serve in an Indian Health 
Program or Urban Indian Organization for a period of obligated service 
equal to at least the period of time during which the individual 
participates in such program. In the event that the individual fails to 
complete such obligated service, the individual shall be liable to the 
United States for the period of service remaining. In such event, with 
respect to individuals entering the program after the date of the 
enactment of the Indian Health Care Improvement Act Amendments of 2004, 
the United States shall be entitled to recover from such individual an 
amount to be determined in accordance with the formula specified in 
subsection (l) of section 110 in the manner provided for in such 
subsection.
    ``(c) Equal Opportunity for Participation.--Health professionals 
from Tribal Health Programs and Urban Indian Organizations shall be 
given an equal opportunity to participate in the program under 
subsection (a).

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

    ``(a) Grants Authorized.--For the purpose of increasing the number 
of nurses, nurse midwives, and nurse practitioners who deliver health 
care services to Indians, the Secretary, acting through the Service, 
shall provide grants to the following:
            ``(1) Public or private schools of nursing.
            ``(2) Tribal colleges or universities.
            ``(3) Nurse midwife programs and advanced practice nurse 
        programs that are provided by any tribal college or university 
        accredited nursing program, or in the absence of such, any 
        other public or private institutions.
    ``(b) Use of Grants.--Grants provided under subsection (a) may be 
used for one or more of the following:
            ``(1) To recruit individuals for programs which train 
        individuals to be nurses, nurse midwives, or advanced practice 
        nurses.
            ``(2) To provide scholarships to Indians enrolled in such 
        programs that may pay the tuition charged for such program and 
        other expenses incurred in connection with such program, 
        including books, fees, room and board, and stipends for living 
        expenses.
            ``(3) To provide a program that encourages nurses, nurse 
        midwives, and advanced practice nurses to provide, or continue 
        to provide, health care services to Indians.
            ``(4) To provide a program that increases the skills of, 
        and provides continuing education to, nurses, nurse midwives, 
        and advanced practice nurses.
            ``(5) To provide any program that is designed to achieve 
        the purpose described in subsection (a).
    ``(c) Applications.--Each application for funding under subsection 
(a) shall include such information as the Secretary may require to 
establish the connection between the program of the applicant and a 
health care facility that primarily serves Indians.
    ``(d) Preferences for Grant Recipients.--In providing grants under 
subsection (a), the Secretary shall extend a preference to the 
following:
            ``(1) Programs that provide a preference to Indians.
            ``(2) Programs that train nurse midwives or advanced 
        practice nurses.
            ``(3) Programs that are interdisciplinary.
            ``(4) Programs that are conducted in cooperation with a 
        program for gifted and talented Indian students.
    ``(e) Quentin N. Burdick Program Grant.--The Secretary shall 
provide one of the grants authorized under subsection (a) to establish 
and maintain a program at the University of North Dakota to be known as 
the `Quentin N. Burdick American Indians Into Nursing Program'. Such 
program shall, to the maximum extent feasible, coordinate with the 
Quentin N. Burdick Indian Health Programs established under section 
117(b) and the Quentin N. Burdick American Indians Into Psychology 
Program established under section 105(b).
    ``(f) Active Duty Service Obligation.--The active duty service 
obligation prescribed under section 338C of the Public Health Service 
Act (42 U.S.C. 254m) shall be met by each individual who receives 
training or assistance described in paragraph (1) or (2) of subsection 
(b) that is funded by a grant provided under subsection (a). Such 
obligation shall be met by service--
            ``(1) in the Service;
            ``(2) in a program of an Indian Tribe or Tribal 
        Organization conducted under the Indian Self-Determination and 
        Education Assistance Act (including programs under agreements 
        with the Bureau of Indian Affairs);
            ``(3) in a program assisted under title V of this Act; or
            ``(4) in the private practice of nursing if, as determined 
        by the Secretary, in accordance with guidelines promulgated by 
        the Secretary, such practice is situated in a physician or 
        other health shortage area and addresses the health care needs 
        of a substantial number of Indians.

``SEC. 116. TRIBAL CULTURAL ORIENTATION.

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

``SEC. 117. INMED PROGRAM.

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

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

    ``(a) Grants To Establish Programs.--
            ``(1) In general.--The Secretary, acting through the 
        Service, shall award grants to accredited and accessible 
        community colleges for the purpose of assisting such community 
        colleges in the establishment of programs which provide 
        education in a health profession leading to a degree or diploma 
        in a health profession for individuals who desire to practice 
        such profession on or near a reservation or in an Indian Health 
        Program.
            ``(2) Amount of grants.--The amount of any grant awarded to 
        a community college under paragraph (1) for the first year in 
        which such a grant is provided to the community college shall 
        not exceed $100,000.
    ``(b) Grants for Maintenance and Recruiting.--
            ``(1) In general.--The Secretary, acting through the 
        Service, shall award grants to accredited and accessible 
        community colleges that have established a program described in 
        subsection (a)(1) for the purpose of maintaining the program 
        and recruiting students for the program.
            ``(2) Requirements.--Grants may only be made under this 
        section to a community college which--
                    ``(A) is accredited;
                    ``(B) has a relationship with a hospital facility, 
                Service facility, or hospital that could provide 
                training of nurses or health professionals;
                    ``(C) has entered into an agreement with an 
                accredited college or university medical school, the 
                terms of which--
                            ``(i) provide a program that enhances the 
                        transition and recruitment of students into 
                        advanced baccalaureate or graduate programs 
                        which train health professionals; and
                            ``(ii) stipulate certifications necessary 
                        to approve internship and field placement 
                        opportunities at Indian Health Programs;
                    ``(D) has a qualified staff which has the 
                appropriate certifications;
                    ``(E) is capable of obtaining State or regional 
                accreditation of the program described in subsection 
                (a)(1); and
                    ``(F) agrees to provide for Indian preference for 
                applicants for programs under this section.
    ``(c) Technical Assistance.--The Secretary shall encourage 
community colleges described in subsection (b)(2) to establish and 
maintain programs described in subsection (a)(1) by--
            ``(1) entering into agreements with such colleges for the 
        provision of qualified personnel of the Service to teach 
        courses of study in such programs; and
            ``(2) providing technical assistance and support to such 
        colleges.
    ``(d) Advanced Training.--
            ``(1) Required.--Any program receiving assistance under 
        this section that is conducted with respect to a health 
        profession shall also offer courses of study which provide 
        advanced training for any health professional who--
                    ``(A) has already received a degree or diploma in 
                such health profession; and
                    ``(B) provides clinical services on or near a 
                reservation or for an Indian Health Program.
            ``(2) May be offered at alternate site.--Such courses of 
        study may be offered in conjunction with the college or 
        university with which the community college has entered into 
        the agreement required under subsection (b)(2)(C).
    ``(e) Funding Priority.--Where the requirements of subsection (b) 
are met, funding priority shall be provided to tribal colleges and 
universities in Service Areas where they exist.

``SEC. 119. RETENTION BONUS.

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

``SEC. 120. NURSING RESIDENCY PROGRAM.

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

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

    ``(a) General Purposes of Program.--Under the authority of the Act 
of November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder 
Act'), the Secretary, acting through the Service, shall develop and 
operate a Community Health Aide Program in Alaska under which the 
Service--
            ``(1) provides for the training of Alaska Natives as health 
        aides or community health practitioners;
            ``(2) uses such aides or practitioners in the provision of 
        health care, health promotion, and disease prevention services 
        to Alaska Natives living in villages in rural Alaska; and
            ``(3) provides for the establishment of teleconferencing 
        capacity in health clinics located in or near such villages for 
        use by community health aides or community health 
        practitioners.
    ``(b) Specific Program Requirements.--The Secretary, acting through 
the Community Health Aide Program of the Service, shall--
            ``(1) using trainers accredited by the Program, provide a 
        high standard of training to community health aides and 
        community health practitioners to ensure that such aides and 
        practitioners provide quality health care, health promotion, 
        and disease prevention services to the villages served by the 
        Program;
            ``(2) in order to provide such training, develop a 
        curriculum that--
                    ``(A) combines education in the theory of health 
                care with supervised practical experience in the 
                provision of health care;
                    ``(B) provides instruction and practical experience 
                in the provision of acute care, emergency care, health 
                promotion, disease prevention, and the efficient and 
                effective management of clinic pharmacies, supplies, 
                equipment, and facilities; and
                    ``(C) promotes the achievement of the health status 
                objectives specified in section 3(2);
            ``(3) establish and maintain a Community Health Aide 
        Certification Board to certify as community health aides or 
        community health practitioners individuals who have 
        successfully completed the training described in paragraph (1) 
        or can demonstrate equivalent experience;
            ``(4) develop and maintain a system which identifies the 
        needs of community health aides and community health 
        practitioners for continuing education in the provision of 
        health care, including the areas described in paragraph (2)(B), 
        and develop programs that meet the needs for such continuing 
        education;
            ``(5) develop and maintain a system that provides close 
        supervision of community health aides and community health 
        practitioners; and
            ``(6) develop a system under which the work of community 
        health aides and community health practitioners is reviewed and 
        evaluated to assure the provision of quality health care, 
        health promotion, and disease prevention services.
    ``(c) National Community Health Aide Program.--The Secretary, 
acting through the Service, shall develop and promulgate regulations to 
operate a national Community Health Aide Program consistent with the 
requirements of this section without reducing funds for the Community 
Health Aide Program for Alaska.

``SEC. 122. TRIBAL HEALTH PROGRAM ADMINISTRATION.

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

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

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

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

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

``SEC. 125. NATIONAL HEALTH SERVICE CORPS.

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

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

    ``(a) Grants and Contracts.--The Secretary, acting through the 
Service, may enter into contracts with, or make grants to, accredited 
tribal colleges and universities and eligible accredited and accessible 
community colleges to establish demonstration programs to develop 
educational curricula for substance abuse counseling.
    ``(b) Use of Funds.--Funds provided under this section shall be 
used only for developing and providing educational curriculum for 
substance abuse counseling (including paying salaries for instructors). 
Such curricula may be provided through satellite campus programs.
    ``(c) Time Period of Assistance; Renewal.--A contract entered into 
or a grant provided under this section shall be for a period of 1 year. 
Such contract or grant may be renewed for an additional 1-year period 
upon the approval of the Secretary.
    ``(d) Criteria for Review and Approval of Applications.--Not later 
than 180 days after the date of the enactment of the Indian Health Care 
Improvement Act Amendments of 2004, the Secretary, after consultation 
with Indian Tribes and administrators of tribal colleges and 
universities and eligible accredited and accessible community colleges, 
shall develop and issue criteria for the review and approval of 
applications for funding (including applications for renewals of 
funding) under this section. Such criteria shall ensure that 
demonstration programs established under this section promote the 
development of the capacity of such entities to educate substance abuse 
counselors.
    ``(e) Assistance.--The Secretary shall provide such technical and 
other assistance as may be necessary to enable grant recipients to 
comply with the provisions of this section.
    ``(f) Report.--Each fiscal year, the Secretary shall submit to the 
President, for inclusion in the report which is required to be 
submitted under section 801 for that fiscal year, a report on the 
findings and conclusions derived from the demonstration programs 
conducted under this section during that fiscal year.
    ``(g) Definition.--For the purposes of this section, the term 
`educational curriculum' means 1 or more of the following:
            ``(1) Classroom education.
            ``(2) Clinical work experience.
            ``(3) Continuing education workshops.

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

    ``(a) Study; List.--The Secretary, acting through the Service, and 
the Secretary of the Interior, in consultation with Indian Tribes and 
Tribal Organizations, shall conduct a study and compile a list of the 
types of staff positions specified in subsection (b) whose 
qualifications include, or should include, training in the 
identification, prevention, education, referral, or treatment of mental 
illness, or dysfunctional and self destructive behavior.
    ``(b) Positions.--The positions referred to in subsection (a) are--
            ``(1) staff positions within the Bureau of Indian Affairs, 
        including existing positions, in the fields of--
                    ``(A) elementary and secondary education;
                    ``(B) social services and family and child welfare;
                    ``(C) law enforcement and judicial services; and
                    ``(D) alcohol and substance abuse;
            ``(2) staff positions within the Service; and
            ``(3) staff positions similar to those identified in 
        paragraphs (1) and (2) established and maintained by Indian 
        Tribes, Tribal Organizations, (without regard to the funding 
        source) and Urban Indian Organizations.
    ``(c) Training Criteria.--
            ``(1) In general.--The appropriate Secretary shall provide 
        training criteria appropriate to each type of position 
        identified in subsection (b)(1) and (b)(2) and ensure that 
        appropriate training has been, or shall be provided to any 
        individual in any such position. With respect to any such 
        individual in a position identified pursuant to subsection 
        (b)(3), the respective Secretaries shall provide appropriate 
        training to, or provide funds to, an Indian Tribe, Tribal 
        Organization, or Urban Indian Organization for training of 
        appropriate individuals. In the case of positions funded under 
        a funding agreement, the appropriate Secretary shall ensure 
        that funds to cover the costs of such training costs are 
        included in the funding agreement.
            ``(2) Position specific training criteria.--Position 
        specific training criteria shall be culturally relevant to 
        Indians and Indian Tribes and shall ensure that appropriate 
        information regarding Traditional Health Care Practices is 
        provided.
    ``(d) Community Education on Mental Illness.--The Service shall 
develop and implement, on request of an Indian Tribe, Tribal 
Organization, or Urban Indian Organization, or assist the Indian Tribe, 
Tribal Organization, or Urban Indian Organization to develop and 
implement, a program of community education on mental illness. In 
carrying out this subsection, the Service shall, upon request of an 
Indian Tribe, Tribal Organization, or Urban Indian Organization, 
provide technical assistance to the Indian Tribe, Tribal Organization, 
or Urban Indian Organization to obtain and develop community 
educational materials on the identification, prevention, referral, and 
treatment of mental illness and dysfunctional and self-destructive 
behavior.
    ``(e) Plan.--Not later than 90 days after the date of the enactment 
of the Indian Health Care Improvement Act Amendments of 2004, the 
Secretary shall develop a plan under which the Service will increase 
the health care staff providing behavioral health services by at least 
500 positions within 5 years after the date of the enactment of this 
section, with at least 200 of such positions devoted to child, 
adolescent, and family services. The plan developed under this 
subsection shall be implemented under the Act of November 2, 1921 (25 
U.S.C. 13) (commonly known as the `Snyder Act').

``SEC. 128. AUTHORIZATION OF APPROPRIATIONS.

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

                      ``TITLE II--HEALTH SERVICES

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

    ``(a) Use of Funds.--The Secretary, acting through the Service, is 
authorized to expend funds, directly or under the authority of the 
Indian Self-Determination and Education Assistance Act, which are 
appropriated under the authority of this section, for the purposes of--
            ``(1) eliminating the deficiencies in health status and 
        health resources of all Indian Tribes;
            ``(2) eliminating backlogs in the provision of health care 
        services to Indians;
            ``(3) meeting the health needs of Indians in an efficient 
        and equitable manner, including the use of telehealth and 
        telemedicine when appropriate;
            ``(4) eliminating inequities in funding for both direct 
        care and contract health service programs; and
            ``(5) augmenting the ability of the Service to meet the 
        following health service responsibilities with respect to those 
        Indian Tribes with the highest levels of health status 
        deficiencies and resource deficiencies:
                    ``(A) Clinical care, including, but not limited to, 
                inpatient care, outpatient care (including audiology, 
                clinical eye, and vision care), primary care, secondary 
                and tertiary care, and long-term care.
                    ``(B) Preventive health, including mammography and 
                other cancer screening in accordance with section 207.
                    ``(C) Dental care.
                    ``(D) Mental health, including community mental 
                health services, inpatient mental health services, 
                dormitory mental health services, therapeutic and 
                residential treatment centers, and training of 
                traditional health care practitioners.
                    ``(E) Emergency medical services.
                    ``(F) Treatment and control of, and rehabilitative 
                care related to, alcoholism and drug abuse (including 
                fetal alcohol syndrome) among Indians.
                    ``(G) Accident prevention programs.
                    ``(H) Home health care.
                    ``(I) Community health representatives.
                    ``(J) Maintenance and repair.
                    ``(K) Traditional Health Care Practices.
    ``(b) No Offset or Limitation.--Any funds appropriated under the 
authority of this section shall not be used to offset or limit any 
other appropriations made to the Service under this Act or the Act of 
November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), 
or any other provision of law.
    ``(c) Allocation; Use.--
            ``(1) In general.--Funds appropriated under the authority 
        of this section shall be allocated to Service Units, Indian 
        Tribes, or Tribal Organizations. The funds allocated to each 
        Indian Tribe, Tribal Organization, or Service Unit under this 
        paragraph shall be used by the Indian Tribe, Tribal 
        Organization, or Service Unit under this paragraph to improve 
        the health status and reduce the resource deficiency of each 
        Indian Tribe served by such Service Unit, Indian Tribe, or 
        Tribal Organization.
            ``(2) Apportionment of allocated funds.--The apportionment 
        of funds allocated to a Service Unit, Indian Tribe, or Tribal 
        Organization under paragraph (1) among the health service 
        responsibilities described in subsection (a)(5) shall be 
        determined by the Service in consultation with, and with the 
        active participation of, the affected Indian Tribes and Tribal 
        Organizations.
    ``(d) Provisions Relating to Health Status and Resource 
Deficiencies.--For the purposes of this section, the following 
definitions apply:
            ``(1) Definition.--The term `health status and resource 
        deficiency' means the extent to which--
                    ``(A) the health status objectives set forth in 
                section 3(2) are not being achieved; and
                    ``(B) the Indian Tribe or Tribal Organization does 
                not have available to it the health resources it needs, 
                taking into account the actual cost of providing health 
                care services given local geographic, climatic, rural, 
                or other circumstances.
            ``(2) Available resources.--The health resources available 
        to an Indian Tribe or Tribal Organization include health 
        resources provided by the Service as well as health resources 
        used by the Indian Tribe or Tribal Organization, including 
        services and financing systems provided by any Federal 
        programs, private insurance, and programs of State or local 
        governments.
            ``(3) Process for review of determinations.--The Secretary 
        shall establish procedures which allow any Indian Tribe or 
        Tribal Organization to petition the Secretary for a review of 
        any determination of the extent of the health status and 
        resource deficiency of such Indian Tribe or Tribal 
        Organization.
    ``(e) Eligibility for Funds.--Tribal Health Programs shall be 
eligible for funds appropriated under the authority of this section on 
an equal basis with programs that are administered directly by the 
Service.
    ``(f) Report.--By no later than the date that is 3 years after the 
date of the enactment of the Indian Health Care Improvement Act 
Amendments of 2004, the Secretary shall submit to Congress the current 
health status and resource deficiency report of the Service for each 
Service Unit, including newly recognized or acknowledged Indian Tribes. 
Such report shall set out--
            ``(1) the methodology then in use by the Service for 
        determining Tribal health status and resource deficiencies, as 
        well as the most recent application of that methodology;
            ``(2) the extent of the health status and resource 
        deficiency of each Indian Tribe served by the Service or a 
        Tribal Health Program;
            ``(3) the amount of funds necessary to eliminate the health 
        status and resource deficiencies of all Indian Tribes served by 
        the Service or a Tribal Health Program; and
            ``(4) an estimate of--
                    ``(A) the amount of health service funds 
                appropriated under the authority of this Act, or any 
                other Act, including the amount of any funds 
                transferred to the Service for the preceding fiscal 
                year which is allocated to each Service Unit, Indian 
                Tribe, or Tribal Organization;
                    ``(B) the number of Indians eligible for health 
                services in each Service Unit or Indian Tribe or Tribal 
                Organization; and
                    ``(C) the number of Indians using the Service 
                resources made available to each Service Unit, Indian 
                Tribe or Tribal Organization, and, to the extent 
                available, information on the waiting lists and number 
                of Indians turned away for services due to lack of 
                resources.
    ``(g) Inclusion in Base Budget.--Funds appropriated under this 
section for any fiscal year shall be included in the base budget of the 
Service for the purpose of determining appropriations under this 
section in subsequent fiscal years.
    ``(h) Clarification.--Nothing in this section is intended to 
diminish the primary responsibility of the Service to eliminate 
existing backlogs in unmet health care needs, nor are the provisions of 
this section intended to discourage the Service from undertaking 
additional efforts to achieve equity among Indian Tribes and Tribal 
Organizations.
    ``(i) Funding Designation.--Any funds appropriated under the 
authority of this section shall be designated as the `Indian Health 
Care Improvement Fund'.

``SEC. 202. CATASTROPHIC HEALTH EMERGENCY FUND.

    ``(a) Establishment.--There is hereby established an Indian 
Catastrophic Health Emergency Fund (hereafter in this section referred 
to as the `CHEF') consisting of--
            ``(1) the amounts deposited under subsection (f); and
            ``(2) the amounts appropriated to CHEF under this section.
    ``(b) Administration.--CHEF shall be administered by the Secretary, 
acting through the central office of the Service, solely for the 
purpose of meeting the extraordinary medical costs associated with the 
treatment of victims of disasters or catastrophic illnesses who are 
within the responsibility of the Service.
    ``(c) Conditions on Use of Fund.--No part of CHEF or its 
administration shall be subject to contract or grant under any law, 
including the Indian Self-Determination and Education Assistance Act, 
nor shall CHEF funds be allocated, apportioned, or delegated on an Area 
Office, Service Unit, or other similar basis.
    ``(d) Regulations.--The Secretary shall, through the negotiated 
rulemaking process under title VIII, promulgate regulations consistent 
with the provisions of this section to--
            ``(1) establish a definition of disasters and catastrophic 
        illnesses for which the cost of the treatment provided under 
        contract would qualify for payment from CHEF;
            ``(2) provide that a Service Unit shall not be eligible for 
        reimbursement for the cost of treatment from CHEF until its 
        cost of treating any victim of such catastrophic illness or 
        disaster has reached a certain threshold cost which the 
        Secretary shall establish at--
                    ``(A) the 2000 level of $19,000; and
                    ``(B) for any subsequent year, not less than the 
                threshold cost of the previous year increased by the 
                percentage increase in the medical care expenditure 
                category of the consumer price index for all urban 
                consumers (United States city average) for the 12-month 
                period ending with December of the previous year;
            ``(3) establish a procedure for the reimbursement of the 
        portion of the costs that exceeds such threshold cost incurred 
        by--
                    ``(A) Service Units; or
                    ``(B) whenever otherwise authorized by the Service, 
                non-Service facilities or providers;
            ``(4) establish a procedure for payment from CHEF in cases 
        in which the exigencies of the medical circumstances warrant 
        treatment prior to the authorization of such treatment by the 
        Service; and
            ``(5) establish a procedure that will ensure that no 
        payment shall be made from CHEF to any provider of treatment to 
        the extent that such provider is eligible to receive payment 
        for the treatment from any other Federal, State, local, or 
        private source of reimbursement for which the patient is 
        eligible.
    ``(e) No Offset or Limitation.--Amounts appropriated to CHEF under 
this section shall not be used to offset or limit appropriations made 
to the Service under the authority of the Act of November 2, 1921 (25 
U.S.C. 13) (commonly known as the `Snyder Act'), or any other law.
    ``(f) Deposit of Reimbursement Funds.--There shall be deposited 
into CHEF all reimbursements to which the Service is entitled from any 
Federal, State, local, or private source (including third party 
insurance) by reason of treatment rendered to any victim of a disaster 
or catastrophic illness the cost of which was paid from CHEF.

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

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

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

    ``(a) Determinations Regarding Diabetes.--The Secretary, acting 
through the Service, and in consultation with Indian Tribes and Tribal 
Organizations, shall determine--
            ``(1) by an Indian Tribe, Tribal Organization, and by 
        Service Unit, the incidence of, and the types of complications 
        resulting from, diabetes among Indians; and
            ``(2) based on the determinations made pursuant to 
        paragraph (1), the measures (including patient education and 
        effective ongoing monitoring of disease indicators) each 
        Service Unit should take to reduce the incidence of, and 
        prevent, treat, and control the complications resulting from, 
        diabetes among Indian Tribes within that Service Unit.
    ``(b) Diabetes Screening.--To the extent medically indicated and 
with informed consent, the Secretary shall screen each Indian who 
receives services from the Service for diabetes and for conditions 
which indicate a high risk that the individual will become diabetic 
and, in consultation with Indian Tribes, Urban Indian Organizations, 
and appropriate health care providers, establish a cost-effective 
approach to ensure ongoing monitoring of disease indicators. Such 
screening and monitoring may be conducted by a Tribal Health Program 
and may be conducted through appropriate Internet-based health care 
management programs.
    ``(c) Funding for Diabetes.--The Secretary shall continue to fund 
each model diabetes project in existence on the date of the enactment 
of the Indian Health Care Improvement Amendments Act of 2004, any such 
other diabetes programs operated by the Service or Tribal Health 
Programs, and any additional diabetes projects, such as the Medical 
Vanguard program provided for in title IV of Public Law 108-87, as 
implemented to serve Indian Tribes. Tribal Health Programs shall 
receive recurring funding for the diabetes projects that they operate 
pursuant to this section, both at the date of enactment of the Indian 
Health Care Improvement Act Amendments of 2004 and for projects which 
are added and funded thereafter.
    ``(d) Funding for Dialysis Programs.--The Secretary shall provide 
funding through the Service, Indian Tribes, and Tribal Organizations to 
establish dialysis programs, including funding to purchase dialysis 
equipment and provide necessary staffing.
    ``(e) Other Duties of the Secretary.--The Secretary shall, to the 
extent funding is available--
            ``(1) in each Area Office, consult with Indian Tribes and 
        Tribal Organizations regarding programs for the prevention, 
        treatment, and control of diabetes;
            ``(2) establish in each Area Office a registry of patients 
        with diabetes to track the incidence of diabetes and the 
        complications from diabetes in that area; and
            ``(3) ensure that data collected in each Area Office 
        regarding diabetes and related complications among Indians are 
        disseminated to all other Area Offices, subject to applicable 
        patient privacy laws.

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

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

``SEC. 206. HEALTH SERVICES RESEARCH.

    ``The Secretary, acting through the Service, shall make funding 
available for research to further the performance of the health service 
responsibilities of Indian Health Programs and shall coordinate the 
activities of other agencies within the Department to address these 
research needs. Tribal Health Programs shall be given an equal 
opportunity to compete for, and receive, research funds under this 
section. This funding may be used for both clinical and nonclinical 
research.

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

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

``SEC. 208. PATIENT TRAVEL COSTS.

    ``The Secretary, acting through the Service and Tribal Health 
Programs, shall provide funds for the following patient travel costs, 
including appropriate and necessary qualified escorts, associated with 
receiving health care services provided (either through direct or 
contract care or through Funding Agreements) under this Act--
            ``(1) emergency air transportation and non-emergency air 
        transportation where ground transportation is infeasible;
            ``(2) transportation by private vehicle (where no other 
        means of transportation is available), specially equipped 
        vehicle, and ambulance; and
            ``(3) transportation by such other means as may be 
        available and required when air or motor vehicle transportation 
        is not available.

``SEC. 209. EPIDEMIOLOGY CENTERS.

    ``(a) Additional Centers.--In addition to those epidemiology 
centers already established at the time of enactment of this Act, 
(including those for which funding is currently being provided in 
Funding Agreements), and without reducing the funding levels for such 
centers, not later than 180 days after the date of the enactment of the 
Indian Health Care Improvement Act Amendments of 2004, the Secretary, 
acting through the Service, shall establish and fund an epidemiology 
center in each Service Area which does not yet have one to carry out 
the functions described in subsection (b). Any new centers so 
established may be operated by Tribal Health Programs, but such funding 
shall not be divisible.
    ``(b) Functions of Centers.--In consultation with and upon the 
request of Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations, each Service Area epidemiology center established under 
this subsection shall, with respect to such Service Area--
            ``(1) collect data relating to, and monitor progress made 
        toward meeting, each of the health status objectives of the 
        Service, the Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations in the Service Area;
            ``(2) evaluate existing delivery systems, data systems, and 
        other systems that impact the improvement of Indian health;
            ``(3) assist Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations in identifying their highest priority 
        health status objectives and the services needed to achieve 
        such objectives, based on epidemiological data;
            ``(4) make recommendations for the targeting of services 
        needed by the populations served;
            ``(5) make recommendations to improve health care delivery 
        systems for Indians and Urban Indians;
            ``(6) provide requested technical assistance to Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations in 
        the development of local health service priorities and 
        incidence and prevalence rates of disease and other illness in 
        the community; and
            ``(7) provide disease surveillance and assist Indian 
        Tribes, Tribal Organizations, and Urban Indian Organizations to 
        promote public health.
    ``(c) Technical Assistance.--The Director of the Centers for 
Disease Control and Prevention shall provide technical assistance to 
the centers in carrying out the requirements of this subsection.
    ``(d) Funding for Studies.--The Secretary may make funding 
available to Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations to conduct epidemiological studies of Indian communities.

``SEC. 210. COMPREHENSIVE HEALTH EDUCATION PROGRAMS.

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

``SEC. 211. INDIAN YOUTH PROGRAM.

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

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

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

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

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

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

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

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

    ``(a) Studies and Monitoring.--The Secretary and the Service shall 
conduct, in conjunction with other appropriate Federal agencies and in 
consultation with concerned Indian Tribes and Tribal Organizations, 
studies and ongoing monitoring programs to determine trends in the 
health hazards to Indian miners and to Indians on or near reservations 
and Indian communities as a result of environmental hazards which may 
result in chronic or life threatening health problems, such as nuclear 
resource development, petroleum contamination, and contamination of 
water source and of the food chain. Such studies shall include--
            ``(1) an evaluation of the nature and extent of health 
        problems caused by environmental hazards currently exhibited 
        among Indians and the causes of such health problems;
            ``(2) an analysis of the potential effect of ongoing and 
        future environmental resource development on or near 
        reservations and Indian communities, including the cumulative 
        effect over time on health;
            ``(3) an evaluation of the types and nature of activities, 
        practices, and conditions causing or affecting such health 
        problems including, but not limited to, uranium mining and 
        milling, uranium mine tailing deposits, nuclear power plant 
        operation and construction, and nuclear waste disposal; oil and 
        gas production or transportation on or near reservations or 
        Indian communities; and other development that could affect the 
        health of Indians and their water supply and food chain;
            ``(4) a summary of any findings and recommendations 
        provided in Federal and State studies, reports, investigations, 
        and inspections during the 5 years prior to the date of the 
        enactment of the Indian Health Care Improvement Act Amendments 
        of 2004 that directly or indirectly relate to the activities, 
        practices, and conditions affecting the health or safety of 
        such Indians; and
            ``(5) the efforts that have been made by Federal and State 
        agencies and resource and economic development companies to 
        effectively carry out an education program for such Indians 
        regarding the health and safety hazards of such development.
    ``(b) Health Care Plans.--Upon completion of such studies, the 
Secretary and the Service shall take into account the results of such 
studies and, in consultation with Indian Tribes and Tribal 
Organizations, develop health care plans to address the health problems 
studied under subsection (a). The plans shall include--
            ``(1) methods for diagnosing and treating Indians currently 
        exhibiting such health problems;
            ``(2) preventive care and testing for Indians who may be 
        exposed to such health hazards, including the monitoring of the 
        health of individuals who have or may have been exposed to 
        excessive amounts of radiation or affected by other activities 
        that have had or could have a serious impact upon the health of 
        such individuals; and
            ``(3) a program of education for Indians who, by reason of 
        their work or geographic proximity to such nuclear or other 
        development activities, may experience health problems.
    ``(c) Submission of Report and Plan to Congress.--The Secretary and 
the Service shall submit to Congress the study prepared under 
subsection (a) no later than 18 months after the date of the enactment 
of the Indian Health Care Improvement Act Amendments of 2004. The 
health care plan prepared under subsection (b) shall be submitted in a 
report no later than 1 year after the study prepared under subsection 
(a) is submitted to Congress. Such report shall include recommended 
activities for the implementation of the plan, as well as an evaluation 
of any activities previously undertaken by the Service to address such 
health problems.
    ``(d) Intergovernmental Task Force.--
            ``(1) Establishment; members.--There is established an 
        Intergovernmental Task Force to be composed of the following 
        individuals (or their designees):
                    ``(A) The Secretary of Energy.
                    ``(B) The Secretary of the Environmental Protection 
                Agency.
                    ``(C) The Director of the Bureau of Mines.
                    ``(D) The Assistant Secretary for Occupational 
                Safety and Health.
                    ``(E) The Secretary of the Interior.
                    ``(F) The Secretary of Health and Human Services.
                    ``(G) The Director of the Indian Health Service.
            ``(2) Duties.--The Task Force shall--
                    ``(A) identify existing and potential operations 
                related to nuclear resource development or other 
                environmental hazards that affect or may affect the 
                health of Indians on or near a reservation or in an 
                Indian community; and
                    ``(B) enter into activities to correct existing 
                health hazards and ensure that current and future 
                health problems resulting from nuclear resource or 
                other development activities are minimized or reduced.
            ``(3) Chairman; meetings.--The Secretary of Health and 
        Human Services shall be the Chairman of the Task Force. The 
        Task Force shall meet at least twice each year.
    ``(e) Health Services to Certain Employees.--In the case of any 
Indian who--
            ``(1) as a result of employment in or near a uranium mine 
        or mill or near any other environmental hazard, suffers from a 
        work-related illness or condition;
            ``(2) is eligible to receive diagnosis and treatment 
        services from an Indian Health Program; and
            ``(3) by reason of such Indian's employment, is entitled to 
        medical care at the expense of such mine or mill operator or 
        entity responsible for the environmental hazard, the Indian 
        Health Program shall, at the request of such Indian, render 
        appropriate medical care to such Indian for such illness or 
        condition and may be reimbursed for any medical care so 
        rendered to which such Indian is entitled at the expense of 
        such operator or entity from such operator or entity. Nothing 
        in this subsection shall affect the rights of such Indian to 
        recover damages other than such amounts paid to the Indian 
        Health Program from the employer for providing medical care for 
        such illness or condition.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

``SEC. 221. LICENSING OR CERTIFICATION.

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

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

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

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

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

``SEC. 224. LIABILITY FOR PAYMENT.

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

``SEC. 225. AUTHORIZATION OF APPROPRIATIONS.

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

                        ``TITLE III--FACILITIES

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

    ``(a) Prerequisites for Expenditure of Funds.--Prior to the 
expenditure of, or the making of any binding commitment to expend, any 
funds appropriated for the planning, design, construction, or 
renovation of facilities pursuant to the Act of November 2, 1921 (25 
U.S.C. 13) (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 and applicable, that 
        such facility meets the construction standards of any 
        accrediting body recognized by the Secretary for the purposes 
        of the medicare, medicaid, and SCHIP programs under titles 
        XVIII, XIX, and XXI of the Social Security Act by not later 
        than 1 year after the date on which the construction or 
        renovation of such facility is completed.
    ``(b) Closures.--
            ``(1) Evaluation required.--Notwithstanding any other 
        provision of law, no facility operated by the Service may be 
        closed if the Secretary has not submitted to Congress at least 
        1 year prior to the date of the proposed closure an evaluation 
        of the impact of the proposed closure which specifies, in 
        addition to other considerations--
                    ``(A) the accessibility of alternative health care 
                resources for the population served by such facility;
                    ``(B) the cost-effectiveness of such closure;
                    ``(C) the quality of health care to be provided to 
                the population served by such facility after such 
                closure;
                    ``(D) the availability of contract health care 
                funds to maintain existing levels of service;
                    ``(E) the views of the Indian Tribes served by such 
                facility concerning such closure;
                    ``(F) the level of use of such facility by all 
                eligible Indians; and
                    ``(G) the distance between such facility and the 
                nearest operating Service hospital.
            ``(2) Exception for certain temporary closures.--Paragraph 
        (1) shall not apply to any temporary closure of a facility or 
        any portion of a facility if such closure is necessary for 
        medical, environmental, or construction safety reasons.
    ``(c) Health Care Facility Priority System.--
            ``(1) In general.--
                    ``(A) Establishment.--The Secretary, acting through 
                the Service, shall establish a health care facility 
                priority system, which shall--
                            ``(i) be developed with Indian Tribes and 
                        Tribal Organizations through negotiated 
                        rulemaking under section 802;
                            ``(ii) give Indian Tribes' needs the 
                        highest priority; and
                            ``(iii) at a minimum, include the lists 
                        required in paragraph (2)(B) and the 
                        methodology required in paragraph (2)(E).
                    ``(B) Priority of certain projects protected.--The 
                priority of any project established under the 
                construction priority system in effect on the date of 
                the Indian Health Care Improvement Act Amendments of 
                2004 shall not be affected by any change in the 
                construction priority system taking place thereafter if 
                the project was identified as 1 of the 10 top-priority 
                inpatient projects, 1 of the 10 top-priority outpatient 
                projects, 1 of the 10 top-priority staff quarters 
                developments, or 1 of the 10 top-priority Youth 
                Regional Treatment Centers in the fiscal year 2005 
                Indian Health Service budget justification, or if the 
                project had completed both Phase I and Phase II of the 
                construction priority system in effect on the date of 
                the enactment of such Act.
            ``(2) Report; contents.--The Secretary shall submit to the 
        President, for inclusion in each report required to be 
        transmitted to Congress under section 801, a report which sets 
        forth the following:
                    ``(A) A description of the health care facility 
                priority system of the Service, established under 
                paragraph (1).
                    ``(B) Health care facilities lists, including but 
                not limited to--
                            ``(i) the 10 top-priority inpatient health 
                        care facilities;
                            ``(ii) the 10 top-priority outpatient 
                        health care facilities;
                            ``(iii) the 10 top-priority specialized 
                        health care facilities (such as long-term care 
                        and alcohol and drug abuse treatment);
                            ``(iv) the 10 top-priority staff quarters 
                        developments associated with health care 
                        facilities; and
                            ``(v) the 10 top-priority patient hostels 
                        associated with health care facilities.
                    ``(C) The justification for such order of priority.
                    ``(D) The projected cost of such projects.
                    ``(E) The methodology adopted by the Service in 
                establishing priorities under its health care facility 
                priority system.
            ``(3) Requirements for preparation of reports.--In 
        preparing each report required under paragraph (2) (other than 
        the initial report), the Secretary shall annually--
                    ``(A) consult with and obtain information on all 
                health care facilities needs from Indian Tribes, Tribal 
                Organizations, and Urban Indian Organizations; and
                    ``(B) review the total unmet needs of all Indian 
                Tribes, Tribal Organizations, and Urban Indian 
                Organizations for health care facilities (including 
                hostels and staff quarters), including needs for 
                renovation and expansion of existing facilities.
            ``(4) Criteria for evaluating needs.--For purposes of this 
        subsection, the Secretary shall, in evaluating the needs of 
        facilities operated under any Funding Agreement use the same 
        criteria that the Secretary uses in evaluating the needs of 
        facilities operated directly by the Service.
            ``(5) Needs of facilities under isdeaa agreements.--The 
        Secretary shall ensure that the planning, design, construction, 
        and renovation needs of Service and non-Service facilities 
        operated under funding agreements in accordance with the Indian 
        Self-Determination and Education Assistance Act (25 U.S.C. 450 
        et seq.) are fully and equitably integrated into the health 
        care facility priority system.
    ``(d) Review of Need for Facilities.--
            ``(1) Initial report.--In the year 2005, the Government 
        Accountability Office shall prepare and finalize a report which 
        sets forth the needs of the Service, Indian Tribes, Tribal 
        Organizations, and Urban Indian Organizations, for the 
        facilities listed under subsection (c)(2)(B), including the 
        needs for renovation and expansion of existing facilities. The 
        Government Accountability Office shall submit the report to the 
        appropriate authorizing and appropriations committees of 
        Congress and to the Secretary.
            ``(2) Beginning in the year 2006, the Secretary shall 
        update the report required under paragraph (1) every 5 years.
            ``(3) The Comptroller General and the Secretary shall 
        consult with Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations. The Secretary shall submit the reports 
        required by paragraphs (1) and (2), to the President for 
        inclusion in the report required to be transmitted to Congress 
        under section 801.
            ``(4) For purposes of this subsection, the reports shall, 
        regarding the needs of facilities operated under any Funding 
        Agreement, be based on the same criteria that the Secretary 
        uses in evaluating the needs of facilities operated directly by 
        the Service.
            ``(5) The planning, design, construction, and renovation 
        needs of facilities operated under Funding Agreements shall be 
        fully and equitably integrated into the development of the 
        health facility priority system.
            ``(6) Beginning in the year 2006 and each fiscal year 
        thereafter, the Secretary shall provide an opportunity for 
        nomination of planning, design, and construction projects by 
        the Service, Indian Tribes, and Tribal Organizations for 
        consideration under the health care facility priority system.
    ``(e) Funding Condition.--All funds appropriated under the Act of 
November 2, 1921 (25 U.S.C. 13) (commonly known as the `Snyder Act'), 
for the planning, design, construction, or renovation of health 
facilities for the benefit of 1 or more Indian Tribes shall be subject 
to the provisions of the Indian Self-Determination and Education 
Assistance Act (25 U.S.C. 450 et seq.).
    ``(f) Development of Innovative Approaches.--The Secretary shall 
consult and cooperate with Indian Tribes, Tribal Organizations, and 
Urban Indian Organizations in developing innovative approaches to 
address all or part of the total unmet need for construction of health 
facilities, including those provided for in other sections of this 
title and other approaches.

``SEC. 302. SANITATION FACILITIES.

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

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

    ``(a) Buy Indian Act.--The Secretary, acting through the Service, 
may use the negotiating authority of section 23 of the Act of June 25, 
1910 (25 U.S.C. 47, commonly known as the `Buy Indian Act'), to give 
preference to any Indian or any enterprise, partnership, corporation, 
or other type of business organization owned and controlled by an 
Indian or Indians including former or currently federally recognized 
Indian Tribes in the State of New York (hereinafter referred to as an 
`Indian firm') in the construction and renovation of Service facilities 
pursuant to section 301 and in the construction of sanitation 
facilities pursuant to section 302. Such preference may be accorded by 
the Secretary unless the Secretary finds, pursuant to regulations 
adopted pursuant to section 802, that the project or function to be 
contracted for will not be satisfactory or such project or function 
cannot be properly completed or maintained under the proposed contract. 
The Secretary, in arriving at such a finding, shall consider whether 
the Indian or Indian firm will be deficient with respect to--
            ``(1) ownership and control by Indians;
            ``(2) equipment;
            ``(3) bookkeeping and accounting procedures;
            ``(4) substantive knowledge of the project or function to 
        be contracted for;
            ``(5) adequately trained personnel; or
            ``(6) other necessary components of contract performance.
    ``(b) Labor Standards.--
            ``(1) In general.--For the purposes of implementing the 
        provisions of this title, contracts for the construction or 
        renovation of health care facilities, staff quarters, and 
        sanitation facilities, and related support infrastructure, 
        funded in whole or in part with funds made available pursuant 
        to this title, shall contain a provision requiring compliance 
        with subchapter IV of chapter 31 of title 40, United States 
        Code (commonly known as the `Davis-Bacon Act'), unless such 
        construction or renovation--
                    ``(A) is performed by a contractor pursuant to a 
                contract with an Indian Tribe or Tribal Organization 
                with funds supplied through a contract, compact or 
                funding agreement authorized by the Indian Self-
                Determination and Education Assistance Act, or other 
                statutory authority; and
                    ``(B) is subject to prevailing wage rates for 
                similar construction or renovation in the locality as 
                determined by the Indian Tribes or Tribal Organizations 
                to be served by the construction or renovation.
            ``(2) Exception.--This subsection shall not apply to 
        construction or renovation carried out by an Indian Tribe or 
        Tribal Organization with its own employees.

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

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

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

    ``(a) Funding.--
            ``(1) In general.--The Secretary, acting through the 
        Service, in consultation with Indian Tribes and Tribal 
        Organizations, shall make funding available to Indian Tribes 
        and Tribal Organizations for the construction, expansion, or 
        modernization of facilities for the provision of ambulatory 
        care services to eligible Indians (and noneligible persons 
        pursuant to subsections (b)(2) and (c)(1)(C)). Funding made 
        under this section may cover up to 100 percent of the costs of 
        such construction, expansion, or modernization. For the 
        purposes of this section, the term `construction' includes the 
        replacement of an existing facility.
            ``(2) Funding agreement required.--Funding under paragraph 
        (1) may only be made available to a Tribal Health Program 
        operating an Indian health facility (other than a facility 
        owned or constructed by the Service, including a facility 
        originally owned or constructed by the Service and transferred 
        to an Indian Tribe or Tribal Organization).
    ``(b) Use of Funds.--
            ``(1) Allowable uses.--Funding provided under this section 
        may be used for the construction, expansion, or modernization 
        (including the planning and design of such construction, 
        expansion, or modernization) of an ambulatory care facility--
                    ``(A) located apart from a hospital;
                    ``(B) not funded under section 301 or section 307; 
                and
                    ``(C) which, upon completion of such construction 
                or modernization will--
                            ``(i) have a total capacity appropriate to 
                        its projected service population;
                            ``(ii) provide annually no fewer than 150 
                        eligible Indians and other users who are 
                        eligible for services in such facility in 
                        accordance with section 807(c)(2); and
                            ``(iii) provide ambulatory care in a 
                        Service Area (specified in the Funding 
                        Agreement) with a population of no fewer than 
                        1,500 eligible Indians and other users who are 
                        eligible for services in such facility in 
                        accordance with section 807(c)(2).
            ``(2) Additional allowable use.--The Secretary may also 
        reserve a portion of the funding provided under this section 
        and use those reserved funds to reduce an outstanding debt 
        incurred by Indian Tribes or Tribal Organizations for the 
        construction, expansion, or modernization of an ambulatory care 
        facility that meets the requirements under paragraph (1). The 
        provisions of this section shall apply, except that such 
        applications for funding under this paragraph shall be 
        considered separately from applications for funding under 
        paragraph (1).
            ``(3) Use only for certain portion of costs.--Funding 
        provided under this section may be used only for the cost of 
        that portion of a construction, expansion, or modernization 
        project or debt reduction that benefits the Service population 
        identified above in subsection (b)(1)(C) (ii) and (iii).
            ``(4) Applicability of requirements in the case of isolated 
        facilities.--The requirements of clauses (ii) and (iii) of 
        paragraph (1)(C) shall not apply to an Indian Tribe or Tribal 
        Organization applying for funding under this section for a 
        health care facility located or to be constructed on an island 
        or when such facility is not located on a road system providing 
        direct access to an inpatient hospital where care is available 
        to the Service population.
    ``(c) Funding.--
            ``(1) Application.--No funding may be made available under 
        this section unless an application or proposal for such funding 
        has been approved by the Secretary in accordance with 
        applicable regulations and has provided reasonable assurance by 
        the applicant that, at all times after the construction, 
        expansion, or modernization of a facility carried out pursuant 
        to funding received under this section--
                    ``(A) adequate financial support will be available 
                for the provision of services at such facility;
                    ``(B) such facility will be available to eligible 
                Indians without regard to ability to pay or source of 
                payment; and
                    ``(C) such facility will, as feasible without 
                diminishing the quality or quantity of services 
                provided to eligible Indians, serve noneligible persons 
                on a cost basis.
            ``(2) Priority.--In awarding funding under this section, 
        the Secretary shall give priority to Indian Tribes and Tribal 
        Organizations that demonstrate--
                    ``(A) a need for increased ambulatory care 
                services; and
                    ``(B) insufficient capacity to deliver such 
                services.
            ``(3) Peer review panels.--The Secretary may provide for 
        the establishment of peer review panels, as necessary, to 
        review and evaluate applications and proposals and to advise 
        the Secretary regarding such applications using the criteria 
        developed during consultations pursuant to subsection (a)(1).
    ``(d) Reversion of Facilities.--If any facility (or portion 
thereof) with respect to which funds have been paid under this section, 
ceases, within 5 years after completion of the construction, expansion, 
or modernization carried out with such funds, to be used for the 
purposes of providing health care services to eligible Indians, all of 
the right, title, and interest in and to such facility (or portion 
thereof) shall transfer to the United States unless otherwise 
negotiated by the Service and the Indian Tribe or Tribal Organization.
    ``(e) Funding Nonrecurring.--Funding provided under this section 
shall be nonrecurring and shall not be available for inclusion in any 
individual Indian Tribe's tribal share for an award under the Indian 
Self-Determination and Education Assistance Act or for reallocation or 
redesign thereunder.

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

    ``(a) Health Care Demonstration Projects.--The Secretary, acting 
through the Service, and in consultation with Indian Tribes and Tribal 
Organizations, is authorized to enter into construction project 
agreements and construction contracts under the Indian Self-
Determination and Education Assistance Act (25 U.S.C. 450 et seq.) with 
Indian Tribes or Tribal Organizations for the purpose of carrying out a 
health care delivery demonstration project to test alternative means of 
delivering health care and services to Indians through facilities, 
including but not limited to hospice, traditional Indian health, and 
child care facilities.
    ``(b) Use of Funds.--The Secretary, in approving projects pursuant 
to this section, may authorize funding for the construction and 
renovation of hospitals, health centers, health stations, and other 
facilities to deliver health care services and is authorized to--
            ``(1) waive any leasing prohibition;
            ``(2) permit carryover of funds appropriated for the 
        provision of health care services;
            ``(3) permit the use of other available funds;
            ``(4) permit the use of funds or property donated from any 
        source for project purposes;
            ``(5) provide for the reversion of donated real or personal 
        property to the donor; and
            ``(6) permit the use of Service funds to match other funds, 
        including Federal funds.
    ``(c) Regulations.--The Secretary shall develop and promulgate 
regulations not later than 1 year after the date of enactment of the 
Indian Health Care Improvement Act Amendments of 2004. If the Secretary 
has not promulgated regulations by that date, the Secretary shall 
develop and publish regulations, through rulemaking under section 802, 
for the review and approval of applications submitted under this 
section.
    ``(d) Criteria.--The Secretary may approve projects that meet the 
following criteria:
            ``(1) There is a need for a new facility or program or the 
        reorientation of an existing facility or program.
            ``(2) A significant number of Indians, including those with 
        low health status, will be served by the project.
            ``(3) The project has the potential to deliver services in 
        an efficient and effective manner.
            ``(4) The project is economically viable.
            ``(5) The Indian Tribe or Tribal Organization has the 
        administrative and financial capability to administer the 
        project.
            ``(6) The project is integrated with providers of related 
        health and social services and is coordinated with, and avoids 
        duplication of, existing services.
    ``(e) Peer Review Panels.--The Secretary may provide for the 
establishment of peer review panels, as necessary, to review and 
evaluate applications using the criteria developed pursuant to 
subsection (d).
    ``(f) Priority.--The Secretary shall give priority to applications 
for demonstration projects in each of the following Service Units to 
the extent that such applications are timely filed and meet the 
criteria specified in subsection (d):
            ``(1) Cass Lake, Minnesota.
            ``(2) Clinton, Oklahoma.
            ``(3) Harlem, Montana.
            ``(4) Mescalero, New Mexico.
            ``(5) Owyhee, Nevada.
            ``(6) Parker, Arizona.
            ``(7) Schurz, Nevada.
            ``(8) Winnebago, Nebraska.
            ``(9) Ft. Yuma, California.
    ``(g) Technical Assistance.--The Secretary shall provide such 
technical and other assistance as may be necessary to enable applicants 
to comply with the provisions of this section.
    ``(h) Service to Ineligible Persons.--The authority to provide 
services to persons otherwise ineligible for the health care benefits 
of the Service and the authority to extend hospital privileges in 
Service facilities to non-Service health practitioners as provided in 
section 807 may be included, subject to the terms of such section, in 
any demonstration project approved pursuant to this section.
    ``(i) Equitable Treatment.--For purposes of subsection (d)(1), the 
Secretary shall, in evaluating facilities operated under any Funding 
Agreement, use the same criteria that the Secretary uses in evaluating 
facilities operated directly by the Service.
    ``(j) Equitable Integration of Facilities.--The Secretary shall 
ensure that the planning, design, construction, renovation, and 
expansion needs of Service and non-Service facilities which are the 
subject of a Funding Agreement for health services are fully and 
equitably integrated into the implementation of the health care 
delivery demonstration projects under this section.

``SEC. 307. LAND TRANSFER.

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

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

    ``The Secretary, acting through the Service, may enter into leases, 
contracts, and other agreements with Indian Tribes and Tribal 
Organizations which hold (1) title to, (2) a leasehold interest in, or 
(3) a beneficial interest in (when title is held by the United States 
in trust for the benefit of an Indian Tribe) facilities used or to be 
used for the administration and delivery of health services by an 
Indian Health Program. Such leases, contracts, or agreements may 
include provisions for construction or renovation and provide for 
compensation to the Indian Tribe or Tribal Organization of rental and 
other costs consistent with section 105(l) of the Indian Self-
Determination and Education Assistance Act and regulations thereunder. 
Notwithstanding any other provision of law, such leases, contracts, or 
other agreements shall be considered as operating leases for the 
purpose of scoring under the Balanced Budget and Emergency Deficit 
Contol Act of 1985 (2 U.S.C. 901 et seq.)

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

    ``(a) In General.--The Secretary, in consultation with the 
Secretary of the Treasury, Indian Tribes, and Tribal Organizations, 
shall carry out a study to determine the feasibility of establishing a 
loan fund to provide to Indian Tribes and Tribal Organizations direct 
loans or guarantees for loans for the construction of health care 
facilities, including--
            ``(1) inpatient facilities;
            ``(2) outpatient facilities;
            ``(3) staff quarters;
            ``(4) hostels; and
            ``(5) specialized care facilities, such as behavioral 
        health and elder care facilities.
    ``(b) Determinations.--In carrying out the study under subsection 
(a), the Secretary shall determine--
            ``(1) the maximum principal amount of a loan or loan 
        guarantee that should be offered to a recipient from the loan 
        fund;
            ``(2) the percentage of eligible costs, not to exceed 100 
        percent, that may be covered by a loan or loan guarantee from 
        the loan fund (including costs relating to planning, design, 
        financing, site land development, construction, rehabilitation, 
        renovation, conversion, improvements, medical equipment and 
        furnishings, and other facility-related costs and capital 
        purchase (but excluding staffing));
            ``(3) the cumulative total of the principal of direct loans 
        and loan guarantees, respectively, that may be outstanding at 
        any 1 time;
            ``(4) the maximum term of a loan or loan guarantee that may 
        be made for a facility from the loan fund;
            ``(5) the maximum percentage of funds from the loan fund 
        that should be allocated for payment of costs associated with 
        planning and applying for a loan or loan guarantee;
            ``(6) whether acceptance by the Secretary of an assignment 
        of the revenue of an Indian Tribe or Tribal Organization as 
        security for any direct loan or loan guarantee from the loan 
        fund would be appropriate;
            ``(7) whether, in the planning and design of health 
        facilities under this section, users eligible under section 
        807(c) may be included in any projection of patient population;
            ``(8) whether funds of the Service provided through loans 
        or loan guarantees from the loan fund should be eligible for 
        use in matching other Federal funds under other programs;
            ``(9) the appropriateness of, and best methods for, 
        coordinating the loan fund with the health care priority system 
        of the Service under section 301; and
            ``(10) any legislative or regulatory changes required to 
        implement recommendations of the Secretary based on results of 
        the study.
    ``(c) Report.--Not later than September 30, 2006, the Secretary 
shall submit to the Committee on Indian Affairs of the Senate and the 
Committee on Resources and the Committee on Energy and Commerce of the 
House of Representatives a report that describes--
            ``(1) the manner of consultation made as required by 
        subsection (a); and
            ``(2) the results of the study, including any 
        recommendations of the Secretary based on results of the study.

``SEC. 310. TRIBAL LEASING.

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

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

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

``SEC. 312. LOCATION OF FACILITIES.

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

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

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

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

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

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

    ``(a) Applicability.--The Secretary shall ensure that the 
requirements of the Buy American Act apply to all procurements made 
with funds provided pursuant to section 317. Indian Tribes and Tribal 
Organizations shall be exempt from these requirements.
    ``(b) Effect of Violation.--If it has been finally determined by a 
court or Federal agency that any person intentionally affixed a label 
bearing a `Made in America' inscription or any inscription with the 
same meaning, to any product sold in or shipped to the United States 
that is not made in the United States, such person shall be ineligible 
to receive any contract or subcontract made with funds provided 
pursuant to section 317, pursuant to the debarment, suspension, and 
ineligibility procedures described in sections 9.400 through 9.409 of 
title 48, Code of Federal Regulations.
    ``(c) Definitions.--For purposes of this section, the term `Buy 
American Act' means title III of the Act entitled `An Act making 
appropriations for the Treasury and Post Office Departments for the 
fiscal year ending June 30, 1934, and for other purposes', approved 
March 3, 1933 (41 U.S.C. 10a et seq.).

``SEC. 316. OTHER FUNDING FOR FACILITIES.

    ``(a) Authority To Accept Funds.--The Secretary is authorized to 
accept from any source, including Federal and State agencies, funds 
that are available for the construction of health care facilities and 
use such funds to plan, design, and construct health care facilities 
for Indians and to transfer such funds to Indian Tribes or Tribal 
Organizations through construction project agreements or construction 
contracts under the Indian Self-Determination and Education Assistance 
Act (25 U.S.C. 450 et seq.). Receipt of such funds shall have no effect 
on the priorities established pursuant to section 301.
    ``(b) Interagency Agreements.--The Secretary is authorized to enter 
into interagency agreements with other Federal agencies or State 
agencies and other entities and to accept funds from such Federal or 
State agencies or other sources to provide for the planning, design, 
and construction of health care facilities to be administered by Indian 
Health Programs in order to carry out the purposes of this Act and the 
purposes for which the funds were appropriated or for which the funds 
were otherwise provided.
    ``(c) Transferred Funds.--Any Federal agency to which funds for the 
construction of health care facilities are appropriated is authorized 
to transfer such funds to the Secretary for the construction of health 
care facilities to carry out the purposes of this Act as well as the 
purposes for which such funds are appropriated to such other Federal 
agency.
    ``(d) Establishment of Standards.--The Secretary, through the 
Service, shall establish standards by regulation, developed by 
rulemaking under section 802, for the planning, design, and 
construction of health care facilities serving Indians under this Act.

``SEC. 317. AUTHORIZATION OF APPROPRIATIONS.

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

                 ``TITLE IV--ACCESS TO HEALTH SERVICES

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

    ``(a) Disregard of Medicare, Medicaid, and SCHIP Payments in 
Determining Appropriations.--Any payments received by an Indian Health 
Program or by an Urban Indian Organization made under title XVIII, XIX, 
or XXI of the Social Security Act for services provided to Indians 
eligible for benefits under such respective titles shall not be 
considered in determining appropriations for the provision of health 
care and services to Indians.
    ``(b) Nonpreferential Treatment.--Nothing in this Act authorizes 
the Secretary to provide services to an Indian with coverage under 
title XVIII, XIX, or XXI of the Social Security Act in preference to an 
Indian without such coverage.
    ``(c) Use of Funds.--
            ``(1) Special fund.--Notwithstanding any other provision of 
        law, but subject to paragraph (2), payments to which a facility 
        of the Service is entitled by reason of a provision of the 
        Social Security Act shall be placed in a special fund to be 
        held by the Secretary and first used (to such extent or in such 
        amounts as are provided in appropriation Acts) for the purpose 
        of making any improvements in the programs of the Service which 
        may be necessary to achieve or maintain compliance with the 
        applicable conditions and requirements of titles XVIII, XIX, 
        and XXI of the Social Security Act. Any amounts to be 
        reimbursed that are in excess of the amount necessary to 
        achieve or maintain such conditions and requirements shall, 
        subject to the consultation with Indian Tribes being served by 
        the Service Unit, be used for reducing the health resource 
        deficiencies of the Indian Tribes. In making payments from such 
        fund, the Secretary shall ensure that each Service Unit of the 
        Service receives 100 percent of the amount to which the 
        facilities of the Service, for which such Service Unit makes 
        collections, are entitled by reason of a provision of the 
        Social Security Act.
            ``(2) Direct payment option.--Paragraph (1) shall not apply 
        upon the election of a Tribal Health Program under subsection 
        (d) to receive payments directly. No payment may be made out of 
        the special fund described in such paragraph with respect to 
        reimbursement made for services provided during the period of 
        such election.
    ``(d) Direct Billing.--
            ``(1) In general.--A Tribal Health Program may directly 
        bill for, and receive payment for, health care items and 
        services provided by such Indian Tribe or Tribal organization 
        for which payment is made under title XVIII, XIX, or XXI of the 
        Social Security Act or from any other third party payor.
            ``(2) Direct reimbursement.--
                    ``(A) Use of funds.--Each Tribal Health Program 
                exercising the option described in paragraph (1) with 
                respect to a program under a title of the Social 
                Security Act shall be reimbursed directly by that 
                program for items and services furnished without regard 
                to section 401(c), but all amounts so reimbursed shall 
                be used by the Tribal Health Program for the purpose of 
                making any improvements in Tribal facilities or Tribal 
                Health Programs that may be necessary to achieve or 
                maintain compliance with the conditions and 
                requirements applicable generally to such items and 
                services under the program under such title and to 
                provide additional health care services, improvements 
                in health care facilities and Tribal Health Programs, 
                any health care-related purpose, or otherwise to 
                achieve the objectives provided in section 3 of this 
                Act.
                    ``(B) Audits.--The amounts paid to an Indian Tribe 
                or Tribal Organization exercising the option described 
                in paragraph (1) with respect to a program under a 
                title of the Social Security Act shall be subject to 
                all auditing requirements applicable to programs 
                administered by an Indian Health Program.
                    ``(C) 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.
            ``(3) Examination and implementation of changes.--The 
        Secretary, acting through the Service and with the assistance 
        of the Administrator of the Centers for Medicare & Medicaid 
        Services, shall examine on an ongoing basis and implement any 
        administrative changes that may be necessary to facilitate 
        direct billing and reimbursement under the program established 
        under this subsection, including any agreements with States 
        that may be necessary to provide for direct billing under a 
        program under a title of the Social Security Act.
            ``(4) Withdrawal from program.--A Tribal Health Program 
        that bills directly under the program established under this 
        subsection may withdraw from participation in the same manner 
        and under the same conditions that an Indian Tribe or Tribal 
        Organization may retrocede a contracted program to the 
        Secretary under the authority of the Indian Self-Determination 
        and Education Assistance Act (25 U.S.C. 450 et seq.). All cost 
        accounting and billing authority under the program established 
        under this subsection shall be returned to the Secretary upon 
        the Secretary's acceptance of the withdrawal of participation 
        in this program.

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

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

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

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

``SEC. 404. CREDITING OF REIMBURSEMENTS.

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

``SEC. 405. PURCHASING HEALTH CARE COVERAGE.

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

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

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

``SEC. 407. PAYOR OF LAST RESORT.

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

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

    ``For purposes of determining the eligibility of an entity that is 
operated by the Service, an Indian Tribe, Tribal Organization, or Urban 
Indian Organization to receive payment or reimbursement from any 
federally funded health care program for health care services it 
furnishes to an Indian, any requirement that the entity be licensed or 
recognized under State or local law to furnish such services shall be 
deemed to have been met if the entity meets all the applicable 
standards for such licensure, but the entity need not obtain a license. 
In determining whether the entity meets such standards, the absence of 
licensure of any staff member of the entity may not be taken into 
account.

``SEC. 409. CONSULTATION.

    ``(a) National Indian Technical Advisory Group (TAG).--
            ``(1) Establishment and membership.--The Secretary shall 
        establish within the Centers for Medicare & Medicaid Services a 
        National Indian Technical Advisory Group (in this subsection 
        referred to as the `Advisory Group') which shall have no fewer 
        than 14 members including at least 1 member designated by the 
        Indian Tribes and Tribal Organizations in each Service Area, 1 
        Urban Indian Organization representative, and 1 member 
        representing the Service. The Secretary may appoint additional 
        members upon the recommendation of the Advisory Group.
            ``(2) Duties.--
                    ``(A) Identification of issues.--The Advisory Group 
                shall assist the Secretary in identifying and 
                addressing issues regarding the health care programs 
                under the Social Security Act (including medicare, 
                medicaid, and SCHIP) that have implications for Indian 
                Health Programs or Urban Indian Organizations. The 
                Advisory Group shall provide advice to the Secretary 
                with respect to those issues and with respect to the 
                need for the Secretary to engage in consultation with 
                Indian Tribes, Tribal Organizations, and Urban Indian 
                Organizations.
                    ``(B) Construction.--Nothing in subparagraph (A) 
                shall be construed as affecting any requirement under 
                any applicable Executive order for the Secretary to 
                consult with Indian Tribes in cases of health care 
                policies that have implications for Indian Health 
                Programs or Urban Indian Organizations.
            ``(3) Nonapplication of federal advisory committee act.--
        The Federal Advisory Committee Act (5 U.S.C. App.) shall not 
        apply to the Advisory Group.
            ``(4) Meetings.--The Secretary is authorized to convene 
        meetings of the Advisory Group as often as needed to fulfill 
        the responsibilities under this section.
    ``(b) Solicitation of Medicaid Advice.--
            ``(1) In general.--As part of its plan for payment under 
        title XIX of the Social Security Act to a State in which the 
        Service operates or funds health care programs or in which 1 or 
        more Indian Health Programs or Urban Indian Organizations 
        provide health care in the State for which medical assistance 
        is available under such title, the State may establish a 
        process under which the State seeks advice on a regular, 
        ongoing basis from designees of such Indian Health Programs and 
        Urban Indian Organizations on matters relating to the 
        application of such title to and having a direct effect on such 
        Indian Health Programs and Urban Indian Organizations.
            ``(2) Manner of advice.--The process described in paragraph 
        (1) should include solicitation of advice prior to submission 
        of any plan amendments, waiver requests, and proposals for 
        demonstration projects. Such process may include appointment of 
        an advisory committee and of a designee of such Indian Health 
        Programs and Urban Indian Organizations to the medical care 
        advisory committee advising the State on its medicaid plan.
            ``(3) Payment of expenses.--Expenses in carrying out this 
        subsection shall be treated as reasonable administrative 
        expenses for which reimbursement may be made under section 
        1903(a) of the Social Security Act.
    ``(c) Construction.--Nothing in this section shall be construed as 
superseding existing advisory committees, working groups, or other 
advisory procedures established by the Secretary or by any State.

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

    ``Notwithstanding any other provision of law, insofar as the State 
health plan of a State under title XXI of the Social Security Act may 
provide (whether through its medicaid plan under title XIX of such Act 
or otherwise) child health assistance to individuals who are otherwise 
served by the Service or by an Indian Tribe or Tribal Organization, the 
Secretary may enter into an arrangement with the State and with the 
Service or 1 or more Indian Tribes and Tribal Organizations in the 
State under which a portion of the funds otherwise made available to 
the State under such title with respect to such individuals is provided 
to the Service, Indian Tribe, or Tribal Organization, respectively, for 
the purpose of providing such assistance to such individuals consistent 
with the purposes of such title.

``SEC. 411. SOCIAL SECURITY ACT SANCTIONS.

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

``SEC. 412. COST SHARING.

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

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

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

``SEC. 414. NAVAJO NATION MEDICAID AGENCY FEASIBILITY STUDY.

    ``(a) Study.--The Secretary shall conduct a study to determine the 
feasibility of treating the Navajo Nation as a State for the purposes 
of title XIX of the Social Security Act, to provide services to Indians 
living within the boundaries of the Navajo Nation through an entity 
established having the same authority and performing the same functions 
as single-State medicaid agencies responsible for the administration of 
the State plan under title XIX of the Social Security Act.
    ``(b) Considerations.--In conducting the study, the Secretary shall 
consider the feasibility of--
            ``(1) assigning and paying all expenditures for the 
        provision of services and related administration funds, under 
        title XIX of the Social Security Act, to Indians living within 
        the boundaries of the Navajo Nation that are currently paid to 
        or would otherwise be paid to the State of Arizona, New Mexico, 
        or Utah;
            ``(2) providing assistance to the Navajo Nation in the 
        development and implementation of such entity for the 
        administration, eligibility, payment, and delivery of medical 
        assistance under title XIX of the Social Security Act;
            ``(3) providing an appropriate level of matching funds for 
        Federal medical assistance with respect to amounts such entity 
        expends for medical assistance for services and related 
        administrative costs; and
            ``(4) authorizing the Secretary, at the option of the 
        Navajo Nation, to treat the Navajo Nation as a State for the 
        purposes of title XIX of the Social Security Act (relating to 
        the State children's health insurance program) under terms 
        equivalent to those described in paragraphs (2) through (4).
    ``(c) Report.--Not later then 3 years after the date of enactment 
of the Indian Health Act Improvement Act Amendments of 2004, the 
Secretary shall submit to the Committee of Indian Affairs and Committee 
on Finance of the Senate and the Committee on Resources and Committee 
on Ways and Means on the House of Representatives a report that 
includes--
            ``(1) the results of the study under this section;
            ``(2) a summary of any consultation that occurred between 
        the Secretary and the Navajo Nation, other Indian Tribes, the 
        States of Arizona, New Mexico, and Utah, counties which include 
        Navajo Lands, and other interested parties, in conducting this 
        study;
            ``(3) projected costs or savings associated with 
        establishment of such entity, and any estimated impact on 
        services provided as described in this section in relation to 
        probable costs or savings; and
            ``(4) legislative actions that would be required to 
        authorize the establishment of such entity if such entity is 
        determined by the Secretary to be feasible.

``SEC. 415. AUTHORIZATION OF APPROPRIATIONS.

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

              ``TITLE V--HEALTH SERVICES FOR URBAN INDIANS

``SEC. 501. PURPOSE.

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

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

    ``Under authority of the Act of November 2, 1921 (25 U.S.C. 13) 
(commonly known as the `Snyder Act'), the Secretary, acting through the 
Service, shall enter into contracts with, or make grants to, Urban 
Indian Organizations to assist such organizations in the establishment 
and administration, within Urban Centers, of programs which meet the 
requirements set forth in this title. Subject to section 506, the 
Secretary, acting through the Service, shall include such conditions as 
the Secretary considers necessary to effect the purpose of this title 
in any contract into which the Secretary enters with, or in any grant 
the Secretary makes to, any Urban Indian Organization pursuant to this 
title.

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

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

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

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

``SEC. 505. EVALUATIONS; RENEWALS.

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

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

    ``(a) Procurement.--Contracts with Urban Indian Organizations 
entered into pursuant to this title shall be in accordance with all 
Federal contracting laws and regulations relating to procurement except 
that in the discretion of the Secretary, such contracts may be 
negotiated without advertising and need not conform to the provisions 
of sections 1304 and 3131 through 3133 of title 40, United States Code.
    ``(b) Payments Under Contracts or Grants.--Payments under any 
contracts or grants pursuant to this title shall, notwithstanding any 
term or condition of such contract or grant--
            ``(1) be made in their entirety by the Secretary to the 
        Urban Indian Organization by no later than the end of the first 
        30 days of the funding period with respect to which the 
        payments apply, unless the Secretary determines through an 
        evaluation under section 505 that the organization is not 
        capable of administering such payments in their entirety; and
            ``(2) if any portion thereof is unexpended by the Urban 
        Indian Organization during the funding period with respect to 
        which the payments initially apply, shall be carried forward 
        for expenditure with respect to allowable or reimbursable costs 
        incurred by the organization during 1 or more subsequent 
        funding periods without additional justification or 
        documentation by the organization as a condition of carrying 
        forward the availability for expenditure of such funds.
    ``(c) Revision or Amendment of Contracts.--Notwithstanding any 
provision of law to the contrary, the Secretary may, at the request or 
consent of an Urban Indian Organization, revise or amend any contract 
entered into by the Secretary with such organization under this title 
as necessary to carry out the purposes of this title.
    ``(d) Fair and Uniform Services and Assistance.--Contracts with or 
grants to Urban Indian Organizations and regulations adopted pursuant 
to this title shall include provisions to assure the fair and uniform 
provision to Urban Indians of services and assistance under such 
contracts or grants by such organizations.

``SEC. 507. REPORTS AND RECORDS.

    ``(a) Reports.--For each fiscal year during which an Urban Indian 
Organization receives or expends funds pursuant to a contract entered 
into or a grant received pursuant to this title, such Urban Indian 
Organization shall submit to the Secretary not more frequently than 
every 6 months, a report that includes the following:
            ``(1) In the case of a contract or grant under section 503, 
        recommendations pursuant to section 503(a)(5).
            ``(2) Information on activities conducted by the 
        organization pursuant to the contract or grant.
            ``(3) An accounting of the amounts and purpose for which 
        Federal funds were expended.
            ``(4) A minimum set of data, using uniformly defined 
        elements, that is specified by the Secretary in consultation, 
        consistent with section 514, with Urban Indian Organizations.
    ``(b) Audit.--The reports and records of the Urban Indian 
Organization with respect to a contract or grant under this title shall 
be subject to audit by the Secretary and the Comptroller General of the 
United States.
    ``(c) Costs of Audits.--The Secretary shall allow as a cost of any 
contract or grant entered into or awarded under section 502 or 503 the 
cost of an annual independent financial audit conducted by--
            ``(1) a certified public accountant; or
            ``(2) a certified public accounting firm qualified to 
        conduct Federal compliance audits.

``SEC. 508. LIMITATION ON CONTRACT AUTHORITY.

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

``SEC. 509. FACILITIES.

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

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

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

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

    ``(a) Grants Authorized.--The Secretary, acting through the 
Service, may make grants for the provision of health-related services 
in prevention of, treatment of, rehabilitation of, or school- and 
community-based education regarding, alcohol and substance abuse in 
Urban Centers to those Urban Indian Organizations with which the 
Secretary has entered into a contract under this title or under section 
201.
    ``(b) Goals.--Each grant made pursuant to subsection (a) shall set 
forth the goals to be accomplished pursuant to the grant. The goals 
shall be specific to each grant as agreed to between the Secretary and 
the grantee.
    ``(c) Criteria.--The Secretary shall establish criteria for the 
grants made under subsection (a), including criteria relating to the 
following:
            ``(1) The size of the Urban Indian population.
            ``(2) Capability of the organization to adequately perform 
        the activities required under the grant.
            ``(3) Satisfactory performance standards for the 
        organization in meeting the goals set forth in such grant. The 
        standards shall be negotiated and agreed to between the 
        Secretary and the grantee on a grant-by-grant basis.
            ``(4) Identification of the need for services.
    ``(d) Allocation of Grants.--The Secretary shall develop a 
methodology for allocating grants made pursuant to this section based 
on the criteria established pursuant to subsection (c).
    ``(e) Grants Subject to Criteria.--Any funds received by an Urban 
Indian Organization under this Act for substance abuse prevention, 
treatment, and rehabilitation shall be subject to the criteria set 
forth in subsection (c).

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

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

``SEC. 513. URBAN NIAAA TRANSFERRED PROGRAMS.

    ``(a) Grants and Contracts.--The Secretary, through the Office of 
Urban Indian Health, shall make grants or enter into contracts with 
Urban Indian Organizations for the administration of Urban Indian 
alcohol programs that were originally established under the National 
Institute on Alcoholism and Alcohol Abuse (hereafter in this section 
referred to as `NIAAA') and transferred to the Service. Such grants and 
contracts shall become effective no later than September 30, 2007.
    ``(b) Use of Funds.--Grants provided or contracts entered into 
under this section shall be used to provide support for the 
continuation of alcohol prevention and treatment services for Urban 
Indian populations and such other objectives as are agreed upon between 
the Service and a recipient of a grant or contract under this section.
    ``(c) Eligibility.--Urban Indian Organizations that operate Indian 
alcohol programs originally funded under the NIAAA and subsequently 
transferred to the Service are eligible for grants or contracts under 
this section.
    ``(d) Report.--The Secretary shall evaluate and report to Congress 
on the activities of programs funded under this section not less than 
every 5 years.

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

    ``(a) In General.--The Secretary shall ensure that the Service 
consults, to the greatest extent practicable, with Urban Indian 
Organizations.
    ``(b) Definition of Consultation.--For purposes of subsection (a), 
consultation is the open and free exchange of information and opinions 
which leads to mutual understanding and comprehension and which 
emphasizes trust, respect, and shared responsibility.

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

    ``(a) In General.--With respect to claims resulting from the 
performance of functions during fiscal year 2004 and thereafter, or 
claims asserted after September 30, 2003, but resulting from the 
performance of functions prior to fiscal year 2004, under a contract, 
grant agreement, or any other agreement authorized under this title, an 
Urban Indian Organization is deemed hereafter to be part of the Service 
in the Department of Health and Human Services while carrying out any 
such contract or agreement and its employees are deemed employees of 
the Service while acting within the scope of their employment in 
carrying out the contract or agreement. After September 30, 2003, any 
civil action or proceeding involving such claims brought hereafter 
against any Urban Indian Organization or any employee of such Urban 
Indian Organization covered by this provision shall be deemed to be an 
action against the United States and will be defended by the Attorney 
General and be afforded the full protection and coverage of the Federal 
Tort Claims Act (28 U.S.C. 1346(b), 2671 et seq.).
    ``(b) Claims Resulting From Performance of Contract or Grant.--
Beginning with the fiscal year ending September 30, 2003, and 
thereafter, the Secretary shall request through annual appropriations 
funds sufficient to reimburse the Treasury for any claims paid in the 
prior fiscal year pursuant to the foregoing provisions.

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

    ``(a) Construction and Operation.--The Secretary, acting through 
the Service, through grant or contract, is authorized to fund the 
construction and operation of at least 2 residential treatment centers 
in each State described in subsection (b) to demonstrate the provision 
of alcohol and substance abuse treatment services to Urban Indian youth 
in a culturally competent residential setting.
    ``(b) Definition of State.--A State described in this subsection is 
a State in which--
            ``(1) there resides Urban Indian youth with need for 
        alcohol and substance abuse treatment services in a residential 
        setting; and
            ``(2) there is a significant shortage of culturally 
        competent residential treatment services for Urban Indian 
        youth.

``SEC. 517. USE OF FEDERAL PROPERTY AND SUPPLIES.

    ``(a) Authorization for Use.--The Secretary, acting through the 
Service, shall allow an Urban Indian Organization that has entered into 
a contract or received a grant pursuant to this title, in carrying out 
such contract or grant, to use existing facilities and all equipment 
therein or pertaining thereto and other real and personal property 
owned by the Federal Government within the Secretary's jurisdiction 
under such terms and conditions as may be agreed upon for their use and 
maintenance.
    ``(b) Donations.--Subject to subsection (d), the Secretary may 
donate to an Urban Indian Organization that has entered into a contract 
or received a grant pursuant to this title any personal or real 
property determined to be excess to the needs of the Service or the 
General Services Administration for purposes of carrying out the 
contract or grant.
    ``(c) Acquisition of Property for Donation.--The Secretary may 
acquire excess or surplus government personal or real property for 
donation (subject to subsection (d)), to an Urban Indian Organization 
that has entered into a contract or received a grant pursuant to this 
title if the Secretary determines that the property is appropriate for 
use by the Urban Indian Organization for a purpose for which a contract 
or grant is authorized under this title.
    ``(d) Priority.--In the event that the Secretary receives a request 
for donation of a specific item of personal or real property described 
in subsection (b) or (c) from both an Urban Indian Organization and 
from an Indian Tribe or Tribal Organization, the Secretary shall give 
priority to the request for donation of the Indian Tribe or Tribal 
Organization if the Secretary receives the request from the Indian 
Tribe or Tribal Organization before the date the Secretary transfers 
title to the property or, if earlier, the date the Secretary transfers 
the property physically to the Urban Indian Organization.
    ``(e) Urban Indian Organizations Deemed Executive Agency for 
Certain Purposes.--For purposes of section 501 of title 40, United 
States Code, (relating to Federal sources of supply, including lodging 
providers, airlines, and other transportation providers), an Urban 
Indian Organization that has entered into a contract or received a 
grant pursuant to this title shall be deemed an executive agency when 
carrying out such contract or grant, and the employees of the Urban 
Indian Organization shall be eligible to have access to such sources of 
supply on the same basis as employees of an executive agency have such 
access.

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

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

``SEC. 519. COMMUNITY HEALTH REPRESENTATIVES.

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

``SEC. 520. REGULATIONS.

    ``(a) Requirements for Regulations.--The Secretary may promulgate 
regulations to implement the provisions of this title in accordance 
with the following:
            ``(1) Proposed regulations to implement this Act shall be 
        published in the Federal Register by the Secretary no later 
        than 9 months after the date of the enactment of this Act and 
        shall have no less than a 4-month comment period.
            ``(2) The authority to promulgate regulations under this 
        Act shall expire 18 months from the date of the enactment of 
        this Act.
    ``(b) Effective Date of Title.--The amendments to this title made 
by the Indian Health Care Improvement Act Amendments of 2004 shall be 
effective on the date of the enactment of such amendments, regardless 
of whether the Secretary has promulgated regulations implementing such 
amendments have been promulgated.

``SEC. 521. ELIGIBILITY FOR SERVICES.

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

``SEC. 522. AUTHORIZATION OF APPROPRIATIONS.

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

                ``TITLE VI--ORGANIZATIONAL IMPROVEMENTS

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

    ``(a) Establishment.--
            ``(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 Assistant 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, 2005, the term of 
        service of the Assistant Secretary shall be 4 years. An 
        Assistant Secretary may serve more than 1 term.
            ``(3) Incumbent.--The individual serving in the position of 
        Director of the Indian Health Service on the day before the 
        date of enactment of the Indian Health Care Improvement Act 
        Amendments of 2004 shall serve as Assistant Secretary.
            ``(4) Advocacy and consultation.--The position of Assistant 
        Secretary is established to, in a manner consistent with the 
        government-to-government relationship between the United States 
        and Indian Tribes--
                    ``(A) facilitate advocacy for the development of 
                appropriate Indian health policy; and
                    ``(B) promote consultation on matters relating to 
                Indian health.
    ``(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) Duties.--The Assistant Secretary of Indian Health shall--
            ``(1) perform all functions that were, on the day before 
        the date of enactment of the Indian Health Care Improvement Act 
        Amendments of 2004, carried out by or under the direction of 
        the individual serving as Director of the Service on that day;
            ``(2) perform 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) administer 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 and Education 
                Assistance Act (25 U.S.C. 450 et seq.);
            ``(4) administer all scholarship and loan functions carried 
        out under title I;
            ``(5) report directly to the Secretary concerning all 
        policy- and budget-related matters affecting Indian health;
            ``(6) collaborate with the Assistant Secretary for Health 
        concerning appropriate matters of Indian health that affect the 
        agencies of the Public Health Service;
            ``(7) advise each Assistant Secretary of the Department 
        concerning matters of Indian health with respect to which that 
        Assistant Secretary has authority and responsibility;
            ``(8) advise the heads of other agencies and programs of 
        the Department concerning matters of Indian health with respect 
        to which those heads have authority and responsibility;
            ``(9) coordinate the activities of the Department 
        concerning matters of Indian health; and
            ``(10) perform such other functions as the Secretary may 
        designate.
    ``(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).
    ``(e) References.--Any reference to the Director of the Indian 
Health Service in any Federal law, Executive order, rule, regulation, 
or delegation of authority, or in any document of or relating to the 
Director of the Indian Health Service, shall be deemed to refer to the 
Assistant Secretary.

``SEC. 602. AUTOMATED MANAGEMENT INFORMATION SYSTEM.

    ``(a) Establishment.--
            ``(1) In general.--The Secretary 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 for each 
                area served by the Service;
                    ``(C) a privacy component that protects the privacy 
                of patient information held by, or on behalf of, the 
                Service;
                    ``(D) a services-based cost accounting component 
                that provides estimates of the costs associated with 
                the provision of specific medical treatments or 
                services in each Area office of the Service;
                    ``(E) an interface mechanism for patient billing 
                and accounts receivable system; and
                    ``(F) a training component.
    ``(b) Provision of Systems to Tribes and Organizations.--The 
Secretary shall provide each Tribal Health Program automated management 
information systems which--
            ``(1) meet the management information needs of such Tribal 
        Health Program with respect to the treatment by the Tribal 
        Health Program of patients of the Service; and
            ``(2) meet the management information needs of the Service.
    ``(c) 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.--The purposes of this section are as follows:
            ``(1) To authorize and direct the Secretary, acting through 
        the Service, Indian Tribes, Tribal Organizations, and Urban 
        Indian Organizations, to develop a comprehensive behavioral 
        health prevention and treatment program which emphasizes 
        collaboration among alcohol and substance abuse, social 
        services, and mental health programs.
            ``(2) To provide information, direction, and guidance 
        relating to mental illness and dysfunction and self-destructive 
        behavior, including child abuse and family violence, to those 
        Federal, tribal, State, and local agencies responsible for 
        programs in Indian communities in areas of health care, 
        education, social services, child and family welfare, alcohol 
        and substance abuse, law enforcement, and judicial services.
            ``(3) To assist Indian Tribes to identify services and 
        resources available to address mental illness and dysfunctional 
        and self-destructive behavior.
            ``(4) To provide authority and opportunities for Indian 
        Tribes and Tribal Organizations to develop, implement, and 
        coordinate with community-based programs which include 
        identification, prevention, education, referral, and treatment 
        services, including through multidisciplinary resource teams.
            ``(5) To ensure that Indians, as citizens of the United 
        States and of the States in which they reside, have the same 
        access to behavioral health services to which all citizens have 
        access.
            ``(6) To modify or supplement existing programs and 
        authorities in the areas identified in paragraph (2).
    ``(b) Plans.--
            ``(1) Development.--The Secretary, acting through the 
        Service, Indian Tribes, Tribal Organizations, and Urban Indian 
        Organizations, shall encourage Indian Tribes and Tribal 
        Organizations to develop tribal plans, and Urban Indian 
        Organizations to develop local plans, and for all such groups 
        to participate in developing areawide plans for Indian 
        Behavioral Health Services. The plans shall include, to the 
        extent feasible, the following components:
                    ``(A) An assessment of the scope of alcohol or 
                other substance abuse, mental illness, and 
                dysfunctional and self-destructive behavior, including 
                suicide, child abuse, and family violence, among 
                Indians, including--
                            ``(i) the number of Indians served who are 
                        directly or indirectly affected by such illness 
                        or behavior; or
                            ``(ii) an estimate of the financial and 
                        human cost attributable to such illness or 
                        behavior.
                    ``(B) An assessment of the existing and additional 
                resources necessary for the prevention and treatment of 
                such illness and behavior, including an assessment of 
                the progress toward achieving the availability of the 
                full continuum of care described in subsection (c).
                    ``(C) An estimate of the additional funding needed 
                by the Service, Indian Tribes, Tribal Organizations, 
                and Urban Indian Organizations to meet their 
                responsibilities under the plans.
            ``(2) National clearinghouse.--The Secretary, acting 
        through the Service, shall establish a national clearinghouse 
        of plans and reports on the outcomes of such plans developed by 
        Indian Tribes, Tribal Organizations, Urban Indian 
        Organizations, and Service Areas relating to behavioral health. 
        The Secretary shall ensure access to these plans and outcomes 
        by any Indian Tribe, Tribal Organization, Urban Indian 
        Organization, or the Service.
            ``(3) Technical assistance.--The Secretary shall provide 
        technical assistance to Indian Tribes, Tribal Organizations, 
        and Urban Indian Organizations in preparation of plans under 
        this section and in developing standards of care that may be 
        used and adopted locally.
    ``(c) Programs.--The Secretary, acting through the Service, Indian 
Tribes, and Tribal Organizations, shall provide, to the extent feasible 
and if funding is available, programs including the following:
            ``(1) Comprehensive care.--A comprehensive continuum of 
        behavioral health care which provides--
                    ``(A) community-based prevention, intervention, 
                outpatient, and behavioral health aftercare;
                    ``(B) detoxification (social and medical);
                    ``(C) acute hospitalization;
                    ``(D) intensive outpatient/day treatment;
                    ``(E) residential treatment;
                    ``(F) transitional living for those needing a 
                temporary, stable living environment that is supportive 
                of treatment and recovery goals;
                    ``(G) emergency shelter;
                    ``(H) intensive case management;
                    ``(I) Traditional Health Care Practices; and
                    ``(J) diagnostic services.
            ``(2) Child care.--Behavioral health services for Indians 
        from birth through age 17, including--
                    ``(A) preschool and school age fetal alcohol 
                disorder services, including assessment and behavioral 
                intervention;
                    ``(B) mental health and substance abuse services 
                (emotional, organic, alcohol, drug, inhalant, and 
                tobacco);
                    ``(C) identification and treatment of co-occurring 
                disorders and comorbidity;
                    ``(D) prevention of alcohol, drug, inhalant, and 
                tobacco use;
                    ``(E) early intervention, treatment, and aftercare;
                    ``(F) promotion of healthy choices and lifestyle 
                (related to sexually transmitted diseases, domestic 
                violence, sexual abuse, suicide, teen pregnancy, 
                obesity, and other risk/safety issues); and
                    ``(G) identification and treatment of neglect and 
                physical, mental, and sexual abuse.
            ``(3) Adult care.--Behavioral health services for Indians 
        from age 18 through 55, including--
                    ``(A) early intervention, treatment, and aftercare;
                    ``(B) mental health and substance abuse services 
                (emotional, alcohol, drug, inhalant, and tobacco), 
                including gender specific services;
                    ``(C) identification and treatment of co-occurring 
                disorders (dual diagnosis) and comorbidity;
                    ``(D) promotion of gender specific healthy choices 
                and lifestyle (related to parenting, partners, domestic 
                violence, sexual abuse, suicide, obesity, and other 
                risk-related behavior);
                    ``(E) treatment services for women at risk of 
                giving birth to a child with a fetal alcohol disorder; 
                and
                    ``(F) gender specific treatment for sexual assault 
                and domestic violence.
            ``(4) Family care.--Behavioral health services for 
        families, including--
                    ``(A) early intervention, treatment, and aftercare 
                for affected families;
                    ``(B) treatment for sexual assault and domestic 
                violence; and
                    ``(C) promotion of healthy choices and lifestyle 
                (related to parenting, partners, domestic violence, and 
                other abuse issues).
            ``(5) Elder care.--Behavioral health services for Indians 
        56 years of age and older, including--
                    ``(A) early intervention, treatment, and aftercare;
                    ``(B) mental health and substance abuse services 
                (emotional, alcohol, drug, inhalant, and tobacco), 
                including gender specific services;
                    ``(C) identification and treatment of co-occurring 
                disorders (dual diagnosis) and comorbidity;
                    ``(D) promotion of healthy choices and lifestyle 
                (managing conditions related to aging);
                    ``(E) gender specific treatment for sexual assault, 
                domestic violence, neglect, physical and mental abuse 
                and exploitation; and
                    ``(F) identification and treatment of dementias 
                regardless of cause.
    ``(d) Community Behavioral Health Plan.--
            ``(1) Establishment.--The governing body of any Indian 
        Tribe, Tribal Organization, or Urban Indian Organization may 
        adopt a resolution for the establishment of a community 
        behavioral health plan providing for the identification and 
        coordination of available resources and programs to identify, 
        prevent, or treat substance abuse, mental illness, or 
        dysfunctional and self-destructive behavior, including child 
        abuse and family violence, among its members or its service 
        population. This plan should include behavioral health 
        services, social services, intensive outpatient services, and 
        continuing aftercare.
            ``(2) Technical assistance.--At the request of an Indian 
        Tribe, Tribal Organization, or Urban Indian Organization, the 
        Bureau of Indian Affairs and the Service shall cooperate with 
        and provide technical assistance to the Indian Tribe, Tribal 
        Organization, or Urban Indian Organization in the development 
        and implementation of such plan.
            ``(3) Funding.--The Secretary, acting through the Service, 
        may make funding available to Indian Tribes and Tribal 
        Organizations which adopt a resolution pursuant to paragraph 
        (1) to obtain technical assistance for the development of a 
        community behavioral health plan and to provide administrative 
        support in the implementation of such plan.
    ``(e) Coordination for Availability of Services.--The Secretary, 
acting through the Service, Indian Tribes, Tribal Organizations, and 
Urban Indian Organizations, shall coordinate behavioral health 
planning, to the extent feasible, with other Federal agencies and with 
State agencies, to encourage comprehensive behavioral health services 
for Indians regardless of their place of residence.
    ``(f) Mental Health Care Need Assessment.--Not later than 1 year 
after the date of the enactment of the Indian Health Care Improvement 
Act Amendments of 2004, the Secretary, acting through the Service, 
shall make an assessment of the need for inpatient mental health care 
among Indians and the availability and cost of inpatient mental health 
facilities which can meet such need. In making such assessment, the 
Secretary shall consider the possible conversion of existing, underused 
Service hospital beds into psychiatric units to meet such need.

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

    ``(a) Contents.--Not later than 12 months after the date of the 
enactment of the Indian Health Care Improvement Act Amendments of 2004, 
the Secretary, acting through the Service, and the Secretary of the 
Interior shall develop and enter into a memoranda of agreement, or 
review and update any existing memoranda of agreement, as required by 
section 4205 of the Indian Alcohol and Substance Abuse Prevention and 
Treatment Act of 1986 (25 U.S.C. 2411) under which the Secretaries 
address the following:
            ``(1) The scope and nature of mental illness and 
        dysfunctional and self-destructive behavior, including child 
        abuse and family violence, among Indians.
            ``(2) The existing Federal, tribal, State, local, and 
        private services, resources, and programs available to provide 
        behavioral 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 behavioral health services to which all citizens have 
        access.
            ``(B) The right of Indians to participate in, and receive 
        the benefit of, such services.
            ``(C) The actions necessary to protect the exercise of such 
        right.
            ``(5) The responsibilities of the Bureau of Indian Affairs 
        and the Service, including mental illness identification, 
        prevention, education, referral, and treatment services 
        (including services through multidisciplinary resource teams), 
        at the central, area, and agency and Service Unit, Service 
        Area, and headquarters levels to address the problems 
        identified in paragraph (1).
            ``(6) A strategy for the comprehensive coordination of the 
        behavioral health services provided by the Bureau of Indian 
        Affairs and the Service to meet the problems identified 
        pursuant to paragraph (1), including--
                    ``(A) the coordination of alcohol and substance 
                abuse programs of the Service, the Bureau of Indian 
                Affairs, and Indian Tribes and Tribal Organizations 
                (developed under the Indian Alcohol and Substance Abuse 
                Prevention and Treatment Act of 1986) with behavioral 
                health initiatives pursuant to this Act, particularly 
                with respect to the referral and treatment of dually 
                diagnosed individuals requiring behavioral health and 
                substance abuse treatment; and
                    ``(B) ensuring that the Bureau of Indian Affairs 
                and Service programs and services (including 
                multidisciplinary resource teams) addressing child 
                abuse and family violence are coordinated with such 
                non-Federal programs and services.
            ``(7) Directing appropriate officials of the Bureau of 
        Indian Affairs and the Service, particularly at the agency and 
        Service Unit levels, to cooperate fully with tribal requests 
        made pursuant to community behavioral health plans adopted 
        under section 701(c) and section 4206 of the Indian Alcohol and 
        Substance Abuse Prevention and Treatment Act of 1986 (25 U.S.C. 
        2412).
            ``(8) Providing for an annual review of such agreement by 
        the Secretaries which shall be provided to Congress and Indian 
        Tribes and Tribal Organizations.
    ``(b) Specific Provisions Required.--The memoranda of agreement 
updated or entered into pursuant to subsection (a) shall include 
specific provisions pursuant to which the Service shall assume 
responsibility for--
            ``(1) the determination of the scope of the problem of 
        alcohol and substance abuse among Indians, including the number 
        of Indians within the jurisdiction of the Service who are 
        directly or indirectly affected by alcohol and substance abuse 
        and the financial and human cost;
            ``(2) an assessment of the existing and needed resources 
        necessary for the prevention of alcohol and substance abuse and 
        the treatment of Indians affected by alcohol and substance 
        abuse; and
            ``(3) an estimate of the funding necessary to adequately 
        support a program of prevention of alcohol and substance abuse 
        and treatment of Indians affected by alcohol and substance 
        abuse.
    ``(c) Consultation.--The Secretary, acting through the Service, and 
the Secretary of the Interior shall, in developing the memoranda of 
agreement under subsection (a), consult with and solicit the comments 
from--
            ``(1) Indian Tribes and Tribal Organizations;
            ``(2) Indians;
            ``(3) Urban Indian Organizations and other Indian 
        organizations; and
            ``(4) behavioral health service providers.
    ``(d) Publication.--Each memorandum of agreement entered into or 
renewed (and amendments or modifications thereto) under subsection (a) 
shall be published in the Federal Register. At the same time as 
publication in the Federal Register, the Secretary shall provide a copy 
of such memoranda, amendment, or modification to each Indian Tribe, 
Tribal Organization, and Urban Indian Organization.

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

    ``(a) Establishment.--
            ``(1) In general.--The Secretary, acting through the 
        Service, Indian Tribes, and Tribal Organizations, shall provide 
        a program of comprehensive behavioral health, prevention, 
        treatment, and aftercare, including Traditional Health Care 
        Practices, which shall include--
                    ``(A) prevention, through educational intervention, 
                in Indian communities;
                    ``(B) acute detoxification, psychiatric 
                hospitalization, residential, and intensive outpatient 
                treatment;
                    ``(C) community-based rehabilitation and aftercare;
                    ``(D) community education and involvement, 
                including extensive training of health care, 
                educational, and community-based personnel;
                    ``(E) specialized residential treatment programs 
                for high-risk populations, including but not limited to 
                pregnant and postpartum women and their children; and
                    ``(F) diagnostic services.
            ``(2) Target populations.--The target population of such 
        programs shall be members of Indian Tribes. Efforts to train 
        and educate key members of the Indian community shall also 
        target employees of health, education, judicial, law 
        enforcement, legal, and social service programs.
    ``(b) Contract Health Services.--
            ``(1) In general.--The Secretary, acting through the 
        Service, Indian Tribes, and Tribal Organizations, may enter 
        into contracts with public or private providers of behavioral 
        health treatment services for the purpose of carrying out the 
        program required under subsection (a).
            ``(2) Provision of assistance.--In carrying out this 
        subsection, the Secretary shall provide assistance to Indian 
        Tribes and Tribal Organizations to develop criteria for the 
        certification of behavioral health service providers and 
        accreditation of service facilities which meet minimum 
        standards for such services and facilities.

``SEC. 704. MENTAL HEALTH TECHNICIAN PROGRAM.

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

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

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

``SEC. 706. INDIAN WOMEN TREATMENT PROGRAMS.

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

``SEC. 707. INDIAN YOUTH PROGRAM.

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

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

    ``Not later than 1 year after the date of the enactment of the 
Indian Health Care Improvement Act Amendments of 2004, the Secretary, 
acting through the Service, Indian Tribes, and Tribal Organizations, 
may provide, in each area of the Service, not less than 1 inpatient 
mental health care facility, or the equivalent, for Indians with 
behavioral health problems. For the purposes of this subsection, 
California shall be considered to be 2 Area Offices, 1 office whose 
location shall be considered to encompass the northern area of the 
State of California and 1 office whose jurisdiction shall be considered 
to encompass the remainder of the State of California. The Secretary 
shall consider the possible conversion of existing, underused Service 
hospital beds into psychiatric units to meet such need.

``SEC. 709. TRAINING AND COMMUNITY EDUCATION.

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

``SEC. 710. BEHAVIORAL HEALTH PROGRAM.

    ``(a) Innovative Programs.--The Secretary, acting through the 
Service, Indian Tribes, and Tribal Organizations, consistent with 
section 701, may plan, develop, implement, and carry out programs to 
deliver innovative community-based behavioral health services to 
Indians.
    ``(b) Funding; Criteria.--The Secretary may award such funding for 
a project under subsection (a) to an Indian Tribe or Tribal 
Organization and may consider the following criteria:
            ``(1) The project will address significant unmet behavioral 
        health needs among Indians.
            ``(2) The project will serve a significant number of 
        Indians.
            ``(3) The project has the potential to deliver services in 
        an efficient and effective manner.
            ``(4) The Indian Tribe or Tribal Organization has the 
        administrative and financial capability to administer the 
        project.
            ``(5) The project may deliver services in a manner 
        consistent with Traditional Health Care Practices.
            ``(6) The project is coordinated with, and avoids 
        duplication of, existing services.
    ``(c) Equitable Treatment.--For purposes of this subsection, the 
Secretary shall, in evaluating applications or proposals for funding 
for projects to be operated under any Funding Agreement, use the same 
criteria that the Secretary uses in evaluating any other application or 
proposal for such funding.

``SEC. 711. FETAL ALCOHOL DISORDER FUNDING.

    ``(a) Programs.--
            ``(1) Establishment.--The Secretary, consistent with 
        section 701, acting through the Service, Indian Tribes, and 
        Tribal Organizations, shall establish and operate fetal alcohol 
        disorder programs as provided in this section for the purposes 
        of meeting the health status objectives specified in section 3.
            ``(2) Use of funds.--Funding provided pursuant to this 
        section shall be used for the following:
                    ``(A) To develop and provide for Indians community 
                and in school training, education, and prevention 
                programs relating to fetal alcohol disorders.
                    ``(B) To identify and provide behavioral health 
                treatment to high-risk Indian women and high-risk women 
                pregnant with an Indian's child.
                    ``(C) To identify and provide appropriate 
                psychological services, educational and vocational 
                support, counseling, advocacy, and information to fetal 
                alcohol disorder affected Indians and their families or 
                caretakers.
                    ``(D) To develop and implement counseling and 
                support programs in schools for fetal alcohol disorder 
                affected Indian children.
                    ``(E) To develop prevention and intervention models 
                which incorporate practitioners of Traditional Health 
                Care Practices, cultural and spiritual values, and 
                community involvement.
                    ``(F) To develop, print, and disseminate education 
                and prevention materials on fetal alcohol disorder.
                    ``(G) To develop and implement, through the tribal 
                consultation process, culturally sensitive assessment 
                and diagnostic tools including dysmorphology clinics 
                and multidisciplinary fetal alcohol disorder clinics 
                for use in Indian communities and Urban Centers.
                    ``(H) To develop early childhood intervention 
                projects from birth on to mitigate the effects of fetal 
                alcohol disorder among Indians.
                    ``(I) To develop and fund community-based adult 
                fetal alcohol disorder housing and support services for 
                Indians and for women pregnant with an Indian's child.
            ``(3) Criteria for applications.--The Secretary shall 
        establish criteria for the review and approval of applications 
        for funding under this section.
    ``(b) Services.--The Secretary, acting through the Service and 
Indian Tribes, Tribal Organizations, and Urban Indian Organizations, 
shall--
            ``(1) develop and provide services for the prevention, 
        intervention, treatment, and aftercare for those affected by 
        fetal alcohol disorder in Indian communities; and
            ``(2) provide supportive services, directly or through an 
        Indian Tribe, Tribal Organization, or Urban Indian 
        Organization, including services to meet the special 
        educational, vocational, school-to-work transition, and 
        independent living needs of adolescent and adult Indians with 
        fetal alcohol disorder.
    ``(c) Task Force.--The Secretary shall establish a task force to be 
known as the Fetal Alcohol Disorder Task Force to advise the Secretary 
in carrying out subsection (b). Such task force shall be composed of 
representatives from the following:
            ``(1) The National Institute on Drug Abuse.
            ``(2) The National Institute on Alcohol and Alcoholism.
            ``(3) The Office of Substance Abuse Prevention.
            ``(4) The National Institute of Mental Health.
            ``(5) The Service.
            ``(6) The Office of Minority Health of the Department of 
        Health and Human Services.
            ``(7) The Administration for Native Americans.
            ``(8) The National Institute of Child Health and Human 
        Development (NICHD).
            ``(9) The Centers for Disease Control and Prevention.
            ``(10) The Bureau of Indian Affairs.
            ``(11) Indian Tribes.
            ``(12) Tribal Organizations.
            ``(13) Urban Indian Organizations.
            ``(14) Indian fetal alcohol disorder experts.
    ``(d) Applied Research Projects.--The Secretary, acting through the 
Substance Abuse and Mental Health Services Administration, shall make 
funding available to Indian Tribes, Tribal Organizations, and Urban 
Indian Organizations for applied research projects which propose to 
elevate the understanding of methods to prevent, intervene, treat, or 
provide rehabilitation and behavioral health aftercare for Indians and 
Urban Indians affected by fetal alcohol disorder.
    ``(e) Funding for Urban Indian Organizations.--Ten percent of the 
funds appropriated pursuant to this section shall be used to make 
grants to Urban Indian Organizations funded under title V.

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

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

``SEC. 713. BEHAVIORAL HEALTH RESEARCH.

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

``SEC. 714. DEFINITIONS.

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

``SEC. 715. AUTHORIZATION OF APPROPRIATIONS.

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

                      ``TITLE VIII--MISCELLANEOUS

``SEC. 801. REPORTS.

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

``SEC. 802. REGULATIONS.

    ``(a) Deadlines.--
            ``(1) Procedures.--Not later than 90 days after the date of 
        the enactment of the Indian Health Care Improvement Act 
        Amendments of 2004, the Secretary shall initiate procedures 
        under subchapter III of chapter 5 of title 5, United States 
        Code, to negotiate and promulgate such regulations or 
        amendments thereto that are necessary to carry out titles I, 
        II, III, and VII and section 817. The Secretary may promulgate 
        regulations to carry out sections 105, 115, 117, and titles IV 
        and V, using the procedures required by chapter V of title 5, 
        United States Code (commonly known as the `Administrative 
        Procedure Act'. The Secretary shall issue no regulations to 
        carry out titles VI and VIII, except as necessary to carry out 
        section 817.
            ``(2) Proposed regulations.--Proposed regulations to 
        implement this Act shall be published in the Federal Register 
        by the Secretary no later than 270 days after the date of the 
        enactment of the Indian Health Care Improvement Act Amendments 
        of 2004 and shall have no less than a 120-day comment period.
            ``(3) Expiration of authority.--The authority to promulgate 
        regulations under this Act shall expire 18 months from the date 
        of the enactment of this Act.
    ``(b) Committee.--A negotiated rulemaking committee established 
pursuant to section 565 of title 5, United States Code, to carry out 
this section shall have as its members only representatives of the 
Federal Government and representatives of Indian Tribes and Tribal 
Organizations, a majority of whom shall be nominated by and be 
representatives of Indian Tribes, Tribal Organizations, and Urban 
Indian Organizations from each Service Area.
    ``(c) Adaptation of Procedures.--The Secretary shall adapt the 
negotiated rulemaking procedures to the unique context of self-
governance and the government-to-government relationship between the 
United States and Indian Tribes.
    ``(d) Lack of Regulations.--The lack of promulgated regulations 
shall not limit the effect of this Act.
    ``(e) Inconsistent Regulations.--The provisions of this Act shall 
supersede any conflicting provisions of law in effect on the day before 
the date of the enactment of the Indian Health Care Improvement Act 
Amendments of 2004, and the Secretary is authorized to repeal any 
regulation inconsistent with the provisions of this Act.

``SEC. 803. PLAN OF IMPLEMENTATION.

    ``Not later than 8 months after the date of the enactment of the 
Indian Health Care Improvement Act Amendments of 2004, the Secretary in 
consultation with Indian Tribes, Tribal Organizations, and Urban Indian 
Organizations, shall submit to Congress a plan explaining the manner 
and schedule (including a schedule of appropriation requests), by title 
and section, by which the Secretary will implement the provisions of 
this Act.

``SEC. 804. AVAILABILITY OF FUNDS.

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

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

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

``SEC. 806. ELIGIBILITY OF CALIFORNIA INDIANS.

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

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

    ``(a) Children.--Any individual who--
            ``(1) has not attained 19 years of age;
            ``(2) is the natural or adopted child, stepchild, foster 
        child, legal ward, or orphan of an eligible Indian; and
            ``(3) is not otherwise eligible for health services 
        provided by the Service,
shall be eligible for all health services provided by the Service on 
the same basis and subject to the same rules that apply to eligible 
Indians until such individual attains 19 years of age. The existing and 
potential health needs of all such individuals shall be taken into 
consideration by the Service in determining the need for, or the 
allocation of, the health resources of the Service. If such an 
individual has been determined to be legally incompetent prior to 
attaining 19 years of age, such individual shall remain eligible for 
such services until 1 year after the date of a determination of 
competency.
    ``(b) Spouses.--Any spouse of an eligible Indian who is not an 
Indian, or who is of Indian descent but not otherwise eligible for the 
health services provided by the Service, shall be eligible for such 
health services if all such spouses or spouses who are married to 
members of the Indian Tribe(s) being served are made eligible, as a 
class, by an appropriate resolution of the governing body of the Indian 
Tribe or Tribal Organization providing such services. The health needs 
of persons made eligible under this paragraph shall not be taken into 
consideration by the Service in determining the need for, or allocation 
of, its health resources.
    ``(c) Provision of Services to Other Individuals.--
            ``(1) In general.--The Secretary is authorized to provide 
        health services under this subsection through health programs 
        operated directly by the Service to individuals who reside 
        within the Service Unit and who are not otherwise eligible for 
        such health services if--
                    ``(A) the Indian Tribes served by such Service Unit 
                request such provision of health services to such 
                individuals; and
                    ``(B) the Secretary and the served Indian Tribes 
                have jointly determined that--
                            ``(i) the provision of such health services 
                        will not result in a denial or diminution of 
                        health services to eligible Indians; and
                            ``(ii) there is no reasonable alternative 
                        health facilities or services, within or 
                        without the Service Unit, available to meet the 
                        health needs of such individuals.
            ``(2) ISDEAA programs.--In the case of a Tribal Health 
        Program, the governing body of the Indian Tribe or Tribal 
        Organization providing health services under such Tribal Health 
        Program is authorized to determine whether health services 
        should be provided under its Funding Agreement to individuals 
        who are not otherwise eligible for such services. In making 
        such determination, the governing body shall take into account 
        the considerations described in clauses (i) and (ii) of 
        paragraph (1)(B).
            ``(3) Payment for services.--
                    ``(A) In general.--Persons receiving health 
                services provided by the Service under 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 404 of this Act or any other provision of law, 
                amounts collected under this subsection, including 
                medicare, medicaid, or SCHIP reimbursements under 
                titles XVIII, XIX, and XXI of the Social Security Act, 
                shall be credited to the account of the program 
                providing the service and shall be used for the 
                purposes listed in section 401(d)(2) and amounts 
                collected under this subsection shall be available for 
                expenditure within such program.
                    ``(B) Indigent people.--Health services may be 
                provided by the Secretary through the Service under 
                this subsection to an indigent individual who would not 
                be otherwise eligible for such health services but for 
                the provisions of paragraph (1) only if an agreement 
                has been entered into with a State or local government 
                under which the State or local government agrees to 
                reimburse the Service for the expenses incurred by the 
                Service in providing such health services to such 
                indigent individual.
            ``(4) Revocation of consent for services.--
                    ``(A) Single tribe service area.--In the case of a 
                Service Area which serves only 1 Indian Tribe, the 
                authority of the Secretary to provide health services 
                under paragraph (1) shall terminate at the end of the 
                fiscal year succeeding the fiscal year in which the 
                governing body of the Indian Tribe revokes its 
                concurrence to the provision of such health services.
                    ``(B) Multitribal service area.--In the case of a 
                multitribal Service Area, the authority of the 
                Secretary to provide health services under paragraph 
                (1) shall terminate at the end of the fiscal year 
                succeeding the fiscal year in which at least 51 percent 
                of the number of Indian Tribes in the Service Area 
                revoke their concurrence to the provisions of such 
                health services.
    ``(d) Other Services.--The Service may provide health services 
under this subsection to individuals who are not eligible for health 
services provided by the Service under any other provision of law in 
order to--
            ``(1) achieve stability in a medical emergency;
            ``(2) prevent the spread of a communicable disease or 
        otherwise deal with a public health hazard;
            ``(3) provide care to non-Indian women pregnant with an 
        eligible Indian's child for the duration of the pregnancy 
        through postpartum; or
            ``(4) provide care to immediate family members of an 
        eligible individual if such care is directly related to the 
        treatment of the eligible individual.
    ``(e) Hospital Privileges for Practitioners.--Hospital privileges 
in health facilities operated and maintained by the Service or operated 
under a Funding Agreement may be extended to non-Service health care 
practitioners who provide services to individuals described in 
subsection (a), (b), (c), or (d). Such non-Service health care 
practitioners may, as part of the privileging process, be designated 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 individuals as a part of the 
conditions under which such hospital privileges are extended.
    ``(f) Eligible Indian.--For purposes of this section, the term 
`eligible Indian' means any Indian who is eligible for health services 
provided by the Service without regard to the provisions of this 
section.

``SEC. 808. REALLOCATION OF BASE RESOURCES.

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

``SEC. 809. RESULTS OF DEMONSTRATION PROJECTS.

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

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

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

``SEC. 811. MORATORIUM.

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

``SEC. 812. TRIBAL EMPLOYMENT.

    ``For purposes of section 2(2) of the Act of July 5, 1935 (49 Stat. 
450, chapter 372), an Indian Tribe or Tribal Organization carrying out 
a Funding Agreement shall not be considered an `employer'.

``SEC. 813. PRIME VENDOR.

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

``SEC. 814. SEVERABILITY PROVISIONS.

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

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

    ``(a) Establishment.--There is hereby established the National 
Bipartisan Indian Health Care Entitlement Commission (the 
`Commission').
    ``(b) Duties of Commission.--The duties of the Commission are the 
following:
            ``(1) To establish a study committee composed of those 
        members of the Commission appointed by the Director and at 
        least 4 members of Congress from among the members of the 
        Commission, the duties of which shall be the following:
                    ``(A) To the extent necessary to carry out its 
                duties, collect and compile data necessary to 
                understand the extent of Indian needs with regard to 
                the provision of health services, regardless of the 
                location of Indians, including holding hearings and 
                soliciting the views of Indians, Indian Tribes, Tribal 
                Organizations, and Urban Indian Organizations, which 
                may include authorizing and making funds available for 
                feasibility studies of various models for providing and 
                funding health services for all Indian beneficiaries, 
                including those who live outside of a reservation, 
                temporarily or permanently.
                    ``(B) To make recommendations to the Commission for 
                legislation that will provide for the delivery of 
                health services for Indians as an entitlement, which 
                will address, among other things, issues of 
                eligibility, benefits to be provided, including 
                recommendations regarding from whom such health 
                services are to be provided and the cost, including 
                mechanisms for making funds available for the health 
                services to be provided.
                    ``(C) To determine the effect of the enactment of 
                such recommendations on (i) the existing system of 
                delivery of health services for Indians, and (ii) the 
                sovereign status of Indian Tribes.
                    ``(D) Not later than 12 months after the 
                appointment of all members of the Commission, to submit 
                a written report of its findings and recommendations to 
                the full Commission. The report shall include a 
                statement of the minority and majority position of the 
                Committee and shall be disseminated, at a minimum, to 
                every Indian Tribe, Tribal Organization, and Urban 
                Indian Organization for comment to the Commission.
                    ``(E) To report regularly to the full Commission 
                regarding the findings and recommendations developed by 
                the study committee in the course of carrying out its 
                duties under this section.
            ``(2) To review and analyze the recommendations of the 
        report of the study committee.
            ``(3) To make recommendations to Congress for providing 
        health services for Indians as an entitlement, giving due 
        regard to the effects of such a program on existing health care 
        delivery systems for Indians and the effect of such a program 
        on the sovereign status of Indian Tribes.
            ``(4) Not later than 18 months following the date of 
        appointment of all members of the Commission, submit a written 
        report to Congress containing a recommendation of policies and 
        legislation to implement a policy that would establish a health 
        care system for Indians based on delivery of health services as 
        an entitlement, together with a determination of the 
        implications of such an entitlement system on existing health 
        care delivery systems for Indians and on the sovereign status 
        of Indian Tribes.
    ``(c) Members.--
            ``(1) Appointment.--The Commission shall be composed of 25 
        members, appointed as follows:
                    ``(A) Ten members of Congress, including 3 from the 
                House of Representatives and 2 from the Senate, 
                appointed by their respective majority leaders, and 3 
                from the House of Representatives and 2 from the 
                Senate, appointed by their respective minority leaders, 
                and who shall be members of the standing committees of 
                Congress that consider legislation affecting health 
                care to Indians.
                    ``(B) Twelve persons chosen by the congressional 
                members of the Commission, 1 from each Service Area as 
                currently designated by the Director to be chosen from 
                among 3 nominees from each Service Area put forward by 
                the Indian Tribes within the area, with due regard 
                being given to the experience and expertise of the 
                nominees in the provision of health care to Indians and 
                to a reasonable representation on the commission of 
                members who are familiar with various health care 
                delivery modes and who represent Indian Tribes of 
                various size populations.
                    ``(C) Three persons appointed by the Director who 
                are knowledgeable about the provision of health care to 
                Indians, at least 1 of whom shall be appointed from 
                among 3 nominees put forward by those programs whose 
                funds are provided in whole or in part by the Service 
                primarily or exclusively for the benefit of Urban 
                Indians.
                    ``(D) All those persons chosen by the congressional 
                members of the Commission and by the Director shall be 
                members of federally recognized Indian Tribes.
            ``(2) Chair; vice chair.--The Chair and Vice Chair of the 
        Commission shall be selected by the congressional members of 
        the Commission.
            ``(3) Terms.--The terms of members of the Commission shall 
        be for the life of the Commission.
            ``(4) Deadline for appointments.--Congressional members of 
        the Commission shall be appointed not later than 90 days after 
        the date of the enactment of the Indian Health Care Improvement 
        Act Amendments of 2004, and the remaining members of the 
        Commission shall be appointed not later than 60 days following 
        the appointment of the congressional members.
            ``(5) Vacancy.--A vacancy in the Commission shall be filled 
        in the manner in which the original appointment was made.
    ``(d) Compensation.--
            ``(1) Congressional members.--Each congressional member of 
        the Commission shall receive no additional pay, allowances, or 
        benefits by reason of their service on the Commission and shall 
        receive travel expenses and per diem in lieu of subsistence in 
        accordance with sections 5702 and 5703 of title 5, United 
        States Code.
            ``(2) Other members.--Remaining members of the Commission, 
        while serving on the business of the Commission (including 
        travel time), shall be entitled to receive compensation at the 
        per diem equivalent of the rate provided for level IV of the 
        Executive Schedule under section 5315 of title 5, United States 
        Code, and while so serving away from home and the member's 
        regular place of business, a member may be allowed travel 
        expenses, as authorized by the Chairman of the Commission. For 
        purpose of pay (other than pay of members of the Commission) 
        and employment benefits, rights, and privileges, all personnel 
        of the Commission shall be treated as if they were employees of 
        the United States Senate.
    ``(e) Meetings.--The Commission shall meet at the call of the 
Chair.
    ``(f) Quorum.--A quorum of the Commission shall consist of not less 
than 15 members, provided that no less than 6 of the members of 
Congress who are Commission members are present and no less than 9 of 
the members who are Indians are present.
    ``(g) Executive Director; Staff; Facilities.--
            ``(1) Appointment; pay.--The Commission shall appoint an 
        executive director of the Commission. The executive director 
        shall be paid the rate of basic pay for level V of the 
        Executive Schedule.
            ``(2) Staff appointment.--With the approval of the 
        Commission, the executive director may appoint such personnel 
        as the executive director deems appropriate.
            ``(3) Staff pay.--The staff of the Commission shall be 
        appointed without regard to the provisions of title 5, United 
        States Code, governing appointments in the competitive service, 
        and shall be paid without regard to the provisions of chapter 
        51 and subchapter III of chapter 53 of such title (relating to 
        classification and General Schedule pay rates).
            ``(4) Temporary services.--With the approval of the 
        Commission, the executive director may procure temporary and 
        intermittent services under section 3109(b) of title 5, United 
        States Code.
            ``(5) Facilities.--The Administrator of General Services 
        shall locate suitable office space for the operation of the 
        Commission. The facilities shall serve as the headquarters of 
        the Commission and shall include all necessary equipment and 
        incidentals required for the proper functioning of the 
        Commission.
    ``(h) Hearings.--(1) For the purpose of carrying out its duties, 
the Commission may hold such hearings and undertake such other 
activities as the Commission determines to be necessary to carry out 
its duties, provided that at least 6 regional hearings are held in 
different areas of the United States in which large numbers of Indians 
are present. Such hearings are to be held to solicit the views of 
Indians regarding the delivery of health care services to them. To 
constitute a hearing under this subsection, at least 5 members of the 
Commission, including at least 1 member of Congress, must be present. 
Hearings held by the study committee established in this section may 
count toward the number of regional hearings required by this 
subsection.
    ``(2) Upon request of the Commission, the Comptroller General shall 
conduct such studies or investigations as the Commission determines to 
be necessary to carry out its duties.
    ``(3)(A) The Director of the Congressional Budget Office or the 
Chief Actuary of the Centers for Medicare & Medicaid Services, or both, 
shall provide to the Commission, upon the request of the Commission, 
such cost estimates as the Commission determines to be necessary to 
carry out its duties.
    ``(B) The Commission shall reimburse the Director of the 
Congressional Budget Office for expenses relating to the employment in 
the office of the Director of such additional staff as may be necessary 
for the Director to comply with requests by the Commission under 
subparagraph (A).
    ``(4) Upon the request of the Commission, the head of any Federal 
agency is authorized to detail, without reimbursement, any of the 
personnel of such agency to the Commission to assist the Commission in 
carrying out its duties. Any such detail shall not interrupt or 
otherwise affect the civil service status or privileges of the Federal 
employee.
    ``(5) Upon the request of the Commission, the head of a Federal 
agency shall provide such technical assistance to the Commission as the 
Commission determines to be necessary to carry out its duties.
    ``(6) The Commission may use the United States mails in the same 
manner and under the same conditions as Federal agencies and shall, for 
purposes of the frank, be considered a commission of Congress as 
described in section 3215 of title 39, United States Code.
    ``(7) The Commission may secure directly from any Federal agency 
information necessary to enable it to carry out its duties, if the 
information may be disclosed under section 552 of title 4, United 
States Code. Upon request of the Chairman of the Commission, the head 
of such agency shall furnish such information to the Commission.
    ``(8) Upon the request of the Commission, the Administrator of 
General Services shall provide to the Commission on a reimbursable 
basis such administrative support services as the Commission may 
request.
    ``(9) For purposes of costs relating to printing and binding, 
including the cost of personnel detailed from the Government Printing 
Office, the Commission shall be deemed to be a committee of Congress.
    ``(i) Authorization of Appropriations.--There is authorized to be 
appropriated $4,000,000 to carry out the provisions of this section, 
which sum shall not be deducted from or affect any other appropriation 
for health care for Indian persons.
    ``(j) FACA.--The Federal Advisory Committee Act (5 U.S.C. App.) 
shall not apply to the Commission.

``SEC. 816. APPROPRIATIONS; AVAILABILITY.

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

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

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

``SEC. 818. AUTHORIZATION OF APPROPRIATIONS.

    ``(a) In General.--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.''.
    (b) Rate of Pay.--
            (1) Positions at level iv.--Section 5315 of title 5, United 
        States Code, is amended by striking ``Assistant Secretaries of 
        Health and Human Services (6).'' and inserting ``Assistant 
        Secretaries of Health and Human Services (7)''.
            (2) Positions at level v.--Section 5316 of title 5, United 
        States Code, is amended by striking ``Director, Indian Health 
        Service, Department of Health and Human Services''.
    (c) Three Affiliated Tribes Health Facility Compensation.--
            (1) Findings.--Congress finds that--
                    (A) in 1949, the United States assumed jurisdiction 
                over more than 150,000 prime acres on the Fort Berthold 
                Indian Reservation, North Dakota, for the construction 
                of the Garrison Dam and Reservoir;
                    (B) the reservoir flooded and destroyed vital 
                infrastructure on the reservation, including a hospital 
                of the Indian Health Service;
                    (C) the United States made a commitment to the 
                Three Affiliated Tribes of the Fort Berthold Indian 
                Reservation to replace the lost infrastructure;
                    (D) on May 10, 1985, the Secretary of the Interior 
                established the Garrison Unit Joint Tribal Advisory 
                Committee to examine the effects of the Garrison Dam 
                and Reservoir on the Fort Berthold Indian Reservation;
                    (E) the final report of the Committee issued on May 
                23, 1986, acknowledged the obligation of the Federal 
                Government to replace the infrastructure destroyed by 
                the Federal action;
                    (F) the Committee on Indian Affairs of the Senate--
                            (i) acknowledged the recommendations of the 
                        final report of the Committee in Senate Report 
                        No. 102-250; and
                            (ii) stated that every effort should be 
                        made by the Administration and Congress to 
                        provide additional Federal funding to replace 
                        the lost infrastructure; and
                    (G) on August 30, 2001, the Chairman of the Three 
                Affiliated Tribes testified before the Committee on 
                Indian Affairs of the Senate that the promise to 
                replace the lost infrastructure, particularly the 
                hospital, still had not been kept.
            (2) Rural health care facility, fort berthold indian 
        reservation, north dakota.--The Three Affiliated Tribes and 
        Standing Rock Sioux Tribe Equitable Compensation Act is 
        amended--
                    (A) in section 3504 (106 Stat. 4732), by adding at 
                the end the following:
    ``(c) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as are necessary to carry out this section.''; 
and
                    (B) by striking section 3511 (106 Stat. 4739) and 
                inserting the following:

``SEC. 3511. RURAL HEALTH CARE FACILITY, FORT BERTHOLD INDIAN 
              RESERVATION, NORTH DAKOTA.

    ``There are authorized to be appropriated to the Secretary of 
Health and Human Services $20,000,000 for the construction of, and such 
sums as are necessary for other expenses relating to, a rural health 
care facility on the Fort Berthold Indian Reservation of the Three 
Affiliated Tribes, North Dakota.''.
    (c) Amendments to Other Provisions of Law.--
            (1) Section 3307(b)(1)(C) of the Children's Health Act of 
        2000 (25 U.S.C. 1671 note; Public Law 106-310) is amended by 
        striking ``Director of the Indian Health Service'' and 
        inserting ``Assistant Secretary for Indian Health''.
            (2) The Indian Lands Open Dump Cleanup Act of 1994 is 
        amended--
                    (A) in section 3 (25 U.S.C. 3902)--
                            (i) by striking paragraph (2);
                            (ii) by redesignating paragraphs (1), (3), 
                        (4), (5), and (6) as paragraphs (4), (5), (2), 
                        (6), and (1), respectively, and moving those 
                        paragraphs so as to appear in numerical order; 
                        and
                            (iii) by inserting before paragraph (4) (as 
                        redesignated by subclause (II)) the following:
            ``(3) Assistant secretary.--The term `Assistant Secretary' 
        means the Assistant Secretary for Indian Health.'';
                    (B) in section 5 (25 U.S.C. 3904), by striking the 
                section heading and inserting the following:

``SEC. 5. AUTHORITY OF ASSISTANT SECRETARY FOR INDIAN HEALTH.'';

                    (C) in section 6(a) (25 U.S.C. 3905(a)), in the 
                subsection heading, by striking ``Director'' and 
                inserting ``Assistant Secretary'';
                    (D) in section 9(a) (25 U.S.C. 3908(a)), in the 
                subsection heading, by striking ``Director'' and 
                inserting ``Assistant Secretary''; and
                    (E) by striking ``Director'' each place it appears 
                and inserting ``Assistant Secretary''.
            (3) Section 5504(d)(2) of the Augustus F. Hawkins-Robert T. 
        Stafford Elementary and Secondary School Improvement Amendments 
        of 1988 (25 U.S.C. 2001 note; Public Law 100-297) is amended by 
        striking ``Director of the Indian Health Service'' and 
        inserting ``Assistant Secretary for Indian Health''.
            (4) Section 203(a)(1) of the Rehabilitation Act of 1973 (29 
        U.S.C. 763(a)(1)) is amended by striking ``Director of the 
        Indian Health Service'' and inserting ``Assistant Secretary for 
        Indian Health''.
            (5) Subsections (b) and (e) of section 518 of the Federal 
        Water Pollution Control Act (33 U.S.C. 1377) are amended by 
        striking ``Director of the Indian Health Service'' each place 
        it appears and inserting ``Assistant Secretary for Indian 
        Health''.
            (6) Section 317M(b) of the Public Health Service Act (42 
        U.S.C. 247b-14(b)) is amended--
                    (A) by striking ``Director of the Indian Health 
                Service'' each place it appears and inserting 
                ``Assistant Secretary for Indian Health''; and
                    (B) in paragraph (2)(A), by striking ``the 
                Directors referred to in such paragraph'' and inserting 
                ``the Director of the Centers for Disease Control and 
                Prevention and the Assistant Secretary for Indian 
                Health''.
            (7) Section 417C(b) of the Public Health Service Act (42 
        U.S.C. 285-9(b)) is amended by striking ``Director of the 
        Indian Health Service'' and inserting ``Assistant Secretary for 
        Indian Health''.
            (8) Section 1452(i) of the Safe Drinking Water Act (42 
        U.S.C. 300j-12(i)) is amended by striking ``Director of the 
        Indian Health Service'' each place it appears and inserting 
        ``Assistant Secretary for Indian Health''.
            (9) Section 803B(d)(1) of the Native American Programs Act 
        of 1974 (42 U.S.C. 2991b-2(d)(1)) is amended in the last 
        sentence by striking ``Director of the Indian Health Service'' 
        and inserting ``Assistant Secretary for Indian Health''.
            (10) Section 203(b) of the Michigan Indian Land Claims 
        Settlement Act (Public Law 105-143; 111 Stat. 2666) is amended 
        by striking ``Director of the Indian Health Service'' and 
        inserting ``Assistant Secretary for Indian Health''.

SEC. 3. SOBOBA SANITATION FACILITIES.

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

SEC. 4. AMENDMENTS TO THE MEDICAID AND STATE CHILDREN'S HEALTH 
              INSURANCE PROGRAMS.

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

                    ``indian health programs''; and

                    (B) by amending subsection (a) to read as follows:
    ``(a) Eligibility for Reimbursement for Medical Assistance.--The 
Indian Health Service and an Indian Tribe, Tribal Organization, or an 
urban Indian Organization (as such 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 or 
under waiver authority with respect to items and services furnished by 
the Indian Health Service, Indian Tribe, Tribal Organization, or Urban 
Indian Organization if the furnishing of such services meets all the 
conditions and requirements which are applicable generally to the 
furnishing of items and services under this title and under such plan 
or waiver authority.''.
            (2) Elimination of temporary deeming provision.--Such 
        section is amended by striking subsection (b).
            (3) Revision of authority to enter into agreements.--
        Subsection (c) of such section is redesignated as subsection 
        (b) and is amended to read as follows:
    ``(b) Authority To Enter Into Agreements.--The Secretary may enter 
into an agreement with a State for the purpose of reimbursing the State 
for medical assistance provided by the Indian Health Service, an Indian 
Tribe, Tribal Organizations, or an Urban Indian Organization (as so 
defined), directly, through referral, or under contracts or other 
arrangements between the Indian Health Service, an Indian Tribe, Tribal 
Organization, or an Urban Indian Organization and another health care 
provider to Indians who are eligible for medical assistance under the 
State plan or under waiver authority.''.
            (4) Reference correction.--Subsection (d) of such section 
        is redesignated as subsection (c) and is amended--
                    (A) by striking ``For'' and inserting ``Direct 
                Billing.--For''; and
                    (B) by striking ``section 405'' and inserting 
                ``section 401(d)''.
    (b) SCHIP Treatment of Indian Tribes, Tribal Organizations, and 
Urban Indian Organizations.--Section 2105(c)(6)(B) of such Act (42 
U.S.C. 1397ee(c)(6)(B)) is amended by striking ``other than an 
insurance program operated or financed by the Indian Health Service,'' 
and inserting ``other than a health program operated or financed by the 
Indian Health Service or by an Indian Tribe, Tribal Organization, or 
Urban Indian Organization (as such terms are defined in section 4 of 
the Indian Health Care Improvement Act)''.




                                                       Calendar No. 802

108th CONGRESS

  2d Session

                                 S. 556

                          [Report No. 108-411]

_______________________________________________________________________

                                 A BILL

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

_______________________________________________________________________

                           November 16, 2004

                       Reported with an amendment